IVF: An Emotional Companion. Brigid Moss

to my love for Charlie? Then I think, well, David’s family are all utterly gorgeous, and the child would be fully related to them. I’d be carrying the baby for nine months then, when the baby was born, nursing him or her. I’d probably be too busy to worry about whose eggs helped make the baby.

      We have been offered three possible donors so far, who are egg-sharers, which means they’re willing to give away half their eggs in return for most of the cost of their IVF treatment being paid for by the recipient of the eggs. But we’ve rejected all of them. The first two were blonde, and that was what put me off. Then I changed my criteria to dark-haired women only, and the perfect person came up: educated, brunette, in her early 30s. But David and I talked it over, and decided to say no. It feels quite fi nal, but we haven’t said never.

      Q: WHAT WAS THE MOST USEFUL ADVICE YOU WERE GIVEN?

      To be honest, all the doctors were quite negative, though I suppose they were only being realistic. My friends and family helped by telling me that I’d got pregnant once, and so I could do it again. Going to see a refl exologist was a great support, too. She used to remind me that I was still ovulating sometimes, that I wasn’t fully menopausal.

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      If you still have periods, some clinics will perform IVF with your own eggs, even if you have high FSH and/or low AMH. Your chance of success, of course, is low, but there is a chance as long as you’re ovulating. The Lister Fertility Clinic in London (ivf.org.uk), for example, specialises in this category of women, and recommends that you start treatment as soon as you can after diagnosis. Create Health (also in London) treats women with reduced ovarian reserve. The medical director, Dr Geeta Nargund, believes that a lower-dose drug regime is often more successful in such women (see createhealth.org and Chapter 9).

      The main UK charity for premature ovarian failure is the Daisy Network. They hold an annual conference with speeches by experts in premature menopause. Their website (www.daisynetwork.org.uk) has information on IVF using donated eggs, as well as adoption, surrogacy and being ‘positively childless’. Another good source of information on donated eggs is the Donor Conception Network (donor-conception-network.org). See pages 172—3 for more information on egg donation. And make sure you tell your doctor that you’re considering egg donation, as it may affect your treatment for menopausal symptoms.

      The International Premature Ovarian Failure Association (ipofa.org) has a useful factsheet too. And you may want to see a counsellor or consider therapy. To find a counsellor or therapist, go to bica.net, bacp.co.uk, psychotherapy.org.uk and bps.org.uk.

      I couldn’t give my son a sibling

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      If conceiving your first child was as simple as putting your Pill in the bin, or was even a happy accident, finding out you can’t get pregnant again can be harder than you’d imagine. Fertility coach, Anya Sizer, says that women often assume they should pull themselves together when they already have one child, and that not having a second or third can be dismissed as less upsetting than having no children at all. The poor relation of primary infertility, if you like.

      ‘I don’t think there’s much sympathy for women with secondary infertility,’ she says. ‘Maybe you’re at the school gates being a mum, so people assume you should be fine. When that was me, I was very grateful for my first child, but the fact I couldn’t conceive for a second time still made me feel as if I was walking around with a black cloud over my head.’

      For a woman who desperately wants that second child, but can’t get or stay pregnant, it can feel as if there is a huge hole in her family. ‘In fact, secondary infertility can be harder to accept than primary infertility,’ says Dr Lee Lim, Consultant in Obstetrics and Gynaecology, Oxford Fertility Unit. ‘And families who really want a sibling for the first child are under extra pressure when they compare themselves to friends who are having their second or third baby.’

      There are lots of reasons for not wanting a single-child family: maybe you didn’t like being an only child yourself, or you come from a big family. Sadly, secondary infertility is as common as primary. ‘Of those who had no problems getting pregnant the first time around, around 15 per cent have problems the second time,’ says Dr Lim.

      Of course, it’s not officially infertility until you’ve been trying for a year, even if you got pregnant easily the first time. ‘You need to give yourself a year before you label yourself as having a problem,’ says Dr Lim. ‘Often, people who come to see me are anxious, and I need to explain that each month, their chances of pregnancy are only 30 to 35 per cent.’

      Secondary infertility is also less likely to be due to underlying physical issues than primary infertility. ‘The family dynamic can change after a first baby, so you may not have intercourse so often,’ says Dr Lim. ‘Or you could have experienced a difficult birth, which can be a very good natural contraceptive, as childbirth is so intimately related to the birth canal. You might not realise that you’re avoiding sex or why. One sign of childbirth trauma is that you may have had a problem in attaching with your baby. A gynaeocologist isn’t always the best person to help you talk about this; a counsellor can be better.’

      Having said that, there are often physical reasons for secondary infertility. If you have a new partner, it may be down to his sperm (although that’s not strictly secondary infertility). If you’re still breastfeeding, you may not be ovulating regularly. Another risk is scar tissue in the uterus, which can happen if you have an operation, post-miscarriage. ‘A telltale sign is that your periods have changed after this procedure,’ says Dr Lim. Or it could be that you have or have had an infection that has blocked your tubes. Secondary infertility can also be caused by problems with your previous pregnancy and delivery, including infection, as well as other problems such as endometriosis, PCOS and fibroids.

      But the reason that surprises most patients, says Dr Lim, is that a woman may be less fertile because she’s put on weight after having a child. ‘If your body mass index [BMI — a calculation that assesses your weight, taking into account your height] is over 30, it’s much harder to get pregnant.’

      Weight is often an issue for women with PCOS, as weight gain is part of the syndrome. ‘Even if we have been able to help a woman with PCOS ovulate the first time around using medication if, by the time she is trying for her second baby, she has put on weight, it gets much harder,’ says Dr Lim.

      Finally, there’s the question of age. If, for example, you had your first child at 35, by the time you get round to having your second or third, your fertility will have reduced naturally. ‘It’s not uncommon now for women to try for their second baby at 40 and, at that age, it’s always going to be more difficult to get pregnant,’ says Dr Lim. And, as your fertility is uniquely personal, it could happen earlier too. Abby, who tells her story below, got pregnant easily at 33 but, just two years later, found she couldn’t get pregnant again.

      The investigations for secondary infertility are the same as for any infertility, and may include blood tests and scans to check hormone levels and that you’re ovulating properly, an internal examination and tests to check your Fallopian tubes are still working. And your partner will need a sperm test, as both quantity and quality can decline with age.

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      It wasn't until Abby, 37, a TV producer and writer from London, started trying for a second baby that she had problems.

      I didn’t even have to think about whether having two children was right for John, my husband, and me. I had always envisaged lots of kids running around. It took around seven months for me to get pregnant with Jake, my first baby, when I was 33. I really threw myself into motherhood and loved it so much that I remember thinking, five months in, I really want this again. So when Jake was 14 months, we started trying for a second baby.

      But, month after month, I didn’t get pregnant. I started using ovulation kits and, I admit, became completely obsessed with pregnancy. It was all I wanted and it consumed my thoughts. At any given time, if you’d asked me, I could have told you exactly where I was on