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October 30, 2017

After having one baby naturally, most parents believe the path to child number two will be smooth, but this isn't always the case. JAI BREITNAUER speaks to couples who are hoping to grow their families...

Elle & Tom 

When high school sweethearts Elle and Tom Johnson decided to try for children, they didn't expect any problems and nature didn't disappoint. They fell pregnant with daughter Willa, now five.
 "I wanted a two-and-a-half to three-year age gap and, because Willa had been so easy, we waited until we were bang on the dates to start trying again," says Elle. "I fell pregnant easily that second time to, but miscarried at six weeks."
Elle admits she and Tom weren't too worried after that first miscarriage, and carried on trying. They fell pregnant again within weeks, and again miscarried at seven weeks.
"We spoke to our GP, who reassured us they wouldn't be concerned until we'd had three pregnancy losses in a row," says Elle, "We decided to have a break, let me body recover. Five months later we started trying again and fell pregnant straight away."

As this was their third pregnancy after two miscarriages there was some trepidation, but Elle had the morning sickness she experienced with Willa and other pregnancy symptoms. At 12 weeks, they told close friends and family, and even Willa who was excited to be a big sister. “But at my scan toward the end of my 12th week, there was no heartbeat,” says Elle who noted the embryo was complete, and they dated its growth to 12 weeks. “That one was really hard, and we began to think something was seriously wrong. I also felt a sense of grief that the family I had planned wouldn’t happen. We were already up to a four-year age gap and we weren’t pregnant yet.”

Elle was admitted to hospital at her request, and they did some tests on her and the embryo. She and Tom were then referred to the Fertility Plus recurrent pregnancy loss clinic for further investigation. "We were told that while the baby we had just lost was fine - it was just bad luck - I did in fact have a chromosomal abnormality. Two of my chromosomes were the wrong way round."  

This condition, called a balanced translocation, explained the first two early miscarriages, and they were offered publicly-funded IVF PGD, where the embryos are screened for viability. Elle and Tom suffered another natural pregnancy loss in March this year, before being offered the IVF in June. They managed to produce seven embryos, but when biopsied, none were suitable for transfer. 

“That news was quite scary,” says Elle. “Is that how bad our chances of a second child are? Our reality is that it’s going to be very hard to fall pregnant again.” Elle and Tom are considering whether to go ahead with another attempt at IVF PGD. They admit the process of trying for another child has been very consuming, taking its toll physically and emotionally.

“Your whole life seems on hold, and although we’ve coped well so far, you don’t know when you might break,” says Elle. “We feel the need to put a timeframe on it, to have a moment where we can move on. But equally, we are desperate to have another child. Willa is amazing and very fulfilling, but our family doesn’t yet feel complete.” Elle and Tom have benefited from counselling at Fertility Plus, an important service that helps couples gain some perspective.

“It’s really quite unexpected for these couples to find they are struggling to conceive a second time,” says Fertility Plus Counsellor Megan Downer. “They suffer feelings of shock and disbelief that it’s happening to them, and a loss of control. After all, the first time they were just able to get pregnant.” Megan says many couples talk about the loss of their dream family as the imagined age-gap begins to widen. “Both the age gap and the size of the family planned can be affected by delayed fertility. We try and help couples regain some perspective by exploring their dream and adjusting to their new normal.”

Megan also notes that many couples feel guilty that they are at Fertility Plus at all, bearing in mind they have a child already, and she is keen to stress this guilt is misplaced. “Some friends and family who, meaning to be helpful, say things like ‘You should feel grateful you have one child’, which can make the couple feel like their feelings aren’t valid. But this is a non-judgmental place where couples can openly discuss their experiences and express their frustration and sadness. Everyone’s experience is unique.”

Henry & Julie

Henry and Julie Moores experienced one early miscarriage before having son Eddie, now three and a half. “Admittedly, that was quite hard,” says Julie. “You think that you are pregnant and that is it, but by talking to doctors and doing some reading I realised that is an unrealistic expectation. Quite a high number of pregnancies end in miscarriage.” 

The Moores are both from big families, and dreamed of having three or four children, but since having Eddie they’ve had five miscarriages – one of which was a partial molar, a rare occurrence where the material of conception grows but it is not an embryo. “That was quite scary,” says Julie. “They can be cancerous. But we remained philosophical and kept trying.”
After their third consecutive miscarriage, they were referred to the clinic at Fertility Plus. However, tests showed there was nothing ‘wrong’ as such.

“About 50% of recurrent pregnancy loss is explainable, and 50% of the time there is no medical explanation. We were a bit bummed to be in that latter group,” says Julie. “We didn’t want anything to be wrong, but at least if we were diagnosed with something then they could help.”
With no explanation, and no treatment available, the Moores’ only available course of action is to keep trying. Fertility Plus is able to help support them with this.

“We can go in as soon as we are pregnant and have my hormones monitored, so I know if it’s viable or not, early,” says Julie. “It’s reassuring to have that service. And there is counselling available to us as well.” Despite that support, she admits it is difficult to keep a positive mindset. “We aren’t overweight, we aren’t older parents, we don’t smoke … there really isn’t any reason for us to be in this position,” says Julie. “A friend told me about her cousin who had a child and then ten miscarriages and then another child. That’s a positive story. If we can handle ten miscarriages then perhaps we should keep trying and see if there is a baby at the end of it. The miscarriages do become easier as time goes on.”

Julie says their journey has been all about resilience and adjusting their understanding. “If you feel resilient then you should keep trying, that’s our philosophy,” says Julie. “Although I know Henry finds it hard that it is me who bears the brunt of it all. We had expectations – about the size of our family and age gaps – but we won’t let it take over. We have to be realistic.”

Adjusting Expectations 

Lead clinician at Fertility Plus, Emily Liu, says that secondary infertility is not uncommon, yet many people do not understand that. “Around 15 per cent of women experience miscarriage, with 10 per cent of women who have already had a child unable to have another,” explains Emily. “Yet when this happens it is most unexpected, and people have a lot more trouble trying to comprehend it than they do if they’re struggling to conceive for the first time.” But Emily says secondary infertility can be treated. 

“There are a wide range of treatments depending on the cause,” says Emily. “If there is a condition, or if it is related to the age of the mother, there are options, such as preimplantation genetic screening or donor egg, and the prognosis is often positive.”

There are, however, 50 per cent of women with re-occurring miscarriage that has no explanation. “Only one per cent of pregnant women experience three consecutive losses or more,” says Emily, who is keen to reassure worried couples that this is statistically a very small group. “But having had one child doesn’t mean you are guaranteed a second. If you’ve been trying for 12 months or more then you should be assessed for underlying issues, even if you have already had a successful pregnancy. Don’t leave it, help is available.”

Fertility Plus provides comprehensive fertility assessment and treatment services both public and private. Please call Maree on 6309943 ext: 27520 to discuss your options. 

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