Hard to conceive

For many couples, attempting to conceive a child can turn into a trauma. Ariadne Massa speaks to a woman who went through such an experience and sheds some light on infertility.

Children were never foremost on Krista's* mind but when she tied the knot five years ago, starting a family became the most natural course for her life to take... except now that she wanted them, she couldn't have them.

After trying unsuccessfully for a year, Krista, 34, and her husband started suspecting that there could be a problem to conceive and sought advice.

"I went to my gynaecologist and he prescribed the infertility drug Clomid for three months to induce or correct ovulation. What had bothered me is that I was prescribed the tablets without even being checked or scanned," she said, as she sipped a glass of sparkling water.

"Making love suddenly became a mechanical thing... you go home and plan the next session in your diary. You become like a robot and it takes the passion right out of the act," she said laughing as she recalled those hard days.

When the three months were up and the couple had had no luck, she returned to the gynaecologist, who prescribed another three-month treatment.

After the second course failed, Krista and her husband started getting concerned that something could be very wrong, so they went to a private hospital to do a series of tests in an effort to discover the core of the problem.

"It turned out that apart from having one of my fallopian tubes blocked, I also produced a lot of oestrogen - I was like a walking contraceptive pill," she said.

The news was, indeed, a bitter sweet pill to swallow - while on the one hand she was relieved to establish the cause of her infertility, she was also upset that she couldn't conceive easily.

"It was an emotional roller coaster. I started feeling like I was letting my husband down and you also feel less of a woman."

However, Krista was determined to do something about it and after nearly four years of unsuccessful attempts they opted for in vitro fertilisation (IVF).

"We had read up a lot on the internet and also spoke to a number of doctors - we felt this was our last attempt after all else had failed," she said, hunching her shoulders and moving forward in the armchair to recount some of the most difficult moments of her life.

The IVF procedure and the entire course of tablets and injections cost Krista and her husband about Lm1,300.

Krista had to be injected - once in her buttocks and a second time in her tummy - twice a day for about 10 to 12 days to produce eggs.

"Once the eggs are transferred you start 10 days of living hell until the blood test establishes whether you're pregnant or not. When I used to get my period after nine days I would be devastated.

"There were times when I felt I had had enough and thought of throwing in the towel. Luckily I have a very supportive husband who was constantly reassuring me saying: 'I didn't marry you for kids but because I love you. And even if we don't manage to have kids, my love for you will never change'," she said.

One of the most difficult things she had to face was seeing her friends get pregnant with ease.

"Your friends call to break the good news and though you're happy for them it's so hard when you are trying for the same thing but failing miserably. I'd burst into tears the second I hung up."

A few months passed after the couple's first attempt at IVF and they decided to give it a second try.

"When I failed to get pregnant the second time it was a bigger blow. Nothing prepares you for the devastation. When I got the news I burst into tears. I couldn't utter a word," she said. "In such moments you feel you've got nobody to talk to."

There was a time when Krista went through a very bad phase, when she didn't want to go to work and was constantly arguing with her husband.

"Luckily I managed to snap out of it. I tried to focus on the positive aspect of things - such as when my friends couldn't get a babysitter and join us for a drink or if they had numerous sleepless nights," she said, laughing.

The couple put the bad times behind them and started looking at the procedure of adopting a child. They filed an application for adoption in November and started their wait.

On New Year's Eve they had an intimate evening and after a few glasses of champagne the topic shifted to their yearning to have a child.

"I told my husband I wished to try IVF for the third and final time."

Krista went through the procedure again and started the 10-day wait for the blood test that would confirm whether she was pregnant or not.

Two days before the test the couple were out at a Chinese restaurant with friends. When she went to the toilet she discovered a blood discharge - and at that moment she saw her dreams go down the toilet.

On Monday she was scared to go for the test, fearing the worst. But she dragged herself to the hospital and went to work, trying to bring a semblance of routine into her life.

"A couple of hours after I got back to the office I got an SMS from the lab technician asking me to call him. I started shaking; I couldn't make the call myself."

Luckily Krista and her husband work together so she got him to make the call. She started nervously pacing up and down the corridor, much to bafflement of her colleagues who had no clue what she was going through.

"I kept signalling my husband to see if it was good news. He gave me the thumbs up sign - I was pregnant! I thought I was going to pass out with joy," she said, her eyes welling up with tears as she relived the heart-thumping moment.

Today she is nearly five months pregnant and overjoyed at the prospect of becoming a mother.

"A lot has been said about IVF and I won't even go into it - everyone is entitled to their opinion. All I can say is that for us IVF was the last resort after years of trying other alternatives - it changed our lives and was worth every penny."

* Names have been changed to protect the person's identity.

Wanting and waiting

Couples who cannot have children face physical, emotional and spiritual struggles, so with this in mind an infertility support group was set up within the Cana Movement called Wanting and Waiting.

Donia Scicluna, the group's facilitator, was instrumental in setting up the group in 2001 after she herself encountered fertility problems.

"I have been married for 16 years and after we tied the knot we started trying for a child. After four years of trying I got pregnant with my son Patrick - sadly he died after six weeks and we have remained childless since," she said.

After going through such an experience Ms Scicluna felt the need to set up a support group to help couples channel their anger and emotions through help and encouragement.

"Many couples feel they cannot share their problems so keep everything bottled in. Since setting up we have helped 38 couples - many more are failing to seek help as you can see from this low figure," she pointed out.

The main aims of the group are to increase the awareness of infertility problems, offer solidarity, friendship, hope and encouragement to couples facing this trauma, bring together people who share common experiences and offer informal support and information through regular meetings and talks by professionals.

"Sometimes couples come to the meetings with a package of anger and misunderstandings that is diffused after eight sessions," Ms Scicluna said.

The infertility support group can be reached on 2123 8068, 2123 8942 or e-mail: info@canamovement.org

Ask the doctors

We cornered Mark Brincat, chairman of the Obstetrics and Gynaecology Department, and Donald Felice, president of the Malta College of Obstetricians and Gynaecologists, to take some time from their busy schedule to answer some questions on infertility:

How many couples experience infertility problems in Malta?
It is estimated that one in every seven couples in Malta (about 15 per cent) will experience fertility problems. This seems to be similar to the rate in other Western countries and has to be seen in the context of a massive drop in the country's birth rate. According to the National Statistics Office, the birth rate in Malta has dropped by about 20 per cent in the last 10 years for various reasons including a change in lifestyle, priorities, expectations and, strangely enough, in parallel with an improved standard of living. This, together with increased life expectancy, poses potentially serious demographic problems - from a shortfall in the young active workforce and subsequent increase in problems with pensions, to the care of the increasing elderly population. It also poses the question of whether we should actively consider incentives geared towards encouraging our couples to have more children.

Does infertility affect a particular age group? And are women further postponing having children?
When women hit 30, their fertility rate is reduced by 50 per cent and by much more after 40. However, infertility can affect couples at all ages and many are quite young when they realise there is a problem. The number of infertility cases is becoming more obvious in recent years, mostly due to modern lifestyles and couples waiting longer to have a child. A relatively new phenomenon is the increasing number of second relationships, which for age reasons makes infertility more likely.

Does infertility affect more women than men?
Infertility is roughly just about as common in women as it is in men - about 30 per cent in males and females. Treatment of male infertility has always been notoriously difficult but has seen major advances with the advent of Direct Sperm Injection (ICSI) and procedures to retrieve sperm directly from testicular tissue. This can potentially give males with a zero sperm count the possibility to father their own children.

How many Maltese couples resort to IVF each year? What's the success rate?
No exact statistics are kept since a number opt to go for treatment overseas. In Malta there have been between 60-80 a year. The first IVF Maltese baby is today over 14 years old but prior to that there were others conceived overseas. Unfortunately, the treatment is laborious, expensive and has a success rate of about 20 to 30 per cent depending on the methods and technique.

A lot of concerns have been raised about IVF in the past weeks, especially on issues such as the risk that the baby could be born with defects. What's your opinion on this?
If one includes the background risks to high-risk pregnancies that IVF couples have due to their "poor" reproductive health and any genetic problems inherited from the couple, then it could appear that the final outcome regarding IVF children is no different to other children conceived in a different way. With the current knowledge there is no increase in congenital abnormalities due to IVF and as yet no clear suggestion of an increase in other childhood or long-term effects.

What other alternatives are there to IVF for infertile couples? How long should couples wait before seeking help?
IVF procedures are a last resort when all the other methods have been exhausted. On average a couple needs to be actively trying to get pregnant for at least one year before seeking advice. If all fertility treatments, including repeated assisted conception and IVF, fail the only options for these couples are to either accept their predicament, which can incidentally although rarely resolve itself spontaneously, or finally resort to adoption.

Facts and figures

¤ Deliveries of babies in Malta dipped to a total of 3,838 last year, as opposed to 3,995 the previous year, according to Department of Health Information statistics.

¤ The modal age group of mothers who gave birth in 2004 remained at 25-29 with 37 per cent of all deliveries occurring in this age bracket. There were 85 deliveries to mothers aged 40-44 and another four to mothers over 45 years of age.

¤ Malta's total fertility rate (which is defined as the average number of babies born to women during their reproductive years) in 2004 stood at an all-time low of 1.34. In 1975 the TFR was 2.1 and started declining in the 1990s.

¤ According to the World Health Organisation, about 15 per cent of couples of childbearing age seek medical help for infertility, usually after about two years of failing to conceive. It believes that there are about 60-80 million infertile couples in the world.

¤ Most infertility cases - 85 to 90 per cent - are treated with conventional therapies, such as drug treatment or surgical repair of reproductive organs.

¤ In infertile couples, where women have blocked or absent fallopian tubes, or where men have low sperm counts, IVF offers a chance at parenthood to couples who until recently would have had no hope.

¤ Stress plays a prominent role in our modern day world and is increasingly being cited as a contributing factor in a wide array of diseases and disorders. In addition to the association with heart disease and other disorders, stress has now been shown to interfere with the fertility process.

¤ You can't eat your way to fertility, but eating well and keeping yourself at a healthy weight can make a difference. Eating lots of fruit and vegetables, eliminating alcohol and cutting down on caffeine can be a good start.