Transcription
This podcast is brought to you by Australia’s LGBTQIA+ community media organisation, Joy. Keep Joy on air by becoming a member, a subscriber or donate. Head to joy.org.au.
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Fertility Journeys introduction
Welcome to Fertility Journeys with Newlife IVF. Every fertility journey is different. Especially within the LGBTQIA+ community. On this podcast, we’ll be sharing real stories, as told by Newlife IVF patients chatting about their journey and diving into the messy, heartbreaking, sometimes silly and often amazing world of fertility.
Our experienced medical professionals will also be on board to share their expertise and answer your questions. So, strap your boots on, buckle up and join us on this wild journey.
Oh, and don’t forget to pack the turkey baster.
Episode 1: The basics
Emily Tresidder: Welcome to our very first episode of Fertility Journeys with Newlife IVF. I’m your host, Emily Tresidder. And today we’ll be going through the basic things you need to know about IVF, especially if you’re a member of the rainbow community. Dr Chris Russell will be chatting with Kristina, a patient he helped through her fertility journey. Kristina shares her stories, the ups, the downs and the beautiful moments that made it all worth it. Then we’ll round out the episode with a discussion that unpacks in vitro fertilisation.
Before we hear from Kristina, we’re going to need some very basic facts. So, Dr Nicole Hope, thank you so much for joining us today. I’m challenging you to a two-minute rundown. In two minutes, we need you to give us a basic explanation of exactly what IVF is.
IVF (in vitro fertilisation) explained
Dr Nicole Hope: Okay, well, IVF stands for in vitro fertilisation. This means putting eggs and sperm together in a lab to create embryos, which can then be transferred into the recipient in order to get pregnant.
So naturally, people only ovulate one egg per month. In an IVF cycle, we want to be able to collect multiple eggs in just one month. The person who is providing the eggs has to take hormone injections for around 10 days. And this includes follicle-stimulating hormones to make multiple eggs grow, and also other injections to make sure they don’t ovulate too early.
They have an ultrasound after one week to confirm the eggs are growing. And then we schedule the egg collection procedure, which is usually around days 12 to 14. The egg collection is done under a light anaesthetic. An ultrasound is inserted into the vagina and a needle passes through the vagina directly into the ovaries to retrieve the eggs. It takes around 10 minutes.
After the eggs are collected, they are inseminated with sperm. They can be placed directly next to each other in the lab to allow natural fertilisation, or sometimes the sperm is injected directly into the egg. The next day, the eggs are assessed for signs of fertilisation.
The fertilised eggs, or embryos as they are now called, are then placed in an incubator and grown for five or six days until they reach what we call the blastocyst stage. This is an embryo with over 100 cells. In a blastocyst embryo, we can already see the cells that will make the baby and the cells that will make the placental membranes. The embryo is then transferred back into the uterus in a procedure that’s similar to having a pap smear done. We usually just transfer one embryo at a time, and any extra embryos can be frozen for use in the future. Then we wait. Patients often call this the two-week wait, and it’s the time between the transfer and the pregnancy test. Sometimes this is the hardest part of the IVF cycle.
What I’ve just explained in two minutes usually takes place over one month, so it’s the exact same amount of time it would take if you were trying without IVF.
Emily Tresidder: Dr Nicole Hope, that was very impressive. Thank you so much for that two-minute rundown. First up, Newlife IVF fertility doctor, Dr Chris Russell, chats to Kristina, a patient who he helped through the IVF process.
Dr Chris Russell is joined by one of his patients, Kristina
Dr Chris Russell: Kristina, I do appreciate your time today. Thanks for joining us for this, our first podcast.
Kristina: It’s my absolute pleasure.
Dr Chris Russell: Thank you. You’ve got two beautiful children, Lily and Sebastian.
Kristina: I do.
Dr Chris Russell: How did they come about?
Kristina: Lily was actually home insemination, and she is now nine, and Sebastian was through IVF. So, two different methods of conception, but both with amazing outcomes.
Dr Chris Russell: Wonderful outcomes indeed. What made you decide to do IVF with Seb?
Kristina: My main consideration probably would have been my age. We did try a few home inseminations, but by that stage, I was 38 and didn’t really want to waste any more time trying when we had obviously the option of going through IVF to conceive Seb.
Dr Chris Russell: We do a lot of things to prepare you for IVF. You would have had discussions with me. We usually have you have discussions with nurses and with counsellors. How useful did you find those?
Kristina: I found the consultations with you really useful. I’m not medically minded in any way or form. So, coming at it from scratch was a real eye-opener. The other thing that really assisted was the interaction with the nurses. Really, after we see you, the majority of the contact is with the nurses, and it’s your main point of call. Of course, we can contact you, but we get a quicker response obviously by going to the nurses, and they monitor. It was really, really good support.
Dr Chris Russell: We do love to work as a team, and I think it’s really important because nurses and doctors do talk about things in different ways and come about things from different perspectives. I think that’s a strength and really does help patients a lot.
Kristina: It was out late at the start, so we knew kind of what to expect. It was a very easy process in terms of the communication and the support.
Dr Chris Russell: Now, IVF, if you could just take us through that a little bit and what it’s like from a patient perspective.
Kristina: I probably came into it a little bit naive and just thought it would be a few injections and some medication, and then I would have obviously the eggs collected. The injections themselves are okay. I’m quite okay with that. I know that some people really struggle with that part of it, but I was okay with that. What I struggled with was the side effects of the gel. I found that it just made me really anxious. I just wasn’t myself. My partner at the time just goes, ‘What is wrong with you?’ I just felt like I would say something or react in a certain way, and I’d be like, ‘Oh my God’, that’s not how I would normally react. So, I found that side effect emotionally quite draining. But after I had the collection of the eggs, I found the process much easier. What really killed me was the two-week wait and not knowing whether you’re pregnant or not pregnant. That was the hardest bit.
Dr Chris Russell: Yeah, it’s very hard. If only we could hit the fast-forward on that two-week wait.
Kristina: I know, I know.
Dr Chris Russell: So Kristina, you mentioned you were a little bit nervous about the injections and whether it affects your emotions and your feelings. I must admit from my point of view, some women are affected by it in that way. Many aren’t. And it’s always hard from my point of view to know, is it the situation you’re in? You’re trying for a baby and it’s incredibly important, and it’s that stress and anxiety that leads to the side effects. Or is it a physical thing to do with the actual injections? How did you find the effect of the injections on you?
Kristina: The physical part of actually doing the injections I was okay with, but I found emotionally it did affect me. I probably, in hindsight, should have known that because I’m quite sensitive to normal medication in any event. I did find that my emotions were heightened, that I was obviously more emotional, more teary. I became agitated a lot more easily. Those were the things that I really struggled with, I think. But that passes after the egg collection. I found it not too bad, but it also was not the funnest time in my life.
Dr Chris Russell: Absolutely. Was there anything in particular in that time that helped you get through it?
Kristina: I would often liaise with the nurse and just say, “Is this normal?” I had an amazing support network around me. I also did things like acupuncture and got massages and things like that. Just things that would help relax me and really make me mindful and take me back to my body, if that makes sense. Otherwise, yeah, I found it quite stressful if I just kept going and ignored it. I felt it was quite difficult doing it that way.
Dr Chris Russell: How many IVF stimulations did you have?
Kristina: I would have had about five, I think.
Dr Chris Russell: Did you find those things got easier each time because of the realisation and the preparation you were able to do?
Kristina: Yeah. Even my partner at the time, we knew we made a joke about it. Oh, here we go again. We knew what to expect. I knew that it was only a temporary thing. It made it much easier to get through and keep going with it.
Dr Chris Russell: I guess another aspect of the treatment is the egg collection. How did you find it?
Kristina: I found it really tough, the egg collection. There was one egg collection where I was overstimulated and ended up in hospital. That was more to do with the collection at the time. The other ones, I think it’s just afterwards, there’s a lot of bloating, it’s uncomfortable, obviously there’s bleeding. But as you just asked before, as you go on, it gets a lot easier to navigate.
Dr Chris Russell: What about impacts on professional life, you know, I guess particularly during the stimulation and how it affected your mood and then the physical recovery from the egg collection? Did it have a major impact on work?
Kristina: My work can be quite stressful and what I started to do is in the days leading up to an egg collection, I would get acupuncture. I would take time out, and in the days following as well, I’d really try and relax and not do too much and work from home. I think that really helped. I think you’ve really got to, when you’re going through it, you’ve really got to realise that it is a huge thing for your body to go through. You’ve just got to take it as if you had an injury, is the way I looked at it. If I’d hurt my leg, I wouldn’t be going out and running a marathon. Not that I would anyway, but that’s the way I viewed it.
Dr Chris Russell: When people start the IVF process, they’ve got to think, well, do I tell my family, do I tell my friends, do I tell my work? Do you have any recommendations for how to tell people?
Kristina: I’ve spoken to a number of people about this and there was always the, I would say, misconception that you shouldn’t say anything to anyone about your journey to parenthood within the first three months in case you lose the baby. Can I say, I think that when you go through IVF, you need all the support you can get. You need people to understand, as much as they can, what you’re going through. And I’m a big advocate for reaching out and using the people that you have around you for that support. It can be that two-week wait, like I mentioned, is just gruelling. Because you’re on medication that essentially mimics the pregnancy, or pregnancy hormones going through your bod. Every little thing that happens, you’re like ‘Oh, I must be pregnant, I must be pregnant’ or if you get a cramp, you’re like ‘I must be losing the baby’. And I think you really need people to ground you and distract you. I think that’s a big important thing in it.
Dr Chris Russell: In that two-week wait, did you find you had to modify things you do much?
Kristina: No, not really. Initially, when I first had my first-ever transfer, I stayed at home, didn’t do anything and then I realised that that’s ridiculous – I can go out there and I can live my life. What I did is, I guess, was just a lot of self-care in that two-week wait and doing what I could to distract and get through that period.
Dr Chris Russell: Okay. Just going back half a step to the embryo transfer. What was your experience of that?
Kristina: I really loved the embryo transfer. When you go in, they give you a little printout of the embryo or a photo of the embryo that’s getting transferred. I always found it really interesting meeting the doctor that would be transferring the embryo and then wishing you luck. You just walk out of there going, ‘Wow, I could actually have had my child implanted in me today’. I didn’t find it painful. It was very straightforward. It was maybe 10 minutes – if that. Yeah, I really liked it. I thought it was a really nice process.
Dr Chris Russell: Great. Interestingly, today, we don’t give out photos. We actually give you videos of the embryo developing.
Kristina: Really? Oh, that’s amazing.
Dr Chris Russell: Yeah. I think patients really do like that.
Kristina: I think it really makes a difference. It makes it more personal.
Dr Chris Russell: One other thing I was going to ask you, Kristina, is you’ve had the perspective of being both the patient and the partner of someone doing IVF. Do you have any tips for partners?
Kristina: I would say just don’t have any expectations about how your partner will react during the process and really just be there and support them. Having had the benefit of doing both, I think that it puts you in a better position to know how they’re feeling as much as you can.
Dr Chris Russell: Kristina, you are quite heavily involved in Prospective Lesbian Parents. How is that going and how did you come about being involved in that?
Kristina: Probably about I think 10 years ago, I was asked to come and give a talk to PLP, we call it for short. It was really lovely to be in a room with all these women who wanted to conceive and being able to help them navigate what that looks like for them legally. From there, when the facilitator stood down, she asked whether I would like to take it over. I really liked the fact that I could give back. I liked the fact that I could form relationships with doctors such as yourself and be able to bring people that are supportive and like-minded into that group and to be able to educate the group. I think that there are so many women that come through that group who are just desperate to start a family and don’t even know where to start. And I think the fact that we’re able to give information sessions from yourself and give the legal sessions really helps them to understand and navigate the process. Because it’s a massive process and I think that you need to be as well as you can be informed as to how to guide that, how to get through it.
Dr Chris Russell: We could talk all day about this, couldn’t we? Yeah, we really could. It’s just very rewarding being able to tell people that they have options for a family when they may have thought that that wasn’t possible.
Kristina: 100%. Even little things like the community knowing or the other women in the group knowing that they can access super. For example, their superannuation to pay for IVF. A lot of women come through, they’re like ‘Oh, we’d love to do IVF, but we can’t actually afford it’. And you’re like ‘Well, you can’. I mean, I know that you’re dipping into your superannuation, but there are ways to do it. And I think it’s really important, just little things like that, being able to know that information is really important.
Dr Chris Russell: Kristina, do you have any advice for people in the rainbow community and how they can take steps to have a family?
Kristina: Yeah, look, I would say find a specialist that is supportive of you and your family. I’ve had some experiences where former specialists haven’t been. I think that’s a really important process. You’ve got to trust and like your specialist. The other thing is, if you’re not 100% on going through IVF and you decide that maybe you’d like to try home insemination, every time I get a client that comes in and asks or says ‘I want to do a donor agreement, what are your thoughts?’ I really strongly advise them to get their donor to give their sperm sample to an IVF clinic so it can be quarantined. So, I’ve had a lot of women that have tried home insemination for six, eight months and then go, ‘Oh, it’s not working. I’m now going to go through an IVF clinic’, and then they have to wait three months with it being quarantined. So that would be my one bit of advice for anyone who’s thinking about this.
Dr Chris Russell: So be prepared, so you don’t have to wait for that three-to-six months.
Kristina: Yeah, so you can jump straight back into it.
Dr Chris Russell: Kristina, I’m not sure if you’ve seen the movie ‘Lost in Translation’.
Kristina: No.
Dr Chris Russell: There’s a line by Bill Murray’s character where he says ‘You know,
the day you have your first child, your life is changed. But your children are the most delightful people you would ever meet’. Do you agree?
Kristina: I do agree. I think the first time I held Lily was the, you know, the best experience of my life. And they would do things on a daily basis that you just go ‘Oh my God, that’s fabulous’. And then they’ll also drive you quite mad. But, yeah, I agree. It’s the best thing in the world.
Dr Chris Russell: Absolutely. Couldn’t agree more. And, you know, that quote often bounces around in my head when people say ‘So why do you go to work every day? Why do you do what you do?’ And I think that quote sums it up nicely. I want everyone to have that experience.
Kristina: Yeah, I agree.
Dr Chris Russell: Kristina, thank you so much for your time. I really do appreciate it.
Kristina: No, it’s a pleasure. You’ve given our family so much, so it’s the least I could do.
Dr Chris Russell: Thank you.
Dr Nicole Hope explains the conditions needed for IVF
Emily Tresidder: You’re listening to Fertility Journeys with Newlife IVF. That was Dr Chris Russell and Kristina sharing stories of her IVF journey. The IVF process is a complicated and delicate one. There are many measures that need to be taken to ensure the process is safe and successful. Dr Nicole Hope explains.
Dr Nicole Hope: So, the best outcomes with IVF are achieved if we can mimic the exact same conditions that we see in the fallopian tube and the uterus. This means keeping things warm, dark, with no exposure to air, and with minimal handling of the embryos. In an old-fashioned lab, embryos are grown in incubators, where in order to see what’s happening, you have to open the incubator, take out the embryos you want to look at, and then move them to a separate microscope.
Often there are several people’s embryos in one incubator. So, every time you open the incubator, you are letting the warmth out, you’re letting the light and air in. And this affects all the embryos, not just the ones you’ve taken out.
Then the embryos have to be examined really quickly to minimise the time they are kept out of the incubator. And this usually only happens once a day. So, you are just getting information about what is happening at that single point in time in a 24-hour period.
At Newlife IVF, we use special incubators called EmbryoScopes. The embryos can stay in the EmbryoScope for the entire time they are in culture. They are kept warm and dark, but we have time-lapse photography. So, we can watch every stage of the embryo’s development at any time we want without actually taking the embryos out.
Now there are times when we do need to move the embryos. For example, when the embryos are being ready to transfer or frozen. So, we also need to make sure the lab environment is the best possible environment for the embryos. Our microscopes are kept warm and we actually keep them in a humidicrib so that we minimise the embryo’s exposure to air and pollutants.
We have special lighting in our lab to eliminate harmful blue light. There are air purifiers and positive air pressure ventilation to filter out the pollutants in the air. We even have specially sourced flooring, paint and table tops to minimise the release of volatile organic compounds, which are chemicals that are released from synthetic products for years after they are installed. All of our equipment and storage tanks have alarms to let us know if there are any unwanted changes in the temperature or environment.
A good IVF lab is also really dependent on the embryologists. The eggs, sperm and embryos need to be handled very gently and as little as possible. It takes years to master these skills, and Newlife IVF is very fortunate to have an experienced scientific team.
Patients often ask us how we make sure that we are using the right eggs and sperm, and our embryologists are also in charge of this. As well as manually double-checking everything, at Newlife IVF we label all our eggs, sperm and embryos with a barcode which is monitored via radio frequency. This means that we always know where someone’s eggs, sperm or embryos are located in the lab, and it minimises the chance of any mix-ups.
So, a successful modern IVF lab uses a combination of modern technology, such as the EmbryoScopes and radio frequency monitoring, specific planning and design to minimise environmental pollutants, and experienced staff to handle and monitor the embryos.
Emily Tresidder: Up next, I sit down with Dr Chris Russell to chat more about his discussion with Kristina, as well as delve deeper into the IVF process.
Dr Chris Russell is joined by Emily Tresidder
Emily Tresidder: Dr Chris, that was a wonderful chat you just had with Kristina. Such a beautiful process. And also, what a wonderful outcome for Kristina and her family. Just to summarise, what actually happens during an IVF cycle?
Dr Chris Russell: Yeah, so there’s a few aspects of IVF which I’ll break down just a little bit and we sort of are into a few different phases. So, we sort of talk about the stimulation phase and that’s where we get a patient to administer injections and medications that get her ovaries to produce multiple mature eggs all at once.
Now in Nicole’s two-minute rundown, she sort of mentioned how usually a woman will produce one egg per month. But in IVF, what we’re trying to do is to get her to produce somewhere eight, ten, twelve, fourteen eggs, something like that -– so we use medications to do that. And one type of medication gets those eggs to grow; another type of medication prevents ovulation, so it traps those eggs within her ovary. And during that time, everyone responds a little bit differently. No one’s the same. So, we have to monitor how the patient responds to those injections, and to do that we use some blood tests and we use some ultrasound scans. And usually, most patients would need at least one, but potentially two and maybe even three of those tests during the stimulation phase to see how they are responding. And on the basis of those results, we’re then able to decide when the next step takes place, which is the egg collection.
Emily Tresidder: How long does that stimulation process last for? And Kristina mentioned that she was overstimulated – what does that mean? Is that too many eggs?
Dr Chris Russell: So, the actual process takes about 10 days. Again, everyone’s a little bit different – might be a little bit shorter, might be a little bit longer. So, everyone’s a little bit different. But you can sort of expect that. About 10 days of stimulation and then an egg collection around day 12 of the cycle.
Now overstimulation is a situation where the woman produces more eggs than expected. And in some ways, it’s a nice problem to have because if you do produce a lot of eggs, it means you are going to have a higher chance of having a baby. But the issue is that everything comes at a cost, and that is that it can make the patient more bloated, can give them more pain and the recovery can be not quite as smooth as a result of that.
Emily Tresidder: Right, but then there’s more possibility because there’s more eggs.
Dr Chris Russell: Correct. The real danger with hyperstimulation is it can make you unwell enough to be in hospital. So, we really want to avoid that sort of situation. But there are lots of steps we can take to still harvest a woman’s eggs or still have a person’s eggs without them having significant complications.
Emily Tresidder: Yeah, it makes sense. That’s why you’re ultrasounding frequently to avoid those problems.
Dr Chris Russell: Correct.
Emily Tresidder: Is there a difference between heterosexual couples that go through IVF and
same-sex couples that go through IVF?
Dr Chris Russell: There are a few differences and I think the first is that often heterosexual couples are coming from the point of view where they’ve tried to have a baby naturally and they’ve run into some sort of problem. So, there may be problems with the woman’s eggs. She may be a little older. There may be other things that make it harder to become pregnant.
So, what I do find is that women who are coming in for donor sperm treatment tend to respond a lot better to the medications and they tend to do a little bit better with treatment as well. The other thing I’d say is that it also gives you a few more options if you’re dealing with lesbian couples in particular, because we’ve got two women who could supply the egg, and we’ve got two potential women who could carry the pregnancy as well. So, it gives you a few extra options.
Emily Tresidder: What about homosexual gay couples? Does Newlife IVF support the meeting of a potential person who will give them their eggs?
Dr Chris Russell: Yeah so that is a little bit more complicated. We certainly do support that process. Unfortunately, we haven’t had a lot of patients go through with that at this stage. And one of the complicating issues is that surrogacy law in Victoria is such that you can’t have an egg donor also carry the pregnancy. So that means, for gay men, they would need to find a woman to be the egg donor and a woman to be the gestational carrier as well, which makes things a little bit more complicated.
Emily Tresidder: But still, a fantastic support that you can offer them once they have.
Dr Chris Russell: Absolutely! And we’ve helped a few couples over the last couple of years in that regard.
Emily Tresidder: Fantastic! When a patient first comes to Newlife IVF and they’re about to start their first cycle, what do you think the most common concern, or I guess, apprehension, when going through that process is for them?
Dr Chris Russell: If I’m talking mostly about the rainbow community, the biggest concern is how they go about getting sperm. And the reason being that Victorian law is quite strict in terms of how you access sperm donors. And that makes it quite difficult to recruit your own sperm donor and use it. And similarly, it makes it quite difficult for us to recruit our own sperm donors into the clinic. So, I think most of the concerns are related to sperm supply.
Emily Tresidder: And how do you at Newlife IVF try and alleviate that concern?
Dr Chris Russell: Well I think the first thing is that often the patients are surprised that we do have quite good supplies of donor sperm. And I saw a patient today who had been to other clinics and was told there’s a 12-month wait list for donor sperm. And that’s not something that we’ve ever had to instigate. We’ve always got supplies. So, I think just being able to tell patients that we do have a bank of sperm available and that there are always donors coming on board. There are always donors whose sperm is being used up and they’re no longer available, but sort of is a constant process.
Emily Tresidder: Fantastic! Dr Chris, from your personal perspective, what’s the best thing, the most fulfilling thing, about being a fertility specialist?
Dr Chris Russell: At the end of a cycle, I always see all of my patients for a pregnancy scan, and I really love that part of my job. I see them all at seven weeks, doing an ultrasound myself and seeing that heartbeat. And just seeing the joy that brings them. And the joy is often followed by worry and concern. The thought that they are going to have a baby – ‘What am I going to do with this baby?’ But that quickly dissipates. And then the other is getting the photos and getting the pictures and the thank yous.
Emily Tresidder: Magical moments for you. And you get to have them constantly which I imagine is really fulfilling. What would you tell a couple or a person that’s considering potentially starting their IVF journey?
Dr Chris Russell: I think the hardest part is deciding. So, once you’ve decided you want to do it, it’s actually quite a straightforward process. You just need to see a specialist and have some fairly straightforward tests. There are a few steps that you have to do in Victoria which involve catching up with a fertility counsellor. And that’s really about just making sure you understand the IVF process well, making sure you’re well consented, and making sure that we’ve identified any issues that might mean you need extra support during the treatment.
Emily Tresidder: It’s comforting for them to know that before they’re actually injecting anything or doing any of the tangible steps in the process, there’s plenty of support. There’s a huge amount of making sure this is going to work for you. If we need to alter the process, then we will. If, for example, someone’s listening to this podcast and they’re considering ‘I want to start a family’, you know, ‘IVF is probably my only route’, from an emotional perspective, what would you tell them?
Dr Chris Russell: I think the most important thing to think about is just your desire to have a baby. And if it’s there, you should really look into it, because it may be that your preconceptions are different to reality. You sort of mentioned a patient who thinks that they might need IVF. They might not need IVF at all. There might be more straightforward treatments that are available. And I would also tell them to just be confident because there are options out there today, and we do have treatments that can help them have a baby.
Emily Tresidder: Fantastic. Thank you for summarising and giving us all that info, Dr Chris.
Dr Chris Russell: No problem.
Emily Tresidder: Thank you so much to our guests on the first episode of Fertility Journeys with Newlife IVF. To Dr Nicole Hope for sharing important information on the IVF process. To Kristina for sharing her fertility journey. And to Dr Chris Russell for chatting to us about the ins and outs of IVF.
You’ve been listening to Fertility Journeys with Newlife IVF. To find out more about Newlife IVF, visit newlifeivf.com.au. And to find more episodes of the podcast, visit joy.org.au/fertilityjourneys or search ‘Fertility Journeys with Newlife IVF’ on your favourite podcast platform.
This podcast is produced on unceded Aboriginal land. We pay our respects to elders past and present as well as brother boys and sister girls within the LGBTQIA+ community.
Tune in to the next episode of Fertility Journeys with Newlife IVF.
This podcast was produced by Joy 94.9, Australia’s rainbow community media organisation.
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