The Sigla Blog

Like many bloggers, I avoided my computer over the Christmas/New Year period. I’m hoping to blog some more reviews this year, but here’s a lengthy piece I had intended to post in December and it’s especially relevant this week as it’s three years since the leukaemia diagnosis that prompted me to address my own fertility issues.

Happy New Year to everyone who stops by here.

Just before Christmas I was a panellist on RTE’s The Big Bite to discuss the issue of infertility. If that seems like a first line bombshell, let me clarify my connection to the issue. I don’t even know if I’m infertile (which will become clearer as you read on) but I was there to speak in broad terms about cancer and infertility. I was also asked to contribute to the show because of an article I wrote in the December issue of U magazine. What started out as a personal piece about my feelings on infertility should it be an issue for me, became a piece about the wider experience of women my age when it comes to having children.

One of the other panellists was Dr. Tony Walsh of SIMS Fertility Clinic* in Rathmines. Before the show, he mentioned the fact that women are postponing pregnancy until their mid to late thirties is a huge cause of infertility. In Ireland, one in six couples will have problems conceiving a child. Dr. Walsh estimates that in the next 20 years, this will rise to one in four. One of the most shocking reasons he cites is the huge rise in Chlamydia in young girls which, left untreated, will lead to tubular problems and infertility.

For a country where multiple pregnancies were the norm up to a couple of decades ago, Ireland is facing a huge fertility problem in the future. The problem for women is that many of us want to have children, but biology dictates it must be within a certain timeframe whether that suits your life, career or financial situation. Factor in the idea that we all just assume we will be able to have children and it seems there may be much heartbreak for increased numbers of women on the horizon.

I’ve reproduced the article here (with some slight edited updates) and apologies for the oh-no-not-leukaemia-again introduction, but the piece required context.

Most people, when they get married, can expect to be hounded by everyone from clucky friends to concerned aunts about when you’ll start having children. No conversation or interaction with relatives is safe from the ‘patter of tiny feet’ patois. I managed to sidestep it adeptly and dodge it indefinitely. Not by producing a progeny nine months after the wedding, but by being diagnosed with leukaemia. These days, no one dares bring the topic up for fear of being insensitive or prompting tears. Six months to the day since my wedding, I was rushed to casualty. A chronic chest pain turned out to be a massive embolism that had broken off from a DVT in my leg. Initially judged to be a side effect of the pill, the fluctuating white cells had been ignored and bone marrow was mentioned. When the doctor informed me in hushed tones that she wanted to speak to me with a family member present, I began to feel very afraid. I can’t remember for sure, but I think that fateful conversation started with: “Well, the news isn’t good.” Regardless of age, I can’t imagine that anything prepares you for the news that you might die. My first thoughts were of my husband and my family. Then I started to think about all the things I still wanted to do, like the godforsaken book I’ve been threatening to write for years. When the consultant arrived he explained how the treatment would go and detailed the amount of chemotherapy and drugs involved. My first question was to ask if I would die (”No guarantees, but not if we can help it”) and the second, was about my fertility, because on that long list of ‘things to do’ should I survive, was having children.

Like most of us, I have always assumed that I would have children. Some of my friends had children in their early twenties, more and more were starting families as they hit 30. Sitting there, trying to take in the news that I was looking at six months of hospital and treatment, the issue of children weighed heavily on my mind. A few years ago, when working as a television researcher, I remembered a guest from one show, that had her eggs frozen in the UK before her cancer treatment began. The process was not available in Ireland at the time but is now. A female egg is one of the largest cells in the body and given its large water content, is not ideally suited to freezing. My chemotherapy was scheduled to start two days later and I asked if the process was a possibility we could look at. The answer was a resounding no because I was seriously ill and time was a huge factor. It just wasn’t an option for me.

There it was right there. I might not be able to have kids if I had the treatment to save my life. Like many women, I spent my teens and twenties trying not to get pregnant and looking after my reproductive health. In one afternoon, all of that seemed to fall asunder and there wasn’t a thing I could do about it. I was on cocktails of drugs, anti-coagulants, chemo, morphine - and a drug to suppress menstruation. This was partly to stop pregnancy and because bleeding in any way while harbouring a clot is a bad idea.

Without going off on a million tangents, the months that followed included a lot of harrowing treatment and difficult times, but I got better. I was so engrossed in getting better that every time the issue of children popped in to my head, I shoved it right back out again. A couple of friends announced pregnancies around this time and I was delighted for them, but a sadness weighed on my heart at the thought of never feeling what they felt.

After six months of primary chemotherapy, I made an appointment to see my gynaecologist. The results, as she predicted, showed my fertility was at the same level as a post-menopausal women, ie zilch. She was quick to point out, however, that this is what she would have expected so soon after finishing such heavy doses of chemotherapy. Gradually my periods restarted and my body, still on maintenance drugs, began to recover.

More than two years since that gynaecology appointment and with the illness thankfully behind me, I have started to think about what most of us in our twenties and thirties will think about at some point “do I want children?”. For some it may have already happened, possibly younger than we had planned it. For others, the flurry of our career-driven twenties will mean we’ll be having our children in our thirties. These days, the fact that a large number of us are leaving it until later, will ultimately result in some women being unable to conceive naturally.

Why are we leaving it so late? One factor, as someone pointed out to me recently, is that these days our thirties seem more like our twenties. Not only are people getting married and having children later, but most of us are still travelling, partying, staying single and living at home well into our thirties. If those basic demographics have changed, it makes sense that women are reluctant to give up all of their perceived freedom and put off having a family. Demographic changes from careerism to staying younger for longer are worthy reasons, but the biggest reason most of us wait is far more simple - we all just assume that having children is something we will be able to do. This presumption that biology will triumph is mostly true, but for many of us it won’t be the case.

Research from Holles Street maternity hospital has shown a shift in the main childbearing age of women attending the hospital. In the last couple of decades it has shifted from the 25-29 age group to the 30-34 group. After 35, a woman’s fertility begins to decline and by the time she reaches her late thirties, the chances of getting pregnant even with the aid of IVF are one in ten. Statistics of one in six that are set to rise to one in four mean that anyone who doesn’t experience infertility directly will know friends and family who will.

The other angle to this debate is that there is never a good time to have a baby. At the start of my treatment, nearly three years ago, the amount of time I would have to wait before I could consider this option, seemed endless. Months of chemotherapy made me initially infertile post treatment (an expected side effect of the drugs) but until I reached the end of the maintenance drugs, there was no point in even thinking about it. December 2005 saw me three months clear of all drugs and - for the first time in three years - if I wanted to try and have a child I could. This in itself brought up a lot of issues for me. During all the time I was taking mountains of tablets and having fortnightly blood tests, I imagined that as soon as I was given the all clear, I would get straight down to the business of starting a family. As December drew nearer, the urge faded and a slight panic took hold at the idea. In many ways I feel conflicted - the last year has been very successful workwise and I’m determined to focus on my own writing this year (as well as harbouring fanciful notions of travelling) and yet I’ve recovered, am in my early thirties and want children - but not now.

I’ve talked to several friends about this and it seems than more and more women of a similar age feel the same sense of doubt. Where once the idea of wanting children “but not yet” was at least 7-10 years away, now time is catching up. Being too young, not ready, single or financially challenged have bought many of us time, but now as we trundle out of our twenties, with boyfriends or husbands in tow, decisions will have to be made either way.

For me, it’s a case of when I decide I’m ready, it still might not happen for me (in natural terms anyway). In a way, it has been a very long journey to come to this point, a point where I will accept whatever the outcome may be. A few months ago I resolved to have my fertility rechecked the moment the drugs left my system, but now I’ve decided to not get hung up on this issue and just see what happens. These days, there are more options including adoption, IVF and egg donation, but I’m an optimist. Where some people are glass half-full folk, I’ve always belonged to the glass-brimming-over faction (which is probably why I got better so quickly). I can’t say I won’t be upset if children aren’t an option for me, but I’ll counter this by being thankful that I’m still here to write these words and that I can be an aunt to all the gorgeous kids my friends already have and all the new arrivals to come.

* The SIMS website has a lot of useful information on infertility, its causes and treatment and can be found here