Episode 4 The Baby Makers

In the UK, an estimated one in seven couples

suffer fertility problems of some kind.

Every year, thousands of these will seek help

in the form of fertility treatment.

For some, this will be a success,

resulting in a much longed-for child.

It's as real as it'll ever be and fingers crossed, everything goes OK.

For others, it will be an uphill struggle.

At the heart of all this is our desire to become a family

because we have so much to give.

This is the story of the arduous journey faced by many couples

and individuals as they strive for their ultimate goal, a newborn baby.

Journalist Jilly works for a well-known national newspaper

and has been married to Peter for five years.

Now in their efforts to start a family, Jilly and Peter

are hoping to undergo fertility treatment and are having

an initial consultation to investigate the options.

-Are you allergic to anything at all?

-No.

Peter and I met on a blind date.

I think I just knew, when we left, that Peter had a great catch.

-I thought he's a very lucky man.

-The feeling was mutual, of course.

-How long have you guys been together?

-Nearly five years.

Jilly has been pregnant before

but unfortunately, it did not last the full term.

OK, that's good.

Peter was off playing football on the Thursday night,

I came home and I didn't feel well.

Then I had started to miscarry.

We knew then there was no chance of the baby surviving

and I think I fell into a big tunnel of emotion and I just went...

It was just really, really hard.

-And you've never been pregnant?

-Yes, we have. We lost the baby.

-OK, when was that?

-November 2009.

I think after we lost our baby, our first baby,

the idea of trying for another child just filled me with absolute dread.

That's something that, if we were given the chance to become parents,

I'm going to have to get my head around the idea that you've got

eight or nine months, hopefully, to deal with this.

-Medically, any problems?

-Nothing.

Apart from carrying extra weight, I suppose.

As part of this consultation,

all patients have their BMI or body mass index measured.

Jilly has to get hers below a certain level before

she can start her treatment.

You may or may not be aware that the ideal BMI is less than 30 in terms of

success rates, in terms of response to the ovulation induction drugs,

in terms of sedation risks for all the procedures.

The top level for Origin is 33.

My BMI is too high for them.

They prefer it to be at a certain level to have the IVF drugs.

Whatever the drug it is they give you,

it kind of seeks out fat molecules

and it's got a lot of work to do with me.

That's what I've got to do.

As women get older, their chances of achieving pregnancy decrease

as their egg production rapidly diminishes.

However, egg freezing has now become an option for women

who may want to store their eggs for possible use in the future.

Once we've got the eggs frozen, vitrified,

they can remain in storage for, theoretically, indefinitely.

There are legal constraints as to how long we can keep them

but biologically,

they can be safely stored in liquid nitrogen indefinitely.

Barbara is in her late thirties and is currently single.

She has decided to investigate the possibility

of having her eggs frozen and stored so that if she decides

to have children in the future,

she has a better chance of becoming pregnant.

I've made the decision now to look at possibly freezing

some of my eggs for future.

I'd like to have the option in the future still to be able

to have a family with somebody.

At least then I know I've done something about it,

something that is going to be of importance to me in the future.

My body is still how I felt when I was in my 20s,

so, I don't feel any different.

It's just a case, I'm a little bit older now.

I just need to find out a little bit more.

Today, Barbara is meeting Jenny Hall,

managing director of Origin Fertility Care,

to discuss the procedure.

OK, what we try to do with drug stimulation,

is we would use hormone drugs to help you to produce more eggs

than you would normally produce,

then use a process called vitrification to freeze the eggs.

I do think it's a good idea because Barbara is in her late 30s.

If all the other parameters are OK, then she should do that

because that is the only other choice she has at the minute.

Because you are a little bit older

and your ovaries may not respond

to the drug stimulation, we may not be able to collect enough eggs.

What we would propose to do in the first instance, is do a blood test.

That blood test...

I think the urgency is to do it as soon as possible

because of my age, so that the eggs are going to be the age I am now,

not the age next year and the year after.

I'm quite happy to proceed if the blood tests do come back

and they seem to be well.

Yes, I'll be happy to go ahead.

26-year-old Angela has been married to Mark since 2006,

but their efforts to have a child have been hampered

by fertility problems.

When I was 18, my monthly periods stopped altogether,

so I went to my GP.

From there, they found out I had polycystic ovaries

and they decided to put me through fertility.

I had treatment but I over-stimulated which meant all our embryos

had to be frozen.

Four months down the line after that, we got pregnant

but then I had a miscarriage after three or four weeks.

Now, Angela wants to use her remaining frozen embryos

in a second cycle of IVF treatment.

I wasn't ready to give up.

I had still some embryos frozen there, so I decided to go ahead

and use the rest of them up and keep trying.

Angela has a total of 11 frozen embryos,

but during the thaw process, not everything has gone to plan.

They thawed out six embryos but, unfortunately,

four didn't survive.

Two did survive but the didn't divide

so they had to thaw the remaining five out.

Out of the five, two were suitable for transfer,

which is happening today.

It's basically our last hope because that is all our eggs used up now.

Next time round, hopefully there is not a next time round

but if there is, it would be another fresh cycle for us.

OK, ready?

The embryos are prepared in the adjoining lab

and are then placed in a catheter for transfer into Angela's uterus.

..then pass the catheter through.

Thank you.

OK, they're going in now. Good luck.

-OK.

-Thank you.

This is the worst bit for them.

It's about waiting now two weeks to find out if the test is positive

and there isn't anything you can do at this time.

Two weeks is a long time,

so it is one of the worst parts of the cycle, really.

Whether it's a fresh transfer or a frozen,

you still have to wait that two weeks.

There is no easy way around it.

It just takes two weeks and then that is it.

We look forward to hearing from you.

-Just give us a wee shout if you have any queries.

-Thank you.

-OK.

Determined to lose weight so that she can begin

her fertility treatment,

Jilly has embarked on a new healthy lifestyle including

weekly Tai Chi sessions.

I don't think we're going to get another chance at this.

It's an expensive process for anybody to go through and at my age,

I need to be realistic that this is our chance.

We are throwing everything into this chance, losing weight,

having good vibes from people, having prayer from people,

taking all the help we can get.

Jilly has also opted for an alternative therapy,

known as Maya massage, which she hopes will complement

her fertility treatment.

Nice, light movements.

Maya massage is best performed three months before IVF.

We want to start working on a body, we want to start preparing

the body for IVF and what it has to go through.

This movement here is both very relaxing....

Our chances are low but at the same time,

at least we have a chance and we're doing something positive.

We're actually doing something active and positive about it.

If things worked out for us within 11 months, we could be,

not nursing basset hounds, we could be nursing a child.

That is the possibility. We could also just been nursing basset hounds.

Elaine and Andrew have been married for six years

but their efforts to have a child have proven difficult.

I think we were trying for about a year and a half

before we both agreed, we needed to look into this,

we should see if there's a problem and why it's not happening.

Then we discovered there was a private clinic in Belfast.

We booked an appointment with them and then in January,

started the first cycle of treatment.

But in the final stages of Elaine's treatment, a problem arose.

There was a risk of me having Ovarian Hyperstimulation Syndrome.

The clinic weren't keen to continue with my treatment at that stage,

they weren't willing to take that risk.

So, they froze all my eggs.

We were called up again to start the treatment

and it was a much shorter, much easier cycle because the eggs

were already there and it was just a matter of thawing those.

I tested positive on the morning.

About four o'clock in the morning I got up and tested positive.

Eventually went to get a blood test before I could totally

convince myself this was real and this was happening.

Then, we went for a six-week scan which confirmed that

the pregnancy was viable.

In a few months' time, Elaine is due to give birth

to the first baby to be conceived using a frozen egg in Ireland.

Today, Elaine is having her 24-week scan

and it is her first scan using 4D technology.

To see the four dimensional and to see the face

and to see life inside of me, it was absolutely amazing.

That's amazing.

It was the first time I had seen a 4D scan in my life and it just

blew me away just to see how real everything was and the detail.

We are just so positive and happy now that we know that

we're going to have a baby very shortly and will be a proper family.

We feel now we can go out and start planning the nursery

and doing all the things we want to do,

up until now, we've been thinking about and dreaming about.

Wondering would it ever happen, I think it's as real

as it will ever be and fingers crossed, everything goes OK.

Barbara is in her late thirties and is hoping to freeze her eggs

for possible use in the future.

Today, she has returned to the clinic

to get the results of an important blood test.

I'm a bit apprehensive, obviously.

Tried not to think about it too much but today, we could ultimately

find out if we can proceed with the treatment really.

The doctor will tell me the blood results today.

It could come back good, it could come back negative,

so, we'll just have to wait and see.

The blood test was taken to measure Barbara's AMH

or Anti-Mullarian Hormone level.

This hormone is a good indicator of the function

of Barbara's ovaries and how she is likely to respond

to fertility treatment.

Now, I have your AMH here,

which came back as 1.92.

This is a low AMH, and that is compatible with your age.

-Yeah.

-Right? And normally we expect a low ovarian response.

-Therefore, we need to use the maximum dose, OK?

-A-ha.

What happens is we need, of course, to do the cycle and see how the

ovaries will respond, because the AMH is only at best, it's not 100% accurate.

-The actual reality is when you start the stimulation.

-Yeah.

-OK? And see what happens with that.

-OK.

Well, the doctor gave me the news of the Anti-Mullerian hormone.

As expected, it was going to be low.

Just due to my age, anyway.

But this is inconclusive, so, you know,

we can still go away with doing the treatment,

still, you know, do the egg production.

While at the clinic, Barbara is scanned to check

how many follicles she produces in a normal monthly cycle.

This is your uterus there.

Each follicle will usually contain one egg.

So, the more follicles she has,

this higher her chances of producing more eggs.

The follicle there is a small size,

but probably that is what you would expect with a low AMH.

So, it may take a few more days for the left ovary to develop

and ovulate from there.

Yeah. You know, I am still quite positive.

At least there was some there, and up my mind at ease.

I think still, you know,

work on it and at least then I have had a go, at least I have tried,

rather than just giving up at the first hurdle.

So, no, I'm OK about it actually.

Jilly has managed to reach her target weight to enable her

to begin her fertility treatment.

Those are all the things that you have to be aware of.

Today, she is at the clinic for a scan, to see if her treatment

is working and to check if her ovaries are producing follicles.

What we're looking at today is just to see the response you've had

to the stimulation. There is no set timetable

that you need to reach, we'll just have a look at your response

and plan it from there.

So, you've got the ovaries, the whole area

and then these black areas here, those are your follicles.

I had my eight-day scan and it revealed that I have...

the drugs are working.

There are four main follicles which are really good size.

And I think three or four smaller ones,

which may or may not get to the optimum size.

I think they need it 17 mm.

That's a nice response. We've got a look at the chart here.

You've got four main follicles that are developing.

These are your leading follicles,

so these are the ones we're interested in.

Well, I am delighted,

because I was really worried about coming in today.

I just thought... We were driving down the road, I thought,

I could be driving out of here and going back to get

the rest of those drugs and that could be the end of it all.

Well, that looks great. We like at least three, so well done.

Well, that's brilliant. I am so relieved. I really am.

No, I know.

Yeah, I'm upbeat and I'm happy.

I'm delighted I don't have to go down the road in tears and snotters.

But anyway, you know, we still have to take this in a...

just take it sensibly and not be getting too OTT about it.

But I am...I have to say, I am thrilled,

I am absolutely thrilled that we got this far.

After the transfer of her embryos, all Angela and her husband Mark

can do is wait,

as she can only take a pregnancy test two weeks after the procedure.

This week has been quite good, you know, I've been busy.

I'm just worrying a wee bit about next week.

I'm sure the days will drag,

but I'll just have to keep myself busy and occupied.

I just feel like everything will be fine, you know,

the outcome will be fine.

It will just make my family complete,

so that's it, that's what you want.

A family to settle down with kids, wife, that's it.

There's nothing else we want.

We don't want big things in life, you know, just simple,

simple things in life to make you happy.

That's all we want.

At the clinic, it's an important day for Barbara,

as she is being scanned to see

if her ovaries have responded to the drugs she has been taking.

The scan is to check for follicles which may contain eggs

that Barbara could freeze for use in the future.

This is your ovary on the left-hand side.

At the moment, there is no...response on that side.

-Nothing?

-No.

This is your ovary on the right-hand side.

-And you've got one follicle.

-Yeah.

That's developing, which equates to, we'd expect, one egg.

Which is, you know, disappointing, but when we look at that AMH level

in your ovarian reserve,

-it's one of the possibilities that we are facing.

-Yeah.

I mean, you can see your ovary very clearly there and there is no...

none of the little black blobs that we would hope to see.

So, I'm sorry, that's a bit disappointing.

But I will take this out, we'll let you get dressed

and then we'll have a chat.

Unfortunately, things have not gone very well.

She told me there is only one follicle there.

Which may or may not have an egg,

we never know until the time of the egg collection.

-Yeah.

-Because we can't see that on the screen.

'I feel disappointed knowing that I'm not going to go forward

'and have the egg collection.

'So, that little bit of'

peace of mind has been taken away again.

So, very disappointing.

If there were more follicles, even if there were three or four

follicles, I would say yes, it's worth going ahead.

-Because probably that is what we will get, two or three eggs.

-Yeah.

And it will be a good asset.

But going ahead with only one follicle,

which then we have to strip it down and see if it's mature,

I don't think really it's worth doing it.

-Just for one, yeah, I know.

-Just for one.

'I don't think the possibilities are there for me to do it again

'because they need eight to ten

'or preferably 12, so...'

I won't be, obviously, pursuing that,

because I would have to do quite a few cycles to actually retrieve

that many eggs, eight to 12.

-OK?

-Thank you very much.

-All right then, nice to see you.

-Thank you.

You know, I'd stress to any friend to try it

and don't leave it too long, cos, you know,

look at what has happened with me.

I've left it a long time and I wish I had done it earlier.

Today is a big day for Jilly,

as it's finally time for her egg collection.

Embryologist Richard is preparing for the procedure.

So, I'm just making sure that everything is up to temperature.

These are the dishes we are going to collect the...

collect the eggs in.

We're just going to keep these up.

The first tube, you can see the yellow follicular fluid

and the pink flesh medium.

The fluid is taken from the follicles in Jilly's ovaries

and then checked for the presence of an egg.

As Richard checks each fluid sample,

he calls out the result to the doctor in the theatre.

Egg number two.

Egg number three.

Great, so four big follicles, four eggs, fantastic. That's really good.

They will be stripped in this dish

and then put into a pre-ICSI dish to be injected later.

Later that afternoon,

Richard begins the treatments of Jilly's eggs with a process

known as ICSI or Intracytoplasmic Sperm Injection.

This process involves the selection of individual sperm for direct

injection into each of Jilly's eggs.

So then we are going to take this sperm in tail first.

Pick out one of the eggs.

And we're just going to give it a little prod just to make sure

we are in the right place.

And then we are going to go in.

Suck backwards.

And then back in, so the sperm is entering the egg now.

And then back out.

So, that went very smoothly.

Good break of the cytoplasm in the egg.

So second sperm.

This process is then repeated on Jilly's three remaining eggs

before all four are incubated overnight.

OK, this is the post-ICSI dash.

I am just going to remove the eggs from here into the dish for overnight culture.

OK.

No problems with the eggs, no problems with injecting them.

The cytoplasm broke very easily, the sperm went in very easily,

so really that is all we can do.

And just wait till tomorrow morning.

It's been over six weeks since her embryo transfer and Angela

and her husband Mark are coming to terms with the negative result.

When it fails, you just wonder why it hasn't worked and you do

a lot of research about different avenues of what can happen next

and you just have to keep going.

You see people playing with their son or daughter

going down to town or anything, it will just pop in your mind.

Like Sunday there, for instance, I took my niece to swimming

and it was like a family session, you know,

all the families there with their kids and all.

That's...just wee situations like that makes it jump

into your mind and you think,

"Oh, I hope I can do this one day with my child."

After her efforts to freeze her eggs failed,

Barbara is now getting on with life and remaining optimistic.

I had to kind of say, don't be too hard on myself,

at least I've had to try.

Yes, it wasn't successful,

but I probably would have still been curious.

If I don't ever have my own children, I would adopt or perhaps even foster.

I don't think my life is going to be empty as such in that way.

Despite an initial successful implantation,

Jilly's treatment was ultimately unsuccessful.

We understand implantation took place with two,

so we would've basically been having a twin pregnancy.

And then we lost... we lost the pregnancy, basically.

So, it was just... It has been a terrible, really awful time.

Now, after undergoing extensive tests,

Jilly has a possible explanation for her fertility problems,

which provide her with hope for the future.

There is a system that we all have called natural killer cells

and they are the things meant to prevent us from getting cancer.

And I have elevated levels of those.

So, while you are meant to have under 15%

to keep your body on the level,

mine are in the 20s, 20%.

So, what they do is they recognise

any new body,

any new cell that comes into your body

as a foreign object and they go in and they fight it

and they get rid of it.

So, that has given us an explanation for what we have been through.

We know I have a situation where we are going to go through,

hopefully, the IVF system again,

whether it is ICSI or whatever way they do it,

so I feel very hopeful.

I've always felt we'd have a little girl.

I still feel we're going to have a little girl

and while there is hope,

there is every chance, I suppose.

But I just feel we've got a better chance now.

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