Patient stories Article · 15 January 2021

The long road to happiness – in vitro through the eyes of patients

Many of us consider parenthood to be one of the most beautiful things in the world. Unfortunately, it is not always within reach. Jadwiga and Andrew, Marta and Matthew, and Julia and Robert – couples who decided to use the in vitro method – have learned how difficult it is to fulfill the dream of becoming parents.

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Many of us consider parenthood to be one of the most beautiful things in the world. Unfortunately, it is not always within reach. Jadwiga and Andrew, Marta and Matthew, and Julia and Robert – couples who decided to use the IVF method – have learned how difficult it is to fulfill the dream of becoming parents. Each of them is at a different stage of trying to have a child. Each is accompanied by slightly different emotions. They told Malgorzata Rozenek-Majdan about their extraordinary struggles in the documentary “In vitro. Science or Miracle?”. WATCH THE PROGRAM


In vitro is our last chance” – Jadzia and Andrzej’s story


Jadzia and Andrzej live in a small town between Krakow and Katowice. She is a letter carrier, he is a miner. As they themselves say, they were brought together by love at first sight. Right after they got married, they didn’t think about a child yet. Their first pregnancy was a coincidence, although of course they were happy when the pregnancy test came out positive. “We have a lot of friends with children. More than once, when we all get together, I see that the children are drawn to me like a magnet to a refrigerator,” Andrew laughs.


The first ultrasound did not reveal any abnormalities. Later, however, there was spotting, so the couple went to the hospital. Despite the fact that it was already 8 weeks and the baby’s heart should be beating – it wasn’t. The pregnancy hormone test was also coming out worse and worse. The doctor concluded that it was a dead pregnancy and had to be terminated.


The couple quickly started trying for a second one, but this one ended before Jadzia noticed that she was pregnant. “It gave me something to think about…” – she recalls. Tests began, and since they came out correctly and there were no contraindications, the couple began trying for another child. Unfortunately, they were unsuccessful this time as well. With Jadzia’s fourth pregnancy it was supposed to be fine. The spotting did not appear until later. The woman ended up in the hospital, and the pregnancy, like the previous ones, had to be terminated. She did not carry the fifth one either – it ended in a spontaneous miscarriage. The next two were already ectopic pregnancies. The last one the woman remembers as if through a fog…


Unsuccessful attempts to enlarge her family brought Jadzia to the brink of mental exhaustion. She closed herself in, cried nonstop and did not want to leave the house. She ended up visiting a psychiatrist and taking antidepressants. As she recalls, it was a time when she didn’t feel 100% woman because she couldn’t have a child.


The growing problem of infertility in Poland….


In such a situation as Jadzia’s, there is one in five Polish couples, or about 3 million people. The host of the program – Malgorzata Rozenek – Majdan – asks why reduced fertility is becoming an epidemic of the 21st century? What is the reason for this? Is either gender at greater risk of infertility? Or does the cause lie equally on both sides?


“It is estimated that in Poland about 1.5 million to 2 million couples have problems with infertility. We are not talking about infertility, i.e. the total loss of the ability to have a child, but some difficulties in this area. Currently, one in five couples of reproductive age has problems getting pregnant. The reason for infertility can lie on both the male and female side. Statistically, in 30 to 50% of cases the cause is on the side of the man, and the woman is responsible for 30-40% of cases. We must also keep in mind the so-called idiopathic infertility, i.e. infertility when we don’t know what really causes the difficulty in getting pregnant. It affects about 30% of all cases,” explains Anna Bednarska-Czerwińska, MD, an obstetrician gynecologist, endocrinologist and infertility treatment specialist at Gyncentrum.


And it is precisely such, not fully understood causes of infertility that doctors talk about in Jadzia’s case: “What frustrated me the most was that it was not known why I could not get pregnant. A doctor at one of the clinics we were at, after more tests, told us he could no longer help…” – she recalls. Every time Jadzia learned that one of her schoolmates or those in her closest circle had become pregnant for the first time or another, she felt immense anger. This was followed by tears: “I was angry that some people are able to get pregnant just like that, and I spend so many years trying and nothing…”- she explains.


Diagnosis first and foremost!


Infertility diagnosis is a very complex process. It involves a whole range of tests and requires the involvement of many specialists. Fortunately, with the available diagnostic tools, in many cases it is possible to determine what is causing the problem. When should such diagnostics be started?


“Couples who do not manage to get pregnant for a year, despite regular intercourse, 3-4 times a week, without protection, should already undertake diagnostics. Sometimes tests are recommended earlier, mainly to assess the patient’s ovarian reserve. In young girls, it is low until puberty. We talk about true ovarian reserve, the kind that determines a woman’s fertility, only from puberty,” explains Dr. Czerwinska.


To determine ovarian reserve, a simple blood test is enough. It determines the so-called Anti-Müllerian Hormone (AMH). Its concentration in a woman of childbearing age should be between 1 and 3 ng/ ml. If it is lower, we can expect problems with getting pregnant naturally. However, this is not the only necessary test. So many factors affect a person’s fertility that sometimes it is necessary to make sure how almost the entire body functions. One checks whether the uterus is properly structured or whether the fallopian tubes, through which the egg cell enters the uterus, are unobstructed.


With male semen getting worse and worse….


“Statistics show how dramatically semen parameters in men have declined over the past 20 years. Less than two decades ago, at least 30% of normal sperm was considered the norm. Today, few men fall within the latest norm.” – Rozenek notes. Fortunately, they can improve their semen parameters in a very simple way.


“The decline in semen parameters is indeed huge. Semen standards according to the WHO, in terms of sperm density and concentration, are 15 million/1 ml ejaculate. Motility must be shown by more than 40% of the sperm, while the normal structure must be only 4% – this is the minimum that must be met, “explains Dr. Czerwinska. How to achieve this?


“It is enough to change underwear for looser ones or give up saunas. This is because frequent overheating of the reproductive organs can reduce sperm motility. Equally important is diet. It should include as few highly processed products as possible. We should also not forget about the factor of stress. Men are very prone to stressful situations, and this works badly for them. Giving up stimulants is also key. Statistics state that 4-5 glasses of alcohol per week already reduce fertility,” points out Dr. Czerwinska.


After diagnosis, it’s time for action!


Jadzia and Andrew have a comprehensive diagnosis behind them. Since they’ve been trying unsuccessfully to have a child for 10 years, a doctor from the Gyncentrum clinic – after carefully reviewing the test results – offered them the IVF procedure as their only chance to have offspring. The couple agreed immediately, knowing that this was their last chance: “I would love to have a child…Or maybe two, three, four… I’m even thinking so much about whether to buy some kind of bus. We could have a whole soccer team,” Andrew laughs.


Jadzia, on the other hand, despite being a Christian and going to church every Sunday, doesn’t think IVF is a bad thing at all. She says it’s their last chance and hopes it will work out in the end: “If it worked out, I would probably be the happiest in the world. Everything I went through, physically, mentally, financially, would be gone.”


In vitro step by step


Deciding to undergo IVF is only the beginning of a very long road. Its first step is hormonal stimulation. It involves taking and injecting hormonal drugs.


“The duration of hormonal stimulation varies greatly. It depends on the patient’s ovarian reserve, how she responds to the drugs and which stimulation protocol we chose for her. This is because there are different types of protocols. We can perform stimulation with a short, ultra-short, long or ultra-long protocol. Depending on which protocol we choose, the entire stimulation procedure can take from a few days to as long as three months. Ovarian stimulation is aimed at achieving so-called multiple ovulation, in which we achieve more than one egg cell. We end it by administering a drug that causes the ova to mature, and after 36 hours we perform an ovarian puncture, “says Dr. Dariusz Mercik – obstetrician and endocrinologist at the Gyncentrum infertility clinic.


Jadwiga’s stimulation lasted 13 days and was not an easy experience for her. Painful injections, lower abdominal pain, and on top of that, sudden and hard to stop crying attacks – this was her reality during the stimulation. After it comes the time for ovarian puncture. It is during this procedure that the doctor retrieves the egg cells obtained through stimulation. How does such an LP proceed?


“I perform the LP under ultrasound guidance. First, I insert an ultrasound head through the vagina with a special guidewire attached to it. Then I insert a needle through this guidewire, pierce through the vaginal walls and puncture the ovaries, after which the follicular fluid is drawn off one by one. After the puncture of the ovaries, the material goes directly to the embryology laboratory, where the embryologist ‘searches’ the fluid and, having found cells in it, prepares them for the IVF procedure.” – Dr. Mercik explains.


In vitro – or a miracle in glass


Thanks to in vitro, what normally happens in nature can be transferred to a laboratory slide. And so a couple that can’t get pregnant naturally, through in vitro fertilization, gets a chance at parenthood.


“In vitro historically means ‘in glass.’ Today we are a step further. We don’t bring about self-fertilization, but we force the sperm to surrender to us and then place it inside the egg. This method is called micromanipulation. Micromanipulators are like joysticks in a game. They manipulate very, very thin needles with which we first hold the reproductive cells, and then one is pushed into the other,” explains Dr. Wojciech Sierka – a clinical embryologist at the Gyncentrum infertility clinic.


The fertilized oocyte goes into an incubator, where it begins to divide until it reaches the blastocyst stage. The embryos created during the IVF procedure are either transferred to the uterus or frozen. In the second case, we speak of so-called cryopreservation. The embryo is placed in liquid nitrogen at a temperature of -196 degrees C. In such conditions it waits safely until it is transferred.


A chance that must be taken – the story of Marta and Mateusz


Marta and Mateusz live in Silesia. Their relationship was very dynamic from the beginning. They got engaged at a Chelsea match, after only a few months of knowing each other. They then got married and began trying for a child – unsuccessfully. “It was trial after trial, with nothing coming out of it. But we kept trying.” – Matthew recalls. Each time Martha’s period was late they hoped that this time it would work, but unfortunately only disappointment awaited them. They decided to get help from specialists and went to one of the infertility clinics. There, a series of tests awaited them, and they also started taking medication. And although these measures cost a lot of money, they did not bring results. They couldn’t bring because Marta and Matthew were misdiagnosed – “We wasted that year”. – emphasize both of them.


They changed the clinic, and there practically “on good day” they got referrals for genetic tests. No abnormalities were detected in Marta, while Matthew was found to have a translocation in three chromosomes. Such abnormalities do not interfere with everyday life, but they pose a problem when trying to conceive. If Matthew passed this defect on to his child, the child would not have a chance to develop properly. “With my affliction it is difficult to get pregnant naturally, it is even harder to carry such a pregnancy to term, and there is very little chance of giving birth to a healthy child,” says Matthew.


Fortunately, modern medicine can handle such complicated cases as well. Martha and Matthew were offered IVF. It was explained step by step how the whole procedure would work and what they themselves still had to do to properly prepare for it. “From that moment on, we felt we were in good hands”. – recalls Matthew.


Marta has already had both ovulation stimulation and ovarian puncture. Eight cells were taken from her, of which as many as six were mature. The embryos were, of course, tested to see if Matthew had passed on any abnormal chromosomes. Such tests (called preimplantation tests) greatly increase the chance that the pregnancy will be successful and the baby will be healthy. It turned out that as many as 3 out of 6 embryos have normal chromosomes.


“We felt tremendous joy…Since fertilization was successful, we have 3 embryos, now we just wait for a positive pregnancy test and the end of the subject. However, it turned out that it won’t be so simple…” – Marta recalls, crying. The first embryo given to Marta did not result in pregnancy. Doctors were unable to determine why the transfer failed. “The hardest thing was watching Marta and how she was experiencing it. After that, the most important thing for me was to make another appointment. I wanted to know if it was just coincidence, bad luck, and if there was still something more we could do,” – Matthew says. Eventually Marta and Matthew returned to the clinic, where the second embryo is to be administered. “At a certain point I did, I felt sorry for Marta, because she can become the mother, I can’t necessarily become the father. Of course, with medical help it is possible, but the chances are assessed as slim,” adds Matthew.


Embryo transfer is a very precise procedure, but not so invasive that the patient needs to be anesthetized for it. A speculum is inserted vaginally, followed by a two-part catheter, which is such a guide. The embryologist pulls the embryo into the flexible catheter and hands it to me. I insert it into the uterus and, under ultrasound guidance, look for the right spot where the endometrium is nicest and the embryo can be injected there. It’s a short, precise procedure, and depending on how it’s done, you may or may not achieve a high percentage of pregnancies,” explains Dr. Mercik.


About 10-12 days after the transfer, the lab performs a test of the beta hCG hormone level in the blood. Elevated means pregnancy.

Despite an unsuccessful start, Marta and Matthew are not giving up. They believe that at some time they will definitely succeed. “I believe that if there is a chance, you have to take advantage of it, because why not? We would like to try to have a child of our own, and I would love to be pregnant,” – Marta points out.


Julia and Robert – efforts crowned with success!


Julia and Robert tried to get pregnant for 1.5 years. And they succeeded! Julia is 13 weeks pregnant. The in vitro fertilization procedure was successful the first time, and the baby is developing normally. When the woman learned that the pregnancy test came back positive, she started crying. She did not know how to explain to her husband that what they had both been waiting so much for had happened. Robert, at first, didn’t know what it was all about and what the elevated beta hCG level meant,” they recall with amusement. The example of Julia and Robert proves that IVF, although tedious and expensive, has a chance to succeed!


IVF success the result of concerted efforts


Although IVF is an arduous procedure and does not always succeed the first time, it gives great hope to all infertile couples who wish to become parents. Of course, this would not be possible without the vast knowledge and experience of the specialists working at the infertility clinic, who every day with full commitment help infertile couples fulfill their biggest dream – the dream of parenthood.

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