Molly Whale is a third year medical student who recently spent some time in a fertility clinic as part of a student selected component. Molly reflects on what she found.
I’ve always been absolutely fascinated by people and how they respond to circumstance, particularly in the face of adversity. Some might say I’m nosy, but I like to call it observant. My Mum says that I chose to do medicine because it was the only career where I could discover all the tiny details of an individual’s life for a legitimate reason.
Interestingly, the more time I’ve spent as a medical student on various placements, the more I’ve realised it’s possibly one of my most valuable skills. I’ve never been the medical student who can tell you reams and reams about a particular condition, come out top in my exams, or recite hundreds of medications and their doses. However, I am utterly passionate about being the best caregiver I can be for a patient, looking after their mind as well as their body. I think this is what I find to be my pull towards fertility, a branch of medicine that can be at times so heart wrenchingly difficult, but also so wonderfully fulfilling and hopeful.
It made me realise the importance of normalising conversation surrounding fertility and how this could present great benefit to others in their hopes to fall pregnant.
When I first came to the fertility centre, I had never spent any time in the field before, so I was relatively naïve as to what to expect. There were many preconceptions about fertility that I had fed into. Therefore, as a young woman, with very little exposure to the difficulties surrounding getting pregnant, there were things that I found surprising. Namely, how common it was for couples or individuals to struggle to fall pregnant, as well as the frequency of miscarriage. I was aware that it was something that people at times find hard to openly discuss, but when I read a bit more into it and realised the frequency of such events, I realised it was perhaps a struggle that people more often keep hidden. It made me realise the importance of normalising conversation surrounding fertility and how this could present great benefit to others in their hopes to fall pregnant.
- Around 1 in 7 couples may have difficulty conceiving.1
- In those who are aware of their pregnancy, around 1 in 8 will end in miscarriage. Many more miscarriages happen before people realise that they are pregnant.2
One of the biggest privileges of being a medical student is being able to sit in consultations, listening to patients and learn about their stories or journeys. The power of sitting, listening, and looking cannot be underestimated – it is one of the best ways for me to learn and I’m always so grateful to play witness. Something that can be different in the world of fertility in comparison to other areas of medicine, and particularly in the time of COVID-19, is how partners are encouraged to attend most appointments together. This obviously makes a lot of sense; typically, it takes two to tango when it comes to falling pregnant. It struck me as being so important to maintain that sense of unity in partnership throughout the process. This is not just for the procedural bits and the ‘what goes where’, but also the support and togetherness that is required to make the pretty immense decisions about how life is going to be in the future.
Alongside couples, you also get individuals who are empowered to start a family without a partner, as well as same sex couples who require fertility support. For these people there are the options of using sperm and egg donors. We’re so fortunate that these days there are routes for people to go down and options to explore, and the result of these treatments can be amazing for those who are struggling to conceive. However, the treatments can be strikingly gruelling (particularly for the individual who plans to fall pregnant) and require enormous amounts of resilience at times.
- Medicines – different medicines have different actions. Many revolve around stimulating regular ovulation.
- Surgery – again is dependent on the problem. Surgery may be used to repair structures, remove blockages, or retrieve sperm.
- Assisted conception – refers to intrauterine insemination (IUI) and in vitro fertilisation (IVF)
For those who go down the route of assisted conception, there are many appointments to attend, and individuals are sometimes required to persevere through multiple rounds of treatment.
The appointments too, can involve discussing intimate and personal topics, from things like how often the individual is having sex, to their weight, and whether they’ve had any sexually transmitted infections in the past. The way that these subjects are approached have a huge impact on how comfortable people are. I realised how important it is for there to be that sense of trust and safety between the patient and the doctor or nurses, because it’s vital that these things can be discussed without any sense of judgement, to have the best chance of a positive outcome. Difficult discussions also need to be had in terms of whether people are eligible for NHS funding when it comes to assisted conception. This is something that is limited by the constraints of the money that the NHS has, and what they can afford to spend. I understand this, but it is still hard for me to fully accept that money should be a determining factor in allowing someone the chance to conceive and start a family.
Treatments can be strikingly gruelling (particularly for the individual who plans to fall pregnant) and require enormous amounts of resilience at times.
- Women under 40 who have not conceived after 2 years of unprotected sex or after 12 cycles artificial insemination (6 of which should be IUI), should receive 3 full cycles of IVF
- Women aged 40-42 who have not conceived after 2 years of unprotected sex or after 12 cycles artificial insemination (6 of which should be IUI), should receive 1 full cycles of IVF. Provided they have never had IVF before, there is good ovarian reserve, and they have been informed of the potential implications of pregnancy at this age.
- You and your partner have no children already (including from previous relationships)
- Healthy BMI
- Within a certain age range
An unexpected finding from my time in fertility, and one that I felt was important to share, was quite how emotive I found it. Good and bad. Out of all the specialties I have spent time in, it was the one where I found myself having to take a deep breath and stop my mind from wandering back to that one couple who just… It seems trivial to be saying this when I’m not the one who is personally going through it, but really it just showed me the importance of tapping into what will best help those individuals. There are a vast array of feelings and emotions that swim alongside treatment, and it is paramount that as professionals we ensure patients feel supported. There should be no passing of blame, only enabling of the best choice and evidence-based guidance. On the flip side, there is such joy and relief surrounding successful outcomes and as cheesy as it sounds, I can see how these moments really do make the process, and the job, worthwhile.
Despite how doom and gloom I may have made things sound, the beauty of fertility treatment is that it can have the most delightful, life-changing, outcomes. I watched in action, one of the kindest and caring teams of doctors, nurses, receptionists, andrologists, embryologists, health care assistants (the list is endless) that I’ve come across; a team who genuinely want to see their patients achieve the best possible result. And throughout the various appointments and consultations that I was privy to, where the most difficult of things might have been discussed or done, almost no one left without at least a small smile on their face and an action plan.