Kim Goggins: The Advance

“First comes love, then comes marriage, then comes mom pushing a baby carriage.” It’s the stuff fairy tales and childhood rhymes are made of – boy and girl meet; fall in love; get married; have children. But real life isn’t as predictable as Disney would have you believe.

Barrie fertility clinic has helped hundreds of childless couples

About 14 per cent of infertility problems are unexplained, as in Michaels’ case. If you have not been able to conceive after a year of unprotected intercourse, Browning suggests you see your family physician who will conduct some preliminary tests before referring you to the fertility clinic. “(When you first see us), we come up with a game plan we think is best for you. Once you get started on the treatment program, we usually give it three tries (months) to see if we’re successful,” he explains.

“If you haven’t conceived after three times, we reconvene as a couple and doctor, and go over those cycles to make sure there was nothing we could have done better.

Couples may be able to nail down the love and commitment part, but 15 to 20 per cent are having difficulties conceiving. Ann Michaels (not her real name) first found herself in this position four years ago. She had always wanted children, but it wasn’t until she was 39 and married for the second time that she was ready.

Ironically, she and her husband decided to wait six months before attempting to get pregnant, but then couldn’t conceive after six months of trying. Although doctors prefer couples to have unprotected sex for one year before determining fertility trouble, Michaels was anxious to see if there was a problem.

She went to see her family physician who referred her to the Barrie Fertility Clinic. Now in its third year of operation inside RVH (although a separate entity from the hospital), the clinic is growing quickly.

Last year, doctors Andy Browning, John Bologna, Jan Moreau and Enrique Reyes, along with a nurse co-ordinator and three part-time nurses, treated 179 new couples. That’s an increase from 144 new couples during the first year.

“I think we are the largest fertility clinic towards the north,” says Browning. “There are certainly places that do some fertility work north of Barrie, but they don’t see the volumes we see. We do a good job (here) and, by word of mouth, I think we’re seeing more couples come from other areas, and some of these areas have (their own) fertility clinics.”

Michaels and her husband soon became one of these couples. Although they were living in Simcoe County when they were initially referred to the Barrie Fertility Clinic, they later moved to Oakville. Rather than attend a more convenient Toronto clinic for most of the treatments, Michaels says she continued to travel to Barrie, in large part, due to the emotional support she got from the medical staff – especially nurse co-ordinator, Ann Mitchinson.

“Ann has been wonderful because not only is she technically good at the things she needs to be – especially taking blood, because when you’re going through this and it stretches into years, your arms get really sore and she was absolutely fabulous– but also for the emotional support,” recalls Michaels. “Everything starts with Ann, and everybody there is great. It’s like they’re having the baby, too. They so want you to get pregnant.”

The couple’s journey was long and often frustrating. For three years, Michaels underwent a variety of unsuccessful ‘treatments’ from taking the fertility pill Clomiphene to stimulate her ovaries, to daily hormone injections for 24 weeks.

She also endured a number of costly and invasive procedures, including seven Intrauterine Inseminations (IUI), where her husband’s sperm was injected directly into her uterus using a fine catheter; three In-vitro Fertilization (IVF) procedures where ovulation was-

induced, her eggs were taken and united with her husband’s sperm in a petri dish and once fertilized, returned to her uterus; and three Intra-cytoplasmic Sperm Injections (ICSI), which is similar to In-vitro Fertilization, but an individual sperm is also injected into each mature egg obtained. None were successful.

As the couple contemplated a fourth IVF, they looked into the possibility of finding an egg donor to help them. It was a big decision, but the couple – who were also on an adoption waiting list – believed it was the direction they needed to go.

“We did it prior to (former Health Minister) Allan Rock’s moratorium on things. He asked that doctors not use egg donors, but there has been no legislation saying it’s illegal to do so,” explains Michaels, who likens the process to donating sperm or blood. By this point, a very determined Michaels had made getting pregnant her full-time job and first priority, so she had the time and opportunity to check out various Web sites devoted entirely to egg donors.

“For us, the money wasn’t the issue, but the whole (commercial) attitude was,” continues Michaels, who wanted the opportunity to interview a selection of women and ultimately choose the donor herself. They decided, instead, to place ads in a number of newspapers, asking for someone with a Christian heart and good attitude, who also shared some of the same physical attributes as the blonde, blue-eyed Michaels.

Nineteen responses were pared down to nine potential candidates and finally, after many e-mail exchanges, a woman was chosen. The Michaels’ lawyer drew up a contractual agreement and it was signed by both parties. Then the process began for the stranger, who would provide the ultimate joy to the couple. She was treated with fertility drugs and then had eggs retrieved for insemination by Michaels’ husband’s sperm in the laboratory. Two of the fertilized eggs were transferred to Michaels’ uterus. There was nothing more they could do, but pray.

“We have a strong belief that it’s in God’s hands,” she explains. “If it’s meant to be, it’s meant to be. Faith has a lot to do with it.” Two months ago, she gave birth to a healthy baby girl. “Life has done a complete turnaround,” she says. “Previously, I had a corporate life. I owned a company which I sold in 1997. I’ve lived all over the world and I’ve met all sorts of interesting people. It’s really been a fairy-tale life. But Sarah (not her real name) is just better than anything I’ve ever done and when she smiles at me, my heart just melts.”

Although Michaels insists the positive outcome very quickly made them forget everything they went through, their journey was not an easy one – nor was it inexpensive. In fact, at about $400 for each IUI (after OHIP), $1,000 per month for the high-tech fertility drugs (many private benefit plans will cover this cost) and about $6,000 for each IVF, not everyone can afford to explore all options. However, it’s important to note that treatment does not always have to be expensive. Many women who simply aren’t ovulating regularly can take low-tech fertility drugs, like Clomiphene, for about the cost of an antibiotic prescription and become pregnant.

“What makes a big difference is whether or not the couple has a drug plan that covers their medication, because there’s no doubt that if one has to use high-tech medication to try to get pregnant, then that’s by far more costly,” says Browning, who notes that after a year, even couples who do not have any obvious fertility problems only have about a three-per-cent chance of conceiving each month without assistance. The causes of infertility are varied and can include an abnormal sperm count of less than 20 million, blocked or nonfunctional fallopian tubes, Endometriosis or the most common, anovulation, where the woman does not produce eggs on a consistent basis.

Then we make a decision to either stop there or continue or perhaps move on to something more high tech.”

Although the closest fertility clinics that offer IVF – the highest of high-tech fertility procedures – is in Toronto, the Barrie Fertility Clinic will monitor the IVF cycles if the patient attends the START (Success Through Assisted Reproductive Technology) Program in Toronto. “Years ago, they would literally have to drive to Toronto every morning and have their blood work and ultrasounds done. Now, we have a relationship with a very busy, well-respected fertility clinic in Toronto and our patients have by far the vast majority of their treatment and monitoring done in Barrie and often only have to make two trips to the clinic in Toronto, as opposed to about 15 in a month,” says Browning.

Comparing success rates between Ontario clinics is not an exact science because some clinics may turn away women who will have a more difficult time conceiving because of their age or medical issues. But Browning assures that is not the case in Barrie, where they deal with any woman who wants to do something to improve her chances. Because many patients come from out of town for their fertility treatments– as far away as Thunder Bay, Owen Sound or Newmarket – it’s often not known if some of these women do in fact have babies. What Browning can say is that last year, they had 72 pregnancies out of 245 cycles (and conception wasn’t necessarily the goal for every cycle), making the pregnancy rate about 30 per cent. It’s the national average, but it still means many couples are frustrated in their quest to have children.

“I don’t think it is an easy process emotionally,” says Browning. “I think that number one, women who are not getting pregnant are at times as emotionally distraught about it all as women who have a severe illness. I think that makes it challenging for both the patient and the physician to deal with that type of emotional situation.”

The clinic tries to offset the stress by opening at 7:30 a.m., so blood work and ultrasounds can be done before most women have to be at work. The nursing staff has also been specially chosen to provide the support needed when couples are going through such emotional upheaval. “One thing that separates our clinic from some clinics is the quality of the nursing staff that we have,” says Browning. “I think that’s the key to the success and support that these women need.”