Of all the ways I imagined spending my 37th birthday, crying in the rain outside a London hospital was not one of them. But there was a good reason. I’d just found out that my second round of IVF, and final chance of NHS-funded treatment, appeared most likely to have failed. The fertilised embryo that had been implanted into my uterus two weeks previously had vanished from my scans.
It ‘failed to implant’, the doctor explained.
Several months of daily hormone injections into my abdomen, weekly internal scans, and minor procedures under sedation – not to mention the emotional tidal waves this all induced – had proved fruitless.
I stood, alone, outside the doors of the hospital, the lashing rain drenching my skin, and thought: ‘This is never going to happen.’
‘My perfect, miniature human’: Emma Woolf, 41, with new-born son Ludovic after his birth last Monday. He was conceived after three rounds of IVF
The worst part? The underlying sense that perhaps I was, to some extent, to blame.
If it hadn’t been for a decade of anorexia – during which time I fuelled my body on nothing but apples, broccoli and low-fat yogurt – it’s likely my partner and I would have conceived naturally.
The condition, which I developed aged 19, increases the risk of infertility four-fold, and dramatically raises the chance of miscarriage as poor nutrition plays havoc with the body.
I knew all this when I started trying to get pregnant eight years ago, aged 33, but naively thought that, somehow, we’d be all right.
What followed was nearly a decade of disappointment, including multiple fertility investigations, scans and treatment, costing in the region of £10,000.
In last weekend’s Mail on Sunday, I, along with a host of experts, warned about the repercussions of fad dieting on fertility, not to mention long-term health. But anorexia is a mental illness, not just a fashionable diet. And while stopping a fad diet can resolve potential fertility problems relatively quickly, eating disorders are a harder nut to crack.
The restrictive eating patterns are driven by a cruel, punishing mindset, telling you nothing you do, or achieve, is ever quite good enough.
Despite regaining weight by my mid-30s, natural conception still wasn’t possible.
Starvation had done its damage to my reproductive system. And when two rounds of IVF couldn’t help either, I began to believe my dream of having a family was over.
Yet, eight years after we started trying here I am, at 41, sitting with my son, just six days old, sleeping in the cot beside me.
My third round of IVF worked – and I still can’t quite believe it. I can genuinely say that anorexia has never felt so far away. But I’m aware of how acutely lucky I am.
Persevering, when all the odds are against you, is no easy task.
Hoping for a miracle: Emma as she was at the beginning of her eight-year IVF journey in 2012. Despite regaining weight by her mid-30s, natural conception still wasn’t possible
And, at times, eight years ago I wish I had known the simple – yet vital – bits of information I learned along the way.
In fact, I wish doctors had warned me of the long-term effect of ultra-thinness way back in my 20s.
If I’d had these insights, perhaps my path to motherhood needn’t have been so long, or as painful.
Yet despite the many healthcare professionals I came into contact with during my illness, no one explained it all in the detail I really needed.
Roughly half of all pregnancies worldwide between 2015 and 2019 were unintended, according to a new report in The Lancet.
A certain amount of body fat and fuel to the brain are needed to release the sex hormones that activate the reproductive system – including periods. And I didn’t have a single period throughout my 20s.
I’m an extreme example, but many women find their menstrual cycles stop, or pause, when they’ve lost a few pounds through a new exercise regime.
It is a red flag not to be ignored. It wasn’t until I first had problems conceiving that I learned this through my own research.
‘If you’re not having periods, it is unlikely that you are ovulating and that your body is releasing an egg for fertilisation every month,’ explains Dr Michael Dooley, a consultant gynaecologist at The Poundbury Clinic in London.
My periods returned, albeit irregularly, three years later – thanks to a new relationship that provided the support I needed to reach a healthy weight.
But after nearly a year of trying, there was still no pregnancy and it was then that I decided to ask for a referral to fertility specialists for investigations.
Gynaecologists at the Reproductive Medicine Centre at London’s University College Hospital monitored my hormone levels over the course of a month, via blood tests. Irregularities were spotted – and these, they said, caused my lack of periods, and scant ovulation.
By the time this was flagged, I was approaching 36.
In most areas, women under 40 are entitled to three goes at IVF, on the NHS. But it is a postcode lottery, writes Emma Woolf (file photo of IVF in a labaratory)
Between the ages of 30 and 40, the chances of IVF resulting in a successful birth drops from a third to just 20 per cent. The risk of miscarriage doubles, according to studies. I kicked myself for not having investigated my periods, or lack of them, ten years ago.
In fact, irregular periods can be a warning sign of a host of other problems, including polycystic ovary syndrome and thyroid disease. These can make it harder, if not impossible, to get pregnant, if untreated for long enough. But if spotted early, there are steps you can take to preserve your chances of motherhood.
Roughly a year after my first fertility appointment, I found myself sitting on the edge of the bath with my partner, staring at a plastic stick, willing another straight line to appear.
My first round of IVF hadn’t worked – only a single line showed: I wasn’t pregnant. I felt an immediate, intense sense of failure.
Diet warning: Our report last week, featuring Emma Woolf’s advice
Women are designed to conceive so why couldn’t I manage it, even with medical intervention?
To make matters worse, the side effects of hormone treatment cruelly mimic pregnancy.
I already needed to run to the toilet all the time, couldn’t sleep and had sore breasts. The only thing missing was the baby.
With hindsight, my expectations shouldn’t have been so high. What I didn’t know then, but do now, is that only roughly a quarter of couples conceive after the first round.
If you have three cycles, as I ultimately did, the success rate jumps to between 45 and 53 per cent. In most areas, women under 40 are entitled to three goes at IVF, on the NHS. By the third go, your doctors are well-versed in your hormone cycles, so know exactly when to deliver which drug, and with what exact dosage.
But it is a postcode lottery, and I live under a health authority that only offers two cycles of treatment. I was lucky enough to have a pot of savings that would fund a third round, at the same clinic I was already being treated at (many do both NHS and private work).
Many women don’t know this is possible – but you can find out if a consultant or clinic does this, simply by asking them.
During my first two IVF attempts, I put myself pretty much on bed rest, afraid to move, and the final – successful time – I did almost none of these things, writes Emma (file photo)
If you’re looking for a fertility expert who is also versed in treating women in recovery from eating disorders, there’s the Facebook group No Period Now What, run by biologist Nicola Rinaldi, in which users share recommendation and resources.
Ask any woman undergoing IVF what the most excruciating element is, and she’ll answer: ‘The two-week wait.’
It takes two weeks after fertilised eggs have been implanted before you know for sure if you’re pregnant or not – and if the past four to six months of medical treatment has been worth it.
Q&A: Can I see my mum in her care home now, and are pools safe?
Q I want to visit my mum in her care home – do I need to take any special precautions?
A At long last, thousands of care home residents are set to be reunited with relatives, after the Government gave the green light for visits to begin again.
However, this does not mean a complete return to normality.
It will ultimately be down to local health bosses to decide if and how visits can take place, and you will need to check with the care home before visiting on any measures they have put in place. Many homes will have an appointment booking system, to ensure numbers are kept to a minimum.
New official guidance states families should nominate a ‘single constant visitor’ per resident in order to limit the risk of infection spreading and keep footfall down.
This means that the same person should visit the care home resident every time, if possible.
The visits may need to take place in a communal garden or outdoor area – where the chances of transmitting the virus are lower.
Visitors will be encouraged to wear face coverings, to wash their hands regularly and maintain social-distancing, keeping at least one metre away from others not in their household. Hugs and handshakes should be avoided.
If you want to bring a gift, check with the care home first. It’s likely that it will need to be something which is easy to sanitise – such as a box of chocolates – instead of a bunch of flowers.
Q Can you catch Covid in a swimming pool?
A Evidence suggests that chlorine in swimming pools will kill off any coronavirus that makes its way into the water. In fact, according to The Pool Water Treatment Advisory Group, chlorine in a well-maintained pool should ‘deactivate the virus within 15-30 seconds’.
If someone splutters while swimming past you, it is possible that you could be exposed to the virus. But facilities should have measures in place to stop this from happening – including limits on the number of people allowed in the pool at one time and widened lanes.
Avoid changing rooms if you can – arrive dressed for your swim and shower at home afterwards – as we know that the virus spreads more easily in enclosed indoor spaces like this.
Each time, I had to put life on hold, unable to concentrate on work. I’d return to the hospital every other day for internal scans that would instantly update me as to which eggs were further along than others. And although the doctors tell you what’s happening, and there’s nothing you can do to change the outcome, you can’t help but try.
For the first two rounds, I refused to go anywhere near a hot bath, or swim for fear that, somehow, the embryos would be flushed out of my body. Of course, this just isn’t possible. I took all the supplements under the sun, every morning and evening, and forked out for alternative therapies such as acupuncture – which some claimed could help me relax, apparently improving the chances of pregnancy.
During my first two IVF attempts, I put myself pretty much on bed rest, afraid to move, and the final – successful time – I did almost none of these things, relying on a few minutes of mindfulness meditation in the morning, and a few daily vitamins.
I continued to travel up and down the country for work – and even flew between Europe and Belfast every week for a number of months.
I could get on with my life, and the wait really did feel like two weeks, rather than two years. And now, nine months later, I sit propped up in bed, having just nursed my son.
Breastfeeding is another revelation, given that for most of my life, I’ve never had a cleavage. But despite what you might think about eating-disorder sufferers, my novel motherly curves have proved anything but anxiety-provoking. I did worry that they might be at first.
After all, most women feel unsettled by bodily changes beyond their control, not to mention the pressure, mostly from gossip magazines, to ‘snap back’ to your pre-natal self within weeks.
But I’ve loved digging out the girly, pretty dresses I never used to be able to wear and filling them.
Gaining weight for a baby feels nothing like going up a few stone during eating disorder recovery or even putting on a few extra pounds at Christmas. My own neuroses and habits have gone out of the window. Since the day I found out this was going to happen, my sole focus has been keeping those embryos, and now my baby, healthy.
For the first time in my life, I have a reason to look after myself.
So far from worrying about gaining weight, I’ve been panicked about losing it.
I’d bombard the doctors with questions about whether I was too thin.
And when I finally got pregnant I would ask about eating enough to feed the baby.
But my worries were always unfounded. Firstly, my baby has been larger than average from day one – born weighing a healthy 6 lb 15oz and, secondly, the doctors were always satisfied that I was a healthy weight.
I am not saying that pregnancy is a cure for body hang-ups or disordered eating, by any stretch.
Who knows if that self-loathing voice, buried deep within my mind, will resurface once faced with the challenges of motherhood. Will I turn to old, restrictive habits when I feel helpless and out of control?
The truth is, I don’t know. But what I do know is that I’ve been gifted, without sounding corny, what feels like a real miracle.
And today, having just breastfed my perfect baby son, whom I’ve named Ludovic Cecil, after my late father, I know I couldn’t care less about my ‘post-baby body’.
This body gave me a child – and what could be more beautiful than that?