I usually arrive in Hari at 7.15am to meet Sharon and Sarah; we are the first nurses who start seeing patients from 7.30am. After setting up the two ultrasound machines and getting organised with paperwork, we see six women before 8am, when the rest of the crew arrives.
We have a small theatre where we do our egg collection, which involves retrieving the female egg from the ovaries (see panel). This is done under sedation by our anesthetist using an ultrasound scan with a needle attached. The doctor retrieves the eggs (oocytes), the nurse assists and the embryologist is handed the test tube with fluid; she checks it under the microscope and detects the egg, which is then put into an incubator while waiting for a sample of sperm.
Once a couple arrives to have their eggs retrieved, we instruct the male patient where and when he must produce his sample. Then, when we are all set up in theatre, we start on time and while the female patient is in there, the male produces the sample.
One nurse assists with the theatre procedure and another is with patients recovering after their procedure. This takes about 45 minutes and once they are fully awake and their observational signs are all normal, we give the couple a cup of tea and send them home.
Mid-morning we have a coffee, breakfast and a gossip before going back to do more scans. Sometimes when we do a pregnancy scan, it’s good news and we get a lovely heartbeat. I get goosebumps all over and feel so lucky to have the privilege of being part of helping couples to have a family.
Throughout the day the phone doesn’t stop ringing with couples anxious about various aspects of treatment. I also have to check emails and phone patients about referrals and arrange funding for two nurses to attend a conference abroad so I have to meet with our quality manager to ensure all the nurses’ training records are up to date.
Then it’s time to start intrauterine inseminations (IUI), in which we track the female’s ovulation cycle. By doing this we can tell when ovulation takes place and therefore we know when to inseminate the sperm and, hopefully, help the couple to become pregnant.
At noon, we start staggering lunch breaks and one of us will help the clinician to transfer embryos under ultrasound guidance so everyone can see the specific area in the womb where the embryo is placed. It is a wonderful experience and couples leave with hope and expectation.
This is the hardest part, as they must wait for 16 days before they can find out the outcome. If positive, we can do a scan and hear a heartbeat. If it’s negative, we ask the couple to come back for a review with our patient support team and clinician.
The rest of the day passes with more scans, transfers and meetings. During our multidisciplinary meeting, we discuss scans and blood test results with our doctor and embryologist. We cut doses where necessary, phone patients with various instructions, and schedule transfers and egg collections.
Each day is different and we scan patients, take blood and instruct women on how to administer follicle-stimulating hormone injections at home. The waiting room is busy every day and the scan room and theatre are usually in full operation.
One of our patients has a large polyp and she needs to stop treatment in order for it to be investigated. She is upset, but luckily our patient-support team is superb and takes full control of the situation. They are qualified counsellors who support all our patients. As nurses we work very closely with this department, as often we cannot give the time we would like to help and reassure our patients.
On Tuesday mornings, we have our weekly nurses’ meeting to discuss any issues arising and communicate with each other to ensure we are happy and that all problems are discussed and resolved.
We also have management meetings where managers from each department attend to discuss clinical, patient and staff issues. So far this year, we have a 50 per cent success rate.
We discuss how to improve our rates and service, and these meetings can get heated as people and departments differ. But it’s good that we can argue our own cases for and against and know that it is about work, so it is not personal; this is about Hari and making it a great clinic.
This week I also need to arrange for two nurses to go to the UK annual nursing conference which takes place in Manchester. It’s important that these meetings are well attended by highly experienced fertility nurses who are knowledgeable. The other girls won’t thank me when we are two nurses down on the roster, but I feel it’s important for us to have a good representation.
I have to give a lecture to public health nurses who are attached to Trinity College. They will be working in the community and, therefore, it’s important that these nurses are aware of what we do.
We also have a research meeting once a month. We rely on our research so we can base our policies, procedures and protocols on evidence-based medicine. We also compete nationally and internationally with other clinics and have three nurses doing the year-long UCD ultrasound course. It’s intense but important that our staff are highly qualified and trained appropriately, as fertility nursing is very specialised and training is extremely important. I enjoy the interaction of a multidisciplinary team.
The hardest part of the job is doing a pregnancy scan and finding out that the baby is not viable and seeing couples’ disappointment when their test proves negative. But the best part of my job, after 16 years here, is the hope we give to so many couples. And I feel privileged to scan patients who are pregnant and visualise the tiny flicker of the baby’s heartbeat.
Out of Hours
On my day off I sleep until 8am. I love sport: running, swimming, tennis and going to the gym.
I also enjoy going to dinner, having a few glasses of wine or going to the movies and spending time with my partner.
Some evenings after work I may go out to dinner with friends, head to the gym or to an exercise class or simply go home, watch “Fair City” and head off to bed feeling wrecked from the day.
But one evening last week I bumped into a patient with her beautiful baby. She was all excited and so very, very thankful. I went home feeling elated.
IVF – step by step
Fertility assessment
The first step is a meeting with doctors to discuss a couple's medical and fertility history. Both then have a fertility assessment that includes ultrasound, blood tests, sperm count and quality of eggs. Down regulation This is where the ovaries are suppressed.
Ovulation stimulation
Medication is used to induce ovarian follicle development and oocyte (egg) maturation. It also prepares the uterus for embryo implantation. Development will be monitored by ultrasound scanning until the follicle is ready for collection. This usually takes about two weeks.
Egg collection (oocyte retrieval)
The egg-collection procedure is conducted under anaesthesia, putting a needle with a suction device into an ovarian follicle. The IVF process After the eggs are collected, they are inseminated by sperm in a fluid medium in the lab, and are checked for signs of fertilisation within 24 hours.
Embryo transfer
Embryo transfer is normally carried out 48 hours after egg collection. A fine tube is passed through the cervix and the embryos are injected high into the uterus. A urine pregnancy test is carried out 15 days after the embryo transfer. If the test is positive, the monitoring continues until a foetal heartbeat is detected.
