While Alison Collins always knew she wanted to have children, she never expected to be weighing up her fertility options as a single woman in her early twenties.
Alison, from Tower, Cork, had an irregular menstrual cycle but it was only when a colleague suggested that it could be a symptom of polycystic ovary syndrome (PCOS) that she decided to get it checked out. A blood test revealed that she was overproducing prolactin and she was sent for further tests to ascertain if she had a benign tumour of the pituitary gland that produces the hormone.
There was no tumour, but her colleague was right: a gynecologist confirmed that she had polycystic ovary syndrome, and told her that it was unlikely that she'd be able to conceive naturally.
PCOS is a hormonal disorder that affects approximately 5pc to 10pc of women of reproductive age. Women with the disorder can have infrequent, absent or heavy menstrual periods, which leads to fertility issues; 'follicular cysts' on one or both ovaries and elevated levels of male sex hormones, which can cause excess hair growth, severe or cystic acne and balding.
Some PCOS sufferers have regular periods, and are therefore much more likely to conceive naturally, and some sufferers, like Alison, only show mild symptoms. "The only other symptom I had was a little facial hair on my lip," she explains, "but it was nothing major."
According to Dr Moya McMenamin, consultant in reproductive medicine at Waterstone Clinic, about 20pc of women will have the appearance of a polycystic ovary on the scan, but not all of those women will have the symptoms of polycystic ovary syndrome.
"So quite a number of women can go through life and not even know that they have polycystic ovaries," she explains.
She adds that the term 'polycystic ovary' is a misnomer of sorts. "This is actually a poor term because it gives the connotation that there are cysts in the ovaries when there are not. There are follicles, which are normal, fluid-filled spaces where the eggs come from."
Some women only discover that they have PCOS when they try to get pregnant. Alison, on the other hand, was aware that getting pregnant was going to be a problem. So when she met Ron, at the age of 27, she knew the conversation would eventually have to be broached.
"Very early on I did have to sit down and explain to him that there may be no babies and he said, 'Look, Alison, I'm happy if it's just the two of us'."
Two years later, the couple began trying for a baby, even though they knew their chances of conceiving naturally were slim. After months of trying unsuccessfully, they went back to Alison's GP, who referred her to an endocrinologist.
A few weeks later she was prescribed Metformin, a drug that stimulates ovulation in women with PCOS. "It can be hugely successful for some people with PCOS, but it was definitely not for me," says Alison. "I just got really overweight and my face was deformed-looking. Some people lose weight while taking it but I was just really bloated."
It was at this point that she was referred to the Waterstone Clinic, an IVF and fertility clinic in Cork, but as Alison and Ron were now engaged, they decided to take a few months out to focus on their wedding first.
"I went on a real health kick before the wedding," explains Alison. "I was always a size 8/10 up to my twenties but the endocrinologist told me that I'd gain about half a stone a year with PCOS. It wasn't that I was massively overweight but I gained weight very easily.
"And it was always on my stomach. There was always that pot belly and I felt people were looking at me thinking, 'Is she pregnant or isn't she?' I also gained a lot of weight after taking the Metformin."
Weight gain is one of the most common PCOS symptoms. Dr McMenamin points out that approximately 40pc to 50pc of women with PCOS will be overweight or obese, which is why they always encourage the patient to implement some lifestyle changes, mainly around weight management.
"A lot of international studies have documented very clearly that even a quite modest reduction in weight in these women can help them start to ovulate more regularly and get more frequent periods," she says.
"And it has been estimated that a 10pc weight loss from base line weight can result in approximately 50pc of women [with PCOS] achieving pregnancy naturally without fertility treatment."
Alison's health kick involved spinning, weight-lifting and kickboxing, combined with a high-protein/low carbohydrate diet.
On her wedding day, in November 2012, she was a "healthy size 8". The following January, at her first Waterstone Clinic appointment, she was fighting fit for the emotionally and physically strenuous journey ahead.
"I couldn't wait to get to the clinic," she continues, "but at my first appointment with Dr Waterstone, he put me on Clomid, which stimulates the follicle.
"I thought, 'Clomid! That just makes you crazy and fat!' I remember bursting into tears. I thought I was going to walk in and he was going to hand me a baby!"
When the Clomid wasn't successful, they tried intrauterine insemination (IUI), and when that didn't work, they decided that it was time to try in vitro fertilisation (IVF).
"During the first round of IVF, I over-stimulated and during the second round, I under-stimulated. It's a really slow, drawn-out process with two months in between each round," explains Alison.
Finally, on the third round, they collected 16 eggs: 11 matured; seven fertilised and they had two eggs to freeze on day five, and one to freeze on day six.
Everything was finally going smoothly, until Alison developed ovarian hyperstimulation syndrome (OHSS). "I had shortness of breath and it caused me to rapidly gain weight within days," she says. "They cancelled the transfer as it was far too dangerous."
OHSS, explains Dr McMenamin, is a well-recognised risk factor when women with PCOS have IVF treatment - "particularly young, slim women" - and they had prepared for this possibility by giving Alison injections to prevent blood clots.
"They watched me like a hawk," adds Alison, "but luckily I got three embryos to freeze and then I took six months off. I needed to take a break from the drugs."
Six months later, they performed a frozen transfer and, in November 2015, Casey was born, happy and healthy - some six years after the couple first started trying for a baby.
Alison is now 37, while Casey is two. "I'm very happy with my lot and if I just had Casey I would be happy with that," she says, "but I would have loved to have had children younger in life.
"I think a lot of women think they'll be able to go off and get IVF and have a baby, but polycystic ovaries are a different ball game."
The cost is another consideration, she adds. "I don't know how much it cost us altogether," she says. "I would probably shock myself. I keep saying about €10,000 but I think it was definitely more than that."
Dr McMenamin's advice to women who have the symptoms of polycystic ovary syndrome is to get advice from a GP or fertility specialist, sooner rather than later.
Alison agrees: "I knew at the age of 29 that I needed to start [trying for a baby] but what if I had waited until I was married at 32? How many years would have been lost?"
Health & Living