How many holes? 
​Waking up drowsy, feeling the blood pressure cuff on my arm, oxygen mask on my face, oxygen saturation recorder on my index finger, hearing the alarm for my heart rate going off beside me, the only question I had on my mind was “How many holes do I have in my stomach?”.

When I finally got to ask my caring wonderful nurse she replied “4 my love, you have endometriosis” My heart sank, I tried so hard not to cry. 

Just hours earlier my fertility specialist had said to me “if you wake up with 2 holes in your abdomen you’re good, 3 or 4 holes and you have endometriosis”. I immediately wondered where the endometriosis was, how extensive and what this meant for my egg freezing process. Knowing my recovery was going to be slower and longer with more time off time than initially expected. 
​
Laparoscopy is the gold standard for diagnosing and removing endometriosis. At this moment I was glad I opted to have the surgery and find out. Knowledge is power and I’m glad it was removed before it could get any worse and potentially affect my fertility. 

During my recovery I had lots of time to research endometriosis and there really isn’t much information about who is at risk, how it occurs, how to prevent it or even how to treat it. 
Studies suggest 1 in 10 women of reproductive age are affected with endometriosis. Women also present very differently with it, some don’t even know they have it. Some of the possible causes I found were long heavy periods, family history or low body weight.  Some of the symptoms can be pain with menstruation, spotting prior to your menstruation, or bladder and bowel problems. There is no real proven link of lifestyle factors causing endometriosis. It was all so confusing with no real answers except for try and be as healthy as possible.

At my post-op appointment my fertility specialist looked me in the eye and said “did you have pain?” well I did, but I wouldn’t have said it was a huge amount of pain, it definitely had gotten worse over the past 15 months and I’d had irregular bleeding all of which prompted me to seek help in the first place. He let out a big sigh and said  “women just accept pain when they shouldn’t and most of the doctors who told them to over the years were men who don’t have it, it’s not physiologically advantageous for a woman to be in pain every month”. Huh, so all these years doctors having been telling us it’s normal to have pain when really, biologically, it’s not. Interesting.

I held my breath while he told me where my endometriosis was, it was on my bladder, the ligament holding my uterus and a little on my uterus. I let out a big sigh thankful my fallopian tubes and ovaries were ok. That was my biggest concern! 

One of the conversations I had with the fertility specialist previously was about women with endometriosis often having to freeze embryo’s rather than eggs if their ovaries had been affected. I had been having conversations around the complications of freezing embryos with many many questions arising.  How to select the sperm while i’m single, how to ask someone and who? How to even come to a conclusion about who? How to select an anonymous donor? During covid where I might be restricted to QLD only? Can I even ask someone I know rather than a stranger? Will I know their medical history? Or just physical appearance? What sort of contract would need to be discussed, what sort of role would I want them to play in any future child’s life? How would my future partner feel if he had to use someone’s else’s sperm if we couldn’t conceiving naturally? Who would be ok with that? As you could imagine my head had been spinning with these questions.

Thankfully my AMH levels were 10.7 – slightly lower than he likes to do an egg freeze cycle (11-30) however, he thinks I can still try to freeze egg’s rather than embryo’s. To which I let out another big breath.

The information that followed from the IVF clinic for my fertility preservation journey was overwhelming. The hormones, the appointments, the schedule, the blood test, ultrasounds OMG! Have I done the right thing?

Conversations of a single woman in her 30’s….
 
When asked by my gynaecologist “Do you want to have children”, my response was simple;
“Yes, at some point in the future.”

​She turned her chair towards me and gave me the look, the motherly empathy with a hint of authority and some stern advice.
“See the fertility specialist about egg freezing NOW. A 37 year old egg is better than a 40 year old egg.”

She went on to describe her situation where she was rushing to have her eggs frozen 2 weeks before her 40th birthday so she could snag her last 39 year old eggs. 

I was laughing because I could so see myself doing this. But then I had time to process and think it all through. And boy did the questions and frustrations come out. How does that even work? How much will it cost? Do I need time off work? Am I going to be crazy if I’m on hormones? Why is this even happening to me?
Why can’t I have just met someone when I was 25 and be married with kids by 30 like my perfect plan?

These are the questions or debates for women over 35 who are aware of what’s going on. For the ones who aren’t aware of their female anatomy and egg quality it might be too late. 

Stage 1 – Anger
I went through stages – firstly there was anger. Anger that I had to even think about this as an option. Questioning why it just seems to work for some people and not for others. 
Knowing that despite having lived my amazing life, the circumstances now meant I was 37 single and childless. I called a friend and was so mad and upset asking her why I couldn’t just have a penis and do whatever I wanted. To not have to think about it. What followed was many conversations with friends and a lot of research. 

Stage 2 – Girl Power
After I calmed down a little, I remembered being a woman is fabulous! Yes we go through a lot in our lifetime but what our bodies are capable of is just so awe inspiring and miraculous. I should never speak badly of my body as it works tirelessly for me every day. The miracle of being able to have a healthy baby is in itself a wonder. 

When you are born you have approx. 1-2 million eggs, by the time you are at puberty you have 400,000 remaining. Over the span of your reproductive years only 300-400 will be ovulated. Of which one egg will be developed and released from your ovaries during your menstrual cycle. ONE! Mind blowing.

Stage 3 – Getting informed
I went to see the fertility specialist about egg freezing, he calls fertility preservation. 
Which I kinda like the sound of better. He gave me all the options, 
1. Do nothing (could have very easily stopped here)
2. Test my AMH levels and decide if I go further
3. Check for endometriosis through a laparoscopy and/or go ahead with fertility preservation. 

The egg time test ie a blood test of your AMH (anti-mullerian hormone) levels which is an indicator of your ovarian reserve level AKA how many egg’s you have left.  If the levels are ok from a quantity point of view, the fertility specialist likes to do a laparoscopy surgery to check for endometriosis (it can potentially reduce the quality of the eggs) and remove if needed. Following this the fertility specialist can see where your endometriosis is and if it has potentially affected the quality of your eggs and therefore your ability to freeze eggs. If it has then you have the option of freezing embryo’s. This is where you have the sperm and egg combined prior to freezing. 

At this point I was just getting all the information. And WOW was this a lot of info. I had many questions, especially this one:

“Would I be ok if I didn’t have children at some point in my life.” 

I asked a few women in my life who haven’t had children to get their opinion on how they felt either not having had children or not being able to have them. Was there regret? 

Not one of them regretted it but all said how amazing this technology was to give options for women. Options that weren’t around in their time. 

I’m a thinker, so I thought a lot and I tried to think of this from every angle. My brain telling me it’s logical, the smart thing to do, it buys me time to meet a man without the pressure of having kids straight away. Feeling from my heart knowing that I’m not ready to give up on being a mum, and knowing that I’m not ready to rule out becoming a mother on my own. Knowing that I need more time. The biggest contemplation at the end of it all is why wouldn’t I do it? The technology is there, money shouldn’t even be a factor in the insurance of being able to have a child, and it puts my mind at ease knowing I have more time. 

Make the choice yourself, it has to be yours, you have to own it. 

I decided knowledge is power. So, I have decided to go through with fertility preservation aka “my insurance policy”. Whether I use it or not, I know they are there. 

Starting with the AMH blood test and the laparoscopy to see what’s going on. 

Do I regret any of the decisions that have led me to this point in my life? Absolutely not! I have loved and lived and travelled and explored and thoroughly enjoyed my life. But when I’m ready to become a mum I know I have a back-up plan if needed. 

But hmmm having to potentially select a sperm donor if I have to freeze embryo’s, well that’s a whole other ball game………

To be continued.

What does your bladder do? How does it relate to your pelvic floor muscles? What happens with pelvic floor weakness? 
Such great questions and very common ones. Let’s start with your bladder….  

Your bladder if under the age of 70 should store 350ml to 500ml of urine and will send a stretch message to your brain when your bladder is full. 

The bladder is a muscular pump sitting behind your pubic bone and shaped a little like a water balloon. Your kidneys feed urine into your bladder and your bladder empties out via a tube called your urethra. Your urethra has a sphincter on the end of it which is a little like a clamp. The bladder muscles itself is called the detrusor muscle.

Once your brain gets the message that your bladder is full, your pelvic floor muscles and your urethral sphincter (clamp) relax, then it’s your bladder’s job as a muscle (detrusor) to pump out the urine by contracting.
Your pelvic floor then contracts and the outlet is closed (meaning no urine escapes out), allowing your  bladder to relax and refill as you go about your day. 

So basically it’s your pelvic floor muscles that tell your bladder when to pump and when to relax. 

So what happens with pelvic floor weakness or if your pelvic floor muscles have lost some of their strength?
Your pelvic floor might lose control over the bladder and it may start contracting whenever it wants, known as “urgency” or some leakage may start to occur. Particularly with movements that are high intensity like jumping or a high intra-abdominal pressure like coughing and sneezing etc.  

Essentially you want to have a strong pelvic floor to be able to contract your muscles but also know how to relax them to allow the normal bodily functions to occur. That’s where we have our endurance based exercises as part of our PPF programs and our control section of the exercises. To allow you to build your awareness and strength in both turning on and turning off your pelvic floor muscles.  Learn More

Blader hints:

• Never strain to empty your bladder or push on your stomach, just relax your pelvic floor and your abdominals allowing your urine to flow out easily.
• Sit on the toilet, with your feet just under you, on your toes allowing your body to learn forward slightly. This position helps with both bladder and bowel movements adjusting to the position of gravity. 
• Drink enough water to stay hydrated, .033 X your body weight for a rough estimate in litres/day and more if you are exercising or breastfeeding.
• Caffeine can be an irritant to your bladder – minimise the amount you have per day (that includes caffeinated tea)
• Alcohol is a diuretic, a bladder irritant and a muscle relaxant which will make frequency or urgency issues worse. Reduce or avoid if possible. 
• Stop doing the “just in case visits” to the bathroom, only go when you get the sensation your bladder is full. 
• Only encourage your daughters to urinate when they need to.

References
Womens’ Waterworks by Dr Pauline Chiarelli 
Pelvic Floor Essentials by Sue Croft