Meet Monique Cormack, WHEN’s Fertility, IVF & Pregnancy Nutritionist. When Monique first began her fertility journey, she was conscious that she would likely struggle to conceive. But she believed that with the assistance of fertility treatment, she would fall pregnant in no time. “I eventually went through IVF and thought I’d retrieve a tonne of eggs and freeze lots of embryos… how wrong I was.”
Although her journey wasn’t straightforward, the obstacles she faced along the way are what inspired Monique to utilise her skill set and support others through fertility, IVF, and pregnancy with expert nutrition. “ I want people to be in their best health and empowered with a better understanding of fertility.” After taking proactive steps to improve her fertility, Monique’s journey resulted in two successful pregnancies.
Learn more about Monique’s experience, from fertility treatment misunderstandings to how to give yourself physical and mental support.
When did you start thinking about your fertility?
“I started thinking about my fertility in my late 20s, just around the time I was getting married. I’d struggled with an anxiety disorder and an eating disorder in my early 20s and had issues with my menstrual cycle ever since then. This made me hyper-aware of my fertility, so I started thinking about it well before I wanted to fall pregnant. I feared that it would be tough for me to conceive, but I wasn’t sure at the time what I could do about it or how I could assess my fertility at all.”
What were your expectations before beginning your fertility journey?
“By the time I took action, I’d been conscious of my likely fertility issues for some time. I was very eager to do something, do anything, to have a baby. I think, rather naively, that I expected that I would conceive very easily as soon as I started fertility treatment. I had no awareness of all the complications that could occur.”
Medical Note: It’s a common misconception that fertility treatment is a guaranteed solution that will result in pregnancy. For some women, the fertility treatment pathway can be a long road and, even though for many women it is successful, not all patients will achieve a pregnancy using their own eggs and sperm.
What did your fertility journey look like?
“In 2014, I was preparing to get married, aware of problems with my menstrual cycle (hello, not ovulating ever), and starting to worry about future fertility but decided to try to ‘forget it’ until after the wedding.
Between 2014 and 2016, I was quietly panicking but not sure how to take action. I eventually saw a doctor and began some initial investigations to assess my fertility, which suggested that I had hypothalamic amenorrhea. The doctor didn’t share any details about my ovarian reserve or any other results with me, so I was in the dark with no idea about my future fertility. To be honest, this was a tough time in my relationship as we were living overseas, trying to soak up the world and travel, and I was so caught up with my fertility and crying every time one of my friends announced a pregnancy. I feel like I missed out on much of the joy I could have experienced.
Medical Note: Hypothalamic amenorrhoea is a condition that occurs when the hypothalamus (a small structure in the brain) stops releasing gonadotropin releasing hormone (GnRH). This hormone signals to another structure in the brain, called the pituitary, to release follicle stimulating hormone (FSH). FSH stimulates a follicle on the ovary to grow and then release an egg. If the brain isn’t releasing GnRH, no FSH will be released, no follicles on the ovary will grow and the woman will not ovulate or have a regular menstrual cycle.
Sometimes hypothalamic amenorrhoea can be caused by stress (physical or mental) on the body, such that may occur with very low body weight, vigorous exercise, illness or severe psychological stress. In these cases, hypothalamic amenorrhoea is likely to be reversed when the stress placed on the body is removed. However in other cases, hypothalamic amenorrhoea is not caused by physical or mental stress and it cannot be reversed. For women in this latter category, injections of FSH can be prescribed by a fertility specialist to induce ovulation (cycle monitoring is essential as sometimes more than one follicle can develop which increases the risk of a multiple gestation).
In 2017, I looked into comprehensive investigations into fertility issues and saw a fertility doctor in London. But I didn’t do anything as we agreed it was too hard overseas with no support. When I turned 31, I panicked and felt I needed to start. We decided to move home to Australia and I saw a fertility doctor within a week of arriving home. I pre-booked it all while away.
I took action from 2017 to 2018 with six cycles of ovulation induction (ovulated but not successful) and two full stimulated cycles of IVF. In the first cycle, I experienced empty follicle syndrome, which was devastating. I got one egg from 13 follicles, which became an embryo and was transferred, but it failed. In the second cycle, I got seven eggs and five embryos, but only one was suitable for transfer and freezing, so the rest were discarded. Amazingly, the one embryo transfer split, and I had identical twin boys, born very prematurely at 31 weeks, in January 2019.
After continuing to work on my fertility and improving my cycles, I conceived naturally in 2021 and have a singleton boy, also born prematurely, at 34 weeks.”
Can you identify any moments during your journey that clashed with your expectations?
“The biggest clash with my expectations was when I went through fertility treatment. I didn't know how it worked, what the success rates were, what could go wrong, or what needed to go right.
After so many failed ovulation induction cycles, the first cycle of IVF really crashed me back down to earth – and it suddenly dawned on me that fertility isn’t always straightforward. I realised how little I knew about fertility.”
Medical Note: It's normal for some individuals and couples to feel uncertain about their fertility treatment. Fortunately, most fertility clinics have a wealth of information available on their websites. Having a thorough discussion with your fertility doctor can help you feel more informed before starting treatment. The clinic's fertility nurses are also a great resource of knowledge, so it's important to access as much information as possible before undergoing treatment.
What was the most surprising thing that happened to you during this time?
“Honestly, it was probably my loss of confidence. I was one of those people who went in thinking, ‘It’s all good, I’ll do IVF and we will have so many babies!’. That wasn’t my experience, and it really challenged me.”
What was the most rewarding thing that happened to you during this time?
“The absolute best thing to come out of my experience was that it made me realise that we can do better to help people through fertility treatment. I realised that I had a skill set that could contribute, and I wanted to help people get in the best position possible before starting fertility treatment.”
What do you feel is the biggest misconception surrounding fertility?
“I think the biggest misconception when it comes to female fertility relates to age. The idea that ‘you’re young, so you’re fertile’ and ‘you’re older, so you’re not fertile’ grossly oversimplifies the actual truth of the situation. While age is absolutely a significant factor when it comes to fertility, not every single person with ovaries is affected in the same way by age. The other problem with this perception is that there’s ‘nothing you can do’ and it’s all about age. This is not true! We can take steps to optimise our fertility at any age.”
Medical Note: We need to consider age when planning reproductive goals as egg quality and quantity decline after the age of 35.
What was the most helpful thing you did for yourself during this time?
“Experiencing fertility challenges made me prioritise my physical and mental health because, in my situation of hypothalamic amenorrhea, both aspects are so important to healing and improving fertility. Besides working on my nutrition (an obvious one for me to do), I found yoga and acupuncture incredibly helpful. Yoga became my time to be in the moment, appreciate my body and meditate at the end of each session. It was helpful for me for the mental health benefits and because it was a gentle exercise option to let my body heal. Acupuncture is well known for its fertility benefits, in particular with assisted reproduction. I did acupuncture throughout IVF and both pregnancies.”
Medical Note: Self-care is such an important consideration when going through fertility treatment. There are many ways to care for one's physical, emotional and mental wellbeing. Whether using yoga, meditation, acupuncture, a massage, facials, or doing something enjoyable, like going to the movies. It's all about finding what works for you.
What advice would you give anyone who hasn’t yet gone down their fertility path?
“Knowledge is power. Whether you have known fertility issues or you’re just ‘fertility curious’ and thinking about the future, there’s so much you can learn about your body, your fertility and also about the business of fertility – i.e. how fertility specialists work, how clinics work, and how you have choice!
This also extends to knowing that there are modifiable factors that affect your fertility, like nutrition, lifestyle and environmental exposures. You can start taking positive steps at any time. Combine these positive steps with knowledge of your own fertility situation and you can empower yourself to take on the future, no matter what your journey may look like.”
