A new fertility treatment which could dramatically improve a woman's chance of getting pregnant during IVF is enjoying one of its first successes in Northern Ireland. Any day now, Alison and Andrew Allen are expecting the joyous gift of twins in what will be for them a truly miraculous end to an agonising five-year IVF journey.
It was during their fourth and final attempt to have a baby that Alison became one of the first women here to have "endometrial scratching", which has been introduced by the province's main private fertility clinic, Origin.
The emotional and financial toll of their fraught IVF journey meant that they had decided that this was their last hope for a family.
Now 30 weeks pregnant with twins and well out of the danger period, Alison still can't quite accept that she is going to be a mum.
"I know it sounds really weird but I still think to myself, 'Is this really happening?'. I'm petrified, even though I have been reassured that everything is great. After all we have been through I don't think I will believe it until I hold my babies in my arms."
Scientists in Nottingham and Brazil claim the technique has improved live birth rate by around 20%. It involves medically administering damage to the inner lining of the womb to stimulate fresh blood which helps eggs to fertilise.
The 'scratching' is given just once to women – between seven and 14 days prior to undergoing fertility treatment.
While scientists are still not sure why the procedure is working and trials are still ongoing, one theory is that it is 'awakening' the womb by encouraging regeneration.
Head embryologist at Origin Dr Steve Green said while it was impossible to prove conclusively that it was the addition of the scratch that resulted in a positive pregnancy, there was enough evidence to suggest that it played a key part. And, while the treatment is now being tried around the world on fresh embryo transfers, in Belfast, Origin is pioneering it on frozen embryo transfers.
Dr Green says: "The idea of the scratch is that it aids implantation and there are several theories about how it works. The most commonly held theory is that the womb responds to the scratch by producing factors which are quite important in the implantation process. There is very little data on frozen cycles and we are pioneering that aspect of it on thawed embryos.
"We started using the scratch about a year ago and have treated 33 patients with a history of implantation failure, of which 38% achieved a pregnancy. Alison had been trying for a long time to get pregnant and she had an excellent fresh cycle and didn't get pregnant.
"We managed to freeze lots of really good quality embryos and the only difference the next time was the scratch treatment, and she got pregnant, so, while we don't know for sure if the scratch led to the pregnancy, all the evidence seems to suggest it did."
Alison (38), owner of the Miss Daisy Driving School, and Andrew (46), an IT specialist, from Belfast, have been together for more than eight years and started IVF five years ago.
Alison had suffered from endometriosis, a gynaecological condition where tissue similar to the lining of the womb grows in other areas of the body, most commonly in the pelvic region.
She had been through numerous surgeries and had always feared that it might interfere with her ability to conceive, even though she had been assured that it shouldn't
She was in her early 30s when she and Andrew first decided to try for a family but when nothing happened after a year, she went to her GP to enquire about IVF.
She says: "I knew it would take some time once you are referred, which is why I went to the doctor. In the end, it took 18 months before we got our free IVF on the National Health Service."
Alison provides a powerful insight in to the impact physically and emotionally of the treatment: "It's not just the fact that all your hopes are built up. The medication has a real effect on your emotions too. It works to shock your body into menopause.
"The doctors need to be 100% in control of your cycle and they can't have your body doing anything on its own.
"They inject you to stimulate your ovaries. They are stimulating you in to your monthly cycle. Your hormones are haywire. It's like having all the emotion that come with 15 periods rolled in to one. It's just horrible and no-one tells you about it. On your first time they don't know how effective the drugs will be in helping produce follicles, and every case is different. When it doesn't work it's just so blunt. It's a case of, sorry it didn't work, and that is it over.
"You don't get a second chance yet they will have learned from the first time how much of the drug you need so that if there was a second time, you would have a better chance. It just doesn't seem right."
The failure of the first of four courses was the most devastating for Alison and Andrew. She describes it as being like grief, and cites the emotions she dealt with – shock, devastation and anger.
She says: "It was horrific, your whole world ends. It is like somebody died. It was a long time before emotionally I could consider going through it again."
Deciding to try again meant finding over £4,000 to pay for IVF. It was money they had to borrow from the bank and when that course failed, the financial burden made it even more heartrending.
Alison says: "I thought I would cope better second time round but it was just as devastating. It was a huge burden borrowing the money and we had to think hard about if we could afford it or not.
"When it didn't work and you are still paying back a loan every month, every time that direct debit goes out it's another little reminder that it didn't work."
Fortunately, Origin was able to extract 12 healthy fresh embryos from the treatment and freeze some which meant that the couple could try again at a much lesser cost of £1,000.
When it failed for a third time, Alison and Andrew knew they had more eggs in storage, but in the interests of their emotional and Alison's physical health, they decided the next attempt would be their last. It was then that Alison was offered the new womb scratch treatment.
She says: "I was in a better place this time round. I had been to Reiki and Maya massage and been more pro-active and I felt better. The consultant in Origin explained that there was a new treatment but that it could be painful. He said that while it had some success in America, he couldn't guarantee anything but that it wouldn't do me any harm.
"Basically, it involved scratching the womb to make it bleed and the idea is that the blood would rush to the wound to heal it and when the eggs went in they would attach to the new blood flow and have a better chance of taking.
"It was like a horrific smear – very painful."
After her implants Alison and Andrew decided to go to Portugal to deal with the difficult two-week wait to find out if she was pregnant for what was their last chance. It was in Portugal that they did a test and couldn't believe that it was positive.
"We were shocked. You just don't believe it. You are in denial. My first reaction was to get another test.
"In total I did 14 tests and even though they all came up positive I still couldn't take it in."
It says everything about their journey that the couple have been terrified of feeling any joy until they have their babies in their arms.
In the early stages of her pregnancy Alison faced a couple of scares, when it was feared she might lose both or one of her twins.
Just 10 days ago she went in to early labour, and she pays tribute to the marvellous staff at Belfast's Royal Jubilee Maternity Hospital who managed to stop it and send her and her babies safely home again.
Evidently anxious not to tempt fate, she hasn't decorated a nursery or bought baby equipment because she still can't quite accept all will be well, although out of necessity she had to recently buy car seats and some baby clothes in preparation for their births.
She says: "The babies are both over 3lb and could be born safely now, but I can't get excited. I'm just so worried that someone is going to take them away.
"I haven't been able to buy much but we know they will probably be premature and have to go in to neo-natal care, which will give us time to get what we need. I think there were so many issues in my early pregnancy that I'm just holding onto the panic I felt then."
While Alison can only hope for the happiest of endings, she is also mindful of the fact that many other couples going through IVF are also experiencing the despair which was her constant companion for the past few years.
She says: "If people suspect they are having trouble getting pregnant my advice would be don't wait, go to your GP now, as the whole process takes so long. It does happen for a lot of people and I would urge people to keep the faith and not give up and at the same time not let it take over their whole lives.
"I think family and friends need educated about what it involves. It also really tests your relationship as well.
"I'm very lucky because I married my best friend and we are as solid as a rock but it did push us to the very limit.
"I can only imagine the toll on any couple who have any issues in their marriage. I am so incredibly thankful. I really do appreciate that it's happening."
Clinic offering hope to childless couples
Origin Fertility Care has introduced a number of other new fertility treatments which are having encouraging early results.
One new approach allows embryologists to isolate mature sperm which are known to have less DNA damage and other abnormalities so they can match them with the eggs.
It is the only clinic in Ireland to use the treatment and it is also proving very effective, with two-thirds of patients getting pregnant.
An even more recent breakthrough is Primo Vision Time Lapse Imagining, which allows embryologists at the clinic to monitor continuously how embryos are growing.
Dr Steve Green explains: "A picture is taken every 10 minutes and from this time-lapsed image we can learn lots of things about each embryo and see what is happening as it grows.
"This allows us to choose the most likely embryo that will create a pregnancy.
"It's very new but it also has been very successful, with about two thirds of patients becoming pregnant."