Passionate advocate at work in ART: technologies used to assist infertile couples to have a baby have changed radically over the past 25 years. Dr Karin Hammarberg is one of a handful of nurses to witness the dynamic world of fertility care both in Australia and overseas and to research the experience of infertility treatment on women, men and children.

Karin is a passionate advocate for using clinical practice to inform research and improve patient care.

'If you work as a clinician, through the course of your work you become aware of unanswered questions about the experience of having fertility treatment.'

The question of how women experience motherhood after assisted conception led her to complete a PhD at the Key Centre for Women's Health in Society at the University of Melbourne.

'Infertility and infertility treatment is something that has a lasting impact on your emotional wellbeing,' she says.

While infertility treatment is colloquially referred to as "IVF" by most people who recognise its growing popularity, Karin says "Assisted Reproductive Technology (ART)" is a more accurate description for the spectrum of treatments used.

Her PhD research is the first comprehensive Australian study to examine motherhood after ART. It found that women who conceive via ART have more early parenting difficulties than comparison groups, a finding with important implications for the care of pregnant women and new mothers. (See breakout box)

When Swedish-born Karin first began in the specialty, IVF treatment was relatively new, but nevertheless in demand. She had to hit the ground running when appointed to coordinate Scandinavia's first fertility centre in the university city of Gothenburg. 'I was administering the waiting list which was out of control and also doing the day-to-day care of patients,' she recalls.

At the time Sweden was at the forefront of infertility practice, a fact that didn't go unnoticed by one of Australia's leading infertility treatment specialists Alan Trounson who met Karin on a visit to the country in 1986. Karin's connection with Melbourne meant she also became known among other Australian infertility specialists who were keen to work with an experienced nurse. Before too long she was invited to coordinate Melbourne's first public IVF program at the Royal Women's Hospital. The move worked out on a personal level also as Alan and Karin have lived together since and now have two children.

After some years in clinical practice in Australia Karin felt she needed more intellectual stimulation and her career became more research focussed. Her Master's research, also done at the Key Centre, examined women's experience of IVF treatment. She found that patients were most anxious in the days and weeks following an embryo transfer before a pregnancy was confirmed (or not). Other difficult times involved having egg collection and finding out how many eggs were able to be retrieved, when partners were having their sperm analysed, and discovering whether the eggs had fertilised.

'Having this awareness of the most stressful and vulnerable times meant that we could spend more time with people then and were able to educate staff about this,' she said.

'The research and clinical practice has been able to mutually inform each other to improve outcomes for patients.'

Karin is now working on two projects related to infertility and ART--the psychosocial impact of infertility on men and the health and development of adolescents who were conceived via ART.

She also runs training courses for nurses and others working in ART programs.

'It is important that nurses know about what the research is telling us about people's experiences, so they can improve the psychosocial elements of practice,' she says.

For more information visit http://www.kcwhs.unimelb.edu.au/aboutus/staff/karin_hammarberg.html

RESEARCH SUMMARY

Women who have conceived babies after having fertility treatment can be at risk of early peenting difficulties, acording to Karin Hammarberg's research findings.

These difficulties included:

* lower sense or maternal confidence

* a three fold higher rate of admission to early parenting services in the first 18 months

* lower rates of breastfeeding at three months Women who conceived with ART were more likely than other Victorian childbearing women to have had a caesarean section and to be disappointed with the birth experience.

The findings have important implications for the way pregnant women ann new mothers are managed if they nave conceived via ART, says Karin.

Care could include providing realistic information about the high risk of having an operative delivery after ART to help lessen disappointment about the birth.

Promotion of maternal confidence to boost womens belief in their ability to care for their baby Clear, concise and consistent breastfeeding advice anti intensive support.

Provision of practical advice on feeding and settling babies after leaving hospital.

Dr Hammarberg suggests that women who conceive with ART may have very high expectations of life with a new baby and this may leave some a bit unprepared for the demands involved in caring for a newborn, and the tiredness that most new mothers experience.

Reference

"The experience of birth and ealry mothering after assisted conception" Karin Hammarberg, Doctor of Philosophy, University of Melbourne, 2006 (supervised by Associate Professor Jane Fisher and Dr Healther Rowe, Key Centre for Women's Health an Society)