Posted April 11, 2020 06:04:01

It's a secret of unspoken heartache doing the rounds in rural Australia.

Regional folk may be happy to spout volumes about the fertility of their livestock, but find it much harder to talk about their own battles to conceive.

Raine Holcombe is a tough-as-nails contract musterer, raised on a crocodile farm in the Northern Territory.

She's able to stare down just about any rogue animal and withstand the toughest of conditions alongside her husband, Potter Holcombe.

The couple envisioned growing old wrangling their cattle and kids in the rugged landscape they love.

"Ever since I was a little girl playing with dolls and looking after our friends' young siblings, I've always loved children and dreamed of having our own family," Ms Holcombe said.

After they got married, Mr and Ms Holcombe faced a flood of questions from well-meaning but sometimes insensitive friends, who didn't grasp the silent battle the couple was waging.

"In the first 12 months you sort of brush it aside, and then the next 12 months was the harder part," Mr Holcombe said.

"If you're on social media, there'll be a birth announcement sometimes there's six in a week [and] that really gets you down, but at the same time you have to be happy for them and thankful they've had better luck and good fortune," Mrs Holcombe said.

It's been a gruelling process.

The couple have had two egg collections and seven embryo transfers.

The logistics of fertility treatment are 10 times harder from a remote cattle station.

"Our local closest IVF clinic is Darwin and because we travel around for work, it's up to six hours [travel], sometimes further," Ms Holcombe said.

"We can't really go to the local clinics that are close by because we need the blood results the next day or a couple of days later and those remote clinics take a week or longer to get the results."

Much of the treatment also puts the Holcombes substantially out of pocket.

"There are some payments that come from Medicare for your egg collection surgeries, there's nothing available for your embryo transfers, and there's no subsidies for travel if you live remotely," Ms Holcombe said.

All of the couple's IVF attempts have failed, and in a cruel blow, they have only recently learned that the $100,000 process was never going to work.

Undiagnosed for years has been a rare genetic condition. Both Raine and Potter carry the same DQ alpha gene, which causes an embryo to self-abort.

It has forced them to explore a different path at a clinic in Melbourne, 4,500 kilometres away from where they work.

It's their last hope and the only treatment option left.

The process involves mixing Potter and Raine's blood to create a serum, which will ideally give them up to six months to try more IVF.

If that doesn't work, it's back to the drawing board.

According to the Fertility Society of Australia, difficulty conceiving is a nationwide trend.

It estimates one in seven couples will experience some form of infertility within one year of trying.

This is partly due to the rising age of women and their declining fertility, as well as more diagnoses of fertility conditions, like endometriosis and polycystic ovary syndrome.

This is made all the more difficult by scarcity of clinics in regional Australia.

Doctors like Nicky Purser know only too well the barriers facing remote couples, particularly when it comes to hormone and fertility tests.

"Sometimes the woman might need blood tests every two or three days, and if you are 300 or 400 kilometres from a blood collecting centre and you've got to do a 600- or 800-kilometre round trip every two or three days, that's just an enormous thing to have to undertake," she said.

For testing in Darwin or Adelaide, the couple would have to spend two or three weeks in town, a trip many find logistically impossible.

"For a lot of people in IVF generally, often it is all too hard and [they] give up, besides all the extra issues that happen in the bush," Dr Purser said.

Healthcare delivery across all areas of medicine is no doubt harder in the bush, but fertility experts say addressing limited ultrasound availability, reducing sluggish turnaround times on blood tests at remote clinics, and increasing access to financial assistance could make it easier.

"The issue about blood tests and ultrasounds with a population like we have, it's not something that's going to be solved easily," Dr Purser said.

"It's always going to be a big source of sadness for people. I don't think that's really going to change."

Kimberley Mackay and her husband Angus welcomed their third baby in January.

Umbearra, their sprawling cattle station on the South Australian and Northern Territory border, is a kids' paradise, with poddy calves, motorbikes and endless plains to explore.

But while their herd of cattle boasts some impressive fertility rates, their own journey was taxing.

"A lot of people can't relate, so it was quite awkward with the people you were talking with and we did feel quite alone and isolated, especially living out here where you don't see too many people," Ms Mackay said.

She was diagnosed with polycystic ovary syndrome and fertility help was a 13-hour drive away in Adelaide.

She began treatment with a fertility drug, Clomid, which forces egg production and enabled her to fall pregnant with their first child, Ollie.

Their second attempt was more heartbreaking.

The couple went through six cycles of Clomid and then three rounds of IVF, resulting in a pregnancy that didn't last.

But they persisted, and 37,000 kilometres and four rounds of IVF later, they had Millie and considered their family of four complete.

It was a complete surprise when they found Ms Mackay was pregnant with their third child, naturally-conceived Aubrey, last year.

"We didn't believe it," Ms Mackay said.

"It was a miracle baby, really.

"We were told it wasn't going to happen. Sometimes you get lucky."

Watch this story on ABC TV's Landline on Sunday at 12:30pm or on iview.

Topics:health,fertility-and-infertility,reproduction-and-contraception,rural,rural-women,healthcare-facilities,healthcare-clinic,nt,australia,melbourne-3000,alice-springs-0870

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The long, lonely journey of infertility in the bush can involve a six-hour drive for one blood test - ABC News

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