Lorelai Iuli 3, and Joshua Iuli, 6 months, were both born via IVF. Their parents call them "our ultra-miracles". Photo / Supplied
Little Lorelai Lucy Iuli and her baby brother Joshua will never know the aunt with whom she shares her middle name.
The 29-year-old died of cancer a few months before the Ashburton siblings' mum and dad began a roller-coaster, five-year in vitro fertilisation (IVF) journey to parenthood.
The lives of Felicity Iuli's younger sister Lucy Mosley, and those of her young children, crossed paths somewhere between grief and hope, between the legacy of life which ended too soon and the resilience to fight for a future dreamed of, but never guaranteed.
It was Mosley's memory that encouraged Iuli - with her husband Jarrod - to keep trying for the family they so desperately wanted.
Mosley gave her "the strength and determination not to give up", Iuli says.
"You just realise that you're blessed and lucky to be alive and healthy and that you even get a chance to try for a baby, because there are so many things [in life] that are unfair.
"I just knew she'd be saying, 'Don't give up'."
They're sharing their story as Australia's first IVF baby, Candice Thum, who now lives in Auckland, celebrated her 40th birthday last month and continued her advocacy around fertility education.
Worldwide about nine million babies have been born through fertility treatment, including IVF, since British baby Louise Brown was the first in 1978.
In New Zealand, where Amelia Bell became our first IVF baby in 1984, the number is up to about 35,000, based on year averages, which are thought by Auckland fertility clinic Repromed medical director Guy Gudex to have increased from roughly 100 a year in the 1980s to around 1500 annually now.
IVF works by fertilising, in a glass dish, a woman's eggs with a man's sperm, creating an embryo or embryos, which are nurtured in a special growth medium before being put in the woman's uterus.
It's a process that has given the joy of new life to millions who may have otherwise missed out on the experience of parenthood and it has come a long way since a newborn Brown was pictured on newspaper front pages worldwide.
Success rates are more than 60 per cent per egg retrieval for women aged under 38, Fertility Associates medical director Dean Morbeck says.
That's a massive leap from the early days, when fewer than 10 per cent of egg retrievals resulted in an eventual live birth.
But it also shows that despite the expectations modern generations place on modern technology, success is far from a sure thing and the best thing those seeking assisted reproduction can do is stick with treatment as long as possible, Morbeck says.
If he needs a poster woman for that message, it might just be Iuli.
For Iuli, the journey to parenthood began a few months after Mosley's death and continued, in part because of her, for more than five years.
After eight months of unsuccessfully trying to conceive naturally, Iuli was diagnosed with endometriosis.
Concerned about her age - she was then 35 - affecting the viability of her eggs, the couple decided to go private for their first three IVF cycles to avoid a 12- to 18-month public waiting list.
Their first cycle wasn't successful, while the first embryo transfer from the second cycle ended in miscarriage.
But another embryo from the second cycle was transferred successfully a year later and resulted in the birth of Lorelai three years ago.
Life changed, and so much for the better.
Their firstborn loves art and unicorns, favours pink for her wardrobe and is chatty and funny, her mum says.
"She's also incredibly loving and affectionate."
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Hoping for a second child to complete their family, Iuli underwent a third cycle of IV but was told none of the embryos were viable.
In the meantime, Iuli unexpectedly conceived naturally, before miscarrying six weeks later.
The couple then used donor eggs for a publicly-funded cycle - a points system factoring in various markers, such as age and BMI, funds two cycles for those eligible - but that was also unsuccessful.
Another donor was arranged, but the Iulis were then told some embryos from the third cycle of IVF were now considered viable.
"We thought it was a wrong number when [the clinic] called."
Six months ago Joshua - born from one of those embryos and five years after the couple's infertility journey began - came into their lives.
They're still getting to know their little boy but can already report that he's happy, he loves his sister "so much" and his favourite song is Happy Birthday - despite being yet to celebrate his first, Iuli says.
"If we sing it to him, it always makes him smile."
Parenting a baby and a pre-schooler is no doddle - Joshua's not at his best when tired or hungry and Lorelai has her moments too.
But Iuli says she's so glad she fought so hard for the two little people who have made their family complete.
"It's amazing [being their parents]. It was never easy, but it was worth everything we went through."
IVF is miraculous - when she was born in 1980, and now, 40 years later, Candice Thum says.
"I look back now and marvel at how my parents must have felt when they received the phone call to tell them they were pregnant. It was a miracle then and still is to each and every person who bravely faces fertility treatment."
Thum was born Candice Reed in Melbourne as Australia's first IVF baby, and the world's third, at a time when IVF involved "collecting a single egg on a natural cycle and hoping", she says.
"To think how far the industry has advanced and how families who would otherwise be childless are not due to the amazing developments of IVF. It's come a long way since my conception in the early 1980s and I now look at my own children and think, 'If IVF hadn't created me, they wouldn't be here'.
"It's a humbling thought. Thank you to all the specialists, scientists, nurses and all people in the amazing world of IVF."
Thum has done her best to give back to the technology that made her life possible, supporting advocacy organisations for IVF families and, with a fellow early IVF-ling - the name given to those born from IVF - Rebecca Featherstone Jelen set up the charity Fertility Matters to improve fertility education.
Both have spoken about the need not only to educate young people about how not to get pregnant, but also the facts around fertility so when they later decide to start a family, they are able to.
"As we celebrate the first 40 years of IVF we need to enter the next 40 focusing on better educating young adults on fertility health, fertility preservation, diversity of families."
It's a message Te Aroha mum Tessa Jenkins shares.
She's had two cycles of IVF - the first resulting in the birth of her and husband Michael's son, Blake, three years ago.
An embryo transfer from a second cycle a month ago failed. They have one remaining viable embryo, which they plan to use later this year.
And Jenkins, who paid for private IVF after discovering she had low egg reserves and other fertility problems and didn't want to delay by going on the public waiting list, was told two months ago she was going into early menopause aged 33.
"One in a 100 women have it, and there's a lot of anonymous stories. I want to use my story to help others. If I'd known I would've got my eggs [frozen] in my 20s.
"We talk about uni, work … but we don't ever talk about fertility choices. We go to uni, to work, we get married and then we go to have a baby and sometimes, as in our case, you're fighting against nature and fertility."
Through their attempts to have children - the couple also lost three babies to miscarriage - they'd come to terms with the fact they might not be able to be parents.
Even when she was carrying Blake, Jenkins didn't believe she "would be lucky enough to have a baby".
"I don't know how to articulate what life is like with him. He's very precious. Whether or not we can add to our family [with the final embryo transfer], we were so very lucky.
"He's really changed our life for the better."
Jenkins and Iuli, Thum's parents before them, and the millions of parents of IVF babies between, share something in common - they've been able to get on with their lives, carrying their dreams for the future with them.
For so many in the past, and some now, infertility means that isn't possible, Morbeck, the Fertility Associates medical director, says.
"Anybody who hasn't been through infertility doesn't appreciate that every single month is a heart-wrenching failure, and it's repeated over and over again, and it's never something anybody recovers from, because you go on to the next hope," Morbeck, himself a father of three, says.
"You have a failure, you grieve a little bit, but you start right again into hoping and that can go on for years, and it's quite relentless ... your peers are moving on with their lives and living the dream that everyone had, and yours is stuck and you don't know if you'll ever have it, and many don't and didn't."
Those who seek IVF and other assisted reproductive technologies were deserving of respect, especially in the early days when success rates were lower and intervention higher.
"Now we control everything, but in those early days they were having to track, when did the signal for ovulation occur, and that required frequent blood tests and possibly doing the work in the middle of the night to get the eggs."
Eggs were now retrieved through the vaginal wall, a less invasive procedure that in the past, when an incision was made through the belly, requiring general anaesthesia.
There was also the backlash from religious groups against assisted reproduction, which was rarely an issue now.
"These women, in the early days, they were pioneers themselves and deserve to be recognised as heroes for this generation, because that's how we learned and advanced, and they had to go through a lot for us to get to that point."
Advances include egg donation, freezing embryos, improved medications to control hormones, testing of embryos for genetic diseases, the ability to grow embryos for a couple of days longer, increasing the likelihood of a successful transfer, and intra-cytoplasmic sperm Injection - where a single sperm is injected into a mature egg when sperm quality is too poor for conventional IVF to work.
The most recent development is a move to using artificial intelligence to choose the most viable embryo to implant.
"You show a machine pictures of embryos that implanted and those that didn't implant and it picks up features in those embryos that we can't see with our eyes. It can say 'this one has a pretty good chance of implanting', and we wouldn't know why because it's features that are hidden from eyesight."
He doesn't think people will be disturbed by the thought of a machine choosing which embryos should be implanted.
"As an embryologist, we're thrilled with the idea of having help. Because we look at a group of embryos and we know there's one that has the best chance of implanting and we can't pick it out consistently.
"We're pretty good - we've got 60 per cent chance of getting it. But we'd like to have 80 to 90 per cent chance and having a computer helping us will get us there."
Infertility affects about one in eight of us, with a fairly even split between the sexes, although, for some couples, both are found to have fertility issues. For others, no reason is ever discovered.
Maternal age is really important in the success of procedures such as IVF, Morbeck says.
"It changes dramatically at say 38 … under 38, to have a baby from, maybe not the first transfer, but from at least eggs collected from one egg retrieval … over 60 per cent of them are having a baby from that.
"For over 38 we're talking less than 50 per cent per egg retrieval, and much less than that depending on the age. And there's just nothing we can do about that, at this point."
There were a lot of initiatives now about how to educate young people to be aware of the limit on fertility for women, and for women considering freezing their eggs for future use it was "optimal" to do so between ages 30 and 35.
"After 35 it's just not as effective."
Others had had their eggs or sperm frozen for future use following diagnosis of cancer or other diseases where the reproductive system could be affected, with public funding available.
"Cancer therapy is an amazing success story but one of the quality-of-life measures that's affected was the ability to [become a] parent."
IVF, which ranges in cost between about $10,000 and $15,000 per cycle and is offered at eight clinics nationally, has also enabled more same-sex couples and single people to become parents.
"It's a small percentage of the total [number of IVF procedures], but there's been some beautiful stories coming out of those cases where it wasn't possible before.
"That's a great success story of how we've been able to help all sorts of individuals to have a lovely family."
Societal change has done a lot, as has science.
But beyond that he sees the next big focus being on improving the emotional support for those going through assisted reproduction, Morbeck says.
Everyone thinks their IVF will be successful the first time, that's human nature, but for those who weren't, having a "warrior mindset" about the challenge they're facing is important, he says.
"So we're looking at how can we use things like apps and technology to improve the patient experience to make it so we're giving better emotional support. Because the longer patients can stay in treatment, the better chance they're going to have that baby.
"To me, that's the biggest thing we have on our horizon, to improve care both in terms of experience and probably how many babies are born. We've had so many amazing technological breakthroughs … now we need to take care of the patients better."
Iuli, whose five years of IVF hard slog created her happy household of four, is also a proponent of the warrior message.
Buoyed by her sister's legacy, and her own dreams, she didn't give up.
She hopes others won't either.
"If you realise something's not working, re-evaluate your dreams, even if it means using donor sperm, eggs or embryos. I totally got with that when I thought we had to."
The wee girl who wants to wear only pink and the wee boy whose favourite song is about a life ritual he's yet to celebrate, are worth it all.
"They were just so hard to get and it's so amazing that they got here, when you think about all the things that happened when they were 5-day-old embryos.
"We call them 'our ultra-miracle kids'."
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