Category Archives: Fertility

A letter to my 40-year-old self

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(This is primarily about learning to live with infertility.)

Happy 40th birthday. Except it really isn’t. The phone call yesterday took away that possibility. The phone call that was the endpoint of weeks and months of tests and drugs and gynecological examinations and surgery.  First the pathway to  IVF treatment of heavy duty hormones to regulate your periods which were never irregular anyway and which made you emotionally unstable for months. Though that wasn’t really first, because it followed years of trying to get pregnant the way that most people do – sex whether either or both of you wanted it or not because it was that time of the month and the tests said fertile window. Then the follicle stimulating drugs that you had to inject into your stomach to force your body to produce extra eggs where you were dangerously over-treated to the point that your abdomen hurt when you walked. Then the euphemistically named ‘eggs harvesting’ when they didn’t give you enough sedative so you partly came round mid-surgery, aware of the blood and in terrible pain but unable to move or speak on the operating table, desperately trying to let them know you were conscious. But – great news – your body had produced 28 eggs (way more than it safely should have) and at least seven were suitable for fertilisation. Might you want two or three to be implanted when they fertilised? Sure, twins would be a challenge but how exciting.  Might you want to freeze some, just in case? ‘We’ll ring you tomorrow to tell you how many have fertilised.’

I can still see you answering the phone. ‘We’re sorry, zero fertilisation.’ That’s it. Done. No return to the clinic for the embryos to be put in your womb. No ‘two-week wait’ to see if they implanted, to see if you will be pregnant. You’ll call your partner, hardly able to speak with the grief and ask him to come home to be with you.

That was your one and only shot on the NHS. What will follow is three more privately funded attempts. You will know that you are ‘lucky’ to be able to do this, to have some paltry savings to plunder, a home to remortgage and a job and credit history that permitted you to get into debt.

You will become pregnant once. Elated you will buy a ‘you and your pregnancy’ book. You will never get beyond the stage when the foetus is as big as a kidney bean. You will sit in the sunshine on the stone steps to the office, sobbing after you’ve seen the blood in your pants. You will hit lows that you have not anticipated. You will become depressed, but you won’t take medication because it might affect a pregnancy. You will forever hate the acronym PMA and the phrase it stands for: ‘positive mental attitude.’  The book will go in the bin. You will come to believe that hope is the most cruel of emotions.

The fourth time will be the last. You don’t expect it to work but you want to know that you took it as far as you could. You need to stop hoping.

You are the oldest of six half-siblings with two step-siblings and six parents between you (it’s complicated); the oldest cousin of 25 from one set of grandparents alone. You have worked in busy women’s refuges bulging with women and their children. You’ve always been surrounded by children and always been remarked upon as ‘a natural’, you knew you weren’t, you’d just been trained since birth. You have always enjoyed children but  will come to find their presence unbearably painful. Nothing more than a reminder of what you cannot have. You’ll feel stuck – what’s the template for long-term relationships, where is the evolution when you don’t become parents?

You will not be supported at work, in fact your line manager will use your vulnerability against you. You will walk out of your job with nothing to go to next. And it will be a blessed relief. You will be able to burn your fertility medical notes in the garden incinerator before you are able to burn your work supervision and appraisal notes. You will tell yourself that the break will be a chance to re-evaluate and decide if working in organisations supporting women subjected to men’s violence is what you really want to do. You will find that it is, that nothing else feels right. You will get a job as CEO of a fantastic organisation. It will be wonderful and sometimes hellish as funding crises threaten its viability, there will be times when you really don’t think there’s a way out, but with the board, and the senior management team, you will manage to find a way through. The commitment of the staff team and the horrors that they face in their day to day work will humble you.  The strength of women subjected to men’s violence will inspire and motivate you. A young woman that you have never met will be killed by the ex- boyfriend she was trying to leave and she will change your life. You will start to count dead women and you will record their names.

You will struggle with the concept of ‘mother privilege’.  You know that reproduction has been weaponised as one of the main tools of the oppression of women, you can clearly see the many and wide-ranging negative impacts on other women. You can even empathise when they describe the difficulties the endure, but you are deeply jealous and wish that you faced some of those difficulties. You watch other women battle over the concept. You mainly keep quiet. You can see both sides and admitting to either feels like a betrayal of the other.

One day, a Saturday morning just over four years after that phone call, you will read an article in the paper about a woman who has recently set up a support group for women who are struggling to come to terms with childlessness. You’re probably still sobbing when you send the email trying to find out how and whether you can take part. A few weeks later you will find yourself one of a small group of involuntarily childless women about to undertake a 10-week one-evening-a-week set of group work sessions. You will feel surprised when you hear yourself tell the group that being passed a baby feels like being passed poison to you, that you automatically recoil, that this is who you have become. You’ll go to the group and you will struggle with the concept of finding a ‘Plan B’, because your life is okay, your ‘Plan A’, which was never really a plan but just what happened is fine, except you’re not raising a family.  One session, you are asked to think about the things you used to say to yourself that might have stopped you doing or achieving what you wanted. You realise that you still do this. You say no to things that you think are not for someone like you, that someone else can probably do better. You recognise that these are bound in your social and sex class socialisation. You resolve to start to say yes. Outside of this, you won’t be able to pin down how or why the group helped you, except it is very clear that it did. Something shifts.

People will continue to say thoughtless things. They’ll ask if you’ve thought of adoption or tell you that they understand because it took them some time to conceive, but it stops being so painful. The people who do will sometimes surprise you, as will those who show empathy and support that you would not have expected.  You will lose friends, sometimes because they can’t be there for you, sometimes because you can’t be there for them. You will let them go, sometimes with sadness but always with acceptance and you will wish them well. Some will stay with you and you will make new ones and they will become a genuine source of joy, love and sustenance in your life.  Your relationship with your partner will adapt and grow. The notion of ‘once in a lifetime holidays’ loses meaning as you get opportunities to visit places you thought that you never would and places that you’d never even heard of before. You’ll begin to love to travel and your partner will be the perfect travelling companion and much more.

You will start a PhD. Haha, yes, really. I still don’t know whether you’ll complete or pass it – but you might. One of the reasons that you started was because you were worried that what you said wouldn’t have any validity without it, but you will also come to see that academic tail-chasing can stop people from taking action. You will realise that you have something to say about men’s violence against women. Women and feminism will bring so much to your life.

You will see your brothers and sisters and many cousins many photos of their many children on facebook and you will no longer need to hide or unfollow them. You’ll feel the joy of being part of a big family again but you will regret that they are so far away. You will see your contemporaries become grandmothers and though it will be bittersweet, your smiles for them will be genuine. You will still wonder what old age will hold when you don’t have a family of your own to accompany you through it.

Your unconscious mind will remind you every year of that phone call and the miscarriage, you’ll feel a strange cold hollow that you can’t explain until you remember, but it gets easier. You won’t remember the last time you cried about your childlessness and even though you know it will not have been the last time, that will be okay.

You will notice that you have slowly begun to accept that the ‘surprise pregnancy when you had stopped trying’ is not going to happen to you. You are too old. You will not be defined by your infertility, even though it will always be part of you.

You will never know why.

You will love your mardy cat too much. You will enjoy and value your life. It will feel full and fulfilling. You will be happy. Sometimes you will even wonder whether it’s better this way. It’s fine not knowing.

Simone Jabakhanji – Infertility, suicide and male violence

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Reports on the inquest into the death – by hanging – of Simone Jabakhanji, 27, bring together two issues that are important to me: male violence against women and infertility.   Simone’s death has been covered in the mainstream British press including  the Daily Mail, The Telegraph, The Sun and The Independent. She was from Lancashire but living in Gambia in August 2011 when she died.

The Independent, The Sun and The Telegraph describe Simone as a bride, the Mail as a newlywed bride.  Actually she wasn’t, she was a woman.  A woman who had been married to a man for a year and a half at the time of her death.  A woman who was a human being worthy of acknowledgement in her own right regardless of her marital status, a woman who does not need to be defined by virtue of her relationship to a man, or indeed any other person.

The Sun refers to Simone as “Row wife” in the title of its piece on her, the Mail refers to her “tempestuous relationship” with husband Mohammed Jabakhanji and the Independent describes how Mrs Jabakhanji had been rowing with her husband ( thus positioning her as the active subject, the instigator and him the passive object, the receiver) .  Most reports also cover that Janice Lally, mother of Simone Jabakhanji, told the inquest that her daughter was frightened of Mohammed Jabakhanji, that she had to give him quiet space for days when he got angry, that this quiet space was preferable to him breaking her legs.  Close friend of Simone, Abigail Stone told the inquest that she had spoken with her friend on the day of her death and had advised her to return to England.  Not one of the sources above used the phrase “domestic violence”, not one of them referred to Simone’s death in the context of “male violence against women and girls”.

The titles of three of the four pieces manage to tell us that Mohammed Jabakhanji was African and place Simone Jabakhanji’s death in the context of her husband’s infertility.  The Sun, winning a rare prize for relative diplomacy, waits until the first paragraph of its piece before raising the issues of either race or infertility.  Positioning  Simone’s death in relation to her husband’s infertility further removes  Mohammed Jabakhanji from the role of abusive perpetrator and closer to that of victim, victim of infertility.  The Mail doesn’t quite let him off the hook, telling us that his infertility was a result of his unhealthy lifestyle, his smoking  cannabis and drinking.  Mohammed Jabakhanji may well have been infertile, but I know of no fertility test that has the ability to identify the cause of infertility as alcohol or smoking.  There is a correlation between heavy drinking and smoking and reduced fertility, but correlation is not causality.  It is worth considering too, that there would probably be far fewer babies born if the relationship were quite so straightforward.

Coroner Simon Jones has been quoted as saying,  “When a death like this happens in this country [the UK], we get police statements, photographs of the scene.  To record a verdict of suicide in the UK, I have to be satisfied to a very high standard of proof that she did what she did intending to end her own life.”

“But we can’t be certain what she did was done with the intention of ending her life. That would be at odds with the conversations she had with family and friends. Similarly there is no evidence to suggest anyone else was involved.”  Simone’s body had been embalmed without an autopsy in Gambia before being repatriated to the UK.  An open verdict was recorded in relation to her death.

Several small studies have demonstrated a link between infertility in women and psychological distress, reporting high rates of anxiety, depression and suicide. There is less research into the impact of male partner infertility on women’s mental health. It is possible that if Simone Jabakhanji killed herself, her husband’s infertility was a factor, possibly even a crucial one in her decision.   However, research from the Women and Equality Unit, has shown a  clear relationship between domestic violence and suicide in women victims: every year in the UK, 500 women who have experienced domestic violence in the last six months, commit suicide.  Despite each of the four articles managing to link Simone’s death to Mohammed’s infertility, not one of them positioned it in relation to domestic violence, into his coercive, controlling and frightening aggression.

Another woman dead, reduced to her status in relation to a man; another man’s violence minimised and overlooked.

Simone Jabakhani

Heard the one about another miracle IVF advance?

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It’s surprising that I haven’t had five children, the number of miracle breakthroughs that there have been since the fourth and last time I had unsuccessful IVF treatment four years ago to the month. Prop open the doors of the maternity ward, ‘cos here comes another.

Today’s miracle, as reported by the BBC, concerns a mixture of citric acid and bicarbonate of soda to replace the carbon dioxide incubators, medical grade gas and air purification systems needed to grow the embryos outside the body before they are replaced in the womb. Apparently this will reduce the cost of IVF from approximately £5,000 per cycle to £170.

My partner and I paid for IVF three of the four times we had it. Those three cycles cost around £20,000 in total.

When paying for IVF, you pay for1

  • Blood tests (him and her)
  • Sperm tests
  • Drugs to down-regulate the woman’s cycle so that the next stage starts from a ‘zero base’ (usually taken for 10-14 days)
  • Drugs to hyperstimulate the ovaries so that multiple eggs are produced
  • The syringes to inject the aforementioned drugs into whatever part of the body deemed most appropriate twice a day (stomach for me)
  • Regular scans to monitor the progress of the ovaries (a good old internal probing every two or three days) along with blood checks to monitor hormone levels
  • A final mega injection of human chorionic gonadotropin to trigger ovulation
  • An operation (sometimes performed under general anaesthetic, sometimes local) to extract the eggs (involving an ultrasound-guided great big needle piercing the vaginal wall to reach the ovaries and suck out the eggs.)
  • The bit where eggs and sperm are introduced and hopefully the sperm fertilises the egg, then the embryo is left to develop for a few days
  • The transfer of fertilised embryos back in to the body
  • Progesterone pessaries (your choice – front or back)
  • Any other bit of quackery that you allow yourself to be duped into paying for.

Each stage of the process costs. The miracle process that will allegedly cut the cost of IVF treatment is the ninth one in the list above. I really cannot see how an advance in that stage of the process will reduce the total cost of IVF from (a conservative) £5,000 to £170. At best it will reduce the cost of that stage of the process.

The mainstream fertility industry in Britain is reportedly worth an estimated £500million a year (2011) and rising. Does anyone really think the industry is ready to kiss its profits goodbye?

And back to the BBC piece linked above, is there not a whiff of an incitement of racism, the special brand of racism reserved for people in developing countries, in the sentences : “Experts said there was big potential to open up IVF to the developing world.” Repeated later on, in case you missed it the first time as “If you don’t have a child in Africa, or also South America or Asia, it’s a disaster.” Or is it just me who imagines the ” ‘They’ don’t need encouraging to have any more babies” reactions of badly informed bigots who haven’t the inclination to take the time to understand the relationship between world poverty and birth-rates?

I’m angry that another development in the IVF process is being so irresponsibly reported as presenting something that it cannot. Not for me, it’s irrelevant. I’m done with IVF. But for everyone who will be getting a ‘don’t give up, have you heard about this new treatment?‘ call, text, email or even newspaper cutting over the next few days from well-intentioned friends and relatives who desperately want to support someone trying to conceive through IVF; for everyone who’s thinking, maybe they won’t give up, maybe with this they can afford to give it another xxx attempts, for every poor bugger whose hopes are being falsely raised by this article and others like it, I’m bloody raging.

1 There are several different methods of IVF, this is the method I had.

Related articles

Infertility, patriarchy, profit and me, or: “KERCHING!” – Infertility and woman blaming, woman shaming, woman controlling

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I awoke this morning to what I thought was good news: a campaign to raise awareness of the relationship between a woman’s age and infertility.

I’m 45. I’d assumed that I’d become pregnant when the time was right. The time felt right when I was around 36 years old; I believed I’d been a mixture of lucky (not to have had an unplanned pregnancy, to have had a decent-enough education, to have a challenging and rewarding job, to have a home/mortgage and to have met someone I wanted to share life and parenthood with), unlucky (it had taken a while and a few ‘not so great choices’) and sensible (it had all taken effort). The ages 38 to 41 brought the delights of temperature/ovulation charts, followed by drugs to control ovulation and eventually four failed IVF attempts, one reaching the dazzling ‘success’ of an early miscarriage; complete with a side order of giving up alcohol and caffeine, vitamin and mineral supplements, losing weight, acupuncture and – and it pains me to admit this – listening to awful visualisation CDs, surrounding myself with ‘fertility colours’ and a strategically placed piece of rose crystal (no, not internally). I’m going to blame the mind altering ovulation and IVF drugs for my descent into those, please allow me and also grant me lifelong forgiveness for any adverse reaction that I might have to the phrase ‘positive mental attitude’. I’m now, jointly with my partner, about twenty thousand pounds lighter in pocket. 1

The years between the ages of 40 and 44 were not easy ones for me, with grief, loss, depression, jealously, bitterness, emptiness and despondency the companions of dwindling hope. I found out that our first IVF attempt hadn’t worked the day before my 40th birthday. I can still see where I was when I received that phone-call.

I didn’t have a seamless transition into acceptance of childlessness but one Saturday morning, in February 2012 came across this piece by Jody Day on her work to set up Gateway Women, and – once I’d stopped sobbing – I contacted her and eventually enrolled on her group work programme. It set me free, allowed me to move on.2

I’ll probably never know why I didn’t get pregnant, none of the testing involved with infertility treatment found any problems, I have ‘unexplained infertility’ but certainly age is a – if not the – most likely significant contributory factor. Fast forward to this morning and the issue of women, age and fertility being discussed on the radio and in social media and I was pleased. Pleased because I genuinely believe that there is insufficient attention paid to infertility, in society, in education and also in feminist discourse on women and reproduction.

However there are awareness-raising campaigns and ‘awareness-raising’ campaigns. The one people were talking about this morning is part of First Response’s “Get Britain Fertile”, campaign and is purportedly about warning those women who want to and are able to delay motherhood about the risks of doing so. First Response is a registered trademark of Church & Dwight Co. Inc., a £1.7 billion ($2.6 billion) company with headquarters in New Jersey, USA with brands including Arm & Hammer, Trojan, Nair, Oxi Clean, Orajel, Lady’s Choice and First Response. Whether they knew it or not, people were talking about an awareness raising campaign that is funded by a multi-million pound company that also trades in diet foods and hair removing products, products that rely upon misogyny created self loathing like chips need potatoes. The campaign is lent legitimacy through the backing of Zita West, the self-called “UK’s no. 1 for preconception planning, natural fertility, assisted fertility, pregnancy coaching and post-natal support”. I found three active UK companies registered is her name, all selling fertility products and treatments.3 In other words, this awareness raising campaign is about selling products through the medium of raising awareness. There doesn’t appear to be any of this messy business stuff referred to in the campaign.

When I think about raising awareness of issues relating to women, age and fertility, I want us to be talking about the facts. Whilst the average age of a first-time mother has been increasing, a woman’s fertility peaks in her early to mid-twenties after which it begins to decline, this is true of both natural and assisted conception. Three out of four men and women overestimate by five years the rapid decline in women’s fertility at 35 not 40.

When I think about raising awareness of issues relating to women and fertility, I want us to be talking about how women are judged for getting pregnant too young, for getting pregnant without a long term and male partner, for getting pregnant or failing to get pregnant when too old, for getting pregnant and remaining in or leaving paid employment, for only having one child, for having too many children, for having abortions, for staying in abusive relationships or leaving and breaking up ‘happy families’. Teenage mothers, single mothers, lesbian mothers, older mothers, women who work, women who stay at home, woman who have ‘x’ number of children, childless women, women who leave, women who stay –whether through choice or lack of choice- what unites us is that according to someone, we’re doing it wrong!

When we’re looking at why some women are delaying the age at which they have children and why some choose to have them as soon as they can, we need to look at how hard we make it for women to afford to be able to have children, how hard it is to have children and rewarding paid employment, how expensive and for many, unaffordable, childcare is, why for some young women their aspirations do not go beyond motherhood or why for some a child is seen as the solution to their sense of isolation, loneliness and worthlessness. We need to look at equality issues, we need to show the concept of ‘reverse-Darwinism’ – the panic about the trend for women with higher levels of education to have children in later life and fewer of them (and therefore more likely to face infertility) – the contempt it deserves, whilst looking at what we can do to support women of any social background in their decisions to have, or not to have children and to be able to plan the size of their families.

We need to look at the roles of men in raising families and at the effects of their ages, their jobs, their contributions in the home. We need to look at gender stereotypes and their impact on family life, relationships and woman and men’s ‘choices’. We need to make it no big deal for families to be made of people in same sex relationships whether or not they have children.

We need a global perspective. We need to look at poverty, inequality and fertility rates and ensure the relationship between higher birth rates and countries with lower GDPs and higher gender inequality, are seen as problems of international poverty inequality and gender inequality.

TV presenter Kate Garraway fronts the new campaign; she said that she “agreed to become Ambassador to the campaign” because “I want to alert women to start thinking about their fertility at a younger age than our generation did. They should get prepared and make informed choices early so there is no chance of sleepwalking into infertility.’ According to a report in the Telegraph, as part of the campaign, Garraway spent a day being transformed into a heavily pregnant 70 year-old by a prosthetic make-up artist, to “shock and provoke debate about how old is too old to have a baby”.

kate garraway old pregnant women article-2326293-19D52D22000005DC-611_306x450

The thing is I’ve never met anyone who planned or plans to delay having a baby into their 70ies. Women’s fertility declines through their 30ies and 40ies, what’s the point in an awareness campaign featuring a woman supposedly in her 70ies? Isn’t this confusing the message? Isn’t it telling women that they don’t want to delay motherhood until their 70ies, not that they cannot? The only way that this photo has impact is by exaggeration based on misogyny, the special misogyny reserved for older women in a society where women are valued by what they look like and an ideal of beauty rooted in youth.

This new campaign is not about raising awareness of the relationship between women’s age and infertility; it’s not about supporting women to make informed choices and making society more supportive of women’s choices. This campaign is about persuading women to start spending money on fertility treatment at a younger age and it relies upon misogyny to do so.

Footnotes

1 Yes, I know that not everyone is fortunate enough to be able to make the choice to spend a lot of money on unsuccessful fertility treatment.

2 Gateway Women was hugely beneficial for me, and I’d encourage any woman struggling with issues around childlessness by circumstance not choice to find out more: gateway-women.com

I’d also like to acknowledge that the support of Jodie and the group that I was part of contributed to me daring to start blogging.

3 They’re not legally required to disclose their annual turnover and I wasn’t able to find it.