A letter to my 40-year-old self

(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.

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Heard the one about another miracle IVF advance?

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.