Friday, 28 March 2008

The assvice just keeps on coming

Yesterday I went to the acupuncturists. Because it is a training clinic, each week, I am initially seen by a group of students, who ask me a number of questions about my general well-being, listen to my pulse and look at my tongue, before going off to report their findings to the Chinese Fertility Goddess herself. The CFG then comes in and repeats the whole process, before deciding on a course of treatment. She then supervises while the students insert the needles.

Yesterday, I was seen by a new group of students. How old was I, asked one of them. 'Thirty six,' I answered. 'Oh, that's no age at all,' he exclaimed, 'the newspapers are always full of stories about women having babies in their fifties: it's marvellous what doctors can do nowadays, isn't it?' 'I think you'll find those women conceived using donor eggs,' I explained, testily. 'Not necessarily,' he answered, 'I have a couple of women friends who both conceived naturally at the age of 44.'

How can this possibly be considered a helpful thing to say to somebody who has just undergone a cancelled cycle of IVF, and who is worried that her poor response could well be a sign of diminished ovarian reserve?

After the treatment, the same chap came in to remove the needles. 'Are you absolutely sure you want a baby?' he asked. 'Raising a child can be awfully hard work.'

Really? And there was I thinking that it was going to be a walk in the park! Does he not imagine that, after five years of trying to conceive, and the best part of three years of psychoanalytic psychotherapy, I have never before stopped to question my motives for wanting to become a mother?

Why am I surrounded by people offering unsolicited assvice? Why does everyone I encounter seem to have an opinion on my infertility?

The student in question informed me that yesterday was his last day in the clinic for the time being, so hopefully our paths won't cross again - otherwise I would have requested that he had no further involvement in my treatment.

I do, however, have every confidence in the Chinese Fertility Goddess. Yesterday, she spent some time explaining how she plans to tailor my treatments to support me through my IVF cycle. She also told me that I should cut down on the amount of dairy products I consume, and eat more seeds and nuts - in particular walnuts.

Such is my faith in the CFG that I immediately went out and bought a large bag of walnuts, which I am chomping through as I type!

Wednesday, 26 March 2008

Friendships lost... and found

I've been a bit hopeless at posting over the past week - I begin composing posts in my head, but then never get round actually to writing them. Instead, I've been mulling over all the assvice I received last week from our friends and family - and this in turn has got me thinking about my best friend, Stella.

Stella and I met on our very first day at university. We lived in the same halls of residence, and were doing the same degree course. Our friendship really cemented itself, however, after we left university. We saw each other through shitty jobs and broken hearts. We went out dancing, and stayed up all night talking.

After dating a number of inappropriate men, and crying on each others' shoulders when it all went wrong, we both settled down with our respective partners. Eventually, the inevitable happened - Stella invited us round for lunch, and told us that she and her husband were expecting a baby. I held it together all the way through the meal, but then fell apart in the car on the way home. 'Don't you understand that that's the way it's supposed to happen?' I shouted at Mr H. 'You come off the Pill and then you get pregnant a few months later. It's not supposed to take eighteen fucking months.' Up until then, we'd been doing a pretty good job of pretending that we didn't have a problem - Stella's pregnancy was actually the catalyst that led us to make that first appointment with the doctor.

Eventually, Stella had her baby - a boy. Eighteen months later, she had a little girl. In the meantime, we underwent the standard battery of tests, and were placed on an NHS waiting list for IVF. As time went by, my weekly telephone conversations with Stella became more and more one-sided: she talked about her children, while I listened.

And then I had a miscarriage. We hadn't told anyone about the pregnancy - we'd agreed to wait until we were safely into the second trimester - but Stella was one of the first people I had planned on sharing my news with. After I lost the baby, I couldn't face picking up the phone to let her know what had happened, and so I sent her an email instead. Over a week later, she sent me a text message: 'I hope you're feeling better now'. When she did eventually ring me, I explained that I was a little hurt that she hadn't got in touch sooner. She then proceeded to tell me about an article she'd just read in a magazine, which suggested that a miscarriage was a bit like having a particularly heavy period. After that, I didn't really feel like phoning her again.

That was just over two and a half years ago. Stella has not made any effort to contact me since that last phone call. I've sent her Christmas and birthday cards, but she hasn't responded. I really thought that we would be friends for life, but it turns out that our friendship wasn't strong enough to survive me losing a baby.

As I fell further and further down the rabbit hole of infertility, I felt increasingly isolated. And then one day, I stumbled across the infertility blogosphere. I couldn't believe it - here was a group of articulate, angry, witty, sarcastic women who were just as pissed off as I was! For a long time, I lurked, silently and nervously - it seemed such a tight-knit community, would they let me in?

Eventually, I took a deep breath and started writing. It felt a bit like throwing a message in a bottle into the ocean - I had no idea whether anybody out there was actually reading. But then Melissa actually mentioned something I'd written in one of her Friday roundups! Gradually, the comments started to come and I began to realise that I was in fact part of an extraordinary grass-roots movement. When my first IVF cycle was cancelled and I put out a plea for help on Lost & Found, so many people whose blogs I'd never even visited before rallied round to offer their support and advice. After I'd been away for a few days last week, several people stopped by to say 'welcome home' - and at the moment, this does feel like home. I know that, here in the blogosphere, I will meet with more support and understanding than I have received from the majority of my 'real life' friends. I'm sorry that I haven't been around over the past week - I've been lax at commenting, as well as posting - but just wanted to say thank you, all of you, for being there.

Wednesday, 19 March 2008


Over the course of the past few days, it has been suggested to me that, if only I could 'just relax', I might still manage to conceive 'naturally'. I have been regaled with tales of a friend of a friend of my sister-in-law's who apparently did just that, and who then miraculously fell pregnant just before she was due to start her first cycle of IVF. I have been asked to consider the possibility that perhaps we are not meant to have children of our own and that, given the circumstances, we could always 'just adopt'.

All of the above is, of course, standard assvice. Anyone struggling with infertility will doubtless have heard similar things before from their own friends and family. But why is it considered helpful, or even acceptable, to say these things? Do these stock responses in fact say rather more about their embarrassment and discomfort, than about my infertility? It strikes me that there is at the moment no broader discourse on infertility and loss - or rather, that in the act of telling our stories and sharing our experiences, we are in the process of creating one here in the blogosphere. Unfortunately, however, the ripple effect seems slow to spread. Perhaps in time, people will begin to have greater understanding of the difficulties associated with infertility, and will stop and think before coming out with this crap.

Surprisingly enough, none of this came from my mother-in-law, who managed studiously to avoid the topic of our infertility - instead, she spent much of the weekend criticising Mr H and cooking up the type of highly-processed food that I never buy at home - over the course of the weekend, I've eaten more saturated fat and refined carbohydrates than ever I would in a month of Sundays.

I am accordingly both exasperated and bloated, but indescribably relieved to be back home!

Wednesday, 12 March 2008

My mother-in-law

Mr H's mother is a woman of firm and decided opinions, many of which appear to have been gleaned directly from the pages of the Daily Mail. She is a devout Catholic, I am a committed feminist. There are many issues on which we do not see eye-to-eye: a woman's right to choose, UK immigration policy.... I could go on.

Mr H is one of five children - a fact which may well be attributable to his mother's religious beliefs, rather than to any strong maternal instinct on her part. She fell pregnant with Mr H and his brother soon after getting married and, in her own words, was 'absolutely devastated' to discover that she was carrying twins: 'I didn't want to be pregnant at all, let alone be having two babies'. Ten months after Mr H and his brother were born, she gave birth to a daughter. After what one can only assume to be a period of some twelve years' abstinence, there then followed two further babies - a girl and then, five years later, a boy. Although I can accept that ambivalence plays a necessary and important role in mothering, and that coping with three young children ten months apart in age is in particular a lot to contend with, from what Mr H has told me about his childhood, his mother reminds me of nothing so much as a turtle, who swims up to the beach, lays her eggs and then basically f**ks off and leaves her offspring to get on with it.

I will draw a veil over many of the more tactless remarks she has made over the time we've been struggling with infertility - suffice it to say that our difficulties in conceiving have not met with any degree of understanding or compassion from Mr H's mother. After I miscarried, she sent Mr H an email (she apparently could not be bothered to pick up the phone to speak to either of us in person). One particular sentence will forever be engrained on my memory (and please bear in mind that, at that stage, we thought we were dealing with male factor issues only): 'it is good that Ms H has finally relaxed enough in order to be able to conceive. Maybe next time, when she is less stressed about her studies, she will manage to carry to term.'

I was - and still am - speechless at her insensitivity. Had she perhaps been reading one of the many Victorian medical textbooks that warn of the dire effects of intellectual work upon a woman's reproductive system, or was this something she'd picked up from the Daily Mail? Does she in all honesty believe that my eggs have been addled by too much thinking?

Mr H has a few days' holiday left, which have to be taken by the end of the month. We are accordingly going down south to spend a long weekend with his parents. When you also factor in the smug fertiles and their intrusive questions, I think it will be a miracle if I get through the next four days without losing my temper and telling someone exactly what I think of them.

Monday, 10 March 2008

Letter to my body

We've been together a long time, you and I. Like many long-term relationships, ours has shifted and developed over time.

In my teenage years, I was very bothered about how you looked. I spent a lot of time comparing you to other women's bodies. I measured you against the bodies of my friends, and against the bodies of the airbrushed models in fashion magazines, and I felt inadequate in comparison - somehow, you didn't quite seem to measure up. At that stage in my life, I was hung up on external appearances; your internal rhythms remained a mystery to me; your monthly bleeds were nothing more than a messy inconvenience.

In my twenties, a late period was a cause for panic, rather than optimism. The decade seemed to pass by in a whirl. I stayed out late, and subsisted on coffee and KitKats. I took it for granted that you could handle whatever I threw at you. I didn't treat you with the respect you deserved. For all the Big Macs and the tequila slammers, I am truly sorry.

In my thirties, I began to take better care of you. I ate right, and exercised. And I grew increasingly angry with you when you failed to repay that care. I felt frustrated and betrayed by your inability to do what you were designed to do - to conceive and sustain new life. Paradoxically, it was only after I suffered a miscarriage that I was able to let some of those negative feelings go. The only way I could begin to come to terms with having lost a baby was by trusting in you - by accepting the fact that you had recognised that the foetus was not viable, and so had dealt with it as quickly and efficiently as you could. I decided that I needed to have a little more faith in you; I learnt to respect your rhythms and chart your cycles. But the odds were stacked against us - tests had revealed that there were fairly major problems with Mr H's sperm. And so we felt we had no option but to turn to ART - ICSI, to be precise.

Over the past three months, I've put you through a lot. I've pumped you full of artificial hormones designed to put you into a temporary menopause. As if that wasn't enough, I then took even more drugs designed to make you work overtime, and to produce more eggs than ever you would when left to your own devices. And, perhaps understandably, you rebelled. You failed to respond to those drugs.

Next month, I'm going to ask you to do the same thing all over again - only we'll be using even more drugs. And this time round, I need you to trust me; as alien and as counter-intuitive it might feel to you, this seems to be the only way for us to have a baby. Please, please work with me on this next cycle.

Yours, hopefully,

Ms H xx

The Letter to My Body project was initiated over at BlogHer. My own letter was prompted by Melissa's thoughtful post on how infertile women in particular view their bodies. You can read Mel's own letter, as well as links to those of other women struggling with infertility and loss by following this link.

Thursday, 6 March 2008

Plan of action

Yesterday, we returned to the Great Big Fertility Clinic for our review appointment with Dr Abrupt.

Dr Abrupt, I am now beginning to appreciate, responds better when confronted with specific questions, as long as they are not overly emotive, and are couched in relatively scientific language. 'Are my ovaries on their last legs?', for example, will not meet with a good response. If, on the other hand, this same question is rephrased as, 'How worried should I be at this stage about diminished ovarian reserve, or could my poor response to the last cycle simply be down to either over-suppression or under-stimulation?', he is more willing to engage in dialogue.

His answer to the above was that, at this stage, we simply don't know. Once again, he reiterated that my FSH levels (7.6 in March 2007, 5.6 in September 2007) did not appear to indicate any underlying problem which could have been anticipated before we started treatment in December; we simply have to try a different protocol and see what happens this time round.

He recommended that we wait another month before trying another cycle. This time round, we will do a shorter, 'flare' protocol, and will triple the dose of Menopur from 150iu to 450iu. I did ask why he thought Menopur was the best option - would I perhaps respond better to a recombinant? He referred to an unspecified meta-analysis (as anyone who has read of my prior dealings with Dr A will know, he is very keen on statistics and meta-analyses) which suggested that the choice of either a recombinant or a urinary based stimulant did not appear to have any major impact on success rates. Having had such a poor response to the Menopur last time round, I do feel a little bit iffy about taking it again, and will perhaps raise this particular concern with him at our next appointment.

He also suggested that, this time round, we would definitely proceed to retrieval, whatever my response. We are now at the stage where he feels it necessary to have a sense of the quality of any eggs I do produce - that way, he will be able to advise us on whether he feels that there is any point in us continuing treatment.

Such a lot is riding on this next cycle. Although there is a tiny voice inside me telling me not to panic, that I could well be OK on this new, more aggressive protocol, there is a far larger part of me that is trying to begin to find a way of processing the fact that this cycle could possibly mark the end of the road for us.

Monday, 3 March 2008

The (Infertility) Time Warp

Last week, I stepped off the treatment treadmill. I drank coffee! And wine! Had I been able to find anywhere in Granada that served sushi, I'd have probably eaten that as well... but instead, I gorged myself on tapas - salt cod croquetas, albondigas, calamares and pulpo alla gallega. We visited the Alhambra, and had a memorable meal in a Lebanese restaurant in El Albaicin, the old Moorish quarter of Granada (as you may be able to tell, Mr H and I lay down our holiday memories in terms of what we ate - a week in Nice, for example, is now largely defined by an exceptional tarte au chocolat, which still sparks fond reminiscences two and a half years later).

But the best thing about going away? Spending time with my husband. Infertility, I have come to realise, can make it extraordinarily difficult for one to live fully in the present. Instead, I seem to spend much of my time trying to second-guess what the future may hold. The reality is that at the moment we simply don't know whether we will have a child or not, and so we have endless conversations about whether we should move house, or whether we should wait until things have resolved themselves one way or another. I worry about whether I should go all out to get a permanent job, or whether I should put my career plans on hold while I focus on IVF.

As soon as I realised that our first cycle of IVF was going to have to be cancelled due to my poor response, I was looking to the next cycle. What will we do differently next time? How soon can I start treatment again? Even when we are not undergoing treatment, I find it difficult not to think in two-week increments; either I am awaiting the moment when I am ovulating, or I am looking out for the signs of early pregnancy - and then my period starts, and the whole cycle of hope and disappointment begins all over again.

I'm so busy thinking about what is currently missing from my life that I don't spend nearly time appreciating what I do have. But last week, I realised how lucky I am. I am married to a wonderful man, who makes me laugh. Even after seven and a half years, I can still get butterflies in my stomach when I look at Mr H across a room. We can stay up late into the night talking, but equally we can sit in companionable silence, each lost in our respective books. Things will undoubtedly be different if we don't have children, but our lives will not be over. And so I have resolved to stop endlessly trying to project myself into the future, and to focus more on enjoying what is going on in the here-and-now.