Wednesday, 25 June 2008

June is the cruellest month

This month marks the anniversary not only of my miscarriage, but also of my mother's death.

It is seventeen years today since my mother died. She had just turned forty-four. I was nineteen.

In the first few weeks and months after her death, I thought that I would somehow sense her presence, or hear her voice. It took me a long time to accept the finality of death, that my mother had gone and was never coming back. Even now, I still dream about her. In those dreams, she hasn't come back to pass on some significant piece of advice or family lore, instead she is just simply there - sitting at the kitchen table drinking a cup or tea, or else stirring something on the stove. I wake up and, just for a split second, I am able to believe that she never really went away. But then the fact of her dying registers with renewed violence, and suddenly I am reduced not even to a young woman struggling to find her way in the adult world without a mother's guidance, but to a little girl who wants her mummy.

As many feminist psychologists and psychoanalysts have suggested, the experience of motherhood inevitably stirs up a woman's memories and fantasies surrounding her own mother. In becoming a mother herself, a woman identifies--whether consciously or unconsciously--with her mother. She tends to use her childhood experiences as a blueprint for her own mothering. For the motherless woman, motherhood thus holds out a particular promise: it enables her to re-enter the mother-child relationship, and hence to reconnect with her own mother.

Infertility has robbed me of that chance. Instead, as I mourn both the mother I once had, and the child I might have had, I feel that my links with what Jungian analyst Naomi Lowinsky calls the "motherline" have been irrevocably severed. I feel lost. Cast adrift. And it is at moments such as this that it seems that all I am ever going to feel is grief, loss and emptiness.

Monday, 23 June 2008

Halving it all?

Thanks to Bitch PhD, I came across an interesting article in the The New York Times about shared parenting.

In parts, the article makes for depressing reading. It cites some recent research carried out by the University of Wisconsin, which revealed that the average wife does 31 hours of housework a week while the average husband does 14 - a ratio of slightly more than two to one. As one academic interviewed for the article points out, this ratio has not altered substantially over the past ninety years: back in the days when women had to tend fires and put clothes through the wringer and then hang them outside to dry, the average woman spent 50 hours a week on housework, and the average man 20.

The article set me thinking about the division of labour within my own marriage. Our current lifestyle is by and large enabled by two things: Mr H's salary, and my unpaid domestic labour. Although I do some part-time teaching when the opportunity arises, to all intents and purposes Mr H is the sole earner. He has assumed full responsibility for covering all our monthly outgoings while I am writing up my PhD. Looking at other postgraduate students, many of whom are struggling to hold down several part-time jobs while also trying to write up, I realise how lucky this makes me.

In return, I do the bulk of the shopping, cooking, cleaning and laundry. Sometimes I resent this - particularly at weekends, when he is sitting in the living room watching the television, while I am scrubbing the bathroom or changing the bed linen. Once I am able to take on more regular paid work and am contributing to the household finances, the situation will have to change. Either we will have to divide the chores more equally, or we will have to use some of that extra income to pay for extra help around the home.

But how would this change if we were to have a child? For the purposes of the University of Wisconsin survey, housework was defined as things like cooking, cleaning, yardwork and home repairs. Child care was an entirely separate category: where the housework ratio was two to one, the wife-to-husband ratio for child care in the United States turned out to be closer to five to one.

For the NYT article, author Lisa Belkin interviewed a number of couples who were determined to buck the trend, and to take equal responsibility both for parenting and for domestic chores. What I took from the article was just how hard they had to work to achieve this - not because of any ingrained resistance on the part of either partner - but because of a marked reluctance by employers to afford their employees, whether men or women, the right to flexible working.

One of the couples interviewed said that, before having children, they had decided to get a dog. The husband explained that it was a kind of 'test' to see how willing they both were to change their schedules to accommodate this additional responsibility: "we would have to decide who would take the dog out at night, who would walk her early in the morning, who could work with vomit.”

Although Mr H is very good at dealing with vomit, the cat remains by and large my responsibility: I am the one who remembers to buy more cat food, who knows when her vaccinations are due, who arranges to take her to the vet. Interestingly, the cat herself appears to perceive me as her primary care giver: when she decides at 5 o'clock in the morning that it is in fact time for breakfast, it is me who is awoken by a polite but persistent paw tapping at my face!

Would this also be the case if we were to have children? I think that both of us would have to work very hard to ensure that it did not become so. As Bitch PhD points out, if equal parenting is going to work, both parents have to want it equally. On this issue at least, "feminism needs men, which means we *all* have to get over our gender essentialism."

Both Mr H and I are the products of very traditionally gendered relationships: both of our fathers were the sole earners, while our mothers assumed full responsibility for the home and for childcare. For better or worse, that remains our model of a successful marriage. There are moments when - in spite of all our intentions - we tend to fall back upon stereotypical ideas of what constitutes "men's work" and "women's work": he takes out the rubbish and checks the oil in the car, while I do the laundry (I do, however, draw the line at ironing his work shirts!). The knack is, I think, to be aware of what kind of assumptions underlie these decisions, and to continue striving towards a relationship in which we are both equal partners and peers - even if this is sometimes easier said than done.

Thursday, 19 June 2008

Infertility and the City

Even among its detractors, it is generally acknowledged that, in its frank portrayal of female sexual freedom and unconditional friendship, Sex and the City was a ground-breaking television series. As well as some amazing outfits, it also covered some pretty serious issues along the way: the challenges of combining motherhood and a career, breast cancer and, something particularly close to my heart, infertility. The title of this blog was indeed inspired by Charlotte's infamous comment that she wasn't barren, just reproductively challenged.

But SATC was also ultimately a fairy tale, a fantasy in which no-one ever so much as popped out for a pint of milk unless they were wearing full makeup and a pair of Manolos. And that is why those who criticised the ending of the original series were perhaps missing the point. As all little girls learn very early on, at the end of every fairy tale, the princess settles down with a handsome prince and lives Happily Ever After. Carrie was always going to end up back together with Big, and even Samantha was probably going to fall for someone at some point (although that particular plot line said more to me about how uncomfortable our society continues to be with actively desiring women once they reach their forties and fifties - once female sexuality is no longer tied to its reproductive function, in other words).

But sometimes we could all use a bit of harmless escapism. Mr H started his new job this week, and flew out to Madrid first thing on Monday morning. In his absence, I am struggling on with the slow, hard slog of writing. Home alone, I find that my inability to conceive or to carry to term a child is weighing even more heavily than usual. And so I decided to take myself off to the cinema, to renew my acquaintance with Samantha, Charlotte, Miranda and Carrie. All I really wanted was to forget about the PhD and the failed cycles of IVF, and to enjoy a couple of hours of fashion and frippery.

And then it happened. Even sitting in the dark at the cinema, I am apparently not safe from the news of other people's surprise pregnancies. Perhaps I should have been better prepared for Charlotte's little announcement; as I wrote above, happy endings are, after all, pretty much inevitable in SATC land.

What saddens me about this aspect of the film was the inference that adoption didn't quite provide a happy enough ending, and that the best possible outcome to an infertility storyline is a child that is genetically related to both its parents. What kind of message does that send out to those who have adopted, or who are considering adoption, or indeed to those who are themselves adopted?

But what really, really angered me about it was that, in breaking the news to Carrie, Charlotte went on to say that, according to her doctor, this happens all the time, that lots and lots of previously infertile women suddenly get pregnant just after they've adopted (Really? Does anybody out there know anyone in this situation? No? Me neither!), and that sometimes all you need to do is to stop trying so hard.

So, according to Sex and the City, all any woman struggling with infertility needs to do is to relax! Sound familiar?

When even such an influential cultural product as SATC continues to perpetuate such myths, then it becomes difficult to hold out much hope that social attitudes towards those struggling with infertility will change at any point in the near future.

Thursday, 12 June 2008

In remembrance of things past

Once upon a time, I was one of those women - you know, the ones who we're all secretly convinced are in fact an urban infertility myth - the ones who get pregnant just before they're about to start their first cycle of IVF.

The month before we were due to start treatment, we went on holiday. I'd stopped charting at that point, so it wasn't until we got back home that I realised that I was a whole week late. Prompted by Mr H, I took a home pregnancy test for the first time in my life. I sat and watched incredulously as that magical second line appeared. Just to be sure, I took another test the following morning - and there it was again. I went to the doctor's, where a third test confirmed that yes, I was in fact pregnant. For two whole weeks, I hugged the precious secret of my pregnancy to myself. With every wave of nausea, it started to seem more and more real.

And then the bleeding started.

They booked me in for a scan later on in the week, but by then I already knew that I'd lost my baby. 'You've been a very lucky girl,' said the sonographer. 'The evacuation is more or less complete; you won't need surgery.' And so, two years ago to this day, I was discharged from the early pregnancy assessment unit at our local hospital.

That was it. My one brief experience of pregnancy.

And two years on, two attempts at IVF down the line, I can't help but wonder whether that was in fact my one shot, my only chance. Would all the subsequent BFNs somehow be easier to deal with if I hadn't had that one brief positive?

Monday, 9 June 2008

Polyp watch

On Saturday morning, we returned to the Great Big Infertility Clinic, where a scan revealed that, despite my best attempts to jiggle it loose via an extended session on the Powerplate at the gym, the polyp still continues to cling stubbornly to the wall of my uterus.

How was I, asked Dr Approachable.

I explained that, after two poor responses, I was wondering how many more times I could put myself through all this. Was it perhaps time to start exploring other options, such as egg donation?

And then Dr Approachable uttered the magic words, 'Well, I'm not willing to give up on you just yet.'

Although he and I both now agree that my left ovary does not appear to be functioning as it should, the (Day 9) scan revealed eight follicles on my right ovary. Dr A considers this an indication that there is still clearly something left to stimulate, and so is not willing definitively to diagnose diminished ovarian reserve. He has a plan of action:

First of all, I need a hysteroscopy to deal with the polyp. I phoned my private health insurers this morning to check if this is covered under my policy. They will not pay if it is being done as part and parcel of fertility treatment (UK health insurers will not cover anything whatsoever to do with assisted conception), but will do so if Dr A is willing to recommend that it is an abnormality which should be investigated and removed regardless. If they won't pay, then we will have no option but to find the money ourselves, or else to sit it out on an NHS waiting list.

Once the polyp has been dealt with, we will then attempt to thaw and transfer the one embryo that resulted from this last cycle. Since I ovulate regularly, Dr A suggested that we do a natural cycle FET. I am more than happy to go along with this, as I am reluctant to pump myself full of yet more drugs - particularly when there is a possibility that that one embryo may not survive the freezing process.

If the FET doesn't work, then Dr A recommended that we try an antagonist protocol next time round. In contrast to many of our previous appointments at the Great Big Infertility Clinic, where I've barely had a chance to put my knickers back on before being hussled out of the door, he was in particularly relaxed and chatty mode (perhaps it being a Saturday had something to do with it), and explained in detail the different effects of GnRH agonists and antagonists on the pituitary gland. Given that I haven't responded particularly well either to a long or a short GnRH agonist protocol, he feels that an antagonist protocol may be a better option for us.

We also had a lengthy conversation about the pros and cons of urinary vs. recombinant FSH. Dr A remains a fan of urinary FSH, as he believes that it has the added benefit of LH, which may help with the quality - if not the quantity - of eggs produced.

I'm still struggling with the question, when is enough, enough? But I think I'm coming round to the idea that all any of us can do is take things one step at a time, one cycle at a time. So, first things first, I'm going to deal with the polyp.

Monday, 2 June 2008

What I learned from Voltaire about infertility

For my French A level, I studied Voltaire's satiric novel, Candide. Its eponymous hero is at the outset a rather naively optimistic young man, who has been brought up to believe that everything happens for the best. Over the course of the novel, he undergoes a series of ever more improbable adventures, and witnesses the widespread and random destruction caused by both war and natural disasters such as earthquakes and tsunamis. He is captured and tortured by the Inquisition, before making his escape to South America, where he acquires - and loses - a vast fortune. On his adventures, Candide also meets a number of different characters, who try to engage him in philosophical debate as to the broader meaning of the events that constantly overtake him. At the end of the novel, he is reunited with his great love, Cunegonde, and his old tutor Pangloss. He has also had enough of philosophical debate. 'That's all very well,' he says to Pangloss, 'but now we must cultivate our garden.'

Voltaire is right. We can waste an awful lot of time wondering 'why?' and 'what if?'. Sometimes terrible things do just happen. Our infertility was not caused by anything we did or did not do; it is rather just a piece of biological bad luck, a random instance of dodgy plumbing. And there are indeed times when all any of us can do is tend to our gardens.

We live in one of a row of small terraced houses that was initially built by an enlightened Victorian factory owner to house his workers. What my father somewhat grandly refers to as my 'courtyard garden' is in fact a small back yard, which would originally have housed the coal shed and the outside privy, but which is now filled with an ever-expanding collection of pots, in which I attempt to cultivate a selection of flowers, vegetables and herbs. Although my efforts pale in comparison with those of some of my fellow bloggers, I am quite happy pottering about in my yard.

I do have one raised bed, which has largely been taken over by a very vigorous passion flower that has a tendency to choke all other plants in its vicinity. At the weekend, I went out into the yard armed with a pair of secateurs, intending to chop it into submission. But then I discovered a small nest right in the very centre of the plant. Inside the nest are three bright blue eggs.

I am trying very hard not to attach any wider symbolic significance to the eventual fate of these three eggs.