Thursday, 31 July 2008

Building bridges?

Luna recently wrote a thoughtful post in which she asked why she found herself unwilling or unable or unprepared to approach certain topics on her blog. "Is it simply a matter of time? too soon or too late? too personal? too overwhelming, complex or confusing? Am I too lazy? too defensive or protective? too afraid (and if so, of what)? Am I not in touch with how I feel enough to articulate it? Am I trying to retain some sense of privacy that is forever lost when sharing an intimate thought or fear? Am I simply trying to exercise some discretion? Or are there just certain words that must remain unspoken, at least for now." She came to the conclusion that it was perhaps "a bit of everything".

I too am struggling with similar questions. I started blogging in a bid to try to make sense of what I was going through, and also as a means of connecting with others who were in a similar situation. And in the process I have found myself part of a much larger, grass-roots movement. It strikes me that part of what is happening here in the blogosphere is what second-wave feminists might have termed 'consciousness raising': in sharing and analysing our own personal experiences, we are in the process of creating a discourse on infertility and pregnancy loss, and that awareness of these issues is - however slowly - beginning to filter out into wider society.

On another level altogether, I often experience a sudden flash of recognition when reading other people's blogs. Sometimes it seems that others are able to articulate what I cannot: it is only through reading other women's stories that I am able to gain access to parts of my own life narrative.

What we cannot or will not say can be as revealing as what we do say. I often have ideas for posts that I don't write - this may be because I simply never get round to it, or because after a few days whatever it was I wanted to say no longer seems that important. But there are other things which I consciously avoid writing about, most notably my work. I am anxious lest anyone should search for either my real name or my research topic and be led here to my blog.

And yet it is becoming increasingly difficult for me to maintain such a clear cut separation between my interests as a feminist academic, and my lived experiences as an infertile woman. In the spirit of Mel's latest initiative, I want to try and build bridges between these two areas of my life. And so I am beginning to gather material for a book that examines the feminist discourse on infertility (or, perhaps more accurately, the lack thereof). I'm interested in the fact that, while feminism has been quick to embrace the possibilities represented by ART (ART has been seen by many feminist theorists as a positive thing, in that it loosens the ties that bind motherhood to biology), it is noticeably silent on the impact that infertility can have on our identity as women.

Friday, 25 July 2008

It's a mixed up, muddled up, shook up world

Sometimes I wonder what the world is coming to. First there was the whole waxing incident, and now this.

Since when did daily hormone injections and scans take the stress out of trying to get pregnant?!?

For the love of g*d! IVF isn't a lifestyle choice for celebrities who are "too impatient" to try and conceive a child through good, old-fashioned, loving sex, or who just want to "knock out" two babies in one go, so they can reach their target number of kids. It is a MEDICAL treatment, which was developed to help those with MEDICAL conditions.

No wonder we have to keep spelling it out.

Tuesday, 22 July 2008

Is nowhere safe?

I have just got back from having my monthly brow and bikini wax.

When I arrived at the salon, there was no-one at the reception desk. All of a sudden, a very bright and smiley woman appeared from out of nowhere. Was I there for my ultrasound, she asked.

Like many women, I like to have a little tidy up before my dates with the dildo cam. I generally make sure that I book in for a wax the week before my first appointment at the clinic. Had I somehow mixed up the two appointments in my diary? I stopped for a moment to double-check. I was definitely in the beauty salon, and not the Great Big Infertility Clinic.

No, I was fairly sure that I had a waxing appointment, I replied.

"Take a seat in the waiting area," the smiley woman said, ushering me into a room full of women in varying stages of pregnancy.

"Are you here for a scan, too?" asked the woman next to me, happily stroking her belly. "I'm so excited, I can't wait to see how much the baby's grown."

By this stage, I was beginning to feel like I had stumbled into the Infertility Twilight Zone. All became clear, however, once I finally got in to my appointment. The therapist explained to me that they had decided to rent out a room to a private medical company that performs those 4D scans where you get to see the baby suck its thumb, yawn etc, etc.

And so it seems that nowhere is safe. I can't even get a wax without being surrounded by reminders of my infertility.

Tuesday, 15 July 2008

Happy birthday, Louise Brown!

Louise Brown, the first ever baby to be born as a result of IVF, is thirty years old today.

The BBC news coverage of her birthday celebrations highlights the fact that, although IVF was pioneered in the UK, the majority of cycles undertaken in this country are paid for privately. Professor Robert Edwards, one of the doctors responsible for developing the treatment, voiced his regret that IVF was not more widely available on the National Health Service (NHS).

In 2004, the National Institute for Health and Clinical Excellence (NICE, the financial watchdog for the NHS) recommended that all infertile couples in which the female partner is aged between 23 and 39 should be offered three fully funded cycles of IVF.

The NHS is administered by a number of different Primary Care Trusts (PCTs), each of which is responsible for delivering health care to their local area. Each individual PCT manages its own budget and sets its own priorities. What this in effect means is that access to certain therapies - and even to certain drugs - is determined by where in the country you live (the so-called 'postcode lottery').

Figures recently released by the government have revealed that, out of a total of 151 PCTs, only nine are offering the recommended three cycles of IVF. About two-thirds of the trusts offer only one cycle. Four offer no funding for IVF whatsoever. More than half reject those who already have children, including those from previous relationships. Many impose additional social criteria: 35 trusts specify that neither partner must smoke, 30 say that patients must be in a stable relationship, and 33 impose age restrictions beyond those in the NICE guidelines.

We have been on an NHS waiting list for IVF treatment since October 2004. During that time, we foolishly decided to move house. Our new PCT was not willing to take into account the time we had already spent on the waiting list in another area, and so we went to the bottom of their list. In May 2007, we received a letter explaining that, owing to financial difficulties, the PCT had taken the decision to withdraw all funding for assisted conception treatments. That funding has yet to be reinstated.

We are fortunate that we have been able to save the money to pay for private treatment. But, to many couples, an NHS funded cycle represents their only chance for a baby. Whether or not they get that chance is determined by where in the country they live.

But, regardless of the iniquities of the postcode lottery, today I would like to propose a toast: to Louise Brown, and the 3 million other babies that have been born as a result of IVF, and to Robert Edwards and his colleague Patrick Steptoe, who together pioneered the treatment, for giving infertile couples the hope of having a child.

Thursday, 10 July 2008

When is it time to let go?

Last week, many British newspapers featured an item about a woman who had just given birth to a daughter conceived after she had advertised, first in the window of her local newsagents and then on the back of a London bus, for an egg donor. She was fifty-six years old.

This story could - and should - have generated debate about the severe shortage of both egg and sperm donors in this country. Instead, it provoked a range of predictable concerns about the so-called 'selfishness' of women determined to extend their reproductive life beyond what is 'naturally' possible. I listened to a radio phone-in on the topic, in which several callers pointed out that the woman in question would be in her seventies by the time her daughter was a teenager, and would in all probability not live long enough to see her mature into an adult woman.

This is, perhaps, a legitimate concern. Having suffered the effects of premature maternal bereavement first hand, I know how traumatic the loss of a mother during late adolescence/early adulthood can be. My mother was first diagnosed with breast cancer when she was thirty seven, just one year older than I am now. She died two months after her forty-fourth birthday. As I have grown older, I have become less convinced that I am destined to follow the same way, and yet it is always in the back of my mind: if I have a child now, and die at the same age as my mother, then that child will be just seven years old. In my experience, mothers do die, and leave their children before they are ready, and I cannot help but worry that that may happen again.

But this case also sent me back to the perennial question, when is enough, enough? At what point do you decide to let go, to move on, to build a life for yourself beyond infertility? I seem to have spent much of my thirties trying unsuccessfully to have a baby. And I am tired - I am tired of the endless monthly cycles of hope and disappointment. I am tired of the repeated minor surgeries, of the injections and internal scans. I am tired of having to plaster a pleased expression on my face whenever I hear about someone else's surprise pregnancy. I am tired of crying all the time. I am tired of feeling a failure. I don't know how much longer I can keep putting myself through this. I cannot imagine that in another twenty years, I will still be plugging away at fertility treatments, still living from cycle to cycle.

Given my most recent prognosis, I can no longer believe unconditionally in happy endings. Of course I have hope that I may yet have a child, but I am also beginning to confront the fact that childlessness remains a very real possibility. I know that I will be forever scarred by infertility. I feel that it has robbed me of a major part of my identity as a woman. There will, of course, always be reminders of the baby I lost, of the children I might have had. And yet, I hope that, over time, I will journey towards some kind of acceptance. My life will follow a different course from the one I had envisaged, but it will continue nonetheless.

But what happens if, when other women my age are seeing their children off to university, or even welcoming their first grandchild, I am still longing for a baby? What if that deep, visceral ache for a child never subsides?

Monday, 7 July 2008

Telling it like it is

After our first cycle of IVF was cancelled, I asked Dr Abrupt whether my poor response could be down to diminished ovarian reserve. He replied that, at that stage, he could not be sure. All we could do was to try again with a different protocol and an increased dose of stimulants, and to hope for a better response next time round. After our second cycle yielded only three mature eggs, I again raised the possibility of diminished ovarian reserve, this time with Dr Approachable. Was it time for me to give up, I asked. Just last month, Dr Approachable suggested that my antral follicle count was such that he did consider it worthwhile me pursuing further treatment.

This morning I received a copy of a letter sent by Dr Abrupt to my GP (general practitioner), informing her that he had performed a hysteroscopy to remove my polyp last week. He also took the opportunity to fill her in on my most recent cycle of IVF, and to tell her that he considers my poor response to stimulation to be a reflection of 'reduced ovarian reserve, reduced ovarian function and reduced fertility potential of the eggs within the ovaries.'

This isn't entirely unexpected news, and yet it still came as a shock to see it written down in such bald terms. It is, moreover, entirely unacceptable that Dr Abrupt saw fit to communicate this to my GP, yet apparently did not think it worth his while to explain it directly to me, his patient. It also raises the question of whether or not we should go ahead with another cycle, as recommended by Dr Approachable, or whether it is in fact time for us to begin looking into other options, such as egg donation.

But, however angry I may be at the manner in which it was communicated to me, the facts of the matter remain. My ovaries are on their last legs. My eggs are past their use-by date. I have in all likelihood left it too late to have a baby.

Wednesday, 2 July 2008

Hasta la vista, polyp!

My polyp is no more. It has ceased to be. It is, in fact, an ex-polyp.

I went in on Monday to have it removed. Fortunately, my private health insurance agreed to cover the cost of the hysteroscopy, and so I was able to go to the Fancy Private Hospital just over the road from the Great Big Infertility Clinic. Dr Approachable is away on his summer holidays at the moment, so the procedure was carried out by Dr Abrupt (who, incidentally, is far less abrupt when working out of the Fancy Private Hospital; perhaps the coffee is better over the road, or the chairs in the doctors' lounge more comfortable?)

Having had a laporoscopy in the past, I had been gearing up for something similar this time round, so was pleasantly surprised to learn that a hysteroscopy is a far more minor procedure. I was able to come home within a couple of hours of waking up, and spent much of yesterday on the sofa, reading magazines and catching up on the second series of Brothers and Sisters. I feel pretty much back to normal today, though.

Dr Abrupt came to see me just before I was discharged. He said that he'd taken the opportunity 'to have a good look round in there', and that everything looked perfectly fine. The polyp appeared benign, and my two small fibroids do not seem to be affecting the endometrium in any way. He is happy to attempt a natural FET on my next cycle.

And so, after the best part of two months on the bench, I will climbing back on board the ART rollercoaster.