This is the first blog post I ever wrote. It was first published on Medium on 12 November, 2016, during my second miscarriage. Our daughter was born around a year later.
It wasn’t until a few years later that I properly grieved our two miscarriages and two failed IVF attempts as the loss of four babies in one year. Before that I hadn’t really thought of them as baby losses. In my head they were incredibly difficult events that had happened to me and my husband.
Having let myself grieve properly I feel more at peace with this time in my life. The babies we lost will always be part of our family story.
Living with uncertainty—our infertility story
In January 2013 two things happened which have shaped everything about my life since then: I was given approval to take a year-long career break (which I kicked off with three months of trail-building in Iceland), and I got together with the man who would become my husband.
Being the intense people we are, and knowing that after just a few months of being together we’d be embarking on a long-distance relationship, we had a lot of Very Serious Relationship Conversations early on. Amongst other things we discovered that we did both want to have children, and that—although we had very different career aspirations—we could imagine enough ways to make a shared life work for both of us that it was worth pushing through a difficult first year of mostly being apart.
Fast forward two and a half years: having taken the plunge and quit my job I was busy working on my MSc thesis, we were in the depths of wedding planning, my fiancé had just started his dream job in the City, and with my 35th birthday fast approaching, my biological clock was ticking away ever more insistently.
Being very much a Planner, I decided to have a fertility MOT, in the hopes of being told I’d still got a year or two to get my new career established before needing to worry about starting a family. Instead, one morning in June, I was told that my egg reserve was already so low that we should start trying to conceive immediately, that we shouldn’t even wait the five months until our wedding, and that if we weren’t lucky enough to conceive within six months we should think seriously about starting fertility treatment.
I cried a lot that day.
A fertility specialist and family friend told us that, in one study, five out of six women with a similar egg reserve to mine conceived within three months—cue a mixture of excitement and terror at what life might have in store for us in a much shorter time-frame than we had anticipated. For us though, three months become five and, much to the relief of my dressmaker, no adjustments were needed to my wedding dress.
On the day after our wedding, we decided it was time to pay attention to the fact that, although my cycles are irregular, my period did seem to be a couple of days late. It was such a joyful end to an incredibly happy weekend to be able to call our parents and let them know that I was pregnant! The following week passed in a blur of GP appointments and honeymoon logistics—I wasn’t supposed to take the required antimalarials in my newly pregnant state so we had to fully change our destination with a week’s notice. Thank goodness for decent travel insurance and our wonderful travel agent.
For a week and a half I loved knowing I was pregnant, but it was short-lived. We were well aware of the likelihood of miscarriage—one in five confirmed pregnancies don’t make it to full term—but I was in no way prepared for the gory physical reality. After a D&C under general anaesthetic to stop the bleeding, we went on to enjoy the rest of our honeymoon, although in a more subdued way than anticipated. Back home, the timing of my miscarriage made it particularly difficult when catching up with friends—happy questions about our honeymoon always brought a flood of emotion, but never seemed to be an appropriate time to talk about our loss.
It’s been really hard to have such a huge part of our lives be something that’s so difficult to share. The convention of not announcing a pregnancy until after the twelve week scan is primarily a way of ensuring that we don’t have to talk about miscarriage. At an individual level I can see the logic—if you announce a pregnancy to the world too soon you risk having to make a very private grief public—but I believe that removing this cultural practice of secrecy would in itself make sharing that grief a more positive experience. I hope that talking openly about our story will go some small way towards making that change.
The “internet ladies”, who post about every aspect of their fertility journeys on forums and blogs, are an antidote to this secrecy, and they’ve formed the backdrop to our fertility story. I turn to them for advice on practical things we can do to increase our chances, to read similar stories to ours in an attempt to feel less alone, and to find validation and empathy for the roller-coaster of emotions I’ve gone through—everything from guilt and jealousy to rage and despair.
Although treatments have come a long way since the first “test tube baby” was born in 1978, a huge amount is still unknown about the world of fertility, partly because of the ethical difficulties of carrying out controlled experiments on women who are trying to get pregnant. Of the one in seven couples who have fertility problems, 15–30% are only ever given a diagnosis of “unexplained infertility”. In our case, although we know that aged 34 I probably had fewer eggs left than the average 45 year old, we don’t know much about the quality of my eggs, and no-one can tell us how soon I’ll go into menopause—leaving us with a strong, but vague, sense of time running out.
This lack of evidence leaves a lot of room for speculation, as women try to piece together information on what might be stopping them from conceiving, and what they might be able to do about it.
It also creates perfect conditions for the crazy to flourish.
On one website women describe the symptoms they’re experiencing during the dreaded “two week wait” to find out whether or not they managed to conceive this month, and other women vote on whether or not they think the original poster might be pregnant. Although it mostly makes me sad that this is a thing, I do sympathise with the need to share this symptom spotting with other people going through the same experience. It quickly becomes apparent that any symptoms you might have during the two week wait are just as likely to be a sign of an imminent period as a clue that you might be pregnant. Despite that, nothing will stop you desperately trying to interpret every random twinge, bout of wind, headache, and even excess of earwax in one lady’s case, as a sign that this will be the month of the coveted bfp (big fat positive).
All this uncertainty has made the decisions we’ve been faced with particularly challenging:
- Should we try IVF?
- If so, how long should we try “naturally” for first?
- How many times are we willing to go through the emotional, physical and financial upheaval of IVF before accepting that it won’t work?
- If IVF doesn’t work with my eggs, should we consider using donor eggs?
- Do we have what it takes to adopt a child?
- Could we ever reach acceptance that bringing up children won’t be part of our lives?
My husband and I have discussed all of these, and more, although some of them may never crystallise for us. Our answers have changed over time as we’ve gathered more information about what the various possibilities could really mean in practice, and I’m sure they’ll continue to change as we work our way through them. After some early panics when it was impossible to see how we’d ever resolve things if we held seemingly opposing views, we’ve learnt that it’s OK to sit with those differences and process them in their own time. “One bridge at a time” is the phrase we use to remind ourselves that we don’t have to deal with everything at once, although we frequently find ourselves trying to do just that.
In January, not long after my 35th birthday, we made an appointment with a London fertility clinic. The doctor wouldn’t give us definitive advice on the best timing for our first round of IVF—except to say that, given our situation, straight away wouldn’t be too soon, and he thought that waiting a year would be too long — leaving the decision making to us. I struggled between feeling like we were being impatient by not even waiting a year before starting treatment, to worrying about leaving it too long and diminishing our chances even further. In the end, despite firmly telling my husband at one point that I didn’t want to go for it so soon, we decided to go ahead in March, and were told we had about a 22% chance of success.
Having got started, going through the actual process of IVF wasn’t too difficult, although it was time intensive and physically invasive. Emotionally though, I found it exhausting—more than once I got home in the early afternoon after a scan and had no energy to do anything other than go straight to bed.
IVF involves a series of scans to see how many eggs are maturing, and to determine the best time for egg collection. Then you wait to see how many were actually collected, how many of those fertilised, how many of the fertilised eggs are looking good after three days (and sometimes again after five days). At each of those stages its likely that some eggs or embryos will be lost, and success rates are very much tied to the number of embryos produced (despite it also being true that “you only need one”, that double-edged phrase which means however much the statistics are against you, unless treatment is cancelled altogether, you still have a chance).
On our first round of IVF we were told at the first scan they might cancel the cycle as only one egg seemed to be maturing, but over the week another couple started to catch up. We ended up with two eggs, both of which were top grade embryos at day 3, and one was still looking good on when we transferred it back on day 5. Our second cycle looked more promising in the earlier scans, but in the end only one of the three eggs fertilised.
Neither cycle was successful.
By the end of our first cycle I felt grotty, I caught a cold during the two week wait (the internet ladies will tell you that even that can be a pregnancy symptom) and felt hugely lacking in energy. So after a few days of wallowing and eating all the Easter chocolate, I decided it was time to go on a health kick—to my husband’s amazement I cut right back on sugar, I stopped drinking alcohol altogether, and I started taking a selection of supplements which seemed to be at least slightly grounded in evidence.
Despite feeling on great form as we went into our second cycle a few months later, all the uncertainty and waiting left me so wrapped up in anxiety that I needed counselling by the end to remind myself that I really do have value as a person outside of this process, and regardless of the outcome.
Solid evidence for which lifestyle changes can actually make a difference to fertility is patchy and often doesn’t exist, meaning it can be hard to resist an attitude of “well, it can’t hurt…”. Even the most fertile women only has an 25% chance of conceiving in any given month, meaning that the actual timing is most likely simply down to chance. Search any forum, however, and you’ll find an abundance of “lucky pants” stories along the lines of: “bee pollen really works—we tried unsuccessfully for eight months, then I started taking it and got a bfp in that same cycle”. So far, the changes I’ve made haven’t had an obvious impact on my fertility, but they do at least leave me feeling healthier and more in control of my own body.
As I finish writing this I’m sitting in a hospital gown waiting for a D&C to remove the final “products of conception”, after waiting five weeks in vain for a second miscarriage to fully pass naturally. Having spent the last year feeling irritated with all the people who suggested different ways that I could “just relax”, I got pregnant whilst on holiday in Cyprus (and probably feeling the most relaxed I have since we started this journey). Although there’s no clear evidence that stress (other than serious trauma) affects fertility, and several doctors have told me that I shouldn’t worry about it, we’ve just added to a wealth of anecdotal evidence that suggests there may be some link. In some ways that feels positive, as maybe there is something more I can do to affect what happens next, but at the same time it’s another stick to beat myself with when I’m wondering why it hasn’t happened for us yet.
At some point in the next few months we will most likely have to do our best to navigate the next round of seemingly insurmountable decisions. For now, I feel blessed to be sharing this experience with my wonderful husband—who I know I can talk to about anything, no matter how crazy, and who looks after me so well when it all gets too much. I’ve no idea where our story will take us next—which has been the only consistent feature of the last couple of years—but I do know that whatever happens, this shared experience will continue to shape our lives. Happily, I also know that it will only make us stronger and more resilient, both individually and as a couple, and in some ways that feels like a great blessing.
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