Just the two of us – postscript

(A spoken word recording of this post can be found here.)

Sadness is but a wall between two gardens.

Khalil Gibran

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Some years ago, when I was still working in my first and favourite subtitling job, my fellow shift workers and I found ourselves working on a Labour Day Bank Holiday. To mark the day as different from any other typically mundane Monday, a couple of us decided to use our break times practicing an altogether different skill to our usual subtitling one. We took off our headphones, got up from our desks and set up our little corner of the office as a nail salon. Then we invited our co-workers to swap their usual coffee breaks for a few minutes of manicure.

There were many lovely things about this experience but the best one was the most unexpected. While I filed, primed and painted their nails, my friends and fellow employees, both male and female, started opening up to me about stuff that they’d never discussed with me before. I still don’t know what the cause was – is there something in the chemicals in hairdressing and beauty salons that makes us chat with relative strangers about our lives? – but the effect was lovely. They left my pod with beautiful nails painted in the colour/s of their choice, and I stayed behind with the warmth of their stories – some happy, some sad, some funny, all, without exception, better for having been shared.

When I first decided, two long weeks ago, to share my story of infertility, I had no idea that I was setting myself up for a similarly heart-warming exchange. I thought when I started writing that I was doing it as an exercise in catharsis. I thought that by writing my story down and looking at it from a distance I’d be able to find some threads of sense in it that would make it easier for me to move on. Any thoughts that I had about sharing were focused on the desire to be open and honest, and were certainly not concentrated on the possibility of getting anything back.

My Dad, when he’d read Part Two of these posts, said he was concerned that there was a danger, in telling this story, that I would ostracise people with my grief. But instead of separation or the solitary contemplation that I’d anticipated, I’ve experienced a groundswell of warmth, support and solidarity that was wholly unexpected.

Some people have written to say, “Oh, really? Me too!” Some have shared stories far, far more harrowing than mine, and my heart goes out to them. Some have told me of the IVF experiences of their friends or family members. One friend sent me a heart-wrenching sequence of poetry that he’d written about his experience of the same subject, part of which has recently been published by the Poetry Society. Some have said that they’d never thought about the issue before and were glad to have it brought to their attention. Some said that they never wanted to have kids themselves but were thinking of me anyway. Some have sent virtual hugs and kisses, which are always rapidly snapped up by someone like me, who lives too far away from the source of most real ones to grab hold of them very often. All have been utterly appreciated and have made me feel a thousand times better, at this stage of the game, than I’d have thought possible.

And still I have pages and pages and pages of notes on this subject that I’ve not found a space for here, and I don’t really want to change my blog title from Notes from an eternal expat to Notes from Infertile Girl. (Although one lovely friend said that “Infertile Girl” sounds like a superhero so perhaps I should reconsider…). Maybe it’s just time to find another forum.

For the meantime, though, I’ll write down a few more thoughts for anyone who has the time to indulge me just a little bit further. (And please know that these are generalised observations of myself and our society, and are not specific reflections on anything that’s ever been said to me by my friends and family, all of whom have been immensely supportive.)

*

When you buy a ticket to visit the Apartheid Museum in Johannesburg, you’re arbitrarily assigned a classification of “white” or “non-white”. This classification determines which entrance you take into the museum. When M and I went there a few years ago, we bought our tickets together then were immediately separated. We felt estranged, isolated and apprehensive – exactly the emotions you’re supposed to feel as you enter the rather intimidating structure and empathise with those who suffered the segregation imposed on them by the apartheid system.

Please don’t misunderstand me. I’m not for a second suggesting that the experience of finding yourself childless in a child-filled world can be compared to the suffering experienced by those living under oppressive regimes.

But it turns out that there is a degree of separation and misunderstanding between those with kids and those who would have liked to have them but can’t. Growing up, settling down and having kids is seen as the normal trajectory. So when you’re forced to skip one of those steps you suddenly find yourself outside of the norm. Abnormal. And the fact is that you can start to feel rather estranged and isolated.

There are all sorts of platitudes and stock phrases that we, as a culture, trot out in given circumstances to make other people (or maybe just ourselves) feel more comfortable in a range of conversations. I cringe when I think of some of the things that my younger self might have said to people in the past. Things like this:

  • “You’re engaged? Congratulations! So when are you getting married?”

Younger Michelle, perhaps they’d just like to be engaged for a while. Can’t they live in the now, rather than feeling forced to rush onto the next big event?

Maybe I could have just said, “Congratulations! The champagne’s on me. Here’s to a happy engagement!”

  • “Wow, you’re married now. How exciting! So when do you think you might have babies?”

Idiot, younger Mish!

1. Let them enjoy just being together. Life is long. Give them time!

2. Maybe they’re already pregnant and don’t want to make the announcement just yet. They’ll tell you when they’re ready.

3. They might not want to have kids. That’s their business.

4. They might already have been trying to have kids, so far without success. Don’t make them feel awkward about it.

  •  “You’ve had a few failed cycles of IVF? Well, keep trying. I know someone who got pregnant at 47 after her 8th treatment. You’ll get there in the end.”

Or maybe they won’t, younger me. The IVF industry is constructed on a very solid foundation of hope, but the awful fact is that the ground underneath that solid concrete is crumbling. The recently outgoing chair of the Human Fertilisation and Embryology Authority, Lisa Jardine, used her departure to make a point that she’d felt unable to make strongly enough during her six years in the position. She said:

‘This is a sector that trades in hope, and the papers and women’s magazines are full of encouragement. Yet the success rates for IVF remain discouragingly low. The last figures we have show that for every cycle of IVF, fewer than a third of patients will emerge with a baby…That leaves two thirds of would-be mothers and fathers with the heartbreak of “failure”.’

Do read the article if you have time. It’s excellent. http://www.bbc.co.uk/news/magazine-24652639

I’m sorry if anyone reading this is still hanging their hopes on IVF. I hope with all my might that it works out for you, that you’re among the lucky ones.

But I also really think it should be more widely known that IVF doesn’t work for the vast majority of people forced to resort to it. Everyone who goes into IVF believes that they’ll come out the other end with a baby, but most don’t. Our knowledge has come such a very long way since Louise Brown was born in 1978 but there’s still a very great deal that we don’t know. I’ve had three ART specialists tell me now that getting pregnant, with or without IVF, is a matter of luck. Even a lucky person like me would be in the minority if she came up trumps in the lottery that is IVF.

  •  “You’ve had a few failed cycles of IVF? Never mind. Have you ever thought about just adopting?”

So, younger Michelle, you’ve said this to people and managed to leave the conversation without having your eyes gouged out? Amazing! Every person who’s been through years of fertility treatments has thought about adopting. But adoption itself, while often a wonderful outcome for the parents and children involved, is not a cure for infertility. And it’s an arduous, time-consuming and expensive process.

 M and I are 49 and 43 respectively and we move countries frequently. I think these facts make us mature, ready and responsible, and in a great position to bring children up in an exciting international environment in which they’ll rapidly become citizens of the world. But I fear that an adoption agency might use the same factors to judge us as both old and incapable of providing a stable environment for children. Adoption is not an easy solution.

  • “Maybe it’s just not meant to be.”

Mm-hm. Yep. Right. Erm…according to whom? Does that actually mean anything other than, “I’ve had enough of this subject now… Can we please move on?”

*

On another topic altogether… M has said recently that he’s going to stop taking photos of me. It’s a protest against the fact that on the rare occasion that he does take control of the camera, I invariably hate any resulting photos in which I’m the subject and threaten to delete them.

However there’s one picture of me that I’ve always liked, and that I’ve used as my profile picture on various websites for years. The picture was taken by my best friend’s eldest daughter when she was three, long before she became the grown-up nine-year-old big sister of two that she is now. Against her mother’s strictest instructions, she’d crept into the attic room at their place where I’d slept, woken me up and kept me company as I got ready.

When she took this photo we were playing sharks. The bed was the ocean and she was the scary many-toothed monster that was going to chomp me into little bits and spit me out again. In a desperate bid to get away from the boat-capsizing beast, I’d just dived in to the water, risking my life. The shark stopped to take one last photo of me before her final deadly attack.

It seems, when I look at this picture now, that I wasn’t really too distressed about the prospect of succumbing to my fate. It’s been a blast, I seem to be thinking, and now I’ll go out with a bang.

That is, I think, the way I have to approach this next unexpected stage in my life. I’d thought that I was going to be a mother and I’ve done everything I possibly could to make that happen. But it didn’t, and now, barring some miraculous future event, it probably never will.

But things aren’t looking so bad really. The ocean is blue, the horizon is out there and I’m swimming in the finest of company. The compass is set for adventure.

Hm. Maybe it was, after all, meant to be.

Mish in hat

Just the two of us – part three

(A spoken word recording of this post can be found here.)

Like a roller in the ocean, life is motion, move on.

Abba

With six IUIs and two and a half IVFs behind us, M and I needed to decide which direction to go in next…

I consider myself to be an extremely lucky person. I must admit to being more than a little pissed off at having drawn the infertility short straw (one in six couples, as it turns out, will experience infertility in one way or another), but I’m completely aware that my circumstances could be a whole lot worse. While some couples have to work two or three jobs or re-mortgage their homes to fund their fertility treatments, I’ve been fortunate enough to focus fulltime on baby-making while living in a lovely house in the French countryside. M and I have, of course, watched with wide-eyed concern as M’s life savings have been decimated (the “college fund” was long ago rebranded as a “conception fund”), but I’m really not about to start playing tiny violins in any sort of woe-is-me self-pity fest.

OK, maybe I did feel a little sorry for myself after the second IVF failed. But the fact that we were able to use M’s Easter break to drive down to the south of France and stare at the sea as we contemplated our next move went some way towards softening the blow. The ironies of Easter’s symbolism were not lost on us – what are Easter eggs if not a symbol of the fertility and rebirth that was proving to be beyond our grasp? – but I tried not to think about that as we washed them down with a bottle of Champagne that my sister Luli had bought for us before she’d flown back to Australia a few days before.

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The day after our arrival on the French Riviera we took a drive up the coast to the medieval hilltop village of Èze. Before we began the ascent through the cobbled streets of the village to the Eagle’s Nest restaurant where we were to have lunch, we stopped at the Fragonard perfume shop at the bottom of the hill. I think I thought that a new fragrance might be the start of the development of a new me – I wasn’t best enamoured with the old me, infertile creature that she’d turned out to be – and so purchased a bottle of Fragonard’s finest. I didn’t know then that the Rêve Indien (Indian Dream) that I bought that day would always make me feel a little nauseous, so strong were its associations with that difficult time.

It was there in Èze, as we watched the sun struggle to burn through the mist that was eclipsing our view of the ocean below, that M and I started to talk about the fertility options still open to us. As there was no obvious reason for me not to have conceived after all these attempts, one conclusion that we were forced to draw was that perhaps my ageing eggs were just not up to the task of developing into real-life, baby-sized Mini-Mes. Perhaps we’d have to consider clutching at the next straw extended to us by those in the know – using another woman’s eggs.

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When we got back to Geneva and had the post-failure follow-up consultation with Dr Pyramid, he looked somewhat dejected as he went through our file, speculated on the probable reasons for the failure and talked through possible new drug protocols for our next attempt. When I interjected and told him that we were considering the possibility of using donor eggs, his whole demeanour was transformed. He closed the file, sat up straight in his chair, smiled at me and said, “If you do that you will be pregnant within a year.” In fact, just for emphasis, he actually said that twice.

I don’t know what he was basing his optimism on – the fact is that even with donor eggs, the chances of success for a woman of my age are still not that great – but his enthusiasm was certainly infectious. I put aside my reservations about using another woman’s DNA to make our baby, and replaced them with the thought that it would be my blood that would flow through the baby’s veins. I tried not to think about the fact that I’d never be able to look at our child and see my own brown eyes or feint traces of my Mum or Dad or my much-loved siblings, and instead reminded myself that at least M’s features would be in the mix, and it would be my body that would bring our baby into the world. Egg donation is not legal in Switzerland, so we left Dr P’s office with a list of Spanish clinics that we could contact in our own time. Of course I was going to contact them. I’d been assured (twice) that I’d be pregnant within a year.

Another decision that we made around that time was that we wouldn’t tell anyone about this next attempt at IVF. This was an easy decision for M – his quiet reserve and stoic self-reliance make him less than likely to chat about any troubles in his life – but I grew up as one of six kids, five of us girls, and that gave me a solid grounding in the benefits of talking things through. The trouble with that approach to this problem, however, had been that there was a weight of hope and expectation during each cycle that I couldn’t carry any more. It was so beautiful knowing that there were people out there who cared and were thinking of us, but having to break the bad news when things didn’t work out required more strength than my diminished reserves now contained. So when the Spanish clinic found us a donor whose physical and mental well-being and apparent resemblance to me made her a perfect match for us, we told everyone we were taking a summer holiday and took off to Logrono, Spain.

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After a brief Monday-morning visit to the clinic, during which M made his contribution and the doctor checked that the drugs I’d been taking had sufficiently prepped my body for the imminent embryo transfer, we were in fact free to enjoy a few days off. It was so bizarre to think, as we visited the mountains and monasteries and fantastic modern architecture of northern Spain and indulged in the gorgeous tapas for which Logrono is famous, that an anonymous young woman was at that moment going through potentially life-changing surgery on our behalf. For weeks she’d been injecting herself with hormones, and on the morning of our brief consultation, she was under a general anaesthetic having her eggs “harvested”. For us. We couldn’t stop thinking about her, and for the ten days that we stayed in Spain we looked at every young woman and wondered if maybe she was the one who’d done this extraordinary thing for us. We wanted to thank her. In Spain, however, unlike in England, egg donation is anonymous, so the best we could do was exude a general air of heartfelt thanks to any woman who would consider doing such a thing for nothing more than the knowledge that she’d given the most amazing of gifts to a less than perfect stranger.

Two weeks later, we were set to learn whether this extraordinary young woman’s eggs were as good as her intentions. My Dad had been staying with us for a week on the day that I had the pregnancy test, and had been subject to the symptoms of my stress, without, poor thing, having any idea of the causes. He knew I had a doctor’s appointment that morning but he didn’t know what for, and neither did my lovely friend with whom we had lunch in the park several hours later. It was she who took this picture of me and Dad that day; the evidence of my earlier blood test is still showing on my arm.

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The call from the clinic came while we were all still soaking up the sun as we chatted in the Parc des Bastions, our backs to the statues and bas-reliefs of the Reformation Wall. When my mobile rang I separated myself off from the others. I took the call – “Je suis desolée, madame, mais le test est négatif” – and sobbed as I phoned M to convey the news to him. Then in my best impersonation of Emma Thompson in the only great scene in the awful Love Actually, I wiped away my tears and went back to chat with the others. I could almost hear Joni Mitchell singing Both Sides Now.

 *

Between the amazing young woman’s excellent eggs and M’s Superman sperm, we’d actually managed to create five embryos while we were in Spain, and only three of them had been implanted. So we still had two left, cryogenically suspended. So last month I went back to Logrono to try my luck with these last embryos. (In case anyone’s wondering… Yes, that was the trip that I was on when I recently wrote about travelling solo.)

Over our years of treatments, I’ve had to be the bearer of bad news rather than babies too many times. I wasn’t sure that I could make that call to M again. So on the day of the last blood test, two weeks after I’d got back to Geneva, M took a proper lunch break and we met up in a busy restaurant in Geneva so we could be together when we got the call from the clinic. While we ate and waited, we allowed ourselves the most gorgeous half-hour of happiness.

If it’s a girl, M said, I’m going to buy her loads of Scalextrics.

And if it’s a boy? I asked.

Still loads of Scalextrics, M replied. And all of her toys will be made of wood.

Simultaneously: Apart from the Scalextrics…

I’m so glad we allowed ourselves that.

The call didn’t come through until after M had gone back to the office, so I was alone again when I took it, but I was somehow buoyed up by having had that conversation. At least we’d been happy for half an hour. I didn’t even cry when I phoned M and told him this time.

Instead, I surveyed the scene at the Botanical Gardens from the park bench where I sat. It was a fairly grey and overcast day, so I had the park pretty much to myself, sharing only with the peacock that was strutting its stuff in front of the flowerbed just near my bench. The beautiful merry-go-round at the Lake Geneva end of the park had been closed down for the winter, but it stilled retained an air of all the fun kids had had on it earlier in the year. A man wearing silly running shorts over baggy jogging bottoms went past doing that sideways dance step that footballers indulge in during training sessions. And a waft of coffee came down the hill from the almost abandoned but still open café. Life, it seemed, was still beautiful.

Get up off this bench, I told myself, and get on with the rest of your childless life.

And so I did.

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*

Now that I’ve got to the end of telling my sorry tale, I realise that I still have more to say on this subject. I thank you so much for your patience in reading on this far and warn you that, alas, there will be a postscript…

Still (but not for very much longer) to be continued…

Just the two of us – part two

(A spoken word recording of this post can be found here.)

No challenge should be faced without a little charm and a lot of style.

The Bluetones

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And so, a quick recap… Four years ago, M gave me a beautiful silver bracelet to mark the day we decided to make beautiful babies together. By the time we left Israel two and a half years later, we’d had five IUIs and an IVF and as yet there was no baby in sight…

A couple of years after we’d jumped aboard the baby-making train, I realised that I’d taken my eye off the destination. I was having so many hospital visits, tests, drugs and injections that it all seemed to have become about the process rather than about what we were trying to achieve. I needed to start thinking about babies again. I was walking along Jaffa Street in Jerusalem one day when I saw, in a shop window, a miniature version of the ethnic slippers I’d been thinking about buying for myself. I bought them and arranged them on the coffee table in our East Jerusalem apartment as a reminder of what we were working towards.

Until a short while before our departure from Israel, we’d thought that our next destination was going to be Kampala, Uganda. I was thrilled at the prospect of living in Africa for the first time but a little concerned that assisted reproduction for over-privileged foreigners would be at the bottom of the list of Ugandan national priorities. Soon before we were to make the big move, however, M was offered a job in Geneva, Switzerland. And so those little sparkly orange baby shoes came with us to live in the centre of Europe, the continent which, at least in 2010, led the world in Assisted Reproductive Technology (ART). (http://phys.org/news197093421.html).

A good friend in Jerusalem had recommended her Geneva-based ART specialist to us and I was pleased to be told when I contacted him that he did not operate a waiting list; we were able to secure an appointment with him five weeks after our arrival in our new home. The doctor’s desk was decorated with beautiful lapis lazuli pyramids. I’m not really a crystal-healing kind of a girl so I won’t look for any symbolism in that, but I will allow them to at least give our doctor a name…

Dr Pyramid did not pull any punches during our first consultation. He said that at my age I had, at very best, a 10% chance of getting pregnant, and that each cycle would cost us 8,000-10,000 Swiss francs (that’s £5,500-£6,900, or US$8,900- $11,000). He also said that the HSG I’d had in Jerusalem could only detect 60% of any potential problems with my reproductive system and so suggested that I have a laparoscopy. This is a keyhole surgery in which a light source and a camera are inserted into the abdomen through the belly button to study the organs and tissues inside the abdomen and pelvis. The thought of it made my knees go queasy but we signed on the bottom line anyway and once again bought our season pass for the roller-coaster ride that is ART.

The next couple of weeks looked something like this:

October 23: During a pre-op consultation with the anaesthetist who would put me under for the laparoscopy, he put a stethoscope to my back and blithely mentioned that I have a heart disorder called mitral insufficiency. This is why I’ve spent my life staying as far away from doctors as possible. I’ve always believed my own press about being in perfect physical health but as soon as I started letting doctors anywhere near me they began to make lists of stuff that I should be concerned about.

October 25: I visited Dr Pyramid for blood tests and he said that he wanted to rule out any possibility that I’d inherited the breast cancer that had cruelly killed my mother when she was 41 years old. He made an appointment for me to have a mammogram the next day.

October 26: As I went past a construction site on the walk between the tram and the Clinique des Grangettes, I was hailed with the wolf whistles and shouting that anyone with breasts has become accustomed to. On the way back, when a mammogram and an ultrasound had confirmed that all was fine in my chest area, I wanted to whip out my X-rays and shout, “The doctor says I’ve got tremendous tits!” Sadly the construction workers all seemed to be on their lunch break.

October 29: M and I jumped on a train to Lausanne, where Dr Pyramid has his second office and where his embryologist is based. We were shown through a PowerPoint presentation of how the whole procedure works and what our various options would be if the process was unsuccessful at different stages, and given a rundown of the staggering costs that would be involved.

October 31: I checked into the hospital for the laparoscopy and was thrilled by the difference between hospital treatment in Geneva and Jerusalem. At Hadassah I’d had to walk through the hospital in a surgical gown and was expected to push my way to the front of the queue and shout louder than my sisters in infertility to get any attention from the hospital staff. In Geneva I was shown to a lovely private room with en-suite bathroom, given a menu and asked to choose the food that I’d like to eat post-operatively, plied with gorgeous drugs and wheeled down to surgery in my bed.

After I woke up, Dr Pyramid came to see me and said that they’d removed a couple of spots of endometriosis, and that all was well for another attempt at IVF in December. He also said that although they were unsure why, the laparoscopy itself often seemed to increase the chance of IVF success in the round that followed. So I felt positive as I tucked into the best hospital meal in the history of hospital meals – chicory salad with walnuts and blue cheese dressing, king prawns with a cream and lemon sauce, and apple strudel and proper coffee. You get what you pay for, I guess.

November 8: M and I had an appointment with Dr Pyramid, and in one of the more surreal half hours of my life, he showed us through detailed photographs of my internal organs. The good doctor revised the drug protocol we’d used in Jerusalem and confirmed that we were good to go.

*

When M took me on a surprise birthday trip to Rome the following week, I packed all the vials, syringes and sterile wipes that I’d need to begin the new drug regime during our stay in the Eternal City. (I also packed a letter from the clinic that I could wave under the noses of the Italian authorities if they thought they’d happened upon the world’s unlikeliest international drug smuggler.) The drug that I’d start with was Cetrotide, which suppresses the body’s natural production of hormones so that its goings-on can be chemically controlled by the physician. (I tried not to think too much about the long-term effects that all these drugs might have on my body.)

I know that a lot of women hate the hormone injections associated with IVF and of course I completely understand why – stabbing yourself in the stomach with a needle full of hormones on a twice-daily basis isn’t exactly the dream. But I have to admit that, in a weird way, this is actually my favourite part of the process. While IVF has forced me to reluctantly confront the fact that I have absolutely zero control over my reproductive destiny, doing my own injections at least makes me feel as though I’m taking active steps towards achieving my dream. I’m very lucky that I don’t seem to be blighted by the terrible mood swings and weight gain that some women suffer (although M might tell a different story…). For me the weeks of hormones are a positive time during which I can live in hope that this time Lady Luck might be on our side.

It seemed, when I had the next appointment with Dr Pyramid two weeks later, that my positivity might be justified. The blood test and ultrasound revealed that all was as it should be, and Dr P prescribed a new drug that was supposed to stimulate the production of fewer but better quality eggs.

My positivity started to wane, however, when after five days of Menopur injections it became evident that there were only two eggs. Dr P doubled the dosage. But two days later he declared that despite the doubled drugs, there was now only one egg. It wasn’t worth going through the egg retrieval. So after weeks of hormone injections, the IVF cycle was cancelled. Dr P would give us an IUI instead (at our vast expense, of course) as a sort of sad consolation prize.

Meanwhile, back in my adopted homeland of the UK, Kate Middleton announced her pregnancy. In a brief moment of bitterness I wrote and submitted a letter to the Guardian’s “What I’m Really Thinking” column. The paper wrote to say that they were considering it for publication but they never printed it in the end. It’s probably just as well; I wouldn’t want to bring down the national mood. My letter read:

So Kate Middleton’s pregnant. How wonderful. Now not only will it seem that everyone in the world has babies apart from me but the whole country will be nattering about what a joy they are. Don’t talk to me about it! I already know! Otherwise I wouldn’t have spent three years and the GDP of a small country trying to have one!

People with small children tell me how much they envy my lifestyle. I can (and do) pop to Paris or Rome for weekends, I sleep when I want to and I’m not being crippled by childcare costs. “Want to swap lives?” they ask. Well, yes, I bloody well do! Superfluous sleep and weekends away are just consolation prizes; I want to be woken up at five o’clock on a Sunday morning by my child stomping on my head but that joy is being denied me so I go to Rome instead.

Some friends who know that I’ve been having fertility treatments for years try to console me by saying that you can still live a happy and fulfilled life without children. I’ll take that from friends who are childless, by choice or otherwise. But if another person utters those words while bouncing their beautiful baby on their knee I might just have to suggest that I take over the parenting of their child, then. They’d be just as happy and fulfilled without the baby, right?

Forgive me. It was a bad day.

And needless to say, the second-prize IUI didn’t work.

*

Without going into any further tedious detail, we had another round of IVF, which went right through to egg retrieval and embryo transfer, several months later. My eldest sister, who here I’ll call Luli, as our brother used to when he was a baby, had planned to come and visit us, and by coincidence her holiday ended up exactly coinciding with my surgery and our two-week wait. She was there when my bed was wheeled down to surgery (when M had had to go off to Lausanne to leave his contribution with the embryologist), and when I was wheeled back, fighting my sleepiness so that I could catch up with my beloved big sister.  She was there a few days later when we went to Lausanne for the transfer of three healthy embryos. She was there for the duration of the stressful two-week wait, as I struggled between a desire to be optimistic and a fear that again we’d be disappointed. And she flew out on the day that we received the test result to say that the IVF hadn’t worked.

One day soon after, M and I went for a walk in the hills around the beautiful nearby village of Chanaz, and I lost my Silver Bracelet.

The fact that we remained optimistic is both a testament to the human spirit and a boon to the IVF industry.

We wouldn’t give up.

To be continued…

Just the two of us

(A spoken word recording of this post can be found here.)

Man’s main task in life is to give birth to himself.

Erich Fromm

I try to be very honest in this blog. I’ve sometimes written about things that were quite personal, and I’ve been so grateful that people have taken the time to read what I’ve written, and sometimes sent messages to say that my experiences have chimed with them. But I must confess that I’ve only been telling a fraction of the story…

My blog is predominantly about my experience of being an expat, and as my experience is generally very positive that’s the tone that I most often try to maintain. But the other day a friend posted a status update on Facebook that made me think. She wrote:

As much as I am happy that all my friends are having happy days, it painfully reminds me of how crap my life is… — feeling sad and lost.

My inclination, when something is troubling me, is to hide myself away and work it out on my own; I’m very aware that everyone has problems of their own and I don’t want to risk boring people with mine. But my friend’s words made me wonder if that’s perhaps a little dishonest of me. While my family and my friends that I see regularly have generally been apprised of what’s been going on with me for the last four years, those at a greater distance only see the highlights of the happy times. Sometimes people tell me how lucky I am; they say they’re jealous of my adventures or playfully ask if I’d like to swap lives. But that’s only because they don’t know the whole story. The truth is that I AM incredibly lucky and I DO have a wonderful life. But nobody has it all and I’m now just about at the point where I’m starting to have to accept the possibility that I won’t ever have everything that I thought I would.

I know it’s not necessary to share everything with everyone – a stiff upper lip and a determined, independent resilience were two things that were deeply ingrained in me as a child – but the more I think about it, the more I think it’s incumbent upon people who’ve been through the experience that I have over the last four years to start talking about it for the benefit of those who might go through it after them. The taboo around the subject seems to be being broken down slowly in the States but I’m not sure that’s yet the case in the UK. In fact it’s still such an uncomfortable subject to discuss that even I, who have been living with it for the past four years, am having trouble spitting the word out. But here goes. I’m going to be brave.

This is the first of three posts I’m going to write on the subject of infertility.

Nearly four years ago I got on a plane in London, where I then lived, and flew to Johannesburg, the closest international airport to Pretoria, where M then lived. M picked me up from the airport and we made the most of the sunshine by having lunch outside at an all-organic, all-artisanal street market, and it was over our chickpea curries that we decided that we were going to start trying to have a baby. M bought me a beautiful silver bracelet from the market stall beside us to commemorate our decision.

The next six months were not our proudest in terms of environmental impact. M’s job with an international humanitarian organisation and my work for a UK-based global technology company meant that we were not then able to live in the same country. The many emails we exchanged during that time helped to solidify our relationship across the distance, but the act of flying was as essential to our family planning as were any more traditional baby-making activities. The miles flown between South Africa and the UK stacked up until they almost toppled over, and in April M accompanied me on a work trip to the States. And all the while we looked forward to the time when we would occupy the same hemisphere and have more time to concentrate on turning the two of us into three.

I wasn’t terribly worried, in those days, that each month brought another negative pregnancy test. I’m from a vastly fertile family and M had no reason to doubt his fertility, so we just enjoyed the brief periods we were able to spend together and hoped for the best. I never wanted to be one of those women who took her temperature every morning and obsessed about whether she was ovulating – what a turn-off that would be! – and I was sure that sometime soon we’d be swapping air miles and hotel loyalty schemes for prams and baby-friendly restaurants, just as most of my friends and all of my family had done some time before.

When our chance to occupy the same landmass arrived six months later, I was even secretly relieved that we hadn’t got pregnant up until that point… Call me old-fashioned but I can’t help but imagine that joint parenting decisions are made most easily when both parents inhabit the same country as the child. The fact that that landmass was the Middle East was thrilling; M was posted to Jerusalem and I felt privileged to be able to join him in such a fantastically vibrant and historic city. I reluctantly resigned from my job and could have kissed my boss for requesting that I continue to represent the company at all the international broadcast exhibitions that I’d attended previously. He also asked if I would assume responsibility for maintaining the company’s relationship with a technology partner in Tel Aviv, just down the road from my new home. Perfect.

Nine months after Silver Bracelet Day I was back in the UK for a few days after a work trip to Amsterdam, and decided to have a chat with my GP about fertility. I knew that M and I needed to spend a lot more time together if we were serious about starting a family, but I wanted to check that there wasn’t any obvious impediment to pregnancy. My GP carried out the initial rudimentary checks – for syphilis and other assorted STDs, it seemed – and after giving me the all-clear on those he double-checked my file and realised with horror that I was 39 and therefore beyond the allowable age for NHS fertility treatment. He had no choice but to eject me from his office.

Months went by and although M now spent most of his time “at home” in Israel and the Occupied Territories, I continued to travel frequently. (How does one say no to paid international travel which allows you to do a job that you love in Berlin, Dubai, Las Vegas, Singapore and London? Oh, if only I’d known…). When I was at home in East Jerusalem, the fact that I was spending half of my life on planes didn’t stop me from morphing (illogically) into that woman that I’d promised never to become. The basal body thermometer was purchased and every morning, when the rest of East Jerusalem was waking up to the call to prayer, I was recording my temperature and sometimes wondering how best to word my request that M pop home “for lunch” later that day.

When nothing had happened by June – 18 months after Silver Bracelet Day and a year after we moved in together – we decided that M should have the simple checks necessary to make sure that all was well with his contribution to our baby-making efforts. He took himself off to Hadassah Hospital in the Jerusalem Hills, and was delighted, as I’m sure most men would be, by the doctor’s use of the word “Superman” in describing his sperm quality. I had to fly to Singapore for work soon after and I tagged on a trip home to my native Australia, where M joined me to spend a week catching up with my family. We joked that we’d name our baby after the place in which it was conceived, but ultimately decided that lumbering our child with Ningaloo or Fremantle would be a less than loving first parental act. Anyway, little Ningaloo decided not to be conceived in Australia so her name was a moot point.

At around this time we started to wonder if perhaps we were too old for the “cross your fingers and hope for the best” approach to starting a family. One of my four sisters had recently had a baby at age 43 so there was evidence of longevity in the fertility of my family, but as this was her fourth child her situation wasn’t really comparable to mine – I’d never been pregnant despite not always having been super cautious, so a little seed of doubt was now planted in my mind about whether perhaps I couldn’t conceive.

It was time to take drastic action. At the broadcast exhibition I attended in Amsterdam in September, I told my boss that I’d no longer be travelling for work. I cried when I told him. I’d always known, of course, that I’d have to make sacrifices if I wished to have a family, and having waited until such a late age to start trying, I was more than prepared to make them. Perhaps naively, however, I’d imagined that the need for sacrifices wouldn’t begin until after the baby was on-board. Having worked in jobs that I’d loved for my entire adult life, I was daunted by the prospect of giving all that up to concentrate on the possibility of conceiving. But with M living on one continent (in which I was not allowed a work visa) and my job being on another, I seemed to have little other choice.

When we met with the head of fertility services at Hadassah Hospital, he explained that contrary to popular perception, one doesn’t just launch into a course of IVF without first exhausting all other avenues. It was around this time that I first became familiar with the acronym IUI, for Intrauterine Insemination. The procedure is designed to eliminate the variables involved in human procreation, like, erm…sex. The best of a man’s contribution is introduced directly to a ready-to-be-fertilised egg, right in the place where the party is set to start. This, despite there being no drugs or major interventions involved, was not a cheap procedure, and every visit to the consultant’s office was preceded by a tricky conversation with the hospital’s finance department, who insisted that I sign forms written in Hebrew whose contents I had no way of comprehending.

In retrospect, the hospital staff and I were quite endearingly optimistic about my first IUI. The consultant didn’t even bother to do ultrasounds to monitor my egg development. He just took me at my word when I told him that my thermometer suggested I was ovulating, and after M had made the dread visit to the special-purpose room in the hospital, our doctor found his way around the apparently quite spectacular twist in my cervix and placed the sperm where it needed to be, wished me luck and told me to come back for a blood test in two weeks’ time.

It was lovely, that first optimistic two-week wait. I ate well, exercised gently, thought about baby names and calculated when the baby would be born. I wondered which of our two spare bedrooms we’d make into the nursery and thought about how our neighbours in East Jerusalem would react to the sight of a western woman going about her business with a new-born baby strapped to her chest. There was no question of whether or not the IUI had taken; I was just waiting for the confirmation that it had.

It came as something of a shock, then, when a blood test indicated that there was to be no baby.

When another two “natural” IUIs had failed, it was time to bring in the stims to kick my body into fertility overdrive and ensure that next time the doctor drove around that tricky bend there would be many an egg ready to welcome our new friend to the party. The daily injections about which anyone interested in fertility treatments hears so much became a normal part of my existence.

I was pleased to have stopped travelling internationally for work – what was I ever thinking in so drastically reducing my chances of conceiving by being away from M so much of the time? – but I still wanted to enjoy the adventure of living in this fascinating country. Over the months that followed, when the first IUI with hormones failed and led on to the second and then to the third, my drugs came with me wherever I went. The long list of places in which I gave myself hormone injections included an underground Hellenic water cistern at Beit Guvrit, a waterfall in Ein Gedi, a guest house in Petra, and the car park by the Ramon Crater in the Negev Desert.

After the third of these procedures had failed, our doctor suggested that I should have a hysterosalpingogram (or, for the less linguistically gifted among us, an HSG), which would determine whether there were any blockages in my fallopian tubes which might prevent pregnancy. The procedure is very bizarre. In the company of two men and a woman, I had dye injected into my inflated uterus and we all watched the monitor suspended from the ceiling to see whether the dye would fill the tubes and spill out into the abdominal cavity. I was later given a DVD of the whole procedure to share with my friends (or perhaps just with future consultants). Although it was good news that the HSG revealed no problems, the diagnosis of “unexplained infertility” provided its own frustrations.

In the background of all these goings-on was the added stress of knowing that when M’s contracted work in Jerusalem shortly came to an end, we’d have to contemplate a move to a country with considerably less to offer us in terms of assisted fertilisation than our current home. The first two requests for M’s particular skillset came from Liberia and Uganda, both countries in which I’d be fascinated to live, but neither with an international reputation for advances in reproductive medicine. For that reason, our doctor allowed us to skip the last of the usual half-dozen attempts at IUI and bring out the big guns. Surely an IVF treatment, we thought, was all we needed to finally realise our dreams of a family?

M’s contract expired a week after I’d had the embryo transfer and he had to fly out to Geneva for a debrief. We’d packed up our East Jerusalem apartment and sold our car, so I rented an apartment in West Jerusalem for a week and spent the time in a similar happy reverie to that I’d enjoyed after our first IUI. Then on the last day of the two-week wait, when I stood looking at the beautiful view of the Jerusalem Hills from the Hadassah Hospital in Ein Kerem, I wept as I told M on the phone that the IVF had failed.

The next day I got on a plane out of Israel and flew into an uncertain future.

To be continued…