A lot of people don’t like prologues, but I needed one for this story. My prologue is a living, breathing, pooing human entity that has taken residence in my home. His name is Coen, and he makes an adorable audible sigh when his body snuffs a sneeze. Sometimes, when I’m changing his nappy, he pees on my hands, or farts faecal peanuts on my fingers.
I love him.
There were moments, in the first months of his arrival, that he seemed to smile, and though I knew he was too young to have related the social convention of widening the mouth with contentment — he was more likely passing gas — I nevertheless flushed with parental glee.
He loves me!
My son is my prologue.
He lets the reader know where this story ends — because this is a story about fertility. And like so many of my peers, it is therefore a story about hope and despair; about fleeting joy and crushing sadness.
That’s why this prologue is not specifically for you, dear reader. It’s for me. Because I could not have shared this story without Coen in my life.
Two psychological obstacles hinder our ability to talk openly about fertility — jinx and taboo. I offer my story now to address the taboo, now that the jinx has been negated by my son’s arrival — I could not publish this until he was safely among us, for fear of ironic catastrophe. It’s silly, I know, but it’s the reason prospective parents commonly keep their pregnancy private until the second trimester, when the risk of miscarriage falls sharply.
Swarana and I were married in 2016, in our mid-30s, and — the deafening tick-tock of our biological clocks ticking in our ears — we started trying for a baby shortly thereafter. However, our enthusiastic endeavours, though spirited and numerous, were nevertheless fruitless. And so we sought assistance beyond the usual conception supplements, non-spermicidal lubricant, pregnancy tests and all manner of ovulation tracking apps.
We went to the NHS to have our respective equipment checked.
Initially, it appeared I was inadequately producing sperm — there were enough of them, but the majority non-performing. Part of me wishes this had remained the case, but a second test revealed my metaphorical swimmers were as numerous and sufficiently aquatic as one could hope.
In the same consultation at which we received my good news, the doctor gave us my wife’s results: we were told she had a low ovarian egg count, and would not qualify for NHS fertility treatment.
The ovarian count is assessed with two measurements: Anti-Müllerian hormone (AMH), and a visual count of the follicles released on a given ovulation cycle, called a total antral follicle count (AFC). Swarns scored low on both; lower than your average mid-to-late-thirty-something. The consultant informed us that we were too unlikely to conceive for the NHS to waste valuable resources trying fertility treatment. It turns out — in our borough at least — that NHS IVF is only offered to those who fall within a clinical window, between not fertile enough to bother, and fertile enough not tobother.
There is now a peer-reviewed scientific report that debunks the efficacy of these tests to ascertain a woman’s fertility, not least because they do not relate to egg quality, but only to probable quantity. Since you only need one egg to fertilise, women with exceedingly low scores are still able to become pregnant. I know this because the NHS published its assessment of the report on its website, but our NHS Trust still uses the ovarian count tests to decide whether or not to provide IVF treatment.
Instead, our doctor was handing us leaflets about egg donors, and telling us our only option was to go private.
Coming to term
There is a cavalcade of emotional trauma when faced with a dilemma like this, accompanied by an intellectual and political self-flagellation. At first, it’s the shock of comprehending that our baby cannot exist with both partners’ genes — it will never be “ours” in the purely genetic sense. You can take comfort by saying the mother will carry the baby, and so will feel, for all intents and purposes, like the biological mother, but words of this kind fall on deaf ears during those first days of disappointment.
Of course, intellectually speaking, you shouldn’t care whose egg your baby springs from, it’s still your baby. Just as an adopted child is loved unconditionally by its new parents, so too would an egg-donor baby. At some length, reasoning of this kind softened Swarana to the idea, but the distress returned when we enquired about the ethnicity of the donors.
For reasons I have not been able to ascertain, there are vanishingly few egg donors from my wife’s ethnic group, specifically British Indian. Again, one might argue it shouldn’t matter — an adopted child no more needs to be the same ethnicity as their new parents as they do from the same country — but there’s already a leap for an egg-donated mother to take when having a baby with no trace of themselves in its DNA, to then say the baby won’t even have any similar ethnic markers whatsoever.
The doctor suggested either black donors or going to a clinic in Spain or Portugal for a Mediterranean donor. At least the baby won’t be blonde, was the implied message.
“It shouldn’t matter,” whispers the voice of reason, while the heart says, “This baby will be ours in dependency only.” To be torn between what’s intellectually right and emotionally gutting is hard at the best of times, but making a case for the former to a woman grieving her ovaries makes you feel like a despicable ghoul, both in upsetting the woman you love and belittling the difficult choice thousands of couples have taken before you.
I wanted to be angry at the NHS. This traumatic choice seemed thrust upon us by an uncaring consultant too concerned with bean-counting than baby-creating. It would have been cathartic to unleash my fury at that beleaguered institution, but it would have been wrong: We all know it’s not the NHS’s fault they don’t have the funds to more widely offer this kind of care. It’s the government’s fault; it’s New Labour’s disastrous PFI policy; it’s austerity; it’s successive Conservative governments’ cuts that have forced each Trust into devising these money-saving conditions for treatment.
This conflict between personal affront and social conscience is draining; it would be far easier to get angry, and much more gratifying — healthy, even. I felt at odds with my own sympathy, for the subject of my ire was twice removed: Not the consultant, not the institution, but the government.
Privilege and procreation
Our story continues because of wealth. We are not rich people, though we are not poor. We are able to save, unlike the two fifths of the UK population who cannot gather £100 at the drop of a hat. And our respective families have enough saved were we to ever be in desperate need. Poverty is not just personal destitution, but lonely destitution, when there is no one around you who can offer help.
So we were able to go private, and try our luck where the NHS would not even let us roll the dice. Once again, my middle-class Prosecco-socialist mind is uncomfortable with my privilege: imagine the thousands of couples who cannot scrape £10,000 together, or who must take out a loan they may never be able to repay to fund their human right to bear children. It’s not right! But there we were, accepting help where we could get it — how dare we?
Amid the throes of socialist self-deprecation, we had to pick a fertility clinic. This is the first introduction to the community of the infertile.
Learning the lingo
You can assess the longevity of an online community from its use of acronyms — in writing, we all work on our WIP (work in progress), perhaps with a YA MC POV (young adult main character point of view) in a SFF (science fiction fantasy) realm with an M/M relationship (two chaps). The writing community, you see, is established.
Tragically, so too is fertility-web, where MC does not mean main character, but miscarriage, and the very act of love making is euphemised twofold, once to: “the Baby Dance”, and then abbreviated to BD for who knows what reason?
Abbreviations are sought when repetition is rife and responses are multitudinous, and are used even if they may confuse matters; someone might say on a forum they went to their ER, and while a newcomer gasps at the thought of a pregnant woman going to the emergency room, regular posters know she is referring to egg retrieval.
Most poignant of these abbreviations is IF — meaning “infertility”, but surely to many readers it remains the monosyllabic conjunction: what IF? What IF my treatment doesn’t work? What IF I had started trying for a baby sooner? What IF I can never have a baby? What then?
That these abbreviations persist is a symptom of how long any given hopeful procreator can be in the IF system; so of course, why wouldn’t you obfuscate the words that cause you such heartbreak?
But learn the lingo you must, in order to comprehend the reviews and experiences of the clinics at your disposal.
Picking an IVF clinic is a minefield. Each has its devotees and detractors, because success rates are roughly 50/50 across the board. In the end, we picked one on a friend’s recommendation that claimed to specialise in women with low ovarian counts (if you know someone who has been open enough to divulge their fertility troubles, I suggest getting their input rather than poring over faceless reviews).
So off we go to the clinic for yet more examinations, and disclaimers, and reality checks, and hope delivered in a matter-of-fact manner, but nevertheless tainted by my socialist cynicism: Of course they’d recommend that treatment — it’s the most expensive, I grumblingly mused. Do they really think we can be helped? Or are we just a cash cow wandering into a dairy farm looking at brochures.
It’s hard to throw off that disdain when you’re repeatedly presented with BUY 3 IVF TREATMENTS FOR THE PRICE OF 2 offers. The life-giving leeches.
One wonders if they would take our money if I’d had a vasectomy and my wife had no womb. “It probably won’t work, but you never know until you try!”
We paid the money — thousands of pounds — for a single round of IVF. I was too incensed by their refusal to refund in the event that success was achieved in the first round of a three-round package to plump for three, but that says more about my disdain for corporate avarice than my confidence in the treatment. We bought the drugs we’d need, and listened intently as they instructed us how to inject them at home.
We were committed; hopeful. Waiting for my wife’s period to arrive so that we could commence upon the following menstrual cycle.
But that period never came.
Because Swarns was pregnant.
The elation and surprise was intoxicating. We laughed and cried, and never quite believed we had achieved naturally what the NHS deemed too unlikely to assist with, and what the private sector demanded thousands of pounds to deliver. For free! (barring conception supplements, non-spermicidal lubricant, pregnancy tests and all manner of ovulation tracking apps).
Our IVF clinic refunded us the majority of our outlay, minus fees for the consultations and drugs we’d already bought. And so we continued life with a spring in our step, buoyed up by good fortune and hope for the future.
We kept the pregnancy to ourselves, of course. It’s the rule, isn’t it? Don’t tell anyone until you’re through the first trimester. That’s partly to do with avoiding a jinx, but it’s more to save yourself the emotional trauma of informing those you previously told of any loss, should the unthinkable happen. And “unthinkable” is a perfect word, because you cannot bear to imagine an “MC”, let alone utter the word.
And so it goes: living in semi-secrecy for 12 weeks. It’s a long time, three months. Especially with a potentially life-changing secret doing a jig on the tip of your tongue. And there are obvious indicators to tip off close friends — a sudden alcohol abstinence; declining shellfish at restaurants, or pâté at weddings; or asking the pub’s kitchen staff if the mayo with your chips is from a jar or made in-house with unpasteurised eggs. It does not take Sherlock Holmes to deduce the root of these behavioural changes.
I would love to affect the etiquette regarding everyone’s Super Sleuth friends. At least be more like Columbo and keep your thoughts to yourself until the end! Be less like Holmes with his arrogant “Aha! I have found you out!” style of detective work.
I joke, but on a serious note, screaming in a public place: “OMG WHY AREN’T YOU DRINKING? OMG LOOK EVERYONE THEY’RE PREGNANT” is less than helpful. In fact, it forces the prospective parent to lie — lie to their friends; right to their faces.
Before you declare your deductions, perhaps consider the following:
- If a woman is indeed pregnant, she will tell you when she is good and ready. Trying to drag an admission of pregnancy out of her will only make her feel awkward, or force her to lie, or defy her own choice of secrecy.
- The woman may not be pregnant, but trying to become so. Perhaps fruitlessly. For who knows how long? She might be sensitive to so many setbacks, she certainly doesn’t need a public trial to ascertain the contents and efficacy of her womb.
- Being excited for someone is charming, but internalising it won’t quash that excitement. Keep it to yourself, and then when your friend feels safe and ready to reveal it, you get to say: “I knew it! That day in the pub, I knew it, oh I’m so happy for you!” Just delaythe congratulations. No dramas.
Thankfully, the first two months passed relatively easily, though Swarns was occasionally enduring a painful throbbing in her ribcage that would persist for hours until she was sick and had retched every drop of bile in her stomach and spat it, groaning, into the toilet bowl. (Nothing relatively easy about that, thinking back on it.)
There was also a trip to A&E, when Swarns found some blood spotting in her pants. Perfectly normal, we were told, after a gruelling four-hour wait to be seen by a doctor. It doesn’t seem right to have pregnant women waiting in a huge room filled with the sick and injured, but that’s by the by.
We were almost at our 10-week scan — the magical time where the miscarriage stats drop from 1 in 4 to 1 in 100 — when she found more blood. It was late, on a weekend, and we were sitting in A&E again, and I was trying to comfort my wife saying “This happens, and it’s not always bad,” and some bloke sat beside me said, “What are you guys in for?” — who the fuck asks someone what they’re in for at the A&E waiting room?!
Anyway, we were seen by a doctor, but without access to the ultrasound suite (which had closed for the night) he couldn’t confirm anything, so sent us home to come back in the morning for a scan. We didn’t sleep that night.
The scan in the morning confirmed what we had expected, and feared.
Our baby’s heart had stopped — and some time ago, it appeared. He or she had barely grown since the 6-week scan, meaning it had likely died in week 7.
Numbing sorrow followed. A deep, puzzling grief for someone who never was; for their potential, for the dreams of meeting them, getting to know them; playing, joking, laughing, crying, consoling, feeding, bleeding, weening, and one day sending off to university. Names, imagined experiences, a phantom personality we held in our minds but never dared articulate.
And then a haunting medical procedure to remove the foetus. What do we want to do with the remains? My God, what a question. I’m sure an argument might passionately be made either for clinical disposal or personal burial, but I felt a hollowing guilt for opting for the former when my wife was unable to reply.
Our lives became a miserable procession of smiling to others and crying behind closed doors. We told the few people who knew about the pregnancy what had happened, and each time it shattered us. Swarns was even more distraught, and soon found working in a secondary school utterly incompatible with her state of mind. Unsure of the compassionate leave she was entitled to, and given very little guidance from her management, she returned to work far too early, and the pressures of a misbehaving classroom, a long commute and the punishing workload all too familiar to those in the UK education system finally broke her considerable resolve. She quit.
Again, perhaps our privilege shows, for I could sustain us (with the help of a bit of our savings) until she was well. Not everyone would have that. It didn’t make it feel any easier.
But, with time, and counselling, and a shit-load of weeping hugs that I am certain made our relationship stronger — even at its most strained — Swarns returned to part-time work as a receptionist. The cut in wages was a price worth paying for the complete eradication of stress — not to mention the fact those months were pivotal in building back her self-confidence.
The blame game
There is a persistently present demon that raises its head in every step of the baby-making process — culpability. If a body isn’t producing eggs or sperm as it should, there is blame; if an ovulation fails to produce a pregnancy, there is blame; and when a miscarriage is endured, there is blame. Have I irreparably poisoned my body with years of consuming prosecco and coffee? Did I sneeze too hard? Did I offend some supreme being, and if so, to which one must I make the appropriate dedications?
What. Did. I. Do. Wrong?
Of course, no one was at fault, but try convincing a woman of that when she’s grieving the loss of an unborn child. She will take it allupon her shoulders; an Atlas of guilt.
And there’s also guilt in despising other people’s joy. Suddenly, everywhere we looked, someone was announcing a pregnancy, or celebrating a birth, or revelling in the joy of parenthood. Swarns told me she’d even practiced saying “I’m so happy for you” in the mirror, to make it sound genuine.
It’s not that we weren’t happy for our friends’ happiness. We just weren’t happy.
Around January of 2018, we spoke often about getting a pet. We had love to give, and an overwhelming urge to take care of a creature. We settled on getting a kitten.
Enter Roxy, the subject of our abundance of love, and the warmth in a grey and daunting life.
I could write a whole article on my love for this stupid (and often inexplicably wise) little cat, but an animal lover doting over their pet doesn’t make great reading. Suffice to say, Roxy filled a hole in our lives, helped rebuild our strength, and delivered joy where we could only pretend there was happiness.
She’s the best.
That spring, we returned to the fertility clinic, explaining our loss, and meekly asked to restart the process. I almost felt like apologising, so odd was our return — as though we had spurned their help and tried to go it alone, only to fail.
Even though I knew they were grateful for the custom, I couldn’t shake the feeling my tail hung between my legs.
By May, we were beginning our treatment. This meant injecting Swarns twice a day with hormones into the belly, which caused no end of bruising; and cutting down on alcohol, sushi, chocolate and caffeine (sounds like a perfect meal). I also had to stop riding my bike to work, for fear of knackering my knackers.
Friends will know this will have coincided with our annual friendly bar crawl, the ignominiously named Drink Like A Twat Day (once an excuse to get hammered, now a haloed chance to see our friends all together, outside of weddings).
For those that attended DLATD XIII, I apologise for lying to you about my ginless G&Ts, my Virgin Mary professing to be bloody, and my coke suspiciously unlightened by rum. I lied to you. I did not drink like a twat. I was sober. For you see, the following day I had a date with a plastic pot in a sterile clinic’s wank room.
In the infinite catalogue of evidence proving how men have it easier than women in every avenue of life, page 1,045,447 details how egg collection for women involves sedatives and surgery, while men are asked to watch porn in a room and unceremoniously beat one out into a cup.
They provide a choice of video clips, reader. But being choosey about the wank inspiration felt too intimate, and so I picked the first video. Only later, in shame, did I realise most other men would have done the same, so we presumably all thrashed it out sat on the same tissue-topped chair to the same forgettable vanilla fuck scene.
Still, these are not insurmountable troubles when the mother-to-be is groggily recovering by eating biscuits and sipping water as the world ebbs back into focus.
A few days later we got a call to say the insemination had succeeded; of the three eggs harvested, two had become embryos, one of excellent (read: hopeful) quality and the other of good.
Yet more drugs followed to prepare Swarns for the implant, and within a few days we were back, she once more in a hospital gown, me with a hairnet and plastic bags over my shoes as my wife was wheeled into theatre to have the embryo shoved in place (you may balk at this terminology, but this part of the procedure is little more than placing the embryo on a stick that gets prodded up in place and withdrawn, accompanied by a “Good luck!”).
Pregnant. Or so we hoped.
We still had a few weeks before the first scan…
Apps for tracking a pregnancy encourage you to pick a pet name for your embryo. Our natural, lost pregnancy we had named Szechuan, because we calculated that the day it was conceived was one evening when we were APPROPRIATELY ENGAGED, and the doorbell rang with our Chinese takeaway, so we rushed to a delightful conclusion, before legging it down the stairs sweaty and befuddled, opened the door and deliriously thanked the delivery chap for the food.
However, for the IVF embryo, we did not choose a name. We’d spent a year recovering emotionally from the miscarriage, and so we layered everything with a sheen of impersonal ambivalence. We had to. Hope is the killer. Imagination is the weapon. Disarm the killer by stealing their ammunition and you just might survive.
Thankfully, the first scan revealed a tiny growing foetus, and after a few more ultrasounds at the clinic that showed everything progressing normally, we were discharged to the NHS, where our history of miscarriage, and the fact that we had an artificially inseminated pregnancy, afforded us more regular consultation with specialists. For this we were grateful, but we still went for a “reassurance scan” at 16 weeks, where usually you’d have one at 10 weeks and another at 20. That was too broad a window not to perpetually contemplate catastrophe, so we paid a few quid to have a look inside Swarana’s belly in a private clinic.
It was a strange offering. You’d think finding out your baby is still alive and growing normally would be enough, but all sorts of up-selling products are available at these places; you can have your “4D scan” (what’s the fourth dimension? — time?) printed on a mug (decidedly rigid in that fourth dimension, lads), or a T-shirt, or a keyring, or a giant canvas frame for your kitchen.
Imagine wearing a T-shirt with a weird orange picture of an unborn baby on it. To what social engagement would you wear such a thing? A barbecue? A pub lunch? Maybe on your office 5k run? Astonishing. But I wouldn’t be surprised if that part of the business is as lucrative as the scans themselves. The entire model is based on reassurance, which means anxious parents, potentially ecstatic at each new successfully reached milestone.
Scratching the surface
The rest of the pregnancy passed without too much incidence, until the third trimester, when Swarns developed an unquenchable itch all over her body, but with no visible skin rash or irritation. After being fobbed off by our hospital’s triage (“Don’t come in if you are itchy, you might spread an infection around the ward!”), we mentioned it to our consultant, who ordered blood tests and diagnosed her with cholestasis, an elevated level of bile acid in the bloodstream. Apparently, it wouldn’t harm the baby, as long as he didn’t reach full term, when there was a high risk of still birth (or, as we referred to it: “bad things”, still incapable of uttering the unthinkable).
So we were scheduled for an early-as-possible induction. It was stressful, with the ever-present spectre of those “bad things” instructing every decision. And it was tumultuous, with the inducement drugs working too effectively and drawing forth a labour too swiftly for the body to prepare itself. Plus, there were some distressing drops in the baby’s heart rate caused by the umbilical cord wrapped around his neck, and an anaesthetist too busy elsewhere to administer an epidural.
But fuck all that, because Swarns was a hero, and our son was born that same evening, and everyone is healthy.
That’s our story
It’s a happy ending — or a happy beginning, really. But the journey matters. It matters because we rarely talk about a lot of these things, because it feels easier not to. Why dredge up those torments and grief when you can let the sediment settle at the bottom of your soul?
That’s why it isn’t brave of me to tell this story, of miscarriages, dashed hopes and depression. It isn’t brave, because I had to wait until I had a prologue, so I knew where the story was heading. Anyone who can tell their story without that has courage I doubt I could ever wield.
If you’re trying for a baby, and want to ask anything in confidence, you can drop your Twitter handle below and I’ll DM you. Talking is good. It does help. But it helps most when it’s someone who has been through it too. Because this is membership of an alumni that I wouldn’t wish upon my worst enemy, but it’s also immensely comforting if you do find yourself among us, to be among people who know. Who understand.
Anyway, big love.
Coen says “GaahaA!”