The Pursuit of Motherhood

by Jessica Hepburn

  (OT)D-day draws closer. I buy a First Response pregnancy test. It’s burning a hole in my bag as I oscillate hourly about if and when do it. Eventually I decide to do it the day before my official test day, before Peter gets home from work. Maybe this is selfish. If it’s positive, I’m taking away the shared joy of seeing a double pink line. But if it’s negative all I have to manage, at least for a while, is my own disappointment.

  It’s negative.

  What did I expect?

  Come on. What did you expect?

  The Infertility Diaries Part XXV

  My dad will be ninety-two next month. He had me in his early fifties and I spent all my childhood thinking he would die because he was so much older than all my friends’ dads. But he didn’t. He was blessed with good genes and was active until his late eighties, when he started to have a series of strokes. For the last few years he’s been in and out of hospital, where he also contracted MRSA. I have to admit that I’m guilty of googling ‘MRSA and infertility’, to check whether there is any known link and I’ve gone and caught it. (As far as I can see there isn’t.) I should add this to the list of other insane Internet searches I have done, including, ‘Am I pregnant if my pee smells weird?’ and ‘Can too many crisps make you infertile?’ Google: my doctor and my devil.

  MONEY

  I sat down last week and did the maths. I worked out that over the last seven years we’ve spent over £50,000 on IVF and fertility treatments. Fifty thousand pounds and nothing to show for it – except perhaps the ability to appear on Mastermind with IVF as my specialist subject.

  Looking back, I don’t know how we’ve managed it. We have remortgaged our house (twice); taken out bank loans; borrowed money from our family (which they and we know we’ll probably never be able to pay back); and maxed out the credit card. Whatever happens in the end, we will be paying back what we owe for many years to come.

  I tried to arrange a balance transfer on my credit card to try to lower my interest payments. It was refused. The man at the end of the phone politely explained that he couldn’t tell me why but that I could check my credit score online. It hasn’t quite gone into minus figures, but I wouldn’t give me any more credit either.

  I know our financial situation is bad and real, but when you’re going through IVF it does start to feel as if you’re spending Monopoly money. You don’t usually pay for the process in one lump sum, as the costs vary depending on how many drugs you need, the type of treatment you have and what day your embryos go back. Each time you go into the clinic you hand over your card for something or other. After a while you don’t think about the cost, beyond perhaps feeling you’ve got a bargain when it’s a few hundred rather than a few thousand. One day I got talking to a fellow patient. She said that she’d stopped asking the amount and, as long as they deliver her a baby at the end of it, they can take what they like. But, sadly, in this game of Monopoly you may never pass go.

  Now – after my ninth unsuccessful round of treatment – I have to face the fact that even if I want to go through it all again it may be financially impossible. And even if someway, somehow we can raise the cash, I am starting to wonder whether it’s worth increasing our debt even further – let’s face it, probably for nothing. I know that sounds negative. I know Price Pritchett would probably have a thing or two to say about it. But there does come a point when you have to accept that, however hard you work at having a baby, it might not happen. And even if we can raise the money, the choice between going through it all again or going on an amazing holiday we’ll remember for the rest of our lives is starting to feel like a tough decision. It’s like Deal or No Deal. Do you take the Banker’s offer, which is in your control, or go for the box, which isn’t at all?

  I take my dilemma to the monthly meeting I now have with my fellow Hoffman participants. I ask the group whether they think it is time for me to stop and get on with the rest of my life. Of course no one can give me the answer, but towards the end of our discussion someone asks what I’d do if money wasn’t an issue. I surprise myself by knowing the reply instantly. There is no question in my mind that physically I can put my body through another round. There is no question in my mind that emotionally I can face it, whatever the outcome. The only thing stopping me is the money. But if money were no object, of course I’d go through it again. And again. And again. And again. Until there’s no more hope.

  Then I remember what my friend Ella said: it’s all about the number forty-three. I’ve just turned forty-one. Based on most fertility statistics, I’ve got two years left (give or take) to have my own biological baby. At forty-three the chances of IVF being successful drop to less than 3 per cent. If it’s only the money that’s stopping me, then we have to do whatever we can to find it. We must keep on trying. It’s too late to give up now.

  The Infertility Diaries Part XXVI

  I was at a talk today by a leading academic. He was speaking about the difference between things that are complicated and things that are complex. Cars and computers are complicated. It’s difficult to understand how they work, but if you put in the time and effort you’ll get there in the end. Things that are complex are much more difficult to fathom. There are so many subjective variables that it may be impossible to ever really know the answer. He was talking about cultural theory but it made me think about my infertility. Am I complicated or complex? Will it ever be possible to know the reason why?

  NATURAL SELECTION

  After two tries with Taranissi it’s time to move on. That’s not to say I wouldn’t recommend him to others. But he hasn’t been able to work his miracles on me. Nobody has.

  We still don’t have any answers. But I can tell that, despite there being no technical reason we can’t get pregnant and are continuing to create beautiful embryos in the laboratory, even the doctors at Mr Taranissi’s clinic – allegedly the most successful fertility clinic in the country – are starting to doubt that it’s ever going to work. Perversely, perhaps, this makes me even more determined.

  When I get home from work each night I go to Google for inspiration and solace. One evening I stumble on an article about a clinic which practises ‘mild’ and ‘natural’ IVF. This is basically IVF with few or no drugs. The article says that although this means you produce fewer follicles and fewer eggs, which in theory reduces the statistical chance of success, it’s better for your body and improves the quality of your embryos. Whilst I’ve been happily pumping my body with fertility drugs for years now without giving a second thought to the long-term consequences, I am immediately struck by the quality argument. Given my advancing age, maybe our last hope is to try and harvest the best egg I can and set it up on a date with Peter’s sperm.

  The next day I ring the clinic and make an appointment.

  I hand over my lever arch file of past notes to the director of the clinic. She’s the first female fertility doctor we’ve seen. She’s also a professor, which I guess means she must be clever.

  ‘The results of all Peter’s sperm samples seem normal,’ she says, leafing through our file. ‘Can I ask why you’ve always had ICSI?’

  ‘Well, years ago now, we did a twenty-four-hour sperm survival test,’ Peter says. ‘The results indicated that my sperm didn’t survive very long. Our clinic at the time recommended ICSI rather than conventional IVF, and since then every clinic we’ve been to has just followed suit.’

  ‘That test has been all but discredited these days,’ she says. ‘At this clinic we believe in natural selection. Unless there is a clear reason for ICSI – and I don’t believe there is in your case – I would recommend standard IVF in order to let the best sperm choose themselves.’

  ‘So do you have any idea what our problem might be?’ I ask her.

  ‘It’s difficult to tell. The biochemical pregnancies and miscarriage suggest there might be implantation problems. And your age now will certainly be a factor, but it wouldn’t have been when you started. Maybe over the years you’ve had too much intervention.’
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  ‘Too much intervention? What do you mean?’ I say.

  ‘I believe that many couples are given high dosages of drugs and procedures like ICSI before it’s needed. My theory is that you should start by trying as naturally as possible, using no or low levels of drugs, and work your way up from there. Not the other way around.’

  She is equally definitive about Mr T’s immune therapy – ‘unproven and unlicensed’ – and about alternative treatments like acupuncture and supplements: ‘unproven and unnecessary’.

  ‘In the first instance my recommendation would be that you undertake a cycle of mild IVF,’ she says. ‘This means that we will give you some stimulation drugs, but far less than you’ve been used to having.’

  ‘What will that do?’

  ‘It will induce more than one follicle, but, Jessica, you’ll need to stop any obsessions you have about egg numbers,’ she says pointedly. ‘With natural and mild IVF we are only trying to produce a small number of eggs. We’re interested in quality not quantity.’

  It is as if she had read my mind, but I have to admit that the thought of it is quite liberating. After all, we only need one plus one (or, if we’re double lucky, two plus two).

  We decide to give the clinic a go. An added benefit is that mild IVF is cheaper than conventional IVF (on account of there being fewer drugs), and considerably cheaper than a round of treatment with Mr Taranissi (on account of there being less of everything). But it is nerve-wracking. I’ve now grown accustomed to the daily blood tests and scans that carefully monitored my progress. This time it’s just down to me and my body, which it is now blatantly clear can’t be trusted.

  On egg collection day the result is five. Five eggs and I’m feeling fine. It’s actually only three less than I achieved the last two times with Taranissi, on half the drugs, which does make me wonder whether we’ve been wasting our money all these years. After the collection one of the embryologists calls us through to discuss next steps.

  ‘Your eggs and sperm look good,’ she says. ‘Having said that, I think my recommendation is that you do ICSI again rather than IVF.’

  ‘Why?’ I say confused. ‘We were told that if Peter’s sperm looked fine you would do conventional IVF.’

  I am surprised and a bit disappointed at the sudden change of tack.

  ‘That’s true,’ she says. ‘We would usually, but I’m just going on your history. At least with ICSI you know you’ve got a record of successful fertilisation. If we do IVF there is going to be a small danger that none of them fertilises.’

  ‘How much of a danger?’

  ‘Maybe about 15 per cent.’

  ‘But at least we would learn something new,’ I say.

  ‘Yes, but you’ve got to think about how you would feel if you didn’t have any embryos to put back. ICSI is definitely the safer bet in your case.’

  She is very patient with us as we talk around and around each option. Then she suggests we go out for a walk to think about it. I can see that, when faced with a relatively small number of eggs and our past record, it might suddenly seem foolhardy to try something different. But at the same time, that’s what everyone else has done and it never got me pregnant. The fresh air emboldens me. If nobody can give me the answers to why we’re not getting pregnant then maybe it’s time to start looking for them myself.

  ‘I think we should risk it,’ I say to Peter.

  ‘Go against the embryologist’s recommendation?’

  ‘Coming here was about doing things differently. If none of them fertilises then at least we’ll definitely know that my eggs and your sperm don’t like each other. It will give us more information.’

  ‘But how are you going to handle it if that happens?’

  ‘My instinct is already telling me that none of them will fertilise and this round will have been for nothing…but we’ll have learned something.’

  We go back to the clinic and tell the embryologist. Then I all but put it out of my mind, convinced that this round of IVF is over. It feels hard, but I’m also dealing with the fact that my dad has just been taken into hospital again and is very ill. At least I won’t have to cope with that alongside another two-week wait.

  The next morning the phone rings at 8.20 while I’m in the bath. It’s the embryologist.

  ‘Good morning, Jessica.’ She sounds a bit excited. ‘Do you want to know how many embryos you have today?’

  ‘Go on, tell me.’

  ‘Five! All five eggs have fertilised.’

  ‘Really?’ I say incredulously.

  ‘Really. 100 per cent success.’

  ‘Oh my god. That’s amazing. AMAZING.’

  Peter rushes in from the kitchen and punches the air.

  ‘I have to admit I was worried,’ she says. ‘It was the first thing I looked at when I came in this morning.’

  ‘It’s incredible. INCREDIBLE,’ I say.

  ‘It is. And just think, all those years of ICSI and you never needed it.’

  I’m staggered and delighted in equal measure. In seven years it’s the best fertilisation rate we have ever had.

  ‘I am so delighted for you, Jessica,’ the embryologist says. ‘I will be waiting and watching for the result of your pregnancy test.’

  I put down the phone. Optimism may be good, Mr Price Pritchett, but let me tell you: there’s nothing quite like pessimism when it’s proved wrong. Right now I feel like the luckiest person alive.

  Peter looks at me.

  ‘I love you,’ he says. ‘You made a massive decision yesterday. I love you for your bravery.’

  Two days later, three of our five embryos are put back. Two grade ones, one grade two. On the dreaded Day 13 of the two-week wait I start spotting. I take a First Response pregnancy test. It’s negative.

  Later that day my dad dies.

  Life gives and it takes away. Today it took away a lot and gave me nothing back in return. Sometimes there isn’t any justice in the world.

  The Infertility Diaries Part XXVII

  I don’t want to hear any more stories about someone’s friend of a friend who tried to have a baby for years and then suddenly fell pregnant when they stopped trying. Who are these people? I don’t believe that you ever stop trying.

  THE OTHER OPTIONS

  So when is the right time to think about the other options? Egg donation? Sperm donation? Surrogacy? Adoption? Looking back over seven fruitless years, I just wish that we had done it earlier. Now it feels as if this journey has to result in our own biological baby or nothing at all, and that’s largely because I haven’t got the energy to start all over again on something new.

  I must know practically everything there is to know about IVF using our own eggs and sperm. But I know practically nothing about what’s involved in adoption, except that it can take years and often involves intrusive interrogation by well-meaning social workers. I do understand that this is an important part of the process, but at the same time I don’t know if I would be able to hide my fear that I sometimes feel our infertility means we don’t deserve to be parents and that it’s nature’s way of telling us that we won’t make very good ones. As for egg and sperm donation, I’ve always felt it was something I wouldn’t consider and no one ever suggested it to us until I turned forty. But I’ve recently seen two great documentary films about donor conception. The first – Donor Unknown – was about an American guy who spent his twenties in producing rooms, ejaculating for money. At the latest count his sperm has fathered at least twelve children and the film followed their quest to find him. He’s now a hippy living in a camper van on California’s Venice Beach with four dogs and a pet pigeon.

  The second documentary – Donor Mum: The Children I’ve Never Met – was about a woman who conceived her son through donor sperm and wanted to give something back, so she anonymously donated two of her eggs at the same time. They were given to a woman who had been involved in a plane crash in which her own two children had died and who had sustained such severe injuries herself tha
t she was no longer able to conceive. It was the most heart-warming story, above all for the generosity and humility of the woman who had donated her eggs, and the gratitude and joy of the woman who had received them.

  But despite these extraordinary and wonderful stories I still can’t imagine carrying and giving birth to a child that is genetically unknown to me, especially when there are so many children around the world who have already been born and need new parents.

  And then there’s surrogacy. I don’t even properly understand when this becomes an option. I presume it’s when a woman can’t carry a child herself. Surely our healthy eggs and sperm and my inhospitable womb would make us a potential candidate, yet, again, no one has ever suggested it to us.

  The problem is it’s difficult to navigate the other options, especially when you’re diagnosed with unexplained infertility. You just keep hoping that natural or assisted conception is eventually going to work. Of all the clinics we’ve been to, not one of them has actively helped us to explore all the options or even contacted us six months on to find out how we are. I sometimes wonder whether all the doctors we’ve seen over the years ever remember us and wonder what happened. Or are we just a failed statistic that brought their year-end success rates down and then, thankfully, disappeared?