The messy middle

TRIGGER WARNING- this post contains references to miscarriage and fertility issues.

I went jogging today. I’ve been doing this quite a lot over Christmas. Partly the cliched penance for too much wine and cheese, but also because I love it and haven’t been able to do it very much lately. Not, fortunately, a result of having been laid up with Covid, like so many this year, but because I’ve been trying to get pregnant.

For anyone who has been able to get pregnant the “normal” way, this might sound like an odd statement. Sure, you feel tired in your first trimester, but you don’t need to sit on the sofa more before you get pregnant. In fact, it’s good to be fit. Just like it’s good to eat healthily and show some restraint on the booze. Relax. Live your life. Within reason.

But this advice doesn’t apply if you’re one of the many who need a little help. Or at least the advice is unclear. No “vigorous” exercise. “Gentle” walks. Or as one swiftly deleted Mindful IVF app put it: “protect your precious cargo”.

One of the good things about 2020 (in amongst the legions of cheering news stories) has been the opening up of the conversation about fertility. When I had my first, gut wrenching, drawn out miscarriage in April, I was determined not to let it be a secret, though I was anxious that people would think I was attention seeking or fussing. Turns out the risk was real, if you play forward to comments levelled at Chrissy Teigan and Meghan Markle later in the year. But I didn’t want to be “off work” with a mystery illness, especially at the height of the first wave of Covid. I didn’t want my colleagues to think I had gone AWOL in one of the busiest and most stressful periods we’d ever experienced as a team.

I’ve been more private, though spoken to close colleagues and friends, about what came before and then followed those horrendous few weeks.

The meeting after the Fertility MOT where I was told I scored at 3.5–8 on a scale where 20–30 would be more normal for a woman of my age, and that my irregular cycles probably indicated I wasn’t releasing an egg often, if at all. The decision to try the less invasive IUI procedure (where you are stimulated to produce and release an egg before a doctor inserts the crème de la crème of your partner’s or donor’s sperm) rather than IVF. The pure surprise and thrill when our first go resulted in a pregnancy.

The animal fear — the sound I made — when I started bleeding on a walk a few weeks later. The frantic calls to NHS 111, and the impossibility of getting through at the peak of the pandemic. The anxious wait over the Easter weekend for a scan. The hope when the doctor said it looked like twins and there was one heartbeat still there. The dread when I “felt different” a few days later. The horrible resignation and the loud silence when I went for another scan.

The frustration when I went to have another go a couple of months on, and the doctor told me a shadow on my scan indicated that the procedure to clear my womb after the miscarriage had not been performed properly (in spite of two goes at the time). The lovely doctor who did the follow up for me, and told me that local anaesthetic wouldn’t help with this and did I want to wait for a general, isolating for two weeks in the meantime? I grit my teeth.

Three more goes at IUI. One unsuccessful, with an infection acquired along the way forcing an incredibly uncomfortable drive back from our break in the Peak District. One abandoned when my body just refused to play ball and respond to the drugs. One more unsuccessful.

And so to IVF. The idea with IVF is that you make lots of embryos, insert the best one or two into the womb to develop, and freeze the remainder in case you want them in the future — because the first embryos don’t result in a birth, or because you later want more children. End to end the process takes about two months, and during this time the most cautious read of the advice is that one should act (and abstain) as though early in pregnancy. I suspect most women are sufficiently highly strung by the time that they reach IVF to abide by this.

The process is riven with points of failure. The stimulation — do you have enough follicles (spoiler — in my case, not really, no). The collection — did you yield a rich bounty of eggs (in my case, a very modest harvest). The fertilisation — did the eggs and the sperm make friends in the lab (yes, yes they did!!) The embryos — are they any good?

This last question was a particularly emotive one in my experience. When I went for the “embryo transfer” I was told there were five eggs fertilised. Embryos are graded A-C. I had one embryo of C quality. One of unknown quality (not yet developed enough). And three less developed still (which were later discarded as they didn’t make the grade).

What does C quality mean? I didn’t get a great answer to this. A is the best. “It’s about how the cells look”. Birth defects? “No, we can’t say, we aren’t testing for that.” And when pressed… “It should be ok but it might not be that beautiful”. Right.

In the end my husband and I opted to transfer the C quality and the unknown quality embryo. You’re then told to go home and rest. Within a few days I had what I recognised as pregnancy symptoms. I kept quiet, as if the “precious cargo” might be breached if I said it out loud. And that turned out to be true. I confessed to my husband, and less than twenty four hours later I started to bleed, the cramps reaching a peak as I donned reindeer antlers for online workplace festivities. The symptoms abated, even though I continued to take the drugs (which can themselves, cruelly, mimic the side effects of pregnancy). A week later I cycled to the hospital for a blood test with an inevitable negative result.

Now I’m back at the starting line. With no embryos frozen, despite nearly a year of being or trying to be or pretending to be pregnant, 2020 might as well not have happened when it comes to our “fertility journey”.

And that’s really why I am writing this. While the conversation about fertility and “women’s problems” has opened up, the narrative is still dominated by intrepid journeys followed by happy endings. The determination to pursue multiple IVF cycles. Bravery in the face of multiple injections of mood bending hormones. Loss followed by light. The joy of making it, of beating the odds. So many social media feeds. So. Many. Babies.

In many ways this is as it should be (though at lower ebbs I have reflected on whether some posts could do with a trigger warning). Anyone undertaking IVF is doing so in pursuit of an outcome they really want. It is not, I can vouch, something you would do for fun. Stories of success can motivate, and goodness knows those who got through it all and end up with a child have cause to celebrate. Yet I think there is a danger that, in this quest for resolution, we overlook the stories of people who don’t get the result that they hoped for, or drown out those who just don’t know their destination yet with “little miracles”.

Many I have spoken to about my experiences proffer a case study of a friend who “tried for years” and now have one, two or even three happy children. Others point to famous childless women (never men, or couples!), or tentatively talk about all the kids out there who don’t have loving homes. These are both understandable and well-meaning responses, intended to help you keep going or, indeed, give you permission to stop. And those do seem to be the obvious choices. Fulfilled with biological children. A poster girl for surviving without.

At the moment I’m not either. 2020 taught us much about living in ambiguity and we must allow it to apply here too. I don’t know if I’m on a journey. I’ve made some decisions and experienced some consequences. I have more decisions to take. I’m sharing the messiness of this point in the story as I know that countless others will be in this situation too. A buzz phrase of this year has been “it’s ok not to be ok”. When it comes to trying to have a baby, it must also be ok not to be there yet, to not know where you are going, or when or why you will stop.