The Pursuit of Motherhood Read online

  ‘It’s good to talk,’ she replies.

  I set down my cup and turn to her.

  ‘Shall we have a coffee?’

  ‘That’s a bit reckless, isn’t it?’ she laughs.

  ‘Sometimes you need to say, “Fuck it, right now I need a double-shot cappuccino more than I need a baby.”’

  ‘You’re right. And let’s have a slice of cake too.’

  ‘I bet cake’s banned.’

  ‘Everything’s banned these days.’

  ‘So let’s start a revolution!’

  A few months later Peter and I go through a frozen IVF cycle using the remaining embryos from our initial round of treatment. This proves to be far less intense than the first time and simply involves shutting down my natural cycle, taking some drugs to create the right environment within my uterus, and then popping the fertilised eggs back. All four of our frozen embryos survive the thawing process, but as only two can be transferred we have to say goodbye to the others. Some things aren’t different about the process though. Firstly, there’s another two-week wait to contend with (nor is it any easier this time around). And secondly, we end up with the same result as last time – although, thankfully, the uncertainty is less prolonged. The first blood test indicates that I am pregnant but the HCG level is low. Two days later the level has dropped. Another biochemical pregnancy.

  Again our doctor says that, whilst this is disappointing, it is still a good sign. He encourages us to undergo another full round of IVF as soon as possible. His advice is that we simply replicate everything we did last time. As I responded so well, there’s no reason to do anything differently. So we do. I down-regulate, take the same dosage of stimulation drugs, and turn up for egg collection in eager anticipation of another anaesthetic. What I don’t know, as I breezily enter the clinic saying ‘hello’ to the now familiar receptionist, is that I’m about to learn two of the most important lessons of IVF: firstly, that no two rounds are ever the same; and secondly, that the happy ignorance of your first round will never be repeated.

  When I come round from the anaesthetic, Peter is sitting waiting for me. I don’t feel quite as refreshed as I did last time, and the tea and bourbon biscuits don’t taste quite as good.

  A nurse comes through to check on me.

  ‘Well done, Jessica,’ she says. ‘You did really well. We collected nine eggs.’

  ‘Nine?’ I say.

  ‘That’s right.’

  ‘Didn’t I have more last time?’

  ‘I’m not sure, I haven’t got your records here. But there’s nothing to worry about. Nine is good, very good.’

  The next day we go into the clinic, just as before, to see how many eggs have fertilised and watch them being moved into new Petri dishes. Of my nine eggs, four have achieved fertilisation. At face value, nothing to worry about here either. But – and it’s a big but – a new chapter in my IVF journey has begun.

  Last time, the first time, I didn’t pay any attention to egg numbers and fertilisation rates. I had sixteen eggs; thirteen fertilized; two embryos were transferred on Day 3; four more were of good enough quality to be frozen. As far as I knew, this was what happened to everyone. Even if it didn’t, it was what happened to me.

  So why are things so different this time around? We did everything exactly the same. The only change was that I had a bit of acupuncture and took some supplements prescribed by a very chi-chi clinic that promotes natural therapies alongside conventional IVF. Surely this should have helped, not hindered the process.

  I do feel ungrateful saying this. I’m sure some women have to face a situation where they produce no eggs at all or they do but none of them fertilises. Whilst it is significantly fewer than last time, we are still lucky enough to have four embryos, and although two of them don’t survive much beyond the second day, the other two are put back on Day 3. But as we go home to start our third two-week wait, I have this sinking feeling that, whatever happens this time around, my relationship with IVF is never going to be quite the same again.

  When we get home, we decide to treat ourselves to a Chinese takeaway and an evening of trash TV – heaven, apart from the absence of a glass of red wine. We go to bed, tired and happy. Peter kisses my tummy and says goodnight to our babies on their first night at home with Mum and Dad.

  In the middle of the night I wake up with a pain in my chest. Indigestion.

  ‘Hello,’ I think. ‘Why now?’

  It is at least a month since my last attack and I have almost forgotten the dull, unrelenting ache. I lie still with my eyes shut, trying to pretend it isn’t there, but after a while the sickness starts. I run to the bathroom and retch: a case of last night’s Chinese takeaway revisited. I crawl back to bed and lie on my back with my knees up. Then on my front in child’s pose. Then on my side hugging a cushion. Nothing is comfortable. Nothing will relieve it. I run to the loo again. More Chinese with a bit of leftover lunch mixed in. I go into the sitting room and turn on the television to try to distract myself from the pain. It doesn’t work. I’m sick again, this time barely getting to the loo in time.

  After a couple of hours Peter suggests we walk round the block. The cool night air is refreshing but the movement just shifts the pain; I bend over and throw up in the gutter. I must look like I’m on my way home from a good night out. If only.

  We go back home to bed. It’s starting to get light and usually things would be easing off by now. Four hours of agony is generally my maximum sentence. But the pain and sickness is showing no sign of subsiding, even though my stomach is empty and all I have to offer up is canary-yellow bile. Peter has to go to work and I insist that I’ll be all right on my own. It’s a Saturday so at I least I don’t have to go into the office myself. When he gets home in the evening I’m still in bed. The pain and sickness has finally gone but I am utterly exhausted.

  A few days before I am due to do my pregnancy test, I start spotting. The day after that I start bleeding. I don’t even bother to take a test. I can’t believe anything would have survived that first night of indigestion and sickness anyway. What’s the point?

  The Infertility Diaries Part VI

  As soon as your friends start having babies, and you don’t, your relationship changes. They want to talk about sleeping patterns; how long to breastfeed; whether to Gina Ford or not to Gina Ford. It’s not that I find these conversations upsetting, or that I’m not interested (although these subjects aren’t particularly interesting if you don’t have children). I just don’t know how to have them. So after a while you stop getting invited round to dinner, and you stop inviting them. Then you realise that your friends have made some new friends – friends who all have babies too.

  THE 100M HURDLE RACE

  The IVF process is like the 100m hurdle race, but with six huge hurdles instead of ten. At every stage you can only see the hurdle directly in front of you, but as each one is cleared, the finishing line, with its definitive ribbon of success or failure, gets closer.

  Hurdle 1: How many follicles?

  The first hurdle is how your body responds to stimulation. The aim is to develop a decent number of follicles of a similar size in each ovary. You’re always anxious prior to the first scan. What if there are only a couple of big ones and the rest are tiny? What if there aren’t any follicles at all? During stimulation the number of follicles becomes your first daily obsession.

  Hurdle 2: How many eggs?

  Soon the number of follicles becomes irrelevant; now the important question is how many eggs? Not every follicle will release an egg, and not every egg released will be mature. As soon as you wake up from the anaesthetic after egg collection, it’s the first question you ask. It’s a numbers game: the more the better.

  Hurdle 3: How many fertilised?

  The morning after egg collection is the next hurdle: how many eggs have fertilised? In IVF it’s rarely, if ever, 100 per cent, which is why you need a good number of follicles and then a good number of eggs in order to increase your chanc
es of success. Today everything that’s happened over the previous two weeks no longer matters. This is now regarded as Day 1; you’re halfway through, just three more hurdles to jump.

  Hurdle 4: Days 2 to 5

  Over the next few days your embryos begin cell division and all you can do is watch and wait. As each day passes some will progress, others will falter and fail. From Day 2 of your embryos’ life they start to be graded, and this influences the decision as to which ones should be put back when. In the UK, currently, if you’re under forty you can have two embryos back; and over forty, three embryos. As soon as it becomes clear which embryos are the best – or maybe they are the only embryos you have – your clinic will want to put them back where they belong. If you have produced a small number of eggs, it becomes clear pretty quickly which to put back. If you have produced a larger number and all of them are developing nicely, they are likely to hang on to see which embryos develop into blastocysts. This is the term used for embryo development on Day 5. In theory, an embryo that becomes a blastocyst has the best chance of survival, but the embryos will only be cultured to this stage if there are more than a few good ones of similar quality.

  Hurdle 5: The two-week wait

  The penultimate hurdle is the dreaded two-week wait: the period between your embryo transfer and pregnancy test, when time seems interminable. You become hyper-aware of every twinge, or lack of twinge, in your body, oscillating between thinking it’s a good sign, then thinking it must be bad. Every physical movement or negative emotion feels like it might have jeopardised the process. You know that being positive is important, but you also don’t trust yourself to deliver.

  Hurdle 6: The pregnancy test

  And finally, the test itself, when all that stands between you and happiness is a double line. But having longed for the wait to be over, you now wish it could continue. After all, there’s no guarantee of a medal at the end of this race, and to prolong doubt is to prolong hope.

  The Infertility Diaries Part VII

  Infertility has ruined the beautiful relationship I had with alcohol, my perfect partner at the end of a hard day’s work. These days our dealings have become uneasy. I am suspicious of whether it is affecting my fertility. I am even more suspicious of the affair it may be having with Peter. Yet, at the same time, I’m grateful for its ability to numb the pain; to make the world seem an infinitely more survivable place. But then I start to resent it, knowing that reality and regret always follow later. I long for something else to come along that will force me to walk out on the relationship – just a trial separation of nine months would do. Maybe then we can rekindle our love again.

  DREAMING SPIRES

  It’s time for a change. For the last few years we have been living in a series of one-bedroom flats in different parts of London, and I am starting to become obsessed with the idea of buying a house and having our own front door. We start spending our Saturdays trawling around estate agents. I realise it’s probably some form of baby-displacement activity.

  It’s the height of the property market and it soon becomes clear that the only houses we can afford are in neighbourhoods on the outskirts of London, which are full of thirty-something couples and their Maclaren buggies. I want a house but I can’t bear the thought of being the odd couple, so, in a moment of reckless spontaneity, we buy a house in Oxford. Not that there’s anything wrong or reckless about Oxford per se. A house there is certainly cheaper than its counterpart in London and, according to the UK’s property oracle (aka Kirsty and Phil), it’s a good investment as it will always be rentable to students (and rich students at that). Nevertheless, it is a bit of a weird thing to do when you don’t know anyone else who lives there. And you work in London.

  But there is another reason. I have been going through a tough time at work. I’m spending an increasing number of hours at my desk, regularly coming in with the cleaners at six in the morning and not leaving until past ten at night. I am also going in at weekends, which, along with workaholics everywhere, I tell myself is the only time I can get anything done. Peter keeps nagging me that this can’t be helping our attempts to conceive. I know he’s probably right and that I’m using work to numb the pain of not having a baby. We both hope that a move to Oxford might be a good, if slightly drastic, way to force me to change my work–life balance.

  As soon as our offer is accepted I ring Beth to tell her. She has now been through several rounds of IUI. All negative. She is on the NHS waiting list for her first round of IVF.

  ‘I’ve got some news,’ I say.

  ‘Really?’ she says excitedly.

  ‘Not that sort of news,’ I say quickly. ‘We’ve bought a house.’

  ‘You have? Where?’

  ‘Oxford.’

  A moment’s silence.

  ‘Where?’ she says again.

  ‘Oxford.’

  ‘That’s what I thought you said. Why?’

  ‘It seemed like a good idea.’

  ‘What about work? Are you going to commute?’

  ‘That’s the plan.’

  ‘At least you won’t be tempted to go in at weekends any more.’

  ‘That too.’

  She’s silent again. She seems to be processing the information.

  ‘Do you know anyone there?’

  ‘Not a soul.’

  ‘But you’ll meet people,’ she says. ‘It’s exciting.’ Her voice sounds genuine, if a bit cautious.

  ‘It is,’ I say. ‘A new start is just what we need. Anyway, how are things with you? Got any news about your IVF yet?’

  ‘No…but I do have some news…’

  She is hesitant, and I feel a familiar crumpling in my chest as I realise what she’s about to say. Why isn’t there a word in the English language for feeling happy for someone and sad for yourself at the same time?

  Shortly after we move into our new house, we decide it’s time for a change of clinic too. Over the last two years we have been through four failed attempts at IVF there (rounds one and two which resulted in biochemical pregnancies; round three being the indigestion episode; and a fourth round in which I also started spotting and then bleeding before test day and was negative). As much as I love the staff there, it feels like the end of a relationship, when you both still care about each other but instinct tells you that it’s not going to work out in the long term and it’s time to move on.

  The first thing we do is sign up with a new GP in Oxford. When I go for my registration appointment, I am seen by a friendly male doctor. He asks me about my general health and I give him a brief summary of the last few years.

  He listens attentively.

  ‘I realise how hard it must be,’ he says. ‘I really do. My wife and I have been through infertility treatment ourselves.’

  ‘You have?’ I say.

  ‘Yes. If you’re thinking about going to a new clinic there are a couple that I would recommend. One of them is here in Oxford, based at the John Radcliffe Hospital. It takes both NHS and private patients. It worked for us.’

  I can hardly believe his candidness or his kindness. A lot of GPs are rather aloof and uncomfortable around the subject of infertility. It is so comforting finally to find one who is open and clearly wants to help.

  A few weeks later I bump into him in the supermarket on a Saturday morning, two beautiful children hanging off his shopping trolley. I smile tentatively, not really expecting him to remember who I am.

  ‘Hello,’ he says.

  ‘Hi – I’m one of your patients,’ I say, just for clarification.

  ‘I remember,’ he says. And then more quietly, almost conspiratorially, as he nods towards his children: ‘See, it can work.’

  Sadly, I never saw that doctor again. A few months later he left the practice for a new job. But in that moment – a chance encounter between two almost strangers in a busy supermarket aisle – there was a profound sense of connection and understanding. I made up my mind. Our next clinic would be the Fertility Unit at the John Radclif
fe Hospital.

  So maybe there is another reason we moved to Oxford. Maybe these dreaming spires are meant to lead us to our longed-for child.

  Our first appointment is with their consultant gynaecologist, a softly spoken, charismatic Irishman who has recently been listed in a weekend newspaper supplement as one of the most successful fertility doctors in the country. We talk openly about our treatment to date. He says that in his opinion our previous clinic is very good, and that it probably won’t be possible for his practice to facilitate the same level of witnessing as we had there. At least he’s honest. He also says that everything about the response and results of our treatment to date indicate that we should try again, and that we have a very strong chance of success. We like his style and decide to embark on another, our fifth, round of IVF.

  Things go pretty well. I don’t reach the dizzy heights of egg numbers and fertilisation rates that I did on our first round, but it’s better than our recent tries and, on Day 3, I get some exciting news. The clinic calls to say that five of our embryos are still developing really nicely and they are going to wait to see which become blastocysts and put them back on Day 5.

  Rightly or wrongly, the blastocyst has become my Holy Grail. Statistics indicate that embryos which are transferred on Day 5, when they have reached this developmental stage, are the most likely to implant and go on to achieve a successful pregnancy. In fact, some doctors say – but this is not something that is commonly acknowledged or practised – that it is not worth putting embryos back before Day 5 because, unless they reach this stage in the lab, it is very unlikely that they will form a viable pregnancy. Until now I have always had my transfer on Day 3, so to be going beyond this feels like a mini-triumph. It also gives my body a few more days to recover from egg collection and, in my mind, for our embryos to grow stronger before they are unleashed in the hostile environment I’m starting to think my womb must be. By Day 5 four of our embryos have developed into good quality blastocysts, so two are transferred and the other two are frozen.