When Rebecca Seal decided at 28 she wanted a baby, she thought she was
starting young. She and her partner never dreamed they’d need IVF.
Wasn’t infertility an older person’s problem?
Rebecca and Steve: ‘We assumed that within a year or two we’d be parents.’ Photograph: Felicity McCabe for the Guardian The
doctor shuffled the papers holding our test results. I had just had the
first of what would turn out to be many internal ultrasound scans and
was feeling shaken by the brutal indignity of it: the stirrups and the
dildo-shaped scanner. “Well, it looks like everything is fine,” he said.
“Oh. Ah. No.” He pulled out one of the papers. “No. It’s very unlikely
you’ll be able to conceive naturally.”
When I was 28, five years and 48 crushingly regular periods ago, I
suddenly and desperately wanted a baby. Two of my closest friends
announced they were pregnant and there it was, sharp and inescapable:
jealousy. I wanted one, too. It was impractical timing – I was newly and
precariously self-employed and the house I rented with my partner,
Steve, was tiny – but there was no chance I could be rational. It felt
primal and urgent and strange.
Steve sensed that this wasn’t a negotiable issue, and over a curry
one night, we agreed we would try to get pregnant. Few of our other
friends had children yet, but that didn’t matter. We’d be pioneers, cool
young parents. By the time the rest of them got round to it, we’d be
nappy-changing, sling-wearing experts. We joked about how ironic it
would be if we had trouble conceiving, given how much of my early 20s
I’d spent worrying about getting pregnant. But we were young, and
infertility was an older person’s problem, wasn’t it? That night, I
cried happily into my dhal and assumed that within a year, two at the
most, we’d be parents. Instead, here we were, sitting on the edge of a
hospital bed, weeping, wearing hairnets and blue plastic
shoe-protectors, while the doctor went off to check with the
embryologists whether there was any point in trying for a few more
months (there wasn’t).
The first six months of trying for a baby was a happy time. I
obsessively Googled “early pregnancy signs” (hint: absolutely anything
can be an early pregnancy sign, if you really want it to be, including,
once, a tub of creme fraiche smelling off), and every month my period
relentlessly returned. I bought books about understanding my body’s
fertility signs, took my temperature before getting out of bed every
morning, tracking it on a graph to see when I ovulated, or peed on tiny,
expensive sticks that showed a less and less appropriate smiley face if
the right hormones were present. None of these activities are
aphrodisiacs.
Two years passed and nothing happened, at least not to us. We seemed
to be surrounded by people who only needed to look at each other to get
pregnant. Couples who hadn’t even met when we first started trying were
already lapping us. Our closest friends all had babies; some even
managed to have two. From the outside, our life probably looked pretty charmed. I’m a food
writer and Steve is a photographer. Our work was going well. We bought
and renovated a house. We wrote and photographed two cookery books
together. I started working as a presenter on Channel 4. We collected
mid-century-modern furniture and argued over paint samples. I took up
knitting and made quilts. But running like a thread through everything
that was going right was a horrible absence. What was the point of
working hard if there was no one to provide for? Why bother building a
family home if we were just going to clatter about in it by ourselves?
I couldn’t help feeling like a failure. I had never experienced such a
lack of control. Usually, through hard work and bloody-mindedness, I
could force things to go my way. But you can’t work hard at being
fertile.
Spending time with pregnant couples or their new babies became
unbearable. Hardly anyone knew what we were going through; we didn’t
tell our families and, while I told a few close friends at the
beginning, it was several years before Steve confided in anyone.
Guiltily at first, then, as time passed, bitterly, I stopped sending
baby cards and gifts. Baby showers, once silly but sweet affairs, left
me bruised: there’s nothing better than a few rounds of
pin-the-sperm-on-the-uterus in a room full of baby bumps to make the
childless feel bereft. At a Christmas party, two sisters announced they
were due to have babies in the same week, and that one was having twins.
I locked myself in the bathroom, cried, and then got very drunk,
ignoring my friends and instead hanging out with other, much younger,
child-free guests.
I have three close girlfriends, who all had daughters within a year
of each other. As any proud parent would, they sent me photos regularly;
unforgivably, I asked one to tell the others to stop. If babies came up
in conversation, often I would simply leave the room. Later, friends
admitted that they mistook our distance for disdain. “We just thought
you hated children,” said one. Others assumed I’d chosen my career over a
family.
About one in seven couples is unable to conceive naturally within two
years. It’s highly likely that you know couples who have struggled, or
had some kind of treatment. Photograph: Bruno Drummond for the Guardian
Infertility is a deeply private experience, something most of us
wrangling with never discuss. Fertility, on the other hand, is not. “Do
you think you’ll ever have a baby?” “You two should hurry up and have
kids.” “Best thing I ever did.” “I know what you career women are like.”
I was in my 30s by then, and most weeks a client, friend or relative
would ask me when we were planning to have kids, or remind me not to
leave it too late. Kudos to my friend Sam, who, when her great aunt told
her that at 33 she should be trying harder, said, “I’ve had four rounds
of IVF and an ectopic pregnancy. How much harder do you think I can
try?”
Nobody forgets to have children. It’s usually either a positive
choice or there’s a raw and painful battle dragging on behind the
scenes. It wasn’t something I wanted to discuss just before a meeting,
in a bar, or at some distant relative’s wedding anniversary. Whenever
anyone asked if I wanted a baby, I’d say, “Oh, I couldn’t eat a whole
one,” and laugh like a crazed hyena.
I know that what I’m saying smacks of cognitive dissonance. I want
infertility to be more openly discussed. But I couldn’t have talked
about it when it was happening to me. Back then, what I really wanted,
apart from two blue lines to appear on a little white stick, was for
people I barely knew to stop treating the question of whether I would
ever manage to have a child as small talk, akin to chatting about the
weather.
The latest data from the UK’s Human Fertilisation and Embryology Authority (HFEA) suggests that two-thirds of women who have IVF treatment in the UK are under 37.
The most quoted statistic – the one that makes women in their early 30s
unnecessarily nervous – is that their average age is 35, as though our
ovaries all spontaneously combust as that birthday approaches. In fact,
just under 44% of women who have IVF are aged between 18 and 34. The
idea that only older women need IVF is out of date, too – less than 20%
are over 40. I was 31 when we discovered we’d need treatment; Steve was
32.
About one in seven couples is unable to conceive naturally within two
years. It’s highly likely that you know couples who have struggled, or
had some kind of treatment, even if they never tell anyone. Nearly a
quarter of a million babies have been born in the UK as a result of IVF
since 1991. Now, they account for 2.2% of all births annually.
In about 30% of cases, the man is the cause of a couple’s
infertility. Steve’s sperm and my blood had been tested and cleared by
our GP, but because our infertility was still unexplained, we were
referred for tests at a clinic. My ovaries and fallopian tubes were
checked for cysts and blockages, and more sophisticated checks were done
on Steve. As his sperm count and motility were fine, we both expected
that the problem was with me; most people assume that infertility is a
primarily female problem.
We were wrong. Steve has anti-sperm antibodies. At some point in his
life, the usually impermeable barrier between his semen and his blood
supply had been broken, perhaps by a sports injury or during an illness
such as mumps, and his body started to attack his sperm as though it
were an invader, making it practically impossible for us to conceive.
Estimates vary, but as many as 10% of men may have anti-sperm
antibodies. It’s impossible to know for sure, because they don’t always
result in infertility, and the effects depend on the type of antibody
and their severity. About 1% of women produce antibodies which attack
sperm.
The only option for us was intra-cytoplasmic sperm injection (ICSI), a
more complex version of IVF. Standard IVF means an embryologist mixes
harvested eggs and sperm and leaves them alone to allow fertilisation to
occur. When ICSI is used, an embryologist injects a single sperm into
an egg; about half of all IVF treatments involve ICSI.
We were lucky in that we qualified for NHS funding: our borough would
pay for one round of IVF and two frozen transfers, if we had any
leftover embryos. Despite clear guidance from the National Institute For
Health And Care Excellence, whether patients get funding or not is a
postcode lottery. Because the cause of their infertility isn’t clear
enough, my friends Steph and Jake are paying for private treatment. They
would qualify for funding if they lived 400 metres farther down their
road and were under the care of their neighbouring NHS trust.
We waited a long, sad year between finding out our situation and
starting treatment. By the time we got our referral, we were in the
middle of moving house and Steve sensibly insisted that we didn’t try to
do both at once. We grew up together and are incredibly close, but
sometimes during that year it felt like a channel was opening up between
us. My need to be a parent had expanded to fill all my thoughts, all
the time, but for Steve, the years had allowed him time to question
whether he wanted children at all. Isolated from our friends, and now,
increasingly, from each other, we were both lonely. We never talked
about what would happen to us if IVF didn’t work, or what else we might
try, because it simply had to work.
Fertility clinics are strange places. While you are a patient, they
become the hushed, sterile centre of your universe. Then, as soon as
you’re discharged, you try to forget you were ever there. There was
abstract art on the walls of our waiting room, patterns made up of
disconcertingly large eggs and sperm, and a noticeboard covered in
photos of the babies the staff had helped create. Whether cheerful or
tragic, every waiting-room conversation was whispered; like any waiting
room in Britain, no one met anyone else’s eye. One day, surreally, a
harpist arrived, unannounced and unexplained, and started playing. He
couldn’t turn off the television, so BBC News 24 babbled on in the
background.
Before we could begin treatment, we were invited to an open evening
for new patients. Incongruously, it took place in the teaching
hospital’s large, tiered lecture theatre; there were hundreds of us,
lined up in anxious rows, like barren students. While the nurses and
doctors explained what was about to happen to us all, I scribbled
pointless notes about success rates (30-40%) and looked around the room:
how many of us would this work for? How much time, energy and, later,
money, would we have to throw at having a family, something which comes
so easily to so many people?
Finally, in February last year, I began injecting myself in the
stomach with hormones so that the clinic could take control of my cycle.
I congratulated myself on handling the injections rather well, until I
thought I was having an allergic reaction to a new drug and made Steve
ring an ambulance. I was actually having a panic attack, but still they
gave me an ECG while I lay, horrified by my own hysteria, in my pyjamas
on the kitchen floor. Every day or two, I’d go back to the hospital and
my blood would be checked and the doses tweaked, until my ovaries had
produced enough eggs for collection. On a cold and sunny spring morning,
I was given a general anaesthetic and the eggs were collected using a
long, thin needle. Before I was put under, Steve and I made polite
conversation about the landmarks we could see from the high hospital
windows, both of us ignoring the incomprehensible thing we were about to
do: give little bits of ourselves to a scientist, who was going to try
to make these bits into a person. When I came round, slurring my words, I
kept asking how long I’d been gone, thinking that longer meant more
eggs. More than 20 had been collected and were on their way to the lab.
When we were discharged I had to sign a piece of paper promising I
wouldn’t use a kettle for 24 hours.
Over the next few days the numbers kept dropping. Sixteen eggs were
viable. Eleven had fertilised. Seven survived the first few days. A
couple had made it as far as blastocyst stage
by day five, meaning they were the most likely to result in pregnancy.
When we were called in for the embryo transfer, when the doctors would
shoot the microscopic blastocyst up a tiny tube into my uterus, my
overwhelming feeling wasn’t fear or excitement but of desperately
needing the loo. The transfer has to be done with a full bladder, and
during a trial run a few weeks before, I’d been told off for not
drinking enough beforehand. This time, I’d gone completely overboard and
nearly peed all over the operating table. Unexpectedly, the doctor
asked if we would like one or two embryos put back, and we suddenly had
to decide if we wanted twins or not. (Multiple pregnancies are more
dangerous for both babies and mothers, and HFEA has set limits on how
many of them a clinic should risk.) We opted for one. The nurse did well
not to laugh when I asked if it was all right to go to the loo
afterwards, wanting to check that it wouldn’t fall out.
It would be another 18 days before we could do a test. We spent the
time in a kind of limbo. Though I knew I was unlikely to be pregnant, I
had to treat my body as though I was, while the synthetic hormones I had
taken ebbed and flowed away, making me feel sick, sore and exhausted.
On the day of the test, I was awake and staring at the ceiling at 5am.
Steve rolled over. “Do you want to do it now?” I was crying before I
even got to the bathroom and ripped the wrapper off, wondering if I
could manage, physically and mentally, to repeat the last weeks again,
and perhaps again and again. Steve said he could tell the result before I
got back to our room by how fast I was moving – skittering instead of
the slow walk and quiet “no” that had soundtracked every test so far.
Rebecca and Steve with baby Isla. Photograph: Felicity McCabe for the Guardian After four years and more than 40 negative tests, we finally got a
positive one. The IVF treatment had worked, first round, first time.
Three weeks after that we got to see a heartbeat on a screen and took
home a photograph of a tiny, peanut-shaped glimmer of a person. Our
daughter, Isla, was born in December. She has six potential siblings
safely locked in a freezer somewhere – a fact which is as difficult to
accept as it is that Isla, beautiful and chubby as she is, began life
under a microscope.
Steve was relieved to feel instantly euphoric; like me, he fell in
love with Isla the moment she appeared. Mothering after IVF brings with
it specific challenges: the first few weeks are startlingly hard for all
new parents, but if you’ve been waiting half a decade to achieve what I
expected to be a state of bliss, the reality can seem shockingly
painful at first. I’ve never experienced anything as relentless as
having a newborn baby. But then, I’ve never been so happy, either .
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