(A spoken word recording of this post can be found here.)
Man’s main task in life is to give birth to himself.
I try to be very honest in this blog. I’ve sometimes written about things that were quite personal, and I’ve been so grateful that people have taken the time to read what I’ve written, and sometimes sent messages to say that my experiences have chimed with them. But I must confess that I’ve only been telling a fraction of the story…
My blog is predominantly about my experience of being an expat, and as my experience is generally very positive that’s the tone that I most often try to maintain. But the other day a friend posted a status update on Facebook that made me think. She wrote:
As much as I am happy that all my friends are having happy days, it painfully reminds me of how crap my life is… — feeling sad and lost.
My inclination, when something is troubling me, is to hide myself away and work it out on my own; I’m very aware that everyone has problems of their own and I don’t want to risk boring people with mine. But my friend’s words made me wonder if that’s perhaps a little dishonest of me. While my family and my friends that I see regularly have generally been apprised of what’s been going on with me for the last four years, those at a greater distance only see the highlights of the happy times. Sometimes people tell me how lucky I am; they say they’re jealous of my adventures or playfully ask if I’d like to swap lives. But that’s only because they don’t know the whole story. The truth is that I AM incredibly lucky and I DO have a wonderful life. But nobody has it all and I’m now just about at the point where I’m starting to have to accept the possibility that I won’t ever have everything that I thought I would.
I know it’s not necessary to share everything with everyone – a stiff upper lip and a determined, independent resilience were two things that were deeply ingrained in me as a child – but the more I think about it, the more I think it’s incumbent upon people who’ve been through the experience that I have over the last four years to start talking about it for the benefit of those who might go through it after them. The taboo around the subject seems to be being broken down slowly in the States but I’m not sure that’s yet the case in the UK. In fact it’s still such an uncomfortable subject to discuss that even I, who have been living with it for the past four years, am having trouble spitting the word out. But here goes. I’m going to be brave.
This is the first of three posts I’m going to write on the subject of infertility.
Nearly four years ago I got on a plane in London, where I then lived, and flew to Johannesburg, the closest international airport to Pretoria, where M then lived. M picked me up from the airport and we made the most of the sunshine by having lunch outside at an all-organic, all-artisanal street market, and it was over our chickpea curries that we decided that we were going to start trying to have a baby. M bought me a beautiful silver bracelet from the market stall beside us to commemorate our decision.
The next six months were not our proudest in terms of environmental impact. M’s job with an international humanitarian organisation and my work for a UK-based global technology company meant that we were not then able to live in the same country. The many emails we exchanged during that time helped to solidify our relationship across the distance, but the act of flying was as essential to our family planning as were any more traditional baby-making activities. The miles flown between South Africa and the UK stacked up until they almost toppled over, and in April M accompanied me on a work trip to the States. And all the while we looked forward to the time when we would occupy the same hemisphere and have more time to concentrate on turning the two of us into three.
I wasn’t terribly worried, in those days, that each month brought another negative pregnancy test. I’m from a vastly fertile family and M had no reason to doubt his fertility, so we just enjoyed the brief periods we were able to spend together and hoped for the best. I never wanted to be one of those women who took her temperature every morning and obsessed about whether she was ovulating – what a turn-off that would be! – and I was sure that sometime soon we’d be swapping air miles and hotel loyalty schemes for prams and baby-friendly restaurants, just as most of my friends and all of my family had done some time before.
When our chance to occupy the same landmass arrived six months later, I was even secretly relieved that we hadn’t got pregnant up until that point… Call me old-fashioned but I can’t help but imagine that joint parenting decisions are made most easily when both parents inhabit the same country as the child. The fact that that landmass was the Middle East was thrilling; M was posted to Jerusalem and I felt privileged to be able to join him in such a fantastically vibrant and historic city. I reluctantly resigned from my job and could have kissed my boss for requesting that I continue to represent the company at all the international broadcast exhibitions that I’d attended previously. He also asked if I would assume responsibility for maintaining the company’s relationship with a technology partner in Tel Aviv, just down the road from my new home. Perfect.
Nine months after Silver Bracelet Day I was back in the UK for a few days after a work trip to Amsterdam, and decided to have a chat with my GP about fertility. I knew that M and I needed to spend a lot more time together if we were serious about starting a family, but I wanted to check that there wasn’t any obvious impediment to pregnancy. My GP carried out the initial rudimentary checks – for syphilis and other assorted STDs, it seemed – and after giving me the all-clear on those he double-checked my file and realised with horror that I was 39 and therefore beyond the allowable age for NHS fertility treatment. He had no choice but to eject me from his office.
Months went by and although M now spent most of his time “at home” in Israel and the Occupied Territories, I continued to travel frequently. (How does one say no to paid international travel which allows you to do a job that you love in Berlin, Dubai, Las Vegas, Singapore and London? Oh, if only I’d known…). When I was at home in East Jerusalem, the fact that I was spending half of my life on planes didn’t stop me from morphing (illogically) into that woman that I’d promised never to become. The basal body thermometer was purchased and every morning, when the rest of East Jerusalem was waking up to the call to prayer, I was recording my temperature and sometimes wondering how best to word my request that M pop home “for lunch” later that day.
When nothing had happened by June – 18 months after Silver Bracelet Day and a year after we moved in together – we decided that M should have the simple checks necessary to make sure that all was well with his contribution to our baby-making efforts. He took himself off to Hadassah Hospital in the Jerusalem Hills, and was delighted, as I’m sure most men would be, by the doctor’s use of the word “Superman” in describing his sperm quality. I had to fly to Singapore for work soon after and I tagged on a trip home to my native Australia, where M joined me to spend a week catching up with my family. We joked that we’d name our baby after the place in which it was conceived, but ultimately decided that lumbering our child with Ningaloo or Fremantle would be a less than loving first parental act. Anyway, little Ningaloo decided not to be conceived in Australia so her name was a moot point.
At around this time we started to wonder if perhaps we were too old for the “cross your fingers and hope for the best” approach to starting a family. One of my four sisters had recently had a baby at age 43 so there was evidence of longevity in the fertility of my family, but as this was her fourth child her situation wasn’t really comparable to mine – I’d never been pregnant despite not always having been super cautious, so a little seed of doubt was now planted in my mind about whether perhaps I couldn’t conceive.
It was time to take drastic action. At the broadcast exhibition I attended in Amsterdam in September, I told my boss that I’d no longer be travelling for work. I cried when I told him. I’d always known, of course, that I’d have to make sacrifices if I wished to have a family, and having waited until such a late age to start trying, I was more than prepared to make them. Perhaps naively, however, I’d imagined that the need for sacrifices wouldn’t begin until after the baby was on-board. Having worked in jobs that I’d loved for my entire adult life, I was daunted by the prospect of giving all that up to concentrate on the possibility of conceiving. But with M living on one continent (in which I was not allowed a work visa) and my job being on another, I seemed to have little other choice.
When we met with the head of fertility services at Hadassah Hospital, he explained that contrary to popular perception, one doesn’t just launch into a course of IVF without first exhausting all other avenues. It was around this time that I first became familiar with the acronym IUI, for Intrauterine Insemination. The procedure is designed to eliminate the variables involved in human procreation, like, erm…sex. The best of a man’s contribution is introduced directly to a ready-to-be-fertilised egg, right in the place where the party is set to start. This, despite there being no drugs or major interventions involved, was not a cheap procedure, and every visit to the consultant’s office was preceded by a tricky conversation with the hospital’s finance department, who insisted that I sign forms written in Hebrew whose contents I had no way of comprehending.
In retrospect, the hospital staff and I were quite endearingly optimistic about my first IUI. The consultant didn’t even bother to do ultrasounds to monitor my egg development. He just took me at my word when I told him that my thermometer suggested I was ovulating, and after M had made the dread visit to the special-purpose room in the hospital, our doctor found his way around the apparently quite spectacular twist in my cervix and placed the sperm where it needed to be, wished me luck and told me to come back for a blood test in two weeks’ time.
It was lovely, that first optimistic two-week wait. I ate well, exercised gently, thought about baby names and calculated when the baby would be born. I wondered which of our two spare bedrooms we’d make into the nursery and thought about how our neighbours in East Jerusalem would react to the sight of a western woman going about her business with a new-born baby strapped to her chest. There was no question of whether or not the IUI had taken; I was just waiting for the confirmation that it had.
It came as something of a shock, then, when a blood test indicated that there was to be no baby.
When another two “natural” IUIs had failed, it was time to bring in the stims to kick my body into fertility overdrive and ensure that next time the doctor drove around that tricky bend there would be many an egg ready to welcome our new friend to the party. The daily injections about which anyone interested in fertility treatments hears so much became a normal part of my existence.
I was pleased to have stopped travelling internationally for work – what was I ever thinking in so drastically reducing my chances of conceiving by being away from M so much of the time? – but I still wanted to enjoy the adventure of living in this fascinating country. Over the months that followed, when the first IUI with hormones failed and led on to the second and then to the third, my drugs came with me wherever I went. The long list of places in which I gave myself hormone injections included an underground Hellenic water cistern at Beit Guvrit, a waterfall in Ein Gedi, a guest house in Petra, and the car park by the Ramon Crater in the Negev Desert.
After the third of these procedures had failed, our doctor suggested that I should have a hysterosalpingogram (or, for the less linguistically gifted among us, an HSG), which would determine whether there were any blockages in my fallopian tubes which might prevent pregnancy. The procedure is very bizarre. In the company of two men and a woman, I had dye injected into my inflated uterus and we all watched the monitor suspended from the ceiling to see whether the dye would fill the tubes and spill out into the abdominal cavity. I was later given a DVD of the whole procedure to share with my friends (or perhaps just with future consultants). Although it was good news that the HSG revealed no problems, the diagnosis of “unexplained infertility” provided its own frustrations.
In the background of all these goings-on was the added stress of knowing that when M’s contracted work in Jerusalem shortly came to an end, we’d have to contemplate a move to a country with considerably less to offer us in terms of assisted fertilisation than our current home. The first two requests for M’s particular skillset came from Liberia and Uganda, both countries in which I’d be fascinated to live, but neither with an international reputation for advances in reproductive medicine. For that reason, our doctor allowed us to skip the last of the usual half-dozen attempts at IUI and bring out the big guns. Surely an IVF treatment, we thought, was all we needed to finally realise our dreams of a family?
M’s contract expired a week after I’d had the embryo transfer and he had to fly out to Geneva for a debrief. We’d packed up our East Jerusalem apartment and sold our car, so I rented an apartment in West Jerusalem for a week and spent the time in a similar happy reverie to that I’d enjoyed after our first IUI. Then on the last day of the two-week wait, when I stood looking at the beautiful view of the Jerusalem Hills from the Hadassah Hospital in Ein Kerem, I wept as I told M on the phone that the IVF had failed.
The next day I got on a plane out of Israel and flew into an uncertain future.
To be continued…