Today was the sombre meeting with Dr W, a meeting I had requested as I was suddenly struck by fear and indecision about ploughing back into an IVF cycle with the exact same hormones, protocols and probable results.
I had a difficult time setting up the meeting, with the nurses answering my calls and pleading queries with some delay. I really think that IVF doctors and nurses are completely understaffed in Singapore, particularly at the public hospitals and especially since the start of the higher government co-payments. In particular, I think it is ridiculous to have doctors treating both IVF and regular cases. I understand that they need the practice and the repeat business but, personally, women in their latter stages of pregnancy, by definition, are no longer infertile. There are infertility queues out the door at public hospitals and it would make much more sense to have a few doctors concentrate on those cases.
In the meantime, I request to have my bloodwork tested again, and this time, after our glorious break in the US, my FSH, which had remained high through April–July, plummeted to 11.4. What was going on here? Either my hormones were out of whack — a very likely explanation, really — or else the break in the US had this effect. And if it was the break, was it the break from work and work stress or the break from the social stress of always being reminded of children and having a homogenous and, to be honest, stiflingly undiversified circle in Singapore? Was it a freedom break from the preoccupations of women in Asia, circling between seasons to marry, work and have children?
I wanted to believe, or think, that it was a response to both, to somehow feel validated that, as much as I liked to believe my work wasn't stressful, my bloodwork said otherwise. Neither the input nor the outcomes were replicable, of course. But in fact, all my theorizing, too, was put to pasture by Dr W. today. He explained that it simply meant my hormones and ovarian reserve were not getting worse, but they were certainly poor, and that corroborated with the dismal result of getting just 1 egg in the past cycle. FSH measures were not the best (did he say this to discourage my independent seeking of the re-test?) and fluctuated with cycles, and 11.4 or 15.6 were all purely indicative, but of the same thing.
Also, he said that the protocol they used in NUH was what I had followed the previous time; therefore, that would be the same protocol used going forward. While I have often said that public sector clinics are really good at what they do, one area of deviation, I feel, between my previous private-sector doctor and our doctor now, is that the private-sector doctors are more willing to work with individual patient needs. So, if you are an older woman, or a poor responder, or have low ovarian reserve (or all of the above), then you might actually get better results (may, not saying you will) with a different protocol. Firstly, what Dr W. seemed to be saying is that the protocol worked for most patients, so that's what we all were given, which didn't sound particularly good to me, given my poor results on it; and, secondly, in terms of using any additional therapies, he said he had so far only had three patients on growth hormones (injectibles for three months prior to IVF cycle), so, in essence, although he is renowned as a very good doctor, it seemed that at least his IVF cases weren't very difficult. And, in a way, they couldn't have been if he had prescribed them all the standard protocol. That was troubling.
All in all, he told us that while each cycle was independent and there were definitely instances of drastically different results, I would most likely get similar results and the probability of succeeding in an IVF round — wait for it — was as similar to that of women in the 40–45 age group, who had similar test scores to myself, and that probability was south of 10% (whereas it should be 30% at 32).
Well. There it was, as always, matter over mind. As it always is in such circumstances. And so put to rest all the silly theories about letting yourself get fat, or exercising more because it made you feel good, eating hot food and just banking on your physiological age. None of it really matters if your eggs are few, old and of poor quality.
Being an investing person, I can only conclude that 10% is a terrible risk-reward. I would never bet on it and it felt like I would just be hurling myself off a cliff of medication and drugs, to try to get a hope that was laughably unfavourable. If I knew something had a 10% chance of a successful outcome, I would say thank you very much and walk away; to do otherwise is irrational.
IVF is a lot like chemotherapy. There are no guarantees that it will eventually lead to a completed deal, but without it, there's no chance for success. Each cycle is a necessary step in an evil, painful process. At the end of each session, you pray that soon, the process will draw to a close. And maybe one day it does.
Also, like chemotherapy, infertility seems full of false promises, phoney cures and hope, rather than failure. It always seems to be somebody's friend, somebody always seems to have succeeded, somebody had twins, somebody got pregnant at 42 (you don't think those celebrities freeze their eggs earlier or use donor eggs?), somebody's friend, every knows somebody who suddenly got cured and is so blissfully well — it's torturous. Somewhere in a Thailand clinic, or while taking Peruvian superfood supplements, or using growth hormones, there is an infertility-free town, with an infertility-free circus and an infertility-free clown, who dances for infertility-free kids. The audacity of hope makes it so hard to move on while it's still Possible.
One thing that I do often think is that I didn't get married particularly late. I didn't start in any of this process particularly late. There are so many women who fall into the 50% of woman fall pregnant within 6 months of actively trying (yes, that is the actual statistic, if you're wondering, the remaining 25% within 1 year and 15% within 1.5 years), but when I look around the clinic at the many women who have not and will not, I often think they should test all the women before they start on higher and tertiary education. How many of us would push on to an MBA or a PhD, if we knew we had a 10% chance of success at IVF? How many of us would have married the first suitable guy that came along? We might have been happy, the same way arranged marriages are often happy. Would I have? I don't know — maybe. I'll never know because you can't miss what you never had. I moved past it.
More broadly, I just feel that much of this mismatch between biological and chronological age for women is inefficient. Whether it's because you made different choices, or whether you met the right person late, the truth remains that a very small percentage of women get married at 24 and have children at 27. The process of meeting and being with a partner, or even knowing yourself, isn't efficient; it doesn't rest on whether you are thoughtful, beautiful, dynamic or intelligent; it's path dependant. Yet, we don't, globally, encourage fertility testing, allowing women a completely unplanned decade of their twenties, followed by a stressfully planned decade of their thirties.
I don't know if it was his stern outlook or just a weakening of my own resolve, but, after a few tears rolled away after the meeting, it didn't hurt as much as I thought it would. It felt terrible, don't get me wrong, but it corroborated with our lousy result from before. Maybe because my own dad is a gynaecologist, I inherently had always understood the quality implications of the poor response to even the most aggressive dosage, or that there had never been fertilization, after all this time.
Over the course of this process, even though it has reduced me to a whingy, depressed, "shattered" — as one insensitive clout described my tired appearance this morning — shell, one thing I have noticed is that it has reduced the importance of most other things as well. I have become less inclined to jump to conclusions, react to inequity or try to build relationships when I no longer see the point of the effort. I don't care about many things anymore, nor care, as I used to, about what some people say or think. I think this experience has hardened me, humbled me and strengthened me. Maybe it's just the process of so much senseless hurt that it has been an unfairness so unforgivable, so basic, so hard to let go of, that it makes other slights easily forgivable and exposes the triviality of most acquaintances, assumptions and exchanges.
It mattered little that I could have achieved a result before and more that once we were done with this process, we truly would have just each other, and how we were to each other and what we planned to do with our lives going forward. The truth is, I was living in fear that one by one, I'd see all my friends disappear into their families and I'd see younger, or even older women, easily being able to get pregnant again and again, and it would never stop hurting and reminding me of what we did not have. The truth also is, though, that the husband and I could easily have had children, had we tried when we were dating, or had we met and decided to be parents at 22 (which we didn't and could not have). That we don't have them now, or even if we don't ever have them in the future, is not so much a tragedy as it is a circumstance, even a coincidence, of context. And while it is not a good thing, it is also not a bad thing to have really considered parenthood, in the way that only adoptive parents have really and necessarily considered it.
Maybe it was time to work on that and put aside these fruitless attempts at fertilization and just get on with finding our little boy and girl, and someday our dream of having a family, a family that would love, irritate, support and travel with each other. It hurts because I know I love them, even though I've never met them. It hurts less because I know I can love them. How much more should I really make myself unhealthy if I want to be around for our family later on? I know I'm doing what I am now because it matters, but one day, it won't matter and they will.
Second cycle, I still don't know what to do.Thank you to all the readers, unknown and otherwise, for your kind comments. It really has made my day each time, I am so grateful and humbled by your concern.
