For the first time, it has been tough to update this series. Not because it has become any better. In part of this month (Part 2), I just cared less and increasingly, I felt like nobody reads this anyway, except people whom I would eventually update in person.
It had started as a way of writing to sound out my mind, to myself, and in the last month I hadn't really needed or wanted to. I had had such a horrific first part of the month that I was just raging, raging with emotion, so much so that I didn't even have the detachment to write. I wrote in small portions, saved into my own email. Verses for when I felt well enough to write the whole story. And in the second month I was so disillusioned and perhaps distracted that I, again, didn't feel the need to write until the whole cycle started again. And the longer I stayed away, the harder it was to reach back into my emotions and pull them out into writing.
Just to backtrack then, after the screening results at NUH, we were scheduled to be in IVF after another two months (we had missed the cut-off for the month before). In the interim couple months until late June, I went to New York with my mum to help my ailing godmother who had had a hip replacement surgery and then to Australia with the hubby. It wasn't a good time. I never felt anxious or increasingly desperate about the impending IVF, but now, looking back, I realise I must have been. It was also a tough time for my husband and me, with him going through the difficulties at work that I mentioned before. I travelled, perhaps partly acting out against that feeling of a deadline.
We had been trying 'naturally' since the last IUI in January, and of course my periods arrived with due, regular and irritating alacrity. I was bang on 28 or 30 days; in fact, by the last week I would feel the characteristic bloating and cramping, and I tested negative so much — and, more importantly, agonized and then felt stupid through enough boxes of pregnancy kits — that I resolved to give up testing at all. I still talked hopefully and not wearily about having a baby, but the weariness and wariness about whom I spoke with was creeping in.
Day 1: Conveniently, it is Monday.In at 7.45am, out at 10am. Doctor's queue is backed up because the main professor is away (in Paris as I later find out) and the secondary doctor is here. Not for the first time, I notice some things about the women in the IVF clinic. Firstly, there are a Lot of them. Each time, I am easily just one of 30 people and, considering I only stay there for maybe 20 minutes max, this adds up to a lot of people a day. The nurse told me that NUH limits each cycle of patients to 80, so that the system isn't overtaxed and the waits aren't ridiculous. Second, they are a hostile crowd. I am generally much younger than the average age of the women who are here. I get stared at when I walk through. It took me awhile to understand why. It's because there is a cold statistical probability to this process. Less than 40% of us in this room will be successful. We will probably all have undergone the same tedious process and medications. It will not be fair.
And although our individual probabilities have nothing to do with each other, as a group we represent a pie chart. And we are all used to being the sliver of failed in the bigger pie chart that is the general female population. Of course, it hurts, and we are a walking reminder to each other of where we're at.
Lastly, compared to the regular gynaecological crowd, these women are different. They are generally better dressed. They are in better shape. They are less tired-looking, more made up and generally older. There are a lot of Indians but I've yet to see a Malay woman.
From time to time, one lady, usually one with a heavy accent, will have a breakdown and rail at the counter staff about how her appointment was at 9am and what is the use of that if she hasn't even seen the nurse before 10? (I glanced at my phone and it was 9.40am when she had this little hissy fit). First, I have to say I give NUH credit for being the hospital (and I've been to four, so I know what I'm talking about), that has the Shortest waits. Even so, if you do decide to do IVF, get prepared to deal with uncertainty and waiting. God knows, the wait to even be this infertile should have prepared you with a longer fuse and more patience for events beyond your control.
But I think sometimes women who have waited so long for a natural event have a very aggressive impatience for appointments (like the 9am doctor) that they feel they have scheduled and are, unlike how the rest of this process has gone for them, their entitled right. And of course, they are hormonal, and sad and desperate and any magnitude of awful things that doesn't excuse you losing it. As she stormed off, I raised my eyebrows at the nurse and she rolled her eyes at me.
The IVF program involves a crapload of waiting. I'm not very good at it myself. But I've come to accept that it can't be helped — doctors get called away to surgery, to deliveries, nurses have to explain medications and self-injections to new patients, and you don't know how long each session will take. And people do screw up processes. It is very frustrating to wait around all the time and to feel that prick of insult to injury — that, on top of all the waiting you've already done, and which is the main reason you are here, you are still treated like the bottom of the totem pole, unable to progress, inconsequential patients whose time means little. This is aside from all the waiting that you have to do at an individual level.
Day 1: They have us signing a myriad of forms, everything from financial forms to permission to use, destroy or donate your fertilized eggs should you have any excess or should you or your spouse divorce or die before the process is complete. Checking the box to donate the eggs to another couple that wants to have a baby makes me sad about all the couples that would be in that situation, as well as all the undeserving but fertile people who just have more children than they want or can care for.
It made me think of my gay friends who, in choosing to live as a gay person, inherently know and choose that it may mean not having their own biological child. I don't know if it pains them, but if they feel part of the confusion and sadness that I do now, I would let them, if it were legal, have one of our fertilized eggs. Of course, that is in the hope that we have excess eggs at all. And of course, we hope that we will have plenty of excess eggs, so I might not have to go through the injectibles more than once! How amazing would that be.
And I've made up my mind to be positive. Positive about this whole experience, positive about what we have together, positive and grateful that we can do something about it and that we will move forward, no matter what. In truth, the husband being able to have the time to be at each visit and just to be there each day has made this process so much easier than the previous IUIs that we attempted. I was less stressed about his not having a job and having to financially support us (which is true), but right now, I'm really thankful that he is able to drive me around, put away things and help at the slightest notice, and that has made this all bearable and even to feel like it's a journey we are taking together.
Day 7: The program itself isn't exact: you shoot up for 11-14 days, depending on how quickly you grow follicles. These are harvested and implanted 3-5 days later, assuming they germinate. You may go to work in between the 2-3rd day before implanting or the last week of pregnancy testing, if you are not doing menial work and don't get an infection.
The drift here is, if you have any hope or thought of pinning down dates when you can be active, or go out to dinner, or make a date, I suggest you spare yourself and throw them out the window early. When you choose to do IVF, it is tempting to think that you are gaining 'control'; in fact, the only truth about IVF is that you are essentially relinquishing control over the ability to make any commitments of even the most minute kind. Welcome to the land of the pathetic and heavily druggéd.
How do you live? I definitely asked myself this question. I hate the residual, inherent feeling that this is The most important thing in my life. That just makes me feel like I have further to fall if it is all for nothing. My compromise is, I make plans and I believe I'm going to be available to do them. And if they fall through, then I hold tight to my belief in my bank of goodwill and cancel plans left, right and centre at the last minute. I am not particularly proud of being this way, but I rationalise.
Day 9: The first 7 days have been injections of Gonal-F, which is delivered via an epipen. This epipen is so fine as to not really be painful. It is, and I know this sounds wrong, my favourite injection. It feels like nothing; it goes in so clearly and out that the process itself takes less than half a minute, and it doesn't make you feel particularly bad after.
The only thing that does bother me — so I don't think about it — is the amount that I am taking. The doctor has prescribed the most aggressive 400mml dosage, and this is almost triple the dosage during the process of IUIs. When using the epipen, I sometimes look at the liquid contained within it and almost sub-consciously suck in my breath at how voluminous it really is.
In the first week, it is easy to think the injectibles aren't really as scary as they look. You might feel the needle going in, but it's nothing you won't forget after awhile, after all, we've all lanced a pimple or a wart. The upside of it is that you will discover reserves of resilience that you never credited yourself for.
You will be imminently qualified to administer booster jabs to little children, vodka shots to helpless strawberries and emergency epipens to epileptic or allergy victims.
It helps to have a bit more fat around your stomach. The injections I took when I was fatter where distinctly breezier than those I took when I was skinny. It also helps to press on the hole after injecting, so that you do not form a bruise. And to ice the area, so that you return to a flat, smooth surface of skin. It also helps to moisturise with a rich, fatty cream every two or three days. This might seem like unnecessary trouble, but trust me, it's easier to be happy and positive when you don't have the red-pocked, punxture-riddled stomach of a drug addict.
One side effect of injecting is you will have a very good delineation of where your fat bits are, and there will come the day that you marvel that, when the needle slides into that fatty spot, you feel absolutely, incredibly, nothing at all. You will also discover a hardened awe toward drug addicts, now that your awe of their puncture holes has been greatly lessened.
It is in the second week that the weariness sets in, the excitement that you are making progress or tangibility of it is all over, and the injectibles get more and more painful. Other than the Gonal-F, you also have to take Cetrotide, a medication that prevents ovulation (rather like a contraceptive) and perhaps another injectible like Pergoveris, to improve the quality of the follicles.
These latter injectibles are much more painful: firstly, they are delivered via a thicker syringe, and secondly, the medication itself is more viscous and therefore more uncomfortable. They make you more achy, more temperamental, and, I think, more tired. I try to keep my spirits up by swimming every other day, eating healthy and by being in bed by 10.30pm every night, but of course I slip up as well.
By the last few days of the injectibles, you are going purely on necessity, perhaps adrenalin and out of sheer determination. The days seem to be simply divided over morning injectibles and night-time injectibles and the hours in between merely a wait till the next day. It is hard to do anything else, nor can you be anywhere else. On one hand, 14 days does not sound like much, but by the second week, it feels like forever. Your stomach is riddled with little red holes, perhaps some spectacularly green and yellow bruises. You can sometimes barely keep up the pretense of being "all right", especially as you feel, increasingly, like you can't do much more.
Every three to four days, we are back at the hospital and in for both the ultrasounds and blood tests. I am so sick of these painful pricking blood tests and sometimes the visits take so long, toggling between the regular and then the IVF clinic. It throws our days' schedules out of sync, but we are grateful that the hospital is nearby and that we are there together.
Day 14: The follicles are growing so well, I can scarcely believe it. We had 8 good follicles, and miraculously, over the two weeks, they have grown at almost the same rate, with the largest ones slowing and the smaller ones catching up, textbook-style. I usually produce dominant follicles and few others, so this is, as our doctor says when he returns from his holiday and takes over from his understudy doctor, as good as it gets with my hormone levels. By the last day, we have 10 follicles of a good mature size, and although they constantly warn us that, with my hormone levels, it is to be expected that not all the follicles will yield eggs, we are really pleased!
It had really been hope keeping us alive and cheerful and keeping us going. Hope that we are progressing in the right direction and our luck might just change, in an instant. It felt good to be doing something, and I felt strong and, despite the medication, stable and happy.
We prayed for strength to accept any outcome, for blessings to have a safe retrieval and for the mercy of a good result. Just one, we hoped, with all our heart, just something. It sounds odd to say it, but in all this tedious process, there were moments of joy, real joy, laughter, when we delighted in being together and where my husband would hope for twins. Twins... surely we would not be so lucky, but maybe with 10 follicles it could happen. Or even with 7, or 8, or even 3 or 4, one never knows, right?
The time closer to the retrieval is all a big blur, much like your wedding or graduation or exam, or anything else marked by a goal and time. I fasted the night before and the morning of, I showered attentively; we checked in, they registered me and rested me on a bed in a heavy canvas blue gown. I was wheeled into the room on the stretcher bed and they explained that they would put in the IV drip and, after I was out, they would push a breathing tube down my throat to help with the process, but they will pull it out as soon as I show signs of waking. 15 minutes later, it would be all over.
Time passed at once very fast and very slow, and I wasn't sure if that was from the fear, or the anticipation or the adrenalin. The room is cold and metallic and clinical, but not severe. I have never had a major surgery, nor even a minor surgery, and I was filled with trepidation. This young doctor, whom we are later told is our doctor's surgical assistant, comes into the room with his colourful skull cap and asks me, for the fifth time, to check through my details and registration identification. The theatre is a humming room of machines and quietly shuffling assistants moving quietly between the apparatus.
I struggle to keep my eyes afloat and suddenly, I am woken by the noises in the room. The operation is over. I glance over at the clock and it has been twenty minutes. I am laid on the stretcher bed and leaving the theatre when out of the corner of my eye, I see a shockingly familiar face.
A husband and wife are cuddled on the bench nearby; she is in a matching surgical gown, and with a pang I remember that they were two single divorcees who married because she had already become pregnant, yet here they were, some years later. How odd life is sometimes and how small Singapore is. He looks shocked to see me, unsure if I'm awake and unsure what to say. His wife walks into the theatre and as I am wheeled away, I look directly at him, lift my hand and say, Good luck. He looks relieved at my acknowledgement, but doesn't smile, and says, You too.
I'm gleeful to be back in the room, with a waiting husband and a fussing nurse. We are so pleased that it's all over and I realize the hardest part has been done. It hasn't been that bad. I'm still alive and I feel fairly normal, if slightly sluggish. The doctors have to keep me in until I can go to the bathroom, which is fairly quick, an hour or so. Then there is a knock on the door.
.
