The longer I wander and the more I delve into it, it seems to me that there are many misconceptions that every woman who approaches IVF has and which, looking back, I realize I did as well. This was something I contemplated when I recently met up with a friend who has been thinking about IVF but has been put off starting. The first misconception is that it is an enabler. When I first began this process earlier in the year, I did not realize that more often than not, IVF tells you incrementally what is wrong and why it won't happen. Let me put it this way.
The statistics for success are 30% if you are under 30, which most IVF participants are not. That means that even if you have nothing wrong on a cellular and physical level, you will need on average, three cycles to succeed. That is supposing that you did not do any IUI or Clomid cycles before IVF. This means on average, 14 days multiplied by 3 jabs a day, 42 injections, multiplied by three tries, somewhere in the region of 130 injections, not including the trigger shots of HCG to time ovulation. It is also, for every cycle, about 5 blood tests, so a total of 15, and 7 separate doctor visits, or a total of 21, during which you could conceivably spend up to 3 hours each time between the clinic and the fertility center, or 63 hours in total. That is not including acupuncture sessions or TCM sessions, where you effectively double the time you spend at the doctors. This is also not including incremental jabs, anaesthesia, operating theatre time for egg retrieval or embryo transfers or subsequent medication for frozen embryo transfers (FETs).
Even excluding the time, cost and health effects involved, the process is tedious and it is very clear why the doctor's job is made a lot easier if you are healthy and young — consider just this: that the statistical average yield of follicles to eggs is 70% and the fertilization rate at best, is also 70% (we are not necessarily dealing with the best of samples), then the rate of developing into a three-day or five-day embryo is a further fraction of that. That means that even if you start with a good number of 17 follicles, you would have 12 eggs, maybe 8-9 would fertilize, from that maybe 4 would make it to a 3–5-day blast and after that, has a 50% chance of sticking. So even if you go through this process with a lot, you might end up with 1 or 2.
I don't even want to delve into the cost of the whole exercise right now, the intricacies of public vs private care, finding treatments suited to you, or the ridiculous shortage of healthcare professionals dedicated to infertility and lack of regulations and proper process for egg donation, surrogacy or adoption, except to say that I am slowly putting together a letter that I'd like to send to our health minister and that I'm going to be more involved in these discussions, which I think, with our diminishing fertility and more alternative societies, need to be and will be, one day, publicly addressed.
The second misconception is this idea that it only takes one egg, one embryo, which I will come back to later on.
I had spent months chasing this rabbit down a hole, piling on weight, discovering that the medicines are stronger than you — it had all been a pretty terrible experience. To say that I no longer felt like myself would be an understatement. That's not to say that I haven't loved many things that I've discovered along the way, like friends who have put up with me when I am at my angriest and crankiest, in fact, most of my friends really have put up with it in some form, knowingly or not, from those who've had me postpone or cancel out of their weddings, to those who gently told me about their own pregnancies, to work colleagues who overlooked my erratic behaviour and constant rescheduling. The truth is, I don't feel like celebrating this year, because this Thanksgiving, I have misgivings about what exactly to be thankful for.
A few weeks ago, I had two experiences that have helped bring me back a little to front and center. Through the year, I've been talking about re-centering and re-finding that balance. In a way, this journey has shown me how thoughtlessly and pathetically my life had been slip-streaming into being very conservative, routine and really lived through what I wanted, from what other people wanted. It had been a long time since I had stood up to ask myself what was really important and celebrated where I was headed in life.
It had all become very occluded by these vague notions of babies, fertility, family and future. These are certainly not bad things, but I wanted them in the way that I wished for it to happen, with little acceptance of life and choices as they can happen. Chasing this whole process had exaggerated the worst parts of being in a somewhat narrow social range in Singapore and moving back with the parents, with their well-meant work ethic and prejudices (my dad, for example, books air travel 7 months ahead of flying) — as it failed, I had become emotional and closeted, as opposed to fair, responsible and aspirational.
The experience was a Great Eastern Women's run that my friend signed me up for; it is one of the only women-centric races in Asia. On the surface, it was a bit obscure, getting up at the crack of dawn to run with a crowd. I had never done anything like that before; in fact, I was perplexed as to whether I had even run that far in my life. The funny thing is (and maybe as with most unexpected experiences in life), it made me feel really great.
The race was crowded with women, but a real diversity of women. To my surprise, there were white-haired old women, there were schoolgirls in their yellow and green school-coloured ribbons, of an all-girls school, there were women running holding hands, overweight women, women in tudongs, white women. There were mothers who ran with shirts that said "Association for Children with Rare Diseases". Despite the announcer's megaphone exhortation to "leave it all behind, leave your husband and children and just run for yourselves!", there were streets of children and spouses lining the finish to cheer on their partners. It just made me feel fuzzy and warm inside. It was nice to know I could still be touched by these things, as deeply as I was used to resenting other women.
As I ran around the Bay, the breeze blew cool and warm and I looked at the changing cityscape and then the unchanging water and I thought about how in ten years, I would be 40 and then 50 and these structures or landscape would still be here and this time in my life would pass. I really felt, for a while, like the same person I'd always been and I made a mental decision that I would try to hold on to that person, to be happy. I know it sounds absurdly childish, but being able to finish, to feel strong and even cheerful, made me glad that at least in some ways, my body hasn't completely failed me.
It was on that confident high that, a few days later, we were back in Dr Nair's clinic. And guess who we should see there, as they were strutting out of the clinic doors, but my husband's ex-girlfriend and her husband. She was very pregnant with their second child and she didn't really see us, so happily and excitedly chatting were they, but I caught a glimpse of her husband and as our eyes met briefly, I could see he had recognized us just as they walked out the door.
We hadn't even known we were both patients of the same doctor, but of course, in a small place like Singapore, it isn't uncommon. This ex was from his high school and the same age as us both, so they have a large number of friends in common (as do I and her) and although relations were not exactly cordial, they weren't frosty either. I guess just faux-indifferent.
I sat there, determined not to make a fuss and thinking that really, I had nothing to hide or to be awkward about. Unfortunately, we could hear them discussing, laughing and swearing in the corridor, when they discovered they had forgotten to pay and whether they should come back in but risk facing us there. Unfortunately, because the empty corridor amplified everything they were saying, it floated back in through the doors, so we heard everything. In the end, the nurse told me they called her on her mobile and promised to be back to pay at the next visit, because she didn't want to see "someone she knew". And she, the nurse, giggled with me at the farcical nature of it all.
I don't know if I'm being too sensitive here, but there is little in life that prepares you for the occasional and odd experience of overhearing yourself being discussed and feeling your heart slide out from under you, because the other people don't even know the situation you're in. It is a surreal and humiliating feeling. My dominant feeling was one of indignance at how both of us were dealing with it — I have no problems with congratulating her, or her knowing our situation. In fact, we are both plenty old enough to handle it with maturity, grace and supportive empathy and it grated on me that we were doing the clear opposite. High school was a long time ago and we were all different people. I knew neither of them then and I sincerely don't care. I believe, in my heart, that the reason she didn't want to come back in was not herself, but a fear of making us feel uncomfortable.
My secondary feeling, though, was one of heaviness, tinged with some kind of inexplicable regret. It's easy to say the past shouldn't haunt you, but the truth is, my own past has shaped and haunted me more often than I care to admit. To be sitting there, waiting for your truths or options to be meted out to you, is so radically different to where she was, close to delivering her second child, that to some degree, I felt even for my husband. That second experience just reaffirmed my wanting to break from that overriding feeling of self-pity and passiveness, to step forward in learning to be accepting, patient and progressive, and to do so with compassion and laughter.
Dr Nair suggested, despite our approaching vacation to Europe, to try Elonva, a different medical protocol, which has good results with low responders of a younger age, because instead of trying to push the system to produce more eggs, it saturates the antral follicles that are already present (so assuming you are young and do have those follicles, in theory, it should induce you to a better result without pushing the whole equilibrium into overdrive. In theory. As is everything about fertility, I sometimes feel).
I had been on the DHEA for three months and coincidentally on the day of the visit, I was on the conventional Day 4, which is when most cycles begin. He could see 5 antral follicles and he suggested to start right away, because December and January tend to be bad months for embryologists, sandwiched between different public holidays. In a different moment, I would have said, are you crazy?
Why would you start now, what if it runs into our pre-booked holiday? And, it required me changing my pre-scheduled work trip again, for the second time. And, 5 antral follicles isn't much; there is literature to suggest you shouldn't start unless you have 6 or 7. We are going for our pre-adoption briefing in two days. But riding as I was on this wave of positivity and maybe also that Elonva is less taxing becuase it is administered once for 8 days, we looked at each other, shrugged and said, ok.
We were whisked off into the second room and the jab was administered (coincidentally also, since our appointment was so late at night, I could take it as if it had been the next morning and would not have to come back the next day). I have to say it stung a little like Pergoveris, but after a break from all this, it didn't hurt that badly and I was overtly thrilled that this was all there was. And that was that! For 8 days! What? Really? I went home and oddly was happy! I told the hubby, well, here goes nothing. If there's something, there's something and if there's nothing, well, we've been there. And we'll know and can move on being no worse off.
The thing is, we've done two Gonal-F cycles and we've never actually completed. The first time, there was only one egg which failed to fertilize and there was obviously nothing to transfer. The second time, there was not even anything to retrieve and the cycle was cancelled. Why my response was so poor to 450iu of Gonal-F, I don't really know, considering that it was also the medication used during the IUIs — which had follicular response, but had also all failed. Was it that the follicles never yielded eggs? Or was it that the eggs were poor quality and never fertilized or split?
The jury and statistics are really split on whether doing IVF for a third round would make any difference whatsoever; in fact, the odds were really that it would not, despite all that you hear about people succeeding on their 7th or 9th IVF try. It is possible that just reiteration and pure dumb luck would make it succeed, but particularly when you start with very low numbers, that is just statistically not realistic. What I knew is that I was not going to do a 3rd IVF cycle with Gonal-F and unfortunately that meant that the avenue of public health care was closed to us.
This makes little sense as public healthcare is best positioned to requisition any kind of drug needed for customized or differentiated medical protocols. However, the sheer volume of patients that they push through the system and the conveyor belt approach to care means that there is little patience or indeed attempts to try to solve specific problems. This makes sense, because most specific problems in fact, can't be solved and the likelihood of restructuring the issues is not high. But at a relatively young age, they had jumped straight, in our case, from failed Gonal-F cycles to donor eggs, and although I could have gone back to Prof W. to ascertain what would be the next course of action, if there was one, I had not yet done so.
The paradox is, the first time I had to cancel my work trip, for a natural cycle, I was moody as hell. Irritated, infuriated at my lack of planning ability or life living freedoms, cue the usual rhetoric. The second time I had to cancel it, I was honestly indifferent and a little relieved. Was it because I didn't care as much the second time around, or because I have had to learn to let go so many, many times? Or was I optimistic and hopeful that it would be for some purpose? I really don't know.
I made it a point this time not to tell anyone or talk to anyone about the whole process. I was done with talking, done with sharing because it only came back to hurt me. Most people, truth be told, only care about their own business, Facebook updates are just the tip of the iceberg in illustrating this. What we deem as social media, really isn't interactive as much as it's just...social. And I really wasn't in the mood to be social. I didn't tell my parents, because I didn't want to raise their hopes. And as much as I didn't feel like talking about it with them, I didn't feel like talking about it to anyone who knew me less well, either.
The reason I don't want to talk about it anymore is not because it doesn't matter to me, or because I am past it, but it is a collary of that feeling. When I talk or share or am reminded about it, it hurts. It doesn't really matter if that reminder comes externally, or it's because I talk about it, it's still a reminder. And with that reminder comes sadness. It's not surprising, really, I guess I should have been prepared that some hurts don't go away. It's like when you lose a loved one, or your husband has an affair — it doesn't matter how much else has happened, or how much you've moved on, the truth is, the reminder, no matter how accidental or well-meant, is always going to make you feel sad.
And the truth is, what are people going to say anyway? Pat your hand and say, don't think about it so much? Or that you should take a sabbatical, or a vacation? Or re-start the whole TCM debate? I mean, it's been two years. We've tried everything, at least once, some things, many many times. We've taken vacations, we've prayed to be the urban legend that gets pregnant right before IVF or before you see a doctor, it's not for the want of trying, it's probably because your eggs for whatever reason aren't fertilizing or your embryos aren't dividing. Yes, of course there are miracles. And other than this continuing, ridiculous saga, I am perfectly capable of communing, being a friend, dealing with life's regular ups and downs and the other crisis of health and age that I'd like to go through together. But why would I remotely be in the mood to see your fifteen consecutive posts about your children or have to act like everything's ok?
By the next morning, I no longer felt triumphant and carefree. I felt a little foolish and a little regretful about what we had decided because I knew in my heart of hearts that every time you put yourself through any cycle, you open yourself to disappointments, distress and health risks, but I was still riding high at the start of a three-day conference. I felt a little rumbling in my abdomen till lunch time, when I demolished a big, fat, juicy steak and then, after lunch, I experienced the weirdest sensation of tiredness, almost to the point of memory loss. I was sitting in a meeting and suddenly could barely keep my eyes open. The numbers that the counterparty was saying, I was having trouble grasping them. Sorry, I said. Repeat, what? What was going on? I stumbled through the end of my meetings, drove home and toppled straight into bed, blacking out into a deep sleep for 2 hours. When I woke up, I felt much better, but this is when I realized that even if you take one jab, growing follicles is still a lot of work.
This pattern continued the next day, and the next. I ate proteins, and drank water, copious amounts of water and as much as I wanted it to not affect my life, the truth is, I was too tired to exercise. Secondly, even though Dr N had promised that this protocol had no injections for 8 days, that is not completely true. After the 5th day, we still needed to apply the medicine that is the brake to prevent you from ovulating, from the drug genre known as ganerilix. In past cycles, this was Centrotide; this time it was Orgulatron. So on Day 5-8, I still had to take one quick jab in the mornings, but compared to a Gonal F cycle, I knew I'd got off very easily for a first week.
