One of the recommendations was Dr. Nair, a gynaecologist specialising in fertility who practised at one of the large private hospitals. Although I wasn't sure about the continuing cost of private healthcare, I felt that for the initial check-ups, which were covered by work and insurance, I could go to a private doctor who might have better service and shorter waiting queues.
How wrong that was! There is, it seems, no shortage of a queue in Singapore, especially in healthcare and childcare-related issues. What I know now is that one should always make use of government subsidies and medical facilities for the initial check-ups because they are such standard tests.
His is a thriving practice and my first clinic session was a surreal experience. The waiting room was filled with many richly-dressed expatriate women, and decorated, for want of a better description, like a cross between an 1980's upscale medical clinic and an Indian living room. The fluorescent-lit space had green-grey carpeting and fat, squat tufted green wooden chairs with carved handles. The nurses, mainly Indonesian and Filipina, walked around in light blue uniforms and a sole black electronic photoframe flashed pictures of the bald doctor, with the multitudes of babies that he has delivered over the years.
I waited for two hours that first time, sitting uncomfortably in the sunken sofa, tapping my feet, observing the other women with their braids and Blackberrys.
They all looked as uncomfortable as I felt but waited patiently, ever so patiently, with such hope on their faces. I wondered if I looked the same, all lined up there to meet the Wizard. There were far more women than men, and the few men in the waiting room looked like they'd rather be anywhere else.
Over the time that I've been at Dr. Nair's, I've a lot of Indian girlfriends. They are understanding, talkative, sparkly, well-travelled and quick-witted. They email me "their coordinates" so we can keep in touch and update each other on our progress. I can understand, with the strong cultural significance of child-bearing and the social taboo of infertility, that it is particularly awkward to be an ageing, childless Indian woman and why they want a doctor who can understand the delicacy of their situation and perhaps the depth of their quiet anguish.
That first time, I waited all the way till I had to rush off to an arranged dinner. I asked the nurses to call me when it was time to come back. 9pm passed and they didn't call. Then 10pm. I was having such a good time at dinner, part of me didn't want them to call, nor have to face facts. Finally at 10.15pm, they called me and said to come over but not to rush. Really? My husband was astounded. It was later than 11pm when we finally arrived back at the clinic. What kind of doctor would we be seeing at this hour?
As it turns out, a really nice doctor. A really calm, soothing, firm doctor, with impeccable bedside manners, and an efficient and confident manner. I was reassured, even happy, after that first visit and I discovered that given my work hours, I really liked what I would come to call "his Cinderella slot". At least we were progressing; I practically danced my way out the corridor of his office.
He explained that while I had a clean bill of health, I did indeed have a high FSH level (Follicle Stimulating Hormone, the hormone that indicates how hard your body is working to ovulate and thus implies proximity to menopause), but he was not overly concerned about that with regard to a first pregnancy. I was also right on the edge of a low egg reserve, "normal" being classified on a score of 4.5–19 (I was 4.6), but that I should not be overly hung up about my mother's warning, as it did not necessarily indicate the quality of eggs.
***I now know that while there are lucky exceptions, a poor ovarian reserve, especially at a young age, is indeed often a sign and pre-cursor to having low quality remaining eggs and embryos with various chromosomal issues and a high attrition rate, even with IVF.***
The husband, on the other hand, had a good count, but the motility was poor, with about half of it passive or dead on arrival and so was the morphology, with only 2% of "normal shapes", as opposed to 5–6% in a regular person.
Conception itself, I had to realize, was frustratingly exact and inexact. The human body, if you consider the hundreds of eggs and millions of sperm cumulatively produced since puberty, is incredibly inefficient (and yet some people were so damned efficient at it!) and the kind of tests that they can run to distil your statistical and reproductive facilities, was breath-taking. I wish I had known when I was younger. I wish I'd known before we got married, indeed, when we got married.
***It was clear why it did and would, take us so much longer, perhaps 4-5 times as long as a regular couple, to conceive. It seemed right away, with our characteristics combined, quite unlikely that we would even squeeze in more than one child, before I would inevitably be hitting menopause.***
***The only thing I could reflect on, was that if we had known how low our chances inherently were, I would have put my foot down sooner, and that we should have, could have, started earlier. That was an awful feeling. It made me think that these tests should be de rigour for married couples, especially in light of the government's attempts to encourage fertility and child-bearing.***
He also explained that we did have some options if we should need them; he expressed positivity that we were in the fairly low-risk spectrum amongst his patients. Although he stopped short of suggesting anything right away, we could go down the route of assisted procedures, like IUI, intra-uterine insemination, where a catheter of washed semen is deposited within the cervix, follicle stimulation, where you encourage, via oral or injectible hormones, more eggs to be produced and released, and finally, the various stage of IVF, in-vitro fertilization treatments.
Over the next few months, we would continue to try unsuccessfully and come to that same conclusion.
