IVF

Something different for my 900th post. I don't normally blog personal stuff, but the Dr and I want it out in the open that we're doing IVF. There's a weird taboo around the subject, and even people who know that we're doing it don't always know what it entails or quite how to respond. We're just starting our second attempt, and a lot of people seemed surprised that the first go didn't work. IVF is not some miracle pill that lets “career women” have babies later. It's a last resort, with the odds stacked up against it.

This goes on a bit, is probably a bit mawkish and we know that everyone has their own shit to deal with. But anyway, here goes...

The usual method of making a baby is via the ancient combination of alcohol, fumbling and interlocking body parts. There are all sorts of reasons why this might not work – apparently some one in seven couples have fertility problems. All sorts of tests and treatments can help spot the problem and, with luck, sort it out.

This all takes time. You might hear helpful comments about IVF being for women in their mid-thirties who have “left it too late”. The Dr and I have been “trying” (i.e. with alcohol and interlocking parts) since before we got married in 2004, when we were both in our late twenties. The doctors won't consider you've got a problem until you've been trying for about two years, so we started tests in late 2005.

There are a lot of tests: taking supplements, giving samples, prodding around in the plumbing. We collect matching punctures from the blood tests. None of it is particularly fun, and we made regular trips to the GP and two separate hospitals. I'll write about the joyous practicalities of sperm tests – and the instruction sheets they give you – another time. Medical stuff works on the basis of “Have a go and see what happens.” We tried a lot of different things.

For most of 2008, the Dr was on nasty stuff called clomid which made her paranoid, weepy and claustrophobic. About 11 pm every night she'd want to be home in bed, and away from other people. We didn't know this at first, of course, but worked it out by degrees. By the last month of the treatment I'd realised that when the Dr said “I want to go now”, whatever the time, wherever we were, we had to get up and go – usually without saying goodbye to anyone.

Gradually, I also worked out that I should let people know at the start of a night out or meal or wedding that this was what we might do. “Don't,” I'd say, “worry, or hold us up as we go. We'll just disappear.” And it helped to have enough money on me for taxis so as to avoid crowded trains. Generally, it made even the most simple tasks much more complicated. And after all those months, the clomid didn't have any positive effect.

If none of these tests and experiments work you get put on to in vitro fertilisation (IVF), where instead of using alcohol and interlocking parts the sperm and egg are mixed up in a petri dish. We were recommended for our first go at IVF in late 2008, and went through it last summer – more than five years after we began “trying”, and in our mid-thirties.

There are all sorts of percentages for how successful it will be depending on the exact problem. For example, you seem to have a better chance if the chap's sperm is okay and the issue is with the lady. The statistics are also less good for women after they turn 35 – we're luckily just inside that bracket before we try this second go. One doctor said this was because we had “got through the tests relatively quickly”, so some poor women must find this all especially cruel.

Once you're doing IVF, the process takes about two months. The wheeze is to jump-start your system to get it going, then extract the bits, put them together manually and re-insert them into the womb. There are distinct stages, and – a bit like end-of-level baddies in a computer game – you can only progress to the next stage when you've passed the last one.

First you go on what's basically the pill. Then, on the 21st day of your cycle you start injecting yourself with drugs that effectively put you through the menopause, shutting down your system. Symptoms of that can include hot flushes, night sweats, hormones all over the place (so lots of crying for no reason) and hair growth (sadly, the Dr didn't grow a beard). You have to inject the drugs at the same time every day, you can't drink and you're not scintillating company anyway. So it kills your social life.

After two weeks you go for a scan to see that your insides are shut down. If they have you're on to the next stage, injecting the menopause drugs and the drugs that put you through puberty. That's why you feel like you're being pulled in two directions. The Dr felt giddy, found it difficult to concentrate and kept forgetting things (she lost her mobile phone three times last year while on the various drugs). She only wanted to eat sweets and her body changed shape completely.

All the stuff with the clomid the previous year had prepared us a bit for these side effects. Knowing to leave early and to apologise in advance made things a little easier, but you're constantly on edge, madly hoping that you'll get to the next stage. It's also not easy to see someone you love going through something like this – and being completely unable to help.

Then there's another scan to see that your ovaries are producing follicles – the things that house the eggs. You'll have some idea already if it's working because you're swollen and sore, and even walking a step is painful. If it is working, they call you in for what's called a "harvesting", where they remove the follicles. This process hurts, so they put you on opiates and you still feel pretty wiped out and bruised. You're not allowed to leave on your own; you need someone else there to ensure you get home. The Dr was bruised for weeks afterwards.

They're hoping for about 10-12 good eggs from this harvesting, so there's some to fertilise and some to freeze so you can skip to this stage if you need to go through the process again. If you're with a chap, he donates his sperm at this stage and the boffins put it all together.

If that putting together works, two days later you're in again for the implantation, which is pretty straight-forward and easy. Then you wait two weeks to see if it's worked. “Try not to worry,” they say, as one might advise, “Try to walk to the Moon”. You get used to the matter-of-fact language as you go through the process. “If you've not bled after a fortnight,” they tell you, “do a pregnancy test”. Depending what statistics you read, at implantation your chances of pregnancy are about 40%.

Once there, you face all the normal risks of pregnancy, though IVF increases your chances of having twins which can mean a whole number more complications. Most people I've talked to who've done this thing see twins as just catching up on all the time spent getting this far.

But if it doesn't work – and last time ours didn't on the 14th day – you can try again.

It's all a numbers game, with the waiting “room” (a corridor) at the Assisted Conception Unit filled with the same despair and desperation, the plaintive longing for miracles, as in any Ladbrokes. According to the British Medical Journal,

“One cycle of IVF offers a 25% chance of pregnancy; three cycles offer a 50% chance”.

On that basis, the National Institute for Clinical Excellence in 2004 published guidelines,

“aimed at raising infertility service provision in England and Wales to the standards enjoyed elsewhere in Europe”,

which included the key recommendation of,

“up to three free cycles of in vitro fertilisation (IVF) for couples who have been unable to conceive for three years because of an identifiable reason—provided that the woman is under 40 years old.”

Caroline White, "Infertile couples to be given three shots at IVF", BMJ. 2004 February 28; 328(7438): 482

That recommendation is still not happening: it all depends where you live and which health authority you're under. We're caught between two health authorities, so went with the one that said it would pay for two goes. Until, that is, we actually needed to have a second attempt, when it admitted it would only pay for one.

It's about £4,000 to go through the whole thing (roughly what I get paid for a novel), and about £1,000 if you've got eggs already frozen, plus the £400 per year for freezing them. There's a brilliant bit of internal market cleverness when it comes to buying the drugs – the hospital gives you a list of the drugs you need and numbers for three suppliers. You take a morning off and ring round these people, getting the best price. There was about £70 difference between them, depending on postage arrangements. We couldn't, though, then order the drugs ourselves. We had to schlep back to the hospital who did it for us. Any savings made had been lost in the time faffing about. But this is apparently a key part of “Patient Choice” and is somehow empowering for us.

We've also had delays because of ongoing building works at the hospital, and our second go looks like it will be split between two different sites, so there'll be added excitements about where we're meant to be for any given part of the cycle. Ordinarily, stuff like that would just be annoying, but on something so complex, emotional and intrusive, it leaves you howling at the sky.

It also doesn't help that we already know what to expect – the side effects and pain, the desperate hope and even more desperate disappointment. It took several months for the Dr to get the drugs out of her system last time; she still felt clutzy and forgetful, and kept finding herself lost or double-booked.

There are difficult decisions to be made about how long you try for: how much the drugs affect the lady, how much you can afford, how close you get at each stage, how much you're wasting your time. It is, all told, weird and knackering. It's like we've both been carrying this weight around with us for years.

You start noticing how much female identity is built up on having kids – especially when women get to their late twenties. It's still surprising how often strangers will ask if you have children and then ask why not – are we “focusing” on our careers? You notice how many people see their kids as an achievement, not the result of alcohol, fumbling and interlocking parts and being lucky in the draw. We've been envious, yes, and sometimes upset, as our friends and relations get pregnant with such relative ease. It's not quite the same as watching my colleagues get thrilling writing gigs – where I'm torn between thinking both, “Good for them,” and also “Bastardsbastardsbastards!”

Sometimes we've hidden away from celebrations rather than be spectres at the feast. Not that that's how other people treat us, it's how we feel ourselves. I struggled for a long time to explain how this feels, but a good friend, K., described what we're going through as a kind of grief. That's exactly what it feels like – as if part of our future has died.

And yet through all of this the Dr and I are closer than we've ever been. Oh, we've had some spectacular rows, but mostly its being howling at the sky rather than each other. I don't think we'd have made it this far otherwise. And we've learned who our friends really are. The weirdest thing about all of this is what it does to other people as they try to help. There's the cheery teasing about us not turning up to things, or about leaving early. Or the ones who interrogate us about how we're feeling and want details of all the worst bits. Or – a favourite – those who tell us how difficult being pregnant and having kids is, as if in many ways we're blessed.

I know it's all well meant but these things don't really help. All that happens is that we want to withdraw, to hide away and lick our wounds. One kind person even told us – for our benefit, I'm sure – that we were being over-sensitive. But it's difficult to feel anything but broken, and constantly pelted with stones. There's news of abuse or neglect of children, or you see people shouting at their kids in the street, or yet another “authority” speaks out about IVF or even that marriage is all about having kids, or that some medical condition is a moral judgement on the person who has it, and it's like twisting the knife.

We're not expecting the second go at IVF to work. We're already prepared for the result of that: the blunt statement that we can't have children. We just have to grit our teeth and get on with it; whatever happens, then we can move on.

So the best thing is not to crowd us, or worry if we disappear. But it is good to know that our friends are thinking of us. The best thing to ask is, “How are things going?” and after that, “Would you like a drink?”