When my wife and I embarked on the process of treatment for infertility I had no real concept of the emotional impact the process would have on both of us. Yet, as we continued along the treatment road, it became increasing clear that the hardest thing of all was the emotional impact of this process. The levels of pain, fear and hopelessness experienced were extremely high and women seemed to feel completely disconnected from each other. There was a support group provided by the IVF clinic, and counselling was made available, but from speaking to five women involved in the process there was somehow a disconnection within these sessions. The only thing that seemed to help was talking to other women in exactly the same position, yet even then the women found it hard to trust that what they felt would be normalised by another person. I decided to look into research done on the emotional experience of women undergoing infertility treatment and was disappointed with what I found. There seemed to be a great deal of quantitative research but very little qualitative research. I decided after a long series of discussions with the women from the support group that it would be worthwhile researching the phenomological experience of a woman in this group.
Aim of research
The aim of this research is to present a very real account of a women’s internal emotional world with regards to the experience of infertility and infertility treatment. To identify some of the main themes that impact a woman going through this process, and in doing so, perhaps offer women in this situation some level of normalisation of their own internal process.
There has been much research done on emotional and psychological impacts of infertility and the impact of these on infertility itself. Some examples of this type of study are summarised below.
One study highlighted by the Harvard health Newsletter (2009) reported that 200 couples seen consecutively at a fertility clinic, for example, found that 50% of the women and 15% of the men said that infertility was the most upsetting experience of their lives. Couples dealing with infertility may avoid social interaction with friends who are pregnant and families who have children. They may struggle with anxiety-related sexual dysfunction and other marital conflicts.
Drugs and hormones used to treat infertility may cause a variety of psychological side effects. For example, the synthetic oestrogen clomiphene citrate (Clomid, Serophene), frequently prescribed because it improves ovulation and increases sperm production, may cause anxiety, sleep interruptions, mood swings, and irritability in women. Other infertility medications may cause depression, mania, irritability and thinking problems. Patients and clinicians may find it hard to figure out which reactions are psychological and which are caused by medications — yet identifying causes is essential for determining next steps.
The summary point of the research
- The relatively recent focus on physical causes of infertility means that its psychological impact may be overlooked.
- Medication side effects, money worries, and uncertain outcomes all contribute to infertility-related stress.
- Individuals who learn they are infertile often experience the normal but nevertheless distressing emotions common to those who are grieving any significant loss.
- Typical reactions include shock, grief, depression, anger, and frustration, as well as loss of self-esteem, self-confidence, and a sense of control over one’s destiny.
In 1993, another study in America, Domar (1993) showed at the psychological symptoms of a group of women dealing with infertility were compared to women dealing with chronic medical conditions. All subjects completed a standardised, validated and widely used psychological evaluative questionnaire. 149 subjects were dealing with infertility, 136 dealing with chronic pain, 22 undergoing cardiac rehabilitation, 93 with cancer, 77 with high blood pressure and 11 with HIV.
The research showed that the scores for depression and anxiety in the infertility group showed no statistical differences with that of the cardiac rehab, cancer, high blood pressure and HIV patients. The result showed that the psychological impacts of infertility were very similar to those for a serious medical condition, and as such standard psychosocial interventions should be applied.
One study in Taiwan by Ting-Hsiu Chen (2004) used a rigorous research instrument — a structured diagnostic interview with a psychiatrist — to examine 112 women seeking assisted reproductive treatment. Few studies have adopted the proper psychiatric diagnostic procedures.
METHODS: All consecutive women visiting the assisted reproduction clinic of a university-affiliated medical centre, with the intention of starting a new assisted reproduction treatment course, were recruited. A psychiatrist made a diagnosis of psychiatric disorders using a structured interview, the Mini-International Neuropsychiatric Interview (MINI).
RESULTS: Of a total of 112 participants, 40.2% had a psychiatric disorder. The most common diagnosis was generalized anxiety disorder (23.2%), followed by major depressive disorder (17.0%), and dysthymic disorder (9.8%). Participants with a psychiatric morbidity did not differ from those without in terms of age, education, income, or years of infertility.
There have also been some studies into the benefits of group psychological interventions on pregnancy rates for women undergoing fertility treatment. A study in California, E.Sawlsby (1999), set out to determine the efficacy of two different group psychological interventions on viable pregnancy rates in women experiencing infertility of less than 2 years’ duration.
The study was a controlled, single-blind, randomized study where participants were randomized into a 10-session cognitive-behavioural group, a standard support group, or a routine care control group. They were followed for 1 year. There were a total of 47 in the cognitive-behavioral group, 48 in the support group, and 25 in the control group. There were statistically significant differences between participants in the two intervention groups versus the control group.
This lead to the conclusion that group psychological interventions appear to lead to increased pregnancy rates in infertile women.
All of the studies mentioned here clearly show that the psychological distress experienced through infertility is a serious issue that is now being considered and dealt with by the major health care providers around the world. However, all of these studies identify a situation from a quantitative angle and do not offer a qualitative look at the experience of women within this area. I hope to present a piece of relational centred qualitative research which will hopefully move beyond the factual data and enter into the personal journey of a women wading through the emotional turmoil of infertility so that the reader gets a real sense of what it is like to be in this situation.
Relational-centred phenomenological research design:
This is a form of qualitative research design where the researcher is drawn into the participant’s experience, in much the same way as a therapist is drawn into a client’s experience of the world. As a student in advanced clinical training in the psychotherapy method of Transactional analysis, I brought with me into the process my knowledge of TA and my knowledge of the therapeutic encounter. The research is not a piece of therapy however, the information gathered will be informative, and hopefully useful to others, but there is no long term contract with the participant here and neither is there an aim for psychological change which is often the aim of therapy. However, like therapy, there is a relationship formed if only for a brief amount of time, and both researcher and participants feelings and thoughts are considered throughout the process and examined after the process to bring out a precious range of colours which are all too often lost in the black and white quantitative research designs . My unique take on this subject has its role to play in the research, as does the relationship built between myself and the participant. There may also be some therapeutic shift through the process, or indeed after the research, and the research itself may impact others on a therapeutic level. Relational-centred phenomenological research data is about the fruit that is born from daring to connect with another, and as such the participant is in fact a researcher themselves, as they are exploring paths they may not have travelled before.
The transcript and audio recording were listened to and read simultaneously over a period of several weeks and for over 14 hours, sections of the recording where listened to time and time again to really try and understand how the participant was feeling and the though process that was attached in the process. Though this intensive absorption of the interview it was possible to identify the key themes of the interview of which there were seven. After long deliberation and a discussion with the participant five themes where selected as being the most relevant to the aims of the research. These where then focussed on individually and once again the recording and the transcript where studied for each theme in turn.
The participant presented in an articulate and clear way throughout the interview. She also allowed herself to get in touch with her feelings and review her own emotional process of her experience throughout. There was so much rich content within this research piece that it was difficult to be selective of what to include within it. Through spending so many hours, just listening to the recording and letting myself be touched each time by the emotional depth of the feelings that the participant explored here, was a moving experience.
Participant was female aged 33 she has had infertility issues for 3 years and had IVF treatment twice with the second attempt being successful. She was a volunteered for the research.
The interview location was a private room at an IVF clinic based in the northwest.
2 hours had been allocated to perform the interview and set questions where used within the interview, however a degree of flexibility was allowed if it felt like a theme needed closer examination during the process.
The interview was audio recorded which would then be transcribed and analysed.
Participant signed a MIP-participant consent form which is enclosed in the appendix
Consent was agreed for the interview.
Consent for audio recording given.
Consent for transcription of interview given.
Participant has requested to remain anonymous which was agreed so for the purpose of the interview she asked to be referred to as Nicky.
Consent agreed for findings to be disseminated and published.
Participant reserves the right to halt the interview and not answer questions, participant has been given full access to all aspects of the interview and has the right to ask for it to be destroyed after it has been analysed.
This is in line with UKCP ethical committee report.
Nicky was also given free access to a trained counsellor via the IVF clinic if she felt she needed to explore any issues that the process may have evoked for her.
a short intro signposting your themes would be useful here
The early bird catches the worm/ a change in perspective
I found it extremely interesting to find out about Nicky’s perspective on infertility treatments like IVF, prior to having infertility issues herself. She had like many people before her held an internal belief that if you couldn’t conceive naturally then perhaps that was evolutions way of telling you that you should not be having children. Nicky has a scientific background and as such present this very black and white initial outlook.
Nicky: “…..I kind of, didn’t agree with IVF.”
Me: “Tell me a bit more about that.”
Nicky: “….in my twenties…..I kind of thought, well, you should have had children earlier, you should have sorted it out earlier and then you wouldn’t be in this predicament. And I, kind of, thought from a, like, an evolutionary point of view, well, maybe you shouldn’t have children.”
Nicky then went on to tell me about how she felt now in the light of her experience of being one of these women now that she was referring to from her perspective in her twenties.
Nicky: “…I think, God, that was very judgey of me, it was very judgemental because for me it, it wasn’t a choice, as such, to not have children before I was 32 because I hadn’t met the right person………but it’s surprising when it’s you, everything seems very, very different.”
I am familiar with this early opinion on IVF because it is one that I shared, as did my wife, and indeed as do many people that I have talked to over the years. I think it is especially relevant when people have discussions on the use of tax payers’ money being used to fund IVF treatments and research. People often site Nicky’s black and white view point, yet we see here that views and opinions can alter tremendously when it affects you directly.
Helplessly waiting and waiting and waiting…..
One of the themes throughout this research was the feeling of having to wait. It emerges all the time, and as we explored this I kept imaging a large ticking clock that’s hopefully going to stop at some point, because this would mean a successful pregnancy. But you never know when, or even if, it will stop. And there is an added feeling of fear due to the fact that the longer the clock runs in time the less likely that it will stop at all. I refer here to fact that for thirty something women experiencing infertility, time is always working against you, because the simple fact is that the older you get the less fertile you get and therefore the less likely you will have a successful pregnancy.
For Nicky it was 18 months before she and her husband were seen by a consultant at the hospital and before this it was just a series of tests and results and vitamins and more tests and more results. From this early phase of the process the ticking clock was impacting upon Nicky.
Nicky: …..”every single delay once you’ve realised that there’s something wrong is agony. Every month, every week before you actually get going and something starts happening to change the situation is awful…………………I knew there was something wrong but they still make you go through all the tests and all the investigations, even though the solution is always the same thing, it’s always IVF.”
There is a real sense of urgency in Nicky’s tone of voice and hand gestures, even now after the event you could feel the desperate need for her to just speed up the process, like she knew she was fighting against time and yet every step she was taking just seemed to take more time. It was another 18 months after first seeing the consultant that Nicky was put forward for the IVF treatment. 3 years had passed and she had not yet started the IVF treatment.
Nicky: “I think it was about 18months we knew there was something wrong, that’s when we started on the….. (Nicky took a very deep breath in and had a look of someone who had just climbed a high peak only to realise that there was another higher peak to climb in the distance) …oh, the very, very long road.”
It turns out that the process of being selected for IVF treatment involves a lot more tests and more waiting for results, the clock keeps ticking and Nicky’s feelings of fear about this seemed to really plague her. She seemed particularly focused on the age of 35 years. For her, it was as if this was a threshold, a cut off, that might mean a point of no return. She had become aware of the statistical information that in the literature and studies within the field of infertility 35 was always shown to be the category at which you were placed into another group, the over thirty five group where fertility levels became lower and the chances of pregnancy diminished. Nicky talks of the process being so “time consuming” and I have heard this phrase many times before, but it was something in the way that Nicky used this phrase and the emotional feelings of urgency that I was feeling in the room that really gave the sense of time really being consumed, time being eaten up, taken away from Nicky. I could tell her rapid pace of speaking here that time was an issue; she barely pauses for breath, as if racing against the clock, I could really feel this I felt out of breath myself after this section of dialogue.
Me: “How did you feel about the first treatments and tests….prior to your IVF treatment?”
Nicky: “….it’s so time consuming and you’re always waiting, it was waiting for the next appointment and waiting to see somebody and then waiting for you to get a letter and then wait for the appointment and then wait to see them and then they do a test and then you have to wait and then you go back and it’s so time consuming and by this point you’re 33, you’re 34 and every month that goes by you’re getting older and older… and in infertility…….the magic number is 35, everything gets worse when you’re 35. “
It also emerged that for Nicky waiting also meant that she and her husband had to spend a great deal of time sitting waiting rooms, for Nicky this in itself was an agonising ordeal. She talks about the insensitivity of the waiting room scenario and how ill thought out planning and a lack of emotional consideration made waiting in these waiting rooms so much more difficult than it needed to be.
I got a sense again of how easy it is to miss people like Nicky when you yourself are not directly going through the process yourself, how a consultant or a nurse or even a women with a baby can miss the pain that might be being felt by another person, probable without realising that’s its even present, simple because it’s not you that’s feeling it. I have a sense that if others did realise the extra level of pain caused within the waiting room, that they would endeavour to make reasonable steps to alter the situation. Even as a husband of an IVF couple I didn’t even see this myself but I certainly felt it as Nicky explained it to me.
Nicky: ……”things that people don’t think about, is that you’re going for this scan where they shoot dye up you to see what your tubes are like but they do it in the same department as the women having their 12 week scans (Nicky is very tearful here)………you’re sat there desperately unhappy waiting to find out if ….that’s why you can’t have children and your sat next to someone who’s pregnant………I just don’t think people realise how painful that is, how, how you don’t even want to look at someone who’s pregnant……I don’t know if it’s just the NHS or if just no one thinks..”
Throughout the IVF process there are many as Nicky describes them “hurdles” that have to be overcome. Each hurdle crossed allows the process to continue but equally Nicky revealed that if you fall at a hurdle you must then go back to the beginning and start the process over. For Nicky this meant that for each appointment along the IVF trail (each hurdle) of which there are many could mean the end of one cycle and the beginning of a new. Needless to say this fear for Nicky cause her a great deal of anxiety when waiting in the waiting room of the IVF clinic to be called in to assess whether or not the hurdle had been cleared.
Nicky: “ …… sitting in the waiting room, waiting to have one of the scans is agony because you’re waiting for someone to tell you whether you’ve got through that hurdle or not and every minute that you’re there you just want to know, you just want to know, you just want to know.. , but waiting to find out all the time is so difficult. ”
For Nicky it became almost unbearable to cope with and as such she had to resort to methods of distraction to simply cope with this high level stress. This in itself created its own tension as she had to rely on her husband to listen out for her name because if she missed her appointment this would only involve more waiting.
Nicky: “I ended up having a talking book on and headphones and my husband would, sort of, stay alert and wait for the person because if I’d had my book on and I’d missed my appointment somehow and I’d had to wait longer, I mean that, that would have been awful.”
The way in which Nicky talks about the process of waiting and the stress caused by the waiting rooms, really impacted her as I write this, I feel her sense of exhaustion and stress as she describes it to me. I get an inner sense of being in some sort of purgatory, it make me feel like I want to get out of there and go to a place to lie down in the dark and wait for a knock on the door when it’s my turn, to shut out the world until its time, to be rendered unconscious or simply to be able to fast forward time, anything to avoid the intensity of having to keep waiting.
Nicky: “….the treatment’s hard, it’s hard to keep going and keep positive and get through the waiting, the endless waiting.”
I hate you….your pregnant…..Injustice
For Nicky the fact that she was having to go through the process of infertility treatment was in itself, seen by her partly at least as some sort of unfair discrimination. Like she was being punished by a God that she didn’t even believe in. I got a sense of anger during these parts of the interview, anger at the situation, anger over why she had to go through this, anger at the perceived injustice of her isolated position.
Nicky: “…you just wonder, why is life so unfair……is it being unfair for a reason……is someone trying to tell me something? Which is ridiculous because I don’t believe in god or fate or anything. …I found out there was something wrong it was like, why is this happening to me? Why me?”.
Alongside this was the angry and frustration that was felt towards the injustice of how the world works. In that so many people get pregnant and have children that are undeserving, it was almost like she realised as a result of her condition that having a baby was not something to be taken lightly, but that it was the most precious gift, the only thing in her life at this time and therefore anyone who did not realise this and demonstrated this in the way that they treated their children where simply considered by her as not being worthy of it in the first place. She even extended this view point to all people within the infertility community. Again I could feel the angry in her words and in my own body as she explained her frustration to me, with hardly a pause for breath.
Nicky : ”People within that community, that, the infertility community, you do have this great sense of injustice, of all the, the unworthy people who have children, people who don’t want children, people who are horrible to their children and mistreat them and abuse them and it’s so easy for them to get pregnant, it’s so easy for them to do this thing that you’re so desperate to do.”
Nicky really struggled when she saw pregnant people during this time, I got that same sense of anger and frustration again from her when she talked about the impact of seeing pregnant people and hearing from friend that had recently become pregnant. She could she that this was an unfair projection to apply to these women, yet she was also unable to avoid the growing well of hatred that she felt for these women. The heightened levels of intense almost primal jealousy that would come over her, made life very difficult for her. As a women in her late thirties going through infertility treatment she was inevitable surrounded by friends, family and other patients that where pregnant. This painful experience for her, was one of the hardest emotionally draining parts of her experience. It was clearly easier for her seeing complete strangers than seeing or hearing about close friends, yet even with complete strangers you get a true understanding for her internal struggle, as she describes how she felt.
Nicky: “…God I wish she wasn’t smiling it would be easier, if she didn’t look so happy, if she didn’t look so smug and it’s ridiculous because she’s not smug……she could have been having a horrible day…….but the hatred that you feel for people that are pregnant sometimes is unbelievable jealousy.”
She went on to explain the impact for her of finding out that a close friend had got pregnant after trying for only a month. The pain of this experience hit her harder than she even thought. It was as if she was experiencing bereavement, a loss, of a life experience that she could not be a part of. I felt during this part of the interview that Nicky had feelings of being alone, isolated, abandoned as if watching friends and family boarding a boat for new life in a new place but she did not have rite of passage and as such she had to remain on the key side and just be left with her pain and loss.
Nicky: “…..you take it as a personal attack and it’s not personal……I was that upset I couldn’t go to work the next day. I set off for work and I couldn’t stop crying.”
This continued pain that was felt by Nicky time and time again eventually became too much for her to hold, she could not carry the burden any longer and as such she decide to flip an internal switch, to compartmentalise her internal experience, to dissociate from her feelings about it. It was either this or she somehow got so used to the pain that she became desensitised to it, in perhaps a similar way that soldiers have to in order to get on with their jobs amongst brutal conflict. She talks of being not feeling emotions around it, being numb, like it all just got too much for her, when another close friend reported to her about her second pregnancy within 18months of the last, this being the sixteenth pregnant friend since she had embarked to her own painful journey. When her friend tried to explain that she understood how painful the news was for Nicky, she was quick to correct her.
Nicky: “….it doesn’t hurt me anymore…….it doesn’t upset me, I feel like I’m dead inside, and that really upset her but it’s how I felt. I just felt numb and like I couldn’t have any more emotions about it.”
Death and infertility
Nicky had a miscarriage during the IVF treatment which triggered a large emotional response both at the time and when we looked at this time during the interview. She was still very much grieving for this loss; the root of this deep sadness seems to be for herself at this time, which unfortunately coincided with the Christmas break. She talked about how she felt sorry for herself at thus time because now with a successful pregnancy and healthy child she can look back with a great deal of compassion for her then wounded self and her husband.
Nicky: “…..I feel so sorry for me at that time……You see its not losing the baby that’s making me cry, it’s thinking about me and Jim at that time, at how wounded we were and how we just didn’t know that it was ever going to get better”.
For Nicky the feelings of pain linked with the loss of the baby and the continued struggle with the treatment made her really question her thoughts on life and death. She adopted a view point where she believed that what she was experiencing was somehow a worse loss and pain to that of a bereaved person losing a loved one. She found herself in feeling like her pain might never end and that unlike the loss of a loved one you could reclaim yourself and your life slowly but surely after the loss, it was clear that she felt that she might never reclaim her life back from the endless process she felt trapped in. When I asked her about contemplating giving up IVF treatment her description of the continued pain of loss and uncertainty really did seem to me that she was trapped, cornered on all sides. She explains how her friend challenged her on the loss of her mother.
Nicky: quoting her friend “…she said, it never ends, you know, you never stop feeling” “ and I was trying to say, ………. when you lose someone they’ve gone and you ……..learn to frame your life around the fact that person isn’t there anymore and you live with that loss but at least that loss is final. With infertility it feels like it’s never going to end. You’re never going to suddenly not want to have a child anymore so it’s never going to end, it’s only going to get worse.”
Out of control and fighting
Nicky talks about how the week of waiting to find out if she was pregnant when taking fertility drugs, was really difficult for her, she suggests something a kin to losing touch with reality. She seemed to feel powerless and at the mercy of the treatment, like she was out of control, a bystander just helplessly looking on and trying desperately to interpret every small bodily sensation. Nicky wanted more than anything to get pregnant but she also wanted that week to be over quickly so that she could just stop wondering, stop questioning, stop hoping so that she could get back to the two weeks of positivity she felt rather than be in this powerless place of uncertainty.
Nicky: “ You drive yourself crazy. You’re trying to interpret every single feeling………you’re constantly battling to be realistic but trying to stay positive and you end up not really doing either. You’re wishing your life away because you just want that week to be over because in some ways you’d rather it just got over and you got your period and you knew you weren’t pregnant.”
This idea of being out of control of her body and the process was a major theme of this research piece, not just in terms of how the drugs affected her body and whether they had the desired outcome, but also in terms of how she planned her future even two weeks into the future was as she saw it out of her control. She just had to wait and hope and second guess herself for years. When finally she started IVF treatment this out of control sense of self continue, but for her it had an added dimension now. It span out in front of her like a dichotomous flow chart and each time she reached a branch an obstacle had to be overcome, a battle had to be fought because each of these numerous junctions could have meant the end to the treatment. But this was a battle once again that she had absolutely no control over.
Nicky: “I felt like I was going crazy because I felt so out of control……there’s so many stages to get through and at each stage there’s two paths…..some sort of obstacle to get through but it’s not an obstacle you can do anything about, you can’t control it, …..you can’t work harder, or try harder, ….your completely out of control, your body is just doing stuff..”
Nicky really saw herself and her husband in a battle a fight against infertility itself, with the prize being of course a healthy child. I really could see and feel this struggle this fight in the words she used and the way she spoke the words, with so many deep sighs in the dialogue and the clarity with which she articulated the mood of this time. The very term used in the IVF treatment is a round of IVF, a round of drugs, the first round of injections. Like a boxing match when each time the bell strikes you know you have made to the next round, but will you make it through the next and the next. I could see that even now having in effect won the title fight in that she had achieved her goal of having a child the scars of the fight remained with her in a real and deep way.
Nicky: “It is a fight because you’re fighting. You’re fighting an unknown opponent….and an opponent you can’t do anything about, you can’t outsmart them and you can’t push harder, you can’t do anything, you’re fighting an invisible opponent..”
For Nicky and her husband the fight took its toll and while going through this ordeal they remained united, Nicky describes being close to the edge. Almost unable to carry on with life, in a place of wanting to stop and shut down, switch off, remain on the boxing ring floor and not get up again. There were times that she thought that the fight was lost, when her hope and positivity had just disappeared from sight and she didn’t have the strength or will to try and find it. She describes a realisation that she might have needed some medication to help her through the really tough times.
Nicky;…”I remember nights of just crying….just crying for an hour and that was all the time……if you didn’t know what was wrong with me you would think I was seriously clinically depressed. I probably was depressed…….I think I came close to losing myself.”
And yet it seems that with the support of her husband, just being there for her, with her on the journey, carrying her for a while, she would regain her sense of purpose and stand up and move on to the next battle. There is a sense that her relationship was of absolute importance in her ability to get through the whole process and although she acknowledged that he could not understand the complexity and overwhelming feelings she had with regards to the yearning of a women for a child of her own. It was clear that his role majorly significant in holding the Nicky up and being as it were in her corner.
Nicky:…”it can tear people apart, people split up all the time………it’s so hard and if you’re not totally supportive of each other, and I know he had to support me more than I had to support him”
Rob: “Did you feel that it brought you and your husband closer together in your relationship?”
Nicky: “ Definitely, whenever anything’s difficult we say, we got through IVF, we can get through anything.”
Infertility is much more than just not being able to have a child, although it is undoubtedly the pebble that is dropped into the water, infertility and its treatment becomes a bigger entity for those going through it. It is the waves of ripples extending from this issue that really need to be considered and understood if we are to fully experience what it is like to in this position. This type of qualitative research could potentially have great value for anybody involved in the infertility process due to it being a real example of a woman’s thoughts, feelings and behaviour during this time period. How many women are internalising a similar process to that of Nicky’s and may benefit from knowing that they are not alone, or going crazy as they struggle with the emotional impact of infertility. This type of research could offer people an external permission to accept with compassion that which they are feeling and experiencing. Through seeing perhaps a commonality with another in the same situation. This thereby normalises the painful experience. The psychotherapy model of Transactional Analysis recognises the importance of permission giving and normalisation of thoughts, feelings and behaviours to be of great therapeutic value.
The benefit to the health services could also be incredibly valuable, how many of the doctors, nurses and receptionists really understand their individual patient’s sense of self and state of mind during the infertility treatment. And more importantly what could be the possible consequences of this awareness for their patients. Might it be possible that through this understanding the waiting room situations could possibly be changed so that infertility and postnatal care where not cheek by jowl. This might well avoid the distress clearly caused for Nicky by not having to be placed in this situation. Staff training based on phenomological research like that presented here might hopefully mean that they would gain a unique insight into their patient’s internal process that may currently be absent from the situation. This could lead to an improvement in the relationship with staff and patients where a culture of empathy and clear communication could be established.
The realisation of the importance of the couple’s relationship in dealing with infertility could also play a part in the treatment process. It might be of great value to offer couples embarking on the infertility treatment road seminars aimed at helping couples to communicate, understand and work through difficulties together as well as offering couple counselling if things get difficult. For men in particularly it might be useful for them to be able to identify their role in the process rather than feeling like a bystander, they might also better understand their partners internal world and their feelings.
These are just a few ideas about how this type of research could be of use to people dealing with infertility and its treatment. It might also be interesting to analyse the effects of putting the benefits mentioned above into practise. Could there be a biological impact? How they might they improve the overall outcome for the women undergoing the treatment and for the fertility units in terms of numbers of successful pregnancies.
Nakamura (2008) presented a piece of epidemiological research was carried out where all studies from 1980 – 2007 that tested the link between stress and human reproductive failure where evaluated. The conclusions drawn from this research showed that positive correlations had been identified between various pregnancy failure outcomes and pre-conception negative life events. It also showed positive correlations between pregnancy failure outcomes and elevated daily urinary cortisol levels. In addition to this through looking closely at the two strands of evidence it has been suggested that there may be a programming of stress susceptibility in mother and fetus via a so-called pregnancy stress syndrome. From the emotional states described by Nicky in this work, its seems highly likely that infertility and its treatment, could easily be considered a negative life event whereupon it would seem natural to experience high levels of stress and therefore cortisol as this is a hormone released when individuals are under stress. Of course this claim would need backing up with data, put it does suggest that pregnancy rates might well improve if the experiences like those shared by Nicky where taken into account and acted on.
This research was conducted by me, Rob Costigan and as a result the project could well have some views and outcomes that might have elements of biased due to the following reasons. I decided to research this area because I felt that it was under represented in the research I could find but also because I am the husband of a women whom has gone through the process of infertility treatment. As a result I have experienced a large amount of the emotional difficulty put forward here in this project, I have had to support my wife and also feel her pain as well as that of my own. I selected my participant (Nicky) rather than going through a process which should really have been a random selection. I also knew the participant reasonable well through a support group based at the fertility clinic.
To be a fully independent piece of research the interview should really be conducted by a researcher with no prior knowledge of the participant and also with no experience of the process of infertility treatment. It could be argued that due to my understanding of infertility and my knowledge of the participant that I may have affected the interview process perhaps even leading the interview in such a way as to generate the desired outcomes that suited my purpose, even though that was not my intention. At the same time it could also be argued that this relationship and this knowledge, gave the participant a sense of safety and security that she might not feel any shame or discomfort as she was comfortable in the knowledge that I perhaps would understand. As a result the details and depth of the work may well have been enhanced because of this.
Another limitation of the piece is its overall scope. This research is limited by the fact that the interview was carried out with just one participant. The views shared here may not be common to the experience of other women going through the same process. To make it a more valid research study it would be important to interview a larger number of participants from a wider range of age groups. It would useful to have some knowledge of the participant’s childhood to see if this impacted on their views and opinions. Also the cultural background of the participants in future research could be considered to see if this has bearing on how the participant feels about the process.
The strengths of this piece lie in its depth, as shown at the start of this project most studies in the area have focussed on the quantitative data that can be gathered about the emotional challenges faced by those receiving treatment for infertility. This project was a focussed piece of work looking at one participants experience but with detailed and considered purpose.
It has opened up the internal world of a women’s experience through the process of infertility and highlighted the challenges faced by her. It has allowed us to step into the shoes and really connect with another person’s pain, anger and sadness. For some it may be an uncomfortable experience to read but at least this study reflects a reality, a truth that perhaps cannot be realised by statistical analysis.
48,000 women a year undergo IVF treatment on average in the UK, with only a 25% success rate. The inability to conceive a child is as emotionally painful for these women as bereavement and it can cause mental illnesses like depression. In the words of a leading fertility consultant speaking at a seminar in Merseyside. ”Women don’t choose to want to have children, it’s like breathing, it just is, you can only choose not to have children.” It is important for women understand that they are not alone in their pain, that they are understood. Research of the phenomological format is of great importance when looking at emotionally challenging life processes like that of infertility because it gives people a voice and normalises the often intense feelings that people might not otherwise share or understand. Nicky has shared herself in this piece of research, opening the door on the emotional challenges faced by herself and the impact on her relationship with her husband in trying desperately to overcome hurdle after hurdle in order to conceive a child. This research allows others to see Nicky’s personality and form a relationship with her through the written word as well as offering those that work in the field some valuable insights. As Carl young put it “The meeting of two personalities is like the contact of two chemical substances: if there is any reaction, both are transformed.”
HARVARD MEDICAL SCHOOL. (2009) The psychological impact of infertility and its treatment. [online] Available from http://www.health.harvard.edu/newsletters/Harvard_Mental_Health_Letter/2009/May/The-psychological-impact-of-infertility-and-its-treatment. [accessed 14th Dec 2014].
DOMAR,A. (1993) The psychological impacts of infertility. [online] Journal of psychosomatic Obstetrics and Gynecology. Available from. http://www.informahealthcare.com [accessed 15th Dec 2014]
TING-HSIU CHEN (2004) Prevalence of depressive and anxiety disorders in an assisted reproductive technique clinic. [online] Human reproduction vol. 19. Available from. http://www.eshre.eu [accessed 15th Dec 2014]
DOMAR,A. (1999) Impact of group psychological interventions on pregnancy rates in infertile women. [online] Fertility and sterility vol 73. Available from http://www.fertstert.org
NAKAMURA,K. (2008) Stress and reproductive failure: past notions, present insights and future directions. Journal of assisted reproductive genetics. Vol 25 (2-3) .p.47-62
Research Project Proposal Form
Name: Rob Costigan
Topic: The phenomological experience of female infertility
How will you prepare your participant and minimise any risks of harm to your participant?
I have been part of a support group for IVF patients and a member of the group is extremely keen to be part of this project. She is now finally an IVF mother but she feels strongly that it would help others if she could document her internal experiences. It is my belief that she is robust enough to cope with this project. This person has been told that her name will not be used directly so she will not be identified to ensure her confidentiality.
She understands that through the interview she will most likely trigger painful emotions and that if she wishes to stop the interview at any time she is free to say so. In terms of support it has been agreed that she can have free counselling sessions with the qualified professional at the infertility unit as well as the continued support of the group.
My participant has been told that if she wishes she can read the research after it has been written and that I would be open to discussion if she disagrees with my findings.
Signed: Rob Costigan
Date: 1st sept 2014
Approval given by: Stephanie Cooke
Date: 10th sept 2014
MIP Interview – Participant Consent Form
I agree to be interviewed about my personal experience of :
The emotional experience of infertility and treatment
I consent to this interview being audio-taped.
I understand that the interview will be transcribed and this will form the basis of data which will be analysed more generally as part of a research project for the researcher’s training as a psychotherapist. I understand that course tutors will read the final research report and that it is possible the data/findings/report may be disseminated more widely (e.g. it may be published in some form at a later date) while my particular details will remain strictly confidential if I so choose.
I understand that this interview will be conducted in accordance with ethical standards laid down by the Manchester Psychotherapy Training Institute (in line with the United Kingdom Council for Psychotherapy Ethical Committee Report Ethical Guidelines for Research, July 1997). I understand this to mean that:
- I have the right to withdraw from the interview at any point and I can refuse to answer any questions which might make me feel uncomfortable.
- The interviewer will do all he/she can to treat me with respect, care and sensitivity.
- I can make a choice about confidentiality. If I so choose, the contents of this interview will be kept entirely confidential. There will be no record of my name anywhere (a pseudonym will be used). Everything I say will remain anonymous.
- I will have access to the transcript of the interview and that I have the right to ask that any data (tape and transcript) be destroyed after it has been analysed.
- I have the right to ask for particular quotes not to be used in any published work.
I do not wish my real name to be used. I wish my pseudonym to be:
Other conditions agreed:
Access to counselling through fertility clinic
Signed: (digital signature sent by email)
Date: October 28th 2014
Interviewer Name and contact details: Robert Costigan 28 Leadale lea, preston tel 07881561572
Transcript of interview
|Can I ask you how did you feel about having a baby prior to finding out about your fertility issues, that you had? What were your thoughts and feelings around having a baby prior to all that, if you can remember?
Kind of neutral really, not mad excited, just like it was the next step, like, the next thing we should be doing. But I remember I’d been on holiday and seen my nieces and nephews and, and thought, yeah, you know, this is, this is the right thing to be doing now, I’m married now and, erm, I wasn’t giddy with it or anything, just, yeah, have a baby now, that’s, that’s the next thing to do but I’ve always wanted children, I’ve always known that I wanted children, so it was just a case of waiting for the right time to do it and that, that seemed like the right time.
And, erm, did you take for granted, perhaps, the fact that you’d just be able to conceive naturally and it wouldn’t be a problem? Did you think …?
I think I did actually, I think I thought, you know, it might take six months, maybe a year, because I, I’d been on the pill for a long time and I was only 32 so, and I just thought, I look like I should have children, I look child bearing, I just, to be honest it never occurred to me that there would be a problem, I thought it just might take, I didn’t think it would be instant but I never thought there would be a really serious problem.
And how did you feel about infertility and IVF treatments prior to finding out about your own fertility issues, did you have an opinion on IVF and things like that?
I’ve got to be honest that I, kind of, didn’t agree with IVF.
Tell me a bit more about that.
I, kind of, thought, when I was in my twenties and I read about IVF and people struggling to have children I, kind of, thought, well, you should have had children earlier, you should have sorted it out earlier and then you wouldn’t be in this predicament. And I, kind of, thought from a, like, an evolutionary point of view, well, maybe you shouldn’t have children, maybe that’s why you can’t have children, so you shouldn’t be messing with things. And I look back now and I think, God, that was very judgey of me, it was very judgemental because for me it, it wasn’t a choice, as such, to not have children before I was 32 because I hadn’t met the right person so, you know, you shouldn’t be having children with someone that’s not the right person so it wasn’t like, oh, I’ll just leave it, I’ll leave it till I’m 32, it, it wasn’t like that. But yeah, I, I didn’t really agree with, erm, messing about with people’s fertility, I don’t agree with a lot of medical intervention to be honest but it’s surprising when it’s you, everything seems very, very different.
Mmm. And when did you find out about your own infertility issues?
It’s really hard to say, to be honest. I think we were trying about a year before I started thinking something was wrong and then I got this, sort of, at home fertility monitor which is supposed to tell you when you’re fertile but it never really seemed to work properly as it was supposed to and I, I know now that’s because my hormone levels were never quite right so it never worked properly. I think it was about 18 months when we first saw a consultant but then they wanted us to wait another 3 months after that, erm, giving my husband vitamins and at that point I knew, I knew there was something wrong and it, it just, and every, every single delay once you’ve realised that there’s something wrong is agony. Every month, every week before you actually get going and something starts happening to change the situation is awful and, and that was quite bad, even right at the beginning, I knew there was something wrong but they still make you go through all the tests and all the investigations, even though the solution is always the same thing, it’s always IVF, it doesn’t matter what’s wrong with you, it’s always IVF. Erm, but all the procedures I had to have and, and they tried me on these drugs that are meant to make you more fertile and they didn’t work and we had two goes of that so, yeah, I think it was about 18 months we knew there was something wrong, that’s when we started on the, [sighs] oh, the very, very long road.
And what was the, I heard you saying that your husband was given vitamins, was there, what was the nature of the infertility issue, what was the …?
They never really found out, I had low egg reserve, which means I don’t have a lot of eggs, but I’ve had eggs, and there may have been some sort of hormone problem that meant that, erm, every month I wasn’t producing a good egg, I don’t know, they never really found out because I think, because there’s nothing they can do about it, there’s no point really, finding out.
They just found out that there wasn’t something quite right with my hormone levels, or my eggs, or something.
OK. And what, what were your feelings and thoughts, what came up for you when you first found out that there was a fertility issue?
In some ways it was a relief in that something was going to get done, they weren’t, they weren’t going to say, there’s nothing wrong with you so just keep trying, because the keep trying was awful but on the other hand to know that there’s something wrong with you was, was really difficult because, erm, I think, I’ve always felt like I wasn’t quite normal, I didn’t quite fit in, I wasn’t quite like everybody else and this was another reason why I wasn’t like everybody else. It, it wasn’t going to be easy for me, it wasn’t going to be simple, there was going to have to be some pain and difficulty and I think I just, I felt like life was very unfair at that point and people within that community, that, the infertility community, you do have this great sense of injustice, of all the, the unworthy people who have children, people who don’t want children, people who are horrible to their children and mistreat them and abuse them and it’s so easy for them to get pregnant, it’s so easy for them to do this thing that you’re so desperate to do and you just wonder, why is life so unfair, and then you think, like I thought, is it being unfair for a reason, should I not be having children? Is someone trying to tell me something? Which is ridiculous because I don’t even believe in things like that, I don’t believe in God, or fate, or anything. So I suppose when I found out there was something wrong it was like, why is this happening to me? Why me?
How did you feel about the first treatments and tests that you had prior to your IVF treatment?
It was awful.
Mmm, tell me a bit more about that.
Well, that, it sounds petty but it’s so time consuming and you’re always waiting, it was waiting for the next appointment and waiting to see somebody and then waiting for you to get a letter and then wait for the appointment and then wait to see them and then they do a test and then you have to wait and then you go back and it’s so time consuming and by this point you’re 33, you’re 34 and every month that goes by you’re getting older and older and in infertility, you know, the magic number is 35, everything gets worse when you’re 35 and you know as a rational person that the day after you become 35 doesn’t automatically mean that you’re not going to get pregnant but you’re like, if I’d got pregnant at 33 that would be better than being 35 and still waiting for treatment and still waiting for things to go on. I mean it’s, it’s very painful as well, no one talks about that.
Tell me a bit more about that.
All the blood tests and the scans and the, the internal examinations and it’s painful and, and the little things that people don’t think about, is that you’re going for this scan where they shoot dye up you to see what your tubes are like but they do it in the same department as the women having their 12 week scans when they’re pregnant so you’re sat there desperately unhappy waiting to find out if your tubes are blocked and that’s why you can’t have children and you’re sat next to someone who’s pregnant, all excited because they’re having their scan and I just don’t think that people realise how painful that is, how, how you don’t even want to look at someone who’s pregnant, never mind sit next to them and wait for an hour for your, for your horribly painful procedure while they get to lie down and have jelly on their tummy, you know, it, but it’s the NHS and, I don’t know if it’s just the NHS or if just no one thinks, maybe that woman doesn’t want to go to that department to have that scan.
But unless you’ve had problems with infertility you could, you would never put that together, you would never realise how awful that would be for that person because even when I was pregnant I think I started to forget, you know. I would see a pregnant person and think, God, I wish she wasn’t smiling, if she wasn’t smiling it would be easier, if she didn’t look so happy, if she didn’t look so smug and it’s ridiculous because she’s not smug and, you know, she, she could have been having a horrible time that day for reasons not connected with being pregnant but the hatred that you feel for people that are pregnant sometimes is unbelievable, jealousy. So, yeah, the, the procedures and tests were drawn out, painful, physically and mentally, and, and, kind of, embarrassing, you, kind of, feel, it’s a strange thing, it’s not like anything else being wrong with you, you know, I’ve had loads of tests and things for, you know, I’ve had kidney problems and all sorts and, and loads of tests and you go into them and you always feel sort of, oh, you know, I’m being looked after, and you feel like people are looking at you like, oh, you know, poor you, you’re having to have this test today, and you feel like it’s not your fault and it’s nothing to be ashamed of but when you have infertility tests for some reason you do feel like it’s something to be ashamed of, you feel like you’re lacking in some way and you’re faulty in a way that you, you don’t feel when there’s something else wrong with you and it doesn’t make any sense. Logically it makes no sense but that’s how it feels, like you’re broken.
Some shame there for you, in that, then?
Mmm. You do, you feel ashamed, yeah, ashamed.
Mmm. It sounds really difficult, does that. When your drug treatment didn’t work how did you feel about that, you know, when your consultant advised you? I don’t know, I presume your consultant advised you at that time to go the IVF route. How did that impact on you when you, sort of, realised that your treatment hadn’t worked on the drugs and that you were going to have to go down the IVF route?
When he said, and I refer you for IVF, I think, I can’t really remember. I think there was a break because I had to lose a lot of weight to get IVF and I, I think there was a break between, I can’t, I can’t remember …
… what happened exactly but I do remember when he said, right, you’ve lost the weight, erm, the, the treatment hasn’t worked, I’m going to refer you for IVF, I just felt immense relief.
Tell me a bit more about that.
Just felt finally something is going to be done, something scientific, something technical, something with a bit of clout is going to be done rather than all this namby pamby wait and see, wait and see, take some vitamins, take these hormone drugs that are meant to do something but nothing, I think I wanted something physically to be done, some sort of physical intervention because the, the waiting to see was killing me. I think we had two goes at these drugs and when you, when you’ve been trying for, like, two, I think it was, like, two years at this point, every month the same cycle over and over again, you’ve got the horribleness when you get your period and you realise you’re not pregnant, you have about two weeks where you feel hopeful because you’re trying, or you’re taking the drugs and you’re trying and you think, yeah, might work this time, might work this time, keep positive, keep positive, you have the agony of the waiting to see whether you’re pregnant or not.
Tell me a bit more about that because you seem really, when you said the agony, it’s like, …
Oh, oh, oh, it was awful.
… seems really powerful.
You drive yourself crazy. You’re trying to interpret every single feeling or, you know, thing that your body might feel, the number of times you’ll look on the internet for very early symptoms of pregnancy or, you know, I’d say to my husband all the time, this has happened this month, and, erm, he’d say, OK, but that happens every month. Oh, no, no, it doesn’t, it doesn’t, it could be, it could be the implantation bleeding, it could be this, it could be that and, you know, and he was so patient but I was just fooling myself for, or trying to, you’re constantly battling with trying to be realistic but trying to stay positive and you end up not really doing either. And I don’t know if it’s that deep down I knew I wasn’t going to get pregnant naturally or, you just, you swing backwards and forwards between thinking that you will and thinking that you won’t and that, sort of, week
where you’re waiting, you’re just trying to get through that week, you’re just trying to, you’re wishing your life away because you just want that week to be over because in some ways you’d rather it just got over and you got your period and you knew you weren’t pregnant and you could go back to the two weeks of being positive than just be in that week where you don’t know and I know it’s the same for everyone who can’t get pregnant but me especially, I don’t do well with things that are uncertain, I like to know what’s going on, I like, I like to be able to plan what I’m going to do and …
You feel quite powerless?
So powerless. For years, years this went on. Years of feeling powerless and not having control of my own life and you can’t plan anything. Or you can but you don’t know if it’s going to be true, you know, you say, we might go on holiday, but we might not because I might be pregnant, but I probably won’t, but I don’t know, shall we or shall we not, I don’t know because we don’t know anything, and you forget that, once you have a child you forget the limbo, the feeling that you can’t move on, you can’t move down one path, you can’t move down another path, you can’t go anywhere because you, you don’t know what’s going to happen.
Mmm. Sounds really stuck, like a stuck place.
Yeah. It was.
How did it impact on your relationship with your husband and sex within the relationship and things like that?
[Pause] [Sighs] I remember sometimes where we were having a break from the fertility or for some reason we knew it was, like, the wrong time of the month to even try and we used to go, sex for fun, sex for fun, and we used to get really excited because we were having sex just because we wanted to and we’re very lucky, I think, that we made it through that, that period of time without sex becoming a massive issue because you are a lot of the time having sex when you don’t want to and I think we always got through it but sometimes it was, I don’t know, it was always good but it, it was, it’s a bit like having a meal when you’ve just had a, just had your dinner, you’re not really hungry but you eat it anyway because someone’s made it for you.
Mmm. Just moving on to your IVF treatment could you explain to me what the treatment was like for you and how the treatment, the IVF treatment, impacted on you emotionally, as you went through the process?
The first set, set of treatment I felt like I was going crazy because I felt so out of control. Even though I was pleased that something was happening because I, even though they, they give you a flow chart of what’s going to happen there’s so many stages to get through and at each stage there’s two paths you could go down so, you know, you start the drugs to shut down your system and then you have to have a scan to see if they’ve shut it down enough and then if they haven’t shut it down enough you have to continue on and, and then if you get down that path then, erm, you start another set of treatment and you have to have a scan to see how your eggs are responding and then, erm, you might have to have more of that treatment or you might have to book in your egg collection so you’ve got to get through that and then you have to have your egg collection and see how many eggs you get and then you’ve got to see how many fertilise and it’s not like you have your treatment and you start it and then it goes on for a few days and then it’s over, it’s weeks, it’s, like, seven or eight weeks and every few weeks or every few days there’s some sort of obstacle to get through but it’s not an obstacle you can do anything about, you can’t control it, you can’t work harder, or try harder, or do anything so again you’re completely out of control, your body is just doing stuff and responding or not responding and it’s other people making the decisions and it’s other people’s timescale and, erm, when your appointment is even, you don’t get to choose that. So you’re trying to get through each one of these hurdles and each one is a battle, and again I keep using the word but it is agony. Even sitting in the waiting room, waiting to have one of the scans is agony because you’re waiting for someone to tell you whether you’ve got through that hurdle or not and every minute that you’re there you just want to know, you just want to know, you just want to know and then you can process it, and either you’ve not got through it or you have and you can deal with it but, but waiting to find out all the time is so difficult. Even people walking up and down the corridor was difficult because you keep thinking it’s going to be the person that’s coming for me and I’m going to get into that room and they’re going to tell me now whether we’ve got through this bit or not and waiting to hear was just awful so, you know, I ended up having a talking book on and headphones and my husband would, sort of, stay alert and wait for the person because if I’d had my book on and I’d missed my appointment somehow and I’d had to wait longer, I mean that, that would have been awful. Erm …
So your book was your way of …
Just switch, …
… just coping.
… just trying to switch off because I don’t want to talk to other people, I don’t want to hear about their experiences, not in that room anyway. And I remember one day a woman came with a baby and I thought, you know, we didn’t know why she was there, maybe she’d had one round of IVF and it had worked and she was having another one and I thought, oh my God, how insensitive to bring that baby in here. No one wants to see that baby, well, I didn’t, some people like to hear about success stories, erm, I would only want to hear a success story if that person’s circumstances were exactly like mine, you know, I don’t want to hear someone who’s got one ovary who managed to get pregnant. It’s like, well, yeah, but that’s not my circumstances so that doesn’t help me get through this because I, it doesn’t apply to me. Erm, yeah, so the treatment’s hard, it’s hard to keep going and keep positive and get through the waiting, the endless waiting. I don’t think people realise how long it takes, it, it took us I think from September, middle of September is when we started, that cycle, and it was early December when we found out, erm, that we were pregnant, that time.
And I know that you, your first round of treatment, that time you were just talking about, was unsuccessful. How do you feel about that? How did that impact on you as well? It must have been incredibly, incredibly painful, I know.
Well, it was successful in that we did get pregnant, we were pregnant for two weeks, maybe, and then we lost it.
What was that like for you?
[Pause] It was, it was weird in that I didn’t, I don’t know if I knew it wasn’t going to last, or I feared it wasn’t going to last, but I wasn’t that surprised.
Had you had a positive pregnancy test?
Yeah, yeah, pregnancy test was positive, I’d told a couple of people. I remember getting dressed for work and putting my tights on and thinking, I’ll need to get maternity tights soon, and then thinking, no, I won’t, I won’t. And I started bleeding the day my friend’s baby was born and then again there was a week of waiting because you can bleed in early pregnancy and everything be fine and it was nine days before we found out whether it was actually gone or not.
It must have been a really hard nine days.
[Pause] Yeah, it was. [Pause] Because no one can ever tell you anything and it was only someone at school, that, the fertility centre said, just wait and see, wait and see, and I think that’s the one occasion when they really let me down because you find out later that, when you’ve lost your baby a pregnancy test will still say a positive for a long time so we were still doing tests every day. We had those ones that, sort of, tell you the number of weeks and it wasn’t increasing but it wasn’t decreasing but no one tells you that the hormones will be there for ages and I can’t believe that the fertility centre were so insensitive as to not do something sooner and then eventually they said, come in for a blood test, and then you have to go back a day later and have another blood test to see if a certain hormone is, is rising and if it is then you’re still pregnant but I also had a scan, erm, at the local hospital and I think deep down I knew, I knew it was over but you just hope that it’s not over. You’re just looking for things on the internet that’s the same as what’s happened to you that’s been OK.
But it wasn’t OK. And I know now that, you know, it was for the best because there was obviously something wrong but to have gone through all that and, erm, and been so happy for a week or so, scared and fearful that it wasn’t going to last, but then, but, you know, you’re never 100% anything when you’ve got fertility problems, you’re never relaxed, you’re never completely happy or completely unhappy because you’re always swirling around with hope and fear and worry and, you know. And it was very, it was a very, a very hazy Christmas.
Mmm. [Pause] Thanks for, thanks for sharing that, it must have been really painful for you, I can see that.
It’s more, I feel, I feel so sorry for me at that time.
Because I’m so happy now.
Is there a sense of wanting to go back and tell that person that was so sad at the time?
I said that all the time at the time, if someone could just say, you will get pregnant, you will have a baby, it’s not going to happen for three years or four years or whatever but you will get pregnant, this, this will end at some point, but no one can tell you that, for those people that try for 7 or 8 years and have like five rounds of IVF I don’t know how they carry on, I don’t, I don’t know how they do it because it is awful. I mean I keep saying it’s awful but I can’t think of another word. It is awful.
I think awful, awful’s OK. It’s a good word.
Because at the same time all this is going on, you know, you’re still trying to live your life, you’re trying to go to work and, you know, in some ways it was so awful that it was at Christmas because you have to see people and you don’t want to tell random friends of your parents that you’re actually a bit down because you’ve just had a miscarriage, you know, you can’t, you don’t want to do that but you, but you can’t also wander around looking miserable at Christmas so you’ve got to put a brave face on, whereas if it wasn’t Christmas you could have a couple of weeks where you didn’t really see people that you don’t know that well and you don’t want to share your private pain with.
[Pause] [Sighs] You see it’s not the losing the baby that’s making me cry, it’s thinking of us at that time, at how wounded we were and how we just didn’t know that it was ever going to get better, just wish I could tell us, say it is going to be OK, in 2 years you’re going to have a baby at Christmas and he’ll be wonderful and perfect and beautiful and it’s going to be OK.
Sounds like you were quite lost at that time.
I can see you must have been in a lot of, a lot of pain. Did you ever contemplate at that point just cutting your losses and giving up with IVF treatment or …?
The difficulty is, is that that wouldn’t stop the pain.
I tried to talk to my friend about it, she lost her mum when she was in her twenties which was a horribly painful experience, and I tried to say, you know, at least that has an end point to it, and she got quite upset, she said, it never ends, you know, you never stop feeling, and I was trying to say, no, I don’t mean, when you lose someone they’ve gone and you get, you, you know, learn to frame your life around the fact that person isn’t there anymore and you live with that loss but at least that loss is final. With infertility it, it feels like it’s never going to end because if you stop having IVF are you going to keep trying, are you going to look into adoption and even if you did look into adoption are you going to keep trying, is it, it’s never going to end. You’re never going to suddenly not want to have a child anymore so it’s never going to end, it’s only going to get worse and then when you’re 50 or 60 and you go through the menopause and you can no longer have a child so at least you stop thinking, well, I might get pregnant, then I don’t know how those people must feel. I can’t imagine that amount of loss and pain. So you want, you want to not want a child at that point, you want to be able to cut your losses and say, enough of this now, this is too painful, but you can’t remove the part of you that wants a family so it’s like fake cutting your losses because you can’t actually cut your losses because, because you can’t stop wanting a child.
Mmm. And how did you feel about other women with children around, you know, around this time? Well, throughout the whole of this process but particularly, sort of, after your miscarriage?
It weirdly gets easier. I remember my friend got pregnant, she’d been trying a month and she got pregnant three months before her wedding because she was that afraid of what had happened to me that she wanted to start trying so that if it took, was taking more than a year then she would be able to go to the doctor and say, I’ve been trying a year, because she was that afraid, because she was, you know, same age as me but she got married like two years later than I did, so she started trying early and then got pregnant straight away and I couldn’t stop crying. I think I was crying for about three hours. I just felt so, I know she hadn’t done it to hurt me but I just thought, oh, for God’s sake, could you not just have waited till you got married? I now have to go through your wedding with you pregnant with everyone else there with all their children and, you know, you take it as a personal attack and it’s not personal. And then I was that upset I couldn’t go to work the next day. I set off for work and I couldn’t stop crying in the car and I had to come home. And I had to go to her hen do and her wedding and she phoned and said, I understand if you don’t want to come to my hen do, and this is my, this is my best friend. We’d been friends for 15 years and she knew that going to her hen do would wound me because that’s how upsetting it is being around pregnant people. And I went to the hen do and my other friend was eight months pregnant and her sister was six months pregnant and then I remember, you know, it’ll be nearly a year later, my friend that was there that was eight months pregnant, she was pregnant again, or eighteen months, it was a long time because we’d been at this for so long and, erm, she rang to say she was pregnant and she was so sorry, I’m so sorry, this is really going to hurt you, blah, blah, blah, and I remember saying to her, it doesn’t hurt me anymore because you’re literally the sixteenth person that’s got pregnant while I’ve been trying to get pregnant, and she said, no, no, I mean don’t pretend it’s not going to upset you and I said, it doesn’t upset me, I feel like I’m dead inside, and that really upset her but it’s, it’s how I felt. I just felt numb and like I couldn’t have any more emotions about it, I couldn’t let myself get upset anymore about it because it was just going on and on and on and on. When the first five or six people who get pregnant when you’re trying, you get so upset and it happens over and over and over and over and there’s someone with twins and there’s someone who gets pregnant by accident and then, and you have a grading system, and I’ve spoken to other women suffering with infertility and we all feel the same way, if someone gets pregnant when they’ve been trying for ages you feel happy for them and then if someone gets pregnant really quickly you’re like, er, er, and if someone gets pregnant by accident, whatever that means, and is a bit annoyed about it, you hate them, which is irrational, but you hate them because that’s how easy it is for them. Not even trying. It must be, you know, like for people who have to work very, very hard for something and someone else just gets given it them, it just comes in the post, and they just get it, just a present, and you’ve been trying for 20 years to get it and you know it’s not helpful to hate people that you don’t hardly know and, but you do, you just feel so resentful of them. And even now people who don’t know me that well will say, are you going to have another one, and, you know, I sort of say, oh, no I don’t think so, or, we’ll see, and I want to just wear a t-shirt that says, life is just not that simple for me, I don’t get to choose whether I have another child or not. I can choose to want to have another child but I don’t get to choose if I actually have one and you saying that to me is, reminds me of that, that I am not like everybody else. Life’s just not that easy for me when it comes to this area. And I never say that to people. I never say, will you have another one, unless they’ve brought it up first, that they’re thinking about it, I might say, oh, yeah, are you thinking about it? Because you just don’t know what, what people’s circumstances are.
Mmm. Thanks for sharing that. So how did you feel about your second round of treatment, going into that after your first attempt hadn’t been successful? How did you feel about entering into that for a second time?
[Pause] I was a lot more relaxed. I think a lot of things for me are about knowing what’s happening and knowing what’s coming and even though they give you a flow chart of what’s happening you don’t really know what it’s going to be like and, and because we’d been through it once before I did know what it was going to be like so I was a lot more relaxed about the physical procedures and the timescale and I knew it was going to take 3 months and from that point of view it was fine. As I was saying before you swing backwards and forwards. Some days I thought, I’m just going through the motions here because it’s not going to work, and other times I thought, well, it worked really well last time and we did get a blastocyst and it did impregnate but there was obviously something wrong with it genetically so realistically speaking we did really, really well last time, we did just as well as someone who got pregnant naturally, that doesn’t always stick so at least we’d got that far last time, at least we were successful so I need to be positive because it’s probably going to work, it worked last time. And then you know that for some people it works one time, it doesn’t work another time and you become obsessed with statistics but then statistics don’t mean anything, it doesn’t matter. It wouldn’t matter if IVF was 99% successful because you could still be the 1% and you’re just as likely to be the 1% as anyone else. So I felt, in terms of non-fertility stuff I felt better because I felt in control because I knew what was happening, I knew what was going to happen next. In terms of, would I get pregnant or not it was, it was, I was just backwards and forwards all the time, hopeful, not hopeful. But in a weird way it was a, a really special time.
With me and my husband, it was very special because we were in it together and it was, it was just us and no one else really understood what was going on and we were, you know, striving together for the same thing, for our life and our family and sometimes I used to feel that it was me who really wanted a child and he wasn’t bothered either way really, would like one, but, you know, wouldn’t be devastated if we didn’t have one but sometimes it felt like we were, we were totally together and united and I don’t think, I don’t think men can ever really understand the yearning that women have for a child. They can want a child but it’s not in the same way, you can’t understand the, the depth of it for a woman. Erm, but it was special. We talk about it now, even. Special because it was our fight together, we got through it together.
It is a fight because you’re fighting. You’re fighting an unknown opponent …
… and an opponent you can’t do anything about, you can’t outsmart them and you can’t push harder, you can’t do anything, you’re fighting an invisible opponent, you know, your own body or your own circumstances.
Did you feel that it brought you and your husband closer together in your relationship?
Definitely, whenever anything’s difficult we say, we got through IVF, we can get through anything, and we can, and we have.
Because I know it can tear people apart, people split up all the time from, from infertility because it’s so hard and if you’re not totally supportive of each other, and I know he had to support me more than I had to support him and I did my best to be there for him when he was struggling with the fertility and with other things, I did my best, but I, I was a bit broken at that point. I tried. The second time I was better, I was a lot better, erm, and in between the times I think I was pretty good because I, I’d been through it once and I knew I was going through it again. I can’t really remember to be honest, it all blurs. I remember nights of just crying, you know, nothing in particular had happened, just crying for an hour, and that was all the time, that was a few times a week. You have your up days and your down days.
And it’s hard to remember now, I have to remind myself, I, I was, I mean if you didn’t know what was wrong with me, you would think I was seriously clinically depressed. I probably was depressed, I probably could have done with some treatment but, erm, not a good idea to take antidepressants when you’re trying to get pregnant. But the trauma of it was, was, er, drove me very close to the edge, I think.
Mmm, it’s interesting that you used the word, broken, and then before you were talking about your treatment and you used the word, faulty.
So there’s a bit of an emotional and a physical link with those two, feeling broken and physically feeling faulty.
Emotionally as well.
Yeah. Because the problem is, is that with other things that require you to do something physical, a lot of the time people say, you know, it’s 90% mental and it is, you know, if you’ve got to run a marathon or, I had to lose a lot of weight to have IVF and that was mental, it really was, it took mental strength to do it. And the problem with IVF is that you can’t physically do anything to help so you can have all the mental strength in the world but you can’t direct it to anything, you can’t do anything apart from take your drugs at the right time but you can’t try harder, you can’t work harder, you can’t push yourself just that bit more, you can’t do anything. So your mental strength has to go into not falling apart and, and that was too hard for me, I couldn’t not fall apart, I fell apart all the time and had to keep putting myself back together or being put back together and then you, sort of, get back up and you carry on and then you fall apart again a couple of days later [sighs].
So on the second round how did you feel when you realised that second round that you, that it had been successful? I mean, did you, presumably you had a pregnancy test?
I, I knew I was pregnant, I knew the day after the embryo was put back in, but I knew the same thing the last time.
I knew I was pregnant so the pregnancy test wasn’t a big surprise, I knew I was pregnant.
But I, I wasn’t allowing myself to be happy about it really, I wasn’t, I was happy but I wasn’t getting excited. My friend was here and she was talking about buggies and all sorts of things and, and I said to her, I want to hear these things but I’m not really taking them in because I don’t really think, sometimes I did really think it was going to happen and sometimes I didn’t. You just go, again, you just go backwards and forwards, you can’t, you can’t fix on an emotion, or a, or a, or a feeling about being pregnant, it’s not fixed, you don’t think, right, I’m happy, great, it’s, I’m happy, I’m frightened but it could all go wrong and it probably will and one in three pregnancies, blah, blah, blah, blah, blah, blah, blah. So unfixed I would say is how I felt, unfixed and you’re just waiting, again, you’re just waiting, always waiting. We were waiting for the 7 week scan where you see if there’s a heartbeat, so it was …
How, how did that, well, presumably that was successful. How did you feel and respond when you went to the 7 week scan?
I remember going for the appointment and, erm, she asked me my name and I started crying.
Because I was so scared that it wasn’t going to be OK and I was trying, just trying to keep it together and I’d sat in the waiting room again, the bloody waiting room and then I made it into the room and she asked me my name and I was like, oh, …, crying and then she did the scan and there was a heartbeat and, and you, kind of, think, well, it’s still not all OK, you know, but I kind of knew at that point that it was going to be OK. But when we left we, we both felt a bit down really and I think it was because it, it was a shock, when you’ve spent three and a half years thinking that you’re not going to have a child and then you’re suddenly told you are you’ve got to like switch onto another track. You’ve, you’ve got to rearrange everything in your thinking because I think we’d pretty much thought, we’ll have three rounds of IVF and then we’ll give up and then we’ll try and get our heads round the fact that we’re not going to have children but we’re going to give it three goes because we need to give it three goes and I think we were surprised and we were shocked that it was, it was actually going to happen. [Pause] So [sighs] relieved, I felt relieved and shocked.
Happy in a way but I don’t think anyone who’s pregnant is ever really happy because you’re so scared all the time …
… and I know that’s true for everyone who’s had IVF or who hasn’t. You are happy but you’re scared and again you’re trying to get through hurdles, you’re trying to get to the 12 week scan and make sure everything’s OK and then the 20 week scan and then you just want to keep them in until 36 weeks and then you just want to get them out so that you can look after them. So I was happy, I was very happy when I was pregnant, very happy, but scared.
And how do you feel now that you had a successful pregnancy and you’ve got your baby, who you always wanted?
I feel, erm, complete.
That’s a really good word.
I feel like I’m, I’m where I’m supposed to be. Because for me it was never about a baby, it was about a family.
And now you’ve got your family.
I, I don’t want another child.
You don’t want another child?
If the child just arrived, you know, then that would be fine but I don’t, I don’t want to be that person again, who’s trying to get pregnant, who desperately wants another child and can’t get pregnant and has to go for IVF and is always thinking about it all the time, that’s the only thing in your head and all the time because I know it happens, I’ve spoken to people who’ve had a child naturally and then couldn’t get pregnant again and had to have IVF or, and at the moment, like I said before, you, you don’t get to choose to cut your losses when you want a child and you can’t get pregnant but I can choose that now, I can choose to say, one is enough, and I can choose not to go down that road again of wanting another child because I don’t desperately want one, I don’t need to have another child. I might fancy the idea, I might want one, it might be nice for him to have a brother or sister but it’s not this deep longing and feeling of being empty and incomplete anymore and, I, I can choose not to feel that way because I’ve got a child, I’ve got my family and I don’t need to do that to myself or my family. So, yeah, I can say, I don’t want another child, in that it’s not going to eat me up inside if I don’t have another child.
What does that feel like?
It’s a relief, it’s just relief. I don’t have to be that person again. Because I think if I did, if we did say, you know, we would quite like another child, and we have a frozen embryo and then I got to the point of saying, right, yeah, yeah, you know, we can afford it and we would quite like another child, and then I went to that place, sat in that waiting room and had that embryo implanted and it didn’t work I would be that person again.
And you don’t want to be that person.
I don’t want to be that person again.
Too painful for you.
I, I think, I think I came very close to losing myself.
Really close and when I got pregnant I felt like I was myself again. I felt like I was me again and, you know, and having a baby wasn’t easy, especially the early days, it was really, really hard and he’s turned a corner lately and, and I feel like myself again now, I feel normal and happy and myself. And yeah, it would be nice for him to have a brother or sister but I don’t think it’s worth him losing his mum for a year or so for, I, I don’t want him to see that, don’t want, don’t want him to watch me be in pain when I can prevent it.
Yeah, and you’re complete anyway so …
Yeah, I am, I really am.
That’s great. Thanks for sharing, I really appreciate that. We’ll stop there if that’s OK with you.