Repost / Babies Everywhere, But Not For Us

Originally published in the NYT here 

 

KABUL, Afghanistan — It was about a month ago that I realized I may never have children.

I was sitting next to my husband at a small in vitro fertilization clinic in Istanbul, the kind entirely decorated in different shades of cream. We had already had three failed I.V.F. cycles, but we were hopeful and happy. In Afghanistan, where we live, there is no I.V.F., and with our modest incomes it seemed like a blessing to have affordable reproductive treatments a five-hour flight away. Between injections and consultations, we wandered by the Bosporus, holding hands and tearing apart fish sandwiches, as though on vacation.

The doctor, a handsome man with a shock of white hair, walked up as I was thumbing through one of the few books in the waiting room, “Infant Massage: A Guide for Loving Parents.” I expected to be ushered into the surgical quarters for the final stage of I.V.F. treatment: Since their extraction three days earlier, my eggs, fertilized by my husband’s sperm, should have divided into cells ready for transfer back into my body. The doctor’s solemn greeting told me instead that in a petri dish somewhere in that clinic, my eggs had refused to do anything at all.

More than two years earlier, my husband and I had sat in our high-walled garden in Kabul, fingers entwined, and decided that we wanted children. It had not been an unqualified yes. We had debated if it would mean too fast an exit from our new home in Afghanistan: My husband was a journalist, as was I, sporadically; the story was fresh, and other work hard to come by. We often traveled together and would ruminate over how a child could fit into our lives and how much of what we loved we would have to give up.

But the idea of a baby took root, irreversibly. Children are plentiful in Afghanistan — the average birthrate is about five per woman — and in this country mired in war, they have repeatedly stunned me with their ability to conjure joy. I have marveled at a giddy 3-year-old unaware of the enormity that her leg had been lost to shrapnel and at two teenage girls in a ramshackle school who said they wanted to study astrophysics.

We named our baby — Ramona, for a girl; Billy, for a boy — and when Afghans asked me, as they almost always ask, if I had children, I would smile and say, hopefully this year. They would nod in approval and respond, Inshallah.

During two years of increasingly invasive medical intervention, I saw not failure, only challenges. Reproductive medication like metformin and clomid did not work; neither did timed sex, two surgeries, two intrauterine inseminations and three rounds of I.V.F., for which we had to fly to another country. As we dug into our savings, spending $10,000, then $20,000, then more, I became increasingly dedicated. I gave up coffee, declined alcohol, submitted to acupuncture and took daily a range of vitamins sold on websites picturing babies wrapped up as presents.

To be infertile in Afghanistan has been difficult. One intrauterine insemination, which we tried before I.V.F., was canceled when the most reputable clinic in Kabul forgot to order a catheter. Looking sick with guilt, the gynecologist finally broke the news to us after we had waited three hours at the clinic. I howled in the waiting room, clutching my husband, as the heads of pregnant Afghan women and their husbands bowed around us, uncomfortable with seeing a married couple touch in public.

But at least in Afghanistan, we earned enough and lived cheaply enough to afford treatment in Turkey. Had we lived elsewhere — like in my native Australia — we might have gone into debt for it.

I.V.F. is a remarkable medical innovation, responsible for more than five million babies since it was pioneered in the late 1970s. But its success has been oversold, and in my experience the professionals involved rarely articulated the high probability of failure. This is perhaps out of a benevolent desire to maintain patients’ hopes. It is also likely because of the mass commercialization of I.V.F. Rather than being told the truth, I was sold a fertility fantasy.

Our I.V.F. clinic in Istanbul had said our chances of pregnancy were good. I began treatment at 36, and fertility typically declines at that age, though not as much as is popularly thought: According to at least three recent studies, women ages 35 to 40 have around an 80 percent chance of getting pregnant naturally.

Everyone I knew seemed able to relay an I.V.F. success story. And we were healthy, nonsmokers. We asked about living in Afghanistan as foreigners; our doctor said stress has never been proved to inhibit pregnancy. He told us that I.V.F. might not work the first time, but that it often did on subsequent attempts.

What he never told us was that for most women, I.V.F. fails more often than it succeeds.

For such a common medical procedure, statistics are hard to find, difficult to understand and flawed, sometimes even excluding women with the poorest prognoses. One of the more comprehensive reports I found was from the Australia and New Zealand Assisted Reproduction Database. In 2014, it found, I.V.F. cycles in which women used their own eggs had only a 20 percent chance of resulting in the birth of a baby. In my age bracket, 35 to 39, there was a less than 18 percent chance of success. For women between 40 and 44, the odds were under 7 percent.

I.V.F. clinics and associations often claim higher, misleading figures. They publish results for I.V.F. involving donor eggs and surrogates, which often have better outcomes, particularly for older women; or pregnancy rates, rather than birthrates; or figures based on embryo transfers, ignoring that some women who start I.V.F. cycles — myself included — may not have any suitable embryos to transfer.

In any case, statistics are just averages, and we relied on our doctor to be our best resource. After he broke the news of the fourth I.V.F. failure, simmering from grief, I dismissed his usual anecdotes of past miracles. I demanded answers, facts. When pressed, he delivered them: From our initial tests, some nine months earlier, he had estimated we had only a 10 percent chance of having a baby through I.V.F.

“And now?” I asked, my voice rising.

“Less than 10 percent,” he said, peering at postcard-size scans of my womb — misshapen triangles of dark static — neatly clipped to a light green folder.

“Five percent? Seven percent?” I shrieked.

“A slim chance.”

When to stop trying is a formidable decision to make. In the past month, I have grieved for a child who has never existed, and then, remembering I have a friend who had a stillbirth, have felt ashamed of my self-indulgence. I also have thought of the Afghan woman I met who, unable to have children, sat silent over the evening meal as her family discussed how long her husband should wait until he took a second wife. I may be infertile, but I am fortunate, and remain deluded: Our chances keep getting thinner, but the sliver of possibility still seduces me.

4 Responses

  • A very potent post. My first baby was born still at full term. Years later, after my 2 boys were born I donated my eggs to someone very close to me to go through IVF (in Canada where I live it is a donation). 2 people have gone through IVF in my family, it can be a long and heartbreaking road. Peace and love to you.

  • I live in France and my story was quite similiar to yours except for the fact that here, artificial insemination and IVF are covered under social security. The first 5 attemps for either procedure are FREE for married couples and in my case, non-smokers. The doctors are very up front with your chances. They told me from the get go ( age 36) that I had a less than 10% chance of conceiving. All the doctors I talked to were not very positve or supportive. When the 1st, 2nd and 3rd treatment failed the staff tried to gently discourage me from continuing. I was crazed with the idea of having a child, you know how it consumes you. I went to the 4th round even though my husband was shattered after 3 years of it. The IVF was cancelled due to poor stim results but so as not to “waste” the drugs they decided to go ahead and do a A.I., and it took. The staff did not rejoice with us, they were very wary and turned me over to an OB/GYN who continued to discourage us from getting our hopes up that the pregnancy would stick. It did. I gave birth to a healthy boy and got pregnant naturally 16 months later. People tell me I’m too fusional with my kids, that I’m wasting my talents by being a SAHM. I tell them they had it too easy, but they still don’t get it My heart goes out to you.

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