The strange thing about trauma is the little things you remember. I can still recall the burble of BBC Breakfast and the numbered ticket I clutched in my hand. A six-year-old boy whose high-pitched screams alerted hospital staff to a McDonald's balloon jammed precariously between two plastic seats. The gentle sobs coming from examination room B and the coolness of gel between my legs.
Every day, countless women walk into ultrasound rooms across the country and, with a dampness in their gusset, walk out harbouring an empty feeling, deep inside, where a heartbeat should be. The six-year-old is still running riot, the television continues to burble and yet, in the midst of all the everyday chaos, something has been irrevocably lost. The waiting room is still the same, but your compass has imperceptibly shifted – quietly, acutely, behind a closed door. Retracing your steps past the pregnancy bumps and foetal-development charts on that lonely walk to the elevator, anguish distorts into a strange kind of shame.
My story doesn’t begin with a singular experience of miscarriage at my local early-pregnancy clinic – that’s not how infertility works. Like my scattered memories, this one event, like a random scrap of quilting fabric, constitutes only a tiny piece of an ever-expanding patchwork of loss, longing – and intermittent hope. Over the last four years, my desire to become a mother has coaxed me, incrementally, into a strange kind of no-man’s land, concertinaing time. In 2015, ovulation apps were swapped for hormone injections and a poorly graded embryo in a petri dish. Last year, my “non-viable” pregnancy ended in a surgically managed miscarriage. Science doesn’t always have all the answers – this much, I’ve learnt. Uncertainty breeds anxiety; prescribed fertility hormones intensify the lows.
Yet, despite its pervasiveness, we rarely talk about infertility in relation to long-term psychological wellbeing – and when we do, the conversation is too-often hijacked by scaremongering headlines challenging the detached “ethics” of assisted reproductive technology. As VICE’s wellness website, Tonic, pointed out last year, “fertility treatments take a toll on mental health.” In the UK alone, between 1991 and 2016, there have been over 1,100,000 IVF treatment cycles in UK licensed clinics. And yet, despite the numbers, when it comes to engaging with infertility – and, most importantly, treating it – mental health isn’t always an instinctive focus of concern.
Over the years, I have watched friends traverse smoother paths, met their new partners and watched households expand from three, to four, to five. It never gets easier
“People can feel incredibly socially isolated,” Catherine Hill, communications manager at Fertility Network UK, tells me. We’re discussing the everyday psychological impact that “trying” to conceive can have. “The effect of fertility problems on a person’s mental health are severely underestimated,” she says. “Not being able to have a baby commonly triggers a life crisis in both women and men. It impacts on so many different aspects of how you live and can be absolutely devastating.”
In 2016, Fertility Network UK uncovered just how devastating living in limbo can be. Their survey of over 800 respondents found that 90 per cent felt depressed and, shockingly, 42 per cent experienced suicidal feelings as a result of fertility problems and/or treatment. When the charity published their findings, they warned how it painted a “stark, distressing picture of what it is like to experience fertility problems in this country". Key recommendations at the time called for greater education among GPs and funded counselling to support those experiencing high levels of distress.
When I underwent IVF in 2015, I was able to access unlimited counselling via the NHS – therapeutic sessions that, at particular points during my gruelling cycle, offered me a lifeline amid the stinging needles, bruised thighs and yo-yo moods. I was one of the lucky ones. Mental-health support is mandatory if you’re going through fertility treatment, Hill tells me, but that can be just one session, something she says can be “far from enough". And, although the government last week announced increased funding to care for the mental health of new and expectant mothers, it is worth highlighting that those struggling to conceive are still falling between two stools.
With NHS budgets being squeezed, Hill tells me that “the counselling that’s needed isn’t in place as it should be". The same could be said for equitable fertility provision in England: last year, it was reported that 13 areas of England had either restricted or completely halted IVF treatment to couples trying to conceive. “We’re fighting at the moment to enable women and men to be able to access IVF in England – it’s very much a postcode lottery,” says Hill. With IVF rationing spurring increasing numbers of vulnerable would-be parents to overseas clinics, lured by bogus success rates (some as high as 98 per cent), now is arguably the time to demand greater protections for those seeking invasive treatment without the necessary support to guide them along the right path.
In the absence of fairness and cohesion, it is essential that we coax the conversation away from coarse headlines and towards a holistic, nuanced understanding of what that much-used acronym TTC (for the uninitiated, "trying to conceive") really means. The psychological strain felt by those seeking fertility assistance is emotional, social and financial, Fertility Network UK underline – and the practical and existential questions raised by such assistance can be hugely overwhelming to tackle on your own. We often talk of sadness in regards to infertility, but we rarely talk about the worry, the anxiety and the frustration; the strain on existing relationships; and the devastating social alienation it can cause.
Infertility isn’t restricted to the confines of an NHS waiting room – it spills out into everyday life, defying hospital walls. Over the years, I have watched friends traverse smoother paths, met their new partners and watched households expand from three, to four, to five. It never gets easier – and perhaps that’s my point. The truth isn’t always what you permit it to be; what appears is seldom what is. Appearances can be deceptive – and I should know. Days after my miscarriage, I placed my hand on my friend’s swelling bump and smiled.