‘Why was a baby not happening for me?’

In my late teens, like many women, I had a pregnancy scare. I thought I was going to become another 'young mum' statistic. Instead, what transpired was a diagnosis of Polycystic Ovarian Syndrome (PCOS) and a frank conversation with the physician.

Best case, they said, you will barely notice it exists, if at all. Worst case, you will struggle to conceive, if at all. Globally, 8-13 per cent of women of reproductive age are affected by PCOS, whilst 70 per cent of females remain undiagnosed. Those with severe cases will experience irregular periods, excess hair across the face and body due to high levels of male hormones, and oily skin coupled with acne. This can be a problem when you are in your teens/twenties, dating, self-conscious and awkward, trying to cover up all your flaws. 

Then there the psychological aspects, intertwining with infertility. PCOS leaves feelings of anxiety, depression. My self-image has always been flawed, rock-bottom. People pointing out my hair growth, even believing I was born a man, didn't help. 

Fast forward to my late 20s and meeting my now husband. He made it clear he wanted children. I was an only child and desperately wanted at least two. I would scroll Facebook and see friends I went to school with announcing their pregnancies and be delighted for them. But I had also tried to close that part of my heart off after receiving my PCOS diagnosis. It always played on my mind: would I have an understanding partner who knew my diagnosis? Even the possibility of infertility can cause strain on a relationship (Bakhtiyar et al., 2019). Infertility affects around 17.5 per cent of the adult population globally, and PCOS is one of the most common causes due to the nature of the diagnosis including anovulation (lack of ovulation which is needed for fertilisation). 

Due to my husband's work in the armed forces, we moved country and decided to start trying for our first child. We found a clinic, undertook the required tests… sperm count, as 9 per cent of males can be the cause of infertility in a couple; underlying health conditions that could harm a foetus; general family history. We started the process straight away. 

Between IUI's (Intrauterine insemination) and negative results with that sinking feeling, the initial excitement of professional help was wearing off. I would see these social media 'challenges' such as 'how long you can hold your pregnant belly in for'. Why couldn't I have that 'you are here' moment? Having suffered in the past with depression, I knew all the signs and symptoms to look out for. Now, being a Psychology MSc student, I felt more self-aware than ever! I told myself, when those feelings of despair creep in, do not pay attention. That small voice in your head telling you that you are failing is lying to you. You are doing everything you can, eating healthily, walking a minimum of two and a half miles each day, trying to distract your brain and focusing on positive activities. This, unfortunately, still does not stop tears and emotions flowing. 

IVF

By the end of summer, we had the discussion with our doctor and underwent the IVF process. As a female, I found it so difficult to comprehend why my body was failing me in the one thing in life I desperately craved. In the interviews carried out by de Castro et al. (2021), they discovered participants felt worthlessness – I completely sympathise with that. Fieldsend and Smith (2020) conducted a qualitative analysis of those who are involuntarily childless in midlife and identified pain and loss being part of their everyday life. The researchers found self-worth and life value were brought into question by their participants, and suggested a prolonged depressive state because of these feelings. I was born for this to be able to happen… why was a baby not happening for me? 

Friends who I had told about the process were rallying around me. They were adamant good things happen to good people, and I was one of the best they knew. So why did it feel like I was being punished? The small voice has days where it feels like it is shouting but I was determined not to let negative thoughts further hinder an already fragile situation. I had enough in my life with the PCOS diagnosis, the bullying at school, and a Borderline Personality Disorder (BPD) diagnosis which taught me resilience no matter how difficult as things seem. 

In fact, my decision to study Psychology stemmed from my BPD diagnosis. I wanted as full an understanding as possible into how the mind works in certain situations. The fertility situation, the emotions I went through… it's certainly worth knowing some of the science! Yet still, I ended up in such a dark stage that I even questioned why my husband was still with me. Why wasn't he off finding someone who could give him what he wanted? 

And then… third cycle, suppression medication taken – positive. My first positive! So it is possible! 

Grief and taboo

We were elated – there was no other word to describe it. I made sure I followed all the advice and guidance, because there was no way, after all I had been through, I was going to cause any unnecessary harm. The day after Valentine's Day, I got into bed and a wave of cold filled me to the point I was shivering but I thought nothing of it. I had a nine week scan the next day and I had miscarried. 

The thought had never occurred to me, considering all I was going through. I thought the hardest part in all of this would be the initial 'getting pregnant'. Yet here I was, falling into a deep pit I felt I would ever be able to get out of. I had just started my MSc. I was working hard, and the thought that I was pushing myself for my unborn child had been spurring me on. Once I had miscarried, my studies were the one thing in my life that I had full control over and I pushed myself that much harder – not just for me, but to keep myself from falling into the black hole.

This whole process has been filled with anxiety and depressive moments, but grief has been a recurring theme too. In my late teens, I had to endure knowing that there was every possibility I would not be able to achieve one of my biggest ambitions in life. That's a lot to put onto a person who has only just left the naiveties of childhood behind. For that to continue into adulthood… to go through processes believing it will help only to find that trauma continues… pushing grief into mourning… that takes its toll. 

In the last year of my criminology in psychology degree, within the contemporary developmental psychology module, we were asked to produce a narrated poster critically evaluating two perspectives/theories of grieving across the lifespan. Everything I had learned doing this assignment came flooding back to me and I tried my hardest to remember the coping mechanisms. It wasn't easy, but I will not forget Kubler-Ross's Grief Cycle or Erikson's Psychosocial Theory in a hurry!

And there's guilt. That study from Castro et al. (2021), and an earlier one from Baram et al., suggests that from 38-45 per cent of those interviewed feel guilt over fertility issues. Experiencing a miscarriage added immense anxiety and feelings of guilt to my existing health issues affecting fertility. Despite being able to carry, the fear of losing the pregnancy led to self-blame and constant 'what if' thoughts. Knowing my partner relied on me to nurture our unborn child intensified my guilt, especially when I couldn't 'provide' as easily as others. This is echoed by both Dr Georgia Witkin and those who support individuals with Endometriosis.

18 years after IVF was introduced to the world, the Center for Reproductive Psychology was opened in San Diego to allow for those suffering the psychological effects of infertility to seek professional intervention. Drs Martha and David Diamond had been having their own difficulties, and with their colleague, Dr Janet Jaffe, they looked to offer professional intervention for those suffering the psychological effects of infertility. In 2017, the APA Monitor wrote about the Center, and how a growing number of psychologists are helping people with reproductive challenges navigate the complicated grief process. And yet, stigma still exists.

Susan Seenan from Infertility Network UK has even said that infertility remains a taboo subject. 'When women are labelled as infertile they feel a failure, because they have let themselves and their partner down. Their basic biological instinct to have a child is kicking in – and at that point everyone seems to have babies, but they can't.' In 2013, BBC health reporter Philippa Roxby spoke with Seenan and wrote about new research showing how women aged 35-45 feel judged for not having had a baby. Even if they plan to have a child, nearly 60 per cent have at some point felt stigmatised for leaving it too late. Around 40 per cent are too embarrassed to talk about fertility, especially with friends and family, often one of the biggest sources of pressure.

Choice, and lack of it

Infertility does not come with a sign above a person's head explaining what they are going through. It is that person you see scrolling through their phone on the bus; the one who makes sure their friends are treated like royalty when they become pregnant; the loud one making jokes. Many of us reach a certain age where we make the decision whether to have children or not. Some of us have always felt destined to be a parent; some who do not feel passionate one way or another; others just know they don't want to have children. These are all our own prerogatives. 

And then there are those who have that decision made for them, whether they like it or not. We need to stop asking 'when are you planning on having children?' or 'isn't it time you thought about having children? Your clock is ticking'. You never know what people are experiencing.

References

Bakhtiyar, K., Beiranvand, R., Ardalan, A. et al. An investigation of the effects of infertility on Women's quality of life: a case-control study. BMC Women's Health 19, 114 (2019). 

Baram, D., Tourtelot, E., Muechler, E., & Huang, K.-E. (1988). Psychosocial adjustment following unsuccessful in vitro fertilization. Journal of Psychosomatic Obstetrics & Gynecology, 9(3), 181–190. 

de Castro, M. H. M., Mendonça, C. R., Noll, M., de Abreu Tacon, F. S., & do Amaral, W. N. (2021). Psychosocial Aspects of Gestational Grief in Women Undergoing Infertility Treatment: A Systematic Review of Qualitative and Quantitative Evidence. International Journal of Environmental Research and Public Health, 18(24), 13143. 

Fieldsend, M., & Smith, J. A. (2020). 'Either stay grieving, or deal with it': the psychological impact of involuntary childlessness for women living in midlife. Human Reproduction, 35(4), 876–885.