Sound bites from the letter we received from the consultant following the conference call we’d had on the 19th January 2010.
‘We reviewed the results of the tests you had...irregularity of the uterine cavity due to a calcified area in the left side of the fundus…both tubes normal…ovaries of normal size but only contained a total of 5 antral follicales…ovarian assessment report showed egg retrieval score of 6 out of 20…only a fair chance of obtaining 5 eggs or more through ovarian stimulation…this score is below average for your age group…normal female karyotype…recommended hysteroscopy…in view of reduced ovarian reserve I’ve recommended IVF treatment.’
The letter confirmed the telephone conversation, only it was like an echo: IVF, ONLY A FAIR CHANCE, REDUCED OVARIAN RESERVE, BELOW AVERGE. Splintered words that brought with them a strange reality and a painful truth. At 35 years old my body was deemed a wreck and my age was suddenly against me.
We re-read the letter a hundred times. Chris smoked a large joint. I tried not to cry and our wonderful friend Trish helped us to make sense of it all. To me it made zero sense, the biggest shocks being the confirmation of scar tissue (that Dr B had noted and Mr L had ignored) low fertility count and recommended IVF procedure. We whispered in tight breathes that we’d wait for the dust to settle before making any decisions about what to do. But I was now aware of my fu*king reduced ovarian reserve and I couldn’t leave that angry thought alone.
When you receive fertility news of that calibre (having thought you were fertility wise A.OK) you begin to question the god forsaken medical profession who previously told you that you’re fine. You begin to pick through your memory with a certain paranoid urgency and everything you thought was right begins to twist on its axis. And then comes the ultimatum, you can allow the shit to hit the fan, or you can try and fight it. I wanted to know what the odds were for having a family and I became like a dog with a bone searching out the truth.
At best I knew I didn’t want to return to the UK. I didn’t believe the clinic there had my best interests at heart, so within a week I contacted the fertility clinic (recommended to me at Christmas) in Johannesburg, South Africa. I corresponded with one of the directors whose address appeared on their website and he replied immediately:-
1. Very definitely, the scar tissue in your uterus would need to be removed prior to the tempting any method of conceiving. One of the methods of evaluating the scarring is by doing an x-ray called an HSG. This will also allow us to evaluate the condition of your tubes. This information may influence the decision about how best to help you conceive.
2. The OAR is a calculated number based on other very important information - the FSH, the AMH and the antral follicle count. All of these could influence the decision-making regarding the method of conception. It would be of value to have these individual results in order to pass an opinion about the OAR.
3. The fact that you have spotting may be due either to your hormone profile or the fact that the lining of the womb has been compromised by the scar.
4. I think the information you have been given is very important and needs to be put into perspective for you to make the appropriate decisions.
I was impressed, but I emailed my UK GP and a nurse friend for further advice before committing. I flippantly googled ‘fertility clinic Kampala’ and was astonished to find there was one in the city run by a well respected Ugandan, Dr Sali. With all the facts finally available Chris and I decided to seek help in South Africa. I booked the appointment, the flights and the accommodation – a backpacker’s in Johannesburg. We would be gone for 2 weeks but before leaving I visited the Women’s Fertility Clinic in Kampala, I was plain curious and too nosey not to.
Dr Sali spoke softly and was sensitive to my history and understood the quest I had found myself on. He’d worked for several years in the UAE followed by a year in the UK at Ipswich hospital (where I was born and where I had given birth to Ella). His modern clinic could provide much of what London had advised me to have, but I explained we’d arranged a visit to SA. He asked where, I said Johannesburg. He asked if the clinic was Vitalab, it was. Ironically he’d been there the week before and spoke highly of the surgeons, the facilities and the treatments. If the statistical evidence was anything to go by he was convinced I was in the right hands.
We flew to Johannesburg on the 30th March (a date that is now iconic 12 months on). I had a simple ultrasound that immediately picked up the scar tissue - the consultant astounded I hadn’t been scanned after the infection I’d had after loosing Ella, let alone post miscarriage. During the second day of my period blood was taken to check my FSH & LMH levels and blood was sucked from Chris. We had a few days free so hired a tiny car and bolted to the coast in an attempt to clear our heads. Having returned to the city Chris gave a sperm sample and I had the suggested operation, a hysteroscopy and laparoscopy. I spent the following day in bed staring at the ceiling suddenly wondering what the hell we were doing.
48hrs after the surgery we had a consultation. Chris was golden balls, his semen and blood top notch whereas my blood results were rubbish and my ovaries were of ‘diminished volume and slightly crenated’ (the photos displayed what looked like pickled eggs). The hysteroscopy confirmed grade II Ashermans syndrome and retained products of conception had been removed during the operation. The laparoscopy showed adhesions of the right fallopian tube followed by the consultant’s comment, ‘the pregnancy rate in women in these circumstances is less than those with normal hormones and ovaries’.
The conclusion was similar to that we had received from London two months earlier. We were advised to return for a follow up in one month’s time which was something we hadn’t expected or factored into the costing of things. I felt sick, surely enough had been done, but no, a post operative check was absolutely necessary. The next day the stitches were removed from my tummy button, pubic line and from below my abdomen. Knackered we flew to Uganda that night - both of us beaten, bruised and feeling utterly helpless.
I had been given a course of Estrofem and Provra and once finished there was a tiny bit of spotting followed by a normal period. That month we attempted to tick on with life, Chris spent time in Murchison and I worked from home. On May 16th we returned to Johannesburg for a 36hr visit and prepared ourselves for the consultation the next day. I was scanned, whereupon the consultant confirmed I would require further surgery to remove the final bit of scar tissue in order to obtain a healthy uterus. I held my head in my hands and cried, it felt like I was on a one way mission of self destruct. We were due to return to Uganda that night until Chris made the decision that if they could operate the following morning we would stay, they could and he changed our flight by 24hrs.
I underwent a second hysteroscopy. Afterwards the surgeon, Dr Gobetz, told us that everything had gone well and the remaining scar tissue had been removed however during the procedure he’d ‘perforated the fundus of the uterus’. WHAT THE F.UCK!? This meant if I were to become pregnant again I would require a c-section as the pressure on the uterus at 38+ weeks would be too much. Based on everything we’d gone through Chris said a c-section was a small price to pay...r.e.a.l.l.y?! We tentatively asked if I had to return, but he suggested we got on with living and if I wasn’t pregnant within 3-4 months he advised IVF. I asked if he’d made my uterus golden lined and he squeezed my hand and told me yes. We prepared to fly that night, unsure of when we’d be back.
Another course of drugs, but this time I experienced a big bleed similar to having your torso sawn in two and immediately after finishing the course I had a heavy period. Physically my body seemed to be purging itself of the recent surgery coupled with the last eighteen months of pain. A normal life was difficult to obtain with Chris often being away and the thought of sex at a certain time each month began to take its toll. When you feel the finger of infertility pointing at you the pressure starts to rise and we both felt it. Finally I decided that the time frame we’d given ourselves, October, was too long a wait. The hurt, the damage, the memories and the childless days were crippling and we began to explore all possible options…IVF, adoption and surrogacy were spoken about with intent.
Eventually we decided to return to SA and Chris arranged an appointment in August for us to discuss the clinic’s IVF programme. I was to book flights but said I’d do them once I got my period (which was tirelessly relevant to the appointment). In the meantime I drove to Nairobi with a girlfriend advising her I had to be home the following Friday. Having been told at my age and with my ovaries there wasn’t a snowball in hell’s chance of being able to conceive naturally I wanted to make sure, and with my period back to some semblance of normality I put everything on the line that one last time. I was chasing the wisp of a dream and I knew it. We arrived home that Friday but I could only guess - was my body ovulating? Was it able to catch a shooting star? Would Chris be aware? Could love conquer all?
Looking back on that weekend neither Chris or I had any idea about anything and to be honest I didn’t hold out much hope for the hunch, I just took a chance. So we got drunk on cheap wine and later celebrated the news that my nephew, Rory, had been born into this often unforgiving, but loving world. We slowly looked forwards and began to get ready for the trip to SA in anticipation of getting more answers. We were also realistic and knew there may be problems, that this next journey could be fraught with impossible expense, heartache and failure. I just needed to book the flight, I just needed to get my period…..
It was at 11:45pm on the night of August 9th that I weed into a shot glass and did a pregnancy test. I was watching The Blind Side, but in my subconscious I was curious about my period being late, something that hadn’t bothered me one dot during the last 13 months and so I hit pause, wandered into the kitchen, grabbed the glass, the little stick and waited. I put the glass on the bedside table and left the room. Five minutes later I crept back, picked up the glass and stared at the stick holding it up high to the light - it had a prominent blue line straight across the front and I slid to the floor in complete disbelief. Chris was in Murchison and his phone was off, but it was ok, I just held onto the moment and absorbed the feeling of hope. I rang him early the next day and told him to sit where the view was beautiful. He was sat overlooking the Nile and that was the moment I told him he was going to be a father, that we were going to be living the dream.
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Life can be ruthless. She throws painful curve balls regardless of who you are and there is often no way of escaping. The journey Chris and I found ourselves on the night we lost our precious Ella has been unforgiving, heart breaking and soul searching. There have been days when I’ve raged against a machine that’s spat me out further than I could fly. Words have helped, words have hindered. Physically there have been times when all but giving up has been the only silver lining in a world of darkness and anguish. Mentally friends and family have provided love and support and it’s that, combined with a fierce marriage that’s skidded along the corridors of hope and courage, which has seen Chris and I walk down the other side of the mountain to face a future (whist never forgetting the past) that we never thought possible.
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Thank you for reading, it’s been a long time coming but it’s a journey I needed to tell…..and if there's something to be grasped from all the words, please never give up. Not on anything. Xx
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