Barren Mare

Allow me to clarify

The flat selling saga finally resolved today after a series of twists too bizarre to go into. We ended up having to compromise on the price, but it's worth it, I think, to get it sold.  Now I can move on and think about nesting in the new place.

I think I should probably clarify something I wrote in my last post, since the use of the word "casually" seems to have confused things somewhat. I was not for one minute intending to suggest anyone approaches a decision to terminate a pregnancy that way. Rather, I was responding to something which I picked up from an earlier comment.  Initially, I decided I wasn't going to get into this, but I think it did get under my skin a little bit, and it later crept out.

The commenter expressed a view that he or she hoped I was doing the nuchal "just so I could be prepared to do the best for the baby from the very start, no matter what". And then followed that with a link to a newspaper article, the gist of which is how, due to prevailing attitudes nowadays, prenatal testing seems to ends up making your right to abort your disabled child more about a duty to abort, and why is it that society thinks that way.

Without going into that particular debate, I have to say the views expressed bothered me on a number of levels. Firstly, there is the use of the word "just", the very sound of it which makes my hackles rise. I think anyone who has tangled with infertility comes away with a pathological loathing of that word, and the way it tends to be thrown around with such maddeningly casual frequency. As in, just relax. Just do IVF. Just adopt.  Just accept and be grateful for what you already have. Just so you can be prepared to do your best for the baby no matter what.   

The thing that I so particularly hate about the word "just" is that in that sort of context, the speaker is- consciously or not- trying to reduce something- an experience, a conflict, a crisis- into a simplistic equation. To distill it down, to package it up into a neat box, to sweep it away. Problem eliminated, just like that, ta-da! Complication banished, why go on about it? 

And for the person on the receiving end, who is invariably dealing with something confusing or painful or distressing or difficult; well, it's the verbal equivalent of a slap in the face. So for someone to suggest to me that I should be doing prenatal testing "just" for one reason and one reason alone was one more incident in the long "just" parade.

Secondly, while I think it inappropriate to pass judgment on anyone's decision to test or not to test, I find it even more outrageous to infer that testing is to identify the presence of Down's syndrome with the underlying aim of seeking a termination in those cases. Now, maybe statistically, in the majority of cases, that is in fact what happens. I don't know- I have no information about that. But in any event, I've never believed in signing up for the status quo. A statistic doesn't apply until you've actually gone through that situation. For the record, I had given it a lot of thought, and I had grave doubts as to whether I would even go for an amnio in the event of a bad result- because in my heart I did feel that while I was prepared to accept things (no matter what), I was not prepared to take any risk, however small, of losing this baby.

As it happens, I've luckily been spared some of that angst, since I got the call today. The blood work results having come in, the outcome is that we are low risk- so much so that I feel very comfortable about not doing any further invasive testing.

Now, I'm extremely grateful for that relative peace of mind.  But I'm also sort of glad that the whole experience did make me question certain things and did cause me to ponder the possibility of difficult choices, some of which still may lie ahead. Because sometimes dicing with the scary painful stuff, even in your own mind and heart, does leave you better prepared for what lies ahead- far more so than "just" could ever imagine.

Coulda shoulda woulda

It seems that sometime during my transit back to ye olde Caledonia, a debate has sprung up in certain quarters as to the extent to which my blog is a "trainwreck". Huh. Interesting. I always kind of figured that in the big scheme of things, my little story was more akin to, say, a minor bicycle accident.

Basically, in the annals of infertility blogging, there is really not much new here to excite a whole lot of discussion. I mean, whatever. I get it. There are people who don't get it. They don't really see why infertiles feel the need to do all this unseemly thrashing and whining. Fine. You know, I'm not immune to the idea that the world might contain opposing view points- for example, I don't see why anybody would willing ingest pork scratchings, but I saw some on sale at the mega mall of death when I was home, so there must be some prospective purchasers out there.

But you see, the difference is that I don't hunt out Pork Scratching bloggers and then post links making deliberately nasty comments about their culinary preferences- especially since I sort of figure who died and made me the Chef God.

So, I don't really wish to add fuel to the fire, since let's face it, it's not a particularly interesting conflagration. However, I do feel perhaps if I ought to take this opportunity to go on record about a couple items. Just to ensure, as much as possible, that no one is confused in their tiny minds as a result of me Not. Spelling. Things. Out.

Firstly-stop the presses! E. and I have not actually "broken up." Things are not completely settled by a long way, and the outcome may be still be somewhat murky in places. That's the interesting thing about relationships, which are generally not static organisms sitting prettily on the coffee table for the neighbours to admire. But at this point we're still working on it, so let's not break out the violins quite yet on my behalf, thanks.

Secondly, I really take exception to this notion that I was somehow the instigator of all our fertility treatment plans, and meanwhile, E. was secretly sitting back trying to figure out how to break up with me. As if it were all up to me. As if spending all that money and energy was somehow just a neat ploy to keep me happy. Well, golly gee whiz, call me crazy but embarking on a course of ruinously expensive medical treatment involving both parties' time and effort, the outcome of which may be a pregnancy and the birth of a child is a pretty fucking complicated way of extracting oneself from a relationship, no?

Thirdly, I'm sure glad some folks were able to detect all these prior warning signs about E'.s possible prior aversion to parenthood. Oooh, if only I could have your handy psychic powers around at all times- how much less fraught with life would be! Actually, what I suggest is to maybe try reading the fucking backstory about exactly why we didn't live together "full time" in the traditional sense, before making all sorts of snap judgments about whether or not that was some sort of "warning sign" for me to discover, and whether or not anything was indicative of well...anything.

Listen, I can see where people are coming from. I understand it's probably real easy to look in from the outside and draw inferences, especially if that's not how you would have chosen to handle things. However, despite what others may decide to interpret about me, given the main subject matter of this blog, I'm not a total moron with my head up my vaginal canal.

What I will say is that life is sometimes complicated, and occasionally you end up having to do the best with what you have, even if it's not an ideal solution. And that's exactly what we were doing at that time. We. As in he and I and the mutual agreement we reached together about how we wanted to make our relationship function in our particular set of circumstances. Hell, I'm sorry if it doesn't meet with someone's personal approval on the Big Checklist of how people should arrange their lives. But frankly, I never was much into other people's checklists.

Lastly, notwithstanding all that, perhaps E. did conceal his intentions, and I just simply had the blinders on. But I don't think so. Because if nothing else, last I checked, it took two people to make an embryo during IVF treatment. It certainly took two of us to sign all the endless reams of consent forms.

And of course, I was unconscious at the time, but I didn't get the impression there was anybody in the clinic holding a gun to his head when it came time for him to do his bit on retrieval day. Probably because fire arms in the wank room would be considered a major passionkiller.

The bottom line? We made the decision together to do IVF. Once we'd done it, we realised there were certain issues that we needed to look at afresh and to address. Did the existence of those issues mean we shouldn't have done it at all? Would we feel differently about everything if it had worked? Um, yeah, maybe. Or not. Who knows. That's the thing about the benefits of hindsight and speculation about what might have been- those lovely gifts come after the fact, not before.

Finally, I think I made it explicitly clear on more than one occasion that I myself was extremely ambivalent in many ways about further treatment, and that living child free was absolutely a viable option for me. In fact, I was well on my way to exploring that option, and probably coming to a resolution on that front at some point when we got sidetracked with other problems. So I find it somewhat laughable to have the accusation leveled at me, of all people, that I am obsessed beyond all measure about pregnancy and having a child.

I think that about covers it. I have a sudden craving for pork scratchings.

The trick is to keep breathing

Oh, hell. Clearly, the mammoth pile of poo that is my life at present was not considered by high or stinky enough by yon Powers that Be, because another calamity has befallen the House of Mare.

Or should I say, rather, the House of Mare's Parents. My sweet father, who is prone to the occasional goofy pratfall, fell off a ladder and broke his foot. This may not sound like such a big deal, but it's quite a bad break, and will require some intricate surgery to mend. He'll be on crutches for at least three months, and while he may regain normal use after about six months, he may always be a bit...lurchy in future. In any event, any planning of my much longed-for visit over the holidays will now need to put on hold for the time being; at least until after the surgery, and the visit itself may get pushed back some months. Considering I have seen my parents for a grand total of four days in the past year, I am not exactly filled with the joys at this latest turn of events.

All of this makes scream internally: what the fucking fuck? From whence came this black cloud of doom dogging my every step?

I like to think that I possess a certain amount of resilience in the face of adversity; that I can, most of the time, pick myself up after a right hook to the mental jaw and carry on with at least of modicum of optimism. But lately, it's all beginning to seem like...well... a bit much. It feels like the Universe has decided to take umbrage to my plucky attitude toward life, and is therefore dishing out extra large portions of super spicy crapola on toast. Just to show me who is the boss.

People often say that the universe/fates/God/Yahweh/the Three Blind Mice will never give you more than you can handle. I've now come to the view that this is the latest piece of bullcrap to throw onto the Bonfire of the Platitudes. I mean, how do you define "handle"? At the moment I am getting out of bed in the morning, washing myself, going to work, eating food, and sleeping. But to tell you the truth, much of the time, I am a husk. I am going through the motions. I don't mean that in a self-pitying sort of way- it's a normal reaction to recent events, which have been both extraordinarily painful and largely out of my control.

Does that mean that what I am doing is "handling" it? Because I'd actually call it "surviving", which is not at all the same thing. People can survive a great deal; whether that means any of it is remotely bearable, in any real sense, is an entirely different matter.

I know that eventually this too will pass; that one day I will wake up and give the Universe the finger, and the response will be a casual shrug at my insolence rather than another plague of locusts on my doorstep. But before I get to that point, there is a very real risk that much of what I have known, loved, fought and worked for over the years will be entirely swept away.

The only way I can even begin to "handle" that prospect is to keep breathing: in, out, in, out, in, out.

I am the horse

I like my emotional upheavals to be brisk and snappy in their resolution, so I am pleased to note that I appear to have moved on to the next step. If we were to apply a Kubler-Ross model to my current emotional roadmap, I think I would now fall firmly into the "Angry" bracket. (Incidentally, I notice there is no bracket set aside in that model for the "Swilling Booze and Eating Cake while Lying on the sofa watching Crap Telly". Which, as any sensible infertile person knows, is a key stage in the grief process.)

Harumph. Yes. Having dispensed with the floor-crying for the time being, I find myself in a state of rabid pissiness, a sort of volcanic irritation with the world. It's to be expected, I suppose- when the universe sticks its tongue out at you saying "Neener neener neener!", a little anger is normal. I suspect my annoyance with the latest turn of events is on a grand scale, but it's the minor things that bugging me. For example, who was the fuckwit who left the bag of rubbish outside the door of the flats, so the foxes and other urban vermin could come and strew it everywhere in the middle of the night? Thanks, jerkwad. And you there, the person in the queue behind me. Yeah, you. Do you have to stand RIGHT BEHIND me, breathing your fumes over my shoulder, pressing the wire shopping basket into my lower back? This is my dance space, asshole, that is your dance space. Back the fuck off, Jack.

That kind of thing.

Plus, it doesn't help that subsequent to my recent IVF shipwreck, I have been subjected to more assvice than a clamped buttock. What I want to know is: when did people become so emotionally backwards? Why is it that everyone seems to think the correct response is to offer up endless unsolicited solutions? Whatever happened to a good old fashioned, "I'm sorry- would a soothing cup of tea help?"

Disclaimer: I should stress that I am not referring, in this post, to fellow bloggers and kind friends. I have had some preliminary solution-oriented discussions with a few people, much of it at my instigation. To a woman, everyone has been unstintingly helpful, supportive and unassuming. For which again, my thanks. No, rather I am referring to the insta-platitude dished out in a "careless shoot from the hip while shooting off the mouth" kind of comments from the seemingly oblivious hoards around me.

For example:

"Oh well, at least you can go on holiday now and drink lots of booze.". Why, yes. Yes, we can, and indeed we plan on doing just that very soon. I'm not stupid, I know that a holiday with the prospect of copious amounts of doing nothing at all while around drinking wine is a definite plus. But while I am grateful that we are able to have a nice break, the main reason we're taking a vacation is because we both feel like we have been dragged backwards though a hedge of emotional and psychological thorns. Because we're tired and still more than a little lost as to what to do next. But believe me, I would have happily foregone holidays for some time coming if it meant things could have turned out differently.

"Maybe you could work part time. You know, so you can relax?" There was a near throttling at this one. Leaving aside the other implications of the "R word", why do people automatically assume that working part time will equate to complete relaxation? As if during the days you are not in the office, you have nothing better to do than lie on the sofa engaging in the aforesaid "Crap Telly and Cupcake Fest". For me, working part time equals less salary, equals less money for treatment. Any advantage of having the time to sit at home freaking out about our options would be offset by the attendant freaking out that we no longer have enough resources to pay for those options. Erm, no.

"Will you try again?" Ah. While this no doubt is an interesting and relevant question, it's not something that should be pitched casually. The first time I was asked this was on the day after shipwreck, as I sat in a hysterical ball, trying to pull it together enough to speak the words "I can't come in today". Timing= bad. Also, the speaker's well meaning but offhand tone made it sound like it was just that I had had a complicated cheescake recipe turn out badly. As if it was simply a matter of whipping of a fresh batch, pop it in the oven and away you go! Tone=bad.

And lastly, my personal favourite, spoken by a person with three kids. "Well, you just have to stay positive. Get right back on the horse.". To which I say, oh please do shut the fuck up, sunshine. I am the horse.

Since you asked

It seems the view is quite good from up here on the soapbox. Having gone through all the trouble of making the ascent, I hope you'll bear with me if I stay a short while longer and answer/clarify some of the points and questions from the comments on my last post.

BJ asked (hi, BJ!) what is meant by "treatment" in the UK in terms of all this assessment malarkey. What constitutes treatment under the legislation has actually been the subject of some complex legal discussions in the highest courts in the land. But the short answer is that for the purposes of the Act, we're talking about HFEA- licensed treatment, which includes anything involving mixing sperm and eggss outside the body, or anything involving any donor material.

BJ also asked whether the law/Code of Practice means that lesbians are unable to get treatment here in the UK. The answer is that, strictly speaking, by law no category of woman is specifically excluded from treatment. So in principle a single woman, older woman or lesbian couple can be treated. My understanding is that at least half the licensed clinics in the UK do offer treatment to single women or lesbian couples, with a few clinics operating on a definite "yes" policy of such treatment.

However, before the treatment can commence, the welfare of the child assessment has to take place, as it would for any other couple. If in the terms of the legislation, the child will have "no legal father", then according to the current HFEA Code of Practice the treatment centre is expected to "assess the prospective mother's ability to meet the child's needs and the ability of other persons in the family or social circle willing to share responsibility for those needs." Whatever that means!

Whether in practice single women or lesbian couples are actually assessed more stringently is not something I can answer, since I don't personally know anyone in the UK who has experienced this. Like I say, even for heterosexual couples, the extent of the assessment can really vary from clinic to clinic, depending on how they apply the Code.

To be fair, the current view emanating from HFEA is that the welfare of the child test should at least be amended in its anachronistic reference to the need for a father, so as to be less discriminatory to single women and lesbians. Things have changed in some ways in this country since the dawn of the Human Rights Act, and while I'm not aware that anyone has ever raised a legal challenge on that basis, I would have thought there was a good chance that eventually, someone will- if things stay as they are.

BJ's wonderfully inquiring mind also wondered what was the deal for unmarried couples, like myself and E, and whether that affected our treatment options. Again, the answer is that we have to be assessed like anyone else, and there may be some clinics with particular policies on treating unmarried couples. At our clinic, our unmarried status does not in and of itself make any difference. There are some peculiar legal quirks here in Scotland about parental rights for unmarried fathers. And the Code of Practice recommends that clinics explain that legal position to unmarried couples before commencing treatment. I'm not particularly worried about any of that. Things could get very legally messy at other points in the treatment process, but that would apply to everyone, even married couples.

Estel commented (hi, Estel!) that her government is taking a leaf out of the UK's book with introducing more checks prior to commencement of fertility treatment. To that I would say, whoa, Nellie! To look to the UK for inspiration seems like a misinterpretation of the way the wind is blowing here.

In fact, very recently, a report was published by the Parliamentary Committee on Science and Technology, inquiring into a number of issues, including the ethical framework for legislation and reproductive technologies. It's long, but it makes for extremely interesting reading. The upshot is that one of the things the Committee are recommending is abolition of the welfare of the child principle in its current form, on the basis that "it discriminates against the infertile and some sections of society, is impossible to implement and is of questionable practical value in protecting the interests of children born as a result of assisted reproduction".

The Committee is also quite openly critical of HFEA in more ways than one, so it is quite heartening to see that common sense has not completely vanished from government.

Whether it will actually make a difference is something we will have to wait and see. I'm not naive, but I do hope so. I really do, especially since there is every sign that infertility is on the rise in Europe, and more and more people are going to be affected. Not to mention that evidence indicates that it is male infertility that is on the increase. Which sort of makes me go "hmmmm."

But certainly if things get any worse, I am joining LEB (hi, LEB!) in the hills, stockpiling assault weapons, like water-pistols.

OK, I am done. Next time, something more prosaic, I promise.

They be Guidelines!

Oh, I assure you, I was deadly serious when I said that we were given forms to take to our GP. Forms on which it is open to them to opine on our fitness to be parents.

Some of you may recall this discussion, in which I asked for your views on a public consultation being held by the Human Fertilisation and Embryology Authority (HFEA). However, having read over that post, I am not sure I explained myself very well as to the dealio in the United Kingdom. So, let's review.

The Law

If you were to run run run to your British statute book, flip merrily through the pages to the Human Fertilisation and Embryology Act, and scroll down until section 13(5), what you would find is this little gem:

“A woman shall not be provided with treatment services unless account has been taken of the welfare of any child who may be born as a result of the treatment (including the need of that child for a father), and of any other child who may be affected by the birth.”

I won't get into how we ended up with such a provision- though the short answer appears to be because MSPs were worried about single or lesbian women getting treatment. If you are interested in the full background of how we were saddled with such a law, there is a very full, cogent and worthwhile dissection of the issue and its history here.

Right, so what does the section mean? It means that by law, anyone in the UK seeking fertility treatment cannot be provided with that treatment until the provider has considered what is commonly referred to as the "Welfare of the Child" principle. It makes no difference that the "child" to be born from treatment is but a mere hypothetical at that stage. A twinkle in the lab technician's eye, as it were.

The observant among you will note that the section does not say anything about how one goes about making such an assessment, and indeed, the Act itself is silent on that point. Obviously, given a very stringent interpretation, it would be open to clinics to make prospective patients jump through all sorts of hoops. And what's more, theoretically, clinics could simply deny treatment to anybody they didn't like the look of.

The Code of Practice

However, in order to receive and retain a license for fertility treatment, clinics must comply with the HFEA Code of Practice. Now, as Captain Barbossa would say, the Code is more like...guidelines. These guidelines are issued to all clinics, to set out some parameters as to how they should go about meeting the legal requirements of the welfare principle, and the kinds of factors which should be "taken into account" in assessing prospective patients. And it was those guidelines which were recently up for review, and on which HFEA carried out their consultation.

I responded to that consultation, and my main view was insert wet ppppphhhhttttbbb sound. Though, to be fair, one of the possibilities is that in response to the consultation, the guidelines might be loosened up somewhat.

In the meantime, every fertility clinic can choose to comply with the Code as they see fit. And it would seem there is some room to move around to how the assessment takes place. So what you get can really vary. For example, despite my disgruntlement about other aspects of the Ass Con clinic, they did manage to dispatch the "taking into account" rigamarole with relative lack of fuss and bother. We had to fill out a questionnaire and talk to Dr Percent about a few general things like our living situation. But that was about it, and it was handled in a very low key, non-intrusive way.

The Declaration by General Practitioner

The OC on the other hand, have obviously opted for the other end of the Code spectrum. Before we can commence treatment, both E. and I have to have our respective GP's sign off on the rather grandiosely titled "Declaration by General Practitioner". What this requires in a nutshell is for the GP to declare that they have discussed fertility treatment with [me]/[E.], and considered "the interests of any children born as a result of treatment". The GP also has to tick a box that says :

A: "I know of no reason why treatment should not proceed, or relevant facts that should be brought to the clinics attention;

B: There are issues which should be taken into account;

C: I am/am not (delete as appropriate) willing to supply information that I consider to be relevant upon request.

Sign/date/practice stamp. Love and kisses, Doc.

Oh, and we also have to fill out another questionnaire, in which we are asked stuff like, "have you ever been convicted of a criminal conviction", or even been investigated for a criminal offence. The latter part leaves no option to do a Danny Ocean- you know, "Well, ma'am, as you say, I was never charged."

E.'s GP has already signed the form, ticking A (with a little grumbling about what a crock of shit it was) and I am hoping that my GP will have no difficulty in simply doing the same.

How do you like them apples?

Er, yeah. How do I feel about this? Huh. Not great. But you know, when one is looking down the barrel of a shotgun, one's options for complaining about the person with the finger on the trigger begin to seem a little...limited. We need the treatment, so we need to get the form stamped. That's the reality. And I can only hope that in time, with other aggrieved voices added to the chorus, that things can change.

Until then...? Well, I've known for some time now that infertility is a dish served with lashings of injustice and unfairness, with a side of helping of bitterness. This part of it is, for me, simply one more sour garnish. It won't kill me- but I suspect I may never get the bad taste out of my mouth, ever again.

Choice and necessity

Today at work, someone compared IVF to having cosmetic surgery. Not to go into detail, but just to put things in context, we were having a discussion about the extent to which my employer should offer medical leave for an IVF cycle.

The person to whom I was speaking remarked that in some ways, IVF is more like cosmetic surgery than, say, a triple bypass. Because, they reasoned, it involves an active "choice" on my part in relation to a "non-essential procedure", whereas something like heart surgery is a "medical necessity".

This got me thinking about the concept of "choice" and "necessity" in relation to infertility treatment. I was distracted all afternoon, rolling this around in my head, until at one point I was so vexed that I resorted to drawing little diagrams and flowcharts.

What I came up with remains, to my mind, somewhat unsatisfactory, so I thought I would put it out en blogue for my wise friends to chew over. In the meantime, if you can stand it, I offer you some fumbling analysis of my thinking.

Let's start with this notion of "choice."

The problem is, when we refer to choice in connection with family building, it normally tends to be approached from the Fertile Perspective. In the Fertile's construct, the decision to have a family is invariably followed by a pregnancy and a birth. A couple chooses to reproduce, they take the necessary steps in the usual way of these things, and as a result, they are parents. They can also choose not to have kids, in which case, things remain as they are- just the two of them, until death do them part or until one of them runs off to Las Vegas with the pool guy/gal.

Of course, from an Infertile Perspective, things are quite different. The option of remaining childless is open to them, but the other route- so easy and available to others- is not. To get to where the fertile couple are, some definitive action is required- choices within a choice. To seek medical treatment or to adopt. Otherwise, by default, they are likely to be stuck within the status quo.

It's when you reach that point- the choice within a choice- that the Fertile Perspective simply does not work. In some ways, it's like comparing apples and oranges. The outcome may be exactly the same, but the means by which an infertile couple gets there make it something quite different, almost a hybrid of its own. And in the process, what might have ordinarily been a positive decision- to live child free- becomes not a choice at all, but rather, a worse case scenario, thrust upon them against their will.

To use another rather grim analogy- in ascending a perilous rocky mountain face, a climber's arm accidentally becomes trapped under a boulder, and he cannot free himself. He is miles from civilization, and no one hears his cries for help. Eventually, he realises that although he cannot reach his phone or his water bottle, he can grasp his pocket knife with his spare hand.

What does he do? Unless he cuts off his own arm, he will almost certainly die in that spot. Amputation or death, those are his options. He still has to make up his mind. But to me, the involuntary nature of his dilemma again makes it something quite different from a "choice" in the traditional sense of the word.

Admittedly, this is an extreme example, and I am not exactly suggesting that infertility creates such a black or white, life or death position. But it seems to me that it is somewhat the same as the Fertile/Infertile Perspective. The trapped climber facing an awful moment is suddenly having an entirely different experience from his best friend who uneventfully climbed this same rock yesterday. Both make certain choices along the way. But for one them, it ultimately becomes a decision about whether to cut off his own arm, rather than, say, where to stop for lunch. In the end, the divergence between their experiences is so great that the only thing they really have in common is that both of them decided to make the climb in the first place.

So, "choice" is somewhat problematic. What about necessity?

When I hear our decision to undergo IVF wrapped up in the same sentence as "cosmetic surgery", it makes me bristle. I guess because everything about that equation seems wrong to me. I can see where that mindset comes from- the old mantra that IVF is not considered medically "necessary". But then, a lot of ailments are not life-threatening and we don't automatically go around accusing people who seek a remedy of being selfish and self-serving.

Nor do we, as a rule, make arbitrary distinctions about those life-threatening illnesses, for example distinguishing between someone born with a congenital heart defect as opposed to someone who directly contributed to their state. For example, the guy next to me received a medical leave of absence to undergo that triple bypass. A medical necessity, they said, albeit in his case, a condition largely brought on by years of smoking, heavy drinking and excessive consumption of bacon sandwiches. But they don't talk about that. He had to have the treatment, because regardless of how he got into that state, it is now life-saving and essential.

Whereas IVF is not. It is "something you are choosing to do".

Which takes me back to the point I was trying to make above, albeit perhaps not very well. Somehow, labelling IVF treatment as a "choice" in this context seems to be an overly simplistic and inappropriate way of briskly packaging up a personal tragedy and thrusting it back on the person who has the misfortune to find themselves in this position in the first place. Justifying it with a dash of what is "necessary".

Slotting assisted reproduction in with cosmetic surgery, as if decisions about whether to live without breast enlargements or collagen lips are somehow just the same as a decision to live without children for the rest of your life.

Red Card

E. has a number of peculiar quirks that I find endearing, possibly because he is so different from me. For example, I tend to avoid background noise whenever possible. If I am trying to concentrate, I prefer silence. I cannot bear to have the television or radio on if I am on the phone. And apart from the occasional exuberant belting of Broadway showtunes in the shower, I also observe a sort of monastic quietude when I am home alone.

E., on the other hand, likes a running soundtrack. Much of the time he creates his own. He whistles, he hums, he carries on private monologues with himself out loud as he is cooking, driving, or trying to remember where he left his sunglasses. He cannot bear to eat dinner without music playing. And the first thing he does in the morning upon getting out of bed is turn on the radio.

Specifically, he tunes in to a sports talk show. To my ears, this program sounds like blahblahblah sports blahblahblah football ("soccer" to you Americans out there) blahblahblah. People phone up to express their views on the minutiae of the game, dissecting every detail in every play, every tactic, every move. For hours. And hours. And hours. Occasionally there is a little digression to talk about something like horseracing, but then it's back to football.

I don't know if I can accurately convey to you the the absolute obsession with which some people follow football here, but let me tell you, it's pretty all consuming.

My interest in football extends mainly to observing the trends in David Beckham's hair and tattoos. I also get relatively animated about the game during the World Cup. But that's because there is usually a football pool on the go, and if my team win I get something like £10 or so as prize money. Plus it's hard to escape it during World Cup time, as the whole country seems to grind to a halt when the England games are on. But otherwise, all the football chat sort of washes over me in a wave...

One thing, though, that I have picked up, partly from this barrage of radio chat and partly from watching the odd game here and there, is the notion of a "red card". For those of you who like me who are hopeless ignorant about soccer/football, this basically means a player gets ejected from the game for bad behaviour or misconduct, like a malicious foul. The player cannot then be replaced. The referee doesn't even have to say anything, he just holds up a red card, and off the player must go. Like David Beckham! During the World Cup against Argentina! Because, like a dickhead, he kicked that guy! And England lost because of it! And it was oooo, dramatic!

I've decided that it would be really useful to have Infertility Red Cards. You know, for those scenarios when somebody has said something so unbelievably stupid or crass that it doesn't even warrant discussion or explanation. Just hold up the red card and bam! That person is summarily ejected from the room/conversation/relationship.

I'll give you an example. The other day, I was talking with my (now heavily pregnant) Team Leader near the end of a very tiresome working day, in which everything had gone badly. Another person came up and started chatting to us, and quickly realised from our hangdog expressions that Team Leader and I had had a growler of a day.

"I bet you two wish you could just head off to the pub and drown your sorrows," said the person. "Oh, well, I don't mean you, Team Leader, obviously, given your condition. Hahahaha. But you, Mare, you could go swally down a few pints if you felt like it, I bet. Unless, HAHAHA, there was something you were wanting to tell us. HAHAAHAHA."

Awkward pause. Team Leader and I exchanged pained glances.

Excruciatingly, the person then went on, TOTALLY OBLIVIOUS, and grinning like an inane loon. "There isn't anything though right, Mare? That you were wanting to tell us?" Nudge, nudge, wink wink.

See? Infertility Red card, right there.

Since then, I've mentally handed out at least two red cards a day. It's actually quite satisfying. Now if only I could devise a lifetime ban for some of these people...

Vox Populi

The S.I.P.P.Y. ("Scottish Infertility Political Posturing and Yammering") alarm went off a few days ago. I sent a squad car out to investigate.

Turns out there was a debate in the Scottish Parliament last week on infertility services. But wait! Before you start issuing tiny squeals of delight, let me assure you that it's not all that.

While I do applaud the efforts of the Minister for raising the issue, unfortunately a fair bit of the debate was also comprised of politicians engaged in self congratulatory drivel. Yes, well done, Mrs. Hairy McClary, thank you for sharing you once had a problem with endometriosis. Hooray for you, Ms Hortensia McCleod of the Clan McLeod on behalf of your constituency on the shores of Loch Shiel, for revealing that you nearly had to go through IVF once, but instead were saved by (and I quote) "a "miracle pregnancy!

Honestly, a bunch of us infertiles could have achieved more in a half hour coffee klatch in Soper's kitchen than Scotland's elected officials did in a hour of parliamentary discussion. All this blah, blah, blah, and no indication of the problem might be solved.

Note this: only one male MSP hung around for the debate. Perhaps it had something to do with the fact that it was scheduled for after 5pm, not exactly political primetime. Or it could be that they all had something more pressing to do, like topping up their spray-on tan , or lighting the curtains on fire. But that did not deter our sole stalwart male politician from attending, oh no- after all, this was clearly an unmissable opportunity to spout crap.

Let's dissect a few gems, shall we?

1. "Members have raised issues about age. I agree that the age at which people qualify for treatment should be raised, especially as nowadays people who have careers often marry or settle down much later in life. However, I have a slight reservation. I do not condemn my parents in any way, but my mother was 37 and my father was 42 when I arrived. That was fine: I had caring, loving parents. However, when it came to asking, "Are you going to come and play football, dad?" that was a wee bit beyond his level. We must bear the needs of the child in mind."

Woof. Did someone fart, or does it suddenly reek of HFEA in here? To this I say, please, spare us your childhood trauma. I'm really sorry you didn't get whatever you needed from your daddy when you were growing up, but take it up with your therapist, not the debating chamber.

2. The sexual health of the nation is poor. We do not know how many infections there are. I would back the idea of a chlamydia testing scheme. For many people, the problem is a matter of lifestyle. They get into drink and drugs; they end up having sex and getting infections. That damages their lives.

Where do I even begin to discuss how very, very wrong this is? Thank, Mr MSP, for equating infertility not only with lifestyle choices, but to infer that it's all the drink! the drugs! and the STDs! causing the problem. How dare you suggest this is our fault, the result of our irresponsible living? And what the fuck would you know about the lifestyles of people needing treatment anyway, you ignorant moron? Do you have any evidence to back up your assertions, or do you just like the sound of your own verbal dribbling? And anyway, last I checked, this town is full of pissed-up junkies pushing prams en route to the methadone clinic.

If you are already thinking this asshole really should have shut up by now, just wait. He saved the best for last.

3. "Many contraceptive preparations damage women's fertility. They can limit a woman's physical capability to have children. Moreover, the sheer angst caused by fertility problems can cause mental health difficulties and those, again, can postpone children. There should be some form of counselling for people who have such difficulties."

In other words, all you women are to blame for using that nasty birth control stuff in the first place. Because birth control doesn't just prevent unwanted pregnancy, it ruins your fertility forever! Now look at what you've done, you stupid bitches. Made yourself infertile AND crazy. Get a shrink, or some electroshock therapy, you unhinged hysterical freaks. Oh, and just relax.

If you're wondering, what is that faint high pitched noise you are hearing right about now? It is the echo of my primal scream of frustration.

Have a slice of controversy with a portion of ethics du jour

Somehow, this news slipped under my radar, probably because it issued when I was thrumming with hormones and crying in the middle of the office. But I was rummaging around online the other day when I came across this which reports the following:

"The Human Fertilisation and Embryology Authority (HFEA) are launching a wide public consultation into how clinics should protect the interests of children born through fertility treatment. Under new consultation Infertile couples could face routine criminal records checks before they are given treatment".

The consultation in question, snappily labeled ‘Tomorrow’s Children’ can be found here. I urge anyone living in Britain affected by fertility issues to read and respond to the questionnaire. The consultation paper focuses on three main areas:

• The kind of enquiries to be made of prospective parents – whether medical or social and which other professionals (i.e. social services agencies or the police) should be involved.
• The factors to be taken into account in the assessment – whether these should include medical, physical, psychological risks and social factors.
• Whether patients undergoing different kinds of treatment need different assessment and information – such as people using donor conception.

Suzi Leather, (the deliciously named Chair of HFEA), has said: “The law sets out the important principle that, before any treatment is given, clinics must consider the welfare of any child who may be born as a result. Our job as the sector’s regulator is to ensure that this is delivered in practice. There must be a reasonable, proportionate, fair and practical system that delivers an appropriate level of protection for children without unjustifiably hindering the treatment of people who need medical help in having a child."

Having read the consultation paper, my first point is that much of the news reportage of the issue has somewhat unfairly focused on the rather sexy angle of CRIMNAL CHECKS! FOR INFERTILE COUPLES! It should also be recognised that HFEA are talking about revisions to a Code of Practice rather than a change to the law. And at the moment, some assessment of medical, physical, psychological and social factors already takes place (or is meant to) prior to treatment. So in some ways, the consultation opens up the possibility for relaxing the current code.

However, the bottom line is that what the current consultaton throws into sharp relief is a key question: namely to what extent should infertile couples who require medical assistance to reproduce be treated differently than couples who conceive naturally?

I should start by saying that I view anything that HFEA says with a certain amount of wariness, primarily because I inherently distrust an organisation comprised of unelected representatives holding themselves out to be an ethical regulator and "fertility watchdog".

My views on the consultation proposals are this: On balance, I think that the legal requirement to take into account the welfare of any child born as a result of assisted conception should be generally be limited to questions of medical risk to the child to be born. I think that any further routine "social enquiries" involving any third party/agencies takes us into into dangerous territory, a tenuous ethical landscape where external value judgements and assumptions assume a crucial yet dubious importance. I think it's a slippery slope that has potential to give even more authority over a couple's family building choices to physicians and clinicians, who in some cases already have far too much power over the process, in my opinion.

I can fully apprecate the arguments that it would be preferable if drug addicted, child-abusing psychopaths did not become parents via IVF. Moreover I can see a thorny ethical issue in a scenario arising where a patient seeking IVF, apart from any obvious medical risk to the child, appeared to all concerned to be a wholly unsuitable candidate for parenthood. For that reason, I think there probably should be scope to make additional enquiries in exceptional cases where there is a clear and justifiable reason to do so. But even that makes me a little uncomfortable-because how do we define what is a clear reason? Who gets to decide if a certain factor is a "problem"?

Furthermore the whole issue generally makes me grapple with how we go about evaluating the welfare of the child - a child that is not yet in existence and may never come into existence. How do we fully and properly assess a future scenario that may never come to be?

What HFEA seem to recognise is that at present it can be very hard to to ascertain in all cases if there is a "problem" and if so how is that issue explored or resolved is a bit of a grey area. The consultation paper talks about using a patient questionnaire. But they also recognise that, cunningly, people with a potential problem which might preclude them from receiving treament might lie on such a questionnaire. At the moment some clinics make enquiries to GPs, but of course in many cases, a GP is really not going to be in a position to give any sort of meaningful evaluation of fitness to be a parent. I mean, I have met my GP maybe 5 times. Which leaves talking to a social worker, or the police.

The problem is that takes us from one end of the spectrum (not many checks) to the other (criminal records search, for example). Anything in the middle risk is fairly unsatisfactory, in that it risks pissing off potential patients (who frankly, are usually feeling vulnerable enough as it is) while failing to really ensure any problems are caught.

Findings on the use of the current "welfare of the child" assessment guidance indicate that patients are rarely refused treatment, suggesting that any benefit of the present system is disproportionate to the time and resource required to carry out the checks. I'm guessing that has a lot to do with the fact that most people who reach the point of seeking assisted conception have already thought long and hard about parenthood, have already undergone a certain amount of intrusive and painful interventions, have already made difficult decisions about family building.

But leaving aside all the ethical dilemmas, I have to say that on an emotive level I simply find the whole notion that infertile couples should have to contemplate the possibility of additional hurdles, such as an interview with a social worker, or a criminal record check to be repugnant, invasive, and downright creepy. I cannot even begin to imagine how upsetting and stressful it would be to sit in the waiting room, knowing that not only will your physical body be wide open for all to see, but wondering if they are going find anything else which will prevent you from receiving treatment.

It also may a knee-jerk reaction but all I can think if IVF candidates are required to routinely undergo detailed checks, then who's checking the parents who conceive naturally? The people who in some cases conceive carelessly and thoughtlessly? Or who make reproductive choices as private decisions, and subsequently parent without being subjected to any sort of assessment whatsoever? HFEA's rationale on that point seems to be that once a person requires the intervention of third parties, such as medical staff, then this does put people on a different footing, one more akin to adoption. So really, if ever there was a practice designed to further widen the gulf between the experience of the bountiful uber-fertile and the bitter isolated infertile, this is it.

I'd really, really appreciate comments on this, which may help me to finalise my opinion and articulate my views to HFEA when I come to respond to the questionnaire. I'm also very interested in what goes on in other countries- for example, is there any form of check in the States prior to commencing treatment? If so, how do you feel about that?