After the second IUI, I went through two more. But I went about these with a perfunctoriness that came from anger and dejection. Like a sulking child, I went through the motions resignedly, not with purpose or intention. I didn’t even take time off to regroup.
Between December 2011 and February 2012 I had three back-to-back IUIs – all drawing blanks. My uterus did put up a good show each time, producing four to five ripe follicles and a thickened endometrium, but inside I harboured no conviction that it would work – because if the second IUI which had my maximum investment had not brought the desired result, how was anything less going to suffice?
I also went through a hysteroscopy, which is believed to be the gold standard in the evaluation of infertility. The doctor inserts a tube with a light and camera into your vagina to take a deep look at the uterus for any irregularities. Mercifully, this procedure is done under anaesthesia. After the test Dr Leela proudly handed over a CD with the images of my uterus captured during the hysteroscopy. Everything was perfect.
There was nothing wrong in Ranjith’s semen analysis either. She was pleased with her footage and exhorted us to view the images. “What was the point?” we thought. If everything was so splendid why was I not getting pregnant? We still didn’t have a medical reason to explain our inability to conceive.
Unexplained infertility is a conundrum – on the one hand, your reproductive system is deemed medically fit and fine. On the other, it is unable to perform the very function it was created for.
After every round of investigations I felt disappointed to know that there was nothing significantly wrong, nothing which needed to be corrected. This meant going back to the roulette table and placing our bets on a random number.
The odds were pretty much the same. If there was a fixable problem, it would have given us something concrete and tangible to work on and work towards, but instead we were shooting in the dark.
“The success rate of an IUI cycle is only 15 to 20 per cent, and most IUI pregnancies occur in the first three or four attempts,” Dr Leela said, practically. We were meeting her after the fourth failed IUI.
To me the IUI appeared to be only slightly better than sex – the sperm and egg still had to meet and fertilise on their own. The only advantage it offered was the timing and creation of proximity for the two to meet. It was increasingly looking like a waste of time and money. We needed something more robust and adaptive to coax my reproductive system to deliver.
“What about IVF?” I inquired.
“Yes, we can try that. But you don’t have any serious problems which warrant it. Such as tubal damage, abnormal sperm or diminished ovarian reserve. And you are still quite young.”
“I know. But we have been married for six years and I don’t want to wait any longer.”
I was thirty-one and Ranjith was thirty-five. We felt there was no point in squandering our precious reproductive years trying out procedures that had a limited success ratio. So we waited for four or five months after the last IUI and went back to Dr Leela asking for IVF.
Here the reader might get the impression that it was an easy and uncomplicated decision to make.
Ranjith and I sit across the table.
Ranjith: IUIs have failed. What should we do?
Me: IVF, of course.
Ranjith: Great! Let’s do it then.
End of scene.
No, the conversation didn’t quite pan out like that. Emotionally and mentally, IUI was an easy call to make because it was quite close to natural conception. Dr Leela recommended that we have intercourse on the day of the IUI. So, if a cycle worked it left enough elbow room for us to believe that it may have happened “naturally”.
But IVF gave us no chance at feigning that it was “natural”. Every stage of conception was controlled and manipulated, and fertilisation was expected to take place in a laboratory, outside my uterus.
There were other reasons too stacked against IVF. It was exorbitantly expensive, a single IVF cycle potentially running up a bill upwards of one lakh fifty thousand rupees. To make matters worse, a single cycle would not be enough. We had to commit ourselves to at least three cycles to have a reasonable chance of success. The success rate for an IVF cycle in a good clinic is 30 per cent to 35 per cent. So, unless we signed up for three attempts, we were going into battle with too few cannonballs.
IVF was also a staggering commitment in terms of time and effort. It was IUI raised to the power of ten. I would have to make daily visits to the hospital for a month. During the first stage, known as ovarian hyperstimulation, drugs are injected into the woman’s body to persuade the ovarian follicles to yield more eggs. Blood tests and ultrasounds are done every two to three days to assess how the reproductive system is faring.
When the follicles have bloated up, the “trigger shot” of hCG is given for final maturation of the eggs. Up until this point the process is similar to IUI, except that IVF is a higher-voltage version. But instead of just injecting the sperm inside the woman’s body at this point, as in IUI, in IVF the doctor opts to wade in and retrieve the egg from the follicle because she doesn’t trust the two to do the job on their own. Once the egg is picked up from the body it is handed over to an embryologist.
A few thousand sperm and the retrieved eggs are sent on a blind date by the embryologist, who just places them in a petri dish where they have the opportunity to hook up. For better results sometimes, a more aggressive procedure known as intra-cytoplasmic sperm injection (ICSI) is performed. The embryologist picks up a single sperm with a fine needle and pierces the egg with it, in an act of forced mating.
If the sperm succeeds in fusing with the egg, an embryo results. An embryo is a single-cell entity, the grain-equivalent of a fully grown human being comprising trillions of cells. This microscopic life form is placed in an incubator for the next five to six days. It is expected to cleave symmetrically into two cells, then four, then eight and so on with each passing day.
On the third or fifth day after the egg retrieval procedure the embryo is typically transferred back into the woman’s uterus where it must attach itself to the uterine lining to result in a pregnancy. Did I say there’s nothing “natural” about IVF?
I wanted IVF and I did not want IVF.
Excerpted with permission from What’s a Lemon Squeezer Doing in My Vagina: A Memoir Of Infertility, Rohini S Rajagopal, eBury Press.