Tuesday Tidbits #40 - The Birds And The Bees

1
Last night in bed we took a mighty leap forward in DD's understanding of where she came from and how she was made.

DD: Without girls you can't have boys.
Me: Right.
DD: And without boys you can't have girls.
Me: Right.
DD: Wait, why can't you have girls without boys?
Me: Because you need a boy and a girl to make a baby.
DD: But you didn't have a husband. You made me in the hospital.
Me: I got the boy's seed from the hospital. Some men give their seed to the hospital for woman who don't have husbands.
DD (with a big soppy smile): I'm glad you did it that way. (She means, I'm glad I've got you all to myself and I don't have to share you with anyone.)

2

Me: The pigeons have laid two eggs on my windowsill.
DD: Ugh! Can't you just push them over the edge or something?







As it happens, the eggs have gone. I woke up the day after posting about the pigeons and there they were - gone!. I think I scared the birds away when I opened the window to take that final photo (the one above that after taking it I promised not to disturb them again). *sigh* *guilt* *100 sorries*. But I have no idea where the eggs went. I can't imagine that the birds could move them successfully from a third storey ledge. *mores sighs* *more guilt* *Wonders if DD has supernatural powers*.

Someone wrote in the comments that baby chicks are blogging gold so I'd be adequately compensated for the inconvenience of a nest on my windowsill. LOL, But actually I was quite into the idea by that time. Oh well, you know what they say - don't count your eggs....

As with all things fertility, it's not in our hands.

Single Motherhood, Should You Or Shouldn't You?

There's a meme going around whereby you answer questions set by the person who tagged you. I was tagged by Candi at Looking for Blue Sky but, as luck would have it, the same week a friend asked me to answer some questions about being a single mother for a presentation she's giving next month. So I'm answering these questions instead but thank you Candi for the tag.

What is your name? Rachel, blogging about this very subject at http://midlifesinglemum.blogspot.com

What is your child's name? Adiele
How old are they? 6
How old were you when you had them? 46

What are your hopes and dreams for your kids? The same as every parent I imagine - that she should be happy, healthy, fulfilled, and surrounded by loving family and good friends her entire life.

Why did you decide to take this route? I was entering my 40s, single, and facing the possibility that I would never be a Mummy. This was unacceptable to me and more than a bit scary.

How did people react to your decision? Most people understood me completely and were very positive and supportive. A couple of single women just a few years older than me said they'd wished they'd done it themselves but it hadn't been as accepted, available, or as successful even 10 years before. Interestingly it was the most religious women who were the happiest for me that I was pursuing this option as they totally got it about being a mother. Actually that's perhaps not so surprising on reflection. A few single men expressed regret that they didn't have the same option.

Others, also interestingly all of them women who already had children of their own and therefore never faced the prospect of being childless, were anti: it's selfish (not sure why it's any more selfish than two adults wanting a baby), it's irresponsible, you won't be able to cope, it's not fair on the child, you don't understand how hard it will be, etc... I had a very simple response to this. These people were dropped from my life at least until after Adiele was born. Then some of them came back but tbh, it was never the same relationship.

Who and how have people surprised you along your single mother by choice journey? The only surprise was how many other people were going this route or already had. Even more surprising were the women who'd done it 20 or 30 years ago (mostly without the IVF).

What have you learned along this journey? Getting pregnant and staying pregnant isn't so easy this side of 40 - I though it would be easier. You can't control everything so it's best to be laid back and fit in the 'procedures' around your regular life whilst just going with the flow (no pun intended). It took me four years from my initial meeting at the IVF clinic to bringing home my daughter. And when you have your baby you realize that the end goal of IVF and everything before the birth was nothing. Motherhood is where it all begins.

What would you advise someone thinking about it today? The best piece of advice I got was from my family doctor who said just do it. Don't think about it too much or you'll scare yourself out of it.

From the other side and six years on, I admit that there were difficult times - scarily low finances, day after day of baby/toddler routine with no promise of adult company at the end of the day (thank goodness for facebook), being torn three ways between needing to work for money, do household tasks and entertain your child, and putting your own social life almost completely on hold until you can afford babysitters or your child is old enough for sleepovers. But it all passes. Now we are 6 everything is a lot easier and, for me, a lot more fun.

For those with modest careers and no trust fund, the biggest fear seems to be one of finances, and rightly so. However, I believe that there is no such thing as not being able to afford one child if you want to be a mother. The question is how much you want it. Do you want it enough to move to a cheaper area, live a much more frugal life, change your career rather than be bankrupt by childcare fees, give up your car, etc, etc. I wanted to be a mother above all else so the choice for me was an easy one.

Do you have any regrets? No

When Emotions Cause Social Forum Abuse

This isn't the post I was planning to write today. However, I was shocked and saddened earlier to read that my doctor, Dr. Yuval Bdolah from the IVF clinic at Hadassah Hospital on Mt Scopus in Jerusalem, has been slammed in an Israeli fertility forum and accused of professional negligence. A man who always treated me with respect as an intelligent and full partner in the fertility process. Who went out of his way to solve each complication as it arose, and there were certainly many complications over my four years of treatment. He looked into new solutions for every possible problem, took advice from his colleagues and left no stone unturned in order that I may fulfill my dream of being a mother.

At my first consultation at the IVF clinic, I was a single woman in my 40s who just desperately wanted to be a mother. At my age (42 at the time) I would say I was probably at my all time most vulnerable and entirely at the mercy of strangers to save my life from being meaningless. Before you all jump down my throat, for me life without a child was meaningless. Maybe I would have found some other meaning if it didn't work - who knows. This is my personal story and true for me. It also serves to illustrate the delicate position of the staff in such a place. They hold so many women's hopes and dreams in their hands. That's a huge role to take on.

From the moment I stepped thought he door of the clinic until I brought home my beautiful baby girl, now four years old, everyone involved from the Head of Department, to the doctors, the nurses, the ultrasound technicians, the receptionist, the porters, and even the cleaner showed me the utmost sensitivity and kindness throughout. You can imagine that during four years of treatment a lot of sensitivity and kindness was called for - and gratefully received.

Every time a decision had to be made Dr. Bdolah took the time to explain it to me with all the implications and risks. He gently guided me towards sensible choices but never forgot that I also had a say in my treatment. When my instincts were wrong he told me so. He would not allow any action that was too dangerous for my health or that of the baby. I was given the option to reduce to one foetus when I was carrying twins but he accepted my choice not to. Sadly I lost those babies to miscarriage at 5 months. When I resumed treatment he made it very clear that he would be against another twin pregnancy for me and made me sign an agreement that I would have a reductive procedure if there were triplets.

I won't go into the details of the accusation against him but basically, a woman had her treatment stopped because of suspected medical complications in her reproductive organs and she's not happy about the way it was handled. I feel for this woman and her loss. I could cry for the women who have to come to terms with not being a mother - as I almost did myself. But I cannot in any way believe that Dr Bdolah did anything other than his best to help this woman as long as it was medically viable.

My first early miscarriage was in the days when the 12-week ultrasound had to be done at a private clinic. A doctor I didn't know from Adam told me, "There's nothing there to see. Looks like it stopped at about 7 weeks. You need to have a D&C immediately. And don't forget to get a refund for the lab work as we won't be processing your blood test." With that, he abruptly left the room.

I walked out in a daze and and tried to phone my health fund clinic where I was seeing one of their gynecologists. It was closed for the weekend. I called the IVF clinic as I didn't know where else to turn. Dr. Bdolah kept me talking on the phone while he had a nurse make all the arrangements for a D&C on Monday morning.

When I 'graduated' from IVF I chose Dr. Bdolah to be my physician for the pregnancy (twice). He gave me his mobile phone number to use not just in an emergency but whenever I had a question. I tried to be considerate of his private life but I disturbed him in concerts, on holiday, at weekends, and in the middle of the night. He was always ready to listen and give me answers (incredibly without any hint of irritation - ever).

It saddens me that such a good doctor and a good man should be hauled over the coals like this. It's natural to want to find someone to blame when your world has fallen apart through no fault of your own. But I know, sure as eggs is eggs (pun unintended but noted), that Dr. Bdolah is not the man to go for.

More generally, this has made me aware that in such highly emotional situations, there's a danger of ruining a good person's reputation on social forums before all the facts have been investigated. And that's just not fair.

It's Not My Fault I'm Childless

I've just read an interesting article in the Daily Mail Online called: I'ts not my fault that I missed the chance to become a mother.  (Click on the link to read the article.) I wanted to leave a comment after the article but there were already nearly 200 comments and what I have to say, well, I want to say it publicly and I want it read.

The author of the article, Megan Lloyd Davies, laments that it was bad luck that she didn't meet the right person with whom to have a family. She isn't prepared to go it alone (as I did) and she won't freeze her eggs (even though at 40 it's a bit late to start considering this option) because she doesn't want to go through fertility treatment alone. She describes how she went through a period of grief and mourning for the children she would never have, starting at age 38. She labels her situation emotional infertility rather than biological infertility and states that it is just as bad. Eventually, she made some big changes in her life, has come to terms with the way things are and is making a good life for herself as an independent, single woman.

As you can imagine, I have a number of things to say about this. The bottom line, however, is that it is your fault. I applaud Davies for working through her grief and coming out the other end with a positive outlook. However, she hasn't quite missed the chance to become a mother but rather is choosing to focus on other things. Her choice.

Ruth and Naomi

I too held out for the traditional love, marriage and a few children, in that order. When I turned 40 and realised that it may not happen I did something about it. I suddenly woke up to the fact that many things do not happen unless you happen them. I could say that my single state at the age of 40, despite some very nice boyfriends and relationships along the way, was bad luck. But it wasn't. It was a result of my choices.

Like Davies, I also chose to hold on to relationships that were going nowhere because I was enjoying myself and hoping things would change - even though I knew deep down that they rarely do. When I started IVF treatment it was because I had managed to give up on the whole fairy-tale package and focus on what was most important to me - becoming a mother. I also wasn't oblivious to the friends who started out with the fairy-tale and tragically things went wrong.

Like Davies, I also chose not to do it alone while I felt I was financially insecure. I lived in rented accommodation throughout my 20s and 30s and I'm a teacher (nuff said). I was marginally better off by the time I reached 40 but it was still my choice to delay. It was only the shock of being 40 and childless that made me go ahead regardless. Whilst I no longer enjoy the life I once had vis a vis travel and entertainment (unlimited heat in the winter, a take out meal once in a while...), this is also part of the choice I made and I don't regret it at all.

I know many women in their 40s who are single and childless. I know married couples who were not able to have children. I also know many women in their 40s and couples who did not accept being childless. Most of them started out with IUI and IVF and if they were unsuccessful, upped the ante to donor sperm and/or eggs. I know those who have used a surrogate and those who have adopted. All these people could have been emotionally infertile (or as I used to call it circumstantially infertile) but they chose not to be.

I've said before that some of my friends considered going it alone and decided, for whatever reason, not to. That is a totally legitimate decision as long as we're all clear that it is a decision.

For me, becoming a mother was the most important thing, as I said, and I thank God that I realised this before it was too late. It wasn't an easy journey and I lost a few good friends over it on the way. I went through all my savings in the process and I didn't speak to my mother for almost half a year. Without going into details, I chose to leave behind any negative baggage in whatever form it appeared, and forge ahead with single determination. I was lucky to have the support of many good close friends but essentially I was on my own.

To Megan Lloyd Davies, I want to say that the period of mourning you experienced at 38 is probably largely biological as many women (even mothers) go through an intense broodiness as they approach the end of their reproductive years. It's there for a reason. By giving reasons why you would not follow any of the options open to you, you have made your decision very clear. I don't think any less of you for not having children any more than I wouldn't look down on women who decide not to marry or any other life choice. I'm happy for you that you have a fulfilling life and that you have such a great relationship with your nieces, nephews and godchildren. But all our lives are a result of the choices we made. It is your fault, sorry.

Disclaimer: I certainly don't want to offend anyone who has tried every possible route to parenthood and is still childless. There are people like this and I am not belittling your pain and loss. There are unfortunately, people with severe obstacles to parenthood.

Credits: All the illustrations on this page are taken from Google Images under childlessness.

IVF: Don't Test Early

It is about time I continued with the IVF Journey, especially as I left you after my first IVF return of four embryos (of various grades) and about to begin the notorious 2WW again (2 week wait - not Second World War).

June 2005

The bits of paper they'd given me to bring home told me to take 2 Estrofem a day, continue with the folic acid and to vaginally apply 8 Uterogestan (for in the morning and four in the evening). These are basically thick cream enclosed in a thin plastic spherical coating which dissolves quickly. If you think this sounds like a country you wouldn't care to visit, you'd be right. It's as inconvenient as it's unpleasant. Nuff said.

I was to return in two weeks time for a blood test. This time I couldn't resist buying a home pregnancy test from the pharmacy. It was negative on the twelfth day. However, on reading the printed material that came with it, I learned that the drugs I was taking could interfere with the results. And what's more, after IVF they suggest waiting even longer for a more reliable result. I wanted so much to believe it but I was now more anxious than if I hadn't taken the test.

Two days later I went back to the hospital for my blood test. I had to go anyway to get a renewed prescription for Estrofem and Uterogestan. "Call at 10.30 for the results," said the nurse. "Good luck." The nurse was hopeful, after all it was IVF so there's no reason that it shouldn't work, right? I still didn't feel anything but, on the other hand, I still didn't know what I was supposed to feel.

The negative home pregnancy test weighed on my mind though. These things are pretty reliable. If they say you're not pregnant then you're probably not pregnant. I didn't need to use the prescription for more Estrofem and Uterogestan. I made another appointment to see one of the doctors and start again.

The First Return

It was June 2005 and my IVF journey continued...

I called first thing on Sunday morning. They had 4 embryos for me. Again I was surprised. 16 eggs retrieved and I end up with only 4 embryos? I went to see Dr. B and he explained it to me:

"We had 16 eggs. As this was  your first IVF we did an experiment. We put eight of the eggs in a dish with sperm and waited to see if any of them would be fertilized. None of them were. The other eight we fertilized by ICSI (actively putting the sperm into the egg). Four of them took and we are going to return these to you today."

I went down to 'Day-Surgery' and undressed up to my waist. There was no anaesthetic so no pre-op procedures. I was told to drink a lot as the embryos are easier to place on a full bladder. So I lay on a bed sipping from a little bottle of water. I finished the water and waited. I was desperate to wee and the nurse said it would be another 15 minutes until I went in. Impossible! I was advised to go and partially empty my bladder. Well you try doing that on a full bladder. Whoosh! I was empty.

I quickly refilled my water bottle and gulpted down 750ml in one go, hoping it would have enough time to reach my bladder before I went in. Twelve minutes later I was called in. I gave my name to the Cheshire Cat face in the hatch and put my legs up into the stirrups. "Have you drunk?" "Yes," I replied truthfully.

The metal clamp was inserted into my vagina and the doctor began to screw the two lips apart. This was the most painful part, having your vagina stretched to the circumference determined by the doctor for her convenience. The rest was a doddle. The slight twinge as the catheter touched the internal nerves was so slight compared to the stretching pain that it was almost a welcome distraction. She didn't mention the state of my bladder so I wasn't about to ask.

Then it was all over. They wheeled my bed in from outside and had me slide carefully on to it. I was wheeled back to the before-and-after room and told to lie still for at least half an hour for the cervix to close. Then I could go home.

I got out my book and started to read. The effects of the 750ml of water suddenly hit me. I looked at my watch. I'd only been there for 10 minutes. My bladder felt fit to bursting and I had to lie there like that for at least another 20 minutes. I tried concentrating on my book. I made myself read to the end of the page before checking the time again. Less than two minutes had passed. Another page read - another two minutes. Still 16 minutes to wait.

I worked out that five minutes was 300 seconds so if I counted to 1000 slowly I would be over the time. I started counting. Strangely enough it was easier to count than to read. When I reached 500 I did a time check. I'd counted so slowly that ten minutes had passed. 360 more seconds and I could go to the loo! I made myself count to 400. I was comfortably over the half hour but uncomfortably about to wet myself. I tried to walk smoothly to the bathroom, not wanting to jiggle the embryo if it had found a nice place to implant itself, but it was at best a fast-smooth walk. Needs must.

Greatly relieved in every sense of the word, I took a taxi home. I asked the driver to drive as smoothly as possible but I don't think he understood the importance of the request. I attempted to glide up the three flights of stairs to my apartment and, once there, I slid into my bed for the remainder of the day with a pile of magazines I had prepared earlier.

IVF 1

I recently recieved a comment under a post from my old friend Anonymous, asking if I wouldn't mind conitnuing my IVF story. I looked back through the archives and found that my last blog on this subject was back in July. I hadn't meant to leave it this long so thank you for the push to resume the journey. We had left things just as I'd been switched from IUI to emergency IVF as I had far too many eggs to leave things to chance.

I went up to IVF at 8am on Thursday as intructed and one of the nurses, Anat, took me down to 'Day-Surgery' in the bowels of Haddasah Hospital. "I'm coming with you as it's your first time," she told me, "next time you can come straight down here yourself." What next time? I've got 22 eggs, why would I need a next time? At some point I noticed that my phone had no reception. It was like Journey to the Centre of the World.

I went through all the preliminaries with the nurse on duty - medical history, weight, blood pressure/pulse. I undressed, put my belongings in a locker and returned the key to the nurse. I kept my glasses, my book and my watch - time is more manageable if you know how much of it has passed. The woman in the next bed went in and came out again within half an hour. And after 40 minutes I was taken in to the operating theatre.

Dr. B was there with his big smile. He had that Tony Blair/Ehud Barak thing about him - like a big schoolboy about to have fun with cutting things and technology. The politician's first commandment: look like you're enjoying all this immensely (except when someone has died) and everyone will think  you have it all under control, nothing to worry about. If this was the case, it worked. I felt safe and relaxed. As I got to know Dr. B better I learned that there is nothing calculating about his behaviour and it was his sincerity that led me to trust him completely.

The anaesthetist started sticking little round patches in strategic places around my upper chest and shoulders. These are... well actually I meant to ask but I never did and so I still have no idea what that was about. Suddenly a grinning face appeared through a hole in the wall. It asked me to say my name. wished me good luck and disappeared. If I dreamt about the Cheshire Cat I'd know why. The drip was connected via my arm and I was told to count to ten. I don't remember how far I got.

I woke in the recovery room. I call it the recovery room but it was more of a corridor half-way between the operating theatre and the before-and-after room. It was cold and my stomach hurt. Not really my stomach of course but rather like a bad period pain. There was no one else around as far as I could see in front of me and I was still too out of it to be able to turn over and do a full recky. I decided that groaning would help. The noise detracts from the discomfort and it may attract a nurse. I wanted a blanket and a painkiller.

Someone came. It was Anat from IVF. She found a blanket and put it over me. "I'll get you something for the pain," she said. Then she put her hand on my forearm and stroked. Three quick strokes up and down followed by a gentle squeeze, and she was gone. I cannot express how much comfort that brief moment of human contact gave me. This wasn't a warm room with a picture on the wall, a bedside table, and a comfortable chair by the bed. It was the corridor with the air-conditioning on too strong and not a soul in sight. I just wanted Anat to return and and put her hand on my arm again. I was reliving that moment like it was the most desireable of fantasies one could ever have.

They must have put me back to sleep again as the next thing I knew I was waking up in the before-and-after room. I was warm and the pain had gone. My glasses, watch and book were in the drawer next to the bed where I had left them. All was right with the world. The nurse popped her head in and told me to wait for the doctor. About 20 minutes later Dr. B arrived looking very pleased with himself.

"We got 16 eggs." he said. I was surprised as there had been 22 eggs measured and listed on the ultrasound chart, what happened to the other six? I didn't like to ask so I just said 'thank you' in my terribly British way.

I stayed and rested for about an hour, drifting in and out of sleep. Dr. B said that the test was if I could walk to the door and back without falling over I could go home. I needed to go to the bathroom, which killed two birds with one stone as it required walking even farther than the door. On the way back I retrieved my locker key from the nurse and picked up my clothes and bag. "Take it easy for the rest of the day and be ready to come in on Sunday morning as we may be putting back embryos."

I got into a taxi and went home leaving them to make my baby in the lab.

Five Things I Want You To Know About Your Father

The Friday Club Parenting Carnival is back at Notes from Home. This week's theme is: Five things I want you to know about your father. An interesting enough theme for most people (read the other entries here). For us it has a different context. I don't know DD's father personally, he was/is an anonymous donor. Nevertheless, here are five things I want DD to know about her father:

1. Your father and I have never met. I don't know his name and he doesn't know my name or your name. Probably he doesn't even know that you were born. What he does know is that once he gave a very special gift - he gave some of his seed to the hospital to help someone have a baby.

2. The hospital gave him some money for giving his seed but he didn't have to do it. There are plenty of other ways to make money. This was a very generous and selfless thing that your father did, and I thank him for it everyday.

3. Your father is Jewish and Israeli of North African/Middle Eastern descent. I chose that your father should be Sephardi because I am Ashkenazi (of European descent) and I wanted a mix of genes. Children of mixed genes are often very beautiful, as you are, and strong and healthy. I also have olive skin and I wanted you to have more chance of looking like me. And, darker skin is much easier to care for, especially if we are living in Israel.

4. Your father has a profession and I'll tell you what it is. His profession required him to study for a degree and also to have good English. So he is educated and employed, as I am. I hope you will inherit his study and work ethic with encouragement, support and example from me.

5. After more than a year of trying to become pregnant, and nothing was happening, the doctor suggested I stop using your father's seed and try another donor. But I chose not to. I had become very fond of your father. He was family already. We had started this journey together and, eventually, I got you. So you see it was absolutely the right choice to stick with him.

Who's The Brave One?

This post was originally written as a guest post for Nicki Cawood at Curly & Candid back in July. As I am madly preparing lessons for a new job that starts on Sunday, this is a good time to post it on my own blog. Enjoy.

By far the most often heard comment about my decision to have a baby on my own has been, "you're very brave." From the time I started showing right up until today, with an almost three year old daughter, I have heard this comment time and time again: You're very brave.

During my pregnancies (there were three) I had no idea what it meant. With the hindsight of being a mother I understand it a bit more. However, being brave is the opposite of what I was. Bravery to me is facing old age without ever having been a mummy. Bravery is giving up on the love of your own baby and child. Not having the chance to bring up a child and help her (or him) to reach her best potential. Not to pass on all the things you have learned in life. Not to be part of the club that is motherhood.

A little background about me: I was the kid who always wanted to hold and play with the babies. I was the girl who was babysitting at the age of 12. As a teenager I was a leader in the local youth club and later ran it. I taught in Sunday school, I spent my gap year working in a children's house on a kibbutz and I became a primary school teacher myself. I was the single friend that married friends with children could feel comfortable asking to stay for the weekend and even, one time, if I would go on holiday with them. It was inconceivable (pardon the pun) that I would not have children of my own one day.

I was ready to have a baby at the age of 12. Obviously I wasn't mature enough or in any position to do so, but in my head my biggest ambition in life was to be a mummy. Whilst some of my friends wanted to be doctors, lawyers, or teachers, I honestly set my sights on being an executive wife, making dinner parties, and bringing up a large family. Man makes plans and God laughs – no kidding.

So there I was in my 40s and still no baby. How did this happen? I was extremely social as a young adult but somehow I never found Mr Right. I always said I would go ahead and have a baby on my own if I got to 38 and was still without a partner. But at 38 I was living in a rented apartment and I felt my life was too insecure to bring a baby into it. When I was 39 my parents (and the bank) helped me buy an apartment.

I now had a home but I was also dating someone. I hoped that we would simply get married and fit in a couple of kids before I was too old – not necessarily in that order and I did try a number of times to let nature take its course. (Btw, I blame the gossip magazines for featuring celebrities with their babies born at 40+ or even 45+ and failing to mention the intervention that was almost certainly required. They give older women a false sense of their fertility at an age when it is really very difficult to conceive.) Sadly the relationship didn't last.

Happily, my friend N, had twins with the help of IVF. All my hesitations flew out the window and I knew that it was now or never. Luckily for me and every Israeli woman who doesn't conceive naturally, Israel recognizes that many women need help in having children.  And I don't use the word 'need' lightly. Some women choose not to. Others never make a conscious decision but find different ways to make their lives full. However, many childless women carry a sadness with them all their lives. In Israel the Health Funds cover most of the cost of IVF for women up to the age of 45, and up to two children. There are no psychological tests or investigations. You can be married, single, with or without a partner.

I was determined to be a mother. Every disappointment along the way (and there were many) was a frustrating delay, but just that: a delay. I went from accepting the notion of donor sperm with IUI, to drug induced ovum stimulation, to IVF. There are many ways of upping the ante when you are definitely going to be a mother, from donor gametes all the way through to adoption. I think I would have gone the whole way had it been necessary.

I have single friends who started fertility treatment and it sadly didn't work. Others gave up after a couple of tries. Women just a few years older than me were not aware of the opportunity and it was not as widely accepted as it is now. I have friends who have thought about it and decided that single motherhood is not for them. So who is the brave one? Not me – I'm the lucky one. 

IVF: Too Many Too Fast

Before starting this post I took a quick look at my list of tags. This is the 16th post in my IVF journey. 16 posts and I'm still faffing around with dreams of effective IUI! I'm irritated that I didn't take the advice given and move on faster to the real treatment. I'm bored with how long it took quite frankly. I suppose at the time I didn't realize how long the journey would be (four years in total). If I had I would have been devastated. So, because I cannot bear to go through it all agan so slowly, I am gong to speed up the telling.

I had been  prescribed Cetrotide (stops early ovulation thereby allowing the eggs to mature longer), Gonel F (to stimulate the growth of more eggs) and Ovitrelle (stimulates the final maturization of the eggs and releases them from the ovaries). On day five of my cycle I went to the IVF unit at Haddassah, Mt Scopus. Blood test done, ultrasound approved and the nurse took me into a private room to show me how to inject myself with the Gonel F.

I was nervous but I know diabetics who have to inject several times a day for their whole lives. I could certainly do it for a short time in order to have a baby. The Gonel comes in a pen. You set the dial for the doseage, screw in a very fine needle, and pull out the end (it comes out according to the set doseage). You swab your stomach with an antiseptic wipe, push in the needle and squeeze down the end of the pen. Easy peasy lemon squeezy. My hands were shaking just handling the needle, let alone jabbing it into my stomach. I held my breathe and....surprise! It didn't hurt at all. The needle was so thin it was like acupuncture (I imagine :-) ). Then I squeezed the liquid medicine into my flesh where there wasn't a space for it and it killed - OWCH!

I was told to take 225 units a day and come back four days later. At this point I want to say something about the Cetrotide. I honestly don't remember taking it. I don't even remember what it looked like. I do remember having something left over which I never used and this could be it. On googling Cetrotide I found out that it is usually taken between days five and seven. By this time all the medicines have probably changed anyway so let's just move on.

On day nine I had about six or seven eggs big enough to measure on both sides. And there were more little ones visible. The nurse showed my chart to the Prof. "You're shooting too many too fast," he said. "You're producing them like a 22 year old. We'll have to slow you down!" He certainly knows how to give a compliment that Professor.

My doseage of Gonel F went down to 150 units and then 75 units per day. And one day I went into the clinic to be greeted with the news that I would not be having IUI but instead would be undergoping IVF. There were simply too many eggs for IUI. It would be irresponsible as I could end up with a multiple pregnancy. As they didn't want to waste all those fabulously large eggs, they had arranged it all with my health fund and I would probably have the operation in two days time.

I was stunned. Stunned and excited. I was to take 37.5  units of Gonel F this afternoon, have the Ovitrelle injected into my bottom at 9pm tonight, not eat or drink from 10pm tomorrow as I would be having general anaesthetic, and turn up at 8am on Thursday morning. Sometimes it's best when desicions are taken out of your hands.

DNA Is Over-rated

I am moved to write this post after finding myself recently commenting the same thing on a few other blogs. In my opinion DNA is vastly over-rated.

I first wrote some of these thoughts as a response to an article in the Daily Mail a few years ago in which a 40-something man accidently found out that his father wasn't in fact his biological father. He was devastated. He blamed his mother, he cut off all ties with his 'father's' family as he no longer considered them his family. He felt orphaned and without roots, his whole life had been a lie, etc, etc... In fairness to the man in question, I have since found out from my friend Karen's experience that you can't necessarly believe everything you read in the Daily Mail. I hope they also misquoted this man because what I read really made my blood boil.

Many people choose the donor route when trying to conceive. It may be a matter of age, the lack of a partner, same-sex partners, other fertility problems, genetic abnormalities in the family or reasons that I've not even thought of. Others have used surrogacy with only one or neither partner contributing. Many more couples and singles, over the years, have decided to adopt. The effect is the same - a child in your family who has different genes. A child with a different set of DNA. So what?

DNA does not give you a happy and secure home. It does not give you a feeling of belonging to a loving family. Your DNA does not educate you, read you stories, kiss your knee or your forehead when you fall over. DNA cannnot give you wonderful childhood memories and an album full of funny photographs to reminisce over. Your DNA does not pick you up from school every day and take a day (or a week) off work to look after you when you're sick.

Brothers and sisters and cousins become close through shared experiences and family traditions. Mummies and daddies, uncles and aunties, and grandmas and grandpas, exist by the power of their love, their pride and their joy in the children of their family.

DNA cannot even keep families together. I know adopted children who have no desire to find their biological origins. My maternal grandfather was an immigrant with no family in England. Unfortunately he died when my mother was only eleven years old. She and I have no knowledge of or connection with any of his family. Many people have no knowledge of or connection with one side of their family. Many make the decision to cut themselves off from whole sections of their family. Families that survive as a unit do so because they are emotionally healthy and filled with love and support.

As my wise friend L said: children will accept their identity - it is a matter of how you present it. Maybe the Daily Mail man should have been told the truth, but in those days there was reason to feel secure that the truth would never come out. In these days of advanced genetics it is reasonable to assume that nothing can remain a secret. DD will know how lucky I was to be able to have her and about all the help I received in order to do so. She will know that DNA exists and that it is something to study in science. I firmly believe that it will have little impact on her identity and on her sense of family.

Hysterosalpingogram? I'll Pass.

It was time to up the ante to IUI with ovum stimulation. Time was passing and I wasn't getting any younger. It was May 2005 and I had another consultancy with a doctor. This time I saw Dr. M. She had an elegant European style about her, a wedding band on her finger, and she spoke fluent English as well as Hebrew. She probably had children at home and almost definitely had a another language. I immediately felt inferior. Then she smiled and she was nice. I wanted to be like Dr. M when I grew up. Except that she was probably about six years younger than me.

Like Dr. B, she was one step ahead of me on the treatment hierarchy. "There is very little chance that IUI will work even with ovum stimulation. With IVF the chances jump up to 25%." But I was still on the crusade of as little intervention as possible. I still couldn't believe that, with my strong maturnal instincts, my child-bearing hips, and my fantastic FSH scores, my body wouldn't be thirsty for pregnancy. And that it wouldn't quench that thirst at the earliest opportunity.

"I also want you to to do a hysterosalpingogram (HSG)," said Dr M.
"What's that?"
"They pass a tube into your uterus and inject a dye through to your fallopean tubes. This shows up on an x-ray and they can check for any blockages. Sometimes the precedure itself clears any blockages and there's more chance of pregnancy. Make an appointment with radiology. They will probably want to do it straight after your next period. Then come back here on day five of your cycle." Before I left she gave me prescriptions for Gonel F, Ovitrelle, and Cetrotide.

I made an appointment with radiology and a few days later I was talking to my friend Z, who has twins through IVF. "Oh my God, I had to have that. It killed! I stopped the procedure half way through and the doctor was really horrible about it. He told me to stop making such a fuss as it didn't hurt that much."
"Yeah right, when was the last time he had one?"

I called radiology and cancelled my hysterosalpingogram. Z didn't do it and she had twins, so that was all right then.

IUI Round Two

The three weeks until my next appointment went much faster than the previous two of the 2WW (the two week wait). This time I saw Dr B who explained that doing IUI without any intervention had a success rate of about 2% whereas IVF for a woman my age (42) was about 25%.

"I feel I want to give it one more go before I start having operations." I told him, "It seems hastey to rush into the operating theatre just because it didn't work the first time."
"There is another option," he said, "a sort of in-between stage. We do IUI but you take hormones to stimulate your ovaries. There will be more eggs thereby raising your chances of success."
"What does the success rate rise to with that procedure?"
"For a woman your age [I wished he would stop saying that] about 5%."
"Better but not much."
"Or you could go straight to IVF?"

In other words - stop wasting everyone's time - is what he meant. When I look back on it now, six years later, my optimism was laughable. However, I hated the idea of messing up my system with drugs - I'd never even taken birth-control pills before. I was the customer and though Dr B wasn't convinced, he agreed to let me try one more IUI without intervention.

I was told to come in for the blood test and ultrasound on the fifth day of my cycle. As I was already on day 10 this meant waiting another month. However, the fifth day rolled around again, and again I started the process of early morning visits every few days. On day 15 I was ready for the IUI and this time there were two eggs. This time around I knew more about the system and had paid my 350 shekels and done all the paperwork before knocking on the door of the Sperm Bank at 11am  precisely.

This time I knew to hold the tiny vial of sperm suspended in about 3ml of pink solution, tight in my hot little fist. I returned to IVF and went to add my name to the treatment list. I was horrified to see about 10 people already listed. I looked round the waiting room and there they all were, one hand fisted, sat in order on the row of plastic chairs, each fiercly guarding her place in the queue.

I realized that I had been too British. When I was told 11am, I should have turned up at 10.30. It was a repeat performance of the last time. Except that instead of four women ahead of me waiting for four treatment rooms, there were 10 women. And of course, you can have 104 treatment rooms but if you only have two doctors working...

Then one doctor was called away to do an emergency ceasarian. If I were needing an emergency ceasarian I'd also want the doctor to drop everything, I reasoned. But I'd been there for over an hour and my fist was numb from trying to keep the sperm warm. The receptionist said she'd call another doctor to come and it would only take a few minutes. A few minutes can be a surprisingly ambiguous length of time. When the new doctor arrived he saw the next two women on the list. And suddenly, I was the only one left. The doctor was willing but we had to wait for a treatment room to become available.

I'd been waiting over two hours when Professor H arrived for the daily staff meeting. He was the Head of Department, the most experienced, the Professor, the one who told all the other doctors what to do, the one who made all the big decisions. But it doesn't matter how important or brilliant you are, if sperm cannot survive for two hours in an aching fist you cannot make a baby.

Prof. H seemd surprised to see me still sitting there looking dejected but resigned to the fact that I'd probably wasted my time. He quicky found a free room and hurried me in. He was kind enough to make encouraging noises but I was already thinking about the next time when I would be banging on the door of the Sperm bank at 10am.

It may be that spern can survive for hours in their little pink bath but I didn't want to ask. What was I going to do if he told me there was no chance. Make a fuss? Demand my 350 shekels back? Go somewhere else next time? No, better not to know. And anyway, there's not much difference between 2% and 0% is there?

Two weeks later, during which time I desperately tried to feel something but didn't, my non-pregnancy was confirmed.

IVF: Gearing Up For Round Two

So I wouldn't have my first child at 42 but I could still get pregnant at 42. I read gossip magazines when they came my way (Hello, OK) and focused on the Hollywood stars in their late 50s with their 10 year old children. Some of the children are adopted and even though I was still far away from considering that option, I revelled in the fact that a woman in her 50s could be the mother of a small child and that it was acceptable. I loved it that the pictures looked happy and natural.

If I had to have a Hollywood body in my 50s, so be it. Whatever it took not to be the mother at the school gates who looks like the grandmother. If anyone could pull it off, I could. Years of being an indoors person had saved my skin. I'm uncomfortable in the heat and sunbathing has to be the most boring passtime ever invented - I'd rather watch the paint dry. I'd have to get my weight down but I'd done this before and I could do it again. I was ready for 'round two.'

Meanwhile, my friend M had a party for just her women friends. There were about 15 of us of all ages, cheese and wine, and even a programme of activities (M is a great one for organizing). The first activity was an ice-breaker. We sat in a circle and everyone had to tell a short story or some unusual  information about themselves. Some of the accounts had to be made up so that afterwards we would all vote on which we thought were true and which not.

One woman had a small baby with her. As she dandled him on her knee she said, "This little thing was the result of IVF and he's a miracle baby because we only did it once and it worked." I liked that story. Other stories were more or less interesting but varied enough to keep us amused. A very attractive woman who looked about my age, told us she was in fact 48 and had had her daughter at 44. She was now trying to conceive again for a second child. I liked that story too.

We completed the circle and M suggested we take a ten minute break to refill our glasses and then reconvene for the voting. She also suggested that when we come back, we sit in different places to make it more of a challenge to remember everyone's stories. I wasn't so interested in all the stories, though there turned out to be a few surprises, as I was so focused on the baby stories. The woman with the baby was easy to remember - he was still sitting on her lap.

We all voted 'yes' as it was such a simple story. Why bother to make up something like that? It was so matter-of-fact that it was almost boring. The woman laughed, "I lied! I got pregnant the old fashioned way eight months after our wedding." I was furious with her. How dare she laugh off IVF as if it were a frivolous detail - like where you had sex when you conceived and in what position. I missed the next vote entirely as I was busy regaining my equilibrium.

The other baby story woman was also easily remembered as everyone had been fascinated by her. She was the oldest woman in the room and the most attractive. Thankfully her story was true. I didn't yet realize what trying to get pregnant at 48 entailed, but I was reassured that she wouldn't be trying if there was no hope.

The Day of the Pregnancy Test

The 2WW was over. I had resisted the urge to get a home pregnancy test at the pharmacy. I still didn't feel a thing but everyone kept telling me that you can't count on feelings. I thought about those women who go to the doctor because they're feeling tired and putting on weight and the doctor tells them that they are eight months pregnant. I always thougth that could only happen to stupid women - I mean how could you not know? Then it happened to someone I know - a normal, intelligent, educated woman who had been through a very stressful year with ailing parents and a small baby to care for. I understood that you can put a lot of strange feeling down to stress. Or if you are so exhausted, you could ignore them. I even knew that your periods could stop for a while if you were really stressed. Now I was thinking that you really could get through a whole pregnancy without feeling anything.

"But you're not stressed," pointed out a calm friend.
"But I don't feel anything."
"Well you're only 5 minutes pregnant that's why."

There was no doubt in my mind that I was pregnant. I'd never been ill, my periods had always been regular, and my hips were as wide as a house. Even the timing had been arranged for the rendevue of sperm and ovum - an ovum that we had seen and measured on the ultrasound. I had to be pregnant, there was absolutely no reason not to be. Besides, I had told about 10 people.

I was in the hospital at 7.30am and waiting at the door of haematology as they unlocked it. There was no problem drawing blood, down the corridor to the lab with my blood sample and into the red heart-shaped basket. I was at the bus-stop by 7.50. Everything had gone smoothly, it felt like a lucky day.

The results of the blood test did not need to be discussed by the doctors. There was no treatment - either I was or I wasn't. Therefore, I didn't have to wait until after the doctor's meeting at 1pm in order to get the result. I had been told to call at 10.30. The 2 1/2 hours dragged and it was extremely hard to concentrate on my work. D who shared the office with me, was also watching the clock.

At 10.29 I took my mobile and went to find an empty office. There wasn't one so I stood on the stairwell and dialled very slowly. The ringing tone started at exactly 10.30. "We don't have the results yet, call back in half an hour." Aaargh! The waiting was supposed to be all over.  I went back to the office and D looked at me with expectant eyes. "Another half an hour." She was as frustrated as I was.

Half an hour later I got through to the nurses' station. "Sorry it's not pregnancy." I remember thinking that this was a nicer way of saying it than: Sorry you're not pregnant. Less accusatory. IT is not pregnancy, it's
not you it's 'it'. Not your fault at all.

They gave me back to the secretary to make an appointment with the doctor to discuss my next move. It was in three weeks time. "Three weeks?! Nothing sooner?"
"Sorry, we're completely booked up."
I wanted to see the doctor tomorrow and get staright back on track. I wondered if they deliberately made you wait to get over the disappointment and sort out your emotions. Now I'm sure that they purposely slow you down. You need to do this thing calmly and have quiet periods in between when you're not running around after ultrasounds and health fund authorizations. And they want you to have at least one natural menses.

I went back into the office and sat down. I kept my head down and made a short announcement: I'm not pregnant and I absolutely do not want to talk about it. There was silence but the disapppointment hung in the air. D tried to say something soothing. "D! I cannot stress how much I don't want to talk about it." I said brusquely. "Sorry, sorry," she mumbled and we got on with our work. After a while I was able to break the silence. It had to be me otherwise we would have sat there in silence all afternoon. I took a quick look at the newspaper online and made some inane comment about the headline. I can't remember what it was but we discussed it for two minutes and normal service and office relations were resumed.

As I walked home later I called some of the people I had told. "It's ok, I'm going straight back to try again. It would have been an absolute miracle if it had happened the first time."
"Maybe don't tell so many people next time?" Suggested J. And I knew she was right.

It was the beginning of March 2005. I would not be a mother at the age of 42.

The Two Week Wait (2WW)

I have to write this post today as it is two weeks tomorrow that I wrote about my first attempt at pregnancy. In real life it takes two eternal weeks before you can find out if you are pregnant - it would seem, dear readers, that you are going to have to suffer the wait in real time.  

The 2WW - which looks something like the Second World War and is only slightly more traumatic - is not a phenomenon exclusive to women undertaking fertility treatment. Of course everyone who is trying to get pregnant (or trying not to) has to wait about two weeks to find out the success or failure of their efforts. The thing about fetility treatment, and especially IVF, is that you cannot simply try again next month. Apart from having to wait at least a couple of months for the drugs to wear off and your hormones to settle down (both chemically and emotionally), there is also the cost involved. All in all, the amount you put in - effort, emotion, money - is directly correlated to the level of pressure to succeed and the disappointment if you don't.

If you look up IVF websites there are pages of message boards featuring women going crazy over the 2WW. Every feeling, every twinge, every dream, smell, desire to eat something unusual, is examined. The most frequent, desperate question is: I don't feel anything, does that mean I'm definitely not pregnant? This is usually followed by half a dozen replies along the lines of: Don't worry, I didn't feel a thing either and I'm now in my sixth month!

Other questions relate to bleeding (Don't worry, etc, etc... and I'm now in my seventh month), how much you can exert yourself (Don't worry, I accidently picked up a sack of potatoes and I'm now in my eighth month), and women just trying to get throught the wait and looking for general support. Scroll down a few pages and the supportees become the supporters, whilst simultaneously becoming novices on the confirmed pregnant board (Don't worry, etc, etc... and now I have beautiful twin boys!)

The first week wasn't so bad as the blood-test seems so far away that you might as well forget about it. I told three or four friends. The second week is much harder, not least because you expect to start feeling something. I went to a friend for lunch and there was another single woman there whom I'd known for years and we used to be quite close. I pulled her outside to the garden and told her excitedly that I might be pregnant.

Instant fertility education lesson 1: Be careful what you say to your single or childless friends as there may be a whole lorry-load of emotions parked somewhere inside them. One word on the subject from a prematurely excited possibly pregnant person is like taking off the handbrake and sending that lorry down a ski-jump. Everyone's reaction is different. This friend, in her late 40s, launched into a speech about how she had never wanted children herself. I was shocked. All I had expected was a, "Good luck, I hope it works."

I played along, "yes I know that's never been your thing..." I had no concept of a woman never wanting a child but I needed her to stop. I realised that, in my eagerness to share, I had been insensitive and I wanted to stop her discomfort but I also resented slightly that I had to be apologetic about something so patently wonderful. Why did my decision have to be a negation of all her life choices? I now know that at 47 she still had time to become a mother (with ovum donation and IVF, or adoption) had she wanted to. But back then I thought she had missed the boat and I was kicking myself for opening my big mouth.

Over the next week I still felt nothing. At the back of my mind was the memory of sitting for over an hour clutching my little vial of sperm whilst waiting for a treatment room and a doctor to become available for my IUI. However, I found myself encouraged by the 2WW cheerleaders on the website and I told a few more friends. Maybe talking about would make it happen? Everyone you ask says that positive thinking is a great help. I was nothing if not positive in my thinking at least.

The First Attempt at Pregnancy

On the day of my I.U.I. (intra-uterine insemination) I called the sperm bank at Hadassah Hospital to tell the bank manager that I needed to collect today. She told me to come at 11 am and that it costs 350 shekels. Before that I have to do one last blood-test and ultrasound as a final check. I went through all the steps in a relaxed state and as slowly as possible as I had two hours to kill until 11am. Everything was in the right place, the right size or the right thickness. We were on!

I made some phone calls, went to the cafetaria for breakfast, tried to read my book... anything to stop watching the clock work its way round, second by second, to 11am. At precisely 11am I knocked on the door of the sperm bank with my 350 shekels in cash in an envelope. She didn't want the money. "You pay downstairs at the reception and bring me the receipt."

I return to Reception. I take a number, swipe my card, get a print-out, wait for my turn, see the same woman I saw the first time I did this two hours previously. Of course I could have paid my 350 shekels then, but who knew?

Back upstairs with the receipt and we do the switch. I get the smallest galss vial I've ever seen with less than 1cm of transparent pink liquid in the bottom. This is what it's reduced to? I wonder how many sperm are in there and I make a mental note to ask. I can't help smiling when I think of al the extra stuff you get when you do it naturally. The bank manager laughs at my bemused expression. She knows exactly what I'm thinking.

I take my vial of sperm back to the IVF clininc, trying to hide it behind the piece of paper I am still carrying and trying to look nonchallent in the lift with half a dozen other people. I go to the nurse's station and hold up the vial proudly to show them. One of the nurses quickly takes it and presses it into the palm of my hand, closingmy fingers around it. Apparently I was supposed to keep it warm.

I sit down to wait thinking: they've probably all died of exposure by now. I hold the vial very tightly, perhaps I can heat it up again in my sweaty palm and revive the little fellows.

There are other women waiting for the same thing. You can tell by the way they or their husbands have one fist tightly clenched. I am about fourth on the list. The woman next to me tells me that the procedure only takes about five minutes but then you have to lie still for twenty minutes until your cervix closes. I see that she must be right as the doctor is in and out of each treatment room in a very short time and the woman only emerges much later.

The waiting area is lined with doors. I know what is behind some of them and I try to calculate how many treatment rooms there are. I  hope there are more than four or I will be waiting for more than half an hour for my turn. My hand is beginning to cramp. I try not to think of the sperm shrivelling up from exposure, cold, or from boredom maybe.

At 12.10 I was called in. I had to prize my fingers open from an hour's worth of gripping. I undressed my lower half and lay on the bed with my feet in the stirrups. The doctor inserted a metal clamp and opened it to create an unobstructed passage through my vagina. This hurt and I braced myself for more pain. Then he prepared the catheter and slowly inserted it. There was a small twinge of pain as it passed through my cervix and entered the uterus. And then it was all over. On his way out the door, the doctor passed me my book and my phone, told me to wait at least 20 minutes, and wished me good luck.

Half an hour later I emerged. "Come back in two weeks time for a blood-test," said the nurse. "Good Luck."

For goodness sake, can we do it already?

I was so close to having my first attempt at getting pregnant. I had my Hadassah Hospital morning routine for ultrasound and blood-test and could do the whole thing and be at work by 8.30am. I had sorted out Maccabi (my health fund) and the bank - I no longer had to worry about owing them money as I now had a working direct debit.

So far I had been in to the IVF clinic on the morning of the third day of my cycle, the fifth day, the tenth day and the twelfth day. As I've already said, we decided to start with I.U.I. (Intra-Uterine Insemination) which is basically the turkey-baster method with very little or no intervension. When I called to get the results on the twelfth day I was told to come in another two days. "Will that be the day of the I.U.I?" I asked hopefully.
"No, this is another blood-test and  ultrasound."

They tell me to call the sperm bank and tell them that I will be needing to collect within the week.

I am so ready to move on to the next stage. On day 14 I am told that the I.U.I. will probably be in three days time. The ultrasound doctor can see the ova still in my ovaries (I think I had two) and she reckons they're not quite cooked yet. The ovum sacs only measure in the early teens and they need to be 18 or 19 apparently. 18 or 19 what, I don't know. I don't care - let's just get on with it already!

On day 16 I go to check in at Reception. Every receptionist is busy except the one in the window marked 'Personnel.' There the woman is filing her nails. I go up to the window and hand her my print-out and notes. She begins to process them without batting an eye-lid. Suddenly there is a man behind me who is obviously in a hurry. He is wearing a plastic name badge which classifies him as personnel. He taps me on the shoulder. When I turn around he searches my breast area and, not finding what he is looking for, asks, "are you personal?"

He pronounces it 'personal' (emphasis on the first syllable and with 'al' at the end). I look him straight in the eye. I'm in no mood for any more delays. I've dealt with Maccabi, I've dealt with the bank, and I can deal with you too! "Yes," I say, emphatically, "very personal." And I turn back to the window to collect my notes.

At IVF, they tell me to come in tomorrow for I.U.I. It will be at about 11.40am after I've collected the sperm from the sperm bank. I have to call the sperm bank at 7.30am and ask them to prepare the sperm.

I had the I.U.I. on day 17 and... it was a complete farce. I'll tell you about it tomorrow.

The IVF story continues: Direct Debit or Bust

After my first round of blood tests and ultrasound on the third day of my menstrual cycle, and after being told by the hospital that I owed money to my health fund, I called the clinic at 1pm to find out the results. They told me to come in five days time for another blood test and ultrasound. Meanwhile I had to deal with the money I owed Maccabi or the hospital would not treat me.

Apparently my visit to a GP and my initial meeting at the IVF clinic, my only two visits to a doctor in ten years, had woken a sleeping monster. As the visits occurred in two different quarters of the year, I owed six shekels per visit. Add to that a few hidden administrative costs and I owed them all of 24 shekels (about $8 at the time). The woman behind the desk at the Maccabi offices (the wonderful Mika) suggested I open a horat kevah. This is merely 'direct debit' in English, but in Hebrew it conjures up horror stories of money disappearing from your bank account at the whim of the recipient, never to be returned or explained.

This is probably left over from the days when they didn't read every water, gas or electric meter every month. Rather they would estimate the bill and make compensations at the end of the year. The result of this was either a massive bill that was very hard to afford in one month, or else you found that you'd overpaid by hundreds  of shekels. The house would be credited - sometimes just before you were moving apartments or leaving the country. In effect, you had given a free loan to the electric/gas/water company which may have sent you into overdraft for which you paid interest for months. Many people in those days would do anything to avoid the dreaded horat kevah.

In 2005 there was a sense that things were better. At least there was a network of telephones and computers so you didn't have to personally visit every office and literally accompany your paperwork through the system. I signed all the relevent documents and Mika told me she would send it to my bank and the whole thing would be set up. I asked if I could pay the 24 shekels meanwhile, as I was sitting there and as I had the money. No, Mika assured me that it would be included in the horat kevah.

I went back to the IVF clinic five days later. This time I knew to sign my name on the ultrasound list before doing anything else. It was 7.30am and I didn't want to be there all morning, again. I got my notes from the nurse and rushed down to get them stamped at the reception before heading up to haematology for my blood test. I remembered to swipe my Maccabi card through the machine and get my printout. It was full of little notices in Hebrew which I didn't bother to read.

"It says here that you owe some money," said the receptionist.
"No, I dealt with it. I went to Maccabi and set up a horat kevah."
"I'm sorry, it says here that you owe 24 shekels. This is your second notice so we can't allow the treatment without authorization from Maccabi."

I called Maccabi. it was 8am and the recorded message said that the office opens at 8.30. I called the emergency 24-hour number in Tel Aviv. They told me to call the Jerusalem office at 8.30. So I waited - for a change, and then called Mika at 8.30. She got on her computer and confirmed that there had been a problem with the horat kevah. The bank hadn't accepted it. I called the bank. "What do you mean the problem was with us? Maccabi didn't send the right forms."

I called Mika back and promised to come in and sort it out, but could she please fax an authorization through to Hadassah Hospital as I needed my treatment today and they only did the blood tests until 9.30am. I really tried not to cry and I sort of managed it. Whether it was the tremble in my voice I don't know, but Mika faxed the OK and I was through to the next level.

Up two floors, take a nunmber, give blood - only two tries this time before striking gold, put the vile of blood in the heart-shaped plastic basket in the lab, back to IVF. They were way past my name for the ultrasounds but I was first on the list so I went straight in. "Call at 1pm for instructions." And I was back at the bus stop at 9am. I'd halved my time. This was getting easier.

Back at Maccabi Mika discovered that although a new horat keva can be set up via a request from the health fund, a previously cancelled arrangement required me to go to the bank and reactivate it. I was puzzled. Had I ever had a horat kevah for Maccabi? Then I remembered. We had all had one about 15 years previously, before health care became a pay-as-you-earn tax. When that came into effect we all rushed to the bank to cancel our horat kevah so that we didn't end up paying twice.

One trip to the bank and it was sorted. And my phone call at 1pm told me that I had to do the whole morning routine at the clinic again in two days time.

Entering the IVF System or On the Fifth Day I Waited

I had done all the blood tests and acertained that I didn't have HIV, hepatitus C, diabetes, and various other conditions. My donated sperm was waiting for me at the Sperm Bank and my FSH count was high (basically the number of eggs you have left). I was very optimistic. I'd opted for IUI without any intervention. This is, to put it simply, the proverbial turkey-baster method. They take the sperm and squirt it into the uterus with a catheter. No drugs. No procedures. I just had to come to the IVF department five days into my cycle for a blood test and an ultrasound. In this way they would start monitering my ovulation. "And start taking 5mg of folic acid a day." No problem.

On the fifth day I set the alarm at 6am. I got up and showered (I was going for an ultrasound) and was out of the house by 6.45. On the bus at 6.55 and at Hadassah Hospital at 7.25. Smug? You bet! The unit opens at 7.30 and N had told me to get there early or I'd be waiting around all morning. By 7.30 the queue was already starting to form.

I waited, with my notes from the blood tests and my letter from the Sperm Bank, to see the nurse. She told me that I had to get my papers stamped at reception and then go up to the fourth floor where I would give a blood sample in haematology.

I went to reception and took a number. I waited. At last my number came up and I went to the vacant window. "Where's your printout from your health fund?" asked the clerk.
"What printout?"
"You have to swipe your card through the machine on the wall and you will get a printout."

I went to swipe but I had lost my place. I took another number and waited again. Meanwhile, I read the printout. It seemed that I owed Maccabi (my health fund) some money. This was confirmed when I reached the window again. "You have to go to Maccabi and sort it out. If it comes up again we won't be able to give you treatment."

My notes were stamped and I went to haematology. There was a corridor full of women ahead of me. I took a number and waited, again.

When it was my turn I went in and sat down. I'm not nervous of needles but apparently I have very narrow veins. I once tried to donate blood and they couldn't find any. They eventually took it out through the back of my hand. Not pleasant. I explained about my narrow veins. The nurse wasn't interested. She took blood from a hundred people a day and she certainly didn't need my help in finding it.

The needle touched my inner elbow and I winced in anticipation. Then I felt it go in. Actually it didn't hurt at all. "Interesting," said the nurse, "you do have narrow veins. I'll try again over here." She tried again. "Maybe give me your other arm?" This time it worked. I took my blood and returned to IVF.

"What have you got there?" asked the nurse.
"My blood sample. Where should I put it?"
"You were supposed to take it to the lab in haematology."

I went back upstairs. And it's not just back upstairs. It's downstairs, along two corridors, across the reception area, past the coffee kiosks, up two flights of stairs, and along another corridor. I deposited my test-tube of blood and returned along the corridor, down the stairs (two flights), past the coffee kiosks, through reception, along the corridors (two) and up the stairs.

I was ready for the ultrasound. I retrieved my file from the nurses' station and added my name to the list. I was number 33 and she was only just seeing number 15! I looked around the waiting room. There were only six women waiting. Where were the other 12?

Slowly other women began arriving. I recognised some of them from the queue in haematology. They sat down without signing up for ultrasound. One of them was called in and her name was crossed off the list. She was number 16 for ultrasound and yet she'd been after me for the blood test. The penny dropped. What an idiot I was. Of course you sign up as soon as you arrive - before you get your notes stamped, before you go to haematology, and you're already on the list!

I went in for my ultrasound at 10.45am. It took five minutes. "Call us at 1pm and we'll tell you what to do," said the nurse when I returned my file.

At 11am I was waiting for the bus to go to work. 3 1/2 hours. Three years later and after about a hundred of these early morning sessions, I'd got it down to half an hour. One time I was back at the bus stop by 7.50am. But back in February 2005, I wasn't planning to become a regular fixture in IVF. I was planning to be pregnant in about two weeks time.