On November 16, I’ll begin fertility treatment. The date is circled in the calendar but every time I look at it I’m filled with dread. Why? Because I don’t know if I want to go through this process. And I likely won’t know until I’m in the thick of it.
How can I possibly prepare for parenthood if I don’t know how – or perhaps more importantly “if” – I’ll make it to pregnancy?
I find myself thinking of this while swilling a perfectly chilled white wine around my glass in the kitchen of my friend’s flat. She’s cooking, I’m getting drunk – which is both helping matters and, well, not.
Talk turns quickly to children, as it often does for childless women in their thirties – especially ones with unanswerable questions like I have swirling inside my mind incessantly.
In Britain, women wait until around 30 to have their first child, and are under considerable pressure to choose if and when to do it. And that pressure is increasing, especially for millennial women.
I, we, hate it. It’s not as easy as, “Yes, I want kids” or “No, I don’t”. Nevertheless, it seems to be a consistent point of contention, whether we like it or not.
My friend and I share more than a loathing of children-chat and an appreciation for cheap Sauvignon on a school night. We both have endometriosis, which makes natural conception difficult; have miscarried in the past and have struggled enormously with pain, sexual trauma and less-than-dad-worthy partners. I also have polycystic ovarian syndrome (PCOS), a chronic illness that, amongst other things, impacts my fertility.
“I don’t want kids,” she says. I say I do and we both smile at each other. It’s hard to know how to want something you know you might not be able to have. I tell her this. She nods, then begins to cry.
For people struggling with fertility, pursuing parenthood is a negotiation with heartbreak.
It’s not just about whether or not you’re capable of raising children. You have to weigh up the intense journey ahead of you. You have to want it so bad you’re willing to risk your physical and mental health for something – someone – you may not even hold in your arms at the end. Or, compromise with the shame of choosing not to have children.
I’ve always thought I wanted children. After all, society teaches us to want kids. I never interrogated that want until I found out about my infertility. Turns out, for me at least, it’s not until you’re being forced to truly consider what having children might mean for you that doubt creeps in.
Reports on ambivalence towards motherhood are exposing the distress of indecision, and cultural shifts towards normalising ‘childfree by choice’ perspectives are holding the limelight (and rightly so).
But indecision is a privilege of able-bodied people. Those of us struggling with infertility and disability must decide either way. We don’t get to put our trust in fate and allow for accidents to happen. For us, everything must be chosen, again and again. And so, we must think about everything.
The weight of ‘what if’ is heavy on the shoulders of people like me. What if I have multiple miscarriages? What if IVF doesn’t work? What if it does and I end up with postnatal depression – could I handle that? Would I survive all of this? What if what’s left of me after this process is unrecognisable? What if I can’t salvage myself? What kind of mother would this make me?
Meanwhile, you make appointments to speak with the right doctors and nurses and jump through hoops that toy with your sense of self.
Fertility care isn’t as accessible as people think it is. For example, different NHS trusts have different criteria. For those in Barking and Dagenham, changes were made to eligibility criteria in April 2023 so that women up to age 40 can access up to three cycles of IVF.
My trust required me to be under a 30 BMI for six months before I could access fertility care, which I can only access up to the age of 40 and am eligible for two cycles of IVF treatment.
People with PCOS can experience unexplained weight gain as part of their symptoms, on top of their infertility, and are likely to develop eating and sleep disorders. This is something I’ve struggled with first-hand, for years.
The only way I’ve been able to lose weight successfully and consistently is through taking Ozempic – which is not advised if you’re trying for children, or if you suffer from eating disorders (which I have done). Nevertheless, it was my doctor who recommended it to me, despite being unable to prescribe it.
The confusing part? I didn’t meet the BMI criteria for it to be prescribed on the NHS – it was too low. But my BMI at the time was too high to access fertility care.
Constantly being caught between hypocrisies like this chip away at you and cause you to feel immense shame. Meanwhile, you’re faced with a cutting singular line on every pregnancy test you do, every month, as you try desperately to conceive naturally. You never get over that disappointment.
To rub salt firmly in my wounds, when menstruation occurs, the pain caused by endometriosis is so severe that I collapse, and have ended up in hospital. It would seem that this happens regularly, as 58% of people with endometriosis end up in A&E.
Endometriosis is as common as diabetes and is responsible for a 20% increase in the likelihood of miscarriage. And yet, the Endometriosis APPG Report in 2020 found that 58% of respondents were not offered fertility support and treatment, despite endometriosis doubling the risk of infertility.
Globally, rates of infertility are on the rise. The World Health Organisation reports that one in six of us will struggle with fertility issues and has called for urgent action to increase access to affordable, high-quality fertility care for those in need.
Infertility is so much bigger and more complex than knowing whether or not you want children. It’s dealing with the constant barrage of physically painful and often debilitating symptoms that go alongside your infertility, the bludgeoning sadness of not being able to fulfil what society has deemed your womanly purpose, and, amongst it all, having to choose how much more of yourself you can risk losing while grieving the parts of you already lost.
And, it could all be for nothing. How do you come back from that?
Looking down the barrel of what I’m about to go through fills me with equal parts joy and despair. I’m privileged enough to meet the criteria, to have a shot at parenthood. But it is just a shot – and I have my limits of what I can allow myself to go through.
So, even though I know I want to be a parent, I don’t know if I want to experience what it takes to become one. Maybe, that’s okay. Maybe wanting kids isn’t enough.
Katie Baskerville is a freelance journalist covering sex, health and women’s rights. Find her latest articles on www.katiebaskerville.com or follow her @iambaskerville across social media.