2013-07-15

“Offer IVF treatment to women with unexplained infertility who have not conceived after 2 years.” (NICE Guidelines, Assessment and treatment for people with fertility problems)

“Couples who experience problems in conceiving should be seen together because both partners are affected by decisions surrounding investigation and treatment.” (NICE Guidelines, Assessment and treatment for people with fertility problems)

I wrote a bit the other day about how our IVF clinic presents what they do as female-centric and functional, and how the husband and I have absorbed that. I’ve been going to the appointments and so on without the husband for the most part, and this seems to be the norm at our clinic.

But whose IVF is this anyway? Throughout the process this has bothered us.

At our clinic, IVF is presented as being all about me. It is assumed that I will attend appointments, and it is my name that is called in reception (even when the husband is there), and it is me who letters relating to appointments and progress are solely addressed to. One time the husband phoned up to make an appointment, but it was me that they phoned back about it. Not so much as a name check for the husband, like he is nothing to do with it.

Now I’m the one they are trying to get pregnant, so obviously the majority of the procedures are done on me. But it won’t just be my baby; I’m not the only one who wants the child, I am not the only one with a genetic stake in the child, and I’m not the only one who will be responsible for the child when it is born. Even if my partner didn’t have a genetic stake in the pregnancy (donor sperm, and/or if my partner was a woman) I’m sure we would still think we were having a baby together. From the perspective of the patient(s), I think in the majority of cases IVF is something that couples think they are going through together.

And then they get into it, and find that one partner is systematically and institutionally excluded.

So for us, although the husband has chosen not to go along to the functional stuff he has also been made to feel surplus to requirements throughout. It is unclear what his role is, outside ‘sperm machine’. I spoke to another couple doing IVF at my clinic, and the male partner said that he felt the clinic were ‘disrespectful’ to him when it came to this issue. So it’s not just us.

But I spoke to my friend who is a GP and she just couldn’t get her head round what I was going on about. It was so clear to her that of course it is the female partner that is doing IVF and that is being treated, not the man, so the woman is the patient and you deal with the patient. It is as simple as that.

So OK, I get it, I am the one taking pills and injections and having appointments and being sedated and having eggs sucked out of me and embryos placed within me. All the guy has to do is make a deposit into a jar. In fact, in a frozen embryo transfer the guy doesn’t have to do anything, to the extent that he has to sign a consent form in advance because he is not expected to attend the clinic at all during the process. So functionally, yes, IVF is all down to the female partner.

But I just can’t conceptualise it this way in my head. In my head, the husband and I want to have a baby together and this is how we are going to have to get that baby. But it is our baby. Both of us. And conception is about the genes of two people coming together and growing into a baby. Again, two people. I feel like when the two people are embarking on the process together it is a joint effort and both parties should be acknowledged.

The more the guy is cut out, the more responsibility for fertility the woman has to take. This is a bigger and further reaching issue than IVF, than pregnancy, than babies. Men buy and wear condoms, or are involved in the decision to stop using contraception. They attend the 12 week scan, the antenatal classes, the birth. These days many men are involved in all of this. Why should IVF be different? Men’s involvement in IVF damn well should be a gender equality issue. Reproduction is a joint responsibility. This is childcare, this is maternity leave, this is household roles. And IVF sets the tone.

Cutting the guy out exacerbates the potential for women to feel that infertility is their ‘fault’ or ‘their issue’. It is bad enough having to go through infertility and do IVF, let along feel responsible for it or guilty about it as well.

So being ‘woman centric’ is not all good for the women. It over-states their responsibility which can have make them feel bad and can have far-reaching personal and societal consequences. And generally, at a hugely difficult time this stuff isn’t great for the wellbeing of either member of the participating couple.

“Ah ha” though my GP friend would say, “you are the one being treated”. But am I? OK let’s go back to finger pointing and blame for a second. What is broken and being fixed here? If my eggs were crappy, yes I would be the one with the medical issue. If my tubes were blocked, same again. So if I’m the one with the medical issue, I’m the one to be treated.

But what if a husband had a low sperm count and his wife is normally fertile? In that case it is the man that has a medical issue to be fixed, and that can be be treated through IVF by doing something medical to the women. The man’s medical condition leads to a woman without a medical condition being treated. That’s the counter argument to me, that’s where the whole ‘treatment’ argument falls down.

And what about unexplained infertility, which the husband and I have? Having ruled out the usual suspects the doctors have no idea which of us has the medical issue. It could be one, or both, or neither. If I was with another guy or he was with another girl perhaps neither of us would be infertile at all. It is could be that it is the combination of us two together that isn’t working, so it is the combination that needs to be fixed. Any way round, for us this can only be a joint thing. And it just happens that I’m the one that has to do the legwork.

And you know what, back to basics, there is absolutely no chance I’d be doing IVF if the husband didn’t want me to. It is very much a joint decision. This isn’t like choosing whether to have a slice of cake after dinner. You’re both in, or you’re both out.

So why is IVF suddenly all mine?

I just never saw it like that.

But the NHS does.

This is more than simply a question of how functional the appointments are and whether the husband could or should come along to them. This is about whose future-baby it is, and how the NHS hasn’t noticed.

Sometimes all it takes is small changes to make a huge difference to the way that people experience things. Choice. Asking at the start of IVF who will be involved and the extent to which the partners would prefer to be involved, and directing interactions and correspondence based on this. Respect and compassion. Identifying appointments at which it would be appropriate for the partner to attend and explicitly inviting them along, producing leaflets or running support sessions specifically aimed at partners.

But I don’t think it is as simple as that.

I do believe that the way that doctors conceptualise ‘the patient’ in IVF treatment and who participants think are ‘the patients’ in IVF treatment is different. I also believe that the way that things are done is based around this institutional view and has the potential to make stakeholders in the process feel bad, and I quote ‘disrespected’. These things don’t just change. Not overnight, anyway.

Should we expect or demand different, or better? Or is this just the way it has to be?

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