Infertility, Fertility, and Subfertility

 This is a more personal post that I sometimes write, but which will serve for an introduction into a planned short series of posts on this subject.

NB, while I will try to stick to neutral terms, many of my sources do not, so apologies if I appear to flip between gendered and neutral terminology. 

Infertility affects men, women, and those who identify as both or neither. Infertility doesn't care if you are married, single; old, young; gay, straight; poly or monogamous; what race, colour, nationality or heritage a person has. It doesn't care about any of those, or anything else. It doesn't discriminate, and neither should we. 

Definitions

Fertility

Fertility is defined as "the quality of being fertile, productiveness", and while it can refer to non gestational matters, such as the imagination, it is usually used to refer to the ability to conceive children or young of any species.

Infertility

Infertility is technically the absolute opposite of Fertility, as can be seen by the quotes below:

"...infertility is defined as not being able to get pregnant (conceive) after one year (or longer) of unprotected sex." ~ CDC, USA

"a disease of the reproductive system defined by the failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse." ~ World Health Organization

"Infertility is when a couple cannot get pregnant (conceive) despite having regular unprotected sex." ~ NHS, UK

"Infertility is the inability of a person, animal or plant to reproduce by natural means." ~ Wikipedia

According to the WHO, there are three types of Infertility:

Disability - whereby infertility is caused by external factors, such as maternal sepsis or unsafe abortions. This is thought to predominantly affect developing countries.

Primary - the inability to carry a pregnancy to a live birth, ever

Secondary - when a person has had one (or more) live births, but is unable to conceive or to carry to live birth any subsequent pregnancies.

Subfertility

Subfertility is an underused term, in my opinion. Its definition is as follows: "Subfertility generally describes any form of reduced fertility with prolonged time of unwanted non-conception." ~ Gnoth et al.

Subfertility as a definition can be seen to hold a position on the continuum in between the absolutes of Fertility and Infertility. If fertility is the presence of the ability to reproduce, and Infertility the absence of that ability, Subfertility is the state whereby a person who can't reproduce may be helped.

It is notable, to me, that our local NHS clinic, is known as a subfertility clinic, rather than an infertility clinic. I like this, because for me it implies that their place is to assist people in moving towards Fertility, not in moving them Out of Infertility. 

I find that I dislike "Infertile" as a diagnosis as it feels fixed, insurmountable, and immutable. If you are infertile, then you have reached an absolute, a state which is unchangeable. Subfertile feels like a medical professional is acknowledging that you need assistance to achieve "Fertility", but that there is the potential to get there. You might need medication, assistive reproductive techniques (IUI, IVF), donor gametes, or a gestational carrier, but you have the potential to achieve "fertility"...

A Series?

So, I mentioned I plan to make this a set of posts. I don't plan to write and/or post them in any particular order, or without any other subjects else covered in between, but here is a rough list of my intentions:

1. How to get pregnant and when to be concerned
   Like many people, my Sex Ed at school focused on NOT being pregnant, and in many ways overemphasised the risks of sexual activities as MIGHT became WILL. This is intended to give a brief balance to that and then to state when you should go talk to a doctor.
2. Miscarriage - facts and support. 1 in 4 pregnancies don't make it to live birth, but we still don't talk about it. Miscarrying is horrid, but not something to be ashamed of.
3. Assisted Reproductive Techniques 1 - IUI
4. Assisted Reproductive Techniques 2 - IVF and related ICSI, IMSI, and IVM
5. Donor gametes, DNA, and genetics
6. Gestational Carriers & Surrogacy - you are still the parent
7. "Bingo!" - why saying "Think Positive" or "Just Adopt" will likely make the hearer want to poke you in the eye
8. Other ways to make a family

Needless to say, a lot of this will be UK focused, as that's where the plurality of my information comes from, but I plan to include wider international information where possible.

The intention behind this loose series is to provide a place to share thoughts and information with friends and relatives dealing with various aspects of this whole shitshow.

Having a Laparoscopy Operation

OK, so I briefly touched on this earlier but I thought I'd write it out to try and think it through.

I was due to go in for a minor operation on the 14 December but due to winter pressures on the NHS the Trust decided to cancel all non-urgent operations to make more bed spaces in the Surgical Short Stay areas. I was caught up in that and mine was one of the ones cancelled.

Thoughts from that:

• I don't cope well with unexpected changes. I only found out shortly before I was due to head in and had a panic attack trying to figure out what I should do now about work. Luckily my boss is a good person who calmed me down, told me to have that day sick and to take the next as TOIL, and then come in as normal on the Monday.
• Winter pressure is to be expected. It sucks, but I'd prefer little old ladies who have fallen to have their hips put back together again, thanks very much! What isn't really acceptable is to allow departments to schedule surgery when you (Trust) expect to send out a cancel-all-operations order. Just don't book the damn operations, so we don't take unneeded leave, and the bed spaces are there. You can always ring someone up like you did in January to give them as "last minute cancellation" if you find out you have the capacity!
• The NHS needs better funding and to lost Hunt of the Rhyming Slang. And most of the leading MPs of the current day.

So... fast-forward to a few weeks later, and I was wondering what was happening about my operation re-scheduling. I spent a week or so ringing on and off to try to get hold of someone in the department I needed to find out what I should do, if anything. One Wednesday afternoon I was chatting to Mum as I walked in the door after work and decided to have a go then. To my surprise I got through, and gave over my hospital number etc.

"Can you come in tomorrow?"
"Err." *flustered* "I would have to check with work but I think so."
"Well we'd have to book it now, if you can't then..."
"No, no, I think I can. I'll check now and ring back if I can't but I'm sure I can." *panicking now*
"OK, that's great. Can you come in at 12:30 please?"
"Yes, no problem. Is it the same as on the previous instructions re food/drink?"
We clarified that, yes, I could have BLACK tea, and some toast before 07:30, and then nothing except water from then until 10am, when it went to nil.
"See you tomorrow."

One panicky phone call to my boss later, and I was packing my bag of things to take with me. Then rang TGO at work to let him know and also to persuade him that taking the day off work was pointless - I wasn't exactly going to be around and I figured I'd be unlikely to get home before 6 anyway. Various other phone calls to my older sister to sort out nephew collection duties as usually they come to us after school on a Thursday while she does marking etc.

There were then two more phone calls from the hospital:
1.
"I'm really sorry, I forgot to ask you before. Is there any chance you might be pregnant? You know we can't do the operation if there is any chance."
"Definitely no chance."
"That's great, see you tomorrow."
2.
"Have you had a pre-op?"
"A pre-op? What's that? I don't know."
Explained what the pre-op was
"No, I don't think so. I wasn't scheduled for one last time either though."
"Hmm, well we'd better do one just in case. Can you come in a bit earlier?"
"No problem. When were you thinking?"
"About 12ish would be fine"
"OK"

Early night and early up so I could finish breakfast before 07:30. As an aside, black tea is tolerable but I REALLY wouldn't choose it! Just before 08:00 the phone rang, with the withheld number again like the other calls from the hospital, so I panicked that they were cancelling.
"We do need to do a pre-operation and we can't go ahead without it..."
"I can come in now!" *panic* "I'm only around the corner in [local area]"
"Oh!" *relief-sounding voice* "Great! How soon can you get here? Can you get here for 08:30?"
"Um, yeah, OK, no problem"
"See you soon"

So panic stations! I'd walked about so Mum had been nearby able to hear when I was on the call. She'd just run a bath so I was pushed at it, Dad was summoned and told to ring a taxi now (road works between home and hospital meant she couldn't drop me AND get to the class she was teaching for 9am). Speed wash in the bath, grabbed some clothes, put things mentioned on the letter (pills, types of clothes, pads) in a bag, shoved in some books with a charger, tablet, and phone. Had some cash shoved at me by Dad and was bundled into a cab. Husband at this point is oblivious as he'd been dropped off at the station just before the hospital rang.

Got to the hospital without any problems, and went into the Surgical Short Stay Unit (SSSU) to find out where I was supposed to go for the pre-op. Pre-Op is in the bowels of the hospital, so I got down there in plenty of time. As there was almost no one else there I went almost straight in.
Pre-Op was:

• MRSA swab of nose
• MRSA swab of groin
• Height and weight
• Blood pressure
• "Do you have any allergies or intolerances?", version 1
• Confirmation of data, part 1

All done by 09:00. I wasn't sure what to do next, so I ambled back towards the SSSU catching Pokémon. I debated walking down to Tesco nearby to get the gym there, but was worried about whether I was expected to stay on site so I didn't. Hung around in the SSSU registration area for a while until someone spotted me. Explained why I was there and that I wasn't sure what to do now, but that I didn't really want to go home and come back - could I sit in the Day Room? Nurse toddled off and came back to say they could admit me now and I could just park up on my bed and read if I liked or have a nap. So I did!

I read Ashes of Honor, some more of Games Creatures Play, and then a good chunk of The King Must Die, plus I got caught up on Facebook and Twitter (well as much as one can say caught up with either of those). I would have played Pokémon but I was tantalisingly just out of reach of the nearest stop and low on balls.

The rest of the time I had a number of visits from various people including nurses, the surgeon, and the anaesthetist, all who asked me for my allergies/intolerances, date of birth, and address. I know why they do it (so they know they have the right patient with the right notes), but it's both boring and exasperating after a while. At about 16:30 I was given my oh-so-sexy support stockings and put into the gown to be wheeled down. As I was moving from one bed area to another we took all my stuff with me to go into a locker while I was in surgery.

I came around about 6ish I think, and sat up. Lady next to me had had "growths" removed and was very groggy, but I didn't feel too bad so I stayed sitting up all the way back to the Unit. They found some endometrium where it shouldn't be, and removed it. Hopefully things will be a little better now... I had to drink a ton of water once I was in recovery because they won't let you out until you pee. My bladder was happy to take about 2 pints before it would go, so I was stuck there until about 8pm.

Other slightly random thoughts:

• My anaesthetist was great and had a funky moustache. He agreed to gas me until I was under enough to not know there was a needle nearby. Good man!
• I have a slow release bladder - I was still able to pee at nearly 16:30 before I was wheeled down, despite having drunk nothing since I was admitted at 09:30... Bodies are weird!
• Gas is much nicer than injections but I was burping it for 2 days afterwards and it tastes BAD!
• Recovery is both fast and slow - healing was very quick and clean, but I am still pretty tired 2 weeks later. It also occasionally twinges. I'm told this is because healing starts at the skin and works inwards, so while the holes are closed up now, the insides are still stab wounded.