Fertility vs. Career: My Two Pence on Kirstie’s Latest Crusade

Like many other parents, I’ve been reading the reactions and debate prompted by the interview with Kirstie Allsopp in yesterday’s Telegraph with great interest. And whilst I neither passionately agreed not disagreed with many of the statements in the piece, I found myself, for the second time in 18 months feeling like she may have slightly missed the point.

To be fair to Kirstie, I’m not sure that these comments were ever supposed to be the focus of the interview, which was initially intended to promote an upcoming craft venture and began by discussing the death of her mother – which carried important messages in itself that have been largely ignored in the media storm that’s followed.

To be fairer still, her appearance on Newsnight, where her opinions were not subject to the direct sweep of an editor’s hand, she was able to clarify that women should “Do what you want, but be aware of the fertility window. Make your choices in an informed way. This has been a taboo topic. People have not discussed it.”

That is a statement that I can wholeheartedly agree with: The idea of informed choice (not so much the part about it not being discussed. Are there really many women who aren’t aware of the finite nature of female fertility?) And that statement contrasted sharply with the slightly prescriptive and didactic tone of her opinions as they were written in the Telegraph article.

You see, I don’t believe that there can be a “one size fits all” approach to when to have children, which was the first thing that struck me on reading it. Her thoughts seemed like a mass over-simplification. It seemed to me that there were too many assumptions being made. Such as the fact that finding a partner – the right partner – to have children with is easy. Many people simply aren’t ready to settle in to a relationship that, if children result from it, will be ongoing to a greater or lesser degree, until they are older and have matured more. Had “life experiences” or “found themselves”, use whatever cliches you will, but I know that I was a very different person at 28 to the one I was at 21.

Kirstie’s pathway also relies on the fact that all women have the kind of support from family that allows them to disregard some of the financial implications of having a family young – such as the cost of housing, whether rented or bought. Sadly that isn’t the case for vast swathes of the population.

And finally, there also seemed to be the massive assumption that starting a career as a thirty-something is any easier than conceiving as a thirty-something. For many people fertility hasn’t yet become as issue in their mid-thirties, and equally some people will establish careers successfully at this stage in their life. But we cannot ignore the fact that society is not set up to accept this “alternative” pathway, and for many women the barriers are huge either way. And this is why I think Kirstie is missing the point. The problem is not simply when women choose to have children. The issue is much bigger than that.

I’m writing this from the perspective of someone who has done exactly what Kirstie seemingly advises against. I spent over six years at University and subsequently established a successful professional career. Then I settled in to a relationship (and got married, though that is slightly beside the point) where I wanted to have children. For me, that urge did not arise until my late twenties, and had nothing to do with my career, and everything to do with simply not wanting children until then. So we bought a house together and then had a baby, at the age of 31. You could say it’s easy for me to disagree with Kirstie based on my circumstances alone.

But I’m not naive, I know that it doesn’t work out that way for everyone. And I’m also writing this from the perspective of someone who is knee-deep in infertility and all the heartache it brings – one of the very things we are supposedly being warned about. We’re the prime example that even if you start well before 35, the unexpected can happen. For us, that was Ian’s fertility “dropping off a cliff” at the age of 32. In short, we’re a prime example of just why a “one size fits all” approach won’t work. And for us, the very fact that I have a good career has allowed us to afford all of the expensive fertility treatment necessary to (attempt to) overcome our problem. (The bill now stands at around fifteen thousand pounds. Infertility is an expensive business.)

I’m both lucky and unlucky. Unlucky that we’ve been hit by infertility in the way that we have but so lucky that I managed to essentially “have it all” initially with both a career and family elements falling in to place. And it really is luck, as much as anything else. For the heart of the matter, the root of the problem, is the reluctance of society as a whole to accept, never mind support, anyone trying to do more than one thing at a time. Women are constantly derided for trying to do it all, warned they are foolish for putting career before family or lambasted for “only” wanting a family, yet often totally unsupported In the workplace if they try to combine both things.

I agree with Kirstie that, in general, fertility is the most immovable obstacle. We can’t overcome the hurdles that nature has placed with any amount of medical science. In an ideal world, it would be the priority. But for that to happen we need a societal shift. What is really missing is the support for women entering careers later in life and an end to pervading ageism. And what we really need is an end to the notion that family and career are mutually exclusive options. We need greater acceptance of flexible working options for both men and women. We need more affordable childcare options. And we need an end to the attitude that work and family can’t co-exist. We need to eradicate the fear – an the opinions and policies that drive it – that women instinctively feel for their careers when they begin to contemplate family.

So yes, I think Kirstie has missed the point. I don’t think the answer is to tell the daughters of our generation to focus on having babies first at the exclusion of all else. Nor do I think we need to remind them that they don’t have all the time in the world in which to have children, because I think that message is already being delivered loud and clear. I think the focus should be on changing the attitudes of all the children of our generation – both male and female – and our own attitudes at the same time. We need more help for everyone to live their life the way that is right for them, without having to make a choice about whether “family” or “career” dictates the way.

Right now, Kirstie’s suggestion might well be the best of all options, but that in itself isn’t good enough.

On the Flip Side…

A couple of days on, I’m concerned that my last post may have come across as unnecessarily negative or self indulgent, and that perhaps it requires some balance.

For starters, I’m acutely aware of how many alternative scenarios I could be facing that are infinitely worse than anything I’ve ever experienced or am facing now. It may be a big deal to me in this moment, but in the grand scheme of things, it’s a minor blip.

I’ve spent my entire life refusing to be someone who says “It’s not fair”, because, frankly, that is only stating the obvious. Life is intrinsically unfair.

Perhaps the most difficult part for me is the lack of control. I’m used to working to get what I want and holding no one accountable but myself if I don’t get to where I want to go. And whilst I’ve made changes to my lifestyle and devoted hours to monitoring and recording my “fertile signs”, doing everything in my power to optimise our chances of successful conception, ultimately there is only so much that I can do. At the end of the day, much of it is out of my hands and comes down to chance, or to good old-fashioned luck. It’s hard for me to get my head around that.

I feel sometimes like my body is saying “no” to me, which is not something I find easy to accept. As someone who has met a lot of narrow minded prejudice in my life, I’ve learned always to be clear with people that they shouldn’t tell me not to do something that I really want to do. Not to tell me “no” based on their own assumptions of what they could, or would, do if they were me or in my position. The greater the barriers people raise, the higher I will jump, or the further I will go, to get around them. I  generally set a limit on my limitations rather than letting my limitations set a limit on what I can achieve. I can assure you that without this attitude I wouldn’t be where I am now, doing the job that I do, living, and having lived, the life that I do.

But none of this works when then problem lies in the way that your body works. Or doesn’t. I can’t go any further or work any harder, and my passivity is translating in to negativity.

On the flip side, at least I’m used to things not really working how they should. I’m used to unexpected twists to the journey and I’m used to getting bad news about my health. Even a commonplace broken leg for me had to be complicated by the simultaneous rupture of my achilles tendon which led to three surgeries and a total of more than six months in plaster. I never do things by halves, and perhaps my biggest mistake is allowing myself to be surprised that this isn’t going smoothly.

The positive side of all of this is that I’m built to cope. If I can’t direct my strength and determination into actually making it happen myself, at least I can direct it into re-setting my expectations and coping with the journey.

And not giving up.

Flowers on the piano

Broken

I’ve been a bit quiet lately, both online and off. It’s not for a lack of things to write about or share. It’s not even as simple as a lack of time, although things have been exceptionally busy. It’s more down to a lack of motivation and a slide in to reversed philosophy of not doing today what can be put off until tomorrow. That, and every time my thoughts turn to my blog, or to other parenting blogs – and hence Twitter too – with so many sibling tales and happy pregnancy announcements throughout, they can’t help but turn to the baby we keep failing to conceive.

I never meant for this blog to turn in to a “trying to conceive” blog. And I certainly never dreamed it would become an infertility blog. When I first wrote about trying for a second child back in February, we’d already been trying for a number of months and I made the decision to share because I wanted to touch on the subject of the extra stresses that are associated with the experience when you have diabetes. I honestly thought at that time that we wouldn’t have too much longer to wait, so it seemed like the best time to cover the topic.

But here we are, eight months down the line, no nearer to having another child but with the newly acquired diagnosis of “secondary infertility”. The cause, if any, is as yet unknown. And I’m starting to really feel the strain. Even Ian’s attitude of calm, relaxed patience is starting to falter. Time and again he’s been the one to remind me that it’s “normal” for this to take up to a year. But just this week he has conceded that though this statistic is often bandied about, we know very few people who have waited that long and then suddenly conceived without fertility treatment. In fact, we know far more people who have experienced accidental surprises, or fallen pregnant on their first try.

Somewhere along the line this has stopped being about a desire for a nice tight age gap – although the number of Phil & Ted’s pushchairs at the local park is still a stark reminder of what we now won’t have. But these days it’s about desperation to complete the family I aspire to, whilst slowly losing hope that it will happen at all. I feel as though I’m surrounded by pregnancies, or families with more than one child. I know it’s partly because I’m focused on it, but it’s hard to do anything else when you want something so badly. It’s hard not to wonder why it seems to be working out for everyone around me.

I’ve tried to be positive about this. I’ve tried standing the typical questions on their head and asking not, “why us?” but instead, “why NOT us?”

I think it’s probably selfish to believe that we’re somehow more deserving of an easy ride than any other couple and I know just how lucky we are to have one fantastic child. But yet I can’t help but think that I’ve already dealt with enough crap and, in particular, enough of my body’s failings. Whilst no one else may deserve to be in this position either, I think I’m justified in wishing for a break.

My entire medical history, not mention life story, is too long and too boring to share here. Besides, I don’t care for the medical one-upmanship that abounds across the internet – there is no competition or prize for the longest list of bodily ailments. I prefer to focus on living well despite limitations. But here are some of the important facts of the matter: Diabetes pre-dates my earliest memories. I literally do not know what it feels like to live with a body in full working order, to not be reliant on an external supply of an essential substance that most people barely even know about, never mind take for granted. Then, following a run in with meningitis as a teenager, I’ve dealt with a life altering diagnosis which severely limited my freedoms and opportunities at precisely the time of my life I should have been seizing them. Instead, I was seizing in an entirely different way. To this day I live with brain circuitry that is dependent on medication for its proper function. And whereas many people couldn’t tell you where their pituitary gland is located, I’m intimately familiar with each of the hormones it produces and what can happen when their function goes haywire too.

I live with a broken body. Bloody hell, I live well – a good life – with a broken body. But I think it’s understandable that just sometimes I wish my body would do what it is supposed to do, without the need for medical assistance, without any hiccups. I’d like for things to simply work.

I’m not normally one for reading horoscopes (I mean, come on, can those little paragraphs really each be so applicable to one twelfth of the population?) But at the hairdressers earlier, the page in the back of a magazine caught my eye. Under my own sign, it included the statement “eventually life runs out of ways to torture us”.

Today, feeling down as I do, I couldn’t help but wonder when that time might come for me.

Why I Believe Fertility Support for Women With Diabetes Needs a Rethink

Like a lot of women with diabetes, I spend a lot of time ensuring that people see that it doesn’t have to interfere with life and that there aren’t very many things that I can’t do. We don’t want or need special treatment in most ordinary circumstances in life. That said, it certainly complicates life at times, and many things need a little more thought and planning. Pregnancy is an obvious example. Women with diabetes can, and frequently do, have happy healthy pregnancies with happy healthy babies at the end. But it does take a lot more planning and effort to achieve than for many women without diabetes.

Pregnancy prep, for a diabetic, begins many months before “trying to conceive”. Current available evidence suggests that the risk complications is reduced if blood glucose control is at optimal pregnancy levels for some months prior to conception. Most experts seem to recommend a minimum of three months of good control. And this has benefits for the mother-to-be too, as very rapidly tightening control after learning about an (unplanned) pregnancy is associated with a greater risk of worsening any pre-existing eye complications, or bringing new ones on, as well as a much greater risk of hypoglycaemic unawareness and severe low blood sugars – potentially dangerous for both mum and baby.

Pregnancy standard of control achieved for the requisite time, you get the green light to start “trying” in the normal way in the hope that a positive pregnancy test will soon follow. Except, obviously, sometimes it doesn’t. In the presence of good control and regular cycles, there is nothing to suggest that this might be related to diabetes. But all the while that tight control needs to be maintained.

Unless you live with it, it’s impossible to truly understand what that means, but here is a small flavour: Testing blood sugars frequently (up to ten times per day) day-in, day-out. Counting every carb that passes your lips and calculating the corresponding insulin dose. Restricting dietary choices in pursuits of better post-meal blood glucose levels. Aggressively correcting high blood sugars whilst trying to avoid too many lows. Dealing as best as possible with the hormonal ups and downs of each cycle and their effects on your carefully calculated control. And doing that over and over as each month your period arrives and your pregnancy hopes fade.

Vibe CGM Graph

Trying to conceive can be trying for everyone, but trying to conceive with diabetes is a double whammy of struggle.

If you’re under 35, like other women in the UK, women with diabetes are expected to endure 12 months of this roller coaster of trying and waiting until basic fertility investigations are carried out on the NHS. By this stage the obsession over blood sugars has already been going for at least 15 solid months. You then spend month 13 of “trying to conceive” getting blood tests done on appropriate days. And possibly month 14 having these repeated in the hope of a different result. Then you might wait anything between six and eighteen weeks to be seen by a fertility specialist (unless you opt to pay privately, of course). All of which adds up to over 18 months of super tight diabetes control. Two pregnancies worth, before you’re even pregnant.

It’s easy for outsiders to dismiss, to tell you to take a break and that it won’t hurt. Even my GP suggested to me that I stop trying quite so hard to keep my control so good, and if I did happen to fall pregnant I could quickly “sort things out” then. It’s easy to say if you won’t be the one unable to move on should that pregnancy end in miscarriage, forever wondering if those weeks of slacking were the cause. It’s also easy to say when you don’t understand that “sorting it out” isn’t always as easy as it sounds. Because where blood sugars are concerned, stability breeds stability and chaos breeds, well, chaos. Keeping on the level is hard work, but comparatively easier than creating good control out of a mess.

I’m well aware, as someone who wants to minimise the impact of diabetes on my life and health, that we should all be striving for tight control for our own sakes, not just our unborn children. But there is a difference in the level of control required long term to reduce the risks of complications and the extra level required to really minimise the risks to a growing baby. The difference is that just two weeks of terrible control in a forty week pregnancy is a relatively long term. Two weeks in the three decades of diabetes behind me and the many, many years still stretching ahead of me is comparatively tiny. I can slip up for a few weeks, slack off and only test a few times each day. I can take a break between CGM sensors if I so choose and I can be lazy and let my pump infusion site run on for four days because I don’t feel like changing it. In the grand scheme of things it won’t make much difference, unless you throw a potential pregnancy in to the mix. A baby is the biggest motivation for good control ever. But it’s also the biggest fear factor.

I can’t say it often enough that people with diabetes on the whole don’t want to be treated any differently than those without. For the most part there is no need. But sometimes it’s essential. Our pregnancies aren’t managed in the same way as pregnancies which aren’t complicated by diabetes, and I don’t believe that the assessment of our fertility should be either.

I wouldn’t for a moment suggest that women with diabetes should somehow jump the queue for fertility treatment and I fully understand and support the general need to wait a while before testing fertility, as most often all that is required is time. But for some people all that time will turn out to be a waste, because pregnancy could never have been achieved without some form of intervention. That is sad, and hard enough to bear for any couple. But for a woman with diabetes who has driven herself to burnout in all the months of obsessive control, it’s even harder.

The basic fertility tests offered to women who’ve been trying for a year are relatively inexpensive in health service terms and I believe that they should be offered sooner to women in this position. Even if it’s just reassurance that all the effort is worth while because there is nothing obvious going on and pregnancy is as likely as for every other couple. If the news is less good, then at least it’s possible to make informed decisions about diabetes management moving forwards. Because what is the comparative cost to the health service of managing pregnancies in women who have tired of all the hard of work of diabetes and burned out long before the successful conclusion of a pregnancy? These women are at increased risk of miscarriage, need even closer monitoring in pregnancy, have increased risk of needing a caesarean delivery, and increased risk of birth defects or still birth.

Obviously this is something about which I’m very biased, impatient as I am to have another child and as burned out as I am by controlling diabetes right now. I know that every women who is trying and failing to conceive is desperate for answers and wants them as soon as possible. What I’m trying to illustrate is how dealing with an all-consuming chronic medical condition makes this process harder. I’m constantly baffled by how we are left to struggle yet the moment the second line appears on a pregnancy test, there couldn’t be more help on offer.

I could certainly have done with a bit more support on this journey. It’s amazing how much better I’m beginning to feel now that we’re finally getting it.