The silent sorrow of unfulfilled longing

The avalanche of correspondence I got in response to my memoir is a poignant reminder of the pain and shame of infertility which affects many couples, writes Martina Devlin.

I thought it was something I could address briefly and move on, but I was wrong. Two years ago I wrote an article for The Irish Times about "baby hunger", as I called it - that overwhelming urge for a child which once colonised my life.

As a result of the feature, I was asked to write a book about my experience.

I hesitated. I suspected my feelings of loss, despair, alienation and victimisation at parenthood denied were not unique, and that other men and women shared them. Yet I was loath to revisit the wasteland of those baby hunger years, to re-inhabit the pain.

I wrestled with the reluctance to surrender my privacy, with my fear of opening a Pandora's box of might-have-beens that I could not seal up again.

And then I remembered how savagely, utterly, desolately alone I had felt, during those years, and I agreed. There were dozens of reasons not to write the book and only one to do it, but that single reason was compelling.

Other hearts were hollow and other people felt isolated, disenfranchised, stigmatised. So I wrote my memoir simply to let them know they were not alone.

Then I hunched down and waited, wondering how those to whom I hoped to reach out would react. I was not left long in suspense. The Hollow Heart precipitated an avalanche of correspondence from across Ireland and Britain - women and a surprising number of men, who struggle with the grief that is childlessness.

Nothing prepared me for the level of reaction, for the honesty with which people revealed harrowing details of their thwarted efforts at parenthood, for their raw anguish as they articulated what childlessness means to them. Often I was the first person to hear their story.

It was a poignant reminder that infertility affects a great number of us, although a combination of pain and shame keeps people silent. Some estimates suggest one in seven couples will face fertility problems; many are putting their faith in IVF, in-vitro fertilisation.

A minority beat the odds and bring home a baby - success rates vary between 15 and 20 per cent - but it is no miracle treatment. Or if it is, the miracle is highly selective. The majority of couples who try IVF fail, and are left mired in a pitiless landscape - a vacuum of bereavement and incomprehension.

I was one of those people who turned to IVF for my miracle. As a newly-married woman in my early 30s in Dublin, I longed for a child more than anything in the world. It went beyond a craving - it became an overwhelming urge. The more I was denied my baby, the more desperate I grew. Three IVF cycles ended in failure, destroyed my marriage and annihilated my self-confidence, for a time.

Hardest to come to terms with, however, was the belief that I was alone: singled out for punishment. I questioned myself mercilessly. Did my inability to conceive represent an intrinsic failure on my part? Could I have succeeded if I had been a better person, a worthier mother? Had I failed because I was fundamentally defective?

It was only later that I realised many of the emotions I experienced are universal. One woman wrote to me: "My family does not know we went through the treatment and I hope to keep it that way. All through my years of tests and three IVF cycles I told no one, not even my sisters, because I did not want to be seen as faulty goods or, worse still, pitied."

A man spoke of feeling flawed because his low sperm count was the blockage, and of his guilt that it was his partner who had to hand over her body to the medics. She became pregnant but miscarried at 19 weeks, and he said: "That was easily the worst time of my life. We cried together for a week at least. I can't help wondering what our baby boy would have been like."

Stigma surrounds infertility, a perception of fault. My own childlessness happened when I contracted a bug during a loving, long-term relationship - it was not, as one reviewer suggested, brought on by an "affair" I could "barely remember". As a result of this infection my Fallopian tubes became warped and blocked, and fertility treatment was my only hope of motherhood.

I had no idea what I was signing up to at that IVF clinic: all I cared about was the chance of motherhood it offered. We handed over our money with blind faith that a baby was the inevitable corollary, and failure was traumatic.

Some couples can weather the demands of IVF more readily than others. Some even manage a happy ending, I'm glad to say, but we expect it to happen for all of us. While the cure does exist, it operates in random fashion - there's no rhyme or reason, sometimes, why one couple hits the jackpot and four or five other couples are left empty-handed.

Random. It's a cruel word.

The trouble is we tend to see IVF as a quick-fix solution - we live in a quick-fix society and place absolute faith in the medical profession. The stark reality is that the majority of us are left disappointed, and this is not discussed. As a result IVF is perceived as a panacea for childlessness, a treatment that's virtually guaranteed. Unsuccessful couples suffer in silence, too ashamed, too raw, too saturated in grief to discuss it even with close friends and family. It's one of the last taboos. I want to tell them that their grief is legitimate. That it is possible to mourn the absence of something from your life. And that it is essential, having acknowledged it, to move on.

The lack of guarantees is no reason to shy away from trying IVF, but couples need to manage their expectations. IVF has enormous physical, emotional and psychological ramifications and they can take their toll on a relationship.

The pressures are intense. In our case, all my husband and I wanted was to be a family - not such an overweening ambition - but after three failed IVF cycles we were no longer even a couple.

People don't realise how demanding the treatment is, that it's hi-tech medical intervention. It requires a woman to take a heady concoction of drugs which set her hormones whirling madly. This cocktail overrides a woman's menstrual cycle and puts her into a fake menopause, then another barrage of hormones turbo-charge her ovaries into overdrive. Instead of producing one egg a month as normal, she grows numerous eggs - I managed 14 the first time, little battery hen that I was.

These eggs were extracted under anaesthetic and fertilised with my husband's sperm, converting into embryos. In each of my three IVF attempts, three embryos were returned to my womb, at which point the men and women in white coats stepped aside. (I liked to think of it as a Caesarean in reverse.) Then it was a case of going away, resting and hoping for the best. On each attempt I miscarried all three embryos after a few weeks. Maybe-babies though they were, I was devastated. I still mourn them, years later.

The physical stresses are exacerbated by the emotional ones: by the fact that, when couples finally reach the IVF stage, they're in the Last Chance Saloon. They can be extremely vulnerable, feeling as though every other option has been closed down.

IVF has the potential to make men feel sidelined. One man told me he waits in the car because he feels extraneous in the clinic while his partner has her injections and scans. "I felt I was just a number, or a mechanical sperm factory with no feelings," he said. Such stories remind me that couples urgently need counselling if they choose the IVF route. It's not enough for clinics to take our money and shunt us through the system, or to tell us counselling is available if we choose. It should be mandatory and it should be routine because it's essential at every stage of the process.

Another issue is the unhelpful attitude of some senior doctors who wag the finger at women for delaying motherhood, implying their fertility problems are the result of reckless deferral.

Of course it's easier to have a baby in your 20s than in your 30s, that's an inescapable biological fact.

But we're not delaying because we're selfish, because we're prioritising our careers or our social lives; in many cases we're doing it for financial reasons. The reality is that most couples need two incomes to pay a mortgage and run a home.In addition, some women are waiting until they meet the right man - and they're getting their knuckles rapped for that.

Women do need to be encouraged to have children sooner, however - I wish I had been. We don't have an infinite amount of time, because while we may have taken control of our reproduction in terms of preventing pregnancy, we're not in charge of the conception end. After 30 it is tougher to conceive, after 35 it is trickier again. Instead of demonising women, we ought to recognise this as a problem for society as a whole. It's not just women who have babies, after all, it's couples. Incentives should be put in place to persuade women to have their babies sooner and employers and government can take the initiative with workplace creches, tax credits and other motivations.

Yet inevitably a number of us will face fertility problems, and most of us who try IVF will fail. So is there life after baby hunger? Here's what happened in my case. In the wilderness of the aftermath, I believed I was confronted by a brick wall, my life plan in ribbons.

By and by, however, I realised that walls can be tunnelled under, scaled over, shimmied around. Beyond that wall lay nieces and nephews, 11 of them, and they have been a source of joy, helping me to re-engage with life. That's the wonderful thing about families: they're inclusive - there's room in them for aunts and uncles, babysitters, godparents, friends. And believe me, they do help hollow hearts to plump out again.

The Hollow Heart by Martina Devlin is published by Penguin, price €13.99