Kathryn Blaze Baum is an investigative reporter with The Globe and Mail. She is the author of In Fertility: The Story of a Miracle and the Big Business Behind It, from which the following essay has been partly adapted.

To most people, the question in my daughter Sidney’s recent Grade 2 math homework would have been an exercise in logical reasoning and sequential thinking.

“My baby sister was born four days before the day after five days before January 2. When is my baby sister’s birthday?”

Not all that long ago, the mere mention of the word “baby” or “sister” was not a dagger to my heart but a machete to my soul.

Sid was naturally conceived without much drama, born tiny but healthy in early 2018. The path to giving her a sibling was a hellscape.

Its beginnings date back to April of 2019, when I suffered a miscarriage. It was the first of several losses in the odyssey my husband, Dan, and I embarked on to create a brother or sister for Sid.

One after another, I would add black-and-white sonograms of near-life that, for one reason or another, some known and some unknown, never became much more than they were in those hauntingly sweet images.

We eventually turned to in vitro fertilization (IVF) to help grow our family, but even assisted reproductive technologies couldn’t protect us from the heartbreak of miscarriage, from all the unknowns that come with struggling to make a baby. We had no idea what we were in for.

I now realize how common it is for fertility patients to have outsized confidence at the starting line. Most are flying blind. We don’t know what we don’t know. To boot, many patients go into the process with a baseline level of anxiety that only intensifies as time goes on.

Few minds are noisier than that of a person going through IVF. The journey, by its very nature, is all-consuming. It takes over your days, spent at the clinic or waiting by the phone or computer for test results and medication instructions. It takes over your body, hormonally and physically. It should come as no surprise that it takes over your mind.

“The pressure squeezes you,” one woman struggling with infertility told me. “Whether it’s financial pressure, the ticking-clock pressure, the sibling-age-gap pressure. It squeezes you and squeezes you.”

So many people are unable to do so.

Infertility – and the pressure it creates – doesn’t discriminate between the rich and poor. And the disparity in access to treatment is vast. If you’ve got time and money, you’ll probably be able to have a baby if you persist. One day, one way. If you don’t, you’re at the mercy of nature and luck. That’s the sad reality.

You might think that because I eventually came out the other side with a bigger family that I will be evangelical about IVF, that I will sing the praises of the baby-making industry and laud it as a panacea. But I’m not. And I won’t. That wouldn’t be my honest truth, and it wouldn’t honour or reflect the experiences of the people I have spoken with during our journey and in the years since.

There are aspects of the IVF process in Canada I believe must be improved, particularly as it relates to protecting the consumer – that is, the patient. Access to care and funding varies wildly depending on a patient’s postal code. There are some provinces and territories that don’t have a single IVF clinic. Accountability is lacking. Clinics aren’t required to publish their success rates.

There are no national, standardized criteria for disclosing IVF complications. There’s no system for regulating or licensing embryologists. There’s no licensing regime for surrogacy agencies, and the way some of them operate might even be illegal under federal law, if only on paper. Clinics push add-on services that cost thousands of dollars and might not improve the chances of conception.

Fertility patients, no matter where they live or seek treatment, are often uninformed and desperate. It’s a dangerous combination, particularly given the gaps in protections.

Patients are willing to go into debt, take out a second mortgage, sacrifice everything. As one long-time fertility doctor put it to me, there’s a “dark side” to the massive and growing industry in which people “prey on their patients’ fears.”

The measure of a successful or “good” fertility story isn’t just whether you end up with a baby. That shouldn’t be the sole metric. You can have a horrible experience and come out of it with a child. The two are not mutually exclusive.

I remember our journey so vividly, with such specific detail and emotion.

I waged that war because I wanted another baby. I needed another baby. The yearning was primal and relentless. A fertility journey is among the most punishing, consequential pursuits a human being can endure. The rest of my life faded into the background, the B plot to the main storyline. I couldn’t remember what it was like to think of other things.

I couldn’t remember what it was like to be the me I was before IVF. I was tired – so tired – but I couldn’t bring myself to make peace with my body and stop.

When I first walked into the downtown Toronto fertility clinic on a November morning in 2019, after yet another early pregnancy loss, I was hopeful.

Most of the women at the clinic appeared to be roughly my age, somewhere in their thirties. It was quiet. There was little to no chatter among patients. We were all looking at our phones or books or had our eyes cast to the floor. There was lots of yawning and coffees in hand. It was so dark outside. So fluorescent in the clinic. One thing I would come to learn about IVF is that the days tend to start early, in darkness.

Many other women had come before me and many more would follow suit, marching along the same trajectory, day in and day out: blood work, empty your bladder, ultrasound, meet with your nurse, pick up your medications, take the elevator down to start the rest of your day.

I wondered how many of them already had a child, like me. How many were there to make their first baby? Had they had miscarriages, like I’d had? Were they at the beginning of their IVF journey, in the middle or at their wits’ end?

If they were anything like I was, they were consumed not just by a grand vision for the future but also by the minutiae and microtrauma that often comes with trying to conceive. If they were anything like I was, fertility was the white noise of their life.

There was also something oddly empowering about the whole thing. I was the boss of the body that had made a habit of disobeying me. Here I was, telling it what to do through the language of hormones. It was exhilarating to feel such a sense of control.

I felt strong. Tough, even. That’s why I didn’t want to complain much when my ovaries started responding to the follicle-stimulating medications, swelling with each developing egg. I had been told to expect a bit of discomfort. I knew I was lucky to be in a position to do a retrieval so soon after signing on with a clinic. I was also lucky to be responding so well to the meds. I felt like I had no business complaining.

The more crowded my ovaries got, the more painful these ultrasounds became. The more angles the technician had to reach with the probe. The more swollen and tender everything felt. By late November, there were 20 eggs growing in my right ovary and another 18 growing in my left. That’s a lot, though not all of them would reach maturity.

I felt bloated, not just because of all the eggs I was growing but also because the medications cause water retention.

My trigger injections – the medications that would prompt my ovaries to release the eggs so they could be retrieved and fertilized – were scheduled for the late evening of Dec. 3 and the morning of Dec. 4. My first retrieval, at a cost of around $16,500, including preimplantation genetic testing but excluding medications, was booked for the morning of Dec. 5.

I remember trying to fall asleep on the eve of the procedure, entirely depleted by what was going on inside my body but also anxiously anticipating the retrieval. I rested my hand on my tummy, knowing my eggs were maturing and would soon be ready for harvest. It was wild and wonderful to think one of them could become our baby.

On retrieval day, I was led to the procedure area, which is separate from where the cycle monitoring takes place. It felt good to cross the threshold.

I stripped off my clothes and put on a periwinkle-blue medical gown with a matching disposable cap and foot covers. I took a selfie at 8:31 a.m. and sent it to my sister.

Perhaps that was for the best. But I still wish I could go back, take her face in my hands, look her in the eyes and tell her to be patient. To let go of her arbitrary timelines. To let go of looking ahead at the calendar, picturing how big her bump would be for this friend’s wedding or that family vacation. I wish I could hug her and tell her it will be a long road – but it will be okay.

I was given an Ativan, which is a benzodiazepine medication. I put the small white pill under my tongue and let it dissolve, leaving a bitter taste in my mouth. “It will help relax you,” the nurse said. Within minutes, I felt a sense of calm wash over me. The Ativan slowed everything down, gave me a full-body deep breath. My mind quieted, and I was at ease.

The nurse inserted an IV, which would administer fluids to keep me hydrated throughout the procedure, Gravol to help prevent nausea and an antibiotic to guard against infection.

The Ativan-Gravol combo sent me into the perfect peaceful drowsiness. IV pole in tow, the nurse helped me to the nearby bathroom so I could empty my bladder on the way to the procedure room.

A team was inside waiting for me, prepping the necessary medications and instruments. One of the nurses helped me onto the bed. I placed my feet into the stirrups, knees touching to guard my privacy until I had to splay them open. There’s no modesty in fertility. There’s no room for it. The work can’t be done without exposing yourself. Your body is laid out for strangers to see and to know. A certain level of intimacy is required.

I don’t remember much of what happened next. I was administered two more drugs for pain management – fentanyl and Versed, which together pulled me into a state known in the medical world as conscious sedation. Colloquially, it’s sometimes referred to as “twilight” because it suppresses consciousness without putting the patient all the way to sleep. The procedure room and all the faces around me became foggy, and then I was out.

Next thing I knew, I was back in my recovery bay, feeling only slightly more conscious than when I was under conscious sedation.

My doctor came to my bedside to let me know how the procedure went. Thankfully Dan, who sometime during all this had provided his sperm sample, had come to the recovery area to take in the information. The only thing I recall from this exchange is my doctor’s face. I couldn’t absorb any numbers or specifics, but the take-away was that the retrieval had gone well. I started to get my bearings and was able to get dressed.

Dan held my arm as we walked to the elevator and made our way to the car. When we got home, I crawled into bed and closed my eyes and prayed.

I prayed, even though I’m not particularly religious. I don’t believe in a higher being the way you do if you’re somebody who says things like “God doesn’t make mistakes” or “God has a plan.”

What got me through the relentless journey that ensued wasn’t a belief in God. It wasn’t my belief in fate. It was my belief in free will. It was my belief in my power to control my emotions when I couldn’t control anything else.

The day after the retrieval, we got a call from the clinic’s lab with an update on the fertilization. We were told that a total of 31 eggs had been extracted.

“One?” I whispered to him. He nodded and then passed me the phone.

I left our table and found a quiet spot near the restroom to speak with our doctor. There was more bad news. The results had come back from a test I had recently done to assess the structure of my uterus. It showed there was a band of scar tissue, likely from a procedure to resolve the miscarriage I’d had the April prior.

Scar tissue in the uterus, my doctor explained, can interfere with embryo implantation and could increase the risk of miscarriage. I probably needed surgery. I would have to do another retrieval if we wanted more than one shot at a baby. I hung up the phone and stood there, outside the restroom, stunned.

That phone call changed everything. Our bubble was burst. IVF was not going to be straightforward for us. Tears in my eyes, my head spinning, I made my way back to the table and explained to Dan what I had just heard.

We had already spent more than a year trying to make a baby. We felt like we were so close to an embryo transfer, on the precipice of a pregnancy, and now the goalpost was moving away from us. Dan reached for my hand and squeezed it, knowing I was gutted but putting on a brave face for Sid.

I couldn’t have known it at the time, but there would be many more devastating phone calls in our future – many more twists and turns than we could have ever imagined.

A couple of years and several failed IVF cycles after that heartbreak at the restaurant, someone who overcame infertility told Dan and me to be open to a total miracle. I remember being deeply annoyed. Easy for her to say. She was out the other side. She already had her baby.

By this point in our journey, I was all but done with hoping, all but resigned to the notion that it was over for us.

I had a while prior adopted the mantra One day, one way. But I had started to despise those words. My mantra became It will happen or it won’t, and either way we will be happy. I had to start letting go, even if we kept going. It wasn’t necessarily about doing less; it was about letting less of the pain in.

Credits

Story by Kathryn Blaze Baum. Digital storytelling and photo illustrations by Laura Blenkinsop. Portraits of Kathryn Blaze Baum by Melissa Tait. Editing by Mark Medley.