Miss Directed. Weight Loss

All of these techniques depend on accurate timing. Injections need to be given at a certain time, blood tests and ultrasound scans need to be done at the right moment, so it is often a case of early morning dashes to the clinic or taking time off work. That takes either a very compassionate and supportive employer or a decision for the woman to leave her job so she can devote her time to the quest. This in itself is a very expensive and time-consuming exercise.

In the relatively short time that these techniques have been available, they have gone well beyond acceptance in the community. It’s as though it’s become an obligation for infertile couples to give it a go, like you really haven’t done your bit if you haven’t had a few cycles of IVF. Now let’s take a look at the figures. Depending on the clinic and the individual case, IVF has a take-home-baby rate of twenty to twenty-five percent. GIFT is slightly better at around thirty percent, so that means a lot of satisfied customers who beat the odds. What it also means is that three out of four couples will go through it all for nothing more than the satisfaction of knowing that they have tried the best that medical science can offer. But at what cost? Financial considerations aside, there is a huge personal toll.

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A number of different techniques to help fertilization are now fairly commonplace. IVF (invitro fertilization) simply means ‘fertilization in glass’. Apart from being the best-known technique, it is probably also the most emotionally draining.

We have become quite familiar with the media images of delighted couples nursing their IVF twins or triplets following years of heartbreaking infertility. The woman’s eggs are collected from her ovaries, mixed in a special glass container with the man’s sperm (collected by masturbation) and, if fertilization occurs, the cells multiply over the next few days and are then inserted into the woman’s uterus. It is literally a bypass of the Fallopian tubes.

If there is at least one healthy Fallopian tube, the GIFT (gamete intrafallopian transfer) technique can help the egg and sperm get together. The man masturbates into a jar to provide the sperm. These are examined and washed by a technician. The washing process ‘energizes’ the sperm which are then transported to the operating theatre. With the woman under a general anesthetic, a laparoscope (a fine tube with a camera attachment) is inserted into her abdomen through the navel and it is used to locate the ovaries. Mature eggs are collected through a suction tube, combined with the sperm and the mixture injected directly back into the Fallopian tube where fertilization hopefully takes place. After that, it’s up to Nature to take its course.

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Some couples will choose to accept infertility and not have children. For others the need is so strong that they are prepared to do whatever it takes to overcome it, including fertility tests, operations and the prospect of repeated disappointments.

For these would-be parents it is absolutely essential to know exactly what they are in for before they make the decision to go ahead. That means understanding what the tests involve and how the whole process is likely to affect them both. All of the major fertility clinics have access to counselling services to help out with this. One of the issues that needs to be sorted out very early in counselling is whether one or both partners is secretly blaming the other for their inability to conceive. Whatever the cause, a conception of any sort needs to be a team effort. Harboring resentment against your partner for their ‘inadequacy’ will stand in the way of that. The other objective is to make sure that both partners have realistic expectations of success. It is not easy to strike a balance between optimism and caution when so much is at stake.

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For conception to happen naturally, an egg (ovum) has to be released from the woman’s ovary. It then travels into the Fallopian tube where it meets up with the man’s sperm, which is deposited into the vagina during intercourse. Fertilization takes place if one of the two to three hundred million sperm released is able to penetrate the egg, and the cells multiply to form an embryo. Once the embryo reaches the uterus, it takes another few days to implant itself into the lining of the uterus. So to achieve a pregnancy it takes a sexually functioning man with a good sperm count, and a woman with the right hormonal balance, functioning ovaries, open tubes and a healthy uterus. On top of all that, intercourse needs to take place during the fertile time of the month. This last point might seem to be stating the obvious but more than once couples have sought help for apparent infertility when they just don’t have intercourse often enough or at the right time of the month to get pregnant.

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It can be particularly difficult for someone who has been in a relationship for many years. A woman in her late fifties said, ‘My husband left over five years ago and I have been on my own ever since. Earlier this year I met a man through some mutual friends and we started seeing each other regularly. It may seem a bit silly at my age but I am thinking about having sex with him. I know he is interested. Obviously I don’t need to worry about contraception anymore but I have heard about it being important to use condoms these days. Trouble is, I have never seen one and I am too embarrassed to go into a shop and buy them.”

Thinking about new relationships after years with the one partner can be nervewracking. It’s not just the safer sex issues but the etiquettes of dating, and the skills that go with getting to know another person intimately. People in this situation know how Rip Van Winkle must have felt. Facing decisions and social situations for the first time in decades would be like emerging from a time machine.

This can be doubly difficult if you don’t have a trusted and respected friend or family member to talk to. For both men and women it is hard to admit to ignorance or relative inexperience.

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Another case where a secondary relationship can develop is when one partner becomes seriously ill or permanently disabled to the point where a sexual relationship is no longer possible, as in the case of advanced AIDS-related illness. The other partner takes on the role of carer and may remain deeply committed but establishes a separate sexual relationship.

A secondary relationship may also reflect a person’s lack of self-confidence — asking themselves if they are still sexually attractive — but it can also be a sign of a relationship in trouble. If a person is considering leaving their partner, they may well be looking to establish another relationship before they finish it. You could call it the ‘Tarzan Tactic’. Imagine Tarzan swinging through the trees from vine to vine. He won’t let go of the last vine until he has a firm hold on the next.

There is no question that the disclosure of a secondary relationship can leave a partner feeling shocked, betrayed, jealous, angry and hurt. It is frequently the cited cause of relationships breaking up but does this necessarily need to be so? It can be a good time to reassess the whole relationship.

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However, in most sexual relationships sex interacts with all other aspects of your life. Sex can be used as a weapon to manipulate a partner, surreptitiously or even overtly — for example, when one partner deliberately withholds sex as a punishment for something the other person did, rather than talking the problem out.

On the other hand, some couples can get into a situation called the ‘Fight and Fuck Syndrome’. While it is understandable that making up after a fight is a natural resolution and in some respects a reassurance that you still love each other, for some people the high emotional charge of a good screaming match loads up your sexual energy at the same time. This in itself is not a problem. In fact having sex after a fight is a practical way of releasing the tension that has been built up. It’s a different matter if it gets to the point where you need to fight to get sexually excited. In this case a counsellor would advise that you dissociate the sexual climax from the emotion of the fight, by avoiding sex after fighting for a while, and connect it with a more gentle build-up.

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