As a doctor, I knew the statistics were on my side when it came to getting pregnant. I was 28, and in good health, with an active lifestyle. The evidence shows that 95% of couples will conceive in the first two years of trying. If you’ve been trying for a year and nothing has happened, you can speak to your GP, who will arrange tests and offer a  referral to fertility clinic. This referral happens sooner for ladies with other risk factors, for example age over 36, or reduced periods.I didn’t feel that I needed to think beyond those initial positive statistics, but 13 months in, I realised that my road to starting a family might not be as straightforward as I had planned.

From the start, I had my plan set out: I would settle into married life for 3 years, get my hospital placements and night shifts done, be done with exams, get to decide my own working hours and then, finally,  have kids.

But call it broodiness- something about helping to deliver baby after baby on the Labour ward made me change my mind. I decided I didn’t want to delay any more. If Allah blessed me with a pregnancy, I told my husband, it was meant to be and we’d handle it. Flushed with excitement and the bloom of possibility, I stopped the pills in March 2018. For the first few months, I did a pregnancy test in the fourth week of every cycle, heart thumping in my chest. That single pink line was dismaying, but it was fine, I repeated the mantra: the stats were on my side. 

A year came and passed. I had finished hospital placements now, and had joked with the Labour Ward midwives that they might see me again on the other side soon, since it was my local hospital.

Casually, I discussed the idea of a fertility referral with my husband- we weren’t worried, but what was the harm? Why not get checked out, or get the ball rolling just in case? I asked for a fertility work up from my GP, and we went through the semen analysis- an awkward situation for anyone, but for a Muslim couple? Another level. We laughed it off, comforted each other after each normal result. We awaited the fertility clinic appointment, which was with a consultant I had worked with directly during my O&G placement. She gave me a hug when she saw me in the clinic, and arranged for us to have an IVF consultation after some further investigation. I was almost taken aback that we were at this point- I had gone along with the whole referral process on the assumption I would naturally get pregnant before anything needed to be done. This whole thing was supposed to be a ‘Just in case’, not the actual plan.

I assumed we would proceed to treatment within a month or two, and describing the timeline now, it seems very easy to jump from one stage to the next. What is not so obvious is the long stretch of time between each test, each appointment, each interaction with a specialist.

The micro-anxieties, like having a hysterosalpingogram because the ultrasound suggested either an abnormality or a simple fluid bubble in my womb. Having to repeat a semen analysis because morphology was abnormal. Covid-19 hit in the middle of this and delayed all our appointments. By the time we came to discuss IVF and start the consent process, we were at the two year mark.

In the background, I noticed the increasing attention from family and the wider community, who were beginning to notice time stretching on, and still no pattering of little feet.

 As women, we accept the inherent pressure of our biological clocks if we want children. As Muslims, the role of the mother is massive, three times as important as the father. As a Pakistani, the cultural expectation, although ever changing, has been that women will not work, and will raise a family. Now, as more Pakistani women work, the expectation remains that they will raise a family alongside this.

Motherhood is woven into our cultural and religious DNA, and as a Pakistani Muslim woman, that pressure on me seemed to be tripled. 

For me, the perfect scenario would be that nobody discussed my future childbearing plans at all.

If they wanted to pray for me, I’d rather they did it privately, than announce to the room that they would pray for Allah to fill my lap.

I’d rather not be put on the spot, even if it is well-meaning. I’d rather people stayed out of my bedroom, literally and figuratively. Maybe other ladies would prefer to have a positive discussion about it. I don’t know- and I suppose I don’t know because nobody shares their experience. Infertility is a web of hushed comments and judgements, a club that everyone’s itching to get out of, and once they’re out, they’re so relieved they don’t look back.  

There were the comments from those around – a particularly abrasive aunt of my husband demanded to know (in the middle of the hallway surrounded by my in-laws) why I was ‘sat doing nothing’ with myself and told me I should get on with it and have kids. Another well-meaning family friend took me to one side and told me in a low voice that it wasn’t good to delay having children. Visiting a house where a baby had been born, the daughter-in-law of that household appraised me from head to toe and said, ‘Don’t you want kids?’. Another replied acidly to my comment that the house had been quiet with, ‘Well it must always be quiet there- no kids running around.’ Each time, I was stunned into silence.

I was astounded by the lack of sensitivity in women of my own culture.

Had they never experienced difficulties conceiving, either themselves or with their own daughters? Most were from Pakistan, having been raised there and then moved to the UK once they were married. 

There were also undertones of savage satisfaction from some, of ‘she can’t have it all, can she?’

Most women in this community did not work or have any further education, but were full time mothers and wives. It was their entire identity.

I got the sense that when I married into the family, many of these women in particular decided I was one to be suspicious of – the dreaded Career Woman. There were two schools of thought when it came to me- either I was putting off kids to forward my career, which made me despicable, or I was unable to have kids, which confirmed that I couldn’t have the best of both worlds.

 Despite the wealth of information we were given in clinic, chats with the consultant, and allowing myself to check a few online forums, the treatment still took me by surprise. Our first cycle of IVF was hard- a month of painful bloating, breast tenderness, injections, pessaries, being sedated for an egg collection.

The stress of waiting to hear if any embryos had formed. A constant rollercoaster of cautious good news, followed by anticipation again of the next step. After the embryo transfer, the technician printed the ultrasound scan freeze-frame with the embryo sitting neatly in my womb in a little fluid bubble. She said all the signs were good. I had to wait two weeks before doing a pregnancy test, and despite my insight as a doctor, I couldn’t stop getting hopeful each time I had a wave of nausea or some breast tenderness. 

I had a small episode of spotting four days before I had to do the pregnancy test. My hope didn’t waver for a second- it was likely an implantation bleed. It didn’t seem like a period at all. By this time my annual leave (scheduled around all these appointments) had run out and I was back at work. I ignored the odd pain and spotting and continued with my busy clinics. I wasn’t going to do a pregnancy test until the day it was scheduled, because a negative might be a false negative if I took it too early. 

When the cramps started in earnest, to the point that I could no longer focus on speaking to patients, I took myself to the toilet and stared in disbelief at the evidence of a heavy bleed.

Undeniably a day one period bleed. The one work colleague who knew I was going through IVF spotted my pale face, eyes glazed above my mask, and intuited what had happened. From a covid-safe distance, I burst into tears and assured her I was fine and could carry on with my clinic, and she tried to offer comfort whilst being unable to hug me. At her insistence, I stopped for a cup of tea and a chocolate bar before jumping back into my list. I didn’t want to think about it. The next morning, I did the pregnancy test anyway, even though the pain was like a drill boring into my pelvis, and my urine was bloody. I still waited for that result, and with the inevitable, cruel single line, I cried into my pillow until I felt hollowed out. That was the end of it. “Failed IVF” as I’d seen scrawled on so many notes.

Four months have passed, now. We are past the three year mark, and I know the chances of natural conception are slim at this point. We have been offered further IVF cycles, and are considering them.

What changed, since then?

I have thought about it a lot. Maybe I am not meant to be a mother. Maybe Allah is protecting me from a tragedy down the line. Maybe I won’t live to this time next year. Maybe the timing is not right. It is easy in principle, but very hard in real life, to accept that Allah may have a different plan for me than what I planned for myself, but I think I am starting to come to terms with that. 

I am trying to change how I see this period of time during which I have not conceived.

Until recently, every time a period came, I thought- what a waste. Each cycle was a means to an end. And yet- could I not have been using that time to achieve excellence in other areas? In my deen, my profession, my personal life?  Why have I just been sat waiting for the next stage of my life to begin? Could it be that Allah has something else planned for me, but it depends on me using this time and seeing it as an opportunity? After all, mothers often seem to look back and fondly remember when they had time to do other things. 

I decided to be proactive rather than reactive- so I sat and made a chart of goals- as a wife, as a person, as a doctor, as a member of my community.

How would I define success in all these areas and how can I make steps to get there? I set things in motion, I started making small changes – I read more books, I do more writing, I’ve sought opportunities to develop at work, and it has certainly helped. I have found that in my duaas, when I say to Allah that I am happy with whatever He has written for me, because I know it will be best for me, I mean it. And I feel that if the outcome of this test is that I pushed myself to become more present and achieve success in every other area of my life, then it has surely not been a trial, but a gift. 

Why write this, then? I don’t pretend to have achieved a zen state of mind. I’m still on this journey, and who knows where it will lead?

I want to say though, to my sisters who are struggling with a similar situation- I see you and my heart and duas with you. I hope you can take some comfort from this, and whatever difficulties you face, I pray Allah replaces the sorrow and the hardship with joy and contentment, even if it’s not in the form you imagined it. 

And to my sisters who know someone going through infertility- be kind, respect the boundaries set by that person, and again, be kind.  If we do not support and speak up for our fellow women, the sons we raise will not either. If we do not break the cycle, nobody will.