It is certainly a privilege to be able to offer as sophisticated a procedure in our hospitals as IVF. While over 300 babies were born through IVF between 2013 and 2019 alone, let us not turn our backs on the other side of the procedure, the ‘unsuccessful one’, if you will, and how our laws must cater to all realities of IVF.
Karen Zerafa knew she wanted to be a mother since her childhood. The only question was when. “My desire to have my own family, irrespective of the relationship I had at the time, led me to get married at the age of 24”, she explained further.
Zerafa suffered several sexual health issues during her marriage, such as infections that led to a sexually transmitted disease and pre-cancerous cells in the cervix. Following several treatments and a laparoscopy, doctors realised that Zerafa also suffered from Polycystic Ovaries (PCOS), which proved to be a setback.
When IVF was still a taboo
“At the time I was given Clomid, as IVF was not an option in Malta, and we did not have the financial stability at the time”, Karen explains, seeing as seventeen years ago IVF was still a taboo on the Islands, and couples considering the procedure spoke only to their nearest and dearest. “Though they tried to help in their way, I believe no one could ever understand the pain and the heartbreak unless they have been through it themselves”.
Clomid proved to be very challenging when it came to mood swings, hot flashes and hormonal changes, and was unfortunately futile in Zerafa’s case. “At one point I was even told that I was wasting my time and should start IVF, otherwise I would never become a mother”.
No one could ever understand the pain and the heartbreak unless they have been through it themselves.
At this point, Zerafa tells us, her marriage had come to an end and her dream to become a mother had to be postponed once again until she began a new relationship. At the beginning of 2016, she finally saw the little pink plus sign. “I was thrilled because it meant that I was able to conceive naturally, but at the same time horrified as I was spotting. Indeed, I was miscarrying”, she explains.
Two weeks after her miscarriage, Karen was told her application with Mater Dei’s ART Clinic had been chosen for the next cycle. “I had mixed emotions. I was looking forward to starting the cycle, but I did not have enough time to regain my strength and energy. I had to wait a couple of weeks to undergo an ultrasound to confirm that my uterus was clean and that there was no need for a dilation and curettage. The staff at the ART clinic was very supportive and helpful. We were also offered psychological support”.
Karen soon learned to use fertility drugs and inject herself daily for ovarian stimulation before going to work. Her ultrasounds revealed to her that she had an inverted womb, which she says felt “like your body is being used – trial and error, but it helps doctors decide whether to increase or decrease dosage”.
One of the more difficult moments during the procedure, Karen describes, is the waiting time from the pick-up, when mature eggs are retrieved, to when the patient is informed how many eggs have been fertilized. “I remember during the call I was informed that only one would be transferred but during the embryo transfer, the embryologist informed me that another one had fertilised so instead of one they will transfer two”, which meant that Karen had a better chance at conceiving.
“I received the grading of the embryos ahead of the end of the cycle, about two to three days before, and searched online to try to understand what the results said. I even forwarded the result to my gynaecologist. My hope faded, and for the nth time, my body failed me. Days later I received a call from the ART clinic to give me the blood test results. They were very compassionate, but I could sense from her tone and from her words that IVF was not successful”, Karen explains.
Zerafa’s IVF bill reached €3,000 at the end of the road, and she adds that the procedure being (eventually) completely free of charge will certainly help more people start a family.
Karen tells TheJournal.mt that “as long as the biological clock does not stop ticking, there is always a ray of hope”, and therefore the present legislation needs to be overhauled, and any restrictions removed so the Maltese can have the same opportunities as citizens of other countries.
As long as the biological clock does not stop ticking, there is always a ray of hope.
“If we have a state-of-the-art hospital and labs, as well as very good professors, consultants, doctors and embryologists, why should we go abroad? Why should we restrict age? Why are we imposing restrictions? Why don’t we have the same opportunities as others do? Each woman’s biological clock is ticking and cannot wait for the policymakers to make changes”.
She also highlighted the need for better awareness of the subject, particularly for couples undergoing the procedure. “Couples need to be prepared ahead of the IVF treatment of what the process entails, the difficulties, the emotional and psychological implications, how to handle stress and disappointments, and even how to handle people’s comments”.
The importance of speaking up
Zerafa described speaking at Partit Laburista’s conference last week as though a weight had been lifted from her shoulders. “I wanted to speak up to challenge myself, and to make everyone understand that it is time to act. This is the 21st century and the matter should no longer be subject to discussion. I believe more private individuals should speak up, as this puts more pressure on the policymaker and eventually kicks-off discussions to change the law”.
Nisa Laburisti President Nikita Alamango echoes this claim, telling us how “having real people discussing these issues goes far beyond the statistics. Behind the number, there is a human being and a story. We believe there are changes to be made at a legislative level to give couples a fighting chance”. Alamango also expressed her belief that the State should cater for all, including PGD and surrogacy.
Asked what kind of emotional support anyone going through the procedure would need, Karen Zerafa replied that empathy and support are crucial. “People have their own beliefs, but that does not make them experts in the field. Sometimes they are neither empathetic nor supportive. There were many times I had to attend baby showers only to then cry my heart out. There were many times I had to hear that ‘the best gift in life is the birth of your child and their arms around your neck. There were many times I had to celebrate Mother’s Day in silence”.
Accepting she would never be a mother was very much like bereavement, Karen explains. “The thought of motherhood can become an obsession, which at the end of the day will lead you nowhere. Seek other things that make you feel good about yourself, communicate more with your loved ones, and be open to discussions. That was a good healing process for me”.
Karen Zerafa is just one of many women whose dreams of motherhood needed to be pushed aside due to different situations. While one should take the time to grieve and seek the necessary support, Karen also reminds us that “life has more to offer, and a woman can be much more than a mother. Not having children is not the end of the world, there is much more that we women can accomplish”.