Sunday, May 4, 2014

What they don’t tell you in Biology class

I had the rare occasion of meeting a childhood friend after 25 years. Sylvia looked just the same as I have remembered her. Slim, fair, perhaps a little older as her pore-less facial skin no longer radiates that ridiculously pinkish glow it once used to.

At 39, she looks better than many women younger than her. Hell, she looks better than me.

As a child, I had always admired Sylvia. I wanted to be just like her. She had that quiet beauty about her and I honestly think she was completely obliviously of it, making her even more appealing. She had a gentle soul. She was smart, athletic and yet graceful. I thought she had it all. So when we reconnected recently, I was eager to find out how life had unfolded for her all these years.

When I saw how little she has changed physically, I imagined life is treating her well.

“I never thought I wanted one but now it’s kinda too late. I wish I had known earlier.”

I thought our dinner had gone splendidly despite my initial nerves. We ate, drank and talked for three hours but those were the words I took home with me that night, along with a bag of left-over barbecued spare ribs. She still eats like a bird.

When Sylvia told me she has been trying to have a baby through in vitro fertilisation for the past two years without much success, I was stunned for two reasons. First, there are not many women of her age whom I know who want a baby and second, the increasing number of women seeking fertility treatment in Malaysia.

According to Sylvia, it’s an emerging multi-million ringgit industry and it’s only the beginning because she pre-empts more fertility clinics infesting the city to feed the increasing demands of couples with reproductive health problems.

“If you don’t believe me, just visit any fertility clinic in the Klang Valley. The queues would make you think that Aphroditus has left town,” Sylvia laughed while I wondered why she mentioned Aphroditus instead of Aphrodite.

I’ve known Sylvia as the type who keeps things pretty much to herself. She listens more than she speaks and so the fact that she revealed something so intimate that night convinced me that she thought it was important for me to know.

“I hope I’m not stressing you out by telling you this. I don’t think women should suddenly readjust their lives because they think time is running out.” She said apologetically. I thought I saw that familiar pinkish hue on her cheeks for a split moment.

Throughout our conversation, I was conscious of the fact that Sylvia was trying hard not to appear desperate. For instance, when she talked about how empty she felt of her 10-year marriage, finally understanding her Mother’s wisdom that every couple eventually needs children in their lives, she would quickly followed the thought by reasserting how much she enjoys her career as an artistic director for an advertising company.

Like 70% of Belgian women who had their eggs frozen, Sylvia wished that she had done hers much earlier. A Belgian study carried out last year revealed that women who freeze their eggs in hope of improving their fertility in later years wish that they have done it at an earlier age. I had also read that American women feel the same way too. I wonder whether this holds true for Malaysian women as well.

Since I have no authority to speak on behalf of all Malaysian women, I shall share a brief history of my family’s fertility.

It was probably in their late teens when my Grandmothers had their firstborns. Both went on to have more than 10 children each, discounting those not carried to full term. The rate of miscarriage was quite high then but the lack of contraceptive awareness made reproductive rate even higher. So it wasn’t surprising for reproductively healthy women my Grandmothers’ generation to have an average of seven to ten children easily.

About half a century later, Mom gave birth to my brother at the age of 29. I was conceived two years later. We are only two but Mom’s siblings have an average of three children each. Dad’s have more.

I suppose it was considered late for a woman back in the 70s to give birth at the age of 29 but my parents had their reasons. Dad had just started his own business and Mom was there to support him every step of the way. Mom told me that it was one of the toughest time of their lives. The constant thought of failure and losing all their savings inevitably meant endless hours of hard work and sleepless nights. Mom said it was all worth it because what would be the use of hoping for a successful business if not to secure her children’s future?

I have just turned 38, married with no children. Both by choice. When I look at the circle of people I spend my time with, I am not an exception but rather the norm. Most of my friends are single and childless. I suspect they are happy just the way they are although I can’t be sure because these things can often be sensitive and private. So I try not to ask.

A survey by the National Population and Family Development Board revealed that the average age of marriage amongst Malaysians is 33. It could be higher now since the data is slightly outdated. Apparently, the number of those who are not married by the age of 30 has doubled since 2007. The common reasons given are that women are finding it harder to find men with equal or better educational qualifications and they have higher expectations in men than before. According to a local university associate professor, the fact that women are getting married later explained the rapid increase of infertility rate.

Many of the women I know are fiercely independent, professionally successful and generously kind. They love their jobs and enjoy their independence and why shouldn’t they? They’ve earned it by working hard and proving they can be as good as men in a society that is still patriarchal at large. Modern women make it clear to the world that they are not defined by their husbands or children. Marriage and parenting have become an option, rather than the norm.

I don’t think the single women I know are averse to marriage or children at all. In fact, I am sure many make good wives and mothers. Not wanting to settle for just anyone has been the common reason I’ve heard. The truth is, I think modern women are caught in two separate worlds – transitioning from a world that was intent on keeping them in supporting roles to one that suddenly expects them to be heroines. I believe somehow along the way, women begin to enjoy their newfound stardom but yet, they are unable to abandon their embedded biological code programmed since time immemorial to ensure the continuous survival of humankind.

I must admit that women have themselves as much to blame for making this transitional period very difficult. We can be very unkind to one another. For example, there are mothers who scorn at single women for living what they deem as irresponsible and selfish lifestyle while single women at the peak of their careers judge stay-at-home Moms as losers who cease to exist but for their children.

I spoke to my friend Siew Mei a couple of months ago and she said one of the most honest things I’ve heard in a long time.

“We’re so afraid of being judged that as women, we can’t even say out loud we want a baby for fear of being seen as a walking biological time bomb waiting to explode. It’s so not sexy anymore for women of our time to admit we want to be mothers, as if acknowledging our biological role is so shameful these days,” she said bitterly. “For the longest time I’ve lied to myself and my friends. I pretended not to have any interest in having a baby simply because I am not seeing someone. If I had a partner who wanted a baby with me, I would be the first one on that train to motherhood.”

Siew Mei is still waiting to find a suitable man who wants to be the father of her child. The last time I checked, she was still optimistic.

Now, here’s the thing I learned from Sylvia which I wish I had been told during Biology class many years ago. Many of us are aware that a woman’s fertility decreases with age. Biology says that each woman is born with a fixed number of eggs. Once a reproductively healthy woman hits puberty, an egg will be released from her ovary to her uterus every 28 days. If the egg is not fertilised by a sperm, it will shed as menstruation and this cycle repeats itself, provided the woman becomes pregnant. Therefore, a woman in her 40s would have less eggs than when she was 20 which then makes logical sense that her fertility would have reduced with age.

What was not told in Biology class is that our bodies release the best eggs first, saving the worst for last. This is also one of the reasons why the chances of delivering a healthy baby becomes lower with older women. It isn’t just because we have less eggs or our bodies are likely less fit or healthy, it’s also because we start “producing” F grade eggs.

“The doctor said I have less than 10% chance of pregnancy. Even if successful, I should have pre-natal testing to ensure my baby is normal. Apparently, if I had sought treatment before I was 35, I would have a greater chance of pregnancy but I didn’t think I wanted children then,” Sylvia said regretfully.

I asked her whether she would have reconsidered her choice if she had known this information earlier.

“Yes, definitely yes. When the doctor told us that we have the final option of fertilising another woman’s egg with my husband’s sperm, I nearly gagged. You can’t believe how humiliating it was for me to hear the doctor described the egg donors as ‘younger women in their 20s’. That their eggs are of ‘top quality’. I felt so shameful and inadequate.”

Sylvia later confessed that she had put her career and freedom above her marriage. Having a baby was on her list of things to do but it was right at the bottom, even after a trip to Bhutan. She thought she could put off motherhood as late as possible. After all, she has always maintained a healthy diet and lifestyle. She thought if Hollywood celebrities are popping babies in their 40s, why couldn’t she?

“By the way, smoking seriously reduces a woman’s fertility. It makes your eggs disappear. Seriously. I’m not kidding.” Sylvia cautioned although I had no idea why she thought I smoke.

I never thought my meeting with Sylvia could give me so much food for thought. For a start, I never thought someone as perfect as her could ever find herself stuck in this situation. I must confess that it also made me uncomfortable for the mere fact that it challenges my own choice.

She was however right by saying, “I don’t think women should suddenly readjust their lives just because they know time is running out but at least such information would allow us to make informed choices. I regret not knowing because I think I would have done what I could possibly can to ensure that I have the possibility of delivering a healthy baby.”

“If I am financially able, I would even consider freezing my eggs because if I have no problem spending thousands of ringgit traveling, why not preserving something which one day could become life?” She added.

In vitro fertilisation is an extremely costly procedure. It averages between RM10,000 to RM18,000 per cycle of fertilisation. A couple can easily spend up to RM50,000 for a small chance of getting a baby. What hope does it leave for those who have no financial means?

I think in the midst of trying to educate children on safe sex, we have forgotten the importance of reproductive health. We are so concerned about not getting pregnant that somewhere along the line, we’ve forgotten how to.

The original article was first published here on 3 May 2014.