The human body consists of 12 biological systems that carry out specific functions necessary for everyday living. The circulatory, the digestive, the endocrine, the immune, the lymphatic, the nervous, the muscular, the reproductive, the skeletal, the respiratory, the urinary and the integumentary (skin); all systems that keep us alive. We also have many organs; five of which are vital and essential for survival – the brain, the heart, the kidneys, the liver and the lungs. Just as we are so reliant on the effective functioning of our human body, we are just as reliant on our human spirit. They come as a pair, this human spirit and this human body. Unflinching and resilient, they can be put through the test – time and again – and still triumph over adversity, with their resolve still intact and carrying their bruises as proud badges of honour. If one falters, the other overcompensates, never letting go. Like a pact. Like a promise. Like yin and yang.

Lately, I’ve been thinking about just how remarkable these two lifelines are. During the last 2 weeks, I’ve been watching episodes of The Handmaid’s Tale. Fictional – yes. Plausible – probably not. It is set in the future of mankind. Other than an already-exhausted storyline of a ruling fundamentalist regime that treats women as property of the state and where fertile women are forced into sexual servitude, it is largely based around the notion of collapsing fertility rates as a result of sexually transmitted diseases and environmental pollution. I do not know about the worldwide prevalence of STDs, but I do know that infertility is on the rise. And many people believe it to be because of environmental and lifestyle factors.

The hardships, pain and trauma inflicted on the handmaids got me thinking about concentration camps of the past – and present. It got me thinking about the people whose bodies and spirits go through so much; and about those that survive. This led me to reflect about traumas that near, far and dear ones have faced – or are facing – and how they have survived. I further pondered over ‘smaller’ inflictions, injuries and discomforts that we all face. How we endure and overcome illnesses, both in our physical selves and those around us. And how our body – time and again – stands tall. How our spirit – time and again – has proved that it cannot be broken unless we break it ourselves.

On the 16^th of January, I started the preparation for my 4^th IVF cycle. A period of downregulation followed by stims (injections) again. Then the egg collection (in sedation), fertilisation, followed by the 6-day wait to blastocyst stage. If you’d like a re-cap on the whole process, have a read here.

(I am still finding it difficult to comprehend that I have been through multiple rounds of IVF. I once had vouched never to go through more than two rounds, and I cannot believe I’m done with number 4. Again, I reiterate: could IVF be disguised as an addiction after all?)

Did you know that the brain is the only organ that can ‘sense’ pain? When we feel pain anywhere in the body, it is the brain that is ‘feeling’ and sensing it. It is the body’s pain receptor. That is why, when the brain is being operated on, there is no pain because there is no other sensor in the body that can, well, sense pain for us. FACT. (This side story has a purpose.)

I have come to develop a ‘method’ whereby I can ‘minimise’ any pain felt by simply thinking outside my brain. It is actually really difficult to describe in words, but it’s something that I have stumbled upon accidently whilst going through the various physical pains over the infertility years. For example, during the IVF cycle just gone, I found I could somehow reduce the pain during the injections by simply ‘thinking outside my brain’. It lasts for a few seconds only, but it’s there – the pain subsides. As bizarre as it sounds, it is real. Not only does it work for injections, but for other inflictions and interventions too. (Again, this side story has a purpose too.)

On the 27^th of February, we found out that this cycle was unsuccessful too. That’s 6 weeks of putting my body and spirit through the test again. And we survived.

On the 16^th of January, I also underwent a ‘mock’ embryo transfer (or ET, as we like to call it), in the form of ERA. The Endometrial Receptivity Analysis (ERA) test is a biopsy to determine the window of implantation (i.e., to determine the period that is most receptive for me to have an embryo in the uterus for higher chances of implantation.). It is sensitive to the hour (± 3 hours). For most women, the period of receptivity is standard. For others, it can be shorter or longer, and this test is advisable if embryo implantation has not been previously successful. The results demonstrated that I am indeed late responsive. In other words, I needed to have the ET done 12 hours (±3 hours) earlier than standard.

As I said before, the ERA test is a mock ET. This essentially means that the body is prepped as if it was going to be receiving an embryo; but instead of the embryo, a biopsy of the endometrial lining is taken. So, the drugs to prep are the same as before. This time, I had some undesirable side effects; the not-so-glamourous haemorrhoids and a fissure. (I thought I had gotten all the prodding covered; it turns out there was still one more hole left.)

You know, we were actually advised and offered to take the ERA test last summer, before we had the ET. However, after much consideration, we decided to not go for it because, “Many people get pregnant naturally. I’m sure Jaya’s embryo doesn’t know that it has to reach her womb on Day 5, and Isabelle’s embryo doesn’t know that it has to reach her womb 12 hours earlier.” (That was my reasoning. And my gut instinct was against going through the ERA test. In addition to actually feeling physically sick every time I thought about more treatment, more tests, another 7 weeks of more drugs, and so on, I had no energy left. I had already been ‘on treatment’ since April 2018.)

(And, just to be clear, both Jaya and Isabelle are figments of my imagination.)

Then, when the ET failed in September last year, it was obvious that the next plan of action would need to include the ERA test. I couldn’t go through another round of IVF without having the ERA test. It would not make any sense.

As I normally do, I voiced my thoughts with people around me. I was explaining my reservations of ERA to two of my friends. Upon hearing me out, one of my friends stated the obvious; “In natural conception, it’s biology that is doing the work. And biology knows best.” So simple; yet so true. (One of life’s mysteries is biology. Or so I believe.) This simple statement made me warm towards ERA.

The biopsy is actually undertaken in the consultant’s room. It does not require theatre-action. In the comfort of the room, in the presence of the consultant, the nurse and my husband, this ERA biopsy is the most painful thing I have come across (unsedated). Yet, I didn’t flinch. My body was patient and brave. My spirit was strong. I did that thing where I ‘think outside my brain’. And my doctor was impressed. She said that I am “So, so stoic”. And because of that, she was able to go in and take not one, but three biopsies. Because both my body and spirit have shown – time and again – just how resilient they are.

“So, so stoic.” This is what I remember most from that day. And I wear it as a badge of honour.

The preparation for the ERA test began on the 31^st of December 2018. I had my biopsy on the 16^th of January 2019. That’s 17 days of putting my body and spirit through the test. And we survived. Again.

[Stoic (noun). Definition: a person who can endure pain or hardship without showing their feelings or complaining.]

This is what all human bodies and human spirits have in common. In face of hardship, we survive. And thrive.