Infertile In Istanbul

Doing IVF while living abroad

Image: ZEISS Microscopy

The most recent coup attempt in Turkey, which took place on a balmy Friday night in July of last year, led to the unraveling of many lives. I was in Istanbul when it happened, only to fly to New York two days later for a friend’s wedding. It was surreal to read about the purges and arrests of government workers and teachers in between visits to the Met and drinking beers with friends on the LES. Any Turk ostensibly linked to Fetullah Gülen, the U.S.-based cleric accused of masterminding the coup, felt the government’s wrath.

Amidst all the stories of careers ruined and families torn apart, it was a seemingly small tragedy that stuck with me. In the weeks following the attempted coup, the government shut down the Istanbul Women’s Health and IVF Center, a private clinic established by an Armenian-Turkish doctor, and seized everything in it, frozen embryos included. My husband and I had been trying to get pregnant for 10 months when I first read about the affected couples and their desperate hunt for their embryos. At the time, it seemed like a particularly cruel byproduct of a purge gone too far. But now, after undergoing one round of IVF and with three embryos in the freezer, the plight of these women and men fills me with inexplicable dread.

The plan was to have a baby in Istanbul, even though it was thousands of miles away from family and friends. I was working from home in a flexible position. My husband was established at his school. We fell in love in Turkey, so it made sense to grow our family here. Plus, Turks love babies and children — it’s not uncommon to see men and women alike soothing crying toddlers on the bus or cradling a stranger’s infant. I daydreamed about our potential child feeling the warmth of a loving community.

But the months kept piling up with no positive test in sight. I began reading Taking Charge of Your Fertility and tracking my temperature and cervical mucus, certain that a few small shifts would do the trick. When it didn’t, I took to message boards where posts filled with acronyms and emojis espoused the virtues of drinking an ungodly amount of grapefruit juice and wearing thick socks all the time. Surprisingly, these old wives’ tales did little more than keep me hydrated and warm.

After a year of trying, we found ourselves at the American Hospital, of all places. With white marble interiors and an in-house art gallery, the building has the aesthetic markers of a first-rate facility — it helps that the hospital, the oldest private care facility in Istanbul, sits right in the center of the posh Nişantaşı neighborhood. As its name suggests, the American Hospital prides itself on adhering to North American medical standards for physician and nurse quality and diagnosis and treatment technologies. Ironically, the care that I’ve received in Istanbul, not least its cost effectiveness and efficiency, has by and large eclipsed my experience at American clinics and hospitals.

Still, for all its flaws, medical care in the United States is held up as the golden standard. In grad school, when I casually mentioned that I bought my birth control pills in Turkey, two of my friends admonished me for not using FDA-approved drugs. “How do you even know that those pills aren’t laced with something else?” one asked. Even now, some people seem taken aback that we’re choosing to pursue IVF abroad, and insist that maybe a doctor in the U.S. or the U.K. (my husband is British) would provide better care. Just as I have to periodically reassure friends and family that Istanbul is not, in fact, a war zone, so too must I use soothing tones to convince them that my hospital and doctors are up to snuff.

The process of getting a diagnosis was relatively painless. I researched doctors on the American Hospital’s website, ultimately deciding on the head of the Assisted Reproduction Unit, Dr. Bülent Urman. When I called to book an appointment in November of last year, he was available to see us the following week. At our first meeting, he strode into his office wearing scrubs, his tall frame moving with an unexpectedly smooth gait. Two women doctors rushed in and out, handing him dossiers and giving him updates on procedures in hushed tones. In between these comings and goings, the tea lady slipped into the room and placed a Turkish coffee and six almonds on his desk as I rambled on about my menstrual history.

After a rash of blood tests, an HSG to test for clear tubes, and a semen analysis, Dr. Urman gave us the frustrating news that there’s no obvious reason why we can’t have a baby. The lack of a clear and easy-to-understand problem seems to encourage others to tell you their theory on why you’re not pregnant — diet, exercise, stress — and ways to boost your fertility. What’s worse is that a small part of you wonders if they’re right. Such is the undignified realm of unexplained infertility.

Forced to make hard choices with incomplete information, we talked through our options with Dr. Urman, who coolly summarized the latest research on IVF and IUI (the less invasive intrauterine insemination) for couples with unexplained infertility. While a number of factors influenced our decision to bring out the big guns and jump straight to IVF, it mainly boiled down to cost. The first round of IVF, including monitoring, egg retrieval, a fresh embryo transfer, the freezing of any other remaining embryos and all medications, was estimated to cost us around 14,000 Turkish Lira. At the current exchange rate, that’s just under $4,000. In the United States, the average cost for a complete IVF cycle is around $12,000 plus medications, which usually tack on another $3,000 to $5,000. To us, the choice was clear.

The relative ease with which I cycled through a round of IVF only confirmed our decision. When I was given the clear to start stimulation drugs, specifically follicle-stimulating hormone (FSH), I simply walked into a pharmacy across the street from the hospital and within minutes had everything in hand. After my husband injected me every night, we would both remark on how surreal it all felt, like it wasn’t happening to us but some other couple in a parallel world. The biggest hurdle I faced was on the day of my egg retrieval. The intake nurse only spoke Turkish, which led to a protracted conversation about what exactly I’m allergic to while I was hunched over in pain from my swollen ovaries.

No matter how lucky we have it — that we can afford to pursue IVF, that I avoided many of the procedure’s worst side effects — the disappointment and anguish of infertility is never wiped away. After retrieving fifteen eggs, we ended up with four day-5 embryos. They transferred the best-looking one back into my uterus immediately and froze the remaining three. On the day of the fresh transfer, the embryologist gave us a printout showing our blastocyst. We nicknamed it Harpus, a silly mash-up of our last names that made us laugh. Ten days post transfer the nurse called to say that my blood test was negative. I hid the printout in my desk and cried all morning. When I stumbled upon it two weeks later, I threw it out.

There are downsides to doing IVF in Turkey. Couples must be married in order to undergo treatment, and donor gametes and embryos are forbidden. Unmarried or gay? Have bad eggs or sperm? You’re shit out of luck. The system here is built for families, but only if they look a certain way.

Such a retro mold does result in broader acceptance of reproductive medicine. Abortion is a fact of life; whenever it comes up as a topic of conversation, I’m always a bit surprised at how readily friends and acquaintances discuss their abortions. In a country where single parenting is not a done thing, having a child out of wedlock is to be avoided at all costs. Likewise, if you’re married and having trouble getting pregnant, there’s no shame in seeking out assisted reproductive technology. The cleaner at my old office regularly told me about her IVF trials and tribulations over tea in the kitchen. Everything revolves around the nuclear family, a cultural construct that we benefited from as a married, heterosexual couple.

This summer my husband and I are moving to Milan. We’ll try to fit in a frozen embryo transfer before we go, assuming that my body cooperates. Regardless, any embryos that we have left will stay in Istanbul, forbidden by Turkish law from leaving the country. I don’t believe anything will happen to them while we’re away, but I’m still filled with unease. The very real possibility that IVF might not work, that a baby isn’t in the cards for us, occasionally tightens my throat. Striking out is something that no one wants to discuss. At least in Turkey we had the chance to step up to bat.

Emma Harper is a Milan-based writer and editor. Follow her on Twitter: @emineharper