on ivf and eating disorders

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i write this on the ‘other side’ of our first cycle of ivf. everything went well – far better than i had any right to hope for – but it still ended up with a negative pregnancy test last weekend and, after a slightly delay while all the progesterone worked its way out of my system, the appearance of my period yesterday. the constant and gruelling nature of ivf hasn’t really left much time for anything else recently. we’ll try again in a few months (probably) but it’s bloody hard. it’s bloody hard for anyone. it’s really bloody hard when you’ve got an eating disorder.

i feel that i should start by saying that i don’t think my eating disorder is the cause of our infertility. everything is as good as it can be with me and i responded very well to the various drugs. when we started trying to conceive (a long time ago now), i was probably the healthiest and happiest i’d been for a long time. the eating disorder was definitely in remission and my relationship was food was fairly uncomplicated; it continued that way for a good 18 months (the fact that it got more complicated again is nothing really to do with the infertility). lots of people who have/have had eating disorders conceive naturally. some people who have/have had eating disorders need some help. it’s the luck of the draw really. (i should also add that i’ve also only ever had relatively short periods of amenorrhea in the past too).

for someone with such a litany of mental health diagnoses to their name, i’m actually pretty laid back about the big things in life and so i didn’t feel like the ivf process, in itself, phased me much at the time. with the benefit of hindsight though, i can see that there were some elements that i really struggled with and which were directly related to the eating disorder.

for a start, ivf treatment is predicated on you (and by you, i mean the woman) being at a normal bmi. when you’re trying to get away from measuring your self worth by your bmi (and when a lot of eating disorder treatment is based on you falling to a certain bmi), this can be hard. some people may have happily been in recovery for years and suddenly find themselves needing to drop weight, often pretty quickly. for others, like me, it means putting on weight. i basically binged myself into a healthy bmi. it did not help my mental state at all.

once you cross that first hurdle of actually being eligible for ivf, you have to face the fact that lots of people are going to see you with very few clothes on. of course, they’re all medical professionals and they see hundreds of vaginas a day but that doesn’t change the fact that you have to wander round in a flimsy hospital gown or lie on your back, legs akimbo, with five or six people staring intently at your naked body. in some ways, i found this part the easiest to dealt with (partly because i was always a bit more worried about triggering my ptsd but mainly because quite a lot of the procedures require a (very) full bladder and i normally had to concentrate all my energy on not wetting myself). but the fact remains that i am far from happy with my body and far from happy about having people see it. (side note: i was also self-conscious because of scarring from self-harm but that was generally ignored by everyone much to my relief). added to this is the fact that the hormones and all the follicles that grow inside you often lead to bloating (and weight gain) and you have a recipe for feeling shit about yourself.

clearly, for the ivf to work, you need to be eating three meals a day and eating a relatively healthy diet (there are also some other dietary suggestions they make – like lots of protein and full fat milk – which i tried to follow as much as i could). on the whole, i managed to eat regularly because i was so worried that my failure to eat would be the reason that the cycle didn’t work. it was, it goes without saying, hard particularly as you are advised to limit exercise both before and after transfer.

what i struggled with the most though was that the regime of drugs i was on required that i eat at certain times. there were some drugs that i had to take with food in the morning, some which i had to take on an empty stomach (ie at least two hours after eating) and some which i couldn’t eat for at least an hour afterwards. i had to take those latter two drugs three times a day. there are simply not enough hours in the day. so i was having to desperately force myself to eat or not to eat at certain times and i spent all day consumed with the thoughts about when/what i would next be eating. controlling my food intake is so deeply ingrained as a coping mechanism (particularly in times of stress) that to have it controlled by something else was, frankly, unbearable and it was also somewhat unexpected.

if this had resulted in a positive pregnancy test, i’d probably have a very different view. it will surprise nobody (least of all my psychiatrist) that i’ve stopped eating very much since we found out that the cycle failed. i was only really embracing recovery (to the extent that i did) for the sake of a future pregnancy and although this is certainly not the end for us, it seems that much further away now. my eating disorder is absolutely loving it.

obviously though, i need to be at a healthy weight for another cycle and i can’t cope with the idea of not giving the embryos that we have in the freezer the best possible chance of life. but there’s part of me that’s terrified of doing it all again (possibly with the same outcome) and so losing weight seems to be the best option. and so, yet again, i feel like i’m stuck in the middle of a war zone.

i know that we are incredibly lucky to have access to ivf treatment and, in particular, that we ended up with a fair number of high quality embryos so the odds are in our favour.  i certainly don’t take it for granted at all. when/if we go again though, i can only hope that, in the end, it’s all worth it.

stirring dull roots with spring rain

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on friday, my psychiatrist and i agreed some rules for april. unless i make what he described as significant progress by the start of may, he will suggest that we take a break from treatment and i consider my options. for the last few months, i’ve been stuck in a sort of half-recovery, doing just enough to avoid getting into serious trouble but not really trying as hard as i know that i need to.

the rules are simple. don’t lose any weight. three solid meals a day, totalling at least 1,200 calories. reducing the bingeing that has crept in to twice a week, max. no purging behaviours. basically all the stuff that ‘normal’ people do (except maybe the bingeing).

april needs to be the month that i crack this. partly because being kicked out of treatment (even if it’s done in the nicest possible way) will be (yet another) way in which i’ve failed but primarily because we’re hoping to start ivf this month. my missing period turned up over the weekend so i need to call our clinic tomorrow morning to get the ball rolling; a prospect which is both more terrifying and more exciting than i can put into words.

sadly, yesterday – the 1st april – wasn’t much of a success. it was perhaps slightly ambitious to try and stick to the agreed rules and host easter lunch for my in-laws at the same time. at the moment, any kind of social occasion – even one in my own home which i am firmly in charge of – generates a huge amount of anxiety which generally translates into all the behaviours that i’m not supposed to be engaging in.

it astonishes me that we’re in april already. the year is slipping past, lost in a blur of bingeing and restricting and purging. i don’t want to go on like this. today is going to be a better day. it has to be a better day.

{title quotation from the wasteland by t.s.eliot}

god, how i ricochet between certainty and doubt

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i started writing a blog post on friday afternoon. it was full of positivity. i’d eaten breakfast and lunch. i’d made an appointment with our fertility clinic to discuss next steps. it felt like something had clicked into place and that i was going to beat the eating disorder. i was even considering cancelling tomorrow’s appointment with a nutritionist because who needs that? i was feeling pretty fucking good.

and then, somewhere between the stress of eating in a restaurant, a difficult session with my psychiatrist and the realisation that i am nowhere near at peace with the underlying cause of (this bout of) my eating disorder, it all went a bit to shit.

i sat at dinner on friday night in one of my favourite restaurants, too anxious to be able to let go of my husband’s hand under the table. every ptsd-battered synapse in my brain was screaming at me to run. but i couldn’t because we were out with some extended family and i had to be polite. by the time we finally managed to escape into our cab home, the anxiety was overwhelming. my therapist has given me all sorts of techniques to try and manage the anxiety but when i’m in the middle of the storm, i feel like i can’t do anything other than give into it. and so, when we got home, i waited until my husband fell asleep and then binged on anything i could find. anything that would make me feel something other than that crippling anxiety.

and that’s really set the pattern for the weekend. the sense of being out of control on friday night – both of my environment and of myself – spilled over into a saturday which alternated between restricting and bingeing and, just to top it off, some laxative abuse. because what else are saturday nights for? i’m sure at some point i used to have some kind of life that didn’t look like this shambles.

today i’ve tried to get some control back the only way that i know how. by not eating. this morning, i cooked brunch. avocado toast (because we like to pretend we are millennials) with crisp rashers of streaky bacon and some imperfectly fried eggs (in my defence, it was actually my first time frying an egg). and then i didn’t eat anything. instead, i ignored the messages from my psychiatrist pleading with me to eat and tidied up the spare bedroom because, clearly, when all else fails, i can tidy (i’m aware that this is just another way to impose control).

i wish i knew why i woke up on friday feeling certain that i was strong enough to beat this. and why i woke up this morning and couldn’t even find the strength to eat the miserly portion if yoghurt i usually let myself have. and i really wish i knew when i was next going to have a moment of believing that i can actually do this.

{title quotation from sylvia plath}

my doctor told me to stop having intimate dinners for four. unless there are three other people.

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very briefly yesterday, i had a flash of what it felt like to be ‘normal’.

my parents came round for sunday lunch to mark mother’s day. we had champagne to start and then sat down to twice cooked chicken with chilli sauce and kaffir lime leaf salt (more delicious than anything with such a pretentious title deserves). with it, we had wild rice and green beans and crisp broccoli, roasted with garlic and ginger. and i ate. and i wasnt anxious about eating. that is mainly because i had cooked everything and i’m sure that the champagne helped (as it always does) but still, it felt like a step forward.

and then, because i’d eaten and, paradoxically, not felt guilty about eating, i decided to make myself feel guiilty by punishing myself with a binge. it wasn’t a massive binge – nowhere near the scale of friday’s – but it was a deliberate and conscious act intended to remind me that i’m worthless and don’t deserve to enjoy anything.

one thing that my eating disorder has shown me is how central food is to my life and how, without it, my world has become so limited. i’ve used a litany of excuses after the last few months to avoid social situations where i will be expected to eat. when i’ve had no choice – generally because my mother has mandated my attendance somewhere – the anxiety that it has provoked in me has rendered me unable to focus on anything else. how can i engage with other people when i’m so consumed by what’s on (or not on) the plate in front of me?

i’ve never really been comfortable eating in front of other people, immediate family aside. i can trace this back to the very start of my disordered eating habits; it’s the seed from which the last twenty years of restricting and bingeing has grown. i never ate lunch at school. the anorexic voice in my head (which i didn’t recognise or acknowledge as being that at the time) told me that anyone who saw me eat lunch would automatically think that i was fat and greedy. even though i know (and knew) that people are generally far too self-absorbed to really give that much thought to what anyone else is eating. i think this is relatively common with eating disorders; when you spend most of your time thinking about food and what you, and everyone else, is eating, you expect other people to do the same.

clearly now, the idea of eating anything in front of anybody other than my husband or parents is too terrifying to contemplate but i can also see that, even when i’ve been ‘healthy’ (ie not now), this anxiety has both limited and also dominated my life; even simple things like choosing my food in a restaurant based on what i think other people think i should be eating rather than what i actually want to eat.

so when i think about what ‘recovery’ might be like for me, i realise that actually, i don’t know because i’ve never been there. yes, there have been long stretches of time when the eating disorder has been quiet but i’ve always felt its presence, just waiting for me to slip up and fall back into its arms. and, frankly, the idea of not having it there anymore is simply bloody terrifying.

{title quotation attributed to orson welles}

every morning, for every human being, is in some sort a morning after the night before

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last night was not a whole lot of fun. for the first time in my life, i ended up eating so much that i was sick. not deliberately sick but self-induced all the same. i ended up going to bed at 7.30pm leaving my husband to fend for himself all evening. this meant that i woke up at 4am this morning so now my body clock is totally confused and doesn’t really have a clue what’s going on. i feel like i’ve got a hangover despite not having had a drink for a long time. i’m still feeling quite nauseous (did a quick 10 minute yoga flow and thought i might vom during a downward dog) and uncomfortably bloated. more than that, it feels like my whole body hurts and i’ve actually just emailed my doctor to ask if i’m okay to take some codeine for the pain or whether that’s a bad combo with the sertraline / diazepam / olanzapine because the naproxen that i’ve already taken isn’t touching it. mentally, i’m all over the place, my thoughts jumping around trying desperately to avoid thinking about the things that i don’t want to think about. and i’m feeling pretty sorry for myself.

but today is a new day.

it’s saturday and i can hear my husband moving around. although it’s raining, the temperature is mild enough that i need the balcony door open and all i can hear is birdsong. it’s starting to feel like spring is in the air although i mainly say that because my hayfever seems to have started up. our plans for the day include sorting out the little garden we’ve been trying to cultivate and painting one of the walls in our bedroom which has remained unpainted since we moved in 5 years ago. tomorrow my parents are coming for lunch and i’ve planned an ottolenghi feast from the nopi cookbook. on monday, we’re getting a new floor in our bedroom to replace the cheap carpet that was only ever meant to be there for a few months and on tuesday we’re getting a new bed with a super comfortable mattress delivered.

last night was a new low for me and the thought of feeling like that/this again is terrifying. bouncing between starvation and bingeing for the last couple of weeks has taken its toll. it isn’t the way that i want to live my life. if i thought anorexia was all consuming, this form of ‘recovery’ (which i know isn’t really any kind of recovery) is a hundred times worse. i’ll be honest and say that, for the immediate future, i think that i will be clinging even more strongly to the restrictive eating habits which make me feel safest: i’ve cleared the fridge, freezer and cupboards of the foods i’ve been hoarding to binge on (not that there was a huge amount left) and although i generally think that our bodies are perfectly able to detox themselves without any help, i’m definitely going to make sure i consume a lot of water today so that i can feel like i’m flushing out all the crap that’s floating around inside me (even if all it is really doing is making me wee a lot).

when i was in the throes of bingeing last night, i couldn’t see a future. today, i can. for the moment, that may involve making my peace with anorexia and letting it have its way but i’m hoping that, eventually, last night will be a turning point.

{title quotation from the slaves of solitude by patrick hamilton}

even the dust would be running away

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today i really want to run away from my life.

i had a challenging session with my psychiatrist today. i think, ultimately, it will be challenging in a good way but the fall out has been pretty intense.

after a rough few days of bingeing, laxative abuse (the glamour) and self-harm, i’d found a little bit of relief in my familiar patterns of restriction. my weight – the number which dominates my thoughts from the moment that i wake up to the moment i go to sleep – had been settling after yo-yo-ing around by half a stone or more.

and so, i was feeling more like myself. or, at least, more at peace with myself.

and then my psychiatrist asked me today what i think the future holds with and without anorexia and, fundamentally, which future i’d prefer. and i honestly couldn’t answer. i can recite the reasons why i should want to get better without pause but i can’t picture what that life looks like. i know it’s not sustainable to keep losing weight and that the only place that leads is a hospital but the idea of a ‘normal’ life that’s not dominated by my relationship with food feels further away than ever at the moment. even though i had many years of just that before this relapse.

so i came home and i binged. it’s over 5,000 calories so far and i’m not sure it’s finished even though i’m in so much pain that i can barely move.

i think we have broadly come to the conclusion that i’m not really ready to recover yet. or at least i don’t want it enough to change. all i want to do is to see that number on the scales go down and therefore not to feel like my entire world is crumbling around me; which it does at the moment.

i’m just so tired of this constant battle though. there aren’t even good days and bad days really anymore. they’re just days and each one seems like such a struggle.

{title quotation by ali smith}

life itself is the proper binge

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i had a dream last night that my husband and i argued over what type of waffles we should have for breakfast today. not only is every waking thought about food at the moment but it’s clearly started to invade my sleep as well.

the picture above isn’t today’s breakfast, needless to say, but a picture of some spectacular chicken and waffles that i ate at poppy and rose when we were in la for our honeymoon a couple of years ago. the buttermilk waffles were crisp and tender. the coating on the chicken was heady with seasoning and the meat was juicy and lucious. the smoked honey butter that it came with had just the right balance of sweet and savoury. god, it was bloody delicious.

i put on a fair amount of weight on our honeymoon (which was a slightly extravagant five week jaunt). it wasn’t a huge surprise really given that we ate out at least once, if not two or three times a day. i even ate foie gras carbonara (twice); surely that is the height of excess? there was no bingeing or restricting though, just a real and thorough appreciation of the good food that i was eating.

it’s just under two years since we went on our honeymoon. it was, without a doubt, one of the best experiences of my life. it came after a stressful few months filled with our wedding, a major operation for me and a long wait for the outcome of the police investigation into a historic allegation of rape that i’d made. we finished our trip staying in an apartment a few blocks from venice beach. on the last day, i went for a walk by myself and stood at the edge of the pacific ocean with my toes in the still-freezing water and realised that everything was going to be okay.

for most of the last two years – and the last year in particular – it hasn’t felt that way. i’ve never had to battle so hard and so constantly. and in that fight, i feel like i’ve totally lost myself.

twice in the last week, i’ve binged. i’ve not really binged since october so it’s been a shock to the system to say the very least. my doctor has said that it’s totally normal and part of the recovery process; my body is screaming out for calories and it will do anything to get them. last night i binged until the early hours of the morning, clearing out the fridge of anything that i could eat quickly and mindlessly. as a result, the number on the scales has risen hugely and my breakfast this morning has consisted of 200mg of sertraline and a laxative. i know this is wrong on all sorts of levels but i’m powerless to stop it.

of all the disordered activities that i partake in, i find bingeing the most shameful. our society does not look kindly upon those people who just can’t stop eating. they’re greedy and fat and unable to control themselves. i feel all of those things about myself when i binge and it just reinforces every negative self-belief that i have. but, just as restriction serves a purpose, bingeing also serves a purpose for me.

after i went to the police to report my rape, i had to give a video statement. if needed, this video could then be used in court in lieu of me giving evidence. the process lasted for two hours and went into all sorts of intimate detail that i never expected to have to tell anyone, let alone a police officer that i’d only met ten minutes before. my video interview was at 11am and i was too nervous to eat anything beforehand. after it was finished, i was supposed to go back to work. i didn’t (at least not immediately). instead, i went to buy as much chocolate as i could afford at hotel chocolate and gorged myself until i could think of nothing more than how sick i felt. only then was i able to force myself back into the present. that pattern continued throughout the two years that it took the for the cps to finally come to the decision not to press charges.

last night’s binge wasn’t related to the rape or any of the ptsd symptoms that characterised my long period of binge eating last year. but i felt anxious and sad and defeated by the thought of the fight ahead of me and so i binged. and today i know i’ll restrict.

and so the cycle goes on.

{title quotation from julia child}

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