I try to make my peace with the fact that if I get pregnant, I could die. I’ve suffered two ectopic pregnancies in the last 18 months, one ending in surgery for the removal of my right fallopian tube. Without treatment, my fallopian tube would have likely ruptured, causing internal bleeding and possible sepsis. Despite this, I am still trying to get pregnant. Somehow, I’m wishing for something that could put my life at risk.
An ectopic pregnancy occurs when a fertilised egg implants itself outside the womb, most commonly in a fallopian tube. While they are relatively rare – affecting around one in 90 pregnancies – the likelihood of recurrence is high, going up to around one in ten. After my second, the chances of me having another have increased once more – to one in four.
Those odds make the monthly wait to find out if I am pregnant terrifying. While desperately wishing for a positive test, I spend a large part of every month scared about having to face another ectopic. I am stuck in a two-week limbo between ovulation and my period, my emotions continually pulled in all different directions.
At my lowest ebb last summer, I had a panic attack while taking an ovulation test. The dread of the cycle starting all over again took over my whole body. When my period arrived later that month, I was wracked with guilt at the relief I felt. On one hand I was heartbroken at another missed chance at pregnancy, on the other hand I was enormously thankful that I didn’t have to cope with the pain and trauma of another ectopic or possible surgery. I was diagnosed with PTSD soon after.
The term ‘two-week wait’ (or TWW) will be familiar to women who are trying and struggling to conceive. A mere fortnight can feel interminable as the days stretch on. Hundreds of different personal experiences get bundled into that little acronym. It’s used all over the parenting and pregnancy forums that I scour on my phone at 2am. Often I’m Googling early pregnancy symptoms. Breast tenderness, exhaustion, mood swings, which are all – to my endless frustration – incredibly similar to period symptoms due to the rise in progesterone following ovulation.
During this time, those hoping to start or expand their families might choose not to drink – just in case! – or forgo hot baths or certain foods, until they know for sure. A glance at Mumsnet shows dozens of threads with the title TWW, started by women at the end of their tether. Instagram lists similar hashtags #twoweekwait, #twoweekwaitsucks, #twoweekwaitiskillingme. On Tiktok, videos of women desperately looking for signs of implantation – when a fertilised egg attaches to the uterine wall at the beginning of pregnancy – are reaching millions of views. We’re all playing the same guessing game.
Birth rates in the UK have been falling since 2010, down to 1.49 children per woman. With the increased cost of living, and the recent pandemic, it’s perhaps not a surprise that the decision to have a family is stalling, but panicked headlines pile the blame directly onto women. The fact that many women are trying to conceive every day is rarely part of the conversation. The pressure is on us to fix things, for the sake of future taxes and healthcare. Our own wellbeing is rarely mentioned. It’s an enormous amount of pressure on an already difficult time.
And despite what we all learnt in school, that any unprotected sex can lead to pregnancy, the science is much more of a shot in the dark. In reality, a woman’s odds of conceiving each month of actively trying are just 15-25%. Which, as any woman over 30 will know because she is endlessly told, reduce further with age. So while trying to conceive month after month can feel impossible, it is actually perfectly normal for it to take couples as long as a year to get pregnant.
For mother of one, Lucy Ecclestone*, 36 from Sydenham, London, the TWW while trying for her second child has been a challenge, but she had been braced for the process. “The first time we tried, it was lockdown: it totally consumed me, because time moved more slowly,” says Lucy. Following a pregnancy loss, the process became even harder to bear. “Seeing babies makes it much worse, so I am brisker at the nursery gates and avoid friends with small babies or nearing their due dates,” she tells Cosmopolitan.
I recognise this avoidance tactic in my own actions. I’ve backed away from spending time with friends and family with newborns, or newly pregnant loved ones. It is enormously difficult to find yourself avoiding people who want to support you. How do you counter that struggle each month? “I step up quite aggressively with everything else: more therapy, more friends, more exercise,” says Lucy, who is still trying for another baby. “There really isn’t a decent solution but owning it and accepting it’s shit has helped.”
We are in the dark about so much during conception. Getting the timing right can be helpful, and many women choose to use ovulation tests as a guide to the best time to try to conceive on our most fertile days. “They detect the pituitary hormone luteinising hormone (LH) in your urine,” Fertility specialist Channa Jayasena tells me. “A surge of LH triggers your ovaries to pop its biggest egg (ovulation), which is how the test works”. These tests can be expensive – some costing around £30 for 10 – and they’re not a perfect science. “You may miss the LH surge (which only lasts a few hours) and panic unnecessarily that something has gone wrong. The best predictor of ovulation is having regular periods – if your periods are not regular, get them checked out,” Jayasena advises.
As much as we’d like to do something to get some clarity and control during the TWW, Jayasena confirms my suspicions that checking every possible symptom is a fruitless endeavour. “It’s impossible to tell how things are going just from symptoms alone. Ultimately the proof is in the pudding.” He likens the two-week wait to a letter being posted. We’re waiting for the delivery – the reality is that by that point in the cycle, the outcome has already been determined.
We might be able to get the timing right, and we can eat well and exercise and generally look after ourselves (which medical professionals advise couples to do when trying for a baby), but once ovulation has taken place, there’s nothing we can do to influence the outcome. We can only wait. Therein lies the problem. With waiting comes imagining – what our life might be like with a baby, how things will change, and how quickly that will happen if we are pregnant. It all shifts in a second. For many women that limbo is an impossible emotional situation, one that’s often caught up in failure when it doesn’t happen.
“There’s a pervasive narrative that getting pregnant is relatively straightforward, which can make those of us who are struggling feel utterly isolated and inadequate,” says Sophie Robertson from Folkestone, who was 35 when she and her husband started trying for a baby. “I think I turned to IVF as a way to hurry up a process I’d assumed was inevitable. The TWW was definitely a major factor.” Sophie tried to conceive naturally for three years before turning to IVF. “Each month, the anxiety and anticipation would build up, only to be crushed by negative results. The cycle of hope and despair was emotionally annihilating. We realised continuing that way wasn’t sustainable for us.”
The feeling that Sophie articulates, the cycle of hope and despair causes a helpless limbo effect. It can be enormously damaging to our mental health, explains psychologist Sadia Khan. “Being unable to switch off from something that's out of your control creates a level of uncertainty that can enhance anxiety and depression. It stops you from living in the present. All future plans will be determined by the results. All of your current plans are put on hold. You cannot appreciate the current state that you’re in.”
So what can women do to tackle this state of flux? “If you can find a way to like the life you live, with or without children, the more distracted you are with genuine happiness. That might involve engaging in more of your hobbies and more or your interests,” suggests Khan. Sometimes keeping busy just isn’t enough. I knew I needed more help when my panic attacks became as regular as my cycle. I sought out support from the Ectopic Pregnancy Trust, and later a course of CBT which helped me move past the fear that I felt each month. All of the experts I’ve spoken to talk about keeping busy during the TWW, but distraction only goes so far. If there are signs you’re not coping with your emotions – withdrawing from your social life, checking out of work, disconnecting from your partner – speaking to your GP is crucial.
“I tried various strategies to distract myself, like immersing myself in work, picking up new hobbies, and spending time with friends and family. But the underlying anxiety was always there,” says Sophie. “Looking back, I think it unbalanced me to an alarming extent that shouldn’t be underestimated. I knew every moment of every day which stage of my cycle I was on. I was in a constant state of hyper-awareness of my body, continually calculating how far along I might be if I had got pregnant, what that might mean for when I’d have a baby.”
Sadly, Sophie’s IVF treatment didn’t result in a baby, and she has decided to stop trying for the sake of her mental health. “The emotional toll of the TWW is real and valid. It’s okay to feel overwhelmed, anxious, and even hopeless at times. You don’t have to fight that feeling or pretend it doesn’t hurt. Seeking support, whether through therapy, support groups, or talking to friends and family, is crucial.”
My therapy for PTSD wrapped up a few months ago. I’m trying to conceive and still in the TWW limbo, but I am coping with it far better. The wait doesn’t fill me with the panic and fear it once used to – sometimes I even feel optimistic – but I do feel the relentlessness getting heavier. While I was writing this, I had one eye on an ovulation test, waiting to see if the smiley face would start flashing, the familiar sign that it was time to start the process over again. My husband and I will keep trying; but I often ask myself, what if I’m just not strong enough to keep going? What if I give up and next month would have been the month that sticks? Each month I feel another chink in my resilience.
“No one has a magic wand or a crystal ball: all the person going through it wants is to know that people see them,” Lucy tells me. “They aren't expecting you to solve it. Just see them, in it.”
Lucy’s right: I can’t predict the future, no-one can. Whether a pregnancy puts my life at risk again is another unanswerable question. What helps enormously is empathy, rather than blind positivity that brushes trauma and fear under the carpet because it’s too uncomfortable to talk about. People are very keen to tell women to get a move on, to put the pressure of statistics onto our shoulders, instead of giving us space to talk about the emotional and mental strain of trying to get pregnant. Women trying to conceive can find themselves stuck between two lives, and we have to acknowledge that for some, wanting a baby can be to the detriment to their own mental health. We risk a lot of ourselves to see those two little blue lines.
*Name has been changed.
For more support on ectopic pregnancies, speak to the Ectopic Pregnancy Trust.
