The pressure Nobody talks about

The pressure Nobody talks about

By Dr. Avanthi Vellala

She was 30. Five years of marriage. Multiple failed OI, timed intercourse, and IUI cycles behind her. Nothing alarming from either side good ovarian reserve, normal semen parameters. The kind of case where the biology looks fine on paper and the unexplained is the hardest thing to sit with.

We started IVF. Stimulation was smooth, hormones were fine throughout. 14 eggs retrieved, 8 mature, 7 fertilised. Three day 3 embryos. We had used microfluidics for sperm selection.

The issue was egg quality. We transferred all three day 3 embryos.

Negative.

I sat with them and was honest. A second cycle with their own eggs carried a 40 to 50% success rate. I also explained donor eggs as an option with significantly higher success rates.

The couple didn’t say much. She cried. He said they’d think about it and come back.

I could see the anxiety in their faces. Not just about the result there was something else sitting underneath it. Something heavier.

Two months later they came back. They had decided to go ahead with donor eggs. And they mentioned that there was a lot of family pressure.

We started the donor cycle. Beautiful embryos formed.

And then fluid in the cavity.

We tried different protocols. I wanted to manage it conservatively. But it kept coming back. Every time we cleared it, it returned. Transfer kept getting pushed. Days became weeks.

She broke down more than once during this time.

One day her husband told me what was actually happening at home. He was being pressured to remarry. His family was pushing six years of marriage, no child, relatives asking questions at every family gathering. The pressure had become unbearable.

I looked at him and said what’s the guarantee a second partner would conceive immediately? Stay strong. The delay is the issue, not your wife.

To understand the fluid, I did an HSG to rule out hydrosalpinx. Normal. Then I took her for hysteroscopy.

We found it. A small crypt in the posterior wall of the mid cavity a pocket where cervical secretions were collecting and causing the fluid. Most likely from a diagnostic D&C done at a previous hospital. Something that had gone unidentified through every other investigation.

We managed the fluid conservatively alongside the transfer and we transferred two blastocysts.

Right before the transfer date, her father-in-law walked in.

He told me he had been pushing to get his son remarried. I asked about her what would happen to her? He said she would stay in the family.

Then he looked at me and said “We are not able to attend any family function. Relatives keep asking. They’ve been married six years. You try to understand.”

I was dumbfounded. I could feel the pressure landing on me now too.

He noticed the Ganesh idol on my desk. He said “Ask your Ganesh to give you the best result.”

I said that’s what I always pray for.

He left with a parting line if this doesn’t work, he may have to get his son married again, though his son isn’t agreeing. A sweet warning, I told myself. I understood what he meant.

She is thin, small built, quietly pretty. She had been sitting through all of this the failed cycles, the fluid, the delays, the family pressure, her husband being pushed toward remarriage carrying it all without a word of complaint.

I prayed. And I transferred.

Positive.

Her mother came in the next day. Happy tears.

She delivered a baby girl.

On a lighter note I remember this case not because of the clinical complexity, though that was real, but for the father in law who walked in before the transfer and gave me a sweet warning.

The pain of infertility is hard enough on its own. But in so many homes, it doesn’t travel alone. It comes with relatives asking questions at weddings, with whispers at family gatherings, with pressure that turns inward and becomes unbearable.

She carried all of it. Quietly. And she came through.