Our reality is created in our minds!

The demure young girl sat on the patient's chair in front of me. She was wearing a bright yellow saree with a red blouse. There was a green string of beads on her neck. She had parted her hair in the middle and braided her hair loosely. She sat there quietly as her aunt who was accompanying her spoke to me, 

"She is married for 3 years now, but is not yet pregnant. We want to check her up and make sure that she has a baby soon. Otherwise her in-laws won't have her. They have sent her back"

The girl was intently gazing out of the window which is right behind where I was seated. Then she started looking down at her own feet. She never lifted her eyes to meet mine. I started asking more details of her history. Slowly her story unravelled. She was 17 years old. She was married 3 years ago immediately after attaining menarche. She was living with her husband since past 3 years. She had totally had only 1 menstrual cycle after attaining menarche. Now she was here to undergo treatment for primary infertility. We ran a routine urine pregnancy test and found that she was pregnant. She did not get regular periods for 3 years. Probably her young pubertal ovaries were not functioning properly. And the first instance when they decided to ovulate properly, she got pregnant! 

A few weeks ago we saw a middle aged couple. They had two daughters and the husband had undergone vasectomy after that as a permanent method of birth control. They had come after the wife had missed her period and was late by 20 days. We ran a pregnancy test and she was pregnant! They were in so much distress, because what they thought was a permanent solution to preventing unwanted pregnancies had turned out to be not so permanent!

Another couple in their early 20s came to us several weeks ago with high levels of stress and anxiety to conceive. They had been married a couple of years, but were undergoing a lot of abuse and insult in the society around them as they weren't pregnant yet. The husband's semen analysis showed reduced sperm count. So they had gone to a fertility centre and were planning an in vitro fertilisation (test tube baby) that would cost them close to 2 lakh rupees. That amount was more than their entire family's life savings. So they were in high distress when they came to us. We reassured them because of their young age and started the couple on healthy life style. Within a month the woman became pregnant and the couple were ecstatic! 

Three pregnancies, all different from each other, one common thread is the social expectation, huge uncertainty and anxiety associated with all three. The first one was not even a legal marriage, and before the girl could even become of legal age for marriage, they were investigating for infertility. The second one was a failure of anti-fertility intervention and the third one was how the vulnerability of a young couple was going to be exploited for financial gains by a fertility centre, and nature prevailed! The emotions these pregnancies evoked were also very unique. In the case of the adolescent girl, it was a pleasant surprise, in case of the failed contraception it was shock and distress and in the last case it was one of wonder and gratitude! 

What better proof can there be for the fact that our every day reality is created in our minds? The way a couple responds to a pregnancy strongly depends on the social and cultural dimensions in which we live. I wish, we could spend more time to understand this and engage actively with this as clinicians!