The last few months...

June 2014

When I share with friends and family that my husband and I are having trouble having a baby, they often ask us how long we have been trying to conceive.  Presumably this should be an easy question to answer, but for some reason for me, it is not.  What counts as "trying"?  Foregoing birth control like 90% of the world who gets pregnant naturally?  In my mind, I cannot possibly be really trying until I have had at least 100+ injections, blood draws and ultrasounds.  I'm not being facetious; I seriously cannot conceive (pun intended) of waking up one day, deciding to have a baby, having sex once or twice at precisely the right time and bringing home a little bundle of joy 9 months later.  Such notions are crazy.  In my mind, a little human can't possibility be brought into this world without the assistance of nurses, reproductive endocrinologists, embryologists, andrologists, billing clerks, acupuncturists and marital therapists.  

For the sake of argument, I could say I have been trying for almost 3 years.  For the first year and a half, I was convinced that absolutely nothing was wrong with my very fertile 32-year-old eggs.  It just must be a scheduling issue, and well, if I could ever figure out when I was ovulating, all of our problems would be solved.  I was wrong.  Obviously we were just having a problem getting all the guests to the party at the same time, right?  I refused to acknowledge the possibility that there just might be something medically wrong with my husband or me.  I've never had a serious medical issue in my life, other than being a little too type-A from time to time, of course. I have planned and choreographed each and every aspect of my life.  I have planned for best case scenarios, worst case scenarios and everything else in the between.  Unfortunately throwing genetic material at a wall and seeing what sticks just doesn’t fit within the constructs that I have put in place for myself.  Nevertheless, I have no choice.  I have to accept that fate is not in fact in my control and that no matter how much I hope, wish and plan – it just doesn’t make a difference.

I have been through multiple IUI cycles, a fresh IVF cycle and a frozen one, yet have nothing to show for my efforts except for some sub-par seven day 2013 embryos.  My husband and I refer to them as the “2013 embryos” because we are convinced that they are jinxed.  You see, we’ve had a bout of bad luck.  In 2013, we underwent multiple failed fertility treatments, watched my husband’s mother succumb to a terrible illness and said goodbye to our beloved 17 year-old tabby cat, Lizzie.  A few days after Lizzie died, overwhelmed with grief, I visited an animal shelter against my husband’s wishes and adopted a kitten who I was convinced picked me to be her mom.  A mere eight weeks (and $4,000) later we had to say goodbye to her as well because she was suffering from a rare fatal virus.  Therefore, anything and anyone created in 2013 must be cursed and cannot be counted on.    

So here I am in 2014.  Getting ready for another 100 days of IVF.  My doctor says that I should assume that my fresh cycle is going to get canceled and that my best chance at holding a chubby-cheeked bundle of joy is a frozen cycle a month or so thereafter.  IVF is bad enough as it is – adding a second cycle – just adds insult to injury, at least if you ask me. 

We have taken the requisite break.  In fact, we literally traveled to the end of the earth. 15 Bhutanese monks prayed for us, the head lama blessed us and we forked over a fortune in offerings, not to mention Bhutanese junk food and liquor, as instructed by our tour guide.  Trust me, we relaxed, just like everyone who is not fertility-challenged told us to do.  Of course, we are the reason we are not getting pregnant.  It has nothing to do with our biology.  If I was a little less type A, didn’t work quite so hard, and finally drank the magic herbal tea that a cousin’s aunt’s friend recommended, then, of course we would have a baby by now, or at least so I am told. 

Nevertheless, we are ready.  The stars are (at least conceptually) aligned.  Yet, the thought of being hopeful this time around seems ill advised.  Last time we transferred two good quality embryos, but they didn’t make it.  They disappeared as if they never existed at all.   They defied the odds and failed to implant in the very fertile multi-striped lining that I had so carefully nurtured for their benefit.   I was hopeful, made plans and none of it really mattered.

My husband thinks it is some sort of cosmic justice.  He says that we can’t have a baby because we have been successful in other areas of our lives, both having had the opportunity to pursue challenging educations and rewarding careers.  E followed in his parents’ footsteps and became a physician; I am a laywer.

Growing up I never felt smart and was terrified that no one would ever hire me, let alone marry me.  I remember feeling this way beginning around third grade, which is pretty depressing.  Yet, I was determined to pull myself up by the bootstraps and do whatever I could to ensure that I enjoyed at least a little happiness.  This led me from high school to college, where I was determined to do well, if not by virtue of talent, then by sheer force of will.  My sights were set on staying in Ann Arbor for law school; I applied to Harvard on a whim, not even bothering to ensure that my application was typed properly, most likely for fear of wanting something that I knew I couldn’t have. Everything changed when I started law school.  It was the single most life-changing event of my life and a part of me believes that it may be why we can’t have a baby; life only hands out so many miracles and that was mine.  Either that or the world is just not ready for the super awesome evil genius that E and I would create together, a theory that I have shared with E’s urologist who asked me whether I was asking theoretically or medically.  I, of course, replied both and was not entirely kidding.

So, here we are, getting ready to go again, and all I can think about is what if we don’t even get one good quality embryo.  What if we get a sign that we are destined to fail?  What if this is the end of the road?  I don’t think it is, but I can’t help but think that it is.  I’m afraid to assume even the most modest of outcomes.    

July 2014

When I wrote my last entry it did not occur to me that, well, things could be worse.  I committed the ultimate sin of the fertility challenged.  I took even the most basic step in the process for granted.  I assumed that I would make it to the egg retrieval.  I assumed that my ovaries would respond to the protocol that was so carefully selected just for my benefit and that I would have at least a few fertilizable eggs to show for my effort.  I didn’t assume that we would get embryos; I merely assumed that we would have harvestable eggs and should have known better.  How silly was I to assume that making it through 10-14 days of shots and daily blood draws would mean that we could move forward in this process?  Who knew that I could respond “too well” to the medications?  Although I had already been hyper-stimulated, it did not occur to me that on a less aggressive protocol I could possibly have twice the reaction to half the meds causing my entire cycle to be cancelled.   Apparently 60 follicles are 40 follicles too many and an estrogen level of 7,000 is pretty concerning as well.   Staring down at the constellation of injection marks currently decorating my deceptively bloated stomach, I can’t quite absorb the fact that I am no further along than I was a month ago.

In fact, I feel somewhat numb, like I was just in a car accident and unable to process the events that just occurred right in front of me.  I’m enjoying the fog of denial and disbelief, but I’m fairly certain that it won’t protect me for much longer.  Sooner or later I am going to have to feel what happened and process what it means, which is that I may end up a childless widow who gets eaten by her obese tabby cat.  Until then, I wait.  I wait for my defense mechanisms to tumble down like dominos and for helplessness and grief to take over, which, like everything else, I can’t control.

I fear pregnancy announcements the most, so much so that I have gone out of my way to let just about everyone who is close to me and of child bearing age know that they should never feel compelled to let me know that they are pregnant in person.  I am incredibly appreciative that they are sensitive to my situation and would like to be respectful of how their absolutely wonderful news may devastate me, but a phone call, email, text or even carrier pigeon would be a preferable method for delivering the news.  I unfortunately learned this the hard way…

Two weeks after E and I found out that our frozen transfer failed we went out to dinner with two good friends.  We were looking to put our disappointment behind us, pretend it never happened and enjoy a fun filled evening out on the town.  Our friends had a toddler, but were having a little difficulty having another child, so we felt comfortable sharing our most recent disappointment with them.  The majority of the evening was wonderful; we shared a great meal and E and I excitedly talked about our upcoming trip to India, Nepal and Bhutan, completely ignorant to the emotional time bomb heading our way. 

Halfway through dinner they shared the news that they were expecting their second baby in September, exactly when we would have been expecting our baby had the frozen transfer worked.  My girlfriend was only 8 weeks along, but our friends felt compelled to tell us in person right away because they were moving away to another state in a few weeks.  Mind you, this is the same girlfriend who said “oh well, you’ll just do IVF” when I first shared that I was having trouble having a baby years ago, as if IVF were the equivalent of having a cavity filled at the dentist.  Well, it was a simple procedure, until she was the one going through it, of course.  Not at all to my surprise, when she went through all of one IUI herself, she acted as if she was being treated for a terminal illness.

Nevertheless, in that moment, hearing that they were having the baby that I felt should have been ours, I could have just died, right there at the table.  I congratulated them. I smiled. I suppressed the heat filling my chest rising to my cheeks and burning my eyes.  I held it together, but then my girlfriend, with a small but detectable amount of glee, told me that if I just gave acupuncture another try, I could be pregnant just like her.  E, bless his heart, squeezed my hand under the table, but it was too late.  I politely excused myself from the table and locked myself in a bathroom stall where I sobbed like a teenage girl who had just been dumped by her boyfriend right before the senior prom.   

Although it may not sound like it, I am a fairly reasonable rational person.  I get that my reaction to this situation was not appropriate and that pregnancy is not a zero sum game.  Someone else’s pregnancy has no bearing on my own.  Nevertheless there is something about hearing that someone else’s wish was fulfilled, even after a prolonged struggle, that stings.  I think it is because I feel left behind.   It just hurts, more than anything else.     

  

August 2014

        

So apparently my ovaries overachieve in more than one respect.  They are equal opportunity offenders, increasing and decreasing in size at equally remarkably rates.  So, here we ago again…

To be honest, I have mixed feelings about getting back on the merry-go-fertility-round, particularly so quickly after such an unexpected disappointment.  Understandably, I had a lot of questions for my doctor after my last failed cycle.  I wanted to understand whether it would be even possible for me to make it through a stim cycle, whether he would finally admit I have PCOS, whether having PCOS meant that I could not produce quality eggs, whether he had any explanation for why I reacted so strongly to the meds, and, most importantly, whether he was paying close attention to my case. 

         Early on, while going through IUIs and my first fresh/frozen IVF cycle, I felt like an anonymous number.  I legitimately questioned from time to time whether my doctor had ever reviewed my chart or could pick me out of a line-up.  Given that the majority of my interaction was with the nursing staff, I began to think that perhaps he was an urban legend.  His nurses spoke of him as if he existed, but I surely did not see or talk to him myself.  I am still unsure of whether he was in the room for my embryo transfer.  My husband assures me that he was there and that I was too hopped up on Valium to notice, but I’m still not entirely convinced. 

Part of the problem was that whenever I met with him, I felt like he was just reciting a rote memorized speech that he gives all of his patients rather than engaging in a meaningful conversation about the specifics of my case.  It also probably did not help that he would not allow me to go through my questions at my own pace.  Instead he would have me hand over my list so that he could run through my questions quickly, or at least those that he felt inclined to answer.  Not allowing me the courtesy of at least somewhat controlling my own appointment just exacerbated my frustration.  I also did not feel much better when a fellow patient told me “not to worry, once you have your first miscarriage, he will pay attention to you.”  Good grief.  Nevertheless, I continued on with my doctor because he was supposed to be the “best,” and I’m supposed to be tough.  I don’t need him to hold my hand, I just need him to get me pregnant (or at least so I tell myself).

Interestingly and somewhat ironically, I now have his attention.  Ever since my estrogen hit 7,000 and my second cycle was canceled, he was been supportive, and more importantly, accessible.  He has kept his word that I can email his nurses anytime I want to talk to him directly instead of to them and he would call me back.  The problem is that now that he is engaged in my case, I’m not.             

I’m over this whole process.  It has been fun and all, but I’m ready to pack up my crayons and go home.  E and I are not “we must have a baby at all costs” people.  We can see a broader more nuanced picture of what life can and should be.  Nevertheless, it is hard to find the middle ground.  I know that if we really want a family, that we can have one, it will just be different from what we originally set out to create.  Yet, I feel like if I were truly committed to being a parent then I would want a baby at all costs.  I would be willing to go through IVF five times, I would be willing to get second, third and fourth opinions, I would consider donor eggs, donor embryos and adoption.  The truth, though, is that I find all of those options exhausting; the thought of being a human science experiment indefinitely or going through a lengthy and uncertain adoption process is just too much to bear.   A friend suggested to me a few weeks ago that I should change fertility clinics because maybe just maybe a different environment or embryology lab might be what I need to make things work.  I told her that her suggestion sounded a lot like blowing on a broken VHS tape before putting it back in the VCR, hoping that it will have some magical effect.