(In)fertility, part 2: The Paperwork

I remember sitting with Josh in a small office, thumbing through a stack of papers.  These were the legal documents we had to read through, initial, and sign in order to move forward with IVF.  The first 57 pages outlined the health risks to me, which included EVERYTHING that has EVER happened to ANY woman who had IVF.  Yes, I understood the risks of bloating, abdominal pain, mood swings, headaches, diarrhea, nausea, vomiting, bruising at injection sights, insanity, etc. etc.  Did we understand the risk of ovarian hyperstimulation syndrome?  Even though I knew it was rare, preventable, and treatable, images of exploding uteruses (uteri?) kept coming to mind.  Logically, I knew that the risks were relatively rare, but I felt myself becoming increasingly agitated as we initialed next to each paragraph, each forewarning of What Could Happen.  We quickly moved ahead to the next ream of papers, which I now refer to as the “Playing G-d Forms” or “This Could Be a Plot for an Episode of Law & Order Paperwork”

First, we had to state our preferences about the fate of any embryos that might come out of the process, whether they were in the freezer or in me.  Who gets “custody” if Josh and I were to divorce?  What happens to the little cell clusters in case both of us die?  What if there are embryos that don’t get transferred (that’s the term used for putting the embryos back into me)?  Where do those go?  Are they destroyed?  Donated to science?  Offered to another couple trying to get pregnant?  I don’t remember what we decided for many of these questions, as it all seemed so… theoretical.  Unlikely.  Irrelevant.  I wasn’t convinced we would ever get that to stage, and I couldn’t bear even contemplating the possibility of something happening to Josh or me or our marriage.  However, I do remember the decision we made regarding any unused embryos.  I know we didn’t want to destroy them, because although I am 100% pro-choice, and I do not believe that a cluster of 4-6 cells is a living being, there is something amazing about the potential inherent in those cells – either to create a life, or to help sustain someone else’s.  It didn’t take us long to decide to donate any unused cells to science.  I think I remember saying, “Fuck you, George W.,” as I checked off the “donate to science” box.  I relished that one brief moment of feeling empowered in an otherwise fairly crazy process.

Then we had to decide what to do with any problems that might arise after the embryos were transferred back to me.  Although our doctor was quite conservative, there was always a possibility that one embryo could split into identical twins, or the transfer of two embryos could result in triplets or even quadruplets.  In the event that I did become pregnant with more than one fetus, and one or more of them were endangering the lives of the other(s), our doctor wanted our permission ahead of time to “reduce” the number of embryos/fetuses.  Selective abortion.

I am glad my doctor asked.  She asked on paper, and we had a conversation about it.  I can’t help but wonder whether or not these conversations were happening in some of the well-known cases of high-level multiples that have been in the news (and tabloids) lately.  It’s an important conversation, because our answer would ultimately help inform our doctor’s decision.  If Josh and I were unwilling to reduce for any reason at all (religious, moral, etc.), then she would transfer only one embryo.

Josh and I gave permission for a medically-necessary reduction.  It wasn’t a hard decision.  Yet, despite my unwavering commitment to, and belief in, a woman’s (or in this case, a couple’s) right to choose, it was a difficult moment.  There is a reason I call myself pro-choice, and not pro-abortion.  Abortions may be necessary and they may be the right thing to do (for both the mother and/or the fetus), but they aren’t easy, and they are painful.  I can’t imagine facing that choice, and I have the utmost empathy for women (and men) who have.  Checking that box was just one of the many moments when I looked at Josh and thought outloud that we shouldn’t be making these decisions.  These are G-d’s choices, and they didn’t belong in our hands.  Yet there they were.

Finally, we had to release the clinic and lab from liability should anything happen to our little embryos.  Did we understand that the embryos might not unfreeze?  That the power might go out in the facility?  That an act of G-d (interesting choice of words) might damage the facility?  That a terrrorist attack could destroy the freezers?  Yes, yes, we understood.  We went from thinking about creating a life to having to destroy the potential for that life to reading statements that felt more like the refund stipulations for plane tickets.  My brain couldn’t manage it.  I felt overloaded.  It wasn’t the first time, and it wouldn’t be the last.  But we plodded ahead, signed and initialed on the dotted line, and made an appointment to meet with the nurse about the injections Josh would have to give me.

Flight attendants, prepare for take-off

7 Months!

The (in)fertility Story, Part 1

We wanted Choochie.  Ok, to be honest, not Choochie, because we didn’t know her.  We wanted someone, a baby, a child, an extension of our family.  We tried.  I started taking my temperature and plotting it on the tiny chart that came with the thermometer almost from the beginning.  Why not, I figured.  We were serious about getting pregnant, and I didn’t want to waste any time.  Ha.

Josh found ovulation testing strips on sale through the internet, and I carried them with me, along with a small plastic cup, in my purse so I could take the test the same time every day, regardless of where I was. Work? No problem – I got good at peeing and testing in between client sessions. Summer picnic with friends? So nice to see you. What a lovely dress! Is it new? Oop, excuse me for five minutes while I go pee in a cup and then dip a tiny strip into it and then stare at it for five minutes so I can know whether or not to make my exhausted husband have sex with me tonight. Save me a drink!

We squinted together at that little strip – one line or two?  How can it be so damned hard to tell?  Do we need to have sex tonight?  Can we wait until morning?  What about tomorrow night?  How long does sperm last anyway?  As time passed, we started feeling a bit worried, a little anxious.  Oh, how we fought about sex – when to have it, how often – neither of us really knowing what we were talking about but both of us firm in our position.  And so it went.

We counted off the months as we dropped yet another negative pregnancy test in the trash.  Josh eventually found those on sale as well, after he discovered that I was taking two or three tests each month, often well before my period was even due.  I remember searching the aisles of the pharmacy, reading the backs of those boxes so carefully – Was the early pregnancy test really the earliest?  Where is the really really early test?  Why don’t they make a ridiculously early test for all of us crazy neurotic freaks out there who can’t wait any longer and want to take the pregnancy test seven minutes after sex?

After about eight months, our focus shifted from counting how many cycles (we no longer counted in months, only cycles) it had been since we started trying to how many more fruitless (literally) cycles we would have to endure before we could go to the doctor.  I continued to take my temperature each morning, carefully, carefully, before getting out of bed as that might send the mercury (actually, digital readout) artificially high.  But by that time, my heart wasn’t in it.  I was sure that the only way we would get pregnant (short of fertility treatment) would be by surprise.  How badly I wanted to be one of those couples who made it the appointment to see the fertility doctor only to get two purple lines the next week.  (Oops!  I tripped and fell and landed on sperm and now I’m pregnant with twins!  Like that.)  Anyway, I was sure that by taking my temperature and testing for ovulation I was jinxing our chances, but I kept doing it.

The surprise did not come.  The months passed, we hit the year mark, and we called the clinic.  Weeks passed, and we met with the doctor.  We were both tested – urine samples, blood samples, sperm samples, physical examinations, and images taken.  The images were the most amazing part (well, I can’t speak to Josh’s experience making his “donation”.  That might have been pretty amazing, but given that I wasn’t there for it, I really don’t want to hear about.)  Anyway, they shot this chalky-dye up my hoo-ha (that’s the clinical term for it) and then took x-rays.  The dye made everything (uterus, fallopian tubes, ovaries) visible on the screen, and it was incredible to see.  (It looked just like the pictures in my 8^th grade biology book.  Who knew?).  I remember watching the dye move through my reproductive system and thinking that it all looks so complex, yet so simple.  Just like how getting pregnant can be so easy and yet so ridiculously hard.  I spent the first ten years of my adult life worried I might get pregnant – was I going to spend the next ten worried I wouldn’t?

Anyway, after much testing, we got the results.  Unexplained infertility.

I knew that diagnosis from my work as a clinical social worker.  Infertility NOS, not otherwise specified.  This is basically doctor-speak for “we know something is wrong with you, but we don’t know what”.  Great.  Thanks.  Super helpful.  On the one hand, it was helpful to know that there wasn’t anything glaringly wrong, like a missing uterus or a tumor the size of a grapefruit on my ovary. (Why are tumors always the size of grapefruits?  Why don’t you ever hear about tumors the size of grapes or clementines?)  On the other hand, it would have been nice to know that they knew what was wrong, and that they could fix it.

The doctor was hopeful.  We were young, we were healthy.  It would happen.  I was relieved, but had a hard time believing her.  At 31, I didn’t feel young, and the discarded pregnancy tests in the garbage told me I wasn’t healthy.  We left the office knowing that something would have to happen – IUI, IVF, a soup of letters that spelled out our inability to get pregnant on our own.

Josh and I had driven in separate cars to the clinic.  As we left, he hugged me and told me that he loved me.  It’s going to be fine, I told him and then myself, over and over again.  But then the tears came, and they wouldn’t stop.  I tuned the radio to the country music station and really let ‘em flow.  I was practically bawling by the time I got home, and it felt good.  Awful, but good.

It was only the middle of the morning, but I put on my pajamas.  It wasn’t sadness I felt, or even anger.  It was disappointment and self-pity.  I wanted to wallow in it, roll in it, take a nice long bath in it.  I had been strong for so many months, reassuring Josh and myself that it would happen, the medical advances are amazing, aren’t we lucky to live in this era of modern technology and thank g-d we have such good health insurance that will cover fertility treatments in a state where they have to pay for it.  But I was tired of being strong.  I put on my slippers, and dragged myself down to the corner store.  I was acutely aware of, yet completely unconcerned about, the businessmen and vagrants standing next to me, staring at my lavender pajamas with shooting stars on them.  “Wish upon a star,” the fabric said.  “Fuck you,” I thought, “I’ve wished upon everything I could think of, and I’m still not pregnant.”  NOT PREGNANT.  I put my Diet Coke and pint of Ben & Jerry’s on the counter and pointed out the lottery tickets I wanted.  I’d never bought a lottery ticket before, but I decided it was about time for my luck to change.  I went back to my car and used a penny to scratch off the metallic dust.  Apparently my luck hadn’t changed.

“Don’t waste your time,” the doctor advised.  “Go straight to IVF.  The insurance will pay for it.”  IVF.  In-vitro fertilization.  That seemed so… dramatic.  Extreme.  IVF was Louise Brown, the test-tube baby.  It was TV shows of families with multiples of eight and bitchy, bitter wives and overwhelmed, disconnected Dads (not that I’m talking about anyone in particular. Ahem.)  It was a last resort after years of failed attempts.  IVF was debates about men and women playing G-d, about creating embryos with potentially unknown destinies.  IVF was many things, but it wasn’t us.  It wasn’t me.  I was healthy.  I come from a fertile family.  My younger sister and brother were welcome surprises to my 40-something mother.  My grandmother had four children before her 30^th birthday, and a fifth child ten years later, g-ddamnit.  Fecundity runs in my genes.  I shouldn’t need the help of a petri dish and a catheter to get pregnant.  I should be shooting babies out like bb’s.  IVF was a web search, a Wikipedia page, an article in the New York Times.  But it certainly wasn’t me, wasn’t us.

And yet it was.  Phone calls were made, consultations sought, advice solicited and given.  An uncle’s ex-wife was a fertility specialist, she recommended a more conservative approach, but also thought our doctor was an excellent one.  Long afternoons passed on the sun porch, conversations back and forth, pros and cons weighed.  We briefly considered continuing to try on our own, but we were eager to get pregnant.  The conversation quickly shifted to a question of which procedure – should we start with the less invasive (and potentially less effective) intra-uterine insemination (IUI) or go straight to IVF.  Looking back, I don’t remember what we were conflicted about, but we really struggled with the decision.  Or maybe it just took us awhile to get comfortable enough with the idea to actually move ahead.

As we talked about it, my self-pity returned from time to time, in small doses, sound bites, fleeting thoughts triggered by stories of friends who got pregnant “by accident” or on the first try.  I snapped out of those bitter, frustrated moments fairly quickly, eager to make a decision and take action.  So we kept talking, Josh and I, and eventually chose a path.

Sometime in late October of 2007, we decided that we would move ahead with IVF.  We were the technology, the statistic, the aggressive intervention.

Update on Grandma and the Clusterfuck

Yes, I will get back to my story, but for those of you who were following my conversation with my grandmother about the clusterfuck, I thought I would share this recent e-mail exchange we had:

Grandma,
So, here are some of the comments I got on Facebook about my “clusterfuck” post on the blog:
“Dude. Just seeing the words “grandmother” and “clusterfuck” in the same sentence makes my brain clusterfuck. Hmm… can you use clusterfuck as a verb?”
“You have a much cooler grandmother than I do.”
“you’ve got a pretty freaking cool gramma!”
“What an awesome thing to be able to share with your grandma! Mine is 95 and I have to sort of translate my current English into old-person English whenever I write to her — yes, we communicate via snail mail because she is practically deaf and can’t hear me on the phone and doesn’t own a computer.  Not that I’m complaining about my grandma, cuz she’s awesome. But it would be pretty cool to be able to discuss the mysteries of “clusterfuck” with her…”
“I’m not at all sure how my grandma would talk about “clusterfuck,” but she did crack up the entire family one night with a story about going to the hair dresser “for a blow.”"
Love,
SWMama

Her response:

Gee, “cool”?….truth to tell, I’d rather be hot!!…but that’s for another time….anyway. can you get me the name of your friend’s grandma’s hairdresser??????????….and your cousin’s Obama office was impressed that I could Google!!!  xoxox

Thinking about Writing about My Story

I have a story to tell.  I’ve spent a lot of time thinking about how and where to tell it, and even if I want to.  It’s a personal story, but it’s not just mine.  It’s my husband’s, and my daughter’s, too.

It’s the story of how we got pregnant.  Actually, it’s the story of how we didn’t get pregnant, and then we did.

I’ve known for awhile that I wanted to write about it, but I wasn’t sure what to do with that writing.  I could leave it in my journal, a few pages of memories for me to come back to later in life, perhaps to share with F when she has questions.  I also thought about really writing something and trying to get it published somewhere.  That option is appealing to me for a couple of reasons – first, my story  might reach more people, and perhaps it would be helpful to others.  Second, I wouldn’t have to tell my family and close friends about the publication.  I wouldn’t have to feel bad about not telling them sooner, and that would be easier.

But I’m a social worker (and a Jew), and we don’t do easy.  We’re gluttons for punishment.  We like it messy and complicated and conflict-laden and hard because that’s life and that’s family and that’s relationships and that’s reality.  We’re all about talking about things people don’t talk about, ostensibly to help other people, but we won’t lie to you – we get more than a little benefit out of it ourselves.

After much consideration, I have decided that I’m going to tell my story here, on my blog.  No, I don’t have many readers.  And yes, my family and friends may read it, and they may have comments and feedback that I may or may not want to deal with.  But that’s what being part of a family is all about, right?

The most important reason to tell the story on my blog is because many of the people who read this blog know me, and hopefully they will feel comfortable asking me questions about my experience, or consider sharing my story with a friend who might be interested.  Perhaps they will even think about sharing their own stories.  As a social worker, a woman, a mother, a wife, and someone who’s been through it, I’m happy to talk about my* experience with infertility and in vitro fertilization (IVF).  People don’t talk about these things enough, and the less we talk about them, they more painful and shameful they become.  And there’s just no reason for that.

So, I’ll start writing, and hopefully you’ll keep reading.  Either way, it’s time for me to tell my story.

*I have talked to my husband about sharing this story on the blog, and he’s ok with it.  However, I’m writing about  my perspective and my experience, and I’m not speaking for him.  You can ask him about it yourself.  I bet he’d be happy to talk.

Baby in a Hat

Thanks, Friend

Dear Friend,

Thank you.  I was having a terrible week (a week when even a little retail therapy didn’t help) and I called you and blurted out my craziness, my worries, my fears (so much for focusing on the present, I guess) and without a pause or hesitation, you invited me over.  We sat at your kitchen table, eating our sandwiches, and I told you about the burn (even though I’d already told you the story two? three? times before).  You listened and nodded and supported and agreed and never once offered me advice or pithy statements or trite generalizations.  You just let me talk, and when I said I was done talking about it, you said I didn’t have to be, and I guess wasn’t, because I kept talking and you kept listening.  And I knew you were really listening, not just using my voice as background noise for your own inner thoughts and ramblings, as we exhausted and overwhelmed mothers often do, despite our best efforts.  I felt better.

And when I was done talking about it, you talked about your life and your family and children and your ups and downs, and that made me feel better, too.  You got me outside of my own brain, where I can get stuck all too often.  You told me about the time your baby fell onto the table, and was bleeding from the forehead and you weren’t sure whether or not to go to the emergency room, and the triage nurse wouldn’t tell you what to do over the phone so you ran outside and asked a woman walking by with a stroller.  And this woman who didn’t know you, and didn’t know your baby, said that if you have to ask you should probably go and so off you went, packing up the toddler and the baby.  And as crazy as the story sounded in the telling, I understood it, I so understood that need to find someone else, anyone else, ANY ADULT WITH A PULSE to tell you that you’re not being totally insane as you try to figure out what the hell to do with this little being that someone somehow decided you were capable of taking care of.

Your baby was fine, and still is fine, but you showed me the scar, the scar that you always see, but I couldn’t see it at all until I leaned way in and squinted and moved aside the soft little eyebrow hairs, and that made me feel better too, because I knew that you really do see the scar as much I couldn’t see it, and that’s what being a mother is all about.  Other people look at our children and see Generic Baby, and we may look at their children and see Generic Baby, but when we look at our own children we see all of our hopes and successes and fears and failures.  Oh, the failures – every fall and bump and bruise and book left unread and music group missed and temper lost, all wrapped up in this little person that we somehow manage to love beyond all reason.  And somehow that all-encompassing, anxiety-inducing, mind-warping, brain-melting love gets us up out of bed every morning for another day of poop and screaming and tears and spilled coffee, and it feels like the best, most important thing we’ve ever done or will ever do.

Anyway, thanks.  Let’s hang out again soon.

How would you describe it?

In response to my last post, my grandmother sent me this in an e-mail:

……who…….or what is a clusterfuck??????????????

My response was:  It’s like… a general life mess.  Like when the phone is ringing and you drop your purse and the baby is crying and you can’t find your keys and the cat is meowing and everything is a clusterfuck.
Or, Paris Hilton.  Like that.

She wrote back:  Gotcha!!!!!!!  Who’s Paris Hilton????????????????

Yeah, this from the lady who once asked my sister if a) she had seen the Paris Hilton sex tape, and b) if she learned anything from it.  Ahem.

I’d love to hear your definition of a clusterfuck.  There might even be a prize for the best one (doesn’t have to be Mommy or kid related, and yes, this is my way of soliciting your comments.  I’m a comment whore.  What can I say?).

A Meditation on… Meditation

I’ve always wanted to meditate.  Actually, I’ve always wanted to be a Person Who Meditates.  People Who Meditate are calm and grounded, they drink tea and wear attractive yet sensible shoes.  They wash their hair every day, and don’t burst into tears while listening to a sad country song.  Meditators cook healthy meals and eat them slowly.  Their husbands never ever have to remind them that the car window is down so they should probably not be people-watching quite so loudly.

I am not a Person Who Meditates.  I can’t stand tea, I don’t cook, and I cry at phone company commercials.  I use the words “kerfuffled” and “clusterfuck” on a regular basis.  I’ve tried to meditate, on more than one occasion.  I even went to a few sessions of a meditation class at my synagogue.  I put on my most sensible-yet-attractive shoes (more sensible than attractive, sadly), and plopped myself down.  Our Rabbi led us through a relevant, thought-provoking conversation (the kind that People Who Meditate often have), after which we sat.  We were to sit and notice our thoughts, accept them without judgment, and then bring ourselves back to our breathing.  (Did I mention that People Who Meditate accept without judgment?  I do not do that.  I don’t want to do that.  I have a dear friend who thinks judging is fun. He considers it feedback, and he’d like to set up a “feedback table” at the mall.  He’s my hero.)

So, we’re sitting, and I’m trying to notice and accept my thoughts, but the problem is that all I can notice is that I really have to, well, pass gas.  And once you notice such a thing, you can’t just accept it and go back to your breathing.  You have a decision to make.  Are you going to let it go and hope for the best?  Try to hold it in?  Walk out of the room, potentially distracting a whole room of People Who Meditate from their sitting?  Regardless of what you decide, the likelihood that you will be able to notice your need to fart, accept it, and go back to your breathing without giggling madly is unlikely.  Unless you are a Person Who Meditates.  In which case you have some secret ability to make the fart just go away.  I do not have that ability.

The other reason I don’t meditate is because, until today, I didn’t really get it.  Yes, I have read the studies about the benefits of meditation – less stress, anxiety, and pain, lower blood pressure, improved memory and learning, cuter shoes, etc etc.  I get that.  But I don’t really get how meditation works, or why it works.  Even when I can calm my mind for 3 minutes or 7 minutes, or even 20 minutes, as soon as I walk out of the class, I revert back to my anxious, Diet-Coke-addicted, fast-eating, loud-talking self.

I had a breakthrough today.  I was out for a walk, and all of a sudden it came to me.  (My realizations happen when I’m in the shower, on the toilet, out walking, or anywhere else far away from pen and paper.)  I was thinking about F and the burn (you didn’t really think I was over it yet, did you?), and I was remembering what happened, wondering how I could possibly prevent something like this from happening again (Do they make Nomex onesies?).  Just as I was getting good and worked up and starting to really agonize over the very remote possibility that she might have a scar someday, it occurred to me that she’s fine.  She wasn’t fine on Sunday when it happened, and she will undoubtedly not be fine at some point again in the future, but right now, at this moment, she’s healthy and happy and fine.

I guess that’s the point of meditation, or so those People Who Meditate would have me believe.  The coffee is spilled, the future is unpredictable, so all I can do right now is get myself a Diet Coke, put the baby in a helmet and wrap her from head to toe in bubble wrap, and focus on the present.