Follow up to my previous post

The New York Times ran a second article today about the immensely painful challenges associated with fertility treatments titled “Grievous Choice on Risky Path to Parenthood“.  I have no commentary on this one, other than to say my heart goes out to the families profiled in this article, and to all families facing this unbelievable choice.

IVF and Twins

The New York Times ran an article today about the high rate of twin births associated with IVF, and all of the related risks.  And it got me thinking… which gets me writing.

I’m not going to rehash the entire article, but it makes a few good points about why there are so many more twins and why that’s not actually a good thing (twins are much more likely to be born prematurely, which can lead to a host of short- and long-term problems).  But before I get into it, I want to say this to all of the parents who have gone through IVF and ended up with twins:

I get it.

I totally get it.  I so understand the difficulty of the decision, the desire after so many months of trying, after so many months of appointments, injections, tests, and procedures, to do anything you can do to maximize your chances of getting pregnant.  And so you hear that your chances of getting pregnant will increase if you transfer two embryos instead of one, and you know that your chances of getting pregnant with twins increases, and that having twins is risky, but then you think about all of your friends who have had healthy twins and it doesn’t seem like such a big deal.  And if you only want two kids, well, how great would it be to never have to go through IVF again?  And, if you’re paying for all of it (which Josh and I didn’t – we’re lucky enough to live in a state where fertility is covered through insurance), then the pressure is even higher.  What if it doesn’t work this time?  Will we be able to pay for it again?

Like I said, I get it.  I’ve had all of these thoughts, and more.  Josh and I really struggled with the question of how many embryos to transfer.  Our doctor would have transferred two if we had really pushed, although she strongly recommended only one.  In the end, we transferred one, and I delivered a healthy, full-term baby, for which I feel very blessed.

Anyway, back to my thoughts about the article.  It points to two financial incentives for transferring more than one embryo, one which is patient-initiated, and one which is physician-initiated.  I already mentioned several reasons why patients might want to transfer multiple embryos.  Physicians are motivated by their success rates – first, they got into the profession to help people get pregnant and have healthy babies, so they feel better when it all works.  Secondly, and more cynically, fertility clinics’ stats are public record, and fertility treatments are big money.  The more embryos transferred, the more likely you are to get a pregnancy, the better the clinic looks, the more patients seek treatment there.  Despite the guidelines of several national organizations discouraging multiple births (as noted in the article), fertility docs keep transferring multiple embryos.

So, what can we do about this?  First, this is yet another reason why we need serious health care reform (and, in my perspective, a public option plan, but let’s not focus on that here).  If fertility treatments were covered by insurance, patients wouldn’t feel compelled to transfer multiple embryos because of an inability to pay for a second IVF round if the first one didn’t work.  Furthermore, the cost of a single IVF treatment pales in comparison to the astronomical costs associated with taking care of premature babies, both in the immediate aftermath of birth and in the long-term.

Secondly, although I do appreciate that doctors need to earn a living, and I do believe that most doctors make decisions based on their patients’ well-being, I also think that doctors are only human.  Thus, I think fertility doctors who have high rates of multiple transfers need to review and re-evaluate their practices and procedures.  Perhaps they are making the best decisions possible, perhaps they aren’t, but they need to seriously consider what is motivating the choices they make.  Health insurance reform might take some pressure off these doctors, because it would take pressure off the patients to want to get it all done in one shot.

The reality is, it’s a hard decision, and having been there, I don’t envy any of us who end up having to make it.  I guess the best we can do is to stay informed, seek support, and make the best choices possible.  Read the article and share your thoughts – I’m interested.

(In)fertility, Part 6: The “Transfer”

Hello, Dear Readers.  I’m back.  No, I haven’t finished the paper that is due next week (haven’t even really started it), and no, I’ve not tidied up the loose ends from work, but here I am anyway.  I feel like I should do something productive, and it sure as hell isn’t going to involve unloading the dishwasher or putting away laundry, so it might as well be this.  You all probably thought you were more to me than a decent alternative to chores, but apparently you were wrong.  Sorry about that.

Anyway, last you read I was being probed.  Yes, like that.  They took my little follicles, and his little swimmers, and put them all together in what I think of as the The Baby Blender.  I actually have no idea what they did with them, but I imagine a tiny little Kitchen-Aid with an “embryo” setting on it.  Anyway, whatever happened, a couple of days later we got a phone call.  Of my six follicles, five had fertilized and four had developed into embryos.  They were all top-notch (OBVIOUSLY), and we should plan to come to the clinic the next day for The Transfer.

Actually, the conversation wasn’t that straight forward.  Somehow the doctor and I got into a discussion about how many embryos to transfer.  She had been very clear from the beginning that she recommended transferring one embryo and only one, but she would consider two if we really wanted it.  When we knew we had four good embryos, all of a sudden the possibility of transferring two became very real.  On the one hand, transferring two embryos might increase the chance of one taking.  On the other hand, it also increased the risk of twins.  On the other hand, Josh and I loved the idea of twins.  We have several friends with twins, and we love hanging out with them and their babies.  Also, two for the price of one!  On the other hand, gestating and birthing twins carries with it a number of serious risks to both babies and mother.  On the other hand, lots of women give birth to healthy twins.  On the other hand, we weren’t guaranteed twins, much less one baby.  Overall, too many hands for a woman shot up with a shitload of synthetic hormones to deal with.  I freaked out, cried at my desk, and then jumped into action.

I did what I always do.  I called everyone and their mother who might have an opinion or advice to give.  The first call was obviously to Josh, followed quickly by calls to my aunt who is a doctor, her husband’s ex-wife who is a reproductive endocrinologist, my friends who have also conceived through IVF, friends with twins, and everyone else I could think of.  The whole time I was on the phone all I could think was, “We shouldn’t be making this decision.  This should be G-d’s decision.”  I’m not a terribly religious person, but there were times during this process when I felt like we were crossing an invisible line in the sand of baby-making.  It’s a bizarre experience.

Anyway, after an hour of frantic phone calls, Josh and I talked again.  We agreed that our doctor had not steered us wrong in the past, and we would do well to take her advice.  One embryo it would be.

I was given a number of instructions to follow on the morning of the transfer.  No make-up or jewelry, and I was supposed to drink a lot of water so that my bladder would be nice and full for the ultrasound they would use to guide the transfer of the embryo back into me.  I complied carefully, ditching my usual extensive early morning make-up routine (HA!) and leaving my bling in the drawer.  (Didn’t I feel like a schlub when we got there and I saw every other woman in the clinic dressed to the nines.  Jesus, ladies, it’s a fucking fertility clinic – you should have already found your sperm donor by the time you get there!)  Anyway, I downed a shitload of bubbly water on the way there, only to find out that bubbly water is a no-no because the bubbles in your stomach can screw up the image.  Great.  Because at that point I really wanted to drink more.

After consuming enough water that I was considering building an ark to deal with the inevitable flood, we were finally called into the baby-making room to do a little baby-making.  Sadly, not like that.  It was so not hot.  There was an exam table with a big-ass pair of stirrups and an ultrasound machine and a doctor and a nurse and a lab tech and a big screen on the wall and nary a candle or bottle of champagne to be found.  I assumed that all-too-familiar position, and they put this image up on the screen:

Yep, that’s our little munchkin, embryo-style.  I think she looks like me.

The nurse put me on ultrasound and immediately gasped.  I thought there was something wrong, but in fact she had rarely seen someone with a bladder as full as mine.  She even offered to let me go to the bathroom and empty it a bit if she thought I could stop myself, and still keep most of the pee in.  Seriously??  Anyway, there was no way I was going to be able to shut that door once it opened, so I stayed there with my ultra-full bladder.  They got everything all prepped, and suddenly a woman in scrubs, a cap, and a mask appears through a second door I hadn’t even noticed.  (That freaked me out, but not for long.  I was too focused on getting to the part where I could pee again.)  She handed the doctor a petri dish containing the embryo we had seen on the screen a few minutes earlier.

After the embryo was properly inserted into the catheter, she disappeared again.  The doctor then proceeded to attempt to cath me.  And it didn’t work.  And then he tried again.  And it didn’t work again.  There was some amount of mumbling about trying a rigid catheter instead of a flexible one, but the doctor decided against it.  So he tried to cath me again.  And again it didn’t work.  And then attempt number four, also a failure.  Please keep in mind that all of this is happening while I’m flat on my back, legs spread, with a bladder full of 2 liters of bubbly water and 3 cups of flat water.  Not only did it hurt like a bitch every time he shoved the tube up there, but do you have any idea how damn hard it is not to pee when someone keeps shoving a tube up your hoo-ha?

Finally, the doctor agreed to switch to a rigid catheter, and it goes in on the first try.  He dropped the embryo off at her new address (#1 Uterus Lane), pulled all the tubing out, wrote a quick note on the computer and headed out to his golf game.  I had to lie there for ten minutes (they even set an egg timer next to the table for me) before I could get up and go to the bathroom.  The nurse was kind enough to leave a little bed pan there for me in case I couldn’t hold it, but I was desperate to hold on to the last tiny little shred of dignity I had, and there was no way in hell I was letting loose into a bed pan.  Besides, the nurse saw how full my bladder was – what on earth made her think that such a pathetic little bed pan could possibly contain the tsunami that was sure to erupt once I finally opened the floodgates?

Josh, being the sweetpea that he is, was trying desperately to distract me from how badly I had to go.  He chatted me up, told a few jokes, and politely refrained from poking me in the bladder.  Then he wandered over to the computer and started reading the note the doctor had written.  Most of it was pretty standard and boring, until he got to the part where the doctor described how the embryo had been “skillfully introduced” into the top of my uterus.  Skillfully introduced, my ass!  Man, I would hate to see what an sloppy transfer would look like – inserting the tube into the wrong hole?  (Did I really just say that?  Sorry.)  I tried to get Josh to amend the note, but he was a good boy and didn’t do it.  B-O-RING.

Anyway, as soon as the egg timer went off I was on my way… slowly.  It’s not easy to walk with a ridiculously full bladder, but I waddled as quickly as I could down the hall, past a number of other patients and staff members, to the bathroom.  (Remember that last shred of dignity I mentioned?  GONE.)  There is no possible way I can describe to you how good it felt to finally go the bathroom.  I’ve never done crack, but maybe it felt like that.  (That’s not a bad idea for a PSA – Hey kids!  Don’t do crack!  Just go drink a shitload of your favorite non-alcoholic beverage, hold your pee until you are more uncomfortable than you ever thought possible, and then hold it ten minutes longer.  Finally, let it loose.  Better than drugs!)

While I was peeing, the nurses asked Josh if I was a nurse.  Apparently they didn’t think anyone who wasn’t a nurse could be capable of holding urine for so long.  (Perhaps nurses have larger-than-average bladders?  Or lots of experience holding pee?)  Anyway, Josh told them that I’m a social worker, and apparently that was an acceptable substitute.  Nurse, social worker, resident bad-ass, whatever – it was all the same to me and my rockin’ bladder.  That little badge of honor more than made up for the doctor’s “skillful introduction”.

After that, Josh and I went home to start the long process of waiting to find out if it took.  I hate to leave my readers in a state of suspense, so I’ll just offer this little hint:

(In)fertility, part 5: The “Retrieval”

Josh said it best.  My reproductive system was hijacked.  With a few pills and more than a few injections, They took over everything, and bent it to Their will.  Mother Nature just didn’t do the job, so she was fired, replaced by synthetic hormones and long needles.  I don’t remember all the details, but I do remember starting the process by going back on The Pill for a few weeks before starting the injections.  (By the way, I love The Pill.  If I had my druthers, I would subsist entirely on The Pill, Diet Coke, and Advil.  Don’t worry, though, I’d throw in some multi-vitamins for good measure.)  Then it was a few weeks of the easy insulin needle injections before we moved on to the The Shots That Could Be Called Horse Shots Except Even Horses Would Be Scared Of The Fucking Needle.  Those were a total bummer, rivaled in suckiness only by the week and a half of almost daily blood tests and internal ultrasounds to carefully monitor the growth of the follicles.  Yes, that’s right, I said almost daily blood tests and internal ultrasounds.  I won’t go into details, but let’s just say it involved something that looked disconcertingly similar to the Seattle Space Needle, minus the needle part (Thank G-d for small favors, right?).

After nearly two weeks of starting my day with a visit to the phlebotomist and lab tech (We were on a first name basis.  They were lovely ladies, really.), we got a call from the doctor that our little follicles were fully baked and ready to go.  We had six, and it was time for them to evacuate my ovaries and take up temporary residence in a petri dish.  The official term for moving day is The Retrieval.  Josh and I were told to be at the clinic the next morning.

We showed up at the clinic, and were led to a corner of the room where the “privacy sheet” was closed around us.  (Interestingly enough, “privacy sheets” aren’t all that private.  You might think they’re sound proof or something like that, but they’re not.  Just so you know.)  So, we’re sitting there listening to all the other couples at various stages of their fertility journey (why do people always use the word “journey” to describe shitty situations that no one else really wants to be in?) which is not really what you want to hear when your hoo-ha is about to be spelunked in ways that it has never been spelunked before, not even by the Space Needle.

The plan was for my follicles to be retrieved (isn’t that such a nice, cleansed way to say that they were going to be up to their elbows in my lady bits?) while Josh would be escorted to a plush little room, complete with videos, magazines, and a wet bar where he could make his donation to the process.  (That’s how I imagined it, at least.)  Afterwards, my precious little eggs that the doctors, phlebotomists, lab techs, Josh and I had to carefully nurtured and tended over the past weeks would be unceremoniously pipetted into the petri dish, where Josh’s sperm would be eagerly waiting.  Party time, boys!

And that’s pretty much how it happened.  The nurses came by, checked my vital signs, hooked up the IV, and began the process of knocking me out.  (Would you want to be awake for this?)  I was becoming increasingly groggy as they wheeled me into the procedure room, and this is what I remember:

They put the gurney in the middle of the room, and I was immediately surrounded by men and women in full scrubs, complete with the caps and masks.  I swear there must have been 10 of them, circled around me, poking and prodding and moving and positioning.  They dimmed the lights, turned on the biggest spotlight I have ever seen, and pointed it, well, you know where.  So, there I am, flat on my back, ankles in the stirrups, legs spread about as far as they’ll go, and I’m staring into the silhouetted faces of masked strangers, the huge spotlight bright behind them, and the last thing I remember thinking is “Wow.  This must be what it’s like to get abducted by aliens…”

(In)fertility, part 4: Nurse Clusterfuck

Ok, so where were we?  Oh yes, Josh and I had just finished filling out the reams of mind-bending paperwork regarding the fate of my eggs, his sperm, and the potential for a power outage at the embryo freezer.  The next step was to meet with the nurse to plan out the schedule and learn how to do the injections.  No biggie, right?

Um, yeah.  Remember my clusterfuck post?  Well, in case you’re still not clear on what a clusterfuck is, read on.

After the doctor reviewed our paperwork, she reminded us that we needed to schedule an appointment with the nurse to go over everything. As we walked out, I talked to the receptionist about a time that might work, and I noticed that she didn’t put it in the computer.  I asked about that, but she said it was fine, Nurse Clusterfuck (not her real name) would definitely be here, and we just needed to show up.  I was concerned about this plan, but I didn’t want to be That Patient.  As a (mental) health care provider, I know That Patient and I don’t like That Patient – you know, the one who is uppity and rigid and needy and annoying and assumes you can’t do your job and bugs you to high heaven about every last detail.  So I kept my mouth shut.

Moron.  We both took time off work and school, we showed, and she didn’t.  Strike 1.

So, we rescheduled, and this time the receptionist was mortified enough to put our appointment in the computer.

We show up to the next appointment, and are promptly ushered into Nurse Clusterfuck’s office.  Oh dear G-d.  That should have been the first warning.  Ok, actually, it was my second warning, and I should have said something, but… well… you know – the whole That Patient thing.  Josh and I carefully oh so carefully make our way through her narrow cave of an office, sucking in, holding our elbows tightly so as not to disturb one of the precariously balanced mountains of paperwork and brochures on either side of us.  There was one tiny little chair wedged between a bookshelf and a small table overflowing with more crap, and Josh and I somehow managed to smoosh ourselves onto it.  He was held in place by the bookshelf, and I remember holding on to him so I wouldn’t fall into her boxes and papers on the table next to me.  Strike 2.

Nurse Clusterfuck has wandered off somewhere, so Josh and I take a minute to survey our surroundings.  Almost immediately our eyes land on her computer screen, which is turned on, and has her patient dashboard up.  For this of you unfamiliar with this sort of thing, it means that we can CLEARLY see the full names, ages, and diagnoses of about 8 other patients.  I hope that any of you readers who are familiar with HIPAA (or at the very least, the notion that medical information should be kep private) are having the same reaction that Josh and I had at that moment – a mild coronary followed ARE YOU FUCKING KIDDING ME?    Strike 3.  She should be out, but she’s not.

As Josh and I are working very hard to not look at her computer screen, Nurse Clusterfuck returns and begins madly shuffling through papers to try to figure out who we are and what we are doing.  I try, as calmly as possible (while still holding on to Josh to avoid falling off the one chair that we are sharing), to remind her that no, we aren’t doing IUI, we are going straight to IVF, no we have never done IUI, no, really.  Finally she seems to understand the words that were coming out of my mouth, shuffles through some more paperwork, figures out who we are, and what we need to know.

The first step is to explain the injections to us.  I have blocked out most of the details, but I do remember that the first series of shots was pretty straightforward – insulin syringes and little bottles of liquid.  Fine, I thought, we can do that.  After that we moved on to the needle with the huge barrel and multiple dials.  This was an important shot, and required turning the dials just so, and hearing a certain series of clicks in order to make sure that the right amount of medication was being loaded and dispensed.  The amount depended on the results of some testing I would have right before taking the shot, so we couldn’t preload it at the doctor’s office.  The nurse reminded us how important this shot was, and told us stories of patients whose whole IVF cycles were screwed up because they didn’t get THIS SHOT right.  Josh and I nodded somberly and paid close attention as she started to demonstrate.

Her sample syringe was broken.  Of course it was.  Now, I ask you, dear reader, of presumably reasonable intelligence (although you are wasting time and precious brain cells reading my blog, so it’s hard to know), what would you do in this situation?  Yes, that’s right, after scaring the crap out your already shell-shocked patients, after smashing them in the corner, leaving them hanging on to the tiny-ass chair for dear life and hoping that the tower of outdated brochures about chlamydia doesn’t fall on them, you would go find another syringe. That’s what you would do.  Because you’re not a Clusterfuck.

Nurse Clusterfuck, however, is a different story.  She keeps fiddling and twisting and plunging away, muttering about how it should work this time, now it will work this time, even though the damn thing is clearly broken.  Meanwhile, Josh and I are trying to avoid making eye contact with a) her computer screen, so as not to reread the confidential information glaring at us, b) each other, so as to avoid bursting into tears (at least on my part), or c) her, as I was on the verge of grabbing the syringe out of her hand and sticking in it in her eye.  Strike 4.

(And thus the baseball analogy goes terribly awry.)

Once she is convinced that the Super Complicated and Super Important Syringe is broken, she hands us a piece of paper with instructions and assures us that it will be fine.  Josh and I nod numbly as she pulls out what can only be described as The Shot That Could Be Called a Horse Shot Except Even Horses Would Be Scared Of This Fucking Needle.  Seriously.  This thing was at least 4 inches long, and wide enough that an ant could drive a very tiny car into it.  Seriously.  I could look down the shaft of this needle.  I did look down the shaft of this needle.  Nurse Clusterfuck is just about to start explaining how this particular syringe works when her phone rings.  Rather than ignoring the call because she is, oh, WITH A PATIENT, she proceeds to have an extended conversation about another patient and the effect that her genital herpes will have on fertility treatments.  (I still remember the patient’s name.  It’s burned into my brain.  My mother remembers where she was when she found out Kennedy was shot.  I remember that Sally Jones (not her real name) has genital herpes.  You know.  Like that.)  So there I am, hanging on to Josh, listening to a conversation about another woman’s genital herpes, and staring down the barrel of the death needle.  Strike 5, bitch.

By the time she gets off the phone, I have gone into shock.  Or something like it.  My brain is no longer processing information, and all I can think is, “I have no idea what we’re supposed to do.  How is this possibly ever going to work?”  Actually, I don’t think I was even capable of putting together that many words into a sentence at that point.  It was probably more like, “We’re fucked.  We’re so fucked.”

The rest of the session was a blur.  I remember Nurse Clusterfuck pointing at dates in the calendar, counting over and over again, but somehow the dates never came out the same.  The thing is, you have to get it Just Right otherwise the whole cycle is shot (ha!), and you have wait a few months to start all over again which may not seem like a big deal unless you have been trying to get pregnant for over a year and you felt old before you even started and now you feel like your ovaries are shriveling up right before your eyes.  Needless to say, we wanted to get it right.  As we left the nurse’s office, I really didn’t see how that was a possibility.

And that, my sweet readers, is a clusterfuck.

Post-script:  After this meeting, Josh and I decided to buck up and be Those Patients.  We contacted our doctor (who is great) and told her what happened.  She responded professionally and appropriately, and we got an appointment with another nurse who met with us in her nice, big, organized office, and took the time to walk us through everything, functional syringes and all!  Needless to say, we ended up getting it right.

Also, I feel compelled to say that the feedback we got about this nurse from her colleagues was entirely positive, and they have the utmost regard for her work with patients.  Perhaps she was having a hard day.  Hopefully she has better interactions with other patients.

Coming soon:  In which Carla’s reproductive system is hijacked.

(In)fertility Part 3: It Really Wasn’t That Bad

The next installment of my (in)fertility story is ready to go, but before I post it, I want to put out this caveat.  The thing is, the next couple of posts will be about some less than positive experiences.  Yes, you be shocked to hear this, but not every part of IVF is fun.  In fact, much of it just downright sucks.  However, having said that, I need to clarify this one important point:

It wasn’t that bad.

It’s true.  Sure, there were bad moments, but even as we were going through it, Josh and I noticed that it wasn’t that bad.  I still feel that way.  Let’s be clear – it wasn’t great fun.  All things considered, I’d rather eat pie or play Parcheesi, but I would do it again, and in fact, I probably will.

Knowing that I am about to describe some of the less than pleasant aspects of our IVF journey, I wanted to make this point for a few reasons.  First, our doctor and her team gave us *excellent* care, and I want to be respectful of that.  She gave us great advice and treatment every step along the way, which was one of the big reasons why our experience was as positive as it was.  Second, while I know that IVF is a miserable experience for many people, it wasn’t for us, and I want others to know that it doesn’t have to be truly awful.  Finally, it’s important to me, and for me, to keep things in perspective.  Josh and I are incredibly fortunate to live in a time and a place when this technology is available, and we have health insurance that will pay for it.

So, that’s what I wanted to put out there before I continue with the story… read on!

(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.

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.

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.