Julia Leigh’s Avalanche

Reading Julia Leigh’s new book Avalanche: A Love Story stirred up many emotions and memories.  Leigh, a successful screenwriter and author embarked on a long, difficult quest to bear a child, first with her husband, then with a known donor.  Moving from her husband’s vasectomy reversal to the first flush of hope to disappointment and divorce along the road to eventually multiple cycles of IVF, Leigh chronicles her journey to letting go of her dream.

One of the parts I loved about Avalanche was Leigh’s beautiful writing as she unsparingly documents the reactions of her friends and family, procedures, clinics, and interactions.  The prose comes across as almost ethereal initially, but there’s some sharpness in the mix.  Leigh has a knack for dropping the most devastating lines almost casually.  Leigh notes a Bentley in the MD parking of a clinic in a single sentence without further comment, but the juxtaposition with her own significant financial outlays is jarring.

Avalanche captures well the quixotic mixture of hope and fear that often accompanies infertility treatment and IVF.  There’s no doubt that entering a fertility clinic involves a certain amount of hope upfront, a certain fundamental belief that this will work, somehow.  Otherwise, who would go through the physical, emotional, and financial difficulties of IVF?  I nodded in total recognition as Leigh goes over the few statistics she could find, considers her chances based on those, and then talks about how she was convinced that she would be the exception.  It’s at once familiar and heartbreaking.

As Leigh gets further into treatments, she talks about the ‘extras’ she could – for a price, of course – add on to her IVF cycles to attempt to increase her chances of success.  None of them fully proven, but showing the possibility of helping.  I remember clearly feel the difficulty of making some of these choices (about ICSI in my case), wondering if this might be just enough to tip the cycle over the edge into a baby.

The moment in Avalanche, however, where I literally gasped out loud comes near the end.  Leigh’s doctor has told her over and over that if they can get a blastocyst embryo to transfer, her chances are 40% that she will get pregnant.  Leigh asks if this is among all age groups at one point, and her doctor truthfully tells her yes, but neglects to mention the clinic’s actual statistics for women Leigh’s age using their own eggs.  Finally, she is given the grim numbers: 2.8% for 44 year old women, 6.6% for 43 year old women.  After reading that section, I sat for a long time, almost unable to think.  While I suppose Leigh’s doctor was technically correct in her numbers regarding blastocysts, it seems unconscionable to withhold the actual numbers, so pertinent to Leigh’s situation.  It is a stunning betrayal, an abdication of the physician’s responsibility to carefully explain all potential risks and benefits of a procedure.

However, Avalanche is, at its core, a love story and in the end, it remains such.  The love of Leigh for the child she wanted so much is evident as she slowly lays down and buries this almost palpable being in the end.  Leigh’s great love for her family also shines throughout the novel, especially that for her nieces and nephews.  There’s a stunning generosity of spirit – from the moment when her own mother initially refuses to support her attempts to have a child to stories about the children in her life – that runs throughout the book.

That Avalanche is a love story, despite these numerous betrayals, is very much a triumph.  It turns the logic of “never give up” on its head.  Certainly, none of this is without enormous loss and pain, something I don’t want to minimize.  Instead, in drawing a boundary, accepting, and moving forward, Leigh preserves herself and her spirit in spite of everything she has faced.

The Perception of Infertility Stories

I recently finished reading Julia Leigh’s new memoir Avalanche, a book by turns interesting and difficult in its frank depictions of fertility treatment*.  At times, I found myself nodding in understanding or literally gasping at some of her recollections.  In any case, I was interested when I saw that the New York Times had picked it for a book review along with another book on infertility.  While I see articles and books on topics such as miscarriage and infertility appearing periodically – and perhaps more often than I once did – I’m trying to be hopeful when a major media outlet takes on infertility.  It’s a more common issue than people think and important to discuss.

Then I read the review.

Rachel Cusk doesn’t so much review Avalanche, for which she reserved the majority of her commentary and barely touched on author Belle Boggs’ work The Art of Waiting.  Instead, she used her column inches to write essentially an op-ed on how she perceives infertility and the treatment of such.

There’s a lot in the article that as a woman who has experienced primary infertility and gone through fertility treatments ranging from Clo.mid and timed intercourse to injected fertility drugs, IUI, and IVF I find breathtakingly ignorant, judgmental, and frustrating.  Others, including Elissa Strauss in Slate , Pamela Tsigdinos in Medium , and Loribeth at The Road Less Traveled have written excellent rebuttals to Cusk, taking on many of these points as well.

Cusk writes of women writing about undergoing IVF or fertility treatment “The woman writing about the travails of assisted reproduction, on the other hand, is in a somewhat curious position…This woman doesn’t – can’t – fear what having a child will mean for her hard won social and intellectual autonomy; she isn’t concerned with the right to express ambivalence toward this oldest and strongest of binds – indeed, she perhaps views maternal ambivalence as a somewhat grotesque luxury.  No, this woman is unambivalent: she wants desperately, blindly, to become a mother…”  In this, Cusk seems to less be critiquing Leigh’s book than she is offering some sort of categorization of all infertile women writers.  It feels dismissive and untrue.  I know I did not brush away lightly the concerns about what having a child would do to my career or life.  With everything I was putting on the line, I was more aware than ever of that conflict.  I had a lot of time to consider exactly how a child might impact my life and marriage – possibly more than some fertile people simply because of the extended time and effort required.

Throughout the review, Cusk makes references to infertile women selfishly chasing something that simply isn’t going to happen, almost a delusional state where everyone else can see the writing on the wall but the woman keeps pouring resources into it, defiantly refusing to see what is staring her in the face.

This is where, to me at least, Cusk misses the point entirely.  It is because of books and authors like Julia Leigh speaking up that women experiencing infertility have these varied stories to consider in making decisions about treatments like IVF.  From the time I was diagnosed, I had books such as Melissa Ford’s The Land of IF that examined the varying pros and cons of the options open to me once the doctor told me that I most likely needed medical help if I wanted to conceive.  Silent Sorority by Pamela Tsigdinos helped me to understand that IVF was no guarantee and encouraging me to do my own research.  It was also the book that reminded me, from early on when I did not have the luxury of knowing how this was all going to turn out, that no matter what, I could – and would – figure out a way forward regardless of how treatment ended. There were so many other books I read, all with different stories and endings, from Waiting for Daisy by Peggy Orenstein to Cracked by Miriam Zoll to Good Eggs by Phoebe Potts.

These women put it out there, shared their hard won experiences and wisdom, and because of them, I was better able to consider my options, empowered to set boundaries on the treatments I was personally willing to consider, and know that I had choices.  Not always good ones, certainly not always the ones I wanted, but these books (and bloggers) had a tendency to pull off the blinders I sometimes developed in the midst of treatment and help me reevaluate.  It was often good to be reminded that everyone has different feelings and reactions and resources to apply to various paths out of infertility as well as tolerance levels for procedures like IVF.

Avalanche is a multidimensional work that examines the facets of an individual experience and how infertility – and motherhood – are perceived in today’s world.  It’s a voice in the conversation surrounding the ethics and issues when fertility isn’t a given.  The voices and experiences are indeed diverse, but for me – and many of these writers – speaking about infertility isn’t a purely intellectual exercise, it’s an intensely personal, life-altering condition.  This is another place I struggled with Cusk’s review: I cannot speak about infertility with an airy, detached, academic quality.  It is the very real, wrenching memories of sobbing in ultrasound rooms, the physical scar tissue from PIO injections, the messy reality of bleeding.  Cusk displays an incredible amount of privilege by treating the subject as merely a thought exercise instead of treating it with compassion and empathy.

Cusk once wrote the following of a review her own book A Life’s Work received: “…for [the reviewer] was not judging the book as a book.  She was judging it as a social situation.”  Cusk obviously takes exception to such judgment when applied to herself.  It is a shame that she falls into the same trap when considering Julia Leigh or Belle Boggs and their experiences.

*Pamela Tsigdinos is hosting a book tour of Avalanche on Wednesday, September 21, which I am looking forward to participating in.  If you want to join in or read along, the details are at Finally Heard/Silent Sorority.  It promises to be an excellent conversation.

Thanks to Mel at Stirrup Queens for hosting and originating Microblog Mondays.  If you want to read more Microblog Mondays posts or submit your own, head over to her blog.  

An Update and News

Content note: pregnancy.  If you’re not in a place for that or it’s triggering, please take care of yourself first and skip this one.  

Back in June, I went to see Dr. E for my saline infusion sonogram (SIS) to check my uterus for scarring.  He pronounced my uterus free of issues and also noted that my ovaries looked much better than usual.  I knew I’d been getting positives on the OPKs for a few months as well but had mostly discounted them.  Despite trying to manage my expectations, we’d been trying just in case something shook loose.

One July Friday night, I went to work and shortly into my shift, made a mental note to add “buy new bras” to my list for Monday.  My chest felt like invisible flames were dancing over it, a phenomenon that went on most of the night.  At around four in the morning, it finally hit me.   I’d only felt like that once before.  I counted the days off in my head.  The timing was right.  No way, I thought.

I’m an inveterate POAS addict, however, so I got home the next morning, did my thing, and then stared in shock as the lines popped up positive almost immediately.

On Monday, I called the RE’s office to do the blood tests to confirm.  Either 13 or 14 dpo (depending on the method of counting), my beta hcg came back at 180, a huge number for me.  My previous betas were 30 (11dp3dt with twins that I miscarried one at a time), 22 (10dp5dt with an ectopic pregnancy), and 63.4 (10dp5dt with my daughter).  I held my breath to the next beta forty-eight hours later, which had shot up to 530.

In the next few weeks, I had a spotting scare that revealed a 6w4d baby with a heartbeat and a tiny bit of bleeding in my uterus.  Waited.  Had a bright red bleed a week and a half later that sent me into a panic but the ultrasound showed a subchorionic hematoma (SCH) of about 1.8 cm that was pronounced “small” and not a major concern.  Given that the SCH that most likely caused me to PPROM at 21 weeks with my daughter started at 2 cm, I was less than reassured.

Despite the worry, the bleeding didn’t come back and the SCH shrank. My OB kindly works with my anxiety and checks in weekly to make sure there’s a heartbeat still.  I see the perinatologist (high risk OB) in a couple of weeks due to my history of preterm birth.  I’ll be 13 weeks on Monday, and just starting to believe that there might actually be a second baby in March.  I’m beyond excited at that thought in many ways but also know all too well that there’s no such thing as a ‘safe zone’ when it comes to pregnancy.  At the moment, though, the pregnancy appears to be progressing the way it should.

Truthfully, I haven’t known what to say here, hence the long delay in posting.  The whole thing didn’t seem quite real at first and then felt tentative with the bleeding.  I know well that feeling of hearing pregnancy announcements and the last thing I want to do is cause any one caught in the many difficult spaces of infertility pain.  I know all too well that ache.

I’ve always been honest in this space, though, and it’s time to come forward with this news.

So, for whatever it’s worth, here I am…nerves, happiness, survivor’s guilt, and all.

 

Preserving A Space

Over the last few months, I’ve played around with the idea of printing out my blog as an actual, physical book.  Not to work up for publication or for any sort of distribution, but because, well, it’s my life.  Certainly edited and condensed in some respects – many posts have ended in my drafts folder, countless sentences and paragraphs pruned, life outside of infertility often left undocumented – but definitely truthful and an accurate chronicle of the last several years.

It’s funny how the internet is at once permanent and constantly shifting, blogs and platforms and media appearing and disappearing at breakneck speed.  I went back recently to find a post that I loved from a blog, only to find the blog and post gone.  While I have no plans to move out of this space right now, I know I don’t want to lose the entries if one day the terms of service with the hosting or the platform itself changes or for any other reason.  Printing them out in a tangible medium feels somehow more permanent to me, more real.

In the end, it’s a big part of my story.  It’s the space where a lot of moments live that in real life are long gone.

So, my question to all of you is this: have any of you printed out your blog?  What service did you use?  How expensive?  How much difficulty or ease?  Any advice or stories to share?

This post is a part of Microblog Mondays.  If you want to get in on the action or read more, please head over to Stirrup Queens.  Thanks to Mel for originating and hosting.

Eleven Years In…He’s Still Wonderful

Our eleven year wedding anniversary was on Saturday.  We went out on Thursday evening (since I had to work on Saturday) and Arthur brought me a card and small bouquet of flowers.  Sunday, Arthur got me up from my nap with the following words: “Hey, don’t freak out, but…”

Uh-oh.

“I think I saw a mouse.”

Management followed through superbly after I notified them and the exterminator came out yesterday.  He placed a few glue traps and a childproof box of mouse poison.  I winced.  “So…if the mouse gets poisoned…I might have to pick it up?”

“Yeah,” he said, “or it might crawl outside to die.  If it gets stuck in a glue trap, you’ll be able to see it, but you’ll just throw out the whole thing.”

I stared at him.  As much as I sometimes complain about it, I adult reasonably successfully most days.  I’ve dealt with job losses, infertility, IVF, miscarriages, and very premature birth.  I have a job with a high degree of responsibility.  I can balance my checkbook and figure out large swaths of paperwork.

Dead mice, though?  No way.

Arthur shook his head when I told him when he came home for lunch that I was not touching this one.  “But all you do is sweep it into the dustpan with the broom and get rid of it,” he said.

“Nope.  Not happening.”

“You weren’t this upset on Sunday.  You once had a live mouse in your hair during family reunion and didn’t start screaming because you didn’t want to cause a panic.”

“Live mice don’t ick me out as much as dead ones.  It’s not rational.  But I don’t want it living in our house, either.  So you’re just going to have to deal with it.  If I find it, you’ll probably hear the shrieks all the way over at work.”

Arthur was putting on his shoes to go back to work when we both heard it: a loud squeaking and rustling from the kitchen.  “I’m not going in there,” I announced.  “You go look.”

Arthur came back.  “It’s under the fridge, I think.  I’ll deal with it when I get home.”

I took the easy way out and called maintenance, who came, moved the fridge, and informed me the mouse had escaped.  I texted Arthur the news.  He texted back that he agreed “Mouse Hunt” would be a good movie to watch soon.

For our anniversary, I’d been working on a sweet, romantic sort of post about the reading we had done at our wedding called “The Blessing of the Hands”.  There are a few versions out there, but it talks about how these are the hands that will hold you in sickness and through trials and in the good times.  I had been thinking along the lines of how his were the hands that moved our whole apartment by himself and held mine during a long hospital stay and when we were pretty sure we’d never have a baby and so on and so forth.

That’s all true, but I have a very different, way less dramatic or romantic or sweet line to add now: “These are the hands that will check the traps and clean up the dead mice you hate so much.”

Or maybe not so much less romantic…after all, eleven years, and we’re still happily putting up with each other’s quirks and foibles.  We’re laughing and joking together, working as a team.

And really, what else could be better?

That Thing With Feathers

Hope is the thing with feathers

That perches in the soul,

And sings the tune without words,

And never stops at all…

– Emily Dickinson

 

We never really did much natural cycling when we first started trying to conceive in 2012.  My cycles were so incredibly abnormal right from the start that we had done our initial testing, gotten the PCOS diagnosis, and started seeing an RE before the one-year mark.  Even when we’d do a few months between medicated cycles and then ART cycles, I didn’t have normal natural cycles.

Once I quit breastfeeding (or, more accurately, attempting to breastfeed), the spot-bleed-spot-bleed-no-normal-periods came roaring back for several months.  Since that was my normal before my daughter was born, I wasn’t particularly surprised, just frustrated.  In some deep, dark recess of my mind, I’d genuinely hoped that giving birth would “fix” my reproductive system.  I tried a bunch of supplements, stayed on met.formin, lost weight, and nothing changed.  I saw my OB/GYN, got a prescription for birth control pills, picked up a pack, declared myself done with natural cycles, and then in a fit of pique, decided to pull a Scarlett O’Hara: “I’ll think about that tomorrow”.

Every day thereafter, I reprised.  I kept up with the supplements and met.formin.  Until one day, the bleeding stopped.  I marked the date as cycle day 1 and shrugged.  I wasn’t too hopeful.  I had an ultrasound in December because I was having pelvic pain and wondered if I had a cyst.  My ovaries had the classic “string of pearls” appearance of PCOS.

I started spotting on day 21, but then on day 28, had an actual round of bleeding that was easily identifiable as a real period.  I marked the cycle again and waited.  The bleeding stopped in a timely manner.  Again, I had a period on day 28.  The acne also started to let up a bit.

Well, this is new.

In late February, we decided to see what would happen if we ditched any form of preventing pregnancy.  In April, unsure if my body was even making the right hormones or trying to ovulate despite having cycles, I ordered some cheap OPKs.  They’ve come up positive each month for an LH surge and are appropriately negative otherwise.  I have a basal body temperature thermometer, but with my odd hours (I work nights twice a week) temping has not clarified anything.

A couple of weeks ago, I realized my met.formin prescription was going to run out, so I called the RE’s office to get that prescribed.  Since I was on the phone with them, I figured that I’d go ahead and schedule my saline sonogram.  It’s a bit on the early side since we’re not planning to transfer until next spring, but I reasoned that if anything showed up as an issue, then we’d have some time to figure out next steps.

Today, I saw Dr. E, my RE, for the sonogram.  When Dr. E checked my ovaries, he noted that they don’t look polycystic the way they usually do.  I looked at the screen.  I know the appearance of my ovaries well, and the usual bunch of immature follicles was definitely missing.  Dr. E asked about my cycles, and I told him about the positive OPKs, regularity, and the supplements.  “Well, keep it up,” he said.  “It seems to be doing something good.”  He told me that it was hard to say given my history if I’d get pregnant naturally, but it was worth continuing and he hoped it would work out for us.

It’s somewhat promising as infertility situations go.  Definitely an improvement in many ways, but is it enough to actually get pregnant? Even with ICSI and a surfeit of eggs, we really don’t make a lot of embryos – and the ones we do make tend to be about a day behind.

I really want to be hopeful.  I really want to think that even after all this, the “old fashioned way” might be truly possible.  I really want to think that even if this doesn’t work out, one of the embryos will work next spring.  There’s no doubt I have seen (and had) longer odds and stranger things work out.

At the same time, I also know all too well the painful wounds that appear when hope flits away and reality unwelcome rushes back.  As I told Arthur recently, “Everyone keeps saying you need hope to live.  But in my case, it usually just f*cks me over.”

That’s where we stay for now in terms of infertility.  In the gray area between hope and not, possible and not, that unsatisfying non-answer.  What I keep reminding myself is that this is a season, not forever – and much of the rest of life is good right now.  Today, though, definitely lightens that gray a little and causes the ‘thing with feathers’ to stir.

Want to read more Microblog Mondays or participate yourself?  Please head over to Stirrup Queens and enjoy!  Thanks to Mel for originating and hosting.  

Returning Home

Big time spoilers for The Lord of the Rings – especially the ending – ahead.  

It’s no secret that I am a huge fan of The Lord of the Rings.  There aren’t too many things in my life that have stayed constant since age 14, but these books continue to inspire, motivate, and comfort me.  As I’ve grown, aged, and lived, the meanings have changed, the understandings deepened, but every time I pick them up, I find something new.  When I first read the books, I was thrilled by the exciting adventure, the battles, and, oh yeah, Aragorn.  These days, it’s a different part that I keep turning to read.

One of the things I love about The Lord of the Rings now is the ending.  The movie version leaves out part of the original ending, and I understand that choice at some level.  The original ending is messy, hard, and complicated in a way that’s difficult to translate to the screen.

For those who aren’t familiar with the book ending, it looks initially like a very traditional storybook ending wrap-up.  Then the movie and book part ways: there is evil waiting in the Shire for the returning hobbits.  They have to fight yet another battle to get the Shire back – their home is ugly and changed by that evil.  The book and the movie return to sync when Frodo departs Middle Earth.

When I initially read The Return of the King, the scouring of the Shire irritated me a bit.  It seemed…unnecessary.  The major task was fulfilled, the ring destroyed, the epic showdown at the gates of Mordor fought, and the hobbits returned home triumphantly.  Then Tolkien throws in this seemingly discordant sadness and destruction.  It’s no wonder Peter Jackson left it out of the movie.  It feels unfair that after everything the hobbits have done and the horror they’ve been through they don’t come home to a hero’s welcome, that there’s still more to do.  This isn’t a Harry Potter ending.

Now, though, I get it.  Tolkien has captured the reality of life after being touched by struggle and tragedy, in whatever form that comes to particular people.  You don’t walk through Mordor and remain untouched.  Even once the main event is over and evil seemingly vanquished or at least survived, it’s coming home to find more work to do and reminder after reminder sitting in your front yard.

We walked through Mordor the days my daughter nearly died.  We walked through Mordor when my brother so inexplicably left us.  The days when nothing made sense.

I hoped when we finally came back, naively, it would still be mostly the same.  I knew better.  But I hoped.

Instead, it’s been the weariness of battling back what those journeys took from us.

It’s no longer the epic battles of life and death.  It’s the bitterness at the bottom of the glass, the sh*ttier stuff, but battles that are no less for their smallness.  It’s fighting those unwelcome triggers and reclaiming home.

It’s knowing when to lay down the swords and begin the peaceful work of planting and bringing green life back to damaged land.  It’s showing mercy.  In some ways, this is almost harder.  It requires vulnerability, patience, honesty, kindness, and diligence.  Qualities that some days are tough to muster.

Tolkien doesn’t give Frodo a beautiful happy ending in his beloved Shire.  The wounds simply go too deep.  I take a lot of heart, though, from Sam’s ending.  Sam, who also bore the Ring, touched evil, who also walked through Mordor.  Sam, who “planted saplings in all the places where specially beautiful or beloved trees had been destroyed and he put a grain of the precious dust in the soil at the root of each.  He went up and down the Shire in this labour…”  Sam, who receives these words at the last, painful farewell: “Do not be too sad, Sam.  You cannot be always torn in two.  You will have to be one and whole, for many years.  You have so much to enjoy and to be, and to do.”

That is an ending – or perhaps another beginning – worth all of the work.