Oh, Right…Infertility

I like to think I’m not particularly superstitious, but when Arthur and I got down to talking about the nuts and bolts of transferring one of our two remaining embryos in the fall, I couldn’t help it.  I used to love fall.  My birthday is in late October and I’m a huge fan of pumpkin spice everything, jack-o-lanterns, the beautiful days with crisp evenings, and the leaves turning brilliant colors.  However, the last few years have gone something like this:

A few days before my 30th birthday – Diagnosed with PCOS and told that it was “not impossible, but unlikely” that we’d be able to conceive on our own.

31st birthday – In the middle of ovarian stimulation/egg retrieval for the first IVF cycle that ended in miscarrying twins.

Shortly after my 32nd birthday – Arthur unexpectedly lost his job and I started bleeding with the SCH (both on the same day!).

33rd birthday – My brother shot himself.

SO…while I can intellectually accept that all of this is unrelated and probably coincidence, fall just doesn’t seem to hold the good sort of surprises for me.

We looked at each other when I brought this up and I knew as soon as I said it that we probably needed to put the transfer off a couple of months.  Not only did it give us some much needed financial breathing room, it gave me some emotional breathing room.

I don’t know how I’ll handle that first anniversary of my brother’s death.  I do know that the stress inherent in a transfer cycle, mega-doses of progesterone and, if I was lucky, HCG in my system won’t make it easier emotionally.  I also know that it’s not the time to deliberately set myself up for the terrible disappointment of a negative beta, the anxiety of an early pregnancy, or the devastating loss of miscarriage.  If we got pregnant on our own around that time, well, we’ll cross that bridge if we ever come to it, but making a choice to throw a transfer in there is a whole other situation.

I have such mixed feelings surrounding putting transfer(s) off until early 2017.  Relieved because I just don’t know how much more stress/loss I can take right now, and it’s a wonderful chance to get to simply enjoy parenting E (who has become a great deal of fun to interact with).  Hopeful because we have two frozen embryos and some time for natural cycles.  Frustrated because at some level, I’m tired of infertility.  I’m tired of knowing that we likely have about $7,000 – 10,000 in RE bills coming to complete the transfers.  I’m tired of waiting and just want to be finished with the process.

Regardless, I know it’s the right decision.

In a month or two when my met.formin prescription runs out, I’ll probably make an appointment to re-up that and do the saline sonogram to check my uterus for scar tissue or other problems.  I’m hoping sonogram comes back okay, but at least if there are issues, we have some time to mull over options before next spring.

In the meantime, we’re informally seeing if something breaks loose in a natural cycle.  Truthfully, I don’t see this happening.  We needed a lot of medical intervention to get pregnant, have no idea at this point if my left fallopian tube is open, and while I am having surprisingly regular cycles, we never made lots of great quality embryos during the IVF cycles.  I know what the deck looks like, and it’s not stacked in our favor.  At some level though, it’s almost as if I need to try this for a while – if just to satisfy my curiosity and answer the “what if” in my head.

Beta Results #1 and #2

First, I wanted to say a huge, huge thank you to everyone who has sent me encouragement, left comments, etc. I appreciate it more than I can say. Seriously. I wish there was some word or way to truly convey the depths of how much that has meant to me. Thank you.

I have the beta results from the IVF cycle back, and just wanted to say – if you’re not in the space, don’t go there. I get it. I’ve been there. Certainly, the last thing I want to do is cause anyone more pain.  It is so hard to be struggling through all of this at any stage of treatment or even beyond, and I wanted to give fair warning before getting into the results.

Monday morning 6 days post day 5 transfer, I finally couldn’t help myself: I pulled out one of my cheap pregnancy tests and took it. It was negative. I sighed. On the one hand, I now knew the HCG trigger shot was out of my system. On the other, I had really hoped it would turn up positive. I reminded myself that on neither pregnancy was my HCG particularly high and my own mother had had almost no pregnancy symptoms with either of her successful pregnancies, suggesting perhaps this was the normal for my body. It was still disheartening.

Tuesday morning, there was bleeding. I cried. And when I say I cried, I mean completely hysterical sobbing for hours. The sobbing wouldn’t stop. Even when I was finally feeling more okay with the situation, I continued to cry. I cried through trying to read. I cried through putting on a TV program. I literally couldn’t stop crying. Finally, by the time Arthur arrived home, the bleeding had stopped entirely and I had finally managed to calm myself to sniffling with occasional rounds of sobbing that were more like 10-15 minutes in duration instead of hours. Later that evening, a light bulb suddenly went on in my brain.

The only time I ever cry like that is when I have HCG in my system. I’ve done it after a couple of my trigger shots. I’ve done it when I was pregnant the first time. I did it when I found out my pregnancy was ectopic, but there was still HCG in my system.

So Wednesday morning found me dipping another cheap pregnancy test strip in the cup, crossing my fingers. I fully expected the result to be negative. I tossed it on the bathroom counter when a line didn’t appear right away, showered, and stepped out. Glanced at the strip. Did a classic double take.

“Arthur,” I said weakly, “I need you to take a look at this. I think I may finally have started seeing things that aren’t there, but I think there’s a very faint second line here.”

Arthur came over to inspect the test. “I see it too,” he said.

I decided I needed a better pregnancy test, so I hurried out to the store to buy the ultimate pregnancy test: the First Response Early Response. That evening, I tore in the door, barely said hello to Arthur, ripped the foil wrapping off the test, and did my thing. I stared at it as the test window saturated. Lo and behold, before the test had even reached the 3 minute mark, I could see the line beginning to appear. Still fairly faint, but no mistake: pregnant.

The thing is, as much as I know there are so many people who simply long to see a positive pregnancy test at all, I also know that for me, I’ve had two pregnancies that didn’t result in a live baby. As excited as I was to see the test results come up, I knew what had happened before. I took a deep breath. There was nothing to do but wait.

There was a tiny, tiny bit of spotting on Thursday. I gritted my teeth and finally couldn’t resist the urge to consult Google. In this case, that turned out to be a good thing. I had forgotten that the Endometrin I’m on for progesterone support can – and often does – cause spotting. The spotting was one and done, and I let out the breath I was holding just a little.

Friday was the first beta. I was 10dp5dt, and I let the nurse know as she was drawing my blood that I had a positive home pregnancy test, the line was getting darker, and that I was hoping it would be good news. She was excited for me, but I was nervous. A positive home test was a decent sign, but those things are pretty sensitive and it didn’t mean that my beta number would be high.

Dr. E called with good news. My beta came back at 63.4. For me, that’s a huge number. My beta with my first pregnancy (one day earlier, but still) was only 30. The beta with the ectopic on 10dp5dt was only 22. He wasn’t extremely concerned about the spotting because of the Endometrin, but told me to keep an eye out for anything further.

I’m trying to live in the present and just be in the emotions I’m at in that moment. Sometimes that works, sometimes it takes something akin to mental jujitsu, and other days I can’t manage it. “It’s a good day,” I kept telling myself. And it was. I was very excited and happy, but the shadow of what has happened both other times I have had a positive beta kept sneaking in.

By Saturday night, I was completely freaked out.

I reminded myself that there was nothing I could do – beyond what I already am doing – to change the outcome. I reminded myself that no matter how excited I do/don’t get about the whole thing, it will still hurt just as much if it goes wrong. I reminded myself that I would live through this, no matter what the outcome.

By Sunday morning, however, I’ll admit I was still pretty nervous as I drove to the RE’s office. I prayed out loud most of the way, wishing, hoping, and begging that my HCG be rising appropriately and somehow we might still be in the running for a miracle.

Today’s beta, 12dp5dt, came back at 204!

We are grateful. We are hopeful. We also know we have a long road still ahead of us. But today, it is a good day.

Ultrasound is set for October 13. It is the first time I haven’t had to schedule a third beta after getting the results from beta #2.

Egg Retrieval and Sundries

Tuesday morning, I went to the RE’s office for an ultrasound. I’d noticed for the past couple of days that my ovaries were very tender and achy, quite different from my first cycle. The first IVF cycle, I’d had a small amount of tenderness, but it was isolated, small twinges of discomfort. Monday, I’d instead felt a steadily increasing pressure and burning in my lower abdomen. I was definitely ready to get checked, because I knew something had to be going on. I just hoped it was good.

As the ultrasound tech read off the follicle sizes and count, I felt myself getting excited. There were a lot more follicles. They were also closer in size than during the first IVF cycle. Just to be certain, I asked for a printout of the final follicle sizes and count from my first cycle, and sat, comparing the two. During the first IVF cycle, I’d had seven follicles that were 18mm or larger and five that were 14 mm-18mm. This time, I counted eleven follicles 18mm or larger, and an additional seven that were 16mm-18mm. There were also several 14 and 15mm follicles.

I crossed my fingers and waited nervously for the call with my blood work results. I knew internally I’d be triggering that evening, but it was hard to wait for the confirmation. Finally, the nurse called to give me my numbers, the time for my trigger shot, and my retrieval time.

Thursday morning, we headed out for the clinic at 4:45 in the morning, Arthur drinking his coffee, me grumbling about the lack of coffee since I couldn’t have anything to eat or drink after midnight. For me, it’s actually not the caffeine that’s the draw – I can go decaf in a heartbeat without it bothering me – it’s the whole ritual preparing and drinking of the coffee. It’s also far easier to grumble about a lack of coffee also than face the major nerves I was feeling about the upcoming procedure.

When we arrived at the clinic, I calmly pointed out the good vein in my arm to the nurse, who managed to get my IV in on the first stick. I changed into my hospital gown and sat down on the gurney. First, the anesthesiologist came in to speak with me, confirm the plan, and make sure he had all the information he needed. Then the embryologist came in to make sure we didn’t have any questions about the lab process. After the embryologist, Dr. E and a resident came in to go over the final details of the egg retrieval and escort me to the OR.

Everyone liked my socks for the retrieval:

DSC01361I thought a “Birds and Bees” theme very appropriate to the occasion…

I woke up just as I was being transferred from the OR table back onto the gurney and wheeled back to my room. Arthur, Dr. E and the resident were there, and I vaguely remember slurring out “How many?” and Dr. E answering that he had retrieved 32 eggs.

32! I just sat there in shock. I had figured based on my final ultrasound that there would be around 18 or 20, but I hadn’t expected this at all. The first IVF cycle, 15 eggs had been retrieved, 11 had been mature, and 5 had fertilized.  This was a much better response so far.  I reminded myself about the crappy fertilization rate from the first IVF cycle and not to get overly excited.

I felt pretty good all the way home, but early in the evening, started feeling nauseous off and on. I wound up reclining with my eyes closed on the couch, listening to episodes of TV shows I’d already seen because I wanted something to take my mind off the discomfort, but unable to read or tolerate watching the flickering images. Finally, Arthur suggested going to bed.

In the morning, I was extremely glad that I’d proactively decided to take the day after the retrieval off to recuperate, because I felt wretched. What started out as mere lightheadedness and some achiness for a couple of hours turned into full on nausea and had me laying in the dark on the couch again interspersed with quick sprints to the bathroom and carefully sipping some fluids to rehydrate between rounds.

The lab called in the midst of all this. 22 eggs were mature, and 18 had fertilized normally. Even feeling icky couldn’t quell my enthusiasm. When the nurse called from the RE’s office just to check in on me and confirm that the plan was for a day 5 transfer, I was pretty chipper for feeling as rough as I did. She told me to call Dr. E if I kept getting sick throughout the afternoon or started to get dehydrated and said she’d alert him about my nausea in case it got worse.

Arthur brought me more fluids and saltines on his lunch break. Finally by about mid-afternoon, I could actually move off the couch without feeling like I was going to fall over or throw up again. Arthur got home, made us a light dinner and I spent the rest of the evening resting, exhausted but finally less nauseated.

There’s still a long way to go. I’m still pretty nervous about tomorrow, which is when the lab could call if something went terribly wrong and they suddenly needed us for a day 3 transfer. I know everything looks good, but I’ve had so many times things looked good in the past and didn’t work out. All I can do is wait and hope.

So Far…

“Wow,” I remarked to Arthur on Wednesday evening seeing the enormous box parked in the center of the living room when I got home from work. “The drugs are here. I think this cycle’s about to feel pretty real.”

Except that it didn’t.

The first fresh IVF cycle, I counted down the days to the cycle start with equal amounts of anticipation and nerves. I had my protocol memorized by the time I stepped into the clinic for my start-cycle ultrasound, and remained at a high emotional pitch throughout the whole thing. I was, in short, obsessed and anxious the entire cycle.

This time, even though I’ve done so much more preparation work for the cycle, it still doesn’t feel entirely real to me. I’ve lost 22 pounds, which Dr. E thought might help the PCOS and I’m at a weight I haven’t seen since high school. I’ve been taking metformin and co-q10 since June. I gave up soda before my FET, and have recently given up a pretty decent amount of refined sugar and flour. This last has been particularly painful since I have a wicked sweet tooth and love bread. Fruits, vegetables, and lean protein have become my new normal.

I went Friday for my start-cycle visit. My ovaries actually look about as good as I’ve ever seen them look on an ultrasound with a lot fewer of the characteristic PCOS cysts than what I’d consider my normal. The ultrasound tech also noted that I have a lot less fluid in my abdomen than I’ve ever had. The nurse drew blood to check my estrogen levels, which were low indicating my ovaries were suppressed sufficiently.

Okay, I thought. Now, it gets real. Especially after that check I just wrote.

Except that work got busy, and by the time I got home later, I almost forgot to start the medications. I scrambled to get the injections in at the time I wanted to set for the injections.

Saturday, we spent a pleasant afternoon watching Bones, and then went to help a friend move. It was busy, and even though we needed to get home for me to take my medication, I barely thought about the cycle. Sunday, I worked on cleaning. I cleaned out my closet and did the photos and listings for the items I figured could be sold. Cleaned out the bookshelf and prepared to take the three bags over to the local used bookstore.

Didn’t think much about the IVF.

Monday was my next check, so we had to head over to the city to the RE’s office first thing in the morning. I was bummed about that at first, since Monday was our only day to sleep in, but it turned out really well.

After I got done with the requisite ultrasound and blood work, we headed out to the walking trails along one of the rivers. “Do you have your phone, in case the RE’s office calls?” asked Arthur.

“Nope,” I said. “I just want to go hang out with you. We set my Wednesday appointment already, they can leave a message if there’s anything of note.”

It was a perfect morning for a walk: warm enough, but slightly overcast so that the sun wouldn’t beat down on us. We walked along the river, through the greenery and parks, just meandering and talking for a few miles. It was relaxing and wonderful. As we walked, we could smell fresh bread baking somewhere.

The scent finally had us walking back to the car to go get some breakfast. I knew a great local breakfast place in town, so we drove over and got in line. Despite how busy the restaurant was, we were seated within ten minutes. And oh my goodness, the food was good. Fresh orange juice with eggs and biscuits for Arthur and a heavenly dish of angel food cake French toast with strawberries for me. I’d never had anything like that before, and it was perfect: crisp on the outside, fluffy and delicate on the inside.  It was a real treat.

After we left the restaurant, the RE’s office called, telling me to up my doses of stimulation meds slightly and that yes, they’d need to see me on Wednesday. And that was it. I turned my cell phone off, slipped my arm around my husband’s waist, and we went to a movie with a couple of free passes I had for a matinee. Did a little bit of shopping. Had an early dinner. It was lovely, and for most of the afternoon, the IVF cycle seemed to barely exist.

Tuesday night, I almost forgot to take my medications again. Arthur came home to find me on the couch, frantically reconstituting Menopur and dialing up the Follistim pen trying to get my shots in on time.

Wednesday morning I had another check-up, which went fairly well. I’ve got 23 follicles ranging from 5-9 mm, the majority between 6-8mm. The good news was that they’re fairly similar sized and hopefully will continue to grow at the same rate to produce mature eggs at the same time.  My estrogen level is rising steadily, so we’ll see how this goes.

I have to admit I’m perhaps a bit glad of the less heightened sense of reality this time around. It means I’m mostly going about my daily life with less worry and less constant obsessing about the IVF cycle. I’m starting, I think, to accept that there’s very little I can control about this process other than choosing to undergo it in the first place. So I’m just trying to keep living and keeping my fingers crossed that it goes well.

Next check-up is on Friday.

Gearing Up

Visits to the RE’s office make me think of the scene from the movie Juno where Jennifer Garner’s character is first introduced. She’s one of those Pinterest-perfect Martha Stewart types, and when we meet her, she is straightening her beautiful McMansion and nervously tugging on the sleeves of her subtly expensive shirt. She’s trying to create the impression that she is responsible and well-off, and that in short, she belongs in the mommy club. Watching the scene, I can almost feel the tension radiating off of her.

It’s not unlike what happens when I’m getting ready for a visit to the RE’s office. Except that instead of Jennifer Garner’s cool nervousness, I’m a ball of cranky anxiety. Monday morning found me having a full on FWP* snit trying to choose between a pair of embellished navy cardigans. I’d put one on, decide I didn’t like the shirt I’d layered underneath, try on the other, change the undershirt, put the first one back on, then tear through the laundry looking for the pair of jeans I wanted to wear.

Much easier to freak out about which cardigan to wear – or straighten one’s house – than focus on the kind of potentially life-changing stuff that’s about to happen.

It’s funny how, as a friend once put it to me, the days can be long but the weeks, months, or even years are so short. When we had our consultation with Dr. E at the beginning of June, August or September seemed far away and plenty of time. Some of it, I suppose, is the profound ambivalence I feel surrounding the whole cycle. The first time we chose to go forward with IVF, there were some issues, there were some doubts, but on the whole, I felt strongly that IVF was the right choice in our situation. It was something we were certain – if not of the details – was the choice we needed to make.

This time, things are so much murkier. There is a part of me that wonders if I’m not stupidly setting myself up for even more heartbreak. When I look back at my writings or remember my thoughts prior to the first IVF, I remember trying to prepare myself, to be realistic in my expectations. I also see a great deal of lovely, naive hope behind all the fear that actually got me through a lot. Unlike the last time I sat on the eve of an IVF cycle, I’ve explored more of the dark places personally and what I’ve learned is this: it doesn’t matter how thoroughly I’ve mapped their surfaces. There is always a sharp spot to catch on and it will not be less painful for being familiar.

At the same time, I have to take into account all the other pieces. After talking extensively with Arthur and having some sessions with a therapist to work through all the flotsam and jetsam of emotions, we’ve come to the conclusion that we want to give it another shot.

Some of it has to do with the fact that for us, we both worry that if we don’t take it in five or ten years we’ll look back and regret that decision. When it becomes time to move away from treatments – and we both know that with or without a child, that day is coming – we want to do it with the understanding that we have done everything reasonable for us. We want there to be as few loose ends as possible, as few regrets. We don’t want to wonder ‘what if’. It’s a decision made with much difficulty, entirely personal to our situation.

After meeting with Dr. E (having finally picked a cardigan – the one I happened to have on when we needed to leave), I feel calmer about going forward. For starters, it was so entirely different than what happened before my first IVF. Last time, I was in tears midway through the teaching consult with the nursing staff when the nurse was trying to go over the protocol instructions because there were some things they were bringing up that Arthur and I hadn’t planned on. This time, Dr. E calmly explained why he wanted us to use a particular form of progesterone until beta day which was a question we had. We went over restrictions as far as lifting and exercise and he worked with me to come up with a plan that helps me manage my stress, live my life, and not have issues with my ovaries. Dr. E also helped us plan a start cycle date that worked well for all of us so that he’ll be the one able to really supervise my care.

The other thing that’s different now is simply that while I am still very afraid of hurt, sadness, and more loss (a reasonable fear, given my history), I am far more at peace with the idea of life without a child. One thing I’ve learned through all this is that, much to my surprise, I did survive what I previously believed I could not.

This time, I know something I hoped but didn’t know before: my life will go on. While sometimes that feels more like a threat than a comfort, especially on the days where it feels like only enough light gets in to make the darkness feel even more oppressive, it’s the truth. And eventually, the light gets brighter and while these losses are never going to be okay, I know I will be.  Not right away.  Not easily.  Not without pain.  But it will happen.

Because I am so much more than my reproductive capabilities (or lack thereof). No matter what society or anyone else says.

* FWP = First World Problem

Follow Up Appointment

A week ago today, Arthur and I had our post-cycle follow up with the RE. As is my usual when I have an RE appointment, I had, over the past month or so, compiled a list of questions I wanted to ask. I jotted the questions down as I’d think of them, and by the time the end of May rolled around, I had a solid list. We faxed them to the clinic to place with my paperwork for the appointment.

What I did not include on that list was probably far more telling than what I did include: I opted, for the most part, to leave out the intense emotional struggle about my experiences with fertility treatments. As far as I was concerned, this was more of an issue for a therapist than an RE. I’m sure some of it bled through in the phrasing of the questions, but I mostly dismissed the whole thing as too messy and time consuming to delve into.

Walking in the door of the RE clinic was harder than I expected. It’s one of those typical medical office waiting rooms, although a little nicer than most with olive green upholstery and slightly “arty” tables sporting silk flower arrangements. It doesn’t seem like the kind of place that should provoke a deep emotional response, but it’s the very nondescript quality juxtaposed with some of my worst memories that makes it almost more weirdly upsetting. I kept up a nervous stream of chatter with Arthur as we sat and mentally placed a Frida Kahlo painting on the soothing colored wall that seemed more appropriate to my situation.

By the time we were taken back to the office and Dr. E came in to talk to us, I could physically feel the anxiety welling up. I stared at the stylized designs on my cardigan sleeves, arms tightly crossed over my chest. Relax, I kept telling myself. I unbent enough to shake Dr. E’s hand and to put what I was trying to pass off as an attentive, calm expression on my face.

That lasted for all of about 30 seconds. We got to discussing my ectopic, and Dr. E pointed out that I was fortunate, that I hadn’t had to have a blood transfusion, hadn’t needed surgery, and that I’d made it out as smoothly as it was possible. This, incidentally, is not an untrue statement and I could tell that he hadn’t made it in an insensitive or dismissive way, more simply as a statement of fact. It didn’t matter at that moment. I had had it.

“Yeah, yeah,” I interrupted, finally unable to master the caustic combination of anger, grief and anxiety chewing through me, “I know. I know I’m ‘lucky’. I get that. It could always be worse.” I felt the tears start to well up, spill over, and paused. “I can’t believe I’m having to deal with this bullsh*t disease that’s not even real.”

The fact is, even as much as I try to tell myself that infertility is a very legitimate health problem and that PCOS is definitely a disease, there is a part of me that struggles to believe that. There is always some part of me that thinks, but I could have cancer. Or kidney failure. Or a debilitating autoimmune disease. I feel guilty for feeling so awful and for not soldiering on with a brave face. This was first time, however, that I’d stated it so baldly in front of a doctor.

I was staring at the desk when I said all of this, unable to even look Dr. E in the face. There was a pause. Then Dr. E closed the folder with my questions in it, and simply said something to the effect that we could talk about the details of another IVF cycle on a different day. “These aren’t really what you’re concerned about, are they?” he asked me gently, gesturing to the folder.

Part of me, the part that wanted to leave the office with some threadbare shreds of my dignity intact wanted to say these questions are what I’m concerned about, answer those and we’ll be on our way, but I couldn’t. “No,” I admitted, “they’re not. I can’t believe this has happened to me. It all sounded when I came here just over a year ago like it was going to be so much more simple than this. When the ectopic happened, all of a sudden I’ve started to have to face the fact that this isn’t a ‘when’ any longer. It’s an ‘if’, and that’s really hard for me. I mean, I’ve known since I got diagnosed that it was an ‘if’, but there was so much to try and Dr. D was so positive. Now I have to face that I may never have a successful pregnancy.”

So we talked. I cried. Arthur was awesome and was able to calmly bring up some of the stuff we’ve been discussing at home. Dr. E told us that he was glad we wanted to take some time off before even considering starting another IVF cycle. He mentioned that I probably needed to have some professional counseling at this point. I managed to bring up the question that I have struggled with for the past months about where to draw a line in treatment. “I know we could keep doing IVF for a long time,” I started.

“No,” he said, stopping me.

Dr. E explained that another fresh cycle was medically reasonable in my case if that was what we wanted. He stated, however, that IVF was a major procedure, he could see how much distress I was in, and it definitely wasn’t something he wanted us to do over and over again. He told us that the maximum number of fresh cycles he felt comfortable doing with us was three and even that number was highly dependent on our emotional state, our wants, and whether or not new information came into play that would affect the chance of success.

It was at once what I needed to hear and what I never wanted to hear: that while IVF is still an option now, we are approaching a point where IVF would no longer be a good way for us to build our family. However, I was glad that Dr. E did not try to minimize the impact of IVF on us or the limitations of medical science in treating infertility.

Arthur and I have talked a lot about where our limits are as far as treatment. At this time, we have tentatively decided to proceed with another fresh IVF cycle probably in late August or early September to give us some time to heal and think. If we’re not ready, that’s fine too. Even with this as our current plan, we still know that both of us need to start considering what life looks like beyond fertility treatments because there are no guarantees.

Counting the Cost

Back in January of 2013 when I was setting up my first RE appointment, I asked specifically for an appointment in March. This was to give both Arthur and myself some time to complete testing, take a vacation we’d already scheduled and paid for before we realized how serious the situation was, and to allow us to come to terms with the fact that we were now at a new level of intervention and care for infertility.

I also ordered some books to read during that time, one of which was Silent Sorority: A Barren Woman Gets Busy, Angry, Lost, and Found by Pamela Mahoney Tsigdinos. This might have seemed an odd choice for someone just starting their infertility journey, who hadn’t even had an IUI or an actual RE consult at that point. It’s also worth noting that the prognosis looked fairly bright, as the problem appeared to center mostly around lack of ovulation and at 30, I was fairly young. The theory went that if I could ovulate, I could probably conceive a successful pregnancy.

By that time, I’d heard the media and people talk about IVF like it was no big deal, that if I really wanted to get pregnant, technology would make it possible. I wasn’t so convinced. I knew how much emotion I’d felt when I’d gotten the PCOS diagnosis, when I’d been referred to an RE, and I had a feeling that this wasn’t going to be so easy.   At the time, I had sort of started to blindly feel around the very outer edges of an idea sitting amidst the whole infertility mess.

I had this vague intuition that the worst outcome I could imagine didn’t end with Arthur and I never having a child. Don’t get me wrong: that idea certainly was, of course, distressing for two people just starting to navigate the treacherous currents of infertility, weighing treatments and whether or not we wanted to look into adoption. But I knew, deep down, there was something much worse.

It was this: we would never figure out a way to live beyond the damage infertility had wreaked in our lives. That we would lose ourselves, each other, and everything we’d worked to build in a never-ending quest to have a baby.

Then I entered treatment.

It’s strange the tricks that treatment can play on your mind. Even though I’d gone in with what I thought was a healthy set of boundaries, before I knew it, I’d taken the headlong plunge down the rabbit hole into a world of injections, IUI, IVF, and total desperation. It’s amazing how one treatment segues into the next, how the previously almost incomprehensible idea of doing IVF suddenly starts to look like the shining beacon of hope.

Magical thinking took over my brain entirely. I felt as though if I even considered the idea of doing all these treatments and ending up without a baby to show for it, my treatments would fail. I needed to be more positive. Not think about the other potential endings to the story. Because if I even thought about the possibility of a treatment not working, it wouldn’t work. Then I’d feel guilty if I did think about it, and when the next cycle failed, I’d find myself wondering if something I’d done had caused me not to become pregnant.

This, of course, is patently ridiculous, but desperation and fear do awful things to the mind. And honestly, if my thoughts are so powerful as to actually manipulate things like embryos or my ovaries in the physical world, I’d have done it already.

The December miscarriage changed everything.

There was nothing I could have done differently to make that pregnancy work. I had diligently taken my medications and religiously followed every restriction. Except for a few quiet moments of guilt spurred by the incredible sadness, I knew I had given everything I had to keep the pregnancy healthy. There was nothing I or medical science could have done to prevent the loss.

I recently went back and reread Silent Sorority. As I read Tsigdinos’ words describing why and how she came to the decision to leave treatment and live without a child, I knew this wasn’t as theoretical an idea as it had once been. When I had first read the book, I had a number of options for treatment in front of me. Now, having been through some of the most advanced treatments that medical science has to offer for infertility, it’s much more of a possibility that Arthur and I will walk away from this table with no lasting pregnancy or child to show for it.

I needed to know that there was a life – a good life, a life worth living – if I could never become a mother. That there existed a place where it would be okay to stop treatments, not be able to adopt, and move on. I am profoundly grateful to author Tsigdinos (and others as well) for stepping forward and demystifying what life looks like after an infertility journey without children.

For the first time in our entire infertility journey, we have no obvious forward path. We have plans to meet with Dr. E in June for a follow up, and hope that maybe he can answer some of the questions we have about our IVF failures. I think at this point, both Arthur and I have a sort of tentative plan to do one further fresh IVF if Dr. E doesn’t have some sort of new information that would give the whole thing a much lower chance of success than we were hoping. We occasionally talk about the idea of adopting, but right now, the idea of doing all we would have to do – moving, saving up, completing the mountains of paperwork, working through our grief in a meaningful way – is simply overwhelming.

Arthur and I sort of accepted that when I got the PCOS diagnosis, the question about having children was an ‘if’, but there were a lot of options that made it feel a bit more like ‘when’. Perhaps in so many ways, that is one of the greatest losses that comes with this latest miscarriage other than the loss of the pregnancy itself. Suddenly, the question really has changed – at least in my mind – to ‘if’.

We’re both starting to see far more clearly what it is that Tsigdinos articulates so well in Silent Sorority: that there is a place where you realize you simply have to stop in the quest to have a child. The cost is too high. It might be financial, it might be emotional, it might be your relationship, it might be other dreams you finally realize you can’t sacrifice for “maybe”. It might be all of the above, or it might be something specific to you alone.

I genuinely don’t know right now where that place is for us. Is it after another IVF?  Is it further down the road?  Is it if there are more physical issues discovered?  What kind of adoption options would we consider?  I suppose the next leg of the journey probably has something to do with figuring that out.