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04/28/2010

What if?

Long story short: friend of a friend.  Names changed.  That part where I went to the dentist and had a root canal without benefit of anesthesia totally made up, and, man, is Oprah pissed.

...Ohhh.  A little topical humor there.  You can always count on me for timely, up-to-the-minute comedy.  Stay tuned.  I'm working on a hilariously transgressive bit about Jay Leno and Conan O'Brien.  I should have it ready sometime around October, provided that no new developments bump the Teapot Dome scandal up to the front of the queue.

Anyway, I know this couple.  They got married and immediately started trying to conceive.  She got pregnant fairly soon after the wedding, but miscarried shortly thereafter.  And, sure, they were sad, but they were still doing okay; their disappointment didn't eclipse their relief that she'd gotten pregnant quickly to begin with.  According to her gynecologist, the fact that she'd conceived was encouraging, and they had plenty of time to try again.  No reason to be concerned.

They tried again.  Seven months later, she conceived again, and miscarried shortly thereafter.

No big deal, said her doctor.  (I imagine him patting her knee, but then I'm kind of mean that way.)  Try again.  These things happen.

The woman is 42.

These things happen.  So they were going to try again.

Like I said, friend of a friend.  My friend — the point of connection — heard all this and, with admirable delicacy, did not shake them by the shoulders until they'd juddered their way to an RE's office, but instead asked me what I thought.  "Shake them by the shoulders," I told her, "until they've juddered their way to an RE's office.  And bring me the head of that charlatan who told them to try again."  I probably said this in a booming tone that brooked no dissent.  I can't really remember but since that's usually my go-to tone for ordering decapitations, it's probably a safe assumption.

She shook, invoking my name.  She probably called me "my friend Julie, who heals with a mere laying-on of hands," which is silly because I've asked instead to be called "my friend Julie, destroyer of worlds," but then I'm used to having my name mispronounced.  But more importantly, she passed along my advice under my authority as a former fertility patient and someone familiar with the gentle art of jamming needles where they'll do the most good.  (Sure, okay: my formal medical credentials are limited to years of stealing prescription pads from the pockets of Dr. Google's lab coat, but they haven't caught me yet, and I'm damned if they'll take me alive.)

Anyway, her shaking bore some fruit, to churn an already awkward metaphor into a goddamn smoothie.  The couple had their first IVF.  Their goal was to do PGD in the hope that they could transfer only a healthy embryo.

Five eggs retrieved — not bad for a woman in her 40s, I thought — three of which fertilized, two normally. 

On our friend's advice, the woman called me on day three post-retrieval and we had a long talk.  I was initially fearful because I wasn't sure what her state of mind might be, how realistic her expectations.  It was a relief to hear that her understanding of their chances was reasonable, that no one thought IVF would turn bad eggs magically good, that she and her husband were as level-headed about it as it's possible to be.  Hopeful but not expectant.

Indeed, in the end, not expectant.  One embryo remained on day five, chromosomally abnormal.

And I don't know how this will end.  I think they're planning to try again.  I know they're even more acutely aware now that time is not on their side.  Soon she'll be 43.  They've lost an entire year.

...

What's crazy is that as I talked to her on the phone I was biting back envy, thinking, Damn.  Five eggs.  I never got five eggs.  She told me how low her FSH was and I actually said aloud, "Whoa."  I felt a tiny twinge of nostalgia for those days of intensity, even the deep sick thud of failure.  Let me repeat that: I felt jealous of how well a woman in her 40s, with no children and two miscarriages under her belt, responded to fertility treatment.  Clearly what's crazy is me.

We got from treatment what we came for.  Ben and Charlie are out playing in the wet scurf of an improbable spring snow.  Three embryos chill in a tank, awaiting disposition.  Infertility is over for me.  But my file is on my desk.  I pulled it out shortly after my last conversation with this woman, mainly to see if what I thought I remembered was true: Was it really that bad for me?

It was.  It's not now.  The daily dread, the stealthy creep into every aspect of my life — that's over, thank science, thank God.  But the patient in me dies hard.  I speak to a woman in the thick of it and wish I could travel back in time, storm into her gynecologist's office, and grab his jaw to make it form the words, "Don't waste another month."  I look at my file, a page peeking out, its edge studded with Xs — did not fertilize, did not divide — and think, What if we'd waited?

...

I was 30 when we started treatment, 33 when Charlie was born, 37 at the birth of Ben.  For us, infertility wasn't strictly a matter of age.  (I say "strictly" because, although I was on the young end for treatment, my ovaries, even in my early 30s, behaved like those of a 72-year-old postmenopausal man.)  What if we'd waited?

What if my gynecologist had brushed us off instead of referring us to an RE? 

What if we'd started trying to conceive when I was, say, 35?  Or what if we'd only begun treatment then?  That year all three cycles we attempted were cancelled for lack of response.

I want to be clear: This isn't really about waiting to start a family.  My phone friend said wistfully, "If I'd tried when I was younger..." and I stopped her before she could finish.  We do the best we can, after all, with the knowledge we have at the time.  And how many of us truly wish we'd tried with the men we knew at 20?

It's about making sure that people get the help they need as soon as they're ready to get it, as soon as they possibly can.

What if, instead of sending them home to try again, their gynecologist had looked at the date of birth on her file and referred them immediately to an RE?  "But she hasn't gotten pregnant even with treatment," is what you might be saying.  That's true.  But a year might have made a difference.  A patient one year younger, with an egg a year less damaged — one of those embryos could have been fit for transfer.

But maybe not.  Maybe it was already too late.  IVF doesn't salvage damaged chromosomes, and PGD is not a silver bullet for aneuploidy, after all.  Maybe instead, it could have saved them two miscarriages and months of misplaced hope. 

Whatever else it can and cannot do, IVF does abbreviate the timeline.  It could have bought them some time to consider other options.  Who knows?  They could be well on their way to parenthood through other means, if that year hadn't been lost.

Niaw_logo I'm writing this post as part of Project IF, the effort by RESOLVE and Mel of Stirrup Queens to highlight the many and far-reaching consequences of infertility as part of National Infertility Awareness Week.  Mel has asked that participants end their posts "with a new, positive 'what if' — a best-case scenario for you personally, what you hope to see happen either for yourself or for someone else."

First, in the personal sense, I hope my phone friend and her husband find success, however it might come.  She's brave and they're strong and I wish them the very best.

Now, in the larger sense, I hope no gynecologist ever breezily tells another woman in her 40s — one who's miscarried twice, no less — to go home and keep trying.

I hope every doctor so inclined can be made aware not only of the gravity of such women's reproductive situations, but also of what's at stake emotionally.

I hope women who want a pregnancy are given, without delay, advice, access, and solid information that educates them about their options, gives a realistic picture of their chances, and lets them pursue treatment, if that's what they want for themselves.

Seems like a small thing to ask.

I'm going to do a tiny bit to help things move in that direction.  I'm taking a copy of Mel's book, Navigating the Land of IF, to the office of my own former gynecologist.  (He did refer me to our clinic, but then he also did three Clomid IUIs on me without monitoring, so, you know, pick your poison.)  I'm going to leave it in the waiting room and hope it helps someone who's struggling.

I will also provide five of you with your own copy.  You can do the same — leave it where you think it'll do the most good — or keep it for yourself or send it to someone who'll benefit.  All I ask for you to qualify is that in the comments here, you share an infertility story or tell us what you'd do with the book if you won it.  (Make sure you leave an e-mail address where I can reach you; it won't display on the site.)

One entry per reader, please.  I'll draw five winners on Monday, May 2.

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