Everything I need to know I learned on codeine

I've been correponding with my friend H., who's been in on our diabolical scheme from the beginning, and a very helpful sounding board throughout. She's a veteran of several painful episodes of her own, and had this to say about my ectopic adventure:

"Pain is an interesting bedfellow. It teaches you things...but I'm not sure what you learn is actually worth it."

Infertility for dummies

I was thinking today about what H. said to me about pain, and it occurred to me that I've learned a lot so far. Courtesy of my inner Pollyanna, here's a partial list — I think each phase teaches me something, though I'm not sure it's worth it.

1. Take as many drugs as you can legally acquire.

Pharmaceuticals are your colorful gelcapped friends. There is simply no reason to be undermedicated if you're going through painful procedures or pregnancy loss. If they offer you Tylenol 3, fill the prescription and take it, frequently. If they offer you something stronger, thank your lucky stars and take it, frequently. If they offer you horse tranquilizers, feel free to take them, frequently. Believe me: you will be glad for any help you can get.

If, on the other hand, they offer you nothing, grab your doctor by the lapels of his immaculate white lab coat and ask. In fact, insist. You might end up not needing pain medication, and you don't have to take it, but you should have it readily available just in case. If worse comes to worst, you can slip it to your nosy sister-in-law should she ask too many questions.

2. People who love you will say stupid, stupid shit.

No matter how dear they are, how sympathetic, how supportive, the people you love are going to say something sooner or later that's so breathtakingly stupid it'll make you want to scream. They love you and they want to make you feel better — and they honestly won't be able to help pissing you off.

They need to say something, because they truly hope to comfort you in a difficult time. But because they may not have dealt with infertility or loss themselves, they don't know what not to say. Either way, consider cutting them some slack. They do love you, stupid shit aside.

You have a couple of choices as to how you handle this: you can suck it up, or you can educate them. I personally chose to respond with a sickly smile, as I could see they truly did mean well, and crammed all my rage into a tiny ball, way down deep inside. (This approach may not work for those of you who are, you know, sane.)

3. There is not a limited amount of fertility in the world.

I can personally guarantee that while you're going through treatments, there will be at least one of your friends who gets pregnant with no trouble at all. In my case, it's three so far. Most days, I'm tempted to feel bitter (no shock, since we have already established that I am a petty, stunted person who should be shunted off immediately to work among the lepers for a much-needed lesson in generosity). Other days, the tiny rind of magnanimity in my soul surfaces and I think, Good for them. They're as happy as I'd be.

On these rare occasions, I'm able to remember that one person's pregnancy doesn't count against some great cosmic total: their extravagant fertility doesn't reduce mine. If nothing else, an acute appreciation of schadenfreude gets me over the hump: I may wish I had their ovaries, but I certainly don't envy the rest of their lives.

A little knowledge is a dangerous thing

It hit me hard this week: I'm back at square one, no closer to having kids than I was before.

Even a garden-variety miscarriage might have brought some weird solace; for a few days I was able to console myself by chanting, "At least you know you can get pregnant. At least you know you can get pregnant."

Well, I don't really know that, do I?

(At the moment I refuse to seethe about the righteous indignation some infertile women can summon. "I've never even had a positive! At least you know you can get pregnant!" "Yes, and I also know how devastating it is to lose it — I hope you never learn." Wait. I guess I don't refuse after all.)

From our first cycle, I know I can make eggs, though not as many as those loathesome perfect cyclers who bubble up dozens without turning a hair. I know we made a pretty embryo.

But I also know that we only made the one, possibly due to a male factor that our several semen analyses didn't detect. And I know that the single pretty embryo we did make lodged itself firmly in my Fallopian tube, revealing the greater possibility of another ectopic in the future and the possibility of tubal damage. And as a special bonus, I learned that there's an implacable endometrioma perched on my ovary, taking up space and suppressing egg production, possibly requiring a laparoscopy before our next cycle.

I knew if our first cycle was unsuccessful, at least we'd learn from it. I didn't expect to be so goddamned discouraged by that knowledge. What we learned is that there are numerous plausible reasons for our infertility, instead of the single simple explanation I'd hoped to discover — in short, we're more mysteriously fucked than we thought.

I don't want to dwell on last cycle — if I must, I'd rather be reflecting on our new knowledge as a tool to improve our future chances. I intend to have achieved this remarkable feat by the time I have my next consultation, when we'll plan our next onslaught.

Kindly old aunt, my ass

I find I sternly disapprove of the attempts to make this whole process seem warm and fuzzy. Take a look at any Internet message board where infertility is being discussed: You don't develop follicles; they're follies. You don't transfer embryos; they're embies. You don't bleed like a hemophiliac once every 28 days; you get a visit from your kindly old Aunt Flo.

If anything, mine's closer to being like Paul's evil grandmother. She was a crazy old bat who survived all her children by dint of pure meanness. In her declining years one of her grandchildren found her on the stairs, viciously kicking the shit out of her black leather handbag. "Uh, Grandmother...why are you kicking your handbag?" asked the grandchild. She paused, shook her head muzzily, and said, "Oh. I thought it was the cat."

That's my period.

So why do we (and by we I mean, well, they) feel the urge to make something cute out of infertility?

Outnumbered

After the embryo attains a CRL of 5 mm, the probability of subsequent loss falls to 7.2%. The loss rate drops rapidly thereafter to 3.3% for embryos with a CRL of 6 mm to 10 mm and to 0.5% for embryos with a CRL of 10 mm or more (i.e., 5 weeks postovulation or 7 weeks after the last menstrual period). That 3.3%? That's us.

Only 1.9% of pregnancies have small gestational sacs in relation to crown-rump length.

According to that same study, 80% of pregnancies fail when the difference between MSD (mean sac diameter) and crown-rump length (CRL) is less than 5 mm.

Another study with a smaller sample, however, found a more ominous failure rate: 94%.

Pregnant women have a lot of magical talismans they like to invoke against the potential for loss. One of them is the mythical 5% — "Once you've seen the heartbeat, your chances for miscarriage drop to 5%." There are a lot of things wrong with that statement, primarily the assumption that any statistic pertains to any individual. I am most painfully aware that even if you assume that magic number is accurate, somebody still has to be in that 5%.

Fluid dynamics

The March of Dimes has this to say about oligohydramnios, the condition of having too little amniotic fluid (and thus too small a gestational sac):

The most important known cause of oligohydramnios early in pregnancy is birth defects in the baby (often involving the kidneys or other parts of the urinary tract) and ruptured membranes. The effect of oligohydramnios on the baby depends on the cause, the stage of pregnancy in which the problem occurs, and how little fluid there is.

In the first half of pregnancy, too little amniotic fluid is associated with birth defects of the lungs and limbs and increases the risk of miscarriage, preterm birth and stillbirth. [...] The causes of oligohydramnios are not completely understood. The majority of pregnant women who develop the condition have no identifiable risk factors.

All of a sudden I get it.

I had a minor epiphany as I waited for the D&C. Though I knew this pregnancy was over, I would have given anything to change the situation if I could. I felt frantic, terrified, and absolutely desperate.

And then I thought, "Maybe this is how women who are having an abortion feel."

Oh.

Women with an unwanted pregnancy probably feel just as trapped and scared as I did. I felt utterly violated by this procedure I was about to undergo — and I imagine that women who don't want to be pregnant feel every bit as violated by the presence of a heartbeat inside them.

I've always been pro-choice in theory, though I've never had to put that to the test. When my college roommate had an abortion, I saw that while the procedure itself was difficult for her, the decision to do it was not. As for me, I'd always been sure I'd have an abortion if I ended up pregnant at an inopportune time; if I ever imagined it, I saw myself resolute and implacable as I slung myself into the stirrups.

I never really thought of the emotional aspects of it — how many women who undergo abortions must be propelled by panic and desperation.

But as I sat in my cubicle, fighting off waves of anxiety, it occurred to me: Two sides, same coin. As much as I longed for my pregnancy to continue, they long for theirs to end. As destroyed as I felt, they'd be just as devastated if they didn't have the option to terminate.

I think I truly understood for the first time how important that option is. For the first time, I felt real empathy for anyone in that position. What a strange time for me to be feeling the power of sisterhood, though at least it kept me from feeling the full horror of my own situation.

Something to look forward to

Fun fact: Women with diminished ovarian reserve who do manage, through some fluke of nature or science, to get pregnant at all...

...are at higher risk for miscarriage.

Mighty, mighty

One aspect of the two-week wait after IVF drives women particularly crazy: the progesterone.

Most women are subjected to the nightly pleasure of a stab in the ass with a 1.5" 22 gauge needle. (For those of you unfamiliar with the gentle art of injection, that's roughly the length and diameter of a #2 pencil.) I, on the other hand, get off easy, with only the lowly progesterone suppository.

Our British friends call it a pessary, but that reminds me too much of a cassowary — the thought of shoving a large, flightless bird all up in my business makes me feel a little bit faint. I mean, would you look at the bony helmet on that thing?

So after that zoological digression, we'll stick with suppository. When I began my first IVF, I was worried about the progesterone injections; a friend had told me they were agonizing. Imagine my relief when the nurse told me I'd be inserting suppositories thrice daily instead. (And imagine, if you're feeling stout-hearted, the strangeness of being relieved by hearing the words, "suppository," "vagina," and "three times a day" in quick succession.)

Anyway, back to my original point, which I momentarily mislaid. Progesterone will make you crazy.

Its side effects mimic exactly those of early pregnancy — tender breasts, occasional nausea, slight uterine cramping — but also those of an impending period — bloating, depression, insatiable cravings for carbohydrates. But wait! There's more! At no extra charge, we'll throw in crippling constipation. Now how much would you pay?

At any point after embryo transfer, any physical sensation can easily be attributed to progesterone. You can think you're pregnant when you're not even close. Or you can think your period is imminent when you won't get another one for almost a year. In short, you're screwed; you can't count on a single one of your body's cues to tell you truly what's going on within.

In my case, the progesterone side effects swooped in overnight. I woke this morning with enormous breasts. Now, I am normally on the shapely side, which is a delicate way of saying I'm a brick...house. I am indeed mighty, mighty, but I do not dare to let it all hang out lest I destroy small villages with the devastating pendulum action of my breasts.

Today they are even bigger. Behold the majestic ProgesteRack^TM! Look upon my breasts, ye mighty, and despair!

Plan B: Make someone else do the thinking

I normally do pretty well during the two-week wait after any event intended to induce pregnancy, from the low-tech option of doing it like Amazon tree frogs on up to the high-tech maneuvers of IVF. Or I have so far, because I've always known what plan B was.

Ah, but this time is different.

Here are our options, as I see them, if my two embryos have killed each other in a bitter uterine gang war:

• Another cycle of IVF at a top-tier clinic
• A few cycles of stimulated IUIs
• Adoption
• Donor eggs
• Bellowing "Stop the insanity!" and giving up on the idea of having a family

It all looks so good, I don't even know where to begin!

On the way to the hospital to have the embryos transferred, Paul and I had a long talk. You have never seen a man turn so pale so fast as when I said to him, "Living without children is not an option for me." To be fair, it's not the kind of discussion you ever imagine you'll have when you're first planning a life together. In principle, we'd agreed that we wanted children, but we'd never before confronted the possibility that we might not be able to have the kind with his peasanty-looking nose and my ineffable charm.

He has the usual reservations about adoption — How could I be sure I'd love the kid unconditionally? — but recognizes, from his experience with his own family, that shared blood is no guarantee of love to begin with. He worries that he'll look at an adopted child and always think, I wish we'd had one of our own. What he doesn't know is whether that's a show-stopper, or whether it would assume the same level of importance as the wish that we'd had a kid with, say, red hair or a flair for music.

These things are, alas, unknowable. The one argument I could make — and it's not really an argument — is that we often find our stance on theoretical issues changing once we confront the reality of a thing. Once the theoretical becomes the actual, the specific, the concrete, our thinking changes to embrace it.

I finally put it to him like this: I do not share his discomfort with any of the options. At this point, the goal (a squirmy, pissed-off toddler refusing to put on her shoes) is more important to me than how we finally get there. Therefore, he gets to pick. He needs to consider our options, decide which makes him the closest to comfortable, and choose how our family will come about.

Poor guy is still catatonic from the shock. I have stood him in the corner and have been using him as a coat rack.

So while I remain entirely agitated over the absence of a contingency plan, I am trying to lie low and let Paul do some thinking. Behind the scenes I am, of course, busily wishing, plotting, and scheming...

...and trying very hard to make these forlorn little embryos feel at home.

A "maybe" is worse than a "no."

Here is something I did not know: an unequivocal negative is easier than an ambiguous positive.

To women who've never had a positive pregnancy test, that will seem like the rankest heresy. In unison: "At least you know you can get pregnant."

Now let's try it in a round, to the tune of "Row, Row, Row Your Boat."

Great! Next let's break it down old skool-stylee.

Wait, that last was a really bad idea.

The truth is that I do have the knowledge that I can get pregnant, but it's not the comfort you might think it is, because I also have the knowledge that I can lose it. I can be happy, the happiest I've been in my life — and that happiness can be yanked away unceremoniously in the space of thirty seconds.

(Perhaps it's crass of me to mention money, but I must point out that it particularly stings when you spend $11,000 getting happy...and they still charge you a co-pay when that happiness is shattered. My most recent D&C cost me more than a live birth would have. But I'm not bitter.)

It's oddly soothing to know that's not at stake this time. This time, I can go on a valedictory vodka bender, cry until I look like Marty Feldman, and know it's over. Then, somehow, I'll just manage to scrape myself off the floor to pursue plan B.

Exquisite understatement

The IVF process can be emotionally stressful, frustrating, confusing, and sometimes a great disappointment.

          — the handbook my clinic gives out to new IVF patients

Great Wall

I've been thinking a lot about adoption in the last couple of days, thanks entirely to Dawn's extraordinary journal. It should be required reading for anyone who labors under the misconception that adoption is an easy avenue to becoming a parent. It should be required reading for anyone with a soul, in fact, but your soul is your own business so I can't really insist.

However. I have been thinking about adoption.

So much so, in fact, that last night I dreamed Paul and I went to China.

I have always wanted to go to China. My top two priorities:

1. See the Great Wall in many different places so that I can marvel at the different construction methods and materials used in each region
2. Stare at the mountains, which I am told actually do look the way they're portrayed in classical paintings

(I am a fascinating travel companion. Oh, yes.)

It's no surprise, then, that my dream prominently featured those cuttlebone mountains and the Great Wall. It also featured a visit to an orphanage and the acquisition of a tiny, solemn-faced daughter.

In my waking mind, adoption is a distant possibility, one to consider when I feel we've exhausted our other options (or exhausted my body, anyway). My dreaming mind clearly has other ideas.

The dream was worth it alone for the startling spectacle of Paul in proletariat blue, riding a rickety bicycle toward the Forbidden City.

Pollyanna: Twisted bitch

If all my friends are giving birth now, neatly coinciding with my first due date...

...it means that at least they won't be giving birth during the second week in March, my second.

Who says I'm not a cock-eyed optimist?

XXX libris

So I was thinking today about the naked lady magazines that are an inevitable feature of any clinic's "collection room." (I guess that's a nicer term than "wankatorium.")

I was wondering exactly whose job it is to select the visual aids. Are they chosen by someone with relatively cosmopolitan tastes, or by someone who picks them up gingerly by a corner, making a moue of displeasure? Is there some general medical consensus about which topics should be covered, or is it entirely an aesthetic decision on the part of the hapless curator?

Do they send the lowest-ranking staff member to that skeevy adult bookstore out by the airport? Do they keep petty cash on hand for just such occasions, or does the employee have to fill out an elaborate request for reimbursement? Description: January 2004 Manholes. Purpose: Client entertainment.

Or does the office simply maintain yearly subscriptions to an array of quality periodicals? Does the postman do a double-take when he sorts the daily mail and finds this month's Juggs nestled coyly beside this month's Breastfeeding Outlook? Who's in charge of sending in the card that says, "YES! Please send me 12 jam-packed issues of discreet, efficient masturbatory inspiration!"?

I know nothing of my own clinic's literature holdings. I keep meaning to send Paul in with a pad and pen so he can make me a list. The only helpful information he has volunteered so far is the intriguing fact that on the very top of the stack rests a pristine and current copy of The Journal of Light Construction.

For the record

Among the photocopied pages from my file is the psychological evaluation the state requires before a couple undergoes IVF. I should note that said evaluation was performed by one of the cadre of skilled and caring mental health professionals getupgrrl captures brilliantly, velveteen and all.

I will treat you to some highlights from the report, with my comments:

[Julie and Paul] cite major ambivalence about having a child as their reason for wanting to significantly limit the number of embryos put back... A year later, I now invite my doctors to reinstall as many embryos as my body can manage to make. I don't really lose sleep these days over the possiblility of high-order multiples.

They report they currently have a nice lifestyle and are not 100 percent convinced that they desire to be parents... I felt it would be dishonest not to acknowledge some reservations about the ways our life would change. We do have a comfortable life (I would never have said "lifestyle"), and children will change that drastically, in some ways for the worse. Funny, though — I never saw this as a sign of ambivalence, as the psychologist clearly did. I saw and see it more as a gesture toward pragmatism, and possibly a sign of our true commitment to having children, even though we know we'll be losing some of the things we love about our life together.

[Julie and Paul]...report a history of anxiety and depression which they seem to be managing quite well together as a team...They both deny low self-esteem...Both deny thoughts of death and suicidal ideation. No evidence of delusions or hallucinations. Oh. Good. Not delusional. Whew. And if you were looking for problems with my self-esteem, it's not low you'd need to worry about.

[Julie and Paul] are a couple coming to seek fertility treatment but with expressed ambivalence about the procedure... I think you'd have to be a nutjob fruitbat wingnut not to feel ambivalence about the procedure. They stick needles into your ovaries, for crying out loud.

They do have concerns about the new responsibilities of having a child. I think their ambivalence will enable them to accept the results of any negative outcome of this treatment. This bit near the end sent me into a rage last night, and I find myself getting sputtery about it again. Can you see why? Wait, I'll rephrase it to make the infuriating part obvious: Because they're not sure they want a child, they will breathe a sigh of relief if this voodoo shit doesn't work. First of all, we are sure we want a child, and recognizing that it won't all be moonlight, roses, and unsoiled fuzzy sleepers doesn't dull that desire. Second, I defy anyone to "accept" the "negative outcome of this treatment" — the many Gothic ways in which things have gone haywire for us this year — with anything but rage, anguish, and a feeling of powerlessness so profound that I can barely make myself pick up the phone to order the next round of drugs. If my "ambivalence" makes this easier, I'd hate to see how people with "delusions or hallucinations" about the romance of parenthood handle it.

A brief reproductive history of Christmas

Last year at Christmas we gave my family the news that we'd gotten married. We were on the schedule to do our first round of IVF in January. With a curious mix of optimism and pragmatism, we decided our families would handle the news of a pregnancy with greater enthusiasm if we were no longer, you know, living in sin.

On Christmas day my period arrived. In the pre-holiday shuffle I'd packed neither tampons nor ibuprofen, so I spent the bulk of the day in festive contortion with a giant wad of toilet tissue making the crotch of my trousers bulge most attractively. When we'd finally finished unwrapping the presents, I crept out to the nearest open gas station and bought a box of Tampax Slender Regular (the only flavor available) and about a dozen two-tablet pouches of Advil (the only denomination available).

This Christmas day was cycle day 14, and I ovulated right on schedule. But Paul and I spent the night in separate bedrooms, so unless some immaculate nookie took place that I don't know about it, I am not, at the moment, even remotely pregnant.

If you've ever had difficulty conceiving, you may be aware that there's a certain perverse comfort in knowing you're not pregnant. I don't even have to wonder. There's no urge to weigh my breasts judiciously in my hands on an hourly basis. I don't have to sneak into the second bathroom to plunder the Aladdin's cave of HPTs under the vanity. And I can worry that the twinges in my lower abdomen are the result of a grapefruit-sized fibroid instead of hoping that they're implantation cramping.

"I'm sorry." And leave it at that.

Yesterday someone found this site by searching for the term:

appropriate response when a friend's IVF is unsuccessful

Thank you, anonymous searcher, for having the sense and kindness to know that there are appropriate things to say. (Contrast this with the preponderance of jackasses whose outpourings of wisdom resemble nothing so much as a broken sewer main.)

As a rule of thumb, I will say that funny hats and noisemakers are probably not in order.

But you may need more detail than that. Always eager to please, I will make a short list of some comments that might be appropriate:

• "I'm so sorry."
• "Oh, God, you must feel rotten. How are you holding up?"
• "Do you want to talk about it?"
• "FUCK. I was really hoping this would be the one!"
• "What can I do to help? Cook you dinner? Take care of your pets for a few days while you're feeling low? Bring over a fifth and get you really, really shitfaced?"

And, ever the completist, I will list some comments that will not be helpful in the slightest:

• "I know how you feel." No, you don't. You couldn't possibly, no matter how eager you are to share my burden. (Note: Even if you've been through several failed IVFs of your own, this is not the time to shift the conversation to yourself.)
• "It just wasn't meant to be." Thanks for the help, Nostradamus. Now shut your couplet-spouting trap.
• "You can always try again." You know what? At $15,000 a pop, maybe I can't.
• "Maybe you should just accept the situation and move on." Hey, great idea! *smacking forehead* I'll just accept the situation. Why, as soon as I set my mind to it I'll be over my grief in a jiffy! I'll move on. Now why didn't I think of that? Who needs the worthless baggage of lifelong dreams, anyway? Thanks! I feel much better now.

I'm sure this has been helpful.

Can't work. Too easy.

As I lie fretting in bed at night, every bit as insomniac as I am during an IVF cycle, I think of every one of the very good reasons this IUI can't work.

Low motililty.  Abysmal fertilization in the lab.  Iffy Fallopian tubes.  Theoretically bad eggs.  No suppression, so possible early ovulation.  And the crappiest attitude north, south, east, and west of the Pecos.

But those, I tell myself, can be overcome.  They have been overcome, at least for a very short time, once.  Those reasons are mere technicalities, easily dispensed with by telling myself firmly, "It happened before.  It can happen again."

However, there's one reason I can't wave away: This can't work because it's too easy.

A quick comparison reveals all.

IVF: At least 31 days of preparation before starting stims.
IUI: "Oh, hey, my period's here.  Now where'd I put that syringe?"

IVF: $10K and up, without meds.
IUI: $210.  Sometimes I spend more than that on my hair.

IVF: Three injections a day.
IUI: Just one little prick.  Uh.

IVF: Progesterone suppositories, laying waste to any unfortunate defenseless underpants in their path.
IUI: A well-regulated vagina, prim and oozeless.

It must feel different when you're going from Clomid to injectables, going one more step up the ladder toward expense and invasiveness, but when you're moving backward from IVF to IUI, an IUI seems like a goddamn cakewalk. 

How could something so easy possibly work?  How could I get pregnant without the most extreme intervention, the most esoteric manipulation, the most ruinous expense?  Although it worked last summer, it worked only after the suppression and the daily barrage of injections of a planned IVF — to say nothing of the grinding anxiety and panic as cancellation loomed large.

This can't work.  It's too easy.  No pain, no gain...right?

This kept me awake last night for at least an hour after I went to bed.  And then it occurred to me: Why worry that I'm not putting myself through enough when the hard stuff hasn't worked, either?

And then I slept like a Benadrylled baby.

Take that, Fred Phelps

God loves gay people and I have proof.

My cousin J. is a middle-aged single man living in New York. The only people in the family to be surprised when he came out were his parents and my grandfather. (The other member of the oldest generation, my grandmother, took it with characteristic aplomb, but then I can't be sure she really understood what he meant. My grandmother is a shining exemplar of the power of peaceful denial.)

The rest of us sort of rolled our eyes and said, "Well, yeah, and...?"

J. is going to have a baby. He found a surrogate who lives in the Midwest, provided her with the necessary biological product — sorry, I can't really think about a family member's semen without cloaking it in several layers of protective euphemisms — and, voilà! 40 weeks later, he's going to be a father.

See how easy that was?

Now it's true that individual gay people are just as prone to infertility as breeders. (Get it? Infertility? Breeders? Hah? Hah?!) In fact, PCOS seems to be twice as common in lesbians. But in any given gay couple, what are the odds that both partners will be infertile?

If you're a lesbian with blocked tubes, your partner could still conceive a child. If you're a gay man with a low sperm count, it's probable that your partner has no such handicap. Let's face it, with two sets of ovaries at your disposal, you can afford to cherry-pick. With four testicles in play, your specimen cup runneth over.

In either case, you're still going to need to involve a third party, so the necessity for ART is a foregone conclusion. That third party is likely to be healthy and fertile — he or she wouldn't be in the running otherwise. And needing medical intervention of some kind doesn't exactly come as a shock when, you know, we're talking two men or two women.

Straight people in monogamous relationships don't have these advantages. First, you just have one set of each flavor of gonads. If my ovaries are tapped out, I can't really turn to my husband and ask him if I can borrow his. Second, the notion of turning to a person outside your partnership for help is an awkward one for many couples. Third, we're brought up to believe that any man and any woman can reproduce, and we grow up expecting we'll be no different.

Imagine our surprise and delight.

Now, according to the people who make my holiness their business, aren't straight married couples supposed to be favored by God? Aren't we supposed to receive all sorts of divine fringe benefits because of our unimpeachable piety? If God's so crazy about us hetero marrieds, shouldn't he be giving us the cosmic high-five every time we do it on cycle day 14 — or at least every time we turn, defeated, to infertility treatment?

But noooo. It's gay people who have the reproductive advantage!

The only conclusion I can draw from this is that God actually prefers gay couples. He loves them so much, He wants them to be fruitful and multiply. I just knew the homophobes were wrong.

Update: J.'s baby was born on January 27. Beautiful, beautiful family.

Lupron anniversary

The first wedding anniversary is known as the paper anniversary. I am not sure what the tradition is for celebrating ART-related anniversaries. A year ago today I started Lupron injections for my first IVF.

It's hard to believe it's been only a year. I certainly have made the most of it.

But it's also hard to believe it's been an entire year, a whole year spent doing very little beyond trying to procreate, with little — well, nothing — to show for it.

Perhaps this should be regarded as the straitjacket anniversary.

You didn't know me then. May I introduce you to the Julie of January 2003?

Like everyone else, we embarked on IVF with the expectation that it would work. Oh, we didn't think it would work immediately, the first time out of the gate — we were, we thought, fully prepared for the first cycle to be nothing more than a diagnostic tool. "IVF usually doesn't work," we'd tell each other in what was actually a twisted pep talk, "but we'll learn a lot from it." We'd plod through the first one, disappointed but determined, ready to apply that new knowledge to our second cycle, optimized to the hilt.

We were really rather smug.

I also believed — wait, I'm laughing too hard to type — that I'd make — ahahahaha, doubled over — dozens of perfect eggs and — oh, my sides hurt — a lively clutch of flawlessly dividing embryos, suitable for freezing. Oh. *fanning self*

My, how we all did laugh.

Recovering from the hilarity, I have to say that wasn't necessarily an unreasonable expectation based on my age and bloodwork. At 31 with an FSH hovering around 5, I couldn't have foreseen that I'd have only four mature eggs to work with. And at that point Paul's sperm certainly seemed able to swim the, oh, inch and a half from the edge of the dish to its egg-bearing center.

If I were inclined to be easy on my historical self, I'd say those facts might excuse my complacency. But, really, what was the January Julie thinking? We hadn't gotten pregnant. There was obviously something wrong. We'd expected IVF to uncover a cause for our infertility. It says a lot about my psychotic optimism that I was so blindsided when I learned there was a cause.

But I'm getting ahead of myself. That's the Julie of February. Quiet! Don't frighten her. If she sees her shadow she'll pop back down into her dank little hole and there'll be another six months of infertility.

Back to January. We didn't expect our first IVF to work, but we expected it to give us the necessary information to make our second cycle count. And we congratulated ourselves on our pragmatism.

My, how we all did la — oh, you know.

I firmly believed I wasn't going to become one of those women, the ones who went through cycle after cycle, refusing to take the hint. I thought that if three cycles didn't work, I'd be smart enough to stop and wouldn't look back. I am embarrassed by that now, to have thought of "those women" in such a way. What can I say? I get it now. I get it.

And I swore it wouldn't change me. I resisted the notion of changing with all my might, in fact, and I can be one determined mofo. Well, I know now that infertility changes people whether they think they need it or not, and I can even grudgingly admit that some of the changes have been positive. But in January I knew better. I laugh to think about it. (Okay, by "laugh" I mean, "shudder, appalled, then look uncomfortable and change the subject.")

The sole saving grace of the 2003 model (with optional trim package) is that she knew she was strong. I didn't know how strong, though — I didn't know how strong I'd eventually need to be. I believed I could handle whatever the process threw at me, without having the first idea of how bad it could get. The January Julie had spunk. ("Well, thank you." "I hate spunk.")

Happy anniversary.

It's not exactly a good magazine

Move over, jackass sisters-in-law. You've been unceremoniously demoted. Now there's someone infertile women despise more: Oprah Winfrey.

An article about the manifold dangers of fertility drugs appeared in the January issue of O magazine. Poorly researched, deeply sensationalistic, and irresponsibly alarmist, the article is exactly what you don't want your mother to read if you've jacked yourself up on gonadotropins. It's a worthless piece of frantic muckraking expressly intended to scare women, particularly women already made vulnerable by the stresses of infertility.

In that respect, it's unforgivable, and if Oprah Winfrey had a cock it would need a good old-fashioned slappin'. On Friday. In Italy.

But should we expect anything different?

Oprah's magazine has immense reach and she herself has enormous influence (and enormous diamond earrings, but that's not important right now). In the best of all possible worlds, she'd use those powers for unalloyed good instead of highly purified intramuscular evil. But her disapproval of ART has been well established. Just like any lesser immoderate loudmouth, she's using every outlet available to her to promote her position. O's not a medical journal or a news magazine. (Sleuth that I am, the cover photo tipped me off.) It's an inch-thick glossy devoted to perfume samples and so-called service journalism, which is as prone to slant as any other kind, and probably more so.

I think it's a crying damn shame that women will read that article and be frightened (and, on a more harrowing note, that our mothers will call us, scared out of their collective maternal gourd, begging us not to get accidentally impregnated by a rogue doctor). But what might be a greater shame is that many women will rely solely on the good offices of Barbara Seaman instead of, you know, talking to someone who actually knows his or her way around a Fallopian tube, or reading something more intellectually rigorous than a feel-good femmey stroke book you can buy at the checkout stand.

Aren't we smarter than that? I know we're smarter than that.

When O gets its first Pulitzer nomination, let me know. Until then, I want to believe that women can be trusted to make informed decisions about our own health care, to give no undue weight to incompetent "reporting" when it rears its misshapen head, and to turn to O for nothing more important the latest scoop on the astonishing, newsworthy metamorphosis of Madonna.

Friendly skies

Yesterday on an airplane I was seated next to a man who wanted to talk. Apparently he also wanted me to hurt him.

At first the conversation was innocuous, but then he started to rail about his ex-girlfriend. I conspicuously brandished my wedding ring.

And then he complained about being sent on a business trip to Florida, "where there's the highest concentration of AIDS in the country — I was afraid to get out of my car." I asked him whether getting out of his car really required the use of his penis, his anus, or his mouth, then instructed him, friendly-like, about the normal vectors of HIV transmission.

And then he told me about his ex-wife and why he divorced her: "She lost two babies, and it changed her. She just wasn't the same person I'd married after that."

Realizing there was simply no way, in our cramped coach-class row, for me to deliver the roundhouse cockslap he deserved, I stood up, gesticulated wildly at my seatmate, and bellowed, "There's a terrorist on the plane!" And enjoyed my ringside seat for the savage beating that ensued.

I like my chocolates bittersweet

Today is my birthday. (If you must sing, I prefer Björk to the Beatles — something about that scream gets me every time.)

Let's get this out of the way immediately before anyone starts cooing: There is nothing remotely romantic about having a birthday on Valentine's Day. Even if you buy into the hearts and flowers thing, which I do not, there are serious disadvantages. To wit:

1. If your husband wants to take you out to dinner that night, neither of you will remember that reservations must be made months in advance. The day before your birthday he will be frantically calling all over town to find some place, any place that has a deuce open — hope you like Denny's. You will be seated at 9 PM if you're lucky, just in time to watch other loving couples stare grimly into each other's eyes over death by chocolate. Your dessert will arrive as the janitors are stacking chairs and bumping your feet with a mop.

2. If you'd like to see friends that day, you will have to satisfy yourself with only those who are unhappily uncoupled. The others, you see, all have plans, probably involving dinner out at a decent hour, floral offerings, and imaginative pubic topiary. When it becomes clear that a Hallmark holiday is of more significance to them than the actual day of your birth, you will feel more annoyed than is strictly warranted.

3. If you expect double the presents from your sweetheart, congratulations! You have tapped into the motherlode of the purest crack in the Western Hemisphere. If you've bought gifts for your husband, you will wonder why the hell you're giving someone else gifts on your birthday.

I sound more bitter than I actually am. I learned these lessons years ago; I'm used to the inconvenience of sharing a birthday with a major commercial holiday and have developed a few useful coping strategies:

1. We don't go out on my birthday. The night before or the night after will suffice equally well. Okay, so there are no lovey couples to sneer at, but I don't have to feel underdressed in my usual uniform of jeans and a black shirt. (Bonus: utilitarian lingerie.)

2. I don't even try to see friends. In fact, I've safeguarded myself entirely from disappointment by not having any friends.

3. I buy myself presents, too. This year my hope addict wants something sparkly...something enchanting...I know! A fifth of Ketel One!

This birthday is significantly different from the last two. My last two birthdays were spent with my legs splayed wide, being romanced by a hard shaft of plastic. (In my current sexless state, that doesn't sound too bad.) I mean that I was at the clinic pursuing pregnancy.

On Valentine's Day 2002 I had an IUI. It was my first IUI under the supervision of an RE (as opposed to the ones done by my OB/GYN, who babbled a mile a minute, bobbled his head like it was too heavy for his neck, and slipped his feet out of his clogs and put them up on the table while we talked). I had two Clomid-induced follicles, a great sperm sample, and enthusiasm on my side.

I actually thought it would work.

The IUI was excruciating. Since it was my first one at this clinic, no one had yet discovered that my anatomy demands a catheter bent just so — "like a hockey stick." Afterward I clasped Paul's hand in my sweaty palms and said something naive about a pregnancy being the best birthday present a girl could hope for.

Laugh with me, won't you?

A year later, I was back in the same room, back on the same table, this time for my first ultrasound after starting stims for IVF #1. My follicles were growing apace, my E2 was increasing with appropriate decorum, and I saw, at that point, no reason the cycle should fail.

Again, I actually thought it would work.

This year I quailed at the thought of being back at the clinic. I am more relieved than I can tell you that I will not be celebrating my thirty-third birthday staring up at acoustical tiles, making a wish I'm no longer sure will be granted.

Mother love

Mindy wrote:

I want to move in and listen to your stories, and I promise not to talk about my children. In fact, be warned before you click on my homepage that my blog is entirely about the kids and that you will likely hate me to the hilt before you manage to find the Back button and navigate off the page again...

Incorrect!

See, I like kids. I'm crazy about kids. I like mothers. And I especially like warm, perceptive, funny, wackaloon mothers.

I'm aware that many infertile women can't stand to be around attractive small children or fulfilled parents — it only emphasizes the lack in their own lives. I know it's hard to be reminded of what you don't have and may never achieve. If nothing else taught me that, the time I sat next to a new mother and her six-week-old infant while waiting to confirm the demise of my second pregnancy surely did.

But generally I don't suffer from that. I don't see everything through the lens of my own disappointments. Okay, almost everything, since I find I'm quite capable of relating anything to infertility. (Go on, try me.) But not that.

If there were a limited amount of fertility in the world, I might take other people's successes more to heart. If your having kids meant that I couldn't, yes, hilt-hating might well be in order. But my situation is entirely my own. No one else can resolve it, and no one's to blame for it. (Not even Ron Mitchell*, who gave me chlamydia in 1991 after meticulously palpating my breasts like he was looking for lumps.) So why should I begrudge you your joy in your kids, particularly when I want the same for myself one day?

If I thought I had no more options, I might feel different. Since I'm truly still hopeful, I can look at your kids and feel happy for you. Envious, yes, but happy.

...Having said that, let me also say that I too went through years of TTC and hearbreak and failed pregnancy, only to spend weeks by the bedside of a newborn on life-support, so I am not a blithely insensitive visitor. I wept at your stories, and spoke about our loss for the first time right here, so I feel a special affinity with the women who are supporting each other so gloriously here. I would be honored if you would let me visit and listen and learn.

Mindy, I'm so sorry for your loss.

All that I've written above sounds very gracious. But I'm really not so noble. While I like mothers in general, I confess I am biased: I really, really like mothers who've had to work hard to get there.

Welcome.
_______________
* Why, yes, that is his real name.

At least I know

Cyn asked:

Maybe it's just me, and Julie and the other ladies, tell me if I'm wrong...but isn't it MORE frustrating when these ART things go wrong (or just go SLPAT!) when you KNOW your body can get pregnant (whether or not you stay that way) so why the hell it isn't working now?

Well...I don't know.

Is it more frustrating to endure the disappointment of bad cycle after bad cycle when I know I can get pregnant? For me, nah. I now know my body can do part of its job, with one hell of a lot of help, and that may in fact be what motivates me to continue. If I hadn't gotten pregnant on my first two IVF cycles, I don't think I'd still be pursuing ART now — my past pregnancies are more inspiring than frustrating. Although they could well have been flukes, I prefer to see them as proof that perseverance may yet pay off.

At least you know you can get pregnant. I hear this a lot. And it's true. I do know that. I don't yet know that I can conclude a pregnancy with a healthy infant at the end, but I've already had more encouraging outcomes than many infertile women ever know. It's what keeps me going — the deep desire to feel that bone-deep happiness again, and the knowledge that I still have a chance at it.

I'd love to hear what the rest of you say. We all wear our hair shirts differently, after all. (I like mine with a V-neck, please, to showcase my rather opulent rack, and nipped in at the waist so you can see that despite all odds, I still actually have one.)

My work here is done.

That's it. I'm retiring. I have accomplished something.

I want to post a couple of messages I got last night.

First, from someone on her third miscarriage:

Hi Julie — just wanted to thank you for your posts in April of last year regarding your experiences with ectopic pregnancy and Methotrexate.  It's 2:30 AM and I'm sitting at the computer trying to determine why the cramps/abdominal pain are absolutely killing me when my doctor told me I'd feel "some abdominal discomfort."  They haven't prescribed me any pain meds suggesting I take "extra strength Tylenol" (and I guess I can self-medicate by chewing on a leather belt).

Although I'm sorry you went through such agony it is comforting to me to know that SOMEONE else is having the same bad experience I am.  I was seriously beginning to think I was the biggest wimp in the world when it comes to pain.

Of course she's not a wimp; she's a brave woman going through an almost intolerable ordeal. Plus, her doctors are sadistic jackasses.

Next came this one, which rendered me uncharacteristically speechless:

My sister wishes me to extend her heartfelt gratitude for your journal. Reading your stories...and the ones found through links...finally pushed me into agreeing to donate my eggs for her. [My sister], after battling breast cancer as a teen, had two miscarriages and a stillborn baby girl. All three pregnancies were positive for cystic fibrosis. [She] and I aren't genetic sisters — just steps — and I'm clear for all testable conditions.

I've had some ethical objections to fertility treatments — you've probably heard all of them before. Mostly I felt that infertility treatments and issues were a huge crock invented by the medical establishment. (I have issues with doctors.) I've been surprised to see the diversity of women experiencing infertility, and heartbroken to read the stories of those who couldn't afford in the first place or ran out of money halfway through treatments. We talk about sacrificing for your kids...I can't think of anything more honorable than trying everything, with enormous financial and emotional cost, in order to bring those children into the world.

[...]

I'm just glad that you helped me decide to help my sister.

Kickass.

I hope all of you will keep on talking — those with blogs, those without, those who post on message boards, those who go to Resolve meetings. All of a sudden I believe it really matters.

My favorite year

A year ago today I had my first egg retrieval.

I'd prepared myself to be a fit sacrifice: manicure, pedicure, careful depilation, the works.  Because the weather was bad and we didn't want to risk a delay, Paul and I had stayed overnight at a hotel near the hospital.  I wore my lucky fleece socks.  I was ready.

We were ready.  I wish I could capture the feeling of tenderness Paul and I shared.  We were careful with each other.  No, careful isn't the right word; that suggests fragility when in fact we felt strong.  Maybe reverent, maybe awed.  We knew this could be big.

Because this was before I became truly obsessed, I don't remember how many follicles I thought I had; I knew I didn't ask how many eggs we might expect.  Even then I had a pretty strong deterministic streak — we'd get what we got and move on.  But at that point Paul and I were still having sober but excited conversations about how many we'd transfer, and how we would handle subsequent frozen cycles if this cycle failed, as we reminded each other was likely.

But then we didn't understand how many frightening forms failure could take.  Although we read and signed the consent forms that warned of all the things that could go wrong — nothing retrieved, nothing fertilized, nothing survived to transfer, no pregnancy, miscarriage — we didn't give it a lot of thought.  We knew the most likely scenario was a garden-variety negative, and concentrated on preparing ourselves for that. 

Ah, the clean, close shave of Occam's Razor.

But we weren't thinking of failure as I lay gowned and tethered to an IV.  I took off my garish socks so that I could admire my pedicure — Essie's Scarlett O'Hara, my favorite, the kind of color you'd paint a motorcycle.  I annoyed Paul by singing Steely Dan.

I was in fine form.

When I was finally wheeled into the operating room, I was terrified — this was surgery — but composed.  I counted the spots that flecked the acoustical ceiling tiles and sang to myself as my follicles were aspirated.  It hurt despite the anaesthetic but I didn't care.  I could hear the conversation of the doctors ("Yeah, there's another one") and even felt tempted to participate ("Don't nick my aorta, okay?"), but, no, counted flecks and sang.

Paul busied himself filling a cup.  I assume he too was in fine form.

Afterward I was wheeled to the recovery room, where I was plied with juice I didn't want.  They wouldn't allow me to leave until I'd proven I could urinate, so I pounded several ounces of cranberry-flavored sugar water and waited for the inevitable urge.  While I waited, my doctor came in, patted my arm, and said, "Perfect stim.  We got ten mature eggs."

I peed like Secretariat, got dressed, and left in a fog of optimism and Versed.  We thought everything had gone beautifully.

A day later I was to learn that only one egg had fertilized.  Almost a year later I would learn that we hadn't, in fact, had ten mature eggs — we'd had only four.  Two weeks later I'd learn that I was pregnant.  And that's when I started my journal here.

You've come a long way, baby.

Note to self: Buy lottery ticket

Okay, still more proof that this is the February that does not suck:

Nurse: So how many vials of Follistim do you still have?
Julie: Nine.
Nurse: Okay, hold on a minute... [Nurse puts Julie on hold. Julie sings along with the Muzak, appreciating the rich irony of hearing Elvis Costello's "Radio, Radio" as performed by 1000 Strings]
Julie: ...And the radio is in the hands of such a lot of fools tryin' to anesthetize the way that you feel...
Nurse: Um, Julie?
Julie: [Clears throat] Yup!
Nurse: I just looked in the closet — we have ten amps of Follistim that will expire in April. You're welcome to have it.
Julie: Thanks! Oh, boy! Oh, boy! Oh, boy! [Remembers self, tries to act vaguely adult] I'd be happy to pay for it.
Nurse: No need. It would only go to waste otherwise.
Julie: [Vigorous hula of triumph] Great. Thanks! Now could you put Elvis back on, please? I need to have a word with him about The Juliet Letters.

The free amps won't be entirely sufficient. I'll need to order more at some point in the cycle. So what? At the moment I feel like the universe is smiling on me for at least these few brief days of the shortest month of the year.

Now if I know what's good for me I'll enter the Publisher's Clearing House sweepstakes, buy a Powerball ticket, audition for American Idol (flaming batons, check; spangled unitard, check), and hit Paul up for some one-sided oral sex. I'm feeling that lucky.

What do I know about me?

Have you heard the PSAs Planned Parenthood runs on the radio?

You hear a lot of different women's voices asking, "What do I know about me?"

"I know I'm ready." "I know I'm not ready." "I know I have choices." "I know my body." "I know I probably shouldn't be hittin' it doggie-style with that chancre-sporting Merchant Marine."

Okay, I made that one up.

The only thing I write about here is infertility. That's not because it's all I think about. I do have other interests — I simply discuss them elsewhere. I've tried to keep this journal focused, since it's my only real outlet for the powerful feelings (and lame-ass creative impulses) my infertility has inspired.

Yet it's precisely this focus that gives a skewed picture of who I truly am. I'm infertile, yes, but the whole of Julie is greater than the sum of her crappy malfunctioning parts. So for just one entry, I want to tell you a little bit more about the rest of me, if only to prove that I can go five minutes without the barest mention of my vagina.

100 Things About Julie

1. My name is Julie.
2. You knew that already, but you probably didn't know this: it's pronounced in the French manner.
3. I am well aware that that sounds pretentious. What can I say? I blame my parents.
4. Try it: /zhoo-LEE/
5. In my full name, there are two Xs.
6. One of them is silent.
7. I really hit the jackpot in the X department.
8. Not so much in the "names strangers can pronounce" department.
9. I only correct people when they matter.
10. I kept my last name when I got married.
11. I didn't want to lose a precious X.
12. Plus, I'd spent many long years making my signature attractive and illegible.
13. I didn't want to relearn it.
14. I've only been married for fourteen months.
15. I only got married, in fact, to shut people up.
16. ...Okay, and because we're lazy and didn't feel like drawing up complicated legal papers when it looked like pregnancy was looming.
17. There are worse reasons.
18. We got married by a drunk Justice of the Peace in our living room.
19. No one was invited.
20. I have some lingering regret about not cashing in on the chance to be given expensive linens.
21. ...But none about keeping it private and low-key.
22. I wore jeans and Polarfleece.
23. We shared cheeseburgers and shakes as our nuptial feast.
24. I adore a good cheeseburger.
25. I am an enthusiastic carnivore.
26. However, I do not eat weird meat (organs, tongue, head cheese, and the like).
27. I lost ten pounds on the Atkins diet but it bored the piss out of me.
28. I felt faintly stupid eating big slabs of pork but limiting my consumption of salad greens.
29. So I stopped.
30. ...And accepted pasta once again as my personal savior.
31. Carbohydrates and dairy fats are the twin pillars of the only religion I currently follow.
32. I was raised Episcopalian.
33. It's not a bad religion if you like to drink and get divorced.
34. Mormonism is.
35. My brother is a Mormon.
36. I don't have the nerve to ask him if he's serious about it.
37. Once when I was walking along minding my own business, I suddenly found myself surrounded by five Mormon missionaries riding bicycles.
38. That's some fucked-up shit right there.
39. I am not very respectful sometimes.
40. In fact, I have a well-documented problem with authority.
41. I've never been fired for being so damned mouthy, but I've probably come close.
42. Although I can be exquisitely diplomatic, it's hard for me to act like I think bad ideas are good ones.
43. Impossible for me to work well with people I think are stupid.
44. It's really best that I work mostly on my own.
45. I do have a job, believe it or not.
46. I enjoy it, largely because I can do it without pants.
47. I work at home.
48. In college I worked at home, too, as a phone sex operator.
49. I usually wore pants, but I'd lie when the callers asked what I was wearing.
50. Nobody gets off on baggy gray sweatpants.
51. Let's just say my love for swearing came in handy.
52. I was, ah, a little immoderate in college.
53. I had a lot of sex, took a lot of drugs, and nearly flunked out.
54. Best goddamn years of my life.
55. Um, that was a lie.
56. I finally changed my major to English — the path of least resistance — and graduated, surprising everyone, including me.
57. This was in 1993, when the Internet as we know it was just a baby.
58. Straight out of college I got a job tending that baby.
59. Since then I've never worked in any other field.
60. (I did not get rich in the dot-com boom, but I was also never laid off, so I pretty much broke even.)
61. I'm not qualified for anything else.
62. ...Unless advanced housewifery is now a paying gig.
63. I bake. A lot.
64. I garden.
65. I throw a damn fine dinner party. I have even mastered the delicate art of not getting any drunker than my guests.
66. I make things, mostly quilts, mostly for other people.
67. Very often for other people's children.
68. Like my nephews.
69. Domestic goddamn goddess.
70. Paul, who could happily live in a single room furnished with milk crates and concrete-block-and-plank bookcases, appreciates me for other reasons.
71. I met him online.
72. Hated him at first, but quickly changed my mind.
73. He is much smarter than I am, but never makes me feel stupid.
74. Frivolous, yes. Stupid, no.
75. We moved in together in Manhattan in 1996.
76. He was mostly concerned that he wouldn't like the cats.
77. There were three of them then.
78. We still had all three when we moved away from the city.
79. But then there were two.
80. Now there is one.
81. Too bad he's not the good one.
82. I'm a little embarrassed by how much I loved that cat.
83. Sometimes I had a funny way of showing it.
84. I don't always have good judgment.
85. But I will do almost anything for a laugh.
86. ...Including abasing myself before strangers.
87. I was on a game show twice.
88. First time was as part of their teen tournament; second was the tenth reunion tournament.
89. I lost both times.
90. But both times the guy who beat me went on to win the whole thing. I could have been a contender, if I hadn't, you know, sucked.
91. I doubt they'll ask me back again; I embarrass myself on camera.
92. The first time I talked about roller disco.
93. The second time I said I'd met a few guys as the result of my earlier appearance, but implied that one of them was gay.
94. When the guy in question sent me e-mail after seeing this, I deleted it without reading it.
95. My hairdo has improved, but I'm still the same old jackass.
96. The woman who cuts my hair now is a middle-aged Italian who refers to my hair in the plural. "Oh, they long today!"
97. Yes, they is, relatively speaking.
98. But short overall, as they has been for most of my life.
99. I've needed glasses since I was 18 months old.
100. And been cranky since a very early age.

Lone gunman

Any minute now I'll knock it off with the anniversary posts, but I just want to note that a year ago today, our lone embryo from IVF #1 was transferred.

It was, as people whose cycles have just failed like to say in bewilderment, 8 cells, no fragmentation, "perfect."

It had potential.

But I swear to you that if I'd known at transfer what havoc that little bastard was going to wreak, I would have squashed it under my thumb in its dish.

Fortune favors the bold. I, therefore, am screwed.

I am scared to start this last IUI.

I am frightened of all the usual things, of course — the lackluster response, the likely negative, the novelty of disappointment as yet another unexpected disaster occurs. But I'm used to those fears by now. I've internalized them neatly into a series of attractive tics. Every time the phone rings when I'm cycling, I convulse like Shabba Doo circa 1984.

What troubles me now is bigger. It's taking more nerve than I expected to volunteer for this again, because if this cycle fails — which is, after all, the very likely outcome — I'm one step closer to the end of the road.

We'll try IVF at a different clinic. But if that doesn't work, which is, after all, the very likely outcome...what then? We might try again. But we might not. Depending on the way it fails, that could be it — time to consign my exhausted ovaries to the glue factory, where they will be simmered into mucilage, to be used by resentful preschoolers in the ham-fisted creation of macaroni art.

I am not very good at living in the moment.

I feel like I'm on the threshold between the known and unknown, the comfortable and the inconvenient, the ineffective and the probably-also-ineffective-and-even-more-expensive. It's an awkward place to be. They talk funny here and their currency looks like Monopoly money, and we won't even talk about what passes for toilets.

I want this IUI to work because I want a child. I also want it to work because I'm terrified of what might lie ahead if it doesn't — more disappointment, new and different kinds of grief, and ultimately having to settle for less than I want. Like Monica, I'm fighting the urge to see this as just another step along a progressively more tortured path. I am trying to believe this could work. Otherwise I might lose my nerve entirely.

Melts in your mouth, fucks up your cycle

Paul and I went to the supermarket a few weeks ago, and we parked next to a minivan that had a couple of utes in it — two pre-teen white kids dressed in high rapper style. They had hip-hop blaring from the radio while Mom shopped inside.

"Look," I said to Paul, dancing a little jig of delight, "tiny white rappers!"

Paul paused, cocked his head to one side, and corrected me: "Peanut Eminems."

That is what I thought of yesterday when I asked him to tell me how large 19 mm is. Sure, he could have just said my cyst was about three-quarters of an inch. But because he knows my limitations well, he chose instead to use an example I could relate to: a peanut M&M.

Bitter but better

Today I am better.

Yesterday was a bad day. All at once I felt every one of the accumulated disappointments of the last several months — not just the cancellation of this cycle, but the fiasco that was January's and the failure of November's. Most keenly and most surprisingly, I felt the grief of August's miscarriage, a sadness that had, I thought, receded. Not so, not so, particularly as we enter March, when I would have been due.

All of those defeats combined to knock me flat for most of the day. All those things I've lost. I cried in the car. I cried in the shower. I cried for a long time in bed. And this morning, like my friend, I got up.

Despite my fears about moving farther down the path, closer to the end, this isn't over for me yet. I won't get pregnant this month, but I probably wouldn't have, anyway. I won't get pregnant next month, but that was going to be a rest cycle, anyway. And in May, who knows what will happen? Even then, pregnant or not, I'm not out of options.

They aren't what I wished for, but none of this is. I have to work with what's at hand.

In January I had a cyst, too, though it was smaller and diminishing on cycle day 2. We went ahead with no apparent difficulty (at least not from the cyst). This one's different. This cyst is big. I can feel it. It hurts. Although I suppose I could have asked to have it aspirated, and I could have urged my doctor to do the bloodwork on the off chance that the cyst wasn't producing estrogen, I decided against it. I don't see the point of that. I choose to believe that my body is trying to tell me something important.

I can't believe it would work out well to try to overcome my body's objections this month. I don't put a lot of faith in the notion that things are or are not meant to be. If I did, I'd have been able to take my infertility with much more grace and — behold the staggering irony — would likely be a mother now through adoption. But I do believe this: you can only fight your body so hard. I know. I fight it every month. Most of the time it wins.

Instead I'll give it another month to rest. Perhaps I can lull it into an illusory sense of comfort — you know, fatten it up, soothe it with expensive unguents, deck it with shiny trinkets — so that when I mount my assault in May it'll surrender peaceably, with a minimum of rebellion, and a golden age of civilization will flourish thoughout my pelvis.

If not, I'm calling in reinforcements.

To think in such a place I led such a life

This morning I was over at Jo's alluding delicately to the promiscuity of my college years. This afternoon's mail brought an appeal for money from my university's alumni association. The back of the envelope says it all — not, however, in the way they meant.

When I arrived on campus as a freshman, I was not entirely sexually inexperienced. That is to say that while my high school classmates were larding their college applications with sports and meaningful volunteer work, I was engrossed in extracurricular activities of another sort. There I was at fifteen in the front seat of a Fiat convertible — the car had no back seat, and the front was so cramped that to this day I'm still not sure whether I lost my virginity to a red-haired senior who played in the band or the goddamn gearshift knob.

(Okay, even for me, that was coarse.)

By the time I arrived at college, I was an accident waiting to happen. No sooner had my parents dropped me off at my dorm than I was rifling through the phone book in a frantic search for the number for Planned Parenthood. Registering for classes could wait — I knew what was important. Important: birth control pills so that I could avoid unwanted pregnancy. Unimportant: condoms so that I could avoid STDs.

I knew about them, of course; always a good student, I'd held my ninth-grade health class spellbound with my compulsory oral report on syphilis, which I delivered in verse. Either they were speechless with revulsion or awed by my brilliant enjambment; I admit it was a masterstroke to rhyme chancre with ...skank. Her...

I