The story so far
I'm Julie. When I met Paul 8 years ago, we didn't think immediately of having children. In fact, I'd spent most of my 20s trying very hard not to. Unfortunately, I devoted significantly less energy to avoiding STDs. My doctor delicately referred to those years as "your days of wine and roses." It would be more accurate to call them my days of dope and vodka, but his phrasing is certainly more poetic, so we'll just go with that and move on.
I contracted chlamydia, which didn't seem important at the time, and HPV, which did. The chlamydia succumbed to a single course of antibiotics, but the HPV was more worrisome. Although I never had any symptoms at all beyond abnormal Pap smears, I did need painful cryosurgery to remove the abnormal cells from my cervix, and endured frequent followups for the next year. Oh, and let's not forget the humiliation of having to make some very difficult phone calls to my many casual sexual partners. "Hi. Uh, remember me? No? Well, um..."
This brush with grossness pretty much cured me of my promiscuous ways, and by the time I met Paul in 1996 I was older, wiser, and somewhat more prudent. (Translation: I'd learned which end of the condom was the business end.) Our romance progressed apace; by September that year we were living together in Manhattan.
There are certain things you just don't know about a person until you share close quarters. I didn't know about Paul's annoying habit of leaving dishes in the sink "to soak," brimming with cold, gray, greasy water. He didn't know about my crippling monthly periods, five days of the harpy — heavy bleeding, excruciating pain, and a junkie's need for frequent large fixes of Advil.
And what I didn't know until I visited a gynecologist in 1997 was that these were classic symptoms of endometriosis. A laparoscopy revealed that my insides were just riddled with the stuff, including one of my ovaries that was almost turned inside out with it. Because we weren't planning to have children in the near future, I didn't ask many questions about what this could mean for my future fertility. At any rate, I was too psychotic from the six-month course of Lupron that followed my lap to say much of anything beyond, "TURN ON THE AIR CONDITIONING OR I WILL MURDER YOU IN OUR SWEAT-SOAKED BED."
But by late 1998, having children began to seem like an option. I jettisoned my birth control pills and waited for nature to take its course. We weren't making any special effort, hadn't yet succumbed to the tyranny of the calendar, so it didn't seem alarming that I hadn't become pregnant by early 2000.
Then the efforts began in earnest. Because I didn't want to pressure Paul, I started keeping careful but secret track of my own personal fertility cues. Never was a woman more engrossed by mucus than I! While we agreed we were ready to have kids, I was determined not to turn our sexual relationship into something mechanical and sterile, so while I was toying with my cervix and watering OPK sticks on a daily basis, I was trying hard to keep the more intricate plotting and scheming to myself: Pee on a stick in the morning; frolic gaily in bed at night while seeming not to have a care in the world; keep hips elevated for half an hour while clenching teeth grimly; mark the calendar the next day and count the days until my period inevitably arrived again.
Lather, rinse, repeat.
I must have been insane, but I think I did a good job of hiding it. Paul swears I didn't make him crazy. Good man. Or fine liar.
By late 2001, we'd moved out of Manhattan and had settled into a big house in a small New England town. We knew we were ready to have a family, and we knew that I should have managed to get pregnant by now. The first doctor we consulted was an OB/GYN with no particular expertise in the fertility arena. He performed a painful HSG, an unsuccessful IUI, and then, having emptied his meager bag of tricks, wrote a letter of referral to the state's only infertility clinic.
After looking at the HSG results, Paul's sperm analysis, and my cycle patterns (28 days like clockwork — the trains run on time around here), the new doctor suggested a few more IUIs, just to make sure we'd given the least invasive treatment a chance to work. Clomid, hCG, and a syringe full of love were enthusiastically and hopefully applied, but in vain.
By winter 2002 we were shrugging our shoulders in puzzlement. By this time I was 31 and Paul was 44, and we both appeared to be healthy. No obvious reason seemed to exist for our inability to conceive. So we brought out the big guns and began our first IVF cycle at the end of January 2003.
I started on birth control pills to regulate my cycle, then began a course of Lupron to prevent me from ovulating prematurely. Once my hormones had been beaten into submission, I started twice-daily injections of Follistim and Repronex, along with the Lupron I'd already been taking. Twelve days later, I was given an injection of hCG to mature the eggs that were studding my ovaries, and on February 23, 7 mature eggs were retrieved from 11 large follicles. "Perfect stim," my doctor said, patting my hand before he left the hospital that day.
Unfortunately, the rest of the cycle went straight to hell shortly thereafter. On Monday I was told that only one of our 7 eggs had fertilized. For the next couple of days I agonized, worrying that our single embryo would die before transfer. We were briefly in luck, as it grew into an 8-celled beauty, which we then transferred on February 26. And I did get pregnant, as I found out in early March.
That's where my journal picks up.
In the pink
Today I peed on a stick and got two pink lines. The first positive pregnancy test I've ever had.
I am one smug motherfucker today.
I showed it to Paul, who was skeptical. (It's his job to keep me pragmatic, and I love him for it. Really. Stop laughing.) "Are you sure the shot's out of your system yet?" he asked.
Reasonably sure, since today is 9 days past transfer. But just to be one the safe side, I stole out like a thief this afternoon and bought three more pregnancy tests to use on the sly.
New Jersey, I am sorry.
I must hereby apologize to the lovely state of New Jersey. When your pristine shores are awash this summer in medical waste, well, that's my fault entirely. The syringes, needles, and vials from the stim drugs were bad enough. Now we can add about ten home pregnancy tests to the drift. (Can I help it if they come three to a box?)
And every one of them has been positive.
Blood test tomorrow morning to learn the magic number. I'm no longer worried about a false positive from the hCG shot. Now all (all) I have to worry about is the next hurdle on Wednesday: the all-important doubling.
I had my second beta today. The numbers are just okay. Not great — not the textbook doubling they like to see. I went from 129 on Monday to 226 today. That's a 75% rise, adequate, I suppose, but stellar would have made me happier.
But then perhaps I am asking too much. This uppity little blob of cells is, like, five minutes old and it's already making me anxious. It figures that any embryo of mine would fail to work to its full potential.
I've started feeling strange abdominal cramps. I'm worried that something is going wrong. Obsessing about my uterus was a useful distraction, at least, from the horrible movie Paul and I went to see tonight. (Not even the delectably pockmarked Jet Li could save it, and I normally like the hitting.)
For the record, I refuse to believe it has anything to do with helping Paul move lumber yesterday. I keep chanting to myself, "Slave women gave birth in the fields and kept on working." I, cream puff that I am, need not worry about overexertion.
Aside from the sore breasts I've had since I began the progesterone suppositories, I had my first symptom of pregnancy tonight at the movie. Paul unwrapped a chocolate bar and the smell of it was so intense I had to get him to re-wrap it. It felt like an assault. It didn't make me feel sick, but, wow, sensory overload from a whiff of chocolate. Since then, I have noticed that everything smells like cigarettes. Some women get a lush new rack. Some women get lovely skin. I get a full pack of Camels crammed right up my nose. Thanks.
If something is wrong, there is, of course, nothing to be done. Third beta is tomorrow.
Fat lady, you're wanted onstage.
The news isn't good. My third beta rose from 226 on Wednesday to...269 today.
Dismal, dismal, dismal.
I've been asked to return on Monday for yet another beta. The nurse presented three possibilities:
- a failing pregnancy;
- an ectopic pregnancy; or
- a meaningless statistical blip in an otherwise healthy pregnancy.
That Hallmark moment
My beta went up, so theoretically I'm still pregnant. And shocked to the core.
It increased from 269 on Friday to 713 on Monday — that's a 63% two-day rise.
Now the Internet, blessed fertility oracle that it is, tells me that's adequate, although certainly not ideal. (And getting medical advice from the Internet has proven so far to be a great idea.) But after our two-day stall last week, I refuse to get too excited.
Seems like I've been refusing to get too excited for weeks now. I was quietly smug after the first beta, cautiously optimistic after the second, and solidly grounded in determined pessimism by the third.
Goddamn it, I completely missed that Hallmark rush of elation. You know, the one where I present Paul with, I don't know, a tiny pair of booties and he looks bewildered for a minute, then breaks into a smile whose brightness rivals the sun. And then he lays his hand lovingly against my still-flat belly (not that it's flat to begin with, but this is my fantasy), and speaks in a hushed tone of wonder and says...
I have lost my mind entirely. See, I told you this whole thing fucks you up good. To be fair, we're not exactly Hallmark people to begin with.
I'm scheduled for a scan early Friday morning to see what's going on. By then my hCG levels should have risen, if they're going to, to about 1,200 — that's right around the discriminatory level for seeing a sac with transvaginal ultrasound. First we want to see a sac in the right place. Then, though I don't really dare to hope, we want it to be the right size.
Until then, I will be working very hard to will a comely little sac into existence.
Relatively good, absolutely bad
The good news is that we saw a gestational sac via ultrasound today. The bad news is that it's much smaller than it should be at this point. (It should be at 10 mm by now, and mine is only 5.)
So the good news is only relatively good: it just means that we can pretty much rule out an ectopic. Indeed, the doctor stirred the ultrasound wand enough to check out my tubes and ovaries, and they appear to be normal, with no fluid masses.
The bad news, however, remains absolutely bad. This is not a viable pregnancy. I asked my doctor if the sac could somehow catch up to where it needed to be. Because he is a kind man, he gave the appearance of considering it, but finally had to say, "I would be shocked."
This is what we expected to hear after the appalling lag last week in my hCG levels. But expecting bad news doesn't make it any easier to take when it's delivered at last; it just makes it easier not to look like you've been kicked in the gut.
The best of three bad choices
A miracle did not occur. We were not surprised.
Today's ultrasound showed that the gestational sac had grown, but it was still about a week behind where it needed to be, with no yolk sac, no fetal pole, and obviously no heartbeat. If you don't have most of those things at 6 weeks 5 days, you're just not going to get them.
It confirmed what we already knew. I felt a dull sadness, a background version of the more turbulent feelings I've been having for about two weeks now.
My doctor offered three options.
I could wait to miscarry naturally. As far as I was concerned, this wasn't an option. On the one hand, you know beyond a doubt that the pregnancy is really and truly over. On the other, that could take weeks, and could happen in the supermarket checkout line. At this point, haven't we gone through enough without imposing more uncertainty on ourselves?
I could have a D&C. I briefly considered this, but decided I'd like to avoid that if possible. I worried about the pain of the procedure, and I worried that I'd have to wait for an appointment. I wanted it over.
I could take misoprostol, a drug that induces miscarriage. (It's usually used in conjunction with mifepristone, but in IVF patients the other drug is unnecessary.) It's taken vaginally, and it causes your cervix to soften and dilate; the ensuing contractions usually empty your uterus of the products of conception.
I decided on the misoprostol because it will cause a predictable miscarriage that I can endure at home, properly medicated, without surprises. I'll be inserting the tablets tomorrow, after which I intend to spend the weekend feeling hideously, operatically sorry for myself.
I took the misoprostol yesterday as directed. I put it in around 8 AM and sat down to wait for my uterus to explode.
And pretty much wasted the entire day just waiting to feel something. Finally around 5 PM I started feeling some gentle cramping. Because I thought the festivities were beginning in earnest, I girded my loins with the thickest maxi-pad I could find, dosed myself with Tylenol 3, and stationed myself on the sofa.
Now I grudgingly concede that my vagina and what eventually issued forth are not of interest to everyone. Skip the next part unless you really want to know.
At long last the cramping grew stronger. At around 10 PM I began to pass some gelatinous fragments of grayish-looking tissue. There was never a lot of it, and very little bleeding. In fact, there was no red blood; I had only occasional scant dark brown spotting.
I found this disconcerting, as I'd expected to be floundering in a pool of my own blood by now. (First time in my life I actually hoped to see blood.) But I cheered up a bit once I decided I would probably wake up in the middle of the night having soaked through the sheet, lying in a pool of my own gore. I went to sleep with high hopes.
And woke up this morning lying in nothing more than a lighly spotted maxi pad.
The dark spotting has continued, but I still haven't seen a single drop of red blood, and since last night I've passed no more of the grayish matter.
I hope I'm wrong, but I'm not convinced it's over yet.