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.

Underachiever

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.

Unhappy cramper

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:

1. a failing pregnancy;
   
2. an ectopic pregnancy; or
   
3. a meaningless statistical blip in an otherwise healthy pregnancy.

I sure would like to believe it's the latter, but I don't think that's a realistic hope. To say I am sad doesn't really cover it.

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.

Bloodless coup

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 waited.

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.

And waited.

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.

Shit.

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.

I liked it so much I did it again.

I went back today to get my blood hCG levels checked after Thursday's dose of misoprostol. My doctor saw me in the waiting room and took me aside to ask me how it had gone. When I told him that it was mostly unproductive, he furrowed his brow and suggested an ultrasound. Why not? It had been days since I'd been romanced by a cold piece of medical equipment. A girl could start to feel neglected.

Sure enough, half of the sac was still there. He said I would probably pass that on my own if I was willing to wait, but he didn't seem surprised when I said I was eager to get it over with.

The weeks without a resolution have been excruciating. From the day of my second beta test, I've worried; from the day of my third I've known this wasn't a viable pregnancy. At this point, I'm in favor of anything that will hasten the end of this discouraging cycle.

On the way home, I stopped and picked up three large Symphony bars, a giant bag of potato chips, and a fifth of vodka. (A girl needs her medicine.) When I got home I inserted the tablets as before and sat down to wait for my insides to fall out.

I didn't have long to wait. This time it took effect more quickly. Within three or four hours I was having some fairly strong cramps. Now I'm having some spotting, some bright red blood instead of the dark sludgy stuff of last time. I have taken to the sofa and I will not budge until it's over, or until I need more chocolate, whichever comes first.

I can't even do this right

I don't believe it worked.

I bled some during the night, but not enough to convince me this is over yet.

I have yet another hCG test scheduled for Friday...my eighth, I believe. I am thinking of having a convenient grommet installed in the crook of my elbow for easy withdrawal.

Third time's the charm

I went in today for more bloodwork to confirm that the second dose of misoprostol worked. I had my doubts, as I'd finally had some bleeding, but not as much as you'd expect from a real live miscarriage. (I'd sort of expected to wake up the next morning with HELTER SKELTER painted on the wall in blood.) As I waited to be taken back for the blood draw, my doctor breezed past the waiting room, saw me, wheeled back cartoon-style, and took me aside to ask me how it had gone.

I told him what had happened, and what hadn't, and he seemed nonplussed. I had no ultrasound scheduled, but before I knew it, there I was, naked from the waist down and impaled on a probe. (Hello to you, too.)

What we saw was not encouraging. The remains of the sac were still there, the same size they'd been on Monday. "Want me to just get it out?" he asked.

"God, yes," I said.

A harrowing description of my cervix being wrenched open follows. You've been warned.

I gave my blood for the hCG test, took a couple of Vioxx, and waited for them to take effect. I asked for a sheet because I was cold. "I'm not cold," said the doctor. "Are you cold?" he asked the nurse. "No," she answered. "In fact, it's kind of warm in here."

"See, the thing is," I pointed out reasonably, "you're wearing pants." A sheet was produced with alacrity.

Shortly thereafter, the doctor and nurse collected their tool kit and got down to business. Speculum: check. Cervix swabbed with iodine: check. Panic attack held valiantly at bay: check.

"Okay, first I need to see where your cervix goes," the doctor told me. "Everywhere I do," I answered. Oh, how we all did laugh. Discuss among yourselves this question: why must I try so hard to be entertaining?

"Now I'm going to attach a grasper to your cervix to open it up," he said, and I was instructed to cough. It took him three tries to get a firm grip on my recalcitrant cervix.

"Grasper," I said, when I'd caught my breath.

"Yeah," he said. "It sounds less threatening than tenaculum."

And then things stopped being funny. I was given a local anaesthetic — lidocaine, I believe — and he waited a moment for it to take effect. Then the nurse, a real sweetheart, came to stand beside me, held my hand tightly, and said, "This is going to hurt, for only about 30 seconds."

It did.

Finally the doctor said, "That's got it." He and his nurse were quick, efficient, and as gentle as they could be under the circumstances. And they did a first-rate job of not letting me see any of the implements used or the so-called products of conception. (I know I would have looked. I don't think it would have bothered me, but I can't really know.)

My uterus continued to cramp for several minutes, so I lay quietly on the table under my hard-won sheet. The nurse brought some water, which I didn't want but drank. Another nurse came to check on me in a few minutes, and assured me that I could stay as long as I needed to. In about 15 minutes I was on my way home.

I guess I can't complain. It's not like I had a co-pay or anything.

Still pregnant

After three attempts to end this once and for all, I am still pregnant. Only today, 8 weeks and 3 days after my egg retrieval, was I finally diagnosed with an ectopic.

The doctor's office called and said the pathologist found no chorionic villi in the tissue removed during my D&C. We weren't sure whether I'd passed it during my earlier miscarriages (and how strange is it to make that plural?), or whether it was a more ominous sign, so I went in for bloodwork to make sure my hCG levels had decreased as expected.

Well, they hadn't. In fact, they'd risen — a pretty clear indication of an ectopic pregnancy. Why didn't we know this earlier? I blame society.

No, wait. I blame the pseudosac.

Apparently, in 10 to 20% of ectopic pregnancies, a pseudosac is formed in the uterus, mimicking the appearance of a real gestational sac. I don't know why a pseudosac sometimes develops. Who the hell does it think it's fooling?

In my case, the sac we saw on ultrasound looked like an early intrauterine pregnancy — just one that was far behind where it should have been in size.

As to why this wasn't detected sooner, I can only assume it can be hard to tell the difference. Either you can wait for the development of a yolk sac and a fetal pole to be sure it's a true sac, or an ultrasound can show the characteristic double ring (known as the double decidual sign).

My doctor pored over the ultrasound films and determined that it looked like a real live sac. Because I was eager to move on, we didn't spend any more time waiting for a yolk sac to develop. We concluded it was simply a non-viable uterine pregnancy, and acted accordingly.

What can I say? Mistakes were made.

I've had attentive followup care; otherwise the situation could have become dangerous. I have some mild symptoms (cramps, bleeding), but I would have ignored them because they're also what you'd expect after a D&C.

I go in tomorrow for a shot of methotrexate, which should arrest the growth of the pregnancy, allowing my body to resorb or jettison the remaining tissue. After working so hard to achieve a pregnancy, I never imagined I'd be working just as hard to end one.

CAUTION: CHEMOTHERAPY!

After a quick detour for still more bloodwork, I went in today for the aforementioned methotrexate injection. Now, methotrexate works by interfering with rapidly growing and dividing cells — i.e., an embryo. Or a tumor.

That's right. Methotrexate is used to treat cancer. The pharmacy gives you the medicine in this big lightproof bag with fluorescent stickers all over it: "CAUTION: CHEMOTHERAPY!" and "DO NOT HANDLE WITHOUT PROTECTIVE CLOTHING." It makes you want to use tongs and gloves just to carry the bag back up to the nurse (who then dons a disposable gown, gloves, and fetching plastic cap, of course).

It seems like a scary drug, but apparently it's very successful in treating unruptured ectopic pregnancies. About one patient in 20 will still require surgery, but I have no intention of being among those ruptured few.

The injection itself was uneventful. I was given a stern talking-to about the absolute necessity of follow-up bloodwork on a weekly basis, and a long list of things I must not do:

1. Drink. Methotrexate screws up your liver, so just when you need it most, alcohol is forbidden.

2. Consume dark, leafy green vegetables. Folic acid impairs the efficacy of the methotrexate.

3. Drink orange juice. OJ is heavily fortified with folic acid, so see above.

4. Have marital relations. I must not be jostled, lest we free the embryonic beast within.

5. Spend time in the sun. Methotrexate makes you susceptible to really bad sunburn.

6. Be far away from a phone. I guess that's in case the creepy little thing ruptures and I need to dial 911 to bellow, "THAR SHE BLOWS!"

Sunday, bloody Sunday

Every time I go to the bathroom, it's like I'm visiting my own murder scene.

I am shocked to be bleeding this much. I started bleeding after my D&C more than a week ago and haven't stopped since. It wasn't clear where the D&C bleeding stopped (if it ever did) and where the ectopic bleeding started (if it has). There's certainly been a qualitative change in the bleeding, though.

I am totally fascinated by the torrential downpour landing on my maxi-pads. If you're not — and who could blame you? — don't read any further, okay?

See, at first the bleeding was just this thin bright red stream. It looked almost like Kool-Aid, cheerful and watery. When I'd crouch over the toilet, curling over to watch it leak out, it would just flow and flow like urine.

But in the last couple of days I've been producing these awe-inspiring clots. Today I passed one the size of a quarter. The blood has gotten darker, a little more serious-looking, and rather viscous. I'd swear there's mucus in there; when I wipe with toilet paper there are these impressive pink and gooey strings.

I can't wait to see what's next.

The downward spiral

This morning's hCG level seems to have plummeted from 4,583 to an astonishing 317.

Can this be right?

I'd thought it should take approximately as long to come down as it did to go up. I found an interesting note here, though:

After successful tx of ectopic, serum hCG decreases in two-phase distribution (initial half-life 5-9h; secondary half-life 22-32h)

If this is true, today's number makes a lot more sense than I initially thought.

No major change on the pain front: Still hurts like a motherfucker. I'm experiencing general abdominal cramping, with special bonus throbbing on my lower right side. The nurse assured me this is expected as the pregnancy detaches from the tube. Don't let anyone tell you Tylenol 3 will do the trick, though; hold out for the Percocets. This really hurts. And I assure you I am no piker when it comes to pain tolerance.

I'm also sprinting to the bathroom every half-hour or so, but yielding only these ridiculous little trickles. I unbuckled my belt for that? I'm told that the increased urinary urgency is a result of blood in the peritoneum — I guess that's not supposed to sound as alarming as it does, because the nurse didn't seem concerned.

The bleeding appears to have stopped for the moment. Since this morning I've had only scant spotting, quite a change from yesterday. Overall, I appear to be holding my own, except for the minor matter of abdominal agony, inadequate pain relief, and the complete denial I seem to be luxuriating in.

This too shall pass

All hail my Fallopian tubes. I passed it at last.

The pain was bad throughout the afternoon. I called the doctor's office to ask for some sort of medication. All they could prescribe without an order in writing were those damned Tylenol 3s. (Thanks for the war on drugs, Ronald Reagan. Fucker.) The codeine didn't help much, but I was gobbling them hungrily, for want of any other relief.

By evening, I was spending a lot of time in the kind of pain that made me see stars. The cramping was intermittent but strong. When a cramp came on I was reduced to taking fast, deep breaths to try to work through it. The breathing didn't help but it was the only thing I could think of to do.

I lay in bed most of the time because I felt light-headed whenever I stood. Sometimes I'd walk to the bathroom, sit on the toilet, and then sink to my knees and crawl back to the bed to avoid fainting.

At one point I became convinced that only a hot bath would soothe the cramps. I ran a tub full of hot water and sat in it for about half an hour, until I was well and truly boiled. The hot water did help relieve the pain for a while. When I got out, though, I was light-headed again, so I lay down on the bathroom floor to rest for a while.

Just in case you're planning ahead, a word of advice: Never do this unless your bathroom has been cleaned within, say, the last week.

Another word of advice: If you're easily squicked, read no further. Really.

When I finally managed to stand up, I realized I'd been bleeding all over the bath mat. I also realized that the mass that had been in my right tube wasn't there any more, because I felt it slither down my vagina. I had the presence of mind (and the requisite twisted interest) to cup my hands between my thighs to catch it.

Now, I should make some excuse for my deep fascination with this. All along I've felt like a human science experiment. My body's reaction to the stims, my weird pregnancy symptoms, my apparent inability to miscarry when told to — I've found all of these things mysterious and interesting. Since my narcissism is apparently infinite, maybe it's no surprise that I wanted to inspect the yield this time, too.

And inspect it I did. It was about the size of a walnut, and composed of three distinct parts. Part of it was a giant blood clot. Another part looked like ground meat. The third part looked like whitish tissue.

I wonder which part was which. I couldn't tell. I imagine it had gone through some unpleasant compacting as it got squeezed through the chute. There was nothing there that looked remotely like baby, but then I didn't expect that at such an early stage. It was pretty much what I did expect: a gelatinous blob of rejected tissue.

After inspection, I deposited it unsentimentally into the toilet and gave it the royal flush, with my most intense feeling being relief.

Now, you know, there are women who save the remains of a miscarried child and bury them in the garden. There are women who can't save the remains and agonize because of it. There are women who memorialize their never-to-be babies, who name them, who think of them as angels who simply never had the chance to live on Earth.

I didn't. I don't. This wasn't a baby, a child, or an angel. It was an agglomeration of cells that grew in the wrong place, and that might have killed me had it grown much more. Forgive me if I don't seem, well, maternal.

What I am is tired. I'm feeling exhausted from the pain, relieved that it's over, and strangely peaceful at last.

Note to self: clean floor before dying.

Have you ever honestly thought you were going to die?

The early hours of the morning found me on the bathroom floor again, the floor which needs a good wash now more than ever. I lay there naked on a towel, thinking, I wish I'd made a will.

After I passed the big clump of tissue last night, it seemed that the worst was over. I limped into the den and arranged myself very carefully on the sofa, aching and enervated but feeling rather triumphant. I couldn't stop talking, making poor Paul listen to Blood-soaked Tales of Horror from the Master Bathroom, rendered in glorious verbal Technicolor. I guess I was giddy. I know I was proud of myself for making it through.

When we went to bed, I dutifully took two Tylenol 3s, thinking it would send me into a dreamless sleep of exhaustion. Not two hours later, though, I was back on the bathroom floor, planning my many bequests.

I didn't know whether there was still more tissue that my tube was trying to jettison, or whether it was just trying to shrink back to its normal size, or whether it was spraying a hot jet of blood through my abdominal cavity like a garden sprinkler. Maybe it was all of the above.

Three hot baths and three blood-spattered towels later, I'd finally concluded that it was time to go to the hospital. I'd spent the last several hours arguing with myself. I knew surgery at that point was probably unnecessary, as expelling the mass earlier surely removed the possibility of a tubal rupture. But I was also pretty sure that if I went in, it was fairly likely I'd still be put under and sliced up.

But, see, they'd give me really good pain drugs.

At that point, that's all I wanted: really good pain drugs. Okay, and someone else to be in charge of deciding what to do with me. Someone else in charge of taking care of me, because clearly I was doing a piss-poor job of it, lying naked and whimpering on the filthy bathroom floor.

So I took my last hot bath of the morning. I tried to get dressed quietly, but I woke Paul up in the process. He had to wake up sometime, because I'd decided it was time to call the hospital.

I did, and eventually spoke to the doctor on call. He listened very patiently to my whimpering, and offered the reassurance I needed: "I don't think you're in any imminent danger, and I don't think it's an emergency. You should probably be seen, so you can come in now to the ER, or you can wait until your doctor's office opens and see them then, whichever you prefer. But you're not in any immediate danger."

Paul was already awake and showered and revving the engine out in the garage, poor guy, ready to whisk me away to safety. I decided I'd wait until my doctor's office opened, only an hour from then, so he came back inside and stood by the bed holding my hand while I lay there panting.

I'm pretty sure I've never looked lovelier.

My doctor called in about half an hour, having been notified by the doctor on call. Just imagine it, if you will: "Dude, your patient's having a real, for-true crazy-person four-alarm meltdown." To his credit, my doctor was, as ever, attentive and reassuring. Despite all evidence to the contrary, he succeeded in convincing me that the worst was over, that I just needed to lie still, take enough Tylenol 3 to fell an ox, and rest. I'd spend most of the day feeling like I'd been hit by a truck, he warned, but it would get better.

It did, some. I slept most of the day. When I wasn't sleeping, I was lying in bed feeling like I'd been worked over by Turkish prison guards. But the worst did truly seem to be over.

Again.

File under love

So where was Paul while I was doing all this writhing and moaning?

Why, he was feverishly filling out extension forms for my income taxes so I wouldn't have to do my writhing and moaning in jail.

Love. That. Man.

Enough already

This morning I left a message for the nurse, just a progress report to let them know how I was doing: slight fever, very painful abdomen, burning when I urinate. I guess those are alarming symptoms, because the nurse called back shortly thereafter and asked that I go in that afternoon. Paul drove, and I kept up a monotonous whine as he hit every bump in the road.

I'm lovable these days.

Now, this particular nurse is very good at her job. She did not say, "My God, which rock did you crawl out from under?" She didn't even say, "You don't look so good." She said, "I'm glad we asked you to come in, because you don't look like you feel very well." May I introduce Sherlock Holmes, R.N.? Wonder what tipped her off. My unwashed hair? My red-rimmed eyes? My hollow, crazed look? The fact that I needed to be flanked on either side as I lurched down the hall to the exam room, unable to straighten up?

I then had a short visit with the doctor, who looked me over briefly, examined my nails and my skin tone, and opined that I'd had some internal hemorrhaging, but that it had stopped. Then he gently prodded my belly to see just how tender it was.

I surprised myself by bursting into tears on the table.

I mean, it hurt, but not that much.

I've simply had enough. I've been hurting for days, feeling entirely abused by the universe. I'd been completely unprepared for the pain, and don't feel that I was properly medicated for it. This was just one more indignity, one more poke, one more vigorous jack-booted kick while I was down, and I lost it for a minute.

That's what it's like. Physically, I'm holding my own; though sore and tired, I'm definitely on the mend. Emotionally, I am 100% tender, well-marbled belly. Enough with the goddamn poking.

Only slightly pregnant today

Got the news that my hCG is down to 67. At this rate I'll be totally not pregnant in no time!

I'm already feeling very, very different. My breasts stopped being sore overnight, and the strange pervasive smell of cigarette smoke has dissipated. I assume the radiant glow and mother-of-Christ halo I've been sporting have vanished as well.

I am turning a corner, I think, at last.

A woman of leisure

Today I felt well enough to do a few things. Now I'm exhausted. I'm embarrassed to admit how little I actually did: folded a couple of loads of laundry, unloaded the dishwasher, and helped a bit with dinner.

That is all. I guess it's enough.

I'm still working the Tylenol pretty heavily, but I haven't been taking the ones with codeine. Junkie that I am, I'm hoarding them for times of greater need...like, say, if I ever get accidentally decapitated and need something to take the edge off.

Cue the banjos

I'm on vacation, but I've been instructed to have bloodwork weekly, no matter what, until my hCG level has fallen to zero. Since this little Southern town barely has electricity, I dare not hope for state-of-the-art medical technology. I'll settle for hoping the good people at the hospital have discovered the merits of, you know, clean needles, antiseptic, and boiling water.

I bet they still give you a leather strap to bite down on when they amputate your leg after it's turned black and gangrenous. I bet they put a knife under the bed to cut the pain.

I do not feel pregnant in the least, and I'm fully expecting to have bottomed out by now. I still have twinges now and then in my right tube. It's an odd thing to know exactly where my Fallopian tubes are. Two months ago I couldn't have found them without calling AAA for roadside assistance.

Four point fucking three

hCG's at 4.3. I can't even zero out properly. How boring is that?

I'm tempted to blame the hospital, but I must grudgingly concede that they probably knew what they were doing. I was there for thirty whole minutes and I didn't catch even a little dysentery.

Party on, Julie

"You're off the hook," said the nurse on the phone. My hCG level is at zero at last.

To celebrate the end of the adventure, I:

• Ate spinach
• Drank vodka
• Had sex

Now let us never speak of this again.

Tired of hearing about my pelvis? Join the club.

I've been having pain in my lower left side for about two weeks now — I'm pretty sure it's my ovary, since my intestines are behaving impeccably as usual and I don't recall storing any other organs in the vicinity. It hurts when I bear down or bend; sometimes the jolt of my footsteps as I walk can set it off, too.

My ectopic was on the opposite side, so we can rule out lingering irritation from that, I think. My doctor optimistically suggests that it's just ovulation starting up again. I'd like to believe that, though it seems strange that the pain would have lasted so long. My fear is that the endometrioma on that ovary is planning a bloody coup. I have radioed for help from neighboring countries and will hole up in my bunker until reinforcements arrive.

For my next trick...

Okay, at this point all we're waiting for is the resumption of my normal cycle so that we can subvert it entirely. Once my period begins, I'll go on birth control pills to regulate my cycle — trust me, the irony of this is lost on no one who's been through infertility treatment, so don't even bother mentioning it. After a few weeks of pills, we're off to the races, beating my system into submission with Lupron, then whipping it into a frenzy with Repronex and Follistim shortly thereafter.

This is the first time in my life I've eagerly awaited the arrival of my period. The true indication of how much I want a child is the fact that I'm willing to endure several periods without ibuprofen.

Stuck pig

My period arrived Thursday night with its usual bloody fanfare. Now the worst of the cramps seem to be over. I can't decide whether they're not as intense as usual, or whether I'm so happy to be back to normal that my brain won't allow me any reason to complain.

Not that that stops me, but there you go.

Birth control pills start today.

Wide, pink, moderately coated

Today I had my first appointment with the acupuncturist. Now, I'm not entirely sure how I feel about acupuncture. I don't doubt there's a lot Western medicine doesn't know, or ignores on purpose; I'm just not convinced the Chinese have it figured out, either. But I also think there has to be something there, and I don't think I have to be a devout disciple for it to help me. In short, I don't have to believe in it if it believes in me. Can't hurt, could help.

The acupuncturist himself inspired a fair amount of confidence. The office was clean and bright, instead of clouded with the herby funk I'd expected, and nothing about him screamed "smelly hippie." We talked for several minutes about my medical history, my answers to the intake questionnaire, and my goals for treatment. (Long-term: healthy pregnancy. Short-term: resisting the impulse to play with the needles when he left the room.)

He made a lot of notes and looked at my tongue ("wide, pink, moderately coated"). Then he gave a very thorough explanation of what I could expect as the needles were inserted. Then I hopped up on the table for the stickin'.

Sure enough, the "fish biting a line" sensation was pronounced when he stuck me (ears, wrists, calves, and ankles, for those of you playing the home game). It was a strange feeling but not especially unpleasant.

Once I was stuck, I was left to lie on the table for half an hour. I felt a very unusual sensation: my limbs felt very heavy and almost useless. I had no interest in moving at all, which is rare for me — I tend to be quite restless. My mind was clear, but my body went into this remarkable state of relaxation.

I plan to go back throughout my cycle. Aside from the possibility that it could help enhance our chances for success, I really enjoyed that state of heavy physical relaxation. At this point, anything that helps me relax is fine by me. Besides, my qi/blood deficiency is in dire need of attention, to say nothing of my appalling and acute kidney/yang deficiency.

It's the drugs, I swear

In four days I start Lupron. In my mind, though, the cycle is already well underway. I'm already wound more tightly than...than...some excessively tightly wound thing...and obviously already suffering from the breathtaking cognitive lapses that plagued me last time.

Last time around, nobody told me that the worst side effect from all my medication would be that I'd lose my fucking mind. The drugs really should come with a warning label: While using this drug, patients should not operate heavy machinery. Or shower.

A quick flip through my journal reminds me that not only did I take the car up two one-way streets, jumped the curb at least twice, burned myself on the iron, nicked my hands with a chef's knife, grated my thumb into a pile of Parmesan cheese, and set off the smoke alarm so often it sounded like we were at DEFCON 2, I also apparently forgot how to use toiletries.

The documentary evidence seems to show that one morning in the shower, I shampooed my hair as usual, rinsed it, and picked up the conditioner...which I then dispensed into my hand and proceeded to rub all over my body. I couldn't figure out why it wouldn't lather.

Five minutes later, I applied hair product to my face, for that bouncy, manageable look that turns heads on the street.

"And I can't be sure," I wrote on February 21, "but I have the strong aroma suspicion that I applied deodorant only to one (1) armpit."

Stuck in the middle with you

I just performed the inaugural injection of this, my second IVF cycle. Even as we speak, the Lupron is coursing through my veins. I am imagining myself as the Incredible Hulk, with my clothing hanging around me in fashionable tatters as the bloat and the emotional upheaval turn me into a raging green-skinned beast.

Don't make me hormonal. You wouldn't like me when I'm hormonal.

(Assuming you'd like me otherwise.)

The worst side effects I had from the Lupron last time were occasional headaches (and I think the worst one was actually a bit of a vodka hangover). As long as I remember to drink more water than usual, I should be fine.

The actual injection was nothing. The shots don't bother me — at least not until later in the cycle, when I run out of virgin flab to pierce. I've found that my inner thighs and abdomen are the most hospitable territory — very little pain there, unless you get too close to the navel. None of this candy-assed icing the area beforehand, or warming the syringe, or daintily swabbing on numbing cream, thanks. The pain's no worse than an insect bite, and certainly not worth complaining about when you consider the big picture.

I'm somewhat concerned that in our attempt to create more eggs we're decreasing the Lupron as opposed to increasing the stims as I thought we'd discussed, but I am trying very hard to turn off my brain and let my doctor do the thinking. I grudgingly admit that he probably knows a tiny bit more about manipulated reproduction than I do. My ovaries are merely putty in his competent hands.

Pinhead

For the first time today the acupuncturist stuck needles in my face, a veritable bouquet of stainless steel sprouting up between my brows.

As the first one went in, I vanquished the temptation to yell, "Ow! My third eye!"

You can tell how committed I am.

On your marks...

This morning I went for my baseline ultrasound and bloodwork after ten days on Lupron. We expected to see no follicles developing on my ovaries, and my estradiol level needed to be below 100.

All quiet on the ovarian front, and my E2 has been effectively bullied down to a timid 24. We're cleared for takeoff.

I'm starting stims tomorrow and will go back on Tuesday to peer into the murky cavity of my abdomen once again.

Day 2: Mental block

Day two on stims, and my right ovary is already complaining. It's been sending up indignant twinges since this morning.

Even so early, this cycle feels very different to me. I have a definite mental barrier that's making the injections more difficult: I sit there and poke myself gently with the needle, reluctant to just shove it home. Once it's in, I press the plunger slowly, instead of resolutely sending the medication off. At some level I'm feeling a real resistance to going through with it this time, and that's very different from before.

Day 6: Team player, my ass

This morning's scan wasn't promising. I've cried all day, leaking tears since I left the hospital. I even cried through acupuncture. The tears ran into my ears, and when I tried to wipe them I dislodged several needles protruding from my cartilage. (The acupuncturist was very kind, offered some thoughts about loss and unfairness. I hate to say it, because it's not like me to neglect such a ripe opportunity for gleeful mockery, but it was not creepy in the slightest.)

The scan showed that my right ovary isn't really rising to the challenge, and while I have several teeny follicles on my left, I also have a single malevolent giant that will probably require us to cancel the cycle.

The suppression drugs (Lupron, in my case) are supposed to keep your ovaries from developing a dominant follicle. What you really want is a bunch of them all the same size, developing at the same rate: a clutch of team players. When one leader decides to upstage the rest, it can keep the others from growing. It can cause also ovulation before retrieval — poof, no eggs, no cycle, no refund.

Because my clinic uses a team approach, I don't see the same doctor each time. The doctor I saw this time was one I hadn't met before. She was very emphatic about the likelihood that we'd cancel, but said they'd discuss it at the team meeting later that day.

I was somewhat relieved this afternoon to hear that my regular doctor wasn't necessarily convinced that cancellation was necessary. (I say "somewhat" because I wonder whether even unhappy certainty would be better than just not knowing. The anxiety is relentless.) He suggested that I continue the drugs and return on Friday to see what's going on.

If we have to cancel, we could still convert to IUI, but given that our problem is fertilization, I don't think that buys us anything. Good money after bad; on this Paul and I agree. By waiting until Friday to make a decision, the only thing we have to lose is a couple of days' worth of injectibles.

Oh, and my sanity. But that's okay, because I'm not really using it for much anyway.

Day 8: Whatever gets you through the night

The relaxing and effective ways in which I am coping with the likelihood of a cancelled cycle:

• Hyperventilating
• Wrenching my shoulders up into a twisted shrug only Chang and Eng Bunker could love
• Producing oceanic tides of stomach acid
• Standing up, sitting down. Standing up, sitting down. Standing up, sitting down to gauge the relative jolt sent through my ovaries by the shock.

Day 9: Limboland

Still stuck in limbo, as nothing truly definitive occurred at this morning's appointment. I appear to have 4 good follicles on the left, plus the big bad one, and 1 good one on the right. I've dodged cancellation for the moment. That's the good news. The bad news is that we can't guarantee that the big one won't cause me to ovulate before retrieval. It's a risk.

I grilled my doctor on whether he thinks we could do better on another cycle (ignoring for the moment the dominant follicle, which he said might be the result of the lower dose of Lupron but could also just be a random occurrence). Answer? Unknown. Based on my first cycle, it seems my ovaries respond slowly, but we don't really have enough information to assume any kind of overarching pattern.

Lazy and unforthcoming. Me all over, really — I should be pleased that my ovaries aren't trying to buck the trend.

So if the other follicles continue to grow, and if the big one doesn't cause ovulation before retrieval, and if I don't do a half-gainer off a building before then, I guess we'll just keep plugging along until the path becomes more clear. Let the hormonal rages commence.

Day 10: Zen and the art of mucus cycle maintenance

I just wanted to say that I have never seen so much clear, stretchy mucus in my entire life.

By that, I mean I think I produced more in a single day than in the last 20 years combined.

I love Paul enough not to make him look.

Day 11: Itchy trigger finger

The doctor's office is so different on a Sunday. You know everyone in the waiting room is there for IVF, and not for routine OB/GYN care. Everyone was quiet and self-contained, and it seemed so tense that I had to fight a perverse urge to swagger around the room bellowing, "So! Whaddya in for?!"

It's kind of good that I am me. Otherwise I'd have to hate me.

But I digress. I personally was in to have my follicles counted. The doctor located four likely-looking follicles. Two were large-ish, two were slightly smaller, and then the rest were mere bagatelles. I hauled my ovaries out of bed at 6 on a Sunday morning for this?

Later on the phone the doctor told me she didn't think we could buy any more time, and advised that we trigger that evening. She said she thought we'd get three decent eggs, four max. It wasn't too late for us to cancel.

Paul and I agonized over it for a few hours. We finally concluded that we wanted to go ahead — that even if we ended up with only two embryos, we'd have improved on last cycle. At this point that was our focus, that and trying to make something worthwhile out of the last week's stress.

The doctor called back to get our verdict. When I told her, she said, "I think that's a good decision. So you should go ahead and do your trigger shot now."

"Now?" I said, startled.

"Yep, for an 8:30 retrieval Tuesday."

Now one thing you may know about me if you've read earlier entries is that I'm almost psychotically compliant. So Paul and I marched off dutifully to do the shot. It didn't occur to me until half an hour later to count the hours: the trigger's supposed to be given about 35 hours before retrieval. We'd done the shot at 4:30 PM...

...making retrieval necessary at 3:30 AM Tuesday.

Obviously something's wrong. The strange thing was that I, normally anxious, didn't feel an angstrom of panic about this. Their mistake; they'll make it right.

After all this ridiculous drama, I'm wretchedly ambivalent about going ahead, because this cycle has been a clusterfuck from the word go, but also hugely invested in doing so. Otherwise the last three weeks of anxiety are going to feel like an enormous, upsetting waste.

Mission: aborted

Today started badly and got steadily worse.  I was up at 6 to wait by the phone.  I knew the doctor's office didn't open until at least 8, but I guess I wanted ample time to work myself into a high enough dudgeon. 

The first call was around 9, from the doctor who'd instructed me to trigger yesterday.  She apologized for the timing mistake, but reported that my doctor's opinion was that we'd be better off converting this cycle to an IUI after all.

My usual doctor called later after he got out of the operating room, and reiterated that opinion.  He said, "If I'd seen the ultrasound yesterday, I would have given you that advice then."  On Friday I'd had one follicle larger than all the rest, but by Sunday, he said, a second had jumped out.  "Three eggs, max," he said, "but more likely two" if we went to retrieval.

It was an extremely difficult conversation.  When I'm upset I shut down — these long silences occur while I try to think of something to say that sounds sufficiently sane and controlled, with no sputtering or swear words or inarticulate squawking.

I finally asked him what accounted for the discrepancy in his opinion today and the other doctor's comments yesterday.  He said he didn't think there was one, claiming the other doctor had agreed with our desire to go to retrieval as a gesture of respect for our autonomy.

Here's where I actually did start squawking.  We don't need a doctor to validate our fragile feelings of independence, for crying out loud; we need a doctor to give an informed medical opinion. 

"We're not allowed to be directional," he reminded me. 

"Please," I sputtered, hoping my eye-roll was audible.  I get very impatient with this statement, which he's trotted out on a couple of occasions.  Pop quiz, kids!  Who knows more about assisted reproduction: my doctor or, well, me?

Generally speaking, my doctor (yes, he has a name, and yes, I do know it) seems to tend toward optimism.  But his predictions about this cycle's potential for success were so grim that they frightened and convinced me.  An IUI it is.  Practically speaking, that means another $185 down the tubes with nothing to show for it — with our fertilization history we might as well write it off before it even happens.

As we wrapped up the conversation, he said that if we thought we'd be happier at another clinic, he'd write us a referral.  I don't even know how to think about this, and will worry away at it later when I'm bored by the usual topics.  For now I'm feeling sufficiently pathetic to leave it alone for the moment, thank you very much.

Now let us never speak of it again.

As we sat in the waiting room today before the IUI, my doctor lured us into a conference room, apologized for the clusterfuck that this cycle had become, and told me the IUI was on the house. He also gave us meds from the sample closet for our next round of IVF, free of charge.

I don't know what to make of this. I hope I said something grateful.

The upshot of this cycle is that it cost us only time and sanity. Because I am crass, I can admit that the failure seems to sting slightly less when the insult of losing money is removed.

It occurred to me to refuse, to say they should give them to someone who really can't afford the medication — I'm not exactly sure why I didn't, because I don't truly think we deserve any special compensation. I don't think my poor response to the protocol could have been predicted or averted.

Mostly I think I just didn't want to have to discuss it any further. I am worn the fuck out.

Paul, who yielded a sample this morning without turning a hair, joked with me while we waited, and sat steadfastly next to me while the IUI was done. ("Um, hey, sit near my head, not at the other end, okay?") The procedure itself was easier than it's been in the past. Veteran that I am, I instructed the nurse to bend the catheter "like a hockey stick," and it slid in easily once the speculum was wrenched open.

So it's done. I'm considering this cycle finished — I don't believe it can work. I've felt lighter all day, relieved that the stress I've been under is over. We won't go through another cycle until October at the earliest. See you in the penalty box.

Hope is the thing you pee on.

I am more of an optimist than even I thought.

I went out two days ago and bought six (6) home pregnancy tests. I hid them from Paul like a thief. Every once in a while I go into the bathroom and visit them.

Yesterday I succumbed, hoping to see whether the hCG trigger shot from a week ago was out of my system yet. It seems to be. So a false positive from here on out seems unlikely.

My brain is running constant diagnostics on my body, searching for symptoms. Breasts: normal. Ovaries: crampy. Uterus: present, to the best of my knowledge. But, really, the only thing I truly feel is epic constipation, brought to you through the magic of progesterone supplementation.

And I know this IUI didn't work, but I want it so badly that my heart is stubbornly overriding that certainty. Not for nothing, but my heart's not exactly a cheap date at the drugstore.

Uteropolis: A nice place to live

My pelvis is a veritable city of industry.

There's something going on down there. Although I know quite well that it's most likely just the aftershocks from all the drugs, I can't help noticing that my uterus feels much...busier than usual.

The sticking point

So, um, yeah, I appear to be pregnant.

If the faint line I got on this morning's HPT is any indication, I appear to be pregnant, indeed.

I wordlessly showed it to Paul, assuming he'd know what he was seeing. He didn't. He is a manly man, our Paul, who's had no truck with pregnant women or birthin' babies.

I explained. Paul is a cautious person when it comes to getting his hopes up: "Could that still be the trigger shot?"

Theoretically, I suppose it could be. I'm only 12 days past trigger. But I think it is safe to assume that the IUI actually worked. I think it is safe to get excited, if only a little.

I am 10 days past ovulation. My period isn't due until Tuesday. Between now and then I expect to urinate gleefully on everything in the house that even vaguely resembles a stick. Note to Paul: hide the toothbrushes.

Nice kitty. Eat up.

Paul's relatives are visiting this weekend. Amid the tumult, I am getting immense enjoyment out of having a secret. Whenever the teenagers begin to bicker, for example, I tune out and run endless internal diagnostics. Uterus: busy. Fatigue: crushing. Correction: I tune out after muttering something about young whippersnappers — I forget exactly what.

I've peed on every stick in town, and that gorgeous pink line crops up every time.

I can't stop smiling. I am the cat's meow. The cat's whiskers. The cat's pajamas. In fact, I am the whole cat. The cat that swallowed the canary. And them's good eatin'.

L'esprit d'ascenseur

I went in early this morning and had blood drawn. As I was waiting for the elevator, I saw my doctor in the hall. He arranged his features into a properly sober expression and said, "Not this time, huh?"

"I think it did work," I said, getting on. "Stick was positive."

"Hey, that's gr—!" I heard him say incredulously as the doors closed.

"Hee hee hee hee hee," I said, all the way down to the parking lot.

And great it is. My hCG level at 13 days past ovulation this morning was 72, a good, strong number.

I am pregnant. How'd that happen?

You beta, you beta, you bet

I hate to admit it, because to do so would reveal that I am, y'know, human, but I'm worried about Wednesday's blood test. Last time around, the first indication we had that something was amiss was the failure of my second number to double.

I keep thinking that if we can just clear that hurdle, I'll be satisfied with whatever happens next. This is, of course, a big, big lie. But it's all I can focus on right now, so it'll have to do.

I asked A., who's visiting now, to go with me for moral support. Maybe I didn't make my needs clear; she doesn't think she'll go, as it would be difficult for her to get up that early. Hey, thanks for the help, A.! I sure hope I don't wake you as I'm leaving.

Update: I did.

Double your pleasure

Second beta number is in: 165. More than double. Hurdle cleared.

The next one we face is our first ultrasound, which won't be for another week and a half. We'll be able to ascertain whether the sac is in the right place, and not much else.

Don't distract me. I am working very hard to put it where it belongs.

Pollyanna is a fickle bitch.

On the spur of the moment, Paul and I went to the coast this weekend. It did me enormous good to get out of the house, to stop reading esoteric medical abstracts, and to focus on something other than my very busy pelvis. (Unless I am entirely mistaken, that's the sequel to The Very Hungry Caterpillar.)

As far as symptoms go, I am feeling utterly normal, aside from tender breasts and tiredness, which I've had for a couple of weeks now. I did feel intensely flushed right around 9 PM over the past few nights, but I'm assuming it's the hormones surging happily.

Things look good. So why am I intent on preparing for the worst? When I was packing my overnight bag. I considered taking the Tylenol 3 and a supply of maxi-pads, just in case I miscarried over the weekend. I realized at the last minute how morbid I was being, and gave myself a stern exasperated talking-to.

What's wrong with me? As excited as I am, I can't stop acknowledging that it could all go horribly awry any minute now. I've let myself feel joy, but I still can't seem to squelch the random surges of pessimism. I did my level best to smother them in a pile of dismembered lobster carcasses. Didn't work, but you can't blame a girl for trying.

Womb with a view

We had our first ultrasound this morning at 5w5d. We expected only to see a tiny gestational sac, as it's too early to expect to see much more. I am relieved to report that I managed to put the sac in the right place this time. (Look, we all know I can't even be trusted to remember where I've left my keys, so it's a bigger victory than you might think.)

We have an appropriately sized intrauterine gestational sac, complete with a lovely round yolk sac. The yolk sac is thickened on one edge; that's the embryonic disc, which will soon separate from the yolk sac and further develop into, well...

...into a tiny little person.

It's got a good beat. You can dance to it.

Holy fucking shit. This thing has a heartbeat.

At this morning's ultrasound we saw a gestational sac, a yolk sac, and a tiny squib with a single flickering pixel of a heartbeat. (The embryo is between the cursors in the picture.)

The doctor turned on the sound so that we could hear it, but I found the visual far more affecting. I could have watched it all day. On-off-on-off-on-off-on-off.

The doctor who'd given me the order to trigger was there, and she kindly apologized once again for the confusion that caused. Still gobsmacked by my pixel, I could do nothing but beam. This has all been hard, really hard, but at this point I don't care how I got here. It doesn't matter. I'm here.

Next thing you know I'll be thanking the Academy, my agent, and Jesus Christ above. Stop me before I start looking like a dork.

Oh. Wait.

Start spreading the news

Paul and I had a number of long and thoughtful discussions about whether to tell anyone about this pregnancy before the traditional twelve-week mark. (Paul: "Do you think we should maybe wait...?" Julie: "NO." End of conversation.) The incidence of miscarriage drops significantly after seeing a heartbeat on ultrasound — down to between 5 and 10%, depending on which sources you believe. It's still no guarantee. But since I only got about five minutes' worth of happiness out of my first pregnancy, I am determined to milk this one for all the pleasure it's worth.

We decided to tell my parents. My dad's birthday is coming up. Since we happen to be visiting them, along with some other gifts we gave him a printout of our latest ultrasound picture. He and my mom were visibly pleased. The rest of the weekend we talked about my pregnancy, how huge I'll be when they see me at Christmas, how I'd better have more dinner since I'm eating for two. ("Actually, Dad, I'm so hungry it feels like I'm eating for five.")

I know we're not out of the woods yet, but it doesn't seem like a bad idea to tell a select few. My rule of thumb: I only want to tell those whose support I'd want in the event of miscarriage. And I think I can count on my mother, who had four losses of her own. ("Wow, I never knew." "Sure. Why do you think your brother was born so long after you were?" "Um, well, I guess I always thought maybe you'd lost your mind entirely.")

I guess we spoke too soon.

This morning's ultrasound was grim.

The doctor who did the scan inserted the wand, looked around for a moment, and said, "What is she, about six weeks?"

As soon as she said that, I knew the news wasn't good. I'm 7w5d today.

The rather dippy doctor who was assisting shocked me by turning on the sound so we could hear the heartbeat. "I love hearing that," she said brightly. Note to doctor: I could tell the news was bad just by looking at the screen — so don't get my hopes up by making me listen.

Although the embryo is more or less appropriately sized, and although we have a strong heartbeat of 140 beats per minute, the gestational sac is far smaller than it should be, measuring at about 5w2d.

My usual doctor came in and looked at the scan with us for a few minutes. Then I got dressed and we waited for the bad news. It is easier to discuss such things while wearing pants.

"We both know that's not what we wanted to see today," he began. He said that although he'd seen cases where a small sac resolved itself successfully, he said it could also mean an impending loss. Though he said he's seen a worse case than mine turn out all right, he was not especially encouraging.

When the sac isn't large enough, the embryo doesn't have enough room to develop properly. The embryo gets compressed. Depending on whose statistics you believe, between 80 and 96% of pregnancies with such discrepancies between sac and embryo will fail.

Someone has to be in that 4-20% of successes, and I've been on the surprising side of the odds many times. But I have a feeling that this time I'm going to be in the unhappy majority.

The only thing to do, of course, is to wait. My doctor said he'd be happy to do additional scans as frequently as I liked; his recommendation was that I return two weeks from now. I didn't ask whether I was likely to miscarry before then, but I'm assuming that if it's going to happen, it'll probably happen before then.

Don't bet the farm

I talked to my doctor on the phone today. After Monday's ultrasound, I was too stunned to ask any questions, so I was glad for the opportunity to get some answers.

Sure wish he'd had some.

His predictions weren't as grim as my reading had led me to believe — he said he'd guess our chances were in the neighborhood of 50/50. "If I had to put money on it," he said, "I'd guess it'd turn out okay."

But I'm pretty sure he's not exactly packing his bags for Vegas. What I don't know is whether he's talking entirely out of his ass, or whether he's basing his opinion on specific aspects of my case and his own experience. He and his staff have always tried to give me the best possible care, but I'm not convinced this is within his field of expertise. I am not especially reassured.

I asked what causes early oligohydramnios. Unknown.

I asked whether I should be concerned about it in future pregnancies. Unknown.

I asked when we could expect a resolution. If I'm to miscarry, will it be sooner or later? If I'm not, when will we be able to breathe easily? He couldn't offer any idea about how swiftly I might miscarry. His opinion was that if I make it to 12 weeks, he'd feel comfortable (with some hemming and hawing) releasing me to a regular OB/GYN. But he also said he'd recommend various kinds of prenatal testing, which we otherwise wouldn't have considered based on my age.

He tried to be encouraging about our future prospects. "We did get you pregnant both times..." he said, in reference to this cycle and the previous one. (I waspishly reminded him of our numerous prior unsuccessful IUIs. I am not particularly receptive right now to encouragement.) From a clinical standpoint, I suppose it is good news that I can get pregnant, but that information is of little comfort in the absence of a live birth.

Running the diagnostics

I can't really say whether I'm feeling any different, because I'm paying attention to my body in an entirely new way now. Before Monday, I'd been experiencing the occasional cramp, thinking casually, "Oh. That's normal." Now, I feel my stomach knotting with every twinge, wondering if this is how it'll begin.

My breasts are still quite tender, more so, I think, than earlier in the week. I'm as tired, if not more so, but it's hard to tie that to anything concrete — it could well be my response to stress. Finally, over the last several days I'd been experiencing quite a lot of dampness, but today it seems to have vanished.

All of these things could be normal, or could be ominous. I don't know what, if anything, is changing.

No blood as yet. The embryo could have stopped developing at any time without causing bleeding, of course, but without blood at least I feel there could be a chance.

An infinitesimal one, to be sure.

Heart: beaten

No heartbeat.

As soon as the doctor inserted the wand and located the sac onscreen, I knew we'd lost this one. I wasn't looking for a heartbeat, so that's not what I noticed. What I noticed was the lack of room inside the gestational sac — it was even more crowded than it was a week ago. There just wasn't enough room for the embryo to grow.

The doctor searched for the heartbeat for a few minutes. She brought in a colleague to confirm her findings. No heartbeat.

I surprised myself by my response, or lack thereof. When I'd imagined this happening (and I had, playing it over and over in my head as if I could rehearse my way into acceptance), I'd wondered whether I would gasp, or cry, or squeeze Paul's hand until I broke his fingers. No: I lay on the table feeling enormously detached, as though I were a disinterested onlooker just watching this all happen.

I didn't cry at all. The most emotional I got was when I felt a crazy urge to complain: "You didn't give us a picture this time!"

I got dressed and the doctor took us into the consultation room. I've always liked this doctor before; she's the head of the department and inspires great confidence with her friendly manner. This time she was all business — still kind, but absolutely grave as she outlined our options. I'd heard this before, but I let her explain.

A natural miscarriage could happen that day, she said, or it could take up to a month — there was simply no way to predict. This wasn't an option for me. The thought of going about my business as normal and waiting to expel the pregnancy that was already over...no.

I could take misoprostol again. This option at least had the virtue of predictability, but I would still have to endure the ordeal of cramping, bleeding, and passing massive amounts of tissue. I was too scared to do that. Waiting for the ectopic to resolve last time frightened me enough that I wasn't going to volunteer to sit at home and bleed.

If I chose a D&C, it would be more involved than the one I had before; since I'd had no Cytotec to dilate my cervix, I'd have to go to the hospital for the procedure and undergo some kind of major anaesthetic. I asked how long I'd have to wait for a D&C to be scheduled. The doctor said I didn't have to choose immediately, but I could get it done the same day once I'd decided.

Well, that was that, as far as Paul and I were concerned. We asked to be scheduled that day.

I think we surprised the doctor, who seemed more used to counseling people who'd been surprised by such sad news. For better or worse, we'd expected it, and had already spent some time talking about our options. The sooner my body could begin to heal, the sooner my heart could. Theoretically.

The wait of the world

Once we'd learned the embryo no longer had a heartbeat, we asked for an immediate appointment for a D&C. The nurse who was making the arrangements consulted her schedule, then pointed out that my usual doctor happened to be in the OR that day, so he'd be the one to do the operation. I thanked her for her help, and resisted the urge to say, "I don't care who does it — just get it out of me."

I guess I was feeling a lot less detached than I'd felt in the exam room.

In order to have it performed that day, I'd have to be an "add-on": they'd see me in the OR after the rest of the day's scheduled cases had been completed. They couldn't say when, but would call when they were ready for me.

It was a long wait. A long, hopeless, foodless, drinkless wait.

It didn't make sense to drive home, so Paul and I wandered aimlessly downtown. We walked down by the lake for a while, watching the ducks and trying to process what lay ahead. We went to the bookstore to buy a distraction or two, where I couldn't help mocking the nice young man who earnestly wished us a nice day. We sat in a Starbucks for hours, having nabbed two comfortable armchairs. Paul drank chai and read while I cadged the occasional ice cube and cried discreetly. (In case you ever need this information, Starbucks' unbleached napkins are hard on a delicate nostril.)

Our chairs looked through a large plate glass window onto a busy pedestrian mall. Most of the busy pedestrians in question had babies, strollers, toddlers, preschoolers, or some combination thereof. Many of them, it seemed, were visibly pregnant. They all looked entirely carefree, seen through my personal bloodshot lens. I tried not to stare. I also tried not to be noticed as I cried. Hard to avoid when everyone in the coffee shop is trying to glare you out of the comfy chair you've been monopolizing for two hours.

It all made for a monumentally wretched day — the wait, the lack of privacy, the sadness I felt I couldn't politely show. And the worst was yet to come. As I told the nice young man at the bookstore, "Why, this day just keeps getting better and better!"

Completion

When the hospital called around 4 o'clock, we headed over. As soon as I got off the elevator on the surgical floor, I panicked. My heart started pounding and I realized I was sweating. No, no, no, I thought, I shouldn't be here. It's not too late to go home. It's not too late to get out of this.

I don't know what I'd expected, but when I saw the alcove where I was supposed to undress and wait, everything in me rebelled. This was a hospital, where people have operations. Surgery. Major medical interventions. This couldn't be right. I shouldn't be here.

Oh.

Wait.

I kept feeling this rising tide of panic, which I tried to beat back by reminding myself that nothing I could do would save the pregnancy, which was already over.

As Paul parked the car, I got settled in my alcove, changing into a gown and slipper-socks, getting my blood drawn, and generally trying to stave off a system-wide freakout. Every doctor and nurse who stopped by had a kind word, making me cry all over again each time. Every gentle pat on the knee. It's the kindness that gets me — as long as everyone is matter-of-fact I can hold myself together.

My usual doctor stopped by and asked if it was okay if someone else did the operation — he'd been in the OR since early that morning. "I don't care if the parking lot attendant does it," I answered, "as long as it gets done," and managed a bleat that passed for laughter.

Now a brief digression while I ponder this question: Why do I need to entertain my doctors? And why am I so intent on seeming impervious to every dreadful thing that's happened? And how scarily robotic does that make me seem? Truth be known, one of the main reasons I trust my usual doctor is that he seems only occasionally nonplussed by my primary personal coping mechanism: breathtakingly inappropriate humor.

We had a short discussion about the current score. One ectopic, one miscarriage. I'm 0 for 2! Maybe next time we can go for the hat trick. We talked briefly about the possibility of doing another IUI with injectibles rather than a full-blown IVF, but agreed to come back to that in a couple of weeks. I wasn't entirely equipped to be making major decisions just at that moment.

Then the anaesthesiologist came in. After a cursory inspection, I was relieved to conclude that he didn't look like a junkie. We had an awkward moment when he asked me if I was here for "completion." I didn't know what he meant. "Are you pregnant?" he asked. And I didn't know what to answer. Yes, there's an embryo inside of me. No, it's not alive. Completion. Indeed.

Finally, around 7 PM, I was wheeled into the operating room. An oxygen mask was fitted over my nose and mouth. The anaesthetic was introduced into my IV. Next thing I knew, I was awake, unspeakably groggy, smelling smoke.

Burned toast. The nurses give toast to patients emerging from the anaesthetic, a kind and merciful act considering that I hadn't eaten all day. When I felt well enough, I ate some toast (buttered, white, delicious) and drank a little water. Correction: Since they wouldn't let me leave until I'd proven I could urinate normally, I drank a lot of water.

At one point the nurse asked me if I was in any pain. "A bit of cramping," I answered, expecting to be given a couple of punk-ass Tylenols. To my surprise, I got a scrumptious hit of morphine right to the IV. I was shocked by how quickly it took effect; within five seconds I was feeling just fine, thank you. So I didn't win the jackpot — at least there was a nice little consolation prize.

Once I'd made it to the bathroom and demonstrated my urinary prowess, we were cleared to go home. I dressed, keeping on the funky disposable underpants I'd been diapered in while still unconscious, and Paul drove us back home. Two Tylenol with codeine, for forgetfulness, and I was out like a light.

Foul discharge

The last week has been grim.

After the D&C Monday night, I slept hard with an assist from my faithful henchpill, Tylenol with codeine. I took it easy the next day, hunkering down in a soft nightgown with a couple of shockingly crappy novels. I was bleeding, but not in any alarming amount, and while I felt sore all over it didn't seem unwarranted.

On Wednesday and Thursday I couldn't seem to do anything. Even unloading the dishwasher was a chore too daunting to face. I moped around the house looking tragic while Paul quietly and efficiently kept us fed and clothed.

Friday I started hurting. It felt like a bad period of mine: the bloating, the intestinal mutiny, the widespread abdominal inflammation that made me curl up in bed like a comma. And, hey, throw in some unusually persistent lower back pain just for kicks. Paul pestered me so skillfully that I finally phoned the doctor on call, who basically told me to suck it up, take more drugs, and ignore it unless I had a fever or "foul discharge." Neither of the above, so I simply continued my systematic abuse of narcotics.

I felt physically lousy, but emotionally I thought I was holding my own. Emotionally, I'd pretty much been okay — surprisingly, suspiciously okay. That came to a screeching halt on Sunday. I don't know if it was the chronic discomfort that finally wore me down or the hormone crash I'd been expecting, but since then I've been in an implacably evil mood. In fact, it's fair to say that pretty much every word that's come out of my mouth has been angry, sharp, and bitter.

I'm not a nice person to live with right now. Mostly I've managed to spare Paul the worst of my vitriol, mostly, though there was an unpleasant and uncharacteristic contretemps today over a missing tortilla. Although I try not to take it out on Paul, who's been nothing but kind, patient, and helpful, I'm furious at the world and the anger just keeps oozing out, a foul discharge in its own right.

Do you ever feel...you know, not so fresh?

Progress! My period began today, 35 days after my D&C. It hurts. A lot.

I'm holding steady somewhere around 7, I'd say. But I don't think the faces above accurately reflect my true feelings. Add pimples, fangs, and some of those slanty evil eyebrows, and at least we'd be in the ballpark.

I can't tell if it's worse than a normal period, as I'm told post-miscarriage cycles often are, or if it's just the absence of ibuprofen that's making it seem that way. Either way, the result is the same: I am an evil-tempered, foul-mouthed booby trap of a girl just waiting to explode all over some poor hapless passerby.

I hope Paul's up on his guerrilla tactics.

Even though I'm supposed to wait until the Sunday after my period begins, I started the pill today. I decided, with my extensive body of medical knowledge, that one day surely couldn't make much of a difference. (No, and don't call me Shirley or I'll tear your goddamn throat out.)

I just couldn't stand the thought of being put off by yet another week. I could tell Paul was debating whether to object — he made the wise decision not to, and may live to fight another day. But I make no promises.

Wish list

Day two of Lupron and already I'm bored to tears. I just can't get excited about this cycle.

I can't really decide what the worst possible outcome would be. For my first cycle, I was sure the worst-case scenario would be a negative. For the second, my greatest fear was an ectopic. Now, who knows? Repeat cancellation? Repeat ectopic? Repeat miscarriage? A negative? I don't know what exactly to fear...so I fear everything.

Seems like a good way to make sure all my bases are covered.

I also don't know what to hope for. My first cycle, I hoped for a positive. My second cycle, I hoped for a definitive positive with a doubling beta and a vigorous heartbeat. And we saw how those turned out.

Maybe I wasn't specific enough. Maybe I should be hoping for a definitive positive, an exuberantly doubling beta, a strong and unflagging heartbeat, an absolutely uneventful but joy-filled pregnancy, a quick and drug-cushioned labor, a textbook birth, a sweet safe babyhood, a fun-filled childhood, a happy and productive adulthood — all followed by a peaceful old-age death in his or her sleep, long after my own.

And I should probably point out what I don't want, just so we're clear: a flair for biting, grade school gunplay, a stint in juvie, or unregenerate Republicanism. (That last is important.)

Is it really too much to ask?

Lupron achiever

I am only on day four of Lupron but I've been very productive. Here's what I've done so far:

• reduced my poor husband to tears
• caused several highway accidents
• cut myself shaving
• destabilized the yen on the world market

Tomorrow, if I can find the time between vandalizing the old folks' home and frightening the kids on the handicapped bus, I may very well annex the Sudetenland.

Day 5: Swear to God I'm fine.

I must be truly jaded — it's day 5 of stims and I'm still quite sane, quite sane. I'm not obsessive polling my ovaries to see what's going on. I'm not checking my underpants for interesting mucus. I'm not pulling up my shirt every hour to see if the welts have faded.

Really, I gotta tell you, I'm fine.

Operationally speaking, the Bravelle is no different from Follistim. It may sting a bit less, but because I am so very, very mighty, that was never a big issue for me. And in general, this cycle is a lot less fraught than the last one. Last time the injections were psychologically difficult for me. This time, I don't even worry about picking a good spot. While I still try to be careful about sucking every last drop of medication into the syringe, I'm remarkably cavalier about actually delivering it. Without standing on ceremony, I simply grab whatever fold happens to be convenient and stab with authority.

In general, I've gotten sloppy. I don't keep track of my weight in hopes of staving off OHSS — just doesn't seem likely, given my past performance. I don't give my injections at exactly the same time each day. I don't even use the alcohol swabs that came with the needles — the Lupron bottle gets a cursory swipe every now and again if I'm feeling fancy, but that's it. Sure, I suppose I could get an infection, but I'm thinking gangrene would be a goddamn cakewalk after all this.

I do the shots and I move on. I do care about the outcome, but somehow I don't much care about the process this time around. I am determined to believe this is progress.

Day 6: All systems go

Went in this morning to have my follicles measured, and — whaddya know? — I have some. Four on the left, three on the right, to be precise. This is a big relief to me, as I'd feared my right ovary would stubbornly refuse to come to the party. (I can see why — the rest of me is none too eager to attend, either.)

The exam was done by the same doctor who did my final ultrasound on pregnancy #2, and who did the D&C on same. I wanted to thank her for her kindness throughout that whole nightmare, but couldn't bring myself to speak about it. Don't know if I thought I'd somehow tempt fate, or if I simply thought I couldn't do so without dissolving into an embarrasing blob of jean-clad jelly.