No sex, please. We're infertile.
So when you're trying to have a baby you have sex all the time, right? It may be joyless, mechanical, and obligatory, but at least it's frequent, right?
I haven't had sex in two months.
The last time was a few days before egg retrieval. My abdomen felt swollen and fragile and I wasn't especially interested at first, but somehow it seemed like the thing to do. And it actually was; it was gentle, friendly, and sweet, a good way to be nice to my body when I wasn't treating it particularly kindly otherwise.
After transfer, I was instructed to observe pelvic rest (no penetration, no orgasm) until after the pregnancy test. Foolishly, we didn't seize the opportunity immediately once we had a positive. And only a couple of days later we learned that the pregnancy wasn't viable — a situation not exactly conducive to moonlight and roses.
So then I was going to miscarry. And then I didn't. And then there was the ectopic. And now I'm benched again until my hCG bottoms out.
The funny thing is, I don't miss the reality of it. My poor battered pelvis has been through enough. I don't even want to do it by myself — I know, I was surprised, too. I've had not a single stirring of desire in the last several weeks. I miss the idea of it, but my interest at this point is only vague and theoretical.
Which is a crying damn shame. It all used to work so well.
Three's a crowd
Got word today that yet another friend — the third — is expecting a baby in mid-November.
No wonder none of my friends were available to commiserate as I went through IVF #1. They were all busy conceiving children of their own!
A little knowledge is a dangerous thing
It hit me hard this week: I'm back at square one, no closer to having kids than I was before.
Even a garden-variety miscarriage might have brought some weird solace; for a few days I was able to console myself by chanting, "At least you know you can get pregnant. At least you know you can get pregnant."
Well, I don't really know that, do I?
(At the moment I refuse to seethe about the righteous indignation some infertile women can summon. "I've never even had a positive! At least you know you can get pregnant!" "Yes, and I also know how devastating it is to lose it I hope you never learn." Wait. I guess I don't refuse after all.)
From our first cycle, I know I can make eggs, though not as many as those loathesome perfect cyclers who bubble up dozens without turning a hair. I know we made a pretty embryo.
But I also know that we only made the one, possibly due to a male factor that our several semen analyses didn't detect. And I know that the single pretty embryo we did make lodged itself firmly in my Fallopian tube, revealing the greater possibility of another ectopic in the future and the possibility of tubal damage. And as a special bonus, I learned that there's an implacable endometrioma perched on my ovary, taking up space and suppressing egg production, possibly requiring a laparoscopy before our next cycle.
I knew if our first cycle was unsuccessful, at least we'd learn from it. I didn't expect to be so goddamned discouraged by that knowledge. What we learned is that there are numerous plausible reasons for our infertility, instead of the single simple explanation I'd hoped to discover — in short, we're more mysteriously fucked than we thought.
I don't want to dwell on last cycle — if I must, I'd rather be reflecting on our new knowledge as a tool to improve our future chances. I intend to have achieved this remarkable feat by the time I have my next consultation, when we'll plan our next onslaught.
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:
- 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.
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.
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.
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.
After the embryo attains a CRL of 5 mm, the probability of subsequent loss falls to 7.2%. The loss rate drops rapidly thereafter to 3.3% for embryos with a CRL of 6 mm to 10 mm and to 0.5% for embryos with a CRL of 10 mm or more (i.e., 5 weeks postovulation or 7 weeks after the last menstrual period). That 3.3%? That's us.
Only 1.9% of pregnancies have small gestational sacs in relation to crown-rump length.
According to that same study, 80% of pregnancies fail when the difference between MSD (mean sac diameter) and crown-rump length (CRL) is less than 5 mm.
Another study with a smaller sample, however, found a more ominous failure rate: 94%.
Pregnant women have a lot of magical talismans they like to invoke against the potential for loss. One of them is the mythical 5% "Once you've seen the heartbeat, your chances for miscarriage drop to 5%." There are a lot of things wrong with that statement, primarily the assumption that any statistic pertains to any individual. I am most painfully aware that even if you assume that magic number is accurate, somebody still has to be in that 5%.