There’s no easy path to IVF, because nothing about coming to that decision feels good. Before couples choose IVF, they have had their hearts broken, maybe irretrievably. They’ve been on the receiving end of crushing news, perhaps more than once, perhaps many times. And they’ve resigned themselves to the fact that their family makeup had been decided for them, but for this one last Hail Mary.
That’s the boat we were in the day of our first appointment with our new reproductive endocrinologist. We were there to check a box, to say we did all we could, but we were not naïve to what seemed to be our fate and I questioned whether I had it in me to check this box, whether it was wise to even try. Over the previous two years, and the weeks leading up to this appointment specifically, I spent a lot of time feeling sorry for myself, letting myself be taken in by the defeat of being a fertility patient. On good days, I managed to practice gratitude for the miracle of life already running roughshod over me with his toddler tantrums, the kind of tantrums that make a person second-guess second kids. On bad days, I beat myself up for waiting so late to start a family, for not being grateful enough for the family I already had, for wasting time in my 20s in a harmless but dead-end marriage, for failing to listen to my old OB back home who warned me the chances of conceiving in my 30s dwindle with each passing birthday. That same OB also seriously counseled me to just quickly procreate before I signed divorce papers, so I really can’t be blamed for wholesale dismissing her advice as hot garbage, but I should have listened to the age thing. I should have known this is where we would end up. I should have done more, been better, decided differently. It was a punishing shame spiral, punctuated by due dates that came and went for babies that never happened.
Sitting in a brightly lit office waiting to meet our new doctor, I was anxious and uncomfortable remembering the last time I visited a fertility specialist. He had come highly recommended by the patients who were successful in growing their families with his help. But not every family is successful, and those of us who had no guarantees we would come out of this struggle intact need a soft touch. His touch was…straightforward. From the outset, our experience with our new doctor was different. She didn’t always have great news, but she had a way of delivering that news with warmth and tenderness, as if she had a deep understanding of how brokenhearted her patients might be by the time she was sitting across the desk from them. She believed in science and numbers and she pulled no punches about the data, but she also used them to paint a picture that put a spotlight on numbers that were in our favor, instead of the other way around as I was prone to doing. Her delivery of bad news was comforting, and it made me less reluctant about coming back for more.
First, she advocated taking some time to grieve and heal, and if it happened the old-fashioned way in that time, she promised to shepherd us through the early weeks with the kind of advanced care a frequent miscarrier might find reassuring. She suggested we do this for six months, and because of the portrait she painted – in some cases actual hand drawings, which I wish I’d saved – we had come to understand her advice was born of her not yet being convinced we were the best candidates for IVF. She thought my test results were only borderline concerning, and she believed our two miscarriages could have just been extremely bad luck. Anomalies, she said. Isn’t that a nice way of reframing two years’ worth of near-constant devastation? “I know it feels bad, but that badness doesn’t bear itself out in the data. The data are divided.” She drew a line down the middle of a blank page to illustrate her clarity.
We took her advice. We were gunshy about getting knocked up the old-fashioned way, but we otherwise followed doctor’s orders and took time to heal without thinking too much about what was behind us, or what might be in front of us. We just lived. There’s almost no way to describe the euphoria of living life without the stress of trying to conceive. It is so freeing. I could hear birds again and see colors and smell beauty. I laughed when Moses laughed. I was reminded what it felt like to be loved by Randy without an agenda.
We did not conceive.
Next, she suggested IUI, or intrauterine insemination. It’s basically a precisely timed, doctor-assisted old-fashioned way. I didn’t love this approach, and I wasn’t sure she loved it for us either. It was expensive, and it did nothing to alleviate my anxiety about poor-quality eggs turning into a poor-quality pregnancy. But under the heading of exhausting all options, we gave the doctor-assisted old-fashioned way the old college try. We did that twice, and we did not conceive.
By the end of 2017, a Hail Mary was all that was left. If you had asked me in the spring of 2016 whether I would ever consider IVF for our next pregnancy, my answer would have been a flat no. I don’t want it that bad I might have said, because as some of you may recall, I was an asshole. But two years, two miscarriages, a phantom cancer pregnancy, major surgery and two IUIs later, I realized maybe I did want it that bad. We began IVF in January of 2018. It was a new year and a brand new day.
IVF is work. Plus, the stakes are high and the dollars are many. It requires a complicated, flawless combination of organization and endurance, and a better than basic understanding of both anatomy and chemistry. I’m a writer. Left to my own devices with a chemistry set, I would probably blow up the house. So on the first of many days I would be trying not to blow up the house, I sat at my kitchen table with a pharmacy’s worth of drugs and needles and sharps containers laid out in front of me, my hands shaking and my heart beating in my throat.
Retrieval protocol: Take two powder vials of HMG (Menopur) in the morning and 300 IUs of FSH (Follistim) in the evening. Your morning medication should be about 12 hours apart from your evening medication. You will mix the vials with the total volume of 1 ml liquid. You will also start Saizen medication. Reconstitute Saizen vial with 1 ml of diluent. Inject subcutaneously 0.50 ml of Saizen starting on medication cycle Day 1 of stimulation and continue every other day. You will continue Saizen every other day until notified to stop.
IVF medication has to be mixed immediately before use and then administered at exact times, multiple times a day, for days or weeks or months on end, so it’s impractical to have a professional do the work in the clinic every time. But the professionals had trained me for this. They showed both Randy and me exactly how to clean and disinfect the injection site and the vial of medication. They showed me how to push air into the vial so the saline solution and the medication would draw into the syringe in a way that would prevent the force of built-up pressure inadvertently spraying $150 all over the room. Even as I write these words, I’m still a little unclear about the science of that trick, so it should come as no surprise that on the morning of my very first self-administered injection, I sprayed $150 all over the room.
There was too much pressure. In the vial of medication and in my chest.
I laid down on the floor, letting its winter coolness calm my hot nerves. I stared at the ceiling and took deep breaths. This is the position I often find myself in when I need a break. Just me, my body and my breath, stretched out on the floor somewhere, trying to understand what people were thinking when they carved that pattern into the plaster over our heads. Sometimes even just picturing myself on the floor, judging the ceiling, helps.
When the pressure in my chest subsided, I got up, wiped one hundred and fifty American dollars off the walls and tried again. I did it right that time and every time after that, because I wanted it that bad.
IVF is performed in two phases: egg retrieval and embryo transfer. Egg retrieval is a relatively straightforward process of using medication to suppress ovulation so all potential eggs are the same size and age at the starting line; then using medication again to hyper-stimulate ovulation so a few dozen eggs show up to the party; then, at a time that is planned down to the minute, surgically removing those 20 or 30 eggs from both ovaries before they can be released spontaneously, in the hopes that some of them will be of good enough quality that they can be fertilized into pregnancy-friendly embryos. Easy.
We retrieved 11 eggs. Three of them disintegrated before they even made it to the lab. Another four were determined to be of such poor quality they were unable to be used. The remaining four eggs were successfully fertilized into four embryos. This felt like good news. But one embryo was lost in the lab, due to medical error or more bad luck; one was graded abnormal; and one was what’s known as a mosaic, which means it had both normal and abnormal cells, so the quality of the embryo could not be determined to be either good or bad and therefore did not meet our clinic’s standards for transfer. And with that, we had just one embryo left.
Our Hail Mary.
I took the day off work for our embryo transfer, which is one part surgery, one part suddenly being pregnant if the stars align and the embryo attaches itself to its new home. Preparing a body for embryo transfer is similar to other medical procedures in that I was given a low dose of Valium before my office visit and was required to have someone drive me to and from the appointment and whatever happened would alter the course of my life. It was unlike other medical procedures in that instead of fasting before my appointment, I was given strict instructions to fill my bladder, all the way to the top, and when you think you can’t fill it any more, fill it more, and then hold it. Is that good? No, fill it more. More? Yes, more. A full bladder changes the position of the uterus, creating a straight line for the catheter to follow. It’s a simple thing that has a dramatic impact on success rates, and it was hands down the most uncomfortable part of the whole experience, and that’s including the daily intramuscular injections with a needle the size of my leg bone for the better part of the next three months, which was a giant pain in the ass, and I mean that as literally as possible.
My reproductive acupuncturist met us at the clinic and put her magic needles to work while I squirmed on the table. To this day, I still don’t know if I believe acupuncture works, but neither can I be sure it doesn’t. My doctor the data nerd neither confirmed nor denied her belief in it either, but she encouraged me to do whatever it took to relax my body and my mind, and she went out of her way to provide us a procedure room for a pre-transfer treatment, so maybe we’re all a little bit woo woo when it counts. And if the goal was relaxation, it worked. My full bladder and I melted into the table and waited.
By the time our doctor joined us in the procedure room, I was feeling pretty optimistic. We’d been through a lot. We’d come a long way. We had fully committed to giving our family this one last shot, and I felt good about it. I felt good about our chances, despite having no real reason to have high hopes, but I also just felt really good that after all we’d been through, Randy and I were still so strong. We had clawed our way back from the brink of that very dark place in the early days of our infertility and come out the other side more united than we’d been at any time in the previous two years, maybe more united than at any other time in our relationship. I was thrilled with our team, our partnership, and I got very sappy-weepy about it. So anyway, the Valium also worked.
After the procedure, we went home. It was a Thursday and Moses was in preschool, so Randy and I curled up on the couch together and binge-watched Game of Thrones. For the next two weeks until the first of many tests that would determine our future, we clung to hope that it had worked, fully immersing ourselves in the possibilities, the love, the caffeine withdrawals.
I just realized I totally lied when I said a full bladder was the most uncomfortable part of this experience. It wasn’t. Caffeine withdrawal was. I drank my weight in both coffee and wine until the day before our transfer, and then I quit both cold turkey, and let me tell you, do not do that. Do. Not. Do. That.
I don’t remember going to the lab for the blood test that would give us an early indication of whether the embryo attached, but I do remember the phone call later that day from the nurse who had been managing our case since the beginning. She was there when we learned about the phantom cancer pregnancy and had to refer me for surgery; she was there when I sprayed $150 all over the room and had to talk me off the ledge when I thought I couldn’t do this anymore; and now, she was there on the other end of the line reading the lab results that would change our lives, which she clearly wouldn’t have believed if she hadn’t been looking at them with her own eyes.
“Your beta hCG numbers are through the roof. Oh my goodness, Julie! You’re actually pregnant!”
Hail Mary, full of grace – blessed is the fruit of thy womb.