I liked the new fertility doctor right away. We sat down in his office and he smiled at us across his desk and I immediately thought, “Oh, thank God.” He had a kind face, and when he listened, I could tell that he wasn’t thinking of anything else — not his kitchen remodel, not another patient, not the box score for his favorite sports team. He was totally focused on our case.
He didn’t demoralize us with statistics, but he was honest about what we needed to do next.
“You’ve had three IUIs,” he said, looking at our chart. “Is that right?”
“Yes, plus the one that was cancelled for overstimulation.”
He looked up from the file. “You know what’s next,” he said.
He nodded. It wasn’t news. We already knew that would be the recommendation. I’m 41, and we’d had three failed cycles. IVF was the last-ditch, and an expensive one: $20,000 per cycle at our last clinic, and probably not much cheaper anywhere in the greater New York area.
The next step was a physical exam, and things immediately got interesting.
“The opening of your cervix is TINY,” he said. “TINY, TINY, like a pinhole.”
“Do you think…?”
“YES,” he said, and then very professionally did not say what I could see him thinking, which was, What the @#$% was the matter with your last doctor?
It’s possible that I’m projecting.
Anyway, it turned out that the reason my hormone panels were mostly fine and I wasn’t getting pregnant wasn’t because the assays were wrong, like one of our doctors suggested, or that my egg quality was bad despite the very decent egg quantity. It was because my cervix was essentially closed, almost like a natural diaphragm, and it was very unlikely that any swimmers could get through.
Unlikely, but not impossible.
“Hmm,” he said, looking at the ultrasound. “This lining is very thick.”
“Oh, that’s good, right?”
“Yes.” He frowned at the screen for a second. “In fact, if you don’t get your period next week, I want you to come in for a blood test. It wouldn’t totally surprise me if you were already pregnant.”
That’s bananas, I thought. And at the same time, I also thought, I am definitely, totally pregnant. I’m the most pregnant. I’m getting an A in pregnancy.
That was around 12 weeks ago. And now I sit here, wearing maternity jeans as I write this to you, at the beginning of the second trimester.
If I had a nickel for every stupid fight I’ve gotten into on Facebook, I’d have at least one very grimy dollar. And I’m a non-confrontational person. Generally my feeling about personal disagreements in real life is, “Meh, I’m tired.” When a fight breaks out on Facebook, however, I’m all:
This is clearly a sign of insanity. And yet there’s something about Facebook that brings out the worst in me and just about everyone I know. I’ve had fights with people on Facebook in which we’re both on the same side of the argument, and yet still become mortal enemies by the end of the thread. Sort of like this:
Me: I want to like oranges, but the white stringy parts creep me out.
Beloved Friend of Over 20 Years: I agree! Oranges are the worst!
Me: Well, I mean, the orange part is good. I could just do without the surprise flossing.
Friend: Right? Oranges are gross.
Me: WHY DO YOU NEVER LISTEN TO ME? I BET YOU VOTED FOR DONALD TRUMP.
Again, in real life, I would never behave this way. But all forums and social networks make it easier to hide behind a wall of code. It’s not even necessarily Facebook’s fault, except that I suspect they tweak the algorithm to make sure we see stuff that will enrage us, so that we’ll interact more with the site. But probably any social site that I visited every day would turn into the same thing.
Except Instagram, which is apparently full of ladies’ butts. At least, that’s what I’m getting from my followers’ list.
The last birthday I skipped was when I turned 6. I was in the hospital, having my second surgery for a ruptured appendix, and the nurses asked me if I wanted to wear a badge that said, “Birthday Girl.”
“Today’s not my birthday,” I said.
“It is!” they said. “You’re turning 6!”
“It’s not my birthday, because I’m in the hospital.” My birthday obviously couldn’t be in the hospital. My birthday was at home, where things didn’t smell like disinfectant and things that needed disinfecting.
That’s how I feel this year. It’s not my birthday, because I’m about to turn 41 years old, and I’m not a mother. We spent the better part of two years and thousands of dollars to try to become parents, and it hasn’t worked. Three years from now, even the Commonwealth of Massachusetts (pinko land of my birth) will acknowledge that I’m too old to keep trying.
I’ve been thinking of giving up. People who haven’t gone through fertility treatment might see that “I” and wonder where my husband is in all this. He’s resigned, mostly, but supportive of whatever I decide. Which also unfortunately means that I have to decide something.
I’d be crazy not to think about quitting, at this point. But I can’t quite pull the trigger. I’ve been doing acupuncture lately, hoping to get my kidney yin in order (apparently). People tell me they’ve had miracles through acupuncture, but it’s hard not to feel like a fool while I lie there on my lounge chair, crying quietly so I don’t disturb the other clients.
I think I always knew I wouldn’t be able to have a baby. When I think about being pregnant, it feels like an impossibility, as if I were a man or already post-menopausal. I can’t really picture it happening. But then, I can’t really picture a headache going away when I take an ibuprofen, so it’s possible that I’m not super strong on cause and effect.
The worst part of all of this is that I know it will never really go away. My shrink told me that this kind of grief is like losing a person you loved very much. At first, you think you’ll never laugh again. About two weeks later, you laugh about something stupid and feel guilty about it. In short, you get used to it.
On a long enough timeline, I know I’ll get acclimated to the grief. I’ll be able to carry it around so that other people never even notice. But it will always be with me.
For now, I’m still here, waiting, figuring out if I’m still trying or if it’s time to move on. If I’m still trying, 41 is a hard age. If I’m not trying, I have to figure out what to do with the portion of the next 20 to 40 years I was going to spend parenting. Frankly, it’s kind of exhausting.
If you want to make a med student disappear, especially a male one, try the following:
Stand in the center of an exam room, fully clothed, having put your pants back on after a half hour of pants-free waiting. Clutch fists loosely at sides as if prepared to make a run for it.
Wait until female doctor and male med student appear at door. The doctor will no doubt look confused about why you’re clothed. Face her with a crazy look in your eye.
Shout, “I am a sexual assault survivor and I am not spending even one more minute waiting on that table with no pants on. I HAVE BEEN WAITING IN THIS ROOM WITH NO PANTS ON FOR HALF AN HOUR.”
Observe as the male med student spins on his heel like a pop-up duck at a carnival shooting gallery and leaves the room, and possibly the building, county, and state.
Wait for the Ativan prescription that will soon be yours.
To be fair, the Ativan prescription doesn’t come from yelling. I don’t want to mislead you. It comes from the sobbing that you’ll do when the female doctor, now on her own after the male med student left the room to go Google alternative careers, tells you that the transabdominal ultrasound isn’t providing a clear enough image, and that she’s going to have to do a transvaginal ultrasound.
“OK,” you say, as your husband clutches your hand. “Get it over with.”
“Do you want to put the wand in?” she asks.
“No,” you explain through gritted teeth. “I want to go to Paris in my mind. You do whatever you need to do down there. I’m leaving, essentially.”
“Is it better if I don’t talk?” she asks, and you’re grateful, because someone gets it. You work out parameters: she’ll tell you when you’re going to be touched, and then she’ll spare you the blow-by-blow. After, she’ll tell you what she saw on the screen, and that everything looks healthy and sound—uterus, ovaries, follicles, all present and accounted for, all as they should be, in order to conceive the baby you’re not conceiving.
Later, popping an Ativan before the first of a series of injections, you wonder about that. Your official diagnosis is Unexplained Infertility, but most of the doctors you’ve seen are pretty sure the issue is egg quality. It’s the only thing they can’t measure, without more invasive means, for one thing, and for another, you’re getting up there, late 30s when all this started. But there’s a lot they can’t see, even if they did exploratory surgery, even if they did a whole-body scan.
For example, they can’t see if you’re damaged in ways science can’t measure right now. They might be able to, someday—measure your cortisol levels and whether those suppress hormone function, see if your telomeres are hopelessly shrunken, making you years older than your actual age.
For now, though, you just have to wait and endure. You don’t have much hope that this will work. In the blood lab, a tech says brightly, “This is the cycle.”
“We’ll see,” you tell her, thinking about how tired you are of talking to anyone about any of this.
She reaches up behind a sheaf of papers stapled to a bulletin board and pulls out a ceramic figure. “It’s a fertility god. We have them all over.”
“Probably no Irish ones,” you say. “They’re not safe for work.”
She laughs and you think of the bright blue Sheela Na Gig you bought years ago in Ireland. The goddess (or gargoyle, depending on whom you ask) squats and holds her vagina open. Probably she’s just showing off her fecundity, but to you, it always looks like she’s saying one thing: Take a good goddamned look.
Scared of ultrasounds? She’d swallow the wand.
Picture that, then, and forget Paris. Think about a woman, any woman real or imaginary, so strong she levels buildings and streets, city centers and town squares. A woman with every past and future, who doesn’t so much recover from what’s been done to her as she consumes it, uses it like fuel to create and destroy. A woman who is angry and terrified and powerful and insistent.
Look at me, you think. Take a good goddamned look.
If you’re voting for Donald Trump, and you turn up on my social media to tell me about it, I will straight block your ass, and I won’t even feel sorry.
Furthermore, I will do so while reflecting (briefly) on the fact that you’re a racist, xenophobic monster who thinks reality TV is real but global warming is fake — or that you’ll willing to elect someone who is all these things, so that you don’t have to vote for a lady or Democrat or whatever.
Because don’t fool yourself: Trump is a proudly racist, sexist, homophobic, xenophobic, ableist garbage fire of a person, the kind of guy who thinks that being a rich, white male is normal and everything else is a variation, and not a positive one. Furthermore, he is the worst kind of stupid person: the kind who thinks he’s smart, while ignoring actual scientists on subjects like vaccines and the environment. He also assumes you’re a dumdum (dumber even than him!) and that, like him, you want to think that most difficult problems are lies, so why bother solving them, and he’s hoping to turn your stupidity into profit.
He wants to make America great again … for people like Donald J. Trump. He couldn’t give two shits in a hat (manufactured in China) what happens to you.
And here’s the thing: we don’t need to dig to find all this out. He tells us.
Here’s a lovely little selection of things Donald Trump has tweeted:
How amazing, the State Health Director who verified copies of Obama’s “birth certificate” died in plane crash today. All others lived
As Maya Angelou once said, “When people show you who they are, believe them the first time.”
Prior to this election cycle, I was a big believer in living and letting live, when it comes to political opinions, especially on social media, including on my own feeds. My feeling was, conversation is more important than any one specific point of view, and that the most dangerous thing we can do is to live in our own little echo chambers — which most of us do, both voluntarily and involuntarily.
Most people surround themselves with likeminded people and only make time to consume media that reinforces their perspective. If you’re on Facebook, Twitter, etc., it’s worse: not only do you choose your connections, but the site’s algorithms often show you only what you want to see (or at least, what you’ll respond to).
I still believe that the exchange of ideas is important, but for my mental health, I’m not going to put up with Trump supporters commenting on the parts of my online presence that I curate. If you want to support him on your own sites and feeds, go ahead. Show up on my virtual lawn, and I’ll turn the electronic hose on you.
Before my doctor’s appointment, I made a list of things to remember to ask. This was especially important, because I’d be by myself for this one. Adam’s been able to attend most of my appointments, which is good, because it means that I can take Ativan before the ultrasound, and therefore not waste everyone’s time by sobbing throughout. And thanks to the Gonal-F, there’s been plenty of sobbing, partly because of hormones and partly because I was in unbelievable amounts of pain, in the midsection region.
“Honestly, I wish they’d tell me I can’t take these drugs anymore,” I told Adam grimly, while gathering my materials for the next day’s appointment. “I’d never be so happy to waste thousands of dollars.”
I’m pretty tired of crying, I have to say. I wouldn’t characterize myself as a crier or a non-crier in ordinary life: I believe I cry a typical amount for a female person with circulating estrogen – in other words, a person who has been encouraged by society to let it all hang out, provided I don’t ask for anything in return. But since we’ve been doing this, Jesus, there’s just so much crying. The other day, I didn’t realize I was even leaking from the eyeballs until Adam asked me what was wrong.
“Oh, you know,” I said. “The usual. Just ignore it. It’ll stop in a minute.”
I was not going to cry at this appointment and I did not cry, and I felt pretty good about that. Unfortunately, I also lost my ability to stop talking, as well as my filter, and chose to sublimate my nervous energy by babbling at the doctor until she very nicely asked me to hold my thoughts for a moment while she measured follicles.
Which is probably why her poker face slipped for a second when she saw all the follicles on her screen.
“What day did you say this was?” she asked.
“Three.” I paused for a minute, trying to hold in the torrent of words. “That looks like a lot of follicles. Are those from the Gonal-F?”
“Probably,” she said. “Are they putting you on birth control before the next cycle?”
“I don’t know,” I said.
“I wouldn’t be surprised,” she said.
“I’ll be curious to see what my estrogen levels are,” I said.
“Yeah, me too.” She frowned at the screen and moved the wand. A throb of dull pain pulsed through my left side.
“Sorry,” she said. “Did you know, when you press on the ovary like this, it’s just like pressing on a testicle? That’s why it hurts so much. I’m sorry to hurt you, but I have to get the wand close, so I can see the follicles.”
“I know you’re not doing it for fun,” I said.
She looked alarmed. “Ha. Ha ha ha ha, no. No. Absolutely not.”
I have no idea if I really was making her uncomfortable, but thanks to my talking problem, I couldn’t stop. By the time we were finished, I was pretty sure that I’d come off like a drug-seeking pervert who shouldn’t be left alone near a school or a pharmacy. I’m 85 percent sure that’s in my head, though.
The good news is that I have 20 ovarian cysts, and the reason that’s good news is that I can’t possibly do another cycle right away. See that? I sort of got my wish, and I didn’t even have to waste thousands of dollars’ worth of drugs. Who says dreams don’t come true?
When I first started fertility treatment, a friend of mine said something to me that didn’t sink in until … well, last week.
“Maybe it’s not that people think they know better than you, when they say you’ll get IVF,” she said. “Maybe it’s just that they’ve been there, and they’ve seen how things sort of progress, no matter what their original intentions were. Like, they thought they were going to do artificial insemination, three rounds, tops, but then six months later they were pregnant with twins after their second round of IVF.”
It was easy for me to pooh-pooh what she said, because she had never been through fertility treatments, but I should have listened. Because this month, I started to see how people get started rolling down that hill, from IUI with oral medications to IUI with injectable medications to IVF and so on. [Please note: I have not changed my mind about doing IVF, and I’m still doing fine without extra advice on our fertility situation, in case you’re composing an email to me in your mind as you read.]
That’s because this month, I moved to injectable meds, and had such a “strong response,” as the doctors put it, I had to cancel my cycle, lest I wind up pregnant with octuplets. That put me in a weird spot, and not just because my ovaries were swollen to what felt like five times their normal size and my hormones were making me depressed and ragey.
See, before this particular round, I’d decided that this was the last-ditch effort. That might sound early, especially to people who’ve gone through multiple IUI and IVF cycles, but it was one more than I thought I had in me after our Clomid round in May.
I had a bad reaction to Clomid, to put it lightly. I was on the lowest dose, and only produced one egg as a result, but I had a crippling headache that Tylenol didn’t even touch, and I felt crazy, like someone who might be arrested for knocking over a display in the post office or defacing political posters outside the VFW. The whole month, after I started the pills, I felt like someone who was one straw away from the proverbial broken back.
To up our chances, and cut out the Clomid crazies, our doctor suggested moving to Gonal F, an injectable medication that would increase egg production and give us almost double the chance of conceiving, 15 percent as opposed to 8 percent with oral meds. It sounded like a good deal to me, so we went for it.
The long and short of it was that we had to cancel my cycle, which put me in a quandary: did half a cycle count as our last-ditch effort? And regardless, did I want to go forward with another try?
My body, not to put too fine a point on it, is fucked up. Hopefully, if you’re reading this, you’re not squeamish, but if you are, now’s your chance to ditch. I’ll wait.
OK, still here? OK. So, this weekend, I started bleeding a bunch, about a week too early for my period. It also didn’t feel like my period. My periods come with pain, on a scale of Doubled-Over in Pain to Cancel Yo’ Plans, and weirdly, this one is pain-free. That would be good news, but there’s also a lot more blood than normal, and it’s not period-type blood.
If you’re not a uterus-haver, and don’t have a lot of experience with periods, I’ll explain it like this: ordinarily, when a period-having person has her moon-time, it’s very evident that tissue is departing the body. This is more like I’ve been stabbed.
I was understandably a little bit nervous about the whole, “Hey, have I been stabbed?” issue, so I called the office to see if they thought I was dying. Unfortunately, it was Sunday, so I had to leave a message for the nurse line. In fact, I left two messages. Then, I fumed for the rest of the day, as my phone remained dark and quiet.
It felt like I was dating again.
This morning, a nurse called me back and said that she’d left a message this weekend, which I’d never received. The message said that I should have come in this morning, but since we didn’t speak until after morning office hours were over, I’ll go in tomorrow.
She did not seem to think I was dying.
She did describe tomorrow’s appointment as “a baseline,” however, which filled me with anxiety, because “a baseline” is generally what you have at the beginning of a treatment cycle.
I don’t know yet if we’ll do another round, but I can tell you that I do not want to do one right away. I felt like garbage this month, especially after my brush with Ovarian Hyperstimulation Syndrome. My whole body hurt, my belly was swollen (ironically, like a someone entering her second trimester), and I had violent chills. I’m still not right in the head. I’ve been chasing a weird smell around the house for days now, which typically means one of two things: either I need to take out the garbage, or I’m getting depressed. The garbage situation is under control, so it’s probably the latter.
The best/worst part is, tomorrow’s appointment, which involves a transvaginal ultrasound, will have to be drug-free, as Adam is working and the state of New York would prefer it if I didn’t take Ativan and drive.
So, get ready, everyone. If you turn on the news and there’s a report of a woman running around Westchester, wearing only a paper drape from the waist down and shrieking, you won’t even have to look for my name. Just assume it’s me.