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.
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.
Friday morning, I had a transvaginal ultrasound and bloodwork scheduled. This is what’s known in the fertility biz as “monitoring,” and you have to go through it if you’re doing IUI or IVF or whatever they invent tomorrow that coaxes babies out of recalcitrant gonads and uteri.
I hate transvaginal ultrasounds. I don’t want to go into the whole thing right now, but I do want to say that the Republican congressmen who think women who want abortions should have transvaginal ultrasounds before they can have a relatively uncomplicated medical procedure should be forced to sit on a robot dick.
Yes, that’s right: a robot dick, right in the pooper, for anyone and everyone who makes even one single woman get one of these when she doesn’t need one. They are vile. I made such a scene at my first one this cycle, they gave me Ativan. Do you know how hard it is to get Ativan right now? I was so obnoxious that they couldn’t give it to me fast enough. They threw that shit at me, while begging me to stop crying. That’s how bad.
Anyway, at my near-daily assault, Adam mentioned that there were a lot of potential eggs showing on the exam-room screen, which I was not watching, because everything inside the human body is repulsive.
At the time, I thought that was good news.
Then, at my next ultrasound, the doctor said something that sounded less positive.
“So, you’ve have good response,” she said. “But possibly too good. I need to look at your bloodwork, to make sure you aren’t at risk for Ovarian Hyperstimulation Syndrome.”
Fortunately, I was on Ativan, so my response was basically, “Oh, word?”
Ovarian Hyperstimulation Syndrome is not good. I’ll let you fall into your own Google k-hole if you want, but in short, it’s when your ovaries pop out too many eggs, and your estrogen skyrockets, and parts of your body that are ordinarily not suffused with fluid become sloshy. If it gets bad enough, your kidneys stop working so good, as do your lungs and other organs that you might want to be functioning at top capability.
If it gets rill-real bad, you can die. The only upside to this is that our culture loves a dead mom, and I assume a dead lady who was trying to become a mom is only slightly behind on the veneration scale. I could have become a secular saint this week, is what I’m saying.
Because that’s what was going on, albeit a really mild form of it. They cancelled my cycle and I took to my couch, where I curled up under my Slow-vercoat, which is what I call the bathrobe with a sloth printed on it that my mother-in-law got me for my birthday one year. It’s an almost guaranteed cure for depression, and yet I was very sad, because I don’t have a baby and also because I was in almost unbelievable pain, due to the fact that my ovaries were shooting off eggs like discount fireworks at a swap meet.
Sunday, Adam had to work, and I woke up in such bad straits, I actually called the doctor on call to ask if I was dying. I had to leave a message, but that’s fine, because it only took him three goddamn hours to call me back. By the time he did, I was so mad, I had reverted to gritted-teeth cheeriness. Adam tells me that this is terrifying, and way scarier than if I were to start yelling.
“Oh, hello,” I said brightly, like a washed up southern belle about to comment on how fast gin goes in the hot weather. “I’m so glad you called back.”
“Yes, sorry,” he said. “Er, busy morning.”
I told him my symptoms, which are mostly disgusting, so I’ll spare you. But to give you an idea of how outlandishly bad, let’s pretend that our conversation went like this:
Me: “I’m in a lot of pain.”
Him: “That’s normal.”
Me: “I’ve gained two pounds since last night.”
Him: “That’s normal.”
Me: “My vagina turned inside out, escaped my underpants, and flapped away over the horizon.”
Him: “That’s normal.”
In short, this is the third worst thing I’ve ever been through, and I once had surgery without anesthesia and saw my own intestines. It is fucking repulsive, and I can’t believe it’s even a thing. I’d be outraged at the person who did this to me, except that I signed up for it myself, and I really can’t take the self-esteem hit right now. I’m trying to be kind to myself, and outrage doesn’t fit in.
If my organs start actually leaving my body, however, I might need to reassess.
Hello, there. I’m Jen. But if you’re reading this, chances are, you already know that, because you stumbled across this piece via a link on one of my social media dealies. That being the case, there’s also a chance that you’ve read a bit about my infertility bullshit (I refuse to use the word “journey” and have worn the velvet off “struggles”) and only a slightly smaller chance that you’ve offered me advice about it.
First of all, I want to thank you. I genuinely do. I know that everyone is busy and that you could be watching a YouTube video of a tiny goat in pajamas trying to jump over a bale of hay.
Instead, you’ve opted to give me some advice, because you sense my pain and want to do something to make it stop. I totally understand. I would also like to make it stop.
What you might not realize is that internet advice probably isn’t going to do it. The odds that you’ll come up with something my reproductive endocrinologist, regular endocrinologist, gynecologist, primary care physician, rheumatologist, therapist, nurse/husband, and nurse/mom haven’t come up with is mighty slim. By the time you give your advice, I’ve almost certainly heard it, upwards of 20 times. This is true even if you’ve been through infertility—yes, even if your decision led to a baby.
Still, I don’t mean to give you the impression that I think I’d do better. I give people advice they don’t want all the time, for the same reasons: I want to make their pain stop. Also, I think I’m pretty smart. Smarter than most people, even.
Chances are, neither of us is actually smarter than most people. The best we can hope for is that we pay attention, so I’m trying to pay attention to this, and remember it for the next time I decide I have the perfect solution to a friend’s problem. I hope you’ll do the same.
But just in case you’re not feeling me on this one, I’ve decided to compile a list. In it, you’ll find specifics about what we’re not doing, so that you don’t ever have to ask us again:
IVF worked for you, or for your friend, or for your friend’s friend. I’m really glad. We’re not doing it, however.
Our RE gave us a 15 percent chance, per cycle, of IVF succeeding. In our neck of the woods, IVF costs $20,000 per cycle. People often do two or three cycles before they succeed … if they ever succeed. We do not have $60,000. We are uninterested in borrowing $60,000, no matter what loan situation you got from your clinic.
But even if we were millionaires, we wouldn’t do IVF. Speaking of percentages, I’m 100 percent sure that my mental health would not survive the process. This is true even if you did it, even if you have your own special challenges that made it harder than normal, etc. I’ve had 40 years to figure out what I can and can’t deal with. You can trust me that I know IVF is on the other side of the line.
No, there aren’t “thousands of kids out there looking for a good home,” unless you’re talking about older kids with challenges … ones we’re not set up to meet. It’s OK for us to want a baby. It’s OK for us to want a baby that shares our DNA. Adopted kids deserve more than being a “what about…?.” (“What about adoption?”) Also, if you feel that strongly about adoption, I have wonderful news: you can adopt. You can! If the next words out of your mouth are, “But we were able to have a baby,” then there you go.
Please, and I say this with gratitude and also desperation, please stop offering me your womb, ladyfriends of mine. Every time someone does this, I feel like getting on a bus and starting my life over in a new place, where no one knows me. What do we need me for, if I can’t even carry our kid?
Before you step in and console me that I’ll have plenty to do when the baby is born, listen to what I’m actually saying: as far as we know, my uterus is fine, so we don’t need anyone else’s. And hearing about how easy it is for you to get pregnant gives me a sad.
I understand that you’re now offended, because you/your sister/your best friend used a surrogate or was a surrogate. I’m sorry about that. The last thing I want to do is pick on your choices, which seem like really good choices—for you. They’re just not our choices.
Also, if we used my eggs, I’d have to go through egg retrieval, which is one of the reasons I don’t want to do IVF. That shit is gnarly.
I know, I know. Genes don’t make a family. But here’s another thing: if we use Adam’s sperm, and someone else’s egg, my lizard brain says that it’s like he had an affair, and I agreed to raise the child, like some sort of sad secondary character in a Regency romance novel.
“Choosing” a child-free life.
We might well wind up there, but please stop telling me how lucky we are to have each other (we know) and how tough and expensive kids are (we know that we don’t really know) and how we can go on fabulous vacations now. It’s really not helping.
If we wind up not having kids, we’ll be very grateful to have each other and we’ll enjoy our life. But we’ll always be a little sad, even when the real gut-twisting grief fades. It’s not the same as deciding, right from the get-go, that Kids Are Not for You.
In closing, I would like to say that I understand that by titling this “A Complete List…,” I’ve set myself up for advice on options I didn’t think of this morning when I sat down to write. Do me a favor and just mentally tack on whatever you’re thinking. We don’t want to do it. Really. We don’t want to do reiki or acupuncture or guided meditation or fertility coaching or prayer or mega-vitamins or going gluten-free or working out a lot or working out never or standing on our heads and envisioning Kundalini energy while we try to create a dependent. We’ve got this. We’re good.
This afternoon, I was tap-tap-tapping away at my keyboard, when my phone buzzed with a text message from Adam.
ADAM: Honey, I’m sorry, but can you help me clarify something about fertility stuff? Is the $5,000 cap for ALL fertility drugs? I thought the financial aid person at the clinic said it was just for IVF.
ME: She did, but she was wrong. The nurse at the insurance company told me that it all comes out of the same allowance. Why, is it crazy expensive?
ADAM: We reached the cap, so the copay for FSH is $600.
For reference, we have done ONE other cycle so far. ONE. And it required $120 worth of fertility drugs, because we did Clomid, which is so old, it’s what Mary took to conceive Jesus. Just kidding, Mary was a teen, and everyone knows that the best way to get pregnant is to be totally financially unprepared to have a child. Which is excellent fucking news, because after we’re done burning through the rest of our cap for two entire cycles, we will have none dollars and none cents left, it appears. I assume I’ll be pregnant with octuplets by Halloween.
I mean, yeah, we can find 600 bucks, and I realize that we’re lucky that this is the case, but who knows what the next thing will be? “Oh, sorry, we only cover one actual IUI procedure. After that, we ask that you earn out the rest by dressing up in a chicken suit and standing at the corner of the street that runs past the clinic, holding a sign that says, ‘CLUCK, CLUCK. ARE YOUR EGGS WORTH A BUCK? INQUIRE WITHIN.'”