Three weeks ago I went to Target to pick up some last minute things for our summer trip. With a hellish school year finally at its conclusion and a holiday week approaching, we decided to take off to Northern California to replenish, reconnect, relax, and all the other neglected “R” verbs starved by infertility. We have some desperately missed friends in San Francisco–special people, folks you cherish if you’re lucky enough to be loved by them–who had the nerve to conceive easily and have a baby while we were suffering, and it was time to face that and start enjoying them again. The California coast is a magical place that floods the heart with memories of our engagement (B popped the question during a 2007 road trip up Highway 1 from LA to Vancouver) and, en route to an even more magical Maui, our honeymoon: memories of innocence and love and optimism about the future. We needed this to feel whole again.
I stood in that Target dressing room and discovered (1) that my breasts had gone up a cup size and (2) I was bleeding when I should be getting ready to ovulate and start estrogen priming for IVF. My heart sank. I walked to the pharmacy section and put a home pregnancy test in my basket. I knew at that moment what would happen when I got home. And there it was.
These two lines, a teensy peek under the lid of Pandora’s box, set off a head-spinning chain of events, the implications of which still have not entirely resolved. I spent all three days in San Francisco in a total tailspin of medical follow-up–calling for scripts and having them printed, schlepping back and forth to the blood lab, leaving messages for nurses, and watching my phone like a girl with a crush while I waited for callbacks and results. I spoke to all 3 nurses and 2 out of 3 doctors since in the midst of all of this we also had our scheduled regroup with Dr. Schoolcraft, another example of our incredible luck since the first full day of our vacation was the ONLY room in his calendar to talk. After beating our heads against the wall with 4 failed IVFs, here’s yet another spontaneous pregnancy on its way to miscarriage; which has reared its ugly head on the night before this precious getaway (one of the few endeavors in our lives that was actually NOT about infertility) and just in time to disrupt IVF plans that have been 4 months in the making. Instead of finding escape, we strained to enjoy the time while juggling worry and medical minutia.
But we did find joy, in the raw beauty of the coast with its big sky and craggy bluffs and pounding surf, in bright produce and boutique wines and cheese crafted with love’s labor in the spirit of Northern California’s cultural imperative to savor life’s sensual gifts, in the rare moment of old friends from far and wide gathered under one roof, off the grid in a cozy mountain house perched on the edge of wooded canyon and surrounded by ancient trees with good food and wine and board games and belly laughs.
A plane crashed at SFO the day before our departure. Our flight turned into a red-eye. We came home sleep deprived and dragged ourselves to Cornell at 7 A.M. for beta monitoring right from the airport, as per their insistence since they hadn’t gotten a level from me in 5 days. It’s also worth noting that the BART was on strike the whole week we were in town, which made getting around the city…interesting. The transportation gods did not smile on this trip any more than the fertility gods did. In fact, screw the gods. They’re dicks.
Once I returned to New York and Cornell had me in their grasp to “monitor [me] as closely as [they] would like,” the rest of this relentlessly draining, infertility-consumed week unfolded like so:
Monday- The beta is continuing to rise, but it is not a healthy pregnancy.
Tuesday- I go into the city for blood and ultrasound at Cornell. The beta is still too low to see anything on ultrasound, but they’re worried about the risk of an ectopic because of my history and right tubal rupture last winter. They send me to East River Imaging. They still see nothing. They’re comforted by my lack of pain and 13mm lining because these things indicate a uterine pregnancy. The beta results come in, and they are still rising. They also realize at this time that they dropped the ball on the Rhogham shot, which I need so I don’t make Rh-antibodies against my husband’s children. They call it into a pharmacy that doesn’t carry it, and I spend a bunch of time waiting and walking around Manhattan for nothing before I finally get fed up and go home. On Tuesday night, I start bleeding again and feeling distinctly left-lateral localized discomfort, which is terrifying.
Wednesday- Cornell is likewise alarmed by my symptoms and they want me back. I make the voyage yet again to the Upper East Side for another beta and a scan with Dr. Davis. He sees nothing as predicted, but the symptoms mean we have to act sooner than later to bring the pregnancy to resolution. My choices are to have a D&C to rule in/out a uterine pregnancy, and if the beta continues to rise, I will need to take methotrexate. Or I can skip the D&C and take methotrexate, which will end the pregnancy immediately with 2 drawbacks: I would never know if it implanted in the tube and potentially damaged it, which could hinder implantation for IVF, and it would prevent me from cycling for 3 full months due to the disruption of folate in antral and pre-antral follicles; this last part would make the out-of-town cycle in Colorado or Oregon incredibly difficult since I would need to leave town early in a brand new school year. I opt for a D&C but (of course, in line with my luck) Dr. Davis can’t do it because he is leaving town to lecture in Austria.
Thursday (my 4th wedding anniversary, emotional as it marks 4 failed years of TTC)- My day begins with calling contact numbers provided by Dr. Davis’s office to find an OBGYN who will perform the D&C. They are expensive and out of network and busy. One doctor wants to do it without anesthesia in her office. We can swing by on our way to the 1:00 Yankee game, tickets I booked so we could do something FUN for our anniversary (God forbid). My husband makes us late, which causes a huge fight in the car, and the doctor needs to leave to do another procedure. We trek all around the city in the resumed search for a pharmacy with Rhogham and make a quick jaunt over to Cornell so the PA can administer it, which makes us 45 minutes late for the game. My heart is pounding in my chest from rushing when we finally arrive.
Friday- I head into Manhattan bright and early–my 5th consecutive trip into the city this week–for my D&C. We head all the way uptown for an office visit with the OBGYN so she can examine me before the procedure. She gives me her spiel about “risk of clinically significant scarring” to the uterus, which is marginal but could potentially affect future implantation and lining development. I rush off to the “surgery center” center downtown rattled and scared. When I get to said “surgery center,” there is a form in my paperwork asking whether I would like to be counseled on effective forms of contraception (?) and I realize, after the nurse looked so surprised and confused when I asked to speak to someone from billing about filing for insurance reimbursement, that I am at a rich lady’s abortion clinic, and this explains the oddly lavish accommodations in my recovery room–an Oriental area rug and a full-sized bed enrobed in red velvet blankets and a mountain of plush decorative pillows, for example. I just had an abortion; I watch the doctor check “missed abortion” on the billing paperwork. I feel sick, and my head is spinning, and I want to go home.
Saturday- The fellow at Cornell never calls me with the lab results from the D&C, which I am anxiously awaiting since the OBGYN told me the day before that we should see an immediate drop in beta in the recovery room and evidence of pregnancy in the tissue collected if this were in fact a uterine pregnancy. I start harassing him around noon, and he finally calls to tell me the worst news: no evidence of pregnancy in the tissue, no drop in beta.
I am devastated.
The ramifications of an ectopic pregnancy are far-reaching and life-altering. If the pregnancy is in the tube, then I effectively have no tubes and no chance of pregnancy outside of IVF ever again. I will need to have yet another laparoscopy to assess the damage, during which the doctor might determine that the tube is inflamed and a hindrance to IVF, and I could wake up with no tubes. I will need to take methotrexate, which shatters any chance of going out of town for IVF this summer. Will I be able to go out of town for IVF at all? It’s scary to take a leave in the fall with a new principal starting in September who doesn’t know me from a hole in the wall and will be writing my evaluation. The fellow calls Dr. Davis (overseas) just to double-check that methotrexate is the next step. Dr. Davis wants to run one more beta tomorrow.
Sunday- We get up at 6 A.M. to start this familiar journey into Manhattan. They pull the beta and “rush it,” but they’re not expecting results until noon. We start the process of trying to kill time, roaming the Upper East Side–breakfast, walk around the park, walk around the park some more. We start heading back to Cornell around noon; I’m hot, dizzy, nauseous, crampy and uncomfortable, sad, and this time spent milling around to delay the inevitable bad news and hammer blow of methotrexate and the destruction of my only remaining tube just adds insult to injury. We get there and the fellow calls me in: the beta dropped.
The beta DROPPED!
“Wait. Why? How? Can I see that? Wait. Oh my God. Thank you. Thank you.”
The news of a swiftly and steadily dropping beta reinvigorated efforts to get the IVF cycle back on track. To the calendar! To the phones! At this point I was locked and loaded with for IVF in Portland, mostly because of the nauseating cost of IVF at CCRM and the nearly equally dazzling success rates of the lab at ORM. I called and spoke to nurse M about planning the estrogen priming this coming cycle after my period, which was due on the 20th and arrived on time; this is because I bled, surged, and ovulated all while pregnant, as verified by OPK and a second corpus luteum visible on ultrasound. But wouldn’t you just know it: Dr. Hesla is on vacation the last week of August, which is just exactly when the final critical days of stimulation and trigger decision would occur–back to the drawing board.
Option A: Cycle in Oregon at the end of September even if it pisses off parents and my new principal. Allow my “diminished” ovaries to languish yet another month. Spend another 30 days combing donor databases like a stalker and drowning in my fears of something that hasn’t happened yet.
Option B: Cough up the cash to cycle at CCRM at the end of August.
So I came up with the following list of reassurances to fortify my decision to go forward with CCRM:
(1) It’s just money. We can find more money. We have had really good insurance coverage through all of this, so now is really the first time we’ve had to deplete our savings for infertility. And it’s really only an additional $6k. It’ll be okay. It’ll be okay.
(2) If I’m just going to fail at the end of this, I will know I failed at the absolute best place in the country (the world?) and that it’s not my fault; that there was nothing else I could have done; that donor egg will be a turn of luck and not a failure of precision.
(3) They have experience combining EPP and microdose Lupron flare, whereas this was something experimental for Dr. Hesla that he was willing to try at my insistence.
(4) There ARE girls whose outcomes at CCRM improve significantly as compared with previous repeated failures at other clinics, whether because of lab or protocol or both. I believe Dr. Schoolcraft said that 40% of patients see enhanced embryo quality in their lab.
(5) The timeline is emotionally important. I can’t start a new school year in the same maddening holding pattern. Something needs to move forward. Time is a commodity.
(6) If I actually get embryos that make it to blastocyst and are healthy enough for biopsy this first time around, I can always go forward with the second banking cycle I planned in Oregon, where an additional cycle is more affordable. And I can do the transfer wherever I please. There’s something powerful and freeing about assembling my care piecemeal from three top clinics.
And now we wait for this all to unfold. The elements at play from here on out are out of my control. My ovaries will respond well or they won’t. My embryos will grow or they won’t. It’s still terrifying, but I’m at least in a place of personal resolution, perhaps even resignation, that I have most definitely beyond a shadow of a doubt done ALL I could have done to influence my fate. This is not my fault.