Tuesday, August 25, 2020

Patience Is A Virtue (I Don't Have)

My commitment to natural conception lasted a total of two weeks. During that time, just to feel like I was doing something, I started seeing an acupuncturist. I’d read that the ancient Chinese practice could improve egg quality.

My acupuncturist was the kind of woman I wished I could be: comfortable in her own skin, naturally beautiful, effortlessly fashionable, with a sweet and calm demeanor. She specialized in fertility, and had a slew of recommendations to help me get pregnant: nettle tea, keeping my feet and belly warm, eating hot foods. She also said I should enjoy my life, as is, right now. I nodded my head but had no idea what that meant. Little brought me joy anymore, other than exercising outdoors. What is this “fun” she wanted me to have?

While I soon disregarded acupuncture as an expensive nap, one good thing came out of it: the acupuncturist recommended I have my thyroid checked because mine seemed sluggish and that could make it harder to get – and stay – pregnant. Sure enough, when Dr. Baby-Maker tested my TSH (Thyroid Stimulating Hormone), the results showed I was inching towards hypothyroidism. She prescribed a small dose of Synthroid, and my TSH level soon normalized.

By late May, my husband and I weren’t yet able to try to conceive naturally because he was still healing from his vasectomy reversal. In the absence of hope, fear took over – fear that we would waste six months (or more) trying to get pregnant on our own, only to realize it would be too late to do IVF with my own eggs. Fear that we wasted money on the vasectomy reversal that could have gone to an egg donor cycle instead. Fear that even if I did get pregnant naturally that I would miscarry and we’d have to start the whole process all over again.

“I wish I could just start IVF tomorrow,” I said to my husband. “What are we waiting for?”

“We agreed to try naturally first,” he said. “We just need one sperm!"

"Um…actually you need like 20 million to conceive naturally," I informed him. We might be able to make do with 5 million sperm for IUI, but a sperm analysis showed my husband only had 2 million sperm with 11 percent motility (meaning, this is the percentage of sperm that actually moved). In sum, he had a meager amount of lazy swimmers. If we were to do IVF, Dr. Gerber said ICSI would be mandatory, not an optional add-on. My husband’s sperm couldn’t even be trusted to find and fertilize an egg in a petri dish! The situation looked dire. The numbers game of conception was not on our side.

To make matters worse, it was spring. The world was green and budding. The sun was shining and people were out with smiles and sunglasses on their faces.

I wanted to not exist.

It seemed like every living thing was reproducing, from dragonflies to ducks to rabbits. A robin made a nest in a tree on the side of our house and laid four blue eggs there. Four! Even the birds had more eggs than me. 

One night during dinner, I was talking my husband’s ear off about baby-making options. IUI, I had decided, was a waste of time and money because the success rates, even with healthy, motile sperm, topped out around 16 percent, while IVF had up to a 34 percent success rate.

Once again, I don’t know what changed his mind, other than his desire for me to shut up.

“If you can guarantee we won’t go bankrupt, I’m OK with starting IVF now,” he said.

If I’d learned anything about fertility treatments, it’s that guarantees were few and far between. But, worst-case scenario, we would do one cycle of IVF, and if it didn’t work, natural conception would be our only option left. There would be no more deliberation because we’d be out of money.

I called the Minneapolis IVF clinic and soon our IVF cycle was “dated,” meaning we were scheduled on Dr. Gerber’s calendar. It was a huge milestone in the assisted reproductive technology (ART) world. July 8 was our estimated egg retrieval. Over the phone, a nurse rattled off everything we had to do before that date, starting with a boatload of paperwork, which the clinic mailed to me.

There were surreal decisions to sign off on, like if we wanted to be tested for a slew of rare genetic conditions, the hitch being that if my husband or I had any of them, you would need to do PGD to make sure your embryos didn’t carry them, lengthening the time from retrieval to transfer and making yourself crazy with worry in the process. We looked at the price tag and decided against it. We already knew the major diseases our potential offspring was at risk for; why go looking for more?

There was also the question of what to do if we had extra embryos. I thought it was sweet of them to assume there would be leftovers when Dr. Gerber hoped for two embryos, tops. But let’s say we won the fertility lottery; would we freeze the extra embabies? (For an annual storage fee, of course.) Donate them to another infertile couple? (Probably not. I couldn’t handle knowing "our" children were out there somewhere.) Give them to science for experimentation? (NFW.) Let the clinic dispose of them? (Don’t kill my babies!) We opted for frozen storage.

Next was STD testing, accomplished with a simple blood draw. (All clean.) Then it was time for an SIS (Saline-Infused Sonogram), which was similar to an HSG but involved a saline injection in my uterus during an ultrasound to see if my baby house was the right shape.

I was nervous about the SIS given my excruciating experience with the HSG. On the appointed day, I lay on the treatment table and studiously stared at the fluorescent lights above me. The panels were splattered with green paint, like the clinic had entrusted a toddler with interior design. It cast a sickly hue over the room.

I turned my head when Dr. Gerber came in. He looked older than I remembered but was handsome in a boyish way with his pink bowtie. He stood by as a nurse did a vaginal ultrasound and together they counted my resting follicles on the screen – seven. The average for my age group was nine, though some women have as many as 25.

“That’s about what I expected, given your low AMH,” Dr. Gerber said. His tone wasn’t enthusiastic or discouraging; just factual. (I felt stupidly reassured because I’d seen an episode of Keeping Up With the Kardashians where Kourtney visited a clinic about freezing her eggs and she only had five resting follicles -- and she was one of the most fertile women in her family. So there.)

Dr. Gerber inserted the speculum, disinfected my cervix with a long, Q-tip-like device, then inserted a catheter. He removed the speculum and injected a tablespoon of saline into my womb. He was gentle; I didn’t feel anything. A 3-D image of my uterus appeared on the screen and Dr. Gerber traced the triangle-shaped outline with his finger.

“That is a textbook perfect uterus,” he said.

My womb was ready. At least we had that one thing going for us.

SIS complete, the next item on the IVF to-do list was LH testing, which I could do at home with an ovulation predictor kit. Once I had an LH surge (which indicates ovulation is about to occur), I’d come in for a progesterone test. Then I’d start a medication protocol; there are several used in IVF and explaining them all would be above my pay grade. Mine was called “Long Agonist,” which sounded foreboding. My husband’s frozen sperm also had to be shipped to the IVF clinic in case he didn’t have enough swimmers come retrieval day.

We were on the IVF treadmill now. It was dizzying trying to keep all of these steps straight but I also felt comforted by having a plan. We didn’t have to decide anything anymore; we just had to follow directions. Or so we thought

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