Friday, November 20, 2020

O Aunt Flo, Where Are Thou?


My heart and my mind were on board with trying for a second donor-conceived baby. My body, however, was another story.

One of the first things you need to start infertility treatment is a period. It marks Cycle Day 1, and without it, I couldn’t schedule the saline-infused sonogram (SIS) that I needed to get on West Coast IVF’s waiting list for a match.

Dr. Baby-Maker had told me that at the two-month postpartum mark, if I didn’t have my period yet, I should take a pregnancy test. I didn’t have the former, so I did the latter, and it was negative. (No surprise.) By three months postpartum, I still wasn’t seeing red, and the pregnancy test again came up negative. Dr. Baby-Maker said I could make an appointment for four months postpartum, but reassured me that my period would probably come by then and I could just cancel the appointment.

Well, the four-month mark came and my period didn’t. Leave it to Aunt Flo to crash the party when you don’t want her to and to go off the grid when you desperately need her.

I trekked to Dr. Baby-Maker’s clinic. While I waited in the exam room, I could hear her and another woman discussing an egg retrieval that apparently didn’t go well, judging by the intermittent gasps. It made me glad I was skipping that part of IVF and going straight to the embryo transfer.

Finally, Dr. Baby-Maker came in, bright and bushy-tailed as always. We got right down to business.

“I want to get back on the fertility train,” I told her. “We want to give our baby a little sister.”

“Are you ready?” she asked.

“If I could transfer today, I would,” I said.

She seemed surprised, but happy to help. I explained that I was moving forward with the donor-donor embryo program at West Coast IVF and that I needed to schedule a SIS. There was just one problem: I was supposed to do it on certain days of my cycle, but how was I supposed to know when to schedule it if I didn’t have a period?

“I’ll put you on Provera for 10 days,” Dr. Baby-Maker said. “That will bring on a period. Then you can schedule the SIS. This could take two to three weeks until you’re all done.”

I couldn’t believe how well-versed she was in infertility. I mean, it’s her job, but still. Competent doctors are rare.

In addition to the labs West Coast IVF required for its program, Dr. Baby-Maker ordered a whole lotta bloodwork.

“I’m curious to see what your AMH is now,” she said. “I’d also like to check your FSH again. I imagine it’s higher than last year.”

“And what would that mean?” I asked, though I suspected I already knew. “Not…menopause?”

“Perimenopuase,” she said. “But if your FSH is over 30, that is considered menopause.”

The possibility of perimenopause wasn’t a complete shock. A few years back, I’d written a newspaper article about creative women coping with peri/menopause…and realized I had many of the same symptoms as they did. But post-pregnancy, I actually felt better than I did back then. I was now thinner, had more energy, and was rarely depressed. But I did still have some perimenopausal symptoms. One of them was high cholesterol, which made me wonder if I didn’t have Familial Hypercholesterolemia but instead was in menopause – not that I liked that idea any better. (Isn’t aging fun?!)

“Any questions?” she asked as we wrapped up.

“Is menopause going to prevent me from getting pregnant again?” I wondered silently. (Because one would think that it would make getting pregnant, well, impossible.) But I wasn’t ready to confront that situation yet. I would just have to wait on the bloodwork.

And the wait was worth it. Not only was my FSH in the normal range (11.3), it was lower than it had been pre-pregnancy! My estradiol, prolactin, and TSH were all normal, too. It was almost as if pregnancy had been good for me. I was all balanced.

The one bummer: my AMH was indeed lower than last time. It was 0.08, down from 0.24. But with numbers that low, and the fact that I wasn’t even going to attempt to procreate with my own eggs, did it really matter?

“Your labs are not indicative of menopause,” Dr. Baby-Maker wrote on my online chart. “I am OK with you going ahead with another donor embryo transfer.”

The Provera produced a period as promised, though as far as my periods went, it was pretty lackluster. It was two days long and mostly rust-colored (read: old) blood. On day six of my cycle, I went to Dr. Baby-Maker’s clinic for the SIS.

Unlike my previous SIS with Dr. Gerber at the Minneapolis IVF clinic, this one was performed by a sonographer and a nurse, not by a doctor – and therefore, was not the quicky, easy, and painless in-and-out procedure I’d had before.

The sonographer started with an abdominal ultrasound to make sure that everything was where it was supposed to be, anatomically speaking. Then she switched to a pelvic ultrasound.

“You’ve had these before, right?” she asked.

“Oh, lots,” I said.

And yet, this time, it was really uncomfortable. The wand felt twice as big as I remembered it and the pressure was intense as she examined each ovary. But everything looked normal, so she brought in a nurse to do the SIS.

There was a disconcerting moment as the two of them stood over the tray of tools and surveyed them all with perplexed expressions, as if they’d never done this before.

“Sorry,” the nurse finally said. “They gave us all new equipment.”

They futzed with the catheter for a moment and one of them mentioned a balloon.

“No!” I thought. “Not the balloon!” (I was still traumatized from my HSG.)

As they discussed which attachment the saline went in, I had a terrifying vision of them blowing up my uterus with air instead of saline. Could a uterus burst like that? For a second, I thought about bolting. Did they really know what they were doing?

They turned out the lights and put a hot spotlight on my lady parts. The speculum had a tight grip on me, though I didn’t feel the catheter or the saline.

The sonographer and the nurse both peered at the monitor. They didn’t say anything alarming, but they didn’t exactly reassure me, either. A couple of times, the sonographer said, “Oh, is that something?” and then a minute later, “No, I guess not.” It seemed like she was looking for abnormalities and was disappointed when she didn’t find any.

Just being in the ultrasound room brought back a lot of anxiety, reminding me of those early pregnancy days, watching the screen, holding my breath, trying to decipher shadows and light on the screen.

“We got some really detailed pictures,” the nurse said at the end. “You did really well.”

I wasn’t sure what that meant. It wasn’t like Dr. Gerber at Minneapolis IVF triumphantly declared that I had “textbook perfect uterus.”

I asked the sonographer if she could send the results to West Coast IVF.

“The doctor needs to review the images and write a report. It could be a few days. How soon do you need it?” she asked.

“No hurry,” I said in that stupid, Minnesota Nice way of mine.

“You aren’t transferring for a few months yet, right?” she said.

“Right,” I said, though I immediately realized that West Coast IVF wouldn’t put me on the waiting list until they received the SIS results.

Rather than reassuring me that I had checked off one more box from the onerous to-do list for West Coast IVF’s program, the SIS made me question if I was really up for another pregnancy. The procedure had made me uncomfortable, and resulted in hours of cramping afterward, and as we know, humans don’t like discomfort. Humans wants to be cushy and comfortable and stay with the status quo.

Part of me wondered: “What am I doing? Why am I messing with perfection? Maybe I should just leave well enough alone. Maybe my body isn’t up for this again.”

I wasn’t ready to give up yet, though. I figured the best way to fight the fear was to check out every angle imaginable of my health. Assuming a match was months away, I started taking care of things I’d been putting off, like dental work and gum surgery, as well as preventative appointments, like my annual mammogram. I met with a genetic counselor and spit in a tube for a 47-gene cancer panel (which came back negative on all fronts, though because of family history, I am still considered high-risk for breast cancer).

I also followed up with Dr. Cardio. After three months on Crestor (and, to my credit, some hard-won diet changes), my total cholesterol was down to 188! Out of an abundance of caution, I also requested a calcium score test, which is a CT scan of the arteries to check for plaque buildup. My score was a 0 (which meant no buildup). 

“My husband and I are moving forward with a donor embryo transfer next year,” I told Dr. Cardio, who was unusually chipper during our conversation. “I will be OK off Crestor for a year, right?”

“If it’s just a year, I’m not concerned,” he said. “You gotta do what you gotta do.”

And I was going to do it. My body seemed to be saying, “All systems go!”

By late October, West Coast IVF had all my paperwork, labs, and the SIS report. My coordinator confirmed we were on the waiting list for a PGS-tested female embryo. Just as I settled in for a long, six-month wait for a match, I received an email. West Coast IVF had news for me – and it was very, very good

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