[Disclaimer: This blog discusses real life stuff in real life detail. Reader beware. Also, it is long. So, sorry about that.]
Author’s note: This post has taken me almost a year to write, with multiple edits and additions throughout. Please forgive any issues with tense, as I have had to go back through and rewrite what was previously in present or future tense and correct it to past tense as time went on.
For the last two years, I’ve been dealing with a very private issue. An issue that, until recently, I was not ready to discuss publicly. While a handful of very close friends knew about my issue, the overwhelming majority of people – including most of my family, until just a few months ago – did not know that this issue was a very present part of my life. But today that ends, because I know (although I do not always feel) that the issue is not mine, alone. And for that reason, and my own sanity, I am going to tell people about it.
That issue is what I think of only as the ‘I’ word, for a very simple reason. Because it is still very hard for me to say ‘infertility.’
In April of 2014, JEM and I started trying to have a baby. ‘Trying’ consisted of me not taking birth control anymore and consummating like bunnies. I figured it would take a few months – Rome wasn’t built in a day, amiright? – and, sure enough, in July, I was late. I happened to be out of town when Aunt Flo didn’t show, so I waited until I got home to take a pregnancy test. At that point, I was five days late. Pregnancy test was negative. I was surprised, but I guess still hopeful that I might just get a positive later. The only positive I got later was my period the next day.
In August (that was going on 5 months of trying), a dear friend (one of very few who knew we were trying) suggested I try using ovulation predictor tests so we could time the deed better each month. I bought a box of “pee sticks” and promptly started peeing at the suggested times. Sure enough, like clockwork, the little happy face signaling ovulation-hormones showed up month after month, and, just as often, JEM and I did our thing. And, just as often, I got my period right on time on Day 27. Month after month.
Last November (that was going on 8 months of trying), my sister-in-law (who was, at the time, about 3 months pregnant) suggested I start charting my basal body temperature. She said it helped her confirm when and that she was ovulating so that, in the future, it was easier to predict when ovulation would occur, and thus, when to knock boots. I dove in head first. I bought a thermometer, religiously took my temperature at the same time every morning before I did so much as sit up in bed, recorded it all in an app that charts your temperatures, and confirmed what I had believed all along – the temperature rise on Day 15 signaled that I was ovulating on Day 14. Month after month, the temperature rise occurred. Month after month, the happy face appeared just a day or two before the temperature rise occurred. And month after month, I got my period right on time on Day 27. Month after month after month.
In January of 2015 (going on 10 months of trying), I started to worry. I knew that the overwhelming majority of couples conceive within a year of trying, and that it wasn’t until you hit the 12 month mark that it was considered “abnormal” (not the medical community’s term, mine). But I was still hopeful. But I was also starting to feel crazy. So I halted the ovulation tests because I believed I knew, at this point, when I was ovulating. I did, at this point, keep taking my temperatures so I could monitor whether my post-ovulation temperature was staying high (which, if it stays high and your period is late, is usually indicative of pregnancy). January went by. No change. February went by. No change.
In March (rapidly approaching a year of trying), I had my annual OBGYN exam. I told them a very nutshell version of our attempt-to-conceive story (“We’ve been trying for 11 months, my cycles are VERY regular, I always get positive indicators on OPKs, and I get a temp rise every month after I ovulate which stays high through the end of my cycle, I don’t know what’s wrong!”). They decided to put me through two cycles of Clomid. For those of you who are fortunate enough to not have to know what Clomid is, it is basically a hormone that tricks your brain into thinking it is not making estrogen, thus kicking your body into producing MORE estrogen than you actually would, which is supposed to spur your body to make better (and possibly more) eggs that cycle. They said that if after two cycles of Clomid there was no success, they would refer me to a specialist.
First round of Clomid resulted in absolutely nothing. It basically put my body through the ringer for no apparent reason. I got 9 days in a row of “high” fertility, never a signal of peak fertility, and got my period a week early. This is not to mention a whole host of physical side effects and the roller coaster of emotions thanks to my new levels of estrogen. Wholly frustrated and now over a year after we started trying, I got to a new level of pissed off. And accepted, for the first time in the whole process, that we were within in the throes of the “I” word.
About a week after the first round of Clomid failed, the rest of the country celebrated Mother’s Day. I mourned Mother’s Day. The entire day was an exercise–and a failure–in not crying. Having to sit through an hour-long mass that consisted primarily of praising the worth and importance of mothers in our lives, celebrating the moms in the room by making them stand, and generally otherwise making me feel like absolute dog shit. This was the exclamation point on the weekend, because the day before, we found out some of our very best friends were pregnant after only a couple of months trying. By noon I wanted just to go home and go to bed. But, of course, we couldn’t. And we didn’t. And so the rest of the day, I sat around with family and pretended I wasn’t dying inside. But I was.
My second round of Clomid might have been worse, emotionally, than the first round, although considering the timing of Mother’s Day, it wasn’t. Everything was looking a lot more “normal” during my cycle. At least at first. I got my signal of “peak” fertility, but then days followed and my temperature stayed low. I think this was enough for me to subconsciously accept that I had probably not ovulated. But the hopeful idiot inside me told me otherwise. So the two week wait went by and Day 27 landed on the day I met my beautiful (then) 9 day old nephew. And… no period. On Day 28 I took a pregnancy test, and it came back negative. And still… no period. On Day 31, I took a pregnancy test, and it came back negative. And still, this whole time, I stayed hopeful. On Day 34, a week late, my period showed up.
And so I took a couple of weeks off. No temperatures, no pee sticks, no pills, no appointments. My whole life felt like an exercise in fertility-futility, and I was tired of it. So I let the rest of June fade by with no plans, in an effort to regain some of my sanity.
At the end of July (15 months of trying), I was referred to a reproductive specialist. After a three hours of every question you could possibly think of regarding reproductive history, and almost two hours of waiting, we met with the doctor for a grand total of three minutes. It was just long enough for him to tell us that I was probably ovulating based on my cycles, but he wanted to do a bunch of lab work on me and Eddie, a transvaginal ultrasound on me, and a run of the mill pelvic exam to check for a whole host of things. Based on the nature of human biology, and based on my insane travel schedule last Fall, that took three cycles to accomplish.
In October (18 months of trying), we met with him to discuss the findings. It turned out that all of my lab work and all of Eddie’s lab work came back normal. He said my hormone levels were really good, I was ovulating, so that was all good. However, he suspected I had moderate endometriosis based on my pelvic exam. But it wasn’t severe because it was not picked up in my ultrasound. So his plan was for me to have laparoscopic surgery to remove the endometriosis (which basically creates a toxic environment for conception, but oddly enough, not implantation or pregnancy itself). Without laparoscopic surgery, really my only chance of getting pregnant was IVF.
At this point in the process, we decided to tell our families. The natural next question was, “How do you feel about this?” And the answer was, I didn’t know. I was happy to know what was not the problem and that I could confirm what I believed all along – that my ovulatory system was working like it should and JEM had a whole brigade of swimmers at the ready. I was happy to know that there was a plan. (I love plans.)
I was not happy that our chances of conception were only 60%. I used to think 60% was a lot. Well, maybe not a LOT, but enough. Hell, I only needed 60% to pass the bar in New Mexico. If someone tells me that my chances of something bad happening from a chosen action is 60%, that’s definitely enough of a motivator for me to not do it. If someone told me the odds that I would win the lottery were 60%, of course I would play. 60% is more likely than not. It was more likely than not that laparascopic surgery would result in a successful pregnancy for us. And I like those odds framed in those terms.
But deep in the back of my mind–or, actually, right at the front of my mind–was that mean voice that lives in all of our heads (and who, in some minds, speaks louder than others) that reminded me that, so far, the odds had not worked in my favor. It reminded me that 92% of couples trying to conceive do so within one year, and we were not one of them. And that scared me. Because I hated getting my hopes up. My hopes had been as up and down as my [normal] hormone levels. So I was still somewhere between hopeful and pessimistic. I didn’t know if my heartstrings would allow me to swing all the way to the positive side for fear of the pendulum swinging back.
At the end of October, the surgery was done and completed successfully. They removed all the bad stuff and confirmed through an HSG test that I did not have any type of tube blockage. He said the surgery went very well and to call him if by February I was not pregnant so they could put me on hormone therapy to try and speed things along.
The bottom line was that once the surgery was done, I had a 10-12 month window to try and get pregnant, and the odds were about 60% for having a successful pregnancy. After that, the endometriosis would become a problem again, and basically our only option at that point would be IVF (also only about a 60% chance of a successful pregnancy). IVF is a cost-prohibitive procedure since it is fully out of pocket and not covered by insurance. Needless to say, I was ready to start 2016 (21 months of trying) with a clean uterus–er, slate.
Fast forward to the last week of January, 2016. I had just finished my third cycle post-surgery [read: I had just started my period.] I decided I would go on and start the hormone therapy in an effort to speed things along. What I didn’t know was that hormone therapy works best with IUI, or intrauterine insemination. IUI basically takes ALL the fun out of baby-making. During the first week of my cycle, I would be required to have an ultrasound so they could check how many follicles I had developing. Then, over the course of the next five days, I had to take a combination of [very expensive] pills and self-injected hormones to beef up my egg production so I would release more than one follicle and increase my chances of conception. THEN, on about the 12th day of my cycle, they would give me another injection that would trigger ovulation within 24 to 36 hours. The following day, they would directly insert Eddie’s “sample” into me at the doctor’s office. After two weeks, I could take a pregnancy test. Despite all of these shenanigans, IUI still only has about a 20-25% success rate for women in my age group. Oh, it also costs about $1,100 a cycle, all out of pocket.
The hormones were not horrible, meaning they did not make me feel any more crazy than I was already feeling. Injecting them, on the other hand, was not my favorite activity. Stabbing yourself in the stomach with a needle is not up there with my most positive experiences. However, by the time IUI came around, I had three ripened follicles ready to hatch eggs, so I was, once again, very hopeful.
Two weeks later, on a Friday, I took a pregnancy test. Negative. I was surprised, but not defeated. I would just wait a couple of days and see what happened. Two days later and still no sign of a period, I took another pregnancy test. Still negative. At this point, I basically gave up on that cycle. I knew the chances I would have positive test after I was three days late was all-but-impossible. And yet still, the hopeful idiot talked me into thinking positive. Two days later, I took another test. Still negative. I really hate that hopeful idiot. She can talk me into anything.
A week late, my period came. Determined that IUI round number two would be the one, I called my RE to set up my next round of appointments. I re-ordered my $500 in hormones and showed up that Thursday ready for my ultrasound. After two hours in the waiting room, I started getting annoyed. Luckily, I was called in soon after and assumed the position in the stirrups.
“Did you empty your bladder before you came in here?” the resident asked me. “Yes…,” I said, staring up at the ultrasound screen at the huge black blob. “Huh. Interesting. I think that’s a cyst. Let me get Dr. Noble in here.”
Because of the hormones, one of my follicles had turned into an ovarian cyst. Not just any cyst. A 5 cm cyst. My doc’s exact words were, “Usually your ovary is about the size of a walnut. This cyst on your ovary is the size of an orange. It’s nothing to worry about, just a little hiccup. We will wait a cycle for it to shrink and then we can resume treatment. By the way, don’t do any strenuous exercise or you could cause ovarian contortion.” Oh good. That doesn’t sound worrisome at all. And then he said these words: “Have you ever taken the pill before?”
The pill? As in the Pill?
“You mean like birth control pills?”
“Yes, I’ve taken birth control pills.”
“And you tolerated them well?”
“Sure, I tolerated them fine. Why do you ask?”
“We’ll need to put you on a cycle of birth control pills to shrink the cyst.”
At that point, I could not get out of the office fast enough. The lump in my throat was as big as the cyst in my pelvis. Birth control? Are you kidding me? I paid for my sonogram and barely made it out the door before the tears started coming down my face. Once I got to the Jeep, all hell broke loose. After 22 months of trying to have a baby, you want to put me on birth control?
That was six weeks ago. I did my duty and took my birth control pills. I never went back to follow up on the cyst, but I assume it shrank away because I have not felt any detrimental effects from it. But I think that was the end of my IUI journey, at least for now. I no longer have the stomach to put my body through the roller coaster of artificial hormones. I no longer have the will to sit for hours on end in a waiting room. I am tired of having nurses talk to me about fertility treatments as though they’re talking about brands of cereal. I am tired of having to drop everything, both work and personal, to make it to endless doctor appointments. I am tired.
So, here we are. Exactly two years from the month we started trying. And we are back to the old fashioned route. There are some more holistic, alternative options I’m looking into for the remainder of this year, but I have all but resigned myself that IVF may be our only legitimate option left. I think by this time next year we will have been able to save enough for IVF, so we may explore that option more when the time comes.
Here is what I know: I am lucky. I am lucky that I have JEM as a partner in this whole awful mess (and who agreed to let me put our personal life out there), who has been 110% supportive of me, understanding when I freak out, cry every 27 days, get pissed off for no reason whatsoever, schedule sex like it is a court hearing, try every over-the-counter remedy possible, and just generally be me [read: a weirdo]. I am lucky that I have health insurance that has covered a lot of my fertility treatment . I am so lucky to have understanding family and friends (those who knew) who have been so sympathetic, empathetic, positive and uplifting during this process. I am so lucky to have beautiful friends with beautiful babies and toddlers that have been able to sub-in to feed my little person cravings. I love being Auntie Rae Rae to both my actual nephew and “surrogate” aunt to my several unofficial nieces and nephews. I am so lucky to have been able to share in the joy of two close friends who found out they were pregnant, knowing I was dealing with infertility, and still felt comfortable enough with me to want to include me in the celebration. I am lucky to have been able to travel to amazing places this year and participate in a whole host of activities that would have been all but impossible to do if I had been pregnant and/or had a newborn. I am lucky that I have two huge dogs that I can dote on and spoil and who remind me that I am already a very loved mother of two. Mostly, I’m lucky to lead what amounts to a charmed life with wonderful people in it, and blessings around every corner.
And now, for your PSA of the evening: April is infertility awareness month. Remember that one in ten couples struggles with infertility, and one in four women suffers a lost pregnancy. Remember that your innocent question asking when someone is going to have kids could be a reminder of the huge gaping void they feel in their life. Remember that not all pregnancies are planned, and not all couples without kids are trying to keep from becoming pregnant. Getting pregnant, being pregnant, staying pregnant and becoming parents are all extremely emotional, personal decisions, some of which we have no control over. So be sensitive to those around you of child-bearing age because you never know what their circumstances are.