An Interesting Case

Here is what happens when you spend your 30s trying to have babies. You create in the process the War and Peace of medical records. Mine was getting out of control -- a menagerie of random test results, dictated notes from physicians, ultrasound reports. It was time to clean it up.

So before I met with the new RE, I sat here sorting through the mammoth stack of paper, letting my nerd flag fly as I categorized the records by stage: "Recent recurrent losses," "Full-term pregnancy," "IVF," "IUI/Clomid." Of course I had to stop every once in a while to read something monumental and remember some milestone from the past six years, like road signs on some highway of doom. I'd see something like the surgeon's note on H's c-section and erupt in tears, realizing that I could be doing this without an actual child already living in my house, that my story could have kept being sad without the joyful vacation of a bona fide pregnancy that resulted in that Holy Grail of assisted reproduction: a live birth. Then I'd realize my walk down memory lane was keeping me from a very important show like Housewives or Keeping up with the Kardashians, and I'd refocus on the task at hand.

Anyway, the result was a highly organized, epic medical record, complete with an at-a-glance timeline I created for the top of the stack. The doctor was duly impressed. He brought us into his small office and was sort of hopping around like a cat on a hot tin roof as he started talking. I don't know if it was that he was excited by my case or the fact that we were veterans that knew what was going on, but he was pretty jazzed about my faulty uterus. Which was helpful, because as I said I'm exhausted by this process and went to the appointment with a certain degree of weariness about the whole thing. He basically said we should do IVF with the genetic screening, and gave us a rather convincing sales pitch about that, even though he was careful to say that the ultimate choice was up to us. I did ask what it meant that the last fetus tested as chromosomally normal, and wouldn't that mean the screening wouldn't really do any good, to which I received one of those circuitous answers that you can't really remember or repeat verbatim. It was essentially that those tests are ultimately not totally conclusive as there can be an unhealthy fetus that tests as healthy. Which makes no sense, but whatevs. I guess it's one of those things where you can't let the facts get in the way of hope.

So here I am. Waiting for my period so I can have a saline sonogram and then possibly shell out a good $8,000 for IVF with chromosomal screening (with insurance) so I can live the rest of my life knowing I went to the ends of the earth to give H a sibling. I'm a little torn because I was told at a second-opinion consult with an RE in my old city (who I almost cycled with before moving to my new city; more on those visits in a future post) that the screening probably wasn't necessary and I think I'm sort of in his camp. I actually think what's happening is that the PCOS is still at work, exposing my eggs to the wrong concoction of hormones as they develop, and that IVF rights that by letting the docs take control of your body, which when left to its own devices just cannot be trusted to produce a living human being. That's my Google MD assessment.

So anyway I'm torn and not sure how we'll proceed, and I guess just hoping my period takes another three months to arrive so I can have a break and think about it.

And oh, by the way, another medical professional let it slip and inadvertently blurted out the gender of my loss in May and this one was a boy. A brother in the making that my H will never know.

Forty-Six Healthy Chromosomes. Zero Explanations.

In general, I don't think of the fetuses I've lost as lost children. That is an evolution from my first loss, pre-H, which, because it was my first-ever pregnancy, felt most like the loss of someone. In general, I find it easier to go along with the doctors and assume these pregnancies were the beginnings of life forms that were ultimately incompatible with human life, and my body had the good sense, for better or worse, to recognize that and let them go.

But every once in a while there is a wild card that throws off that construct I've tried to build neatly around these losses. There was the second of these past four losses, last year, that looked perfect on-screen right up until the moment it left my body, suddenly, without explanation. That one still haunts me. What was wrong with it? Did my body reject a healthy baby? Could that have been another sweet little H who might have walked and talked and said funny things?

And now I have another one to ponder, another pregnancy that suddenly seems more like it could have been a loss of an actual person than some ersatz collection of cells. The OB called yesterday and told me that the karyotype on this pregnancy came back showing no chromosomal abnormalities. Which is now sitting out there like some ominous clue in a bad suspense movie, leaving us to ponder why, then, the heart of this little creature started beating but couldn't become anything more. Why it then died too, joining four other siblings, or mizukos, or promises of lives that were, for whatever reason, defined or never to be known, not meant to be.

It's hard to know sometimes how to read the highway signs of life. What am I to take away from this fourth loss? Do I listen to this nagging voice saying maybe it's time to toss that proverbial towel? Or do I listen to this other voice that says this is your dream, and you don't walk away from your dream just because the going gets tough? What if I'd walked away before H? Some people do, and no one would have blamed me if I had.

My meeting with the new RE is tomorrow. For the first time since I started this slog six years ago, I have no plan, no direction, no clue what I want to do. All I know is that I've spent my entire 30s to this point trying to have babies, and I'm exhausted.

Day Three

I was doing fine, but I forgot about day three. That dreaded day three. It doesn't matter how you feel in your head, because when the hormones take a nosedive, they're taking you with them. My OB told me about the curse of day three when I lay in my hospital bed weeping, inexplicably, after delivering a perfect little baby three years ago. The day three business of dropping hormones also happens when you get a sick fetus sucked out of you, and this is just one of life's unfair, dirty little secrets. You can't be okay about it even when you really feel okay about it, because the physical process is going to force you to cry.

And cry.

And cry and cry and cry until you're limp and the only thing you know how to do is binge eat ice cream.

I also drove myself to get sushi for dinner, blasting Florence Welch on the way. Next up: a reckless caravan of additional verboten pregnancy foods including unpasteurized cheese, meat sandwiches from food trucks, etc. And, as soon as I'm done with this doxycycline, a bottle of wine.

Habitual Aborter

Serious shizz has gone down, people. We moved again -- a major, out-of-state move this time. Because I love my husband and he hated his job, because, let's face it, I was bored in the little town where we last moved, and apparently, because I'm a glutton for punishment, which upending your entire life when you have a preschooler so clearly is.

But let's start with what's germane to this forum, namely: girlfriend realizes, a mere two weeks after arriving in her new town, that her period probably should have arrived by now. This cycle was all thrown off because I'd stupidly thought I could handle squeezing in an IVF cycle before moving. I thought, hey, I am the queen of multitasking! I can handle this! But no. I could not handle it. So after four days on the Pill I stopped the Pill and pulled the plug. And I had a withdrawal bleed (right after my regular one) so my RE said that could throw off timing and don't be surprised if it takes a good six weeks to get my period. 

So I wasn't worried when I bought the test. I had been talking to my friend that day (one Who Knows) and told her I was going to test but there was No Way, Repeat, No Way it would be positive. Which in retrospect makes no sense, because why would I be testing if I thought there was no way. But anyway when I got home from the playground I sat H in front of the boob tube and went to pee on another stick, and I'm telling you, the "Pregnant" line lit up before the control line, literally as soon as a drop of pee landed on it. I definitely shrieked from shock, and I'm pretty sure the words were, "You have GOT to be kidding me," and I later thought I would definitely have to rewrite history on that if this pregnancy stuck around. And then I thought, I will probably be punished for not being instantly filled with joy. But I'm sorry, once you've had a miscarriage or two -- or three, or four, if you're me -- if you are alive and a feeling human being and not a robot, your first feeling at seeing the two lines is dread-laced fear. 

Anyway, I will get right to the point: the D&C was yesterday. I don't know what was wrong with this one. I only know that when I went for my second OB visit (after scrambling to locate one in my new area who might be able to handle me), I was talking to the receptionist when I felt the gush of blood. I bled profusely as they did a scan and saw a sac and a yolk sac and sent me on my merry way with a 50/50 prognosis. I returned last week and the OB, who scanned me herself, told us there was a heartbeat but it was incredibly slow. We scheduled the D&C for yesterday and scanned again just to be sure. Another day, another still screen, another IV of sedatives, another vacuum ripping out what could have been my bonus baby. 

I didn't cry this time. Well, I did, just a little, when I heard "Isn't She Lovely" in the car last weekend, because it moves me and I was hormonal and the tears were sort of involuntary. But that was it. I never connected with this pregnancy, never allowed myself for a second to believe that it could come true. So there was nothing to mourn, really. I realize this could sound harsh and unfeeling to someone who's never been in these shoes. But trust me, after one miscarriage, or two, or three, or four (this was my fifth, all told, with one before H) bring you to your knees, you sort of reach a point where you don't have to do that again in order to let it go. It's sort of like shorthand, or muscle memory, or something. You sort of say to yourself, yup, this sucks so bad, but you don't have to actually go through the histrionics to reach the same conclusion. You decide you could spend some time falling apart but quite frankly you'd rather search on Pinterest for some decorating ideas for your new house.

So. I can read the writing on the wall (I'm smart like that). If I want another baby, I have to put on my big girl pants and do the damn IVF. There are moments, though, when I'm not sure. You know sometimes when you try really hard for something, like a new job? You buy a new suit, you arrive early to the interviews, you make sure you're totally on point. And then they keep having you back to meet with different people and you don't hear from them exactly when they tell you that you will, and you start to get the sense that you bought a new suit for nothing, that they may never actually hire you? And then the whole thing starts to jump the shark, and you feel like, damn it, if they don't want you then you don't want them either? 

That's how I'm starting to feel about this. Like, if being a mom of two doesn't want me in its fancy little club, then I have better things to do than to keep trying to sneak under the velvet rope.

I'm meeting with an RE in my new area in two weeks. We'll see if he can say anything that makes me feel hopeful again.

Stuck.

So, picking up again, here's where we are.

The miscarriage isn't over, ladies and ladies. My last beta was on Saturday, and the level was...drumroll...1.6. This is down from 3.5 the week before. I've been bleeding again, for the past week and a half. I found out I was pregnant in October. The calendar says it's January. Will this one ever end?

Meanwhile, there was one final, craptastic piece of bad news I needed to hear about this loss: the result of the genetic testing. I suppose I'm grateful we had a result at all, as I realize this is not always the case. But it's not easy, no matter how mature and rational you think you can be, to hear about what was wrong with the fetus you thought might be your baby. I shook while the nurse told me this one had Trisomy 8. And although I knew it may not be totally advisable, I let her also share that it was XX.

We all build our own framework of how we think the world works: who God is, how we're all here, when we believe life begins. We listen to politicians debate the same, and sometimes we vote based on those beliefs. But those views are all theoretical, aren't they, until the lines are all blurred when we find out we're pregnant with a much-wanted baby and then it's gone as quickly as it came. Our frameworks break down. We're left with questions, curiosities. This fetus had a beating heart inside of me. Yet Trisomy 8 is a condition incompatible with life. So was it ever alive? Can you have a beating heart and not be alive? Was it ever really a girl if it could never actually be a person? It makes my head hurt. To say nothing of my heart.

When my beta finally reaches zero I will go in for a recurrent miscarriage panel to ensure nothing else is going on other than wonky, old eggs with genetic defects. Then I will try one IVF cycle and see if it works. I have no idea if it will, or if this is a good plan or where I will be if it doesn't work. Or if it does. At this point, I have questions and no answers.

Friends and family members are getting good pregnancy news. I have authentic, deep, boundless joy for them. Truly. But may I also admit this thought: why not me too? It wouldn't take anything away from anyone else, would it, for the universe to grant just one more? Why not a wait that ends with good news, just one more time, for this girl too?

The One Where She Has Emergency D&C After Waiting to Avoid D&C

Well, that was fun.

Ready to hear the tale of how this latest pregnancy finally came to its miserable end, with a spectacular display of pain and suffering that only someone like me, with the worst reproductive luck in the history of humankind, could incur?

Well, gather 'round, friends. Pour yourself a glass of something good. I'm ready to tell it.

So last weekend I was nearing the end of my threshold of patience for "waiting it out." Although my history of uterine scarring (Asherman's) gave my doctor much understandable pause about doing a D&C, I was nearing ready to try Misoprostol, despite my own personal really bad luck with it (during the first of my five pregnancies -- the pre-H miscarriage following my first IVF attempt). Because let's be clear: Waiting to bleed out a dead fetus is most definitely not like "waiting for a period" as myriad health care providers will try to convince you it is. I was sick of feeling pregnant without the benefit of shopping for cute baby outfits. Call me vain, but I wanted the ability to fit in pants beyond my one pair of acceptable borderline fat jeans I keep around in case of emergency.

So I'd called my OB's office to give me the medication, and I'd decided last Monday would be the day I'd take it. The thing about a plan to take medication that makes you bleed your girl parts out is that you have to find a time in your schedule where it's convenient to sit on the toilet bleeding your girl parts out all day long. My husband agreed to stay home on Monday and watch H so I could do the deed.

Except last weekend I started spotting and then Monday morning I woke up with period-like bleeding. I felt very crampy on and off for most of the day. The cramps were quite heavy at times, and I can't say I was having a great time, but it all felt very manageable. Until it didn't.

I went upstairs to take a shower around 3:30. When I got out of the shower, I felt a gush of something and I feared looking down, but I really didn't see anything. I thought it was kind of weird but there's plenty of weirdness going on when you're passing a pregnancy so I didn't dwell on it. I went back downstairs to my perch on the couch to watch a Christmas special where Giada and a house designer remake someone's house and then teach them how to cook. I was silently cursing Giada for being so adorable and yet so hatefully, enviably skinny, when I felt another gush.

I ran upstairs.

It was blood. So, so much blood. So much blood I don't even know how to describe it here.

You know how they tell you that you will know you're bleeding too much when you soak more than a pad an hour for three hours? I would like to know right now who the hell came up with that ridiculous measurement. Because when you're bleeding too much, it cannot be contained by a pad, your underwear, your pants or the seat beneath you. It gushes out of you in a way that actually feels uncomfortable coming out of you. It feels like it must be stopped. Right now.

I ran outside, where my husband was playing with H. I told him I needed to go to the hospital. He heard me, but he is a man, so he thought I was telling him I was going to the hospital, like "Ta ta! I'm off to the hospital!" You'd think after all we've been through he would know better. I told him he would be driving me, thank you, as I was not interested in blacking out behind the wheel if it came to that. Except I was really upset, so I'm not sure it sounded calm and reasonable, or even like English. But he got the message and ran to the car with H.

When I got out of the car at the ER door, I felt more gushing. I literally waddled into the door, where I was greeted by three women, thank God. I sat down and promptly bled all over their triage chair. I really didn't need to say anything, but I told them I was likely hemmorhaging and needed urgent medical care. And I got it. They wheeled me directly back. Apparently bleeding is one of those things that gets you a ticket out of a two-hour wait in the ER, in case you're ever wondering.

Also, if you're ever looking for a good time, or to test your ability to think swear words urgently but not scream them out loud, I highly recommend a pelvic exam during a miscarriage at the exact same time that they're trying to jam an IV into your arm. The good thing is, you're not sure where to direct your discomfort sensors. Is the feeling of having blood clots grabbed out of your lady bits more or less comfortable than a tube entering your vein? The jury is out, my friends.

After some waiting, I was then wheeled to an ultrasound with the Worst Ultrasound Tech in the History of Infertility and Pregnancy Care. I won't trouble you with the details except to say that she was slower than slow except when she needed to tell me something urgent like, "You have lots of fibroids!" or "Wow, you are bleeding a lot!!!!!"

Finally, I was wheeled back to my little ER room, H having been released to a very kind friend willing to come and get him and take care of him for the rest of the night. The ER doctor came in and told me -- newsflash -- that I needed a D&C. She said there was a good amount of tissue remaining and I'd probably just keep bleeding as I was until it was out. She said the OB (a partner of my own, who was not the one on call) was on his way in and he'd come and discuss it with me when he arrived.

Meanwhile, my one stroke of luck sauntered in: the best anesthesiologist on the planet. Not only had she gone through four D&Cs herself, but she actually said the words, "You tell me what you want for anesthesia." You know, I can't believe it's true that it's actually hard to find a doctor who is willing to be kind to you when you're going through something like a miscarriage, but it is. This doctor, thankfully, was one of them. I knew the D&C was going to suck, but I knew it would suck less with her near my head during the procedure.

Then, the OB walked in. With some hindsight, I think I understand why the conversation didn't go well. I think he thought he came all the way in to the hospital during his call to meet a patient who had presented with severe bleeding and that he would be hailed as a hero. Instead, he got a patient who was informed, hesitant and full of questions. Who dared suggest that he talk to her RE about her Asherman's case. Who asked questions about the way he would conduct the procedure. He didn't like it very much. He asked if my RE was the only one who could touch my uterus, why wasn't she on call 24 hours a day for me in case of this situation? He questioned the wisdom of waiting in light of the outcome. He was defensive and sort of generally not very nice to me, and since I was already fragile I broke down in tears immediately. I simply could not believe that I was in this situation, about to get the D&C I walked around with a dead fetus in me for three weeks to avoid, in a new care setting (because it felt like an emergency I went to the hospital near my new town, which is my OB's hospital but not my RE's), with a doctor who was not only new to me but who obviously hated me too.

Both of us sort of backed off after I started crying. I just sort of recognized the obvious, that I was in no shape to get up and go to a different hospital or wait for my RE to be available the next day, that I needed a D&C now and despite the doctor's attitude he seemed skilled (naturally I'd looked up his bio when I learned his name) and aware of the need to not go crazy with the scraping. I'd said my piece, he was aware of my concerns and I just needed to let him do his job. And I think he recognized he'd been overly defensive.

And so they wheeled me into the OR and I had the surgery. I was awake the entire time, with little more anesthesia than IV narcotic. I heard the tissue get sucked out of me. The whole time I was just thinking,

I never want to be here again. I don't give a crap about another kid. Just get me home in one piece to the one I have.

Recovery was quick. As I stood up from the wheelchair and got in the passenger side of my car, the fresh air against my cheeks brought me back to life. The streetlights had that muted glow of early winter and I had that sense of gratitude you have after being really afraid of something and then realizing everything was going to be okay.

I don't know where we go from here. I don't know why I have to be having another freak show nightmare miscarriage in the middle of Christmas. I don't know why this all has to be so hard.

All I know is, thank goodness it is Christmas, actually, because what would I do if it were just the dead of winter with the ice and the slush and without 10,000 sparkling lights all over the bushes outside my window? What would I do if I couldn't take this all away just by thinking about a boy upstairs right now who believes in Santa Claus with all his heart? A boy who reminds me what is possible if you just keep on pushing through all the pain, if you're crazy enough to keep trying even when a voice inside you says it may be time to stop?

The Invitation

I just declined a baby shower invitation. I got it a couple of weeks ago, right after I found out. I wasn't surprised at all when I found it in the mailbox, both because I was expecting it and because I've come to expect that the universe thinks it's funny to mess with me.

This shower is for a former co-worker, the loveliest girl you'd ever hope to meet. This is her first baby. She was the only person at work who knew I was going through infertility when I was going through IVF for H. She gave me an ear when I was desperate for one during the work day and, although she wasn't married at the time or remotely in the realm of babymaking, she was sympathetic and thoughtful. But the shower is next Saturday, I'm still walking around with a dead fetus in me and it just feels ill-advised to go. I just keep thinking of the advice we received in my mind-body program for infertility, to look at times like this with an eye toward self-protection. We got permission to say no to events like baby showers, without guilt.

So then why do I feel like such an asshole?

This feels just like the time when I said no to a college girlfriend's baby shower, when I'd just found out about my pregnancy with H -- I was pregnant, for crying out loud, with a good pregnancy -- and everything felt so tenuous and fragile, and I was still terrified. I just couldn't handle sitting there looking at baby stuff when it was so uncertain whether it would be mine too, in nine months or ever. And as soon as I hit send on the decline, I felt selfish, like a miserable person whose happiness for friends was contingent on her own fortune, an even fertility score.

What, exactly, am I so afraid of? I am not prone to public meltdowns. I'm pretty sure I can avoid a Kristen Wiig/Bridesmaids moment and restrain myself from knocking over the chocolate fondue fountain or attacking the giant cookie during the event. I'm already miserable, so even if I cried in the car all the way home, it really wouldn't be much different from what I'm doing now.

I definitely wouldn't attack the cookie. I could be gracious. I can be happy for others. I am. But I just couldn't bring myself to go and sit and look at the onesies. I couldn't say yes.