The Great Fertility Hand-Off

I received a package today. Normally, mail time is a highlight of my day (#realtalk #oldandsad). Aside from all the bills (SO MANY BILLS), it usually brings with it all kinds of fun stuff. Paychecks! Birthday cards! That thing I ordered from Amazon! Today was no exception. FedEx appeared, dropped off the goods, and I tore it open. I was excited. I knew exactly what it was and I was ready for it. But when I opened it, all that excitement quickly turned into something else.

Something heavy.

Something messy.

And the worst: something totally out of my control. 

This package contained the torch of the IVF Olympics, the first symbol of The Great Fertility Hand-Off: my first cycle of IVF medications.

My kitchen island looks more like a torture chamber these days.

And just like that, all the pressure of this whole making-a-baby escapade transferred from Bobby (where I liked it just fine, thankyouverymuch) to me.

You see, in theory, all of this medical intervention we're using to get pregnant is an effort to bypass Bobby's fertility issue: his low morphology. 

[Before we move on, I need to take a moment to say congratulations to Bobby's little swimmers. His most recent semen analysis showed that he has 2% - not 0% - morphology. Go, Bobby tadpoles, go!]

As I was saying, until now, the reason we weren't having any success was because of an issue with Bobby. I felt safe in my cocoon of fertility, a cozy spot from which I played the role of supportive wife as Bobby grappled with what I know was an incredibly emotional process for both of us, but especially him. And Bobby handled the stress like a pro, probably way better than I would have. Ok, definitely way better than I would have. There was a brief moment early on in this process where I was mistakenly told I might have premature ovarian failure and I didn't handle it with nearly as much maturity as Bobby handled his diagnosis (think tears and all the emotions and lots of self-pity). Yes, this has been so hard on Bobby, but for the most part, he handled the immense weight of his infertility diagnosis with grace, sensitivity, and humor, and I've watched in awe with an ever-deepening love and overwhelming appreciation for this man every step of the way.

But now, with IVF and ICSI (pronounced ick-see), we're sidestepping the problem that has been holding us back. From here on out, if we don't conceive, IT'S ALL MY FAULT. Yes, yes, I know that's totally irrational, but irrational fears are still fears nonetheless. And this fear is real.

WARNING: I'm about to say all kinds of words about the female anatomy and menstrual cycles. If you find that kind of stuff offensive, this probably isn't the blog for you (also, grow up).

For all you natural conceivers out there who are fortunate enough to not have to know a thing about this, there are many steps in the IVF treatment cycle, and thus many places where my body can fail me (and us) in making a baby. Here's a brief rundown:

PHASE 1: STIMULATION

It all starts with day 2 of my cycle. That's when I officially begin treatment - and by treatment I mean up to 3 self-administered injections daily, oral medications, and a few 1.5" needles straight into the coolie (in addition to about 10 check-ups over the course of 2 weeks to do blood work and barrel-of-laughs transvaginal ultrasounds. Did I mention how fun this is going to be?). The aim here is to stimulate my ovaries just enough to make a whole bunch of eggs (the body normally makes about 1 on its own each month) so they can be harvested later.

How I can fail: Mix the medications incorrectly; inject myself incorrectly; accidentally hit a major artery and bleed out (kidding); OHSS, or ovarian hyperstimulation syndrome, in which my ovaries go bonkers from all the hormones and I end up in the hospital or, you know, dead (not kidding, but this is very, very rare).

PHASE 2: RETRIEVAL

After about two weeks of medications - and assuming I don't screw them up - it's time for the docs to put me under anesthesia, poke holes in my uterus, and retrieve the follicles growing on my ovaries (which hopefully contain some eggs) with a little sucky tubey thing. Meanwhile, Bobby is in another room providing a sample so his sperm can be whisked away, injected into my eggs (that's the ICSI part), and then cultured in a petrie dish for a few days. Isn't it romantic? Upside: I get drugged up. Downside: Did you read the poking holes in my uterus part?

How I can fail: Not produce enough eggs; not produce healthy eggs; not produce any eggs at all. No pressure.

THE WAIT

At this point, many people would begin gearing up for transfer day (more on that below). However, Bobby and I have opted to put all of our eggs in one basket (see what I did there?) and get genetic testing done on our embryos (assuming we come away with any). Because we're footing this procedure 100% out of pocket, we want to do everything and anything that will give us the best chances for a healthy pregnancy in one cycle (again, no pressure!). Genetic testing will help us eliminate any embryos that likely wouldn't have made it very far once transferred back into my uterus anyway. This takes about two weeks, so the embryos are frozen and then transferred during my next cycle about one month later.

How I can fail: Oh, there are many ways, but for this month, none have to do with fertility.

PHASE 3: LUTEAL PHASE

A mostly meds-free month will have elapsed by this point, and then, right about halfway through my cycle, Bobby will give me progesterone shots (those 1.5" needles in the booty again, oof) for 5 consecutive nights leading up to transfer day. This is to hopefully thicken my endometrial lining and create a cozy, welcoming environment for our embryo.

How I can fail: Not produce an endometrial lining that's thick enough; produce an endometrial lining that is too thick. Essentially, tell my poor little embryo that there's no room at the inn.

PHASE 4: TRANSFER & THE TWW

This is the biggie, guys. On day 5 of my luteal phase, I'll head back to the clinic to have our 5-day-old embryo transferred into my uterus with what is, as I understand, the spitball method. No anesthesia here, unfortunately. Just a quick wham, bam, hope you implant, mam. We go home and then begin what all of us on the TTC (trying to conceive) journey refer to as the dreaded TWW - the two week wait. And there's not much more to it than that: for two weeks, we wait, and hope, and pray (even though we're not the praying type) that our embryo implants and I'm officially pregnant.

How I can fail: Oh, just like, not implanting or getting pregnant, essentially flushing about $20,000 (give or take) right down the drain along with our hopes and dreams of becoming parents and being left with nothing but the painful choice of giving up or starting the whole process again.

So here we go. If all goes according to plan, this time next week I'll be injecting myself for the very first time and the weight of it all will officially be on my shoulders.

Body, don't fail me now.

Conception/Misconception

In a way, we’re all victims - victims of misinformation and a tendency, as a culture, to avoid talking about the uglier sides of life. This fact becomes all the more apparent when you have trouble conceiving. A quick Google search for “tips for getting pregnant” will lead you down a rabbit hole of terribly unscientific, unfounded, and completely misguided advice (this is the fertility version of typing “headache” into WebMD - just don’t do it). Eat this, don’t eat that, drink this, don’t drink that, try this position, sleep this way, exercise more, exercise less, manifest, distract yourself, work more, work less, do this, no this, no but THIS really works.

These well-meaning “experts” would lead one to believe that infertility is an easy fix and, if you’re not getting pregnant, you must be doing something wrong. Eat pineapple core after ovulation! Prop those hips and lift those legs after sex! Try yams for twins! Down some cough syrup! Smear yourself with lamb’s blood and wait for a full moon! And my personal favorite: Just relax and stop trying so hard! I’ve heard them all and yet here we are.

When someone suggests a new “trick” to get pregnant.

But there’s something particularly cringeworthy about that last one. However good-intentioned, this piece of advice implies that infertility is a state of mind instead of a medical condition; that if I believe it, I can conceive it! It suggests that if I just get my thoughts in the right place and open myself up to the universe and its preordained plans, poof! A baby! See, it was all in my head after all!

I’m rolling my eyes so hard I’m afraid they might get stuck in the back of my head.

From the time you get your first period, it’s drilled into your head how easy it is to get pregnant, like if a guy even sneezes in your direction at the right time of the month, well, sorry kid, you’re a momma now. Most of us spend the better part of early adulthood actively trying our hardest not to get pregnant, because we’re taught that the moment we let our guard down, it will happen. It’s just that easy (in fact, it’s so easy that there is a multi-billion dollar industry dedicated to preventing it). And for many, it is.

But what about the rest of us (and there are a lot of us)?

We’ve been indoctrinated from such a young age to believe that our ability to get pregnant is a given; that it’s what our bodies were designed for; that our ability to conceive is what makes a woman a woman and a man a man. Perhaps these false - though widely accepted - notions are why infertility is such a taboo topic. They’re what make an infertility diagnosis feel so shocking and shameful, like we have some terrible disease or personal shortcoming that we should never talk about or acknowledge outside of those designated places where “our kind” secretly commiserates.

Case in point: Since we first shared this blog just a few days ago, countless women and men from all parts of our lives have reached out and shared their infertility stories with us in solidarity. Many of these people now have children, and to this day, very few of them have shared their infertility struggles with anyone outside of their very closest friends and family. Their child is a living, breathing miracle of science, but few know it. These people have silently and secretly battled through what I can tell you firsthand is an immensely trying ordeal, mentally, emotionally, and physically.

Now, let me be crystal clear: This is in no way, shape, or form meant as an indictment of the brave people who have come to me to share their stories. My heart is bursting with gratitude for these warriors who have chosen to reach out to share one of the most painful periods of their lives just to take a bit of that pain from mine. I fully and whole-heartedly understand their choice to stay quiet. No, the blame for their silence falls squarely on the shoulders of a society that has forced them to suffer beneath a veil of shame.

So if conceiving is supposed to be so easy, then what’s wrong with all of us?

That’s a question we’ve asked ourselves a million times over the last few months. Why us? What did we do wrong? What could we have done differently? And the answer? Not a damn thing. Life isn’t fair. In fact, sometimes it’s downright brutal.

But I don’t have to tell you that.

We all have a cross to bear, a battle we’re fighting behind closed doors. This process has reminded me that it’s so important to be kind, to be gentle both with myself and others, and to consider the impact that my words, however good-intentioned or harmless they may seem to me, might have on others. None of us truly knows what anyone is going through outside our narrow view of their world, what thoughts race through their minds when they turn the lights off each night, and what reality they wake up to each morning. A smiling face often conceals a breaking heart.

And if you want tips for getting pregnant, ask an infertile couple. We’ve tried it all.

A Dream Deferred

It was the dream I mourned the most when I heard the news. I'd taken the dream for granted, assumed it was a given. It was part of the master plan, the script I'd read and revised a thousand times, the movie emblazoned on the backs of my eyelids. We won't be part of the statistics, I'd tell myself. We live healthy lives. We eat right, exercise regularly, get our eight hours on most nights, use organic and all-natural products... and, of course, there was the dream. The one that doubt had not yet tainted.

The dream went a little like this: There'd be a twinge. A feeling. I can just tell. A stomach full of butterflies as I wait for the test results. The uncontainable excitement when I see the second line. Running to Bobby to shove the stick in his face so he can see for himself. We're going to be parents. We did it. Jumping on the bed, dancing, crying, plotting how we'll share the news with our family and friends. A boy or girl? What will we name it? A nursery to decorate! 

The first few months were fun in all the ways you'd expect trying for a baby to be fun: the planning, the daydreaming, the trying. The first negative test was upsetting, but only fleetingly. It's only the first month. Most people don't get pregnant that quickly. Onto the next! Two, three, four months went by and the excitement built, the hope never waned. At five months though, what was once a brief sadness of another negative test, another period, became a gut punch. It was around this time that I got the feeling that something wasn't right. Not quite wrong... but off. Despite all the studies that show many healthy couples take up to a year to conceive, I just knew. Something isn't right. The thought worried at the back of my brain with each failed cycle, but I forced myself to ignore it. Not us. It won't happen to us.

It was somewhere around the sixth or seventh month that we decided it was time to investigate. With the exception of a brief scare on my side that was the result of a doctor misinterpreting my hormone test results, all signs pointed to things working well in my reproductive system. I had even undergone an ultrasound months earlier, for unrelated reasons, the results of which led my OBGYN to assure me that I was "very fertile."

Relief.

Briefly.

The next step was for Bobby to see a urologist. His first semen analysis showed that all of his numbers (count, motility, volume, etc.) were at or above normal, except for one: morphology. Morphology has to do with the shape of sperm and, therefore, its ability to penetrate the egg. A normal morphology range is 4-14%, meaning that's the percentage of "normal" shaped sperm a man has to have to be considered fertile. Bobby's was 0%. He also had white blood cells present in his sample, which the doctor thought could be the cause of the morphology issue. He was put on a round of antibiotics and an anti-inflammatory to try to kick any underlying problems. We left with a plan, a follow-up appointment for six weeks later, and - outwardly, at least - hope. Recently, we admitted to each other that we both had a terrible, gnawing feeling from that point on. Some things you just know. And we knew, although neither of us said so, aloud, just yet. We put on our brave faces - for ourselves, for each other, and for the few people around us who knew what was going on - and followed the doctor's protocol. And we waited. Lots of waiting.

The next appointment with the urologist showed that nearly every single one of Bobby's numbers improved, except his morphology. Still 0%. But the doctor felt hopeful that, because the treatment had improved every other aspect of Bobby's sample, another round could move the needle on his morphology. More prescriptions. More brave faces. More waiting.

In December, right before a holiday trip Italy, we went back to the urologist to see if the second round of treatment worked. I had a pit in my stomach the whole night before and the morning leading up to the appointment. We had tried everything - medications, supplements, vitamins, dietary changes - and, despite my gut telling me otherwise, I found myself hopeful. We had even joked about how we could make our "miracle Christmas baby" on our trip. Bobby produced his sample, and we waited... and waited. Infertility, which no one tells you, ever, anywhere, requires more patience than you ever thought you could muster. Finally we sat down with the doctor.

Every single number improved.

Except morphology.

0%.

We were given the diagnosis of male-factor infertility that left us with no option but IVF with ICSI (an additional procedure in which the sperm is injected directly into the egg before being transferred back into the uterus). We were, officially, a statistic. We were infertile. And so, off to the fertility specialists we go.

Hearing the i-word is devastating for so many reasons. There's the fear that you may never have a child of your own, made with your DNA. I wonder if I'll ever get to see what our child would look like, sound like, be like. I fear that I'll never get to experience pregnancy and delivery. I worried then, and still do now, about how Bobby was taking the news; seeing the person you love most in the world in pain, especially when there's nothing you can do about it, is excruciating (but more on that another time). And then there was the dream. It seems trivial to someone who hasn't experienced it, but knowing my pregnancy journey wouldn't be anything like I envisioned is gut-wrenching. Even if I do get pregnant with IVF, all the fun and romance has been zapped from the entire experience. It's now going to be so clinical, involving doctors, nurses, technicians, anesthesiologists, coordinators, insurance companies, pharmacies, and a million other people who don't belong in our bed. And there is no guarantee that, even after all that, we'll end up with a baby. That was the day I lost the dream. And I cried for so many reasons, but also for the dream.

The thing that no one tells you about infertility is how incredibly isolating it can be. There's a certain stigma with infertility, even now, that keeps those who experience it always on the outside. No matter how many listening ears you have, unless those people have experienced it themselves, they simply can't understand how it feels. At some point, you begin to feel like your infertility is a burden to everyone around you, no matter how wonderful, supportive, and good-intentioned they are or what they say to the contrary. You don't want to upset your parents, who will be upset simply because a child's pain is the parent's pain, too. You don't want your friends to feel awkward or unsure of how to respond. If your partner is the one with the infertility diagnosis, you don't want them to feel responsible. This deeply emotional experience devolves into a series of strictly medical and progress updates devoid of any emotion at all. And once you begin to have trouble, it feels like everyone around you is suddenly getting pregnant. You don't want to diminish their joy with your pain, so you smile, and tell them how happy you are - and you are happy for them. You're just also devastated for yourself.

And you feel so very isolated.

That's where we are today. Alone, but together in our loneliness, which you come to find is something incredibly special, in a way. The only silver lining in this process so far has been that it has, in so many weird and unexpected ways, brought Bobby and me closer. It's proven to me that infertility sucks (like, big time), but there's no other man in the entire universe that I could go through something like this with. So there's that. And the sadness and loneliness, too, but love has a way of outshining them both just when you need it most. Love will get us through this, whatever the outcome.