A decade ago, on the cusp of 28 and applying for jobs, I decided that I wanted to become an SMC. I was talking on the phone to my ex, referred to here as Dr. Boy, and he was prattling on about jobs that looked good for me, and I remember whining, but I just want to have a baby. A year later, after my first semester on the tenure track, I started hunting down REs in the area and within a couple months was sitting in her office for a consult. You're twenty-nine, she said, and you want to do donor insemination? She wasn't judgmental, and she certainly didn't say no, but it was clear that I was a first for her.
I came home from that appointment with an infertility diagnosis (628.9), which was clearly for insurance purposes alone. Other than a suspected case of luteal phase defect, there didn't seem to be anything to worry about. HSG showed my tubes were open. All my blood work—at least ten vials, I remember I almost passed out—came back fine. I did IUI #1 in June 2002 and started bleeding at 8dpo. My progesterone level came back at a measly 7, but by then it was too late to start supplementation. I did two more unmedicated cycles (badly timed, due to travel) and then turned to Clomid, which is what the RE had recommended all along. I got pregnant on my third Clomid cycle (#6 total) and experienced what felt like the longest miscarriage in human history. Almost six weeks of waiting to bleed naturally, followed by methotrexate and eventually a D&C. I actually started lactating afterward. In all of this, that was probably the lowest point of my life. Happy 30th birthday.
Wonderful Former RE (WFRE) had me take a mandatory 3 months off from ttc attempts. I started trying again in March, Repronex this time, strategically timed not to increase number of follicles but just to boost follicular development. I'd had a miscarriage, I'd been diagnosed with antiphospholipid antibody syndrome (at my request, she did an entire RPL workup, even though I'd only had one loss), and she absolutely did not want me pregnant with twins. I hated Repronex, and even at a measly ½ amp for 3 days, I ended up ovulating around day 10. I asked if I could try Clomid again, and only managed to ovulate even earlier. Then I had a cyst and was told I needed to take a cycle off; I did it anyway, unmedicated, ended up with 2 mature follicles. A little less than nine months later, after a whole lot of heparin and monthly ultrasounds, I gave birth to LG. Lucky Cycle #10.
My plan was to have two children five years apart. So when I hit 35, and LG was 3.5, I had my ob/gyn check my hormone levels. Everything checked out fine (my FSH was maybe 7?), other than a still wickedly low progesterone level. I really wasn't ready to start trying; professionally this was a low-point for me (my third year review) and I have to say the absolute worst age for LG was not 2 but 3.5. We're lucky we both lived through that year. Then she turned 4, I got through my review and had a semester off, and I bought 6 vials of her donor.
I had no reason to think I wouldn't get pregnant relatively easily. I thought maybe the universe owed me (ha!) and I might even get pregnant more quickly than I did with LG. I did two unmedicated cycles and one clomid cycle with Dr. Evil. On my second Femara cycle with Dr. Gorgeous (May 2009), I got pregnant. Very low but appropriately doubling betas; I asked for a fourth because I was paranoid and of course the pregnancy was over by 6 weeks. Repeat RPL testing: MTHFR. Start Folgard and heparin. Antibiotics to rule out infection. Still, the math said I was fine: I could easily write off the three cycles at Dr. Evil's (they didn't check sp*rm count, but the samples at Dr. Gorgeous's had low numbers and one was riddled with bacteria they needed to rewash, likely from being transferred from Dr. Evil's place). Even then, I was pregnant within 5 cycles.
I did another Femara cycle (June), an IVF turned to IUI (July/August), a real IVF (September/October 2009), a Follistim cycle (Nov 2009) that resulted in a freaky bleeding episode at 9dpo that Dr. Gorgeous could only explain by saying it was a very early loss. I plowed ahead and did an unmedicated cycle (Dec 2009); it was around then that she brought up the possibility of donor egg. But I figured that it took me 10 cycles to conceive LG when I was 29-30, so, really, there wasn't a reason to rush things. I wasn't happy about how long things were taking, but it wasn't completely unexpected. She agreed, and said the only reason to do donor egg (at newly 37) was if it was more important to be pregnant now than it was to be pregnant with my own eggs.
I took the winter off. Then I did two Femara cycles (March/April, 2 follicles). May 2010 brought a weird Femara-oops-there's-a-cyst-unmedicated-no-make-that-Follistim combo and a micropolyposis diagnosis (2-3 follicles). More antibiotics. June: Femara/Follistim hybrid (2-3 follicles). July: Menopur cycle from hell (1 follicle). August: IVF attempt #3 turned to IUI (3-4 follicles). September: unmedicated, questionably timed (2 follicles?). October: ½ dose Femara (1 follicle). November: unmedicated, questionably timed (1 follicle). December 2010: simultaneous Femara and Follistim (3 follicles, perfect lining on scope, E2 over 1100, progesterone at 62). And still, nothing more than a faint second line that could have been an evap line at 9dpo.
Diagnoses: ovarian dysfunction, diminished ovarian reserve, poor responder, low AMH, recurrent pregnancy loss, micropolyposis, APA, MTHFR. Dr. Gorgeous said I've been determined, more determined than most of her patients. I've tried DHEA supplementation, acupuncture, royal jelly, and more supplements than I care to name. I take Folgard, Lovenox, baby aspirin, and 400 mg Prometrium to deal with immune issues. She said we've given my body a fair chance. She said if I need to do another IVF we can do it, but she's pretty certain egg quality is an issue (3 beautiful follicles, she said, and still, nothing). When I asked for her opinion, WFRE told me in the spring that yes, DOR seemed likely but too early to move to DE; give it a few more months. Dr. Slideshow said in October that he'd give me a 5-35% chance on IVF with my own eggs, most likely no higher than 17% vs. 75-80% with DE.
I remember when I was 29 and attending a local SMC meeting one of the women who eventually adopted said she got pregnant on her 18th IUI cycle and then miscarried. I couldn't fathom doing 18 cycles. I've now done, I think, 20. There was another woman whose history I didn't entirely understand but had tried for a long time before doing DE around age 48. She was old enough to be my mother, living in an area of the country where women her age were routinely grandmothers. I looked at her and wondered how long could I keep trying, when biologically I had many many years ahead of me before menopause. And here I am now, still probably years away from menopause, with a decent FSH level, a low-normal AFC, and significantly younger than most women who turn to DE.
Logically, 20 cycles seems like more than enough. That I should have had more than a miscarriage and a possible chemical pregnancy or two in all these months. Dr. Gorgeous truly thinks I'm a good candidate for DE, that my problem is egg quality, but we'll use Lovenox/steroids just in case.
I'm trying to look at the facts. Is it worth spending approx. $9K and a couple extra months for a less than 17% chance of having a child who shares my DNA and the chance to prove to Dr. G and myself that I really did have one good egg in the batch? Do I need to have another cancelled retrieval or another batch of poor embryos in the lab in order to be able to move on?
When my OB recommended a c-section, 21 hrs into an induced labor that was going nowhere, I asked my doula--a natural childbirth advocate, former RN, mother of 6—is this reasonable? Her answer was yes. I still have doubts. I still wonder what would have happened if she'd let me labor just a few more hours. I'm still angry that the birth I wanted was stolen from me. But those feelings pale in comparison to the result, having a healthy baby, one I'd fought very hard to have and honestly feared I'd never bring home alive. Dr. Gorgeous has never told me straight out to do DE, but what she said yesterday--we've given your body a fair chance--was what I needed to hear. I will always wonder if a different protocol—EPP, for instance, or using pregnyl instead of ovidrel, or adding Menopur based on daily LH testing, or triggering earlier or later, or using more or less estrace—might have given me a better shot. But if the goal is the baby, isn't it worth the almost-sure thing?
I have enough superstitions about throw-away natural cycles that it's well worth $600 to forge ahead with an unmedicated IUI in January (someone needs to come confiscate my Follistim pen, really), unless I match with a donor, like, next week and can just go on the pill. But I've had two "last" cycles—beautiful cycles, one of which could have gone to retrieval if I'd wanted it to—that didn't pan out. I'm done, folks. I'm exhausted.
I showed LG a videotape last night of my ultrasounds from pregnancy with her. I want that again. I want that now. And I'm not going to let my vanity or hang-ups about my body's failure get in the way. Dr. Gorgeous is right; if I need to do an IVF, I should do it. But a co-cycle has the potential to ruin a very good thing.
This feels a lot like December 2002, when I was thick in grief with the loss of the baby I'm sure was a son. That loss changed me in profound ways but it doesn't hurt on a daily basis the way it did before LG was born. What I'm feeling now is much the same; I lost a baby who would be turning one in a couple weeks, my last proven pregnancy. I think I'm finally, really, grieving that loss, the loss of my fertility and the last pregnancy with my own eggs. And it really sucks. But the possibility of having a baby in my arms as soon as I can? To let LG have the sibling she so desperately wants, hopefully before she turns 8? I think I'd be stupid not to pursue it. The rest of it? Well, that's what therapy is for.
p.s. Valium is very nice indeed. It's a good thing I don't have any more of it or I might be an addict in the making.
