Judging by the chunky blood clot and Crinone combo that splatted into the toilet last night with startling velocity, CD1’s arrived. Between 6pm last night and 8am this morning, I had to make a decision. As I laid myself down to sleep last night my mind was darting back and forth from decision to decision. Every option was on the table:
- Call it quits for good;
- Take a break, enjoy our summer, and return to birth control until the fall;
- (Stupidly) try a natural cycle;
- Just do more of the same (injects, intercourse, intralipids, etc.);
- Do the same as before, but add IUI;
- Say fuck it all and do IVF with local RE; or,
- Say super fuck it all and do IVF and immune cycle management with my RI.
I’m not lying when I say that I was wholeheartedly embracing each of these decisions at various moments throughout the night. I literally had no idea which way to turn, and, even after making a decision, I’m still not sure it’s the right one. I’m just so tired, so weary, so spent. No decision seems right, no decision seems wrong. The only thing I was certain of was that a decision needed to be made, so I made one. I might as well have put all the options in a hat and pulled one out. That approach would have at least had the benefit of gaining me more sleep last night.
More on our decision later, but first a story.
As I’ve mentioned countless times before, we moved to a tiny little village last summer. Wonderful change, amazing quality of life… save the full-frontal reminders of the barrenness that keeps me from being fully engaged in community life, save the fact that my employer runs the town and that creates some awkward personal life/professional life quandaries, save the fact that absolutely everyone knows you and everyone knows your business. This is one of those stories.
As you might expect, I’m somewhat of a local celebrity at the itty bitty community hospital laboratory. I was first recognized because I brought the average age in the waiting room down a good hundred years. Then, the phlebotomists committed me to memory after I was able to knowledgeably tell them which arm is the best, which arm is most scarred, and which seemingly plump veins have a tendency to roll. I’ve had hundreds of blood draws in the past 3.5 years, I see no sense in staying quiet and letting them use me as an experimental pin cushion, when I know better than they do what veins are the winners and what veins are just posers. As if that wasn’t enough, then I had to use that lab for my gigantic ReproSource draw in February. In I strolled with three big boxes of self-provided tubes, giving them instructions for what samples had to be mixed, which had to go on the centrifuge, and how to repackage them and have them waiting for the FedEx guy. That gal looked so overwhelmed. She brought out textbooks because she didn’t know what order to draw the vials in, she asked for an audience and advice because she wasn’t sure she could get it all in one draw (she did), and she damn well remembers me. I also remember her. I tend to ramble on when I assume the blood-drawing position. I always worry that they are going to think I’m “really” sick (like, not just harboring what most insurances consider a cosmetic issue). So, I get word vomit. I told her what the testing was for, she broadly asked what we’d been through, I gave my usual canned response, and she offered to be my surrogate because, “Being pregnant is awesome!” So, yea, I fucking remember her.
When I went for my beta on Monday I had a different gal (thank God). Business as usual. Me in, blood out, off I went. Hours later I got the call that the beta was 11. While less than 5 is not pregnant, my “kinda pregnant” 11 was a result of the HCG boosters I’d been taking. It was as negative as it could have been, despite being slightly above 5. I was, as you all already know, devastated.
Yet, with my history of ectopics and my “kinda sorta pregnant” first beta level, I still had to return on Wednesday for a redraw. Color me thrilled. I pounded down coffee, went to the lab with a scowl on my face, and waited. And waited some more as outpatient intake let the toddler across from me and his doting parents cut the line. He was cute, I was not. When I finally got back to the lab, I assumed the position and remained silent. The phlebotomist – not the one from Monday and not (thank God) Ms. Surrogate – seemed confused. So, she went for it.
“Why are you here? Didn’t you get good news on Monday?”
[Wait, this is really happening? Hooray for medical privacy!] “Um, I’m here to confirm what we already know. I’m not pregnant. At least that’s what I’m hoping for. I really don’t want another ectopic experience.”
“But, your level was positive on Monday! I remember because I had to ask for help. The doctor requested we run extra tests [my TSH and P4, btw] if your value came back positive, but none of us knew how to interpret what positive was for a quantitative HCG. We rarely do anything but a qualitative. So, all three of us girls went and asked a doctor. He told us any number is positive, and we were all so happy for you. Honestly, we were kinda cheering when he told us. We know what you’ve been through.”
“Nope, that 11 should have been a lot higher. Oh, and anything under 5 is negative too. It’s possible to have very low levels of HCG in your system even when you are pregnant. But, it doesn’t matter anyway. That 11 was purely from the HCG injections I’ve been giving myself. Today it should be negative.”
“Well, you never know!”
“Yes, yes I do. We’ve been doing this for so long, I do know. The only thing I don’t know is how much longer we’re going to keep doing this. I think we’re pretty close to done.”
“Oh, honey, you’re so young. Don’t give up hope! There’s always a chance!”
“Sure. Thanks. Bye.”
And here’s the problem that these women, that no one in the fertile world understands. At a certain point, grasping desperately to hope hurts more than moving on. A moment exists for everyone (and that moment is different for everyone) where hope hurts. When saying, “I will never have a biological child,” sounds better than silently asking, “How many more years of appointments, procedures, injections, and waiting do I have left in me?” When thinking of a future without children remains devastating, but looks more appealing than spending even more hours of your life in a hospital laboratory, in the stirrups, in the car on the way to your latest D&C. I know I’m reaching that moment.
But, whether out of stupidity or stubbornness, our decision is to delay that day of “No more!” for a little while longer.
I just got off the phone with the nurse. I return on Monday for my baseline. Another probe, another prick, another cycle. Same cocktail as last time (Gonal-F, microdose Lupron, Intralipids, Lovenox, PIO, Crinone, HCG trigger, HCG boosters, baby aspirin, Metformin, Synthroid, L-MTHF, B12, D, prenatal). IUI.
Rinse and repeat with IUI#2 in August. Sure, yea, maybe it will work, but preparing for the worst is a whole lot easier than being blindsided by it when it comes. Sure, we don’t need to be deciding more than a cycle ahead of time, but we kinda do. And here’s where I’m hoping my insurance provider isn’t reading. Though I moved to one of 15 states with an insurance mandate for infertility coverage, I got one of the weaker mandates. (And, we must remember, there are plenty of ways employers can get out of this coverage mandate, but luckily mine is not one of them.) Bottom line is, if a plan in this state covers pregnancy, they must also cover infertility diagnostics, medications, and treatments at the same co-pay levels as other comparable services. Coming from a no mandate state this is fucking awesome. But, here’s the hitch. All bets are off when/if we get to IVF. Same meds, same probings, same blood draws are 100% covered during an IUI cycle, but totally out of pocket if we are doing IVF. So, for the next two months we will do two IUIs. Not because they will get me pregnant, not because they do anything to improve our chances (NONE of my medical conditions are remotely bypassed by IUI), and not because it’s a barrel of laughs to have another man inseminate you with a turkey baster. We’re doing it entirely to game the system. To stockpile meds for step 3 on our IF final solution. IVF.
We’ve decided to do 1 IVF cycle in the fall. One last chance to say, “We did everything we could and we’ve reached the end.” I’m not sure whether we are doing it for ourselves or to silence those around us who ask, “Why not just do IVF?” I’m not sure that I care what the justification is. I just am happy we have a roadmap.
IUI in July, IUI in August, IVF in Septemberish, FETs if we have any frosties, then the end. Life has a way of changing such neatly designed and thoroughly agonized over plans, but at least we have a baseline template that can be modified when/if needed, rather than entirely flying by the seat of our pants.
I’ll either be pregnant in 2013, or I’ll be moving on and learning to embrace our childless future in 2014. Making this decision has been brutal, but the resulting silence is a blessing. Now, with the decision made, in my head I don’t weep, I don’t hope, I don’t wonder. I just embrace the silence that certainty has offered.
Hello darkness, my old friend
I’ve come to talk with you again
Because a vision softly creeping
Left its seeds while I was sleeping
And the vision that was planted in my brain
Within the sound of silence
– The Sound of Silence, Simon & Garfunkel, 1964