Tag: healthcare

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Baby talk 6: and then, the good news

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Content note: infertility, pregnancy

I hate curtain patterns that don’t repeat in a nice orderly fashion. Something about them makes my brain twitch, and I don’t like to think how much of my life I’ve spent staring at drapes (or wallpaper) trying to find the nice clean border where everything starts all over again.

It feels like I should draw some deep-and-meaningful lesson from that but I can’t think what it is.

The curtains in the little rooms – more like cubicles – in the old Fertility Associates office in Wellington did not repeat. They were an obnoxious mess of green and blue and orange and yellow, squares and swirls and stripes, and oh, what a relief for my brain it was to have that chaotic vomit to focus on instead of what was ahead: our second embryo transfer, with the spare, frozen blastocyst from our first round of egg harvesting.

The clinic was busy that day and I could hear parts of murmured conversations in the neighbouring cubicles. It felt very isolating, and not just because I was on my own for this one. The thing is, you and every other person in there is in exactly the same boat – nobody else in the world knows as well as they do what you’re going through at that exact moment – but you’re separated, by literal walls and also social ones. This isn’t a waiting room where you make eye contact and smile at other people, much less strike up a conversation. You don’t know what stage they’re at – what news they’re here to hear – but you know exactly what the worst case scenario is.

The clinic is obviously aware of this dynamic, so there’s a sign on the cubicle wall for their Facebook group. Here, it says, here’s a safe place to make those connections. We never joined. I don’t like sharing my grief in the moment (she says, on her public blog), I don’t even know how to contain it within myself, it just felt too hard to push it onto others or have theirs pushed onto me.

Once again, it was a quick, clean procedure. Almost too much so. There’s nothing big and scary like sedation or a waiting period to focus your anxiety, so it all goes onto the next week-and-a-bit waiting for the next pregnancy test; and in my case, on work. I was at Parliament while we went through this, and our second transfer happened at the end of July; only six weeks before Parliament dissolved and I lost every scrap of job security.

They say there’s never a good time to have a baby, but I still feel like we chose a particularly terrible one;* on the other hand, it wasn’t a choice. It was a need.

And then the results came in.

And we won the lottery.

I’d spent the whole month, since our first transfer failed, telling myself over and over that someone has to beat the odds. That’s the ironic thing about what I mentioned in the last post, about the idea that every infertility story has a happy ending. When you’re going through it, it feels like everyone you talk to has an unhappy ending. Or tried and tried and tried and tried again and maybe, finally, through sheer force of will and luck and persistence, it happened.

I don’t think I know anyone who got as lucky as we did.

J was home when I got the phone call, so he found out almost as soon as I did; and in true J fashion, his first question was whether there was something performative he was supposed to do. I told him jewellery, or a car.

It was the happiest day of my life, and yet … it’s the same story I feel I’ve told already. Every bit of success on this path just opens up more avenues for failure and anxiety. This blood test was good. But there was another only days away. Three weeks after that, the “early scan”. More appointments in the diary to get good news, or the worst.

I just assumed these early days are when there’s the highest risk of losing a pregnancy. But no one ever said it. I guess you don’t need one more thing to worry about.

Probably the worst bit was having to keep up the damn pessaries. I was looking forward to having clean underwear again.

And on top of all that we had J’s contract at work ending, the election another week closer, and at some point we had thought about moving house before we had a baby, and …. how???

I’m almost happier now, reflecting back, than I was on that day. Because now I’m free of those worries (found plenty of new ones, have no fear). I know that the Wednesday blood test will be strong again, and the early scan will be the first time I see my baby’s heart beating, and everything, everything will work out. Hindsight is great like that.

~

*Four days after the pregnancy test, four cases of COVID-19 were found in Auckland, which went into a level 3 lockdown, the rest of the country to level 2. Great timing, like I said.

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Baby talk 5: the bad news

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My life is just a series of unexpected hiatuses (hiati?) at the moment so I shan’t keep apologising for the break in posting.

This is pretty much the verbatim post I wrote, on 11 June 2020, when it was confirmed our first embryo transfer hadn’t taken. I still find it upsetting to read, and it gets sweary, so, approach at your own discretion.

Content note: infertility, pregnancy loss

I was pretty sure what the result would be. I thought I’d been pretty chill. Not getting my hopes up, and not setting any expectations, reminding myself it’s all just a coin toss and no one knows why it does or doesn’t take. But there was too much blood, and it was too red, and so it wasn’t a surprise when they called with the blood test results. Negative. No baby this time. And I cried anyway. For a moment. But I was at work – my first day back after the COVID lockdown, what fun – so I pulled my shit together and powered through the next four hours, with just a tiny catch in my throat when I called J to let him know.

It’s always really awful to realise you have no idea what’s going on in your own head. Because I thought I had it together. Like I said: no expectations. No telling myself the stars were aligned, the odds were in our favour. I think a core part of me just assumed we’d fail, like so many of our friends failed, again and again and again. I hoped, but I didn’t stake my mental wellbeing on hope. I thought.

It’s so fucking hard to cry and not have any idea why. To not be able to pin down the frustration, the source of the pain. I didn’t think of our embryo as a baby, not yet. I kept telling myself the odds were bad. But – as J kept reinforcing to me because he’s wonderful – it’s still a loss. It’s still a disappointment. And whether you’re thinking about it or not, whether you think you’ve got closure on it or not, there’s all the years of disappointment that suddenly crystallize into one point in your mind and demand emotional release.

The TLDR is I just cried a lot. Without having anything to say, which is unusual for me.

I decided to vent everything by drinking a whole bottle of prosecco. It wasn’t as satisfying as I thought. J had his friends over for their usual game night so I stayed in the study, trying to find something on Steam that would give me the right mix of mindless, violent entertainment without requiring any skill or coordination, which is not in any way my usual gaming taste. I watched some random YouTube videos. I wrote angry tweets about Black Lives Matter and explained in cold, crystal terms why JK Rowling was a confirmed transphobe in Facebook comments. I daydreamed about shouting at people I’d never be allowed to shout at.

It’s almost cliche that when I’m upset, my brain turns to the political injustice of the situation. It’s too painful to dwell on my own frustrated need to be a mother. It’s too hard to reflect on whether I already did think of our doomed little embryo as a baby, a future child. I hadn’t picked a name. But I had picked the name I wanted to pick if the test were positive. But that’s not the same. Unless it is.

Fuck all that. It was so much easier to sink into a rant – to myself, to my non-operational webcam – about fat politics, about our fucked up health system’s racist fatphobia which just happens to impact some white women like me.

We could have been trying this five years ago (when the odds are incrementally better) if the Ministry of Health didn’t use fucking BMI to ration healthcare. If we’re doomed to not have children, if that’s something I’m going to have to accept and work through, we could have been and gone through that fucking trauma already, and have a plan to age disgracefully through our 40s and 50s instead of still being stuck at the trying, and failing, and having no fucking idea stage.

I keep yelling at the mirror: I do (well, before COVID, did) eight hours of dance class a week. Our infertility isn’t anything to do with my health or my size. Yet my size is used, was used, continues to be used to deny us the chance to have children without forking out tens of thousands of dollars.

How the fuck am I supposed to succeed with that stress hanging over my head?

Addendum

The funny thing is, there’s been some conversation on Twitter recently about how every infertility story you hear has a happy ending. The accepted, appropriate narrative to share is one that ends with miracles and sunshine. And let’s be honest: that’s what these posts are. I know I only feel comfortable sharing my outpouring of grief and frustration *because* there’s a baby-shaped pot of gold at the end of the rainbow.

And that sucks. It was something I felt really strongly when we were in the middle of this process, and a big part of me was convinced we were going to fail anyway. And aren’t I now just contributing to that narrative by only posting these posts with the hindsight of a positive outcome?

The thing is, whatever the outcome, the process is a gruelling, alienating one. And a lot of it gets glossed over even in the happy-ending narratives (probably because comparing your vaginal discharge to candle wax is a little TMI for most people. But not me!). There are few enough raw, nitty-gritty accounts of what it’s like to go through IVF – certainly I couldn’t find many when I needed them – and from other experiences I’ve had since baby was born I’ve really appreciated the power of a personal account with those little details you just don’t get from a fertility clinic webpage or a human interest news article. The feedback from members of our family, who knew we did IVF but had no idea what that really entailed on a day-to-day basis, and the sheer number of people I know, who’ve now told me they did IVF but never mentioned it before, tells me this has value.

For those who have tried, or are trying, or stopped, for whatever reason, I know that it’s only a matter of sheer bastard luck that I’m not in your shoes. And that’s so unfair. And your stories deserve to be told too.

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Baby talk 4: first transfer

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Content note: this one involves my vagina, like, a lot. Also blood. And that whole infertility/anxiety thing.

Of our four fertilised eggs, two were deemed high-quality enough to proceed to the next stage, embryo transfer. The old days of putting multiple embryos back into your uterus to increase the chances of pregnancy are gone, apparently, so we were able to keep one, and freeze one as a backup. That provided a lot of reassurance, and even a tiny sliver of hope that we could think about having a second baby one day, without having to go through all this rigmarole again.

But first: the pessaries.

Between egg collection and embryo transfer the clinic gave me progesterone pessaries. “Luteal support” they call it. It’s great for maintaining a soft cushy lining in your uterus, and also for getting SUPER FAMILIAR with your own vagina.

I was on two pessaries, three times a day. You insert them much like a tampon, except it’s a small plasticky ball bearing (indeed, two small ball bearings) going right up to the edge or your cervix – and sometimes the little sods WILL try to follow your finger back out and sit uncomfortably like an over-full tampon right at the opening.

They warn you, “You’ll get some waxy discharge.” The pessaries are mostly made of vegetable oil, and that’s the part that doesn’t get sucked up your cervix. So it makes sense something’s going to come back out. Except you’re thinking “vegetable oil” and not “it will look like someone’s literally ground the end of a candle into your knickers”. It’s white. It’s solid. Bits WILL fall out of your labia or off your loo paper and float on the surface of the toilet like cut-price fake snow.

It is a deeply weird process.

My top tip? Set your timer ten minutes early. Use that time to cue up a podcast, get into your pyjamas (obviously for the last-thing-at-night round, but maybe also for the other two as well?) and go to the toilet, after turning the bathroom tap on to warm.

I was doing this as winter was threatening, and there is nothing that’s going to make this routine worse than washing your hands in icy cold water before they go up your snatch.

The transfer

Every other stage of the process has a heavy sense of ceremony, even though what’s happening is invisible. The daily injections. The close monitoring of your ovaries. The drugged-out ritual of egg collection.

Embryo transfer was simultaneously the most important thing we ever did, and the most trivial. No sedation, no long waiting period; you walk into the room under your own steam and lie down on the same bed, but fully aware of everything; you try to make out the shape of your own uterus on the ultrasound; and then there’s a long needle, a twinge, and a tiny white speck seems to float up into your body.

And that’s it. Get up, off you go. The paperwork is reassuring: literally, “don’t worry, your embryo won’t fall out”. They are very good at knowing what you’re afraid of. But I was already an overthinker before we started all this and after weeks of hyper-focusing on every little detail, worrying that anything could be The One Thing That Makes Or Breaks This – am I timing the injections properly? When do I need to stop eating? Are the pessaries in far enough? Have I lain down for long enough? Don’t forget you can’t lie down all the time, some exercise is good! But what kind of exercise? – having that microscopic dot so full of potential and hope sitting back inside your body really does feel like the one thing you cannot fuck up.

I’d seen it. It was really there, even if I couldn’t feel it. And everything rested on whether or not it would find a home in the lining of my uterus. I was the closest I had ever been to being pregnant, but things were still completely out of my control.

There was nothing to do but wait for the blood test that would seal my fate. (You could probably take an over-the-counter test but God, why do that to yourself?)

The wait.

Nine days later, I was 90% sure my period had started. But I didn’t want to think about that, so I ignored it, telling myself again and again that what mattered was the blood test, the phone call, the certainty of a clinician’s voice on the line, not my own total inability to determine if the smear on my pad was actually red (bad) instead of reddish brown (possibly good).

Some brownish spotting is normal, you are told. Or at least they phrase it, “some women do have brown spotting before a positive pregnancy test” but they don’t give you the exact numbers because like every other stage of this process it’s really just magic. It happens or it doesn’t. No one knows why.

Of course, for me and many other people who menstruate, brownish spotting is ALSO perfectly normal immediately before my period properly starts. So the past 24 hours was really fun: checking the paper every time I wipe, is that brown? Brownish? Is there a bit more pink than last time? Inserting pessaries becomes a whole new world of miniature gore when you get to pull out your finger and assess what’s trapped under your fingernail. Definitely brown. Reddish but brown. Definitely.

Don’t worry, part of me definitely wonders if this is Too Much Information. But I really do wish I’d known about some of this in advance. I wish I’d spoken to my friends who have also gone through IVF about these small mucky details – but that’s a whole other difficult topic. The point is, what the clinic are going to tell you is the cool, clinical (sorry) details. However compassionate they are, there are just details you don’t hear about and have no way of anticipating.

The literature they give you is full of reassurance. It’s normal to overthink things. It’s normal to worry, or cry, or take a day off work. Normal normal normal.

But when it’s your first time, nothing is normal. And every abdominal twinge, every damp feeling in your knickers, is either a sure sign you’re pregnant and it’s wonderful OR a definite sign you’re not and you’ve failed again, and you swing between the two on an endless painful oscillation that only ends with time.

The phone call came. And it was not good news.

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Baby talk 3: the eggs, the lube, the triggering

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So we took a bit of an unscheduled posting hiatus there; but more on that later. Today we’re talking eggs, lube, and triggers.

Just as the self-injection routine started to get good and routine, and I wasn’t having a total emotional break on a daily basis, came the sharp reminder that this was only one stage in a massive project, and things had to be kept on track. At this point, that meant an ultrasound, and not the television-friendly wand-on-the-tum kind. The question was: were my ovaries responding properly to the hormones, and growing a whole bunch of eggs?

They were.

I got to see the swollen follicles myself, gaping black voids on the surface, a definitely upsetting experience for anyone with trypophobia (the fear of lots of little holes). They were measured and found to be sufficient in quantity and size by the doctor – who was not my usual consultant; and a bit of warning might have been nice, given he was a man.

A note on lube

Now, I have nothing against cis men – like Cher, I love dessert – but there’s a distinct difference when it’s a guy controlling the plastic wand going up your groin. On the social conditioning side of things it just feels very very awkward to be giving guidance like “a bit lower; no, that’s too hard; yep, that’s it” to someone I have zero, possibly even negative, sexual interest in.

On the physical side of things, there’s lube.

I’m just going to put it like this. If you are a medical professional who does not now have, and never has had, a vagina, and your work involves putting things in other people’s vaginas, you need to lube that wand like it’s going up your own butt.

IVF is a process that involved a lot of vaginal ultrasounds so I can definitively say, from the other side of it, I would rather have to wipe some excess gel out of my labia afterwards than feel like screaming “what’s wrong with a kiss, boy?” in my best John Cleese at a thoroughly professional clinician.

Anyway.

Things looked pretty good, so I was sent home with more drugs, ready for the next stage.

And there was not much to do but sit at home and be consumed with ~feelings~. It’s a paradox: after so incredibly long, thinking about nothing but wanting this and trying for this and counting days and degrees and becoming an expert on one’s own cervical mucus, we’d overcome one of the big hurdles … and I wanted things to slow down.

From deciding to go private to the first consultation was only a few weeks (longer than usual due to COVID); from consultation to first injection was only a week after that, thanks to a well-timed menstrual cycle.

Then it’s one more week, and you’re on the doorstep of egg collection and insemination (and handing over another couple of thousand dollars) and a whole new cycle of waiting and hoping and not being able to do anything to affect the outcome, until you get told if you’ve been lucky, if there’s an embryo, if they can try to plant something back into you that might become the baby you’ve ached for and you have no idea what you’ll do if you can’t make a home for it inside yourself.

It feels impossible that everything can move so quickly after it’s taken so long to get here. It feels unthinkable to process it all in just a few weeks – when you couldn’t even start to process the idea of being infertile for a decade.

Triggering

There’s an obvious internet-discourse joke to be made here. I will refrain.

Once the ovaries were signed off and the blood tests were checked, we were on a rigid timeline. The New Injection, Ovidrel, had to go in at 9pm sharp. It’s a “trigger” injection that tells your eggs to get ready to rumble after they’ve been hanging out on your ovaries, refusing to go anywhere. That was the easy bit after a week of practice with Gonal-F: same pen shape, same needle tip.

Then put 36 hours on the clock for egg collection. It’s a weird time span to think about. Doing something 24 hours beforehand? Easy, that’s how time works. Doing something this evening to prepare for the morning after tomorrow morning is confusing as hell. I don’t know how many times I checked the instructions and the calendar and the time – yes, Stephanie, today is TUESDAY so the after tomorrow is THURSDAY and you are taking the drugs at the right time, that’s why the text message from the clinic says TONIGHT, just like that, in all caps.

They’re used to these kinds of meltdowns.

On Wednesday, do not eat after midnight (and make a Gremlins joke). On Thursday morning, clear liquids only and three paracetamol.

Off to the lab. Local anaesthetic. Sedation. Prepping for a needle to go all the way into my ovaries and burst those little black bubbles – so huge on the monitor but only 2cm across in reality. Which may or may not be huge in the context of an ovary. I don’t even know how big an ovary is. Call myself a feminist!

And hopefully, the bubbles contain eggs, which the clinic pulls out of me and introduces to J’s elite swim team; and Mum picks me up and takes me home and I sink into an indulgent haze of tea and biscuits and awful television.

That was the plan, and clearly everything went according to it, but I simply don’t remember. It’s like having your wisdom teeth out: I have such a vivid memory of the dentist telling my mother, “I’ll give you the instructions because she won’t remember”, and I scoffed, and after that … nothing.

I took a very bleary selfie in the prep area. I stared at the bizarre curtain patterns. I walked myself into the procedure room, very proud of not being the slightest bit dizzy, and then … not a freaking clue. I don’t even know if I got tea and biscuits.

End result: four eggs, which didn’t feel great. From that, four fertilised eggs, which felt miraculous.

And then we waited, to see how many would survive the first five days, and be viable to be implanted back into me.

It always comes back to waiting.

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Baby talk: the needles

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(Content note: infertility, IVF, injections)

I definitely didn’t plan it this way, but here we are carrying on with the anniversaries: because it was a year ago today that I found myself wandering down Victoria Street carrying five thousands dollars’ worth of the less fun kind of drugs.

The first big piece of the IVF puzzle is the eggs. You need to stimulate the ovaries to produce as many as possible, then collect them so they can be fertilised in the lab. And that means playing with hormones – which is exactly what you need on top of all the emotional and psychological pressure of nearly a decade of trying and failing to have a baby.

Put it this way: I needed to start taking the first set of jabs on day 1 of my menstrual cycle. And as everyone with a period tracking app knows, day 1 is counted from when you get full or “normal” flow – for your typical cycle – before noon.

So when my period started at 12:30 on a Saturday, I naturally had a minor breakdown about how to count days, and also time. Did that count? Was it day one??? How heavy was a normal period for me anyway????

J gave me a very firm look and said “It’s full flow before noon. That means day one is tomorrow.”

On the plus side, I impressed the Fertility Associates nurse with my quick command of popping a needle onto the drug pen and jabbing it into a weird beige eight-by-five centimetre piece of demonstration “belly” skin. It felt like a weird magical ritual, and also too easy, but also the most difficult thing in the world. At least I knew that my feelings were very normal, based on how many times the nurse reassured me that I definitely wasn’t going to screw it all up.

I didn’t. My hands didn’t even shake. But that didn’t stop at least some part of my brain from freaking out anyway; I spent the rest of the evening walking around with incredibly tensed posture, like my belly was made of porcelain and any movement might shatter it. Porcelain with a very very sharp little mosquito bite in it.

My medication plan involved taking the injection (Gonal-F) for a week, and on day 6 adding another one (which hurt like hell) to make my ovaries hold on tight to all those precious eggs they were (hopefully) prepping.

When it came to it, I once again forgot what counted as day 1 of my cycle, and/or how to count to 6, and ended up calling the clinic just to double-triple check the very clear instructions I had already been given verbally and in writing.

They are very, very accustomed to those kinds of phone calls and were very, very kind about it. It didn’t stop me feeling bloody silly. How on earth was I qualified to have a baby if I couldn’t manage something this simple?

You’d think that by day seven it becomes old hat, nothing to worry about, you’ve nailed this process. You’ve got your little prep ritual ready, with a comfortable place to sit and a cup of peppermint tea at the ready to stave off the nausea.

But with IVF there’s always the next step in the process to worry about. And the next step was an ultrasound scan to see if my ovaries were cooperating. Something I could not see or control or have any sense about until it happened.

No pressure.