Lightning Strikes Twice

Last week was the eye of the storm. I went into practical mode, making appointments, researching anything I could to discuss with my RE and ObGyn. My best friend visited for a few days, and her presence was a welcome distraction from the threatening rains. But I knew the clouds would break when I started bleeding.

♥

I prepare for our WTF appointment. I make notes from my research and organise them under four headings: Past Protocol; Next Protocol; Embryology; Second Opinions. I create a table to compare the four cycles: one unmedicated, cancelled; three transfers, each resulting—one way or another—in a Big Fucking Negative.

DH prints my notes, and I briefly grinned at the generic font his computer substituted for the premium one on my [graphic designer’s] computer: Courier is so unlike me, but its designer said of it, “A letter can be just an ordinary messenger, or it can be the courier, which radiates dignity, prestige, and stability.” It’s an appropriate typeface for such a document.

♥

The day of our WTF, the bleeding starts. There isn’t much flow, but plenty of dense clots. The cramps come in waves. Madame Uterus has awakened, disgruntled. I was pregnant for only a couple of days, so I am surprised by her loud protest, by the kind of tissue I am already passing.

This is not just a period.

♥

We drive, sombre, to our RE’s office. We’ve talked about our expectations for the meeting, but we go over everything again. I tell DH that our RE is going to emphasize the problem as being my uterus—because even if she suspects there’s a problem with the freezing, she’s not going to admit that to us—and that she’s going to bring up surrogacy.

I think about the offer from my friend, T. She said she’d happily be our surrogate, if that’s a path we decide to pursue. Her offer is, in and of itself, a gift. It takes off some of the pressure and allows me to imagine what it would be like to be a mother via egg donation and surrogacy.

I think about the logistics of that. We wouldn’t have to pay an agency fee or a surrogacy fee. And as T lives in a country with socialised medicine, we wouldn’t have to pay a health insurance premium.

But the incidental expenses would add up: in addition to the cost of her FET, we’d have to pay for her flights to and from the US; legal fees in both countries; meeting with a mental health professional, possibly in both countries, to ensure we’ve thought through everything; life insurance; child care; adoption paperwork; my flights to/from her country—not just flights for the three of us (DH, V, and me) for the (fingers crossed!) birth, but milestone ultrasounds. Who can say how much that would cost?

I think about the impact such an agreement might have on T’s life. She’s also a mother via egg donation, so I know the concept of alternative family-building—and everything that goes in hand with someone else’s DNA—is something she understands firsthand.

Until my complicated pregnancy and delivery disqualified me, I also planned to be a gestational surrogate one day: I know what it means to seriously consider being a surrogate. I just never imagined I might need one.

I think about what it would mean for me to give up yet another dream, this time of carrying my child. Could I relinquish the control of the pregnancy and birth? What would that feel like?

And what would it feel like to commit to this process and then not have it work?

♥

I stare at the white membrane. A little stingray. I can’t bring myself to flush it away. I continue the tradition of burying it in the earth of my peace lily. I cringe at the thought of the women who regularly offer “their moon” to their plants. I am not such a woman, but here I am, scrabbling in the earth again anyway. Except mine is not an offering. It is withdrawal.

I wonder if my peace lily will bloom around what would have been my due date, like last time.

♥

Our RE starts talking. She begins by saying that it is all the more disappointing, even devastating, to be sitting across from here after a positive home pregnancy test. She says at this point, after three failed transfers, the culprit is most likely my uterus.

She suggests we do the e-Tegrity test, a genetic test that examines whether I, as a woman with endometriosis, lack a couple of proteins essential for implantation. The treatment for it is 2-3 months of Lupron, a drug that makes me depressed and anxious.

“But I thought I was treated empirically?” I enquire. I was on Lupron for only three weeks, but it seems like we’re clutching at straws here. Yes, I have endo, but I haven’t had problems getting pregnant in the past.

And she mentions surrogacy.

I turned to DH and said, “Told you…”

I know she’s planting a seed at this stage, but I’m still shocked that it has come to this. I feel like after miscarriage, infertility, a genetic diagnosis that led to my not passing on my genes, DEIVF, a complicated pregnancy, a terrifying delivery, lightning is about to strike for a second? third? fourth? fifth? sixth? seventh? time.

I want to scream at the fertility gods, but my culturally English side—the part that shuts off my emotions to get something unpleasant done—kicks in.

“I am very active in the online infertility community and PVED forum,” I begin. “I have some ideas that I’d like to discuss. Not because I wish to challenge your expertise—rather, because these ideas have proven successful for other people, and I want to hear why you wouldn’t consider…” and I rattle of a laundry list of ideas.

• ERA test: not as valuable as the e-Tegrity test;
• Endometrial scratch: we already did that, technically, with the hysteroscopy;
• Lovenox: no evidence that this would help; thinned blood could be catastrophic if I were in an accident;
• Prednisone: no evidence that this would help; high correlation with cleft palates when taken during pregnancy;
• Autoimmune protocol / NK cells: no evidence that this would help;
• Unmedicated cycle: my lining naturally gets to 8mm, so as it’s about the same as medicated there’s no clear advantage to trying without meds;
• Thawing our eggs to do a semi-fresh cycle: better to use our existing embryos first;
• Transferring two embryos: my chances of pregnancy would increase (she would have to check with the lab for the latest statistic) and the chance of twins would be 40%, but she would want to take my ObGyn’s lead on this.

She is quick to say that she is happy to do any of these things if I want, but she “wouldn’t know what [she] would be treating.” At this point I know she’s humouring me. The one thing she agrees to do (which doesn’t feel like she’s humouring me) is staying on estrogen for longer than a week. She explains it’s not the amount of time you’re on estrogen that matters—because once you have a triple line, you’re body is ready—but agrees with me that the worst that could happen is that my lining shrinks and the cycle would be cancelled. I also make that point that back in 2014, my donor took an extra six days to stim, which meant I was on progesterone for an extra six days, which meant my lining got to 9mm, and I got pregnant. Also, logically, didn’t it also make sense that with my history of accreta you would want the lining to be as thick as possible? I wasn’t expecting her to agree with my logic, but she did.

She is pretty convincing that my uterus—not the lab’s vitrification method—is the problem. She tells us that plenty of people have got pregnant with embryos frozen before or around the same time we did. I can’t argue that the problem isn’t my uterus, but I am quick to point out that plenty of women go on to have successful pregnancies after accreta—how else would we know, statistically, once you’ve had accreta you’re more likely to have it again…

♥

Next steps with current RE: e-Tegrity, perhaps followed by 2-3 months of Lupron, then transfer of one (possibly two, if ObGyn agrees) embryos after “extra” week on estrogen.

Other next steps: second, maybe third, opinion.

♥

At home, my shock turns to anger. I feel really fucking angry that I weaned my girl. Because if accreta is known to cause implantation problems, WHY THE FUCK DIDN’T MY RE TELL ME? If I’d known, I would have weaned her when she and I were both ready.

I feel so cheated. By all of this shit… but especially that I made a decision based on incomplete information. I don’t care if it was unlikely, I should have been told.

♥

The blood keeps coming. It seeps and spills, and collects at the bottom of white porcelain. Traces of what might be my last ever pregnancy.

I am so angry, it’s hard to breathe.