The Eye of the Storm

I beat Monday morning rush hour traffic and arrived early to my blood draw. I sat, miserable, in a corner of the waiting room. To my right sat a happy woman about to ‘graduate’. I stole a glance at the woman with a stoic face opposite, and I imagined she was new to the infertility world.

My name was called. I sat in the blood draw chair, could barely look up to verify my name and date of birth. I had to blink to write my phone number on a green slip. Not wanting to seem rude, I hoped the phlebotomist could see I was distressed. The needle jiggled in my vein and I was glad for the brief distraction of impending bad news.

On my way out I passed Amber, the nurse who’d performed all of my FET3 ultrasounds and whom I’d spoken to on Saturday, when I had pinked-tinged brown spotting. I tried to slip past her unnoticed, but she recognised me from behind and greeted me cheerfully. All I could do was suppress my tears and shake my head. I fled to the car and cried. I pulled off the blue bandage with smiley faces and drove home, against the flow of traffic.

♥

My clinic called earlier than expected, at 2.30pm. I heard my RE’s voice and knew the news wasn’t good.

“Hi Lauren, it’s Dr. F. I’m calling with bad news.”

“I know…” I whispered.

“I’m afraid the pregnancy test was negative.”

“What was my beta?”

“Less than five,” she said softly.

Again. Less than five. DH squeezed my shoulder.

“I know this news is difficult. When you’re feeling up to it, I’d like you to call the front desk to make an appointment to go over everything.”

I got off the phone. I texted a simple Beta negative. Not pregnant to the circle of friends and family who I quietly shared news of our faint positive with. After sharing the news on social media, I cried and lay on the sofa staring at the ceiling. DH asked me if I wanted a drink. Sure. Why not. I cradled my whiskey until the ice had melted. And when I had finished drinking it I picked up the phone to dial two clinics. One, my RE’s; the other, my Ob/Gyn’s.

♥

Monday June 12 is my WTF appointment. I haven’t come up with a strategy with DH, but I’m guessing we’ll let Dr. F do the talking first. I’m pretty sure she’s going to raise the possibility of surrogacy. (You know, like we have a cool $120,000+ lying around…)

Unless she doesn’t mention it first, I will ask about:

• Endometrial scratch before transfer.
• the ERA (Endometrial Receptivity Array) test, an $800 genetic test that verifies the embryos are being transferred on the optimal day.
• Lovenox. Lots of people take it. Should I?
• Prednisone. Should I take it for longer than three days?
• An autoimmune protocol. (I have eczema and endometriosis.)
• Even though FET3 had a week’s delay at the start, we kept the original transfer date—meaning I was on estrogen for only one week, not two, before starting progesterone. My lining reached 7.55mm—with V, I got to 9mm. Maybe I need to be on estrogen for the full two weeks.
• I am Rh-, so is it possible that I have developed antibodies as a result of carrying an Rh+ child whose blood we know mixed with mine (per the Kleihauer-Betke test performed)?
• If we were to transfer two embryos, by how much, if anything, would that increase our chances of getting pregnant?
• And if I did get pregnant after transferring two, what would be the chance of twins? (Very risky for me, given my medical history.)
• Is there any point to thawing and inseminating the 13 eggs we have?

Scenario 1: The embryos are the problem

• If the embryos were damaged during the freezing process, presumably the eggs were too?
  • As eggs only have one cell, they generally do not tolerate freezing and thawing as well as multi-celled embryos. However, with vitrification (aka flash freezing) a blastocyst has an inner mass which is injected with fluid prior to being frozen. So is it possible that with badly done vitrification eggs fare better because they are a single cell and can’t be injected? That is, is it this injection which causes the damage?
  • Guesstimate for creating new embryos with our eggs is $6,000. This doesn’t include transferring them. It’s a pretty big financial risk for us to take.

Scenario 2: My uterus is the problem

• If we assume the embryos are fine and it’s my uterus that’s the problem, why would we transfer healthy embryos into me?
  • Surrogacy, even with a low- or no-cost surrogate, is out of our financial reach. Even if someone we know offered to do it altruistically (saving us the agency fee), the incidental expenses would add up fast.
  • But let’s say we came up with the money—we could still find out there’s a problem with our embryos.

Scenario 3: I’m all ears…

• Maybe this is all just bad luck?
  • FET1 may have failed because I was stricken with one of the worst migraines I’ve ever had just five hours after transfer.
  • FET2 may have failed because five days later, my beloved dog attacked my daughter which led to us having to put him down the day before my beta.
  • FET3 may have failed because sometimes statistics don’t fall in your favour.

♥

Tuesday June 20 is a consultation with my Ob/Gyn, a woman who I see for all my regular gynaecological care, placed and removed an IUD, performed both my D&C and hysteroscopy, oversaw my pregnancy, and delivered my daughter via caesarean. She has seen the inside of my uterus more than once, and held it in her hands. No one knows my uterus better. I’m thinking of a list of questions to ask her, including:

• Is it possible for a uterus to be traumatised by a complicated delivery?
• Do you think my uterus is capable of getting pregnant?
• Do you think my uterus can sustain another pregnancy?
• Does RhoGAM, the prophylactic treatment for an Rh- mother, always work? / Have I developed antibodies that is causing my body to kill embryos?
• If we transferred two embryos, what additional risks (beyond a standard twin pregnancy) would I face? (I’m already facing a likely possibility of caesarean-hysterectomy.)
• Given my medical history, if I got pregnant with twins, at what point would there be a discussion about selective reduction?

♥

Tuesday, we talk about ultimatums. If we don’t get pregnant within the next four FETs [which we’ve already paid for in a package deal], let’s call it quits. If we’re not pregnant by January 1, 2019 [by which time we will be in our early- to mid-40s], that’s it. We’re not beholden to these ultimatums, but we recognise at some point we will have to draw the line financially, if not in terms of quality of life and moving on.

And through it all, I envisage us as a family of three and ask myself if only having one child would really be so bad?

♥

Wednesday. Last night I dreamt I miscarried. I watched as red treacle pooled in the toilet, and felt a surge of revisited grief. This morning, I am calm, but depressed. Able to laugh, able to research, make plans. Grateful to my circle of comrades and allies who check in, and wrap me up in hugs and messages.

But I expect the full rage and the overwhelming sadness, the creeping anxiety and the long longing to strike me when the bleeding starts.