Saturday, September 26, 2015

IVF: Stuff You Might Want to Ask

I have officially started my first IVF "cycle," which lasts about six weeks total (with the actual medical procedures at the end of that six weeks) and encompasses two menstrual cycles, during the first of which I'm taking birth-control pills to suppress ovulation.

That's a hell of a lede. Maybe I should just jump right into...

IVF: The Musical! 

No. Wait.

IVF: Stuff You Might Want to Ask

Why are you doing this?
My husband and I have signed on to do IVF because: 1) we want to have a family (that includes human children); 2) I just turned 37, and my husband is 39, so now's a good time to get going on that, both because conceiving gets harder the older you are, and because we'd like to have lots of time with any kid(s) we have; 3) I am impatient; 4) we can afford to do it.

For us, it's not that IVF is our only option -- but it's the option most likely to help us conceive fairly soon.

A little history might be good here. (Skip down to "So how much is IVF?" if you don't really care about my particulars.)

I have always wanted to have a child (like, unequivocally; I have never not wanted this), and my husband has always wanted to have a child -- but it wasn't until recently, when we got married almost two years ago, that the stars aligned for us both to feel comfortable doing so. Yes, there are tons of single parents who rock. But for whatever reason, probably just that I can be about as conventional as the next person in some ways, my preference was always to have a buddy around to help raise the child. We got married and started trying right away. We hit some snags -- my IUD (which I'd been using for birth control since early 2008) broke on the way out when my gynecologist was trying to remove it (well, he was actually instructing what seemed like a doctor-in-training, and it broke when she was trying to remove it... having never removed one before; my doctor exclaimed: "That's never happened to me in 20 years of practicing!"; lucky me). This set us back a couple months due to my needing to have a hysteroscopy (an outpatient surgery for which I was put under anesthesia but not "cut into;" my doctor went in through my... vagina) so that my gynecologist could remove the broken IUD piece, and then recovering from that.

We tried for about 10 months, and finally conceived during our belated honeymoon in Nepal about a year after the wedding. (We put our "honeymoon" trip off until the most beautiful time of year to visit that part of the Himalayas, which the guidebooks told me was fall, after the rainy season, when everything is green and lush but it's no longer raining buckets.) Not a week after my doctor confirmed the pregnancy with a blood test -- I began having miscarriage symptoms, and we lost the pregnancy at just short of six weeks. Since we had conceived, my doctor was confident that we could get pregnant, and suggested we try again for at least a few more months. No luck, so I made a new-patient appointment at Shady Grove Fertility, and have been impressed with them since Day 1.

They ran the usual battery of blood tests, which determined that I have mild hypothyroidism. This means that my thyroid was slackerly and underperforming, leaving my metabolism sluggish and causing me to be more likely to feel fatigued, gain weight, plus a few other symptoms. Most relevant to our cause: The thyroid governs a lot of the fertility-related hormones, and women with hypothyroidism are less likely to conceive... and more likely to miscarry if they do. We also learned that my vitamin D level was a bit low, which surprised me because I've been taking a pre-natal multi-vitamin for years now, since a couple of months before we got married (plus I take regular walks out in the vitamin-D-bestowing sunshine, on the trail near our townhouse, every day). My doctor prescribed a pill (levothyroxine; brand name Synthroid) to get the thyroid level down (at last check, it was at a good level), and I've been popping a lot of extra vitamin D; I have an appointment with a primary-care provider next week to check up on both of these issues, just to make sure everything is perfect going into IVF.

My doctor also suggested I repeat the HSG, which is a test during which you lie back and a trained specialist uses a sort of X-ray machine while flushing a special dye up through your Fallopian tubes and into your uterus; if the dye flows smoothly into your uterus, then yay, your tubes are nice and open for an egg to travel through; if not, uh oh. The test can tell whether one tube is blocked (roughly cutting your odds of conceiving in half, because there's no telling which side your body will choose to ovulate from on a given month... and if it ovulates on the blocked side, then whoops, the egg gets trapped and just disintegrates), or both (meaning there is no possible way that an egg can get out, so pretty much your only option is IVF). An earlier test showed my left tube was partially blocked; the repeat test showed it appeared by now to be fully blocked. So there you go -- another reason we have likely had less luck than other healthy couples our age.

Because we're in otherwise good health, and with the thyroid issue under control and one open tube to work with, my doctor suggested we first try two or three rounds of IUI (intra-uterine insemination), partly because it's cheaper and much more... minor than IVF, and also because my insurance covers it. In order to boost the odds of my ovulating on my "good" side (where the tube is nice and clear and open, like a tiny waterslide), my doctor prescribed me some hormone pills (Clomid) and an injection (Follistim, which is synthetic FSH, or follicle-stimulating hormone) to make my ovaries produce "bonus" eggs (beyond the one egg per month a woman normally produces). Well, my body responded too well to the drugs -- I banged out something like eight viable eggs, and I got a call from the clinic saying that if I went through with the IUI, I might become an Octo-Mom. We cancelled that cycle and decided to lower the meds for the next round.

Note: Producing tons of eggs is good if you are doing IVF, because: 1) this gives you more eggs to work with, and possibly some left over to freeze to possibly make siblings someday; and 2) everything in the IVF process is tightly controlled, meaning the doctor has absolute control over how many embryos (fertilized eggs) are transferred into your uterus, eliminating the risks (premature birth, etc.) associated with "multiples" (twins, triplets, and so on). In IUI, the conception process is more like it is during "real sex" only with a few boosts, and far more is left up to chance -- one, two, three, four (or more) eggs might get fertilized and implant and turn into babies, or maybe none of them do. All the doctor is doing during IUI is injecting (specially treated) sperm up into where, if you've been taking fertility drugs, you've been growing more eggs than usual. The rest is left up to "God" (i.e., Nature).

The next cycle, I took only the pills (a lower dose) and no injections; it all worked like a charm, and I had something like four eggs, including three on the good side. My husband's sample was proclaimed to be "excellent," with a good "count" and all. I went in for the (very minor, painless) actual IUI, during which my doctor fed a thin catheter up into me and injected the "washed" sperm (treated in a... thingie like a magical medical turbine, to separate out the "strong swimmers" from other random semen debris that might get in the way) directly into my uterus, bypassing other potential obstacles for the sperm (e.g., sub-optimal cervical fluids of the wrong pH or whatever that could kill the sperm before they reach the uterus), and we waited.

During the two-week wait, my doctor had me taking a couple of hormone pills through my vagina (I'd have to go lie down on the bed, will myself to relax, and... put a pill way up where the sun don't shine). There were two kinds, one (progesterone) that they pretty much always prescribe after any IUI or IVF, because it's good to have in abundance in case your body needs to prepare "the nest" for a baby; and another (estradiol; the brand name is Estrace) to thicken my uterine lining back up (i.e., also to help prepare a nice "nest" in there for a maybe-baby)... because, of course, the Clomid I had to take to help me make a bunch of eggs also has the side effect of thinning your lining. Oh, and the estradiol ever-so-slightly cancels out my thyroid pill. So you see, the drug craziness started very early on for me, even before signing up for IVF.

No symptoms. The day I was scheduled to come in for my customary post-IUI blood pregnancy test, I got impatient and took a pee-on-a-stick drugstore pregnancy test. It was a digital kind that simply tells you "Yes" or "No;" mine, of course, said "No." (No real shock there, since I'd had a disappointing lack of symptoms -- never in my life have I wanted so much to puke! -- but of course, still a bit depressing just the same.)

The original plan was to do another round or two of IUI -- but I started worrying that taking the Clomid for so many cycles in a row was going to thin my uterine lining out to the merest sliver... and I want my uterus to be a freaking sumptuous palace for any baby who might like to dwell there. So I made an appointment with my doctor to re-think the plan. He was completely on-board with proceeding directly to IVF -- a given IUI cycle comes with only maybe 10-15 percent odds of conceiving at my age, whereas with IVF, the odds per cycle are more like 40 percent (and our doctor said that, due to our good health and my epic response to the medications in the past, our odds are more like 55 percent per try).

Part of his recommending IUI first was that we're young(ish; it's when the woman is 40 that they basically start to say "piss or get off the pot," and suggest considering using donor eggs with IVF if you want to conceive), plus my FSH level (again, that's follicle-stimulating hormone, a decent indicator of your ovarian reserve/health, i.e., how many eggs you've got left and the quality/viability of them) is more like that of someone in her 20s or something. (There's nothing good I did to achieve a low FSH level at my age -- it's probably just genetic, or luck.) Good/low FSH = no huge rush to get pregnant, because your ovaries aren't in there going: "Hurry up! We're almost outta eggs, and all the good [healthy] ones are almost gone!" And also, again: IUI is covered by my insurance, IVF is decidedly not.

So here we are. Yes, we could have done more IUIs, but that'd be more cycles during which I'm all drugged up on lining-depleting hormones with low odds of actually conceiving each time. Yes, now that my thyroid level is down, we could just try some more on our own and hope I ovulate more on my "good" side -- but again, we sort of want to get going on the whole family deal, plus, well, we can afford to do IVF. It's a high-enough priority for both my husband and me to feel good about shelling out a ton of dough (more on this below!) to try for this. It's time, we're emotionally and financially ready, we're on-board. Here we go.

What is your actual cause of infertility?
For my husband and me, there appear to be maybe two and a half mild contributing factors, but nothing really major. Again, we did conceive once, even though it ended in miscarriage; and if we had anything too major going on, we wouldn't have been accepted into Shady Grove's Shared Risk program (you can read more about that below).

On my end, I only recently discovered that I have mild hypothyroidism, as indicated by my high level of TSH (thyroid-stimulating hormone), which we found out about during the routine "new patient" bloodwork. For your average person, it's best for the level to be below 5.0, and for a woman trying to conceive, Shady Grove likes the level to be below 2.5 (I've read that some places like it to be between 1.0 and 2.0 for women trying to conceive). Well, mine was 5.4 at first check, then got down to 2.3 the most recent time I had it checked (thanks to taking levothyroxine, which is basically a synthetic hormone). But -- two of the medications I've been on, estradiol (to thicken my lining, which gets thinned out when you're taking fertility medications, mainly Clomid) and the birth-control pills that all women doing IVF start out taking, make the thyroid medication not work as well. So I'm currently working with a new primary-care provider on the side to keep an eye on the thyroid issue, and maybe bump my dosage up if the TSH level starts to creep back up.

Also -- and this is probably the bigger deal -- two different HSG tests (that's the one I mentioned above, where they pump a special dye through your Fallopian tubes to make sure they're open enough for an egg to pass through at ovulation time) have showed that my left tube appears blocked. Clearly I can still conceive with one working tube, since your body sort of "takes turns" ovulating on each side. But it's anyone's guess which side my body will choose to ovulate on during a given cycle, and basically having a blocked tube means our odds are cut in half each month thanks to the dang faulty tube.

Other than that, there are a few tiny, ever-so-slightly sub-optimal things on both sides, but nothing major. If I had to phrase it like a person in "infertility jail" answering the question, "So what are you in for?", I would probably just say, "Hypothyroidism and a blocked tube." Which, in the grand scheme of infertility, isn't that bad -- the thyroid issue can be fixed with a simple daily pill (whose dosage I might have to up soon), and the issue of the blocked tube is completely mitigated by doing IVF, since the doctor goes in and gets the eggs (we don't have to sit around and wait for an egg, or multiple eggs, to shoot through a Fallopian tube).

Oh, and I would be remiss if I didn't mention another key reason we've struggled to get (and stay) pregnant: AGE. It's a hard biological fact that it gets harder to conceive, you're more likely to miscarry, and your baby's risk of having certain health problems goes up the older the woman is (there's a little more difficulty as the male's age goes up, too, but the age of the woman/eggs appears to be far more critical when it comes to getting and staying pregnant). Any woman who's age 35 or older and just starting to surf around through the various "TTC" (trying to conceive) websites and support forums has seen the "special" sections for us "Olds." Thirty-five is far from old in normal-people years, but good grief, if you're a woman trying to conceive -- the second you turn 35, all the websites make it seem as if your fertility plunges over a steep cliff and into a dizzyingly vertiginous free-fall.

This is not exactly true -- everyone is different, everyone's body is different, and testing certain hormones (such as FSH, plus another one called AMH, or anti-Mullerian hormone) can be a better indicator of ovarian reserve (quantity/quality of eggs you've got left) than purely going by age. But in general, once you're my age (37), it's time to get movin', if you want to use your own homegrown eggs.

You've been pretty open about drinking a lot (basically... being an alcoholic) during your late 20s and early 30s. Does your infertility have anything to do with this?
You know, as far as I know -- no, it does not. I no longer go out to clubs, parties, and other places where I'm tempted to drink, and my lifestyle in the past year or two has changed radically. Most nights -- even weekend nights, when fun club events and parties are happening -- I'm home, probably out walking or reading or writing, maybe listening to music on the treadmill. So those olden days of going out drinking three or four times a week are history.

I've been abstaining from alcohol almost completely ever since we started trying to conceive, the only exception being right after I get my period, at which point I will sometimes give myself the "consolation prize" of getting to drink a little bit, usually a cocktail at some social gathering or other, after I get my period but well before ovulation, i.e., I will not drink if there is even a snowball's shot in hell of my being even just barely pregnant.

I've read that heavy drinking, over many years, can affect the quality of your eggs -- but smoking is more of a problem for this (I've never smoked even one cigarette), and as far as I can tell, having gone through a "wild" spell for a few years shouldn't have any lasting effect, as long as I have stopped drinking like that. Which I have.

On a weirdly metaphorical or karmic-guilt level, there have certainly been times when I've felt as if the infertility is sort of... what I deserve for waiting so long to try to start a family. I went a little wild in my late 20s and early 30s, went out to clubs and drank and danced and got involved with a series of guys, had a crazy fling with a professor in New Orleans, packed up and moved to California (and then came back), traveled to perhaps more far-flung locales than many people thanks in large part to my adventuresome husband (Nepal, New Zealand, Patagonian Chile). Part of me feels as if Life is looking at me, hands on her hips, like, "Geez, all that life experience wasn't enough for you? You want to get to have a baby, on top of all that?"

Why, yes. Yes I do.

So how much is IVF?
From what I've found online, depending on the clinic, a round of IVF is something like $12,000-$15,000. That's typically not including all of the medications you have to take, which are legion. Oh my god, SO many drugs and shots! Luckily there are discount pharmacies (Freedom Fertility is the one that Shady Grove recommends; I order my meds through them by phone and they ship very quickly to my doorstep... sometimes in a Styrofoam cooler full of ice, because the shots need to be kept in the fridge!), and if you need financial help with any of it, a lot of clinics have entire financial departments focused just on that. I'm not sure what my medication total for one round of IVF will be, because we haven't ordered them yet -- but for one round of IUI, my meds cost me $800 (it was the injection that cost the most: about $600!). Granted, I got sort of tricked by my insurance company, who swooped in and gave me the meds before I could work with the discount pharmacy, so it shouldn't really have been that much. (At the time, I was getting all these calls from all these different entities -- the clinic, the discount pharmacy, my insurance company's mail-order pharmacy -- so I was honestly a little confused about whom I was ordering the drugs from!)

Our clinic, Shady Grove, has this sweet program called Shared Risk, and the deal is: For roughly the price of two IVFs, you get six tries... and you either go home with a baby, or you get all of your money back. (Meaning: If you have a miscarriage before the sixth try, you'd get to try again. Also meaning: If you get pregnant on the first try, then yes, you have paid for two IVFs while only needing one -- but that's the titular risk part of the program.) Now, you have to be accepted into the program -- Shady Grove's website says they estimate that about 70 percent of their patients would be accepted into the program if they all wanted to be in it. The ones who aren't accepted tend to be older (you must be younger than 39), or have high FSH or other ovarian-reserve-related hormones for their age, or other major reproductive issues that lead Shady Grove to believe the woman would not likely conceive even after six rounds of IVF.

I should note that a woman who's OK with going the egg-donor route is far more likely to be accepted into Shared Risk even if she's a bit older than 39, simply because, again, the success rate goes way up when the egg is younger, even if the woman herself is older (and even if the man is older). The egg-donor route is far more expensive (in part because the donor gets amply compensated, understandably; she has to take a bunch of drugs to sync up her cycle with that of the recipient, and has to go through egg retrieval and part with some of her eggs, after all), and the steps for that kind of IVF are different, so I'm only talking about the more "standard" kind of IVF here in this blog post.

So: In our case, we're dropping easily twenty grand, probably more, plus the cost of all the tons of medications I have to take. The answer to "How much is it?" is: Expensive.

I am aware that I'm incredibly lucky to be married to a man who had a really well-paying job for a while (working in Baghdad, as a jihadist-propaganda analyst providing intelligence reports to U.S. military officials, several years after he was over there with the Army) and was brilliant at saving and investing his money (including paying off an entire house in the college town of Morgantown, West Virginia, which he rents out to college students and other locals, with help from a property-management company), and that is the only reason we can do IVF. I'm no wastrel, but I'm not very good at making or saving money, either. I reckon I'd take out a loan or work closely with the financial department or, geez, take a loan from my folks or something if I hadn't had the money and wanted to do this. It is possible to do something like this without having the money set aside beforehand. But I know it must surely be a stressful financial burden for many people who decide to do this, and I'm pretty constantly dumbstruck by how lucky I am to not really have to deal with this burden (aside from stuff such as: "Maybe we will take one fewer overseas trip in the next couple of years").

I've told my husband that, after this is over, if I have a little money to donate to some charities -- I'm giving it to organizations that help make this sort of "last resort" family-having option available to people who are unable to afford it.

What are the various steps of IVF?
I should start by reiterating that I had already been an established patient at my clinic for a few months -- I'd already had the "initial bloodwork" and ultrasound appointments (with ultrasound, the technicians could check out my uterus to see if it's a normal shape, see how many fibroids I might have and how big/problematic they might be, check out my lining, see how my follicles, or would-be eggs, were looking early on in a natural/unmedicated cycle), already signed a bunch of the initial paperwork, had a ton of stuff already on file. So for someone just starting out, all that initial stuff would need to be done first.

Also, there are little steps that I'm sure differ from clinic to clinic -- for example, my husband and I spent about 45 minutes the other night watching a series of "video modules" with little quiz questions at the end, and we have to go to an "injections class" soon, mostly just to feel comfortably familiar with the staggering litany of drugs I have to take at various times. The education process surely varies a bit depending on where you go, so the steps below focus on the medical parts of the process.

There are also slightly different medication "protocols," so if you ever find yourself all signed up for IVF, some of the drugs you take might be a little bit different than the ones I mention here. If my husband and I go through a couple of IVFs with no success, there is also, of course, the chance that my doctor might do some additional testing, prescribe more, or less, or different, medication, etc. So consider these steps a rough guideline. (And again: It's a whole different ball game for those going the egg-donor route, both price-wise and when it comes to the overall procedure.)

1. Birth-control pills. Whuuut. First real part of IVF for me, believe it or not: birth-control pills! Yep -- you can probably imagine how counter-intuitive it feels for me to be popping those suckers right now! (This is the part of the IVF process that I am currently on.) The BCPs, as we shall abbreviate them henceforth, serve a couple of purposes early in an IVF cycle. Again, an IVF "cycle" is really about six weeks, or ~two menstrual cycles. For the first menstrual cycle, your ovaries are hormonally suppressed from ovulating -- both to give them a little rest before the onslaught of "ovarian stimulation" that's to come, and also because somehow this step helps cut down your chances of developing painful ovarian cysts (during the stimulation part) that might make you sick and/or need to be "drained."

2. Mock embryo transfer. Next up is my "mock embryo transfer" appointment. This is no big deal -- I come into the office, climb into the stirrups-chair like always, and the doctor threads a little catheter into me, checking the action out via ultrasound. This is to make sure they use the right-sized catheter for the actual embryo transfer, and also to make sure I'm not shaped all weird in there, which might make the catheter's path all labyrinthine and arduous. (This shouldn't hurt much; it's been compared, in terms of discomfort, to the IUI, which I barely even felt.)

3. Monitoring. A little later, I go in for the first of many "monitoring" appointments that I'll need to do during the rest of the IVF cycle. Each of these appointments is bloodwork plus ultrasound, and they're a breeze, usually all over very quick: Go into Room 1, quick poke in the ol' elbow-vein from the nurse, go into Room 2 for a completely painless vaginal ultrasound (it just feels to me like if you imagine someone smeared a bunch of Vaseline on one of those roller-ball deodorants and sort of pushed it up against you), pay my $30 co-pay at the front desk, head on out the door.

4. Drugs! If everything's shipshape, I start taking drugs! My RN (who works very closely with my Shady Grove doctor) gave me a handy calendar filled in with the dates on which I take all of the various medications, nearly all of which are shots. I'll be shootin' up with pricey synthetic hormones all the livelong day. The goal: to grow a bunch of eggs, at a uniform rate so that you don't have one trying to be the star of the show (this is what happens during a normal menstrual cycle -- one egg is sort of "the chosen one" and is released, while the would-be eggs, or follicles, just sort of wither away or shrink back up; the doctor wants to retrieve a whole bunch that are about the same size when "mature"). At some point, after a bunch of monitoring (every 2-3 days at some points during the cycle) -- it'll be time for me to drop the bunches of eggs I've had growing in me, so I'll give myself what's called a "trigger shot," which basically releases a hormone that tells the eggs that "It's go time!" and makes them "mature" or ripen to the point that they'll be all ready for fertilization.

5. Egg retrieval, then fertilization in a freakin' lab. The next real appointment I have is the almighty egg retrieval -- the most major medical portion of the procedure, meaning I'm put under anesthesia and my doctor goes into my ovaries (via my vagina) with a needle and... sort of sucks the eggs out. Around the same time, my husband provides an, ahem, sample. These two components are then mixed (is the over-simplified way of putting it) in a lab until some of the eggs are fertilized and we have some embryos. (This takes a few days.)

6. Freeze some of the embryos, and put one in me. The hope is that I will respond well to the medications again and churn out beaucoup eggs, in part because there is always some attrition -- eggs/embryos are lost at each step along the way. I might crank out 15-20 eggs, but maybe only 8 of these get fertilized, and maybe only 4 of those embryos seem to be viable, i.e., likely to stick in me and turn into an actual healthy baby. In a perfect world... well, OK, in a perfect world I would already have three kids by now, but in a perfect world in which I have to do IVF, we have 2 or 3 good-lookin' embryos left over to freeze and use to make additional babies (siblings for the baby we are trying to make now).

This is good because a) it would mean that we could try for another baby later but not have to do egg retrieval again (saving us money, and sparing me a more major medical procedure); and also b) the eggs/embryos would stay "locked" in whatever age I was at retrieval. Meaning, I could pop one of them in when I am age 39... and the egg/embryo would still be as healthy as one produced by a woman who has only just turned 37. Basically, it removes the pressure that comes with aging, for those of us trying to have babies with our own eggs.

The doctor and the embryologists will determine which embryo is most likely to be viable. Yes, it is totally weird to just be off somewhere in the world while a team of medical professionals takes a look at (maybe) a bunch of embryos, all of which have technically been "conceived" (fertilized), and selects one of them in a pretty blatant display of "survival of the fittest." True, the other viable ones get set aside, and one or two of them might get used later to create a sibling or two -- but in the meantime, those incipient or potential people (not getting political here; just... sort of stating a fact -- for the record, I am pro-choice) are literally just chillin' in a freezer, for years, maybe.

And here's the weird thing, which is all kinds of ethically fraught: There's the possibility that we might not be able to use all of the viable embryos. I mean, my husband and I would only want maybe two kids in the most perfect of worlds (well, OK, I'd be cool with three, but probably not more than that). This means any extra embryos would either be donated to an infertile couple, donated for research, or discarded. Unfortunately, my husband and I have heard that infertile couples very rarely go with donated embryos -- it's fairly rare for both partners to be completely infertile, so in many cases either donor sperm or a donor egg is used (a donated embryo is basically both). My husband and I have agreed that if we ever had to make this decision, we would donate the embryos to research, so that their little spark of life on this planet will have really meant something, will have potentially helped someone, or a lot of someones.

But back to the IVF process, which is what I'm supposed to be writing about here. From what I've read, the actual embryo transfer is a far more minor medical procedure than egg retrieval is, and again, discomfort-wise, is analogous to the pain-free IUI procedure -- the doctor sort of blows the embryo up into my uterus with the aforementioned catheter, with a little air puff, and helps guide it (with help from the ol' vaginal ultrasound) to a nice spot in my uterus. No anesthesia, no required rest afterward -- just go home, and not do any heavy lifting or anything else crazy, but otherwise basically return to normal life. Oh, plus popping all of those vagina pills I mentioned before (progesterone, and probably estradiol for me to make sure my lining is nice and plump).

7. Two-week wait, and blood pregnancy test (or... store-bought pregnancy test if you're impatient like I am, then blood pregnancy test just to make extra-sure). And then we just wait. Since the birth-control pills are supposed to make my (normally slightly irregular) menstrual cycles run like clockwork, we go ahead and make an appointment for the blood pregnancy test at the clinic, for the day of or after my period is supposed to show up (if we're unlucky). And that's it. If it doesn't work the first time -- for us, since we're in the Shared Risk program, we repeat x5 until baby or money back.

Shots, yikes. Do they hurt? Is it hard to give yourself shots?
This is the part I want to shout from the rooftops, within earshot of any women who are considering or about to start any fertility treatment (IUI, IVF, etc.) that requires them to give themselves these shots: The shots don't hurt! They're even sort of fun, in a scientifically fascinating way. They make me feel sort of hard-core! I should note that I have read accounts from women who've had a little bit of pain when giving themselves (or having their partners administer) the shots, but for me, they've been easy-peasy. All I have to do is grab a good pinch of belly chub, then poke the teeny-tiny, nigh-hair-thin needle in, push the other end of the shot slowly until all the hormone is in me, then pull the little needle out, and dispose of the needle in the little "sharps" container that came with my first-ever shipment of fertility drugs. (It looks like a tiny trash can, marked in bright colors kind of like with hazardous waste.) 

The only part I don't like, really, is when the "pen" you use to give yourself some of the shots (for example, the Follistim pen, which is not single-dose, so you put in new cartridges and stick new needles on the end) is a little bit too multi-step and I worry I've forgotten or done one of the steps wrong. Giving myself shots, receiving them, watching the needle go in -- all of that is totally fine for me!

You keep talking about drugs. Are you having any side effects from all the hormones you're swallowing, shooting, and inserting into your vagina?
Actually... no! Several of the medications make my boobs ache a bit (the Clomid did, I think, and the progesterone, and possibly the estradiol), but only sporadically, and only about as much as they've hurt on their own here in recent years, both around ovulation time and right before period time for me during a normal, unmedicated cycle. So for the most part, no.

How is all this affecting your relationship with your husband?
I hear (or: read online, mostly) a lot of couples going through IVF say the same thing: It can put a weirdly pragmatic spin on sex (timing things for conception, the husband having to produce "samples" in medical cups all the time, the wife in the next room popping pills into her va-jay-jay), but ultimately the whole process seems to often bring couples closer together. I mean, it makes sense -- you're working together, as a team, to overcome a heart-wrenching obstacle together and reach a mutual goal, comforting each other and pepping each other up. When it's "us against a hurdle," I think it can sometimes eliminate a sense of "me against you" (uh, not that my husband and I really have any "me against you" stuff going on to begin with).

Maybe this sounds weird, and maybe this only reflects the fact that I'm not omniscient so I have no clue what anything is like for vast numbers of people -- but I have never heard or read anything from anyone saying, "Going through IVF made us break up" or "Doing IVF created emotional distance between us." If anything, it seems to frequently bring people closer.

Of course, dealing with ongoing infertility will put a strain on probably most relationships, just as any persistent obstacle will, whether it's money or dealing with family hardships or whatever. But I can honestly say that, in our case, if anything I think it's only made us feel more firmly cemented as a "team." Things like my husband being unhesitatingly willing to commit a bunch of dough (that, really, he earned, not me!) to something that might help us have a family has only caused me to love and respect him even more. Ditto for all the times he's cheered me up, accompanied me to even more routine appointments, offered to handle the financial paperwork (since I gotta keep up with the drug craziness, and get poked and prodded all the time), and just been generally reassuring and optimistic and awesome.

Why are you going through all of this expense and hassle when you could be adopting a child who needs a home?
You know, this is a question that I wonder if people frequently want to ask but don't out of politeness. It's a question I've asked myself, too, many times. Here's my honest answer:

I want to have a baby. I want to have the experience of being pregnant, of growing a child inside me, hearing the heartbeat on the monitor, feeling it kick and move inside me, and (crazy as it sounds) of giving birth. This is just something I have always wanted to do. It's not something everyone wants to do, but it is something I have always wanted to do.

I would like to have a baby who is part me and part my husband. Is that kinda selfish and vain when you think about it? I suppose that, when viewed in a certain cynical light, maybe you could say it is. You could perhaps especially say it's selfish and vain to go to such extremes (i.e., pay for and go through IVF) "just" to have a baby who is part you and part your partner. And yet, it's what we would ideally like to do. I don't know what to tell you -- that I'm human and I'm allowed to be selfish sometimes, if the "selfish" thing I want is likely to come along with a lot of beautiful and completely life-transforming experiences? And if the "selfish" thing is a pretty normal part of many people's life experiences that I want in on, too?

As far as genetics and such, it's certainly not a requirement that any kid of ours look like us -- I sure have had conflicted feelings about the way I look over the years, plus lots of kids don't look much like either biological parent at all; genetics is sometimes pretty whack. I guess it's maybe more the symbolism of it -- "This baby is part me, and part the person I love."

Another thing I've thought about a lot: There are a lot of kids who need good homes. Do I want to give these kids a good home? Of course I do! Could my husband and I provide a nice, safe, happy, healthy, fun, educational, loving, nurturing home for some poor kid who needs one? I absolutely believe that we could. But -- and here is where I start to feel like a terrible person -- a reality is that many (maybe all?) of these kids have some kind of sad backstory going on. Maybe they were put up for adoption as a baby, and never knew their parents; or maybe they do remember them. Either way, I'm not sure that I feel 100% equipped to competently handle that kind of emotionally difficult situation in the way that would be best for any kid.

And if I'm being completely honest, and not just saying the things I feel like I'm supposed to say... there's a small part of me that can't help imagining what it would feel like when the kid got a little older and wanted to find and connect with their "real" mom or dad. Of course I want to believe that, in that situation, I would be totally supportive and not feel jealous or unappreciated at all -- but I'm human, and honestly, although I know I would want whatever would make the kid feel the most fulfilled and "complete" and happy... I don't know that I would feel OK as the "not my real mom" in that scenario. A lot of people stronger and more noble than I am would do just fine in that kind of situation -- I'm not sure that I would.

I guess I was supposed to start out with "I hear adoption is actually a very bureaucratically challenging and frequently frustrating process, and it's nothing at all like taking in a pet from a shelter" -- but again, if I'm being honest, it's that more emotional stuff I think of first when I ask myself why we didn't just skip straight to adoption instead of going to all the trouble of doing IVF.

You're being pretty open about all this. What about your possible future kid? Don't you think he or she might not want the world to know they were conceived through IVF -- that it might make them feel "not normal"? Shouldn't sharing this fact be a decision the kid should be able to make someday?
These are very good points, and yes, I've felt guilty at times for being so open about all this. I mean, if my husband and I make some announcement in a few months, everyone we know will know that we conceived through IVF. And it's true that you never know what kind of kid you're going to get -- I'm super-open about everything, but maybe our kid will be more private (like... well, like my husband, actually, whom you might notice I refrain from outright naming on this blog), and will someday be mad that I wrote about all this in such a public manner.

But here are the reasons I ultimately decide to just go ahead and write about this stuff anyway:

1) Nobody reads this blog; the only people I share the link with are a trusted few with whom I'm friends over on Facebook, plus a couple of other "subscribers." It's pretty much the equivalent of discussing it with a few friends and relatives, because... that's exactly what I'm doing. (Although yes, I know -- if you put it on the Internet, you basically make it immortal.)

2) I believe that there a ton of women out there who are going through the same thing (or similar situations) as I am, and I believe there's a lot of value in sharing my experiences and thoughts about all this. Being more open about this stuff makes it less weird. Be the change you want to be in the world, and all that. We gain nothing by shutting up about things that fall outside the ideal or the norm.

3) There are tons of IVF babies nowadays, and you know, it's actually not weird at all. Not super-common, not the norm -- but not exactly science fiction either.

4) Really, if anything, when everyone knows how hard and how much you tried to have a baby, the great lengths you went to in order to bring that baby into the world -- they know: This baby is loved. This baby's parents are rollin' out the welcome mat. This baby is the (secular) miracle answer to these (atheist) parents' prayers. This baby was made with love and science! The very fact that this baby exists is a testament to just how much this couple has longed to have a family, and a testament to the life-transforming technology that can be dreamed up by the human brain.

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