Sunday, November 15, 2015

Onward (Miscarriage #2)

Somewhere in Kissimmee, Florida, along the fringes of Orlando well within Disney's orbital pull, just outside the gated entrance to a time-share resort that has multiple pools and one employee dedicated solely to kids' crafts workshops, on a sidewalk that leads you to a busy road you must cross if you want to get to the eternally crowded drive-thru Starbucks, there's a pine-green metal bench. The bench is blah. You have no reason to notice it, or remember it.

Except I'll always remember it, because it's where I got some bad news.

Almost exactly one year to the day after my first-ever pregnancy ended in miscarriage, I learned that my second-ever pregnancy was ending, too.

Our first-ever round of IVF
had been a success. We'd gone through all the rigmarole, the shots, the every-other-day monitoring (bloodwork and a vaginal ultrasound at each monitoring appointment, my one good vein growing pinpricked and weary from being poked so much for the bloodwork), getting wheeled into the operating room and put under anaesthesia and having my ovaries stabbed with a surgical needle 20 times because that's how many eggs I had grown in the course of one menstrual cycle, limping around slugging down Campbell's soup and electrolytic sports beverages as I recovered from a "mild" case of Ovarian Hyper-Stimulation Syndrome, the anticipation of waiting to hear how our embryos were faring in the incubator in the days leading up to the embryo transfer, losing hope at the high attrition rate (out of 20 eggs, 17 were mature; of these, only 9 fertilized; by the day of transfer, only two had made it to a transferrable stage, with none left over to freeze), four thousand dollars' worth of hormone drugs (on top of the $20k we'd paid to get into my clinic's Shared Risk IVF program).

When our plane landed in Orlando for a long-planned family vacation with my parents, my brother and his (pregnant) wife, my sister and her husband, I took my phone off airplane mode and checked my voicemail. There was a message from my doctor, telling us "Congratulations," saying the pregnancy test I'd taken that morning was positive, even saying that the number was strong for a first "beta." It was so strong that I suspected both of the embryos we transferred had implanted (my doctor had advised transferring both of the ones that'd hung on until transfer day, due to the fact that I'm 37 and odds of pregnancy go down with age).

I excitedly told my husband, who was sitting in the seat next to me, as a million people above and around us hefted their wheelie suitcases out of the overhead compartments and crammed into the aisle. We could wait for the rushers to get their stuff and move on out; we were in no hurry -- everything was right with the world.

We (OK, I) decided to tell my family at the fancy seafood dinner we'd had planned for our first night in town. Before dinner, we all hit the grocery store to stock up on breakfast cereal and snacks for the week ahead. At the grocery store, my husband and I held hands and giggled like kids passing notes in school; we had a secret I was bursting to share. At dinner, I waited for a lull in the conversation then made our announcement. Cheers all around, water glasses hoisted.

I shouldn't have been so rash. I should have waited to tell them. It's not like I haven't had an early miscarriage before -- although technically, I am supposed to call this one a chemical pregnancy. Actually, technically, I think I'm supposed to call them both chemical pregnancies (some define miscarriage as a loss after you have seen for sure via ultrasound that there was a baby in there, not just an empty sac or blighted ovum secreting hCG) -- but I don't like that term. To me, it invalidates the emotional component of the loss. It just sounds like a biological misfire. Which, yes, it is -- but for many women and couples, it's much more than that. For many of us, it's stabbing a knife into the heart of a long-held dream. (When it comes to a very few subjects, I will allow myself to get maudlin.)

For nearly a week, we were pregnant. I was cautious, of course; even when relaying my doctor's message to my husband on the plane, I said stuff like, "Now, it's very early, of course... We have to do a bunch of follow-up betas [blood tests to make sure the embryos are growing at the proper rate] to make sure things are going OK." But part of me thought, "Surely to God this won't happen to me twice. Surely the odds are against that. Surely it is our turn to be lucky, to have this so-called miracle that seems to happen for everyone who wants it except for us."

My husband and I sat on the ledge of a pool at my parents' time-share resort one day and splashed our legs in the water and finally, after being so cautious and guarded for so long, I burst out: "I'm pregnant!" We got cautiously attached to the idea of having twins, even, despite knowing the risks that come along with "multiples."

It was a drag going for the follow-up blood tests while out of town -- I had to find a LabCorp location near me, make an appointment online, borrow my sister's car (she drove down with her husband from where they live in South Carolina), GPS over to the LabCorp on unfamiliar streets... then, since I didn't have my lab order printed out, my husband and I had to find a goddamn Kinko's and print the sucker out from my e-mail and drive back. Then, wouldn't you know it, we walked right out of there without picking up my driver's license and insurance card that I had surrendered to the front-desk chick when signing in... and had to drive all the way back out there to get those kinda important items.

By the time we finally got back to the time-share, LabCorp had faxed the results over to my clinic, and my RN had left a message on my phone: The numbers were going up, but not as much as they really were supposed to. I Googled around frantically trying to see if maybe the numbers reflected a "vanishing twin" -- two embryos implant at first and are secreting a bunch o' hCG, then one drops off, so the number rises slower than normal at first.

Then, three days later, after my second trip to LabCorp for another follow-up blood test, I checked my e-mail and saw the note from my RN: The number was going down. I did some more desperate math. To my mind, this latest number didn't appear to be enough to account for just one embryo to be in there and doubling at a healthy rate. It was over.


I sat on that pine-green bench, mercifully alone early in the morning in a town where everyone is on vacation, and of course I cried. I walked back to our room. My husband was reading a library book on the balcony, his back to me on the other side of the sliding-glass door. There he was, the hopeful one of the two of us, the optimistic one; he had kept faith in the pregnancy even when I had worried. I couldn't tell him just then. I waited until he came inside.

* * *

As I mentioned above, my brother and his wife are having a baby. My new niece will be born in March. In Orlando, my brother and his wife bought gifts for the baby -- a Luna Lovegood wand at Universal's Harry Potter world, a yellow onesie with the face of a Minion on it, a mouse-ears hat with the baby's name embroidered on it.

After I found out about the low beta number (I didn't tell anyone but my husband about this until after we came home), my family went to an outlet mall. In the Lucky Brand Jeans store, I overheard my brother and his wife talking to a sales clerk who was assisting my brother's wife with buying a sporty jacket. I heard the sales clerk say, "Is it your first?", and heard them say yes, that they're so excited.

I had to leave the store.


I haven't cried as much this time around. I don't need to take a week off work like I did last time.

I don't have nicknames for the two embryos we transferred into my uterus (I have a nickname for the first baby I miscarried), although I blew kisses to each of them every time I passed by the photo of them given to us by the embryology staff after the transfer. I sang to them in the shower: "Heavy seas of love... radiance is in you." I did dopey stuff -- when putting in my progesterone inserts, a pill I take vaginally using a tampon-lookin' applicator, I would warn the "embies" that something was coming toward them in there -- "Incoming!" My husband and I got two fortune cookies with some Chinese take-out, and I decided that each of the "embies" would get a fortune. The healthier-looking one ("Grade A," my doctor said, best quality rating on the scale) got a fortune about how it would "make friends;" I took this to mean it had a buddy there in my uterus. The other embryo, the underdog, got the fortune about being a part of advanced medical research, and I thought, hey, an IVF embryo is surely that. (On the little slips of paper, the fortune messages are bookended by smiley faces arranged uncannily similar to the way our two embryos are lined up in their photo.) 

But I was guarded, in a way I didn't even intend -- it's almost as if I could float outside of myself and observe, in an objective, third-person manner, "Hey, this chick is weirdly aloof to all this." I tried a couple of times to rest my hand on my belly and talk to the embryos, but it felt forced. I've read about how women who've had miscarriages will sometimes protect themselves by not bonding with the baby until the pregnancy is safe and the risk of loss is low. I reckon that's what was going on with me -- and yet, I sang to them; and yet, I gave them fortune-cookie messages, arranged each message in front of each embryo in the photo.

Even now, typing this, I'm aware of a degree of numbness that I find almost alarming -- it's kind of like, "Have I become some unfeeling sociopath or what?" But then I'll realize that I can't walk past the strollers and baby clothes in Target without getting all teary-eyed, or my voice will crack on the phone while un-telling my parents about the pregnancy, and I realize, "OK, I'm still alive in there."

* * *

I don't want you to feel sorry for me.

It's OK if your instinct is to say something like, "I'm so sorry." That's a nice thing to say, and it's the natural thing to say -- it'd be the first thing I'd say to someone who has suffered another loss.

But I guess it sort of grates on me, picturing myself as some pitiable figure, someone you feel sorry for, someone you whisper about -- "Poor Christie and her barren womb!" I am extremely privileged. You saw up there where I casually mentioned my husband and me dropping 20 grand to be in our IVF program? Most people couldn't afford that. We live near one of the best fertility clinics in the country, and the Shared Risk program gives us a total of six IVF tries, resulting in either an actual live baby or all of our money back. That means we get five more tries for the price we have already paid.

I just turned 37 in September -- that's on the older side for babymaking with your own eggs, but our situation is far from dire. I'm a "high responder" to the fertility drugs, which is better than being a low or no-responder. My FSH (follicle-stimulating hormone) level is low for my age, more like that of someone in her twenties; this means I likely have a decent ovarian reserve, that my body isn't yet stepping on the gas to pump out the last of my eggs. (In some clinical studies, women over 35 with FSH as low as mine is get lumped in with the under-35 crowd, because hormonally we're "younger.") I have been pregnant twice; this last time, even though I responded too well (too fast) to the medications and we had to dial back the dosage, which compromises egg quality -- we still got a couple of viable embryos out of those less-than-ideal conditions, and one or both (no real way of knowing which) still implanted in me and stuck around for a few days.

There's hope. We get five more tries. My clinic has a truly impressive track record of knockin' chicks up, and I trust my doctor and RN completely.

So onward we go. I have a consultation appointment with my doctor this week to discuss all the things we'll do better this time. I go on birth-control pills again for one menstrual cycle, to calm things down in the ol' ovaries before the next bout of stimulation with the shots -- then we start up the shots again next month. My egg-retrieval and embryo-transfer procedures come soon after that, around the New Year, I think.

It will be another sad Christmas this year. Yes, I have already bought an ornament that, for me, symbolizes the two embryos -- a glass globe full of snow, two Christmas trees and a deer playing with them, a winter woodland scene. It will hang on the tree next to the angel I bought for my first miscarried baby.

I'm a rational person, an atheist for 17 years now, but a part of me still has the capacity to accept certain occurrences as... if not divinely intentional, then at least fortuitously timed and placed. Around the time I had a hunch I might be pregnant -- before my doctor's call -- I looked up at the black sky on my way to the Metro one early morning before work and saw, obvious as anything, two stars, one burning a bit more brightly than the other one. I couldn't stop looking at them as I hustled down the cold street.

In Orlando, on one of the "free days" when my family didn't have a Disney park on the schedule and I was sitting by the pool, I looked up and saw a short smidge of rainbow in the clouds; among the women who haunt the "TTC" (trying to conceive) forums online, a "rainbow baby" is one that you have after a miscarriage, something beautiful after a storm. (Though normally I dislike the term, because to me it makes the miscarried baby sound like a "storm," something dark and negative.)

I'm an atheist, but I broke my own laws of rationality and prayed -- when I was having the first miscarriage, and this last time. Of course, in the cartoonish way I have always thought about God when I've believed in him, I imagined him up there in the clouds with his arms crossed in a vaguely sassy manner, thinking, "Well, look who's come crawling back!" I always hated it when religious people would say the thing about how "there are no atheists in foxholes," a rather dated saying implying that a person in need will, in fact, come crawling back to God if they think it might help -- but, well, there I was, crawling back. I realize this sounds nonsensical, paradoxical, when I tell you that I am still an atheist and never really stopped being one -- but the praying was sincere. In those moments, I believed. It makes a sort of emotional sense to me.

Dandelions grow in our tiny front yard -- that see-through kind you blow on to make a wish. I've developed the superstitious, quasi-spiritual habit of picking any that I see and blowing on them, always making the same wish (guess what). What started as a sort of charming if not self-consciously precious ritual has evolved into something aggressive, weirdly desperate -- instead of plucking them reverently from the ground, I yank them up and blow on them hard; if some of the little fluff sprouts stay stubbornly embedded in the dandelion nucleus, I blow harder, and if that doesn't work, I rip them out.

Infertility: It ain't for pansies.

Going through IVF is a grim slog, even if you only do it once. But in gambling terms, you can't win if you're not at the table. We have five more rolls of the dice. We have a lot of work, a lot of money for new drugs (medication costs are not included in that $20k we paid), a lot of relying on the generosity of our bosses to let us miss work or come in late on monitoring days, a lot of anxiety ahead of us.

I'm up for it.

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