by Suzy Becker
Dr. Rankin (the gynecologist’s referral we’d dissed) was our surgeon. The nurse described him as more “laid-back” than Dr. Penzias. Dr. Penzias had never struck us as uptight, but we weren’t nurses. Dr. Rankin was very kind, not the least bit disapproving, but Lorene never passed up an opportunity to make an extra-good impression. She complimented his accent, which he revealed was Scottish.
The anesthesiologist arrived and Lorene kissed me good-bye, gave my wedding ring-less hand a last squeeze, and went off to the waiting room. The next thing I remember, I was being transferred to the post-op area. Lorene came in about the same time as the saltines and ginger ale. We were free to go, or to stay as long as we liked. The lab would call us with the official egg count in the afternoon.
Egg Retrieval
The doctor uses a vaginal ultrasound to guide a hollow needle to the ovaries. The needle punctures the follicle and the egg and fluid are suctioned out.
The count was twenty. (The average count is ten to twelve.) I called to brag to my IVF-vet friend. She was unimpressed. (She was also alone with her twins, without child care for the week.)
“The egg count is unreliable,” she said. “What really matters is how many fertilize.”
She was always one step ahead. Lorene’s and my sanity-preservation plan required us to celebrate the step we were on. I stayed in bed, did a little work. I felt fine, felt like I was slacking, in fact, since I felt no pain, just my normal afternoon drowsiness. I closed my eyes for a second and woke up two hours later when the phone rang.
“Suzy, it’s Margaret” (the neighbor from across the street), “Do you have any eggs?” Do I have any eggs? Do I have any eggs? Well, Margaret, let me tell you. I have TWENTY! TWENTY EGGS! “I just need one.”
She was at the door a few minutes later. I handed her the lone egg, recognizing, after the fact, that my bedhead conveyed a certain not-exactly-working-from-home ethic.
Fourteen of my twenty eggs fertilized. I called my IVF friend. She was not impressed. “What really matters is how many good embryos you get.”
We got two “beautiful eight-cell embryos” and one six-cell embryo which we agreed to freeze.
The transfer doctor’s resemblance to Al Franken stuck with me, whereas his last name, something one-syllable, did not. He put the two beautiful embryos back into my uterus (while I was off in general-anesthesia land), and we were back on the road an hour later. Dr. Franken called around noon to report that my six-cell embryo never made it into the freezer; it had started to fragment. So much for my two beauties.
I couldn’t refrain from asking, while trying to head off a nonanswer, “I know you may not know, and your answer won’t change anything, I’ll still have to wait to see whether I get pregnant, and of course, I won’t hold you to it, I’m just asking, really for my, you know, my peace of mind, what’s the likelihood of the transfers fragmenting?”
“As you said. We don’t know.”
The IVF coordinator called in the late afternoon. She was following up: Fourteen out of twenty was a high fertilization rate, very promising. Two embryos out of fourteen fertilized eggs was very low. The results of the stain testing they’d done on the extra eggs and sperm might tell Dr. Penzias something about the egg/sperm quality, which could inform the next cycle.
I interrupted. “So this one’s not going to work out?”
“I’m sorry, I didn’t mean to suggest that. Not at all. You only need one good egg.”
It’s just that that one can be so damn hard to come by.
A Little Bit Pregnant
TIPS TO STAY SANE WHILE WAITING FOR YOUR PREGNANCY TEST RESULTS
1. Once your transfer has taken place, there is nothing you can do to influence the outcome. Pessimism, anxiety, etc. will not influence outcome.
2. Embryos cannot fall out (into a pothole, toilet, etc.).
3. Progesterone will cause confusing symptoms. Only a test will tell if you are pregnant.
It was a rainy spring. The rain took the pressure off weekend yard work, although some of the pressure wended its way into the weekday evenings. The sounds of our neighbors’ mowers marred the few good sunsets we might have otherwise enjoyed.
Lorene and I had gone to Vermont to celebrate our first anniversary, leaving the yard and house far behind. Sunday morning, the actual day, we went to Dot’s Diner, where we’d had our first “civilly united” breakfast. We brought the New York Times back to the house and read all through the afternoon in front of a fire. There were long stretches that weekend when I didn’t care if I was pregnant. We would have a happy, more self-indulgent life together without children.
Then I started to bleed. I cried for a few minutes alone in the bathroom. Lorene looked up when I walked back in. “I’m sorry,” I said. She needed no further explanation. “I really thought this time . . . ”
“I know,” she said. She was crying, too.
The rest of the day, the sight of red—cutting cherries, red sock fuzz on the white porcelain bathtub—would turn my stomach. And then the bleeding stopped, and I started having cramps.
“You know,” Lorene said, “spotting and cramps are pregnancy symptoms.” By the time we dined on bread, cheese, baby artichokes, and defrosted wedding cake, I was willing to believe again that I could be pregnant. Spotting and cramping certainly marked a departure from the first seven failed attempts.
The sun was out on Tuesday, the morning of the pregnancy test. Lorene was now positive I was pregnant. I had gone so far as to think maybe I might be, too. Getting to take the blood test was, itself, something of a milestone.
An hour and a half after I had been back at work, pretending to have a normal day, my studio phone rang. Lorene appeared on my stairs out of nowhere. It was Boston IVF. It did occur to me in that split second that ten thirty (vs. after lunch or at the end of the day) was an auspicious time for a call, and I wasn’t all wrong.
“Suzy, your pregnancy test was positive,” the nurse said flatly. I gave Lorene the thumbs-up and she gasped. “However, the positive hCG value is low,” which would explain the nurse’s affect. “There is a fifty percent chance of a healthy pregnancy. We’d like you to come back in for another test in two or three days.”
Lorene and I sat on the stairs and I repeated the nurse’s four sentences. Three days was more convenient, but we didn’t want to wait. (And since when was convenience a factor?)
After I scheduled the test, I succumbed to an online hCG-research session while my cartoons, book, Ride FAR, and the library roof grant application waited. Best-case scenario: delayed implantation. Probable-case scenario: miscarriage or ectopic pregnancy.
Human Chorionic Gonadotrophin (hCG)
A hormone produced by the developing placenta post-conception, measurable in blood or urine.
That night, I started to bleed heavily. I would’ve just thought it was my period if I hadn’t had that stupid pregnancy test. We were sorry all over again. Lorene wanted to cancel our dinner plans to stay home and cry. I couldn’t be convinced of the upsides. THIS has already taken up too much of our emotional energy. Besides, if I started crying, I might never stop.
My hCG value, with brazen disregard for my heavy bleeding, doubled on Thursday, which was a “good” sign. My healthy-pregnancy odds stayed at fifty percent. In just two short days, these sounded like “good” odds to me. The nurse suggested I curtail all physical activity: “We’re going to treat this as a pregnancy with a bleed.”
Meanwhile, I had to treat it as a seventh-grade menstrual period. No tampons. Nothing up my ying-yang other than the progesterone suppository, which was helping me hold at fifty percent. I had a supersize self-stick sanitary napkin stuck between my legs.
Meredith woke us up the next morning. Two weeks ahead of her due date, her water had broken. I padded up my pants, packed up my gear, and got the phone chain going. I gave my dad’s partner, Linda, the news first, then I paused the chain to put in a call to Boston IVF to report even heavier bleeding. Back on the chain, I ca
lled my mother. She had somehow reached my father in the intervening ninety seconds and he’d told her the news. “Your father is always the first to know,” she said.
I apologized and tried to explain, “Dad needs to arrange flights—”
“I’m her mother, Su—” (call-waiting beep).
“I have to take another call—it’s the doctor’s office calling about my miscarriage.” I flipped over. According to the nurse, I am “a pregnancy with a bleed until my next pregnancy test, which is scheduled for Monday.”
I didn’t feel like a pregnancy with a bleed (I felt like a miscarriage about to embark on a marathon) as I loaded my stuff into the car. I arrived at the hospital just after Meredith had her epidural. I was glad I missed it—I’d sooner take a horse needle than watch them give it to my little sister. Within the hour, Henry’s 100-plus-percentile head made its way into the world, followed by a left shoulder, a graceful twist, and the remainder of his twenty inches.
One-hour-old Henry in Grandma Belle’s wig
Lorene brought a bottle of champagne over to the hospital after she got off work. We toasted Henry and their new life, as I was surer by the minute that we were losing ours.
I was at the airport before nine the next morning to collect my dad. His extra-cheap airline didn’t have any monitors in the arrivals lobby, which fouled up my extra-cheap parking. I couldn’t wait for the airline’s two employees to agree on the status of my dad’s flight. I raced back out, doing a double take as I passed my dad on the way to the curb.
I was sobbing over my windshield by the time he got there. “How much is it, Sue?”
I looked. “Fifteen dollars.” He handed me a twenty once we were in the car and said, “Linda told me some of what you’re going through, which helped me put everything in perspective. She explained how when you undertake this kind of a thing, the thing you’re undertaking, you mentally prepare yourself, you’re psychologically prepared for anything.” He paused. “I am here this weekend to celebrate being a grandfather.”
Wow. I wasn’t psychologically prepared for that ending. I adjusted my chauffeur’s cap, drove him to the hospital, and dropped him at the doors.
My hCG value went up again Monday, although I was a hundred percent sure my pregnancy was part of the unhealthy fifty percent. On Thursday, nine eternal days after that first test, my pregnancy was declared “abnormal.” I was relieved. I was not cut out for another 270 days of a marginal pregnancy. And I was now free to shelve the suppositories. Free to resume my normal activities. I put the garden in. I got back on my bike.
Lorene was grieving. And uncomfortable with the one-week waiting period until we would find out how this abnormal pregnancy would terminate. My belief—that whatever it was I was carrying around wasn’t meant for this world—was of no comfort to her. Neither were Meredith and her new baby.
The day before our “resolution” meeting with Dr. Penzias, I went to New York for my rescheduled Cover Girl presentation. The Jell-O brain mold salad I’d prepared set a humorous tone (although I got only two takers), and the tenor of the lunch was generally very upbeat. I made the rounds after lunch, collecting a What to Expect the First Year for Meredith and stopping by a college friend’s desk. She was now an editor. I gave her my pregnancy update. “That is so weird!” she said. “It was like that with my son.”
“Your son?”
“Yep, he was completely borderline for, I don’t know, a month, six weeks—seemed like forever.”
“Then?”
“Born healthy. Totally healthy kid.” I started to rethink everything.
I went into our meeting with Dr. Penzias with a list of questions, my “resolution” resolve wavering. “Do you think we should do more blood work, just in case? I ran into a friend of mine whose thirteen-year-old son was the result of one of these borderline pregnancies . . . ”
“I’m afraid yours isn’t borderline.” Mine had gone further south. “Yours is an ectopic pregnancy.” I modified my mental picture.
My options were to have an injection of methotrexate, which had an eighty percent chance of ending the pregnancy; the rest of the time another injection, or a second injection plus surgery, were necessary. Or I could have the surgery straight away. With either option, there would be a three-month recovery/waiting period before we could try again. And neither option would have a negative impact on my chances of “achieving pregnancy” going forward.
“I’m not feeling so lucky,” I said to Lorene. “I’ll be one of the twenty percent.”
“I’d rather you avoid surgery, if you could,” Lorene said.
“The shot is the least invasive option,” Dr. Penzias interjected from the other side of the desk.
“You could do it now?”
“Francesca can administer the shot right next door at the end of our meeting.”
“All right.” I was ready to go. Luckily, Lorene remembered our questions.
“Is there anything we can do to improve our chances? Do we know why the embryos fragmented? Did that stain test tell you anything about the egg or sperm quality? Should we try for better sperm?” Steve was planning to visit over the summer.
“Should I go on the pill?” I added. “And my friend said something about ICSI . . .”
Dr. Penzias smiled. “The stain test didn’t really tell us anything. Remember, under the best of circumstances, chances are one in five. Obviously, we are trying to improve your chances, working around obstacles which we’ve already acknowledged.” He leaned forward. “But, there is a silver lining in all of this. An ectopic pregnancy is a pregnancy—evidence Suzy can get pregnant.”
We went next door. Francesca gave me a shot in each cheek and apologized, “Your muscles are going to be sore.” She also told me to keep out of the sun, which I forgot, then remembered when I felt as if I was going to throw up in the middle of my bike ride the next day.
I spent July and August training for and organizing Ride FAR and working with designers to lay out the brain book. Lorene worked and went for late-night swims while I pored over book proofs. She stopped asking if I would join her. I had become so unromantic. A swim = a drive in the car + getting wet + a wet drive in the car. I just wanted to lie down.
I was lonely. What about her, do you think she likes swimming alone? And I felt guilty. This wasn’t the life I’d promised Lorene in front of the fireplace a year ago.
I wished I was someone who wanted to swim at night, but as any infertile person will tell you, wishing won’t make it so.
In A Parallel Universe
Ride FAR 8 was a success. We raised a record $140,000 for HIV/AIDS service organizations, and I was in fine physical form: drug-free since the methotrexate injection three months earlier.
Biking 100 miles a day for 5 days gives you the feeling that you can do anything. Except the one thing.
My three-month hiatus gave people plenty of time to reflect on my infertility:
More than one person had asked me why I wasn’t adopting. The answer I gave—I wasn’t adopting because I wasn’t done trying to get pregnant—wasn’t entirely honest. (Nothing says you have to give a highly personal question a highly honest answer.) And the answer I gave myself—I was too afraid of the unknowns, the genetics and the physical and mental health histories—wasn’t entirely truthful. The truth (which I didn’t know back then) was, I was too afraid of the knowns. You begin an adoption, you end up with a child. Some small part of me preferred leaving my outcome to chance.
I was ready to get back on the baby project. When I called Boston IVF, I was transferred to the insurance liaison. Now that I was forty-one, my insurance wanted me to “pass a Clomid challenge” before they would authorize more treatment.
DAY 1: Bloodwork
DAYS 5–9: Take two 50 mg tablets of Clomid
DAY 10: Bloodwork
Pass = Estradiol rising, FSH dropping
I called a friend on Day 2 to ask her what Clomid was like. “I’m surprised they’re putting you on it,” sh
e said. “It’s for people in their thirties.” I wanted to remind her that forty-one wasn’t so far out of my thirties, but I explained it was just a test. “I don’t remember it being any big deal. It kind of makes you more . . . you,” she said. “Higher highs, lower lows. PMS plus.”
I felt nothing one way or the other on Clomid. My personal challenge was remembering to take it twice a day. On the third day, the Saturday after our new housecleaners came, I couldn’t find my Clomid anywhere. The pharmacy agreed to refill the prescription.
I was out $54 (small change in the fertility accounting department) but I was still in the game. I passed the challenge. Another small victory, another roadblock circumvented.
In November 2003, we picked up where we’d left off back in May.
The morning before the first ultrasound, a bowl of leftover dog dinner fell off the top of the refrigerator onto Lorene’s head. We tried not to take it as a bad omen, but sure enough, the ultrasound was not routine. “Do you have both ovaries?” the tech asked. “Have you had endometriosis?” She shook her head. “Something’s going on here.”
Techs can never say what is going on, but that never stops me from asking. “Something’s going on with your left tube,” she answered. “Could be a hemorrhage. Could be a cyst. Could be . . . anything, really. I wish I could tell you more.” It was enough. Tears ran down the sides of my face and pooled at my hairline as I lay there. Now my good tube was ruined. I’d won the Clomid battle, but I was losing the war.
When we got home, our updated injection instructions were on the machine: stick with the same dosage of Gonal-f, no mention of my tube. When I called back, I was told they were running tests on the blood, but Dr. Penzias wasn’t concerned. We were probably looking at some leftover ectopic-pregnancy tissue.