The long wait

As I see it, there are four phases of trying to get pregnant with medical assistance each month: the run-up where you prep yourself with both chemicals and inner-morale boosting; the days of trying which sometimes feel fraught with performance anxiety all around; what is currently called the TWW or two week wait where you wonder: "maybe I am; maybe I'm not?"; and the week after finding out that you're not. This latter phase is the worst for me: feeling like my body isn't doing anything at all productive, I feel bereft on these days. Right now, I'm in the TWW period, the slowest time of all, right smack dab in the middle. It's gloomy in New York and I feel sluggish and tired. Spring is on the verge of being here, so it's a bit humid and warm, but also chilly at the same time. The streets are full of debris from the last snowstorm. We need a good, cleansing rain. And some flowers.

The Inseminator

We did an IUI procedure this morning. No one told us that we had to abstain for 24-36 hours before, so D's semen volume was about half of what it should have been ("the other half wasn't wasted," the doctor said.) but the percentage of motile sperm was extraordinary (a fact that D is very proud of), so the doctor said that this made up for the lack of volume. We had to wait 45 minutes while they "washed" the sperm, so because I hadn't done that level of planning, D had to run off to work. I went to get a yogurt from Starbucks as a prophylactic against the impending yeast infection likely to follow the super-dose of doxycycline that I had to take the day before, the day of, and the day after the insemination.

The procedure itself was as uneventful and painless as all of the online information I read described it to be. The doctor used "the inseminator," (package pictured above) which was a syringe with a flexible catheter attached. She used a speculum, and then urged the catheter up through the cervix, which she said was "hiding." (They say that about my left ovary sometimes, too. Weird.) She told me as she was inserted the washed and concentrated sperm, and then she turned out the lights and told me to take a little nap for about 20 minutes. But my mind was racing and I started worrying about whether the seepage was D's sperm saying "oh, no you didn't!" and rushing back out because they didn't like the egg for some reason. I wanted to jump up from the table and ask someone, but I stayed still--if not calm. Then I started worrying about whether they'd forget me in there, and the fact that I had to get to a meeting by noon (it was already at least 1030 am). I spun the computer screen that was in reach towards me and it appeared to be 10:50, so I figured I would give them ten minutes to come and get me before I got up and got dressed. No one came to get me, so I just got myself ready and on my way out, I asked about the seepage and was assured that it was completely normal. (I didn't believe it, though, so googled it as soon as I could. It's fine.)

So, I don't want to jinx anything, but I have to say, if we're not successful this month, I have a list of things to remember from next:

1. Have sex 36 hours before the IUI so that the sperm is fresh, but abundant.

2. Build in enough time for the partner to be there.

3. Take your iPhone to the table so you can time how long you've been laying there, and have something to distract you with (maybe even update Facebook while laying on the table).

4. Take the day of the IUI off so you don't have to rush back to work.

5. If you do rush back to work, make sure you don't jump on the train going the wrong way, start reading, and not realize that you're in Queens until you're like, halfway into Queens half an hour before your meeting starts.

Intrauterine Attempt #1

Tomorrow morning we're off to the doctor to give D's little guys some direction. When I went for my check-up yesterday, the doctor told me that I had one really good follicle that will absolutely produce one good egg. She said we'd be ready on Friday morning. D had to give me the trigger shot (obtaining the medication is a whole nother story that I'll deal with in a separate entry) at 9 pm on Wednesday.

My insurance company covers at least three intrauterine insemination attempts (IUIs). Tomorrow begins another two week wait. I should have sushi tomorrow night.

The latest worry: a friend telling me that the quality of a woman's eggs at this age can mean that if assisted fertilization and implantation actually does happen, a less-than-perfect egg can produce a child with flaws. I harbor no illusions that my possible future child will be perfect; no one is. But to intentionally create a less-than-perfect infant....gives me pause. I gotta find more information about that.

Sushi Panic

On my way to the doctor's office on Wednesday morning, I had a thought that made me gasp: if the test indicated I was pregnant, I hadn't had any sushi lately, and from what I understand, sushi is verboten during pregnancy. Many a friend has counted down the days until she could drink and eat sushi again.

For whatever reason, the universe said no to conception this month, so we went out for sushi.

Processing my Blood

So now I wait. I went to the doctor's this morning for a blood test, and the phlegbotomist asked if I had done a home pregnancy test. I haven't. The blood test is the most accurate at this stage, so I don't want to get my hopes up with a false positive, or my hopes dashed with a false negative. I'd rather be on pins and needles until 2 pm when I am supposed to get a call from the doctor's office. Somehow I thought the news would be immediate; apparently they have to process my blood. When I called D from the lobby to tell him we'd get the news at 2 pm, he sounded terrified when he answered the phone. This is another one of those moments where I feel like I'm standing on a giant precipice waiting for the world to change.

False Alarm Every Ten Minutes

They call it the "TWW" or "two week wait" at the fertility clinic and on the online fertility sites. I'm not a very patient person, but this is really trying whatever patience I do have. Because of the progesterone vaginal inserts that I have to take, I'm a little oozy . . . that ooziness feels like I'm getting my period. So every ten minutes or so, I have the feeling that I've gotten my period, and so far, it's just been progesterone ooze.

I guess I could cut down on this false alarm phenomenon by taking the progesterone at night like I'm supposed to, but I find it unappealing to have sex with the progesterone insert in for an hour (precisely because of ooziness), which is what the blogsters out there suggest. My doctor said to insert the progesterone pill AFTER having sex -- this was his answer, after receiving an anxious text from me asking if we could have sex at all for the 21 days I am using the inserts -- but I like to fall blissfully asleep after sex, so the idea of having to go in and put the insert in after sex was not appealing.

At any rate, my period should have come yesterday, today, or tomorrow (depending on what online calendar you use). I have a doctor's appointment Wednesday morning for a pregnancy test, so all I can do until then is try to resist running to the bathroom every ten minutes to check.

My heart sinks, and then it's happy . . . but no matter, I have to keep reminding myself that this was the first month of this type of intervention and it isn't necessarily going to be successful.

What's funny is how similar this "false alarm" feeling is to a "false alarm" feeling when you DON'T want to be pregnant . . . the waiting for the period to come.

New York Magazine had a really interesting story this month called "Waking Up From the Pill: Fifty years ago, birth-control pills gave women control of their bodies, while making it easy to forget their basic biology—until in some cases, it’s too late." I found the article to be perfectly relevant to what I'm dealing with now. Like this passage:

Now many New York women have shifted their attempts at conception back about ten years. And the experience of trying to get pregnant at that age amounts to a new stage in women’s lives, a kind of second adolescence. For many, this passage into childbearing—a Gail Sheehy–esque one, with its own secrets and rituals—is as fraught a time as the one before was carefree.

Suddenly, one anxiety—Am I pregnant?—is replaced by another: Can I get pregnant? The days of gobbling down the Pill and running out to CVS at 3 a.m. for a pregnancy test recede in the distance, replaced by a new set of obsessions. The Pill didn’t create the field of infertility medicine, but it turned it into an enormous industry. Inadvertently, indirectly, infertility has become the Pill’s primary side effect.

One of my colleagues in the women's rights/reproductive rights field thought that the article blamed the pill too much for women postponing childbearing, but I don't think that was the point of the article at all. What the pill did, I think the article argues, is relieve women of having to think so much about their reproductive capabilities. Like the author explains:

. . . [W]omen are half-consciously rebelling against the artificiality of the Pill’s regime. Removal from one’s true biological processes was more appealing in the Mad Men era, when machines were going to save the world and pills could fix everything, even the ennui of housewives. But for the wheatgrass-and-yoga generation, there’s something about taking a pill every day that’s insulting to one’s sense of self, as an accomplished, adult woman. “I feel like I’ve gotten a message over the years that the less I have to do with the nitty-gritty biological stuff of being a woman, the better, and that’s a weird message,” says Sophia, 35, who was on the Pill for fourteen years. “In my ninth-grade health class, I remember the teacher saying, ‘You can get pregnant any day of the month, so always use protection,’ and I kind of knew that wasn’t true, but because I was on the Pill, I never really cared about finding out the right answer. The Pill takes a certain knowledge away from you, and that knowledge is empowering.”

And, in fact, what I think the article argues for, although I think it could have done so more thoughtfully, is that women should be made aware of ALL of the risks and implications of taking the pill. I am constantly surprised at how much I don't know about my own body: blame it on inadequate sex education in school or at home, whatever. The fact is, before taking a drug that prevents conception, we should really understand conception altogether, and at least for me, I know I didn't. Of course I knew that waiting too long would make it more difficult to get pregnant, but I like the fact that the author talks about how easy it is to hit the "off switch" on fertility for a while with the pill, and not have to think about your body so much.

To arrive at the stage when one stops taking the Pill and starts timing one’s ovulations is to enter a new and anxious universe. After that, if you’re unlucky, you may enter a kind of medical and bureaucratic purgatory of doctors’ waiting rooms and insurance companies and worries that’s very far indeed from the freedom you enjoyed before.

On the Pill, it’s easy to forget the truths about biology. Specifically, that as much as athleticism or taut cheekbones are, fertility is a gift of youth. The body that you wake up with after fifteen or more years on the Pill is, in significant ways, not the one you started out with.

The notion of "choice" and "sexual freedom" in this discussion of the pill was also fascinating. The author talks about how NARAL and Planned Parenthood and other "choice" groups don't want there to be any public discussion about the relationship between the pill and infertility. It may be true that, as my colleague suggests, that the article overdoes it by actually insinuating that a "side effect" of the Pill is infertility ("Inadvertently, indirectly, infertility has become the Pill’s primary side effect."), I do believe that choice groups don't want to talk about how these issues intersect. As the author explains:

[I]ronically, this most basic of women’s issues is one that traditional feminism has a very hard time processing—the notion that this freedom might have a cost is thought to be so dangerous it shouldn’t be mentioned.

. . .

Sexual freedom is a fantastic thing, worth paying a lot for. But it’s not anti-feminist to want to be clearer about exactly what is being paid. Anger, regret, repeated miscarriages, the financial strain of assisted reproductive technologies, and the inevitable damage to careers and relationships in one’s thirties and forties that all this involve deserve to be weighed and discussed. The next stage in feminism, in fact, may be to come to terms, without guilt trips or defensiveness, with issues like this.

Choice is a more accurate word when the chooser—us—is aware of all the possible consequences of taking different possible paths. But reality has a hard time getting into these areas, let alone the Brave New World of infertility medicine.

Henna Tradition

I love Alanis Morissette. This is a picture of her surrounded by other women with a henna tattoo on her stomach. Apparently, there is a tradition in India and Morocco to have a henna design painted on the belly during the third trimester. The custom is said to "protect and bless the mother and child from any evil or malicious spirits that may be near during delivery," according to the Henna Caravan website. I have to remember this if we are successful.