Fertility Part 1: Two Weeks At A Time

(This letter was written over a year ago on June 6, 2016)

The emotional challenge of living in 2-week intervals has finally come to an end.  When my husband and I were ready to try for another baby our son was almost 1.5 years old. We didn’t know at the time just how difficult the next two years would prove to be.

We tried to conceive naturally for the first year without any results.  Each month was bisected into The Trying Period followed by The Waiting Period.  Two-week chunks of time passing by.  You can set your calendar by my cycle, it is so regular.  I couldn’t imagine what was wrong.  Because of my age, 34 at the time, we had decided to see a fertility clinic at the 9-month mark even though technically we were three months shy of meeting the requirements for “fertility issues”.   I was seeking some reassurance that physically, medically, everything was okay.  We weren’t yet pushing for any medical interventions. 

One thing came up in the test results; I have a low AMH score suggesting a low ovarian reserve, or low number of eggs left in the bank as compared to an average healthy woman of the same age.  We were told there was no reason to suspect the quality of my eggs was compromised, just the quantity.  Since we weren’t looking to multiply our family by dozens, “just” one more, it wasn’t overly concerning.  And we already have a very beautiful, very healthy, very loud and very active little boy at home to remind us of what is possible.  The news was far from devastating.  I was otherwise completely healthy, and my husband’s tests showed he could sufficiently “populate all of Canada”, as our doctor once joked. 

The fertility clinic attributed my low AMH score to the chemotherapy I received as a child when I was diagnosed with leukaemia.   They were surprised to hear that our son had been conceived naturally (and quickly), and I was surprised that they were surprised.  Apparently it is common for children who have had chemo or radiation to experience fertility issues later in life.  It makes sense when I stop to think about it but I had never stopped to think about it.  And it bewilders me how the possibility of chemo-related fertility issues never once came up in any of my semi-annual, annual, or bi-annual cancer follow-ups at the hospitals over the past three decades.

Both my husband and I were reluctant to start any medical interventions due to our anxiety over having multiples.  The bulletin boards at the clinic were filled with Thank You cards from happy new parents and I couldn’t help noticing how many of the photos showed twins.  But after a few more months of disappointment we headed back to the clinic in June of 2015.  We insisted on taking small, incremental steps despite our doctor’s recommendations to be more aggressive.  He respected our approach without pressuring us.  In fact we tried three months of natural cycles with insemination before moving on to injectables.  Which of course slightly terrified me since I was getting 3-5 eggs each time on a low dose of drugs. 

Injecting myself didn’t bother me much in the beginning.  I am familiar with needles from my childhood.   My son would even pull up a stool on the other side of the kitchen counter before breakfast to watch the routine.   What I didn’t like about the process was just how easy it could be to screw up your entire cycle by dialing the wrong dose or simply forgetting to take the injection altogether.  It was stressful.  I also resented the hours spent at the clinic for invasive cycle monitoring.  Often times my son came along to the clinic, handling the 2-3 hour wait times with far more grace than me.  He charmed the nurses and amused himself with the Little Tikes playhouse.  He sat quietly on my lap whenever the nurses drew blood and looked at his Curious George books in the exam room during my ultrasounds.  He even sat through a few of my inseminations on days when he was too sick to go to preschool, and the doctor seemed more nervous than I did about having him in the room.  Honestly my son, who can throw a tantrum like no one’s business, was wonderfully behaved during these frequent playdates at the clinic where he was usually the only child.  I was grateful.  But often I also felt guilty, wondering what the other thirty women in the waiting room were thinking as they watched us playing or reading.  Wondering how many of them hated me for already having a child.

The next months continued to be lived in 2-week intervals: two weeks of injections and appointments followed by two weeks of waiting and hoping, always ending with disappointment.  Now it came in the form of a call from the nurse with my negative pregnancy results and then instructions to stop the hormones and return to the clinic once my period arrived to start the next cycle.  And repeat.  And repeat.  And repeat. Eventually when we were told we could go on the wait list for the funded IVF program we decided to take a break from the clinic.  It had been too overwhelming and things were about to get crazy again at work.  So we went back to trying on our own through the winter.  And then in the New Year we took a lovely vacation.

Upon returning from our trip we discovered we had qualified for the funded IVF program.  My hope was restored, believing it was our best shot at getting pregnant.  Furthermore for the funded program only one embryo would be transferred at a time which was just fine by us. I imagined going through only one more cycle of injections to produce a dozen or so eggs that could be fertilized in a controlled setting.  Then an embryo would be transferred each month until we finally found success.

That simply wasn’t the way things played out.   The daily multiple self-injections, weekly acupuncture sessions, frequent clinic appointments and endless app reminders to take some hormone or supplement every 8 or 12 or 24 hours stressed me out.  But that didn’t even compare to the crushing disappointment when we would review my numbers mid-cycle.  My body just wasn’t responding to the drugs despite the high doses I was taking.

My lowest point was receiving the news of a second impending IVF cycle cancellation from a female doctor at the clinic, not my primary doctor, but someone who was filling in.  She.  Was.  Horrible.  The news was dictated clinically to me that I only had two eggs after a second round of intense (and costly) drug stimulation.  I remember hearing her say “…this month is worse than last month…” and “…your ovaries are becoming resistant to the drugs…”.  She never once offered a tissue.  Instead she awkwardly patted my shoulder on her way out of the office as I sat crying and said she would tell the nurse I was still using the room. It was my rock bottom day.  In the weeks leading up to that day I had been resenting all that my body was going through, screaming daily at my son who was going through a particularly terrible tantrum phase, and wanting to just get the hell away from home.  It was a dark place to be.

Gratefully, after a difficult few days of hard conversations with my husband, I came out of the darkness.  We met with our primary doctor who helped us make the decision to do one last round of IVF meds in hopes of more promising results.  I recognized that I had to climb out of that dark place in order to give any of this a fighting chance. I started with regular morning walks through the quiet and quirky neighbourhoods around us, listening to a series of podcasts that transported me into someone else’s life for an hour at a time.  Working from home every day can feel occasionally lonely so it was a refreshing change of environment. And it did wonders for my mood.  By far my favourite podcast to listen to is Moth Radio, a series of true and often extraordinary stories told to live audiences by real people.  The stories could have me laughing out loud or weeping uncontrollably while walking down the street.  Sometimes I streamed the stories for hours at a time even after I was home.  It was therapeutic to experience all those raw emotions.

When it came time to do my egg retrieval in April I celebrated.  We had finally made it to the next step.  The results had been no better than the previous month; just two eggs.  For people who are unfamiliar with the IVF process an “average responder” might get 10-15 eggs on a lower dose of drugs than I had been taking. A friend of mine had gotten 22.  So two eggs, just double what I naturally get each and every month for free, is far below average.  But somehow the news hadn’t devastated me this time around and we were ready to move forward.  Maybe it was the beautiful spring weather. Or the hour-long morning walks. Or the open conversations I was now having with my husband, my family, my friends about our struggle.  It just felt good this time despite the numbers.

I don’t deny the first few days following the egg retrieval were intense.  Only two mature eggs had been retrieved and many women who have undergone IVF have lost far more than two eggs between the day of retrieval and the day of embryo transfer.  Not all eggs may fertilize.  Not all embryos may grow.  Miraculously when we were scheduled for our Day-3 transfer both embryos had survived.  We were told that the probability of success for a Day 3 transfer is around the 20%-30% mark at best, and we were not a best-case scenario.  But waiting for a Day-5 transfer offered little benefit for various reasons so we proceeded with our doctor’s recommendation.

Despite all of my positive energy the first embryo transfer didn’t work for us.  The two-week wait following the transfer had been made easier by the distraction of a cousin’s wedding and the accompanying days of family get-togethers.  But we received the bad news on the weekend of Mother’s Day.  Disappointing confirmation of what I had already suspected after receiving my body’s own natural signs that the transfer had failed.  You see, every month I experience an agonizing migraine at the onset of my period.  It can be debilitating, the sensitivity to light accompanied by nausea and pounding relentless pain. My migraines, which typically last a full day or more, have become an all-too-familiar sign that my period is about to arrive.   This month my migraine had struck days after the wedding.  Like each month before I already knew the results before taking my pregnancy test.

My husband and I went forward with our final embryo transfer without taking a break.  I didn’t feel there was any physical or emotional reason to delay, although I understand why some people do.  My overall mood was still very positive but we had started discussing the real possibility that we might never have more children.   I wasn’t giving up hope but instead preparing for either outcome. I needed to believe that not having more children was as acceptable of an outcome as being pregnant.  Otherwise the stress of transferring our last embryo would be too much to bear.

This month ended up being refreshingly straightforward.  Since it was a frozen embryo transfer there were no injections to stimulate egg growth, fewer clinic appointments, fewer hormones, fewer app reminders.  I celebrated my last cycle monitoring appointment.  I celebrated my last acupuncture appointment.  And after the transfer I celebrated my last fertility-related medical intervention.  It was very liberating and the two-week wait didn’t feel as long as in previous months.  Actually sometimes it felt like time was passing too quickly.  As long as I didn’t take a pregnancy test I could go on feeling great and believing I was pregnant until someone told me otherwise.  Or I got a migraine.  The only tricky part was being reminded not to pick up anything over 20lbs (e.g. my son).  Fortunately he was mindful of the doctor’s orders and happily jumped onto my husband’s back instead.  That didn’t stop my son from checking in with me most days in case I had been given the green light to lift him up again.

I walked the 7km home from the clinic this week after taking my pregnancy test, listening to Tony Robbins talk about the Psychology of Success and feeling awesome.  For the first time I had made it through the entire month without a migraine.  A very good sign.  A very good sign made irrelevant when the nurse called four hours later to say my results were negative.  When she instructed me to stop the hormones and come in after my period started I interrupted to tell her that we were done. We were finished.

After two long years of heartache and tears, of 2-week schedules and thousands of dollars, I haven’t learned much more about what is preventing us from having another baby.  I’ve only started learning how to accept it.    With every disappointment along the way people have said not to give up, that perhaps we just need a break, that it will happen for us.  My mom didn’t say those things.  When I called her after the first embryo transfer had failed she told me we were trying everything, that if the last transfer didn’t work, well then we could relax. She said that sometimes things don’t work out for reasons you just can’t explain.  It was simple, it was sad, and it was the truth that surprisingly provided some comfort.

This is the way I see it.  Getting pregnant the first time around was like throwing a basketball from centre court and getting a swish. No one told me the odds against it, and I didn’t know any better.  Then I spent a year throwing balls from centre court and missed.  When we started fertility treatments I moved 10 paces forward, took shots, and missed. When we started IVF I moved another 20 paces closer, took shots, and missed.  For two years I’ve missed.  I have heard the uplifting success stories of couples who had to try for much longer than two years.  And yes, we could “keep trying” naturally.  But after missing shots from just beneath the basket, knowing the odds now, the view from centre court looks bleak.  I think I’ve earned the right to put down the ball.

I had a good cry after calling my husband at work followed by a few hours to myself.  Then I went to pick up my son from preschool.   My son, who I’ve never forgotten is the love of my life and clearly a miracle child.  The first thing he asked of me was to finish reading his Franklin book before we left.  I did.  The second was if I could lift him up.  And I did.