It took us a little over two years to get me pregnant.
I was 37 years old when we got married, and I was aware that there were risks associated with middle-aged pregnancy. I knew about the elevated risks of Downs Syndrome and other genetic disorders. I knew about the elevated risk of miscarriage. I did not know much about declining fertility. I mean, I was vaguely aware that as you got older your fertility declined, but I did not know that the curve turned sharply downward at 35, nor did I know about the giant cliff-like drop off at age 40.
See? Actually, that looks more like a black diamond ski run from ages 40 to 50, but you get the idea. (By the way, I got that chart, here: http://www.rmapa.com/Infertility/Age-and-Female-Fertility.aspx)
Over the years, I've pondered why I didn't know about this. Why did no doctor ever give me the hard truth that the older I got, the less likely it would be for me to get pregnant? My conclusion is that doctors do not want to appear as if they are pressuring a single woman in her mid-thirties to have babies. What would be the benefit in telling a woman with no husband or partner with whom to have a baby that she might want to hurry up and have one anyway, or it may be too late? It hearkens back to another era when women told their daughters that they didn't want to wait too long to have babies because of "the change." In our 21st Century feminism, maybe we're not able to acknowledge biological facts and not take offense, maybe. Still, it would have been good to have this information. It would have been good to be somewhat prepared. Maybe it would not have come as such a shock to me when pregnancy did not come easily or quickly.
Anyway, after trying for about six months, I went to the OB/GYN for my routine check up and to be examined for possible infertility. The OB/GYN ordered what would be the first of many diagnostic tests, a hysterosalpingogram (HSG). In an HSG, a doctor expands a balloon in your uterus and then shoots radiological dye in there. You are then X-rayed to see where the dye goes. If the dye spills easily out of the ends of your Fallopian tubes into your pelvis, then your tubes are clear. Good news for you: you don't have to have surgery to try to clear a tubal blockage. My radiological dye flowed quickly out the end of each tube like a crazy straw.
The OB/GYN also ordered a semen analysis on hubby. And it turned out basically fine. I am sure that he could probably tell you a lot more detail about that test, but my recollection is really the bottom line from the OB/GYN: "I can't figure this out; you guys need a specialist."
As it turns out, we went to three different reproductive endocrinologists before one finally was able to conjure up an egg healthy enough to produce The Boy. The first fertility doctor I saw, when I was just a couple of months past age 38, did something called the Clomid Challenge Test on me. It's a fairly standard test used to determine the woman's egg reserve. They pump you up with a ton of Clomid, draw some blood and then check the serum follicle stimulating hormone (FSH) level. If the FSH level is above a certain number, you are diagnosed with a diminished ovarian reserve, which means that you do not have a lot of eggs left in the basket with which to make your little chicken.
I was diagnosed with a diminished ovarian reserve.
And so, here was where the real infertility adventure began. I would need drugs, lots and lots of powerful drugs, if I wanted to produce a baby.
I cannot begin to tell you how incredibly depressing it was.
The first fertility doctor did not furnish us with optimism. He, in fact, refused to treat me in any way other than to do two to three rounds of drugs plus an intrauterine insemination (IUI). He was emphatic that in vitro fertilization (IVF) on someone with diminished ovarian reserve was futile. (He turned out to be right about that, sort of; I never had a successful IVF cycle.)
We sought a second opinion. The second doctor was wonderful and kind. He taught reproductive endocrinology at the local medical school. And he was optimistic that something could be done, even with my elevated FSH.
We started with Clomid. Clomid has been the go-to fertility drug for decades, but here's something interesting that doctor #2 told us: Clomid was originally a birth control pill. At high doses, Clomid "bums" eggs. So dosage is important with Clomid: less is more. I did three cycles of Clomid with no result (other than hot flashes). So we decided to move on to IVF.
But before that, in July of 2009, the second doctor wanted to do an exploratory surgery: I had a hysteroscopy and a laparoscopy. I was put under general anesthesia, my abdomen was pumped full of CO2 and the doctor entered my abdomen through my naval with a camera to view what it looked like in there. He also viewed the inside of my uterus with a camera during this procedure. Here's what he found: the right ovary was smaller and slightly yellow, the left ovary looked normal, the inside of my uterus was "beautiful," and I had some very small external fibroid tumors on my uterus that should not be a problem. Basically, he found nothing, other than the shriveled right ovary, that would prevent me from becoming pregnant.
I did three rounds of injectable medications to try to produce enough healthy eggs to get a baby. The drugs I injected during this period were varying combinations of two drugs called Follistim (which is synthetic FSH) and Menopur, a combination of FSH and luteinizing hormone (LH) derived from old lady urine. Seriously. Post-menopausal women have incredibly high levels of FSH and LH. During menopause, your pituitary gland starts ramping up your FSH and LH production in order to force your ovaries to dump your last remaining eggs. The elevated FSH and LH are the reason for the hot flashes. This is also why older moms are more likely to have multiples; their elevated FSH and LH levels cause them to ovulate more than one egg at a time. And then the hormone levels just stay up there post-menopause. I haven't been able to figure out exactly how they harvest the old lady urine, though, and I don't really want to think about it too hard.
Back to how the lady-system works to make babies: FSH and LH work synergistically to encourage the ovary to release eggs. In ovulation, the LH "surge" triggers ovulation. It's all controlled by the pituitary gland if things work normally, or by syringes, if things do not.
At the end of each cycle, I would also take a trigger shot, Ovidrel, which would force ovulation within 12ish hours of the injection. Ovidrel is a recombinant human chorionic gonadotropin (hCG), which replicates the LH surge telling the ovary to release the egg.
I should also mention that all of these medications came with a raft of side-effect warnings including blood clots, hot flashes, mood changes, weight gain, dizziness, etc. Thankfully, my side effects were not all that serious -- some hot flashes, some moodiness, and some weight gain. But I didn't really care much about the side effects and was mostly concerned with the immediate results. Will this round make a baby?
My husband cared; he didn't want me to die in pursuit of a child. And he did not want me to get ovarian or breast cancer later in life because I was flooding my system with these hormones in my late-30s. I worry about that too, now. Will I get ovarian cancer in 10 or 15 years? Will I get breast cancer? They assured us that there was no known link between disease and these drugs, but doubt lingers. And when I'm quiet, I do sometimes worry about The Boy having a sick mom someday. Without the drugs, though, there would not be The Boy. There is, accordingly, nothing to regret.
I never had a successful IVF cycle with the second doctor. I never produced enough eggs. We converted these failed IVF cycles to IUIs, but neither did those produce a baby.
With each failed round, I became increasingly depressed. Seeing babies was hard. Being around babies was hard. I tried not to be jealous, but was. I threw a lot of pity parties for myself. My husband tried to keep me on the rails, but he was concerned as well. He didn't like what it was doing to me. Too, my depression -- and, to be honest, desperation -- was affecting him. And let's not forget that he also wanted a baby. It wasn't just me in all of this.
We started to consider donor eggs. In egg donation, young women do exactly what I was doing -- shoot themselves up with FSH, LH and hCG -- and then undergo light anesthesia for egg retrieval, which involves a long needle inserted through the vaginal wall to retrieve the eggs from the ovaries. An egg donation could produce from five to 35 eggs, with the average number being in the teens. The young woman's eggs are fertilized with the husband's sperm and the resulting embryo is implanted into the wife, who becomes pregnant and gives birth to her non-genetic child.
Egg donors get paid a lot -- usually $5,000 to $10,000 -- but, in my opinion, it's not enough. They undergo quite a lot physically and even risk suffering side effects from the medications, and even possible infection resulting from the harvesting of the eggs and/or risks to their own future fertility. They should be compensated for that risk.
Some egg donors get paid very well. "Harvard" eggs can go for $50,000 or more. Eggs of certain ethnicities command premiums. It becomes unseemly, this purchase of genetic material. Still, we had gone onto a registry and looked at potential donors and had chosen a few of them who seemed like they could be me-only-better. Looking back, it seems difficult for even me to believe that I considered this option. I wonder, now, if I would have followed through with it. Possibly, I was looking into it because I needed to feel like there was one more option out there for me . . . that we hadn't tried everything yet.
Even though I liked the second doctor, I had become frustrated with him. It had been more than a year and we had seen no result. Not even a miscarriage. And he would not consider egg donation on ethical grounds. Given all that surrounds egg donation, this is not an unreasonable stance. My husband was also not yet sure that egg donation was what we needed to do. But after so much failure, and with my 40th birthday looming a few months away, I wanted results. I wanted to change. I wanted a baby.
We went to a third doctor who was in a practice that does work with egg donors and recipients. Our last reproductive endocrinologist has a bachelor's degree from MIT and a Harvard medical degree. If she could not figure this thing out, what brain could? At our initial consultation, she and my husband hit it off pretty well. (Ivy Leaguers.) I liked her too. She was slim, Korean, pretty, personable, intelligent, about my age. From the photographs in her office, you could see that she had two small children. Her husband is also a doctor.
She was surprised that all of the injectable medication protocols I had been on had been so-called "short protocols." She emphatically told me that, at age 39, it was not time to think about donor eggs yet. If I were a few years older, yes, but not now. She encouraged me to try with my own eggs again. And, importantly, she would not let me wallow in self-pity about my situation. I had thought I needed sympathy. What I actually needed was a firm hand from an intelligent, confident doctor. She really did turn my attitude around. I agreed to try.
She decided to go "old school" on me and use a long protocol: six weeks. This time, I started with Lupron injections, which suppressed my ovaries for about 3 weeks, then I started with Follistim and Menopur injections. During this cycle (and it was the case with every attempted IVF cycle), I was closely monitored by blood draws and sonograms.
With this cycle, the sonogram showed that I produced five follicles on my ovaries, but only one had matured to a size sufficient to house an egg. And whether that egg would be healthy was anybody's guess. She recommended that we convert this cycle to an IUI because there were not enough eggs to harvest for IVF. When asked, she hazarded about a 14% chance of success given these circumstances. We've been down this road before, I thought. Still, I did the Ovidrel shot when instructed to do it, and on a Friday in late June of 2010, we did the IUI. And then we waited.
A week later, I went back to have my blood drawn in order to check my progesterone level. It was pretty high. That was promising, apparently, but I wasn't holding my breath. Another week later, I went back for a serum pregnancy test. The phlebotomist asked me if I'd taken a home pregnancy test. I said, "No, I don't do those. They depress me." She chuckled. She'd heard that before. She drew my blood and I went to work.
Later that day, I got a telephone called. July 2, 2010: I was pregnant, about five weeks. We were stunned, in utter disbelief. A week later, we had a sonogram, and there was The Bean who would be The Boy one day. Another week later, another sonogram: and the strong, tiny heartbeat. We could see it flutter. We could hear it.
She released us to the OB/GYN. No longer an infertility patient, now, I was just a pregnant lady, with a due date of March 11, 2011. On September 17, 2010, bang on at 15 weeks of pregnancy, I had amniocentesis. Ten incredibly long days later, on September 27, 2010, we found out that The Bean would be The Boy, and that he was healthy. We went public at that moment. Not long after that, I felt him move for the first time.
And then lots of stuff happened during the pregnancy that was mostly normal (except for the bedrest for the month of February 2011). But it all came to fruition on March 5, 2011, when after about 20 hours of contractions and labor, we finally got to meet that little stranger, our little boy. The two years of depressing, painful, frustrating infertility treatments forever receded into the background. And at center stage lay this happy little creature, The Boy, who was totally, absolutely worth it.
