I am pursuing motherhood again.
I was pregnant in the fall and lost the baby in the first trimester. Ever since I've wanted to return to that blissful, hopeful, future-oriented state. The other day I opened a fortune cookie and allowed myself to dream that this month might bring me to that very place. Your dearest wish will come true. For me this means a healthy expanding family. Aaron will survive and flourish and I will become a mother at least once more.
I am pursuing motherhood again and there are many obstacles to overcome. They are the same ones I faced in conceiving my son, only this time they are magnified because there is no waiting out the effects of the chemo as we did before. It is more than likely that my husband will be sterile post transplant and so I must rely on medical techniques to bring me another child.
This path is not the one I want to walk. In trying to conceive the last time Aaron was in treatment, I underwent many intrauterine inseminations. For those of you unfamiliar with the language of infertility and reproductive medicine, IUI's involve delivering sperm to the uterus. In our case, we used sperm frozen just before Aaron began chemotherapy. There are many problems with frozen sperm. It doesn't live as long as fresh sperm, only about 6 hours compared to 3-5 days, so timing the sperm's life to the egg's seems near-to-impossible. Add to that the fact that Aaron was so sick when we banked his sperm that it wasn't very good quality. No one ever bothered to tell me this, including Aaron, who later confessed that he hadn't wanted to discourage me from trying because...you never know.
Month after month of tracking my ovulation through blood work and ultrasounds yielded nothing but frustration and fear that I would never become a mother. Eventually I couldn't do it anymore. I just stopped and decided to wait and see if Aaron regained competent sperm. We endured two miscarriages before we ultimately created Sasha. Whether they were from sperm still suffering the effects of the chemo, other random cytogenetic problems, or autoimmune issues for which a specialist put me on blood thinners, we'll never know, but finally we were blessed with a child.
I always knew I wanted another child. Having grown up an only child, I didn't want that for my son. Certainly the circumstances are different for him than they were for me being raised by an elderly grandmother who told me every day that she didn't want me, but I was lonely for a sibling then and I still am. Perhaps I am projecting my own issues onto Sasha, but regardless I want another baby. I do. We both do. At the moment of Sasha's birth, I looked at Aaron and said, "Let's do this again. And soon."
If we want another child, we have to act. If I was 30, and I thought I had four or five years to see if Aaron eventually becomes fertile again, then I would. But I'm not 30 and I'm not convinced that Aaron will be able to get me pregnant again naturally so we decided to revisit this whole medical process of conception. Honestly, I don't know if I can do this again. I don't have a strong enough belief that I can get pregnant this way. I tend to be a fairly natural person. My body seems to be as well. My body seems to prefer the magical essence of natural conception. I have been pregnant six times naturally. And not once when we tried a medical intervention. So it's hard for me to garner up the faith that I need to keep myself from cycling into depression and desperation while we go through this process.
This time around, Aaron froze better sperm. But I know that I can not endure the same sense of failure with the IUI's. As much as I didn't want to have to go there, we decided to try a natural IVF cycle this month. A natural IVF cycle is essentially the same as regular IVF--an egg or eggs are retrieved, joined with the sperm for fertilization and ultimately placed in the uterus for hopeful implantation--except in a natural cycle there are no drugs involved. Because I am completely regular hormonally, the doctors feel that there is no need to fine tune me. We are just tracking my natural cycle and going in to retrieve the egg of the month.
It all sounded good to me. I thought that we would avoid the whole timing issue with the frozen sperm and the egg. I knew that they would end up together, I only then had to hope the egg would be fertilized and that my uterus would welcome the embryo. This is what I believed but not how it went on Wednesday.
All month, we'd tracked my cycle--blood work, ultrasounds, driving in and out of NYC each day. I tried to ignore my ambivalence and accept that this is what I must do in order to have a child. The plan had been to do the egg retrievel on Thursday morning, but on Wednesday afternoon, the doctors determined that I was so close to ovulating that they might miss the event if we waited. I wasn't mentally prepared but was quickly ushered upstairs, gowned up and given a valium to calm my nerves. After twenty minutes, I felt no effects of the valium and found myself trembling in anticipation of the procedure. I've endured some fairly barbaric gynecological procedures to correct ill effects of an incompetent D&C and as the fear settled in fully, I could hardly walk to the nurse when she called my name. She assured me that the retrieval would be nothing compared to having my cervix debrided with no anesthesia and propped me up on the table. Legs spread, we began.
She was correct in her assessment that I'd experienced much worse pain, but no gynecological procedure is comfortable. Giving birth was by far the best and possibly easiest experience I've ever had with an OBGyn, which surprised me. The pain did not rattle me in the way I am completely unnerved by probes and needles. Up on that table, I kept breathing and reminding myself that all of these efforts were worth the discomfort that seemed to go on much longer than I'd expected. And then after twenty minutes...
All done. No egg. No egg. All done.
"What? Where is my egg? What do you mean no egg?"
No egg today. Sorry no egg.
I was getting hysterical. "What do you mean there is no egg? I had an egg. Where is it?"
"I need to speak with Dr. Zhang."
The doctors at my fertility clinic are all Chinese. Some speak English, some not so much. I pressed myself off the table and while the nurse tried to lead me to a chair to sit down, I told her I was getting dressed immediately and needed to see Dr. Zhang. Pulling on my pants with one hand, I called Aaron on his cell. He was in Central Park with Sasha. "You need to get back here. They said I have no egg."
"What? Where is the egg?"
We found ourselves sitting with Dr. Zhang who began by telling me that while he was sorry that they miscalculated my ovulation, they apparently gained valuable medical information.
I was not ready to hear this. "Where is my egg?" I repeated over and over.
"It was too soon," he explained. "Based on your hormones we thought the egg was getting ready to detach and we could flush it out. It wasn't detaching yet so we couldn't get it."
"So where is my egg?"
"Still in the follicle."
"Can we get it?"
"No it's ruined," he said.
Suddenly the effects of the valium kicked in and I could barely keep my head up. "I want my egg."
"This is important. In hindsight, we should have waited. Next month if everything looks the same, we'll wait. It is hard on a natural cycle. It's not an exact science. Too soon, we can't get the egg. One minute too late, and we can't get the egg. You can go home and have sex."
Now I lifted my head up and wanted to jump across the desk and punch him. "If I could go home and have sex, you would never have met me. We are here because my husband is going through chemotherapy."
"Sorry. That's right, don't go home and have sex."
"What about this egg?"
"I know you put in a lot of time and effort."
"Can it still live?"
"Maybe. You can come back tomorrow and if the follicle is still there, perhaps the egg will be trapped inside the collapsed follicle."
"The follicle is collapsed?"
"We made a hole and took out the fluid. It will collapse. But perhaps it will seal up and the egg will still be there and we can rescue it."
I told him I would be back.
As we drove toward home and I cramped and bled, all I thought about was rescuing my precious egg. Aaron agreed that we needed to go back and at least see if there was any hope. He knew that I would never be able to move forward until I exhausted every effort. But before we could go home, we had to stop at the oncologist and discuss Aaron's new treatment plan. He's not close enough to remission to do the transplant at the end of April, so we are switching regimens and pushing back the date at least a month.
When we arrived for our five o'clock appointment, completely defeated and exhausted, (except Sasha who had a wonderfully long car nap and was eager to check out the clinic) we were told that the doctor knew we were there and would be back as soon as he could. Forty-five minutes later we were greeted by the doctor who began to tell us what a hellish day he'd had. He ushered us into his office only to announce that despite the fact that he insisted on seeing Aaron to discuss the plan formulated by the doctors in Boston, the doctors Aaron met with last week, he actually had nothing to say. I don't have anything to add. Do you have any questions?
"Can I kill you?" I wanted to say with the same urge I'd had earlier in the day to climb over the desk and then punch him.
All night, I dreamed about my fortune cookie and my dearest wish. All morning as I waited in the clinic, I repeated to myself dearest wish, dearest wish. When the doctor said the follicle looked worse for wear, dearest wish. I met with billing. "How much is this rescue mission?" Nothing if we don't get an egg. A no egg cycle is just one price. Okay great, a flat rate.
"We're on. Rescue my egg."
The nurse offered me valium again, wondered if I was tender and needed something more.
"I don't want anything. Let's just do it."
Another doctor. Though the follicle was just seen on a ultrasound, he explained that he couldn't find it. A different doctor appeared. He found the follicle, asked me again if I was willing to endure the discomfort for something that looked unpromising. Dearest wish.
Now I knew when the pain would come and I breathed in and out. This time after just three flushes, he told me he was sorry. The egg probably escaped out of the hole before it collapsed. "Hopefully next month will be better," he added. "You can always go home and have sex."
"No, I can't," I reminded him. "Remember when we met last month, we discussed my husband's cancer."
"Yes. That's right."
Aaron, Sasha and I returned to the car and left the city. Sasha soon fell asleep. I was too numb to speak. Aaron let himself off at work and I headed home to snuggle Sash all day long. After many quiet hours, I needed to talk about what had happened but so few people knew that I was going to do this, I felt trapped and alone in the experience. It was my choice not to share my plans. I don't want people to judge me for trying to have another child in the midst of so much happening with Aaron's health and because of this, I felt I should keep my journey private.
As you can see, I've changed my mind. If people think that I am nuts for pursuing motherhood again in our circumstances, then I will have to face that criticism. It's the least of what I am going to face these next months.
Thankfully my friend, Polly, called to let me know that she'd enjoyed the leftovers we'd shared with her family and I spilled out the whole story.
"In three weeks, you will be three weeks older, not six years. You've overcome odds before and you did it. Look at beautiful Sasha. You'll do it again. You will."
I wanted to believe her. I will do this. Somehow we will have another child. But will I do IVF again, knowing that there are also issues of timing on top of many other unknowns--fertilization, implantation-- or will I return to the IUI's. I make a plan to think on it over the next few weeks and hope the right answer comes to me.
But I am afraid that no medical conception plan will work. How will someone like me-- who believes in the part of conception that is not definable by science, who charts her cycles as much by the moon waxing and waning as by hormones rising and falling, who makes poulstices and spiritual baths to nourish my womb-- conceive in a very clinical way, in a very clinical setting, away from my husband and my sanctuary? How can I set my intentions to do it this way when I am frustrated and angry and am just hearing no egg no egg no egg and fearing that this will be the same anguish each month?
I am in need of maintaining a connection with and faith in myself. I know many women endure more than I have in trying to have a child. I have been fortunate once. Not everyone is. I know this. I really do. And I know that not all of my friends and family are going to support what I see as a life-affirming choice. I have to prepare for this.
But I can't do this alone. I need support. If you have any words of comfort, wisdom, anything that will bolster me in my creation, please help me prepare. Is there a lesson in these circumstance that I am missing?
I am in need of these things tomorrow.
Today I am just angry and disappointed and needed to just tell this story in any way I could get it out.