Urban Legend

April 5, 2010

In some ways, 2009 was kind of a rough year. I pulled together all our tax paperwork last week for our accountant, and I noticed, over and over again, all the bills for our medical expenses.

A large chunk of those expenses were for infertility coverage. There was extra insurance to cover the costs of fertility treatments in our state. There were extra procedures to figure out if we can have a girl without chromosomal defects. And sometimes there were extra costs on top of those procedures that aren’t always reimbursed.

That’s a bunch of extras.

And that doesn’t include the ongoing costs: parking and routine lab-work, co-payments and babysitters so we don’t have to schlep our son to these appointments. More to pay to get additional coverage at daycare and nursery school. More excuses. More guarded explanations.

Our three-year-old knows what it means when I say I have to go to an appointment. “What’s the doctor’s name?” he’ll ask. He hasn’t yet figured out which name signifies what medical issue is being examined.

So what exactly did we do in 2009?

* One fresh IVF cycle over the summer, that ended in an early miscarriage and D&E. (transfer July 4th. Try explaining to your friends who have come to your neighborhood to watch the parade in front of your house about why you are leaving your son with a babysitter while you and your husband are trying to sneak out of the driveway. To get to a clinic. That no one knows you are visiting. At 9 in the morning, no less.)

* One frozen embryo transfer in the fall that didn’t develop into anything. (Circa Columbus Day Weekend).

* One vaginal procedure to figure out if there was any scarring obscuring anything en route to the uterus. (The week of Thanksgiving. Some minor scarring, but only enough to direct future people to enter with their assorted medical tools and whatnot “at 7 o’clock.”

* Another fresh IVF cycle that started around MLK weekend, 2010, but ended in an even earlier miscarriage by Valentine’s Day.

We honestly didn’t plan any of this around holidays. It just worked out that way.

For my 40th birthday this spring, the insurance company gifted me with yet another test. To prove that my old lady ovaries were still working properly (and therefore, worth insuring for another round of IVF), I had to do a Clomid challenge. This entailed yet more blood tests, several days of taking Clomid to help amp up my ovaries, and then a vaginal exam to determine my uterus was still clean and clear.

The nurse who did the exam remembered me from an appointment last summer, when she confirmed that I’d need a D&E for a miscarriage/failed IVF. “How are you doing,” she asked mournfully. “Still trying to have a baby,” I replied, all matter-of-fact, with advice: “By the way, go in at 7 o’clock and use a tiny speculum.”

She did and she did. “I see one follicle in here,” she noted. “I’ve been taking Clomid,” I reported. When not being mandated by one’s insurance company to prove ovaries are still working right, Clomid is the first line of treatment when you aren’t conceiving. I’d taken it many cycles before, long before the IVFs and the IUIs, the workups and the endless bloodwork. It had never done much for me, honestly.

But maybe could it work now?

I went home with a new mission.

“Let’s have sex!” I told Mr. L. What did we have to lose? A follicle was in sight. Never mind that we’d been here many times before, so many times that actually having sex for recreational fun was something I’d nearly forgotten how to do. As I had many times before, I bought an ovulation predictor kit and dutifully peed on a week’s worth of sticks.

The ovulation predictor tests were never entirely conclusive, but the egg white mucous pouring out of me one day suggested it was all systems go. Once again, we tried to do what most of the rest of the world does to conceive.

How shocking—we were in a bed, just the two of us! For once, I was not draped in a hospital gown and a paper shower cap, my feet up in stirrups, Mr. L sitting at my side, both of us freezing in a clinical exam room, our eyes glued to a monitor as a pipette with fresh or frozen embryos were gently, carefully, guided through my cervix and into my uterus, as my full bladder threatened to leak all over the doctor doing the transfer, the nurse assisting, and the embryologist who was always there telling us which embryos looked the best for the procedure.

Romantic, no?

But this time, things were a bit more ordinary. The typical way the majority of people conceive.

Again, since I’ve been here many times before and have never gotten pregnant with just sex, without a round of fresh IVF, both the Mister and I carried on with the rest of our lives. My day-to-day blood sugars were okay, but not stellar. My thyroid levels were a bit low. The only minor change this time: I was taking Metformin, a drug my infertility doc recommended, not because my sugars were out of line or because I’ve ever shown any sign of having polycystic ovaries, but because it might “help my hormones,” whatever that meant. I continued to eat deli meat and drink diet Coke.

One week later, at a party, I ate a smidge of Brie cheese. Weirdly, after we were on our way home an hour or two later, I felt sick to my stomach. Mr. L had to pull off the highway so I could find a bathroom. I couldn’t tell if I had to vomit or sit on the toilet for a long time. Thankfully, I didn’t vomit.

“Maybe you’re pregnant,” Mr. L said, after I left the Gas and Go’s public bathroom, shuddering.

“Maybe. Wouldn’t that be something?” I said.

I didn’t have a lot of faith.

In the meantime, we met with a few other doctors. This included another infertility specialist to get a second opinion. She told us she would keep doing what we’re doing, but to stop using PGD, an expensive procedure that tells you the chromosomal makeup (and gender) of embryos before you they are transferred via IVF. We didn't have any history of chromosomal abnormalities, and the procedure might even damage healthy embryos, so it wasn’t worth doing, she told us. A nutritionist said I was on the right track. My endo told me my A1c was 6.1 and that my bloodwork, for the most part, looked fine.

“We did try this month, but I’d be shocked if it meant anything,” I told them all. “Good luck,” they all said. One medical assistant, who waited with me as I waited to see my diabetes endocrinologist, regaled me with stories of patients she’s seen who get pregnant on their own after years of infertility treatment. A friend I haven’t seen in ages told me a distant mutual friend, one I’d lost touch with over the past year, recently delivered her healthy son. The new mom was a woman who’s done as much if not more fertility treatment than me, and had conceived her toddler daughter after a lot of IVF. Her newborn son? Conceived naturally.

I’d always thought these stories were urban legends. You hear about them, but do they really happen?

We had our follow-up appointment with our reproductive endocrinologist on a Friday in April, about two months after the last IVF ended in another early miscarriage. We’d waited the appropriate amount of time. We’d had more bloodwork to see if there were chromosomal or genetic reasons why my last two pregnancies ended so prematurely. Nothing showed up. All we had to do was wait for my period to start and we were geared up to start the next fresh IVF cycle. I was all set to order the drugs the day my period started.

That weekend, my period never showed.

I bought a pricey digital pregnancy test that promised results in three minutes.
In less than one, we had our answer:


We’ve never been here. We don’t know the embryo cell count, the potential for implantation, exactly how many days post-transfer I am. How many were transferred?

That Monday, I went to the infertility clinic for a blood test. The nurse left her message on my cell.

Beta count: 165. “Very good. We want it to be anything over 100.”

Progesterone level, that indicates the uterus is prepping to support an embryo: 40. “It doesn’t get much better than that,” the nurse said.

How did I get here? The Mister and I actually had sex and get pregnant? And me at age 40, no less?

I honestly have no idea.