When I came back and started catching up with the fertility blogs I read, I was amazed at how quickly things change. While I was gone, people had found themselves pregnant, lost pregnancies, gotten news good and bad. So often each moment seems like we are frozen, and yet so much changes so drastically in such a short time.
Here's what's changed for me:
My cycle in August was the first cycle with monitoring and an hCG shot, my first cycle taking clomid and metformin at once. I didn't think it would work. During that two-week wait, I obsessed very little. I was busy. We closed on our house. We did a million things getting ready for vacation, and for moving.
But it turned out it worked. IT WORKED! An HPT was positive, and I had good, rising hCG levels in my blood.
Mr. Jae and I spent that week in a really weird state of disbelief.
I didn't write here because I didn't believe it yet.
I didn't believe it yet, and I was thrilled, and I was trying to start the long shift from the pessimistic attitude that served me so well for the past year an a half to the optimism that seems more useful and enjoyable in pregnancy.
Then we left for the aforementioned vacation. We met my parents at the coast, and we told my immediate family the news. We told them while my mom was chopping up cilantro, and she dropped the knife and the cutting board on the floor and cried and cried, and kept wiping her face with her hands, which were covered with cilantro bits, and she got cilantro bits all over her face, which I kept wiping off for her.
In the wee hours of the next morning, I woke up to pee, and when I wiped I could see blood. Reddish brown. Ugly.
I panicked. I didn't wake anyone up. I lay in bed letting tears soak my pillow and thinking, "God: If you are out there, I hate you," until, hours later, I fell asleep.
I called my RE's office in the morning, and the nurse told me not to worry as long as the blood was brown. And I tried to be all brave and cheery and optimistic but the bleeding seemed to increase and there was even some I'd say was brownish red rather than reddish brown, and I had cramps exactly like I'd get before having a really nasty period, and I spent the whole afternoon on the bed in the downstairs bedroom, crying and wiping my nose all over my snotty pajama shirt.
My mom brought me a sandwich and Mr. Jae sat with me and was amazingly calm and said amazingly right things (How did he know just what to say to a woman who was sure she was miscarrying?) My mom told me all about the bleeding she had while pregnant with me, and the bleeding my aunt had while pregnant with each of my cousins. I think I was tempoarily insane. I didn't really believe how common bleeding is (even though the nurse had told me on the phone), and I couldn't see how everything could be ok.
Finally I told them I wanted to take a nap, and Mr. Jae and my mom left, and I lay there clutching my snotty PJ top. The only thought I could think that was even slightly hopeful was, "Stay with me, little soul." And I kept saying this to myself as I fell asleep.
And I did NOT wake up to harder cramps or a gush of blood. I slept for a few hours, and woke up, and found the same unenthusiastic, ugly, brown spotting.
And it went on like that. I spent the whole vacation in a slowed-down state. I slept a lot, and went to the bathroom every half hour, probably, to check the color and quantity of the moment. Amazingly, amazingly, the spotting tapered off. And then came back. And then tapered off again. I made a few more teary calls to the RE's office and had a few more teary conversations with my family.
By the time we left for home, I'd had two days of no bleeding.
After we got home, it started again. On and off, sometimes seeming worse than the initial incident that had scared the living bajeezus out of me. The RE said they wouldn't do an ultrasound for another week, because it was too early for anything to be conclusive. Which I think is a load of crap. But the last thing I needed was anything else to be unconclusive, so I stuck it out. For a week I went back to that two-week-wait state - expecting the worst, hoping in my tiny little buried optimistic soul for the best: Stay with me, little soul. I couldn't write about it then. I couldn't put anything down without knowing how it would turn out.
The ultrasound was on a Wednesday, a week and a half ago. We held our breaths. We saw a heartbeat. The doctor said, "There's only one." I was too choked up to say, "One is perfect. One is all we need. One is just right."
I've had no bleeding for almost two weeks now, and I have been discharged to the care of a regular OB, who sees no problem with my quitting the metformin, having rambunctious sex, and taking up trampoline polo, and who says I will not be having ultrasounds every two weeks to preserve my sanity. I am still proceeding with caution.
I know so much about What Could Happen. And I am still making that shift, from protecting myself by expecting disappointment, to letting myself be THRILLED and hopeful, even while knowing there are no guarantees.
The world seems so dangerous, full of things I could breathe, swallow, or touch, that would severely fuck up what's going on inside me.
But here I am, almost nine weeks, and seemingly still pregnant. Nauseated on occasion. Gagging on dried apricots for no reason. Reading about pregnancy, which I never, never allowed myself to do before this. And feeling my mind turn, like a sunflower, to look at things differently.
What I want to talk about is a couple of weird fertility references in fiction I've read in the past couple of weeks.
A few other bloggers have written about the awful portrayals of infertility, and especially infertile women, from all kinds of sources. Wish I could give credit, but I don't remember where I read what. This is a little different, anyway.
What I'm thinking of are two pieces of fiction: Middlesex, which I guess is currently the favorite gnawing bone of book clubs everywhere; and a short story called "The Fractious South" that was in last week's New Yorker.
Both of these pieces show women taking their temperatures to track their ovulation, and using the thermometer to drag their husbands into sex at the right time. (I know, I know, the basal thermometer is such a sexy, sexy piece of hardware).
There is plenty of weirdness about this. Not least, it shows the women being demanding in a petty way, and completely devoid of any carnal desires other than to get pregnant (or, in the case of Middlesex, to get pregnant with a female baby). Each of these characters wields the thermometer like some kind of magic wand ... she waves it, and lustless sex is hers, on demand.
Maybe none of that is surprising. The characters in question are not infertile, but the way the authors depict their fertility-related behavior is not too far from the infertile = selfish equation we see just about everywhere.
The other strange thing is that these characters have some whacked out ideas about how body temperature, ovulation, and conception are related. In both stories, the women take their temperatures at all times of day - afternoon, evening, whatever - and demand sex when they see a high temperature.
Now, call me a Taking Charge of Your Fertility nerd, but:
1. Temperatures taken during the day aren't going to be accurate, and
2. If their temperature has already gone up, haven't they already ovulated and missed their best chance?
Was there at one time the belief that daytime thermometer use and sex after a temperature rise were the way to go? Are these authors trying to show characters who are clueless about the workings of their reproductive tracts? Or are the authors themselves working under some kind of delusion about how this all works?
Anyway, given the total absence of an audience, it's perfectly ok for me to write another verse - and not even a very innovative one - in the age-old ballad entitled, "They Say the Most Unbelievable Things."
On Saturday, Mr. Jae and I went to a wedding. The groom is a good friend of Mr. Jae's but more of an acquaintance of mine. And though I knew a few friends of the couple there, the wedding reception was largely populated by people I had never met before in my life.
Now, here's a pop quiz. Where would you think would be the most appropriate place to discuss my reproductive status?
a. Among close friends and family.
b. At the aforementioned gathering of complete strangers.
The answer, my non-existent readers, is b. It's true. Although even the friends and family who know about my infertility rarely if ever ask how the journey to parenthood is going, and although I often feel like the Bad Evil Infertile Bitch Lady when I bring up the topic, every man, woman, and child at this wedding saw fit to make a polite inquiry about my reproductive life.
I am standing on the lawn with my husband; a female friend I'll call Kay, whom I suspect may be having a secondary infertility problem, although I don't know her that well; and a woman my husband and Kay sort of know but whom I have just met, and whom I'll call Sue, which is her real name (look out for Sue, everyone!):
[general wedding chit-chat, blather about how old and mature Kay's three-year-old son is getting, etc.]
Sue [to Kay]: So, are you guys trying for another one?
Kay [whose social grace is way, way, way up there at a level I can't even dream of reaching]: Oh, maybe sometime soon.
Me [knowing I'm next]: I'm going to get something to drink. [Speedy exit without graceful farewell to anyone. Berate self for not being strong enough to stay there and give Miss Manners's recommended response, "I'm surprised you would ask that."]
Turns out that after I left Sue did ask Mr. Jae when we're going to have kids, and Mr. Jae, being far more composed, charitable, and willing to lie to lubricate a social situation than I, replied, "We don't have any plans." I love that man.
At dinner I'm seated next to a guy named Christopher, a complete stranger.
[could you pass the butter, what do you do for work, aren't housing prices outrageous, etc.]
Christopher: So, are you guys going to have kids?
Me [looking away and trying to be poised, but mumbling]: Hopefully someday.
Christopher: Sorry, what? Hopefully someday?
Me: Do you have any kids?
I should have just said yes, because we are going to have kids, whether through adoption or through pregnancy. But was I calm enough to think of that? Certainly not.
Damn. Why does it rattle me so much? It always comes out of nowhere, this nosiness. Yuck.
In the fuzzily-lit, overdramatic story on the Russian gymnast Svetlana Khorkina, she looks at the camera and says, I want to win as much as I want to mother my own child.
Let's aside for a moment most of the reasons why the media coverage of this woman is grossly sexist. Also, let's set aside the word own in my own child, which has some shades of unfairness as far as how to make a family.
Those things aside, I find it really heartening that Khorkina used this comparison publicly, and that it seems to have as much resonance for the mostly-fertile general public as it does for me. As much as I want to mother my own child. It's reassuring to me that people see how great this want can be.
And also, I wonder if some of the meaner media commentary on Khorkina has its roots tangled up with this want. Women aren't supposed to want things so much, are we? When we do, we are called self-indulgent. Or greedy. Or divas.
So much of the nasty stuff that infertile women deal with seems to come from others denying our desire, trying to dampen the strength of our wanting. On blogs I've been reading this last week, there's been some great talk on the ways this happens, the things people say: You won't care that you were never pregnant, and Pregnancy isn't that great, and Be glad you have one child and don't be greedy for another.
It's not only the well-meaning others that do this. I think we do it inside ourselves, too. Deny our want. Minimize it. I know I do. I can barely ever get up the strength to acknowledge how much I want the whole experience of pregnancy, birth, breast-feeding, baby. I carry it around inside me, another kind of embryo.
Even if I never give birth to a baby, at least I can keep nurturing this want 'til it presses out at the sides of me, and finally let it out into the world, hollering at the top of its lungs.
I don't want to exaggerate my rank among the infertiliterati. I haven't been reading Metamorphoses. I have been reading Jeffrey Eugenides' Middlesex, which - besides helping me Keep My Mind Off Things and containing stunningly inaccurate stuff about the relationship of ovulation, body temperature, and conception - contains that little bit of eggy wisdom.
It's true. Everything comes from an egg. Or, a tad more poetically: From an egg, everything.
Everything. What I'm sure Ovid didn't detail is that before Everything, there is the Beginning of Everything, which comes during the two weeks after there is an egg and before Everything proper begins. The Beginning of Everything contains things that I'm sure Ovid did not write about. Like fascinating and ever-increasing breast swelling. Like the purchasing of unreasonably expensive pairs of jeans. And the checking and re-checking of the calendar to see how many days it's been. And the obsessive ingestion of orange Milanos. With big glasses of milk to balance out the carbs.
Anyway. I ovulated yesterday. And now the Beginning of Everything begins. And so far I am just as calm as can be. I know that the obsession is bound to ratchet up to earsplitting, unbearable, Milano-binge-inducing levels over the next fourteen days. For now, I am feeling so cool it's a little ridiculous. I'm feeling like, "Huh. If I'm pregnant, I am, and if I'm not, I can drink a lot of wine." I'm feeling like, "Yeah, I think I'll wait until I have eighteen high temperatures to even pee on a stick."
Yeah. I'm sure waiting eighteen days will be no problem at all.
Please tell me this: Why does everyone - my mom, my husband, and, like, seven women on a message board I visit - say, "It only takes one"? And why am I not comforted by it at all?
It does only take one. Obviously. Am I totally spoiled to want a fantastic response out of my ovaries, something more than one little-engine-that-could follicle?
I know the chances of pregnancy on any given cycle, even if I manage to pop out the world's most perfect egg, are slim, slim, slim. But I'm feeling pretty content at the moment anyway. Mostly because I was fearing I'd have nothing going on down there after taking the Clomid, and I'm so relieved to see some action.
As far as the mental and emotional landscape goes, lately I'm feeling like a stranger in a new country.
Not the least of it is the experience in the RE's office. Everyone knows what they're doing: the techs, the nurses, the appointment-making-lady. And most of the patients. And clearly I am supposed to just know what to do. But I don't.
In the waiting room, I don't know I'm supposed to sign in on the little form, or what I'm supposed to write on it. In the ultrasound room, I don't know where to put my clothes, and I drape them over the arm of a chair. And then the nurse ends up sitting there, instead of in the swivel chair on the other side of the exam table where I thought she'd sit, and she knocks my pants and undies onto the floor and doesn't even flinch or apologize or make a move to pick them up. Now, did she do that on purpose out of spite because I put my clothes on Her Chair?
After the scan, Nurse Chair tells me I need to have blood drawn, sets a piece of paper with my name on it on the desk, and leaves to let me get dressed. I put on my pants and feel the mundane details of what needs to be done pile up. It's like trying to buy a bus ticket in Kathmandu.
There is a point to this exhaustive look at every pixel of This Week's Ultrasound Visit. The point is that the RE's office is a foreign land, and the natives are not always that helpful.
The weird thing about this sense of culture shock, though, is that some part of me really treats the experience like moving to a new place: I'm new here, and everything's mysterious. But, boy, how clever I'll feel when I'm on my seventieth ultrasound and this all feels like home.
Sick, huh? Sad, that we have to get used to that place. That there are so many of us. That already the reason for all this probing and pilling and tweaking - and the hope of a good outcome - is so obscured from view that the main thing I wished for in that moment was not that my stay would be short but that soon I'd know what to do in that strange, strange place.
The other sense of travelling I have is more to do with the problem we'd all have all the time, if we thought about it: not knowing the ending. Not knowing where I am on the journey. Is this only the beginning, or am I almost at the end? What's up ahead? I feel like I'm constantly reframing my view of the current moment in terms of my latest fantasy or nightmare about what the next year will hold.
It is a great, great boon for my sanity that there are so many women out there who are brave and frank in telling their stories about this crazy country. It's humbling to see what might be up ahead, and to see the grace with which my infertile blogging sisters (still strangers, at the moment) face it all. It is immensely comforting to see all this living proof that whatever comes, it can be lived through, and that somewhere - maybe near, maybe far, but somewhere on this road in a place I will reach one day - is my new home. And it ain't in the ultrasound room, and Nurse Chair is nowhere to be seen.
Of course, there's what I said last week, a few hours after the fact: That I'd like to be a more perfect patient. And who wouldn' t really? Certainly the nurses and techs and doctors save out the good drugs for the ones they like, right? The ones who are cute and personable and can manage some kind of poise while scooting their butt up to the edge of the exam table. I didn't feel all poised and articulate. And cute and personable is always a stretch.
To this, the answer, I know, is that there are women who have been on this road longer and way, way harder than I have, who are saying, fuck articulate and personable, how about sane, how about preserving a scrap of dignity, how about staying alive to your body?
Besides that, there's the fact this little viewing of my innards was such a big deal for me (I'd waited for this start of treatment for for six months before even getting in for a consultation, not to mention weeks of waiting for my period, etc.) and it lasted all of three seconds and was clearly, clearly one of three bazillion vaginal ultrasounds this tech would do that day.
And the answer to that is, get used to it, suck it up, it's going to be a long ride.
But here is what's unacceptable: While the tech was doing the ultrasound and calling things out in secret ultrasound tech code to Sweet Nurse Jane, Sweet Nurse Jane was also asking me questions. Asking me medical history stuff, and what dose of metformin I'm on, etc. etc. etc.
I felt like I was in sensory overload. And no wonder.
Is this acceptable anywhere else? In any other setting? Something technological is in my vagina and I'm supposed to be chit-chatting with a nurse about stuff that's already in my chart? Is there any other kind of medical exam where they double-team you like that and expect your body to be examined while your mind and mouth answer questions? Have I just had mercifully little medical treatment in my life?
It doesn't seem right. From now on, I answer no questions until after the probe is withdrawn, dammit.
That news aside, I was pretty underwhelmed by the whole ultrasound experience. I wanted painstaking explanations of what was on the screen. I really could not decipher it on my own. Nor could I understand what the ultrasound tech was saying to Sweet Nurse Jane. She was conveying something to her in a secret code while I was preoccupied with the grey swirly images on the screen and the hi-tech quickie going on in my nether parts.
By the time I got around to asking, "Can you explain what you're looking at?" there was only time for, "This is your left ovary, and that [a giant black blob] is a cystic region."
Sweet Nurse Jane let me put my skirt back on and then wrote out a giant prescription sheet and an appointment for another quickie a week from today.
She also insulted my dear ob/gyn by saying she "threw" Clomid at me without any monitoring or HCG shots or anything. Which, ok, is technically true. But my dear ob/gyn was very smart and articulate about why it was statistically a decent idea to give it a try before sending me upstairs to the expensive, time-consuming world of Fertility-R-Us.
And I wanted to give Sweet Nurse Jane some kind of defense of my dear ob/gyn and also myself for having decided to go along with the two unmonitored, un-Metformin-ed Clomid cycles last fall and winter. But I was still on sensory overload from the quickie and the weird blobby cyst thing and the giant prescription sheet, and Sweet Nurse Jane was in a hurry, so I left for work kind of unsatisfied but determined to be a more perfect patient next time.
For now, let me just report that I am at last wearing the red jersey, and that tomorrow I will go for my first baseline ultrasound. In other words, a technician will be taking a peek at my ovaries and uterine lining so that the RE, sitting at his enormous desk, can scrawl something in my chart to tell the nurse how much Clomid to tell me to take this cycle, and for how long.
It occurred to me Saturday morning as I lay in bed that this could be kind of awkward. I mean, assuming the exam position on the second day of my period. Ew.
But, obviously, there are more important things in the world to worry about.
Like whether the ultrasound technician might pan the camera around my abdomen, do a double-take, and ask me gently, "Has anyone ever told you you don't have any ovaries?"
That's what they call it, anyway.
What's happened is, I've never had anything approaching a regular, 28-day period in my life. As a teenager, this didn't bother me at all. I'd get a period maybe four times a year, and I was happy about that. I think then I saw menstruating, disdainfully, as a girly thing, something that would bring me down (I thought the same thing about having kids, then, too).
At doctor visits they inevitably asked me when my last period was. And when the date was two or three months before, they'd give me the raised eyebrows and ask if I was pregnant. When I said no they'd pause, lean in closer and ask, "Are you sure? What birth control are you using?" Seventeen-year-old, self-righteous, nerdy me would answer, "Uh, abstinence?" Sometimes it took several rounds of this to get out of there without having to take a pregnancy test.
Every health care professional I encountered between puberty and age 25-ish seemed quite concerned that I might be hiding a pregnancy.
But no one ever, ever seemed concerned about naming or fixing the problem of my infrequent menstruation. I'd occasionally hear, "Oh, we'll worry about that when you want to get pregnant."
When, in my mid-twenties, my periods became even less frequent and I started to worry about my fertility, it took visits with three ob/gyns and a great deal of insistence on my part to get anyone to even attempt a diagnosis.
PCOS is a syndrome, not a disease. Which means we don't know what causes it, and in fact it's likely that as the syndrome becomes better understood, docs will break it down into a couple, or several, different diseases, each with different causes.
For now, they toss everyone who has certain symptoms into the PCOS bin. I don't have some of the more common symptoms, like extreme acne and hairiness, high body mass, insulin resistance, or thyroid problems. What I do have is infrequent ovulation and a nice set of cysts of different sizes on my ovaries.
The PCOS diagnosis is firmed up by the fact that I seem to respond somewhat well to the drug metformin, which seems to help a lot of folks with PCOS ovulate.
Yep, that's right. It made me ovulate. I think. Not once, not twice, but three times. The story is:
Last September, after five months off the pill with no ovulation and no period, I did a cycle of Clomid. No egg.
November: Clomid cycle two. No egg.
January: convinced my ob/gyn I should give the metformin a try despite my lack of the "classic" PCOS symptoms. Started the metformin.
End of February: ovulated after having given up on ovulating.
Mid-April: ovulated again, had tons of well-timed sex, spent thirteen days in a state of complete obsession over the fact I might be pregnant, then got my period.
Late May: ovulated again, on cycle day 30, same as last cycle, but my husband was away the entire fertile window.
Mid-June: met our RE for the first time, and, all cocky and convinced I was on a regular 44-day cycle, elected to put off treatment and see if one last "natural" cycle would work.
And did I ovulate on cycle day 30 as hoped and expected? Of course not. Did I ovulate at all? Of course not. Day 40 - almost three weeks ago now - I threw in the towel and demanded Provera. Took the pills for seven days as directed and waited for the promised period. And waited. And peed on home pregnancy tests (well, one). And huddled in the corner of the conference room at work to have furtive phone conversations with the nurses at the RE's office about the precise color of the spots of blood that every now and then eek their way out of me, and the stunning increase in breast size that the fertility gods have granted me in the past week.
I am still, in fact, waiting for my period to start, now eleven days after finishing the Provera. And I would really, really, please, like it to come so I can go ahead and take the Clomid (which is supposed to be extra-super-powerful when taken in combination with metformin) and commence the regular ultrasound viewings of my ovaries, and get with my husband at the right time, and become all round and glowy and pregnant and pop out a lovely baby, et cetera.
But for now I am waiting to bleed.
Too bad there's so much of it to be done.
Mr. Jae and I have had a number of conversations about my low reserve of patience in general. He and I and my friend R (who shares the desire to see everything in the world hurry up a bit) have had a number of conversations about R's and my "journey to patience." Usually they end with R or me whining, "Are we there yet?"
Though I can't say I'm liking all the waiting I've got to do, or even tolerating it very well, I am starting to become aware of the great variety of textures and types of waiting. I could make a list like you'd find in the pillow book of Sei Shonagon:
The long, constant waiting where you are checking for something that might actually be there, like stretchy cervical mucous as a sign of ovulation, or a high temperature in the morning, but really it doesn't come for months and months and the waiting becomes a low drone under all the other types of waiting.
The shorter, but still legato waiting where you are checking for something that is definitely coming, like your period after taking Provera for seven days.
The mind-spinning, bounded waiting to find out whether something is, when any signs that can mean yes can also mean no.
The short, adrenaline-loaded, eyes-averted waiting in the RE's waiting room with the racks of noticeably non-child-related magazines and not enough to do with your hands.
The fed up waiting for something that should have happened three days ago but hasn't yet, like when you thought you'd ovulate on cycle day 30 and here you are eggwhite-y as hell and still with preovulatory temperatures on day 35, or like when your period should have started within a few days of quitting the Provera but it hasn't yet and neither Smart Nurse Jill nor Dumb Nurse Lisa can figure out why.
The flash of waiting between peeing on a stick and seeing one pink line appear.
The long, high note of waiting over it all, the arc of waiting from the day you start hoping to be pregnant to the day you stop.
I made a wish. Then I blew so hard that the powdered sugar erupted off the cake in a cloud, coating the sunglasses and my nose and upper lip, and the slivered almonds took flight in what I'm sure would be a great model of some sort of catastrophic geological event, and landed in about a two-foot arc on the far side of the cake. We have photographs of this: the almonds in flight, me blushing.
One candle stayed lit. My wish was to get pregnant and have a baby.
And that was before we knew for sure it would be hard to do. We suspected it might not be a breeze. I figured I ovulated irregularly on my own, if at all, but had heard magical things about anovulatory women coming off the pill and conceiving immediately. When I stopped taking the pill about two months after the cake incident,my husband and I both felt like we were getting on a train without knowing which direction it was moving, or how fast.
Now we know. Well, we know more. It's been sixteen months since we pulled the goalie. I've taken my waking temperature approximately four hundred times; become more acquainted than I'd ever hoped to be with my cervical fluid; swallowed metformin, provera, and clomid (not to mention profuse quantities of green tea and grapefruit juice and the occasional robitussin chaser); and popped a grand total of three eggs out of my sluggish ovaries. None of which found its way to a happy union with any of my husband's many eager little soldiers of love.