Friday, June 14, 2013

Searching for the Fruits of my Loins

The girl (and I WILL call her a girl, because she will certainly call me an older woman) who came into the room to do my first ultrasound was a pretty young medical intern, a doctor in training whose looks far surpassed her bedside manner. But I won't hold that against her. I appreciate socially stunted pretty women. It's a nice anomaly in life. Like a rooster that doesn't crow. 

My mind wanders away from what I'm about to find out, spending more time wondering about the young doctor, about her future, her marriage and baby plans (I bet she'll be smart and lucky and do it right, in her early 30s, with a great, stable, well-employed guy, I imagine.). I wonder what she thinks of me sitting there on the stirrup table undressed from the waist down. Do I look desperate? Am I a sad case to her? Does she see me in simple terms, a cautionary tale, the one about the older woman who missed too many boats? Maybe she pulls a life lesson from me. (Do it right, have babies in my 30s! Don't wait too long.) Perhaps her bedside manner isn't a personality issue, maybe she simply cannot look squarely into my hopeful, anxious eyes because they ask too much of her. They ask her what my future holds.

She was quick. It didn't take long to count my follicles. One. A nearly barren desert on the plains of my ovaries. I was expecting about 10. Or more. No, I wasn't expecting, I was assuming. Of course I would have a high, healthy, normal count. When it comes to medical tests, ALL of my numbers are healthy and within better than normal range for people half my age. I like saying that. Healthier than people half my age. It's one of the small perks of older age sprinkled about like confetti. Wait...people half my age are now drinking age adults, maybe that's what explains why my numbers are better than theirs... 

Anyhoo, as the pretty doctor said, “only one.” It's you and me, follie. You and me against the world.
I had more fibroids than follicles, and after the doctor quickly measured and took ultrasound pictures of my non-follicle formations, she grimly smiled and left the room. Got the hell out of Dodge. Did she know the news might at any moment hit the weak spot in my emotional dam? I wonder how often the rooms in this clinic are backed up due to crying despondent women. I wonder what the office policy is for how long to let a lady sob before ushering her out the door.

Initially as I dressed, as the information sank in, I felt as I always do when I first get bad news. Stunned, but strong. Courageous. Ready to deal with it and move on. That's the knee-jerk reaction for me, and it's probably a protective mechanism, but it's what I do. My mind works through the new reality with stiff stoicism during this initial phase.

Zipping up my jeans, alone in the room, I rolled the idea over in my head to see how it felt: You are an infertile woman. You are an infertile woman. You are an infertile woman. It felt Old World. Like when people used to whisper, She's a frigid woman.

I bolstered myself with the idea that many great women have been infertile. I thought of Karen Blixen. The scene from Out of Africa when Blixen receives the news of her infertility came to mind. She was also putting her clothes back on as the reality of it sank in, and we could see the shock and tragedy on Merryl Streep's face. We are a tribe, the waist-down-naked-women of the world, who learn the children we dreamed of having are now erased from our futures. I realized, of course, that modern medicine and fertility treatments might mean I could still conceive, but I now understood what so many women before me have felt. The moment you learn such a fate is a deep, defining, dividing line in a life. There is before knowing and after. It is two different worlds. I had just dipped my toe into the scary one.

But knowing that I might be infertile felt surprisingly empowering all the sudden. The decision that I had delayed and delayed and delayed for a myriad of reasons was finally made for me. Oh, shit, I really did wait too long, was one thought that skittered through my head. But I was also immediately feeling unburdened to unequivocally devote my energy and time and desires to other endeavors. I did not have to figure out how to fit a baby into my life. I did not have to spend the next 18-years as a food factory, maid, babysitter, chauffeur, and all around slave to what will surely be an unappreciative human until at least his or her fist therapy session. There were plenty of other adventures, challenges, projects and ambitions I could pursue if a child was not in my future. I was free. That thought propped me up for about five minutes.

The lump in my throat started to grow as I waited for the nurse to take my blood. I stood out in the clinic hallway, against the wall, trying not to be in the way as the doctors and nurses and patients went about their business. One thing you barely notice about aging until it's well upon you is the shift from being the youngest in the room to being the oldest. I looked around and everyone, all these adults, well into their busy, full lives, were younger than me. And here I was standing on the sidelines alone, realizing perhaps I had waited too long to start the life I wanted. At that moment, I felt the world was moving on and past me very quickly and without sympathy. I was being left behind by the machinations of life. I fought back the tears.

The nurse was my kind of lady. Dry and sassy. The kind of nurse who talks you through any procedure with competent caretaker humor. She doesn't have to try at it, it's just who she is. I tend to faint when stuck with needles, so there's a big note in my chart that says: “Must be supine for blood draws.” Lying on my back, staring at the ceiling while she tied the rubber hose around my arm made it easier to confess: “I just found out I only have one follicle.”

I had to tell someone. The news was starting to feel like a twisting knife in my side. I was on the verge of sobbing. I wanted a little sympathy for my disappointment or at least some recognition of it.

“Well, that's the magic egg then,” she shot back without a moment's beat, laughing because I was so silly not to realize that. “Didn't they tell you we have magic eggs around here? One of those is all you need.”

She made me laugh. Through my tears. Literally. I didn't expect such irreverent words. But her simple lighthearted gesture of hope stopped my self-pitying spiral. It was exactly what I needed to hear at that moment, and I love her for it.

I had to make a decision that week if I would move forward with the process. Jeanelle, Dr. P's sweet and patient right hand woman who will guide me through the nitty gritty of treatments, taught me how to take the two different types of shots I would have to give myself everyday. I took good notes, completely ignoring the fact that I was terrified of giving myself shots. It's like dropping a diamond earring into the toilet. Even a dirty disgusting toilet. You suck it up and you just stick your hand down in there to grab it. It's just something you have to do and fretting about it only makes it worse.

I spoke with Dr. P, and he said it was possible, after injecting my body with the ovarian stimulation drugs, that more follicles might appear. He said a few might even be hidden behind the fibroids. He noted, too, that he had not done the ultrasound, so he could not be sure if the young intern simply missed seeing teeny follicles that a more well-trained eye would spot.

Also, as is common in fertility treatment, I was prescribed birth control pills for 21 days to suppress follicle and egg growth in my ovaries. In a normal cycle, our ovaries produce several follicles, and they compete to become the one dominant follicle that will develop into the single egg that will be released that month. The rest of the follicles and potential eggs die in the competition. Think of it as The Hunger Games for a much younger crowd.

The well-proven theory for fertility treatments is that putting a woman on birth control will suppress the competition between the follicles so that none of them become dominant. The next step is to rev up the ovaries so that every follicle grows into an egg instead of just the dominant one. It's like cutting back a flowering shrub so that a greater number of buds per branch bloom next season. Regardless of whether I retrieve my eggs to freeze or fertilize, the goal is to harvest as many blossomed eggs as possible in one cycle.
But sometimes, the birth control, especially in someone my age, can over-suppress follicle growth. That, too, could account for the desert landscape on my ovaries.

Despite the bad news, I wasn't ready to throw in the towel on this cycle yet. I wanted to give my body a chance to let the ovarian stimulation drugs go to work and surprise everyone with a basket full of bushels. I also simply wanted to get this done as soon as possible. But I knew that one follicle was a truly bad sign. I couldn't imagine spending the $10,000 - $15,000 (no, all those zeros are not a typo) to go through the whole process if we'd only retrieve one egg, which has such a low chance of actually becoming a baby. I needed lots of eggs to raise my odds of a successful pregnancy.

I had three days to think about it...

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