Don’t give up before the miracle happens.
Fannie Flag
I started a family later in life. I had my first child at 34, and my second at 37. I did not marry until I was 28, partly because I wanted to finish my doctoral degree without distraction (I admire so many people that do it with a job, family, and/or other responsibilities), and partly because no one asked me until I was 27. I finished my PhD degree in the spring of 2001, started my post doctoral training in the fall of 2001, and a year later realized I was getting old, so if I wanted children, family planning needed to start now.
At my yearly woman’s check up, my physician discussed with me getting a workup at the fertility clinic. I had a history of symptoms that were linked to a disorder known as polycystic ovary syndrome (PCOS), and because of that, getting pregnant naturally might be a challenge. Due to my advanced age (apparently, 30 is over the hill in reproductive years), she advised I be aggressive if I wanted to have children. I decided I wanted to start off simple: tracking my ovulation during my cycle to find my optimal fertility window. After a half year of this not resulting in pregnancy, I agreed to see a reproductive endocrinologist for evaluation. I went in thinking this wasn’t going to be a big deal. After all, everyone just gets pregnant, right? Even though it hadn’t happened yet, we’d only been trying for a few months. Everyone in my immediate family had multiple children, so the idea I might never have a child did not even enter my mind. I mean, people get married partly to reproduce, right? At least, that was one of my reasons: to have a family.
My doctor took my health history, did a few tests, and decided I most likely had PCOS, but since I had not one obvious symptom that said “yes, she has it!”, she couldn’t make a definitive diagnosis. I didn’t have cysts on my ovaries characteristic of the disease, I didn’t have sugar issues or insulin resistance that are linked to this disorder, and my hormones were normal. So my official diagnosis was irregular ovulation, and I was prescribed a hyper stimulant, clomid, to promote multiple egg production during my cycle and increase my chances of getting pregnant. Of the possible side effects of the drug, short term and long term, the one that was most troubling to me was the risk of multiples, perhaps twins or triplets. Because even then, I was thinking yep, I’m getting pregnant, it’s just how many babies will I have? It became the joke in the lab I was doing my postdoctoral training that I’d soon be seen carting around triplets in a stroller.
As is a trend in my life, I tend to be spectacularly naive about some things while terribly realistic about others. I don’t think it hit me I was actually having issues with getting pregnant until the day I was ready to “trigger” release of the multiple eggs I had produced during my first clomid cycle. I had 3 mature eggs according to the ultrasound that day, and was given a prescription for human chorionic gonadotropin, or HCG, that I was to give myself via intramuscular injection. Wait, what? So far, it had been popping a few pills, uncomfortable blood draws to monitor hormone levels, and routine transvaginal ultrasounds to monitor egg production. But that night, I was supposed to inject myself with HCG using what looked like a knitting needle length syringe into my thigh. Being a bit squeamish, I admit it took me about 30 minutes of eyeing the full syringe, numerous alcohol wipes of the area I was going to inject into, and finally an exaggerated stab into my thigh, which due to my flinching at breaking the skin, resulted in a bruise that was probably more painful than if I hadn’t panicked at the last second. This entire process was so far removed from what should naturally occur, so clinical, that moment was when the enormity of what I was doing to have a child hit me. And this might be only the beginning. But it was done, and after the rest was done, the wait period began. Fourteen days….
That cycle, my first of what turned out to be seven treatment cycles, did not result in a pregnancy. Undaunted, I cycled again. Who gets it the first time, right? Another 14 day wait, the call from the doctor’s office, and no success on number 2. So onto lucky number 3. After this 14 day wait, the call I answered with my pregnancy test results was a surprise. Yes! I was pregnant! But my pregnancy hormones were so low that most likely the pregnancy was not going to be viable. Wait, what? So here I was, ecstatic on one hand that the treatment had worked, but crushed that it wasn’t going to work out. The next cycle the same thing happened: I was pregnant, but the pregnancy was not viable. Being proactive, more testing on my anatomy and possible contributors to why I was able to get pregnant but not maintain the pregnancy was performed, but did not reveal any smoking guns. I was further diagnosed with “poor quality eggs” and a “hostile uterine environment,” but my fertility team and doctor remained optimistic (Lovely terminology in what is already an emotional time in a woman’s life. I began to feel like a medical object.)
With no more clarity, I went onto my fifth cycle, which resulted again in pregnancy. This one started off much more positively, my pregnancy hormone levels were adequate, and I made it to the first ultrasound. That was when things unraveled. There was the gestation sac, implanted; however, knowing exactly how far along I was, the ultrasound indicated that development was not on track for a healthy pregnancy. But, it was early, 5.5 weeks, so I was told to come back at 8 weeks to monitor progress. You can guess what was seen. An empty sac, aka blighted ovum, a missed miscarriage. I was prescribed medication in case my body did not naturally recognize and pass the nonviable pregnancy before 10 weeks. And so started the phase in my life that I call the Long Dark Tea Time of the Soul (you can see why I prefer coffee…).
Although I had suffered two early miscarriages already, this one was so much later in the first trimester, had been more “real” to me, that this loss hit me hard. I didn’t realize how hard until I was at the chemical fume hood in the lab, working with some toxic solvents, and I had an anxiety attack and froze up, pipet in hand. I panicked and called my colleague to help me, because I didn’t want to cause a lab accident and kill myself or others (thank you, Jane). This happened a couple of more times, getting progressively worse, to the extent I was not able to pick up a plate of microbes without feeling anxiety. Clearly, I was not dealing with this well, and I could be a harm to myself and others, so I went to a therapist to try to work things out, because that’s what you do when you can’t function.
I took a break for 6 months from fertility treatment as I worked through the losses, not just of my pregnancy, but the loss of what I thought my life was going to be. My therapist urged me to try to deal with the grief I was suppressing due to the losses (she said she had never seen anyone hold in pain as well as I could, but obviously I was cracking with the panic attacks, so she suggested I try to let it go). She didn’t laugh at me when I said that during the last pregnancy, when I was waiting for the followup ultrasound at 8 weeks, I had had a dream it was going to be a little girl, and her name was Maya. Since I rarely remember dreams, this one stuck with me. She told me that I should perhaps try a ritual to resolve my grief, and so I bought a hydrangea shrub (my favorite as they remind me of a beach cottage on Cape Cod) and planted it in my back yard as a memorial to my daughter I would never know. To this day, it is one thing that can bring tears to my eyes in memory.
In some languages, “Maya” means “illusion,” so the name that came to me in my dream seemed to be particularly appropriate, as I had to not only deal with the miscarriages and my illusion that things would be simple, but the loss of the idea that what I was sure was going to happen (have a family) may not be what my life would be. I might never be a mother. I had to rethink what I thought my life was going to look like, and what that meant. How long would I go through treatment until I said enough? If I couldn’t have a child naturally, was adoption an option? What would my life be if I were childless? My mother reminded me that at one time, in my mid twenties, I asked her if she minded not having grandchildren because I wasn’t sure I wanted to have children. I was so passionate about my work at that time in my life, that I wasn’t sure it would be fair to have a family if I was dedicated 24/7 to the lab. Did I even want children, or was I thinking I did, because that’s what you do when you get to be a certain age? Would my career be enough? I joined online support groups with women who were in my predicament, and listened to their stories to gain more perspective. Of course, there are two people trying to have a child, so it wasn’t just me (though it seemed it was my “fault” I couldn’t carry a pregnancy to term) deciding about these paths, and I had to consider that as well. And at 3 am, at some dark level of my soul, I started to question myself as a woman, because wasn’t having children and caring for them an integral part of what women did? I was defective, apparently. So, who was I, and what did I want?
Over time, as I struggled to answer these questions, my anxiety lessened and the panic attacks disappeared. The one thing that was clear was that having a family was important, and if I could have a child biologically, I was going to give it another try. I went back for another round of treatment. The next type of treatment, an injectible hormone, was more expensive than the clomid, but I was told might result in higher quality eggs. My patient file was now 3 inches thick, and my doctor would shake her head and say that by now, I should have had results with everything she’d seen of my case, and she was very optimistic it would work this time. Putting my faith in my doctor, I started the nightly injections and entered another 14 day wait period.
I’d like to say that was the cycle it worked, but it wasn’t. Seven is my favorite number, and the next cycle was the one I finally had my miracle occur, and my son was born 9 months later, healthy. I’d like to say that the pregnancy was easy, but it wasn’t, and my son was actually one of two; his twin was non viable at 10 weeks, but by his birth, the remnants of his sibling were gone. I named my son after my maternal grandfather, whose name was Victor, and whom I am indirectly named after, as the meaning “Victory” seemed to fit. Though it was a long road, I was given this blessing. Along the way, I learned humility, that there are limits to what is knowable and controllable in the universe, that life is truly a miracle, and, the most important thing, when I looked into my son’s eyes for the first time–unconditional love exists and flows between us. And, if you just keep trying, there is the chance that what you most want in life may happen. Never give up, and you will receive so much more than you can ever imagine.
3 am thoughts and musings 