Welcome to IVF
By Karen Dempsey
“If we have a baby, we can tell it, ‘This is the desk you were conceived on,’ ” I say.
The desk is where we sit for the injections that will pump my little eggs—our unconceived children, John calls them—with hormones so they will grow big and strong.
I hold the syringe like a dart and stab it in two inches from my navel. The fatty flesh of my abdomen offers little resistance, and the sinking of the half-inch needle is oddly painless. Watching, John reminds me to release the pinch of flesh. Then, sensing somehow that my instinct is to draw back on the syringe, he tells me to press down to release the single cc of clear liquid. I fumble, too many fingers and thumbs. My skin resists the plunging, and I really have to press
“This part hurts.” I tug the needle free from my skin. “Done.”
Tender bruises mark my belly from three months of injections. We have spent more than half a year in infertility treatment, but with this cycle we graduate to IVF, in vitro fertilization. We have tried oral fertility drugs and a procedure called intrauterine insemination. If we are going to conceive a child, IVF is our best and last hope.
My doctors can only guess at what is causing my infertility. Eight years ago, when I was twenty-three and single, an odd, painful pressure began in my pelvis. A surgeon threaded a tiny camera into my abdomen and saw dense endometrial tissue, not lining the uterus where it belongs, but running over my right ovary and fallopian tube and binding them together. “We’ll do everything we can to protect your fertility,” the doctor said. Her words frightened me enough that I opted for the most aggressive treatment option, a harsh course of steroid injections to induce temporary menopause, shrink the errant endometrial tissue, and allow my body a chance to heal. I endured intra-muscular injections into my buttocks, suffered hot flashes and night sweats. But soon enough the pain in my pelvis went away. I felt like myself again. Cured.
Today, we know that my fallopian tubes are clear and that John has plenty of enthusiastic sperm trying to reach my eggs. But we are in our seventeenth month of trying, our seventh month of treatment, and still there is no baby.
I entered the world of infertility treatment with a prescription for Clomid, a low-dose, oral medication that puffs up the ovaries and helps them release a fat egg or two each month. I had read the literature on fertility drugs and their frightening side effects—bloating, cramping, exploding ovaries. Triplets. But I had also talked with a woman who’d struggled with infertility thirty years before me, whose marriage ended as a result. “If I’d had the options you have today,” she said, “I would have pushed the sky.” So I swallowed the pills and pictured my ovaries inflating a little each day, like a slow balloon. I bought the ovulation predictor kit. I swelled. I cramped. I had sex. And then I got my period again.
I counted the days to my next ovulation and called in a refill of the Clomid. At the pharmacy, I learned that the store had run out of the tiny white pills. I would need to return the next day, delaying my planned departure for an out-of-town weekend. “Half the people in this town are on Clomid,” I told John.
It is true that at times infertility treatment seems to have caught on like some sort of fad. But it also seems I am surrounded by babies, in strollers and grocery carts and those little baby-backpacks people wear. I ride to work on the subway and watch two little girls whisper conspiratorial, nonsensical things to each other as they wind themselves around their father’s limbs. I sit alone, my lap holding only my overstuffed work bag. It is hard not to feel I’m the only one.
When the second round of Clomid failed, I had a late-night phone conversation with my ob/gyn. We talked about further treatment, which would involve my seeing a specialist at an infertility clinic. In the meantime, I would try Clomid one more time, at double the dose. Before hanging up, my doctor promised that pregnancy is in my future—a matter of when, not if.
The night I took the last dose of Clomid, I woke from a deep sleep, felt my way down the stairs from my bedroom in the dark, and flipped on the bathroom light. It flashed and flickered. I suspected a dying bulb until the hallway light did the same. Electricity’s going out, I thought, listening for wind or thunder. I moved through the house flicking switches. By the time I reached the dining room, everything in my peripheral vision quivered, like the view through heat rising off highway blacktop. I stared at our oil painting of a Hong Kong street scene; it seemed to ooze grays and blues and yellows. Gas leak, I thought. I tested the black knobs of the stove and checked the carbon monoxide detector. Then I got it. The drugs.
I flicked the lights a few more times, then crept back upstairs and under the covers, trying not to wake John. I wanted to show him the view from inside my head, but instead I closed my eyes and tried to sleep. Tilt-a-whirl. The room began to dip and spin. I lay flat on my back, breathing. I pressed gently on my frightened eyelids, my popcorn ovaries.
My vision had returned to normal by morning, but I called an ophthalmologist, convinced that I had somehow detached a retina. He had me come right in. His assistant took my medical history. She skipped through a list of questions in a cheery voice, her words layered in a brogue that lent drama to even the most innocuous phrase. “Clomid … Now what is that for?” she asked. “Right! Thank you.” She dripped some cold drops into my eyes to dilate my pupils, and I sat back with a copy of the New Yorker to wait for the doctor. A haze settled over my dilating pupils, and the print on the pages blurred.
“I’m not used to seeing younger people in here,” the ophthalmologist said as he looked at my file. He sat in a chair opposite me and pulled forward until we were almost knee-to-knee. Through the haze he looked like a rounder Steven Spielberg.
“How are you doing with the treatment?” he asked. I hesitated. He went on to say that he and his wife had gone through five and a half years of infertility treatment. “Look,” he said. “We are of a generation. I don’t even raise an eyebrow anymore when I see a thirty-one-year-old woman on Clomid.” He said infertility treatment has just become part of the process for some of us. He said it in a way that acknowledged the sadness of it all but made me feel a little less like an aberration, a little less crazy.
He examined my eyes and told me they looked great. “Now let me say this,” he told me. “You are going to have a baby. Unless there is something radically, radically wrong, and that’s almost never the case, and you’d know it by now. You are going to have a baby. This”—he gestured, capturing the bigness of infertility, the way it permeates a life—”it does fade into the background. And then you have all the other traumas and stresses and worries. I would want to say this to you anyway because you seem like a nice person, but I’m saying it to you as a doctor and because I’ve been there and because it’s true.
“Your eyes are fine,” he said again. “Come back after you have your baby.”
The infertility clinic was located in the same building as my ob/gyn, just down the hall from his office. I glanced in his window as I passed by. I missed him.
In the clinic waiting room, patients sat singly and in pairs, avoiding one another’s eyes. One woman strayed from this code of behavior and scanned the faces in the room. I pretended to read a magazine. Beneath it lay an envelope of x-rays. The films showed a foggy envelope of a uterus and tendrils of injected ink flowing freely—healthily—through my fallopian tubes.
John describes our first conversation with the infertility specialist like this: When you first walk in, you believe that you are there to learn about a whole host of new options. IVF still sounds to you like something out of a science fiction movie, something you might need to consider in the distant future. But then you sit down with the doctor and review your file and discuss the statistics that you face. The likelihood that you will conceive on your own at this point: two percent. The success rate for intrauterine insemination, combined with hormone injections: maybe eighteen percent. In vitro success rates: forty to forty-eight percent. By the time you walk out of there, IVF has become your best friend.
The other option, IUI, is a type of artificial insemination. Doctors use a catheter to boost the sperm up into the uterus, nearer to the fallopian tubes. But the egg must still travel down through the tubes from the ovary. If the path is imperfect, if the ovary is displaced or the tubes marked by scar tissue, the egg can lose its way. Based on my history and medical testing, the doctor suspected that my eggs weren’t surviving the journey. In vitro fertilization—fertilization outside of my body—might give my eggs a chance. She pushed us toward IVF.
Our treatment plan was not her decision and it was not our decision, either. While we are fortunate to live in a state that treats infertility like the medical condition that it is and mandates that health insurance companies cover treatment, we also have to follow the insurance company’s timeline. My doctor would pitch the case for IVF to my health maintenance organization. And, she said, she would probably lose. Even though she was convinced that only IVF will work in this case and even though the IUI cycles require the same painful injections, the same numerous ultrasounds and blood tests, she believed my HMO would make us try it.
She was right. When she called to tell me that the insurance company had mandated two IUI cycles before we could try in vitro, she reminded me to save my energy for IVF. “Think of these next two months as something you just need to get through.”
I am okay with needles as long as I can watch them go in. When nurses stick me with a flu shot or probe my veins to draw blood, I stay relaxed as long as I can monitor their efforts. So while John and I waited to meet with Paula, the “patient educator,” for our “injection demonstration,” I told myself I’d been preparing my whole life for this and I tried to remember that people jab themselves with needles all the time. Insulin, I thought as I went into the office and saw the syringes laid out on the table. Heroin, I thought when I held one and pulled off the plastic cap.
John practiced first, on a rubbery blue pillow that looked like a miniature waterbed. He held the needle over the pillow, hesitated, and cast an anxious, guilty look my way. I took my turn next, and then Paula suggested that I try a practice injection on myself, on my actual flesh. I rolled up my shirt, watched my belly rise as I inhaled, pinched my skin, and sailed the needle in without flinching. Then I pulled it out and stuck myself in the finger.
In the room where we planned to put the crib, we now keep a mini pharmacy. A desk holds alcohol prep pads, sterile bandages, and tiny plastic bottles of Gonal-F and Pregnyl and the sterile water used to dilute them. Plastic syringes lie next to dozens of needles in two different sizes and a red plastic container, the size of a shoebox, marked “Biohazard Infectious Waste.”
Two months of injections, ultrasounds, and inseminations. Of blood tests and, ultimately, the cramping and bleeding that signal another failed intervention. Two failed IUI cycles. And now we have graduated to IVF.
Through the ultrasound, my ovary resembles an insect’s eye, holding countless eyes within it: my exhausted eggs, my tiny, un-conceived children. Every few days we’re up at six to drive to the clinic and check the swelling of the egg follicles. Twelve millimeters, thirteen and a half, fifteen. When the follicles reach eighteen millimeters the eggs within them will be mature enough for a surgeon to extricate them from their nest, from among their too-small sibling eggs, with yet another glistening needle.
When we last counted the eggs and saw that some of the smaller ones had ballooned, I looked away from the ultrasound monitor to see John’s eyes, wide with something like alarm. In the car he sat for a moment and rested his hands on the steering wheel. “You’re going to have triplets,” he said. It is a bitter irony that we live with limited chances of conceiving at all and still struggle with the possibility of multiples. But later he kissed my tired face and said, “Tell the twins I want them to come straight home from school today. I’ve got things for them to do around here.”
The day after my final injection of the cycle, I sit in my office and sense the last bits of my energy seeping away. I leave work early and struggle to walk the few blocks to the station where I catch the subway. I feel I am in danger of floating away, like a helium balloon: empty. I move among a crowd of people who all seem grounded, held by gravity, and I think that I am linked to this earth only by a ribbon-thin string. I board the train holding onto this image of the string linking me to earth, and I somehow find a seat and count the stops until I am home.
Along with the isolation, the depression, the sheer physical exhaustion of infertility comes the overwhelming feeling that my body has let me down. But as I look back over the past months and consider what infertility treatment has required of me, I think about the strength it must have taken for my body to have endured—to have survived each cycle of aggressive treatment and tremendous disappointment, to have recovered from it and readied itself for the cycle to begin again.
A good friend who experienced infertility repeated to me something she had heard from another survivor: “IVF will bring you to your knees,” she said. And I have watched infertility bleed over into my entire life—my relationships, my work, my way of being in the world. It has worn me down a little more each day.
Has infertility brought me to my knees? I think it has. But on the morning of the surgery to retrieve my eggs, I rise and shower and put on my favorite sundress, and I know that I have pulled myself back up.
At the infertility clinic, we are greeted outside the surgery by a nurse named Amy, who says in a soothing but serious voice, “Welcome to IVF.” John and I roll our eyes at each other, but Amy understands that we have arrived here after a very long journey. We are ready. Amy holds my arm as we glide around a wide, white room, me in my hospital slippers, she in her soundless white sneakers. Here is the scale where we check your weight. Here is a tiny locker for your things; I will keep the key for you.
John sits beside me until he is banished to the waiting room. When they come for me, I feel a bubble of nausea rise up from my stomach. The operating room is cold, and the lights blind me as I lie on a table waiting for the anesthesia to take. A woman appears at my side: “I am the scientist who will take care of your eggs.” She and the nurse speak in murmurs that grow softer. I think about my little eggs and of John in the waiting room, thinking of me, holding the ribbon-string that tethers me to the earth, holding me fast and safe as I push the sky.
Author’s Note: I wrote much of this essay during a writing workshop that coincided with my infertility treatment. I wrote on the subway between home, class, work, and home again, and I scribbled notes after appointments and encounters with people whose words and gestures had an impact on me. In one of the few morning classes I managed to attend when I wasn’t at the infertility clinic, I met the remarkable woman who told me she would have pushed the sky to have a child. I survived infertility, in part, because of a few generous people who, like her, experienced infertility before me and shared their stories with me.
Brain, Child (Spring 2005)
Karen Dempsey’s writing has appeared in The New York Times, Babble and other publications. She lives in Massachusetts with her family. Follow her on Twitter @KarenEDempsey or read more of her work at kdempseycreative.com.