by Sara Connell
“My wife and I had all our kids through IVF. And scheduled C-sections. I’m telling you,” he said, his face boring into ours, “IVF is the best way to go.”
“It may be the best way when you have seventeen million dollars,” Bill said in the cab on the way home. We didn’t know for sure how much his friend’s family had, but they owned several homes and often flew in their own plane, so we were fairly sure cost hadn’t been a consideration in their family planning. While I had purposely not asked for exact numbers on IVF yet, I’d heard rumors that one round could be somewhere around $20,000.
Additionally, IVF was complicated: a complex matrix of medications, injections, and frequent doctor visits—for “monitoring.” More than that, though, I realized that I’d perceived IVF as extreme, something to turn to as a last resort. I didn’t like that we were at this place. If we tried IVF and it didn’t work, we had nowhere to go biologically.
“The advantage is that we’ll take over your cycle, or, in your case, create a cycle and have control of every aspect of the process,” Dr. Colaum was saying. “The statistics for conception are higher”—about 33 percent per cycle, Bill and I had read. “And if we get a good batch of eggs, as there’s every reason to believe we will, based on the stim cycles, we can implant more than one embryo and your chances of pregnancy go up even more.”
We told Dr. Colaum we would take some time to think about it.
“We’ve already started people for December cycles,” she said. “You could do one more round of stim over the holidays and then, if you’re not pregnant, we can regroup in the new year.”
“We pretty much knew this was where we were headed,” Bill said on the somber drive home. Most of the leaves in the city had fallen to the ground weeks before. On the stretch of the ride coming out of Dr. Colaum’s office, however, a few rows of trees maintained a fiery orange mane, leaves hanging proudly on the branches on the sides of Ridge Road. The sun, in this last warm breath before winter, was hot through the windows of the car.
“I know,” I said, “but I feel kind of freaked out anyway. IVF involves a lot of shots.”
I thought about the day in London when Bill and I had decided I should stop taking birth control pills, the first time I had viscerally imagined having a child. I thought about the promise Bill and I had already made—that we would do anything, whatever was necessary, to have a family. I was committed to this promise like a covenant, and yet I was balking slightly in the face of moving forward. I thought about a talk I had heard once about covenants: They can provide whatever power or courage is necessary for their fulfillment.
“I want to take a little bit of time before we start the process, just to be sure this feels right,” I said.
Bill looked at me, and I tried to appear confident.
“Since we can’t do IVF right away anyway,” he said, “I’m up for doing one more round of stim and deciding in the new year.” I agreed.
I reclined my seat and stared up at the trees that whizzed past against the pale sky. I felt comforted that Bill and I continued to agree on what to do next. The light was fading, but the sun still shone overhead. I found my coat, which I’d left in the car earlier, and laid it over me like a blanket. As we crossed from Evanston into Chicago, I thought that I was lucky. Bill and I had each other, the power of a covenant, and, according to a note Rachel had handed us on our way out of the office, a strong likelihood that our insurance would pay for a good portion of three rounds of IVF.
“Three rounds. Thirty-three percent chance each round,” Bill said, almost to himself, calculating the odds.
Chapter 5
Before we made the final decision to do IVF, I wanted to take quiet time each day in meditation, to see if I could reach some clarity about our choice. Bill did not practice formal meditation. He tended to have a gut feeling about things, either immediately or over time. If he was uncertain about something, he cooked or gardened or took a walk.
“It’s the same as what I do,” I said once when he described his process.
“It’s not meditation,” he said. “It’s just the way ideas come to me.”
“Same thing,” I repeated.
Since I’d returned from England, I’d been immersed in a writing project on female sexuality and feminine energy. I’d done extensive research on the female archetypes around the world, and in my reading I’d come upon what Carl Jung called the Cosmic Mother and primal cultures called the Great Mother—the mother archetype that showed up in most every culture and religion.
A friend in the UK who knew about the work I was doing had sent me a card the year we moved back to Chicago that featured a watercolor painting of Quin Yin, the mother goddess from China. The image was painted in washes of pink, rich purples, and blue. One of Quin Yin’s hands was raised, thumb and forefinger touching, with her palm forward in a gesture of peace. The folds of her robe and the outline around her face were etched in gold. I knew I’d saved the card somewhere in my office; I found it in a box on the lowest shelf where I kept old journals and vision boards and thank-you cards from clients. I’d protected the card in a cellophane sleeve; the pulpy watercolor paper was still a crisp white, the image beatific and serene. I carried the photograph upstairs and placed it next to my bed, leaning it against a stack of books on my nightstand.
In a way I hadn’t done since I was a child, I knelt at the side of the bed. I asked the Mother for guidance. I wasn’t sure what, exactly, I was praying to—I had not grown up with a female image of God—but it didn’t matter. I believed that God, in whatever form, was multifaceted and that some aspect of it was female, and maternal. It was this aspect I prayed to. What I was really praying for was a sign.
In the two weeks that followed our November consultation with Dr. Colaum, I dutifully did extra meditation every day. But by the middle of the second week, I didn’t feel any clearer about doing IVF. I had not received the kind of sign I like: I hadn’t driven by a billboard with the letters “IVF” on it, nor had any stranger accosted me on the street, saying, “Sara, do IVF.” I did, however, keep going back to a lecture my professor of reflexology in London had given about complementary medicine. “Our work is to use the best of what modern medicine and holistic treatments offer to bring about the most successful outcome or healing. Do not become rigid and holistic-exclusive,” she’d said.
Then Kaitlin called from London to tell me about a documentary she’d just watched on IVF, in which the embryologist talked about being a channel for conception, versus “playing God.”
“I’d always regarded IVF as unnatural,” Kaitlin said, “but I feel differently now. I’d do it if we needed help.”
I had not yet told Kaitlin, or any of my other friends, for that matter, that we were considering IVF, yet she’d provided a new context, one I needed. If Kaitlin, who practiced holistic medicine almost religiously, was open to IVF, perhaps I could embrace the process as well.
I still felt ashamed that we needed help to do something that was supposed to be the most natural, basic, biological thing a heterosexual couple could do. And I still felt fearful that IVF was a last resort, that if we couldn’t become pregnant this way, we might never become pregnant at all. But Bill pointed out that we already hadn’t become pregnant any other way. If we did not take this risk, we would never know what IVF could make possible.
By the fourth week of meditation, I began to accept that I really didn’t know what was “natural” and what was not. For Bill, the decision had been easy: IVF was the logical next step for us.
We called Dr. Colaum’s office in mid-December and asked to be added to the rotation for the next available IVF cycle. We met with Tracey, Rachel, and Dr. Colaum in January and began the involved precycle regime. Bill and I returned to the office for a mandatory infectious-disease panel—$1,000 worth of blood tests that our insurance did not cover. We would be required to get this panel for each future cycle to confirm we did not have AIDS, HIV, syphilis, gonorrhea, chlamydia, or TB.
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sp; “Is this really necessary?” Bill asked, as we sat side by side in the lab, our veins popping from the rubber straps banding our biceps.
“It’s the FDA’s rule, not ours,” Rachel said. After she’d finished filling the requisite tubes of blood, she handed Bill a plastic cup. “We always take a backup donation precycle,” she said, “in case someone is unable to perform on the day.” She motioned to the hallway. Bill trudged grudgingly toward the “man room,” his shoulders hunched.
“Men can be babies sometimes,” Rachel said. “Wait until he sees what you have to go through.”
With these preprocedures completed, we would begin our actual IVF cycle in March.
But I continued to feel unsettled. I told him I just needed a little time to assimilate to the regimen that was coming. I prayed and meditated in the mornings, asking for courage and alignment with whatever we needed to do to have a family. I felt no different after the meditations, but by the Monday morning of our first Lupron injection, something had shifted. I woke feeling committed, like a warrioress going into battle.
If stim was like taking an intro-level class on fertility, IVF was a PhD program.
The first two weeks were easy. I went to the doctor’s office for a monitoring ultrasound once a week. Each morning at home I injected five milligrams of Lupron into my abdomen and took a birth control pill and seventy-five milligrams of dexamethasone. On the fifth day of the cycle I stopped the birth control pill and my period started—right on cue. During week three, the medications increased. I continued the Lupron and dexamethasone in the morning. In the evenings I took Follistim, Repronex-Menopur, and an injection of estrogen on alternating days.
I guessed this was around the point in the cycle where people started having meltdowns or freaking out. A friend of mine told me she experienced paranoia and obsessive thoughts just from taking Clomid, and a friend of hers said IVF drugs sent her into a depression. Rachel had cautioned me about side effects ranging from sore breasts to bloating, and noted I might feel more easily overwhelmed than I typically would.
Aside from some general, low-grade anxiety over the process and a full feeling, as if my stomach had been inflated a few times with a bicycle pump, I felt normal. Tracey and Rachel seemed surprised.
“Do you think it’s because I meditate?” I asked my friend Sandy over the phone. We’d met at a life-coach-training program the year I moved back from London and had become immediate friends. Sandy had been meditating for over twenty years and had often spoken of the benefits she experienced from her practice. When she moved to Santa Fe, I started to visit two or three times a year and we set up a monthly phone date.
“It might be the meditation,” she said. “I think it’s also the way you’re approaching this process. You and Bill have chosen to be positive and let this bring you closer.” I could envision Sandy on her back porch, drinking hot water with lemon, her cropped blond hair catching the light as the sun rose over the arroyos and canyons of the Sandia Mountains. I longed to be there for a day or two, to lay my body on the desert floor, to go hiking at night and see the thousands of stars in the black sky.
Sandy was one of the only people I told we were doing IVF. I no longer felt ashamed of our decision; I just didn’t want people asking me if we were pregnant or when we would know. I found it challenging enough to be with the thoughts in my own head, the hopefulness tinged with fear, the useless attempts to not think about the outcome. We’d been general with our parents, too, sharing only that we were doing fertility treatments and we’d let them know when we had any news.
I tried not to think about catastrophic outcomes as I dutifully injected my abdomen each morning and night. As we neared retrieval (the procedure in which Dr. Colaum would go in and extract the eggs), my abdomen grew sore inside. The injections made constellations of angry red dots across my stomach, and in one or two places I had small purple bruises where the needle had punctured a capillary.
“Is there a way to avoid this?” I asked Tracey at one of my appointments.
“I’m afraid not,” she said. “It just happens sometimes. It’s nothing to worry about.” The “injection site,” as the instructions called my stomach, did not exactly hurt. But the skin felt itchy and stung when I rubbed it with the alcohol swabs.
Dr. Colaum measured the growth of my follicles and counted my eggs. I tried to count along with her but could still make out only fuzzy circles on the ultrasound screen. I would have guessed seven, but she consistently came up with nine. When the largest egg grew to her desired measurement, she would set the date for retrieval. We would transfer three days later, she told me, if we had embryos.
In the mornings, I read Zen axioms about being flexible with desires and supple as a reed, but as we neared the hoped-for retrieval and transfer dates, I felt like a violin whose strings were wound a few turns too tight.
When I was working, I focused on the work, but the drive back and forth to Evanston every other day gave me an abundance of unstructured time in which to fixate on our fertility process. My least favorite part of the drive was the long, utilitarian strip of Ashland Avenue that took up about twenty minutes of the commute. I logged the landmarks as I drove: car wash, a White Castle drive-through, and several blocks of sad, neglected-looking storefronts. Once I turned onto Ridge Road, though, in Evanston, the scene became more picturesque. The bare street opened onto a wide, tree-lined drive, and the long driveways and expansive lawns calmed my mind, so that by the time I reached the parking lot my spirits had lifted somewhat and I could breathe fully into my belly again.
On the drive back, I would feel calmer still, by a decimal point or two, having seen with my own eyes that the follicles were developing, that we had not hyperstimulated, that the eggs were growing “beautifully” (as Dr. Colaum liked to say), and that in about one week’s time we would be ready for retrieval.
I didn’t ask Bill to accompany me to the appointments. The frequent visits were disruptive enough to my routine, and we agreed it was better for him to work. In some way that I never named aloud, I felt that the monitoring was my responsibility: The eggs were growing in my body. I began to think of the appointments as part of my preparation for motherhood. When we had a baby, there would be errands and classes and check-ups at the pediatrician. IVF was like an early-start parenting program. I was taking care of our child before he/she was even conceived.
At night, as I lay in bed, I would imagine myself lying next to Bill heavily pregnant, feeling a tickle of excitement run up and down the front of my body. I knew what I was doing was a risk. The 33 percent statistic flashed in my head as a reminder. I would have been wise to keep my mind open to all possibilities, to stay in the moment, to be at peace with whatever was coming. But my heart already beat with these visions of pregnancy, and I started to find it hard to imagine that it could be possible not to be pregnant, after doing all this.
On my way home I stopped at Whole Foods to pick up groceries: bread, eggs, tea, spinach, and Ben and Jerry’s frozen yogurt for Bill. I had told exactly one friend—Sandy in Santa Fe—that we were attempting pregnancy with IVF. I’d felt unburdened after I called her and longed for more connection as I sat in my car in the parking lot. Impulsively, I picked up the phone and dialed my parents’ number.
“What a nice surprise,” my mother said upon answering. I heard the score of some musical in the background. “Am I interrupting dinner?” I asked. It was five thirty in Chicago, and I sometimes forgot to factor in the hour time difference.
“Your father is out fighting for one of his causes tonight, so I’m going to get out of my work clothes, straight into pajamas, and eat a big bowl of cereal.” She sounded thrilled.
“I wanted to share that Bill and I are doing IVF,” I offered, bypassing any small talk. “We have two procedures—retrieval and transfer—sometime next week.”
“How are you feeling?” she asked, continuing the conversation seamlessly, as if we’d just discussed fertility treatments the week before, instead
of a single time many months earlier.
“A little anxious—about being pregnant but also about the retrieval procedure,” I said. “I’ll be out with general anesthetic while our doctor retrieves the eggs from the follicles.”
I considered telling her about the eggs, how Dr. Colaum was pleased that I had so many. I began to, but stopped. If for some reason we couldn’t complete the cycle, I worried I’d have her disappointment to contend with as well as my own.
“It’s amazing what modern medicine can do,” my mother said.
“I know. Thanks for letting me share,” I said.
“It sounds like you’re doing great, honey. We’re praying for you. Keep us posted.”
The following Wednesday, the first week of April, Dr. Colaum scrutinized the ultrasound screen and pronounced us ready for retrieval. I could make out the individual follicles on the monitor now and counted eleven or twelve viable eggs, ranging in size from nine to twenty centimeters.
“HCG tomorrow night,” Dr. Colaum said to Tracey.
In an IVF cycle, HCG has to be injected at a precisely scheduled time, down to the minute, exactly thirty-six hours before the retrieval procedure. Unlike the other injected medications in the cycle, HCG is injected intramuscularly, which means in the buttocks, or in the “love handles,” Rachel told us on the day of our first IVF consultation. “For you,” she said, assessing my body, “I recommend the buttocks.” Bill and I had henceforth referred to HCG as “the butt shot.”
Our time for the butt shot was nine o’clock on Thursday night. I let Bill administer this one because the needle was longer and I couldn’t work out how to twist myself around and inject the shot in either cheek. Bill said it would be fun—for him, at least, trying to make light of it—but I was jumpy all evening. A lot rode on this shot. I thought of the hours spent driving back and forth to Evanston, the month of injections, the lab tests, the $1,500 worth of extra procedures RMI included as part of its IVF package that insurance did not cover. If we screwed up, all of our efforts to this point would be wasted.
