I didn’t tell him the other part—that Clomid also appears to increase the cancer risk for women who never ultimately bear a child, though it’s not clear whether it’s the drug or the infertility itself that’s the culprit. No problem, I thought, it just has to work.
Talk about ratcheting up the stakes. Swallowing that little white pill was the first time I did something I swore I wouldn’t in order to get pregnant: I willingly put my health on the line. It was in that moment that desire and denial merged to become obsession; it was then, right then, that doing anything to get pregnant, regardless of the consequences, became possible.
“You’re trying to control me!” Steven yelled.
“I am not!” I said.
“Yes you are!” He’d been pedaling his exercise bicycle in our den, something he did for a half hour each day. Now he swiveled to face me. “First you told me no jockey shorts,” he said, enumerating on his fingers.
“You never wore jockey shorts,” I interrupted.
“Still, you said it. Then you said no hot baths.”
“You’re not supposed to heat up your testicles. Hot baths kill sperm for three months.”
“Men in Japan take hot baths every day. If that were true there’d be no Japanese children.”
“They don’t have borderline sperm.”
“The doctor said my sperm was fine. Now every time you walk by this room you look at me like I’m killing our chance to have a baby.”
“It’s proven that men who ride bicycles have lower sperm counts,” I said, my voice shaking with anger. “You know that. And you’re deliberately riding that bike. I’m taking a pill that’s doing God knows what to my body so that we can have a child, and you can’t even give up that fucking bike for a few months.”
“Then come to me like a person and talk to me about it instead of giving me your little looks. I am not doing this to hurt you. And anyway, it isn’t going to make any difference.”
“It will!
“You’re being ridiculous. If you don’t stop this, I’m not having fertility sex this month.”
The Web posting from Babyfever that I’d dismissed—and the easy promise I’d made to Steven after reading it—flashed through my mind. I ignored it. “You cannot ride that bike! You cannot ride that bike! You cannot ride that bike!” I shouted.
Never mind cancer. Clomid’s hormones made me a raving lunatic. I may have been right about the bike’s lowering sperm count—it does, really—but lately my response to any challenge, no matter how small, was rage. The way Steven chewed his toast in the morning infuriated me. When he commented on a sloppily folded T-shirt, I dumped a basket of laundry on him. The okra he put in the minestrone was an obvious affront. (He knew I hated okra.) My hostility peaked around ovulation. “Why don’t you just get a porn video and watch it in the other room,” I said. “When you’re ready, I’ll be in bed.”
“It’s really better if you’re interested, too.”
I shrugged. “Yeah. Well, wake me up if I’m sleeping.”
A few weeks later, he gave away the exercise bike.
Another three months went by. My progesterone was pumping. My mucous was gorgeous. We had the timing right. Still, nothing happened. Risa recommended we add intrauterine insemination (IUI) to the Clomid using Steven’s sperm. He would once again get busy with a Dixie cup, then she’d inject his boys directly into my uterus, giving them a running start. The cost would still be minimal, about $350 a month. But we’d crossed another critical threshold: sex—or at least intercourse—was no longer a precondition of conception. We’d become a threesome, though not the fun kind. I lay on an exam table, shivering in my snowflake-covered hospital gown, legs in stirrups. Steven stood by my head, where I could focus on his face, holding my hand. Risa threaded a slim plastic tube through my cervix. It cramped a little. Afterward I stayed prone for fifteen minutes, my tush propped on a cushion. Steven kissed me, but I couldn’t shake the idea that Dr. Kagan might have just fathered my child.
My thirty-eighth birthday came and went. “I’m aggressive with this in your age group,” Risa said. “You need to think about a specialist.” She gave me the number of a local guy. “He’s one of the best in the Bay Area. Maybe you won’t need him. You’ve only tried Clomid four times. But he’s booked months in advance. If you make the appointment, you’ll have it just in case.
“If anyone can get you pregnant," she added, “he can.”
Gee, I thought. And I was hoping Steven would.
The descent into the world of infertility is incremental. Those early steps seem innocuous, even quaint; IUI was hardly more complex than using a turkey baster. You’re not aware of how subtly alienated you become from your body, how inured to its medicalization. You don’t notice your motivation distorting, how conception rather than parenthood becomes the goal, how invested you become in its “achievement.” Each decision to go a little further seems logical. More than that, it begins to feel inevitable. My hesitations about motherhood hadn’t disappeared, but they were steamrolled by my drive to succeed at pregnancy.
By our last round of Clomid we’d completely mechanized the attempt to conceive. The drug controlled the development of my follicle, the fluid-filled sac that contained a microscopic egg. Risa measured it every few days with an ultrasound. When it was ripe, a nurse injected me with a hormone that triggered ovulation. Twenty-four hours later Steven would visit the Russian nurse, where, after a stint with Golf Digest, his sperm was washed and spun, the Olympic contenders separated from those doing the dog paddle. That was my cue: I tucked the vial of his best stuff inside my bra (now the most erotic part of the process) to keep it warm while we race-walked out of the lab, past the Whole Foods and the Chevron station (at which point I clapped my hands across my chest, to protect our future progeny from any toxic fumes), up the stairs of Risa’s building, and into an exam room, where she transferred the contents to my uterus. My hormones were kicking. Steven’s sperm was turbocharged. I didn’t get pregnant.
It is one thing, I was discovering, to think, “Maybe I won’t have kids,” and quite another to be told, “Maybe you can’t." This is how impatience turns to desperation.
Hope? Dr. Aleksandr Stawecki’s waiting room was steeped in it, right down to the blue and rose furniture reminiscent of a nursery. A sculpture of an expectant mother, hand curled around her belly, stood on a table in one corner. To its right were educational pamphlets on fertility drugs, IVF, and egg donation. To its left was a shelf of three-ring binders bursting with birth announcements and holiday cards from satisfied customers: other people’s memories that we wished for our own. There was a picture of a laughing family posed with a snowman, of a baby cast as Jesus in a Nativity scene, of twin boys with the peeling, freckled noses of summer.
You couldn’t help but project yourself into those albums. Once you did, once you envisioned yourself wreathed in the smug victory of parenthood, how could you retain your objectivity? The message was clear. Science could relieve our pain. Science, in the form of the good doctor, would deliver our baby to us. What empty hand wouldn’t grasp at that straw?
Dr. Stawecki came out to greet us, an Eastern European man whose ring of white hair, white beard, and white jacket suggested both a guru’s wisdom and a physician’s expertise. “He looks like Oliver Sacks,” Steven whispered to me as we followed him to his office.
“I think he looks like God,” I whispered back.
The doctor had a reputation among his patients for being gruff, even rude. It’s true, he wasn’t warm. But we appreciated his bluntness—it won our trust. According to him, our main problem was that I was thirty-eight (and a quarter). “A woman’s age is the greatest determinant of a successful pregnancy both for IVF and spontaneous conception,” he explained, in his clipped accent. “You’re born with all of your eggs, and they age with the rest of the organism. As they do, there are more errors in the chromosomes, and the embryos derived from those defective eggs ultimately won’t be successful in implanti
ng a healthy pregnancy. We know it’s the eggs, because with donor eggs the age of the recipient has little impact on the likelihood of conception.”
He pulled out a graph to illustrate his point. It showed a gentle downward slope in the rates of healthy pregnancy between ages eighteen and thirty-five then—Whammo! The bough breaks, the cradle falls, and down come your dreams of baby and all. “The biological clock truly starts ticking at thirty-three,” he added. “It gets louder and louder at thirty-five, and by forty-five it’s stopped.”
Steven looked stricken. He traced the line with his finger. “I always thought it was a gradual decline, but it’s like falling off a cliff." He turned to me. “Did you know this?”
“Kind of,” I said, feebly. “I thought if we started at thirty-five we’d probably be fine.” The truth was, I’d never seen it laid out quite so starkly. Women’s magazines warned that fertility slips away with age, but I armored myself against the message by looking at it politically. The “infertility crisis” sounded to me like the “man shortage” of the mid-1980s, the one that claimed a woman who wasn’t married by forty was more likely to be killed by a terrorist than to catch a husband. That was not only wrong, but inverted—there was actually a glut of single men on the market. Besides, although one out of three women over thirty-five may have trouble getting pregnant, the other two won’t. I’d written the issue off as another attempt to scare women back to the kitchen.
Steven was staring at the chart again. “It’s like our chances are disappearing by the minute,” he said, softly.
“Yes,” Dr. Stawecki agreed, seeming oblivious to our dismay. He pulled out another piece of paper and a pen. “Your cycle is about thirty-four days,” he said to me. “Given your track record, I calculate the odds that you’ll conceive on your own as”—he paused a moment—”less than ten percent.”
“But,” I corrected, “I did get pregnant.”
“A pregnancy with a miscarriage is not the proper end point for fertility. It doesn’t solve the problem.”
I nodded, chastened by my own failure.
“If we add injectible medications with intrauterine insemination, your chances would increase to about… fifteen percent a cycle.”
Steven winced.
“With in vitro fertilization,” Dr. Stawecki paused again, “the odds are closer to thirty percent.”
Thirty percent? Coming in here, those odds would’ve made me blanch—the likelihood was 70 percent that we wouldn’t have a baby—but suddenly they sounded pretty good.
“One in three?” Steven said. “That’s not so terrible.”
I didn’t know anyone (other than Risa) who’d conceived using fertility drugs alone, but my sister-in-law had gotten pregnant twice using a less invasive cousin of IVF; several other friends had, too. Maybe we would be like them. Steven felt optimistic. I was guilt-ridden. We were sold.
Walking back down the hallway, I stopped in front of a framed list of the names of all the babies that the doctor had made. I wondered how soon our child’s name would be up there. I wasn’t euphoric exactly, but I was heartened. We were finally getting the help we needed. Dr. Stawecki and his team would take the guesswork, the agony, out of getting pregnant. All we had to do was follow their instructions.
In IVF a woman injects herself with hormones to stimulate the development of multiple eggs—the more the merrier. When mature, they’re surgically removed and placed in a petri dish with her husband’s sperm {in vitro is Latin for “in glass”). In that unnatural environment they’re supposed to do what comes naturally—form embryos. After incubating for a few days, several of the best looking—those with the most symmetrical cells that are dividing the fastest—are transferred back to the woman’s womb. One or two for a younger, more fertile woman; three or four for a doddering oldster like me; eight for those people who believe it’s God’s will that they end up with quintuplets (though, strangely, not God’s will that they accept their infertility).
No one knows exactly what makes the next part work, but a couple of weeks later—Hocus Pocus Jiminy Crocus—with any good luck, you’ve made a baby. A single cycle costs about twelve thousand dollars, none of which is covered by insurance. That put us in the class of people for whom having a baby depended on having the means. One of Steven’s friends had opted against IVF for that reason. She and her husband could afford either one round of IVF or adoption, but not both. Adoption guaranteed them a child. Over time I would almost envy the clarity imposed by their financial limits. I knew women who’d gone through six, even seven rounds of IVF, sometimes traveling to another state to go to a new clinic that offered a different protocol. There would always be a next new thing to try. And as long as the money holds out and there’s a possibility, a sliver of a chance, that you could bear a child yourself, it’s excruciating to turn away.
So twelve thousand dollars on a 30-percent shot at success—it seemed to me that only a sucker would take that bet. Except that the potential jackpot was so great. And, again, there were those two nagging questions. What if it works? I thought, as I wrote the first of many checks to the clinic. What if this is the only way we can have a child?
For nearly two weeks I injected myself with the purified urine of postmenopausal Italian nuns—that’s what the first drug prescribed to me was originally made of. Why Italian? I don’t know. Why nuns? Postmenopausal women produce massive amounts of the hormone that stimulates egg growth in a futile attempt to revive the ovaries. They excrete the overrun in their pee. Retirement convents offer the most efficient one-stop shopping for elderly women (though I can’t quite picture how they gather the goods). We get pregnant, they get enough money for a new stained-glass window. Everyone wins. It certainly put a new spin on the notion of Immaculate Conception: my potential child would be conceived without intercourse via an egg created by a virgin’s pee. Putting voodoo dolls beneath my mattress no longer seemed so unreasonable.
My second drug was equally bizarre, derived from the ovaries of Chinese hamsters. Why Chinese? Again, no clue, though I hoped the drug wouldn’t hold a grudge against Steven’s Japanese sperm. Neither nun pee nor hamster ovaries came cheap: three vials injected morning and evening plus another drug to suppress my natural cycle ran over $350 a day—the same as I’d spent in an entire month doing IUI with Risa. A girl could buy a lot of shoes with that kind of scratch.
In addition to the familiar side effects of Clomid, the injectible drugs bumped up the likelihood of twins or triplets to 30 percent. That gave us pause. On one hand, it would be a bargain: two for the price of one, an instant family. Steven, whose siblings were each about a year apart, sort of liked the idea of our kids being the same age. On the other hand, he also recalled seeing a friend six months after becoming the father of twins: “They had extinguished the light from his eyes,” Steven said. “He looked like a well-dressed character from Night of the Living Dead.” In the end we convinced ourselves that while we would surely be among the 30 percent who succeeded in getting pregnant, we wouldn’t be in the 30 percent of that group who had twins. Numbers, I was learning, are funny that way.
I had practiced giving injections on an orange. Let me tell you something; your thigh, cellulite aside, is nothing like an orange. For one thing, it feels pain. For another, it’s yours. The first night I meticulously laid out my supplies: alcohol wipes, the vials of powdered medication, the sterile water to dilute them, and two syringes, one for each drug. I twisted a long, thick needle onto the first syringe, and, snapping the glass tops off the vials (using gauze to avoid cutting my fingers), I drew up some water, squirted it into the first vial of powder, and gently swirled until it dissolved. Drawing the mixture up, I repeated the process with the next vial and the next. I changed to another needle, about a half inch long, tapping the syringe briskly until all the air bubbles disappeared. I felt very Medical Center. Then I pinched some skin with my free hand, took a breath, and jabbed. I couldn’t do it. At the last second I pulled my hand back and the needle bounced,
barely nicking my flesh. I reminded myself grimly of how much I wanted to have a baby. No, truth: how much I wanted to accomplish pregnancy. I gritted my teeth and jabbed again. Only about fifty more shots to go.
After eleven days a measly four follicles had developed. Doctors like to see at least twice that many, since there’s attrition at every stage: not all follicles contain usable eggs, not all eggs will fertilize, and not all fertilized embryos will become babies. Many clinics cancel IVF cycles when there are fewer than five follicles to save the patient additional expense, the heartache of probable failure, and, perhaps, to avoid dinging their own statistics. Dr. Stawecki had another philosophy. “The odds may be low,” he told us, “but that’s what odds are: they just tell you a likelihood. In my best professional judgment, Peggy, you’ll never do any better than this, so what’s the point of canceling?”
Steven wasn’t convinced. The priciest part of IVF was the egg retrieval surgery. “I thought we agreed not to go ahead if you didn’t produce enough eggs,” he said. He was right. But I’d already invested so much of my time, energy, and anticipation. I’d already given myself so many shots. Besides, I told Steven, our friend Kristin only produced four follicles and now she and her husband had two-year-old twins. “So you never know,” I said.
“That doesn’t mean a thing," he countered. “I’m sure there’s a supporting anecdote for every situation.”
“But if this is as good as it gets …”
Exactly thirty-six hours before the egg retrieval was scheduled, Steven injected me with the ovulation-inducing drug. This was a more serious maneuver, using a needle three times as long as the others. It had to go into a specific area on the back of my hip that was difficult for me to reach. I leaned over the bed, my weight on one leg, squeezing my eyes shut.
“Okay,” Steven said, “One, two …”
Waiting for Daisy Page 6
