Employed By My Ovaries

The one good thing about having pregnancy become a high priority is that, on a day when all you’ve checked off your to-do is list “do laundry” and “have sex,” at least you can feel like you’ve accomplished something.  At least, that is, until the end of the month, when you find out you haven’t.  But the rest is pretty much all bad.

It’s weird when fertility becomes an issue in your life — perhaps the salient issue.  I mean, it’s not like I didn’t know that women had increasing trouble getting pregnant as they got older, it’s just that for most of my existence, that whole thing never seemed to apply to me in any practical way.  Until I was 21, I didn’t have sex (I was a late bloomer who didn’t know how to flirt, with commitment issues.  Given all that, it’s surprising it only took that long).  Once I started having sex, my goal, like that of most young single women, was to not get pregnant.  Then it didn’t really dawn on me that I was becoming not so young for while because I was single for almost a decade, from my early 20s through my early 30s, and living the cheap freelance lifestyle — so the idea of having a baby seemed to make about as much sense as owning a boat: while I knew it was something that would be nice to have at some point, I wouldn’t know how to use it, I wouldn’t know where to keep it, and I certainly couldn’t afford it.

I only started thinking about babies more seriously after I found myself with a serious boyfriend at age 33.  By that age, maybe it seems kind of silly to call your guy a “boyfriend,” and “manfriend” would seem more appropriate, except for the fact that it sounds like a dude you’d meet on a 1970s pornography site and that most men in their their 30s, in my experience, really are still basically boys.  And the reason for that is basically the same as the reason that my relationship got pushed to extinction: a woman realizes, perhaps suddenly, that her biological clock is ticking (yes, I just used that term that is such a frickin’ cliché that that’s another reason it’s hard to believe that it really exists) at about the same time that a man who can’t make up his mind about whether he wants to have children realizes that he definitely doesn’t want to have children yet.  I, for my part in this scenario, didn’t really want to have children yet either, my career wasn’t at all where I’d expected/hoped/deluded myself it would be by that time — aka I was not getting paid to write or direct stuff, or at least not a real amount on a regular basis — but suddenly I realized that waiting for the life I’d been hoping for to really get underway before contemplating kids was a luxury I no longer could afford.  I was only a couple of years older than him, but suddenly I found myself much farther along on the road to adulthood — and I don’t really mean that as in the nice sense of finally being more ready to start acting like an adult, I mean in as in OLD, in the dark and ugly sense, as in closer to having my bodily functions break down and closer to death.  Men don’t really have to start feeling old until they actually feel old.  With women, it just suddenly hits you like a big bitch slap in the face when your gynecologist suggests that maybe it’s time you thought about freezing your eggs.

Breaking up with that boyfriend did give me a new lease on immaturity, though.  Because without him I no longer had a possibility of becoming part of the nuclear family that I wanted, I was able to forget it all and take the next few years to do a lot of things I had previously written off in my quest to make my life more stable and “adult,” aka baby-friendly.  I took advantage of the freelance lifestyle I had sought to jettison by taking long trips to Guatemala, Argentina, Chile, Peru and Bolivia.  I had flings.  I started another documentary that provided what might have been a similar, all-consuming parenthood experience, filled with much fulfillment and joy, as well as worry, frustration, and sleepless nights punctuated by crying fits (except they were mine).

When my relationship with my then-boyfriend-now-spouse developed into a serious one, however, the bioclock concerns came roaring back with a vengeance. I was 40 when we started dating, so we started having conversations about The Future waaay earlier than you would ever typically want to in a relationship.  Then I actually got pregnant the moment I went off birth control, which forced us to realize that those conversations had meant fuck all in terms of actually preparing us to have a baby.  The pregnancy ended up not being viable (at six weeks, there was no heartbeat), which sucked, but in the long run, gave us the time to have conversations that needed to happen and work toward the idea of having a baby as a couple in a way that actually meant something. 

Then, we were ready to embark on the fertility treatment process.  Although realistically, it’s the kind of wonderfully dehumanizing experience that nothing can truly make you “ready” for.  It started when we met with a specialist, who, as it turned out, I would hardly ever see again.  When you go through fertility treatment, at least at the facility where I did it, you realize fairly early on that your fate, not to mention your everyday routine, will now be ruled by 1) the faceless health care bureaucracy that tells you whether and when you can come for treatment and how much you must pay for it, and 2) nurses.  Nurses are the ones who take your blood, call you with test results just about every day for those important two weeks out of the month, give you instructions on which drugs to take and how much, give you the trigger shot that makes you ovulate and, eventually, inseminate you.  (I know, that sounds creepy, and it is kind of creepy if you think about it too much, but that’s why you try not to).  And the nurses are good at all of these things.  Plus, the head nurses at NYU are thin, surprisingly attractive older women who dress nicely, like they have somewhere to go after they spend their mornings taking care of the dozens of women who pass beneath their needles daily, and this inspires confidence.  You only lose faith in them when you encounter a problem that they haven’t been trained to handle.

“…And then we’ll see you for bloods and scans on Thursday.”

“Okay, thank you.  While I have you on the phone, I have a question.  My doctor has prescribed progesterone for after insemination.  My first cycle, I had a prescription for Crinone, but it is pretty expensive, so my second cycle, her assistant got me samples of it.  But this time, she didn’t have any, so she told me to ask the nurses, but all they had was Endometrin.   Which is fine, except I was reading the insert and it looks like the dose of Endometrin is more than twice the amount of Crinone, since I’m supposed to use it twice a day instead of once.  So I just wanted to make sure that this was correct.”

“If it tells you to use it twice a day, you should use it twice a day.”

“Okay.  But I was having some negative symptoms, like mood swings and bloating, from the dose I was taking before, so I’d really rather not increase the dose.”

“Well…progesterone is not necessary for everyone, a lot of people don’t use it, so if you take it once a day, that’s probably fine.”

“But then why am I taking it at all?”

“Well, some doctors prescribe it.  You’ll have to ask your doctor.”

The problem with this was that I couldn’t ask my doctor anything because she never seemed to have time to return my calls.  I got quite familiar with her assistant, Carla, who I’m sure she got quite familiar with the repetitive process of me calling and asking for the doctor to call me, her telling me Dr. F___ would call me on the next day she was in the office, and then my calling back to say that the doctor had never called me.  And since I probably wasn’t the only mood-swingy, bloaty, frustrated woman calling her on a regular basis, it’s easy to see why Carla’s voice had at some point reverted to an unemotional monotone.

“She didn’t call you?  Well, she’s not in today.  I’ll give her the message and she should call you on Thursday.”

“How many days a week is she in?”

“Two.  The other days she’s at her practice in Connecticut.”

So I learned to figure out the answers to my treatment questions on my own with a little help from WedMD and the zillions of online fertility forums frequented by anxious women who are being pumped with mood-altering hormones.  These folks have the same problems with spelling, grammar and punctuation that the vast majority of people who post to online forums seem to have, but they also prefer to revert to using acronyms for everything that they are uncomfortable talking about.  
“hi ladies, O day is coming up and I’m wondering if we should bd everyday or every other day. what are you ladies doing?  Also… if DH has been drinking (New Year’s Day, bowl game) does that affect his little swimmers?”

“My RE says that you should BD every other day leading up to your peak fertility and then everyday for the next 3 days during and after O. If you try too much too early, you likely have less cm and not be as interested in doing.”

“Every other starting on CD8… when you get a positive OPK you do it that day, the next and the next (so 3 days in a row) I assume if you get multiple positive OPKs you do it everyday of positive +2. Then one day off then do it one last time… then wait for BFP or AF.  So… if I had done this this cycle Id have DTD on CDs 8,10,12,13(+OPK),14,15,17 which would have totally gotten the job done AND saved me some soreness.”

O = ovulation
bd = baby dancing (aka sex)
DH = dear husband
RE = reproductive endocrinologist
cm = cervical mucus
CD = cycle day
OPK = ovulation predictor kit
BFP = big fat positive
AF = Aunt Flo (aka menstruation)
DTD = do the deed (aka sex)

I learned these terms from an online discussion devoted solely the meanings of the acronyms, because there are so damn many.  I also have to point out that sex and menstruation clearly make these women so uncomfortable that they choose to use acronyms of euphemisms in order to speak about them on an online forum where they are anonymous.

But nevertheless, the internet is helpful, and the community there helps you feel more normal about all of the decidedly abnormal stuff you have to do to try and get pregnant. You find out quickly what the different drugs are — name brand and generic — and what to expect in terms of effects and side effects: this one will make you crazy, this one will make you crampy, this one causes you to leak clear liquid out of your vagina, so wear a panty shield, but at least it doesn’t give you that clumpy discharge that you have to scrape out of there with your finger that the other one does. (And if you’re glad I told you about all that, trust me, it’s nothing compared to the joy of experiencing it first hand). Yes, as you can probably tell, you get pretty up close and personal with your reproductive anatomy. You also get comfortable sticking yourself with needles, something you probably never thought you’d do unless you’re a drug user or a diabetic, but which could come in handy later in life if you become either one of those things.

One good thing was that I didn’t have to rely on the internet for emotional support, because my then-boyfriend-now-spouse was taking part in the process and hated it perhaps even more than I did.  Every month he would have to go in to what he affectionately called “the spank room” and make his contribution.  I suppose for people who frequent peep shows and the like, masturbating in a small room where you have to be aware that many, many other men have masturbated before just seems normal, but for him, it was definitely not.

“I didn’t want to sit down anywhere, I was just looking at all of the surfaces and thinking about who, or what, had sat on them.  Then I thought maybe I would try the porn.  I really didn’t want to touch the remote, but eventually I got myself to do it.  It was pretty standard heterosexual male porn.  There was one channel of oral sex, one of vaginal, and one of lesbian.  I wonder why they don’t have homosexual male porn, they must have homosexual sperm donors…I used a lot of Purell. I’m going to take a shower.”

He did like the necessity of our having additional sex, however.  He also got involved in the internet research when I mentioned that I’d read online that sex every other day during the days before ovulation were what was recommended.

“Nope, as far as I can see, there’s no data suggesting that every other day is more likely to result in pregnancy.  Every day for that entire week is really the safest way to go.”

As far as sharing the information that you’re trying to get pregnant with others, it’s sort of a crapshoot.  I told my mother, who I knew, while she would be curious and perhaps opinionated, would handle the news with the appropriate amount of respect for my privacy, only asking about it when I brought it up.  

“So, how is that all going?”

“Oh, it’s not fun.  And it’s expensive and frustrating, and my doctor sucks.”

“Hmm.  Are you sure you want to do this?  I mean, are you sure you want to have a baby at your age?  It just sounds like a lot of work.”   

My mother, being 72 and having recently babysat for my two rambunctious nephews, was of course projecting some of her own feelings on to me, but this is pretty much what happens with everyone.

“Oh, that’s so wonderful!  You’re going to love being a parent!“

“You know, that’s great.  I mean, having kids is great.  But I often think not having kids would also have been great.  So either way, it’s not a big deal.”

“I guess all women do have that nurturing instinct, that’s why we feel like we need to do it, but once ___ and I decided not to have children, we never looked back.  We get to travel all the time, we go out, we have so much freedom…”

“But why are you doing all of this?  You should just adopt.”

“You know, we had friends when you were growing up who adopted children, and every single one of them had problems.  Developmental problems, emotional problems.  Look at ___.”

And then things get really interesting when other friends your age start considering the same options and you start sharing information.  Suddenly, the way that you used to talk about internet dating, you’re now talking about adoption and egg freezing.  Only somehow, talking about this stuff makes laughing about the 60-year-olds who propositioned you regularly or the guys who sent out form-letter flirtations (“Hi.  I really liked what you wrote in your profile.  You look like someone I’d like to get to know.  This whole internet dating thing is so strange, don’t you think, ha ha?”) seem a lot more fun, and normal, than it did at the time. 

“The first time she did the extraction I was feeling under the weather, and I knew it wasn’t going to go well, so we had terrible results.  But my FSH was really good, so I convinced her that we should try it again, and the second time we got like five or six, and then the next month we did again.”

“How often did you have to go in?  Was it tough?  How did the drugs make you feel?”

“Foreign adoptions have slowed to a trickle. Now I’m worried that with RU86 becoming legal here, it’ll be like it is in Australia, it’ll be impossible to adopt domestically too.”

“All of my procedures were covered by my insurance, but none of the drugs were.”

“We did ICI — intracervical insemination — with a midwife, it was less expensive.”

“Domestic adoption is only really difficult if you want a white baby.”  (And more than one person has said this to me).

Yeah, it’s a lot of tough information to digest about stuff that you really wish you weren’t talking about at all. 

Don’t get me wrong, I think it’s great that women can have these conversations.  We are lucky that so many of us have these options and that we can talk to each other about them, and I think we should.  The challenges of getting pregnant or adopting a child aren’t things that should be taboo or even uncomfortable, they are just realities that a lot of us are facing at this age, at this time in history, in certain parts of the world.  But it can be exhausting.  Everything involves the kind of risk and expense that nobody wants to have to consider (not that just having a baby the normal way doesn’t involve some of that too — I read an article recently about how many health care plans don’t cover the ridiculously expensive costs of pregnancy and giving birth in this country.   I mean, seriously, do we just not want Americans to have babies?).  And if you’re really a reflective/obsessive thinker like I am, it all makes you delve more deeply into your previous choices and possible missed opportunities.  Should I have gone to law school like over 50% of my friends with kids did?  (Who knew law school and procreation went so hand in hand?)  Should I have married my college boyfriend and gotten it all out of the way by age 26 — or married-by-26 any other of the guys who I dated, or think maybe I could have dated, who are now people I see on Facebook happily smiling with their lawyer wives (is she really that much prettier than me or does she just photograph well?) and their 2-4 children?

These are the kinds of thoughts we just shouldn’t be allowed to have.  Hopefully, once you have them, you get a chance to look back on everything and realize that you really couldn’t have done anything all that differently, or wouldn’t have wanted to, because it was all kind of great, or at least it was all yours. And if you don’t entirely feel that way, at least you get a chance to get your regret-a-thon over with now, rather than when you’re 80.

I did four cycles of fertility treatments (one on Clomid and three on the hard, injectable stuff) and I didn’t get pregnant.  The anxiety and depression of the last two cycles was the worst part. That and the fact that during the third cycle, I thought I was pregnant because the progesterone gave me some symptoms. And that my doctor, true to form, never called me at the end, or ever, to follow up, or see how I was doing, or discuss what my options might be going forward.  Bitch.  But at least all of that made me truly relieved when it was over.

Now we’re still trying, but sex is free (and fun, although having to do it at the end of a sixteen hour workday isn’t so much, but then you get to go to sleep right afterwards).  It’s too much of a long shot at this point to think we’ll succeed, but giving up drinking, sushi and Advil for ten days a month is probably a good thing anyway.  And in the meantime, since we can’t really afford to adopt right now anyway, my then-boyfriend-now-spouse and I can take some more time to contemplate what we really want to do with our lives.  Maybe that’s not something I should be doing at 44 because I should have figured it all out by now, but since this is one luxury that I have as a childless middle-aged woman, I might as well enjoy it.

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