IVF Diary
On July 25, 1978, the world's first test-tube baby was born. Louise Brown. I was 5 years old. I didn't understand how a baby could be born inside a test tube. Or why people would name a baby Louise. I now understand only this: they don't use a test tube: it's a petri dish.
LUPRON. You must first stop your own clock. You do this with a drug intended for kidney patients. I read on the Internet that it's actually cow urine, but that's probably not true.
After a series of missed opportunities and invasive procedures, it becomes clear that I'm in need of more than divine intervention. In vitro fertilization is my only option. A test-tube baby, a petri dish baby, of our very own.
I am 28 years old.
Office visits, $504. Ultrasounds, $541. Blood tests, $604. Procedure Suite, $1600. Supplies, $305. Ultrasound guidance for oocyte aspiration, $355. Egg Retrieval, $1500. Culture and Fertilization (Petri Dish), $1800. Anesthesia, $475. Embryo Transfer, $591. Embryo Hatching, $385. Cryopreservation, $780.
GONAL-F. Since they're now shut down, you have to jump start your ovaries. Trick them into production. $38 a vial. You use up to six vials a day. You have a blood test and an ultrasound every day. You play count the follicles.
There are hidden costs as well. Piece of cheese pizza before the transfer, $1.50. Bruises. Plastic Sharps container for my empty needles, $3.00. Mental instability.
I bring the Sharps container into the office every few days for emptying. I dump out my used needles in the huge container next to the blood test chair, where women before me and after me dump theirs. Gallons of expired syringes. A three-foot high plastic tub filled with all of our injected hope.
Places where I've had injections: My dining room table. Fold of skin at my waist, when I bend forward. A Tampa hotel room. Back of my arm. Bathroom of the American Airlines Arena during halftime of a Miami Sol game. Top of my thigh. The bathroom of ACII during a class break. Small window where my back meets my ass. Brooklyn, New York, Mary's sister's 4th floor walkup. Camping, Key West, Bike Week.
hCG. When your eggs are cooked, you have to kick them out of your body. The nurses call you, tell you exactly when to have your shot. You have a 10 minute window. You have exactly 36 hours before retrieval.
The language of IVF remembers 7th grade biology. Words you never thought you'd need to know beyond the vocabulary test. Follicle. Oocyte. Zygote. Blastocyst. Embryo. Cycle.
As if I wasn't damaged enough, I'm on crutches the day of my retrieval. I had strained some tendon in my knee that is apparently useful in bending and straightening. Mary has to help put on my paper suit. A nurse practically carries me into the procedure room ($1600).
VERSED. You can't wear deodorant or lotion to the retrieval because the fragrance could damage the eggs. You comply. You'll believe anything. The anesthesiologist pumps white liquid into your veins. Milk of Amnesia, he calls it. " You won't remember the pain, " he says. But you'll still feel it. You wonder about pain. Does it only hurt if there's a memory of it? You feel sorry for the part of you that has to feel the needle in your ovary. But then you forget.
The anesthesiologist likes to listen to music while he works, so he puts on the radio. " The Circle of Life " is playing. I laugh. I am not part of this circle. I'm on some nearby parallelogram. Clearly, by lying on this table, with my legs up in the air, an audience of strangers preparing to meet my eggs, I am bypassing the circle.
Seven eggs. That's what I made. 7. Barely enough to fill half a carton. But it will have to do. I've been in the office when the nurses come out to announce the arrival of 40 eggs from one woman. I have 7. I feel my hope diminishing.
Seven
Dr. K, the embryologist, calls on Sunday. Five eggs have fertilized. Petri Dish Economics. " They look good. " He says this to everyone; he's said it to me before. I am officially pregnant. The cells are in a dish splitting and growing 5 miles from my body, but I am pregnant. Each day after conception is a miracle, regardless of logistics.
Five
What I never learned in 7th grade biology is how like eggs our eggs are. They have a shell that must be cracked. The embryos in the petri dish have a week to do their division before they must bury themselves in their home. Because I already have one ectopic pregnancy under my belt, my eggs will be hatched for me. Dr. K will scratch at the sides of the shell of my embryos so they break out faster. They won't escape this time. I think of all the cookies I baked with my mom, all the eggs I cracked that never made it to the bowl. Six days instead of 7.
Tuesday. Dr. K calls me in the morning. There are now four embryos. They all look good. " I'll call you back and tell you when to be here. " Please give me warning, I have 90 students to take care of. I have a life outside of my life.
Four
He gives me 30 minutes. I don't remember where I shuttled my students. I don't remember how I got Mary to make that 40-minute drive so quickly. I don't remember how I got there on time. I just remember getting there, trying to breathe. Trying to be calm. Trying to eat the lunch Mary bought, her knowing I'd forget to eat. Waiting to receive my pregnancy.
The doctors meet with us before the transfer. " We're putting in all 4. Is that okay? You're young, you should be pregnant. " We look at each other. We weren't prepared for this question. Three is the standard. By law, they're not supposed to transfer more than 3 the first time. But this isn't the first time. This is our last time. We agreed. But, tell us, what are the chances?
30% for one baby. That seems very low. I feel my hope slip further away. 20% for twins. I've always wanted twins. I don't want to go through this again. Twins would be nice. 9% for triplets. Three babies seems like a lot. How would anyone survive with 3 babies? 8% for quads. Suddenly 8 seems like a large number. Too large. Quietly, we say 3. We hope it's the right answer.
MEDROL, TETRACYCLINE, BABY ASPIRIN. This room is through a hidden doorway of the office. It's a labyrinth, this place. Magazines, televisions, a much more comfortable table. Back in your most familiar position, legs in the air, clothes cast off to the side, embryo transfer is a four-handed job. Dr. J inserts a catheter into you. Dr. K brings in your embryos, and puts them into the catheter. Slowly they release them. You are pregnant, first person.
I am pregnant.
I will be pregnant until I'm not. The act of having 3 embryos inside of me makes me more pregnant than I've been before. I have a week and a half to be pregnant, until the next blood test can tell me otherwise. I will enjoy this week. I will not obsess. I will not obsess. I will not obsess.
Three
I am pregnant.
PROGESTERONE IN OIL. This is the shot you're both nervous about. It's an intramuscular; it goes deep. It's in oil; it moves slowly. Mary meditates over it; she doesn't want to hurt you. You can't explain that this pain is the least of it. She aims well. It doesn't hurt. If you stay pregnant, this will be the first of 84 shots. If you don't, there will only be 10.
I will not obsess.
Three.
I am pregnant.
There are well-documented signs of pregnancy. Loss of menstruation is only one of them. Some women know immediately, from the moment of conception. I feel nothing. I've been through the checklist before. Metallic taste in mouth. Sensitivity to odors. Nausea. Breast tenderness. Nothing. I was pregnant. But now I'm not. When did they slip away? Did they go all at once? Or one at a time? Did they try to fight? I picture a sci-fi, Star Wars departure: embryos hanging on to the lining of my uterus, falling, falling, until they don't exist anymore. Did they prefer their petri dish? What's so uninhabitable about the inner workings of my body?
Beta-hCG. That's the fancy name for pregnancy test. No stick to pee on. It's Saturday morning. Two weeks to the minute after the retrieval. " Do you feel pregnant? " asks the nurse. No. Mary says you are, but you don't believe her. " Let's hope, " says the nurse, crossing her fingers. You're disappointed. You were hoping for something more scientific than grade school superstition. You shrug your shoulders. It's okay. You start picturing a future without children. You imagine vacations and second homes and novels you will write. " We'll call you later, " says the nurse, as she puts your Band-aid on.
The normal range of Beta-hCG for pregnancy is 14ÔÇô50 two weeks after ovulation. Last time, I was a 7. The number is supposed to double every 24 hours. Mine went cock-eyed, tripling one day, barely inching the next. That's how they knew it was ectopic. It was the baby we never saw. A friend had twins. Her number was 200. Mary hopes it's in range. I resign myself to more bad news.
The phone call comes at 11:30. It's Marlene; our favorite nurse. I throw the phone at Mary; I can't answer it.
613.
I am pregnant.
Three.
LUPRON. You must first stop your own clock. You do this with a drug intended for kidney patients. I read on the Internet that it's actually cow urine, but that's probably not true.
After a series of missed opportunities and invasive procedures, it becomes clear that I'm in need of more than divine intervention. In vitro fertilization is my only option. A test-tube baby, a petri dish baby, of our very own.
I am 28 years old.
Office visits, $504. Ultrasounds, $541. Blood tests, $604. Procedure Suite, $1600. Supplies, $305. Ultrasound guidance for oocyte aspiration, $355. Egg Retrieval, $1500. Culture and Fertilization (Petri Dish), $1800. Anesthesia, $475. Embryo Transfer, $591. Embryo Hatching, $385. Cryopreservation, $780.
GONAL-F. Since they're now shut down, you have to jump start your ovaries. Trick them into production. $38 a vial. You use up to six vials a day. You have a blood test and an ultrasound every day. You play count the follicles.
There are hidden costs as well. Piece of cheese pizza before the transfer, $1.50. Bruises. Plastic Sharps container for my empty needles, $3.00. Mental instability.
I bring the Sharps container into the office every few days for emptying. I dump out my used needles in the huge container next to the blood test chair, where women before me and after me dump theirs. Gallons of expired syringes. A three-foot high plastic tub filled with all of our injected hope.
Places where I've had injections: My dining room table. Fold of skin at my waist, when I bend forward. A Tampa hotel room. Back of my arm. Bathroom of the American Airlines Arena during halftime of a Miami Sol game. Top of my thigh. The bathroom of ACII during a class break. Small window where my back meets my ass. Brooklyn, New York, Mary's sister's 4th floor walkup. Camping, Key West, Bike Week.
hCG. When your eggs are cooked, you have to kick them out of your body. The nurses call you, tell you exactly when to have your shot. You have a 10 minute window. You have exactly 36 hours before retrieval.
The language of IVF remembers 7th grade biology. Words you never thought you'd need to know beyond the vocabulary test. Follicle. Oocyte. Zygote. Blastocyst. Embryo. Cycle.
As if I wasn't damaged enough, I'm on crutches the day of my retrieval. I had strained some tendon in my knee that is apparently useful in bending and straightening. Mary has to help put on my paper suit. A nurse practically carries me into the procedure room ($1600).
VERSED. You can't wear deodorant or lotion to the retrieval because the fragrance could damage the eggs. You comply. You'll believe anything. The anesthesiologist pumps white liquid into your veins. Milk of Amnesia, he calls it. " You won't remember the pain, " he says. But you'll still feel it. You wonder about pain. Does it only hurt if there's a memory of it? You feel sorry for the part of you that has to feel the needle in your ovary. But then you forget.
The anesthesiologist likes to listen to music while he works, so he puts on the radio. " The Circle of Life " is playing. I laugh. I am not part of this circle. I'm on some nearby parallelogram. Clearly, by lying on this table, with my legs up in the air, an audience of strangers preparing to meet my eggs, I am bypassing the circle.
Seven eggs. That's what I made. 7. Barely enough to fill half a carton. But it will have to do. I've been in the office when the nurses come out to announce the arrival of 40 eggs from one woman. I have 7. I feel my hope diminishing.
Seven
Dr. K, the embryologist, calls on Sunday. Five eggs have fertilized. Petri Dish Economics. " They look good. " He says this to everyone; he's said it to me before. I am officially pregnant. The cells are in a dish splitting and growing 5 miles from my body, but I am pregnant. Each day after conception is a miracle, regardless of logistics.
Five
What I never learned in 7th grade biology is how like eggs our eggs are. They have a shell that must be cracked. The embryos in the petri dish have a week to do their division before they must bury themselves in their home. Because I already have one ectopic pregnancy under my belt, my eggs will be hatched for me. Dr. K will scratch at the sides of the shell of my embryos so they break out faster. They won't escape this time. I think of all the cookies I baked with my mom, all the eggs I cracked that never made it to the bowl. Six days instead of 7.
Tuesday. Dr. K calls me in the morning. There are now four embryos. They all look good. " I'll call you back and tell you when to be here. " Please give me warning, I have 90 students to take care of. I have a life outside of my life.
Four
He gives me 30 minutes. I don't remember where I shuttled my students. I don't remember how I got Mary to make that 40-minute drive so quickly. I don't remember how I got there on time. I just remember getting there, trying to breathe. Trying to be calm. Trying to eat the lunch Mary bought, her knowing I'd forget to eat. Waiting to receive my pregnancy.
The doctors meet with us before the transfer. " We're putting in all 4. Is that okay? You're young, you should be pregnant. " We look at each other. We weren't prepared for this question. Three is the standard. By law, they're not supposed to transfer more than 3 the first time. But this isn't the first time. This is our last time. We agreed. But, tell us, what are the chances?
30% for one baby. That seems very low. I feel my hope slip further away. 20% for twins. I've always wanted twins. I don't want to go through this again. Twins would be nice. 9% for triplets. Three babies seems like a lot. How would anyone survive with 3 babies? 8% for quads. Suddenly 8 seems like a large number. Too large. Quietly, we say 3. We hope it's the right answer.
MEDROL, TETRACYCLINE, BABY ASPIRIN. This room is through a hidden doorway of the office. It's a labyrinth, this place. Magazines, televisions, a much more comfortable table. Back in your most familiar position, legs in the air, clothes cast off to the side, embryo transfer is a four-handed job. Dr. J inserts a catheter into you. Dr. K brings in your embryos, and puts them into the catheter. Slowly they release them. You are pregnant, first person.
I am pregnant.
I will be pregnant until I'm not. The act of having 3 embryos inside of me makes me more pregnant than I've been before. I have a week and a half to be pregnant, until the next blood test can tell me otherwise. I will enjoy this week. I will not obsess. I will not obsess. I will not obsess.
Three
I am pregnant.
PROGESTERONE IN OIL. This is the shot you're both nervous about. It's an intramuscular; it goes deep. It's in oil; it moves slowly. Mary meditates over it; she doesn't want to hurt you. You can't explain that this pain is the least of it. She aims well. It doesn't hurt. If you stay pregnant, this will be the first of 84 shots. If you don't, there will only be 10.
I will not obsess.
Three.
I am pregnant.
There are well-documented signs of pregnancy. Loss of menstruation is only one of them. Some women know immediately, from the moment of conception. I feel nothing. I've been through the checklist before. Metallic taste in mouth. Sensitivity to odors. Nausea. Breast tenderness. Nothing. I was pregnant. But now I'm not. When did they slip away? Did they go all at once? Or one at a time? Did they try to fight? I picture a sci-fi, Star Wars departure: embryos hanging on to the lining of my uterus, falling, falling, until they don't exist anymore. Did they prefer their petri dish? What's so uninhabitable about the inner workings of my body?
Beta-hCG. That's the fancy name for pregnancy test. No stick to pee on. It's Saturday morning. Two weeks to the minute after the retrieval. " Do you feel pregnant? " asks the nurse. No. Mary says you are, but you don't believe her. " Let's hope, " says the nurse, crossing her fingers. You're disappointed. You were hoping for something more scientific than grade school superstition. You shrug your shoulders. It's okay. You start picturing a future without children. You imagine vacations and second homes and novels you will write. " We'll call you later, " says the nurse, as she puts your Band-aid on.
The normal range of Beta-hCG for pregnancy is 14ÔÇô50 two weeks after ovulation. Last time, I was a 7. The number is supposed to double every 24 hours. Mine went cock-eyed, tripling one day, barely inching the next. That's how they knew it was ectopic. It was the baby we never saw. A friend had twins. Her number was 200. Mary hopes it's in range. I resign myself to more bad news.
The phone call comes at 11:30. It's Marlene; our favorite nurse. I throw the phone at Mary; I can't answer it.
613.
I am pregnant.
Three.
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