Implantation to Obstetrics

This content is largely a revision to 2022-03-18 newsletter.

On the last checkups (around the February 10^th), Dr. Rackow saw what she needed and set us for the implantation on the 12^th. A few anxious days later, we took yet another trip down to the clinic at Columbus Circle. Lauren and I were escorted back to the pre-introduction waiting room. Columbia’s COVID policies had recently changed there so that I could “go back” as well. I had never been beyond the waiting room, and it was really nice to be able to be together. Nervous, we browsed silly things on Twitter, looked for funny images, and tried to quell our nerves.

Eventually, it was Lauren’s turn and she was brought into a small room and made to lie back. While we were settling in we were told that Lil’ Frosty had defrosted beautifully and had “puffed up.” We were given to understand that this is a positive thing indicating that the blastocyst thawed properly and is ready to go.

Through the prep process, the two surgeons constantly checked and recited birthdates and UPC numbers to ensure that it was not “Some other Frosty” but rather “our Frosty” that was going to be homed:

“I’ve got an embryo for Lauren, birthday….; number …..”
“Confirm, here on receipt is number… for Lauren, birthday….”
“Lauren, please confirm your birthday….”
“Lauren, please read this number aloud.”
“Embryologist, does Lauren’s number match your record?”
“Yes.”
“You are cleared to prepare.”

Watching on the monitor, the doctor prepared the catheter of introduction. The embryologist provided the loaded payload, the surgeon put it through, and we all watched, breaths-held, as a small puff of air showed up in the ultrasound. And that was that.

Afterward, Lauren and I walked eastward and wound up near my office. We wound up at (office-favorite) legendary Irish bar/grill P.J. Clarke’s and treated ourselves to a pub-food meal without constraint (well, no alcohol, but no wheatgrass and strawberry smoothie either).

We walked around a bit more and did odd, trivial shopping as we considered the possibility that the organism now renamed to “Lil’ DeFrosty” might find a home.

With the benefit of hindsight, Lil’ DeFrosty, did find a home, that night, in fact. We didn’t know that, of course. So the next 10 days were spent in agonizing suspense: Could a too-hard sneeze end the thing? Would Byron pawing Lauren end it? The surgeon assured us that such things were not possible, but the irrational part of our hope cortices delighted perversely in vividly imagining failure.

Another fun bit of hindsight: at that meal, we popped this quick selfie to commemorate the day:

A few weeks later, I was reading the New York Post (generally not recommended), and I found out about Frank Sinatra’s quirky dining habits when out in the City (the man hated pretense; when he ate out, he never ate alone). One of the few restaurants he liked? P.J. Clarke’s. In fact, he had one particular table, #20, right under the clock.

We celebrated our insertion day at Frank Sinatra’s table? I guess we needed Old Blue Eyes’ blessing to make it stick.

Two days later, we celebrated a cautious Valentine’s day by heading out on a frigid night to the East Side for Persian food and a change of vicinity. Thanks to the pandemic and Lauren’s discomfort, bumpy cab rides and farther-off exotic destinations were out.

Over the next few days, Lauren started to “feel things.” She started getting out-of-breath more often and felt “tightness” inside. She reported feeling strange “zap” like twinges as well. Even Byron changed: he stopped laying on Lauren’s belly and, even now, will only rest on her leg. On the 10^th day we headed to the clinic for a blood test. That afternoon we got new information: HCG levels were robustly surging. A pregnancy had begun. Columbia sent a PDF in the email entitled “Guide to Early Pregnancy.” While we were in a very vulnerable phase, the fact was clear, the organism was triggering HCG release in her, it was feeding off of nutrients she provided it: pregnant. We had failed to fail. The next hurdle was set for March 4^th.

In the intervening time, Lauren’s symptoms intensified, that is, worsened. She started to feel a steady wave of nausea from morning to night. She started feeling aversion to certain smells and foods. On the 4^th, we had our first ultrasound session with our main doctor, the wonderful Dr. Elizabeth Rackow doing the examination.

I’ve read that top-skilled submarine captains can do a 360° scan with a periscope in about 3 seconds and can accurately describe the state of the surface if queried. Much like grandmasters looking at a chessboard or an expert programmer looking at a program, these captains can see the shape of things and act on them almost by intuition.

I watched our fertility captain, Dr. Rackow, scan the screen, first seeing nothing and then in the few microseconds where the picture came into resolution I immediately saw the flash of recognition on her face. Before the image had settled she started talking about what was there. She said there was definitely an embryo in there and growing, as the picture stabilized she pointed to an embryo, a yolk sac, and a pregnancy sac. She then added that she was glad to see something — something that must have started but hours ago — the primordial form of a heartbeat. We watched the screen and she showed a slight flutter. Inside of Lauren was a tiny 4 millimeters of life trying to be. Lil DeFrosty had found a home and was exchanging life with Lauren. Again, we had failed to fail.

Dr. Rackow’s notes:

CRL .41cm 6w1d Flicker seen ROV 24mm CLC
...
Routine first trimester instructions

We went back home and were glad, but were still hesitant to celebrate. Lauren started developing more food aversions, food cravings, and smell sensitivities. She also began to feel nauseous all. the. time. This has been a continued challenge for her as has fatigue.

Another two weeks later, we went in again. Knowing what to look for in the scan, my eyes watched the screen with the doctor. As the emitter was placed on Lauren’s belly, I looked to find that dumpling bun of a pregnancy sac and, having found it, saw that there was a smudgy white smear next to the yolk sac. Lil’ DeFrosty was there, and bigger.

The measurement confirmed that the creature was now 75% larger than it had been at the previous checkup. As programmers, we have a special relationship with powers of two; to hear that cells had nearly doubled we couldn’t help but be awed and pleased.

Dr. Rackow said she was going to listen to the womb and suddenly over the speakers in the examination room we could suddenly hear a watery in/out wash of a heartbeat pounding like a dance track. She stopped the sound abruptly because she “Didn’t want to upset anyone in there.”

She’s a considerate and classy lady. She said the heartbeat was strong and sounded good. I won’t deny that there were some tears shed at that moment. We’d failed to fail in a way that felt intensely real.

While we were still in the very delicate phase of the first trimester, we remained guardedly optimistic. We didn’t speak of DeFrosty as a him or a her; we didn’t think about names; we didn’t send announcements; we didn’t even think about a future where their life is a fact. Instead, we just hoped, every day, for another day of failing to fail.

On the 22^nd of March we went in for our “graduation” scan.

Dr. Rackow told us that we were ready to go to plain obstetrics. It was the end of the IVF phase of this experience. All those months of process, needles, vitamins, heartbreak, disappointment, unsaid hopes ended right there in the mid-morning right south of Columbus Circle. Lauren hugged Dr. Rackow and we left the facility. The phlebotomists and the nurses Lauren had seen dozens of times clapped for us as we walked down that hallway our final time. From then on, we would be visiting the practice one floor down.

Afterward, we received an email with this line:

Congratulations on officially being discharged from our care!

And that was it! Our IVF journey had reached an end. We were now just another couple with an embryo trying to become a fetus in a different waiting room on a different floor. It felt wonderful.

One week later, we visited our new obstetrician Dr. Silvana Ribaudo who welcomed us to her practice. She’s affable and funny and very smart. She did our first scan in her practice and showed us that in the intervening week, our embryo had grown even more:

Somehow having our first obstetric appointment feels like the real proof of our progress. Somehow on the last try, on the last round, with the last dollar, with the last hope, something amazing happened.

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