IVF

After Lauren’s salpingectomy, we began IVF.

According to our log, we started our first IVF round on 2020-11-25. While in non-pandemic times this would be right around the Thanksgiving holiday, for us, it was the beginning of the shots-and-waiting part of IVF. Additionally, the damned pandemic meant it was a good time to stay focused inward.

In the days prior, thanks to the pandemic and supply chain shortages, Lauren went from pharmacy to pharmacy to piecing together the required equipment for an IVF cycle.

Eventually, it came down to the first night: we received instructions and links to online videos on how to inject the drugs.

Naively, I had thought that IVF meant “You go to a clinic and someone spikes you.” No, in IVF, you-spike-your-damn-self (or your partner does it). The reason is that there are just so many shots.

The first night, Lauren and I sat at our dining table (disinfected with alcohol) and watched videos trying to learn where to pinch fat for injecting or how to make sure you’ve injected the payload fully. I think the first shot took us about 90 minutes to figure out. By the end of this process, Lauren could do it in 5.

When the moment came, my brave Viking of a wife stood up and, imperceptibly at first, drove a needle into her belly and winced and whimpered her first Gonal-F shot. There was another nightly shot and a set of pills. We did that for 10 nights. On 2020-12-13 we got the word that egg retrieval would be the next day. The retrieval netted 10 oocytes, but 8 of these were immature. Some matured overnight, but it was not an optimal first haul. The result from the doctor’s notes:

No embryos viable to bx/cryo. Very disappointing.

To be absolutely clear, we had been warned. We knew that multiple IVF cycles are often required. At this point “nothing major” was clearly out the window and, thankfully, WINFertility meant that we had another 1.75 covered cycles. We could do it again, that is if Lauren wanted to go through the process of needles and sharps boxes and internet videos of injections again. We decided to do so and signed up for a cycle beginning on 2021-01-22.

Round 2

While, for us, the days were full of discomfort, feeling like she was going to burst, and needles, writing it all down makes it seem like it was just simple mechanics. On the 22^nd she started shots and then on 2021-02-04 we went for retrieval. It reads so simply, but amidst that, there was so much discomfort. Some of it’s personal but there are shots, blood draws, inspections, ultrasounds…there’s just so much invasive handling of the female body that I can’t accurately capture here. But on the 10^th we got the grim update:

no embryos bx’d and cryo’d today

We’d busted again.

Wounded

It’s hard to remember how we felt in those days, but the sensation I have now is of feeling wounded, riven with some sense of bitterness. At times I would foam (internally) with a seething blackness for anything that had gotten in the way of Lauren and I “just doing the natural thing” years earlier:

• “Why’d we been oriented on being married first?”
• “Why’d we oriented on finding financial stability before we got married?”
• “Whom did we owe anything to?”
• “Why didn’t we have a country that supported new mothers?”
• “Why’d I pursue college and career and fancy apartments in expensive cities instead of having kids?”
• “Why couldn’t I ever just be happy?”
• “What if I missed my chance?”
• “Maybe you can’t have it all in this world in this time in this culture.”

I can’t say that all those points of rage are entirely reasonable now (and some are all-too-reasonable!), but that’s where we were. Looking at my cameraphone reel, I can see that I was marveling at the ice storm on February 7^th:

And then we got the news on the 10^th and then I photographed nothing until Valentine’s Day. I was ruing the results. In retrospect, I don’t remember much of that time except an expanding sense of ennui and despair: the pandemic, the insurrection of the Trumpists, the ice, the snow, the injections, and the pain I helped serve up to Lauren every night by the milliliter.

The feeling was mutual for Lauren.

At that point, we were sick of that and looking to move apartments. We decided to take a break. We told Columbia that we were going to take a break. Lauren got some farewell notes (“DHEA and CoQ10 supplements might help”) and we headed upstate again to heal a bit.

We came back to Manhattan and tried living life sans IVF concerns for a few months.

Round Three

After February’s disappointment, we set about moving from 94^th street down to 87^th street. There were cleaning-outs and giveaways and movers to contact. We took custody of our new apartment a few weeks before the movers came so that we could map out the space and hand-carry some precious things. The remaining extra IVF medications were one of those payloads that we brought to the new refrigerator. We didn’t discuss it, but we weren’t ready to toss the drugs either.

After moving in, we got our COVID vaccinations! We could start to see the leaden weight of the pandemic easing. We spent the late Spring and early Summer building out our space: adding tons of storage, ordering a sofa, mounting a TV, etc. In general, we were making our new space ours. Just as we finished that, Summer in its furious humid glory fell upon us. We rode bikes to watch the 4^th of July fireworks and a few days later went to Aruba.

But as late summer started, cooling temperatures overtook us and we prepared to take our first international visit since the pandemic, back to Paris for Lauren’s birthday.

I remember the afternoon near Place Vendôme when we returned to our hotel to rest for the afternoon and I brought up the question: “Are we going to try again?” The sun was setting and dusk was rising. The conversation lasted for about an hour and night filled our room as we talked. We decided that if we had the funds, we could stomach (ha!) it one last time.

Now we had been very lucky that my employer / WINfertility provided robust infertility treatment benefits. But, after two failed rounds, that was running out. They would cover most of this round. After the third round, though, we were going to be 100% out of pocket. We weren’t going to do that. That would be our final boundary, a true red line. The game would be over.

Also, because of the pandemic (uh, thanks, uh, COVID?), there had been some special provisions around FSA accounts made by the federal government. Medical savings that normally would have expired were going to be available for another year. So while our third round would be substantially covered, the remaining costs would be substantially defrayed by putting my 2020 FSA with my 2021 FSA savings. It was affordable.

I know it’s hard to talk about money and pregnancy and infertility, but it’s everyone not doing that that lead Lauren and me, in part, to some complacency. The cost of treatment and the cost of the kid are real things and the blind assumption “we’ll figure it out” is hallmark human (in a bad way). As my Dad said: “Hope is not an effective strategy.”

We live in a world where the rich have more options (and while not rich, Lauren and I are an example of how science and money can give you some options where you would have had none). If you’re not well-off, you’re best advised to reproduce early, get awesome benefits, and/or get rich.

We kicked off our third round with updated bloodwork on 2021-10-22.

Round 3

As we lined up for the next cycle, we restored our caches of syringes and swab pads, needles, and sharps boxes. At the end of November, Lauren endured 10 days of shots, multiple days of doctor visits, pain, bloating, shuffling everywhere, and the general hormonal head-screw. By the time those 10 days were up, we were into December and barreling toward Christmas. We were nervous but resigned as we went to egg extraction on December 9^th. Out of benefits, out of money, we waited. The initial notes say:

As you remember, we retrieved 15 oocytes (eggs) yesterday.
Of these, 10 were mature … Today we have 8 embryos that fertilized normally and will be cultured in the IVF laboratory. It is day one for embryo development

And then on the 16^th

one day 6 embryo bx’d and cryo’d.

Most miscarriages happen because the chromosomal unity of sperm and egg are not viable. Since IVF removes the body from being able to reject such non-viable candidates, it’s considered wise to do genetic testing on any candidates. We sent our lone candidate off for testing.

On the 30^th of December we got the final word: our sole candidate tested “Normal.” Says Dr. Rackow’s notes:

One euploid embryo!

The plan, roughly, then was to take a bunch of drugs to try to, uh, optimize the environment for receptivity, implant, and then hope for another statistically-unlikely roll of the dice.

Lauren and I took to calling this little embryo “Lil’ Frosty.” Kinda like a rap name. To distance ourselves from the heartbreak of failure, we never called Frosty “him” or “her.” Just “Frosty.” The process of turning a science experiment into offspring was our next hurdle.

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