Well, it’s time for the first IUI at the new clinic and I’m having a totally new doctor do the insemination. Actually, he started the clinic and photos of him and his family line the waiting room walls. Oh yeah, and photos of him with all the babies he’s created.

Anyway, there I am, lying in the chair in my gown and he comes waltzing in. Blab, blab, blab… on he goes about I don’t know what. But my ears perk up when he asks if Dr. G- has tested my mucous. Nope, I say. “Well, we’re going past that with the IUI but I am doing a study to test how many women have this problem. Would you be part of the study? It might be the reason you haven’t been able to conceive,” he says. He explains it’s really simple and I can’t resist knowing the instant results. He takes a swab of my mucous and puts it on a glass plate. He takes some of the husbands semen and puts it on the same plate. He enlarges the display from the microscope and I’ll be damned! Those swimmers are drowning!

I am flabbergasted. I’ve been killing the husband’s sperm. He notes my results in the chart and quickly performs the IUI. Two weeks later I find out that despite bypassing the killer mucous, we are not pregnant. On a new visit to Dr. G- she completely dismisses the mucous test and theory. According to her, it’s not a reliable test and it definitely does not explain why we haven’t conceived with IUI. I am sad and frustrated again.

We decide to sign up for some IUI cycles. Dr. G- tells me that she will put me on Gonal-F but a much lower dose as I’m a high responder. She will also monitor me closely, every second day.

It all starts out easily enough. The office visits stretch out for at least two hours, however. At this clinic, each patient sees her doctor on each visit and a decision on dosages, timing, etc., is taken at that visit. There are no phone calls in the afternoons, no wondering anxiously what I’m going to have to do next. But the payment for this is getting to know the patterns in the carpet on the clinic floor (when I can’t get a computer) — note to self — bring own laptop.

One of the things I start to resent is the kiddie play area. Whenever we have to come in on the weekends, it’s family day at the IVF clinic. All the moms with secondary infertility bring their kids. It is a total slap in the face. No, I don’t see it as hopeful. Both the husband and I see it as a stinging reminder of our own inability to conceive and I’m sorry, but the atmosphere is hormonally-charged enough without bringing real, live babies into the waiting room.

But for all that, I do admit that seeing Dr. G- on a regular basis makes me feel like she’s got a good grip on how things are progressing. She is able to get my ovaries to develop three follicles and to stop them from developing a fourth, which I have learned already is the line in the sand between IUI and IVF. Apparently allowing four follicles to potentially inseminate is medically unethical, but I guess Octomom’s specialist didn’t get that memo.

My insemination is going to be the following weekend and one of Dr. G’s colleagues will be covering the clinic. Oh well. I already know that IUI is a breeze.

One day the husband comes home very excited. Trust me, he’s never excited about work. He had a new patient today that had an emergency and she is – wait for it – a fertility specialist! Of course, he peppered her with questions and since he did her a favour, she would be happy to see us in her clinic tout de suite.

For the past little while, IVF has been on the back burner. We have not so much as discussed it. We seem to tacitly agree that going back to clinic #1 is not going to happen. But now the husband has caught the infectious positive attitude of this new doctor and he books a consult.

I meet the new Dr. G- (yup, their names all start with a G). She is a chirpy, peppy person. “If you want a baby, you’ll get a baby at the end of this process”, she emphatically assures us. We are, indeed, reassured. “Oh my goodness, she says with her usual stacatto intonation. “They’ve been giving you so much drugs, and just look at the puny size of you!” Okay, now I’m feeling even more reassured that she knows what she’s doing.

This new clinic is quite nice. Calm tones, comfy chairs, wired computers, and best of all, no other patients with any other issues. Everyone in the waiting area is here for the same reason. Furthermore, no one is pacing around in a hospital gown.

I wonder how many clinics, on average, couple attend if IUI or IVF does not work for them the first or second try? Two? Three? We have friends that are on their third clinic. Steping into the new clinic, there is always hope – maybe false hope – that this time things will be different. The doctor has a different approach; the embryologist is better; the nurses are nicer; the clinic is less stressful than the last one… and the list goes on. Are we just fooling ourselves?

We’re going to try IUI again, but this time the doctor has taken me off Clomid and is going to try me on Gonal-F. I am not thrilled that this is an injectable drug. Needles of any kind are anathema to me and on a daily basis — well, it sounds horrible.

I pick up the drugs at the pharmacy and cannot get over the cost! $3000 and it will probably be more. The place is madly busy and no one goes over how to do the injection. Thank god my husband is a physician; I figure he can help. The next morning, I make him give me the injection as I squish my eyes shut and look the other way. But I find it’s nerve-wracking to allow someone else to do this for me, especially in the sensitive area of one’s stomach. Plus, he freaks me out the way he pinches my flesh and gets ready to jab the needle. It becomes obvious to me that I must learn to do this myself.

The next morning I try to jab myself; unfortunately it is not a good idea to do this tentatively. One must forcefully (but not with overt force, mind you) stick the needle in. Otherwise it’s a slow, painful experience. The stinging is not too bad; icing the injection site afterwards helps.

On my next appointment (I have not had one between day 3 and day 10) there are worried looks on the nurses and fellow’s face. Uh oh. This can’t be good. They won’t say anything directly to me — infuriating! I have to wait for the 3 o’clock phone call. But then, I get a call much earlier. As I’m driving home from the hospital, as a matter of fact. The stunning news is that because I’m a super responder to drugs (didn’t we establish this already?) I have developed more than four follicles and I will either have to abandon the cycle or covert to IVF! I am flabbergasted. I can’t believe that they have given me what I surmise is a too-high dose … probably the same issue as the last time… same dose for everyone no matter their size.

Within a minute, I get another call and it’s a very good friend. I can barely say hello; the floodgates open and I am bawling into my cell phone. She wisely tells me to pull over, which I do, and stays on the phone until I calm down. I tell her my predicament and that I had never signed up for IVF; I never thought it would be something I’d have to do. I’m not ready for this radical new step. But we’ve already shelled out so much money on the drugs. I am caught in the middle and I don’t know what to do. Worse still, I have to decide before 3pm! I am so angry; I am wondering, don’t they know that they can’t just spring this on me? That this is a huge decision that can’t be made in a few hours’ time? I am adamant about not doing IVF but the guilt over the money we’ve spent on the drugs, and the idea of four or more follicles bursting inside me is not appealing. Reluctantly, I decide I’ll have to do the IVF.

At four o’clock in the afternoon, I am at the clinic in a seminar room attending an information session on what to expect during IVF. It is a wrenching experience for me and I am looking daggers at the nurse presenter the entire time. I now have to come in for monitoring every other day — gee whiz, they finally decide they should keep closer tabs on my super-responsive ovaries. Now, this seems a more proper approach, I think.

At the next appointment I lay into the fellow with my opinion on how they make decisions on drug doses and my incredible unhappiness at being in this position. He is somewhat contrite but blames it on the system. I hate when people do that: take responsibility and change the system if it’s not working well for the patient!

On top of all this, the husband does not see “what the big deal” is about IVF. I firmly tell him that he can keep his opinion to himself (sorry, husbands out there, but this is a traumatic time for me). And here is the rub: the woman must carry the baby. Oh, if only it weren’t so. I just can’t get over the fact that I am going through torture just so the husband can have a child. So you see, when things are easy, it’s “our child” and now it’s “his child”. Not semantics, just that we both have different ideas of how far we’re willing to go to have a child. I feel I’m bending over backwards for him, and I know if he were more casual about it then we would not be going down this road that I am so uncomfortable with.

On the day of the retrieval, we arrive at 6:30am. We find the right place but no one is there yet. I sink to the floor (ugh — yucky hospital floors) and wait. Thankfully the nurse — a cheerful, matronly Irish woman — is extremely competent. She finds a vein and with minimal pain sets the IV. She is so comforting I actually relax. I requested that the fertility specialist and not the fellow perform the procedure, so Dr. G- is inside the retrieval suite getting ready.

Unfortunately, I feel the punctures to my ovaries. It is not pleasant. The morphine is upped. I feel much more comfortable in a matter of seconds. After the procedure I actually feel pretty great and I inform the husband that I think I can make it to a friend’s baby shower. We get home and I pass out. So much for the rest of the day.

The next morning I wake up in unbelievable pain. My abdomen is swollen more than it was with my grapefruit sized ovaries. I’m not the type to suffer silently and besides, I want the husband to appreciate just what I’m going through. Thankfully I do not have a fever, which I’ve been warned is a bad sign. I’m somewhat better the next day. And on day 3 we are called into the clinic. Of the nine eggs retrieved, six have fertilized and they decide to implant three embryos. This is a short, painless procedure and the progesterone suppositories are not that bad and I’m on the two week wait.

I’ll just get it over with right here: I had what’s called a chemical pregnancy. After the bloods on the second day it was obvious hCG was falling below normal levels. So in the end, the procedure did not work. I am wrung out and decide I need to take a break. I am not willing to go through this harrowing process again.

It’s my very first IUI. The clinic, which is in a hospital, is like a food stamp line in the former USSR. The ultrasound room is in the centre of the floorplan and other offices surround it, and surrounding that on the perimeter is a waiting area and the blood lab. We IUI or IVF women line up to get our gowns, to wait for a change room where there are no lockers or security, waddle through the waiting area in front of hoardes of patients that don’t have anything to do with fertility, and wait in the hallway for one of two seats where our blood is taken. Then we walk back and wait in another part of the hallway, in full view of patients not in those pathetic hospital gowns, for our turn with the wand. I feel like one of those people on a long term care ward, walking around with her gown open at the back, except of course mine isn’t. But other patients still give us querying looks because they’re not in gowns.

Finally I’m in the ultrasound room. But I don’t even get to see the doctor. A nurse and a fellow do everything. Like he knows what he’s doing. He’s a newbie! I’m sent out to change and someone will call me in the afternoon after all the charts have been reviewed with the actual doctor. I am immediately sceptical of this process and it turns out that I have reason to be.

My dose of Clomid is the same as everyone else’s and apparently I’m a super-responder. So my ovaries are blown out and they fiddle and fiddle with my cycle until it’s time for my ovaries to pop. I line up again for the actual insemination, which is done by the nurse and the fellow and it isn’t too bad at all. But I’ve had every possible side-effect. Migraines, dizziness (I was really worried about driving), loss of appetite and more. I’ll skip ahead here and tell you what you must already know: it didn’t work. And the following month, I got cysts from the Clomid, which is a typical side effect but they don’t warn you about it.

What really gets my goat, is that they don’t warn you about anything. Drugs are prescribed and it’s assumed you’ll just take them without question. No one sat me down and explained side effects and no one talked about the possible link to ovarian cancer. And this is an elective process, one for which we pay dearly. I don’t want one of those dear things to be my health.

It’s our second visit to Dr. G. Guess what? We’re normal. Not a thing is wrong with us. We are so relieved, we’re smiling. In fact, we’re a bit smug. Ha! Take that, infertile world! We are normal!

But wait. If we’re normal and nothing is wrong… why is it not working? Dr. G- suggests that we head straight to IVF. Whoa there, Nelly! I am not — repeat, not — interested in invasive in vitro. That is like science fiction and we’re normal, right? Surely there has to be an easier way. In fact, says Dr. G- there is: intrauterine insemination or IUI. Although she recommends using Clomid, the success rates are low, about 10 to 15 percent for unexplained infertile couples. Apparently our diagnosis is “unexplained infertility.” It’s better than having something wrong with one of us, we think. How wrong we are, we find out much, much later. In the world of infertility it is much better to have a problem that can be fixed. But this is in retrospect. Way back at this second visit, IUI sounded like the perfect plan.

The husband is so grateful that I’ll try this — try anything at all — he is floating on cloud nine. Wow. Well, we’ll see how it goes, I think to myself and tell him that this is as far as I’m willing to go. How little did I know.

Thank god I took the day off work. Today was the first step in a horrifyingly undignified process of conception that will culminate in the most degrading act of all: birth. Most people think that having sex is the beginning, but no. I’ve learned – and perhaps I’ve come full circle to grasp hands with the desperate womenfolk desiring pregnancy (except I’m not doing this out of desperation) – that sex is simply a quick, painless tool to achieve the end result.

Somewhere in that process is a whole lot of cold steel, catheters, ultrasound wands and vomiting. If sex isn’t effective, as is our case, we need to find out why. And in this fast-paced world of medicine, my doctor has scheduled all the tests very close together. She’s not waiting to find out about the husband’s sperm motility; she’s having my insides evaluated pronto. I was leery of this at first because, well, it’s an invasive procedure and I’m pretty queasy about these things. After today all I can say is, the husband’s sperm had damn well better be swimming like Olympic medallists for me to have gone through this.

Everyone tells me not to worry, it’s not a big deal, it just seems that way. Well, they are wrong. First of all, I’m in the medical imaging center for hours. The initial ultrasound isn’t so bad. In fact, it’s like sticking a vibrator up there and waving it around for a few good uterine close-ups. But then we get to the tubal patency test, which means a lot of instruments and poking about in a region that generally doesn’t like that kind of interference. Perhaps it’s different for each woman. For me, it takes the doctor five tries to insert the catheter after so much prodding and poking that my cervix is bleeding. At the fifth attempt, I am honestly thinking of telling the two doctors and one tech to just forget the whole thing because I can’t even hold my legs up in those stirrups for another minute (it has been 40 minutes at this point). My legs are aching. And then, the catheter slips in and stays in; but the balloon is inflated, my insides completely revolt and I yell bloody murder. Not intentionally, of course. It’s a bit embarrassing, but it hurts like hell. I can only imagine what birth feels like, and I am not interested in feeling it. What are they thinking, telling me this feels like a mosquito bite? Apparently they’ve never had the procedure, otherwise they’d know that it’s worse than a thousand mosquito bites. It feels more like the worst day of my PMS cramping times a hundred. Of course, my blood pressure plummets, I’m sweating buckets, and my legs are shaking. After the whole thing is over, I’m so faint I vomit. The technician doesn’t even allow me to get up; she makes me lie down for a half hour. She brings me cookies and ginger ale – what an angel – and hails a cab to take me home.

Bottom line: reproductive medicine is barbaric. I can hardly believe that a nose puff has been developed to help men with erectile dysfunction, but no one has thought of a way to anesthetize a woman’s uterus during an invasive, painful procedure.

September

Oh gosh, it’s time to face the music and even I — the penultimate denier — know it. My husband and I are having a very uncomfortable conversation. It’s the one about seeing a fertility specialist. I desperately do not want to go. The roles here are reversed: usually the man is the one that’s reluctant to get tested. I’ve always been squeamish about medical stuff and now we’re talking about a very private, internal part of my body. Let’s just say the imagery is not enticing.

But the husband is visibly frustrated. Why, oh why, I wonder, can’t things just be easy for once? Why do I always come to the fork in the road where I either have to do something unpleasant in this baby business, or I have to contemplate divorce? It’s a question that will recur many times in the future on this crazy journey. Honestly, I have no idea if divorce is a palatable option to the husband, but I know the stats. The main cause of divorce is money; the second is children. I am painfully aware that marriage is a partnership and that this is one of those huge compromises that I’ll be making if I want to stay married. And I unequivocally do.

This is why we end up in Dr. G’s spartan office that’s painted hospital-issue-peach with its pathetic baby wallpaper trim and 1980s computer monitor that looks like it can’t turn on, never mind compute. Ugh. I am not inspired nor confident. Oh, but she is! She is horrified that we have waited so long to conceive and lectures us on the stats. We leave her office crestfallen, with requisitions for a battery of tests, mostly that I have to do. (One thing I cannot get over is how nice other specialists are and how forceful and superior infertility docs are.)

I don’t know what to think at this point. I am disbelieving of the fact that I could be infertile. I mean, how is this possible? There is no infertility in my family; my mom had her last child in her thirties! Can it be that I’ve reached the past-due date? Are my eggs shrivelled up, grey-haired little things that don’t have the strength to pop out of my ovaries? Am I all cobwebbed and mothballed inside? Has that ambivalence I’ve always felt indeed an indicator of the fact that perhaps I’d never been fertile in the first place?

Well, we are about to find out. Oh joy.

June

It’s ten months since we started TTC and things are progressing albeit slowly. I think I’m actually with the program now! The husband jokes that for someone that likes change, this is one change I clearly have not wanted. Yep, it’s taken me quite a while to get comfy with the idea of being a mommy. TTC every month is just a matter of fact now; instead of being freaked out at the consequences of pregnancy I am calm. The workouts have helped immensely; besides the endorphin boost, I feel like I’m being proactive. It’s so important for me to know I can control something.

The other thing is that I am starting to notice kidlets everywhere and I see that people manage somehow. I’ve also seen the husband with our friends’ kids and he has such a good time. They adore him. I still do not like other people’s children. Don’t you love it when parents say, When they’re you’re own, it’s different. Actually, not so much apparently. According to G- you do have an innate irrational love for your kids but that doesn’t change the fact that when they are being monstrous little devils, you can have second thoughts! And G- is a real bona-fide mommy. So you see, I have not been worrying about parenthood in vain.

The other way I know I’m with the program is dinner conversations with friends have changed. A few months ago I lost my appetite talking about this and believe me, I am still horrified at times. But here’s an example.

We’re having dinner with same couple from last December and they want to know how it’s going. It’s obvious we’re not yet expecting a little bundle of joy. So they think we need more pointers:

  • Every TTC couple needs a thermometer. The mommy-to-be takes her temperature every morning at exactly the same time and records it in a chart. after about 4 months you’ll get the hang of your ovulatory cycle. Apparently when the temperature is at a certain point you’d better book off some time for TTC sex or you’ll miss your two-day window.

I raise an eyebrow and look at the friend’s wife. She’s a busy lawyer. “Do you have time for this?”

“God, no!” she says. “But some people have sworn by it.”

I know it’s not going to work for me, because I don’t have the time or inclination to do it!

  • Get a pregnancy book; apparently these also come with thermometers and charts and advice — whose advice, I’d like to know?

You know it’s an industry when there are baby-planning books in pink and blue binding at the local book shop. Argh. Are they more informative than the baby boards online? If they’re written by anyone like my doctors then they haven’t got a clue. Besides, why does everyone take such a happy tone in these types of things?

  • Ovulation predictor kits take the guesswork out of the temperature method and they are quite expensive unless you can get them in bulk. I can imagine the mail carrier’s smirk. Although peeing on a stick beats a thermometer.

All this I can handle but here’s the one that makes me choke on my food:

  • Egg whites are your new best friend. If you are beat from trying and just can’t get excited anymore, egg whites are a similar consistency to mucous. Unlike other gels, egg whites won’t hurt hubby’s swimmers.

I guess we haven’t arrived at the point where sex is awful. Wait — this means there actually is such a point. I cannot believe they’re telling us this and secretly hope that  we never have to resort to it otherwise I’ll never eat eggs again.

Oh, dinner table conversation: so honest, so appalling.

Late December

The husband and I are having a big fight. I am absolutely furious with him. It’s only been four months since I went off the Pill and it feels like Everyone Knows. It’s the last thing I want. I want us to feel no pressure. Not from family, or friends, or colleagues. It seems that pressure is the one thing that does not help get anyone pregnant and not that I’m in a hurry, but I don’t want everyone to know about my personal life. I’ve read enough of the desperate mommy web site forums that I know I don’t want people to feel sorry for me if I don’t conceive ‘according to schedule’. I do not want people talking about me behind my back and how ‘sad our situation is.’ I’ve heard enough talk like this to last me a lifetime.

To make things worse, it seems that sometime in the past two months, the husband has let the word slip to his mother. Every time she phones, there is a tentative and slightly insinuating, “Anything new?” I wondered what that was all about until I heard the husband and the mother-in-law on the phone the other night. “No, we’re not pregnant yet,” said the husband. “We haven’t been trying that long. Anyway it’s a major lifestyle change for her, so we’re trying to get her used to the idea.”

I almost freaked out right there.

Then tonight, the husband raises it over dinner. Over dinner, of all places! I almost slide under the table.

The odd thing is, our friends – who are really the husband’s friends so I don’t know them all that well – they were all ears. They are eager to hear all about it. It’s like we’re in some sort of “Trying Couples” club. They have lots of free advice to offer: stories of fabled conceptions, surprise miscarriages, the best herbs, foods, drinks, etcetera. I sit politely and stone-faced throughout this ordeal. I want to change the topic as fast as possible.

As we get into the cab on the way home, I spit my venom. I don’t care that I berate the husband in front of the cab driver.

“Can’t this wait until we get home,” the husband tries to shush me.

“Who cares?” I say. “Everyone else knows! Why not the cab driver?”

“Damn it! You’re blowing this all out of proportion. My mother deserves to know, doesn’t she?” I shoot him a dagger glance.

“No, no she doesn’t”

“Well, she’s my mother and I can tell her things that are important to me.”

“No, you can’t. Not if they have to do with me! This is between you and me and no one else. If someone is curious, that’s too bad. Maybe some day I’ll be comfortable speaking about it, but I am not. Comfortable. Right. Now. Can’t you understand that?”

“Alright, alright,” he sighs. “I guess you’re right. I can see that it’s not fair to you.”

“Damn right, it’s not fair!” I shoot back. “And what’s up with raising the topic with them? This is the 21st century – conception is not a community event!

“Oh c’mon. They’re good people. They care. And I didn’t raise the topic, I’ll remind you. They asked if we’re considering kids and I simply told the truth.”

“Well, sometimes you shouldn’t tell the whole truth,” I say acidly. “Sometimes one should avoid a conversation.”

I run up the five flights of stairs, let myself into the apartment and slam the door. We had agreed we weren’t going to be One of Those Couples…. And here we are. Our intimate details being shared with other couples that want to share their intimate details. I guess the husband got the message, because during the next conversation with the mother-in-law, I hear him telling her that he’ll inform her if we have news, and otherwise not to ask about it.