In the Cathedral Hill neighborhood of St. Paul, there is a small, independent wine shop called Solo Vino. With its creaky wood floors, handwritten shelf cards, and exceedingly knowledgeable, passionate staff, it reminds me of my favorite independent book stores. Every time I walk through its door, I breathe out the stress and chaos of my day and breathe in the promise of a relaxing evening with a dog in my lap.
I stopped in on a Tuesday night a few weeks ago and when the sales person asked if she could help me find something, I felt a wave of gratitude and relief wash over me. It was a small thing, I know, but I was having a rough week, and a kind offer of help went a long way in making me feel cared for.
“How about a sassy weeknight red, not too full-bodied,” I said, and gave her my price range. She asked what I would be pairing it with, and I had to stop myself from telling her the truth. Bitter disappointment with a side of generalized failure was just a bit too real for the current state of our relationship. So I told her a different truth (leftover chana masala) and left the shop with a lovely Crizana.
As I’m sure you’ve gathered, I’m not pregnant. Just shy of two weeks after our IUI, I started my period again, indicating that the insemination had failed. On the very same day, I got called into the office of one of my administrators, who informed me that the school had received an anonymous complaint from a parent about this blog you are currently reading. They were apparently alarmed that I was writing about such intimate matters and publishing it on the internet, where anyone could read it.
I was shocked; how anyone could read my blog and see it as anything other than the story of a committed couple who love each other deeply and want more than anything to build a family is beyond me. Suddenly I went from feeling brave and proud of my honesty to ashamed and exposed, irrationally worried about being fired (my administrators, by the way, were incredibly supportive of me). This all happened on a Friday; I spent Saturday night in the hospital cheering on my sister as she delivered her first child, which was amazing beyond my capacity to articulate but also, for someone living her life in the eye of an infertility hurricane, pretty fucking intense.
The following Monday I went in for an ultrasound and found out I had two large cysts on my right ovary.
So yeah, I was ready for a glass of wine.
That’s some catch, that Catch-22
Here’s a maddening irony of infertility drugs: the same treatments that improve your chances of conceiving by tricking your body into releasing more of the hormones it needs to do so also cause side effects that make it impossible to continue taking them. This is exactly what happened with me when I went in for my baseline ultrasound. When you’re undergoing any kind of medicated infertility treatment, your doctor will ask for something called a baseline ultrasound within the first few days of your cycle to check for cysts or other abnormalities that may have been caused by the drugs. The tech didn’t have the wand up there for more than a minute when she said, “looks like you’ve got two big cysts on the right side,” and my heart sunk.
The consultation with my NP confirmed it. She explained to me that this meant a moratorium on any kind of treatment until the cysts had gone away, hopefully on their own. In the meantime, I was to take it easy on the strenuous exercise and call her immediately if I felt any acute pain on that side. She tried to cheer me up a little by pointing out that, because it found cysts, this ultrasound and appointment wouldn’t be coded as infertility treatment (and not count toward my $8,000 lifetime max) when they submitted the insurance paperwork.
Saving a couple hundred dollars is always good news, but I couldn’t appreciate it in the moment. All I was thinking about was that, to my list of things to be anxious or depressed about, including the failed IUI, the work thing, and the panic that, at this rate, I would start menopause before these treatments worked, I could now add the fear of ruptured ovarian cysts. Awesome.
“I think it’s good news”
If we were going to have to take a month off of the infertility treatments, at least I could take care of yet another test to rule out yet another reason that I can’t get pregnant. It’s called a sonohysterogram and it involves pumping saline into the uterus, sort of like filling a water balloon, so the doctor can get a close look (via ultrasound) at the uterine lining. If they find any cysts, growths, or fibroids in the lining, which would prevent implantation of a fertilized egg, it’s likely the cause of your infertility. Part of me wanted them to find something. While it would require another uncomfortable procedure to remove them, at least it would be an explanation. But I was greatly relieved when the image of my uterus on the big TV screen opposite the exam table showed no trace of anything that shouldn’t be there, just a clean, dark oval of empty space.
After the exam, my OBGYN stayed to talk to us about next steps. Since the sonohysterogram hadn’t found anything, he suggested we start IUI again on my next cycle, using relatively the same medication protocol. There was nothing anatomically wrong with me, he explained, so the problem had to be hormonal. I didn’t refer him to all the blood tests I’ve had over the past year showing that my hormone levels, from my FSH to my AMH to my LH to my progesterone, have all been declared “within normal range”. Instead, I talked to him about my impending mid-life crisis.
“But considering I’m 39 and five months, should we just skip ahead to Follistim?”
(Follistim is a more potent – and expensive – drug than Clomid that sends your ovaries into egg production hyperdrive.)
He told me I shouldn’t start worrying about my age just yet, that I still have a few years before the odds against us become insurmountable. I told him we’d reach that point a lot quicker if we had to keep taking a break every other month. He didn’t dispute it, just gently reminded me that it was unlikely I’d develop ovarian cysts after every treatment and that he’d been doing this a long time.
“Get some rest this month,” he said, standing up to leave. He opened the door but turned back before walking away. “I think it’s good news,” he said, and gave me a calm smile and his trademark shrug.
Something about his casual confidence cheered me a bit. I left feeling not quite as scared of aging out of infertility treatment as I’d been that morning. And while I had to stifle a laugh at the ‘rest’ part of his prescription – May is notoriously hectic for teachers, especially those of us who teach A.P. classes – I had to admit, it would be nice not to worry about taking six different pills at four separate times of the day and fighting with my insurance company to cover my trigger shot and finding people to cover for me at work when I have my appointments. I could have the normal amount of coffee required as a human and a glass of wine at the end of a busy day and I wouldn’t be constantly obsessing over the timing of my fertility window and figuring out all the optimal times for us to have sex (and then actually finding time to do it, s/o married people!) It would be like a little vacation.
Don’t Hassle Me, I’m Local
The problem with that is, after a few days, I suck at being on vacation. I can’t just NOT work on something and wander aimlessly through my day, devoid of purpose; I need a project. So I was delighted when my cycle came to a random, abrupt halt at 24 days and I could get back to the clinic for my baseline ultrasound.
It came up clean, thank heavens. And because I’d continued to chart my cycle during our off month, I felt empowered to have a conversation with Jaimi, my nurse practitioner, about hormone supplements. I could show her tangible evidence of my short luteal phase – at six days that month, it was less than half of what it should be – and lobby for a prescription for progesterone.
“And can we talk about my lining?” I continued; I was really on a roll. “Since it was on the thin side last time, shouldn’t I be taking the estradiol sooner to thicken it up?”
If the me from a year ago, when I attended my first intimidating infertility support group meeting, knowing nothing about all these tests and drugs and hormones, could hear the me I am today, I don’t think I’d recognize myself. I’ve come a long way from that circle of hard metal folding chairs in a Lutheran church basement. Back then, I was a tourist in this land of battle-weary vets who spoke another language, filled with jargon and acronyms I couldn’t comprehend. Now it’s become my mother tongue and I speak it with ease, using those same jargon and acronyms to advocate for what I know is best for me. I don’t plan on spending my life here, but it’s where I am for the foreseeable future, so I may as well know the lay of the land.
I may not know what’s going to happen next, but one thing is sure: I’m calling the shots now.