Well, it ended how I thought it would when I heard there were only two follicles. It can be a real curse of being a realist, a OBGYN kid and decently good at math. Despite pushing on three more days, the follicles on the right were tiny and there were just the same two on the left (and not a whole lot bigger, 10mm and 8mm). The medications might have produced discomfort but they basically didn't do anything. My resistance to them has grown, or else was just so high that they made no difference. The doctors explained that given our previous poor yield and no fertilization, there was a high chance that this might be the same and, anyway, the big difference between the performance the last time and this did not justify not cancelling.
On one hand, the frustration level hit a new high. I cussed out loud in my mind, quite a bit in this process. On the other hand, one can't help but be resigned, disappointed and sobered. I had tried, we had given it time, and, ultimately, I think it turned out exactly as I had thought. I don't think, however, that I had thought it into being. That is being slightly ridiculous.
But that wasn't out of the picture for the doctors — who today asked me, are you stressed? Which, by the way, is a great question to ask to royally piss your patient off right after their IVF cycle has failed. What exactly would be a good answer here? Yes, I am really stressed, that Must be why it didn't work, is that what they taught you to blame it on in med school? Or no, actually, I feel equally stressed, or no more stressed, than the previous time we did this cycle and any other month, except that we still can't find a better reason? The eggs you release today are actually formed three months ago, so it's really a crapshoot in guessing, or remembering, exactly when you were or weren't stressed.
This is what they can't figure out though — two months ago, we ran this same cycle. Whilst the yield from the follicles was totally crap, the follicular response to the meds was actually pretty good. In the interim between the two cycles, my natural FSH hormone levels actually came down (this is a predictor for how you might respond to the meds, which are a stronger form of FSH hormone, if your own levels come down, you would typically react better to meds, although these levels fluctuate from month-to-month). But this time around, my response seems to have totally crashed out. The ovaries refused to respond. The blood tests showed that my inherent estradiol levels, which are typically high when you are in follicular stage, were 1/3rd what they were in the previous round, showing that my natural hormone level was completely in sync with the low level of follicular response. So, in some way, this cycle was screwed, maybe from really early on, and it was a bad month to pick. Both the bloodwork and the poor follicular response were why the cycle was cancelled but let's put it this way, even without further medication being cancelled, basically they were shooting for Level 60 and my entire bodily response was already, no thank you, come hell or high water, we are chugging along at Level 10.
So, I am a poor responder. I am increasingly a poor responder, meaning that I am developing either a very high tolerance or resistance to these meds. It's also possible that having used Noreistherone to time the cycle better, but in doing so, suppressing my natural cycle, did not really work (it has been suggested in some literature that suppressing an already low ovarian reserve will just cause them to not perform altogether). The deduction is the same as it was immediately after Day 5. I think, in the back of my mind, I knew this. This morning, when we went in for the check-up, I didn't even administer today's injectibles before leaving the house. That's how sure I was, to some extent, that they wouldn't be needed.
But here's what else strikes me as ridiculous. We have now done two IVF cycles (yes, this one was prematurely aborted at a fairly early stage, but still, there was a heavy load of stimulation right from the get-go) without ever getting to an actual fertilization. In fact, in this one, it is so premature that we will not even get to any retrieval. In the sum of both cases, there was almost nothing to retrieve. We are in this IVF process because dear hubby's morphology (shape of sperm) is 2% normal (14% normal being the ordinary, with some people at a stunning 50%, meaning sure get pregnant the first time, because every other sperm in a 9mn per ml sample of typically, 5ml per ejaculate, is viable — if you've never evaluated your friends' husbands and your exes by their virility, you should do the mental exercise, it is incredibly illuminating). But once in, what we then realize is that maybe I just already have dud eggs or at least, eggs that refuse to respond to treatment. If you want to be positive, you can think that I have great immunity, and it's true, I generally develop resistance to all medications very quickly, something that I've noticed in the past. Unfortunately, IVF requires the opposite, great response to medication, to work. My timeline also isn't great, since this is correlated to low ovarian reserve and thus early menopause.
This is where most people trot out the 'you can still conceive one day, I know someone who conceived after 10 years of trying.' Well, firstly, I may not have 10 years. But in essence, I agree wholeheartedly. It is absolutely possible, but statistically, it would just be a damn miracle. And I don't just mean statistically, in theory. I mean, in fact, which we've already seen with the same blind test of medication and stimuli.
The nurse who closed out our case file today clucked at us sadly. I tentatively asked for copies of all the blow-by-blow medical reports and, apparently, those are confidential to the hospital. She at once agreed to give us the detailed medical write-up but not the actual charts and notations, which they are unable to release. I was grateful I could bring this up to her before speaking to Dr W., who has always struck me as a competent, taciturn and not uncaring, but mercurial and distant doctor. I told her we have to ask around and check on different medical protocols. She said, in my position, she would do the same. What do the others do, I asked? Do they try private doctors? Do they just conceive on their own? With the rare number of donor egg cases and adoptions in Singapore, I know they don't do that, I told her. There are only 300+ adoptions a year and I've already seen more than that number just in this clinic. She didn't disagree. I don't know, she admitted, they don't come back.
We came into the NUH hospital, so full of hope and having negotiated and waited for 6 months from the last IUI to our first IVF. Less than 3 months later, we are literally being given our walking papers. I can't tell you how much willpower it takes to ignore that and hope that either by staying on or exploring our options, there's an answer somewhere for us. In the last couple of visits with Dr W, I had already sensed his waning interest and maybe a certain defensiveness or insistence about how this was working out or with my understandably more medically naive questions. In his wall of fame of babies, we weren't in the lucky camp. And IVF, generally, is a self-directed journey; no doctor calls to check in on you; no hospital calls with appointment times. If your time's up, or you aren't an ideal case, it's up to you to seek treatment since medically, there isn't anything classifiably wrong with you.
And that is not the ridiculous part. That is actually the sensible part. It's the part that we have, guts out, tried and for the same reasons, flunked badly. Or rather, flunked so badly that you could almost never imagine it was going to work (I suppose this was Dr W's <10% chance warning). The ridiculous part is something different, something that I've been feeling for a while. In Chinese, there is a term, 'yinyang' (not the light and shadow that refers to the unity of opposites), it means, literally translated, nutritious or nourishing. When you say something is not yinyang, you mean, typically, that you are eating junk or snack food. But it can also be used metaphorically to describe learning, that is monotonous or non-progressive, or any kind of unhealthy activity or exertion. And this, this is all not yinyang.
I am sick of having this be part of my life and since we're not getting any babies, I want my life back. I want to be able to get back in shape (there are hardly any tangible differences between July and Sept, one being that earlier in the year, I think I was in much better shape), or rather, I want to feel strong and lean and fit again, I want to travel when I want, to feel like working again, to drink coffee or soak in hot water baths, or learn to ride a Ducati, or fly a helicopter, or throw up what now feels like a responsibility and looming timeline of expectation, pressure and conventionality. I don't want to go through time feeling scared or deal with this unrelenting sadness. Or constantly be aware of how much stomach feels. I want to have normal neurosis and frustrations. I want to feel free to feel stressed or be stressed, without feeling guilty, or be vegetarian, or not eat protein, or fish, or the myriad of supplements. I want to be able to fret or flare up or be fierce about real things, not intangibles and certainly not other people's constant pop-up pregnancies or lives. I want to live without looking back at time in regret, without entertaining insidious thoughts that if I'd married earlier and differently, I'd have kids by now and I want to be able to sleep without thinking. I want to not be jumping through hoops or hold out hope for every tedious or quack fertility aid. I want to not feel resentful, not feel sick to my gut or emotional and teary about children or motherhood. I want to be able to not plan business trips around doctor's visits and ovulation and cycles, and to stop driving out for these long-ass waiting room times and tedious, painful acupuncture sessions. I don't want to live with it; I want to be able to not care.
The whole point of IVF is that it guarantees the fertilization: when they put the blastocyte back in, it is good to go, it is good to hope. But all we have received from the hospital in terms of care is a ton of invasive, potentially harmful chemical medicines that wound up entirely ineffective. Particularly because we haven't been long-stayers on the IVF program — in fact, quite the opposite — I feel it has been an incredibly stupid waste of time, energy, emotion and money. I am leaning toward adoption because we have spent two years doing this in our bid to become parents, but honestly, it is taking up as much time, energy, emotion and money as it requires to Be parents. If we had a few rounds of fertilization and subsequent success or failure, you could write it all off as the balance of luck. But with our record, it would seem that we are trying to create a child out of what is clearly not very suitable grounds and it would almost be easier to simply get a child who is already in existence and otherwise consigned to the rubbish heap of life. Then we might be able to move on to formula, lullabies, discipline, dinner times, swimming, building forts, camping, road trips and college, rather than the not yinyang kind of activities we are currently stuck on.
This came up today because the doctor (not our doctor who is away, but the attending) brought up her worst-case suggestion of donor eggs. It would be your husband's sperm, you would carry the pregnancy, except that it wouldn't genetically be yours — she managed to explain in a way that was both as bland as it was qualified. How typical that they have made breakthroughs on allowing all men to be fathers, while not enabling women to be genetic mothers, although they can still do the bothersome work of carrying the child through labour. I had also thought this one through before. It would be, I told my husband, like donor sperm. If it wasn't possible for us together, then I'd rather just take our chances on a level playing field of a child that is neither of ours biologically. The only compelling reason to create this genetical mutant is to avoid the prenatal problem element in adoption, for which you would probably have to assume that there was about as much care as in the initial, unwanted conception.
Emotionally, I suppose it boils down to my wanting a little boy that looks like my husband, in some ways, maybe for him (and misguided perhaps, because he really wants a little girl). I have this idea for myself, that he could be so cute and easy to love and for my husband, that he would be proud of him and his beautiful, tall, athletic elements. If you think I'm delusional, I don't disagree — I am just as certain he could be a stout, fat, slow, sweaty cad, frustrating to teach and thankless to raise, but hey, a girl can dream, no? For myself, I have to say that I have never really cared whether my kid was biologically mine and in some weird Freudian way, I am afraid that I would be very harsh on a daughter if she did look like me, because I would always expect her to do better. I've always felt in my own life, and believed, that it's just deciding to care and to love that has always been the real basis of friends and family in the end. It's making people a priority that determines what we mean to each other and whether they miss you when you're gone.
Realistically, even if we could fluke one kid, or even two, with our circumstances, we might never feel we completed our family without adopting, anyway. So it had always been a possibility for us. But some things do give me pause and make me wonder how well we will do when there's an element of choice in the equation. Like a couple of weeks ago, when I went to my friend's house for her son's first-year birthday and I found myself hurting. He even had great-grandparents (a mathematical impossibility for my generation of women, unless the next two generations are teenage brides) and all making a fuss. It made me wonder whether, if we adopted, we or anyone else would be excited like first-time parents about welcoming home a baby that was not there one day and then there the next. I know it sounds silly, but we will never know what it feels like to go through the exercise of bringing home a swaddled bundle, back from the hospital, and maybe he will never know what it's like to have a family waiting. Does it matter? Am I just after the gratuitous black-and-white new-born parent portraits? (The husband says rationally, this is all romanticised and nobody cares a heck about a second-born so get some perspective — always nice to have a straight-talker in the house.)
I'm trying to be circumspect, and we will keep at it, take DHEA for three months, get back in line on a hormonal and emotional level and research our private options and maybe even give it a shot before too long, but in the meantime, it all really continues to roll downhill and it's so damn frustrating.
