- Get married
- Buy house
- Start and finish master’s degree
- Have two kids
Your wedding was small and beautiful. Even your parents admit you planned a lovely event, although you still have to stop your mother from doing her usual postmortem of how she could have planned things better. Your mother-in-law, fresh from the end of chemotherapy, cooed over your best friend’s five-week-old baby.
You and your husband live in your separate condos at first; you’re 35 and he’s 41, and you’re both settled in your own spaces. But as soon you buy a house, a fixer-upper with 100-year-old painted bricks and 40-year-old avocado green appliances, you pack and move and sell your old place in between coursework for your degree.
Your father, who is also your business partner and a real estate broker, wants to know why you need such a big house. He really means, “Why aren’t you living closer to us?” but you explain that the house has five bedrooms: a room for you and your husband to sleep in, a room each for an office, and two rooms for kids.
Both your parents are surprised. “Aren’t you too old to have kids?” You explain that all your friends had kids in their mid to late 30s, but your parents only know Indian families, and good Indian kids get married in their 20s. Your father persists. “But won’t the child be mentally deficient? Won’t it take some kind of medical miracle for you to have a baby?”
The things you didn’t know
The plan is to lower the basement floor to build an apartment and at least renovate the kitchen and bathrooms before having a baby. You want a year of marriage before having kids. You’re a little afraid of how having a baby will derail your degree and your nascent writing career and irrevocably change your life. You know you don’t have a lot of time, but you want to do this sensibly, in an orderly way. Responsibly. You blow the entire renovation budget and more on the basement.
The clay drainage pipes shatter in the dig, and in the flooded muddy mess you find drowned sewer rats. The heat goes out on the night of your first reading of your first published work of fiction, and the hot water tank is punctured when you have the reading of your first play. Your front and back yards become repositories for construction debris and mud.
Everything takes too long and you turn 36. You begin trying to conceive, and you get bogged down in the issue of timing. All the advice you find is about normal, 28-day cycles, but you’ve never had one of those. In the last few years, your cycle has gone from short and slightly irregular to anywhere from 16 to 45 days. You blame it on stress.
You’re well-educated, but you’re surprised to discover that you have no idea when you ovulate. In a normal cycle, the follicular phase, when an egg grows, lasts about two weeks, followed by ovulation and a luteal phase that lasts another two weeks. But if you have a 16-day cycle, do you ovulate on Day 2 or Day 14? How long does it take to grow an egg in a follicle? When is a lining thick enough? You’ve heard of estrogen and progesterone from birth control pills, but what exactly do they do?
You look into the movie trope of taking your temperature and discover that temperature rises after ovulation, not before; it doesn’t tell you when to try, but confirms the time has passed. You start peeing on ovulation predictor kits that test for a surge in the luteinizing hormone, or LH, which triggers ovulation. You’ve never heard of LH before.
Your family doctor finds out you’re trying and orders a test for follicle-stimulating hormone, or FSH, on Day 3 of your cycle. You’ve never heard of FSH before either. Your results come back slightly but not concerningly high. Still, she refers you to a fertility clinic. “It can take a few months to get an appointment,” she says. “So you may as well try to book one now.”
The first appointment date is the day of the opening of your first play in Seattle. You move the appointment to two weeks later and already feel like a bad mother for choosing career over children.
The house is still full of boxes; you combined two households and your husband is a packrat. You refuse to unpack anything inessential, since you’ll only have to pack it and move it when you renovate that part of the house. You keep the vases and the crystal and most of your books in boxes. Your husband drags his feet on decluttering. “Why don’t we move this stuff to the second bedroom?” he says. “We aren’t using it.”
You refuse several times before you snap at him. “That’s the baby’s room. I don’t want us to fill it up and get used to using it for stuff and then have to empty it all out when I get pregnant.” The arguments stop. You move an old sofa in there, which the cats sleep on, but otherwise leave the room empty and waiting.
You still think having children is a choice you can make. Of course you do. They call it “birth control,” as if you will magically get pregnant the moment you stop actively preventing it. You will learn this is not the case.
Before you see the fertility doctor, you draw the line at in vitro fertilization (IVF). “We aren’t going to go crazy on this,” you say to your husband. “We’re just going to rule out anything not simple and easy.” You don’t want to become one of those women who go crazy trying to have a baby, injecting themselves with hormones and blowing thousands of dollars. At this point, you fully expect the doctor to tell you it’s just stress. You’re under a lot of stress between work, school, the renovations, your parents, and sharing a household with another person for the first time in years.
The doctor is well dressed and pretty. She’s Asian and you imagine that, like you, she is a child of immigrants. She speaks frankly and asks many questions and then orders several tests. For your husband, blood work and sperm tests. For you, blood work, transvaginal ultrasounds, and a sonohysterogram, which involves filling your uterus with saline and then checkin for abnormalities.
The numbers reveal you have diminished ovarian reserve. Your FSH is a touch high, your AMH—that’s anti-Müllerian hormone—is normal, but your follicle count is very low. In plain English, your reproductive system looks more like that of a 42-year-old woman than a 37-year-old one. You are pissed off to realize that your parents were right about your being too old even though you are not actually too old.
There is reason to hope. You still ovulate regularly, and in fertility terms 37 isn’t old, although egg quality typically declines rapidly after that point. You ask if there are any tests for quality but there are not. Medical science can only use age as a best guess.
The doctor prescribes Clomid and a few rounds of IUI—intrauterine insemination—and you’re relieved by her cautious approach; you felt certain you were going to be pressured into expensive and unnecessary IVF treatments. The internet tells you that if IUI works, it usually works within three rounds. You are told to hope that Clomid will stimulate your ovaries into producing two or three follicles. An egg grows inside a follicle, and more eggs means better odds.
The internet tells you that some women get as many as six or seven follicles and have to cancel their cycle. You and your husband discuss selective reproduction. You take the warning about ovarian hyperstimulation syndrome—a potential and occasionally fatal side effect of stimulation—very seriously. You still think medical science has solutions. No one tells you that with your numbers, these possibilities are laughable.
Your in-laws, bless them, do not say one word to you about grandchildren, even though your husband is their only child. Your mother-in-law only repeats, “The children must make their own decisions.” No one else is this polite.
At your in-laws’ dinner table one night, your father interrupts a conversation about movies to say, “You know, in India, they have a really great system for surrogacy.” Your in-laws are confused, and your husband gives you an odd look. The two of you have never formally discussed keeping infertility treatments secret, but you haven’t told anyone either. But you are used to your father’s inability to read a room.
He continues: “It’s so efficient. The citizenship is worked out before the baby is even born. Uncle Dinesh’s son, Rohit—he and his wife had some problems. That’s what they did. It’s a very good system.” This is actually the fourth time your father has told you this, and you shut it down. “Yes, it sounds like a good system. If someone wants to do that.”
Progress on the basement chugs along slowly. A concrete floor has been poured and the walls have been framed in, but when the plumbers replace the leaking cast iron stack, they discover there is no support under your toilet, and so you are left with a shower upstairs and a cramped powder room on the main floor. The electricians rewire the house, ripping into every wall and ceiling, revealing that your ductwork is covered in asbestos paper. On the advice of the removal company, you save $1,200 and rip it out yourselves, cutting wide gashes in the lathe and plaster walls. The baby’s room—in fact, every room—has broken walls.
Every fertility treatment starts with a baseline monitoring appointment, blood tests, and a transvaginal ultrasound. The internet infertility groups you find call the ultrasound “being twatwanded” or “visiting the dildo-cam.” You arrive at 7 a.m. to see the assembly line in full swing, but you don’t yet know your place in it. You wait to get blood drawn, then strip from the waist down, put on a gown, and walk down the hall, back of your gown gaping, to wait for your ultrasound.
The nurse, reading names off a clipboard, tells you that next time you should put on two gowns, one opening to the front, one to the back. You go into a dim room and put your feet in stirrups. A young doctor—not your doctor—rolls a condom over the wand, loads it up with gel, and inserts it. She moves it around, pressing on the inside of your hip to get a better view, and calls out numbers to the nurse. Then you’re hustled out of there without knowing what any of those numbers mean. You wait for a nurse, who hands you a prescription for Clomid and tells you to start taking it tonight. You ask questions, but she can’t answer them because she’s not your doctor, but you aren’t going to see your doctor. Is this normal?
Other women on the internet complain about their Clomid symptoms, but you feel nothing, and when you go for monitoring a few days later, there’s only one follicle, the same as what you could do on your own. Before leaving the ultrasound room you ask the doctor when the IUI will be. She says usually not for another week. You explain you usually ovulate very early, but she tells you Clomid changes that. A nurse calls that night and tells you your blood work shows a surge in LH. You’re ovulating and need to go for IUI tomorrow.
IUI is in a different room, brightly lit, and the stirrups are covered with bright red oven mitts for padding and warmth. The internet tells you to carry on as normal, but, conflictingly, to take it easy and keep your feet up. You wear warm socks just in case they will bring warm blood back to your uterus and help with implantation, and you eat pineapple core — not the flesh, only the core — for exactly five days afterward. None of this has any science behind it, but you try it even though it seems ridiculous. None of it works.
For your second IUI, they try the highest dose of Clomid. Your second monitoring appointment is the day before Christmas, and the clinic is closed on Christmas. You ask the doctor—a different one again—when your IUI might be and he says not for a week, chuckling like it’s a silly question. You try to explain that this happened last time; he should look at your chart and see, but you’re ushered out of the room so the next woman can come in.
Still, your doctor has left a note to give you a trigger shot—an injection of hCG hormone that mimics the LH surge—in case the last time was a weird fluke. You are shown how to use it and will be told when to take it. But like last time, the nurse calls to say your LH surged on its own and you are ovulating, but to take the trigger shot anyway. You are instructed to have intercourse at home.
You’ve never injected yourself and at first you want your husband to do it, but you take over because you’re afraid his nerves will make you more nervous. You line up the sharp steel point at 90 degrees to a pinch of belly skin. The hardest part is getting over the idea that you are supposed to avoid sticking sharp objects into yourself.
You’re still not pregnant, but your period doesn’t come when expected. After more monitoring, more blood tests, and more dates with the dildo-cam, they tell you to wait it out, which means more waiting before you can try again. Your period is three weeks late, but no one tells you what happened or why.
You go through your calendar, your posts in infertility groups, and your memory and start writing down every piece of data. You make an Excel spreadsheet and look for patterns. It’s clear no one else is keeping track for you.
After baseline monitoring for the third IUI, you come home and work on writing assignments on the old couch in the future nursery; the third-floor room you were using as your office is uninsulated and too cold. The phone rings and the nurse tells you not to take Clomid. “Your FSH is fifty-eight.”
“What does that mean? What’s wrong?”
She can’t answer your questions because only the doctor can do that. The IUI is cancelled but you can try at home with an ovulation predictor kit. You call to make an appointment with your doctor. The medical secretary tells you that you’re lucky; there’s a cancellation and she can see you in a week. You later find out that there’s always a cancellation when it’s bad news.
They say never consult Dr. Google, but you do, and everything you find about Day 3 FSH of 58 says something about menopause. You are only 37. Your FSH at your first appointment was 9.8. You’ve been led to believe that your problems are mild. What is going on now?
At the appointment, you discover your Google-diagnostic skills are pretty good. You are not, technically, in menopause, but your menopause-like levels of FSH indicate that there is no point in giving you any fertility medications. All stimulation medications increase FSH to make more follicles, but your FSH is already so high, medication won’t make a difference. You ask, “How come it was lower before? Why did it spike?”
“It varies from cycle to cycle, but your highest number tends to be predictive of how things will go.” The doctor never answers the question of why, because the whys are unknown.
“What about IVF?” you ask, even though Google has already answered this question. The doctor shakes her head. “I’d estimate your chances with IVF to be between five percent and ten percent.”
IVF success is highly correlated with the number of follicles they can stimulate the body into producing. More follicles, more eggs, more chances. Most of the medication used pumps the body full of FSH to try to get 10 or 12 eggs, but you’d be lucky to get 2. Very few eggs become babies. This isn’t because of IVF, but is mostly because of what happens naturally. Only 80 percent of eggs fertilize. Then only 50 percent of those survive to become five-day blastocysts, which is when they are frozen or transferred back into the uterus. Only 30 percent of them will implant. You wonder how it is that any of them manage to live.
Your doctor asks if you’ve considered donor eggs. You didn’t cry when Google suggested this, but now your eyes fill up with tears. Google also told you that South Asian donors are rare in North America. You find a news article from a clinic out west explaining that in those cases, they try to find a Hispanic or Indigenous American donor, as those turn out close enough.
Close enough doesn’t seem like enough.
Your mother-in-law’s cancer comes back after four years. The five-year survival rate of her cancer is very low, but you still somehow imagined her playing with your children. She begins chemotherapy again, and your husband sits on her hospital bed and tells her about the fertility treatments. She’s the first to know, and she’s happy, because after that awkward dinner with your father, she thought you didn’t want children at all. She was so sad about this but never said a word.
The thing with 5 percent odds is that they aren’t zero, but it would cost you thousands of dollars to bet on those odds. What’s the price tag for a child? There is no test for egg quality, but if IVF fails more than statistically expected, you can conclude it was probably due to egg quality.
How do you put a price tag on failure? You become obsessed with your own data. Statistics was your worst subject in math, but you get your husband to teach you how to calculate cumulative odds and you run the numbers over and over again.
The question of trying is no longer about having a baby. You are probably not going to have a baby. Instead, it is about not having regrets. You need to be able to look back and see that you tried everything. You run the numbers and work out how many times you’re willing to try before you can walk away in peace.
You seek out a second opinion from a doctor at the most cutting-edge clinic you can find, although given that you are older than the first baby born via IVF, the cutting edge is a rapidly moving target. You don’t bring your medical records — you don’t want your original doctor to know — but run through your spreadsheet and astonish the new doctor with the details you remember. The new doctor concurs with your original doctor, but agrees that it makes no sense to move on to donor eggs without trying your own. “Miracles happen.”
You like him because he listens and explains things, drawing diagrams on paper and openly admitting what is unknown or untested. He wishes you luck and gives you his card, saying to email him and let him know how it goes. You believe he sincerely wants to know.
You go back to your original doctor, saying you want to try IVF. She demurs, repeating odds and asking about donor scenarios. But eventually she agrees to try.
You tell everyone that you’re starting IVF and your odds are terrible so it probably won’t work. You put it on Facebook. Twenty people reach out to you to say that they, too, sought fertility treatments. You had no idea.
You start fertility acupuncture, and two friends from university tell you not to buy into the snake oil; you should trust medical science instead. You explain that medical science can’t help you, but they still treat you like you’re planning to inject your eyeballs with heroin. You tell them they can be supportive or they can fuck off. Neither of them are your friends anymore.
Your cousin tells you that she had multiple miscarriages and took Clomid to conceive, and then explains that she couldn’t possibly be your surrogate because it would be too weird. You are simultaneously annoyed and furious. You don’t need a surrogate, and a history of miscarriages would make her a bad candidate anyway, but how dare she pre-emptively refuse? What if you had needed one?
Your mother-in-law reveals that she tried for seven years, but a doctor gave her “some hormones” and she got pregnant with her son, your husband. You figure out that it must have been Clomid.
Your mother suggests adoption from India. “I could pick one up the next time I go.” You explain that adoption is much more complicated than that, but she doesn’t take it in. “You don’t want to get pregnant. It’s too much trouble. This way is much easier.” You explain again that it isn’t, and tell her about egg donation. You want her to be prepared if you go that route. She decides that your cousin’s wife, who is nothing like you, would be perfect. “I’ll tell her next time I’m in India.”
At your first baseline monitoring appointment, the nurse has trouble getting a vein and eventually does the draw from your wrist. She asks if you’re excited.
You’re not but you try to joke it off . “I don’t think anyone is excited to stab themselves with needles.”
She admonishes you. “It’s very exciting. Think about the baby!”
You want to scream at her and ask her if she understands what the numbers on your chart mean. You don’t understand how a person can work at a fertility clinic and still think IVF always leads to a baby. But you say nothing. She draws your blood. You get twatwanded and go home.
After the appointment, you get a phone call telling you not to inject yourself with the expensive hormones. “You have an estrogen-producing cyst on the right.”
You ask questions, but they have no answers. They only tell you that you cannot do IVF because the cyst will interfere with the medication, but you can try again next month.
The next month, you have an estrogen-producing cyst on the left. Cancelled again. What infertility taught me
The next month, you have an estrogen-producing cyst on the right, but the doctor doing the ultrasound is your doctor. “Come back in two days, and we’ll see if it resolves.” Two days later, the cyst is gone. You never thought you’d be happy to stab yourself daily with needles. You go back for monitoring two days later and then head up to the cottage. The clinic calls. “Stop taking medications,” says the nurse. “You’ve already ovulated.”
You try asking questions but they have no answers and cell reception is poor. You make an appointment to see your doctor. Luckily, there’s a cancellation. The pants-on appointments are always bad news.
Your doctor explains: “What we thought were cysts are actually follicles that developed too early, out of sync with the rest of your cycle.” Eggs. Potential babies. Three chances, lost. You are angry to the point of tears that they can be so cavalier about skipping months, as if you have eggs in abundance and all the time in the world. You ask about different protocols, about the possibility of suppression medications to prevent the follicles from developing early. Your doctor shakes her head. “Now that you’ve tried three IVF cycles, have you thought about donor eggs?”
You don’t consider three cancelled cycles trying IVF at all, and you walk out of the clinic crying. You fumble in your purse for the business card of the other doctor. You call and get an appointment in two days, and then call the clinic you just left and ask them to send over your medical records.
Having settled on a new plan, you’re calm again.
The new doctor explains. Follicles and cysts look the same on an ultrasound. Follicles produce estrogen but so do some cysts. The follicle they saw must have ovulated, then disappeared, and then became a corpus luteum, which produces progesterone, confirming ovulation. All of these look the same on an ultrasound. The clarity is a relief. They were not withholding answers. They were guessing.
Your writing desk now sits in the future nursery. Writing on the couch hurts your back. The contractors are working in the basement in fits and starts; you can’t stay on top of ordering material for them. You should be working on your thesis but you can’t focus. The house, with its mud and gravel yard and the inside full of dust and broken plaster and cat-fur tumbleweeds, looks like depression.
The acupuncturist you see specializes in fertility. It’s a relief to talk to him about IVF without having to explain the medical details; you’ve all but completely given up on talking to anyone else. He kicks your ass about your thesis and holds you accountable for writing deadlines. You have no idea if acupuncture is helping, but you look forward to the weekly chat.
There are no gowns at the new clinic. You strip from the waist down in the ultrasound room and wrap a paper sheet around yourself. Afterward, you see a doctor — as usual not necessarily your doctor — instead of a nurse. Otherwise, the routine is the same.
One day you leave the clinic only to find out your contractor asked for the wrong-sized door. You hop on the subway, borrow your mother’s van, pick up the door, and go to exchange it. It’s time to inject, so you sit in the steamy van in the parking lot of Home Depot, mix diluent into powdered Menopur, and inject yourself. You feel badass. You half expect someone to call and report a junkie shooting up drugs.
You decide to have a party for your 38th birthday, to celebrate your broken house, and to force yourself to clean. You unpack the boxes of crystal you’ve kept packed for three years while waiting for the end of the renovations. You no longer know when you’ll be done.
The cycle runs long. Despite the injections, nothing is growing. Your doctor advises you to wait it out, and eventually one follicle grows. There is no miracle that makes you grow more. You’re given a trigger shot to take precisely 36 hours before your egg retrieval. You and your husband go to the clinic, you’re given an IV for twilight sleep, and your husband dons a surgical cap and gown and goes in with you.
Afterward, you hazily remember something went wrong. They wheeled you out of the room without retrieving anything. Your doctor explains: even though you took medications to suppress ovulation, you ovulated through it. The one precious egg is lost somewhere in your Fallopian tubes.
That night, your husband is called to the hospital. Your mother-in-law’s chemotherapy has not been going well. There are lumps growing in her throat and blocking her airway. After much hasty discussion in the emergency room, she gets a tracheotomy. She cannot speak with the tube in. No one tells her that she’ll have this tube for months.
Every problem in your life you have solved by declaring war on it, but you are in a war with no allies. Your friends sympathize but lack the medical knowledge to keep them from asking stupid questions or suggesting that you just relax. Your husband is now overwhelmed by his mother’s illness.
Your parents are worse than useless. You have your doctor, your acupuncturist, and the internet. Your life now consists of bouncing back and forth between the clinic and the hospital. You keep writing cheques to contractors, but you’re still in a house with holes and no full bathrooms. Landscapers come to lay out new paths, but the weeds have taken over what’s left of the mud piles. You and your husband agree to ignore the marriage, because neither of you have the energy. There are medical questions without answers everywhere you turn. Infertility seems so much less than cancer. You’re not dying. But you can’t make life happen.
At your next baseline, the doctor — not your doctor, another one — tells you that you have a cyst and to keep taking estrogen to see if it resolves, but you might need to cancel the cycle. You explain that this happened at your last clinic, that they weren’t cysts but early follicles, that your cycle goes out of sync. He tells you it’s a cyst and that you should take estrogen. You tell him to look at your chart, look at your clinic records, because what if this one is an egg? He tells you it’s a cyst and that you should take estrogen. You’re talking to a wall.
You’re angry but you leave the clinic with a prescription for estrogen. You sit outside the doors on a sunny bench near a coffee shop patio. You start writing an email to your doctor, but midway through, he walks up from down the street. You tell him that you were about to send him a message, and he says he’s seen the results and sits on the bench beside you to talk.
He listens as you explain. “I’m afraid we might miss a chance. That this is actually an egg.”
He understands, although he still believes it’s a cyst. But he tells you cyst aspiration and egg retrieval are the same procedure and suggests trying it. “If nothing else, for your peace of mind.” He sends you home with a trigger shot, and the aspiration/retrieval is scheduled for two days later, on the fifth day of your cycle. Far too early for an egg in a normal cycle, but nothing about you is normal.
A different doctor performs this and an embryologist is standing by in case. You are in twilight sleep, but you hear someone say there’s an egg. Your doctor is surprised and says you were right. You tell him to cheer up — maybe he’ll get a case study out of this. The egg fertilizes, proving that it is viable, and grows to two cells before arresting. The embryologist thought it might be slightly immature. You look at the photo; you created a life, even if it didn’t last.
The next cycle goes long, like your first one. Your mother-in-law gets sicker, trying different chemotherapies, until eventually they stop trying and start talking about palliative care. But she does not want to stop trying, even though there is nothing left to try. She tells you, writing on a pad of paper, that she dreamed you were pregnant. “I was so happy, I felt like I was in ninth heaven.” She rushes you out of there so you won’t be late for acupuncture, and afterward you work on your thesis because the deadline is close.
The next day she dies.
It is a Friday.
Death comes with a lot of paperwork, and you take that on so that your husband and father-in-law can grieve. You email your thesis adviser and tell her you have to delay your first draft. The following Monday, you go in for monitoring. Your one follicle is nearly mature, and you calculate that the retrieval will probably be on the day of the funeral. Medication could delay ovulation, but you’re on a special, low-cost, no-medication plan. Your doctor is away for Rosh Hashanah, but the doctor you speak to remembers your bizarrely early egg retrieval. Still, he suggests skipping this cycle and waiting for a better one.
You tell him you don’t have better cycles and about your late mother-in-law’s dream. You are not skipping anything if there’s a chance. He tells you to talk to your own doctor and leaves the room without giving his condolences.
You email your doctor and see him the next day, and he pulls some strings to let you take the medication. The retrieval is the day after the funeral. The egg doesn’t fertilize.
On the day of the funeral, landscapers visit your house to lay a fresh green lawn. At least your house looks beautiful on the outside. You go through three more cycles. The first is another bizarrely early cycle that has your doctor apologizing to the nurses for nonstandard requests. But it results in a perfect eight-cell embryo for the freezer.
The second, you ovulate before your baseline appointment. The third is unusually normal, and results in a six-cell embryo for transfer.
Your doctor recommends transferring the frozen eight-cell embryo along with the fresh one, but you are afraid. That embryo is safe in the freezer, but once you transfer, that might be it. Eight-cells might be the closest you ever come to being a parent. There won’t be school photos or wedding photos, but at least you have a photo of eight perfect cells.
You transfer both.
One becomes your son.
Every child is supposedly a miracle, but your child proved two doctors wrong by merely existing. On your last appointment, you thank your doctor. He shrugs and says, “I’m just the waiter.” He can’t get a case study out of this, since there is no way to prove if this came from the normal cycle or the bizarrely early one he’d done on your request. But both of you know, deep down, which one it was.
Excerpted from Through, Not Around, edited by Allison McDonald Ace, Ariel Ng Bourbonnais and Caroline Starr © 2019. All rights reserved. Published by Dundurn Press.