For the 1 in 10 women and men of reproductive age affected by infertility, pregnancy can be delicate and elusive. At age 35, SELF staffer Stephanie Dolgoff wanted desperately to have a baby. Over many months, through doctor visits and infertility treatments, she chronicled her quest in a diary. Join her as she faces the surprises that awaited her on the long, painful and sometimes funny road to motherhood.
May 26, 2002
I hope he uses sunscreen on the top of his head, I think as I stare at Dr. Sandler’s sparsely covered pate through my splayed knees.The strangest things pop into your brain when your feet are in stirrups, your vagina visible to a team of medical professionals, none of whom you’re sleeping with.
Dr. Sandler is concentrating on gently inserting the latexcovered ultrasound wand, while his nurse, Jeanne, stands by with lubricant and a sympathetic smile.My ovaries appear on the monitor. “Very good, very good.You see, you have one, two, three—a total of six eggs today, Stephanie,” Dr. Sandler says. “Your ovaries love this stuff!” I chuckle out of politeness. Dr. Sandler had said the exact same thing the last two times I’d taken Clomid and my ovaries produced first four, then five, now six eggs. Clearly, I didn’t get pregnant or I wouldn’t be back flashing him again.
Clomid is often the first line of treatment for anyone with unexplained infertility like mine. Dr. Sandler says most women who get pregnant on it do so after three rounds of pills, so this is my last try before advancing deeper into the infertility maze. The next steps: injectable drugs, high-tech in vitro fertilization (IVF), maybe, ultimately, adoption.
As grateful as I am to know there are options, I dread the idea of exercising them. But I’m most scared that I’ll exhaust them and still not get pregnant. I’m finding it hard not to view my trouble conceiving as karmic retribution, perhaps for catting around in my teens and 20s, with not even a pregnancy scare.Other times, I’m just impatient. I’ve been ready to have a baby for four years, since before I had a willing partner. My husband, Sergei,* and I have been trying to get me pregnant for about a year. (His real name is Paul, but he said I could write about this only if I called him Sergei with an asterisk.) I came to see Dr. Sandler after six months, once I figured out that I wasn’t ovulating. I’d charted my temperature, peed on test sticks and examined my cervical fluid (and, to Paul’s horror, made him inspect it as well).
Now the Clomid is working, and boy, am I ovulating. My eggs are raring to go, so Dr. Sandler has Jeanne give me a shot of human chorionic gonadotropin (hCG), the hormone that will tell my ovaries to release the eggs within 24 to 36 hours. I am to come back tomorrow morning, with Paul’s lovingly collected sperm in a cup, for my third intrauterine insemination (IUI). Dr. Sandler will deposit the sperm directly into my uterus so they won’t even have to swim upstream. They can just hang out and kill time until one of my eggs happens by. Paul had his semen analyzed months ago as part of a fertility workup. Dr. Sandler also made sure my fallopian tubes weren’t blocked and that my hormones were normal. Paul’s sperm is turbo, and I’m good to go in every quantifiable way. And this round, I have so many eggs that Paul and Dr. Sandler are optimistic. I am, too.
I get my period. I scream unprintable words, scaring my cat. I don’t even care. My heart hurts, like it’s a clenched fist taking up too much room in my chest. I slam the box of tampons into the tub, scattering them all over the porcelain like Super Plus pick-up sticks. The cat gives me that “you’re a nutjob” look and ricochets out of the bathroom. I’d let myself believe this Clomid thing was going to work. “Big mistake,” I think. “You got your hopes up and had that much farther to fall.” Ugh. Then I fight to evict negative thinking from my brain. One way or another, I tell myself before calling Paul at work to give him the news, we’ll have a baby in our life.
Up until I saw the spot of blood on the tissue, I didn’t think of myself as really, truly infertile. Infertility is officially defined as actively trying to get pregnant for a year without success, and it’s been a full year.There’s nothing obviously wrong with me, so what the hell is wrong with me? I’d had a feeling I wouldn’t get pregnant right off the bat, but I’d written that off as my classic Jewish “God forbid life should be easy once in a while” way of thinking. Still, I thought at the very worst, a lot of sex and a little medication would lead to a baby. So did Paul, who is generally more mellow about the process.
He wants a family but is less concerned than I am about how long it takes. Did I mention he’s male? He doesn’t have Sylvia Ann Hewlett breathing down his neck. I told some of my friends that we were trying, because it helps me to talk about it. All are supportive, but many say unhelpful things like “You just need to take a vacation,” like I was somehow stressing our baby out of existence. I’m learning to selectively keep my mouth shut. Comments that even vaguely imply it’s my fault we’re not pregnant or that I’m being too hyper make me furious.
June 11 I have a long talk with Dr. Sandler. He lays out our options as follows: I can do nothing and hope I get pregnant. I can try a series of injections of gonadotropins, powerful drugs that could make my six little eggs look like small potatoes. I can have a laparoscopy, surgery in which they puff up your abdomen with air, stick a teeny camera into an incision made inside your belly button and root around to see if you have endometriosis (rogue uterine tissue) or scar tissue gumming up the works. Or I can skip all that and go the test-tube baby route.
Frankly, I don’t like any of these possibilities. For a second I think of a few of the teenage girls at the urban community center that Paul runs, and how they seemed to get pregnant all too easily, ready or not. Their options aren’t so hot, either. But they can conceive, and I’m a little jealous. Why does the world work this way? I tell Dr. Sandler that IVF sounds extreme. It can cost upwards of $10,000 (most of which my insurance would not cover); I would need shots twice a day for weeks; and it may not even work. Or it could work too well, and I could spawn an entire family singing group all at once. I need to talk to Paul. We don’t even know if we want more than one child. I mean, how did I get here? I’m not “infertile.” That word. Oh, wait. Yes, I am.
Not happy with the “unexplained” part of my unexplained infertility, I press Dr. Sandler for a reason. He says he thinks I may have endometriosis (though, like many women, I have no other symptoms besides infertility). But without looking under the hood with a laparoscope, he can’t be sure. This whole experience is like renovating a house: You think you’re just going to lay down tile, but when you take up the old stuff, you find the floor is rotted out, there are termites and you have to do $10,000 worth of repairs just to get to where you thought you already were. I don’t want to think what they might discover if they look too closely at why I can’t conceive.
We’ve decided to do IVF. I’m a little freaked by the idea, but it seems like the best option. Paul says he’ll do whatever I want to do because I’m the one who has to go through the discomfort of any procedure. He’s being incredibly supportive.
And I’ll need his support, because IVF is an ordeal that takes a couple ofmonths. First you shoot yourself once a night with a drug called Lupron, which squelches your hormonal activity.Then you crank your system into overdrive for a couple of weeks with hormonal drugs, such as Gonal-F and Repronex (which stimulate the eggs’ development and help them mature).When the eggs you produce as a result of this process are looking big and ripe, the doctors knock you out for 20 minutes and extract the eggs with a needle and throw them into a petri dish with some sperm. (Why don’t they call them petri dish babies?) Three days later, they pop a few of the embryos back into your uterus to see if any stick.More shots—the hormone progesterone, this time given by your partner in your butt— to keep the uterine lining hospitable.And the fervent hope that in about two weeks, you don’t get your period.
I decided on IVF because doing nothing is far too passive for me. I ruled out just getting shots of Gonal-F to create more eggs, because I had plenty of eggs using Clomid. More eggs, a girl really couldn’t ask for. Taking hormones that will produce even more (and, I fear, make me grow a beard) doesn’t seem like it will solve anything. My problem seems to be with the eggs and the sperm getting together or implanting once they do hook up. This narrows our choices down to IVF or a laparoscopy—during which they might be able to treat any mild endometriosis or scarring they find with a laser.Then again, they might not. I called a girlfriend of mine who had IVF and now has a 10-month-old to ask about the laparoscopy. She advised me to skip it. If endometriosis is my problem, she opined, I might need to have IVF anyway. “Why have a surgical procedure and not even have the possibility of a baby at the end of it?” she asked. That was the first clear-cut, logical thought I’d heard in months. Sold.
I have decided I’m not infertile. I’m calling myself prefertile. I will have a baby, even if the entire pharmaceutical industry has to crawl inside me to make it happen. I feel better now that we have a plan of action, though I have to admit, I’m jealous of Paul. No shots for him, no speculum wedged uncomfortably into his nether regions.The worst that will happen is that he may have to “provide a sample,” as they call it, in the doctor’s office.There’s a room rumored to be equipped with stroke mags and porno videos.When we had our turkey-baster inseminations, we brought his contribution from home, me carrying the covered cup in my armpit on the subway to keep it at body temperature. But with IVF, the timing must be perfect, so Paul may have to go where many men have gone before him.The thought grosses him out. I’m sure he’s worried he won’t be able to,well, concentrate.
I’m here at Dr. Sandler’s to start on my IVF checklist,which is mostly blood tests and a mammogram, to rule out breast cancer. They want to make extra sure the hormones you’re going to get won’t stimulate an existing tumor. I love people watching when I’m in Dr. Sandler’s waiting room. There are always interesting-looking folks, mostly women alone. Some are reading or talking on cell phones, while others—the long-termers, I guess—cluster into little cliques to give each other updates. Clearly, infertility doesn’t discriminate; there are all races, always a lesbian couple or two. I especially love eavesdropping on the couples. Most of them seem very much in it together. I’ve heard infertility can wreak havoc on a relationship, but so far Paul and I have found something to laugh at every day.What’s going to happen will happen, so we may as well laugh about it.
It is pretty ridiculous, too. Dr. Sandler has seen me naked from the waist down more often than Paul has in the last few months. As soon as I leave the office, I call Paul to tell him about one couple, Orthodox Jews. The man asked a nurse if there was a room he could pray in while he waited. She led him off in the direction of the semen collection room Paul so dreads. I pictured the poor guy in the masturbation chamber surrounded by tattered porno magazines asking for God’s help with his wife’s IVF.
Today Paul and I attend a mandatory four-hour IVF class with six other couples. We all avoid each other’s eyes at first, focusing instead on the huge pyramid of cookies on the conference table. A nurse goes through the process, teaching us every hormonal abbreviation known to modern medicine. The Fab Four are FSH (follicle stimulating hormone), estradiol (which the follicles secrete to help the egg mature), luteinizing hormone (it encourages the mature egg to release) and progesterone, which prepares the uterus for the fertilized egg. I’ll be taking all of these except estradiol; my body will make that one in response to the others I’m getting courtesy of Dr.Sandler.
The nurse details what happens at each day of a typical treatment cycle; at one point she explains that the male partner should not be abstinent for more than four days at the time of retrieval—the day they collect my eggs and fertilize them with his sperm. Something about fresh sperm being better. That’s the only note Paul takes during the whole class—Male partner should never, ever be abstinent for four consecutive days. Then he crosses out four and writes two. Then he crosses out for two consecutive days and leaves it at that, double underlining never. I crack up, oddly pleased that we’re the Beavis and Butt-head of the IVF class.
By the last hour, the cookie pile is dwindling and things loosen up as we practice giving injections. (The intramuscular injections have to be given in the behind by someone other than the woman.) The teacher passes around a dummy butt, basically the bottom half of a mannequin. When it reaches Paul, he holds it, perplexed. The nurse shows Paul where to shoot. “It’s just that this isn’t a realistic butt size. The ones I’m used to aren’t this small.” I turn red, he turns maroon, realizing how that sounded. He tries backtracking (“I didn’t mean your butt, sweetheart!”) and only digs himself in deeper. By the end, the whole room is cracking up. The size 4 dummy would have laughed, too, if she hadn’t just been a butt.
Paul proves a little shaky at giving shots, which makes me cringe. If I trust anyone who is not a trained health-care professional, I trust Paul. I suppose. But the nice couple from
I went for a mammogram after all this morning, to be thorough, and now I wish I hadn’t. After the procedure, the radiologist came into the room with my film, looking stricken and speaking as if he was on fast-forward. I heard “suspicious mass” and “biopsy” and “one step at a time” and “it will have to come out.” If he said, “Don’t worry,” I didn’t hear it. I retreated into that little part of my brain where I can completely lose it internally without it showing on my face. I wasn’t even going to come here today, was my first thought. My second was, If I have cancer, I can’t have a baby anytime soon. My third: Or ever. Facing the possibility of something far worse, I’m still focused on having a baby. That’s how badly I want one.
When the doctor left the room, I called Paul and very calmly told him they found something, but that he shouldn’t come to the office because they’re just doing a biopsy and we won’t know anything ’til Monday. He was there in 10 minutes, at which point I became hysterical. The doctor did a biopsy with a machine that sounds like a staple gun, and I cried even harder.
BENIGN! B-9.Benign.Thank God or whoever is calling the shots. The radiologist sets me up with a surgeon to have it removed anyway, just to be sure. This will delay our IVF, but I don’t care. I’m not sick.
My breast surgeon schedules my lumpectomy for the earliest possible date, August 1, so I can get back on track with the fertility treatment. She clearly understands. Getting pregnant for me is like running a marathon when I thought I’d just signed up for a 5K. I didn’t know to pace myself, and I spent the last year plus wondering why I wasn’t there yet. My breast lump—and the possibility of having bigger problems than not getting pregnant—made me see how much longer the race could have been.
My lump is confirmed to be totally harmless. I replay the results three times on my voice mail before calling my doctor to ask her, “Will the surgery interfere with my ability to breast-feed?” I can hear her rolling her eyes over the phone. “Stephanie, you asked me that three times already— twice during surgery! ”We both laugh. I now feel like I have plenty of time to get pregnant. If IVF doesn’t work this round, it will work the next, or the next. There’s nothing like thinking you’re going to lose what you already have to make you feel lucky. I am so, so lucky. I don’t resent “having” to do IVF anymore. I just can’t wait to start.
Today I begin my drug regimen. Over the next three weeks, I’ll be giving myself shots once or twice a day, according to what my nearly every other- ay blood work shows. Today it’s Lupron, the drug that shuts down everything. I fumble with the syringe, one of those small, fine needles used by diabetics, not the big nasty ones that come later. I can pop myself in the stomach or in the thigh, whichever has more padding. My stomach wins. And in it goes. Not so bad. I was braced for much worse.
I’m starting acupuncture, which I’m told can help relax your uterus and make it more receptive to an embryo hunkering down in there. I’m on my back as Suzanne, my acupuncturist, inserts some 25 minuscule red- and bluetipped needles into key points all over my body. I lift my head slightly. My body looks like a golf course peppered with flags, and the needles hurt worse than any of my shots.
Suzanne talks a bit about how fear affects the body, and asks me what my fears are about having a baby. I tell her that fear of not being able to have one is the only one I’ve been experiencing. I give it some thought, and what arises, after fear of never losing my baby weight and never being able to see a movie again,was the biggie: What if the kid turns out to be someone I don’t like and can’t relate to at all? I can feel myself relaxing after simply letting that thought surface.
I’m back in the stirrups again, and Dr. Sandler is checking on how my ovaries are doing. I’m due to start the Gonal-F injections tomorrow, to get my eggs growing. I ask him if he thinks fear of having a baby could contribute to infertility.He doesn’t look up until the ultrasound wand is in position. “Western medicine doesn’t deal in fear,” he says and refers me to a nurse for instructions on Gonal-F. I’m glad I have both his and Suzanne’s perspectives. Sure, at the infertility clinic I sometimes feel objectified. Some staff members barely look at my face because they’re so focused on tinkering with my plumbing and checking my hormone levels. They want sperm and egg to come together and make a baby. Period. Suzanne, on the other hand, recognizes how the body and the mind interact and how your emotional life can affect the way your body functions.
Between Suzanne, Dr. Sandler’s team and Paul, I can’t not get pregnant. On the way out, I notice hundreds of twin and triplet snapshots on Dr Sandler’s bulletin board. Also, a baby announcement with a stork on it. I find this hilarious. The only thing this whole procedure has less to do with than sex is perhaps a bird.
They’re adding a drug called Repronex to my protocol because it contains luteinizing hormone, to help the eggs already developing to mature further. That means I’ll be taking three drugs in all. Dr. Grunfeld, a colleague of Dr. Sandler’s, gives me a sonogram and tells me there are five eggs in my left ovary and three on the right. “C’mon, ladies, hop to it,” I think to myself.
On Suzanne’s table, golf course set up, I ask her how she thinks fear could prevent pregnancy. She explains that fear in my spleen and stomach meridian could make my uterus inhospitable to an embryo. It makes some sense to me, though I know Dr. Sandler wouldn’t buy it. She asks me to repeat to myself as I lie there, I am ready for the responsibility of raising a child. “Let’s see what comes back to you when you say that,” she says, closing the door behind her. So I did. I mostly feel excitement. Only a little fear.
My final day of shots before the retrieval. At last count, I had five in one ovary, seven in the other. Retrieval will be in two days, on September 11, the anniversary of you-know-what. Friends have asked if I find it freaky or sad that I’ll be conceiving on September 11. I don’t. I think of it as making another person—a good one, if Paul and I have anything to say about it—like many of the people who died.
That night, Paul gives me the hCG shot in my butt muscle to get my eggs ready to be retrieved. Having your husband shoot you in the ass is an exercise in blind trust. I didn’t see us in this kind of situation until we were elderly and one of us had to help the other to the bathroom. As is his style, he makes a production out of it, drawing a big green X on my right butt cheek with a felt-tip—way bigger than it had to be. He’s grinning like an imp as he assures me he isn’t deriving any pleasure from this. I’m laughing so hard that my butt keeps moving, and he almost misses his ample target. But his aim is true. It hurts. I tell him he did good and that I love him. I have to sit on my left butt cheek all the next day.
I go in for a blood test and tell Dr.Sandler that my ovaries feel like two avocados. The big
I barely remember anything about the retrieval, which took place on another floor of the clinic. You’re out cold, then you wake up and it’s over. I didn’t feel a thing.
Paul, on the other hand, has quite a tale to tell. His job, of course, is to ejaculate on demand. Imagine the pressure! We’d spent some $5,000 on drugs alone and had timed this perfectly. It simply couldn’t be screwed up. And I couldn’t make the experience more fun for him, because I was lying on a gurney with a shower cap on waiting to be aspirated. Achilly nurse led him to a special room (not the legendary masturbation room, but a different one), where he found cups, paper bags and instructions on the wall to wash his hands and his genitals, and to keep the door locked. But the door wouldn’t lock. So Paul pushed the garbage bin in front of it and held it in place with his foot. But with his foot in position, he couldn’t reach the sink. The fear of someone barging in must have made him more flexible and he was able to do the deed—I have no idea how.He told me later he didn’t use the wrinkled copy of CD Babes that was there.The idea of touching such a frequently fondled magazine skeeved him.
September 12 The clinic calls to say I have produced a dozen eggs and that all is going well. I imagine our Petri dish like a junior high school dance, with boys on one side, girls on the other, edging toward one another. I urge them in my mind not to be shy. Paul and I talk in the evening. We’ve both been so positive about this, but I feel like I have to remind him that it may not work out the first try. He says he knows that, but why not presume it will until we know differently? I think some of his can-do mentality is starting to rub off on me, but I’m glad I brought it up. I need to remind myself, so I have the emotional endurance to go through another round if we must.
September 14 Transfer day! Paul and I sit in the waiting room with two other couples.All the women are drinking the prescribed liter-plus of water. Puffing up your bladder bumps your uterus into a position where it can be seen via an abdominal ultrasound, so they’ll know where to put the embryos. We’re all nervous and have to pee but can’t. One couple, Marianne and Jim, are nice and chatty. (I’ve changed their names.) Marianne tells us she’s hoping for twins, “a two-for-one special.” She can’t wait to quit her job and chase them around. Jim rolls his eyes, but we can tell he can’t wait either. Marianne goes first. I wish her luck.
After a bit, Paul and I move to an anteroom. Dr. Sandler swings by and says that my 12 eggs and Paul’s gazillion sperm made six embryos, three of them viable. “Two look very good, and one looks OK,” he says. Immediately, I’m worried. “Not great?” The ideal, we were told in our IVF class, is a symmetrical embryo that has split into eight cells by day 3 of development. One of ours has five, another six and the other seven.“ Well, just because not everyone gets an A doesn’t mean they don’t pass the class,” he says. Paul makes a “No child of mine will get anything less than an A” joke, and I laugh. But not too hard. I really, really have to pee.
They take me into the transfer room, where Dr. Sandler and a few colleagues perform the transfer, which they broadcast on a TV monitor mounted in the corner to my right. They have me ID my embryos at least three times, by showing me the dish with my name and social security number on it. No lawsuits for these guys. The table has a hole cut out of it for my butt, so my pelvis is tilted at an accessible angle. I watch the monitor as they suck each of the three little blobs (blown up by the camera to the size of oranges) into a tube of fluid, then discharge it into my uterus. They then suck some fluid into the empty tube and push it back out, to show me that no embryos have gotten stuck.
“A perfect transfer,” Dr. Copperman says. I ask how much the smoothness of the transfer matters in terms of pregnancy rates. He says, “More than you know.” They give me permission to urinate (I didn’t want to pee the embryos out, but they swore there was no way), then wheel me to a room next to Marianne, where we are to hang out for a half an hour before going home and taking it easy.
Dr Sandler brings us a photo of our embryos, and I can immediately see what he meant about one of them only being OK. It looks a little like Paul’s uncle Lou, kind of uneven and mottled. Paul reminds me that might very well be the one that winds up being our kid, and that I should shut up. I concede that the embryo has character.The other two look heartier, though not as perfect and flowerlike as Marianne’s. She had three put in as well, and I could easily see her having triplets.We wish each other luck, and Paul and I go to the diner on the corner. I have eggs.
Two weeks after the transfer, a blood test revealed I was pregnant; an ultrasound a few days later showed three dark smudges that Dr. Sandler said were—gasp!—triplets. All three embryos took. My only thought: No way. No freakin’ way. And I meant it: There was no way I was having three. The risks to babies and mother are greater with three. Besides, I was pretty sure I only wanted one child. When undergoing fertility treatments, you start to feel that having even one baby is impossible, so you don’t really consider the increased chance of multiples. I was about to ask Dr. Sandler about what is euphemistically called “a reduction” (an abortion of one or more fetuses) when he went on to say that one of them might not develop. We just had to wait. The next exam, at six weeks, revealed only two heartbeats. On the one hand,
I was relieved. On the other, I was horrified— I was still having TWINS! I had months to get used to the idea, though, and to an extent, I did. But right up until May 15, when our girls Sasha and Vivian were born, I had deeply mixed feelings. The picture I had in my head—peaceful strolls with my baby snuggled close in a BabyBjÃ¶rn— was shot to hell. Two was going to be utter, round-the-clock madness. But there was no way I was looking a gift test tube in the mouth. I’d take what I was given and make it work. Now that they’re here, I don’t have to “make” it work at all.
Somehow, our insta-family just makes sense. Each girl is her own little prewoman, as distinct as if she’d had my womb all to herself. I can honestly say that, even at with a wide-awake Sasha or Vivian (or both) looking up at me, I’m glad things turned out the way they did.