The Miracle of Life

I remember reading about embryo development in one of my biology textbooks while I was a University student. The author commented that given the number of steps that take place, from chromosome alignment to cell division and beyond, it is truly miraculous that so many normal forms are produced. I didn't interpret his words as a religious or spiritual connotation, but rather as a scientific observation. As there are so many stages of development, each step invites the potential for errors. Applying a mathematical probability theorem, the odds of producing a healthy human being are much longer for an individual, let alone for a population at large. Yet, not only do we expect perfection from our reproductive efforts, we demand it.

I was still in an absolute state of shock days after hearing that all of my eggs had fertilised. Post retrieval, the embryologist described that of my twenty oocytes, 13 were initially mature and one was 'indeterminate'. We thought it was a bonus just to have that egg mature, let alone fertilise. When the nurse from XYZ called to follow up she commented that everyone on their staff was amazed with our fertilisation rate. New Girl echoed that you almost never see a 100% fertilisation with the number of eggs that I had. I had to ask if they were sure that these were our embryos. How could I, a 38 year old woman with brittle ovaries whose parter has low normal morphology, be defying the odds?

One of the reasons why we've excluded my parents from this process, is that we know they would get way ahead of themselves. In the time from my transfer to the BFN from my beta test, my mother would have knit three hats, two sweaters and a blanket, while my father would have built a play house in their backyard. I'm not exaggerating, they really are that zealous. We knew we couldn't get ahead of ourselves either. We may have kicked ass on this round, but there were other rounds that could kick our ass. This just meant that we are starting from a higher point than where we were last time.

In my naive state, I really didn't anticipate that I would be doing a day 3 transfer with my last cycle, and I had to cancel an afternoon session of patients at the last minute. This time around,  on day 3, my afternoon was blocked off as I was due to attend a computer training.  If I needed to do a transfer, I had a built in excuse to leave the office and I would only need to sign up for another training session. However, it wouldn't be necessary. My RE called and reported that nine embryos were in the 'good' category. One arrested and the other four were less than six cells, or were described as 'fair' or 'poor'. Last time, we had three listed as 'good' two as 'fair' and one as 'poor'.

I was relieved to learn that we weren't going to be transferring at this time, although it would have been nice to skip out on my computer training. The bloating really set in on day 3 and I was afraid of Ovarian Hyper Stimulation Syndrome (OHSS). I was quite distended and uncomfortable. Holy shit, is this what pregnancy is going to feel like? If so, why again am I doing this? Additionally, my vagina was really sore. It felt bruised as if it took quite a pounding.

Two days later, I looked and felt much better. I was contemplating a fresh transfer, even though it would mean giving up everything I wanted to gain with PGD testing. I couldn't stop thinking about the fact that we implanted with a fresh transfer and failed with two frozen embies. I had to ask my RE if that were a compelling argument to transfer now, even though it would mean just randomly selecting an embryo with the hope that it is normal. A practice I previously dismissed as being 'daft'. If we fail with our frozen transfers, I fear I would regret not taking a chance with a fresh transfer. My RE didn't feel it was an indication as my prior embryos had thawed well. The explanation for my prior failures was either an abnormal embryo, shitty luck or a combination of both. It wasn't worth the risk of OHSS, as he noted that it's almost universal practice to defer a transfer for anyone with E2 levels greater than four thousand. The high exposure of estrogen makes the endometrium disogranised and unfavourable for implantation. I could risk wasting an otherwise good embryo or be at a higher risk for miscarriage if a pregnancy occurred.  I know OHSS is no joke and my RE takes pride in the fact that he has never had to hospitalise a patient with OHSS. Interestingly, our former mutual patient who went to another group as she didn't like his bedside manner, developed severe OHSS and was admitted for four days and had a total of 9 litres of fluid drained from her abdomen.

Once again, I was the damsel waiting by the phone, hoping my RE would be calling with good news. At last, I heard a beep from my phone. Myrtle had texted me a picture of little Myrtle. Despite our Don't Ask, Don't Tell policy, Myrtle just has this intuitive sense of when I've received some news from my RE and sends a picture of little Myrtle. Her birth announcement arrived in the post on the day we learned IVF was our best option. An invitation to her Christening came in on the BFN from our first IUI. I received a Christmas card that featured little Myrtle on the day of each of my miscarriages. As I was walking out of my RE's office fighting tears after hearing his projection of 6-8 mature eggs during my first IVF cycle, Myrtle texted the most adorable photo of her daughter in a lamb costume for Halloween. I cannot make this up.

I feel such a sense of awe and amazement when I see photos of little Myrtle, in addition to my usual jealousy. She is so beautiful and her hair is getting so long. She was wearing a headband with a bow and looks like such a sweet little girl. The resentment started to gnaw inside me. I want to scream. I want to shout. I want to shake Myrtle and other fertile one hit wonders by their shoulders and yell "do you have any idea how lucky you are?" It just took one month, one act of intercourse, one egg, one sperm, one pregnancy and you hit the jackpot with a perfect creation for the cost of zero dollars! This defies scientific logic! Don't worry, Marty. As long as you hit that wire with the connecting hook at precisely 88 miles an hour, the instant the lightning strikes the tower... everything will be fine!

They would not listen, they did not know how

Perhaps they'll listen now

My RE had been pretty consistent about phoning with his updates at the same time. I waited an hour and then decided to take a shower. It worked. Despite the fact that this man has been inside my uterus, inside my ovaries and most recently, inside my hoo-ha more than my own husband, it still felt awkward to be speaking with him whilst wrapped in a towel. Six progressed to become grade 1 blastocysts and were successfully biopsied. Six. Once again I was overwhelmed with disbelief.  I'm sure I should have asked some intelligent questions. First off, I'm curious to know if any restraints were used during my retrieval as I developed a contact dermatitis on my upper thighs and inner ankles. Now I'm just hoping I don't have to do another retrieval to find out.

As I hung up my call with my RE, I noticed that Myrtle had sent a second photo of little Myrtle. The resentment was consuming me again. It has taken us thirty-one months, many acts of intercourse, twelve missed opportunities, five attempts with intrauterine insemination, forty-five eggs, millions of sperm, three transfers with four embryos, two unsuccessful pregnancies at the cost of nearly fifty grand just to get to this point. Not all of my six embies will be euploid. Even if we do transfer a normal embryo, it still may not result in a pregnancy. Even if it did, I could still have yet another miscarriage. It still feels so elusive.

I had projected that we would end up with four to six blasts, so I was quite happy to be on the upper end of my prediction. "That's all?" replied Husband "Now it's my turn to be disappointed. I was hoping for more." "Shut the fuck up and be reasonable!" I shot back. "Nearly fifty percent of our fertilised embryos went to blasts! Do you know how astonishing that is?" Even as I was admonishing him, I could appreciate from where he was coming. As infertiles we have to accept that not all our eggs will hatch into chickens, while we watch fertiles score with just one shot. Yet, don't think for one second that I don't know how fortunate I am. I know there are so many women who have been waiting twice as long, if not longer, who have spent twice as much, if not more. I know there are many who wish they could be in my position.

They would not listen, they're not listening still

Perhaps they never will 

Epilogue:
In the summer of 1995, I went with my parents and their friends to see Don McLean perform in an outdoor amphitheatre on the campus of Western Connecticut State University. He waited until darkness fell so that he could close his set by singing Vincent under a starry night sky. He held the last note of 'they're not listening still' for a few extra seconds, and then extended a pause before piercing the silence with the closing line, 'perhaps they never will..' It gives me chills as I reminisce, until I remember that he came back on stage for his encore and led an audience of old hippies and drunk college students singing a rousing version of American Pie.