Can't Buy Me Love

The HBO premiere of The Normal Heart truly had a profound effect on me. As I wrote previously, the film encouraged me to reflect upon my personal and professional experiences with HIV and AIDS, and it made me confront the inevitable decline and death of my beloved cat, Angus. I've kept it on my DVR's playlist, and it has now become my choice for background noise while I'm cooking or cleaning. One day, perhaps in an effort to procrastinate from my chores, I started to Wiki search the bios for the actors in the film, and I discovered that half of the main cast are gay. I know that performers do not like to identify themselves as a 'gay or straight actor' in a 'gay or straight' role, but it does add an element of authenticity to the mission of the production.    

I also took note that one actor has three children with his married partner via surrogacy. I almost never think that a little everyday person such as myself, ever has anything in common with a celebrity, but I was more struck in this situation. He's fluent in my language. He knows the terminology of a day 3 embryo or a day 5 blastocyst. He understands the significance of rising HCG quant numbers after enduring a two week wait. I never would have imagined that our worlds could overlap in any way.

Last year, when it was announced that Jimmy Fallon and his wife had a baby with the use of a gestational carrier, he was praised for speaking openly about their fertility struggles. "It wasn't a secret, my wife and I had been trying for a while to have a baby. We tried a bunch of things... and one who's tried, knows -it's awful. So, we had a surrogate." While I appreciated his sincerity to identify with the common infertile people, my inner skeptic couldn't resist this critique; yes, but it's a little different when your monthly pay cheque covers the expenses of surrogacy. I scoffed when a fellow blogger wrote about disclosing her infertility treatments to her boss, who responded, "I watch Bill and Giuliana, so I understand." As if that made her capable of relating to someone else's infertility experience. I've since done a little Wikipedia research on the Reality TV couple, and while I don't want to come across as if I'm celebrating their struggles with a BFN and a recent miscarriage, I appreciate that their show illustrates the facts that IVF and even surrogacy aren't guaranteed solutions.

A few months after Jimmy Fallon joyously announced his new arrival, actress Aisha Tyler opened up about her experience with infertility and the disappointment of unsuccessful treatments. Presumably diagnosed with a diminished ovarian reserve, she went through the ultimately futile exercise of self administering stimulation injections in pursuit of a 5% chance for a take home baby. Even if cost is not a barrier, it still difficult to accept the option of donor eggs. I know many have commented on how hard it must be for me to work in obstetrics while infertile; but I truly felt for Aisha, as a pregnancy had been written for her character on the (brilliant) animated series Archer. Perhaps it was a little easier, as she only had to look at a cartoon version of herself in a pregnant state, but I imagine it still stung. I'm sure there are other actresses who have had to portray a pregnant woman or a mother, while struggling to conceive themselves. Some actresses best known for playing many maternal roles, whether by choice or biology, never had any children in real life.

When I first made the observation that the aforementioned actor and his partner were versed in the REI adventure, my initial reaction was akin to Husband describing his friend who needed to go through IVF due to his vasectomy; it's just not the same experience. Yet, after giving it some more thought, I had to concede that their situation is actually much more daunting. So many more decisions; selecting a surrogate, anonymous egg donor or asking family member in order to increase genetic representation, determining whose gametes will be used. Not to mention the challenges after conception. I've known some lesbian couples who each became impregnated with the sperm from the same donor, so the siblings share a genetic link and both women experienced a pregnancy. I've also had to have some awkward conversations with my lesbian patients and their partners advising who likely has better eggs, or who would be more suitable as the tummy mummy.

During my most recent stimming cycle, Husband opened up to his physical therapist, who revealed that she and her wife went through IVF at the same REI clinic. They decided to transfer the embryos fertilized with the younger partner's eggs into the other woman's uterus. This was perceived to offer the best of all worlds, one had a genetic connection, the other a biological one, and as both embryos successfully implanted, the boy/girl twins are full siblings. She shared that they experienced a few miscarriages and BFNs as well and offered some 'don't give up hope' encouragement. When I attended the infertility conference almost two years ago, one RE admitted that he requires a psychological evaluation for any same-sex couples seeking his services, and I called him out for engaging in a discriminatory practice. The physical therapist revealed that my RE's partner who did their treatments, asked them at least 3 or 4 times if they planed to stay together. My RE has never inquired about the status of our marriage and we engaged in a 36 hour silent treatment stand-off just last week!

While I was working in Connecticut, I cared for a patient who was serving as a surrogate for her brother and his partner. They used an anonymous egg donor, and transferred two embryos that were fertilised with sperm from each man. At the time of her visit with me, her RE had already confirmed the successful twin pregnancy. As it was still really early in my career, and this was one of my first IVF patients, I thought IVF worked that easily. I now have a much greater appreciation for the fact that only one or no embryo could have implanted. She was ten weeks along at the time of her visit, which is always my favourite time to scan, as the foetus actually looks like a baby. I've done ultrasounds with thousands of couples, but the reaction of those two men is among my fondest memories. Seven months later, I contacted the  L+D Nurse Manager to request an exception to the one support person in the operating room policy. She agreed, and both dads were present during the Cesarean birth.

I know I shouldn't have such trivial concerns, but I do fear that when I go public with our IVF journey (hopefully with a pregnancy announcement) that I'll be labelled as an elitist within my own little microcosm. It is important for me to be very honest with the details; not only did we need to do IVF, but it took X number of cycles and transfers. My bet is that Myrtle's father will be the only one tactless enough to ask straight out what we've spent; but inquiring minds want to know, and it's not too hard to do the maths when you know the base price of a cycle (which doesn't include meds or many other hidden expenses). I can picture Michael Scott gossiping with our practice manager, 'well isn't it nice that she could afford IVF.' Mostly, I feel for one of our front desk receptionists. She saw me as a patient a few years ago; she had irregular cycles and her husband was diagnosed with male factor issues. I know that even if they scraped and saved for a few years, it would be a stretch to finance just one IVF cycle.

Financial resources may provide a means to obtain treatment, but money can't alone defeat infertility. No one is immune. Jimmy Fallon is right. Any couple who cannot procreate with their physical act of intimacy knows -it's awful. I've had to accept that fertility is not mine to command. So have many others.