I've previously written a few posts that have attempted to disconnect the association between fertility and relaxation, and I have been careful to mention that I'm not advocating for stress. Stress reduction has important benefits for mental and physical health, but a relaxed state will not necessarily enhance fertility. However, my recent conversation with Myrtle is making me reconsider my position on stress. She suggested that Husband and I take a trip to Hawaii after a transfer. Eye roll. Face palm. Head shake. God Damn, fertiles just cannot get off that vacation notion. Apparently, one must be on a sandy beach with a Mai Tai in hand in order for implantation to occur. Of course a fertile wouldn't understand how stressful it would be to try to coordinate a trip around the time of a transfer. Nor could she appreciate that it would be hard to fund an FET and a holiday in the same month.
Although many have commented about how tolerant I am of Myrtle; I have a bit of a confession. The academic in me really enjoys schooling her when she comes up with some pretty ridiculous shit. "Jane, your job is so stressful. What if you just took a few days off?" Once again, we ran that play last time. My transfer was on a Wednesday and I had PTO for the rest of the week. I worked on a presentation, which was more time consuming than a stressful task. To complete the relaxation cliche, I had a facial and a massage. Since XYZ won't assign a time for my transfer until the night before, I have arranged to take the entire day off, so that I'm not cancelling patients at the last minute, although on two of my transfers, I could have worked through the morning session. I've just wanted to avoid the clusterfuck that occurred with my first transfer.
When my RE called with my fertilisation report, he tried to assure me that we would be able to transfer on day 5, but I sensed he was holding something back. Three days after my retrieval, my cat Angus followed me from room to room and repeatedly meowed for no apparent reason. I know it sounds crazy, but I felt he was trying to tell me that I would be transferring that day. Shortly after I arrived at work, my medical assistant informed me that a radiologist was calling with a stat report. As I was the only provider in the office at that time, I had to take the call.
It was a patient who had recently miscarried and the radiologist suspected she had retained products of conception. My colleagues and I have often observed that the radiologists tend to over read retained products. However, this radiologist just wanted an answer, what did I want to do with her now? During this time my phone rang, displaying my RE's office number. Oh fuck. It was barely after 9 AM and he was calling as soon as he arrived in his office. This was not a good sign. I had to let the call go to voicemail. Meanwhile, I needed to deal with this patient situation.
I called my colleague who had seen the patient and ordered her ultrasound. It was her day off, but fortunately she answered her cell phone. She shared my skepticism on the interpretation and noted that the patient wasn't bleeding too heavily, so she thought she could be managed medically. I called in the prescriptions, had my medical assistant schedule a follow up appointment for her and asked our nurse to go to the radiology suite to review the instructions and plan with the patient. Surprisingly, this only took ten minutes.
When I was finally able to call my RE, he had already started seeing patients. I waited on hold for over ten minutes, before I hung up and called back to inform them that I couldn't wait any longer. I now had three patients waiting in rooms and I was running twenty-five minutes behind. "I'll pull him out of the room" Misery offered. Another bad sign. Five minutes later he came to the phone and delivered the recommendation to proceed with a day 3 transfer. I had promised Husband that I would call him as soon as I heard from my RE, but I had to start seeing some patients. Especially if I were going to be leaving the office early.
Fortunately, those first three patients were relatively straightforward and weren't too upset about the long wait. I brought Husband up to speed and then called my RE again. During my freak out over the possibility of twins, he let it slip that due to my 'poor prognosis,' it actually wouldn't be unreasonable to transfer three embies. I wondered if we should proceed at all. Disaster was written all over this plan. I told our office manager that I would have to leave for the afternoon to tend to a "family emergency," which was technically kind of true. I rushed out of the office leaving a mess of paperwork on my desk, phone calls unanswered and I only glanced at my results to see if anything was urgent.
Husband and I talked during the drive to XYZ Fertility Centre, which prohibited me from drinking the required amount to fill my bladder, as it wasn't sufficiently full by the time we arrived. The hottie embryologist described that our embies weren't too bad, if we only had more, we could have held out until day 5. I was questioning my decision to proceed with these two as my RE was placing them inside my uterus. My thoughts oscilated between panic about twins to fear that the entire cycle was a bust. I felt extremely tense during this transfer and it was the most uncomfortable of all four procedures.
For almost a year, I have been trying to understand how an abnormal embryo of mediocre quality could implant under unfavourable circumstances, while three superior quality embryos failed in an allegedly ideal transfer situation. Did the stress of that day have a positive effect? Was there something about my release of cortisol or endogenous adrenaline that helped implantation? I've argued against the "just relax" theory by pointing out that pregnancies occur in many stressful situations, physicial attacks, famine, war, etc...We often see a bump in the birth rate nine months after a natural diaster or other catastrophic event as people decide to do something life affirming. Once I countered that as Husband has decreased sperm production and I have a long follicular phase, we may be too relaxed!
I acknowledge that I'm absolutely grasping at straws, but it did spin some wheels in my mind. Should I try to induce some stress into my transfer day? I thought about not taking the day off work, maybe calling in sick for a morning transfer, or trying to work in the morning if I were scheduled in the afternoon. My conscience forbids me from doing that. I hate cancelling patients at the last minute. Instead, I looked through the schedule for the week and made recommendations for my medical assistant on where she could reschedule patients. Maybe we'll get delayed by traffic, although that's unlikely as Husband will be scouring the traffic reports and will build in plenty of 'oh shit' time. The fact that I have to keep a super full bladder is nervewracking. Not only is it physically uncomfortable, I worry my cup may runneth over. I'm scared that it will be another difficult transfer and I'll feel doomed right from the start.
Thus, I suppose the situation alone should represent enough stress. This is our fifth transfer within a year, and possibly the penultimate one. We running out the clock. Our enthusiasm, our patience, our resources and our hopes are all fading. I feel a particular sense of desperation that I didn't have a year ago. Maybe that's just the difference I need.