Unexplained

There are some things in life that people tend not to talk about. Depending on your family and cultural background, your personality, and exactly how the unnamed "thing" affects you, that list may be short or long. When you're an introvert from Minnesota (ahem) shortening the list of unmentionables can sometimes seem a lofty goal.

I created this blog first as a way to leave a record for Maisy - a virtual photo album with accompanying narrative, mostly focused on her with a little of the rest of us thrown in - and second as a way to help stay connected to family and friends who we may not see as often as we would like. Of course, as photo albums and notes to family and friends tend to do, this blog presents an edited view. There aren't (many) images of Maisy having a meltdown. (And certainly none of me having a meltdown.) Many of the mundane details are missing. And often many of the complex ones, too.

I have been thinking about whether I could/should/might leave some record (for myself? for Maisy?) of something that I have held very close to my chest for more than five years. I have come to the conclusion that I will. It's quite a bit easier to share about something when you're on the other side of it. I am. We are.

So what's this mysterious topic? Infertility.

Dave and I started dating in 1997 and were married in 2003. In about 2008, having grown together over the past decade and built a strong foundation for our family both in our relationship with each other and in our professional lives, we felt ready to add to our family. Some number of months into this exciting endeavor, the giddiness of trying to conceive gave way to the disappointment of charting my basal body temperature and other biological details. It gave way to wondering whether something was wrong.

We tried to conceive on our own for about a year before consulting with a reproductive endocrinologist at UCSF's Center for Reproductive Health. I had some tests. Just a few, mostly bloodwork, but also a hysterosalpingogram (there's a reason it's known as HSG). Everything came back looking great, to which we said: Good?

"Unexplained infertility," the doctor said.

The 2009 treatment plan was intrauterine insemination (IUI) with injectable medication. This meant that I self-administered a subcutaneous injection -- a follicle stimulating hormone -- into my abdomen on a daily basis for a week or more. The goal was to stimulate the development of eggs (yes, eggs), then to trigger ovulation with the injection of a different hormone, then using a catheter insert sperm into the uterus. Sperm, meet egg(s), and baby results. Right?

Why on earth would this be a private topic?

I'm kidding.

In 2009, we were lucky. Although the first round of IUI was not successful, the second round resulted in a healthy single embryo. That embryo grew, I had a normal and healthy pregnancy, and on June 21, 2010 Maisy was born!

Immersed in pregnancy, and then in parenting, the emotional memories of trying to conceive faded. We thought, "See, look how well my body handled being pregnant! It will be easier the next time." We were wrong.

I'm not even sure how long we tried on our own before returning to the specialists at UCSF. Certainly at least a year. Once we did return to UCSF, our doctor agreed with the positive part of our general view: things worked so well the last time! So we made a plan to try IUI again.

In mid-2012 we began fertility treatment again, and went through three unsuccessful rounds of IUI. I suppose it bears mentioning that while each round is more or less a month, there was always at least one off month in between, because the drugs had so stimulated my ovaries it would have been unsafe to stimulate them again until they had calmed. After about six months and three failed rounds, we decided to take a break. Among other things, we were in the thick of things with the renovation of our home. Stress levels were high. It wasn't the right time.

In mid-2013 we returned for two more rounds of IUI. Doing more IUI was our choice; we felt that our stressful life circumstances had impacted the previous three rounds. We felt very positive that it would now work. Unfortunately it didn't. And so we left the minor league of IUI for the big time: in vitro fertilization (IVF).

IUI was not fun. Injecting yourself in the abdomen with hormones is not fun. The effect of said hormones on your body is not fun. Having internal ultrasounds every few days to check follicle growth is not fun. Being inseminated by a catheter? Also not fun.

But IVF? IVF was a different beast altogether. Yes, I resumed subcutaneous injection of hormones, but the protocol was more complex and involved much higher dosages. I injected a cocktail of hormones designed to firmly take control of my body's reproductive cycle. Imagine: for IUI the hope was that I might ovulate one-to-three eggs. For IVF the hope was to retrieve as many eggs as possible.

Such high levels of hormones caused physical and emotional discomfort, and also brought with them a list of restrictions. I couldn't run (or do any high-impact exercise) lest my gigantic ovaries twist or torque. Even low-impact activities such as yoga included warnings and restrictions. Did I mention I also wasn't supposed to drink alcohol? Ugh. I felt "pregnant" but I hadn't even ovulated yet.

Finally, in February 2014 I administered the final subcutaneous injection: the hormone which would trigger my body to ovulate. Two days later, I had outpatient surgery to retrieve the eggs. When I woke up after the surgical procedure, I discovered a note in Sharpie from the medical team on my right palm:

Fourteen. They had retrieved 14 eggs! These eggs were whisked away to the adjoining laboratory, where innumerable of Dave's sperm waited eagerly in competition to be selected by the doctor to fertilize an egg. Ten of the eggs retrieved were mature, and all 10 were fertilized. Of the 10 fertilized eggs, one was discarded, leaving nine embryos to grow in the laboratory. Three days following the retrieval, I took a Valium (easily my favorite part of the whole process) and returned to UCSF where two embryos were implanted in my uterus. (The remaining seven were frozen.)

And then the next stage began. I took the steroid methylprednisolone for five days. I began taking a progesterone supplement, as well as an estrogen supplement. Somewhere in there -- post-stimulation and -retrieval, during steroid, during the early days of estrogen and progesterone supplementation -- I lost it. I was not myself and I was very, very sad. In time I began to feel better, but a few days before my scheduled pregnancy test (a blood draw to test for levels of HCG), I started to bleed. The procedure had failed.

After we had a chance to grieve and to gather ourselves to think about moving forward, I spoke with my doctor. We still had seven frozen embryos, and we could try again. He advised me I should think of it as a 50% chance, not a full chance. The embryos were, after all, part of the same cohort that had just failed. In spite of the lukewarm chances, we were not ready to go through another retrieval (the procedure was expensive, not to mention all the other things I mentioned), and we decided to try once more with our existing embryos. The medical team developed a calendar for my medications and procedures. Plans were made to thaw two embryos, or possibly three depending on how the embryos had been frozen.

My calendar of medications in April and May included an estrogen supplement (transdermal), a hormone to suppress ovulation (subcutaneous injection), progesterone (now to be administered daily by intramuscular injection into my glute/hip area), and the steroid methylprednisolone (oral). I was happy when I reached the morning in early May where I was directed to take a Valium. Finally a medication with a pleasant effect! I would have enjoyed the buzz anyway, but of course the Valium was prescribed to help me relax for the embryo transfer. That day at UCSF the team transferred three embryos into my uterus.

After the embryo transfer, I finished up my steroid prescription and continued on with the estrogen supplement and progesterone injections. I hovered in a strange place: not positive, not negative, mostly focusing on doing as I had been instructed and trying to keep both feelings of hope and of despair at bay.

This time, hope prevailed. My pregnancy test was positive. And the next one was, too. (I had them at intervals, so the doctors could observe whether levels of HCG were rising appropriately). At an ultrasound appointment in June the doctor found a single embryo. I was pregnant!

Our relationship with fertility treatment did not end there. I received a daily intramuscular injection of progesterone for the first 12 weeks of my pregnancy. Dave was usually my kind and capable administrator of progesterone, although at one point when Dave was away, my friend Katie stepped in to help with the injections. And later in anticipation of another period of days apart from Dave, I learned to self-administer the injections. I continued estrogen supplements, too.

Finally, in July I made it through my first trimester of pregnancy, stopped the injections and supplement, and "graduated" from the care of the fertility team to a regular obstetrician and midwife. We began to relax and to look forward to the arrival of Maisy's little sister, anticipated around January 20, 2015.

At first Maisy suggested her little sister be named Diamond-Laura Sparkle-Shine. I believe this is in homage both to some characters from "My Little Pony", which she watched on the airplane that summer, and to me. In that order. Later she changed her preference to Jenna, which is the lovely name of one of her beloved preschool teachers. Dave and I had a few ideas of our own.

Elizabeth Audrey Brown was born December 20, 2014. Welcome, beautiful child.

A pause.

I worry in re-reading what I have written that I may appear to be complaining, a "look at all I went through!" sort of thing. That wasn't my intent in writing this. That isn't what I took from this experience. Yes, it was difficult. Of course it was worth it. I just wanted to write it down; it feels like some kind of closure on the experience of infertility. And maybe someone will find it interesting. Maybe someday Maisy or Elizabeth will want to know. So here it is.

I am also conscious that whatever I went through in trying to conceive, it was all our choice. Dave and I have close family and friends with both chronic and acute illnesses; their journeys involving medications, procedures, and the successes and failures of these things and of their own bodies are different. By no means do I think my experience compares. And yet: because it was my experience, it is the story I have to tell.

I am so grateful that for our family this story has a very happy ending.