Sometimes, Treatments Fail~ By Leah O.

Writing this post today I find myself surrounded by a half dozen cats and dogs, my Starbucks cups dripping with condensation. Outside of the occasional bark or meow my home is quiet. I suppose for many this would be a peaceful place – but often it feels like a dark reminder of the holes within my home. Within the next three days my next menstrual cycle will start, and my husband and I will begin trying for the sixty-sixth cycle in a row. Officially five and a half years of actively trying to conceive. Approximately 21% of my life, my entire marriage, and nearly my entire 20’s. These months have gone by in a slow torture of pee cups, test strips, and tears. Yet despite that, it has flown by. I count the months individually, but when I look back, I can hardly remember that hopeful girl in Cycle 1. It is all a blur of repressed memories… except those months where treatment failed, those cannot be lost in time. They are singed into every synapse I have.

                  After years of battling with doctors to take our infertility seriously a series of testing revealed that Stephen and I were dealing with a severe case of male factor infertility. Outside of a medical miracle the odds of us ever experiencing natural conception were basically: zero. It came as an absolute shock as years of societal conditioning had told me it had to be my problem – fertility is a woman’s issue, after all, isn’t it? All it took was one semen analysis to break that wall down and reveal the truth. Infertility is a reproductive issue regardless of sex, race, or financial position. Finally armed with the facts we ran full steam ahead for our next course of action, IVF with a reproductive endocrinologist.

                  Cycle 32 was filled with joy and hope. As a first time IVF couple we were excited about the possibility of becoming parents. By all initial indicators we would find success with this treatment. We were young, heathy, and I had great hormonal testing. We expected to get lots of healthy eggs and end up with multiple embryos. I remember quite frequently telling Stephen, “We could be making all of our children this month! Isn’t that crazy!” Through the anxiety of stimulation and the fear that came with the egg retrieval we held onto the belief that this month would be different. We would be ending this cycle with a beautifully photographed announcement and applause heard around the world (literally, we have friends in a few continents!) This state of euphoria stayed strong after our egg retrieval brought 22 eggs, 19 of which were mature and considered beautiful upon visual inspection. Even as I write this today, I can still feel that jittery anticipation as we gowned up for our transfer. My husband, ever so handsome, looked like an absolute goof in his gear and I could not stop sneaking photographs. We would surely want to remember this day. But as our doctor came into our little corner of the office, we knew something was wrong. Her grip on her notes was just a little too tight and the smile on her face was forced and unnatural. This was not the positive doctor we had always experienced before. She spoke in a steady and even tone, doing her best to ensure that we would understand. Just five days prior we began with 16 successfully fertilized eggs, but as we sat in that chair, we had one “early-stage” blastocyst and two weak morulas. The doctor put forward a plan to transfer the one “early-stage” blastocyst and strongest morula, allowing the other embryo to transfer for one more day to be frozen or discarded. My brain made an audible crashing sound as these facts came out; my world felt like it was literally falling. I shuffled into that transfer room like zombie. I could barely manage a “yes” to confirm the identity on my arm band when the lab technicians came in to double check. I could barely force myself to watch the transfer on ultrasound, it was too painful. As I sat up everyone in the room was grinning ear to ear and wishing me luck as they handed me a photo of my embryos. Congratulations and good luck echoed around the room. Despite this joy I felt empty. I cried the entire 90-mile drive home. A week later the phone call came and when I heard my doctor on the other end, I knew it was not going to be good news. That same stern and solid tone was back, not the joyful playful voice we had always known. “I am so sorry Leah. Your results came back at 0. There is no indication that your embryos tried to implant. This cycle is over.” I remember laughing awkwardly and telling her it was okay before rushing to hang up the phone, I did not want her to hear my pain.

                  Cycle 49 brought us back for our second round of IVF. After a little extra testing we could not find any rhyme or reason why our embryos were so low in quality. The doctor proposed some medication changes and we thought for sure it would help. Our last cycle had to be a fluke – we were young and healthy after all, remember? So, with the same enthusiasm and force we rushed through stimulation and held hands until we had to part for the egg retrieval. This time the doctor harvested 14 eggs. I was immediately uneasy about this number, though she swore to us that it was great. Our goal all along had been to collect less eggs in the hope they would be better quality after all. I repeated that to myself for days as we waited for our transfer day to come. This time there was not the fun picture taking in the dressing room and we surely were not chatting about how our entire family was in a petri dish somewhere. This exact spot is where our dreams had gone to die just 17 months before. Our intuition was confirmed to be accurate when the doctor told us that out of our five fertilized eggs, we had two low-grade morulas available for transfer. The doctor tried to tell us to keep hope and that the uterus is a much better environment than the lab, and they could very well thrive once they were transferred. It was hard to believe her, and as I laid back in those stirrups, I knew they were sending my two little morulas home to die.

                  Cycle 60 was a tumultuous round of IVF. We now knew that our problems were not a fluke, we had severe embryo quality issues. But all the tests on my husband’s sperm came back saying it was of great quality, the count was just low. All the testing on me was average, and the eggs were great upon visual inspection. But for some reason when they come together, they seem doomed to fail. Prior to this cycle we had done even more testing, invested thousands in searching for answers. We read book after book and began taking so many vitamins it was nauseating to look at our counters. We tried everything we could and tried to find the hope that maybe it was enough. With this egg retrieval they collected 22 eggs and I felt a bit of comfort, we had to have at least one embryo with that many eggs. But when the fertilization report came in the next day the person on the phone was literally left speechless and had truly little to offer in means of explanation or comfort. I was baffled, and so was she. Out of 22 eggs they had only gotten 6 to fertilize, even while utilizing the most advanced technology they offered. It was traumatizing, to say the least. But we had done okay with less before so when transfer day came, I chugged the Gatorade bottle by bottle and prepared to gown up once again. Except, when they called us back, we did not turn right towards the procedure room. Instead we took a sharp left and they seated us in the meeting room, a big round table with a box of Kleenex in the middle. I could not bear to look at my husband, I was so ashamed at how my eggs had failed us once again. Our doctor was somber as she walked me to the bathroom to relieve my bladder and she rubbed my back the entire way back to our meeting room. She broke the news that all our embryos had arrested and there would be no transfer. I remember asking her what we do next, to which she simply said, “I don’t know yet.”

Sometimes… treatments fail.

                  Failed IVF cycles for me have always left a feeling of great loss. Proudly magnetized to my refrigerator are two grainy photographs of the four embryos we transferred. While they never stuck and my HcG stayed at baseline I know in my heart that I carried them in my body for as long as I could. They went into me, they ceased to be, and I lost them forever. They are just as much a part of me as my right arm, but what does it mean? By technical definition it is not a miscarriage. It is not a tangible loss. It is this weird limbo of what should have been and what really was. I mourn the loss of my embryos every day and struggle to find a way to remember them appropriately without taking up too much space in my life. But outside those four embryos I transferred are the other 22 that never had a chance to come back to me. They expired in a petri dish in a cold, sterile lab and there is nothing I could do about it. Again, it is “nothing.” The statistics say that you will lose half of the fertilized eggs in the maturation process and it is not out of the normal. But my heart thinks about how it was a microscopic meeting of my husband and myself. It existed. It was something. And even if it does not make sense to me as a pro-choice woman, I hold space for those fertilized eggs too. How much loss can one heart hold? Sometimes I feel like I am at my max capacity – but I must find a way to create more space or we can never go through treatment again.

                  With IVF, for one month out of the year we can have hope, and the other 11 we mourn all that we have lost along the way. The spontaneity of reproduction. The romance in trying to get pregnant. The privacy that I used to have with my most intimate body parts. The comfort in knowing that someday we would have a family. How does one spend so much of their year experiencing pain in some level every day? I do not know. But as infertility fighters, we simply do. And we overcome.

                  When a treatment cycle fails there is only one option: survive. However long you must mourn, it is okay. If you are attached to what you lost in the process, that is okay. If you have no feeling towards it and wonder if that is normal, it absolutely is. If you want to rush into another cycle and immediately try again, you deserve it. If you are scared and unsure if you will ever be ready to try again, that is completely normal too. If you change your mind every day on where your journey goes next, that is to be expected. The thing is we have no guidebook for what to do when treatment fails. We know it if works you plan an announcement, prepare your home, and move onto that next big step in life. It is a simple 1-2-3 we are prepped for from our own births. But no one guides you on what to do when you have given your all and still come up empty. But for up to 67% of us following a first IVF attempt that is our reality. A completely unchartered territory that none of us know how to forage.

                  Sometimes treatment fails… but us? We never fail. As long as we, as individuals, are planning through what choice is best for our individual journeys we are succeeding. We are taking a cruel and unfair fate and reclaiming our reality. The treatment may fail, but we do not fail. We overcome. We survive. We will be okay.

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