Yesterday was ER (egg retrieval) day. (Scroll down for update.)
It started out fine. A long drive to our clinic from the dear friend’s home where I’ve been staying after a late pick-up of the LP at the airport the night before. I was nervous but relieved to be at this point. The road has been long enough already.
The LP expressed worry about my having to be under conscious sedation. I was not worried about this. I was too busy being relieved about not being under general anaesthetic because I get wicked blood pressure drops (and my BP is on the low end to begin with) and severe nausea despite fasting, both of which need to be treated in advance of and during the surgical process. I know this from the two missed miscarriages of our five losses, both of which have required surgery under general anesthetic. The most recent of those surgeries was performed a short 3-ish months ago, in late September. The first was in January 2011. I remember each of them in greater detail than I would like.
Knowing that I would need an IV for ER, I tried to prepare myself emotionally for the possibility that I could be triggered by the ER process to relive some part of our most recent loss. I thought I had things in check. Wrong.
There is something to be said for private medical care (I live somewhere with public health care, where private care and queue jumping is a big no-no, save for fertility treatments by and large). No waiting area pre- or post-surgery with scads of other women who are either having D&Cs or other nerve-wracking reproductive organ surgeries (I live somewhere with a women’s hospital, at which both of my D&Cs have been performed). No recovery room with the same scads of women, in which most recently I cried and cried and waited far longer than I needed to because the porter took the wrong patient back to their room first and then disappeared for an inordinate period of time.
On the private-care positive note, in addition to the traumatic memory inducing hospital “gown” (a sheet with two strings at the otherwise open back is not a freaking gown, people. Really!), the clinic to which we’re paying gobs of cash provided me with slippers and a white hotel-style housecoat and a locked cupboard in which to store my things, as well as heated blankets at every step of the process. Nice!
After offering up a urine sampe (to confirm the hcG shot worked), I was instructed to sit in a big comfy chair (nice again!). I did so and took note of the IV stand and saline bag beside that comfy chair. Hmn. Despite my mental preparation, I was struck by a sudden sense of dread and a sharp memory of that September surgery to remove lost baby #5.
I looked at the LP, seated on a not-so-comfy chair beside me. “I can’t help thinking about the surgery on September 24th”, I said, mindless as to how this might affect an already worried-sick and by nature deeply anxious LP. I went on to say that I bet if I had any surgical procedures requiring an IV – dental surgery, even – in my 50s, I had little doubt that my association would still be the D&Cs I’ve gone through. I said maybe this experience will be positive and I will be able to have a new association for IVs.
It was too late. I had already “gone there.”
A few minutes late, the IV was installed in my arm and I was walked into the OR. I had to climb onto the operating table, which was the same kind used for my D&C surgeries. The kind with a hollow into which your bum has to rest and legs that will be split and your legs kept on them as the procedure is performed. I began to cry immediately. Quietly. Trying to keep it together. For whom? I have no idea. I was already reliving past traumas and the LP was no longer with me. I may as well just have lost my poop altogether, but I held on. Until one of the nurses asked, “have you had any surgeries before?”
Do these people read my freakin’ chart or what?
My answer was yes, most recently in September for a D&C due to a pregnancy loss, which was making this experience feel “really shitty”. Exact words. Let the sobbing begin. The Question Nurse offered me tissue and I tried again to compose myself upon dabbing at my eyes. I suddenly wished to leave this whole experience behind me and longed for the conscious sedation to render me unconscious instead.
Wish granted. I was out like a light in minutes. Amen.
When I awoke, the nurse told me that the RE collected 5 eggs. Yay. Five of my six follicles gave up a mature egg. That was good news (in relative terms).
Then more bad news. Or so I thought. The LP couldn’t come up with a sample of fresh sperm. He had a second-chance appointment in one of those private rooms. I tried to help. No luck. I waited while he tried on his own again. While I waited, one of the embryology lab team members who had talked to us before the ER came and spoke with me. He said that the LP should stop trying, the lab would use the frozen sample we had the foresight to have the LP collect in November, when I first realized he may not be able to perform in the high-pressure climate of ER day. Amen for that, too.
Even though the embryology lab team member told me that in no way would using the frozen sample compromise the outcome since we are using ICSI (for male-factor infertility or MFI issues), I was furious. I wasn’t upset that the LP hadn’t succeeded on ER day, but that from my perspective he had made no efforts to attempt to ensure a different outcome on ER day, i.e., he hadn’t practiced, or taken any initiative to make sure he could weather whatever storm came his way on this critical occasion.
On this basis, I berated the LP for a good chunk of the drive back to my friend’s home. Being “impaired” (as the nurse advised me – no driving for 24 hours) did not stop me. I demanded he tell me how he had taken any steps to fulfill his small role in this process on the critical day. He fell silent – as one often does when being verbally assaulted by someone and as the LP usually does if faced with an emotional tsunami. Eventually I softened and asked him to speak, leaving a space for him to do so.
He told me that he had planned this day for a long time. But then when I mentioned the D&C in September, all he could think about was our past losses and his fear for how this all affects me (and I’m sure his anguish over how it has all affected him, though the LP would volunteer that). He had not planned for that. He had not expected it or seen it coming. He was completely derailed and could not get those thoughts out of his head, kyboshing every intention he had brought to ER day. In addition, he was flooded with fear about things not working this time and us suffering yet another loss.
Of course. Why hadn’t I thought of that? Where was my compassion? If I had been thrown into a PTSD-like hell in the OR, immediately after voicing the association I could not shake, and had myself abandoned all hope of being the calm, peaceful, hopeful IVF patient I had intended to be on ER day, how could I expect anything different from the LP?
Humility has been my travelling companion on all critical journeys in my life. Thank you, Humility, for reminding me how much I have yet to learn about being a good person, spouse, friend, mother. And thank you, LP, for speaking up.
I cried some more and saw the LP’s tears in his eyes as he drove on. We resolved to keep working on communication and candour at all stages of our journey together. He acknowledged that keeping what plans he had made for ER day and the efforts he had put into planning fueled my sense of doing everything and him not being a team with me in the IVF process, and facilitated my misconceptions. By shielding me from his inner dialogue, he had shut me out and I in turn felt alone and shut out. I apologized for having jumped to conclusions and resolved to listen and check in, reminding him that mind-reading is not in my skill set.
Most importantly, I was flooded with compassion for each of us and determined to reassure ourselves about frozen versus fresh sperm. Some research revealed another source of humility. Studies show no statistically significant difference in effectiveness of frozen relative to fresh sperm in IVF with ICSI. In fact, one study’s results indicated a small but consistent (though not statistically significant, according to the authors) advantage with frozen over fresh sperm when ICSI was used.
Head down. I should have looked that up first. I should have trusted the embryology team member who told me the same thing. I should have made space for the LP to tell me his experience instead of launching into my frustration and disappointment, no doubt making him a scapegoat for all of the anxiety and disappointment of this cycle to date.
In the end, I felt closer to the LP and I hope he felt closer to me. And I truly hope that the call we get this morning from the embryology team will bring good news. In an ideal world, all five eggs would have fertilized and survived the ICSI process of being injected with a single sperm. I know this is not a realistic outcome. Yet I know I will be disappointed with less. I know, too, however, that I am supposed to trust the intentions I set and the efforts that the LP and I have made to effect our intentions, then place my faith in the Universe and let go.
And so, with yet another deep breath and a fresh round of prayer, I plant my feet on the ground and envision roots growing from my soles into the earth and spreading out to anchor me. I imagine my arms as branches from which seed-filled pods have grown and await distribution with the help of time, wind and rain.
Okay, Universe. Your turn.
UPDATE: Universe, you can be so cruel. I will trust in your wisdom notwithstanding the fertilization report this morning (Three were not dividing this morning. Two fertilized, one of which is abnormal. The embryologist said she was very surprised because the sperm were normal and eggs were mature. They chocked the result up to my age. Always the way of Western medicine to lay blame. Tired of it being on my doorstep just because “we don’t know why” isn’t acceptable in science. I have shed my tears and am now resigned and simply hoping our wee embryo hangs in there for our Day 3 transfer on January 6th).