The story so far

I'm Julie.  When I met Paul 8 years ago, we didn't think immediately of  having children.  In fact, I'd spent most of my 20s trying very hard not  to.  Unfortunately, I devoted significantly less energy to avoiding STDs.   My doctor delicately referred to those years as "your days of wine and  roses."  It would be more accurate to call them my days of dope and vodka,  but his phrasing is certainly more poetic, so we'll just go with that and move on.

I contracted chlamydia, which didn't seem important at the time, and HPV,  which did.  The chlamydia succumbed to a single course of antibiotics, but  the HPV was more worrisome.  Although I never had any symptoms at all  beyond abnormal Pap smears, I did need painful cryosurgery to remove the  abnormal cells from my cervix, and endured frequent followups for the next  year.  Oh, and let's not forget the humiliation of having to make some  very difficult phone calls to my many casual sexual partners.  "Hi.  Uh,  remember me?  No?  Well, um..."

This brush with grossness pretty much cured me of my promiscuous ways, and  by the time I met Paul in 1996 I was older, wiser, and somewhat more  prudent.  (Translation: I'd learned which end of the condom was the  business end.)  Our romance progressed apace; by September that year we  were living together in Manhattan.

There are certain things you just don't know about a person until you  share close quarters.  I didn't know about Paul's annoying habit of  leaving dishes in the sink "to soak," brimming with cold, gray, greasy  water.  He didn't know about my crippling monthly periods, five days of  the harpy — heavy bleeding, excruciating pain, and a junkie's need  for frequent large fixes of Advil.

And what I didn't know until I visited a gynecologist in 1997 was that  these were classic symptoms of endometriosis.  A laparoscopy revealed that  my insides were just riddled with the stuff, including one of my ovaries  that was almost turned inside out with it.  Because we weren't planning to  have children in the near future, I didn't ask many questions about what  this could mean for my future fertility.  At any rate, I was too psychotic  from the six-month course of Lupron that followed my lap to say much of  anything beyond, "TURN ON THE AIR CONDITIONING OR I WILL MURDER YOU IN OUR  SWEAT-SOAKED BED."

But by late 1998, having children began to seem like an option.  I  jettisoned my birth control pills and waited for nature to take its  course.  We weren't making any special effort, hadn't yet succumbed to the  tyranny of the calendar, so it didn't seem alarming that I hadn't become  pregnant by early 2000.

Then the efforts began in earnest.  Because I didn't want to pressure  Paul, I started keeping careful but secret track of my own personal  fertility cues.  Never was a woman more engrossed by mucus than I!  While  we agreed we were ready to have kids, I was determined not to turn our  sexual relationship into something mechanical and sterile, so while I was  toying with my cervix and watering OPK sticks on a daily basis, I was  trying hard to keep the more intricate plotting and scheming to myself:  Pee on a stick in the morning; frolic gaily in bed at night while seeming  not to have a care in the world; keep hips elevated for half an hour  while clenching teeth grimly; mark the calendar the next day and count  the days until my period inevitably arrived again.

Lather, rinse, repeat.   

I must have been insane, but I think I did a good job of hiding it.  Paul  swears I didn't make him crazy.  Good man.  Or fine liar. 

By late 2001, we'd moved out of Manhattan and had settled into a big house  in a small New England town.  We knew we were ready to have a family, and  we knew that I should have managed to get pregnant by now.  The first  doctor we consulted was an OB/GYN with no particular expertise in the  fertility arena.  He performed a painful HSG, an unsuccessful IUI, and  then, having emptied his meager bag of tricks, wrote a letter of referral  to the state's only infertility clinic.

After looking at the HSG results, Paul's sperm analysis, and my cycle  patterns (28 days like clockwork — the trains run on time around  here), the new doctor suggested a few more IUIs, just to make sure we'd  given the least invasive treatment a chance to work.  Clomid, hCG, and a  syringe full of love were enthusiastically and hopefully applied, but in vain.   

By winter 2002 we were shrugging our shoulders in puzzlement.  By this  time I was 31 and Paul was 44, and we both appeared to be healthy.  No  obvious reason seemed to exist for our inability to conceive.  So we  brought out the big guns and began our first IVF cycle at the end of  January 2003.

I started on birth control pills to regulate my cycle, then began a course  of Lupron to prevent me from ovulating prematurely.  Once my hormones had  been beaten into submission, I started twice-daily injections of Follistim  and Repronex, along with the Lupron I'd already been taking.  Twelve days  later, I was given an injection of hCG to mature the eggs that were  studding my ovaries, and on February 23, 7 mature eggs were retrieved from  11 large follicles.  "Perfect stim," my doctor said, patting my hand  before he left the hospital that day.

Unfortunately, the rest of the cycle went straight to hell shortly  thereafter.  On Monday I was told that only one of our 7 eggs had  fertilized.  For the next couple of days I agonized, worrying that our  single embryo would die before transfer.  We were briefly in luck, as it  grew into an 8-celled beauty, which we then transferred on February 26.   And I did get pregnant, as I found out in early March.

That's where my journal picks up.

In the pink

Today I peed on a stick and got two pink lines. The first positive pregnancy test I've ever had.

I am one smug motherfucker today.

I showed it to Paul, who was skeptical. (It's his job to keep me pragmatic, and I love him for it. Really. Stop laughing.) "Are you sure the shot's out of your system yet?" he asked.

Reasonably sure, since today is 9 days past transfer. But just to be one the safe side, I stole out like a thief this afternoon and bought three more pregnancy tests to use on the sly.

New Jersey, I am sorry.

I must hereby apologize to the lovely state of New Jersey. When your pristine shores are awash this summer in medical waste, well, that's my fault entirely. The syringes, needles, and vials from the stim drugs were bad enough. Now we can add about ten home pregnancy tests to the drift. (Can I help it if they come three to a box?)

And every one of them has been positive.

Blood test tomorrow morning to learn the magic number. I'm no longer worried about a false positive from the hCG shot. Now all (all) I have to worry about is the next hurdle on Wednesday: the all-important doubling.

Underachiever

I had my second beta today. The numbers are just okay. Not great — not the textbook doubling they like to see. I went from 129 on Monday to 226 today. That's a 75% rise, adequate, I suppose, but stellar would have made me happier.

But then perhaps I am asking too much. This uppity little blob of cells is, like, five minutes old and it's already making me anxious. It figures that any embryo of mine would fail to work to its full potential.

Unhappy cramper

I've started feeling strange abdominal cramps. I'm worried that something is going wrong. Obsessing about my uterus was a useful distraction, at least, from the horrible movie Paul and I went to see tonight. (Not even the delectably pockmarked Jet Li could save it, and I normally like the hitting.)

For the record, I refuse to believe it has anything to do with helping Paul move lumber yesterday. I keep chanting to myself, "Slave women gave birth in the fields and kept on working." I, cream puff that I am, need not worry about overexertion.

Aside from the sore breasts I've had since I began the progesterone suppositories, I had my first symptom of pregnancy tonight at the movie. Paul unwrapped a chocolate bar and the smell of it was so intense I had to get him to re-wrap it. It felt like an assault. It didn't make me feel sick, but, wow, sensory overload from a whiff of chocolate. Since then, I have noticed that everything smells like cigarettes. Some women get a lush new rack. Some women get lovely skin. I get a full pack of Camels crammed right up my nose. Thanks.

If something is wrong, there is, of course, nothing to be done. Third beta is tomorrow.

Fat lady, you're wanted onstage.

The news isn't good. My third beta rose from 226 on Wednesday to...269 today.

Dismal, dismal, dismal.

I've been asked to return on Monday for yet another beta. The nurse presented three possibilities:

1. a failing pregnancy;
   
2. an ectopic pregnancy; or
   
3. a meaningless statistical blip in an otherwise healthy pregnancy.

I sure would like to believe it's the latter, but I don't think that's a realistic hope. To say I am sad doesn't really cover it.

That Hallmark moment

My beta went up, so theoretically I'm still pregnant. And shocked to the core.

It increased from 269 on Friday to 713 on Monday — that's a 63% two-day rise.

Now the Internet, blessed fertility oracle that it is, tells me that's adequate, although certainly not ideal. (And getting medical advice from the Internet has proven so far to be a great idea.) But after our two-day stall last week, I refuse to get too excited.

Seems like I've been refusing to get too excited for weeks now. I was quietly smug after the first beta, cautiously optimistic after the second, and solidly grounded in determined pessimism by the third.

Goddamn it, I completely missed that Hallmark rush of elation. You know, the one where I present Paul with, I don't know, a tiny pair of booties and he looks bewildered for a minute, then breaks into a smile whose brightness rivals the sun. And then he lays his hand lovingly against my still-flat belly (not that it's flat to begin with, but this is my fantasy), and speaks in a hushed tone of wonder and says...

I have lost my mind entirely. See, I told you this whole thing fucks you up good. To be fair, we're not exactly Hallmark people to begin with.

I'm scheduled for a scan early Friday morning to see what's going on. By then my hCG levels should have risen, if they're going to, to about 1,200 — that's right around the discriminatory level for seeing a sac with transvaginal ultrasound. First we want to see a sac in the right place. Then, though I don't really dare to hope, we want it to be the right size.

Until then, I will be working very hard to will a comely little sac into existence.

Relatively good, absolutely bad

The good news is that we saw a gestational sac via ultrasound today. The bad news is that it's much smaller than it should be at this point. (It should be at 10 mm by now, and mine is only 5.)

So the good news is only relatively good: it just means that we can pretty much rule out an ectopic. Indeed, the doctor stirred the ultrasound wand enough to check out my tubes and ovaries, and they appear to be normal, with no fluid masses.

The bad news, however, remains absolutely bad. This is not a viable pregnancy. I asked my doctor if the sac could somehow catch up to where it needed to be. Because he is a kind man, he gave the appearance of considering it, but finally had to say, "I would be shocked."

This is what we expected to hear after the appalling lag last week in my hCG levels. But expecting bad news doesn't make it any easier to take when it's delivered at last; it just makes it easier not to look like you've been kicked in the gut.

Denial is a lovely name for a girl

This is the worst mindfuck I've ever had. I know my pregnancy isn't viable. I've seen the evidence myself on ultrasound. I've left no electronic stone unturned on my Internet quest for a single piece of research that could prove the ultrasound wrong. I've found nothing. I know it's over.

So why did I dream last night that we had a baby girl whose name was Lucy?

The best of three bad choices

A miracle did not occur. We were not surprised.

Today's ultrasound showed that the gestational sac had grown, but it was still about a week behind where it needed to be, with no yolk sac, no fetal pole, and obviously no heartbeat. If you don't have most of those things at 6 weeks 5 days, you're just not going to get them.

It confirmed what we already knew. I felt a dull sadness, a background version of the more turbulent feelings I've been having for about two weeks now.

My doctor offered three options.

I could wait to miscarry naturally. As far as I was concerned, this wasn't an option. On the one hand, you know beyond a doubt that the pregnancy is really and truly over. On the other, that could take weeks, and could happen in the supermarket checkout line. At this point, haven't we gone through enough without imposing more uncertainty on ourselves?

I could have a D&C. I briefly considered this, but decided I'd like to avoid that if possible. I worried about the pain of the procedure, and I worried that I'd have to wait for an appointment. I wanted it over.

I could take misoprostol, a drug that induces miscarriage. (It's usually used in conjunction with mifepristone, but in IVF patients the other drug is unnecessary.) It's taken vaginally, and it causes your cervix to soften and dilate; the ensuing contractions usually empty your uterus of the products of conception.

I decided on the misoprostol because it will cause a predictable miscarriage that I can endure at home, properly medicated, without surprises. I'll be inserting the tablets tomorrow, after which I intend to spend the weekend feeling hideously, operatically sorry for myself.