I was always more sure I’d have kids than that I’d get married. I told myself if I turned 32 and didn’t have a husband on the horizon, it’d be time to start thinking about adopting or choosing a sperm donor.
I’ve always had a healthy, active lifestyle. I’ve kept my skin out of the midday sun, never smoked, rarely drank. I recycled. I figured it’d be smooth sailing, and I was as giddily excited as I used to be before embarking on a trip around the world. As many books as I may have read, I still never really knew what to expect. And this was even more amazing, because we’d be creating a new human being. How crazy is that?
I bought the obligatory What to Expect When You’re Expecting and read it cover to cover. In a moment of exuberance, I even bought a maternity dress at Goodwill.
Then we “just relaxed” with the best of them. I knew it took a healthy couple an average of six months to conceive, so it was only mildly disappointing when I found myself not pregnant for the first few months.
Then in the fall, when I was on a book tour, instead of my cycle starting, I felt like battery acid was flowing through my chest. I had bouts of outrageous exhaustion, as if I’d been shot up with Valium, and moments of Extreme Rage and Impatience, which I called “Progester-Rages.” I was on a tour and among strangers, so I had to find a way to behave myself when the ‘Rages came. It wasn’t easy.
But it was magical. I felt an ineffable presence, and I felt lighter than air.
I was too smug to do something as quotidian as ask someone to drive me to a CVS so I could pick up a pregnancy test. Whatever this was, I was just going to ride it like a wave…
Even worse? I actually told people on the tour that I thought I might be pregnant. It seemed so cosmic and cool, why not share it with the people around me?
Well… It ended several days later, when I was back in Oklahoma for a quick PBS interview and a visit with my family on the way back to New York. Because I didn’t take a pregnancy test, I’ll never know if it was real or psychosomatic.
Either way, I was shaken, but not gutted. I knew (because I had studied) that about 20% of pregnancies end in miscarriage, usually in the first trimester. I figured it was just a normal setback. We were only on Month 4 anyway.
Back in New York, my doctor found a type of cyst on my left ovary that indicated I probably had endometriosis. I’d also been having mysterious, excruciating abdominal pains for the past couple of years. But I could knuckle through them. No big deal. (Piece of advice: If you’re having pain that you feel like you have to “knuckle through,” you should probably go to a doctor quicker than I did…)
The look on her face suggested this might be serious, but I was all sunny excitement and rose-colored glasses. My other ovary was fine, after all! You only need one, right?
(Endometriosis, I would soon learn, is a disease characterized by abnormal tissue growth in the abdomen that can cause pain, adhesions, cysts, and reproductive issues. Most women who have it can manage to have children, but for many it makes conceiving difficult and sometimes impossible, even if it’s mild and even after it’s cleaned up via surgery. Doctors aren’t sure why. Up to 10% of women have endometriosis, but numbers are hard to come by because you can only diagnose it through surgery, and many doctors are content to tell women to just relax and take an Advil.
Here are two lists of celebrities who have endometriosis, since we all know things are easier to bear when the rich and famous have to deal with them, too. Among them are Padma Lakshmi, Jillian Michaels, Susan Sarandon, Julianne Hough, Whoopi Goldberg, and Marilyn Monroe.)
My cyst just kept growing, though, and the pain kept getting worse. We moved to Oklahoma in the spring, and I signed up for affordable insurance through ObamaCare. (Yay!) By the time I was scheduled for keyhole surgery in April 2014, the cyst was the size of a grapefruit, and I had a brand new cyst on my right ovary.
When that second cyst appeared, I finally started to realize this might actually be a tough road…
The doctor found most of my internal organs glued together by adhesions (scar tissue). He was able to fix that, which got rid of most of my pain. But he decided the cysts were too big to remove laparoscopically. He drained them, which bought us some time, but eventually I’d need to be opened up to get those suckers cut out.
We kept trying for a baby, but with the cysts distorting things (including, possibly, the hormonal environment of the abdomen), we had little hope. We tried an IUI (intra-uterine insemination), which cost a thousand bucks, just to see if we’d get lucky. Nope.
In December 2014 my abdomen was sliced open and my ovaries were dissected. The doctor said the (now-orange-sized) cysts came out beautifully, very cleanly, and they should heal well.
But none of this stuff is exactly good for my internal organs. I also have mild hypothyroidism, which may or may not indicate autoimmune issues that could affect embryo implantation.
All in all, he said, if we really wanted kids, our best bet would be to head straight for In Vitro Fertilization (IVF) as soon as I healed from the surgery. Otherwise our chances are probably 5% or less per cycle (compared to 15-20% for a couple without endometriosis). We could easily try for two or three years without hitting pay dirt.
Plus endometriosis usually comes back within a few years of surgery. The best way to keep it at bay is through birth control pills or pregnancy (both of which put your cycle in suspended animation). The more time we spend not-pregnant and not taking birth control pills (i.e., trying naturally), the better chance we have of the disease creeping back in, necessitating another surgery and, probably, IVF anyway.
Doing IVF now is the only way to get our chances up to the same as couples without endometriosis in a reasonable time frame. In addition to putting more eggs in play, it takes a lot of steps out of the body, where things could go wrong, and makes them more precisely controllable.
(I wish, by the way, that I’d had any idea clear what endometriosis was or that I might have it or what it might mean when I was first having symptoms. If I’d known, I wouldn’t have waited until the wedding to start trying, and we might have had a toddler by now!)
If you’re not familiar with it, IVF is a process of using the same hormones your body produces, just in higher doses, to trick the body into letting several eggs grow and mature on the ovaries instead of only one. It doesn’t affect your ovarian reserve because the extra eggs would have died during that cycle anyway. A healthy woman loses about a thousand eggs per cycle.
A woman doing IVF can produce anywhere from zero to 50 or more eggs, with 15 being the optimal number. Your chances for pregnancy don’t increase if you get more than 15, but your chances for side effects do.
Once the eggs are mature, a surgeon removes them with a needle attached to an ultrasound wand, incubates them with your husband’s contribution, and lets the resulting embryos grow in a special medium, either into eight-cell cleavage-stage embryos (at day 3) or blastocysts with more than a hundred cells (at day 5).
It’s safer, arguably, to let them grow only to day 3, as growing them becomes more complicated after that, and half of embryos tend to die between day 3 and day 5. Some argue that only the non-viable embryos die, so there’s no real loss, but others aren’t so sure. Some also say culturing embryos outside of the body until day 5 can have unknown epigenetic effects.
Basically it’s still a young science, and there’s a whole hell of a lot nobody knows. Every individual body is also different, and each doctor has his or her own preferred protocol. You just have to hope the stars align in your favor. Fewer than 50% of IVF cycles, even for people at my tender age (35), are successful.
IVF costs about $15,000 a try in the US, which is extortionate if you ask me. A lot is involved, but not enough to justify charging the cost of a new car. Luckily there are plenty of other countries that do IVF, luckily our jobs are mobile, and luckily one of the cheapest and most popular IVF destinations happens to be my husband’s native country, Turkey. In Istanbul you can do a cycle — medications included — for less than $4,000. Still not cheap. But not ridiculous.
I’m also lucky in that I have few side effects from the treatment and don’t find it particularly difficult. What’s tough is the cloud of uncertainty hanging over our lives and the loss of thousands of dollars with no guarantees. And not having air conditioning in a stifling Istanbul summer.
The peaches, cherries, grapes, and tea are amazing here, though.
You might ask, though, why try IVF at all when there are plenty of kids in the world who need homes? I’ll write a post later to address this question more fully, but believe me, if someone offered to give me a healthy baby right now, no strings attached, I’d take it. I have no problem with adoption as such, and I want to be a mother yesterday.
The problem is that it costs about $30,000, and agencies prefer nice middle class homeowners, not freelance nomads like us. There’s a good chance we wouldn’t even qualify.
Adopting through the foster system can be low-cost or free, but the kids are usually older and sometimes, even if you make it clear you wish to adopt, they can end up going back to their biological parents. The idea of falling in love with a kid and then having him or her taken away is more than I think my heart could take at this point. We may consider it down the line, but for my first kid, at least, I’d like to be as sure as I can that it’s for life.
Accepting a donated embryo is another possibility. More than half a million embryos are sitting in cryo tanks in the US, left over from other couples’ IVF attempts, and some couples would rather donate them than destroy them or keep them in tanks forever. Transferring a donated embryo is cheaper and easier on the body than IVF, and there’s very little red tape.
But while I don’t care too much about my own genetic contribution, I think my husband will make beautiful babies, and I’d like him to have that chance. We live in the US away from his family. It would be nice for his kid(s), at least, to be biologically (and ethnically) related to him.
There’s much more to say about all the different options for building a family, and I’m always glad to hear from people who’ve been down those roads. They might well end up being our roads, too. If so, we’ll dive into them with full and open hearts.
We’re just not quite there at this time.
Treatment in Turkey
After three months of healing from surgery, I had another book tour in March that took me through Scotland, Bahrain, Qatar, Kuwait, and the UAE. It was fun but totally exhausting. My Turkish publishers also set up a stressful line-up of interviews (including one on live TV) as soon as I arrived in Istanbul.
That week of interviews was the same week our first IVF cycle started. Just as the interviews were ending, I came down with a horrible summer flu. The night before egg retrieval, I had a fever of 102. I was afraid the eggs would come out hard-boiled.
To our relief, we got six mature eggs, four of which fertilized, and we ended up with two day 5 embryos that looked great. About half of a couple’s embryos will, on average, be chromosomally non-viable (aneuploid). We had high hopes at least one of these little cell balls would be our kid, maybe even both.
But we had them genetically tested, and both were non-viable. Our first roll of the dice had come up snake eyes.
It didn’t help that we got the results on our second anniversary.
We were also missing friends, family, events, and playing soccer three times a week back home. We were renting a room in a place that had a tiny, dirty kitchen and a moldy shower that overflowed onto the floor and could never make up its mind whether to freeze or scald us. It’s not good when even your showers are stressful.
We just wanted to get this over with, get back home, and put the whole unfortunate episode behind us. So we rushed into a second cycle with no break despite the fact that there were some red flags indicating we’d be wise to take a month off before trying again.
That cycle was an even bigger disaster.
So, with several thousand bucks down the drain and not a single embryo to show for it, we retreated to an island off the Asian side of Istanbul in the Sea of Marmara.
After some hours of mourning and three days of hiking, cooking, and chilling, we decided to take a full month off, cleanse our minds, settle into the fact that it was our fate to be in Istanbul for a half a year (not the worst fate, honestly), find a more relaxed neighborhood (and a cleaner place) to live, go for long seaside walks, pet a lot of semi-stray kittens (Istanbul is loaded with them), meditate, write, read, take ferry rides, drink tea, watch the sun set over the Old City and its fairytale minarets, and change our mindset from “Let’s get this over with!” to “Let’s do this right.”
I did hours and hours (and hours) of medical research on established practices and experimental treatments. We decided to quiet my system with birth control pills, then try a Microdose Lupron Flare protocol, which super-charges your own hormones before adding more. (For the first two cycles, we did the short antagonist protocol using Gonal-F, Menogon, and Cetrotide, with no down-regulation.) We also chose some peripheral treatments that have shown promising results in recent scientific studies.
Out of that we were lucky enough to collect 13 eggs, which is pretty close to the magic 15. Five of them fertilized and grew into day 3 cleavage stage embryos. (We didn’t want to chance letting them go to day 5 this time.)
Four look beautiful (8-cell), and one is lagging behind a little. (I call it Ghost after Jon Snow’s runty direwolf that grew up big and strong.) We decided to freeze them all since there’s evidence it’s healthier to let your body rest and heal from IVF and then transfer the embryos into your badass baby-gestating muscle balloon (uterus) when your body’s more calm and natural. We also decided not to genetically test them this time because there’s a chance — however small — of false positives, and we just don’t want to risk it.
In a couple of weeks we’ll transfer the two nicest-looking embryos (Nymeria and Summer?) and then head back to home sweet Oklahoma. If it works — fabulous.
If not, I’ll play a lot of soccer to make up for lost time, and we’ll go back to trying naturally for a while. Then, if necessary, I’ll come back to Istanbul in January and transfer the final three contestants.
Here’s hoping at least one of our five embryos can find its way to us as a child.
If not, it’s wonderful to know there are other amazing ways to become parents. We really can’t wait to meet our child(ren).
UPDATE FROM MARCH 2017: Our first frozen embryo transfer, of Summer and Nymeria, ended in a blighted ovum miscarriage at nearly 6 weeks. I went back the next summer to transfer the remaining two (one didn’t survive to blast), and it was negative. (There was also a military coup the day after our embryos were thawed, so that added some stress, plus my idiot doctor made at least one crucial mistake that might have tanked our chances. All in all a horrible summer.)
UPDATE FROM SEPTEMBER 2017: Our second attempt with CC resulted in a beautiful bouncing fetus that looked perfect on its week 12 ultrasound. Here’s hoping the little frog makes it! Due in March 2018.
UPDATE FROM MAY 2018: Our boy Ali Julian Dogan was born on April 9, 2018, healthy and perfect!
P.S. It’s times like these when you really find out what your marriage is made of. Let’s just say… I’m a lucky woman. 🙂