The Last Steps

We started the summer by facing our biggest obstacle since matching: the mock cycle. It was the test that would determine final medical clearance, and everything hinged on it. If Becca’s uterine lining didn’t thicken with the help of medication, there could be no embryo transfer down the road, and we’d need to find another carrier. Throughout the prescreening this past year, we’ve known that even the slightest issue could bring everything crashing down, but I was never more afraid than when we began the mock cycle.

A few weeks beforehand, Becca received instructions from our fertility nurse, and on June 26th, she took her first dose of estrace. Thirteen days later, after some blood work and an ultrasound, she began injections. Another ultrasound and an endometrial biopsy– for a brand new procedure– were scheduled for the following week. The Endometrial Receptivity Array (ERA) was so new that our doctor had still only done about a dozen of them when we first spoke of it in January. This advance in treatment analyzes genes from a small sample of the lining to help pinpoint the best window for implantation. Prior to this, everyone generally received the same amount of exposure to progesterone leading up to an embryo transfer… the problem is that as many as 30% of women need either more or less exposure to be fully receptive, and the wrong amount can result in failed transfers and, subsequently, the loss of precious embryos.

Since most women are fine with the normal protocol, and the research is still in its infancy, the choice on whether or not to proceed was ours. But due to the higher cost of surrogacy and the struggle for me to create embryos, our doctor did recommend it. The expense ($600 for the biopsy and $595 for analysis) would be significantly lower than doing multiple transfers or further IVF cycles for new embryos, and if we chose not to do it and our first transfer failed, I knew we’d always wonder, so we felt it was worth doing now. We wanted to give ourselves the best possible chance of success from the beginning.

On July 15th, Becca stopped all medications and a biopsy was taken of her lining to be sent to an outside lab. We’d need to wait a while for those results, but the mock cycle had ended, and I expected to hear from the clinic right away to confirm (or deny) medical clearance. And yet… nothing. It wasn’t until a full week later that we got the call from our coordinator with approval to move on to legal. For something that took so much time and effort, it was said so simply, without gravity or ceremony: we had full medical clearance. 

Getting the biopsy results from the lab took longer. After the second week, on July 30th, our fertility nurse called with the news that Becca actually is one of the women who fall into the 30%, and her body needs a little longer to be receptive to an embryo. Immediately my stomach dropped at the thought that we could have moved forward without that information– and what that could have meant for us. We may have saved ourselves a lot of heartbreak, time, and money, but I’ve often thought of the women who went before us and didn’t have this option… what would be different for them?

With medical behind us, we turned our focus to the very last step: the carrier contract. All of the surrogacy process is difficult as none of it is truly in our hands, but legal is one of the worst parts for me. If ever there is a reminder that this path to parenthood is not normal, this would be it. In 2014, it took us six weeks to draft and sign a contract that spanned more than 40 pages and involved multiple lawyers. While this time around should be slightly less complicated, we will still each have separate representation to avoid conflict of interest, and every possible outcome will be addressed. From stillbirth or life-threatening health issues to our carrier fighting us for parentage, we will have to imagine and plan for each of our worst-case scenarios. Our contract will likely also state that our carrier cannot terminate the pregnancy, but we will sign the papers knowing that that is truly unenforceable– it’s just part of the reality of surrogacy. Even though we trust her completely, these weeks are a cruel and painful exercise in dwelling on our nightmares. 

Every day I wait to hear from the lawyer with a draft of the contract for us to review. If all goes as planned we could be signing the final copy within a few weeks, and once that’s complete, our lawyer will petition the clinic for full legal clearance as well. And then we’ll be done… sort of. Actually, it is only then that we’ll really be able to start.

It was last October that Becca offered to carry a child for us, but it has taken almost an entire year to even start thinking about thawing our embryo for transfer. For a year her life has been appointments and testing and injections; for a year she has planned her life around this process. For us, the wait has been even longer. Four years ago, in November 2015, a few months before Ross was even born, we started planning and preparing for a second surrogacy journey. Two years ago, around late Summer 2017, we were able to take our first active steps in the process, and for nearly every day since then we’ve worked and waited. The grief, stress, and fear of the surrogacy process have become the background noise of our lives over these years, a constant IV-drip of pain. We have put so much time and energy into getting here, but the possibility of walking away empty-handed is still very real.

“In another moment down went Alice after it, never once considering how in the world she was to get out again.” 

-Lewis Carroll, Alice’s Adventures in Wonderland

Not long ago it seemed as though we might never get to this point, but now that our time is coming, I’m terrified. At least during these years we were “safe” in this period of limbo; once we have that transfer day, we will open ourselves up to new risks and the likelihood of more heartache. I know it’s the only way, and I know it’s what we have to do for the chance of something good, but we are scarred and traumatized from loss, and I don’t want to go through more. When I think of our future and what might happen this fall, I don’t feel excited– I just feel sick with dread.

For anyone who is familiar with the Bachelor franchise, Holly & Blake (who met on Bachelor Pad several years ago) recently shared a video on their journey with infertility and surrogacy, and I think it shows so well what it’s like to keep opening yourself up to this process:

Finding a Match

Our first surrogacy journey, while unfathomably difficult at times, went about as smoothly as was possible, and from the very beginning I had always imagined doing a sibling journey with Elle. But, after speaking openly about it with her in January 2018, she wasn’t sure she could commit to the process again for various reasons. Of course, I completely understood, but in that moment I realized that I’d always harbored this image of matching with her for a second time, and to let go of that dream was devastating.

Facing the enormous obstacle of finding a gestational carrier filled me with paralyzing fear. I knew what we had to do, but I had no idea how to go about it. So, in hopes of having the right person stumble upon our story, I created a separate page on this blog about a year and a half ago to say that we were looking for a match. I further shared this information wherever I felt comfortable doing so, even swallowing my pride and posting on moms’ groups full of women from college that I barely knew anymore. Elle gave me the names of websites and social media groups where I might be able to find someone and acted as a sounding board as I attempted to navigate this strange new world. The posts themselves amounted to what was essentially an advertisement for our family: please help us. please choose us. please find us deserving of a child, was the humbled plea behind my words. Over the course of several months, I spoke with a handful of women, but each time we reached a dead end.

When Elle’s circumstances started to change over the summer last year, we began to revisit the possibility of a sibling journey. For a few months we discussed every issue imaginable, including all the things that would eventually be laid out in a contract, wanting to be prepared for the legal part of the process. But, the biggest obstacle we faced in matching was the contract we’d signed with the agency in 2014, which would require us to pay them again if we pursued a sibling journey with her. It was an exorbitant fee, by far the most costly aspect of the entire process, and we didn’t know how we’d be able to meet it. In the meantime, we were in the midst of packing and moving, and Elle was busy with things in her own life. It wasn’t until October that we had enough in place to move forward. I took down the page on the blog stating that we were seeking a carrier and contacted the agency to submit my application to become an Intended Parent with them for the second time, on October 9, 2018.

Less than 48 hours later, I walked downstairs to get breakfast ready and start the day. Already awake with a cup of coffee, Kyle looked up from his phone to tell me we’d gotten an email from a friend, Becca*. She’s offering to carry a child for us, was all he said. I was so shocked, I couldn’t think of anything to say. I’m not sure I even reacted other than continuing the task in front of me as I tried to process his words. Hearing him read her email in full didn’t make it feel any more real, the words just bounced off my brain.

It seemed like a bit of a long shot. She had a non-recurring issue with her first pregnancy that could eliminate her right away, and we had no idea how much she understood about the process (did she know there would be injections and invasive procedures? would she change her mind when she saw the litany of steps we’d need to take?) or whether we would agree on the important issues that could arise in the process. We also hadn’t really seen each other since we’d moved to begin Kyle’s degree a few years ago. This— having a friend or family member willing and able to carry for us– was exactly what we had hoped and prayed for over the last seven years, but I had long ago let go of that dream. Now that it had happened, I didn’t know how to proceed.

I texted Elle later that day to keep her informed, and she was very gracious in telling me that she wanted whatever was best for us, as well as assuring me that if something fell through during the prescreening, she would still be willing to help. After dinner, I brought up Becca’s profile on facebook, and as I looked at her picture, I just cried.

Following several weeks of correspondence with Becca to discuss some of the bigger issues, I reached out to my surrogacy coordinator at the fertility clinic to have her medical records sent to Dr. K. He had complete veto power, and getting his approval would be the first phase of many in prescreening. Unfortunately, due to miscommunication and errors on the part of the clinic, this step stretched out to last more than three months. It wasn’t until January 23rd, the day I took the trigger shot for my 3rd IVF cycle, that I received his call approving Becca as a candidate for surrogacy.

Although things start to slow down after an IVF cycle is complete, the surrogacy process never truly stops. As our surrogacy timeline shows, we are working toward this nearly every day. While being without an agency will save us tens of thousands of dollars overall, I have taken on a vast majority of the legwork in its place, and the experience has been both incredibly stressful and extremely overwhelming. In November 2018, while also attempting to deal with numerous insurance issues for my latest treatment cycle, I pictured the surrogacy process stretching out in front of me like an endless journey through the desert. After a few particularly frustrating phone calls, it hit me that I was well and truly alone in figuring all of this out. There wasn’t really anyone on my side that I could trust and no one to ask for advice or call for help in trying to untangle some of the mess. That night I cried to Kyle, telling him that it seemed unlikely to ever come together, and in the many months since then, I have often felt the same.

Alice looked round her in great surprise. ‘Why, I do believe we’ve been under this tree the whole time! Everything’s just as it was!’

‘Of course it is,’ said the Queen, ‘what would you have it?’

‘Well, in our country,’ said Alice, still panting a little, ‘you’d generally get to somewhere else — if you ran very fast for a long time, as we’ve been doing.’

‘A slow sort of country!’ said the Queen. ‘Now, here, you see, it takes all the running you can do, to keep in the same place. If you want to get somewhere else, you must run at least twice as fast as that!’

– Lewis Caroll, Alice’s Adventures in Wonderland

It wasn’t until February, when we submitted the $2,800 payment (for the physical side of prescreening) that we were considered officially matched by the clinic. Still, there was a long way to go. Becca was required to have an HSG test (to view her uterus and fallopian tubes), a mock cycle (to determine whether her uterine lining would thicken enough for an embryo transfer after a few weeks of injections), a mock transfer (to ensure everything goes smoothly for the real thing), a consult with Dr. K, and whole lot of blood work (plus her husband would need to be tested too). In addition, psychological screening was required as well: she would need to pass a personality assessment; she and her husband would need to meet with a social worker individually; Kyle and I would need to meet with a social worker individually; and we would need to complete a group session all together. We would also need to hire someone to meticulously go through her insurance benefits and determine whether she would be denied coverage for prenatal care if the baby she’s carrying is part of a surrogacy arrangement. Finally, lawyers representing each side would need to be involved in drawing up and signing a carrier contract. Only after all of that was completed would we be eligible to move forward with an embryo transfer.

Needless to say, we are still working through the list. In March, Becca passed her personality inventory, but we were also suddenly informed that our coordinator was no longer employed by the clinic, which further slowed us down. In April, Becca’s HSG came back normal. This month each couple completed their individual sessions with the social worker, and on Friday Ross missed school as we traveled to their area to attend the group session. Despite knowing them already (we didn’t meet Elle in person until the group session in 2014) and knowing what to expect, I couldn’t shake my nerves that morning. It was more than a little surreal to find ourselves in such a similar position nearly 5 years after doing this the first time.

By the end of May, Becca will have had her mock transfer, blood work, and consult with Dr. K, as well as (hopefully) a start date for the mock cycle, which will be the last and most precarious step of the physical prescreening. From the start I have been very cautiously optimistic, only allowing my heart to become slightly more invested as each step is behind us. The remaining fear of continued loss and heartbreak is something we will never truly get over. Even now, I am aware that there is no guarantee of moving forward to an embryo transfer, much less having a child. I have known arrangements to completely fall apart at this stage due to unforeseen issues, and that is something we simply do not have control over. Furthermore, her insurance may not pass verification, or, under the best of circumstances, we still have several weeks of legal issues to sort out ahead of us. It has been a long seven months already, with several more months of this to come.

On Saturday, after receiving approval from the social worker to continue moving forward, we got together outside of the medical scope of this process and introduced our young kids to each other. For their part, they are completely unaware of this incredible undertaking and the ways in which we might someday find our families connected; they are unlikely to even know anything about it for a long while yet. But, as I watched them run around and interact with each other, free of the heaviness that their parents are shouldering, something felt like it clicked into place.

That afternoon when we got home and looked at some of the pictures we’d taken, Ross pointed to the photo of all three kids sticking their faces through the holes of a sign painted to make them appear as farm animals. There were four spots– two occupied by Becca’s children and another for Ross, with one opening left next to him.

“Who goes there?” he asked me.

“I don’t know,” I answered, wondering the same thing.

*Name has been changed for privacy reasons.

A Year, Frozen in Time

For the last few months, I’ve watched as the days tick by, drawing closer to today, May 10th. Somehow it’s been a year since having my second egg retrieval and gaining nine new embryos in a line of seventeen. Of the nine there was just one that survived, and the last one standing was you

Over the summer, in the weeks following treatment, we lived life. We picked blueberries and let Ross stay up late to catch fireflies and see his first fireworks. We sailed toy boats in the middle of Central Park and dedicated two months to raising several dozen monarch butterflies. We splashed in the waves on the beach and dismantled the nursery to begin a new chapter of our lives. With boxes still waiting to be unpacked in our new house, we picked out a door jamb and drew the first of many lines to mark Ross’ ever-changing height. When the weather turned colder, we filled a small backpack with essentials and held Ross’ hand as we introduced him to his new preschool class and teachers. We picked apples and pumpkins and enjoyed sugary apple cider donuts outside on picnic tables. We visited his auntie at the zoo to meet her favorite penguins and marched in the hometown Halloween parade. Fall gave way to an early winter snowfall. As is tradition, we made our annual visit to see the Christmas tree in Rockefeller Center and walked through twinkling Christmas lights until our hands and feet were numb from cold. We got on a plane to see family in Florida and wore Mickey ears for our first trip to “Mickey Mouse’s house.” We waited for Santa to come and we put birthday candles on another cake, this time with a Toy Story theme.

And now, it’s spring again. In the last few weeks, we’ve painted Easter eggs and shared a picnic lunch with friends, soaking in the warmth of the spring sunshine. It is all these moments and more that have kept me afloat because, despite all of the smiles and happy memories, this has actually been a really difficult year. Throughout all the changes in season, we have spent quite a lot of time struggling to accept painful realities and feeling weak in the face of our obstacles. We’ve cried many tears and grieved significant loss. We’ve questioned this second surrogacy journey and anguished over the aching void in our family. There are no photos to commemorate those moments, but we carry the burden of them just the same. So much can change in the span of 12 months, but not always in the ways we hope.

In a normal situation, I would have received an embryo transfer myself shortly after the retrieval last May. If we were successful, this baby would already be in my arms. Ross would already have a sibling who’d be a few months old. Even when we completed that second treatment cycle a year ago, we believed we’d be doing an embryo transfer during the spring of 2019, but that possibility was lost to the endlessness of the surrogacy process, and we are still so far from where we need to be. Any day now I will open up the mailbox to a new bill for $600, the price of keeping our embryo on ice for another year.

There is never a day when I am not reminded of what could have been. In this year I have attended more baby showers and bought more gifts for second (or third) children than any other year of my life. Ross has watched as almost every single one of his friends has welcomed a new baby at home. The words brother and sister were added to his vocabulary, despite my reluctance to explain them to him. Pictures of toddlers holding their newborn siblings pop up on social media with frequency and feel like a punch to the stomach. And, above all, one of the hardest environments to be in this year has been the preschool community, where pregnancy, babies, and postpartum issues are bonding experiences. They are such normal topics of conversation that there is never an event that goes by when those subjects aren’t discussed.

At church, people are increasingly quick to point out that we don’t yet have a second child. They want to know why? And when? And, do we know that it’s past time already? Recently at a young families group I stood outside a circle of no less than five pregnant women. Isn’t it wonderful, all these babies? someone nearby remarked. Among the remaining women, each one had given birth within the year except for one, whose youngest child was still just 18 months. And then there is me: forever standing on the outside, even for the months that I was expecting. The most that I can ever hope for is to masquerade as a member of their exclusive group.

The truth is that the “baby life” seems to be very far away from where we are today. Over this last year we exchanged the crib for a toddler bed, purchased our last box of diapers, and packed away the final remnants of babyhood scattered throughout the cabinets and drawers of our house. Every time I open the storage closet, I’m confronted with relics of another life, and I wonder what the circumstances will be when I unpack them again– will I be preparing them for a child of mine? Or will I be doing what I perhaps should have done all along— giving things away to someone who can use them? Having everything so close, ready and waiting, often feels like tempting fate.

This part of me, the part that still turns down the wrong aisle to avoid walking by a pregnant woman in Target, is messy and ugly, but it also feels forgotten and invisible from the outside. It’s something the photos will never reflect, and it’s too inconvenient or uncomfortable to acknowledge, so it gets lost as life goes on.

It’s been a whole year with you now, but a whole year without you, too.

IVF #3: Retrieval & Results

You know the cyclone scene in The Wizard of Oz when the tornado tears through Dorothy’s farm? It rips her house off the ground and she’s swirled through the sky as everything shifts around her. Outside nothing makes sense: chickens in their coop fly by her window, two men tip their hats as they row their boat along, and Miss Gulch is on her bicycle, eventually morphing into the Wicked Witch. Then, as the house begins to fall, Dorothy braces for impact when– suddenly– it’s over. Her world stops spinning, and everything becomes eerily still. In the deafening silence, she gathers up her dog and her basket and opens the door.

That is kind of how I picture an IVF cycle. It’s easy to feel completely consumed by treatment as you detach from the routine of normal life and try to hold on in a world bound together by an extreme lack of control. It’s a bizarre reality, so different from what you once imagined when you envisioned having a family. Each ultrasound, each blood draw, each injection brings you closer to the egg retrieval. And then it all ends so abruptly. There are no more appointments to organize your life around; any leftover boxes of expensive medication and unused syringes become utterly useless. The stillness that follows feels strange and unsettling, and you’re left with this number– such a simple thing that holds so much meaning. The intention is to resume life as normal, but the experience has changed you, and anyway, you’ve been dropped in a different place than you started.

Resting in recovery after egg retrieval #3; January 2019

On a late morning in January, I woke up from my most recent egg retrieval hurting more than the last time but not as much as the first. My left ovary, with its endometrioma and years of damage, was intensely painful in a way I didn’t fully experience last year, and it took a little longer to get it under control. Finally, after what felt like hours, the attending nurse pulled back the curtain with the number I was waiting for: 19 eggs. It was 2 more than the last cycle but still 8 eggs less than the first. The small improvement left me hopeful that we’d have an embryo count in the double digits this round– an arbitrary marker I had become focused on over the last few months of preparation.

We didn’t.

The next morning my nurse called to say there were 9 new embryos bearing my name, the same number as my previous cycle… and I felt a stab of disappointment. Experience had taught me that while my early numbers were always objectively good, those embryos were likely to suddenly, inexplicably fail to thrive right when it mattered the most.

Over the next several days I wandered through life feeling disconnected, waiting for updates and fearing the worst, chastising myself for pushing so hard to do treatment at a time when we seemed to be barely surviving our normal lives. But on the fifth morning, the call came through that four embryos had survived to be biopsied and were frozen until further notice. Again, it was exactly the same number as our second cycle, and again, the numbers still seemed good.

We’d been in this position before, though, just nine months prior. And, just like last time, the results came back two weeks later that nearly all of our embryos were abnormal– only one remained. In the IVF world, the popular phrase is that, “you only need one,” but that wasn’t true for us four years ago as we waited to transfer our second and last embryo. From this cycle we bought ourselves a single chance– but certainly no guarantee. We now have two embryos on ice, and for that, I am so grateful, but our window to create more, if any, is rapidly closing. As the months– now years– continue to pass, I feel the burden of that increased pressure.

For a long time after completing treatment, I felt… adrift. It’s taken me nearly three months just to sit down and write about the results, and in that time my retrieval already feels like it happened in another life. The truth is, I don’t know what to say anymore. This is my 100th entry here since I began posting in 2014, and sometimes it just feels like I’m writing the same thing over and over again. For nearly 8 years now, infertility has been a merry-go-round that I just can’t step off. And now, after so long, there are days that I feel like the only thing I want to say is… it hurts. It hurts so badly.

A dream is a wish your heart makes
When you’re fast asleep
In dreams you will lose your heartache
Whatever you wish for, you keep

Have faith in your dreams and someday
Your rainbow will come smiling through
No matter how your heart is grieving
If you keep on believing
That dream that you wish will come true

-Walt Disney’s Cinderella

IVF #3: Trigger & Retrieve

“I wish I hadn’t cried so much!” said Alice, as she swam about, trying to find her way out. “I shall be punished for it now, I suppose, by being drowned in my own tears!”

– Lewis Carroll, Alice’s Adventures in Wonderland

Treatment is strange in that it seems to flip life upside down for a while. Time starts to lose its relevance and routine is lost to frequent appointments, blood draws, ultrasounds, daily phone calls with new dosage instructions, and strict injection schedules. This time around has been no different, and now, at the end of these weeks, I am ready to go back to normal life.

For the first time ever, I’ve done this treatment cycle on my own. The general busyness of Kyle’s current schedule has meant sitting by myself in a waiting room, often surrounded by couples. At times it has been very lonely. Although there is never much for him to do at this point, it was always a comfort simply to have him there for these appointments in previous treatments. Instead my family has been here to help with Ross: two of my sisters and my mom have taken shifts to keep him busy for each doctor’s appointment and the time in between. Somehow we’ve cobbled together a way through.

Then, after regular appointments every day this week and every other day last week, by Wednesday it all started to feel like too much. The side effects, the hours spent driving to the clinic and back again, the upside-down life we’ve attempted to become accustomed to– I didn’t know how much longer we could keep pushing. I knew I was getting close to the end: for the last few days I had egg follicles already within the ideal 18-22mm range and my estrogen level was rapidly approaching 4,000, the point where things start to get dangerous. Still, there was a part of me that hoped I’d get to stim for one more day. It was difficult last time to lose a greater percentage of eggs to immaturity compared to the first time, and in my limited understanding, it seemed like waiting just a little longer could give me a better chance. But, once those first follicles are ready to go, we can start losing eggs the other way too, rendering them unusable. Everything is a delicate balance.

That afternoon I received the phone call with my trigger instructions: stop all other injections and do the final one into my backside at exactly 10:30pm. The trigger would tell my ovaries to finish preparing the eggs and 36 hours later I’d have my egg retrieval to collect them before they are all released into my body and lost.

Last one!
The dreaded “trigger shot”

Yesterday I had off from everything as I waited for the retrieval this morning. This, to me, is the hardest part now. I feel ill and uncomfortable and I’ve cried an ocean of tears from skyrocketing levels of manipulated hormones. My ovaries are so large I can feel them through my skin, and the left one is pressing or pulling on scar tissue and causing sharp pain, as if a fish hook is caught in there. I hate that I am not allowed to eat or drink past midnight prior to the surgery, and as a psychological response, I’ve been feeling both desperately thirsty and ravenous with hunger pretty much since the minute it was no longer allowed. The anticipation of the procedure and my results is getting to me now, and I am ready for it to be over.

Yesterday was also significant in that it was the day we celebrated Ross’ 3rd birthday. I often think of how he came to be, but it felt even more poignant as I remembered back to four years ago, when I was struggling through this very same process in order to have him, too. It’s never easy, but it was more than worth it, and I am so grateful to still have this physical role. There is so much that I do not have control over and so much that has been taken from me, but not this, not yet. The results may not always be what I am hoping for, but I can still ask my body to do this.

In less than three hours now, I’ll be in the room with the doctor, nurses, embryologist, and anesthesiologist. By early afternoon I hope to be in my own bed recovering with a number of eggs retrieved and the hope for more embryos.

IVF #3: Third Time’s the Charm?

‘Who are you?’ said the Caterpillar.

Alice replied, rather shyly, ‘I–I hardly know, sir, just at present– at least I know who I was when I got up this morning, but I think I must have been changed several times since then.’

‘What do you mean by that?’ said the Caterpillar sternly. ‘Explain yourself!’

‘I can’t explain myself, I’m afraid, sir’ said Alice, ‘because I’m not myself, you see.’

-Lewis Carroll, Alice’s Adventures in Wonderland

Last Saturday, after more than two weeks of daily lupron injections with seemingly no end in sight, my period finally came. At that point I was able to schedule a baseline appointment for Monday, the last hurdle before getting the green light to begin stims.

There are very few surprises left in this process, but when a nurse handed me a packet of papers and told me I’d be having my FDA donor testing that morning, I was a little caught off guard. This is something we go through for every IVF cycle specifically because of the surrogacy, and should we find ourselves needing further treatment, we’ll go through it again. Beyond being tested separately for any infectious disease, both of us are required to submit urine and blood samples, receive an exam, and answer several pages of questions regarding our lifestyles: Have we been in prison recently? Have we had sex with someone who was in prison recently? Have we used any non-sterile needles in the last several months? Have we engaged in homosexual intercourse? Have we traveled to certain countries? How many sexual partners have we had in the last 12 months? Since the Zika scare, we also have to list any and all time spent in Texas and Florida over the last year. Everything is overseen by the Food & Drug Administration, and the risk we pose to a gestational carrier (through our embryo) is determined by the results.

As a woman, I am assumed to carry less risk to an embyro (and therefore, a gestational carrier) based entirely on stereotypes of sexual behavior, so I’m able to complete this testing within 30 days of my egg retrieval. However, as a man, Kyle is only given a week of clearance. Several years ago, when we knew nothing about all the extra steps required for an embryo transfer via surrogacy, the testing felt excessive and humiliating. Now it feels excessive and annoying (and maybe just a tiny bit humiliating, too). But, it’s usually done during the end of my treatment cycle, so I hadn’t mentally prepared myself for it yet. Nevertheless, fifteen minutes later I watched as 10 vials of blood drained out of my good arm to be set aside for the FDA.

When it comes down to it, the questions and the tests don’t feel like much of a difficulty in the midst of the invasive procedures that come with fertility treatment. What bothers me is the name: donor exam. At its most basic use, I understand why this term was chosen, but it’s a painful label to carry in a process where I already feel so devalued. Although my body will not receive my embryo, this is not a donation. I am not a donor.

Fortunately, the rest of the appointment was uneventful. Dr. M remarked on the large number of follicles present, particularly on my right side (my better ovary), but I am lucky in that this has always been the case for me. Still, he seemed pleased by how many there were, which made me feel hopeful that somehow this cycle might be a drastic improvement. That afternoon my nurse called to say that Dr. K had given me the green light for treatment. We could start!

A tidy look at one day’s worth of stim medication.

Throughout stims, I’ve continued my lupron injections each morning, and as of Monday, I mix three little vials of Menopur powder with 1cc of diluent to inject into my stomach along with 225 iu of Gonal-F each night. It’s been longer than I’d hoped since my last treatment cycle, but muscle memory has benefited me greatly when it comes to administering the medication, and with a lowered dosage of lupron, I’m relieved to be experiencing less nausea and fewer hot flashes. I do still feel as though my emotions are wildly out of control, and most days I just want to sit and cry while eating a box of good chocolates and ordering things online, but that will probably last a while longer.


Yesterday I went back to the clinic for more blood work and another ultrasound to check on progress. There’s not much to see yet, but I did have at least one measurable follicle. Tomorrow morning I have another appointment, at which point I’ll be on my sixth day of stim injections. I’m hoping to have off on Sunday morning but will likely be back at the clinic every day throughout the next week as I wait for my egg retrieval.

I’d like to say that I have no expectations of this cycle, but if I’m being honest, that is not the case. I suppose that I am at least expecting to do no worse than last time. Only time will tell…

IVF #3: Begin Again

After spending the afternoon on Christmas Eve trying to untangle the latest snag from our insurance, I wasn’t very hopeful that much would be accomplished the day after Christmas. But, I attempted it anyway, and for several hours throughout the day, I made and answered phone calls between the on-call nurse, the fertility pharmacy, and the insurance company. As the day went on, it didn’t look promising.

Then, while in the car that evening on the way to celebrate my mom’s birthday, I got a call that things were starting to come together. By the time we got out of the car, the nurse called one last time to say that my insurance had finally agreed to cover a significant part of the medication. So, while my family enjoyed some outdoor Christmas lights, I sat to the side on the phone with the fertility pharmacy trying to get my order processed. By 7pm I received word that my lupron injections should arrive just in time. It wasn’t until later that I found out my nurse had stayed late that day just to make sure everything was taken care of for me, and it is only because of her that I had a chance at cycling in January. It’s been a long time since I felt like someone was fighting for me, and her determination gave me the boost I needed.

First thing in the morning on the 27th, I had my Cycle Day 18 blood draw and ultrasound to confirm ovulation. As I walked through the office, it struck me just how little thought I gave to being there. No one had to show me where the rooms were or explain what to expect; everyone already knew who I was. It was strange to realize how completely comfortable I had become with this world that had once seemed so intimidating. And, when the test results came through that afternoon, I was given approval to start treatment for IVF. At the very end of 2018, we found ourselves at the beginning of a brand new cycle.

Medication for IVF #3: A small glimpse into one of many difficult things we have to do just to try for a baby.

I started my injections the following morning, a single lupron shot into my stomach after breakfast. I haven’t hidden this part from Ross, figuring that I can at least model a lack of fear around needles for him in hopes of making his shots at the doctor go a little smoother. He likes to help me pick where each one will go (though he sometimes gets a little bossy about it), and he carefully studies my face while I inject the medication, waiting to see if I flinch. Then when it’s finished, he likes to say, “See, that wasn’t so bad!”

Likewise with the comfortability I now have at the office, I also don’t give much thought to the injections. It’s strange to remember back to my very first one four years ago, and how it felt like sticking a needle directly into my own stomach went against every instinct I had. Now I think it might be the easiest step of the entire process, and I would happily do this every day for the rest of my life without complaint if I could have another child, especially if I could carry that child on my own.

I’m relieved to have finally started this process again, but while so much of it has become easier with repetition, it’s not without its hardships. My body has never done well with lupron: last treatment cycle I passed out with my first injection, and when I was on it in high school I struggled to get through the day at school. All of a sudden, memories of the nausea, motion sickness, crying, and hot flashes have come flooding back. Today was my 10th day of injections so I likely have a handful more before I can begin the actual stimulation cycle injections and monitoring appointments, but I’m getting closer.

In the meantime, I feel fragile. I know that what my brain is telling me right now is not necessarily true… but I feel very alone, too. I don’t know what will come of treatment this time, but I am trying to keep my expectations low after the disappointing turns we experienced the first two times. Any past success is not a reliable indicator of continued success; so much of it is up to how my body decides to respond to the medication, the doctor’s decisions for my individual situation, and a fair amount of luck. People who are unfamiliar with IVF tend to view it as a magic bullet that ends with a baby, but really it’s just a treatment that can give you a chance that you otherwise wouldn’t have had.

I’m hoping this gives me a chance.

Missing You at Christmas

It’s been more than four years since I started writing here. Enough time that I can look back to what our lives were like the first time around, before we were in the car headed home with a newborn.

Lately I’ve been thinking about a post I wrote around Christmas 2014 and how much of what I wrote then still applies to our lives now, despite everything that has changed in that time:

In general, holidays are hard for those who have lost a loved one or are grieving, but for some reason most people seem surprised that it would be the same for those with infertility. Although we have not lost a loved one in the usual sense, there is a similar void in our lives that is impossible to ignore throughout the surrounding celebrations. But instead of time ‘healing all wounds,’ this pain has cut deeper with every year that passes, and each Christmas hurts more than the last.

The holiday season is full of painful reminders that we are infertile in a fertile world. Every December Christmas cards pour into our mailboxes with photos of happy families and updates of new babies or pregnancies. The majority of Christmas traditions that I love so much all revolve around children. Then, at the center of all the celebrations, we focus on the birth of a baby. The words behind nearly every seasonal hymn– or sometimes just the sight of a quiet nativity scene– feel like a punch to the stomach. Getting through the holiday season is now more an act of survival than reflection, peace, gratefulness, or enjoyment…

We passed this Christmas by being dragged through the motions by our families, while inwardly we focused on the surrogacy process in order to avoid hurting too badly. We’re hoping that this past Christmas was the last one that we’ll celebrate without having a child of our own, but this is not the first time we have held onto that hope… nor is it the second, or even the third. Christmas 2011 was meant to be our last just-the-two-of-us Christmas, and now every one that follows serves as another reminder of how incomplete our family of two feels and just how much time has passed since we first felt that way.

December 28, 2014

A year ago, Ross helped me pick out a small polar bear, which I’ve been carrying with me, just like I carried a Paddington Bear while we waited for Ross. It’s been with us for all of our fertility appointments, every weekend away, and each holiday– a physical reminder of our embryo and the potential of the baby we are currently fighting for.

Knowing the gender of our embryo has made the wait harder in many ways. We’re better able to imagine that child and our life with them– but we remain barred from both. This Christmas there is someone out there who is missing from our family, a void that we’ve lived with since first getting the call. But it’s not as easy as scheduling an embryo transfer in order to give that child a chance at life, and the reality is that we don’t know if this child is “for keeps” yet. We will carry it in our hearts for all this time and still the chance of a failed transfer is high– maybe as much or more than 40%.

A new ornament as we wait and hope.

Tomorrow morning I am scheduled for my next blood draw, the beginning of my third IVF cycle. If the results confirm ovulation, I can start 2 weeks of daily Lupron injections before adding in my stimulation injections and ending with an egg retrieval in the latter part of January. Last week I spent nearly an hour scheduling the delivery of all the needles, alcohol swabs, and medication I’ll need over the next month. The only hurdle left was to run everything through insurance to determine whether any of it would be covered. Saturday we expected to receive everything, but instead, nothing showed up. It was never sent, and the fertility pharmacy never called to inform me or tell me why. Without that box, I will not be able to start my injections, and because of the timing of Christmas, this cycle will likely be canceled– again.

Coming to that realization, now the sixth time we’ve had to cancel a cycle, was devastating. Defeated and fighting back tears on Sunday morning, I started to process yet another delay, wondering whether this is a sign that I will never hold that child in my arms in this life. That maybe we’re meant to give up and start the process of acceptance so we can heal in whatever way possible, rather than continuing to leave this wound open. We keep pushing on and keep hitting road block after road block: at the clinic, with the surrogacy process, from our insurance. The obstacles feel endless. I’m heartbroken, and I’m angry. I don’t know how to keep finding the strength to do this.

The last few months have been especially difficult, even without the grief of infertility and stress of the surrogacy process. For as much as I think I can shield Ross from the effects, he is often far more perceptive than I give him credit for. Recently he surprised me one morning when he paused while eating breakfast and asked, “This is a hard time, huh?” And it is. Every day is so hard, but I don’t want him to carry that too.

In the meantime, despite the pain of this season, I am so grateful for the distraction of watching Ross experience the wonders of the holiday. We didn’t have that before and it changes everything. Throughout December, we have been opening daily windows of his Paw Patrol advent calendar from my mom. Every window reveals a new little toy– sometimes one of the dogs or another animal, sometimes a tiny tree or snowman. It’s the first thing he wanted to do each morning when he woke up as we counted down to Christmas. Then, on Sunday, the day I was faced with the possibility of canceling our cycle, he opened the last gift before the final one on Christmas Eve: a polar bear.

There is not a day that goes by when I don’t think of you and wish you were here.

Explaining Surrogacy… to a Child

The first time I had to explain surrogacy to a child happened when Ross was 8-months-old and we were staying with family friends. Their young daughter had asked to look at baby pictures on my phone, and, for several minutes, she scrolled through my camera roll– normal photos, pictures of Ross trying sweet potatoes for the first time or playing in a pile of brightly colored leaves– before stopping at a photo of him as an embryo.

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This will always be one of my favorites pictures of him.

It was easy enough to explain the embryo photo without going into the details of gestational surrogacy, but I knew we were likely headed into complicated territory. The concept of surrogacy wasn’t something I necessarily wanted to get into, but I didn’t want to lie to her either. As I watched her swipe, I wondered which photo would be the one to give us away, but a picture of us with Elle during the second trimester went by undetected. It wasn’t until she saw Elle holding a newborn Ross while still in a hospital gown that she hesitated.

“Did she give birth to her baby in the room next to you?” she wanted to know.

“No…” I started, not sure how forthright I should be, or even really where to begin.

At first I tried to give a vague answer, something simple, but it only led to more questions until eventually, without intending it, I had her full attention. After she’d absorbed the basics, she wanted to know how surrogacy was possible, why Ross wasn’t considered to be Elle’s baby instead of mine, whether getting pregnant (by taking Ross from my body and transferring him to Elle) had required surgery, and how long Elle had been a part of our lives. They were all questions I’d answered many times with adults, but finding the words to make the answers accessible to a child made the conversation difficult in a new way. To start, I referred back to the embryo picture and told her that although my body could make babies, it wasn’t able to carry them. I explained that someone else had offered to carry Ross for us until he grew big enough to be born and come back home to us.

It took her a few moments to process and accept it, but then she surprised me by asking in a rather matter-of-fact way, “So… now you guys are like sisters?”

“Yes,” I answered, shocked by her immediate understanding of our deep gratitude for Elle and the amazing thing she had done for us. At 9-years-old she had grasped on her own what most adults struggle to understand about our surrogacy journey.

On the other hand, explaining the way we became parents to our surrogate-born child presents further challenges. We don’t just have to reveal it to him, we will have to help him process his own feelings about his birth and choices that were made before he was even in existence, including our choice to write openly about it. We will also need to give him the ability to explain it, refuting on his own the common misconceptions and stigma. It’s not something we will do once; we will work through this issue for and with him throughout several phases of his life and understanding. I don’t doubt that at some point he will come across detractors. I imagine there will be someone who tells him that we were selfish for not adopting, that I am not his real mom, or that he is the product of his dad’s physical relationship with someone else. I know this because I have witnessed and experienced it myself.

From the beginning, we decided we wouldn’t hide the surrogacy from anyone, especially Ross. But there is no model to work from or book to consult when it comes to an explanation, nor is there anyone in our lives who can relate. We don’t want it to be something he remembers learning, but that means talking about it well before he is able to grasp the concept.

So, when Ross was a newborn in the fits of a colic episode, and I’d spend hours just rocking and talking to him as he squalled in my arms, sometimes I would tell him his story. Later on in his infancy, we bought every surrogacy book available for kids (so, basically, all three of them) and kept them in the rotation. My favorite, The Very Kind Koala, tells the story of a special koala who carries a baby koala in her pouch to help another couple become a family.

After he’d passed his second birthday and we began another cycle of IVF in the spring, we started talking about it more in depth:

“Did you know that when you were a teeny tiny baby, the doctor took you out of Mommy’s belly and put you in Aunt Elle’s belly so you could grow big?” I asked him casually one morning.

“Ohhhh,” he replied very seriously. And then, to my amusement, he added, “That’s cool.”

Shortly after the move this summer, we read Sophia’s Broken Crayons together. When we got to the part with the woman who had a broken belly, I stopped reading and placed my hand on my own stomach, telling him that the same was true for me. The words tasted bitter even as I forced myself to say them, and I shared that it was something that made me very sad.

“That’s why Aunt Elle carried you in her belly,” I carefully explained, “She made Mommy and Daddy so happy, because now we have you!”

After finishing the book, we moved to another activity, but he wanted clarification.

“Is you belly broken, Mommy?”

“Mmhmm,” I answered, nodding in encouragement of his understanding but not really wanting to repeat it.

“I will carry you baby, Mommy! I will carry you baby!” he said brightly. Not knowing what to say, I hugged him tightly and thanked him while blinking back tears. “You’re welcome,” he responded simply.

Since then he’s been the one to bring it up on occasion, like the other week when he started talking about it at dinner or Saturday when we ran errands and he randomly asked me if I remembered when “Aunt Elle carried Ross in her pouch.”

Yes, Sweet Pea, I remember.

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Where Have We Been?

Since receiving and sharing the results from our second full IVF cycle in May, a lot has changed. Life was busy at the time and, despite my best intentions, I stopped posting altogether. The week following my egg retrieval, with a belly still swollen from treatment and a roller coaster of emotions made worse by unnatural levels of hormones, we celebrated Kyle’s graduation. It was a culmination of the previous three years of our lives, and as his name was called, I couldn’t help but think back to everything he’d been through in that time. After weighing multiple job offers in varying states, Kyle accepted a position, and a month later we put an offer on a house just 15 minutes away before beginning the enormous task of moving for the fifth time in less than nine years.

It was difficult to close that chapter of our lives, and I wasn’t ready to leave the apartment where our dream of becoming parents had finally come true. That was where Ross had taken his first steps, the only place he had ever known as home. All of his friends lived there– right outside his door and always ready to meet on the playground. It was also the last place our dog, Orion, had known as home, the last place he spent the night curled up beside me. I didn’t want to put distance between us and those parts of our lives.

These three years haven’t been easy by any means– the sacrifices we made, especially financially, of leaving behind an established life and starting over so Kyle could pursue his graduate degree, will affect us for a long time to come. The final months of 2015 following the move were terrifying, and for a while I believed we’d made the biggest mistake of our lives. Some of that time was devastating: the sudden and unexpected loss of Kyle’s mom followed by the loss of three of our aunts & uncles to cancer (all of whom were between their early 40’s to mid-60’s and still had so much life yet to live), the painful reality of the third trimester as I faced not being the one to deliver our child, the decision of putting our beloved dog down just two weeks after Ross was born, and the never-ending challenges of navigating a chronic illness that seeps into every aspect of our lives. But, we also gained so much in that time: we developed friendships that are more like family after these years of living in student housing together, we learned to live on so much less than I ever thought possible (and I think we’re better for it), and we finally, finally got to bring our baby home. Together, the three of us built a life filled with fun adventures and amazing experiences.

Now, here we are again, starting a new chapter.

As always, one thing has remained the same: the struggle to have a child. Nineteen years after diagnosis, it feels as though fertility (or rather, the lack there of) is still the thread of my entire life. In more than seven years we haven’t taken a break from actively working toward having a baby– not even when Ross was born. We’ve spent so many years just trying to put together the ‘picture’ of our family despite missing so many necessary puzzle pieces.

The injections and ultrasounds came to a halt following my egg retrieval nearly 6 months ago, but in the meantime, the surrogacy process trudges on. We knew this would be roughly a two-year journey, but the strength and determination I once felt is waning due to complications with beginning my third IVF cycle. The fertility treatment aspect, which is one of the more straightforward and uncomplicated parts of the process, has been a greater hassle than we anticipated, taking up valuable time and energy that could be used to focus on something else.

When we went through IVF for Ross, we were given a 3-year window to focus on treatment for another child. It wasn’t a guarantee that it would even be possible, but the recommendation was not to wait. We anticipated going through another cycle in early 2016, but surrogacy complicates everything, and I didn’t start injections again until two years later after postponing twice more (Summer 2017, January 2018). At the end of my cycle last May, we looked forward to another attempt in August. But again, we were unable to proceed with IVF as planned. It was a hard to accept, but October didn’t seem too far away…

I should be in the middle of my injections right now, but I’m not. It’s a story for another time, but we were forced to postpone treatment again, meaning that over the last two and a half years, we’ve missed out on completing IVF cycles a total of five times due to circumstances beyond our control.

The new hope is for January 2019, but I am feeling wary of hope, especially since that will be the same month that marks the end of the original 3-year window.

In the meantime, I don’t know what else to do other than to keep trudging.