Flotsam

IVF is like tax law in that it is generally only interesting to and understood by a small, obsessive coterie of practitioners. Unfortunately for my non-infertile readers, it will be the main topic of conversation here for the next several weeks. Believe it or not, an IVF cycle can be quite thrilling, but only if you know what the hell is going on. So, I thought it would behoove me to explain the process (or at least the process involved in my particular protocol) as we go along.

The premise is simple. Your own reproductive hormone mechanisms (which presumably haven’t been doing you much good anyway) are forcibly shut down so that your cycle can be manipulated by your puppetmaster Reproductive Endocrinologist, who will instruct you to inject precise amounts of hormone aimed at producing 10 to 15 mature eggs, rather than the one you would ovulate in a normal cycle (unless you are like me, in which case a normal cycle is one in which you produce no egg at all). These eggs are surgically retrieved from the ovaries and combined with sperm in cunning little dishes. Hopefully some will fertilize and divide to become embryos. Two-ish embryos will be transferred into your uterus, and any high-quality leftovers will be frozen. If you are lucky one of the embryos will implant, and if you are even luckier it may grow up to be a whole, live baby.

Today I started the first part, the forcible shut down of my own reproductive system. Well, truthfully it started some weeks ago, with birth control pills that I will continue to take through next Monday, but this morning at 7:00 I began injections of Lupron. Lupron turns one’s ovaries from nubile, fresh faced milkmaids into wizened schoolmistresses with Kleenex in their cardigan sleeves and tragedies in their pasts that have left them bitter and unable to love. It also ensures that your body doesn’t ruin things by ovulating, sending eggs slaloming down your tubes before they can be retrieved. It may seem odd to begin a cycle designed to produce many times the eggs of a natural cycle by suppressing your ovaries until they are withered, smoking husks, but think of your ovaries like new army recruits, or an unruly stallion Pa brought home to teach you a lesson about perseverance: first you must break their spirit. Only then can you methodically train them, building them up until they are docile, well-behaved, and can kill a man with nothing but a pop tart and a drinking straw. Or something. The point is, Lupron slams you into faux menopause as your hormone-producing gears grind to a halt.
A week after I start Lupron I will have an ultrasound and bloodwork to ensure that I am properly suppressed. This is my first looming hurdle of the cycle. Though it ultimately suppresses the ovaries, Lupron works by first causing your pituitary to dump all of its gonadotropin releasing hormone into your bloodstream. After this surge, no more is released, causing the crone-ifying effect described previously. However, sometimes the initial hormone dump will encourage the growth of cysts, which might cause your RE to cancel your cycle. So if you feel a palpable hum of anxiety in the air the night before my suppression scan, don’t worry—that’s just me, willing my ovaries into submission.

For now, I am only permitting myself to think about that first obstacle, the suppression check on August 9th. Yes, there are many spectacular ways this cycle could go wrong, but I can only focus on the one immediately in front of me. Otherwise my mind scampers forward from failed suppression check to cancellation before retrieval to cancellation after retrieval to poor fertilization to bad embryos to negative cycle to chemical pregnancy to no heartbeat to miscarriage after heartbeat to stillbirth to SIDS all the way to Kid in College, Never Calls. It takes years of practice to worry so efficiently that within 45 seconds you are fretting about events 20 years in the future, so I wouldn’t try this at home. As much as I would like to relax during this process and not worry about anything at all, I think the best I can hope for is to confine my neurosis to one potential disaster at a time. Of course horse tranquilizers might work as well, but I hear they adversely affect egg quality.