A Post Nearly as Long-Lasting and Tedious as My Infertility Itself.

Last week Scott cleaned out my trunk, shoving everything in bags for me to sort through at my leisure. Yesterday I inventoried said bags—one large paper sack, one tote, two plastic garbage bags—and with the exception of two books, a pair of old snow boots, and a questionable-looking mug, everything they contained had something to do with getting pregnant. I hadn’t used my trunk in an embarrassingly long time, almost two years (on account of it being full of two books, a pair of old snow boots, a questionable-looking mug, and a metric ton of infertility paraphernalia), and there was a bizarre time-capsule quality to sifting through what was left there. Most striking was how one-note it was, how focused. But I suppose it was fittingly so. I was pretty one-note back then, too.

In the bags I found ovulation predictor kits, progesterone cream, pregnancy tests (digital and the strip kind bought in bulk over the internet), Vitex supplements, soy supplements, IVF informational packets from two clinics, a thick binder full of materials from the first of two “Mind/Body” infertility classes I took, a textbook of infertility articles, a sheaf of Letrozole consent forms, a file folder full of IVF pricing schedules with notes to myself scribbled on the outside, RESOLVE newsletters, journal abstracts, papers…you get the idea.

It was odd to see it all, like finding an old picture of yourself that you don’t recognize. For a long, long time, all I thought about was having a baby. I don’t just mean that I thought about it often, or wanted it intensely, I mean that ALL I THOUGHT ABOUT was having a baby. My whole life had narrowed to that one pursuit. I thought about it in the morning while I walked to my car, I thought about it all day at work, I thought about it while I drove home, I thought about it as I tried to fall asleep at night. The only period between December 2004 and September 2007 when it wasn’t the one track my mind whirred along was after Scott and I decided to get married and I began planning our wedding, and I think that is why the months between our impromptu engagement and our nuptials stand out as such happy ones. Oh, infertility was still at the forefront, to be sure, but it was sharing and sometimes ceding the spotlight to happier topics like cake, and whether or not to get a Brazilian wax.

Sometimes it feels like so much wasted time, each month that existed only as an arrow pointing to its end. Waiting to ovulate. Waiting for my period. Waiting for an inevitable miscarriage—twice. Waiting for the next test or procedure or ultrasound. Now, tethered to my beloved baby, I can think of so many ways to have better spent all those hours. Traveling! Sleeping late! Rolling nude in the piles of money I wasn’t spending on diapers! But please, if you know someone struggling with infertility, and you value the clever way your appendages are attached to your body, do not tell them to “enjoy this time while they have it.” Don’t you think they would like to? Don’t you think they would, if they could?
Wanting a baby when you can’t have one is excruciating. I would have loved to cut the desire from my chest and save it for later, but it can’t be done. Because my reaction to a lack of control is to read things, I spent months studying behavioral endocrinology in the hopes of understanding the desire, which had swooped down on me seemingly from nowhere. I read this book and this book and this one, but understanding an earthquake doesn’t muffle it.

You might think that having spent so much time thinking of nothing but my future baby, I would have been similarly single-dimensioned once that baby was here. But on the contrary, having Simone has freed me, opened up my world, given me my self back. Yes, she is the most important thing in my life, now, but she is not the only thing, and I have more energy for and interest in my writing, my marriage, my whole life, than I ever did during my pursuit of motherhood. One of the greatest tragedies of infertility, I feel, is the way it can stunt a person’s growth. The childfree and I disagree about some things, but on this point we agree: no woman should be reduced to whether she has or does not have children. Women are more than mothers or not mothers. Infertility turned me into something I could scarcely relate to, and besides the bizarre emotional pruning of whole chunks of yourself, infertility reduces a person in more practical ways: you become afraid to plan for the future, because surely by then you will be pregnant, or in the middle of a cycle, or home with a sweet-smelling newborn.

This is National Infertility Awareness Week, but for people still deep down in it, every week is about infertility. It is vicious. It is soul-destroying. “Relaxing” will not fix it. “Just adopting” will not fix it. And by the way, Mr. Rutten, did you know that adoption is nearly always more expensive than IVF? If you chose the cheapest, easiest, least-fraught-with-complicated-emotional-issues way to have your children—natural conception—you have no right to suggest that infertile people ought to do differently.

So, what can we do? My suggestion would be that you call or write your congressperson about H.R. 697, The Family Building Act of 2009. The act would require group heath plans that provide maternity coverage to also provide coverage for infertility treatment.

People tend to get very stroppy when it comes to this topic. But please, does it seem proper to you that my insurance plan had a yearly allowance for male performance enhancement drugs and yet no coverage of medication related to fertility? Or that some plans cover intrauterine insemination (IUI), a procedure more likely to result in multiple birth, but not IVF, regardless of what the doctor feels is most appropriate for the patient in question?

One of the leading causes of premature birth is multiple pregnancy, and one of the leading causes of multiple pregnancy is fertility treatment. People think twins are “cute,” but you know what? Twins are dangerous. In countries where infertility treatment is covered, the transfer of a single embryo during IVF is the standard practice in women under 35. As, frankly, it should be. But with no insurance coverage, what happens if you can only afford one IVF cycle? How likely are women to pin all of their reproductive hopes on one embryo?

I would be remiss if I did not mention that IUI, not IVF, is responsible for the vast majority of multiple births resulting from artificial reproduction. I tried an IUI cycle. I took a small dose of a medication, Letrozole, designed to help me ovulate. This medication is so mild and so unlikely to result in even twins, that some OBGYNs routinely prescribe it or something similar without monitoring, sending patients off to take the pills, have sex, and see what happens. My doctor was careful, and so I had an ultrasound after a few days to see whether the Letrozole was succeeding in developing a mature egg or maybe two.
I had ten follicles over 10mm. Six that my doctor was confident would release. This kind of response is rare, but can happen in women like me, with PCOS. My cycle was canceled, because, you know, I DIDN’T WANT SEXTUPLETS. If I had not been monitored so closely, I could have ended up with a dangerous high-order multiple pregnancy. Instead, I moved to IVF so that we could control the number of embryos we placed in my womb. IVF cost about $12,000. Letrozole cost me about 50 bucks. If you were a woman with PCOS and no insurance coverage, I wonder which you’d choose?

The March of Dimes does an excellent job of funding research into the causes of premature birth, but there is one area in which I feel they could do more. Many babies in the NICU are there because they were part of a multiple pregnancy. To make a substantial difference in the number of preterm births, why not throw the substantial weight of the March of Dimes organization behind The Family Building Act? Why not educate doctors and patients about the risks of multiple pregnancy, and the benefits of single embryo transfer in young women? Why not raise awareness among obstetricians about the dangers of providing drugs like Clomid without proper monitoring? Why not remind insurance companies that covering infertility treatment is more cost-effective than paying for hospital bedrest, NICU stays, and ongoing medical care for fragile preemies?

When we moved apartments last year, I opened a cupboard and was faced with my overflowing sharps container from the IVF cycle that resulted in Ames and Simone. I hadn’t been able to throw it away. It was tangible evidence of what I went through to create them, and when Scott insisted that a bucket of used needles had no place in an apartment that was about to be home to our baby, I took pictures before disposing of it, so that I would remember:

I haven’t looked at the pictures since, because it turns out I don’t need a reminder. Like diamonds or membership in a violent street gang, infertility is forever. It changes who you are.
I’m not likely to forget anytime soon.