Odds and Omens: Superstition and IVF -The Toast

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black-cat-1432960-2-mOn the first day of our IVF cycle, Alice Munro won the Nobel Prize. I was up early for a routine blood test and ultrasound appointment and found out as soon as the news broke. On my way out the door I saw one of her books on the bookshelf, a best-of collection I’d bought at an airport while waiting out a delay. At the time, I’d found the thickness of the collection comforting, reassuring. I stuck the book in my bag and drove to the clinic. My mother had told me that she was praying for success for my husband and I, and while I didn’t quite feel comfortable doing that myself, I liked the idea. But even if I didn’t pray, Alice Munro winning the Nobel was akin to sainthood, wasn’t it? I could abide by that. In the clinic waiting room, I opened the book to a random page and started reading, and kept it with me for each subsequent appointment.

I’ve looked for omens often throughout the process of trying to conceive a child. They’re mostly fleeting, flimsy things – maybe I’m driving home from an appointment and there’s something gorgeous about the morning sky, something inexplicably lovely that makes me think: this can only mean something good. Sometimes it’s more obvious. The day after my birthday, my husband and I woke up after only a few hours of sleep to go to the clinic for an IUI attempt. It was a Sunday morning and the downtown core was empty; we walked through the streets and for a moment it felt as though the city belonged only to us. It was an omen, I thought, it had to be. One does not spend the morning after their birthday at a fertility clinic getting inseminated without having good results. Later I spoke about it with a friend who had gone through various fertility treatments before getting pregnant. I could hear her smiling through the phone line when she said, “Everyone always thinks it’s going to work on their birthday.” It didn’t work. Six months later we found ourselves back at the same doctor’s office about to start the more aggressive, invasive procedure of making a baby. We’d prepared as much as we could–read the literature, done the tests, taken the vitamins. I went to weekly acupuncture sessions and invariably fell asleep on the table as dozens of needles were flicked into geometric patterns on my stomach, between my toes, in the curling cartilage of my ears.

With IVF, the first goal is to produce many eggs, but it’s a fine balance. Too many and you run the risk of developing Ovarian Hyperstimulation Syndrome and eggs that aren’t mature enough for fertilization. Too few and the odds of the IVF working drop dramatically. The drug protocol you’re given is based on factors like your age and the results of a series of tests, particularly your AMH level, which is currently the best approximation of ovarian reserve. And then, when the medication starts, everything is scrutinized on a daily basis. Blood tests measure hormones: estrogen, progesterone, lutropin, prolactin. Ultrasounds–transvaginal with a wand–pinpoint follicles and measure their size in millimeters, as well as monitor the thickness of your uterine lining. The tests are analyzed quickly and just hours after you’ve left the clinic, your medications are adjusted accordingly.

And there were many medications. At its peak I gave myself a morning injection to delay ovulation, a pill to prevent my thyroid from going out of whack, two more injections in the evening to stimulate follicle growth, and then finally, before bed, a vaginal suppository to manage prolactin levels, a drug that prompted the pharmacist to ask if I had Parkinson’s Disease, since it was commonly used to treat it. With all of the needles and ultrasounds and pills, it was hard not to feel like a walking, breathing science experiment. At night I would look at my slowly distending belly dotted with bruises from clumsy self-administered shots, and wonder what exactly I was brewing inside my body.

At first, the most dramatic part about IVF is the idea of giving yourself injections. It seems unnatural to do it to yourself, like you’re crossing some sort of medical boundary. The night of the first shots, we cleared off the dining room table and laid out the implements: syringes, mixing needles, injection needles, alcohol swabs. The medication came powdered in tiny vials. I had to draw sterilized water into the syringe first, inject it into the vial, mix it, draw the fluid back up into the syringe, flick out the air bubbles and then inject it into a flabby fold of skin on my stomach. After preparing the first needle, we realized that the room was uncomfortably, tensely quiet. My husband got up to put on a record. There was some guitar and then Lou Reed’s voice. I don’t know just where I’m going, but I’m gonna try for the kingdom if I can, ‘cause it makes me feel like I’m a man when I put a spike into my vein. At that moment I wanted not only for the shots to work, but also for our eventual child to get my husband’s sense of humour, to be the kind of person who would play “Heroin” when their partner was nervous about giving themselves a needle. We listened to a lot of Lou Reed over the next few days.

Mercury was in retrograde the entire length of the IVF cycle. During a retrograde, the planet doesn’t really travel backwards, it just appears to from Earth, but this optical illusion is enough to wreak astrological havoc. If you’re the kind of person who cares, you know that Mercury Retrograde is not the best time to make major decisions or purchases. You know that confusion, mix-ups and mistakes are common occurrences. I was sometimes the kind of person who cared, and so I tried my best to ignore the timing. We were working with science, not astrology.

There’s a misconception that IVF is the failsafe cure to infertility issues. The odds are better, but you’re still gambling. Our odds going into this, we thought, were pretty good. We knew, or thought we knew, what the issues were and how to circumvent them. But, when my daily ultrasounds and blood tests started saying otherwise, we were puzzled. One morning after another round of tests, I went to talk to the nurse. She studied the charts. She always had tiny wings of eyeliner on her otherwise bare face, even at 6:45 in the morning. She frowned. I thought of Mercury Retrograde and then tried not to. I thought of Alice Munro and how she hadn’t been home to answer the phone when the Nobel Committee called her to tell her she’d won. I wondered what kind of voicemail they’d left.

Despite the predictions we’d had going into the process, my body wasn’t responding the way the doctor thought it would to the drugs. There were more appointments, more discussions. We went through with the rest of the steps anyway: the egg retrieval, the fertilization, the embryo transfer. Once the eggs are removed from your body, they’re cozied up to sperm in a petri dish and, from that point on, all you can do is sit back and wait. There are suddenly no more injections and no more early morning appointments: the clinic simply calls you with updates on how the embryos are doing. The odds of success depend on how many of the fertilized eggs divide the way they’re supposed to over a five day period, from two cells to four cells to eight cells, then to a raspberry-shaped cluster of cells called a morula, and finally, for the best odds, an uncountable cluster of cells called a blastocyst. During that five day period, sometimes the embryos stop growing. The nurses referred to this as arresting. You can’t say that they’ve died because they’re not actually living things–they are just cells, multiplying or not. Over the next few days, embryos arrested one by one, and then suddenly we were left with only three, and no reassurance that they would be in good shape for the actual transfer. These, we knew, were not good odds.

niagara-falls-1435993-mOne morning during that five day period, we weren’t quite sure what to do with ourselves. I’d started to feel better from the egg retrieval procedure, so we got into the car and drove, crossed the border and stopped in Niagara Falls. The American side. It was one of the first truly cold days of winter and there were only a handful of people watching the Falls. The American side is calmer than the Canadian; the city is more desolate and doesn’t translate into as many visitors, but there’s a proximity to the water that you don’t get on the Canadian side. You can follow the river until it just drops down. The ground was muddy and there were intermittent rainbows hanging in the mist. We’d gotten engaged at Niagara Falls four years earlier, a winter day when the trees were covered in a crystallized coating of frozen mist. Maybe by being there, standing there, we could invoke that day, that time period.

The day before the embryo transfer, Lou Reed died. Oh, Lou. I tried not to think about what it meant.

You don’t find out if the embryos have reached the crucial blastocyst stage until you’re in the room with the doctor and the nurses, naked from the waist down, bladder full, legs splayed open, waiting for the transfer. “Let’s talk for a few minutes,” the doctor said. “You can close your legs.” She was sorry to tell us that our embryos hadn’t reached that stage, that based on their level of growth, our odds had now dropped to 30%. The actual transfer took less time than the discussion and afterwards she pointed out the embryos to us on the ultrasound screen. Two of them, a single white dot suspended in the strange, wavy spaciness of my uterus.

The embryos would either continue growing and implant, or they would stop and eventually get rejected. Because of the multitude of drugs your body has absorbed, all of the regular markers of pregnancy–sore breasts, fatigue, cramps–can just as easily be side effects. But still, I studied myself. Wondering if you’re pregnant is a funny thing. You pay attention to your body in ways you never thought of before, analyze every cramp and twinge and back ache, every nap or bout of insomnia. I felt, for a few days, like I was pregnant. I don’t know why exactly, other than that I felt different, a buzzing in my bones I’d never felt before, a new warmth, a heaviness. But then one morning I woke up and that feeling dissipated: I was just myself again, the same person I’d been before the white dot of embryos, before the injections, before the tests.

The day of the pregnancy blood test I crossed my fingers anyway.  When the phone call confirmed what I had known deep down, I was still disappointed. I still cried as though I had lost something dear I had actually been in possession of. But I shouldn’t have been upset, I told myself. How could I have expected it to work? There was Mercury Retrograde and Lou Reed had died. Fine, Alice Munro had won the Nobel and there had been those misty rainbows in Niagara Falls, but how could those have outweighed the others?

Omens are selfish, indulgent impositions on the world. They assume that outside, independent events are somehow portals into your own world, signs you can analyze, interpret, rely on. But odds derived from scientific facts can feel just as malleable. If your odds of success are 30%, why not look to external clues, to clouds, to magic? There are odds and there is hope. I’ve been let down by my omens, yes, but I’ll continue to look for them anyway.

Teri Vlassopoulos is a writer living in Toronto. Her second book, a novel, Escape Plans, was released in October. She's an Aries with a Gemini rising.

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