The Ol’ College Try

I was just reading an article about the “baby deadline test,” which is apparently the media’s new nickname for the Anti-Müllerian Hormone test. That’s the blood test I took at my diagnostic visit that was an indicator of the amount of eggs I had left. Although it’s been used for a while to help diagnose infertility, apparently it’s got a new use: helping any woman predict how long she can realistically wait to start trying to get pregnant, and/or whether she’s a good candidate for egg freezing.

I’m a person whose nimble mind is always pondering the deepest essence of human language. …By that, I mean I’m irritatingly hyper-aware of the potential for stupid jokes involving puns, parodies, double-entendres, metaphors, and the like (e.g. when I was watching The Masters with my husband’s family this weekend, and they were discussing the players’ sartorial choices, so I helpfully dubbed one of the golfers “The Pink Pantser”). The “baby deadline test” made me think of college, of course. I’ve been through a lot of college and have been student, TA, and professor – makes sense that my mind would go there.

I suddenly imagined a metaphor for my infertility situation. Knowing I’ve been slacking, I stop by the TA’s office hours and ask when the baby deadline will be. The TA tells me that the baby deadline is long past and that I should have read the syllabus. I tell the TA that I never got a syllabus, so how could I know the deadline? The TA shrugs, notes that my attendance has been quite poor and I’d probably missed an update. She takes a look at my grades, and suggests that the best course of action at this point is to take a Withdraw Failing.

That involuntary fantasy made me a little melancholy for a moment after I was jarred out of it, until I realized that I had actually found a more clever solution than “withdraw failing.” I found a super smart, nerdy, and optimally unscrupulous classmate, and paid her to do the rest of my tests and assignments for me!

***

Speaking of which, her work here is done. I’m just waiting on my final exam scores. My embryo transfer was yesterday! (ooh, transfer! Like a course credit transfer!!!). For those who haven’t had one of those, let me tell you what it was like!

My husband and I dropped his daughter off at school. Then, we went to breakfast in the city at this awesome brunch place a few minutes away from our old house. We’d never actually taken the time to visit it when we lived 40 seconds, rather than 40 minutes, away. We are massive idiots. That place was amazing. I had a sip of his fancy mimosa, which will be my last drink for a while if all goes as planned! (better than what it was going to be…. half a bottled Blue Moon I found in the fridge and drank the night before, just for the principle of the thing). After that, we realized that we had two hours to kill, so we went to Target and bought ourselves a bunch of new bum-around-the-house clothes. We then headed up to the fertility clinic a good hour early and just hung out.

The nurse came out to the waiting room and told me to take my Valium, because they could get me in early. They give you Valium to take about a half hour before the procedure to reduce your anxiety, but Valium never does anything to me except make me move a little more slowly. I always take it anyway, just in case I need an excuse for saying something stupid. They took me back to the transfer room, where there’s a torture-device looking chair with thigh-stirrups – it doesn’t actually look that scary, though, because it’s covered with those soft absorbent puppy-pad looking things, pillows, and warmed sheets. Underneath all that, though, it’s a pretty weird-looking chair. There’s an ultrasound machine next to that.

I won’t go into too much detail about the procedure. It’s easy enough to imagine what it involves. They put embryos into a catheter and put the catheter into your uterus. It’s a teeny tiny catheter, so it just sort of feels like a really long drawn-out pap smear. Not what I’d call pleasant, but honestly it’s not at all unbearable. It only takes a minute, really. The most physically painful, horrible part of the whole thing? The fact that you have to arrive at the appointment with a full bladder, and hold it during this whole procedure, AND for 20 minutes afterward.

***

Q: Why do you need a full bladder?

A: For two reasons. First, they guide the catheter with an ultrasound, and a full bladder helps the ultrasound get a better picture. They want to make sure to place the embryo(s) in the right spot. Second, when you’re on your back, your bladder sits on top of your uterus. For most women, the uterus is tipped forward at an angle, and if your bladder is full, it weighs it down and straightens it out a little bit. That way, the catheter won’t have to bend. Success rates are highest when the embryos land in the right spot and when there is minimal disturbance to the cervix and uterus.

Q: Why can’t you just go pee right afterward?

A: Because my clinic says so and my husband is apparently less rebellious than me. Many clinics have you do “bed rest” after the transfer for 10-30 minutes (mine seems to compromise at 20). I think there are still some clinics out there that require 24 HOURS bed-rest, although presumably they let you up to pee. Either way, this has been standard post-transfer practice for a long time, but there is no solid evidence that any length of bed-rest increases success rates, not even 10 minutes. Despite knowing this, I’ve indulged my clinic, and the main reason is because my husband really wants me to do what they say. If he weren’t there with me, I’d just say “Look, I read a whole friggin’ stack of articles suggesting that it’s not helpful, and may even reduce success rates! Hand me my flip flops, I’m outta here.” (I would put a citation here, but seriously, just go to Google Scholar and search “bed rest embryo transfer.” Tons of articles will pop up. People study this a lot. That’s how much people hate laying in a weird chair, staring at a ceiling, with a full bladder).

Q: But can’t the embryos fall out?

A: No, geez, the damn embryos aren’t going to fall out. People get very concerned about this. In fact, my post-transfer discharge instructions always say “Coughing, laughing, sneezing, or using the restroom will not disturb embryos.” The embryos will only fall out if they do not survive, in which case they won’t “fall” out so much as get flushed out during the next menses.

….I could go on and on about all the other rules and restrictions, and the legitimate and/or dubious reasons for them, but something that makes this whole process weird is that it completely fails to simulate what a normal, fertile woman would experience during the first two weeks of her embryo’s life. During the first two weeks of a normal, fertile woman’s embryo’s life, she has no idea there’s an embryo! She stands up and walks around, she drinks alcohol, she has sex and orgasms, she consumes caffeine, she undergoes stress. But, obviously I get it. I’m not going to drink alcohol, I’m avoiding caffeine and stress (good luck with that, right?), I’m going to begrudgingly follow the celibacy protocol, mostly (c.f. Tremellen et al. 2000). When you pay so much money, time, and emotional energy into the creation of that embryo that a normal, fertile woman wouldn’t even know is there, and could create again for free a few weeks later, the tendency for extra caution can be forgiven.

***

After we found out that all 17 successfully fertilized eggs were still steadily-growing embryos on Saturday, my husband and I took “The Price Is Right”-style bets as to how many would still be alive yesterday. I said 6. He said “all of them!” HE WON!!! 16 of the 17 were still alive. 8 were morulas and 8 were blastocysts. I would guess that most of the morulas probably didn’t make it through to today, as they were a little old to still be morulas yesterday. 8 blastocysts, though! That’s crazy! The clinic will call me today to let me know how many are left that are suitable quality for freezing, and they said that they expect I’ll have, at minimum, 4 left. They implied that they were happy I’d have some for siblings. Hahahahahaah! Siblings! Cute. I used to want a gaggle of kids. But after going through all this, one kid sounds like perfection.

So anyway, if you’re the type that offers prayers, thoughts, pagan rituals, mental transfer of warm healing lights, lovingkindness meditations, implorations to the cosmic chaos that we remain in the particular multiverse whose future leads in our preferred direction, or anything else of that nature… please send them to the two little blastocysts they transferred to me yesterday! I’ll post their photos later on, if one or both decide to stick around 🙂

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