Infertility, Part 5

I charted my next cycle, notations and all, but I was completely wrung out. I couldn’t face any more failure. I woke up tired. I didn’t want to be sad anymore.

Plus all the hormones were taking their toll. I had chronic migraines. I was lethargic. I had several bouts of painful cystic acne, something I only suffered occasionally prior to all of this. I lost a lot of hair. I cried all the time.

For my migraines, my neurologist put me on beta blockers and prescribed triptans for when a migraine broke through. These medications helped considerably.

For my skin, my dermatologist wanted me to use creams and take antibiotics. I sat in his office and thought about the last time I felt like myself.

Sure, I felt great the first few months off the pill. But ever since then, I’d slowly started feeling worse. I wasn’t sure how much of my state was hormonal and how much was emotional and mental, but I knew one sure way to start finding out.

I took the prescriptions from my dermatologist, but on the way home I called my OB rather than go to the pharmacy. When she called back, I told her I wanted to go on the pill.

“Are you sure?” she asked. “I’m confident that we’re close.”

“I’m sure. I need a break.”

I started taking the pill in February.

—-

That June, in 2009, I went to a baby shower for a friend. Everyone was so excited and happy for her, and I knew that I should be, too. And while a part of me truly was happy for her, I just couldn’t convince myself to stop thinking about my own situation. I was miserable and then I felt guilty on top of it.

Then my marriage started having problems. More specifically, Josh started having emotional problems. He’d previously concealed some things and they started leaking out everywhere. I can’t be any more specific because it’s not my story to tell, but I came to thoroughly distrust him. I still don’t trust him as much as I did before that summer. I don’t know if I ever will. I realize that, at this point, the diminished trust is just as much my shortcoming as his.

So, I entered a prolonged phase (that really lasted until a few months before Tiny was born two years later) when I doubted whether we shouldhave a baby, nevermind whether we even could. What kind of parents would we be? How could I possibly bring a child into this kind of chaos? Why was I so selfish?

Those old, self-defeating thoughts were back and, in some ways, stronger than ever. And now there was another person’s mental and emotional fitness to consider.

—-

I spent the second half of the year losing the thirty pounds I’d gained during the previous two years. Josh worked out with me a couple times a week, which allowed me to exorcise some of my anger at him. We grew close again, even though I still had my doubts about him, about our marriage.

That Christmas, Josh surprised me with a planned trip to Colorado. We’d go there the following July, in 2010. I went to Colorado once as a kid and loved it. I was so excited to share that place with him. For the first time since we started trying to conceive, I had something to look forward to.

—-

The Colorado trip was perfect. Josh did all the driving while I read aloud. The mountains were just as amazing as I remembered them and he was awestruck. We saw the Cardinals play at Coors Field. We hiked and ate amazing food. I took lots of photos. We talked about how wonderful it would be to live there.

The plan was to try to conceive after my next period. I’d been taking baby aspirin and folic acid and a folgard tab every day for over a month. A different person might have felt confident in the plan and the preparation. Instead, my anxiety had begun to fester before we’d left St. Louis. But once we were in Colorado, I found it easier, fortunately, to stay in the moment and enjoy myself.

I woke up early one morning. Josh was still asleep. I thought about the baby I still wanted, the baby I doubted we’d ever have. Then I thought about all the fun things we’d done so far. I thought about all the places I still wanted to visit, all the things I still wanted to experience and share with Josh.

I was struck with the simplest thought.

I will be okay if I don’t have a baby. I will still have a good life. Josh and I will still be okay.

And just like that, I finally felt free. A new place had actually lent me a new perspective.

I’ll probably never have a better vacation the rest of my life.

—-

When we got back to St. Louis and I started my next cycle, I started a new Excel file. This time, I only tracked the days we had sex, suspected ovulation symptoms, and when my period started and ended. There were days I didn’t open the spreadsheet. There were times I forgot to enter data. I didn’t worry over it.

This time, I heeded my OB’s words and I stopped reading about infertility. I limited my internet reading mainly to baseball sites.

This time, armed with my new “if it happens, it happens” outlook, I felt less pressure. I know Josh did, too. If we didn’t get pregnant, well then I guess we just had a lot of sex. We were both okay with that.

During my third cycle, I began to experience all sorts of new symptoms. It started with very heavy breasts and extreme fatigue. I thought I was coming down with something. But then, I’d never had any illness where my nipples felt like they were being sliced open whenever anything touched them. This time, I didn’t allow myself to take a pregnancy test until I was actually late. I didn’t stress over it. If I was pregnant, I would find out soon enough.

When I was one day late for my period, I took a pregnancy test. It was the first test I’d taken in just under two years.

It’s going to be negative, I thought.

I set the test on the toilet tank and went to start a load of laundry. I came back to check it about ten minutes later. This time, I’d used a digital test; I was greeted with the word “Pregnant” when I picked it up.

It was unambiguous.

“Huh,” I said. I didn’t believe it.

I called Josh and told him about the positive test. I also told him I was extremely skeptical. We devised a plan: I would take another test Monday morning. If it was positive again, I’d call my OB. This time, we decided to tell no one until we knew more.

I went to a bachelorette party that night, a Saturday. I had about a quarter of a beer, sipped slowly through dinner.I didn’t want to drink too much, for obvious reasons, but I also didn’t think I’d be able to lie if any of my friends asked me why I wasn’t drinking.

Sunday morning, I had cramps. My note from that day reads “sensitive nipples, breasts. mild cramping on occasion. I think period will start soon.”

Monday morning, I took another test. Again, it said “Pregnant.” My note from that day reads “slight bloating. I think period will start soon.” I called my OB.

When she called back around lunch, she said I could go that afternoon to get my blood drawn or I could wait until the next day.

“We need to see your hCG levels,” she said.

I was dreading it, so I waited until Tuesday. On Tuesday, they drew two vials of blood: one for hCG and one for progesterone. My notes from Tuesday read “Occasional heartburn and queasy feeling.” I had the same symptoms on Wednesday. On Thursday I had more blood taken, again to measure my hCG levels.

Friday morning, I woke up and my breasts weren’t sore anymore. “I’m paranoid I’m losing it,” I wrote. I didn’t know whether I’d hear the results from my OB Friday or Monday. I spent the day watching TV, trying to distract myself.

Late Friday afternoon, my doctor called me.

“Your hCG levels have had an excellent increase!”

I beamed. This was finally happening.

(To be continued, one last time…)

Infertility, Part 4

“I want you to do something,” my OB said. “I want you to go the lab first thing tomorrow morning, if possible.”

“Sure,” I said.

“I want to see where your hCG level is.”

That was the one constant. My hCG levels were never what they were supposed to be for the supposed length of my supposed pregnancies.

—-

My weird positive/negative test was on day 46 of my cycle, roughly 26 days after my typical ovulation. I don’t know what my hCG levels were that day, but I know they were not strong enough to trigger a clear positive result.

Some fertility math: day 46 of that cycle would be at least ten days past the point where a home pregnancy test should trigger a positive result. Most home pregnancy tests have an hCG sensitivity of 25 mlU/ml. hCG levels double, roughly, every two to three days. So a normal pregnancy test result should’ve been clear by day 46.

If we work backwards ten days, to day 36, my hCG levels should have been at least 25, strong enough to trigger a clear positive on a home pregnancy test. Three days later, day 39, they should’ve been around 50. Following a pattern of roughly doubling numbers every three days, by day 48 my hCG levels should’ve been near 400.

The day my hands freaked out, and I had what proved to be a second positive pregnancy test, I would’ve been on day 62, or nearly 9 weeks pregnant. Here’s a rough guideline of what my hCG levels should’ve looked like by the time I took that second pregnancy test:

  • Day 51 hCG ~800
  • Day 54 hCG ~1600
  • Day 57 hCG ~3200
  • Day 60 hCG ~6400
  • Day 63 hCG ~12800

I had blood work taken on day 63, and got the results on day 64.

My hCG level was 36 mlU/ml.

Thirty-fucking-six. I was barely pregnant at all, and my hCG levels were definitely not doubling every three days. Of course, we already knew from the ultrasound that things weren’t right.

On the off-chance that I ovulated extremely late in my cycle, my OB had me get tested again on day 68. I would get the results the following Monday, my 28th birthday.

On my birthday, Josh and I went bowling during the afternoon. No one was there except for league people who were practicing, each of them alone, focused. I had fun, even though I didn’t feel well, even though this was all happening, or not happening. I even kind of forgot about it for a little while.

Then my OB called.

My hCG level from Saturday was 42.

We decided to test again on Wednesday. We’d get the results Friday.

Friday, my OB called to say my hCG levels had risen to 46.

“So, you have a couple options here,” she said. ”We can keep doing bloodwork every few days and see what happens, or…”

“We can terminate the pregnancy?”

“Yes,” she said.

“How do we do that? There wasn’t anything visible on the ultrasound.”

“There’s a drug called methotrexate. It’s often used to terminate ectopic pregnancies. I’m confident, based on your slowly rising hCG levels and history, that you are having an ectopic pregnancy. Obviously I can’t be 100% certain until it develops further, but by then it could be dangerous.”

“I understand,” I said.

“I’ll call in the prescription today and you’ll have to bring the medicine in to the office tomorrow. I’m not in on Saturdays, so a nurse will administer the shot,” she said.

“Okay.”

“Do you have any questions? Concerns?”

“I mean… No. I’m already having enough problems. I can’t risk losing a fallopian tube.”

“Or worse. I agree. I’m very sorry.”

“Thank you.”

“Please don’t give up hope. We’ll talk soon.”

I hung up the phone.

—-

The treatment for sporadic, unpredictable ovulation is Clomid. Clomid is so good at forcing ovulation, so good at launching ripe follicles from ovaries, that there’s a 10% chance of having fraternal twins.

The treatment for MTHFR is extremely simple: one enteric-coated baby aspirin, one 1 gram pill of prescription grade folic acid, and one prescription grade B-complex vitamin every day.

I’d been following the MTHFR treatment regimen for just under two weeks when I had my first positive test. We timed it so that I’d be taking them a month when I ovulated post-Clomid.

I had probably already conceived when I began the regimen.

—-

I picked up the box of methotrexate Saturday morning and drove, alone, to my OB’s office. Josh, ever faithful and supportive, offered to leave work early to go with me. But I wanted to be alone. I’d known since the ultrasound that things weren’t normal.

I’d known for twelve years that things weren’t normal.

I thought about women who terminated when they discovered their desperately wanted baby was missing a brain hemisphere. I thought about women who gave birth to stillborn babies. I thought about all the women who would never, ever conceive. I thought about women who knew they didn’t want to be mothers, took appropriate steps to prevent it, and yet were so fucking fertile they got pregnant anyway. I thought about “miracle” babies and how they survive long odds and go on to be healthy. I thought about all the women who never once had to worry about any of this.

I didn’t once have second thoughts about ending my pregnancy.

I felt like absolute shit about ending my pregnancy, but not for moral reasons. I felt like absolute shit because I wanted to have a baby. Iwanted to be a mom. I was intentionally halting a process that has occurred billions of times throughout history. It just felt wrong, but only because termination wasn’t the outcome I desired.

I knew I was making the right decision for my health.

—-

I sat in the busy waiting room and looked at all the pregnant women. Everyone there was pregnant, including me.

Technically. For now.

A nurse called my name. She walked me down the hall to an exam room and asked for the medicine. She opened the box and removed a tiny vial of clear liquid, grabbed a sterile, packaged syringe from the instrument tray, and expertly measured the proper dosage.

“You okay?” she asked.

“Yes.”

“Alright. Which side?”

“Sorry?”

“Which hip do you want me to do?”

“Oh, uh, right I guess.”

“Okay, go ahead and turn away from me and face the exam table,” she said. “Lift up the back of your shirt and kind of stick out your right hip.”

I felt ridiculous.

“Now roll down the top of your jeans a little.”

I peeked over my shoulder and watched as she plunged the needle into my upper buttocks. There was a drop of clear liquid left behind as she extracted the needle. She quickly swiped over it with her gloved thumb.

“All done,” she said.

I adjusted my clothes and went home.

—-

Four days later, I started bleeding. I bled and passed clots for eight days.

On December 12th, over a month after that positive/negative pregnancy test, my hCG levels were measured at 15 mlU/ml.

I had my blood drawn again on December 23rd. Because of the Christmas holiday, I didn’t get the results until December 30th, Josh’s 29th birthday. My hCG level was below 5, or, effectively, zero.

I wasn’t technically pregnant anymore and we were free to start trying to conceive again the following month.

I decided to go back onto the pill instead.

(To be continued…)

Infertility, Part 3

This time, when my OB asked me if I wanted to try Clomid, I said yes.

The faintly positive negatives, the wasted months of no ovulation, the miscarriages, the hours spent reading, the money spent on pregnancy tests and ovulation tests, the time spent in lab waiting rooms, the needle sticks from all the blood work, were all hanging over me.

I said yes.

I started taking Clomid on day 5 of my cycle. I was dizzy and nauseous within a couple hours of that first pill.

The second day I was dizzy and nauseous all day. The third day was fine. The fourth day… Oh the fourth day.

Turns out, Clomid is not to be trifled with.

On the fourth day, I was uncontrollably moody. Josh was being a tad prickish that day – probably in reaction to my general hostility – but his behavior wasn’t worthy of the scathing things I said, the fury I felt. At one point I became aware that if I was near him I would injure him, so most of my raging was done from across the room.

Finally, I called a friend and had her talk to Josh about how the hormones were affecting me. I needed someone else to tell him what I needed: for him to be calm and not react to me at all. I needed him to be a warm, breathing Ken doll just until I wasn’t possessed by these hormones. I felt out of control for the first time since I was a teenager on drugs. It was not liberating. I was scaring myself.

The next day was better, except I completely dried up. Everywhere. My skin was itchy and sloughing off. My eyeballs were dry. (Clomid can cause visual disturbances, like floaters, and they can be permanent. Nearly four years later, mine have finally mostly disappeared.) I had really bad cotton-mouth.

Oh, and I started barely spotting light brown blood.

On day 11, I took an ovulation test, the next step in this process. It was negative. The ovulation tests were negative on day 12 and 13, too.

Frustrated, I got in the shower and cranked it as hot as I could handle it. I was tense and I needed to relax. I stood still under the water, closed my eyes, and slowed my breathing until the water started to lose its heat. Then, my hands started to itch. Figuring the Clomid had dried the skin, I gently rubbed a pumice stone on my palms. It felt fantastic. But the relief halted as soon as the scrubbing stopped. I looked at my palms; they were lobster red and looked a little puffy.

I jumped out of the shower, wrapped myself in a towel and dug around the medicine chest for Benedryl. It seemed obvious that I was having an allergic reaction to… something. While I waited for the Benedryl to kick in, I held my hands under cold running water, the only thing keeping me from wanting to remove my skin.

At a certain point, the cold water wasn’t helping either.

I went to the living room, opened my laptop and Googled “itchy red hands.” One of the top posts was concerning pregnancy.

But I just had a negative pregnancy test, I thought. Unless the faint shadow line was really a positive this* time.

(*This had happened at least two other times. The first time I completely wrote it off as a negative. When it happened a second time, my OB sent me to the lab for blood work that came back negative.)

I ran to the bathroom and ripped open a pregnancy test. It took a long time to pee under the pressure, but I finally did. I set the test on top of the toilet tank and stared at it. I didn’t have to wait long.

It was positive.

“Oh, fuck,” I sighed.

—-

The next day, a Monday, I put in a call to my OB as soon as her office opened. When she called me back, she was flustered.

“I must have forgotten to tell you to take a pregnancy test before starting the Clomid. I’m so sorry.”

“You didn’t tell me, but I took one. It was negative.”

“This is very strange. I’m going to try to get you in for an ultrasound today. Wait – can you come in today?”

“Yes.”

“Okay, I’ll call you back.”

I waited.

She called back. They couldn’t get me in.

“If you’re alright with it, I scheduled you an appointment with a colleague. My ultrasound tech is out of the office tomorrow, and the office I’m sending you to has better equipment anyway.”

“That’s fine,” I said.

“The doctor there will confer with me later in the day and I’ll get back to you hopefully tomorrow afternoon, early evening. Just hang in there.”

“Thank you.”

I waited.

—-

Josh went with me to the other OB’s office. I filled out paperwork and looked around the waiting room. Everyone there was pregnant, including me. Technically.

When we went into the ultrasound room, I got nervous. I so desperately wanted to see something on that screen, but I suspected I wouldn’t.

An external ultrasound again revealed nothing. So, transvaginal ultrasound it was.

“Have you ever had a transvaginal ultrasound?” the OB asked.

“Yes,” I said.

She directed Josh to stand at my shoulders and warned him that I might become uncomfortable. He nodded and we got started.

“I’m very sorry, but I don’t see anything to indicate pregnancy,” she said.

The room was very quiet. I thought about all the disappointment they’d been a party to.

“There’s a small cyst on your right ovary here,” she said, selecting the area with her computer mouse. “It’s possible your right ovary is preparing to ovulate, but I’m not sure.”

She twisted the ultrasound wand to my left side.

On the screen, I saw a floating empty sac at the end of my fallopian tube. I remember being amazed that my fallopian tube looked exactly like they do in sex-ed illustrations.

“Again, I’m sorry. I don’t see signs of pregnancy.”

“What is that sac thing?” I asked.

“It looks like an empty fluid sac. Perhaps a small cyst burst.” She removed the transvaginal ultrasound wand. I sat up.

“Why am I having positive pregnancy tests if I’m not pregnant?” I asked.

“I don’t know much of your history, so it’s hard to say. But it could be a chemical pregnancy,” she said.

I nodded.

“I’m very sorry, and I’m sorry to have met you under these conditions. I wish you luck.”

She shook my hand, then Josh’s hand, and left the room.

“Sorry, baby,” Josh said.

“Me too.”

I got dressed and we went home.

—-

My doctor called that afternoon and we talked about all of my spreadsheet notes about my last cycle. There wasn’t anything out of the ordinary about the days leading up to that period. When I knew I’d be taking Clomid during the next cycle, I took the pregnancy test. I told her that the test was so faintly positive that there wasn’t even color to the line; it was a clear positive line. Considering my history, she understood why I’d thought little of the vague positive/negative.

She asked about all of my previous pregnancies and whether I’d ever had any sharp abdominal pain. I told her that I recalled having some cramping, especially during the miscarriages, but nothing like…

Suddenly I remembered the heating pad incident from back in April.

“I think you cleared an ectopic pregnancy with that first miscarriage.”

“Really? I didn’t know that was possible.”

“They’re fairly common,” she said. “The only time you know you have one is if the fallopian tube ruptures.”

“So the fluid sac at the end of my fallopian tube…”

“You’re probably having an ectopic pregnancy. We just caught it very early.”

(To be continued…)

Infertility, Part 2

I called my OB who said to go to the ER.

Josh signed me in and we waited. There was only one other person there.

When the nurse called me over and asked me what was going on, I barely said the words “pregnant” and “bleeding” before she produced a wheelchair. The nurse apologized to me and told me that I’d be able to lie down soon.

We finished the admittance routine and I was taken to an exam room. I was told to put on a gown and a pair of gauze underwear with a very thick pad in the crotch.

I lied on the bed. I cramped and bled a lot.

Josh sat next to me and we held hands. Occasionally I said something about how I knew there was something wrong with me.

“No, honey,” he’d say, frowning.

Someone came and drew blood. Vital signs were taken.

Eventually, an ultrasound tech came to get me. She wheeled me down a maze of hallways and into a different exam room. An abdominal ultrasound revealed nothing, so she administered a transvaginal ultrasound.

“How far along were you?” she asked.

“Seven weeks,” I said.

She was silent for a long time. I was uncomfortable and sad and it was very cold in the room. My teeth chattered, but probably not because of the cold.

“Have you ever heard of polycystic ovaries?” she asked.

“No,” I said. “Why?”

She was silent for a minute.

”I shouldn’t have said anything. I’m very sorry for your loss,” she said.

Neither of us spoke as she wheeled me back to the ER exam room.

The doctor and a nurse were waiting for me.

The doctor was enormous. He looked like a retired NFL player. The last thing I wanted in this situation was an unfamiliar OB/GYN, but he had the softest hands and the gentlest demeanor. I felt instantly at ease.

“We got your blood results back. Had you had this pregnancy confirmed by your OB yet?” he asked.

“No, the appointment is for next week,” I said.

“Well, this is rather puzzling then. Your hCG levels are not consistent with being seven weeks pregnant.”

“So… what -“

“This could mean that you were pregnant for less time than that. Or it could mean that your body was trying to hold onto a pregnancy that wasn’t developing.”

I asked him about the cysts that the ultrasound tech mentioned and he said that the body sometimes makes cysts during pregnancy and that it might not be anything. He seemed completely unconcerned.

He examined me and told me that there weren’t any tissues evident. He asked if I’d seen anything grey or beige streaks in the blood I’d passed and I told him I hadn’t. He told me to follow up with my regular OB/GYN and to take it easy for awhile.

I cleaned up and was discharged.

We went home.

—-

That spring, the large coffee chain I worked for closed my store for a rebuild and I was transferred to another store. I hated it.

I hated it before the miscarriage. But after the miscarriage, I needed to take a few days off work – doctor’s orders. My manager was a very nice and understanding person, but I was anxious about returning to my temporary store. It was a stressful work situation. The customers were less friendly, my coworkers less professional, and it would be months before my store would reopen. Plus, I missed the consistency of my previous store. We were all friends. There were plenty of days that barely felt like work at all.

So, Josh convinced me to quit my job. He thought that the time off would be good for me, that I could relax and regroup.

I would’ve done just about anything at that point. I was depressed. I lacked will. I was a hormonal bundle of raw emotions.

I quit my job.

—-

You can’t try to conceive for at least one cycle following a miscarriage. (Depending on the pregnancy length, sometimes you’ll be told to wait three months.) But I still tracked my body’s every shift and symptom.

I had to get a new OB-GYN because mine was retiring. Ever since the ultrasound tech said the phrase “polycystic ovaries” I’d been researching it, so I had all sorts of questions for my new doctor.

The day of our first appointment, I went through my story and told her how I’d charted everything. She looked over the dates and the details she’d written down.

“Do you work in the medical field,” she asked.

“No, I just like to read.”

“You’re reading too much,” she said.

I laughed.

“Do you have a history of blood clots, stroke, anything like that?”

“No.”

“What about anyone in your family?”

I told her that my mom had a blood clot once, following a medical procedure, and that her mom had mini-strokes. And that a maternal great-grandfather died from a stroke.  She took notes.

“Here’s what we’re going to do, if it sounds okay to you. After your next period you are free to start trying to conceive again. Until then, use condoms.”

I nodded.

“If we hit the year mark and you still haven’t had a successful pregnancy, we can talk about other options. Has your husband had a sperm count?”

“No.”

“Let’s wait on that. Since you two have conceived at least once, for now I’ll assume it’s not him.”

“I don’t think it’s him either,” I said.

“Try to look on the bright side of this,” she said. “You actually conceived. I’m very sorry that you didn’t stay pregnant, but some women – no matter how much medical intervention they get – will never conceive.”

“I hadn’t thought of that,” I said. Then I brought up what the ultrasound tech said about cysts and asked her if she thought I had PCOS. I mean, I did have some of the symptoms. She shook her head and rolled her eyes.

“First, that tech shouldn’t have said anything to you. That is not her job. Second, no.” She shook her head. “I don’t think you have PCOS, but that’s just a hunch right now. Let’s give this until a year, okay?”

“Okay,” I said.

“And stop reading medical journals! Just stay off the internet.”

I laughed.

I kept reading.

—-

In May 2008, our apartment building was sold. The new owners were making lots of changes, taking away basement storage, and jacking up the rent. We decided to move.

The move was abrupt and frustrating. I wanted to throw things away as we packed. I wanted to thoroughly clean the new place before we started moving our belongings there.

Instead, Josh and his brother did everything the way they wanted to. I was overruled on nearly every matter. Plus, Josh took off just enough work to haphazardly pack and move us.

All the unpacking was left to me.

I was pissed off. I was alone in a place that wasn’t my home yet, in a body that kept betraying me. I had nightmares about being raped. I had dreams about broken eggs and dead ladybugs floating in my cats’ water dish. Eventually, I didn’t want to sleep anymore. I struggled with insomnia for the first time since I was a teenager.

I probably should’ve gotten help. I was completely overwhelmed and felt unequipped to deal with any of it.

Meanwhile, we kept trying to conceive.

—-

My first period following the miscarriage didn’t show up for almost seven weeks.

In July, I suffered a two week stretch of low back pain, nausea and heartburn, sore breasts, hot flashes, and extreme exhaustion. My body was completely out of whack.

August and September were uneventful.

In October, at the request of my OB/GYN, I started taking ovulation tests. Basically, I peed on a stick. I started testing nineteen days into my cycle because, at this point, we knew (thanks to my obsessive spreadsheet!) that my cycles were typically 38 days long. I peed on a stick every day for two weeks. Not one of these tests was positive.

My doctor sent me to a lab for blood-work. She wanted to test me for a genetic defect on the MTHFR gene.

Five days after I’d had my blood drawn, a nurse from the OB/GYN called me late on Halloween and told me that I’d tested positive* for the defect. Fortunately, I only had it on one of my genes.

I took notes. Then I went home and looked it up.

(To be continued…)

—-

*Specifically, I am MTHFR heterozygous C677T if you want to nerd out on infertility research.

The short version as explained by my OB: MTHFR defects act as a microscopic blood-clotting disorder due to the gene’s inability to properly process folic acid.

Apparently, there is some debate over whether or not MTHFR defects truly cause chronic miscarriage. I only have my situation on which to base my opinion.

Infertility, Part 1

I got pregnant when I was 15.

I had unprotected sex. It was reckless and stupid.

I wasn’t exactly healthy back then, and I hadn’t had a very regular cycle during those first few years of young womanhood. So when I missed a period, I didn’t think much of it.

When I missed a second period, I really started to wonder.

I talked to my best friend. Just a few months earlier, we’d gone to a drugstore and stolen a pregnancy test for her. We would do the same for me.

—-

It’s not difficult to shoplift if you act like you own the place. Wearing baggy jeans, large t-shirts and your grandfather’s extra-large flannels helps, too.

So does having a friend to help with misdirection. One of you can ask a clerk for help while the other shoves a pregnancy test down a sleeve or into a waistband. You can even buy something small. See? I’m a customer, you’re saying.

Once you leave the store, be sure to wait until you’re past the reach of the cameras to remove the box from your waistband. I know it’s digging into your hip bone and rib cage, alternately, with every step. Keep walking. Appear normal.

—-

It’s not difficult to face a possible teen pregnancy if you’re drunk. Well, it’s less difficult. It’s certainly easier to laugh it off. But you don’t want to be so drunk that you cause a scene, so try to take it easy with that vodka you’re chugging.

When you’re a teenager, the best place to take a pregnancy test is a public restroom. You don’t have to worry about your parents – or a friend’s parents – finding the test in the trash bin. They will freak out if they find a pregnancy test, even one that is negative. Until you can take it, treat the test like it’s drug paraphernalia and keep it hidden in your closet, your underwear drawer, or your gym locker at school.

When choosing a public restroom, you don’t want it to be a single stall restroom. If someone needs to use it and you’re locked in there too long, management will come and make you leave. You’ll need five or six minutes to yourself to do this, so you want to find a restroom where you feel comfortable. Maybe find a restroom you’ve smoked a joint in, or one where your friend has also taken a pregnancy test.

It’s not difficult to pee on a stick. It’s probably the easiest test you’ll ever take. It’s even easier if you have a friend to run the faucet while you go.

No matter what the result, but especially if it’s positive, you are going to want someone to hug you.

—-

After my positive test, my friend and I huffed air duster. For weeks, I kept right on living like I had been – drinking and getting high and skipping school. I made jokes about the pregnancy. Mainly, I tried not to think about it.

I tried not to feel.

One morning, I woke up and I didn’t feel well. I walked to my bathroom, arm wrapped around my abdomen – an abdomen that never did get any bigger, by the way – and miscarried.

I was 15 years old.

I was relieved.

I flushed the toilet and went to school.

But I also had this voice in my head telling me that this was my fault, that something was wrong with me. Crackheads have babies all the time. I’m not even a crackhead, I’d think.

And so I did my best to shut that voice up. I spent all my waking hours either drinking, using or looking to score. Usually I was doing all three at once, and if I wasn’t high, I was raging. This singularity of mind and will lasted roughly a year.

During that year I was suspended from school more than once. I ended up being expelled from school. I was raped. I was admitted into rehab. I was put on Paxil and lithium. I was caught drunk or with stolen merchandise by the police more than a couple times. (They let me go or just called my mom every single time.) I was admitted into rehab again. Then I was sent to a residential rehab near Kansas City. My cousin, who I’d been very close to growing up, killed himself.

Through it all, there was one constant: I kept using.

One day, I did something awful. I won’t say what it was other than to say that I finally had my wake-up call.

From that day forward, I stayed clean. I stopped stealing and lying. I got my psychiatrist’s permission to come off my medications. I learned to be thoroughly honest, even if – especially if – it was painful for me and those around me.

I abstained from sex for about two years, though not for moral reasons. I was busy trying to become a real person again.

When I was 18 or 19, I went on the pill. I had a boyfriend who I mostly trusted and I wanted to avoid pregnancy. I was too young to have a baby.

Plus, that voice was still there, doubting that I would be a good mother, reminding me of how horribly I behaved when I was pregnant. I’d heard all the things that my support system said the times I tried to talk about it – that I was a kid, that it was a blessing, that I should forgive myself, that miscarriages are common, etc.

But every once in awhile I’d think things like “I could have a 5 year old right now.” And I’d shame spiral all over again.

I knew girls and young women who’d had and kept their teen-pregnancy baby. (Most of these babies ended up being raised by the teen’s mom.) I only knew of one girl who didn’t (though there were probably others). She had an abortion, something we only talked about once.

Like her, I mostly kept my thoughts to myself.

—-

[Regarding the birth control pill: it has been wonderful for my health.

I suffer from migraines. Some of my migraines – the ones that cost me days of my life, days spent in bed, in the dark and quiet – are hormonally triggered. Without the pill, I would suffer at least one hormonal migraine every month, and sometimes two. The months when I have two end up costing me a week. Someday I won’t be able to take the pill (I’ll be too old!) and I fear for my brain when that happens.

The pill is definitely not just a form of birth control for me. It’s a wonderful medication that should be available to any woman who needs it for whatever reason. It should be nobody’s business except for a woman’s and her doctor’s.]

—-

In 2007, Josh and I got married. I had been taking the pill for over seven years. We only got married because we wanted to have kids, so within a few months of our wedding, I stopped taking the pill.

It took a long time for me to have a period, nearly two months. Once I did, it was very short. I was mildly concerned. This was nothing like the periods I had before the pill, but I’d heard it could take a few months to normalize. I tried to relax.

I came home from work one evening to find Josh with a stack of baby name books that he’d checked out from the library. We started making lists of names. (I was alarmed to learn that Josh liked the name Jasmine. Somehow we got through that, but those were dark, dark days.) It was fun and we grew closer.

One day, a couple months after we started trying, I felt nauseous and violently so. I thought that I might be pregnant. I waited a day or two and took a test. It was negative. Eventually my period showed up again.

For five more months we tried to get pregnant. Nothing. I’d feel sick for a day or two, or I’d be a little late, but nothing came of it.

I read forums and books about trying to conceive. I started charting my basal temperature and when we had sex. I charted cycle lengths. I charted mucous viscosity. I made an Excel file that was color coded and had notations.

I was obsessed.

—-

People tell you not to worry about fertility problems until you’ve been trying for a year, but I’d always suspected there was something wrong with my body.

When I had my miscarriage as a teenager, I told my aunt about it, the one adult I opened up to. I told her I thought there was something wrong with me. She told me that people who are depressed always think there’s something wrong with them.

I knew she was right about that, but I never felt like it applied to me.

—-

Very late March, 2008:

I went to work one night. I had a decent shift but I was extremely tired when I got home. Normally I would stay up a few hours and watch TV, maybe read some baseball blogs. So, I sat on the couch with my laptop and I tried to relax. I was tired and I couldn’t get comfortable. I had a dull pain in the right side of my abdomen. It became sharper to the point that I felt like I was going to pass out. I felt drugged. I remember grabbing the heating pad from the linen closet and draping it across my stomach. I fell asleep.

But I didn’t remember any of this until later.

Early April, 2008:

I had a positive pregnancy test. We were thrilled. I called my OB and set up an appointment to confirm the pregnancy. My mom and Josh were happy. They assured me I was okay. “See? There is nothing wrong with you! Your body just needed time off the pill!”

I was happy.

Two days later, I felt sick. I felt foggy. I told Josh that something wasn’t right. We met my mom for lunch and I told her that something wasn’t right. They reassured me that I was fine, that people feel sick when they’re pregnant, that everything was normal.

I didn’t believe them.

I had a miscarriage the next day.

Damn Spot

Five years ago this month, Josh and I bought a used car. It was five years old at the time and in pretty good shape. We had a mechanic look at it before buying it and he gave us the all-clear.

The car was about $1500 below market value because it had been in a front end collision. The owner was a body shop mechanic at a Honda dealership. He said he’d been driving the car for a month as he fixed it and had no issues. He showed us the work he’d done. It was professional work. He was very nice, outwardly religious, and a family man.

So, of course we got hosed.

___

Within a few weeks of buying the car, I noticed a wet spot on the carpet covering the driver floorboard. I told Josh about it. He downplayed my concern.

“It’s raining. It’s probably from your shoes,” he said.

“None of my other cars ever got wet spots from wet shoes.”

He remained unconvinced. I’d bring it up now and again, but I never made any headway. Sometimes, when it rained, the floor remained dry.

I’d feel around under the dashboard, even under the pedals, and there was never any moisture except for the spot.

It was puzzling.

___

The following May, the transmission went out.

I had just gone to Baskin-Robbins for a quart of chocolate chip ice cream. (Baskin-Robbins has the best chocolate chip ice cream. Yes they do. Don’t even try to argue otherwise.) I went for ice cream because it was pretty hot and nothing beats chocolate chip ice cream on a sweltering day.

I broke down on the way home, about a mile from our apartment. I did not hurry to eat the ice cream, though maybe I should have. I don’t remember what happened to it.

We decided to have the car fixed. The engine only had 107,000 miles on it – not bad for a Honda. And we still owed quite a bit of money on it.

At least we would have a new transmission.

___

Through the years, the water spot grew. So did a crack at the bottom of our windshield.

“I bet the water is coming in through the crack,” said Josh. “We just have to get the windshield fixed.”

“It’s not the damn windshield. I’ve been telling you about the water for years.”

“I don’t remember that.”

We must have had that conversation at least a dozen times.

Sometimes, the spot would dry up. Sometimes, the spot would be squishy.

I repeatedly insisted to Josh that we get it fixed, that I didn’t want the metal under the carpet to rust, but there was never enough money for something so trivial. The work truck constantly needed more important repairs.

Then, I was pregnant. I tried to use that to my advantage.

“Josh, please just look up under the dashboard. I can’t get down there with this belly.”

“Babe, it’s the windshield,” he’d say.

Then I had surgery and Josh missed work while I recuperated. It definitely wasn’t on my mind.

Then, we had a tiny baby and there wasn’t time to deal with it. I was too tired to even think about anything other than sleeping whenever I could.

Then, Josh was too busy with work, trying hard to catch up before winter.

There was always something else to do.

___

One hot and muggy day, baby carrier in hand, I opened the car door and was smacked with warm, sticky, mildew-y air.

I would be seriously downplaying matters to say that I freaked out.

So, Josh took the carpet out of the car. He had a glass company replace the windshield.

“It should be fine now,” he said. “Go ahead and research replacement carpet.”

“Why? So we can ruin another perfectly good carpet?”

“What do you mean? We just fixed the windshield.”

“Why won’t you listen to me?” I laughed.

“I’m listening,” he said.

I waited.

___

A car without carpet inside is much louder, even a quiet car like ours.

But you get used to it.

___

It was getting cold out. The car was colder inside and I didn’t want to have the water and ice we brought into the car freeze to the metal floor. So, I ordered the carpet.

When you order vehicle carpet and padding online, it arrives folded and shrink-wrapped. It needs time to unfurl.

We took it to the basement and unwrapped it. The carpet didn’t have that “new car” scent; it had “new car” fumes. I told Josh we should let it breathe awhile.

After a few weeks, sometime around Christmas, Josh installed the carpet. I’d put him off as long as I could.

A few days later, the spot hadn’t returned.

“See? It really was the windshield!” Josh said.

“It’s cold out.”

“We’d know by now if it was still leaking,” he said.

Within two weeks, a small spot appeared.

“That’s weird,” he said.

“Now will you go look for a crack under the dash?”

He took a flashlight outside with him and looked. Sure enough, there was a hole. But it wasn’t a crack.

It was a seam.

The previous owner missed a spot when sealing the seams.

I researched and found the product we needed. He bought it the next morning and sealed the seam that afternoon.

Then, he removed all the seats and the plastic trim at the floor line. He removed the center console. Finally, he removed the carpet so that everything – the floorboards, the carpet, the floor mats – could thoroughly dry. Then he replaced the plastic trim and the seats. He didn’t come back inside until after 9pm.

“We’ll wait a few days for the sealant to cure, and then I’ll re-install the carpet.”

“Thank you,” I said.

___

“Do you think you could find the time to put the carpet back?” I’d ask.

“Where do I find it?”

“Maybe back in January when you weren’t working everyday?”

“I worked everyday.”

“Babe, I know you missed days because of the weather.”

“When do I get time for myself?”

“When do I?”

And so on.

___

I was trying to get Tiny’s stroller out of the trunk today. For the last few months I’ve asked Josh to please take his tools out of the trunk because the stroller keeps getting caught on the tool box.

I don’t even know why we need tools in the trunk.

The stroller got caught on a tire iron, which was wedged into a jug of coolant, which opened and leaked all over the stroller handle – the stroller handle I was holding.

I wrested the stroller from the trunk and opened Tiny’s door with my pinky finger. I found the spare wipes in the car and wiped my hands. I wiped down the stroller. Tiny jabbered contentedly.

We headed into Target. I knew as we were stepping into the elevator that I should wait until I was calm to call Josh. I had shopping to do, I could just walk and talk with Tiny and relax. Nothing was going to change while I was in the store. And yet…

Which is how I found myself muffled yelling at Josh as I speed-walked through Target.

After my shopping, I stopped at Starbucks. I got a double espresso. It wasn’t as good as it normally is and the lid wasn’t on right. I snapped it down into place and Tiny and I headed home.

___

Josh re-installed the carpet today. He removed the extraneous tools from the trunk and put the tire iron in its proper place. It only took him nine months. Or five years, depending on how you want to look at it.

Tiny and I ate lunch in the kitchen instead of the dining room today. She was going to eat something with blueberries, and I didn’t want her to fling it all over the hardwood or the curtains.

After a few bites, Tiny dropped her spoon. The purple food splattered the floor and a little got onto my shoe. When I looked down to assess the damage, I noticed something at the bottom of my white shirt.

It was a teeny, tiny spot of espresso. I turned towards the window to get a better look. I saw another spot. And another. And another. I took off my shirt and held it up to the light.

There were little spots everywhere.

Orange Tom

Warning: this post contains graphic imagery.

Tiny and I were at Target Monday morning when Josh texted me to say he had a migraine and he’d be coming home early from work.

Tiny and I finished our shopping and I headed home. As I approached our street, I saw an orange cat lying in it, almost in the center, almost touching the intersection.

Cats don’t just lie in the middle of roads.

Josh’s truck was parked in front of the house already. I called him to come downstairs and help somehow. I heard the urgency in my voice which only made me feel more anxious.

While I was getting Tiny out of her car seat, he went and looked at the cat. As he was walking back to us, the cat yowled. It stayed on the street.

“It’s alive,” I said.

“For now,” said Josh, taking Tiny from me.

I decided to call Animal Control. I walked toward the cat. (Did you know that St. Louis City Animal Control has an automated menu when you call them?) I tried to focus on the menu options, but the cat’s glassy eyes and attempts to get away from me as I came closer told me that we – he – didn’t have that kind of time.

Plus, the smell. It smelled like absolute rot by that cat.

I rushed back to Josh.

“Honey, – “

“I’ll do whatever you want,” he said.

I wanted him to put the cat into his truck and rush it to an animal hospital.

He found a box in his truck, opened the flaps, dumped the contents onto his seat, and somehow slid the cat into the box. He put the box in the bed of his truck and then he left.

Tiny and I went inside.

___

Nearly ten years ago, I was the passenger in a car when we came across an injured cat lying in the road. It was twitching and thrashing, but not going anywhere.

“Oh, god,” the driver said.

“We need to hit it,” I said. “It’s suffering.”

“I can’t,” she said.

“You have to.”

“I can’t.” Her voice cracked.

“I’ll take the wheel. Just close your eyes and I’ll do it. Please.”

“I’m sorry.” She switched lanes so I couldn’t swerve into the cat.

The cat’s body had been crushed. Its left eye had burst forth from the socket. Its tongue lolled out of its mouth.

I couldn’t stop myself from looking.

___

I knew the cat wasn’t going to make it, even if he made it to the hospital alive.

Josh later said it stopped crying a couple minutes before they got there. He took it inside anyway. You never know.

He told the vet tech how I’d found the cat and called him, how he’d hurried this random cat to the hospital because I wanted him to.

“Sir,” she said, “did you hit the cat?”

“No, ma’am. I told you that my wife found it.”

She sighed and took it into the back. Josh called me to tell me he didn’t think the cat made it and that the tech thought he hit the cat.

“Did she see how big your truck is?” I asked.

“No.”

“If she saw that thing, she’d know you didn’t hit him.”

He told me how she was being rude and giving him dirty looks while they waited to hear the fate of the cat.

“I’ll call you when I know,” he said.

He called a few minutes later and said the cat didn’t make it.

“They gave me his collar. But I told them it wasn’t my cat.”

___

We decided to find out whose cat it was. There are some apartments near us, and Josh thought the owners might live there. I thought maybe he belonged to the neighbors at the end of the block, right by where I found the cat.

“They’re moving,” Josh said.

“Well then we better ask them soon.”

No one was around that day. But later in the evening, people started coming home. Josh talked to the neighbors who are moving and the cat wasn’t theirs. The man said he thought it belonged to a couple in the apartment building.

Josh came home and told me.

“He said he’s pretty sure the couple who owned the cat are on drugs.”

“Great,” I said.

“Yeah. He said the lady looks strung out.”

“Do you think they’ll assume you hit the cat?”

“I mean, the vet tech thought so.”

“Then should we tell them?” I asked. “I feel bad not telling them, but…”

“Right,” said Josh. “We don’t know how they’ll act.”

We went out to dinner. We ran some errands. During blips of silence, my mind wandered to the cat.

“They’re going to wonder where he is. Maybe we should tell them?” I said.

“Maybe.”

—-

Last night, while I was getting Tiny to sleep, Josh went to pick up dinner. When he got home, a guy from the apartment complex – a guy Josh knows from a long time ago when they worked at a restaurant together – asked Josh if he’d seen an orange cat around lately.

Josh told him the story, about how I found the orange tom, how he’d taken it to the hospital. But that unfortunately the cat hadn’t made it.

“Oh, man. I better go get my buddy,” the guy said.

Josh waited outside while the guy retrieved his friend. And when Josh told him what happened, the orange tom’s owner wept.

“I told him I had his cat’s collar and asked if he wanted it. He said yes,” Josh said.

“And then I hugged him.”