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…)

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