Leaving IVF, and Its Promise and Possibility, Behind

The first ultrasound of our third IVF cycle showed four burgeoning eggs in my right ovary—a good number, for us. “How is the left looking?” I asked Dr. Hertz.

“Well,” she began, gesturing to something that looked like a black bubble against the grainy white background of the screen, “we cannot really do anything until this cyst resolves.”

After my exam, she advised us to take a month off from IVF. “This cyst is going to resolve on its own,” she predicted.

A month later, although we timed our injections perfectly and retrieved a good amount of eggs, none of the resulting embryos were viable. “Is there something else I should be doing?” I asked the doctor, thinking about friends’ testimonials for acupuncturists, massage therapists.

She said quietly, “If that were the case, we would have all of our patients doing those things.”

*

Our first attempt at a third IVF cycle had fallen apart once already, a month earlier, while my husband Derek and I were in Great Smoky Mountains National Park. Dr. Hertz’s assistant, Anna, had informed us it’s standard to have blood work and ultrasound monitoring at another fertility clinic if the cycle began while we were traveling. Once in Asheville, we went to two fertility clinics, two labs, the Urgent Care facility of a local hospital, and a doctor’s office recommended by a kind staff member at the Urgent Care, and not one had a lab technician on site that weekend.

I had already peeled off the estrogen patch I’d been wearing for the past week—I felt strongly that it was time to start injecting Menopur, a gonadotropin meant to encourage egg follicle growth, and Follistim, another hormone that prompts the ovaries to produce many eggs in advance of ovulation. I called Anna, and began crying in a way both unexpected and involuntary. “I’m sorry,” I said, “I‘m having a hard time.”

“Perfectly understandable,” she replied. “Now. You have your estrogen patch on, right?”

Once we made the choice to pursue IVF I realized how much I wanted it to work, and that images of a potential future had formed long ago, but not materialized.

After our search for a lab early that morning, we’d driven to the Cataloochee section of the national park, west of Pisgah National Forest, en route to Tennessee. Fog obscured the austere peaks of the Smokies for the entirety of our visit—it was unnerving to see only partial glimpses of mountains, a momentary strike of green on a downhill slope too massive to be contained within our field of vision. Fleeting breaks in the cloud cover revealed dense forest and steep mountainsides, the tiny roads and valleys between two mountains minuscule and distant. On the Blue Ridge Parkway, I anticipated the moment the clouds would part and thin and drift away, and the mountains, like set pieces in silhouette against the early evening sky, would appear in tableau. But though the clouds were restless, they weren’t going anywhere.

Due to the fog, we began at Cataloochee, a low-lying network of trails meandering over and alongside the Cataloochee Creek. Downed logs straddled the creek, suggesting that break, decay, burial, and regeneration occur regularly and without force there. We began walking the Caldwell Fork trail, but it rained steadily. Water flooded the snaking tree roots, and mud soon rendered the trail impassable, creating a constantly shifting surface for our footfall. Our rain ponchos covered our arms and hands, leaving only our faces exposed. At some point we turned to one another and Derek said, “Let’s go.”

We paused to take in the creek, an idyllic juxtaposition of bright green foliage overhead, a bed of pale grey river stones at the bottom, and petite whitecaps surging on a ceaseless current. The morning had been fraught, and I felt dreadful about how our anxiety followed us through that pristine wilderness. We would lose the remainder of that day replacing the patch.

“The patch would buy you time, by keeping your estrogen level up,” Anna said.

She suggested I fill a prescription for a new patch, and wear it until Dr. Hertz could read the results of blood work. Derek sat in the car in the parking lot of a shopping center in Bryson City while I waited in line at a local pharmacy. If the patch would help, I wanted the patch.

I was thirty-seven when I got married, and I had a measure of acceptance about my timing. Yet once we made the choice to pursue IVF, I realized just how much I wanted it to work, and that images of a potential future had formed long ago, but not materialized.

Later that afternoon, patch on and no blood work or ultrasound completed, Anna suggested I start injecting. In the passenger seat of our rental car, in the parking lot of Guayabitos restaurant in Maggie Valley, I affixed a “Q-Cap,” a circular piece of plastic with a tiny plastic needle at the center, to the end of a syringe. The cap clamps onto the top of a medication vial, the plastic needle just penetrating the rubber circle at the center. I evacuated a vial of saline into the syringe, then clamped the Q-Cap onto a vial of powdered Menopur and shot the saline in to mix it with the medication. I unscrewed the Q-Cap and replaced it with a needle. In the car, this necessitated handing Derek the first vial, then the second, then the needle, and taking each item back in sequence. I measured 300 mL of Follistim, a hormone in a glass tube the size of a perfume sample, by rotating the top half of an injection pen. I pressed the top of the pen to inject, and the measurement dial rotated counterclockwise, resetting back to zero.

*

A year before, on my last day leading a dance and storytelling program for Kindergarten students at a public school in Brooklyn, a school aide brought in her three-year-old grandchildren—triplets who reminded me of the three exuberant baby spiders who remain with Wilbur at the end of Charlotte’s Web.

The three girls immediately joined the warm-up circle, following the movements precisely. One, Kayla, broke from the circle and stood to dance alone. The other two followed without a word. Then they rejoined the circle and another, Joy, climbed into my lap and curled into the fetal position, her cheek against my chest. Suddenly, I could not speak—I knew that if I tried, I would cry.

Later that evening, Derek and I leaned against the headboard of our bed, talking. We’d been discussing getting another cat; my cat, Bailey, who I adopted as a rescue when I was twenty-five, had died a few weeks earlier. When I first brought him home, many of my cousins and college friends were planning for and having children. It was fine at the time—adopting Bailey was, for me, one small step in building a tiny household; one way to start making a home in the world.

“Rather than getting another cat, I was thinking we could have a baby,” Derek said.

But when I consulted Dr. Hertz, I learned that we had all but let the possibility go by waiting.

I believe we have a right to pursue our lives on our own terms. But in becoming acutely aware of my body’s limitations, I now understand better that all things, eventually, yield to time. The period of months between our second and third IVF cycles was the first time I have ever felt a down spell in my persistent belief in possibility—a nagging sense that something within me once felt unremitting, but has since been stretched to its limit.

*

When Derek and I returned to the park, the clouds were again deceptive. We walked a half-mile uphill to the Clingman’s Dome Observation Tower, atop the highest peak within the Smoky Mountains—the highest point along the Appalachian Trail. The frequent rain at such elevation allows for an alpine forest, firs and pines and spruces, which we could smell but not see. On an especially clear day, the view from the tower extends one hundred miles and spans seven states.

The ascent was steep, and I stopped to catch my breath more than once. Each time, I noticed the marked contrast in mood between us and the giddy couples, families, and individuals taking selfies and posing for group photographs against the enveloping and ghostly backdrop of cloud cover. Despite the damp weather, many wore shorts and tank tops, capris and flats, apparently impervious to discomfort. The usual thrill Derek and I experienced in visiting a new place was absent on that trip. But we were someplace entirely new. Both the fact of passing time, and the truth that IVF was a long shot for us, became unavoidably real while we were there.

For years, I held my life against the lives of others to measure its completeness—now, I know that any losses are for me alone to comprehend.

A few months later, in line at my favorite café in Brooklyn on a Saturday morning, I will see a woman with a baby sling secured to her chest rotate her torso one way, then the other, to soothe her baby to sleep. The baby drops its head against its mother’s chest; its hair is fine and scant. I envision my body inside of something that looks like a mist-filled bubble—inside, I see myself as whole and three-dimensional.

I repeat this vision many times in the months that follow my last appointment with Dr. Hertz, not to seal myself off, but to shore myself up—at the library, when a young girl seated across from me becomes engrossed in the first book of the Japanese manga series Hunter x Hunter, and again when I finish teaching a dance class and a first-grade student named Alexa watches as I sip water from my Nalgene and offers, “In my family, we have that water bottle, too.” Teaching, I have realized, has been a measure of practice for parenthood. I eye parents greeting their children at the end of the school day as if I can pass through doors and walls and universes soundlessly, like a superhero, the faint form around my body eventually becoming inseparable from the air around me.

I slowly begin to think through our remaining options for parenting—or not parenting. I know that Derek and I would be good parents. That is, in itself, consequential. It is one of the new observations I carry along with me in that composed, ephemeral shape, as the reality that a child from my body will not happen settles deep within me, like a bedded stone at the bottom of a creek. For many years, I held my life against the lives of others, friends, cousins, colleagues, to measure its completeness—now, I map the past and the future and know that any losses are for me alone to comprehend.

The view from the circular deck of the observation tower at Clingman’s Dome was of an endless expanse that we, of course, would not see that day. The clouds billowed, shiftless and opaque. We did not see trees, or land, or mountain peaks, or anything formed and solid through that haze. But it was still beautiful, as if we had moved through a work of performance art, in which human bodies can effortlessly drift in and out of the ephemeral—the blinding, and confusing, and disorienting—and emerge, somehow, unharmed.

• 0