“How I went from being 38 and single to 40-something, mother of fraternal twins and pregnant with baby #3…”
IVF.
That’s the short answer. I sometimes wish IVF stood for “Miraculous Scientific
Procedure that Changes Lives!” but it doesn’t. It stands for boring “In Vitro Fertilization”.
Here is my story.
All through my 20’s and 30’s, I never struggled to find a relationship. I was in a 5-year relationship, 4-year relationship, a 2-year relationship, and so on. I met men who were kind, funny, smart, handsome, athletic and easy going. I never prioritized marriage- not sure why. My mother died when I was in high school. I suppose she and I never got to that part -she was busy dying from breast cancer and I was busy trying to please her but still rebel. It was a tough few years. I did the best I could, and my boyfriends did the same. I figured marriage would happen at the right time (still think that).
I always knew I wanted children though.
At 38, after a particularly hard breakup, I found myself in my Primary Care MD’s office for a check-up, looking fabulous (I always exercise as therapy to get through a breakup) – so while my blood pressure and resting heart rate were
exemplary, I was an emotional wreck. I had read or maybe heard that if you aren’t pregnant by 38, the clock starts ticking like a timebomb and your chances become slim to none. Well, here I was, 38, single, and not pregnant. I was literally sobbing in her office. Luckily, my PCP was amazing. I had known her for 20 years and she – as always – knew exactly what to say. “Hey now, it’s ok. There are women who struggle at 25 to get pregnant and women who have no problem at 40. You cannot go into any of this if you are not emotionally healthy. Get your mind right and then we can talk about your options.”
She was right, of course. I had been ready to drink any magic potion or go to any snake oil doctor to get pregnant because I was so vulnerable. My friends were getting married and having their first and second, even third child, while I was crying and panicking. It was time to get practical. I went to actual therapy (sometimes the gym just isn’t enough!) and after a few months, felt MUCH better.
I am not sure which came first -if my MD brought it up, or I knew someone, but somehow NYU was on the radar. I did happen to know someone, which always helps, and he recommended a fertility doctor for a consultation.
I went for my consultation, nervous but excited. I was professionally successful, financially stable, and emotionally healthy. I just was single. I met with the doc and LOVED her. I mean, this woman was cheerful, honest, thorough, non-judgmental and ready to help me. She explained everything. There was a large and terrifying degree of truth to the 38 years old panic button, while there were also exceptions in every age bracket. She explained that female eggs continue to age and even decay, although we as women can be sprightly, in great shape, get regular periods and feel 10 years younger than we are. I was fascinated. It all made sense and at that very moment, I stopped blaming myself and started to feel empowered. Yes, I was in a situation, but here I was actually doing something proactive.
Go me!
I was also open to everything – almost nothing was off the table for me, as far as egg freezing, donor eggs, donor sperm, donor embryos – I drew the line at adoption because I always dreamed of being pregnant and carrying the baby, giving birth, the whole thing. I had no qualms about any of this because I was raised in a bi-racial household. My mother was Jamaican, and my father is Jewish. I never questioned whether they were my parents even though I didn’t exclusively have the racial traits from either one. I favored my mother in many ways but skin tone -I am very light skinned- high yellow as they would say – often being mistaken for Latina (which makes sense because most Caribbean Latinas are racially mixed). I knew she was my mother, even though having lost her so early in life I could never “prove it”, which made me feel even more indifferent about genetics as a priority. I knew that if a child is loved, nurtured, and enveloped in a solid family structure, they can grow up healthy, productive and proud of who they are. I was living proof.
I set the date for my egg freeze cycle to begin. Wouldn’t you know that during all this emotional health and consistent working out, I met someone? Long story short, I deeply love this person – out of respect for him/us, I will leave it at that.
I was still on track to freeze my eggs and so I went.
Egg freezing is a trying process. You must have the funds -anywhere from $10,000 to $15,000 dollars. It is not generally covered by insurance except in rare instances when the woman has a potentially fatal chronic condition. For most healthy, child-bearing aged women, it is a choice and therefore you pay out of pocket. Yikes! I was fortunate in that my health insurance at the time covered a generous portion of the medication costs. You then get yourself on a course of hormones, which you typically self inject. You also must go in for “morning monitoring”. This means you go the clinic during their walk-in hours, typically 7-9am, to have blood drawn and sometimes an ultrasound of your ovaries and follicles. If your clinic is on the other side of the world from where you work and live (like mine was), this only adds to the effort. I did all of this- injections, morning monitoring, draining my savings account. For some odd reason, I reacted very well to my course of hormones! I was on cloud 9, feeling super maternal and loving towards everyone. Must be the estrogen, the nurses said, chuckling. In a typical non-medicated ovulation cycle, a woman releases one egg. This egg can be healthy, not healthy, or even non-existent (sometimes you ovulate but no egg gets released. Go figure.) During the egg freeze process, the hormones and monitoring are an attempt to get your body to release several eggs at once. My doctor thought for sure I would get about 10. Midway through my monitoring, this estimation started to look less and less likely. She put me on the strongest dose of hormones and we hoped for the best. After close to 2 weeks, I was ready for my retrieval. This is when the team puts you under for about an hour, while they retrieve whatever eggs you have managed to produce. The thing is, no one really knows this number until they get inside and look around. In the meantime, the prospects can start to seem bleak. First you must hope your retrieved eggs are fully matured (not guaranteed). Then reality – about half of the eggs frozen will survive the thaw once you decide you want to fertilize them. About half of that half will successfully fertilize. Another half of that half will successfully implant and lead to a pregnancy. Let’s pretend I got 10. That means 5 will survive, 2.5 will fertilize, and maybe one will successfully implant… It would have been nice to get 10. But I didn’t get 10, or 8, or 6. I got 5. Total. Do the math. Its crazy. My doctor was disappointed, but I was just happy it was over.
Years passed, and at 41, I took a long look myself and finally dared to consider myself “single”. This allowed me to really understand that my choices for pregnancy would revolve around this fact, regardless of whether this would (and it will) change in the future. I had not literally considered single motherhood because I always figured my relationship would straighten itself out and we would skip into the sunset, making a baby along the way. Not so much. I struggled emotionally quite a bit- bitterness, envy, jealousy, all the most toxic emotions: I was full of those. Friends got pregnant naturally and it seemed like it was all they could ever talk about. Random pregnant women on the street just served to remind me of what was missing. I found the podcast “Beat Infertility” and it nearly saved my life. I acknowledged my triggers, forgave myself for my less than generous feelings and found community with tons of other women struggling with the yearning to get pregnant and become Moms. Once I knew I was ready to act- by declaring myself single and on a mission – I never let myself over-think any of it. I just knew that time was running out. Every mom wants to have energy for her kids, and even though I was in the best shape of my life (no joke) I was also starting to get very content living on my own. I didn’t want it to get harder and harder for me to share my time, my space or my life with my baby. It was time to put one foot in front of the other and journey forward. I made my appointment with my beloved fertility doctor. She was as upbeat as ever, happy to see me and ready to get to business. I had some time to think about it because I would need to undergo another full round of hormones for a complete IVF cycle. This is like the egg freeze process in that you administer hormones and accelerate the egg production process, but at retrieval instead of freezing those little guys you fertilize them. This time insurance covered everything, because certain insurance plans consider IVF a viable medical procedure to assist infertile women/couples. Phew! Because that sucker is expensive. One round of complete IVF can run you from minimum $12,000 to close to $20,000. Insurance usually covers a dollar amount, not a fixed number of rounds. So, lets say you are covered for $25,000 worth of meds and procedures. You do a round – it doesn’t work (more on that later). You may or may not have the coverage for another round. You might have to make up for the remaining dollar amount out of pocket. Imagine couples who go through 4 or 5 rounds of IVF (Very common!). It gets heartbreaking except when you hear the success stories. Then there is no dollar amount that matters. I still had my 5 frozen eggs, which was comforting but realistically might only yield one viable embryo that would successfully implant. Now at 41, my poor eggs were even older and more decayed than they were at 38. I didn’t love the hormones this time either. My Doctor continued to reassure me – I felt alone and scared – the right person who was meant to be in my life – we would figure it out. This did not have to deter me from my dreams of motherhood. Several close friends echoed this sentiment. It was time for action. The retrieval yielded 7 eggs. Woo-hoo! 7 plus the 5 I got last time! This was amazing. I had to wait an entire 24 hours (eternity) for the clinic to call and tell me which ones fertilized. Well, beyond my wildest dreams I never would have imagined that of my 12 little eggs, 11 of them fertilized! 11!!! This gave me great hope. Yes the math is supposed to keep you grounded in the possibility of a less than stellar outcome. But with 11, my math was just fine!
On to the testing…. when sh*t gets real.
In the IVF process, every woman/couple is given the option to test your embryos for serious genetic flaws that would potentially result in a miscarriage. These tests are not covered by insurance unless you have had breast cancer due to the breast cancer gene. Even though my mother died of breast cancer, it was not due to her genetics and so these tests were not covered. Still, the idea of miscarrying after going through all this was enough for me to agree to test my little guys. Mind you, the fertilized eggs are very fragile, and testing introduces a micro-level trauma to the embryo, just like thawing the egg introduces a threat to its survival.
My doctor and I decided that we would test MOST of my embryos, but leave at least
one to chance, shielding it from this extra trauma, but also not guaranteeing
that it would successfully implant and continue to develop a heartbeat.
I got the call a few days later that of the embryos sent out for testing, not one of them came back as “normal”. As a reminder, I started out with 11 fertilized embryos. Now I was down to the one that I didn’t test, from my frozen batch. Remember the math? Always divide what you have in half and then do it again. This meant I had a 50% chance of this embryo implanting and another 50% chance that it would yield a successful pregnancy, beyond the first tenuous few weeks where miscarriage rates are high. Then you must remember that this embryo was not tested! It could have all manner of genetic abnormities that would result in a pregnancy loss or a condition where the child would be looking at a short life expectancy. My heart sank. I was at work – no time for tears but they came anyway. So much for 11. I soldiered on. I had come too far to let the statistics scare me. My transfer date was set. This was the day they literally put the fertilized egg inside you and you cross your fingers and pray and don’t tell anyone and pray some more. I remember waiting for my doctor to come in – it felt like an hour, but it was probably 10 minutes. She had some paperwork for me to sign, as well as some interesting news. There were two embryos that did not get tested but that looked in her words “really good.” She asked me if I was ok putting in two embryos. Most large scale fertility clinics like NYU or Cornell these days will not just transfer multiple embryos -that’s why the testing is so popular. You no longer have to transfer multiple embryos hoping that one will “stick” if you already know you have a healthy embryo – just transfer that one. Multiple pregnancies – twins, triplets, etc…, are hard on the mom, more expensive and often are high risk, requiring bed rest and still resulting in per-term births.
This was my chance at becoming a mom. It was all happening right here in this small
office. Of course, I said, lets put in 2. The alternative would be to re-freeze the remaining one but again, thawing it introduces trauma. So, 2 embryos were transferred that day. I walked back to work trying to “feel something” but I felt nothing.
The rest is history – or so I thought at that point. My tow precious embryos
weren’t guaranteed to implant – but they did. They weren’t guaranteed to
survive and produce strong heartbeats, but they did. They weren’t guaranteed to
live past the first trimester, but they did. They were not guaranteed to be genetically normal, but they are.
There is never any guarantee of their sex, but I got my perfect little family – a boy and a girl. I started showing. People congratulated me. I harbored a bit of stigma, self-imposed shame and a dark voice in my head… (Everyone suspects I am having twins because of IVF. IVF is cheating. IVF is for old and desperate women…IVF is for rich people…And on and on) I am finally through all that. Babies are due in mid-August 2018. My belly is huge. I have not exercised in months. I eat ice cream often. My family is thrilled, and my baby shower was awesome.
My twins were born healthy and without complication – I literally experienced two vaginal births on one day! It was exhausting but exhilarating. The man I mentioned earlier, the person I deeply love -he was with me in the delivery room for all of it. It was a truly miraculous morning. I thought I was done. Flash back to about month 6 of this pregnancy: I get a bill from the fertility center. I was confused – what could they possible be charging me for? I do some digging/calling and it turns out…I had another two embryos in storage! I must have forgotten or blocked them out because at the time when I got the genetic testing results, remember I said that there were no “normals”. Well this was accurate and I am sure all the disappointment from hearing that just blocked out my capacity to think rationally about anything. So if its true that I had no “normal”, then what did I have?
I turns out I had two embryos, one whose status was “mosaic” and another whose status was “no result”. What does that mean??? A mosaic embryo is an embryo, who when the cells are tested, return back with some potential for abnormality. This does not mean that they will manifest in a true genetic abnormality, but it means that they might. Emphasis on “might”. There is also the fact that the cells tested are not yet designated as particular body parts – in other words, this cluster of potentially abnormal cells could turn out to be the placenta, or a toenail, or something so minor that it would not even register on a later more thorough genetic test. Basically, if you had one embryo left on this planet to implant, and it was mosaic, you would probably go for it and hope for the best. My other embryo was labeled “no result”. This means that whatever material was tested did not yield any information. This is identical to being not tested at all, which is the same as my twins. So here I am, 6 months pregnant with twins, wondering if I should pay a storage bill for two embryos when I literally thought I had everything I could ever want. I consulted with a friend who is also an OB specializing in fertility. She advised me to pay the bill, give myself some time to think, but emphasized that pregnancy is NOT a time for major life decisions. Too many hormones! Thank God for her! I took her advice and moved along with my twin pregnancy, and forgot all about my two stored embryos – almost. I had my miraculous birth, and began the task of mothering newborn twins. It was awesome. I was in heaven. I found the right support to help me sleep train the twins, giving all of us a sense of schedule and predictability, which enabled me to feel centered, grounded, and focused. I began to get good sleep at night, decent exercise during the day, and eventually, after about 4-5 months, I could see the weight coming off and with it the old me coming back.
Naturally I had to return to work at some point. I looked into nannies and local daycares, none of which were what I wanted. This next part is really and truly God/the universe looking out for me (kind of a theme in this story!)…my workplace literally JUST opened a daycare onsite. I went for a tour and was sold! This is where my twins would go. I would be working right upstairs in the same building. We were set!
I found my rhythm. I took the kiddos on the train with me in their double stroller, we walked across town, I dropped them off, hit the gym for a quick workout, and was at my desk for 9am. I continued to lose the weight and feel great. I was not tired (sleep training!) – actually I was energized and inspired….so energized and inspired that one day it hit me – I could have another baby! I could do this again. I’ll never forget that feeling of empowerment, excitement, fear and “Am I really considering this?”
Yes I was. I made an appointment with my fertility doctor. As usual, she was upbeat, happy to see me, and straightforward. She reminded me that I was not getting any younger, and that yes, the no-result embryo was just like the twins. It would be pure chance as to whether it implanted, developed a heartbeat, made it through the first 13 weeks, and proved to be genetically normal. Was I up for it? Absolutely. We did the standard exam – luckily, I had two vaginal births, so there was no scar tissue in my uterus, nor was there any hiccup in my cycle. We basically just had to wait until the right day/time for my natural ovulation, and schedule the transfer. I told no one except my immediate family, whose reaction was mixed. Another? So soon? The twins at this time were just about 8 months old. Yes I said, its now or never and I am really excited. I think this is the part of motherhood that one just has to know for oneself. Its hard because other folks cannot truly relate to how it feels to create, carry and give birth to life. We as women and mothers know that joy and have to be true to what our hearts and bodies tell us, if and when we want more children. We must also have the means and the responsibility to care for another child. I had done my math and it would be tight, but it would be OK.
Can you guess how this ends? I had my transfer on a Friday. 10 days later on a Sunday I went in for bloodwork. Numbers looked good. Another week and I went in for confirmatory blood work. Numbers were rising! (This means you are pregnant for sure!) I gasped for air at the news and immediately got down on my knees to thank God and the universe for the privilege of being a mother – again. This little “no result” baby has been a wonderful, healthy, “normal” pregnancy. When she is born, sometime in late December 2019, the twins will be 16 months old. I will also be older, ha ha ha!
I could not be happier or more excited or more grateful or more stunned or more aware of how fortunate I have been and continue to be.
My children took 6 years, thousands of dollars, courage, tons of support and many, many tears.
I got myself three miracles and it feels REALLY good. Grateful is nowhere near sufficient to describe how I feel. Sometimes when I think about the little embryos that became my children, my heart feels like it will burst. It’s an amazing feeling!