Fertility Journeys Beyond the Case File: Alex's Story

In Their Own Words: Fertility Journeys Beyond the Case File

A patient’s fertility journey is more than just a set of numbers and results on a screen.

Each patient has had their own path leading them to their doctor’s office, and a different vision of what they want their family to be. Patients respond to treatments and medications differently. There’s decisions to make along the way, and they often involve other people.

We want to share different fertility journeys, including the different medical procedures patients go through, complications they may face, and the emotions they feel. We do this to honor the unique path each person finds themselves on, as they consider what the next chapter of their fertility journey might be.

In this interview series, five women spoke with Jenni Quilter, author of Hatching: Experiments in Motherhood and Technology (2022), a non-fiction book about reproductive technologies. These interviews are in their words, with Jenni editing and compressing their accounts.

Some women have a very easy path to pregnancy through IVF; others have a harder time. These interviews chart a range of experiences--but all of these women agree that, faced with the choice to embark on IVF, even knowing the outcome(s), they would still do it all over again.

To start this series, we'll begin with Jenni's own story. The passage below is an excerpt from Hatching.

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On infertility message boards, the 2WW—two-week wait—is the period of time between ovulation and your next period, which is the time you wait in order to find out if you’re pregnant: if sex, or an IUI (insemination by catheter), or an embryo transfer (the result of IVF) has actually worked. The uncertainty and the waiting are universally understood as a torture.

The 2WW is part of a broader reorganization of time, a development of the art of waiting. I had spent that summer waiting: waiting to start, then waiting for my next period, then waiting for retrieval, then waiting for transfer, and now waiting for implantation. It could be that nothing had actually changed. It could be that everything had. Those first few days after transfer, the knowledge that two living creatures were inside me was strong; it colored everything like a kind of light filter. As the days passed, it became a binary: the embryos were dead or alive, and even if they were alive, they might be chromosomally abnormal; statistically speaking, 50 percent of a thirty-five-year-old woman’s eggs are abnormal.

Online, there are many articles about how to bear the seemingly endless stretch of days (television, treating yourself, new cooking techniques, tackling small jobs), but they all seemed to miss what makes the two-week wait particularly unbearable, which is the fact that women suffering fertility issues go through this experience over and over again. In a two-week wait, it is tempting to avoid social occasions where people will ask how you are. You cannot drink. You are unusually risk-averse. As if you were ill, you are strangely deliberate about what to do with your energy. Do you dare jump into that waterhole? What about staying in the sun all day, dehydrated and hungry? The hope that you are pregnant slowly begins to build, like algal bloom in a pond. You inspect your breasts. Are they bigger? Every stomach twinge is interpreted as implantation cramps. You never thought of yourself as a nauseated person, but now you feel butterflies all of the time. It’s hard to organize holidays or plane flights. You are constantly delaying decisions. You try to avoid calculating your due date, and fail. And then at the end of two weeks, you might find out that you weren’t really waiting; you are not pregnant, and you were not really living your life the way you wanted to, and now those two weeks are gone and it’s time to start all over again. You are always postponing your life for another that may never come. This feels like a profoundly discontinuous way of living. It requires a reassessment of how you understand momentum in your life, of how much the future provides some kind of scaffolding for the present.

I had practiced yoga for many years, and thought I knew my body fairly well. I had grown proficient at isolating my awareness to particular parts; I understood, for example, when I stood a certain way, how the ribs on my right side were working in relation to the inward rotation of my left thigh. But this did not help me now. I did not know what was going on inside of me. My body was not speaking to me yet. I felt utterly normal, and was terrified of what that meant. Before IVF, time sluiced through me like a waterfall. Now, I felt more like an old-fashioned water mill. The minutes filled me up, like drops of water in a cup at the end of each paddle. Time moved so slowly, adding, and adding, and adding—till I brimmed, then over I went again, with a splash.

This uncertainty could be said to be a fundamental part of living, regardless of gender or pregnancy. There is a remarkable cognitive dissonance between our conception of bodily knowledge—the signals our body has of fatigue, hunger, or desire—and the world of cellular formation and degeneration. We do not know ourselves at a biological level; it is even hard to visualize the blood and flesh below the skin, the way our organs fold into each other, the composition of fat, blood, vein, and muscle. Our love of on-screen physical violence, particularly decapitations, amputations, arterial spray, or disembowelment, is a consequence-free way to remind ourselves of the existence of our insides. Our corporeality is remarkably easy to forget—so easy, in fact, that one senses an evolutionary advantage of some kind to putting aside the knowledge that your heart has beaten fifty times reading this paragraph. Our experience in our bodies is often discontinuous, and that doesn’t have to be a patriarchal thing.

At the end of my two-week wait, I was on holiday in Maine. I was expecting the nurse’s call, and knew I was going to be somewhere mundane, but I was still surprised when the phone rang and I found myself standing in an outdoor gear store, in between the Therm-a- Rests and camping stoves. I was embarrassed to answer the phone so politely, to wait for her to say something. I wanted to scream. Tell me! Tell me!

I was pregnant. But the nurse was cautious. My hCG—the hormone that over-the-counter pregnancy tests measure—was “lower,” she said, “than I would like.” I would need to take another blood test at the local hospital in two days, and the amount of hCG would need to at least double in that time.

I was ecstatic, literally hopping up and down with happiness. I tried to continue the holiday: hiked, ate lobster, fought off low fog and mosquitoes. In two days, I returned to Bar Harbor, and killed time between the blood draw and the results with shopping, watching families on holiday, daring to directly look, for the first time in months, at babies.

The nurse called again in the afternoon. I knew straight away from her tone. My hCG had risen, but not enough. It turned out you could be sort-of pregnant. It was likely that the embryo had implanted, but that it had chromosomal abnormalities. She told me I would miscarry, probably within the next two weeks. I returned to New York that day, holiday forgotten. All I could think about was the blood to come.

My miscarriage never happened. More blood tests revealed that the hCG was still rising: not enough to indicate any kind of viable pregnancy, but in such a way that my body did not know to expel the embryo. I waited one week, two weeks, three weeks, imagining this tiny collection of cells inside of me, still alive but lost, like a blindfolded person headed off in the wrong direction. I found myself measuring where I would’ve been had the pregnancy been healthy. By now there would be a heartbeat. By now, I would’ve been able to see it in an ultrasound, moving around. I had so badly wanted to be pregnant, and now, all I wanted was to have this embryo out of me, to move on, to let it go. It was remarkable to me how I reversed the current of my desire.

My doctor recommended a surgical dilation and curettage, which meant that under anesthetic, my uterus’s lining would be scraped away and with it, any implanted embryo. It amounted to an abortion. The clinic they recommended was too expensive, costing thousands of dollars, so I went online. Try searching “abortion” on Yelp. There were abortion clinics up near Central Park, as well as Planned Parenthood. In the end, I didn’t want to sit with a group of women who didn’t want a child. I found a clinic in Chinatown that made oblique mention of pregnancy terminations, and called. The woman who answered told me I could come in the next day.

All of this only came about because I started looking inside my body, and saw what I didn’t consciously know. What had I gained, and what had I lost?

It was tempting to say that the past two months were a waste. I didn’t have a pregnancy to show for it—in fact, I’d had my first abortion. My body was still healing from all the needles. I still felt bloated from the hormones. My life was so taken up with the process that I could barely communicate with people outside it. I didn’t fault the clinic for my failure; I knew the odds. The overwhelming feeling was that I had rolled the dice, and lost. Two other blastocysts had been frozen. I didn’t know if they were abnormal either, though my doctor reassured me that he didn’t think they were. He wanted me to register the positive part of the experience. “We know you can get pregnant now,” he said. “We know implantation doesn’t seem to be a problem.” He wanted me to continue.

Some people, reading all of this, will see the ways in which the medical industry controlled—to the point of smothering—a pregnancy, and a pregnancy loss. No matter the laughter, or the complications of experience, the outsourcing of conception beyond two bodies is seen as a violence. This suspicion creeps into the most well-reasoned anthropological accounts of IVF. Consider Sarah Franklin’s recent analysis of ICSI, the fertilization of an egg by pipette (with sperm inside), and the process that my eggs underwent with Shahzad’s sperm. Franklin is probably the most well-known anthropologist today writing about new reproductive technologies, and there are times when her language of close reading persistently assumes the dangers of objectification. She points out how, in videos of the process of ICSI, the egg is, literally, “taken in hand.” These videos cannot help but reproduce the point of view of the manipulator and the embryologist, not of the woman. With ICSI, Franklin writes, fertilization is “not narrated as a journey, an adventure romance, or an epic quest, but as a difficult feat of manual control.” She suggests we have moved from an act of witness to an act of manipulation, and asks us to consider the consequences. Do we think of that moment of fertilization any differently? After all, our “failure” is all the more visible. Our bodies cannot be left to their own devices, even at a cellular level.

Franklin’s interpretation and question sound reasonable, but it’s also assumed that it is a violence—in and of itself—to take on the point of view of the embryologist, to internalize it, to absorb a detached view of one’s own body. Can’t it be both an adventure romance and a feat of manual control? Why does it have to be one or the other?

I am aware that I might sound like an apologist for objectification at this point, too much the daughter of a scientist and a doctor, a woman who has so thoroughly internalized an objectifying mode that she can only see the good in it. It might also be the case that the detachment I’m describing is a symptom of a broader bodily alienation that is more contemporary than gendered.

It is easy to look inside ourselves, but harder to know what to do with that knowledge. Having had ICSI performed on my own eggs, I want to consider not just what I lose, but what I gain if I take on the point of view of the embryologist. The visualization of what has, for nearly all time, been a hidden, embodied, often silent and instinctive process, is a remarkable form of self-knowledge. To look inside the body, to understand its constituency, is to understand more about the relationship between parts and the whole. Having watched these videos, I am more in awe of the process of conception rather than less. We can understand causality in a new way—perceive, for instance, how infertility is not necessarily mysterious, but the result of a blocked fallopian tube, or endometriosis. Rather than viewing it as a way of removing agency, reproductive technologies could be seen as a way for patients to connect feeling with sight. Initially, it is an awkward mental adjustment, like learning to reverse a car for the first time using the rearview mirror. This is my body? Ultrasound offers a kind of anatomical recalibration. To emphasize a patient’s passivity in the context of a sonogram might also overlook the other emotions she experiences, which is often a rush of joy or feeling when she sees visual confirmation of blood and bone. This can sometimes make her feel more powerful, not less. Not all objectification is surrender; for centuries, portraiture was a way for the wealthy to confirm their power. That their image could exist apart from their bodies was a sign of influence in and of itself. To dismiss objectification completely is to miss the pleasure of image-making, which is substantial for those interested in aesthetics in general.

When I remember myself from this time, it is me, standing in front of the mirror, syringe in hand, eyeing my body, gauging my target: a self-portrait of some kind. An adventure romance or journey is a feat of manual control. I had begun the process assuming that waiting was an agony, and it continued to be. But I also started to sense the ways in which the experience was revealing. It had been so easy, up until this point in my life, to not think too hard about the passage of time and my experience of it. I had confidently understood what meaning could be generated in each unit of time: a day, a week, a month, a year. Now, a day could expand like a balloon, and I felt real panic at how neverending each could be. Passing time became a challenge. And yet part of me knew that this panic was important, that I was being presented with a door through which I could understand my life— as in the time I had to live—very differently. A new way of living had casually revealed itself to me, like the flash of a lining of a coat, visible and crimson.