The following year, each month was another infertility battle, and I was getting worried about losing the war. Having miscarried my baby, I guess I misplaced my period as well, because I couldn’t menstruate. No unfertilized egg burst out of its watery ovarian home and bumbled down my fallopian tube each month, triggering a shedding of uterine lining. Medical tests confirmed that I wasn’t ovulating, but couldn’t explain why. But without eggs, there couldn’t be a pregnancy. I became increasingly cynical, furious that my body had failed me, my baby, and my partner. My world seemed newly populated by pregnant women and unwanted pregnancies. I dreaded trips to my OB/GYN, who merely reassured me time and again that miscarriages were “perfectly normal” and that I should “just relax.” Ha.
Spring and summer came and went with no period to end my sentence of barrenness. My physician finally prescribed Clomid to stimulate ovulation, but the only thing it awakened was my inner Mr. Hyde, whom my more kindly Dr. Jekyll struggled to subdue. The most trifling things drove me to the refuge of our walk-in closet, where I would scream into a pile of sweaters.
Per our OB/GYN’s orders, we waited one year before seeing an RE. Because our particular northeastern state mandated that health insurance cover infertility treatments, our fertility care would be paid for, but with two caveats: patients without male factor infertility had to complete three rounds of intrauterine insemination (IUI) before undergoing IVF, and there was a lifetime cap of three IVF cycles. Before my long-awaited Fertility Clinic Consultation (believe me, it merited capital letters), I solicited friends’ recommendations on clinics and REs, researched clinic success rates, made an appointment with the best I could find, and waited.
I’ll skip over much of what happened during the first few months of treatment, when I was on a merry-go-round of tests and consultations: testing, bloodwork, provider conversations, followed by more testing, more bloodwork, more conversations. Matt and I dutifully proceeded through three IUIs, accompanied by lengthy consent documents and shopping-spree-sized bags of fertility drugs, leaving trails of discarded syringe needles in our wake. We completed our third IUI early on Christmas morning, inventing some lame explanation for our absence to our holiday houseguests. When January 2007 brought confirmation that there would be no New Year’s baby-to-be, I was more than ready to move on to IVF.
We began our first IVF cycle in February. The IVF regimen was almost identical to the IUI protocol, but with closer monitoring. Our egg retrieval proved successful, netting twenty-one mature eggs. The night of retrieval, I pictured those eggs frolicking with sperm in their petri dishes and awaited the next day’s fertilization report. But our nurse delivered devastating news: only five embryos had fertilized, and we’d try to transfer the survivors back into my uterus on day 3 instead of day 5, per clinic policy. Crestfallen, I thanked the nurse and hung up. The expected fertilization rate for IVF embryos was approximately 75%; my rate had been closer to 25%. Sure this first cycle was a bust, I sobbed on Matt’s shoulder. He tried to reassure me, reminding me five embryos gave us an excellent chance of having one baby. But I wasn’t consoled; fertility math is notoriously unpredictable. Confident I knew better (I’d done a ton of Internet research, after all), I expected the worst.
The next three days crawled by. We wouldn’t know how many embryos we had to transfer until that morning, and it was possible that all would stop dividing, leaving us with nothing. But our phone stayed mercifully quiet, and on the morning of transfer we drove to the clinic, wondering what we’d find. When we were ushered back into the surgical prep area, we saw what a difference three days could make.
On day three, viable embryos are six to ten cells in size. Embryos are graded according to their quality on a scale from A to D or 1 to 4, and are also evaluated for fragmentation, or how many portions of cells have broken off during their division. A high-quality embryo will have little to no fragmentation, and its cells will appear uniform in size. Any embryos that are not transferred are left to develop until day 5, and then, if they are still active, are frozen (or cryopreserved) for future use. We had two grade-A embryos and one grade-B, each with minimal fragmentation; two were eight-cell and the third had seven cells. One embryo, however, had an “M” in front of it; a query to the embryologist revealed this meant “mutation,” conjuring up images of embryonic X-men invading my uterus. Seeing my look of consternation, the embryologist explained, “It means the embryo is dividing more rapidly than we’d expect.”
But three embryos created another problem: we’d agreed beforehand to transfer only two embryos, and we didn’t want to freeze a third embryo by itself, or endure a second IVF cycle. Sensing my hesitation, the embryologist pointed to the third embryo marked “M” and quipped, “This one might be happier in you than outside of you.” It was ridiculous to anthropomorphize embryos as if they could be happy or sad, or indeed feel anything. Yet, that remark somehow resonated with me; part of me embraced the idea that M needed me. My first act of maternal love could be transferring it, rather than dooming it to a cold and uncertain cryopreserved future. And we only had a few more moments to make this decision.
“What are the odds of triplets if we transfer three instead of two?” I asked.
“Oh, about 3%,” said the attending physician.
To me, those sounded like pretty good odds, given the likelihood that M wouldn’t implant. That made the decision easier. Deliberately having triplets seemed irresponsible; dooming one of the three seemed heartless. Transferring all three and allowing nature (or God) to decide felt much better. The doctor had just said the odds that all three would implant were miniscule, and we were still not convinced we could get pregnant at all.
“Let’s do it,” I said.
•••
Back in the RE’s office, I shook my head in disbelief.
“Triplets?”
“Not a viable triplet pregnancy yet, but yes, you have three gestational sacs.”
A stunned silence ensued. Despite transferring three embryos, I had never considered such a possibility.
“Would you ever consider selective reduction?” my RE asked.
“I suppose so,” I responded, though I didn’t even know what that meant. (Selective reduction is a procedure terminating one or more of the fetuses at approximately twelve weeks into the pregnancy.)
After I left the RE’s office, I made a very memorable phone call to Matt.
“Hey, honey? It’s not twins. It might be triplets.”
One week later, after an episode of bleeding and an emergency ultrasound, a technician reassured me I was still pregnant—in fact, very much so. For now we had three heartbeats—and a viable triplet pregnancy.
•••
Despite our initial shock, we didn’t undergo selective reduction. Though I believe my RE felt I made the wrong decision, he deferred to our decision and remained supportive. He explained the risks we faced in carrying a “higher-order multiple” gestation. He even set up an appointment with Dr. Michael Evans, the New York physician who had pioneered the reduction procedure. But after seeing our three wiggly lima beans via ultrasound and contemplating yet another fertility-related procedure, I knew I couldn’t go through with the reduction. Quite honestly, after three IUIs and one IVF cycle, I just wanted to be left alone.
I strongly believe everyone in this position must make this decision for themselves, according to what they feel is right. I’m thankful for this freedom. I also feel we couldn’t have anticipated that all three embryos would implant and thrive, and so attach no blame to my RE, his staff, or for that matter, to us. We had researched IVF thoroughly and repeatedly read over every consent form that we received, and our RE ensured we understood what we read. So much of fertility treatment is still a black box, making reproductive medicine as much an art as a science. Nor was a single-embryo transfer a customary medical practice in 2007,