Part II ~ Leaving my job and diving into IUIs and HSGs

It was January of 2014 when I made the decision to resign from my job. I had been dreaming about it for months, wondering what life would be like without the daily, unending stress. Wondering if I could make a living doing something entirely different. Wondering if I could just quit and figure it out along the way. Knowing on some deep level that there was a struggle on the horizon that I would need all my stamina to navigate. On a day in early January, shortly after finishing a three-week trial that had depleted my energy, I found myself sitting in my windowless office feeling numb. An enormous stack of files glared at me and my voicemail needed listening to, but I couldn't bring myself to function. I found myself perusing health and wellness blogs and researching clean eating recipes, wistfully imagining the lives of the bloggers: morning yoga, quiet writing time with coffee in the sun, hitting a farmer's market in the afternoon and cooking a healthy dinner, with no stress of adversarial court proceedings looming over their heads.

Okay, okay, I know that's probably not what every wellness blogger's life looks like! In my imagination, however, there was a life out there, outside my daily bubble of florescent lights and arguments, and I wanted to experience it. I couldn't shake what the doctor had told me, "the most important thing you can do when trying to conceive is to get enough rest and keep your stress levels low. A baby needs a warm, welcoming environment." I knew my adrenaline, caffeine-fueled, exhausted body probably was the exact opposite of the environment the doctor was describing. It probably screamed, not here!  This is not safe!

That day in January, exhausted from trial and lacking the strength or motivation to be the kind of attorney my clients deserved, something just clicked and I knew it was time to go. I calculated my savings, figured out my financial safety net, and drafted my letter of resignation that day. I enrolled in a program to become a certified health coach with the Institute for Integrative Nutrition. Three weeks later, I walked out of my office and away from my steady paycheck for the last time. I was ready to get my body in balance and focus on becoming a healthy, calm person, ready for motherhood. It felt incredibly risky and incredibly right all at the same time. It took faith that everything would work itself out. I didn't know if I was making a mistake or not, I just knew that if I didn't quit and I didn't end up getting pregnant, I would always look back and wonder if I should have taken that leap of faith and given it my all. I didn't want that kind of regret.

Shortly after leaving my job we started our first rounds of medicated intrauterine insemination (IUI). I was lucky enough to have some infertility coverage through COBRA after leaving my job, so the IUI's were covered. We had to travel to San Francisco for the appointments, but since I was no longer working I was able to make the trip without difficulty. My newfound freedom gave me the chance to focus on my health and my journey with a lot less stress, something that felt entirely new and exciting.

I wasn't super excited about taking hormonal medication, but I was confident that with a little nudge we would soon be successful, so I embraced it. Sure enough, I was soon bloated, cranky, and had headaches... but with that first medicated ultrasound we were happy to see I had three follicles growing, all to "maturity," or 18-24 mm. My body was responding! I took this as a sign that all was well. That first month as we waited for the results, I was positive we were pregnant. That's the tricky thing about the hormonal medication, the side effects mimic the early symptoms of pregnancy. So not only are you all sensitive and emotional, you are actually tricked into thinking you've succeeded. It was a cruel wake-up call when I finally tested and the results were negative. I was devastated, but I remained hopeful, knowing it could take a couple tries. The next two months were more of the same: Negative. Negative.

Each time I got a negative result, I felt crushed. The agony of waiting, when we were trying so hard for something we wanted so badly, it was indescribable. Every month my doubt crept in a little more and I wondered, is this ever going to work? Is something wrong with me? Am I being punished for something? Even more frustrating for me was the lack of answers. I don't have any of the typical, worrisome problems that typically cause difficulty conceiving: I don't have PCOS, endometriosis, hypothalamic ammenorhea or irregular cycles. My blood work continued to be good. No one could give me an answer as to why this may not have been working. I kept feeling like I must have been doing something wrong.

After the third negative cycle, my RE suggested we do an hysterosalpingogram (HSG) to see if there was anything blocking my tubes. Basically, an HSG involves a radiologist squirting dye into your uterus while you are under an x-ray machine and waiting to see if the dye flows out through the fallopian tubes freely. If it does, then presumably your tubes are open and not obstructed by scar tissue or some other blockage. This sounded like a reasonable test to undergo, especially since I had suffered three abdominal surgeries and scar tissue was a real possibility. I was hopeful again we would find an answer, or at least rule out a possible obstruction.

The day of the procedure, I was told to take an ibuprofen prior to going in, and that I might experience "mild to moderate cramping." This scared me a little, but I'm no stranger to cramps so I didn't worry about it too much. I expected to be uncomfortable but I was sure I could handle it. What happened was far worse than I was prepared for. (To be fair, not everyone has the reaction I had and this post is not meant to scare anyone facing an HSG! However, I think it's important to be aware of the potential effects and the accuracy of these tests.) Everything was fine until the moment they squirted the dye inside me. If I hadn't known better, I would have said they squirted boiling hot fire water inside my body. The pain was shocking and unbearable, and I have a high pain tolerance. I screamed and writhed against my will. I remember trying to breathe and calm myself down, but I went into shock and I literally felt like I might be dying. I thought maybe I was having an allergic reaction to the dye as I looked at my hands and they started to spasm uncontrollably. It was absolutely the scariest and most painful procedure I've ever experienced. They rushed me to the ER so that they could give me some IV pain medication, the whole time rolling their eyes as if I was overreacting and a pain in their ass. As they took me to the ER I could hear them saying my left tube was blocked. The left. The only side where I had a functioning ovary. I was devastated, terrified and in pain. Not a great day.  I spent the rest of the day crampy, cold and wrapped in blankets, recovering from the physical and emotional shock of what a blocked left tube meant for us.

When we met with our RE a couple weeks after the procedure to discuss the next steps, he suggested we try a tubal recannalization. This procedure would be similar to the HSG, I was told, with the possibility of unblocking the tube. Of course the thought of going through anything similar to what I had just been through was beyond terrifying but after some insistence, I was assured that I could be sedated the next time. Seeing no other option short of IVF, I agreed to give it a shot.

We went to San Francisco for the "tubal recan", and although I was scared, I was trying to remain hopeful and positive. This time my husband was with me and as they got us all checked in and got me prepped I was trying to fight back the panic rising in my throat. I kept reminding everyone who dealt with me how painful I had found the previous HSG and that I would need to be sedated and I was assured I would be. The radiologist who was performing the procedure came in to talk to me then, and asked, "do you understand what we're doing today?" "You're going to try and unblock my tube," I responded with a hopeful tone. He smirked at me and said condescendingly, "apparently you don't. I can't unblock your tube, that's not what we're doing. I'm just taking a look to see if it's actually blocked." I was confused and tried to explain what my RE had told me. The radiologist just looked more and more disgusted with me and said something like, "you obviously haven't done your homework, expecting the impossible."  Then he turned to my husband and said, "you sure you even really want kids?"

We were stunned. I had been trying desperately to keep my composure, but at that point I lost it and started crying and shaking. I could see the nurses look at each other sideways with concern; they were obviously aware of this doctor's unprofessional bedside manner but were too afraid to say anything in front of him. My husband was about to lose his mind and wanted to go punch the radiologist in the face. I insisted we wait for my RE to arrive so I could talk to him. There was no way I wanted to be put under and trust my body to that guy! When my RE arrived, he was apologetic and explained that the radiologist was the best and what he did, he just didn't have any bedside manner. He told me I could trust him to do the best job and that he would be in the room with us the whole time. I was absolutely terrified, uneasy and sick to my stomach but I didn't know what else to do other than go forward. I reluctantly agreed and just tried to give myself over to being knocked out, saying a silent prayer for the best outcome.

After the procedure, I was told my left tube was actually open and likely had never been blocked. They explained that sometimes, if the woman has a bad reaction to the dye like I did, the tube can spasm and appear to be blocked when really it's a temporary closure caused by the test itself. I was so confused ~ was my tube naturally closed, and just pushed open by the dye in this current procedure, or was it naturally open but had spasmed closed during the first HSG? My RE said there really was no way to know 100%, but that he suspected the latter to be true. It was at this point that I started to realize how much guess work really goes on with reproductive science. There is a lot they can find out, but there remains a lot they don't know. Between this and the "missing" ovary on my right side, I started to feel like maybe my situation was way more complicated than I had ever suspected. My RE remained positive though, and said now that they felt sure my left tube was open, we should try one final round of IUI. I agreed.

That final IUI experience was a profound one and calls for its own post! Look for it in Part III, the possibility of life, death, and love.