“Right now I am day 6 post loss 5. I am drinking prosecco and eating popcorn and writing a blog that I will probably never post.
I knew I lost it as soon as I looked in the toilet. I had bled the night before and it was bright red. Not the transparent bloody discharge and spotting that’s normal in early pregnancy, but red like a rose and the color of hell.
I told myself it was ok, because I had been to the doctor earlier that day and they’d done an ultrasound. It was probably just bleeding from the probe. That’s what I told myself. And I went to sleep.
I saw the clot in the toilet the next morning and I knew.”

I wrote those words about 18 months before sharing my misbehaving uterus with the world.  It’s a little hard to read them.  The language is so raw.  It reminds me how jagged everything felt.  As I read my posts over time, I can sense my own healing in the language.  I’m sure you can too.  But for this post I want to try and revisit that place or pain as I share about my fifth loss. 

Our fifth loss was after our first IVF transfer. IVF is a long process, and it influenced the experience of this miscarriage.  The treatment burdens I endured to achieve my fifth pregnancy was so intense that it heighted the pressure and increased the expectation of a positive outcome. 

We started the IVF process with my doctor in Seattle (a reproductive endocrinologist).  But I was also continuing to be treated by my doctor in Chicago (a reproductive immunologist).  I really liked my Chicago doctor and trusted her recommendations, but my Seattle doctor was not supportive of an anti-inflammatory treatment plan.  This left me in the middle, uncertain of the right path, afraid to disappoint my new doctor (and my old doctor), and worried that by choosing incorrectly I would cause another loss. I think the phrase here would be “emotionally fraught.”  

Unsure what was causing our losses, I was terrified to stop any medications.  Instead, we threw the metaphorical kitchen sink of treatments at the pregnancy.   Not only did I take all the drugs necessary for IVF, I also continued to take my anti-inflammatory medications, and I even flew to Chicago a week before the transfer to receive an IVIG infusion in the hopes that it would decrease my inflammation levels. (IVIG stands for intravenous immunoglobulin.  Its use is controversial for the treatment of RPL and my doctor in Seattle refused to administer the drug).  

The whole process was physically draining.  With IVF there are just so many gosh darn needles. And pills. And blood draws. And monitoring appointments. And while I had responded very well to the stimulation meds for the egg retrieval (see previous post), I did not respond as well to the transfer meds and struggled to meet the threshold of endometrial thickness required for a transfer. But we did eventually make it to transfer day. 

Before the procedure, we had to legally authorize one of our embryos to be thawed.  The form included an option to specify the gender. I have a distinct memory of discussing whether to use this option – sitting in the bleachers buy the neighborhood baseball field, eating croissants and sipping coffee. I remember thinking maybe we should leave it to “chance” and what was “meant to be.”  My husband reminded me that absolutely nothing about our family building process had been “meant to be.” He said because of everything we’d been through, we had a choice that most people don’t, and we shouldn’t feel bad about taking advantage of the opportunity. So, we chose a girl.  “Happy,” I called her, because we named our seven embryos after the seven dwarfs, and she was the fifth one on the sheet and our fifth pregnancy. 

The transfer procedure was sort of magical (though that could have been a result of the midazolam…) It is a miraculous thing to see your embryo on the screen, watch the embryologist pull it up into a syringe, and then witness your doctor place it into your uterus.  I mean, science is pretty freaking cool.

The two-week wait after the transfer was not so cool.  It was two weeks of constant anxiety and a preoccupation with every physical sensation. I would squeeze my boobs to try and determine if they were tender.  I would spend endless hours wondering if the cramp I felt was a good sign or a bad one.

My dad came out to visit, which was a welcome distraction.  That also meant he was with us when we got the news that we were pregnant.  My dad has a very particular intonation, and I can still hear his response exactly in my head when we told him it worked.  He said, “All right.” As if it was going to be all right.  As if this pregnancy would finally correct the failures of the past and put us on the right path forward. If only.   

At this point, though I lived in Seattle, I was regularly commuting to and from Chicago for work. My company let me work remotely most of the time, but I spent about one week a month in the Midwest.  (Sounds pretty typical now, but this was pre-Covid, so remote work was not as common.) During these trips I bounced between my parents’ and my sister’s houses. The morning of the loss, I was with my sister.  I remember waking her up to show her the blood in the toilet.  “I lost it,” I said.  She tried to reassure me, but I knew.

Then I did what I now consider to be a ridiculous thing: I went to work. My sister told me I was crazy.  She encouraged me to call in sick.  But I had an important meeting that I was leading with key a supplier, and my mind was so messed up that I couldn’t see a way out of it.  So, I drove to Milwaukee.  I went to the meeting.  I lead the conversation.  I smiled and made small talk and pulled professionalism from some well deep inside that I didn’t know I had.  After the meeting, I got in my car and cried.  Then I went to McDonalds, bought fries and a McFlurry, and headed back to the office. 

Another important point of context here is that around this time I started dotted-line reporting to a new manager.  My formal manager was aware of my losses, but I hadn’t shared any of what was going on with the new guy.  So, on the drive back from the meeting to the office I made the decision to tell him.  “I’ll just walk into his office and calmly explain what’s been going on,” I thought.  “I’ll tell him I’ll be taking some time over the next few days, but that it’s nothing to worry about.”  Professional.  Stoic. No big deal.  I got about as far as, “I need to talk to you about something in private,” before I burst into hysterics – and I do mean hysterics.  It was one of the most uncomfortable workplace encounters I have ever had.  To his credit, the guy was as comforting as someone can possibly be when blindsided by a sobbing employee, but we still both tried to end that interaction as quickly as possible. 

After my breakdown at the office, I drove to my mom’s house.  My sister came over and the three of us ate two pints of ice cream.  (Ok, I ate an entire pint of ice cream while they shared the other one.) I flew back to Seattle the next day.  “Burnout” is described as a process of trying harder and harder but not seeing any different results.  That’s how our fertility journey felt.  We had tried everything for this pregnancy.  We prepared for months, we did all the special science, we’d shelled out tens of thousands of dollars.  And the results were the same.  Hopeless didn’t even begin to describe it.  I was not ok.

A few weeks later we took a vacation to Canada to spend some much-needed time in the woods. We returned home knowing it was the beginning of the end. “One more,” I told myself.  I could try one more time.  But we would also start to explore other options.