Yesterday was a pretty bad day in terms of trying to conceive. Not the worst day–no miscarriages here–but my blood test came back negative for HCG, the pregnancy hormone. That’s the one that makes a second line or a plus sign appear on pregnancy tests after you pee on them. A negative blood test means that you’re not pregnant.

In other words, the latest transfer failed completely. That blastocyst, with a little heart on it, just got out of dodge, didn’t even stop to say hi and implant even a little. We’ll have no way of ever knowing why it didn’t implant, what went wrong on the chromosomal level (because everything else was textbook). It’s just gone, and we’re back to square one.

(side note: this show was awesome)

Well. Not really square one, because we know certain things now. We know how much IVF medication is enough for me and how much is too much. We know that I need to have a 38 hour trigger instead of 36 for optimal results. We know that I can easily become overstimulated, and that I would prefer not to do that because it’s not fun or healthy or good.

And we know that if we want to succeed now, we’re going to have to do preimplantation genetic screening, or PGS.

That’s not entirely true. We don’t have to do that. There’s still a chance that we’ll get lucky with the odd blastocyst that’s somehow magically good. But I’m tired of wasting my time and wrecking my body with no results. When Kyle and I were in Texas this weekend, I told him that my biggest fear in this process is that we’ll exhaust all our options and come up empty handed. That I’ll have wrecked my body–because the IVF process has definitely wreaked havoc on my health–for nothing. I don’t mind if I’m a mess but we’ve got a kid at the end; it’ll be worth it.

But to be a physical disaster and have no kid as a result?

So PGS. We’ve talked about it with our doctor before but always deferred because it’s not covered by our insurance. PGS costs about $2500-3500 at our office; in some offices, that number skyrockets to the $8000 range (at which point, I’d just say, “You know, we’ll just keep taking our chances or maybe rob a bank.”). And, well. We’re financially comfortable–we don’t have to choose between mortgage payments and food or electricity payments and daycare–but we’re not that financially comfortable. We don’t generally have that much money lying around for a rainy day. This isn’t because of poor spending habits on our part (on the contrary, we’re all pretty content to not spend money unless it’s necessary, like a $600 car repair or something), just because we’re not rich. Having $2500-3500 to throw at something is a tax bracket or two above us.

And even now, when PGS is our primary hope, I’ve been pretty sure that we didn’t have $2500-3500 to throw at it. I knew we had some extra money in our account–Kyle got a nice bonus this year, and our tax return was higher than it’s ever been–but I figured it was more in the $1000 range of “we don’t know how to spend money, so we’re not” rather than the $3500 range of “we’re rich.”

(if we were rich, we could do this. We wouldn’t, because that isn’t how physics works, but we could)

I mean. $1000 that we can throw at anything is a much better place than we were in five years ago. It’s a much better place than most folks we know, but it’s still a far cry from $2500-3500, especially when you consider that by the time we’re done buying groceries and paying bills, we’re also desperately trying to lay track to get to payday. That money would take a while to save up, even with a nice starting base of $1000. I figured that if we really pinched our pennies, we could do it in about ten months, or by next February-March.

(if we gave up food and gas for the cars, we could manage in five months, but while we’re all trying to exercise and eat healthier, that particular plan didn’t seem prudent)

And, well. That’s a wait. Next March would mark three years on this particular venture, and I’d be approaching the dreaded 35. Medically speaking, 35 is the age when your egg health swan dives off a cliff, leaving you with just wrinkly dusty things that may or may not be healthy. Your risk of chromosomal abnormalities–not just survivable ones like Trisomy 21 (Down Syndrome), but the ones that destroy viability like Trisomy 16 and other aneuploidies–skyrockets.

That’s not to say that it’s impossible to conceive a healthy child after 35, just that it gets a lot rarer and more difficult.

(here’s a graph)

So I was brainstorming ideas to come up with the extra money quickly. I thought about doing a GoFundMe, but that felt icky to me. I’ve helped a lot of friends through GoFundMe, but it’s been for situations that really warranted help, like “our house burnt down” or “this person has cancer” or “someone has died” or sometimes all three at once (I gave a lot of money on that one because holy hell, universe, calm down). Crowdsourcing something that I could save myself over time seemed… wrong. Petty. Like taking money away from people who really need it.

I thought about selling a kidney or other body part through the black market, but that seemed counterintuitive to my attempts at a healthy pregnancy (I thought about selling Kyle’s kidney without him knowing, but our bathtub just isn’t big enough for the amount of ice we’d need).

(Kyle doesn’t believe in Candy Mountain anyway)

I thought about robbing a bank, but that’s just impractical. You generally can’t get more than a cool thousand robbing a bank, and anyway, I’m not very stealthy. I’d probably get caught, and that would ruin the whole thing (though it would make for hilarious novel fodder and would maybe get me a Netflix series–maybe a knockoff of Orange is the New Black. I’d call it Dumb Baby Jail, because I would be dumb and would have gone to jail trying to get money to have a baby).

I thought about taking out a loan, but we have a lot of those already–student loans (ell oh ell), car loans, mortgage, credit cards. Our credit scores are kind of ugly right now, thanks to a nasty combination of all of the above plus Kyle’s identity being stolen a couple of years ago around tax time (it’s a lot harder to use your tax information to fix your finances when your finances are consistently monitored, not because you did a Bad, but because the powers that be worry that you’re an impostor you). I don’t know that we’d even get approved for a loan, even if taking one out was a good idea (it’s not).

So waiting, obnoxious waiting. I whined about it to Kyle when we went to bed last night, how I know we’re really lucky to even be having this conversation, but that I’m so tired of waiting. I’m having baby fever something fierce; I want another kid. I love our kid, our beautiful Sam (who is such a miracle I can’t even tell you), but I want another kid. And then, once everyone’s a little older, I want to adopt, maybe from foster care, and that will complete our family.

But anyway. I whined about money, and Kyle asked how we were doing in that regard, because we have a couple of bills due this week (specifically the ones he takes care of, which are two: his car payments and daycare. I take care of the rest). I looked at our bank account, expecting us to have enough for the car payment and daycare, plus that extra thousand, but not much else.

Instead, my bank account reminded me that oh, by the way, you never spent your tax return because you never thought to, so you actually have an extra more than $2000 sitting around, which is ridiculous considering that we were completely broke not five years ago.

(for context: five years ago, Kyle and I moved up to Massachusetts from Texas to keep from completely depleting our savings after I lost my job, which was our sole source of income at the time. My parents offered us their in-law apartment, rent-free, so we were able to just keep paying minimal bills while we looked for work. Kyle managed to get a great job in web UI development around August of that year, and now we’re here)

So. The point of this long story, in which I sound ridiculously privileged (don’t get me wrong–I have gallons of privilege, and I’m hyper aware of that fact) is that we don’t have to save up as much as I thought we would in order to accomplish the simple task of getting pregnant, which most people can do for free, uterus, I don’t know what your damage is. And that makes me feel better, even though I’m not currently pregnant.

(that and moscato)

Yesterday, Kyle and I had our follow-up appointment with our reproductive endocrinologist (RE), and it ended up being really reassuring but at the same time not reassuring at all.

The first thing we talked about was the most recent miscarriage, which honestly came as a surprise to everyone. That blastocyst had been perfect from day one and was still perfect when they transferred it. It was classified as 4AA, meaning that it was getting ready to hatch and that the cells had divided to look like a textbook blastocyst on day 5 after fertilization. Both the inner cell mass (that’s the fetus) and the epithelium (the cells that become the amniotic sac and placenta) were well organized and looked good. The transfer went “beautifully,” and when I got my pregnancy test bloodwork back about ten days later, the numbers were almost double what they’d expect them to be at that point. They increased at the exact rate they were supposed to, so everything looked really good. I thought that maybe this would be the one.

The only thing that didn’t look good was my progesterone number. Progesterone basically helps a pregnancy to stay in place–it tells your immune system, “look, we actually want this foreign body in us, so DON’T ATTACK IT.” It helps the uterine lining, or endometrium, which is thickened with estrogen, to stay intact and healthy. For the first several weeks of pregnancy, the ovaries produce enough progesterone to keep the pregnancy in place; after that, the placenta takes over.

In a frozen embryo transfer, your ovaries are basically turned off (the absolute polar opposite of an IVF cycle, and my god is it refreshing), so you have to take supplementary progesterone. This can happen in a number of ways, but the two most common are intramuscular injections and suppositories. You can either take an ENORMOUS needle and shove it into your buttcheek every day (sometimes twice a day for kicks!) or you can shove a bunch of goop where the sun don’t shine twice a day, every day.

Isn’t infertility a blast?

(so. much. fun.)

Without getting into too many details, I chose the latter because while I’m a-okay with most needles, I do have a limit (and also because either Kyle or Kat would have to give me the injections, and bless them, but no). It had its drawbacks (which I will not go into here), but those paled in comparison to how little I wanted an enormous needle in my buttcheek.

(Maui gets me)

So fast forward again. When I got my bloodwork back, the nurse told me that while my HCG numbers (HCG is human chorionic gonadotropin, the hormone produced exclusively during pregnancy… or testicular cancer, which I most assuredly do not have) were really great, my progesterone was extremely low. It was above a 5, which is the cutoff for a viable pregnancy, but it was still much lower than they wanted to see. They scheduled me for an earlier ultrasound, just to make sure that things were still growing, and long story short, we never made it to that ultrasound.

Logically, I put two and two together. My progesterone was low; I’d lost the pregnancy; therefore, I’d lost the pregnancy because my progesterone was low. I was taking so many progesterone supplements at that point that I guessed the problem must have been with absorption, and the culprit for that, I figured, was the ridiculous volume of estrogen I was gulping down every day (6 mg, for those playing along at home). Too much estrogen can overwhelm the progesterone in your system, so that just made sense to me. Maybe my body just got a taste of estrogen and decided to go full ham, churning out the stuff at staggering speeds and volumes. My progesterone never stood a chance.

Well. This is why I’m not a reproductive endocrinologist.

(that and all the math)

My doctor looked back at my numbers and explained that my estrogen levels had been, like everything else in this swing-and-a-miss pregnancy, “beautiful.” My progesterone levels had seemed low because I was opting for the suppository route, which delivered progesterone directly to my uterus. Levels would have stayed pretty low in my system until the placenta kicked into gear because I was basically bypassing the bloodstream. If I hadn’t been getting enough progesterone, I would have experienced breakthrough bleeding, and I didn’t, not until the miscarriage itself.

(I’ll spare the gruesome details and just remark that it looked like The Shining)

So that itself was reassuring: I didn’t do anything wrong. Different progesterone supplements wouldn’t have changed the outcome; like the last two miscarriages, this one had likely been the result of something going wonky with the chromosomes when Kyle’s DNA and my DNA merged and split. We weren’t able to save the fetal matter, so there’s no way to know for certain what the problem was, but chromosomal problems are kind of impossible to prevent anyway, so it wouldn’t have mattered much.

In that vein, we talked about chromosomal boogaloo, and my doctor basically said that while it’s usually an egg health issue, there’s no way to test for egg health before fertilization. You basically have to fertilize as many eggs as possible, freeze them, and then do what’s called a preimplantation genetic screening, or PGS. PGS basically makes sure that the embryos are chromosomally healthy (and can determine the genders of any embryos, which makes it pretty controversial), that there aren’t too many or too few chromosomes (a condition called aneuploidy). The embryos are refrozen after PGS takes place and can be transferred at leisure.

SO. What does all of that mean for the future of me getting knocked up?

FIRST. We’re going forward with another frozen cycle ASAP. Initially, I’d thought, “well gee, I’d like to wait a couple of months and just give my body some time to chill,” but whether because I’m not feeling hopeful or because I’m tired or whatever, I just want to get this frozen cycle over with. If it works out, awesome, I’ll have a due date sometime in December or January. If it doesn’t, we can move on. The last frozen blastocyst is of a 3AB quality… not picture perfect, but I’d rather have a fetus that grows than one that’s textbook perfect as a blastocyst.

SECOND. If this doesn’t work, I’m going ahead with another IVF cycle, though I don’t know when that would take place. I talked to my doctor about making sure I’m not overmedicated this time like I was last time (I am NOT doing the OHSS boogie again, that was miserable), and with any luck, we should have found the right medication cocktail to produce a lot of healthy eggs. Those will be fertilized with ICSI (intracyatoplasmic sperm injection, basically they’re going to actually inject the sperm into the egg to make sure the poor lamb doesn’t get lost), and then we’ll freeze them to do PGS.

Which, why haven’t we been doing that all along? Well, because it costs $2500 minimum, but usually closer to $3000-3500; and while I’d love to say I’m rich enough to throw that much money at anything whatsoever, I’m not. We’re not. We’re going to be saving many pennies for either PGS or, if this frozen cycle works, upgrading our baby stuff (our stroller is very sad, and we’ll need new carseats and a new car).

(pictured: not me)

Initially, my plan was to just do back-to-back-to-back IVF cycles, get as many embryos as I could, and then test them all in one fell swoop; BUT apparently our insurance requires that we use all frozen embryos before doing another IVF cycle. That’s entirely fair, and I just hope that any future individual cycles produce enough embryos for testing.

(this all makes me sound like a mad scientist. I’m not… a scientist, that is)

So that’s the path forward. Emotionally, I’m… I don’t honestly know. Guarded, I suppose. I feel like I just want to move on, keep going. I’m not planning anything, and I’m trying to avoid getting my hopes up even a little bit. We’ll see what happens, I suppose.