Will Someone Die Every Time I do IVF?

As you may recall, my father was diagnosed with stage 4 pancreatic cancer just after I went through my embryo transfer for IVF. And, as I started this process again, and tried to articulate the particular strands of trepidation I was feeling, the thing I was not telling people was that I was wondering whether someone would die every time I did IVF. To be clear, even though I am an only child, I don't really believe that everything in the world revolves around me. But I know about the circle of life, both from the Lion King and from that movie where death takes a holiday, and I know that usually, someone, somewhere is leaving this mortal plane when someone else is arriving via birth. Really, God, I get it. It does not have to be illustrated for me with such a direct connection as it was in the spring.

But apparently God, or the Powers that Be, or the Great Narrative Arc of my life feels otherwise.

Because I started my Lupron shots on Friday night, and today I have learned that another loved one is dying of cancer in the very near future.

Last Thanksgiving, while my parents were visiting us in California, we found out that a close friend of theirs, Virginia, was diagnosed with lymphoma. She had started treatment, but, with a variety of pre-existing conditions (including congestive heart failure), no one thought she had long to live. When I started IVF and my father was diagnosed, my mother and I were really not able to call or help or even really think about Virginia's condition. Luckily, she has a nephew who really stepped in. While my father was on life support and in his final days, the nephew moved Virginia to an assisted living facility near his house.

Now, Virginia has not had an easy life. Her first husband was a fighter pilot, and was MIA in Vietnam. She remarried a squadron-mate of his, and they had a son. When their son was 8, he was killed by a drunk driver on the sidewalk in front of their house. We met them a few years after this, and Virginia and her husband Bob took an instant liking to me. They took trips with us, to Hawaii, and the Caribbean and France. They wrote cards and called and spent holiday after holiday with us. And then, in 1991, when I was caught up in the whirlwind of college, Bob died of cancer. Virginia was alone. She did not have any siblings. She had lost both of her parents. Really, her nephew was her only relative. And we were the next closest thing.

A week after my father's funeral, I drove my mother down to see her. We had a terrible dinner in her assisted living facility, but she was happy to see us. She complained about her room; she complained about the food; she complained about how old and boring and lifeless her new house-mates were. Honestly, she didn't even seem sick anymore. She sent us out to buy some bottle of wine and some Doritos. And then my mother and I drove back up to my mother's house to continue the strangely sad and technical work of executing my father's estate, writing a new will for my mother, and preparing for the other major life transitions I was about to go through (including a surgery and a move to a different state.)

And now, just as I've started the long Lupron protocol for IVF, Virginia has moved to a hospice. There is a tumor in her spine and possibly one in her brain. She told her nephew that she is not afraid of dying, she is only afraid of dying alone. And he has promised her that he will be there for her.

And I will continue my protocol. I will not make plans to fly across country to see her, because, as my Reproductive Endocrinologist reminded me, I am not as young as I was six months ago.

And if Virginia does die alone, I will always feel I have failed her.

when you hear hoof beats

Don’t look for zebras. Unexplained fertility is a misnomer. It is a transitory point in time that comes after the failure of fertility treatments based on the educated guess of the moment. It’s the fall back when the injections, hormone replacement, hormone suppressant, radioactive dye insertion, catheter procedures and prodding and altogether too much poking around, fail. Sometimes there is a post treatment regroup, and it comes after this too, after you’ve tried the acupuncture needles, the boiled seed pods and east Asian herbs and possibly, if you haven’t disclosed your vegetarian status, gecko. It comes after you, a lifelong agnostic, have visualized your uterus to be a metaphysical white glowing nest of life, after you have publicly banned your husband from the spinning bikes at the gym, after you’ve taken the drain from the bath and placed it in the linen drawer, where it can’t be used to take hot water baths, that mortal enemy of male fertility. Behind every unexplained fertility diagnosis are the best guesses of the OB/GYN, endocrinologist, andrologist, urologist, mother, mother in law, inquiring neighbor, well-meaning friend. Unexplained fertility exists to prove Hickam’s dictum. And now, I can bid that diagnosis goodbye, good riddance, certainly a well-earned good luck, because a little over a month ago, I turned thirty-five, which puts me unambiguously in the infertility category of “advanced maternal age.”

How do you like them horses?

Infertility hasn’t consumed my life. In 2006, just as I was in the middle of a series of IUIs, my father, then sixty, who was probably my closest friend in the world, was diagnosed with adenocarcinoma of the ampulla of Vater. This is a bad cancer, a rare cancer, so rare that there is no real treatment protocol, a bona fide fascinoma. The current course of treatment for ampullary cancer follows the one used for pancreatic cancer. After a few months of the roller coaster that Nayla referred to earlier, my husband and I decided to delay our fertility treatments. And why not, after all? I had plenty of time. We adopted a shelter cat named Lola, and two years passed.

In the summer of 2008, three weeks before my appointment to resume fertility treatment at a large medical center in the neighboring county, my mother asked if I wouldn’t mind taking my sister to the airport. Our mother had a medical appointment that day, and might not be feeling so well after. My mother, a non-smoking, non-drinking, near vegan, has never been less healthy than a horse (that mythical creature) so I didn’t think too much about it. One week and a few days later, she was diagnosed with second to third stage squamous cell esophageal cancer, a rare cancer seen most often in heavy drinkers and smokers.

I am a congenitally pessimistic person. I’ve never quite been able to convince myself that lilies will bloom at room temperature, so I either buy them past the bud stage, or worry the petals until they turn a filthy brown and then lop over. Even so, I did not see this coming.

During the next eight months, my mother went through chemotherapy, radiation, and a certain surgical procedure colloquially referred to as “the mother of all surgeries,” while my fathers’ health declined precipitously, as the cancer metastized to his spine and meningeal layer. One morning in December, as I sat in traffic on Highway 101, my mother, in the passenger seat, vomited into the small plastic container that now followed her everywhere. I dialed AT&T directory assistance, and asked them to patch me through to the local hospice agency. That morning, on the two-hour drive to my mother’s chemotherapy appointment, I arranged for in home hospice.

Outside of the bay window of my parent’s house, there is a hummingbird feeder that has created a generational welfare state among the birds of our street. It’s a lovely thing to see in summer, above the green lawn, the American Beauties and the plum tree, but in winter we let the lawn go fallow, and bright red plastic of the feeder is something garish against the brown grass and bare thorns. Still though, I believe that the easy availability of sugar water has offset normal avian reproductive constraints, because hummingbirds visit the feeder year round, or at least they did that winter, when I spent plenty of time staring out the bay window, at the hummingbirds on the other side of the glass, the dead lawn and the desiccated rose hedge, the county road that is never quite maintained and the field beyond that, the jackrabbits and the pheasants and even, like an awkwardly timed joke, the Appaloosa horses kept by our neighbor. After my mother and I returned from chemotherapy that day, we moved a hospital bed into the living room, moved my father to the bed, and that is where he died six weeks later.

There are two separate ways through which I measure time; the first is the thirty-five year mark, an alarmingly red chronological demarcation line that increases medical costs at the fertility clinic and decreases odds of conception. The second is in the passing of time since last winter, in they way I’m never quite sure what month it is, whether I should look for potholes in the road, or replace the air conditioner filters. In sense, I’ve not moved past last January, while my body, consistently uncooperative, has moved on into another, more precarious phase. So it is with some misgivings that I am going to be starting fertility treatments. Some. But less than I would have had, had I not met Nayla.

I’m sorry, how rude. Let me provide an introduction: