It was a Thursday, just about 9:15 AM. I was sitting in the waiting room for my name to be called, feeling hopeful and hopeless at the same time. This was my second time coming in this month to check whether any follicles had grown. One month, two rounds of Letrozole, only a week apart: Not Fun. To anyone else that feels like a crazy person when taking those five days of Letrozole, I hear you and I feel you.
I had spent the last two weeks eating beans, nuts, lentils, Maca, anything and everything thought to be even remotely good for fertility. I had even eaten six oysters the night before just hoping it would give me that extra push. But deep down I knew it didn't work - and neither had the pills. My first month, Letrozole actually had functioned as it was supposed to, and the three days leading up to my ultrasound, I swear to you, I felt the follicle inside me. You don't have to believe me, but I promise you throughout those three days I was walking around, clutching my abdomen due to a sharp pain. It felt like a ball was inside of me trying to get out, screaming to be let free.
That day, however, I didn't have pain. Just like two weeks prior. So in my gut, I had a feeling, it didn't work. Again.
It was not my usual office and it was a male ultrasound technician. I knew the drill, though. I peed and got undressed in the adjoining bathroom. He was pretty silent during the examination. The first time, when a follicle actually had grown in, the technician had been excited for me and chatty. But I tried not to harp on that. This was a different person, a different personality. His silence didn't necessarily mean it didn't work. I closed my eyes instead of watching him. I prayed in my head, please, please, please, let there be a mature follicle.
He pulled the device out and said, "All done." I knew it then.
"Nothing grew," I said, matter of fact, like I was dead inside.
"Yes, I'm sorry. Nothing."
I walked to the bathroom, silently clutching the paper gown. I wanted to cry. I wanted to punch the wall. But, I held it in. I wanted to be able to ask the technician in a strong voice what would come next. I wiped the lube, got dressed, and walked out.
"Will I be getting a call from the doctor to discuss next steps?" I said "doctor", but he knew I meant nurse team. You never get to speak to the doctor at these places, not unless you booked it 2-3 weeks in advance.
He answered with a curt "yes" and that was that. I walked to reception with my chart and credit card in hand so that I could dash out and cry in the car. Every second holding it in was excruciating. I jammed my card in, waiting for the beep.
"Wait, one second, are you preparing for your IUI?"
This was the sixth time a team member asked me about IUI. Why bother having a chart when no one looks at it? The first time I did Letrozole, the month before, the same thing happened. "Checking the ultrasound to prep for IUI, miss?" "Okay, you are all set for your IUI!" Last month was even worse - they had gone as far as booking my IUI. It was my second cycle, you morons. I was doing timed intercourse. No one had even taught me what an IUI was at this point. FUCKING READ THE CHARTS.
My response was inaudible. I wanted to scream so many things at once:
1. I AM NOT DOING AN IUI.
2. LETROZOLE DIDN’T WORK THIS MONTH.
3. YOU ARE AN INSENSITIVE, IDIOT.
But it didn't come out. She could see I was crying under my mask, the tears swelling.
"I just wanted to know if you needed a cup for a sample," she said, not even apologetic. Just emotionless.
I said, "No." and walked out.
The tears poured out. A failed month. An entire month, gone. The whole ride home I ran through what I had done. Was it the one cup of coffee each morning? Maybe it was time to give up coffee completely? Did I take the Letrozole too late in the morning each day? Is it because I took Letrozole thirty minutes late on Monday? What did I do wrong or different this month?
I tried to remind myself that it wasn't my fault. I tried to tell myself there was nothing different I could do. But was that actually true?
The worst part is, I didn't even know Letrozole could not work. Why didn't I know that? Why is that not information I deserve to know? When the doctor put me on Letrozole, I barely got a description. I got a PDF that said what Letrozole was, what it did, possible side effects, and that's it. I did not know there was a possibility Letrozole could work one month and not another. But that's typical. These places have their routine. Taking time to explain things is not part of the job description as far as they seem to see it. It would have been nice if it was a conversation: "Hey, so we are going to start you on Letrozole dose "x"; it is possible that dose is too low and eventually we may need to increase it. The way we increase it is by... Also it is totally possible to work one way one time and another way the next time."
If I wanted to become a doctor, I would have gone to medical school. I didn't. So shouldn’t it be part of their job to educate us? I'm not talking about a forty-day course in reproduction. I am talking about the basics. When an IVF doctor gives you a game plan, you follow it. They know best and all you care about is getting pregnant. You chose this doctor because you trust them (to a certain extent). But what is going on with all this prescribing without educating? It's such an ancient way of thinking, like the old saying, "Take two of these and call me in the morning."
Women, we need to cultivate our reproduction education. It is part of who we are biologically - whether you are trying to get pregnant or not. Understanding the process of ovulation can actually help you avoid pregnancy as well. I was discussing all this recently with a friend who has three kids. She tried for less than four months for all of them. She was asking me about the ultrasound and what they were checking for. I told her they wanted to see if the follicle had matured. She looked at me confused and continued with a line of questions: Does only one mature? What happens if it does? What happens next? And I realized she never needed to break down any of this. Her doctor probably told her the same thing as mine at my first appointment: "Count ten days from your period, take an OPK test everyday, when you see a smiley face have sex for the next five days."
She just happened to be one of the lucky ones who probably did see a smiley face, and her husband's semen was good, her tubes were clear, and she doesn't have PCOS.
If I understood more about my reproductive system before I started trying seven months ago, I think my mental health would be in a far better place today. I think I wouldn't feel this resentment I have against the healthcare professionals and the system in general. When you are TTC*, every second of every day is precious. Every meal, every activity, and every appointment is a way to get you closer to that baby. So when you have fertility issues and you have to spend hours educating yourself because no one else is, thoughts come up like, "Well, shit, if I had known that before maybe I would have started taking Inositol months ago!" or "Seriously? So my doctor could have figured out I had PCOS three months before my IVF appointment if she had just bothered to ask more questions?" You learn about more things that should have been tested right away or different diets that could have started to improve your egg quality sooner. You learn about common home cleaners or shampoos that actually have a correlation with infertility. It's hard not to feel defeated.
We spend our teens and early twenties doing everything we can to avoid pregnancy. My father-in-law taught his kids growing up: Rule #1, don't get a girl pregnant. When we are brought up to avoid it, are we also brought up to learn less about it?
The more I educate myself, the more I want to learn and the more I want to pass it along. I think about my friends or my sister who haven't started trying yet. I don't want to scare them or anything. I don't want them to think they will automatically have issues trying. I want them to be educated. I want them to question their doctors when they tell them to take a new medication. I want them to ask questions I never thought to ask. I want this for the future of women. I want a new day, where women understand their own reproductive systems as much as they know their own skincare regimen. I want something to change to make things better.
Education doesn't mean you want a kid tomorrow. It can mean as little as knowing you don't need to take a Plan B pill for no reason because you ovulated 2 days before. It also means that when the time comes, you will be prepared. If you are TTC right now, then you understand the emotional hell. You understand that "had you known sooner, things would be better." As cheesy as it sounds, knowledge is power. It is empowering. It is taking control of your own future.
*TTC - Trying To Conceive
*IUI - Intrauterine Insemination
*PCOS - Polycystic ovary syndrome
