Published on December 6th, 2022 | by Karen Kovach4
Count to Ten and Stop Counting
I received the coverage determination letter while preparing for a pre-IVF weekend getaway with a friend—nearly 20 weeks pregnant with her fourth child. All words blurred except DENIED.
“People don’t talk about it enough,” is a comment I hear more frequently when I begin to openly discuss my infertility journey. It seems more women are, in fact, talking about it, or at least acknowledging that we should. But like the journey itself, talking about it isn’t easy.
I truthfully didn’t think about my fertility until watching an episode of New Girl pointedly called “Eggs.” In the episode of this otherwise silly show about roommates who are too old to have roommates but couldn’t afford to live in Los Angeles otherwise, the characters Jess and Cece are told by their gynecologist friend Sadie (played by the brilliantly no-filtered June Diane Raphael) that they only have so many eggs left to have babies. The pair decide to get their bits checked out, and Cece—in her early 30s—receives news that makes her rethink her timeline for potential parenthood.
It’s been nearly a decade since that episode aired, and in the meantime I mostly put it out of my mind except for when my annual exam came around. But once I hit Cece’s age, the internet reduced my anatomy to a ticking clock and I was bombarded by social media ads for at-home fertility testing. And then, two years ago, just shy of 36, I got married.
A month before my wedding and only two months after losing my father-in-law, I stopped taking the pill for the first time since starting it at age 18. I was told it would take time for my cycle to find its natural rhythm again, but I still dreamed of a honeymoon baby despite a raging pandemic that shifted our plans from a week in Tulum to two days on a secluded bay in Maine.
Not long before my now-husband got the call to hurry over to his parents’ house a town away, I’d written his father a letter, telling him how we planned to name a child in his honor, that it was a plan made even before his cancer diagnosis—that was true. But when he died, the intention became a mission. I downloaded an app and started tracking my ovulation.
It turned out that grief left my husband with sex as the last thing on his mind. He had no energy or inclination, yet we tried for months to “make it fun” like everyone advises. We booked hotel rooms on my predicted ovulation day three months in a row. And when we could no longer afford to keep that up, I became a typecast nag. As my advances were dismissed, I felt rejected. I cried in bed. I made it about me.
A month before our first anniversary, I suggested we take conception off the table, to allow us to reconnect and be present for a long pandemic-belated wedding reception with family and friends—and we did.
But putting it back on the table a couple months later ended up putting me on a doctor’s examining table.
Initially, I scheduled a fertility consultation to take the pressure off. I thought that if I was being proactive, I could stop obsessing and “let things happen naturally”—another well-intentioned piece of advice people love to dish out when they hear that you’re #TTC. But when I revealed both my age and our months of trying, what seemed at first like just bad timing or bad luck was revealed to be pathological enough to warrant intervention, and eventually, surgery.
My piece of advice: find the friends who get it. One of my closest lifelong friends has been trying even longer than us. Shortly after her first miscarriage, she attended my bridal shower. “The good news is I can come to your wedding,” she’d said.
She’s always done this, made light of the heaviest things. “At least I can go wine tasting,” she later said after a second miscarriage. But there were no attempted silver linings after an ectopic pregnancy resulted in emergency surgery, after she feared for her life while her husband sat in the parking lot, restricted from entering because of Covid. Nor were there consolations when a seemingly miraculous fourth pregnancy ended prematurely. This time, an ultrasound revealed that the fetus had stopped growing, that nature would soon “run its course.”
These nightmares—these realities—somehow only increased my own desire to conceive. I’ve always defended my friends like they’re kin. In high school, when this same friend’s car had been keyed by a jealous rival, I wrote a scathing editorial about it for the school paper.
It was as if I wanted to right this wrong with my own body; by proving our bodies were capable of bearing life.
In late August of 2021, following weeks of blood panels and semen analyses, I was scheduled for a Hysterosalpingo-Contrast Sonography procedure (commonly referred to as a HyCoSy) to examine my uterus, ovaries, and fallopian tube function. After driving more than an hour to the facility, I was informed that my referral for the procedure was never received, a mistake that was remedied by several calls to my PCP, fertility specialist, and insurance company, but not before audibly shedding tears in the waiting room.
When I was finally seen, I was so relieved I nearly disassociated from the discomfort I experience during any pelvic exam, let alone a transvaginal ultrasound via a large wand. As a sufferer of vaginismus with a history of trauma, pain and tears are par for the course. Despite the absolute angel of a technician who tried to set me at ease, I still had to engage breathing techniques I’d been taught by a vaginal physical therapist more than a decade ago.
“Lots of chips in these cookies,” said the tech, her way of reassuring me of my healthy ovarian reserve. “We stop counting at 10.” But then she got quiet.
After directing me to look at the monitor, she pointed to a white mound along the otherwise smooth edge of my uterine wall.
“Likely a benign polyp,” she said, again with reassurance, though quieter and with less of a lilt. “The good news is we have an answer, and we can take care of it.”
By this, she meant it could be removed. What I didn’t know at the time, either while lying on that table or while driving home in silence, was that the polyp—according to my fertility specialist—had likely been acting as a natural IUD, a foreign body preventing implantation. To this day, I wonder how long it was there, if I ingested hormones for 18 years for no reason at all…
The very next day brought news of a Texas abortion ban bill—the now-obvious tip of the crumbling Roe iceberg. Even in my effort to have a child, I felt the crushing blow. If this process has taught me anything, it’s that even experts of the female body know so little about how it actually works that those who know even less have no place legislating it. Since writing this, it’s only become clearer that such bans have further repercussions, including threats to the IVF process.
The day of my surgery, in late October, I took stock of the names of people who touched my body: Manish, the med student shadowing Emily, the resident who likely performed my surgery (post-op notes say Dr. W was “scrubbed in and present throughout”); Dr. W, who introduced himself bedside; nurses Sam, Kelly, and another woman whose name I never got (post-op and still groggy, I asked if she was Sam, then asked why her screen said Phillip, to which she responded, “I’m not Phillip”); the very pregnant anesthetist Dr. Kim and her resident Dr. Russell, who put me out; and Cindy. I can’t recall Cindy’s role, but I remember seeing her name tag and saying, “Cynthia, I haven’t met you yet,” to which she responded, “You won’t know me long.”
My husband took a rare day off, and for this I was grateful. At least the ride home was easier.
I’ve been told to reframe my trying timeline. It hasn’t really been two years, they say. Still, it’s been eight months since my polypectomy. In that time, we’ve tried six cycles on our own, counting days, tracking ovulation. The other two cycles, we attempted the insurance-allotted IUIs (intrauterine inseminations). Both times, I made the same hour-long drive in the middle of a workday to pick up my husband’s “specimen” from the reproductive endocrine lab, tucked it in my bra for warmth as I made my way across the hall to the reproductive surgery wing, then laid back on crumpling paper while whichever OB on the schedule that day inserted it directly into my uterus via a catheter.
Both attempts failed, the second on my 38th birthday. I was two days late and had let the hope creep in. As I was reading on my stomach in the grass outside our family cottage in Maine, I felt the emergence of a substance thicker than liquid. I stood up to find a single spot of red on the front of my white cotton dress.
After making my way to the bathroom, I pulled down my underwear to find a bloody clotted coil of tissue dangling between my vagina and the thin nude fabric. Had it been something, this thin strand reminiscent of an umbilical cord, or was my body just shedding its uterine lining as it has since I was 12?
IVF is all that remains on the table. And it’s been denied by insurance. Should our appeal ever be successful, insurance will cover only two rounds. Add that to our six post-polypectomy cycles and our two IUI cycles, and that makes 10 assisted cycles. At that point, will we stop counting?
Author’s note: Shortly before this publication, my insurance appeal was denied. The provider ultimately determined that IVF was “not medically necessary.” Thanks to a recent job change, my husband and I have since enrolled in a new plan and will again request coverage. For now, at least, we are still counting.