Have Patience, Will Travel

Plane over Maho Beach, St. Martin © Shutterbug

There is no time a southern escape is more required or more appreciated by a Torontonian than in February. The mercury has been below zero for weeks on end, and six-foot icicles are hanging from our eaves. They are also falling from the eaves, and hit my honey in the back of the head as she tried to clear a path to our recycling bins. Time to get away.

For the first time in recent memory, our flight was at a decent hour (11 a.m.), meaning we had the luxury of sleeping in until 6 a.m. before getting ourselves ready and taking the dogs to their home away from home–where they take off at a full gallop once released with nary a look back at us. Everything went according to plan, and the Park 'N Fly shuttle at the airport picked us up in five minutes. Thank God, because despite layering our summer clothing, February is simply too damn cold to bear for long without a parka. The speedy transfer was also appreciated because the couple waiting at the shelter with us were both smoking their brains out, and blocking the doorway with their bags. Yuck.

Our seats were towards the back of our Air Canada flight, a newer 767 plane with the first-class section set up with individual futuristic pods. Pod people. I wonder if I'll ever experience what it feels like to sit in that section? I was just thrilled we were not on a charter for a change. Air Canada feels cleaner, roomier, and just more…well, dare I say Canadian?

The plane had a couple of technical issues–a panel above me leaking condensation in a dirty stream upon takeoff, and an entertainment system that kept crapping out and requiring a reboot. We had to go through the painful onscreen menu several times, sit through mandatory advertising clips, start the show…only to have the screen go blank and start all over again. I don't know that this is such a great improvement over the "old days" when we just brought a book. That was my solution, as the passengers groaned.

Several minutes into the flight we became hyper-aware of the couple sitting across the aisle from us, as did pretty much everyone else. Their every thought was voiced at top volume. "JOHN IS 26 AND SHE'S 22. DO YOU KNOW THAT A GENERATION AGO THEY'D ALREADY BE MARRIED WITH A COUPLA KIDS?" I tried to ignore them and focus on my book. The wife took out a crossword puzzle book. "WHAT'S THIS WORD HERE? SEE IT HAS TWO Ts, BUT I CAN'T GET THE REST. LOOK AT 81 DOWN. 81 DOWN. DO YOU KNOW WHAT THAT IS?"

The husband was even worse. "I DON'T KNOW 81, BUT I SEE 42 ACROSS. IT'S "ARRIVE". TO GET THERE IS TO ARRIVE." Then he leaned over the aisle to peer across us at the view out the window, and proceeded to describe the scene in excruciating detail to his wife. She mentioned she was hungry, so they proceeded to discuss food options. This brought about a more spirited conversation about food in general, both their likes and dislikes, at which point I decided to put on my noise-cancelling headphones, even though the in-flight system was not working. I caught the eye of the man sitting in the row behind them, who was shaking his head and mouthing the words "oh my God" to me. At that moment, the husband let loose an explosive burst of laughter that startled the wife of the man behind them, who was trying in vain to sleep. Her eyes flew open and met mine, at which point all three of us rolled our eyes and muttered "holy shit".

We lasted half an hour. By this time none of us were making any attempt to hide our irritation, and my wife had started to passive-aggressively mimic some of the couple's louder conversation–but they remained painfully oblivious. People on the far side of the plane were looking at each other incredulously as the chatter continued, and I just couldn't take it any longer. I tapped the man on the shoulder and said, "Excuse me, I don't know if you realize this, but the people around you can't focus on anything but what you are saying. Would you mind keeping it down a bit?" To my surprise he seemed embarrassed, nodded and said, "Ok, sure." And that was it for the rest of the flight! That never happens!

The food/beverage carts took well over an hour to reach us at the rear of the plane, and of course the bulk of items available for purchase were sold out. This turned out to be a blessing, because my sister was seated a few rows ahead and ate what we would have ordered - and was sick for the rest of the day. We ordered the one and only selection available, which was a roast beef sandwich for each of us. The older flight attendant with close-cropped grey hair who had previously seemed rather unfriendly suddenly seemed quite apologetic. She said she would only charge us for one sandwich and would comp us some wine as well, saying with a smile, "It's the least I can do." My lovely wife's intermittent gaydar kicked in, and leaned towards me to whisper, "Membership has its privileges."

Before we knew it, we were there.

One of Life's Great Mysteries

My mother and father  (copyrighted)

It's become quite commonplace with all the genealogy websites for people to search for their roots. I, however, am searching for something more like the whole tree.

My parents broke up when I was barely two months old. I never knew my father, which sounds like a blessing given all of his apparent shortcomings. Coming from a "broken home" was unusual in a prairie city in the 1970s, and although I don't recall being teased about it, I do remember feeling different than my friends. My mother eventually remarried, I acquired my first father figure, and I quickly learned the lesson about being careful what you wish for.

My "real" father was something we just didn't talk about. I wasn't comfortable asking, and my mother clearly wasn't comfortable telling. In hindsight I have to give her full credit for everything she managed NOT to say, because despite the difficulty of growing up with so many unanswered questions, it would have been harder to hear the truth about what an ugly, drunken, loser he truly was. It's impossible for me to imagine my smart, kind, giving, funny, hard-working, loving, successful mother choosing to settle down with this underachiever, but she was ridiculously young and agrees now with the statement that "you marry to the level of your self-esteem".

She finally provided some answers when I worked up the courage to ask a few direct questions in my 30s. When I learned something about what her life had been like with him, and how little he had ever done to help care for her or for me (including going on a bender the day my mother unexpectedly went into labour, leaving her to drive herself to the hospital and recover alone for days - gold star, Dad), I made the decision to not look for him. I asked Mom questions because my curiosity was on the verge of getting the better of me, and I'd found myself periodically Googling his name. Her story made me feel that nothing could be gained by finding him; that if I did, I'd be more inclined to harm him than to hug him.

Fast forward ten years, and I find myself in a very different place. I don't need this man to be my dad. I'm not looking for someone to give that moniker to, nor to share holidays with, nor to impart sage fatherly advice. As I have embarked on a journey to create my own family, what I find myself needing is simply some answers to basic questions that harbour no judgement. I just want to know half of my family's medical history, where I came from, and what became of my relatives (including a half-brother overseas that this only child would love to know). I fear I've left this too long now. If I'm fortunate enough to have my own children, I don't want to pass on the feeling of being incomplete. The gaps in my family history are big enough to fall into.

I've finally set the ball in motion, and called a private investigator. I started with a well-known firm in Toronto called Pinkerton's, but it took Glen Bacon so long to acknowledge two voice mails and an email that I chose to find someone else. Since I think my father may be in BC I called Arbor Investigations in Vancouver, and gave them a $500 retainer.

It's been two weeks since I handed over this very emotionally-charged case to a rough-sounding young woman with a smoker's voice. She could call me at any minute and tell me my father died years ago, and the trail ends there. Or she could call me with an address and phone number, and a new trail begins there. If she calls and says they require additional money I'm not sure what I will do. I think I have to know what became of him, and I'll probably keep going until someone finds me the answer.

Which will it be? 

TTC - Mt. Sinai Centre for Fertility

Mt. Sinai exterior  © Shutterbug

This is where our journey began, at the Mt. Sinai Centre for Fertility and Reproductive Health; an ugly, dated building on Dundas St. West situated across from a police station. Police officers often sat in their cars in the parking lot, watching people jaywalk to our appointments with the gods. Both fertility clinics we've been to have had similar, nondescript exteriors, like a copy of an adult magazine that arrives in a plain brown wrapper. The interior of the building was equally dated, with ancient, wobbly elevators to lift you to the newer-looking clinic on the 7th floor. The bland waiting area was small and cramped when busy, and the receptionist's attitude ranged from simply unhelpful on a good day, to hostile on a bad one. Sarcasm gathered in a pool beneath her desk.

Mt. Sinai interior  (c) Shutterbug

Our god was Dr. Kimberly Liu, a youngish woman with a serious but friendly face, and no-nonsense approach. This was fine with my wife and I, as we had a lot of information to absorb and little time to waste. It was frightening, exciting, and overwhelming to finally be taking the steps towards starting our family.

Dr. Liu reviewed my blood tests and medical history, and seemed optimistic enough about our prospects of parenthood. I felt optimistic too, despite being nearly 40 years old. So many of the clinic's statistics and so much of what we read online centred around women with a variety of medical conditions causing infertility, from endometriosis to polycystic ovarian syndrome (PCOS). I had none of this; my only issues were my age and my same-sex relationship. We had every reason to believe that our path would not follow their graphs, and prepared ourselves for the possibility that this could work on the first try. 

How did you get here, reader? You're probably a woman. You probably arrived at this page by searching online for information on the procedures, the clinic, or the doctors. If you are anything like me you've probably spent a lot of time already in online forums, trying to predict how it will all turn out for you. I decided to write some posts on what we've been through as a means of coping with our experiences thus far, and maybe for someone else to use as the sort of resource I never found when I was starting out. I couldn't write about all of this while it was happening, because it took too much out of me. Out of us. Trying to get enough sleep and trying to perform well at my day job while spending so much time in a parallel universe was tough enough. Looking back on it with a year's perspective is sobering: if only I knew then what I know now.

At Mt. Sinai, after the basic blood work and consults the next step was a (torturous) test called a sonohysterogram, which is a dye scan to check the fallopian tubes and uterus. There is no point in putting your body and wallet through expensive treatments if there is a zero chance of success due to blocked tubes. I should really know by now that when a doctor says "you may experience some mild discomfort", there is likely some serious pain on the horizon. Apparently my cervix is uncooperative. Crooked. My wife, ever the ham, joked during the test, "No part of you can be straight", giving everyone in the room a laugh. Later that day, she got a call from her mother, who said she'd received an odd message on her answering machine. She could hear our voices and some laughter, and we realized that my purse must have been jostled during the procedure and speed-dialled my future mother-in-law on my cell phone, recording five minutes of our appointment for her. Thank God she has a sense of humour (and poor hearing).  

We got the all clear and moved forward with booking our first cycle. We'd spent months already reviewing and debating sperm donor options, finally deciding to use a company called Outreach to obtain our samples. My mental picture of flipping through thick, full-colour catalogues of donors at multiple clinics was dashed and replaced with the reality of a short, sparse online list of ID numbers at only two companies (see previous post here). We wanted an "open i.d." donor who would agree to potential future contact from the child, so our pool of "Canadian compliant" donors was further reduced. Then of course there were fees to pay in order to view full donor profiles with childhood photos and voice recordings etc. Cha-ching. We began to realize just what a business this is. 

The decision-making was tough. Was it more important to have someone with the physical attributes we liked, or more important that he be a high achiever? Could cancer be overlooked in a grandparent, but not in a parent? Did we trust the verbal medical history being given by a man young enough to be my son? We finally just had to choose and make the leap. And that is exactly what it felt like, jumping out of a plane and hoping the parachute opened. 

Once we had selected a donor, we also had to choose how many samples to order. It began to feel like the decisions would never end (little did we know). Since I am older than my wife, our plan was for me to have our first child, and then she would use the same donor to have our second child. We needed to purchase enough samples to be sure more were available when we needed them, but then you also have to pay monthly storage fees. In this case there were only two samples available from our chosen donor, but more would be released soon (there are tests and quarantines on donor samples). We shipped them both to Mt. Sinai in advance.  

April 2010 was our "go time". We were doing a natural cycle with no medication, since my biggest fear at the time was ending up with twins. I was told there was no reason I couldn't perform my own cycle monitoring at home, and took daily tests with a home ovulation predictor test kit (OPTK) until my LH surge was detected with a happy face symbol. At Mt. Sinai all communication is done via leaving voice mail messages on the main line. A nurse returns the call later, which can be a challenge if you have a day job with little privacy for incoming calls (and if the messages are hard to decipher). I called to tell them my LH was rising, and they called with an insemination appointment time for the next day.

LH surge detected © Shutterbug

I obsessed about timing. How did they know I wasn't ovulating right now? The window for actually getting pregnant is so small, much smaller than we were told in high school health. What if my LH had actually begun surging just after yesterday morning's negative test, and had been already rising for the full 24 hours? I just had to trust the clinic. It was, after all, a research hospital. My wife and I lay awake nearly the entire night, alternating between hope and anxiety.

At the clinic the next day, we were asked to sign paperwork consenting to thaw our sample (donor numbers, my name, and my file were all carefully marked and reviewed multiple times). It would take half an hour until the sample was ready, so off to Starbucks we went. It seemed appropriate to be there on this auspicious day, since I had been proposed to in a Starbucks near our house the year before.

We proceed to sit there drinking coffee like it was any other morning, when it was like no other morning.  

My observant wife noticed a box marked "CMV Status" on the form we just signed, which neither of us understood. I assumed it was something about the sample for the clinic to deal with, but my wife wanted to ask the question of the nurse when we returned. Giulia, a terrific nurse, took us to an exam room to review the procedure. It is nurses who actually perform the inseminations, not the doctors. When we asked about the CMV status, she explained it was a common virus that most people would have had in childhood, and both mother and donor should have the same status. Perplexed, we said no one had told us to consider this when choosing donors, and we were unaware of my status. Giulia began flipping through my chart with a growing look of concern, and then excused herself from the room. This did not bode well. 

Giulia returned with Dr. Liu in tow, who explained to us that Mt. Sinai had missed screening for CMV in my initial blood work. The test was not something they could run on the spot for me now. The danger is that if I happened to be negative, and a donor happened to be positive, and I happened to get pregnant (kind of the idea here folks), I could contract the virus and a baby could be born with hearing defects. She felt pretty confident that at my age my status would be positive (and then using a positive donor would be fine), but they couldn't be sure of my status.

Before we had digested that piece of news, they also told us that the sample they had thawed was of terrible quality. Samples are given two scores, one for motile sperm (meaning they are alive and moving around), and one for progressive sperm (meaning they are swimming in a clear direction, and able to aim for an egg). Our figures were 800,000 and 500,000, respectively, when they normally want to see counts of at least 2 million. Outreach guaranteed their samples at 10 million, so this put the news into perspective. 

Now, with these two developments explained to us…did we want to proceed with our IUI?

After preparing for months, and counting down days, and getting our hopes up, and trying to plan a wedding around the possibility of a pregnancy (oh, such optimism), and finally getting to this day….yes we did. We thought even with a bad sperm count, the fact that we were having it put in exactly the right spot at exactly the right time had to give us some sort of a chance. The CMV issue seemed a remote possibility, so we pressed onward.

The room where the potential magic happens is like your average doctor's office exam room, save for the odd addition of oven mitts on the stirrups for comic relief. 

The romance of conception  © Shutterbug

The procedure was unexpectedly excruciating for me, and even the nurse was frustrated by how long it took to pass the catheter through my cervix. Finally the deed was done, and my wife and I were alone in the room for a few minutes. We hugged each other, filled with emotion. Walking back to our car we passed a daycare, and we stopped for a moment to watch the kids and consider the gravity of what we'd just done.

My wife and I both went for the CMV blood test the next day, and while waiting for results we went back on the Outreach website to review our donor's profile. We were shocked to discover he was marked as no longer Canadian compliant. Our panicked call was eventually returned with the explanation they were just temporarily out of stock, which seemed an odd way to describe this fact. Next we had to begin the complex administrative process to receive a refund for both of our poor quality samples - we had asked Mt. Sinai to also thaw and test the second sample in storage. We did get a credit with Outreach, however there was a lot of added stress to an already stressful situation.

A couple of weeks later (the dreaded "2ww" - two week wait), we were sad to find out that our procedure had not worked, and I was not pregnant. It turned out to almost be a relief when my blood results came back that not only was I CMV negative at age 40, but so was my wife at age 36. Unreal. We had to choose a new CMV negative donor, and ship new samples to Mt. Sinai.

In May we began our second cycle, and once again I used the OPTK at home. The happy face showing an LH surge never came. I left messages expressing concern on the main line voice mail, and was told to just continue testing, which I should have refused. I should have trusted my instinct and demanded an ultrasound, but didn't know enough to ask. A nurse finally told me to come in for an ultrasound on the morning of cycle day 15, which of course showed I had already ovulated and missed the window to try for a pregnancy. Another month was lost.

We decided to focus on wedding planning and losing some weight over the next two months, returning to Mt. Sinai in August. This time I asked for my cycle to be monitored by the clinic. The process was to call on day one of my period and leave a message, which was returned with an appointment time for the following day. I would sit in the main waiting area (full of interesting characters we couldn't quite believe would likely procreate) until they called me for blood work, where my small, deep veins always made me feel as though I should apologize to the humourless technicians. They rarely found a vein on the first try, and I often ended up with several telltale cotton balls taped to my arms and hands. 

One band-aid covers two holes = 4 tries for blood  © Shutterbug

After blood, then it's off to another waiting room to change into a double hospital gown (the first one open to the back, and another worn over the top "like a housecoat, please") and sit until I'm called to yet another area to wait for an internal ultrasound. That's right - an internal ultrasound on day 2 of your period. Awful. Scans have to be done that early in the cycle to ensure there are no cysts or other concerns that would cause the cycle to be cancelled. After a day two all-clear, I went back on day 8 or 9 to begin the daily regimen of blood tests and ultrasounds that continue until the day of insemination. It's a very peculiar thing to sit side by side rows of gowned women, all at various stages of their journeys. I never saw another spouse with a patient in ultrasound, but my wife came with me into the room every time. Perhaps the other women didn't know that was possible. Never be afraid to ask. The ultrasound is impersonal, done by a different doctor each time, and attended by a nurse. They speak to each other in a code we don't understand, and then if we're lucky they will say that my follicle looks good, and tell us someone will call with blood results and instructions later in the day.

Blood work and ultrasound waiting areas  © Shutterbug

This third cycle detected my LH surge earlier than ever before, and the IUI was performed on cycle day 12. It was just as painful, but I told myself in the grand scheme of things this was just one day of discomfort. It was less than a week before our wedding day, and we were exhilarated. A new donor, a fitter body, a positive attitude, and a clinic-confirmed cycle...it had to work. 

We discovered that it didn't in a most unusual way: in the Vatican hospital in Rome on our honeymoon, whilst I was in the middle of a gallbladder attack (see previous post here). No baby.

The TTC roller coaster began to climb again.

Days after returning from Italy we were back at Mt. Sinai for more cycle monitoring. It was becoming impossible to keep private, as the appointments piled up and cut into my work days and other plans. Although my boss was understanding when I finally confessed what we were up to, I resented having to have the conversation.

This fourth attempt was the most frustrating one yet as we received confusing, conflicting messages from accented nurses whom we could barely understand. I was told to come in for an IUI, then was told to hold off as they scheduled more tests. I was unprepared for the highs and lows and amount of stress building up as we went along.

Dr. Liu attended the next day's ultrasound and said my hormone levels were not as high as expected, and that day's blood work would determine the course of action. Unfortunately the voice mail message we received was hard to understand and infuriating, as the nurse seemed to say they weren't sure what was going on and it was up to us if we wanted to "spend the money" proceeding with this cycle. For the donor sample, the procedure, and storage fees it was well over $1,000 per month for a natural IUI cycle. 

We went for one more ultrasound appointment, and had a helpful doctor and nurse that day. They explained my estrogen levels were falling, which could indicate the follicle was filled with fluid only and no egg, or it could contain a "bad" egg. It simply wasn't a good cycle to proceed with, and another month was lost.

It was soon discovered that I needed to have gallbladder surgery, so the next month would also be a no-go. On the one hand I was grateful I had not gotten pregnant, since surgery would have been impossible during pregnancy, and another gallbladder attack could have been serious. On the other hand it was beginning to feel like the fates were against us.

After recovering from surgery it was back to Mt. Sinai in November to try again. We had a very negative experience of waiting an hour past our given appointment time in a crowded waiting room, and then discovering my name was not on the nurse's list for blood or ultrasound - despite having an appointment and checking in with the receptionist from hell upon arrival. Organization is not their forté. They rushed us through the usual routine, with a very rough and gruff doctor. On our way out, my wife noticed a small sign posted at reception stating that they would be closed over the Christmas holidays. What?! This clinic, attached to a hospital, would be closed for 10 full days. We decided if this month's cycle was unsuccessful, we would need to find a new clinic for December. I was not about to lose another precious opportunity to try for a pregnancy.

Our IUI was performed by a new nurse named Jacinta with a thick Irish brogue who kept saying everything was "grand". The sample was grand, the catheter instructions we gave her were grand, my numbers were grand. And hey, how appropriate since it was costing us a grand! It was not as painful to be in her hands, and we tried to renew our enthusiasm for potentially being on track to having our family. We imagined telling our mothers at Christmas this year that a grandchild was finally on the way, and vowed to enjoy what we hoped would be our last holiday season as a childless couple.

We counted the endless days until we could start testing, but they were all negative results again. My period arrived right on time, and yet another month was gone.

Feeling dejected, frustrated, and disappointed with Mt. Sinai's level of service, we placed a call to Create IVF, and leapt off another cliff.