And Then There Was One

Please note: children are mentioned in this post. I am terrible about pointing this out in general, so I'm not promising to always mention it, but there you go.

SuperDoc had indicated yesterday that he was fairly certain that I would have a Day 6 transfer, not a Day 5. He had said to expect a call in the morning rescheduling me for Day 6, but they had me on the schedule for today, just in case. He seemed so sure of it, that I was surprised that my phone didn't ring this morning. By 11:30, I realized if they were going to call, they would have called by then. After all, I only had a couple hours left before I had to be at Ye Olde Fertility Clinic. Clearly, my Day 5 transfer was happening. How odd. Fortunately, I'm not stupid, and I *had* arranged for transportation to the clinic today, just in case. And my ride arrived at my house, right on time.

I got all checked in and got an ID bracelet on my wrist and taken back to a transfer room. I was told to undress from the waist down and wait with the drape over my waist for the doctor. This reminded me that I didn't know which doctor I was going to be seeing - so I looked down at my ID bracelet to see what doctor was listed. Sure enough, it was one of the few doctors in the practice that I don't particularly care for. Just my luck. Whatever, I thought, it's not a big deal - all the doctors in the practice are extremely good doctors whose knowledge in their field is unquestionably stellar. It certainly doesn't matter whether I like a doctor I don't have to see much - it only matters that I love my own doctor, who calls all the shots on my protocol, and with whom I interact on a regular basis.

And it is with this backdrop that Dr. After-Today-I-Hate-You-So-Much-You-Don't-Even-Deserve-A-Snappy-Pseudonym walked in the room. Aw, to heck with it, that's too awkward to write every time. I'm going to call you "Dr. Loathesome" because I'm too prim and proper to write "Dr. Fucker" every time I have to write your name.[1]

Right. Um. Where was I? Ah yes....

... And it is with this backdrop that Dr. Loathesome walked into the room. He introduced himself to me and said, "It's nice to meet you." I didn't correct him and inform him that we've met at least half a dozen times before. After all, they're a busy practice, and it's been probably 3 years since he's seen me, but hey, I haven't forgotten him, so why should he forget me!? I am memorable, darnit! Right. But realistically, my clinic sees thousands of patients a year, and I wasn't even his patient, so I don't expect he'd remember me. So I'll forgive his transgression and simply appreciate the nicety of his statement, shall I? Moving on...

If I could have written anything down, I might be able to give a lot more detail, but, actually? Probably not, because he glossed over a lot of this.

We went through the numbers. I had 14 retrieved, 8 fertilized normally, 1 fertilized abnormally (this was news to me, but I imagine that's not unheard of), 5 didn't fertilize (I imagine that two of those were the two that were not mature, but he didn't mention that). Today when they looked at the embryos, I had two compacting embryos (morulas), of which one was looking "okay" and the other was clearly lagging behind [2]. I also still had a 5 cell hanging around, but clearly that wasn't particularly helpful. He said that since there was a clear winner between the two morulas, they would do the transfer today, rather than waiting until tomorrow. The reason to wait until tomorrow would be if they couldn't tell today which would be the better choice. Honestly? I think my doctor would have waited until tomorrow. But I'm 100% certain he would never tell me that now. I'm quite certain he won't contradict a decision that a colleague made. He didn't seem hopeful that there would be anything to freeze, but said anything's possible.

I had been a *little* concerned that since my regular doctor wasn't there that there might be some discussion about whether eSET was the way to go, but SuperDoc already had me covered on that and had made it clear that we were only transferring one. So Dr. Loathesome (and I'll explain the pseudonym forthwith) wrote on the form that we'd be transferring one, and turned the form to me to sign. *screech*

And this is where the story starts to turn ... ugly (later it will turn fugly, just you wait).

"Is it absolutely necessary that I sign this piece of paper."
"Yes. You must sign this piece of paper."
"Then we have a problem. I've made it clear ahead of time that I can't sign anything today; that I could have signed anything ahead of time, provided any sort of consent necessary, etc., but that if there was going to be anything that I needed to sign today I needed to know about it ahead of time so that I could ask my rabbi whether it could be done."
"Well, you have to sign it, without your signature, I can't do this transfer today."
"I guess we have a problem then; I'm an Orthodox Jew and the fact that I'm even here today required specific arrangements ahead of time to make it happen. I cannot sign that piece of paper."
"There are exceptions," he said with an exasperated sigh, "and this is one of them."
"Well, I'm glad you went to Rabbi School after you went to Doctor School, but there simply must be another way to handle this. I know I am not the first patient this clinic has had present with this issue."
"Well, I'll go check with someone else," he said, and he left the room in a huff.

While he was gone I sat there contemplating what I would do if he came back and said I had to sign it. Would I just go ahead and sign the stupid piece of paper? Or would I say, "Well, I guess we're doing a Day 6 transfer"? I hadn't made a decision, mostly because I was distracted by contemplating my somewhat full bladder, when he walked back in the room followed by two techs.

"We have a team of witnesses," he said, "who will witness your verbal authorization for me to sign the consent."

So peace was established at the negotiating table, and all was right in the world. Life was good. Dr. Maybe-You're-Not-As-Loathesome-As-I-Thought-You-Were and I went back to congenial discussion while he waited for the embryologist to come in and confirm my identity, etc. The techs asked about my kids. We made small talk about my pregnancy. I told him that SuperDoc was never going to live down the triplets, and he asked how many I transferred that time.[3] Time passed, he got the speculum and catheter in place, and we're chatting. All the while his hands and face are spending alltogether too much time in my lady bits, but you gotta do what you gotta do, right? [4] And then it happened.

I made my standard comment about how this one (little George Jr.) isn't allowed to split into identical triplets. Because that would be wrong. And do you know what this doctor said to me? ME? The mother of triplets? The very-well-educated-mother-of-triplets? You won't believe what this man said to me. Are you ready? Are you really sure you're ready? Positive? Because, me? I'm still fuming over this.

He said, "Oh, you can't have identical triplets. That doesn't happen."

Um.

"Yeah, um, I know several sets of identical triplets."
"No you don't. Just because they look alike doesn't mean they're identical."

Oh thank you for that lesson, asshole. Because maybe I should have been more specific.

"Yes, but the spontaneous, monozygotic, monochorionic triplet girls that I know up in [city near me] that were born at [hospital my husband works at] almost exactly a year ago are clearly identical. You can't have three babies share one placenta and not be identical, unless it's a fused placenta, but there are tests for that."

Dr. Seriously-I'm-Not-Kidding-You're-Really-Getting-On-My-Nerves-At-This-Point made a noncommittal grunting noise.

"Or, you know, the 2 1/2 year old identical triplet boys that I know in [other city nearby]. Also spontaneous."

No response.

"Or my friend in NYC who had two embryos transferred and one split into monozygotic triplets and both embryos implanted, so she was pregnant with quads. She reduced to a singleton. In fact, the very same scenario once happened here at YOFC."
"No it didn't."
"It most certainly did; about 3 or 4 years ago."
"Well I've been here since [longer than that]."
"She was SuperDoc's patient; she had 2 embryos transferred, both implanted, one split into identical triplets, and she didn't reduce so she had quads. SuperDoc told me about her himself when I got pregnant with the triplets - you can check with him."

Seriously. My legs are in stirrups, his hands are in my nether-regions, and he's telling me he knows more about triplets than I do. Not okay.

I'm sorry, but you are not allowed to be contrary with your hands in my vagina![5] No sirree!

Fortunately, Dr. I-really-do-loathe-and-detest-you-Now noticed at that moment that it had been an absolutely indecent amount of time since getting all set up for my poor sad little embryo to appear, so he sent a tech looking for it, and my embryo appeared right then. Saved by the embryologist.

"I hope he's cute," I said to the embryologist, who looked a little ill. "Can I call him George?" She looked mortified. GOOD HEAVENS, PEOPLE! DO YOU HAVE NO SENSE OF HUMOR?

"Sure," said Dr. I-Don't-Even-Care-What-I-Call-You-At-This-Point. "George, Georgette. Whatever. Now let's see if we can get you pregnant."
"Well, I guess I've got to go with George, Jr. The last one was George. And though he was cute, he didn't do me a lot of good. But this one's going to work, right?"
Pause. (In fairness, I think he was busy trying to get the embryo, you know, into my uterus.
"Of course!" said Dr. You're-Definitely-Not-SuperDoc-And-You'll-Never-Be-As-Cool-As-Him.
"That didn't sound so confident."
"I thought that was very confident!"
"You should work on that, Doc," I said with a grin. "Thanks for your help. Hopefully I won't be back here for George III."

My discharge nurse was awesome - she was the same nurse I had for my first embryo retrieval and I loved her. I had a good time with her. So that was great. But all in all, I'm still annoyed. Even 10 hours later. Probably I should get over myself. But it's really hard to get past such an annoying experience because.... let me see if I can explain. You see - my experiences at YOFC are so universally positive and my interactions there are so perfect every time. Every single member of the staff is amazing. Every nurse, every receptionist, every phlebotomist, every technician, every sonographer, every doctor, every embryologist, every member of the marketing team, everyone. Every interaction I have with YOFC is better than the previous one. So for this interaction to have been so jarring - it stands out. If it were just a monitoring session - I'd blow it off and not care. But this was something really significant. Today was a make-or-break-it day. If I hadn't transferred today, I don't know whether they would have let me transfer tomorrow and what that would have done for my odds of success. I don't really want to think about it. Frankly, I almost made him get SuperDoc on the phone. Basically? It wasn't okay.

There's another dimension to this that I haven't touched on. I think that our initial disagreement (over the signature) was problemmatic for another reason. There's an inherent imbalance of power when you've got the big, scary, all-knowing, all-powerful doctor on one end of the clipboard and the (perceived) stupid, ignorant patient on the other and the patient is sitting there half naked with a flimsy paper drape covering her lap with her butt exposed to the back of the room (where the door is and anyone could walk in without any notice). You'd think I'd have no sense of modesty left, but... turns out, I do. I have a personal belief that this last discussion of how many (and which) embryos to transfer ought to occur just before the patient is instructed to disrobe, therefore leaving the patient with a shred of dignity and not putting her in a position of feeling like this imbalance of power is so significant.

The amazing thing is that I may never have noticed this, had it not been for one of the amazing partners in the perinatology practice I went to - she did something that made me feel unbelievably human throughout my pregnancy. Each time I saw her, as opposed to the other practice members (who I LOVED, so I'm not criticizing them), after my ultrasound exams, she would say, "why don't you get dressed and then come into my office and we can talk?" The other doctors gave me just as much information, and probably the same information, as she did at each of my appointments, but she spoke to me as an equal. She made me feel dignified for 10 minutes and allowed me to sit there speaking with her and asking my questions without wondering whether my rear end was flying out of my gown behind me. It was something I always appreciated about her. As terrifying as my appointments could be - at least I was treated in a dignified fashion.

Anyway, as for now, I'm on "bedrest" for the moment. Or as close as I can get to it. We'll see how that goes. I'm told not to drink alcohol or caffeine until I get a negative result or deliver a baby, whichever comes first. Whatever. I feel extremely crampy, which I don't remember from last time. My cervix is also very sore, which I don't remember from last time. And I feel some pain from where the speculum scraped against me on the way out. Pleasant. But I'll assume all of this will go away soon enough. I was going to say that I'm hoping not to POAS, but who am I kidding? I'd pee on one right now if I thought it would show anything. Heck, I might anway, just to have something to compare it to. (I'm kidding. Um, maybe.)

I've already told my nurse to expect me back in August. Optimist that I am.

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[1] This will be especially funny to any of you who have actually spoken to me in real life and know that not only do I sound like a drunken sailor most of the time, but I could probably make a drunken sailor blush with the language that comes out of my mouth. But I try to tame my mouth when it's being applied to the keyboard. Even I have to wash my proverbial mouth out with soap occasionally.

[2] Unlike early embryos and blastocysts, compacting embryos are not graded. It's not fabulous to transfer a morula on Day 5, essentially because it means your embryos are a day behind, but it also doesn't mean all hope is lost either. For more information on morulas, see Dr. Licciardi's blog post on morulas.

[3] Way to read my chart, Doc. The triplets were conceived on IUI #6 - after I'd specifically asked, multiple times, to be switched to IVF for fear of conceiving HOMs. Hah!

[4] Have you ever noticed that if you like your doctor and they make you feel comfortable that somehow they can be digging around in your vagina and you hardly notice, but if you don't like the doctor, somehow it feels... dirty? Yeah. I don't know how to explain it exactly, but somewhere in the middle of all of this, I started to feel... uncomfortable. Very uncomfortable.

[5] Now, the hysterical thing about that line is that when I came home from the transfer and recounted this story to my very patient husband who was faithfully indignant on my behalf, I used that exact phrase, except I said "lady bits" instead of vagina. And then when I was talking to Barren later and recounting the story again (I think I was more indignant when retelling the story to her!), she said, without hearing it from me first, "You are not allowed to be contrary while your hands are inside my vagina!" So she gets partial credit for this one. But only partial. But how weird is it that we're so connected that we think so alike?