First Quarter (Zodiac Series): Not the mother they want

It's Sunday, and this is potentially the longest newsletter installment I will ever write, hence the unprecedented two-day delay. My apologies. But hello.
This week, I have intended to progress my special zodiac series by way of considering the sign Cancer's association with motherhood and sacred domesticity, and given the past six months I've spent under an escalating and overt fascist autocracy, I feel naturally obliged to consider the current political stakes of maternal identities. But the timing of this post also coincides with my ongoing physical and psychological recovery from an ectopic pregnancy — which is now my second pregnancy loss — so while I still tend to avoid using Salt for the Eclipse for weekly diaristic updates of my life, sometimes it is simply impossible to write about the larger scale of things without equally focusing on a personal saga.
My solution is to write something very long, very difficult, and very necessary. For while my agonizing craving to bear a child is ritually and ecologically driven, I have little in common with either the pronatalist movement or the antinatalists, and in many regards I am not the kind of mother that the pronatalists want to exist: queer, autistic, requiring a sperm donor, requiring IVF, currently having lost as many children as I've conceived, and planning to give any living child the most gender-liberatory upbringing possible. Of course, IVF has some pronatalist support at the moment, but it's still threatened by the hardliner camp who oppose any practice where embryos are created and eventually destroyed; and in either group IVF still often carries the fundamental stigma of a womb whose "good years" were spent not-gestating, or a womb that was never "fertile enough" to become pregnant "the right way" at all. I have also had the troubling thought that IVF could always become legally restricted to cisheterosexual couples.
Beyond all this, I've felt past due to document the full bureaucratic, institutional, and practically ontological ordeal of what it means to try getting and staying pregnant as that "wrong" kind of mother in this society's medical industry. So few of my close peers have had any children, let alone experienced infertility first, that I often struggle to tidily summarize precisely how and why this journey has proven so overwhelming, and in many ways I think a tidy summary would be a mistake. This process is tedious, messy, and soul-wrenching, even before accounting for the two losses I've now undergone along the way. I therefore implore anyone who has been loosely aware of my quest and invested in my personal well-being: please read this full post, even if you are not a regular reader here, because this is the story I have been trying to figure out how to tell for months and months. The only reason I would ask someone not to read is if you, too, are experienced with infertility, miscarriage, or both, and know full well what sorts of things you will find here without needing to potentially invoke your own pain. There will at times be graphic descriptions, including mention of suicidal ideation.
I need to communicate what it really means, at least for me, to "struggle with infertility." What it feels like to have repeatedly become a mother-and-yet-not-a-mother, and to do so in a culture that fetishizes motherhood yet also pathologizes pregnancy and ignores the very existence of pregnancy loss. And yet, while these meditations will be laden with my fear and grief, within the last few weeks I have also had a transformative epiphany that I had long imagined I would never achieve. So while the story I've meant to tell cannot be finished today — for I do not yet know what the real ending will be — at the close of this piece there will be something less than hope but more than despair: resilience for this apocalypse, salt for this eclipse.
Prelude: Review as you wish
I don't intend to drop too many links or footnotes today, but some things I have already written on my existential desire to have a child from my body can be found either directly or obliquely in some older essays. If you have not read these, it should not impact how today's writing flows for you, but if you would like a more thorough review of what brought me to this point — or if there is anything I may say here that seems to gloss over something worth unpacking — you will find that level of detail and nuance in this earlier material.
- "Fertility in extinction" - This contains some ideas about queer, gender-nonspecific fertility, and also arguments against right-wing pronatalism and against well intentioned but misguided left-wing antinatalism.
- "Maidens, mothers, crones" - This offers some deep context on how my gender and my anatomy relate to one another, as someone who is not a cis woman and refuses right-wing "detransitioner" narratives — but who retransitioned partly out of the desire to become pregnant and the ways that this desire interfaced with evolving gender feelings.
- "Sacred domesticity (a deeper delving)" - This contains perspectives on what I do find highly valuable in performing domestic labor, long associated with motherhood, even though I'm naturally hostile to the "tradwife" archetype.
- "Fertility as fetish" - Targeted thoughts on what the title indicates. Note this post is for paid subscribers only.
- "Embodied, ungendered magic" - A disentanglement of popular misconceptions and memes about the perceived relationship between women, wombs, and the Moon.
- "Strange shadows" - Some of my earliest writing about my November miscarriage.
- "Underworld, Otherworld" - An evolution of those thoughts, recently posted as I had just learned that this second ill-fated pregnancy was ectopic.
This is everything I can think to include in the way of thoughts and ideas that will recur throughout today's missive but that may be written either less directly or precisely than before. With that aside, now I can truly begin.
Background I: Wandering Womb
In 2013, I took my last dose of injectable testosterone because I was done with the experiment of being a man, and I did not yet know exactly what I felt like I was instead but I knew that such a person ought to look more like how I would if I allowed my ovaries to produce their natural amount of estrogen and progesterone instead. I also knew that I wanted to eventually become pregnant, a realization that stood in stark contrast with what I said when I signed the informed consent paperwork for receiving testosterone several years earlier; I had uttered aloud that as for the unproven but hypothetical chance of long-term fertility damage, and as for the much more certain short-term fertility suppression, I really wasn't interested in having children. How the tables had turned.
To this day, I've tried to resist the notion that I inadvertently sealed my future fate with those flippant words, and now I'm especially skeptical because I've come around to the possibility that curses or any other sort of spell cannot be cast by accident. However, I also remember that I was a cautious person back then, I always have been, and I'm sure that if I'd had the money to freeze some eggs just in case, I probably would have sincerely thought about it and maybe attempted it. But my owner and I were very poor back then. And I wish that hadn't been the case, because saving some eggs from when I was 23 could have changed everything for me now.
In any case, returning to 2013: for some people who stop testosterone therapy it takes a little while to start menstruating again, but I had my bleed only one month later. I was pleased by this even though it was as heavy and uncomfortable as I remembered from my younger adulthood and teen years. I was also pleased by my body fat redistributing itself to what felt right, and by the new body hair I'd grown with the injections now softening and growing more slowly. I liked sweating less easily again. It was frustrating to lose my recently acquired muscle development and to be stuck with chin stubble and a tenor voice that I hadn't yet figured out how to control, but I'd braced myself for it and coped as best I could; nowadays it still drive me mad that I haven't been able to afford electrolysis, but my voice hasn't caused me too many discrimination problems and I've re-learned how to sing very well. However, the emotional crash from losing most of the testosterone in my system hit me very hard, and I struggled to adjust to the highs and lows of my innate hormone cycles. I felt like a teenager yet again, not just from going through a puberty-like shift for a third time but also from the specific hormones at play and how they had affected me in the past.
And the bleeding that I'd recovered was not just normal menstruation. Rather quickly, I found that in some months I would bleed again around the likely day of my ovulation or a little bit after. I never bled enough to mistake it for menses, especially because it didn't look right for that, but while some months this mid-cycle event was just a tiny bit of red staining in my regular vaginal mucus, in other months there would still be enough blood to merit wearing a pad for a day or so.
Even though I had already researched anything I could find about the impact of testosterone therapy on reproductive health and turned up the still-held medical consensus that there is no clear lasting damage to that part of the body after testosterone is discontinued — at most there is a risk of uterine atrophy after someone takes testosterone for many, many years — I immediately feared that my body at least hadn't properly "come off" the old hormones. I crossed my fingers that it would clear up. But the longer that things continued, the more frequently these mid-cycle bleeds would occur. Within a couple years or so I reached out to my preferred community health center, got assigned an obgyn, and began investigating. Never mind the testosterone: I still harbored concerns about it, but I also recalled my irregular cycles as a teenager that resulted in spending some unpleasant time on hormonal birth control, and I knew my mother had so much difficulty conceiving her first child (me) that I was a product of alternative insemination. Was it possible that for my whole life I already harbored some kind of issue with my reproductive system, which would make conception difficult for me, too?
I felt obliged to find answers as quickly as I could, though not because I felt any time pressure to conceive as soon as possible; I was still in my 20s. Rather, the pressure was a kind of inverse economic one. At the time, my owner and I could not possibly afford to raise a child, didn't even have a big enough living space for one, and were already aware that (for private reasons) we would need to first afford donor sperm, which typically costs $1300 to $1800 for a single pregnancy attempt. So we could try to reshape our entire lives in hope of making a child seem financially realistic — but this would also be a pointless effort if I couldn't physically have children anyway. We weren't and aren't completely opposed to adoption, but the motives there are not the same, the initial investment is absolutely enormous, and before going ahead with it (if at all) I would require a substantially long time to adequately grieve the foreclosure of experiencing pregnancy itself. Whatever the overall future might hold, I needed some sense of whether pregnancy were worth aiming for.
Naturally, "Western" medicine in its modern industrial form does not look at nebulous systemic conditions first, preferring to focus on acute illnesses with simple one-time interventions. This is not always a bad thing. It's especially a wise approach when any symptoms are concerningly associated with life-threatening or debilitating ailments. And it's sensible to get "easy" diagnoses and treatments out of the way regardless of the stakes. The flip side, though, is that with so many different targeted diagnostic techniques for different potential problems, you can't rule out all of those problems at once. It's always one thing at a time, and this is then slowed down by the bureaucracy of our healthcare infrastructure; and when implicating this particular bodily system where so much has yet to be properly understood in this particular medical tradition, the slowness only multiplies. As I have partially recounted in one of my earlier posts, my reproductive care team and I have ruled out PCOS, intersex conditions, endometrial hyperplasia, uterine polyps, uterine fibroids, adenomyosis, any benign or malignant tumors, and HPV, ultimately settling on endometriosis as the most likely culprit; and we did this through a hysteroscopy, two transvaginal ultrasounds, two endometrial biopsies, a sonohysterogram, and a hysterosalpingogram, the latter of which suggested potential scarring and blockage on my right fallopian tube although later discussions with my IVF clinic have made that seem less likely. The only "real" way to diagnose endometriosis is through invasive surgery, but it's also an acceptable diagnosis of exclusion after everything else, and because my mother had it there's a very strong chance I inherited it.
Unfortunately, not only did it take me about the statistical average of 8 years to reach that diagnosis — and not for lack of initiative on my part — but of all possible conditions in "Western" reproductive medicine, endometriosis is widely regarded as the least well understood. To a pathetic degree.
The conventional wisdom within Euro-patriarchy was once that someone with a uterus was a woman, and that said uterus was a troublesome organ prone to literally shifting itself inside the body and causing all sorts of physical ailments and psychological disturbances — unless it were provided with whatever it was looking for, which according to cismasculine medical authorities had to be pregnancy, being fucked by a man, many orgasms, or all of the above, depending on the sexual politics of the specific century. This concept of the wandering womb was more or less equivalent to the diagnosis of hysteria, whose name comes from the Ancient Greek ὑστέρα (hystéra) for "uterus."
Now the conventional wisdom is that hysteria didn't describe anything real, and that all of this historical obsession with women's disorders centering around fictitious uterine misbehavior was just part and parcel of oppressing the people who were classified as women. How convenient for the patriarchs that doctors recommended marrying women off as soon as possible to ward against hysteria's risk factors, and that if a young woman were already exhibiting symptoms like heavy menses, screaming convulsions, a quarrelsome attitude, or sexual promiscuity, prescribed marital intercourse would one way or another address these issues. Woe to the widows or incorrigible spinsters who might be diagnosed, because with marriage less plausible for them they would often be institutionalized and subjected to staggering torture. I would be among the first to say it's been a welcome development to live in a society where most people with uteruses are no longer treated so explicitly as if those uteruses were the sum total of our health, personality, and social function; and hopefully this society will not backslide into that crude exploitation any further than has already happened.
However, over the past decade I have grown increasingly aware that a simple narrative of, "We[1] knew nothing then, we know better now," is particularly ill-suited for uterine-ovarian medicine (the term I will be trying to favor here instead of the more gendered gynecology). Most of all, I don't think we can impose that sort of narrative on the majority of symptoms that were once aggregated under the hysteria label. On the one hand, a so-called excessive libido is not exactly a guarantee for people who are otherwise experiencing routine heavy menstruation, mood swings, and pelvic pain (including during vaginal penetration), and I would therefore consider the libido an erroneous outlier to the rest of the symptom pattern. But on the other hand, the rest of the package is disturbingly familiar, and this is not just my subjective assessment.
In addition to what millennia-old wisdom has been retained by traditional knowledge keepers in global indigenous and European post-indigenous contexts, within the realm of even "Western" medicine we now find scholars of medical history positioning endometriosis as the most likely candidate for what past hysteria diagnoses referred to. As of 2012 here is a richly detailed, surprisingly humble, and utterly heartbreaking overview from the American Society for Reproductive Medicine that I cannot recommend enough, provided you have enough time to spend reading it as you also have for this essay.
From the perspective of someone who is likely enough to have endometriosis that it should functionally be considered the case, I have come to find the notion of the wandering womb very appropriate. It's not that my uterus is fully mobile within my thorax, but the very nature of endometriosis is that endometrial tissue which should normally grow exclusively within the uterus winds up growing outside of it, usually around the fallopian tubes and ovaries but sometimes in other places. The further from the uterus itself, the less likely it is, but there are still noted cases like endometrium found around the diaphragm and even the brain, so the condition can create health complications beyond the reproductive system itself. Leaving aside those extreme examples, while endometriosis doesn't bear the obvious hallmarks of an autoimmune condition the cyclical flareups are suspected to cause inflammation throughout the body; simultaneously, it's possible that endometriosis occurs in response to existing inflammation, so there may be a two-way feedback loop. Whatever the case may be, the patient is also more likely to develop a sensitive immune response, even if they don't already have allergies or formal autoimmune diagnoses.
And for any systemically inflamed body, the outcome in this medical infrastucture is usually all but guaranteed to feed a lifelong story of nonspecific symptoms that emerge, disappear, regenerate in covert ways, and are never really explained so are never effectively addressed. The patient may develop a reputation for making things up, for psychosomatically inducing their own symptoms, or for hypochondria. After sufficient gaslighting about their experience of their own body, they may come to dread the arrival of any new, strange symptoms because then it means another set of trips to providers who can't and may even refuse to help them. After developing that dread, actual hypochondria might even develop, as I myself experienced for a time, fearing death from unusual conditions that the healthcare system would overlook rather than listen to me.
What nobody in that system is supposed to say anymore, but what so many people dance around saying anyway is, "You're being hysterical."
Yes, I probably am. What is to be done about that?
With evidence for the condition existing for thousands of years, the "real" hysteria is not a disease of modernity, but factors like pollution and microplastics can't help. And in terms of treatment, there is no actual cure. Menopause will basically resolve the condition, but that's simple biology. Ablative surgery can help remove endometrial lesions, but they can grow back. A hysterectomy often works for people who don't want children in the first place, but some people (including those I know) find that the condition can recur even without a uterus in the body. And as for the older conventional wisdom, orgasms or penetrative sex won't do much — the latter often being quite painful for some patients — but that wisdom might have been right about one thing, which is that pregnancy can help.
If nothing else, simply being pregnant means that the body is going through a different pattern of hormone shifts than it does in cyclical menstruation mode, and so for lots of endometriosis cases it seems that just like with some autoimmune disorders it helps to have one's estrogen and progesterone balanced differently. It's also been documented that some people who experience endometriosis find their condition resolves after their first pregnancy. But in a blow to the pronatalists, things are also more nuanced than that; some people only develop endometriosis after getting pregnant, or they find their existing condition gets worse. So although pregnancy offers symptom relief for many, it's no silver bullet either. Nevertheless, I find it an uncomfortably ironic facet of my health. Would becoming pregnant "fix" me?
I don't know that yet. I haven't been pregnant for long enough to be sure. But in terms of getting to that point, once learning in late 2023 that endometriosis was my most likely problem I also found myself immediately referred over to a prominent fertility clinic. With or without any lesions affecting my tubes, at my age it was possible that my ovarian health could also have been impacted. And while I was at last financially ready for pregnancy[2] and wouldn't really know if I was physically capable without trying, now a lot of time had passed, which would only load the dice further against my ovaries.
After my initial consult, in February of 2024 the clinic had me bloodtest a number of critical hormonal indicators for fertility. My FSH (follicle stimulating hormone) turned out to be very acceptable for someone my age, which was critical because FSH will start to rise during perimenopause as the ovaries start to grow less and less responsive. A good FSH level therefore means that the ovaries do not need a lot of help producing the follicles that will become eggs. At the same time, though, my AMH (anti-Müllerian hormone) was lower than ideal; this hormone is generated by the egg follicles themselves, so if it's low then that means there aren't that many follicles generated in a given menstrual cycle. This was verified by an ultrasound showing a low antral follicle count.
I was warned that these types of things — described clinically as "diminished ovarian reserve" — were a potential issue for my fertility because while most bodies only release one egg when ovulating anyway, each follicular phase beforehand involves multiple follicles maturing at once until the most mature and acceptable egg is ready to release, and IVF relies on inducing an abnormally high number of follicles to all become eggs at once, collecting them surgically in one fell swoop. With a lower AMH and antral follicle count, only so many eggs could ever be collected in a single IVF cycle; of the eggs collected, only a percentage will fertilize, and of the ones fertilized, only a percentage will mature enough to transfer, and of the ones that can be transferred only a percentage will be chromosomally viable. Everyone faces an attrition rate in IVF, but the consequences of this attrition are worse if there aren't that many eggs to start with. This challenge would only increase as I got older and my ovaries naturally continued to makes less follicles at once.
There was no way to know if my diminished ovarian reserve was purely from the amount of time I had already waited, or from endometriosis damage. In the latter instance, maybe I would have run into this problem years ago. But certainly waiting any longer would not do me any favors. I was advised to give it no more than two to four attempts at conceiving without IVF before proceeding to IVF, basically attempting to guarantee that IVF would still be as useful as possible.
So after buying some vials of sperm, the selection of which was itself a surreal experience that could merit its own post, my owner and I attempted our first ICI (intracervical insemination) at home by ourselves in June 2024. I waited the obligatory two weeks and then tested for pregnancy on a digital consumer kit. Negative.
We tried a second ICI in July. Negative.
Then I didn't ovulate in early August, which induced panic on my part. Having learned to track ovulation for months in preparation for all of this, I had never skipped ovulation to my knowledge, and I knew that occasional anovulatory cycles were normal for everybody. But with so much time pressure growing, and with the new looming sense that my job was about to be cut as my workplace shifted priorities, I couldn't stand for this anomaly. I had been searching for new work already, but with how long it was taking I had also begun to hope that if I could at least become pregnant and stay pregnant then I might find some job security through announcing it — who would dare lay me off? — and seek a new role for after I was done with any maternity leave. It felt like a slightly ridiculous strategy, but I couldn't think of anything better.
Early September came and because of the anovulatory incident my new fertility doctor and I agreed to re-test my metrics. They had fallen further already. I used an ovulation-inducing drug and managed to perform an IUI (intrauterine insemination) with an obgyn at my regular health center, but as that resulted in no pregnancy we got an IVF cycle rapidly approved at the fertility clinic.
The sand had been running out of the glass for long enough. We couldn't put the sand back in, but it was time to catch whatever we could and use it.
On the same day that this first IVF cycle started, I was informed at work that I would be laid off in October.
Background II: The Sex-Essentialist Work Ethic & the Spirit of Capitalism
Notwithstanding strides of the last few decades, giving jobs to women (or at least women as classified by the hegemony[3]) is antithetical to the successful operation of capitalist economics. Fascists know this and are honest about it because they want those economics to succeed and they're angry that women working outside the home have lately undermined this. Neoliberals sadly do not recognize the problem and can't be honest about it, continuously falling back into the belief that more female CEOs will make capitalism better, which is like saying that will make cancer feel better while it still kills someone.
Realistically, anyone who has tried to take care of domestic work, raise children, and perform full-time wage labor knows that you literally cannot perform all of these activities effectively together. Not even if you let yourself lose sleep for it — in fact particularly not if you lose sleep. Indeed, just handling domestic work and a full-time job at the same time is enough trouble on its own without also having children. For the two-parent households who succeed at making these things happen without everyone developing severe mental health issues and/or divorcing, this is almost universally accomplished through some combination of these resources:
- Enough money from both parents' incomes to pay a third person (and maybe additional people if using a daycare center) to take care of the domestic work or the children
- Enough money from one parent's income for the other parent to only focus on the domestic work and the children, possibly still paying a third person for extra assistance
- A stable enough local familial/peer network that childcare can occasionally be (consensually) offloaded to grandparents or other family members who don't have their own children
This is a fairly commonsense calculation, and of course it means that wealthier and/or closer-knit families have better odds, though if wealth is the only thing to work with this by no means guarantees the children will actually be well-adjusted. But regardless of exact income, it would be rather nice if the labor involved in domestic work and childcare were recognized as real labor in its own right, and compensated accordingly — whether through directly paying homemakers and childrearers for those activities, or through paying a large enough wage to the people who work outside the home that it can support the entire household. It would also be nice not to have a monetary system at all, but leaving that aside, there are at least these other options.
And so when capitalism was finding its feet for the first few centuries, it was only natural to mandate a sex-essentialist economy where the people who don't bear children work outside the house, and the people who do bear children stay in it. Such divisions had existed in various pre-capitalist cultures already, but now they became more of a codified ideology — because the population had to grow in order to perpetuate profit-based economic growth. Women were no longer just considered primarily responsible for childcare but also considered obliged to be pregnant as often as possible, and obliged to not do work outside the home as a result.
There was always a class distinction to this insofar as the working class did have to reproduce in order to supply fodder for the great machines, but too many children would create more of a burden to feed and that might lead to the workers wanting better wages. So working class women could work outside the home sometimes instead — even married women if their husbands' incomes were insufficient. It was even more important for the wives of bosses and landlords, white and demure, to breed extensively and make sure there would also be enough elite (white) babies to maintain power over other populations.
The way out of these strict expectations is to dismantle the system that requires them. However, for several decades we have instead been dealing with a misguided attempt to simply reform the system. It doesn't work comfortably for anyone. And while people with liberatory vision can picture beautiful possibilities where the nature of work is rethought completely and childcare can be more communally managed in general[4], the people who have lately taken over the federal government where I live and are also taking over a lot of other governments — sadly they do not see that sort of way forward.
You say the word mother to them, and they see a cis woman who nominally bears children out of a joy in doing so but is also bound to it; they see a cis woman who nominally works within the home out of the same joy, but is also bound to it. And of course she is white, and married to a cis man, and neurotypical, and slender even despite how many children she's carried.
I would in many respects prefer a life where I myself only need to focus on pregnancy, childrearing, and domesticity. I find gender euphoria these days in knitting. But I do not have most of those above qualities. And any living child I had would be allowed to select whatever pronouns they liked as soon as they could express it, to wear whatever clothing they liked as soon as they could indicate a preference, and to engage in any pastimes they liked that weren't something cruel like killing ants with a magnifying glass. Their genital configuration would be nobody else's business but their doctor's. I also happen to believe, as most reasonable people do, that the goal of motherhood is not actually shared by all women or all people regarded as women, and this is perfectly fine, even good.
Capitalism will try to sustain itself until the bitter end, though. It's now pulling out all the stops as its foundations crumble.
Loss I (Election)
Despite the layoff notice, after a heartfelt discussion my owner and I decided to continue with the IVF cycle. Putting things on pause until I found a new job might mean pausing until it was too late to make any pregnancy happen. We had no idea when I would find a job again, given so many factors that I can't describe here. The layoff notice also was followed by the assurance that I could take a zero-benefits temporary position through the end of January, which would buy more time for income. And we were certain that we could at least switch over to health insurance through his own job. After a decade of waiting and delaying until "just the right circumstance" there was never going to be just the right circumstance.
So in at least decidedly risky circumstances, we kept going. We knew I might not even succeed on the first cycle anyway. Statistically most IVF patients don't. We just had to try.
It almost seemed that this cycle would fail, too. About five days before we were expecting to attempt an egg retrieval, I received a call from the doctor offering to let me cancel the cycle if I wanted, because the ultrasound monitoring was still only showing two follicles, which might give us absolutely nothing when all was said and done. I could spare myself an invasive procedure. I said, "No, let's go ahead," because at least it would look better for upcoming new insurance if I had already completed one IVF cycle.
Lo and behold, this seemed to also be the correct decision because at my next monitoring appointment we suddenly found three more follicles. Five is still considered a distressingly low number — 15 to 20 is ideal — but there was at least some chance of bypassing the attrition rate. I was tempted to credit the fertility spell that I had brought myself to perform at the cycle's outset, which I will have more to say about next week; but I also would have accepted simple good luck.
In any event, on September 30th after fasting for most of the day and in an utterly miserable physical state as a result, I was led into an operating room at the fertility clinic and laid down at a table. A mask was laid over my face while an anesthesia cocktail was fed into my IV. My ears rang, and then I knew nothing. I woke up weeping, which anesthesia is known to cause for some people,[5] but also received the news that all five follicles had been successfully retrieved and were all mature enough to contain eggs.
I went home. The next day I was called with the additional news that three out of the five eggs had fertilized successfully with the thawed sperm. Three out of five was a good rate. I was scheduled for a fresh embryo transfer procedure on October 3rd. That morning I found myself laying in a cold room with my feet in stirrups as I had done for so many other procedures to find out if what was about to happen could be safe or even possible. And there I was given a photo of the chosen embryo in the petri dish, and then this embryo was placed directly in my uterus using a catheter through my cervix. It was somewhat uncomfortable, but I still watched the guiding ultrasound with wonder.
I hadn't really wanted to get pregnant in this specific way, but now that it was potentially happening, I found myself briefly lucky again. How special to see the little air bubble that marked where the embryo was, right there inside me. Some parts of modern medicine are beautiful.
As with all the previous non-IVF attempts, I still had to wait two weeks to know if the transfer actually worked, in the sense of whether the embryo implanted properly. Initially I was only "pregnant" in the loosest sense of having a growing organism inside me, but we were not connected. It's a peculiar limbo stage. Most traditional herbal abortifacients work their best at that time, preventing implantation and encouraging the endometrium to leave — indistinguishable from triggering menstruation. Once implantation has happened, miscarriage is always a common possibility on its own, but intentional termination can require more involving medications.[6] And an effect of implantation is that the embryo triggers the body to start producing increasingly monumental amounts of hCG (human chorionic gonadotropin), which is what a pregnancy test measures.
While waiting to be able to test, I found out that one other embryo had matured enough to be put in frozen storage. However, as previously agreed with the fertility clinic for this cycle, any freezable embryos were going to first be subject to PGT-A testing, which is a type of genetic test to see if the embryos were euploid (chromosomally "normal") or aneuploid (chromosomally "abnormal"). Children can be born with some kinds of aneuploidy, which is the case with conditions like Down syndrome, Turner's syndrome, and so forth; I personally have no objections to raising such kids! But aneuploidy is also often considered a predictor of miscarriage risk, because most miscarriages arise through chromosomal issues that wouldn't produce viable offspring in the first place. So many IVF patients choose to perform this testing if only to make sure that when they finally become pregnant it has a higher statistical likelihood of going to term. I was willing to take a gamble with the fresh embryo transfer — those embryos are not mature enough to be safely tested — but I had a similar mindset about any freezable ones. It would take a few weeks to know those test results, too, but I had to hope for euploidy or the facility would destroy it because they couldn't hold themselves liable for transferring an embryo that was likely to die in utero.
During the wait, I changed my mind several times a day about what I expected the pregnancy test to say. I was having extremely vivid dreams and feeling rather tired; my breasts were increasingly swollen as well. But while these were classic early pregnancy symptoms, I was also on a progesterone supplement to make sure my endometrium stayed as thick as possible, and progesterone could cause these symptoms on its own. I had to allow myself some optimism amid the quagmire of professional life stress I was otherwise in, but not having felt pregnant before, I really couldn't trust that I was pregnant now.
Yet I was. On October 15th the fertility center confirmed this for me beyond a shadow of a doubt with a blood test, not a urine test. I nearly collapsed in shock and giddiness. I knew the average miscarriage rates and also that for someone my age it was probably about 40%, so I tempered my expectations quickly, but it still felt as if a ray of light had emerged from an overcast sky. After a decade of planning, wondering, hoping, and fearing, I had received the news I had longed for more than anything else I could possibly think of.
And I did begin to get carried away, despite my efforts not to. The embryo testing came back aneuploid, so that was bad luck, but assuming a 50/50 euploid vs. aneuploid split for people my age, this meant I could be pregnant with "the good one." I also learned that the zero-benefits temporary role I would be switching to was actually going to have benefits, so I didn't need to change insurance right away, and I felt some sense that maybe not everything in my life was completely falling apart. And within days of receiving the news of pregnancy, I started to feel much, much more pregnant in many ways. I went to a nightclub after many years not able to go to those, only to feel absolutely exhausted and out of breath within minutes of trying to dance; I started to get migraines several times a week; I developed an aversion to cooked vegetables but an intense craving for avocados; I started to feel queasy like clockwork between 10 AM and lunchtime. As my bodymind adjusted to this new reality, it became hard to imagine the feelings coming to an end any time soon, as unpleasant as many of them were. I started a magnesium supplement that helped with the migraines. I loved how my body was already starting to look. I hated the nausea but I found that eating the right foods helped, and I even embraced the sensation because of what it really meant. I was experiencing nighttime hallucinatory flashbacks to that spring's psilocybin trip, but I didn't mind because it felt like the tiny creature inside me was speaking to me in the language of the Otherworld. I visited a midwifery center that I was thinking of transferring my care to once the IVF clinic released me at the 10 week mark.
I just had to first get as far as 7 weeks, when a fetal heartbeat should register on an ultrasound. If there wasn't anything, I would probably miscarry; if there was then, the rest of the first trimester could still be a perilous time but I would have at least cleared a significant hurdle.
My 7 week ultrasound was scheduled for November 6th, the day right after the presidential election. On election night itself, I went to sleep with a sense of foreboding based on bad results I'd watched so far; the next morning, I woke up and did a simple online search with my phone and saw what I was afraid of. I lay numb in bed for a few minutes. I had expected this outcome for months after watching the disastrous Biden and Harris campaigns, but simply expecting the worst possible US political development since roughly 1861 does not make the news go down any easier. I thought of all the things that were now maybe going to actually happen that I had already feared for years. I grasped on some metaphysical level that if there are multiple timelines to reality I was now living in a vastly worse timeline than I had been living in before, which given the eco crisis was very much saying something. Indeed, never mind the risks to my own person or loved ones — this very development was going to probably make the eco crisis grow far worse. I knew the new dictator's environmental agenda.
And while I laid there, frozen in horror, I then pleaded with my god and all the forces of this universe to at least show me a viable child on the ultrasound later that morning. That would have been something. Then no matter what else happened, I would have managed that much, this thing I had striven to achieve for so long.
My owner and I spent a few quiet, nervous hours at home, then drove to the fertility clinic. As the exam proceeded, the ultrasound technician was also rather quiet, and commented that she couldn't see much but that it could have been an imaging problem. We were sent back out to the waiting room for a few minutes, and then I was called back for bloodwork that I wasn't expecting. After that was taken care of, I returned to the waiting room and then we were both called back to a different area by a nurse who was clearly tasked at and adept with delivering bad news.
She said that I should begin preparing myself for the likelihood of a miscarriage. Occasionally development can be about a week behind, but that would still mean being able to see something at all, and there was barely anything. If it did turn out to be a miscarriage, she explained that I would then need to choose whether I wanted to wait for my body to naturally expel the material inside, to move that process along quickly with medication, or to perform a dilation & curettage procedure under anesthesia. I didn't have to make up my mind that day, but I needed to start thinking about it.
I cried very hard. I am not sure how long it took me to stop crying that day. It felt as if when I woke up to the election outcome, my very dreams had been stolen away in my sleep as well. The rest of my memory is blurred by psychic scar tissue. I mostly recall crying in that office, and crying in the car outside, and crying on the drive home, where we swerved to avoid striking a pheasant inexplicably crossing the highway and then watched another car behind us carelessly kill it instead.
I still felt pregnant, and the bloodwork showed my hCG was still rising. Because of that number and because one ultrasound was not enough to confirm arrested development, I had to visit a special facility with superior equipment in order to make sure nothing had gone missing, and I had to wait a week for it. So I spent the days in between choked by this ongoing fog of political horror and personal depression. Now I still don't remember much of that. I just remember being told at that subsequent ultrasound how now they could see a yolk sac.
This was good news insofar as it meant something had possibly grown since the previous imaging, especially since my hCG had risen again. But it was also bad news because it still meant things were developing far too slowly overall. And even worse for my patience, I had to then schedule yet another ultrasound for the next week because we had to be sure that growth had actually stopped — that a miscarriage had actually occurred.
Another wait, another fog, though I recall the symptoms of pregnancy were now starting to fade. This time I went to the ultrasound on my own, to spare my owner his sick time from work when we all knew what was going to happen. I got the news from the same nurse as the first time. No further growth. She never used the technical term, but it was a blighted ovum, one of the most common types of silent miscarriage — "silent" in the sense of not being immediately expelled.
While the little cluster of cells had barely amounted to anything, I had started to think of it as a child, and now it was a shadow-child, having stepped halfway into this world and then disappeared again because their purpose in the realm of the fey was somehow more important than being my baby.
The idea of my baby was dead, and the baby with it.
The process of determining this fact had taken long enough that I was nearly at the 10 week mark, even though the miscarriage itself must have formally occurred at week 9. I was running out of time to complete the miscarriage through the fertility clinic itself instead of being referred over to a hospital, Planned Parenthood, or similar. As far as I could tell, this was due to abortion regulations. For to "complete" a silent miscarriage is functionally the same as having an abortion; the difference lies in how an abortion actually removes tissue that was still alive. The forced birth or anti-abortion wing of pronatalism is thus responsible for harming and endangering not just people who need actual abortions but also people who have miscarried. Psychologically, as soon as I had the miscarriage confirmed I wanted the remains out of myself for closure and to prepare to start over; it would have been agony to wait weeks or even months for my body to instinctively pass anything. And physically, while that wait is often perfectly harmless, the dead tissue in the uterus can still pose a septic infection risk.
Luckily, while I needed to make a snap decision about how to complete the miscarriage, I had no hesitation in what to ask for. While many people prefer dilation & curettage because of how reliable it is, I was so weary of having equipment pushed into my vagina and past my cervix over all these years that I couldn't bear the thought of doing it again for this, even under anesthesia — because I also couldn't bear the idea of going through more anesthesia after how it made me feel the other month. And most of all, I wanted to be consciously, ritually present for this seismic event that was going to occur in my body. Not the labor of new life, but the labor of death. I wanted to be able to sit with my flesh and the flesh that would pass from me, and to sit with my grief in the sanctity of those hours. I chose the mifepristone & misoprostol drug protocol, wherein in mifepristone is first taken to dramatically lower progesterone and weaken the endometrium, and misoprostol is taken the next day to induce uterine cramping. I knew that it would not be physically comfortable, but that in the overwhelming majority of cases it's extremely safe and usually as effective as the mechanical approach.
I took a couple of days to get some minor affairs in order while I was still operating at normal physical comfort, and one of these affairs was to pick up a prescription for misoprostol. Then I returned to the clinic on November 24th for my dose of mifepristone. Per the aforementioned regulations, I could not simply pick this medicine up from the pharmacy but instead had to receive it directly from a medical professional and ingest it in front of them.[7] It felt like crude and impossible to ritualize the way that I wanted, but I told myself that the real ritual would probably be more relevant with taking the misoprostol.
So I thought. After spotting for the past few days once I'd stopped my progesterone supplement, it seemed my body only needed the mifepristone's help to recognize that all was done. A few hours after I returned home from the clinic that day, I started to bleed. And bleed. A safe bleed, but heavy, thick, clotted to a degree I had never seen before. The cramps were likewise strong, and with the blood they increased into the evening.
I lit a candle I had bought for the occasion, swathed myself in a favorite blanket, and sat on a red towel with my legs butterflied to keep my hips open. I did some knitting while my owner joined me, and we watched a film that's one of the best for making me laugh no matter what's happening.[8] I had considered watching a more solemn option, or not watching anything at all, but I had also realized I had no meditation to focus on and I suppose that in some way the humor of the movie would be a worthy focal point — I was mourning but the bleed would bring me closure, and I thought it was time to look forward to another pregnancy attempt even as I said goodbye, so this asked for a light heart.
The cramps grew very painful. Another drug I'd been prescribed was Vicodin, and I had thought I wouldn't use it because I've avoided opioids my entire life, but I took one pill. It helped the pain considerably, but I didn't like the way it subtly depressed my breathing, so after the one dose I didn't take anymore. It was just as well, since the worst few hours were then over, concluding with a particularly odd, repulsive sensation that I can't bring myself to relate in detail but that sent me to the restroom for another pad change; in the process, I saw something that was the same as what had been found on the ultrasound, only now in the flesh. The horror of life's roots, and the beauty of the horror.
I knew the loss was complete. I bled for close to two weeks, but much more lightly, and I thought that would be all I had to manage. My spirits were boosted by a visit from a beloved friend on the bleed's second day. However, as my household then went into the Thanksgiving holiday period, I found myself turning hermitlike and listless. We already don't observe the holiday as such, but sometimes we will join other people if invited, and despite a couple of invitations this year I couldn't fathom it.
And as the days went on, I was slowly possessed by an agony that went down to my very bones, inexplicable in its extreme force. It was not a simple physical pain, feeling more like embodied grief, but I couldn't understand it because I had spent weeks already processing the original grief, which was far from resolved but had diminished considerably before I took the mifepristone. Somehow I was finding myself more depressed than I could bear, let alone remember experiencing before. Intrusive suicidal thoughts kept entering my mind and provoking breakdowns during ordinary tasks like running laundry. I had experienced those thoughts before at a few other low points in my life, but this time it was disturbingly pervasive. Even with no active plans, I thought I was becoming a distinct risk to myself, and I could barely understand why.
Not coincidentally, my hCG had fallen rapidly, to the point that by December 5th I was already no longer testing positive for pregnancy. Many miscarriage patients don't see this result for much longer. But as my hCG fell, so too had other elevated hormones, and it took about a week of this miserable confusion before it occurred to me that my depression was literally postpartum. No one had warned me about this, yet some quick research made the whole problem glaringly obvious.
I cannot imagine what it's like to experience postpartum depression after a live birth, but I do know one thing that at least from my perspective seems like the better outcome in that regard: there is a child, instead of a nothing.
I joined a support group. This started to help. I discussed next steps for a second IVF cycle with my care team. This also started to help. But mostly nothing helped my body and mind's recovery from the hormone drop except time, sheer time. I found myself feeling more alive by Jól.
The Process (Inauguration)
IVF is not just "test tube babies."
The embryos are grown in petri dishes, not test tubes, but I won't insist on this distinction. I say IVF is not just that growth. To focus on simply where the embryos are made erases every step it took to get to that stage, which people who have not undergone the IVF process simply do not know.
The process is first waiting for menstruation to start, and then reporting it with a phone call. Then waiting to be called back with scheduling information for preliminary monitoring.
The process is going in for that preliminary monitoring on day 2, 3, or 4 of menstruating. A baseline follicle count must be performed to see how many follicles may form eggs in this particular cycle. Baseline endometrial thickness must be measured. This is done via ultrasound, which hurts when you have menstrual cramps and especially if something like endometriosis makes them worse. Increase the pain in your imagination when considering that the ultrasound is typically transvaginal because for most patients this offers a better view. In my case, it's easier to see certain things transabdominally instead, but pressing around that area still causes discomfort, and depending on whether I've received the usual technician I may be subjected to a transvaginal wand at first anyway because very few techs simply take your own word for it about which method is more reliable.
Meanwhile, besides the ultrasound, bloodwork must also be performed on the same day. Estrogen and progesterone levels must be known, as well as the level of your LH (luteinizing hormone), which will slowly rise until the follicles are on the brink of releasing eggs. At that stage, LH will spike about 36 hours before ovulation occurs, and with IVF it's necessary to retrieve the eggs as close to ovulation as possible, so if LH spikes unexpectedly early this can ruin the cycle.
The process is drugs. Lots of drugs. For my first cycle, I was on a protocol of two drugs that had to be taken every evening from day 3 onward, in order to bombard my ovaries with more FSH than my body could actually make, ultra-stimulating the follicles so that more than one would grow to maturity; these follicle stimulation drugs are in one case created synthetically and in another case manufactured from menopausal people's urine as it contains high FSH. Besides these drugs, after about the first week or so I had to start another drug that would suppress my LH and make sure it didn't spike. For my second cycle, which started a few days after New Year's, I was on a different protocol where I was given a higher dose of the stimulation drugs and accordingly given a different LH-suppressing drug that had to be started earlier in the cycle.
All the drugs have to be taken within the same 2 hour window every night, except for the second cycle's LH suppressor that has to be taken both morning and night. They also all have to be injected subcutaneously. I was used to at-home injections from the days when I took intramuscular testosterone every two weeks, but I had never been able to stab myself with a needle, asking my owner to do the honors instead. But for this I had to overcome my fear, because it was simpler to self-inject in my belly than to make someone else find the right angle. Some of the drugs come in an auto-injector or prefilled syringes, and others have to be reconstituted from powders in saline solution. It feels like alchemy, creating fertility potions.
The process is these drugs. As they build up in the body and the ovaries are stimulated, estrogen also rises to potentially a higher level than would normally happen. As a result, you are warned of a minor but real blood clot risk. Patients also frequently experience swollen breasts, general water retention, mood swings, and increased vaginal discharge. Some people I now know who have gone through such symptoms hate them, feeling bloated and grouchy. In other people's cases, myself included, the estrogen boosts libido and makes that swelling and discharge much more pleasurable.
The process is more monitoring. Every few days, you need to go in for another ultrasound, another blood draw. They have to see how many follicles are responding to the medication, and how big they've grown. They have to make sure the endometrium is thickening adequately. They have to keep an eye on the hormones. My veins, already inclined to hide from phlebotomists, start to get particularly tired and elusive after so many draws, meaning that with the progression of each cycle I would frequently go in for my bloodwork and have to be stabbed multiple times before finding a good spot.
The process is one more drug when the follicles are virtually ready. They call this the trigger shot. It's a single but high dose of reconstituted hCG, which overrides the LH suppressor and forces the body to ovulate as if the LH spike had occurred. With so much hCG in someone's system, the body then starts to temporarily act as though it's pregnant as well. Each time I've received a trigger shot, my breasts expand my nearly a full cup size for several days afterward. And while blood clot risk doesn't necessarily rise much further, at this point you're also warned to watch for symptoms of ovarian hyperstimulation syndrome, in which the ovaries are now so overwhelmed by input that it causes a buildup of fluid in the abdominal cavity. Very few IVF patients experience OHSS these days, and of those who do, it's mostly physically very uncomfortable; but severe cases can actually lead to hospitalization and complicated drainage procedures. In a minority of those severe cases, people die from cascading systemic effects.
It seems perverse to risk dying to become pregnant by artificial means. But everyone who becomes pregnant by "natural" means also risks death, inherently.
The process is waiting until a couple of days after the trigger shot and then going in to the clinic's surgical center for the egg retrieval. Because of the 36 hour timing and doing the surgery during the day, this means usually the trigger shot had to be injected in the evening or the dead of night. Assuming you've recovered from the sleep deprivation, then because you're going to undergo general anesthesia you can't eat on the day of the retrieval until after it's over. For my first retrieval I was one of the last surgeries of the day, so I was fasting for a nearly religious timeframe and delirious with hunger.
For the second retrieval, I was scheduled on the same day that the new dictator would be inaugurated, during the exact time of the ceremony. I went to sleep on the operating table in a slightly less cruel version of the world, and woke up yet again in a crueler one. This time I cried from more than the anesthesia itself.
The process is waking up from that retrieval and waiting for them to tell you how many follicles were taken. This second time, they told me they got five yet again. But the next day I learned only one was mature enough to actually fertilize. I prayed that it would at least mature enough to freeze. We weren't doing a fresh transfer this time; because of my miscarriage we had planned to test every embryo we could get. But it seemed ironic to receive only one embryo this time, as that still wouldn't give us much information.
And then the embryo failed to grow any further, so it couldn't be tested, and it couldn't be frozen, and I was left with nothing, and it felt like once again in some way the national politics had played some impossible yet cosmic role in my ongoing inability to birth a living child.
After a failed cycle like that one, the process became trying to secure a third cycle, only now through a new insurance carrier as the end of January had passed and in my unemployment I had to switch to my owner's plan.
The process became meta-process.
Because my owner works in one state and we live in another while also usually visiting doctors in that state we live in, in preparing to switch to his plan there had already been some messiness with identifying my PCP as someone who could actually be my PCP. Come February, this was supposedly long since sorted out. All I should have needed to do was have the IVF clinic submit a prior authorization request to the new insurer. I gave the clinic's financial coordinator the new insurance information and proceeded to spend that month's menstrual cycle just getting a carefully timed hysteroscopy to make sure there was no residual pregnancy tissue in my uterus — in other words that the pharmaceutically managed miscarriage hadn't left something behind over the past couple of months.
Everything looked fine, so I waited for the insurance approval and meanwhile at the right point in the month I then started taking a new medication, oral estradiol, that had been chosen for the new approach we were taking with this upcoming IVF cycle. "Estrogen priming," they called it. A routine trend with my past two IVF cycles had been that some follicles would mature much faster than others, leaving a few that were still immature by the time of my trigger shot. Estrogen priming for a week prior to menstruation can help push waiting follicles to grow faster once the next cycle starts. I found immediately that taking the raw estrogen had an even more pronounced effect on my libido, so I didn't mind it per se, but I also knew that when estrogen supplementation isn't also accompanied by progesterone this can gradually elevate lifetime cancer risk. Just taking estradiol for a week seemed safe enough, of course.
But as I had started estrogen priming, I checked in with the financial coordinator about whether we had received prior authorization approval from the insurance yet. He told me he had submitted everything and was having trouble getting a response back, which I felt was immediately explained by the fact that the insurer he mentioned was my old one. Despite the fact that earlier he had acknowledged the information I sent about the new one.
Having sorted out that mistake, the coordinator rapidly submitted a new PA request to my real insurer, but we were now very close to when I would next menstruate and the next IVF cycle would have ideally started. Perhaps I could have been more patient at first, but my stress was also mounting as I followed the news. The executive orders and their effects were flooding in so quickly that although I didn't believe IVF itself to be in jeopardy, I was starting to realize that my owner and I might have reasons to flee the country in as little as a year. Maybe much less. And if we left for another country, the process of resuming IVF over there would take so long (and perhaps be so unaffordable) that I might never have a chance of pregnancy ever again, regardless of what my body's own limitations were.
Regardless of that risk, my blood arrived while I was still trying to find out the PA status. With my last insurance, these things had gone very smoothly, but with this service everything was different. I gritted my teeth on phone call after phone call as the bureaucratic buck was passed. One person made it sound like my PCP needed to be contacted for this even though my PCP had nothing to do with it.
After I sorted out the fact that this did not actually need to happen, I was then bounced for days and days between people making diametrically opposed claims about whether the PA request should have gone to the insurer's PA department in the state where the plan comes from (the state where my owner works) or to the insurer's PA department in the state where the IVF would be performed (the state where we live).
After I sorted out that it was the latter case, the PA request was re-filed correctly, only to be sent back on the grounds that the insurer's offices in our state did not have a record of me in their system. The IVF clinic's financial coordinator and I each had to make several more phone calls in order to determine that something about my personal information had not been updated properly outside the state where the plan was formally administered.
By now it was near the end of March and I was estrogen priming again on the hope that this time it would pay off. The executive orders were still being shat out and every other political development that I was forcing myself to pay attention to set my hair on end. And lo, I caught covid for the first time, and I started to bleed on the same day I tested positive, so for multiple reasons starting an IVF cycle was now precluded.
Through my illness I doggedly persisted with more calls. By this point I had started to reach a degree of mystery so arcane that I would have to be called back after the newest insurance representative conducted research for me, and the representative would always say they'd call me back the same day, but it usually turned into the next day or the day after that. I eventually received the seemingly horrific news that the insurer's office in our state listed both my owner and I as having had our plan cancelled. Inexplicable since we were very much still insured — but perhaps just for now. What did this mean? Now the process was about finding that out.
In the first week of April I finally found out that when I was added to the new plan, the plan was "cancelled" as a one-person plan and upgrade to a two-person plan, but only the first part got communicated out of state.
It was among the most ridiculous roadblocks I could possibly imagine. Yet at least we had worked it out. One more PA request went in, to the right place. Approval came back around the time that I no longer had covid. So I estrogen primed again. The only issue with this PA approval was that it turned out the new insurer wouldn't pay for PGTA testing of embryos.
When my owner and I discussed this, we chose not to pay for testing out of pocket. I didn't want to miscarry again, but not only could that still happen with a euploid embryo — in the past several months we had also learned that PGTA testing was not necessarily meaningful. While most miscarriages are indeed caused by aneuploidy, there are many kinds of aneuploidy that exist when the embryo is first developing and can resolve after the embryo has developed further in utero. In other words, the "abnormalities" perceived while the embryo is still just a blastocyst in a petri dish will not necessarily matter for the pregnancy's viability.
So for this third IVF cycle, we would freeze most of the embryos we got without testing them, and opt for a fresh transfer again like the first time. Suddenly, it seemed that with just a bit of luck, I might become pregnant again in the middle of May.
Signs
May seemed right.
The rule of threes might prevail.
In the seasonal liturgy that I keep, that we keep, May is the primary month of fertilization on many levels. Any child conceived when estimated would be born at the start of February, perhaps even right on the 1st, the holiday of lactation and birth. Perhaps, I let myself suppose, all of the failures and heartbreak and delays of the last 11 months had happened because I was meant to bear a child near that day specifically.
In the days leading up to the cycle's start, approaching the end of April, my owner and I struck a rabbit with our car. I've written about this in at least one other post, but in the immediate aftermath of that tragedy I knew that the event had to signify one (or two) out of three things. One would be an ill omen for the cycle to come, another would be a mystery as the rabbit might have carried a message to unravel, and the last would be a good omen as the rabbit perhaps gave their life to any child I had. The best I could come up with in the short term was an intuition that if I bore a living child from any embryo conceived this cycle, I would have to give it the rabbit's name as a middle name. Whatever the rabbit's name was.
As the IVF cycle got underway, it started to become apparent that our rose bush, which usually only produced a few blooms per year, was going to produce several dozen. It had been accidentally cut back by house painters in the year prior, but grew back insistently as usual, and now that we had removed one other bush that was blocking its morning sunlight it seemed much happier in general. I had to take it as another sign of fertility and abundance.
As the egg retrieval day arrived, this time we were scheduled very early in the morning. Amid the May sunrise we drove the winding road through the woodland near our home to get closer to the highways; on this road we saw, and did not strike, a fox.
Foxes have a different sanctity to me than rabbits. They are boundary-crossers, canine in some respects and feline in others, passing ever between the shelter of the forest and the things they can scrounge from human society. They belong somewhat inherently to the Otherworld. And not long after my miscarriage, I had come into possession of a stuffed fox toy, which I found myself sleeping with every night like a child would; I felt nothing childlike in myself, however. My urge to hold this little fox was a distinct, primal instrinct to hold a missing baby. Because the Northern Lights had also glowed prominently and unexpectedly in the sky during October, the main month of that pregnancy, I also thought of the Finnish myth of the fire-fox whose tail dragging over the sky creates the aurora like static sparks; because the Northern Lights looked like some of my nighttime psilocybin flashbacks, it felt like my shadow-child had spoken to me with aurora through the veil. Fox, aurora, and loss were all wedded together now in mind. The toy I slept with was an animistic vessel for a dead-but-barely-lived spirit. And now a fox had crossed before me on the road as I was about to perform another procedure that might produce another child.
May seemed right.
There were only three eggs in the retrieval, but two fertilized again. One embryo was frozen, and the other was transferred back into my uterus in what was now a familiar manner. I took my progesterone supplement for two weeks again, waiting.
On May 31st, I went in for the pregnancy test. I had my suspicions because of how identical I'd begun to feel, but I still wasn't sure. But once again, the bloodwork was unambiguous. Pregnant again.
Loss II (Parade)
Besides the roses that bloomed a few days prior, another flower bloomed in our garden on that same day as the great news: our poppy. Poppy flowers are exquisitely beautiful, but they wilt quickly, and our poppies typically have dropped all their petals after a single week.
I had already tempered my expectations again on that first day, but I found it harder, not only because of all the signs but because of how recurrent miscarriage is considered rare as a back-to-back event. If it were to occur, that would be clinically concerning, but statistically if I were pregnant again in general then the odds were very much on my side.
Nevertheless, temperance soon came from other numbers.
Just to be sure, always, an IVF clinic will not simply test to see if someone has gotten pregnant. No matter what the pregnancy's chances of success are considered to be, you go back in a couple of days later to make sure the hCG has doubled. If not, you do it again. Maybe again, and again.
Usually it rises appropriately, especially for viable pregnancies. Most people do not get stuck in what is colloquially termed beta hell. But this time, I was. Each time I tested, it seemed like instead of taking the preferred 48-72 hours to double, the hCG was at best managing about 96 hours. This is almost unheard of for a pregnancy that will make it through the first trimester, let alone got to full term. My fertility doctor candidly warned me he had seen a case like mine work out with a live birth exactly once.
So within less than a week of the good news, I was being told to brace for another miscarriage. There was also a chance that I had an ectopic pregnancy, with numbers as low as mine, but I was told not to worry about that right away. While IVF creates a mildly elevated risk for ectopics because of the way that embryos are transferred, even the low odds of recurrent ordinary miscarriage were still plausible for someone my age, especially someone who wasn't testing embryos. So on one morning that I went in for another hCG check, I also had many more vials of blood taken to start screening for other conditions that might make recurrent miscarriage more likely. We would test other things once I wasn't pregnant anymore, which was spoken of as an immdiately approaching inevitability. My veins were growing absolutely exhausted with no end in sight. My one day of joy at the end of May had become ash in my mouth come June.
The hCG rise then began to seem so poor that we could no longer "wait" to worry about an ectopic after all. I went in for an early week 5 ultrasound. Nothing could be seen. The technical classification is pregnancy of unknown location.
At such a stage, it could have been that there was still an embryo in my uterus, but that no gestational or yolk sac had yet formed. If so, between that and the hCG numbers a miscarriage was certain. But it was also entirely possible now that the embryo had implanted somewhere other than my uterus. Most ectopics wind up in a fallopian tube. I kept thinking about how my right tube had been noted on the hysterosalpingogram in 2023 — how endometriosis scarring may have damaged it and made that area more ectopic-prone. We couldn't see anything in that tube, which meant any ectopic was unlikely to be an immediate rupture risk, but not-seeing did not bring any comfort.
I knew now, for certain, that a second pregnancy was going to end without living child. Before I could process this information fully, however, I was still listening to a nurse tell me about the situation. It turned out that she now expected me to undergo an endometrial biopsy then and there. The procedure itself wasn't a surprise, because I had been warned it would be necessary to collect a specimen from inside my uterus and prove whether a (non-viable) embryo had been in there at all, incidentally performing an abortion of sorts if so. What I was surprised about was that I was being asked to undergo an endometrial biopsy without any form of pain management and after I had just received immensely tragic news. I suppose I had taken for granted that I would have been asked to come back in the next day, and that as with past uterine-ovarian healthcare experiences I would have been told to premedicate with over-the-counter painkillers.
So much for that notion, because when I asked for painkillers the nurse looked at me like I had grown three heads — perhaps assuming that I meant opioids, but I blinked in turn when she asked me how I had tolerated this procedure in the past.
How would most people with an average pain threshold tolerate having their cervix mechanically opened and an instrument passed through it to scraped the uterine walls several times? It's functionally the same as dilation & curettage, only it isn't always performed during a pregnancy.
We negotiated for me to come back the next day, in any case. My owner came with me. I took acetaminophen. I saw a different nurse, and overall the procedure then went as painlessly as it could. I cried silently, however, knowing that if the pregnancy had been uterine after all, while that was already a lost cause this activity would end it.
Two days later, I had my hCG tested again. If a pregnancy had actually been ended with the biopsy, my hCG should now be dropping. But it had risen. And as I was also informed, the biopsy showed no evidence that any pregnancy tissue had been in my uterus, despite how several extremely good samples had been collected.
It was time for a different medication protocol. Just one this time. This one is called methotrexate.
Most people will not encounter methotrexate for its on-label usage unless they receive a low dose periodically for rheumatoid arthritis, or unless they receive it for its original purpose, which is as a chemotherapy drug. And like most types of chemotherapy, methotrexate poisons the body — in a very specific way. In this drug's case, it interferes with folate (vitamin B9), creating the same effects as a severe deficiency of that nutrient. Because of what folate normally does in the body, this deficiency prevents DNA from replicating. It's a highly unpleasant but naturally effective way to tackle fast-growing cancer cells, and it's the only non-surgical means to kill an embryo that's growing somewhere outside the uterus.
Had we known where my ectopic pregnancy was actually located, perhaps we could have pursued surgery, both to preempt any rupture and because since I was already engaged in IVF the potential surgical removal of a fallopian tube would not be any great loss to me. However, since surgery is typically avoided for anybody with any condition unless it's truly necessary, and since the embryo was currently too small to locate, methotrexate was the only way to deal with my situation apart from simply watching and waiting. And watching and waiting would have been very dangerous. Tubal rupture is frequently lethal, and it can cause debilitating problems even when it's not. Some ectopic pregnancies will fail on their own, but not enough to take such chances.
On the morning of June 14th, there was a fascist military parade preparing to take place with tanks on the roads of Washington, DC. Yet again, the political and the personal overlapped in ways that people don't normally describe. For on that same morning, I was bent over on a table to receive two gluteal injections of methotrexate, considered one full dose for my body weight.
It took only a few hours for me to grow startlingly fatigued and develop massively uncomfortable gas and bloating. I had to be careful of many things now, too. I would be photosensitive for a full month. I couldn't take my prenatal folate supplement or eat folate-rich foods like spinach, otherwise it could undo progress. Despite no concern of harm to the embryo, I still could not drink alcohol or the interaction with the drug could cause serious liver damage. I still could not take ibuprofen[9] or that interaction with the drug could cause serious kidney damage. In addition to needing to report any symptoms of tubal rupture like bleeding or excruciating abdominal pain, I also needed to monitor myself for any indications of said liver or kidney problems, and for respiratory issues because methotrexate can also damage the lungs. These risks were not presented to me as likely, because I was receiving a relatively low dose, and I was told I probably would not even need a second one, because very few ectopic patients that my care team had treated with it ever needed two rounds.
Exhausted and weak, I went in for bloodwork a few days after this first dose to see if my hCG had dropped yet. No, it had risen. But this was normal, I had been promised; methotrexate takes longer to work than "standard" abortion drugs, and the embryo has to literally reabsorb into one's body. It was more important to see whether my hCG had dropped a few days after this.
I went in for another test on Litha, the summer solstice. If the pregnancy hadn't been ectopic, this would have probably been the day to go in for my week 7 ultrasound and perhaps at last see a fetal heartbeat. Instead I was here to make sure of death, not life. And indeed, now the hCG had fallen.
But not at an acceptable rate. Just to be sure the work was done, I was scheduled to go in for a second methotrexate dose after all. I would get it done the next morning. Then everything should be over.
My body evidently had other opinions. After spotting and twinging for many days, that afternoon I started to bleed and cramp. Not intensely, but genuinely. Somehow despite my history of health anxiety I intuited from my prior miscarriage experience that this was all right. However, I called the clinic to report the bleeding because I was supposed to. I asumed that since the bleeding wasn't severe and the pain was minimal, they would see things the same way as I did, but of course I don't have malpractice lawsuits to consider. They sent me to an ER.
Not just any ER, but an ER at a major hospital in a major city, because they had a reliable on-call obgyn contact there and it would be easier to coordinate my care than at a hospital who didn't have any prior experience with my clinic team. The last thing I wanted to do on Litha was postpone our holiday meal and drive through urban rush hour traffic for a hospital visit I probably didn't need, but I felt powerless to object. I didn't want to seem difficult, and the clinic team had a fair point that just in case things did get worse overnight, it would be better to get out ahead of the issue in the early evening instead.
We left home for the ER at 5:30 PM. Despite how the reasoning for going there was sensible on the surface, by the time we got home at 5:00 AM, we knew that going to this particular ER was a mistake we would not repeat unless we had no other choice. The emergency team was not incompetent: I was triaged appropriately in terms of low physical health risk, and some of the delays we experienced were clearly because of staffing issues and a lot of patients having shown up before us. However, the ER had no dedicated phlebotomy station, relying on assigning patients to private rooms before blood could be taken, which during a busy night is a cataclysmic operational choice. I didn't need a private room, just basic monitoring. While I received an ultrasound in two hours, I didn't get my blood taken to have another hCG check for five hours. Likewise, the ER kept nearly no medications on hand and had to call for most of them across an absolutely enormous, sprawling complex, which meant at that time of night it took several more hours to have a methotrexate dose delivered. Indeed, the only silver lining was that I would get my methotrexate right there instead of having to haul myself to the clinic the next morning in a sleep-deprived state. But I went through all of this thinking that if I hadn't known the pregnancy were ectopic, or if I hadn't known I was a low rupture risk, the amount of time I spent in administrative limbo without clear information about next steps or diagnoses could have sent anyone into a mental health crisis, physical risks be damned.
I spent the following day just barely finding ways to observe the missed holiday — and feeling even more tired, both from the sleep loss and the second drug dose compounding the effects of the first one. I continued bleeding, lightly. I continued cramping, mildly. I assumed that at this rate I was going to experience something like a normal period, albeit slightly prolonged.
With more sleep behind me, I felt the trend continuing the day after that, but only for a little while. Over the course of the early afternoon, I began to bleed so substantially that it reminded me of particularly heavy menses — not dangerous, but unexpected. Then the cramps escalated.
When any pregnancy ends, the body goes through labor. It does not matter whether the ending is a live birth or not. This was what I experienced during my miscarriage, although even before I decided to take the Vicodin I felt that the process was ultimately gentle, my body otherwise healthy and understanding what was happening. On the methotrexate something about this was horrifically different. These cramps were the worst pain I could remember in my entire adult life, perhaps at all. They were rolling, convulsive waves that seized my entire pelvis and gripped it in a vice and made me howl, weep, sob for mercy. I think that some part of my body still thought it was pregnant and was trying harder, pushing harder, to deliver something that wasn't there.
I rolled and seized in bed for a while, my owner doing his best to shepherd me through it, but this wasn't enough. I was considering using leftover Vicodin, and I knew that if things were that bad I should perhaps once again make sure the labor-like pain wasn't masking other pain, given the amount of blood. After another call to discuss this course of action with the IVF clinic, I gathered some personal effects while barely able to stand, let alone walk, and then my owner ferried us to a different ER at a closer hospital.
Let it suffice to say that there they handled everything much better. Some other time I could write up a contrast with the emergency services I received two nights prior. But as the pain passed on its own, as the bleeding tapered, as I was given a saline drip to recover, as the new test results came in showing the pregnancy was now well on its way to concluding — the deep and terrible irony of this additional date was not lost on me.
It was June 22nd. Had my first pregnancy gone to term, my due date would have been the very next day. And I had just spent that night in labor, but again for nothing.
I write this now still in initial psychological recovery from my second loss. I just tested negative for pregnancy on Wednesday. I am also still physically recovering from the methotrexate. Nearly all the side effects and contraindications have worn off or no longer apply, but I remain photosensitive and it also appears that ultimately the medicine may have mildly inflamed my lungs. Just three days ago I was at an urgent care center for pain when inhaling deeply, following several days of noting increasing random bouts of wheezing and nighttime congestion; the doctors there gave me an X-ray and some other tests to rule out any dangerous pneumonitis (which if improperly treated can be lead to lethal conditions at an uncomfortably high statistical rate), but even subclinical inflammation needs treatment. I was given a nebulized medication that helped to open things up, and now I'm in the middle of a week-long prednisone course. I see my PCP tomorrow to follow up.
When I was diagnosed with the ectopic pregnancy itself, I mostly managed to resist the fear that my overwhelming desire to have a child was going to lead to my death. The day that I went to urgent care, however, I couldn't stop ruminating over the possibility that while the ectopic hadn't killed me, maybe the medicine to end it would kill me instead.
Would those who oppose abortion under any circumstance say I had deserved such consequences?
Mother of Vengeance, Guardian of the Thousand Seeds
This motherhood I've known is not the kind that the far right fetishizes. Those mythic mothers conceive whatever offspring are literally thrust upon them, and they do not bleed their babies out. They do not need to abort for any reason. And with the experiences I have had, many people of any political persuasion would maybe question calling me a mother in the first place.
I question it every day. Where is the line drawn? Does motherhood begin at conception, or only at delivery? Whatever the answer, my body is not unchanged by pregnancy. At implantation, trace amounts of DNA start to be exchanged between embryo and uterus. I will always have a little bit of my first child inside me now, and of the second one — especially the second, as the very cells were reabsorbed into mine — and the DNA in question originated not only from me but from the anonymous donor whom I had chosen because his eyes and smile were so much like my owner's.
So some days I don't think of myself as a mother, but on other days I do. I am mother to two ghosts whom I never met with bodies.
But also it doesn't really matter whether I am a mother yet or not. Because I am also not yet a mother in the way I would like to be. I have not yet experienced the full arc of pregnancy. I have not yet pushed the fully formed shape of my young out from inside of myself and heard their first cry. I have not fed them from my breast. I have not raised them from that tiny form to something larger. I have not gotten to make them clothes, or watched and helped them learn about the world, or listened to their first language. I am not the ancestor of anyone.
The crux of all my fears is infertility and extinction intertwined. The pronatalists are wrong that we will save the world by breeding, but I refuse to allow them and the world-killing ideology to be the only ones left eking out some meager existence in the post-apocalypse. I want to help in the Thousand Year Cleanup, and I want to give descendants to that cause, and be a good ancestor while I can. No, I am not without an ego, for none of us are. I have feared that if I can never bear a living child, it will signify something about the way the rest of our species is going.
I walked out of my week 5 ultrasound — the one where this latest pregnancy was ruled of unknown location — and went home in a blind, roiling mixture of grief and abject rage. At the time I was still supposing it might be a second miscarriage, and that would not be fair. Conversely, an ectopic pregnancy signified something different, namely that perhaps this child would have been viable if the embryo had simply implanted in a better place; but this was not fair either.
It was not fair.
There were, and are, no words to adequately describe the unfairness. Just as there are no words to encapsulate the unholy energy that was awake in my heart, my limbs, my blood on that day. I entered my home that afternoon humming from head to toe with the strength and willingness to actually, truly kill something if the right target presented itself. I knew myself to be not just any mother, but Grendel's mother. I knew myself to be Frankenstein's monster. An avenging fury ready to claw apart every authority and even the fabric of the cosmos. I was untethered. I could have spat fire.
I envisioned a future where I retreated into the wild and emerged only occasionally like the Lilac Fairy to curse others' living children to die pricking their fingers on spindles. Here was the awful, ugly bitterness that I had long feared for my spirit if I found myself permanently infertile, even though that diagnosis hadn't been made.
I managed to temper this feeling once I was no longer alone for the day. I held it in through the endometrial biopsy that followed the next morning. I held it in as my owner held me in the hours that then passed.
And that night, that Wednesday night, June 11th, before my ectopic ordeal was anywhere complete, I suddenly understood something.
I have been longing for the rite of passage that is motherhood, parenthood, by the terms by which I define these things, and I have regarded anyone who undergoes that rite as a very strong person in a very certain way. I have been questing to find that same strength. But in idle ruminations, what dawned upon me was that it took another kind of strength, equal and maybe — dare I say it — greater, to try so hard for a child, come up with nothing, perhaps nothing forever, and still survive.
Could the avenging fury's power be turned to something good? Maybe. There could be few things so strong and beautiful and ready to serve future generations as a mother who has lost everything but endured out of sheer stubbornness. In so many other areas of life, I had already come to believe in the existentialist principle that the right things must always be done even when they are done without hope. Hope is not a luxury, but neither is it a requirement.
I can't go on, I'll go on.
And after all, the epiphany continued, this may be what is asked of all humans, especially those of us who are trying to heal the earth. While I was losing my second child on the weekend of the summer solstice, bombs were being dropped in Iran as an escalation of the death spiral politics around nuclear proliferation. We may yet destroy ourselves, whether or not the eco crisis does so. Humans may go extinct even if life itself survives.
We must serve the more-than-human world regardless of our own fate. And so I must serve my fellow humans, and the more-than-humans, and live in rite, even if I have no hope to become an ancestor.
That hope is not yet gone. Another embryo is waiting for after I've built up enough folate in my body over the next couple of months. But I know now what I must cleave to if hope evaporates, whether that might happen from my body's age betraying me or from some other physiological limitation or from the regime that has seemed to loom constantly in the corners of my vision during crucial stages of my fertility quest. I have something to look ahead to, no matter what, which is sheer, perfect duty, fueled by my transmutated pain. I can become the mother of vengeance — but also the guardian of a thousand seeds.
That is not the mother they want, yet in such a role I may destroy as many of their works as I can, and they may despair.
[1] Really meaning the patriarchs.
[2] Having reached a plausible household income, paid off most debt, verified what kinds of fertility treatments my health insurance covered, and helped convince my then-employer to reimburse for donor sperm.
[3] I find this is a worthwhile distinction since I continue to be uncomfortable actually identifying as a woman but I'm distinctly aware of all the contexts in which I'm still treated as one.
[4] This is not a statement about only raising children in a communal fashion. I support having formal parents (biological or not) who take core responsibility for their own children, and making sure children know who those parents are. But from an evolutionary and modern anthropological perspective it is simply absurd not to recognize that "it takes a village," as they say.
[5] I'd had general anesthesia before on a few occasions, but did not recall this side effect. I think it's a new development for me. It feels terrible.
[6] And as for emergency contraception, it actually only stops ovulation from occurring, so if someone has already ovulated, Plan B will not prevent pregnancy. It's only a useful treatment if someone has sex early enough in their cycle.
[7] Currently there are no federal regulations for misoprostol in the same way as for mifepristone, because mifepristone is only indicated for abortion or miscarriage completion, whereas misoprostol's official use is as an ulcer medication. Its particular effect on the body simply also makes it entirely contraindicated for any pregnancy that is not at full term (for indeed, misoprostol is often used to induce or assist with labor). Thus, while both mifepristone and misoprostol are hard to get one's hands on in abortion-hostile states, in a kinder state like mine I picked up my misoprostol at a Walgreen's, no questions asked.
[8] A Fish Called Wanda (1988).
[9] All NSAIDs are contraindicated during pregnancy.
Thank you — much more than usual — for reading.
Next week I'll be writing a comparably much lighter post about my perspective on spellcraft. After that, there will be a post for Occult-tier subscribers.
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