• leaflet

    . . .a thin triangular flap of a heart valve. . . a small book usually having a paper cover . . . a medical lit-art e-journal from The Permanente Press
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The Persistence of Caroline

Prose, Vol 6: Iss 1

When my best friend Katelyn was five months pregnant, her water broke. I had just seen her a week earlier, wearing the cutest maternity top, and had asked her where she had shopped for maternity clothes. At the time, she was exuberantly beautiful. All seemed well.

We had started the IVF process at the same time. She had her specialists at Stanford who advocated a three-day-old multiple embryo implantation plan, while my specialists at Pacific Fertility Center advocated waiting until the embryo was five days old and having genetic testing. This plan meant that implantation would occur upon the next cycle, and so an extra month’s wait. I was only three months pregnant when Katelyn went into preterm labor.

Her baby Joshua was born, and he was perfect. He was also too small. He lived for only five hours. When I heard the news, I cried and touched my growing belly. I was afraid to call Katelyn to offer my condolences. After all, what was I going to say? My baby was alive and hers was not.

In the end, Joshua’s death was what convinced me to share freely with friends, family, and even patients, about our adventures in infertility. That cone of silence; it was in essence a cone of shame. Even before Katelyn and I had gone through the IVF process, there had been almost two years of trying to conceive. But as close friends as we are, it wasn’t until we had moved to IVF, “the Final Frontier of Fertility.” that I even knew she had been going through the same ordeal.

Statistics say that one in eight women will face issues with infertility, which is pretty close to the same statistical probability of facing breast cancer. Breast cancer has pink ribbons and three-day walks. How could best friends not even once talk to each other about the most stressful and painful issue in their lives for two years?

I had never really given a thought to fertility. Throughout my childhood, the focus was on academics. You had to go to good schools and achieve a successful career. I never received a parental lecture about waiting too long to get married or to have children because, of course, that was just going to happen.

It was an unusual attitude for my parents to take because they too had had many fertility issues. My mother in medical parlance was a G9P2. She had been pregnant nine times but had only two successful live births. She had had seven miscarriages before she was diagnosed with a septate uterus. She had a wall down the middle of her uterus that prevented a baby from growing to full term. She was one of the first women in Hong Kong to have a surgical repair of her uterus and to go on to have two successful pregnancies. Her doctors had advised against having a second child, but she fortunately persisted in having me. I wasn’t born until she was 40, which medically is considered “Advanced Maternal Age”.

My sister had easily gotten pregnant at 38 and then again at 40, so at least genetically there were no reasons to assume I’d have problems at 37. I had gotten pregnant the first month trying with my older daughter Sydney, so it never crossed my mind that it would be so difficult to have a second child. I had never heard of secondary infertility. We had started trying to conceive again when Sydney was one year old. We figured we could deal with an age separation of at least two years: We had it all planned out.

However as months passed, and every month I bled, we kept advancing toward more and more technology. We started keeping charts of monthly cycles, with basal body temperatures. We then moved to ovulation sticks and the glories of timed sex. After six months of feeling like a failure, like half a woman, I was really starting to hate my body. I didn’t dare tell anyone because I felt inadequate. I could not complete a simple biologic function. I could not create life.

Next came the Reproductive Endocrinologists and the blood draws. They found nothing wrong. We already had one healthy child. There was a bit of an attitude, “Sure, you’ll be able to do it again, no problem.” After five intrauterine insemination attempts (of course, failures), we were done. We had reached the “Final Frontier,” IVF. I finally shared my shame with Katelyn expecting judgment, but instead I found a sister in trauma.

When you meet with the IVF specialists, the paperwork is a shock. There is a legal document 30-plus pages long that you must sign. It basically covers the rights and responsibilities of all parties involved. It may include you, your partner (if you have one), the sperm donor (if you need one), the egg donor (if you need one), the surrogate who will carry the embryo (if you need one), and the plan for disposition of any “extra” embryos. The nearest thing I can compare it to is the complexity of the paperwork to buy a house.

After you’ve signed your life away, here comes the financial consultation. IVF is not cheap. It remains an option only for women with extensive resources. My mother, a first-generation Chinese American housewife, and my father, a cook, could never have had me if they had needed IVF.

Next came the drugs for egg harvesting. There were pills and shots and a calendar to follow. I took two pills and four shots every day for nearly two weeks. I was lucky. My friend Julia, who also went through IVF, needed painful intramuscular progesterone shots in the buttocks for five months.

Right at the start of our IVF cycle, Katelyn and I were comparing notes and were ruminating over our chances. She had eight eggs and after fertilization she had six embryos. My doctor harvested nineteen eggs. This was considered exceptionally lucky. Most women produce about 8-10 eggs per enhanced cycle. Some unfortunate women only get 3-4 eggs. After fertilization, I had thirteen embryos.  I think she felt envious but I was worried my “luck” wouldn’t hold.

The odds are never in your favor. Our thirteen embryos dwindled to six by day three. By day five, we only had two. They extracted a few cells for DNA analysis and we received the grim news that only one of the embryos was normal. We only had one shot at implantation and a baby. We never needed the clauses in the legal document concerning what to do with the “extra” embryos.

Since the DNA analysis took extra time, they took our one viable embryo and “froze” her for implantation at the next cycle. There was only a 90% chance she’d survive the freezing and unfreezing. But so far she had survived being sucked up out of my ovary, pierced with a needle to implant a sperm cell, and had several cells removed out of a mere 100. She was proving to be persistent.

Six months after we mourned Katelyn’s Joshua, Caroline was born. She had not made the pregnancy easy. I had gestational diabetes, and needed nonstress testing, and countless numbers of ultrasounds.  When my water broke, she chose to stick her shoulder, not her head, into the birth canal. I was not surprised that she needed to be a c-section delivery. But I did not begrudge her a c-section. After all I had gone through, I was just grateful for her persistence. She had fought hard to come into being.

Upon hearing the news of Caroline’s birth, Katelyn gave me a beautiful handmade baby quilt.

The quilt had been Joshua’s.


At the time I am writing this, Caroline is eighteen months old now, and Katelyn is five months pregnant again. We can only wait to see if there will be a happy ending for both of us.  I can only hope for a future where Caroline and Katelyn’s son will get the chance to play together.