The Miscarriage – From Naivety to Reality: Part 3

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The two weeks following the misoprostol were difficult to say the least.  I smiled less, I cried often.  I did my best to put on a brave face at work, but on the inside I was broken.  My bleeding was a constant reminder of our loss.  I felt empty.  I was empty.

I had gotten up for work on a Friday morning, almost two weeks after the misoprostol, and felt like I was finally seeing a small light at the end of our hellish tunnel.  I had hardly bled at all the last two days, and I finally felt like I was getting back to “normal”.

That afternoon at work, I felt a sudden gush of blood into my underwear.  I had a diva cup inserted, so I was a little taken aback that I had filled all 30 mL of it and then some.  I carefully made my way to the bathroom to empty the cup and then carried on with my day.  I didn’t think much of it, until an hour later I felt another huge gush of blood.  What the hell was going on?!  I thought this nightmare was coming to an end.

I waddled my way to the bathroom and discovered I had filled my diva cup yet again and bled all the way through my panties and leggings.  I embarrassed and scared.

My clothes were too blood-soaked to put back on.  I still had to see another three patients that day, there was no way I was going to sit at my desk with no panties and blood everywhere.  I tried to maintain my calm, as my mind flicked through the various outcomes and consequences of what was happening.  The nurses at the fertility clinic said that if I soaked a pad an hour, for two consecutive hours, then that was cause for concern.  Maybe the bleeding would slow down and everything would be fine.  I didn’t want to jump to conclusions.  I put my diva cup in and found a bag for my bloody clothes.  I talked to my manager and explained the embarrassing situation.  As I explained to her what happened I started crying and she told me to do whatever I had to do.

I grabbed my purse and walked to my car.  The second I stepped foot out the front door, I felt blood running down both of my legs.

Oh my god.  I couldn’t believe that my miscarriage wasn’t over.  It was only getting worse.  I didn’t think that was even possible.

I sat in my car and broke down.  I had no idea what to do.  I couldn’t go anywhere because I had no panties and blood streaming down my legs.  I didn’t know if I should go to the hospital, but even still I had blood leaking down my legs under my dress.  I would have left a trail of blood behind me and who knows how long I would have to wait.

I called one of my co-workers from inside my car.  I don’t even remember what I said to her, I was just crying and hyperventilating.  She got me an extra pad she had in her purse and a garbage bag to sit on.  I called my wife and she talked to me in the kind and calm voice that she uses when I’m freaking out.  I started to breathe and get my head straight again.  I felt physically fine and I knew I could drive home safely.  I just needed some goddamn panties and a pad and then I could figure out what to do next.

I drove the hour from Regina back to Moose Jaw trying to convince myself that everything was going to be okay.  I pulled into my driveway an as soon as I got up out of the car, blood was leaking out from the pad and running down my legs.  I ran inside to my bathroom and took my diva cup out.  I had filled the diva cup again, completely soaked the pad I was sitting on and there was blood everywhere.  I went into full panic mode, sobbing and shaking uncontrollably on the toilet.  I knew I was bleeding too much.

My poor wife started cleaning up around me and asked if we should go to emergency.  I still couldn’t think straight.  Deep down,  I knew I had lost too much blood that afternoon, but I wanted to check with the fertility clinic before I went into emergency.  Being a nurse, I didn’t want to go to emergency without a good reason.  I got into the shower to wash the blood off my legs.

I called the clinic and the nurse confirmed that I should go to emergency.  I heard some worry in her voice as I told her about how much blood I had lost that afternoon.  We gathered our things and headed to the hospital for my first emergency trip ever.

The emergency room was like everything else in Moose Jaw: small and quiet.  I was thankful for that because as we sat there I started to feel dizzy. A nurse took my vital signs before admitting me.  My pulse was 134.

I had never been a patient before.  After being assigned a room in emergency, I sat at the edge of the bed, adjusting to my surroundings.  Somehow, laying down on the stretcher would have been admitting there was really something wrong.  I was feeling better now that we were at the hospital.  My wife and I talked lightheartedly, to distract ourselves.  My bleeding had slowed quite a bit in the last couple of hours, which was encouraging.  I felt a bit silly for even being there.  Maybe I wouldn’t need a D&C after all.

The doctor on call was actually my family doctor.  It was a relief to see a friendly face.  He said that we would do some blood work and a speculum exam and the decide what to do from there.  My blood work was drawn by an awkward lab tech and we continued to wait, listening to the buzz of the emergency department around us.

My doctor came back in to the room a while later for the speculum exam.  Ugh.  I knew it had to be done, but I was not looking forward to it.  I laid back and scooched to the edge of the bed, with a wedge pillow under my butt.  I made a joke about how many people had been up in my private bits lately that I really didn’t care anymore.  But that was a lie.  I did care.  It was invasive and awful.  I hated it.

The doctor saw what he thought could be blood clots or products of pregnancy, but he wasn’t sure.  He wanted to do an ultrasound to confirm what was going on.

I walked down the hall to the ultrasound room.  The tech did an abdominal ultrasound first.  She said I still had a bit of urine in my bladder and that I should empty it in order to do a transvaginal ultrasound.  Oh great.  My favourite.

I went to the bathroom that was attached to the room and peed.  I stood up to wipe and gushed blood all over the floor.  How much blood could I possibly have left in me?!  I tried my best to wipe up the floor.  I told the tech what happened and apologized profusely.  I was overcome with embarrassment.

The transvaginal ultrasound was bloody and awful.  I felt so exposed and there was nothing I could do about my bleeding.  I just laid there and stared at the ceiling wondering what I did to deserve this.  The tech was very kind and said that it wasn’t my fault when I kept apologizing for bleeding everywhere.  She said she couldn’t tell me anything she saw on the screen and I would have to wait for my doctor to tell me the results.

As I walked back to my room, I felt another gush of blood.  That continued for the next couple of hours as we waited for the results to come back.  I finally resigned myself to laying down on the stretcher.  I felt tired and defeated.  I just wanted some answers.  I just wanted this nightmare to be over.

The doctor came back into the room and shut the doors.  He told me that the ultrasound had shown some retained tissues from the pregnancy.  He said that though my condition was not emergent, it was urgent and that I would need a D&C the next day.  My worst fear was coming true.  I immediately asked if I would be under a general anesthetic and he said that likely I would be.  That made me feel marginally better.  I started to cry for the first time since being admitted.  I had done so well putting on a brave face.  But that all came crashing down when I knew that a D&C was inevitable.

Somehow we managed to sleep a little bit that night and then we headed to the hospital bright and early the next day.  After checking in, I put on a hospital gown.  It was then that I really felt like a patient.  I sensed all of my autonomy and confidence slowly drain out.  I suddenly had so much empathy and respect for patients I had looked after in the past.  I never truly realized how powerless and frustrating it was to be a patient, especially in a hospital setting.  In the whirlwind of crap that I was dealing with, I felt a small pang of gratitude to have had that experience.  The nurse in me knew that this experience would probably make me a better nurse down the road.  Maybe it’s strange to have felt that just from the folds of an uncomfortable, snowflake-patterned hospital gown, but that’s what I felt.

As an aside, who decided that snowflakes were a good pattern for like every hospital gown ever?  Ew.

The gynecologist who was going to do my D&C came in to speak with us regarding the surgery.  His smile was nice, but his eyes and body language said that he didn’t really care all that much.  He wanted to do another ultrasound, as I had bled a considerable amount last night, just to make sure the D&C was still necessary.

Sure enough, the abdominal ultrasound showed small patches of white in my uterus, indicating that there were still tissues present.

As I began to ask him questions about the procedure, I quickly discovered that he had no interest in informed consent.  I asked him when my period could be expected to come back and about the risks of the procedure.  He said he didn’t know when my period would come back and that there were no risks to a D&C.  I asked about Asherman’s Syndrome, which is a rare complication leading to infertility, and he just waved his hand at me dismissively at me saying that it was nothing to worry about.  He also said that I could just as easily take another dose of the pill and not have the D&C at all and that it was up to me.  He left the room for a few minutes to let us decide.

Well, great.

For the umpteenth time in this whole process, I was glad to be a nurse.  I was already decently informed of the risks of a general anesthetic and had done my own research on the D&C procedure.  But I kind of wanted to discuss it with a real live doctor who specialized in gynecology to make sure that I was making a good decision.  Apparently that wasn’t going to happen today.  It’s no wonder people regularly turn to “Dr. Google” and message boards on the internet.  If you get stuck with a doctor who doesn’t care about you, unfortunately you don’t have anywhere else to turn.

My wife and I talked about what we were going to do.  I was really scared of the D&C.. Though it was irrational, I kept having horrible thoughts of never waking up from anesthesia.  Any surgery is risky and I wanted to avoid those risks, if possible.  Still, but clearly the pill did not work for me the first time and I really did not want to go through all of that again.  Again, I was stuck choosing the lesser of two evils.

The gynecologist came back into the room and asked if we had decided because the anesthesiologist was on her way and if we weren’t going with the D&C then she wouldn’t bother coming.  His tone made it very clear that we were at the bottom of his priority list.  Apparently the schedule of the anesthesiologist was more important than this critical decision to have surgery or not.  I looked at my wife and then told him that I would have the surgery.

After an hour and a half wait, I was wheeled to the operating room.  The bright white lights and air of sterility greeted me, reminding me of my scrub nurse days.  All of the staff were women, which made me feel slightly more comfortable.  I walked to the operating room table and laid down as the anesthesiologist started asking me questions.  Through a veil of numbness, I felt the hustle and bustle of nurses attaching cardiac and vital signs monitoring to me.  I thought of all the times I had prepped a patient for surgery and realized how nervous they must have been, as I put a blood pressure cuff and a warm blanket over them.

I looked up at the ceiling covered with fluorescent lights, a sight that was becoming all too familiar to me, and the anesthesiologists face came into view.  Her eyes looked kind and I imagined what her face looked like underneath her mask.  She asked me if this was my first baby.  Hearing the word “baby” made me burst into tears.  Since the miscarriage everyone had referred to the “products of pregnancy”, which while medically useful, is a very dehumanizing term.  It was like everyone just wanted to pretend that my baby was never there.

I hurriedly explained through my tears that I really wanted this baby and that I was a nurse and that this was not how I ever imagined things would turn out.  The anesthesiologist wiped tears from my eyes with the flannel blanket and said that everything was going to be okay.  This happens to a lot of women.  You’ll have another baby, she told me.  I felt so ashamed of how my body had failed.

She announced that she was giving me a dose of midazolam, which I was so grateful for.  Everything got fuzzy and I felt wonderful.  All of my worries were suspended temporarily as I unknowingly drifted off…

The next thing I knew, I was flicking my eyes open in the recovery room.  The lights were dim and I felt the pressure of the cuff on my arm, as my nurse took my vital signs.  She said that my wife was waiting for me at the end of the hall.  I was so thankful to have woken up.  I felt relaxed and a little dizzy.

I dozed off and woke up to my wife coming in to the room.  I was so happy to see her face.  She read to me a little bit, as I slowly had some apple juice and the most amazing piece of toast with peanut butter on it.  Seriously, guys.  That toast was out of this world.

I walked slowly to the bathroom for the obligatory pee before I was able to go home.  I got my discharge instructions and felt like a princess as a porter wheeled me down to the front door.  I hoped that all of the kind staff I encountered was some sort of nursing karma for the compassion and care I’ve shown my patients over the years.  Either way, I was grateful to step into the sunshine and go home.

The next two days were full of sleep, tears, Netflix, cuddles and comfort food.  I was anxious about taking too much time off because I wanted to save my sick time for future fertility appointments.  I wish I could have taken more time off to really process what happened to me.

I let life whisk me away and I kind of left my emotional health in the dust.  I’m dealing with it as best I can now, with meditation and exercise.  Everyday is a little bit better, but if I’m being honest with myself I’m far from being in the clear.  I put on a smile because I’m pretty good at faking being happy, but I know deep down I have some healing to do.  I’ve been more gentle and compassionate towards myself than I ever have been in my life, which is an area in which I’ve been wanting to grow for some time.

People have said to me that everything happens for a reason and that this experience will make me a stronger person.  I’ve been told that it will happen when it’s meant to happen.  I’ve been told to focus on the positive.  I’ve been told that everything has a silver lining if you look hard enough.  But you know what?

Fuck that.

There is nothing good about my baby dying.  There is no positive thinking that will take away the pain of losing her.  I did not need this traumatic experience to become a stronger person.  I was already strong to begin with.

-K

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The Miscarriage – From Naivety to Reality: Part 2

After finding out about the miscarriage I sat in the doctor’s office crying, overwhelmed and at a complete loss of what to do.  My initial instinct was to get as far away from any medical technology as possible.  I could not even fathom any type of abortion procedure at that time; it made me sick.  After we had adjusted to our new normal, I realized that I couldn’t wait for the miscarriage to happen naturally.  Being as far along as I was, with my hCG levels as high as they were, it could take weeks for my body to miscarry naturally.  The extra cruelty of a missed miscarriage (as if it could be any more cruel), is that my body thought it was still pregnant.  The pregnancy symptoms I had been experiencing were still in full force.  Morning sickness and exhaustion would be well worth it, if it was for the benefit of my little one growing inside me.  To experience those symptoms knowing that I would never hold my baby was just pure torture.  I had to do something.

After doing some research online and speaking with the nurses at the fertility clinic, we scheduled another ultrasound to be done one week after we had received the terrible news.  If there was no heartbeat and no development at the second ultrasound, we could be sure that the pregnancy was not viable.  As a secondary confirmation, I would also have my hCG levels measured again.  If my hCG had dropped from previous testing then we could be sure of the miscarriage.  There was no way I was ending my pregnancy without full confirmation that it was no longer viable.  I couldn’t live with myself without knowing for sure.

Every time the fertility clinic called to check in, I told them I still felt as pregnant as ever.  I felt so betrayed by my body.  I never had any spotting or bleeding or cramping.  No signs whatsoever of the death that took place.  My baby just slipped quietly away, without me even knowing.

The fertility clinic was such an amazing source of support for me during this time.  Suddenly, the hundreds of dollars of clinic fees seemed totally worth it.  A few days after we found out about the miscarriage I called the nurses to get some more guidance.  I was sitting in my car during my lunch break, as our office walls don’t provide much privacy, and started asking about my options.  I soon broke down into tears.  The nurse was so sweet and understanding.  She listened to me cry and said that it was a terrible thing that was happening to me.  It was the first time someone had said that to me and it felt so validating.  She didn’t try to tell me that everything was okay or that I’d have better luch next time.  It was a terrible thing.

A couple days before the second confirmation ultrasound, I knew I had to figure out what I was going to do if we found out for sure that the pregnancy was not progressing.  We had three options: (1) expectant management (wait and see); (2) medical management with misoprostol to induce abortion; or (3) surgical management with dilation and curettage (D&C).

Each option sounded worst that the last.  I never dreamed that after working so hard to get pregnant, I would have to work even harder to end my pregnancy.

Before I go into how we made our decision, let me say that there is no one-size-fits-all choice for everyone.  Unless there is a medical emergency, there is no “right” answer.  Each option comes with it’s own consequences and each person needs to make a choice that suits them in their circumstances, in conjunction with their health care provider.  I spent hours reading stories about all three options, all with extremely different outcomes.  Reading through the stories of people who have had to deal with miscarriages helped me determine what was important to me, which led me to make the decisions that I did.  My experiences that follow are in no way a substitute for medical advice, nor are they a guide for how every woman should handle a missed miscarriage.  This was just how my story unfolded for me.

Expectant management simply was not an option for me.  I could not imagine weeks of waiting for bleeding to start.  Many women opt for this choice, as they feel it is more natural and doesn’t involve any intervention.  I completely agree and that was my initial reaction to finding out about the miscarriage.  Perhaps if I wasn’t as far along I would have waited.  Based on my hCG levels, it would be weeks before my body figured out that I was no longer pregnant.  The other downside is that there was a risk of infection, as the remaining tissues from the pregnancy would be in my uterus until my body could expel them.  I guess didn’t have the courage to wait it out, and maybe that makes me weak.  I just couldn’t bear it.

The second option of medical management seemed to be the middle ground between an invasive D&C procedure and waiting for the pregnancy to pass naturally.  Using the misoprostol pill, I could have the miscarriage in the comfort of my home (not that there was going to be anything comfortable about it), in my own time and with the support of my wife.  There would have been a day or two of downtime following taking the pill and then we could move on.  The nurses at the fertility clinic said that when the pill works, it works very well for most women.  There is bleeding for 1-2 weeks and then it’s done.  The risks of this option included excessive bleeding, uterine rupture and not fully passing the products of the pregnancy.  If the pill didn’t work, then a D&C would be the next step.

The D&C would have been the fastest way to deal with the miscarriage, but the procedure sounded so awful.  I kept imagining myself, legs wide open on the operating table, vulnerable to the world on the operating table with a doctor digging around in my uterus, scraping out the remains of my pregnancy.  I had horrible visions of only being under conscious sedation (instead of being put totally under) and feeling the pressure and pain of the instrument inside me.  It filled me with such anxiety that it made me cry just to think about it.  I already felt so traumatized by the whole experience, that I wanted to handle the miscarriage quietly, on my own terms.  The risks of a D&C included the usual risks of any surgery (bleeding, infection, anesthetic etc), as well as scarring from the procedure, potentially leading to infertility.  This is known as Asherman’s syndrome, and it is extremely rare, but I didn’t want anything ruining my chances of getting pregnant in the future.

Medical management seemed to be the “best” option for me.

I called the fertility clinic on Friday to request a prescription for misoprostol and a pain killer, to ensure that it was ready for me on Monday after the ultrasound.  If we got the confirmation we were expecting, I couldn’t wait another day for the miscarriage.  I just wanted to move on.  The nurse I spoke to agreed with my decision with gentle encouragement.  The nurses never once told me what to do, but said that whatever I chose would be a good option.  She said that the pill works within a few hours and it was very effective for most women.  I hoped that I fell into that category.

On Monday, our nightmare was confirmed.  My wife and I handled the news in a matter-of-fact way, though our hearts were heavy with sadness.  We were much more prepared for the disappointment.  I don’t think it made anything easier, we just didn’t feel the shock that we had at the last appointment.  We knew the miscarriage had happened, but we wanted confirmation in order to move on.  In addition to the ultrasound showing no progress or heartbeat, my hCG levels had also dropped slightly.  Now we knew for sure.

We went straight to the pharmacy to pick up my prescription.  To make matters worse, the pharmacist could barely look me in the eye when he handed me the misoprostol.  He obviously knew that the medication was for an abortion.  He mumbled something about inserting the pill vaginally and that there would be no side effects because it was a local application.  He didn’t say anything else and awkwardly handed me the bag.  I felt so embarrassed and angry.  I wanted to tell him how much I wanted my baby.  I wanted to scream at him that I never wanted this to happen and that he should act like a professional and give me the information that I needed without judgement.  No side effects?!  How about bleeding excessively or uterine rupture?  How about intense nausea and diarrhea?!  He also told me only to take the T3s if I had pain, as if I was planning on going home and getting high on codeine. I was so upset.  After such a painstaking and devastating decision, to be treated with such disrespect was a slap in the face.

I tried to brush off the negative encounter and hoped that I was maybe just particularly sensitive given my present circumstances.  My wife and I picked up grapefruit juice, a McCain’s chocolate cake and some ice cream.  I knew emotionally eating is really counter-productive.  Given what I was about to go through, I really didn’t care.

At home, I nervously unpackaged the misoprostol and, like a good nurse, carefully read all of the instructions and side effects.  Contrary to what the incompetent pharmacist had said, there were side effects even when the pill was inserted vaginally.  I inserted the 800 mcg dose, which was 4 tablets total.  The tablets were uncoated and awkward to insert.  The medication is actually for stomach ulcers, with an off-label use for inducing abortion early in pregnancy and inducing labour.  The nurse at the fertility clinic told me sometimes it only takes an hour for the pills to work.  I put on a pad and anxiously awaited the effects.  My wife and I got into bed, and started watching Voyager (I may be a bit of a Trekkie) and had some cake.  I was so glad to have her there with me.  I couldn’t imagine going through it alone.

Five hours later I began cramping.  It was worse than any menstrual cramps I have had.  I read that the sensation is very similar to contractions, so I tried to breathe through them, imagining that they were practice for labour later on down the road.  I was glad I had taken a T3 and an ibuprofen earlier.  The cramps were so bad I was just moaning and breathing, lying on my side, hoping they would be over soon.  Then the cramps subsided a bit and I was slammed with a huge wave of nausea.  I jumped out of bed and almost missed the toilet.  I vomited violently five or six times while my wife rubbed my back and held my hair.  No side effects, my ass.

The nausea retreated as quickly as it had come on and I was back in bed dealing with the tail end of my cramps.  The cramps only lasted an hour, thank goodness, but I had not actually bled yet.  It was very late at night, since I was not expecting the misoprostol to take so long to work, and I ended up drifting off to sleep.  In retrospect, this was probably a little bit dangerous as I could have bleed excessively in my sleep.  I woke up in the middle of the night and went to the bathroom.  As soon as I stood up, blood was running down my legs.  I had completely soaked the pad I was wearing and could feel clots and blood passing as I sat on the toilet.

I was both relieved and totally heartbroken.  As I was getting back into bed, I remembered that some women had kept the tissues they passed to bury them.  I felt like I was a terrible mother for not showing more respect for the life inside me.  But I didn’t know what else to do.  I didn’t know what I was supposed to do.

I was so emotionally drained.  I hoped everything would seem better in the morning, but I knew it was probably going to be worse.

I rested for the next two days at home, which I felt guilty about because I needed to save my sick time for the next round of IUI.  But I was exhausted and depressed and still having frequent outbursts of tears.  I was also still bleeding quite a bit and I really didn’t feel like I could deal with that at work.  I watched Netflix and my wife brought me cake when I asked for it and we cuddled.  We did the best we could to grieve and comfort each other.

During those two days, we also received a lot of support from our close friends and family who knew about the pregnancy.  Every text, Facebook message and phone call was so very appreciated.  One of my amazing friends back home sent us a wonderful care package with a vegan cookbook and a kilogram of gummy bears.  You can bet I ate every single one of them in less than a week.  I understand why people want to keep pregnancy and miscarriage private.  At the same time, having all of the support of our friends and family made everything so much more bearable.  Every time someone asked me how I was doing, it allowed me to process and express my grief.  Don’t get me wrong, it hurt like hell.  But I think it was better than hiding all of that hurt in my heart.

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As I said in my last post, the misoprostol did not work for me and I ended up bleeding so much that I soaked through my clothes at work two weeks after taking it.  This resulted in a trip to emergency and a D&C procedure, the details of which will be in my next post.

Despite my initial pangs of regret for telling everyone that we were pregnant, I now am so thankful that we don’t have to hide the pain we are experiencing.  Countless friends and family members have reached out to us, offering condolences, compassion and care packages, for which we are so incredibly grateful.  Knowing that we are not alone has made this dark time in our lives a little bit brighter.  Thank you for reading and for being a part of our journey.

-K

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The Decision – Known Donor versus Anonymous Donor

My head was still spinning from the consultation that we had that morning, as my wife and I settled into bed (where we do most of our important things) and cracked open our respective laptops.  For the next few hours we researched and read and hypothesized and discussed and freaked out (well, I did anyway, thank goodness my other half is always cool as a cucumber) about how we were going to get a baby in my belly.

Now, we didn’t want to ignore the recommendation of our fertility doctor, but we did want to see what other options were out there before deciding to spend $2000 a month on IUI treatments (cha ching!).  Also, being the modern day hippy that I am, conceiving in a sterile clinic environment seemed very…sterile.  Not really a thought that gets my uterus going, ya know?  We had always jokingly tossed around the idea of finding a friend and just getting them to, you know…ahem…and then letting a turkey baster do the rest!  We weren’t really sure about the viability of this option (or why everyone insists on using a turkey baster), given the obvious legal issues, but we still wanted to explore options fully before we committed.

It seemed to us that we had two options to get pregnant: (1) a known sperm donor (and turkey baster); or (2) IUI with an anonymous sperm donor at the clinic.

Now, before we dive into the legalities of known donors and turkey basters (seriously, has anyone ever actually used a turkey baster?!), there is a really important question to be answered: how do you tactfully ask for a dude’s sperm?  Well, if you’re like me, you just have a couple of beers and bring it up jokingly in a conversation with your guy of choice and just see what happens!  That way if things get awkward you can just laugh it off and not make your friendship weird forever.  Chandler and Monica had a slightly different approach to this situation.  Despite my lack of conversational grace, we did receive a couple of offers from male friends who were happy to help us become parents.  This made us really hopeful that we could make this more natural and economical method of baby-making work for us.  That was until we saw the other side of having a known donor.

We started delving more into this topic by simply Googling “known sperm donor” and every variation of that phrase that we could think of.  Surely lots of lesbian couples before us have considered this option and there would be plenty of resources for us to follow in their footsteps, right?

Wrong.

The lack of information out there about known sperm donor law was pretty disappointing.  Actually, the deeper we searched, the less we felt sure of anything regarding both LGBT and fertility law.  Our main concerns were: (1) ensuring equal parental rights for my wife; and (2) ensuring that the known donor could not try to claim parentage in the future.  As we sifted through news stories and blogs, we found quite a few alarming stories of lesbian couples who had their known donor change their mind and try to claim parentage of the child after the birth.  I couldn’t imagine a more devastating situation.  Unfortunately, in most of the circumstances, these couples had not done their due diligence and had a known donor agreement (here is an example contract) in place and also had not consulted a lawyer.  My heart broke for these families who had trusted a friend, only to be betrayed in the worst way.  Clearly, the birth of a child can have a profound and unpredictable impact on everyone involved and not always for the better.

So, as long as we had a known donor contract and a legal consultation, we were good to go, right?

Wrong again.

Apparently, there is very little legal precedent for cases of lesbian couples using known sperm donors in Canada, though there are a few cases that have come up in the States.  That means that even with the legalities in place, it still may be possible for a known donor to try and claim parentage.  Regulations on parentage are by province.  Alberta and BC have made some laws that prevent sperm donors from trying to be parents, but the rest of the country is really falling behind in LGBT parentage legislation (this is a decent article from June 2016 with more details).  Ontario updated legislation (for the first time since 1978!) in November of 2016, to be enforced starting January 1, 2017 that ensures equal parentage rights for LGBTQ2+ and straight couples alike (a quick overview on this law is here).  I guess late progress is better than no progress?  Regardless, we weren’t confident in our rights here in Saskatchewan and didn’t really know where to go to clarify the law.  We did email a fertility lawyer in Regina, but never got a response.

A billion articles and websites later, our eyes slowly began to glaze over and our hearts sank a little as we realized that either way we went, this was not going to be a simple process.  From what we could surmise from the piecemeal information on parental rights for LGBT couples in Canada, it appeared that we would need a known sperm donor contract drawn up with a fertility lawyer.  Following birth, my wife would need to declare parentage either through a legal declaration or a second parent adoption.  Both of these options would come with decent lawyer’s fees, though we weren’t sure how much.  Given the lack of precedent, there was still a slim chance that there could be legal complications down the road.  We really did not want to take that chance, never mind that the lawyers fees could potentially be far more than the price of IUI.

Whew…ya’ll still with me here?

That leaves us with the intrauterine insemination procedure recommended by the fertility clinic.  The pros of this option include: full parental rights (with no chance of the donor changing his mind and trying to claim parental rights of our child in the future) and safe sperm that had been washed of any STIs and genetically tested.   An added bonus of this option was also the opportunity to choose exactly the donor we wanted, from blood type to eye colour to whether or not the donor allowed contact with children in the future.  The cons of this option include: conceiving in a clinic environment, paying approximately $2000 per cycle (cha ching!) and having to do a bunch of travelling and taking time off work for various appointments (which is peanuts in the grand scheme of things, but still not ideal for us).  Overall, this was the most straight forward and legal option.  We seemed to be leaning in this direction, but our only hesitation was the price and inconvenience.  We were hoping that the cost would be a bit lower, or that there may be a home option.  Turns out there is an at-home IUI option (through the Repromed Sperm Bank…more on this later!), but it’s twice as expensive as in-clinic IUI because you have to use two vials of sperm each cycle!  Ain’t nobody got money for that…well, at least we don’t.

Needless to say, we were overwhelmed at the reality of the situation.  The other day, I had a patient ask if I had children and I told him cheerfully that I didn’t have kids yet, but we were planning to have one soon.  He told me that trying was the fun part.  If only he knew.

After watching too many episodes of Friends and eating some pizza in bed, we finally made our decision: we were going to go the IUI route.

This option afforded us the most security and parental rights, which was very important to us.  It was a relief to finally have decided that going through the fertility clinic would be the best option for us.  I think every couple is unique in what is important to them, and for us the biggest deciding factor was guaranteeing our parental rights and ensuring the safety of the sperm sample.  Fortunately for us, we have been saving for a couple of years knowing that we weren’t going to be able to have babies the “old fashioned way”, so the cost is not as big of a burden as it may be for other couples.  That being said, we don’t have an endless supply of cash, so if IUI doesn’t work within a few cycles then we may be back to the drawing board again.

Now on to the next step: picking a sperm donor.

As a side note, I could not imagine navigating this process with anyone other than my lovely wife.  She makes me laugh and reminds me to not take anything in life too seriously.  I’m so lucky that I will get to raise a child with this woman.

-K

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The Consult – Our First Fertility Clinic Visit

 

Who would have thought that not having a penis would be such a hassle?

After a three month wait, my wife and I finally had our first consult at the fertility clinic in early January.  We were so excited to finally get this process underway!  I could barely sleep the night before and my mind was racing with questions.  Are my hormones okay?  Are my fallopian tubes blocked?  Are we going to need to sell all of our earthly possessions to pay for treatment?  Wouldn’t it just be easier to have a one night stand with a random guy at a bar?

My wife didn’t seem too keen on that last option, so the morning of our appointment we jumped in the car and drove 2 hours to the clinic.  We checked in and filled out the standard paperwork and then…I had my weight taken.  Ugh.  All of a sudden, every single delicious Christmas cookie and beach cocktail from our honeymoon was staring me straight in the face!  Seeing that number on the scale was the last thing I needed that day.  How could I have let this happen!?

I’d like to say that my following thought pattern was one of body positivity, full of heart warming thoughts about how strong and wonderful my body was, but that would be a lie.  My brain was a familiar jumble of negativity and put-downs, that never really got me anywhere and made me feel like I should just curl up into a ball with my heated blanket and eat a bowl of Chicago mix.  I have struggled with my weight for most of my life and hating my body was a familiar feeling.  Strangely, so was hating myself for hating my body.  I think that is the part that bothers me most because my body is so capable, and yet I can’t help but berate myself for not looking like the cover of a Cosmo.  I am capable of breathing and walking and yoga and weight lifting and hugging and healing and, maybe one day, creating a human being.  So why do I curse my curves?  Why do I lament my waistline?  I am so much more than that, and in spite of my imperfections I can do amazing things!  And yet standing on that scale, it was so easy to forget all of that and just simply hate my body.

Shaking off my insecurities and trying to focus on the appointment ahead, I went back to the waiting room to meet my wife.  I distracted myself from my mini-breakdown with some pamphlets and started to feel my excitement growing as we were called into the office.  Okay guys, this is it!  The appointment we’ve all been waiting for!!!

It was actually pretty standard.

The soft-spoken doctor had a very calming presence (thank goodness) and introduced herself and the specialties of the clinic.  She went through a basic health history with both of us and launched into the various fertility options.  Given our relatively straightforward situation of being in a same-sex relationship (in the grand scheme of fertility issues), she recommended intrauterine insemination, or IUI.  Basically, we would select a donor from an online catalogue, have it shipped to the clinic and at the next appointment it would be inserted into my uterus with a cannula (small tube).  Easy peasy!  Well, not actually, but I definitely was not fully processing the situation at this point…more on this later!  My blood work looked great, so next up was to check my fallopian tubes and make sure everything down there was in tip-top shape.  I was directed to a change room to undress from the waist down for a procedure called a sonohysterogram.  Say that five times fast.

I always forget how vulnerable it is being a patient.  As a nurse, it’s part of my job to ask a patient to undress for an assessment or expose a private part of their body.  It’s definitely a reality check when another health care professional asks you to take your clothes off, hoist your feet into some stirrups and open your legs for everyone to see, under the blazing fluorescent office lights.  Of course, I realize that this doctor has probably seen a million vaginas that day, and mine isn’t anything to write home about.  As I’m casually laying back on the exam table, the lovely assistant is striking up a conversation to make everything less awkward.  The doctor gels up the speculum and inserts it into my vagina, giving it a few clicks until I feel some pressure.  Definitely my favourite part of any doctors appointment!  She then warns me that I will feel a little bit of cramping as she injects some saline into my uterus.  Normally she has patients take some ibuprofen a couple hours before, but apparently I looked tough.  I felt some pressure in my uterus, which very quickly turned into a painful cramp just like Aunt Flo brings once a month.  Deep breathing, I turned my attention to the ultrasound screen and tried to distract myself.

Next up was the very intrusive transvaginal ultrasound, which is basically a big ultrasound wand that goes in…you guessed it…your vagina!  It was cold and covered in gooey gel, so thank goodness it only took her a few minutes to snap some pics of my bits.  She said everything looked great and there was no blockages.  What a relief!  I hustled out of there to the bathroom to change, hoping I didn’t flash anyone from under my paper gown wrap on the way out or leak leftover saline down my leg.  Feeling much more comfortable in my clothes, I rejoined my wife in the waiting room and headed out for some Indian food.  Nothing like a good transvaginal ultrasound to really give you a hankering for some curry.

All in all, it was a good clinic experience.  A little nerve wracking at times, simply because of my own anxieties and insecurities, but I was very impressed with the professionalism and courtesy of all of the staff.  As we drove the two hours back home, I alternated between processing the reality of the appointment and napping (because of the emotional fatigue of processing the reality of the appointment).  Okay, so we have to pick out a sperm donor, taking into account my blood type and my CMV status, which means I’ll need to get my blood work done to get my CMV status and then we need to figure out some criteria for picking a donor and pick which donor bank we want to use and I wonder if we get to see their pictures and wait…how much did she say a vial of sperm was?  Oh right…eight hundred dollars.  Each.  Not including shipping.  And of course there is the clinic fee and the admin fee and the storage fee and the fee fee.  Not to mention getting time off of work and driving to Saskatoon once a month and potentially forever if I’m really secretly infertile and holycrapohmygodwhatishappening.

That guy at the bar was starting to look pretty good.

-K

P.S.- Mad photo cred to my wife. xo

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