Issue 24 / Winter 2021 / Special Issue: Pleasure
In the summer of my thirty-first year, I decided it was time to become pregnant. It was a decision my husband and I had anticipated for months, years, really, but it was not made until that summer. We had met in the fall of my twenty-fifth year, an age that may seem early to some but felt desperately late to me—me who had seen so many friends meet their future spouses in middle school, high school, freshman year of college. I was in my last year of medical school, he in his last of residency. Our relationship started out casual, but five months later when I matched to an east-coast residency, he said he would move there with me. We were no longer casual. We spent my first year of training together, then he moved back home for fellowship, and we passed three years thousands of miles apart, lucky if we met once a month.
In the summer of my twenty-ninth year, we got married. This decision, too, was a long time coming, had been forming since that first night when we sat across from each other and ate pasta, him in a black shirt splattered with tiny red flowers, me in a sleeveless navy top. That night, when he told me that going to India made him wonder how his ancestors had lived, I thought, I could talk to this man all my life. This man could be my husband one day. And so, he became my husband, in the sort of Big Fat Indian Wedding you might expect, though ours was devoid of any animals. We didn’t have an elephant, not even a horse. Instead, he and his sister perched in a vintage car and led a slow procession towards the hotel, where I was secreted away in a holding room wearing a grass green silk sari brocaded in so much golden thread that the rosy pink of the border was virtually obscured. The ceremony was traditional and elaborate, incorporating the swing ceremony, the placement of a child on the bride’s lap to represent future offspring, the small ritual fire, the knotting of the sacred yellow marriage necklace. A few troubles came later in the day, when the electricity in the hotel suddenly cut out, stranding my sweet mother-in-law in an elevator with the DJ’s young assistant, and later still, when an errant tea light lit a floral arrangement on fire at the reception. (Not to worry: the electricity flickered back after not too long, and the fire was dispatched by a bevy of uncles who ran towards it, shucking their suit jackets to beat at the flames.) That night, I gave an impromptu speech, ruminating on my curious lack of tears during the proposal, declaring that it must have been because our relationship made me feel utterly secure, that nothing would go wrong, that even if it did, we would face it together, and that would make it okay. Ironically, artfully, I burst into tears as I spoke.
We spent the first twelve months of our marriage apart. That year was a blockbuster one for weddings. All told, we attended ten. It grew increasingly difficult to see one another for less than forty-eight hours while we watched other couples get married, couples who got to go home together on Sunday night while we retreated to our respective airport gates, our respective homes in our respective cities. By the time I decided that it was time to get pregnant, I had waited a long time, for a lot of things. Waited to find the right man. Waited to be reunited with my husband. Waited to establish my career. Waited and waited and waited. In that first year after our wedding, I lost track of the number of couples that got married after us and had babies before our first anniversary. The rapidity of their procreation stunned and frightened me. Every new baby announcement triggered a little wave of panic laced with envy and anger. These other women marched through life’s milestones so quickly, with such ease, while I was waiting, waiting, always waiting.
As I sat in the gynecologist’s office that sunny day, I was ready for it to be my time. I had taken all the necessary steps: found a physician I liked, performed bloodwork to make sure my hormones and genes were in order, laid with my feet in stirrups while my doctor wrestled an IUD out of my viciously cramping uterus. I had done it all. I was ready. My friendly gyn told me to hold off on trying to conceive for a month, to allow my uterine lining a chance to plump up after years of austerity. “It’s just voodoo,” she told me, but she dispensed this advice nevertheless. An in-office ultrasound appeared to indicate that I was ovulating right that moment. She smiled at me in my pink hospital gown and crinkly paper blanket. “In a month, you could be pregnant!” I felt confident that she was right. After all, two of my girlfriends from college, women who had met their husbands as teenagers, had recently gotten pregnant in their first month of trying. Why not me too?
The first trouble began that weekend, when I started bleeding ahead of schedule. The timing was all wrong. The doctor had told us to wait a month, and now I felt I had to wait another cycle for my endometrium to wax cushioned and rich. We were already behind. To make matters worse, the next period didn’t come for a full five weeks. I was on tenterhooks those seven days between weeks four and five, waiting and wondering why things seemed to be so off. I sent a message to my doctor. Her response came quickly: Not to worry, she said. Just try. Every day or every other day mid-cycle.
So, we tried. And tried. And tried. As the months rolled by, I accumulated various techniques and doodads to track my cycle, to pinpoint my “fertile window,” to control every variable I could. First it was an app on my phone, which predicted ovulation. Then it was basal body temperature, a daily routine with draconian rules. Every morning after my alarm went off, I stretched an arm to open my nightstand’s top drawer and fish out a thermometer. Then, still supine, I switched on the thermometer, inserted it under my tongue, and waited for the electronic beeping to tell me how warm I was. There are many rules for BBT. You must get at least three to four hours of uninterrupted sleep beforehand. It’s best to check at the same time every morning. You mustn’t drink water or consume anything else in the hours before checking, lest it artificially lower your temperature. Most importantly, you must check it immediately upon awakening, and you must not move before doing so. One movement, even sitting up for a second, can spike your temperature, causing confusion. Your BBT is lower in the first half of your cycle, dips slightly before ovulation, then shoots up and stays that way after ovulation. Once your period starts, the temperature dips again until you ovulate. On and on until you get pregnant, at which point your temperature should stay elevated throughout the pregnancy. I charted my BBT religiously, only to learn that every month, like clockwork, it was an exquisite indicator of the start of a period. Another month of trying with nothing to show for it. Another month older. Another month behind all those other women whose wombs bloomed effortlessly with fruit.
My sister, my mother, my mother-in-law, all of them had tried to conceive younger than me. All of them couldn’t remember how long it took, which meant that it did not take long. My mother-in-law told me to be patient, to try for a year then seek medical attention. My mother’s advice came before my wedding, in a hastily chanted refrain of marriage tips, the way her advice has always been dispensed. Don’t try to conceive at twilight or daybreak, she’d say. If you do, the child will be born “neither here nor there” (her euphemism for ambiguous genitalia). She encouraged me to start trying right after the wedding. If you have the baby before you’re living with him again, I’ll come stay with you to help. I had laughed her off. We hadn’t lived together for years. Did we really want to start our married life off with a baby in tow? My sister was the most sympathetic, offering salves of “that really sucks” and “I’m sorry.” She sprinkled her comfort with exhortations to go see my doctor, do some testing, try to figure out what was going on. Later, she would turn to God. Maybe you guys should go to the temple more, she said with a shrug. Maybe that will help.
One friend, mother to a gorgeous child that resembled a Gerber baby, told me that I simply had to get the digital ovulation test with the smiley face. It was the best. Up till then, I had been using a cheaper version, purchased online in bulk. The little test strips were difficult to read, but they did seem to indicate I was ovulating. I thanked her for the advice but decided to wait a month or two before buying the pricey digital test. More months came and went, and my uterus remained vacant. I sprang for the test with the emoji.
Like the cheap test strips, like my basal body temperature, the digital ovulation test told me that I was ovulating: around the same time each month, roughly two weeks before the next cycle. Yet despite our dedicated efforts, my period came with inexorable regularity. Every month, the start of a new period propelled me into darker and darker moods that lasted a day, then two days, then a week, then longer. I found myself engaging in the familiar thought patterns from my early twenties, when my obsession was not getting pregnant but finding a boyfriend. It was not that I lacked self-confidence or needed external validation. I was just tired of being so far behind. Most of my friends were paired off by that age. For many, their first boyfriend was their only boyfriend, who then became their husband, with whom they now have children. I spent an embarrassing amount of time brooding over my inability to find a man, asking myself what these women had that I didn’t. I used to think that I must not be pretty enough, must be too smart and too unafraid to show it, and too serious to boot.
Once I released my anxieties, I finally began meeting men I liked who liked me back. Now that I’m with my husband, I look back on that wasted time and wish I could tell myself to relax. I suppose I should heed that advice now, but I am incapable of this. One of my best friends, who conceived her baby so quickly that she wasn’t sure she was ready yet, told me that I simply had to find a way to be less anxious. “What’s going on in my head has a big impact on what’s going on down there,” she told me. “I bet if you’re so stressed about getting pregnant, your body isn’t allowing it to happen.”
I knew her advice was coming from a place of love, but I found it infuriating. Not only should a woman eat healthy, exercise, take vitamins, avoid certain medications, stop drinking, reduce caffeine, check her temperature every morning, and pee into a cup to figure out when her ovaries are about to let loose a ripe egg, but she must do all of this while remaining calm and happy. As a society we ask women to control their emotions in dozens of unreasonable ways, but the expectations around conception and pregnancy and childbirth seem the most ridiculous. In delivery rooms, women are advised not to scream during labor because screaming distracts from pushing. New mothers should glow with unfettered happiness when really, they are exhausted and scared and their babies won’t stop crying and they have no idea if they are breastfeeding correctly. And now, before I was even an expectant mother, I was advised to calm down because my stress was probably the reason why I hadn’t conceived.
In those first months, I took up puritanical habits. No alcohol after mid-cycle. No ibuprofen, since NSAIDs could harm fetal kidneys. No retinoic acid for my nightly skincare routine since it could cause horrific birth defects. I spent many a social event discreetly avoiding alcohol just in case I might be pregnant. You never know, I told myself. But as period after period came and went, I loosened my regulations. I thought of all the women I saw in my clinic who didn’t learn they were pregnant until months in, all the teenage mothers on television who surely drank until they realized, to their horror, that they were expecting. I thought of the fact that prior to a missed period, a fetus was really an undifferentiated ball of cells floating through the Fallopian tubes. So I drank a little. I took ibuprofen for a nasty headache. I risked Zika to lay on a beach in Mexico.
The months wore on and by the winter of my thirty-first year, I found myself flat on my back for a hysterosalpingogram. The procedure had been ordered by my gynecologist after I tearfully told her that I couldn’t shake the feeling that something wasn’t right. I knew the contours of the test from medical school: a catheter is inserted via the vagina through the cervix and into the uterus. Dye squirts through the catheter, filling the uterine cavity and Fallopian tubes. An x-ray captures the shape the dye takes on, an anatomical Rorschach test. A misshapen uterus could make pregnancy difficult or impossible, could explain my plight. It was unlikely, but worth ruling out. Besides, my physician offered that for some women, the test seemed to flush out the metaphorical cobwebs, and they got pregnant in the very next cycle.
By the time I arrived at the HSG, I had become steadily more incensed at the unfairness of my predicament. The imaging study cost hundreds of dollars. Testing the quality of my husband’s semen cost hundreds more. Meanwhile, I was seeing patients in my clinic whose mothers gave birth to surprise babies, whose mothers took Plan B yet gave birth months later. These women got pregnant for free, without even wanting it. I wanted it desperately and had to pay to find out if we were even equipped. As I sat in the radiology room in a thin cotton gown, my emotional bandwidth narrowed to one tense line. The technicians asked if I wanted an aromatherapy sticker to calm me. I opted for orange instead of the more popular lavender. I lay down on the steel table, the scent of citrus wafting into my nostrils, wiggled my body down to the edge, and waited, trying to remain calm and follow the commandment to “just breathe.”
I breathed and breathed through a few minutes of impressive discomfort. As I felt but could not discern the manipulations occurring within me, tears began silently dripping from the corners of my eyes. The radiologist paused his machinations and looked up. My cervix was oriented anteriorly, he said, angling his fingers toward the ceiling. They were trying to bring it down so that they could insert the catheter. He went back to work. I envisioned what he saw: a pair of steel tongs clamping around my bubblegum pink cervix, extruding small rivulets of blood as it was wrested into position, and then the os, the passageway to my womb, finally becoming visible. Then began the work of introducing the catheter, but my os was shut tight, so much so that even a minuscule catheter could not pass through. The radiologist stopped again, removed the instruments, shed his gloves, and told me that he could go no further. I would have to come back the following month, when my gynecologist could pre-dilate my cervical opening. He reassured me that this sort of thing was not uncommon for nulliparous women like myself. I thanked him for his time and kindness, shook his hand, then shuffled into the attached restroom to pull on my clothing. As I wiped the betadine from my perineum, I wept, trying to sob as quietly as possible. I did not want the kindhearted technicians to hear me. I did not want their sympathy, which felt too much like pity. I wanted only to stop feeling this way, to not have to go through all of this for something that came so easily to so many others.
A week and a half later, I turned thirty-two. The winter of my thirty-second year. The winter of my discontent. It had been eight long months of trying. Eight months of cautious hope followed by crushing disappointment. Eight months of fighting to control my emotions. Eight months of trying to impose rational thinking but being wholly incapable of doing so. Some women whose bodies do not conform to societal expectations transform themselves into activists. I cannot do this. This is not that. This isn’t an impassioned manifesto that childbearing does not matter, that pregnancy is an imposition on the female body. This is me sobbing in the car after Pilates because my legs wobbled frightfully during class. Sobbing in the driveway after yet another doctor’s visit. Sobbing in a sterile bathroom after yet another procedure. This is me crying because I can’t get my body to do this thing it should be able to do.
I returned a month later to try the HSG again. My husband accompanied me this time, holding my hand and averting his eyes at the right moments. Flat on my back, legs splayed out, catheter wedged in place, I answered the radiologist’s tentative questions with a growing realization that just as I had intuited, something was, indeed, not right. “Now remind me your history…any endometriosis? Fibroids? D&Cs?” No, I told him, no, and no again. I had no untoward gynecological history, had never had an STI, never gotten pregnant then decided not to be. I had always been eminently responsible, my eyes fixed on the future. Once the catheter was out and I was upright, the radiologist explained. There was trouble filling my uterus, and one of my tubes appeared to be blocked, signs that pointed to uterine scars. One could get this from endometriosis, or infections, or abortions. The last possible cause, though rare, was an IUD. He saw my face fall. I know it’s disappointing, he told me, but now we know, and we can do something. He told me it would be okay. He called me Doctor.
The next several months were a blur. I had another pelvic Rorschach test, this one using water instead of dye, ultrasound instead of x-ray. The radiologist, a woman this time, coached me like an aerobics instructor: Breathe in, breathe out, slower, not too fast, stronger. It will hurt but you can stand it. If you think this hurts, you better be ready for childbirth. When her catheter punched past my cervix, wave upon wave of pain passed through my body. I covered my eyes with one hand and wept openly, mouth widening in unladylike fashion as my lips curled and I fought to “breathe, breathe, breathe.” Afterward, she went over the results, pointing out some diagonal lines that flashed in and out of view as the video looped. The lines, she posited, were scars. There had probably been more lines, she told me, down at the bottom of my womb near the cervix, but the catheter must have broken them up. I remembered those waves of pain from before. So, there we have it, she said. You have scars in your uterus. Now go see the specialist and she’ll talk to you about what can be done. I could tell that the appointment was winding down, but a question tumbled out of me unbidden.
“I know you’re probably not the best person to ask, but—have you seen this before? Why does it happen? I mean—why did this happen to me?” My voice cracked at the end. The radiologist shrugged. Probably the IUD, she told me. Before exiting the procedure room, she exhorted me to keep my spirits up. In times of famine or stress, women aren’t supposed to have babies, she told me. Our bodies can sense how we’re feeling and if we’re not feeling good, they won’t let us conceive. You have to be having fun, she finished. I fought the urge to point out that women get pregnant during wars, women get pregnant after rape, women get pregnant who never dreamed of having a child. Besides, the ultrasound had just shown that my mood was not the problem here.
I saw the infertility specialist next, a petite blonde woman with big eyes and an energetic mien. She, too suspected scars, but said the only way to know for sure was to conduct a hysteroscopy and a laparoscopy, Greek and Latin polysyllables standing in for the cameras that would invade my uterus, my abdominal cavity. The surgery was tentatively set for the following month, then delayed another month because of the pandemic. Finally, on a still-dark morning in late spring, my husband drove me to the hospital where I checked in, undressed, donned an open-backed hospital gown. My anxieties about surgery—the physical vulnerability of it, the nudity, the literal exposure of my tender insides to the cold outside world—quickly dissolved as the first anesthetic gently coursed through my veins.
When I awoke in the recovery area, my cheerful infertility specialist told me the good news—no scars after all! My womb was free and clear, though my right Fallopian tube had been blocked by a strategically placed endometrial polyp, then remained mysteriously clogged after the polyp was pulverized. She handed me a stack of images, four photos to a page like a printed slide deck, glossy as a magazine. There was my uterus, glistening and pink and healthy-looking. There was the tiny polyp that had caused such outsize grief, and then there it wasn’t, post-pulverizing. There was the blue dye exiting my patent left tube. Then there was my right tube, its tentacular fimbriae unsullied. To my relief, the next page revealed feathery blue tendrils emitting from the right tube. My doctor said a mucus plug must have caused the occlusion. The results of the surgery, though satisfactory, were anticlimactic. Where were the scars I had been promised? Where was proof of the pain I had endured? Where was the reason that we had tried and failed to conceive for twelve long months?
Following a weekend of bloating and tenderness and discomfort like I had never experienced before, I visited my specialist for a follow-up. I expected a clean bill of health, a dictate to go forth and procreate. Instead I received some cold hard facts. It was good that I had no scars, because getting pregnant with a pockmarked uterus, even after surgical repair, would have been near-impossible. The bad news was that I had spent one full year trying unsuccessfully to conceive, which meant my chances at success with traditional means had plummeted from eighteen percent to one. I was offered a solution: intrauterine insemination. By sidling a catheter past my cervix, the procedure would help the sperm get where they needed to be. I agreed to move forward, listened attentively, then drove home and cried noisily in my driveway. The summer of my thirty-second year was thus spent in ultrasounds and inseminations, bloodwork and bated breath. Three months passed. Three periods came. We decided to go for IVF, which is where we are now, in the fall of my thirty-second year. I am gritting my teeth through every moment, every needle prick for bloodwork, every injection, every pelvic ultrasound. I hate enduring this. I hate my body for doing this to me.
Over the summer, I began seeing a therapist. She told me to stay present-focused. She said I was doing my best. She asked what this process would look like if I forgave myself for being imperfect. I told her I could not imagine such a thing. I told her I don’t know how to stop being angry that this happened to me.
In the spring of my thirty-second year, one of my closest friends made her pregnancy public. She and I had begun trying to conceive at the same time the previous summer. In those first months, we talked about it constantly, exchanging anxieties and encouragement and tips. Unlike me, she began with a reasonable fear of infertility, given her history of endometriosis. Years before, I had accompanied her when errant chunks of endometrial tissue, growing like so many barnacles outside of her uterus, sent her crying to an emergency room. I had worried over her subsequent surgery and sympathized with her concern that it may have rendered her unable to conceive. Somehow, as the months wore on, my anxiety rose while hers seemed to decline. Ultimately, a few weeks before I turned thirty-two, she had texted me, tentatively, that she had taken a pregnancy test, and it was positive. She was scared, she told me, that something may go wrong, but she was happy. She hoped her joy wouldn’t hurt me. I assured her that it wouldn’t, that I was happy for her. I didn’t realize that I was lying. It’s been months since we’ve talked the way we used to. Thinking about her only throws into sharp relief all the things I am lacking. She gave birth in the fall of my thirty-second year. I sent her baby a Parks and Recreation-themed onesie. We still don’t really talk. My inability to house a viable embryo has taken so much from me, and it seems it has taken this friendship, too.
Living in the land of infertility has transformed me into a version of myself that shames me. I snap at my husband. I am irritable with my sister and parents. I fume silently when my patients’ parents talk casually about unexpected pregnancies. I unfollow friends when they document their unborn children’s tastefully decorated nurseries on social media. I want to stop behaving this way, to stop thinking these thoughts, to stop being this sort of person, but I cannot. Add it to the list of things I am unable to do.
I have no pithy lesson to impart here, no bow to tie around my angst to transform it into a bouquet of wisdom. I try not to think about my infertility every day, though when I do, when I ask myself what I did to deserve this, when I wonder why every step of trying to become a mother has been so hard, I remember what my husband says: “You didn’t do anything. It’s just our lot.” I can rage and weep and stomp about in my grief for as long as I can muster the energy, but no amount of emotional grandstanding will alter the shape of my problem, and so I must accept my fate. Maybe this IVF will work. Maybe my ovaries will produce plentiful euploid eggs. Maybe we will find ourselves rich with multiple healthy embryos. Maybe I will finally, finally, finally see a positive pregnancy test in the winter of my thirty-third year. Maybe some of those things will happen. Maybe none. I can do nothing but wait and see what my body can do.
Dr. Chaya Nautiyal Murali is a pediatric geneticist and Pushcart prize-nominated personal essayist living in Houston, TX. Her work, which centers on themes of family, identity, and inheritance, has been published in Aster(ix), Barely South Review, Entropy, and elsewhere. In 2018, she had the honor of attending the Bread Loaf Writer’s Conference as a general contributor in nonfiction. Chaya can be found tweeting @ChayaSays and occasionally musing about food and culture on Instagram @AkkasHouse. She is currently at work on her first collection of essays.