A couple of weekends ago, my husband and I had dinner with an engaged couple we're just getting to know. (Stay with me here.) He, the fiance, made dinner - a Pioneer Woman recipe for short ribs that I will now most definitely be making, as soon as I figure out which package of beef at the supermarket is "short ribs." (OK, that's a serious tangent.) They are an interesting couple - both very thoughtful and introverted. I initially understood that she is a zealous recent convert to Catholicism, he a somewhat bemused and laid-back Catholic of longer standing. Then she told me that she was happy to hear they would be able to have a wedding Mass, because he is not baptized, and cannot be expected to be so before the wedding. (She was surprisingly un-receptive to my offer that we baptize him on the spot, in his kitchen.)
So I'm really still figuring out where they're coming from, obviously. But she made an interesting comment (among others). She is a very cerebral but I think also quite underconfident sort - bookish to an extreme, perhaps. She said that for a long time (having left the dysfunctional home of her childhood), her dream had been to live in a tiny, sterile, minimalist apartment by herself and read books all day. Then she converted to Catholicism and was persuaded that part of the package is that you have to love people. Having now embraced this perspective, she said that what she is looking forward to in her home is "a joyful chaos."
And my reaction to this was several-fold. First of all, I think the ideal of Catholic home and family could scarcely be expressed better. At minimum, she had described my ideal - the dream for my home and family and adult life I cherished for so many years. Secondly, of course, this is an ideal I had to allow myself to become detached from as I slowly realized (while you all watched) that I will never have children (barring particularly mysterious ways on the part of the divine, which one may never entirely rule out. And I want to be clear that I'm not holding out for a miracle pregnancy. In my life, at least, I think it likelier that at some point my home will shelter an unwed third cousin and her infant, or some such randomness). And with that comes some poignancy: yes, you've got it exactly right. That's what you should want. And what I won't be getting. Third (I will persist with this list format long after it detracts from clarity, rather than enhancing it): I thought about the fact that I've been realizing that the "joyful chaos" may be in its purest form with a houseful of loving children and their parents - but that is not remotely the only form it can take. And it may not be the best form, precisely. The best form may be the loving chaos of the people God put in your life, who quite likely are not children, and may not be related to you at all. Fourth, it occurred to me that there really was not an adequate conversational opening for me to acknowledge that this was a dream that (as they probably know) will not be fufilled in the expected form in our lives, but that there are other ways that dream may take shape, and, indeed, paths outside that dream altogether that may be blessed. Or any of the other ten directions in which I was tempted to take that idea. It was more appropriate to smile, nod vigorously, and let her keep talking. And fifth - in spite of the strong emotion attached to this topic, in spite of the endlessly many thoughts I have attached to it (far more than she has had occasion to entertain, I dare say), in spite of the fact that she (unwittingly) said something hurtful - I could let it go and move on, not with anger, or resentment, or even bitterness, but with a relatively peaceful understanding that there is much here that she may never know, but that it is not my mission always to share my difference with the world (though I should be ready to do so when warranted), though it is my job to think seriously on it and try to understand it for myself.
And for the space of calm inside my head that was required to allowed me to ponder on these ideas until I had time to come to an understanding; for the comparative peace that allowed me not to see what she took for granted as my grievance, but as merely the experience of another - of the other, for her life is separated from mine by a gulf that (if God is merciful to her) she will never see; for the slow formation of a scar that will allow me to walk around with a hurt, but one that I can bear - I have many things to thank. But it would be remiss of me if, near the top of that list, I did not put the depo-provera.
As many of you have let me know in one way or another, I took a fairly JV approach to fertility treatment - only two major surgeries, several doctors, countless blood tests, an HSG (or two?), an SHG, a host of ultrasounds, and a bunch of drugs. (Tamoxifen, HCG, natural progesterone, and lupron, at various times - I never took clomid.) I never did an ultrasound series because I didn't want to explain to my boss why I needed every other morning off for two weeks for something that had no treatment value (only diagnostic - and if they find you're not ovulating due to LUFS, there's no reliable treatment for it anyway). I never did clomid because tamoxifen made me insane, and it was already making the endometriosis worse - after surgery #2. After both surgeries, I had cysts again before I had a regular period again. Obviously, I never got pregnant in that "magican window of fertility" post-surgery. I had weird hormone levels, but correcting them with drugs failed to produce a baby. What the drugs were producing was a rapid acceleration in the endo department.
As I was rounding out my 20s, I was increasingly regularly in pain and had devoted almost seven precious years of my life to fertility treatment, with nothing to show for it but pain, weight gain, two giant scars, episodes of psychotic behavior, a strained marriage, and the increased risk of endometrial cancer due to the drugs...any rational person would want to prolong that for as long as possible, obviously. Not being the same sort of rational person as those who have criticized my treatment decisions, I decided enough was enough. I hadn't taken HCG yet and I had heard it had better than average results with lower than average stimulation of further endometriosis problems, so I promised myself I would do six cycles of HCG shots and celebrate the end of fertility treatment with a ritual nude pagan dance on a mountaintop in the moonlight on my 30th birthday. (Obviously, I already knew the HCG wasn't going to do any good either, but I wanted to cross that one last thing off the list and never look back.)
Of course, my avoidance skills exceed my time management skills, and I didn't start the six months in time, or keep at them consistently. Instead, I spent my 30th birthday in bed with the Nora virus (and an ice cream cake forced upon me by my beloved sister, who has standards). I finished the HCG a few weeks later. And shortly thereafter, I appeared in my RE's office to admit the truth: I was in pain all day, every day for more than two weeks in four. Unlike the demon period cramps I'd had since I was a teenager, which were tamed by Aleve, this did not respond to medication. I simply had to go through life in pain. Because of the endo. That I had exacerbated with medications that were supposed to get me pregnant, and didn't. As it turs out, being in pain all the time will make you tired and unproductive and sad - and I was 30. I was in the process of throwing away my life - the life God gave me - in fruitless pursuit of a life He never promised me. My doctor (who makes up for her defects in the communication department with a generous helping of bluntness that I really appreciate) said something that I think would have most infertile women in tears: "Well, I generally only prescribe depo-provera to women at the point where the endometriosis is unmanageable and they're simply trying to postpone a hysterectomy."
"And you're there."
It's a lot to hear, but when it's something you've known for a long time, it's a blessing to hear. Scripture wisely does not teach that lies will set you free. They don't. Every person who told me that I was "still so young" or "you never know" or they were "praying for my miracle" or "you should see my doctor" - those people weren't helping. This is my cross. It's heavy - some days more than others. By the grace of God, I can carry it. Just don't waste my time by telling me it doesn't exist, OK? So, thanks, Dr. C. And she wrote me out a scrip for depo-provera - PRN - and I took it home and filled it right away. I went in to get the first shot administered by a nurse, but after I saw the method and realized it was the same as for the HCG, I asked my DH to do the next ones (he's really good at giving IM injections. Poor guy). Within 24 hours of getting that shot the pain was gone. Gone. And it has been nineteen months since, and it has not been back (with one exception a week or so ago - coming to that).
I took my last shot a few weeks later than I was supposed to, but generally I was punctual and took them every three months. So the last one "ran out" at the end of April 2013. I told myself I would do a year's worth and see how it went. Unfortunately, I didn't take detailed notes (in fact, not charting was one of the big perks of being on depo), but I can remember it pretty well in general.
For the first month or two, I could sort of tell when my cycle was supposed to be (in large part because I knew what window of time to expect it), but the drug was obviously working on blurring the distinction between menstruating days and all other days. After the first 1-3 months, it had succeeded in obscuring the matter quite thoroughly. Through about month six (end of second dose), I was spotting a little bit more days than I wasn't. In months 7-9, though, that pretty well tapered off, and hasn't really been back - the occasional spot, very rare in months 7-12, and still pretty well these days, when I have stopped taking it altogether.
I should explain that depo is simply high-dose progesterone. The pharmacology side is not my area of expertise, but my understanding is that consistent elevation of the progesterone levels suppresses estrogen levels. This eventually eliminates the fluctuation that leads to a cycle. It also suppresses ovulation (which is triggered by high estrogen). In the short term (say, if you were pregnant the day you got your first shot), it would probably support a pregnancy - higher progesterone levels being beneficial to pregnancy. Over time, however (assuming that while you are taking it, you are not pregnant), it makes the body inhospitable to pregnancy (over and above the suppressing ovulation part), due I think to chemical changes in the endometrium and cervix. Nevertheless, there are women who have gotten pregnant days after their last depo shot, and even while taking the drug. (Spoiler: I am not one of those women.)
TCIE mentioned when I was talking about considering the drug the concern that (due to its pregnancy-inhospitable effects) it is a potential abortifacient, and that therefore I should abstain from conjugal relations the entire time I was on it (it being impossible to abstain during your "fertile phase" when you don't have a cycle). I believe I discussed this with her separately, but in case it is a concern for someone else, I will present my thinking here. First of all, I think we have to distinguish the way we approach contraception as a moral issue from the way we approach abortion as a moral issue. Taking a human life is obviously very serious, but contraception actually tends to involve more hoops because we're talking about avoiding a problem we can't actually see; avoiding eliminating the possibility of something, rather than avoiding a concrete (harmful) action with a specific victim. Therefore, certain symbolic considerations may be relevant in the contraception arena (because the point there is about openness and mentality) that don't make sense in the abortion arena. In other words, it would be inappropriate for me to take actions with the intention of foreclosing new life that seem to have a significant possibility of foreclosing new life - even if they don't turn out to have accomplished that effect (say, if we used a condom but I didn't ovulate that month anyway). This is because the intention of withholding my fertility from my husband (or vice versa) detracts from the self-giving nature of conjugal love. Abortion is a completely different story. The question is, is there a realistic possibility of endangering the life of a particular human being, or not? Attitude is not really important.
As of 2012 when I started taking depo, I had an extremely firmly established track record of not being pregnant, despite considerable energy expended in that direction and significant medical intervention. Less effort expended would obviously decrease the odds (which were looking like zero already, as the medical folks had acknowledged), and taking a drug whose label use is as a contraceptive (and it is generally quite effective) would obviously decrease my chances further. At that point, statistically speaking, it's more likely that my husband would get pregnant than that I would. And the likelihood of pregnancy would (given how depo works) lessen the longer I took it, just as the inhospitability-to-pregnancy factor was increasing. Therefore, there was no reasonable possibility of any in utero life that I would need to avoid harming. There is no moral imperative to avoid killing philosophically imagine-able people; only real ones. Contrarily, there is a real harm to my marriage by deciding to abstain for a year (especially for a reason my husband would rightly recognize as irrational, causing him to wonder what my real motive was). Balance a real harm against an imaginary one, and you get a pretty clear moral imperative.
Two other points need mentioning here. First of all, some bloggers (even some I love dearly) insist on the point about God's power to cause pregnancy apparently despite nature - in other words, long after we've given up. Yes, He can. He isn't bounded by nature. But, by definition, His power to work miraculous pregnancies isn't restricted to people who have ovaries and a uterus. In fact, I believe we're told St. Agatha's breasts were cut off by the Romans as torture, and St. Peter (appearing posthumously from heaven) miraculously regrew them for her, offering a whole new angle on the humanity of St. Peter (and making me like him a lot more). And Sarai, St. Elizabeth, and St. Ann were famously well past the age of any biological possibility of children when they conceived their fairly well-known sons. Mary conceived without the intervention of any human male at all. And that's not even coming to the question of melting rocks, forming people out of dust, raising people from the dead, and, hey, creating an entire universe out of nothing whatsoever. God could make me pregnant tomorrow. Or my husband. Or my dog (spayed). Or my dead grandmother (would be 92 this year). Or my dining room table.
It's probably considered impious to discuss the possibility of miraculously pregnant tables (though it is a very nice table and it would be sad if those genes weren't passed on), because it suggests that God is capricious; but (a) see generally the Old Testamant and (b) if we're talking about power, we need to acknowledge that He can do whatever He wants, not just slightly-miraculous pregnancies for pre-menopausal endometriosis patients. In my view, piety does not consist in stubbornly holding on to the conviction that some day God will perform a (very specific) slightly-miracle for me. Nor in making moral decisions based on the conviction that He will do so at the least convenient possible time. That would be like God sending a "miraculous" earthquake so that Abraham would slip the second after he realized God didn't want him to sacrifice Isaac, thus killing Isaac anway. If those were the sorts of miracles God specialized in, it wouldn't be a good idea to obey Him in the first place.
Second additional consideration - my evaluation of the moral effects of my actions are based on the medical facts of my situation. While some of those are (and always will be) unknown, the not-being-pregnant-ever one is really quite clear. But there are infertile women who aren't in the same boat at all, including some who get pregnant pretty readily. The considerations for those women might fall out quite differently, so I think that would be something to discuss carefully with a doctor. There might well be other ways of ensuring that depo (if necessary for treating endometriosis or another medical condition) had no abortifacient effects - maybe an OPK would help, or ultrasounds, or something like that. I'm not a doctor or a spiritual director; I can only share the considerations I believe apply to my situation.
So back to the effects of the depo. I'm sure there's no surprise in this one: long-term depressed estrogen levels means basically no libido. That's definitely a bummer, but it makes perfectly logical sense with how the drug works, and the side effects - taming the endo - are worth it, in my estimation. But it's something to be prepared for (and I should note here that quite likely everyone's side effects would be a little different). Like so many things related to women and hormone levels, it also causes a risk of bone density loss. My doctor said that since I stopped taking it after just a year, she would not recommend a bone scan for me. I also get regular weight-bearing exercise now and while I was taking it, and I've noticed no ill effects in that area. But I will probably get a bone scan in the next few years anyway, just to be on the safe side. God knows I've taken enough hormone drugs to have every side effect in the book by now.
And then there's a side effect that doesn't make it to the medical literature. Of course they mention that it generally halts your cycle (apparently that's a big selling point with a lot of people), but since it's marketed to the population that would like to be less fertile, they don't pitch this idea in the way that would have turned my head: No menstruation. No charting. No "fertile phase," and no way to sneakily wonder whether you timed relations just right and somehow this time it could really happen after all these years. No idea when your next period is due. No way to be "late." There will be no p+16. No PMS symptoms you could confuse for early pregnancy symptoms. Your habits will melt away, and with them your horrible hope, and with it the anxiety and the disappointment and the living with your heart in a reality that isn't, and never was, and you will slowly, without realizing it, find yourself grounded firmly in this reality. And the pregnant ladies and the single girls clamoring to be pregnant will inspire muscle-pulling eye-rolls and a graceful exit from the conversation (perhaps to fetch another cookie - I've been blaming the weight gain on the depo, but...) - but no tears. They're not you, and theirs is not your reality, and that loss is a tragedy, yes, but the wound will scar over eventually if you stop picking off the scab; slowly but surely, your reality is not jarred loose from its foundations every month, but settles into being itself; and you can let them be themselves, and tolerate their discussion of that for as long as your patience holds (not sharing yours, of course; I'm not talking actual miracles here!), and then walk away and do something else, and it will be OK.
Eighteen months ago I was so consumed with anger I didn't think it would ever simmer down. I had ample justification to be angry and it seemed to me that I would therefore be angry forever. I couldn't imagine the provocations being dulled, or knowing what peace felt like. I had prayed for a baby and then guidance and then a desire for wherever I was supposed to go and then peace until I didn't believe my prayers would ever be answered, for anything (though St. Anthony is very kind and finds me things all the time). And I didn't actually notice the change while it was occuring, but one day, some time late last year, I looked back and realized that things were different. I wasn't never angry (I run hot; it's just how I am), and of course there were still provocations, and I still railed against injustices. But I wasn't angry always. I could read parenting-after-infertility blogs most of the time and think, "That's just her life." I could adjust my expectations (lower - obviously - for everyone) for every blogger who said something she'd never have wanted to read, every "friend" who could use me as a shoulder to cry on but couldn't hear word one about infertility, every pregnancy announcement made in the most self-obsesssed way possible, and just shrug. Eh. I probably have some good ones somewhere. But I've been a cynic as far back as I can remember. I expect little of the world. When did that change? (When I needed so much more than usual, and got so much less, obviously. But interior peace means you need less.) Most days, most things, I can just let it go.
And that really did come from a place of interior peace - I'm not talking about Mother Teresa level serenity here, but the peace of an ordinary, moderately healthy person. I reverted back to an attitude that, now that I'm resting in it, seems eerily familiar - it's my attitude. It's the one that all my life, when I've not been in the throes of some great drama, I've been rooted in. It's simple - I get up, and this is my life; this is my today; this is what I'm happy about and this is what I have to change. Maybe today there are battles. Maybe today there are delicious snacks. Maybe today there is a baby shower - but I will be shopping, or messing about with power tools, because I enjoy those things and I don't enjoy baby showers, and I don't have to go. C'est la vie.
Christian readers (you know, if anyone at all is still reading) will want to attribute this to grace, and I agree wholeheartedly. Grace, as we're taught, perfects nature - sanctity may be available to the mentally ill, but with far greater difficulty than to the healthy, and the sanctity of the mentally ill is in any case not a model the relatively healthy should follow. (Though I wonder whether some of the more tortured members of the IF community aren't, in fact, examples of sanctity under great mental instability - at a level of sanctity, in fact, which far outshines the humdrum piety of stay-at-home mothers who pray with their small children. A topic for another day, perhaps.) I believe this peace is the gift of a loving God, Who allows (but does not will) that I should suffer, but Who wishes me, in all things, to have joy, and love, and peace.
But make no mistake about the details. I have not found a smoother road because I've gone to daily Mass more, for example. Quite the opposite - as the anger diminished, I found I was able to return to daily Mass without much inner conflict. I go maybe 50% of the time now. Once upon a time, it was much more. Nor were these changes brought about by a much-expanded prayer life. My prayer life was not robust when I started down this path, and today I can assure you that it is pathetic. I am not proud of that, of course; I must improve it. But prayer was not the efficient source of these graces; long before any improvement, I had stopped praying for peace, it being a prayer God clearly meant to ignore.
I cannot be certain who is praying for me, but I'd wager the list is shorter now than it was in darker times; my FIL assured me fairly recently that he is praying for me to have a baby (I eventually had to have a talk with him), so that's not it. The greatest prayer warrior I know died in the summer of 2012. (Yes, I know how that works out. That could be it, of course.) I've fallen off the radar a bit, blogging-wise, stopped participating in prayer buddies, and I can't imagine any of my friends (IF, IRL, or not) wants to pray for me anymore (it's only satisfying to pray for a baby for someone who's actually likely to get pregnant, and who can think of anything else to pray for, for an infertile girl?). Actually, one (single) friend told me she was praying fervently for us to adopt. I think God listens to her in spite of Himself (that was right before we heard about two adoption opportunities), but I didn't and don't believe that was the plan for us, though I shall prayerfully consider the options presented to us. (Except any messages I get about adoption opportunities in response to this post. I don't need to mirror your lifestyle any more than you need to mirror mine. Knock it off.)
In short, the desire to attribute any positive changes in my life (assuming you acknowledge they exist) to some pious activity is a mistake. Grace operates through many things, and in this case it is obvious it operated through that much-decried contraceptive shot. What I really needed to re-learn peace and sanity was not to menstruate at all for a year, it seems.
I'm going for a length record here, so let's cover the last two relevant points. First of all, what's the story now that I'm off the depo? Well, that's an interesting one. So you don't have to spend a week scrolling up, remember that my last shot wore off at the end of April 2013. I have gained some weight that has been very difficult to lose, reminding me of my efforts before I got the thyroid under control. That can be a side effect of depo, so I blamed the drug. I decided to stop taking it after a year and see how the endo situation worked out afterward. And I was excited to shed a few pounds without having to resort to extreme measures. So I was frustrated indeed when I had to nearly starve to fit into clothes for our vacation at the end of May. After a whole month off it!
And then (being an idiot), I started thinking about the fact that, hey, maybe I would suddenly get pregnant off the drug - maybe it caused some sort of system reset. And I should expect my period back in, well, May, right? So...what if I was pregnant and didn't know it?! This mania actually took me to Dr. Google (we never learn, do we?), but happily this time the depo was the focus of my search. I found one of the most fascinating online fora I have ever read - thousands of comments over years from women (primarily in the US and UK) who had taken depo, starting from its earliest days, and felt deceived (and in some cases clearly were deceived) about its long-term effects. Several were 1-2 years after their last dose, and had been trying mightily to get pregnant without success. The other women pitched in with a variety of information, success stories, suggestions, and medical information - the lot of it truly fascinating. (I need to find that site again. Somebody needs to write a dissertation on this.) Some of the characters were tragic and some wholly unsympathetic, but as I read through with fascination, I picked up the clear story that resuming a normal cycle could take from six months to two years - and that it may be that sterility would be an effect in some cases. While that should be eye-opening for fertile users, it's not so much an issue for me.
So I stepped off the crazy train and just decided to see where this path leads. So far, no cycle back. No return to normal libido or "fertile CM" and only the odd spot here and there. No cramps, either, except for one odd evening, but that responded to Aleve and was gone by morning. But during that evening, I had an arresting thought: I had been impatient to see the effects wear off, but if this was my cycle returning, then that meant it was returning as it had been before - miserable cramps and all. And what was I going to do now? Go right back on the depo? I'd like to give my body some time off before I do that (and of course I was hoping my cycle would come back pain-free, though I realize that's really unrealistic). But I don't have any other intermediate solutions; it's the depo, or the pain, or the hysterectomy. If I'm lucky, my cycle will stay shut down for many more months. So that's what I'm hoping for now.
Final consideration - what are people supposed to take away from this nonsense? The short story is, I think I should have put my body through less torture before I did this, but perhaps I couldn't have come to the decision any earlier than I did. For a chaste single girl, I certainly think this option is a lesser evil than letting the endo rage through her body, but truly, I don't know enough about all the side effects to say that in every case. I know that in my case, it was worth doing, but I had already accepted that I would never be pregnant. If depo would really lower the odds for someone who still has a possibility, it might not be worth it. Then again, might I have been pregnant if I had used depo to shut down my cycle for a while, rather than pounding it with fertility drugs that made the endo spread? I'll never know. And of course, really long-term use apparently has effects on bone density that could be serious. These are all serious considerations, and anyone at this crossroads will have to ponder them carefully.
More particularly, obviously I cannot recommend depo to an infertile woman merely so she can shut down her cycle, not think about pregnancy for a year, and find a modicum of peace. From a certain (very unusual) point of view, my situation is perhaps enviable, but what with the side effects of the drug, I could never recommend it for such a limited purpose. There may be some holistic alternative that would shut down one's menstrual cycle, but I think even that would be morally questionable if done for the sake of foreclosing fertility. (Which, I hasten to clarify, was never my intent. It turned out to be a great blessing, but it was not what I was after - any more than it will be the goal when I eventually have to have a hysterectomy.) More practically, if your IF is of a different character, and you could realistically get pregnant, you're going to be right back where you started as soon as you go off the drug. Throwing the chart away (or TTA?) would probably be a more effective way to "take a break," though each has benefits and drawbacks. Simply put, I suppose, I stumbled onto a way to take a break from the conception issue without meaning to, and though I am touting it as one of the great blessings of my adult life, I can't actually recommend anyone do what I did for the sake of achieving the outcome I achieved. I'm perverse that way.
Blame it on the drugs.