Saturday, January 31, 2009

Under 40, but you should see my ovaries!

After much thought, I'm joining an IVF support group. I've been feeling funked out lately and I can't seem to shake it. Last night I went to bed at 7. Not good. Not good at all.

It's not even a support group per se that I'm after. But I'm starting to feel isolated. The longer this infertility madness goes on the harder it is for me to socialize with my old friends, who are all either procreating or not trying yet and either way just do not understand the depths of our longing/obsession/sadness. Family too is difficult and are prone to try to tell us how they understand (when they clearly don't) or to offer well-intentioned but misplaced advice.

What I would love to find is more of a social group that would fit the situation we find ourselves in: an infertile softball league or an infertiles dinner group. It would be lovely to have a group of women in real life who get it. Not that we'd even have to talk about infertility all that much but just that we'd know that the others knew and understood...

Since I cannot find such a thing, I decided to join a support group. Surprisingly, it was tough to find a general IVF infertility group in NYC. I found adoption groups and donor egg groups, but not general ones addressing the suckiness of IVF and nothing for women who've been through recurrent pregnancy loss.

The closest I could find was a general IVF group for women over 40. When I called the social worker, she said she makes no exceptions - and "given you just turned 37, I don't think this group would meet your needs."

I asked her to let me describe my situation in a couple of sentences and she could decide if it might be a good fit. She ended up saying "Oh, my!" and asked me to come in for a consultation.

At the end of the meeting she said, "I think you would be perfect for this group!" What I wanted to hear, I guess, but hmmm....a bit of a therapeutic backhanded compliment, no?


Wednesday, January 28, 2009

R's baby is here at 33 weeks!

I wanted to share that my friend R. went into labor Tuesday night and delivered her baby girl today at 2:55 pm. Today marked exactly 33 weeks (she made it five weeks from when she first went into the hospital. Pretty good!).

Her little girl weighs 5 lbs., 4 oz., and she scored an Apgar of 8 and then 9 one minute later.

Baby's doing great in the NICU, breathing on her own. R. is very tired, but very happy.

And I am a thrilled and proud new godmother : )


On to co-culture and IVF #4

Saw the RE yesterday. He did an ultrasound and bloodwork and said to expect my period in the next day or two.

And although I tested negative for ovulation, my period came today. Thankfully. I have a call in to the co-culture coordinator to see if I can get on the list to be seen for the biopsy later this month, with stims starting toward the end of Feb.

I laughed at myself a little this morning. I need to learn some patience! One more day and my period would have come all on its own (later than it's ever come in my entire life, even on lupron, but still). It is a challenge not to get completely wrapped up in my sense of urgency about babymaking. But I need to take a breath and somehow find a way to keep perspective.


Sunday, January 25, 2009

Leaving the door open + an update

Thank you for all of your thoughts on deciding between career paths while living with the unknown of whether we will ever be parents. I still don't have any answers but your words of wisdom motivated me to write and submit a grant this week that would fund a research fellowship, should I decide to go that route. So thank you. Very very much. Now if I could just access that inner intuitive voice that would help me know which direction to take, I'd be all set! When I tune in to my deepest desires, all I hear is I want a baby! Which is obscuring everything else. I will keep trying to gain clarity, but at least with this grant I'm leaving the door open for either path for a while longer.

I had to come in to the hospital today to see an inpatient on the same floor as the IVF suite. As I was leaving, a woman and her husband and child got on the elevator. She was carrying a photo of two beautiful blastocysts, which I knew had just been transferred (transfers occur in the late afternoon) inside of her. Seeing her, and the photo, I felt such yearning inside. Being at the point of transfer (of blastocysts!) feels pretty distant from where I'm at right now. I felt sad, and so far from having a child. Then as I stood in the elevator with this family I remembered how Will and I had gone out with a bunch of my school friends to an improv comedy show last night. It was great to socialize, to access the lighter side of things, to remember to keep living and laughing through all this. By the time the doors opened on the first floor, I was able to brush myself off and move forward with the rest of the day.

On another topic, I'm on cycle day 33 with no period in sight. Usually I'm every 28 days like clockwork. Now, I don't have a biology background, but since I didn't ovulate this month, I'm thinking there was no corpus luteum and therefore no progesterone...does this mean no period? Do I have to wait a whole extra month hoping that I ovulate this month? The idea of losing yet another month (or maybe more...what if I don't ovulate again?!) makes my anxiety skyrocket. Does anybody know how this works?


Update: After reading your helpful comments on where to go from here, I called my RE to see how to proceed (always feel like I'm bothering him, but your comments made it seem reasonable to check in). And am now scheduled for an ultrasound and bloodwork tomorrow AM. Will keep you posted.

Thursday, January 22, 2009

Noodle salad with a side of anxiety

First off, this is not meant to be a depressing post. It is my attempt to put a bunch of things together that have been floating around in my brain like seaweed. Last Saturday night I got very little sleep. Mo and I had a bit of a quibble earlier over nothing, but otherwise things seemed fine...or were they? I had a twinge of anxiety - that feeling I get which I cannot quite put my finger on. It starts sometimes like a stealth ninja, a bit of unease, edginess, impatience. Everything seems to become personal, especially when I am tired.

That line of Jack Nicholson playing the eccentric loony Melvin Udall kept running through my head "What if this is as good as it gets?" In the past two years our lives together have been occupied with IVF (and for the period of time when IVF was not occupying our lives I created my own mini-drama - but that is another story). IVF sucks, but it does create structure to our personal lives. It has all the key elements of a dramatic presentation, except so far it has always finished with a sad ending.

Nonetheless, somewhere in the back of our minds, when actively wiping away our tears, is the thought of "next time". And that is where Saturday night kicked in - the realization that someday we will get tired of watching this drama (or too poor to pay for it). Hopefully, of course, we will have a happy ending before then, but what if we don't? Playing this out together has been good material for filling our early days of marriage together. What will we do without it? The anxiety - and at the time I didn't know what I was really anxious about - got so bad I felt like popping out of my skin.

I fell asleep and woke up peacefully Sunday, but this feeling of anxiety kept surging through my body the next few days. Mo and I had just spent an amazing few days in the Mayan Riviera. What could be bothering me? In the end, I don't think it is just one thing, but rather the culmination of stressors.

Having this hiatus from IVF cycles has been a good time to regroup. I think going away made us both realize how much we love each other and how good we are together. It doesn't take the drama of IVF to make us work as one. We don't need a reproductive endocrinologist, andrologist, urologist, embryologist, phlebotomist, anesthesiologist, or IVF nurse to make us complete. Baby or no baby we have each other and that is pretty great.

Before we got married, Mo and I discussed our individual dreams and expectations for having children together. I guess I never really seriously entertained the possibility we would have so much difficulty and I never contemplated the scenario where we would be post-IVF with no kids (PINK). We have now have had that conversation and I feel much better, much more grounded.

In "As Good as It Gets," Melvin counters the statement that everybody has terrible stories to get over: "Some have great stories, pretty stories that take place at lakes with boats and friends and noodle salad." I guess I am just coming back around to realizing that Mo and I love each other and our lives - no matter what IVF does for us - will be filled with love and friends and noodle salads.


Wednesday, January 21, 2009

32 weeks

My friend R. reached 32 weeks today and is still going strong on hospital bedrest at Brigham and Women's. Still dilated to 5-6 cm, still 100% effaced, but hanging in there. She's feeling cheerier now she has a computer.

She's managed to stay pregnant far past her doctors' predictions. She said they refuse to prognosticate further since none of them thought she would make it this far. She's been in the hospital now since Christmas Eve.

I'll keep you posted.

Way to go, R!


Monday, January 19, 2009

Two roads diverged in a wood

I'm at a place in my academic training where I have to decide between various paths. I am applying for post-doctoral fellowships and must choose between a more clinical track (read: flexible and easier but perhaps more isolating, and less prestigious) or a more clinical research-oriented track (i.e.: more academic, more nose-to-the-grindstone grant-oriented, more intellectual, longer hours and more take-home work, but greater opportunity to make a positive contribution to many lives at once, academically more prestigious).

And somehow infertility rears its ugly head yet again to muck up another part of my life.

I am finding that I would choose two entirely different things depending on whether I can have a child or not. Which of course, I don't know the answer to.

I've always thought that I would pick a softer, easier clinical path (maybe part-time) if I had little ones at home (especially if there were multiple little ones, or higher-order multiple little ones even). It has always seemed that then my family would be at the center with work filling out around the edges of my life (at least when my child/children were young). But if childless, my ambitious side has always thought I should do the most difficult, competitive, intense clinical research track.

I had thought by now it would be clear which way things were heading.

Deadlines are fast approaching. I'm being courted by one research fellowship that requires me to apply for a pretty hefty training grant (due later this week). And I am just filled with anxiety about it. I'm a shoe-in for this fellowship. Or I could pursue a more clinical track (which might feel like a cop-out if I don't have kids)... or I could not apply for anything hoping that I will be pregnant by July and can just take some time off for awhile and be (of course if I'm not pregnant by July or don't stay pregnant, this would be disastrous emotionally).

It raises all these issues of legacy and meaning and purpose. Which of course being infertile does too. And leaves me wondering whether to plan as though a baby is coming (when it may not be) or just keep going forward with my life and if a baby appears figure things out then...

Can you see how my head just goes around and around and around? (Looks sort of like the exorcist, except it's just thoughts. My head doesn't actually spin around).

Anybody gone through anything similar? Thoughts on gaining clarity?


Saturday, January 17, 2009

IVF doldrums

Haven't posted because I don't have a whole lot to say. My birthday hit hard. I've always loved getting older (especially since having cancer) but this year, for the first time, I really felt that I didn't want to mark the passage of another year.

Will said to me the night of my 37th birthday, "Can you believe we're in our late 30s already?" and I just started crying. Yes, I can certainly believe it. What I'm having trouble wrapping my head around is the possibility that we may not be able to have children.

That said, all is quiet externally. We're in that between-cycle doldrum place. It is unprecedented, but I didn't ovulate this month. This perhaps explains the hot flashes but just reinforces my fears of perimenopause.

We're using this in-between time to set up some second opinions and to move forward with long-neglected professional tasks (e.g., dissertation, fellowship applications, grant applications) and personal life (vacation plans, yoga classes for Will, new and improved diet).

Hopefully we will get much accomplished and maybe even have some fun doing it. Still I am secretly hoping the time will pass quickly until we can cycle again.

On another topic, my friend R. reached 31 weeks this past Wednesday. She's going a bit batty in the hospital now and is 100% effaced. They aren't doing internal checks anymore because they said the next thing that will happen is her water will break and she will almost immediately deliver (I guess you don't need to dilate to 10 cms when you're this early). But no delivery as of yet - fingers crossed that she gets to 32 weeks - and maybe even beyond!


Wednesday, January 7, 2009

30 Weeks

My friend R. who fell and went into premature labor a couple of weeks ago made it to 30 weeks today. She's still flat on her back at Brigham and Women's doing a pretty good job of keeping her spirits up. That's the good news.

The less good news is that her doctors did an internal exam and she's dilated another centimeter in the past day and is having discharge (she'd kill me for typing that last detail). They told her to expect to deliver in the next couple of days.

I'll let you know what happens.

Please keep her and her baby in your thoughts.

Tuesday, January 6, 2009

Cycle delayed

We heard from the RE's office today that they are booked solid this month for endometrial co-culture biopsy slots. Ugh. We were told to call on day 1 of my next cycle to "see if we can get on the list for next month."

The bottom line is we will be delayed a month in starting IVF #4.

I took this harder than I thought I would. I didn't realize how much I was clinging to the hope of cycling again soon to help cushion the blow of my disappointment over our last failed cycle.

Adding to it all, I have been having hot flashes since Dec. 26th. Several times a night. Which is screwing with my sleep quality and filling me with doom and gloom thoughts of perimenopause. The fact that Thursday is my 37th birthday is NOT helping (Fear is that 37 + history of chemotherapy = the end of the egg supply).

Anybody else ever have hot flashes after IVF? I've had them on Lupron - but I'm not on any drugs now. Every time I have a hot flash, I panic a little that this is it. The beginning of the end of my fertility (not that I was so fertile before, but you know).

Holding on to sanity by a thread over here. Words of wisdom very welcomed.


Saturday, January 3, 2009

IVF: When professional and personal collide

As I sit here at work, I am reflecting on downsides of being a physician going through the IVF thrill ride.

Perhaps the most invasive is that it seems that everywhere we go recently we bump into one of our many physicians. A few weeks before Christmas we went to a holiday party attended by mostly academic types (more PhDs than MDs) for the medical school's anatomy department.

I do a bit of teaching for them and we ordinarily enjoy this particular party since it is a diverse crowd as far as these things go (physicians from multiple departments, PhDs from several areas). The first thing our host greeted us with was "Wasn't there someone pregnant at your table last year?" hinting that it might have been us. NO! IT WASN'T US!! He went after this line of questioning a few more times before we were able to successfully derail him onto another topic.

While appetizers were served, the host selected faculty to give short speeches. This year we were shocked when the RE scheduled to do Mo's retrieval stood up. He hadn't seen Mo during her monitoring and wouldn't have known who we were, but we definitely recognized him just the same. It's hard to remember what he said exactly, something about the beauty of the female pelvis and enjoying having the chance to work with the medical students because they remind him why he went into medicine.

After this I was selected to speak and was a bit dumbfounded to say the least. We had to leave the dinner early to make it home for the exact timing of Mo's HCG trigger shot. As we said our goodbyes, the RE gave us a big smile and shook our hands. Fortunately, Mo's personal RE made a surprise appearance at her retrieval, saving her the discomfort of comparing the carpaccio to the arugula salad with her legs suspended in OR stirrups.

That same night there was another dinnermate, a slightly wacky surgeon who kept saying he had to leave but managed to singlehandedly polish off the entire table's antipasta platter. As we left the retrieval the next morning, lo and behold we saw him down the hospital hallway with a gaggle of medical students and residents. I could see he spotted us and I tried to quickly divert us to the service elevators (no small feat since Mo was still feeling the effects of the conscious sedation). Luckily we avoided him, not that it would have mattered but I just wasn't up for post-party chatter, and who knows what Mo might have said.

Another social event we enjoy is an annual medical charity concert at Carnegie Hall (this is the only charity we are ever invited to - perhaps someone's error?). This year we were fortunate to see both my urologist (of Rocket fame) and Mo's OB/GYN (of you-don't-need-anesthesia-for-your-D&Cs fame). Quite the gang to gather for a little music. There is just something awkward about knowing that the guy sipping a martini next to us had his fingers up my (well, you know). And for Mo to have to stand in her little black dress near the OB who scraped out her uterus oh-so-painfully. It's disconcerting to say the least. Are they thinking the same thing? Nah. Luckily, professionalism still reigns.

We were seated in the balcony, giving us the all-too-tempting opportunity to launch Jujubes (particularly at Mo's OB, who we've both grown to dislike). Alas, other than making snide comments to each other, we remained respectable.

I recently selected a new primary care physician. I chose him because he is, in many ways, unlike most of the physicians at my hospital. His office is in a nondescript midtown office building and he is a believer in alternative medicine in addition to traditional Western medicine. At our first meeting I told him that I was looking for a physician who was outside of my normal work interactions, someone I felt completely comfortable with. He looked at me, smiled, and nodded knowingly. I am the patient and he is my physician. I kind of like stepping out of my work shoes and being heard as a regular Joe.

Best wishes to everyone for a healthy and productive 2009. 2008 had its highs and lows but I am ready to hit the ground running.


The nitty gritty

The details of our cycles and pregnancies:

IVF # 1 (NYC): September '07, age 35
Long Lupron Protocol
300 Follistim, 5 units Lupron
22 eggs retrieved, 20 mature, 14 fertilized
2 blasts transferred on day 5 (3BB, 1BB), nothing to freeze
Betas double appropriately
Fetus measures on track
HB: 140, 151
Missed miscarriage at 8 wks, 4 days.
Cytogenetics: female with trisomy 21 and monosomy x

IVF #2 (NYC): February '08, age 36
Long Lupron Protocol
225 Follistim, 5 units Lupron
11 eggs retrieved, 10 mature, 9 fertilize with ICSI
For personal reasons freeze 6 at 2pn, culture 3, transfer one at day 3.
(When 6 are thawed three years later, none survive in culture)

Natural Pregnancy: March '08, age 36
Betas double appropriately (223, then 425, then 831)
Missed miscarriage discovered at 7 weeks.
Cytogenetics: Lab loses sample

Natural Pregnancy: May '08, age 36
Beta fails to rise appropriately
Natural miscarriage
Cytogenetics: male with trisomy 16

IVF #3 (NYC): November '08, age 36
Long Lupron Protocol
225 Follistim, 5 units Lupron
12 eggs retrieved, 10 mature, 8 fertilize without ICSI
three embryos transferred at day 3 (8, 7, 6 cells, moderate fragmentation)

IVF #4 (NYC): February '09, age 37
Antagonist Protocol with endometrial co-culture
Day 2 FSH = 6.8, E2 = 32.7, LH = 5.47
200 Follistim, 75 Menopur
15 eggs retrieved, 14 mature, 11 fertilize without ICSI
five embryos transferred at day 3 after co-culturing (9, 9, 8, 8, 8 cells, minimal fragmentation)

IVF #5 (NYC): May '09, age 37
Antagonist Protocol with endometrial co-culture
Day 2 FSH = 7.0, E2 = 30, LH = 7.5
200 Follistim, 75 Menopur
Trigger one day early (Day 9)
6 eggs retrieved, 4 mature, 3 fertilized without ICSI
Three embryos transferred at day 3 after co-culturing (9, 8, 7 cells, grade 1 and grade 2)
HCG levels: 9dp3dt: 23; 11dp3dt: 48; 13dp3dt: 36; 15dp3dt: 17
Chemical pregnancy

Natural Pregnancy: June '09, age 37
Beta #1 (15 dpo): 188!, estrogen 271, progesterone 39
Beta #2 (17 dpo): 585!, estrogen 301, progesterone 36.45
Beta #3 (19 dpo): 2,413
Beta #4 (21 dpo): 3,159
Beta #5 (23 dpo): 5,221
5 wk u/s: gestational sac, yolk sac
7 wk u/s: baby w/ heart rate of 167 bpm! Measuring 7 wks 4 days.
8 wk u/s: baby w/ heart rate of 185 bpm! Measuring 8 wks 1 day.
9 wk u/s: no heartbeat (8/6/09). D&C performed.
69XXX - triploidy

IVF #6 (Denver): March '10, age 38
Microdose Lupron Protocol
Day 3 FSH = 5.5, E2 = 33.2, AMH = 1.4
300 gonal-f, 150 menopur, 20 ml lupron every 12 hours
.33 Saizen, .5 dexamethasone
19 eggs retrieved, 14 mature, 16 fertilize with ICSI (13 immediately, 3 more after in vitro maturation with Day 2 ICSI)
7 blastocysts [6BB (Day 7 blast), 4AB (Day 7 blast), 2 x 4BB, 4AA (from Day 2 ICSI), 3BB, 3AB]
Freeze all
Sample sent for sex chromosome FISH testing and microarray to test all chromosomes
Results indicate three normal blastocysts!!!

IVF #7 (Denver): June '10, age 38
(For two months ahead took inositol, coenzyme q10, and melatonin to improve egg quality)
Microdose Lupron Protocol
300 gonal-f, 150 menopur, 20 ml lupron every 12 hours
.33 Saizen, .5 dexamethasone
25 eggs retrieved, 22 mature, 18 fertilize with ICSI
Freeze all
Sample sent for sex chromosome FISH testing and microarray to test all chromosomes
Results indicate five normal blastocysts!!!

FET #1 (Denver): October '10, age 38
Medicated cycle
Took Depot Lupron for two months prior to cycle to improve endometrium/reduce endometriosis
One month of twice weekly electro-acupuncture to improve blood flow to uterus
Transferred 3 FISH and microarray confirmed chromosomally normal blastocysts
(Embryo #5 - 06/10: Day 6 6BA, Embryo #14 - 06/10: Day 6 4BB, and Embryo #6 - 03/10: Day 7 6BB)
Start 40mg lovenox, 10mg prednisone, 40mg pepcid, 10mg claritin, baby aspirin, and intralipids for potential immune issues
Beta #1 (9dp5dt) = 26.8, estrogen = 526, progesterone = 4.87
Beta #2 (11dp5dt) = 56.0, progesterone = 28
Beta #3 (13dp5dt) = 145.5, progesterone = 33
Beta #4 (17dp5dt) = 690, progesterone = 22
Beta #5 (20dp5dt) = 1702, progesterone = 11, estrogen 543
5w5d u/s: gestational sac and yolk sac
6w2d u/s: larger sac + fetal pole?
Beta #6 (31dp5dt) = 12,691, P4 = 23.12
7w3d u/s: no heartbeat, debris in gestational sac. D&C performed.
Cytogenetics: 46XY. Chromosomally normal male baby

FET #2 (Denver): February '12, age 40
Medicated cycle
Took Depot Lupron for two months prior to cycle to improve endometrium/reduce endometriosis
One month of twice weekly electro-acupuncture to improve blood flow to uterus
One IVIG treatment 10 days before transfer to reduce NK cell activity
Took 40mg lovenox, 10mg prednisone, 40mg pepcid, 10mg claritin, and baby aspirin for any immune issues
Transferred 3 FISH and microarray confirmed chromosomally normal blastocysts
(Embryo #3 - 03/10: in vitro matured Day 7 4AA, Embryo #5 - 03/10: Day 7 4AB, and Embryo #21 - 06/10: Day 6 3AB)
Beta #1 (7dp5dt) = 69.3, estrogen = 442, progesterone = 34.3
Beta #2 (9dp5dt, 4w0d) = 155, estrogen = pending, progesterone = 31.16
Beta #3 (11dp5dt, 4w2d) = 445, estrogen = pending, progesterone = 38.68
Beta #4 (15dp5dt, 4w6d) = 3,032, progesterone = 28.2
Beta #5 (18dp5dt, 5w2d) = 7,681, estrogen = 844, progesterone =11.5
Beta #6 (20dp5dt, 5w4d) = 12,362, estrogen = 1,185, progesterone = 70.7
Beta #7 (25dp5dt, 6w2d) = 45,785, estrogen = 616, progesterone = 32.82
Beta #8 (28dp5dt, 6w5d) = 65,543, estrogen = 683, progesterone = 53.15
6w5d u/s shows hb = 127bpm, baby measuring at 7.1 wks
7w5d u/s shows hb = 154bpm, baby measuring at 7.6 weeks 
Beta #9 (36dp5dt, 7w6d) = 140,934, estrogen = 732, progesterone = 39.4
Beta #10 = (42dp5dt, 8w5d) = 182, 833, estrogen = 1,169, progesterone = 57
blood work at 10 weeks, 3 days = estrogen = 852, progesterone = 28.13
blood work at 11 weeks, 2 days = estrogen = 1,116, progesterone = 35.44
Pregnancy continues with partial placenta previa, which resolves
Gestational diabetes develops at 28 weeks but is controlled through diet and overnight insulin
****Baby girl born at 39 weeks, 1 day!!! - via c-section after failed induction****

Natural Pregnancy: February 2015, age 43
Beta #1 = 106.5
Beta #2 = 198.1 (not quite doubling)
Beta #3 = 264 (really not doubling)
Natural miscarriage

FET #3 (Denver): August 2015, age 43
Medicated cycle
Took Depot Lupron for two months prior to cycle to improve endometrium/reduce endometriosis
One IVIG treatment 5 days before transfer to reduce NK cell activity
Took 40mg lovenox, 10mg prednisone, 40mg pepcid, 10mg claritin, and baby aspirin for any immune issues
Transferred 3 blasts, 2 FISH and microarray confirmed chromosomally normal blastocysts, 1 no result
(Embryo #11, a Day 7 FISH/Microarray normal 4BB blast, Embryo #15, a Day 6 FISH/Microarray normal 3BB blast, Embryo #20, a Day 6 FISH/Microarray no result 3BC blast)
Beta #1 (7dp5dt) = 22.3, estrogen = 1127, progesterone = 10.1
Beta #2 (11dp5dt) = 

Thursday, January 1, 2009


As 2009 begins, I am thinking of the pathways we travel in the journey to have a child.

Some journeys are emotional, some literal, some a mixture of both. Last summer, Will and I took a trip to Japan with his parents. It was a culturally rich, stimulating trip, but it was a journey colored by loss.

A few weeks before we left, we found out we had had a missed miscarriage at 7 weeks. Our second missed miscarriage in six months.

As we arrived in Japan, I had just stopped bleeding from the D&C. The loss was still fresh, and I felt vaguely empty and distracted, ambivalent about traveling, but thinking we shouldn't cancel the trip either.

What we found when we arrived was that Japan has space in its culture to acknowledge pregnancy loss in ways that don't exist in the United States. In English, there is no word for a miscarried baby. There are no culturally accepted ways to mourn, and in fact, very few people knew that I had been pregnant or had lost another pregnancy. We deeply felt our losses, but we didn't know how to mark them. How to honor these lives that had been. And we did not know how to move on.

"Mizuko" is the Japanese word for a miscarried baby. It translates to "water child" because in Japanese Buddhism it is believed that the soul flows slowly into a child, the child becoming more solid as they age. In this way the mizuko is somewhere on the spectrum between being and nonbeing, neither a full person nor a nonperson. I loved this conceptualization. It seemed to fit perfectly with our experience of these betwixt and between lives. These losses that were so real but also felt vague and undefined.

You can make an offering to Jizo, a Bodhisattva who will help your mizuko find a second way into being, helping it to either return to you in the form of another baby, or to find another family. There are Jizo statues all over Japan, often adorned with bright red bibs and bonnets, which are made and given as offerings. We had read in a Peggy Orenstein essay about her miscarriage in Japan that we could also leave toys with a Jizo to help our two lost babies find a way back into being. So amid our other sightseeing, we detoured to a toy store and bought small gifts. We found a Jizo statue near the main palace in Tokyo and laid two toys out awkwardly in front of it. It felt slightly alien, but good to do something tangible to acknowledge these pregnancies. It felt like a step toward moving on.

Later in our trip we found ourselves at the top of a hill where there was yet another Shinto shrine (we must have seen more than fifty shrines and temples on our trip). We found a Nanairo-no-yadorigi tree and read that this tree is famous for its symbolic ties to fertility and pregnancy. You can write a wish on a piece of paper and twist it around a tree branch to help you conceive and protect an unborn child.

So we tied our offering to this tree, a prayerful wish that we would conceive a healthy child. The custom is that when our wish is granted we should return to the tree and find and untie the paper.

I am a person who struggles to have faith, to believe that things will work out. But somehow, this trip, which I had been so ambivalent about, felt meant to be.

It felt significant that we found ourselves in this particular country just after losing our second pregnancy in six months. A country where there is a word for a miscarried baby and rituals to help that baby find its new home. That we found this tree to leave our request that we be blessed with a child who could live.

Unfortunately, not long after returning home, we learned that we had become pregnant a third time and were miscarrying yet again. But it is comforting to think that our written wish is maybe still there, sunstreaked, dampened. Perhaps if we are lucky, we will need to return to Japan next year, or the year after that, to find the note twisted onto the tree branch and remove it because our wish has been fulfilled.

Today we welcome the New Year.

We wait. We continue to hope.

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