Stepping Stones to Alternate Plans: Pregnancy Loss through a Queer Lens
by Leah Adam
"It's gone. It's stopped."
I lay on the table, my legs propped up and resting in two stirrups.
"It stopped," someone else repeats.
My eyes are focused on the ceiling above, so I'm not sure who says what. What I know is that the pronoun 'it', being unceremoniously used by my ultrasound technician and reproductive endocrinologist, refers to the heartbeat of the baby I had been carrying for 11 weeks.
Zooming in and out of the ultrasound image, they confirm that the flickering white light that had appeared during the last two scans is no longer present. My partner is sitting quietly at my side and reaches out to touch my knee. I can feel it being squeezed as the reality of what just transpired rolls over us like giant ocean waves.
At this point in our treatments, we had memorized the routine of signing clipboards, having blood drawn, getting an ultrasound, and waiting for our doctor. Our reproductive endocrinologist, Dr. W., is friendly and bright, and is the new fellowship doctor at a sophisticated downtown fertility clinic. Earlier that morning Dr. W found us in the waiting room and slipped into the ultrasound room with us. She wanted to see, with her own eyes, what had been transpiring in my uterus over the past month.
"What can I do for you?" she now asks, her usual charm and sparkle replaced with an expression of defeat.
"I would like a D&C, as soon as possible," I respond in a robotic manner. I can barely breathe, but I stick to the contingency plan.
A dilation and curettage procedure (D&C) was expected to remove the pregnancy 3 weeks ago. We planned the procedure when the heartbeat failed to develop by the 7th week of pregnancy. When we came back the following week to confirm the loss before a D&C, it shocked us to see a miraculous heartbeat. The steady heartbeat of 118 BPM continued the following week. However, our microscopic baby was now measuring an astounding 3 weeks behind.
We had had various conversations over these endless weeks. Some with humour (“Maybe we will have a teeny, tiny baby!”), and some with more realistic expectations of outcome. At one visit, despite having just seen the heartbeat moments before, our doctor offered an abortion. We shook our heads in refusal- so long as this baby was fighting to survive, we would let them. We repeated at every visit, “If the heartbeat stops, we will do the D&C.”
The universe called our bluff and the heartbeat stopped.
Although we knew to expect the worse, when it came, it was no less crushing. After getting the go-ahead, Dr. W hurried out of the room to fit us into that day’s operating room schedule.
A missed miscarriage, or "silent miscarriage" is one in which there are no signs of miscarriage. No bleeding or pain. For most affected, this leads to the unexpected and alarming discovery during a routine ultrasound that the pregnancy is lost, often weeks before.
As we had achieved this pregnancy through assisted reproduction, the outcome and progress were being closely observed by ultrasound on a weekly basis. Over the past month, my doctor, my partner and I had been witness to a pregnancy that had progressively appeared less and less viable.
Through comparison, it was estimated that I had likely lost the pregnancy the day after my last ultrasound, one week prior. I recalled when the sound of the heartbeat had last played out. During the days that followed, I had been singing, cooing and talking to no one. I had held my abdomen, urging whoever was in there to keep fighting. It hadn’t worked, and I felt like a failure. Already so frustrated that it had taken so long to achieve a pregnancy, my frustration now grew that I had not even “miscarried correctly”, if there ever was such a thing. The difficulty we were experiencing was a direct contradiction to the assumption that as a young, queer couple, this should be simple.
Our fertility clinic is inclusive and near our city’s bustling LGBT neighbourhood. The accomplished doctors there see LGBTQ+ patients and alternative families every day. Dr. W didn’t bat an eye when my partner and I introduced ourselves, and expressed our desire to be parents. We were young; I, 28 and my partner 32. We excitedly entered the arena of reproductive assistance and were assured by doctors, and even the mandatory fertility counsellor, that we should see success quickly. We sat in a large waiting room, surrounded by couples. We knew the straight couples had been trying for months, or even years, before even being referred to this clinic. We knew they had long roads ahead of them; they had earned their spots in this room. Imposter syndrome blanketed us. We wondered if we would be pregnant by Christmas, only a few months away.
During routine in-take testing, my Anti-Mullerian Hormone (AMH) came back significantly lower than average for a 28-year-old. When this hormone is found in low quantity, it generally points to a low or diminishing ovarian reserve. My AMH was in the range of someone ten years my senior. Despite my debatably old eggs, and my existing health concerns (hypothyroidism, autoimmunity and progesterone allergy), we were young. In the age-obsessed fertility field, we were on the right side of the statistics. We wore our label as the young queer couple, only temporarily transplanted into the world of infertility because we couldn’t conceive “naturally”. My youth was in our favour and we were given high odds of success. Unfortunately, from that point forward, nothing has met the idealistic expectations about our passage to parenthood.
Slowly but surely, 5 IUIs, 2 failed frozen embryo transfers, and 2 miscarriages have piled up. When we were first encouraged to move to IVF, we also transitioned to our second doctor at the clinic. Since then, we have been trying to conceive with the help of increasingly aggressive reproductive assistance, triggered by high doses of controlled ovarian stimulation drugs to combat my meagre AMH. Our latest transfer targeted my autoimmunity with daily steroids. We are forever grateful for the meticulous care we have received from our doctors; care we know is based on careful consideration of evidence and research.
As I write today, I observe the expected due date for our pregnancy that ended in missed miscarriage. It is astonishing to me that 9 months have elapsed without hesitation. This month, I am embracing my first break and cycle off from treatment in more than a year.
After over a year of treatments, we are now at a crossroads. If the next transfer fails, guidelines indicate that we can begin testing related to repeated implantation failure. Should we experience another miscarriage, we similarly meet the “3rd” incidence needed to investigate the source of repeated pregnancy loss. And while two out of three outcomes is miserable, the third option is an unprecedented success. And so, we persevere. While we have remaining embryos to transfer, we now understand that nothing is ever a guarantee. While we may get a “lucky number 3” transfer, we also know the other 2/3rds of the pie are not as appetizing.
For now, pregnancy and parenting books which once took up prime real estate on bedside tables are stored on a bookshelf in our guest bedroom. The changing table in the aforementioned room has been stealthily converted into a shelf. The diary I had eagerly started in order to document our appointments, fertility treatments, donor profiles and anticipated pregnancy sits untouched in a cupboard. Handwritten documentation of failed treatments and miscarriage was not what I imagined handing down as a legacy. The diary features a cliffhanger ending, with various ultrasound pictures stuffed between its’ pages.
Faced with pregnancy loss and difficulty conceiving, it is hard not to search for answers. It is impossible not to listen contemptuously to every “miracle pregnancy story” that well-meaning friends and families offer, perhaps more for their own solace than yours. Often, folks forget that as a queer couple requiring donor gametes, no surprise pregnancy will ever materialize miraculously, as it apparently did for a friend-of-a-friend of theirs. Still, I listen closely to these stories for the intervening variable that ultimately and supposedly resulted in each successful case. Lifestyle changes- check, diet changes-check, therapy-check, meditation-check, throwing out nearly every plastic item and Tupperware in our home-check.
During my search for answers, I read a book that explained that my future baby exists in spirit form. It theorizes that my spirit-baby feels slighted, or mad at us for an unknown reason. The book advises to communicate with this spirit, in order to correct whatever is wrong. Only by doing this, will our baby come to us. The prospect of an infinite search to figure out what I had done to piss off my apparent ghost baby seems exhausting. The book now sits in the same cupboard as the diary. Often, when faced with the unknown, we look for answers in all the wrong places.
My partner and I have our own answer, though: building a family is our priority, no matter how it is accomplished. We know there are many other LGBTQ+ couples who, like us, have discovered that their “journey” is more like a odyssey. Finding community, and sharing our stories to reduce isolation when things do not go as planned, is paramount.
To prepare for our upcoming transfer, we are planning for the worst, while hoping for the best. We have begun the process of researching adoption, both embryo adoption and public/private domestic adoption. Recognizing that these paths do not lead to any guarantees either, we continue to hope that if we remain open to every option, we will build our family. Before, each failed treatment and miscarriage felt like a step closer to living a childless life. Now, they feel like stepping stones to alternate plans. Our path won’t end once they have transferred our remaining embryos.
During this process, it is hard not to question your body, and forget the wisdom it innately holds. If it hard not to search for a higher meaning, or question the power of the universe, for not having aligned the stars to provide divine intervention. It is difficult not to look outward for answers, validation, and divination. What we know is that no matter what the result of our remaining transfers, we will be parents, somehow. And although that is all I know, it is enough.
About Leah Adam
Leah Adam is a queer writer from Toronto, Canada. Having experienced the world of infertility through a queer lens, Leah is passionate to show the world that neither is mutually exclusive. When not at the fertility clinic, Leah works full time as an autism services provider for adults and children in both community and centre-based settings. Supported by an amazing husband and adorable ferret, Leah can’t wait to raise a child who is proud to come from an alternative family.