The check-in area at the hospital is a row of cubicles. It feels like a bank. I’m sitting there signing in for my second pelvic X-ray when the check-in girl asks, “Do you mind if I ask you why you’re here?”
I could tell she had seen something odd on the screen — her curiosity wasn’t piqued from the insurance information she was processing. If I were writing this scene about a fictional woman, I might have her lean in and lower her voice to a husky whisper because birth control is precious and private.
But instead I leaned back like I was settling in with a cup of coffee and said, at a conversational volume, “My IUD is missing. They’re trying to find it with an X-ray.” The check-in girl’s eyes widened.
“Oh. My. God,” she said.
I laughed and said, “horrifying, right?” because ever since this ordeal started, I’d been waiting for someone to join me in acknowledging the absurdity of it.
“Do you know anyone who’s gotten the birth control implant? The one that goes in your arm?” she asked. “I’m getting it next week.”
“I actually do,” I said. “She had her period constantly and had them dig it out last week.”
The girl clenched her fists briefly. “I hate birth control,” she said. “It all fucking sucks.”
It sure fucking does.
My relationship with birth control is one of the longest I’ve had in my life — longer than my relationship with sex. I was put on the pill at 18, a dermatologist’s attempt to stymie painful and abundant acne on my face. It didn’t work, but while I was on it, my grandmother saw me take it and said, “It’s weird to see you taking those.”
At the time I thought she was saying it was weird for her to see me do something so adult. Now I wonder if it was weird because I was such a late bloomer that it was clear I didn’t have a real need for them. Not in the reproductive sense, anyway. The first time I had truly unprotected sex was 10 years into my relationship with my husband, when we decided it was time to have a baby.
Before that, we had gone through different phases with birth control — the pill, condoms. When we were younger, we always used two forms together. When we were older, we were “less cautious,” which to us meant we were using just one form of birth control. Neither of us is the type of person who’s willing to be thrown curveballs.
Loyally preventing an outcome of pregnancy for more than a decade created a warped sense of cause and effect for me. For so long I’d assumed that the second I thought about semen without birth control, I would become pregnant. Instead, it took over a year. Toward the end, I waded into the waters of infertility treatment. Ultrasounds, hormone tests. My doctor offered a prescription for Clomid — pills to do the opposite of what birth control had done.
A week before I was going to take the pills, I found out I was pregnant. I still have the prescription bottle in my medicine cabinet.
“I’m going to get a copper IUD,” I announced to my husband sometime before my six-week postpartum checkup. During my year plus of trying to have a baby and my subsequent almost-a-year growing one, I thought a lot about hormones. I’d come up with a lot of unscientific theories about things that were affecting my hormone levels and how they negatively impacted my fertility journey. The end result of this self analysis was that I might as well not use hormonal birth control.
I wasn’t sure what was up, but I’d convinced myself something was. No need to make matters worse. I brought my baby with me to my six-week postpartum appointment the way I bring prescription bottles given to me at Urgent Care to follow-up appointments with my real doctor.
Would they need to see her? They didn’t, but they said she was cute. When I said I wanted an IUD, they suggested I not bring her to the insertion appointment.
“It can be a little painful,” they said. Of course it can.
I had some cramping, but who doesn’t? And sometimes when I was sitting, I could feel it pushing down on my cervix. Was that normal? I don’t know. The doctor said to “check for the strings every now and then” to make sure it was still where it was supposed to be. She said it like I should know what she meant, and I didn’t inquire further (this is a mistake I’m learning to make less the further I get into womanhood).
I googled it later, and then, horrified, desperately tried to find the strings. They were elusive. I had an appointment to have the IUD checked a few weeks later so I didn’t try again. “It looks perfect,” the doctor said. She said it was good for 10 years and went over the risks again. Expulsion — that it would come out — was possible, she said, but rare. Rarer still was the chance it’d cut itself through the side of my uterus and go exploring inside my body. Cool, cool, cool. I tend to harbor two simultaneous thoughts when faced with things like side effects and low percentages:
1. That is definitely going to happen to me, oh my god, I’m doomed.
2. I’m rarely elite. Why would this be any different? I’m not the 1% of anything.
But when it comes to IUDs, I’m apparently elite.
About a year after my IUD was inserted, I was walking my dog and felt one very sharp shift of something in my lower half. It went away after a few seconds, and I chocked it up to who knows what. Then some time later, I would sometimes feel a presence. Like, I was aware there was an IUD in my body. Previously I hadn’t been. So, I made an appointment to see my doctor. I was due for an annual physical, anyway. The nurse came in and asked why I was there. I told her I was there for an annual physical and also that I would like to have my IUD checked. Her brow furrowed. “Why?” She asked.
I told her I felt like it was pushing down on my cervix and I was concerned it wasn’t where it should be. She wrote it down, but looked unconcerned. Next a medical student came in. She repeated my interview with the nurse. When I mentioned the IUD, her brow furrowed, too. “It’s rare they move,” she said.
As has been the case for me in multiple medical situations, I started to think I was being judged as overcautious or crazy. “Maybe I’m just overreacting,” I said, downplaying it. “But I’d still like it checked.” By the time my doctor actually came in, I’d gotten such a tepid reaction that I almost didn’t mention it again. But I did. The medical student performed my exam. She said she could see the strings for the IUD and everything was just fine. Then she said, “Oh, wait. I can see it poking out.” My doctor looked shocked. She took a look herself. Beaming with pride, she said, “Look at you, being aware of your body.”
And then she went to remove it. Only half of it came out. Soon she was scheduling me for a hysteroscopy — a no-joke medical procedure where I would be put under so she could look around with a camera and find the piece that broke off. Two weeks later, I was in a pre-operative room in a gown, with a hairnet over my hair and booties on my feet. Then I was wheeled into an operating room and everything went black.
Within a few blinks of coming to, I found my doctor standing over me. “So,” she said. “I couldn’t find it.” What? “I ended up doing a D&C and I didn’t find it.” Could it have come out on its own, somehow? She reached for her lapel, where she had one attached to her name badge. “They’re not that small,” she said. “I keep this one here to show people, but I have to admit, I’m not very happy with IUDs right now.”
I went for an ultrasound — the internal kind, with the wand. I made small talk with the technician as she moved the wand slowly, like a slow-motion game of PacMan. Nothing showed up. In another week, I found myself on an X-ray table. I’d had X-rays before, mainly on my head for my teeth. I’d also had a CAT scan once, when I had appendicitis, and I have to say that the pelvic X-ray was scarier. It felt like a table in an alien laboratory, and the way that X-ray technicians run out of the room before they push the button to zap you feels particularly unnerving. I left grateful that I wouldn’t have to do it again.
My doctor called later that day. “We didn’t find anything on the X-ray,” she said. “I’d like you to do another X-ray.” I didn’t want to. I did. They didn’t find anything again. This time my doctor said she thought maybe I should have a CAT scan, but that she wanted to talk to a radiologist first. She called me back to say the radiologist had talked her out of it. “It’s so much radiation,” she said. “They felt that the cost outweighed the benefit.”
She wasn’t prepared to let it go however, so she and the radiologist X-rayed several IUDs. “They showed up loud and clear,” she said. “If it was there, I think we would have found it.”
So, where is it? I do not know. It’s possible it broke off before my doctor even went to take the IUD out, and that’s why the IUD was out of place. It’s possible it came out after the break. It’s possible, I suppose, that it’s still in there somewhere.
But for now, I’ve abandoned birth control.
My husband and I would be happy with a baby should one show up. My last experience with “trying for a baby,” I’ve decided, was not good for my mental health. So I’m not focusing on it, I’m also just not preventing it.
But in the same way that the first time around I wondered if the years of birth control had done something to my hormone levels, I now wonder about my elusive piece of IUD. Just how much copper does it would take to make my uterus a poor environment for sperm.
As someone who tracks packages up until the minute they arrive at my door — as someone who checks how many steps I’ve taken and how many times I entered REM sleep the previous night using data from my watch — uncertainty is not a comfortable place for me.
And while I wonder where that piece of copper went, or if it’s still with me, I’m forced to give myself over to that discomfort. To see what transpires. What babies find me, or don’t, or what I’ll do after one does. Maybe I’ll discover a birth control that works for me. Or maybe the girl at the hospital was right.
It all fucking sucks.
Lauren Harkawik is an essayist, fiction writer, and local reporter in small-town Vermont.