As an Orthodox Jew, observing Sabbath (Shabbat in Hebrew) and other aspects of my faith is important to me. My practice is personal and never intended to impact or impose on anyone else. I fully embrace a “live and let live” mentality and believe everyone should be free to honor their own beliefs, so long as kindness leads the way without harming others. For anyone interested in learning more, this is an example of an article with information about restrictions on Sabbath: Shabbat’s Work Prohibition: Traditional do's and don'ts for the Jewish day of rest
With that in mind, I wanted to document my FET experience on Saturday.
My husband and I carefully planned the day. Since it was not medically necessary for him to be there, he could not come with me and we knew I'd have to go on my own. I was scheduled to be in the clinic mid-morning for the short procedure so we planned for him to take the kids to synagogue to keep them busy and limit their questions about my absence (another major difference than previous cycles, in the best way possible). I hired a driver to pick me up around the corner from my home, with navigation details and payment arranged in advance including special instructions to make sure to open and close the car door without prompting.
In the days leading up to transfer day, I kept having interactions in the clinic that were bothering me. Small and seemingly insignificant, but they were coming at me frequently enough that I was noticing it. I've been abundantly blessed that my schedule doesn't allow me to harp on things and document every interaction; I've barely been able to keep this blog alive even during an active cycle. Somewhere in my gut things felt off and I was subconsciously keeping track.
The first time alert bells rang in my mind was when we were signing off paperwork for my cycle and they gave me the wrong time interval from trigger to the FET. They had put in the default number but I had undergone multiple tests in order to get an exact hour count, with the past successful FETs following exactly that. I pointed it out to the nurses and they corrected it before handing it back for signature. No harm, but that was when my guard initially went up. I chalked it up to the change in doctors as mine had moved away in recent years, and put it out of mind.
The second time was when they were giving me medication instructions and told me to bring crinone with me to the transfer because the default protocol is to start it immediately after transfer. Again, that was the default and my protocol says to start it the following day.
The next alert came when the doctor came in for monitoring and saw that my lead follicle was measuring the right size. Offhand he calculated what day my transfer would be the following week, again following the default protocol. I know he was just doing monitoring and bouncing from one room to the next but I still corrected him - no, I get an extra day based on my personalized protocol. He hesitated before agreeing, saying they'll make sure to check the charts and get it all straightened out.
The crinone mistake happened again a few days later when the formal instructions came with the exact time of procedure, where a nurse (yawning, chewing, uninterested) was rattling off instructions on the phone and said it again about the crinone timing. I corrected her and for the first time in the conversation she broke away from the rehearsed monologue to check my chart and confirm I was right.
In the week I had a week to prepare for the transfer I contacted the clinic no less than three separate times asking if there was anything I needed to sign or do for the transfer. At one point I specifically stated that I am an orthodox Jew and have limitations to what I can do on Sabbath; another time I said, "in observance of Sabbath I prefer to sign any documents/forms in advance." I was assured that everything that needed to be signed was received.
Transfer day comes. My driver drops me off in front of the building. Being the weekend, there is very little foot-traffic in and out of the building. I waited a few minutes until the security guard walked by and triggered the automatic door so I can walk in the building. I walked past the elevator and headed to the stairs. I climbed the stairs to the fourth floor, excited with anticipation for the procedure. My mind was on trying to calculate how long things would take, and whether there was a chance I could be back before my family returned from synagogue.
On all the other floors there was an entrance to the floor, which I was used to having visited the other floors by stairs in the past when the elevator had heavy traffic. The fourth floor had a new badge scanner with a Restricted Access sign that I didn't expect. I went back to the third floor and walked across the building to another staircase to try another area: same issue. Restricted Access. I knocked on the door but no one answered. I walked back down to the lobby to consider my options. I couldn't go back to the parking lot to get my driver because not only am I not supposed to directly ask him to do things on my behalf, I'd also have to trigger the doors to get him. I waited a few minutes to see if the security guard would reappear but I was on my own. I reluctantly headed to the elevator and bopped the button with my elbow.
I'm going to pause here and say that I recognize this may seem ridiculous to someone who is not Jewish or not Orthodox. I understand. I'm fully aware of how it may look from an outsider's perspective. But to me it was important to try to keep shabbat. With preparation I could have planned for a workaround so this was completely preventable and I was upset.
The elevator opens to the clinic floor and I walk toward the reception desk. I said, "Hi, my name is... and I'm here to check in for my FET." Her response was, "Did you check in at the kiosk?" I took a deep breath trying to hide my frustration, since it's not this lady's fault and I didn't want to sound annoyed at her, and said that I'm an orthodox Jew and prefer not to use the kiosk if it's not necessary. I felt uncomfortable saying it out loud, because even though it's not a big deal for her to check me in on her screen, it was clearly an inconvenience. I felt like I was failing Jews everywhere.
She was so confused. Her solution was to send me to another desk down the line. The lady there was scrolling on her phone, enjoying a slow clinic day. I repeated who I was and why I was there. She started with the same question about the kiosk, but before I could answer, a tech was coming up behind me, smiling, saying "oh I was just coming to get you." Wonderful. Avoided the kiosk.
She uses her badge to get past two doors to get to the patient check-in area. She asked for my ID and insurance, and I handed them to her. She then asked me if I have a living will and I said no. She hands me a paper to sign stating that I don't. I stare down at it and give some pushback. I said I asked to sign everything in advance and that I requested not to have to sign anything today because of the sabbath. She gives me a blank stare. She's just a tech and has no idea how to handle this: she needs the patient to sign a paper to get to the next step and has never encountered someone declining. I asked what happens if I don't sign it, and she said she'd have to get the nurse manager because they can't continue to the next step without it. I handed the paper back to her because at that point I noticed it wasn't even my name on it and if I was going to be forced to sign something I'm only doing it once. She apologized and gave me my correct paper, which I reluctantly signed with my non-dominant hand, feeling the tears of frustration sting the back of my eyes.
She leads me back to a room with a curtain and says the nurse will be there shortly. A lovely nurse comes in to take my vitals, making the appropriate amount of small talk about the weather as she's working. She mistakenly said "egg retrieval" when confirming the procedure I was there for, and I reminded her that it was a transfer. She quickly corrects and said "yes of course I meant that, it was just a morning full of retrievals so I have that on the mind haha." She gives me the rundown about discharge and then, of course, asks me to sign that I understand. At that point I can't hold it in any more. I signed it and started to cry. I was so so upset. I was so frustrated that no one paid attention to what's important to me as a patient. There was no discussion between the clinic and the OR to communicate the limitations I had shared. At that moment I recalled all the red flags which led me to worry that if they cared so little about reading my chart about my Shabbat preferences and my crinone protocol, that they wouldn't get the correct embryo to transfer either and that all this was for nothing.
I tried to dismiss it but the nurse encouraged me to tell her what the problem is so I did. She was very sweet and apologized profusely on behalf of the clinic. I didn't expect her to do anything, and I recognized it wasn't her fault personally, but I appreciated her acknowledgment of my frustration. I calmed quickly enough and changed into my gown to wait for the next step. I was told to arrive an hour before my scheduled procedure and even with the stairs and check in issues, I was still ready to go about 25 min before the scheduled time. I was hoping they'd be ready for me soon so I could head home.
I sat there waiting patiently, just me and my full bladder, trying to put the past behind me and think ahead with positive vibes. I heard the nurses chatting right outside my curtain. They were making small talk with the last of the egg retrieval patients being discharged. They were excited that the work day was almost over ("only one more quick procedure") and their plans for the rest of the day. Already feeling sorry for myself, it was just more salt to the wound. I had waited 3 years for this procedure, with so many obstacles along the way and many conversations and back-and-forth with my husband about whether it would even happen. Then when we decided, it was time to start allocating financial resources toward it. We saved and sacrificed to afford this self-pay option for a last embryo. I understand that these nurses have probably been up since the crack of dawn; I know their profession doesn't get nearly enough credit; I also fully and readily admit that they didn't do anything specifically wrong. But it didn't feel good to sit there listening to them being so cavalier about a possibly-life-altering procedure I was about to go through, on my own, in such an off-hand way. They don't work in a regular place and there's a responsibility and gravitas that comes with it, whether they intend it to or not. This had nothing to do with my religion but just piled on top of the already charged experience.
I'm not even done... the story continues.
The doctor comes in and confirms the information about my embryo. I feel reassured that the embryo thawed successfully and that it was the correct one. He asked me to sign that I understood. For the third time, I signed the paper.
Shortly after, they came to get me for the OR. I held the flap of my gown closed in the back and walked over. They settled me on the table, arranged some warm blankets on my top, and got an ultrasound in place to help guide. The doctor inserts the speculum and it was too short. He asked for a second one, and it wasn't the right fit either. On the fourth one, he tried to adjust multiple times and wasn't getting the view he needed for the procedure. He tried for a few minutes and couldn't get it, meanwhile the second doctor was pressing on my bladder with the ultrasound. After some time, he suggested I go empty out my bladder just a bit (count to six then come back). I was escorted down the hall to the nearest bathroom and counted to six, cleaned up, and walked back to the OR. The door was locked (needs a badge to get in) so I just stood there outside the door. A minute passes and a kind tech sees me waiting there holding my gown closed and asks if I need help. I say that I'm waiting for my nurse to get me back in the room, so he tries his badge but he doesn't have access so he's locked out too. He goes to get my nurse who was at the nurse's station, chatting. She says, "oh I'm so sorry I didn't see you walk right past. We were discussing the pumpkin challenge at the front desk if you want to vote on your favorite." Everyone had cleared out of the room when I went to pee, so we had to wait for everyone to come back. Both doctors took the break to look back at the notes from the last mock transfer to see if there were any issues (there weren't) and I internally groaned about why the eff they'd make me go through a stupid mock transfer if the transfer doctors weren't going to read the notes as part of preparing for my transfer anyway. Like maybe someone could have noted the speculum size used successfully in the last transfer????
As we're waiting for the doctors to return, the nursing tech was trying to make small talk and make me feel comfortable in a very awkward situation. Her small talk was "So, tell me about your sabbath," clearly having been warned by the nurse to be sensitive but also completely missing the mark. I'm sitting there with legs in stirrups and nervous about the situation. Under normal circumstances I'm happy to answer questions and have a discussion about religion. But that was not the time and I was not in the mood. My response to her was, "I'm happy to chat about it and answer any questions you have but maybe another time."
I get back on the OR table, they rearrange the sheets, the ultrasound comes back, they raise the bed again, the speculum dance repeats. Same results - he's unable to get the view he needs. He asks me to release my bladder a bit more. I get back and the second doctor now tries to get the view needed; she is unsuccessful. Everyone else has already left and there are no other doctors to try. He sends me back to the bathroom to release, this time "count to 40". At this point it's already past my original transfer time and I express my concern about the window closing or the embryo degrading. Doctor assured me there's a 3 hour window and we have plenty of time. To his credit, he seemed stressed but very calm.
The whole process repeats an additional two more times until he says to empty my bladder all the way. After what seems like 90 seconds of peeing I'm back at the OR with an empty bladder praying to get through this. They easily and quickly get the speculum in place and step 1 is finally complete and we all cheered, hoping to lighten the mood. The next step was to get the catheter in place and that took several more tense minutes. They were finally able to get the catheter placed, the embryo transferred, and end the ordeal 40 minutes after starting.
I was walked back to my curtain area and my sweet original nurse came in for a last set of vitals. She again apologized for the miscommunication and said that she reached out to the nurse manager who will be in touch with me. I got dressed, and asked my nurse if she can show me which staircase I can use to get downstairs. She offered to walk me out and pressed the elevator buttons for me. Luckily my driver was sitting in the lobby waiting for me. As soon as he saw me he got up to activate the doors and get me home, about an hour later than originally anticipated.
There were so many things that could have gone differently. I did get a call from the nurse manager, and I shared some of this with her. Not all of it because I'm still processing everything that happened, and not sure what her capacity is for hearing it, and the recovering people-pleaser in me feels a strong reluctance to be the cause of trouble. She assured me that if I ever need another procedure on Saturday she would personally ensure that none of this would be an issue. I told her that I'm 41 and this was our last embryo; there won't be a next time. But I did offer her to keep my number handy to discuss ideas to improve patient experience for situations like this that come up in the future.
That brings us up to speed: getting through the 2WW.