And...we're off

Somewhere around 13 antral follicles this morning, which is a little lower than back in May. Hmmph.. Not sure about the estradiol number, but nurse said everything looks good. I start stimming tonight with 225IU of Bravelle and continue that until Tuesday morning when I go back in for ultrasound and bloodwork.

Pre-cycle Freakout

Right before the baseline ultrasound these are the things that I think about and that freak me out.

Is my FSH going to be higher?
Will my antral follicle count be okay?
What's my E2?
Please let me stim well, lots of follies!
But not so well that we have to cancel
Oh god am I going to run out of drugs? 
Twins would be manageable right?
Twins! Hah, you'll be lucky to get one good egg out of this cycle.
Am I having a hot flash?

Change of plans - again

So now we are cycling this month. We had to move some money around but on a wing and a prayer we're cycling. Bravelle is shipping today and my baseline ultrasound/bloodwork is tomorrow morning. Fingers crossed for no surprises or sudden jumps in FSH/E2 and a healthy AFC.

Mantra

My mantra for the New Year:

"I do not know how or when our child will arrive but I know that one day we will be parents." 

Come on 2011...

Sidelined

Well it looks like we'll be sitting this coming cycle out. I had a come-to-Jesus meeting with our budget yesterday and unfortunately we just can't swing the $3,000 + needed by next week to do an dIUI/injectables cycle. After our vacation and the out-of-pocket HSG test, plus holidays gifts for the family, we can't make the math work. So we're sidelined until January/February. It sucks to have to wait (again) but it's probably better on my body to wait one more cycle anyway. Also as of January 1 our Healthcare Savings Account will be replenished and it won't be as much of a financial strain.After six years I really should be more accustomed to waiting but I'm not. I continue to try to think positively about the new year and the outcomes we hope for. Each day puts us that much closer to parenthood, whichever way it comes.

Good news for a change

Finally broke down and called the clinic yesterday afternoon. Coordinator-nurse called me back and said they did receive HSG results and tubes are clear! Even better, they are going to be on-call during New Years so when AF arrives we can cycle! Now I just have to order my Bravelle and we have to finalize our donor selection. It's progress!

A poem for today

Via The Writer's Almanac

The Thing Is

by Ellen Bass

to love life, to love it even
when you have no stomach for it
and everything you've held dear
crumbles like burnt paper in your hands,
your throat filled with the silt of it.
When grief sits with you, its tropical heat
thickening the air, heavy as water
more fit for gills than lungs;
when grief weights you like your own flesh
only more of it, an obesity of grief,
you think, How can a body withstand this?
Then you hold life like a face
between your palms, a plain face,
no charming smile, no violet eyes,
and you say, yes, I will take you
I will love you, again. 

"The Thing Is" by Ellen Bass, from Mules of Love. © BOA Editions, Ltd., 2002.

Quittermas

Doug has deemed this Christmas season "Quittermas", as neither one of us can be excited about it. Saturday we decided we would at least put up a tree. It was a miserable, rainy day and we went to the tree lot in the grocery store parking lot. They had the kind of tree I wanted (Noble Fir) but they were all eight feet tall and around $90, which at this point is more than we wanted to spend. We ended up getting a small Scotch Pine and it made me cry. The tree was not so horrible, it just snowballed from disappointment because I  didn't get the tree I wanted, into disappointment that I'm not pregnant during another holiday season. God bless my husband, he is a saint. Most men in his situation would want to run away from a wife that bursts into tears randomly.

Once we got the tree home we realized we needed another strand of lights, which involved us going to Target - on a Saturday afternoon - during the holiday season. It was a brutal shopping trip and they didn't have the same lights we had at home so we had to get a string of retina-searing blue LED lights. The tree is slightly crooked but we just don't care. 

I managed to get out Christmas cards to our immediate family but that's about it. I'm waiting for the onslaught on holiday cards from friends with uber-cute children. I don't really mind getting these cards but it can make me a teensy bit sad. 

Our trip to Seattle last week was nice, the city was decorated for Christmas and very pretty. We got to spend some quality time together and with friends, plus see one of the most beautiful areas of the country. I did come to the conclusion that the Seattle area must make everyone insanely fertile because I swear every five feet there was a pregnant woman or someone with a baby. We went to a urban craft fair and you couldn't move without seeing a baby strapped to someone. Even Doug was like "where are all these babies coming from?" 

On our own procreation front, I'm waiting until Friday to call the clinic and see if they received the HSG results and if they're closed for New Years. If they are closed then we won't be cycling until the end of January, if they aren't closed then we'll be cycling at the end of this month/first weeks of January. That will also mean we have to order meds and make our final new donor selection, all of which will run us around $1,800.00 total. Merry Christmas to us.

HSG Part Deux

Since we're doing IUI again and you need your fallopian tubes for IUI to have a chance of working, Dr. K told me I needed to have another HSG test. The first one I had was six years ago, shortly after our first appointment with Dr. K and it showed not blockages. I had that one done at the women's hospital next to Dr. K's clinic. A lot of women have severe cramping/pain/bleeding after the HSG but luckily I've only had minor cramping so it's not too big of a deal for me to have the test.

This time around, my clinic suggested I go to a new diagnostic clinic about 25 minutes away. I was skeptical since the women's hospital is 5 minutes from my work but the nurse said everyone was raving about this new place. So I figured it was probably fine and made the appointment for last Friday. The clinic is in North Mississippi which is an interstate ride away. I made it to the clinic in time, after getting lost after I got off of the interstate. The clinic is within sight of the local hospital but it's in an office building that looks almost industrial. This did not instill confidence in me. My insurance does not cover this either so I got the privilege of paying $530 out of pocket for the experience. When the nurse called me back and took me to the room she had to make sure I wasn't pregnant, in fact she needed my clinic's negative HCG test from a weeks ago faxed over to her to confirm. Even after I explained I had had a miscarriage, AF was just last week and it was not physically possible for me to get pregnant on my own. After I said that she then told me she had IVF twice and recurrent pregnancy loss, which was nice of her to share I guess. After they got confirmation I was indeed not pregnant then I got to shed the bottom half of my clothing and lie on a table the width of a plank waiting on the doctor. One thing that bothered me was that their table/machine didn't have stirrups, which made it pretty awkward during the test. It made concerned that maybe they weren't doing enough of these to warrant a table with stirrups. After waiting in a super uncomfortable position on the plank for what seemed like eternity, the doctor finally arrived. He was nice but kept explaining in detail every little thing, which is fine for some people but I had already told him this was the second time I had this test. After it was over they made sure the pictures were good and sent me on my way. They didn't really say if there was any blockages so I have to wait until Dr. K reviews them and confirms the tubes are clear.

I'm hoping for this cycle to start before New Year's because I'm not 100% sure the clinic isn't closed for the holiday. I was going to give them until the end of the this week before I called to pester them about the test results and ordering my meds.

You know you're weird when...

AF finally returned yesterday! Hallelujah! Is it weird I wanted to make that make FB status? Yes? Yes. I made the call to the RE's office and left a message to find about two things. One, will the next cycle (December/January) be the cycle we can start trying again and two, when can I schedule the HSG test. They called me back and said yes, we can start trying at the start of the next cycle (December/January) and I can go ahead and schedule my HSG test. I want to go ahead and get the HSG out of the way as soon as possible so there are no 'surprises'. My tubes were clear in 2004 so hopefully they are still clear. Since we can start next cycle we have some financial adjustments to make in order to fund the thing. I'm just glad we're moving forward again.

Blah Humbug

I have almost no interest in Christmas this year. I never thought I'd say that because as long as I've been alive I've loved Christmas. I have many happy memories revolving around celebrating the holiday. Most years I can't wait to get the decorations out but this year - well I just can't muster any enthusiasm. I thought about getting some of our Christmas things out over the weekend but I never did. We're leaving Thursday for a mini-vacation and we weren't planning on getting a tree until we got back anyway, but now I'm not really sure we'll bother. Part of the problem is I'm still in a bit of a funk. For all intensive purposes I'm a thousand times better off emotionally than I was a few weeks ago. But there's still an underlying layer of sadness I just can't shake off. The holidays are so 'child-centric' that dealing with IF is made that much harder during Christmas. I mean the holiday itself is about the birth of a baby right? Add that to the commercials, magazines, internet ads, articles, etc. that revolve around children and Christmas and its enough to make me go off the grid until January. It kind of seems like the message is 'unless you have children Christmas is no fun.' Sometimes it feels that way too. 

Another reason I'd like to skip right past the holidays is that I know we'll be starting a new cycle (hopefully) in January, provided AF ever returns. Anyone who knows me knows I am notoriously impatient and I feel like I'm just treading water waiting, waiting, waiting to return to the RE's office. It doesn't help that AF is still MIA, I'd really like a status report from my body about what's happening in there. Most information I've found says your normal cycle should return after 3-6 weeks, well it's been 5 weeks for me and still no sign of AF. We can't really move forward with anything until my cycles resumes and its making me crazy. Here's to hoping *something* will happen soon.

Why

Over the weekend I was thinking about some of the questions I've seen perusing adoption applications. The biggie is always "why do you want children?" I spent some time trying to think about how I would answer that. I mean does anyone really know how to answer that? It's difficult to articulate into words why we want children. I can't pinpoint an exact reason but I think this kind of explains it.

We've been married for six and a half years (seven this coming February). We've been 'together' for nine years. During this time we're moved into three different houses, bought cars and washing machines, adopted cats, traveled across several time zones, fought, loved, weathered the storms of health and emotional issues, taken more road trips than I can recall, picked up hobbies, lost and gained friends and watched an insurmountable amount of television. We have loved every minute of it. But we're ready for the next step, the next adventure - having children. I have been really happy and fulfilled with my life for several years, it was no easy task getting to that point but I did. Now that I've reached that level of personal happiness I'm ready for parenthood. I want to change diapers, I want to be awaken at three in the morning, I want to have a chubby, sticky hand reach for mine. I know my husband will be an amazing father. Everyday, even on the days he leaves his shoes lying around for me to trip over, I marvel at how lucky I am to have this kind of partner. 

I am under no illusion that having kids is somehow easy, I know it isn't. I know it isn't rainbows and sunshine and unicorns. Based on what I have seen and heard, parenting is hard and messy and financial and emotionally draining. I still want it. 

$4,796.94

That's my cost for enough Bravelle for another IVF cycle (54 vials) via the specialty pharmacy our insurance company has been having us use. We have used up our $5,000 infertility drug benefit and we are now paying 100% out of pocket. I found the information on the Bravelle HEART program and called Village Pharmacy to inquire about it. I ordered my progesterone from Village because the specialty pharmacy our insurance had us use didn't carry it. Anyway the very nice patient care rep at Village told me with the HEART program my costs would be a lot less than $4,796.94, about $2000 less. It's still a crapload of money that will put even more of a strain on us but it's slightly more manageable than the first number.

Between the time I called pharmacy #1 and the time I called Village I thought of other ways to spend $4,796.94. In no particular order:

• Buy a used car
• Partially remodel Doug's bathroom (maybe even fully remodel it, it's pretty small)
• Airfare and a five star hotel for two persons to London for two weeks
• Purchase 171 skeins of Madelinetosh Pashmina yarn
• Canon EOS 5D Mark III and an assortment of lenses and accessories 
• Vintage Heywood-Wakefield Dining Room set (with some leftover cash for new china)

A new plan

Our follow-up with Dr. K was yesterday, it seemed to go well. We left with a renewed sense of hope - but that always happens after we meet with him. I got a copy of the cycle summary, contrary to what I thought he meant last week, I responded really well, my post-transfer estrogen and progesterone levels were "excellent" and our embryos were of great quality. He did talk about how it took a lot more medicine for me to produce than it did last time. I was taking about $500 worth of Bravelle every day for 10 days (450 units per day). That's a lot of Bravelle. The fertilization rate was excellent and overall I responded much better than I did during our 2006 IVF cycle. Unfortunately we don't know why the miscarriage happened or what caused it, sometimes they just happen. My antral follicle count in May was 17 (good) my AMH level was 1.2 (good) and my FSH was 9.21 (not great but better than it was). There's still some eggs in there, we just need to find some good ones. While we were there he had the lab call the bank we got our donor from and confirmed our donor was a proven donor (meaning someone else had gotten pregnant). No other issues came up during the cycle, everything seemed to go well, except for the miscarriage. 

After a lot of talking we've decided to do at least three IUI's with Bravelle/trigger shot and use a mixture of Doug's remaining vials and donor. I re-ordered the Bravelle/trigger yesterday from the specialty pharmacy and I'm praying we can get it for the insurance rate of $60 instead of the actual cost of $5,000. Although Doug and I are both still on the fence about using his stored sperm because we can't find any good information about the risk of birth defects with irradiated sperm. If the IUI's don't work we may consider doing a third IVF cycle. On one hand I feel like that's a massive emotional and financial risk and we should probably move on with embryo or traditional adoption. On the other hand I'm not even 30 yet and I can't let go of the idea of having a child genetically linked to one of us. That's probably selfish, but so be it. I think we'll also start gathering information on the homestudy process too. If we do go the embryo adoption route we'll need one so it's probably better to look at starting that since it takes so long because of all the paperwork.

The first thing we asked him was "when can we try again?" and the result was we need to wait at least one cycle for my body to recover. So (fingers crossed) my period will return in December and we can move forward with our first IUI in January. It seems regressive to go back to IUI after two failed IVF attempts but at least it's something. Maybe since we've never used donor with IUI we can have a better chance of success. Again I'm trying to walk the thin line of optimism and realistic expectations. I think our new plan is good, at least we'll have something going at the start of the new year. It's almost crippling for us not to have anything happening now that I'm in the "must procreate" mindset. So the plan for the next eight weeks is to relax as much as possible, continue my fish oil/prenatal/DHEA, enjoy the holidays as much as possible and get ready for January. My first meditation class was last night and I think I'm going to really enjoy it. Plus I've been to the gym three times this week so far. I feel so good after I make myself go. I want to continue the momentum so I can shed a few pounds because I'm sure that would be helpful.

So we're back to waiting, the most painful part of infertility. The journey isn't over yet, the road has just gotten longer.

In the news

The American Society for Reproductive Medicine had their annual meeting last month (I think that's why Dr. K was MIA during my betas). Anyway, I was browsing the highlights of their meeting and came across this blurb on how women with 'O' blood type are more likely to have diminished ovarian reserve. This caught my eye because I'm 'O +'. A longer article is found here.

Last week when thumbing through Newsweek I saw this story about early-life experiences can cause permanent changes in eggs and sperm. Essentially things that happened to your grandparents or great-grandparents can negatively affect your fertility.

So there are some more variables to factor in to my infertility issues. Sigh.

Hope is a Bastard

I was listening to Bob Edwards weekend in the car Sunday night and he had Ben Folds and Nick Hornby on. They just collaborated on an album, Hornby wrote the lyrics and Ben Folds did the music. I found the lyrics of this song especially poignant right now.

Looking for answers & direction

Dr. K called me Wednesday night, a much different tone of phone call than I received last Thursday when he called to congratulate me. He gave me the normal "this is not how we wanted this to turn out" talk. I like him a lot, even though we haven't gotten the results we've wanted he's always been very honest and open with us about our options and I don't feel like he gives us unrealistic expectations.  He said they can't really say why the miscarriage happened because it was so early and they didn't really have any tissues to analyze. He very truthfully said he doesn't know what we should do. If this cycle had been a total failure it would be easy for him to tell us we should probably move on past ART, but because *technically* I did get pregnant he's torn as to what to tell us. I told him we're just as torn about what to do. Based on our conversation, I'm pretty sure he thinks there's an egg quality issue. Now I didn't come right out and ask him that but I feel like that's what he was inferring. He said the embryos this time were not as good as the embryos from our 2006 cycle, which I thought was surprising. In 2006 my FSH level was around 12 and this time it was 9. With the use of donor sperm I thought we would have produced better quality embryos than last time. He spoke briefly about embryo adoption, via the National Embryo Donation Center. He's very enthusiastic about the process and said one of their former embryologists now works at NEDC.

Doug and I are compiling a list of questions we want to ask Dr. K at our appointment next week. We need some straight-forward answers about certain treatments aspects so we can make a better decision as to what we should do next. Doug wants to do an IUI cycle and use up the last of his stored sperm, even though we both know that the chances of success with that type of cycle is like -0%. However, for his piece of mind I'm willing to do it. Dr. K will probably think we're crazy but you gotta do what you've gotta do. We did agree we would just do Clomid for that cycle and save the big guns for donor sperm. In my head I think we should do one IUI with what Doug has left, two IUI's with injectables and donor sperm and then make the decision to either do one more final IVF cycle or more on to embryo adoption. 

I feel like I'm on information overload, but really its my own fault. All these possibilities pop into my head and I start trying to compile data on everything. I'm still trying to heal physically and emotionally from the miscarriage. I thought the bleeding/spotting I had over the weekend was it, oh but I was wrong. On Tuesday the bleeding came back with a vengeance and is still ongoing, it's like a very heavy period. Dr. K said it could last eight days! The cramping isn't that bad thankfully, but I have had several headaches, breakouts and nausea since stopping the progesterone and estrogen. Emotionally I'm still have mini-breakdowns at least once a day but it's much better than it was last weekend/Monday.

I'm so tired of the infertility roller-coaster, the ride is too long and expensive and I'm ready to get off. It's nearly the end of the year and by this time next year I either want to be pregnant or moving on with adoption, whether it be embryo or domestic infant.

Trying to look for the bright side

I've been making a list of things to look forward to in the coming weeks, in an effort to refocus my attention from all the sadness and heartache. First, I'm signing up for a six-week Meditation course at local yoga studio that begins in two weeks. I think it will be really beneficial for me to learn to relax and give my mind balance.

Then we have tickets to Iron & Wine on November 14th. I love, love, love Sam Beam and this will be the first time I've gotten to see him live.There's Thanksgiving and hopefully I'll be able to gather all my family together at our house for it. Our Seattle trip is about a month away, we leave on December 2nd for four days in my favorite place. I cannot wait to see our friends, eat at Volunteer Park Cafe, shop for yarn at Little Knits, take the ferry to Bainbridge Island and see the Olympic Peninsula again. This is my fourth Seattle trip and I fall more in love with it every time I go. When we get back it'll be the last week of school and then I'll be done until next semester so I'll finally have my early mornings and late nights back for awhile. It'll be Christmas decorating time soon too, as well as Peppermint Mocha time at Starbucks (even though I prefer local coffee shops I make an exception during PMT).

Our appointment with Dr. K is still on for November 10th, we're working on a list of questions to ask him about what the hell to do next. I'm hoping he'll be able to give us some promising information. We're really hoping he'll say that we could have success with IUI or IVF. If he suggests donor eggs it'll be the end of the road. We both decided that donor sperm + donor eggs might as well just go on to embryo adoption, plus its cheaper. We also want to ask if we should try another donor, if that would make a difference. My biggest concerns are he'll tell us I have more of an egg quality issue than previously thought or poor embryo quality or give us really low success rates for IUI or IVF. We'll just have to wait and see.

The Crying Game

Incidents of crying during the past few days include: 

• The parking lot of Botanic Gardens in Nashville
• In the car when my grandmother called
• When my brother send me a text message asking how I was 
• Looking at Facebook and seeing pictures of other people's babies/children
• When reading the many sweet, supportive notes from friends
• When my boss sent me a text Sunday night to see how I was
• Monday morning when my boss came into the office and asked me how I was (it's really embarrassing crying in front of your boss, at least he's clergy and used to it though)
• In the housewares aisle at Target
• In the checkout line at Target
• The elevator of the RE clinic
• In the shower (three times)
• When I threw away the positive pregnancy tests

I keep telling myself it's going to get better - I'm just not sure when.

Heartbreak

Friday morning when I woke up I discovered I was bleeding. It was bad. I had to wait until 8:00AM when the RE's office opened to call. They told me to come in for blood work but I knew it was over. I skipped my English class, called into work and went to the clinic. Of course there was a hugely pregnant woman on the elevator ride up with me (there's an OB/GYN group next door to the RE). They drew my blood and then I went home and spent the day crying. Doug stayed home from work with me, he's not one to cry but he was just as upset. By 3:00PM the nurse called to confirm, my HCG level had dropped to 33, miscarriage was happening, come back Sunday for another blood draw to make sure it's going down.

One of the worst parts was having to email/text/call the family and close friends who have been so supportive and cheered me on during this process. I'm okay if I can keep myself occupied by knitting or reading or watching tv, but if my mind wanders slightly I'm back in tears. Saturday I told Doug we had to get out of the house, so we drove to Nashville. There's been a Dale Chihuly exhibit at Cheekwood (Nashville's Botanic Gardens) and we had previously talked about going to see it. Well it was not such a great idea. The exhibit was lovely but there was a Day of the Dead festival also going on and everywhere we turned there were babies, children, pregnant women - it was painful. We had lunch and then went to the Frist Center to see their new Impressionist exhibit from the Musee d'Orsay. We had to wait for the 3:15 entrance and guess who's right in front of us in line? Another hugely pregnant women and her small child. Really. I could not get away. I also started feeling light-headed and weak, I went to the bathroom and discovered more bleeding (apparently this is normal). Doug drove home and we listened to a David Sedaris audiobook which made me laugh. When I got home I had several supportive emails from friends and a phonecall from my best friend since the 3rd grade, we talked for a long time and she kept me entertained with stories of her nursing school experiences.

I'm feeling all those traditional signs of grief, shock - anger - depression. I seem to do well for a few hours and then the wave of grief will hit me so hard to almost takes my breath away. To have had this small glimmer of hope so cruelly ripped away feels indescribable. I think about how much money we've spent (again) on this and I want to cry even more. We're supposed to meet with our RE in a few weeks to discuss the next step. I want to know if he thinks we could have success with IUI with donor or if we should move on and consider embryo adoption. We could probably swing another round of IVF if we hadn't used up our lifetime max on infertility drug coverage. Bravelle (the drug that I stim with) cost us $60, without insurance it would have been around $5,000 - for a two week supply.

Traditional adoption is still an option too but it's so expensive ($20,000-$30,000) that it would be cheaper to do another round of IVF or a few IUI cycles. I know that when people say "You should just adopt" they're trying to be helpful but instead I want to punch them in the face. Adoption can sometimes be just as difficult, if not more, than IF treatments and you still aren't guaranteed a child in the end. 

I've read online that it can take 2-3 cycles for your body to be strong enough to support pregnancy again, that would put us at January/February to try something again. I know my body needs time to heal but having to wait even longer and not being able to do anything to move forward is frustrating. Like I've said before with infertility there's a lot of waiting.

This is hard, really, really hard. I am thankful to have the support and love of family and so many friends. I'm lucky to have Doug, who is a great husband and partner and will someday be a wonderful father. But all the love and support in the world can't take away the pain and sadness. It will get better, I don't know when but it will.

The Land of Limbo

On Wednesday I went in for my blood draw and then went to work for an agonizing four hours. I left at noon and went home to take an HPT so Doug and I could prepare ourselves for the result. Well I expected a snow-white test - but there was a faint line. We were confused. We went and bought more tests, again two more tests with faint lines. We tried not to get too excited. Time ticked by while we waited for the blood test results. Finally we got the call, yes it is positive but your HCG is 22 (not good, insurmountable odds for an actual, viable pregnancy) so it could go either way. Limbo. It felt like the 2000 election, no clear winner. I rubbed my abdomen and tried to convince whatever was in there to hang on. I couldn't decide it if was better to get have gotten a negative or to have this teensy, tiny glimmer of hope, it just seemed cruel.

Friday I returned to the office for another blood draw and HCG test. I was not optomistic. Around noon I got the call, the number increased to 48, still could go either way. So the number did double in less than 48 hours (which is good) but it was still low. Sunday morning off I went back to the office for blood draw #3. The phlebotomist had a hard time finding a non-punctured vein to draw from. At one point I thought I was going to pass out because the first place she tried didn't work and she had to stick me again IN MY WRIST. So again I went home to wait it out. Before noon I gave Doug my phone to watch and got in the shower, thinking they wouldn't call until later. Well of course three minutes into my shower Doug comes to the bathroom and brings me the phone. The result? 123. This is good and the nurse sounded confident, I on the other hand am not. No more blood draws for the next two weeks, my veins are happy about that but I'm kind of scared. I need reassurance that there's still something going on in there. Monday the office called and scheduled me for an ultrasound on November 10th - 14 days away. This two week wait my be worse than the first one. 

My mind is constantly running, I find it difficult to concentrate on anything but "Is the number going up?" or "Is there really something in there?". I can't even say the 'P' word. My internet sleuthing (I know, I know I need to stay off the internet) has led met to conclude most low HCG levels don't end well, some do, but rarely it seems. I know I need to stay positive, it's just so scary. Plus in the 5+ years we've been dealing with infertility we've never really caught a break. It almost always seems like something goes badly. Even though I should be relishing my first ever positive test, I'm too freaked out to enjoy it.

The impossible dream

The other day Doug and I were talking about how most people take their fertility for granted. Most people either get pregnant without even trying or decide to try and bam - they’re knocked up. Over the past five-and-a-half-years I have become completely disillusioned; I can’t even imagine what it would be like to be able to get pregnant without involving a team of specialists in the process. Once you go through infertility and specifically In-Vitro Fertilization, you realize what an amazing miracle it is for anyone to get pregnant - ever. There are so many tiny processes that have to happen in order for the sperm and egg to rendezvous successfully and produce an actual, live baby nine months later. I told Doug that I could envision myself in law school before I could envision myself pregnant. It’s been such an out of reach dream for so long I can’t even imagine it anymore.

Tomorrow is beta day. I am 100% freaked out about it. I go in at 7:30AM for the blood draw and they’ll call us with the results by 3:00PM. I had considered doing a HPT in the morning but decided if it was negative I’d still have to go to work for four hours and be upset. Instead I’ll wait it out and once I come home at noon I’ll do a HPT and Doug and I will look at the results together.  That way if it is negative we can be together to deal.

Infertility is hard and ugly and unfair. Your heart feels broken most of the time. You spend more money than you like to think about on high-tech procedures that still don’t guarantee you a baby.  You pump your body full of drugs that you pray aren’t going to give you some awful disease in twenty years. You spend days on the verge of tears because the thing that seems to come to everyone else so easily seems impossible for you. Infertility sucks.

I’m going on ‘radio-silence’ tomorrow; we’re going to need some time to process whatever the outcome is.

On being a crazy person

I'm at 9dp3dt today. I've had mild cramps for several days now which makes me want to cry. I'm afraid my period is on its way and the only thing preventing it is the progesterone. I've felt like crying since I woke up this morning and being at work is not helping. Everyone is annoying me, I feel like yelling at them "Don't you know what I'm going through!?" but I won't. Instead I'll sit here in my office, spending the day alternating working and fishing around on FertileThoughts.com or IVFConnections because I am a woman obsessed. The combination of the hormones, the nerves and the anxiety makes me feel like a crazy person. I just want the waiting to be over so we can either decide what the next step is or be really, really surprised. 

Besides the cramping I have broken out with tiny red bumps on my chest and across my forehead. My bum is still sore from the PIO shots, although I have to say Doug has gotten really good with them. Most nights I only feel a slight sting. I only have four estrogen pills left to make it through tomorrow but I'm not refilling until I know something definitive. I'm also supposed to be ordering progesterone suppositories because if the test is positive I'll need to start them Wednesday night - but I haven't done it yet. Mainly because they're $70 and I'd rather not spend $70 on something I might not need until I have to. I'd be really pissed to spend $70 on the suppositories only to not need them and you can't exactly return suppositories.

Last week in the throes of negativity, I made a Word document that outlined what are next steps should be if this cycle fails. The first step of course is a WTF appointment with Dr. K where he tells us what might have gone wrong (if anything) and I ask questions like "are all my eggs old and dried up now?"  and " is menopause impending?" I used to think two IVF cycles would be my limit, but now I don't know. Financially, I cringe at the thought of spending another $12,000-$14,000 on something that isn't guaranteed. Emotionally, I don't want to totally give up on the idea of having a child that's genetically linked to me. IUI with injectables is an option, but I can't imagine that statistically IUI would work if two IVF cycles didn't.

Highs and Lows

It's Wednesday. It's 4dp3dt (that's four days past a three day transfer).Yesterday morning I went in for blood work to check my E2 and progesterone levels. On the elevator up two ladies told me how nice I looked and they really liked my dress, yay. Upon entering the RE's office I was met not by the regular sweet phlebotomist but instead by the world's angriest phlebotomist. My veins are c r a p p y and this lady was not nice to them as all, she totally slapped my arm until it was red and then tied that pressure thing around way too tight. Wench. The nurse called me yesterday afternoon to tell me the blood work was fine and continue the estrogen and progesterone. She didn't give me the exact numbers, which is probably better because I would have spent hours obsessing and Googling what they meant.

On the sad front, the embryologist called yesterday afternoon to let me know none of the embryos were able to be frozen. I was pretty upset about that even though we knew the chances of having any left was pretty slim. She did reiterate that they transferred the three best ones and they looked better than our previous embryos. So there's that.

Emotionally I'm trying to hang in there. Last night I went to my knitting group and was surrounded by nothing but love and support. However I still came home and had an ugly cry in the bathroom. I felt flooded by the overwhelming possibility that it might not work and fractured my heart a little bit more. Eventually I blew my nose and wiped my puffy face, got my shot and went to bed. 

Physically, I'm really sleepy, which I'm guessing is from the hormone overload my body is receiving. I'm also feeling tiny ovary pangs, maybe they're shrinking back down to size? To top it all off, I got three zits yesterday which is kind of what led me to my ugly cry because I always breakout before my period starts. Must.stop.obsessing.

I know you have a little life in you yet

Today is two days past our three-day transfer. Saturday morning we went into for the transfer. We were the only people having a transfer on Saturday so we had the surgery center to ourselves, which was really nice. The nurse was great too. Doug and I got to spend some time together waiting for the RE and the embryologist to come in for the transfer. After emptying and refilling my bladder (fun!) and taking the valium (way more fun!) Dr. D, who is the third doctor in our clinic's practice, came in to talk to us. As of Saturday we still had 9 embryos, three were 8-cell, grade 2, which I think was pretty good, and the other five were so-so. After talking to the doctor and based on our previous failed IVF cycle and my elevated FSH levels, we decided to transfer the three best ones, the 8-cell, grade 2's. Doug and I had talked before about transferring three but I assumed because of my age they wouldn't let us, but they did. So yes, there is a chance of triplets, but it's a risk we're both willing to take. After we decided to do the three, the embryologist had to do Assisted Hatching on the third one before the transfer started. Shortly thereafter Doug got suited up in scrubs and hairnet and we went into the surgery room. Doug got to sit and hold my hand during the transfer, which was only uncomfortable because my bladder was full and there was a speculum. Apparently the pathway to my uterus was a little curvier than she expected so it took a little longer to get them transferred but they got in there. Afterwords, we got the petri dish they'd been growing in and pictures of them, which is totally surreal. 

 

I had to lie flat for 30 minutes after so I tried to find some 'appropriate' embryo transfer music on my iPhone. But is there really an appropriate soundtrack for an embryo transfer? I settled on this song from Kate Bush, which is in the movie "She's Having a Baby" which I thought would be a good omen. It also makes me bawl every time I hear it

After I was cleared, I got loaded up in the car, driven home and made our bed my fortress. I spent most of the bed rest knitting, watching terrible television and playing on the computer. Saturday and Sunday I had visitors, phone calls and text messages and it meant so much. This IVF cycle has been different from the last one in a lot of ways, but the biggest different is the overwhelming amount of support we've felt. There hasn't been a day that's gone by since I started this cycle that someone hasn't asked me how I was doing. Having that kind of love and support has meant so much to me. 

Tomorrow morning I go in for estrogen/progesterone blood work so hopefully those numbers will be good. I'm taking estrogen twice a day and the progesterone shot at night. We'll also find out tomorrow if any of the leftover embryos made it freezing or not. If we had just two make it to freezing I'd have a better peace of mind, but we'll see. My HCG bloodtest will be on the 20th. Instead of nail-biting and fretting I'm doing a lot of deep breathing and positive thinking.

Dr. Downer and Dr. Fong

I'm back at work today following the retrieval, which went pretty well I suppose. Really the worst part was getting the IV because my veins are for shit. Luckily I had an excellent nurse who was able to get it started on the first try. My anesthesiologist, Dr. Fong, was kind of great, he was an older Asian man with a thick accent but when I told him how sick I was after waking up last time he said he would make sure it didn't happen again. God bless him because there was no 'number 3-ing' yesterday - a marked improvement from my last egg retrieval. I got to change into the backless gown and despite bringing my own rainbow socks from Sock Dreams I had to wear the gray footie socks the surgery center gave me, blah. Doug got to come back and sit with me until they took me to the surgery room. Everything seemed fine until Dr. Downer came in to talk to us. Dr. Downer is not my RE, he's the other half of my RE's clinic. He did my last retrieval but beyond that I haven't had much interaction with him. First off he said "I'll be honest I don't know how many eggs we'll get since last time we got four." Buh? Last time we got 12 eggs but only 8 were mature and 5 fertilized. I reminded him of this immediately. Also he talked about how low my estrogen was. By the time he left I felt like all the air had been sucked out of the room. My doctor, Dr. K, has been much more optimistic about our changes for success. Dr. Downer just made me feel hopeless. Sigh.

Last time I was already out of it when they took me to the room where they were doing the retrieval, but this time I didn't go under until I was in the room. I got a little panicky when I saw all the equipment and they put EKG monitors and an oxygen mask on me. The last things I remember was that "Beast of Burden" started playing on the MP3 speakers in the corner, my nurse read off my name and birth date to Dr. Downer, then I got really warm and I was out. I came to in recovery, feeling a little sore and dizzy. I remember before I was fully awake Dr. Downer came by and told me they got 11 eggs. I stayed in recovery for about half an hour and then they let me go to the bathroom before they took out my IV. I got dressed and rolled out to the car where Doug was waiting. I spent most of the rest of the day in bed, sleeping a little. I had oatmeal and hot tea and used the heating pad a little. Generally speaking I felt 100% better than I did the last time, not nausea and way more coherent. Today I'm a little sore and  have a slight headache but feel okay. 

I was waiting on pins and needles to hear from the embryologist this morning. She called earlier and out of the 11 eggs retrieved, 10 were mature, they ICSI'ed all 10 and 9 made it to this morning. Now we have to hope that a good percentage of those 9 embryos make it the four-cell stage tomorrow and then the eight-cell stage on Saturday. Our transfer is scheduled for Saturday at 8:30AM. We haven't directly spoken about it but I'm almost positive we're transferring two back (as long as we have two to transfer back). 

I'm still trying to think positive, despite Dr. Downer.

Thank God for Valium & Dr. Edwards

Retrieval is on for tomorrow. We have to be at the surgery center bright and early at 7:00AM. Last night Doug gave me my trigger shot, which didn't hurt as much as I had feared. I also started to take Estrace, which is an estrogen pill. They didn't tell me why I should take it but my I assume it's because my estrogen is lower than they'd like it to be. I was instructed to take a home pregnancy test this morning to make sure the HCG had been properly absorbed. It was very odd seeing an actual positive one, all the tests I've ever taken have been void of a second line.

I'm getting anxious, so thankfully I have the valium to take tonight before bed. There are so many things to worry about, Will they get enough mature eggs? Will they fertilize? If they do fertilize will they make it to day 3? Will the transfer go okay, etc. One hurdle at a time is what I keep telling myself. Plus I have no control of what happens after the eggs are out. All I can do is attempt to relax and take care of myself.  

In other IF-related news, the Nobel Prize was awarded to Dr. Robert G.  Edwards, one of the pioneers of in Vitro Fertilization. Of course it was awarded thirty-two years after the birth of the first 'test tube' baby. The sad part of the article was this “Unfortunately he is not in a position to understand the honor he has received today,” said Dr. Michael Macnamee, director of the Bourn Hall clinic and a longtime colleague of Dr. Edwards. Sad.

The news yesterday led to a other media outlets reporting stories of IVF, which I thought was nice. Then I started reading some of the awful comments from people, especially after this CNN story. Then I realized some people are just assholes. 

Running out of veins

So no retrieval today. I went in for an ultrasound Saturday and my lining is good and the ovaries look good too. Continued Bravelle on Saturday night and was instructed to take Ganirelex on Sunday morning and then come back in for another ultrasound and bloodwork. Again my ovaries and lining look good but my estrogen levels were a little low so I had to go this morning for another blood draw. I'm running out of non-punctured veins, yesterday the phlebotomist had to use a tiny vein by my wrist and it hurt like a sonofabitch. At this point we used the last of the Bravelle last night so I'm assuming retrieval on Wednesday. I certainly hope so because I feel like a whale right now. 

Saturday morning I took Doug with me to the clinic because we planned on going for breakfast afterward. We were there for over an hour, which I understand because on the weekends they're working with half the staff they normally do. There are a lot of people cycling right now so that adds to the longer wait. On Saturday there were not one, but two couples with small (like two-year old) children running a muck in the waiting areas. My clinic has a big exterior waiting room and then when they call you back you go to a much smaller waiting room with five chairs. I always leave Doug in the big waiting room because there just isn't room in the smaller one for every patient and their partner. Other people do not adhere to my belief and bring everyone in their family back there. The father of one of the small children was a grade-A jackass and did not understand the concept of the 'indoor' voice. He loudly announced to everyone that his kid 'was born here'. While that's all well and good can you at least have the common courtesy to realize not everyone wants to be subjected to you and your child? It can be really painful for those of us who have not been successful at our attempts to start a family. Not to mention he was just obnoxious and loud about everything. I wanted to murder him with my bare hands. Of course that could also be the hormones. 

I'm kind of on the verge of an emotional breakdown, I even had a big, ugly cry on Saturday regarding some family issues. I'm doing a lot of deep breathing and I wish I had time to go to yoga but even if I did I don't know how much I could do right now with the egg basket I'm sitting on. Namaste.

Currently...

I feel like the title of this song, which is one of my favorite covers. Ultrasound this morning, lots of abdominal pressure. Nurse called and the plan is stay on the same units of Bravelle and the oral meds. I go back for another ultrasound Saturday morning and hopefully the retrieval is on for Monday. My belly is sticking out and I bought another pair of yoga pants at Target this morning. I've been spending my day off beached on the sofa writing papers. 

I'm trying really, really hard to walk that thin line between being optimistic and trying not have a broken heart. I want it to work so badly but I want to be prepared if it doesn't. The thing is that if it doesn't work life still has to go on. I don't really have to time to mourn. I have a full time job that I still have to go to and I still have three classes to pass. In a way I suppose it's good, at least I'll be so busy I won't have time to wallow.

Moo

Stimming report seems to be okay, at least as far as I can tell. They weren't very specific when they called but I had an ultrasound this morning and my left ovary had several follicles (I'm assuming they're actual follicles because the nurse said they weren't antral follicles anymore?) and my right had at least three. When my coordinator called this afternoon she just continue on with the same amount of Bravelle, the Letrozole, the Dexamethosone and the DHEA (not to mention the doxycycline and the prenatal).

I'm starting to feeling sluggish and bloat-y, hello elastic waistbands. I also feel like I could eat a bear. On a typical day I have a bowl of vegetable soup and a side of baby greens for lunch. Today I ate a slab of leftover meatloaf and corn and still had room for an apple. Now I'm hungry again. As my high school friend Drew used to say, I feel like a heifer.

Bloodletting (literally & figuratively)

IVF #2: The Final Chapter has officially begun. Thursday morning I went in for my baseline ultrasound and blood draw. I got to the office about 7:35AM and it was packed. I couldn't believe how many people were waiting. Luckily, I didn't have to wait long. The ultrasound was quick, the nurse I like the best (she thinks I'm hilarious for some reason) did it. Then I had to go have my blood drawn. The phlebotomist really sweet but I have craptastic veins and she stuck me once in the crook of my arm and that went badly. She quickly changed her plans and did the draw with a teensy needle on top of my hand. Both sticks left some pretty impressive bruises.

I began Bravelle injections Saturday night and the other oral meds too. Getting the Letrozole and the Dexamethasone was a fiasco. Originally I had my nurse send the prescription to our insurance specialty pharmacy. I called them to confirm they could get it to me by Saturday - they could not. So I had to cancel the order, call the nurse again and have her fax it over to Walgreen's. Then Walgreen's told me my insurance company was denying it because I had just gotten it filled. This resulted in me calling the specialty pharmacy, calling the insurance company and calling Walgreen's. Eventually it was all sorted out and I got the drugs. So far Doug's done really good with giving me the shots, it doesn't hurt, just stings. Side effects include a dull headache and hot flashes. I woke up in the middle of the night Sunday and had to turn on the fan I was sweating so much. 

We've also encountered a problem with Doug's stored 'product'. The embryologist called last week and to make a long story short - the stored stuff has fragmented DNA and will likely not produce a pregnancy. Both our RE and the embryologist strongly suggested we use donor. Big sigh. I'll admit neither one of us was really surprised. The surprising part was no one decided to mention it until last week. So, we've spent days combing through potential donors online and thinking about the possibilities if this whole thing works. We think we've found a donor at a bank in New England. Hopefully, if all goes the donor 'product' should be shipping out in a few days. Another downside, besides the obvious, is this donor 'product' is costing an additional $800. $800 we had not budgeted for, especially since we just had to spend $600 on our central air last week. Double ugh.

Drug Store Dining Room

All my medications came, save for two oral meds I'm waiting on, and there was a massive amount of boxes. I have alcohol swabs and needles for days, plus a shiny new sharps container. All the boxes are sitting in the dining room, waiting for me to have enough time to put everything up. Which means I need to spend a few hours cleaning out the linen closet in my bathroom so I have a place to put it all.

Yesterday we went to the clinic for our injection 'class' (just the nurse-coordinator and us). Awkward moment in the waiting room when the nurse called for 'April' and there was another April. Shockingly, Bitch-ceptionist was slightly (only slightly) less bitchy than usual. During our 'class' I found out each night I take Bravelle I'll be using SIX vials of it. Now granted they aren't huge vials but SIX every night for at least nine nights?! Yipes. I had also repressed memories of Progestrone-in-Oil shots until I was reminded of them and how big the needles are. My bum is going to be sore.

Trial Transfer (or my feet were in stirrups twice this week) & Meds

So we’re edging closer to stim-start date. This past Monday I had my pap smear at my regular OBGYN’s office. I was a little confused as to why my RE’s office didn’t just do a pap during one of the half-dozen times they’ve been perusing my lady bits lately, but whatever. My gynecologist is a nice-enough person. She used to be part of a big, huge practice in the women’s hospital but then she went out on her own and has her own one-woman show. I didn’t enjoy having to share a waiting room with a couple who couldn’t have been more than 19. The guy looked totally petrified and the girl seemed totally bored. I sat playing on my iPhone trying not to seethe with too much jealousy that they’re knocked up and I’m not. The RE’s office is waiting patiently for the pap results and at first I didn’t think too much about it but of course now I’m totally panicking that something might possibly be wrong. Neurotic much?


I also ordered all my medications, which should arrive next Wednesday. By some sort of miracle we only have to pay around $550 out of pocket for the medication. But I was also informed by the insurance company that we have now used up our $5,000 lifetime maximum on infertility drugs. So there’s that. Our injection class is Tuesday and I think the Bravelle is more complicated than the Follistim was. I used the Follistim pen, which you just filled with a cartridge and clicked. Based on what the nurse told me we have to mix up the Bravelle, which will probably involve math and I’m terrible at math. Mister B will be injecting me, the shots don’t hurt but I don’t want to give them to myself unless I have to, especially the progesterone in oil, ouch and ugh.

This morning after downing a vanilla latte and three large glasses of H2O, I drove over to the RE’s office and waddled into the waiting room for my trial transfer. Bitch-ceptionist* was there of course and of course told me I had a balance. I would be shocked if I ever went up to the desk and I didn’t have a balance. This time it was $267.19, the remainder of what we owe for the hysterosonogram. Not to mention that we’ll owe the lab $250 at the end of September for Doug’s sperm storage fee. So.much.money. When I got called back I had my weight and BP taken (BP is perfect, of course) and then got to go to the exam room, put on my pretty paper skirt and meet up with everyone infertilie’s favorite BFF, dildo cam. I sat in there forever, becoming so bored I emailed my friend Lynsey with a pic of dildo cam. Eventually Dr. K arrived with a mostly competent looking medical student and he went over my chart to make sure everything was in order. He also looked through the file to see which of Doug’s frozen sample’s we will be using – it seems it will be a vintage from July 1996, which is really long damn time ago – fourteen years!?! Dr. K assures us its fine though, hmmph. The procedure itself was nothing special, med student used the outside ultrasound wand to show what was happening while Dr. K passed the empty catheter through. I felt crampy and I really, really had to pee but other than that it was fine. He had no problems and doesn’t expect any problems on the actual retrieval day.

Once I start stimming everything will move along super fast which scares the crap out of me. I’m trying so, so hard to be optimistic but I’m also freaking out about what Plan B is going to be if IVF #2 The Final Chapter doesn’t work.


*Bitch-ceptionist is the affectionate nickname I have for the PIA receptionist at my RE's office. She has the compassion of a paper towel. Also every time I see her she wants more money.