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.