Monday, 29 April 2013

Is it Obvious?

A few weeks ago I was at my desk, waiting for my next patient to be ready. Some staff members had gathered around Co-worker to ask about her upcoming ultrasound. "So, you're really not going to find out their genders?" "How are you going to shop?" "What about decorating the nursery?" I looked at the exam room door, hoping my medical assistant would emerge. Nothing yet. I checked my in-box and saw that I had a phone message from a patient looking for the results of her recent STI testing. She had been involved with her current boyfriend for a few months and they both wanted to be tested before having sex without condoms. Unless there is a time sensitive issue, I don't usually return any calls while I have patients scheduled, as I don't want to get stuck on the phone and keep someone with an appointment waiting. This is the type of the message that I would have sent to my medical assistant to relay the news of her negative results, or I would have notified her by email. "I can't believe you're not going to find out what you're having!" Another medical assistant had joined the crowd around Co-worker's desk. Still no signs of activity from the exam room. I picked up the phone and called the patient with her results so I could drown out the peanut gallery. I reviewed every test that was done with her and asked if she had any questions. "No, thank you so much for calling me back!" she hung up the phone and probably went to go bang her boyfriend latex free.

A few days later I came out of the break room with my lunch bag and started to head toward my desk. Again, there was a crowd around Co-worker's desk and as I walked past her, I saw that she was online shopping for maternity scrubs. I kept on walking and went to one of the designated quiet rooms, where I could shut the door and be free of the pregnancy related talk. I made a note to myself to return to the quiet rooms during lunch, not only to make it seem like this is a usual routine for me, but also because I accomplished a lot while I was in seclusion.

This morning, before the patient schedules started, another colleague commented to Co-worker, "You're looking so pregnant! It's awesome!!" he gushed. I surveyed my schedule for the week and tried to ignore the background noise. "Oh, you don't know what you've having! That's so old school and so cool! What have you picked out for names?" I couldn't take it any longer, so I got up from my desk and walked away. I headed to the bathroom, but soon saw that it was occupied. My next option was to seek refuge in the supply closet. After waiting a few minutes, I decided to pick up my favourite set of cervical dilators that I would need for a difficult endometrial biopsy later that week. I carried the instruments back to my desk with a sense of purpose, just in case it seemed obvious that I had vacated the room due to the focus on Co-worker's pregnancy. I need to realise that my avoidance is only apparent to me; to everyone else, I am the invisible infertile who has faded into the background.

My reactions seem bizarre even to me, as I don't want any attention if I do become pregnant. I'd be mortified if someone commented about how pregnant I looked and I would die before I let anyone help me shop for maternity clothes. I'm not jealous of the recognition devoted to Co-worker, even if she hadn't dealt with infertility, she still totally deserves the spotlight. It's just that hearing everyone talk about her pregnancy reminds me that I'm not pregnant and may never be, and it feels especially sour as we could have been pregnant at the same time. I remembered when I was only five minutes pregnant and she was dealing with hyperstumulated ovaries and what she thought was a failed IUI cycle. A rather aloof male colleague told her "when you're holding your baby, it will all feel worth the struggle." My beta was only 344 at that time, but that comment still made me cringe. It was always going to be awkward for one of us.

Saturday, 27 April 2013

Zero Sum Game

Even before I was a passenger on the TTC and later infertility roller coaster, I would cringe a little when I saw the tag line 'We're making dreams come true!' on an REI clinic brochure or website. It annoyed me as not only does it sound cheesy and hokie, it defies reality. I'm surprised their legal counsel doesn't recommend rewording the sentence to: 'Making some dreams come true. Individual results will vary. See take home baby statistics.' Unfortunately, it's not a fairy tale and not every one gets a happy ending.

Apparently, a bunch of OB patients after my first IUI wasn't any kind of omen, so I wonder what it means that there was an infertility theme to my schedule on the morning of my BFN. The comments for my first patient noted that she wanted a referral for an infertility specialist. I was more annoyed about the fact that she was only given a fifteen minute time slot (she was an established patient to the office, but first time seeing me) as I've asked the schedulers not to start a session with a discussion of infertility, menopause or herpes, as it is setting me up to run behind. She had a 9:00 appointment, and needed to change her insurance when she checked in. After her intake was done and she used the rest room, I walked in at 9:12. I reviewed her history; she and her partner were healthy and her cycles were regular, there were no readily identifiable issues. Probable male factor or unexplained, I thought to myself. I reviewed the process for the work up and gave her the list of local REs. It was 9:40 when I finished and I felt that I totally rushed her. I asked my medical assistant to review the instructions with her and I sent her an email asking her to contact me on the first day of her cycle to confirm the timing of her testing.

I was 25 minutes behind when I started with my next patient. She had an unplanned pregnancy last year and had an abortion. Now she wants to conceive, but she had an irregular cycle last month and was concerned that it indicated damage from her abortion. I reassured her that a single irregular cycle did not imply any compromise to her fertility and I reviewed how to chart her cycles and predict her fertile time. I had the feeling I would seen her back soon. My first new OB patient was newly married and was surprised that she conceived so quickly. I've been in clinical practice for over ten years and I am still astonished when a patient admits to not taking any precautions, and then is shocked when she learns that she is pregnant. I asked why, and she revealed that she was very inconsistent with using birth control and yet never got pregnant; so she figured she had fertility problems. I reviewed that taking chances and being fortunate not to encounter an unplanned pregnancy does not equate to an infertility diagnosis.

My next new OB patient was someone I saw over a year ago; she also had an unplanned pregnancy, but wanted to continue the pregnancy (she had two prior abortions). Unfortunately, it turned out to be a chemical pregnancy. She used birth control pills for six months and then decided she wanted to become pregnant again. Last month, she came into the office and expressed concerns that she hadn't conceived after four months, and was given orders for hormone testing. Her period never showed up for her to do the day 3 testing. The final OB patient experienced two years of infertility before her work up identified male factor issues. She conceived spontaneously before her scheduled appointment with a reproductive specialist. Both she and her partner commented that they had "relaxed" and stopped the stressful process of timed intercourse. I also had two postmenopausal patients on my schedule that morning. I was never so happy to talk about incontinence and hormone replacement therapy.

Although only two of my patients had legitimate infertility issues, and the others had more misguided fertility concerns, it did get me thinking about who are the infertility survivors? I know there are some established formulas that can try to predict an individual's potential for success, and many REs will offer conjectures based on their experience, but the factor of the unknown is such a prominent variable. There are stories of women who conceive against multiple odds, and couples with ideal conditions who do not. Ultimately, your treatments will either work or they won't and you truly have a 50/50 shot at being part of the take home baby statistics, which can make infertility feel like a zero sum game.

Aramis introduced this issue eloquently in her post The Infertility Probability Theorem, so I am continuing to explore some of the themes she identified. When you learn about an infertile woman's success, does it make you feel optimistic (particularly if her situation was more challenging it can inspire thoughts of -it worked for her, it can work for me!) or does it prompt a sense of despair? While being extremely happy for her, you start to feel that it will be less likely to happen for you. No, there are not an infinite number of pregnancies, but there also isn't a 100% success rate with infertility treatments. Someone has to represent the other side of the take home baby statistics. It does seem like pregnancy announcements are a kin to finding one of Willy Wonka's golden tickets. As each one is claimed, your odds of finding one diminish.

I know that our own statistics for the probability of spontaneous conception are very low, given my erratic ovaries and Husband's anemic sperm counts. Even though it happened once, my RE described it as a "fluke" and my cheeky second option consult also agreed that we shouldn't try to conceive on our own too much longer. Sometimes I can't help but wonder if that pregnancy was our only shot. I wouldn't feel that way if I saw a patient with my details, but somehow I just can't convince myself. I fell further into the trap of illogical thinking during this past IUI. On the fertility forum, there were 33 women reporting their statistics for IUI treatment this past month. On the day of our procedure, which used only 4 million sperm, I initially felt encouraged when I learned that a woman succeeded with only 5 million. However, it now felt even less likely that within this small sample of 33, you would see two women conceive with lower sperm counts. Even more preposterous; there was another woman who did her IUI at the exact same time as me. When she announced her BFP, it seemed like it was a lot to ask the Universe to grant success to two people at the same time.

There. I've let the irrational side of my brain say what was on her mind, and now I'll go back to focusing on my own lane and disregarding the noise around me. The only trouble with engaging in the sensory deprivation of swimming is that it allows too much opportunity for thinking. I need to re-invoke my 'no maths before 9 AM' rule.

Wednesday, 24 April 2013

Cautiously optimistic...defensively pessimistic...

The rationale side of my brain knew not to be too fussed over the details of my follicles or Husband's sperm count; as we all know, it only takes one. The more volatile emotional side of the brain oddly appreciated the lower count for helping to appropriately set expectations. I have been afraid to be hopeful. It was nearly a year ago that mid-luteal phase cramping convinced me that it was a surefire sign of implantation and my BFP was in sight. Maybe I was just more sensitive to my endogenous progesterone that cycle, but the ensuing arrival of AF was profoundly devastating. Inexplicably, I broke into a hysterical crying fit over that BFN, but didn't cry at all when I knew I was miscarrying. After receiving the news of Husband's semen analysis, I quickly accepted that it unlikely that we would conceive on our own, and went though each cycle with little faith that it would succeed. It was easier to face AF each month when I was anticipating her arrival, and thus wouldn't feel so disappointed.

This was the first time since the crashing letdown of the faux implantation cramping that I felt we had reason to be cautiously optimistic. We did the Advanced Placed version of timed intercourse with an IUI and we had an additional sense of encouragement from our spontaneous conception (an event that Husband often refers to as a "prick tease") Still, I was reluctant to reach out on that limb, knowing how painful the fall can be. The fragility of my emotions could be protected by taking a defensively pessimistic approach. Prepare for the worst, and possibly be surprised...

It's easier to gear up for the practical consequences of a BFN. I picked up my refill of Femara and made arrangements for my Ovidrel injection to be delivered. I started to look at my schedule to figure when would be best to coordinate my baseline scan. It's much harder to brace yourself for a negative result emotionally. No matter now many times I told myself, 'you're not pregnant', no matter how many times I imagined myself seeing only one line on the stick; as long as there is a slight possibility, the notion of a negative result just doesn't completely settle.

I joined a thread for April IUIs on the infertility forum, and I was encouraged early in my 2 ww when   a woman reported that she got a BFP after her 5th IUI and her partner's count was only 5 million. I was actually managing to keep the upcoming test day on the back of my mind until a woman who had her insemination at the same exact time as me posted a picture of a faint second line on her stick 10 days past IUI. Now I was consumed with wondering if I could be pregnant. I refused to test early. Co-worker tested on 11 days past IUI and was negative and was only faint positive on day 14 (and it's a twin pregnancy). I didn't have any symptoms, but I didn't preceding my BFP. By the way, running 10 miles in the mid-day sun and becoming significantly dehydrated is a great way to mimic some signs.

My RE's office instructed me to test 13 days after IUI, which worked well as I didn't have swimming that morning, so Husband and I could be together to celebrate/mourn the results. My internal alarm clock wakes me up at 5 each morning, but I just laid in bed, bladder full and ready to burst, but still not ready to test. Finally, it was time to end the agony. I POAS, and walked out of the bathroom and into the kitchen to count out the three minutes. When I went back in, the familiar solitary line on the stick greeted me.

I simply climbed back in bed, I had about another hour before I was due to get up. Husband wrapped his arm around me. He didn't ask; the absence of any shrieks of joy told him the result. A [my cat] jumped on the bed and snuggled right next to my midsection. I love when he does this, as I can feel him shift or stretch and I wonder if it is similar to feeling a baby move inside you (silly, I know). No crying, just a heavy heart. So maybe you can prepare emotionally for a BFN. Maybe I'm still holding out to possibly be a late positive like Co-worker. Maybe it ain't over until the fat lady [AF] sings. Maybe it's just easier to feel strong when I'm literally sandwiched between such unconditional love and support. Maybe I just don't know what I might face in the course of the day that could trigger the tears.

Random Follow Up Note: I had a moment of achieving a sense of peace with my decision to decline Myrtle's offer to be a godparent to little Myrtle while I was shopping for a card to send her. On a selfish infertility related note, it would have been hard to participate in the ceremony after the BFN from IUI#1, and I now know that travelling to Connecticut for a few days would have conflicted with the start of my next cycle and would have forced us to sit out for a round. I do realise how self-centred that sounds, but as I ovulated the night I flew out for Myrtle's shower, it would have represented missing two opportunities to conceive for someone who succeeded on her second attempt merely by looking at her husband. Anyway, as I was looking through the card selection at Target, I found that I couldn't even stomach getting a card that had some religious sentiment or bible verse on it. "C'mon!" I thought to myself "This is California, they have to have cards for atheists to give their believer friends!" Well, ask and ye shall receive! Seek and ye shall find! I found a white card with the word 'christening' in silver letters on the front and the message inside simply read 'wishing you joy on this special day'. So perfectly generic!

Monday, 22 April 2013

I wish that I knew what I know now when I was younger...

One of the most compelling scenes in 'The Cider House Rules' is when Dr Larch, Homer and Buster are burying a young girl who died from an illegal abortion. Well actually, Homer and Buster are the ones digging, while Dr Larch watches over them. "What did she die of?" Buster inquires. "She died of secrecy." Dr Larch lectures sternly. "She died of ignorance!" he finishes sharply. 

I hate ignorance. I hate misinformation. I hate how ignorance breeds misinformation. I have often declared that I want to hunt down the person who started the rumour that women need to start birth control pills when their period ends. However, one of the greatest challenges in medicine is keeping up with new information and new developments that often require professionals to retract or sometimes contradict previously disseminated messages. I can remember at some point in my training (prior to specalising in women's health) learning that women should use alternative contraception and wait three months before trying to conceive after stopping birth control pills. Some of the rationalisation for waiting three months is to allow for a woman to start prenatal vitamins for an optional amount of time before a potential conception, and it allows a woman to observe her own natural cycles and determine her fertile time. Unfortunately, the suggestion of waiting three months seems to have been translated into a presumption that one can't get pregnant until three months after stopping birth control pills.

I know I obviously have advanced knowledge of pharmacology, but it is too logical to follow that if you need to take the birth control pill at the same time every day in order to prevent pregnancy that it can't take three months to flush out of your system? I thought back to when Myrtle told me that the friend who told her it would take six months to conceive after stopping the pill, also conceived within a month or two of her final pill. At that moment, I chose to ignore the comment, especially as I was annoyed at her for flaunting the fertility of others in front of me. Referencing my title for this post, I wish I had comeback with "Well, she obviously knows what she is talking about." said in an acrid and heavily sarcastic tone. Ah, coulda, woulda, shoulda...moving on...

"What do you have for me?" I asked my medical assistant
"She's here for her annual, but also wants to talk about fertility..." I sensed from her pause that there was more to the story
"She stopped her birth control pills and hasn't had a period, and she mentioned that her boobs hurt, and I know my boobs hurt when I was pregnant..."
"Cut to the chase scene, please."
"Her pregnancy test was positive."
Well, this development makes the fertility talk easy, I thought; but I would soon discover that her case was anything but simple.

She was 31 years old and her history was quite complex. When she was 17 she was rushed to the hospital with what the school nurse thought was an acute appendicitis, but it turned out to be ovarian torsion and she lost her right ovary. When she was in her second year at University, she was diagnosed with Hodgkin's lymphoma and battled her cancer with several rounds of chemotherapy. Quite predictably she was concerned about the effects of her chemo on her surviving ovary. I asked her about her fertility plans. She wanted to conceive in about three years, she and her current boyfriend had only been dating for seven months, but she felt that he was the one. I asked why she stopped her pills now. "I've heard that it can take a long time to get pregnant after stoping the pill." I followed by asking where she heard that notion "It took my sister a year to get pregnant, so I figured it would take me even longer."

The news of her positive pregnancy test was a complete shock to her. While she was happy to learn that she had overcome her potential biological limitations, she was not prepared to be pregnant at this time. She had just completed her master's degree in library science and received a coveted offer to work for the National Institute of Health in Washington DC. As a way of celebrating her graduation, she had booked a trip to Central America for two months before her cross country move. Her boyfriend wasn't planning to move to DC with her until he found a job.

I think the most infuriating aspect about ignorance is that most people are oblivious to their ignorance and may be blissfully unaware of the potential consequences. It makes me think of one of my grandfather's favourite  sayings, "I wish you were a little smarter, just so that you would know how dumb you are." What I found so frustrating was the fact that she thought that stopping the pills without using any other contraceptive method in order to conceive in three years was a sound strategy. Yet at the same time, I had quite a bit of compassion, as given her history of having her one ovary prematurely aged by the effects of chemotherapy, I felt that I could very easily be following her infertility blog.

In a way, we are all ignorant about our own fertility. No one really knows how their reproductive organs will perform until they are taken for a test drive; but sheesh, don't walk into a dealership unless you're ready to buy a car! I've been asking myself if I knew then, what I know now, would we have done anything differently? As we're technically defined as being sub-fertile, if we had started TTC years earlier, we'd be more likely to conceive spontaneously, allowing more time for the stars to magically align. Yet it would have stretched out the process of watchful waiting much longer. I can honestly say that although Husband was prepared, I wouldn't have been ready for a pregnancy too much earlier before we started trying.  I represent the rate determining step, and he's the rate limiting step.  I definitely wouldn't have worried about being pregnant at Myrtle's wedding, nor used Plan B to avoid missing our Olympics trip. We could have started to pursue procreation six months earlier, and if it had happened -everyone would have found a way to deal.

Saturday, 20 April 2013

A Close Call

It was 5:15 on Monday morning, 15 April 2013. I was watching my cat eat his canned food so I could inject him with insulin before leaving for swimming, as is the new routine in my life. Facebook had notified me that Rachel Green had posted on my wall. It was a picture of my parents at a Red Sox game with the caption "your parents are adorable!" My parents befriended three other couples during the sevenites and when I grew up during the eighties, we would spend winter weekends and summer holidays with them. As the decade grew to a close, two of the couples divorced, one (already divorced) remarried and moved to Florida, another relocated in Tanzania and one died. The only members of that original group who keep in touch are my parents and Rachel, the now 41 year old daughter of one of those friends.

There was so much that was captured in that single image, my parents were decked out in their Red Sox gear and my mom was sitting on my dad's lap. They have been together for over forty years, and they're still madly in love with each other. My parents are truly interesting and fun people. They love to travel; each year they go on a 'spring break' (I tease that someday I'll see them on MTV's Beach house). They go watch my dad's beloved Red Sox at a different stadium each year. (BTW, Husband is a Yankees fan -it gets real interesting) In the past year they've seen Sir Paul McCartney and Billy Joel in concert.  They have a lot of friends and love to hold dinner parties. They probably have a much more active social life then we do. They saw almost every Oscar nominated movie this year (using their Senior Citizen discounts at the matinee). When I mentioned to my mother that we hadn't been to the cinema except for the Bond film, she commented "You see, we are cool... and you are not."

It certainly is true as my parents were spending the weekend with someone only 5 years older than me. My local friends look forward to visiting with my parents when they come to visit, which is still odd to me as I remember going through that phase as a teenager when your parents are such an embarrassment to you. My father is Facebook friends with many of our friends here and in England, and he comments on their posts more often than mine! However, as cool and fun as they are; they are still my parents and the complexity of the parent-only child relationship abounds. My father and I have conflicting political views and my mother knows just what buttons to press to irk and annoy me. I am a 36 year old successful professional who still craves her parents' approval.

There were other details I absorbed from Rachel's photo. My parents are starting to show their age. Although my father still has a full head of hair, it's looking quite grey. My mother is wearing glasses. Fortunately, they are both in great health; but I started to wonder how many years of this active life do they have left? More so, I wondered if they will ever be able to share their travels, baseball games and the Macy*s Thanksgiving parade with a grandchild.

I had finished with my morning session when I learned of the bombing at the Boston marathon. I had a friend who had qualified, so I went to check in with her Facebook page to make sure she was okay.
Photo used without permission

I found this email from my parents:

We were at the exact location of the explosion less than 0.1 mile from the finish line, 10 minutes before the bomb detonated. We were on the T at time. Now on the Mass Pike, heading home. Listening to radio coverage. It does not sound good.

 Love Mum and Dad.

It was so surreal. I couldn't believe my parents escaped a brush with death (or a serious injury). More so, I couldn't believe that I didn't know they were at the Boston Marathon. I wouldn't have known that they were in Boston for the weekend, if it weren't for Rachel's photo. My father likes to return to his home stomping ground on Boston's Patriots Day and had always wanted to watch the marathon. I last spoke with them two weeks earlier, and they never mentioned these plans. My parents also live less than ten miles from Newtown, Connecticut and the scene of the horrific school shooting. I am beginning to wonder if there is some kind of black cloud following them. I fear an earthquake might strike then next time they visit us in California.

I started thinking about mortality and began to wonder if I should tell my parents that we are trying to conceive (perhaps not the full story of my miscarriage and infertility issues) so that if they meet their demise before meeting their grandchild, they'll know that we at least tried for them. When my grandmother died, I remembered listening to my father giving the details for her obituary, "No great-grandchildern, but there is one on the way, and she knew about it." I've reviewed the dates; my cousin must have announced when she was only six weeks along. I wrote about my reasons for not telling my parents about our situation in Staying in the Closet . As I acknowledge that my parents hadn't even told me about their weekend plans, I realise that I'm not ready to disclose such a private part of my life. However, I need to talk with them more often. I need to let them know how much they mean to me. I need to do more to let them know how much I love them.

Thursday, 18 April 2013

A 2 ww in review

As it's been a while since I've been in a 2ww, I thought I would take a look back at what I did during the 14 days that preceded by my positive test. Please note, I do not think that anything I did helped achieve my BFP or contributed to my eventual miscarriage.  It's just an activity to pass time...

CD 12 -Positive OPT
Long day and disappointment with the new Bond film contributes to unsuccessful coitus. Rocket ship was on the launch pad, but failed to blast off. Assisted reproduction is starting to seem easier.

CD 13 -Ovulation night
After spending most of the day shopping for kitchen appliances, we finally have obligatory sex around 8 PM, probably too late...

CD 14 -1 DPO
Lament frustration over another futile cycle with a 10 mile run.

CD 15-18 Days 2-5 post ovulation
Swim each morning. Call RE office to arrange to proceed with IUI next cycle.

CD 17 -4 DPO
Discover that AF will likely start during the long four day Thanksgiving weekend and thus I will not be able to have a baseline scan on CD 2 or 3. Decide to use supplemental progesterone to delay her start. Find some Crinone in our supply closet that expired 6 weeks ago. It seems appropriate for my intended use.

CD 19 -6 DPO
Run 5 miles on a treadmill. Remember why I hate running on a treadmill. Visit with a friend and drink three generously poured glasses of wine.

CD 20 -7 DPO
Wake up with a throbbing headache and dodgy stomach. Fuck; can't remember the last time I was hungover. Need to get up to attend a workshop. Hope that a shower will perk me up. It doesn't. Crawl back into bed and consider bailing, but realise I'd have to find time to make it up. Buck up and get dressed. After twice fighting the urge to pull the car over and be sick, do the 'drive thru of shame' at nearest McDonalds. A sausage McMuffin is the ultimate hangover remedy. Sit in the back of the lecture hall as hangover finally lifts. Swear off alcohol (for now).

CD 21 - 8 DPO
Run 80's themed 10 K. Facebook friends comment that I'm looking hot, which validates hard work and infertile status. Later that evening, become excessively distraught over death of a certain character on Boardwalk Empire (which would inspire blog title) -blame emotional feelings on the progesterone I've been putting up my hoo-ha.

CD 22-24 Days 9-11 post ovulation
Swim daily. Break 8 minutes in 400 kicking time trial and beat rival Phelps for the first time.

CD 25 -12 DPO
Thanksgiving Day. Run 10 K trail run. Comments from cousin's insensitive husband about our intentions to have children during dinner encourages consumption of second glass of wine. Four day abstainance from alcohol ends with an exclamation point.

CD 26 -13 DPO
Notice some dried mucus, which usually announces AF's imminent arrival. Burst into short crying fit that I can't seem to catch a break. Tell Myrtle "Quoting Ginger from Homefront, 'there is no way in God's green earth that I could be pregnant!'" She is gracious enough not to repeat these words when I announce news to the contrary. AF doesn't show up, my progesterone delay tactic worked. I am a genius!

CD 27 -14 DPO Still no AF, but run half marathon in a decent time and still feel good afterwards, which is equivalent to a BFN. Pick up Femara from pharmacy in anticipation of upcoming IUI.

CD 28 -15 DPO No AF. Fuck, I've overcooked myself with the supplemental progesterone. Retract 'genius' statement.

CD 29 -16 DPO Scheduled appointment for baseline scan prior to first IUI cycle, but AF is no where in sight. POAS only because RE will ask if I did and I need to give an answer. Blown away when the second blue line appears. Despite the inevitable unfortunate outcome, this was still one of the biggest surprises in my life.

Tuesday, 16 April 2013

My Fur(st) Baby

When I was 20 or 21, I had three aspirations for my life; I wanted a career in women's health care, a ginger cat and a manual transmission VW Jetta. If I accomplish nothing else in my life, I can say that I fulfilled the goals of my younger self.

As soon as I had my first real job and settled into my own place, it was time to acquire the cat. I went to the local shelter and fell in love with A from the moment I saw him. I knew he was meant to be my cat, although I had to go through three interviews with the staff at the shelter. His foster mother commented that he was a feral cat, but despite his instinctive skittishness, she felt that he had the potential to be a very loyal companion. I brought him home, but he remained extremely shy and fearful and hid from me. Six weeks later and I hadn't come close to petting him, friends and family asked if I considered returning him to the shelter. I couldn't do it, as he either wouldn't get adopted, or would be just as scared in a new home. I was stuck with a dud of a cat.

Then one day I noticed his eye looked crusty and he was rubbing it with his paw. Suspecting conjunctivitis, I made an appointment with the vet, without considering how I would get him there. It took forty five minutes of chasing around my apartment, moving furniture and eventually dragging him out from under my bed. As I drove to the vet's office, I figured there was no hope for our relationship. This cat now hated me. It turns out he did have conjunctivitis and the vet prescribed a steroid eye drop and antibiotics. I gave him his medicine as soon as I got him home, figuring he was already pretty pissed with me. I was planning to go to the gym and leave him in peace for a little while, but as I was nearly out the door, I looked back and saw him hiding under the kitchen table with a sad look in his eyes. Carefully, I approached him and to my surprise, he didn't run away. Slowly, I picked him up and moved to the couch. Once I sat down, he just melted in my lap and started purring loudly.

That night transformed him into the affectionate and loyal cat he was predicted to become. He sleeps beside me at night, he greets me when I come home from work. He loves to be petted and held. A is such a great companion, it helped feul my anti-baby arguement in my pre maternal instinct days. How could having a baby be better than what I had with A? Feeding and elimination management was much easier. We could leave A at home and go out whenever we wanted. A would always give me unconditional love and would never talk back or sass me. As A is an indoor cat, I would never have to worry about him staying out with friends and coming home late. Plus, he's much less expensive!

Husband was trying to convince me that there really is something special about seeing something that starts out at the size of a 7 pound loaf of bread grow into a whole person. "You can't play tennis with A... and just think how proud you'll be when junior scores his or her first goal..." I responded that no child of a goalkeeper and sweeper would be a pansy forward -defense is where it's at! I guess that comment revealed that I had been thinking about procreating and was warming up to the idea, but his follow up line melted me a little more, "We should have a baby sooner than later, so he or she will get to meet A and know what a great cat he is." I have wondered about how things would change for A if we had a baby, ultimately fearing that he or she would pull his tail or dress him in doll clothes. I often noted that when I visited friends with new babies, their cats would flock to me, starved for attention. One friend gave her cats away when her first son was born. As if, 'I have my baby now, I'm done with my cats...'

Shortly after my hysteroscopy, I started to take note that I was filling the cats' water and food bowls more frequently and I needed to replace the litter more often. These are cardinal symptoms of diabetes in humans, are they the same for cats? I had my answer when I picked him up one night and could tell that he had lost weight. I expressed my concerns to the vet, but she thought hyperthyroidism was more likely. Two days later I had a voicemail on my phone, "You were right, A has diabetes." I felt so satisfied that I was clinically accurate, but I so wished that I could have be wrong. Soon I was pricking his ears to check his glucose levels and injecting him with insulin twice a day.

I told Co-worker about A's diagnosis and she responded that her cat is also diabetic. "Do you give her insulin?" asked a medical assistant. "Um, no." she replied "it's a cat" not so subtly implying that I am crazy cat lady. Although I confess that I've been feeling like I am Angela from The Office, but how could I not give him the treatment that he needs? He's still maintaining his usual quality of life, finding new places to sleep, playing with his sister and he's as sweet and affectionate as ever. From the moment I adopted A, I've always accepted that a day would come when we say goodbye. Admittedly, it's harder to think about losing my kitty baby before I have a human one. However, I promised him that as long has there is quality in his life, I will fight for him and I will take care of him, until he tells me to stop.

End Note: A adjusted to his new high protein diet and is doing great with his insulin injections!

Sunday, 14 April 2013

This one is for you

It was the 4 x 100 Medley Relay, the final relay and penultimate event of the three day annual XYZ Masters Swimming Championships. I stood on the starting block awaiting Phelps to finish the final strokes of her butterfly leg. Sounds of cheers from the crowd echoed around me. As she was inches away from touching the wall, I whispered, "this one is for you", before I sprung off the blocks and plunged into the silence of the water. I know I wrote in my previous post, Just keep swimming that I need to use the experience of sensory deprivation during swimming to get past the various milestones encountered in our conception journey, but it was harder this weekend as the meet brought back many memories and held so much meaning for me.

Fast dolphin kicks, stay submerged as long as you can, then burst into four fast strokes before your first breath...  My first memory flashed back two year ago when I just started swimming. I could barely finish a modified version of our set with fins, but I was determined to finish the ten week course. The instructor had just established an official US Masters Swim team and had some tee-shirts made up for the few swimmers who were performing at this championship meet. She was desperate to off load the extras that she had ordered, so I decided to buy one. I wanted to do a favour for her, since she was so gracious to keep me in the class and I desired some type of souvenir for myself as a reward for completing the session. I told her that I would buy one if she agreed that I never had to swim in competition. "We'll see about that." was her answer.

Coming up to the first turn, tight streamline off the wall and work on building your speed... The next flashback brought me back to last year when I was finding out that procreation wasn't as easy as I thought it was going to be. The Plan B incident caused a slow start, and most recently we missed having timed intercourse due to my parents' visit. I was starting to feel discouraged as Myrtle had just announced her pregnancy and I sensed my parents' jealousy. Additionally, I knew we has also missed the opportunity to have a baby born in 2012 (remember, that was important to me at one point in time...) Even then I acknowledged that these issues were petty, but I couldn't escape this premonition that we would have trouble conceiving. I needed to suppress these emotions in front of my patients and my parents, but during the fifteen minute drive to the pool each morning, when I was alone in the sanctuary of my car; I could cry.

It was quite ideal actually; soon my red puffy eyes would be covered by my goggles and if anyone ever asked, I could attribute it to the chlorine. I arrived one morning and tried to avoid making eye contact with anyone, when my coach called out to me, "Jane, did you sign up for the big meet yet?" she asked in a sing-song-y tone, "You know you want to..." Oh, fuck it. Why not? I thought to myself. If anything it was just a nice distraction from the futility of our conception efforts, and at the same time, fertility concerns were still so much on my mind that I didn't really process the fact that I was a 35 year old novice swimmer about to swim in her first meet and wonder what I had gotten myself into. I entered one event -the 50 yard freestyle and found out I was swimming in two relays when I showed up at the pool. Without any nerves or expectations, I just went out and swam my events. I would find that the thrill of competition and the rush of adrenaline through my veins is as addictive as any illicit drug. My only regret that day was not entering more events. More so, swimming had me even more hooked than before. This meet transformed me from a recreational into a competitive swimmer. I had new goals; improve my strokes, get faster times.

The wall -we meet again! Half way there...continue to resist don't need air...just build more speed... Now my mind is flashing back to the past few weeks. If this pregnancy had been successful, I would be 22 weeks at this point in time. Presuming I had a normal amniocentesis and anatomy ultrasound, we would be sharing the news with my parents. My plan was to coordinate with Myrtle to find a time when she and her parents would be visiting with mine. I figured if we couldn't tell them in person because of the cross country distance, I wanted them to be with their extended family when they received the news. I would text Myrtle after sending an email to my dad. She would approach him, "Hey, I got an email from Jane with a picture, but I can't open it, can you check on your iPad?" There he would find an attachment of an ultrasound photo with the words, "Baby Allen, due 5 August 2013". Yet, rather than working out these details with Myrtle, my last few weeks have been focused on starts and turns.

Final lap! Stop breathing and kick into overdrive... Well, here I am in the present. I'm not standing on the sidelines cheering on my teammate, wishing I were swimming as I place my hand on my bump to remind me. I'm in the pool now and I've been kicking ass. I've done four events and four relays and established new personal bests in every race. I scored points in each event and have more ribbons to hang on my wall. Co-worker tried to discourage me from swimming days after my IUI "Just walk on a treadmill if you need to exercise..." she advised. Fuck that. I was determined to compete. (For the record, my RE did clear me to participate. Although technically, I just asked if I could 'swim'...I didn't exactly mention what I would be doing...) There it is! the wall is insight, head down, no breathing, go hit that fucking pad!

I got out of the pool 'like a champion' and soaked in the congratulatory hugs and high fives from my teammates. As I started my warm down in the practice pool, I had to answer the question -who was I referring to when I dedicated my swim, this one is for you? The generic ultrasound image on my Dad's iPad that would represent his wish for a grandchild? The potential embryo that could be making it's way to my uterus as we speak? That sounds so corny, I am aghast as my fingers type those words. No, my comment was directed to myself. This swim was for me. This meet was for me. It may look insignificant, I'm truly still a novice swimmer. I'm not a threat to place at the top of any event. I have a lot of technique errors; disaster would be a generous word to describe my backstroke and my breaststroke kick is barely legal. Yet, I've managed to surpass swimmers who have been swimming much longer than me. I'm getting closer to some of our faster swimmers and I feel that I can improve even more. In two years, I've been able to achieve things that I never imagined could be possible, which is how I feel about my prospect for motherhood. At least I know that what ever happens with our fertility treatments, I can always look forward to this meet every year.

Friday, 12 April 2013


Of all the other things that are easier for fertiles, I think included on that list is that they do not have intimate knowledge about their own gametes. Their BFPs arrive without knowing how many follicles of what size were present. They probably don't even know which ovary released the ovum. No one knows the sperm count or the other fun stats, such as motility or progression. It's one more measure of the awkwardness of fertility treatment. There's nothing like knowing exactly what each of you are bringing to the table.

Although, maybe there's a lesson to be learned from the naivete of fertiles. I decided that I would not be too fussed over the details going into our first IUI. I've read plenty of stories on fertility forums and other blogs and I've seen couples get BFPs with few follicles and low sperm counts and women with multiple follicles and a billion post wash sperm come up empty. There are so many variable and other factors at play, it's comparing apples and oranges. They are only numbers and they don't necessarily mean anything.

Well, in the interest of disclosure, here are our numbers. I went in for monitoring on CD 11 and had a lead follicle on my right ovary measuring 18.1 x 16.4 mm, with a smaller one at 11 mm present. There was nothing on the left ovary. I was instructed to trigger the next night and return three days later for IUI. I claimed to need dental X-rays as my reason for leaving the office for an hour. It's the benefit to having bad teeth, I have a convenient cover story; but the irony is that I've been neglecting my dental health and I'm overdue for my cleaning. I could say it felt weird to be leaving work in order to try to get knocked up; but once during our TI days, Husband was departing for a trip in the evening, so I went home during the lunch hour for some afternoon delight, which was probably some of the most fun we've had while TTC. I had my moment of needing to get over the fact that this wasn't exactly as I ever imagined this process would be.

Husband's total count was 12 million, which was his lowest to date. His first post Clomid wank test showed his count to be 17 million, so we were factoring that if we lost half in the wash process, we'd have 8.5 million, which would be within the 5-10 million ideal for IUI range. Unfortunately, his post wash count was 4 million, with motility at 61%.  Just poor timing to have a bad sperm day.

I know that even if we were in ideal territory, the success rates with IUI are still fairly low. Some statistics note that it's not more effective than correctly timed intercourse; but it does help eliminate the potenital for user errors, which in our case, is not an insignificant factor. We struggled with timing and performance issues as well as an accidential withdrawal method. No matter how long I rest with my yoga mat propped under my hips, there are still issues with 'spillage'.  So we probably end up with less than 4 million left to our own devices.

I went back to the office as I had a few term patients left on my morning schedule. I've never really been bothered by the fact that my job forces me to interact with pregnant women all day long, but for some reason I was a bit affected after my IUI. I remember in my pre-TTC days, I would see patients at the end of their pregnancies who were huge, stretch marked and uncomfortable, and would think, 'I'm so thankful I'm not pregnant!' When I accepted that I was ready to have a baby, I would haughtily think, 'I'm not going to look like that when I'm pregnant'. Today as I went from room to room and saw the excitement in my patients' eyes as they anticipate the arrival of their babies, there was a resounding thought confronting me; I'm not going to look like that -full stop. Not from this IUI cycle anyway.

Tuesday, 9 April 2013

Thanks, Masturbation!

Yes, I actually have a shirt with those words. I'll explain the 'why' in just a second, but in the event that an IUI or IVF cycle actually produces a child, we thought we'd give it to our son or daughter when he or she is old enough to understand the, 'here's how babies are made...and this is how you were conceived...' conversation. So, the shirt is from a program I did to promote the Midwest Teen Sex Show. The MTSS was a series of podcasts hosted by a woman who had her first child as a teen and wanted to discuss the dangers of sex, drugs and rock and roll in a format that would connect with young people. The program debuted with a skit discussing Female Masturbation, where the host promoted self exploration as a method of sexual discovery that avoids the possibility of pregnancy and infections. She also describes that the release of endorphins creates a natural high, which makes masturbation the ultimate anti-drug. The scene cuts to an adult actress who is dressed as a young girl (complete with pigtails, cowboy hat and knee socks). She is skipping down the sidewalk, lollipop in hand when a junkie approaches her and offers an array of drugs. "No thanks," she politely declines "I'm going to go home and masturbate!" She then looks into the camera and offers a cheesy grin and a thumbs up, "Thanks, Masturbation!"

An episode of the brilliant BBC comedy Coupling featured a couple going through an infertility evaluation. An American version of the show was attempted, but failed as much of the humour didn't translate or was cut by NBC censors. Additionally, there isn't an American version of a Welsh character. The said Welshman [Jeff] was about to get it on with a woman way out of his league, when they were interrupted by his mobile phone.  "I have to go" he tells her "Steve needs me to go to his flat, pick up some porn, his pillow and a snack and meet him at this address". "Why?" she asks earnestly. "I don't know," he admits, "I didn't think to ask." It turns out Jeff's friend Steve is in the 'special room' at a fertility clinic, but is having trouble with the task at hand. Steve started to explain that he took issue with the porn selection (he prefers lesbian only) but then reveals there were other troubling aspects. "I had to book an appointment, and check in with a receptionist." he details, "There are not supposed to be appointments for masturbation. It's done in secret when there's an opportunity. There is no receptionist for masturbation". What he objected to most, was the notion that "I'm being asked to masturbate...for a good cause." Thus without the sense of wrongness and shame that was so familiar to him during the process, he couldn't rise to the occasion.

Seriously, what words of encouragement can you offer to your partner when he is headed off to the masturbatorium? (yes, that is an official term) 'Good luck'? 'Go get 'er done'! or 'Lie back and think of England'. I decided you can never go wrong with a StarWars reference: MAY THE FORCE BE WITH YOU!

Monday, 8 April 2013

Infertiles Anonymous

It's awkward being in the dual role of referring provider and a patient at my RE's office. At my initial consultation, the receptionist identified my name and asked "Oh, are you the one who works over at XYZ?" I simply nodded. She noted, "your office staff does such a good job of forwarding patient records." I didn't tell her that I personally pull all the pertinent results and notes and write up a summary sheet as I hate receiving incomplete or disorganised records. During my exam, my RE commented, "I can tell you're an Ob/Gyn provider as you've positioned yourself perfectly on the exam table..."

One of my biggest concerns when I first stepped foot into my RE's office was running into a current or future patient. I arrived at the information session early so I could take a seat in the very back of the room and I stared out the window to avoid making eye contact with anyone. I feared someone would recognise me and think, 'she can't be any good -she can't even get herself pregnant!' I schedule my appointments at the beginning or the end of the day when there are fewer fellow patients in the waiting room. I'll also slightly alter my appearance; wear my glasses, pin my hair up, find someway to be in cognito. I bury my face in a book or my phone and use every bit of body language to convey 'don't approach me'.

I feel that I have progressed in this process that if I do run into a patient, I can just say, "Yes, even me." However, I resent the fact that attending a fertility clinic outs your status as TTC. It lets everyone into your private life in more than one way. To a certain extent, it reminds me of the uncomfortableness associated with purchasing birth control as a teenager (okay, late teens) and dreading the judgement from adults who would know that I was engaging in premarital sex. I recall shopping for condoms in Tesco. I selected the queue with the youngest checkout girl as I feared the older women would see me as being the same age as their grandchildren, and might feel compelled to lecture me. I packed my purchases into my rucksack myself and proudly started to walk out the door. An older lady called out to me and as I turned around, she held up the box of condoms, which I had left on the till. She winked at me as she placed them in my hand. Now, I feel the embarrassment is generated by the accompanying pity, 'Oh, you're trying for a baby, and you can't do it by simply having sex?'

Is there a secret code among infertiles? That what happens at your RE's office, stays at your RE's office? Membership to the infertility club implies a promise to keep each other's secrets? At the very least, can I claim access to a type of reverse HIPPA protection that prevents my patients from telling anyone 'Guess who I ran into at the fertility clinic today!'

Speaking of, guess who I ran into coming out of my RE's office today? I was walking out of the office and I spotted my office manager feeding a parking meter. Oh fuck. Every so often she has to attend meetings at the hospital right next to my RE's office. As it was raining, I had an umbrella somewhat covering my face, although I know she would have recognised my jacket. I'm pretty sure she didn't see me as she didn't look up from the meter, and there aren't any signs [from her vantage point] for the fertility office. A reminder that I'm not safe even outside of the waiting room.

Saturday, 6 April 2013

Another one of life's lessons...

They say women marry men who are like their fathers. As Husband and my father get on very well, I can definitely appreciate some similarities. I did not realise, apparently women also marry men who are like their grandfathers. My mother's father was born in 1920 and grew up during the Great Depression. When he was 18, he joined the army and later fought in World War II. Both events had a profound influence on the rest of his life. He refused to waste anything. Many people turn bottles upside down to get out an extra serving or two, he would cut open a plastic bottle of ketchup to spoon out the accumulation in the corners. He would cut into a near empty tube of toothpaste and insert his toothbrush to scrape our every last bit. He would check the change bin every time he passed a pay phone or vending machine trying to find any unclaimed coins. He always insisted on getting value for his money. When I was 8 years old, we went to an all-you-can-eat buffet. He itemised the food on my plate and sent me back to get more so that he'd come out ahead of what he paid. This didn't include the dinner rolls and packages of crackers that he had my grandmother stuff in her purse. I actually still cut up bottles of shampoo or lotion in order to stretch out as much as I can, not out of necessity, but as a way to honour the memory of my grandfather and his greatest generation. It appears Husband does his part to give tribute by refusing to pay for anything that he doesn't have to.

He recently went on his own to pay our taxes. I was quite grateful that I didn't have to give up any precious time on a weekend to listen to the accountant at H&R Block coo over Husband's accent and comment how he sounds like the Geico Gecko. We actualy ended up getting money back from the state of California, which is almost unheard of, but ended up owing the Feds $34.00. He had the option to pay with a credit card at that time, which carries a 2% surcharge. Not wanting to pay one penny more, he took the return home, wrote out a cheque and placed it in our postbox. Long story short: someone stole the return from the box and we became victims of identity theft.

Epilogue: Thanks to attentive personal at XYZ bank who worked with the post office, the thief was apprehended and an arrest was made. He did however manage to change all the contact information in Husband's online bank account and set up new bill pays and he ordered a set of cheques with his name and mine. We had to change all our accounts and order all new credit cards and signed up for Lifelock. Huge inconvenience and hassle, but it could have been much worse.

Once we figured out how the breech of security occurred, I was infuriated with Husband's thriftiness. It's a family joke that I don't like to do maths before 9 AM, but I could have easily figured out that 2% of 34 dollars is 68 cents. Seriously, you can't even get a pack of gum for 68 cents. For 68 cents, we could have been done and dusted with our 2012 tax return. Honesty, they could have charged me 6 dollars and I would have paid it just for the privilege of not having to think about the tax return anymore.

So what, if anything did we learn from all of this? Firstly, pay everything online and if we are sending anything out containing a cheque (reminder to self to send little Myrtle's christening gift) take it directly to the post office. This was the most expensive 68 cents we ever saved.

Thursday, 4 April 2013

It's in the computer...

There is no doubt that computers have had a tremendous impact, improving the efficiency of almost every aspect of daily life. Electronic Health Records (EHR) in particular have helped transform the delivery of health care. Gone are the days of wasting time looking for charts, faxing records between satellite locations, waiting for results to be filed and deciphering illegible handwriting. However, there are some limitations; I can't quickly skim through an EHR in the way I could flip through a paper chart. Additionally, entries in the computer record are still vulnerable to user errors. I usually like to take a few minutes to review some important sections in the EHR before entering an exam room, but especially if it is a patient who is new to me, I always want to verify the history myself. Occasionally, I'll have a patient who find this process frustrating and will give a sigh or an eye roll (sometimes both) and answer my questions with the response, "it's in the computer..." It sometimes amazes me how some very young or much older patients expect that their entire health history is at my fingertips (and that I've read it entirely). I simply explain that I don't blindly accept everything in the database, just because it's in the computer.

Case in point: I was sitting at my desk when my iPhone started to vibrate. It was an unknown 1-800 number. I would normally let it go to voicemail, but I had recently received some calls from an 800 number to coordinate the order and delivery for my Ovidrel, which arrived yesterday. Figuring it was someone from the pharmacy calling to follow up, I answered.
"Hi, this is Blah-blah from [my insurance company]. Do you have a few minutes to talk?"
"Sure" I replied and moved into an empty exam room, feeling a bit nervous. I feared she would tell me that my upcoming IUI wouldn't be covered or something else infuriating.
"We have an educational mentoring program and I wanted to see if you would be interested in participating" she asked, to my relief.

Cool, I thought to myself. I've seen some insurances who have their own special programs for members with certain conditions; newly diagnosed diabetics, heart attack and stroke survivors, but this is the first time I've heard about a program for infertility. Awesome! My insurance rocks! 

"Well," she began "Congratulations on your pregnancy! How are you feeling?"
"I'm feeling fine." I replied flatly "Especially since I'm not pregnant." My heart sank a little.
"Oh my!" she exclaimed, obviously flustered "I'm so sorry...I'm not sure why I had a prenatal referral for you"
"Me neither -especially as I am dealing with infertility."
"Oh, well I do apologise and I do hope I'll be calling you soon." She couldn't end the call fast enough.

I thanked her and didn't bother telling her that because of my profession I probably wouldn't need to enroll in the mentoring program if I were to become pregnant. I know she was embarrassed just by calling on me when I wasn't pregnant and I felt a little guilty about making her feel even worse about the situation by bringing up my infertility. I did so with the hope that she'll inform her supervisor of this error and the glitch can be corrected before another coordinator invites an infertile woman into their expectant mothers program.

Seriously, it doesn't fill me with much confidence that the left hand at my insurance company doesn't know what the right one is doing. I know they don't have access to my actual medical records, just procedure and diagnosis codes. I had two beta tests in November with the code "possible pregnancy, not yet confirmed", followed by a visit for "threatened abortion" and more labs for "complete spontaneous abortion". There should be plenty of charges from my hysteroscopy which was performed for "uterine anomaly contributing to pregnancy loss" and most recently, billed expenses for my IUI meds, which obviously carry the word 'infertility' in the associated diagnosis. Yet, somehow their computer system has me listed as being pregnant. If only it could be that easy. It's in the computer -therefore it must be so.

Tuesday, 2 April 2013

I Can't Help but Wonder Where I'm Bound

I've never been a fan of the 'Father-Daughter' 'Mother-Son' dances at weddings. It always seemed kind of hokie and awkward, so we nixed it at our wedding. I would later feel a little guilty as I learned that my father would have wanted to use "You are So Beautiful" by Joe Crocker. Apparently, he used to sing that song to me when I was a baby. A bit too late, I gained a new appreciation for this ritual at the last wedding I attended. The Bride explained that she had memories of playing on the floor in her father's home office as they listened to vinyl 45s, and she invited her father to dance with her to "I Can't Help Wonder Where I'm Bound" by Tom Paxton. A bit of an unconventional song for a wedding, but as they sang along dancing together, I could see that not only did the song connect them with their memories, but it did seem fitting. A little girl innocently colouring as her life lies ahead of her is now an accomplished career woman marrying her Prince Charming. I think others sensed the sentiment too, as the Groom admitted his song choice wasn't as meaningful, but a few months ago his mother commented that she always thinks of him when she hears a particular song. His mother sprang from her chair and approached to the dance floor absolutely bursting with pride. I don't think she stop smiling as she and her son danced to "I Want it That Way" by the Backstreet Boys, whilst a chorus of his drunk Uni friends serenaded them.

After the song ended, Husband leaned over to me and whispered, "I can't wait for our child's wedding." I so admire the way he is so determined that somehow, some way, someday we will have a child. I know I tend to focus much more on the details within each individual cycle, while his eyes are focused on the ultimate prize. Sometimes, it's easy to lose sight of the fact that, yes, the ultimate end point of this science project is supposed to be a baby. In a way, it becomes a defense mechanism. When your primary goal is to attain that elusive BFP, it's easier to accept disappointment if you overlook the secondary goal.

As we start our fertility treatments, I've been finding myself drawn to the Bride's chosen song. I can't help but wonder where [we're] bound. I confess that in the early months of TTC, when I was awaiting AF or checking the POAS, I was almost as afraid of seeing a positive result as I was for a negative one. There are times I question, 'Can we really do this?' Are we actually responsible enough to be parents? We've been living in California for five and a half years and we don't have an earthquake emergency kit. We do however, have four bottles in our refrigerator that are designated "Earthquake Beer". Two for us and two for our friends. In the event of an earthquake, we'll know we can at least sit on our deck (or where our deck used to be) and have a beer together. There are days when my patient schedule will run late and I'll feel too brain dead to coherently finish my charts. I'll respond to my phone calls and emails and review my results to determine what can wait for the next day. It's hard enough just to get home at a decent hour to make Husband happy, let alone if I had someone else waiting for me.

I wonder if I will still be able to swim in the morning or find time to run or for a gym class. My younger self will die a little the day I hit the trails pushing a jogging stroller. When my nephew was born my cousin's husband told us "Oh, if you ever have kids, all the sports and activities you guys do? All out the window." I took his comment with a grain of salt, considering that he nor my cousin actually played a sport, went to a gym or did any regular exercise before having their baby. It seemed more to me that the baby just validated their sedentary lifestyle. I do accept that our life will drastically change, and I carry the foolish notion of 'we'll find a way to work things out' so that we can still continue to partake in sports and activities. This, of course is included with my other delusional ideas such as 'conception will be easy since I know what I'm doing' and 'I'll get my figure back after the baby is born'...

There's the household maintenance in addition to our renovation wish list. We've been spending a few hours each weekend working in the back and front yards and it feels like we're only chipping away. I do a thorough cleaning job every other weekend and it can take up most of the day. The in-between weekend is just a half-ass attempt to make things look neat. We'd like to redo the shower in the master bathroom, but I don't know how we'd get around to doing it with a kid in the picture. Husband talks of other projects like drywalling our garage, but I just see those ideas getting moved further down on the list of priorities.

A few nights ago, I came across the opening to The Cider House Rules, which is one of my all time favourite movies and one of the few films that has produced tears from my eyes. Dr Larch and Homer were in the nursery when Nurse Angela announces that an adopting couple were waiting in his office. "Life is waiting." Dr Larch informed her. "Let them wait."

Yes, life is waiting and life awaits. As long as we're employed in our current jobs, there will be work for us to do. The pool isn't going anywhere and there will still be races to run. I acknowledge it will be a struggle during the first few years. A friend with twins compared it to my postgraduate years; it was a time when I got little sleep and sacrificed many personal interests for the career I have today. If we do have a little one, I'll look forward to sharing the sports we love with him or her. We'll teach our DIY skills to our progeny and get some extra help with our renovation projects (I was taping and mudding at the age of 4). Cleaning and yard work are never ending cycles. Life is waiting and life awaits. The time to have a baby is now.