And my past comes back to haunt me...

No, not that kind of past. Not the slutty, wild and crazy party girl past I somewhat wish I had. Seriously, had I not had such detailed knowledge about herpes, I think I would have been much more promiscuous. So super selective was my screening process that it limited my number to only a handful of special sponge worthy fellows. My genital-urinary tract was kept sterile from any sexually transmitted infections. I never even acquired HPV, as all adventurous women do. Sometimes, it hardly seems that I am reaping any benefits from my selected chastity from a fertilty standpoint, but anyway.. I am digressing...it's my past history of hypertension.

When I was in my early twenties, I had a blood pressure reading of 150/110 at a routine gyn exam. Repeat readings would hold that it wasn't a fluke. I was ordered to stop my birth control pills and my blood pressure returned to normal, thus indicating that the pills caused my hypertension. Although I admit that I don't go to a doctor unless I absolutely need to (and by need to I am referring to my mandated employee physical) I've never had another dangerously high reading...until my recent pre-op visit. I went swimming that morning and arrived at my RE's office early for my appointment, which is unusual as I am chronically tardy. The medical assistant called me into an exam room to take my vitals. Just as she was inflating the blood pressure cuff, I could feel my brachial artery pulsate. Oh shit. "Are you nervous?" she asked before telling me what the reading was. Was I nervous? I was at my RE's office. Nervous is the default setting when I am there. I'm nervous that I'll run into a patient. I'm nervous about what what will be uncovered during my evaluation and nervous about what I'll be told. 146/100. I figured it must have been from the birth control pills. I didn't think my blood pressure would be a problem, as I'm much more physically active now than when I was a student and I would only be on the pills for a short period of time. Add to the list of 'Things I have been Wrong About'.

She sent me back to the waiting room as my RE hadn't arrived to the office yet. There is only one door to the clinic, which is used by patients, staff and delivery personnel. He walked into the office, stopped to grab his labcoat and then called me back to the exam room. After using his stethoscope to confirm that my heart was pumping blood and air exchange was occurring in my lungs, he reviewed the procedure and asked if I had questions. He hadn't looked at my chart to see my blood pressure. I know this because whenever I am running late and don't review the previous notes in the patient's chart, inevitably during the interview something comes up to make me realise that I should have done my research before going in the room. I brought it up and suggested stopping the pills prior to the procedure, which he agreed was a good idea.

The day before my procedure I brought my pills to work and figured I would have one of our MAs check my blood pressure prior to taking the last pill. It was 164/106. Fuck. I checked again a few hours later. 159/108. Double fuck. On my way home I stopped at CVS to use one of their machines. 181/107. I thought alarms would sound and the paramedics would be called. Now I am becoming concerned that my case will be cancelled. I'll have to wait until my blood pressure normalises and I can handle the pre-requisite birth control pills again. In other words, who knows when. I'll beg and plead with the anaesthesiologist like a junkie looking for a fix; "C'mon, just push 5mg of Lopressor in my IV and I'll be fine. 10 mg of Amlodipine orally and I'll be sorted!'

Although the possible cancellation of my surgery is the most prominent concern at the moment, there is a much larger concern looming. If my blood pressure reacts this way to birth control pills, what will happen if I become pregnant? When my cousin announced her pregnancy last year, my aunt expressed how she would spend the next nine months worrying about her high blood pressure. It fueled my false sense of entitlement. This is why it should have been me. I was the healthy one. I wouldn't be causing this kind of worry for my mother if I became pregnant. Ah, once again my delusional thinking gets the best of me. I am being slapped in the face with the reality that I am just as unhealthy as my sedentary cousin who is 40 pounds overweight.

I feel as if the Universe is telling me, 'listen up Bitch, how many more ways do I have to tell you this is a bad idea?' I feel the hypocrisy of my own words. How many times have I told a patient, "first you get healthy, then you get pregnant." I swim four times a week. I run 10Ks for breakfast and I can finish a half marathon in a decent time with only a few weeks of training. I completed an hour postal swim last month. Despite all the exercise that I do, there is something else not in my command. I see Labetalol in my future. If I ever do become pregnant, I will be labelled 'high risk'.

Breaking the Silence

During this ICLW week, I am reminded how lucky I am to be connected with so many awesome fellow bloggers. I feel that I have gotten to know you all so personally, and I feel that we would probably be friends if we met IRL. Infertility is just the vector that brought us together online. I have a great support network to help me through IF, but going through this experience led me to reconnect with some old friends and meet some new ones along the way. I just wish our partners had the same opportunity to gain such support. We all know how different it is for men. Guys don't talk to each other about this stuff.

Maybe it's fitting as women must endure so much more physical pain during infertility treatments, pregnancy and childbirth that there are more avenues for emotional support, but it doesn't seem fair that there are such limited sources for men. There are a few male members on the fertility forum I joined, but there isn't an actual 'Just for Men' space. After my miscarriage, I googled, 'infertility and pregnancy loss support for men'. I found lots of webpages describing that dealing with these issues is hard for men as many men don't express their feelings...blah..blah...blah... but not many online communities for men to reach out to each other to say, 'it's tough, but you'll get through it, mate'.

When we were waiting to receive the results of Husband's semen analysis, I found myself pleading with the Universe for him not to be the cause. This is in contrast to what I tell my patients who claim, "it's my fault that we can't get pregnant!" I remind them that no one assigns any blame; you two are in this together. His semen analysis  are your results. Your ovaries and Fallopian tubes are his issues. However, I felt that my profession made me more equipped to handle any female factor issues, and I knew that Husband would buy into the archaic (and completely erroneous) notion that male factor infertility would be a reflection of his masculinity.

When we did learn of his semen analysis results, Husband asked me "did you tell anyone?" Immediately, I felt guilty about telling Myrtle. I had violated his right to patient privacy. After that moment, I started asking for his permission to share with my few friends IRL who know of our infertility issues. Meanwhile, I wished that he had some one to talk to.

During our trip back to England, I was hoping he would confide in his longstanding friend Leonard. Not only did Leonard serve as his Best Man at our wedding, but he and his wife Penny came to me with their own fertility concerns when they hadn't conceived in 6 months. For the record, they conceived the very next month and Penny didn't want to didn't use anything for birth control after their first, since it took them "such a long time" to conceive. She was pregnant again before her son was nine months old. Leonard seemed to be giving him an opening as he told everyone at our lunch table (which included my parents, my in-laws and our old hockey friends) about his emergency testicular torsion and corrective surgery, which turned out to actually be a ball lift. I asked him later if he mentioned anything to Leonard when they went off to get a beer together, but he reported that he hadn't.

I guess he wasn't ready to open up to anyone at that time. A month later, he went to San Diego for a stag weekend and divulged all to his friend Raj, another ex-pat. I thought Raj was an unlikely confidant as he and his wife (who many suspect was an agreed arranged marriage) have declared that they have no intentions for children. Not only was Raj a good listener, but he told Husband that two other friends back in England were dealing with infertility issues. I don't know if that reveal was breaking some kind of code of silence, but it was really helpful for Husband to hear that he wasn't the only one facing such challenges. I know he already knew that he wasn't alone, but having a familiar face within the anonymous other infertiles was especially comforting. It sounds silly, but I felt so proud of him for taking this step.

He was coping really well until I had the miscarriage. While I was embracing the positive aspects that it happened early and easily, he was engaged in the disappointment over the fact that he was no longer an impending father. He also started strategizing for the financial planning of infertility treatment, which included asking me detailed questions about my expenses. I felt as it I were being audited, but I understood his rationale. However, when he suggested that I should start looking for another job if I did not get a significant pay raise at my next contract negotiation, I felt that crossed a line. I was not going to put up with him trying to manage my career, and I let him know it. "Do you not understand how devastated I am?" he asked me while finally bursting into tears. I hugged him and let him cry on my shoulder as I felt so helpless, wondering if there was anything I could do relieve his suffering.

I suggested having him talk with his friend Sam, whose wife Diane, had two miscarriages. He thought it was a good idea, but we both agreed that it would be easier said than done. Sam is the last person in the world who is not on Facebook and his only email access is through the Outlook account at his work, which he seldom checks. Husband last spoke to Sam nearly two years ago. It's a bit awkward to contact someone out of the blue to discuss one of the most painful experiences in his life.

Sam and Diane married in the summer of 2006, just months before she turned 35. She was very keen to start trying to conceive right away, but he wanted to hold off until they had paid off their debts from the wedding and honeymoon. I'm not sure how long they had been pursuing conception, but in March of 2007 she got rip roaring drunk at a wedding just after her friend Vera announced her pregnancy. I was so far  from TTC at that time, but I could appreciate the frustration she felt. However, just two months later, it would be her turn. She sent out a mass email after getting her BFP. Unfortunately, her first ultrasound would reveal an empty gestational sac.

We visited with them a few months after the miscarriage and and just after Vera's baby was born. They both described their roller coaster of emotions, from the relief and elation of the positive pregnancy test to the heartbreak and anguish that followed after her ultrasound. They admitted that they were happy about Norm and Vera's new arrival, but it still felt like salt in the wounds that were still fresh from their own loss. "It just seems so elusive for us" Diane explained, but admitted that they were still hopeful as they resolved to continue their quest. I sensed she was holding something back. When we left, I gave Diane a long hug and told her that she would be pregnant within the new year. Diane closed the door behind us and told Sam, "She knows."

A few weeks later she made her official announcement; she was pregnant with twin boys. They waited the suggested three months post D+C and conceived on that first attempt. Diane had made it no secret that she longed for a girl and when the twins were two and a half, she announced to everyone that they would be trying for one. At home and in private, Norm and Vera discussed Diane's proclamation and shared their observations. Vera had noted that they seemed to have very little food in their house, and it was mostly kid food; juice boxes, dinosaur shaped chicken nuggets, cheese and cracker packages. Both naturally thin, Sam and Diane looked like they had lost a little weight themselves. Sam in particular looks like he has aged ten years in the past five. Norm commented that Sam's car is almost always on 'E' and when he fuels, he will only put in five or ten quid of petrol. Their house is tiny and they are already cramped with two growing boys. They have limited options to move in this declining economy.

Norm gently shared his concerns with Sam and asked, "are you sure you're ready for this?" Sam admitted that they are struggling financially, and confessed that he really wasn't too keen on having another baby, but he wanted to make Diane happy. Diane did become pregnant a few months latter, and suffered her second miscarriage. I can't help to wonder what Sam's perspective was. Did he view the miscarriage as a blessing in disguise? Or as a tangible loss that affirmed his desire for another baby? I am hoping it was the latter as their third child was born last Autumn. Another boy.

Anyway, back in California at the present time, Husband and I were getting ready to have dinner with our friends Amy and Sheldon. Amy and I used to work together, and while genuinely a nice guy, Sheldon is rather quiet and a little reserved. He and Husband can talk amongst themselves when we get together, but they wouldn't call the other up to go get a beer on their own. I mentioned to Husband that as Amy knows we are trying to get pregnant, I owed her an explanation as to why I was at her Planned Parenthood clinic getting birth control pills. As Amy and I aren't as close as we were when we worked together, I hadn't told her anything about our infertility or miscarriage yet.  "Go ahead and tell her everything." Husband instructed me. "You can even tell her about my issues". I was driving at the time, but I wanted to pull the car over so I could embrace him. At that moment, I sincerely felt proud of him. It was his declaration that he would break free from any stigma associated with male factor infertility. In the end, I didn't mention it. Sheldon looked uneasy just hearing about my miscarriage and my uterus. Besides, just knowing that Husband was comfortable  'coming out' about his male factor infertility was such a significant achievement.

Temping fate or Jinxed?

I decided to look back at the various things I've done to tempt fate since trying to conceive, or may have possibly jinxed myself...

• Selected our names (Jack William or Kate Victoria)
• Procured anti-stretch mark cream only available in Europe (it may expire before I need it)
• Started a little 'hope chest' with some cute onesies and stuffed animals
• Purchased 'Value-sized' box of tampons from Costco 
• Picked up some large sized T-shirts to use a maternity wear (now stashed in the back of my closet with the hope chest)
• Ordered several new competition swimsuits (which are now stretched and faded)
• Registered for a half marathon (set personal best and did two more)
• Decided to renovate our kitchen 
• Booked wine tasting tour
• Scheduled a trip to Hawaii in September 2013
• Started an infertility blog (two days before the BFP)
• When my hairdresser asked "Do you have any kids?" I told her about my BFP earlier that morning
• Planned how we would announce to our parents 
• Decreased the allowance of my Flexible Spending Account for 2013, thinking we wouldn't need infertility treatment. Miscarried one week after open enrollemnt closed. 
• Bought a copy of The Monster at the End of the Book, while Christmas shopping. It was one of my childhood favourties. I gave it to my nephew when I miscarried.
• Signed up for 18 mile run in May 

Gestational Wheel of Fortune

It's the TTC Game Show, Gestational Wheel of Fortune! I'm your host RE. Let's meet our contestants! Today we have Irregular Cycles and Moderate Male Factor! Irregular Cycles, your won the coin toss, you can spin first.

Well, we've just started trying to conceive a few months ago, so let's start with these letters, F,S,H, E, P and A,M,H.

Okay, I think we have a few of them in there. Spin again.

Oh, we landed on Clomid. Is there a T or I? ...I'd like to solve the puzzle. Is it BIG FAT NEGATIVE?

Yes it is! Well done, Irregular Cycles. We'll move on to the next round.

Okay, this time we'll try S,A and H,S,G. Also, how about I,V,F, and C? ...I think we're ready to solve. Is it WILL NEED IVF WITH ICSI?

Right again! Spin again to start the third round.

OMG! We landed on Positive Pregnancy Test! RE, can we go ahead and solve? Is it LIVE HAPPILY EVER AFTER?

No, I'm sorry. MISCARRIAGE is the answer to our puzzle. Go ahead and spin again.

Sounds good, I'm ready to get started again. Let's see, we landed on Uterine Septum.

Oh, no! That means you lose a turn. Moderate Male Factor, you can spin.

We need some vowels. Can we buy an IUI?

Yes, but be careful not to hit bankrupt each time you spin...

This summarises our story so far... Thanks to Aramis at It Only Takes One for her inspiration to this post.

ICLW: Introduce Yourself!

I'm borrowing an idea from Liz at Wishing on a Snowflake. If you are visiting from ICLW or checking out my blog for the first time, welcome! Please leave a comment with a few lines introducing yourself. Happy ICLW!

Fashionably late

I think the only time in my life when I waited for AF to spontaneously arrive was in the first few years after menarche. Once I started taking birth control pills, I soon discovered that not only was I protected against pregnancy if I ever did have sex, but I had the added convenience of knowing exactly when AF would visit. Even better, I could actually manipulate the pills to control my period. I felt so powerful! Then, I switched to the Mirena IUD and my period pretty much stopped all together. For ten years, I almost never thought about AF. I didn't have to worry about her punctuating a vacation or showing up unexpected on a race day. I didn't even stock any tampons at my house.

So it was actually unsettling when I had to start waiting for AF to arrive. Probably because of all the meaning that is associated with her now. When she was later than expected, I was teased with the possibility of pregnancy. Even when pregnancy wasn't possible, I still had to play the waiting game just to be able to try again, or to do the next diagnostic test or procedure. Early in the pursuit, when I tried to gain an upper hand with Clomid, I discovered that the smiley face ovulation predictor tests also gave me the advantage of being able to anticipate AF! I felt powerful again -my ovaries and uterus were in my command!

Unfortunately, this feeling of authority was short lived. During my first cycle off Clomid, I discovered that I am one of the 40% of women who cannot use simple ovulation predictor tests. I was feeling rather crushed, but the news of Husband's low sperm count and decreased potential for natural conception actually softened the blow. I had one more avenue to pursue before admitting defeat. The Clearblue Fertility monitor that promotes higher accuracy by measuring both estrogen and LH.

It would turn out to be the best $175 I spent on Amazon.com.  I was meticulously noting when I was ovulating and was able to predict AF's arrival nearly to the hour. I was in command again, or so I thought. I was expecting AF to arrive over the weekend. I figured she'd pick Saturday, since I had a 10K race, but Saturday came and went without the slightest hint of a spot. Overnight -nothing. Sunday lunchtime -still nothing. 4:30 in the afternoon -yep, still nothing! This was starting to feel reminiscent of AF's absence during Thanksgiving weekend which yielded my BFP. Maybe we were one of those couples who just needed to schedule a procedure to magically conceive.

The was only one minor, insignificant detail that precluded any joy with AF's tardiness. Besides the limitations due to Husband's decreased sperm count, my age related poor egg quality and a uterine septum diverting the traffic flow to my Fallopian tubes; we were in fact on opposite coasts of the country on 'O' night. The first time Husband was away during ovulation, Co-worker asked in jest, "so are you going to try to find another dude?" I laughed and suggested that we could go to a bar in the City frequented by many ex-pat Aussies and NZers, joking that I could get away with it until the kid started talking and revealed a different accent. In all seriousness, I would never cheat on Husband and I promised that if we needed to use donor sperm, they would be English. However on this particular ovulating night, H and I went to the gay bar, which just seemed to perfectly emphasize how absolutely impossible conception could be.

Thus, the absence of AF could only represent one possibility: my monitor was no longer accurately detecting my ovulation. I felt let down by science. Although if I had ovulated later, such as on Tuesday night when Husband and I were in New York together, pregnancy could be possible. OMG, I would never hear the end of Myrtle telling me 'See, I was right! You never know!', but I could take it. I could accept this slight from science, if she delivered for me in the end. I didn't entertain this daydream too long, as I remembered that I live in the real world, not a fairy tale.

It was 9 PM and AF was still no where in sight. I sent a text to Co-worker, figuring that such an action could inspire her appearance. 'Just let me know if you want any labs done for you' she responded. Ah, she knows me too well. I figured I would do a pregnancy test on Tuesday and Wednesday and if negative, would check a progesterone level on Thursday to see if I had ovulated at all.  Went to bed around 11:30. Still nothing.

5 AM Monday morning -no overnight guest. Even though I knew the answer, I took a pregnancy test. Total BFN. While technically still early, I knew if I had conceived two weeks ago on Tuesday, it could be faintly positive. Time to be realistic: I am way too impatient to wait until Thursday to get any answers. Our lab is funny, sometimes you can get a progesterone level back in a few hours, some times it takes days. I didn't want to wait four more days only to discover that I hadn't ovulated and would need Provera to start a period (thus delaying two more weeks). Besides, I was sure AF would arrive just after I had my blood drawn. Well, apparently just thinking about the lab work was enough. I didn't even have to ask Co-worker to place the orders. AF finally arrived at 8:15 on Monday morning. Fashionably late, but still within range for my fertility monitor. My faith in science had been restored. Command was mine once again. I will not be jerked around by AF only to be misled. Quoting one of my favourite blogs, yeah, Science! .If AF is going to be late, it had better be for the real thing.

The Foreseeable Future

On an early episode of How I met your Mother, the central character was facing a dilemma. He had received a wedding invite addressed to 'Ted Mosby and Guest', where 'Guest' represented a potential girlfriend or date. For the bride and groom, who merely needed the information for seating arrangements and numbers for the catering staff, it was a straightforward question. For the recipient, it was asking a much larger and broader question. 'Number of people attending' was really asking the late twenties bachelor to consider where he pictured himself in three months time. Involved in a relationship with a woman who would be his plus one? Or still single, where attending the wedding stag could lead to meeting someone for a possible relationship, or at least a one night stand. Decisions, decisions...

We found ourselves in somewhat of a similar cross-roads regarding my car. As you may recall, during my no good, very bad week, my car got a little too cosy with a concrete post in a parking garage and significantly dented the passenger side doors. Not that anyone welcomes the unexpected cost of car repairs at any time in their life, but it's especially draining when you're facing infertility treatments, as no one ever really factors those expenses into their budgets. My car is a ten years old VW Jetta with over 125,000 miles, so we were waiting to hear from the insurance company as to whether or not the car would be written off. Husband drives a 2006 SAAB two door convertible. It was his present for moving to America/pre mid-life crisis car. We finished paying for both cars a few years ago. When abstractly talking about having a child, we have addressed the need for a larger vehicle (such as an SUV) but haven't really figured out what we would do. Husband admits his car is less practical and has a higher trade-in value as it is in great condition and has nearly half the mileage as mine, but mine will likely need replacing sooner.

As the picture notes, the car was declared a write-off. The body shop suggested by our insurance estimated the repairs to cost $4,450. Our insurance company presented two options; they could claim the car and give us $5,500, or we could keep the car to get repaired and they would give us $4,100. The real decision for us was, 'do we see ourselves needing a family sized car, and is now the time to get one?'

Well, we are optimistic that we will need the larger family sized car, but we decided that now is not the time. The reality is that we can't look to the foreseeable future without acknowledging our situation in the present. Even with $5,500 toward a down payment, we would be looking at around $450 a month for a car payment. I'm fortunate that my insurance covers 50% of IUI treatments, but that amount is what we budgeted to cover our out-of-pocket expenses for the four cycles we plan to do. Eight months of car payments prior to our anticipated start of IVF would be $3,600 -approximately the cost of meds.

It's interesting how various stages of your life guide how you look at particular costs. When Husband and I first met, I took note how he answered when a friend asked if he wanted to go to a comedy show on the University campus. "No, it's 4 quid. That's 2 beers." During our home renovations, we would stretch our leftovers as a $60 restaurant tab represented four boxes of tiles. Now we are defining various costs by infertility treatments.

Additionally, I wasn't ready to say good-bye to my car just yet. It still runs very well. The brilliant German engineering has resisted my attempts to ruin the motor by letting a month or two (or six) lapse between oil changes. I replaced the clutch three years ago, and just four months ago I purchased four new tyres and shocks. It also holds a lot of sentimental value. When I was in college, I had a very cool boyfriend who drove a manual transmission red Jetta and it inspired me to have one. I made the purchase before I could actually drive a stick shift (my dad took it for the test drive) as I felt like an inferior driver and I was determined to master that skill. My father and I later drove the car cross country together when I moved to California.

We decided to collect the cheque for $4,100 and took the car to a different body shop, who quoted $1,200 plus costs for parts. The job was completed for $1,350, and we also received an $80 credit from our insurance company as we were able to drop the comprehensive coverage for my car. We ended up having over $2,000 to put toward the other unexpected expense of our infertility treatment -my hysteroscopy. The total loss turned out to be our gain.

Be (a) Patient

So far it seems that much of the process of infertility treatment is wait...wait...wait...now HURRY! Once AF makes her appearance, you have to spring into action to make sure evaluations are accomplished on certain days. If you miss this narrow window of time, the cycle could be a bust and you'll be banished into another monthly delay. I received an email informing me that my insurance authorised my hysteroscopy and I was instructed to call on the first day of my cycle to coordinate scheduling the procedure. Based on my fertility monitor, I was expecting my cycle to start on either Saturday or Sunday. The office is only open for half a day on Saturday, and a prior experience of phoning on a Saturday found that they let the answering service respond to incoming calls. I started to become a little nervous about notifying them on day 2 or 3 of my cycle.

I've taken note that my RE is rather particular about certain details. During my initial evaluation, he insisted on using a specific pen to take his notes. As someone else who is also loyal to one brand of writing utensils, this was rather comforting to me, but it also seemed to establish a trend. At the start of an IUI cycle, he prefers to do the baseline ultrasound on day 2 rather than day 3. Day 6 was favoured over day 7 for my sonohystogram. It seemed to follow suit that he would have a preferred day for performing a hysteroscopy. Husband was also trying to coordinate his schedule, as he was planning to take the day off work to accompany me, and had to set up a meeting with a client during the first week of my cycle. Left to our own devices, I was sure Husband would inevitably pick the favoured cycle day.

I called the office to gather some more information and reached his medical assistant. "Are you going to be taking birth control pills?" she asked. When I acknowledged that I was, she explained "it doesn't matter what cycle day as you're suppressing ovulation and keeping your endometrium thin." Wow. There was the obvious slapping me in the face. I have working knowledge of the effects from contraceptive pills, and yet it had escaped me. I felt embarrassed for being so oblivious.

I shared this with Co-worker (now in the second trimester with her twins) who commented, "this is good, you're taking the provider out of the equation and are letting yourself be a patient." For the longest time, I have believed the two roles could not be separated as I have been so concerned about exposing anything that might reflect any professional ignorance. When I told Myrtle that I suspected that there may be something wrong with my uterine cavity which contributed to my miscarriage, she responded, "You're so lucky that you know all this." Her words were very flattering to hear, but I was fixated on thinking that she was the lucky one -she's fertile and everything worked perfectly for her on first pregnancy. Did my knowledge really even matter? Apparently not, and may even be more of a hindrance than be helpful. The night of my miscarriage I bailed on our monthly department dinner meeting. Unable to quickly come up with a plausible excuse, I decided to tell our lead physician what happened. She revealed that she also had experienced a miscarriage, under much more heart breaking circumstances.   At the time of her nuchal translucency scan, the baby's heartrate was low and the measurements were off by 5 days. She wasn't too concerned at first, but the heartrate was persistently low and dropping on subsequent scans. The growth interval was lagging by more than a week. Three weeks later, the heartbeat had stopped, which was actually much to her relief. "At that moment, I could finally move on" she explained "leading up to that point, I still held out for some hope. I was trying to reassure myself with things that I wouldn't say to patients." Those words have stuck with me.

You can go home again...

Returning from my trip East, I wonder why I had debated so much about whether or not to go. I had forgotten how much I enjoy visiting New York City. I didn't have any specific plans, but I walked around quite a bit and just appreciated the energy and the vibe of the city that seems to draw everyone into its atmosphere. I met up with a former colleague for drinks and I had lunch with Myrtle, who works in the city. I realise that too often I focus on the ways that Myrtle frustrates and annoys me, and don't note enough that she is a great friend, who I love dearly. I was really happy to have some time alone with her. I felt reminded that despite all the changes in our lives, our friendship is still intact. However, Myrtle wouldn't be Myrtle if she didn't say something to irritate me. (She also happens to look great.)  In the middle of lunch, she mentioned that her friend Lisa (a former co-worker from 3-4 jobs ago) is pregnant. I met Lisa once at Myrtle's 30th birthday party (7 years ago) and didn't recognise her at Myrtle's wedding over a year ago. So if this detail wasn't insignificant already, she proceeded to mention that it was Lisa who had told her it would take 6 months to get pregnant and then Lisa conceived on her first cycle after stopping her pills.

I've heard this line repeated from some of my patients. Who are these people perpetuating this notion that it takes six months to conceive? Statistics of normal fertility report that after six months, 50% of TTC couples will be pregnant. There are so many variables present, even medical professionals can't make such a forecast, so why are these ignorant individuals breeding such misinformation? I am digressing...It just seemed awkward that she would flaunt her and someone else's fertility right in front of me. Maybe I'm just being oversensitive, but if a friend was downsized and out of work, would you tell her about another friend who just received a promotion?

I just let this comment go and changed the subject. As a revised strategy for dealing with Myrtle, I've decided only to discuss details about our infertility and treatments when she asks. Just when were we back at her office and getting ready to say good-bye, she asked enquired, "Any fertility news? Or do you not want to tell me as I don't know what I'm talking about?" Ding, ding, ding! Actually, I was touched by her admission and I simply acknowledged that I know that supporting me in this situation is difficult, but I always know that she means well. A fellow blogger once noted that none of us are born with the skills required to cope with infertility, and it follows that our friends are not equipped with the tools to help us. We're all travelling in unchartered waters.

A few days later, we met up again, this time with little Myrtle. I think it's always a little strange to see your close friends in their new roles as parents. The first of our friends to have a baby was Jill, who could handle her whiskey in her pre-child days. When I saw her using teething gel on her daughter's gums, I noted my surprised that she wasn't using a dab of whiskey. "I'm not wasting good whiskey on her!' she exclaimed. Parenting clearly hadn't changed some aspects of her. I had come to terms with the fact that despite my jealousy, Myrtle truly deserved this happiness. She's doing a great job as a new mom, I could see how her love and care was so instinctive. It didn't seem weird at all to see her with her baby. Little Myrtle is so amazing. Her face is so expressive and exerts so much personality at only four months old. She is absolutely gorgeous, with a full head of hair, bright blue eyes, a button nose and soft lips. As if I weren't jealous enough...

I know life is not a competition, but Myrtle and I have been measured against each other since we've known each other. Up until this point, I was more successful in all the superficial ways you measure success on paper. I have the advanced degree, the more prestigious career, a higher salary and bigger house. Now Myrtle is dominating all the stats in this category; quick conception, easy pregnancy, textbook delivery and probably cuter baby. I know how shallow and horrible that sounds. If we are able to blessed with a baby, he or she will be beautiful to me and Husband. However, I surrender. Myrtle, you have won this round.

Husband and I did succeed in keeping the secret of our procreation intentions secure during our visit with my parents. My father started discussing plans to visit each other at Christmas, so I guess the fact that they can't appreciate how difficult it is to make travel plans a year from now indicates their lack of suspicion. We also started to look at flights for our Hawaii trip, which was a little hard to swallow. I'm going to be able to go on this trip, which is great, but makes me a little sad as I'd rather be staying home expecting a baby. The next question is whether or not my in-laws are going to join us. They are in their 70s and their health isn't great. At one point Myrtle made a hypothetical bet of $10 that they wouldn't go. She later sent a text, 'Actually I'll be collecting $20 from you, $10 for your in-laws not going and $10 for you being pregnant.' I've found many ways to laugh and make light hearted comments about infertility. I wasn't quite ready to put it in the context of a bet.

Something interesting did come about during a visit with a close family friend. 'The Vicar', as Husband had nicknamed him, is a Minister who recently retired from being the pastoral care director at a local hospital. He revealed that his oldest grandson had dropped out of college, and admitted that he really didn't know the reason as his daughter is a very private person and doesn't share much with him. I found that intriguing, given that so many others confide in him. I hope it was helpful for my parents to hear that not having a close relationship doesn't cast a verdict of being a bad parent, but sometimes that's just how the relationship works.

So this break wasn't a totally relaxing and reinvigorating lie on a beach in a tropical climate, but it achieved everything I wanted it to be. I've been out of the office for four days. I've had quality alone time as well as bonding time with friends and family. The only disappointing aspect is that I'm returning home with another cold. Top tip: if there are two flavours in a box of Lemsips, they're not offering you a choice. One is for day time, the other for nighttime. Read carefully, and don't take your nighttime meds during the day. Especially on your first day back to work.

We were on a break!

So, I could be frustrated about having to sit on the sidelines and be benched from trying to conceive for a while, but I'd rather find ways to enjoy taking a break from this process. I was so annoyed that I had to miss two months of opportunities right after my miscarriage, but after discovering that I have a septum that needs to be resected, I started to consider that maybe the Universe was acting in my favour to make sure I was able to address it before becoming pregnant again. Then I started to appreciate just how helpful a break could be.

The Thrill of the Pill
I want to recapture the excitement I felt when I had my first prescription for Desogen, I was a responsible hoping to be sexually active female eager for experience. I remember the sweet feeling of validation when I swallowed my first post coital pill. I loved being in the club of women who were labelled 'on the pill'. I declined my RE's offer for a prescription and instead picked up a package from a friend who works at Planned Parenthood. I felt like I was back in my early 20s and could reminisce about when Husband and I first met. As I'm getting closer to 40, I'll take anything that allows me to reclaim some of my youth.
The Joy of Sex
It does annoy me that for most "normal" fertile couples, the procreation process involves having lots of enjoyable sex. When you combine an irregular ovulater with moderate male factor, we have to take a stab and determining when I will ovulate and make sure Husband has a three day run up. The act is totally obligatory and usually there are other factors of inconvenience present to make sure the mood is dampened. Pressure free, non-procreative, pleasure fucking is so much better.
Is Mr Freely there? Initials I.P.
My bladder has a relatively small capacity and I drink a lot of water during the day. I'm also a light sleeper. These three features are not a good combination. During my follicular phase, I'll wake up if one of our cats jumps on or off the bed and realise that I need to go to the bathroom. Unfortunately, I can't go, as I need to have at least four hours of concentrated urine to submit during the designated time for my fertility monitor. I must try to go back to sleep and dream about the Sahara desert...
It's Always 5 o'clock Somewhere...
Not that I am a huge drinker, but it's nice to know I can have a glass of wine after a stressful day, or accept an invite to join a friend for cocktails without needing an excuse for not drinking.
The Freedom from 'what if...'
At least for the next few months I can enjoy making plans without having to consider a possible pregnancy
Protection from disappointment
I've already lost due to the 'you can't win if you don't play' rules, which is frustrating in itself, but sometimes it's easier to accept being disqualified for a technicality than admitting that you failed outright.

Most of all, I will not be thinking that we could be one of the couples who conceive while they were taking a break.

Use Birth Control

I used to give a lecture on contraception to medical students and I included 2 clips from an episode of That 70's Show in my Power Point presentation. After Jackie's pregnancy scare, Donna decides to go on the pill, but her father picks up the prescription and has difficutly accepting that his daughter is "Open for Business" -sexually available to men. However, while sitting on the hood of the Vista Cruiser, Donna informs Eric that just because she's on the pill, does not mean she's ready to have sex. Eric tries to get her to pin point a time when she will be ready -his birthday is coming up- but she laughs and walks away just as Red comes around the corner, garden hose in hand. He turns it on full blast, knocking Eric to the ground as he continues to douse him, claiming "It's for your own good, son"

One of the many ironies about my experience with infertility is that I used to be known among my colleagues at "The Queen of Contraception". Wanted to adjust to a different pill to fix your patient's irregular spotting? I had the answers. Needed the know the contraindications for a particular method? I have the WHO medical eligibility chart practically memorised. Have a difficult IUD insertion? I'm your woman. I still love contraception, from the intellectual applications to the challenges of counseling and administering to the satisfaction of helping patients take control of their own fertility. I just sometimes wonder if fate is making me pay a price for being such a heavy endorser...

When I moved to California, I received a parting gift from one co-worker. It was a black tee-shirt with the message 'Use Birth Control'. On the day of my sonohystogram, I thought I'd have a little fun by wearing something inappropriate and chose that shirt. I was wise enough to keep my jacket on while sitting among the other patients in the waiting room, but it caught my RE's attention at the start of my procedure. "I don't agree with your shirt as someone in my profession" he told me. Score! I thought to myself. However, after diagnosing my uterine septum and discussing the plans for my hysteroscopy, he instructed me to start oral contraceptives with my next cycle. "And yet, you disagreed with the message on my shirt..." I couldn't resist pointing out. Touché.

Religion and Politics

I know these two topics are the controversial issues that should be avoided in most discussions, but I feel they are important conversations to have, so I'm going to make an attempt to explore. Starting with my own religious upbringing; my mother was raised Catholic, my father was Lutheran, they eloped and didn't attend church until I was 5. We joined a Congregational church that was close to our house and became active in the church community. My father served as a Deacon, my mother joined the women's group. I sung in the choir and eventually became a Sunday School teacher. When I was of the age to start classes for confirmation, I was denied entry as I hadn't been baptised. My parents let me chose my godparents (I chose Myrtle's parents) and I was baptised at the age of 13, just one week before my confirmation. I have since converted to atheism (I could start a whole new blog about that...) but I feel it was still necessary to have that religious exposure early in my life to have the perspective I have today. I have a lot of respect for those who find a role for God in their lives, but it just doesn't fit with where I am now.

My parents are pretty open minded people, and they made an effort to set that example for me. When I was 12 and wanted to watch the moving Dirty Dancing, my mother had to explain the abortion issue with me. She presented it as what it was; didn't reference if it were good or bad and didn't offer her own opinion. When a gay couple moved next door, my parents also gave a matter of fact description (which was much like Phoebe's song on Friends "Sometimes men love women, sometimes men love men, and then there are bisexuals, but some just say they're kidding themselves...la,la, lah, la-la") They didn't offer any commentary. My father was a registered Republican, while my mother is a Democrat. During the 1992 election campaign, they made me watch both conventions to determine my own party affiliation.

Somehow I don't feel that I could be that patient or tolerant. Maybe it a reflection of our changing times, but it we do have a child, I'll lay it out to him or her; you will be pro-choice, you will support LGBT rights and you will register as a Democrat. However, when it comes to religion, I don't want to be that determining. I would like him or her to have adequate exposure and arrive at their own conclusion. I will hope that he or she would chose atheism, or at least chose a religion that doesn't condemn me and Husband for being atheists.

A few weeks ago, Myrtle and I were speaking on the phone and were trying to wrap up the conversation. We each had tried to explain why we needed to hang up and get on with our day, which only let to talking about a new topic. On the third attempt to close, she mentioned, "I know this is awkward to ask you, since you don't believe in God, and it requires you to provide 'spiritual guidance' but I wanted to ask you if you wanted to be a godparent first, otherwise I'll ask Helen (a college friend)". My first thought to myself was to acknowledge that I couldn't accept. How could I perform in the capacity of providing spiritual guidance when it's something I don't believe in? How wrong would it be for me to stand in a church and agree to this commitment with my fingers crossed behind my back? I don't want to be disingenuous just to accept a title if I don't really deserve it. I have imagined that my role in providing spiritual guidance to little Myrtle would be if she wants to question the existence of   God and learn about atheism. Can you be an anti-godparent?

I politely declined her offer and shared our conversation with Husband later that day. He was really pissed at me firstly for not discussing it with him (he is absolutely right, I should have) and for turning down the offer apparently, I could refuse. He was annoyed when none of his friends back in England selected him as a godparent (presumably because of the distance; again my fault) and saw little Myrtle as his only shot. I questioned which was more important to him, the title or being true to his beliefs? However the doubt was creeping in my mind and I was regretting answering so hastily. As Myrtle's parents are my godparents would it not complete a circle to be little Myrtle's godparents? Myrtle is the closest thing I have to a sister and was bestowing a great honour to me. Should I not have been so selfish and set aside my own beliefs for the benefit of those around me?

I arrived at my own conclusion and I accept the consequences of my words. Interestingly, I conferred with some of my religious friends who felt that being a godparent was more of a social role as they felt that they didn't necessarily receive any spiritual guidance from their own godparents. I also consulted a few atheist friends, and a few thought I should have accepted. "God is abstract, but people are real," one told me. I also realised how much heavier the regret will be if I don't ever have a child of my own and I passed on being a godparent.

Surrounded by my own remorse, I did the next logical thing; question the sincerity of Myrtle's offer. It was a 'by the way' as we were hanging up the phone. We would be seeing her in two weeks, she could have asked both of us in person. Was she really just giving me first refusal, or getting my blessing before asking Helen? Myrtle's husband is Catholic and I'm sure it would appease her mother in law to have a genuine practicing Catholic as her granddaughter's godmother. When Myrtle got engaged, she delicately approached me about having Helen serve as her Maid of Honour. I was actually happy to be relieved of the duty, as it would have been difficult due to my busy schedule and the cross country distance. I told her that I know what she and I mean to each other and I didn't need a title to prove it. Myrtle send me a text after she asked Helen to be godparent and acknowledged, "you two are already family, you don't need the title as godparents."  

May you get what you want...

I have a vague recall of an episode of The Brady Bunch where Carol tells one of the kids about a Chinese curse that reads "May you get what you want". I can't remember what the context was, and I haven't searched the internets to see if there really is such a Chinese saying, or if it was just created by the writers. The phrase has been on mind as I contemplate how at one point I didn't want children at all, and more recently, I didn't want to have a baby who would be born in the year 2013. Well, with the delay created by my hysteroscopic resection, It seems that I'll get one of my wants: I won't have a baby born in 2013 (provisionally accepting that if I do get pregnant and won't have a preterm delivery).

So funny, that I thought it was the number 13 that would bring bad luck. Not having a wonderful husband who happens to have male factor infertility, or being one of the 3% of women with reproductive problems who have a uterine septum. 2014 seems to have multiple features in its favour, the Winter Olympics, FIFA World Cup, Commonweath Games, mid-term elections, including the Gubernatorial race in California. I acknowledge that having a baby in 2014 will be tough on Husband, as he turns 40 that year and wished to become a father at a younger age than his own father. I'm so sorry dear, I never imagined this process would take so long and be so hard.

The other wish that seems to be granted is that I'll be able to complete in our upcoming swimming championships. It's a large three day short course event, and our team does well, despite our small size. On the day of my BFP, I spun the gestational wheel to see how far along I would be for the meet. Twenty plus weeks. I may have been able to participate, but would have needed to adjust my times to be seeded in the geriatric heats with women in their 70s and 80s (who are rock stars at these meets, by the way). Now the meet is six weeks away and I can train as hard as I want with the intention of competeting as hard as I want. Is getting what you want truly a bad thing?

Expect Delays

I know I'm not as seasoned as others who have been travelling down the infertility road for a while, but I'm not a newbie either. I've often thought about what advice or words of 'wisdom' I could offer someone who is just starting out on this journey. The answer came to me when I was driving and took note of a traffic advisory sign: DENSE FOG: EXPECT DELAYS. 'Expect Delays' seems to be the perfect expression that captures our experience thus far. It gives me pause to laugh a bit, as I feel that I've tried to be proactive through this process. I started using Clomid early. When we didn't conceive after 6 months (although it had been less than 6 attempts) we started our work-up by testing Husband. It took over a week before he could even schedule an appointment with the urologist. I had to call the office manager directly and express how embarrassed I was that my husband couldn't schedule an appointment at the affiliation where I work. By June, I attended an informal open house and met my RE, but I had to wait for insurance authorisation and didn't have my first appointment until early July. Husband was referred to a male fertility specialist and in August, he was started on Clomid. IUI was deferred for three months to wait for the Clomd to take effect (which really didn't happen) We were ready to start in November, but had a surprise BFP, which unfortunately resulted in a miscarriage. I thought I would only have to wait one cycle before getting going with IUI treatments, but it was discovered that I have a uterine septum which needs to be resected. Fingers are crossed that   I'll be able to schedule my hysteroscopy in February, and then will probably need to wait another cycle to recover. If all goes well, we may be doing our first IUI in April. Exactly a year later from the point when we realised we needed help and started our evaluation.

From joining the forum and connecting with other bloggers, I know my experience is not unique, and there are many others who have been waiting much longer. Delays seem to be an inevitable part of this process. Cysts happen. Inadequate response cancels cycles. Meds don't arrive in time, lab work gets missed. Finances constrain. Holidays and provider vacations push treatments back. It seems that if it's not one thing, it's another. Just as natural conception requires a series of events to occur and align at the right time, the same can be said for assisted reproduction. Learning to be patient is probably one of the most difficult skills to acquire during this trying time. It reminds me of the final scene in When Harry met Sally. After professing his love to Sally, Harry explains, "and it's not because I'm lonely, and it's not because it's New Year's Eve. I came here tonight because when you realize you want to spend the rest of your life with somebody, you want the rest of your life to start as soon as possible."