If Not You...Who? If Not Now...When?

Clean your dishes!

If Not You...Who?

If Not Now...When?

Many years ago, in what seems like a galaxy far, far away, I worked at a family planning clinic and that sign was posted in the break room to discourage anyone from being that person who leaves the dishes in the sink, thinking that someone else will clean up after them. Our health educator was planning a lecture for the community entitled 'Talking to your Kids about Sex'. As I saw her designing flyers to distribute, I suggested she adopt the slogan from the break room. If Not You...Who? If Not Now...When?

It's starting to feel that way for us at this stage in the process, and I thought about that caption leading into beta day. This is embryo number 6, transfer number 4, trying for pregnancy number 3, in pursuit of baby number 1 (and only). My RE doesn't issue any bed rest restrictions, and even let me go to rowing class the next night. I tend to fall on the side that as exercise improves blood flow, it could favour implantation. I had the faintest bit of spotting and some light cramping two days post transfer, which gave me pause to wonder if it might indicate implantation.

The day before my beta draw, Husband called me while I was at work to ask for my social security number. Apparently, my grandmother left twenty percent of her savings to her grandchildren, so I'll have just over eight thousand dollars coming my way. My initial thought: that will cover two more transfers! Then my mind started analysing my reaction, is this just because I now calculate everything in terms of fertility treatments, or is this because I sense I will need to do more transfers? During my last 2WW, I had a premonition that my results were negative when I dropped a progesterone capsule on the floor and that proved to be accurate. Maybe I do have clairvoyant powers.

I go to a community lab for my betas for the anonymity. The lab was converted from an old 70s style house and it's really dingy and shabby, but it gets the job done. The phlebotomist reviewed my orders, "Will you have to do another HCG test?" she asked. "Well, it depends on today's result." I replied "I know, but sometimes they have you do two..." See answer above. It depends on today's results! "Well, hopefully you'll only have to do one!" she said with a cheery tone. Because THAT is what I wanted to hear! Maybe she was sensing something too, but I hope she was only implying, maybe the results will be where you need them to be and you won't have to come back to this hellhole of a lab! I wanted to burst into tears on the spot, but instead, I gave her a look that I sincerely hope conveyed; just stick the fucking needle in my vein and shut the fuck up!

My beta day routine is to have Misery leave a detailed message with my results on my voicemail and Husband and I listen to it together at the end of the day. I replayed her prior negative results messages in my mind throughout the day so it wouldn't feel as such a shock if I were to hear those words again. We decided to go to Cross-Fit after work, which delayed learning our fate for another hour. This means we're either Cross-Fit crazy, or just plain crazy. When we arrived back at our house, we showered, fed the cats, brought the recycling bins inside... just to stall a bit longer. Alas, it was time to face the music. I'm so sorry Jane, your beta was less than one. Go ahead and stop your meds... Yep, I have her negative results spiel down word for word, although she did add an extra "I'm really sorry" and she genuinely sounded disappointed.

What is it going to take? Perhaps the expectations were too high for this embryo. The stars just seemed to be too aligned. I took Angus to the vet two days after I started stimming, he died the night after we received our CCS results. My grandmother passed just a few days after my transfer. Cue new life! Hey! New life, this is your moment! How are you missing this neon, blinking sign for you? But seriously, what is it going to take? We have had good transfer of a good embryo into a good uterus (or so we thought). Alas, once again we regroup, re-analyze and re-attempt to solve this puzzle. Quoting Steven Gerrard, "We go on."

Thunder Only Happens When Its Raining

During my last visit with my grandmother, a photo of myself with my four cousins caught my eye. We were seated in descending order of age on the diving board of my aunt's swimming pool. The picture was almost 15 years old at that time, and I think, it was the last time all five of us were together. "I tell everyone that I'm proud of my grandchildren." my grandmother announced as she saw me looking at the photo. For the record, that is not the same things as telling your grandchildren that you are proud of them. I looked at each of us and thought about the underlying labels that wouldn't make my grandmother so proud. Abortionist. Adulteress, Mummy's Boy, Heroin Addict, and Closeted Homosexual. Although, as much as I tried to conceal that aspect of my profession, my grandparents never expressed any interest in my work. Fortunately, I never felt that I needed to hear that they were proud of me.

The story of my two youngest cousins is rather disappointing. There was so much potential that was squandered and so much promise that remains unfulfilled. As a child and even into this adolescence, Ben was easy going, very sociable and strikingly confident. He was an honor student, a soccer player and had a good group of friends. His younger brother, Sam was much more quiet and introverted. He had an interest in comic books and at the age of 11 started his own comic series. I came across a sequence that he left at my grandparents' house. He displayed impeccable precession and attention to detail. It featured a scene inside a store and he took note to reverse the lettering in the store window. The dialogue revealed a masterful sophistication way beyond his years.

Sadly, my aunt and uncle failed to nourish their children's talents. They never took a family trip to Comic-Con, which would have had a lasting impression on Sam. They never encouraged him to explore art schools or other creative programs. When Ben was a senior in high school, my uncle informed him that Penn State was his only option for college. As they lived in a small town, Ben probably would have been more suited at a smaller school. Alas, he never made the transition from a big fish in a small pond, to a small fish in a huge lake. He was overwhelmed at Penn State and immediately became lost. Depression set in, which led to experimentation with drugs. By the time he dropped out and tried to enroll in a local community college closer to home, he had moved on to shooting up heroin.

Over the past ten years, he has been in and out of rehab. He spent some time in jail for stealing a car, and especially in a depressed economy, no one wants to hire a convicted felon. My aunt had to take a second part time job to subsidise his apartment.  Meanwhile, Sam opted not to go to University at all, and started working for Verizon. He left his parents house and moved in with a male roommate, but refused to give my aunt and uncle his new address. When he was 27, my aunt was still explaining "Oh, he's just too busy to have a girlfriend" to which my mother replied, "Yes, he's too busy being gay." I can really appreciate that he probably will never come out to his redneck asshole father, but my father observed that he seems to be at a place where he feels comfortable with himself, so I'm especially proud of him for achieving that.

After discussing the details of my grandmother's imminent death, my mother decided to move on to some gossip. "Guess what? Ben is going to be a father." she announced. "On purpose?" I blurted out as I didn't know how else to respond, except in my mind I was thinking that knocking some girl up and being a father are not mutually exclusive. She filled in the remaining details. He's 32 and has been clean since December of last year. She's 22 and has been clean for two an a half years (pausing to reflect on what a tough life one has lived if two years sobriety is on your resume at the age of 22). Her family seems very supportive. My aunt hasn't met her yet, but received an invitation to the baby shower. "Out of all the grandchildren, who would have thought that Ben would be the first to have a child?" she commented. "I can't believe that my baby sister is going to be a grandmother." ...just.twist.the.knife.a.little.bit.more...

Embarrassingly, my initial thoughts about heroin use go to a clip from MTV's The State (high five to anyone who recalls that short lived variety series) where Nancy Spungen and Sid Vicious were portrayed as contestants on the $20,000 Pyramid. "Oh, this one is easy!" exclaims Nancy, after she reads the clue. "Eating, drinking, sleeping, fucking...you know..everything..." "Things people do on heroin!" shouts Sid. Ding, ding, ding!  Now I see my cousin a bit more as Tommy from Trainspotting (which is one of those movies that I have seen many times, but never watched from the beginning to the end). I just hope their baby doesn't suffer the same fate.

I thought back to when I learned my other cousin was pregnant during my 2WW in my first Clomid cycle (which I was so certain had worked). I was jealous and resentful. I felt as if she were stealing my thunder. Alas, thunder only happens when it's raining. It was never mine to steal. I've been reminded of this while attending the one and two year old birthday parties for her son, which coincidentally falls just after my first and second undue date anniversaries. This time I don't feel any jealousy. I don't feel much of anything at all. It doesn't matter that this is the first great-grandchild, as my grandmother was far too demented to even notice. I'm not bitter about not being the first to procreate, as that's not an issue for me. I just hate that my mother is feeling jealousy right now.

It's a simple scientific observation. They are fertile. We are not. Yet, as I draw up my progesterone in oil, I can't help to think of them using the same type of syringes to inject heroin into their veins. "They don't deserve a baby!" exclaimed Co-worker, after I informed her. No they probably don't, just as we don't deserve to be infertile; but most importantly, that baby doesn't deserve to be born into this world with such unstable parents. I acknowledge that I'm being harshly judgmental toward them, and I want to believe that the presence of his progeny will finally break my cousin's ten year cycle of addiction. Unfortunately, I've seen this movie all too many times before and I know then ending. Thunder only happens when it's raining.

In the stillness of remembering what you had,
and what you lost...

and what you had...
and what you lost...    

Veronica

I remember this place.
I remember her in this place.
Sometimes, she was happy.
She'd say "So and so said such and such..."
or "somebody said this and that..."
She'd talk about who knows what,
and one moment you'd be here,
and the next it's 40 years later.
So, you just sit here and bounce around the years with her.

Is it all in that pretty little head of yours?
What goes on in that place in the dark?
Well, I used to know a girl and I could have sworn
That her name was Veronica

Well, she used to have a carefree mind of her own
And a delicate look in her eye
These days I'm afraid she's not even sure
If her name is Veronica 

Do you suppose that waiting hands on eyes
Veronica has gone to hide?
And all the time she laughs at those
Who shout her name and steal her clothes
Veronica, Veronica

Did the days drag by? Did the favors wane?
Did he roam down the town all the while?
Will you wake from your dream, with a wolf at the door
Reaching out for Veronica?

Well, it was all of sixty-five years ago
When the world was the street where she lived
And a young man sailed on a ship in the sea
With a picture of Veronica

On the 'Empress of India'
And as she closed her eyes upon the world
And picked upon the bones of last weeks news
She spoke his name out loud again

Veronica sits in her favorite chair
She sits very quiet and still
And they call her a name that they never get right
And if they don't then nobody else will
But she used to have a carefree mind of her own
With devilish look in her eye
Saying, "You can call me anything you like
But my name is Veronica"

Sometimes we would just sit there,

She wouldn't say anything.

I wouldn't say anything.

You would try to work out what was going on in her head,

but I think it's something we don't understand.

Not yet, anyway.

-Elvis Costello 

This song has always held a special meaning for me, as like Mr Costello, my grandmother's name is Veronica. Unfortunately, she was also afflicted with Alzheimer's Dementia, although it really didn't affect her until the last two years of her life. My last visit with her was in January of 2011, just before her 87th birthday. I've actually only been back to the East Coast a handful of times since then, and there wasn't enough time to swing down to Pennsylvania, or it became hard to justify as she probably wouldn't remember me and wouldn't be able to appreciate my visit.

It's a practical defense, although I acknowledge some selfishness and maybe a bit of cowardliness on my part. I've become a bit like an Alzheimer's patient. My memories of her are frozen in time. Since I was in my early twenties, I started making trips to visit my grandparents on my own, without my parents and without my other cousins present. In fact, it was a confirming factor that Husband was The One, when he expressed interest in joining me for these trips. We would eat dinner at 4:30 in the afternoon, and then spend our evening playing Yahtzee or other board games. We'd have CNN on in the background so we could debate politics, discuss how there will never be any greater baseball players than the inaugural Yankee greats, and how Reagan was the worst president ever, until George W Bush.

My grandfather died in 2008 and I wasn't sure how long she would last after that. She suffered a stroke in early 2009, which really affected her personality. It was after that event, that I felt that the grandmother that I knew was gone. I didn't witness her decline as my mother, her sisters and my other cousins did, I just had a sense that it was happening. I was a bit surprised that she made it through her surgery for her broken hip, and I knew her rehab potential was poor. I hoped she would just peacefully slip away at night or catch a brief case of pneumonia. About a week ago, she went into respiratory distress and was admitted to the Intensive Care Unit. That event became the catalyst for my mother to place her on a Hospice service.

Veronica closed her eyes upon the world last night. At last, it was her time. After six years apart, I like to think that she is reunited with my grandfather. I don't feel a sense of sadness, but relief. People tell me that they're sorry for my loss, as it's social convention to do so, but it sounds so unnecessary. She lived a long and amazing life, even if she was denied the title of great-grandmother.

This song is included on my running playlist, and I find it especially useful during a half marathon. I tend to feel really cranky around mile 8, and the boisterous melody and rare feature of a xylophone always lift my spirits and it reminds me of my grandmother. If she can survive ninety years in this world, then I know I can make it through a few more miles.

Good night Veronica. 

The Xth time is the Charm

"Seriously? You don't know how to get there by now?" I asked as my Husband plugged the address for XYZ Fertility Centre into his navigation system. This is our sixth trip to their clinic in less than a year. Twice for a retrieval, and now we're en route to our forth transfer. It feels as if we should have some type of frequent guest loyalty card. For the record, I asked my RE what is the highest number of transfers he has performed for the same patient. He recalled there was a woman who did 4 or 5 fresh IVF cycles, as she never had any embryos to freeze. She was over 40 and had a low ovarian reserve, plus stage IV endometriosis and her partner had severe male factor. She became pregnant after her first transfer, but suffered a second trimester loss. Her recovery was further complicated by retained products and endometritis. She went through a few subsequent failed cycles before having a beautiful baby boy, conceived with their own gametes.

"The third time is the charm!" offered Co-worker "It worked for us!" she added. Yes, that was the case as it was their third and final IUI before moving on to IVF. This is the third frozen transfer, and hopefully third pregnancy. However, it's the fourth transfer with our fifth embryo, technically sixth if you count our spontaneous conception. I'm not sure how to score this.

As my RE is considered courtesy staff at ZYX Fertility Clinic, they accommodate their own patients first. We waited half an hour after our scheduled appointment time before they called us back to the transfer room. Actually, as I'm chronically late, I interpreted it as a good sign; although irritating as I had been pacing myself to have a perfectly full, but not too full bladder. We were in a different room than we had been for our previous procedures, which was a welcome change of venue. Husband and I both took note that the embryologist wore a Hello Kitty scrub cab, as I am quite a fan of the mouthless feline. It wasn't the hottie embryologist, as she was working in the next room, but Husband caught a glance at her when we were leaving. My RE reported that the embryo thawed beautifully ...blah, blah...blah... I opted not to take the photo and copy of the embryo report, and I asked my RE to keep it in my chart at his office. If this goes the distance, I'll return to collect the images.

It seems to be getting harder each transfer. To borrow a favourite phrase from my friend Aramis; my uterus is an asshole and was completely uncooperative. My RE went through 3 or 4 catheters during the mock transfer; but his patience paid off, as the final placement was perfect. I also carried something else from Aramis. While she was in Prague, she picked up a small figurine of an orange cat, just after Angus died. I thought it was very cool to have something from the Czech Republic, and something that represented Angus with me.  When I got back home, Tyler joined me for my rest and recovery.

Maybe This Time Will be for Real..

I've previously written that there are no external factors that will influence the likelihood on whether or not our embryo sticks. It doesn't matter if I adopt a positive attitude and exude optimistic energy. The recent unfortunate events in our life won't tip the scales in our favour. Even transferring a known euploid embryo doesn't do too much to raise my confidence. Yet, there is one recent observation, which suggests that this might actually work.

In the ever persistent body image battle of self versus self esteem, I'm surprisingly finding myself on the side of self acceptance. In the many weeks leading into the transfer, I once again went through the ritual of dedicating myself to fitness and proper eating in order to optimise my body before a possible pregnancy. Of course, this time was going to be different compared to all the other times I made such a vow in vain.

Well, it sort of was. I was quite frustrated as I couldn't swim or go to the gym for more than a week due to my injured finger; so I did a lot of yoga videos. I've also become Paleo-ish. Aramis, I can hear you groaning how you warned me that this could happen if I joined a Cross Fit gym. To be fair, they really don't push it that hard, but one day Husband decided to order a Paleo cookbook that was recommended on our gym's webpage. I flipped through Nom Nom Paleo: Food for Humans, and the strangest thing happened; I found myself wanting to cook. Never in my life have I ever found any desire to cook; it's merely been an alternative to starving. The author is local to the Bay Area, and she has cartoon pictures of herself and her family throughout the book, which lends to the illusion that cooking is actually fun! I then picked up Make Ahead Paleo and Quick and Easy Paleo Comfort Foods. I haven't fully embraced the Paleo concept, so I'm not strict, but it has been an objective of mine to eat less processed foods as well as avoid foods made with flour and sugars. The Paleo cookbooks provided ideas and instructions, but I've been adding notes to each recipe and making some of my own adaptations. Husband is keen to know who is this woman in his kitchen and what has she done with his wife?

I didn't weigh myself, but within a few weeks, I could tell that I had lost some weight. The one spot where no woman wants to lose. I've read that the first place you lose is the last place you gain, and the first place you gain is the last place you lose. For me, the first loss is my chest. Husband noticed it too, although he admitted he was reluctant to mention it to me. My relay swim teammate was not so subtle, as it caught her ire. "Allen! You need to wear a tighter suit or get bigger boobs!" Loose fabric can cost precious tenths of a second. The other limitation is that I think it would take a famine to reduce my backside. As competitive as I am, I'd rather sacrifice the time than expose any ass cleavage.

There were other moments of frustration. I have such a hard time finding clothes that fit me. I went to Abercrombie and Fitch to purchase a some men's jeans. "Would your boyfriend like some graphic tees to go with these?" asked the saleswoman. I decided that the compliment that I looked young enough to be dating a guy who would wear graphic tees trumped the humiliation that I was buying them for myself. I also saw a photo of Co-worker in a two piece on Facebook. Post full term twins she looks fucking awesome. Fucking bitch. All my insecurities rose to the surface. I'm working so hard just to maintain what I have, how will I ever recover from the affects of a pregnancy?  Fortunately, my Husband was there to offer some much needed perspective. "Ah, you don't look like that now, so don't worry about it." I retreated to our room to sulk and re-consider that I might actually have the time and energy to dedicate to an eating disorder. Husband came in offering a cup of tea, but he didn't apologise or take back his words. "Jane, you can't compare yourself to her. She's a six foot string bean. Look at yourself compared to others who have your frame and muscle structure," as he suggested a few names from our gym. Wow, I thought, as I sipped my tea. He's going to be really good at this if we do have a daughter.

I, on the other hand, may not be such a good role model. I'm finding validation through others. After explaining the swim suit sizing dilemma, two of my swim teammates conceded that I have "a good ass for a white girl". Oddly, Co-worker and two of our medical assistants all paid me compliments one day. I was starting to suspect that Co-worker may have put them up to it, but I overheard a third say, "if I had Jane's body, I'd walk around naked all the time." Okay... a little awkward... A few days later, someone honked and gave me a thumbs up while I was running. Why is there no greater instant injection to your self esteem than the attention of some creepy perv?

Yet most importantly, there have been some moments when I have glanced in the mirror, and my first thought is 'not bad.' It's time to accept that after almost three years of calorie counting, low carbing, gluten freeing, swimming, running, cross fitting and yoga; this is as good as it's ever going to get. Just as after three years of ovulation monitors, scheduled coitus, intrauterine inseminations, a desperation day 3 transfer and some unlucky single frozen transfers; this opportunity with known euploid embryos, is a good as we could ever hope to get. So C'mon embies. All this is yours to wreck.

With Great Power, Comes Great Responsibility

My Colleague had a long standing patient who had three boys and was desperate to have a girl. She scoured the internet and created a particular formula; she would eat a particular diet, they would copulate in a certain position and she requested a prescription for Clomid so she could control exactly when she ovulated. Sure enough, she became pregnant on that occasion, and during her first visit with me, she openly announced that she planned to terminate if the baby were a boy. "So..." I asked my Colleague, "Is it really inappropriate that I am hoping this baby is a girl and that she'll be a total little bitch?" "Not at all." she replied "I've had the same thoughts."

She went on to deliver a healthy baby girl and recently she ran into Co-worker at Whole Foods. "I've been thinking about coming in to talk with [My Colleague] about having another baby!" she announced. (because she needs to ask her permission?) She never made it in for that appointment before she called to report a positive pregnancy test. Apparently, fertility is hers to command.

When my RE called with my PGD results, it never crossed my mind to ask about the gender of the embryos. According to the formula predicted by the XYZ Fertility Centre, it takes 10 eggs to produce 1-2 euploid embryos. I was expecting to have only 2-3 keepers. I would have been devastated if there were none, and very disappointed if there was only one. I never dreamed that my 20 oocytes would yield the upper end of their prediction with four. My most fucked up embryo would have been a female phenotype, Turner's Syndrome with trisomy 1 and trisomy 8. Despite the fact that Turner's Syndrome is highly compatible with life, approximately 90% of 45 X- foetuses will spontaneously miscarry.  

Okay, I admit I am curious to know what the genders could be; I just don't want to actually hear the results. Of course, in my ideal world, all would be female and I'd have four chances to get exactly what I want. How would I feel if we were to learn that they were all male? Would I have less of an incentive to transfer? I don't know. Perhaps, I do know the answer and that's why I never asked the question. Performing a fresh stimming cycle just to obtain a female embryo is simply out of the question.

It's just hard to ignore that this option is available. We signed the consent forms declaring that we did not want to select a particular gender prior to the start of the cycle. At that time, we didn't know if we'd have any embryos progress to the blast and biopsy stage. Yet, it's still not a guarantee. Earlier this year I saw a patient who bore a daughter with her first pregnancy. They really wanted a son, so they travelled to LA to do IVF for the purpose of gender selection. She became pregnant with twin boys after her first transfer, but lost them both at nine weeks. A few months later, she spontaneous conceived -a rainbow baby boy. She was now unintentionally pregnant again, this time with another girl.

If I were to request to transfer a female embryo, and the result were a BFN; my disappointment would contain an additional layer of guilt. Yet, as I have little confidence in embryo grading, selecting based on gender seems as random as any other method. What if we were to exhaust all our female embryos and then succeed after transferring a male? Would that pregnancy feel less desired? However, if our first transfer with an unknown embryo is successful and turns out of be a boy, would I regret not expressing my desire for a girl? I suppose, if that situation were to occur, we could always consider attempting a second transfer if we have any remaining female embryos. Although, this goes against my plans to only have one child and not to have a baby after the age of 40. Of course, my original plans were to not have kids and to never do IVF.

Ultimately, I am hoping that that statistics finally weigh in our favour.  I am primarily referring to the data that shows a 75% implantation rate when an euploid embryo is employed. Yet, while some studies show that traditional IVF produces a higher ratio of males compared to the spontaneous conception population, when ICSI is utilised, there seem to be higher rates of females. I polled our own blogging community. There is definitely a trend toward performing ICSI. In the traditional IVF group there were 5 of 7 boys (71%) and in the ICSI batch, there have been 17 of 20 girls (85%). This does include my second miscarriage. I requested not to know what the gender would have been, and my RE obliged. However,  the lab copied the results to my Primary Care Physician, who divulged that detail. I can't help to wonder if that were my only chance to have a girl.

Of course, the looming question is to ask if that were my last opportunity to have a baby. I am still so skeptical. I am still so dubious that this could actually work. Although, I am convinced that my shitty first cycle produced a tainted batch of embryos; logically, I just can't accept that all four were abnormal. It just doesn't feel that we've gained any ground, except eliminating one aspect of the unknown. We're merely operating under the 'more shit you throw against the wall [uterus], the more that's bound to stick' principle. This is still not mine to command. Not a single aspect; including gender selection.

I'm sure there will be people who will wonder why we didn't indicate our preference. It's an easy question for an outsider to ask, and it's tough to provide a coherent explanation. I suppose it's the remaining detail from our original plan that is still available to us. To learn the gender, not from a piece of paper or an ultrasound image, but during the very first time we hold our baby, if that moment ever comes our way.
 

Everyday Victories

I didn't get called in for Jury Duty. Selfishly, I'm glad I didn't have to use one of my sparse PTO days to provide a civic service. Plus, as I didn't have patients scheduled, I ducked out to swim during my lunch hour. Added bonus; there was some light rain in the sky.

 

We found a new (used) car. It's a 2011 Jetta with only 18,000 miles, and as it's in great condition. We could have gone with a lower priced model, but I opted for heated seats. Every time my butt is toasty and warm, it will feel worth it. It has been only a week, and the car is already infested with clutter and I haven't emptied the box of crap rescued from my old car.


My RE was already ahead of me in wanting to evaluate my uterine cavity, so he performed a sonohystogram at my last appointment. Much to my relief, all was clear. Not to sound like Pollyanna playing The Glad Game; but as much I've been complaining about how long it has taken to get to this transfer, I appreciate that the finding of a polyp or submucosal fibroid could delay this process even further.

As my lining was a plush 12.4 mm, my RE agreed that I could do my transfer earlier -during my vacation week. The cluster fuck of rescheduling patients and re-arranging my time out of the office has been avoided. Additionally, I was able to talk him into letting me take some Valium for my transfer. I don't actually feel I need it, nor do I think it will really make a difference; but -why not?

  

The healing procedure for my severed finger has been akin to a 'will they, or won't they' couple on a sitcom. It would start to look better, but then regress and seem to be getting worse. My hand surgeon assured me that I just needed to be patient as it would take some time. Fortunately, I'm versed in a long drawn out process. After almost a month, I'm down to a small sized bandage. I will be so happy when I can finally put away my first aid kit.

I've discovered Mini.velle patches. Previously, I didn't have a problem with the adhesiveness of my generic estrogen patches, but they don't seem to be staying on as well in the warmer weather. Not only do the Mini.velle patches stick much better, they're so much smaller! A regular Estradiol patch is about the size of a small lemon, where a 0.1 mg Mini.velle patch is the size of a quarter and a 0.05mg patch is the size of a dime. I've actually been able to wear a two piece swim suit to the pool each day. Even better, I've been able to order samples to be sent to my office. Hey, I never claimed that I played by the rules. 

         

Although I really miss Angus, Tyler is a gem of a cat. He has such a gentle disposition, yet a bold personality. He's very curious and loves to open cabinet doors -we may have have to install childproof latches! The linen closet is one of his favourite nap spots. He's very affectionate and is even exhibiting signs of being a lap cat, albeit he has a short attention span. He's quick and a bit mischievous, which led to him being inadvertently locked in the garage overnight.. Overall, he's a perfect addition to our family even though I resent the circumstances that brought him into our life. Even his big kitty sister is starting to warm up to him.

She seems to be hiding from him, but we're viewing this as progress! 

"I Could Care Less..."

I was greeted by AF on the morning of my would have been due date. The same thing happened to another blogger, who astutely described that there is no stronger reminder of your infertile status. At least in my situation, AF's arrival brought an end to my 41 day cycle and the prep for my third FET could begin. When I arrived at work, I found a piece of paper taped to my computer screen. It was my 2015 Expense Request, which asks if I intend to take FMLA time in the upcoming year. As I took it down and tossed it aside, Michael Scott came by and collected the report from my younger colleague. "O-oh I was waiting to see your response to that question!" she cried excitedly, until my colleague informed her that she needs to have knee surgery next year and will be out for at least six weeks. "I'm hoping to be taking a maternity leave in 2016!" she added. Fuck me if I still don't know how to answer this question for my 2016 Expense Request.

"Hi Jane!" My RE was all cheery when he entered the room. "I haven't seen you in a while. What's new with you? Any home improvement projects? Interesting cases?" I wasn't really in the mood for small talk. Just tell me all is quiet with my ovies and that we can proceed with this transfer. As Misery was reviewing my medications, I tried to verify that my transfer would occur during my vacation week. "Oh, I think it will be toward the end of August." she speculated. "Why so late?" I asked "My previous ones have been on CD 22." "Well, we really don't go by your cycle date..." she stammered, "It all depends on how your lining progresses ... blah, blah, blah... We'll see." she concluded in an effort to get me out of the exam room.

Well, that shouldn't be a problem. My lining has always been stunning. Since the correction of my septum, my endometrium is the one thing upon which we can rely. The next day, I had to call to reschedule my next monitoring appointment and I spoke with New Girl. "He has you tentatively scheduled during the last week in August." she confirmed. What the fuck? That's CD27! If it wasn't enough that I had to wait out a nearly six week natural cycle; now you're making me hold out for another month! What's the rationale? Why the change? Why should I think that I am enough of a veteran in this process that I could anticipate my transfer and plan accordingly? At least I'm smart enough not to argue about it now. I know I'll only be told to wait until my monitoring appointment.

It's time for me to play the adult version of the 'Is This a Big Deal?' game. If it is my best interest to delay the transfer, I can get on board with that. It may be worth the hassle of having to re-schedule my vacation time and move a lot of patients. If it's due to my RE's availability, if he has some time off, then just tell me that upfront. More so, it's a big deal in the sense that the momentum is fading. This IVF cycle has become akin to my dad telling a story. He drones on and on, and by the time he approaches the point; you've long lost interest. (I'm sure you can relate to this right now...)

"Are you getting excited for your transfer?" asked my Lead Physician as I told her about possibly needing to reconfigure my time out of the office. I didn't know how to answer. My other colleague asked the same question just prior to retrieval during my first cycle. At that time, I was more fearful that the cycle would be a waste of time and resources. Now I've already lived through that experience and I don't feel so afraid. Rather, apathy is consuming me. I almost don't care anymore. Success or failure, I just want to move forward with my next steps. I walked her through my plans to do two single transfers and then clean out the freezer and transfer the final two embies together. "Jane, you're already setting yourself up for failure..." she informed me. I am infertile and I have recurrent pregnancy loss. This is what I do. Failure is my norm.

A few hours later I was in the break room, chatting with Co-worker, when I was approached by one of our primary care doctors. "Jane, I need to refer a patient to Ob/Gyn, but my medical assistants can't schedule with anyone. Do I need to ask the girls in the front to set up an appointment?" she asked. I was about to reply that I have no idea how the scheduling process operates, and then walk away; but Co-worker answered quickly. "She's booked out for the next two weeks. Everyone's schedule is completely full." The primary care doctor explained the patient's situation; she received a Depo shot just over 14 weeks ago and has had persistent bleeding for the past few weeks. This isn't an urgent issue. She doesn't need an ultrasound or a biopsy, just reassurance and time. "Well, it's annoying that I can't schedule her with my own colleagues." she commented in a snide tone.

I silently sighed. I understood her frustration. Two years ago, Husband called to schedule a consultation with a urologist. He received the run-around from the call centre, and after five days, he still didn't have an appointment. I feared that he'd lose his nerve and bail, so I emailed the practice manager. "I am finding it embarrassing that my husband cannot schedule within my own affiliation. He has a PPO, so he does have other options to explore." Two days later, he had an evaluation with Dr Richard Hurtz. I didn't even have to explain that the urgency for the visit was his 35 year old wife who hadn't conceived in 6 months while her best friend was knocked up on her first attempt. I felt badly for any patient with a true emergent issue, who didn't have such connections.

"I need to rearrange my vacation time, so I'll be opening a few days on my schedule." I softy revealed before heading back to my desk. My mother never practiced Catholicism after she left her childhood home, so I must have inherited her Catholic guilt. A wave of depression crashed over me. Even though it wasn't an actual vacation, I was looking forward to having a reprieve from the office. Now that has been taken away from me, although the silver lining is that it is easier to come back when I've only been out for part of a week. I feel so trapped in this space. I can't escape from this role. My younger feminist, who insisted that I needed to have a career -as being "just a mother" was inadequate, has won.    

When I arrived at my desk, I discovered a sticky note from Michael Scott, reminding me that my expense request was due by the end of the day. It was time to admit something I hadn't acknowledged to myself. Although it was never my original intention, I've been viewing maternity leave as an outlet for my impending burnout. Actually, I originally planned that I would return earlier, and work on a part time basis. Now I want to take as much time as I can, plus that baby bonding time that will allow me to go to the spa. It's time to acknowledge that I may need to create an alternate solution to address my work fatigue. "Do you plan to take any FMLA time during 2015?" That question was still confronting me. I wouldn't ever write the word 'yes', but I also couldn't bring myself to print the word 'no'. I left it blank and placed the form on Michael Scott's desk.