Friday, 28 June 2013

Where I Belong

Late in the afternoon, on the day before my initial REI consultation, I received a call from their office. I didn't answer the phone, as I figured it was just a courtesy reminder, but when I listened to the voicemail I learned that my appointment needed to be rescheduled. Not only did I feel disappointed as I had been looking forward to this consultation, but I didn't know what to do about the time I had blocked off for my 'dentist' appointment. "Just leave for a few hours," Co-worker suggested, "go to the mall..." I shook my head. I would feel too guilty and with my luck I would run into a patient that I had cancelled. I decided that dentists could have last minute emergencies too; besides I would need to re-use that excuse later in the week. Additionally, I had received abnormal genetic screening results for a patient and had been trying to find a segment of time when I could inform her. Without concerns for potential interruptions, I spent 45 minutes explaining her results, discussing her next steps and answering her questions.

Just as soon as I had finished my notes and prepared her referral, there was a knock on the door. It was our front desk receptionist, "Hi. I know you're not really here, but there's a new patient who just came in. She has a new OB appointment on Friday, but she started bleeding..." I informed her that I would see this patient. She already had one child and her family was in the process of moving. They were planning to start trying once they were settled, so this pregnancy was sooner than expected. Unfortunately, her exam and ultrasound findings confirmed that she was miscarrying. They took the news rather well, and were grateful to be evaluated that day. I felt guilty that it was a little self-serving. I re-scheduled my RE consult for the same time as her previously scheduled new OB appointment, which made it easy for me to leave the office.

The morning of my appointment, I received emails from both patients, thanking me for my time. I was touched, but didn't feel that it was necessary as I hadn't done anything extraordinary. Any clinician worth his or her salt could have provided such services. I just happened to be there. I was available as I wasn't at a meeting to pursue my own procreation.

Today is Co-worker's last day before starting her maternity leave. When we discovered that we were pregnant together, we giddily laughed about what would happen in the office with both of us out at the same time. Now that it's no longer a concern, I can appreciate that it really would have placed a heavy imposition on our colleagues. A physician left our group a few months ago and his replacement isn't starting until the middle of August. In the days and weeks following my miscarriage, when I was still fueled on the 'at least you can get pregnant' optimism, I thought it would suck if I were to be absorbing her work while preparing for my own sabbatical. However, I had the foresight then to know that it would suck more not to be pregnant as I watched her depart.

It's not just about jealousy, it's the anticipation of loneliness. When we first met, I knew right away that we would collaborate really well together; but as we got to know each other, I knew we would become good friends. She is so strong in her role and she is such an asset to the practice, and I am going to feel lost without her professional contributions, but I'm mostly going to miss my friend. She's been my source of support for everything, not just infertility issues. I'll miss discussing which patients have hot husbands, re-capping the latest episode of Girls and sharing hysterical youtube clips. The vibe at the office just won't be the same, and even when she returns, it may not go back to the way it was.

As the Universe always seems to find ways to rub salt in my wounds, I had to complete an expense request for the 2014 budget. The first question: Do you anticipate taking any extended time off or applying for FMLA? I responded, 'No'. I can understand the rationale for the question, but still felt it was an encroachment on my privacy. (I did catch a look at the completed responses from our 30 year old family practice doctor and saw that she answered 'maybe :)' I also heard her discuss that she'll be ready to start TTC after her marathon in October. I'm already preparing myself that while I'm stimming at that time, she'll probably conceive on her first try) I decided to look at the vacation calendar to see how much time my colleagues were taking off in the remainder of the year. I noted that one is off during the entire week that would have led up to my due date, and the other two are off on the actual day and for a few more days following that date.

I had long accepted the reality that my pregnancy just wasn't meant to be, but it really resonated at that moment. My presence will be required to provide patient care, as there wouldn't be anyone there to care for me if I were a patient. I will be holding down the fort. It's where I belong...for now anyway...

Tuesday, 25 June 2013

What a Difference a Day Makes...

My BFN from IUI#3 was punctuated with an exclamation point by AF's prompt arrival. Typically, her entrance is heralded with some light streaks -just enough to tease my hopes about implantation spotting. Not this time; there was no courtesy warning. Only hours after my POAS confirmed what I already knew,  I was in full flow. My CD1 was a full 24 hours earlier than expected. Since my hysteroscopy in February, AF has arrived on every fourth Friday. I have been Mary Perfect with the predictable cycles -until now. What a difference a day can make; not only do I lose the convenience of my Saturday monitoring appointments, but Husband is away at the end of the month and is unavailable if an IUI needed to be performed a day earlier.    

AF's earlier arrival has called so much into question for me. My mid-cycle monitoring fell right over Memorial Day weekend. Presuming the office would be closed for the long holiday weekend, (they were closed the Friday and Saturday after Thanksgiving and the Saturday of Easter weekend) I made plans to go out of town, and did my ultrasounds on Friday and Tuesday. It turned out that they had enough patients who needed evaluation, so they were open on Saturday and they arranged to see a few patients on Memorial Day. (Had I known this could have been a possibility, I would not have booked my trip) It may not be relevant, but as my cycle started a day earlier, I wonder if I had been scanned on Monday, would my follicle have been ripe enough that my RE would have instructed me to trigger that night? Could that day have made a difference?

We've been discussing what our next steps will be, but one decision was easily made -we will not be doing an IUI this month. I've been reminded that even with manipulation, my ovaries are not mine to command. I don't want to proceed with a cycle that could be compromised from the start. Interestingly, even with my unpredictable ovaries, cycle monitoring and timed intercourse will still be in play for us. I know it seems a bit inexplicable that trying au natural may be more feasible than an IUI cycle, but apparently, that's the difference a day can make. We also decided that we could use the money earmarked for this month's cycle and will take some cross-fit classes. Yes, we are jumping on that bandwagon -when you can't have kids, you turn toward fitness.

For the record, this marks the fourth time that Husband and I will be away from each other around the time of my ovulation. The first time, I queried if the Universe was mercifully pulling us out of the game, like a baseball manager relieving a struggling pitcher. However, as the Universe hasn't shown us any favours even when we have managed to be in the same place at the right time, I'm convinced that the force within the Universe is indifferent at best. It does foster more of my frustration toward the fertiles who are oblivious to their cycles and still manage to conceive (as they have working gametes). Especially, when they view your cycle monitoring and tracking as being detrimental and instruct you to "just relax and let it happen". It feels like they are the students who don't bother to study and yet still ace the test; while we're the studious nerds in the library, and despite all our preparation, not only do we receive a failing grade, but we have to see the teacher after class.

Oh, what a difference a day can make. For this month anyway, it means no letrozole pills, no trigger shot, no vaginal ultrasounds, no awkward small talk with my RE. It has meant digging out my Clearblue fertility monitor and getting up at 0530 on the weekends to test my first morning urine. It brings concerns for performance anxiety related to scheduled coitus, but the difference of day means I don't have to scramble for excuses to leave work. It has meant appreciating a break and accepting that changing our strategy is not the same as giving up.

Sunday, 23 June 2013

One Step Forward...Two Steps back...

I acknowledge that situation with our infertility is awkward for Myrtle. I felt that I was raining on the parade of her excitement and that she has to censor what she shares with me. As conception was so quick and easy for her, she never had to think much about the procreation process or ever venture into the infertility work up or assisted reproductive options. I truly appreciate that her intentions are in the right place, but as she hasn't experienced infertility herself, she can't understand how misguided her comments can be. I also admit that I'm a bit too sensitive, but I've come to accept that she just doesn't quite know how to support me during this time.  I'm fortunate to have built a separate network of women who do understand and have been an amazing source of strength for me.

I had decided that it would be much easier just to update Myrtle with our fertility project only if she asked; but as frustrating as it can be to talk to her, I still felt the need to share with her. Neither of us had broached the issue during the past few times we phoned, and more recently we kept missing opportunities to speak with each other. I started to question if I was actually trying to avoid her. Then she called on a Saturday afternoon.  I filled her in my swimming and running events, some plans for a long weekend and other miscellaneous topics. She announced that her husband received a two month assignment through a temp agency, which may become permanent, so very good news for them. We spoke for about half an hour, before I noted that I need to leave for a hair appointment. As I started to end the phone call, she commented, "Well, we didn't really talk about your life, so feel free to call me later."

I knew how to read between the lines. She was asking about life (or lack thereof) within my uterus. I realised then that we both had been playing a metaphorical game of chicken, each waiting for the other to make a move. I would be the one to give in. I phoned her back once I got in my car (hands-free, of course) and I blurted it all out. Fertility treatments not working, most likely going to need to do IVF later this year. Preparing myself that I probably won't be pregnant at the time of the would-be due date. Tough at times handling Co-workers pregnancy, which reminds me of what could have been. Just as soon as Co-worker goes out on maternity leave to have her babies, another colleague will be making her pregnancy announcement.

She just listened and offered a few comments of "I'm so sorry that you are going through this", which is all I need to hear from her. It felt good to vent and to be sharing with her. I was ready to take my victory, so I thanked her for listening and quickly changed the conversation to discuss how I was anticipating that the upcoming visit with my parents and in-laws will be rather stressful. "Family visits are tough, but it's like the pain of childbirth," she told me "you just have to push through it..."

Really Myrtle? You had to use that as an analogy? Just after I informed you that I may never have the opportunity to experience that event? hand smack to forehead... 

Thursday, 20 June 2013

0 for 3

I've previously described that taking prenatal vitamins when you can't get pregnant is akin to taking birth control pills when you're not sexually active, but I have to re-assess that analogy. If I had been really determined in my early twenties, I think I could have found someone willing to sleep with me; but even with assisted reproduction, I can't knock myself up. I think my resentment for these nutrient supplements started when we were officially TTC and I bought my first bottle at Target. The clerk congratulated me on my "pregnancy", but I felt so silly explaining that I was only trying and wasn't actually pregnant, so I smiled, lied, and changed the subject before she could ask any details.

I know there is a medical rationale for starting vitamins early, but the daily ritual just makes me feel so desperate and pathetic. I feel like a fraud, diligently taking these pills that really aren't meant for me. I picked up the chewable gummy preparation, as I struggle swallowing pills and all vitamins taste horrible, but now I appreciate that they seem more like a candy snack rather than something medicinal. I also started ordering on-line, but recently Target was offering a $5 gift card if you purchased two bottles, and I couldn't resist a deal. As I queued to be checked out by a young male clerk (who did not comment on the items), I wondered if I would become pregnant before finishing the two 90 count bottles. Thus, a new challenge was issued. If my uterus is still empty by the time the second bottle is, I will switch to a generic multivitamin and folic acid supplement. I'm convinced the cartoon pregnant woman on the bottle is mocking me.

5 days past IUI #3, I read a fellow blogger's post on the woes of progesterone supplements and I suddenly realised that I hadn't started mine. I could offer a few plausible explanations. I was due to start on a Saturday, which happened to be the day of a 10 K run, followed by Co-worker's baby shower, a first birthday party and finished with a leaving party for another friend. I was hardly home for five minutes. Additionally, as one of Husband's hockey friends stayed with us for a few days, I hid all my fertility related products. To an extent, they were out of sight and out of mind.

Yet, I couldn't escape the notion that this was more than an oversight. I hadn't started my progesterone supplements, because I knew then that this IUI was not going to be successful. I would merely be going through the motions, because it was expected of me, but not because it was serving any purpose. I began using them anyway, but skipped many days. I had finished off the bottle that was prescribed to me when I was pregnant and Co-worker gave me her unused supplies. It was easier to use leftovers that otherwise would have been discarded, as I can't bring myself to fill a new prescription for suppositories that will ultimately be used in vain.

It also made for a much easier two week wait. I wasn't in any kind of limbo wondering if I could be pregnant. I thought ahead to the details for our next cycle and our intentions to do IVF later in the year and I often forgot that I actually was in a two week wait. Still, test day arrived. I knew it was a formality at this point in time. Taking my monthly POAS tests is beginning to feel like opening a soda bottle when the distributer is running a give-a-way contest, "One in ten WINS!!!" -which is probably much higher odds that having a positive pregnancy test from an IUI procedure. Not this time:

Three strikes. Yet, we're not out.

Tuesday, 18 June 2013

It's Not a Race (although it feels like one)

As our friends in England started procreating like rabbits, Husband often fretted that we were "falling behind". With every birth announcement, I would remind him that it wasn't a race. Oh, it was so easy for me to make that statement when we weren't TTC or dealing with infertility. I know it still holds true even in our present situation -every couple has their own path to parenthood and you cannot compete in this manner. I think what gets to me at times, is the fact that many of my friends consulted me during their pregnancies. I was the among the first to know before their formal announcements and I was the resource for their questions. It feels strange that I may be the last to actually become pregnant and may receive advice from my friends' experiences.

Recently, I visited with an old friend from University. She married in October 2010 and started TTC a few months later. She had a BFP in April, which unfortunately resulted in an early miscarriage. During her evaluation, it was noted that she had a large dermoid cyst on her left ovary. After spending a few months debating her decision, she was scheduled to have a laparoscopic cystectomy on 24 October 2011, but her case was cancelled when she had a positive pregnancy test that morning. It was the same day that I removed my IUD. Her baby was born almost a year ago, and she had her entire left ovary removed at the time of her Caesarean delivery. She shared with me that they were planning to start trying to conceive just after the baby's first birthday, as their goal is to achieve a pregnancy by the end of the year. Just be prepared...I warned myself...she is going to become pregnant before you... I truly hope she conceives quickly, especially as she has the challenge of a lone ovary. It just stings a bit when your journey can be measured by the second (or more) pregnancies among your friends.

Last summer, Co-worker and I were chatting in the break room, discussing our upcoming infertility consultations. We quickly changed the subject of the conversation when the 30 year old ENT doctor entered the room. Once she left, I informed Co-worker, "you know she will be pregnant before both of us." Sure enough, on the Friday before Labour Day weekend, I did her new OB visit after hours and confirmed her intrauterine pregnancy at six weeks gestation. Patient confidentiality prevented me from giving Co-worker any heads up toward her announcement. Once it was revealed, Co-worker approached me and acknowledged, "you were right." What I also couldn't share with Co-worker, is that she stopped her Nuva Ring in April, had irregular cycles and inaccurate results with ovulation predictor tests, but conceived on the night of her husband's birthday shag.

Fast forward to the present time. Co-worker and I were discussing the events of our weekend before patient appointments started. We took note that one of the primary care physicians walked into office of the practice manager and shut the door behind her. A minute or two later, we heard a shriek from the office manager. The doctor walked out with a look on her face like the cat who swallowed a canary. "I'm pretty sure she just announced that she's pregnant" Co-worker commented.

I can't say it was a complete surprise. In October 2011, she sent me an email, noting that she had a patient who was in her early 40s who wished to pursue IVF, and she wanted to know who refer to and what work up needed to be done. Immediately, I suspected she was asking for herself. Firstly, the personal characteristics fit, but if it were a real patient, she just would have referred her to Ob/gyn and made us do the workup and referral. I also wondered why she had contacted me and not one of our more senior providers. When I needed a primary care referral to my RE, (my insurance is an HMO) I confided in her and asked her to submit it herself, rather than have a medical assistant process the paperwork. "Believe me, I understand the need to maintain confidentiality" she assured me with words that I thought were a bit telling.        

Co-worker did a little recognisance work and received confirmation. "It's still totally secret. She's only four weeks and two days" Whoa! Way, way too early to tell anyone, I thought. "You know she totally did IVF. Probably with donor eggs." Co-worker speculated. So? I thought to myself. There wasn't any asterisk associated with her pregnancy. It didn't matter how the pregnancy was achieved. The results were the same. She was pregnant and I wasn't. I thought I could have been the next pregnant woman in our office. At least the situation is a little easier than it has been with Co-worker. She's in a different department and only works part time. At most, I only briefly encounter her while passing in the hall maybe once a week, if that, and I don't think she'll seek care with our OB department. I now really feel for the infertile medical assistant that I referenced in Perhaps, not so invisable, as she is primarily assigned to this doctor.

This marked a new milestone in my infertility journey; the first time I've been preemptively warned of a pending pregnancy announcement. I think it's easier to accept when you've mentally budgeted for a predictable pregnancy. At the very least, you are granted the satisfaction of having an accurate forecast. It's a little harder to swallow when some one less suspecting blind sides with a surprise announcement. Setting aside my petty, envious feelings; I wish the best for her, and I'm a little nervous as she is so early. I know I'll have pangs of jealousy every time I see her expanding bump, but my heart will break for her if a bump never develops.

No, it's not a race; although it seems like one at times. Especially if it feels like you are losing.                    

Sunday, 16 June 2013

To my Husband,

I know this day is hard for you in the way that Mother's Day was tough for me. The world is celebrating the members of a club that you are longing to join. I see the way you look at fathers playing with their kids. I know there is a lump in your throat when Facebook displays the offspring of your friends. I've come to understand how much fatherhood means to you.

I don't tell you enough how much I love you and I don't thank you enough for the way you love me. When we were first discussing getting married, I told you then that I didn't think I would ever come to want children. I thought that would be a deal breaker, but to my surprise and delight, you still wanted to spend the rest of your life with me, even if it meant giving up on your dream of being a father. Maybe you sensed that I would come around one day, as you sometimes know me better than I know myself.

I don't feel that I've done enough to apologise to you. If we had started this process earlier, we either could have our baby by now, or I'd feel more optimistic about our prospects. I was too arrogant. I thought my knowledge could fast track our procreation attempts and we could circumvent the challenges of our ages. I'm professionally literate to the reality of infertility, as I witness cases on a daily basis, but I was just too stubborn to accept that I could be one of them. We are only as blind as we want to be.

I cringe inside every time I hear you say, "it's my fault". I assign no blame to you, just as you did not attribute any responsibility to me for losing our pregnancy. We're so intwined in this together, your gametes are my gametes and vice versa. We resected our uterine septum, it's our follicle development and our sperm count. There is no one else with whom I would want to procreate, and I wouldn't trade you in for the studliest sperm in the world.

There were so many ways our brief pregnancy was a dream come true. It was a total surprise and caught us off guard as we were getting ready to start fertility treatment. There was something poetic about the fact that you received the news on a hockey field -the same site where we first met. Yet it pains me to think about you standing alone wiping away your tears, as I was back at home counting down the hours until your return. I hope we are together to celebrate if another BFP comes our way.

I can't wait to see the look on your face if we're ever viewing the subtle flicker of cardiac activity on the first ultrasound. I know you'll hold it together until my RE leaves the room, but then may cry a bit and I'll fall even more in love with you. I can't wait to feel your hands on my bump as you try to appreciate our baby's fluttering movements. I can't wait to watch you melt, the first time the bundle is placed in your arms. I can't wait to observe the look of pride in your eyes when the little one takes his or her first steps. I want to see you teach him or her how to play hockey and how to set up a chemistry set. I know you'll be nervous at first, but you're going to be a natural.

I appreciate that there are going to be a lot of tough challenges as well. Nights where we play rock/paper/scissors to determine who gets up to feed the baby. Teething and the terrible twos. We may look at each other and ask "what were we thinking?" Teaching him or her about loss and death and the general unfairness of life. This is all years before the rebellious teenage years, where we're waiting at home hoping our progeny isn't doing anything we were doing at that age. I know they say that nothing really prepares you for parenthood, but I feel that this has been the best test to measure our determination and resolve. Infertility has made us stronger as a couple and if we make it to the other side, we'll be stronger as parents. I hope to able to experience it all with you.

Happy Father's Day to my darling Husband, and to A, B, C, M, CP, SH, Chris, Mike, Andino, Adam, Kenneth, Sarah J's husband, Amber's hubby, Mr Yeah, Science, Mr Closet Infertile, Mr Empty Uterus, Mr Rain before Rainbow, the Artsy Engineer and to all the other future fathers.


Thursday, 13 June 2013

Because I could...

Among my other silly pre-IF concerns was thinking about how far along I would be in relation to the earth's axial tilt. If it were mine to command, I would arrange not to be showing during the summer months when the sun rises before 6 AM and my swimsuits would reveal my expanding bump. During the pre-daylight months I could arrive at the pool early and jump in quickly to hide my secret. I also figured I would  start showering at home, even after the pregnancy was apparent, as I wouldn't want to frighten any of the younger women in the locker room.

I've been dealing with some weight issues for the past few months, well actually for the past few years. I am 5'5" and I weighed 135 pounds on my wedding day in 2006. Since then, it's been slowly but surely increasing. I was in the low 140s by the time I moved to California in 2007. Despite running a half marathon in 2009, I couldn't drop below 145. More pounds were added in 2010 when we started renovating our first house and I did little exercise. I think I peaked around 157 at the start of 2011, but with swimming and training for my first triathlon I got down to 150, which has been my baseline for the past two years. Somehow I got as low as 147 right before my BFP, but I really didn't care about the scale at that time. Since the new year dawned, I've been consistently above 150, usually ranging from 151-153.

I know some of my weight gain can be attributed to muscle mass, but not all of it... Surprisingly, I can still wear some clothes I have from 2006 and I haven't changed my dress size (accounting for the variations between different stores). I try to look beyond the numbers on a scale. In 2006, I wasn't  running, and never throught to enter a 5K or even longer distances. I couldn't swim from one end of the pool to another, let alone compete at a masters level. Co-worker once commented to me "Do you know how fuckable you look? who cares what your weight is!" I know it's only merely a number, but I can't get past the fact that I am technically 'overweight' on the Body Mass Index chart.

I also can't get past the notion that if I'm not pregnant, then I should be at an ideal weight. I'd like to blame the Femara, but I know I can't. I keep telling myself that if I watch my caloric intake closer and start running in the evening, I'll be able to drop these extra pounds, but it's much easier said than done. Nonetheless, the other morning I was motivated by a thought of 'oh, fuck it' and inspired by 'why not?' and I decided to wear a two piece suit to swim practice -just because I could.

To my satisfaction I received a few glances from some of the the older guys at the pool, but also from one in his mid-thirties, who is someone I would probably fancy if I weren't married and in the process of procreating. I do lose a little respect for myself for craving this type of validation, but I figure I'll exploit every silver lining available...because I can...

Tuesday, 11 June 2013

Perhaps, not so invisible...

When Co-worker and I were both trying to conceive, we were both aware of how awkward it could be if one of us became pregnant while the other was still struggling with the process. She has been very respectful and tactful toward me, but it's inevitable that the spotlight follows her while I fade into the background. As I've mentioned before, I don't necessarily want the attention, but the focus on her just sometimes reminds me of my loss.

The other day, I announced that I was walking over to the hospital. "Wait up!" called our lead physician, "I'll come with you." I paused at the top of the stairs. I figured she probably wanted to discuss a recent situation with a difficult patient; but to my surprise, she asked, "How are you doing? I have been thinking of you. I know it can be hard not only dealing with Co-worker's pregnancy, but also caring for pregnant patients." I was completely touched. Suddenly, I didn't feel so transparent and it was comforting to learn that I was in her thoughts. Interestingly, I had never intended to share any of our procreation plans or subsequent problems with her. I did so in a fleeting moment when I couldn't come up with a plausible excuse to explain my absence for an important meeting. Once again, I was reminded that emotional support can come from unexpected sources.

She shared her frustrations from when she experienced being an infertile gynaecologist and barren obstetrician, "I felt that I would deliver everyone else's babies, but never one of my own." I always knew that I wasn't alone, as there probably are a fair number of infertile women's health care providers, but it was still surprising to learn that I was in such close proximity to another comrade. I expressed that I feel incompetent and inadequate when patients present for fertility consultations. It doesn't bother me too much to care for pregnant patients, but at times I'm reminded of how privileged I am to have this connection with these women and their families and I'll wonder if this is the extent of my exposure to this human experience. She detailed that during their first year of TTC, multiple sister-in-laws and college friends quickly became pregnant. Eventually, she began to anticipate someone else's pregnancy announcement with every negative test she had. Finally, after one year and at the point when she thought it would never happen, she received a BFP and went to to deliver a healthy baby girl. So, you didn't actually have a times I just can't turn off the clinician in my brain.

"You'll get there. I know you will." She said emphatically and repeated it over and over as we talked. You haven't seen our numbers; you don't have any evidence... I needed to remind myself that she was speaking to me as a friend and not as a doctor. I struggle so much to accept the proclamations of "it will happen," as it strikes me as being so fallible. As someone who does not hold spiritual faith, I rely on science; but I accept that science is not without limitations and imperfections. Despite models calculated to predict success, the element of the unknown is still an influential variable. The unexplained nature of infertility still baffles the greatest scientific minds. As a core element, every pregnancy requires follicular development, ovulation, fertilisation and implantation; so while the science is always accurate, unfortunately, it is not always predictable. Truthfully, no one knows if it will happen or not, which makes it hard to hear the presumptions.

Recently, Co-worker shared with me that when she was hyperstimulated and thought there was no possibility of pregnancy, she went to one of our primary care providers to evaluate her abdominal pains. The medical assistant who did her intake recognised the significance of the medication Clomid, as she shared her own experience with infertility. She was now in her early 40's and struggled to conceive on her own for seven years. By the time she sought evaluation by a specialist she had no ovarian reserve and was experiencing menopausal symptoms. Co-worker commented that it was just recently (when she was 26 weeks) that the medical assistant approached her and said, "So, ...I never actually asked you what you are having..." which was her way of addressing the fact that it took her this long to acknowledge Co-worker's pregnancy.

I don't know this woman very well as she works in a different department, but immediately I had empathy for her. Should I ever have a viable pregnancy, it will be one more announcement for her to endure. I know that I can't say anything to her, as not to betray the trust and confidence between her and Co-worker. I just wish I could let her know that she is not invisible -and that someone is thinking about her.

Sunday, 9 June 2013

Unspoken Communication

I've discussed in previous posts about my decision not to disclose any of our TTC intentions or infertility and miscarriage struggles with my parents. Many years ago, I told them that I didn't desire to have any children (which was the case at the time) and I haven't updated them on our change in plan. I'd rather have them think that my stubbornness is the restrictive factor, and not our biological limitations. I don't want them to follow the disappointment of our failed cycles and I truly want to present the ultimate surprise of their lives if we ever are successful. In particular, my mother and I don't have the kind of relationship where we share personal details. 

Since we've started TTC, she's only raised the issue with me twice. While visiting shortly after Myrtle's announcement, my mother and I dished that we both weren't keen on the name Myrtle was considering if the baby were a girl. "What names do you like?" she asked. Maybe I had one too many glasses of wine, as I told her our selected names. "Oh! I'm going to dream about little Jack or little Kate!" she gushed before heading off to bed. How funny that while she was dreaming, we were in my closet quietly engaged in what eventually became unsuccessful coitus.

Later that year, when we were in England for the Olympics, Husband and I arrived earlier and stayed with his parents for a few days before mine met us in London. I had my hysterosalingogram performed two days before I flew out and I still had my paperwork with my authorisation in my purse. I took it out and left it folded over on my night stand. A last minute change in plans had my parents spending our last night with us at my in-laws. We let them stay in Husband's old room and I forgot about the paperwork, until Husband picked it up the next morning. I tried to reassure myself that I didn't suspect my mother would snoop. As we were driving to the airport, she asked if my 42 year old cousin was planning to have her tubes tied during her upcoming repeat Caesarean delivery. "Is that what you would recommend professionally?" she inquired. I replied that she still has fertility potential and is at a higher risk for a miscarriage if she does conceive again. "I know you don't plan to become pregnant, but do you ever worry that wouldn't be able to carry a pregnancy?" she inquired. I responded that most miscarriages are due to chromosomal abnormalities and not uterine structural issues (oh, the irony). However, I questioned her choice of words be able to carry a pregnancy and wondered if she may have looked at my paperwork. As a nurse, my mother can figure out what a hystersalpingogram is.

As Husband has to umpire at a hockey tournament every Thanksgiving, I'm left on my own that weekend. I've started setting up our artificial tree during his absence, but wait until he returns to decorate it together. (Although decorating it together really means he drinks beer and watches football while I put the ornaments on, but at least we're in the room at the same time). As we were celebrating the news of our positive pregnancy test, the boxes of ornaments remained un-opened. Despite my warnings of not getting ahead of ourselves, we spent the next two weeks, discussing everything from testing, when and how to announce, re-locating Husband's home office to life insurance. Then in the last full week before Christmas, I miscarried. Shortly after, I finally noticed that the tree was still bare -although it did have lights, as we keep them on each year. Not necessarily out of mourning for our pregnancy loss; I decided I couldn't be bothered to decorate at that point in time, since I'd just be packing everything back up in another two weeks. I simply put the boxes of ornaments back in the closet.

It was a bit difficult talking with my mother shortly after the miscarriage. I did my best to convey that everything was business as usual, just so her maternal instinct wouldn't pick up any sadness in my voice. She let me know that she had shipped our presents and asked me to call her when they arrived. It was a late Christmas Eve delivery, but I opened her package and found my old Christmas ornaments. I called right away and confessed that I had been too lazy to decorate our tree, so her gift was perfect! I know her underlying motivation was just to clean more stuff out of the attic (every time she visits, she brings more old relics) but to me it just felt like some how she was able to offer her support, even if she didn't know exactly what I was going through.

More recently, she sent me this necklace for my birthday. She picked it up for me when she was at the Boston Marathon. It's a bit funny to me, as my mother doesn't really know what race distances I run. She just knows that I run races and have my bibs and medals hanging in the guest closet. I've done a handful of half marathons, but especially after bailing on an 18 mile race, I'm not anywhere close to running a marathon. I appreciate the slogan on the necklace, as when I was dealing with Myrtle's quick conception and discovering our infertility issues, a fellow infertile described "it's a sprint for some, and a marathon for us." I found this analogy to be very accurate and I discussed in my post, A Marathon versus a Sprint , that while sprinters seem to attract all the attention, it's marathon runners who command respect. Almost anyone can run 100 metres, while only a few have the strength to endure the longer distances.  I wore the necklace during my last IUI procedure, which was especially comforting as Husband had to take a friend to the airport and couldn't attend.

Maybe I'm just grasping at straws to feign that my mother and I have an unspoken communication and understanding. Sort of how Jessa from HBO's Girls was trying to will a connection to her father:

I got a text from him the other night, which are few and far between, and it was just a bunch of random numbers and letters, but I felt that it was something, it felt like he was trying to tell me something...I think it was some sort of sign...

Hannah: Maybe he just sent you a butt text....

Thursday, 6 June 2013

Just another day at the office...

Although it's not at the same level as the uncomfortable and invasive procedures that women endure during infertility treatments, I do have some sympathy for the awkwardness men experience during their visit to the Andrology lab.  Please read a post by Chris, the partner of Risa from Who Shot Down my Stork?, for a brilliant description of the process from a man's perspective . I was really nervous during Husband's first wank in a cup (WIAC) test, as I wasn't sure he'd be able to complete the task at hand. My husband is a Virgo and he also has mild OCD. His goal in the room is to avoid touching anything. I'm actually surprised he hasn't asked me to bring home some latex gloves as I don't know how he handles turning on the faucet or turning off the light switch. Mostly, his 'don't touch anything' rule applies to avoiding any of the pornographic material that the clinic offers, so he has some favourite clips downloaded on his iPhone. My cousin has a friend who took her husband into couples counselling after she found some porn sites on his web browser. I didn't realise there were still some people who are uptight about illicit videos (if it had been gay porn, I'd agree she has some concerns...) but it gives me pause for a laugh, as files of salacious material are merely a component of our procreation process.

I exhale with a sigh of relief every time I receive confirmation that the emission was accomplished, as I still fear he could miss the cup or accidentally spill the contents. However, I learned today that I had been underestimating his ability to triumph in the face of uncouthness. A rather cute, medical assistant led him to the special room, picked up the remote control and turned on the small TV set, which opened with an orgy scene already in progress. She continued talking with him to check the identity on the label and reviewed the instructions for where to place the collected sample as he stared at the floor, shifting uncomfortably. I wondered it were specifically written in her job description:
  • Escort gentleman to masturbatorium 
  • Turn on Pornography
...all in a day's work...

Wow. It seems like it were only yesterday when I was overly optimistic about our last IUI attempt. During my first cycle, I asked my RE if I needed to do LH surge predictor testing, as Co-worker's RE had her do. He replied that it wasn't necessary and commented that many patients use the tests even when he advises against it. He asked me to test during my second IUI, but I forgot about it and then he never inquired about the results. This cycle, I decided I would be compliant, not that I think it makes much of a difference. In the interest of collecting my infertility stats, as I was away over the long weekend, I tested for my LH surge in my fourth airport bathroom. Washington Dulles gets added to the list with Toronto Pearson, New York -JFK, and London Heathrow. Additionally, I administered my Ovidel trigger at a Major League Baseball stadium. I am truly feeling like an infertility veteran.

Continuing with our TMI details; my lining was 10.2. My left ovary was the bread winner again, with a dominant follicle at 23 x 18 mm (biggest to date). The right ovary made a valiant effort, but came up short with a 14 x 14 follie, which was unlikely to mature in time. Unfortunately, Husband's count was back in his usual territory; 14 million pre-wash, 70% motility, progression scored as '3'. So it was a poor showing with only 4 million used for insemination, but at least the guys who came to play seem really determined. Additionally, we supplemented with a post-IUI "intercourse can only help" bonus bang. High five! Let's see if the third time really is the charm...

Monday, 3 June 2013

What's your excuse?

Among the other unpleasant aspects of infertility treatment is needing to explain your absence from work during your appointments. It is particularly hard for anyone who has any type of scheduled clients, meetings or visits. Not only do you feel guilty about the fact that your absence is affecting others, but there's a public record for everyone in your office to view, and thus wonder why you need to be excused so frequently.

I hate having to lie. I'm not very good at it, and I fear that I'll get caught. I often work out the details of my back story with precision, trying to determine what type of flaws could be exposed. It's hard to find the right balance. If you don't provide any reasoning, it looks questionable, but if your alibi comes across as being too rehearsed or too specific in the details, that can also arouse suspicions.

Sometimes I don't give any explanation; my recent IUIs have been scheduled at 11:30, so I'll have a hold placed on my appointment slots after 11:00 and I'll just offer that I need to leave early. It's been a little harder for some of my monitoring appointments, which tend to be scheduled mid-morning and require me to leave and return in the same session. I feel a little more obligated to justify why I'm slipping out for only an hour. Fortunately, as I have really bad teeth, dental appointments have been my default excuse. The irony is that I haven't been to the dentist for a routine cleaning in nearly a year and I'm looking for a new dentist that works nights or weekends, as I can't take any time off from work for a dental appointment, even if it is legit.

Two years ago, I had a failed root canal that eventually required an implant, so I've been able to repeat that history. Routine cleaning finds a cavity. Need to go back for follow up X-rays. Dentist determines it needs a root canal -refers to endodontist. Endodontist thinks a root canal will only be temporary, recommends implant. Oral surgeon agrees proceeding with implant is the best course. That back story bought me five absences. Unfortunately, it's reached the end of the line as the next step of the implant process involves extracting the tooth and 6 months later installing the implant. When I actually had it done, I took the rest of the day off as my mouth was packed with gauze. I can't fake the effects of the transient Bell's palsy that comes with having dental procedures preformed.

Although there are a few people at work who know the truth behind my departures, at times I've been tempted to completely come clean, just so I don't have to lie any more. Then I remember that there is a reason I've only been open with a few selected individuals. I don't want everyone I work with to know such an intimate detail in my life and I don't want my work colleagues to follow my treatments and to be able to ask, "so, are you pregnant yet?"

So now I'm trying to be creative and think up new excuses. One day it was because we were getting our alarm service inspected. When I was leaving DC recently, my connecting flight was held up on the Tarmac for over an hour. Last year, I was bumped off a flight and had to cancel an entire day's schedule of patients due to my delay. I thought it might actually happen again, and although I made my flight, I contemplated claiming that I didn't, just so I could cancel out my morning. It would have been nice, I could swim, go home and get cleaned up before my RE appointment and then go into the office early and catch up on results and messages before the afternoon session.  I would feel too guilty about cancelling on patients at the last minute (many who have also budgeted time from work) and I would be too fearful of getting caught, especially as I once nearly ran into our office manager coming out of my RE's office. However, I still could exploit the situation. I claimed that I did miss my connecting flight, but was able to get on another flight that arrived at a nearby airport. My bag however was on the re-routed flight and I needed to leave to pick it up as it arrived off the carousel.

I do hope I get pregnant soon. Otherwise, I'll have used up all my potential excuses by the time I need to be dismissed for prenatal appointments.

Saturday, 1 June 2013

Baby Shower Survival Guide

Even prior to experiencing infertility, I never really cared for attending bridal or baby showers. I tend to view the event with the same obligatory effort that others approach having their yearly GYN exam; you don't really want to go, but it has to be done. Many years back, Myrtle and I were bridesmaids for a mutual friend's wedding. When the maid of honour was scheduling the date for the bridal shower, I replied that it was during my finals week, and would not be able to attend. As it turned out, I finished with my exams earlier than expected, but rather than drive back to Connecticut for the shower, I spent the weekend at the beach. It's a secret I've kept from the bride and Myrtle to this day.

I had no guilt, as I knew that I had no intention of holding my own bridal shower. Since we started TTC, I've participated in three at-work events for expecting staffers and I've attended three formal baby showers. At each one, I still feel strongly about not registering for items and not allowing anyone to plan a shower for me, should the opportunity present. However, the issue is starting to seem less relevant. The sense of 'always a bridesmaid, never a bride' is more prominent and I can hear the Gershwin lyrics, they're writing songs of love...but not for me... in my head. Baby showers can be particularly difficult for infertile couples. It's a blatant display of what you want and what has been so elusive for you. Here are the Mine to Command tips for surviving a baby shower.

Look hot
Choose an outfit or dress that rocks your bumpless figure.

The best defense is a good offense 
Talk about the upcoming events in your life; a project at work, upcoming vacation, home renovations, recent race or other athletic event. If you can set the topics, it might deflect the conversation from "when are you going to have a bay-bee?"

Have a response ready
The mother-to-be will probably prefer that you not take this opportunity to come out about your fertility. Stick with the traditional responses 'in a few years'...'just waiting for the right time'.  My personal favourite; "Why, do I need one?"

Identify an ally and create a code word
Enlist the help of a friend who can rescue you from a difficult conversation.

Get a job
I found that it was easier to get through the baby shower for the ones I hosted. My focus was on organising the games and serving the food, and my attention was distracted from the gifts and discussions regarding breast pumps and diaper genies. Offer to help set up the cake or dessert. Be the person who boxes up the opened presents and carries them out to the car, which provides moments of repose.

I don't have a baby! Everybody drink!
Remember the words of Samantha Jones from Sex and the City. Enjoy the booze in moderation.

Prepare for the worst case scenario
Pack your make-up case in the event that you end up crying in the upstairs bathroom.

Have an exit strategy
Should the urge to bail become overwhelming, some good excuses include: needing to do an airport run, pet sitting duties, or attending another event scheduled on the same day. In my case, it happened to be true; I left Co-worker's baby shower to attend a first birthday party for another friend's baby.