Wednesday, 28 August 2013

Going Through the Motions

As it has become my routine, CD1 involves discreetly carrying a tampon and my phone into the bathroom, so I can call my RE's office for baseline monitoring. At least this past time AF had the courtesy to appear on a Friday, which meant I could go in on Saturday morning. "There's no one else scheduled tomorrow" the office manager informed me. "Can you come in today at 12:30?" So funny that with my other cycles, he's been meticulously insistent on a CD 2 scan, but I was happy that he would have a Saturday morning free to do whatever he would do on a Saturday morning that didn't involve going into the office. Yes, 12:30 could work for me, although it would mean delaying an in-box of patient calls. Fortunately, nothing looked too urgent and could wait for my return. I grabbed my keys and was about to leave when I received a call from the office manger "I hope you haven't left yet. There's another patient who needs to be seen tomorrow, so we can see you then if you'd like." This was the bright spot in an otherwise shitty day. I truly felt the advantage of the personal attention from a smaller office.

I arrived a few minutes early for my appointment and the front door was still locked. I could see Misery through the window. I silently groaned thinking she would be even less excited to see me knowing I was half of the reason why she had to work on a Saturday morning. "Good morning, Jane. How are you?" she pleasantly greeted me. Who was this woman and what had she done with Misery? Firstly, I don't think she's ever identified my name without checking my chart or the schedule first. Secondly, she actually smiled. I'm sure she must get paid overtime, so maybe she's happier when she's working on the weekend. Maybe she's starting to feel badly for me. I even got a sympathy pat on the outside of my thigh from my RE as he wished me a good weekend.

It just seemed like we were going through the motions. Ovaries quiet, go ahead and start Femara today. I mentioned to my RE that starting the Femara on day 3 yielded the best production from my ovaries thus far. He responded with a shoulder shrug and "you can start on day 3, it won't make much of a difference." Who knows if it was a coincidence, but I started on day 3 and had two ripe follicles on my left side by CD 11. Co-dominate follicles at 22 x 19 mm and 18.5 x 20 mm to introduce a new term as well. Lining: I don't remember. Insemination on day 13.  Husband's count was as per usual. 14 million pre-wash, motility 75% progression '4'. 4 million selected for the journey to my uterus.  At least he scores points for consistency.

It was a peaceful process. I had to do some last minute juggling with my patients to clear time in my schedule, but miraculously everyone showed up on time (a new patient even arrived early to register and complete her paperwork -a rare occurrence) and I was able to leave the office when I needed. I had a great set at swimming and the magic person in my iPhone came up with a great selection of music for my drive to and from the office. It's all seeming so routine, which is starting to really resonate that it's time to change the game plan. I texted Husband with his numbers. His reply: Crap :( Don't know if I can be bothered with IUI anymore. Alas, we're ready to move forward.

Monday, 26 August 2013

We Need to Talk

"So, can we arrange to have the IVF talk?" I asked my RE, as I rose out of lithotomy position at my recent monitoring appointment. "Sure, we can talk now." he replied to my surprise. I was expecting to need to set up a separate visit, which would require insurance authorisation. I had a dentist appointment (for real) following my scan, but I figured since I was already nearly a year overdue for my cleaning, I could be a few minutes late. I wasn't going to pass on an opportunity to pick my RE's brain. I've outlined some of the details of our conversation, but I would really appreciate some insight from any IVF veterans!

Getting Started
Would need to start planning a month ahead. As I went into hypertensive crisis on birth control pills, he would prefer to start Lupron in my luteal phase. I offered that I could re-challenge the birth control pills by taking my blood pressure meds at the same time, as I did respond (relatively) quickly to them. I just have an aversion to Lupron, based on the experiences with my patients. He did point out that this is not Lupron in the way that I'm familiar with it, a 3.75 mg monthly injection or 11.25 mg three month depot, which is often used to treat endometriosis or fibroids, but rather a micro dose. It still gives me a little concern that the Lupron could over suppress my ovies, and I'd rather take my Labetalol and deal with my blood pressure to avoid Lupron if I can!

Intracytoplasmic sperm injection (ICSI) is considered the standard of care for male factor infertility issues, my RE explained, also noting trends towards widespread use. "In you were only to apply indications, it's use should be about 20%, in the state of California it is performed in about 70% of IVF treatments." He commented that his own ICSI rate is about 65%, but some large facilities such as Massachusetts General have nearly a 99% ICSI rate.

Initially, I was dead set against doing ICSI as each week my Medscape update would feature some article regarding risks of ART and especially ICSI. A study published in May 2012 examined 309,000 Australian children and found 9.9% of ICSI conceived children had some birth defect, compared to 7.0% of conventional IVF babies and 5.8% of offspring that resulted from a roll in the hay. Interestingly, my greatest fear about procreating in general is autism. We're the typical prototype: Late thirties, Caucasian, middle class and educated. I don't know how I would handle the guilt if our progeny has autism. There was a reason why you weren't meant to conceive! This is what happens when you defy the natural scientific order! Those thoughts would haunt me for the rest of my life. One study found that there was no increased association between ART (did not distinguish conventional IVF vs ICSI) and autism spectrum disorders in singleton births. However, it was an observational study that only looked at 370 autistic children, so it doesn't reassure me that much. Looking through the database, they note an increase risk of inherited structural chromosomal anomalies, which makes me wonder if we should karyotype Husband. Beyond that, studies examining ICSI conceived children until the age of 10 note no significant psychological, neurological or other health related differences. Christos Coutifaris, the REI Department chair at the University of Pennsylvania, concludes that outcomes for adverse health effects of ART are still incredibly small. "Even if there is some underlying process that makes some of these [children] susceptible to certain condition, the vast majority appear to be normal." Thus applying the infamous quote from David Grimes, "two times a very small still a very small number."

Here's where the blogging community has made me so much wiser. A year ago, I was looking into minimally stimulative IVF options. Now I want to stimulate the hell out of these puppies and get as many eggs as I can produce. One of my father's best pieces of advice that he gave me was, "the more shit you throw against a wall, the more that's bound to stick." (Mind you I was only 10 or 11 and it was probably controversial to say 'shit' in front of your child...) However it seems so relevant now. My RE commented that he would strongly advise against even a split ICSI cycle. I shared that I estimate I may get a dozen eggs from my ovies and if half fertilise, we'll have 2-3 maybe 4 at the most with which to work. He thought that was pretty accurate. Leftover embryos? Oh, I won't even entertain that thought. I sure as hell won't let them be adopted by a fertile pastor and his wife.

To GPD or not to GPD
I expressed an interest in genetic preimplantation diagnosis. As per usual, my RE gave a very methodical answer that we didn't have a true indication; we're not carriers of an inherited condition and we haven't been through recurrent losses. He even noted that I wasn't at too high of a risk for aneuploidy at my age. Um, I'm an old bird, I thought to myself, but didn't interrupt him. I responded that I wouldn't want to receive abnormal screening results or discover a trisomy on a pathology report after a D+C. If we're taking the scientific approach, I want to exploit every advantage. He pointed out that it would cost an additional $3,000 - 5,000. Oh, and after referencing my age for the second time, he asked me to remind him just how old I am. I was flattered. Having someone think you're on the underside of the advanced maternal age status is akin to being carded in your late twenties.

I am having trouble selling Husband on the idea. As he just tends to see dollars and figures, he looks it as increasing the cost by 1/5 to 1/3. I see it as insurance protection to what is already an expensive investment. If we're going down this road, I want to get in right the first time. I tried to rationalise in terms of dollars and cents for him; we could get pregnant on the first try, only to discover after the fact that there is a chromosomal abnormality and need to start over with a frozen embryo (if we have one) which also costs $3,000 - 5,000, thus negating the GPD investment. This doesn't account for any of the emotional anguish. How hard would be be kicking ourselves if we were to encounter that situation? More so, what if we have no normal embryos? We would avoid all the financial and emotional costs associated with transfers. However, both my RE and Husband pointed out that transferring normal embryos still doesn't guarantee successful implantation and a miscarriage could still happen. They both seem to be on the page that we could just roll the dice and have a reasonable chance for a good outcome. I'm not sure I'm comfortable with that. It's not an abstract concept for me. I've scanned patients at nine or ten weeks and confirmed the absence of a heartbeat. I've delivered the diagnosis of an abnormal karyotype. For fertile couples, this provides some relief; an explanation for their loss. Once they recover emotionally, they just jump back in the sack and call with a positive pregnancy test in a few months. In our situation, the devastation is compounded by the frustration that we could have prevented this occurrence. We're still debating and discussing this item.

'Neat' or 'On the Rocks'
I pretty much already had an answer to this question. If an embryo makes it to day 5 and survives freezing and thawing, it is perceived to be a good quality embryo. Additionally, performing a frozen transfer at a later date allows optimal priming of the endometrium, which can sometimes be compromised during ovarian stimulation, especially in cases of OHSS. My query was based on the fact that their pricing structure designates a day 3 transfer.

A Weighted Concern
I know it is completely shallow, but one of my greatest fears about the IVF process is the potential for weight gain just from the stimulation process. I took notes on two of my patients who presented for their first prenatal visits after conception was achieved with IVF and both were ten pounds above their baseline weight. One was a triathlete, who had earned the 140.6 sticker on her car, the other was a gym rat. My RE just shifted in his chair and pointed out that I'll be gaining even more weight with my pregnancy. Damn it! this is the same response I give to my patients who ask about weight gain with birth control methods. there is nothing more annoying than hearing the echo of your own counseling. I quickly countered by referencing the stats on my patients and pointing out that ten pounds represents half of my allotted weight gain. He just sort of muttered "with exercise, you'll be fine".

I had some other questions such as benefits of endometrial injury, what point would we no longer consider a single embryo transfer, but would need to leave those to another day as I was seriously late for my dental appointment. Fortunately, they were able to still see me and I had a good check-up. Another item for my Resume of Life: Neglected dental health without any serious consequences. Score!

Saturday, 24 August 2013

Best Laid Plans

It all seems so easy when it's written on paper (truly a figure of speech, typed on a key board seems more accurate). I had figured we would have our last ditch IUI attempt in September before going to Hawaii and start our IVF process when we return. Although, I suppose if it's really much easier when you write it out, I could just script a spontaneous conception with a viable pregnancy.

Anyway, an IUI cycle seemed to be the prefect antidote to moderate male factor and two sets of in-laws who would be visiting during my LH surge. Husband could claim that he needed to run an errand for his work; although as his parents are in the loop, he offered that he could just tell his mother "I'm off to go wank!" Hello, are you a fucking idiot? I asked. "Do you want to think about your mother right before you go into the masturbatorium?" Providing, he could pull that off, I would leave in the middle of the work day to get inseminated and no one in the parental unit would be any wiser. Yet, the reality involves sneaking away to give myself my trigger shot, hiding my progesterone supplements and maintaining my game face in front of my in-laws at the end of the two week wait.

It all gives me pause to laugh. It was just less than a year ago when we were first planning to start IUI treatments, and we actually considered postponing them a few months; in the event that it worked on our first cycle, the impending arrival would coincide with the in-law invasion and the Hawaii trip. I refused to delay. This family fun time holiday was never actually my idea and I wasn't exactly consulted about it. I never really said much when it was discussed between Husband and my parents, I thought it was more of an abstract concept. Then one day it was happening. I didn't want to put our lives and the life of our potential child on hold to accommodate a multi-family vacation. Little did I know it would happen anyway. The spontaneous pregnancy, miscarriage, septum resection and recovery led us to starting IUIs in March.

So now here I am, willingly passing on an opportunity for another treatment that technically doesn't conflict with the trip. It's yet another reminder of how much I've learned and how much I've changed during this process. I never fully appreciated the notion of needing a break during infertility treatments prior to my own experience. I could understand the constrains and some of the rationalisations, but it just seemed counterintuitive. If getting pregnant is your goal and you've been through so many other delays, why chose to wait any longer? There's a voice inside my head that questions my commitment: C'mon, if you really wanted to, you could make this cycle work! Fortunately, the logical part of my brain speaks louder. Yes, I want this, but there are some things I'm not willing to compromise. I already have enough angst surrounding this visit with my in-laws and parents. I will not torture myself by adding the stress of an IUI and 2WW.

The disadvantage of living so far away from your parents and in-laws is that your time off going home is not really a holiday. In particular; even if you are going to Hawaii but can't get laid because you are sharing quarters with your parents and in-laws, then it is not by definition a vacation. We can't even try the 'take a vacation!' approach, as firstly I'll probably ovulate before we leave, and the challenge of sneaking off to find a discreet spot wouldn't add any extra pressure on to Husband...

At least I can enjoy a vacation from infertility treatments. It may not be the vacation that I planned, but probably one that I need. I can "relax" on the beach while knowing that it won't contribute to getting pregnant, just to my well being. Although there will be many moments of frustration and annoyance, there will be a lot of memories to cherish. For the first time, I'm actually starting to look forward to the trip.

Thursday, 22 August 2013

Dreams, they complicate my life...

I've never really spent much time trying to understand my dreams or to analyze what they could be mean. Probably because most of the time I don't remember many details, and when I do, the dreams are very mundane and literal. I'll dream about work, or sometimes I'll sleep through my alarm and miss going swimming, because I've been dreaming about getting ready and driving to swimming. A few years ago, I had an exceptionally realistic dream.

That story actually starts in the time before I met  Husband. I was out with a friend at a night club in London and it was my turn to get a round of drinks. Across the bar, I spotted a rather attractive man with dark hair. Our eyes locked and held a gaze for a few seconds. When I rejoined my friend, she was warding off some unwelcome male attention, so we decided to relocate to a different spot in the bar. Whilst in transit, I was approached by the handsome man I saw across the bar. My knees went weak the first time I heard him speak. He was a Kiwi. I've always had a particular affection for Australians, so New Zealand is just as close, and I'm not referring to geographic proximity. We began to chat and after a few minutes I noted that he was holding my hand. The attraction was quite intense and when he started to lead me to the dance floor, I willingly followed. An hour or so later, last call was announced. He leaned in and invited with his irresistible accent, "Do you fancy waking up in my arms tomorrow morning?"

It would have been my first (and perhaps only) one night stand. Although my loins were quivering, my pragmatic brain prevailed. He could be a serial killer, Jane. They'll find your mangled corpse in a dumpster and the police will have to tell your parents what a little slut you were. Or he could have herpes. 70% of transmission occurs during periods of asymptomatic viral shedding. An orgasm is temporary, but herpes are forever! Alas, I declined his very tempting offer. He did ask for my email address, and to my surprise there was a message in my inbox the next morning. We corresponded over email for a few weeks, and I didn't find any evidence that supported or refuted him being a serial killer. In fact he seemed like a pretty nice guy. I inquired and learnt that he had nine prior sexual partners (a respectable number for his age) and recently had a negative STI panel (although I didn't specifically ask if he had HSV1+2 antibody testing done). We shared the same grammatical pet peeves, and I am such a nerd that I found it quite hot. We discussed meeting up to consummate the primal desires which had commenced from the moment we first saw each other. I truly contemplated it, as I wondered if I could compound some Valtrex and slip it into his drink, but I think at that point I wanted something more than a fling and he was just looking for the lay that could get him into double figures. I also rationalised that the version of our passionate coitus that I carried in my head was probably much better than the reality. Thus, he became the best shag I wish I had.

A few years ago, I had a dream that I slept with him. It was very average. Much like in real life when the first encounter is accompanied by the slight awkwardness of wanting to impress the other person without seeming like you're trying too hard. Thus, even the manifestation of my overactive subconscious was a total buzz kill.

Anyway, I am digressing and indulging in a bit of nostalgia to illustrate that I have very boring, if not disappointing dreams. Earlier when I wasn't trying to conceive, I had some pregnancy scare dreams, although I knew that I had my IUD in place and needed to confirm that the pregnancy wasn't an ectopic. See what I mean about my dreams being so literal?

Prior to the scheduled date for my first scan and before I started bleeding, I had one relevant dream during my brief pregnancy. I was going in for my CD2 monitoring, but it was my Favourite MA who preformed the ultrasound. She just started giggling and said, "um, you're already pregnant" (which actually was true, as I was pregnant on the day of my first CD2 appointment for what would have been our first IUI cycle). She kept reiterating that she couldn't tell me any details, but I could see that there was a single viable fetus at approximately nine weeks. Myrtle laughed when I shared the dream with her as she noted that it was fitting that I would have such a clinically accurate dream, but she thought it was a good omen. She also added that in one of her dreams, I revealed that I was having a girl.

I didn't share it with Husband, but in the final nights of our last 2WW, I had kept seeing two lines on a pregnancy test in my dreams. Mind you, I don't remember any details, such as if it were specifically my pregnancy test, but over and over again, I saw a pink line and a blue line. Then in the final night, I was dreaming about beta numbers. When I went for my first draw after my BFP, I emailed the office with my LMP and conception dates and I projected my HCG levels would be between 175-200. It was 171. In this last dream, I was in the lab chatting with the same phlebotomist who did all my previous beta draws and I was guessing at my beta numbers with her. It seemed so vivid.

A few nights after I composed my post about taking one step at a time and not looking too far ahead, I dreamed that I was pregnant. It was the first time in any of my dreams that I actually had a bump and I could feel the baby move. I was also in quite a bit of pain, and I precipitously delivered the baby at home in my living room. Yet, two of my colleagues and a random paediatrician magically appeared, and just like on TV, one of them handed me a three month old baby - a girl. She had Husband's eyes and she was beautiful. Then I woke up.

Tuesday, 20 August 2013

One Step at a Time, One Day at a Time

A fellow blogger once wrote "no one is born with the skills to cope with infertility, it's something we acquire during the process." I think I would also add that your coping mechanisms also evolve based on your experiences. It had been a tough week. After observing our would have been due date to erroneously anticipating a possible pregnancy, we felt like we had experienced an emotional wipeout. "I don't know if I can keep doing this." Husband commented. Mind you, we are still in the minor leagues of infertility treatments.

It feels like the ultimate game of high risk and high rewards. So much is put on the table; financial investments, physical pains, emotional vulnerabilities, with only two possible scenarios. Win the jackpot, or walk away empty. I reminded Husband that on a base level, we do have hope that this could work. If we didn't, then there is no point in going forward. Yet how do you carry your hopes, without becoming too hopeful?

I've decided to induce anterograde amnesia, a loss of an ability to make new memories, or in my case an inability to make potential memories. I'm restricted from daydreaming. I won't let myself fantasize about a positive pregnancy test and the potential milestones that could follow. I won't look ahead to future events and wonder if they could be affected if I were pregnant. I can't ever get ahead of myself again. My focus is only on the here and now. It's one step at a time. One day at a time.

Sunday, 18 August 2013

Eyes on the Prize

This past week Risa, at Who Shot Down My Stork? has featured some guest bloggers who wrote two excellent posts about their experiences with multiple miscarriages.  Although, I only have one to my credit, I noted that no one outside of the ALI (Adoption, Loss, Infertility) community has any appreciation for what the experience means to you. Thank you so much for all the support you have given me. I endured my RE, my colleagues, Co-worker and Myrtle all tell me, 'well, at least you can get pregnant'. It's the shittiest consolation prize in the world. I was too numb to absorb it at the time, but now I want to scream, 'do you have any idea how hard it was to become pregnant? and it doesn't mean it's likely to happen again?' Those same people including myself also noted that I was 'fortunate' as it happened so early. Perhaps, but it doesn't change the end result.

I know it's hard to search for the right words to say in a tough situation, and it's only when you've been on both sides can you realise how some innocuous phrases can be difficult to process. When I told Myrtle about my miscarriage, she offered apologies and condolences multiple times, but ended the conversation with "get pregnant again soon, little Myrtlepants needs a playmate." Sheesh, because we need to think about how this affects you. A week later, I received a bouquet of flowers from her. The card simply read; Love Myrtle, Mr Myrtle and Little Myrtle. I presumed they were sent in sympathy for my miscarriage. I would later learn that they were just a 'Holiday Bouquet', as she send the same ones to my parents.

I'm not one who fishes for compliments or tries to draw attention to myself. I never announce when my birthday is coming up, as I prefer to allow the day to pass without anyone noticing. However, I mentioned to my colleagues that on what would have been my due date, I'll be the only one in the office as everyone else is on vacation. Co-worker knew when my would be due date was, as it was four days before hers. I mentioned 'August 5th' twice to Myrtle. Yet no one reached out to me around that time. Even Husband forgot what the actual projected date was.

When Myrtle announced her pregnancy, I send her a congratulatory card, as well as a Mother's Day card for an expecting mother, another card after little Myrtle's birth,  one for her Christening and I sent Mother's Day and Father's Day cards to them. Had my pregnancy progressed, I know she would have done the same for me. Yet, it didn't. Is it too much to ask for a simple text that offers a message of 'hey, I know this is a difficult day. Thinking of you'? I have often described that self confidence is achieved when you don't need validation from others. However, in this situation, it would be nice to know someone else is acknowledging your pain. Thus, you don't feel so alone as if you're grieving an abstract concept.

Leading up to 5 August 2013, I was dreading the day. Not that I would have been in the 5% of patients who deliver on their actual due date. It could have been a day that changed our life as we know it. Instead it was just another day at the office, and to the outside world, it was as if my miscarriage never happened. While consoling me, my RE informed me, "when you're thirty weeks pregnant, it will all be a distant memory." Perhaps. Even if I don't ever get to be 30 minutes pregnant, I know the memories will fade, but I'll always feel disappointed. I will always feel that an opportunity was taken away from me. However 6 August was supposed to be liberating. No longer would I be confronted by pregnant women and feel reminded of what could have been. 6 August was meant to be the first day moving forward after finally closing the chapter on my failed pregnancy.

I like to think that I am moving forward, but I'm still carrying a few heavy emotions. I may be free from baby bump ghosts, but I'm still left without a baby. My parents recently shared their plans to go to a Bed and Breakfast in upstate New York to celebrate their 39th wedding anniversary. I remembered thinking that they could have been on the west coast celebrating while holding their new grandchild. Then we received an invitation from my cousin to attend her 'oops!' baby's first birthday party. I have a lot of unfair and misplaced resentment to this cousin. I had just started Clomid when at the age of 41 she announced her spontaneous conception after a prior experience with infertility. I was filled with a false sense of entitlement, this is supposed to be my news! Oh, how I look back and laugh to myself thinking I was entitled to become pregnant. As if it were mine to command. Yet, here we are celebrating the birth of her miracle baby rather than welcoming mine into the world. I know it's not her fault in any way, but it just seemed like she was besting me once again.    

Husband replied to the E-vite as a 'maybe', noting that we would be returning from the northern part of the state after running a half marathon. I thought that was enough to excuse us, but Husband was adamant that we needed to make an effort. So funny that he whines about going to my Aunt's house for Christmas dinner, but as my cousin's husband gave him some legal advice recently, he felt we were obligated to make an appearance. I thought we could get away with picking up a gift card from Safeway's gift card mall, but he also insisted we needed to bring a proper gift. We stopped into Babies 'R Us and made our selections as quick as possible. "Do you want to sign up for our rewards program?" the clerk dutifully asked "NO!" we answered in union, mentally adding we just want to get the fuck out of here!

I thought it was an odd concept to have a party for a one year old that is really catering to other children, especially as I learned that they did have a small family party with the grandparents and my other cousin and her kids who were visiting from Washington state. There was a bouncy castle for the half dozen kids who ranged from 3 to 6 years in age. The birthday boy's brother thought the gifts were for him, twin girls wore fancy dresses as if it were their party and all the kids were much more interested in the cake than the guest of honour. As their older son turns 3 in less than three weeks, I'm presuming we'll be repeating this scene in the near future. However, being surrounded by a bunch of screaming little kids was calling so much into question for me. Have I been romanticising this experience? Creating a fantasy that is better than the reality? Do I have the patience for this?

Interestingly, the parents didn't seem phased at all by the chaos. It was as if they had become immune. They sat in a circle enjoying their wine or beer, occasionally checking in to make sure that no kid was bleeding or had dislocated an arm. Naturally, they ignored Husband and me, since we didn't have our own hyperactive ball of energy to add to the mix. Then again, many of my cousin's friends were pretty douche-y even before they had kids. Toward the end of party I started getting the 'have we met?' looks. "I'm her cousin Jane" I re-introduced myself, mentally adding we've met at least ten times before at some other events. It's okay -I don't remember your name either....

At last, and to the delight of the screaming kids, it was time to cut the cake. My cousin pointed out that they selected an island design to commemorate their 'surprise souvenir' from Hawaii. Husband and I just looked at each other and telepathically rolled our eyes and gagged. We had prepared a response in the event that my cousin's husband started warning us of the island's magical fertility powers. "Um, there is this stuff called birth control..." was my ready to use retort. Husband would follow with a note that sharing a condo with your parents and in-laws is in fact the best form of birth control in the world.  Despite the irritating underlying theme of the cake, after running 13.1 miles, we felt we had earned a piece.

Oh, how was our half marathon? Well in the weeks and days leading up to it, we realised that we hadn't done any training for it, but we also couldn't get out of our hotel room reservation, so we would run it anyway. On our drive, we discussed potential times if we had trained. Husband thought he might break two hours and I projected I could get between 2:15-2:20. He finished in 1:59 something and I crossed the line at 2:13.25. Added to my resume of life: ran second best half marathon time without proper training (and didn't suffer the next day). Yeah, fertiles...this is our version of 'we weren't even trying!'  Not that you were interested ...

Wednesday, 14 August 2013

Within Our Grasp

The night before he escaped from Shawshank Prison, Andy Dufresne shared his dream of owning a hotel and charter fishing boat in Zihuatanejo, Mexico. "You shouldn't do this to yourself.." his best friend Red warns, "Hope is a dangerous thing..."

In the final days and hours before my test day, I was in denial or I was delusional. I felt different than I did in any of my prior IUI cycles. Although I didn't have any symptoms leading into my BFP; previously I just didn't have any sense that I could be pregnant and the BFN seemed inevitable. In addition to my emotional outbursts, I had persistent waves of nausea and my appetite was decreased -all symptoms that were present during my five minute pregnancy. Most of all, my breasts felt bigger and perkier. Husband was only too happy to grope me to verify.

In my previous failed cycles, I started light spotting 14 days post IUI and AF began her full flow on day 15, with the exception of the cycle that started a day earlier. Husband and I decided that we would wait to test on day 15, unless AF decided to show up earlier. In the final 24 hours before the moment of truth, I was texting Husband with updates every three hours. There was no sign of AF. I kept feeling myself up to make sure the fullness of my breasts was still there.

This could just be due to the effects of the supplemental inner voice nagged. True, but I had used the same progesterone supplements in my previous cycles (although not as consistently) and never had these symptoms. This time truly felt different. If I wasn't pregnant, I would find more reason to be disappointed. Had I known when I was younger what putting progesterone capsules up your hoo-ha can do to improve your rack -I could have gotten a lot more action. Seriously, that shit is better than a Wonderbra.

Oh, let this be it
Let this cycle be the one
Let there only be one if this is it...

It's an intoxicating temptation to shift your thinking from could I be pregnant? to I could be pregnant. I refused to do anything really stupid, such as wheeling out a potential due date, but I was lured into other moments of contemplation. I thought about going to the lab over the weekend, instead of going in for Day 2 monitoring. I imagined my final viability scan at their office and saying goodbye to my RE and the memories of my ex, as well as to my Favourite MA, Porn Buddy and Misery. Maybe the corners of Misery's mouth would turn upward at the sight of me leaving. I even started thinking about how I would announce the news in a post, and felt badly about any feelings of  haplousy it might induce. I saw a few term patients who were on my schedule and while after my first IUI, the sight of their large bellies reminded me of what wouldn't be in store for me, I could now see myself in that state. While discussing a birth plan with a patient, I had thoughts about my own delivery.

It was now 2100 hours. 9 more hours until test time. With my previous failed cycles, I had been blotting, spotting or lightly bleeding by now. This was the longest I had been post IUI without any signs of AF and with pregnancy symptoms. We were officially in unchartered waters. Last check before going to bed -still clear.

Around 3 AM, my cat A, our raccoon patrol, alerted us of an intruder on our deck. I flipped on the sprinkler system and watched the little buggers scamper away. Still no sign of AF. "This has to be it!" Husband said excitedly. "It might be" I cautiously warned. "The alternative is that this mother-fucking progesterone supplement is fucking with us like she's never fucked before." Neither of us slept at all for the next three hours.

I peed into a collection cup, as I figured I'd be running multiple tests. On my final blot with the toilet tissue there was a faint hint of orange. Fuck. Then I had an idea. As I pretty much have an entire back office lab in my bathroom, I ran a regular dipstick on my urine to see if there was any evidence of blood. Negative. I went ahead with my pregnancy test and left the bathroom. During my three minute wait, I checked into Facebook and saw I had been mentioned by one of my field hockey teammates. "Can't wait until the start of our season! Hope no one is pregnant!" Note to self: don't log in to Facebook while waiting for your pregnancy test results...

I went into the guest bathroom and did another blot -all clear. I walked back into our bathroom to view my results. I had even offered an extra minute in case the blue line was fashionably late. The pink control line was bright and prominent. There was not even the faintest hint of a possible blue line. It was the most negative looking pregnancy test I have seen. Nonetheless, I ran two more and received concurring opinions.

Husband and I sat in our kitchen and commiserated over a cup of tea and some toast. Our collective disappointment was palpable. All BFN's suck, but this one really hurts. It felt as if we were so close that it was within our grasp. I reminded him of a conversation we had the night before. "What would we do about telling our parents during their visit and the Hawaii trip?" He asked three times. I deliberately ignored him on the first two, then I relented and gave my answer.

"We would have to tell them. I think I'd be about ten weeks. I know we planned to wait until after the amnio and anatomy ultrasound results, but nothing in this process has gone according to plan. How could we not tell them? At the rare moment in time when all four potential grandparents would be together? While we're in Hawaii? If things were to work out, they would always remember that they learned the news in Hawaii, and the trip will hold even more special of a memory. Not to mention, my mother would probably figure it out."

Yup, that pretty much sealed our fate right there. Such a story book ending would not be scripted into our real life.

By the way, Progesterone -Fuck You. Fuck you for raising false hopes and crushing them at literally the last minute. Fuck you for making me look and feel so stupidly foolish. Please be more courteous in the future. At the same time; lesson learned. I shan't dream of a positive pregnancy test again. Never, will I imagine ultrasounds, maternity clothes or birth announcements. Until someone is instructing me to push and I hear a subsequent cry, will I ever beleive that I am going to have a baby. Not even for a second, will I permit a single ray of optimism to enter my mind. I'll snap an elastic band on my wrist to keep my thoughts in line.

Shortly after breakfast AF's full flow effect made IUI#4 an official failure. Now I actually had a sigh of relief. While I was hopeful that I could be pregnant, I was also a bit afraid. What if I miscarry again? I preferred the alternative of not being pregnant in the first place. Time to call my RE's office and start again.

Dear Red, reads Andy's letter at the conclusion of The Shawshank Redemption
If you're reading this, you've gotten out and if you've come this far, maybe you'll come a little further. You remember the name of the town. I am hoping that this letter finds you, and finds you well. Remember Red, hope is a good thing, perhaps the best of things; and no good thing ever dies.

I hope.

I wanna be Sedated

Of all the artificially manufactured states during infertility treatments, suppressing the ovaries, stimulating the ovaries, proliferating the uterine lining, replicating the luteal phase...etc...couldn't this list include inducing selective amnesia or a medical coma during the two week wait? Another item on the list of fertile envy is the fact that these women can just go about their lives, then one day it dawns on her that her period is nearly a week late. She pees on a stick, sees two lines, and you know the rest of the story. They are never forced to endure this tortuous countdown. Many aren't even aware of the two week time frame between conception and a positive test, let alone earn the bonus points for knowing the term 'luteal phase'.

I find that it's not too hard to distract myself for most of the two week wait. At times, I'll forget about the potential for pregnancy and drink some wine or sprinkle some blue cheese crumbles on my salad. For the first week, I can feel relieved to have the IUI completed and I can enjoy the fact that I don't have to navigate the challenge of leaving the office. Yet, in the final few days before D-day, I have to contemplate logistics. I need to get my bits waxed before AF's arrival and I have to eye when I may need to do my day 2 monitoring. I don't want to anticipate a negative outcome, but I must be prepared.

I've thought about the different ways to face the music. Early on, I tried just waited for AF's arrival, which would allow me to feel like a "normal" person. Yet each passing hour just serves to tease me before the ultimate devastation. The advantaged to doing a home test is that I can deal with the results in private and don't have to hide the distracting disappointment while I'm at work. However, the home test can still leave some doubt. Is it just too early? It is a bad test? It's not over until the fat lady (AF) sings. My RE always asks if I want to go for a blood draw. I've been tempted, as I wonder which is harder, willing a blue line to appear on a stick, or pressing play on a voice mail. Then I realise that I don't want to receive the news from Misery, who would have the same monotone matter of fact voice regardless of the results. Additionally, I can't justify the additional health care system costs for a beta that can tell me the same result as the box of tests I stole borrowed from the office. Although I don't have trouble having my blood drawn, I feel that I have to earn it. I'm not going to waste the phlebotomist's time for no reason. If we're at the point of doing betas, I want to see some numbers.

I can manage the first 12 days of the two week wait pretty well. It becomes much harder when it gets reduced to a two day wait. It's so hard not to symptom spot. One week after my IUI, I felt some cramping. Fuck off uterus, I am not falling for this crap again! I've had twinges of nausea, but that's not too unusual for me. Urinary frequency is actually the most commonly acknowledged symptom, but few people pay notice to it. I drink a lot of water, so I already always need to pee. I've noted that my breasts feel fuller and I had my emotional outbursts, which were the only two symptoms I had during my brief pregnancy. I recognise that something feels different this cycle, but I can't quite put my finger on it. If the test does out to be positive, it would feel validating, but if it's negative; it's another form of the body's betrayal.

Twenty-twenty-twenty-four hours to go
I want to be sedated.. 

Monday, 12 August 2013

Perhaps, a touch hormonal...

I've always hated how women often get dismissed for being "hormonal" or "emotional". As if she has no other reason or right to be upset about something, but rather, it must be 'that time of the month'. I've always held to the mantra of 'never let them see you sweat' and always try to maintain my demeanor, but I do find that shifts in endogenous hormone production or additions of exogenous hormones can sometimes exaggerate one's reaction to certain situations...

I really don't mind when Myrtle gives me updates on little Myrtle. In fact, I enjoy hearing how she is progressing, although I confess I'm ticking off her Denver Developmental milestones. I do however find it annoying when Myrtle refers to her by her nickname. "Little Myrtlepants and I went to the park today." "Little Myrtlepants and I may try to visit you next year."

I should explain that Myrtle creates a nickname by adding the word "pants" to one's name. It started with her cats, "Cooperpants" and "Jackiepants". She tried to do it with my cats, but they were having none of it. I thought it was a pretty dumb nickname for her cats and it seems even more ridiculous for her kid. I should also add here that I don't really like the name Myrtle gave her daughter. My polite response when she revealed it to me was, "I think it would be more fitting as a middle name." Myrtle's husband wasn't keen on the name and jumped on my band wagon promoting it as a middle name. Rather than stand up to Myrtle regarding his preference for an alternative name, I think his strategy was to hope the baby would be a boy. I pointed out to Husband, that Mr Myrtle may have sperm, but that doesn't mean he has any balls.

Often when I react to something pregnancy or child related, I apply a test: would this have bothered me prior to my experience with infertility and pregnancy loss? In this case, I feel the answer is yes. Pet names are meant to be personal, not public. Husband's nickname for me is 'Chicken', but he doesn't refer to me as Chicken to anyone else.

I was recently speaking with my Dad, who was filling me in on their plans for the  weekend. "Mrs Myrtle, [Myrtle's mother] Myrtle and little Myrtlepants are coming over." Three thousand miles away, I rolled my eyes at his mention of the name 'little Myrtlepants'. He then started discussing his progress on their new composite deck and added "We need to have it finished as little Myrtlepants is crawling around now."

So many thoughts flooded my mind at his second use of little Myrtlepants. The first, that name is so fucking irritating! I also realised at that moment that I felt left out. Not because I didn't have my own baby with a silly nickname, but because I live so far away. It was as if Myrtle and her family and my parents formed a club and calling the baby 'little Myrtlepants' was part of their secret code. That resonated into a sad realisation that even if we do have a baby, living on the other side of the country means that my parents will see much more of little Myrtle growing up than their own grandchild.

However, as fucking irritating was the initial thought, that's the one that fostered my reaction. "Her name is just little Myrtle." I admonished "She already has one stupid name, she doesn't need a second one." My Dad awkwardly searched for a new topic of conversation. It dawned on me that this was my second outburst in front of my Dad. I hope he is as clueless as I think he is.

Less than twenty-four hours later, I had another mini-meltdown. I finished my last dose of progesterone on a Sunday morning and planned to pick up my prescription when I was out doing errands. I painted 5 cabinet doors and cleaned our kitchen and bathrooms, which took longer than I thought it would. Husband came home from hockey later in the afternoon and offered that he would accompany me to the store after he showered and had a bite to eat. I was agreeable as it would make planning our meals for the week easier if I had his company. About an hour later it occurred to me that the pharmacy closes earlier on Sunday.

I wasn't going to be able to pick up my prescription in time and would miss a dose or two. Medically, I knew this wasn't critical, but I was focused on the bigger pictures. I felt so disappointment in myself. I had set a goal that I would be 100% compliant with the supplemental progesterone during this cycle and I had let myself down. This obviously had larger implications too. If I couldn't manage to put the P4 in my VG twice daily, how was I ever going to be able to give multiple daily injections when we're in the IVF process? Obviously, there was no way I would ever be able to take care of a baby as I screwed up on this task. Clearly, my world was crashing down around me, as I had been declared the most inept person on the planet.

"Don't you have some of that stuff in your office?" Husband asked, quickly growing tired of listening to me whine. We occasionally have some samples of Crinone that we rarely use. I was able to get access to one box which contained two doses, enough to last me until I could pick up my prescription. I felt reminded that yes, during the IVF process and definitely during parenting, I'll make some mistakes and will have to learn to be resourceful. However, I also found it ironic that continuing to dose myself with the product that was driving me to act so crazy was now keeping me sane.

Thursday, 8 August 2013

in it Not to win it

Perhaps it was inspired by my Ovidrel trigger shot, but I was overdue for an emotional outburst. I expressed to Husband that whatever is the outcome of our infertility journey, whether we are fortunate enough to have a baby or whether we continue our fabulous child-free life, there will always be a part of me that resents the fact that it was all so easy for Myrtle. (Please note, I don't resent her for it; I wouldn't wish infertility or pregnancy struggles on anyone. She was merely fortunate. I do resent her for her lack of sensitivity and lack of interest in the details of my fertility treatments, but I've covered that in previous posts) I expected Husband to tell me to get over myself and to move past it, but he said something that truly surprised me.

"I know you will." he stated calmly "It's because you're so competitive, and that's why I love you so much."

It was so obvious and yet so eye opening. However it finally made sense to me. For so much of my life, being competitive has been a good thing. Until that moment, I had no idea it endeared me to my husband. My competitive drive has enabled me to achieve so many of the accomplishments in my life. It never occurred to me that my competitive spirit could have negative consequences too. It has made me bitter and petty.

In my early adolescence, I had little self esteem and struggled academically. When I got to the 9th grade, the teachers in the maths department listed the top 5 students in each of their classes on their bulletin boards. After our first test, I looked at the board. The usual over-achievers were in the top spots, but there in a three way tie for fifth place was my name. With that small piece of validation, I began to believe in myself. Armed with my newly found confidence, I started working harder in all my classes, but especially in maths, as I was determined to stay in the top 5. Several years ago, I went back to my old high school to tell the teacher how much that top 5 list influenced the path that I was on and led me to one of success. "Oh, the top 5 list?" he noted "We had to stop doing that a few years back. Too many parents complained."

More recently at my last swim meet,  I was pacing around the deck trying to calm the butterflies before my 100 m butterfly. I was approached by one of our team's veteran swimmers. She was a child swimming prodigy in her home country of Japan, who was invited to swim on the national team, but burn-out had taken its toll and she stopped swimming for 25 years, until she joined our group. She's a relentless worker and she still dominates the backstroke events with her flawless stoke that she makes look so effortless. "I'm so jealous of you, Jane." she began "You always go out and get your best times in competitions." Perhaps it was the years of having so many expectations upon her that she struggled with her performance during the actual event. Where as for me, I carry no pressure, so I can just go out and race. Still, it was so surprising to hear that such an accomplished swimmer could have any envy toward me.

Since I was young, I have been living the virtue of 'set a goal, work hard for it, achieve, rinse, repeat'. This is something that I can't achieve with hard work and determination alone. I'm not in control of my own destiny to a certain extent. I can remember my tennis coaches telling us "Your level of play may not influence the outcome of the match" which is a covert way of saying, 'you'll run into someone much better than you, and even though you'll play your best tennis, you'll still lose'. It feels like I'm in that situation again. Despite our best efforts, we may still lose. It's up to the force in the Universe and is [literally] someone else's hands.  I realise that I will always carry these frustrations and resentments, it's the way I'm wired, it will always be a part of me, but I can work on learning to live with out them. To quote Amber at Old Lady and No Baby, "I'm okay coming in last place, just as long as I get my medal for finishing." I'm in it not to win it.

Monday, 5 August 2013

You're Still not Here

Although Rolling Stone only ranks Green Day's American Idiot as number 225 on their list of The 500 Greatest Albums of All Time, I rate it as one of the best ever. I offer a few compelling arguments. This album matured the band from the grunge punk era, where their songs discussed the inertia of their generation, to a group that was demanding to be taken seriously. Politically, it was so brazen. Just a year earlier, the Dixie Chicks were boycotted for their mere mention of embarrassment to be from the same state as George W Bush. Green Day delivered a no-holds-barred stinging criticism with their lyrics "Seig Heil to President gasman/Bombs away is your punishment/Pulverise your Eiffel Towers/Who criticise your government" and they were embraced with the 2005 Grammy Award for Best Rock Album. It seemed to represent the first time since 9/11 that the citizens of the United States could look at their country with a critical eye. Musically, it was loud and featured "balls-out" boldness (Billy Joe Armstrong's words) which also makes the album a great running track. Artistically, it re-introduced the rock opera and the composition lead to the production of a broadway play and upcoming film. Interestingly, the behind the music backstory reports that the main tracks from their current project were stolen from their studio. Thanks to the thieves in Oakland, the band decided to produce something new that promised to be better than their prior work. A great reminder that a setback is merely an opportunity to become more creative and innovative. Practically; it's the only CD I have in my car and I know every word of every line in every song.

Recently I've been drawn to the third verse in the musical suite Homecoming:

I feel asleep while watching Spike TV
After ten cups of coffee (months of cycles)
And you're still not here,
Dreaming of a song, where something went wrong
And I can't tell anyone
Cause no one's here...

You're still not here.

I've often prepared my patients who have miscarried that the marking of the would have been due date may be difficult, because I merely projected that it could be.  Now I know personally that it is. I also now know that it could feel easier if I were pregnant at this time. At the time of my miscarriage I felt encouraged, if not bolstered by the prospect that I could actually get pregnant. We had been trying for just under a year and technically only had seven valid attempts. Heck, maybe we weren't even that infertile! It feels like the verdict has been rendered -oh, yes, you are. 

Last November, one of our previous front desk receptionists presented for a new OB appointment. She left about a year ago to work in the main administrative office. It was her sixth pregnancy. She had five kids, four of them were delivered by C/section. Her last two deliveries were fairly complicated and her doctor encouraged her to have a tubal ligation. As a devout Catholic, she refused. The doctor even wrote a letter to her priest, explaining that her life could be in danger if she were to go through another pregnancy, but he maintained that she could only use natural family planning methods. She seemed a little indifferent about the pregnancy and confided to our office manage that she had finally adjusted to having five kids. Co-worker and I just looked at each other and acknowledged with our eyes that we weren't at all surprised that the most fertile of Myrtles was pregnant before either of us.

Her ultrasound revealed an embryo measuring just over 6 weeks without any cardiac activity. By dates, she should have been closer to eight weeks. I've had a few patients with unplanned pregnancies that were not viable and they actually expressed a slight feeling of relief. This was not one of those cases. She burst into tears and cried hysterically. I spent quite a bit of time counseling her and I gave her my personal contact information. Interestingly, I was late leaving the office that night and we needed to catch a later showing of Skyfall. I had a positive ovulation predictor on my Clearblue monitor that morning. We returned home too late to have coitus that night and settled for a Hail Mary bang the next night, which led to our brief conception.

She wanted to return for weekly ultrasounds to see if any cardiac activity would emerge. My colleague did her scans, but about four weeks after her initial visit, she sent me an email asking to arrange for a D+C. She requested to have a copy of all of her records to give to her priest (which I thought was a little creepy) and she also asked to have her products. "I know it won't look like anything, but we would like to have a proper burial". I didn't think her second request was odd, as I had buried my own products a week earlier.

I learned from some of her Facebook friends that they held a memorial service and had a burial complete with a small headstone reading 'Angel'. It struck me that both an atheist and devout Catholic went through nearly the same process to heal from a miscarriage. A few months ago I sent her an email to request a change to my schedule. At the end of my message, I added a note 'how are you doing?' She replied, "I am okay. Still taking it one day at a time. Thanks for asking."

It resonated to me that a miscarriage can be extremely difficult for anyone to process, regardless of your faith (or lack there of) or whether it was an unplanned sixth pregnancy or a conception finally achieved after infertility. We all share the same pain. I needed to visit this spot today and soak in the beauty of the view of the bay.

My heart is beating from me
I am standing all alone
Please call me only if you are coming home
Waste another year flies by
Waste a night or two
You taught me how to live

Saturday, 3 August 2013

No one ever said it would be this hard

In his book, Sex, Drugs, and Cocoa Puffs, the pop culture essayist, Chuck Klosterman discusses how most men resent Coldplay; the Brit pop group who write melodramatic alt-rock songs about unrealistic ideals of what love should be whilst using four gloomy guitar chords. "For you I bleed myself dry, sings the blandly attractive frontman, brilliantly informing us that the stars in the sky are, in fact, yellow. How am I going to compete with that shit?" In Klosterman's case, he couldn't. Perhaps his particular bitterness stems from the fact that he arranged to spend a romantic weekend with his girlfriend at the Waldorf-Astoria in New York, but she chose to fly to Portland to see Coldplay's first US appearance. Perhaps because Chris Martin is a fellow countryman, Husband rather appreciates their music and in fact, The Scientist is one of his favourite songs. Perhaps because it is a song about his profession. Although the song seems to be the sad tale of a geeky scientist who was probably dismissed by a girl who was out of his league and still yearns for her. As I tend to do, I recently thought how the lyrics relate to infertility and pregnancy challenges.

Nobody said it was easy
No one ever said it would be this hard

While it may be true that nobody particularly declared that the process of procreation is easy, one of the most painful aspect of infertility is watching how others make it seem so easy.

The One Hit Wonder
The couple who conceives on their first attempt. This scenario has the potential to inflate the male ego and to convince himself that he must have the Michael Phelps of sperm. (I truly hope it's not the case; but how ironic would it be if Michael Phelps had male factor infertility issues?) A fellow blogger put these couples in their place by pointing out that you do not have super fertility powers, you're just fertile and lucky. Actually, this makes you normal. Average, in fact.

We weren't even trying!
Many of us have endured a pregnancy announcement where the couple adds that note as an exclamation point, just to emphasize how effortless it was for them. As if they're entitled to some type of extra credit bonus points. Interestingly, upon further questioning, it is often revealed that the couple was intending to conceive. 'Not trying' just means that they weren't on a sex schedule based on menstrual charts, OPK results, BBT recording, you know, like a crazy infertile person.

We used to be indecisive, but now we're not sure...
I've encountered some couple who describe that they're not pursuing but not preventing a pregnancy and merely figure, "if it happens..." We are actually talking about the enormous responsibility (and cost) of bringing another human life in to this world and you regard that decision as if you were selecting 'chicken or fish' from a wedding menu?

The unexpected "surprise"
Then there are some for whom their fertility is a burden and a pregnancy is described as being an "accident". Even after ten years in clinical practice, I am still baffled when a patient is surprised or shocked about her pregnancy. "So, you weren't planning to get pregnant, but you were having sex and you weren't taking any measures to prevent pregnancy?" Do you know how the process of human procreation works? Do you need to read a copy of 'How Babies are Made'? Arlene Fowler explained it well during a recent episode of True Blood:
"When you stick your Mr Happy into a lady's hoo-ha, and don't wear a raincoat, babies come out!"

Oh, if only it could be so easy...While there are fertiles who suffer miscarriages and pregnancy complications; for the majority, everything about their pregnancy seems easy. The first ultrasound reveals a perfect little bean with a flickering heartbeat. Blood testing is all normal. The anatomy ultrasound is a fun experience viewing the baby and discovering if it's a boy or girl. Months later, the baby arrives and they live happily ever after. They would think nothing of celebrating and announcing immediately after a positive test, or prematurely shopping for baby items. For them, a BFP equals baby. It's that simple.

Although it is irrational, I still feel it is logical to expect that if it is so difficult for infertiles to get that BFP, the rest of the pregnancy should be easy. We accepted that it's not going to be easy to get pregnant. Procreation involves multiple injections and ultrasounds, porn and masturbation, retrieval and transfers, sometimes freezing and defrosting. Yet, no one ever said it would be this hard to have a baby.

Just how difficult? As I am a numbers driven person, I compiled statistics on the 30 blogs that I follow. I will admit there is quite a bit of population selection bias, as I tend to follow bloggers who are about my age and who have also had a miscarriage. The Clinician in me knows that some of the factors contributing to infertility may also lead to early pregnancy failures. That bloody recurring theme of gamete quality. The petulant child in me knows it's a second helping of unfairness. I feel these numbers demonstrate that it's not as easy as 'just do IVF'. Infertility is such an evil bastard that even successes must be handled with caution.

Spontaneous conception = live birth - 1
Spontaneous conception = early miscarriage - 12

Clomid/Injectables with TI = live birth - 2

IUI = currently pregnant - 2
IUI = chemical pregnancy - 2

Fresh IVF = live birth - 1 (twins)
Fresh IVF = currently pregnant - 4
Fresh IVF = early miscarriage - 4
Fresh IVF = chemical pregnancy - 3
Fresh IVF = BFN - 10
Fresh IVF = Cancelled cycles - 6
First time IVF (or ET) Success - 4

FET = currently pregnant - 5
FET = chemical pregnancy - 2
FET = BFN - 6

Required surgical correction (septum, fibroids, endometriosis, etc..) - 6
>2 IVF/ET failures - 9
Never pregnant - 8

I was just guessing at numbers and figures
Pulling the puzzles apart
Questions of science, science and progress
Do not speak as loud as my heart

Nobody said it would be easy
No one ever said it would be this hard
I'm going back to the start

If only I could...

Thursday, 1 August 2013

No Expectations

It was 10:30 on a Wednesday night. 90 minutes until the online registration for my upcoming swim meet closed. I signed up for some of my usual events, the 100 m butterfly and 50 m free and figured I'd be swimming in at least two relays. Then I remembered the words of advice from my teammate Stewart, "At each meet, you should enter an event that you've never done before. That way you have no expectations for yourself." I looked at the schedule of events. After the 100 m Fly, I'd get a short break during the 100 m breaststroke and then would have the 50 m Free, followed immediately by another relay where I'd have to swim another 50 m Free or Fly. The last event of the day was the 800 m Free. I figured that I'd probably be swimming that distance in my cool down, so why not enter it and maybe earn some points for our team. (I was thinking that not too many would compete in this race) I entered a rather slow estimated time. After all, I had no expectations.

I decided that 'no expectations' would be my mantra for this cycle. I'm not expecting that this cycle will work, but I'm also not expecting that it won't work. I'm staying neutral and I'm not venturing into optimistic or pessimistic territory. Although our IUI TMI data does offer a little encouragement.

On my day 10 monitoring, my left ovary was once again in the lead with a 14.2 mm follicle. As usual, my right ovary tries to do too much only to come up short, and had two small follies at 10.4 mm and 8.8 mm. I returned three days later and my left follicle had grown to 18.2 mm and to my surprise -the right follicle caught up at 16.4 mm! My right ovary gets on the board! My spontaneous conception occurred when I ovulated on my right side -maybe it's my lucky ovary. Additionally, my endometrial lining recorded it's thickest measurement to date at 12.2 mm. It's the only place I don't mind being fat. Go ovaries! Go endometrium!

My RE instructed me to trigger on day 14 and plan for IUI on CD16, which is actually two days later than previous cycles. I brought reference to the fact that I suspected I may have ovulated early on my last IUI cycle. I received a long winded answer that amounted to 'yeah...that can sometimes happen...' He offered that we could trigger that night and inseminate on CD15, but noted that he preferred to give the follicles another day to develop. Given, that this is my first opportunity to have two follies, I was inclined to agree.

While I was at the front desk scheduling my appointment, my RE approached me. He leaned in and said softly, "You and Husband should have intercourse on Wednesday night in the event that you do ovulate early." I don't think I've ever been propositioned to have sex with my husband, by someone other than my husband. Slightly awkward... but we were able to have scheduled coitus as prescribed. After all, it was Wednesday -the day designated for Business Time! We were anticipating his count to be a bit lower, and it wasn't too bad. Pre-wash was 14 million; 3 million were selected for insemination, and post wash motility was 86% -a personal best! I was impressed with his ability to perform under pressure twice in less than twelve hours. In turn, I am being compliant with my luteal phase support. I am putting the P4 in my VG like a good girl.

Hoping to have a 'A Funny Thing Happened on the Way to the Forum' story on the morning of my IUI, I discovered that I forgot to pack underwear in my swim bag (I shower at the pool and go straight to the office). This was actually not a problem, as I keep a spare pair in my car in the event of such an omission (black and lacy in case it happens on Sexy Underwear Wednesday). The fact that I forgot to pack shoes was a problem. I saw my first few patients wearing my flip-flops (no one noticed) and Husband brought a pair of shoes to my RE's office when he went to drop off his sample.

Anyway, getting back to my swim meet... It was my first time ever swimming in a long course metre, proper Olympic sized pool...which looked really big up close in person. I began to feel a little nervous when other seasoned swimmers thought my schedule of events was ambitious. Nonetheless, I knocked them off. 4 x 100 m Free relay, 100 m Fly, 50 m Free and then another 50 Free in the 200 Medley relay. Just my easy 800 m Free, which was to be considered my cool down.

Only I forgot that the longer distance swims are seeded fastest to slowest (all regular events are slowest to fastest). I was in heat 9 of 12 and needed to wait two hours before my swim. Despite jumping in and out of the practice pool, I could feel the effects of prior races as my muscles became tight. It was now 5:30 in the afternoon and the temperature was cooling as the sun was setting. I had been up for 12 hours and at the pool since 7 AM. The vendors had left and the only people remaining beside the swimmers in the final three heats were the meet officials and some truly dedicated coaches.

Yet once I dove into the water, my muscles loosened and I felt as if I were in a zone. Interestingly, the 50 metres seemed shorter doing multiple laps than it did during my sprint races. At the advice of my teammate, I looked at the clock, which was helping me keep my pace and may just be the fix to my problem with intervals. As it was so late in the day, there were no volunteers to help count laps.

stroke, pull, kick..stroke pull, kick...blah, blah one...stroke, pull, kick, stroke, pull, kick...blah, blah five, stroke, pull, kick...blah, blah eleven..stroke, pull, kick...blah, blah fourteen...two more laps to go...

As I flipped into my turn to start my fifteenth lap, I heard a bell ringing above my head. It serves to wake up the timers at the scoring table to notify them of the final lap...but I think they just do that for the lead swimmer...OMG! I think I'm the lead swimmer! I pushed my tempo for a strong finish when I touched the final wall. I took a second to look back at the swimmers still finishing in the other lanes before I looked up at the scoreboard and saw the number 1 next to my name.

I won a heat. It was heat 9 of 12, but I won my first heat. I started dancing on the deck to the amusement of the tired and cranky timers and stroke judges. My coach described my splits as "impressive". Somehow, the girl who sucks at interval training managed to get it right when it counted. With the exception of my first and last, my 100 m splits were within 2-3 seconds. My time was 38 seconds below my seeded time, which was notable as I forgot to convert yards to metres when I was entering my time. I placed second in my age group and not because there were only two swimmers competing. I beat out two other swimmers. When I returned to practice the next morning, Stewart was one of the first to congratulate me, "You know, the danger of swimming a 'no expectations' race is that you may end up with a new event..." Perhaps.