Thursday, 29 May 2014

Waste Another Year Flies By,

He walked in just before the elevator doors shut. Tall, dark hair, handsome, wire-rimmed glasses and a nice smile. The attraction was instant.  He introduced himself; a first year intern working in the primary care clinic. I was still a student gaining clinical hours in the women's health department. "Hopefully, I'll see you around" he said as we walked in our separate directions. As the clinics shared the same break and lounge area, we bumped into each other a few days later and started chatting again. Soon I found myself accidentally on purpose trying to run into him. Then one day I discovered he was waiting for me after work. He asked me to join him for a cup of coffee, which led to dinner, which led to making out in his car. (Classy, I know...)    

I was due to return to my campus for a didactic session in a few days. When I said goodbye to him, he asked for my phone number (sadly this was in the days before everyone had a mobile phone). I figured it was an empty gesture and I didn't expect he would bother with a girl living two hours away. Much to my surprise, he did ring me a few times and eventually invited me to attend a local tennis tournament with him. As I was driving along the interstate, I wasn't sure if this was a 'let's hang out as friends' weekend or if there would be a possibility for intimacy. Good thing I shaved my legs just in case.

He greeted me with a warm hug and a kiss on the cheek. As we spent the day together, I remembered how comfortable we were with each other and the conversations flowed effortlessly. We returned to his flat in the evening and opened a bottle of wine. Half-way into the bottle, he seemed to check his watch and then leaned into to kiss me. This led to consummating the relationship on his sofa. Before I left the next morning, we scheduled another weekend where I would visit. I don't think we left the flat at all, and if memory serves, I think I spent most of the weekend looking at the ceiling.

A week went by without a phone call. I didn't think much of it, but then one week became two weeks. Two weeks became three, and then three weeks became a month. I decided to break The Rules and I rang him. Twice. The second time, he answered. He had a million reasons why he had been too busy to call, but reported that he had been thinking about me. After updating him with the things that I had been doing that should have made me too busy to notice that he hadn't called, he asked a question, "so, how's your love life?" It seemed like an odd inquiry from the man who had been inside me just a little over a month ago, but it was clear to me that if he had expectations that I could be seeing someone else, then he was probably involved with others as well. I don't remember much of what we said during the rest of the conversation, but it would become the last words we shared with each other.

For the record, I wasn't so much upset about discovering that he wasn't exclusive, but it was the fact that I hadn't been informed that there was an option not to be exclusive. Okay, maybe I was also a little bitter as I really didn't have any opportunities to break my exclusivity. Although I always put safety first and never let him within a 12 inch radius without a latex shield, I was paranoid about the possibilities of infections. Like Hannah Horvath, I was obsessing about the stuff around the sides of condoms, and this was in the days before Google! I did the walk of shame back to Planned Parenthood for testing. I don't think it was the same Clinician who saw me during my pregnancy scare, but for story-telling purposes, let's say it was. I lied and told her that I was in a new relationship, but we both wanted to be tested before having sex as we're super uber responsible people. She raised her eyebrow as she filled out my lab slip and I telepathically read her mind. Jane, you ignorant slut. When are you going to get enough self-respect to become involved with someone who respects you for a change? Stop giving it up to anyone with an Australian accent!  

I survived the STI roulette, but the lessons stayed with me. I declined an invitation from an irresistible Kiwi for a one night stand, and the next person I dated...became my husband.

This post reflects two anniversaries. I spent another year on this planet and it marks the first meeting with my RE. Two years ago the month of May brought a heartbreaking BFN, my 36th birthday and a six month milestone of trying to conceive without success. I decided to start the REI Open House tour. I'm chronically late for pretty much everything, but I was the first to arrive for this information session. I explained to the office manager that I couldn't write my name on the sign-in sheet and handed my details to her on a sticky note. The clinic's senior doctor gave the presentation, and I spent the time pushing back my cuticles so that everyone would know how bored I was. When I looked up I saw that someone else had entered the room.

He was tall, with thick dark hair and wire rimmed glasses. Memories of my ex flashed through my mind for the first time in over a decade. (I've referred to him as an ex-boyfriend, but 'Fuck Buddy' is probably a more apt description) His eyes met mine and he smiled at me. My heart was pounding and I had to focus on my breathing. He looked to be in his early forties, which was about the right age for my Fuck Buddy. What were the odds that this could be the same person? I recalled that he was interested in neurosurgery, but his mother was an Ob/Gyn, so maybe he had decided to follow in her field. I started looking around the office for anything with this other doctor's name, but at the same time I realised that I couldn't remember FB's last name. Is it really bad that I can't remember his full name? More so, is it bad that I don't know if I'm embarrassed or proud of this fact?

The older doctor concluded his spiel and offered that he and his associate would individually meet in private with anyone who wanted to discuss her specific situation. I just wanted to get the fuck out of the clinic as quick as possible. However, my bladder was about to burst and it would be an uncomfortable drive home, especially with a manual transmission. As I was walking back from the bathroom, the doppelgänger met me in the hall. "Hi, I'm Doctor ___________. Would you like to step into my office?" I exhaled a deep sigh of relief. I still couldn't remember the other guy's surname, but I knew that wasn't it. I checked out the dates on the diplomas hanging on his wall. He was not my former liaison. In fact, he was actually younger than me and just missed being one of my students. Actually, after teaching students from this prestigious medical school, I had vowed that I would never go to any doctor who had graduated from that establishment.

I started the brief consultation by informing him of who I was and what I did and I pronounced that I was too cool for school and already knew everything that had been covered in their presentation.  As I was sitting across from someone who conjured these repressed memories, it was at that moment that I realised I was never really heartbroken over the Fuck Buddy. I wasn't in love with him; it was a relationship of convenience that fit into our lives for that time and that time only. In particular, I was more annoyed at myself for sacrificing so much study time during those weekends, which had led to a 'B' on an exam. It was my ego that was bruised and my pride that had been damaged.
Especially as Myrtle conceived so quickly and seemingly easily, I really took it to heart that our inability to conceive was a failure of my professional abilities. I felt like such a fraud; I've counseled thousands of patients, lectured other health care providers, but I didn't possess the know-how to knock myself up. I decided to succumb to the humiliation. I shared our full story including the Plan B incident, my inability to interpret the cheap OPK test strips, my experimentation with Clomid, and I described how a failure to launch incident and issues with irritated foreskin had led us to doing at home artificial inseminations. I admitted that we needed help. I was hoping that he would reassure me that it wasn't a lack of knowledge preventing us from conceiving and I was hoping he would say that we could get pregnant without doing IVF, but he didn't. Instead he wrapped up the consult with the probably standard line of "schedule an appointment so we can complete your work-up and evaluate your options."

I've wondered if the staff at REI clinics wager on who will return after an open house or initial consult, as it's probably something that I would do. I would have been doubtful about myself, but I came back six weeks later for my formal consultation and I'm still here almost two years later.  It has taken two years, two miscarriages, a corrected uterine septum, five failed IUIs and two failed embryos transfers to achieve my Good Will Hunting "it's not your fault" moment. I am infertile. I am not incompetent. This isn't something I can outwit, outlast and outplay.

A few months ago, I discovered that I have been at my current job for five years when a patient returned to have her expired Mirena IUD removed and to have a new one inserted. She had moved to Southern California, but wanted to have me do her procedure again. It gave me pause to reflect on the relationships I've built with so many patients during this time. Recently, I was touched when I overheard my medical assistant say "it's amazing, she knows her patients so well..." It occurred to me that most REIs probably hope that their patients will be a one treatment one night stand. Send them away pregnant; wham, bam, you're welcome Ma'am. Only return for baby #2. You're not supposed to have a long term relationship with your RE. One way or another, I will break things off before the three year mark.

Monday, 26 May 2014

Inclusion Criteria

I recently attended an all-day continuing medical education workshop. During a break, one of the conference administrators drew names of participants to give away some water bottles and other promotional items. As I really don't want one more piece of clutter in my house, I was hoping that my name would not be called. Then the administrator called any pregnant women or anyone who had a baby within the past year to the front of the auditorium, as she had a special gift - a baby bib.

I'm not sure what came over me, but I thought, "I'm about to start infertility treatments -does that count?" I realised that no one here knows me. I could come out as an infertile woman. I started to walk up to the front of the room. Then suddenly I stopped myself. I didn't want to hear others talk in an excited tone about our up coming IVF as if it would actually work. I didn't want to have to explain that this is actually our second cycle, so our prognosis isn't very promising. I didn't want anyone's pity. Yet at the same time, I feared that the administrator would tell me "No, you can't have one. You don't have a baby and you're not pregnant. 'In the process of an IVF cycle' doesn't count..." I highly doubted she would say it, but those words were in my own head.

As an effort to cover up, I walked over to one girl who I earlier overheard announce that she was pregnant with her second and asked if I could take a look at the bib. Hers was yellow as she doesn't know the gender and it had the company's logo on the front. The material looked cheap. If I were pregnant I wouldn't actually want one. As I returned to my seat, my inner bitter infertile returned; Fucking A! I can't escape it anywhere!

Once seated, I had a view of all the new parents and preggers who were holding their bibs and posing for a photo to go up on the company's website. I metaphorically gagged a bit, but I acknowledged that I didn't belong among them. It was a game of 'one of these things is not like the others'. A mere hopeful, pathetic infertile is not entitled to the same recognition as actual parents and women with a viable pregnancy. Then it really hit me. I'm really reluctant to admit this, but part of me just wanted to feel included. Perhaps it's the most petty of all the infertility related pain, but it's presence is nonetheless palpable. I feel like the girl in high school who is rejected by the popular clique.

"You didn't want one?" asked the guy who was sitting next to me. He was probably in his late 50s or early 60s. Earlier he had mentioned that he had two grown kids and a one year old grandson, whom he described as the new "love of his life". A lump was forming in my throat as I thought about the words my parents would use for their grandchild if they ever were to have one. Please don't ask me if I have any kids, I telepathically pleaded and he obliged. "Oh, I was just curious to see what they looked like..." I lied as I pulled out my notebook to prepare for the next session. After the next break he returned with a bib in hand. He picked one up for his grandson. "Here, you can see it up close." he showed me.

"I am infertile and I've had two miscarriages." I revealed to him. "I thought about asking for one as we're in the process of infertility treatments, but I can't allow myself to engage in any optimistic actions as it makes it so much harder when we do encounter heartbreak." Silence. There were no words of encouragement offered. No looks of pity in my direction. No questions asked. He opened his notebook to the next session. Not only were the popular girls scoffing and dismissing me, it seemed that no one else wanted anything to do with me. I felt like the girl sitting alone at a table in the cafeteria, as she watches everyone else laughing and having fun.

Thursday, 22 May 2014

Some days are harder than others

About a week ago, the 18 week pregnant primary care provider approached me to ask a favour. She was too inpatient to learn the gender to wait one more week for her anatomy ultrasound, and wanted me to take a look. I have to admit that I'm not too good at making this determination, as I don't do many second trimester scans, but I was able to offer a conjecture with some confidence. In return, I asked her to keep it a secret among everyone in the office so I would save face if I were wrong. "OMG! She's having a girl!" squealed one of our medical assistants who received a text message from her after the official scan. Well, what do you know, I was right.

Throughout the day, I kept hearing echoes of "congratulations!" and chatter about the baby girl. It was as if we were going through her pregnancy announcement all over again.  Sigh. Oh, by the way, I also had an ultrasound this morning, was anyone interested in my scan? Actually, I wasn't even interested in my own results. Based on the OPK data, my cycle would be starting tomorrow at the earliest. However, I have to fly to Southern California this weekend. My RE had agreed that I could do a preliminary scan to make sure I didn't have any sabotaging cysts, but I had to remind him multiple times that I'm technically CD Negative One. With the exception of a degenerating corpus luteum on my right side, my ovaries are quiet enough for us to proceed after AF arrives!  Oh, my endometrial lining was 17.4 mm, so I can look forward to a nice heavy period.

I recognised a familiar name as I scanned the patient messages in my inbox and I had a feeling I knew why she was contacting me. She delivered her firstborn just over 18 months ago, and although she was a bit high maintenance during her pregnancy; she was always polite and very appreciative and she worked her way into the hearts of almost every staff member. "So guess who is pregnant again?" I shared the news with Co-worker. Sensing that I might feel jealous, she inquired "You okay?" "Oh, yeah." I sincerely replied as I quickly recalled that we had started TTC when I diagnosed her first pregnancy and I thought we might overlap. Now it seemed as if I was trying to catch her again on her second.

I had just finished with my last patient of the day when I noticed that I had two voice mail messages. The first one was from Discover Card. It appears my recent purchases at the pharmacy were considered suspicious activity and I have to call to confirm, "Yep, that was me...I'm infertile and I charged my fertility meds. Yeah, I know I bought estrogen replacement, ovulation predictor tests and condoms last's complicated..." The other call was from Misery. My estrogen level was 82, even though it's probably a normal level for the luteal phase, my RE feels it's too high and doesn't want me to start my stims this weekend. I have to go back in next week for another blood draw and scan.

Another sigh. Seriously Si and Am, we're doing IVF and you still can't cooperate with us. I only need to go away for three days! I recall my RE indicated that we could just continue Lupron for a few more days, if necessary. Sometimes it's hard to tell what is a big deal. I have a good friend who is a first grade teacher and would do an exercise with her kids called 'Is this a big deal?' She would talk about responding appropriately to minor situation such as your mother won't let you sleep over at your friend's house, or you miss your favourite cartoon program as well as serious issues such as a friend moving, a grandparent's illness, or the loss of a pet. Parents would comment to her at teacher conferences that their kids would often try to keep their own reactions in check, "Mommy, don't yell at the other driver! It's only a little deal!" I advocated that she needs to share these lessons with adults. However, I don't know if this delay is a big deal.

Perhaps it only is to me in the sense that I'm more scared and more skeptical with this cycle and I just want everything to go according to plan. I acknowledge that I sound a little like Tara Reid's character from American Pie who insists that her first sexual experience must be absolutely perfect. I love her best friend's response, "it's not a space shuttle launch, it's sex..." It seems a little counter intuitive as I've already lost my IVF virginity, but rather I'm fantasizing about a stim cycle and retrieval that mirrors perfunctory, obligatory lovemaking with familiar, predictable moves, yet still ends with a dramatic climax.

There were two bright spots to my day. As I had to drop Husband off at the airport right before heading to my RE appointment, I missed swimming this morning. While I was waiting at my RE's office, I learned via facebook that Amanda stopped by the pool with her newborn baby. I was in my first stim cycle when she announced her pregnancy and I was wondering if I could be considered 'almost pregnant'. I didn't need to feel reminded that the answer was a resounding 'no'. At least I had managed to avoid one baby related commotion. There was a gentleman sitting across from me in the waiting room who was staring at the floor. I figured he must be here for a semen analysis.  Sure enough, I saw Porn Buddy greet him with a plastic cup in hand as she led him to the wank tank. When I was called to go back for my blood draw, I noticed this sign placed in front of the room:

I didn't see any men in hard hats walking around...
wouldn't a 'Do Not Disturb" sign be more subtle?

Sunday, 18 May 2014

Don't Ask, Don't Tell

As we've recently celebrated some historic achievements for the LGBT movement, freedom to marry in Arkansas and the first openly gay football player was drafted into the NFL, it's hard to believe that Don't Ask, Don't Tell (DADT) was signed into law twenty years ago. DADT was considered an accomplishment at the time. Although it represented a compromise, gay men and women could continue their service in the military with some protection from prosecution, just as long as they concealed that part of their identity. Objections to DADT eventually emerged as it became clear that this doctrine essentially amounted to the old separate-but-equal provisions and discrimination still ensued. In 2010, DADT was repealed, which was a signifiant triumph for LGBT rights, and made me feel a bit old, as I could remember the time when DADT was seemed to represent progress. Nonetheless, I'm willing to engage in a little nostalgia as I feel so proud to be living in a time that is is advancing toward acceptance.

Meanwhile... after a particularly upsetting phone call with Myrtle after the transfer of our promised embryo delivered a new chapter of disappointment, I was starting to consider that I needed to repurpose our friendship. However, I had no idea what that would be or how I would accomplish it. Many of my followers have suggested talking to her, but I had no idea what to say. It was time to start brainstorming. Hi, can you try not being such a huge bitch? came up in my first draft. Do you realise that you're being rather insensitive? was my next attempt, but I had to admit that was probably sounded a bit condescending on my part. I know you mean well, but sometimes you don't come across as being sympathetic to our situation... Maybe that would work. I failed to return two calls from her while I searched for the best choice of words.

Even though I am an atheist and don't recognise the Easter holiday, both my mother and Myrtle feel obligated to ring me on that day. I knew that I couldn't keep avoiding Myrtle forever. I also had some misgivings that this may not be the best time to reconnect since I was coming off the final BFN that put the nail in the coffin of our first IVF cycle. Fuck it. Maybe it would be best for her to see me in my raw emotional state, if I snapped, so be it! I picked up my phone and pressed the call button. Her voice mail greeting answered.

Hi Myrtle, it's Jane. It's after 5 your time, so I hope you're home from your mother-in-law's place and are enjoying a long overdue glass of wine. We just did brunch with my aunt, I'm sure your heard from my mother that she was diagnosed with breast cancer. So... we got more disappointing news of the fertility front. You know... same shit, different day...If you want to talk about anything else, I'll be home for the rest of the evening. 

Myrtle phoned back about 10 minutes later after she fixed little Myrtle's dinner. She was compliant with my request and we chatted about everything else from work frustrations to our husband's annoying habits. I remembered why we're still friends after all these years, and after spending the weekend with sporadic crying fits, it felt good to be laughing for a change. It was what I needed from a friend at that moment.

Yes, I swept everything under the rug. Very good Jane, you'll be an excellent role model of conflict resolution for your child if you ever have one! Yet, you know what? It worked. Okay part of my cowardliness was also from her anticipated reaction. I thought she might whine about how hard it is for her. How she doesn't know what to say to me. How frustrating it is for her as she may feel that she can't talk to me about her experiences as a mother. I'm not denying that these impositions are real for her, but I really didn't want to acknowledge them at that time. Thus, it was preferred to become the proverbial ostrich with her head in the sand.  Don't ask; don't tell.

I had another pleasant and enjoyable conversation with Myrtle on Mother's Day. Once again, a little part of me hoped that she would reach out and acknowledge that this day is a bit hard for me. However, if I am to enjoy the benefits of DADT, I must appreciate that there are some sacrifices involved. It's as if were back in 1994, although this time without the bad hair styles and emergence of grunge music. For now, don't ask, don't tell represents progress. There will be a time in the future for it's repeal.

Thursday, 15 May 2014

Gender Benders

*This post discusses a very sensitive topic. Reader discretion is advised* 

Even though Husband is hoping that we have a girl if I ever manage to get pregnant again, he was reluctant to designate a gender preference with our PGD testing. "I think there are somethings you still have to leave to chance" he advocated. In theory, I concurred. If we had conceived spontaneously or even with an IUI, we were planning to keep the gender a surprise until the birth. However, we weren't in Kansas anymore, Toto. We were in the middle of our first IVF cycle with plans to go PGD testing for the primary purpose of avoiding the transfer of an aneuploid embryo. Advance knowledge of the gender would only be a secondary benefit. Yet, as I know my heart's desire for a girl, I felt I couldn't pass on the opportunity to make that dream come true. If we were having to go to such extremes to have a baby, then we might as well take advantage of the perks! I thought the process would amount to slipping the embryologist twenty bucks to get her to thaw a girl. Unfortunately, it doesn't work that way. We both had to sign the consent forms indicating a gender preference. Shamefully, I pulled the uterus card and coerced Husband into signing the forms.

Recently, my medical assistant was rooming my new OB patient, I started looking through her chart. She was 26 and this was her second pregnancy. I found a phone message she sent to her primary care provider; she just learned that she was pregnant and wanted to know how soon she could know the baby's gender. Oh, how nice when that's your primary thought process. No worries about whether or not this pregnancy will be viable or euploid... I bitterly acknowledged, as I once again reminded myself that these women live in a different world. My medical assistant emerged from the room. "She's ready." she announced. "She really is quite eager to know the baby's gender!" ...and I know why... I thought to myself.

Sure enough, the couple didn't say much during her interview or exam. Her ultrasound revealed a single viable intrauterine pregnancy measuring 9 weeks and 3 days. She didn't ask what her due date was. She didn't want to know the heart rate. They didn't inquire about the baby's size, as most couple tend to do; usually just after I've cleared the screen with the measurements. She only had one question: could I tell if it was a boy of girl? I replied that it was too early. I knew what was coming next. They wanted to know the gender as soon as possible as they plan to terminate the pregnancy if it were another girl.

My stomach flipped a bit as I looked at their absolutely gorgeous two year old daughter. She had perfect curls in her hair and her bright eyes were framed with long lashes. Due to my patient's age, she's not eligible for NIPT testing. The lab we use holds to the evidence that the test was only studied in high risk populations (Advanced Maternal Age, Personal history of a fetus with chromosomal abnormality, or abnormal serum screening or ultrasound findings) and will only perform the test for women who meet that criteria. Even if a couple is willing to plunk down a few grand in cash, they will be turned away if they're not appropriate candidates, which really makes me respect the integrity of the lab. The perinatologists in our area won't perform Chorionic Villi Sampling (CVS) or an Amniocentesis for a couple who only is looking for gender confirmation, unless they're carriers for an X-linked disorder such as haemophilia. Her best option was to do a 3-D gender scan, which could be performed before her anatomy scan at 18 weeks. "It's not covered by your insurance and would be an out of pocket expense." I informed them as I acknowledge that it sounded a touch bitchy.

When I worked at a reproductive options clinic, we would periodically engage in values clarification exercises. Various aspects surrounding abortion were proposed and participants would be divided into groups that would answer the questions either supporting or refuting the position statement. Then the groups would swap papers and would defend the other team's answer. The purpose of the exercise is to try to see things from someone else's point of view. Yet in all my time working at this clinic, the issue about doing an elective termination for gender selection was the one question that many struggled to argue for the supporting position. Even the most ardent pro-choice banner carriers admitted that gender selection made them feel a little uncomfortable.

Meanwhile, the consent forms for PGD testing were still sitting on our dinning room table. I was waiting until I had a department meeting in a few weeks, which would bring me in proximity to my RE's office and we wouldn't need to make a separate trip. I was also stalling as I had been re-thinking my intention for a gender preference. As Husband has a limited attention span and twice missed an initial and a signature on the forms for our first IVF cycle, my new tactic is to spread them out on the table and use 'sign here' stickers. I told them the latest batch was ready to sign. When he got to the question about whether or not we wanted to know the gender and if we had a preference, he dropped the pen when he saw my initials next to the option "I DO NOT want to know the gender" and came over to embrace me in his arms. "This is the right call Jane" he whispered to me. I know. We're not in Kansas anymore, but we've been in Oz long enough to understand what really matters.  

Sunday, 11 May 2014

The Second Wave of Grief

There isn't a manual or instruction booklet to guide a woman and her partner through the process of a miscarriage. However, I thought my professional experience offered an advantage. I knew it was a possibility in both situations, as I'm aware of how common miscarriages are. I was also able to derive some positive aspects during each occurrence. After my first, I was able to embrace the 'at least you can get pregnant' mantra. We had conceived spontaneously in just under a year since my IUD was removed, and when you added up our actual attempts, it was just over six months. This actually put us within the range of normal fertility! Although I would develop some regret that we didn't evaluate my cavity when it was initially suspected that I may have a septum, I was relieved when it's presence was confirmed. I felt there was an explanation for my loss and once it was corrected, my prognosis would be improved.

It's now apparent that I was lulled into a false sense of confidence. The spontaneous conception and corrected septum probably gave me a little too much hope for success with an IUI procedure, and hence we probably should stopped after the third, rather than pursuing two more. The regret of not starting IVF sooner set in immediately upon learning our embryo report. I had very low expectations that my first transfer would result in a pregnancy, and my skepticism continued after the pregnancy was confirmed. I almost didn't feel any sadness at the time of diagnosis, as I felt so prepared for the news. Once again, I felt fortunate that we had an explanation for our loss, the formula for a victory was seemingly apparent -just transfer an embryo without a lethal anomaly. I was comforted by the fact that we had embryo insurance and I felt hopeful that at least one would come through for us. As I bailed on doing PGD testing after my day 3 transfer, no one will ever know if they were normal.  

I didn't have that much hope for our final embryo, so in theory I shouldn't have been that disappointed. Thank you hindsight for making me realise that I should have followed my RE's recommendation to load both at the same time, as I feel really silly for transferring these losers individually. I'm sure the hottie embryologist regards me as 'the one with crappy embryos who is overly paranoid about twins'. As I fear that a second cycle will produce another tainted batch of embryos and the possibility for our baby seems so far out of reach, I've discovered that I'm going though a second wave of grief for what was once within my grasp.

The losses feel more tangible now that the bubble of optimism has burst. The devastation and disappointment that I should have felt at that time is resonating now. After the diagnosis, my coping method was to look on the bright side. It's one of the many shitty things about infertility and pregnancy loss; we mitigate our pain by acknowledging that there are seemingly worse situations. We're still healthy, this isn't like being diagnosed with cancer. I'm fortunate that it ended so early, it would have been much worse if I were further along... As the brightness is fading, it's really hitting home. Twice I was pregnant, but neither pregnancy would produce a baby. I may not become pregnant again.

Mother's Day hit a little harder this year. Two years ago, I reached the 6 month mark and was starting to research REI clinics. I sent cards to Myrtle and three other friends who were expecting to join the motherhood club later that year. I was hoping karma would take note of my efforts especially since I may never be a mother myself. C'mon Jane, you're being just a touch dramatic... I acknowledged at the time. Last year, I found myself mourning my lost pregnancy a bit on the fête de meres. I kept the door to our guest room closed, so I wouldn't feel reminded that it still didn't have plans to function as a nursery. Yet, I still felt hopeful. We could try a few more IUIs and we still that the IVF option in our back pocket. This year, as we're embarking on our second IVF cycle, I don't feel that my former self was being so dramatic.      

Thursday, 8 May 2014

You Can't Always Get What You Want...

During their first year of marriage, Co-Worker received a call from her husband's brother, inviting both of them and her parents to a birthday BBQ for her Sister-in-Law (SIL). Although her actual birthday was on a Thursday, the celebration would take place on a Saturday. "Sure, we'll be there!" Co-Worker accepted. Then she noted: "It's also my mother's birthday on that day." Please take note, that's all she said. She didn't suggest to make it a double party. She didn't ask to add her mother's name on the cake. However, her Brother-in-Law (BIL) responded "Oh, can you guys not mention that it's your mother's birthday. After all, this is SIL's birthday weekend."

Pausing for a moment to acknowledge the concept of the birthday weekend, which should really only apply if your birthday actually falls on a weekend, or by extension on a Monday. Otherwise it feels reminiscent of the Sex and the City episode leading into Charlotte's first wedding; "You guys, this is supposed to be my week!" she whines until Miranda puts her in her place, "You get a day, not a week." Co-worker's SIL is a quintessential only child (who makes the rest of us look bad) and always has to be at the centre of everyone's attention. One would think her birthday wouldn't be different than every other day, but apparently not. Even after her birthday, she can't share the spotlight on someone else's actual birthday. Additionally, other than the milestone years (16, 21, 30, 40 etc..) doesn't one get past making such a fuss over her birthday after the age of 10?  

Earlier this week, Co-Worker received a call from her BIL with the news that SIL's water broke and she would be delivering her twins a few days before her scheduled repeat C/Section. Co-Worker sensed that he seem subdued. "What's wrong?" she asked. He sighed. "Today is SIL's birthday. All she wanted was to have a singleton, and to not to have a baby on her birthday." Co-Worker and I waited until he called back and announced the arrival of two healthy twin girls before we burst out laughing and started crying crocodile tears over the fact that little Miss Super Fertile wasn't getting exactly what she wanted. The woman who couldn't even acknowledge someone else's birthday two days after her own, would now have to share her birthday with her daughters for the rest of their lives. Karma is a pissy little bitch.

No, you can't always get what you want
But if you try sometimes, you just might find 
You get what you need

Monday, 5 May 2014

The Absurdity of Infertility

It's CD14. If I were a typical woman, my ClearBlue Fertility Monitor would indicate that ovulation is imminent. However, as I was still reading 'low' as of yesterday, I don't think that it's going to happen. As I'm still working on ordering my meds and trying to navigate around Memorial Day weekend, this prolonged follicular phase is actually working in my favour. Finally, Si and Am are actually cooperating... by being lazy. My monitor is still reading 'low'. Now I'm starting to feel a little nervous that my ovies may be out of commission. If my day 21 progesterone were negative, would we measure on CD 28? CD 35? At what point would we need to induce a withdrawal bleed with Provera and induce ovulation with Femara?

When I arrived at work, I was greeted with a glob of egg white cervical mucus. At first, my instinct was to ignore it. While I was suppressing my ovaries during my FETs, the estrogen from my patches increased my cervical mucus. I've been misled by EWCM before. However, even a broken clock is correct twice a day.  Last June, I had a false negative with my monitor, (which I attributed to nocturia and a less than full first morning specimen) but I noted an increase in mucus on what was confirmed to be the time of ovulation. Now doubt was starting to creep into my mind.

A few years ago I delivered a talk on contraception to an audience of general practitioners. I tend to receive a few emails after a lecture. Usually from someone who felt too embarrassed to ask a basic question, or a wise-ass who wants to double check my sources or call attention to a typo in my slides. This time I received a response from a woman who explained that she only discusses fertility awareness methods as she views birth control to be abortificaents. "It's simple" she wrote "the body     knows when it's fertile and when it isn't" Accordingly, she claims that in ten years of working with over three hundred patients, she is only aware of two unintended pregnancies. I was tempted to write back and ask if she actually listened to my lecture. Specifically, when I explained that contraception prevents pregnancy, and thus does not cause an abortion. I also considered asking if she thinks it is ethical to restrict the information she provides her patients. Instead, I just hit delete. Now I'd like to reply and confront her claim that determining when the body is fertile is "simple". I've been specalising in women's health for over ten years and I have no fucking clue when I'm fertile.

I decided that I would need more data. Although I've received inconsistent results with the happy face LH tests, it couldn't hurt to have more variables. I ran to Safeway over my lunch break, feeling a bit cautious as many staffers often do some shopping during this time. Fortunately, the OPKs are at the end of the aisle adjacent to the self-check stations. I'm convinced that these were invented for the purpose of purchasing personal products. In one swoop, I grabbed a shopping basket, dropped the box into the basket and covered it with my purse, scanned my item and then threw it into my purse while I finished the payment process. I could not be any more discreet. For the record, an absent smiley face agreed with my ClearBlue monitor.

As it had been 30 days since Healthnet had covered a box of 4 estrogen patches and only charged me with a $10 co-pay, I was able to pick up another supply. It would also give me an opportunity to speak with my pharmacist friend to make sure he would be able to order my meds in time. While we were chatting, he asked one of the pharmacy techs to grab me a box of estrogen patches. I'm guessing he thought that everyone was pretty familiar with me at this point in time, but we were both a bit surprised when he placed a box of Ortho Evra on the counter. Admittedly, I was rather relieved that he didn't immediately suspect that I needed to be on postmenopausal hormone replacement therapy. Besides, my friend in Kansas has a much more embarrassing pharmacy mix-up story. In the small and very conservative town, all birth control products are kept behind the pharmacist's counter and one must ask directly for them. (Interestingly, pregnancy tests are sold on the shelves without restrictions...) When she asked the 20 year old pharmacy tech for some Today Sponges, he referred her to the housewares aisle...

I was getting ready to leave the office, when I received a text from Husband with an invitation to have intercourse later that night. Actually, his message was much cruder, and I'm paraphrasing for politeness. (By the way, can that be considered a booty call?)  Anyway, I should mention that Husband is creeped out by my progesterone suppositories and goes on a vagina boycott during the simulated luteal phase. He was away during the brief post progesterone and pre-AF period and consequentially, I don't think either of us can remember the last time we had sex.  I did recall my conversation with Misery when I asked if I should check my progesterone level one week after  my monitor indicated ovulation. "Jane, you can't try to conceive at this time!" From the other end of the phone, she couldn't see me rolling my eyes. "Oh, Misery, please give me credit for being smart enough to know that."
"Yes, I'm sorry Jane."
"Besides, we've long accepted that ship has already sailed. I think it reached South Africa." That quip actually generated some laughter from Misery.

My protocol doesn't allow for that miraculous spontaneous conception just before starting IVF as I have to start Lupron in my luteal phase. In fact, the pre-requisite for this cycle is that we not get pregnant, which is something we're actually quite good at! Although two monitors are indicating that I am not fertile, the presence of that mucus was still weighing on my mind. We would need to take precautions. "You'll have to wear a raincoat" I informed him as I swallowed my Co-enzyme Q-10 and DHEA capsules with a sip of wine. I was somewhat hoping this would put him off the idea and we'd go back to the fail proof method of abstinence. "Do we even have any condoms?" he asked. I think I got rid of them after a broken condom marked our inaugural intercourse after my IUDectomy. We checked every place we thought they could be, but couldn't find any. Oh, well.    

Apparently not. Just as we finished dinner, Husband offered, "I'll clean up if you'll run out and get condoms." Oh, he must want it badly... I thought to myself as I drove to a nearby CVS. I stood on the other side of the aisle where a few months ago I was pondering over the choices of sanitary napkins. Now I was perplexed my the myriad of condom options. As I studied the names Extended, Ultra Thin skin-to-skin, Charged, all felt eerily familiar to the titles for feminine hygiene products, Radiant, Infinity, Ultra Thin, Long, Active. By the way, Trojan Sensations for her pleasure... yeah, not so much...

I grabbed a box and went to the queue sans camouflage items. By the way, sometimes you do need to choose your camouflage items carefully as I once stopped at a convenience store and the guy in front of me was buying a large box of condoms, a jumbo sized bottle of Gatorade, and he asked to see one of the stopwatches in the display case... Anyway, I had a peculiar smile on my face, which would be expected from one who is wearing flip-flops and gym shorts in CVS at 8:30 on a Monday night, making a sole purchase of condoms. Rather, I was laughing my ass off inside my head, as here I am; Ms Infertile Myrtle, can't get knocked up with IVF... and I'm getting some condoms...

My purchase history for today includes, postmenopausal estrogen replacement, an ovulation predictor kit and now condoms. I'm a walking contradiction.

Thursday, 1 May 2014

Arrested Development

I admit that there are times when I can't turn off the clinician inside my brain. Although I don't have much experience with babies and paediatrics once they leave the womb, I do remember studying the Denver Developmental milestones. Whenever I see my friends' kids, I can't help running through that checklist. While spending Christmas Day with my aunt and cousin in 2011, I carefully observed her fifteen month old son. He was able to speak random words such as "turtle" or "bubble" which seemed to be on target.

Despite our close proximity, we don't get together with my aunt or cousins that often. Our interactions are pretty much limited to major holidays and when my parents are visiting. In particular, I don't think I saw my cousin at all during 2012 until the Thanksgiving and Christmas holidays. While I was dodging my cousin's questions about when we were going to have kids, and watching everyone fuss over her second baby, I took note that her two and a third year old son didn't seem to speak much and when he did, it was only one or two words. I spent some time reading with him and saw that the could count and connected that he had four books. This seemed really basic and I would have expected to see much more progress in his sentence structure.

I had a few private conversations with my aunt, who is a paediatric nurse. She has shared my observations, but felt a bit of relief when he finally uttered a complete sentence by the time we was two and a half. Just before his third birthday, we attended a gathering with my cousins and their friends with kids. As I was watching all the tots play, his delayed speech was really apparent. He seemed to be just making random sounds, and there didn't seem to be much purpose to the one or two words he employed.

A few months later I spoke again with my aunt as we were cleaning up Thanksgiving dinner. She had observed that while her grandson could speak short sentences, he would mostly repeat what others were saying ("Is the moon bright?" - "yes the moon is bright"). He didn't seem to express much original thought. The teachers at his day care/pre-school had a conference with my cousin and recommended a specialist evaluation. However, my cousin was resistant to this idea as she was in special education classes during her elementary school years and she didn't want her kids to go through that experience. I wondered why my cousin couldn't appreciate that she need to address this developmental issue now to prevent her son from attending the special-ed classes when he gets older.

We got together with my aunt and cousins for brunch on Easter Sunday. Although we're atheists, Husband and I felt it was important to attend so that another six months wouldn't go by before we visited with my relatives who live ten miles away from us. Additionally, we learned that my uncle was recovering from his second hip replacement and my aunt was just diagnosed with stage I breast cancer. The tumour was detected at an early stage and the surgeon feels she has a very encouraging prognosis. If her lymph nodes are negative and the pathology reveals clean margins, she most likely won't need any adjunctive chemotherapy or radiation treatments. Her lumpectomy as actually planned to be an outpatient procedure, so I offered to check on her that night as well as to be available for dressing changes. My aunt commented that so far, 2014 has been a tough year on their family medically, as their oldest daughter just had surgery on her neck and my other cousin is scheduled for a cystocopy to evaluate her chronic urinary tract infections. I added my grandmother's hip fracture to that list. "Plus, what we've been through" Husband offered privately, but it didn't seem to compare.

I'll admit that I'm not in a good position to evaluate my nephew and his speech development since I don't see him often and our interactions are quite limited. I also admit that one paediatrics rotation does not make me an expert and this is definitely outside my area or expertise. However, it's so glaring to me. What I see is a lack of progress in the past year and a half. I took note that his parents and grandparents (finally) dropped the baby talk and seemed to be making an effort to engage him in conversation. Yet even getting him to recall his Easter presents was difficult and was met with just one word answers. Husband, who has no experience with kids and no related training, not only picked up on how behind he is, but he noted that his younger brother (the spontaneously conceived 'surprise') seems more advanced.

My aunt later revealed that the director at his pre-school gave my cousins a two week notice to find another school for him. Holy shit! I never knew you could get dismissed from pre-school! Apparently, he failed to meet their potty training deadlines and he wasn't transitioning well when the class would move from one activity like colouring to story time. They enrolled him in a Montessori program, which my aunt isn't sure is going to be the best fit. She added, "I have heard from some of my patients that the three-year old instructor at his old school is not very good."

So we're moving to the tactic of blaming the teachers... I recalled that when he was two yeas old, my cousin's husband acknowledged that his speech was behind. "You just want to hear that everything with your kid is perfect" he admitted. Although I may not get to this place, I've been thinking about how infertility's effects still linger during pregnancy and while parenting. Can it induce a form of blindness? Or throw one into denial? Okay, selfishly it also concerns me that their IVF conceived child is delayed while that natural one is seemingly normal. I lament how hard conception and pregnancy are for us, but I'm reminded that it may only represent only the beginning of our challenges...