Should I Stay or Should I Go...

It has been a no good, very bad week. To start, I caught Husband's cold and have been feeling miserable. As it has been exceptionally cold, I haven't been swimming. Actually, I haven't done any exercise in over a week, which has contributed to my misery. Work has been really busy. I haven't taken any vacation time since I got back from England in early August. Our office was only closed on Christmas and New Year's Day, but all of my colleagues took some personal time around the holidays and one has been on an extended vacation, leaving me to cover in their absence. I'm starting to feel like Peter Gibbons in Office Space. As my progesterone level officially confirms I'm in my luteal phase, I've been feeling rather hormonal and especially emotional this week. I had a few moments when I felt like crying and I erupted into a fit of anger when I discovered that Husband didn't bring the rubbish bins in from the curb. Alas, I had made it to Friday. Just had to get through the next eight hours and I could escape into the weekend. While driving into the parking garage, I swipped a concrete post, scrapping and denting the passanger side of my car. I wanted to burst into tears and it wasn't even 9 AM.
Throughout this week, I have been contemplating if I should go back to east with Husband and visit with my family. I know I need to take some time off from work before I burn out, but I don't know if this is a break that will recharge me. Returning home and spending time with parents is not a proper vacation. Additionally, I don't know if I'm ready to face Myrtle and to see her in her new role as a mother. It pains me a bit to admit that to myself.  Plus it's really cold in Connecticut.
However, it would be comforting to see my parents. Even though I'm not ready to share anything about our fertility project yet, I'd like to spend some time connecting with them. I'm a 36 year old woman who still wants her mommy. I know I'll eventually have to encounter Myrtle. Six, nine months down the road, if I'm still not pregnant, will it be any different? I can't avoid her forever. Also in the decision making equation is the fact that I could be ovulating during this time. Part of me fears this could place extra pressure on Husband (not to mentiont the awkward location) or if I go and it doesn't work, will we look at the cost of my flight as money that could have gone to our first IUI cycle? (or for my car repairs...) But what if ...

You can't win if you don't play...

So, I haven't actually seen any of the movies in the Godfather trilogy, but I am familiar with famous quote '"Just when I think I'm out, they pull me back in!" Although I've never been involved in the mafia, I can identify with that feeling right now. I knew it was still a long shot, but I confess I was a little more hopeful after my miscarriage. I've known of 7 or 8 patients who conceived with the first ovulation following a miscarriage, although the most recent patient had a chemical pregnancy, and I don't think any of these patients had underlying fertility issues.  Did I really expect that getting pregnant once would resolve our infertility issues? More so, did I really believe that our first pregnancy would be successful and we would live happily ever after? Just a few hours after having my blood drawn, I received a call from a medical assistant in my RE's office informing me that my HCG level is finally zero. Ironically, this was the quickest response with the results that were least clinically relevant. My progesterone level was 14, indicating that I ovulated some time in the past week. Unfortunately, it was a bang-less week. One night husband was out with some work friends, the next night I met up with some friends visiting out of town. We stayed home on New Year's Eve, but after two glasses of wine, I was sound asleep by 10:30 and missed seeing the clock strike midnight, which officially means I am old as well as lame. I tweaked my groin muscle during my New Year's Day 10K and was out of commission, which coincided with Husband coming down with a cold (aka "manflu"). I feel like we are the sorriest conception seeking couple ever. The consolation prize is knowing that I did actually ovulate and now I have a 6 day window to expect AF. While I'm happy to see that my ovaries are back to work, I was kind of hoping the anovulation would continue a little longer and then I could possibly manipulate AF's start with Provera and avoid being fertile while Husband is away. Now I'm almost certain that at the moment when I'm ovulating, Husband will be on the east coast playing Wii bowling with my father.  I don't know why I'm so disappointed about missing a chance to conceive spontaneously when we've accepted that we need treatment, but it just makes the possibility of pregnancy seem that much further away. You have to be in it to win it.  At least the advantage to being back in infertileland is the opportunity for further diagnostic testing. On my initial evaluation, it was noted that I may have a slight uterine septum. Although it was thought to be unlikely to contribute to our infertility or cause problems with a possible pregnancy, I'd rather not have this question mark hanging over my head as we start treatments. There's no doubt that I would prefer to have an ultrasound that shows a baby growing in my uterus, but I'm happy to be proceeding with the sonohystogram at this time. Sometimes you have to take a step back to be able to move forward.

The Reflexive Responsive Pregnancy

Do you remember being in grade school and if you were wearing the same clothes as another kid, or playing with the same toys or games, you could be labelled as a 'copy cat'? Some times that behaviour doesn't leave the playground. I think most of us have observed situations where we've speculated that someone became pregnant, just because her friend or family member is expecting. Someone who hadn't indicated any plans for pregnancy, and may not even be in the best place to have a baby, but quickly conceived after the friend made her announcement. Maybe it's a feeling of not wanting to be left behind, or wanting the children to grow up together, but I suspect there's also an element of jealousy and insecurity. Many years ago I had a patient who came in for her yearly exam. She wanted to manipulate her birth control pills so she wouldn't have her period during her younger sister's upcoming wedding, but she asked about IUDs and other forms of long acting birth control as she and her husband didn't want kids any time soon, if at all. A few months later, the younger sister came into the office for a pregnancy test. She was in shock over her honeymoon conception. Three months later the older sister also presented for pregnancy testing. I wondered if the younger sister's pregnancy influenced her to change her mind in regards to their family planning. The younger sister stopped breastfeeding around 6 or 7 months and came into the office to discuss birth control and the older sister accompanied her. Her last period was 35 days ago, still likely to be irregular, but warranted running a pregnancy test. It was positive. Sure enough, the older sister had a positive pregnancy test three months later. I knew that was not a coincidence. It's such a different world for fertiles. I can't imagine what it must be like to command your own fertility, especially when it seems to be a reflexive responsive conception. Copy-cat.
Update on Co-worker: she's nine weeks along and although she feels like crap, the babies seem to be doing well. She broke the news to her mother on Christmas day by having her open a framed picture of the ultrasound photos. Her mother burst into tears of joy and hugged both Co-worker and her husband. About fifteen minutes later, after she had settled down and dried her eyes, she asked "Why did you frame two pictures?" Co-worker had to explain, "...because there are two babies..." The tears and hugs erupted again. However not every pregnancy announcement is as much fun. Co-worker was dreading telling her Sister-in-Law (SIL). Co-worker's SIL is the kernel of truth that contributes to negative stereotypes of only children. She's selfish, self-absorbed, self-centred, jealous and insecure -and those are her good qualities. On her first attempt to conceive, she became pregnant with boy/girl twins. She would go crazy once she learns they won't be the only twins in the family. Co-worker decided to break the news in stages, first disclose the pregnancy and then reveal that she's got two on board. After learning of Co-worker's pregnancy, the SIL listed all the ways that pregnancy and caring for one baby would be so much easier, just so everyone would know that every situation is always all about the SIL. She pressed Co-worker at least three or four times with the question, "Are you sure you're only having one?" A few days later, at a family gathering on New Year's Day and before Co-worker could drop the bomb about the twins, the SIL announced to everyone that they were trying to conceive...

Awaiting Ovulation...

My supposed mid luteal progesterone level came back at 0.7. Not only did I not ovulate at the time I thought I did, but as of Day 19 I hadn't ovulated at all. Looking back, I suspect I was too anxious to start again after my miscarriage. I had misinterpreted all the cues. The EWCM was likely left over from the pregnancy, the twinges of pain were likely muscular aches from swimming and the lustful thoughts for the male nurse in the elevator probably reflects the fact that I've been with the same person for fifteen years. My hormones levels were probably still scattered and likely triggered a false positive on the fertility monitor, implying that I should have stuck to my initial instinct not to use it. I thought I had an understanding with the Universe: I could accept the disappointment from my miscarriage as long as I could move on as quickly as possible. Now I feel like I'm flying blind. I don't know if I ovulated since having my blood work done (not that it matters, since we haven't had sex during that time) or if I haven't ovulated yet (not that it matters, since Husband self-indulged today). It seems like such a foreign concept, no cycle tracking -just hope you're in your fertile time, have sex and maybe get pregnant. I have to remind myself that for most "normal" couples, this is their experience with the procreation process, but it seems so inefficient and futile to me. The most frustrating aspect of the ovulation uncertainty is the fact that I won't know when to expect AF. Although the two week wait is agonising, at least there is an end point. In my situation, there is no joy with the absence of AF. Each passing day without her means more waiting and more plans are put on hold. I've been looking ahead on the calendar. Husband has to go back east for work toward the end of the month and will be away for ten days. I've resigned myself to the fact that I'll probably ovulate during that time. As I have a lot of vacation time saved up (thinking I would use it for maternity leave) I'm tempted to go with him. A few days in New York would be fun, but Husband has already arranged to spend some time with my parents, which is not conducive to baby dancing. It now means two months of missed chances. It's hard to know which is worse -trying to conceive and meeting the BFN or being denied the opportunity entirely.

The Vanity Project

I've dealt with body images issues for most of my life, as do many with double X chromosome syndrome. In my early adolescence, I was starting to pick up the description of being "big boned".  Fortunately, I was directed toward sports and not only added muscle tone to my frame, but I gained the self esteem and confidence to accept the way I looked. Nearly a decade later when I was in my mid twenties and was working in a hospital ward, I would sometimes hide in the locker room when I needed a quiet space to do my charting. The locker room shared a wall with the nurse's break room and one day I overheard a group of nurses discussing what parts they would chose among their colleagues if they were to design an ideal body type. To my surprise, they collectively decided that they would want my legs on this hypothetical woman. Once I knew that someone else wanted what I had, I felt that I had permission to appreciate and actually be happy with my own body. As I wasn't interested in having children at that time in my life, preserving the body that I had was additional motivation not to become pregnant.  I have a colleague, who is a certified personal trainer for pregnant and postpartum women, and I asked her what to expect if I ever had a baby. "Well," she told me, "You'll get your figure back, but be prepared that your body will go through major changes" I took a minute to process her words. So I'll look okay in clothes, but be wrecked naked? "Yep, that's pretty sums it up" she confirmed. I resented Mother Nature for placing such an unfair burden on women. If it's not hard enough to endure the physical effects during the nine month gestational period, why must women bear scars and blemishes after the baby is born? Not to mention society makes women feel pressured to get that figure back right away, while mastering motherhood and returning to work. However, as I turned 35 and the ovaries were kicking up my maternal desires, I started developing crow's feet around my eyes and the waistline wasn't as forgiving if I missed a workout. Whether I had a baby or not, I was going to lose my attractiveness and flattering figure. The more I came around to the idea of wanting a baby and wanting to be a mother, it all seemed less of a sacrifice. That and I also accepted the notion that there is no shame in plastic surgery. Just days before I got my BFP, I noted I was at the lowest weight I had been at in years. I felt happy with the way that I looked, and it was not because anyone else was feeding me any compliments. 'Now, watch I'll get pregnant' I thought to myself. Believe me, I wasn't disappointed in the least and if I were still pregnant, I wouldn't care what number is on the scale. However, a few weeks after my miscarriage and just before New Year's, I was at work and I overheard a colleague say "I wish I could rock a dress like Jane..." Suddenly, I had the motivation to avoid the cookies in the break room.  As 2013 began, I resolved to be committed to good eating and exercising habits, primarily for health reasons, but with a dash of vanity. As long as this body is bumpless, I'm going to flaunt it.

Minor Annoyances

I am fortunate to live in a large city and I had a choice of several REI providers. I know there are couples in other parts of the country who have a 2-3 hour drive to find one reproductive specialist. Our short list was narrowed to two groups that accepted my insurance. Both offices were about the same distance from our house, although the morning traffic was worse getting to one and the other was a little closer to the pool where I swim each morning. The decision was influenced when Husband's urologist sent him to our current provider's office to do his semen analysis and he felt comfortable wanking there. Sold. I could look past the fact that my RE bears a striking resemblance to an ex-boyfriend (not the devoutly religious swimmer) as I do genuinely like and respect him. However, I'm getting more impatient with his office staff. I prefer to use email to communicate, as I find it to be more convenient and in theory should be more efficient, but I'm now doubting this strategy as there have been multiple occasions when my messages aren't being read completely. I sent a message last week about obtaining authorisation for my sonohystogram and haven't heard anything back. For the most part, I feel that I am fretting over minor details, but I'm concerned about the larger picture. If they can't take care of the simple things, how can I trust that they'll put the right stuff in my hoo-ha? The day after Christmas, I received a voice mail from a staff member whose name I didn't recognise. She informed me that my last HCG level was 16 and my RE wanted it to be repeated next week to confirm it reached zero. Seriously? I wouldn't make someone repeat a draw with a level of 16. However, I was curious to know my progesterone level one week after the peak fertility indicator to confirm if I did in fact ovulate. This was my negotiation; I would repeat my HCG level if I could also check a mid-luteal progesterone. I sent an email asking to have a progesterone level added and for the request to be faxed to the lab. I also asked for someone to notify me when this was done, so that I wouldn't waste a trip to the lab. Two days went by without a response. I called the office on the morning when I was intending to have my bloodwork done. A woman's voice answered, but she didn't identify herself. I said I was calling to confirm if the progesterone was added to my lab order, and if it was faxed to the lab. She put me on hold while she went to get my chart. Then she placed me on hold again while she went to check on what was ordered. Finally she returned to inform me that I needed to have an HCG level drawn next week. I asked if the progesterone was added and she confirmed it was. So my message was read. I asked if it was faxed to the lab and she confirmed it was. "Did anyone see my note about contacting me to let me know this was done?" I asked. Silence. No apology. No explanation. I hung up the phone. I sure am working my way to be labelled as a "difficult patient". Maybe I was over reacting and I am confirming that I did ovulate before my progesterone level has even been drawn.

The 2013 Challenge

I started the New Year by conquering a mountain. Well, technically not a mountain, but a steep hill with a gain of nearly 1,000 feet in elevation. For the second year, I participated in a New Year's Day 10K trail run. Last year, I didn't look at the course map before the race started and was so unpleasantly surprised by the terrain that I disabled my timing chip, so I wouldn't register a time. This year my goal was just to enjoy the beautiful view that awaits us at the top of the hill and soak in all the positive energy from the other runners (who are now walkers/hikers at this point). It's hard not to feel optimistic as the New Year dawns. Post race, Husband and I returned home for brunch and I began to work on painting our kitchen cabinet doors. When we were planning our kitchen renovation, Husband wanted to install new cabinets, but ours were in good shape and I didn't want to double the price of the renovation (a wise decision given that we may need those funds for IVF). So we decided that I would paint them. Last February, I started by stripping all the cabinets and facings, and then we took our time selecting the paint colour. I painted the casings in June, but once we got back from England in August, we went into full renovation mode and painting was put on hold. We had all the appliances installed by election day and by Thanksgiving I had moved everything back into the kitchen. Now, the final step of the project was to finish painting the cabinet doors and trim. Husband and I joked that the process of painting the cabinets has been taking as long as we have been trying to conceive. Thus, the challenge of 2013 was issued. Which would happen first: a pregnancy or finishing the cabinets? Here are the stats for those of you who are playing along at home. Fertility project: Me, age 36, FSH 7.1, E2 32, AMH 4.53, AFC 9-10, irregular cycles, possible uterine septum, thin endometrium, one pregnancy -miscarriage at 6 weeks. Husband, age 38, low concentration (range 14-17 million), low morphology 1%, motility 50-60%, mild hypogonadism with slight response to Clomid. The cabinets: twenty doors. I have a rack that allows me to paint both sides at the same time and holds four doors. Each door gets a coat of primer (sometimes needs two coats) and then 3-4 finish coats and 2 coats of a clear protective polish.  For the trim, we have to borrow a special laser level from my dad to identify the lowest point in the ceiling. We still have to select the moulding, do the math on how much we need and add 15-20% for cutting errors. Then all pieces will need to go through the painting process prior to installation and will need touch ups after the caulking. I'd prefer to do this part first as I'm growing tired of seeing the paint spots on the wall and ceiling that are waiting to be covered up by the trim. I do most of my painting on the weekends, but will sometimes do some sanding and prep in the evenings after work. So which goal will be reached first in 2013? I'll keep you posted. Happy New Year to all!