Life happens while you're making other plans...

Every now and then, I'll encounter a patient who has an elaborate or unrealistic birth plan; and I'll gently remind her that she'll need to be flexible and ready to roll with the punches. Labour and delivery is so unpredictable and situations can change without a moment's notice. It somewhat amuses me when patients seem to have a script for their birth performance. Although I obviously have no personal experience, I'll often mention that the lack of personal control during the birth is only heralding the absence of order that will accompany the arrival of baby chaos. I haven't even made it past six weeks gestation, but I've been discovering that nothing related to procreation is mine to command.

Pausing for a brief moment to recall that my procreation plans originally included conceiving early so that our baby would be born in 2012 and could be a leap year baby like me. I wanted to avoid having a baby born in the unlucky year of 2013 (wish granted!) and I'm not holding out for 2014. Although the Universe has been ignoring virtually all my requests, I will mention that 3/14/15 would be an awesome birth date as it's Pi Day out to five places. Until Husband pointed out that technically it's not, as the full date is 3/14/2015 and that it's American Pi Day, as the proper way to write the date is 14/3/2015.

Perhaps equally ridiculous, is the fact that I thought I could plan my first IVF cycle. My RE mentioned a few times that you don't know how things will unfold during a cycle until you start the process. Non Sequitur Chica offered sage advice when she described her first IVF attempt as a diagnostic cycle. Yet I thought I was still operating within reasonable expectations. I knew I wouldn't be a chicken that would produce twenty or more eggs. In fact, I accurately predicted the dozen oocytes retrieved (I just underestimated their maturity). I was surprised when my RE initially expressed concerns for a possible over response.
     
"What is his rationale?" Husband asked, "I need to see the maths." Here is where hubris would get the best of me again. I've felt that I've been sitting on a goldmine in the form of my AMH of 4.53 (Day 3 FSH 7.1). When I first received that result, I questioned it as an AMH >4.0 can be suggestive of Polycystic Ovarian Syndrome (PCOS) in the presence of clinical features. I emailed another local RE to get a consult for a "patient". I listed my age, lab values and noted how much exercise I do to explain that my near overweight BMI is due to muscle mass. He replied: you can reassure "your patient" that she has a good ovarian reserve. (Air quotes were not actually used, but I'm sure they were implied)

My RE was actually the one who initially suggested doing a freeze all cycle. When I asked him about PGD testing, he responded, "You're a good candidate for it" as he noted that he often has patients who are in their early 40s who ask for it, not realising that they won't have enough embryos that will progress to that point. The unknown variable with our cycle would be how my eggs would fertilise given that we are dealing with male factor issues.

Thus, I felt that I had it all planned out. I would produce a decent yield of eggs for an old bird, and hopefully a good number would fertilise and could be biopsied before being sent to the freezer. The PGD testing would allow us to transfer euploid embryos only and thus could prevent the heartbreak from a miscarriage due to a chromosomal abnormality. I even got greedy dreaming that we could select a female embryo. Most of all, we could only transfer one embryo at a time and nearly eliminate the possibility of twins.

From the moment I heard my RE project that we'd only obtain 6-8 mature eggs, I became discouraged. I knew we'd be working with fewer embryos. Although there were concerns about fertilisation, Husband's boys were up to the challenge. His Wank In a Cup (WIAC) results boasted a concentration of 29 million with post prep at 9 million, higher than any of our IUIs. It was his best sperm day ever. His motility was unusually low at 30%, but who cares when you're doing ICSI!

Seemingly, all my plans went out the window when I heard my RE recommend transferring two embryos on Day 3. On a minor detail, I was looking forward to having the stimming and retrieval and the transfer and waiting to be two separate events at different times. I had just refreshed my lingerie collection and wouldn't even get to wear my new underwear once before they would get yucked by progesterone suppositories. Dare I even think that we could select the time for our FET and chose when we wanted to try to get knocked up. I wasn't going to be able to do PGD testing to select a normal embryo for my transfer.  I was being asked to surrender my intention for a single embryo transfer.

I believe my RE was very perceptive when he forecasted that I would regret a day 3 single embryo transfer if it were to fail. He was right. I would know that the lone transferred embryo was a dud and I would wonder if a second one may have implanted. If my beta is negative, then at least I can feel relieved that I'm not facing the possibility of twins. If I am pregnant with twins; I will be pissed. I will be pissed at myself for not sticking to my resolve on a matter that was so important to me. My RE commented that even when we were attempting conception with intercourse, there was still a risk of twins. I smirked. Did he not note how pathetic we were at trying to conceive the natural way? This is part of the reason why we're here. Even with ovulation predictor tests, I couldn't figure out when I was ovulating and whether we could manage coitus was another obstacle. Still, there is a difference between an occurrence of twins as a random event in nature and acknowledging that I uttered the words, "we'll transfer two..." to the embryologist.

I'm ashamed to admit that I had a bit of an outburst when my RE first reported the embryo status and his recommendations. While I appreciate that the ultimate worse case scenario would be not having any embryos to transfer or freeze, I still needed to lament frustration about this cycle. It was more than petulant whining that things weren't going to plan or that I wasn't getting my way. I felt that I had failed to meet expectations. I had to transfer my embryos earlier and in greater quantity as their prognosis was poor. "Jane, Jane, Jane...Jane!" My RE tried to avert me from going off the deep end, although it was a bit too late.  "A Day 3 transfer is not a desperation measure," he reassured. Really? Then why did it feel as if it were. It's never easy to discover that you're not as good as you thought you were.

Even as I'm finally accepting that I have little control over this process, I can't resist trying to plan our next steps. I'm curious to hear my RE's postmortem analysis of this cycle. Would I have been able to produce more eggs if I didn't have to reduce and sometimes hold my stims?  Going forward with another cycle, would it be better to start off at a lower dose and then increase? Would Husband be able to equal or better his awesome WIAC performance? If we have any fro-yos, when would we want to transfer? I'd like to attempt endometrial injury prior to an FET, can I have one of my colleagues do my endometrial biopsy?

Then again, maybe life is what happens to you while you're busy making other plans...

Increasing Efficiency

At the end of our initial consultation, my RE explained that he likes to review the mechanics of reproduction with every patient, regardless of their education level or prior experience with infertility treatments. I turned and gazed at the window to conceal my eye roll, although Husband listened intently. He summarised his birds and bees lecture by noting that human reproduction is very inefficient. Despite the reputation of rabbits, mice are actually one of the most efficient reproducing species (fortunately, he didn't go into further detail...) The female human only has a few brief fertile opportunities each year, while the human male wastes millions of gametes (sometimes recreationally). "Maybe from a standpoint of population control it is very effective, given that humans consume the most resources" I replied, truly intending to make a good point, while enjoying the added bonus of coming off as a smart ass.

When I first had the IVF talk  with my RE, he pointed out that IVF provided a more efficient means of human reproduction. I felt that he was trying to be somewhat consoling; 'I'm sorry that infertility has dropped you in the bottom of the heap'. Yet he did have a point, after you get past the injections, retrieval and fertilisation in a Petri dish , IVF does offer a lot more opportunity than the average romp in the sack. Of course, that thinking is presuming you have a good retrieval, good fertilisation rate, good embryo development and enough embabies to stick on ice.

To a certain extent, we have achieved the goal of increased efficiency. In one cycle, I produced eight mature eggs. Five fertilised. To our knowledge we only had one other episode of fertilisation, and we all know that didn't work out too well. Yes, we're way ahead of where we would be without intervention, but is it far enough? It's so interesting how quickly your perspective can change. Eight mature eggs seemed meek compared to twelve oocytes retrieved. The number eight seemed robust compared to five fertilised eggs. I had the feeling that by my day 3 report, I would be longing for the number five. A week ago, my RE was looking at our number of follicles and at my E2 levels and described that things looked "good". Now our prognosis seems anything but good. I shared some of my concerns with him just before my retrieval. Six to eight mature oocytes meant we'd be working within narrow margins. "When you're pregnant, you won't remember these details" he replied with a hand patting my thigh. I wondered if he was just trying to shut me up before the anesthesiologist did it for him.

I commented to Co-worker that if all five (realistically, at least four) of our embryos made it to day 5 and we could complete our intention for a freeze all cycle, I would consider this attempt to be a success from an efficiency standpoint. She reminded me that my goal with this treatment is to have a baby, not necessarily to have a collection of embryos. She is correct, we only need one to work as we only want to have one child. If we succeed, we really don't need to have any embabies on ice, so maybe this cycle could be deemed efficient in that respect. However, if we only end up with one (or two) embryos to work with, then it's hard to argue that IVF is increasing efficiency, but rather compensating for a defect.

After reading my initial fertilisation report, my RE thought a day 3 transfer was less likely and he seemed confident that we'd make it to day 5. I couldn't escape feeling that the entire process seemed like a long shot. More so, I started to fear that if we couldn't produce a decent yield of embryos would it even be worthwhile to consider pursuing a second IVF cycle? I projected that if at least four embryos survived to day 3, we could proceed with our Day 5 freeze-all. If there were three or less, we would need to do a day 3 transfer. Then I remembered these are our embryos! They have our genetic material. They have Husband's stubbornness and my determination. Progress to day 5? Challenge accepted! Bring it on Bitches! It was the first time I acknowledged any attachment to them. Is it odd that I felt a sense of pride?

My RE called with my embryo update while I had two patients waiting in rooms and I was on the phone reviewing a stat report with our radiologist. As soon as I spoke with him, he wasted no time giving the report and recommendations. Embryo quality wasn't bad, but wasn't good. He was advising transferring two embryos now. If we decided to wait until day 5, we may only have one or two, or worse case, none. I quickly rationalised, that if I were going to lose some embryos anyway, it was better to put some in my uterus. I felt really defeated. It was frustrating enough to acknowledge that we were pathetic at trying to conceive on our own, now we sucked at IVF too.

Here was the situation I desperately wanted to avoid. Transferring more than one embryo and potentially facing twins. Although I was also questioning if our possibility for pregnancy was so low, was I being daft for even fretting about twins? My RE had noted that based on my age, I nearly fell into the 'poor prognosis' category when it would be recommended to transfer three embryos. At the same time, I couldn't deny my fears. I don't want to be another IVF twins statistic. I don't want to have people look at me and think to themselves, 'she should have known better.'

I spoke with my lead physician. She suggested that if he was advising transferring three, than I should at least go with two. Very reluctantly, I agreed. It would increase the efficiency of the transfer. My RE revealed that if he were talking to me about one of my patients [with our details] he would recommend two. If I were a member of his family, he would recommend transferring two embryos. Nearly every REI clinic would advise a transfer with two embies on board. It's so hard to go against such strong recommendations, but at the same time, no one making such suggestions has to live with the consequences. I do. He discussed the potential for regret if I elected to transfer one and it didn't work. Would I wonder what may have happened if we transferred two? Perhaps. I just hope I don't come to regret transferring two.

It turns out that our embryos weren't too bad. We had six that contained seven or more cells (we picked up a straggler!). Three actually had nine cells and one had ten. Yes, those are my over-achieving embryos. However, only three received a grade of 'good', two were 'fair' and one was 'poor'. I think they transferred my good nine and ten cell ones. I have one 'good' embie, two 'fair' ones and another 'poor embie that will try to make it to day 5 and to the freezer. The embryologist noted that if we just had a few more in the 'good' category, we could held out for a day 5 transfer. That was reassuring to hear.

I signed up to participate in Risa's  sock exchange, as I wanted to have socks from another infertile for my frozen embryo transfer in a month or two; but as we all discover, things don't go according to plan. Socks are a little bit of a sensitive topic for me, as that was one of Myrtle's conception tips. "If you wear socks after sex, it will help blood flow to the uterus and will help make things stick" Um, it's all about the boys and their swimming ability at that time. Implantation doesn't take place until 5-8 days after fertilisation, but thanks for trying to apply some scientific theory! I decided that it couldn't hurt, but I wanted to put my own twist on it and went with my compression calf sleeves.

The Deafening Silence

It was little Myrtle's birthday just over a month ago. I selected a present that would be fun, educational and easy to ship cross country. "Is this a gift that you would like to have wrapped?" the sales clerk dutifully asked me. I knew it was a routine inquiry, but it just seemed to remind me that I wasn't making a purchase for my own child. I looked at the selection of wrapping paper and acknowledged that I didn't have any at home. Whatever she would charge for the service was justified by the fact that I wouldn't have to buy some cutesy wrapping paper that would just sit in my closet.   Plus, I figured this would help earn me points for being the good Auntie Jane.

It started to dawn on me that I haven't been that good a friend to Myrtle to support her during her first year of motherhood. I've kept my distance in order to protect my own feelings. I tend not to ask too many questions and I haven't been too available for her to discuss her experiences. A few days after the birthday, I called Myrtle and invited her to talk about little Myrtle's first year. Myrtle recounted the terrifying days of little Myrtle's ICU admission after birth, which was followed by many frustrating sleepless nights once they brought her home. She described that over time she started to gain confidence and felt more comfortable in her new role. She's enjoyed watching little Myrtle's personality blossom as well seeing her reach her developmental milestones, which recently included her first steps without assistance. "People are starting to ask me when I'm going to have my second baby..." she noted (apparently, this happens after the first baby reaches the one year mark) "I'd like to have another one... I'm just not sure if I'm ready yet."

I know there is no handbook or manual for how to deal with your friend who is infertile, but I'm sure if there were; there would be a chapter on not causally discussing your plans for a second child. It was just so striking how she could discuss the possibility with such confidence. There was a part of me that wanted to advise Myrtle that time is passing for her and she may not get knocked up straight out of the gate again. Yet, selfishly I fear that if I give her such a warning, she'll go off the pill and be pregnant within a month. Although Myrtle has no known biological limitations; the three of them are living in a shoe-box sized one bedroom condo, and their prospects for moving to a larger house are restricted by the fact that her husband is only getting part time work through a temp agency. Then again, it still seems more plausible that he could find a permanent full time position and they could move to a less expensive area.

I haven't spoken to Myrtle since I started this IVF cycle. During my IUIs, she couldn't understand the concept of having ultrasound monitoring to track follicle development. How could I explain the process of controlled ovarian hyper stimulation, oocyte retrieval via a needle inserted into my vagina, intercytoplasmic sperm injection, fresh versus frozen embryo transfer and possible chromosomal testing? Lentil once commented, 'why do I bear the burden of needing to provide education just because you don't know your science?' Seriously, there is this thing called the internet that lets you learn all kinds of stuff. Is it too much to expect her to Google IVF? Or maybe read the infertility primer I wrote up for her last year?

However, reading about IVF on Wikipedia only details the process when everything goes according to plan. It doesn't explain the situation of a poor response, disappointing fertilization rates or the unexplained BFN that follows a transfer of perfect looking embryos. Even my Ob/Gyn colleagues are also seemingly unaware of those situations, as their experiences involve caring for the success stories resulting from IVF.

I know it is not intentional and merely coincidental, but Myrtle always seems to send me an update on her baby just at the time when I've received some disappointing news. As I was walking out of my RE's office, upset over the prospect of only having 6-8 mature follicles after twelve days of stimming, Myrtle texted me a photo of little Myrtle. I probably should have sent a one line response to acknowledge that I received the pic, but instead I chose to ignore it. A few hours later, Myrtle nudged me, "did you get the picture that I sent?" Yes, Stan's Dad, I saw your bloody photo...
"Yes, she's adorable" I wrote back and I informed her that I had just received some information which indicates that IVF may not work. "Sorry to hear you got bad news about IVF." she replied "Is there some other treatment you can try?"

Now, I don't know if this was Myrtle's way of asking the 'have you considered adoption' question, or if she really thinks that science and progress may have other methods beyond IVF available. (I suspect the latter) I thought about explaining the option of donor eggs or embryo adoption, but I replied that we still are reasonable candidates for IVF (at least we were at that time) but it may take more than one cycle. Besides, as I was now reminding myself, we weren't out of the game with this cycle just yet. I was merely in the holding pattern waiting for my retrieval and the fertilisation report.

In my groggy post retrieval state, I heard my RE say "twelve". He was able to retrieve a dozen oocytes. As we were getting ready to leave, the embryologist announced that eight were mature. Even before I started my stims, I projected I would produce twelve eggs, and he was spot-on with his forecast on their maturity. I would have been ecstatic (pun: egg-static) to have 9 or 10 mature eggs, but I was very happy to be on the upper end of his prediction. Husband looked online and found that the lab has an 87% fertilisation rate, so he thought that would translate to 7 fertilised eggs. I estimated that we'd have a 50-75% fertilisation rate, which would yield 4 to 6. Well apparently, I am really good at predicting this shit, as we ended up with five fertilised eggs. Now we await the next match report. I have no conjecture on what it might bring, but I'm preparing for a fresh day 3 or day 5 transfer and possibly having nothing to freeze.

As intended, I did go swimming the day after my retrieval. I felt fine as I started my first warm up lap until I went into my flip turn. The process of crunching my lower abdominals combined with pushing off the wall sent me into agony. I think I screamed underwater. I finished the workout, but it was really uncomfortable and I was truly miserable. Alas, some things you have to learn the hard way. Such as discovering that you should have done IVF a year ago.

Measure Twice, Cut Once: IVF DIY

After we bought our house, our addiction to HGTV was replaced by our infatuation with the DIY network. Our favourite guilty pleasure was (and still is) Renovation Realities. This low budget production simply films amateur homeowners as they tackle various home improvement projects. Although a few are successful, most have disasterous results, and it is often a cautionary tale of what not to do. After describing their plans, the participants reveal their budget and estimated time for completion. Husband and I always burst out laughing as almost everyone grossly underestimates the costs and time frame. After multiple projects, we've learned to always double the projected length of time and to overestimate the budget as unexpected costs are inevitable.

So far, our first IVF cycle is following the suit of many of our DIY projects. (Yes, I'm still in the process of painting our kitchen cabinets and should have some updated photos soon) If I were to offer any advice to anyone embarking on this process, it would be to really clear your schedule, and to have extra meds on hand. While it's not desirable to have unused meds, it can cost less in the end than having to arrange for overnight shipping, and is much less stressful. I cannot emphasise the much less stressful aspect enough.

I was quite frustrated at the start of my stimming cycle, when I felt that I wasn't receiving a clear picture of my monitoring schedule. Now I understand how truly day to day this process is. My RE originally projected that I would stim for 9 days and retrieve on SD11. I knew this would be tentative and I would have to be flexible. The original retrieval date was on a Wednesday, so I arranged to have the day off. Husband was scheduled to leave on Friday afternoon to officiate at a hockey tournament in Southern California, but we thought it was unlikely to conflict.

After my visit on SD7 noted 10 follicles and high estrogen levels, my RE noted there would be a slight possibility of triggering on SD9 (Monday) and that a retrieval on Thursday or Friday was more probable. (On the off chance I were to trigger on Monday, I had to order Lupron from a supplier in Southern California, who could deliver in time, but at twice the cost as Freedom Fertility) I figured it would be Thursday, as that was the most inconvenient day for both Husband and me. He was umpiring a highly competitive hockey match (which was televised on ESPN11) and I was scheduled to teach a contraceptive methods class in the South Bay. I made arrangements to have someone else cover for me in the event it would be egg hunting day.

My estradiol level reached 1162 by Monday and I picked up one more follicle on each ovary to bring my total to twelve. "Don't focus on the number of follicles," my RE warned "it only matters how many are mature." Yeah...yeah... I acknowledged to myself. I was budgeting for fewer mature follicles, but whoo-hoo! I was up to a dozen! He was now projecting the ER to be on Friday or Saturday. This was good news as I could fulfill my teaching assignment, but it would mean Husband would have to delay leaving for Santa Barbara. He knew the collegiate umpire coordinator was scrambling to fill as spot for a Friday night game, so he volunteered to do that game, which indebted him to the coordinator. I was so proud of his resourcefulness.

I had to request to take Friday off and I needed to move my patients to Wednesday. I updated my colleague on my status. "Are you getting excited?" she asked. No, I thought to myself. I'm terrified that this is going to be a huge waste of time and resources. Instead, I just nodded quietly. "Just let us know if you need us to see any of your patients" she offered, a gesture I truly appreciated. Two days later, I was back in the stirrups. I was counting the follicles as he was measuring, but I wasn't paying too much attention to their size. There were now 4 or 5 on my right and I think I was up to 9 on the left. Could it be that I have 14 follicles?

It was Wednesday and my Estradiol level was now 1503. My RE thought the follicles might need a little more time to mature and was now projecting triggering on Thursday or Friday for a retrieval over the weekend -Saturday or possibly Sunday. Oh, was this cycle ever going to end? This now meant Husband wouldn't be able to attend the tournament at all. We had been walking ourselves through multiple contingency scenarios based on when the retrieval would be. "So, we'll need to see you back here tomorrow" he instructed "Same time?" I had been arriving at the office as soon as they open to have my blood drawn at 8:30 and then was returning at noon for my scans. It meant a lot of driving, but allowed me to discretely leave the office and most importantly, I didn't have to reschedule any patients, although I was late a few days due to 'traffic'. "Um, I can't come in for my blood work tomorrow morning" I explained that I had a two hour drive for my class. "Do you absolutely need the estradiol level?" I asked while knowing the answer; if he didn't have it, there would be a reason why he'd want it. "We're this close to the end, Jane..." he said in a tone that was reminding me of my priorities.

He left the room and Misery looked over toward me and asked the question that I was thinking. "Do you have good veins and can you draw your own blood?" Yes and yes, I replied. She gave me some supplies and I would have Husband run the vials down to the office. I must admit I was a bit nervous as I can't remember the last time I performed a venipuncture. At least better to do it on myself than someone else. I drew my own blood. That bears repeating. This time with the F-word. I fucking drew my own blood! I started dancing around the house proclaiming, "I am awesome!"

Oddly, that would be the high point of my day. Although my class went well and it's a good thing I didn't crash during the long drive, especially as I was on the phone with Freedom Fertility Pharmacy to secure another overnight order for my antagonist. That's the other unexpected aspect of living day to day in your stimulation cycle. Special shout out to Jen S of Overworked Ovaries who delivered her leftover Ganerelix at the last minute for me. Infertiles truly come through for each other!

I noticed that he didn't count all the follicles this time, just the larger ones, but I wasn't keeping a tally for myself. The decision to trigger was led by my estradiol level, which had plateaued at 1500. "So, I think we'll get 6-8 mature oocytes" he projected. There it was. The let down I been anticipating. The slap in the face from reality that I needed when I was getting excited about the number of follicles. It didn't seem like it would be enough to adjust for the male factor issues to produce a workable yield. All my decisions about PGD and single embryo transfers seemed moot.

"You seem subdued today" he commented and asked me three or four times if I had any questions. I was struggling to keep my composure. I had many questions, but none in particular came to mind at that moment. I figured we'd have our answers in the next few days after the retrieval and fertilization was complete. I'm sure there were other questions I didn't ask as I wasn't ready to hear the answers. I did have one question: can I swim the day after my retrieval? "Well, it's a vaginal procedure, so I'd advise against it..." he replied probably acknowledging to himself that I wouldn't comply.

Misery actually put her arm around me and gave my shoulder a little rub as she reviewed my ER instructions. It was a comforting gesture; one I really needed at that point, although it did give me pause to wonder if she thinks we're fucked. I went to watch Husband's hockey game and sat far away from the crowd. Tears were streaming down my face. Now I understood the blame Husband had assigned to himself. I was the one letting us down. My ovaries were supposed to come through for us! Double the length of time and overestimate the cost... I felt it was time to acknowledge that we may need to do more than one IVF cycle. Nothing like feeling defeated before the game even starts.

In the Water, They Can't See You Cry

The first time I had an infertility related cry was the morning after the 'failure to launch' episode that occurred during my parents visit. Between work and playing hostess, the only moment I had to myself was the fifteen minute drive to swim practice in the morning. Not only did my car provide quality alone time, but at that time of year, it was still dark at 6 AM. I avoided making eye contact with anyone as I walked in and quickly donned my cap and goggles. In the water, they can't see you cry.. I thought to myself as I dove in and started my warm up laps.

The pool would extend the sanctuary that was provided by my car. Free from external stimuli and alone with my thoughts (I've composed many blog posts underwater) I discovered the analogy of focusing on my own lane. Then one week during this past summer, a former 6 AM swimmer returned. She had  moved to the South Bay two years ago, but was visiting her mother who lived nearby, and as you do on a visit, she came to attend a 6 AM class. She was 35 weeks pregnant.

"I'll put you in lane 5 with Jane" my instructor told her. "It's perfect. You're about the same interval pace and if you go into labour, Jane can perform a water birth!". I smiled at them both. There was one more detail she omitted. I had received a BFN from IUI#3 that morning, so it was perfect to put the pregnant woman right next to the infertile. I dove in and tried to swim to the other side without taking a breath so I could avoid all the commotion over her baby bump.  My sanctuary had been infiltrated. Yet still, in the water, they can't see you cry.

At least she was only visiting; and I couldn't help think that I might be the next pregnant swimmer in our group. Nope. Wrong yet once again. This past week, I walked in from the car park with Amanda, a swimmer who is in the lane next to me. I'm a faster sprinter, and she's better at distances, but we often challenge each other. I noted that I hadn't seen her since our meet a few weeks ago. "Just been really tired. It's so much harder to get up as it's colder and darker now" she noted. As I was adjusting my goggles, I heard her talk to the instructor about how much longer she could go before needing to buy some larger suits. "I'm pregnant" she announced.

I went through the obligatory "Congratulations! You must be so excited!" although I did sincerely mean it. She's a sweet girl and her husband has attended a few meets and seems like a genuinely nice guy. They will make great parents. These are the type of people who should be breeding. "Thanks, fourteen weeks!" she announced. I have fourteen follicles...does that count? I quietly asked myself while simultaneously answering. No, it does not. I'm merely in the process of trying to get pregnant. I still have so far to go.

Now I've lost my escape. I can't rely on the water to shelter me anymore. It makes it hard to focus on my own lane when there is a pregnant woman right next to me. If it's not enough that I'm surrounded by pregnant woman though my work, I now have an extra hour of exposure each day. Every day watching her expanding baby bump. Every day another reminder of what I want and what is so elusive for me. I needed a distraction. Fortunately, Jason started coming to the morning sessions again and swims in the lane on the other side of me. I can indulge myself with some impure thoughts about what his undulating hips could be doing to me... Hey, sometimes you have to do what you can to get through the day..

Cluelessness abounds

How do you respond when faced with the question, "So, do you have any kids?"

I recognise that most people perceive it to be an innocuous inquiry as a mere attempt to engage in a simple conversation; but for infertiles, it's like navigating through land mines. Aubrey at Two Hearts and One Dream recently commented that after more than two years of working through infertility treatments, she still doesn't have a good answer to that question. I thought about how I reply. If it's a stranger who I'm not likely to run into again, I like to be completely blunt and reveal that I'm infertile and that I've had a miscarriage. The sadist in me enjoys watching them squirm awkwardly, and my hope is that it makes someone think twice before asking the question again. If it's a more regular acquaintance and I don't want to out my infertile status, I simply answer "not yet..." I've developed a certain tone to my voice and telling smile to convey the message; don't ask me any further questions. Some people are able to read between the lines and end the conversation with a line such as "Ah, you're still young" or "Well, you have time." At least my ego appreciates the perception that I look younger than I am. More so, I'm grateful for the person who acknowledges that I don't want to talk about this subject rather than the one who follows up by asking, "Well, what are you waiting for?"

A few weeks ago, our swim team gathered at a local microbrew after a swim meet to celebrate our second place finish. I saw sitting across from Jason, a guy who is a year younger than me; and one I would probably fancy if I were single, as he has the shy quiet type thing that I find appealing. Although I don't think we'd ever manifest anything more than a physical relationship as apart from swimming, we have nothing in common. I figured Jason was the type of guy who enjoys a beer or two every now and then, so I was a little surprised when he handed the beer menu back to the waitress and noted he'd be fine with just water. In particular, (I know this is horrible stereotyping) as Jason is originally from Vermont, I figured he might be into home brewing his own beer, and would want to at least read about the offerings at this microbrew. Maybe not, and maybe he just didn't feel like having a beer.

Just after the waitress served our first round of drinks, my friend and former lane mate, Peter arrived. As the waitress was really busy, he announced that he would be going up to the bar to get a drink. He spotted the glass of water in front of Jason and asked if he could bring him back anything. "No thanks," Jason politely declined. Peter returned a few minutes later and inquired about the beer I had selected. "That was my second choice" he commented "Do you mind if I have a sip?"
"Go ahead," I replied handing my glass to him. I then asked Jason if he wanted to sample.
"No thanks, I gave up drinking and smoking weed three and a half years ago." he announced.

Peters eyes found mine and with one look we acknowledged what we had both concluded. Jason probably had a problem with alcohol. It all clicked together. Declining to look at the beer menu, using the words gave up drinking, knowing the exact duration of sobriety, refusing even a sip. As Peter and I were frantically thinking of a way to change the conversation, the woman sitting next to Jason, who had been listening in our conversation asked, "So, what do you do for a vice?"

I tried to kick her, but the table was just too wide for me to reach, and after swimming ten events in two days, I barely had any kick left in my legs. Jason admitted to having a cheeky cigarette now and then, and Peter introjected with a question about his work before Nosy Nora could ask anything else. I dawned on me that cluelessness abounds. The same clueless people who ask annoying questions about procreation intentions and aren't receptive to your hints that you'd rather not talk about it, probably operate that way in all situations. I could only imagine that Jason probably gets bombarded with intrusive questions such as, "Why, what happened?" or "Are you an alcoholic -are you in AA?" Social graces are not always universally understood, and common sense is not actually common.

Because they are hard

"We choose to go to the moon and do the other things...
not because they are easy, but because they are hard"

When we first moved to California, Husband and I befriended Kylie though a field hockey league. Kylie was a 34 year old Australian who had just moved the area to start a three year work visa.  She soon developed a friendship with one of her work colleagues. Although they were biologists, there was a strong chemistry between the two, but they were both too shy to make a move. Enter a little too much al-kee-hol at the staff holiday party, and they were inseparable following a drunken snog. After a year, they started discussing their future together. He hadn't proposed, but took her shopping for engagement rings. One day she mentioned that she wanted to marry sooner rather than later, so they could start trying to conceive right away. "Oh, I don't want to have children." He announced. "I've been thinking about getting a vasectomy."

That was a deal breaker that ended their relationship right then and there. She boxed all his belongings from her flat and delivered them to his desk at work the next day. A few months later, he left the company for another job and she started looking into artificial insemination. Her visa would be expired by the end of the year and she knew it much harder for a single woman to acquire donor sperm back in Australia. She asked me to help her select a donor. It was one of the greatest honours I've been given. (Although I would have been happy to go to Australia with her to help select a live donor..) She conceived on her first IUI and gave birth to a beautiful baby boy. When I told my parents about Kylie's pregnancy, to my surprise, my Dad was a little judgmental.

"I just don't see why anyone who chose to be a single parent. It's just going to be so hard to raise a child on your own." he commented.
"Well, she really wants to be a mother and doesn't want to run out of time." I informed him without going into the details of her age (37) or issues of acquiring donor sperm in Australia.
"Besides" I countered. "When something is really important to you, do you become discouraged just because 'it's hard'?" I could see his face softening a little. This was actually starting to become fun. "In fact," I continued "Aren't most things in life that are worth achieving the result of hard work?"
He smiled. "Who taught you that, Jane?"
"Oh, I don't remember... this guy in my life... he calls himself my Dad... thinks he's pretty wise..."

We all know how this process is so much easier for fertiles. Samantha Bee from The Daily Show with John Stewart described that she can't even use the same bar of soap as Jason Jones without becoming pregnant. Eve at Infertile in the Garden on Eden has a friend who practically conceived via FaceTime. It's as almost if they're living in one of those Viagra adverts; when the moment is right for conception, their house magically transforms into a rainforest, or some other romantic setting and invites them for a procreating romp. Total cost: maybe a bottle of two buck Chucks. Sometimes not even that much. Observational studies note a spike in the birth rate nine months after a widespread blackout, as more people are engaging in coitus due to a lack of other entertainment options. There was also an increase in the birth rate in July 2009 -nine months after Barack Obama's electoral triumph. By the way, the easiest place in the world to get laid is at a campaign victory party. I had five offers on the night of Ned Lamont's successful primary challenge, but I am seriously digressing...

We all accept it's going to be a much tougher road, and may discover that it's even harder than we first perceived. I decided to approach the process in stages. Pre-stimulating ovarian suppression, stimming, retrieval and fertilization status, possible CCS testing, then transfer prep leading up to an eventual transfer and two week wait. So far, it was the first stage that was the most miserable. In order to avoid going into hypertensive crisis on the oral contraceptives, I started myself on Labetalol at 50 mg twice daily. The Labetalol worked beautifully to control my blood pressure, but it killed my swim times. In the last few days of practice before our big meet, I was feeling exhausted during warm-up and had no energy to sprint.

I held my morning beta blocker on both days, so that I could compete. My times were a little slower than I wanted them to be; but I'm trying to remind myself that as a sprinter, I'm fretting over tenths and hundreds of seconds. I did improve my times on my distance swims and it was encouraging to know that my interval speed on those events, was my 100 yard sprinting speed two years ago. I was also able to carry this post from Aramis for extra motivation:

You think you're in pain during this 100 m butterfly? Wait until you go into labour, then you'll know pain. SUCK IT UP AND SWIM BITCH!

Quit breathing. When you go into labour, you can breathe all the air you want. 

Oh, and my coach may have issued the ultimate throw down to my uterus when she mentioned that I should work toward entering the 200 Fly by next April.

Acknowledging my unfair advantage, stimming was pretty easy as I'm adapt at administering injections; although I did inflict myself with one small bruise. Four days in and I was feeling fine. My weight was actually down half a pound. What the Fuck? Were these meds even working? Apparently a little too well, as my first estradiol level came back at 317. I was instructed to decrease my Gonadal-F. My first ultrasound found that I had four follicles, which was judged to be "not bad." The E2 was still trending high at 471 and I got to skip out on Gonadal-F'ing myself. Wow, I don't think I've heard of anyone else having to hold meds. Day 6 E2 was 714, I now had to half my dose of Menopur. Man, that stuff burns like a motherfucker. As an atheist, I was happy to have less reconstituted nun-pee in my body. Husband was having too much fun teasing me about whether I was feeling the Holy Spirit or having visions of the Virgin Mary...

I went into for a scan on day 7 and found the number of follicles on my left side had doubles and had quadrupled on my right ovary. I had a total of 10. Ten follicles. My RE seemed pleased with my yield so far. I saw on his notes that he was anticipating a retrieval of at least 10, so I'm pleased to have met his expectations. I anticipated I may produce a dozen, so that seems within reach. It's hard not to feel encouraged at this point in time, but I need to keep bringing myself back to reality. It's like Annie's warning to the newly engaged couple in Bridesmaids, "Awww, you two really love each other...that will go away!" Not all oocytes will be mature, not all with fertilise, not all will be euploid. Yet, I need to be thankful for with what I have to work. I can't realistically ask for anything more.

Of note, I never received any specific instructions on what I could do or couldn't do during my stimming cycle. Not that I would have followed any rules. I kept swimming each day, although I did move myself to a slower lane. I attended Cross-Fit classes, but on day 6, I informed my instructor that I needed to modify box jumps. "Sure honey, is everything alright?" she asked. "Let's just leave it at that I tweaked my groin.." I explained. "O-oh..." she commented with a knowing smile. I may have given the impression that I sustained a sex injury Score! Plus, I got to modify burpees with some air squats and regular push-ups Double Score! I played tennis and I went to a yoga class. I did excuse myself from my field hockey match. Interestingly, I played hockey the day before I miscarried (which I know had no influence) but I wasn't going to take any chances with my ovaries!

I've been thinking about President Kennedy's description about the prospect of going to the moon and how we can't be daunted by challenges just because they seem hard. It's so amazing to acknowledge that only a mere 7 years after Kennedy made that pronouncement, Neil Armstrong was walking on the moon. I often think about Kylie and all the difficulties she faces a single mom. It makes the action of administering injections seem so insignificant. Yet, this part seems easy because it's in my command. I am taking all my meds like a good girl. I am getting my blood drawn as scheduled and attending my appointments with the vag probe. Once things are out of my command, it will feel so much harder...