Lupron Update

The fact that I haven't been posting much about my experience on leuprolide acetate is actually a good thing. Because 'twas endometriosis that got me here in the first place, my RE wanted me on a looooong Lupron protocol - as in, nearly a month of shots before any stimulation will start. Believe me, if I had had a reason to complain, I would have. Because I hate the birth control pill with such a fiery passion, I was expecting to feel the same way about Lupron... but, magically, I don't. No joke, this has been (knock on wood) no big deal.

The biggest thing I have to complain about is a persistent headache. Most of the time it's minor enough that I can ignore it, occasionally it makes me want to lie down and take a nap, but it's really nothing worth writing home about (or, in this case, telling the Internet about.) I have had it since the second day I took Lupron and I really don't think at this point that it's attributable to caffeine withdrawal, but who knows.

I have also had a few strange instances of getting very flushed from my chest to my face and feeling hot without any good reason. Hot flashes? Maybe. There are more than a few post-menopausal women in my life and their experience with hot flashes has been a bit more dramatic, so I don't really feel I can complain - I'm not tearing off my clothing in restaurants while sweat pours down my face. I'm just warmer than usual. And as someone who is chronically cold, a little unexpected warmth in a New England winter is very welcome.

And no, injecting myself hasn't really gotten easier. I haven't resorted to sugar cookies every time (even though, let me tell you, this is the right time of year to find cookies everywhere I look.) It hurts and it's not fun and the only good thing about it is that Harry thinks I'm pretty badass for stabbing myself in the stomach every night. But it's over quickly and it makes me feel like I'm making progress with this whole crazy endeavor, so that's good.

Overall, Lupron? Totally fine. Of course now that I've written this down I'm sure I'll wake up tonight with some sort of bizarre problem like hot dog fingers or spontaneous dental hydroplosion, but so far... so good.

Jumping to Conclusions

Overheard at work: "My beta is in 9 days, I'm so excited!"

Hmmm.

The coworker who said this isn't someone I know particularly well, and to my knowledge she hasn't pursued any Assisted Reproductive Technologies. But she does have one young child and has been very vocal about wanting a sibling, so I've been half-expecting a pregnancy announcement from her for a while now. Still, it threw me for a loop that she used the word "beta" and my head went right past all the other, more logical explanations, to "OMG she just went through IVF and we are IVF twins and I am going to run into her at the doctor's office and she is going to want to talk to me about everything and I wonder if I should wear a disguise from now on and could I pull off blonde hair?"

It's entirely possible, of course, that I misheard her. "My data is in 9 days! My Zeta is in 9 days! My gaydar is in 9 days!" Or she's using the word beta to refer to software development, or even that she just got a positive pregnancy test at home and her doctor wants her to go in for a regular ol' blood test in 9 days. This last scenario is actually the most likely, given her past statements about wanting to have another child. And if it turns out to be the case, then good for her - really. She's a nice person and if she wants to have two children under 2 years old, then bless her.

Still - argh. I have made a deliberate choice not to tell my coworkers that I'm undergoing IVF and I'm not sure if I will fess up if I do get pregnant. On the one hand, there is nothing shameful about being infertile; on the other hand, I wouldn't tell this group of people about my child's conception if the story involved an extra drink on a vacation, so why would I bring them into the loop regarding my unique bio-adhesive progesterone gel application?

Happy Hanukkah!

This is my favorite Hanukkah song:

I will admit, I always envisioned playing this in the car while I was driving around with my children - it's such a catchy tune and a great way to memorize the blessing for Hanukkah candles. I also like the part about how "with the jingle bells and the toys, and the TV shows and the noise, it's easy to forget - at the end of the day, our whole family will say these words for Hanukkah." I really want to participate in my children's Jewish childhoods and build a Jewish household for them, so this year's celebration will be a little bittersweet. And yes, it has me thinking more about actually having a baby as, you know, a positive development. Really, a baby? A baby. Whoa.

Charlotte vs. the Birth Control Pill

The day after my surgery, my doctor called to recommend that I start taking the birth control pill. It made sense - endometriosis gets worse every time you ovulate, and the BCP stops you ovulating - and because of the timing of my surgery I could have started a new pack of pills immediately. Intellectually, I knew this, and I was expecting to hear this advice, so naturally my reaction was to start crying and begin making vague legal threats about how the only thing that would get me to take the pill was a court order and this is America and there's not a court in the country that will force me to take birth control blah blah blah. So, not a productive discussion.

What I should have said (and this happens to me so frequently that I was thinking of titling an entire blog post "What I Should Have Said" and then writing down all the witty, well-reasoned answers that I always think of right when I'm walking away from a conversation) is that I would prefer not to take the BCP because I find the side effects vastly outweigh the benefits. I don't want to start railing against the BCP, which many women find to be very effective. But for me, the three different types of BCPs I have tried produce a change in my mental state that I find unacceptable. I would rather experience physical pain and discomfort from recurring or worsening endometriosis than feel like I have lost myself, especially if that feeling is intended to be part of a long-term treatment. Hormones mess with my head, period. Other women might not experience this, or might not find it to be terribly problematic, but I do. And since it's my body, it's (still) my choice.

So naturally, instead of taking a low dose of convenient oral contraceptives once a day, I have chosen to stick a needle in my belly every night for ~6 weeks to administer huge amounts of hormones in the hopes of creating a pregnancy that, in turn, will send my hormone levels through the roof for months on end. But it's still a more palatable option to me than just going on BCPs and waiting until I felt "ready" to try an IVF cycle. With my tubes all screwed up, I knew that IVF was looming in my future no matter what, and I didn't see any point in waiting around in a depression for months or years until I felt up to plunging deeper into hormoneville (now with extra crying!) And if this cycle fails, which it totally might, I will need to have another conversation with my doctor explaining why I will not take BCPs while we're waiting to start another cycle. My goal if we get to that point is to avoid threatening legal action, but if it ever came to that, I have an idea about where to get a lawyer.

Lupron: One Week

One week into injecting myself with Lupron, I can say: it makes me have a headache. A low-grade, persistent, usually easy to ignore headache. I did break down and have a tiny amount of caffeine yesterday and although I enjoyed the familiar feeling of artificial well-being and energy flowing through my veins, it didn't make the headache budge. Oh well. Maybe I wasn't as addicted as I thought, or maybe both things just give me a headache and I was doubly screwed?

The other symptom that I have, and I mention this only for the benefit of medical posterity, is that my bazooms are a bit sore. My guess is that this is general I'm-about-to-get-my-period stuff, but we'll find out in due time. The really exciting side effects should start 10-14 days after my first dose, so stay tuned!

Fun with Anti-Müllerian Hormone

So my post on CD3 reference ranges got me thinking... what is Anti-Müllerian Hormone, and why does it vary so much from woman to woman? Let's see what we can find out. (And by we, I mean me, and since I am definitely not a medical doctor I encourage you to do your own research on the matter.)

First of all, you kind of have to love Anti-Müllerian Hormone (AMH) for having an umlaut right in its name. And why does it have an umlaut? Because it inhibits the embryonic development of a structure named after a Dr. Müller: the Müllerian ducts. I know, usually when going through IVF we hear a lot about blasts and hatching and the really early stages of embryo development, but what happens after that is still pretty cool. Once in the womb, the embryo continues to develop structures that are common to all humans, like a gastrointestinal system (wouldn't want to be without that...), but very early on in the process - as in, during the first 8 weeks - the reproductive organs also begin to develop. And they develop in the same way for everybody at first, by creating the Müllerian ducts. If you're a girl, you want those ducts to stick around - they eventually turn into your uterus, Fallopian tubes, cervix, and most of your vagina. If you're a boy, however, you don't want those ducts to linger. You want Wolffian ducts instead, which eventually turn into the vas deferens, epididymis, and other structures that will someday allow you to (hey hey!) ejaculate. That's where AMH comes in. If the embryo is secreting AMH from the cells that will eventually turn into his testicles, then the Müllerian ducts die off. If there are no early-stage testicle cells creating AMH, those ducts just keep on keeping on, and the baby will be born with the kind of reproductive organs that someone will one day refer to as her downtown dining and entertainment district.

But, you say, I am not an embryo! Why is my doctor measuring the amount of AMH that I, an adult woman, am producing? If I were an embryo, I wouldn't be reading a blog about infertility, now would I? And I respond, because I can hear you all the way across the Internet, that there's more.

Adult women's ovaries also secrete AMH for their own personal use, and it controls the formation of follicles during the reproductive years. Ovulation is actually supremely cool: ovaries have lots of follicles in them that have the potential to become a mature egg, but how a lucky follicle is chosen to mature is not terribly well understood. (I kind of think of the follicles that do make it to ovulation like the Marines: the Few, the Proud. They grow to over a hundred times their original size and have to compete for the privilege of doing so.) AMH's role in this process appears to be as a kind of counterbalance to FSH, which stands for Follicle-Stimulating Hormone and which does pretty much what its name suggests. You need FSH to stimulate your follicles to grow so they can someday become a mature egg, but if you have too much of it, that can also be a problem - hence the role that AMH plays to limit the effectiveness of FSH. AMH is produced by follicles at very early stages of development, and if you take it away, the FSH does its job a little too well. Ideally, you want to strike a balance. More AMH = more early-stage follicles waiting patiently to develop. And less AMH = not as many follicles awaiting their turn to be used at a later date.

Now, AMH doesn't change during the menstrual cycle, unlike some hormones I could name (coughcough FSH and LH coughcough) but it does decline gradually over a woman's lifespan. Your ovaries age, their overall reserve declines, and there are fewer early-stage follicles hanging around to create this "we're waiting patiently" hormone. Most fertility literature relating to AMH focuses on what to do if your numbers are too low, since it's a common problem for women of a certain age seeking treatment. Although there's considerable disagreement on how low is too low for infertility treatment to be worthwhile, anything above 0.5 ng/mL is probably still good, and above 0.15 ng/mL is considered acceptable. Then again, if your AMH is too high, that can also lead to infertility. Your FSH may not be able to do its job at all - there might be too many follicles giving out the "we're waiting patiently!" signal for the FSH to be able to stimulate one to develop, and that can mean you're not ovulating.

But the thing is, like much in the world of infertility treatment, it's important not to look at just one lab value or test result. (Don't forget, there are lots of other hormones involved with this process - it's as complicated as it is fascinating.) And it's equally important to remember that many of these hormones can be messed with through medical intervention so your ovaries can do what they need to do. Women can, and do, conceive with AMH values that don't look perfect. They also conceive with missing Fallopian tubes, strangely-shaped uteri, and after drinking wayyyyy too many tequila sours. Talk to an RE if you want to know more about AMH, but whatever you do, don't mention that you read about this on a :::shudder::: blog. Blame Wikipedia for that. :-)

Confession

Hi, my name is Charlotte, and I am a caffeine addict.

Phew.

That was surprisingly hard to say! When I was diagnosed with a (benign) heart issue as a teenager, I was told that it would be a good rule of thumb to steer clear of caffeinated beverages. I was very proud of my caffeine-free status for a long time, but over the past year, things started to get out of hand. A mug of Earl Grey here, a small iced coffee there... you know how these things go. It really got bad when I read that green tea helps with conception (although, maybe it doesn't?). I started drinking a cup every day, around 11 AM, when I would start to get hungry but lunch still seemed far away. Yes, green tea has less caffeine than black tea or coffee, but even that was enough. On days that I missed my cup of tea, I felt - could it be possible? - a slight headache. Uh-oh. Withdrawal.

When I started going over my IVF protocol with my RE, one question I asked was whether I needed to make any lifestyle changes. He was surprisingly negative on caffeine in any form while TTC (more so than alcohol), so when I circled the date on my calendar to begin my leuprolide shots, I knew that would also be the end of the road for my daily tea habit. I used up all of the green tea I already had and replaced it with decaf and herbal so I could still have a nice mid-morning warm beverage, and crossed my fingers.

Why do I bring this up now? Because for the last two days, my only symptom has been a low-grade but persistent headache. I hoped it might just be from dehydration, so I guzzled a bunch of water, but that didn't help. The other two likely causes are the leuprolide itself - and it totally could be that, it's a known side effect of the drug - but it could just as easily be caffeine withdrawal. I guess if it continues for the entire time I'm on the leuprolide, I'll know which one was the culprit, but for now I'm leaning towards lack of caffeine. So, in other words, I brought this on myself... sigh.

First Lupron Injection in 3, 2, 1...

So tonight, I am live-blogging my first injection of leuprolide acetate. Okay, so it's not really live - this is the Internet, after all, you have no idea when I'm actually typing anything or if it's even happening - but I promise I'm writing in real time. Near real time, anyway.

This is the first shot I am giving myself ever, which I guess isn't too surprising when you consider that injectable meds are rarely considered the first line of defense for common health issues. I just feel like I should be more confident about it. When I had my IVF orientation meeting I was so uncomfortable with the injection demonstration that I was all smiley and jokey with the nurse and said I had no questions just to get it over with. I was much calmer when we were going over paperwork. Paperwork, now there's something I can do.

The thing is that my questions about the injections are not the ones that she could answer. How much will it hurt? Will the side effects be really bad? Why do I have to do this to have a child and other people just enjoy a well-timed orgasm? (Edited to add: not much; still to early to say; nobody knows.)

Anyway. In preparation for this evening, I've been keeping an informal log of the various "side effect" symptoms I've experienced over the last few days of my drug-free existence, in the hope that I would freak out less when I actually had lab-made hormones running around in my system. For instance, on Friday, I had what felt like menstrual cramps (but weren't); they were bad enough that I considered actually taking some ibuprofen, but then they went away with no explanation. On Saturday, my sciatic nerve hurt intermittently. On Sunday, for about 20 minutes I felt nauseous enough that I was discreetly looking for places to throw up in public if necessary. Okay, so that last one was directly attributable to motion sickness, but my point is that life is full of random little ailments. Most are temporary. Many would never even be worth complaining about. They're no big deal. I NEED TO REMEMBER THIS.

But now I'm just stalling. Ready, everybody? Time to inject some leuprolide. My essential self-injection supplies appear below.

...

And we're back.

If you ever find yourself injecting hormones into your body, I cannot overstate the importance of having a frosted sugar cookie on hand. Please, don't take any risks with this.

But seriously, it wasn't that bad. I cut myself while shaving my legs a few days ago and that was ten times worse, pain-wise. I'm just so resentful that I'm doing this in the first place, which is something I didn't feel when I nicked myself in the shower. (Though maybe I should have been resentful that I was shaving my legs at all, in a sort of second-wave-post-feminist-join-the-sisterhood kind of way?) And I'm also driving myself nuts thinking about the giant hormone molecules currently dispersing themselves throughout my body, just dying to start trouble. I'll be keeping a close eye on them. :::shifty eyes:::

TTC TV

TV shows not to watch when you're TTC:

1. Toddlers and Tiaras. What if I actually do conceive and then start thinking it's a good idea to put a spray tan on a 3-year-old?

2. I Didn't Know I Was Pregnant. Bitches.*

3. The vast majority of TLC's programming. Why do I keep doing this to myself?

TV shows to definitely watch when you're TTC:

1. Modern Family. There are so many ways to create a family, including adoption!

2. Enlightened. When she's not inadvertently sabotaging herself, Laura Dern's character is both giving voice to the crazy person within all of us, and calmly reassuring us that there is beauty in life.

3. 30 Rock. Liz Lemon, like Bridget Jones before her, is reassuringly imperfect. Which is nice because, let's face it, I'm a mess, and also because someday I hope to give my children a werewolf Bar Mitzvah party.

*I felt immediately bad after typing this. I promise it's just your garden-variety infertile jealousy talking; unexpected and unplanned pregnancies can be just as traumatizing as those that require intramuscular shots to get going. But seriously? You had no idea, for nine whole months?

CD3 Reference Ranges

I know I have a legal right to all of my medical records, but it gets a bit tiresome to formally request them every time I have a new test or procedure. This is why I was so stoked when the receptionist at my RE's office just handed me a copy of my most recent lab results to take home, explaining that she had accidentally printed out two copies and did I want one?

Yes! Of course, I love numbers. I wish my RE would share a bunch of de-identified data so that I could start parsing it by age, cause of infertility, drug protocol, stage of embryos at transfer... yeah, keep dreaming. If it isn't required by the CDC, most REs are very reluctant to put their statistics out into the world, and that's a conversation to have another time.

But at least I can look up my CD3 numbers and compare them to others to see if they're normal, or so I thought. Dr. Google was significantly less than helpful in finding standard reference ranges for a healthy, pre-IVF CD3 blood panel - I guess every lab, and every RE practice, does it differently?* In case it's helpful to others, here's what my discussion with my RE nurse revealed:

LH (Luteinizing Hormone) 1.9-12.5 mIU/mL
In a perfect world this would be somewhere between 7 and 12, but the nurse said that it's really only checked against the FSH value. If they're reasonably similar, that's good; if it's twice as much as the FSH, you might have PCOS.
My value: 6.8

FSH (Follicle-Stimulating Hormone) 2.5-10.3 mIU/mL
FSH is a good way to measure that all-important ovarian reserve, so under 6 is said to be good. Other clinics won't work with women who are over 10, but my clinic accepts patients up to 15, so I have room to grow!
My value: 5.7

E2 (Estradiol) 11-212 pg/mL
Ideally, this is less than 75 - if it's high, that suggests not-so-great ovarian reserve. But note that the reference range goes up to 212 without being flagged as problematic. It's a good reminder that you can be a normally-functioning person and just not be very fertile.
My value: 33

AMH (Anti-Müllerian Hormone) 0.65-16.40 ng/mL
Word on the street is that 4.0-6.8 is considered optimal fertility. Higher is better for a successful IVF cycle, although I actually forgot to bring this up during my conversation with the nurse so that's about all I've got.
My value: 5.20

Not gonna lie, I'm feeling pretty good about this, and really lucky. My ovaries appear to have survived the assault from the endometriomas and the surgery with their function basically intact. As I write this, they're sitting around quietly, probably getting ready to pop out an egg or two in the next few days, blissfully unaware that that egg will almost certainly be denied entrance to my Fallopian tube and will instead be forced to wander my abdominal cavity on a brief (but glorious?) adventure before inevitably disintegrating. Hang in there, guys! Your moment to impress us all is coming up soon!

*Edited to add: this page has much, much more information. Thanks for the link, Stirrup Queen!

These Meds are Worth More than my Car

As we were walking into the hospital for my surgery, I caught a glimpse of a doctor in scrubs and a surgical cap through a window and I thought I was going to pass out. I said out loud to Harry, "This is the worst," and I almost turned around to go back to the car.

Yesterday, I picked up a Chinese-takeout-sized bag full of hormones, syringes, and antibiotics from the pharmacy. I had the same reaction when I laid it all out on the dining table at home. This is the worst the worst the worst the worst. These are the medications for a sick person, right? Look at how many of them there are! Look at all those needles!

Okay, Charlotte, let's calm down a little bit here. Take things one step at a time. What are these, and what will they do?

First up, the leuprolide acetate. Note that this is not brand-name Lupron, which I appreciate since my copay was significantly lower. This quiets down my ovaries to the extent that they tell my body I'm in menopause, so really, I see this one as an exciting little glimpse into the future. Side effects apparently include the following:

Leuprolide will cause an initial flare in testosterone or estrogen levels leading to bone pain, urinary problems including blood in the urine, and tingling in the feet and hands.
Common side effects: irregular menstruation, bone pain, sweating, dizziness, water retention, hot flashes, headache, nausea/vomiting, and pain at injection site.

Awesome. Next up, I think I can figure out what this one is:

Follistim will get my ovaries out of artificial menopause and into overdrive. Eggs? Did somebody say to make eggs? Hey everybody! It's egg-making time! I'm told this is the most expensive of my medications, so I'll try not to inadvertently confuse it with the cheese and butter it's sharing space with in the fridge. (I also probably shouldn't have accidentally dropped the pen and then kicked it partially across the room when I was trying to gather everything up at the pharmacy, but live and learn.) Side effects:

The most common adverse reactions (≥2%) in women undergoing controlled ovarian stimulation as part of an IVF or ICSI cycle are pelvic discomfort, headache, ovarian hyperstimulation syndrome, pelvic pain, nausea and fatigue.

So we have that to look forward to. Next is a single, unassuming little tube... Ovidrel! This one will make my hyperstimulated ovaries get ready to release all those eggs they just made - and it will be perfectly timed so my doctor can get in there 36 hours later with a scary-looking needle and grab them before they all head off for their various adventures. Ovidrel warns me:

The most common side effects in women using Ovidrel® include abdominal pain, injection site reactions, nausea and vomiting.

But after ovulation, the fun isn't over: for two weeks, and longer if I actually do get pregnant, I get to apply a "unique bio-adhesive gel" to my cervix, Crinone. Not going to lie, this is the only medication I am kind of curious about, because A. it probably won't hurt, and B. unique bio-adhesive gel? Sounds super space-age! Also, I understand that this replaces the progesterone in oil shots that other women have complained about, so I was pretty stoked to see it on my list of meds - even if it will be messy and gross. Side effect info:

The most common side effects of CRINONE (progesterone gel) 8% include breast enlargement, constipation, drowsiness, nausea, headache, and pain in the pubic area.

Let's not forget the various antibiotics I'll take for a few days at different points in this process, or the prenatal vitamins and baby aspirin I'll take throughout, or the additional meds I will have to start if I am knocked up. First, one thing at a time. Leuprolide acetate begins on Dec. 12th.

No, Infertility is not Cancer

One possible outcome of my surgery, though remote, was that the endometriomas would actually turn out to be cancer. Everyone, from the ultrasound tech to the radiologist who officially read the scan to my Ob-Gyn to my new RE, assured me that it was very unlikely. But it was there.

I was very relieved upon waking up from surgery to find that all signs pointed to your garden-variety, non-malignant, problematic-but-not-immediately-life-threatening endometriosis. I was even happier when the pathology report came back a few days later to confirm definitively that the tissue removed was not cancerous. But as I've written before, my diagnosis of advanced endometriosis, blocked Fallopian tubes, and the advice I got to start IVF immediately was incredibly upsetting, and I want to explain why.

Last year, my mother was diagnosed with cancer. I will save you the suspense and say that she's just fine, she's been in remission for a while, and her doctors think she's likely to stay that way for a long time. But starting on the day of her biopsy, the entire family went through a journey that is best described simply as traumatic. I watched poison be injected directly into her chest and shaved her head during chemo. For six months, we all dove headfirst into the experience of cancer treatment and swam around in that darkness. There were lots of cliches, lots of tears, and lots of celebration when she was finally declared to be done with treatment.

When I first found out that something was wrong with me - when we were still at the stage of "we don't know what's in my belly, but it sure isn't good" - I slipped right back into the same pattern as when my mom was diagnosed. Learn as much as possible about the disease, the treatment options, the doctors who will be involved. Skip virtuously past the blogs and message boards, spend some time on PubMed and UpToDate for more "official" information, then wait until 3 AM to go right back to reading blogs and message boards. How were other people diagnosed? How were they treated? How did they cope? What was the outcome? How bad is this really going to be for me, for the people I love? What does the future look like now that this has happened?

I am very, very grateful that after my surgery I was diagnosed with infertility and not cancer. I feel so lucky that it's a condition that might change my life but doesn't threaten it. But I also recognize that I am treating my infertility journey differently than I might have if I hadn't been through the experience of serious illness in the family so recently. I'm much more anxious about everything relating to medical care than I used to be. I have less patience with doctors, nurses, and office staff. I hyperventilate when I see needles, IV bags, hospital gowns, those socks with little rubber treads on the bottom. And I am using the same coping mechanisms that I did when my mom was sick: get a calendar and write out every treatment date. Circle in red the day that everything will be done, regardless of the outcome. Exercise as often as possible to relieve stress. Apologize to my husband in advance for snapping at him. Focus on positive things that have nothing to do with illness or disease. Wait, wait, wait for it to be over.

And to those who are still struggling with cancer in any way or at any level - hang in there. You are not alone. Be strong.

Why I Chose Charlotte

I swear, I didn't set out to emulate Charlotte York Goldenblatt. I really didn't. Not only is she a fictional character - something that I find really gets in the way of my attempts to live in reality - but I don't actually envy her life from Sex and the City. Sure, she ends up with the fairytale in the end, but let's not forget the breakup of her first marriage, her experience with Brad the bad kisser, or that amazing stinkeye she gives to Big after he leaves Carrie at the altar.

But here's the thing: I actually did grow up in Connecticut. I have a Cavalier King Charles Spaniel (although her name is not Elizabeth Taylor). I married a Jewish man and, yes, I also converted to Judaism. And it wasn't until a few days after my surgery that I realized - oh no. I'm like Charlotte in one more way, too.

I can't do anything about where I was born, and I chose my dog because I wanted a canine companion that would stay within the weight requirement of my apartment lease and have a gentle enough disposition to get along with my older, set-in-his-ways cat. The Judaism thing came as a bit of a surprise even to me - but then I've always loved to study religion, and it was the right choice for me, even if I do feel like people sometimes assume I converted to please my husband. (For the record, he was quite pleased, but never once did he do or say anything that could be interpreted as pushing me into it.) And infertility, well... no one plans this.

However. It could be worse. I've always rather liked the name Charlotte, and if I someday end up baking with my two daughters in a fancy New York kitchen, I promise to be really grateful for my couture clothing and my Irish nanny. Oh, and hey, infertility? I curse the day you were born!

How We Got Here

I remember interviewing for a college that I didn't really want to attend with a man who was a total pompous ass. He said several nasty and arrogant things to me before we even sat down for the formal interview, and then his first question was "So, how did you get here?" Irritated, I snapped back, "In a car."

I was not offered admission to his school.

This is perhaps not the best anecdote with which to begin an acquaintance, even one conducted solely over the Internet. But if you're reading this, you just might be infertile too, and I'll bet you can relate. How do you think I got here? No one starts blogging about infertility for fun. Being declared infertile usually means lots of painful and embarrassing tests, sleepless nights, urine-soaked sticks filling up your trash can, and probably at least one conversation with a doctor where you had to clear your throat a few times before you could continue speaking. Oh, and let's not forget the hours devoted to asking Dr. Google for some advice, or scrolling obsessively through the archives of a stranger's blog hoping that you can find someone just like you who had the same diagnosis, same treatment protocol, and a happy outcome. It is in thanks to those bloggers who have come before me that I have started writing about my own experience. Ladies, you made my productivity at work plummet, but you also gave me hope, made me laugh, and it is an honor to add my voice to yours.

So, where do we start? I'm 28 years old, I'm married to a wonderful man who we will call Harry, and I have endometriosis and blocked Fallopian tubes. (Oh, and I did get here in a car.) We tried to get pregnant naturally for 11 months before my Ob-Gyn discovered a major problem at what should have been a routine annual appointment: a mass in my belly that required further evaluation by ultrasound. A week later, the ultrasound tech waited about 15 seconds after inserting the wand to tell me I had a large endometrioma (9 cm.) on my left ovary and a smaller one (4 cm.) on my right ovary. I asked what that meant exactly and he stage-whispered, "You didn't hear it from me, but you're looking at laparoscopic surgery."

Laparoscopic surgery didn't sound all that bad at first. A few incisions below the bikini line, a couple of days off work, lots of movies and magazines and soup, and then we'd evaluate our reproductive options. Yes, the size of the cysts indicated that I had probably had endometriosis for a long time, but I wasn't in constant pain like some women experience, and I was in otherwise good health. I figured that after the surgery we'd probably try Clomid, maybe have an IUI or two, and someday if things got really desperate we'd be told our best option was to move on to IVF.

Nope! I woke up from the surgery to hear my doctor say that although there were no complications, and I had been able to keep both ovaries, my Fallopian tubes were irreversibly and completely blocked by scarring from the endometriosis. If we wanted to have children, the only thing we could do was move directly to IVF. At the time I was fighting the simultaneous urges to sleep and throw up, so it's not like we had a very long chat, but I was awake enough to be devastated. The process of going through surgery was itself surprisingly upsetting, and waking up to bad news... well. And yes, IVF was bad news to my ears. To me, hearing "IVF" meant that something was terribly wrong with my body, that I would have to endure pain and discomfort and financial burden that most people never need to consider, and that there was a pretty decent chance at the end of the day that we would genuinely fail in this endeavor.

One tough thing in all of this is that even the few people who knew about my surgery and its outcome were sympathetic because they assumed I was just upset that I wouldn't be able to have children. I am, of course. Reproducing is a big deal to us mammals, and I - like anyone - would love to hold my own live young in my arms. Except for one little problem.

Midway through our year of TTC the old-fashioned way, I came to a realization: I'm not all that crazy about the idea of having a baby right now. I love my husband, and we are financially stable, and our apartment even has a second bedroom... but I kind of wanted to do other things first. Like maybe get my PhD. Or write a novel. Or live abroad. It's okay that this is taking a while, I told him. It could be that there's a higher power who knows that this isn't the perfect time for us to have a baby.

Except now, post-surgery, medical science has decreed that this is the ONLY, BEST, MOST PERFECT time for us to have a baby or three. I'm 28, and my ovarian reserve numbers look good even after surgery. My insurance covers a very generous four rounds of IVF. The fertility clinic is two stoplights away from my work. And I'm going to delay this because I think it might be kind of fun to live in London for a year, assuming that we could find jobs and an apartment and get the right kind of visas and figure out the difference between a crumpet and a strumpet?

So, IVF it is. I'm clutching a copy of my CD3 bloodwork in one hand and my sonohysterogram results in another. I start injecting myself with hormones on December 12th. I might be a mother by this time next year, or maybe never. Here we go.