Reunited

Disclaimer: this is not my embryo. But you'd believe me if I told you it was, right? Because our cell fragmentation rates are so similar? Oh gosh, we get that all the time. :::blush:::

Transfer this morning was similar to what I expected, based on all of my fellow bloggers' many descriptions. I changed into back-to-front hospital gowns and grippy socks, had a conversation with my doctor about how many embryos to transfer (spoiler alert: just one), and then it was on to the big event. I put my feet in the stirrups while my RE put in a regular speculum as though I was about to have a pap smear, then a nurse used the ultrasound wand on the top of my belly to see my uterus. The only wrinkle was that my uterus was at a weird angle, so they kept trying to adjust the table and use a different catheter and finally my RE left the room for a moment while he tried to find one he liked. Yes, that's right: left the room! While I had a speculum shoved up in my personal region! And I had to pee! I overheard some snippets of conversation about someone maybe not having ordered or restocked the catheters correctly... dun dun dun. Anyway, he came back and put in the right catheter, then the embryologist did this elaborate thing with him where they verified back and forth that I was who I said I was and my embryo was who it said it was, and then he said "I'm ready to inject" and I felt the tiniest cramp in my uterus. On the ultrasound screen I could see a little bit of movement, and after a brief pause, he took the catheter out and the ultrasound nurse stopped pressing on my bladder. I chilled on the table for another 20 minutes reading the Golden Globes fashion issue of People magazine, and because I know you're wondering, I will put the matter to rest right now: in the final analysis I don't think I liked Angelina Jolie's dress. Too severe on such a thin figure.

We transferred one embryo, for several reasons:
1.) At my age, and without any reason to suspect other infertility factors, transferring more than one embryo is not likely to increase the likelihood of a successful pregnancy. All it does is increase my chances of multiple births.
2.) We believe in eSET. My unpleasant experience with egg retrieval aside, we are covered for four IVF cycles at this clinic, and we believe that the ethical thing to do is to attempt one birth at a time. Multiples, even twins, have higher rates of complications - which means more healthcare dollars spent by us and our insurance company overall. We have the luxury of making this choice because we do have four cycles covered, although we strongly believe this kind of coverage should not be a luxury.
3.) I just really don't want twins if I can avoid it. I'd rather hear that the cycle failed (and that we are moving forward with a FET) than be as sick as my cousin was when she was pregnant with her boys! She just could not stop throwing up, it was awful. If the embryo splits into identical twins then we'll deal with that when it happens, but I saw no reason to deliberately choose it.

The other reason I feel good about our decision is because this embryo got literally the highest grade the lab gives out. They said that it was always the leader in dividing, day after day, and it was hatching this morning right before transfer. My RE was very impressed by our embryos overall and said that we will have at least three to freeze, though we won't know for sure until tomorrow. So far only one has arrested, so ten are still technically candidates, although a few are going so slowly at this point that it's unlikely they'll make it. Three frozen embryos would be a gift; we went into this knowing that we could have none in the freezer so we're very grateful for whatever we can get.

One final, memorable thing about transfer day: so as I was lying on the table reading People, one of the nurses gave me a printed picture of our embryo. I thanked her and then a few minutes later, when I was finally released to go use the ladies' room, I realized had nowhere to put it. I mean, think about it - no pockets in my hospital gown, no purse, no friendly little shelf in their tiny bathroom holding extra toilet paper, no nothing. I settled for sort of perching it behind the sink faucet and handles, but then when I went to wash my hands, the picture FELL INTO THE SINK!!! And the ink started to run, and I was watching the only picture of the only child I've ever had start to swirl down the drain, and I took it out immediately and tried to blot it with a paper towel but that just made it worse, so there was nothing to do but start laughing hysterically and fess up to my idiocy. I walked out and showed the nurse my sad, wet, grayish piece of photographic paper and she laughed too and printed me another one. I have to say that I hope it wasn't a bad omen, but I also kind of want to tell the kid this story someday to illustrate what a spaz his or her mother was. I promise to treat the actual embryo much better than the picture!

Weekend Update

Unbelievably, all 12 embryos are still hanging in there. I am having visions of Mother Ginger from the Nutcracker.

I am hanging in there, too - I started back on solid foods last night when Harry made me the most delicious scrambled eggs ever (I ate them in tiny tiny bites and couldn't stop exclaiming about how they were the tastiest eggs I had ever had the privilege of eating. Then I had a small bowl of the most delicious yogurt I had ever eaten in my life - what were the odds! It was getting to the point where I was ready to start exclaiming that the water was the most delicious water ever, too.) Today I had a real breakfast, and lunch, and yes we are having steak for dinner. My belly is still sore, but nowhere near what it was yesterday. I hope that the upward trend continues.

Transfer is on Monday morning and I'll let you know how it goes, but my only hope is that nobody attempts to make it a touching spiritual occasion. My friend who has been through this twice at this clinic said that her doctor asked right before transfer if she wanted to say a prayer, and then proceeded to join with her in asking for a little assistance from the divine. Not my style at all - when I pray it's on my own time, not with a bunch of medical staff I barely know. I certainly don't get the sense my RE will bring it up as an option, but I think if he did my only reaction would be amusement, not reverence. And speaking of amusement, that's what I'll be doing in the meantime, catching up on TV shows and trying not to think about things too clearly. "Just relax," right?

What Happened, Food? I Thought We Were Friends

Not burying the lead: all 12 embryos have survived to fight another day. The clinic is planning on a day 5 transfer.

That's the good news. The bad news is that while I had planned to write a chirpy little post about how I was trying to increase my protein intake to avoid  Ovarian Hyperstimulation Syndrome (OHSS), I ended up having a really rough night with the belly pain. I ate an actual meal last night for the first time since Wednesday's nauseapalooza, and I think my GI system did several backflips when it realized it had something substantial in it. I'm sure the doxycycline I'm taking isn't helping matters either. Now I'm racking my brains for ways to increase my protein intake without writhing on the couch for hours - I had a single piece of toast with peanut butter this morning and so far so good. I also brought a high-protein shake to work and it's sitting on my desk, where I am staring at it with apprehension as though it's about to jump down my throat of its own accord and start causing trouble in my tummy.

I mean, at some point my belly has to stop hurting, right? Until then, I'm just going to have to tread carefully and eat whatever I can manage to eat. And I'm also wondering if more dietary protein to avoid OHSS is a good idea at all, since I'm having trouble finding a professionally authored study on this, even though it's all over the infertility message boards as accepted post-retrieval advice. (If you have hard data to back this up, please let me know.) Either way, Gatorade, ginger ale, and Saltines do not a balanced diet make, so I've got to start mixing it up.

A Painfully Detailed (Ha! Get It?) Description of my Egg Retrieval

First things first: 16 eggs, 12 fertilized naturally with IVF (no ICSI here.) I will find out my transfer date tomorrow.

At 6 AM yesterday (oh, who are we kidding, I was actually up tossing and turning starting at 5) I got up and headed over to my clinic. This was the first time I arrived right when they opened, and it was like a scene out of a play: the curtain opens outside the door to a fertility clinic. A dozen people stand outside in perfect silence, desperation and resignation written on their faces. None of the women look younger than 35 and no one smiles, either to themselves or to each other. If there is a sisterhood here, it is a sullen one. The door opens: wordlessly, everyone forms a single-file line and heads in.

Surreal. Anyway, once I finally got in, it was the usual pre-procedure drill: confirm my name and birthdate a few thousand times, put on a bracelet, sign the consent forms, change into the hospital gowns and grippy socks. I did find that after all these injections, I no longer get squicked out about watching needles go into my skin, so I watched the whole time as the nurse put in my IV (and saw the giant bruise start to form that I just knew was going to happen.) I took a single pill of Ativan and she had me wait on a gurney and gave me a magazine at random - the issue of Lucky where Elizabeth Banks describes her struggle to get pregnant and eventual decision to use a gestational carrier. I read the article and tried to think to myself, this is okay, Elizabeth Banks did this, you can do it too.

But as much as I'd like to just keep asking myself WWEBD (What Would Elizabeth Banks Do?) and act accordingly, I bet that she had actual anesthesia for her retrieval. Which brings me to the part of my story where I was totally right to be concerned about the conscious sedation. Don't worry, I'm not experiencing post-anesthesia PTSD or anything, but damn, I felt everything. After getting my legs in place and draping over my personal region, the nurse hooked up my IV to a syringe of Fentanyl. She sat on my left side and took my left hand in hers and put her right hand on the syringe. She explained that she was going to hold my hand the whole time and push the Fentanyl with her other hand as needed - um, okay. It was weird to hold a stranger's hand, but then she pushed a small amount of the Fentanyl and it was like getting drunk very quickly: sure, I'll hold your hand, especially since you're buying this round! She started asking me questions about my siblings and I knew that she was just talking to me to distract me, but at that point my RE came into the room and I was glad to have something to focus on besides what was going on in my vagina. Which was: two burning pains from the local anesthetic as it was injected on either side. A prolonged and sharp digging sensation as he worked on my right ovary and then the same thing on the left. The really bad part was when he said "so, in order to get these last two eggs, I'm going to have to puncture the endometrioma. Okay?" I said okay, and then as he stabbed it, I squeezed the nurse's hand really tightly in spite of myself. It felt like, well, being stabbed! I was still with it enough to feel him do the mock transfer (which appeared to be just putting a catheter into my uterus and wiggling it around for a second under ultrasound), but after that I have no memory until I was laying on a gurney in the recovery room with an IV of antibiotics going into me. I don't remember whether I walked to that gurney, which honestly bothers me more than the memory of the pain itself - I really don't like knowing that I was walking and talking with no knowledge of what I said or did.

This is the other strange thing: once I was in recovery, the pain began to really mount. It started around a 1 or a 2 on a scale of 10, but kept building until I described it to the nurse as more like a 4-5. I was starting to panic because they were saying things like "maybe you'll be out of here in a few minutes" and I didn't know where this was going to level out and didn't want to find out the hard way, and the nurse said the only thing she could do was push more Fentanyl, but that would delay our departure which apparently they didn't want to do. I mean, it kind of seems to me like I shouldn't have had to bring my own drugs to the clinic, but eventually they settled on having me take some of the Percocet that I had been given after my surgery in October that I brought with me just in case (once a Girl Scout, always a Girl Scout) which then made me predictably nauseous - somehow we managed to drive home with the help of a pillow cushioning my belly from the seatbelt and one of those kidney-shaped containers in case I ralphed in the car.

I spent the rest of the day in bed trying to figure out whether the pain or the nausea was bothering me more, though the winner became pretty clear when I started repeatedly throwing up.  I finally got some soup in me around 8 PM and took my doxycycline and medrol around 10 when it seemed like things were going to stay down. I slept okay last night and am back at work today with a bottle of extra-strength Tylenol and a heating pad strapped discreetly beneath my sweater - in an ideal world, I'd have taken today off, but I just don't have the time. Besides, it's better than waiting around at home obsessing about the 12 embryos in a lab across town that contain genetic material from both me and Harry (a very weird concept, but frankly, I'm thrilled that they have a babysitter today because I am just not up to childcare in my current state.)

So that's where things stand - if you've been reading some of my earlier posts, you will know that I harbor no small amount of anger about having to undergo the physical pain and trauma of IVF. Now that retrieval is behind me, I do feel some relief, although as I get farther and farther away from the pharmacologically induced relaxation of yesterday's sedatives, I am seriously considering changing clinics for our next attempt. Other bloggers have described how nice it was to feel the drugs knock them into unconsciousness before any needles were taken to their ladyparts, and I've seen lots of terms like "Operating Room" and "Anesthesiologist" thrown around. My retrieval was in a slightly-larger-than-usual exam room - definitely not an OR. And the highly scientific hand-squeezing technique that the nurse used is, I'm sorry, no substitute for a heart monitor or an EEG to measure pain response. I had real surgery recently, and this was no surgery. This was an in-office procedure that is routine for their staff but not to the patient, and while many women may feel that this is an acceptable level of pain to achieve their dream of becoming a mother (or simply don't realize that they have a choice), I just don't agree. I'm not going to make any decisions now, but Harry and I will have a big talk about our next steps at some point.

On another note, I have to send some love out to AJ, who had her retrieval yesterday too; to Emily, who is planning out the next stage of her journey after getting this week's IUI results; and to Blondie, who is currently incubating the cutest lil' blastocyst. I hope that all of you get good news soon.

"Trigger Shot" Should Be the Name of a Cocktail

First of all, Harry and I rarely refer to it as a trigger shot. We much prefer calling it "the kick" after Inception or even "the bounce." When I think of the words "trigger shot," this is what I picture:

(Duck hunt, anyone?)

In reality, this is what's about to happen:

Either way, I'm triggering ovulation tonight. Looks like the count is holding steady around 22 follicles, of which a handful are likely too small to be viable, but there's no sense in worrying about that now. I did remember to ask this morning about my most recent E2 number and it was 2319, which brought me much joy because of its association with Monsters, Inc., but I'm going to try to take my RE at his word that everything looks good and not focus on the details too closely. Retrieval will take place on Wednesday morning at 8:15 AM under a haze of Ativan, Fentanyl, and Versed. A heavy, heavy haze. A haze so thick I won't be able to see through it or feel anything or remember anything. Right? Right.

CDsomething and I'm Makin' Eggs

Because of my super-long Lupron protocol, I have no idea what cycle day I'm on. But I do know this: today marks my one-week anniversary of stimulating my ovaries, and this is happening, people. I have 14 measurable follicles on my right ovary and 8 on my left ovary. (I realize that in my last post I reversed the count so it looked like lefty was the major producer, sorry about that - just my latent right-left confusion causing trouble.)

The doc who performed my ultrasound said that I'm responding very quickly to the Follistim and I might trigger as early as tonight, but left the final decision to my RE. Turns out he wants to wait one more day and monitor me again tomorrow morning to see if any of the smaller follicles are catching up to their friends, and then probably plan on a retrieval Wednesday or Thursday. I'm really surprised because my RE and I were initially planning on a Friday or Saturday retrieval (and I wanted the extra time to recover over the weekend, which I suspect I now will not get), but like everything with this infertility process, there's just no way to predict how things will go.

So that's the good news. The bad news is that as my overachiever ovaries have been popping out all of these follicles, I've been feeling increasingly worse. The twinges I felt in my belly on Thursday morphed into a constant menstrual-cramp-like pain by Friday, and got worse all day on Saturday. By Saturday night I was also feeling intermittent low-level nausea, which has continued today and which I've also felt when I've had intense menstrual cramps in the past (thanks, endometriosis!) I'm not actually throwing up and it could be much worse, but I've spent most of the day on the couch taking Tylenol and sipping on tea and juice. Work should be interesting tomorrow, but we'll cross that bridge when we come to it. And in terms of days to spend sitting on the couch - it could be worse, I have the playoffs to watch!

What Can I Say, I Enjoy Being Stimulated

Four days in and I am a much happier camper than I was before I started Follistim. Seriously, I woke up the morning after my first dose with a sense of optimism that I hadn't felt in several weeks. I'm sure it was all in my head, but just knowing that I had lady hormones coursing through my veins again - and knowing that I was one day closer to this process being over - made a huge difference in my outlook. My Lupron-induced headache has subsided almost entirely, plus I appear to have had my last hot flash on Monday morning, so that is also exceedingly helpful in keeping my spirits up. My ovaries appear to like Follistim too: this morning's count was 13 follicles on the left and 7 follicles on the right. I have felt a few twinges in my belly, which is annoying but also a good sign that things are moving in the right direction. Overall, I'm doing as well as I would have hoped during this point in my cycle.

But I made the mistake yesterday of listening wistfully to an album on my iPod that I had been rocking out to on a loop during the spring of 2010. I was so happy then. Harry and I were planning our future together and everything seemed so bright. It's funny how sensory memories can be: bulgogi will always remind me of fall 2006, when I discovered how tasty it was and made it for dinner at least once a week. My green cowl-neck sweater will always remind me of my senior year of college, when I bought it as a birthday present for myself and wore it through a freezing winter. And it got me thinking, what will be my dominant sense-memories from this season of my life?

Smell: Kendall Webcol Alcohol Prep pads. I open up the package every night and the tang floats up to my nose to remind me that there are really only 5 minutes every day when I am actively addressing my infertility. And those 5 minutes just reek of rubbing alcohol.

Taste: Karfiolleves. If you haven't tried it, I recommend it - I was really unenthusiastic when I first read the recipe but it turned out to be an amazing comfort food. The dumplings are really buttery and the cauliflower is really soft and the hot paprika gives just the right amount of kick. Stirring sour cream in makes it even better.

Sight: This amazing 3-D painting/sculpture/piece of abstract-but-not-abstract-enough art at my RE's office that depicts a sperm fertilizing an egg. Harry and I both had to contain our laughter when we saw it on our first visit there, because we are Not Mature. One of the nurses noticed our smirks and said that a former patient made it, which makes me wonder what kind of craft project I could give them at the end of this process that they would feel obligated to display. Maybe something made out of cat hair.

Touch: Needles going into my skin! I always think of the Bic mechanical pencils I used to play with at school, clicking the little column of lead almost all the way out and then pretending to give myself a shot as the lead slid back in. Except that this time, I actually go through with it and the needle does pierce right through my skin and into my belly. It's so strange, like living a childhood fantasy in reverse.

Sound: Gotta be Shake It Out by Florence + The Machine. This song basically got me through the first wave of crushing depression that followed my surgery in October and will kick off the infertility mix on my iPhone if I ever get around to making it. (Which I haven't done because - that whole crushing depression thing? Yeah, that leads to some questionable musical choices. I have lately found myself sobbing to Phil Collins, but then, who hasn't?)

Woman's Intuition: Pfft, I wish I knew. I have no intuition about whether this cycle will be successful, I just like including this as my sixth sense on principle.

Anybody else?

Body Art

Is anyone else making designs with the little marks from their injections? No? Just me?

I'm up to a diamond pattern on both sides of my belly button. Trying to figure out how to turn them into a star before they start fading. I'd post a picture but it's not actually that pretty!

Watch out! Bears!

So, as usual when I start obsessing about something, naturally I've started seeing references to IVF everywhere I go. Which is why I clicked on this article as soon as I saw it. And then I laughed.

I've long suspected that women undergoing IVF are some of the most highly motivated patients that a physician is likely to come across. By and large, people really really really want their cycles to be successful, and since IVF isn't covered by so many insurance plans, there's often a huge financial incentive as well. If your doctor told you that rising every morning to greet the sun while painting your naked body with fertility symbols had been proven in a randomized double-blind trial to aid in achieving pregnancy, you'd do it, right? Compare that to a medical specialty like Cardiology, which is a lot of "please stop eating cheese, no really, I mean it this time" with very little compliance.

But people aren't perfect, and even the best motivated patients have trouble adhering to what are actually some pretty stringent lifestyle changes. The results of this study don't surprise me, especially because so many of these behaviors are stress relievers and an IVF cycle is incredibly stressful. And the lead author's statement that because an IVF cycle is only 28 days long so she's surprised that people aren't more compliant also tells me that she might not have exactly the same perspective as an actual IVF patient: yes, it's 28 days of some really intense TTC activity, but many patients have been TTC for so long without results that it's hard to keep depriving yourself of things as though you're actually about to get pregnant. And in the earlier stages of an IVF cycle, when you know you're not knocked up but you may be within a few days... well, it's hard to find the motivation to pass up that drink. (Especially if doing so will lead to a lot of well-intentioned but hurtful comments from your companions about why you're not drinking, winkwink nudgenudge.)

Anyway, my favorite part of this article is definitely the part about not running during an IVF cycle because it makes your body think you're fleeing a BEAR. (Yes, really.) That is just sheer awesomeness, my friends. While I was running earlier today I kept trying to envision a bear behind me to see if it would make me run faster, but to no avail. (Lady Gaga does a much better job motivating me, and she probably smells better too, though I cannot speak from experience here.) I wonder if other methods of exercise provoke the same reaction: biking makes your body think you're about to be hit by an 18-wheeler! Swimming makes your body think you've been swallowed by a whale! Yoga makes your body think you're being judged by all the other people in the class who have those fancy straps they use to carry their mats!

I mean, I get it, I do. Running isn't a good idea during IVF because it jostles growing ovaries, plus it can be some damn strenuous exercise when you want your body to focus on a different project. I'm just tickled to have read an article that involved IVF and bears that didn't mention the phrase "turns women into snarling raging beasts not unlike _____." And it made me feel extra special about taking a run today, my first full day of stimulation - although I think it will be my last one for a while, thanks to the shinsplints I'm getting from the crappy gym treadmills I have to use in wintertime. By the time my legs feel better, I'm expecting my ovaries will be sore, but we'll see. I might also meet up with a bear and then where would we be???

Stimulation has Begun

You guys! You guys.

I HAVE FINALLY BEGUN TO STIMULATE MY OVARIES.

As of a few moments ago, I am no longer in menopause. (Kind of.) In addition to 5 units of leuprolide acetate, I injected 225 IU of Follistim into my belly. And this comes after a whopping 33 days of downregulation. It's the longest Lupron protocol I can find anywhere on the Interwebs, but it. has. finally. ended.

Welcome back, ovaries! We have a lot of work ahead of us. First order of business: Golden Globes fashion critique. Angelina Jolie: yes or no? I'm leaning towards no, but I still haven't seen a full-length shot of her.

Rose! Hyper on Two!

(If you can name the movie I'm quoting above, you get a gold star.)

Today was my extra-special crazy-lady appointment at my RE's office (with a bonus unscheduled appearance from my RE himself!) to talk with the nurse coordinator about my concerns regarding egg retrieval. I will admit, embarrassingly, that I do feel much better now that I've voiced all my worries to somebody and seen the procedure room and been assured in no uncertain terms that this will not be agony and if it is, they'll stop. Sigh. The Ativan prescription I picked up probably won't hurt either.

The only thing that continues to bother me is that when I related my friend's story about trying to take her feet out of the stirrups but being prevented from doing so by an additional drug being pushed into her IV, the nurse's reaction was immediately that it had never happened or if it did, it didn't happen exactly that way. I mean, it's hard for me to get all indignant about it because it's not my story, but I really don't think my friend is lying and even if she is mistaken about the details - this is what their former patient perceived to be her experience at their clinic, and it was upsetting. Period. If I had a horrific experience at a doctor's office of any kind, I would tell them about it in no uncertain terms, but my friend isn't interested in doing that so I guess the matter will just rest here.

The other new development to come out of today's meeting is that my RE asked if I had 5 minutes free to meet with him to go over the calendar for my cycle - believe it or not, we are pushing back my start date for Follistim AGAIN! This time it's because my RE has to be out of town on what would have been my retrieval date. I can stay on the leuprolide acetate "indefinitely" (it's similar to being on Lupron Depot, which would last for several months, so two more days of the injectable stuff won't actually harm me - it just keeps me in a holding pattern until we're ready to start). Part of me feels like this is a stay of execution but another part of me just wants to get the show on the road already! Anyway, I am now starting Follistim on Sunday 1/15. With any luck sugar cookies will be involved.

Our TTC History

Okay, first things first: after another (less contentious) discussion with my RE, I am going to meet with the nurse coordinator at my clinic on Friday to discuss my concerns about the egg retrieval procedure. I get the sense that they all think I’m a crazy person and that I’m just a being a total weenie about the pain, which I would politely dispute, but at least we’re moving forward.

So – I want to give a little more background on our experience TTC in the hopes that it will make my post a few days ago seem a little less like it came out of nowhere. All the crying over the past week has made me think about how closely I associate TTC with illness, and why I’ve approached every step in this process with such crippling dread.

I mentioned that my mother had cancer recently, and it was actually her diagnosis that kicked off the entire endeavor. The night that she called to say the biopsy was positive, I turned to Harry and said, “We need to have a baby as soon as possible.” I said this because I wanted kids (I do want kids) and I couldn’t imagine our children not knowing their grandmother. And my parents want us to have kids so badly! I could just picture their faces when I would tell them, mid-chemo infusion, that I had some happy news to distract us all.

Well, Mom was diagnosed in July, I had to finish up a course of medication that would have been dangerous to a developing fetus, and I had to make an appointment with my Ob-Gyn to end our current method of birth control. Once all that was done, our first cycle officially “trying” was October 2010. Nothing happened, of course, and by January 2011 my mother was (thankfully) in remission. That month I told Harry that maybe this wasn’t the perfect time to have a child after all, and we made a tentative plan to hold off for a little while. The next month was February… Valentine’s Day was right in the middle of my cycle… and when I woke up the next morning the first thing I said to Harry was, “Well, I guess we’re back to trying for a baby!” Of course, that month was another negative.

In March, my mom had a scan that revealed the cancer might have come back, and naturally we all freaked out again. Back to Plan A, except this time with more technology: I went out and bought a basal-body thermometer and a bunch of ovulation predictor kits and joined Fertility Friend to track my cycles. When nothing had happened by June, I began to get suspicious. We had hit the nail on the head three times in a row (so to speak) and none of that carefully timed “activity” had had the slightest result. I happened to have an appointment with my regular GP, and mentioned that we were having difficulty conceiving. She reiterated the statistics about healthy couples taking 12 months on average, said that we were probably fine and should just keep doing what we were doing, but recommended that I make an appointment with my Ob-Gyn to discuss it just in case. September (!) was the earliest date the Ob-Gyn was available, although in the meantime my mother went back into remission, so that was a major relief.

The appointment with my Ob-Gyn was routine until the bimanual exam. If I may be so blunt: he had his hands in me for about 5 seconds before he said, “Hmmm…” and my blood just froze. There was a mass in my abdomen, an ultrasound revealed that I had endometriomas on both ovaries, I needed to have laparoscopic surgery, I had to find a surgeon, we set the date for late October, I watched almost disbelieving as my feet walked me towards an operating room, I lay down on the table, I put my arm out to the side for them to start the drugs in my IV, and as I felt the anesthesia start to flow I had one clear thought: This is the first time since my diagnosis that I don’t feel upset about it.

Yeah, well, when I woke up that good feeling was gone. My surgeon said that although he had taken them out, the endometriomas were likely to recur any time I had a normal menstrual cycle, so I had basically three choices for treatment going forward:
1. Pregnancy, achievable only through IVF due to my blocked Fallopian tubes
2. Long-term hormone therapy, which could be as routine as the birth control pill or could take the form of Lupron Depot
3. Do nothing, monitor me closely with routine transvaginal ultrasounds, and accept that the endometriomas will recur but might do so very slowly so an additional surgery wouldn’t be necessary for a while.

After some serious discussion with Harry, I elected to move forward with IVF. It was the only option that offered any kind of happy outcome (people love babies, right?) and even going back on the pill was likely to be a stopgap measure while we geared up for IVF. We wanted children someday, and the stars seemed to be aligning that this was our someday, so when I had recovered a bit from my surgery I made an appointment with my new RE to find out when we could start.

I have so much to be grateful for, including but not limited to access to excellent medical care, a loving partner and family, financial stability, being born in the age of assisted reproductive technologies, and four (four!) IVF cycles covered by my insurance plan. And I give thanks daily for these blessings, I really do. But when it comes to the unpleasant details of IVF, this is all I ask: please don’t expect me to be enthusiastic, excited, or knitting little baby booties while I’m waiting for yet another horrible thing to be done to my body. I mean, I've never had a giggly conversation with my husband about how much fun it would be to have a little mini-us running around. It has been a very long time since any thought I had about having children wasn’t tied in with serious illness and mortality. This is sad, and unfair, but no more unfair than anyone else’s path to infertility – and for that matter, it’s no more unfair than finding out that you’re having an unplanned pregnancy, which a huge number of people have to deal with. If we are lucky enough for this cycle to work, I will love our child fiercely and do everything in my power to give him or her the best life I can. If it doesn’t, we’ll regroup somehow, even if things seem dark at times. I know I’m not in this alone, and I am really grateful for everyone’s support – thank you for your positive comments, and in return, I’ll try to keep the positive posts coming.

Thanks, Menopause!

Not much new to report here, things are still pretty bleak. But after yesterday's depressing post, I wanted to add something that was positive and uplifting. Are you ready?

My skin is the clearest it's been since puberty.

So I have that going for me.

Monday Morning was Almost a Relief

Hey, how was your weekend? Good? Glad to hear it. What did I do? Oh, well, I cried. I oscillated between sobbing → weeping → choking for breath → welling up during an otherwise normal conversation → doing the "ugly cry" → screaming into a pillow → sniffling behind my sunglasses in public → curling up in the fetal position on the floor. (Oh, but I did watch Downton Abbey.) I am literally hoarse today and have a sore nose from all the crying. I also got about 10 hours of sleep total between Friday night and Monday morning, because I just couldn’t stop my brain from obsessing – it finally took two antihistamines and a dramamine to knock me out at 4 AM on Saturday.

This whole “we only plan on relieving 80% of your pain during egg retrieval” thing has just opened up the floodgates on my emotions relating to IVF, and none of them are good. Let’s try to break them down one by one, just like we did with the takeout bag of medications:

1. Anger.
I don’t know why this is missing from so many of my fellow IVFers’ blogs. Aren’t you angry that you have to do this? Am I really the only one who feels this way? I titled my blog the Reluctant Infertile, but what I should have written was the F*cking Furious Infertile. I wish I could say that although my diagnosis was intially upsetting, I managed to come to terms with it and now have a positive attitude towards treatment, but this is just not true. A terrible thing has happened, and what I want to hear from my doctor is that he will do everything in his power to help me and make me as comfortable as possible, not “this is what we offer and if you don’t like it you’ll just need to find another doctor and pay out of pocket.” Why don’t I deserve 100% pain relief during surgery, huh? Why are you subjecting me to anything more than the bare minimum?

2. Self-Loathing.
You know, I probably do deserve this. I’m sure I’ve done something to cause my infertility and I don’t know why they’re bothering to relieve my pain at all. And Harry? Harry shouldn’t be part of this process at all. Harry is fine and fertile and he would be so much better off if I were just out of his life entirely. He could find someone else and be happy and procreate naturally and never have to wake up in the middle of the night to find his wife doubled over next to him in bed trying to sob as silently as possible because she can’t perform the most basic function of making another human.

3. Fear.
One unpleasant surprise from Friday’s scan is that although my ovaries are resting just fine under the influence of the leuprolide acetate, the endometriomas that caused this problem in the first place have already recurred. The one on my left ovary is actually big enough that it’s borderline whether I can go through an IVF cycle at all, and although my RE wants to proceed with this one because, he says, “we just can’t keep doing more surgeries on you,” my plan of doing one cycle and then taking off a few months to assess my options if it’s unsuccessful has gone out the window. At one point I thought there might be some light at the end of the tunnel – come Feb. 1, if I’m not pregnant, I’ll hopefully have some frozen embryos in the bank and I’ll be able to take a break from the crushing depression of infertility for a few months while we gear up for another cycle. Now it looks more like an unsuccessful cycle will end with another, more aggressive surgery, or a round of more aggressive hormone therapy, and both options are just so unpleasant to contemplate it's ridiculous.

Conspicuously missing from this list, you may notice, is any mention of excitement that the cycle might actually be successful and I might get pregnant at the end of it. Yeah. For a few weeks there I was reading stories about people’s joy when they discovered they were expecting, and thinking that this whole baby thing was pretty great, but I’m just so upset right now I can’t see straight. Oh, and in case you were wondering about my last post, the official word is that Harry is not allowed in the room during my egg retrieval. And because of the way my insurance coverage is structured, this is the only clinic that they will reimburse for my IVF expenses – remember when I said that I had a very generous four cycles covered? There’s a catch, and this is it. I have until Friday to figure out some kind of plan.

Cycle Update and a Question

Lots of news this morning after my discussion with my RE - I will almost certainly be able to push the start of my stimulation to Jan. 13, which is good because it solves some scheduling issues for me. I'll write more later but first I have a question for my readers (yes, all five of you):

How does your clinic handle anesthesia for egg retrieval? If your clinic only offers conscious sedation, do they allow your spouse or another person to stay in the room with you?

I ask because my clinic does not offer general anesthesia for retrieval, only Versed and Fentanyl for conscious sedation. My real-life IF friend who has been to this clinic for retrieval twice said that she had two different experiences with them: the first time she was in agony for the entire procedure and basically felt everything, and the second time she was so scared of the coming pain that she actually started freaking out and trying to take her legs out of the stirrups before the procedure even began. At that point the doctor gave some signal to the nurse to push something into her IV and the next thing she knew she was in the recovery room. I want my retrieval to go more like her second experience than the first one, obviously, but my conversation with my RE on this topic didn't go very well. I reiterated my concerns about retrieval, he reassured me that I would be fine, and then I said (thinking that this would be no big deal) that I would appreciate having Harry stay in the room during the procedure seeing as how I would be conscious and all. That is apparently a major problem for them and they have never ever had a spouse stay in the room, or even had anyone ask for their spouse to stay, and the conversation just got worse from there. I tried to stay as calm as possible but I don't think I did very well, and now my doctor says that he'll have to check with some people and get back to me and if this is going to be a dealbreaker then I can't even start stimulation until the issue is resolved.

So, other women in infertilityland, would you mind weighing in? I know that some clinics do offer general anesthesia for retrieval, but others don't, and I have definitely read stories about people's partners being in the room during the procedure. This being the Internet, you never really know what's true and what isn't, but if I am way out of line for asking this of my RE then I'd like to know. Thanks.

Feeling...

HOT HOT HOT!

The last time I wrote about my leuprolide acetate side effects, I said that I thought I might be having hot flashes. I am no longer wondering if this is the case. Yowza! Bring it on, winter! Seriously, it is mighty cold here today, and I am sitting around in my office wearing a t-shirt waiting for the next wave of self-generated heat to hit me.

What does a hot flash feel like? Well, for me, I'll just be sitting around minding my own business when all of a sudden a hot feeling prickles up from my chest to my face. It's like wearing a ton of layers in wintertime, heading inside but not taking any of them off, and then a few minutes later suddenly realizing how overheated you are. I start sweating all over and the only thing that feels like relief is pulling up my shirt to expose my belly and back to cool air. Of course, if I'm in a meeting or something, I can't exactly do this, but the good news is that the feeling passes in about a minute. Then I get really cold for a few moments, and then my body settles down again for a few hours. It's not like I'm sweating so profusely that I've ruined clothing, and so far nobody has looked at me strangely to ask what's going on. It's mostly just weird. Oh, and my headache continues, although it's more intermittent now.

In a strange way I'm actually kind of grateful that the hot flashes have gained intensity over the past few days, because somehow I managed to convince myself over New Year's that I had been doing the Lupron injections wrong and the entire cycle would be ruined and I would have to start all over and it would be dooooooooooom. (And no, I don't have any real reason for thinking I had done the injections wrong, it was more of a "Wait, was the needle supposed to go in at a 45 or 90 degree angle? And do I need to wait a full ten seconds before taking it out? I've poked a lot of holes in the top of the little vial at this point, does this mean there's air getting in there that will ruin the medication?") The answer appears to be that everything is fine, for now at least.

The question I'm now wondering is - can I stand these symptoms for another week? (And then replace them with different ones?) I was supposed to start Follistim on Jan. 6th but I may need to delay for a just a little bit longer. I'm worried about over-suppression because I've read a few horror stories but my RE will give me the final decision on Friday - he is the expert and we'll have a plan soon.

Norse Mythology? Really?

I have been to two fortunetellers in my life, both times at (spoiler alert, lameness ahead) a renaissance faire. Awesome, right? And even though I'm sure they used at least some amount of cold reading techniques on me, I have to say it was entertaining to speak with both of them. Since we've embarked on our first cycle of IVF, which has a maddeningly inscrutable 50-50 rate of success or failure according to my RE's statistics, I have thought back on their words for some clue about what the future holds. Oh, I know it's silly, but at least it's keeping me entertained while I wait around for real answers.

Fortuneteller #1 read tarot cards for me when I was 16 or so. I wanted to know the usual: when will my crush and I finally get together!?! She didn't have a specific time frame for that development, but I do remember that at some crucial point during the reading she flipped over a card and it was The Star. She told me this meant that I had a special talent, and if I followed it, I would have a career that made me happy as well as a husband and children and prosperity and good health and a long life. Great advice for a 16-year-old, right?

Fortuneteller #2 was much more recent, and much more specific. Two summers ago, when my friends and I were done eating turkey legs and they went off to buy some souvenirs, I said that I would rather spend my $20 having my fortune told. This time, there were no tarot cards. I waited for a moment outside the woman's tent while she finished with the last customer, and then I remember it being really awkward as I walked in and sat down because she was looking off in the distance and not acknowledging my entrance. Abruptly, she turned to me and said "You will have a daughter, and I see her - I don't know what this means - but she's a valkyrie." I must have looked suitably confused, because she went on to say that she didn't know why that word was so strongly associated with my daughter, but she saw it clearly. I didn't really know how to respond so I sort of smiled politely and we moved on to other topics (which was actually really creepy, she told me a lot that was true about my siblings and my job and I don't know how she could have possibly guessed all that just from looking at me.) And then I promptly forgot about the whole thing until we started IVF, and I began obsessing about children and whether I could have them, and part of me wants to type this all up now and put it on the Internet with a timestamp just so that in twenty years when my daughter has finished Valkyrie Training School™ I can prove that the fortuneteller's vision was correct.

Except, of course, that the odds of that happening are very low indeed. First of all, we have no guarantee that I will ever have children, and even if I do, who knows if I'll have a girl? Will I have only one girl, or a few to choose from, or perhaps one girl among several boys? Will I adopt, and could I deliberately make the fortune come true by seeking out a female baby with Nordic heritage and raising her among lots of ravens and horses and battlefields? I guess I should be glad that two years ago, long before any of this was on my mind, the message I got from beyond was that motherhood was in my future - the fortuneteller could have said "Oh, hello, nice to meet you, you will never have children." I'd rather have false hope in a happy future than none at all... I think.

Welcome, 2012!

May you be:
joyful
peaceful
eventful...