Someone... was nice to me?

Wait, what? A nurse at my fertility clinic just did something nice for me. Really, truly, she didn't have to do me this favor but she did and I'm all - huh? Stop that! What are you thinking? You're not nice people! You don't care about me! Your colleagues have f*cking told me on multiple occasions that this whole mess was my fault! You're not on my side, you're not my partner or my protector or my advocate, you think I'm an ungrateful patient who complains for no reason!

What happened was this: a few months ago, I was trying desperately to find a way to go back to Clinic 1 for a frozen embryo transfer without, basically, going back to Clinic 1. Even a FET cycle takes a lot of cashish, and I wasn't convinced that I was going to feel any less anxious at Clinic 2, so I tried to see if Clinic 1 would be okay with determining my treatment based on tests (such as the sonohysterogram, ultrasounds, and bloodwork) performed at my OB's office. OB-Gyns also perform SHGs, you know, they aren't the exclusive property of the REs of the world! Clinic 1 was surprisingly okay with it - there were some paperwork hassles that I would have to coordinate, but the only time I would have to see them was for the actual transfer and a consult appointment or two.

This was all back when I thought the only thing determining my family planning efforts was that I would "lose" the 3 remaining IVF cycles covered by my insurance in June 2014. But then! My ovaries woke back up and all of a sudden the schedule was real, with dates circled on the calendar and receptionists who were trying their hardest to fit me in. My SHG back in 2011 at my fertility clinic was a five-minute event so I was expecting to hear something similar from the OB. However, not only did they not have an opening for 3 weeks, they said that the test would take an hour. I said of course, that makes sense, I have to check in, get undressed, sign some paperwork, etc. And their coordinator said no, all that was taken care of in the 30 minutes before the test itself, the actual appointment would be for 90 minutes so that we budget 60 minutes for the test. Um, no. What are they doing in there for an hour? You push some saline, take a few pictures on the ultrasound, remove the catheter, and you're done! I don't dare look it up because even reading descriptions of the procedure will upset me for the rest of the day, but has anyone ever heard of this procedure lasting more than a few moments? Long story short, I said thanks but no thanks and called the fertility clinic instead. Four days later, I had a 20-minute appointment there during my lunch break and was back at my desk before anyone could even notice I was gone (so yes, Clinic 1 does score points for efficiency.)

However, now that my cycle is underway, I received a very nice phone call from a very nice nurse who has been assigned to my case. She was new to the clinic (at least, I hadn't interacted with her at all during my previous cycle) and I took a deep breath and gave her a little background information. I explained that the last cycle I had was incredibly traumatic, that I now felt very anxious and uncomfortable to even be in their building, and that at one point I had tried to coordinate at least part of my care through my OB to avoid having to go to the fertility clinic any more than absolutely necessary. She seemed sympathetic but not terribly interested in the details of my story - except that a few days after our discussion, she called me again to say that she had arranged for my next ultrasound and bloodwork to take place at my OB's office so I didn't have to come back to their facility. And of course it was terrible timing, I was about to run to a meeting and I was holding a bunch of papers and grabbing my purse and my laptop etc., and I sort of just said "Okay, thanks, bye" and hung up.

Should I have thanked her profusely? Fallen all over myself to tell her how very grateful I was for her help? Probably. It's the polite thing to do, after all. She didn't have to make those extra phone calls and fax over those extra orders. And I really appreciate her help with this - I'm dreading the experience anyway and knowing that I don't have to sit in a waiting room that makes me have panic attacks is great.

Honestly, though, I'm not sure how to have that conversation without sacrificing any more of my dignity. I struggle through these waves of self-loathing about having returned to Clinic 1 - it's sort of a credibility thing. How bad could it really have been if I'm going back? If I hated it so much, I wouldn't still be their patient, right? Something traumatic might have happened to me there, but what kind of person lives through that experience and simply goes back for more? Am I just colluding with their "let's torture Charlotte" plan? Have I finally accepted that they were right, that I was personally reduced by my diagnosis, that I am to blame for my infertility, that my reaction to their perfectly standard and humane treatment was just plain extreme, that they did nothing wrong and the fault does indeed lie with me?

My strategy towards those feelings thus far has been to be as detached and professional as possible. I've been giving them my office phone number, for example, since I know that at work I won't let myself fall apart when they call with appointment reminders or whatever. I would rather die than show any vulnerability to any member of my care team. (It's true that my SHG was pretty straightforward, but there was a moment when I asked the doctor how much more saline she had to push into my uterus, and I hated myself for doing it. I've been beating myself up about it ever since. I should have been more stoic.) So calling this nurse back and telling her how much I appreciate her efforts on my behalf is really throwing me for a loop. I am genuinely grateful for her help, but I also don't ever want to owe her anything. I don't want to owe any of them anything. I don't want to be the patient who requires special treatment because she's such a special snowflake. I just want to get out of there in one piece.

So: to those readers who work in a medical profession, and I know there are a few of you, listen up. The power dynamic between patients and caregivers is no joke. I know, you're really friendly with your patients. You put them at ease, you're kind to them and knowledgeable about their care and you would never want to make them feel uncomfortable in your presence. You are also the one on the other end of the needle. At the end of the day, they are physically at your mercy. You might forget this from time to time - it's easier to ignore these things when you're the member of the privileged class - but trust me, your patients do not. They imbue your words and actions with deeper meaning than you do to theirs, so choose them carefully. (Example: just look at this blog post! No, actually, look at this whole damn blog!) It's that old familiar great power-great responsibility thing, of course. And bear in mind that if your patients ever seem insufficiently grateful for all of your efforts, the reasons behind their reaction may be more complicated than you know.

***

To my nurse, who with any luck will never read this: thank you.

Sequel in pre-production

Well, this is happening. IVF 2: Return of the Frozen Embryos is coming soon to a theater near you.

My sonohysterogram wasn't that bad, but then, I didn't remember it being anything to write home about after my first IVF either. If you look carefully you'll see that it doesn't even appear in my writing from that time except as a brief mention in my first post. I mean, there's a little bit of cramping and what I perceived as a deep burn from inside my uterus, but a partial list of things that hurt more than a sonohysterogram would include stubbing my toe, grazing my hand against a hot teakettle, and slicing open my thumb with the blade of an open pair of scissors (all of which I've done this week. Go me.) Yes, I was completely freaking out the whole time, but that's old news.

More interesting was what the test found - my uterus is fine and dandy, but my ovaries are back to making trouble. They were so quiet for so long but it's clear now that when I stopped nursing back in August, the mini-pill alone was not enough to stop me from ovulating, and there was evidence of that on the scan- including a brand new cyst. It's on my right ovary, 4 cm, and in an interesting departure from our usually scheduled programming, may not be an endometrioma. The current theory is that it's a simple ovarian cyst common in women of reproductive age, so it may go away on its own (shrink? rupture? nobody seems to want to discuss that with me...) and the only real risk is that if its a functional cyst then it could mess with my hormones at the end of my upcoming 20 days on lupron.

Wait, what? Lupron? Already? Yes, friends, I will start it later this week. Almost one year to the day after the birth of my beloved first child, I will begin injecting myself again with drugs in an effort to give him a sibling. I thought we had more time before this whole process started again, I really did. Can I really do this again? Can I disrupt my life, my husband's life, and now my child's life by going through the same terrible process as in 2011-12? Getting this diagnosis meant choosing the best of a series of bad options for my body going forward. I hate that, basically, my kids are wrapped up in those choices. There are two separate decisionmaking processes here and in an ideal world we could tackle them separately: first, what should I do to keep my body as healthy as possible for as long as possible? And second, do we want to add another member to our family?

Our decision is to move forward with the FET in early December. It's a compromise in a lot of ways but I hope and pray that it's the beginning of the end of this whole IVF nightmare. A huge amount of questions remain unanswered - will our incredible luck hold, and will I get pregnant again? If this cycle doesn't work, will attempt another one? If this cycle does work, and we still have an embryo or two left in the freezer, will we try for yet another pregnancy? How far am I willing to go to try to reproduce before I give up, hug my child and husband tight, and wait to see what my body does next?

I'm having a sonohysterogram tomorrow?

You know how sometimes nothing happens for a long time and then everything starts happening all at once?

When we last left off with our story, I was debating between two clinics with very different financial implications and thinking tentatively about an FET between now and next June. Well, two things happened: one is that after a lot of looking at our bank account and the calendar, I'm going with Clinic 1. (I know. The place where I had a bad experience. I will get to this in a moment.) And the second thing is that I got my period - twice.

Wait, what? I bled after childbirth last fall, obviously. But then I started taking the mini-pill (which gives you a continuous low dose of progestin) and I didn't bleed at ALL between December and August 28... when I saw some spotting and immediately got a serious pit in my stomach. The mini-pill only suppresses ovulation in about half of menstrual cycles, and by the end of the day I knew what was up. I was sure it was my fault - I had been late with one pill about two weeks earlier (the first and only time, I swear!) and it was probably a one-off. My doctor had told me that I might have some irregular bleeding while I was taking it, but this wasn't light and it wasn't much fun. I mean, I've dealt with endometriosis cramps for years and pre-diagnosis I was pretty stoic about it because I thought it was normal, but now that I know it isn't normal and that every time I bleed it's literally damaging my body on the inside, I have much less patience for the whole process.

Still, the bleeding only lasted a week, and then we were back to our regularly scheduled programming. I was so confident that this was an isolated event that I didn't even have any supplies on me when, 29 days later, I noticed that - oh sh*t - I had gotten my period again. Once could have just been a mistake. Twice was a pattern. Looks like the game has changed, and the mini-pill is no longer providing me the protection I thought it would. Touché, body, touché.

Given this new information and after discussion with my OB-Gyn, my RE, and my insurance, I have decided to proceed with a FET cycle for December. Which means that in the coming weeks, I need to survive at least one consult appointment, a sonohysterogram, several blood draws, probably three transvaginal ultrasounds to check my uterine lining, and the actual transfer itself at Clinic 1. And that sonohysterogram is taking place TOMORROW.

To say that my feelings about starting this process again are mixed is obviously an understatement. Part of me is terrified about what's coming. Part of me is simply bewildered that it's happening again so soon. And part of me is oddly satisfied that I get to return to the scene of the crime, as it were. Of course I don't want to do any of this, nobody does. But as bad as it has been to be Clinic 1's patient, at least I'm not facing the additional guilt of writing big checks and asking people to take time off work to drive me, tripping on valium, to and from procedures at Clinic 2. I don't have to explain myself as much at Clinic 1 - at Clinic 2 I went to such trouble to introduce myself to the doctor and nurses as a patient who might need a little more accommodation and hand-holding and their sympathy mostly just made me feel embarrassed. Now I'm just planning on keeping my head down, talking as little as possible with everyone I encounter, and hopefully getting out of Clinic 1 with a healthy pregnancy. My expectations are different; I know that terrible things are going to happen to my body and I know I'm not going to get any sympathy for that so I might as well stop stalling and get on with it. I'm trying to work more on self-reliance and not falling apart at the drop of a hat, and this decision is part of that effort.

One more thing before I sign off: it occurs to me that when I mention trauma and traumatic events in my past, I should be clear that I am not referring to sexual abuse or assault. There are survivors of both who are close to my heart and I would never want to minimize any of their experience. Trauma occurs in many ways and for many reasons; my sympathies and support go out to out to anyone who struggles with any of it.