Negative is as negative does

In the year's least hotly anticipated news, my official beta hCG test was negative for pregnancy. I don't know the exact value. I was kind of hoping for a nice fat 0.0 so I could make an Animal House joke, but I don't have the energy anyway.

As I wrote in my last post, it was pretty obvious what was coming since I got my period on Sunday. There was no ambiguity about it. It wasn't like there was light spotting and oh maybe things are still okay and I should keep up this insane farce that we were going to be taking home a sibling for our son in late August. I. Got. My. Period. Five days (calendar days, not business days or days spent crossing time zones or whatever, actual 24-hour days as determined by the rotation of the Earth) after my transfer. While I was having intramuscular injections of progesterone in oil, using Crinone gel, and taking oral estrogen. This doesn't appear to be a commonplace occurrence. This morning I tried googling the phrase "5dp5dt bleeding heavily" from a computer I rarely use and do you know which blog came up as the second hit? MINE! Maybe other people have experienced it and didn't write about it, or maybe the stories with negative outcomes aren't the ones that people want to read so they don't get a lot of prominence in the search algorithm, but when you look to the Internet for advice and its best suggestion is to read the post you yourself wrote earlier this week? Not a good sign.

Something went badly wrong with this FET cycle. (Something way above and beyond the interactions I had with my clinic, which are a separate topic and are still being addressed professionally.) In an alternate universe my RE and I would have a conversation to figure out what happened scientifically and what our next steps are, but in this one, I have decided to cease all treatment and stop seeking care for infertility indefinitely. This process has brought me the greatest gift of my life - our son - and it also did a pretty damn good job of destroying everything else. I think back on the person I was in September 2011 and I barely recognize her.

Do I think "indefinitely" really means forever? No. I think it is likely that I will embark on another IVF cycle at some date in the future, but I have no idea when that will be. In case you stumble upon this blog between now and then, and you start wondering "hey, what ever happened to her?" I will tell you this: I'm fine. I'm not great, but I'm okay. My record across two IVF cycles performed with my own 28-year-old eggs, despite advanced endometriosis and blocked tubes, was good - I took home a beautiful baby boy. If that's your diagnosis and you want to have a child, then I hope you read my story and feel optimistic about your own chances. If you found this site by looking up some other combination of words - maybe "infertility anger" or "egg retrieval traumatic" - then the only thing I can offer you is the knowledge that you are not alone in your feelings and experiences.

To my readers in the past, present, and future: thank you for your time, and good luck. I wish you all the best.

I cancelled my transfer, but then I did it anyway, and things do NOT look good

Okay. Lots has happened since my last post - too much to go through in detail, plus it basically all sucks so there's no point in moseying down memory lane. Here are the bullet points:

- My transfer was set to take place on Monday, December 9. I needed to work out a conflict with my work that day and tried to reach the nice nurse I've been working with, but instead talked with her colleague who I barely knew. The conversation went about as badly as it could have gone. I was hysterical and my husband had to pick me up from work, then I went home and sobbed for the next ~16 hours. I couldn't calm myself down. In desperation, around noon the next day, my husband actually called my parents and they dropped what they were doing to drive to our house and try to help me somehow. I ended up taking the 2nd Ativan of my entire life (the first was right before my egg retrieval, funnily enough) and ate some macaroni and cheese with my mom on our couch while she tried to console me, and finally I fell asleep for about 4 hours. It was one of the worst experiences of my entire life, but I mean, this whole process has been characterized by bad experiences so I feel like saying to that weekend oh, get in line.

- What happened during that conversation with the nurse to upset me so much? I apologize that I am unable to provide any details. That's because things finally got so bad with my clinic that I'm working with patient relations for their larger practice. The next (and final) time I speak with anyone from that office will be with a mediator present. However, I don't know when that will be, because the patient relations rep I spoke with said that she had to check with her supervisor and risk management before she gets back to me. Risk management… I wonder what I'm getting myself into.

- By Sunday afternoon, after I had told my parents the whole story of this cycle (they had no idea it was  even happening) and after lots of discussion with my husband, I made the extraordinarily difficult decision to cancel the transfer that was now tentatively scheduled for Tuesday AM. We were prepared to just walk away from the cycle altogether. I wrote to my clinic asking them to remove me from the schedule and everything. But…

- On Monday, I spoke with two additional physicians who urged me to go through with the transfer. One made kind of a deus ex machina maneuver and got us back on the schedule for Tuesday. Harry came with me to the appointment and mercifully I didn't have to interact with anyone who had been involved in my care to date. I shudder to think what the rest of the staff were told about me but we just stared straight ahead as we walked through the waiting room, talked with everyone as little as possible, and got out of there as soon as it was over. From a medical standpoint, the transfer itself was pretty straightforward. I did feel anxious to be back in that room again but I also felt so much anger by that point that the fear was pretty drowned out by the adrenaline coursing through my bloodstream.

- I felt some light cramping on Tuesday afternoon and some heavy cramps on Wednesday. I even had some very minimal spotting on Wednesday evening and Thursday that I thought might be implantation bleeding. However, this morning at 5dp5dt, I had a completely negative pregnancy test. Before you start thinking "wait, this sounds promising, don't give up hope yet!" I will also tell you that this afternoon I started bleeding heavily. The only conclusion I can draw is that the timing of my transfer got so screwed up that somehow I was insufficiently suppressed (maybe? I really have no idea) and we transferred the embryo into a uterus that was several days past when it could receive it. But yeah, I have my period, despite the progesterone-in-oil shots (which really do suck by the way, they are indeed very painful and upsetting) which I thought would keep the heavy bleeding at bay until my beta hCG blood test on Friday.

- This is the sort of thing that I would love to ask my clinic about, but I'm pretty definitively clinic-less since I have officially terminated my professional relationship with them. (Taylor Swift said it best.) I am thinking I'm going to ask my regular OB-Gyn if he would be willing to put in an order for a beta test to confirm the failure of this cycle, after which I will stop all medications. Other than that I don't have a plan. I'm mourning the loss of this potential little life, obviously. Our son was actually not the embryo that the clinic intended to transfer back in January 2012 - they were going to transfer embryo #1 but then #8 started hatching and they changed their plans at the last minute - and I was haunted by the thought of that switch. In a single moment, their fates changed and one went into the freezer and one went into my uterus and grew into a baby. Now, two years later, the unlucky embryo is disintegrating within me and the lucky embryo is upstairs sleeping peacefully in his crib. Oh, G-d, what have I done.

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.

We're sorry that this happened to you, and we're here to help

That's what I wanted to hear when I found out that my endometriosis was extensive and my Fallopian tubes were blocked. I really thought that someone, somewhere along the way, would say it to me. Or I thought they would say it in their actions, kind of the way all of the oncology doctors and nurses kept telling my mom about how much they wanted to help her manage her side effects during chemo, there were support groups she could go to, and had she received the shawl that a local survivor knitted? From the moment of her cancer diagnosis, everyone she interacted with was unequivocally supportive, and when I got my infertility diagnosis, I naively expected the same.

I never heard the phrase above, or anything like it. I heard other things that my doctors seemed to think were helpful: don't worry about whether you get right back into ovulating after surgery, "we can make you ovulate, that's not a problem." I really wouldn't worry about egg retrieval, "we'll probably relieve around 80% of your pain." Oh, you're feeling anxious while you're lying on the table about to start your retrieval? Well, let me point out this machine, "it might make some beeping noises but don't worry, everything is okay." I understand that your belly is in agony and you haven't been able to eat anything for days, but "it's normal to have pain after retrieval."

I've spent tons and tons of time thinking about this, and I think there was at least one really big disconnect between me and my doctors: what I saw as a tragedy, they saw as an opportunity, and later as a triumph. They skipped right over the part where I was trying to process the idea of myself as a sick person - of course I was sick, otherwise I wouldn't be seeking out their help, duh - and jumped right to the treatment they thought would solve all of my problems in one fell swoop, regardless of how invasive and life-changing it might be. Endometriosis recurs and worsens when left to its own devices, and my best options to keep things dormant after surgery were birth control pills, Lupron injections, or pregnancy that was only achievable through IVF. I had been trying to have a baby without success for almost a year, right? Well, now there was a really obvious reason explaining our lack of results, and the pregnancy would be beneficial to my body overall. And then! Then I got pregnant, first try, single embryo transfer! My IVF cycle was a success! They were happy for me, and I wished I could be happy too. But the whole time this was happening, I was driving home after work every day trying to see the road through tears, waiting until I got home so I could go upstairs, lie on the bed in the dark, and really sob. Something was terribly, deeply wrong with me, no one seemed to care about me or my needs when there was this potential-but-then-actual pregnancy to consider, and every time I was confronted with someone telling me that the destruction of my body was good news or that the pain and discomfort I was experiencing during treatment was normal, I wanted to shout at them. Didn't they see? This isn't good! It's awful! And if it's normal, well, it shouldn't be!

The worst part by far - I can hardly type this - was that I kept thinking I would wake up one day and I would feel the overwhelming joy that I had always thought I would experience when I got pregnant. I did want children, really and truly. I grew up wanting them, my husband and I had always discussed having a family, and if you had asked me about my #1 goal in life, I would (and still will) answer "to be a mother." Some of the pain that got wrapped up in this whole mess was truly about infertility, though I know that my brief dalliance with the fear of never becoming a parent doesn't come anywhere close to the heartache that many other infertility bloggers have experienced. Much more of my experience, however, was about the lack of bodily integrity and helplessness I felt during a time of extraordinary physical and emotional vulnerability, and what I perceived as a lack of support for these feelings from almost everyone around me. I thank G-d for my son every day and he is worth every second of this pain, but oh, how it breaks my heart when I remember how I felt during his conception, gestation, and birth and I compare that to the joy and celebration he deserved.

Since this is my blog and I want to keep writing about the disconnects between what people said and what I heard, I'm about to take this normal-sized post and turn it into a MegaPost. TL;DR: I'm really upset blah blah blah. Now, to expand a bit on the examples above:

"Oh, don't worry about whether you're ovulating on your own, we can make you ovulate. That's not a problem."

My RE said this to me at our very first consult, when we knew I needed surgery to remove my endometriomas but we didn't yet know that IVF would be my only option to conceive afterwards. For the six months before this meeting, I had been diligently taking my temperature and tracking my cycles, and I was pleased to see that they looked pretty typical even though there had obviously been no results. I thought that was a good thing and an indicator that I was probably healthy. But during our meeting, my doctor only looked at my Fertility Friend printouts for a second before saying the above. I remember not knowing how to react - I think I went with a nervous smile. I was scared about the fact that I needed surgery in the first place, and I was clinging to any sign that my body wasn't as damaged as I feared. I suspect that my doctor was trying to be reassuring - "Don't worry Charlotte, even if your ovarian reserve is damaged then we have ways of getting around it!" - but the reassurance I was looking for was more along the lines of "That's great news, because it might make your treatment easier." Also: nobody is going to make me ovulate. I am going to take drugs to ovulate when and if I want to, thank you very much.

"The tubes were completely blocked. You'll need to have IVF in order to conceive."

This was my OB to me as I was lying in the recovery room after my initial surgery. He is an extraordinarily kind person, and I think he'd be horrified to know that when he said this, something within me broke irretrievably. I had thought, naively, that after surgery I might be "cured" of the endometriomas that had brought me there (as much as I could be cured of a chronic condition, anyway.) At the very least I expected to have bought myself some time to process the trauma of the surgery itself - the surprisingly upsetting knowledge that I had let strangers mess around in my vagina and in my body while I was unconscious - before I had to make a massive life decision about having a child. I knew there was a small chance they might have found cancer in me, and it was a big relief when he said earlier in this same conversation that all the tissue they removed appeared to be benign. But then he mentioned IVF, and he suggested embarking on it as soon as possible - given the timing of my cycle, it could even be next month! - and the general anxiety I had felt building in the weeks before my surgery crystallized into a very real, almost palpable, pointy-sided knot of fear. Holy shit, IVF, holy shit, holy shit. I have to do IVF and I have to do more tests and more procedures and let more people violate my body and what if it works and I actually get pregnant and then I need even more exams and procedures and I have to give birth and somehow take care of an infant while I feel so unbelievably terrible about myself?

"I wouldn't worry too much about egg retrieval. We give you a local around the cervix and then we only have to puncture the wall of the vagina twice, once on each side. There aren't many nerves once we're in the ovary and most people aren't too bothered by it. We'll also give you versed and fentanyl, and that will probably relieve around 80% of the pain."

This was my RE to me, in his office in early January when we were going over the plans for my IVF cycle, and the memory of this conversation was and is so upsetting to me that it's taken days to type it out. I know he was aiming for reassurance. And on the surface of it, look at all the things he's offering me! Local anesthetic, minimal vaginal punctures, systemic analgesics, and the experience of other patients who said it wasn't that bad. But this conversation marked the moment that my anxiety and guilt about infertility and IVF first turned into anger - anger that was initially directed toward my doctor. I think I stopped short of pounding my fists on his desk, but I definitely raised my voice. It wasn't good. The 80% thing threw me for a loop in particular, because it felt like a calculated judgment - infertile people only deserve partial pain relief. Because this happened to you, because you got endometriosis and it permanently damaged your body, you are now marked for extra suffering. Other people conceive by having an orgasm, but you, you we're going to torture. While you are awake. So you get to remember it. And it's not like I had this conversation in a vacuum, never having heard of egg retrieval protocols at other clinics - for better or worse, reading so many other infertility blogs had given me a general idea of what to expect. People kept talking about their "anesthesiologists" and "going to sleep," and at first I was simply surprised that my clinic did things differently. Then another patient at my clinic warned me that she had found this procedure very painful, so when it came time to discuss the actual details of my cycle with my doctor, I suggested that it might be comforting to have my husband in the room. My doctor countered with the statement above and denied my request to have my husband present. I would chalk this one up to another miscommunication - the things I would have found reassuring just weren't the things he happened to say - but the reality is that he offered me everything his practice could provide (they don't have the ability to administer propofol, which many practices use in their sedation so the patient has no memory of the procedure, and they don't allow family members in the room according to their policy.) And the repeated suggestion in this conversation and others (see below) that I was the outlier, that their other patients handled it better, meant that all the anger I felt started to turn inward toward myself.

"Now, I'm going to hold your hand, okay? And I know you're feeling anxious, so I want to make sure I point out that machine over there. It's got lots of buttons and it's going to make some beeping sounds, but I don't want you to be nervous, it doesn't mean anything bad. It was probably designed by a man, they don't always understand that these things can be annoying."

This was the nurse coordinator at my IVF clinic, with whom I met prior to my retrieval as part of the fallout from when I "expressed my concern" to my RE (see above.) After the not-very-productive conversation we had where she tried to reassure me about the procedure in advance but ended up getting pretty defensive, I suspect that she made sure that she personally would be the nurse holding my hand throughout in an effort to help mitigate my concerns. This was a really, really nice gesture... except that the things she wanted to reassure me about were entirely not the ones that bothered me. I remember that as I lay down on the bed and put my legs in those awful, awful industrial-strength stirrups, she made a point of showing me the equipment in the room. She mentioned that some of it would beep occasionally and said that it was likely designed by a man, which, what? What does that have to do with anything? And also - I am freaking out because I am about to have a gigantic hollow needle shoved up into my vagina so my flesh can be sucked out of my body, not because there's an infusion pump in the room! I know she meant well, and I know that there wasn't much positive news she could tell me about the giant needle, so she was trying her best to demystify everything else. Except I didn't need it demystified - I mean, even if I didn't have any professional connection to medicine, I still live in North America in 2013 and use a computer and carry a cellphone and I've installed smoke detectors in my home, so things that beep aren't exactly a tremendous mystery. What she thought was helpful, I thought was condescending.

"Hmm... yes, I remember Dr. X saying that he punctured an endometrioma during retrieval, but that shouldn't have much effect on your recovery. It sounds like the pain you're describing is normal."

Same nurse. Still condescending. Let me back up a bit here - when my RE punctured my endometrioma, it was by far the most painful part of my retrieval. I continued to have significant belly pain while in recovery, which seemed to surprise the nursing staff. I spent the next three days trying to remain as still as possible and eating next to nothing, because every time I had any kind of movement within or outside my belly it was like having bad endometriosis cramps. I'm talking about rationing the water I drank so I didn't have to walk to the bathroom any more than the bare minimum. At this point I was about 3 months out from my laparoscopic surgery so the memories were very fresh, and I remember thinking that the recovery experiences were about equivalent - except that with my IVF cycle, I couldn't take the strong painkillers I had taken for my surgery, and I didn't have the days off from work. So when this nurse called me the Saturday after my retrieval to ask how things were going - a very nice thing to do, especially on a weekend! - I was past the worst of it, but I did mention that I had been in a lot of pain, perhaps because of the punctured endometrioma and the fluid that was released into my abdominal cavity? She was pretty dismissive of my theory and said that the pain I had felt was normal. Again, she might have meant well (and I could easily have been wrong about the endometrioma puncture and the two things were unrelated) but instead of feeling reassured I felt like I was being chastened for complaining.

None of this was a major problem, really. People have miscommunications all the time. Even with everything that happened where I felt like I was completely alone in my suffering, completely at fault for my diagnosis and my reaction to treatment, I think I would have moved on long ago if it hadn't been for my memories of the egg retrieval itself. That's the experience that keeps replaying itself when I close my eyes to go to sleep at night. It's what I think about when I get up in the morning - you know how sometimes you wake up and you can't quite remember something really big? And then the memory comes flooding back and you think, that's right, I did get a raise yesterday! That's what happens to me every day. I wake up and everything seems okay until I remember: stirrups, low lighting, surgical scrubs, you let someone do this to you. I'm varying degrees of functional throughout the day depending on how distracted I am - sometimes I'm fine, sometimes I'm sobbing. But when it's time to go to sleep at night, I fight it for as long as I can because I know that in the space right before unconsciousness I have to see everything again. There's no distraction at that point - just me, looking at my doctor's eyes above his surgical mask and below his cap, trying to be friendly as he waves at me from between my splayed legs. Over and over. Every day is the day of my egg retrieval, so every day is the worst day of my infertility journey. It just. Doesn't. End.

Trauma, Recovery, and IVF

When I was sixteen, I went through a tough event at high school. I won't get into the details here except to say that it taught me one important life lesson. That lesson was that there is no cavalry coming. No one is going to save you. You are responsible for saving yourself. Bad things happen and even if you played no role in causing them, that doesn't matter. There won't always be justice and the people you trust to protect you won't or can't help you when you need them. As Blazing Saddles illustrates, son, you're on your own.

That traumatic event is connected to my recent departure from the blogosphere. (And let's just pause for a second here to acknowledge how very small my corner of the blogging world is: I do have a handful of regular readers, but most people who visit my blog are searching for pictures of my pregnancy tests so they can compare them to their own; sorry, guys, for letting you all down. Hope you found someone else's urine to look at.) It's connected because in both cases I felt completely blindsided by a tremendous life change, I looked to people in positions of authority for help and comfort and didn't find it, and it took a very long time for me to recover psychologically. That's how I feel about my infertility diagnosis and treatment experience, from the distance of almost two years: it was a trauma. A huge, life-altering trauma that still has me floundering.

To bring you up to speed, here's a brief synopsis of events that have taken place since O's birth last fall:

October: Have baby. Labor and delivery go pretty smoothly and we are blessed with a healthy, adorable, bouncing baby boy. I notice that I have a few weirdly obsessive nights where I keep thinking about the birth, and it takes much longer to feel physically "recovered" than my doctors predicted, but I move on to focusing much more on my delicious little newborn than my IVF cycle, my pregnancy, or my delivery.

December: 6-week followup appointment with OB. Have promising ultrasound showing no major endometriosis-related problems, decide to start the mini-pill, generally feel optimistic about life.

January: Go back to work. O starts daycare, immediately gets a series of minor colds and coughs, and everyone's sleep and commuting schedules suffer. Still, as the days get longer and the sleeping arrangements get back on track throughout the spring, I continue to feel pretty great.

April: Find out that the events of the past year and a half have had external consequences that I genuinely didn't see coming. Memories and anxiety that had previously been held at bay come flooding back. Another ultrasound shows that my endometriosis is about as quiet as I could hope, but it doesn't matter, because everything else is completely falling apart.

June: Find out that our current insurance plan - the one that covers four cycles of IVF at one clinic and one clinic only - will be ending in June 2014. Would we like to have another child between now and then?

July: After a tremendous amount of discussion, agree to see a therapist. Spend 45 minutes of a 60 minute appointment grilling her on her treatment style, philosophy, approach to patient care, and make her agree to send me a copy of her notes. Tell her the digest version of what's happened in my life since 2010 and she makes some sympathetic noises. Three weeks later she actually does send me the notes, which thankfully are unobjectionable but are also completely unhelpful. Decide not to return.

August: Go for appointments at two different fertility clinics. Clinic 1 is where we went for the fresh cycle that created O and where I left my egg retrieval feeling utterly destroyed (a feeling I re-experience daily and which generally leaves me sobbing and gasping for air, but which seems weirdly right when we actually have to walk into their building again.) Clinic 2 is brand new in every sense of the word - their offices are still partially under construction, even.

Here's what we learned at Clinic 1: they consider me a success story, what with my single cycle of IVF and my single embryo transfer and my term birth and my (if I do say so myself) utterly gorgeous son. The conversation takes a bit of a turn when I mention that I think about my egg retrieval all the time, I'm completely haunted by the memory of it, I'm generally miserable, etc. etc. Our RE is sympathetic about my bad experience and understands why I would choose to go elsewhere for further treatment, but it's clear that the financial implications of my insurance coverage are not his area of expertise. We talk about how to transfer embryos to another clinic if need be. We also talk about what would be involved if I chose to somehow get past my earlier experience and have a Frozen Embryo Transfer (FET) cycle with them. It's nowhere near as invasive as what I went through before, obviously, and they even say they prescribe Crinone for progesterone support so I wouldn't have to do those vile progesterone-in-oil shots. And to his eternal credit, right before the end of the appointment, our RE does admit that "we tried not to hurt you, but it sounds like we did hurt you a little bit, and we're sorry about that." I leave feeling like we repaired the relationship quite a bit, but part of me wished that I had abandoned RationalCharlotte at the door and taken advantage of the opportunity to scream and curse at someone who was "responsible" for all of my unhappiness. Except I didn't, because he isn't. And while I was sitting in his office and during the weeks following our visit, my anxiety level has continued to be through the roof - especially when I think about even stepping foot in that building again.

And here's what we learned at Clinic 2: they will knock me out during egg retrieval if it ever comes to that (which it probably wouldn't, because that would be very tough for us to afford just paying cash, but it's still the first question I asked.) They're willing to accept a transfer of our frozen embryos and work with us on a FET. They too are sympathetic about how upset I've been - maybe I'd like to try some valium before a procedure, or investigate acupuncture, or join them for Fertility Yoga on Tuesday nights? The price tag for a FET without insurance coverage will be steep but not prohibitive. However, they do use progesterone-in-oil shots, and the minute I hear this the whole world seems to dim for a moment. Those needles are long and thick, injecting them into my ass is humiliating, the process as well as the aftermath is painful, and my heart rate skyrockets when I so much as think about the shots. And even in a new space, with new faces, the mere discussion of what's involved in infertility treatment is enough to make me feel completely terrible.

So, what do I do? Start blogging again, it seems. Other than that I have no idea.

My Body's Doing Great; My Mind, Not So Much

First, the really good news: a followup scan of my ovaries revealed that they look healthy and normal! Well, mostly - there were two small endometriomas as of December, and although it does appear that they're still there, they're actually smaller than they were the last time we saw them. I guess that mini-pill really is doing something.

I don't mean to minimize the above. This is a really, really big deal. When my doctor confirmed that I was stable for the time being, I felt a tremendous weight lift off my shoulders. I've just bought myself six months of the status quo (knock on wood), and that's a pretty good quo if I do say so myself.

But. But but but but but. For a variety of reasons, the last three weeks have been pretty awful. I've been re-confronting a lot of my negative feelings about infertility, pregnancy, medical care, my body, and my own mental health. It's been over a year and a half since I found out that I was infertile. A very eventful year and a half, but still - this is not exactly breaking news. I am extraordinarily lucky and I feel so grateful that I have a healthy child after my first cycle of IVF. Yet I spent most of the past three weeks on the verge of tears while I waited to hear the all-clear from this scan. Why?

First of all, my infertility journey isn't over. Not by a long shot. I have three embryos on ice from the cycle that gave us our darling O, and I feel a responsibility to give each one of them a shot to grow into a baby. This means that there will come a day when I have to walk back into the fertility clinic that I associate with so many bad memories, sit down across a desk from my doctor, and go over my future plans with him. Then I'll have to go through at least one Frozen Embryo Transfer (FET) cycle with them - the same doctors, the same nurses, the same waiting room, the same exam rooms. I cannot tell you how much I am dreading this. And if my recent scan had come back with any indication that the cysts were growing, it was possible that I would have set up that next fertility appointment as soon as the clinic had an opening in their schedule. So while I'm thrilled and relieved that I bought myself at least another six months, I still know that this is going to happen at some point, and I do feel a bit like all I got was a stay of execution and not a full pardon.

Also, there was a bad moment during the scan when the ultrasound tech saw something odd in my uterus (no, not a baby, I promise) and asked if I had had an endometrial biopsy. Let me assure you now that I have no indications that would suggest I needed an endometrial biopsy, and when I spent a few minutes with good old Dr. Google looking at related ultrasound images after the appointment, I think that all the tech was asking was if I'd had one in the past since it might have explained a particular finding. I haven't, and the finding was benign, so there's nothing to worry about. Except that in between when she said it and when I got back to my computer and did my research, I took two minutes to look it up on my phone, and learned that it's usually an in-office procedure that is performed without sedation even though some women find it painful. This was enough to send me into a total tailspin. It's hard for me to articulate how upset I was even reading about women's experiences with endometrial biopsy; as I write this today, just getting the link for the sentence above I lost about twenty minutes reading comments and holding back tears. And this is for a procedure with which I have absolutely no connection! The problem is that I know someday, someone will recommend that I do have an endometrial biopsy - or a hysterosalpingogram, or a dilation and curettage, or any number of other gyn procedures that are invasive and painful up to and including another fresh IVF cycle - and I will just want to die.

Wanting to die when you hear that other people - who, let's recall, are not you - have had or are going to have painful gyn procedures is a bit extreme. I don't have any actual thought of suicide (shudder), I just have this idea in my head that experiencing more trauma between my legs would be so terrible that it seems incompatible with life as I know it. And that's not right, I know it isn't. Most of the time I feel fine - really, overall things are going well, and it's springtime and I'm wearing the sundresses I couldn't fit into last year and my baby has incredibly kissable cheeks - but I'm concerned that something so relatively minor could send me off the rails. Concerned, and angry, and ashamed, and all of the feelings that I struggled with last year. Clearly they're not just in the past.

That Mythical Second Pregnancy

I suppose opinions might vary on this, but on my list of things I DIDN'T want to experience while taking care of an infant, contracting a nasty stomach bug was right at the top. Thankfully O is fine - we think I might have gotten food poisoning, actually, and since he rarely eats takeout he probably wasn't exposed - but the past few days were not pretty. We've spent all this time and energy worrying about how to keep O safe from the influenza epidemic that's affecting the entire country, but it never occurred to me that I might suddenly become nauseous, feverish, and spend two days unable to get off the couch. Harry helped out as much as he could, but at one point I was alone and I needed to get O from our living room downstairs up to his nursery, change him, and put him to bed for the night. I swear to you that accomplishing that task while trying not to vomit was equally as difficult as actually giving birth to him back in October. So why am I already obsessed with planning for baby #2? I mean, I spent weeks upon weeks of my pregnancy feeling debilitated with nausea. I also lay on the couch for entire weekends and routinely slept 9-10 hours on weeknights, and still felt exhausted. I complained about being pregnant to anyone who would listen. Yet even a tiny reminder of that nausea and exhaustion wasn't enough to dissuade me from daydreaming about when I can start my next IVF cycle.

It's not just that I'm excited about the possibility of having another baby - it's more than that. I'm also incredibly nostalgic for my pregnancy, believe it or not, and that feeling started almost as soon as they placed my tiny little boy on my chest in the delivery room. Right after we got home from the hospital, only one day after my official due date, we brought O to the pediatrician to check his bilirubin levels. Their office is located on the same floor as a very busy Ob-Gyn practice, and on our way in we encountered no fewer than three pregnant women. One looked like she was ready to deliver, her belly just as huge and as distended as mine, now deflated, had been mere days before. Did I give her a sympathetic glance and a cheery "Good luck!" like some sort of recent Pregnancy Academy graduate? Nope. Instead I got really sad, because all I could think was, I wish I were still pregnant. And it didn't stop there. Right up until I had passed what would have been my 42nd week, every day I would think, You know, I could still be pregnant. Right now. A lifetime has passed since O was born, but it didn't have to work out that way. We could still be the way we were, living in a state of nervous excitement, sleeping long hours, fielding phone calls from expectant relatives, feeling our little boy wriggle and kick from inside my belly. And when the sadness peaked, I would console myself by thinking, I can do this again. I can get pregnant again - probably. I can try, anyway. I bet it will work. And then I get to go through this incredibly special thing, this absolute miracle, at least one more time.

At this point, I'm going say what longtime readers have been thinking: are you CRAZY? You hated being pregnant! Don't you remember the constant stress, the worry, the wear and tear on your body, the daily obsession with whether the baby was going to survive, not to mention the psychological damage from a traumatic IVF cycle? You were miserable for your entire first and second trimesters - as in, really miserable, clinically miserable, miserable enough that you didn't dare bring it up with your doctors because you knew they would be horrified and start talking about drugs and therapy and all sorts of unpleasant things. That kind of miserable. All you wanted was the baby to be out and safe so you could have a chance at feeling like yourself again; you wanted him to be happy and healthy and now he is and why isn't that enough?

I've spent the past three months going over and over these questions, and what follows is my best guess at why I've had this unbelievably surprising reaction:

- Hormones, plain and simple. Postpartum changes are generally acknowledged to be terrible and make you think crazy things. (By the way, did anyone else catch the fertility drug references on 30 Rock recently and maybe laugh a little too knowingly?) But... it's been three months. And I still think all the time about getting pregnant again.

- We really do want to have another baby. Harry and I both grew up with siblings, and the picture in our heads of our eventual family has always had more than one child in it. I'm often hesitant to bring this up in conversation because I know that people can hear "we want to have another baby" as "my existing baby just isn't enough to satisfy me," and that's not it at all. I would frame it more that we love O so much, we can't wait to love his sibling(s), and we're excited for him to love those siblings as well.

- I just want to get this over with. Who knows how much longer I have with my ovaries intact? Could be months, could be decades. (In other words: my biological clock is ticking!) There's that, but there's also the outgrowth of my initial hesitation to have a baby. We've now had a baby, he's here, he's wonderful, and he is also most definitely a ton of work. I'm back to looking at my other life goals with a bit of a longer lens and thinking, you know, in ten years maybe I could do this... in fifteen, maybe that... but if I extend my childbearing years, those goals just get farther and farther away. If we're committed to another child, then let's just get the show on the road already.

- Pregnancy is really special. Yeah, I'll go ahead and say it. I miss the attention more than I would have ever predicted. But I also miss walking around with an amazing secret inside of me. It was a time outside of normal cares and concerns; everything else in my life took a backseat while I concentrated on my #1 job: create a tiny human. Now that things are back to "normal," I am surprisingly wistful about the ability I had over the last year to determine what was important and what wasn't. In other words, I'm back to sweating the small stuff.

- I feel like I screwed it up last time. Oh, it's not like I did something really awful while I was pregnant that I now regret. I didn't ingest banned substances or spend nine months skydiving and eating sushi and generally ignoring all of my obstetrician's advice. But I did spend a large amount of my pregnancy weeping, fretting, and generally feeling sorry for myself and my baby. I know I can't control for all of those things (or for actual medical complications), but I also can't imagine how different it would be to go through a pregnancy that felt... joyous. Or at least not so upsetting.

So we'll see. For now, just to follow up on a recent post, I did decide to take a progestin-only pill while we wait to see what my ovaries do next - for the moment, they're stable with endometriomas between 1-2 cm on each side. I feel generally okay although I think I'm a bit "flat" compared to my usual pre-surgery, pre-IVF, pre-pregnancy self... then again, I have no idea how I would feel with just the hormonal changes that come along with breastfeeding, so it's hard to blame anything on the pill. Nothing remotely interesting will happen in my reproductive life until at least April, which is O's six month birthday and the absolute earliest anyone would entertain a discussion with me about another IVF cycle (and even I recognize that jumping right back into things this soon isn't great for my body overall.) So we wait. Who knows, by April I might feel differently, and in the meantime, I have the most wonderfulest little baby in the world to snuggle and love.

Next Steps and Continued Hormonal Funtimes

Hey, look, we've made it to six weeks! Good job, everybody!

Six weeks means that O is smiling (sometimes), cooing (occasionally), and extremely cute (all of the time.) It also means that I had my six weeks postpartum checkup, which ordinarily would have focused on healing Down There and birth control plans, but was a bit more interesting for me. The endometriosis that got us into this whole IVF mess is a problem that won't go away, so there are a few things we're going to continue to monitor going forward.

First of all, some good news. I passed another milestone this week: I'm off Lovenox! No more enoxaparin sodium for this girl, at least until/unless I get pregnant again. For those of you keeping score at home, this was nearly a full year of daily injections, with a few short breaks here and there. Someday I'll post the total number of needles that it took to get O from theory to reality, but for now I'm content just watching the bruises fade.

Also, the preliminary results suggest that the endometriomas have not recurred (or are pretty small if they did.) The one on the left was 4 cm right before my IVF cycle and we'll see what continued breastfeeding does to keep things quiet. I've seen it described as "natural Lupron," which would be nice since I want to avoid taking that stuff again if at all possible.

Since I had a complicated pregnancy, I also wanted to go over whether I'd have to be concerned about attempting any other pregnancies in the future. Yes, I will likely have to be on Lovenox again, but my risk of placenta previa is only slightly higher than normal and the fact that it resolved this time is a good thing. I also had some weird liver stuff that popped up on my bloodwork at the very end, but that just means they'll be on the lookout for pre-eclampsia as they would for anyone. Overall, I guess I'm not a terribly complicated patient when it comes to another pregnancy, which is nice!

Now for the tricky stuff. The endometriosis which caused my tubes to scar over and my ovaries to grow endometriomas will theoretically get worse every time I have an ovulatory cycle (though how much worse, and how much it will bother me, is kind of a question mark.) Ordinarily I would probably be prescribed a combination estrogen/progesterone birth control pill, but thanks to my DVT, I'm not a good candidate for that. I'm likely headed towards a progestin-only pill or maybe a Mirena IUD - and yes, I really am considering taking the pill despite my earlier protestations about systemic hormones. Why? Well, partially because the side effects are theoretically less problematic than the combined BCP, and partially because I can wrap my head around taking a pill if I know it's only for a short period of time.

All this to say: it's a matter of time before we're back on the IVF train. Don't think I've forgotten about those three embryos on ice, and because of a combination of family and medical factors, we're probably looking at attempting another cycle in a year. Or less. Or maybe a little bit more. There are a lot of moving parts to consider, even though we're committed to giving O a sibling - or at least trying our hardest to do so. We've been so blessed to have him, and I hope and pray that our luck continues!

Childbirth Class

So. Childbirth class. Harry and I went in expecting it to be an opportunity for unintentional hilarity, and we definitely got that. I didn't storm out in tears, which I actually thought was a distinct possibility when the day began, so we will count it as a success.

What did we learn? Well, the class as a whole learned about the stages of labor, techniques for breathing through contractions and pushes, a couple of the interventions that might be used, protocol for births at the hospital where we'll be delivering, and we went on a tour of the facility. The instructor was approachable, knowledgeable, and had a good sense of humor (case in point: laboring by standing with one foot on a chair is colloquially known as the "Captain Morgan" position; laboring by kneeling in front of a chair and hugging it is the "After the Captain Morgan" position. Don't have to tell me twice, lady!)

But what did I learn at this class? Excuse me while I bust out the bullet points:

- Most people have "normal" labors and deliveries. The odds are that I will too, anticoagulation worries aside. Wait, what? The only birth stories that stick in my head are the bad ones, of course. Or are they? What counts as normal? How much intervention can you have and still call it normal? Can I really expect to go into labor at home and spend several hours having mild contractions while my husband keeps me calm and feeds me light, easy-to-digest foods? I put a lot of faith in statistics and it's true, most babies at this hospital are born vaginally with little to no complications, so I have a good chance of being in that group. The cynic in me whispers, "yeah, but most people have normal conceptions too, and look how well that turned out" but it did get me thinking that this might not be a total sh*t show from start to finish.

- Their email notification system is busted. I swear! I made Harry check the website right before we left the house because I thought we might have to bring something and he confirmed that there was nothing about that, and we had a little printout showing that we had paid for the class so we were all good there, so off we went. And then we arrived, and every other pregnant couple walking into the building was holding two pillows, and argh! I. Never. Received. The. Pillow. Email. Not even in my spam folder. And maybe if it's so important you should put this whole pillow thing on the website! (It was totally fine, btw. Another couple lent us one of theirs since you really didn't need two. But still.)

- There is such a thing as labor massage, and some childbirth educators expect you to learn it in a darkened conference room with a bunch of other strangers all lying on the floor next to each other on exercise mats. Props to the guy who, when she turned the lights back on, shouted "What the... this is not my wife!" and broke the tension.

- I am on the high-maintenance end of the spectrum when it comes to patient involvement. (Raise your hand if this is coming as a surprise. Yeah, that's what I thought.) Case in point: the instructor mentioned two common interventions and how they work - breaking the amniotic sac and administering a Pitocin drip - and presented the Pitocin thing as a decision that the doctors would make if they thought you needed it, even though it would make your contractions longer and stronger. Nothing about discussing it with the patient beforehand; it seemed from her description like they might just come in and hook up a bag of Pitocin and then your head could start spinning like in The Exorcist. So when she asked for questions, my hand went right up. (Be glad I didn't run to the front of the room Jerri-Blank-style and yell "I've got something to say!") I wasn't as coherent as I would have liked, but my point about how patients need to give informed consent to interventions ultimately came across. It's kind of strange since this is a basic tenet of health care, and at first she started to reply that the doctors and nurses just wanted a good outcome, and I had to say again that actually, there are specific guidelines about interventions that can be performed without patient consent. Obviously everybody shares the same goal of a healthy baby and a healthy mother, and the goal is always a mutual decision based on a thorough conversation between the patient and caregiver, but yeah. That informed consent thing will get you every time.

- I think I can expect some of the compassion and hand-holding for the delivery that I didn't get, and really could have used, during my IVF conception. I've written extensively on here about how much I freaked out during my cycle, in part because I felt like my diagnosis of infertility was a huge and horrible bombshell and I wanted my reproductive endocrinology clinic to acknowledge that. I wanted them to say how sorry they were that I had to use their services and how they would do everything in their power to keep me as comfortable as possible during my treatment. Instead, I had some pretty impersonal (and literal) get-in-line-with-the-other-infertiles experiences and a legitimately painful and upsetting surgical procedure. On the other hand, the tour of the hospital's Labor and Delivery floor revealed that it had been recently renovated to make it feel more comfortable and homey. They talked to us about exercise balls, hot showers, and jacuzzi tubs. Nobody is going to make me take out my contacts, shave my personal region, or require me to have an enema. The kicker was when we were encouraged to bring in pictures, other decorative items, and - get this - air fresheners to make it seem less like a hospital. Before my IVF experience, I probably would have scoffed at hearing this, but now it actually made me feel much better. It's not the tubs or air fresheners that matter, it's the realization that someone cared enough to make them an option, and if they care about how the place smells, they probably care about me as a person, too.

In summary: yeah, I probably am going to have to give birth in the not-so-distant future. It has a shot at not being a terrible experience. And if I show up in active labor and am told I should have received an email about bringing along two pillows, I am going to march right on down to the IT department and give them a piece of my mind!

The Belly Button of Doom

It's coming.

Every day it's poking out a little bit more.

It's...

MY BELLY BUTTON! SHRIEK! COVER YOUR EYES IN HORROR!

(I don't have tails - yet - but I'm pleased to see that Melusina, 

inspiration for the Starbucks logo, also had an outie.)

And no, Vanessa Minnillo, I don't think it's like having a third nipple. But then I also didn't pose for any sunset babymoon pictures, either. That's cool though. Yours look great.

In other news, has anyone else read the article on IVF that was in the New York Times this morning? I feel like it isn't particularly controversial - in fact, for those of us who have been through this process and know how it works it's downright boring to read - but I'll be intrigued to see if it comes up in conversation today with the NYTimes junkies I know. For the record, 22 follicles, a mild case of OHSS, three frozen embryos, and one pregnancy later, I'm not sure they could have sold me on low-dose IVF at the time of my cycle. I'd rather get all of the unpleasantness over with as fast as possible, especially if insurance picks up the tab. But knowing what I know now about the risks of hyperstimulation? Hmmm. Maybe. Anyway, back to what's really important here - my belly button. I think it needs its own theme music, like in a horror film, so people know when to run screaming from the room! (It's okay, belly button. I still think you're pretty great.)

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.

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???