Our TTC History

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

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

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

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

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

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

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

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

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

No, Infertility is not Cancer

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

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

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

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

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

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

How We Got Here

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

I was not offered admission to his school.

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

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

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

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

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

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

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

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