Monday morning was DEFINITELY a relief

The only weekend that comes close to this one in terms of angst, lack of sleep, and general crappiness was January 7-8, 2012. Once again, 4 AM seems to be the magic hour; it's when I finally went to sleep on Saturday ("Friday night") and it's when I got up this morning. HAPPY MONDAY, EVERYBODY! UP AND AT 'EM!

The weekend was made even better by the fact that my husband had a minor car accident on Saturday. Thankfully he is fine, but it could have been so much worse. I can't even think about it without the nausea starting to build, so that's really all I can say.

My MRI is this afternoon and I'm already strategizing how to get my results right away, rather than wait for my appointment with the oncologist next week. I think I'm going to press for an OB-Gyn to go over them with me before I leave their office complex… there's no way I'm going to have the uncertainty of this hanging over my head over the entire Thanksgiving holiday. I'll be really nice about it but I'm not leaving there without an answer, even a partial one. I have this giant work event tonight (perfect timing, as ever) so I can't fall apart no matter what happens. Busy day… I'm off to get a bagel.

How do you like me now?

I have a complex cyst on my right ovary. Given my age it's very unlikely that it's malignant (really, look it up, I'm not just saying that) but that still means the following:

- I got a blood test for my CA-125 level today!
- I get to have an MRI!
- I get to go meet with a gynecologic oncologist!

No word yet on whether my FET cycle will simply be delayed (if all indications come back that the cyst is benign) or if it will be cancelled altogether (which could happen if the cyst is cancerous, or could happen if the testing to rule out cancer pushes my transfer date back past the embryology lab's annual closure over the Christmas holidays.)

I knew it couldn't possibly be that easy.

Not that I'm complaining

I've tried to write this post several times, but because I keep checking updates from fellow IF blogs before I start typing, I haven't felt able to go through with it. What do I have to complain about, honestly? It takes about five minutes of clicking around to find heartbreaking, awful stories from women who have lost their babies, whose cycles did not work, who are preparing for life without the children they so desperately want. And then there's me, trucking along just fine on my FET cycle, heading home each night to my healthy son and my loving husband, and I have the gall to start moaning about how terrible things are?

Yup. Brace yourself (or stop reading), because I am totally about to complain. But here's the thing! I don't complain to anyone in real life anymore. I don't talk about this cycle with my husband, my parents, my siblings, my friends, my coworkers. As far as they are concerned, there is no cycle happening, no attempt at another pregnancy, everything is just status quo. (I should clarify: my husband knows that this cycle is happening, but that's all. I do not discuss it with him.) It's my first time really experimenting with denial, and I have to say, it's going much better than I expected. A lack of sympathetic faces in my life means that I don't turn to them when things get tough. And if I don't have the option of getting any sympathy - if it simply doesn't exist - well, I find I don't need it as much as I thought I did. And then at least I can cling to that thought - as bad as it gets, as bad as it has been, at least I haven't burdened my loved ones with my inability to cope.

And what is there to cope with, really? Here's a brief summation of what's happened in the last few weeks:
- Right after my SHG, while I was on the antibiotics they prescribed, I got a yeast infection. I tried OTC remedies unsuccessfully for two days before finally procuring some prescription-only Diflucan (don't ask - let's just say that I managed not to hassle my OB or RE.)
- As the yeast infection was coming to an end, I started bleeding heavily. It lasted for three weeks and was similar to my post-partum bleeding, with clots the size of walnuts. I went through a staggering amount of feminine supplies. Another period? Just more irregular bleeding? Who knows!
- I started Lupron injections and got a headache that never really goes away.
- I had a monitoring ultrasound and bloodwork that looked good enough to move on to the next phase of my FET. The 4-cm cyst had gotten a bit smaller, from what I could tell anyway (the OB's office was under strict instructions not to interpret my results and wait for the RE to weigh in, but then all the RE said was to proceed, so I don't really know what's happening with that.)
- I started taking oral Estradiol and injecting myself with Lovenox, since I'm a clot risk after the DVT in 2012. The Lovenox has given me giant, painful bruises on my belly that I believe I have successfully concealed from everyone besides my husband - and even he didn't see them for the first few days, so artful was my dressing/undressing.

None of this is particularly terrible, but yeah, since we're complaining and everything, I will tell you that I've been doing my usual amount of sobbing behind dark glasses. I feel pretty decent about 90% of the time, it's just occasionally that the self-loathing takes over. I start feeling sorry for myself, and then I hate myself even more for wallowing in self-pity, and usually the cycle continues until something external breaks it. Which is often - I'm crazy busy with work, travel, and life in general. That pace is unlikely to slow down for at least another month, which ordinarily would feel daunting but these days is a very welcome distraction.

Next up: at least one more monitoring ultrasound coordinated through my OB's office, another two weeks on medication, and the transfer itself at my RE's office. I am trying to figure out how to casually bring up the topic of the transfer when my nurse calls me in a few days with next steps... for instance, I don't want to put my legs in the stirrups. Could they do the transfer with my feet flat on the table? And what about my RE himself, is it worth even bringing up whether it's possible to have someone else do it? I get the feeling that his embryo transfer technique is probably the best in the practice, and of course I don't want to have to go through this ever again so I want to do everything I can to achieve a pregnancy on the first try, but I am horrified at having to physically put myself in the same position that I was in for my egg retrieval. I don't know. Sometimes I feel angry and empowered, but sometimes I just feel so defeated - sure, go ahead, do whatever you want to my body, it's not like it's worth anything anyway.

And then... then, in December, I'll find out whether this worked. Either way I will have a whole new set of decisions and obsessions. I'll come back here and complain some more, so get psyched!

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?