October 25, 2014

Quick Update

I've felt bad about not checking in on here. You know how you want to make a post, but you keep deluding yourself that you are going to wait until you have more time to do it justice, but then you never seem to have that time or energy? Yeah, that's what I've been doing. So I am just going to briefly say that my fertility journey has taken a turn for the screeching halt. One month ago, prior to beginning our last IVF and FET of our normal embryo, they found a suspicious mass during my mammogram that has turned out to be breast cancer, early stage two. I've been going through the process of becoming a medical expert in a new field. My prognosis of beating the cancer is good, but it is going to be a long road of chemotherapy, surgery, more chemotherapy, and hormonal therapy.

I just don't have the strength to write about it too much right now, but I wanted to at least put a placeholder here because I HATE it when I read blogs and they just abruptly end, leaving me hanging, confused, and concerned. I don't know for certain what all of this means for my dream of starting a family. Right now, I am forced to just focus on trying to get well and survive this attack. I will still be reading my IF blogs and rooting for all of you still in the thick of things.

September 8, 2014

Anniversary

I was pleased to notice that my blog started just over a year ago, and this is my 52nd blog post, which means that I've averaged about once a week with entries! Not bad for a chronically unreliable journal/diary keeper! Even though there were busier and slower time periods during the year, I am going to pat myself on the back for keeping the blog current in general. It's nice to have a record in existence to aid my failing memory on details. The blog has also helped cement the cyclical pattern of all the emotions. While I tire of going through some of the negative things over and over, it is nice to see the more upbeat moments recorded alongside them.

Nothing much has really been happening on the IF front here. I started taking BCP in advance of my third and final fresh IVF starting later in September. I had a repeat of my mock embryo transfer/saline sonogram, the previous one being in January. Since I had the pregnancy, miscarriage, and D&C in March and April, they just wanted to be sure nothing looked amiss in my uterus before we plan to transfer the one golden embryo we have on ice. I also am awaiting my mammogram results (yay turning 40) from last week's scan. Hopefully nothing funny going on with that either.

I have been reminded again how happy I am that I switched RE's. My RE has phoned me several times trying to touch base about the upcoming cycle--doses of meds, plans, etc. It was nice to talk in person with her and pick her brain a little. I am pondering adding HGH (human growth hormone) to my regime of drugs for IVF #3. I had considered pushing for it with cycle two, but I did not want to mess anything up by adding it when cycle one had been great. Now that I've had the "worst case," I figure why not? Well, the cost is the main reason, along with the fact that there is no persuasive evidence that this will be any type of magic bullet. Still some studies seem to show positive results, and many women in my IVF group have been given this drug as part of their plans, several believing that it aided in getting them normal embryos. Again, I tire of trying to read studies and do medical research as a non scientist. I do my best, but I never feel certain of the "right" decision. I don't want to crazily grasp at straws, but this is my last chance to get any genetic children as back ups if the one good embryo does not stick.  Hopefully, we will come to a decision this week and get my medications all ordered and ready to go for late September, either with or without the HGH.

Emotionally I am all over the place, per usual. I am burned out, but I am also feeling a faint glimmer of something like relief that the "end" is getting closer, whichever way it all plays out.


August 27, 2014

Genetic Results

The results did not arrive until Monday instead of Friday, so it was more waiting all weekend up in here. We do have one genetically normal embryo. The normal was one of the three frozen from cycle one. I do not know yet if it was the AA or one of the AB's. We were not told gender, but I am hoping they will allow us to know since there is only one, if not now, maybe right after they transfer it. I feel....not much. Just numb or something. Intellectually, I "feel" grateful and relieved, but emotionally I don't really feel a lot. A guess it is self-protection. It is difficult to accept that cycle number two yielded one bad embryo.

Anyway, we are going into our last fresh cycle. I begin birth control pills tonight for a few weeks prior to starting stims again. We plan to put back this frozen normal embryo at the end of the cycle. I have been searching around for statistics on what to expect in putting this normal back. I estimate around a 60% chance, maybe more or less. At least it is a chance.

August 20, 2014

IVF #2-Saga Continued

After the disappointment of getting such a lower number of eggs and embryos sort of evaporated into please just let these we have do something, I felt a lot calmer. On day three, the five embryos that had progressed on day two continued to move forward appropriately--one was at nine cells and the other four were at eight cells. I somehow managed to muster some positivity, repeating what my RE had told me about the last IVF cycle being the best predictor of how our eggs would progress this time. There is no day four update, sadly, so it was out of my hands. I knew I would get a call on the morning of day five with what had happened and how many had been biopsied and sent off for the genetic testing. In my mind, I was hoping for at least two, possibly three to be sent. Based on last cycle, three embryos would be about half of the fertilized eggs, same percent as last time. They phoned to give me my transfer time for day six. I wrote all the instructions down, willing myself to believe that there would be biopsies sent on day five and at least one normal to put back on day six. I only had a few embryos, but maybe they were stronger on the inside. I did my usual obsessive googling and researching on day 3 embryos making it to day 5. Again, the fields of IVF and embryology are actually fascinating as hell if you aren't in the middle of them. It's amazing what they have learned in the last ten, five, even one or two years. In another five years, I'm sure they will have improved things even more.

I got my cell phone and house phone lined up beside the bed to make sure not to miss the early call on day five that would mean so much. Whenever I woke during the night, I'd check the clock an think about how much longer until my waiting would be finished. We woke up about eight, and still no call. They never gave us a time, but last time on day five we got a very early call confirming we still had embryos and come in for transfer. I reassured myself that maybe they call people in our situation last since we are not coming in that day. Also my nurse had been on vacation for the week prior, so maybe she was clogged catching up on stuff. Plus Mondays are haywire in the office anyway. We got up and ate breakfast and tried to pretend we weren't staring at the phones. Time kept passing. We calmly talked ourselves down from the ledge over and over. Once 10:00 am. hit, it was harder, because we always got a call between 9-11 in the past, and we knew that if they did any biopsy they would have had to have been doing it to send it in time for 24 hour testing. I started to feel what might be described as the beginning of an anxiety attack in my chest and heart. I felt like I imagine I'd feel if I was about to go out onto a stage and give an inspirational speech to a thousand people--physically anxious and sick. Even my calm and cool logician husband was coming out from his office to check in and ask what is going on with the clinic. We set a time to call if we hadn't heard of 11:00. (Neither of us is assertive/pushy, so this helped us set a goal.) At 11:15, I called my nurse and left her a voicemail, calmly checking in and asking her to call with an update. An hour passed with both of us really getting nervous. Why hadn't she called back? Something must be wrong. If there weren't embryos to biopsy, why wouldn't she just call us? Did they make a lab error and now were scrambling to figure out what to tell us? I called and left another message for my nurse at 12:15, this time nearly breaking into sobs toward the end of the message. I expressed that we were incredibly anxious not hearing anything and starting to panic. We went outside on the deck to eat lunch and try to brainstorm what the fuck could be going on. Clearly something was amiss. They would have had to have sent the biopsies to Florida by now already, so they knew something.

At 1:15, my RE phoned us herself to tell us that none of the five embryos was biopsied because none of them was in any shape to be biopsied. Three had reached blastocyst stage but had low cell counts in the outer trophectoderm layer. This outer layer is the part they steal a few cells from in order to do the genetic testing, as it is the part of the embryo that later becomes the placenta rather than the baby. My RE said that she has seen embryos with this issue that can manage to generate more cells. The other two embryos were not quite blasts--one was compacting (morula) and one was cavitating. Basically, none of them were where they "should" be for day five. She said that she has seen all of these progress to more normal blastocysts, but that it was unlikely. Asked to give us odds on whether any of them would be able to be biopsied on day six, she gave us 10-15% that one of the five might be. So basically the entire IVF cycle has come down to no transfer and possibly one blastocyst limping into contention on day 6. It hurt. A lot. I also just felt a lot of relief to know after waiting for two days and especially over the five prior hours. In actuality I'd been "waiting" on this outcome for the past three plus months since I had the D&C and planned to do another IVF.

I will give the RE credit. She sort of had a back up plan to offer us to help us accept the crashing of the cycle. Remember how they wouldn't be able to thaw, biopsy, and refreeze our three frozen embryos in tangent with the fresh cycle? Now she said that she had spoken to the lab, and they could do that on day six along with any fresh that managed to make it, and send all the biopsies on day six. We agreed to this plan, since we had already discussed sending the frozen later if this cycle didn't work out. The bonus would be (theoretically), that they were going to be able to charge one biopsy and one freeze fee for all of them together instead of trying to double charge us as they dumped on us last week. So in some ways this was costing us less overall, though obviously it would have been better to have the three fresh already being tested and a transfer planned. The nurse called me back later to sort of apologize for not calling me, saying that the doctor really wanted to call me, so that was why. I guess the doctor was busy until after 1:00. I could tell she felt bad and referenced my messages. She has generally been a great nurse so far--new since April--and I like her much better than my previous nurse, so I tried to just let my anger at her go. I know they are juggling a lot all at once, but it felt inexcusable not to just phone and say none were biopsied yet because they are not ready but the doctor wants to call you and touch base.

We didn't hear anything until late in the morning of Day 6. The nurse called to say that as of 7:20 a.m., none had made it to the right stage, though the compaction one had become an early blastocyst. She said they would recheck later and she'd call again. Much later in the day we got a call that one of the five was able to be biopsied--one of the ones with low trophectoderm cells had grown enough. So we did get one tested from this cycle. Unfortunately, I guess because it was later in the day, they opted to hold on the frozen three until the next day. The nurse said that they would only charge one biopsy fee still. I asked would they still only charge one freezing fee, and she said she would check on that, so please please let that be the case. Otherwise we will be paying $1750 to freeze that one limping blastocyst they tested that could be abnormal as well as another $1750 to refreeze the other three. Can I just say that I think it is total crap that the clinic charges a full fee to freeze even one embryo? They previously had a single embryo freeze charge of $250, but have since changed that. I am just hoping they take pity on us and let us by with one fee.

And so now today I will wait to hear if all three thawed okay and that the biopsies were sent off to the lab. Once the lab has the samples, we should hear within 24 hours if any of the four tested are genetically normal. That means that I should know by Friday. We were told that at my age, one in four embryos are likely to be normal, and we are sending four, but I am very anti-statistic. My feeling is they get that stat because many people get 3 or 4 normals--the good egg older people, but many people get all abnormal--the bad egg older people. There is a little part of me that has had an ongoing "feeling" (yeah, not necessarily worth anything) that one of the three frozen is normal. I sure don't know what to expect, but I am grateful that we will know the answer sooner rather than later!

Our plan has become the following:

1) Hope that one of the tested is normal.
2) Go into another IVF fresh cycle--our third and final try.
3) If we have a normal on ice, we will put it back in on day five or six after the fresh egg retrieval.
4) We do not know what we will do yet regarding any eggs or embryos from the next cycle, as it will depend on what normals we get from testing as well as how many embryos we get.

It is truly frightening to start reaching the end of the line in having a child that is a marriage of your genes and the genes of the person you love--a child you have fantasized about and envisioned for years. This realization is finally hitting my husband for the very first time. He has always been so much more positive and optimistic that this would work out for us than I have, so I don't think he let himself "go there" until now, when all of a sudden I don't seem to be a good responder to IVF, and we are truly down to last chances. We actually really talked about the thought of donor eggs last night among many other topics. He expressed that he never thought he'd even have to think about this idea, and my response was to recall how shocked and upset we were when our first RE mentioned IVF at our first appointment with her years ago. We honestly never thought we'd "need" that either. You fall through this infertility rabbit hole and tumble deeper and deeper, it seems. You wonder why you are the unlucky one that the treatments don't work for, but all along I've said that everyone who did not get a baby out of treatment never thought that would be her outcome. They had hope all along until they realized it wasn't going to happen. So much hinges on the call we get Friday. If we have a normal, we have a chance. If we don't, things will seem so much more ominous, though we still have a chance. It is just difficult to even know what the odds are anymore, and odds can be so comforting when they are helpful. Instead, we just have a plan to get us through this week and a few more.

I have to just pause and express gratitude again for the Affordable Care Act allowing me to even have these chances to have my baby. If we were paying out of pocket for all the meds and doctor visits, we would be over 25k in debt right now beyond what we have already spent out of pocket for copays, coverage, embryo fees, etc., which is not an insubstantial amount. We would feel even worse about everything because we would be financially crippled and looking at no more hope. Even when discussing donor eggs and adoption last night, phrases like $20,000-$30,000 were popping up and extinguishing any realistic hope of where to go if this doesn't work. I am emotionally exhausted, and I don't know what I would do if I were financially exhausted as well. How do you even determine the price of your innermost dream of having a family? As always, I just push that thought aside for the moment because it is too crushing to ponder while experiencing the day to day emotions of the rest of it. For the moment, I must just get to Friday and deal with that news, either way.


August 15, 2014

IVF #2

So many times I planned to update this blog as I was going through my second IVF over the past few weeks, and for a variety of reasons, I just never did. The main culprit, I believe, was my continuing feelings of detachment and ambivalence. Later,when things seemed to be going poorly, I just felt angry and worried and overwhelmed. Writing it out probably would have helped me to get some clarity or at least articulate my negative feelings. For anyone checking for updates that never appeared, I apologize. Now you will hear almost the whole story in one shot, so no suspense. This post is probably the longest post ever, so save it for a day when you have time to kill while waiting somewhere :)

Heading into this cycle, our tentative plan was very tentative because there were so many variations on ideas, all depending on how many fresh embryos we ended up with on Day 5 of this cycle. We contracted to have our Day 5 embryos biopsied, with the biopsies being sent to IVIGen in Miami by express that morning. The results would be phoned back to our clinic the morning of Day 6, and any embryos that were normal would be popped back into my uterus. I hated this plan on many levels--namely that letting the embryos hang out that extra day would result in a slight decrease in their quality that we could never get an exact figure to calculate. The positives of the plan were that we could utilize one of our insurance covered embryo transfers and see if we could get pregnant with a normal embryo and somehow escape this crapfest. Also, we would not be paying to freeze a set of biopsied embryos that would mostly and possibly all be abnormal. The freezing is about $1800. The plan created a time pressure--only those available at the exact right stage on the morning of Day 5 could be included. What if some or all were not ready? We would end up having to freeze the stragglers anyway or let them go. We also had an ongoing debate about what the heck to do with our three frozen embryos from last cycle--untested and unbiopsied. Essentially we decided we cannot put back untested embryos and endure a fourth miscarriage if it is caused by genetic issues. That leaves us with the option of thawing them, biopsing them, and then re-freezing them. Not ideal but the other choice is just leaving them there and doing nothing with them. As I obsessively rolled all of these ideas and scenarios around in my head for my weeks on birth control, I could never feel like we could make a "good" plan. As with most things in life, and especially infertility, the best plan can only be viewed in retrospect, after everything has played out and you finally have all the information you needed but couldn't get prior to your cycle. Obviously, for most people, us included, the other factor limiting your optimum decision making is MONEY. All the biopsies, testing, freezing, etc costs a lot of money. We'd happily agree to spend it all if we had any guarantees on what we could get for our money. Since guarantees are lacking, we try to plan for both good and bad scenarios and ponder long term plans in addition to this cycle. I cannot express well enough how frustrating this part of infertility is. You know you are doing the best you can given all the variables at the time, but you also know from all your experience that statistics are only useful to a certain degree. You've been on the wrong side of them so many times that you don't even know what to think anymore.

So with all of this in my mind, I started the shots. It's amazing how blase it all seems the second time around, actually. The hope and excitement are so minimal compared to the first IVF. Plus my husband has had a time consuming and stressful work crisis of epic proportions that has ballooned into a parallel pure hell involving ridiculous hours and pressure--right when we are getting back on the IVF hamster wheel. I couldn't be there for him in any major capacity. I couldn't "care" enough because I was consumed with thoughts and worries over what I was doing in the IVF side of this. At least his crisis involved a sense of control in that the things he was doing would have a clear impact on the outcome.

The base scan prior to starting showed a lower antral follicle count than I'd ever seen--eleven. They reassured me that because I was on BCP, not to make too much out of that, but of course I was worried and disappointed. I'd taken three months off to do acupuncture, eat a diet of even healthier foods, and take supplements, so I was hoping and even expecting to see something great. I tried to keep reassuring myself, but I had a bad feeling in my stomach.  My next visit in after the first three days of shots showed five small follicles. I was really upset because I feel like last cycle there were more follicles there to start. Again they reassured me, but I couldn't help stressing. Two days later, they measured only four follicles and saw five much smaller.  Now I felt sheer panic. During my first IVF at the same point, I had had fifteen measuring. I really hit a low point at this stage. I knew my first IVF cycle had gone beyond well, beyond my wildest expectations as far as egg and embryo production given my age. That first cycle spoiled me, and it was difficult to lower my expectations.  All I kept thinking of was our phone consult with the genetic people--the stat they gave was that at my age one in four of my day five embryos could be expected to be normal.  Last time, with the best cycle imaginable, I only had five day five embryos. What would be the outcome with this cycle? Was I going through all of this only to get no normals? The fewer I had the more likely this nightmare scenario seemed.

On my third visit to the office, they measured eight and saw maybe six smaller. At that point I felt like I had been given a slight reprieve. Even though it was not as good as last cycle, it was looking a little better, which is all I could hope for at this stage. Two days later, they measured thirteen, but the range of sizes was so vast, going from like 12mm up to 22mm. Some were ready to trigger and some were not close, which isn't good. They planned to hold off triggering another day to try to let some of the smaller ones catch up. When I went back for my scan the next day, some had caught up, some seemed to disappear or shrink (WTF?), and I had just given up on trying to understand or plan what would be retrieved. I think they measured twelve that day, and they triggered me that night.

Egg retrieval was two days ago. Everything was proceeding smoothly as we arrived and prepped--old hat in the surgical suite by now, sadly. I was the first retrieval of the day at 9:00 a.m. The practice is that the doctor doing the retrieval that day comes in to go over your plan prior to surgery. He got there just before nine, which seemed rushed. Of course it was the doctor I left in order to switch to my current RE!! Awkward but I assumed he would not even remember that or me. He was grumpy and curt, which I can honestly say is not usually how he is. He holds up our plan for us to sign, and I see on the plan a surprise--ISCI. (For the uninitiated, ISCI is when the lab actually captures one sperm in some type of syringe and injects it directly into my egg. It is used primarily for couples where there is male infertility, yet my husband's sperm is great.) We had not had that last time, nor had we discussed adding it. I believe last time we said it was OK to use if things didn't seem to be working au natural. I had not researched it fully, and I had heard some negative things about using it unless you had to use it. I couldn't remember what exactly the negative things were, but I felt incredible pressure as it was now approaching nine. I tried to ask the doctor about it. He said, "I'm just the messenger." He acted standoffish and rude. I will never know if it was because he remembered I had previously been his patient and switched, though it could have been his rushing. I tried to ask his medical opinion regarding ISCI and whether there were any negative consequences and whether it might have been added because we are doing genetic testing this time, but he would not really be helpful. If I ever needed reassurance that I made the right call in switching RE's, then I received it. I KNOW he knew something about ISCI and why it might be on there! Flustered, I said okay and signed it. I know a lot of people who have used it, but the whole thing was stressful, and husband had no idea if I was just freaking over nothing. So they walk me to the bathroom to pee one last time and then back to my cubby, where husband has now googled ISCI and has a bad feeling about signing it without time to process. The OR nurse is literally standing there to walk me to the surgery, so I said something to him like do more research or follow up on this. I was unclear. My meaning was that while I was in surgery, he could get the info so that when I woke up we could then tell them yay or nay before the lab got to work on things. He interpreted that as go into emergency mode and started asking the other nurse and even attempting to catch the doctor himself to get more info. Soooo, as I am on the operating table and the anesthesiologist is just starting to inject some sleepy meds, the other nurse comes bursting in and grabs the plan and says "wait your husband says you have a problem!" DRAMA. I am partially drugged, though he stopped when she came in. I start crying and saying sorry we didn't know about that and we felt rushed and can we check it after? So she says yes and I don't honestly remember this part well--just feeling stressed, embarrassed, and emotional, and telling everyone I am so sorry about this happening. 
 
I came out of the surgery and did some embarrassing things as I woke up--luckily funny embarrassing, causing my nurse to tell me I must be a hilarious drunk. I am glad I could amuse not only my nurse but the couple next door. I am sure it made their last minutes before their retrieval less stressful. In my mind I had decided that an okay result given the scans I'd had would be eight eggs retrieved. A great result wold be ten.  They got twelve. I felt happy with that. Last time we had retrieved fourteen. During my surgery, my RE had come down to meet with my husband and she wanted to come meet with me herself to discuss the ISCI. Her rationale was that with PGS, doing ISCI prevents one possible problem. In a regular fertilization method, they sit the egg in with a bunch of sperm, and one "winner" will fertilize the egg. However, a bunch of other sperm can end up as debris on the outside of the fertilized egg, and I guess there is a chance when they biopsy the embryo later that some of this debris (other sperm) can contaminate the biopsy somehow. There is a small increase in issues (she quoted 2%) with ISCI fertilized embryos. I felt I should defer to her opinion, and later googling didn't stress me out, so I guess we made the right call to go with it.

Yesterday morning I got the call I had been waiting for since I woke up from surgery--how many were mature and how many fertilized. Last time we had 14/14 mature and 10 fertilized. This time we had 9/12 mature and then 6/9 fertilize. I felt so sick when she was telling me the result. Again, last cycle just spoiled me. I have to say I am just disappointed and angry that everything I did seems to have had no effect, at least not yet. This cycle is so much worse than last cycle--we are only at 60% of where we were last time.  Also, last time only half of the fertilized embryos made it to blastocyst, so if that same stat happens this time, we are looking at only three day five embryos. Statistically, based on one in four being normal, there is a chance none will be normal. I can only assume that the variation in sizes among all the follicles meant that some of the eggs were not able to mature in time. On the other hand, I have to be thankful to have the six I have. I keep telling myself that maybe my efforts will pay off in the strength of the ones we do have somehow. Maybe more will grow, and maybe more are normal. My mantra is that I can't control any of this anyway.

There was a whole bunch of other drama that came out in that phone call about the frozen embryos we have not being able to be tested with the fresh now, as well as that costing us another $3500 that we hadn't been told prior. I was a hysterical basket case after that call. I won't go into all the details, since I feel a lot better today. This whole process is such a bumpy ride of ups and downs, and the process just erodes your emotional resilience and ability to cope effectively with setbacks. Luckily my husband was working from home yesterday and had some time to sooth me and make some charts for us to analyze money and odds with the new data. We have decided to let the frozen rest for now and see what happens with these six. Today I am sitting here waiting for the call that will update us on the fertilized eggs. I feel okay at the moment. "The one" could still be in this little batch of six, and I am not giving up on my little embabies trying to grow in the lab just yet.

BONUS: Just as I was about to publish this post, I got the call, so you will get the immediate thrill of knowing the update. As of today, five have progressed to four cells, while one has slowed down and is at two cells still. This report is not bad! I will take it. Now I have to wait another 24 hours to get the next scoop.

July 31, 2014

Snail Mail

Somebody in my online IVF support group suggested we do a lucky sock exchange, sort of a secret Santa where you are randomly assigned a name in the group. Then you send that person a pair of lucky socks for her upcoming cycle, egg retrieval, embryo transfer, or daily wear :) What a positive project in the midst of a lot of negative energy around me. Today I got my delivery of socks in the mail, all the way from Portland, Oregon, containing not one but two pairs of socks, along with some lip balm and an encouraging note. I have been checking the mail box excitedly every day lately, waiting on my surprise, and I couldn't have been more pleased with the socks.




More than the "luck" the socks contain, they bring the knowledge that so many others out there are going through this crap. It has meant the world to connect with these intelligent, kind, thoughtful women from around the country (as well as one Australian member). Since meeting for coffee or lunch is not really possible, the socks are a tangible way to feel the support that all members of the group are sending out to each other all the time.  Maybe I will just keep rotating these back and forth every day for the next four weeks to make it through the cycle? 

As for me, I was lucky to get the name of a woman in the group who had become pregnant right after I had in March, and who then miscarried right after I got the bad news that my baby had stopped developing. She is in the subset of women in our group (myself included) who got pregnant and lost pregnancies over the past three months.  Sadly, there are actually five of us out of about twenty whom that happened to! I sent her a pair of symbolic socks--yes, my English teacher is showing but I couldn't resist.  


The colors are crazy intense, but this beautiful Phoenix rising from the ashes felt so right. Recovering from miscarriage, yes, but recovering from the monthly fiery crashes we face over and over again as we keep trying. We emerge anew from our own ashes, perhaps not fully formed or unscorched, but definitely forever changed and stronger for surviving the latest inferno. I wish I could send these socks to everyone going through a new cycle after the repeated failures in the past. I wish all of you could get a package of these in the mail from a friend who is thinking of you and sending you her support and love.

July 25, 2014

Moving Forward

For insurance and advanced maternal age reasons, it is time to get back on the infertility hamster wheel.  I continue to feel ambivalent, bitter, angry, burned out, and many other negative things, despite trying to stay positive and remind myself of good things. I realize that I am more motivated by wanting to get everything resolved than by wanting to be a mom. That is how far things have gone for me. The thought that makes me happy is just being done with all of this either way. I want closure, and I want to move forward and out of infertility treatments.  The years of limbo have taken a psychological toll on me. I have only limited coping skills. I want this cycle to work so that I don't have to debate next steps, another cycle, or past mistakes.  I am trying to be okay with this reality. I do not 100% trust my feelings or perspective on things.  As I've stated many times on here in the past, I just desire to take a year off from trying to get pregnant in any fashion and just live my life--whatever that would look like--for a whole year without even pondering how my choices impact fertility or childbearing.  I am so all over the place. I hate how bitter, cynical, and confused I am feeling, but I guess it has to be considered normal on some level.

We got back from vacation last week--back to the reality of an overwhelmingly stressful situation with my husband's job of epic proportions and back to getting all the ducks lined up for my upcoming fresh IVF cycle with PGS (genetic screening). I have been on BCP for a few weeks and finish those on Monday. I have my first office visit on Tuesday morning for a baseline to check on everything before starting the shots. If that goes smoothly, I start taking shots one week from today. As with each cycle, there are several balls to juggle and last minute issues that threaten things working out. There are more papers and forms to fill out to make the PGS happen, as well as a phone consultation meeting. There's a new pharmacy to work with in order to get a discount on the PGS, so that is in process. There's a realization from the clinic just today that I should have had a mammogram on file in order to make the cycle happen since I am now 40.  Who knows what tomorrow will bring? There is always a chance they will spot something at my baseline like a cyst or a problem that will delay things, too.  I am trying very hard not to go insane wondering how I will respond to this cycle--how many follicles, how big, how many eggs retrieved, how many fertilize, etc. I keep telling myself that I will know all in a few short weeks and that worrying won't make anything happen any differently.

I do feel lucky to have my online support group--really a group of close friends at this point--in my corner going into IVF #2. They have been with me through IVF #1, the loss, and the wait.  Several of the group members miscarried just after I did and are also getting back into the fray with a cycle now or next month, and it makes me happy to see us all rising from the ashes together. During my vacation I was actually able to meet two of the group members for dinner and drinks one night. We each drove 1.5 hours, and it was such a wonderful experience. It was like meeting up with high school or college friends I hadn't seen in years. We just had the best time, and I had to feel very lucky to have found these new friends who feel like long lost old friends.

June 11, 2014

Apathy

I'm just not feelin' it these days, and by it, I mean dealing with infertility stuff. I keep dragging my feet each step of the way, feeling drawn back and forth in my plans and thoughts about what has happened and the future. My beta got back down to negative, so I have closure on the miscarriage. It still feels weird calling what happened a miscarriage because I feel like we had to decide to let it go rather than it happening, but I hate the phrase missed abortion about as much as products of conception.  Basically any term related to bad pregnancy results kind of sucks. 

We were able to switch to a younger, female RE in the same infertility clinic, and we met with her last week to review things and make a plan for next steps. While I didn't feel the same negative vibe as with my previous RE, I still didn't get all warm and fuzzy from this visit. I am trying to let it go, but my fantasy version of our meeting was that she would have read our history before we met with her and would have thoughts, opinions, analysis, and plans to share with us for the next cycle. Yeah, totally ridiculous and naive considering how this practice operates, but I sure would have loved to feel like we weren't just herded in and out. I also got the creeping feeling that they don't like to meet with patients between cycles to discuss the last IVF and the next one. It was sort of like, "ok why did you want to meet?" I have to let it go, but she basically thought the only things "proven" to maybe help were acupuncture and DHEA.  She didn't think the other supplements and stuff or any of the other drug protocols were proven to help egg quality. She did mention making sure my BMI was normal, and I am just outside of the normal range again since the last IVF. To make matters worse, the computer system was down, so she couldn't call up our records to look at when we started the meeting. Essentially I feel she had no idea who we were and what our history was.  We had to summarize and tell her everything and lead the meeting  Eventually she was able to get back online and contribute some thoughts based on what she saw, but it left me feeling the same sort of disappointed feeling I usually get over there. She has ordered some blood tests to rule our karyotype issues and autoimmune issues just in case these are a factor in the miscarriage. I feel sort of apathetic about even getting the tests.  I just feel flat and tired on the IF front.

After the meeting with the RE, we were put in the second waiting area to have a follow up with the financial counselor to talk costs of genetically testing any embryos we get in the future, but the counselor never showed up and we eventually just left due to time issues. I got a follow up letter telling me to check the websites for Natera and IVIGen for costs. Sooo, guess I will just be in charge of pricing it all. I find it so bizarre that just like the medicines out of pocket, they give no information on costs and stuff to patients dealing with genetic testing??? Am I their first patient to need the info? Why wouldn't they have some pamphlets or handouts to give people? Are there ten other patients this week googling and doing this same research I am about to do just because the clinic doesn't care to help facilitate this process? It's not like my clinic doesn't get a boatload of money when we test. They charge a $1500 fee to biopsy and send off the cells, plus $500 if we thaw the three on ice to biopsy, plus $1750 to freeze them all afterwards. 

And I guess now I have actually gone on a negative rant that I didn't want to go on by updating my blog. Every time I thought of updating, I felt so negative that I held off until I could process it all and try to put it into perspective, but I just can't seem to do that. I have such irritation with the clinic, its financial counselor, its gouging ways, its level of care. 

On a better note, I did get my period six weeks after the D&C, so I guess I am recovering physically. I will keep exercising and trying to lose some pounds while taking the supplements and getting acupuncture over the next month.  Once I get my period in July, we plan to start a new cycle of fresh IVF, with egg retrieval in early August, I guess.  We want to get any embryos genetically tested so that we can put in only normal ones, but I have to do some research on prices and options.  I am hoping over the next weeks, my ambivalence and apathy toward all of this will fade a bit so that I can feel some energy about starting the new cycle when it comes.

May 13, 2014

Many the Miles

It's funny how you project where you are in your own life onto what's going on around you. Like, when you fall in love, all of a sudden the syrupy songs you've been singing for years take on an extra layer of meaning. You hear them on a deeper level. You can relate. They feel so true. That's you they are singing about!  

Oddly, going through infertility and miscarriage has started to creep into my song interpretations a lot lately, too. Certain love songs that I used to think about in terms of romantic love have started to morph into songs about love for a baby. Songs about break ups seem to hold a lot of wisdom about fetal loss when your mind is in that space.

A singer I love is Sara Bareilles, and one of her songs from an album or two ago has been coming on Pandora a lot lately.  The catchy little chorus seems to chant in my ear, echoing a feeling in my heart about becoming a mom:

How far do I have to go to get to you
Many the miles
Many the miles
How far do I have to go to get to you
Many the miles
But send me the miles and I'll be happy to follow you Love

I do what I can wherever I end up
To keep giving my good love
And spreading it around
Cause I've had my fair share of take care and goodbyes
I've learned how to cry
And I'm better for that

Sing how far do I have to go to get to you
Many the miles
Many the miles
How far do I have to go to get to you
Many the miles
Send me the miles and I'll be happy to
Follow you Love


How far do I have to go to get to you? I keep hearing it in my head. If only the universe could send me the exact miles (or months, or days, or years) right now, it sure would be a lot easier to keep walking. 

May 2, 2014

Bright Side



It's a beautiful Friday afternoon.  I am healthy.  I am loved.  I have more than so many other people.  And I have wine.  And this glass is gone already.  So grateful for the moments when I can feel grateful.

April 27, 2014

One Basket

I guess it's pretty much par for the course to start regrouping and brainstorming next steps whenever you encounter an epic fail on your infertility journey.  As per normal, you first cannot help but revisit your past decisions, analyzing them for errors in judgement.  Why did we not get the embryos genetically screened, I keep asking myself.  We had five good looking day five blastocysts, which is more than I ever hoped we would end up with as we started the IVF cycle.  It was only when I joined my online support group at the beginning of the treatment that I realized that good looking blastocysts can still be majorly genetically bad.  A few girls in my group had tested embryos that looked fine, only to find out that none of them were normal genetically.  And as far as genetics go, a little too much or a little too little, or something moving to another spot--well, no amount of great uterus is going to heal that and make it normal.  Looking back, were we crazy not to do the genetic testing?  We had kept telling ourselves that we were just on the "unlucky" side of the stats two years ago.  The genetic testing costs a lot, and it also means, in most cases, you can't put any of the embryos you just tested back into your uterus right away.  You have to freeze them and wait for the results to come back in, and then do another cycle--a frozen embryo transfer (FET)--at a later time.  Since we only have three tries in total, three fresh or frozen or any combination, we hated to lose one of our put backs.  We also do not have $5500 or so laying around to toss toward genetic testing when who knows if there is a good one or two there anyway.  It's so hard to judge in retrospect.  With infertility you go along these paths, learning as you go and not really arriving at certain gut feelings until it's ultimately your time to.  You base your decisions on so many what ifs and statistics, doing the best you can to balance reason and logic with your emotional and sometimes irrational leanings.  And of course the money.  Always the money must come into play.  Had money been no object, I would have gotten that test.  I believe there is even a rush option (for a lot more $), where you can have the embryos tested on day 5 and know the results to do a day 6 transfer.  Lacking the wad of cash that would have enabled that, we rolled the dice, hoping for some good embryos.

Right as we were leaving the 7w3d ultrasound where everything went south, I kept hearing this voice in my head chanting, "we should have gotten the genetic testing."  Even my hard nosed accountant husband repeated a similar refrain of "we need to look into the genetic testing" for the future.  We can't go back, and I'm not sure we made the wrong decision given all the information we had and our financial means.  In my sour moments, I ask what is the dollar cost of having this bogus pregnancy eat away 8 weeks of my fertility, the limbo weeks, the waiting to miscarry, the surgical removal, the emotional and physical pain.  It was, after all, free.  Insurance covered all of that.  I am surviving it.  I am not 100% broken.  But I don't want to do it again.  I also am not sure I can do it again.

We are down to two chances of IVF covered by insurance.  We believe in our hearts that the cause of the failure this time was embryo quality.  At 40 years old now, a lot of people seem to think that there is not much you can do aside from donor eggs to improve egg quality, and hence embryo quality.  However, through my experiences with my online support group, I have seen evidence of people improving their results with supplements and dietary changes.  The person mentioned above who had zero viable embryos after her first cycle ended up with all viable embryos in her second cycle after changing her diet and starting acupuncture.  Several others have had improvements with supplements.  And since I can only control me and my body, I am going to spend the next 90 days focusing on supercharging my body and my eggs to the best of my ability in order to maximize my chances for my second IVF fresh cycle.  I have found the book It Starts with the Egg by Rebecca Flett to be an invaluable resource in my planning.  She focuses on three fronts--minimizing toxins that damage eggs (BPA & Phthalates), maximizing supplements that will help with age related infertility and egg quality, and incorporating dietary changes that have been linked to better fertility outcomes.  I feel positive and empowered.  I have been eating well and exercising over the past two years, and I have noticed improvements with my hormonal levels over each year already, so I believe that changes can possibly influence the outcome.  The bottom line is nothing I am taking will be dangerous, and I need to feel I did everything I could do in my power as we close in on the last chances ahead.  And, although it is going to smart, we are going to figure out a way to have any new embryos, as well as possibly our three frozen, genetically tested.  We can only hope to have more embryos to test and that some of them test as normal.

It feels good to have a plan.

April 24, 2014

Done & Complete

Yesterday I had a D&C to end my pregnancy that had stopped growing a few weeks ago.  The chapter of IVF cycle #1 has come to an end, and I feel at peace with my decision.  I think I did the right thing.  The cramping and bleeding are minimal and manageable, and I feel a sense of relief no longer worrying what is going on inside me and when the pregnancy would start to miscarry on its own.  Every cramp or twinge for the past three weeks had me wondering "is this it?"  The procedure went very smoothly, and the luck of the draw gave me the same doctor I like who did my egg retrieval and embryo transfer.  She is very bright and seems super competent.  She also looks you in the eye and gives you leisurely time to ask questions, though I didn't really have any this time.  It was very surreal to be back in the same surgical suite as the egg retrieval for such a less joyous occasion, but compared to the surgical center where my previous D&C was two years ago, this one has several advantages.  For one thing, they let my husband stay with me right up until I walk next door for the procedure, and he is pulled back in right as I am waking back up.  It makes the whole thing less terrible to have him close except for my blackout period.  He was there when I started to cry a little after I was emptied of the pregnancy I so desperately wanted.  He was there to give me sips of water and get me the type of crackers I really wanted.  He was there to make sure they gave me a Vicodin before I left so I didn't have to feel anything and make it worse.  I also had an awesome nurse.  I so appreciated the whole experience being smooth and kind.  Oh, and I also got french toast on the way home.  Never underestimate the power of sugary syrup and carbs to lighten the emotional pain of the worst situation.

I can't say the same for the day before the D&C, which was Tuesday.  I called on Monday to tell my new nurse (yay--a change right in the middle of all of this) that I wanted to go ahead and schedule the D&C, possibly Friday when my husband could take off work.  This nurse is not as into email, which means annoying phone tag.  When I heard back from her, I got news that the D&C's are sort of low on the totem pole after all the egg retrievals, and some days they don't do them, depending on the schedule.  And of course you can't know until two days before once they have the trigger list, so she would put me on for Friday, but it could go until Monday or Tuesday if things were busy.  More limbo.  I asked her about who does the genetic testing of the fetus and insurance coverage.  She was not helpful and actually told me she'd have my RE call me to talk.  Huh?  He is going to talk to me about insurance info?  So Tuesday  morning, very early for me, my cell phone rings as I am just waking up in bed.  It is my RE.  He says he hears we want to do the D&C, and he doesn't know about Friday, but he knows they have time tomorrow, Wednesday.  So I take it, but the nurse will have to call me later with an actual time.  I ask about genetic testing, and he says they use Natera.  I ask about insurance, and his answer is "well, you never know with insurance."  No help. No suggestion of whom to talk to.  No let me have someone call you back who knows. No let me transfer your call.  This callous brush off is what I am used to with my corporate fertility clinic, and I feel the frustration flush over me right away from all the accumulated stresses of past interactions.  I want to say sarcastically, "Thanks for the keen insight.  Your support means the world to me."  BUT of course I always feel this hesitancy to even call them on their lack of help since I have to keep working with them in the future.  Then I feel rage that I can't express my justified feelings and have them resolved--mad at myself for not being more aggressive and mad at them for always putting me in these spots.  

Still, I resolve to try to get to the bottom of this on my own.  I call Natera directly and give my insurance.  They give me the billing codes they use and instruct me on what to ask my insurance.  I HATE calling my insurance people.  I usually get caught in a maze of recorded messages.  It is nearly impossible to get on the hold line to talk to someone live.  Somehow I do.  I actually get some answers.  It is 90% covered if deemed a "medical necessity."  Because we have reached our deductible, I think it will be 100% covered if they deem it a medical necessity.  Otherwise, it is experimental and no coverage.  (Natera said it costs about $3500 otherwise.)  How does one get it to be a medical necessity?  One's doctor must write a letter to accompany the test.  So basically I call back the nurse, leaving a message asking her about the time, the antibiotic prescription, and this letter issue.  I wait and wait, afraid to run my errands I need to run in case she calls and in case the prescription isn't called in.  I am trying to get a lot done in case I am down and out for a few days after the procedure.  My husband and I go back and forth about the risks of trying for the testing.  There is no way to know ahead of time whether the insurance will accept it as a medical necessity.  What if they don't?  Then we have to tangle with them.  I don't have the strength to go through a dispute.  I feel sick just thinking of it.  We feel like we are costing our insurance company a lot of money with our IVF, and possibly they will reject us and make us fight.  Maybe that sounds paranoid, but they are a-holes.  We debate back and forth about what the testing gets us vs. the risk.  We want to put that money toward PGS (pre genetic screening) of future embryos, which we are estimating will cost a little over $5000 for all the parts of that process.  We believe it is likely a genetic error due to my age and the fact that the yolk sac is big.  Still, I want to know.  We possibly have coverage.  I do think there is a case that it could be medically necessary--I am 40, this is my third miscarriage, we need to rule out other factors for future attempts, etc.  I am getting no response back from the nurse, so finally about 2:00 I head out to do my errands, and I hear from her as I walk into the first store.  No help on the letter or the genetic testing stuff.  She had talked to their financial counselor--I HATE HER--who is never any help.  The nurse suggests emailing my Dr. to ask about the letter.  As I reflect back on all of this, I can stay a little calm, but I was heading into a major meltdown when I hung up with her.  I felt so victimized and powerless.  They deal with the insurance companies 24/7 and have, literally, an army of insurance and financial people at the ready.  Payment a day late--you get a phone call!!  Prior authorization needed to do more procedures or tests--they are on it.  Need help with anything that doesn't make them money--good freaking luck.  I am really bitter.  I start bawling and mad texting my super busy husband at work.  I am so sick of getting jerked around with insurance stuff.  We always are put in these positions where we have to "roll the dice" and see what comes up, and it is super stressful, and I can't deal with it the day before I am going to get scraped clean!!  I have such a build up of stress and hate when dealing with these money and insurance issues that I cannot stay calm or cope very well.  Why can't my assigned financial counselor call and say, "We deal with this medical necessity thing all the time.  We are happy to write the letter.  I think you have a good case to be made.  Usually in these situations, 75% of the time there is no issue because the Dr's letter carries weight with the insurance, and they have a hard time disputing it."  OR SOME HELPFUL variation with correct information.  I flashback to dealing with the financial counselor when asking about buying medicines out of pocket.  THEY DEAL WITH THIS EVERY DAY.  Yet, she says, yes there is "some program" called "heart something" that I think some people use.  And you might want to google "discount pharmacies."  I am serious.  I am positive some previous IVF patient would have been happy to type up a handout outlining the pros and cons of different pharmacies and programs--I know I would have--so that they could give it to patients.  These shady bastards just don't care if it doesn't make them money.  Now I am officially ranting, but I hate how I can't scream at them, and so I am screaming at you.  Sorry about that, but my husband needs some time off from my rage.  The point is I just folded up my cards and emailed the doctor to cancel the genetic testing, mentioning the medical necessity issue.  I figured he could always step in and offer to write it or give me more info, but he just emails me back "got it. thanks."  I will never know for sure if there was a genetic issue, what it was, or if there was some other cause to the missed miscarriage.  I am going to assume it was genetic, and let it go, but it really was nice getting the exact info two years ago, and I would have liked to have it again this time, medically necessary or not.  I consider it maternally necessary.

Last night I took my Vicodin at 11:00, and tried to go to sleep by 11:40.  I literally lay awake in bed for four hours.  I could not fall asleep.  I am not sure why.  I have googled sleeplessness as a a side effect, only to see that it is not a side effect of the meds.  I was only unconscious in the procedure for about a half hour max.  I never napped when I got home, though I did lie around in a semi haze for a few hours on the couch resting.  I had to pee every 50 minutes or so during that four hours.  I would have just gotten up to go play on my phone or read, but my husband had a 6:30 wake up call for a work conference and he was sleeping peacefully beside me.  I knew if he awoke and I was gone, he would panic and come find me to make sure I wasn't bleeding or upset after the D&C, and he would never get back to bed or get enough sleep, so I just kept trying to sleep.  Four hours is too long to think about things when you have just lost your pregnancy, though I think I did okay coping considering.  I don't know if I have every had that happen to me in the past five years, and I am not sure why it happened, but tonight I will take a Tylenol PM for sure!

April 18, 2014

Limbo

After the big bomb fell at the 7 week 3 day ultrasound, I felt close to falling apart and was living minute to minute, just trying to stay numb and not think to protect the baby just in case this was some messed up mistake.  I decided that I wanted to talk to my actual RE the next day to try to wrap my mind around how I should be thinking about what was happening.  What WERE my odds?  I was so shell shocked and sad at the appointment that I was very ineffective in garnering information.  I sent him an email the day after, and I have to say I was surprised and pleased that he actually phoned me back directly.  It meant a lot to me, and it was not what I have come to expect as far as the level of care at our clinic.  He basically told me repeatedly, "it doesn't look good."  He told me point blank he expected a miscarriage and that there should be a good strong heartbeat by now, not to mention the growth being so behind.  Even though this conversation was not what I wished for or desired, I was very glad I had taken the step of making contact and knowing what he thought.  As he spoke, I realized that I already felt his words to be true myself as far as how I was interpreting the situation.

I kept trying to stay busy for the next three days until our next ultrasound.  I kept taking my hormones and treating myself as pregnant in the event something new would be discovered, but the appointment basically showed no growth at all.  I was much much calmer in the stirrups this time, having had the chance to prepare myself and have reasonable expectations.  The same PA did the scan, and she was pretty up front with us that this wasn't viable.  The more horrible thing was the heart was still "fluttering," which made us feel sick.  No growth, but clinging to life.  We just felt so torn about the situation.  We didn't want to be the ones to "end" things, even though there was not any hope.  They offered to perform a D&C even with the flutter, and I guess they usually won't perform one with a heartbeat, but they felt so certain things were impossible that they said it was up to us.  After a lot of discussion and soul searching, we decided to continue to wait and see.  We scheduled another scan for six days later.  I stopped taking my hormones and worrying about eating perfectly.  I didn't start boozing it up or dying my grays.  I know it makes very little sense, but I had this bizarre logic to my behavior in my own mind.

The most recent scan was yesterday, and nothing had really changed. My favorite person who does scans, the NP, was the one who we met with, and she was so awesome.  In the midst of all of this crappy stuff, having the clinic step up and be so compassionate and humane has made such a difference in my outlook and feelings.  I am overwhelmed by how kind and caring they have been.  She practically gave me a hug in the stirrups.  I don't know if she thought we were somehow hoping the baby would have grown or something, but you could tell she just felt so bad.  She gave us lots of good information and feedback.  Apparently she has seen in half of cases if a woman doesn't miscarry by now, she may not start to.  It gave me something to think about.  I have been so ambivalent about whether to let this play out or to take control and get a D&C.  I have had both experiences in the past, and I largely preferred not seeing the bleeding and clots.  I just worry that every time I go to the bathroom, I will look at my pad and start bawling.  

We tied things off to a certain extent yesterday at the scan.  We were both able to accept fully that this baby isn't the one.  It is fully three weeks behind where it should be.  Even though there is still a little flutter there (and I was hoping there wouldn't be anything), we know that it is sadly not viable.  It can't and won't recover in some miraculous way.  The yolk sac is larger than it should be, which may indicate a genetic problem.  That is what we are assuming must be the case.  

I have a lot going on emotionally and philosophically right now, and I plan to post some more on how I am coping with this all and what our future plans are.  I just wanted to give a quick update and say I am doing ok, all things considered.  Having this "spread out" the way it has been caused a weird psychological response on some level.  I continue to marvel at how much human beings can endure and how they manage to endure it.

April 8, 2014

That Old Familiar Feeling

Looking back I can't believe it has been three weeks since I updated things here. The time has not flown by at all. I had my second and third blood tests, and my levels increased in the normal range. The numbers were on the lower side of normal for successful pregnancies, but still within range. Over a week ago we went for the first ultrasound at the 6 weeks pregnant mark. I had told myself to keep low expectations on what they would see that early. Really they just want to see a normal gestational sac with a normal yolk sac inside it. Sometimes they can see the fetal pole (aka the microscopic baby) adjacent to the yolk sac. They could not conclusively see the fetal pole for our US, but they thought they might see a hint of it. The sac was measuring about three days behind, but we were reassured that a few days does not mean anything at such a small scale. If it is within a week, then it is fine. They confirmed one sac, so no multiples, which was a relief and a disappointment at the same time.

Still, I left that appointment last Friday feeling unsettled. The PA who did our ultrasound, usually one of my favorites over there, seemed ultra clinical and detached. I started revisiting her words and analyzing them. She made sure to tell me to come back if I had any bleeding. Was this because she worried things didn't look good?  I wished the ultrasound had not been quite so early so that we'd have a better reading on the fetal pole and more developed information. The worst part was having to wait ten whole days to see what was happening again.  

I have realized though my experiences with infertility and miscarriages that I have very little trust and faith in my body and its communication with me. All through this pregnancy I have felt very disconnected from my body's signs. Part of it is that my doctors took over my body's chemistry, manipulating it to produce multiple eggs. They "turned off" my body on a certain level and managed things medically. I have been taking progesterone and estrogen since they harvested the eggs back at egg retrieval, basically because my body wouldn't make the right amounts on its own after the IVF stimulation process. So, this whole time, even before they put back the embryos, I have felt pregnancy signs and symptoms of sore breasts, tiredness, and even uterine cramping.  Even since the positive pregnancy test, I have kept taking these hormones and feeling the same signs. Is it the baby or still just the hormones or both? I don't feel this idealized mother earth connection to my body and my baby and my uterus. I don't know what is me and what is what. I keep telling my husband I just don't feel pregnant. Honestly, even not pregnant, I often feel very hungry and tired. That's just me. Not having any dramatic morning sickness or something to reassure me has been stressful. Even as I tell myself that plenty of people have no signs and don't feel pregnant--don't even know they are pregnant--I can't help not believing it. As I said, I just don't trust myself, my judgments, my body. I don't feel pregnant, but I am.  I don't feel pregnant, but I have become a cynical person. I have had the experience of thinking I am pregnant and reassuring myself that I am, only to find out the baby inside me had stopped growing unbeknownst to me. Once that happens, it's hard to really reassure yourself.

The day before the next ultrasound, I woke up feeling less pregnant than ever. I had this great burst of energy and was getting stuff done. Was it because I had lain around all day doing absolutely nothing the day before? I DON'T KNOW ANYTHING ANYMORE. All I do is try to stay as calm as possible while my mind periodically races to bad places. My online support group helped me to keep it together, and I am forever grateful that I have found them during all of this. They make me feel like a normal person instead of an insane freak.

Yesterday morning, before the ultrasound, I did feel more pregnant.  I had felt slightly queasy after breakfast, and it was reassuring and something to cling to as I waited to head to the clinic. They kept us waiting for what felt like an eternity, though it was like 15 minutes in real time, I think.  When she puts in the ultrasound wand and starts measuring the sac, she seems quiet.  I try to stay calm, but she says after a long look, "I have a concern." So, yes, I just start instantly crying. I couldn't help it. I didn't want to hear "we don't see the baby."  All the fear just bubbled up in that moment. She could find the fetal pole, but it was measuring over a week behind what it should be. She was able to confirm a fluttering heartbeat. It was the same PA as last time, and again, I felt she was oddly clinical and detached, not really giving us any true information other than as of that moment it was viable, but it was behind. Later, my husband and I both told each other that we had thought of asking her for some statistics on this thing, but neither of us did. Why? Maybe I just panicked and thought she'd say something I wasn't emotionally equipped to hear. Maybe my husband knew I couldn't hear anything worse in that exact moment.

So here we are in limbo yet again. Internet searches do reveal plenty of miracle babies who weren't measuring appropriately and later kicked into gear, so there is hope. We don't know how much hope to hold out. I have to treat myself like I am still pregnant (which I am) and like this baby is still viable (which who knows).  I am having to stay as detached as possible in thinking about this or I just start to lose it. Our odds were like 70-75% yesterday morning going into this ultrasound that we would get a baby out of this, but today, they are not close to that anymore. Whether they are 50%, 20%, 5%, or 1%, I honestly do not know. We go back on Friday to see what's happening. I am trying not to think about "next steps" and "what ifs" because, frankly, I am not strong enough to do that without freaking out. I am hoping for a miracle baby, but the thing is, I find that I don't believe in miracles like that anymore. I'd sure love to be wrong.

March 18, 2014

Eclipse

Today I had my beta test, the blood test to officially test how much HCG is in my system.  My beta was 320, which tells us a little bit but not much.  Basically, the next step is another blood test 48 hours after the first one to see how well the numbers are progressing.  Supposedly, as long as your numbers are doubling every 36-48 hours (or 2-3 days depending on the source), your pregnancy is proceeding "normally."  If the numbers don't improve along those doubling standards, the scores could be an indication of possible issues. So, I am pregnant.  The score is normal for where I am at, though the normal range is so vast, who knows. These numbers can sometimes start to give you an inkling as to whether you have a singleton or twins pregnancy, but again the range is so vast and the overlap so much, that who knows.  My statistics obsessed better half computed that once we were pregnant, the chance of twins was around 40%, so odds are there is one.  

My morning commute to confirm the pregnancy was peaceful.  It's refreshing to go to their office for a positive reason.  I pretty much already knew the outcome and figured the number would be normal, so I wasn't too stressed.  Now the wait and sees start again.  I realize that I continue to feel incredibly numb and detached.  I don't feel happy.  I don't feel safe.  I grabbed some ginger ale at the grocery store on the way home just in case I start to feel nauseated, but even as I grabbed it, I wondered would this ginger ale be mocking me from the fridge in a week or two when things possibly go south. The congratulations phone call from the nurse felt flat.  Telling our family members who knew the test was today felt a little painful.  The need to couch the reveal in terms of "but it's so early" and "who knows where this will go" sort of negates the happy news feeling.  We've made those calls twice before, and then we had to call again to say never mind, forget it.

Early pregnancy after miscarriage feels joyless.  I am really working to be gentle on myself and just let myself feel whatever it is I feel without judging myself as an ingrate.  I know I am lucky to have made it over the getting pregnant hurdle.  It was exactly two years ago in March 2012 that we got pregnant last time. And it was exactly two years before that in March 2010 the first time we got pregnant.  Both of those ended in April miscarriages.  Our 2012 loss is what I think is really holding down my joy.  We had these same blood tests then--the numbers doubled and all looked good.  The first ultrasound was normal.  The second ultrasound was normal, including a healthy heartbeat.  The odds of losing the pregnancy after that were in the single digits, but it happened just weeks later.  I know this past experience colors my testing now.  So what if the blood test is normal every time?  So what if we see the fetal pole and heartbeat?  There are no guarantees.  I know life itself offers no guarantees.  Maybe I just want the ignorance of four years ago back again.  Yes, I knew it was ridiculously early.  But somehow I thought it wouldn't happen to me.  I had a sort of ignorance to the very real precariousness of things reproductively related.  I still believed in "signs" and "good feelings."  I was such a different person then than I am today.

I guess I am just waiting, trying to take each of the next steps in the process day by day.  Each little victory, even if not accompanied tears of joy, gets us one step closer to the end game.  It's hard knowing that the genetic code of the embryo inside me is either solid or is not.  Right now already. Nothing I can do.  It just needs time to grow and play out either way, and I have to be patient and let it happen on its own terms.  My emotional numbness is helping me to be able to inch along in a somewhat sane state.  I have my therapy, my acupuncture, and my online support group.  A good friend passed along the first three seasons of Downtown Abbey, so I can finally see what all the buzz is about, but I am saving those for a rock bottom day, whenever it arrives.  

I keep wondering to myself when my numb shell will crack open, allowing happiness to envelop me. I suspect it will happen once I can get past where I was in my last pregnancy, but maybe just getting past the month of April will help me relax.  We made it to 10 weeks last time, so close but a million miles away from our aim.  I keep thinking about the dreaded day at the real OB/GYN's office after graduating from the RE.  I have revisited the details of discovering the stopped heartbeat in my mind over and over during the last week, willing a new memory to form in anticipation of a second chance to get it right this time. It will take another long six weeks to get to that new possible memory and an opportunity to eclipse past failures.  My mantra has been: you are in the best possible place today that you could be in, and there is every reason to believe things can continue smoothly.  Looking back at my thoughts, I know they seem incredibly negative, but I just can't help it.  The desired baby is closer than it has been in years, so close that I fear losing the progress we've made.  I end most of my internal dialogues with the same thought: please just let this work this time.

March 15, 2014

Desperation

In case every other two week wait hadn't convinced me thoroughly, waiting to find out if I am pregnant after my IVF treatment b****slapped me completely.  I was doing okay for about three days, and by okay I mean obsessively thinking about what the embryos were doing in my uterus and whether they had hatched and were starting to try to attach.  On day four, Monday, I had what can only be described as an obsessive day of thoughts.  I tried to read and watch TV, but I was so distracted by the constant stream of my thoughts that I couldn't even focus for long.  Did it work?  What is happening?  What if it doesn't work?  I can't take anymore of this. Please let this work.  Do I feel symptoms?  On and on and on.  From the trigger shot and the progesterone and estrogen I was taking since they retrieved the eggs, I already had sore boobs and uterine cramping (kind of like period cramps).  I had no choice but to render these symptoms unreliable since I had them almost before they put the embryos back in.  I realized the constant stream of intelligence for the first weeks of the IVF process--follicle growth, estrogen levels, daily embryo updates--were long gone.  All we had was radio silence and still over a week to wait for my blood test at the clinic.  I had bought a three pack of HPT because I decided I couldn't wait that long.  My plan was to wait until Saturday, or 10dp5dt (10 days after by 5 day transfer).  By then I was confident the result would be indicative.  However, by Monday evening, I had worried my husband so much with my obsessive thoughts and comments, that he actually said, "why not take a test tomorrow, even knowing the result will be meaningless."  This comment was a shock since he is totally against the insanity of the HPT obsession.  The fact he was going along with an illogical act shows the depth of his love!

So I took a test on Tuesday morning, 6dp5dt.  I told myself the result was meaningless.  If it was positive, it still might be the HCG trigger leaving my system.  If it was negative, it was still early enough that even an implantation would not give a positive.  Why take it?  I can only say, and it may not make sense to those not in this position, that I took it just to have anything to do and just to have any type of data to parse rather than radio silence.  I take the test, and it is negative.  After I take it, I realize that I wished it were positive (even though I said either was ok).  I wasn't panicked, but the thought of "oh no" popped into my head for a few secs.  I am ok.  I say, "well now we know the trigger is cleared, so if we get a positive in a day or two or three, we will have this as reassurance."  Then my husband calls from the bathroom that he thinks he sees a barely there line.  "You mean a squinter," I say.  "WTH is that?" he responds, like any sane person not reading infertility blogs and message boards 24/7.  

So we had a squinter.  I posted the pic for my cycle buddies, who all confirmed seeing a faint line.  Most of them relay to me that they honestly believe the positive test is NOT from the trigger, that it is the beginning of a real positive test.  I start to feel like maybe this worked.  I spend about FOUR HOURS googling 6dp5dt squinter and reading various blogs, some squinters resulting in babies and pregnancies, some in miscarriages or no pregnancies.  I feel better about this obsessive reading as opposed to my obsessive thinking the day before and not knowing, so I am glad I took the test.

The next morning I wake up early and have a fear attack.  This shit just got real.  I am petrified of taking a follow up test.  I can't bear the thought of now seeing a negative.  I feel so emotionally fragile that the thought of seeing the negative torments me.  I run and pee without testing just to give myself more time to think that "yes, I might be pregnant."  I can't deal with anything else.  My husband is disappointed and doesn't understand why I did that.  Later, after my therapy appointment and getting home, I agree I can handle the result either way, and take the test.  It is positive with a darker, more solid line.  So, it appears this actually worked.  

You might expect us to cry, hug each other, laugh, cheer, or something dramatic, but with prior miscarriages, all we can do is feel what we call "cautious optimism."  We've been here before twice to no avail, so we know all too well how early it is and how this could amount to a chemical or another problem.  It is so very early. 

Still, in our 50 step process, we have gotten over a few more hurdles, putting us around step 38, I'd say.  It's huge just to get here, whether we can feel joy over it or not.  I feel relieved and positive.  We took another test two days later, and there were still two lines.  We are at about 4 weeks as of today, and I don't really feel pregnant.  I wish I felt exhausted or nauseated or something, but I know logically that the lack of symptoms does not mean anything.  I am doing well with not overly stressing.  My fatalistic side speaks in my ear, telling me there is little I can control.  Our biggest obstacle is a genetic error, and there is either one or there is not, and it will play out as it is destined to play out.  What can I do but hope we are finally on the right side of the odds this time?

March 7, 2014

Over the Hump

I made it to the two week wait.  Our embryos kept growing, and come Day 5 (Wednesday morning), there were two AA blastocysts ready to be transferred--basically the best possible outcome of this entire process. Three other embryos were also graded as good (1 AA and 2 AB), and we elected to freeze those for possible future transfer.  There were two additional embryos they thought might make it to be frozen the next day, but they didn't end up progressing.  To summarize, 14 mature eggs were retrieved.  Ten fertilized.  Five made it to good blastocyst stage.  I consider these results stunningly good.  The cryopreservation was not covered, so that was $1750 out of pocket.  Luckily we felt three was a large enough number to pay that price.

The transfer was easy compared to the egg retrieval.  It all seemed to go smoothly.  There was so little pain! We saw a "flash" as the embies were ejected into the uterus.  We got a framed picture of the two they put in. Hubby and I keep joking that we are trying to get pregnant the "new fangled way" since the old fashioned way left us hanging.  

I've been feeling a lot of swirling emotions now that I've made it.  I feel very numb and weird overall. I do think the hormones I am taking to help with the embryo attaching and growing are making me incredibly tired.  I am sleeping all night and taking a nap each day and still feel groggy.  

The blood test with the clinic is not until March 18, so we have a long time to wonder what (if anything) is going on at a microscopic level in my uterus.  According to my blastocyst day by day chart, by today they should have busted out of their outer shells and started to attach.  When we started this cycle, we had about a 30% chance of getting a pregnancy (not a baby, but just a pregnancy).  Getting to where we are now, we calculate the odds are better than 50%, which is better than we've ever had.  The odds of twins as of today are about 20%.  I have been on the wrong side of the odds so many times, that I take them with a grain of salt.  I am so relieved that all of this went well.  It gives me some hope that even if this cycle doesn't connect, there are still chances.  Yet, with all my reading and experiences, I know that there are still so many things that can go wrong.  I keep thinking of this as a 50 step process, with step 50 being bringing home a healthy baby.  Maybe we are at step 30 or something.  Everyone who is following along with me in real life seems convinced that this will work.  I don't think they realize the harsh realities that abound.  There is a reason I have not gotten pregnant all this time.  The reason is unknown.  Maybe we've already circumvented the mystery issue; maybe it still has time to rear its ugly head and screw things up.  

All this being said, I still have an ember of hope deep within.  The odds fuel that little ember to warm up.  I am cautiously optimistic but hormonally imbalanced at the moment, so all I can do is be gentle on myself, control the things I can control, and try to make time move faster!

March 2, 2014

Eggspectations

Well, I survived the egg retrieval.  They got fourteen mature eggs, which is absolutely great.  I was hoping to get lucky and have ten, to be in double digits.  The fact that trying to get pregnant even involves anesthesia blows my mind, but here we are in IVF land!  The after effects are incredibly swollen ovaries (they fill back up with fluid, apparently) and bloating/constipation.  I am feeling better today (two days later). 

We got the call yesterday that ten fertilized.  Again--awesome.  Then we got the call for today's report that all ten are still growing.  Three are two cells big and seven are four cells big.  Because we have a good number, they are scheduling us for a day five transfer for Wednesday.  We will just keep watching these ten to see if any of them drop off and how they grow.  I am so relieved on so many levels.  I couldn't ask for a better report as of today, so I am grateful.  Also, with a major storm coming in tonight and overnight, I was stressing all day yesterday, wondering how we would get to the doctor's tomorrow for a day three embryo transfer.  Luckily, that worry can be released.

I don't really feel happy.  I just feel relieved.  I can't even believe it's going so well so far, and I am waiting for the rug to get pulled out, I guess.  There are so many ways things can go sideways even at this point that I am just cynical.  We've been on the wrong side of the stats every time in the past, but I know things look promising, and I am getting my hopes up a little.  It looks like we will have something to put in on Wednesday as of right now.  I just have to keep taking this day by day. 

February 26, 2014

Bend Over!

It's time to trigger!  Yesterday the follicle measurements were fewer and smaller than the day before, probably accountable to variation between the way the respective doctors measure.  I am not gonna lie, it was tough to feel like everything was "worse."  The doctor I dislike the most in the practice did the ultrasound, and curtly turned off the machine before even telling me measurements and said "one more day." Huh?  I was under the impression that I would trigger yesterday based on Monday.  So I scramble for the meds I now need that I had cancelled since I thought I wouldn't need--added drama and stress.  When I got my estrogen level yesterday afternoon, it was over 2000, and my nurse told me she was pretty confident I would trigger the next day for sure.  

At today's appointment, they only measured the five larger follicles and confirmed today would be trigger.  I have five follicles in the above 18 range and a whole bunch of others that were not measured today.  Some must be getting close to 18, but I have released control of all of this.  I trigger tonight via the dreaded "butt shot." Friday morning the eggs will be retrieved, and at that time, and at no time earlier, I will know how many eggs they harvest.  I just have to let this go until then!  Follicles don't always mean eggs. Eggs don't always mean good eggs.  Etc. Etc.  I am so tired right now that I am not stressing much, actually. Tonight is filled with firsts--a fanny shot, my husband giving me a shot, and a needle twice as big as any I've used so far. BUT, this will be my last shot for this cycle.  I almost managed to get an acupuncture appointment for tomorrow, but it did not work out.  I am releasing that, too.  I have my first acupuncture appointment a week from tomorrow, instead.  I got a good vibe on the phone speaking to the acupuncturist.  We will see.  I have heard such good things about the relaxation aspect, and I actually have insurance coverage for the treatments :)  If it helps during the two week wait, great.  If I have to do another cycle of IVF, then it can only help going into that, too.  I am feeling positive and resolved for now.

February 24, 2014

IVF Day 10

So, this junk just got real.  Eleven follicles measured over 14 mm this am!  Five are bigger than 18 mm, which I am told is a good marker for a strong likelihood of a mature egg being there.  The other six follicles ranged between 14.8-and 16.5 mm, so they are not that far off.  They may or may not produce mature eggs.  There were five more even smaller follicles closer to 10 mm.  The RE tells me that we will either trigger today (huh? wow!) or tomorrow, depending on my estrogen levels in the blood work.  If the levels are not too high, they will hold off triggering so that maybe they all can just mature a little bit more before triggering tomorrow.  Going through the trigger instructions with the nurse felt surreal--not sure why since I've been waiting for this since last Friday, but I am ahead of the sample IVF calendar I was given, so I was expecting to see some growth and to keep coming back every day this week.  I finally got the call after a long day of waiting that we will wait and check back in tomorrow morning.  The RE lowered my dose of stims for tonight.  All likelihood I will trigger tomorrow, per the nurse this am.  Then this afternoon, the same nurse also mentions out of nowhere it could even go one more day.  I hope not because based on her talk with me this morning, I canceled a refill on some meds I would need if it does go to Wednesday.  I can't worry about that right now, though.  I have two big marker circle on my backside to mark where the trigger shot will go....but not quite yet :)

February 22, 2014

IVF Day 8

This morning's check in at the clinic continued to reveal growing egg follicles.  She measured 12 of them over 10 mm, and a few smaller.  They are all in the same size range, which is good news as the RE doesn't want one of the follicle taking off and growing to maturity too quickly and ruining the good "harvest" of many eggs.  My estrogen level was rising steadily.  The doctor said I may need to come back tomorrow-it was borderline, but when I got my call, they said come back Monday.  I am going to assume that starting Monday, I will be going every day now for morning monitoring.  I am letting myself feel happy that the eggs seem to be doing great for me so far.

The hormones are affecting my emotions more as of yesterday.  Not sure if the morning shot of Cetrotide is the cause.  I am not liking that shot too well :(  It is tolerable, but I have been icing it prior and then warming after.  Today was a little trickier because I had to add this am shot into my morning routine before heading out to the doctor's appointment.  I also feel some pain like a sore patch under the skin where the shot goes.  Again, it's totally manageable, and the shot didn't burn going in (not sure if it would without the icing, but I read some warnings and I'm not chancing it).

So basically good news, plus I get to sleep in tomorrow!

February 20, 2014

Just Keep Stimming

Today is IVF day six.  Been taking my nightly shot--only one in my belly--with not too much trouble. Pretty much this procedure is the same as my last few IUI's, only with more medication.  I am trying to just "enjoy" the relative ease of things for the moment.  I know by next week things will be getting crazier, adding another daily shot to prevent early ovulation and daily office visits.  I joined a cycle buddy group on Fertile Thoughts full of ladies all doing IVF this month.  I feel really positive about the decision to join.  Everyone seems very supportive and friendly.  I know we are all at the beginning stages, so hope is the mood for the moment.  Most of them (if not all) have done IVF at least once before.  What a great resource.  I also got a few phone numbers for acupuncturists in my insurance to try to call.  It is probably too late to really do that much, but I figure it can't hurt, might help with control and anxiety, and could be valuable down the line if more than one cycle is needed. Honestly, it's just being overwhelmed with the IVF stuff, insurance stuff, and medicine stuff that has held me back from getting in gear to check on the acupuncture.

On day four of the cycle (Tues), I went in for my first office check. (Side rant--another 2 inches of snow to clear off my car that morning and then drive through to my appointment.  DIE WINTER DIE.)  I was delighted to hear a report of 16 follicles starting to grow--7 on the right side and 9 on the left.  That is pretty much the best number I could have anticipated given my age and my previous follicle counts.  I took it in as a "win" for the day and felt really happy to get started on a positive note.  They kept me on the same dose of meds.  I already had to call and order a refill on one of them. I guess the meds are a very day to day thing, and I will need to stay on top of it after each office visit to make sure I don't run out on a Sunday!

Today, day six of the cycle, I went in for my second office check.  They measured nine of the follicles, now at around 10 mm each.  They counted six others still there below that size.  They are keeping me at the same doses, but starting tomorrow morning, I add a new am shot to the regimen--Cetrotide, which will help prevent the eggs from releasing before the doctor goes to retrieve them.  I am happy that nine are growing well, and the doctor said not to give up on the other follicles yet, so I will wait and see if any of them catch up.  I go back in two days for my next check.

We also seem to be getting the best deal possible so far on the insurance front.  Looks like the plan covers the meds fully once the out of pocket plan limit is reached.  The refills I ordered for one of the medicines that had a copay last time, cost $0 this time!!!  YAY!  I need to do some more legwork to see what counts toward this out of pocket limit and what we still might have to pay, but it looks very promising indeed.