Not how I thought this would end

Today we were all ready for the transfer. I was thinking two, maybe three embryos. At least one. But the doctor called this morning and said that after fertilizing a few days ago, they all three stopped growing. Just stopped. No explanation as to why. But that means there are no embryos to transfer. No bed rest today. No pregnancy test in 2 weeks. That's it.

I've been through a range of emotions already, from devastation to rage to despair and defeat. Now I'm just a little numb. I don't really know what to do with myself. I guess I could have some caffeine or alcohol today. I could probably start running about a week or so. But those things are little consolation. Maybe Dane and I will try to take a vacation before I begin residency. Who knows. I think today I will lay on the couch and watch a mindless movie. I just don't think I can concentrate on anything else.

It's hard to believe it's over, just like that. We'll still find a way to be parents some day, but probably not until after residency. Thanks for following along on this crazy journey.
~Sarah

Waiting by the phone

Today was one of the most frustrating days so far. I expected to hear from either the doctor or the embryologist this morning with an update on the other eggs and the fertilized embryos. But no call came. I tried very hard to be patient. Yesterday they called at about noon. So today I waited until 2:30 and called the office. Being a Sunday, they have only an answering service on the phones, whether someone is there or not. So I left my name and number, and a nurse was supposed to call me back in a few minutes. Half an hour later she called back.

This nurse was surprised that I was supposed to hear from someone today because they've all gone home already. And if I am actually supposed to have a transfer tomorrow, someone should have told me when and where to show up, among other things. She sounded skeptical of my story, but promised to investigate and get back to me. Another hour went by and the nurse called back to say that my transfer will be tomorrow, and my doctor would be calling me soon to discuss further. But what about the embryos, I asked. She said none of the other eggs had matured. So they didn't even get to try to fertilize them. That's all she knew. She had no update on the existing embryos, how they looked, if they were still all good, or anything. She said the doctor would call and the doctor would know more.

The doctor finally called at 8pm. She had been on call today in what she described as a very crazy day, and she apologized for not calling sooner. She confirmed everything the nurse had said initially, and didn't really have any new information beyond that. They won't have an update on the three initially fertilized embryos until tomorrow morning. At that point we'll discuss the plan. If there are one or two embryos only, they will transfer all they have. If there are three, and they all look great, then we'll have to discuss. The possibility of triplets is concerning, but freezing/thawing just one embryo is very risky as only 80% tend to survive that process. So we'll see what they say tomorrow on that.

The nurse and the doctor say I should try to get some rest. Try to relax. I'm gonna go take a hot bath right now. But I don't really know how to put my mind at ease. It feels like so much is at stake. So much is resting on this one attempt. I had really, really hoped that there would be a few backups. But I'll give it my best. After the transfer tomorrow then I'm on strict bed rest (I can get up for bathroom breaks only) for the remainder of Monday and all day Tuesday. I've already TiVo'd lots of movies and have a good book picked out. It will probably be the longest amount of rest I'll get for the next few years, at least until residency is done. If I have triplets, it will be even longer. I'll try to relish it.

hurdles

Yesterday's excitement of harvesting 11 eggs was relatively short lived. The doctor called today to inform us that only 3 had fertilized normally. So here's the breakdown: 4/11 were too immature to try to fertilize yesterday, so they'll try today and tell us how it went tomorrow. 1/11 appears to have done nothing. 3/11 fertilized abnormally by allowing more than one sperm to penetrate the egg, so they are genetically incompatible with life as they have 3 or more copies of all the genes, instead of the normal 2. And that leaves the 3 normal ones. Three is better than zero, but it is quite disappointing nonetheless.

Tomorrow she'll call back and tell me if those three are still growing ok, and if any of the 4 previously immature were able to fertilize. They will actually use a procedure called ICSI (Intra Cytoplasmic Sperm Injection) to try to maximize fertilization for those others. I don't really expect any of them to fertilize given that they were immature at retrieval, but we'll see.

I just feel like I'm running a race with an unknown number of hurdles. Everytime I jump over one, I hope that the end of the race is coming soon and there won't be any other hurdles, but then there's another one waiting. And I keep watching all these people around me running a simple hundred yard dash with narry a hurdle in sight. And I have no choice but to keep running, and keep jumping. Or just give up on the race. I don't want to give up, but I'm tired. I'm mentally tired and emotionally tired, and quickly becoming physically tired.

I asked Dane today, "When does the disappointment end?" He said "When you stop trying". It's not the answer I want, but it's the truth.

Short, sweet, and to the number

We got 11 eggs!! The retrieval went well, and Versed is a fantastic drug. The embryologist informed us that they were able to retrieve 11 eggs, which is great compared to the 3 we got last time. They'll call tomorrow with the fertilization report. On average, they expect about 60-70% fertilization rate, assuming there are no problems. So we'll see what they say tomorrow.

a tide of emotions

ok, i'm definitely emotional. I just got a call back from the pharmacy and they agreed that there was a mixup about the extra medication, and they are going to take it back. They will credit my account the $600 when they receive the medication back, and they are paying for shipping. This news made me teary, in a good way.

after last night's post and subsequent shot (ouch), I laid awake in bed for what seemed like forever just thinking about all the what ifs. What if this works and i get pregnant? How will that work with my residency? Where would we put the crib? What would we name the baby? What if this doesn't work? Would we adopt a baby? International or domestic? Would anyone choose us to adopt their baby? Would we want to have a white baby and play it off as our own, or would we pick any race/color/ethnicity and have it be totally obvious and open that the child is adopted? How ironic would it be if we got pregnant on our own after two failed IVF attempts? How exciting would it be to be able to share that news with Dane after secretly buying a pregnancy test at the store? And then we could tell all of our friends and family! it would be so exciting! you can see how all of this mind racing is not good for sleeping. so another nap could be in my future today.

I met with the nurse this morning, and the reason they decided to trigger ovulation for Friday retrieval is that all of a sudden my eggs starting growing like crazy! One of them grew nearly a whole centimeter in just one day!! And there appear to be 5-6 on each side right now. They won't all be good probably, but if we get a few from each side, that would be double what we had last time. My estrogen level is now around 3000-4000! So I guess I have an excuse for being emotional. I'll get one more call this afternoon to let me know if the trigger shot worked based on my blood test results. If not, I go in for a booster. But either way, tomorrow at noon will be the retrieval. Just our luck that tomorrow at 10am is supposed to be the peak of a big spring snow storm slated to bring in 1-2 feet of snow to the metro area!! The plan will be to leave early, drive slow, take the 4-runner, and let dane be the one behind the wheel. If we had a wreck on the way down there, I believe it would be grounds for my wanting to leave Colorado. I will say my prayers for safe travels.

Let the countdown begin.

I have no idea if blogspot tells you what time I'm writing these things, but it is currently 12:40am in Denver. In 20 minutes I'm supposed to give myself a huge shot in the bum that will trigger ovulation exactly 36 hours later. That would be 1pm on Friday afternoon. Luckily, at Noon on Friday I will be falling deep asleep under the watchful eye of an anesthetist, while the doctor harvests my eggs.
This is a very precisely timed operation, and it seems I got the raw end of the deal. They usually start the egg retrievals early in the morning, meaning most people give themselves this shot at a normal time, like 9pm or 10pm. But if they have a lot to do in one day, then they continue scheduling until they are all done. The nurse initially thought I would be ready for retrieval on Saturday or Sunday. But all of a sudden in the last two days my eggs started growing a lot faster. And it's also possible that my body decided to trigger ovulation on its own and their hand is now forced. I'm not sure which it is, but I have the instructions to go ahead. And I've unfortunately drawn the short straw and have the latest egg retrieval appointment. Hence, the 1am shot.

Honestly though, I'm glad this is finally happening now. This morning I was really going down hill with respect to mood and patience. I've been doing ok so far, but for the past few nights I've been getting more dizzy and nauseus at night. So I don't think I've been sleeping so well. And this morning I awoke to a phone call saying my morning monitoring appointment would have to be moved to another office much further away because the ultrasound tech at my normal office called in sick. This was quite an inconvenience in an already busy day, but what choice did I have? Next I picked up my latest shipment of world's most expensive medication, only to find they sent me double the amount that I ordered. And they charged me for it! I promptly called their helpdesk, but the woman said a Patient Services Representative would have to sort it out and call me later. She made it sound like the problem was mine, not theirs. I was sooo furious. And at that point, I totally lost it. I was crying, sobbing, completely breaking down. Not on the phone of course, just in the car with Dane. I said how much I hate all of this and I can't wait until it's done. I said I would never, ever, ever go through this again. And I thought, but didn't say, that having kids was probably not worth all of this bullshit.

We came home and I decided the best thing was to lay down for a bit. Two hours later I woke feeling much better. The medication shipment mistake has not quite been resolved despite my calling again, but at least the second customer representative was more friendly and apologetic for the mistake. In any case, the situation certainly did not warrant such drama. I was even aware of that at the time. But I felt completely at the mercy of my emotional surge. So it's better that their going to finally get these estrogen making buggers out, and I can hopefully go back to dealing with this incredibly stressful situation like a normal person instead of like a crazy possessed person.

oop, it's 12:58. Gotta go.

Still growing

I've had so many things I wanted to post about lately, but my time availability and access to internet have been cut short by moving. So I'll see if I can cover the important stuff. Things are going well. My ovaries are both growing steadily with multiple follicles. It looks like the retrieval will probably be this weekend. The bad thing about it taking so long for the follicles to reach the right size is that: a)it is really, really expensive to keep getting refill meds to help them keep growing, and b) the lining of my uterus (endometrium) just keeps getting thicker and thicker with all of this estrogen hanging around. This morning it was 15 mm thick. At about 17mm it will be too thick and they will have to freeze the embryos and transfer them another time. That's fine in theory, but could be difficult to time a two day break from residency (necessary for two days bedrest after transfer) with the right moment in my cycle for transfer. Oh, and it means more money. Everything is more money.

But all told, I'm doing fine. My estrogen is now above 1000 and I'm beginning to feel the effects. In the evenings I have waves of nausea and dizziness. My appetite has improved a little, but when I do eat, then I regret it for all of the nausea. Perhaps this is a primer for pregnancy. But I'm sleeping ok, no hot flashes. And I haven't had any full blown migraines either. This time around has been much easier in the way of symptoms.

And yet, I still want to be babied a little bit. It's probably silly, but I want people to dote on me over all of this. It sucks to take all these shots and go in for all the blood draws. It sucks to feel so hormonally pulled all the time. And it sucks to have no ability to exercise as an outlet. Oh, and I really would love a cup of coffee in the morning and a beer in the evening. Instead, I just watch everyone around me enjoy those things. As much as I want those around me to enjoy themselves and not be inconvenienced by me, I hate to suffer alone. Misery really does love company, or at least an occasional foot rub :)

The other morning at one of my monitoring appointments, I felt a little bit less alone. A young, pretty woman about my age got on the elevator with me and walked into the fertility clinic ahead of me. She seemingly had the same type of appt as me, and may also be doing IVF. I'll never know. Two other young, pretty women came in while I was waiting. It was the first time that the waiting room was not filled with women in their 40s! I always feel very alone when I'm the only young person in the office. Like this shouldn't be happening to me. Infertility should be a problem only for those who wait a long time to have kids. But that particular morning, we were all in the same young, pretty boat. I felt for them. I wanted to tell them that I understood what they were going through. I wanted all of us to commiserate about all of our friends who were having babies while we were not. Instead, I read Cosmo and waited to be called. But for a moment, I felt less alone.

I think deep down we all want to find people who are like us. People who can understand without having to explain. Not that I want to be best friends and go on outings with all of these infertile girls. My friends are friend enough, and I feel very loved and supported. It's just nice to know that someone, somewhere, understands completely.

Pincushion Princess

I have now been on the medications for a week, and it looks like I'll have about 5 more days, give or take. My eggs are all growing, although not exactly at the same rate. Some of them seem to be trying to win the size race, which is not really what we want. But they are at least producing estrogen like they are supposed to. My level yesterday was 190. I should get another level today.

But I have a whole new respect for these numbers. As a doctor, I order and evaluate lab tests all the time. It's an essential part of many, if not most, evaluations. But as useful as the blood can be in determining how to care for someone, people don't come with a spigot on their venous system. It takes a skilled hand to gently insert a needle and tap the vein. Lucky for me, the phlebotomist/nurse who draws my blood at the clinic is one of the best.

But even the best can have trouble some days. Today, my veins were not playing along. Given the two holes that already grace my left antecubital fossa (the front side of your elbow), my veins decided to run and hide today when they saw Ruby approaching with that needle. She tried for a new vein on the outer side, but after much digging around she had to abandon that site. Instead she went for the tried and true big blue vein on the inner side. This one hurts. No, I should say IT HURTS! Every time. I usually ask people not to stick me there because of the sensitivity, but it seems to just thrive in that protected environment, becoming bigger, bluer, and more tempting to those weilding needles. But the crappy thing is, she had to dig for that one too! Was Ruby off her game this morning? Were my veins still asleep in bed due to the early hour? I don't know, but I left with lots of gauze and a very sore arm. Sadly, I know there are many more days of the same waiting for me. Maybe I'll do some curls tomorrow morning before I arrive...

In any case, I'm developing a greater appreciation for what patients must endure at the hospital every time I sign a little order asking for a blood test. And taking blood out is not the only time people get poked. We also put things in. It's almost impossible to rent a room in a hospital without getting fluids pumped directly in via IV. And then there are the medications that get administered IV drip, IV push, subQ, and IM. I'm lucky that my current regimen only includes subQ shots, which means tiny needles that don't go very far in. But my "pinch an inch" tummy is beginning to look a lot like a mine field of bruises. Last night required two shots for one dose of medicine due to the increase in dose. And what do you know? It's time for my next shot.

For all of you reading out there, thank you for your love and support. I think my anxiety level is much lower this time around since I have an outlet for my thoughts and feelings, and so many loving supporters. Happy Good Friday everyone.

Going for broke

I've taken 5 days of the stimulation meds so far, and this morning I had my first monitoring appointment. This consists of a vaginal ultrasound to look at my ovaries and measure the size of each follicle, and a blood draw to measure the levels of estradiol, progesterone, and LH. The estradiol will tell them how functional my follicles are, and the progesterone and LH will tell them if my body is about to ovulate. So I want the estradiol to go up, and the LH and progesterone to stay low.
Today, everything looked great. The nurse said today was sort of like a baseline. They counted the follicles, and hopefully I'll have somewhere between 10 and 15 when all is said and done. They all seem to be about the same size and growing at about the same rate, which is good. My estradiol is only 71, but she said that was normal. I'll go back on Thursday for another such appointment, and hopefully everything will be progressing well.

In the meantime, they've increased my dose of Gonal-F. I was taking 300 IU per night, and now I'm up to 450 IU per night! I suppose I've got nothing to lose, so let's go for broke. I don't really know what the upper limit is on the dosing for Gonal-F, or if there is one. But this feels like a pretty high dose given that I was taking 225 IU for my previous IVF. I expect to get more hot flashes, mood swings, and headaches with this change, and with my increasing estradiol level. We'll see. So far, the side effects have been minimal. In fact, I would actually say I've had more energy lately, and a decreased appetite! I can't help but wonder if this is more like the way I should feel all the time, if my ovaries were making the right amount of steroid hormones all the time... Would be quite a bonus if I could drop a few pounds in the midst of all of this, but that seems unlikely given my now total lack of exercise. I'll just try not to gain any weight I guess.

Well, none of this is a guarantee. But I like having something positive in the end, even if it isn't what I set out to get. So my silver lining (albeit small and arguably insignificant) is that I'm going to take this opportunity to whiten my teeth. Given my forced time away from red wine, coffee, and soda, I've got time to let some whitener do its job. All the products say that for the best results you have to stay away from such staining liquids during the two weeks or so that you use them. So I'm wearing my Crest WhiteStrips right now. My gums are tingling. Come to think of it, so are my ovaries... :)

Distracted

As of yesterday, I've started taking the stimulation meds. The Menopur (LH agonist) is a subcutaneous shot in the morning that makes me feel queasy a few hours later, and in the evening I take a subQ shot of Gonal F (FSH agonist) and a pill of dexamethasone. Supposedly the Gonal F can make you dizzy, but I take it at bedtime to avoid feeling it.

I probably would have something more insightful and eloquent to write about with the beginning of these meds, but I have been distracted by having mangled my car on an icy highway road yesterday. I'm fine, and the other people are fine, but it was terrifying to slide out of control on a mountain highway in the midst of an unexpected snow storm. My car will be repaired and insurance will pay for it, so the damage is really quite minimal in the end. But I am frustrated with all the April snow, and feeling helpless at having planned my trip so meticulously to avoid driving through bad weather only to hit a freak snow storm 45 minutes from home!
I hate pointless destruction, so I've tried to come up with things I've learned from this so as to avoid a similar situation in the future. So far I've got: If I'm in the civic and it begins to snow, turn around and go home. Also, when it's icy, the brakes make you slide, so stay far enough from the person in front of you that you have time to stop with gravity and friction alone. (It is quite frustrating to feel as if I've gone from a confident and controlled motorist, to a scared and helpless "not from here" driver. Everyone complains about people who don't know how to drive on snow and ice, but they never offer up any helpful pointers!)

So you can see why I have been less focused on the IVF. But I am certainly excited that the ultrasound and bloodwork were good yesterday, and I got the go ahead on the meds described above. I'll go back next week for some monitoring, and hopefully my ovaries are on their way to being huge.

Estrogen Dreams

I started the first of the meds yesterday. Nothing heavy duty yet, just some estrogen supplements. My mood is slightly improved, and I have a little more energy. But last night, I experienced crazy dreams like you wouldn't believe. I woke up drenched in my own sweat. In the night I remember taking impossible exams in a school I've never seen, watching people's souls move from one body to another, and fighting people for reasons I cannot now remember. At 5am, I was ready to get out of bed just so I could relax a little!

Now that had to be the drugs. I've found that while I am naturally a vivid dreamer, my dreams can be turned dramatically up or down with the addition of otherwise benign seeming substances. For example, Mefloquine is an anti-malarial drug that makes many people dream crazy things while taking it. But when I took it, it made my dreams go away completely. I had no dreams for four months.

I was initially excited about the Estrogen supplements. They are supposed to increase mood, energy and sex drive. But this whole dreaming fiasco has put a bit of a spin on things. I value my sleep very highly! Well, I did add one other new drug today, called Antagon (Ganirelix). We'll see if that changes anything.

And the countdown for exercise and alcohol has begun. I've got one or two days left of each. So tonight: a trip to the gym and a bottle of good red wine.

Addiction

We had the pre-IVF meeting with our nurse last week. It all went well, and there really weren't any surprises. We went through all the do's and dont's, and what to expect with the meds. The only test I have left to take is a doppler ultrasound, to see if the pressure in the arteries leading to my uterus is too high. If it is, they will recommend accupuncture. For this test, I have to be off of caffeine for at least 3 days. And the nurse basically says that now is the time I need to cut down my caffeine, and be off altogether in the next week or so.

For those of you lucky enough to have no addictions, you will not understand this. I've done it before of course, and I can do it again. And you can't drink caffeine early on in a pregnancy anyway, so I knew this would come. But it will be hard! I will also have to give up running (all exercising actually) and alcohol when I start my stimulation meds. And while I will miss those things, especially the running, I will not have physical withdrawal like I will from caffeine.

I have definitely developed physical dependence on the stuff, even though I generally only have the equivalent of 1.5 cups of coffee per day. I wake up needing coffee. I crave diet coke in the afternoon. A commercial for good coffee or a cold diet coke will sort of drive me crazy. It's a good thing I have no interest in cocaine or anything REALLY addictive, cause I could probably never kick the stuff.

With the last IVF cycle, the thing I never stopped craving was caffeine. It was the first thing I had after I found out I wasn't pregnant. Even after the physical dependence was gone (only takes about a week), I still wanted caffeine every single day. So if you see me and I'm cranky, I apologize in advance. My vices are few, but they are sacred.

What's that? My husband has just cracked open a cold can of soda. Aaahhh, the snap and hiss of that can opening! The cold bite of the first sip! You will be missed.

On the upside, maybe now would be a good time to whiten my teeth...

Stable X

Results are in, and my X-chromosomes appear to be normal. Well, in-so-much as I am not a carrier for Fragile X syndrome anyway. I wish you could all see my little happy dance about this. So we move forward. I'll start taking my first meds in about 3 weeks, and the heavy duty stuff will start about a week after that.

I have to say, a little part of me wanted the test to come back positive. This is crazy, I know. Who would want a genetic disorder? But it would be an answer. And it would also be a way for me to retake control. If infertility can be described as anything, I would say it is a loss of control.
For decades now women have been controlling their fertility with contraception. Along with the assumption that we can prevent having babies until we're ready, we also assume that they will magically appear when we are ready. Infertility is a slow, relentless, painful loss of that illusion. I often get asked the question: "So, when are you two going to have children?". I think people see that I'm a highly educated woman with an important career, and they simply assume I'm waiting until the right time. It doesn't occur to people that my childlessness could be anything but a choice. So when I answer, "I don't really know", people are confused. How could I not know? But it's not up to me really.

If the genetic test had come back positive, then my answer to those questions would be different. It would be proactive. I could say that I've chosen not to have my own children to avoid passing on a destructive genetic defect. I would no longer be slave to the deficiencies of my own body, but would be making a choice to parent an already created child rather than pursue creating my own with such risk to their health. I would regain my control.
(as an aside, I pass no judgment on anyone deciding to have children with a known risk of passing on a genetic defect. it's a personal decision. and i recognize that no child is guaranteed perfect, whether you know the risk and the specific defect ahead of time or not.)

But that is not my path. My defect is not known or explained, and so we press on.

The Plan

We met with the doctor yesterday to discuss the results of our tests, and the plan. As expected, my high FSH predicts a lower chance of success with IVF. According to the doctor, if the number had been normal, our chances of success in one cycle would be about 70%. With my FSH between 12 and 13, success drops to about 55% at their clinic. This number still seems pretty good, but it is weird to spend all this money, time, effort and emotion for something that is as likely as a coin toss. I don't like those odds. But then again, even if she told me the odds were something like 30%, that's still better than the likelihood of having it work out on our own. I guess it's all about setting expectations.

We also talked about what may have caused the decline in my ovarian reserve at the ripe old age of 28. For most people, the reason is never known, even when they look for a reason. But there are a few genetic causes that account for a significant portion of this population. The highest percentage of genetic abnormalities can be attributed to something called Fragile-X syndrome. This is typically thought of as a genetic disorder causing mental retardation in boys. It is an x-linked triplet repeat abnormality. So little boys who get a mutated x chromosome from their mother (the father passes a y to boys) will have mental retardation if the mutation has >200 copies of the extra piece of this gene. If they have less than 200 copies, but it's still more than normal, then the boys can have autistic features or can have psychiatric problems. Girls, on the other hand, have 2 x chromosomes, so they don't get mental retardation usually. But instead they get ovarian insufficiency.

If fragile x syndrome were indeed the cause of my problems, I would not want to pass it on. So I rolled up my sleeve and my blood is now somewhere en route to be processed and my genes examined. I'll know in about 3 weeks. It seems unlikely, but too important not to find out.

So the doctor has this whole plan for how to change up the IVF regimen from what I did last time. I won't get suppression with birth control pills or lupron, which is good because the lupron caused me to have a migraine EVERY SINGLE Day that I was on it. Instead I'll take estrogen supplements for a few weeks before starting the stimulation. Then I'll be on FSH agonists and LH agonists, at pretty high doses. In fact, the look on the doctor's face when she said "Really High Doses" was a little scary... Then, instead of Ovidrel to stimulate ovulation, I'll take a combo of Lupron (hopefully just a short course) and Beta HCG concentrated from the urine of pregnant women. This last one smacks of some sort of witch doctor magic, but at least I understand the reason behind it. I like a little irony though.

I'll start all of this next month, with April being the month where the big stuff happens. If all goes to plan, we'll have a pregnancy test at the end of april/beginning of May. The timing is tight with me starting residency on May 22nd, but at least it will provide a distraction regardless of what the outcome of the IVF is.

So last night I sat in our tiny bathtub, sunk up to my neck in steamy hot water, and began mentally preparing myself for this battle. I wish I could think of it not as a battle, but I know that it will wreak havoc on my body and my mind, and possibly my soul.
Part of me thinks this is a foolish fight. There is a saying: "If you want to hear God laugh, tell Him your plans." If this is true, then I should send God a bill for all the good rolling laughs he must be having these days. But then again, "The Lord helps those who help themselves." How do I balance these things? My plan was so perfect. I knew that many women in medicine put off having children until it is too late, waiting until residency and fellowship are finished and they have established a career. But I didn't wait! I planned a year off to be able to stay at home with a baby. I tried so hard to avoid the craziness that must certainly be pregnancy in residency and all too short maternity leave. But in the end, I feel I don't really have control.

Maybe preparing for a battle is not the right analogy. I am preparing for a wild ride. A ride where I just need to hold on, and hope. Hope that in the end I at least have my sanity and my marriage, and maybe a little something more.

The growing problem

It's hard to talk about the issues surrounding IVF or any treatment for infertility, without talking about the ever present pain of infertility itself. Today was one of the hardest days in a long time. I knew it would be tough, since I had agreed to attend the birthday party for 1 year old Benjamin, who I was Nannying for a short time ago. I expected that the party would be full of young parents with young children.

But the day started out with a trip to the mall to pick out a gift. I never before realized that 90% of the people in the mall have kids. Maybe I just have selective staring power, since I'm sure that as a teenager all malls were filled with teenage girls who were prettier and more popular than me. But today was overwhelming. I was dodging strollers left and right. I saw one couple that must have collectively weighed 700 pounds, and they had a young girl. I saw several teenage couples with babies. AAAaaggggghhhh! It seems sooo unfair!

Finally we found a store with babies clothes, and I actually did alright in there. I tried hard not to focus on the cute and tiny things, and got to work picking out a gift. And then on to the party. We arrived to find just what you might expect: Many babies toddling about in the middle of the room, with parents scattered around the edges. There were a few other childless people there, but they were probably barely into their twenties and not married. The rest were parents. And the conversation always started with some version of, "So, do you two have kids?". Sometimes when we said no, it was simply an awkward silence followed by that person walking away. One guy made a joke about how having kids was contagious and we should "watch out". For the most part, we simply didn't fit in. People who have kids want to talk about their kids. It's natural. But we were outsiders. So we stayed through cake, watched Ben cover himself in frosting, and then ran out of there before the tears came bubbling to the surface.

I'm afraid this problem will only get worse. Most of our friends are married now, and many have at least planned when they will start trying to have kids, while others have changed their facebook pages to be the new baby album. It seems only a matter of time until these types of parties will be the only time those friends get together at all. I now look to residency as a possible relief from these pressures; I'll be so busy I won't have time to think of such things.

Well, to at least touch on the issue this blog was created for: We will meet with the doctor in about a week to discuss the plans for IVF. I don't know what she'll say. I sort of hope she'll say the chances are so low that we shouldn't spend the money and I don't have to take all those hormones. But then again, this is my last chance. I'll probably hold onto any hope at all, and they wouldn't say no to $15k lightly.

Happy note for today's post: NO MORE CLOMID!!! Really! Ever!! I haven't felt like myself for a single day since I started this round of it for the clomid challenge test. But it's over now, and I don't have to take it anymore. I give public thanks to my husband for putting up with me during this crazy hormone controlled month.

Test results

I probably shouldn't have called the doctor's office from the airport yesterday, cause nobody likes to cry in public. But I really wanted to know the results of my clomid challenge test and the day 10 FSH. I was sure that the number would be below 10 and I would have something to celebrate. Boy oh boy was I wrong. Not only did the number NOT go down, but it went UP! It was 12.8, up from 11.4. The nurse wasn't able to interpret this for me over the phone, but we did schedule a followup appt with the doctor in a few weeks. But I don't think I really needed her to tell me what a bad sign this is.
According to what I've read, this means my egg quality and/or quantity has decreased to the point that my body is working really hard to make that dominant follicle every month. For sure this will mean that I should expect to require lots of extra drugs for IVF to even have a chance. At worst, it signals that my chances of IVF being successful are very low. I guess I'll have to wait to get the doctor's expert opinion on that.
So the choices I face now (at least in my mind) are all ones that I'm not ready for. I can't imagine using a donor egg and having a child that is really dane's but not really mine. I also can't imagine going through embryo adoption, a very expensive process, only to find that my eggs weren't the only problem and have those potential babies be lost as well. So that leaves regular adoption. But I just don't know if I'm ready yet to give up on the idea of having my own children. I keep hoping that with enough time, it will just happen sort of miraculously.

Which brings me to the topic of faith and hope. Some days I have faith that there is a plan and that this will somehow all work out. Perhaps there is a baby somewhere out there in the world that really will need me for its mother someday, and if I have my own children I will never meet that child. But other days I have no faith, and this all feels so very unfair. Faith or no faith though, hope is the one that really hurts. I almost don't want to hope anymore. I almost can't take any more testing, because each test that turns out abnormal just takes away a little more of my hope. If hope were just gone, then I could just be sad and then let this all go.
And yet, all the good test results in the world don't matter so much if I don't end up getting pregnant. And if I do get pregnant, then all the bad test results don't amount to much either. These numbers are a proxy, meant to set my expectations appropriately. Well, my expectations are now low. I don't know what my future holds, but it's probably not going to include 9 months of growing another person. And I think I'll be sad about that for the rest of my life.

it's a tear jerker

wow, so i just found this video on the infertility forum I belong to. It's pretty hokey, but I cried my eyes out anyway. The pain is so very present, even when it's in the background. I love so much about my life, but I wonder if I'll ever get to take the next step.

http://www.youtube.com/watch?v=JqfGqOx2iDQ&feature=related

Crazy Clomid

I hate this drug. About a year ago I took 50mg Clomid once a day for five days, for 4 months in a row. It was supposed to help me develop a "better" follicle. And I responded well according to the ultrasounds, but no pregnancy ever resulted. When we decided not to continue with Clomid, I celebrated. It makes you crazy. Well, it made me crazy. I was having hot flashes and migraines, and the most amazing mood swings you can imagine. I would laugh and cry at the same time for no reason. But, it didn't work, so I stopped it.

Well, I'm on it again. Not to help with a pregnancy, per se, but to see if the clomid can suppress my FSH levels on day 10. If not, that's a bad sign for my eggs. So now I'm taking 100mg every night, and the hot flashes just started last night. A new side effect now: dizziness. When I sit at the computer for a while, it begins to feel like I'm floating around in an anti-gravity room, doing flips and spins. The mood swings are starting up again as well. I get all these feelings pent up inside that want to come bursting out, but none of them make sense, so I try to hold it in. A good trip to the gym helped me to unload some of that. But I look forward to getting to the end of this round of clomid. Then I'll probably never take it again.
The scary part is the blood test at the end. It's not the needles, cause that's old hat by now. But what if my FSH doesn't suppress? I don't want to give up hope of having a baby, but I have to be realistic about my chances. Nothing I can do to change it all now.

Oh yeah, and I learned online that bodybuilding men will take Clomid to reverse the testicle shrinking effects of steroids! YIKES! I wonder if they get hot flashes and mood swings too? Probably not.

Day 3 FSH

With the second round of IVF, we're going with a new doctor. As such, she wanted to repeat a lot of the testing we've done already. All of our previous tests were normal. So last week I went in for a baseline ultrasound and Day 3 bloodwork. I completely expected everything to be normal (which is weird really since I know I haven't gotten pregnant). But it wasn't normal. My day 3 FSH was 11.4, which is too high. It means that maybe my ovaries are running out of good eggs, so my brain has to work harder to tell the ovaries to make good eggs. The nurse told me that a more important number is what the FSH turns out to be after I take 5 days of clomid. If it goes back down, I guess that's a good thing. But I have to wait almost another week to know.
Yesterday when I got my FSH result, I was pretty upset. It's not anything I can control, and it's not my fault. Maybe I was just born with fewer good eggs than most people, or maybe my body got rid of them faster than it should have. I don't know. But I can't change it now, and it scares me about my chances to ever get pregnant. There's a lot of guilt when you know that it's your body that doesn't work correctly, even if it's not your fault.

In a way I think I shouldn't be upset, because the FSH has been whatever it's been for a long time. The only thing that has changed is my knowledge about it. Ignorance really is bliss. But now I'm much more acutely worried about what the level will be next week, even though I have no control over that either. And in the end, none of these numbers really mean that much if I don't get pregnant. All normal numbers but no children is really very little comfort. I guess for now I'll just keep taking the clomid 100mg every night. More about the craziness of clomid another time.