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.
Monday, March 30, 2009
Sunday, March 15, 2009
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...
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...
Monday, March 9, 2009
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.
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.
Tuesday, February 17, 2009
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.
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.
Sunday, February 8, 2009
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.
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.
Friday, January 23, 2009
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.
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.
Tuesday, January 20, 2009
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
http://www.youtube.com/watch?v=JqfGqOx2iDQ&feature=related
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