Unimaginative update

I just don’t have it in me to be witty. I worked until 10pm last night (the joys of keeping college student hours, I tell you!), and then had another monitoring appointment this morning. Up at 5, road by 6, work by 8:30. I’m beat.

I thought I owed ya’ll an update, though. My ovaries are cooking nicely. We’ve got half a dozen eggs in waiting. Less than I’d hoped for, but more than required. I’ve learned that any hurdle cleared is reason for celebration. So, I’m celebrating.

And, because I’m me and IF is the biggest mindfuck in the world, I’m also fretting. Fretting about the steroids the clinic nonchalantly has me on. Angry at the nurse who got snippy with me for asking to switch to a different steroid. (“You’re either doing this or nothing! You’ll just have to live with the risks!”) I’m disappointed that, despite the high doses of hormones, the cramps and twinges in my sides, and the PCOS diagnosis I carry, that my body’s only popping 6 (potential) eggs. I’m frustrated that my questions about the size differences between the right and left follicles were dismissed, and am worried that my hidey-go-seek right ovary and it’s two large (16mm and 17mm) follicles is going to mess with the well-behaving left ovary that is currently so jam-packed with follicles she could only measure the four biggest (9mm, 10mm, 11mm, and 13mm). I’m anxious about the timing of this all as more and more “You positively can’t miss this!” events start popping up on my and Mr. But IF’s work calendars in the next 2 weeks. Overall, I’m just wishing the days away, hoping for them to fly by and bring me my answers (whatever they are). And, then, I’m angry at wanting life to blur by. I’m mad that instead of cherishing precious moments with a little one, I’m wishing away the last gasp moments of my 20s.

In other words, I’m in the midst of IVF. I’m up, down, and all around. I’m exactly the same as anyone else that has ridden this roller coaster. I’m ready for the ride to end.

Not quite the Incredible Hulk

So, I started my ‘roids yesterday morning.  After three unexplained miscarriages, a whole host of autoimmune diagnoses (Hashimoto’s, endometriosis, Raynaud’s) and suspected diagnoses (Lupus? Rheumatoid Arthritis?), a full battery of immune testing, and a visit to the reproductive immunologist, it was decided that a low daily dose of steroids might be beneficial during this IVF.  The theory goes that, by quieting my haywire, over-active immune system, we might actually be able to trick my body into holding on to a pregnancy for once.  So, bottoms up.

I’ve heard of others having difficulty sleeping as a result of steroid use, so I asked my clinic if it would be wise to take them in the morning.  They agreed with that plan, so that’s what I’ve done.  I’m laughing at that now, of course, as I initially started this post last night and promptly fell asleep at around 9:30 before getting the chance to finish it.  Insomnia my ass.

I also did my first go-round of injections last night.  225 Gonal, 75 Menopur, and 5 units Lupron.  Other than a little bit of a learning curve with mixing the Menopur (how genius are Q-caps, by the way; why don’t we get them with HCG?), all went smoothly.  It dawned on me then and there, however, how dang much Gonal I’m using this time around.  My first injectables cycle I only used one 900 Gonal pen for the entire cycle.  This time?  I’m going to kill a 900 pen before I even go in for my first monitoring appointment on Monday.  Sheesh!  (And, I totally don’t even have any right to complain seeing as I’m actually a pretty good responder… or at least we think I will be?)

I think it’s pure coincidence, but I’m already crediting my ‘roids for some super human healing powers.  I totally screwed up my knee at my fitness class on Wednesday (see people, this is what happens when you exercise! Much safer on my sofa…).  Yesterday I was hobbling around like an awkward fawn, and moving my heating pad with me to each new desk I had to sit at.  (Luckily, my colleagues are used to my “quirks.”)  Today?  Yea, still a teensy bit sore, but honestly much, much better.  Sure, it was probably just a pulled muscle that corrected itself as pulled muscles are prone to do, but I’m gonna believe it was the healing elixir of my new little pill, the baseballer’s best friend.  Cause, you know, I’m hardcore like that.

I’m glad the knee is on the mend as well because we are headed out of town tonight to make the drive down to the in-laws.  Mr. But IF’s home town agricultural fair is happening, so we’ve got a long day of wandering around looking at barnyard creatures and eating fried things to attend to.  It’s funny how our pre-marriage negotiations went.

Me: “I want kids.  At least 2.  When we’re young.”

Him: “Sure.  No matter where we live, though, I want to get back to the Fair at least every other year.  K?”

Me: “Yea, why not.  I’m sure the kids will love it!”

Well, at least one of us is winning at life, eh?

So, to summarize, drugs flowing, knee mending, fair going.  Happy Friday!

Good thing I’m not superstituous

So, as I wrote yesterday, we’re boarding the IVF train and leaving Waiting Station.  My baseline is tomorrow.  All aboard!

After calling the clinic to set the appointment, I followed a familiar routine.  I opened my personal Google calendar and added the appointment, opened my work Google calendar, copied the event to it, and padded it with an extra 1.5 hours on both ends for travel.  (Sure, sure, my boss doesn’t need to know that I’m “busy” starting at 6 fucking-AM, but I want her to feel guilty and lazy when she sees that appointment on there!)  As I added the appointment, though, something hit me about the date.  September 18.  There’s something special about September 18…

A childhood friend’s birthday is today, so not the 18th.  My aunt’s is in a few more days, so not her either.  I went through my mental inventory of work obligations – my self-report isn’t due for another few weeks, that conference isn’t until next month, and, honestly, when does anything special happen on a Wednesday?  I asked Mr. But IF, but, nope, no important milestones.  I let it be.

After another exhausting Monday, I settled in last night to watch my Steeler’s get stomped.  And to eat my body-weight in carbs.  Some friends have guilted me into attending a twice weekly faculty bootcamp class on campus.  Can I just say how much I am looking forward to the excuse of stims to start dialing back on these classes?  I also booted up Facebook for a quick stalk and mock.

Many folks in the infertility community have a difficult relationship with Facebook.  While I’ve had my moments, it’s never been that big of a source of pain for me.  Maybe it’s because I’m somewhat used to Facebook showing me things I can’t have – friends celebrating birthdays, engagements, and showers with their mothers – or maybe it is because I started using Facebook as an infertility soapbox and support network early on in the struggle – I freely post IF articles, comments about our treatments, and speak to my IF “friends in the computer” via Facebook every day, but for whatever reason Facebook has never been much of a trigger.  Last night wasn’t really any different, save the fact it reminded my why September 18 felt so important.

Yesterday when I pulled up Facebook I was greeted by another wrinkly and squish-able newborn face.  The daughter-in-law of my mom’s best friend had her son.  My mom’s best friend, my “aunt” by choice not blood, is now a grandmother.  Another happy ending.

When I opened up to my “aunt” about our troubles conceiving, she told me her son and daughter-in-law were having issues as well.  She’d been pregnant, she’d lost the baby, they thought it was her thyroid.  I shook my head knowingly and supportively, offered my sincerest condolences, and told her to tell her daughter-in-law to call me no matter when or why and let her know she was not alone.  “We may be next to strangers,” I said, “but please just let her know there’s someone out there that ‘gets it’ and will be there for her if she needs it.  I would have given anything not to feel so alone in the beginning, and I don’t want to know that anyone else feels that way if I can help it!”

She never reached out, and that’s fine.  She was pregnant a few months later, and so was I.  Seems we were both getting our happy endings.

Her son was born yesterday, and mine was miscarried and flushed at just over 9 weeks this past February.

So, that’s why September 18 had a ring to it, caused a visceral reaction.  September 18 was my due date.

After seeing a gestational sac, hearing a heartbeat, seeing the embryonic squirm, September 18 was supposed to be the end of our infertility struggle and the beginning of life as parents.  Instead, September 18 will be the day we start IVF, the day we begin again from scratch, the day we get one step closer to being done once and for all.  While a beautiful and happy new family celebrates in my old hometown, I’ll answer the alarm that will ring at 5AM, scrape the frost off of my windshield at 6AM, be to my clinic by 7AM, and begin the appointments, the injections, the hoping, and the despair all over again.  As they celebrate each newness – eyes opening, hospital discharge, first night at home, first bath – I’ll endure the endless and familiar cycle.  Remove vial from fridge, swab injection site, pull back plunger, stab, sterile gauze, repeat.  While others move on, I continue going in circles.

Look ma, no sex!

Well, I guess we’re (maybe, please let this happen, body don’t fuck with me anymore, seriously did I say “please” yet?) getting this IVF show on the road.  My period arrived late last night, my baseline appointment is scheduled for bright and early on Wednesday, and this better damn well finally be happening.

(But, again, you notice all the apprehension above?  The near compulsive need to use weak words and not express any sense of certainty?  I’ve ridden the chair lift to the top of “OMG We’re Doing IVF!” Mountain before, and I’ve still never been skiing.  I’ll believe this is happening when they’re knocking me out to retrieve my eggs and when I’m handing over that mighty-sized check.  Until then, we’re maybe doing IVF.)

********************

I’ve kept things pretty much geared to the battle-hardened IF foot soldier around these parts.  Half because I’m a big, pompous jerk.  I tend to hate it when I go read IF blogs and they’re spending their time teaching me about cervical mucus and temping. (“No shit, Sherlock.  Temping is sooo 2009!”)  And, of course, half because, in addition to being an arrogant busted-uterus bitch, I’m also about as lazy as my ovaries when it comes to going that extra mile.  I dumped way too many years of my life into explaining newbie shit to newbies on FF, so, yea, when I finally get it together to write a post here you can be sure that (most of the time) I’m diving straight in.  Don’t get me wrong, I love it when I get questions or comments at the end of my posts asking for clarification or more info because 1. that means you are reading (yay!) and 2. it gives me something specific to direct my response to.  In case ya’ll haven’t noticed I tend to struggle with brevity.  If you leave the entire wild world of IF writing to me to tackle in a given day I will try to tackle it fully and completely (and terribly).  Ain’t nobody got time for that (least of all me).

Ok, so, anyone still reading?  Have I insulted you all sufficiently that you’ve huffed on off to greener, rainbowier, unicornier pastures?  No?  Well, hello my masochistic ilk.  How the hell are you doing?

All that was a long-winded (told ‘ya!) way of saying I’m about to do a little IVF 101.  While I know the bulk of my audience are folks that have been or currently still are in these bloody trenches with me, it also warms my heart to know that a few amazing real-life friends have found and follow me here.  And, while these friends with normally functioning lady-bits and man-parts have been truly remarkable in their support of me and Mr. But IF over these past many years, fact remains you really can’t know much about IF until you’ve lived it (and I hope to God none of them EVER have to live it).  So, here’s the only things I hope you ever have to learn about IVF in general and my unique IVF in particular.

Now that my period has started (and, might I add, not on its own but thanks to yet more pills… stubborn MTHFR-er… hehehe <IF insider joke>), I’m set to go to my first appointment of this IVF cycle.  This appointment is called the baseline appointment, and it usually occurs on day 3 of a woman’s full flow menstrual cycle.  For me, that is 7:15am on Wednesday.  At the baseline I will have bloodwork drawn to measure my hormone levels and I will have a trans-vaginal ultrasound performed to check the state of my ovaries.  (Oh, and yea, remember that “full flow” comment before.  That ultrasound probe is one damn lucky piece of plastic, eh?)

Assuming all checks out with this first appointment (hormones that should be low are low, hormones that should be high are high, all the ultrasound shows are a bunch of immature egg-containing follicles, etc.) then I start the injections.  Everyone’s injection schedule is different depending on their IVF “protocol” (and, in fact, some protocol’s would have called for me to begin injections before the start of my period), but I’m going to focus on what I’m doing – the “flare protocol.”

Beginning on Wednesday I will inject 225IU of Gonal-F, 75IU of Menopur, and 50 Units of microdose Lupron nightly.  In other words, and I’m totally not exaggerating here, that’s 225IU of follicle stimulating hormone (FSH) derived from genetically modified Chinese hamster ovary, 75IU of a FSH and luteinizing hormone (LH) mix derived from the urine of post-menopausal women, and 50 Units of menopause-in-a-bottle.  You know how the mass market media always makes IVF and other assisted reproductive techniques sound all high-tech, sciencey, and fool-proof?  Yea, somdays I think it would be better if I just ate some hamster ovary, let some grandmother’s pee on me, and called it a day.

The act of doing daily timed injections is far from new.  I’ve done the Gonal-F and the Lupron before; the Menopur will be new.  What is totally new is the high doses.  In all of our previous cycles we were shooting for one strong, healthy-looking, egg-containing follicle.  Rupture one good egg, have sex (or an intra-uterine insemination, aka IUI), wait two weeks, positive pregnancy test, wait 9-months, healthy baby But IF.  But, yea, that never happened.  And, since that never happened we are now moving on to IVF where all sex is taken out of the equation.  Gone is the 1-egg goal, now I want enough of those suckers to field a pro football team.  More eggs means more drugs.  This is where things get new.

Thing is, you can have too much of a good thing.  Over-stimulation and ovarian hyperstimulation syndrome are real risks.  The possible negatives range from me feeling like a bloated uncomfortable piece of shit, to me entering liver failure or rupturing an ovary.  Put simply, bad things can happen.  But, Mr. But IF and I are so very hyper-aware of those bad things (and our clinic’s apparent blase attitude toward those bad things) that we’ll stay on top of it.  No worries, dearies.

During the days of these injections I’ll return regularly (about every other day) for more bloodwork and more ultrasounds.  This is called monitoring.  We’ll watch as the follicles grow and mature, a process that hopefully occurs at an even-pace across all the follicles.  If I develop a “lead follicle” – or one follicle that seems to be growing faster than the rest – that may threaten the entire IVF.  Remember, the goal here is to retrieve as many mature (meaning similar in size) eggs as is possible without subjecting me to any unnecessary risk.

Once the ultrasounds start showing a bunch of follicles in the 18-20mm range and my bloodwork (primarily estrogen levels) suggest a number of healthy, mature follicles, I go in for egg retrieval (or ER).  There is no way to know for sure when this will happen, but typically it’s about 10 days after starting stimulation meds.  That puts us at about September 28, give or take a few days.  Retrieval is much like many of the other lovely procedures I’ve already subjected my lady bits too in the past several years.  I will strip down, have a needle passed through my vagina and into the ovarian follicles, the fluid from each follicle will be extracted to look for the tiny eggs, and then I’m done for the day.  Oh, and yes, I will be mildly sedated.  Woot!

Once free from my shitty body, the eggs will be injected with DH’s finest swimmers via a process known as intra-cytoplasmic sperm injection (or ICSI, pronounced “ick-see”).  Hopefully, my eggs love injections as much as I do and the egg/sperm combos get down to the business of becoming embryos.  Each day after retrieval we will get a call telling us how our microscopic children are doing.  Many won’t make it, many won’t fertilize, many will appear abnormal.  These things happen to all normal people and are the reason why even the fertilest of Myrtles only have about a 20% chance of achieving pregnancy each month.  By doing IVF with ICSI I’m just kinda getting to live through about a year’s worth of “tries” all at once.

Depending on how the embryos are developing, we will prepare to put one back anywhere between 3 to 5 days after they were retrieved.  This step of the process is called the embryo transfer or ET.  It’s actually not that much different than the IUI I’ve done before.  No needles in the hoohah, just my old friend the catheter.  Catheter in, push of the plunger, catheter out, and I’m what we IF lot call PUPO – Pregnant Until Proven Otherwise.

I get to start a whole new batch of lovely meds after the ER, continuing through the ET, and up to my pregnancy test.  None are knew.  Vaginal progesterone (aka cottage cheese I squirt “up there” daily), intramuscular Progesterone (aka big fucking needle Mr. But IF sticks in my ass), HCG booster injections (aka stuff that fucks with home pregnancy test results and means I can’t use them), and steroids (aka I haven’t gained enough weight with all these other drugs so why not add some more?).  I’ll also be repeating my Intralipid IV infusions.  Both the Intralipids and the steroids are being done under the advice of our Reproductive Immunologist who believes my immune system has contributed to my miscarriages and general inability to get and stay pregnant.

Then, finally, it’s the big day.  The pregnancy test day or beta day.  This will be about 10-14 days after the embryo transfer and will involve yet another trip to the hell on earth that is my local hospital lab.  After that?  Well, either we’re pregnant (“How long will it last?”), we’re not (“Where’s the whiskey and the cheese curls?”), or we’re a little bit of both (“Inconclusive results AGAIN? FML!”).  If the answer is ultimately bad we turn back to the embryos we have left (if we have any left) and go through another transfer called a frozen embryo transfer or FET.  Basically, we do the transfer and the post-transfer meds, but not everything leading up to that point.  We do that as many times as we can, and then start from the very beginning all over again.  We’ve paid for two “fresh” IVF cycles (with the requirement that we use any frozen embryos before moving on to our second fresh attempt).  On one hand this means it can be a little overwhelming to realize how huge a part of the next 6 months to a year of our life this process might become; but, on the other hand, there is a lot of peace to be found in the fact that we know we’ll have a second chance if things don’t go smoothly the first time.

So, in a nutshell, that’s where we’re at.  Oh, and we’re never going to be able to have sex again (it’s verboten throughout most of this process).

“Hey, honey, let’s make a baby.  I’ve got my needles, and here’s your cup!”

Nap time

You know that totally put together, strength of a million mighty women post I published last week.  Yea, I’m a liar.

Well, sort of.  I do think the foundation of that post holds true.  In my heart of hearts I did feel a switch flip and bring a sudden awareness, a silent peace that if I’m never a mother, I’ll make it work.  I’ll find new dreams, live in ways I’d never planned, learn to live on.  That part was true (or as true as any untested predictions we apply to our lives can be).

The lie?  It’s not bravery or strength or courage that’s propelling me, it’s exhaustion.  Granted, it was more lie of omission rather than outright “fooled you!”, but still a lie.

I’m just so tired.  The past four years of my life have been a haze of doctor’s appointments, surgeries, arguments with insurance companies, strained conversations with friends and family, shots, pills, sleepless worry-filled nights, physical therapy, counseling sessions, support groups, MRIs, X-rays, blood draws, IV infusions, driving to appointments, keeping family, friends, and strangers abreast of those appointments, fundraising, waiting to get pregnant, waiting for a new diagnosis, fighting for a new diagnosis, waiting to miscarry, waiting to pick up the pieces and try again.  And, as if that wasn’t exhausting enough I had to watch my husband and my IF friends in the computer live the same struggles and walk the same paths.  Again, and again, and again.  I’m just so very tired.

I would guess that for every minute I spend with a doctor, I spend another 20 minutes on the phone with the doctor’s office, on the phone with my insurance company, on the phone with the mail-order pharmacy, standing in line at the traditional pharmacy, going through outpatient intake to get my blood drawn again, writing out checks for co-pays and co-insurance, and filling out the same medical history form over and over and over again (number of pregnancies: 3, number of live births: 0).  I’m running out of steam.  Actually, I ran out of steam a long time ago.

Last Friday I went back to the lab for yet another blood draw.  We needed to decide whether it was time to give up on my body doing what it’s supposed to do and start a course of Provera to bring on menstruation, or whether we should let it do it’s thing and hope (har har har) for a miraculous naturally conceived pregnancy.  Tuesday’s tests were inconclusive, so I was ordered a repeat course on Friday to see whether levels were going up, down, or staying stagnant.  I hauled my bottom out of bed bright and early, went to the lab, sat through another round of “dumb things fertile phlebotomists say,” and waited.  My clinic never called with the results.  When I called back Saturday, I got an answering service.  On Monday I called at 7AM and started screaming bloody murder.

“Oh, the hospital never sent them.  You’ll have to figure this out with the hospital.”

Two hours, 5 phone calls, 2 times being hung up on, and a whole lot of lost work for my employer later, I got the (now 3-day old) results.  Body as stubborn as ever.  No change whatsoever.  Start Provera.  What’s another 3 day delay, right?

Last night I started spotting.  I started planning out our cycle, mentally scheduling the appointments, checking that I’d be in town and available around the potential retrieval and transfer dates.  I was excited.  This morning the spotting is gone and there are no signs that my period has any intention of starting any time soon.  What’s another two weeks of waiting, right?

I’ve been getting bills from my rheumatologist for a while now because they refused to collect my co-pay on the day of my appointment.  The invoice provides no way to pay by credit card (something I always do because of our flexible savings accounts through work) so I have to call.  Well, I’ve tried to call.  Apparently they are closed on Thursdays and Fridays, leave early on Tuesday, and take lunch every day from noon to 2pm.  After calling today and receiving a brusque, “This is the answering service, the office is on lunch break until 2 <you idiot!>” I lost it.  What’s another hour of waiting to pay a bill for a useless office visit that delayed my chances at trying to conceive for 4 months for no good reason, right?

I’m tired of this being the best that is out there.  I’m tired for my friends (first and foremost among them dear C) who have had to fight tooth and nail for quality of care that makes mine look like the gold standard.  I’m tired of being treated like I don’t matter by “professionals” that don’t know what they are doing, don’t respect the weight of their influence on our lives, and don’t do any more than the bare minimum (at best).

So, that peace and zen?  It’s just a scam.  In reality, I’m just ready for this journey to end.  I’m ready for nap time.

I’m risky business

So, I almost lost bowel control in my endocrinologist’s office last Thursday.  After honestly venting my frustration with how poorly I felt my visit to the rheumatologist was handled last spring, my endo displayed sympathy and a dry wit I hadn’t really realized was there before.

I’ve had a grand total of one visit with this PA since moving north (my initial consult was with the actual MD and left me feeling lackluster and sad that I’d left some excellent quality of care behind in Delaware).  That one visit was good but less-than informative.  He listened without criticism when I complained of back pain and skin rashes (those same recurring ailments that have driven me to various doctors for years), and he even agreed to followup on them with some bloodwork.  That bloodwork found an unusually high titer of ANA which triggered the referral out to rheumatology (and commenced the giant wastage of timeage that was that adventure).  So, yea, when viewed through the usual lens I apply to my physicians (“Did he insult me?” “Did she say something I know to be outright medically untrue?” “Did they send me home with a sterile collection jar and say good luck?”), he was pretty amazing.

But, back to the shitting a brick mid-checkup.  After recounting my time with rheumatology he responded, “That’s so frustrating, isn’t it?  Rheumatologists, man, sometimes I don’t even know what language they are speaking!”

(My eyes began bugging out of my head here.)

So then, he turned from the computer, looked me straight in the eyes, and asked:

What resources have you been able to find to tell you more about your conditions and explain why this has all been so difficult to diagnose and pinpoint?

Breath taken away.  As was my ability to speak, form coherent sentences, and (nearly) keep my shit in place.

You see, I’ve practically made doctor’s-appointment-going a full time job for the past 4 years.  Never once has a doctor asked if I was educating myself.  Never once have I been told of the importance of doing my own homework.  Never once have I not been laughed at for admitting that I’d done tons of reading and research on my conditions.  It seems I now have to amend all those sentences.

This man actually wants me to be proactive, stay informed, and engage in a conversation with him as we work through my medical issues.  As I engaged in my usual dismissive answering behavior (“Yes, I did have that rash, but it went away.  I don’t think it is tied to the seasons, but I guess I don’t know, it could be…”), he actually scolded me a teensy bit.  “No,” he said, “these autoimmune conditions can be funky.  Would you believe I get a flare-up of Raynaud’s every three years like clockwork?  Never any other time, just every three years.  I know countless doctors who would laugh me out of their offices, but I’ve lived it so I know it can happen.  Just keep an eye on those rashes, ok?”

Bestill my beating heart.  I think I’m about to dump Mr. But IF for this 6’4″ older male doctor.

When we got to talking about my future plans – the IVFs, the possibility of more pregnancies, my desire to have his office on my side in those early days of pregnancy when my thyroid is so very prone to wreaking havoc – he offered me more advice.

“You’ll be seeing a perinatologist, right?”

I stared blankly for a while before I managed a, “I’ve always been told I’m not a potential high risk pregnancy.  Is that wrong?”

“Yes,” he answered, “I think you’ve been through more than enough.  I want to make sure you get all the monitoring you think you need.  If you have any trouble, give us a call.”

Now, maybe its odd to be so thoroughly thrilled to be informed I’m “high risk” before I even manage to conceive, but I left happy.  Someone’s taking me seriously for once, and I’m holding firm to that.  (And, let’s face it, after 4 years and 3 miscarriages I’ll gladly take all the extra monitoring they can throw at me if I ever manage to get and stay pregnant again.)

I’m off to see the endo

Can we all just take a deep breath and celebrate the fact that I’ve managed to get it up to post three days in a row?  Huzzah!

I have my regular 6-month check up with my endocrinologist this afternoon.  I’m feeling odd about it.  For the first time in the 3.5 years since my Hashimoto’s diagnosis I’m walking into an endo appointment without a list of questions nine miles long.  Part of me wants to celebrate the fact that that clearly must mean things are finally as they should be and that managing my thyroid disease has become that mythical “not a big deal” all my now-fired doctors once promised.  Thing is, though, that’s not the cause.  The cause is primarily that I’ve gotten so good at managing my own care by now that I really only need the doc to write my scripts these days.  And, of course, there’s the fact that I’ve already had my “I’m-on-the-brink-of-starting-IVF-please-help-me-manage-my-thyroid-through-it” appointment.  It was over a year ago, two doctors ago, and 300 miles away.  Ah, memories.  Nothing like repeatedly gearing up for a whole lot of going nowhere over, and over, and over again!

The one thing I am certain of is there is no way I’m getting delayed.  The fallout from my last endo check was tremendous.  It was this practice that first noted my elevated ANAs last winter, and insisted on my having a thorough going over by a rheumatologist before returning to treatment.  Good right?  Not really.  The earliest this practice would get me in with their sister rheumatology group was 3 months away.  I found another clinic that would only make me wait 5 weeks.  I went seeking answers, and left with a “who the hell knows?”  We’re not doing that again.  I don’t care what they find, we’re sure as hell moving forward this time.

Well, it’s about that time.  An hour up to the doctor, surely an hour wait (they are always insanely over-booked), a 10-minute visit, and then an hour drive home.  The glamour of my life I tell you!

I’ll survive

It happened on my walk home from work.

landscape

And don’t I have a gorgeous walk home? Drool now, we’ll shortly be under 10 feet of snow.

With a gentle breeze blowing, the knowledge that fall is here was inescapable.  I listened to the shouts of our newly-returned students as they played club rugby and ran frisbee drills.  I noticed the new fall flowers along my path.  I noted the watchful father sitting on his front step as his little one climbed a tree.  I passed the women pushing strollers.  I walked in my own back door and instinctively greeted my two cats with the usual, “Hello, my babies!”

Today I realized I’ll survive.

For the first time in nearly 4 years I asked myself, “Will I be happy in a life without children?” and could honestly answer, “Yes.”  For the first time, that question popped up as almost an afterthought – an aside – and I answered instinctively and definitively.  For the first time I asked it without feeling physically ill and I answered it without second-guessing that answer.

I wish I could pinpoint what caused this stealth revelation.  Maybe it is because, with our IVF consult behind us, I know we yet again have a path in front of us.  The prospect of IVF has caused me to hope in way that I haven’t at any stage in our conception journey.  It comes with two kinds of hope.  First, the promise of something new, something different, something unlike anything we’ve tried before.  This, in a nutshell, is the hope I’m still partly afraid to utter.  That hope that things might go differently this time.

The second hope is a harder one to verbalize, but the one I feel most wholly in this moment.  It is the hope that, despite the outcome, IVF will bring us peace.  We may not complete our pre-paid two-cycle package with a baby in our arms, but we will complete it knowing that we did everything we were comfortable doing to achieve our elusive biological child.  (And, I should note here, just because we’ve drawn this highly arbitrary line at 2 IVFs does not mean that is the universal line at which all infertile women and men will draw this very important line.  This is, yet again, another one of those malleable demarcations infertility throws at us.)  Writing about her own recent decision to jump to IVF, Katherine over at Inconceivable! explained:

It’s amazing how once the decision was made, I could finally breathe again.  It had happened, we had survived, we had enough resources to go ahead.  The anxiety level dropped almost immediately.  Finally, we had a plan.  There was no specter lurking in the background to frighten, to wonder if we would have to cross a final frontier.  Now we will know, even if the IVF doesn’t take, that we have done everything in our power to conceive a baby.  I’m finding myself at some sort of peace at last.

And, to that, all I can say is a heartfelt ditto.  The physical challenges of IVF seem trivial – I’ve been doing the needles, the anesthesia, the probes, and the pokes for longer than I care to think about.  It was the finality that scared me the most over the past several years.  Now, surprisingly, it is the specter of exactly that finality that has brought me the greatest solace.

I often feel like I occupy an oddly privileged space in this land of infertility.  Because I’ve experienced so much pain in the past – because I watched my mother lose her battle to cancer when I was just 19 – I’ve often thought of myself as better prepared to handle the entirely different, yet entirely familiar, pain that infertility has brought to my life.  I’d never say that that tragedy dulled my pain (in fact, I’ve written before about how it has actually complicated it), but I will say that having pain as a well-known bedfellow has often helped with processing each failed cycle, each miscarriage, each new bit of bad news.  But, all that said, it wasn’t until today that I had a much-needed revelation.  It’s OK if, once our path to parenthood to comes to a close, I still feel sadness at the future we won’t experience.

For 19 years of my life I envisioned my mom videotaping my college graduation, dancing at my wedding, holding her first grandchild.  In a manner that only the naivete of youth can inspire, I never once doubted that each of those moments would form future memories.  When I lost her, I also lost that future.  Despite the drawn-out cruelty that is terminal cancer, the final blow came quickly, definitively, and inescapably that December night in 2002.  Nothing could return that longed-for future to me, and all around me knew it.  Death is final.

For the past several years, I’ve bemoaned the fact that unlike death, infertility is, in many regards, ongoing.  There’s always another cycle, another treatment, another doctor, another potential way to envision that future coming to fruition.  And, there’s always those around you who either ignore your battle (or don’t know about it in the first place) or try to minimize it.  Infertility has often felt like a never-ending torment.  “How,” I would ask,”can I ever move beyond that future version of my life that I so badly want?”  Ultimately, I believe, I was asking the wrong question.

I didn’t erase the me-with-a-mother thoughts I had for all those years.  I amended them.  My mom wasn’t at my wedding, but the single pink rose we placed on the church alter was there in her memory.  Plans not deleted, but revised.

How it has taken me so long to realize that I don’t have to erase the me-as-a-mother version of myself to move beyond this battle is beyond me.  Hearing our neighbors’ children play, watching them bike down the street as I write this (and future posts) – it’s alright if that always causes a little heartache, a little sadness, a little remorse.  I felt the same sadness when I saw that single rose up on our wedding altar.  It didn’t ruin my wedding, it enhanced it.  Like that rose, awareness of our infertility doesn’t have to destroy, it can also create.  Acknowledging, remembering, and embracing the role this battle has played in my life and our relationship can bring peace.  I’m not scared anymore.  I’ll survive.

Do or do not. There is no try.

Yes, my reproductive endocrinologist quoted Yoda this morning.  So, yea, that happened.

Today was my post-op appointment/WTF appointment/IVF consult.  (Clearly, when you’re driving an hour each way, it’s good to make sure you can cram as much as humanly possible into one trip.)  The visit started nicely enough.  We were escorted back to the comfy couches in what I’ve titled the “Den of Solitude.”  The name’s part a dig at the obscenely dark wall color, and part remembrance of the long-lonesome wait we had there for my D&C that came a day too late.  Awesome room, awesome memories.

The doc reaffirmed that surgery went fabulously, that my suspicious right tube looked “wonderful,” and that I was young.  We discussed my visit with the reproductive immunologist during my last failed pregnancy and went over that specialists’ recommendations.  I said, “he suggested Lovenox, which we added to the last two cycles, and Prednisone, which we didn’t.”  What I didn’t say was, “The Prednisone which the NP said we couldn’t do we didn’t add.”  So, guess what?  6 months after I first sent an email inquiring about Prednisone, I was told, “Why don’t we just try some Prednisone and TI or IUI?  It works for a lot of my immune patients!”  Head, wall, again.

The mister (likely seeing dollar signs flowing through his head) seemed into that (insurance-covered) option, I said, “No.”  We were exactly in this place 15 months ago.  We walked into our IVF consult, we got our calendar, we paid our down-payment.  We left with a plan.  A plan that got derailed by a money hungry clinic, an asinine insurance system, and a interstate move.  I wasn’t leaving this second IVF consult with another aborted IVF plan.  I simply said, “We need to move on.  We need to try something different.  We need to know that there is an end in sight and our lives might one day be back to normal.  This is the step we need to take before I have no stamina left to keep trying.”

The answer?  “As Yoda says, ‘Do or do not.  There is no try.'”

Basically, the next 15 minutes were filled with yoga recommendations, self-help book suggestions, mantra repetition, and the soft-eyes of my close-talking RE glaring uncomfortably into mine.  I’m not a feeler, I’m an analyzer.  I rarely talk emotions, but regularly talk statistics, clinical studies, and journal articles.  There is no more certain way to bring on my rage than to turn my quest for medical insight into a “how do you center yourself?” discussion.  I grinned, I bared, I pinched the skin between my thumb and pointer finger so tight that I can still see the redness 7 hours later.  But, ladies and gentlemen, we have a plan.  (One that I’ll surely relay in fuller course in the next several days.)

See, here’s the thing with conversations that go like this.  I truly do understand the medicine behind relaxing and minimizing the worry.  As someone with both endocrine and autoimmune disorders I get how putting your body under unnecessary stress triggers a cascading waterfall of nasty, hormone- (and thus fertility) impacting issues.  Back in the days before we moved and when we still lived in civilization, I did acupuncture, I hosted a support group, I sought counseling.  I’ve drunk the Kool-Aid when it comes to believing that reducing one’s stress is a can’t hurt, might help accompaniment to traditional infertility treatments.  (And, lest you misunderstand, this is a far, far cry from saying that believe that “Just Relaxing” will cure my infertility.  That, my friends, is just a steaming pile of bullshit.)  It’s exactly this belief in the power of minimizing freak-outs that fuels my hatred for Doc Yoda’s attitude this morning.  You know what stresses me the fuck out?  Knowing I get about 10 minutes with my doctor once every 12 months and having to spend all of it answering questions about my yoga practices.  So, congratulations doc, you just added so much more stress to my life.  A+ effort and all that.

I treated the rest of the appointment like a junkie hoping they’ll get a discount if they listen to their dealer talk about their new pitbull.  Doc’s got the stuff I need, be a good girl and let the doc talk.  I left with my scripts for steroids, stims, estrogen and progesterone support, intralipids, and Lovenox.  Oh, and a healthy dose of stress.

As we were preparing to leave the consult room, Mr. But IF asked a few more questions about the lap findings.  Basically, our third/fourth/fifth utterances of “are you sure my tubes are fine and there wasn’t an endo annexation of my bowel occurring?”  Yes, tubes fine, no, minimal endo.  I replied, “That’s a relief.  I expected worse due to how it looked last time and how many quality of life-impacting symptoms I’ve been dealing with.”

“Are you alive?” he asked.

“Err, yea.”

“Then the quality of what you do with that life is totally up to you.  Only you can improve that.”

[Blank stare.]

“Have you read about the man with no arms and legs?” he queried.

“Uh, no?”

“You should.  If he can find joy, so too can you.”

I left my comments regarding my mother’s joyless chemo unspoken.  I got my drugs.  I got my probing.  I got the fuck out.

My parting gift?  A giant middle finger from my body.  I knew it was too good to be true when he said we could start stims as early as tonight if I appeared to be baseline.  The ultrasound showed a giant follicle/cyst on my right ovary, and bloodwork revealed a mildly elevated P4 and LH.  I could have ovulated (and left a corpus luteum cyst behind), I could be about to ovulate (and be witnessing the final growth of the follie), or I could just have a rock star lazy non-functional cyst hanging around.  Either way, I’m neither ready to start IVF nor ready to take Provera.  Bloodwork on Friday to check what’s up.  More waiting!  Huzzah!

I wonder if I can “use the force” to get this cycle going?  Probably not seeing as I fully inhabit the dark side…