Speechless

I’m sorry I’ve left you all hanging for a week.  I honestly haven’t known what to say.  How to act.  How to exist.  For the past 7 days every moment has been full of equal parts hope and dread.  Every sentence has ended with, “We’ll know more next Thursday.”

Well, it’s Thursday.  And we do know more.

This morning Mr. But IF and I woke at 5AM and drove to the clinic.  I was on the table sans pants by 7:15.  We saw a gestational sac, yolk sac, and wiggly 6w2d fetal pole at 7:17, and heard the 115bpm thump, thump, thump of the fetal heart at 7:19.  (My ultrasound pictures are time stamped.  I can’t tell you how happy it makes me to know I’ll always know when we first saw and heard that thump!)

I’m elated.  We’re both elated.  I’m also a good bit speechless.

After so many years and so many heartaches (including the still painfully fresh memory of hearing a similar thump less than a year ago), I’m gun-shy.  I want to cry from sheer joy.  I want to truly believe this is happening.  I want to be able to start speaking in certainties, start planning the nursery, start enjoying this event that I’ve put so damn much blood, sweat, and tears into for all these many years.  And, I really am getting closer.  Closer than I’ve ever been, honestly.  But, I’m not entirely there yet.

I don’t know what to do with myself.  Infertility has been such a huge part of my life.  I’m not quite sure who I am when I’m not squaring off with it each and every day.  When all that remains is the worry and doubt, but not the tireless attempts to manipulate my body into behaving naturally with drugs, appointments, and prayers.  To be frank, I’m not really sure what it is I do around here anymore.

Gushing isn’t appropriate.  It still causes me anguish, and it makes me remember all the times my heart broke when I had to hear of others’ (often well-deserved) victories.  When you are a member of a group united in the pursuit of a common goal, yet only some have the opportunity to realize that goal, it can make for some balancing.  It’s not lost on me that a few months ago I was writing of the pain of coming to grips with a child-free future.

Fretting isn’t right either.  I’ve done that.  Ad nauseam.  It’s a familiar emotion, but it’s not quite accurate either.  We have more reason to hope right now than we’ve ever had, and I don’t really want to let that opportunity pass me by.  I’ve had such a difficult relationship with hope for so long, I’m ready to start letting it back in, even if just a little bit at a time.

So, at least for a while, I think I’ll default to rote updates.  While it seems out of character to divert from tackling difficult emotions head on here (that was the entire reason I started it), it also seems a good bit pointless to try and examine my emotions when I’m not entirely sure what they are.  So, in lieu of making things up or allowing this site to disappear into the ether, we’ll stick to the facts.

 

Today’s facts:

I’m pregnant.

Fetal pole measuring 6w2d.

Fetal heart rate 115.

Next ultrasound and Intralipids infusion on Wednesday.

I have 800 pieces of candy at home waiting for Trick-or-Treat deluge.

Meet the blob

Not gonna lie, kinda feel like I’ve been snorting sunshine and unicorn shit.  I’m so high on life right now I don’t even recognize myself.  This happiness thing is a total mindfuck.

First, I’d like to introduce ya’ll to Blob.

ultrasound of gestational sac

Say “hi” Blob!

That, ladies and gentlemen, is a fucking gestational sac.  A sac IN my uterus (and not my tubes).  A sac measuring 5 weeks 1 day (pretty damn spot on to my 5 weeks 2 day reality).  And a sac that has a rockstar 5,306 beta value to keep it warm at night.  Did you seriously catch that beta?  Last pregnancy my beta at 7 WEEKS was just 2,083.  Blob here is a total overachiever.  I’m smitten already.

I don’t even know where to start with how the rest of my day went.  I mean, the rest of the day pretty much comprised of me floating from moment to moment on a cloud of euphoria.  Have I said this happiness shit feels weird on me?

After meeting the Blob, I “worked” for a few hours before heading to my first counseling session with a new counselor.  I’d scheduled the session to help me cope with what I thought would be, at best, inconclusive news, and, at worst, well, you know what news I thought I was getting today.  Instead I flitted into my appointment a happy person.  What exactly does one do in therapy when they’re happy?  I’ve totally never had that problem before.  Anyway, Dr. H appears to be a brilliant sweetheart.  She actually reminded me so much of my dear friend A, herself a budding psychologist.  Unlike the previous IF counselor I consulted, she didn’t immediately dismiss me for wanting to have a sense of control in the process – to be informed of my lab values, to have a say in my treatments, to keep in close contact with my doctors.  Instead, she said exactly what I’ve always found myself saying.  She explained:

If you know you are a researcher by nature, having all the data points can be a great source of comfort!  I don’t think you are harming anything by recognizing what type of person you are and what type of relationship you need to have with your physicians.  I just wish you could find one that would listen to you a little better and not belittle your coping mechanisms.

Shut the front door!  45 minutes together and this gal already “gets me” more than most people I’ve ever met.  Score!  I return in two weeks, but have her cell number should a crisis arise in the meantime.

Next it was off to my first ever OB/GYN appointment in a very long time.  I mean, I’ve scheduled many OB appointments, but I’ve never actually made it to one.  Imagining having to go to this appointment a few mere hours after hearing, “I’m sorry, I can’t find anything in your uterus” or “I’m sorry, your beta just isn’t rising” literally kept me up last night.  Visualizing walking into an office chock full of giant bellies and murals of newborn pics made me sick to my stomach this morning, and had me shaking uncontrollably as I rode the elevator up to their sixth floor offices.

When I walked in, no bellies.  No pictures.  An empty waiting room with a few no-nonsense receptionists that were immediately attentive to my presence.  (What?)  I had barely sat down when a nurse scooped me back (an OB that’s on time?), and my 2:40 appointment started promptly at 2:40.  Aside from the nurse being unable to find PIO in their computer system (for which she was highly apologetic and did not blame me like so many other nurses before for having the gall to take such unusual medications), my interactions with Anne the nurse were pure gold.  Not once did she say, “Just relax” or “I had a friend who..” (both phrases that were tossed at by my RE’s nurse just this morning).  Instead, she smiled throughout, congratulating me, fawning over the pic of Blob I brought with me, and told me to call whenever I needed anything.  (Wait, what?)

When the doctor entered the room he had the same genuine smile across his face.  30 seconds in his phone went off (oh no!  I’m going to get rushed and ignored again!).  He told his intern he was with a “very important new patient” and he’d have to call her back.  He then apologized for ignoring me for a total of 15 seconds and explained, “Ah, you know, teaching hospitals.  Everybody always wants you NOW NOW NOW!”  We talked my history, we talked my thyroid, we talked his philosophy, we talked me RE.  He kept reassuring me I was in the drivers’ seat, that no questions were silly, that he’d worked with many of my RE’s (who he kept referring to by his first name) before, and that he will never forget the journey that’s brought us here and always respect the unique challenges our IF has created for us.  He said, “I know there is no ‘normal’ for anyone who’s had to go through infertility.  You won’t believe this baby is here until you’re loading it in the car seat, and that’s fine.  Just promise me you’ll let me know how I can help make it a little easier.”  (OMG, am I on candid camera?)

I told him a bit about this year’s ANA drama (see, for example, here and here for the beginner’s guide).  He was downright annoyed at the way the whole thing was handled.  “You mean, they just sent you away with their hands in the air saying ‘Who knows?'”  Pretty much, yea, that’s what they did.  That did not abide Dr. T.  He ordered a full autoimmune workup for me and drew the blood right there and then.  Another more advanced ANA panel, DNA something, Sedimentation rate, C-Reactive Protein, Lupus Anticoagulant, etc., etc.  If anything comes back abnormal, he’s getting me in with their sister Perinatology clinic.  I have found the only proactive doctor left on this planet.  Holy shit did I hit the jackpot!  He also will be monitoring my thyroid (with both TSH and Free T4… woo!) every 4 weeks and adjusting meds as necessary.  He said he’d find a way to get me in for as many ultrasounds as I needed to feel comfortable (OMG!) and that he’ll be there with me through it all.  He gave me his fucking cell phone number!  Yea, my 2:40 appointment?  I left the building at 4:00.  Not one bit of that was me waiting alone in a room.  What the what?

I will follow up with him in 2 weeks (November 7) to go over the findings of the blood work and give him an update on how things are going with the RE.  Assuming all is well (oh, please let all be well!) I’ll be scheduled for my initial OB appointment about a week later.  Someone pinch me.  Is this actually happening?

So, now, it’s off to see the hubby.  I’ve been running all day, he’s been working all day, and we haven’t seen each other since I rolled out of bed at a crisp 5:30am in order to get to my RE appointment on time.  We’ve texted and had brief phone chats, but now I’m off to meet him, hug him, and gush endlessly at a celebratory dinner.  Good night my lovelies, and thank you so much for helping to hold me together all these past months.  You have NO IDEA how much you’ve all meant to me.

Today I am grateful

Today an old online friend sought me out to congratulate me on the news.  She wrote, in part:

I completely get why you left FF.  I read a blog of yours that kind of explained why you left and could sympathize with the need and want to kind of turn to blogging over forums. I think you do a great job at capturing how this journey is going for you. It ‘s probably the least fluffiest blog I’ve read and I like that. I like the realness and rawness to your writing. I’m sure you have to realize those who have found your blog have found comfort in your words and that you’ve helped them in some way or another.

(I really hope you don’t mind I stole your words A!)

Honestly, that was probably one of the biggest compliments anyone could have paid to me.  I suppose I take a sort of sick pride in being the Debbie Downer of the IF blogosphere.  Not because I’m at all interested in one-upping anyone in the overdone pain olympics (I know my story isn’t the saddest or most painful out there by a long shot!), but more because it means I’m doing a decent job at conveying the way that *I* am living infertility.  Hope and optimism have been absent from much of my infertility experience, and pain and suffering familiar bedfellows.  If my writing is raw, if my words sometimes ache and hurt, then I’m succeeding at what I set out to do when I started this blog.  I’m putting some fraction of the emotions I’m feeling out into the ether, and hopefully freeing myself of some of them in the process.

That said, I’m well aware of how one note that often makes this blog.  Yep, But IF’s worrying again, cursing doctors again, depressed again.  The monotony is accurate, but I’m sure it also feels oppressive.  So, today, let’s try something different.

Today, I am grateful.  Grateful for so many things.  Things I should spend more time appreciating, documenting, and celebrating.  Why not take a moment to celebrate some of them now?  So, in no particular order, today I am grateful for…

  • My husband.  His unfailing support, his intellect, his humor.  The joy he’s brought to my life, the sorrow he’s helped me weather.
  • My life.  These 30 years.  Another happy birthday celebrated with friends and family, old and new.  The phone calls, the party goers, the Facebook messages, the cards.  The yearly reminders that I matter to many, even if I often feel that I’m invisible to all but a very few.
  • This pregnancy.  Today, I am pregnant.  No amount of past heartache or struggle should dull the beauty of that simple sentence.  I know all too well that these moments can be fleeting, so I should also know better than to deny the power of these moments.  Once again, today, I am pregnant.
  • My infertility.  Yes, today I am grateful for it.  This month, this year, and this decade I am grateful for it.  Infertility has brought me my LFP ladies, my FF friends, my Twitter buddies, my blogging pals, my support group gals.  How one disease that wreaks so much havoc, can also add so much to one’s life is beyond me.  I’m grateful for my day with C and R on Saturday.  For friendships with women I’d never have met if infertility hadn’t entered my life.
  • My friends.  The text messages, phone calls, and emails from three friends named A.  Celebrating weddings past and planned.  I wish I was better at staying in touch sometimes, but know I love you all and you’re regularly in my thoughts.
  • My cats.  Yes, even when they wake me at 3AM wretching in the carpeted hallway.  (I most assuredly have crazy cat butt parasites.  C’est la vie.)
  • Sunshine on my birthday.  And the marshmallows roasting over our fire pit it enabled.  And, yes, even the sugar crash that hit later last night.
  • The Internet.  Without the support it has offered I would have lost my mind long ago.  Without it, I wouldn’t have met YOU.  That’s definitely something to be grateful for.

Help! I need somebody!

And, not just anybody.  I need a doctor who will treat my thyroid.  Who knew it could possibly be this hard?  But, I’m getting ahead of myself.

I waited with a fair amount of restless impatience on Wednesday for my latest round of beta results.  And, not just beta and progesterone, either.  I was pretty annoyed on Monday when I discovered my first beta draw didn’t also include a TSH check.  It’s been a standard part of my workup with every other (negative) beta for the past 6 months, so why they left it off this time is beyond me.  So, when my blood was drawn at 7:30am I requested that a TSH be added.  I got minimal push back from the nurse, but I’m used to fighting.  Anyway, blood exited the veins, and I was told I’d hear something by 11am.  At noon I hadn’t heard a thing so I gave in and called.

That phone conversation is hard to paraphrase, so let’s just do this Shakespeare-style.

Me: Yes, I’m calling for my blood work results from this morning.

Nurse: Uh, yea.  Still pregnant.  When do you want your ultrasound next week?  Wednesday, Thursday, or Friday?

Me: Wait, what?  What was the value?  What was the TSH?  How’s the Progesterone?

Her: Um, I gotta open your chart back up. Gimme a second. [Gum smack, gum smack.]  HCG was 256.  That’s fine.  When do you want your ultrasound and who is your OB?

Me: [Doing the math on the fly] But, that didn’t quite double from my 139 on Monday.  Are we really not doing another beta?  I won’t get anything else until over a week from now?  What about the other values?

Her: I don’t know what to tell you.  Everything’s fine, so there is no reason to retest.  You can see the rest of your results in the portal later today.  I already closed your chart again.  Call your OB.

Me: I don’t have one!

Her: Well, that’s silly.  Get one.  We will release you at 8 weeks and won’t help you from that point on.

Me: But I’m barely 4 weeks!  I’m not calling one.  Not yet.  I’ve had to cancel three OB appointments before due to miscarriage.  I’m not doing it again.

Her: Well, I don’t know what to tell you.  How about next Thursday for your ultrasound?  7:30?

Me: [In tears] Wait what?

Her: We’ll see you next Thursday, October 24 at 7:30am.  Call an OB!

After I was hung up on I sent an email to my boss saying I suddenly didn’t feel good and would be going home for the rest of the day.  I stayed home in my pajamas crying for the next 36 hours.  The Mr. and I spent an additional 90 minutes screaming at one another last night about how many more miscarriages we can possibly handle.  He said things like, “I just don’t have the energy to watch you miscarry 9 more times with 9 more perfect embryos!”  I heard things like, “Why did I marry this barren shrew who keeps killing my children?”  It was good times.

Equally good was what I found when I logged in to my patient portal teary eyed on Wednesday night.  Yes, the HCG went from 139 to 256.  Perfect is doubling in 48 hours or less.  Mine was on pace to double at 54 hours.  Not remotely terrible or doom and gloom depression-worthy, but that’s still the emotion it evoked.  After 4 years and 3 prior losses anything less that absolute perfection generates worry.  I’ve been full of worry ever since.

But, it turns out, the beta was just the tip of the worry iceberg.  My amazing progesterone on Monday of over 40?  Yup, dropped to a pathetic 19 despite daily Crinone suppositories and PIO injections.  Oh, and that TSH they had no intention of running?  Yea, about that…

Co-sponsored by the American Association of Clinical Endocrinologists and the American Thyroid Association, 2012’s “Clinical Practice Guidelines for Hypothyroidism in Adults” recommends the following course of action for pregnant women with elevated TPOAbs or Hashimoto’s:

When a woman with hypothyroidism becomes pregnant, the dosage of L-thyroxine should be increased as soon as possible to ensure that serum TSH is <2.5 mIU/L and that serum total T4 is in the normal reference range for pregnancy. Moreover, when a patient with a positive TPOAb test becomes pregnant, serum TSH should be measured as soon as possible and if >2.5 mIU/L, T4 treatment should be initiated. Serum TSH and total T4 measurements should be monitored every 4 weeks during the first half of pregnancy and at least once between 26 and 32 weeks gestation to ensure that the requirement for L-thyroxine has not changed. [Emphasis mine]

When I started this cycle, my thyroid was well controlled on my usual Synthroid dose.  On 9/18 my TSH was a beautiful 0.49.  My redraw on Wednesday?  5.69?!?!?!

On Thursday morning, I wrote my endocrinologist asking what to do.  On Thursday afternoon they left a message on my work voice mail (good thing I skipped work given my hysterical I’m gonna miscarry again crying fit, right?) saying they couldn’t go on what I told them, but needed to have my RE fax lab results to them.  My RE closes at noon on Thursday.  Last night at midnight I wrote a hysterical email to my RE’s nurse basically saying, “Why isn’t anyone paying attention to me?  Why won’t you help me?” (Yes, it was about that eloquent.)  This morning she wrote back saying calm down, we’ve faxed your results.  Later this morning a message arrived from my endo’s nurse saying, “We don’t treat pregnant patients, you will need to talk to your OB.  Who are you seeing?”  I wrote back with the same damn, “I don’t have an OB and I don’t plan on having one!” I gave my RE’s nurse on Wednesday.  And, that was that.

So, basically, by 2 this afternoon, I was left with the following:

  • RE won’t treat my thyroid since I have a thyroid-specializing endocrinologist.
  • Endocrinologist won’t treat my thyroid because I’m pregnant and that’s an OBs job.
  • OB won’t treat my thyroid because, well, I don’t have one.  But, even if I did, my experience has been that OBs won’t see patients this early anyway, so what good would it even do to have one?
  • Oh, and my rural PCP (who isn’t even in the office on Fridays) thinks any TSH under 10 is hunky dory.

Whee!!!

I escaped home from work and started making phone calls again, desperate to get some sense of resolution before the weekend (my 30th birthday weekend!) began.  It went something like this:

  1. Accept I must call a fucking OB at all of 4w4d pregnant.  Hyperventilate.  Explain situation.  Sound like a crazed woman.  God bless the patient receptionist who listened and cared.  Unfortunately, listening and caring doesn’t solve the fact that I’m not their patient, they’ve never seen me before, they don’t have my blood work, and it’s far too early to book an OB appointment with them.  She encouraged me to push my endo a little harder, but, after I told her I was seeing the thyroid center attached to the same teaching hospital their practice is attached to, she acknowledged they tend to not want to treat pregnant women for fear of liability.  Good thing I haven’t had about 5 conversations with my thyroid doc in the past 18 months saying I was specifically there so that they’d manage my care through pregnancy, eh?  Anyway, sweetheart scheduled me in as a new GYN patient (NOT an OB patient) for next Thursday.  Yes, the same day as my ultrasound.  But, at least since it’s a GYN appointment I won’t have to cancel it if I find out that morning I’m miscarrying, right?  Always looking on the fucking bright side.  That’s me alright!
  2. Try and call endo and get an answer that isn’t simply “Talk to your OB.”  Dial.  Press 0 to speak to a member of the staff.   Silence.  Dial back, press 0, silence.  Dial back, press 1 “if you’re a physician or a physician’s representative” (what the fuck do I care at this point?), receive error message that the extension is not available so try another extension.  Cry.  Give up.
  3. Call RE’s nursing line.  Get “Why don’t you have an OB?” heartless bitch nurse on the line.  Simply ask for the slightly less bitchy nurse I sent my emotional breakdown of a portal message to last night to call me back when she has a chance.  Hang up.  Cry.
  4. 30 seconds later, slightly less bitchy nurse returns my call.  She says, “Honey how are you?”  I cry.  And, then cry some more.  She orders me a prescription for 150mcg to replace my 112mcg of Synthroid.  She assures me there is nothing I can do (or that they are really willing to do) between now and next Thursday.  She tells me to always feel comfortable asking for her directly.  As I whimper out a, “Sorry I’m being so unhinged and irrational,” she responds back, “Honey, you have every reason to be irrational right now.  You’ve been burned enough times before and you won’t feel alright until you are holding this baby.  What else can I do to help make this better?”  I just start sobbing even harder.
  5. I call and set up an appointment with an infertility counselor.  Yea, you guessed it, it’s scheduled for next Thursday…
  6. Endo calls back.  He’s ordered a prescription for 137mcg and apologizes for the inconvenience.  He just, “Doesn’t like the confusion of handling pregnant women since usually OBs want to make those calls.”

So, I’ve gone from self-medicating by cutting my pills in half, to shortly having an arsenal of Synthroid prescriptions in different doses in my bedside table.  Not quite sure what the pharmacy is going to make of me, but that’s a call I’ll make for another day.  I can’t handle more phone battles right now.

But, let’s look on the fucking bright side, right:

  • I theoretically have an OB/GYN again for the first time in a while.  (Talk to me about whether this is a bright side when I have to face sitting in that waiting room again on Thursday.)
  • I will shortly have a full party array of Synthroid in all it’s beautiful colors.
  • My RE’s nurse has once again underlined that gold star next to my name denoting, “This chick is batshit crazy, handle with care!”
  • I managed to stop thinking about miscarrying for nearly an entire day since my focus instead was directed toward my thyroid.
  • It’s Friday.
  • I always wanted to have kids by 30, so at least I’ll be able to say I was technically pregnant on my 30th birthday this Sunday.  Close enough, right?

A life lived in pieces

If you’ve spent any amount of time living or watching someone else live an infertile life, you’re almost certainly familiar with the common complaint that, with infertility, life often boils down to a never-ending progression of waiting periods.  For women with regular cycles (something I’ll NEVER understand) these periods are set at about two weeks.  Menstruation begins, 2 weeks of waiting and tracking until ovulation takes place, 2 weeks of waiting and hoping fertilization and implantation takes place, 2 weeks of waiting for betas to get stronger and a gestational sac to be found in the uterus.  My waiting periods haven’t been as predictable – anywhere from 45 days to 8 months to get a period in the beginning, dozens of cycles waiting for ovulation that never came, 4 months waiting for a useless rheumatology consult, a 9 week pregnancy that just stopped growing – but they still fit the pattern.  I, like so many others, live me life in moments ordained by biology, medicine, and physician convenience.  There’s not a moment in these past 4 years where I wouldn’t have been able to articulate what the next milestone was – the next surgery date, the next scan, the next doctor’s appointment, or the next treatment.

Having crossed to this confusing land of early pregnancy after infertility, things aren’t really all that different.  As the news of yesterday’s strong beta washed over me, all I could think of was what Wednesday’s repeat draw might reveal.  If I allow myself to accept that Wednesday’s might be fine, I open my calendar and start to wonder how difficult work will be the day of our ultrasounds, the day we might learn it’s another ectopic, that it’s growing too slowly, that it doesn’t have a heartbeat.  I’m mentally plotting out ways to explain unplanned vacation time on the day the bleeding starts.  I’m still living my life in pieces, but I don’t know what puzzle they go to.  I arrange them all, keeping each in play, waiting for future clarity that may or may never come.

That’s not to say there isn’t tremendous joy in our life right now; it’s just that it’s a little different than some might expect.  I called my aunt yesterday with our update.  She spoke of fate and angels and having dreamt of babies and my dead mother the night before.  She had joy, even as she commented through the phone, “Honey, you sound so sad.”  Hearing her happy made me so very, very happy, but I’m not quite there yet.  I’m happy to live her happiness, but my own will have to wait a bit longer.  I just haven’t gotten to that chapter of the story yet.

But, where am finding, if not pure joy, at least some relief?  It’s really in the silly things, I suppose.  After a night away in NYC for work on Friday, I returned home on Saturday exhausted and content from a day spent exploring the tiniest bit of what the city has to offer.  I just wanted to put on my pajamas, curl up on the couch, and watch endless hours of television as cat#1 kept me warm, cat#2 kept me entertained, and husband#1 enjoyed his boy’s night away in a hotel with his best friend.  It was while deciding what television series to gorge on that I realized I’m slowly starting to find some peace, or at least find ways to fill the void of another round of anxious waiting.  I can’t speak excitedly to my aunt, and yesterday’s walk past the baby aisle in Target still caused sweat to bead up on my upper lip, but I can return to some shows left unwatched once pregnancy plot lines developed.  I watched the first few episodes of the new season of Parenthood that I had all but given up on; I picked back up on Bones which I had declared unsafe territory mid-season 7; I added Call the Midwife to my cue (but still haven’t hit play).  So silly to be measuring my mental state by television viewing choices, but I’ll take progress wherever I can get it.  At this stage of the game voluntarily watching a show with a newborn is about as groundbreaking as buying that first onesie is for a “normal” pregnant lady.

Yet, I’m still living this life in increments.  I’m still trying to get through each episode as quickly and efficiently as possible, knowing that at any moment the show may have to be dismissed from my Netflix cue.

I’m living this pregnancy like I’m watching these shows.  Enjoying while they last, hoping to see the finale, but preparing for an unresolved end.

This is the post

So, this is the post.  That post.  The post I’ve thought about since I started the blog; the post I’ve been terrified to write since 7:06am yesterday morning.

It’s the post where I tell you I’m pregnant.  Or at least a little pregnant.  Definitely closer to pregnant than not.

Back in June, on our 7th wedding anniversary, I typed out a few lines on my iPad while hiding the tears and shielding the screen from the colleagues I was spending the day with at a mandatory work retreat.  My first injectable cycle had failed.  That post was easy.  A few simple and familiar words – I’m not pregnant.  Additional complex and familiar emotions – grief, anger, despair.  More comforting and familiar responses – emails, flowers, gifts, cards, phone calls, shared tears, and virtual embraces from across the globe.

This post isn’t simple.  This post isn’t familiar.  This post,  more than any other, will fail to convey what I’m thinking and feeling.  To be able to convey those messages, I’d have to have a grip on my own emotions in the first place.  That’s something I definitely don’t have as I mentally flit like a humming bird from exhaustion to ecstasy and worry to wonderment.

I’m thrilled.  I can’t stop my mind from the inevitable.  I’ve calculated my due date (1 day shy of our 8th wedding anniversary), I’ve started looking up reviews of perinatologists and OB/GYNs, I’ve held the Mr.’s hand as I’ve said the words, “I’m pregnant.”

I’m cautious.  Having experienced this moment before – October 2011, May 2012, January 2013 – I know how quickly joy can turn to sorrow.  I know how it feels to walk into a maternity ward to terminate an ectopic pregnancy, I know the extreme grief even the briefest of chemical pregnancies can elicit, and I know that a heartbeat and multiple consecutive strong ultrasounds offer no guarantee of a child.  Sometimes this caution manifests in a desire to live each and every second to the fullest – how many times can I chant “I’m pregnant, I’m pregnant, I’m pregnant!” before this pregnancy ends?  Other times, it evokes an uncharacteristic superstitious nature – “You know better than to be calculating due dates this early, you fool!”

I’m ashamed.  I’m embarrassed to have tested this early when so many others have the tenacity to wait for the official word of the blood test.  I’ve been taking home pregnancy tests since the day after my transfer – first to test out the HCG trigger, and then in the hopes of catching a second line returning.  I saw the faintest glimmer of a line return yesterday, and it has darkened some today.  Yet, at only 5 days past a 5 day transfer we’re still in crazy early testing territory.  My official blood test isn’t even until Monday.  Yet, when I saw that faint second line yesterday, I couldn’t hold it in.  I shared it with my long-time IF friends, with Twitter, with Facebook (though, my under my blog persona, not my real one — I’m not that delusional!)

I’m uprooted.  Less than 48 hours since the first flicker of hope entered my heart and I’m already experiencing that familiar identity crisis of the knocked up infertile.  Where do I fit now?  What is this blog for?  Who can I turn to?  How do I comport myself?  Who am I and what am I doing here?  I’ve been pulled out of my old school, the surroundings, teachers, and friends I know are gone, and I’ve not quite matriculated to my new school just yet.  What do I write to the friends back home?  Sunny optimism – “This place is as great as you always thought it would be.  I’m sure you’ll be transferring soon, too!”  Injured honesty – “I’m not that sure I like it here.  I miss you and I’m terrified.  Please let me cry to you.”  The minimal brush-off – “Have a great summer!”

I’m bargaining.  I’m working down my battle-hardened, experiential checklist.  The outcomes for this cycle were negative, miscarriage, or child.  Now we’re on to miscarriage or child.  One line crossed off.  A few more darkening lines, and I’ll tick off the box next to “Not another chemical.”  If we’re blessed enough to have a few normally rising betas I’ll likely strike out (in pencil, though, not pen) “Not a second ectopic.”  If we make it to a heartbeat I’ll check, “Get at least as far as last time.”  And, for any step at which I might falter, I have the memory of the familiar and the knowledge that I’ve survived each one before.  Miscarriages I know, lasting pregnancy I don’t.

But, I’m also pregnant.

For now.

PUPO

Quote of the weekend from the mister: “There’s nothing like trying to make small talk while another man stares at your wife’s cooch.”  That, in a nutshell, was the story of my transfer.

Chick socks

Transfer day socks

We were told to arrive to the clinic at 10 sharp on Saturday morning.  We swung by the farmer’s market, lined up for our Saturday morning chocolate croissants before our town’s magical baking couple even arrived to set up their tent, and were on the road in time to make our appointment with plenty of time to spare.  I even had enough time to leisurely pick out my transfer day socks.  As I Tweeted out the pic of me and my socks in the town gazebo I captioned, “Transfer day socks. ‘Cause eggs and the chicks that produce them rock!”

45 minutes in to the drive we zipped around a blind curve only to find a police cruiser parked sideways across both lanes of traffic.  The friendly local cop sauntered up at the leisurely pace one expects of small town America and said, “Oh, yea, we’ve got a car in a ditch.  Road’ll be closed til the tow truck gets it out.”  Honestly, I’m surprised they didn’t want to search our car right then and there given the sheer sweat-producing panic that news elicited.  I definitely looked like someone hiding something.  We declined to wait and I iPhoned us off-road and through planned community after planned community until we arrived just a few minutes after our scheduled appointment.  Crisis averted.

Upon arrival to the clinic’s waiting room, I was informed that transfers actually take place in their spa facility next door.  Let’s play spot the newbie!  I rolled my eyes and somehow staved off the desire to mumble a chorus of, “You could have fucking told us this before this moment!”  We drove around to the spa entrance, I entered this unfamiliar new territory, and waited.  For a clinic that prides itself on trying to offer a relaxing atmosphere and support positive self-thought, the unanticipated facility change, the constant barrage of “Are you doing acupuncture today?” (No, I’ve paid more than enough for this already, thank you!), and the gaggle of women discussing unruly 1 year-olds just inside my earshot was none too relaxing.  Little did we know the best was yet to come.

We entered the waiting room around 10:05.  We were finally taken back to our room at 11:00.  The doctor came in at 11:30.  Good thing my husband told his boss he had to miss that very important 9am meeting.  Grumble.

Turns out the reason for the delay was the entire clinic was experiencing a wireless networking outage.  4 years (1 hour and 30 minutes) of waiting to do our very first embryo transfer, and the clinic was unable to print any pictures of my embies because of a wireless issue.  Seriously, FML.  It’s odd how much that little fact bothered me.  I’ve anticipated my first transfer for ages.  I’d walk in to the familiar surroundings of my clinic (fail), be presented with pictures of my gorgeous embies (fail), and be in and out calmly and quickly.  Yea, not so much.

When the doctor finally entered the room I was thrilled to see it was my favorite doctor.  He did my latest D&C and I remembered liking him then.  I like him even more now.  He spoke to me of science and medicine, not mantras and yoga.  His professional demeanor did help calm me, even if things ultimately got a little weird.

An embryo transfer is really not much more than a slightly more invasive and prolonged pap smear.  You scoot to the end of the table, a speculum goes in your vagina, the cervix is cleaned with the same medium the embryos have been growing in (aka “Embryo Gatorade”), a small catheter is threaded into your uterus, a syringe containing the embryo is threaded through the catheter, an ultrasound probe is inserted to visualize the uterine cavity, and, when the ultrasound shows that the catheter is in exactly the best spot for (hopefully) future implantation, the plunger is pushed and the embryo’s deposited.  Easy peasy.

Thing is, though, they don’t bring the embryo-containing syringe into the transfer room until the very last moment.  They want you to be waiting on the embryo and not the other way around.  Though it surely didn’t feel like it at the time, a thirty-year-old woman is more capable of waiting than a fragile 5-day old blastocyst.  What this meant in reality was I was sitting there for what felt like an eternity, legs spread wide open, husband at my head and doctor holding the empty catheter in my hooch, waiting for the embryologist to appear.  So, we made small talk.  Awkward, awkward small talk.  I about jumped up and kissed my husband when he broke yet another unbearable silence with a well-timed question about the clinic’s embryo freezing procedures.  Anything to break the silence.  Well, almost anything I guess.  When the transfer was actually happening the doc wiggled the catheter and pointed to the ultrasound screen saying to me, “That’s me waving high from inside you!”  Uh, wha?  As I saw the quick explosion of fluid and embryo flood the ultrasound screen he added, “And now you’re pregnant!”

We transferred one grade 4AA blastocyst – the highest quality blastocyst possible.  We had at least one other 4AA blastocyst waiting as well.  The clinic offered us the choice of transferring one or two blasts, so they had grading ready to go on the two best embryos on the day of my transfer.  The grading of the remaining embryos will post to my patient portal sometime in the next week.  We also found out on Saturday that I had an additional 7 expanding blasts that would be frozen, with the possibility more would reach expanding blast stage by Monday (today, 7 days post retrieval).  I called for the final report this morning.  This cycle has been a dream:

  • 23 eggs retrieved
  • 19 eggs mature
  • 16 eggs fertilized
  • 16 embryos still growing on day 3
  • Of the 16 embryos:
    • 1 blastocyst transferred
    • 9 blastocysts frozen
    • 6 discarded (failed to become blastocysts)

Those numbers are pretty much beyond my wildest dreams.

Because I’m a fiend I’ve been peeing on everything in sight since Saturday.  My official blood test is next Monday, October 14, but I’ve been taking daily home pregnancy tests as well just for giggles.  The shot I administered last Saturday to trigger the final maturation of my follicles in preparation for egg retrieval is essentially a straight dose of the same hormone picked up by home pregnancy tests.  This means if I hope to get convincing news either way with a home test, that I’ve got to follow the tests from positive (from the shot) to negative (from the shot being gone) to, hopefully, positive again (from a pregnancy).  This morning’s test was the first stark white negative.  If a line reappears in the coming days there will be immediate cause for hope.  The earliest I’d expect to see a true honest-to-goodness positive is late this week, but that news surely won’t quash my desire to pee on my hands in a Dixie cup each morning when I wake from now until next Monday.

For now, though, I’m officially PUPO – Pregnant Until Proven Otherwise.  As the doc said after my transfer, it’s time to party like a pregnant lady!

Eggsplosion

So, uh, yea.  I’ve been a wee bit busy.  And bloated.  Here’s the rundown since I last wrote.

Thursday: Clean my bloated little ass off in preparation for my aunt’s visit for the weekend.  We’ve been in our new home/new state since last July, and her visit represents the first time any blood member of my family has bothered to come see us.  She’s been wanting to visit for a long time, but with leukemia (in remission) and drop foot from a badly butchered hip replacement surgery three years ago (lawsuit pending) her ability to pick up and leave on a 6 hour drive is limited.  Which is why my dad was going to come with her to help break up the drive.  Until Thursday morning, that is, when my alcoholic and predictably-unpredictable father backed out.  It seems the drive is “just too far” for him to manage.  I mean, it’s a totally different story when he picks up on a whim and drives 5.5 hours to downtown D.C. to go to an Air Force reunion, but 6 hours on well-paved highways and sprawling country roads to see his daughter?  Yea, that’s a bit too much to ask.  We’ll leave the “this man could procreate but I can’t?” out of today’s discussion.

Friday: Up before the crack of dawn for yet another monitoring appointment.  Hour drive up, probe in, blood out.  Another in the long line of unmotivated NPs proclaims things are progressing nicely.  She hems and haws for a while and decides she’s not comfortable leaving me unmonitored for the rest of the weekend seeing as my12  follicles  have developed quickly in the past two days.  I leave with instructions to return the next morning.  My aunt arrives that night.  We take her to our normal Friday night happy hour where she gets to listen to a ragtag bunch of academics discuss Freud’s views on libidinal energies and sublimation.  Watching her face – the face of a woman that never had the opportunity to go to college and was pregnant with her first child by 19 – was quite interesting.

Saturday: Back up to the RE, this time with my aunt in tow.  No one can say I don’t know to entertain with the best of them.  “Thanks for driving all this way to see us!  Want to spend another 2.5 hours in the car and in an over-the-top zenned-out ski chalet waiting room while your niece gets probed by the NP of the day?”  On the way up I hit a motherfucking bird with my car.  My BRAND NEW car.  My aunt weeps for the  bird, I weep for my car.  I’m compassionate like that.  Perhaps this is why I’m barren?  Anyway, car is fine (bird definitely isn’t).  Back at the RE, this time I got the kind and attentive NP.  She counts 11 follicles.  I’m given instructions to trigger at midnight and return for egg retrieval on Monday.  Shit just got real.  I drive home, we wander the farmer’s market, go to a cider mill, have a nice dinner, and watch home movies.  All in all a beautiful visit with minimal “Have you tried relaxing?”  “What about acupuncture?” “My acupuncturist has this new supplement you should try!” and “Are you sure you really need IVF?”  We go to bed early, but my alarm is set for my midnight trigger.  I stumble sleepy-eyed into the needle, and go back to bed.

Sunday: Wake and send my aunt off with a homemade breakfast of French toast and sausage from the farmer’s market.  Beach myself on the couch for the rest of the day.  The HCG is working.  Things start to bloat and ache.  The mounting discomfort is a nice distraction from the continued failings of my poor Pittsburgh Steelers.

Monday: Retrieval day.  Hubs is flustered because he’s had to call out of work at the 11th hour.  He goes in for the morning and is home by 10am to, uh, do his part.  We leave by 10:30 for my appointment at 11:30.  He’s become a pro at packaging his cargo for the trip.  Ziplock bag of body temperature water, inside an insulated travel mug, with a sample jar on top.  Ideal environment, portable, fits in the car cupholder, and doesn’t scream “I’m carrying a bag of jizz!” when you walk into the clinic.  It amuses me how involved he’s become in planning and executing this aspect of the process.  When I arrive to the clinic I’m informed that (despite incessant phone tag and pharmacy/clinic wrangling) my Intralipids haven’t arrived yet from the pharmacy.  I start to panic.  As the OR nurse looks at me I think a light went off in her head.  She assisted with my latest D&C and I think she remembered that in that moment.  She kindly says, “You’ve had losses before, we’ll make this work.”  10 minutes later I’m hooked up to an IV with someone else’s Intralipids prescription flowing through my veins.  She’s arranged to have my bag replace her bag when it arrives.  (And, according to FedEx, my dosage arrived to the clinic just as I was being put out for retrieval.)  I have a nice nap while the Mr. watches a doc, anesthesiologist, and nurse thread a needle-laden ultrasound probe through my lady bits.  The needle aspirates the egg-containing follicles.  When I woke I asked him for all the details.  “What did they say?”  “How many follicles did you see?”  “What was it like?”  He responds unsatisfyingly but heart-warmingly that he was distracted.  Seems I was babbling, making faces, and grabbing at my oxygen throughout the procedure.  His eyes were on me, not the ultrasound screen.  Messed up priorities with that one, right?  As I come to I savor the amazing brilliance that is a cold can of ginger ale after over 12 hours without a drop to drink (or eat).  The nurse gets us ready to go but seems to be waiting for something.  I know we’re supposed to leave with the final count of how many eggs were retrieved.  She tells us it usually doesn’t take this long, and I begin to silently panic again.  Finally she calls over to embryology from our OR suite.  All I hear her say is, “Over 20?” somewhat amazed.  She hangs up and says, “Well, that explains the wait!  There’s so many eggs they haven’t finished counting yet!  Definitely over 20 for sure!”  We are informed that we will definitely be doing a 5-day transfer given that strong number of eggs.  Just before I get wheeled out of the room the final tally comes in.  23 eggs retrieved.  One shy of 2 dozen eggs.  I’m one prize laying hen, goshdarnit!  The number swirls around in my brain through the drive home, the obligatory stop for a bagel, and the hours of mindless television.  23 eggs seems surreal seeing as the most that were ever counted on ultrasound were 12.  I’m certain most were likely immature, and of those that were mature the quality must be sketchy.  I prepare myself for less-than stellar news when we get the fertilization report the following morning.

Tuesday: I wake up and continue the daily ritual of weighing in each morning.  One of the first signs of ovarian hyperstimulation syndrome (OHSS) is rapid weight gain.  I wasn’t too concerned previously, but knowing I just laid 2 dozen eggs I’m getting nervous.  I’ve gained 12 pounds overnight.  I find the biggest pants I can (hooray for holding on to my pre-weight loss clothes!) and scream down to the mister that we’ll be leaving for work early so we can go to the store and get Gatorade.  He buys me four bottles, and I drink 3 before lunch.  I’m bloated, uncomfortable, and achy, but nothing can assuage the euphoria I feel when the call with our fertilization report comes through.  Of 23 eggs retrieved, 19 were mature and injected with the mister’s sperm via ICSI.  Of those 19, 16 have fertilized.  We have 16 potential children sitting in a petri dish in a lab an hour from home.  I’m overjoyed.  Given all the positive developments, the nurse explains, I won’t be getting any further updates about our embryos.  I’m simply to return on Saturday for a 5-day transfer.  I have no idea how I’ll make it until Saturday.

Wednesday (today): I’m anxious, but delighted.  My ass hurts from my first PIO shot last night, a new Lovenox bruise is welling up on my stomach, and the bloat (which has thankfully subsided quite a bit) is still forcing me to wear the same fat pants I wore yesterday.  I’m taking guesses at how long I can keep on wearing the same pants before my coworkers notice.  This post-retrieval, pre-transfer limbo is a new time to me, and I’m not quite sure what to make of it.  What does one do with oneself when her future children are off cooking in a petri dish?  I’m decidedly not pregnant, my ovaries and uterus are empty, but 16 little embryos are hopefully dividing away in a lab up the road.  I don’t think I’ve ever felt this hopeful and this anxious before in 4 years of trying.  And, that both excites and concerns me.  Hope has been absent from this equation for so long now, that I’ve sort of become used to it’s absence.  Now that it’s back, it feels wonderful to start thinking in “when’s” and not “if’s” again.  At the same time, it’s hard not to feel like we’re setting ourselves up for yet another fall.  Of those 16 embryos surely all won’t mature normally.  Not all will survive.  For 5 days I will sit and dream of my 16 embryos, but the stark reality is that, come Saturday, we may find that 16 started the race, but only 1 or 2 have any chance of crossing the finish line.  Five days is a long time to live with one reality only to have it switched out for another.  And then, after transfer, we wait even more.  My first beta is scheduled for October 14.  12 days until we find out if 16 embryos yielded one potential pregnancy.  Terrified.