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.


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!


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.

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!

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’ll survive

It happened on my walk home from work.


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.