The Transfer (The Good Parts Version)

As promised, let me go into a bit more detail on why Monday was so great. Back in March, the doctor told us that between the miscarriages and not producing very many follicles on the first round of injectables, we might be looking "reduced ovarian response" (probably not exactly the right medical term). If that were the case, we would be facing the likely possibility that none of JF's eggs were any good, and donor eggs would be the only viable option. The next round of injectables, at double the dose, went much better, but the doctor left us both with the impression that there was still serious doubt to the quality of those eggs. So I, at least, spent the last nine months thinking there was a good chance that we were going to eventually start IVF, spend the first round learning that it was hopeless, and then move on to donor eggs. The doctor did tell us this month that he no longer considered this a likely diagnosis, but that wasn't enough to clear the idea out of my mind.

So I spent the weekend trying to enjoy the early Christmas with my family, while inside I was bracing myself for disastrous news, either in a phone call or at our appointment on Monday. I'm pretty sure JF felt the same way -- she said she had nightmares that only one embryo made it far enough along to transfer. I found myself thinking that wouldn't be so bad, at least in her dream there was one that worked! But I didn't want to say anything that would get her down.

So Monday morning we said goodbye to my family, and I drove us to the fancy IVF center with dread in my heart. (Example imagined bad scenario -- there is nobody else there when we get there, because we missed the message saying none of the embryos made it, and it being Christmas Eve they just stayed home.) Because it was a fairly long drive, in winter, we left early, and arrived at the center 30 minutes early. Moments after we got there we were ushered back by a nurse, and that's when I knew we were really in trouble -- surely it could only mean they wanted to give us the bad news quickly.

Only then she took us to a gurney, and gave us hospital gowns, and suddenly there was a ray of hope -- I figured it was unlikely they'd give us gowns to sit down and give us bad news. Then she casually told us that seven embryos had been cleared as normal by the PGD testing, and the doctor would soon be checking over to pick the best ones to transfer. That's when it finally got through to me that this might work out. I felt comfortable enough to joke that this was probably the only time children of ours would be considered normal. I think JF expressed a worry that maybe the doctor might still find a problem with all the embryos, but in my mind the situation had shifted from inevitable trouble to strong hope.

Finally the doctor showed up, and gave us the news. Of the seven, two were still a bit behind, and two were absolutely prime for transferring. (I think this means the other three were merely average.) The question of gender came up, and I momentarily panicked, because this was something we hadn't really thought of ahead of time. But luckily the situation was ideal -- the best two were one of each. The other five would be evaluated the next day (ie yesterday) to determine if any were suitable for freezing.

Exciting as that was, the big news was that the possibility of problems with eggs or sperm is off the table. It now looks like the issues have been hormones and timing -- things IVF is already designed to work around. All the pills and the shots every morning may be a pain in the arse, but they're a lot easier to put up with when it looks like they have a good chance of making everything work.

So there you have it -- easily the best news all year for us. It doesn't mean that this cycle is necessarily going to work. But it does mean there is a good chance it will, and plenty of reasons to be optimistic that things will work out eventually.

Which is pretty much the best Christmas present ever.

The Transfer (The Quick Version)

Just wanted to say (for those of you following along at home) that the transfer today went smoothly. The PGD testing cleared seven of the ten from the last stage, and the doctor transfered the "best" two. So tonight we're exhausted, but incredibly relieved and filled with joy.

I'll try to post more in the morning; for now, JF has asked me to read to her from Gawain and the Green Knight.

SF: earning jewels for his crown

(I first typed "corn" instead of "crown" and almost left it at that ...)

Well, I seem to be over the nausea, but all is not right at our household:

The dog has fallen ill.

She had some, erm, digestive problems that led us to feed her a bland diet yesterday ... which she then vomited up today. And then some. And then some more.

SF got up at 4 a.m. to take care of her and didn't really get back to sleep. The vet said it looks like she has a stomach bug and kept her for a few hours to give her IV fluids. We now have anti-nausea and anti-diarrheal medicines to give her tomorrow.

This has thrown a monkey wrench into our plans to visit SF's parents this weekend, but we'll figure it all out. We can't take a puking dog, but the vet says if she's not vomiting tomorrow, it's probably safe to go.

With the transfer set for Christmas eve, we've been in a difficult position: visit before the holiday and tell them we're a no-go for Christmas day itself and stay home and eat ice cream, visit after the transfer and hang out with SF's pregnant sister-in-law and her husband and try to shut out the evil green monster, or go for the entire four days.

None of these plans is perfect.

Fertilization report

The nurse called this afternoon and said that of the 17 eggs retrieved, 10 fertilized. I don't know anything about quality yet. Maybe ... tomorrow?

Today was pretty slow for me. Between the anaesthesia and the pain meds, I've been pretty out of it for much of the day ... probably could have made it through work if I had to, but (a) I keep falling asleep and (b) we're closed right now for renovations, and the work that needs doing is primarily heavy lifting, which is off limits.

And ... I just threw up. So we'll have to see about work tomorrow. Thank goodness lunch was a long time ago, because it was Spaghettios, and not to be crass, but they taste like puke going in. I really wouldn't care to meet them again.

Home Again

The retrieval fetched 17 eggs, a most auspicious number. I performed my duties successfully as well. I just successfully gave JF her first Progesterone injection as well.

All-in-all, it appears today has gone as well as could be hoped (knock on wood). Now it's just down to various housekeeping activities and catching up on my sleep.

Retrieval

Retrieval is tomorrow morning. The facility is about an hour's drive away, so we're heading out tonight to stay in a hotel. I find myself extremely nervous about the entire process; I've no idea how JF is still functioning at this point.

I have a date!

We'll going in Wednesday for the retrieval, which means a Christmas Eve transfer. I'm not such a n00b as to believe in the magical power of dates in this situation (after being due on my deceased grandmother's birthday -- twice -- and miscarrying -- twice -- these things lose their magic). Simply knowing the schedule will help us try to plan family stuff; they've been very patient with us as we offered them nothing but portions of our own uncertainty.

As I watch the crowd of five kids trying to shovel 11 inches of snow off our entire street, I am glad we decided on a hotel room the night before retrieval over trying to get to the clinic an hour plus away by 7 a.m. in winter.

Hopefully by next week they'll be able to find my uterus again, so they have someplace to transfer to. It seemed to be off roadtripping this morning. Can't blame it: I'd be off in Lungdon or Handsylvania or Puertoe Rico myself, given the chance. Probably stay away from Assyria, though ... I heard a rumor someone's planning on shooting up the place.

Excitement

Just spent 30 minutes shoveling the driveway so we can run out for an ultrasound at 8:30 this morning! This is the one that should tell us our scheduling for this week and next -- if we can make it to the doctors'.

A New Twist

Today's ultrasound went well, looked like there were at least 9 follicles in the 6-8 mm range. But there is a new wrinkle with the Gonal-F injections -- starting Friday we are to scale back slightly on the Gonal-F, and mix it with Luveris before injecting. I can't say I know the reason why, but I suspect JF will have thoroughly researched it on the web by this time tomorrow.

For all that I am still scared by the prospect of serious injections to come, I am kind of geekily excited by this. I think that's because it looks like giving the shot will be about the same difficulty level as a normal trigger shot, so not new and scary -- and there is the cool drug mixing stage with this. Okay, honestly, I don't know why that's cool, but it feels that way to me now. Guess that's better than panicking about it when the time comes.

Gonal-F shots now underway

The call never came on Wednesday, which was supposed to mean we were to start the shots on Thursday. Let me tell all of you out there that this is a bad method of communication, because you're going to sit and wonder if no call really is a positive message or just an accident.

So Thursday morning, we called them and left a message asking the nurse to confirm. At noon I got the call confirming that the blood work was okay -- but this nurse thought that the ultrasounds warranted consulting the doctor, so we were to wait until we heard more. Finally a few minutes after the doctor's office closed, we got the go-ahead to start the Gonal-F.

Okay, that was new....

JF and I went in for the ultrasound check this morning. It's the utterly routine check to make sure everything is looking groovy to start the Gonal-F -- old hat for us by now.

Only this morning, there were two nice sized (11 and 13 mm, I think) follicles sitting there on the ultrasound. The nurse did not seemed unduly fazed by this, but it sure surprised JF and me.

So now we're waiting for the blood work to come back. If it's good, we proceed as planned; if not we wait a week and check again. Apparently the Depo-Lupron should still be in JF's body; it may just take a bit longer to suppress her reproductive system down to the point we can start the process.

Afterward, we paid in full for this round of IVF. There was a bit of a glitch, too, as I had apparently (sensibly IMO) set a limit of $5000 per transaction on the card. I called the number on the back of the card and we sorted things out.

Update

We seem to have fallen out of the habit of updating this blog, as our last few weeks have been extremely busy. Rest assured that we are still working on the IVF cycle, and things are about to get properly under way tomorrow with the first ultrasound and corresponding payment in full for the cycle. We should be back to daily Gonal-F shots on Thursday. (Knock on wood.)

So far, the big excitement on this cycle was last week's Depo-Lupron shot. It is much more serious business than the injectables we have been dealing with in previous cycles -- a longer (and thicker, I think) needle, and it goes into muscle rather than fatty tissue. Because we will have to administer shots like this daily later in the cycle, the nurse made me give JF the shot while she monitored things.

Can I just say how scary I found that? I just hope it gets less nerveracking after a few days of doing it every day. Still, it seemed to go fairly well. JF claims it barely hurt, and I think I know how to make it hurt even less next time.

Questions abound

We have our initial IVF appointment tomorrow. It lasts about an hour. I'm not yet sure what it entails. They call it a "lecture." And so the IVF intimidation begins.

We usually talk to one of two nurses at our clinic. I've noticed we get consistently more complete information over the phone from one than from the other. This afternoon, I got a call from the mail-order pharmacy on my cell phone while I was at work. They were calling to confirm the list of medicines ... which I haven't yet seen (presumably it will be part of the lecture?) and which didn't match what I thought they had described at the consult last week.

I called the nurses' voicemail and left a message. For some reason, when they returned the call, my phone didn't ring. It was the less-complete nurse, and she left a message that didn't answer my questions ... but since the phone didn't actually ring, I couldn't ask them directly to her. She said the calendar of what medicine to take when should be in my mailbox when I got home, and it would explain everything.

It was. But it didn't. Not only does it also not match what I understood from last week, it also doesn't have all of the medicines the pharmacy listed on it. The procedure week was also four weeks earlier on the calendar than they said last week.

We'll get it all cleared up tomorrow, in plenty of time. Maybe they thought we didn't ask enough questions last week, so they spoonfed us some really obvious ones.

SF's last blog post made me blush, a lot, not only because of his generosity in not blaming me for the problems we've had, but also because he's right about the other stuff -- my passport renewal form is sitting on the piano and has been for ... awhile. Sigh.

Friday started out on a rough note. Our cat had a tooth pulled a few weeks ago, and we were referred to a specialist with the news that two more of his teeth looked abscessed but were hard to get at. At his appointment on Friday, we found out he has resorptive disease and we needed to have five of his teeth pulled or consign him to a painful process as they dissolved and fell out of his head. The good news is that he seems to be recovering well from the extractions (he's curled up on my lap asleep right now). The bad news is that it was an $800 bill weren't exactly expecting, an we found out about it as we were walking out the door to go to talk about IVF.

Things went more smoothly with the RE than I'd feared they would. It was absolutely nuts there that afternoon. Every seat in the waiting room was taken, and everyone we talked to seemed a little punchy. I realize that sounds like a bad thing in a medical practice, but it really was what we needed at that point. We asked most of the questions we had, but we also laughed a lot during the appointment. Anytime I laugh more than cry in that room is a successful appointment in my book.

Although he did say he could see an argument for continuing on injectables, he pretty clearly agreed with our decision to move on to IVF. We went over a bit of the medical stuff -- he doesn't think the diminished ovarian reserve is likely to present a problem; he said he'd expect 1-3 follicles if it were trouble, but we've been getting 7-8. He seemed to think our chances were at least reasonable.

Then they brought out the price list.

My eyes went wide.

Eek! The new price listed didn't include the Preimplantation Genetic Diagnosis!

We brought that up so they could add it in ...


... and the result was still $3400 less than the price they quoted us in June. They have comped some of the procedures and have added an option of making payments (which we're hoping to avoid). And they've offered to do all of the monitoring and blood work for one set price now that our insurance coverage for even the lab has conked out.

We were ecstatic. We are ecstatic. It's still going to cost a lot of money, but it takes so much of the pressure off to know that we might have the option of doing a second try if the first doesn't work.

Responsibility and Bravery

In response to JF's last post -- I simply don't see the see the point in holding her responsible for something completely outside of her control. When she leaves the eggs out after cooking breakfast, I'm happy to blame her. When she gets her passport photo and then leaves the application sitting around for weeks rather than mailing it in, I will blame her. But when her body misbehaves, it is simply not her fault. (And that's presuming that it is her body that is responsible, at that -- we have corrected all the issues we know anything about, so at this point we simply don't know where the problem is coming from.)

Where her own behavior is at issue, she has been an incredible trooper in all of this. I can't imagine giving myself all those shots. All the pills, the probings, the bloat... she has put up with it all, and is staring in the face of worse yet to come and getting excited at the prospect of another chance! She is as brave as any person I have ever met.

She deserves great praise, not blame.

Response and responsibility

"It's a shame she had no real children; she would have been a wonderful mother. In a flash of insight, David sees that it's not her fault she has no children: Mr. Trotwood is to blame. That's the reason he's so outgoing and optimistic but prone to tears: he is a man without seed. Every kind thing he does for his wife is some kind of compensation, some small apology."

--Defect by Will Weaver

I, too, find it hard not to feel that way, when I'm the problem. I find myself, much to SF's chagrin, doing things like putting off my dentist appointment because we're already spending so much on my healthcare. It doesn't help the infertility situation, but it makes me feel a little better.

I wonder, though, whether such feelings and actions will eventually become a recipe for a marital difficulty. People don't tend to like people they feel sorry for, even -- especially? -- when they're married to them. No matter how bad I feel for cheating my fertile husband out of the dream of easy family-building, it seems like it's necessary to get past that guilt and sadness ... which is only really possible if the other person doesn't blame you.

So far, SF seems to be above casting blame -- a generous reaction, in my opinion. I hope someday I might get beyond holding myself culpable for the mess we find ourselves in.

Tagged

The Rules:
- Once tagged, you must link to the person who tagged you. (Hi Tina623!)
- Post the rules before your list, and list 8 random things about yourself.
- At the end of the post, you must tag and link to 8 other people, visit their sites, and leave a comment letting them know they’ve been tagged.

8 Random Things about SF and JF:

1. After we were the closest of friends but before they were dating, JF thought, "SF and I aren't dating, but if he asked me to marry him, I'd say yes." Both of our mothers had already figured that out and thought it was a good idea.

2. SF makes the best pizza in the world: spinach, Roma tomatoes, bacon, fresh mozzarella and Gruyere. (This Random Thing is contested, but since I, JF, am typing, it goes on the list.)

3. We want to go to Epcot someday to check whether one of our favorite dead fiddle players is in a Circlevision movie there. (The Disney archivist didn't know.)

4. Our favorite place to vacation is Newfoundland. We've been there twice together.

5. We have four accordions, a piano, two violins, an octave mandolin, a guitar, two mandolins, a ukulele, a bassoon, a clarinet, 20+ tin whistles, a keyboard, and a cello in exile.

6. SF is a strong proponent of the comma before the final "and" in a list of items. JF naturally puts one there, too.

7. SF wrote JF a tune called "The Platinum Ring" for their wedding and surprised her by having all of their friends play it at the reception.

8. Together, we are German, Irish, Scottish, English, French, Finnish, Austro-Hungarian, Cherokee, Russian, and Canadian. But not necessarily in that order.

We don't really know who to tag ... we'll have to think about that part.

The Met Reducing Plan

Turns out I was tracking my weight during the wrong part of the cycle. It didn't balloon upward until after the trigger shot -- when I gained five pounds overnight. That was three weeks ago.

In the past three weeks, I have lost ten pounds, putting me at my lowest weight since SF and I got married; this morning's measure was 3 pounds less than I weighed when we got back from our honeymoon. (Which, as a side note, took place in Northern Michigan in January during a cold snap and included a frightening quantity of Tater Tots. I was down a few pounds from pre-wedding stress, but it came back in spades on the honeymoon.) I have lost weight this week at the rate of nearly a pound a day.

I cut out pop about a month ago. That much sugar mixed with insulin resistance can't be a good thing. But I suspect a stronger culprit: the Metformin has been making me sick again. I don't feel like eating much, and when I do, it ... doesn't stay around long. Something to bring up with the doctor on Friday, I suppose, though I totally don't want him to take me off the drug. I will beg to stay on it, GI side effects and all. I just want to make sure it isn't going to kill me. He swears up and down that Met doesn't cause weight loss, but that equalization period as your body adjusts to its new state of affairs included, for me, dropping about 20 pounds -- plus a few more in the past couple of weeks. Now, if I can just get down about 20 more, I'll be back to what I weighed in grad school when I was subsisting on rice-a-roni and ramen.

options

We have an appointment Friday to discuss our options. I don't know how long before we start the next round. Probably at least 3 weeks, and that's just until we need to start supressing my cycle. I have a box of junk to take with us in case they can use it -- extra needles, the Follistim pouch and pen from our first round, a box of Crinone they lent us in case we needed it. For the first time since the beginning of the year, the sharps container is the only drug paraphernalia in our kitchen. It looks bare, but also less cluttered, less stress-inducing. It's a kind of personal feng shui, I guess. It feels like the phase of those drugs has ended, and we're moving on to a different one.

Telling time

When the news is good, they call around 3:00. When the news is bad, the nurse doesn't call until after 4.

At 4:30, the phone rang.

The test was negative. Bleeding for one day last week doesn't count as a period. It's unusual not to have a period after an hcg shot. If nothing happens by Friday, I should repeat the test "in case something weird is going on."

Even though we were expecting it after this morning, the news has still knocked both SF and me for a loop. I prepared myself mentally -- as much as possible -- for another miscarriage, but not for just an outright garden-variety failure to launch. And though this may technically be better news (in that it doesn't add to the disparity between pregnancies and live births), it doesn't feel that way just now.

Hopeful but not optimistic

It's finally here.

Blood test day.

I called for a lab referral.

It feels like there's a lot riding on this one. If it's negative, we're most likely moving on to IVF.

The home test I took this morning showed one solitary line.

Something concrete

No, not that.

The nurse asked that I call them with an update at the end of the week. I phoned yesterday to let them know the bruise was fading and that the spotting had stopped except for some brown goo.

As a child, I figured I just wouldn't ever take my clothes off in front of anyone, have any of "those" doctor's appointments, or admit to having a menstrual cycle or anything else related to sex. The ease with which I can now leave voicemail messages using phrases like "brown goo" still strikes me as odd, to say the least.

The irony that I am now posting that on the Internet is not lost.

When the nurse returned my call, she gave me some of the most concrete information I've had so far. She said that brown discharge with Crinone is normal if you've had a bleeding episode recently. She also said it doesn't take much blood to make it very brown, that it looks like more blood than it is, and that it is old blood.

There was a pause, and then she said, "I'm glad that bruise went away ... I haven't seen anything like that happen in 10 years here."

I'm knitting with only one needle -- unravelling fast, it's true ...

"I'm going slightly mad ...
I'm going slightly mad
It finally happened
It finally happened
It finally happened --
I'm slightly mad"

--Queen, "I'm Going Slightly Mad."

And that? Is how I feel about (a) progesterone, (b) the end of the two-week wait, (c) assisted reproduction, and (d) life in general.

Feeling pretty useless, too. Need to get off the couch ...

I totally fell asleep on the couch this afternoon. Stephen Colbert, it had NOTHING TO DO with your book. I'm still in the Nation.




even if I did get it from the library instead of buying it.

(wh)eeew!

The bleeding has backed off into brown gunk. I know everyone was just waiting with bated breath, dying to find that out.

Here's the thing: backing off seems like a good thing.

Given the choice, I'd rather have it back off than become a full-on period.

But I am so superstitious I almost can't write it here. There is some part of my head that honestly believes -- fears -- that writing it down will jinx any good things that might be happening, and that now I will be bleeding like a stuck pig by noon. What it boils down to is this: I am my grandfather's granddaughter when it comes to superstition, and --

-- it's still too early to tell anything.

bruising

I have a bruise in my bellybutton. It was bright red and the size of a pencil eraser this morning. I called the nurse, and she said it might be leftover blood pooled from the injections. That seems strange to me, since we've been finished with them for a week.

I thought maybe it was from the button of my jeans pressing into my great bloated belly. But I didn't wear pants with a button today, and this evening the bruise is three times as big as it was this morning.

Very puzzled.

In other news, the nurse also said the bleeding/spotting is either (a) breakthrough bleeding that will stop, (b) breakthrough bleeding that will continue off and on into a period, or (c) an early period.

In other words, it's too early to tell.

Crinone -- spotting 6dpo

We're not quite halfway through the 2ww, and I'm spotting ... bleeding? ... I'm not sure where the borderline is.

Last night when we got home, I had a couple of drops of pink. Then -- and I apologize for the TMI here -- overnight, I had cramping bad enough to wake me up, and the drops of pink turned into dark red blood combined with the typical crinone mess.

Dr. Google says "bleeding on Crinone is not uncommon" and "we found no evidence that Crinone causes early bleeding."

I find lots about pink spotting and brown and orange(?!?) discharge. My doctor says anything less than a full period isn't a period. We're not there yet, but ... I'm worried.

But -- 6dpo? Why so early?

So puzzling.

Gonal-F, round 4, 2nd day past trigger

I am so stiff -- bloated, huge and sore. It's only 9:00, but I'm going to go beach myself in bed and read for awhile. Bleargh.

This morning's weight was something like +3 pounds overall, which is about 2 1/2 pounds up from yesterday.

Ovidrel on board!

It hurt a little more than the Gonal-F, just about as much as the Ganirelix. The syringe is the same.

And now ... we wait. And, if the past is any indication, we bloat.

If I make it to October 30 -- 14 days past ovulation and 16 past trigger -- without a normal-to-heavy period, then they'll do a blood pregnancy test. We start progesterone gel on Tuesday.

Gonal-F round 4, day 10

This morning's ultrasound looked great. Even after Wednesday's bleeding, my lining was 12mm. The nurse said they look for 9-12 and implantation doesn't happen in less than 8. There were several big follicles; the machine measures up to four, and the four they measured were all 18-20mm. We trigger tonight. Let's hope they're not all ancient shriveled up useless eggs!

Gonal-F and Ganirelix this morning ... we did the shot at the doctor's office after the ultrasound. Still not totally fond of the Ganirelix shot, but if it does its job I will forgive half the bad things I said about it.

Weight change since yesterday: -.2 pounds
Net change: +.4 pounds

Gonal-F round 4, day 9

Today SF accidentally pulled the needle out of my skin while trying to shift his hand around to push the still-surprisingly-stiff Gonal-F plunger. No pain, but the first injection site bled a little. We switched needles before trying again, because I am a wimp, and, as I said before, we have 30 bizillion of them.

Today was the first day we added Ganirelix to the mix. Those shots always hurt a little more going in. The needles seem bigger, the small syringe is a little more difficult to handle when you're used to the giant gonal or follistim pens, and the injection site seems to get a little sore afterwards.

U/S tomorrow!

Weight change since yesterday: +.2 pounds
Net weight change: +.6 pounds

Gonal-F round 4, day 8

Completely uneventful shot today, except that we had to do it 15 minutes early so I could make it to a meeting.

Weight change since yesterday: +.6 pounds
Net weight change: +.4 pounds

Gonal-F round 4, day 7

Small bruise from yesterday's shot; no mark at all from today's, which was the first shot I couldn't see going in -- SF's hand was in the way. I kept bracing for it to hurt, and there was a small sting when the needle first touched, but that's it.

The bleeding has slowed but not stopped. According to the nurse, "With all the medicine we're using, it's not unusual to have bleeding at any point during the cycle."

It took her a couple of minutes to say that, though. She was obviously thinking about something else, though she didn't say it. Now it's got me wondering; I should have pressed her. They want me to keep up with what I've been doing, come in on Sunday as planned, and call them if anything changes again.

Weight change since yesterday: +.4 pounds
Net weight change: -.2 pounds

Bleeding?

So. At work this afternoon, I started to cramp bad enough that I couldn't focus on putting the files in my filing cabinet in alphabetical order.

I took some Advil. An hour passed. I could hardly stand up.

Then the cramps went away almost at once. I continued to work and got a lot more done once I could see straight.

My boss stopped by about half an hour later and said she was leaving and I should too. I started getting ready to leave and discovered --

-- I had bled all over myself. Through my jeans and everything.

It's now about 2 hours later, and I'm still bleeding as heavily as a heavyish period. Guess I'll call the doctor tomorrow morning ... I've never had breakthrough bleeding like this before.

So. Very. Frustrated.

Ultrasound results

I am the proud grower of 7-8 follicles of the proper size. Yay me. As the doctor pointed out, 8 follicles doesn't mean 8 babies. SF and I are already well aware of this fact, with many past follicles in our history and still no babies.

BUT -- everything looks good. The lining is thick and comfy looking, there was a good number of follicles of a decent size, no problems with the shots. We're adding a daily baby aspirin as of today. Ganirelix (to prevent early ovulation) begins Saturday. Next u/s is Sunday morning, 8 a.m.

In news unrelated to babies, SF and I went for dinner at the mall last night. It turned out to be more expensive than we'd anticipated; we splurged on this jacket in blue.

I am in love with it. Love love love. I love the color. I love the snaps in the back to snug it in at the waist. I love the down-ness of it. And you know what? I love that the weather is finally cool enough that I can wear it!

Gonal-F round 4, day 6

A little bit of a scratch as the needle came out, but the shot itself was painless. We did the left abdomen today. There's plenty of padding there for the needle to go in.

Weight change since yesterday: +.2 pounds
Total weight change: -.6 pounds

I have an ultrasound in three hours with bloodwork ahead of time. Grow follicles grow!

Gonal-F round 4, day 5

Completely uneventful. Right stomach. Didn't hurt. Didn't bleed.

I'm more puzzled by my weight. On day 5, it was:

Change since yesterday: -.8 pounds
Total change: -.8 pounds

I'm not complaining, but understand: I gained 7 pounds last time. Maybe I'm misremembering, and it didn't happen until nearer the trigger? Puzzling.

Off to do day 6!

Gonal-F round 4, day 4

Today's shot provoked a disagreement. I remember yesterday's shot as going in the left side of my stomach; SF remembers it going in the right. There are no marks on me to prove who is right, so we did the only sensible thing: moved to my left thigh.

Right thigh would have been sensible, too, I suppose. I only specified which one so that if we need to remember, we have it written down.

A little pain from going to fast, but not much. A small drop of blood and a tiny red mark, but nothing needing a bandage. Four days down smoothly.

My belly is definitely starting to feel a little fuller. Not sloshy, like when you drink too much water, but just like there's more stuff in there than quite fits comfortably.

Weight change since yesterday: +.4 pounds
Net weight change: 0

Gonal-F round 4, day 3

SF noticed a barb on the first needle he put on, so he changed it. Luckily, we have dozens of them. Each pen comes with 5, I think, and we usually only use one.

No pain from the shot, aside from a slight sting from the drop of medicine on the end of the needle. Injecting the medicine slowly seems to reduce the sting from the dose of medicine. Fast and it hurts; slow and I don't even notice it.

Good job SF! Three down with no pain.

Weight change since yesterday: +1.0 pounds
Total weight change: -.4 pounds

I feel like I should be measuring my abdomen, too. I'm starting to see a little bit of tightness/pain there.

Gonal-F, round 4, day 2

First the first time ever, I administered the shot today. As always, JF was very brave, and kindly claims I did not hurt her.

ETA: This is JF. It really didn't hurt at all. Honestly, the beardburn I got when I hugged SF afterward hurt more. Also of note: if yesterday's weight is 0, then today we have:

Weight change since yesterday: -1.4 pounds
Total change: -1.4 pounds

Gonal-F, round 4, day 1

Smooth as silk! No blood, no bruise, no pain. Rock on.

Back in the saddle again

This feels like a time for starting new projects. I bought a bunch of material for a new craft project, and I actually got it together and started the new project instead of just letting the materials sit around until inspiration either struck full on or left entirely.

I learned to prepare some of the fabric I wasn't entirely happy with to make it more suitable for my purposes.

I have also picked up an old stitching project again to alternate with the new one.

And ... I have an appointment this afternoon for a day 1-3 ultrasound. It's been four whole months since I've seen my ovaries. I miss them, lazy little bastards that they are.

Beware o an Aberdonian

As of this evening, we've ordered enough Gonal-F to trigger the quantity discount. That's right -- 6 free pens and a free Ovidrel syringe, bringing the total for drugs for this cycle to a mere $1100. Woo! We still had to pay for four pens and the Ganirelix. Oh, and the Progesterone gel, but that's left over from my last failed pregnancy.

It's as close to clipping coupons as infertility treatment gets. If this results in a child, we'll have to give her a good Scottish name.

Keep moving forward

I should perhaps count myself lucky that this summer was as busy as it was. There was no time to dwell on miscarrying for the third time, no time to obsess over our current plan of action (one more round of shots instead of moving on to IVF), no time to do anything other than work, clean up from work, and plan for the next bit of work. From June until August, I ran 5-6 children's programs per week. When that ended, it was time to prepare for my workplace's upcoming renovation, which means moving my office and clearing all of the library materials off of the mezzanine.

Did I mention the two out-of-town, in-the-wedding-party weddings in two weeks? And that my in-laws and newly-expecting SIL and BIL were staying at our house while we were out of state for the second wedding? So it had to be -- erm -- cleanish? (That turned out to be one of the blessings in disguise: we spent FIVE HOURS cleaning before leaving for Chicago, which meant that we actually came home to a clean house for once. It's nice.)

And did I mention that I finally got my period? I started spotting on about CD 63, two days before wedding #1, and that continued until the witch showed up in full, two hours before wedding #2. What was that I said about at least one crampy afternoon in a bridesmaid dress? Oh yes. And this was a port-a-john wedding.

The dress was red, eh, so how bad could it get?

Anyway, that's where we are now. I've begun a pack of birth control, after discussing again with the pharmacist that I do in fact have a reason for taking both BC and prenatals. Soon I will call the doctor and ask for a prescription for the next round of shots. If we're lucky, he won't have any unpleasant surprises for us. And even though he's been talking to other doctors to get their opinions on treating us, I don't hold out much hope that they've got some great idea he hasn't thought of.

I think, though, that this is probably our last round of injectables, our last chance to conceive a child in our home rather than in a hospital. But still -- I am thankful, truly, that this isn't our last chance at anything; only a few short years of science ago, we would have long past run out of treatment options.

Why ...

... does it never get any easier?

I think it's time to call the counselor our RE recommended.

Lower your miscarriage risk with new tests, treatments

Let's see what they recommend ...

2. Stop the stress
"British researchers recently found that feeling happy, relaxed, or in control is linked to a 60 percent reduction in a woman's miscarriage risk. What helps when you can't kick back with a glass of wine? Gentle workouts, dining with friends, or watching your favorite TV show might work (stick with The Office instead of nerve-janglers like 24 or ER)."

So, ladies, if you miscarry, it's because you watched the wrong TV show. I'm waiting for the prescribed list to come out. The marketing people out to get right on this ... are you listening, America's Funniest Home Videos?

Does it work the other way, too? Do 24 and ER do double-duty as erstwhile abortificants?


Maybe I should trust the unnamed British researchers and hope they had a way to correct for this, but ... Do you want to know what, in my experience, is the main cause of stress in early pregnancy?

Do you?

How about MISCARRIAGE OF ALL PRIOR PREGNANCIES?

Or, to simplify, as SF put it: Say you're newly pregnant, not worried about anything. Your doctor says, "You're at risk for a miscarriage." You begin to worry. Then you miscarry.

Clearly because of the worrying, wouldn't you say?

It's all about the waiting

Like we didn't already know that.

I'm on something like CD44. The b*tch can take her own sweet time. I'm not calling her out yet.

Of course, with two weddings this month I can bet I'll be spending at least one crampy day in a bridesmaid dress.

That's the way it works, isn't it?

Whew.

I have spent the last several weeks mostly not thinking about trying to conceive. Work has been a bear, so I've been busy. And we can't start again until I have a period after the last miscarriage, and we're five weeks on now.

Or is it six?

Ah, the bliss of not knowing. It's not very important. In fact, if it'll hold off even another week, I'll be able to stop worrying whether the end of August will involve trying to balance two weddings (one family wedding and the second where I'm matron of honor) with injections and doctor visits.

Our doctor gave us several choices at the last visit:

1. Do nothing for a few months. Take a break.

2. Do another cycle of Gonal-F.

3. Move on to IVF with genetic testing to see whether we can learn why every embryo we produce dies.

4. Egg donation.

He seems to want us to move on to IVF, though he admits he's not sure whether this latest miscarriage was a fluke. But -- he's a doctor, and the way I'm reading the situation is that he wants to know what the answer is.

I am less concerned about the answer and more concerned about the result. For that reason, since he's not sure, we've decided to try one more round of injections. When I told the nurse that, she made it clear she thought that was a fine path, which reassured me some.

The hard part is that, although that seems like the best choice for us -- least expensive (this round of drugs is discounted with the pharmacy and we already have the progesterone) and also least invasive -- it may mean we are effectively choosing another miscarriage.

I have to remember there are no guarantees with any path we choose, at any time. Even babies born at term do not come with a guarantee that they will live long, healthy lives and die in their beds at a hundred and two.

Surfacing for air

Now that I've been gone so long probably nobody is even looking at this anymore ...

I'm still here.

Very, very busy ... but still here.

I'm still not sure when the next step will happen. It's good to have some time off.

I am so sad and so busy right now I can barely keep my head above water. We have some hard choices to make, choices I will outline when I have a minute ... but not yet. Not yet.

Off for the third blood draw. Here's hoping 8 days is enough to get to zero.

Falling

The test results came back earlier this afternoon. My hcg level dropped, so this pregnancy isn't viable. Right now the things I'm thankful for -- no Misoprostol, no ectopic pregnancy -- are pretty dreadful. But I'm still thankful, and hopeful, at this point at least, for next time.

beta 78, doubling time unknown

Just came across this post from The Waiting Womb, and it brought me to tears.

Please stay.

Update

JF called from work to say the official test this morning came back positive. (In the 70-somethings, I think she said.)

By itself, that doesn't tell us a lot -- we'll learn a lot more from Wednesday's test, because the big question now is whether that number is going up or not. But still, every test that doesn't come back negative is a good thing.

The limits of the Internet

There is a lot of information on the Internet. Good and bad, right and wrong ... as a librarian, I spend a lot of time explaining to people what it's good for and what it isn't good for. Some things you just won't find on the web.

One of those things, in my experience, is whether or not your pregnancy will survive. I can find lots of information about spotting during pregnancy, and spotting from progesterone gel, and cramping from progesterone gel, and cramping and spotting in pregnancy, and conflicting information about whether each of those things is normal or a danger signal.

But nowhere out there have I found a page that says, "JF, your pregnancy will last" and gives me 20 reasons not to worry.

Al Gore, when you created the Internet, you should have made it clairvoyant.

Out of words

After some spotting on Saturday, I woke in the middle of the night with cramps strong enough that they woke me up. No spotting then, but I'm afraid what we're seeing this morning probably means this cycle is over.


Ouch.

I don't know what the story behind Kurt Elling's "A New Body and Soul" is, but it clearly is a father addressing his new child, and bits of it make me wonder if his story is not so dissimilar to ours.

"Waiting too long for a sign you would come was what
nearly killed the spirit in the house within me
and when you appeared you brought an answer after praying
like a sailor sighting landfall on horizons of green"

and much later

"And that’s why our teachers teach 'The Itsy Bitsy Spider'
to the smallest ones:
We need a fight song to keep us moving along
I should’ve sung it when thinking you gone.
You weren’t lost / you were coming"

There are certainly days when I could use a fight song myself...

Knock knock? Who's there? Impatient JF. Impatient JF wh--

A friend gave me an extra test.

It called to me. I resisted.

It called again. Again I resisted.

It called again.

A struggle ensued. I peed on it. I'm not sure who won. Here's what happened next:



The oh-so-faint one is from yesterday, 11DPO; the darker one is from this morning. From what I can find on the web, the beta-hcg from the trigger shot should have left my system after 10 days.

I have to wait until Monday for a blood test, and then they will almost certainly want to check for doubling, so we won't know anything for certain for another week.

This is the earliest I've ever tested positive. The first time I got pregnant, the home test didn't go positive until CD36. The second time, a couple of months after that, I didn't test until I was almost 3 weeks past ovulation, and my first beta came back in the low 40s and didn't double.

This is just another kind of limbo. I guess in a way all of pregnancy is. Next week is so busy I'm sure it'll go quickly.

"So, what have you been up to?"

SF and I spent the weekend at my 10-year college reunion. The high points included spending time with close friends we don't see nearly often enough, trying a new dish at my favorite restaurant there, accepting our favorite professor's offer of his office phone for a call to our absent friend in England, and a serendipitous ride in a golf cart.

More difficult moments included the main thing people ask at reunions -- "So, what have you been up to?"

I've talked a lot in this blog, I think, about the difficulty of knowing how much to say and to whom. Ann's current post also touches on the question. As one of my close friends pointed out this weekend, infertility is "like a job" in the amount of time and attention it can consume. So when people who don't need the play-by-play ask how things have been, especially in a somewhat competitive situation like a reunion, I feel like there's a gaping hole in what I'm telling them -- as though their only logical reaction would be "Wait -- that's *all* you do in a week?"

Truth is, they're probably not listening that closely. Maybe I should take Ann's science metaphor in a different direction: those dealing with infertility are like Mad Scientists, working on our secret chemistry projects, projects that we're keeping under wraps for now, waiting for the day when we will unveil them and rule the world! Bwahahahaha!

I don't believe we should always keep infertility secret, that it isn't something we talk about in our culture, but there are times when it's more comfortable to keep your mouth shut, if you can get past worrying what other people think about you. For those times, I'll think of myself as the Mad Scientist, plotting world domination, and I will laugh quietly into my collar.

Bwahahahaha.

1/3 of the way through the wait

Back down a pound from yesterday -- still up 6 pounds since Monday with a great big belly. Not exactly where I want to be right before a class reunion, but whatever. At least it's college and not high school.

Yesterday was an early, busy day at work. I had to be there in time to visit four school grades before 11:00, which meant arriving at work two hours before I usually do. When I got home, we had dinner and SF decided to take a nap. I thought, I'm not really in the mood to sleep, but I'll go curl up and maybe read a little.

Didn't open the book. Also didn't wake up again, except blearily to take medicine, for 11 hours. SF blames the progesterone, especially since now (after 11 hours asleep and 1 hour awake) I could easily go back to bed. So weird ...

The last leviathan

The ovidrel has kicked in, and my belly is huge again. HUGE. And sore. It was sort of funny last time. This time it hurts too much to be funny. My ovaries feel like they're about the size of oranges.

Replaced with pudding

For the first time in months, we don't have any medicine in our house. None on the shelf of the fridge, none on the counter, none in the mail. Instead, we have bowls of butterscotch pudding cooling on the empty shelf in the fridge. It's a nice feeling, for the moment.

So far as I know, yesterday's ultrasound couldn't have been better. I have a 12 mm lining, 8 follicles, and good hormone levels. The doctor cautioned us that even cycles that look great on paper don't always result in pregnancy, but for now I'm going to hold onto the idea that things are looking good. He decided we had the "luxury" of one more day of stims, and the nurse gave us a sample so we didn't have to order (and pay for) another pen. We're to add progesterone suppositories for 12 days starting Monday. I'm not looking forward to that, but I'm game if it might help.

All this has had me thinking about his style of information-giving. Each cycle that we've learned had a problem, we thought was going smoothly. When I was on Femara and ovulated, we thought that was great. Later on, we found out the eggs were probably of poor quality. When I was on Follistim and ovulated, we thought that was great, too, but later found out our numbers weren't so hot -- 4 follicles when the doctor wanted to see 6-8. Last cycle, my numbers were up and we thought that was great, but the hormone levels showed I probably ovulated too early meaning, again, poor quality eggs. This time, we think he's fixed all of those problems, but I can't help but wonder what's out there that our doctor hasn't told us? What is he seeing on the ultrasounds and in the blood work that we don't yet know to look for?

I realize this is not an exact science, and I try to ask questions, but sometimes I don't know the questions to ask.

Day 7 -- G-F and G

Today's Ganirelix shot was easier than yesterday's -- only one location -- but it hurt more afterward, and it left a big red spot the size of a half dollar at the injection site. That's on the list as a normal side effect, and it hasn't "persisted or become bothersome," so I'm not worried. Seem to be getting headaches this cycle, too, but nothing too bad.

Like any obsessive researcher, though, I've been trying to find stories of people's experiences with these two drugs and -- here's the tricky part -- timed intercourse. There are a million sites out there talking about IVF, but we're not there (yet).

I haven't found much, but even if I had, it would have been more to make me feel better than to acquire actual useful information; we won't know what the answer is for us until we get there. Ultrasound tomorrow, then inlaw-diverting, then the 2WW ... I think I can face it this time.

Saturday afternoon's party might be interesting, though, if I can't move any better than I could after the last Ovidrel shot! I blew up like a balloon last time. No better way to make an impression on family-to-be than to arrive bloated and stiff. Woo!

Day 6 -- Gonal-F and Ganirelix

The Gonal-F injection went fine today; Ganirelix took three tries. The first two spots I tried hurt so much I yelled. Third place went in like a charm.

Good ultrasound results yesterday -- six "ladies," as my RE called them, all around 13-14 mm with good symmetry between ovaries (I think it was 2 and 4, but he called it good). We'll see him again on Friday and then trigger Friday or Saturday night. It could be interesting ... my parents, grandparents and in-laws will all be in town this weekend. We may have to send them out to dinner or something on Saturday if we trigger on Friday.

There was a time that would have left me mortified. The thing is, I completely lost my shame filter sometime around the time I lost track of how many transvaginal ultrasounds I've had. So if it comes down to a question of embarrassment about what we're leaving our families to go do or possibly wasting $2000 and another two months because I couldn't stand up for myself in an embarrassing situation ...

Well, let's just say that, for better or for worse, that's not much of a risk at this point.

p.s. Ganirelix sounds like a Star Wars character.

Gonal-F, Days 3, 4 and 5

Days 3 and 4 -- We were at my parents' cottage. Trying to do this in a new place is always a little stressful, but it went okay. I requested a needle change (SF is in charge of the pen prep) on the second shot after one failed attempt. It seems to be that the closer I try to get to the centerline of my abdomen, the more it hurts. So I'm going to try staying a little farther out for the next few.

Day 5 -- this morning. We have an ultrasound appointment in a couple hours to see how things are progressing.

The excitement so far today is that I left the alcohol wipes and gauze at the lake, 2 1/2 hours away. SF suggested something from our well-stocked liquor cabinet, which would probably have worked fine, but I turned up my nose at it, and he ran to the drugstore for supplies.

Yes, I know alcohol is alcohol (except, as SF says, some alcohol is more equal than others), but ...

I guess the feeling comes closest to a superstition. We are given the steps to take. We follow the steps. The drugs work.

We deviate from the steps, the drugs do not work.

The more I think about it, the more it puts me in mind of the structuralism and fairy tales I studied in college:

interdiction --> violation of the interdiction --> bad stuff

Don't venture off the path, or you'll never have a child.

Gonal-F, Day 2

Yesterday's shot did not bruise. It's only a small red dot. I can still see it, which I wouldn't be able to do if it had gone perfectly.

Today I chose a spot about 2 inches southeast of my belly button. The needle stung when it went in, and seemed to hang up with the pain increasing as I pushed.

I pulled it out without having delivered the medicine. A bead of blood welled up. SF replaced the needle, and I moved an inch or so east. No pain, no problem -- and no blood. I can't even tell exactly where the shot actually ended up being. I can only see the misstep, which still has a small bead of blood.

I am not an expert at this

I messed up this morning's shot. The medicine all went in, but I moved my hand so much holding the pen that the needle went "ping!" when I pulled it out of my skin.

That's gonna be a bruise.

Tomorrow is another day

Shots begin again tomorrow. I'm looking forward to them. As I think I've said before (certainly to SF; less certainly here), the shots are actually my favorite time period in this whole messy process.

It feels like you're doing something. Things are growing. The things you're doing are actually helping the eggs along, unlike when you're hoping a maybe-fertilized egg will find the strength to implant. It's different from waiting.

The doctor said today he's adding Ganirelix, a medicine to suppress ovulation until we do the trigger stot, near the end of the course of Gonal-F. It seems I tend toward a premature LH surge. He says that's correctable, and that we're moving forward.

I have hope.

Keep moving forward.

For now, though, I will acquiesce to the cat on my arm and stop typing one-handed and scratch him.

Sigh.

I was in a group of women at work who started talking about their experiences conceiving their kids. They all had an extremely easy time getting pregnant, some multiple times -- several sibling pairs are just over a year apart. One woman said, "I don't know why the doctors tell you it might take a year when it doesn't." Most of the rest agreed. "Yeah, it never does."

I should have held my tongue, but I didn't. All I said was, "It doesn't work that way every time. I've been trying for three years at this point."

It quieted them, but I keep thinking I probably shouldn't have said it. It earned the old "just go on vacation ... relax and it'll happen" advice. Which, sorry to say, I don't believe is true. I regularly "relaxed" the entire first 18 months I was married and, see --

No eggs, no baby. There are a couple of vital ingredients there, and if you aren't putting one of them in the bowl, you don't get cookies.

It's hard to know how much to say when. It's not really my job or my place to correct people's ... goodness, I was about to say misconceptions :) ... about getting pregnant. Is there any value in reminding people of how lucky they are? I don't want to become a figure of pity. Maybe it'll give them just one more reason to appreciate their kids.

Side Projects

Not much to report here ... hence the non-reporting, though I realize I should think of things to talk about even during the endless periods of waiting that come with assisted reproduction. Work has been insanely busy, and home -- Well --

Our main excitement lately has been that S found himself in the chair for a root canal with about 15 minutes' notice yesterday. And as bad as root canals are supposed to be, we've learned they're better than the alternative -- excruciating dental pain.

He said last night, "There's a good chance I may cost more than you this month!"

And that's saying something, but it's worth it. Especially since when you pay because you want a root canal, you know you'll end up with a root canal. I wish I could say the same for the money going to the RE.

Out again

I'm pretty sure this cycle was a bust. A blood test tomorrow will likely prove it. I'm having a hard time even feeling disappointed ... this is what happens, right? You shoot yourself full of drugs and time everything as well as you can and follow directions and take your prenatals and wait thinking this time might be different, only it isn't. I'm beginning to doubt the presence of any eggs at all. I think my ovaries were just blowing bubbles on the ultrasound or something. Stupid feckless organs.

This time is different in one way, though. This time, I'm going to ask the nurse to check with the RE to see if he has any big ideas about how we should move forward *now*, instead of having any surprises sprung on us this month when we're trying to order the injectables and only have a short window of time for appointments.

Live and learn.

How do you know what's normal ...

... when normal isn't normal for you?

I'm having some abdominal pain today, 36 hours after the trigger shot, but I don't know whether that's to be expected with 6-8 eggs bursting out all at once. Called and left a message for the nurse but haven't heard back yet.

Work this morning is supposed to involve crawling around on the floor with a group of preschoolers. Since I can only bend gingerly at the waist, that's going to be ... interesting.

ETA: The nurse called back. Cramping is normal. It may last 2-3 weeks. If it gets bad, I should "cut back on my activity level."

Blargh.

Quick update

The good trend continued at this morning's ultrasound. This time around our doctor is happy with the number, size, and "symmetry" of the follicles. What looked like a systemic problem last time now looks like it might just have been a too-low dosage of the injectables.

Of course, that means we're just right back into the cycle of waiting and hoping... but at least it looks like there may be justification for that hope again.

It's back

I have to admit that I spent the last couple of weeks almost totally convinced that this cycle was going to fail. It was bad enough that twenty-four hours after the ultrasound, the cautiously good news had not sunk in at all.

But today I have caught myself feeling hope several times. It feels kind of battered and bruised, but it is back.

Cautiously optimistic

Today's ultrasound showed six promising follicles and one probable dud.

My RE seemed pleased, and said this cycle looks much better than the last one: "You *can* be nudged."

If I understand him correctly, if the decreased ovarian reserve were severe, we would have seen about the same response as last time despite the higher dose of medicine. Last time, though, SF and I had thought we understood the response was pretty good, and we were completely blindsided by the news that it wasn't. I seem to have developed a wariness about our doctor's optimism -- maybe he's only optimistic because we haven't uncovered the next problem yet.

But if you don't have that kind of optimism, what do you have?

And will it be a little bit easier whatever happens this time, now that I have thought for days straight about worst case scenarios?

Just as an aside ... I think it was the student doctor's first ultrasound of this kind. (ouch!) My RE explained to her what the ovaries and the uterine lining looked like on the screen, and I had the astonishing realization that I knew what we were looking at before she did.

Checking back in ...

I checked out there for a few days ... my period came literally as I was writing the previous post, and the doctor was able to fit us in on Saturday morning at 8 a.m. The ultrasound showed a couple of small follicles, but both small enough not to worry about.

I started injections on Easter -- an auspicious time, as my RE pointed out, to start fertility treatments.

No real stress since then, save for a few minutes of puzzlement when we couldn't tell for certain that I'd got the full shot volume out of the Gonal-F pen. (The button doesn't go in as smoothly or as fully as on the Follistim pen. I haven't noticed bruises this time like last time, though I don't know whether there's a difference between the pens or whether I just got better at giving the shots.)

So ... yeah. No real reason not to post, other than just that I sometimes get tired of thinking about it all the time.

The Power

In college, my roommate and I marvelled at the power we had to control our periods using only the power of our minds. If we wanted them to come, they didn't. If we didn't want them to come, they did. The Power carried us through vacations, formal dances, exams, you name it.

In spite of all of the other madness surrounding infertility treatments, I have not lost The Power. I finished this month's round of birth control on Sunday night, and I really, really, really wanted my "visitor" to arrive as soon as possible so as not to make the ultrasounds conflict with Easter weekend. We're now at Maundy Thursday and she's only phoned to say she'll be here ... sometime soonish ... probably.

I am, of course, completely freaking out about getting the ultrasound scheduled at the proper time. If you ever think trying not to have a baby makes you an expert at period math, just wait until you're trying to have one. If regular period math is like arithmetic, this is like statistics and probability, and it never leaves your head:

"If it starts today, then the ultrasound must be Friday or Saturday, if they even do them the Saturday before Easter, but if it doesn't start until tomorrow, I need to call as soon as possible, because maybe they'd be able to fit me in before the holiday, but what if the blood lab isn't open, and if it starts Saturday I need to get ahold of them that morning because Monday will be the only day possible for an ultrasound, and what if it's one of those ones that starts with spotting and how do I figure out what's day one in that case because if we miss it everything will be messed up and wrong and we will never have a child and it will be even more all my fault than it already is."

Jeez ... maybe I shouldn't be surprised she hasn't shown up. I wouldn't want to visit me, either.

One week later

The absolute, complete, utter, and perhaps naive shock is starting to wear off. Last week's visit to the doctor is still the first thing I think of when I wake up, but it's ceased feeling like a punch to the gut so much as a chest-tightening, "oh ... right" as the memory returns.

I keep finding myself sitting still for too long, living too much inside my head while the dishes pile up in the sink and the laundry remains half done. Our house is still a mess from the drywall, which needs one more day of work to be finished. There's stuff everywhere because we've no place to put it when it can't go where it belongs, and each time I look around I worry about having spent the money on repairs.

We can't bankrupt ourselves to get a baby, but at this point, every option is expensive: IVF, donor eggs, adoption. Among other belt-tightening measures, SF and I have challenged ourselves not to go to any restaurants until May 1, to help both budget and waistlines, but it all feels a little bit like pishin in the ocean.

Pulling it all together

I went to see Ira Glass last weekend, and he talked about how they put stories together on This American Life. It's the same as putting together a sermon, he said: draw your listeners in with an anecdote that leaves them wondering something, give the facts, and then tell what it means -- make some larger point using the story you've told.

I realize I haven't been doing that in these blog posts. It's tough -- when you're still in the middle of the story, you don't know what it means yet. We're still not sure what kind of story we're in, though I for one am hoping for a feelgood romantic comedy, and not Ben Elton's "Maybe Baby." ... Though Hugh Laurie and Adrian Lester can stop by our story anytime they want, I'd rather it didn't end in SF and me, still childless, trying to patch up a broken marriage.

Sometimes,though, you get glimpses of ideas even from the vantage point of the middle. Driving to work today I noticed a larger theme to this past week. Whether we chose it consciously or stumbled on it, I don't know. I mentioned the Great Big Sea and Susan Werner songs. SF and I also went to see "Meet the Robinsons" over the weekend. Besides having me trying to snif back tears ("Stupid *snif* Disney *snif* movie") over the stuff about unwanted kids, it also offered one more piece of advice:

Keep moving forward.

One way or another, that's what we hope to do.

"Let it go, let it go ...

... This is smaller than you know
It's no bigger than a pebble lying on a gravel road
Let it go, let it go
Got to leave it all behind you
Give the sun a chance to find you
Let it go"

--Great Big Sea, "Let it Go"

The doctor's news last week felt like a kick to the stomach. My breath completely left me. I could think questions, but I couldn't make my voice work to ask any of them.

Then I got sick again. I cried and cried Wednesday morning, and my head never cleared up afterwards. It felt like I had a blanket wrapped around it with the ends stuck in my ears. And I had a conference about babies and children to attend for three days starting that afternoon. So I tried as much as possible not to think about it all.

Now, five days and an era later, I still can't quite make my words work to talk about it here. This blog post has been sitting unfinished for days. I was about to say it is going to remain unfinished yet again and post it as it was, but --

-- that's a copout. So ...

Let's start with what I know.

1. This isn't fair. None of it is fair. It isn't fair to me, and it certainly isn't fair to SF.

2. Other people do have it worse. This does not justify feeling guilty for feeling bad about our situation.

3. I still have not learned to handle uncertainty. I can sell most any certain thing to myself: we will have our own child; we will use an unknown egg donor; we will ask a friend or family member to donate; we will adopt; we will remain childless. But I cannot easily hold all those ideas as possibilities in my head. Contrasting the ones we'd prefer with the others hurts.

4. I love a lot of people to whom I am not genetically related. I have no reason to believe a baby should be any different. Thus, the problem is getting past the idea of not passing my genes. Which, let's face it, must not be great or we wouldn't be in this sitch. But -- never seeing what happens when you mix my face and my husband's. No "he has your eyes," or "she has your hair" ... That hurts.

5. I have a husband who, my mother tells me, would eat glass for me. (I told her I hope he doesn't.)

6. I wish our doctor had prepared us more fully for this possibility. He told us at the outset of treatment a year ago, "I don't see you getting to the point where you're trying IVF." Now we're at a point where IVF with my eggs may not even work.

7. Music helps. Great Big Sea's lyrics remind me that I have a choice about how much to let this control how I feel about my life. Here's another, one that looks forward instead of dwelling on the present. Coincidentally, it started to play on my computer just as I typed "Here's another."

And some would say
That time has passed me by
And some would say
That the wells have all run dry
Some would say
That's how its meant to be
So some would say
But I beg to disagree

Cause I know good fortune waits for me somewhere
I will have my portion I will have my share
I'll keep my feet in motion til they carry me there
I will have my portion I will have my share

Cause I do believe
There's a harvest in the field
I do believe
There's truth to be revealed
I do believe
There's treasure to be found
And I do believe
There's enough to go around

I know good fortune waits for me somewhere
I will have my portion I will have my share
I'll keep my feet in motion til they carry me there
I will have my portion I will have my share

Cause somewhere there's a blessing and it bears my name
and soon or late, it's coming to me just the same
Can't wait to see
What's set aside for me
With every new sunrise
I'm gonna keep my eyes wide open

--Susan Werner, "I Will Have My Portion," from her new album The Gospel Truth

8. One way or another, I have to remind myself, the uncertainty will not last. Each month tells us better where we are. And the months will pass.

Back again

Okay, the old SF is more-or-less back again. If JF is brave enough to face this, then I can darn well figure out how to make some money. That's the easy part, after all. I've already got some unexpected optimization contract work lined up.

Well, that sucks

Apparently the reason they wanted to call us in for a meeting was that they were disappointed with the results the last go-around -- not enough eggs produced. On the one hand, I'm a little bit doubtful about this -- my strong impression was that the nurse who took the last ultrasound was not trying to carefully see what all was there, but just wanted to find something that looked promising and take its picture. But on the other hand, this feels like a huge setback. Huge.

My normally cheery outlook seems to be a thing of the past. For the first time, it really feels like failure is an option. It sounds disturbingly like we could spend all our savings (and then some) and have less chance of success than was anticipated two months ago using the nice "affordable" injectables.

JF has been so brave...

Oh yeah, by the way ...

I called the nurse yesterday to request a Follistim prescription for this cycle. She looked at my charts, showed them to the doctor and called me back: she's willing to order the drug, but ... since the last cycle was "what we would call 'less than a perfect cycle,'" the doctor wants to make some changes ... which means an appointment.

Because I'm leaving Wednesday afternoon for a conference lasting the rest of the week, that means tomorrow morning. They fit us in, thank goodness, but here's what has me irked --

Nothing has changed in the past three weeks. At any time since it became clear we had "less than a perfect cycle," someone could have looked at the chart and said, "oh yeah, we should see them before they try to do the next thing we told them to do."

It didn't have to be so last-minute.

Bad as I am ...

... I'm still here. What a week it's been.


Sunday, I dragged SF around his second home & garden show in as many weekends. We picked up a coupon for handyman work that looked like it would be useful for a couple smallish jobs we needed to have done.

Monday, I called the handyman company.

Tuesday, they sent a guy out to work. The two jobs we had were fixing two pieces of exterior trim and one sagging interior drywall ceiling panel. When I moved the bookcase out of the corner so the workman could work, however, I found --

Mold.

Mold on the inside corner corresponding with a rotten piece of exterior trim. We spent an agonizing four hours while we waiting for the handyman to get to the part of the job where he cuts away the interior drywall, so we could see how far the mold problem had spread. He told us a horror story about another house in our neighborhood that they'd "gutted" because the homeowners ignored the mold.

Meanwhile, SF is crushingly busy at work and trying to deal with construction work in the room next to his office while trying to get ready for (a) company and (b) a weekend away.

Finally, it was time to cut the drywall. We learned something: if you spill a glass of water behind a bookcase, move the bookcase and dry the wall. It sucks, but it doesn't suck as much as having drywall done. Turns out the mold came from inside the house -- an isolated incident where the wall must have gotten wet and not dried properly.

All this, of course, made me think I don't deserve a child after all, because the moldy corner was exactly where we'd have put a crib if we had need of a crib. Melodramatic, yes, but that's the way it works.

Yes, I plan for my someday-child to sleep in a moldy corner of the house. I'm surprised the Humane Society doesn't come and take the animals away, because clearly I am not fit to keep a houseplant healthy, let alone a mammal.

Mold, on the other hand ...

The power of a dream

Not much going on this week. We're in the first of three weeks of birth control, passing days until time comes for the shots. I'm not fond of the way the Pill makes me feel; I'm actually looking forward to the injections.

I dreamt Friday night that SF and I were adopting a baby from somewhere in Asia. We were completely unprepared for the adoption; it happened with no preparation and no notice. All of a sudden, we had a child but nothing ready to care for him. I raced around, carrying the baby (who, by the way, could talk) as I tried to gather what we would need to look after him. Despite the somewhat frantic preparations, I woke up calm and happy -- the dream imbued the day with a peaceful contentment I hadn't felt in a long time.

One way or another, things will be all right.

So what happens now?

Another suitcase in another hall ... or another round of birth control and shots. Your pick.

I choose the pills and shots. What that means is that Tuesday I started three more weeks of birth control pills, after which we'll have another ultrasound and start another round of Follistim injections.

I suspect what happened this last time is that we missed the egg. Well, clearly we missed the egg. But I suspect that part of the problem was timing: when they're trying to tell you exactly when to do the deed (erm, "time intercourse"), and the hormone levels tell them you're ovulating without the trigger shot, they don't really have a good way to determine timing. So instead of two tries at their best guess of the right time to fertilize the egg, we got one each of two different "maybes."

How are we? Tired of living life in two-week increments, but resolute about trying again. I keep reminding myself it could be worse: I read an obituary today for a child who was just exactly the age we would have had if the first round of clomid had worked. Our path could be rockier. There's no guarantee it won't be, but we'll take our chances.

In the meantime, I've tried to make Organizer Peter Walsh ... well, if not proud, then at least less horrified. I took two full bags of clothing out of my closet today to give away, including 3 suits I haven't worn in years. Not so much call for suits in small-library children's librarianship. Especially ones that don't fit. I hope they find someone who can use them. And maybe we'll get a little closer to "creating what we want from the space."

Back to the drawing board

Tests were negative, so we start the process over again today.

Naturally...

There was a power outage at the doctor's office, so we get the results tomorrow.

What do you want from your space?

That was the big question Organizer Peter Walsh from TLC's Clean Sweep posed yesterday to an audience of clutterbugs at the Detroit Home & Garden show. I went to the program expecting to hear about how to motivate yourself to clean up your space, but I didn't expect the methods to bring tears to my eyes.

Our house is a wreck right now, between a new job and a week of illness bookended by a weekend away and a weekend of worry. But ... what do I want from the space? That's part of the problem. I don't have the power to put what I want from the space into the space. That doesn't mean I'd logically say it can fill up with clutter if we can't have a baby, but that seems to be the effect.

It's not just our finances stuck in limbo as we try to create the future we want, it's also, in a way, our lives. With each step, we try to move toward the path we want, even though we haven't actually found the trail yet. If we never find this path, which others will we regret giving up or not having followed?

I called the nurse this morning, and she seemed puzzled. Bleeding in early pregnancy isn't uncommon, she said, especially spotting.

It's heavier than spotting, but not as heavy as the heavy period they told me to look for, I told her. Hmm. Puzzling. Any unusual period, she said, and they want to rule out pregnancy before moving on. When she found out it started on Saturday, she moved the blood test up from Thursday to today so I can start birth control in preparation for the next cycle if the test is negative.

"Is the hormone from the trigger shot out of my system?"

"Oh yes."

"Is it late enough to tell for sure?"

"Oh yes. The number will be low if it's positive, because it's still so early, but we'll be able to tell."

So I should have an answer one way or another this afternoon. Either way, it will be fine. A negative is obviously not what we'd hoped for going in. A positive at this point isn't a guarantee of any sort, an unavoidable fact after two miscarriages. But I've never been as good with uncertainty as I am at dealing with the answer when I have it. Positive or negative, we move on.

Not giving up yet...

Based on what JF describes and what I remember of what the doctor told us two weeks ago, I retain hope for this cycle. Of course, all this just makes the waiting more confused.

Guess we'll know a little more after JF calls the doctor today.

Update: JF is going in for a blood test this morning. Should know more by this afternoon.

? ? ? ? ?

Well. Our first cycle of Follistim appears to have failed. 10 days after the trigger shot, I started to spot.

My first thoughts were positive. It was only a tiny amount Thursday night. Women report experiencing implantation spotting resembling what I saw, and it seemed that, at about 8 dpo, implantation was a prime possibility.

I spent Friday in an all-day meeting for work, sneaking out to the ladies' room every chance I got for a "status check." The picture grew more and more dismal. By now, Saturday morning, I have to think that even if there is still a growing group of cells in there, it's not going to have anything left to implant in anyway.

We knew the cycle might not work. I just wish I knew why it failed so ... early. 28 days is usually a minimum for my cycle, and I started to bleed a full week before that. Hormones messed up from the shots? Early early miscarriage? Just one of those things? Another question for which we didn't know we might need an answer.

And I was worried about not being able to come up with things to write about while we waited the final week before we could test.

Ways to take your mind off TTC

SF and I spent the weekend in Toronto, where, as he said below, I actually managed not to obsess about whether or not we caught the egg this time around.

Instead, I was too concerned with how my entire head had become -- indeed, remains -- a snot factory. It's hard to think about anything below the neck when everything above the neck is taking so much energy to run. Bless the hotel worker who brought me a fresh box of Kleenex at 3 a.m. after I'd exhausted the first one blowing my nose for a solid hour (and also the husband who slept through it).

The only fertility-related concern I've had the past few days is to hope that my body doesn't decide it's going to put so much effort into snot production that it can't possibly support an embryo. I realize the physiology there is a little dodgy, but hey, all those parts are connected, right?

Waiting....

This is the part of the process that I'm sure everyone who has done this has gone through -- the waiting. The point when you've done everything you can do, and you won't get any results for another couple of weeks, and in the meantime, there's this huge patch of uncertainty in your future.

JF said our trip this weekend helped get her mind off of the waiting, but I went out a bit on my own to play and hear music, and bumping into various acquaintances, I was asked at least five times what we were planning on doing in August. And the only answer possible was I don't know. One extreme has all our spare money tied up in medication for more attempts. The other extreme has JF in the fifth month of carrying multiples, and not really able to travel. I don't know the odds of either thing happening, exactly.

For now, all I can do is say "I don't know", and pray for a happy medium...

Best-laid plans

Saturday the 24th was my original due date. For months after I lost the pregnancy, I wondered what it would be like to reach the date we'd once anticipated with such joy and have nothing but a normal day planned -- would I be a wreck, a recluse, or happy to be going out for dinner instead of needing an epidural?

The answer turned out to be that I was too busy to care. I had a full day at work Saturday; between that and the current round of fertility shots (not to mention the awesome pirate xBox game we rented), there wasn't time to think about what might have been. I'm too busy right now with what is and what might be, and with becoming a rogue and marrying the Governor's beautiful daughter.

Our doctor is on vacation this week. The nurse did the final ultrasound on Tuesday and explained how to give the trigger shot and when to time our other, erm, related activity. She asked how the shots were going, obviously expecting that I couldn't wait to be done with them. Truthfully, though, I'd take the shots over what's coming -- two weeks of nothing to do but wait for time to pass so we can learn the outcome of this round of treatment.

Then the bloodwork came back, and she called me on my cell phone in the rib joint we hit after the doctors to revise the instructions on when to do the deed. It was, I think, the funniest thing we've encountered in two years of fertility treatments -- nobody calls my cell, so we knew it was probably important, but both of us had barbecue sauce up to our wrists, and the phone was in a zipped compartment of my purse. Hijinks ensued. Ah, the laughs!

Sigh

You would know, my first post and I manage to screw it up and get a double post. Ah, well, at least I can edit the second post to say something different....

The Odds

One thing I find frustrating about this process is that we are surrounded by information, but it is hard to know what any of it means. For instance, it is said that our current treatment has a 20% chance of twins. But how does that information relate to the ultrasound we saw last week, with multiple largish follicles? Does that increase the chance of twins, or (as the doctor said the ultrasound results were normal) is the 20% number normal for ultrasounds that look like that?

It's a frustrating thing for a thoughtful worrier, to not know what to worry about....

Other People

Growing up, I defined my life by what other people did but our family did not. We didn't watch television while doing our homework; that was something other people did. Other people used fabric softener, leased their cars, ate frozen dinners, rode the bus to school, played sports, and generally did a lot of things that looked interesting from afar but were immutably outside of my world. Most of them still are. I backslid a bit on the frozen dinners in grad school, but they will never become food to feed other people.

When, unlike my parents and my brothers, I got through high school and college and grad school without finding a spouse, I began to wonder whether getting married was something other people did. How do you meet someone if not in class or extracurriculars? I had no script in my head.

Eventually, I did meet someone, and some time later I realized I'd met someone and that we had effectively been dating for months -- or was it years? -- without ever actually discussing it. Once we both clued in (me after him ... low slearner...), it was only a matter of time until I found out for sure that getting married wasn't something other people did after all. Looking back, it seems so inevitable. But at the time, my also-now-married roommate and I used to wonder for hours how other people met their husbands.

And now, after three years of marriage and two years of infertility treatments -- five rounds of Clomid, four of Femara, two miscarriages, Metformin and now a round of Follistim injections -- I see myself wondering whether having a baby might be something other people do. I'm not sure whether faith is a prerequisite. But if it is, there might be trouble. At some level, I don't believe my body can do such an illogical, magical thing as to conceive a child and carry it to term.

In some ways, I feel I've become an expert at the attempts we've made until now -- at all of the things that failed to work. I know about Clomid and the chalky anticipation of swallowing those pills and the headaches that followed. I know about Femara and the sight of a fetal sac on the monitor, and I know what it feels like to be taken by the shoulders and told that the shape on the screen will never be a baby. These are things I've learned.

I've also learned that at each stage, I will feel like a rank beginner until we've passed it. Each unfamiliar treatment we try feels new until it's over. I am 4 shots into an approximately 8-shot cycle, and each day begins with my clumsy attempts to remember the doctor's instructions. It feels like mining, like panning for gold, like reaching into the darkness to grasp what might be a jewel, or a tarantula, or nothing at all. Or like sitting by the side of a country road, trying to have faith that someone will surely come, wondering whether we are characters to be mocked or pitied and trying as much as possible not to lose our trousers in public.

As we wait and wish and try each new technology, the process overshadows the goal: we take each step in turn, trying not to spend too much time considering the reason, lest we break ourselves with hoping.