The End of "If This, Then That" Thinking

Once again, I am trying something new when it comes to my approach. Once again, I am trying to let go of The Plan. (Something I tried and failed to do several cycles ago, see here for my thoughts on how I'd do that in September. Of 2010. Yeah, did a great job of that one.) But I mean it this time, really.

I feel consumed. For all of my planning, my careful research, my calendar filled with appointments for acupuncture, maya massage, regular doctor's appointments, therapy, support groups, etc. -- none of it has worked out particularly well for me. And if anything, I have become a woman obsessed, beyond the bounds of what's truly healthy or helpful. I have told myself that I'm taking control of my infertility, but really I let it completely take over my life. I have been guilty of "if this, then that" thinking.

The problem is that all of the things that I do are for the express purpose of getting me pregnant. I don't do them to relax, or let go, or be in tune with the Universe (without caveat). I do them because they worked for someone else. I do them because I believe that if it worked for someone else it can work for me. Everything, almost everything, that I do in terms of my rituals and routines is something that I heard worked for someone else, and so of course I should incorporate it because then it can work for me. The red candles that must be snuffed and not blown out, the onesies, the welcoming ritual--all suggested by people who have succeeded ahead of me. The elephant's mine (courtesy of the internet, and delving into a little fertility feng shui). How I've used my onesies is mine. How I've developed my welcoming ritual is mine. The acupuncture was recommended by resources, by other infertile friends, and I had seen acupuncturists in the past for migraines. The maya massage was recommended by other infertile friends. Herbs and supplements and particular vitamins have been encouraged by practitioners (not medical) and supported by friends, many of whom have crossed over to success. Yoga was recommended by infertile friends. Support group participation was something I sought but was also recommended by resources.

All of these things can be very helpful to varying degrees. Some of these things I am keeping. But my problem was that I had a snowballing list of things I felt I HAD to do to increase my chances. I wasn't going to acupuncture to relax. I was going to acupuncture because it WAS going to increase my chances. If I went to acupuncture frequently and at key times in my cycle, I would get pregnant. If I went to maya massage, I would prepare my uterus and I would get pregnant. If I took particular vitamins or supplements, then I would get pregnant. If I did all my rituals, then I would get pregnant. And if I took any of them away...I would have a much lower chance of getting pregnant. I wouldn't be doing everything I could to take control of my fertility.

Well, guess what? I can't truly take control of my fertility. It's completely out of my control. I have been using all of these things not as a way to relax and be more grounded and let go of the stress that comes with infertility, but as direct routes to success. And I've been more and more frustrated as each cycle goes by and I have not achieved true success. I feel let down. I feel failed. But I obsessively keep marching through everything because if I drop it, I won't be doing enough. I won't be trying hard enough. I won't be as dedicated to my cause as I could be.

Well, I have realized that that's total bullshit. And I am taking control, in a different way. This upcoming cycle is going to be different. I am going to do only the things that help me to relax. I am not going to do ANYTHING (other than inject myself with a crapload of powerful hormones) with the thought that it will get me pregnant. The only thing that is truly going to get me pregnant is having embryos transferred into my uterus and having them stay. If any of the things I've done could help me get pregnant, well, I'd be pregnant already. And at the moment, I am definitely feeling like it is more stressful to put pressure on myself to do all of these things when I think that they are actually increasing my chances of getting pregnant. Financially it's definitely more stressful. I have spent an obscene amount of money (in excess of a frozen cycle) on all of my alternative treatments--from ingestibles to fertility massage to acupuncture. That is very stressful to me. It has taken me a really long time to come to this realization, and I didn't do it on my own. I am so incredibly lucky to have such a patient, caring, patient, loving, and patient husband. I hit a breaking point after our frozen failed and he inspired me to really examine why I do the things I do. And he forced me to take a long, hard look at what I've become through this process. Because he loves me. He has been so supportive of all of my choices and wacky rituals. Rather, he has been so supportive of me and my need to do all of these things, even as he was thinking (and seeing clearly through the haze of red candle soot when I couldn't) that I couldn't keep this up forever without serious cost. In every sense of cost you can think of.

So, I have decided to make my plan the following. I am not going to do anything other than medical intervention that is done for the purpose of getting me pregnant. I am only going to do additional things that are a) vetted by my doctor or a medical study and b) make me feel relaxed and take me AWAY from fertility. That means these are the only things that are staying:

- Therapy (Best thing I have ever done for myself. Tremendous value for the money.)
- Yoga (I get so relaxed by yoga. But if I don't feel like going, I won't. It is only helpful to me if it is a relaxation aid, not if it is something I SHOULD be doing.)
- Support (But only one support group, not two. And again, if I can use that time better on a given day, I will not feel guilty for not going.)
- Vitamins (Specifically prenatal, fish oil, L-Arginine, CoQ10, Calcium w/Vitamin D, and baby aspirin. Which is technically not a vitamin but it's to help with bloodflow/no clotting and I swallow it. NO MORE HERBS. I tried them twice, they didn't work, they cost money and could be potentially harmful. So for me, no more.)
- Relaxation Massage Only (I can't go to Maya or Acupuncture without it being specifically for fertility. I can't be in either of those appointments without thinking about my uterus or my lining or how my ovaries are progressing. It is not helping me get away from all that, it pulls me right in. And while that is helpful to some, for me I think it is a better use of my money to lower my stress levels and take my mind away from all this. So I am planning on scheduling weekly or biweekly massages in lieu of everything else).
- Circle + Bloom Meditation (This nighttime ritual during cycles seriously results in some of the best sleep ever. It is relaxing and good visualization. It has value for relaxing, I just have to remember that listening to it will not actually get me pregnant.)

That is pretty much everything. I am going to take my newfound time, money, and energy and do something completely unrelated to fertility. I am going to try to teach myself to knit. I am going to play my violin more. I am going to write more (and try to do more writing that's not fertility-based, although I enjoy the blog and am not dropping that). I am going to hang out with friends more. I am going to get my ass off my couch and try actually living my life without having fertility take it over. I am going to enjoy and nurture my marriage. I am going to spend time with my husband that celebrates why we want babies, and not spend all our time fixated on why we can't quite achieve that yet. We are going to take a mini vacation, a honeymoon of sorts, and really foster quality time together.

This is all obviously easier said than done. I literally had the shakes over the idea of not going to acupuncture, but then I had to ask myself why. It was a SHOULD. And in the words of my very wise therapist, I need to stop "shoulding on myself." I need to try something different. The danger is that my new plan cannot become something else that I'm doing specifically to increase my chances of getting pregnant. If I start getting back into my cycle of "if this, then that" thinking it could be so easy to say to myself, "Well, so and so did less and changed their approach for a cycle and that was the cycle where they got pregnant." Because I know people where their last cycle was a "fuck it" cycle and they didn't do as much and BOOM, pregnant. Which is great, but the number one thing I keep forgetting is that I am not those people. Just because it worked for someone else does NOT mean that it will work for me. I keep getting smacked in the face with that particular two-by-four but I keep coming back for more. I need to do what's right for me. (Which means, conversely, that you have to do what's right for you--so if doing acupuncture and taking herbs and going for maya and doing all of these 8 billion things makes you feel better, then I am certainly not going to say that my way is THE way. It's not. It's just My Way.) That's the danger. Everyone has something that works for them and it is impossible not to share it like it is some mystical secret to success. I find myself doing the same thing--offering up options to infertile friends of mine like they are silver bullets. To all of us, myself included: It's great to have options and awareness of everything that is out there that can help fertility (or, more importantly, claims to help infertility), but when we talk to each other and make it sound like this is the thing that will totally seal the deal, we are wrong. It may have worked for someone else, but there is no guarantee that it will work for the next individual. We all need to find our own path. Let me rephrase that. I need to find my own path. As a woman grappling with infertility, I am vulnerable. I am eager for results and will try anything to get them. I am easily relieved of my time and money. I am looking for control in a situation where there is very little. And I am realizing that in seeking control, I lost it. So now I'm trying again, my way, and I'm going to give this a go without all my Shoulds. It's not easy for me, not at all. But it's so necessary. I want to come out the other side knowing that I didn't sacrifice too much for the prize. I may not be able to accomplish that, but I can try. Because I want to, not because I should.

Weirdly Disappointed

I had my hysteroscopy on Friday. It was nice--the outpatient surgery center was much more serene and private than the ER pathway I took at the main hospital to have my traumatic laparoscopy. Odd to call a surgical procedure "nice," but the experience at least was a lot less jarring. I was actually kind of excited to be going in for something where I wasn't in pain or uncomfortable beforehand, where it was purely diagnostic. Unfortunately for me, no drinking and no eating in preparation for the general anesthesia had me waking up to a nasty migraine, complete with hideous nausea. I could drink clear liquids until 8:30 a.m., which I did, but it didn't help the migraine. It did help my IV insertion (best one ever!), but the headache was just relentless.

The nurses were fantastic--they got the anesthesiologist to come over early and give me something that might dull the pain before the heavy narcotics got underway. Who knew that you can really get an IV drip of caffeine? They were out, apparently it's on backorder...so I didn't get to claim that experience (rats!).  Instead, I got an anti-nausea agent that causes drowsiness and definitely took the sharpness out of the migraine, but didn't kill it completely. I did find out that general anesthesia will knock you out and knock a migraine out of your head (at least mine). I rediscovered the awkwardness of going into an OR in nothing but a hospital gown and waking up in recovery wearing fishnet hospital-issue underpants--whose job is it to put those on the unconscious patient? I don't even want to know how that goes. It's mortifying to even try to picture it. At least I remembered to shave my winter-insulated legs.

Now that it's done, I'm glad that I had the hysteroscopy, but I don't really know what I expected from it. I wanted peace of mind. I wanted to make sure that there really is nothing wrong with my uterus. But a not-so-small part of me also wanted for there to be something wrong, not anything tragic or hideous, but something small and fixable that could be the AHA!!! moment in our case. As Bryce put it, our smoking gun. There wasn't one. I can say with confidence that my uterus is beautiful, inside and out. It is perfectly healthy. There is NO REASON why my 10 embryos have abandoned ship, either routes north or south. I will not be needing to rent someone else's uterus anytime soon (not that that was ever a serious thought, although people have offered theirs to me. Nice, if slightly misguided, but totally unnecessary as my uterus is not what's broken).

This lack of a culprit is very disappointing, in a weird way. Yes, I am happy that I am normal. Yes, I am happy that we can proceed with fresh IVF #4 and hopefully put a baby or babies in me in March without any fear that my uterus has reason to reject them. But really? There's nothing I can cling to here? I am not a case of unexplained infertility. Both my husband and I have clear diagnoses. I have PCOS (ovulatory dysfunction, lots of cysts, not a lot of mature eggs). Bryce has male factor infertility (low counts on everything). Together that makes having a baby by candlelight in the boudoir pretty much impossible. But at this point, IVF should be compensating for our shortcomings. At least that's how I feel. I feel like at this point, medical professionals are completely controlling my cycle with drugs--shutting my system down and inducing me to develop a bunch of eggs, which are ovulated by needle aspiration. They then only need to pick out as many seemingly perfect sperm as I have retrievable eggs, which at this point has capped out at 12. Even in a low sample of 1 million, I'm pretty sure they can find 12 normal sperm to inject my eggs with. And they have--our embryos for these last two cycles (third fresh, first frozen) were beautiful. The materials as far as we can tell were beautiful. They just didn't stay in the right place. One went up my tube, and the rest went out to sea. Or Lake Ontario, that's probably more accurate given my geography. And now that we know that my uterus is awesome, we really have no information on why that's happening other than we should definitely NEVER go to Vegas. We do not have lady luck on our side. I feel like maybe I'm being unfair to IVF, as it's not a guarantee of success. You can actually do it over and over again and not end up with a viable pregnancy (case in point). At absolute best, success rates are around 50%. Which means that you also have a 50% chance of failing. And we just keep falling on that side. Even though our embryos are beautiful and my uterus is beautiful and, incidentally, I don't have any weird genetic clotting issues. At least not anything significant--apparently there's one really rare clotting gene that is bad if you have two affected alleles, and I have one affected allele. Which means pretty much nothing. I should take baby aspirin with my cycles, which I have done anyway for the last two. So, I got all my answers...which is to say I am left with no answers at all.

I guess we just go with it. If conditions are good all the way around, eventually we will fall in the positive statistics. Hopefully that happens while we still have the wherewithal to keep tossing that coin. That beautiful, perfect coin that just refuses to land on heads. Maybe one more toss will do it.

Next Steps

After a failed cycle, there are steps I go through in order to cope. First, I am very sad or angry. Usually sad, then angry (although this time it was the other way around). Then I go through a punishing phase. This sounds unhealthy, but I swear it's not. I get so pissed off at all the time wasted doing good things for my body when it clearly did not care to reciprocate. I feel the need to do everything possible that was forbidden before. I drink tons of coffee. I drink tons of wine (or tequila if it's Friday night). I eat crappy food, like french fries and un-organic apples and candy. Tasty, processed, refined sugary candy. I take advil if I get a headache (which I most certainly get thanks to the alcohol and caffeine and sugar) without worrying if it is screwing up my lining. I basically take a week or so and undo everything that I did to make my chances greater, and punish that stubborn body of mine for not cooperating with me on this one simple (not-so-simple) request. Then I can throw myself into my plan for my next cycle and begin the preparation and deprivation and uber-healthy habits all over again, in hopes that it might actually be helpful this time.

This last lost cycle had the benefits of the holiday break falling right after our negative. I could really go to town on the bad-habits front, because EVERYONE is eating crappily and drinking too much and trying to fix it with extra coffee and ibuprofen the next day. I looked like everyone else. I definitely didn't feel like everyone else, though. Emotionally I am feeling just a bit (major understatement) beaten down by this whole process. I am exhausted and feeling just slightly hopeless and sorry for myself. I am wondering why it is that we are just not hitting the baby roulette even though we have substantially upped our odds through technology. When you figure that the average fertile couple has only a 20% chance of conceiving in any given month and with all this medical intervention we had up to a 50% chance, it is a miracle that people get pregnant within a month or two of trying and here I am, 7 IUIs, 3 fresh IVFs, and 1 frozen transfer later with nothing to show for it. But whatever. The pity party is part of the steps. As long as I don't stay in this place of relative darkness, weepiness, and frustration, I can keep moving towards our goal.

With each failed cycle or loss, I need to make a new plan to have something new to look forward to. I need to know what we're doing to fix whatever didn't work and move forward in a productive way. In the past I wallow first, then plan. This time I jumped right into the planning, mid-wallow. I need to get going on our next cycle so that I can get this show on the road--if there's truly no good reason for why we aren't getting (viably) pregnant and it's really just a matter of rolling the dice the right number of times, then I want those dice on the table as soon as possible.

So here is our plan:
1) I want to be ABSOLUTELY SURE that there is nothing wrong with that uterus of mine. I am having a hysteroscopy in January to get eyeballs on the inside of my uterus. I realize that I have had a normal HSG (x-ray with dye that is truly meant for checking if your fallopian tubes are clear but also can show if you have anything weird hanging out in your uterus), and two normal saline sonohistograms (ultrasound with saline that fills up your uterus and can show if you have funky things hanging out in there that could interfere with implantation). I realize that I had a laparascopy that, in addition to removing my sad little ectopic pregnancy and my defunct right tube, showed a beautiful outside to my uterus (minus the small amount of endometriosis that was hanging out on the back of the exterior that has since been removed). But I want ACTUAL EYEBALLS peering into my uterus, making sure that the images from x-ray or ultrasound weren't somehow hiding a culprit. The hysteroscopy is a surgical procedure (surgical because I'm sedated, not because of an incision) where my doctor will dilate my cervix and then use a 4mm scope to visually survey the contents of my empty, empty uterus. If there's anything untoward in there (polyp, fibroid, some other insidious but benign entity) it can then be removed. They are also going to do a light scraping of my lining. Or, as I like to think of it, freshening up my baby room with a new coat of paint. I've got dusty wallpaper in there now and I'd like to get some nice sticky paint up that will encourage a baby to hang out for a while. ("Hey thanks, Mom, all I really wanted was some fresh new digs! Now I'll totally stay until I can come meet you guys face to face!") This theory may not be 100% airtight, but it's worth a try. Even if this hysteroscopy reveals a frustratingly normal uterus glowing with health, then at least we will know before dropping an obscene amount of money and putting my body through the trauma of all the drugs that we truly are just very unlucky.
2) I've had bloodwork done to check that I don't have some weird clotting disorder or genetic flub that could be keeping my embryos from implanting. I've been told before (and now) that most likely an issue like that wouldn't keep me from getting pregnant, it would only keep me from staying pregnant, but I think I'd like to know if that's an issue before I have a chance to be pregnant again anyway. Who wants to find out they have a weird blood issue after they've miscarried a precious and long-awaited pregnancy? Not me. So I want this bloodwork, again even if it's just to confirm that we're again just really, really unlucky.
3) We are having our consultation to get on the books for a March transfer. Why March? Because I want a shot, a chance, at a 2012 baby. If we wait until April we're looking at a January due date. 2012 will come and go for sure without a baby on our Christmas card. We won't even have the tiniest chance. So March, I want March. Unfortunately that means that we're doing our egg retreival and transfer in the one month I don't have a break, but quite frankly I don't care at this point. I have to do what I have to do to succeed at having this family, and if it's not convenient in the school calendar then so be it. I'm sure other people don't schedule their medical treatments around break times. I have passed the point where anything but having this baby with Bryce comes first on my priority list. March it is. And, if we do a similar protocol to the one we did over the summer that resulted in a (ill-fated) pregnancy, my time with the needles will be significantly shorter than it was for the frozen cycle. For the frozen I was shooting up daily for about a month and a half. For the lupron-free protocol that resulted in such pretty embryos, I think I did shots for not even 2 weeks leading up to retrieval and then 2 weeks of the progesterone butt shots after that. Shorter. More productive. Less distruptive. Hopefully more successful.

So there it is, the plan from a purely medical standpoint. I am fully aware that all of our exploratory business could be for nothing, that the hysteroscopy could be normal and the bloodwork could be normal and I could be left with truly no good reason why we haven't been able to seal the baby deal. But it is absolutely worth it to me to make sure, to exhaust all reasonable options, before we go into this fourth fresh IVF cycle and fifth embryo transfer. Even if everything just confirms that we just keep pulling the short stick, at least we'll know there is a long stick in there, hiding somewhere. And we will find it. Hopefully in time to have one of those beautiful Christmas card/birth announcements come out in December 2012.