Putting Together a New Plan

I am a planner. I am a teacher, and a special education teacher at that, so I have to walk this fine line between planning (so super important) and flexibility (things don't always go the way you think they will, and sudden death in the classroom is rigidly hanging on to a lesson that doesn't work just because you think it should). There's a big section on "flexibility and responsiveness" on our APPR (performance review) paperwork, and I always speak to it because especially as a special educator, that's the name of the game--adjusting to the needs of your students despite your best laid plans. Several times this year I have thought about how I need to apply (and have) those same attributes to infertility.

After failing my first DE IVF in late June, I went through a variety of emotions. I was shocked at first, then unbearably sad, then angry that this didn't work. Then I put a plan into action. I'm not sure what the stages of grief are exactly, but I sure as hell know that I reject "acceptance" on the list--I don't accept treatment failure, I analyze and look for weaknesses and formulate a new plan that makes failure not an option for next time. I feel hopeless at first, and then have this ridiculous surge of optimism that goes (maybe) a little too far in the other direction because I refuse to be beaten by infertility. I am not ready to be flexible in that regard. I became a machine, gathering information and trying to figure out what I could bring to my consultation that might change SOMETHING, ANYTHING about my plan so that I can hope for success in my FET (Frozen Embryo Transfer).

My consultation with my doctor is today. I have waited two and a half weeks for this appointment. I have been ruminating and plotting and researching all this time. Right after my lovely "you can go off your medications" call, I decided that I was going to advocate for going on the Pill right away, so that I wouldn't lose time and I could do the FET in August if possible. But then, I started worrying. I went back into my notebooks, and saw that it's about 31 days from the start of Lupron to transfer in a FET. My time was dwindling, and what if the lab was closed for a week in August for cleaning? What if when things lined up there were no FETs scheduled? I am not a master of how the lab schedule works, so I decided to email my doctor and see if it was even possible to have a FET in August. Better to know that ahead of time than to spend weeks plotting for it and hoping for it and have more disappointment in the consult. I like my disappointment up front, thankyouverymuch. In addition, I had done some researching on other people's DE IVF protocols. Several other ladies from other states had cycled around the same time as me, and they are (fabulously) pregnant and I am...not. What gives? I wanted to see if there were any glaring things on their protocols that weren't on mine. So that I could present these options to my clinic with some actual evidence, and since these clinics are in different states, I thought a consistency in their protocols would be particularly interesting (and validated) for something to try that had been researched elsewhere and was a common thread across clinics, across states. I was prepared. If you're interested in this protocol discussion, the link to that blog is here.

I love my doctor. I feel like it is the mark of an excellent doctor and clinic when they truly listen to their patients and consider information brought to them even if it's not "how we typically do things." I'm sure that my clinic has gads of research that goes into each of their protocols. I'm sure that their success rates attest to the awesomeness of the protocol. I am just saying that I APPEAR TO BE AN OUTLIER. I need something different. And I don't want to GO somewhere different, I want to bring the difference to the people who have been there for us throughout this whole journey, tweaking and adjusting and improving our odds slightly each time. And I was thrilled that my doctor was open to looking at these changes. Thank you so much, ladies who responded to my call for protocol info! I hope that you will be a part of the changes that will get me over to the pregnancy side of things.

My doctor surprised me, though. He said over the phone that it might not be best to do the FET in August, that we should consider doing a hysteroscopy instead, followed by a FET in September. At first my heart dropped. I NEED TO HAVE ANOTHER ATTEMPT ASAP. The thought of going back to school without another attempt under my belt, without the POSSIBILITY of being pregnant, made me nauseous. Especially since I was out for three days in the last week of school and a number of people knew why. When you work with a lot of teachers, it is nearly impossible to keep totally private your infertility treatments when they require absences at funny times of the year. Luckily (in a way) I have been back at school for what already seems like inordinate amounts of time and will continue this trend through August. So I should run into a lot of these people before September. But regardless, I wanted the chance to still be pregnant, although not publicly, when I came back.

But then I realized, he was saying that doing this, by delaying my FET with the hysteroscopy, he could possibly give us a better chance. That because we've put 18 (holy jeezum EIGHTEEN) embryos into my uterus, and two did something (but not sustainably) and the rest took a trip to Lake Ontario without stopping to say hi, that we just want to make sure that my uterus is free and clear. AGAIN. Especially since these last embryos were beautiful quality and from another source with a clear record of implantation success. I have had just about every test you can have on your uterus. I have had THREE HSGs (forced dye through a balloon in your cervix to fill your uterus and spill out your tubes or tube in my case, this looks for open tubes and uterine shadows that could represent polyps/fibroids hanging out in there), two Saline SonohistoGrams (similar idea, but saline pushed through and the visuals are provided by ultrasound, not scary giant X-Ray machine like HSG), and a hysteroscopy in January 2012. All of which produced normal results. Well, the pathology report from the hysteroscopy showed a miniscule polyp that wasn't visible but the tissue was there in the detritus from the gentle D&C. I also had eyes on the OUTSIDE of my uterus when I had the laparoscopy to remove my ectopic pregnancy and right tube and clean up a little endometriosis (because I would like as many diagnoses as possible, please). It looked lovely--pink, round, healthy. So why do we have to be poking around my uterus again? Don't we know that it's not the culprit? Can't I continue to say to people who think gestational carrier is the answer to everything (thank you, Hollywood) that it's my eggs that are the problem, not my uterus? That my uterus is just fine, thankyouforasking?

Well, no. Which sucked. I do not want there to be something else wrong. I felt a little testy that we were once again going after my anatomy, and that I could be multiple causes of our inability to have bouncing babies crawling all over my own Facebook feed. BUT, they don't necessarily expect to find anything. BUT, it's worth a look just in case there is a Phantom Polyp or Faceless Fibroid that lurked shadowless in both my HSG and SSG this past year, and that's why implantation didn't happen. (No one seems to be clinging, like me, to the thought that DE IVF doesn't have a 100% success rate and maybe I just was unlucky and/or need a tweak to my protocol, not my anatomy.) The good news is, if there's something, then they fix it and we have some kind of answer. And even if there IS nothing, they will do a gentle D&C and freshen up my carpeting in there, making me apparently more receptive to implantation when we do our FET in September. We missed out on this in January, because we did the hysteroscopy and gentle D&C but then didn't do our next fresh cycle until April. Doing the cycle the month after apparently comes with benefits, according to some sources. So, I am letting go of my August FET. I am scheduling this hysteroscopy today in our consult, sometime in August. What's summer without a little outpatient surgery? Last time it was at an ambulatory surgical center, which was absolutely lovely. As lovely as a place can be that sticks IVs in you and intubates your throat, but whatever. I would like to NOT go to the hospital, as the last time I was there was the ectopic debacle and I struggle with returning. I don't even want to deliver in that hospital. The people were great but the circumstances traumatic. This surgery is super un-traumatic. No incisions, they just dilate the crap out of your cervix (thankfully while you are under) and then poke around with a scope, taking cool pictures that I hope I get a copy of. I just can't have enough portraits of my lady parts. Then they do the mild scraping of the lining to redecorate my baby home. And then I recover, and plot for the FET.

I will share the protocol changes after my consult today--I am interested in what my doctor will say about all the information we are bringing. I plan on talking about Medrol, progesterone monitoring/additional support, HCG, SET, and autoimmune response. Oh, and one of my friends mentioned something about getting stung by a bee, which I won't be doing but am dying to know if there is any medical backing to this idea that bee venom will reverse your immune system's response to the presence of embryos. Because that sounds batshit crazy to me, but then again I'm repeating a surgery in hopes it will help get me pregnant with embryos based on eggs that aren't mine and I burn red candles throughout my cycles in hopes of good juju, so I guess I can't really judge on the crazy.

New plan, new protocol, new cycle. Let's hope new results. I would love to be researching morning sickness cures instead of the pros and cons of single embryo transfer or adding a steroid into your protocol. I would love to be looking up labor and delivery tips instead of yet again preparing to have my cervix messed with so that a veritable periscope can be whirled around in there. One of my friends asked if all this dilating will make labor and delivery easier for me, since my cervix has already been manipulated lots. That is a lovely thought but I doubt it--although it would be just fantastic if all this poking and prodding meant that SOMETHING down the line, something that's usually harder for "normal" people, would be easier for me when everything else has been just so HARD. I think that might be a lot to hope for. But, hope is the name of the game. I go in for another surgical procedure in the name of hope. I do a FET at the start of the school year (vomit in my mouth) in the name of hope. Hope's all I've got, people. Hope and perseverance to keep at this until I can join the ranks of the other people who fought and lost and regrouped but ultimately won the battle for the baby.