Wednesday, August 31, 2011

Some Things I Have Learned This Week

  1. I am really, really bad at "taking it easy." I thought I was taking it easy after surgery, I mean I didn't get out of bed until Sunday and even then my big accomplishment was walking at a rate of .5 mph 10 houses down the street and back. It wiped me out. I am now being forced to "take it easy" by staying in bed all week thanks to a followup appointment on Monday where I was basically told to pretend I had the surgery Monday and to stay in bed and stay doped up. I hate it. I feel trapped in my home and my body.
  2. I hate my downstairs. Downstairs has it all--the refrigerator, the bigger TV, the shower, the ability to make myself tea. Except being downstairs yesterday had me walking around (hobbled, hunched over "walking") to get myself tea, and waffles. Not good bed rest. Downstairs means the dog is in my face and wanting to get on the futon. Downstairs means laying on the futon, which is basically a glorified dog bed, an ass-licking station, an allergy nightmare, and not set up for good back support/tv watching/sleeping. Bryce did cover the thing with flannel sheets to mask its disgustingness, but it doesn't work. Downstairs I can see all the rugs that need vacuuming that I physically can't do and I would rather Bryce spend time with me rather than do right now. I can see my gardens that need watering. I can see all the shit that I am supposed to be able to do but can't. And I try too hard to move downstairs. Yesterday I was set up downstairs but after my superfriend came over to visit and saw how much I loathed that setup she set me back up upstairs. Ahhhhh.
  3. I can't concentrate while drugged. Just say NO to drugs! I totally get it. Because while I am thoroughly enjoying the lack of sharp physical pain, and the total numbing of my emotional state of being so that I can concentrate on physical recovery, I feel incredibly stoopid. Not stupid, stoopid. I have difficulty reading. I have difficulty spelling and typing, which is a travesty for me since I pride myself on both those things. Writing this blog is taking me days and I keep deleting it and starting over. I have to do a boatload of school preparation, as I am supposed to be at school right now. I can't concentrate on any of it. The drugs make me sleepy but then I can't concentrate on falling asleep anough to get there. Today was the first day in a while that I actually slept most of the morning and last night I fell asleep quickly. I didn't think sleeping required concentration. I was wrong.
  4. Percoset makes me itchy. Not a biggie, but as the day goes on and there is more narcotic in me, my skin gets itchier and itchier. I look like the people you don't make eye contact with on the subway. It's not a true allergy because there's no rash, but I wish maybe I could skip this annoying side effect.
  5. I am bad at asking for help. I tend to have passive aggressive tendencies. I will do all the work without complaining so that then I can complain later that I had to do all the work. (Sorry Bryce, this is my secret! It's out of the bag! You can thank the percoset for this revelation!) I like to do things all on my own, sometimes to my detriment. I have gotten better at asking for help over time, as I have realized that I can't do it all myself. But I get resentful, sometimes, having to ask for help. Like somehow people should know what I need and magically provide it. Sometimes I think it is common sense. But it is not. I have been hinting and had several people immediately take the hints, friends and family (thank you, said friends and family, you know who you are). I need to feel connected right now. I need phone calls and visits and to feel like I am not an icky representation of loss that needs to be swept under the couch with the other ugly dustbunnies. I need to not feel like an inconvenience to people's otherwise happy lives. When you have suffered a traumatic event, and you are recovering, and that recovery is taking a really long time, it is helpful to receive phone calls and visits and offers of help not just on the day it happens. If six days have gone by and you are still housebound and there are people that you haven't heard from at all since the day of your surgery, you start to feel forgotten. And terribly, terribly lonely. It can be a horrible feeling to feel that you need to remind people that you are still there. I don't think that being busy is a good excuse unless you have been kidnapped and are busy sorting coca leaves in Columbia under gunpoint. A call or even a thoughtful text "I am thinking of you" takes 2 minutes at most. On a side and related note, after a trauma you don't always want to talk only about the traumatic event, there is more to you than that. Maybe you need to talk about a book or a movie or those ridiculous Kardashians instead. This balance in how people relate to you and how you relate to people is by far the most difficult thing about this whole situation. As of right now, at least.
  6. I may never be the same after this. I realized that when you are infertile, things change. So many (SO MANY) people who have gone before me on this journey and have their families now through one path or another have told may become a parent but you never stop being infertile. It is part of who you are. These experiences, these losses and traumas and revelations, they shape you are. You are still the same person, you just don't have the luxury of the carefree anymore. I am not out of this yet and I do not take anything for granted. I appreciate everything. But I also see through the bullshit. Life is not fair. Some things are important, and some things are not. Some people will understand you, and some will not. I feel like I still have a goofy side, a sense of humor that helps me through tough times. I just also feel like a part of me is necrotic. Like I have dark edges that have been burned away and won't grow back. That is part of me too, and while it is not fun and happy-go-lucky, it is something that has to be accepted. Because to not accept my scars is to not accept me. You can't have just the cotton candy parts and call it good.
  7. I have a lot of people to thank who have supported me on this journey. This is an ongoing thanks, it seemed kind of final and eulogy-like when I just typed it but that's not what I mean. There are a lot of people who don't know me that well who have been very supportive. I have a love-hate relationship with facebook. I think that it encourages people to have superficial relationships and feel like an effort has been made when it hasn't, not by human standards. However, facebook has allowed me to share with others for better or worse, and it has allowed me to connect with people I didn't truly know before who are excellent cheerleaders. It has allowed me to connect with people I do know who are going through similar struggles privately. It has given a forum to connect with masses of family and friends quickly and to feel a lot of love. Something as small and quick as a facebook comment or note can really make my day--make me feel loved and thought of and cared about. I also have an email support group that has been tremendously helpful, full of women who have all been or are on this same shitty path. They have been lifesavers when I needed to talk to others who actually know firsthand what this feels like. It has been so helpful to not feel like an anomaly. And my friends and family who have stuck with me through all of this, I thank you. I thank you for sending me elephants and owls in the mail, for calls, for texts when young children made calls impossible. For flowers and cards and visits. For calling me from work to make sure that I'm ok and coming home from work to make me lunch and get me pain pills. For loving me when it is so, so hard and not just when it is easy.

Sunday, August 28, 2011

Coming To Grips With Reality

This week was a blur--a hazy montage of doctor's appointments, pain, phone calls, hospital wards, medications, instructions, and sensations both physical and emotional. I did not have the chance to really stop and realize what everthing truly meant until recently, and even then I am still feeling pretty numb.

I think that part of the problem is that this whole summer was focused on our reproductive endeavors in one way or another, and the way that it went made the summer fly by in a blaze of confusion and uncertainty. The plan for this summer was that I would not teach summer school, I would focus on getting ready for my new positions at two schools in my district while really focusing on getting pregnant as my top priority. July would be all about our IVF cycle, and August would be all about acclimating to our new status--whether that would be the joy and terror of a new pregnancy or figuring out what to do if it failed again. It seemed like an awesome, straightforward plan. It seemed like it would give me plenty of time to deal before school started in September. I was a mastermind of time and scheduling.

Or not.

I had no way of knowing that July would be freaking fantastic--a banner month with the best-news cycle we'd ever had. July was amazing--we had an excellent response, we had beautiful embryos, it was a much calmer and less difficult cycle to deal with emotionally and physically, we had embryos to freeze, we had three to transfer, it was looking really promising. It was hands down our best cycle ever. At the end of July/early August our fears were mostly focused on the chances that we could end up parents of triplets, a scary thought but when you transfer three beautiful embryos, a thought you have to seriously entertain (I don't think anyone can truly be prepared for the reality of triplets in advance).

I had no way of knowing that as awesome as July was, that August would be so hard. Well, hard and beautiful. I had implantation bleeding a few days before my test--light spotting that is the stuff of infertility fairytales--everyone looks for it and hopes it's a sign of pregnancy and not a harbinger of period doom. I felt PMS-y, which was scary but also very encouraging, as most people I know who have gotten pregnant before me on this journey (which at this point feels like everyone) felt that way before their positive test. I was nauseous and nervous but had a strong thread of confidence that we were pregnant. And we were. But barely. August became a month of living day to day. Of enjoying every day that I was still pregnant. Of trying to focus on the miracle of the life struggling inside me rather than the dire statistics telling us that it wasn't likely to last. Of creating playlists and rituals and traditions to support my babyling in its struggle. It was beautiful and exhausting. I had a test every other day or every couple of days, which meant that I could work on school stuff on the days I wasn't receiving a call and on the days I was receiving a call that could potentially end our bubble of fragile bliss, I was good for nothing. Which meant that half the time I really was good for nothing. The weeks in August that were meant for studying up on algebra and earth science and structuring a resource room were spent stalking my phone, reading picture books to my belly, begging for miracles. We honestly were still keeping that miracle alive until Monday when we saw nothing on the ultrasound, and then any possibility that I could get anything done for September went flying out the window.

So I am left dealing with the reality of my situation. That although if I were to pee on a stick today it might still give me a positive thanks to wacky hormones, I am not pregnant anymore. Logically I know that this was a doomed pregnancy that would never have produced our miracle baby. Emotionally I am empty and raw and grieving my chance to harbor a blueberry. I didn't quite get to blueberry size, the emails I had signed up for (and have since unsubscribed from) had the babyling at a poppyseed, then a sesame seed, then a lentil bean. I lost my bean just 3 days shy of graduating to blueberry. I know this is not actually right, because our bean didn't follow the proper growth patterns and was squished in my tube, so I am saved the horrifying vision of a baby-shaped tumor in my tube. It really was a mass of cells, but I prefer to remember it as halfway between lentil and blueberry.

My house is full of remnants of my brief pregnancy--the gallon of milk in the fridge (I wanted to be sure I was getting enough calcium, I was on a self-subscribed glass-a-day to support development); the closet full of progesterone-in-oil (I do not miss the shots but I do miss terribly the reason for continuing them); the supplement box full of my prenatals and baby aspirin and other pills that I can take a break from now that I'm not sustaining a (dysfunctional) life; the stack of picture books that we rotated through and read to our babyling to help it see just how loved it was already (Stellaluna, Verdi, Whoooo Loves You?, Guess How Much I Love You, Moon Child, The Dream of the Little Elephant, I Love You So Much, The Stone Wall Dragon, Goodnight Ocean) are in my guest room along with the child's rocking chair, stuffed elephant, onesies, ceramic elephant, and pregnancy books. Everything is tucked away for next time. And we had a lot of stuff to tuck.

I don't regret the exuberance with which we embraced our tenuous pregnancy, as hard as it makes it to reconcile its violent end. We made a conscious decision to enjoy every day, starting with that low, low 12 and ending with our empty ultrasound that was really the end of our miracle story. And we did it--I said "I'm pregnant" to Bryce with joy in my heart as often as I could. We wrote letters to our baby and felt silly and joyful to sign them "mom" and "dad." I reveled in every bout of nausea because it meant that maybe I would stay pregnant. I don't regret that we chose to be excited while we could, because it did not last. And while it is hard to see my gallon of milk and my food comparison emails that I haven't deleted yet, and especially hard to be aware of my boobs (they seem to be the last to get the memo--they are still very heavy and swollen and pregnant), in a way I love coming across these things. Because everything was so fast and hazy that I could possibly forget that I WAS PREGNANT. I was the miracle for short period of time, and as painful as it is that it's gone, I am so happy that I had that experience. That is my reality now. I cry and I sob and I mourn because I lost something, but the amazing thing is that I had something to lose.   

Friday, August 26, 2011

A Really Bad Movie

Last I wrote, we were due to go back for a fancypants ultrasound on Thursday to confirm ectopic or confirm something abnormal that was hiding in my uterus. Last I wrote, we were still stuck in the awful limbo of uncertainty and things were definitely not looking good. I was still holding out the tiniest amount of hope that this could all be a big mistake and we could still be the miracle story that I so desperately wanted to be. A lot has happened since last I wrote. I could probably write forever on everything that happened, the background, my feelings, etcetera, but I am fairly exhausted and feeling somewhere vascillating between completely numb and a complete hysterical disaster, so I am going to write about what happened since Tuesday the way that it has felt. Like I am watching a bad Lifetime movie where I am playing the part of Valerie Bertinelli playing the part of me, because shit this bizarre and bad can't really happen in real life.

Tuesday we got the call with my HCG beta from Monday. It was 1161. This is a number that would have had me doing cartwheels down the street had I not already seen that my uterus was empty. They were very concerned. A number that high should have yielded something visible and definitive if the pregnancy was in my uterus. The chances that it was elsewhere were much higher now. I was to come in Wednesday for the special ultrasound and we would meet with our doctor immediately after at the clinic. There was a sense of urgency that made me nervous, very very nervous. I was asked if I had any one sided pain or bleeding. I had neither. I felt better.

Tuesday evening I got up from sitting with Bryce and experienced sharp localized pain on my right side. I couldn't ignore it, but I didn't feel that it was severe or anything--I could breathe, talk, I didn't feel like passing out. I waited to call until Wednesday morning, figuring if it got worse I could always call the on call doctor and if it went away, well then it was obviously my brain playing tricks on me because I can't possibly have an ectopic pregnancy. That has been my fear all along. Since starting fertility treatment and learning it's more likely in my new demographic. But it's an irrational fear, because it is so rare, especially with IVF.

Wednesday morning I woke up and still had the pain. I was going to do some work and be productive about the house but quite frankly wasn't feeling up to it and spent most of the morning in bed, reading and watching TV and spending quality time with my phone. I called about the pain and was told that my doctor would definitely be there with us at the special ultrasound. I got up from bed to eat lunch and discovered that I was bleeding vaginally. I started to cry, because this was not good, and it added to the uncertainty. Was I bleeding because there was something abnormal in my uterus that was leaving me now? Or was I bleeding because of the pain I was still experiencing and I was facing the scary chemo drug therapy for an ectopic pregnancy? Either way, bleeding was not a good sign of a miracle.

We went in for the ultrasound and it was impressive--definitely a much higher-tech machine than I'd ever seen, anywhere. I got my first abdominal ultrasound for this pregnancy. It was my last. They saw nothing. Well, they saw my uterus with nothing in it. My doctor walked in as this first part was happening and said, "Hi, how are you guys doing?" and I said "Still empty." Sounds sad when I write it now but it was actually borderline hilarious at the time. They switched to transvaginal ultrasound, which is how they actually do all the follicle monitoring so I am most familiar with that obscene-looking magic wand of interior illumination. It really is like it is in the movies and TV shows. They talk about what they see that is normal, and as soon as they find something abnormal everyone is deathly quiet and the ultrasound tech won't answer any of your questions (like, "Um, what IS that???") with anything other than "that's concerning but I need to talk to my doctor first." This is where it was fabulous that our doctor was there. He explained that that ugly balloon-circle-fluid looking thing we saw was my ectopic pregnancy. Which was why the probing hurt like hell. I was officially entering the nightmare.

We had two options: try the methotrexate (I think I've been spelling it wrong), which would take at least 4 days to wait and see if it worked and then either get another dose or end up going in for emergency surgery, or go for the gusto and have the surgery. I liked that we were given a choice, but it really wasn't one. We had to do the surgery. We weren't willing to wait any more, and I was in pain, and it was apparently fairly sizable already, and the idea of nurses in hazmat suits injecting me with toxins that may or may not take care of the problem sounded horrible to me. Our doctor said that with surgery they could get a better idea of what was going on and also look for other possible issues such as endometriosis, and remove the tube. Because chances were the tube was defective anyway if it was sucking my baby up into it. And if it was defective it was possible that we could have the same problem in the future, so we were all about getting rid of it. I don't need tubes for IVF.

It was about 2:30 at this point and we had gone from being pregnant (my numbers were up to 1350) and uncertain about whether it would be viable or not just a day or two before to being pregnant and knowing without a shadow of a doubt that by the end of the day I would not be pregnant anymore. This is where I think I truly numbed up and decided that this was something happening to someone who looked an awful lot like me but wasn't. Because everything went super fast from here on out. My doctor and the adminstrators at our clinic got all the paperwork together and called the hospital and had us all set for surgery between 8-9 pm. I had eaten that stupid BLT with my tomatoes that I grew myself (proof that I actually can grow something correctly) around 1:00, so it limited where we could go and it made it much more possible that we'd get delayed. How was I supposed to know it would turn into such a whirlwind? The BLT was only one of my ill-timed mistakes. The other was that I had stopped taking my asthma medication the Monday we left for the Boston area last week, when I forgot it one day and our numbers went up. I of course, using all my intensive medical studies and experience as a doctor, chalked this up to Advair=bad for baby developing. By the way, this is totally not true. It was just a fluke but meant that I was going into surgery without my asthma under control. I felt fine but was a ticking time bomb. More on this later.

We got to the hospital at 5:30, got shuffled around due to some admitting issues between the surgery department and the emergency department, and ultimately ended up spending a lot of time in the emergency department, where we really were not supposed to be. They were very nice and rushed us through, but we were unable to avoid three very pregnant women who came in to deliver their babies, not remove them; a woman who was clearly a frequent visitor having a psychotic break; my having to tell the story that yes this was a diagnosed ectopic and yes this was my first pregnancy and yes this is certainly something to be very sorry about. When we got a bed at around 7:30ish it was on the other side of the curtain from a gentleman who had apparently shot his finger with a nail gun and they were in the midst of cauterizing it when we were shown to our gurney. That smelled nice. We had wonderful nurses who did the fastest blood draws and most painless IV insertion I've ever experienced, and who were very sympathetic to the horror of our situation. I finished The Book Thief despite the hubbub around us. Bryce tried to nap, unsuccessfully, but he did manage to remove the outer layer of his hand skin due to obsessive purelling. I had no idea that he was so uncomfortable in hospitals. The things you learn when you have to have surgery to remove your pregnancy.

We did get down to surgery by 10:40 and I was under by 11:00. We sat with pre-anesthesia and Bryce went white as they explained how they would calm me with drugs and then knock me out completely, then stuff a breathing tube down my throat and another tube down to empty my stomach and another tube up my urethra (ahhhh, the catheter). Luckily all tubes would come out while I was still out of it. The nurse anesthetist was very soothing and looked and sounded like the Drug Fairy. It was surreal. The drugs they gave me to "calm" me actually caused me to hallucinate and my knit blanket that was around my knees undulated like a stormy sea and freaked me out but also was weirdly meditative at the same time. I got lots of goodbye kisses from Bryce, especially after he freaked me the fuck out by telling me what a trouper I was and how scared shitless he would be if he were the one going in for surgery. That was nice, because he was genuinely proud of me, but then I was like, "oh shit, I am going under general anesthesia and this IS scary as hell." So lots of kisses and then crying as I realized that the body under the waving serpent sea blanket was pregnant going in and would be truly empty and not quite whole coming out, and that this really was a life-threatening situation and it was happening to ME. Thankfully I was out like a light shortly after that and I didn't have to think about it as though it was me for much longer. The one funny thing was that my doctor told me he caught Bryce in the hall and assured him I was in good hands, and Bryce told him to "Kick some ass in there." So my doctor said "So we're here to kick some ass!" Have I mentioned how much we love our doctor?

I came out of surgery minus my right tube, minus the mass of cells that would have been a baby had it not had a terrible sense of direction, and with the peace of mind of knowing that this was absolutely the right decision because it had already started bleeding and had we waited it would have been a very, very bad situation. They found endometriosis on my uterine ligaments, which was cleaned up. They inspected my left tube and found it physically fine. My uterus is physically fine, which is a relief. In all the bloodwork I did finally find out my bloodtype, which is O negative. Great because it is the universal donor, which is guilt-inducing because I cannot give blood (having donated buckets to my own cause through blood draws, I have learned that my veins are crappy. I did try to donate blood twice during college and was unsuccessful both times due to anemia and crappy veins. Sorry, blood centers. Not happening.) However, this whole negative thing meant that I had to have a Rhogam shot, because of the whole RH negative mother positive-father thing where I will create antibodies that seek to destroy my baby's blood the next time. So even though my baby didn't look like one at all and probably wasn't making its own blood cells, I got the shot anyway as a preventative measure for next time. Which was lucky and I am grateful, but it just seemed like one more thing to add to my oddities.

Oh, and the asthma thing. After they removed my intubation tubes and I was coming out of anesthesia, I had a whopper of an asthma attack due to my idiocy in stopping the Advair because I thought it was having some kind of impact on HCG levels. I had to be nebulized twice and I vaguely remember the sensation of drowning in the gunk in my lungs. I am still chesty and it does not feel good on my incisions or very sore belly to have a deep cough. I wonder if I am so sore because of all the deep coughing so soon after coming out of surgery. I just couldn't believe that I would have such an issue after coming out of such a bizarre surgery to begin with. I was monitored tightly for oxygen and had more adhesive and cords coming from me than I knew what to do with because they were making sure I was oxygenated. I also vaguely remember feeling like I needed to pee in the worst way either before or after the asthma attack. The nurses thought the sensation was because of the catheter, but that I probably had nothing in there, but I was insistent so they gave me a bedpan to lay on (no walking to the bathroom for me, apparently with the heavy narcotics and my breathing that was not a good idea). I can't pee lying down. Or I just didn't have to go. But I did apparently promptly fall asleep on top of the bedpan and snored super loudly, so they took it away.

I woke up at 3:45 and couldn't find my call button. So I said "helloooooo" for about 10 minutes until someone heard me, because I had no voice (thank you, tubes) and no lung capacity to make it louder, and plus I am a generally considerate person and I didn't want to wake anyone up. I did make it to the bathroom but then realized how sore and painful I was, and then I asked for my book. So sad. When Bryce left at 3:00 because he was exhausted and the nurses pretty much forced him to go to bed at home (I was not lucid anyway), he was going to leave my book but the nurses mistakenly told him I wouldn't be able to read it. I would be too loopy and tired and I would read the same page over and over again. There was TV in the room, I would be fine with that. Bryce thought that wasn't the case, but they were adamant and he had to go and so no book for me. I can tell you this--I wanted that damn book in the worst way possible. I am not a TV watcher. And nothing is on at 4 in the morning. And by 4:45 I could totally immerse myself in my book. It was so sad. Another weird thing--there was apparently a severe and dangerous electrical storm at 3 a.m. -- Bryce had to call the nurse to let them know he got home safely it was so bad. Really? All at the same time as everything else?

That pretty much brings us up to now. If you have made it this far I really appreciate your dedication, because this is a really long post. I am recovering and grateful that we have compassionate, talented medical professionals working with us. I am grateful for the family and friends that have flooded us with sympathy, empathy, offers of help, and hugs. I am very high on Percoset all the time because my pain levels are ridiculous even now. I think that this physical trauma is making it difficult to focus on anything but my physical recovery. Although as time passes it is becoming more clear that this was not something that happened to someone else. That it is me that was pregnant and then through a very rare but dangerous situation had to go through surgery to become not-pregnant. It is a lot to take. I have a lot of positives that have come out of this cycle and I will write about those separately. I am grateful for the things we have to look forward to. I am grateful that we are not out of this game. I am especially grateful that I have an amazing husband who is here for me and patient with me as I flit in and out of psychosis and depression and physical agony. He loves me so. But right now I am just kind of sitting in the physical pain and the slow emotional awakening to the fact that I have lost an awful lot in a very short and confusing period of time. I think I liked it better when I thought it was just a bad movie.

Tuesday, August 23, 2011

A Different Kind Of Limbo

Out of everything in this infertility journey, the thing that I hate the most is the waiting. Especially if you are waiting and the chances of the end of your wait revealing something good are pretty slim. We are perpetually stuck in limbo--these last two and a half weeks have been shifting from happy to sad, but always with this in-between uncertainty looming over us. I think I finally feel like I would feel better if there was just an end--either a typical pregnancy for the timeframe or an end to the pregnancy that is mercifully swift and allows us to move on. At some point.

Yesterday's ultrasound did not go well at all. We were all ready to see something, anything--a little dark splotch that was clearly implantation would be ok with me. A yolk sac would be awesome, and a heartbeat out of this world, but we knew better than to hope for that. Just a splotch would be fine. But, after what felt like 10 minutes of searching, my doctor couldn't find a thing except a nice thickened lining in my apparently empty uterus. Because my numbers are climbing, although at an abnormal rate and level, the current theory is that there is something there. It just isn't where it's supposed to be. It is still possible that the development is so far behind that it was too early to see anything with the numbers that we have, but in that case it's likely we are so abnormally behind schedule that viability of this pregnancy is a snowball's chance in hell. We have to go back on Thursday for another ultrasound at the ob/fetal clinic across the hall because they have more sensitive equipment for detecting early pregnancy. Their fancypants machines can apparently detect the splotch more easily, or definitively confirm that there is nothing in my uterus and I am looking at an ectopic. It's even on my script for the appointment there, that this appointment is to diagnose an ectopic. What the hell?

Before I wax pedantic on what ectopic pregnancy means for me, I just have to address a couple of things. First, I think that going to this appointment is going to be a special kind of torture. This is a waiting room that is full of giant pregnant bellies and people with babies. This is a waiting room that rubs in my face the loss that I am inevitably discovering. It's pretty much just a question of which way the loss will go. I think the wait before won't be as bad, since I am still holding tight to that nearly invisible filament of hope that it's a late bloomer and a miracle story and everything will be ok and all these tears are for nothing. It's when we come out, after we've either seen something abnormal in my uterine cavity or nothing in my uterine cavity and I know I am dealing with an ectopic pregnancy, that those bellies will really all be giving me the finger. I would like to think that I could still look at them with hope and the thought that one day, that will be me!, but I don't think that will be possible. It's likely to just make me feel the unfairness of this whole awful situation so much sharper.

Back in the doctor's consultation room, our wonderful RE explained what was likely happening. Everyone was full of "I'm sorrys." I refused to accept that. I kept saying, "It's not over yet..." But as my doctor kept explaining the likelihoods (and in my head I calculated that we are probably looking at 60% ectopic, 39% abnormal gestation, and 1% miracle healthy but slow baby), and he looked so sad as he was explaining this, I lost it a little. "But it's not zero, right? Our chances of just having a late bloomer are not zero, right?" A pause, a sigh. Nope, not zero, but pretty darn close. And...waterworks. My husband swears my doctor had tears in his eyes. We are so lucky to have such a great, talented, and compassionate doctor. So, he continued to explain what was likely going on. There was a disproportionate amount of time spent on ectopic, both by our doctor and by the IVF nurse that came in later to explain Thursday's appointment and what would happen if it confirmed ectopic.

Here is the lowdown on the ectopic scenario. In this scenario, it's possible we have a perfectly viable embryo/almost-fetus that grew and hatched and attached and is developing normally with one huge exception. It picked a crappy location. Our little nugget needs geography lessons. Instead of picking the plush, cozy, and appropriate location of my welcoming uterus, it took a detour and traveled up a tube. Where there is insufficient space for it to grow. Where it will continue to develop until it runs out of space and the tube distends to attempt to accommodate and then ruptures when it can't, causing bleeding and a generally not-good situation for Mom. But, they will treat it well before that rupture occurs. And by treat, I mean I get to have a double shot of low-dose chemo medication, methyltrexate, injected into my hips with that lovely intramuscular needle. The ectopic pregnancy is basically like any tumor--a multiplying mass of cells in the wrong place. It just happens to look like a developing baby. That's the thing that sucks--this could be a perfectly viable pregnancy had it not taken a wrong turn. This is some seriously shitty luck. Oh, and the other thing about the injection is that it means we have to wait three months to try again, because of the poison. And, it means more waiting--after the injections you have another beta (oooh, my 7th potentially) to make sure that the numbers are going down. If they aren't you may have to have another shot and/or surgery to remove the "mass."

The other scenario is that my embryo is super slow because it's abnormal--it's missing stuff. It could be a step behind the blighted ovum (when you have a pregnancy sac but nothing inside it--so the sac was sending out the HCG and making you feel pregnant but there is no developing embryo inside). In this case we don't have a sac yet but we do have the trophoblastic material that sends out the HCG and would become the sac, we just don't have the part that becomes baby. And it just isn't visible as that yet. In that case we can either wait to miscarry naturally or take a pill that will speed things along and hopefully insure a more complete evacuation. Because an incomplete evacuation is bad. Because it's so early and this likely dysfunctional nugget is so tiny, I will probably be spared the D&C.

So there we have it--waiting with bated breath to see which horrible scenario we are facing. I'm not sure which is worse--an abnormal pregnancy in the right place (indicating good implantation but questionable genetics) or a normal pregnancy in the wrong place (indicating a possible tubal factor that didn't show up on previous scans--at the least an absence of the current that normally goes from ovary to uterus, helping the egg go in the right direction and discouraging an embryo from going up the tube). A normal pregnancy in the wrong place would at least mean we don't have a genetic issue. I read somewhere that after 35 you have a 50% miscarriage rate, mostly super early and mostly due to faulty genetics in the embryo. So I don't think I have to worry that we have mutant genes. But it sure does suck bigtime that we are stuck in this place, not knowing again, but definitely in "I'm so sorry" territory. I have the tiniest amount of hope left in me, because I can't give up until it's definitely over. But I am completely beaten down. I sure hope the next two days go by quickly, so at least the waiting for the why can be over. Then it will just be the waiting for the end to come. And then the waiting to be able to start up again, once we have recovered sufficiently in every possible way. And then waiting to see if our next attempt can be our jackpot win. Waiting is nothing short of exhausting.

Sunday, August 21, 2011

I Believe in Miracles

This past two weeks (has it really only been two weeks???) have been incredible. Incredibly stressful, incredibly amazing, and just an incredible rollercoaster of emotions. It has been a test of patience and the ability to keep on going when everything is just varying degrees of uncertainty.

The biggest shakedown to our confidence in this somewhat volatile pregnancy was Monday's test results. We had enjoyed two bloodtests that were super encouraging--after our dismal 12 we doubled to 26 and then tripled to 74, indicating a good growth rate if not stellar numbers for the timeframe. For Monday, which was 5 days after our thrilling 74, we were expecting a number in the realm of 300-400. I was secretly hoping for closer to 600 (thinking if it tripled again it would be 225 on Friday and then around 600ish on Sunday, so that was reasonable). Our call came late despite my getting to the blood lab before 8:00 to get there in time for the early courier. We were already on our way to a business trip that Bryce had to go to in Massachusetts, a business trip that I tagged along on so that I didn't have to give myself the horrid 1.5 inch butt shot of progesterone. If it was bad news, it would be bad news received on the interstate, and no turning back possible. We got the call, and it wasn't bad news--it just wasn't good news. The number had gone up, but to 148. Double, which would have been good if it was 48 or even 72 hours. But it wasn't. It was 120 hours. We were stunned--the numbers were still going up, so we were encouraged by that, but it was a pretty drastic slowdown. All we could think sitting in that silent car zooming down 90 was, "Is this the beginning of the end?" It was terrible. We wanted to celebrate that we were still pregnant but we just had this specter of impending doom shadowing our joy. We decided that it was time to talk to the doctor about what was going on.

I had been procrastinating on the subject of talking to the doctor about this whole low-numbers but still-rising numbers business, because I already have a pretty good idea what the possibilities are for the bad in this situation, but I really only want to focus on the good. No matter how statistically unlikely that is. If I talked to the doctor, then we would have cold hard medical facts thrown our way and we probably wouldn't like what we heard. But, with the slowdown in numbers facing us, I was ready to try to get some medical idea of what was going on. Unfortunately, we connected with our wonderful doctor when I was alone in the hotel room and my husband was at his meeting. It was a good conversation--everyone is rooting for the underdog here, but the reasons for the low numbers were disheartening. It could be an ectopic pregnancy. This one I reject, because I have no symptoms (no spotting at all, no localized sharp pain on one side, no shoulder pain), and the likelihood of ectopic (tubal) pregnancy with IVF is very low. That embryo would have to be super confused to travel up a tube when it is so expertly placed in the uterus during transfer. But ectopic pregnancy is my personal nightmare, my irrational fear. It's life threatening left unchecked and the only turnout is termination of the pregnancy. It basically gets treated like a tumor, because it is (it's a growth in an area that is not appropriate. Left alone, it causes rupture and internal bleeding and possibly death). The other option was an abnormally developing fetus/embryo that is attached, but missing some vital programming. When it gets to the point in development when it needs that programming, it will exit my womb in a devastating miscarriage. The low numbers certainly don't indicate health, but the rises don't indicate an end. The third option is a miracle fetus. One that is at the very bottom end of the bell curve for HCG beta numbers, one that is behind the developmental milestones at the beginning, but one that ultimately ends in a healthy baby. I think our odds of this are only slightly better than an ectopic. Our doctor wanted to give us all of the options, and let us know that we don't have to feel like all hope is lost, we just have to be prepared for the statistical likelihood that this pregnancy won't continue at some point.

That was a lot to take. The best thing that I took from that was that if our numbers went up at all on Friday's beta (my fifth), I would get an ultrasound early next week. Which sounded exciting. We wouldn't expect to see a heartbeat (I'd be only 6 weeks, and while that's possible in a robust early pregnancy, it's highly unlikely with our slowpoke development), and it's possible we wouldn't even see what you would normally see at 6 weeks. But as long as we saw something in the uterus we would be ok. I held on to this information, because I so wanted to make it to an ultrasound. I am holding on tight to the miracle baby theory. We were a little subdued, but we decided to believe that our numbers would go up, and to not forecast a number because we were so wrong the last time and that was disappointing. Maybe if we hadn't been expecting a certain number we could have more confidently celebrated a rise of any kind. So we headed into Friday with a little trepidation but believing in our intuition that this baby is special. This baby is a fighter. This baby is going to make it.

Friday's test came and... 488! Our numbers went up beautifully. We are still low, as at this point most people are well into the thousands, but we are at a much better place. We get our ultrasound this upcoming week! We get to be fully six weeks pregnant. If it was normal, I'd have a lentil bean in there. I have no clue what's actually in there, I just hope that it is viable. There is no guarantee for what we will see on the ultrasound screen, and that scares the bejeezus out of me. We could see the highly unlikely tubal pregnancy. We could see a sac that is empty. Or we could see a little smudge, indicating implantation, and have to wait another week for a re-do and hope we can see something more promising then. In any case, we get to see something. I have faith in this miracle baby--I have faith that there will be SOMETHING visible on that screen. It may not give us total peace of mind--I think it's likely we'll have to repeat it several times before it all looks good. I think there's a bit of catch-up that needs to happen. But I believe that it's possible. I believe in this amazing miracle. Like I told the nurse who called with our results on Friday, this is further than we've ever been. We hold out hope for the best possible outcome, but this pregnancy is nothing short of a miracle. It doesn't make it less difficult that we are being strung along something awful and thrown tiny beautiful crumbs at each test date, but it fills us with such hope and joy to be on this leg of the journey at all.

This is my first ever positive pee stick that I took in the hotel room as a big F you to our crappy news --                                      it's a huge milestone for us, no matter what happens!

Sunday, August 14, 2011

A Playlist for Uncertain Times

While we are stuck here in this limboland of slightly pregnant (so don't get too excited...), I decided I wanted to create a feel-good playlist of songs to serve as a soundtrack for our uncertain times. A playlist to bolster the baby and send good vibes, to let the universe know that I AM NOT GIVING UP on this being pregnant business, to just plain take my mind off things and remind me that no matter what I have a good great thing going with my husband. It's an eclectic mix, for sure. I thought I would share my annotated playlist, in case it would be helpful for anyone else who is going through times that require a little extra musical encouragement.

The Feel-Good Playlist (in no particular order)
- Don't Stop Believin' by Journey (the chorus is the key part... "Don't stop...believin'...hold on to that feeeeeeeling!")
- Today is a Good Day by Anna Ternheim (The song is about a defunct and dysfunctional relationship, but the chorus "Today is a Good Day" makes me feel good)
- All You Need is Love by the Beatles (Without love we wouldn't be in this predicament! Our love will make this happen...)
- Livin' on a Prayer by Bon Jovi ("We gotta hold on to what we got, it doesn't make a difference if we make it or not (well, actually it does but we aren't even considering that possibility), we've got each other and that's a lot...for love--we'll give it a shot! Ohhhh we're halfway there... ohhh-ohhh, livin' on a prayer! Take my hand, we'll make it I swear." So appropriate!)
- Yellow by Coldplay (Just a really pretty love song that makes me happy)
- Clocks by Coldplay (This song always makes me happy even if the lyrics aren't necessarily appropriate to our situation, although I think the tiger waiting to be tamed is this whole infertility business)
- Viva la Vida by Coldplay (Another song that makes me happy and is upbeat, and roughly translates to woohoo, life!)
- Oh by Dave Matthews (Another happy song, a beautiful love song that includes the phrase "I love you oh so well, like a kid loves candy and fresh snow." I choose to ignore the fact that the subject of the song is actually dead.)
- Two Step by Dave Matthews Band (A very happy song, and includes "Celebrate we will, for life is short but sweet for certain." There's my live and celebrate for today philosophy in one of my favorite songs!)
- Inside and Out by Feist (wonderful retro disco song about deep love, could be applied to my love for my husband or the tiny, warrior babyling inside me.)
- Dog Days Are Over by Florence + the Machine (Man, do we hope the dog days are truly over. This is an awesome anthem for finally beating a shitty circumstance. And a genuinely happy song!)
- The Way I Am by Ingrid Michaelson (A lovely love song that is very uplifting.)
- How Sweet It Is (To Be Loved By You) by James Taylor (Super happy love song, and could be applied to both my husband and the tiny baby)
- The Edge of Glory by Lady Gaga (I love this song! And we are on the edge of glory. I don't see full on glory until that baby is out of me and in our arms, but we get closer and closer to the edge each day.)
- If The Stars Were Mine by Melody Gardot (This is such a beautiful, sweet jazz song that is meant for romantic love but could be stretched to mommy love as well--who wouldn't want to make the birds sing only for their baby?)
- Wagon Wheel by Old Crow Medicine Show (I love this bluegrassy love song, and the phrase "rock me Momma like a wagon wheel, rock me Momma any way you feel, heyyyy, Momma rock me" is most definitely inappropriate for a baby but it's Momma, and for the time being so am I!)
- No Bad News by Patty Griffin (This is really cool, because it's played both times I received a call from the clinic, and my iPod is on shuffle so I have no control over what comes up when. The chorus is "Don't bring me bad news, no bad news, I don't need any of your bad news today.")
- Sweet Disposition by the Temper Trap (Another just plain feel-good song, but there's also phrasing in there about not giving up. So he's talking about a girl, but I can apply it to not giving up on this pregnancy.)
- New Soul by Yael Naim (Fun song, happy song, and I've got a new soul multiplying in me. Enough for me!)
- All I Want Is You by Barry Louis Polisar (This is from the Juno soundtrack. A lovely folksy love song, but really All I Want Is... this baby to stay! "All I want is you will you stay with me?" Perfect!)
- Anyone Else But You by the Moldy Peaches (Another Juno soundtrack gem, just a lovely, silly love song.)
- Rings by Leo Kottke (This song does nothing but make me smile every time I hear it. It's our wedding song, and I knew it would be our wedding song from the first time I heard it. Very early in our relationship. Sometimes I am a little creepy. But, it reminds me of the happiest day of my life to date, which is leading us to the new happiest day we will have together.)
- Fighter by Christina Aguilera (This baby is a FIGHTER! And I am a fighter against evil infertility that we have hopefully conquered for this round. This is an anthem for my strength, and an anthem for the babyling's strength. Keep fighting, baby! "Makes me that much stronger, makes me work a little bit harder, makes me that much wiser, so thanks for making me a fighter.")
- I Believe in You by Cat Power (Another song that's really about a dysfunctional relationship, but I love the phrase "I believe in you" because I believe in the little womb warrior!)
- I Feel Lucky by Mary Chapin Carpenter (We are wicked lucky. This song is about being given a dire horoscope outlook for the day and then winning the lottery despite horrible predictions. So even though the stars are stacked against us, we feel lucky, and we will win this freaking lottery! So there.)
- Hold On by Wilson Phillips (Definitely the cheesiest song on the list, but it's telling the baby to "hold on for one more day." I almost didn't add it because I didn't want one more day, I want 35 more weeks. But, in keeping with that "today" philosophy, one more day every day will get us there.)
- You Sexy Thing by Hot Chocolate (Ok, so admittedly it's weird to have your baby referred to as a sexy thing, but the phrase "I believe in miracles...since you came along" makes me so happy. It's my new mantra. I BELIEVE IN MIRACLES!)

So there it is, my feel-good playlist. Feel free to suggest some new songs--this playlist truly makes me happy and boosts me up when I am scared and waiting for a call that could give us more good news or bring everything tumbling down. We refuse to entertain the tumbling down until it happens (which it won't), so this playlist is a soundtrack for our victory!

Thursday, August 11, 2011

A Test of Today

When you have your blood test to detect levels of HCG in your body (known as a beta), there are three things that can happen. You can get a negative, which is 0 at my clinic. You can get a positive, which for many people is at least 50 and as high as several hundred on the first beta. Or you can get a low positive. A low positive, any number under 50, means that you are pregnant but it might not be viable. You could end up with a chemical pregnancy, where your first number is low and then your second number is lower, or nothing--indicating that your pregnancy is ending or has ended. Getting a low positive is an odd little trip to limbo land. It's positive, so you can celebrate the fact that you are pregnant. But it's low and likely not viable, so you have to start coming to grips with the fact that it's most likely temporary and you get the good news that you can get pregnant, but the sad news that at least this time you probably won't stay that way. You do not get a "congratulations" call with a low positive. You get a matter-of-fact "it's positive" but then it ends with "I'm so sorry" because it's likely that the next beta will be disappointing. It can be like a delayed tragedy--with a negative you mourn immediately, but with a low positive you have to wait to mourn and not truly get to enjoy the fact that you are actually pregnant.

We got our call last Saturday. I had Bryce answer the phone, which seemed like a good idea but then quickly got dicey. All I heard was "This is Bryce. Yup, you can talk with me today. Ok. Ok. What does that mean?" I felt like I needed to wrest that phone away and find out what the heck was going on, immediately. I said "What? What is it?" and Bryce put the nurse on hold to say, "remember that situation you said was bad, that wasn't a negative but wasn't good?" Oh, shit. Apparently, we had a positive (hooray!) but that positive HCG number was 12 (crap on a cracker). 12 is bad. I asked the nurse if she had ever seen numbers like 12 survive into a viable pregnancy. The answer wasn't so reassuring--yes, but very rarely. Like 2 or 3 in her time, so I shouldn't get my hopes up. I decided right then that my mission was to be one of the lucky. I decided that my response would be (albeit teary at first), I AM PREGNANT. I may not be pregnant tomorrow, but I am pregnant today and that's never happened before, so I am going to go with that.

This is a test of my new attitude that I've been actively working on throughout this whole cycle. I've been all about celebrating something today, living in the present and not wasting time worrying about tomorrow or next week or 9 months from now. It was hard when it meant trusting in a trigger timeframe that seemed early and ill-advised to me (it wasn't), or getting through the two-week wait with my sanity intact. But now it was going to be really hard. Could I actually be happy in a pregnancy today, knowing full well that the odds were colossally stacked against it continuing? Could I see all the positives in our situation and refuse to acknowledge the negative until faced with it?

I am finding that the answer is...yes. Both Bryce and I decided that we were going to keep up all our rituals and then some. We were going to say "I'm pregnant" as much as possible because who knew how long it would last. We were going to light candles and do our Flying Wish Paper and read picture books to my belly and envision warm orange creation light enveloping the tiny babyling and securing it to my uterus. We were just not going to entertain the possibility that it wouldn't survive.

Our second beta was on Monday. We were wrecks all day, because while we could revel in being pregnant, we were basically sitting on a ticking time bomb of possible bad news. "It's going to be good," I said, over lunch at Pa.nera (in the crazy thought that maybe we'd get the call together). The call didn't come. I went home and lit my red candles and set up the elephant on the coffee table and read my book and then just fell asleep on the couch. At 2:34 my phone rang and my heart just about stopped. And then I got my 12 had bucked up and risen to a 26! It had doubled. That's what I was told was the most important piece by books and support group people...that the numbers go up by doubles at least. Holy guacamole, we were still pregnant! I had to do a retest on Wednesday. But all I could think was, I get to be pregnant for two more days. It was a huge win. I think I made the nurse uncomfortable with my exuberance (26 is still under 50, still low for the timeframe, don't get too excited) but I thanked her for a good news call because I am still pregnant and it doubled and that's amazing. I cried so hard with joy and amazement that our strong belief and faith in our little nugget was bolstering it up. I called Bryce and we just were beside ourselves. We had made it another day!

Now the question was, what would happen on Wednesday? Could I make it through the next two days until Wednesday's call, still celebrating being pregnant today? You betcha. We could say "I'm pregnant" and feel a little less like fakers, like we were barely pregnant. We had doubled. We had a fighter on our hands! Wednesday came and I discovered that the trick to getting an earlier call was to go in for the blood draw before 8:30 when the courier is still there. I wore the same owl shirt and orange underwear that I've worn to every major event in this cycle. (I do wash it in between, and I did buy 4 more pairs of orange underwear so I don't have to do panicked laundry at 10:30 at night like I did Tuesday when I realized my lucky outfit was dirty...) This time the call came at 11:30ish. "Well, the numbers went 74." HOLY SHIT! That's nearly triple! I didn't cry that time though. I was thrilled, but it's a little scarier now. We definitely have a tough little nugget, but now we have more to lose should things go south. I was told once again that the numbers were still low for the timeframe and to be cautiously optimistic. To which I say BLAH BLAH BLAH. If it goes away, it will be a day other than today. And today, I am still pregnant.

I have always wanted to be a miracle story. I have always wanted to beat the odds on this thing, and it has seemed that time and time again we have just fallen on the crap end of the statistics. But this time, I really believe that it's our turn. I believe that we are being given our opportunity, and our attitude will make all the difference. We just refuse to believe that our numbers will go anywhere but up. Do we know all the possibilities for loss? Absolutely. Do we want to entertain them? NO. Whatever will happen is going to happen, and I would far rather spend these amazing first days of being pregnant for the first time in a state of joy and amazement than constant stress and a turbulent sea of "what ifs." I am doing my best to enjoy this miracle each day that I have it, knowing that it might last the whole full-term, 40 week pregnancy and result in a baby, or it may go wrong, early. Our next test is Monday, which is scary because it's 5 days in between and those numbers have to be pretty high by then to keep this momentum going. It's a crapload of uncertainty. I could spend my days in fear, but I choose to believe in the miracle. I choose to revel in the fact that I get to make it to 5 weeks on Saturday. I choose to laugh hysterically when Bryce says, "I love you, mother of my baby!" not because I don't believe it but because I'm just giddy with the reality of it. I am an expectant mother. My baby is the size of a poppyseed, but that poppyseed is our child. And that child is in me. It's just crazy. Crazy wonderful. I have never loved today as much as I do now.

Friday, August 5, 2011

Twin Lust

I am not ashamed to admit it. I openly lust for twins. It is a sticky lust, because twins have their definite benefits but they also have a lot of risks.

The Riskiness of Twins
A twin pregnancy is more of a high-risk pregnancy. Your body is under twice the stress, carrying two precious packages instead of the typical one. You are more prone to complications. Your babies are more likely to be preterm and/or low birthweight. You may have increased monitoring. Your chances of delivering via C-section are much, much higher (although I thought that it was a given with a twin pregnancy, apparently you can still deliver twins vaginally, which frankly sounds terrifying to me). C-sections come with their own risks, including a longer and more painful recovery. There is some evidence to suggest that twins come at a slightly higher risk for developmental disabilities. Apart from the health and wellness risks, twins are more of an adjustment post-delivery for parents--twice the diapers, twice the feedings, no guarantee of in-sync schedules, twice the cost of infant care and upkeep, twice the daycare cost, and the thought of putting two children through college at the same exact time (while we are either approaching or in retirement no less) causes palpitations. There are a lot of things that make twins very, very scary.

The Incredible Positives of Twins
So why, despite all of the risks and financial fears and overwhelmingness of raising two babies at once, do I so desperately long for twins? One of the major reasons is that if we were to be pregnant with twins, and successfully deliver healthy babies, we would be DONE. No more treatments, no more shelling out thousands of dollars for a basic human function, we would have our family all in one shot. It would be a veritable two-for-one sale (I hate to always put this in terms of money, but it's a stark truth of infertility--you are in financial paralysis until your family is complete). I would, once the first trimester passed, never have to take a fertility drug shot ever again. (You have to keep taking the dreaded progesterone butt shot through at least week 10 of pregnancy to keep levels up until the placenta kicks in. The fun just keeps going!) We would have two beautiful babies who would have built-in best friends (for a while, anyway), who would learn the lesson of sharing pretty much from day one. And we would not have to go through infertility treatments with a baby at home. This is something that scares the crap out of me--the idea of going through all of this -- the appointments, the shots, the mood swings, the good-news-bad-news rollercoaster, the psychotic mood swings -- with a baby at home who needs attention and focus. We'd have to split that attention and focus between our firstborn and the process it takes to have a shot at a sibling. I know people who have done it, and who are doing it now, and it causes a tremendous amount of guilt. I know one woman who was playing with her 4-year-old at the breakfast table and asked "What do monkeys eat for breakfast?" "Bananas!" "What do elephants eat for breakfast?" "Peanuts!" "And what do mommies eat for breakfast?" "Medicine!" It was depressing and more than a little heartbreaking. Add into that mix that when you go to the fertility clinic, you need to find someone to watch your child. Understandably, it is preferred that you not bring your young children/babies into the waiting room filled with women who are trying their darndest to have one and not in a stable emotional state. But it adds another layer of complexity to the sibling treatments--who the heck is going to watch your kid while you go for monitoring and hope that you quickly conceive #2 so that you don't take too much away from the precious time you're missing from your firstborn? The worst is stories I've heard of firstborns who ask, "Mommy, can I please have a sister/brother?" What do you answer to that? I'd love to but it takes a lot of work and who knows if it will even be possible the second time around? Maybe that's something I just can't give you? Talk about heartbreak.

The appeal of having twins is overwhelming--yes, they would have to share time with mom and dad from the get-go, but they wouldn't have to share it with needles and progesterone-shot exhaustion and Mom being unable to pick baby up because her ovaries are the size of navel oranges. We actually have a pretty good shot at twins. But that doesn't mean that I will be disappointed if we have one healthy baby in there...far from it. I hope that of the 8 embryos that have been in my body at one point or another in this process, at least one of this batch decides to stay. I would be thrilled, ecstatic with one healthy baby that stayed for the long haul. But if I could get all of our family building done in one fell swoop? That would be amazing.

The two red candles I burn every day (twin candles!), flanking the good luck jade elephant my sister gave to us.

Wednesday, August 3, 2011

You Can Really Only Trust The Blood

The two week wait sucks. It stinks anyway, because you have had a flurry of activity up until the waiting period, where at least every other day you got SOME kind of news. And then...nothing. In IVF, the first week of the wait isn't bad at all because you are still getting some informatioyon throughout that week--you are getting embryo reports, you are having your transfer, you are getting calls from the lab about your remaining embryos if you are lucky enough to have any, you have an estrogen check. It feels like incremental progress is being made and, if you are subscribing to the "celebrate today" philosophy, you actually have new things to celebrate (hopefully).

But the second week of the two-week wait is a long, desertlike stretch. There are no rest stops. There are no road signs telling you how close you are to the end of your journey. You are left in the dark, to contemplate what's going on (hopefully) in your body. Which is not necessarily a good thing. Because you are on progesterone. Yup, that big and scary inch and a half needle that goes darting into your gluteus maximus is full of progesterone, an evil drug that is totally necessary (your body has been messed with so thoroughly that you need supplemental progesterone because your body likely won't produce enough to support an early pregnancy until the placenta takes over), but likes to screw with your head. Because the side effects of progesterone completely and totally mimic all those early pregnancy signs you may have read about in books or while obsessively googling the internet.

2010 embryos. The one on the left is a slightly ugly 8-cell, the right is a 6-cell.
Supposedly, an embryo should hatch and attach within a day or two of getting to the blastocyst stage. At three days after retrieval, ideally an embryo should be 8 celled. At five days, ideally an embryo should be a blastocyst--a cluster of 60 or so cells that are not easily distinguishable from each other but rather look like a circular blob with two parts--the part that will be baby and the part that will be placenta. Our embryos were transferred at the 3-day stage (beautiful, all 8-celled embryos, not like the previous ones that were destined to swim with the fishes), but we also had two go to blast in the dish that got frozen--which was encouraging, because if they made it that far in a dish, surely they made it that far inside of me. And we used assisted hatching, which means that the embryologist made a tiny hole in the "shell" of the embryo (zona pellucida) to help it hatch once it made it to blast. This procedure is usually used on older women or women with egg quality issues. It was used on me because I have had two failed IVF cycles--nothing has ever implanted. So even though I don't have any visible egg issues, something is keeping those little babies from hatching and attaching. My theory is that my crusty PCOS eggs that sit half matured in their follicles don't like to hatch. And without hatching it's off to the septic system they go.

Anyway, since there is a timeline of sorts of when this attaching business will take place, you spend your entire second week of the wait examining your body and any signs that there is life brewing in there. The thing that stinks is that this is my third IVF, so I have two different cycles where I have felt two entirely different things and neither time was I pregnant. Thank you, progesterone. And, on top of that, I know a lot of ladies who have gone before me in this process and made it to the other side, and they share what they felt (or didn't) during their 2-week wait. Every body is amazingly different, but you hear everything from "I felt absolutely no different" to "I felt like I had PMS and was crampy...I was pissed because I was sure I was getting my period" to "I was nauseous starting a few days before the test." There's really nothing meaningful you can take from all that.

And then there's everything you feel during this time:

- extreme fatigue (at least one nap a day, sometimes two)
- sore boobies, boobies that seem bigger, boobies that seem a little veinier than usual
- headaches
- a feeling of nausea/upset if you don't eat at regular intervals
- the constant need to pee

Sound like early pregnancy to you? It's just plain cruel. I have had all of these symptoms before while on the Progesterone In Oil shots, and never have I been even a little bit pregnant. Not once. Last time I even thought I had a heightened sense of smell. I may have, but it was the hormone injected into my ass causing that, not a little nugget. So, this time I am determined to try to ignore it all. I hope, hope, hope that this time anything that I'm feeling is at least one and up to three (yup, that's right, three) embryos burrowing in for a cozy stay. But I know that it could all be a progesterone fake out. There is nothing but the blood test that can truly tell me if I am pregnant or not.

Yup, just the blood. Not even a pee stick is reliable--I know women who have peed on a stick the day before their test or even the morning of and been devastated by a negative only to have the blood taken and find that they were in fact pregnant. That blood test can detect levels of HCG, the pregnancy hormone, way lower than even your most sophisticated pee stick. And this time I am determined not to cave in and pee on one. Every single time I have given in and peed on the stick on the day of my test. It never ends well for me. The first time I had made it all the way to the blood test and was waiting for Bryce to get home so I could check the message that had been waiting on my phone since 1:25 in the afternoon. I caved and peed on a stick while waiting. It was negative. I was crushed but hopeful I would be one of the lucky ones whose stick lies. My stick was a Boy Scout. You would have thought I'd learned my lesson, but last cycle I peed on a stick the morning of the test. I was so sure that I was actually pregnant, all of my progesterone side effects were different and intense and I hadn't started spotting like I had the first time (although, spotting can be "implantation bleeding" and not a harbinger of period doom). I gleefully peed on a stick at 6 in the morning. I waited for that second line to appear. I waited three times the recommended time with tears pricking at my eyelids. I dismissed the negative as stupid internet tests that I'd gotten 20 for $3.99, cheap flimsy strips that I had to dip into a Mickey Mouse dixie cup of urine. But the crack in my positive attitude was there and it only widened throughout the day until, still somewhat sure that it was a mistake and my strip was a big fat liar, I picked up my call from my clinic at school. And was crushed to smithereens when the cheap and obviously faulty strip was telling the truth. So, while for some people peeing on a stick can provide early peace of mind and confirm a pregnancy before the blood test, for me it has been nothing but an exercise in masochism. No pee sticks this time.

I am also not picking up the phone. I am having Bryce be the one to hear the nurse on the other end. I have gotten the call enough times to know that you can tell which direction this call is going to go within 3 seconds. I don't want to try to sleuth out the tone of voice in the "hello" this time. I want someone else to hear "I'm so sorry" or "Congratulations!" and then relay it to me. In the interest of having this cycle continue to be different I think this is the way to go. Bryce is very nervous about it, but I think it's time we switched roles on this one. It is a tremendous burden to get the call. Your heart jumps into your throat the second you see the clinic name flashing on the phone. If I am lucky enough to be next to Bryce when he gets the call, I'll be able to tell which way it went pretty quickly. Unless he has one hell of a poker face, but I really don't think this will be the time for practical jokes. I am really, really jealous of the people who get to pee on sticks and then surprise their husbands with the news in a creative and fun way, instead of waiting with sweaty palms and butterflied guts for a call that could be the best news of our life or yet more disappointment.

It is torture waiting for the blood test and the subsequent call that are the only reliable way to find out if you are carrying the future in your uterus or you are headed down a path to more procedures, more drugs, and definitely immediate plunging into a bottle of some sort. You second guess everything. But this time, I am resolved to be a bit calmer. Even though each day the only thing I have to celebrate that's new is that there's one less day until my test, I really can celebrate my frozens. They will make it possible for us to have another go if we need it as early as the fall. This is the first cycle where, if all the juju deserted us and we are still on that dastardly first leg of this journey, we are for once not left empty-handed. We have two things to show for ourselves--we have frozen embryos for a (much cheaper and less invasive) frozen cycle, and we have proved that we can meld our materials and make some truly beautiful embryos. We are no longer peering down the fork in the road of donor material at this point. We can do it, we just need them to stick. Soon enough, the blood will tell us which way we are headed.

Monday, August 1, 2011

Focusing On Today

Usually, when I am in a cycle, I am a basketcase. I freak out about everything, and I get ahead of myself. That leads to the most freakouts--getting ahead of myself and worrying about what's next. Worrying about what could go wrong instead of celebrating the (even infinitesimal) good things of each day. So, this cycle I decided to approach my attitude a little differently.

It definitely hasn't been easy, because I like to interpret data and extrapolate what it might mean in every, even ridiculous, scenario. And I like to plan. And planning means taking into account what might be happening, what might be in store. But, I was determined to try this new and novel approach of only thinking about today, of celebrating today, of accepting what is happening now as opposed to all of the could-happens. Even though it is in total opposition to my personality. 

It takes a level of trust that is difficult for me. I have to trust that tomorrow will be ok, because today was good (or at least some part of today was good). I have to trust that the people taking care of our reproductive mission know what they're doing. It's not like I think I'm some sort of expert or anything, but thanks to my data-minded self I have a lot of information on all of my cycles, all the way back to the clomid IUIs. I know what my estrogen levels and follicle sizes were for every time they were altered. I even made a chart once of my starting estrogen levels because I noticed they were dropping over time and wanted to see it across all the cycles at the same point. It didn't actually mean anything medically, but again, it gave me a sense of control. I can write all this stuff down (usually pantsless, rushing to get the numbers off the ultrasound screen before it goes to screensaver mode) but really, I can't compare them with any effectiveness. It's helpful because my little notebook can serve as a reference point for some things (how many follicles have I produced on average? What size are they at trigger? What side effects have I had in the past?) but at the same time I don't have the medical knowledge to really make any decisions or understand the decisions being made without having a doctor or practitioner explain it to me. So, I still wrote everything down in my journals, but I had to let go of comparison. I had to let go of the idea that I have some semblance of control over my cycle.

This cycle was so dramatically different that I really didn't have anything meaningful to compare it to--it drove me absolutely crazy. The dosages were different. I started Menopur on the same day as Follistim, which was different. I didn't take Lupron, which was totally different (and lovely). I took Ganarelix instead, and only for a few days. Because of all these changes, my estrogen levels were pretty low throughout my cycle. My follicles were wicked slow coming to maturation, which was very scary for me. It was hard not to think that maybe now I had some other issue butting in on my diagnosis party, some poor responder action showing up for Act Three of IVF. However, because of the change in protocol, I had to trust that everything was going in the right direction. Every day I focused on the fact that my follicles were growing. On my baseline day I celebrated that I had no cysts and my hormone levels were all within normal ranges. On the first day of shots, I celebrated that we were on our first day of shots. We were on our way! Each day after that, I celebrated that my follicles were getting bigger. Even if they only got bigger by a millimeter or so (which sometimes was all the growth I got), it was movement. I hadn't stalled out, I was still in the game. I tried to focus on the fact that there were rises in estrogen and the growth in the follicles instead of how slow everything was moving and how low the estrogen was. And then we got close to trigger, and they told me to trigger and take my last dose of Follistim. But... according to my notebook, the last two IVF cycles only had mature eggs retrieved from my biggest follicles--those measuring 18-22 mm at time of trigger! My estrogen last time was way higher (around 5500) and my follicles measured much bigger. Now, the high estrogen was BAD and not something to hope for. I hyperstimulated last time, required an additional surgical procedure to remove .5 liters of fluid from my abdominal cavity and was on bedrest and out of work for about a week longer than anticipated, all because of that crazy high estrogen. And my eggs weren't even all that stellar in that cycle. So, even though I felt panicky, I had to let go of my comparisons and trust that with follicles topping out at 18mm and estrogen around 1800, that triggering would result in beautiful eggs because the timing and dosages were planned differently. I had to celebrate that I was ready to go for retrieval, even if I felt like maybe it was a disaster in the making. I had to trust in my medical team and this new protocol that I had no comparison for. I had to trust in the quality not quantity approach we were following. I had to be happy about today and not freak the F out about tomorrow. It was really, really hard. I went for my daily stimming wheatgrass shot after my appointment and scheduled an impulse massage--I figured if I was struggling with letting go of tomorrow and I was stressing out about it, I could do something about it. It was the best thing I could have done! I felt so much better afterwards. The next day I celebrated my one day of NO SHOTS in the whole cycle--it's a beautiful day. I didn't freak out about how retrieval was the next day, at least not more than in passing. I always get nervous that I will ovulate early and all those eggs will go flying into the septic system instead of into the dish for fertilization, but I think I did a pretty good job this time of having that fear, acknowledging that fear, and then letting it go. 

All of this attitude adjustment really did wonders for my stress levels during this cycle--I felt really good and balanced throughout the stimming period. It definitely helped that I'm not working this summer--not having the stresses of working in a hot building and the responsibilities that go with teaching summer school has absolutely been helpful. But I really credit this new TODAY philosophy for my saner state of mind. Tomorrow will come and it will either be good, bad, or somewhere in between. But I don't want to taint today's successes with worries about tomorrow's possibilities. And we had a lot of Today Successes. So far, this is the absolute best cycle we've ever had. We had good quality. We had our best fertilization rate. We had beautiful embryos. And we had excellent embryos that made it to blastocyst and were frozen--a tremendous accomplishment! That's something we've never done. This cycle has been so totally different from the others--instead of disappointment after disappointment and bad news after bad news, it's been a good news train the whole way. So now, my mission is to keep focusing on my today and all the success that we've had. And not worry about whether our train will continue on its path towards our ultimate exciting destination or suffer a devastating derailment. Because today was a really good day.