Wednesday, August 28, 2013

Feeling Overwhelmed, Trying to Let Go

August is not my month. This is actually the FIRST August that I have not received bad news in a while, which is encouraging. Of course I wasn't in a cycle this August, so that helps. Trying to squeeze my FET in in August probably wouldn't have been the best idea given my track record (freak ectopic with crazy tube-removing surgery, first awesome positive pregnancy test that August stole with bleeding and plummeting numbers....). I did have that hysteroscopy this August, which turned up some seriously freaky looking hemorrhagic polyps (I have pictures that I decline to post but did text to a "lucky" select few, because one looked like a little alien guy waving or catching a football), but no smoking gun. The polyps were near my cervix, and not near implantation sites, but still would have been problematic come babytime if only for the weird bleeding, so I'm glad they're gone. I am officially rejuvenated in the endometrial area. Sticky and ready for that baby to come in for a landing.

August was also filled with school stuff. I had trainings anywhere from 2-5 days a week and went into my classroom(s) a lot. Especially this week. I figure all this work now will make my September way easier. And take pressure off me since I will start the school year all drugged up and will need to take time off relatively early in the first quarter, which I do not relish. But, such is life. My life. It's less than ideal, but then again I have meticulously planned the timing of all my cycles to be during breaks, or summer, or a time when taking off is not terrible (and I kind of lucked out with the fresh DE IVF which was unplannable, although it didn't work out in the long run). In the name of reducing stress. Well, that hasn't been a winning strategy, so I figure doing all this at the crazy beginning of the year is a nice change--maybe my embryos need to work for it. Maybe they will rise to the occasion. Or it. Not they, as we are doing the single transfer thing. (So not used to the pronouns associated with single embryo transfer!)

Anyway, I've been super busy and full of the Lupron, which has NOT been kind to me. I haven't really noticed the hot flashes so much (probably because I've been in a muggy un-airconditioned classroom that just feels like one long hot flash) but an old enemy has resurfaced that I did NOT miss. Only during the first IVF cycle that we did, when our upstairs was being renovated and we slept on the futon downstairs, have I experienced insomnia with Lupron. Well, welcome back, jerkface. I wake up at 3-something every single night and it takes me at least an hour or so to start to fall back asleep, but then it's just superficial sleep until the alarm goes off. I even took Advil PM last night because I had a migraine and was desperate for good sleep (and I'm in the beginning of Lupron, no lining involved, so it's OK), and I STILL woke up at 3:45. The only difference was I could get back to sleep. That's something, I guess.

Also, I am a complete and total lunatic on this drug. Bryce deserves a freaking medal for dealing with the mercurial freakshow that is me on Lupron this time. Two examples:

      1) Yesterday I had to buy wet food for our cats, because one of them is likely dehydrated (ironically the one who produced such an epic amount of urine last week in our bed, again, at 3:30 a.m.). I had a hell of a time finding a cat food that did not contain meat by-products. Apparently just about every brand of canned cat food contains this creepy food-substance in it. I did not want it. I found a brand that didn't, but it was full of "wheat gluten" which didn't make me happy either, but at least it wasn't beaks or hooves or entrails or whatever the nefarious label "by-products" means. All I could think of was pink slime. So, in relating this frustrating experience to Bryce, he was like, "it's CAT food--if they eat it and think it's yummy, who cares if it has meat by-products in it?" I immediately burst into tears, sobbing, "Our CATS are our CHILDREN--they're the ONLY THING WE HAVE to care for right now!!!" Then did the sob/laugh thing for a little while because I realized how completely ridiculous that sounded. At least I realized it, that proves I'm not totally insane.

       2) Later that same night, I ranted and raved at Bryce for "getting too close to me" in the night. He is a snuggler, which I absolutely love, but lately I feel like I have 6 inches of bed to sleep on because he inches closer and closer and I AM A FURNACE at night and need some space while I sleep. I am lucky that my husband wants to be near me, even unconsciously. However, I was all crazed and mad about it last night, to the point where my harping left Bryce saying, "Fine, I think I'll just sleep downstairs. That will solve this problem." Suddenly I was wailing, clutching onto Bryce like velcro, shrieking "NOOOOOO! You CAN'T sleep downstairs! Please, please, PLEASE don't gooooooooo!" It was clearly a case of "GET AWAY FROM ME! Wait, wait, DON'T GO!" I don't know who hates Lupron more, me or the poor man who has to deal with the demon who temporarily replaces his wife.

So, Lupron has me in its crazypants grip, I am all stressed getting ready for school, and I am quite frankly terrified for this next cycle. School I can get a handle on, and I just need to let go of some things for the sake of sanity. I think you can always go into school for more, there will always be more that you can do, but at some point you have to draw a line. I am trying to draw that line today--I went in for the LAST DAY until Tuesday, which is our opening day for teachers. I am NOT GOING IN AGAIN, as much as the siren call of my classroom will try to lure me in. I seriously don't know what's wrong with me, that the last few days of summer are here and I feel compelled to do more to my classroom/plans/ organizational systems. I am just giddy with the happiness of being all in one building where I have a prayer of filing things in a timely fashion and staying ahead of the game. But NO, I am going to ENJOY THE LAST OF SUMMER even though that doesn't mean a last minute trip to Cape Cod or the Jersey Shore or Maine or even an overnight in Ithaca. Or a place non-western-New-Yorkers are going to think is so wacky -- Skaneatles (pronounced Skinny-atlas, it's a cute town on one of the Finger Lakes.) I am going to try to hide my laptop. I had planned on leaving everything at school so I COULDN'T work on anything, but there's a couple things I can do from home when no one is watching. But I am going to ignore it for the most part and only do it when Bryce is working on a computer project. Heh.

Then there's the sense of terror I have. I really am optimistic about this upcoming cycle. I am optimistic because of the stickiness-enhancing hysteroscopy that cleared out a bunch of aliens from my otherwise welcoming womb. I am optimistic because of the changes in my protocol. And I am optimistic because I am putting just one embryo in. All of these things are exciting changes that hopefully stack the deck in our favor. But I am also afraid, very very afraid. Because when the fresh cycle failed, I had all of this to research and I turned into a madwoman with a cause, trying to figure out what could be done to make the cycle optimal next time. So, I am very hopeful that this one will work and I will be among the DE IVF success stories, that it just took me a little longer to get with the program. However, that evil little voice in the back of my head reminds me that even with all these changes, FET success rates are lower than fresh cycles. I couldn't hit the 65%, what makes me think that I'm going to hit 40% or 35% or whatever statistic is floating around now? I mean, I have good luck with FETs, my one and only uterine pregnancy was from a FET. Freezie-pop babies like me better. My theory on this is that you are not sticking as much crap up your hoo-ha with a FET. I have a personal (and possibly crazy) theory that the patches weren't great for me, and putting all those blue pills and progesterone suppositories up my lady business irritated things and made me less receptive. This time I don't even have to do the dreaded progesterone suppositories, because my dose of PIO is doubled. And the injectable estrogen works better for me than the patches, so I probably won't need to shove tiny blue pills where the sun don't shine, either. So yet another reason to be hopeful.

My fear, that tiny evil voice again, is that if this DOESN'T seal the deal, I have nothing left to research. We will hopefully have robust blasts that will survive the thaw just fine, and so have one more blast to transfer via FET, and if needed, we have those weird little one-day embryos. Which will be an indeterminate number of day 3 embryos, no more blasts. So we have more opportunities, I JUST REALLY DON'T WANT TO HAVE TO TAKE THEM. I will be into the school year when all this goes down, and while I will probably be a wreck if I'm pregnant (happy, but scared to death until we're sure it's staying), I am going to be pretty damn inconsolable if I am left with nothing after pumping my body full of even more drugs and trying something new. I'm not sure how to deal with that.

The good news, is, I don't have to. Nothing is happening yet. I have to go back to my mantra of LET GO. Live for today. Do not freak out about hypotheticals that haven't happened yet and may never happen. Be happy. Well, be as happy as you can be while your body is a hormonal wasteland. Celebrate all the small successes and hope they add up to the ultimate big one. Today I am crazy because Lupron is doing its job, and without Lupron doing its job, I have not a prayer of getting pregnant. So thank you, Lupron, for morphing me into a psychopath so that I may become a wonderful mommy. See? That kind of mental magic is what I'm talking about. Entertain the fear but then let it go, because there is nothing to be afraid of yet. One freaking frustrating heartbreaking step at a time. Don't think about your "About Me" poster that is sadly baby-free, celebrate that it has fun pictures of you and your husband and that you are lucky to have that love in your life. You will just be even luckier when the babies come.

Oh, and here is the picture that I chose for that dreaded back-to-school slideshow--it was a lovely evening on Lake Ontario with my parents--the sunset was gorgeous and it was a fun time. Positive, positive, positive.

Hey FutureBaby, how could you resist coming to join this couple?

Sunday, August 18, 2013

An Article Makes Me Mad Enough to Write A Letter

Oh, GLAMOUR magazine. Usually so forward-thinking in the areas of women's reproductive health and options, you so disappointed me by publishing one of the most infuriating pieces of writing I have come across in a really, really long time.

The piece in question is "Stop That Woman!" by Debora L. Spar, adapted from her new book, Wonder Women: Sex, Power, and the Quest for Perfection, and published in the September 2013 issue of GLAMOUR. Let me share with you the quote(s) that made me so angry:
" has created at least 15 additional ways to have a baby, none of which involves sex."
"I have a friend, a glamourous 42-year-old career woman, who couldn't carry a pregnancy. So she and her husband spent tens of thousands of dollars interviewing surrogacy agencies, surrogates, and doctors to extract her eggs. They made embryos, froze them, and implanted them in strangers' wombs. Nothing worked. Three years in, she's doing IVF again. 'It's so hard,' she told me. 'I just want a baby.'
     Once, she would have adopted. Now we've set the standard that if you can become a biological mom -- by spending exorbitantly and undergoing endless medical procedures -- then you should. Is that liberating? To me, it feels like another way women have to be perfect or, in this case, perfectly fertile."
Can you see why this made my blood boil? I stewed on it for a day, and then just could not shut up about it. My husband said, "Why don't you write them a letter?" So, instead of explaining what I wrote in my letter to Glamour expressing my EXTREME DISAPPOINTMENT in giving a voice to this incredibly insulting view of ART (and adoption, for that matter), here is my letter:
Dear Glamour Magazine,
I am so disappointed in the Motherhood section of the piece by Debora L. Spar, “Stop That Woman!” in the September 2013 issue.  As a woman who is currently pursuing motherhood through donor egg IVF, I found her comments about assisted reproduction both insulting and highly damaging. To say that her friend spent tens of thousands of dollars on IVF and the agencies, “strangers,” and doctors involved in surrogacy, and that this is an example of a woman trying to “have it all,” when “Once, she would have adopted” is completely irresponsible. Whether you decide to pursue parenthood through reproductive technology to treat the disease that is infertility or you decide to pursue parenthood through adoption, it is a CHOICE that women are fortunate enough to have (assuming they can afford either option due to the costs involved). Adoption is NOT easy—it is not the path of least resistance to a family that the author insinuated.  It also typically comes with tens of thousands of dollars in agency fees, attorney fees, lengthy waits, and the possibility of failure.
Both adoption and assisted reproduction are difficult but highly rewarding paths to parenthood, and to put such a negative spin on infertility treatment and make adoption sound like an easier path if you just put aside the desire to be a biological mom “because you can” made me incredibly angry. I have pursued treatment for my infertility because I choose to continue to pursue pregnancy AND a baby. I have looked into adoption and it is not the right choice for me at this time, because I am still treating my medical condition and have hope that a pregnancy and birth are possible. This does not make me someone who has an unreasonable desire to be “perfectly fertile.” This makes me a woman who just wants a family like anyone else, who wants the experience of pregnancy that so many get to experience without a thought, who wants to breastfeed and experience that moment of pumping in a restroom that the author so eloquently described at the beginning of her piece.
Shame on Ms. Spar for providing such a judgmental and biased view of family building for those who have difficulty conceiving. Wanting to be pregnant is not trying to have it all; it is part of the human experience that is grieved tremendously when not possible through sex due to infertility.  I strongly encourage Ms. Spar to go to to educate herself on both the disease of infertility and the realities of adoption.

I am pretty sure that Ms. Spar hasn't experienced infertility herself. There is no way she could have given the complete lack of compassion she showed her "friend." How amazing it must be to pass judgment on those going through an incredibly heartbreaking experience from the side of a woman trying to balance career and family without having to have fought for the piece that people assume is a basic human right--the right to reproduce and create a family unit. No matter how you build your family, there are costs, both financial and emotional. I firmly believe in every woman's right to pursue motherhood HOWEVER SHE SEES FIT and in WHATEVER WAY IS RIGHT FOR HER FAMILY. No one way is easier than the other.
Rant over.

Thursday, August 15, 2013

The Dreaded Back to School Slideshow

The beginning of the school year is creeping up on me. I had my first back-to-school nightmare just a few nights ago (I thought it was the first day for teachers, it was the first day for students and my schedule had changed, I didn't know where to go, I was unprepared, and it was an alternate schedule so the periods were all mixed up and the principal was on the prowl for teachers caught in the hallways during class time...) followed up by a less involved and wackadoodle-y one last night (trying to complete F&P assessments while technology failed my lessons for the whole group and it turned out my fly was down all day). I actually feel pretty prepared for this school year, all things considered. My summer was full of planning and trainings and trying to get organized. I started setting my resource room up yesterday. It feels real. So back-to-school shouldn't be that scary.

Except for one thing: I was supposed to come back in September pregnant.

And, a tradition that I haven't seen since I worked at the high school has resurfaced at my new middle school home: the Opening Day Slideshow.

This is actually a great idea: your administrator asks for photos of you from the summer, and as you come in to sit in the first faculty meeting of the year, you see what everyone's been up to over the summer. It is particularly fabulous if, you know, YOU DID SOMETHING over the summer.

The first and only year I participated in this previously, at the high school, I actually had a good shot. It was my husband and me on top of Cadillac Mountain in Maine. We had hiked up it and were lying on the granite top, with all the Porcupine Islands and the ocean behind us. Pretty cool shot. It almost made up for the fact that SO MANY PICTURES were people with new babies. People with their families. Lots of kids. Some hospital shots. So, since I did not have those, it helped that I had a really cool adventure picture of our fabulous vacation Down East. (Yeah, I don't get either... Bar Harbor is WAY NORTH, but I guess because it's south of the tip of Maine up near Canada and near the easternmost point of the US, Down East it is.) It also helped that I was in my two week wait from my first IVF, and I was full of hope. Those pictures will be ME pretty soon here! I thought to myself.

This was September of 2010. I still don't have those pictures.

So when I got the email today from my assistant principal, looking to bring this tradition to the middle school, I had a little bit of a panic attack. And then I thought, I have to have SOME picture that will represent summer fun with Bryce, even if there's no tiny babyling anywhere to be seen. I went through my camera roll on my phone. Panic crept up again. I didn't have a single picture. Not one. I have the photos from our failed cycle in June. I have more than a couple pictures of me with margaritas and glasses of wine (I don't think when he specified, "Feel free to include friends and family in your photo" he also meant, "and proof of your alcohol consumption habits"). I have a zillion garden photos without any people in them, a lot of tasty dinners, and some videos of my cat being crazy. None of these are particularly exciting, when you consider that there will be family trips galore, new babies, vacations to exotic locales, weddings, etc. running on the slide show. It made me sad, because the photos show that we DIDN'T REALLY DO ANYTHING this summer.

And the sad thing is, in theory, we could have. I had notice of my failed cycle before July even started. Our new cycle isn't until the fall, during the school year. So, why didn't we do anything? Why didn't we throw caution to the wind and book a fun vacation somewhere? (You already know why I didn't go to the Adirondacks with my extended family...)

Because infertility managed to seep into my summer and steal it away, even though I wasn't really in a cycle during any point of it.

Because I was hoping to do my FET in August, so that I had a shot of surviving the pregnancy announcements that inevitably come in the first faculty meeting intact, because I carried a wonderful secret inside me.

Because FETS and cryopreservation cost money, and we had to be ready to drop that money at a moment's notice, right after dropping an obscene amount on the DE IVF cycle. So booking a vacation seemed a little unwise, financially.

Because even though we probably could have swung a vacation, we would kick ourselves if we then didn't have the money to do a cycle immediately, or swing another FET if the first one doesn't work out (which we desperately hope is NOT the case). Plus we are also saving for maternity leave, because while my district has an awesome policy that allows you to keep your job for a year and a job for two, ONLY SIX WEEKS OF THAT TIME IS PAID. Maternity leave in the United States is ridiculous. (If you want to get really angry, look up maternity leave benefits in other developed countries...) I hear babies are expensive, even after you spend a small fortune trying to make one possible.

Because we had follow-up appointments in July, and now I have surgery tomorrow. Granted, not one with a ridiculous recovery time or anything, but it still puts a bit of a cramp in your style.

So, while in retrospect we might have swung a vacation sometime in early July, we had no way to plan for it with everything else going on.

Since I doubt very much "pictures with family and friends" would include a transfer-day shot with our medical team and Mr. Wand to my right, it means that I have to figure something out in the next two weeks. I have to go on a trip with Bryce, even a day trip, where we can produce a fun-loving picture of the two of us, enjoying life without children (heavy sarcasm), making people jealous who have sticky ice-cream-coated toddler photos up on the screen. Ok, maybe not making other people jealous, but at least making me feel like my photo isn't so sad and lonely. "Look! We ate dinner in our backyard! And no one was with us to take our picture, so that's Bryce's arm blocking out half my face! What an exciting summer we have had!"

I wish this summer was different. I wish we had either managed to get pregnant, or had the opportunity to go away and climb a mountain or hike a rocky beach. Instead, we spent the summer reeling from an incredibly disappointing loss (the loss of the hope for positive, not a loss of a baby...but a loss nonetheless). We spent it researching what to do next and how to move towards our next steps. We spent it trying to do our best to set us up for a positive result next time. It was three parts grieving/recovery and two parts preparing for next time. It was no parts pure R&R. We snuck some in here and there, in our Secret Garden, but it was no week-long vacation in Acadia National Park. Summer is not over yet--there is still time to do something interesting, to have some proof that the summer wasn't all sucked up by infertility and school trainings/activity. Having a fun, fabulous photo in that sea of life moving forward up on the screen will go a long way towards me not losing it on the first day of school. (Did I mention I will be on Lupron during this time? Yeah, this is going to be tough.)

Some photos I will not be sending in:

A very silly photo of me all "glammed up"
with a glass of nice white wine, trying to
reenact a truly glamorous shot of a friend.
She was not wearing sweatpants.

A decidedly less glamorous but much more "me" photo
at our favorite Mexican restaurant.
I am demonstrating how my margarita matches my shirt,
and how my face can rearrange itself in new and interesting ways.

Tuesday, August 13, 2013

SET and Thawing Questions: A Followup

To follow up on my last post on Single Embryo Transfer, I had a conversation with my clinic yesterday about my plan -- the changes, ordering medications, scheduling, etc. Everything seemed to be going well, until I received a quick call back right after hanging up.

"It says here in your plan you only want to transfer one?"

"Yup. We are electing for single embryo transfer for this FET."

"Hmmm." (Immediately feel like everyone there thinks we are ill advised to do things this way given our history of crap implantation and limited success. Immediately feel a little second-guessed.)
"So, do you want to thaw one, transfer one, or thaw two and transfer one?"

HUH? Why on earth would I want to thaw BOTH my precious blastocysts and only transfer one? Once they are thawed it's not like you can stick them back in the freezer. I felt badly, but I think I said more aggressively than I intended, "Why would we EVER thaw two and transfer ONE?"

"Well, in case one doesn't make it." (We have been told that the thaw success rate is really really high at our clinic, and in doing 2 frozen transfers with 5 embryos all 5 of them thawed just fine, minus one still viable but ugly blast that was thrown in on the triad transfer. So why all of a sudden is it seeming like we are doing the riskiest thing ever?)

"Ok, well what if you thaw one and it isn't viable, can you thaw the second one on the same day, separately?"

"Yes, we can do that. So you want to thaw one, transfer one, but thaw the second if the first isn't viable."

"Yes. Only if the first one ISN'T VIABLE do I want the second one thawed."

HOLY CHRISTMAS. Am I being sensitive here? Does it seem like the most logical choice was the one I brought up, NOT having a sacrificial blastocyst (or, in my highly paranoid mind, a push to have us do a double embryo transfer anyway because what sane person would say, "oh, they both thawed great? Well, let's just put one in. Sorry little precious blast, not your time to get a shot at implantation." WHO WOULD EVER DO THAT???). I left the conversation a little unsettled. I feel like while they will do the SET, my clinic is not really on board with the whole thing but are humoring our crazy. I tried to explain, "We are looking to have two chances with these two blastocysts. We don't have a lot of chances left." I think that made it a little clearer, but wow.

I felt like we are asking for something incredibly risky, like saying, "Yeah, I need to run a marathon right after transfer, so uh, that's ok, right?" It makes me uneasy. I was very clear about our wishes and if needed I can bring printouts of my research to back our decision up, but I kind of feel like I SHOULDN'T HAVE TO. I shouldn't have to justify a decision that is all over the literature as a good choice, a viable choice. I am now worried about thawing--what if they don't thaw right? What if now is the time when the freeze and thaw process fails us? This is a chance we take regardless, but now it seems amplified since our goal is JUST ONE. I know "what-if-ing" is not a productive train of thought, but I can't help it in this case. I was kind of hoping for more of a positive response for our SET, more of a "look how responsible you are, taking a (very measured) risk to set yourself up for the healthiest pregnancy, birth, and baby possible!" instead of a "if that's really what you want, ok." Even a clinic that I know has transferred anywhere between FOUR and EIGHT embryos at a time has been giving SET its due when people ask how many to transfer or express no desire for twins or have health concerns that make SET the only viable choice. I have many friends who were successful with SET, either because they chose one embryo or because one embryo was the only choice they had as the outcome of their cycles. I feel like choosing this shouldn't make me feel like I'm making a strange choice.

Maybe some of my angst is projecting my own fears onto the nurses and doctors. But it's not all of it. I do worry. What if they don't thaw? What if we have nothing? What if one embryo isn't a good idea for me based on my implantation history? What if? What if? What if? Why do we "only" have two blasts from our fresh donor egg IVF? Why out of 15 embryos left to culture to day 5 did only 4 of them make it to blast? We have those 6 Day One embryos and I don't want to discount them, but they scare the pants off me. How many viable embryos will we actually get from them? Will we end up needing to use those? And then, the scariest question of all, WHAT HAPPENS IF WE USE THEM ALL TO NO AVAIL???

I can't focus on these questions, I want to pour all my energies into this one beautiful blastocyst that will hopefully make me a momma. They are seeping in, though, the fears and the anxieties that infertility has given me. I have a really hard time not catastrophizing. (Is that even a word?) I have a really hard time not worrying about things that haven't happened yet, and I am trying really hard to just let go. To not worry about my clinic's apparent dubious support of our SET choice, because that is their problem and not mine. To not worry about the Embryos of Christmas Future, because their time in the sun isn't here yet. To not worry about what our next steps might be if this all fails, because it could very well succeed on this next try. I want to put all my hopes and energies and dreams into this frozen single embryo transfer, without worrying and fearing the result if things go south. I want to believe that this is it, this is the final countdown. But I am so scarred and damaged by all the NOs that it is hard for me to fully believe in a YES. And now that we've changed so much, I want to feel that that YES is even more possible, so I am not all that excited that now I am worried about thawing and any possible mix ups there may be about thawing JUST ONE. And I am worried that my team thinks we are making a mistake. Things that I didn't really have to worry about until yesterday. Argh.

Do you worry about thawing? Do you feel that your team has questioned your decisions? Am I being sensitive?

Sunday, August 11, 2013

Single Embryo Transfer

I am in that limbo right now, that squishy space between making a new plan and actually having that plan in my hands, ready to go. I had my consult with my doctor and was very, very pleased with how we left things. There are changes, changes that are a direct result of my advocating for myself and having a wonderful husband who is a strong advocate and can put on his "business voice" to get down to the meat of why certain things are the way they are. I researched like a fiend prior to this appointment. I gathered information from other people, people who were successful where I was not. And here are the results:

- a hysteroscopy/gentle D&C to rejuvenate my endometrium prior to the next cycle
- Medrol, a steroid that allegedly can address the uterus's possible rejection of embryos as foreign objects, for four days before transfer
- more progesterone support
- the decision to move forward with Single Embryo Transfer (SET) for our two remaining frozen blastocysts

The hysteroscopy was not my idea, but I had asked about the endometrial scratch biopsy, which they weren't down with but this basically has the same purpose and puts eyeballs on my naughty uterus, which for nothing else than peace of mind has its benefits. This is happening this Friday, and unfortunately for me is happening in the afternoon. No food after midnight makes Jess a cranky, cranky girl more prone to migraine, and waiting until afternoon for the procedure is not going to be fun. My plan: eat a big meal at 11, stay up until 2 am (easier said than done), and try to sleep in most of the morning, waking up to hydrate up until 4 hours before the time for surgery so that they can slip that IV right in. IV insertion gives me nightmares as I've had times when it took 4 tries, which is unpleasant to say the least.

Medrol was totally my idea and supported by other ladies' protocols from different highly respected clinics. I am afraid that my uterus is going OUT OUT DAMN EMBRYO and washing it all away. Maybe this will keep that from happening. The weird thing is that my clinic does use Medrol, but only for Day 3 transfers involving assisted hatching. (I looked this up, and apparently on Day 3 an embryo would actually be in your tubes if things were "normal," and so it is not a normal time in your cycle for the uterus to expect company.) However, they don't do it with regular 3 day embryos and they don't do it for Day 5 transfers, either. Why if there's a chance that the uterus could nix something, and we know there is a medication that can address that, wouldn't you use it all the time? This I do not get. I understand there are protocols for a reason, but in my mind "That's how we do it" is not a reason. Luckily this fell into the "can't hurt and may help, so why not?" camp. So onto my protocol it goes.

Progesterone increase was another thought I brought to the table, and it again fell into the "can't hurt and may help" camp. Nothing too earth-shattering here. More shots for me, but if more needles equals actual baby, BRING ON THE NEEDLES.

Single Embryo Transfer turned out to be the most controversial of the items on our "to discuss" list. Which was a little surprising. Or maybe not. SET is when you transfer just one embryo. Even the language I subconsciously use, "just one" denotes the controversy over this, both personal and socially and even medically. Most clinics that I know of will transfer two, even two blasts. The thinking behind this is that two gives you more of a chance at pregnancy success than one, because two embryos could mean that if one doesn't attach, the other will. Or both will, resulting in twins. And aren't twins a good thing, the proverbial "two for one sale" in the infertility world? I actually wrote about my lust for twins in this post. I wrote this post while in my two week wait for my third IVF, the one where my protocol was new and exciting (and, ahem, egg-quality based). The IVF that resulted in a low positive that improbably kept doubling and tripling, but then went wonky and was still low and caused concern that was totally warranted because it was ectopic and it and my tube needed to go lest they, you know, cause me to bleed to death or something. I had at the time gone through completely and totally unsuccessful IUIs, and two IVFs that resulted in surprisingly poor end results (even before the negative) and so the thought of being done with all this infertility AND completing my family of four ALL IN ONE SWOOP was very, very appealing.

That appeal is pretty much gone now, which was initially puzzling to my doctor. Why wouldn't I want the possibility of twins? Most people in waiting rooms when asked would WELCOME twins. Well, our answer was this: we want to be pregnant, we want a healthy pregnancy, we want the best chance for the best possible outcome, which is ONE healthy baby born without complication. Singletons are not immune from complications such as preeclampsia, low birth weight, and early term labor. In fact (and please don't freak out, pregnant people reading this), for some reason women who do IVF are at a higher risk for all three of those complications, whether you're carrying singletons or more. I don't know if that's because we're already an at-risk population, or on average women doing IVF are older and at risk anyway--it is a mystery and not one I'm willing to research right now. (I want to research how I can GET pregnant and STAY that way, researching birth complications is just not an added stress I need right now.) But in any case, add a second baby in your womb and you increase your risks significantly. Do I know (or know of) women who did IVF, got pregnant with twins, and gave birth at full-term without complications of any kind? Yes, but not a whole heck of a lot. I know more women who spent significant time in the NICU, who feared for their children's survival, who suffered preterm labor too early for survival or complications that ended in tragic infant death. Now, most twin people that I know ended up with babies who are perfectly healthy, after the terrifying and taxing time in the NICU. I just don't know if, at this point in my pathway through this loss, where NOTHING seems to go the way it is "supposed to," if I am willing to take any more risks. Even though twins do have a sense of appeal (I still wonder about how it would feel to be done all in one shot), at this point it is not outweighed by nervousness over the risks.

I'm not alone in this--I actually found a ton of research and articles and interviews and journals that support that the ultimate successful outcome for an IVF cycle is ONE baby per birth. That twins aren't actually considered an optimal outcome. Here is a link to an article by the ASRM (American Society of Reproductive Medicine) that I found really interesting. It isn't a Today show clip (although if you google "single embryo transfer" you will find a fair number of those as well as some Time magazine articles on the subject), but it is awfully interesting how compelling the data is. I have heard the adage, "Two embryos only significantly increases your chances of having twins, it does not actually increase your chances of getting pregnant in any significant way." When digging deeper, I found that transferring two increases your chances by 10% for pregnancy, but 50% for twinning. Hmmm, from a cost-to-risk benefit standpoint, not looking so good. Because, for instance, this last transfer that we had was a double transfer. Two blasts were put into my uterus. Neither of them stuck. Now, if we had only transferred one, it's possible that that wouldn't have stuck, but then we would be playing with THREE blasts for frozen transfers with our new and improved protocol, instead of TWO. We actually would have MORE chances. And that's what a lot of the paper I've linked to states--that you have a higher level of success PER RETRIEVAL with single embryo transfer. Doing a fresh cycle is expensive. Doing a frozen cycle is cheaper, minus the fact that you have to pay for cryopreservation and storage, but that's a one time fee for a set period of time, so if you do your FETs within that period of time you actually have MORE CHANCES for LESS MONEY. Hmmmm. Sounded pretty good to me. Plus, apparently some clinics are offering free cryopreservation and storage to patients who elect for SET as an incentive, because while it may lower success rates per transfer, it increases success rates per retrieval and the possibility of a healthy pregnancy and live birth are higher. The decrease in costs to insurance companies is a benefit as well--the NICU is EXPENSIVE. Oh, and here is another interesting tidbit--in areas (whether countries or states) where there is INSURANCE COVERAGE FOR IVF, the rate of Single Embryo Transfer is considerably HIGHER. Which begs the question, do you want to make a decision on how to have the healthiest pregnancy possible based on the possibility of how much it could cost you in the long run? I know that I have thought this way, because I do not have insurance coverage for IVF, that twins would be "cheaper." But are they, really? Between the higher likelihood of NICU stays and the fears of early labor with not-quite-fully-baked organs like lungs in the mix, and more complications to the mother at birth, I'm not sure that's cheaper. It's covered by insurance, thank goodness, but there is still a cost. 

This is an interesting choice. I struggled with it, because I wanted to hang on to the "one and done" possibility, and I fear that doing a transfer with just one embryo lowers our chances. But, let's be honest. I have put 18 embryos into my uterus. Sometimes three at a time. Never less than two. And I have NEVER EVER gotten pregnant with twins. I have gotten pregnant, but both the freak ectopic and the devastating miscarriage were singletons. I'm pretty sure I can give up on my misguided desire for twins. If I was going to have twins, maybe it would have happened by now. Maybe if my uterus has been doing a rejection service, it has had more notice because there are two or three little HCG emitting babylings in at a time. Maybe one embryo could do a stealth act and sneak on through to the burrowing stage undetected. (Maybe this is crazy conjecture, but it makes sense to me). Is getting two babies for the price of one worth all the risks when I'm already at risk for so much and have experienced so much loss? I really want a healthy baby and a healthy pregnancy. My best chance at that is to give myself the best possibility for only one fetus. Transferring just one doesn't mean that twins are impossible--identicals happen when the embryo splits. I know people this has happened to. If twins are going to happen (and they do, "in the wild," no medication necessary), they will happen. But do I need to induce the conditions to make that risk more likely? In my opinion, for myself, nope. I have had enough. I have put my body through an awful lot. It's not like pregnancy in itself isn't traumatic on the body (your internal organs SHIFT AROUND, for pete's sake!), do I want to TRY to magnify that with a twin pregnancy?

So we convinced our doctor that we are not completely crazy in wanting a single embryo transfer. We opt for more chances to get pregnant over time, rather than putting all our eggs in one basket. We don't have a lot of blasts in the freezer. We have two more chances at a five day transfer, and we don't want to throw them both in at the same time. If (and dear lord I hope we don't have to) we go through both blasts with nothing, we still have six Day One embryos in the freezer as well. These won't get to Day Five and they won't all make it to Day Three. We will HAVE to transfer more than one, because we will have to thaw them in groups since they won't all make it due to attrition. So there's still a chance we could end up with more than one baby in my basket. But hopefully those little frozen embryolets will be reserved for sibling tries. Because that's another benefit of SET--frozen transfers are less traumatic on the body. Shots, yes, but no surgery/recovery/swollen ovaries to contend with when you have a toddler bopping around. It makes thinking about doing this process with a child already if not attractive, then palatable. Doable.

I am not one hundred percent thrilled about this new plan, despite all the logic behind it. What if I need that 10%? Change is scary. But, when looking at the big picture, having more tries with our embryos gives us a better chance of success overall. As Bryce said, when our doctor said, "I'm thinking of your timeline, because we want to get you pregnant as soon as we can" and Bryce retorted, "Nothing messes with your timeline like NOT GETTING PREGNANT." Putting all our embryos in at once puts a lot of pressure on that one transfer. Bryce, ever the scientist, is all about SET, especially given the data. I am going to try to swallow my butterflies and fully commit, mentally, to this decision. After all, both ladies who cycled around the same time as me who are now successfully pregnant transferred a single embryo. One embryo, one baby, more chances hanging out in the freezer for future family building. Sounds like a good plan to me.

Monday, August 5, 2013

What Does Common Core Have to Do With Infertility? (in which I explain how a close read exercise made me want to cry or throttle, not sure which)

If you are a teacher, you totally know what Common Core is. There is no way for you to NOT know what it is. These are the new educational standards for K-12 that 46 states to date have adopted and that expect our students to be working at levels of rigor and complexity that have far-reaching implications into everyday instruction, curriculum development, and professional development. Not to mention new tests and a ton of corporate-for-profit sponsored materials that are being adopted to support this new endeavor. I spent today, from 8-3, in a very intense (and extremely awesome) training on Pathways to the Common Core. A professional development that I am grateful is being offered, but I wish was planned for more in advance as the attendance was really low (not just because it's summer, but because people plan vacations and stuff with their kids pretty far in advance, and this invitation came out, oh, maybe mid-July). Common Core is scary, but with the right supports it can be great. It is causing changes and shifts in instruction and expectations that are not a bad thing.

But, I digress, as this is not a teaching blog. What the heck does Common Core have to do with infertility? Today, everything.

One of our exercises was to do a Close Reading on the Gettysburg Address, and really focus in on the first sentence. The first sentence is the very very famous one:

" Four score and seven years ago our fathers brought forth
to this continent a new nation, conceived in liberty,
and dedicated to the proposition that all men are created equal."
Anything jumping out at you?
Part of the job of a close reading is to really look at specifics within the text. Things like word choice. And then, after reading it and listening to it and annotating it, you talk about it. What word do you think sparked a conversation about word choice and images and metaphors that caused a problem for little old infertile me?
I swear I am not hypersensitive. I am actually the one who initially brought up the word choice for conceived as a particularly powerful one, because later in the address Lincoln continues on this theme with the "new birth of freedom" and it's really quite clever. Which is one reason why it's considered a complex text worthy of a close read. I brought up this word not realizing that this one little word was going to cause me issues for the rest of the day.
Another woman said, "This word is particularly powerful. As a mother."
WHY DO PEOPLE DO THIS? Is the world a more meaningful place once you are a mother? I mean, I would like to think that it is the wonderful mythical thing that I have sought for so long, but when you phrase things like, "And when you're a mother," or "As a mother," or "As a parent," it has implications for those of you, those very few of you in the room who AREN'T mothers, and NOT by choice. It makes it seem like my thoughts and connections to the word conceive just don't carry the same meaning. It's like a meme I saw on another blog-- "No baby on board. Feel free to plow right into me." There's this assumption made that motherhood gives life all new meaning. And while I don't doubt that it does in its own way--I can dream but can't quite imagine properly what it's like to hold close a little person you are wholly responsible for and feel that kind of love, it makes me feel SO LEFT OUT when people make the comment that they understand something deeper BECAUSE THEY ARE A MOTHER. I hear all those things, the "I never knew I could love like this" that really makes me think of the Grinch (her heart grew five sizes that day), and I know that this is just part of the experience of parenthood, but it is so hard to hear those things when YOU WANT IT SO BAD and it just isn't happening for you. I mean, I've been a mother to all the embryos that went inside of me never to be birthed like Lincoln's freedom. I have a slice of it. I've been a mother to the baby in my head that I long for and imagine and wish I could mold into being like some strange fairy tale. But I don't have that same frame of reference. And it makes me feel very alone. It makes it even more apparent that there is a Mommy Club and this girl isn't in it.
The discussion didn't stop there, though. We talked about the use of the word conceived in lieu of other possible choices that were rejected--produced, generated, created. Just wondering if you can suss out where this is going, because I didn't expect it at all and it felt a little like a sucker punch.
Someone else in the circle, another nonmother I might add, said that conceived was so much more powerful than created. Because this isn't some thing CREATED IN A LAB, and CONCEPTION is more powerful than that, a human experience. OH MY GOD I DIDN'T KNOW WHAT TO DO. There is a time and a place for things and I was pretty sure that this small group professional development on the Common Core was not the time to go apeshit on everyone and yell, "YOU CAN CONCEIVE IN A LAB AND IT IS A BEAUTIFUL HUMAN EXPERIENCE, TOO, ASSHOLE!" Because, for one, I'm pretty sure that this wasn't someone bashing IVF. I'm sure it didn't even occur to this person that what she was saying had implications for someone in the room who was going through some of the most assisted reproductive technology ever. I cannot conceive without a lab. Although then there is the question of when conception occurs, which is a whole other ball of wax. Are my embryos conceived? Or is conception when the embryo burrows into your lining and implantation occurs? One is the start of a little life form (how often do we say that our embryos died?) and one is the start of a viable pregnancy. I think they are both forms of conception. I mean, when your parents disgustingly refer to the day you were conceived, they are talking about when the deed was done, not when they found out they were pregnant. It's very sticky. And so not on topic for the textual discussion of Lincoln's Gettysburg Address. So, I had to keep my claptrap shut. I wanted so badly to just be a tiny voice saying, "HEY! Conception can happen in a lab, too." But I think that would have been on the crazypants side of behavior. I mean, if we're sticking with the text, IVF didn't exist in Lincoln's times. I think labs did, but in a much more rudimentary fashion. So the comment was fairly innocuous. It was just, my connection to this statement, as an INFERTILE MOTHER WANNABE, was so strong. And it kind of put me in a bit of a funk.
It just goes to show that your personal experiences are a lens through which you see everything. Nothing escapes the infertility lens. I would have thought an incredibly in-depth unpacking of the Common Core's impact on literacy instruction would have been a safe place for me, but it wasn't. I do feel a little crazy, and debated even sharing this little slip of my day today. I'm pretty sure I'm not alone in these happenings. I'm pretty sure there are other people who are so ingrained into this process that just expecting the question, "So are you traveling this summer?" puts you into a tizzy. I know it does for me, because do I bother explaining, NO, because we failed our first DE IVF and I have to have a hysteroscopy next week and then it's mid August and because we're paying for another FET sooner than later we really don't have the money to go away right now, much less the time? It's a mouthful. And I feel like a sad sap bringing it up at all.
I did have a surprising fertility moment today, when a woman I'll be sharing a room with next year gave me a blessed crucifix as a good luck token, something she's done for several infertile friends and they just happened to get pregnant. I am not particularly religious, and I have never really enjoyed "body crosses," but this was incredibly touching to me. She thought of me enough to get something very meaningful to her blessed and give it to me. She didn't ask any questions, and she said "it doesn't matter if you're not Catholic, not really," and I was just so appreciative. Because she was thoughtful and to the point and any juju is good juju. Because it was meaningful to her, it made it that much more meaningful to me.
So there you have it. The Common Core became a minefield for my sensitivity to the many meanings of the word conceived  and someone surprised me with a very thoughtful gesture. There was some good, some sad, and some somewhat ugly inner dialogue that thankfully I didn't share and question my sanity. Man I hope I'm pregnant before I have to administer the fall writing prompt about Overcoming Adversity. If this training is any indication of my state of mind, we are in big trouble if I am still in this place when giving examples of going through a challenging experience...

Saturday, August 3, 2013

Journey is Haunting Me

This picture is of an actual stop sign that I saw, last April (2012), in Camden, Maine. I just had to get a picture of it. At the time I was in my two week wait from what would be our last ever fresh IVF cycle, with my eggs at least, and I saw this as not just a stop sign but A SIGN. I had this Journey song in heavy rotation in my "Feel Good" Playlist, and to see it spraypainted tongue-in-cheek like that, while on a trip to visit my mother-in-law, while hopefully a baby was brewing right then and there inside me, was pretty cool. It wasn't a sign for that particular cycle, but I kept this picture because I love it.

I also loved my playlist. It helped me get through the uncertainty of the ectopic pregnancy, it put me in a positive mood full of hope and belief through many cycles. It's got some really good songs on it and I added all the ones in the comment section, so go check it out if you want. But, be warned. The problem with having a playlist full of songs that bolster you with hope at sensitive times in your babymaking mission is that when it doesn't work out the way you hoped it would, when you hear those songs later it can be...bad. It can downright go horribly wrong. This happened most notably with the song "I Believe in Miracles" by Hot Chocolate in the post I've linked to. But, in some cases, the song is miraculously not ruined.

Enter "Don't Stop Believing" by Journey. I used to listen to this song not only as a part of the "Feel Good" playlist, but, if I had forgotten my iPod, I would listen to it on YouTube on my phone in the parking lot of the blood draw labs before tests. Whether they were initial blood tests or repeat betas for my wonderful but short-lived uterine pregnancy, this song pumped me up and allowed me to believe that maybe, just maybe, this was all about to be "over." So you would think that this song would make me incredibly sad, now, since it is YEARS of believing and not a whole lot of reality into this dream of pregnancy and parenthood that we hold tight to and fight hard for. But I just can't bring myself to stop. I get really, really close to being shaken in my belief that this is a pathway that will actually end in a baby in my belly and then in my arms. Having a donor cycle that was not successful put a big chink in this believing thing. Really less a chink and more a gaping hole. But, despite that incredible, devastating setback, I am still a believer. We will be parents. I will have a baby. And I still believe that I can get pregnant, and stay that way, given all the right conditions. (I will never, ever, understand why this has to be so incredibly hard for us, but I guess there are some things that just never make sense and will never be fair.)

It seems the Universe is also trying to drill it in my head that I need to keep on believing, keep holding on to that feeling. I have had two weeks where I swear I have heard this song at least two to three times a day. On the radio. On Pandora. In stores. It is everywhere, and I can't always turn it off. Because, sometimes, especially at the beginning of this auditory onslaught, I just felt like ENOUGH ALREADY! Quit telling me NOT to stop believing, because I've been holding on to this for so long and for WHAT? For a whole lot of NOTHING, that's what. So shove it, stupid Journey. It made me angry. But then I would hear it again. And again. And AGAIN. To the point where, when Bryce and I were in a running shoe outfitter yesterday (for him, not me, my running days appear to be over) and he was out running around their parking lot to test the shoes (it's a very thorough place), THAT SONG came on again. And I laughed. Not a full on guffaw but a little snort, a private joke between me and the Sirius radio station. I was like, OK, I get it. UNCLE. I won't stop believing, don't worry. I have a magnet on my fridge, a magnet that has the Winston Churchill quote, "Never, never, never give up." I use it to hold up my protocol sheets. I keep it up even when that protocol sheet has been duly filed into the correct color folder in my Fertility Drawer, to remind me that even when things are dark, there is still hope (right now it's holding up a lovely drawing my cousin's daughter made me as a thank you for a little care package, which also gives me hope that these kinds of drawings will pepper my fridge one day, sooner than I think). And as long as you have hope, and no one is telling you something is impossible, you can keep moving forward. It's like another quote from Winston Churchill, one I don't have a magnet for (but should look for, really, because it would make a nice set). "When you're going through hell, keep going." Don't stop, don't get stuck, just put your head down and plow through the horribleness to whatever is on the other side, because it's worth it.

So thank you, onslaught of a song that has the potential to make me very sad and then very angry but then ultimately just makes me very hopeful. I am not going to call this A SIGN, because in case you haven't noticed I am a little psychotic when it comes to reading into things big and small (timings, supermoons, finally-blooming-lupines, turtles laying eggs in my presence, yada yada yada), so I'm just going to chalk this one up to a cosmic pep talk. I believe that our next chance is the best chance we've ever had. I believe that I can laugh and not cry at the fact that I HAVE SAID THAT PARTICULAR PHRASE SO, SO MANY TIMES but I really and truly believe it. Each time. This time we have a new protocol, beautiful frozen blasts (a B5, people! That's pretty damn near perfect...), a surgical procedure preceding the cycle to make sure my uterus is clean and clear and has been redecorated to be as baby-friendly as possible... I really can't ask for much more. Someone wrote me and said that most couples, 90%, will conceive within 3 DE cycles (including frozen). I am going to hang on to that 90% and ignore the 10%. I will be pregnant, hopefully within my second cycle and not the third. We will make it through this incredible gauntlet of pain and loss and devastation and loneliness. We will have our precious baby, and dare to hope for two in our lifetimes, because we don't give up. We keep on truckin' through it all for what we want, because this journey is incredibly personal and what we want is pregnancy AND baby. We won't stop believin' until that is reality.