Insight fail, data, and the next steps

April 29, 2013 § 16 Comments

I like to think that I’m pretty insightful. When I start getting salty with the Artsy Engineer for no apparent reason or weepy at commercials, I’ve usually determined the etiology of the distress in no time. But I’ve been avoiding this space for the last few weeks, and, while I knew I was doing it, I couldn’t really put my finger on why.

And then Vanessa nailed it. And I was like, YES. Now I get it.

There was this barrage of good news among us, and I was riding on that wave. Whoohooo! Everything is good and golden and bubbly rainbows and we’ll all be pregnant in no time and isn’t life grand? And then BAM. Several of my favorite bloggy friends miscarried. And there were failed IVFs. And then I think what happened is that I promptly put my fingers in my ears and started singing “LALALALALALALALA” on the inside, as loudly as you can do something like that silently.

It was fairly easy to ignore all of you. (Not that I didn’t read. I still read. I just didn’t have it in me to participate.) I have a big deadline to meet (a first draft of the literature review portion of my dissertation MUST be in to my advisor in 7 days) and a trip to plan (sort of). But now that it’s been a few weeks, my strong desire to avoidavoidavoid and self-protectprotectprotect has lessened. And now I feel like a shitty friend who couldn’t stand the heat.

I hope it was (but maybe it wasn’t) a coincidence that it happened at the same time as Infertility Awareness Week, which is now over. Nothing like learning that you will not get pregnant via intercourse coupled with a string of bad results amongst you, my friends, to seal the nail in the infertility coffin. I belong here. And now I know. And I’m upset with myself for “missing” awareness week, because I debated for the last month about how I was going to participate. And then I just dropped the ball.

So, while I go ahead and sit with that (I was raised Catholic; guilt is a fairly comfortable feeling for me), I’ll give you a small/uneventful update about my ever empty ute.

It’ll be quick.

Status?

Still empty.

That’s all you really need to know, I suppose. But if you want more, here goes. Letrozole cycle number three resulted in a negative beta this past Wednesday. I knew it would. In fact, I stopped the progesterone a day early by myself. It just wasn’t going to happen.

We’re going to move on to IUI now. But, truth be told, I’m feeling pretty hopeless about it. See, I’m a stats woman. When I was a kid, I was terrified for years that someone was going to break into my house and murder everyone in my family except me. No amount of reassurance ever resulted in alleviation of this fear until it finally occurred to my mother than she was dealing with the child of two scientists, here, and that maybe she ought to throw some data at her. So at 8 years old, after being terrified for 4 years that my family would be murdered while I slept (I was never worried about myself, just everyone else), I finally chilled the fuck out after learning how few people are actually murdered, the likelihood that any member of my family would be one of them, and the percentage of those who are murdered that are either drug-related or killed by family members or people close to them. And then I was cool. Because no one in my family was going to kill anyone else. And no one did any drugs. And that was that. My odds of not becoming a child of murdered parents were good.

All of that is to say that when I am faced with scary or overwhelming things, I now go straight to the primary source. I read peer-reviewed research articles, and I make my own mind up about the conclusions. And as a result, I believe that IUI ain’t gonna do a damn thing for me. Is it possible? Sure. But it isn’t likely. That being said, I feel like I need to do a couple of them before I can justify moving on to something more invasive and more expensive.

I don’t want to bother with 3 cycles of regular old letrozole+trigger+IUIs. It just seems like a waste of time. But we’re not quite ready for IVF (although we’re probably close), and I don’t want to pay out the wazoo for injectables if I’m doing something that is about as likely to result in pregnancy as a blow job. While doing my lit review, I came across some recent research on an extended letrozole protocol. There are several recent studies that suggest that an extended protocol (CD1-10) is more effective than the standard CD3-7 protocol. For example, in one study, the extended regimen resulted in an average of three follicles greater than 18mm versus 1.8 in the short regimen. Pregnancy rates were significantly greater in the long regimen, as well (up to 18% for couples with unexplained infertility), and there was no significant difference between groups in thickness of the endometrial lining. Rate of multiples was about what it is with Clomid, so not too high.

I have no idea if this extended regimen has made the jump over from science to practice yet, but I called the RE’s office on Friday afternoon to ask if she was familiar with it. Trusty Dr. H was out for the weekend already, but the nurse sounded interested. She said that it definitely wasn’t anything Dr. H had ever done at the clinic, but she also didn’t shoot it down. She said she would put a note with several of the references I provided on Dr. H’s desk so she would see it first thing Monday morning. It is now Monday morning, and I have my baseline ultrasound at 10, so maybe I can argue my case there, too. It’s obviously too late to do it this cycle, as today is already CD4. But maybe I’ll have a shot at it for the next round.

Go data!

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When you can’t have a baby, take a trip

April 7, 2013 § 24 Comments

I hate to fly, but I love to travel.

When I was a kid we never really went anywhere except to my grandparents house. There was a trip to Disney World once. And one or two to the beach. But my parents were poor students (apple and tree comments commence), and they lived far enough from their own families that they chose to spend whatever meager vacation days they had on visiting their folks. But when I was 15, my dad became involved with a doctors without borders type of program and used his charm to convince the director to let me tag along on a trip to Peru. And since then, I have taken every opportunity I have had to get out of my world and to see someone else’s. My career is an example of this, I think. As is my love of stories. And documentaries and reality television. And my desire to travel.

About three weeks ago, a good friend of mine happened to mention in an email that she and her husband were thinking of taking a trip in May. Her husband and mine have been besties since before puberty, and she and I met as juniors in college when we were both just starting to date these two best friend boys. We were super college drunk the night we met and declared that we were going to be great friends and we were right.

The Artsy Engineer and I have only taken one international trip together and that was our honeymoon, which we decided to spend in a very non-honeymoonish way by hostel-hopping through Vietnam and Cambodia for a month. We arrived in Hanoi, Vietnam with zero plans and a plane ticket out of Saigon 4 weeks later. And it was, of course, an incredible adventure. As a brief aside, the weird thing is that I’m not really an adventurous type. I seek it out and then alternate between suffering through it and having the time of my life. I don’t know what that’s about. Anyway,

we’ve always wanted to travel with these two friends. They’re easy to be around, low maintenance. Comfortable. They also live hundreds of miles away from us and we only get to see them once or twice a year when we go visit the Artsy Engineer’s family on the east coast. So when the opportunity presented itself to take a trip with them, something weird happened. We didn’t really think about it. We usually think these things to death. But this time we didn’t sweat over our bank account or calendars. We just took it. Picked dates. Booked tickets. I didn’t even tell my bosses until after it was a done deal. We did it even though we should be saving the money for future treatments. And even though it may mean we try without intervention for a cycle.

I just feel like we’ve sacrificed a lot already. Only 4 years in to my program was I able to take more than a 4 day vacation. And now we continue to sacrifice a lot of experiences for this baby that hasn’t come. That is not to say this it won’t all be worth it. Because I truly, truly believe that it will. But, doggone it, when? And why me? Why can’t I just get knocked up free and easy and have that be that? And just because I believe the wait will be worth it, does that mean that I should just be quiet and quit complaining about it? Sit back? Let things pass me by because maybe this month will be it? I don’t think so (at least, I don’t think so today; it may be different tomorrow).

So, we’re going to Ecuador in 5 weeks.

File:Bolivian Alpaca.jpg

This was not taken in Ecuador, but this alpaca is hilarious. In fact, all alpacas are hilarious. Look at its facial expression! They all look high. I’m serious. Google alpaca and tell me I’m wrong!

Source: Patrick Furlong

But because I can’t get the yellow fever vaccine or take the anitmalarial meds due to this whole trying to have a baby thing, we’ll have to stay in the Andes (above the mosquito line) and out of the jungle, which everyone seems okay with. Don’t get me wrong. I’m not without reservations about the whole thing. But “reservations” ought to be my middle name. What if my timing gets fucked up and I can’t do an IUI cycle in the week leading up to the trip like I have planned? What if I’m pregnant and I get sick? What if I’m pregnant and I miscarry? What if we all die in a horrible car crash because I’ve heard the drivers are madmen? (Have you guys figured out what a ridiculous odd anxious duck I am? I was hoping to hide it. But, let’s be real, here. There is no hiding it.)

I don’t really know what we were thinking with this thing. I think it was something along the lines of this: We have put lots of things on hold for the last year and a half because we thought that we’d get pregnant any day now. And before that, we had to turn vacations with friends and family down because I couldn’t get off of work. And I know I chose that first part of it, but I wasn’t expecting that second part to happen at all, much less follow so closely behind the first. So, I’m burnt out. And I think I finally get it. I’m not waiting around for my life to start. This is it. And if I want to fill it with things I love, I better start doing it now. Because right now I have more life left than I will ever have again. (That was morbid. But, really.)

But, seriously, am I crazy? Am I crazy to spend a bunch of money (that will likely later be needed for future treatment) to fly (because I usually take a benzo when I fly but I can’t if I’m pregnant) to a country that has diseases (that I can’t be protected against) and an active volcano (that I can’t be protected against)? Or is that just my anxious voice talking so loudly I can’t hear over her?

Where Am I?

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