Chaos and due dates

June 28, 2013 § 28 Comments

Friday through Tuesday was a little wild.

By Friday night, we had decided that we were definitely going to move forward with IVF at my clinic home base. I was excited. I felt closer than ever to being pregnant. I would be stimming in early August and that seemed sooo close. I was relaxed. At ease. Over the next few days, our discussions turned financial. We went back and forth on whether or not we would do the shared risk program*, but we seemed to be leaning toward it. My parents were on board, too, thinking it would be better bang for our their buck. We had some reservations about this option, though.

First, we would be required to transfer two embryos. Now, I know that I should be happy with any baby at all and that two babies is better than no babies. But the idea of twins is (at least at this point) pretty effing overwhelming for me. I’ve worked as a nanny in the past. I am not pollyannaish about what parenting will be like. It is hard to care for an infant. Really freaking hard and exhausting. And two infants? Well. That honestly sounds impossible to do while still maintaining happiness and sanity. That is not to say that we won’t eventually choose to transfer two embryos if and when the time comes, but I just don’t like the idea that we wouldn’t (for up to three IVF and as many FETs as there are embryos during the course of that year) have the choice. That didn’t sit well.

Second, as I have whined about several times (sorry), we may be moving next May or June, and the year time frame for the shared success program wouldn’t be over until August. So we wondered if it made a difference that we may only be able to squeeze in 4 cycles instead of 6 (if we need them), or whatever the math ended up being.

My appointment to start the IVF process was set for Tuesday morning at 7 AM. I was scheduled to get my calendar and a blood draw before being put on birth control pills. If we were going with shared success, they also had to take height and weight measurements as well as do a nicotine test, and I would have to “pass” those in order to be accepted into the program.

By Monday afternoon, we still had not made a decision about the shared success, so I decided to have the additional lab work drawn to buy us a little more time. We wouldn’t REALLY have to make up our minds until the consent signing the next week. (Do you see what an odd anxious procrastinating duck I am? How much good will an addition 7-10 days do us? None. That’s how much.)

Then Monday evening. The Artsy Engineer gets home from work, and I can tell he is really on edge. And I’m on edge, but I don’t know why. At the time, I think it’s just the excitement of IVF. The I-can’t-believe-we’re-really-doing-this-es. And then all of the sudden, The Artsy Engineer tells me he doesn’t feel ready. That he wants to do the last IUI, because this is the doctor’s orders, and because if we were to do IVF right away, he would always wonder if that last IUI would have worked. I knew he had reservations about moving forward after only two IUIs, but we’d discussed and discussed (and discussed) and seemed to both come to the conclusion that we were on board. Of course, I offer all of the reasons why I’m hesitant to do this. And then we go back and forth about it for awhile. Me trying to defend our initial decision with solid reasoning (it’s so unlikely to work, the timing will be better, etc etc). And him offering equally good arguments against it (it’s cheaper per percentage point of likelihood of success, we’re still within the first three during which our odds don’t go down yet, IVF is hard on my body and associated with increased, though small, risks to the offspring and what if something were to happen and we were to always wonder if we really needed it.. if that one last IUI would have done the trick).

The clinic is closed for part of August but I don’t know the exact dates, so I know that if we do the additional IUI, we might not be able to move onto IVF right away. I’m stressed (and therefore irritable) and I make this shitty comment about how I want him to sit down with me and count through the calendar so we can see if we can squeeze in one more IUI before IVF without screwing horribly with the timing or getting mixed up in the clinic closure, because “I’m the one who has to do everything and you just SWOOP in at the LAST MINUTE after I’ve spent hours and hours and hours gathering the information and try to CHANGE THE PLAN.” Which actually wasn’t fair, because he’s been involved. He just can’t possibly be as involved as me. And at that moment, that was pissing me off.

And he was stressed, so that comment (which would likely not bother him when he’s feeling good) realllly upset him. And he shot back with something equally hurtful and untrue.

And then I left the house. And I went to the dog park and sat like a creepster in my car for an hour and a half in the rain and cried and watched the dogs play.

When I came home, we apologized. Blamed it on the stress of the decision. Still did not make said decision. Fell asleep.

We got to the appointment in the morning with the plan of asking the nurse if we could squeeze in the additional IUI and start the IVF cycle immediately afterward and then taking 5-10 minutes to decide what to do. We did that, and it was fine. And we decided on IVF now.

So he left for work and I got the blood draw. And I got into work and put the dates into my calendar.

And then I just felt sick to my stomach. And it didn’t go away. And my mom called and asked if I was excited, and I just started crying. And then I realized that I wasn’t ready right this second either. That I needed to be sure that we were ready to spend a shit ton of someone else’s money and put my body at risk for this and that I wouldn’t be sure until we had exhausted all of our options. And then I felt like an ass because this is clearly how The Artsy Engineer felt but I didn’t want to listen to it. My desire to be pregnant as soon as humanly scientifically possible was making me a selfish partner.

I called the RE’s office and asked the administrative assistant if she would kindly ask the nurse to call me back. I wanted to pull out. And could they still squeeze me in for a baseline ultrasound for the IUI? Was I too late?

(This is the point at which I wrote the last post.)

It took three hours for one of the nurses to get back to me, and there was only an hour left before the clinic closed. I was already on CD 3, so I knew that if I was going to do a letrozole+IUI cycle, I needed to get this done immediately. I was really worried that it wasn’t going to happen, and that I’d wasted a cycle. But the nurses were so understanding. I left for the clinic the minute I got off of the phone with them, and they squeezed me in just before close. There was some good-natured teasing involved, which I appreciated. I was embarrassed and exhausted and I needed a little humor.

And then ohhhh the relief. This decision felt worlds better.

I am ready to do IVF. In fact, we have a tentative calendar in place for when this IUI does not work. Because the odds are that it will not work. I will be starting birth control pills in a little under a month, and I’ll take them about a week longer than usual to get us out of that blacked out time when the clinic will be closed. Lupron will begin around August 19th. And I’ll start the stim meds around the 30th. Retrieval is penciled in for 9/11.

I am ready to do IVF. I just wasn’t ready right that minute. Whether or not it’s logical, I need to do this first. I need to know that we need it. And, for some reason, this last IUI will make it official. So maybe we’re paying $1500 for peace of mind about our decision to move forward. But, so be it.

And, yes. This would put our estimated due date (if the first IVF works, which it very well may not) around the time when we may be moving. But. Fuck the schedule. This is my family we’re talking about here.

And also, if I had not lost the only pregnancy I’ve ever had, my due date would have been tomorrow.

I plan on burying myself in backlogged patient paperwork.

Emotions? Who needs emotions?

13dpiui#2

June 22, 2013 § 26 Comments

Once I started, I couldn’t easily stop. I tested again on Wednesday, and the test line on the Wondfo was even lighter, which I did not think was possible. And while that mostly answered my question about whether or not my first “positive” was the result of the trigger shot, it still left a little room for hoping. Of course, I googled “pregnancy tests lighter before getting darker” and learned that it can, in fact, happen. But then on Thursday morning, it was gone completely. No line. So, going into my beta was a bit heartbreaking. I knew it would be negative. And it was.

I’m a little bit ashamed of myself for getting so worked up. I should have known better. Part of me feels embarrassed about showing you all my raw, unfounded excitement based on nothing more than a mixture of intense hope and stronger than ever progesterone supplement symptoms. I typically don’t type things out in real time, especially when these things are super emotionally charged. I craft my posts after the emotional intensity has worn off a bit, which feels safer. Less vulnerable. I feel like I let myself get pranked. In front of a large audience. For a person with a decent amount of social anxiety, that is less than ideal.

But that is that. I’m not pregnant. We’re moving on to IVF. Another IUI feels pointless. There were three eggs in there available for fertilization this last time, and The Artsy Engineer’s numbers were better than ever. The only reason we would do another IUI is if we decide to wait to see if a space opens up in the clinical trial. When I realized I was being put on a waiting list, I emailed one of the research assistants to ask if she would be able to give me some idea of when spots might open up and if I was high enough up on the list to be hopeful that I might get one. She responded briefly by saying, “Possibly till the end of July, but there are very limited spots.” That didn’t quite answer my question to the extent that I was hoping, so I emailed again asking for clarification. This time I got the following reply.

[Lentil],
We may not take candidates until end of July.
We have been running for almost 4 years and have reached capacity for the trial currently, we are not closed yet and will be taking a few more. We will be looking and re-reviewing the prescreening and screening questionnaires. When spots become available we will contact candidates.
I’m reading this to mean that it’s unlikely, right? If I were high enough up on the list to remain hopeful, wouldn’t she say so?
..
This is important because of timing. I know I should not be thinking of timing. Because it will work out regardless. But I’ve been focusing on my career for so long that it’s a hard habit to break. You guys may remember that I will likely be starting an internship next summer, sometime between June 29th and September 1st. And I will likely have to move to whichever state the hospital I’ve been placed is located. We can do IVF right now with my RE. Starting asap with birth control pills as soon as these progesterone supplement leaves my system and I get my period. Say it miraculously works on try #1. The potential baby would be due in late April or early May. This sounds ideal. It would give me more time at home with this potential baby, more time before the move. If we wait (and, again, if it miraculously works on try #1), this potential baby would be born while I’m on internship and I would very likely only be allowed to take 6 weeks off. Yikes. And I’ve also never known anyone who has had a baby during internship. Everyone does it during postdoc (which will be the two years following this internship year), but I have never even heard of somebody who knows somebody who has had a baby during internship.
.. 
I know all of this may be a moot point. There is so much that is out of my control. I might not match to an internship at all. 25% don’t. And IVF often does not work on the first try. But my doctor sounds so confident. Based on her stats with my age range and diagnosis in addition to her “clinical opinion” (based on my all of my numbers and my “strong” response to treatment), she believes we have a 60% chance. She even said she thought we had a 60-80% chance, but that saying that out loud makes her squirm, because she rarely puts people in that range and she hates to give people that much hope when there is, of course, always a chance that it simply won’t happen.
.. 
We also qualify for the shared risk program. If we pay an additional $10,000ish, this would allow us to have the “insurance” of two additional IVFs (and as many FETs as possible) during the course of a year if the first IVF fails.
..
So the options are this:
1) wait until the end of July to see if space opens up in the clinical trial
pros: much (!!) lower cost
cons: seems unlikely to happen, timing would be less ideal, i would have to travel to and from NY during a really busy time work-wise, increased stress levels from travel/working from elsewhere, the clinic has a lower success rate than my clinic at home
2) move forward with IVF with my RE using the simple pay-as-you-go method
pros: it might work the first time, less stress, better timing
cons: it might not work the first time, $20,ooo is very expensive, FET costs around $4,000
3) move forward with IVF using the shared risk plan
pros: three IVFs plus as many FETs as possible better freaking work, so i would venture to say this will likely get us pregnant
cons: $30,000 is holyfuckingshitoutofcontrol expensive and what if it works the first time and we feel like we just gambled away an additional 10 grand
So this is where we are. The plan is to choose one of these three in the next few days. Eeeep.
Anyone want to make this decision for me? I struggle with deciding what to order off of the menu when we go out for dinner. In fact, I usually convince the Artsy Engineer to order one of the two things I want and share it with me, so I get both and I never actually even have to come to a decision. How on earth are we going to figure this one out?

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!

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?

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