Of fingers and dikes

June 16, 2013 § 29 Comments

Well.

I’m not sure where to begin. I think I’ve been missing for nearly 5 weeks.

It was not a premeditated absence. I planned to keep up with everyone while in Ecuador. And then I planned to write about the trip as soon as I got home. Instead, I forgot (mostly) about the fact that I am a person who is trying to have a baby and who can’t. And I withdrew entirely from this infertile world.

And it felt so freeing. I felt so light.

Not the part about being ‘away’ from you guys. That part I felt guilty about. And I wondered about you all. In fact, I lurked. Reading on the periphery but hesitant to dive back in, as if one comment here or there would be like removing my finger from the dike and would result in me (and those close to me) drowning in a wave of my infertileness.

This was not the only reason I was absent. I have also been the outofcontrol holy-shit kind of busy. Aside from two weeks in Ecuador, I was in dissertation boot camp for a week, writing for 10 hours a day in a semi-organized fashion in the library of the university (jealous?), had two friends staying with us for 10 days, and just got back from an extended weekend in Ann Arbor. We’ve been in the company of a good number of the members of our mishpocha. I have not been to yoga since pre-Ecuador, which is a pretty good marker for how off my schedule has been, since that is something I do rather zealously. The Artsy Engineer and I actually counted the days where we’ve had more than an hour to ourselves since May 14th, when we haven’t been sharing rooms in hostels in Ecuador with friends or sharing our home with friends or sharing our family’s homes. It comes out to 5.*

I’m not going to go into any crazy details with this post. I feel the need to just break the silence. Remove my finger from the dike.

But. I will tell you that I am very much not pregnant. And I am doing remarkably well. IUI #1 was a bust. I snuck into the bathroom first thing in the morning, while our friends slept in the bed right next to ours, and took the test, then crawled back into bed and whispered to Bryan the negative result. We were momentarily (and, oddly, superficially almost) bummed. Then we got up, had rich coffee on the porch in our pajamas, and spent the rest of the day rappelling down waterfalls outside of a town situated in a valley where the Andes and the Amazon rainforest meet. It was hard to stay disappointed about anything. IUI #2 took place exactly one week ago, while we had friends staying with us. They are very close friends, and they know about our whole infertile history, so I didn’t have to make up any stories about going out to get bagels on Sunday morning when, in fact, I was being inseminated. They even watched, wide-eyes and jawed, as the Artsy Engineer gave me my trigger shot. These friends are the kind who say all the right things, ask all the right questions, and who have never tried to give us advice of any kind. You know the kind. They were a breath of fresh air. They are also psychologists, so I guess I shouldn’t be shocked that they know how to talk to people about difficult things. And even appear not just interested, but also curious and almost excited about the process. It was just so terribly nice.

Despite my attempt to avoid it, a lot of things have been happening on the fertility front. Last Friday, when I had the mid-cycle ultrasound to monitor follicle growth, I learned that I had three mature follicles (!!) and beautiful, thick lining. Letrozole and I, we clearly get along. I also scheduled and attended my first “what’s next” appointment with my RE, during which she was extremely pleasant and easy-going. She spent 40 minutes with me, which I thought was huge. And she answered every last one of the questions I had prepared without the slightest bit of annoyance. And she seemed to respect my thoughts and take me seriously. I was so relieved.

Right now I am 7dpiui and I have the most sore boobs I’ve had maybe ever (but that makes sense because I also had the most mature follicles I’ve had ever and, thus, the most corpora lutea to produce progesterone I’ve had ever). I’m hopeful. But we also are trying to devise our plan of what to do next. And IVF it is.

We haven’t decided the ‘when’ part, though. The thoughts on this will be included in another post, because this one is becoming a bit of a tome.

We have a couple of what I guess one could call possibilities. We’re on the waiting list for the New Hope IVF Clinical Trial, which would allow us to pursue IVF for the cost of several trips to New York. That is option #1. Options #2 is less good, I think, but we are incredibly lucky to have it. We drive janked up cars from the mid-90s. Mine died mid-left turn this afternoon after we picked up the dogs from kennel. We cannot afford IVF on our own. My parents have graciously (god, that word doesn’t do it justice or even anything close) offered to pay for the entire treatment, stating that they “cannot think of anything better to spend [their] money on.” But this idea is incredibly hard for us to swallow. My parents have some savings, but they are by no means wealthy. And IVF with our clinic is going to cost close to $20,000 when all is said and done. They pay for dinner when we go out together and it makes me uncomfortable. How am I supposed to accept a gift at this level of bigness?

Ok, More later. I have several things to expand upon. The Artsy Engineer and I have different ideas of when (and how) to move forward with IVF. I am beginning to think about which internship sites I will apply to, which is exciting and also terrifying. My parents are moving away in a month. My sister is dating a guy and I don’t like him and I feel like an judgy asshole about it. The dogs spent their first weekend at doggie daycare/boarding and I’m so proud of them for not freaking out and being miserable. Andonandonandon. Progesterone test is tomorrow. Conference in Chicago on Thursday. Beta is Friday. And go.

 

 

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*I am an introvert in the sense that I love to be around others, but I find it physically and emotionally exhausting if I don’t get a good deal of ‘me’ time in order to recharge. So this has been a wonderful but draining month.

IUI #1 and unrest

May 8, 2013 § 32 Comments

*** Just a warning. This is going to be 5 straight minutes of me bitching. I don’t really like to bitch. And it’s a beautiful day here and I turned in my draft of my literature review and I leave for Ecuador in less than a week, so it feels really terrible to be in the mood to bitch. But here we are.

The night before last, the Artsy Engineer nearly passed out after administering my trigger shot. And this morning I was inseminated. Like an infertile heifer. Which was a little weird, of course, but not that weird, actually. And the small weirdness is not what I want to talk about.

If you all remember, I had this grand plan last week to talk to my RE about changing my letrozole protocol based on a couple of studies I read. Truthfully, I didn’t expect her to actually do anything differently. She is the expert. And she obviously has reasons for using the protocols that she uses. But I did expect her to be nice about turning me down. And, ya know? Her words were weren’t awful (mostly). It was just this “you KNOOOW who that sort a protocol is used for, don’t you?” kind of stuff. But her facial expression conveyed displeasure and her tone was accusatory and belittling and it made me feel like a child. During that appointment, she also scoffed at the fact that I choose to continue to chart, even though it “will just be confusing” because of the medications. I explained to her that I knew that, but that I liked doing it because it gave me a false sense of control over the situation. Which she clearly thought was a stupid reason, because she proceeded to “strongly advise” (her words) me to discontinue charting to “save myself a little time.” Come ON, lady. Taking my temperature in the morning takes me all of 18 seconds.

I knew her bedside manner left something to be desired before this, though, so I wasn’t too surprised by this whole interaction. I only thought, this woman is not my favorite. She and I are not going to be buddy, buddy. But that’s cool. Ok, fine.

Then, today, I went in for the IUI (the success of which I still feel totally hopeless about), and she managed to one up herself. Her mood was pretty light at the beginning, so much so that I thought, “Man, she’s actually being friendly! She must be having a really good day!!” I even made a clever joke after accidentally writing my own name where I was supposed to write in the name of the person who gave the semen sample they were about to inject into my uterus. And she laughed. But then when the whole thing was over and done with, I mentioned that I was opting out of the CD 21 serum progesterone test and the hcg test, because I was going to be out of the country.

And no joke. The woman shot me daggers. She then proceeded to tell me that I they would not have done the IUI if they had known that they would not be able to monitor me in the second half of the cycle. She asked if I had told anyone about our trip. Which, I did. And she asked what it was that made me think it would be okay for me to skip out on this portion of the protocol.

Now. Had I knowingly neglected mandatory portions of the protocol, I would deserve this kind of reprimand. But y’all. The last three cycles, I have been told repeatedly that the CD 21 progesterone test and the beta are OPTIONAL. Nobody mentioned that this changes to ABSO-FUCKING-LUTELY NECESSARY-OR-ELSE-THE-BABY-YOU-HAVEN’T-EVEN-CONCEIVED-YET-WILL-DIE when you go from timed intercourse to IUI. And why on earth would I even think to ask? Everything else about this cycle is the exact same as my last three. Why does husband versus catheter insemination make a difference? I’m completely stymied. Still. But, apparently (as she made very clear), it will be my fault if I have an ectopic pregnancy or a low-progesterone induced early miscarriage because I failed to follow the protocol.

Guys, this made me feel like shit. I know it’s silly. I’m not going to get pregnant from this. And, even if I did, the presence or absence of a progesterone test and a beta will not make a difference. I know this. I already supplement with progesterone. Yes, I could have an ectopic. But so could anybody who ever conceived ever. And, no. They won’t be able to see if the egg was fertilized, so they’ll have less data. I guess that’s a bit of a bummer, but I knew that going in.

But somehow this woman succeeded in making me feel like an asshole.

She treated me as if I am some unruly teenager, who isn’t taking this seriously and who is making decisions all willynillylike based on whatever and a bit of selfishness. And she is soooo wrong. And I know not everyone is going to like me and that’s fine. But for some reason, I desperately want this particular human to like me.

I think it’s because I’m relying on her for something so huge.

If her SART stats weren’t the best in the area, I would be looking for a new provider right now.

UGH.

But. On a more positive note.

I’m inseminaaaaaated! Even though this cold cold lady made me feel like I tricked her into it. (And, I know I keep saying there is no chance of it working, but of course I know there is a chance, albeit small. And of course there is a bit of hope, albeit tiny.)

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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