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.

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.


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!

Heavy sighs and burning eyes

March 26, 2013 § 29 Comments

You know when you are standing on a cliff overlooking a quarry or lake and you’re about to jump off and you just freeze? Because it’s so scary to let go of the ground with which you are so familiar. And because it’s terrifying to plunge yourself into the unknown.

That happened to me this morning. I had a beta scheduled for 7 am. The hope I had been feeling for about a week after ovulation had fizzled down to 0. As usual. What was not usual, though, was that I was feeling no emotion about it. I wouldn’t say I was ambivalent. I still wanted very badly to be pregnant. But I was kind of emotionally numb in my response to that wanting. It was bizarre and unlike me. I’m very much a feeler. Some might argue excessively so.

I typically test a day or two before the beta. But this cycle I had such a carefree, happy two week wait that I couldn’t bear to face what I knew was going to be on that stick. So I didn’t test. And I didn’t feel about trying to conceive. I busied myself with exercise, good food and wine (small amounts), trip planning, and quality time with the pooches and the Artsy Engineer. I did things that made me feel good and completely avoided things that didn’t (like my dissertation, which is now glaring at me from it’s minimized position on this computer screen).

And then today.

When it was time to leave for the clinic this morning, I just couldn’t get myself to go. I knew the beta would be negative. I’d been in such a state of ease. It had felt sooo sooo good and all the sudden I felt panic. It was going to end and I didn’t want it to end.

I ended up dragging myself into my clinic 15 minutes later than I should have. I even got there and sat in my car for awhile, screwing around on my phone, not even realizing I what I was doing – my subconscious desperately trying to maintain the status quo. Until that jolt. Lentil, hello? You’re already really late and you hate being late. Go inside.

And now here we are. Blood results are in. They are negative. Of course.

And here I am. Just as I thought I’d be. Crushed.*


*Even as I say this, I know it will be temporary. With every failed cycle, I have a shitty day (or maybe two). And then I move on to the next. Everything is transient (which is true and good). But right now in this moment it effing sucks.

The near death of modesty and coming out of the closet

March 23, 2013 § 30 Comments

I have been hesitant to show my face on here. My actual face, I mean.

I’ve always been a pretty private person. So, I suppose that talking about trying to make a baby on the internet is something that scares me. And I guess that the idea of linking these words to my face makes me feel more exposed.

But I’ve been thinking about this a lot. I want to be brave. I want to be one of those women who provides an in for other women to talk openly about infertility and miscarriage. I think I’ve mentioned that I’m one of the first of my friends and coworkers to try to conceive. I don’t want anyone else to feel like they have to keep this battle to themselves if this sort of thing happens to any of them in the future (which it will, because we know how common it is even though no one talks about it). I don’t want anyone else to feel ashamed.

I deal with difficult things by talking about them, but, until recently, I only talked to a very select few. We’re talking about like two people other than the Artsy Engineer. I didn’t even tell ANYONE we were trying until after the miscarriage. And then I told a lot of people. Like, everybody (not really, but a lot more bodies than I would have ever guessed). About all of it. I needed support. I needed people to understand. So the lips got loose. And I feel good about it. People care. And I can get things out of my head out of my head out of my head and into the world.

But I still worry about the internet. I worry that some future client or future patient will find me out. And will care. Which they probably won’t. And I probably won’t either.

So, I’m going to quit screwing around and just show you my face, because I feel like I need to do this. I won’t promise that it will be here forever. I may freak out and take it down one day. No promises. But, for now. Me. Selfie style.


Meanwhile, in case you all are interested. I’m at 10 dpo. My temperature dipped significantly today. I’m trying to not read too much into it. Last cycle it stayed up until a couple of days after I discontinued the progesterone, so I just expected that it would do the same thing this time around. Bleh. Whatever. I’ve been good at ignoring the two week wait so far. I’m going to try to keep that up for another couple of days. Tomorrow, I’ll be posting promised photos of my stitch fix, which arrived at a perfectly distracting time. And, right now, I’m going to go read for book club. And maybe watch some basketball. Peace, y’all.

Not negative but not positive either

February 25, 2013 § 17 Comments

First of all, I am floored by all of your thoughtful comments on my last post. Truthfully, I didn’t realize how many people both read this and care. You all are amazing.

Yesterday was a bad day. And, ya know, this morning didn’t start out so great either. First, the car in front of me getting onto the ramp headed toward the highway plowed over a bunny who was just sitting tharn in the middle of the road. Right in front of my face. And, don’t say he didn’t see it. He saw the bunny. It was in the middle of the freaking road. And it wasn’t moving. And there were no other cars around. This jackass just chose to not slow down to allow it to get out of the way. Admittedly, this kind of thing probably bothers me more than it should. Forgive me. And then, I somehow just forgot to get off at my exit for the hospital this morning. So, not the best entry into Monday.

But, as the day wore on, my mood improved. The Artsy Engineer called me around 10 to tell me that, whatever the results of this morning’s beta, he is 100% on board with moving forward with treatment. He said that he was having a rough day yesterday, too. He was anxious about money and work. And the prospect of another failed cycle. If I’m allowed to feel shitty and hopeless at the very end of the 2ww, he certainly is, too.

Weird thing. So, a couple of days ago I had really swollen boobs. It lasted for two days. I allowed myself to get a little excited, but I figured it was mostly the progesterone talking. Then, yesterday, the swelling went down. They were still tender, just not as big. I think this is part of what sent me into a tizzy.

But maybe it makes sense.

I went in at 7:45 for the beta, and I got the call back around 11.

In the words of the nurse on the other end of the line (my favorite nurse, by the way), the beta results were not quite negative, but they weren’t positive either. Let me explain. At my clinic, a “negative beta” is below 1. (I’ve always read that the number is 5, but my RE explained to me that their tests are really, really sensitive and can detect trace amounts of hCG that are in the blood stream even before implantation.) My number was a 2. The nurse explained that we clearly achieved fertilization but that it didn’t get much farther than that – it probably never made it’s way out of the tube.

Major bummer.

Of course, we are disappointed.

But, I actually don’t feel nearly as crushed as I thought I would feel. I felt momentarily upset, but then it quickly went away. We achieved conception. Step two may have been a bust, but step one worked. I know the stats. 50% (or up to 70% depending on you who you talk to) of all fertilized eggs end up this way.

I guess this just wasn’t the right combination.

Thanks for all of your support, friends.

On to round 2.

Today everything feels like it sucks

February 24, 2013 § 15 Comments

It’s weird. I had a really good night last night. I attended a fancy work* party with my supervisors and my supervisors’ supervisors. At this work party, I got some pretty good feedback about my performance. People were making comments like, “when we have a student we really like, we try to do everything we can to create positions for them within the department when the time comes for them to get a job.” So, yeah, last night I was feeling pretty good about myself. Last night, things were looking up in the world.

Then for some reason, today everything is wrong. I lie. I know the reason. I have all of these symptoms that I know I can’t pay attention to because I’m on progesterone. My boobs are sore and huge. Or, huge for me, which is still tiny (I like to use the term “perky”). Yesterday afternoon, I took only the second nap I have taken in my entire adult life. My chart is revealing this beautiful triphasic pattern. But. I am 12 dpo on my first medicated cycle. I didn’t test today because I tested yesterday and the day before (at 10 and 11 dpo) and both were negative, and I just didn’t want to see that shit again. Actually, they both had really faint second lines, but that means nothing because of the trigger shot I took less than two weeks ago. And the 11 dpo test was lighter than the 11 dpo test. So, negative.

Oddly enough, despite all of my initial optimism, I wrote this cycle off right after ovulation. I had no good reason to do this, aside from the fact that I am not a person who gets lucky. And I would have to get really lucky to get pregnant on my first medicated cycle. So, in my head, I’ve been looking ahead to the next round of treatment.

And, poor Artsy Engineer. I think this glass-all-the-fucking-way-empty attitude of mine has weighed heavily on him. And now in addition to feeling shitty about not being pregnant, I feel guilty for killing The Artsy Engineer’s hopes. And we’re both really concerned about finances. I make nothing, and The Artsy Engineer works for the state (and so makes just next to nothing). Our insurance does not cover anything related to fertility treatments, including ultrasounds. Just a simple, old cycle with nothing but Femara costs us nearly $500.

The Artsy Engineer and I took the dogs on a walk today. It was really nice out, especially for February in Wisconsin. The sun was out in full force and it actually felt kind of warm when it hit you. But, I was cranky the minute I woke up this morning. Not irritable, really; just pouty. A real Debbie Downer. Sometimes when I get like this, The Artsy Engineer gets pissed at me. Which is understandable. Even from the inside, I can tell that it creates a far from pleasant home environment. Anyway, we were walking. I brought up having to drop another $500 this week for treatments, and The Artsy Engineer pulled a surprising one on me.

It went something like this:

Artsy Engineer: Truthfully, Lentil, I am just not clear on how all of this is helping. We were able to get pregnant on our own back in October. That makes it seem to me that our problem is just a lot of bad luck and poor timing or something. I don’t see the point of these treatments if we did it ourselves once. It would be different if you were not ovulating on your own, but you are.

Me: What. The Hell. Are you saying? I thought we were both excited and hopeful about this next step. Are you hinting at wanting to pull the plug?

Artsy Engineer: Yeah, kind of. Nobody seems able to tell us why exactly this medication is worthwhile in our situation. And I am not one to just trust a doctor because she’s a doctor.

Me: Okay. You’re right. I have no fucking idea why it was recommended. Nobody has said, “Lentil, your eggs will be healthier if they don’t have to wait around in there for an extra week, which will lead to greater likelihood of pregnancy and less likelihood of miscarriages.” It was just recommended. And this is what I assumed. And we both seemed to think it was the right move.

Artsy Engineer: Well, I don’t know if I buy it anymore.

Great. Now look what I did. In all of pessimism, I finally rubbed enough of it off on my always optimistic husband. And, he is absolutely right. I don’t know the justification for this treatment. I don’t know why it was recommended. I feel like I’m just blindly following advice, which is not my style. My RE hasn’t really given me any more than “sometimes it can be helpful, so we will try this first.” Despite a long list of questions that I have in my head, whenever I actually go to the RE and she is finishing up and asking if I have any additional questions, I panic, forget everything, and tell her “no.”

And this also made me realize that he has definitely not come as far as I have in the process of accepting that what we are dealing with here is infertility. To him, it is still some combination of bad luck and sub-par effort or knowledge or something. If we could only figure out what it is we are doing wrong, we can fix it.

My blood hCG test is first thing in the morning, and I am not at all hopeful. I just want to stop putting progesterone into my vagina so I can get on with the next round.


* I don’t actually have a paying job. That would be too much to ask. I’m taking part in clinical training for my degree, which takes up many, many hours in my week and is unpaid. Yes. It is ridiculous.

Sick Day Sunday

January 27, 2013 § 8 Comments

Today is Sunday. For the last 5 years, since I started my doctoral program, Sundays have been work days. They are typically the day when I panic and start worrying about all of the things that I haven’t gotten done yet: the ongoing qualifying exam (which is only a couple of months from being done), several manuscripts that are in preparation, clinical reports that I haven’t finished, the dreaded DISSERTATION. By Sundays, I’m in the position where the anxiety of not getting enough done in the previous week is all but crippling and the knowledge (from hundreds of Sundays of experience) that I will not get enough done in the coming week is downright frightening. But.

But today I feel like I need a sick day. A mental health day. A trying-to-conceive-for-over-a-year-and-in-the-second-half-of-the-two-week-wait day. Today I am 9 dpo. I have a headache (don’t worry, this morning’s test came back negative). I woke up two hours before I wanted to. At 5 AM. On a weekend. Probably in anticipation of taking my temperature.

See, if I get pregnant on this cycle, I’ll be due in October. My birthday month. The month I lost my first pregnancy. And the month that I have to submit applications for my clinical internship. Friends, this internship process is a mess. I will very likely have to move to some other part of the country for it (there is only one of these positions in my whole state). It’s a year long appointment. And then I have to do a two year fellowship (which will likely be in a totally different location). But I’m getting ahead of myself.

For this internship, there is a matching process. You send out applications in October and go on interviews from mid-December to the end of January. There is really no way around it. You can’t not go to the interviews. You can’t reschedule them. There are specific “interview days,” so a site might give you 2-3 of these days to choose from. And you’ve gotta show up or else you’re not considered. People are basically out of town for as much as that 6 weeks as they are in town. Then you submit a ranking of your favorite sites, and the sites submit a ranking of their favorite applicants. And a fucking computer program decides where you’re going to have to move for the next year.

If I get pregnant this cycle, I’ll be due in October. I can manage getting my applications out early in preparation for an impending lentil. But I can’t imagine traveling for several days of every week for 7 weeks (if I get lucky and get a lot of interviews) within a month of giving birth to a baby, so November would a far from ideal due date. December-February would be even worse, though, because most airlines won’t let you fly when you’re in your last trimester. And, of course, being visibly pregnant at a job interview is never on the list of things you should do to increase your odds of landing a job.

We’re not going to stop trying. It’s taken us so long that I don’t want to miss any opportunities to create this child for us. But if it doesn’t happen this cycle, my immediate career plans might take a bit of a hit. I’ll have to see if sites will allow me to do phone interviews. And we all know that if everyone else is interviewing in person, and you’re interviewing on the phone, your odds are probably not as good. I’ve got a pretty warm smile, and I can’t let it do it’s magic through the telephone wires, y’all.

All of this is to say that I’m having a very bad day as far as two week wait days go. I usually don’t test so early, but I’ve tested every day for the last three days. They’re all glaringly white. Negative. Nada. Going into this cycle, I felt really good about it. Like weird intuitive good. Like this was IT. (I’m usually not so optimistic.) And now I just have my negative tests, an unproductive Sunday, a headache, significant irritability that is being directed at The Artsy Engineer (poor guy), and my empty womb.

I know, I know. It’s still too early to count myself out. But in my head and in my heart, it ain’t.

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