Anonymity

In general, I think it would be great if more people were more open about infertility. Awareness would certainly go a long way to dispelling the mythology surrounding early losses or the inability to conceive. I wholeheartedly support and admire those who are able to be completely open and up-front about your lives. And yet...

Family prejudices are different. Some of my family is religious enough to believe that there is a Reason for everything. The rest of my family is so stoic that they just think you should take what you get and be happy that it isn't worse. The Irish side of the family is bolstered in their beliefs by one of those stories that is rare but true, and they have taken it to illustrate their point of view about family planning.

My cousin married a lovely woman and had four perfectly adorable children. After the fourth was born, he and his wife consulted with their priest and all agreed that a vasectomy would be acceptable under the circumstances. He had the procedure done, it went well and that was that. Except - he never bothered to go back for his follow-up appointment. It was almost two years later that his wife went to the doctor complaining of exhaustion and nausea. The fifth child is a miracle, of course, and a lesson to us all not to presume to know what is best for us.

The fact that my cousin then went back to the urologist, made absolutely sure that there wouldn't be any more "miracles" and hasn't had any more children isn't really a part of the story. The story only serves one purpose, and it has nothing to do with following your doctor's orders to come back in six weeks for a post-op visit. Over the years, I have heard many quiet stories of miscarriages, lost twins, and barren aunts. There are also plenty of hurried weddings and very young brides. Managing fertility is not considered a task for mere mortals to concern themselves with.

The thing is, I love these people. They are the dears of my heart. But the only way for us to all happily get along is to keep certain topics completely off limits. So, they probably think that the reason I have never had another child is because I waited too long to have the first one (silly me, with that grad school nonsense) or maybe just because I am some heathen infidel who doesn't deserve to get what I want. Either way, if they knew I was trying IVF and then it failed, it would be forever just a poor sad example of the fact that everything happens for a Reason, and why can't I learn to accept that. My cousin and I would be flip sides of the same story.

The rest of my family isn't especially religious at all, but my mother has said, on several occasions, that my cousins are ridiculous in mourning their early miscarriages - that all women experience those and it certainly doesn't deserve to be treated as a cause of grief. Needless to say, I have never spoken to my mother of either my early losses. I had pursued the issue with her when she told me about a cousin's recent second miscarriage, but the contempt and dismissiveness that she used in describing the exaggeration of my cousin's reaction was enough to clinch my silence on the matter.

Reading other blogs has made this journey so much easier than it would have been if I had always felt as alone in this as I did a few years ago. So, I will share my story on the off chance that it helps someone else. And maybe someday I'll feel brave enough to put a real photo in my profile.

Tag!

Yes, it's true - Shelby has tagged me and now I must describe seven wacky things about myself. I figured this would be easy, since I am generally a bit of an oddball... but narrowing it down turns out to be the hard part.

..............

1. I have a rather large wardrobe of hats. Being a pale frecklish redhead in sunny LA, I don't go anywhere without a hat and sunglasses. I like plain canvas bucket hats or tightly woven straw ones. Absolutley no floppy flowers, no peacock feathers, no grosgrain concoctions.

2. I am one of those people who writes to their congressperson. Not sure if it makes much difference, but I like to think it might occasionally have an effect.

3. Even the thought of pumpkin pie makes me sickish.

4. I have desperate cravings for Pellegrino Limonata. I love the tart fizziness.

5. I almost never remember my dreams. I also never remember to keep a notebook by my bed so I can write down a dream in case I do happen to wake up vaguely remembering one.

6. I don't like products that have a smell. I don't want a scented lotion, scented conditioner, scented soap, scented dryer sheet, scented hair spritz - unless somebody is going to take a very intimate sniffing tour of my various regions, it is just going to be an herbal flowery stew of various marketing ploys. I do use lemon-verbena fabric softener, but it sort of just smells clean.

7. My belly button is such an inny that I can't see the 'bottom' of it.

..............

I'll have to tag some others later, since I haven't read far enough back in any blogs to see who has already done this one. But I promise to do it soon! Meanwhile, I am working on an explanation for my need for anonymity, and a fertility story that has become an instant legend for the rest of my family...

ETA - I hereby tag Claudia, whose blog gave me hope when I really, really needed it.

The Giant Bag

I had my calendar review yesterday and picked up my giant bag of supplies today. It feels like things are getting underway.

This giant bag had so much more in it than I am used to getting. This time I am following an aggressive protocol that requires lots of follistim with ganerelix to thwart ovulation. I do start with just a bit of lupron, and then there are a lot of subtle adjustments along the way, including some menopur as the cycle continues. I will also be taking a steroid, an antibiotic and an E2 suppository. Basically, you could put all this into a man and he would probably cough up some decent follicles.

I am still doing really well as far as maintaining my faux-blase (hmm, two French words in a row - I am practically bilingual, non?) attitude about the outcome. This is merely a scientific experiment, I tell you. Success is a possibility to be considered at a later time.

But the thing is, I know how much that's going to change. Those hormones have a devastating emotional effect on me. I become so desperate with hope that I can barely make it through a day without collapsing into my own sense of doom. I have read my journals from the times of other cycles, and it's like reading the diary of an insane person. It's not depression so much as hope, a hope that rises up because you are flooded with the very chemicals of hope.

I know that what's in that giant bag can change my life, can give me what I have wanted for seven years. But it will also crumble the buffers I've created to protect myself from seven years of disappointment and sorrow. I can tell myself that I am smart enough to know that my chances are slim, that being aware and being prepared will protect me from being disappointed. But I know it doesn't work that way.

Whiling Away

Tomorrow I have a one-hour call scheduled with the clinical coordinator to discuss my plan. I got all my calendar and lab work information, so I'm sure we'll go over that - but there must be more to it. At my old RE's office I was lucky if they could even find my chart, so I'm not used to this level of attention. Of course, if things had worked out at the old office, I wouldn't have cared a bit about their disorganization.

The differences between the offices are striking for two reasons: personalities and success rates. As a first-time IVFer, I chose an RE with whom I felt a personal, intellectual connection. We had both gone to school "back east", liked similar cultural activities and had traveled to many of the same places. We had oodles to talk about and I would have loved to meet her at a cocktail party.

I think she was generally very knowledgeable, but as an "unexplained" infertile, things were murky from the start. I did get pregnant with my very first medicated cycle, on something like a half dose of the smallest stim usually used. That probably complicated all my further treatment there, because after I miscarried - actually, it was technically a "missed miscarriage", meaning that although the heartbeat slowed and then disappeared after several weeks - my body never got on with the unpleasant business of expulsion. After a D&C, she said she had every reason to believe that it was just a matter of time before I was pregnant again. Pathology had shown a trisomy 17, which is not inherited, so she upped my stim dose and sent me on my way to try again. We muddled our way through a few more cycles and then moved on to IUI. The same thing (more or less) happened again, and we then we fumbled through two IVF cycles and somehow two years had passed.

If that was the boutique fertility clinic, this new place is the major department store. The new RE seems like a perfectly nice guy. If I sat next to him at a dinner party it would probably be fine. Maybe not scintillatingly memorable, but certainly not awful in any way. The thing is, I don't care any more. He seems dedicated, research-oriented and willing to discuss all concerns and options. The clinic has one of the best labs in the country and a thoroughness that tries to account for every possible reason that might thwart success. Of course, that's no guarantee, but it's better than wondering if maybe, if only, if possibly...

I wish I had known enough three years ago to just start here. I may never have another baby, and I'm trying really hard to maintain some kind of objective reality about that, but at this point, it's just nice to think that my chart probably won't be lost this time.

Smoosh!

I am stuck in the Doldrums of this cycle, the ongoing nothingness of waiting. Sure, I'm trying to maximize everything by taking the appropriate supplements, going to extra yoga classes, trying to get lots of sleep. My to-do list is full of cycle-related things, but they are usually the same every day - vitamin, wheatgrass, exercise.

I did finally get my first mammogram. I've heard that "it's not so bad" compared to the mammograms of the past, but I didn't really know what to expect. I went to a semi-fancy outpatient imaging center instead of a hospital, which automatically made things better since it didn't smell like pee and antiseptic. It was more like a spa, with orchids in the dressing room.

The mammography room itself was very clinical. The machine has an adjustable platform with a motorized control - like a dentist's chair- that the technician positions just at boob level. Then a top plate - also dentisty- comes down and very gently flattens you into a nice boob paillard. It only takes a second and the tech releases the plate from her station the instant the imaging is over, so you don't even have to wait for her to come back and let you out of the contraption. After doing each side in a sort of flattened out birds-eye-view, the tech adjusts the platform to a 45 degree angle and gets a diagonal view, too. That one squishes the chest muscle, squeezing the armpit-adjacent area. But again, it's quick and the release from the remote station should be given some kind of engineering award.

Since it was digital, the technician let me see each image as soon as it came up on screen. Of course, I'm not an expert, but there weren't any areas that looked particularly different from the rest of the image, which I figure is a good thing. The tech actually said that the doctor would send me an all-clear report in a few days, which surprised me since techs usually maintain completely inscrutable attitudes and defer all questions to the doctor. I figure it's pretty safe to assume that all is well, and relief to know that at least my boobs aren't malfunctioning.

Now I can go back to cajoling my other womanly parts into forced compliance.

Stagnant & Chaotic

I am officially grumpy after a week on the pill. Grumpy and nauseous, a winning combination. I know the only thing to do is just try not to think about it, but my stomach is practically twisting itself into a nifty balloon animal - not so easy to ignore.

This month is, predictably, going very slowly. The excitement - Needles! Follicles! Fentanyl! - won't really kick in for a while. And my natural cycle coincided with the October cycle at my clinic in such a way that I have almost four weeks of this holding pattern. So, I'm doing what I can to make the most of this time, and that includes a visit with a new acupuncturist.

My former acupuncturist moved last year, and I haven't managed to bother finding a new one. It just hadn't ever really made much of a difference. Nice to relax in the middle of the day, but I never felt it was much of a remedy for anything. But I have read so much about acupuncture and fertility, and this is my go-for-broke cycle, that I figured I'd find someone who really specialized in IVF treatment support, and see what happens.

This practitioner will work directly with the RE to optimize the cycle. She did find the same general problems that my last practitioner found - apparently my liver channel is stagnant and chaotic. Seems contradictory, but here's the thing: when she put the needles in for those areas, I felt a sizzle zip through my body - I can't deny she was onto something. I have had acupuncture for pain after a car accident, for allergies, and for migraines - but I have never felt partially carbonated before.

She also told me that migraines and infertility are significant in Chinese medicine. My migraines are few and far between, but I do get partial loss of vision and severe nausea and vomiting. In some ways, it would be easier to explain my infertility in terms of blocked chi . I've always been "unexplained", and as the years went by "advanced maternal age". The idea that my stagnant liver is the problem - that stagnant liver can be fixed, more to the point - sounds just dandy to me.

Other than acupuncture, I am trying wheat-grass juice, restorative yoga, and Cheyzn - a zinc-iron-copper supplement that I get from my chiropractor. Kinda moonbeamy, right? But, after all, I am doing high-tech IVF with all the synthetic femininity modern science has been able to concoct. I figure if a shot-glass of oozy green sludge might help, why not?

Middle-Aged Uterus

Teen-aged skin.

HATE the pill - must go find out if they still make clearasil.

Raining Down in Texas

Probably the closest I've come to actual danger was a Texas flood that my family was caught in when we were on a car trip across the country back in 1981. I was thirteen years old - grown-up enough to sit in the front seat while my mother dozed in the back with my little sister. It was dark and we were still a few hours from the motel we had booked for the night. We had stopped a few times to see if we could get another room, but there weren't any vacancies. The rain was strong and steady, but the roads were flat and wide, so we decided to push on.

We kept the radio on and drove slowly - the visibility was terrible but there wasn't much traffic. There was a flash flood watch in effect, but we were on the interstate, with steep embankments on each side and miles of asphalt in either direction. It seemed unlikely that rising water would be a problem for us - we were more worried about traffic hazards or car trouble. I kept an eye out for exit signs and my father drove slowly through the sheets of rain. I remember thinking it was like a drive-through car wash gone out of control.

Everything was fine until we got off the interstate. In those days before gps and map-quest we had find our own way with fold-out maps from the triple-A. We followed the main road to the one leading to our motel, driving further into residential neighborhoods. We were only a few blocks from the turn-off to the motel when we saw people running towards us. My memory confuses the scene with a night of trick-or-treating. I'm sure there weren't any costumes, but it had a similar quality - families out in the dark together, moving slowly cross the street and holding hands. We didn't know that we were following a creek, that the creek had jumped the banks and was flooding the homes on that side of the road. But we knew something was wrong, so we stopped.

My mother had woken up and was shaking my sister. There was some kind of quick argument about whether we should just go on or get out of the car. I think we were going to try to keep going, but when my dad tried to start the car the engine was flooded. We could see the water rising as if it were a playback of time-lapse photography. In the time it took to figure out if we could manage to take anything with us the water started to come in the the car. When I opened the door it was so heavy I thought I would have to go out the window, but as I pushed the current flung the door outwards.

We only had to go about fifteen feet to higher ground. All of the yards on that side of the street rose up steeply to houses with lights on, silhouettes of people moving in the curtained windows. Some of the people who had been wading from the low side were being welcomed into a nearby house, so we tried to make our way there, too.

The minute I stepped out of the car my feet were swept out from under me. My mother later said that if I hadn't grabbed the car door she would have had to let herself be dragged after me in the hope that the current would carry her to find me. (To this day that is the single most maternal thing she has ever said to me.) I had already let go of whatever I had been carrying - I think it was a little blue canvas zipper bag with a rainbow sewn on the pocket, although honestly it could have been something my parents told me to carry. My shoes were swept off my feet, which somehow made it easier to walk through the rushing water.

I tripped on the curb, but the lawn rose so steeply that I more or less crawled up onto it, and suddenly I was safe. My mom was leading my sister towards the house with all the people on the porch, and my father was looking back towards the car, which was slowly heading off down the road without us. I never saw that car again, but when my father found it the next morning everything had been washed out of the interior - the seats, the steering wheel, the radio. All of our luggage from our trip was gone. My mothers purse, my rainbow bag of lip glosses.

For me, everything changed that night. It was the first time I had ever known real danger, felt at risk of something more than a scrape or a scolding. Before that I had felt that danger was something you prepared for - we did duck-and-cover drills in school, and I knew where to go if there was a tornado watch - but I hadn't realized life could change in an instant, just when you least expect it. As an adult, I realize that the most change is often catastrophic and unexpected, that the changes you plan and work for aren't so much changes as evolutions.

I've been checking on Hurricane Ike all night, thinking about that Memorial Day trip and hoping that all is well in the morning.

It's Official

Sometimes it's hard to know when an IVF cycle really starts. I took the first BCP today, so I am officially tinkering with the system. My transfer is supposed to be at the end of October, with a chance that it will actually be on Halloween. So, it really is going to be trick-or-treat for me this year. I wonder where I should put the big bowl of candy?

Speaking of candy, I am already nauseous. It started about fifteen minutes after I took the first $2.50 pill. I can't believe these things are so expensive and completely not covered by my insurance. My last RE gave me three months of free sample pills - although, she also failed to do much investigating into our possible problems. I guess I'm happy to pay for the little things if the fancy RE takes care of the big ones.

In other weird 40+ news, my clinic has decided that I am not actually 40+. Since I am only just barely 40 they have waived all of the over-40 requirements. I have no idea how this works - I figured you are either under or over - maybe on your actual birthday you can claim to be neither, but... whatever. It's nice not to have to wrangle big tests out of my primary care doc. I'll still do the mammogram since I have never had one. 40 may be the new 30, but it's still the old recommendation for a baseline boob-smoosh.

I have at least a month of these damn BCPs, so it's going to be a long cycle. I can already tell that it's going to be hard not to get my hopes up.

Getting Ducks, Putting in Row

There is a very long list of pre-cycle testing at my clinic. On top of all the regular tests and bloodwork, there is an "over-40" set of general tests. I have been ticking the boxes - pap smear, saline ultrasound, communicable disease panel. Now I have to have a chest x-ray, an EKG, a mammogram and more bloodwork. The trick is to figure out how to get these tests covered under some other lab code sice my insurance won't pay out for anything related to infertility treatments.

Today I finally got the results of the day 3 hormone test - the one I've been dreading. Anything under 10 qualifies for the package deal at my clinic, and since I have already been through two failed IVFs I really wanted the safety net of an extra cycle if I need it. Plus, as silly as it seems, the idea of being deemed too risky for the shared-risk group depresses me. It's a psychological boost as much as a financial one, really.

Anyway, I just squeaked in under 10 - 9.6. My last one was 6-ish, but that was a few years ago. Maybe it's just a technicality, but that .4 means a lot to me. I just feel a teesy bit less doomed - not exactly optimistic, but hovering around neutral. Which is, all things considered, not so bad.

Who, Me?

I know I'm lucky. My daughter was conceived easily, I had an unremarkable pregnancy and a birth that went mostly as planned. I was never especially concerned about any of the possible complications that could have arisen. I took my prescription vitamin and went to pre-natal yoga classes and stayed away from oysters.

I was blissfully unaware that there was much of anything to worry about. I was the first of my group to have a baby, and I was much more concerned about how to manage life after the baby was born than anything that might happen before that. My friends would ask what I was going to do about stretch marks and whether or not I wanted to have an epidural. It all seemed so mysterious, but I never thought of it as fraught or perilous.

The very idea of infertility was so peripheral to my life that I didn't really wonder why I wasn't pregnant again until years had passed. During that time my mother-in-law had become very ill and my husband had to split his time between work and flying home most weekends. Then I was rear-ended by a school bus and could barely move for months. Actually doing any of the things required to get a baby going was completely out of the question. By the time I finally asked my OB if we should run some tests or something, my daughter was five. We had never used birth control.

Somewhere, in the back of my mind, I knew something was wrong. Even though my OB was sure it was just a matter of hectic scheduling - she sent me home with an OPK and said I'd be pregnant in a jiffy - I was beginning to suspect that the second time around wasn't going to be such a cakewalk.

Like Buying Socks

So, I've anted up for the next cycle. I still don't know if I'll be allowed to play in the three-for-two game, but the package deal for 40-and-over isn't really one of those money-back plans, anyway.

If I qualify (after a clear HSG, genetic testing and an acceptable recent FSH) I can pay for two cycles up front, and get a third (should I need it) for free. If I only need one, I just consider myself incredibly lucky and am given a small, ceremonial refund. If I only need two, I am grateful and go on my way. If I need three, I try to be happy that I have one more chance without paying anything else. If all three cycles fail, too bad for me.

My old RE didn't offer package deals, so I've never had to make this decision before. But maybe it makes sense, considering that the idea that it will work the first time seems so unlikely. I have never had an IVF work, so I'm actually at a point where the idea of paying double for a successful first cycle sounds pretty good to me.

I should get the latest FSH results next week - I think that's the one I have to worry about.