Sunday, March 29, 2009

Thanks, But No Thanks

I was never completely freaked out that my cousin and my sister both announced pregnancies last year. After all, I had a new RE, an aggressive protocol, and then - I was actually pregnant myself. I was able to really be happy for them, to ask how things were going, if they had thought of names, etc. It was, you know - normal.

They were due within a month of each other, but ended up delivering on the same day in January. One was overdue with an extremely large boy, the other a few weeks early with twins. I was still pregnant at the time, happy for them, thinking how great it was that all these kids would be so close in age. They would grow up together the way the the five of us who were all within a few years of each other had. Nice.

Today my mom called happily yammering away about seeing my cousin's twins, visiting my sister for a month, letting me know that my cousin will be here next week and that she wants me to meet her babies...

Is my month up, or something? Was that my window of sadness and now I'm supposed to go back to the way it was when we were all having babies together? Isn't it enough that I will have to have these reminders with me for the REST OF MY LIFE without having to go be all smiley and coochy-coo before I can even manage to get through a diaper commercial?

I love my cousin, and of course my sister. I'm so happy for them, especially because they both had crappy romantic experiences and waited a long time for this. I really want to be a good aunt /whatever your mother's cousin is but do I have to do it next week? I just can't believe my mother didn't even ask if I felt okay about any of this.

This is why I don't discuss any of this with her. It's like, if she has to be told how to be empathetic it doesn't really count.

Thursday, March 26, 2009

Cycle Day 165

Not really. I mean, I haven't had my period since October, but I guess pregnancy will do that to a gal.

I am still waiting for my first period after the D&E. If all goes according to the outpatient instructions, it should be soon. Like, Saturday. But what are the chances of that? And what are the chances that I will be my old regular 28-day self afterwards?

The only reason I care is that my clinic has a late April cycle, and I may be able to get away with no BCPs if my periods cooperate. The antagonist cycle I'll be on starts on CD1, and if I can get in sync with their start dates I can do a "natural" cycle. Which is such a silly thing to call it, of course, but if it means I don't have to take the pill I won't quibble about semantics.

I feel so neutral about cycling again. I'm stuck somewhere between just ending this all and getting on with the rest of my life and knowing that I will always wonder what would have happened if we had tried. None of my feelings are especially related to hope that this will actually work. It's more about closure. Either I get it from actively deciding that I am ready to be done with this or having the point made by BFNs. I think there is a sense of control over the process if the choice to stop is mine, and that it can be meaningful to feel that there is something to control about any of this. But it's hard to weigh that against the sense of regret that might surface, over and over, if I don't pursue this, at least to the extent that I have already paid for two more cycles. I am torn, obviously. There is something so attractive about being the strong, practical woman who realizes that her life is already so good, so lucky in so many other ways.

My daughter says, "Aren't I enough?" and of course she is. No other child could be as perfect for me as she has been. Any new child would never be able to have those ten early years with me, often just the two of us because my husband traveled so much for work. Even when we would join him in the more appealing locations, we were mostly alone together in a strange place while he worked all day. We would make our way through foreign cities, trying to figure out menus and public transit and where the best ice cream/gelato/glace could be found. No matter how much I could love another child, it would be impossible to have that kind of experience together.

So, what is it that draws me back in, that makes the idea of jabbing myself with hormones and taking steroids for months seem like the right thing to do? Is it just some biological imperative - Reproduce! - that keeps me going, hoping, trying for something that is most likely to crush me emotionally? I keep thinking that trying again but maintaining an "expect nothing" frame of mind is the way to go.

But - it just doesn't work that way, does it?

Saturday, March 21, 2009

Big Envelopes

Yep - all three schools accepted her. Now we just have to choose...

It's been so much like IVF that I can't help the comparisons. You do what you can, cast your luck out to the discretion of whatever kind of fate you believe in, and hope for the best. And, too often, there is nothing but disappointment and bad news at the end.

I guess I really needed this more than I thought. It's just affirmation that the process of working towards something and being as prepared as possible and knowing that all the variables are covered actually can amount to a positive outcome. Somehow, infertility has undermined my confidence that things can actually work out well. Not a good mindset, even if it does protect you from Too Much Hope Syndrome.

Thursday, March 19, 2009


No, silly. I'm not talking about some kind of Oprah-esque realization that even when bad things happen they teach us something about ourselves, blah blah blah. Although I agree with that idea in theory, I am just not able to get to that point in less than a month.

What I'm talking about does sometimes seem a lot like an IVF cycle. You do everything you can, you go through all kinds of tests, you interview at all the places with the best reputations, you decide you're willing to spend an enormous amount of money in hopes that you'll get what you want in the end. It's a roll of the dice, and sometimes it seems like it only works out for people who don't even really care that much in the first place...

The private school admissions letters come out tomorrow.

Monday, March 16, 2009

So, Hmm...

I've had all kinds of appointments, and although I'm waiting for the next round of blood testing, it seems like I'm good to go. If I want to go.

Do I, though? Really? Does it make sense to put myself through all of this again when I could just be happy that I have my daughter, that the three of us have a really great relationship, that this could so easily be enough for anyone? We take our bikes to the beach, knit lots of lumpy scarves, play ping-pong outside after dark, cook together every day, read gofugyourself together... why would I want to throw poopy diapers into that mix?

Ten is my favorite year yet. I do tend to say that every year, but the point is, I am not looking back on those early years longingly, wishing that my daughter was "little" again. It's not that I didn't like those years, it's just that now things are less exhausting. I know that the teenage years are looming, but she is so affectionate and thoughtful and smart, it just seems impossible that things will deteriorate too drastically. (I know, I know - famous last words.)

I've been thinking about this all weekend, wondering why I am so determined to keep trying, to keep hoping the next IVF will actually work, to keep going when the chances are so slim and the expenses are so huge. And maybe it doesn't make any sense. Even though I still have two tries left with my 3-for-2 contract, the cost of the stims and possibly doing CGH this time mean it will still be a lot. Really a lot, since stimming on my protocol is like plunging car payments into my belly fat. Not to mention that if I do somehow get pregnant I'll probably be a nervous wreck most of the time. And yet...

I still want it. So, I'm tentatively on for the end-of-April cycle, mulling over the idea of doing CGH and starting acupuncture this week. Wheatgrass, CoQ-10, Cheyzn, extra zinc, 2 mgs folic acid (helps with the Protein S) and extra Bs. Am I leaving anything out? Link

Tuesday, March 10, 2009

Lab Results

Somehow, I knew there would be an explanation.

I think the little rehearsed condolence that my OB presented me with at that horrible ultrasound appointment was just something that she learned in medical school. It was too standard, just a clueless assurance that this child must have had some terrible problem and how hard it would have been to deal with those kinds of difficulties after birth, and that I shouldn't worry that it was because of anything I had done. And maybe most people really need that, just a blanket of semi-medical sympathy and a sense that it was "for the best".

Except that in my case, it wasn't.

My labs came back with extremely low levels of a protein that inhibits clotting, and high levels of anticardiolipin antibodies. The protein is "S", which decreases throughout pregnancy anyway, so if the levels are already low you may be perfectly fine until the second trimester, when they really begin to plummet. The anticardiolipins indicate an immune response disorder. The crazy thing is, I've been tested for both of these things twice before since they are part of the standard "recurrent miscarriage" workup. Apparently, you can acquire some of these blood disorders at any time, including....when taking IVF medications.

They don't know for sure that IVF triggered this change. They don't even know for sure if clotting is what ended this pregnancy. They also don't know if my S levels will go back to normal in a few weeks (typically they are very low at delivery and go back up to normal within six weeks). They'll retest for the ACA, too, as well as a jillion other things, but the bottom line is that even if my S is normal next month, it could be that it just gets too low when I'm pregnant.

All clotting problems are worse as people age, so the fact that I had an easy pregnancy almost eleven years ago doesn't really have anything to do with this. Plus, at the time I was on baby aspirin because I supposedly had a mitral valve prolapse (a floppy valve in the heart). I had partially lost my vision one night and was told that the floppy valve can push clots to the optic nerve. Later it turned out that because MVP was overdiagnosed for a long time, my doctor had me rescanned with better equipment and there wasn't even a suggestion of prolapse, so I've been off the aspirin for years. (I have lost my vision again since then, but it turns out to be a precursor to incredibly bad migraines.)

Of course, it just wrecks me to think that a baby aspirin could have changed all this. I had even asked if there was any benefit to aspirin during my IVF cycle, and was told that because I have reflux problems and was not taking any of the acid-blocking medications I should forego all aspirin. Which made sense at the time. Reflux makes my asthma worse, and breathing seemed like an important part of pregnancy.

Okay, when I look back at what I have just typed I feel like I am such a collection of medical problems. Lung, stomach, blood, vision - no wonder evolution doesn't want me to procreate. But I swear I am not some kind of semi-invalid just trying to survive day to day. I feel really healthy most of the time. As long as I don't eat too many tomatoes or sniff a cat I am basically fine. Unless I try to have a baby.

Wednesday, March 4, 2009

Appointment With Dr. Google

As you can imagine, I have racked up quite a few hours googling anything related to second-trimester miscarriage, loss, cause and the like. I have a pubmed password and a research-librarian friend who can get me almost anything else that needs a subscription. I have slogged through countless articles, not because I'm looking for some magic aha! nugget of information that will somehow explain my loss, but hoping for a better understanding of what to ask about, test for, or consider in the vaguely possible scenario that I actually get pregnant again.

I have found THE SITE, the holy grail of actual useful medical information when considering recurrent miscarriage or a fetal demise. And, it's not even password protected! Plus, the writing is lively and the categories are well-organized. So, here it is: Early Path - a reproductive pathologist's understanding of the various things that can go awry in a pregnancy. This may not be useful for most of you, but it so perfectly encapsulates so much of what I have had to dig through, I just had to link to it, if for no other reason than to be sure I can find it later.

I am not a sentimental girl. I am emotional, sure, maybe even overly teary at times - but in the end I am practical above all else. I am happy to have actual reasons to test for things, wait a certain amount of time, and try new therapies on the off-chance that they may work. This site gives specific reasons to wait a few cycles before trying again - reasons having to do with the uterine vessels cleaning themselves out of the debris from a miscarriage - which is so different from what you usually hear. People talk about getting your "schedule" back to normal, which seems to have more to do with ovulation, or checking E2, which is more about the lining. The idea that the vessels may need to repair themselves is a whole new consideration. But I can tell you, if there is the chance that my vessels may not be sufficiently recovered, I am not going to risk another IVF cycle.

I have an appointment (pants on) with my RE tomorrow, just to go over my last cycle and discuss what we might do differently. I figure the chances of actually getting pregnant again are fairly slim. But the chances of a late miscarriage are <5%, and excluding cervical problems are more like <1%. So, I'm already operating in the realm of the very few. At this point, another round of stims doesn't even seem like a big deal. And, if I wait two more periods before starting the dreaded BCPs, not only will my vessels be ready, but I should even be able to fit back into my regular pants again. And at least that seems like an attainable goal, regardless of whatever else may or may not happen.

Monday, March 2, 2009

Moving On

Thanks for all of your kind comments while I have been trying to get myself through these last few weeks. I can't imagine how it would be to feel that nobody has the least idea what this has been like. It's sad that anybody has to know, but in the absence of a solution for that problem, it's comforting to have such empathy and understanding from others.

That, plus a massage therapist, a chiropractor, a facialist, a hairdresser and a trainer - enough experts and I might somehow emerge from this experience relatively unscathed. If I add all of these expenses to the total IF tab, though, I may actually faint dead away. Luckily, our trip to Hawaii was booked on credit card miles and the very convenient fact that my husband's brothers run hotels on two of the islands. (Needless to say, it is our standard getaway.) Still, the financial toll of infertility is just ridiculous at a certain point. The emotional toll is impossible to measure, but I think we all know that it's steep even if you do eventually get the happy ending.

I had my post-op OB appointment today. This is the first time I've ever felt really confident that all of my online research actually gave me a complete understanding of my options - that scouring pubmed articles wasn't just a random and spotty education. I had researched each component of every article that even slightly pertained to my experience, and I had figured out how to filter for my age and for my first trimester test results. Suffice it to say, I had ten vials of blood drawn, I will be tested for everything I asked to be tested for and I have an appointment with a genetic counselor on Friday.

Other than that, I am starting to feel a little bit sort of normalish again. Maybe it's just that the supplemental estrogen is out of my system, but I feel like I might be able to function like a human being again. My OB thinks I will probably get a period in about two weeks, which is a good sign - sometimes it takes the body a while to readjust, but she thinks I am about to ovulate, so maybe feeling somewhat back to normal is just a side effect of actually being somewhat back to normal?