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.
Saturday, March 21, 2009
Thursday, March 19, 2009
Acceptance
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.
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?
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?
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.
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.
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?
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?
Thursday, February 26, 2009
No Answers, and One Big Question
The post-op visit was so basic I could have done it myself. The ultrasound looked perfectly normal, no weird dark spots anywhere and my lining is fine. The premarin apparently did it's job, which was to kick-start the lining growth so no scar tissue could form, and I am officially "fine". Well, as far as my uterus goes.
I didn't get much in the way of answers. I understand completely that this doctor's main concern is that the procedure went well and there are no lingering complications, but a little more information would have been helpful. I can only imagine that it isn't pleasant to discuss too much of the procedure with the patient, and she had certainly perfected her evasive tactics. Basically, I got the "every situation is different" story, and other assorted non-committal answers.
I have to have another post-op visit with my regular OB on Monday, which means I have to sit in a waiting room full of pregnant people. I can't imagine she'll tell me anything new, either. And so much of what I have found by googling "second trimester IUFD" are professional practice guidelines to guard against lawsuits, so I can imagine that part of her concern isn't really about me. I know she wants me to see this as ultimately a good thing, that the baby would have had problems, blah blah blah. But I've done enough research to know that it is impossible to make the assumption that this was a genetic abnormality. The screening could just as easily show an abruption (increased AFP) and demise (increased hCG). I really just need a copy of the actual report and an appointment with a genetic counselor.
Of course, the reason I really want to know if there was something other than a terrible genetic abnormality is that everyone keeps asking me the same thing: are you going to try again? Don't people realize that there is probably a reason I have a ten-year old with no siblings? If it was that easy to just have another, then surely I would have a slew of kids by now, right? So, if some other issue contributed to this, I definitely want to suss it out before risking this again.
I did buy the three-for-two package at my IVF clinic. The contract is good for one year, so we may still have time for two more tries. Right now our inclination is to start right away. I am too old to wait six months, grieve and recuperate and get my groove back. It's not "now or never" so much as "maybe or never." I can't imagine having any kind of hope at all even if I do manage to get pregnant again, but maybe that makes it easier, somehow?
I didn't get much in the way of answers. I understand completely that this doctor's main concern is that the procedure went well and there are no lingering complications, but a little more information would have been helpful. I can only imagine that it isn't pleasant to discuss too much of the procedure with the patient, and she had certainly perfected her evasive tactics. Basically, I got the "every situation is different" story, and other assorted non-committal answers.
I have to have another post-op visit with my regular OB on Monday, which means I have to sit in a waiting room full of pregnant people. I can't imagine she'll tell me anything new, either. And so much of what I have found by googling "second trimester IUFD" are professional practice guidelines to guard against lawsuits, so I can imagine that part of her concern isn't really about me. I know she wants me to see this as ultimately a good thing, that the baby would have had problems, blah blah blah. But I've done enough research to know that it is impossible to make the assumption that this was a genetic abnormality. The screening could just as easily show an abruption (increased AFP) and demise (increased hCG). I really just need a copy of the actual report and an appointment with a genetic counselor.
Of course, the reason I really want to know if there was something other than a terrible genetic abnormality is that everyone keeps asking me the same thing: are you going to try again? Don't people realize that there is probably a reason I have a ten-year old with no siblings? If it was that easy to just have another, then surely I would have a slew of kids by now, right? So, if some other issue contributed to this, I definitely want to suss it out before risking this again.
I did buy the three-for-two package at my IVF clinic. The contract is good for one year, so we may still have time for two more tries. Right now our inclination is to start right away. I am too old to wait six months, grieve and recuperate and get my groove back. It's not "now or never" so much as "maybe or never." I can't imagine having any kind of hope at all even if I do manage to get pregnant again, but maybe that makes it easier, somehow?
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