Ready, set, …um?

Infertility is a mindf*ck. I could write a whole series of posts on how this process has changed me– little of it positive. Yeah, yeah… I know. Find silver linings and all that other bullshit, but I also believe in letting myself have all the feelings. Like even the bad ones.

Of the many side effects, I learned how to navigate the complexities of treatments. I learned to not have expectations on timelines or outcomes. Full throttle it armed with copious notes, spreadsheets, and injectibles, knowing that none of it was given. Expect to be let down, frustrated, disappointed, then go back to my well of resilience and hope there was still something left.

Oh, the arguments I had with my insurance. The test results that came back inconclusive, resulting in more tests that confirmed or denied nothing.

I learned that this is hard.

When I made the appointment with Dr. Petrel a few weeks ago, I was preparing myself to get back into the arena. I was suiting up– filling out forms, calling my insurance, going through my timeline to familiarize myself with the jargon I had willfully forgotten in the last two years.

Mr. O and I went in to see Dr. Petrel together with an agreement– we’ll try our one frostie, but only if it looks like it will survive thawing and be a good candidate for implantation. If not, fine. No more extreme measures.  

I went to my appointment yesterday ready to try to start, with the full expectation that I would walk out with a list of more questions. I brought a notebook so I could take notes because I remembered how easily my heart could make me numb in doctor’s appointments.

I also remembered how miserable waiting rooms are. How you look around at the other people in the room and wonder where they are– are they on their 3rd IVF cycle? Did they just learn they were pregnant? Are they like me or are they one of those “freaks” who gets pregnant without really trying?

But before I could start building their stories, Dr. Petrel appeared in the door and ushered Mr. O and I into her office. She was just as I remembered- kind, upbeat, but also no bullshit. She got right down to business.

Petrel called our embryologist. Our embryo is stellar. It Triple A bonded, or whatever grading system they use. She suspects it has a 95% chance of thawing. So what we need to determine is how my uterus is doing post pregnancy, though since my periods have been pretty regular in frequency and flow, she is optimistic. Still, I’ll need a sonohystogram to make sure, and a few blood tests to make sure my thyroid is behaving.

Then well, that’s it. A sonohystogram, a check on my hormones, then we can get this baby-making started. Depending on those results, I could even technically just introduce the embryo as part of my natural cycle. No (or I should say, fewer) drugs required. Theoretically, our cycle could start in November, almost exactly when the cycle that begat Chick began.

I walked out of the office in a haze. What? Isn’t this supposed to be harder? Isn’t this supposed to take longer?

More importantly, am I really ready for this? Then again, are we ever?

Endurance

I did it.

I made an appointment with Dr. Petrel to talk about Part Deux. This time around, it all feels very different.

a) I got an appointment almost immediately, rather than having to wait 10 weeks like before. I will be seeing her in just two weeks. Eeeek! I supposed this is one of the benefits of being an old-timer in the IF community- less waiting. In truth, I know this is only the beginning of a long series of tests, arguments with my insurance, and so much more. But I appreciate that there was one less hoop to jump through. Or perhaps just a shorter hoop.

Touched Up no sharpening

If my reproductive system were a ship

b) Maybe it’s because this is not my first infertility rodeo, but I feel less apprehensive. I don’t know if that’s really the word I’m looking for. Before I would hold my breath waiting for every test, sure that one of them would reveal the truth of why we couldn’t get pregnant. This is one of the downsides of an “unexplained” diagnosis. You don’t know anything, so it seems like the problem could be everything. In my craziest moments, I was convinced tests would come back explaining that I didn’t actually have a uterus. Thaaaat’s what the problem is! Now, it seems like the next few months of tests are more like fact finding rather than waiting for a death sentence. Like an adventurous exploration of my lady bits to see if they can be colonized, rather than say… Shackleton’s ill-fated Trans-Antarctic Expedition. (Spoiler Alert: it didn’t end well.)

c) If I’m 100% honest with myself, I’m also much more at peace with whatever outcome. We have one frostie in storage, and Mr. O and I have agreed we’ll give it shot. Yes, I would like to have another child or I wouldn’t be doing this. At the same time, Chick is lovely. Our family is lovely. If it turns out we stay a trio rather than becoming a quartet, it’s okay. That’s not to say that I won’t feel sad if the transfer doesn’t work, I miscarry, or any of the other things that could stop a pregnancy before it really starts. But… well, the stakes don’t feel quite as high.

Maybe my mom’s death and becoming a parent in my own right have changed me– I now know worrying about every potential wrong turn doesn’t actually prevent any of it from happening. Preparedness doesn’t really count for much in the end. Endurance, the ship sailed by Shackleton, was built for maximum durability by expert shipbuilders. No one could have foreseen the storms and conditions that caused the crew to abandon her. The ship was eventually crushed, while her crew drifted for months on sheets of ice. And yet this expedition is often described as one of the best examples perseverance when all hope is lost.

Shackleton and every one of his crew members survived.

Heartbeats

Yesterday, Mr. O and I went in for our 6 week ultrasound. I’d been nearly convinced that I would get there, and they would tell me that there was, in fact, no baby inside. A Hot Wheels car? A Hershey’s Kiss? What about a Hermit crab?  All these things seemed much more plausible.

So imagine my genuine surprise when the ultrasound tech found a tiny lima bean hanging out in my uterus. A tiny lima bean with a tiny flickering heartbeat. Fluttering like a small hummingbird. It was awesome.

Afterwards, we met with Dr. Petrel. She was her usual peppy, matter-of-fact self. According to how my little hummingbird is progressing, we have a due date of August 13th. It now feels real.

Mr. O and I sat in her office a little gobsmacked. I completely lost control of my brain. All the smart questions I wanted to ask about potential complications, medications I should be taking, physical activities I should be avoiding… GONE. I just stared ahead at her file cabinet.

In the meantime, Dr. Petrel went over the results of our IVF (besides the obvious successful implantation.) As you all know, I started out with 13 oocytes, 10 fertilized, and then only 3 made it to Day 3. We implanted one, and we have one leftover. That embryo is in excellent condition, we are told. It has a very high grading- it is practically a valedictorian. So if we want to do this again sometime, we have one lovely embryo for FET.

I could feel the conversation winding down, my opportunity to ask all my questions being gently ushered out the door. It’s like that moment in A Christmas Story, when Ralphie is losing out on his one chance with Santa. I was blowing it! Blowing it!

So I quickly spewed all my questions, in no particular order. And as always, Dr. Petrel gave me concise, articulate answers. Some highlights:

  1. We didn’t have a lot of embryos make it, which may have something to do with my egg quality. But it may not. In her eyes, getting pregnant is a little bit like the lottery. So many things have to go right, even if you’re starting off with quality ingredients.
  2. We basically got an entire years worth of trying out in one shot (12 months in a year, 13 oocytes.) Of those 13, 2 were viable. If we had waited another year of conceiving naturally (when I’d be 37) then egg quality would be of a bigger concern from her standpoint.
  3. I can exercise, but nothing crazy. Some light jogging is okay, and nothing that elevates my heart rate over 140. So no more half marathon training for me. The reason they want you to keep things light after IVF is because your ovaries are still very swollen, and there could be some twisting if you’re not careful. (Twisting ovaries. Ouch.)
  4. I can stop taking just about all my meds. My PCP before I moved to Dr. Finch had me on so many damn vitamins which I don’t need. (Given her lackadaisical attitude toward my care, I am not surprised.) I’m now just taking a prenatal vitamin and continued progesterone. No more estrogen patches, fish oil, or additional Folic Acid and vitamin D.
  5. We have another ultrasound in 2 weeks. At that point, we will be considered a “normal” pregnancy. Like this whole IVF thing never happened. I will part ways with my beloved Petrel and will need to find a regular ol’ OB/GYN.

Though still not elated (as I’ve expected myself to be this whole time,) I felt tons better after the appointment. I don’t want to count my ostriches before they hatch (HA!) but I started to feel like maybe this would work out. Maybe the hardest part would be over.

Remember: this is my life we’re talking about. There is no joy without pain, no sunshine without rain.

I get back to work, and actually work. Since I was not fixated on my fertility, I was able to get down to business. So many spreadsheets! There were even graphs and cogent conclusions based on said graphs! At around 4:45, I started to wind down when I got an email from my dad.

On Friday, my mom’s condition took a weird turn. Among a few complications, her heart has started to act “weird.” (Weird. It’s a medical term, I swear.) It will stop for a few seconds, then start up on its own. Her surgeon is recommending that we sign a DNR on her heart. And my dad wanted to talk about it with me and my siblings.

The sad poetry of all this isn’t lost on me. My mother’s heartbeat starts to give out on the day I learn I have two.

All By Myself

Yesterday, I went in for ultrasounds and blood tests for day 4 of stims. On one hand, I’m extremely grateful that Dr. Petrel’s office has early morning appointments. On the other hand (the hand attached to this non-morning person,) I’m thoroughly displeased I had to be anywhere at 8:15 in the morning.

The appointment went smoothly. I got in, got my blood drawn, was unceremoniously probed. Just a typical Thursday morning of the IF crowd.

The ultrasound tech told me that I have 7 ripening follicles in one ovary, none in the other. I will admit now that I was slightly disappointed. I really wanted a bumper crop of those suckers. Specifically 30. I came upon this number through a very thorough process of picking it out of thin air.  Totally at random. I have no idea why, but my weirdo pea brain was fixated on the number 30.

Of course, I have no idea what is “normal” or “good.” Even if I did, I know better than to compare my body to any sort of standard. It does whatever the hell it wants. So I spent the morning reminding myself that ultimately, I just need one. Just one that works and sticks.

Regardless of my lingering disappointment, Dr. Petrel is pleased with my ovarian progress. The stimming cocktail continues, now with the addition of Menopur at night and Ganirelix in the morning.

I have been stimming now for 5 days. Outside of a persistent, low-grade headache, I’ve felt fine. No other side effects to report. The injections themselves are no fun. Not terrible, but not something I’ll be signing up for again under any circumstances. (There goes my long-held dream of becoming a heroin addict. Shucks.)

Gonal-f is a non-event. I hardly notice it.

Menopur stings a bit going in- kinda like a flu shot.

Ganirelix didn’t hurt going in, but the inject spot was sore and a little red for about 45 minutes afterwards.

I’m making Mr. Ostrich do the shots. Between you and me, I’m okay giving myself the shots, but I really want him to be involved. Up until now, I’ve been muscling through the appointments and infuriating phone calls with my insurance on my own. It isn’t because he won’t help– I’ve just never asked him. Which is why I think he is a bit removed from the whole process.

For example, Mr. O came with me to the baseline ultrasound and blood test. He sat in the room with the Tech while the ultrasound was performed. This wasn’t such a big deal to me– I’ve been poked in every way imaginable at this point. But Mr. O was completely floored. He just didn’t realize what all this meant until he saw me go through it first hand.

That’s when I decided to ask him to administer the injections. This isn’t because I want recognition for what I’m going through- I really want him to feel invested in this in a concrete way. It seems harder for men to grasp what IVF means because… they aren’t physically experiencing it? They are biologically programed to not notice? I have no idea.

I wonder if the same is true regardless of gender- If you’re part of a lady-lady duo, does the partner who isn’t undergoing treatment “get it?” Or is this just something you have to physically go through to understand?

To be clear, I don’t intend to downplay the role of anyone’s partner plays in this process. Even if they aren’t getting probed by ultrasound wands or pumped with hormones, they offer so much love and support. They are obviously just as invested in the outcome. I imagine it’s difficult to be in the role of witness too. For Mr. O at least, he has said several times that he wishes he could do some of this for me. But you know… pesky biology gets in the way.

Mr. O and I share so much. We’re disgustingly egalitarian in our relationship. It feels odd that he isn’t experiencing this in tandem, the way we do so many things. For the first time since we started this journey, I feel strangely separate.

November can’t come soon enough

I just got back from my post op with Dr. Petrel.

Things are looking good! My uterus is all clear. Polyps were tested and aren’t malignant (a low chance, but she wanted to test them to be sure.) And my genetic tests came back with no abnormalities.

Now that it is done (and they are fine) I will admit to being a little nervous about the Fragile X test. Thanks to my frenemy Dr. Google, I became convinced that my people must be carriers of some kind. Why? Because in milder forms, Fragile X can manifest itself in learning disabilities and ADD. My brother has both. I have mild ADD, as does my sister.

Just before a full-blown freak out, I stopped myself. Oh, dear sweet logic… Learning disabilities are caused by any number of things. Genetics can be one of them, but so can premature birth. (My brother was born 4 weeks early.)  Worse case, we could do genetic screening on the embryos before transferring.

I also realized that if this was the case, it was DONE. It wasn’t like I was going to be changing my genetic code by eating tons of kale or exercising more. So I decided to “que sera, sera” that shit.

And with good reason, as it turns out there wasn’t anything to worry about. Petrel ordered the Fragile X test because this can be linked to higher FSH levels (which I have.) I asked her if she knew why my levels would be high then, she said she didn’t know but that she wasn’t worried. My AMH levels are good, and that’s what matters. I suppose some things will just remain a mystery.

As with all my meetings with Dr. Petrel, this was really great. She is by far the best doctor I’ve dealt with throughout all this– because she takes us seriously. Crazy idea, I know!

After our consult, we were handed off to Nurse Wren* who went over all the fabulous injections that are in store for me. Not looking forward to this part. But after two years of infertility, I think I can handle two stinking weeks of injections.

With all that done, we’re on our way to IVF. Dr. Petrel’s office will put through the request with my insurance company. That should take two weeks to clear, which means we can’t get a round in this cycle. I’m a little bummed, but I also had set this expectation with myself. I was thinking an October/November timeframe. So November it is! Which means, I have yet another cycle to over-google everything. Yippie.

Mostly, I’m just impatient. I’ve even allowed myself to be optimistic. This could actually work! And when I start seeing that promise in the distance– no matter how far off– I just. can’t. take it.

*Not her real name. But I like her so I gave her a nice bird name…

I

The Storm

I’m happy to say that my hysteroscopy is in the books. Done, done, and done. And lo! I’m still alive!

The night before, I received a call from my doctor’s office that there had been a cancellation. It is the hospital’s policy that all surgeries move up accordingly. So instead of a 9:00 hysteroscopy, I was moved up to 7:40. I successfully avoided panic.

I will admit there was a part of me that believed that this might be my last day on earth. So I tried to enjoy life a little on Thursday. I went to my favorite place for lunch, ordered cake and a latte. For dinner, I ate my favorite kale salad and watched “Scandal.” I sneaked a note into Mr. O’s sock drawer just telling him how much I love him. You know… just in case I DIED. (I’ve officially accepted that I am crazy. For now, anyway.)

The next morning went really well. Since it was so early, the traffic was non existent. We got the hospital in plenty of time. This place is like the freakin’ Taj Mahal of hospitals. When they took our name, we got a beeper (like what you get at Olive Garden.) It buzzed, we were escorted upstairs to the pre-op room. On the way, Mr. O was informed that there were many things to keep him entertained while he waited for me, including an onsite gym. (REALLY? Yes, really.)

Mr. O was stellar. He helped keep me calm and made me laugh. I had a momentary freak out when they put the hospital gown on the bed- it had the same pattern of the ones my mom has been wearing in the ICU for the last 10 months. I took a deep breath, and put it on.

All the nurses were wonderful. They introduced themselves to me and Mr. O and explained the role that they’d play during the procedure. My anesthesiologist was awesome- she explained everything that would happen during the procedure.

Finally, Dr. Petrel arrived. Have I mentioned that she reminds me of my mom, if my mom were a straight-talking RE? I just felt so much more relaxed once she was there. Petrel also explained the procedure, how I’d feel afterwards, and when our post op appointment would be.

The last thing I remembered was moving myself onto the operating table in the OR. And then I woke up. The rest of day was a bit of a blur. I don’t remember talking with Dr. Petrel, but she apparently called Mr. O and explained what happened. There were not one, not two, but THREE polyps up in there. She removed them all and thinks that my uterus looks beautiful. “We are setting the stage nicely,” she told Mr. O.

Once at home, I drifted in and out of sleep for most of the morning. I was still in some pain and experiencing some light bleeding. My appetite was low. Mr. O took excellent care of me, making lunch and dinner, and running to the store for Tylenol.

I committed myself to bed for the rest of the day. Since I knew I’d be immobile, I set myself up with The Roosevelts. What better way to recuperate than with the help of a Ken Burns documentary?! #nerdalert

This is honestly a terrific documentary. It’s a bit more “History Channel” than most of Burns’ documentaries, but the subjects are totally fascinating. Like normal human beings, they faced a shit ton of obstacles. How they survived and overcame them is also what made them.  As you probably know, FDR had polio which he struggled with for the remainder of his life. A nurse once told him Polio was the storm, and he was what remained.

Maybe it was all the drugs or my overall heighten emotional state, but that’s how I think IF is. I don’t believe in the adage “What doesn’t kill you makes you stronger.” Nope, sometimes what doesn’t kill you can gut you. IF is the storm. It sucks. It will leave a mark– has left its mark on me. But at the end of this something will remain. I have to work on what that something is.

Now, I don’t think that this will make me president. In fact, I would settle for a totally benign life at this point. Please, bless me with a sleepy life with my darling little family. Leave all that trial by fire shit for something else, will you?

But then I remember that I’m already here. In the middle of the storm. The only way out is through.

Back in the Saddle

First of all, thanks to all for understanding my hiatus. And for welcoming me back to the fold. It’s truly astounding how warm and loving a set of perfect strangers can be. Way to go, humanity!

And now that I’m back, I will regale you with tales of my RE appointment.

On Monday, I had my first visit with Dr. Petrel since our initial consultation. All of our tests are in, and the results are decidedly weird.

  1. My FSH levels are elevated, but my AMH levels are awesome.
  2. Mr. O’s genetic results are in the clear, but because the practice shifted to a different lab, not all requested tests were actually performed. Basically, they tested 94% of them.
  3. I may or may not have polyps. I had the sonohysterogram done at a different office, and they didn’t let me see the pictures they took of my uterus. Reviewing them with Dr. Petrel, she thinks it could be polyps– or mucus. Yummy.

Therefore, here is our plan of attack for this cycle.

  1. More tests. Dr. Petrel suggested that I get my FSH tested again, since my levels were more consistent with a Day 4 or 5 result. Maybe we got the timing off? She also suggested getting the genetic tests that were left out of Mr. O’s labs, and Fragile X. There may be a connection between my elevated FSH and Fragile X. So let’s just know for sure.
  2. Hysteroscopy. In the next two weeks, she wants to take a peek at my uterus with a telescope. After she gets in there and determines my polyp-y status, she’ll either give me the all clear or remove those suckers. It should take one day, and I should be back at work the next.

Through some miracle, I have not freaked out about any of this. Okay, not through some miracle… Through the calm, rational care provided by Dr. Petrel, I am not freaked out about any of this. The truth is that if this were going to be an easy process for me, I wouldn’t be going to an RE in the first place. Her office exists to help couples like me and Mr. O. If I do test positive for Fragile X, we would just have a different set of choices to make. She walked us through what some of those choices might be. By the time I left, I practically wanted to hug her. #bestdoctorever

And as I wait for those genetic tests to come back, a whole new two week wait begins…