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.

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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…

List of Questions for RE Consultation

When I was preparing for my first consultation with my RE, I kept a whole list of questions to ask her. I organized them into thematic categories (because I’m a nerd like that…) Obviously, this list isn’t meant to be exhaustive. I may have focused on concerns that aren’t relevant to everyone. Lastly, this is absolutely a crowdsourced list. Thanks to all you ladies who offered suggestions!

In case anyone else out there is prepping for a similar appointment and is looking for some inspiration, have at it.

 

TESTING:
What diagnostic tests do you recommend?

What is the likelihood that each of these tests will establish a diagnosis?

How will this test or procedure affect my diagnosis and treatment plan?

Are there any risks associated with the testing?

Does my partner need additional testing?

Do you have concerns about egg quality? How do we determine that?

 

TREATMENTS:
What type of treatment would you recommend trying first based on our diagnosis? What are the risks of treatment?

If IUI, how many unsuccessful rounds would you recommend before moving to IVF?

In your practice, how often does this treatment result in pregnancy for our age group and diagnosis?

Are there any long-term complications associated with this or other treatments?

 

GENERAL/LIFESTYLE:
Are there any lifestyles changes that might help our chances of getting pregnant? Specifically how will this affect my running? (Because this is a really important thing for me. Obviously, this isn’t for everyone.)

In your opinion, how likely is fertility treatment to be successful for us?

Can someone in your office helps us estimate costs for the procedures?

Your Input, Please

In the wake of my panicky post last week about my upcoming consultation, I’ve got a better perspective on this appointment. As always, I thank you for your sage wisdom, fellow infertiles.

My job is to be a human sponge. Soak up as much information as possible, so Mr. O and I can make the best decision for us.

But here’s the rub: I don’t know what I don’t know. But YOU do. Yes, I’m talking to you.

I would love to hear from you about what questions you asked early on that were helpful, wished you’d asked along the way, or never had the guts to ask in the first place.

BRING IT ON, LADIES.

The Unknowns

“As we know, there are known knowns; there are things that we know that we know. We also know there are known unknowns; that is to say we know there are some things we do not know. But there are also unknown unknowns, the ones we don’t know we don’t know.” -Donald Rumsfeld*

My first consultation with a “real” RE is just a week away. I’m not exactly sure what I should expect. When I got my period last time, it was on a Sunday morning. I crawled back into bed and cried a little bit. Mr. Ostrich dutifully spooned me, and tried to comfort me.

ME: I’m just scared. This advance reproductive bullshit terrifies me.

MR. O: Are you sure you still want to do this?

ME: Yeah, but I’m still scared.

I’ve thought about this since it flew out of my mouth. I’m not one who gets scared that often. Typically, I research the crap out of something until I understand it. (Knowing is half the battle.) But all the “understanding” in the world isn’t making this any less intimidating. There is a lot I don’t know. So there is a lot I can obsessively worry about.

This is a brief summary.

1) I’m almost convinced that after reviewing all my tests, my RE will discover something so obvious like I don’t have a uterus. That’s been the problem all along!

2) I’m worried she’ll order a whole bunch more tests. Some of them are a year old at this point, but I still don’t want to have to do them again. Let’s get this show on the road, damnit.

3) What if I have to stop running? Being able to be outside alone, following the rhythm of my feet, feeling my heart get stronger with every stride… this shit has sustained me through the absolute worst year of my life (thus far.) If I can’t do that because of any treatments, I will lose my frickin’ mind.

4) I have to keep track of things. There are the injections, the sticks to pee on, the showing up for doctor’s appointments on time. You ladies make this look so easy. “I took .75 ml of Magical Baby Powder, and now my KLM levels are at 45.” I have no idea what this shit really means. This seems to require a level of organization that I do not have the skills for.

5) Actual pain. Let’s be real. None of this sounds like a massage for your lady parts.

6) The money. My insurance covers some of it, but there is a lifetime max. I have to get this done before the money runs out.

7) The disappointment. Sure, I’ve dealt with the monthly disappointment, but I worry that I’ll have a higher level of emotional investment in the ARTs. What if the sadness I experience at the end of each cycle now is worse?

8) What if, at the end of all this, it doesn’t work? I’ve got a few more stops along the TTC train, but the end is in sight. All this time, I held out ARTs as the backup plan. But my backup plan has no backup plan.

Yes, I am worrying about this prematurely. I haven’t even had the damn appointment yet. One of the hardest things I’ve had to confront during this past year is that I have no idea how anything in this life will pan out. I have to honor my crazy-lady anxiety, but then learn to let it go.

Nothing is guaranteed, the good or the bad.

 

*Yes, I just made a vague comparison between infertility and terrorism. And yes, this is the first and last time I will ever quote Donald Rumsfeld. I promise.