Glutton for punishment

I just fell into a classic TTC trap and I just thought I would share the insanity with you all. So, as you know, the TTW is total torture. The patience involved is totally beyond me and it pushes me to my limit. A friend suggested that the second week is worse than the first, and I must agree. It is during the second week that my resolve always falters, and I end up wasting expensive pregnancy tests, because I am so desperate to catch sight of the elusive double line ASAP.

The strategy behind choosing your testing day is pretty simple: choose a day that is far enough out from your ovulation date to have some possibility of showing a positive result, but early enough that you aren't going insane waiting for it to be TESTING DAY. Some bionic women with super embryos have shown a +HPT as early as 7DPO (days past ovulation) or 8 DPO with first morning urine. When I was pregnant last summer, I showed a +HPT at 10DPO (faint, but visible). Many women don't get a positive result until 13-14DPO. It is very individual.

But, even with this in mind, I have been known to test on 6DPO. 6... I haven't done that for a long time, but still. Somewhere in my brain, it made sense to do that.

This cycle, because I did a trigger shot, I had to wait for that medication to clear out of my system, because it will give a false positive test. It is concentrated hCG (pregnancy hormone) and that is the hormone that home tests pick up. So, using super cheapie tests, I used those for several days watching the line get fainter and fainter. 2 days ago the test was finally stark white, so I know now that if I do get a BFP, it is for real. So, I chose 10DPO (this coming Thursday) to be my first testing day. This sounds reasonable to me because that is when I got a +HPT last July. Good. Done. Decision made.

Then WHY did I decide, in my infinite wisdom, to use an expensive First Response test this morning (8DPO) at 8am when I had already peed at like 5:30am?! Wrong day AND wrong time. Of course the result was negative. Now I am just left embarrassed and disappointed with myself.

There is a compulsion there that is difficult to understand. Imagine you have chocolate in your cupboard and you are trying to lose weight. You have told yourself, "I am saving that chocolate for Thursday. It will taste so much better if I work out for a few days to earn it. I won't touch it until then." But, you can HEAR the chocolate calling to you. You can't think of much else. You are powerless against it, and you sneak it before you can even really taste it.

I need someone to come to my house and remove all HPTs. I am a danger to myself and others. Please, call Candy Finnigan.

Taking bets

Because I still have several days to kill until I will know if this IUI was successful (sometime between Friday and Tuesday), I have been sitting around wondering how many people will announce pregnancies when I return to school tomorrow afternoon. In recent years, there has been an influx of women under 40, and with that...well you know.

One colleague's news has already leaked thorough the grapevine. I always appreciate a little advanced warning of this kind of news, so I can react privately. A year ago, that meant crying, cursing, and feeling sorry for myself. Now, it is basically limited to extreme jealousy. The kind where I bemoan how it is MY TURN and selfishly wish for myself what others seem to get with a night of drunken lust.

So, I am a betting woman. I have spent my fair share of time at blackjack tables in Las Vegas and Atlantic City. In my own humble opinion, I am going to bet on at LEAST one other preggo, probably two. This is a hedged bet because I am privy to information about the infertility and loss struggles of both people I have in mind. I'm laying my $5 on the line.

In the meantime, I am just watching the days tick by. Maybe you can help me with this: I have been debating about how I will feel about posting the results of the IUI here. If it is a BFN, it is going to sting and I might avoid talking about it until it sinks in a bit. If it is a BFP, my superstitious nature might take over. I mean, writing it down might make me miscarry, right? I might also avoid walking under ladders and black cats for a while.

Like all things TTC related, I think this is going to be a wait and see.

Twilight Zone

I got the most perfectly timed, random message from a girl I knew in elementary school today. We are Facebook friends, but never chat. Just occasional comments on posts and exchanged from time to time. Well this morning, I woke up to this:

"Hi [nickname I never, ever use as an adult],
Ok, so this is going to sound random but a few nights ago I had a dream that you were pregnant. This has only happened to me twice before and when I told the people they said that's crazy because I am and nobody knows yet. So...just putting that out there!!! Hope all is good at your end. Your side of the country got a little tremor, I see. :)"
- Friend I last saw in person when I was about 10.

My jaw dropped. I read it out loud to Kev.  I have re-read it several times. It just blows my mind when weird shit like this pops up.

It doesn't mean a thing, but it would be a great story to tell some day if we are lucky this cycle.

Hurry up and wait

Although I savor summer vacation, I am thinking it is a good thing that I head back to work next week. There are several reasons for this (namely, my recent extreme laziness), but mostly it is because the dreaded two week wait (TWW) is upon me. It is that magical period of time between ovulation and the beginning of your next cycle when all you can do is constantly scrutinize every twinge inside of your pelvic region, in hopes that it is an egg fertilizing. This is a period of time that moves by so agonizingly slowly, that if you are TTC, you feel like you will lose your mind.

Because I ovulate so infrequently, I often forget the neurotic tendencies that kick in during the TWW. I go back and forth between hopeful and cynical. I have heated inner dialogues that sometimes make me laugh hysterically, which then, in turn, also make me look like a lunatic to the people in cars next to me. Picture a sort of angel/devil scenario. They typically go something like this:

"This might by the cycle you get pregnant!" vs. "Don't get too excited. The IUI only gives you a 20% chance of success."

"But, that means there is a chance! You haven't had many chances at all in the last year!" vs. "But even if I got pregnant, I would probably lose it. That's what happened last time."

"So many infertile friends have gotten pregnant lately. That means it might be your turn!" vs. "You want it too much. That means something bad is going to happen."

Get the idea? These are the fun times happening in my head all the time. Sometimes they are also followed by an evil laugh.

The hubby constantly shakes his head at me when I go to the dark side of any situation. The endless optimism that he is able to produce is the glue of our relationship, I am convinced. I mean, what the hell would we do if BOTH of us were Debbie Downers all the time? Instead, he chooses to kiss my head, put a hand on my belly, and think good thoughts. The song "Imagination" from Willy Wonka has a great quote about optimism. Willy says, "Hold your breath. Make a wish. Count to three." I keep thinking of those words over and over again. It's like throwing a coin into a fountain. It is just pure, blind hope. I wish I could bottle it and hold it in my pocket.

So, my challenge for the next two weeks is to keep busy, keep some hope, and not pee on hundreds of HPTs in the hopes of that elusive double pink line.

"Trust Me"

Those words are so tricky. Sometimes it seems like every time I put control in someone else’s hands, something goes wrong. I don’t mean this is a crazy control freak kind of way. Just more of a “I live in Murphy’s Law” kind of way. Well, maybe it is more anger at myself when I don’t listen to my instincts (or inner voice, a la Oprah) often enough.

This came up recently with my fertility treatment. I don’t want to give all the gory details, but something treatment related sent up red flags in my brain. I said so to one of the nurses. She assured me the information was correct. Well, needless to say, I was right in my original assumption and it impacted my results.

The good news is that it looks like we can proceed. I did finally show response to the injections. So, on Sunday, I have a date with a turkey baster. I suppose it will be a little more clinical than that, but you get the idea. Can I be honest? Between you and I, it’s a little scary. With PCOS and the medication, there are some risks.

But, life is risk, right?

Wash, rinse, repeat.

One of these days, I am going to get good news when I go in for an ultrasound. One day, instead I saying, "Sorry, I don't see any measurable follicles," they will say, "Wow! Your little eggies are ready to pop!"

I have NEVER ONCE heard those words during my many, many dildocam sessions. Instead, I hear about the ultrasound technician's weekend, her dog's birthday party (YUP!), and the weather. At other times, I have gotten much worse news than no news. I guess it is no surprise that I rarely feel optimistic on the drive over to my RE's office.

Today was no exception. Although my uterine lining is thickening, no dice with the stubborn follies. Looks like I have a lot more shots in my future.

"Your ovaries have great potential"

While in the stirrups yesterday, dildocam in use, this is what the technician said to me. She was peering at the screen looking at "tons" of follicles. Yup, lots of eggs. They are just developmentally challenged. After about 7 days on the shots, there weren't any measurable follicles (we need them to grow to about 15-20mm).  So, they more than doubled my dose of Gonal-F (went from 75iu per day to 112.5iu two times per day). That's right: double the shots, double the fun!

I almost giggled when she said it though. It reminded me of when I was a little kid in elementary school. I used to get comments on my report cards that said, "Not working to potential" or "Needs to give more effort." By the time I hit high school, I swung to the other side of the pendulum, and started to drive myself crazy trying to get all my assignments as perfect as possible. That's kind of the way I approach TTC too. Always preoccupied with what I could do better.

It's nice to know that my egg bags are promising, if they give more effort. 

Inspiration

There were several influences that inspired me to start writing again.

One of these came during a recent trip home to Los Angeles. I had lunch with two high school friends. I hadn't seen one much in the last 13 years. She simply asked me if I was writing these days. In high school, when we spent a lot of time together, I was a writer. I wrote for our school newspaper, school literary magazine, a 'zine (so 90's!) of my own that was included in Zine Scene (a collection of writings), poetry, journals, etc. I was highly influenced by Hillary Carlip (whom I befriended at a reading when I was about 14) and truly saw myself as an author.

I never intended to stop writing. It just sort of happened. I went to college, got busy, started working, got married, became a teacher, blah blah blah. Anyway, that part of my life to a back seat. I did develop other interests, but always felt sad that I wasn't writing.

Anyway, the point of this post is that it feels good to be writing again and I am so excited about the feeling it has been giving me. I am brimming with ideas and have gone back to reading essays by other authors. Of course, right now, I am reading a lot of essays about infertility. My favorite ones are the ones that incorporate a lot of humor into their deeply personal stories. I rely on humor to get me through hard times. It keeps me sane. You can't cry all the time, right? So you might as well laugh.

This is a particularly good example. For those who haven't had a miscarriage it might be a little weird to read. But, I think it is genius. Enjoy.

A little lonely over here...

So, I should preface this post by saying I am a message board geek. My obsession with interest-based online communities actually began when I was 12 or 13. Anyone remember what a BBS is? If not, get a blast from the past here. I used to belong to a BBS with a bunch of other teenagers. We would chat online in chat rooms, post in forums (often song lyrics and deep, angsty poetry), and occasionally would meet up at a mall or some other public venue. Obviously online safety was not a concern back then. :)

Anyway, from then on, if I was into some specific interest at the time, I usually went online and found like-minded folks. When I was in college, there were blogs and chat rooms for area college students. When I went through a major weight-loss effort several years ago, I was addicted to Weight Watchers forums and joined a buddy group. When I was very focused on cooking, I was reading culinary blogs and boards. You get the idea.

So, as you can imagine, when we started TTC, I found several online communities of women who were in the same boat. Although I do have a few friends IRL that have undergone infertility treatment, etc. sometimes the anonymity of these groups is appealing with very personal issues. On the boards, I post questions, answer the queries of other members, and have been an active member of 2 smaller buddy groups almost since the beginning.

The first was a group I joined in the spring of 2010, when we were all TTC at the same time and had similar humor. The women (about 8 of them) are all very friendly and over the weeks and months, we got to "know" each other relatively well. With some I even gmail chat or FB chat. Now, obviously, when a group of women are trying to become pregnant, most are successful within a year. So, as of now, I am one of two women left in the group who has not had a successful pregnancy since the group started. The other woman is 40+ and has a daughter already. It has been increasingly difficult for me to take part in the group as almost all the posts are about being new mamas, or mamas-to-be. I feel like Debbie Downer when I give updates on my lack of progress and have trouble relating to breastfeeding issues and such.

Then, after the miscarriage, I joined a second group comprised of women who are 30+, have had a loss, and have no children yet. This is a smaller group (about 5 women) and I found it incredibly helpful to talk to women who knew exactly what I was going through, but were not connected to me in real life. Well, lately, nearly all of those women have become pregnant too. The rules of the group dictate that you leave when you leave when you get a BFP out of sensitivity to the other members. So, all of a sudden the group is pretty much silent.

I am actually VERY happy for them. I am truly and sincerely happy for anyone who gets pregnant, but especially for those who have battled infertility and loss. I know the intimate details of the pain and suffering many of the women have experienced, and they SO deserve this happiness. But, I must admit, I am avoiding the boards like the plague. It is just too hard. The logical part of my brain says, "Why would you want to feel stress about a virtual community when you have enough stress in real life?"

Still, I can't help feeling like the last kid picked for the kickball team! Sheesh! I know I am doing all I can do to join the mommy club. But man, hurry the fuck up ovaries.

And you thought you knew all the acronyms you needed....

From all my months of trying to get pregnant, I have gained an entirely new vocabulary. You see, there is a whole wealth of words to understand once you start reading books, blogs, message boards, and websites about trying to get pregnant. I liken it to learning HTML or the insider language of any profession. Over time, you become fluent. This is especially true when you are emailing and chatting with friends who are also infertile. Don't believe me?

For reference, here is a mini glossary of terms in no particular order because I am too lazy to alphabetize it:
TTC - trying to conceive
TTCAL - trying to conceive after a loss
PCOS - Poly Cystic Ovarian Syndrome
IR - insulin resistant (most PCOS women are, I am not)
Clomid - baseline (completely ineffective) oral medication to induce ovulation
CD - cycle day (usually followed by a number)
BD - baby dance = sexy times
IUI - intrauterine insemination (The boy gives the sample, they wash it up and prepare it, then place it in my cervix. Fun times.)
IVF - in vitro fertilization
ER - egg retrieval
ET - embryo transfer
HPT - home pregnancy test
OPK - ovulation predictor kit
IC - in-cup test (as opposed to pee on a stick)
POAS - see above :)
WTO - waiting to ovulate (the constant state I am in since I never ovulate on my own anymore)
TWW - two week wait (the horrible period of time between ovulation and when you find out if you are pregnant or not. Longest 2 weeks ever.)
BFP - big fat positive (refers to pregnancy test)
BFN - big fat negative
FRER - First Response Early Response (most sensitive HPTs and very popular)
CBE - Clearblue Easy (similar)
Wondfo - very inexpensive, bulk OPKs and HPTs that you buy on Amazon
US - ultrasound, vaginal or external
BW - blood work
Follicles - when eggs mature, approaching ovulation, they come from these. They swell up before releasing an egg. You want 1-2 mature follicles for an IUI cycle. Too many and they cancel the cycle or convert to IVF to prevent octomoms.
Stims - injectable medication that stimulates your ovaries into producing mature follicles (Gonal-F is an example, follistim is another)
Trigger - no, not a gun. :) This is an injection that induces the release of an egg after stimulating ovulation for several days.

Above all, my favorite new term came from a friend who is pregnant from IVF, when discussing my most frequent procedure: vaginal ultrasounds. While chatting with her, I mentioned I had to go in to get my millionth ultrasound today. She lovingly refers to them as "dildocam." Classic.

It is amazing what I have gotten used to since we starting trying to get pregnant. Not only have I developed an entirely new vocabulary, but also a new appreciation for waiting rooms with current magazines.

Sometimes, I can barely remember the days when I would only be in an OBGyn's office once per year for a pap smear and a breast exam. In and out. No problem. Now, I see the inside of my RE's office no less than 3 times per month. Now that I have started injectable meds and an IUI cycle, I am in every 3 days.


Here is what the itinerary looks like for this cycle:
CD3 - dildocam, start daily Gonal-F injections
CD7 - dildocam and b/w - continue daily injections
CD7-? continue with daily injections, and every 3 days I get the dildocam and b/w.
When the follies mature-  I complete my trigger shot.
24 hours post trigger - IUI. So romantic.
TWW
If I get a BFP = Yay!
BFN = Start all over again

To some, it might seem strange to be in your doctor's office several times per month. During those visits, I get poked, prodded, and AHEM inserted. But, somehow it has become second nature. I'm sure one of these days, the shots will become that way too. Until then, I will continue to marvel at the red biohazard sharps container sitting on my coffee table.

Needles

I am no fan of needles. Never have been. This began when I was 8 and had my tonsils out. I was scared to begin with, and the sadomasochistic nurse put the IV in my hand without numbing it first.

In adulthood, although I always get blood work when I need it, I always have intense fear. I have to look away, breathe deeply, and avoid the humiliation of passing out. Sweating and crying are common.  To make matters worse I have had several inept nurses try to draw blood and leave me with bruises. They tend to blame me for this problem. Occasionally, I have a gifted phlebotomist or other medical professional who has no trouble at all.

Then, when I went for my first D&C after the miscarriage, I had a horrific IV experience. The nurse who was assigned to me tried to get the IV placed TWICE without success. Each attempt included an injection of numbing agent first. That means 4 needles later, and the IV was not placed. Finally, another nurse is able to place the IV. That means it took a total of 6 pokes. 6. 

So, needless to say, I have needle fear. This wasn't helped by the fact that my last blood draw at the RE's office did not go smoothly.

But, after months of setbacks, we finally got the go ahead to start injectable medications, leading to an IUI. This is good news. There is a much higher chance of the treatment being successful than anything we have tried yet. But, then there is the needle.

The first night, after watching the YouTube videos reminding us about how to give the shots, I sat with the syringe in my hand shaking. I tried over and over again to give myself the shot. The inner dialogue went something like this:
"Real women don't need a man to give them the shots."
"I should be able to do this! This will help get us a baby!"
"That needle is huge." (It isn't.)
"How the hell do diabetics do this?"
"Would my stomach or my leg hurt less?"
Etc. Etc. Etc.

Deciding I couldn't do it myself, I handed the needle over to Kev. We started a count to 3 several times. I couldn't seem to get to 3. After 2 venue changes, and much whining, he said, "This is going to happen one way or another tonight." So, after 30 minutes, while hiding my face, we counted "1.....2......3!"

Then....nothing. It didn't hurt. I barely felt it. But what I did feel is like I am an idiot.

But, somehow, the anxiety ramped up even more the next day. In my head, I knew it wouldn't hurt. But, that irrational fear just took over my brain. I started to really wonder if I could ever do IVF if I need to. From many infertile friends, I know THOSE shots are horrific. However, that night, although I shake and fuss, I allow Kev to get the shot done in half the time. Progress.

The third night, I make a major breakthrough. After prepping the shot, I looked at hubs and said, "I'm counting to 3. Just do it."

2 minutes. Done.The ensuing nights are similar.

I might still be lame for not doing it myself, but I'll take bravery in little bits and pieces.

Starting again

This is not a new blog. You might think it is, since you just received an invite to view it. But, this blog originally came to be in July 2010. Caught up in the excitement of my first pregnancy, I made many classic and cliche mistakes. I told several people, I bought a baby journal, and I started a pregnancy blog. Unfortunately, that pregnancy was not meant to be.

Once we found out about our miscarriage, I abandoned the blog. I spent the next year on a roller coaster of emotional and physical recovery, as well as pursuing trying to conceive again. Now that we have officially started to pull out the big guns of infertility treatment, I wanted to return to the idea of a blog. Many other infertility blogs have helped me, and I suppose I hope this will help someone else.

Just for context, let me bring you up to speed with the timeline of our TTC efforts so far.

July 2005: Hubby and I get married relatively young. Both on the same page about kids at some point in the future, but not now. None of our friends are married or having kids yet.

July 2005 - December 2009: Figuring out the whole marriage thing. Some doubts about having children (on my part) followed by all-consuming desire to be pregnant NOW. The proverbial switch gets flipped.

January 2010: I stop birth control after 15 years of being militant about avoiding pregnancy (oh, if only I had saved all that money!). Read "Taking Charge of Your Fertility," the Bible of fertility self-help books. Started to chart fertility signs and temperatures. Bought first of many batches of ovulation predictor kits.

Jan. 2010-July 2010: Long, irregular cycles. I ovulate 4 times in 7 months. I also start to wonder about Poly Cystic Ovarian Syndrome (PCOS) because my sister suffers from it. Lots of books about natural fertility on my nightstand. In April I started acupuncture as well, hoping for improvement of my cycles.

July 2010: Clearblue Easy Digital says "Pregnant!" We are beyond ecstatic. The hubby starts talking to my belly and we give in to temptation and tell our families and several close friends.

August 2010: 2 early ultrasounds show I had a missed miscarriage at 7 weeks. First D&C follows. Most intense emotional pain I have ever felt in my life. We are completely devastated. It also feels as if every other person I know or see on the street is suddenly pregnant.

August - October 2010: I have incessant spotting, no ovulation, and general weirdness. I call the OB/Gyn several times and she tells me to "be patient." Steam starts to come from my ears.

Columbus Day 2010: I forced OB/Gyn to do ultrasound. Retained tissue from pregnancy found. Extreme anger ensues. Second D&C follows.

November 2010-January 2010: I continue to chart and do OPKs, but that elusive egg never gets popped from my ovaries. I am now completely anovulatory. Discovering patience (and lack thereof) that I never knew I had in reserves. OB/Gyn refuses to test me for PCOS.

January 2011: First appointment with Reproductive Endocrinologist (RE). Diagnosed within minutes with "subtle variant" of PCOS. Prescribed Metformin for the first time.

February 2011: First ovulation since July 2010, but anovulatory the next cycle. Ready for more aggressive measures, starting with the oral medication Clomid. I have been "patient" long enough.

April - June 2011: 2 Clomid cycles but no ovulation, both ending with Provera (progesterone) to induce a period. Obviously my ovaries are stubborn and oral meds won't work for me. RE suggests injectable medication followed by intrauterine insemination (IUI) - a.k.a. turkey baster method. We can do several cycles like this, and then head to IVF if needed.

June 2011: Supposed to start first Gonal F (75Iu)/Ovidrel/IUI cycle begins  - CANCELED due to cysts, caused by the Clomid and PCOS. Slamming of head against wall begins.

July 2011: Ironically went back on birth control this cycle due to travel at end of the month.

August 2011: First injectable (Gonal-F/Ovidrel) and IUI cycle begins. FINALLY. Needle phobia also sets in. BFN.

September 2011: As a result of being overmedicated by a covering physician, I am riddled with large cysts, post IUI. Benched until the cysts shrink, while taking BCP. Longest period of my life. Also started seeing a new acupuncturist, who practices TCM.

September 2011 part deux (9/24/11)-late October - Baseline ultrasound shows NO CYSTS! 3 weeks of BCP, electroacupuncture, Chinese herbs, and praying worked! IUI Cycle #2 begins.- BFN

November - December 2011: hiatus; we shrink some cysts on BCP and go on vacation to Aruba.

January 2012: IVF #1: BCP, Lupron, Gonal-F/Menopur, Pregnyl trigger = 23 eggs retrieved, 19 mature, good lookin' sperm, and NONE fertilize. Read about it here.

February-mid March 2012: hiatus; back on BCP, back to acupuncture, and take a trip home to LA

late March/April 2012: IVF#2, with ICSI
same protocol as last time, with Doxycycline, Medrol, aspirin, PIO, and Vivelle patches post retrieval, acupuncture
April 10 - 26 eggs retrieved, 23 mature, 20 fertilize with ICSI!
April 15 - 5 day transfer of one textbook perfect blastocyst with 6 to freeze.
BFP!

So, there we are.