Tuesday, November 3, 2009

Avoidance

I've been avoiding writing something here for a while now. I guess I thought that if I didn't write, then there was a chance we'd get pregnant. It's amazing how easy it is to walk that ridiculously thin line between skepticism/hopelessness and fantasy/hope. I think this is why people become addicted to pregnancy tests. You take a test, and it's negative. Yet, somehow that doesn't compute. You rationalize that the test could be wrong, something else could be going on. You take another test. Still negative. But your breasts are sore, you must be pregnant. Test 3. You guessed it, negative. And so forth. I vacillate endlessly between rationality and absolute snap-crackle-pop insane regularly when it comes to whether or not I might be pregnant. This last cycle, I was still secretly convinced that I was pregnant in spite of having started my period, because my period came so early and was so short (2 days). Evidence staring me in the face, and I still held out hope. Crackers.

So, the update is this. We saw the Reproductive Endocrinologist (RE). More tests. Nothing super obvious showed up. My FSH levels were borderline, which is an indication of my age, but not so high that I'm out of the running for getting pregnant. We discussed over and over again what our options were. The best bet would be to do IVF with preimplantation genetic testing (PGD) to rule out any "bad" embryos. Of course, this comes with a pretty steep price tag. After investing with our insurance, we discover that we have infertility coverage. Theoretically enough to cover one round of IVF. Hopes rise. Another cycle goes by as we work through the insurance hoops. With a new cycle on the immediate horizon, insurance was still balking. In the end, the protocol for covering IVF with PGD requires first having failed 3 rounds of IUI. So, no go on the IVF.

My cycle began a little sooner than it was supposed to, so with just two days to figure it all out, the folks at the Reproductive Science Center manage to switch me to IUI with insurance approval. I received a large, refrigerated package in the mail filled with needles, syringes and injectibles. On Oct 23 I went in for my first follicular ultrasound and began giving myself nightly shots. Ultrasounds again on the 26th, 30th, 1st of November, 2nd and 3rd. Until Nov 2nd, all looks well. Then a funny thing happens. My uterine lining stops growing. The blood test shows that my estrogen is dropping. The doctor calls me today (Nov 3) to tell me that this mornings blood test and U/S show that I'm likely ovulating prematurely, before I can develop follicles and/or a uterine lining. The IUI is off for this cycle. We'll have to wait 2 weeks and try again with a different technique.

Beyond the sheer devastation of another failed cycle, I find myself incredibly frustrated that in order to do all of these last minute ultrasounds and blood tests in Orinda and San Ramon, I had to turn down classes for the next month. At the end of November, that will work in my favor with the advent of the next cycle, but it's frustrating to be out of work without a good reason. I've some development work I can do from home, but the best part of my job is the teaching. I'll miss the interaction of the classroom immensely.

I suppose the good news is that we are finally beginning to understand why I have not gotten pregnant in the last year. Easy pregnancy after coming off of birth control makes sense and will likey be one of the approaches we take in the next cycle. In the meanwhile, another month slips by.

Thursday, August 13, 2009

Slippery Slopes and Incredibly Bad Timing

So another cycle went by with a big old negative result on the inhumanely expensive early pregnancy tests. I can't help but think that we've been plagued with horrible timing in our attempt to have this second child. We really didn't have any difficulty getting pregnant the first time (with Eliot) or the first two times this time around. Then the personal tragedies just started piling up.

As if having 2 miscarriages wasn't already traumatic enough, in the 6 or so months that we've been trying since the second miscarriage, at least 4 of the 6 or 7 times I've ovulated something has happened. The first cycle that we tried after our second miscarriage, one of my dearest friends (and aunt) died. The next cycle my great-aunt, with whom I had been close as a child, passed away. Somewhere in there I received my graduate school rejection letters. Then Kenzie, one of our dogs, became gravely ill. There was a reprieve in early summer, and I believe we did get pregnant if only briefly due to the symptoms I experienced and to the fact that my super regular period came abruptly 5 days early. Not sure what our excuse was in July for not getting pregnant, but my cat died this last ovulation period. It is entirely possible that our infertility - perhaps not the miscarriages - but the months when we haven't conceived can be attributed to poorly timed sex because of external stress factors.

Yet, tomorrow we have our first appointment with a fertility specialist. Rationally, I'm willing to acknowledge that we may not be pregnant because of bad timing and we just need to try harder. On the other hand, every period brings with it disappointment, grief and even greater stress that aggravates the remnants of libido I still have. I want to know if there is something else wrong that we might be able to avoid, prevent or circumvent. It was I who suggested that we take this step. I, who 6 months ago was adamant that we would not use interventions and that we would accept that were were only meant for an only child if it came to this. Now I approach this appointment resolved that I only want to diagnose the problem, and to discover what our options are. I cannot imagine the expense financially and emotionally of continued fertility treatments and IVF procedures. I say that now, but what will I say after another few months of unsuccessful attempts? The line that I've drawn in the sand has already been washed away once and redrawn. How far will we go to have another child? I've lost 11 months in this quest. When we started I was 38.5. Now I'm 39.5. Eliot is four this weekend. Even if we get pregnant next week, I'll be 40 when I deliver and Eliot will be almost 5 years older than his sibling. We'd hoped for just less than 4 years age difference. (Funny how we were so confident that they would be 4 years apart). I wonder what if anything will make us draw a more permanent line in the sand? Will it be exhaustion or sibling age difference or maternal age or financial expense of getting pregnant again? I wish I could know now so that I could have some definitive deadline. In the meanwhile, I find myself sliding slowly down this seemingly endless slope.

Saturday, August 1, 2009

Hormone Induced Amnesia

I can't tell you how many things I've forgotten to do since we began this journey. As I was beginning to plan my son's birthday party, I was jolted by the thought of the birthdays we had missed: three of Eliot's first cousins; all in the 3-7 year old range, too, darnit. I mean if they'd been teenagers or infants, well, I could have gotten away with it, but when you are 3, you know it when you get a present from all but one of your family members. *sigh* So, Amazon to the rescue, but still... when your present is 10 weeks late, well, it hardly seems like a birthday present at all, does it. (sorry, Ava).

Children's birthdays are really only the most egregious of the lapses in memory. I also forgot our anniversary back in October, my parent's anniversary in December, and to send Mother's day cards to my grandmother and mother. I can't tell you how many times I forgot to arrange the dog walker (sorry puppies) because of some adjustment in my work schedule. I seem to live moment to moment. I can handle same-day appointments. I look at the calendar on my computer and see where I need to be that day and usually I manage to arrive there. But anything that requires preparation or forethought, like presents that need to be researched, bought and mailed 2 weeks in advanced: impossible.

Part of it is that I'm working more. There's no question it's difficult to juggle a kid, puppies, cats and a house when both parents are working. There's just less time for everything, and there's no way to describe the 100 meter dash that happens between getting home from school and getting the kid in bed. In a matter of 2.5-3 hours, there is the 20 minute bike ride to school, the extraction, the remembering to pick up the stray bits of clothing that he managed to spread about the preschool grounds, the 20 minute bike ride back home, the arrival home to the famished pets, the picking up of the poop that lines the path from the gate to the building where we store the bike, the doing of the morning dishes in order to clear enough space to pull something (usually left over or frozen) together for dinner, the feeding of the now starving pets, and all of that is before the 45 minutes of cajoling, coaxing and threatening to get the child clean before climbing into bed. [Does it strike anyone else how crazy I must be to actually want another child?] By the time 8:00 roles around keeping track of who has an upcoming birthday is the last thing on my mind.

Still, I really think that a big part of my absent-mindedness can be attributed to hormonal imbalance. Ok. Maybe not really imbalance due to actual hormones, but there is an imbalance of my system. Like 45% of my resting brain power is constantly churning away trying to figure out when we should have sex in order to get pregnant, whether we had sex the right time, whether that weird tenderness in my boobs means we actually got pregnant and then trying not to buy the super sensitive home pregnancy tests in order to see if I actually am pregnant. Then there are the hours spent researching why I didn't get pregnant or why I lost the pregnancies. The hours spent in doctor's offices or labs having blood drawn or at the acupuncturist all add up so that your brain is overloaded with the quest to have a second child. It's amazing I manage to dress and get lunch packed for Eliot most mornings.

I wonder if that what people mean when they stop trying. Not that they've stopped having sex (because that's when they all get pregnant, right.. when they've stopped trying?). I wonder if it simply means that they stopped buying the kits and the herbs and they've stopped thinking about it endlessly. I really don't know. I wish I did. I wish that was something I could do. It'd be good to have my brain back again.

Friday, July 24, 2009

Don't Ask, Don't Tell

I did not truly appreciated the social awkwardness of attempting to get pregnant the first around. We just got pregnant and then held our tongues for a few weeks. We told our family after the first 8 week ultrasound (because it was conveniently timed with the holidays). We waited to tell friends and work until we made it through the first trimester, because that's what you are supposed to do.

This time is terribly different. With the fall pregnancy, we didn't consider telling our family, but I did break down and tell two of my close friends. When we lost it, I had this entirely blundering conversation with the operations manager at work explaining why I couldn't come in to teach.

Me: "err.... I can't come in because... of a .....medical problem...."
Him: >> some probing question about how serious is was <<
Me: >> stuttering response trying to not reveal the situation<<
Him: >> total confusion <<
Me, blurting out: "you see, I'm in the process of miscarrying...and I don't know how long its going to last"
Him: " ..... oh..... I didn't even know you were pregnant"

And so forth. Of course he doesn't know I'm pregnant. You just don't tell people you are pregnant before the first trimester, right?

So then the second time around, I go through the whole thing again. Only this time it's not work with whom I have an awkward conversation, but my son's preschool teacher of all people. I have to cancel a volunteer date that I'd scheduled in order to have the D&C. My attempts at evasive maneuvering through delicate medical questions are obviously shoddy. So once again I babble a little too much, leaving this poor woman horrified that she'd pushed me to reveal something so entirely private.

Which begs the question, why is it so private? Is there something about it that I'm supposed to be ashamed of? After the second miscarriage and a few other things that fell apart in my life, I just didn't have the energy to pretend everything was fine. We told our family that we were trying and that we'd had some difficulty, and we started telling all of our friends. Many of them now know about the miscarriages, not the details, but that we've been trying for a while for a second child. Perhaps this puts them in a difficult position now? They don't know whether to ask how it's going or if we're pregnant or not yet? I'm sorry if it does make others uncomfortable, but I cannot tell you how relieved I am that I don't have to keep everything a secret anymore.

Of course, I have no idea how we would handle another pregnancy. Now that everyone knows we are trying, do you just tell people right off the bat? Yep, we're pregnant. Only 4 weeks, so we could lose it at any time. Isn't that great news? Or do you pretend like you're not pregnant until you get past the scary part and then let everyone know? It's not like our friends wouldn't be able to figure out something suspicious was going on if I don't eat sushi or have a glass of wine or sink into a hot tub. We don't hang around dolts. They'll suspect something. So, the likely thing is that we'll just tell everyone, right? And deal with the consequences if things don't work out. Then again, how do I handle our almost 4 year old son, who wants a baby more than any lego kid or fire truck or any other kind of present. I'm curious whether it would be better to tell him and then tell him about the loss if it happens or if we try to keep it from him even though the grownups around him will probably know.

I know there is no obvious answer to this problem, and short of actually being pregnant again, all I can do is wonder. I suppose we shall see.

Wednesday, July 22, 2009

The Reluctant Mom

I was what you might call a reluctant mom. In the Bay Area, it's not remotely unusual to wait until your mid-30s to begin a family. Frankly, it's often the norm. Between schooling, starting a career, a few years enjoying yourself in the big city, the time swiftly moves by. To be perfectly honest, I was quite certain that motherhood was never in my future.

After a few years of marriage, when I was 34 and Sandy was 30, we found ourselves birth-control-compromised and jokingly 'put it to fate', because I was fully confident that I was infertile and we were a couple meant for four legged children only. Naturally, I was pregnant immediately. Nine months and 65 pounds later, Eliot was born. Thirteen sleepless months later, we acquired, tried and discarded every imaginable baby toy, device and sleep solution in an attempt to sooth our colicky son. Needless to say there was never any consideration of a second child. By the time Eliot was two, I had already started acquiring story books for him on the benefits of being an only child. We were not alone in this. Several of our friends were likely to have only one child, in some cases as an active choice and in others as a by-product of their situation. We were confident enough to give away any remaining baby items that we'd tucked away.

I really cannot point to a moment when this determination changed. I think Sandy was the first one to express an active desire to consider a second child, but that could just be wishful thinking. It could have been me. I do know that I battled with the idea over months. Some part of me would lay out all the reasons not to have a second. The arguments were sound: money, time, scheduling, sleep, sanity, comfort, traveling, and so forth. The original counter argument was fairly weak and easy to override: Eliot would be better off with a sibling. Of course, around then many of Eliot's cousins and classmates were started to acquiring their younger siblings. The guilt grew a little stronger. Then Eliot started asking for a baby because his friends were all getting babies. *sigh* For me, the internal deliberation continued. I wrestled with it, I picked at it, I worried at it, I rolled it around in my head, I chewed on it. You name the metaphor, I did it.

I think it is in this arena that I envy Sandy the most. He's so binary about these sorts of things. This is not to say that he didn't have his own considerations, but I think for the most part he just didn't think about it. If it couldn't be solved at this moment, it wasn't worth worrying about. Just after Eliot's third birthday (August 2008), I finally teetered over to the side of having another child. Sandy said sure, four years apart is a great distance between sibs, and the trying began.

Predictably, we found ourselves pregnant a couple of weeks later (September 2008). That was certainly an 'oh hell' moment for me. All my resolve went out the window. Did we really want to have a second child? We'd gotten rid of ALL of the baby stuff... including the crib... what were we thinking doing this again? How was I (who hasn't driven a car in almost 15 years and has no intention of starting again now) going to get around on a bike with a 3 year old while I was 8 months pregnant? Nevermind that... how I was going to bike around with a newborn and a 4 year old? Where were we going to put it? We've a reasonably sized house, but it still just has the two bedrooms upstairs. How were we going to pay for preschool and daycare simultaneously? The questions ricocheted around my brain. At the point of bursting, I shared with two close friends: Anne, who was trying for a second and Jeanne, who had no intention of having more than one. I confess, I was embarrassed to tell each of them we were pregnant. I, who had spoken so vociferously about the horrors of early childhood, who had planted a flag in the soil for the benefits of having an only child, meekly explained that I had caved to my hormonal other half. Being the truly solid friends that they are, though surprised, neither disparaged me nor poked fun at my broken resolve. Looking back, I still marvel at their grace. Jeanne, must have felt some sense of loss. We'd bonded on the notion of raising our onlies together as pseudo-siblings. And Anne had already had one miscarriage and numerous failed attempts in her try for a second child, but she showed nothing but joy for me and our easy, unexpected pregnancy. You can't ask for better friends than that. Happily for Anne, a few weeks later she was pregnant with her second, Oliver, born mid July 2009.

As you must suspect, since I have not reported our own second child, we miscarried 'naturally' at about 8 weeks. This is not a post about miscarrying, so I will not belabor this, but I have to say that 'naturally' implies simple, accidental, happenstance and so many things that it was not. It was an endless week, a prolonged process of cramps and pains. By the end of the week I was jumping up and down, bouncing on a ball, and anything else I could do to agitate the lifeless thing out of me. By the end, I was a mobile illustration of conflicted. I'd spent the weeks of pregnancy questioning whether I truly wanted to have another and left myself little room to mourn it not coming to fruition. I'd only shared the pregnancy with my closest friends so only they and one or two coworkers and advisers (who we told because of the time off of work/school) knew about the miscarriage. No one else had a clue. We continued to socialize with friends, family, coworkers, classmates and clients as if nothing had happened. The weeks following were surreal. It's not surprising to me that in the haze that followed we found ourselves pregnant a little over a month after the first miscarriage. I say first miscarriage, because the second pregnancy lasted about as long. At six weeks we had an ultrasound and at eight weeks we had another. The fetal progress had stopped. On February 25, 2009, I had a D&C.

There is so much that is blurry about those two pregnancies. I know that at one of the pregnancies we took Eliot with us to the OB for the ultrasound, so excited to share with him his new baby, but I can't remember which pregnancy it was. (Thankfully, he never truly understood that because it was clear at the time of the ultrasound that it wasn't going to happen.) The months that followed the second miscarriage pummeled me. Two deaths of close family members, rejection letters from the doctoral programs to which I had applied, and a near-death illness with one of our dogs accompanied repeated and failed attempts to get pregnant again.

What has happened is a fundamental shift from passive to active in our attempt to have a second child. My image and identity as a 'reluctant mom' is gone. A determination has set in. Over the last months, Eliot and I have been talking a lot about his desire for a new baby. He keeps asking me if there is a baby in my belly. When his friends, Charlie and Raulie, got new baby brothers last week (Oliver on Monday and Emilio on Tuesday), Eliot began telling people he was going to have a baby sister. What has proven most difficult to explain to him is the trying. I think it would almost be easier to just give up and say we are a 3 person (and multi-animal) family. It's the trying that takes thick and callused skin. I haven't decided yet if this quest is Quixotic or Sisyphusian or both. For now, I remain resolved.