Needles, Needles and More Needles

Well, well, well. It has been a mighty long time since I last reported. The last months have been full on many fronts but first and foremost are body art and fertility treatments. It seems I have become a human pin cushion.

First, after our last failed IUI, I decided to return to acupuncture to see if I could liven up those follicles a bit. It certainly seemed to have helped for our only successful round of IUI. We took a few months off from seeing the RE, and I began weekly visits to the acupuncturist. During this time, I also continued working on the lower-leg tattoo sleeve. After the catfish, I had 2 more sessions to add the frog and dragon fly and the rest of the line work for the pond scene.

This time was relatively calm, in spite of the needlework. Somehow in my head the tattoos have become a chronicle of the infertility. I can't really explain how. I suspect it began by having three key elements (catfish, frog and dragonfly). Perhaps it was the doing it in pieces and the incomplete, open-ended nature of it. I don't know for sure. Still, after several months of acupuncture and then completing the line work spurred something in me, and I called up the RE and scheduled an appointment to do a baseline ultrasound to see how the follicles were doing.

I went in and things just went into overdrive after that. We had a good number of follicles. We scheduled a meeting with the RE to talk over our options. The short of it was: IVF with pre-implantation genetic screening (PGS). Insurance approved all but the ICSI and the testing. It all began. I started the pill and had two weeks to squeeze in my first bit of color on my tattoo. Natasha did the frog and then began the ultrasounds, the blood tests, the daily injections, and eventually the egg retrieval. First bad news: we went in with 16-17 sizable follicles, we came out with only six eggs. Next bad news a day later: only 2 eggs were healthy/mature. Both fertilized, but we had too few to do PGS. We did a Day 2 transfer. More shots this time: progesterone and Lovenox. Two agonizing weeks of waiting. Thank god for the estrogen pills. Those little blue pills provide a real pick-me-up. Friday the 24th I go in for the blood test. Four hours later, we get the call. Unfortunately, it was all for naught. We're not pregnant. Moreover, there is little chance of us ever getting and/or staying pregnant with my eggs. Twenty four hours and numerous tears later, I call to schedule an appointment for the next stage of my tattoo. I can't get in until October 17, but there's nothing else happening until then, so I can wait.

My doc wants me to come back in a couple of weeks to talk about our options. At this point we really have two options: donor egg or giving up. We'll keep talking about it, and I'll keep swinging back and forth from one extreme to another, but I really think it's done.

Now I am just stuck on *how* to give up.

It's a Boy!

Not ours, of course, but I have a new nephew, and Eliot has a new cousin. On that side of the family there are now three boys and three girls spanning a six year range. Everyday it looks more and more like Eliot is going to be a singleton, so having cousins with whom he can be close and share history becomes increasingly important.

I only have three cousins, two a few years younger than me and one decades younger whom I never met. All three of them are singletons. Growing up, I shared more in common with one cousin than brothers. We're not super close now, but still comfort in having each other. I can wish for the same or better for Eliot. Regular summer reunions should help ground those relationships.

Running on Empty

I donated blood last Tuesday. Somehow in the thick of it last year, between missy #2 and missy #3, I managed to donate 3 times. Donating 3 times in a year at the Blood Centers of the Pacific (BCP) earns you a personalized desk calendar. It's a clever idea. The calendar marks the days that you donated (in the previous year) as well as your birthday. Mostly what it does - extremely well - is to make me feel guilty every day when I look at it and realize that I haven't donated in months.

So, last week I finally reached the blood-letting inertia escape velocity. Why? Because on Saturday, I finally got my first tattoo. Getting tattooed makes you ineligible to donate for 12 months. The guilt was/is intense. Still, I'm thrilled that I finally took the first step in the body art process. On Saturday I started the first part of a multi-part piece. I had a catfish outlined on my lower right leg. Next will be a dragon fly, a frog and a lilly pad. Eventually, I want an entire pond scene. My tattoo artist laughed that for my first tattoo, I wanted an entire lower-leg sleeve. But it makes perfect sense to me. I have been planning and thinking about this tattoo for several years, but like so many other things, I've been postponing having it done in our effort to have another.

It's insane how many things that I've deferred or balked at in case we got (or actually were) pregnant: vacations, graduate school, career pursuits and of course, getting a tattoo. Likewise, there are so many things that I've held onto for the same reasons. Eliot's closets have been stuffed from floor to ceiling with baby stuff. Our storage area overpacked with the stroller, tricycles, the bike trailer and more. None of which Eliot uses.

I'm not sure what it was exactly, but I think it was the failed round of IUI we did in April/May. I did all the injections and ultrasounds and only managed to produce two mature follicles, and barely even that. So after I got my period, I packed up all of Eliot's baby stuff and gave it to a coworker. Boxes and boxes of stuff. I even gave away his Mountain Buggy. After that I got up the nerve to schedule an appointment for the tattoo.

I can't say that we've decided to quit. That's not the case. My coworker knows that we are trying and won't give away anything without asking us first. It's just that I'm so tired of the waiting. I need to get on with my life. Sustaining hope in the face of repeated and relentless failure is exhausting.

April Fools

Yet another large window has gone by since my last post, with much news to share. After the last described, failed round of IUI, we began a new regimen. This began with going on the pill for two weeks. Huh? You say? You're trying to get pregnant, so you are going on the Pill? Well.... it would seem that we do very well getting pregnant after we come off the Pill. Back in 2005, we went off the Pill, and instantly we were pregnant with Eliot. In 2008, we went off the Pill and bang (so to speak), we were pregnant with Missy #1. (We got pregnant with Missy #2 immediately after we lost Missy #1, so that one was a little different, but still follows a pattern.) Then after Missy #2 in Mar of 2009, nothing, until my last post in November of 2009. It turns out that my cycle goes wonky when left to its own devices, but the Pill gets the rhythm right with my cycle.

SO... we begin the Pill in November. I'm not working at all at this point because I don't know when I'm going to need to drop everything and run to get an ultrasound or blood test. On a whim, I decide to apply for a job at UC Berkeley Extension. Instead of doing classroom technology training, I would be using my MLIS to help design and develop online courses. By develop, I don't mean coding, but rather I would be working with subject matter experts to determine the best delivery mechanism for the content, I'd collect and edit the content, and I'd direct the creation of the online course. Pretty cool stuff. Lo and behold, I get the job. I would begin in January. In spite of some reservations about the salary and the state imposed furloughs, the prospect of working close to home and leaving coding behind me is tempting, and I accept the position.

After two weeks on the Pill, the doctor takes me off. A new refrigerated box of medicine arrives at my door when I start a new cycle. The regimen of daily shots and every other day visits to the doctor for bloodwork and ultrasounds ensues. Meanwhile, I'm visiting the acupuncturist once or twice a week and taking herbal supplements that have me constantly flatulating. I'm walking somewhere (fart), I get on the bus (fart), I'm at the grocery store (you guessed it), and I'm getting a vaginal ultrasound (and trying my damnedest not to fart). I actually went to see a GI doc, who had no idea why I was farting every minute of the day, before I traced it back to the Tang-Kuei Evodia I'm taking. Still, the embarrassment is totally worth it when it becomes evident that the IUI cycle is going to go perfectly. I've 5 mature follicles, the extra shot that I'm taking (Ganirelex) is keeping me from ovulating too soon, and we're ready to use the Ovidrel trigger shot to stimulate my ovulation. Exactly 36 hours after the Ovidrel, I go to the doc for the IUI. Earlier that morning Sandy had gone in to make his deposit. His numbers are stellar. Those boys can swim. There's not much to say about the IUI itself. I had to show ID to pick up Sandy's specimen, and I had to hold the little test-tube next to my skin to keep it warm. The procedure is quick and painless. The waiting for 2 weeks after the IUI is cruelly long, but on December 25, at my parent's house in Indiana, we get a positive home pregnancy test. A couple of days later, we go to Chicago to Quest labs for a blood draw and gestational table that is reported back to our RE in the Bay Area. Congratulations, we're pregnant.

Here's where I'm going to summarize a bit. As soon as we get the go ahead from the RE, I begin my daily shots of Lovenox in order to keep my blood thin in case that's why I'm miscarrying. These shots hurt a LOT more than the hormone shots. Still, we're pregnant. Mid-January, I start my new job at UC. I'm wringing my hands over the fact that I'm pregnant and starting a new job. I confess to Roxanne, my boss, who is a real mensch about the whole thing. I go to the RE for an ultrasound at 7 weeks (instead of 6 and 8 weeks because I don't have a lot of time off accrued at UC yet). All is well, and we see a heartbeat. I'm feeling nauseated, and we're elated. I go to the OB at 10 weeks for an ultrasound. Fetus seems a little small, but the doc isn't worried, we still see a heartbeat. We're almost out of the woods. We go to the perinatalogist at 12.5 weeks for the CVS, the final hoop (to mix metaphors). No heartbeat. Baby died in the last week. We're devastated, and needless to say I don't go back to work that Thursday. Friday I stay home and am on the phone to various doctors to figure out what we do next. My OB cannot perform a D&C because after 12 weeks it's considered a D&E. So we have to see a specialist in Lafayette. We get an appointment later that day to meet with him. He walks us through the procedure. I'll come in the night before for the insertion of laminaria sticks that will begin the dialation process. We schedule it for Monday afternoon, March 1st. Yes, ladies and gentlemen, I'm having a procedure to remove my dead baby on my 40th birthday. Happy, happy birthday. The weekend, the procedure and the couple of days that follow the procedure are a blur of emotions and tears.

In the last month, we did a lot of soul searching and discussed our options with this new OB as well as our RE. Insurance will cover another round of IUI so we're going to proceed with that again. I'm 40 now. There's no time like the present.

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.

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.

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.