Friday, December 27, 2013

Break, Breaking, Broken

It started off so well. Five mature follicles. The first time a medicine regimen has worked since I began trying. Five great opportunities for a fantastic Christmas present.

When that fell through, I pulled myself off the floor. Instead, my Christmas present was a lovely period with cramps and vomiting. I focused on this being a fresh start and new beginning in time for the new year.

Today was my baseline ultrasound for that new beginning. Today I learned that I have two large "leftover" follicles measuring over 25mm a piece, one in each ovary, each looking half deflated and described as entirely useless at this point. I held my breath until 2pm when they finally called to tell me the verdict. My fate for the next month, decided by a doctor.

I'm out.

I am to call them in 28 days if when I don't get my period, in which case they'll prescribe 7-10 days of Provera and then I will hopefully, but never consistently, get my period and begin again. So for the next 28 - 45 days, I am back to waiting without hope.

I don't know how to end this. I don't have anything prolific to say. I keep oscillating between drowning in my own misery and pulling myself back up, moving forward, and staying positive. Frankly, both of these options are exhausting and unappealing.

Thursday, December 26, 2013

Merry Christmas

For this Christmas, I received the beginning of my menstrual cycle, complete with an extra large dose of cramps that actually made me vomit.

I now vividly remember why I went on birth control pills as a teenager, and it had nothing to do with my non-existent sex life. At the age of 15, two years after I began menstruating, I was still having only 4-5 periods per year and it would completely incapacitate me when it did occur. I'm still a little annoyed that no one considered testing me for PCOS at this point.

Merry Christmas to me. If there was ever a shred of hope that the tests were inaccurate, it is now clear as day. I am choosing to look at it as a new beginning, a new chance. Here we go again!

Tuesday, December 24, 2013

Categorization of Christmasyness of Christmas Movies

Moving back in with my parents (i.e. no house to decorate), without kids, and with my sister and her husband visiting for three days, makes it difficult to partake in any holiday traditions that are just for C and I.

If I were to decide on a theme for this year, I would say it would be movies. C surprised me last week with a trip to the cinema for a showing of It's A Wonderful Life. I paid him back by agreeing to watch Die Hard. This spawned a lively debate on whether or not either of these movies are technically Christmas movies, and then a categorization of other so-called Christmas movies. The pivotal question to ask yourself is, "Can you maintain the plot of the movie by taking out (or changing) the Christmas aspects?" (i.e. is Christmas really fundamental to the story line)

Here are my findings...

Most Christmasy Christmas Movies 

  • Miracle on 34th Street
  • Elf
  • Rudolf the Red Nosed Reindeer
  • Charlie Brown Christmas Special
  • Santa Clause
  • How the Grinch Stole Christmas

Moderately Christmasy Christmas Movies

  • Home Alone: I would have put this one lower, but when I considered all of the adaptions that would be required, this one really does rely on the holiday. It just can't be most-Christmasy because it's not really about Christmas so much as this is a necessary component to the movie
  • A Christmas Story: This might be slightly biased and in this category because I don't really like this movie. Yes, it's very much about Christmas and couldn't work without the holiday. On the other hand, it does not capture the Christmas spirit or send a positive message whatsoever. And for that, I deem it not most-Christmasy. 

Least Christmasy Christmas Movies 

  • It's a Wonderful Life: It's a lovely message and my personal favorite Christmas movie, but it could take place at any point in winter and you'd just need to substitute the tree decoration bell with a different bell (cow bell maybe?)
  • Love Actually: Slightly tricky because of the Christmas play that brings the whole country together, but maybe this could be substituted with a rugby match or national cricket championship. 
  • Die Hard: This is not a Christmas movie. Plain and simple. It's a decent action movie. You could very easily substitute the Christmas party for a retirement party and the wrapping tape used to tape the gun to his back at the end (C's biggest argument) could be any office supply take easily found in an office building. PLUS, it doesn't send any positive Christmas messages at all. Frankly, it shouldn't be on this list at all, but I'm including for the sake of argument. 
There you have it. My very biased categorization of Christmasyness of Christmas movies. Am I missing any movies? Would re-categorize any of these?

Monday, December 23, 2013

Scholarly Series No. 3: IUI is Valuable and Cost Effective

Continuing on with the medical community's debate on whether or not IUI is worthwhile, I now take on the counter-argument. For previous articles that initially sparked my interest in this topic, check HERE and HERE. In my last Scholarly Series post, I discussed the first of two chapters debating the merits of IUI and, frankly, it made a very strong argument against this approach. Now I take a look at the other side.

Moolenaar, L.B., Van Voorhis, B.J., van der Veen, F. (2013). IUI is a Valuable and Cost-Effective Therapy for Most Couples. in Biennial Review of Infertility: Volume 3. Eds Schlegal et. al., 185 - 188. 


Compared with the last article, these authors take a more moderate approach and begin by acknowledging that IUI is not the best approach for some diagnoses. They state that, unfortunately, many fertility decisions are made based purely on financial considerations rather than cost-effectiveness, a subtle but distinct difference. The authors do discuss a randomized control trial that compared 6 months of "expectant management" versus hMG and IUI that showed no difference in pregnancy rates and argued that that expectant management should be the "first line" treatment approach for most couples. 

They also discuss several studies comparing the cost-effectiveness of IUI to IVF. While some of these studies did conclude that jumping straight to IVF was more cost-favorable overall, the authors argue some key problems with the research methods in each of the studies. As for the FAST trial, that the previous article I reviewed spent a lot of time discussing, these authors point out that while the median time difference to pregnancy between the two groups was approximately 3 months, there was an equivalent rate of multiple pregnancies and that, ultimately, by 1 year, the pregnancy rate in both groups was equal. The other interesting finding that the authors point out is that, in each of these studies, 14-32% of the pregnancies were "treatment independent", meaning the pregnancies occurred during a break cycle. 

The authors conclude that current evidence show that expectant management for 6 months, followed by IUI is still more cost-effective, but that the duration of treatment with IUI before proceeding to IVF and the additional value of ovarian stimulation to IUI are still unclear. There is an upcoming study that compares IUI to IVF eSET to modified natural IVF, which the authors are hopeful will further clarify this issue. 


The writing style of this article was definitely less compelling than the last article. To be honest, I found some of their arguments more confusing and harder to follow. But I think that might just be the point. Infertility is not a one-size-fits-all diagnosis and it is likely impossible that one, or even a handful, of studies can adequately capture each of the nuances that affect healthy conception and ultimately a healthy birth. There are too many different factors that cannot all possibly be controlled in a research lab, and if they were, would definitely not be generalizable to real-life.

The take-home point from this article that I gathered is that IUI can definitely be valuable to some couples, but trying this approach over and over will begin likely offset its value. Which is probably true with most other approaches/treatments if you think about it. So in other words, for many couples, it is definitely worth a try but not something to spend an excessive amount of time/money on.  

Sunday, December 22, 2013

Questions Without Answers

Day 14. I took a digital HPT to see the words clearly: "not pregnant". I also needed C to see the words, because he was a little dismissive of the early testing.

I feel angry with my body that it didn't pull through. I feel angry with myself that I let myself get too optimistic and hopeful, even cocky at times. Mostly, though, the feelings of anger are masking the more fundamental emotion of fear.

If five mature follicles, a "beautiful" lining, and correctly timed intercourse with normal sperm quality doesn't result in a pregnancy, are we missing something?

How was this possible? What went wrong?

How can we be worrying about the possibility of too many possible embryos and selective reduction in one week, only to find out that not a single egg was fertilized/implanted the next?

Aside from mature follicles, uterine lining, sperm quality, and timing; what other factors can we improve or control (without going on to IVF)?

I think it would have been easier if there was only one follicle. I could tell myself that the egg was just a dud. That happens to everyone. It's normal. But 5 dud eggs?!? I don't get it.

I think the biggest problem is that, in the effort of coping adequately with the impossibly hard time I've had to get my body to ovulate, I've convinced myself of something. I believed that our only problem was anovulation related to the PCOS.

Tubes were checked and cleared. I had a lot of little follicles, ready to mature. Sperm quality/count/motility was not an issue. Everything else appeared to be functioning optimally. The only issue was that my follicles would not grow and then ovulate. Or so I've told myself.

Once we solved this problem, that should be it. That should be our answer. Easy as that. With 5 possible mature eggs and no other issues, this should be a near guarantee. I ignored the stories I heard of others with PCOS that required IVF, that had been trying for 9 years without luck, that ended up adopting. This didn't apply to us, I convinced myself, we only have one small issue.

Now, these creeping thoughts keep finding its way into my conscious. What if it is more than that? What if this isn't going be as easy as fixing one thing? What if this isn't that simple.  What if missing something?

Saturday, December 21, 2013

Read this next CD11

Dear future Katie,

Do NOT test early. One day of dissapointment is plenty, why do you torture yourself?

Progesterone effects are the EXACT SAME as early pregnancy signs. It does not matter that your temperatures keep rising. DO NOT BE FOOLED! It is simply the Mirror of Erised (HP style), but in a pill form that you shove up your vagina daily. Just because some people can tell at 11 DPO or 12 DPO does not mean you will be that lucky. Why on earth would you assume you could be that lucky? Have you ever been lucky when it comes to fertility?

So I'll say it again - Put down the test! Walk out of the bathroom! Wait just a few more days and then you can be justifiably dissapointed and move on.

Your Previous Tortured Self

Thursday, December 19, 2013

Two week crazy... a recap

As I near the end of these two weeks, I get more anxious and crazy. Like any test, the closer you get, the less sure of yourself you become.

My body is not helping matters.

Almost immediately after ovulating, I had very bad pains and bloating that felt like I was constipated and holding onto a full bladder all at once. For days. It would wake me up at night. I convinced myself that I had OHSS, and then the pain subsided.

This symptom was promptly replaced by several days of heartburn. I do not typically get heartburn/reflux symptoms, but this was constant for several days.

The heartburn got more bearable, and now comes and goes. When I don’t have heartburn, I will typically have some mild cramping.

My breasts may be slightly sore and swollen, or I’m just a huge psychosomatic. My nipples do seem to be more erect and sensitive.

Then, two days ago (9dpo), I had an orgasm which was followed the most severe cramping and pain that I may have ever felt. It lasted for about minutes and was severe enough to make me want to vomit.

I have been temping and they seem to be continuing to rise, especially over the past three days. I always question if I’m doing this correctly though.

I am not sleeping through the night. I’m sure this is in no way related to my anxiety over the above…

Some of these symptoms are definitely legitimate. Some may be entirely in my head. None of them do any good in differentiating symptoms caused by the Prometrium (200mg vaginally, 2x/day) versus early pregnancy symptoms. All of them are making me go insane.

All I know is that any envy I had of the two week wait before (when I wasn’t ovulating), I take it back. I am only hoping that, if I do have to go through this again, that I’ll be better at it next time. Please, tell me it gets easier!

Wednesday, December 18, 2013

Knock on Wood

I don't consider myself a superstitious person, but I am a strong believer in not jinxing something. I've been known to "knock on wood" when needed, which usually curbs my anxiety.

Today there was a book signing at my hospital by Michael Roizen, MD, one of the co-authors of the YOU series. I immediately thought of having him sign the book You: Having a Baby to give as gifts or for myself. I thought long and hard about how many books to purchase and ultimately decided not to get one for myself. Better not jinx it, right? I had him sign three copies; one for my friend who recently announced to me that she was pregnant and very nervous about it given a history of chemical pregnancies, and two for friends who are desperately trying to be.

He signed, "So-and-so, Katie hopes that you have a wonderful and healthy journey. (Me too). Michael Roizen."

It was fitting. And I may have told him a small white lie, that these friends recently announced a pregnancy, so he was not even aware of the infertility struggles.

Telling him that I was buying books for people that aren't pregnant yet seemed like I would come across as a nutcase. But secretly, my plan is to write a note for the two not-yet-pregnant friends about how I am sure that they will be soon and have it dated now. So when they finally are, I can give them the book and they'll know I held the faith all along. It doesn't jinx it if someone else does it for you, I've convinced myself.

So, no, I still do not own any pregnancy books. I do not have any baby items. Our future nursery is still in full use as an office and spare bedroom.

My therapist had said that this wasn't necessarily a good thing and that, instead, I should be preparing myself and my surroundings to carry a child. She convinced me to crochet a baby blanket, which I technically did. In reality, I made it extra big so it's not limited to babies, I've told myself that it's not my baby's blanket (maybe I'll gift it or give it to charity), and have gotten it 90% complete over a month ago but have yet to actually finish the damn thing.

Because if it's finished and doesn't have a recipient, then that would been a mess. Because I can't let the recipient be my future baby that doesn't yet exist. Because I don't want to jinx it.

Where do you stand on buying/making baby items ahead of pregnancy: emotional preparation or a big jinx?

Monday, December 16, 2013

Scholarly Series No. 2: IUI - An Ineffective Treatment

In continuation of my nerdy pursuit of professional articles addressing topics related to infertility, I will be running a small section on the current debate over the whether or not IUI is worthwhile. This spawned from C and I needed to make a decision between Time Intercourse or IUI and me happening on the article I reviewed in my initial Scholarly Series post. In this book, two back-back-back chapters discuss each side of the argument and will be topics for my next two posts in this series.  

Johnstone, E.B. & Dorias, J. (2013). Intrauterine Insemination: An Ineffective Treatment. Biennial Review of Infertility: Volume 3. Eds Schlegal et. al., 173-183


These authors take a very pointed stance by clearly stating at the end of the first page that "IUI should no longer be a standard part of infertility treatment" based on several compelling arguments. The article begins by explaining how IUI performed and a little bit about its history (first published article on this was in 1962!) and the rationale for treatment, but then quickly veers into the arguments against its continued use. 

The first argument is that IUI is not significantly more effective than timed intercourse and/or controlled ovarian hyperstimulation (i.e. use of Clomid, Letrozole, Gonadotropins, etc.) and much less effective than IVF. They cited numerous studies, including many meta-analysis studies that analyze aggregated data from all previously published studies, finding that IUI was not more effective than these other approaches in both unexplained infertility and male factor infertility. Compared with IVF, IUI is becoming less beneficial over time as IVF success rates are continuing to increase but IUI success rates have remained stagnant. 

The second argument was made regarding cost effectiveness. They discussed two studies that compared the costs of "expectant management" (e.g. using OPKs, CM checks, etc.), Clomid, and IUI and found that the costs of IUI were significantly greater than the other two treatment options but without a significant increase in chance of live births. One really interesting study they discussed (which I may have to review separately at a later date), called that FASTT trial, compared unexplained infertility couples randomized to either three cycles of CC/IUI followed by three cycles of FSH/IUI followed by IVF (as necessary) to an accelerated track of three cycles of CC/IUI followed by IVF. The study found that not only were pregnancy rates increased with the "accelerated track" but there was also a cost savings of $2624 on average! They discussed several other studies that have concluded that cost-effectiveness data favors immediate IVF over IUI. 

The third argument proposed by the authors is that IUI is much riskier than other procedures and has more adverse events (e.g. discomfort of the patient and potential risk for infection). Infections were found in 1.83/1,000 women undergoing IUI. The biggest "adverse event" discussed was the risk for multiples. While most of the blame for multiples falls on ovarian stimulation (either oral or injectable meds), the issue with IUI over IVF is that you have much less control over how many eggs are mature, fertilized, and implanted. Multifetal gestations carry increased risk of numerous complications for both the mother (e.g. anemia, diabetes, preecplampsia, etc.) and the children (e.g. prematurity, cerebral palsy, visual and hearing deficits, learning difficulties, etc.). These risks are often minimized with IVF, especially with a single embryo transfer.


This was clearly an argumentative style paper. I was surprised by how strongly worded the article was but I am also surprised that this was one of my first times coming across any negative thoughts or opinions on IUI. With both REs that I've consulted with with others that I have talked to, it seems like it is still the standard protocol to go through IUIs before moving on to IVF, especially in those "milder" cases. The idea that this was even up for debate in the medical community was a complete surprise to me. This makes me wonder if either A) the general medical community is slow to change their thinking with new scientific advances or B) these authors are a little extremist and making the mistake of throwing the baby out with the bathwater.

I do have to say that the arguments were very compelling. I would definitely recommend people read the whole article if you're trying to make related decisions. What I took away from it is that, for many couples, IUI does not add much and puts additional cost and time in the fertility journey so that it can be advantageous to just jump straight to IVF. For some couples, taking the gamble of trying IUIs first will pay off and you won't need to move to IVF, but this does't seem to be a statistical norm. I'm sure that there are some psychology studies related to the gambling mentality with all of this.

I purposely did not read the next chapter, the counter-argument that IUI is an affordable and effective treatment, but now I can't wait to see what the others are saying. Until then, I leave you in suspense.

Saturday, December 14, 2013

Two Week Bore

I've noticed that I really haven't had a lot to say lately. There haven't been any new revelations, exciting thoughts, great introspections. Life is mostly boring and it feels like things are in limbo. Is this how the two-week-wait is supposed to feel?

Work has been moving along grudgingly. I find that I am (mostly) able to concentrate fully on my patients when they're actually sitting in my office, giving people my full and undivided attention. This is only what they deserve. My biggest problem has been with the documentation/billing afterwords. It's always been the least liked aspect of my job and I notice that whenever I am preoccupied or otherwise consumed with my own emotions, this is the first thing to go. Oh how I hate the paperwork. I set a goal for myself to get all of 2013 documentation complete before the end of the year, so that I can start the new year fresh. Somehow, just stating this as a goal has not actually made it happen. Dammit.

The pain that I was feeling in my lower pelvic region continued to get worse through Thursday, at which point I was absolutely convinced it was due to Ovarian Hyper-stimulation Syndrome (OHSS) and planning to call the doctor the next day. It woke me up out of sleep for three days in a row! Then, of course, on Friday it got substantially better and today it is hardly noticeable. Better enough that I decided not to call the doctor. Everything I've read about OHSS says that it will continue to get worse until you have a period, or into the first trimester if you're pregnant, and now that I seem to have improved, I'm left wondering WTF?!?!

Christmas is beginning to stress me out, but not for the obvious infertility reasons. There are still several people that I have not gotten gifts for. What's worse, I have no idea what to get these people. It's like I've been so wrapped up in myself lately that I stopped thinking about what others would like. C told me to give myself more credit, because I have bought 7 of the 9 niece/nephew gifts and do have ideas for the other two. Kid gifts are so much easier than grown-up gifts.

I have also made a conscious effort to stop worrying about my weight and getting in the best shape of my life. No, I am not going crazy with brownies and a side of streusel for dinner. I'm just eating what I want, when I am hungry. This decision came shortly after beginning the Follistim and realizing that I am fighting a losing battle, at least while I'm injecting and ingesting medications that are known for bloat and weight gain. And the stress of worrying over this can't be any better then the weight itself when if comes to fertility and overall health. Much to my amazement, this past Thursday, I stepped on the scale that I had been successfully avoiding for the past two weeks (mostly to prove to prove to myself that I had OHSS and was gaining a ton of weight from bloat) and found that I was actually a pound less than when I last weighed myself. Go figure.

C and I are dog sitting his sister's pets this weekend. We bought a new futon mattress for the comfort of our bottoms. And there is a huge snow storm that is absolutely beautiful if you don't have to travel. That's really as exciting as our life is right now. Oh, yeah, and I may be implanting some embryos as we speak, but I won't be able to figure that our for at least another week.

Marv enjoying the snow storm. 

Wednesday, December 11, 2013


Sure enough, I ovulated one time in the past two years and I've turned into that girl. You know, the one who notices every twinge and analyzes it with a fine toothed comb. The one who fantasizes about how to announce the pregnancy and daydreams about baby names on the way home from work. And it's only been three days! I'm in big trouble.

We ended up choosing the Timed Intercourse route, almost at the last minute, based on several factors. Primarily, the research of IUI wasn't particularly compelling and the RE didn't make a strong case for it one way of the other. It was also a financial decision, but whenever I remind myself of how much of this is decided by money I get angry.

The major benefit of IUI would have been the precision that we weren't necessarily guaranteed when you take the do-it-yourself approach. Especially when C's finals week is now, his dad is still hospitalized, and we are living with my parents...oh yeah, and my younger sister decided that this was the perfect weekend to bring over her new boyfriend for us all to meet all weekend! Someday, this will make a great story. ...Son/daughter, your father and I paid money to get your aunt Em and weird new boyfriend out of the house so that we could make you...and your grandmother ended up finding out and helping us coordinate the whole shebang...

It wasn't perfect. We're not machines, after all. But I do think it was good enough from everything I know about how long sperm can live and timing of ovulation based trigger shot timing. And C and I agreed that this was the best part of baby-making so far ;), especially since up to this point our primary moments of intimacy revolved around needles and vaginal u/s wands, so I am glad that we were able to keep that part of things natural.

I started the progesterone suppositories today, but this is not eventful. My only other update is that I legitimately have had a lot of pressure/mild cramping in my lower pelvic area. Sometimes it's concentrated on the right side (where my biggest follicles were) but often it's on both sides or more central. Usually it is relatively dull but last night it did wake me up and I had a hard time getting comfortable and falling back to sleep. Not quite sure what this is about. Too early for implantation cramping? A symptom of Ovarian Hyper-stimulation Syndrome? Is this what it feels for the eggs to travel down the fallopian tubes? Am I just a hypochondriac?

Monday, December 9, 2013

Scholarly Series No.1: Timed Intercourse vs IUI in PCOS Patients

Over the past several infertility decisions we've have to make recently, my nerdy side has kicked in full-force and I have found myself turning to primary-source research articles. It's been very helpful to read the same scholarly journals that the professionals are reading and, given my background in research and statistics, I can actually understand most of it.

Because nerdism should be shared, I've decided to start a new series of posts, hereby known as the Scholarly Series, in which I will discuss an original journal articles. I will try to choose recent papers, likely ones that are relevant to my current situation or ones that I just find interesting. I may include some of the classics as well. In preparation for this, I've actually found several papers that I can't wait to share with people! So without further delay, here is the inaugural Scholarly Series:

Wisner, A., Shalom-Paz, E., Reinblatt, S.L., Holzer, H., and Tulandi, T. (2012). Controlled Ovarian Hyperstimulation in Women With Polycystic Ovarian Syndrome With or Without Intrauterine InseminationGynecological Endocrinology, 28 (7), 502 - 504.


This study evaluated the value of IUI among couples with PCOS and a normal semen analysis. It was a retrospective design, utilizing medical records review. The authors evaluated records of 156 women with PCOS treated with either Clomid, Letrozole, or gonadotropins in 2009 and 2010 and only looked at cycles that resulted in actual ovulation.  Women were given oral medications for three months and then moved on to injectables if not conceiving after this time. IUI was decided based on the physicians preference and was performed 36 hours after the HCG injection. If the couples used Time Intercourse (TIC) instead, they were instructed to perform TIC on the day of the HCG shot and then the following two days. The primary outcome was pregnancy, defines as having a gestation sac and fetal heart activity.

Of the total participants, 86 patients underwent a total of 145 cycles of IUI and the other 70 patients underwent 114 cycles of timed intercourse. Each couple was included in only group. The two groups were relatively similar in regards to the woman's age, BMI, number of dominant follicles, endometrial thickness, and semen concentration/motility/morphology. The results found that there were no significant differences between the Timed Intercourse group (17.5%) and the IUI group (16.6%) overall. In fact, the only variable that appeared to make a difference in pregnancy rates were whether patients used gonadotropins (38.8% for TIC couples and 25.7% for IUI couples) versus oral medications (14.1% for TIC couples and 7.5% for IUI couples). The authors concluded that IUI does not increase pregnancy rates compared with timed intercourse for this population (i.e. normal SA and PCOS).


The study utiized a retrospective design, which isn't as strong as a prospective, randomized control trial because you are unable to control any of the variables or randomly assign participants, which could indicate that there is selection bias in the sample. Also, the study was based out of only site in Quebec, so it's not necessarily generalizable to other locations or populations. It also rubbed me the wrong way that the decision of IUI vs TIC was based on physician preference and did not mention patient preference, but I supposed you also have to consider the audience.

Despite this, the sample size was large and the results were very interesting to me. I previously assumed that IUI automatically added to your chances of success, but then with this article and a few others I came across, I realized that this is not always the case. In fact, one of the current hot topics in reproductive endocrinology is whether IUIs are a valuable tool at all. Based on this research and some others, C and I decided to forgo IUI for this cycle and instead go the Timed Intercourse route. The decision was made easier by the fact that we're still pretty early in the game, as I know it will become much more complicated when/if the decision shifts to trying IUI vs jumping straight to IVF. But alas, that will be the topic for the next Scholarly Series post.

Sunday, December 8, 2013

Some Thoughts on Selective Reduction

"What are you thoughts on selective reduction?" our nurse asked during the final ultrasound on Friday. My initial thought was: thanks a lot, Ms. Debbie Downer, for putting a huge negative slant on one of our first potentially positive monitoring appointments. 

The good and bad news is that, in the two days since my last ultrasound, I have 5 follicles that measure at least 14mm. By the time I take the Ovidrel and actually ovulate, this could possibly result in as many mature eggs. Given that I am still relatively young in the land of fertility, and we have no other known factors, the likelihood of multiple embryos implanting is quite possible.

This is a touchy subject. It can raise a lot of potential moral, ethical, and religious issues. Please know that these are my beliefs and opinions and are not meant to offend anyone and are not meant to start a debate.

I was very glad that C was with me for this appointment and he was able to express his opinions and ask questions I didn't think of. I was also very glad that we had previously discussed this possibility, as the message of having too many follicles was beat down our throats since we began monitoring with the past RE. I am glad that we were generally on the same page.

These are my thoughts: I do not want multiples. I do not want to jeopardize the health and safety of myself and my future child(ren) by risking carrying too many at one time. I do not want the risk and I do not want to subject my body to that. I am also pretty terrified of the idea of raising multiples, as if one isn't going to rock our world enough. This last argument is pretty weak and I'm sure it would be good in its own way, but it's still a terrifying prospect.

From a moral standpoint, I believe that the dichotomous view of life vs death/non-living is limiting. I believe that there is more than just being alive versus not-alive and that having a beating heart doesn't mean full life, either in the womb or on life support at the end of life. I believe that there are actually multiple levels of living and that, at some point, the the rights and health of the mother takes priority over an embryo. As never having had to suffer through a miscarriage, I know that this is my current bias.

The nurse did explain some aspects that were unfortunate surprises. First, from a practical standpoint,  she said that not many centers will readily perform selective reduction procedures and that she knows of only two main facilities in all of US that they trust, the closest being about 2.5 hours away and in the next state.

Secondly, and more importantly, C asked about the timing and when the procedure would occur. She said that they would only recommend this after determining that the embryos were viable, meaning at least 6-8 weeks, after heartbeats were heard. I have to admit that when C and I had discussed this before, we did it thinking about removing a few cells, not actually stopping a beating heart. This fact definitely caused us pause, but ultimately did not change our opinions. I told C later that, if it came to this, I will insist that I do not hear the heartbeats until we are sure that they will all be given a fair shot of developing. Maybe this is unfairly distancing myself to make our decision easier, but it will help me to emotionally cope with this challenging situation.

The nurse was not able to tell us at what point this would be recommended or two what extent (e.g. 3 to 1, 4 to 2, 3 to 2, etc.) and said the the Dr. would discuss this with us in more detail if/when necessary.

They did give us the go ahead. We are moving forward. This is probably the most excited I've been since we began this process. This is literally our first opportunity to experience the "two week wait," to pee on a stick with actual hope. Yet I can't help but feeling a gray cloud leering overhead, far above our happiness, ready to rain on our parade.

Friday, December 6, 2013

A Good Day

I'm not feeling very inspired from a writing perspective, but I should share that today was good.

First,  we had a monitoring appointment this morning and were told that I actually responded to the medication and that we were a go! (more on this later)

Then, C's dad had surgery to remove a tumor near his kidney. His mom was a wreck and everyone was very nervous that this was the tip of the iceberg. The surgery went very well, without complications, and there were no additional tumors to be found! They are still running a biopsy on the tumor but the Dr was optimistic about this.

Finally, I get home to relax and read some blogs to find out that I've been given a shout-out on Stirrup-Queen's 471st Blog Roundup! Silly, I know, but it felt vaguely like in middle-school when the pretty, smart, popular girl compliments your trapper-keeper. I started this blog as a way to journal my feelings and maybe develop some connections with others in similar situations but what I've gotten out of this after a few short months has far exceeded my expectations. Thank you all.

Wednesday, December 4, 2013

Out Of The Closet

My boss just passed by my office, popped his head in, and asked if I was "feeling strong". Sometimes he can be so vague and hard to read, but I think he may have been asking if I was doing well emotionally, handling the infertility stuff OK. See, I finally broke down and told him last week.

I've spent a lot of time writing about how open I should be with people and much more time thinking about it. Over the past several weeks, the positive aspects of keeping silent began to be overshadowed by the complications. First there were the awkward conversations. Then there was me being less reliable than my usual-worker-bee-self. Finally, with the advent of injectable medications, was the need to change around my work schedule to accommodate the vastly increased medical appointments.

My concerns were many. I didn't want people to look at be different or pitty me. I didn't want to seem broken or damaged or somehow less capable as a psychologist because I'm going through a personal issue. I am not invincible, despite how much I try to convince myself of this. I didn't want awkward conversations and inappropriate questions. I surely didn't want advice. Once you get past all this fortune telling, the pragmatic issue of "how" and "when" were also concerns. This isn't usually something that just comes up in conversation. When people ask how I'm doing, my initial response is the obligatory "good, and you?" rather than seizing that moment to explain how I really am. I still remember in my Russian class in high school, the teacher told us that in Russia, when people ask how you are, they are not just doing it as a form of greeting but are truly interested in the response. But we're not in Russia.

First I told two co-workers. It happened during a day that I was trying to figure out how to rearrange my patients to fit in an appointment of my own. They asked how I was doing, really asked, and I told them I was exasperated. Then I told them why. I talked about it in a matter-of-fact, scheduling issue, sort of way. They asked about which doctor I was seeing and this lead to insurance coverage. Then they both said they hoped for the best and we changed the subject. Very nonchalant.

Then I told a different co-worker and one of my mentors at work. This happened on the day of a very stressful patient issue. I was emotional anyways because of the medicine and then this catalyst resulted in a complete emotional breakdown, the kind that hurts your chest and makes it hard to breathe. My co-worker "caught" me in the middle of this and I explained that my emotions were probably heightened because of the medicine but also that something very upsetting was happening. She gave me a lot of guidance and support on the work situation and then she asked about the medicine. Her first response was, "But you're so young!" to which I replied, "Yeah, but my body still doesn't work." After that, she asked about what medications I was on and who I was seeing for care and if I was happy with him*. She was pretty knowledgeable about different medications and the process overall, which was nice. I think this conversation ended by returning to talk about the patient issue again.

So that leads up to the boss. Personally, I love him as a boss but it's sometimes difficult to imagine him as a fellow psychologist. He's very abrupt and goal-oriented and not-warm-and-fuzzy. The first two years I worked here I was downright terrified of him, but less so now. We just don't have many heart-to-hearts. I knew that I would have to have some type of "excuse" to bring it up, and needing to change around my schedule provided just that. Now the silly thing is that I've changed my schedule around for other reasons on numerous occasions and have never gotten his permission. He's basically said not to waste his time with these types of things as long as I continue to have the same level of productivity. But this was the best excuse I could come up with so it took it. He called me into his office to give me support for the patient issue that he heard about from my other colleagues and I told him there was something else I wanted to talk to him about. I fumbled with my words. It was awkward. In the end I said something to the effect that due to increasing infertility treatments and appointments I will need to change around my schedule and maybe cancel an occasionally patient, but I will try to have make a minimal impact on work and patient care.

He responded, "No worries. Take care of yourself. That's the first priority. If you're not healthy then you're no good to the patients anyway."

On the one hand, this was his way of being supportive. I don't have to worry about infertility impacting my job anymore. Despite this, I left his office wondering if he actually heard the word infertility or if he thought I was getting treatment for some other, life-threatening disease. It was definitely an odd response in my opinion, but probably what I should have expected from him. At least now it's over. I'm outed and it feels good. At this point, there is no one else that I feel a burning need to open up to, no one that I feel like I'm hiding anything from. I haven't shouted it from the rooftops (or more realistically, FaceBook) but that's not my thing. Then again, I feel more confident that the next time someone genuinely asks how I am, how life is going, that I will be able to answer honestly.

Coming Out of Your Closet: Ash Beckman at TEDxBoulder

*I think this is a common question because I work at a hospital so everyone assumes they know everyone. 

Tuesday, December 3, 2013

Fertility Status Updates

Apparently 'tis the season to announce your pregnancy...

1. An old friend from graduate school and sister-in-law to my also infertile friend, we'll call her E. This one is much harder for E of course, because the friend/SIL already has a 18 month old and tried for a month or two. In fairness to friend/SIL, she does have PCOS and did take a little longer with the first one, requiring a few rounds of Clomid, so anticipated that the second might be as arduous.

2. My friend from graduate school, who happens to be 42, got pregnant within a few months of moving to the same state as her boyfriend.

3. An old colleague, aged 35, who got married 14 months ago.

4. C's high-school friend/brother-in-law to his sister, due in April, less than 20 months after their first child was born, which was less than a year after they got married. I remember feeling mildly irritated with their first pregnancy and now here comes number two.

All within the past two weeks. This doesn't the count the peripheral FaceBook announcements of people I hardly know or care about. Happy Holidays to you!

I'm not at all bitter.

My updates are much less exciting. So far I've have three ultrasounds, and my Follistim has been upped from 50iu to 75iu to 150iu. Still no eggs bigger than 10mm. On the bright side, my lining was described as "beautiful": 7mm and Trilaminar. I go back tomorrow morning for another monitoring appointment and then will likely need to pick up a third vial of the medication.

As suspected, the fantastic price of the first vial ($0!) was just a fluke. When I went to pick up the refill, I was charged $65, which is still fantastic that my insurance was willing cover a majority of it, but I have a feeling this will begin adding up quickly. I'm trying to stay grateful that my insurance is covering as much as it is (at least until the end of the year) and that I got a bonus round of medications free.

Getting the shots has gotten a little easier as we've developed a routine. I've figured out that it is better if C is talking to me, preferably telling me a good story about his day, and doesn't announce when he's about to insert the needle. So far, the major side effects have been a little hard to determine. I am definitely getting more migraines, which really sucks, but I also got these with the Femera. I did have some IBS-type symptoms over the weekend, which is something I haven't had is a very long time. I've also felt bloated and constipated. These last two, though, I'm not ready to fully blame on the medication considering I've also had two full Thanksgiving dinners/desserts and leftovers around the time I was beginning the medication. As I've gotten back to eating healthier, the case for the medication side effects is definitely growing stronger.

Sunday, December 1, 2013

Thankful for Family

We had two Thanksgivings this year: one with my family on Thursday and then one with C's family on Saturday. Whenever you have over 18 people in a house, for multiple hours, all trying to cook and eat, and with a lot of pre-determined expectations about what the holidays should entail; there is bound to be some emotional drama. To be honest, I expected more drama from my family's side but that's not how it went down.

On Thursday, everyone came over to my parents' house. My one sister boycotted because she's still in her teenage rebellious phase, despite the fact that she is 23, but we knew about this ahead of time. She called later and we had a nice talk. We still had my other sister and her husband, uncles, cousins, and some family friends. "The more the merrier" is definitely a value my family holds dear around the holidays or any other celebration. The sister who came is the one whom I'm not really talking with. We were pleasant with each other, but definitely more distant than we would have been if not for the incident. At one point, we talked for about twenty minutes about the stress happening in her life and then she eventually changed the subject to a TV show without asking about how things were going with me. This was expected. She was very dramatic throughout the evening about how rough her life is going. This was also expected. 

Otherwise, the evening was nice and relaxing. I have no nieces or nephews from this side of the family, my cousins are all single, and most of the conversation focused on my uncle getting remarried rather than family building in the child-sense. There was no pressure and no awkwardness. Marv (our dog) probably enjoyed himself the most and had to sleep most of the next day to recover from the excitement. 

Saturday was different. All three of C's sisters were there, with husbands and a total of 9 nieces and nephews in tow, plus two aunts and his parents. It was also a very full house but with a much different tone. C's dad is in the middle of testing for some medical issues he's been having, and there is talk of cancer. I'm sure this made all the emotions run higher and know that his mom was definitely different than normal and had cried earlier in the day. His oldest sister was also in rare form and, at one point, threatened to leave and drive the 3 hours back to her home after getting in a dumb argument with C. Later in the evening, she gave us all the silent treatment because of something else that C had said. Personally, I think he was sort of pushing her buttons but her reaction was completely disproportionate. The other sisters were taking bets about why she was more difficult and emotional than normal, and pregnancy was top of the list. This made my heart skip a beat. I also couldn't help but get a lump in my throat when (emotional) sister told us of her plans for the parents for Christmas: a family tree with the parents in the trunk, the four children in each of the branches with their spouses, and then all the grandkids as leaves with thumb-prints. I wondered if our branch would really look as sad and barren as it did my imagination and if there would be space for us to add our thumbs prints later or if this was her idea of the family being complete. 

It wasn't all bad. In fact, I laughed and probably had more fun overall. I am very close with his one sister but she lives 4 hours away so we don't see each other as much as we'd like. We had some great talks, she and her husband were super supportive of our difficulties and said all the right things, and we did a lot of bonding via making fun of the other sister (discreetly of course). 

This is family. When we have children, I want it to be like this. I want my children to have the same family values that C and I both grew up with. In good and in bad, despite the drama, your family is there. They love each other. There will be fights and there will be different personalities and opinions. There will also be laughter and support and a common bond that no one else could understand. For this, I am thankful. 

Friday, November 29, 2013

Book Review: Waiting for Daisy

Waiting For Daisy by Peggy Orenstein

I picked up this book because I knew of the author. I had read her other book, Flux, which examined the phenomena of super-women who try to have it all (the career and family 1-2 punch). You could tell that she valued her career and I felt that I could relate to her. Her story was very different from ours (so far) but the emotions and the questions to be considered were all the same. Honestly, I couldn't put it down. I was enthralled and really felt the disappointment right along with her in so many different points of the book. The writing was fantastic and sarcastic humor was seamlessly intwined with thought provoking internal debate and sequential narrative. Her story does have a happy ending, but it doesn't try to pretend that everything is roses after you do achieve a baby. The whole account was superbly realistic and thought provoking. I never re-read books, but this may be one that I am inclined to pick back up.

Some of my favorite excerpts that spoke to me especially:

How was it that despite my achievements, my education, my professed feminist politics, my self worth had been reduced to whether or not I could produce a child?


Clomid was my gateway drug: the one you take because, Why not - everyone's doing it. Just five tiny pills. They'll give you boost, maybe get you to where you need to go. It's true, some women stop there. For others, Clomid becomes infertility's version of Reefer Madness. First you smoke a little grass, then you're selling your body on the street corner for crack. First you pop a little Clomid, suddenly you're taking out a second mortgage for a another round of IVF. You've become hope's bitch, willing to destroy your career, your marriage, your self respect for another taste of its seductive high. Here are your eggs. Here are your eggs on Clomid. Get the picture?


The decent into the world of infertility is incremental. Those early steps seem innocuous, even quant; IUI was hardly more complex than using a turkey baster. You're not aware of how subtly alienated you become from your body, how inured to its medicalization. You don't notice your motivation distorting, how conception rather than parenthood becomes the goal, how invested you become in it's "achievement". 

Tuesday, November 26, 2013

Needle Phobia

I took my first Folistim shot this evening. Rather, C gave me my first Folistim shot. He's in nursing school so I figure I should support his education by providing additional practice opportunities ;)

At first, I was very excited by the gadgets and accessories. My pen came with a really cute carrying case in a lovely shade of green. I was just in the middle of plotting how I could re-use this as a cosmetics case when C got to work and I remembered that I had a fear of needles. As he re-read the instructions three times, my anxiety slowly climbed. I'll admit that I may have quickly questioned letting the student do this when my mom, the actual practicing nurse, was right down the hall. Then he poked me and it felt similar to any other shot I've ever been given in my life. No big deal. Immediately afterwards, the injection site felt a little uncomfortable, mild throbbing and tenderness. That's it. It was actually relatively anticlimactic. C asked if I could feel it working and I told him not to bother me because I was busy growing some eggs like a chicken. 

The slight irony of my anxiety, which C took delight in reminding me, is that I actually cured a teenager of needle phobia yesterday. She came to me initially getting herself in a panic at the mere mention of needles and blood draws. This was problematic because the physician needed blood work and her family wanted her to get the flu shot with the rest of them (two years ago she had to be held down by several people and last year they didn't bother trying). Well after a few treatment appointments with me alone, I coordinated an appointment with nursing and she got her flu shot last month without any difficulty. Yesterday she came in to get her blood drawn and let me just say, she was a champ. I was so proud of her. I was also proud of myself for helping her. Her treatment was textbook and went exactly as I had hoped and planned. Sometimes you just need a win and after last week, I deserved it. 

The most important factor in treating phobias, or any anxiety for that matter, is exposure to the feared stimulus. Avoiding the things that make us scared or anxious will actually serve to reinforce, or heighten, the anxiety. I give this example to my patients: Imagine that you're afraid of heights and I have you stand at the edge of the ledge 11 stories up (it's convenient that my office is on the 11th floor, overlooking a balcony). Initially, you're anxiety is going to be sky high, no pun intended. Your gut reaction will be to back away from the ledge and if/when you do, your anxiety will decrease, thereby telling your body that avoidance is a positive thing because it makes your anxiety decrease. So the next time you come in contact with heights, you will be primed to run. Now imagine that I don't let you back away. I make you continue standing at the edge of the ledge for 15, 30, 60 minutes even. At some point, usually much before 60 minutes, you anxiety will decrease. Partly due to exhaustion. Partly due to the fact that you haven't fallen yet and your body begins to realize that it's not so much the ledge that is scary, it's the falling to your death that is scary, and so far this hasn't happened. After both the shot and the blood draw, my teenage patient reported "That wasn't nearly as bad as I was afraid it was going to be," and this is the typical experience when people face their fears. 

I do not like needles, but perhaps by the end of this experience I will have exposed myself enough that it will be as easy as taking a multivitamin. I certainly don't seem to be avoiding them these days! I also don't like flying, but I don't let that get in the way of traveling to cool new places and visiting with friends. And what is fertility treatments overall if not facing your fears head on? We are all brave souls. 

Monday, November 25, 2013

Early Holiday Emotions

Today I am thankful for the pharmacy, or my insurance, or some computer glitch... Actually, I'm not sure where to direct the thanks, but I am definitely appreciative. I had my baseline monitoring appointment this morning and will begin the Follistim tomorrow. They told me that everything was "boring, in a good way." No cysts. Nothing else that would contraindicate a "Go!".

This afternoon, I picked up the Follistim prescription along with the prescription of the Ovidril, and the progesterone suppositories (oh joy!). As the pharmacy tech rang up my order, I prepared for the worst. I had mentioned earlier that I was hopeful my insurance would be covering the prescriptions until the end of the year, but I never imagined this... the whole bill ran me $24! All of the injectable medications cost $0.00 and the only thing I was actually charged for was the progesterone. I made the tech double-check because I couldn't believe this. Even on covered meds, I'm still supposed to be paying a percentage. The tech told me not to question it, which I think is a good advice. I'm just so used to having everything possible go wrong (especially related to insurance coverage), that it doesn't make sense when something good happens.

So this injectible thing is confusing to me. First, I forgot to get the cartridge this morning from the doctor's office and then the pharmacist told me they didn't carry the cartridges and that I would have to get it from the doctor. So now I have to go back to the doctor's office but they close before I'm done with work so this means getting there bright and early tomorrow before work. I also realized, after leaving the pharmacy of course, that I need to get some alcohol swabs. I'll just plan on "borrowing" these from my floor at work. Do I need band-aids also? I noticed that the Follistim pack comes with 4 or 5 needles, but what happens when I run out and need more? Does it really not matter if I inject my abdomen vs my thigh or was the nurse just saying that to make me less anxious? And when when she told me inject around the same time each evening, are we talkin' within an hour, two-hours, or five minutes?

Aside from the confusion, I actually feel like a kid on Christmas eve. I'm super excited to open up my new package and play with what's inside. I get to put things together and measure stuff and read instructions. Sounds like great fun. Until we get to the part of the needle and actually having my nursing-student/husband give me a shot. I'm sure that part is going to get old real quick. Until then, I'm going to remain thankfused and exciteful. (Sorry, this mixture of emotions makes me really corny apparhently)

Sunday, November 24, 2013

Shopping is the pits

On this latest round of Provera, I'm up another few pounds and my fat clothes are starting to feel uncomfortable. I'm really anxious about the injectables adding on even more weight/bloat so in anticipation for this possibility, I decided to go shopping today for some new bottoms that might be more forgiving. I am into the whole skirt/tights/boots look and that this might be a good strategy so that was my mission of the day. Plus I didn't want to spend a lot of money because I'm still convinced that this will not be a permanent situation.

I may have had a small melt-down in the fitting room of Old Navy. 

In the grand scheme of infertility, complaining about my weight and body image issues seems petty and self-absorbed. But I can't help how I feel. Here are the issues:

1. I don't feel comfortable in my body. I definitely don't feel comfortable being naked, which I know has affected my desire for intimacy with C. Frankly, I feel disgusting much of the time and today I looked in the full-length mirror with the florescent lighted-fitting-rooms and could hardly recognize my body. This is not me. 

2. I am terrified of being asked if I am pregnant. In the past 6 months, this has already happened on three different occasions. A colleague. A family friend at church. A patient's mother. Each time, I froze and then responded awkwardly that I wasn't and proceeded to feel humiliated and horrible the rest of the day. 

3. At the hospital I work for, our health insurance cost is based on the state of our health and healthy behaviors. If you're considered healthy, you need to show that you're physically active to maintain the lowest premiums. If you have one of several chronic health conditions (including being overweight/obese), you have other specific requirements (e.g. for diabetes, maintaining good blood sugar levels; for overweight, losing a set amount of weight). I am now officially 5 pounds over their cutoff of the overweight category (it's a BMI of 27, I assume to give people a little extra leeway). If I am still over the cutoff by the end of the year, then I'll be in the overweight category and then, in order to keep the lowest premiums, I'll be required to lose weight. Which would be great, if I wasn't trying to get pregnant and therefore gain weight. Normally, I fully support this policy, but in the current situation it seems utterly unfair. Truthfully, I haven't fully looked into this to see if there is a pregnancy clause or if I can get a letter from my Doctor explaining my situation. My hope is that I won't have to. In the meanwhile, this is one other aspect that stresses me out. 

4. Having PCOS puts me at greater risk for miscarriage and gestational diabetes. Starting off a pregnancy in the most healthy state possible is really important to me but the longer I am infertile, the worse my health seems to be getting. 

Saturday, November 23, 2013

Two Truths and a Lie: Revealed

I need a break from the stress of being an infertile psychologist with a crazy cat. Plus, I'm impatient. So without further delay, here's the answers to this post:

1. I spent three years of my childhood living in St. Petersburg, Russia.

Unfortunately, this is not true. I only wish it were. The truth is that I spent two weeks in Russia after studying the language and culture throughout high school. I loved it and briefly considered changing my career choices so that I could have a summer home in Russia and visit it yearly. Also, my mother is Czech and we practice Russian Orthodox as our religion so I do feel very connected to this culture.

2. I used to work as a janitor at my old high school.

For three summers, this was true. I was the one who scraped off the gum from under the chairs and desks that you all put there throughout the year! I actually loved this job. I also worked at an ice cream store for about ten years before moving on to more psychologically-minded professional activities.

3. I have a half sister that is 15 years younger than me, despite the fact that my parents have been happily married for nearly 40 years.

How is this possible, you ask? One day, while in high school, my mom came home from work, sat us all down, and asked us what we would think if she chose to have a baby for another family. She knew of a colleague at work who could not have children of their own (due to female factors that I was not completely knowledgable of) and she wanted to offer to be a surrogate. She provided the eggs and uterus, he provided the sperm, and I have a sort-of-half-sister. My mom was in her early 40s at the time. Yes, she was that fertile, that she had another baby after her own family was complete. Little did she/we know that her own daughters would not be so lucky.

We used to visit with the other family yearly, around her birthday, but lately it has been less frequent. Their family now consists of three girls; my half-sister and then two other girls from a second surrogate. In high school, I just thought it was a cool party trick ("my mom is having another man's baby and she's still married to my dad!") and really didn't think too much about it. Only now can I fully appreciate the magnitude of this gift.

Friday, November 22, 2013

Professional Hazards

I was doing a fairly good job of keeping my emotions in check this week. Managing the hormones at work and suppressing the urge to cry over relatively trivial things. Until today. Today I lost it. I lost it several times in fact. Once in the break room trying to make myself a cup of tea in hopes of calming myself. Once on the treadmill in the employee gym that I went for a walk on trying to clear my head. Several times in the confines of my office. And final time when I got home, in my husband's arms.

Today I received a phone call from a mother of a patient informing me that my patient was in the Intensive Care Unit after attempting suicide. They are still running tests to determine the amount of damage that was done to her nervous system and what recovery will look like, but she will survive. I talked with her mother several times throughout the day. I'm not sure if she could hear my voice cracking over the medical machine noises in the background, but it was.

My heart goes out her parents whom I can't even imagine the amount of terror and sadness that they've endured over the past 24 hours. It goes out to her younger siblings who are still trying to process the events that have unfolded. It goes out to her, who can't see past her current despair and was so engulfed in hopelessness that ending her life seemed like the only viable option.

I feel angry towards the other medical providers that I believe dropped the ball. I feel helpless to do anything. I feel a crushing sense of defeat in my past efforts to help her. Most of all, I feel so much sadness for her and her family that my chest feels about to implode.

Thursday, November 21, 2013

Two Truths and Lie

In honor of the start of ICLW, I thought I'd participate in something a bit more interactive. Jenny at Dogs Aren't Kids posted this initial prompt and I was just talking about this game to my parents today! I was telling them about one of the truths that you might never think of as a truth and how I need to remember this for the next time I use this as an ice-breaker with one of my patients. So here's the gist:

Tell us 3 things about you and make 1 of them a lie. Try to think about what other bloggers already know about you, what might shock them and what they don’t know and would simply not being able to guess which one is a lie.

1. I spent three years of my childhood living in St. Petersburg, Russia.

2. I used to a work as a janitor at my old high school. 

3. I have a half sister that is 15 years younger than me, despite the fact that my parents have been happily married for nearly 40 years.

RULES: Comment below with which one you think is a lie. Make a new post on your blog and do the same. After you get a bunch of guesses (or whenever you feel like), make a new post with the right/wrong answers and explain them if you want. If you’re lazy, you can comment and not play along. Party pooper.

Wednesday, November 20, 2013

Random Musings

Sometimes I get really emotional and forget that I'm swallowing hormones on a daily basis. I'm not usually an emotional person, so when the sudden urge to cry rushes over me, it feels very uncomfortable (although now that I type this, I'm sure this wouldn't be a comforting feeling for anyone). I need to remind myself that it's not the situation that's upsetting me, that it's just my messed up body.

In the beginning, I had a lot of anger towards my body. I've gotten around to being more accepting, flaws and all, but some days I still feel like I'm very much at odds with myself. It often feels like my body is trying to F*ck with me, teasing and taunting me and then snatching away any hope at the last minute. Or it just enjoys confusing the crap out of me. Today I am almost done with taking Progesterone to induce my period and I know that it is the drop in progesterone that stimulates the period, so theoretically this should occur after you're taking the medicine. And yet today I noticed about 4 drops of bright red blood on the toilet paper. WTF!?!? Of course this couldn't be re-created later, so now I'm just trying to forget it ever happened and continue with the plan.

I am at odds with both of my sisters now, who are also at odd with each other, and I'm beginning to get stressed/emotional about Thanksgiving (although this may the hormones). Why can't we just have a drama-free holiday for once? It's really so cliche.

I'm fairly certain that my insurance plan is going cover a large proportion of the injectable medications! The catch is that I'm also fairly certain that the insurance is changing next year and they won't be covered. This means that I can get one cycle for sure and possibly two if everything works out exactly as scheduled (but let's not fool ourselves here). I am only fairly certain because insurance companies suck and are nearly impossible to navigate and get a straight answer.

In order to help ensure that I stay on schedule, I've officially jumped off the deep end as far as fertility Googling goes and have found a few natural remedies to induce menstration. Last time the progesterone didn't work so I wanted a backup plan. I learned that possibly Vitamin C and/or Parsley could help in inducing a period so then I promptly drove to Whole Foods and picked up some supplements to begin taking after I complete the progesterone. My thought is that it likely can't hurt and it will really just be to supplement the actual medicine and not replace or go against any prescribed protocol.

I rearranged my work schedule to allow for many more frequent monitoring visits in preparation for this medication cycle. It was a big pain, but I'm glad I figured it all out. I told the secretaries that I was having health issues and now I'm paranoid that they think I'm lying because I certainly look healthy enough when they see me. Oh well.

I did tell two more colleagues this week. Lo and behold, it didn't kill me and really wasn't nearly as awkward as I was afraid of. I'm glad I told them and I think it will make it a little easier in future interactions.

I had a dream last night that I slept until Friday and thus missed two full days of medication and screwed up the cycle. I woke up in a confused panic until I realized what day it was. This may have been precursor to the rest of the day when I became so exhausted after lunch that I put my head down on my desk and actually passed out for ~40 minutes!

My cat is driving me nuts because she's back to peeing on various furniture items. She was out of this habit for about 5 months and we thought we were in the clear, but now it's starting up again and I really am out of ideas of what to do with this (likely more on this later after I can form a more coherent thought).

This was a complete random mess that's been floating in my head all day and I needed to get out so that I sleep tonight. Any one of these paragraphs could likely be expanded into a full post, and just might be when I get around to it. Feel free to take a vote! In the meanwhile, thanks for tolerating my lack of cohesive thoughts.

Sunday, November 17, 2013

This May Be My Migraine Talking

I've decided that medicine is chauvinistic and annoying.

You're prescribed these drugs to regulate and/or distort your hormones, with the ultimate goal of getting and keeping you pregnant. As required, the Drs talk with you about the possible side effects or complications of these drugs. This information is also reviewed by the pharmacist, in the medication information handouts, and online when searching for the medicine. 

I've read a lot of "official" information and talked with a lot medical professionals and I find it increasingly annoying. All they talk about are the "serious complications" related to the higher rate of multiple pregnancies and the possibility for hyper-stimulation syndrome. I get that these are not good and I would not like either. However, could anyone please acknowledge the other, less-serious-but-more-common-and-frustrating-on-a-daily basis, side effects?!?!? 

Since starting on this medication journey, I've gained 20 pounds. I used to be a level-headed person but now I'm overrun with emotions and the irritability often wins out. I feel nauseous many days of the month. I have many more frequent migraines than I used to. I pull out clumps of hair from my head on a daily basis. 

The only time I hear about these other side effects are on blogs, discussion boards, and other informal information sites. It's as though the medical professionals have decided that the ends justify the means and, therefore, the means aren't even worth mentioning. As if I should be so grateful to get pregnant that I should shut-up and quit complaining about these less significant side effects. As if these side effects don't matter because we'll all take the drugs regardless in hope that they give us what we've all been hoping for. 

And we will. I haven't heard of anyone stop taking a drug because they were bloated or crampy or irritable or constipated. I don't plan to either. It would just be nice if these other effects were at least acknowledged as another real factor of crap that we have to go through. 

Friday, November 15, 2013

Two Week Envy

I have a confession. When I read about and hear about the stress and agony of others enduring their "two-week-waits," I get jealous. I know this is ridiculous. I am sure it stressful. I am sure the disappointment at the end must be excruciating. I wouldn't really know. I haven't experienced it. I haven't had a confirmed ovulation since we began trying.

My story has been something like this: take medicine, wait for the ultrasound, get told you're not responding to medicine, wait until you're able to take progesterone, then wait for the period to begin the next round. My two+ weeks consists of waiting for a period, without the hope or expectation that anything else is even remotely possible. Maybe this is easier is some way. My let-down comes at day 12 rather than day 28.

As icing on the cake, without ovulating I don't usually get a period without medicine (and sometimes even this doesn't work) and so my cycles are usually longer than 40 days. My two weeks are usually more along the lines of 3-4 weeks.

My mom keeps asking for updates, wanting to stay abreast, as her way of being supportive. Often I get snippy and agitated because my usual response is that we're "waiting". Never waiting in excitement or waiting with hope. Just waiting.

This is a very whinny and self-absorbed post. Logically, I know that others have had it much harder. But this is how I feel. And this will likely be my only fertility update for the next two weeks or so. I am within the process of waiting and mentally preparing for the next step.

Tuesday, November 12, 2013

Another One Bites the Dust

My ultrasound monitoring appointment was yesterday to see how I was responding to 7.5mg Letrozole. The short answer is - I'm not.

The Dr called me later in the afternoon and spent a lot of time discussing options, which I really appreciated. In fact, my first thought when hanging up wasn't "WTF Ovaries?!?!" but rather "I really am glad I switched Drs. I really like him." Even now, I feel content knowing that I do actually have several options, that I'm being cared for by someone who knows his shit, and that he trusts me and C to have a say in my medical decision making.

Option A: Give my body a little more time and come in for another monitoring appointment on Friday to be absolutely sure. He said he wouldn't put money on this, although unfortunately we actually would be putting money on it in the form of more hospital bills.

Option B: Wait until Friday anyway to give my body a minute to adjust, take medicine to induce my period, and then begin a round of injectibles. The big risk we talked a lot about is a very high risk of multiples, especially given that I have a whole bunch of tiny follicles that could potentially develop, or also hyper stimulation syndrome.

Option C: I am actually a "great candidate" for IVF because I have so many damn follicles and am relatively young. This would also help to protect again multiples because they'd have more control of how many embryos were implanted. Too bad the insurance or the bank account don't see it this way.

C and I had a good talk this evening and decided that Option B is the right choice for us now. We've officially jumped into the higher cost, increased monitoring/appointments, and much more invasive world of infertility treatments. This isn't about taking a pill for 5 days anymore. This is serious.

Saturday, November 9, 2013

Spiraling Downward

In an effort to keeping myself accountable to being as healthy as possible (read more about it here), I will say that this update has some very big highs and then lows.

It started out so well. I had written out all the recommendations for the dietician and posted them in the kitchen. I did some math and realized there were 32 days until Thanksgiving so I decided to have a 30 day commitment (giving myself two days off) of healthy eating before the holiday. I gave myself a sticker on a chart for every day that I followed my commitment of healthy eating, drinking enough fluids, and exercising.

After six days I was down about a pound and feeling pretty good. I felt motivated. I felt like I could conquer anything.

Then the fight with my sister happened. Then I developed a cold, starting with a horrible sore throat and morphing into to a coughing, snotty, congested mess. Since last Friday, I have been entirely eating for comfort not for health. I have not been paying attention to drinking and haven't exercised once.

Right now I mostly just feel miserable because I still can't breath. I struggle between the strong desire to get back on track and physical misery that just wants to make my body happy. The latter is still winning out. I am also beginning to worry that I won't be feeling better by my u/s monitoring appointment on Monday and then all my hopes for a successful response to medication could turn into a snotty disgusting awkward mess of us trying to make a baby. As if the romance hasn't been removed from sex enough already! Fun, fun.

Perspective Taking

As a pediatric psychologist, I have the daily privilege of being let into people's lives and entrusted with some of their most challenging moments and struggles. I have been asked on many occasions, "How do you do it?" as in, how do I not take these struggles home with me at night and I how do I keep sane in spite of taking on everyone else's stress?

The answer has always been easy. Hearing about [and hopefully being able to help] the struggles of others is such a privilege and gives me such a huge perspective on my own struggles.

Today I had to admit a teenager into the inpatient psychiatry unit because she was suicidal. Yesterday a mother called me in panic because her daughter ran away after an argument. Earlier this week I helped a young child who will literally vomit from anxiety every time she is separated from her parents. Last week I worked with a family that is composed of three autistic children all under the age of 10.

Life is hard. Everyone has a cross to bear and there are so many days that I wouldn't trade in my cross for anything. While work can definitely be stressful at times, I am really so glad that I have this job and truly feel honored and humbled on a daily basis.

Thursday, November 7, 2013

Forgiveness, Trust, and Re-victimization

Last week my sister said some very hurtful things related to my fertility. More hurtful was actually what she didn’t say or didn’t acknowledge. Maybe it was just bad timing on her part, but the hurtful conversation happened the day I got the results that I was not responding to the medication. She knew this. She didn’t acknowledge this. Instead, she focused on her own issues and accused me of being insensitive and demanding and overbearing. I’d like to say this was the first time something like this happened with her, but it isn’t the first…or the second…or even the third…

I want to forgive her. Mostly for my own self, because I know that holding on to anger and hurt likely does more harm to me than it does to her or anyone else.

To forgive is to set a prisoner free and discover that the prisoner was you.
~Lewis. B. Smedes

The challenge is how to go about forgiving her without allowing myself to be re-victimized, because that also is not good for my emotional health. In the past, I forgive her and then let me guard down, eventually open up again, and then the whole process repeats itself.

People who know her and the situation all tell me that she is basically incapable of empathy at this time in her life. This sounds harsh, but it’s not just my opinion, its reality. She is far too wrapped up in her own life and stresses to consider the impact that her words and actions have on other people’s lives and stresses. To expect this is to live in a fantasy, which I was told by a few people and am increasingly beginning to believe. A fellow psychologist commented that empathy, or taking the perspective of someone else, is a developmental task that a) not everyone always achieves and b) not everyone can consistently implement.

My new goal is let go of anger and accept that she cannot be a part of my support system. Secondarily, I would like to keep some semblance of family peace as we head into the holiday season. My concern is that these two goals are not simultaneously possible.

Those who cannot remember the past are condemned to repeat it.
~George Santayana

Saturday, November 2, 2013

Unimpressive Ovaries

On Thursday I found out that I'm not responding to the Letrozole. Specifically, the nurse was "not impressed" with my ovaries. Frankly, I haven't been impressed with them for a while.

My estrogen level was actual lower than during my baseline, so the RE wants to bump me up right away to 7.5mg. That's the good news. I remind myself that if I was still with my old RE, I would be taking only 2.5mg now and would likely be forced to wait until my period shows up to do 5 and then wait again to get to 7.5, so it's definitely nice that we get to cut out all the bullshit and go straight into a higher dose. Simultaneously, I am nervous because I know that this is the last stop before injectibles...before I have subject myself to daily shots and a lot more monitoring appointments...before I need to break down and tell my boss that I need to rearrange my schedule to be able to make all these appointments...before we seriously up-the-financial-ante.

I know I shouldn't focus on this. I need to focus on positive thoughts of 7.5mg being "my dose".

Thursday I also got in a fight with my sister. She said some really selfish things and was generally unsupportive of the news I received. This actually made me feel worse then the actual news.

I struggled to finish my day. I went to bed early. I struggled to go through an equally trying work-day on Friday. Then I went out with some friends for a drink and dinner and had a genuinely good time. Today I have the weekend to re-group, relax, and pull myself up. I'll get there. I always do. This is a just another bump in the road.

Thursday, October 31, 2013

My Dirty Little Secret

The other day I had an awkward interaction with a colleague. She announced that she and her husband would be trying for a second child and I stared at her like a deer in the headlights. 

I realized immediately that it was awkward, but not why it was awkward until later. Later it dawned on me that I didn’t respond the way that I was supposed to. If she had told me that her and her husband were looking into getting a dog or looking into buying a house, I would have responded positively and with some excitement in my voice. I think this is how most people must respond when someone tells them they’re trying to have a baby, but I just stared blankly at her and waited for her to change the topic. I would like to think that the situation would have been less awkward if she knew my dirty little secret. 

Very few people know about our troubles with conceiving. I used to like it that way. I liked leading a double-life; being the put-together and accomplished worker bee during the day and the emotional-infertile at night. I liked not getting pity looks or answering dumb questions or having to explain myself. But now this rouse is getting harder to keep up and I’m beginning to think the cost-benefit analysis is tipping in the other direction. 

This is who currently know about our struggles: my parents, C’s parents, my sisters, 1 of 3 of C’s sisters, two colleagues of perhaps 50 or so people I interact with at work, and two friends (of which neither live in the same town and we only communicate via phone). 

These are the people who don’t know: any extended family (that I’m aware of), my other 48 or so colleagues, all of my other friends that are in town and I see regularly, my boss, all of C’s friends but one, all of our mutual couple-friends, and anyone at my church. 

 I should add the most of my mom’s co-workers know, because she talks to them about it. Also, family friends that have watched me grow up know because my mom told them, but no one has brought it up to me so I don’t care much about this and they don’t really count on either list. 

 Why is so easy for my mom to tell people but not me? How do you work that sort of thing into conversation? I had lunch today with a few of the girls from work and never once did it seem appropriate to say, “And by the way, I’m infertile, please pass the ketchup.” 

 We have a big work meeting next Friday and it is a definite possibility that I will have to have a monitoring appointment that morning, which would make me a little late for the meeting. I’m secretly hoping this is the case because then I will have an “excuse” to tell my boss, “I want to let you know in advance that I will be late to the meeting because I have an appointment that morning for infertility treatment….” I’ve got it all planned out. What will hopefully be implied is “…and this is why I’ve been less productive and flakier than usual the past several months.”

 As for the rest of the world, maybe there will come a time when it just seems natural and obvious of when to divulge this information. Maybe I just need to bite the bullet and allow for some immediate awkwardness for the sake of future clarity. 

Monday, October 28, 2013

Cleveland Sports: A Metaphor

As a Cleveland native, I have had a lot of experience with disappointment. Our sports teams are known across the country for countless mishaps and “almosts”, raising our hopes and then crushing our dreams. It’s been this way for most of the last century, although my experience has been a limited to the mid-90's when I became more aware of our sporting triumphs and tragedies:

  •  In the ‘95, the Indians made it the World Series with over 100 wins of the season and some of the best players at the time (Albert Belle, Manny Ramierez,  Kenny Lofton), then lost in six games, although managed to make all but one of these a “one run game” so as to keep us on our feet.
  • Also in ’95, Art Modell stole the Browns and took them to Baltimore. We fought and won to keep the name and colors for when we would eventually get a team back, and this episode was even made into a Snicker’s commercial. Remember the “not going anywhere for a while” campaign? Remember the sad image of two decked-out Brown’s fans sitting in an empty stadium? I do.
  • In ’97, we made it back to the World Series, with Sandy Alomar Jr., Jim Thome and Omar Visquel and made it to the seventh game against Miami. In this final game, we were 2-2 in the bottom of the 9th after a great showing, with one out and all that was needed was to stay the course. Two more outs. Not possible for this city.
  • We finally got the Browns back in ’99, although different players and different owner, and couldn’t have been more excited. That was, until we played our rival Pittsburgh Steelers as the first game back and were crushed in 43-0 loss. Welcome back to football, Cleveland.
  • Then there was LeBron. He gave our city so much hope, promising us a championship and even making it to the play-offs year after year, ’06, ’07, ’08, ’09, ’10. And then choking every time. His star performances in the regular season were never matched and it felt like he was personally letting us down.
  • Then he let us down for real. In what will be forever known as the Decision, he broke up with us on national tv, giving the highly televised “I’m taking my talents to South Beach” bullshit. Basically after promising to do one thing and then doing exactly the opposite we were left jaded and reeling from the break-up. So much in fact that we went on break our previous NBA record of having the longest losing streak in the NBA in 2010-11 season.
  • This year the Indians are back in action, doing well all season, securing a spot in the Wild Card playoff game and then… you guessed it, choking. The very next day, our newly rising star quarterback leading the Browns in a .500 record thus far got injured early in the game and was declared to be out the rest of the season. ::Sigh::

And that is only what’s happened since I’ve been active in the sports world. The full shameful history would be much longer and more miserable. So why do I go into all this on a blog about my sub-fertility? Well, I like all Cleveland sport fans, have had a long history of hope swallowed up by disappointment and of managing this grief. As one writer put it, “At this point Cleveland fans are familiar enough with the stages of grief that I think they just skip right to acceptance." (see the full article here) One might say that my years spent watching and rooting for various sports teams in this town has well-prepared me for the current challenges I’m now facing. Or maybe it’s just made me more guarded from the start. Hope is a dangerous thing. I’ve learned that it’s the high that will enviably result in a crash and burn. And yet hope is what drive us, keeps up from despair, and helps us to keep moving forward.

So here’s to hoping that C and I are able to have a healthy baby before the Indians win their next World Championship, Browns make it to the Super bowl, or the Cavaliers finally get their championship ring! Cross your fingers, pray on your talismans, and pull-out your lucky underwear that my luck is better than the entire city of Cleveland sports. Otherwise, I really am going to believe that it’s the water (our river did catch on fire from pollution back in the day, after all). J