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. 

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 9^th 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

Power Outage

Today we were without power. The electric company reported it was due to down trees, a byproduct of an early and heavy snow with all the beautiful leaves still being firmly attached to the trees. We also lost power on Thursday, but I was at work so I didn't care about this much. Today was a weekend. A day home.

I should also mention that we live in the country so without power we also have no water. Lovely well water.

And I should confess that I forgot to plug my cell phone in to charge last night, so it was dead as well.

I have a very predictable weekend morning routine. Get up without an alarm when my body is ready. Eat breakfast and make coffee. Drink coffee while watching home show (typically HGTV, but I sometimes mix it up). After about an hour of this, I am then ready to start my day.

This is in stark contrast to my weekday routine of getting up with 20-30 minutes to get out the door work, making a smoothie and coffee in to-go containers and drinking them both on my way in as I continue to wake up and mentally prepare for the day. I relish in the contrast.

I digress. Today, I got up as normal and, luckily, went to the bathroom (no water = no flushing toilets). Then the lights flickered and went out. Initially panic set it in. I need breakfast and coffee. I am an angry person without these things. I went back to bed, unable to think of a plan without fuel. Luckily my parents helped me out with this one and suggested we all go to Bob Evans for breakfast. Yes! After my 1/2 omelet and 2 small cups of coffee, I felt human again, like the Snickers commercials.

The hope was that by the time we got home, the power would be restored. We weren't this lucky. Appreciating my full belly more than usual, I decided to embrace the situation.

I finished a book.

I crocheted for a while. Then I spent another 2 hours working to unknot some atrocious mess I made of one of the skeins.

My dog spent the time curled up next to me, keeping us both warm. I also put on my thick socks and snuggled under a blanket.

It was nice. The quiet felt peaceful. I could hear the nature sounds out of window that are usually drowned out by the background of TV noise. I could focus on one thing at time without interruptions of texts, emails, and news blurbs. I didn't feel guilty for not getting caught up on work and documentation. I allowed myself to be mindful and fully present in the moment, enjoying the one activity I had chosen to put my attention towards in that moment. I slowed down. I allowed myself to be calm and relaxed.

The power returned late in the afternoon, just before it began to get dark. Perfect timing really. I am now behind on the household chores and the work I promised myself I'd do this weekend, but I'm not letting this bother me. Some things can't be controlled. We can either let it ruin our day (lives) or embrace it and make-do.

Excuses and Rebuttals

In my promise to keep myself accountable, here it is:

This whole being healthy thing is much harder than it should be. This past week I didn't exercise, once. I recorded everything I ate for two days [out of seven]. I followed the diet plan ~75% of the time. I am down maybe 1 pound, depending on the time and day that I weight myself. Eh. I need to have a more concrete plan and stop making excuses.

These are my excuses for not exercising (and my responses):

• I'm too tired

Working out will actually give me energy. I can always start slow and not push myself, but usually I get more energy once I begin. Beginning is the hardest part. 

• I don't have enough time

I have time to watch crappy TV and other silly things. If a Dr told me that daily workouts were the one medicine that could save my life, I would find the time. If this was a better priority, I would find the time. 

• I should be doing something more productive (like work paperwork)

Exercise is good for me and good for my [future] baby. It will help me have a healthier pregnancy and may even help me conceive. It is just as productive, if not more, than work or chores. 

• I want to be doing something more enjoyable (like blogging or crocheting)

I always feel happy and accomplished after I finish a workout. After I work out consistently, I begin to enjoy it more and more. 

• The gym is too crowded

There's always some space. This is a dumb excuse. You can also always work out at home. 

• The gym is too far away

Work out at home. Stop whining.

• I don't want to sweat and then need to shower (alternatively: My hair looks good and I don't want to mess it up)

You can always do a "light" workout. Alternatively, showering doesn't take long and you're getting better and doing a quick but still cute hairstyle. 

• It's cold, rainy, snowy. 

Suck it up, cupcake!

These are my "reasons" for eating unhealthy:

• It looks good

This is just good marketing. Don't be sucker. How it looks often doesn't relate to how it tastes and definitely doesn't relate to how good it is for my health. 

• I deserve it 

I deserve to be healthy. I deserve to treat my body with respect and only feed it the best, most nutritious food. 

• It will make me happy

Food makes me momentarily happy, lasting MAYBE five minutes. Then this is followed by guilt and self-loathing. The happiness that I feel for a few moments can take hours at the gym to work off or set me back from health goals for weeks. 

• It's convienent / I'm hungry

I will not starve to death. I am not lazy. I can tolerate some hunger and wait until I have healthier food options. 

My plan: These will be on note-cards and I need to read and re-read them daily until the rebuttals are the first thing I think about. 

Dear Daughter

Dear Daughter, 

My grandmother, your great grandmother, was a strong and independent women. She waited until after World War II to have your grandmother, until she was a little older and it made sense to finally begin a family. My mother, your grandmother, also waited until she had established her career and fully settled into her marriage, and then she had me. I wanted to get my doctorate before having children. I wanted to be settled in my career. I wanted to get married and enjoy being a wife before having to adjust to being a mother. I wanted to have my finances in order. Now I'm ready for you, and I've been diagnosed with infertility. 

I am in the process now of tests, procedures, and so many different drugs. Every aspect of my hormonal cycle is regulated by a different medication. They make me irritable, tearful (and you know I don't cry), and give me hot flashes. Month after month I am told that my body isn't responding to the medications, despite the changes I notice in my moods and the weight they've caused me to add. I've started to resent mothers, fertile women, pictures of children and their happy parents posted on the internet, women planning to get pregnant, and those seeming naive when they talk about their specific "plans" and "timing". I am reminded of the saying, "Man plans, and God laughs."

Some day, you will be older and in love and deciding you want to begin having a family of your own. I want you know that I have sometimes doubted my decisions to wait, to hold off on trying until I was ready, until I was a little older. I wonder to myself how things might have been different if I was a few years younger, or at least if I had known what I was in for, if it would have changed some of my decisions. 

Then I think about you and about your grandmother and great-grandmother. You come from a very long line of strong, independent, and bright women. They did not allow fear to dictate when to begin a family and they did not allow their dreams and ambitions to be altered by societal or biological pressures. You shouldn't either. My wish is that the fear I feel now, the uncertainty of infertility, is something that you will never face. But to be dictated by this fear, to allow it to stand in the way of your dreams and goals, would bring me the greatest sadness. You don't exist yet, but I love you already more than you know. 

-Your future mother

Self-Care

The other day, C and I had a serious discussion about how I was coping with the Big I. He discussed how negative and emotional I can be at times and tried to convince me that maybe "taking a break" would be good for me, whereas I tried to convince him that I'm really doing alright overall, have been very active in coping strategies and keeping my hope up, and that taking a break would be the opposite of helpful. This is because the most frustrating thing of all at this point is doing what seems to be a waste of time.

I'm still in the very hopeful mentality that there is a solution out there, it exists, I just haven't figured it out yet.

Every time we do something that leads us nowhere and then have to wait for the next cycle, it's like when you type in the wrong password too many times and then you get locked out for 24 hours. It's aggravating because I know there is a correct password that will work, but now I have to wait even longer to figure it out. I don't mean to minimize the severity of this issue and I know that there will eventually be a breaking point when I lose this hope (although hopefully we don't get there) but right now, frustration is the key emotion I've been feeling.

In psychology, we learn early on that you cannot effectively take care of others if you're not taking care of yourself. One of the biggest reasons psychologists get reported for ethical complaints is because of "boundary violations", which plainly means that the psychologist is using the relationship to meet their own needs and not the needs of the client/patient or otherwise taking advantage of the person. This usually happens when the psychologists' not taking care of themselves.

It's been ingrained in me to monitor and be proactive about taking care of myself so that I can take care of my patients. Especially in this case because my patients are all kids.

What do I do? How do I "self-care"? Here is my current list of things that bring be calm and help me cope:

• Writing this blog. Getting out my feelings. Being anonymous but still sharing with the world is my equivalent of screaming out over an unpopulated ravine to hear the echo. 
• Crocheting. I used to do this in graduate school and recently got back into it because it forces you to focus on something but is still somewhat repetitive and, in the end, I have something to show for my work. Plus the yarn is soft and cuddly. My therapist recommended that I make something for our future baby, which initially I was against because I've been avoiding doing anything that would jinx us. No baby books. No baby things. The possible baby room is currently very actively used as an office. But then I decided that baby things are cute and I can say that I'm not jinxing myself because I know of several other people who are also trying to conceive so just because it's a baby thing doesn't mean it's my baby thing. So I am working on a blanket. Mentally, I haven't committed it as my baby blanket, although I do admit that it's a lot of work and I'm not sure I want to give away when I finally finish it :)
• I have seen a therapist. I met her when I was going through a really stressful time at work and she was very helpful in getting me through that. I reconnected with her because I decided that I deserve any extra support that I can get and, while my health insurance doesn't cover infertility treatment, I do have good mental health coverage so I might as well take advantage of it. 
• C and I are regularly attending the support group meetings put on through RESOLVE. I would definitely recommend this as a strategy to people, especially if you can convince your husbands to come. Since going to these meetings, C has been so much more understanding and supportive (not that he wasn't before, but it felt like there was more of a disconnect) and I have been able to put our situation in perspective and take comfort in the fact that we're not alone in this. It's also nice that C and I have something we do together to cope. 
• I talk about it to people who are supportive - but only when I want to and not to most people. I've been pretty private about our struggle, mostly because I want to avoid the stupid comments. Most people know me as someone who is very career driven so I don't really get the "when are you having kids?" comments and it's usually been helpful to lead two separate lives. At work, I am a psychologist and I am driven and productive and happy. With many of my more casual friends, I am just a fun person to hang out with. I do discuss it with my parents, with my sisters, and with two close friends (who are also in the mental health field so they're great at providing support!). And of course with C; he knows the most about my feelings and thoughts. But even with these people, I am quick to tell them that I'm not mood to get into it when I'd rather focus on distracting myself. 
• I also watch a fair amount of crappy TV and read good books to think about other things, exercise (but this feels still more like work than coping), eat yummy but unhealthy things (not so helpful as an overall approach), dabble in photography, and surf the web. These are things I do that haven't been as helpful, but I still do them because they're easy or good for me or because no one is perfect.

So, yes, I get frustrated. I get emotional (still blaming the hormones on this one). I can be negative. But I also am able to put that all aside when I'm at work or with friends doing fun things or having quality time with my family. I spend much more time happy and content then I do frustrated and distrought. Given the crap that we're going through, I think this is just fine.

T.M.I.

Today was a good day. I got a baseline ultrasound with my new RE and they decided that I could begin taking the Letrozole without waiting for period... as in I get to move on to the next step and I don't have to have a period this month!

When I filled the prescription I was pleasantly surprised that it is covered by insurance and very inexpensive. Then, when I opened the pill container, I discovered the pills were very tiny, which is awesome because I hate swallowing pills.

The only negative was that C, my lovely adoring nursing student husband, was less than impressed with the "technique" employed by the phlebotomist (something about sterilizing from outside-in vs inside-out).

Now the only issue is how not to tell my mom. I have this problem where I tell her a ton of the nitty gritty details when things aren't going well (as in the last few weeks) because she's good at helping with decision making.

The problem is that when things are going well, as in potentially leading to timed intercourse, I would prefer for my mom not to know the nitty gritty details.

Have I mentioned before that C and I moved in with my parents to save for a house?

I can only hope that she doesn't really understand the process in depth enough to know about the timing of various steps and/or can't do math.

Under New Management - Part 2

I didn't mean to leave you hanging all Empire-Strikes-Back-style, but I realize the last post of why I decided to switch RE practices was getting very lengthy. Here's how it all shook out...

After the disappointing conversation with Dr. F's nurse, I decided to contact UH the next day. I talked to the front desk staff and the financial counselor. I asked a lot of questions about how their process worked and what the costs were. The process was very similar to CC with a few distinct differences. First, they have only one sonographer, which I think it great because personally I think this slightly more of an art than a science and it's good to consistency in the interpretation. Second, when they have their meeting in early afternoon to review all the data, ALL of the Drs meet together, meaning that my actual Dr will be in on all of these meetings (assuming he's not off work) and making the decisions himself. Pricing was comparable between both practices. The front desk worker said that she'd give my folder to the nurse and he/she would call me back to get some more history and all the updates since my initial consultation in late spring.

Instead what happened was that Dr. P call, the actual Dr! He left a message because I was with my own patients and couldn't answer the phone but called both my work and home numbers and left messages on both! (Have I mentioned that I haven't actually spoken to Dr. F since the initial consultation, only talking through him to the nurses since this time) Then, the next day, he called again... at 7:20 in the morning! C mentioned that this was likely a professional curtesy because he knows I work professionally, which I agreed with after my initial shock in the lack of typical social etiquette. Or maybe this is just because I am not a morning person; even though I was already close to work at that point.

C and happened to be carpooling in the day, so he got to hear most of the conversation as well. I briefly explained what has happened since last meeting with him. He told me about some brand new research presented at the recent professional conference of a huge study that showed Femera was significantly more effective in patients with PCOS than Clomid. I appreciated that he discussed the actual research studies with me and thought this was very respectful. He then gave me a similar talk as our initial consultation by listing out the several options that I could choose from! These included a "step-wise" approach to Femera, going straight to injectables, or going straight to IVF. I explained my hesitancy towards spending a lot of time on oral medications, but also my desire to given this a shot since it is much less expensive and time consuming. He clarified what he meant by "step-wise", saying that we would start with 5mg (not the 2.5 B.S. Dr. F was insisting on) and monitor me from ~12-13. If I haven't responded to this by ~20-22, I would begin taking 7.5mg immediately so that the whole cycle would take a maximum of roughly six weeks. This way we could give it a shot and say we tried, but not waste too much time and be able to move on injectables (if we need) maybe even by the end of the year. I am thrilled about this plan. It feels like the best of both worlds. Then, he recommended I come in for a baseline ultrasound to see if we could start this right away (if my lining is thin enough) or if they would give me some more medicine to induce a period. Sweet! Let's get this show on the road!

After hanging up, C mentioned that he sounded really nice and felt good about the plan. I agreed and so we officially made the switch.

At one point, we had discussed emailing or setting up a meeting with Dr. F to give him one more shot to explain his rationale and help him to understand my frustration. I haven't done this yet and am not sure it's necessary. I also haven't let the CC practice know that I'm switching teams, but aren't sure this is necessary either. I think this is the loyalty in me that feels bad about breaking up with my employer's practice and doing it by abandoning them in the middle of the night without an explanation rather than having a big-girl conversation. But alas, this is not a romantic relationship, maybe this analogy doesn't really apply at all.

Under New Management - Part 1

I did it. I actually switched REs, switched hospital systems, converted to the dark side. It would probably be a big deal for most for people, but for me especially because a) I consider myself a pretty loyal person and this feels disloyalty (I know I shouldn't see it this way, but I do) and b) I am employed by the hospital that housed my former RE and the hospital system that houses the new RE is our city's biggest rival [and now that I think of it, maybe this is where the disloyalty is]. So here's how it all shook out:

Back in the spring, when I was originally referred to a reproductive specialist from my OBGN, I had consultations with two different people, at the two different hospital systems. I probably wouldn't have done this in the first place, but my OBGYN, who practices independently but is affiliated with my hospital system (we'll call it CC), strongly recommended against the fertility center at CC and gave me a few names of people at UH (the competing hospital). So I met with both of them within a week and my first impressions were that both were very knowledgable and both presented relatively similar options of plans from the start. However, Dr. P from UH generally had a better bedside manor and presented the plan as "your options are A, B, C, or D, depending on how conservative/aggressive you want to be," whereas Dr. F from CC was much more systematic and presented the plan as "First you would do A, if that didn't work we would move on to B, and I'm confident you won't need to get to D".

At that point, the idea of someone giving me a clear direction was reassuring and I felt like there would be a benefit to keeping all of my medical services in the same hospital system (e.g. shared medical record, potential for some special "colleague to colleague treatment") so I chose Dr. F/CC, even though I had a better overall impression with Dr. P/UH. I should say that my insurance doesn't pay for anything after the diagnostics, so everything would be out-of-pocket and insurance converage didn't really factor into my decision.

Fast forward 4 months... I've had really long cycles so I've only gone through three actual cycles. We re-did 100mg Clomid because my progesterone levels suggested I ovulated on the first try of this dose, but at my ultra-sound on Day 12, nothing was growing. They had me come back, just to make sure, and alas I was not responding. So I had a wait while, start Provera, get period, and move on to 150mg. Repeat. This time they only had come in once and they gave up after I showed minimal growth. On to 200mg, which they said would be the highest they would go. Repeat. This time (this past cycle), I went in for monitoring on Day 12 and just like all the other times, I had a crap-ton of little follicles, but none of them were very big. The nurse on that day mentioned that I might be able to move right onto a new drug without inducing my period (great news since it's now October and I haven't ovulated in 4 months and I have super long cycles). But then after consulting with Drs, they wanted me to come back again, "just to make sure" because they wanted to be positive before moving on to a different plan.

I should mention that I keep saying "they" because at CC they work in a team approach so all the Drs in the practice rotate during the afternoon meetings to review all the blood-work/ultra-sounds from the morning so it's not typically your Dr that's actually reviewing your data. So with this plan I called Dr. F directly to make sure this is really what he wanted, because a) this is not what they did last cycle, b) I'm paying for all of these visits out of pocket and would prefer not to have multiple visits just to be told repeatedly that nothing is happening, and c) I want to move on to the next thing already! I talked with his nurse who told me that he says "Sure, why not, it won't hurt" [I'm paraphrasing] and then also mentioned that I've gained some weight and should really work on this and see the endocrinologist and even suggested I take a 6-12 month break from trying to conceive to work on losing weight! (see this post for all my thoughts on this). So like a good little patient, I saw the endocrinologist, saw a nutritionist, and when in for a second ultra-sound a few days later.

Ultra-sound #2 was, surprise-surprise, also a bust. I was thinking, "great, now we can finally move on!"  BUT, then the nurse called me at the end of the day to say that the Drs wanted me to come back AGAIN because a) they want to "give me one last chance" and b) if I come on this certain day, Dr. F will actually we be there see the results. So do I get a refund for the other U/Ss that weren't reviewed by him and were basically just a waste? The emotional toll of being repeatedly told that nothing was happening is not cool. 

For this final ultra sound, I was over it. Things still weren't progressing. The nurse told me that my likely options were to try Femera for a couple rounds (which sounded eerily similar to my experiences with Clomid) or move directly on to injectables. I thought about these options all day, thinking that I am mostly over the whole oral medication thing. Then the nurse called in the afternoon as said that I didn't actually have two options, that Dr. F wanted to just start with the lowest dose of Femera (2.5mg, even though I've read that most people start with 5mg) and then try the other higher doses after this if I don't respond. Basically, the same thing we've been doing that's taken so long, only with a different medicine. I was not enthused.

I thought about this for a week or so while I took Provera and waiting for my period to arrive. Then, after it had been 10 days since finishing Provera and I started to get antsy because they said I should bleed within a week, I called the office. I again talked to the nurse and she said that for some people it can take much longer and I should continue to be patient. I explained all of my frustrations with this past cycle specifically, how much time and money has gone on without any progress, and how I'm mostly over oral medications. I said that I would like to try just one month of Femera, at 5mg not 2.5mg, and then move right along if it doesn't work. She relayed this frustration and my preferences for the plan to Dr. F. His response (she read it to me from the chart): "5mg isn't necessarily better than 2.5mg. The plan will be start with 2.5, then 5, then 7.5, and then we'll talk about the next plan." As in, completely ignoring/discounting my frustration and desires!

This was Wednesday evening, and the day I started seriously considering contacting UH again...to be continued...

Happy Anniversary

This past week C and I passed our 3 year anniversary. We haven't actually celebrated it because C had a final at the end of the week. (He's in nursing school and it is NOT easy!) but we are celebrating it tomorrow with a fancy dinner at Melting Pot.

C and I dated for a long time before getting married, but it was all long-distance. We met in undergrad but didn't actually start dating until I left for graduate school and he was in the corporate world. We didn't actually live in the same town until three weeks before our wedding! It was definitely a transition, and one of the big reasons that we agreed to put off having kids for a little while so we could enjoy being husband/wife before being parents.

The last three years has had its fair share of ups, downs, and transitions. C moved back to the Cleveland vicinity, both our home towns, leaving a secure job so that I could pursue my dream job. He had a very rough time finding a new job in his field and then ultimately decided to trade in the computer for a pair of scrubs and go back to school for nursing.

My dream job turned out to be much less than a dream and much more of a nightmare. I was so stressed and then became depressed, but eventually was able transfer to a different department in the same hospital and now I really do LOVE my job and it really is a dream come true.

C had difficult transition back to school. Nursing is very different from graphic design and marketing. He was put on probation and then forced to take a semester off. He got tutoring and pulled himself off the floor and started having much more success. He recently got a job as a nursing assistant to get more experience.

With C going back to school and not bringing in any/much income, we had to downsize from our original rental house and then ultimately decided to move in with my parents so that we could still work on saving for a house downpayment (although now that saving is in jeopardy of taking a back seat to infertility expenses). This has been a huge transition, but is getting easier.

When I look at everything we've already gone through together, I think it's no wonder that he's been such a great support and we've been a great team on our new challenge of infertility. Sure, there have been times when he doesn't understand me and tries to send my hormonal self straight to a psyc unit, but mostly he's been supportive and caring and patient. I hear from other people suffering from infertility (or many other family stresses for that matter), and how it pulls couples apart and destroys relationships. For us, it's been the opposite. I feel like we are stronger than ever and that we could tackle anything. I think we appreciate each other more and are both more patient and kind to one another. If there is such a thing as a silver lining of infertility, our relationship is mine.

Happy Anniversary

The Weight Of It All

I don’t want to make this a weight loss blog. However, my weight does seem to be very intertwined in my infertility journey. In fact, so far my worst experiences BY FAR have been the THREE separate occasions where people [women!] have asked me if I was pregnant! By the last time, I had my witty response about how this wasn’t possible for me with the full intention of making the person feel half as horrible as they made me feel, but it was a patient’s mother and I decided this probably wasn’t professionally appropriate so I ate some more humble pie. But next time, I’m ready!

I’ve gained about 20 pounds since stopping birth control and starting all the medications, which puts me solidly in the “overweight” category (I used to be holding on for dear life in the “healthy range”) and the RE has mentioned, more than once, that losing 10-15 pounds of this could really help with ovulation. So they referred me to Endocrinology [which is a completely separate department from Reproductive Endocrinology, who knew?!] and this Dr explained that the weight was likely due to all the drugs they were pumping into me, especially the progesterone, and that I wasn’t obese so I shouldn’t be worried. Also, there are several drugs that they could give me to help with weight loss, but none of these are safe for pregnancy so they don’t recommend this. This was frustrating to say the least.

To be honest, as much as the infertility sucks, the weight gain has been just as hard. With the infertility, I get monthly feedback that my body hates me, but with the weight gain the feedback is daily – every morning when I try to find clothes that fit or in the evening when I feel less than sexy and am desperately trying to maintain a sex life in the midst of all the medicalization of what used to be an intimate endeavor. It sounds vain, but this aspects really hits me hard and drives home the feeling of my body boycotting in every way possible (gotta love the increase in acne also!).

So I went a dietician and started seeing a personal trainer. I already eat mostly healthy, except for those times when I don’t (it doesn’t help that the half-price sale starts in the bakery shop just as I am leaving for the day and located along my walk to the car and they keep all the cookies and Danishes in the front window for display. I also doesn’t help that I’m often jacked up on hormones and that sugary, chocolaty things make me happy). I digress. I don’t do this often, but often enough that I need to stop. Also, I enjoy carbs of all varieties and this can have big negative effect on insulin and PCOS symptoms. Also, they recommend that I get up to 300 minutes of exercise per week and this is hard to fit in my schedule.

So I won’t make this all about my healthy eating and exercising efforts, but I will be using this to publicly state my goals, plans, and accomplishments and to keep myself accountable to world [wide web]. It is my blog, after-all.

The dietician recommended the following plan:

·  Meals should consist of at least 20g protein and less than 30-45g carbohydrates (counted as Carb grams – Fiber grams)

·  Snacks should be 15g carbs or less, for a rough total of 120g of carbs per day (calorie goal was 1300-1500)

·  Drink 64 ounces of water per day

·  Aim for 300 minutes (5 hrs) of moderate physical activity per week, but at least a minimum of 150 minutes.

I plan to accomplish this goal by a) recording everything I eat/drink and b) providing weekly Health Updates here for increased accountability. More specific plans/commitments will follow. 

The Waiting Game

I usually have very long cycles, 40 days or so depending on what medicine I’m on. The past 3 cycles, I’ve been on a regimen where I take increasingly larger doses of Clomid and then get ultrasound monitoring around day 12, with the plan to use the “trigger” shot to better time intercourse once the eggs are big enough, but we haven’t made it to this step yet.

In fact, every time I go in I’m given roughly the same message, “Wow, you have a LOT of eggs!” [which I’m learning is both a good and a bad thing, as it puts me at risk for hyper stimulation] and also “None of them are very big”. Sometimes they bring me back for additional ultrasounds to remind me of the lack of progress double-check and give them some extra time to grow, and then eventually they give up and prescribe progesterone to induce a period. My body responds inconsistently to this well, sometimes taking up to two weeks after stopping the medicine for anything to happen.

So if we do the math, I spend about 2/3 of the time waiting for the next cycle, with no hope from the current cycle. Days 1-12 are nice because there’s a little hope and excitement, although I do admit that I’ve been pretty jaded the past few months, but then days 13 – 40 are spent waiting, hoping, anticipating for… a period! Very anti-climactic, I know.

So that is my real, live, late-breaking-update. I finished the Provera 10 days ago and now become hopeful and then subsequently annoyed every time I go to the bathroom and wipe to only the color yellow (gross, I know, sorry). This time I am actually a little more eager for the next step because we’re trying something different: Femera. After 9 months, I’m glad to be getting off this Clomid train. But until this is possible, I need to work on not obsessing about it and focus on the things in my life that I actually do have some control over. 

Infertility is a Dirty Word

I am generally not a fan of the word infertility. The prefix "in" means "not" or "opposite of". This implies that I am not fertile. Not now. Not ever. I don't believe this is accurate (although technically I don't yet have evidence to the contrary). I prefer the term sub-fertile. I am definitely not as fertile as many other people of the world. If I were, I'd have regular cycles, I would ovulate on my own, and, more than likely, I would have been pregnant multiple times by now. But I do have eggs (they just won't grow), my cervix is intact and attached to unclogged tubes. That is better news that many other women I have talked with, and for this I am grateful.

The more people I talk with, the more surprised I am to hear about the wide range of what is considered in the infertility family. I've met with women who have been trying to conceive for over 7 years, have had numerous failed IVF treatments, have attempted utilizing donated eggs, donated sperm, and donated uteruses. I've talked with people who had one child easily and then could never have a second. Women as young as their early twenties and into their forties. Couples who are just now considering consulting with their physicians and those who have seen multiple different medical specialists for varying opinions. Technically, the term infertility is reserved for couples that have had unprotected intercourse for 12 months without becoming pregnant. With medical intervention, many of these couples will go on to have healthy babies and many will not. However, statistically, if you haven't conceived within 12 months, then you're more than likely not going to without some extra help. So we get labeled: Infertile.

An Introduction

This is the story of how we became a family, of how you arrived in our life. You don't exist yet. But you will. I still believe this. At some point, when you ask, "How did I get here?" you will NOT get the crap about "when two people love each other very much." Because that's not how it always works. Sometimes people love each other very much and it doesn't matter. There are some things that love cannot fix.

Love is an emotion. Baby-making is a science. Or at least it will be for you. Love is kind, patient, and beautiful. Unfortunately this does not describe the process of trying to create life, at least not in my case. This will be my attempt to describe the trials and tribulations, the science and emotion, that will hopefully, eventually, bring us a child.