Break. Re-set.

After walking out the door today, I will not return to my office for a full week! My last break of this magnitude was in June and I didn't realize how much I was looking forward to/needing this.

It comes at impeccable timing. In meeting with the therapist last week, we decided collectively to focus on behavioral changes first and keep medication as an option to consider down the road if things don't improve or get worse. I know the behavioral changes that improve mood. I am a psychologist. I just haven't been listening to my own advice. A week off of work is the perfect opportunity to hit the "reset" button and put an emphasis on my health and mood.

Here is the action plan:

1. I have a follow-up therapy appointment in early January. 
2. Focus on sleep hygiene to get enough sleep an feel well-rested. This means turning off the screens before getting to bed, having a relaxing cup of tea or cocoa to down-shift, and taking my heartburn medication as recommended. 
3. Try to get in physical activity every day. Elevate my heart-rate, which is great for endorphin-release and a mood boost. Bonus points if it is outside in the fresh air (but no hard feelings and mentally beating myself up if there is a blizzard and I opt for the treadmill or mall walk!). 
4. Ask for help. Accept that I am growing another human being while working full time and raising a toddler and this is hard work. Don't expect for C to read my mind, but ask to him to assist me completing the first three things on this list or giving me a break from the toddler. 

These are basic, but things that I have not been managing up to this point. Three daily tasks to make my emotional health a priority as we close out the year and I enter the second half of my pregnancy. Now I just need to consistently follow-though. Wish me luck!

Antepartum Depression

I made an appointment with a therapist for later this week.

I am worried about antepartum depression. As a psychologist, you would think a self-diagnosis would be simple. However, mixing in pregnancy symptoms makes it more complex and I decided after calling off work twice last week that I need to be proactive.

Antepartum depression, or depression that occurs during the pregnancy, is more common then most realize, affecting 12 - 20% of women by some estimates. There are many risk factors, including previous history of depression, pregnancy complications, and IVF among others.

Here are the symptoms of depression:

1. depressed/sad mood, 
2. loss of interest in normal activities and relationships (called anhedonia), 
3. fatigue, 
4. concentration difficulties, 
5. sleep disturbance (insomnia or hypersomnia), 
6. psychomotor agitation or retardation (physically feeling agitation or slowed down), 
7. significant weight loss or weight gain, 
8. thoughts of death or suicide, 
9. feelings of worthlessness or guilt.

A diagnosis of depression is warranted when a significant number of these symptoms is present, more often then not, for greater than two weeks, results in impairment in life functioning, and isn't better explained by something else.

This last part complicates things. Pregnancy, combined with a long-lasting respiratory illness that I can't seem to shake from a lowered immune system, also can cause many of these symptoms. It begins with sleep disturbance (in my case, both insomnia and hypersomnia) and fatigue. The fatigue results in concentration difficulties. The fatigue and changing body shape then escalate into psychomotor retardation. Then I am no longer productive and feel like a less-then-adequate mother to my toddler... and now we have feelings of worthlessness and guilt. Significant weight gain clearly doesn't even count in this scenario.

That leaves depressed mood, loss of interest in normal activities, and thoughts of death/suicide. Those are really the only symptoms that can't be explicitly tied to pregnancy. I can clearly rule out the last of these. So how is my mood and my interest? Mostly, "blah".

This is what has me concerned. I haven't felt any lasting joy in this pregnancy. I am too tired to care about much. Objectively, there are some very exciting things going on around me - at work, with family, etc., but I struggling to find enthusiasm for them. Last week, I called in sick two days in a row. The first day was mostly due to illness, but then I realized by the second day that I was really just avoiding work. And I love my job and it is going really well. But I struggle to get there and make an effort. How much of this is due to fatigue versus depression? I can only compare to my last pregnancy, when I don't recall feeling quite this miserable.

So I made an appointment. Because talking to someone and getting another opinion never hurt.

Thankful

I have not felt creative lately. Actually, I have still been feeling low energy and unenthusiastic about most things; blog-writing, work, pregnancy. Despite this, I keep chugging along. In reality, I am grateful for where I am at and what is going on in my life. I need to do a better job of embracing this.

I am thankful to be pregnant with our second child. We are extremely lucky that our IVF was successful on the first attempt for both pregnancies. We are blessed with what is currently a second healthy pregnancy with minimal complications currently. I will be 18 weeks tomorrow and thus far have only had to contend with fatigue, intermittent nausea, and growing heartburn. It is thus far remarkably similar to our last pregnancy. At my last OB visit, my blood pressure was excellent and my weight was "good". (I am up more weight then I would have liked at this point given starting off overweight again, right around 11 pounds, but it's too bad so I am just accepting it for it is.)

I am thankful for my daughter. She lights up my life and brings me such pride and joy. Yes, there are days when I feel too tired and apathetic to be a good parent and lose interest in her repetitive play, but mostly I love watching her grow and develop.

I am thankful for my husband. Lately, likely due to some hormonal surges, I have felt such a renewed of love for him. I cannot believe that we've been together for over a decade now and we still enjoy each others' company. He is such a great father and I am so lucky to have him as a partner.

I am thankful for my job. It is secure and it generally brings me a sense of accomplishment and goodwill. There are many days that it also brings me stress, but I would also never be content in a job without a challenge. It also provides an income that helps us to feel relatively financially secure.

I am also thankful that we are currently in a place where I am optimistic we will be able to weather the next four years. We both have stable jobs and a 30-year-mortgage in a home we love. Our daughter will hopefully have no memories of a time when the country turned its back on women, immigrants, and minorities. I have full faith in MLK's words that "The arc of the moral universe if long, but it bends towards justice".

Still here. Still Pregnant.

I am alive. I am still pregnant.

We went forward with telling my immediate family during the break between the wedding and reception. Our daughter changed into "nap" clothes from the dress she was wearing in the hopes she would nap during the break. Her nap clothes consisted of a shirt that said "Big Sister, Est. 2017". She walked out proudly, with no real idea what message she was delivering, and the family quickly caught on. They were excited. My mom expressed concern that "she's so young", being all of 2.5 years when the new baby will arrive, compared with the 4 year age gap between me and my next youngest sister. I made multiple comments that it was extremely early and we were still guarded.

The morning of my second blood test, I bled again for the last time. The test came back high and with a good doubling time.

Two weeks after this, at approximately 7 weeks gestation, I had my last ultrasound with the RE. One healthy heartbeat. I could feel C's relief. My own disappointment felt selfish and unnatural. They offered no explanation and no real concern for the bleeding.

I put off the first OB appointment because of my experience last time. Then I panicked because I wanted to have the nuchal translucency scan completed and we were approaching the deadline for scheduling this and would be out of town one the weeks in the acceptable window. My daughter came to the appointment did very well "reading books" during the PAP test and full exam. No confirmation of life was completed, but I was okay with this because I knew what to expect this time.

Instead I scheduled the nuchal translucency scan as soon as possible to confirm life. I think I was secretly and partially hoping that they missed something during the first ultrasound. That the second embryo implanted and was growing secretly this whole time. That the bleeding was not a miscarriage.

The scan went well. All is normal with minimal risk for the screened genetic conditions. Still one baby, now the size of a strawberry.

I have been feeling a near-constant combination of nausea and heartburn. It almost feels like constant car-sickness. All topped off with overwhelming fatigue. Sometimes the nausea is worse and sometimes the heartburn is the dominant symptom, but I am rarely getting full relief.

I debate with myself if I feel worse then last time or if it just seems worse because I am now juggling pregnancy with mothering a toddler and home-ownership, in addition to the full time job I managed last time. Either way, it has not been pleasant.

I feel guilty for being a "lazy" parent. I feel apathetic towards my work. I often feel disengaged with this pregnancy, despite my tightening waistband. I have been obsessed with trying to guess the gender, both hoping this well help me to feel more connected and also anxious that my daughter may never get to experience sisterhood.

Officially beginning the 13th week, I am hopeful the second trimester will bring more enthusiasm and less negativity.

A Happy Occasion

My second-cousin is getting married today. I am so happy for her and excited for the festivities. It will be a big Russian celebration filled with a mix of folk and modern music and so many of our family members. These are best types of receptions and I have been anticipating it for a while now.

The ceremony is in the early afternoon, meaning that there will be several hours before the reception begins in the evening.  My immediate family had planned to go to the hotel near the reception location to spend time together. My sister and her baby (and husband) will be there from out-of-town and it will be a relatively rare occasion when my whole family is together in one place.

During the intermission, we planned to have our daughter (hopefully) take a nap in one of the hotel rooms while the adults spend time next door. I fantasized about changing her into more comfortable clothes for napping, which happen to be a new shirt saying "Big Sister, Est. 2017". She walks out into the other room to tell everyone her favorite word ("bye!"), they notice the shirt, and everyone is shocked and excited. It is perfect. I bought the shirt and it arrived today.

Then there was the spotting, that fact that there is only one HCG number 5 days ago, and the reminder that I do not feel an ounce pregnant aside from enlarged breasts.

I am so torn about this. On the one hand, this is a rare opportunity to actually tell some of my immediate family in person and I'm not sure when I will next see my sister. Plus, keeping it from them for a multi-hour hiatus where I am sure alcohol beverages will be the primary option and then again for an entire wedding reception (the stereotypes of Russian weddings and vodka are accurate) sounds nearly impossible. I have also heard that it could be useful to tell anyone that you would want support from if it did go wrong. My family isn't always the most supportive (although having multiple psychologist friends, I probably have exceptionally high standards of support), but I would definitely want them to know no matter what the eventual outcome.

On the flip side, making such a big show of it this early (5 weeks, 3 days assuming all is well) seems inappropriate. I hate believing in jinxes, but I do and this seems like I'm setting myself up.

But this was what I wanted. I purposefully didn't tell anyone in my family ahead of time, unlike our first IVF, because I really wanted to be able to actually surprise them. I really wanted to see their expressions morph from confusion to shock to joy. I felt robbed of this experience last time and I really really wanted to reclaim that.

As far as I see, I have the following options:
A) Trust the tests results and nurses' reassurance, live my fantasy, and enjoy the moment.
B) Try my best to continue hiding it through the festivities, hope they don't notice or suspect anything, and then attempt a different "reveal" after the ultrasound.
C) Tell them tomorrow, but without the big show/shirt. Present it with cautious optimism given the circumstances and avoid the bravado.

The first two options feel very risky, each in their own way, and the third option is just disappointing.

I am honestly still undecided. C mentioned we could always pack the shirt and decide in the moment, but I am usually much more thoughtful then this. Stay tuned! ...or feel free to chime in with an opinion...

623.8

The nurse was very pleased as she told me the blood work was positive. I was pregnant. She asked about my spotting, which has continued, and didn't seem to be concerned at all. At all.

They want me to return in a week for a second HCG reading. This is when I started to cry on the phone, trying to keep it muffled. An entire week to see if the number is rising or falling. An ultrasound wouldn't be for  a week after that. Two weeks to determine if I am in the process of miscarrying one embryo right now.

I want to believe her that there is nothing be worried about. I want to trust the high number. I want to feel overjoyed with excitement that the FET was successful and I am pregnant for a second time.

As soon I got off the phone, I went to bathroom to find more blood. It was brighter red and with a small clot again. As if just to remind me that this wasn't over.

In the research I could muster, approximately 20-25% of pregnancies will have first trimester bleeding episode(s). The research reports that 50% of these will end with a healthy birth. The other half aren't so lucky. I also read that bleeding is more likely in the case of twin pregnancies.

On this exact day in my first pregnancy, the HCG was over 1,000. This was with two blastocysts transferred,  one healthy heartbeat discovered the following week, and no bleeding. I could not find any research comparing blood test results from one pregnancy to the next and what this could imply. Clearly my research has not been particularly helpful or comforting.

My fear is that I was pregnant three days ago. Then the bleeding began with a full miscarriage to follow but the HCG was still high today. My fear is that it was higher three days ago and now it is dropping.

My other fear is that all of this is a partial miscarriage of one of the embryos. In two weeks we are going to find one developing embryo and remnants of a second. They say that if not implanted the embryo will likely just "re-absorb" into the uterus, which is what I am assuming occurred with our first IVF. I find this oddly comforting. It is still with me, reabsorbed within me, because it was not suitable to grow into a human on its own. This is much more comforting then the embryo being slowly dejected from my body. I fear now that if there is one embryo on the ultrasound in two weeks that I won't have any other interpretation of the bleeding but this and it sickens me.

I tell myself to trust the nurse and medical team. I tell myself that there is nothing anyone can do at this point regardless of the outcome. I tell myself to take care of my body and the likelihood that I am supporting life. None of this seems natural. And with my "high" number, I feel so ungrateful and whiny that I am not more enthusiastic and hopeful. This is not at all the reaction to a positive pregnancy test I expected from myself.

Child #2 Anxiety

This is not about the anxiety about my blood draw results tomorrow. That is there, yes, but this time I am aware of a different type of anxiety. It nears ambivalence, but ambivalence seems like too strong of a word to use.

This is the anxiety about if everything does work out. The blood work comes back positive and so does the next one. The ultrasound sound shows a heart beat, or two. The trisomy test is negative and the anatomy scan is normal. Sometime in April, 2017 we welcome home one [or two] healthy child[ren].

This scenario is anxiety provoking in a way I didn't feel with our daughter. With her, the anticipation was entirely positive. And it largely has been. She's had her share of challenges, but she is perfect to us. Our family is near perfect as well. On many days I would argue it is perfect. Which then makes me question, Why are we trying change this?

I question how our daughter will react to a new sibling and how we will manage with dividing our time and our resources. When I spend hours in the evenings playing tea-party and reading books, I am now acutely aware that this will not be possible with a second child. At least not in this way. I get sad when I think about the new child getting attention from others and the thought of our daughter getting brushed aside. I'm not sure how much of this is rationale.

This time I also go into pregnancy and motherhood unblinded. I miss the snuggles and fresh-baby-smell but I am not looking forward to returning to sleepless nights and those periods then they are inconsolable and nothing you do can stop the crying. I cringe when I think about the heartburn of the third trimester and the inability to be comfortable for months at a time. Trying to do all of this with a toddler sounds like an impossible feat.

Yet, clearly having a second, or third, or fourth child has worked out a million times over for women across the world. I have two siblings and my husband has three. I can't imagine growing up without siblings and wouldn't want that for my daughter. I look forward to watching them play together and hearing them giggle in their bedrooms when they should be sleeping. I believe our daughter will be a wonderful, albeit sometimes bossy, big sister.

If the results are positive, I look forward to eventually being able to talk with other mothers on how they balance a second child. Until then, at least I have the blogging world.

Spotting and Symptom Spotting

I woke up this morning to soiled underwear and pink spotting on the toilet paper. Then I made the grave mistake of googling "miscarriage while on progesterone". I do not recommend this under any circumstances! Forum after forum, story after story of miscarriages.

I have to wait until Tuesday to get my first beta, a full 2 weeks after the transfer. These seems excessively long given that the transfer was equivalently five days after "ovulation". I cope with this by reminding myself that I would rather wait to see a higher a number then a much lower number and fret over what this means. As in, I would rather know that I am not pregnant and likely never was then to know that I was pregnant at 4 weeks 1 days but not by 4 weeks 5 days. But then spotting has occurred so this argument doesn't really stand up.

I also tell myself that if I tested early and it were negative that I would lose all motivation to continue the progesterone shots. These are not the most enjoyable way to begin my morning. Neither is spotting.

Clearly I'm stuck on the spotting. And now extremely eager to get to Tuesday. Last pregnancy there was never any spotting or really anything out of the ordinary in the beginning. The worst was when I had a period of cramping between the period of being released from the RE to my first OB appointment, which put me into a tizzy for a few hours, until I realized it was simply constipation pains that resolved itself with a trip to the bathroom.

I am reminding myself that approximately 30% of pregnancies have early spotting. I may to repeat this every 5 minutes, but at least it is something. As long as the spotting doesn't get worse, I will keep from panicking.

In other news, I was planning to write a post on "symptom spotting". I need to preface this by saying that I completely understand that pregnancy symptoms and progesterone symptoms are largely the same. I do not put much stock in these, especially after the one cycle where I had so many convincing symptoms that turned out to be nothing, but for posterity sake, here goes. These are the symptoms I have noticed over the past 1-2 weeks:

• Slightly increased fatigue, but this is very subjective and not nearly to the level that I remember at certain points of my last pregnancy. 
• Slightly more sensitive nipples. 
• Definitely a small increase in breast size and a feeling of fullness. 
• Occasional "twinges" in my pelvic region. It feels like a muscle or tendon is pulled. If I stretch in a particular way then the feeling can be downright severe and painful, but most often it is just a nagging sensation. 
• Spotting. (Does this count as a potential symptom? Ugh.)

Two more days and then hopefully there will be answers. Two more days.

Transfer

My transfer date was this past Tuesday. It was fairly mundane, with the exception of finding the right balance between having a full bladder and not wetting myself. I recall this to have been much easier before having our daughter... Needless to say, I did need to use the restroom before the procedure. They gave me a cup and told me to fill it half full to not let too much, but I couldn't stop myself and kept peeing! Then, for about 10 minute, I felt very stressed that I let out too much urine and ruined everything. Luckily, shortly before the procedure I started getting the urge to urinate again and the ultrasound technician reported that my bladder looked great. Immediately after I had to run to the restroom again so apparently there was still enough in there!

We agreed to transfer two embryos, just like last time. (We also ate at the same restaurant for lunch before the transfer so really going to replicate some past results here!).  Shown on the huge TV screen right before they were sucked up into the straw, both embryos were nearly 50% hatched, which everyone in the room was very excited about.

I felt noticeably calmer or more confident then the last time. Enough so that I was asking more curiosity questions, such as why they embryos shine so brightly on the u/s monitor (that is actually the little pocket of air that they are incapsulated in).

Afterwards, we picked up our daughter from a family friend who agreed to watch her last minute (C turned out to be much more upset that the wouldn't be able to be in the room then I originally anticipated), and returned home to nap and then play. The whole day was very casual, and very typical. Except for the part where I may have gotten pregnant.

Privacy and Support

I made a conscious decision at the very beginning of us talking about a second child that I did not want anyone to know about us "trying".

Last time my family knew quite a bit. I didn't divulge nearly as many details as my sister, but they knew the retrieval date and the transfer date. So did several friends and coworkers, largely because of how it all played out with the ED and internal bleeding issue. Mostly, though, it was because I wanted and needed support. This was a long road and I needed to be able to talk about it and explain away my moodiness.

The down side of telling everyone ahead of time is that they are reasonable humans who can then logically induce when you would be able know if you are pregnant. This changes the entire dynamic of the "reveal". It is no longer a surprise because they are anticipating an answer, and there are only two options.

This time I wanted to be able to surprise them. I was to come out of nowhere. I want to see a different emotion on their face: the combination of shock and joy, not the combination of joy and relief.

I still want that. However, I seem to have underestimated the need for support. Any my horrible ability at lying or anything that seems like like lying, such as withholding the truth.

I told my boss on Friday. He is called me into his office for an impromptu meeting on a topic he likes to call "succession planning" where he tells me that he would like me to take over his job sometime. This first started occurring right before our daughter was born, so by this time I have gotten used to hearing about it but not expecting anything. However, this time was different. This time he started talking about an immediacy and I actually got him to give me some concrete dates/time-lines. His current plan is to make an announcement at the large full-department meeting this fall and then spend a year training me and a back-up person to take over. With this information, I felt compelled to tell him that I will not be present for part of that year if everything goes according to plan. More pressing was the fact that, if everything goes according to plan, my first trimester will be nearing its end right around the departmental meeting and I this did not seem like a good time for him to learn about that news.

A few weeks ago, due to another set of unforeseen circumstances, I ended up divulging a lot of specific details to one of the physicians whose office is next to mine and one of the graduating fellows (I should really devote a whole post to this one). Now the physician asks how I'm feeling every time she sees me.

My best friend knows that we are trying sometime this summer and my best co-worker friend knows that we are actively trying now, but I didn't tell her the specific transfer date.

So it turns out I am really not good at this keeping this private.

Ready, Set...

My transfer is scheduled for Tuesday afternoon. They called for my credit card information on Friday so I know this is really happening. The last lining check showed my lining increase from 8mm up to 12 mm in four days, so if anyone is curious about the effects of one extra little estradiol pill intravaginally, here's some good evidence. The estradiol levels also jumped from high 100s to 500-something. I looked back as my last number and I was over 3,000, but then there was concern about OHSS.

I feel calm. Initially I was stressed about the one vs. two embryo debate and trying to do everything to be healthy as possible before the transfer. The latter ultimately increased my stress because the scale kept creeping up from bloat no matter I did. Then there was a subtle yet profound shift where I accepted that my actions right now will make little difference and that I will leave the rest up to the universe (and the hospital, technically, at this point). I stopped focusing on everything that went into my mouth and instead started eating for pleasure, including a lot more sushi! I stopped using my Visualizing Pregnancy meditation because I kept getting stuck on whether I was supposed to visualize one or two embryos implanting. I accepted that the medications are doing thier job, the doctors and nurses will do their job, and then everything else is out of our [human] control.

I vaguely remember a similar calmness before my last transfer, and anything that feels similar to the last time adds to my trust in the universe.

It's Just The Hormones

My lining check on Friday was "not where [they'd] like it to be". In fact, it actually seemed slightly thinner then when measured on Tuesday. Regardless, they are increasing the Estrodial dose to four pills (three oral and one transvaginal) and having me return on Monday. My tentative transfer date was cancelled and I am thankful I didn't actual move around any patients yet. Depending the Monday results, we will discuss a new transfer date.

Objectively, I am okay with this. It is just [hopefully], a small delay. No biggie. Emotionally, I am frustrated with my body and this process. I am also concerned with prolonging the estrogen supplementation. The side effects on this round have not been enjoyable. Let's review:

1. The first few days there was the urinary urgency, but this only rarely occurs lately.

2. The bloating is upsetting and not just in my head. I've gained nearly 7 pounds since starting this medication. Last week, one of the employees at the hospital cafeteria asked if I just had a baby (a whole new twist on the "Are you pregnant?" question). I don't have a superb memory, but I can tell you the exact times that people have commented on my body in relation to pregnancy:

• A random time in high school or college while checking out at a craft store by the cashier. 
• Three times during my last pregnancy attempts: My not-boss, a lady at church, and a patient's mother. 
• Numerous times when actually pregnancy. (However, I pride myself in that I gave off a sufficient vibe that my belly was only ever manhandled once, by a cousin who is known for not always being socially appropriate.)
• A hospital cafeteria employee, one week into the estrogen supplementation. 

Remembering these comments all bring back the raw emotions of getting punched in the gut. I'm know my stomach is where my body first holds it weight, but looking pregnant before you are pregnant, when you're trying desperately to become pregnant and it's not an easy feat, adds an extra level of bite that is hard to put into words. 

3. The moodiness. I joked about this the other day, but it is no longer a joke. I no longer feel like myself. My body has been taken over by an irrational, highly sensitive person who tends towards depression and despair. I still can't cry, but I want to often. I've lost motivation at work. I snap at C easily and have little patience with anyone else. I am not pleasant to be around. I don't want to be around me!

I feel like this is different than last time. C and I have spent a lot of time talking about this and he very gently reminds me that I was also very moody and irritable last time, and I do have some evidence in writing to back this up. But this time it's different. If not an actual different flavor of moodiness, which I'm still not counting-out, I know it's different because this time I feel more self-aware. I think last time I may have felt these same emotions but the sense was that the emotions were a part of me. I felt connected to them. 

This time, I know that it's the hormones. Objectively I still feel hopeful, despite my body's uncooperative nature. Objectively I know that I do not have major reasons to feel the way I do. But that doesn't stop the feelings. The emotions have railroaded any rational thoughts and are actively working to suffocate the person that I was two weeks ago. My mind is trying to hold on to that old person, but I am worried it is losing the battle. I don't want to slip back into depression. Depression and I go way back: there are two time periods in my life I only remember shrouded in darkness. I feel like I'm actively fight against this and it's exhausting and I'm not sure how much longer I can do it. It's concerning that this change has happened so quickly and I get overwhelmed thinking that I may have many, many more weeks of this. I believe that if I can hold on to the rational person fighting for a voice that I still have a chance, and so I have been separating out the irrational hormonal person that has possessed my body as much as possible. My current mantra: It's just the hormones, it's just the hormones, it's just the hormones... 

Uncooperative

I woke Monday morning to blood on the toilet paper. Bright red blood, that continued in small doses throughout the day.

Bleeding is not supposed to be a part of taking estrogen. I called the clinic and they asked me to come in Tuesday morning for an extra ultrasound. The one nurse I cannot stand called me back to relay the news that my cycle may or may not be cancelled based on the results. She then added that even though the estrogen is supposed to block the ovaries from creating mature eggs and ovulating, sometimes the body just wants to ovulate anyways.

I couldn't help but laugh at the ridiculousness of this theory. To the best of my knowledge, I have NEVER ovulated on my own without copious amounts of medication. My ovaries have no intention of ever growing any eggs, let alone attempting to ovulate them. It enjoys collecting many tiny little possibility of eggs and then hoarding them like an overcrowded bedroom on TLC (seriously, have you ever seen a PCOS ovary? There's no room to breath in there, let alone grow!).

Then again, the irony of this would also fit with how I conceptualize my reproductive body parts: obstinate and uncooperative. If my uterus and ovaries were people, they would be the disgruntled adolescents who spitefully do the opposite of what they think their parents may want.

On Tuesday I arrived for my bonus ultrasound. My lining looked okay and so did my estrogen level. Okay. As a perfectionist, I can't say I'm thrilled with this result. We are moving forward. As if this never happened and without a clear explanation. My real baseline ultrasound will be on Friday and then a likely transfer date. Assuming that my body can follow directions without any more ruckus.

Dual Relationships

My REs office meets over lunch with all of the doctors and nurses on staff for the day to discuss the morning testing results and medication plans for the day for each of the patients seen. Then the nurses call the patients in the afternoon with the plan.

My last name is not very common. In fact, my husband has a rather large Catholic family and whenever anyone has asked if so-and-so is related to me, I've always just assumed that they are and so far I haven't been wrong.

One of the REs in the practice happens to also specialize in adolescent gynecology and we have shared a few patients. Plus, I completed a learning evaluation on her son in the last year.

When I was waiting for a different doctor to come in to perform my hysteroscopy, while undressed from the waist-down and under a blanket, the nurses were talking and it happened to come up that I work at the hospital as a psychologist. One commented that she knew she recognized my last name and had heard it before from one of the doctors whose child was evaluated by me. She explained that the doctor was talking about me professionally and how helpful I was to her son. She didn't say who the doctor was, but I assumed it was this RE who I've also shared patients with.

This morning I stepped into the packed elevator with this physician. She and I briefly made eye contact and smiled at one another. I rode up to the 11th floor and she got out a few floors ahead of me, quietly saying "take care" on her way out.

This is a challenge of being employed by the hospital that is trying to make me pregnant. My husband likes to joke that my employer has some of his frozen sperm, although I'm not completely sure why he finds this so amusing.

Not one of these interactions was inappropriate or in violation of privacy rights, yet I have mixed feelings on the whole thing. She said "take care" with a specific gentleness that I can only assume means she knows who I am as a fertility patient and not just the psychologist who diagnosed her son. This was nice of her. It also kind of creeped me out.

Click here for more MicroBlog Monday Posts. 

The Many Faces of Estrogen

Five days of estrogen and I've turned looney. It started with one random symptom of "urinary urgency," which I didn't even realize was a real thing until, holy cow it's real! Then mid-way through this week came the emotional roller coaster.

1. Sentimentality. Listening to an old CD track that C made a decade ago when we were first dating. My heart swooned as if I was an early-20-something in new love all over again.

2.  Irritability. The burning desire to shake and scream at the technician who reports to me with her never-ending incompetence. It used to get to me on an irregular basis for the really egregious errors, but this week I can't even look at her face.  I know that she objectively hasn't been any worse then normal, but I do not have the time or patience to micro-manage your every action and hold your hand through every G-D decision!

3. Rage. Don't mess with me. Period. Don't blow me off when you say you're going to do something. Don't promise something and then pretend it didn't happen or feign amnesia. Don't expect me to take on more and more responsibility but fail to give any support, emotional or concrete. You may be my boss, but I am ->this<- close to calling you out on all of this B.S. and that may not be my best career move so please stop tempting me.

4. Random Sadness. I have no precipitating causes for this one. Just the random urge to cry. But I am not the kind of person who cries. Ever. So instead I am left with the tingling feeling behind my eyes with no actual release which is even more upsetting.

Which leads to how my husband is the best man ever. This evening I return from work on my second straight day of the emotional coaster, generally stuck in Phase 4 and disappointed that I couldn't even release the sadness. He listens patiently. Then, when I come downstairs with my pajamas on, I find him sitting in front of the TV with Lion King, cued to the gut-wrenching moment in the gorge.

It was perfect and just what I needed. Something to help me release the sadness. Unfortunately, it didn't work. My eyes welled up but that was all. We look at each other disappointed and then he gets excited and says he has another idea.

He has me close my eyes while he prepares... My Girl, beginning with the scene where they share their first kiss under the willow tree and immediately before the boy returns to the woods to find her mood ring. This movie is guaranteed to shed a tear and it came through: one solid tear. Not fully the release I was hoping for, but enough to move on with my evening. I wonder what tomorrow's estrogen adventure has in store for me.

Microblog Mondays: On Being Adaptable

When evaluating a child for intellectual disabilities, one of the developmental milestones I ask about is the child developing a sense of privacy and personal decency. Whenever I ask this question, memories of babysitting preschoolers make me smile: Little kids streaking through the house with only a towel around their neck as a cap, standing at the top of the stairs naked and calling out my name, or barging in when I am in the bathroom.

Then this developmental milestone all goes out the window when a you undress from the pants down, spread your legs, and allow someone to stick a wand up your vagina and stare at your insides from a computer screen.

I had my baseline ultrasound this week to make sure everything looked okay and my lining wasn't too thick. My clinic doesn't always do this for individuals taking the pill, but I was an exception because even while on the pill I hadn't actually bled for the past four months. Yes, ladies and gentleman, it's true that pregnancy and childbirth doesn't always solve PCOS and menstrual irregularity. Not surprisingly, my lining was "in the gray area" with it being thicker then they would ideally like but not thick enough to actually induce a period. We will proceed as planned.

Prior this lining check, I hadn't dropped trou since giving birth to our daughter 20 months ago. I was struck by how it felt just as awkward as the first time I had a vaginal ultrasound. I didn't expect this because the last time someone was up in my business I had absolutely no sense of decency. Childbirth will do that to you. Especially childbirth that follows over two years of people regularly invading your sense of privacy with ultrasounds, inseminations, retrievals, transfers, more ultrasounds, and then eventually cervical checks.

So it turns out that our sense of privacy and personal decency is a developmental milestone that, once developed, can be foregone for goals that are more important (i.e. pregnancy and healthy childbirth) but then returns back to baseline when the competing goals are gone. We are taught to protect our personal privacy, then forced to learn to tolerate having this repeatedly violated, then return to the deeply entrenched privacy sense that we developed as children. So here I am now, back to the need to desensitize myself to this. I anticipate this won't take long. It fascinates me how quickly we humans adapt to our surrounding and what is required of us.

Why I Am Here

In the past 18 months, I had considered writing on multiple occasions. Multiple barriers stopped me. I primarily used the excuse of lack of time from parenting an infant, working full-time, and then owning a new home. It was difficult to be reflective. But it was more than that. I was conflicted. I had forgotten, or more likely never fully understood, why I started blogging about infertility. So therefore it was difficult to know the future of an infertility blog once motherhood was achieved.

I couldn't put my finger on exactly what was so conflicting until just the other day. Something about Mel's 500th/600th Friday Roundup sparked an epiphany. I'm not sure what it was exactly, but I loved her explanation of how certain blogs stick with her and how she fishes for new gems each week. 

I have found myself returning to read others' blogs more frequently within the past several months. Wanting to catch up on people's lives, people that I have begun to consider distant friends or pen-pals of sorts. Although admittedly I am doing this all without commenting or acknowledging my presence. I'm lurking and I apologize for that. This is what I used to do before I had a blog of my own. Because it feels awkward to comment on someone's post without having a link where they can return to learn more about me if they so choose. Because, to me, lurking seems like the better of two evils then a complete or even semi-stranger making it aware that they know about you. Part of why I started blogging in the first place was to "come out" and join the conversation. 

I realized that other day that I was no longer scouring blogs just to catch-up. I was searching. I am still searching. I am searching for people who understand what I am going through. People who have been there before. People who have survived this. I am searching for answers to unanswered questions about what to do next and what the future might have in store for me. This feels like a direct parallel to how I felt in years past, in the beginning of my journey to motherhood, but surprising because I hadn't expected to be back to this place. 

I have also taken to re-reading my old posts. Over and over. I find comfort in them, even the ones with raw emotion of uncertainty and despair. I have found myself looking back to clarify specific dates, or numbers, or stats that have faded from my memory with time. These numbers were once so important, and then no longer important at all, and now may again be important references. I also find myself wanting to empathize with the person shedding her soul. I have largely forgotten those emotions and reconnecting at this point seems helpful for some reason. As though some of the answers I am searching for are found in my own history. 

***

This blog serves as documentation of my infertility journey. I am not a particularly outspoken person, but this blog serves to share my story, in all of it's raw and unflattering details. I do this for myself, so that I return to remember how far that I have come and never forget the toll of an infertility diagnosis even after the largely overcoming it. I do this for others, so that they might find answers and understanding in my words as I have also searched. I do this to be a part of a conversation that needs to become more vocal, less hidden and shameful. 

***

This is not a parenting blog. A huge source of conflict was how to address my daughter now that she was alive and a very real person. Her anonymity and respect for her privacy is important to me. One day I will teach her about social media and all of its benefits and potential problems. But this if for her to learn and figure out how she is portrayed and what she wants to share. As much as I would love sharing about my joys and challenges of parenting, and I am sure that some of that will inevitably filter in from time to time, I could never figure out a way to do this in its entirety while protecting her privacy without turning the blog to private status. While having a private status blog works for many, this didn't feel right and I couldn't grasp why until just now accepting the purpose of my blog. 

This is not a personal journal. Yes, I will write about non-infertility related topics at times because this can also be cathartic and can put the infertility journey in context, but that is is not the purpose. In general, my life is fairly mundane and primarily positive. I have stressors and daily trials like most, but I don't believe that these stories serve much of a greater purpose. Plus, journaling is always too difficult for me to maintain. 

This is not an infertility advocacy or infertility education blog. I hope that it can serve a small advocacy or educational purpose to some, but that is not the primary reason I write. Honestly, I would love to have to the time to serve in more of an advocate or education role for the infertility community. Maybe someday this will be possible. For now, my time and emotional energy in spent on my family and my work/my patients.

***

Some day, I anticipate that my infertility story will come to an end. At some point we will be finished with our family and I will be content with the outcome. The remaining embryos will no longer be in frozen limbo. At some point, I do believe that this blog will be concluded, but not deleted. It will always serve as a document of one person's journey through this [often silent] diagnosis affecting 1 of 8. It will remain, in the archives on the internet, for myself and my child(ren) and, hopefully, for others to happen on and find solace, comfort, and answers to their own questions. 

I am reminded of the moment of when I suddenly and unequivocally realized and accepted that I was a mother, not when she was first placed in my arms, but a quiet moment of breastfeeding when she was three weeks old. My first post in this blog was nearly 3 years ago, albeit with a 1.5 year hiatus. It is with a great sense of satisfaction and slight amusement that I can finally understand and articulate its purpose. 

I'm Back (Microblog*)

Hello, world. Like Episode VII, I have returned after an unknown lull for a new generation. Only I anticipate that my return will have slightly less hype. In fact, it may be more akin to Land Before Time XIV**.

I digress. An entire post is deserved about why I have returned, which I am still sorting out, but the short answer is that I have redefined the purpose of this blog. And by redefined, I mean that I remembered the purpose of creating this blog in the first place. This is the place where I tell my infertility story. As much as I would have liked my story to be ended, wrapped up in a nice little bow with a beautiful daughter, it continues on.

Please allow me to catch you up over the past year-and-a-half of my life. Since December, 2014:

C was hired as an RN in a bone-marrow transplant unit on the oncology building of the main hospital that competes with my employer. He began almost at the same time as I returned to work full-time from maternity leave, which made for a very chaotic time in retrospect. He loves his job but it can be very stressful.

I have returned and continued to be employed as a psychologist, full-time, after a wonderful 12-week maternity leave that I managed from all of my saved-up vacation. My work life has not gotten any less busy, probably the opposite in fact, but I have successfully gotten much better at maintaining my own work-life balance. I almost always leave the office by 5:30 or 6pm at the latest. I have only gone into the office to work on weekends once or twice since returning. I am more efficient at work. I love my job, but have started to consider if reducing my hours would be financially and professionally viable.

We bought a home last summer that I am absolutely in love with, but is requiring more work then I anticipated. This is probably me having been a naive first-time home buyer, telling myself the house was "move-in ready". Which it was, until it required a new septic system that resulted in the lawn being torn up (luckily, this was discovered before closing and thus largely funded by the previous home-owner). However, I think the biggest issue is that I didn't fully anticipate the amount of work it would take to make this house our home and the amount of time it would require to maintain this amount of square-footage and property. As we approach the one-year anniversary of our closing date, I still feel like we are moving in and getting settled.

We got a puppy. Another Cavalier King Charles Spaniel, although different coloring from Marv. This happened over this past winter, with what seemed like enough time to formally mourn our first puppy. As he was so perfect for us, we were torn for a very long time about getting another just dog just like him but not wanting the constant reminder and comparison. We settled on another Cavalier with different coloring. Fortunately, or unfortunately, Ivan has a very different personality. He is much more brave, more energetic, and not as well behaved. He is wonderful with our daughter and watching the two grow up together has been fantastic, although having a crawling baby and a puppy at the same time has not always been easy.

Our daughter is generally doing wonderful and brings us so much joy. She is not without her own challenges though. She was diagnosed with the same congenital heart condition that my husband has, the condition that was diagnosed after one of his cousins died suddenly from cardiac arrest, and is now followed closely by a cardiologist. She takes medication three times per day and otherwise has no restrictions or limitations. She was also diagnosed with Torticollis and was in physical therapy for about 9 months until this was successfully resolved. At her 18-month check-up she was not yet walking and this was discussed at length, but has since taken her first steps and is slowly becoming more brave with leaving the furniture. Her speech was also a concern with no words at 18 months, but she has great receptive language, social skills, and has picked up sign language very easily. I try, and am mostly successful, at focusing on her forward progress and daily feats instead of wondering and researching about what this may or may not mean for her future development.

We have begun talking about a second child. More then talking, actually, we met with the RE last week and have started scheduling pre-testing and nursing visits. We have 8 embryos frozen, all 5-day blastocysts frozen in pairs of two. There is still a lot of discussion and uncertainty about the future of my fertility and our family. How big do we ultimately want our family to be? How many embryos to thaw and implant this time around? What do we do with the remaining embryos? These are all questions that we have not settled on.

This brings us back to the return of blogging: My continued infertility story.

*After completing this entire post, I realized it's not as micro as I was anticipating. However, considering it's a summary of 1.5 years, I'm satisfied with the brevity. 

** Yes, believe it or not, this series returned in 2016 for a 14th film after a hiatus since 2007. Who knew?! Personally, I think I stopped following after the second film.