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.

A Word About Weight

Living with PCOS, although not realizing this until trying to conceive, I have always straddled the line between "healthy" and "overweight". Always is probably an exaggeration, but I do remember feeling awkward wearing leggings in fifth grade, aware that I did not have the stick-skinny legs other girls had. I remember lying slightly when they recorded my weight on my first driver's license and never seeing that number on the scale again. I would occasionally get as low as ten pounds below the arbitrary cutoff point on the BMI scales, but often being a few pounds above. That number has followed me around for over the past decade, always threatening to call me overweight if I overindulged.

Just to be clear, I was never a crash dieter. Mostly because I didn't have the stamina. I would occasionally follow SouthBeach or Wieght-Watchers, lose 5 pounds or so, and then become complacent. I never gained or loss more than 10 pounds in a year. Until infertility.

I'm not sure if was the medication effects, the fact I was no longer managing my hormones with birth control and now they were running amuck, some emotional over-eating from the stress of it all, or that I wasn't exercising as much because I constantly bloated and uncomfortable. It was probably a combination of all of this. Whatever the culprit, I gained 20 pounds in less then a year. Thirty pounds in two years. Three pant sizes. At times, this felt worse then not being able to ovulate.

I promised myself that if the IVF didn't work, we would take some time off of medications and I would focus on my health. It felt like a consolation prize - if I can't have a baby, then at least I want to fit back into my regular clothes.

So, here I am, twelve weeks pregnant. Almost out of the first trimester. I have weighed myself nearly every morning, as soon as I wake up. I watch the scale like a hawk. According to You: Having a Baby, women who begin overweight should gain 15-25 pounds total over the course of pregnancy, compared with the 25-35 pounds recommended for women beginning in the healthy weight range. Specific recommendations are that only 2 - 4 pounds should be gained in the first trimester, with another 8 - 13 in the second trimester, and 5 - 8 in the third. This is especially important for women with PCOS, because we are already at greater risk for rapid weight gain and gestational diabetes.

I am at just around three pounds so far. I'm on track. And I feel horrible. I think I keep focusing on the number because my body image is so skewed. I don't feel pregnant. I feel fat. When I have gained weight in the past, I've always carried it around middle. My pants get tight and this is a sign that the scale is tipping out of my favor. Now, my belly is expanding and my pants are tightening, and the scale is hardly budging.

I'm at this awkward, in-between stage where I'm not yet comfortable "coming out" as pregnant and wearing empire-waste shirts, but I feel horrible in my current attire. It feels like I'm hiding something, which I am. I keep scorning myself for starting out overweight and then I imagine the ideal pregnant woman as someone who with skinny arms and skinny legs and a little belly sticking out so obviously not a part of the rest of her petite figure. At this point, my protruding belly could easily be mistaken as the overweight rest of me.

Now, I keep fantasizing about how I plan to lose the weight during my maternity leave. I look forward to this all being over and getting back to my regular borderline-healthy body. The ridiculousness of this is not lost on me. Here, I spent years and most of our life savings on this goal, and now, not even a third of the way done, I'm looking forward to it being over.

Two week crazy... a recap

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

My body is not helping matters.

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

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

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

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

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

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

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

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

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

Needle Phobia

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

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

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

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

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

Shopping is the pits

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

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

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

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

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

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

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

Spiraling Downward

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

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

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

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

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

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. 

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.