Dang, that hurts

Did nothing but work, walk, and bathe the pupper yesterday (that's her looking sparkly and smelling clean at breakfast today). No trips to the clinic. I planned to work in the evening, but the late-afternoon headache I'd successfully ignored blossomed over dinner. It turned screaming on me and made me wish I hadn't eaten.

As a rule I don't get many headaches, but when I do they pretty clearly come from stress/eye-strain or hormonal shifts. This one was definitely hormonal. I've been getting the same one every few cycles during ovulation time for about a year. I may be wrong, but I've been assuming I get them during a big ol' estrogen surge as my tired ol' reproductive system struggles to spit out an egg. Obviously I'm not ovulating now, but we know the cyst is producing estrogen. This headache doesn't respond to Tylenol (I think aspirin performs slightly better, but I'm not supposed to take that right now), and it doesn't like noise or light or air. Sometimes a hit of cranberry juice will dull it. Probably any fruit juice would do, but we usually have just V8 or plain tomato juice open with cranberry on hand in case of emergency need for cosmos.

Anyway, the cranberry trick did nothing, nor did a why-not shot of pomegranate juice — also a good mixer. (Just btw, no, I'm not imbibing at all while we're cycling.) So I shut down my computer and took to the bed with my fertility meditation CD. That last part was DH's idea. I was so focused on how those few hours of not working might affect my ability to meet my next deadline that he predicted that lying down with nothing but my regular thoughts might not be the best medicine.

He was right, but I'm still not digging the exercises on this CD. I bought two CDs. One specifically for general fertility and one geared toward taking you through the steps of an IVF cycle, from injections to pregnancy test. I haven't done the second one yet because I haven't started the injects. So I'm just using the first one. While I do benefit from concentrating on better breathing, I don't like what I perceive to be a negative approach to getting me to feel better. The narrative basically tells you that you are infertile because your thoughts make you so. You are blocking the soul of the new life trying to enter your clenched-up womb each month. Your sadness/anger/frustration/stress is the only thing responsible for your infertility. That you are infertile is your fault.

Ouch.

Now, the second part of the exercise tells you to stop everything that you're doing to sabotage your fertility. Yet it's not all that soothing and reassuring. Not to me, anyway. If I were creating an exercise, I'd want the listener to dispense with the negative thoughts. And naturally she would have to acknowledge them. But I wouldn't spend the bulk of the time focusing so closely on them only to then vaguely mention switching over to the positive frame. I would spend most of the time guiding the listener to think happy, calming, positive thoughts. We'll see how the IVF exercises are structured. I may just revert to taking a bit of time each day to do some deep breathing while listening to soothing, uplifting music.

The headache is gone today, thank goodness. But now the cyst-area hurts. I'm feeling sharp, stabby pains when I bend or twist at the waist. And it is sore when I press on it. I hope, hope, hope it's not growing. Here's hoping that it hurts because it is shrinking or has ruptured/self-aspirated. I think that's a good thing to hope for, but I don't have time to research all things Ovarian Cyst today. If that's the wrong thing, God and/or Universe and/or Mother Earth and/or My Fertile Soul, please convert my wish to its correct form. Thank you.

I'll know what's up with it tomorrow.

Note to cyst: You're going down

Today's happenings:

My RE put me back on BCPs this afternoon. I gobbled up a pill as soon as the nurse called with the news. She had told me yesterday that an E2 of more than 50 might delay the cycle. My E2 was 34.2. If you're like me, you may be thinking, "Dude, 34.2 is less than 50." But the RE decided to be conservative, calling my number borderline, and I have to appreciate that. Chances are good that the cyst will shrink on its own, and I'd rather start from that point in a few days than to begin injections now and have the cyst grow and interfere later on. I go back Friday for a repeat suppression check.

I had an acupuncture appointment this morning. I think I fell asleep, but I'm not entirely sure. I do know that when the acupuncturist checked on me at the halfway point I was surprised to learn that, no, it was the lights-on-and-go-home point.

DH took the heavy-duty antibiotic Zithromax last night. Four pills all at once to knock any infection-threatening bacteria right on out of his system. For side effects he reported "waves of something going on" overnight and a quite-possibly-related "flat feeling" during the day.

Suppression check, mock transfer, pay(them)day

During today's suppression check, they found a 23–24 mm cyst on my right ovary. Small enough that we think things will move forward on roughly the same schedule. But big enough that the nurse couldn't get a clear AFC on that side. Had blood drawn to see how much estrogen the thing is churning out. Will know tomorrow and get further instructions on the meds from there.

They also did a mock transfer today (that went beautifully) and showed me the catheter type they use to do the real transfer.

And, I paid the main cycle charges. An ouchie total of about $13K. That's on top of last week's meds bill for just under $4K.

Remember how I thought "Take the Money and Run" might be a sign from the Eagles? That happened the day I originally thought we had to pay up. But I had the date wrong. So, technically, that sign couldn't have applied. I wasn't looking for a sign today, not even thinking about it, but when I pulled into the lot this morning I did get one. The tune that DH tells people is "ours" (but it's not) came on (that would be "Dude Looks Like a Lady"). It made me laugh out loud and reminded me that DH was with me in spirit today.

Dreamweaving

Today's a big day. I have my suppression check to make sure I'm on track to start injections. My waking self doesn't feel nervous, but I had violent dreams last night. As in, I was being violent toward a former business associate. Who, of course, never did anything in real life to justify the kicking and stabbing s/he was getting from me in my dream. Scary!

You know, after my first acupuncture treatment last week, I had an exceptionally vivid story dream. It was easy for me to draw a connection between a thought trigger during the treatment to why my dream featured certain characters. Then last night I used my IVF meditation CD for the first time. There's one exercise that tells you to consider negative things you think/have thought about your fertility. Pretty easy, right? But then the voice goes ahead and lists a dozen or more nasty thoughts/terms of its own. In case you need any help. I didn't like that the generation of negativity wasn't left up to me. Hearing "the voice's" list was jarring (I'm not quite as harsh with the IF name-calling as the voice) and also ended up reminding me of entirely different negative life events because the terms didn't seem to apply to IF. At least not in my mind. "Hmmm, I guess I should add barren and empty and imcompetent and stupid to the list of things to call myself tonight. What a helpful, relaxing exercise."

Back to the dream part: I decided that the poor, innocent dream colleague (someone I can't even claim to "know") simply represented Work to me. Whether I was deep-down thinking about how it's tough to balance cycle demands with work schedules . . . or that I was guilty of having focused on work for too many years before TTC . . . or that I just really hated one of my jobs and wanted to hurt it . . . who knows?

The funny thing is, that both acts of dream violence — kicking and stabbing — are in fact the two violent acts I've committed. Ever. In Grade 4, I kicked a boy after warning him that if he called me Bucky one more time I'd have no choice but to kick him square in the shin. He thought I was bluffing. My word was good, though. So I let him have it. It really, really hurt (bad bruise, too), and I really, really, really regretted it. The boy and I were actually on very good terms otherwise. He forgave me (I was sick over it) and refrained from calling me Bucky again until we were all grown up.

On the stabbing incident: When I was 5, I shared a room with my sister. I noticed a pin in our shag carpeting and picked it up just as sis bent down to pick up something else (likely something I wasn't supposed to be breathing on). All I remember is that I was feeling VERY hurt and wronged and helpless about something or other . . . and that the patch of gleaming white bare skin between sis's pants and top — which presented itself right in front of my eyes and within my reach — was too big of a temptation to pass up. So, without much thought at all, I stuck that pin right into her backside.* I didn't feel a thing until she screamed. I've never quite gotten over that one, either. She didn't tell on me, btw, so she must have agreed that she'd had it coming. :)

*DH knows the story and gamely pointed out during the injection class that I'd already had some experience with IM shots!

Nought venture, nought have

That was today's featured thought in my day planner. Playwright John Heywood said it back in the 16th century. That was waaaaayyyy before my dad told me in the 20th century, "You don't ask, you don't get." Either way, the sentiment couldn't be truer.

Told my mommy

I called my mom to let her know about the IVF cycle. So, that makes only two other people (my parents) in the family who know what we're doing. I'm thinking that's enough for now.

Saturday haircut and other feats of the mundane

All in all, this has been a pretty good Saturday. Of course I worked all day on each of the previous ones, so this particular Saturday didn't have to try very hard to impress me.

Before leaving for my haircut this morning (my first since well before my October myomectomy — I seriously needed to be shorn!), I studied my IVF cycle calendar, counting and re-counting my upcoming appointments while calculating the damage to next week's work schedule, and I just tried to breathe.

DH sat down with me, and I said, "I'm feeling all nervous this morning."

"About your haircut?" he asked, somewhat surprised.

"Yeah, about my haircut."

"Oh. About other stuff," he said. Then he did the right thing by asking me a bunch of questions about a bunch of things. Such a good boy.

I got an inch and a half (of hair) taken off, and it feels really good. My hairstylist asked whether I'd had "surgery or anything" recently. I didn't even know I needed surgery at my last haircut! She said that my hair felt different and that it was hard to work with. Which makes sense, really, as it takes a while for the anesthetics to work their way out of your system. I remember being told in the 80s to expect a bad perm after surgery for just that reason. The hairstylist told me to take prenatal vitamins for the hair sitch. Ha!

From the salon I went Starbucks for a breather before . . . nothing, really. I ordered a Superfood juice since I'm off the java juice for now.

The very few other things I did today:

Stopped by the library to see if they had anything I could use for this week's work (yes, but it was all checked out); dropped by the bookstore to see if I felt like buying any books (no, and that never happens); paid off the credit cards online so all limits are available to handle Monday's main cycle charges (I see no reason not to rack up some airline miles for our trouble); put new bars of both Ivory and Irish Spring soaps in the shower; sat on my duff while DH changed the sheets, ran out for milk, made brownies, watched golf, walked the dog, and started doing whatever he's been doing for the last couple of hours in another part of the house; and wrote this post.

Time to get up and make dinner. Not sure what it will be, but at least I know we can have brownies later.

"I think that box is pregnant"

The FedEx guy brought my special combo of IVF-cycle drugs yesterday. I put down the box to look for some scissors, and my pup had the funniest reaction. She walked straight over to it and plopped into a sphinx pose, leaning into the box a little. She protected it. Couldn't have gotten any closer to it. So sweet.

I tried to get a picture, but as soon as she saw the flashy thing she eschewed her duties as pregnant box guardian to go into her treat "sit." It's nice to have that persistent sense of hopefulness in the house:



First look inside the package:



Pup says, "Good idea. You count, I'll sniff":



"THIS little container is built to hold a month's worth of biohazardous waste? That doesn't seem possible. I'm just sayin' ":

Someone moved my Qi

Had my first-ever acupuncture session yesterday. I was there for 2 hours, so with the drive time I was away from my desk for almost 3. I've resigned myself to working odd hours through all of this, so I just made up for lost time by working until 7:00 p.m.

The acupuncturist works with my RE's clinic, and the course of treatment I'm doing with her is designed to address my fertility issues and complement my IVF protocol. She began with a thorough interview (she already had an impressive knowledge of my medical history, and she dug for a bit more dirt that Western practitioners just don't ask about), explained everything she wanted to address and how she'd do it, and then she needled me. She subscribes to a balance of TCM and traditional Western medicine philosophies. Interesting stuff.

Work is calling, so I'll post again later with a few details about the needles, ETC.

IVF meds on the way

I confirmed the IVF medications order with the pharmacy yesterday. Waiting to see if my credit card company will balk. They did last fall when I ordered a new iMac, and the amount for this unusual single purchase is twice that one. Shiny tech items and powerful pharmaceuticals — what more does a girl need?

Things are starting to move. New pack of BCPs today, injection training tomorrow, injectable meds show up Thursday, suppression check next Monday, and then it's time to (really) pay up, shoot up, and "man up."

The adoption question

I received an incredible question about a line from yesterday's post, in which I mentioned worrying about overpopulation . . . when I was 12. Someone asked why I am undergoing fertility treatments instead of adopting, when clearly there are children out there needing homes.

Hmmm, how to answer. You know, we may adopt. There are children in need of families. And I have not one doubt that we would love any child we were lucky enough to bring into our home. It's a very real option for us. I'm sure it is hard for some who haven't experienced IF to imagine why we don't just "move on."

But I have to be honest here. We want to conceive, just as you wanted to conceive when you decided to start your family. The desire to have a biological child is there, and we feel that we have every right to pursue that to its conclusion. The difference between us and other couples is that we are unable to conceive on our own — for documented medical reasons. Health care has evolved to include fertility treatments for the medical conditions that cause infertility in the same way that, say, it has evolved to offer cochlear implants to treat some forms of severe hearing loss. In both cases, patients hope the treatments give them the opportunity to enjoy basic human functions. Functions that most people take for granted.

I'll also add that adoption is time consuming, emotionally draining, expensive, and not always successful. It's of course worth all of that when the end result is positive. DH and I, however, are only equipped to concentrate on one plan at a time. For a long time we concentrated on TTC naturally and keeping on top of my known uterine problems. Right now we are concentrating on trying IVF while I am still young enough to hope for success. What comes next, we won't know till we get there.

Regarding my comment about overpopulation: I really did feel strongly about that as a child. And I can't say that I disagree with my younger self now. But what I didn't have then was life experience enough to understand the complex nature of the human body and its hardwired (in some cases) desire to contribute to the cycle of life. As a grown-up, I have an entirely different take on what I want and why I want it. And, I respect family size and family-building methods as matters of personal choice. Not to mention the fact that some of the happiest, coolest, and most productive families I know are big ones — I want for others what makes them happy.

Here's a good tidbit about infertility and population control from the RESOLVE site — I thought it applied quite nicely:

Myth: Infertility is nature's way of controlling population.

Fact: Zero population growth is a goal pursued in a time of world overpopulation, but it still allows for couples to replace themselves with two children. Individuals or couples can certainly elect the option to be child-free or to raise a single child. Infertility, for those who desire children, denies them the opportunity to choose.

RIP, Suzanne Pleshette

This probably seems like a weird basis for an infertility blog post. You will just have to bear with me.

I saw news of Suzanne Pleshette's death this morning and it made me think about all the images of life, love, and the family unit I grew up seeing on TV — and how I looked forward to living Mary Richards' single career-gal life followed by, after a suitable number of serious romantic entanglements (5), life as part of a solid, loving, respectful, fun partnership, in which we both had careers we cared about and didn't fall prey to any pressures to marry young or start a family right away (if we did that at all). The characters Bob and Emily Hartley of The Bob Newhart Show had the marriage/lifestyle I wanted. And guess what? It's basically what I got.

I was only 12 when that show went off the air, so I was watching it from around age 6 on. I won't say that I consciously thought about the characters as role models. I simply loved the funny show and thought, "Yeah, neat life." At the same time I did actively work on planning my future. I do the same thing now but with the full knowledge and intellectual acceptance that some plans work and some plans don't.

Mindset changes that I am grateful to have experienced over lo these many years since I was 12 include the understanding that I really can't control most things and — probably the most important life lesson I've ever learned (and this was extraordinarily tough for me) — that it is okay to chart a path and then change your course later. For example, you can decide that you don't want something you fought hard to get. It doesn't mean that you have failed by being "wrong" about what you wanted. Same goes for deciding that you DO want something you previously believed you didn't. It's not that you were wrong or stupid for not pursuing it under more ideal circumstances. It's just what is.

Now, those mindset changes evolved during my early 20s (the biggest evolution) and early 30s (the years in which I needed a serious reminder about what I'd previously learned to really "get it") as I worked out relationship, educational, and career choices. TTC was not on my radar then. I've always loved kids, though, and as a child I felt sure that I'd have them. At 12 I used to say that I'd have maybe one bio child (I think I assumed I wouldn't be able to prevent it, what with everyone always acting so freakin' surprised by pregnancy news) and then definitely adopt so as not to selfishly add to the world's overpopulation problem. Then at around age 18–19, I purposely pushed any thoughts of having any children out of my mind. (That was all about my being very serious about following plans I thought were right for me. Too much story to deal with here.) In any case, I always thought I had plenty of time to revisit TTC and that I would when the time was right. No worries about ticking clocks whatsoever.

The whole issue got backburnered so thoroughly that it shocked me (DH too, to be sure) when it came bubbling back up to my surface at age 35. I don't know how the urge to reproduce comes up for others. But for me it was a distant "maybe/probably someday" one minute, and a full-on biological need the next. I woke up to it and have not questioned it since. And, wow, 7 fast years, TTC-delaying events like cross-country moves/job changes/major surgeries, 4 years of TTC failures, and 2 REs later, here we are. The Hartleys for the 00s?

I see that the divine Suzanne Pleshette was 70 and so about my current age when The Bob Newhart Show ended. I love that the series send-off didn't include the typical surprise-baby-on-the-way moment. And although I want more than anything for the next season of our real life to start with a sappy, happy baby cliche . . . I take comfort in a deep-down feeling that we will eventually be okay if it doesn't.

Prince spoke to me through my iPod

Yesterday while driving to the fertility clinic, the classical music I was listening to got on my nerves. So I punched some buttons to find something to psyche me up. I found some Blondie, and that suited. Upbeat, tough, determined. One way or another, I'm gonna getcha, I'll getcha, I'll getcha getcha getcha.

I thought, "If I believed in signs, I could persuade myself into thinking that was a good one." Then, as I pulled into my parking spot, the Eagles' "Take the Money and Run" came on. Dang, dang, dang! What if I DO believe in stupid signs?"

Several hours later I grabbed the dog for a quick walk. I thought of the songs again and decided I'd spin the iPod wheel to see if a random selection from my own mix would give me a BETTER sign to use for judging the day's events (and the rest of the IVF biz to come). It landed on Prince's "Cream." Better already. And he was clearly talking right to me with this:

Do your dance,
Why should U wait any longer?
Take a chance
It could only make U stronger

It totally works when you don't take the classically filthy chorus so literally.

IVF consent appointment

Had our IVF consent appointment yesterday. The purpose was to go over the finalized cycle plan and hand over the paperwork in which we consented to the treatments, verified our understanding of the risks and that there are no guarantees, and initialed 5,000 decisions about what happens to any leftover embryos under all manner of life circumstances. (For example, I get them in the divorce. Research gets them if we don't use them within 5 years. I got a laugh from DH about donating them "over my dead body" in the event of our untimely double death. And we chuckled about the option to name a recipient w/mailing address . . . DH played the role of a niece shaking a package delivered to her dorm room in 2013 — and we knew we'd have to include a "greetings from the beyond" audio.)

The appointment got off to a shaky start when a nurse called my name, DH followed me following her, and she said, "You're here for a physical, right?" Wrong. She wanted me to get undressed anyway. No. She checked with the RE, who immediately fetched us. Her records agreed with our reason for being there, but even she was confused because she hadn't seen the notes saying we'd completed everything we'd needed to on our checklist (a requirement for the consent visit). So, that conversation began with her thinking that we were still deciding whether to even do IVF and must be there to talk it through. Got it straightened out to everyone's satisfaction, but it didn't leave us wowed by the clinic's communication system. It is much better than it was at our previous clinic, though.

I have to laugh that I went through the whole process of familiarizing myself (and getting comfortable) with the lower-quantity transfer info. Based on our specifics, the RE thinks the best way to maximize the cycle will be to put back 3 or 4 embryos. None of that single-tx crap for us. Unless that's all we have to work with.

What else . . . I'm doing the aggressive microdose Lupron flare protocol. We'll do Assisted Hatching but not PGD. And it will be ICSI all the way. DH asked the RE to dispel his feelings that doing 100% ICSI subverts Darwinism. She did that and satisfied further questions about determining egg & embryo quality, DNA fragmentation (who knew there were big, beautiful coffee-table books full of egg, sperm, and embryo photos?), and selecting that single sperm to inject.

Near the end, the RE said, "You don't seem all that thrilled with the plan." DH had a different interpretation of what she meant in that moment (but couldn't recall it later as we debriefed!), but I thought she was saying we seemed unhappy with the plan or that we weren't jubilant enough. I didn't take offense with that interp, but I did say, "Oh, we're fine and ready to go. We just wanted to get a more thorough take on how some of the decisions and recommendations will be made along the way. But, no, I wouldn't attach the word 'thrilling' to any part of this stage." She said, "Yeah, I'm sure you wish you didn't have to be here at all." True in a larger sense, but neither of us are living with that feeling day-to-day anymore. That one is so 2005!

No way can I pretend to be all rah-rah-sis-boom-bah. As DH said, maybe we'd have more of that "Go team!" spirit if we had insurance coverage guaranteeing us several tries. But, we are positive about rolling the dice with this step. Otherwise we wouldn't be where we are in the process. I think our mood is good and our expectations realistic. We hope for success, very much want it, and will do whatever we can within the cycle to help things go well.

I love the java jive, and it loves me

Last night I did some crowing about how easy I found it to step off caffeine. I've been drinking 1/3-caf coffee at home for years now and can usually cut all the way back fairly quickly. Naturally I fell off that particular wagon first thing this morning. My third steaming mug of full-caf Starbucks Winter Blend (leftover from Christmas) is pepping me up right now.

I stayed up working until midnight last night because I need to get ahead a little so that I don't fall behind with all the IVF-related appointments 'n' junk. Actually, I am behind, despite best efforts, but I should catch up by Friday. I meant to start at the crack of dawn today, but I did that yesterday and it turns out that burning the candle at both ends is one activity that confirms for me that I am not as young as I used to be.

So, I ignored DH's 5:15 alarm and got up at my regular time (6:30). I felt tired enough that I didn't think I could manage grinding fresh beans (which takes, what, half a minute?), and so I answered the siren call of the conveniently-ground Winter Blend. I am weak. But boy do I ever feel strong right now!

My goal is to be completely decaf by next Thursday when I start taking Lupron. Trying that yesterday was ill-conceived considering my work schedule this week. I also want to stay away from even decaf coffee as the cycle progresses. Who needs the chemicals. I am so conditioned to the comfort coffee brings me, though, that I might consider brewing a mug's worth each morning just to smell and see and fondle it.

And on that creepy note, I will sign off the blog until Friday.

Single-blastocyst transfer catching on for older chicks

My clinic prefers to do IVFs with single-blast transfers. I was a bit stunned to hear it because my anecdotal information from the discussion forums I frequent told me that women in their 40s often have up to 3 embryos or blastocysts put back in. Sometimes more than that, but that is not considered so cool these days.

For a long time the medical community has been recommending the higher quantity on the premise that, well, 40-somethings are more likely to get a sticky pregnancy that way. We are. But we are also more likely to get pregnant with multiples. Simple math, really.

(I do not subscribe to the romance of wishing for twins. My uterus has been compromised enough that the risks of trying to carry multiples seem clear to me. Then there are the obvious risks to the babies. Would I say no to twins? Why would I? But I have to agree that it is safer and more reasonable to actively try to get just 1 at a time.)

Now studies are showing that we may have just as decent a chance with a single transfer. It's all about the quality, of course. But if you transfer 1 good-quality blast, pregnancy chances are looking just as good as if you transfer 2 or 3.

My first RE said that he would recommend 3. That matched the info I'd seen so far and so I didn't press for his reasoning at that time. He may very well have been assuming that my egg/embryo/blast quality would be bad and so didn't even discuss the other option with me. So I don't know his opinion on the 1-blast tx for his patients overall. He was definitely a worst-case scenario guy. And I did appreciate that in many ways.

When my current RE first mentioned (because I asked) that she'd want to transfer 1 of whatever we got, my position was, "Oh, how can this be? We can't possibly drain our savings on the assumption that this has no chance. This is all-or-nothing. How could we bank on just 1 measly blob of our cells? At least with 3 perhaps 1 might be of sufficient quality to make it OR we'd come out of this experience with enough info to tell us, conclusively, that nothing will stick, not even 3 top-shelf cell blobs nurtured and manipulated by the best reproductive scientists we can afford."

The RE assured me that the final recommendation would be made based on the actual quality of whatever we're working with. It's just that their preference is — and success rates are backing it up — to transfer 1 nice-looking blast at 5 days. If the embryos at 3 days aren't looking hip to surviving in the dish much longer, then whatever is viable will go back in then. Success can and does and doesn't happen under both scenarios.

My feeling is that I have to trust my clinic to do what they do best. That's what their success rates are based upon and where they came up with a prediction for our odds. And we just can't know what we're dealing with ahead of time.

For your reading pleasure:

"IVF Technique Enables Pregnancy Without Multiple Births, Stanford Researchers Find"

"2-for-1 Is No Baby Bargain, Doctors Say"

"What did you know, and when did you know it?"

I chatted on the phone tonight with someone who would absolutely like to know that DH and I are trying IVF. She loves us and would want to offer good thoughts and support. But I didn't say a word about it.

She called to get my advice on vapor barriers (true story). I didn't have any, though (also true). We talked for a bit and were just about to hang up, having not discussed me at all (yes!), when she stopped and tossed out a breezy "Anything going on that I should know about?"

"No," I said, my mouth snapping shut to both create and wait out the ensuing awkward silence. I finally uttered a slightly weird follow-up "Nope" and made plans to talk again soon.

I felt guilty for a bit for not taking the opportunity to introduce the topic. Yet for whatever reason, I didn't feel comfortable in that moment. And I have to be able to share or not share as I please, right?

There, I have absolved myself. Good!

Starting to get started

I'm in a busy work cycle, which helps keep my mind off the pending IVF. To a small degree. (Note that I logged on today to do some actual work.) We are still in waiting mode, sort of. Waiting for the real ART business to start. That makes me anxious, because I like to be in doing mode. No doubt, though, I'll become a basket case when the doing gets under way.

Two appointments this week, injection training next week, and then I'll be off and running with the serious meds. BCPs, which I'm currently on, are for babies. Ha! I meant "babies," as in neophytes or wimps, obviously (to me). That sentence just struck me as funny since under normal circumstances BCPs are for no babies.

Tomorrow is DH's SA update. This will be his third one, and I hate it for him. You know what an SA is, right? It's a semen analysis. He gives them a sample, and they evaluate its quality, looking at criteria such as count, motility, morphology, volume, progression, viscosity, pH, and WBC. Have even one SA done, and you'll be tossing around those terms and what the measurements mean in no time. Especially when the dx is one of severe MFI. You will also learn that there is much disagreement about what constitutes a good or bad result, that nobody really knows what to do to improve a bad result, and that science has come through in a big way with the funding and development of ART therapies that make a bad result a non-issue (as long as you pursue said ART therapies). I certainly applaud that the research has been done and that solutions exist. Don't get me wrong. It's just that I can't help pointing out that no similar line can be drawn from female-specific IF factors to equally successful ART therapies.

The clinic could not accommodate an early morning or end-of-day appointment for DH, so it will be a nooner.

Is that too crass for a blog? Look, I have to entertain myself. I don't plan to write about every single bit of personal biz that goes into the whole circus. (Well, maybe I will in some form, but it won't always be explicitly related to my personal biz.) But you can't give an honest accounting of the fertility-treatment experience without acknowledging the extreme personal nature of what it means to seek medical intervention in order to have a child.

As a couple, we've paid our dues trying naturally and done all the main fertility tests (some of them multiple times), and yet I also want to point out that we haven't even scratched the surface of the full range of testing available. Tests we haven't done haven't been indicated, so for that I am grateful. Unless they should have been indicated and we are wasting our time.

Acronym update

I just updated the list of ART acronyms and abbreviations. Soon I'll create a list of relevant definitions (not today!), too, and link to both in the sidebar. Creating a little order and value for the blog — besides the obvious value as an outlet for me — is a good task as I try to keep myself on an even keel.

One step at a time

I read this NYT essay the other day. I was glad to see it. The author is moving on to adoption. We may do that down the road.

Last year at just this time, I was ready to go for it. It seemed the only option to me. (And it is a fantastic option, but I will not apologize for continuing to ttc while I reasonably can. I've found that I can't move on to that step until I've done all I possibly can to satisfy my brain that conceiving with DH absolutely won't work.) But then we took a break from all of it. I was deep into a cycle of grief and needed to let that play out. When it did, we decided to consult with a new RE.

Should we have done that right away? No real answer. We can only deal with what we can deal with on any given day. I felt battered by years of failure (50-some active cycles in a row, with another 20 or so at least where no preventative measures were taken). I'd let the first RE's attitude cut me off at the knees. DH was gone a lot, traveling for work. Things didn't seem right. Naturally, though, it's hard not to look back and think that had we gone straight to our current RE, maybe we could have cycled soon after. My FSH was much better back then, as was my AFC. And the fibroids I had removed last fall weren't even showing up on u/s then. It's easy to dream that my chances would have been better then than they are now.

But, there is no way to judge that. This RE suspects that the fibroids were in fact growing then but just hadn't taken hold enough to show up. They were firmly rooted across a long stretch of muscle outside the uterus (she took that too) and probably stretched out that way before popping up and poking into the uterus. I tell myself that it is better to cycle now with my sparkly new uterus, which my RE called "beautiful" last time I saw her. Oh, and of course it is better to cycle while DH is living here full-time instead of traipsing back and forth across the country for months on end.

Back to the article I linked to: I love seeing the adoption ending because I get so sick of every story about fertility struggles ending in a birth story. I know that's what people want to read. But we don't all meet a fairytale prince (didn't need or want one of those anyway), we don't all strike it rich by "doing what we love," and we Infertiles do not all eventually end up with a take-home bio baby. I just like the reality of it. Nobody ever talks about Infertiles who adopt and DON'T suddenly find themselves miraculously pregnant. Nor do they talk about those who end up deciding to live child free.

It don't come easy

Sleeplessness

I've been having trouble sleeping since January 1. That's when I started the BCPs to quiet my ovaries. Not entirely convinced that they needed that extra help before starting the more powerful drugs, but that's the protocol my RE uses. I worry that — like so many IVFers I've followed online — I will respond better to a different protocol. Clinics have to start with the procedure they feel is best for most and then tweak from there. I get that. There is no telling how I'll respond until we try it.

But thinking about the astronomical costs, both financial and emotional, makes me ill even on the premise that every part of the cycle plays out perfectly. The meds cocktail might be exactly what I need. I might produce a fair number of eggs (*cough,* for my age). Maybe some of them will fertilize properly — 2, 3? — and turn into viable embryos or blasts that can be put back into my uterus. If there are more than 2 survivors, perhaps there will be 1 or more to freeze for a later FET . . .

Notice how I don't carry that through to a positive outcome? I can't take myself there. That kind of hope is too painful for me. Over the years I've trained myself to tamp down my hopes, to stay as neutral as possible.

So, if I respond well to the protocol, we will have a complete IVF cycle. If I respond poorly early on, we can stop and convert to IUI (a procedure nobody recommends we try under other circumstances). If I respond poorly in an ambiguous might-be-okay-but can't-tell-yet way and we make it to retrieval and transfer, AND the poor response leads to a poor result, well, we are SOL. (Not in my acronym list, but you know that one.) We're also out of tries.

Should I hope for an early indication that the meds won't work? A small part of me does, because I almost never see 40-somethings succeed on the first IVF try. Meds, procedures, approaches get adjusted after that "dry run" cycle.

It don't come easy, Ringo. Sleep, I mean.

ART acronyms and abbreviations

A
Acu acupuncture
AF “Aunt Flo” / menstrual cycle
AFC antral follicle count
AH assisted hatching
AI artificial insemination
AMA advanced maternal age, American Medical Association
AO anovulation, anovulatory
ART assisted reproductive technology
ASA antisperm antibodies
AWOL a woman on Lupron

B
BBT basal body temperature
BBs breasts
BCP birth control pills
BD baby dance (get it?)
BFN big fat negative (pregnancy test)
BFP big fat positive (pregnancy test)
Blast blastocyst
BMI body mass index
B/W bloodwork

C
CBE Clear-Blue Easy (hpt brand)
CD cycle day
CM cervical mucus
CP cervical position

D
D&C dilation & curettage
DC dear child
DD dear daughter
DE donor egg
Dembie donor embryo
DH dear husband
DI donor insemination
DOR diminished ovarian reserve
DP dear partner
DPO days past ovulation
DPT days past transfer
DS donor sperm, dear son
DTD do (or did) the deed (get that one too?)
Dx diagnosis

E
E2 estradiol
EDD estimated due date
Embie embryo
EPO evening primrose oil
EPT Early Pregnancy Test (hpt brand)
ER egg retrieval, emergency room
ET embryo transfer
EWCM eggwhite cervical mucus

F
FB Fertility Blend (proprietary vitamin-herbal blend)
FET frozen embryo transfer
FK furkid (pet)
FM fertility monitor
FMU first morning urine
FP follicular phase
FRER First Response Early Results (hpt)
FSH follicle stimulating hormone

G
GIFT gamete intrafallopian transfer
GnRH gonadotropin releasing hormone

H
HCG human chorionic gonadotropin
HPT home pregnancy test
HSG hysterosalpingogram
Hx history

I
IC Internet cheapie (generic hpt)
ICSI intracytoplasmic sperm injection
IF infertility
IM intramuscular
IUI intrauterine insemination
IVF in vitro fertilization
IVIg intravenous immunoglobulin

L
Lap laparoscopy
LH luteinizing hormone
LMP last menstrual period (start date)
LP luteal phase
LPD luteal phase defect

M
MF male factor
MFI male factor infertility
Morph morphology (sperm shape)

N
NICU neonatal intensive care unit
NK natural killer cells
NMW nurse midwife
NP nurse practitioner, naturopath

O
O ovulation
OB/GYN obstetrician/gynecologist
OPK ovulation predictor kit
OR ovarian reserve, operating room
OTC over the counter
OHSS ovarian hyperstimulation syndrome

P
PCOS polycystic ovary syndrome
PCP primary care physician
PCT post-coital test
Peri perineonatologist
PG Pregnant
PGD preimplantation genetic diagnosis
PID pelvic inflammatory disease
PIO progesterone in oil (injection)
PMS premenstrual syndrome
PNV prenatal vitamin
POAS pee on a stick (the stick = an hpt)
POF premature ovarian failure
Preemie baby born prematurely
PUPO Pregnant Until Proven Otherwise

R
RE reproductive endocrinologist
RN registered nurse
Rx prescription

S
SA semen analysis
SHG sonohysterogram
SMEP sperm meets egg plan
SO significant other
SQ subcutaneous
STD sexually transmitted disease
Stims ovulation stimulation drugs

T
TCM traditional Chinese medicine
TCOYF Taking Care of Your Fertility (popular book)
TL tubal ligation
TMI too much information
TR tubal reversal / tubal ligation reversal
TTC trying to conceive
TWW, 2ww two-week wait (between O and time to test for pregnancy)
Tx treatment

U
U/S Ultrasound

V
VR vasectomy reversal

W
WBC white blood cell

Z
ZIFT zygote intrafallopian transfer

Come on in

Guess I'm going to do this. Blog about my infertility, that is. I've avoided it for a few years now, thinking that adding my thoughts to the blogosphere would somehow put a hex on whichever of the 50+-but-who's-really-counting cycles that might have ended in success.

But now, as I'm primed for what might truly be the end of the road, one way or the other, I'm pretty sure I can't get through the next several weeks without expressing myself. In writing. Because that's how I do my best thinking.

I'd use my MacJournal (well, I will use my MacJournal for stuff I don't want to say here), but I feel a strange responsibility to post to the www on the off chance that doing so might help distract a fellow Infertile for a moment or two.

So, welcome to the blog. I'm starting an IVF cycle rightnow, and I plan to blow off a little steam here writing — candidly and honestly — about my struggle with infertility. I'll also link to resources I've found interesting and/or helpful along the way and pretty much lay bare my fears and frustrations with the IVF process (I am an ART newbie, btw) as they unfold.

About me:

• 42
• happily married
• history of uterine problems
• off BCP since late 2003
• seeking big-gun IF care since 2005
• on day 12 of the BCP cycle before IVF