First RE visit recap

Where do I begin?  From the moment I pulled into the parking lot I was overcome with a sense of dread.  Maybe it speaks to my inexperience with this that I was more worried about running into someone I knew at the RE clinic than what I might actually find out about my body.

DH and I texted each other from our cars, having driven separately.  He works less than 1 mile away from the RE clinic.  The proximity to my workplace would make me even more concerned, but he wasn’t bothered by it.  The odds of someone actually noticing his car are slim.

We trailed in behind another couple.  The waiting room was tiny.  Nervous bladders were emptied.  My blood pressure was great despite my stress.  When 3:00 finally rolled around we were escorted the RE’s office and we began combing through the basics like medical history and any lab results collected in recent years.

He expressed his condolences about the twins and I held my breath as moisture sprung to my eyes.  In retrospect, how dumb was I to not prepare for the obvious trigger?  Repress, repress.  Compose and deal later.  He proceeded to tell me I shouldn’t be in his office for another 6 months, and informed me that assistive reproductive technology is riskier than natural conception.  Fine, the usual disclaimer.  He said he’s happy to proceed with diagnostics and discuss options from there.

My CD3 Level
TSH 2.38 μIU/mL
FSH 14.2 mIU/mL
E2 52 pg/mL

He gave me a brief overview of the treatment plan.  We’ve conceived before, so he doesn’t see any point in attempting IUI instead of timed intercourse unless semen analysis reveals something weird.  He’d normally start with Clomid, however expressed that fertile women actually experience reduced fecundity with Clomid due to problems with uterine lining; he thinks Clomid would hurt rather than help me.  The next line treatment would be injectable gonadotropins (synthetic FSH, like Follistim, Gonal-F, Menopur), however he expressed concern over the risk of high-order multiples.  Finally, there is IVF, which would in his opinion be most successful without risk of multiples.  But more information is needed to know what materials I’m working with.

We discussed my recurrent chemical pregnancies.  I’m not sure he’s convinced I’m not making it up, but if I were in his position I would be skeptical too, so I’ll allow him that.  He did set up a standing order allowing me to go in for beta-hCG draws whenever I want, so I can go in around 7-8dpo (which is when I usually get my strongest early positives, which fade away anywhere from 10-14dpo) to validate I’m actually seeing weak positives.

I will also go in at 7dpo for vitamin D level, progesterone, prolactin, and most importantly anti-Müllerian hormone (AMH) level.  On CD3 I will have my FSH and estrogen rechecked.  Although my TSH isn’t great, he does not want to check my T3 or T4; I’m a bit grumbly about that but I will wait to see what my other labs say.  I forgot to ask about checking my testosterone level but have since emailed to ask about it.

He offered me a hysterosalpingogram (HSG).  I brushed it off initially, questioning whether I really would need such a procedure knowing I conceived the twins from both ovaries.  Both tubes were clearly patent before, but someone has reminded me that things change.  Does anyone have any thoughts or recommendations on HSG?

(If you’ve read this far, thanks, kind soul, because I think I’m boring even myself.)

He reminded DH and me that we should lose weight.  Yes, I know, I continue to work on it.  In fact, I’m rather vocal about trying to lose weight, trying to emphasize to others I’m focused on that rather than desperately trying to conceive.

RE does not believe DH has any sperm issues, and I would agree based on our track record, but since we’re going down this path now it only seems fair to check him too.  He is less than enthused.  I’m also not thrilled about the idea of having to abstain prior to collection!  We usually abstain for most of the two week wait, so I figure he can do it then.  Not that it matters.  Last cycle I finally lost all expectation, seeing the faint second line appear and then fade again over the course of ~4 days with minimal hope and zero surprise.

Grief is like the ocean; it comes in waves, ebbing and flowing. Sometimes the water is calm, and sometimes it is overwhelming. All we can do is learn to swim. -Vicki Harrison
credit: http://www.facebook.com/amandaonwriting

In March I will be traveling during my fertile window, so it’ll be a forced break.  That puts us at April for a medicated cycle… if that’s even appropriate depending on my ovarian reserve.  Everyone knows we were instructed to wait a calendar year after losing the boys—a recommendation based on emotional rather than physical recommendations by the perinatologist—and people are beginning to look at me sideways and with expectation.  Everyone senses I should be pregnant now.  I frequently get asked with meaningful emphasis, “How are things?”

The boys have been on my mind a lot this week.  The idea of trying with assistance, of confronting what must be my declining fertility, all while approaching the anniversary of loss.  Grief comes in waves.

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Subfertile

It’s been awhile. It’s a good thing, mostly. Not blogging means the real world is keeping me sufficiently busy and I’m not so bored or anguished that I need to distract myself by emotionally vomiting onto a Web page (because that’s how I blog).

So here we go. Update time.

What screws us up most is the picture in our head of how it's supposed to be.
credit: girlykat.wordpress.com

Six cycles of two-lines-but-just-kidding-you’re-not-really-pregnant and my ob/gyn has agreed to refer me to a reproductive endocrinologist (RE). She didn’t use that term though. She used the I-word. The bad word. It makes me bristle. It speaks to the profound sense of shame surrounding infertility, even knowing many people out in the world who’ve used Clomid or other assistance to conceive. I suspect it’s something everyone goes through.

Dreaming of BellyBut enough denial. It’s clear I must be subfertile. It’s INSANE to have repeated chemical pregnancies, my uterus rejecting what must be poor quality embryos every month except for the blighted ovum it let nestle in like a mindless parasite—complete with growing placenta and empty sac—until I forcefully evicted it. The twins were the only time I was successful at conceiving—which seems like an enormous fluke now. I feel like I could eventually conceive on my own again, but who knows how long it will be until the conditions are just right? I’m ready to accept help now, and my age finally puts me in my HMO’s allowable RE referral range after six failed cycles of diligent trying. I know. “Only” six months of trying the second time around—“she was only trying __ months” is a common complaint I hear regularly. However, if I am eligible for help to move up my timeline… I am ready for it.

Not that I’m excited to be pregnant again, because I expect to be living in daily fear. The first trimester will be all about worrying whether the pregnancy is viable, and the second (and third) trimester will be spent expecting preterm labor. Can I skip ahead to the baby?

Having spoken to a benefits analyst, RE visits and Rx are $0 with my awesome (albeit expen$ive) double coverage in 2015. (I will have to call back and find out cost for each procedure if ordered.) DH and I elected to splurge on double coverage for me to eliminate surprise hospital bills if I give birth in 2015, but if the benefit instead (or in addition) goes to RE visits, at least I’m getting my money’s worth.

Water

Remove color and this could be water. It’s actually a celebratory glass of pinot grigio.
Remove color and this could almost be water. It’s actually a celebratory glass of pinot grigio.

October 6: Water

My blood was drawn Friday—a “stat” order I might add—and I slowly watched my lab results appear online. CBC with differential and ferritin, thanks for boring me. The only result I wanted to see was the only result I was unable to. I managed to distract myself well enough that I didn’t stew about it, though I was starting to get anxious as Monday afternoon approached and I still hadn’t heard anything.

Worth the wait: Friday beta hCG was 121. I may yet avoid a D&C! Cheers to that!

Bloodwork later this week to determine if it’s decreasing satisfactorily.

October photo-a-day challenge
October photo-a-day challenge by MRKH Mummy to Be. #letsgetsnappy

When BFPs are bad.

When you don't want to see a BFP: two weeks after beginning misoprostol for a blighted ovum.
When you don’t want to see a BFP: two weeks after beginning misoprostol for a blighted ovum.

I think I knew it wasn’t over, even after my second round of 1600 mcg misoprostol (Cytotec). My pregnancy symptoms have lessened dramatically but some never completely went away. My breasts still feel too full.

But wait, don’t I KNOW it can take awhile for levels to drop? Yes. I know this. But when my hCG levels dropped so rapidly after losing the twins that I ovulated exactly 4 weeks after birth, I expect ever faster results with a measly blighted ovum. Okay, perhaps not measly. That sucker was still growing and happy inside my womb when I first tried to evict it around 8.5 weeks pregnant. I would now be 10.5 weeks.

My spotting is light. “That’s a good sign,” the ob/gyn beamed at me before my ultrasound today. My regular ob/gyn was booked. The backup ob/gyn, who canceled yesterday afternoon in a voicemail I didn’t see until the clinic was closed, apparently came down with pneumonia. I refused an appointment with Dr. Is-That-Okay.

This new-to-me ob/gyn was actually great. You can always recognize a good doctor when they have to give bad news. It is what it is, let’s not beat around the bush. Tell me flat out what I want to know and don’t try to lead me on and delay crushing my hopes.

“That doesn’t look good.” My character flaw is that I pointed it out while I’m sure she was still forming in her mind how much to tell me or how to break the bad news to me.

“No, this looks great,” she gestured to the clear area above it. Duh, but you know what I’m talking about, I think back to her. What ultrasonographers call “echogenicity.” Two little chunks of… whatever.

Moments later she called the spots “concerning,” but also said it might not matter if my β-hCG is low; the tissue could be shed later or reabsorbed. I was already mentally combing my calendar for a convenient day for a D&C. Don’t want to dwell and foolishly hope. She admitted she thought I would need a D&C. It’s Friday though, so I wanted specific thresholds. I will see my beta this online weekend, whereas she won’t check until Monday… I want to mentally prepare.

Some people are more anxious when overloaded with information. I am less anxious when I am armed with information for all possible contingencies so I know what to expect.

  • β-hCG < 100 – Another blood test Friday. Wait and see approach.
  • β-hCG 100-200 – Blood test Monday afternoon. If rapidly declining, wait and see.
  • β-hCG > 200 – D&C recommended.

To be continued.  Because duh.  It’s never over.

Day 25: An Open Letter to New Infertiles

I get it -- life isn't fair.30 day blogging challenge details available at I Love You Potato.

Welcome to the club no one wants to belong to! Whether you’re infertile or, as a friend has called herself before, fertile-but-fucked, you are not alone in the childless community. DH and I were welcomed to a neonatal loss group with condolences for our membership in a club no one wants to belong to with the highest possible price tag.

Not all infertiles are bitter, not all fertiles are ignorant. A lot of infertiles have a great fertile friend who can sympathize and listen. That being said, sometimes we just want to ball our fists and bitch about the damn fertiles because life just isn’t fair and sometimes it’s cathartic to complain.

Not all infertiles are women! But men, we love you too. You are more than your sperm count and you’re not alone either.

Everyone comes to the community from a different place, on a different journey, with many different pit stops… and babies are not always the eventual destination.

Everyone copes differently. Find a coping method (or twenty) that work for you, and reach out for help if you reach a point where your fertility journey impacts your ability to function on a daily basis (click here for a sample 8-question depression inventory).

YOUR FEELINGS ARE VALID.
credit: Séamus Gallagher

In spite of this you are not alone, especially if you reach out to the vast infertility community. There will always be people who can relate and empathize with what you are going through, and there will also be people who might not be able to understand where you’re coming from even if you’re both infertile or childless. Whatever YOU are feeling is valid whenever you feel it. We must be gentle with each other.

You will learn a lot about yourself, your spouse or other half, and your support systems. Some relationships fall apart, some are strengthened. You will come out wiser.  If you have a great partner, thank the stars because you are already luckier than many.

If you can find a way to forgive all the people who say the wrong thing, you are #winning, my friend. You win some, you lose some.

You will learn ALL THE ACRONYMS AND JARGON! You will be an expert. You can look down your nose at all the fools who don’t know your lingo. 😉

If you are lucky enough to get that fabled take-home baby, you may still feel different or unable to relate to mothers who have never known difficulty or loss, and that’s normal. It’s also normal if you want to put your infertility behind you forever and move on with your now-blissful life. It’s your life! You don’t owe anyone anything, and this includes the infertility community.

Day 24: New Acronyms

30 day blogging challenge details available at I Love You Potato.
For your consideration, I propose the following new acronyms.

TFF = totally fucking fucked

TFF = totally fucking fucked
When one ‘fuck’ just won’t cut it.

KP or KOP = kind of pregnant

kind of pregnant
When your BFP (big fat positive) is more likely a CP (chemical pregnancy) or impending MC (miscarriage) than a ‘sticky’ take-home-baby pregnancy.