Monday, November 28, 2011

Queasy Peasy

No, I’m not referring to the stomach bug that J caught just a day and a half before Thanksgiving (poor thing, he was miserable and couldn’t enjoy his dinner). I’m referring to the pit that has taken up residence in my stomach and its tenants: nerves, excitement, and my old friend, anxiety.
Last week was chock full of ultrasounds and blood work (Monday, Wednesday, Saturday and Sunday) to see how I am responding to the stims. Monday the nurse simply did a blood draw to check my E2, which was over 300 from being 20 on Thursday, so things were headed in the right direction. They lowered my meds to 5iu lupron, 150 follistim, and 2 vials of menopur to make sure I don’t respond too quickly and have one or two pull ahead and eat up all the meds. Tuesday I had a “date with the vag cam” during which we saw that I have 10 follicles between 6 and 11mm. The doctor told me to go enjoy my Thanksgiving and come back Saturday because it was still early, and meds were lowered again to only 1 vial of menopur (thank goodness, because that one kinda burns!)
Thanksgiving with Justin’s family was really, really lovely. Before dinner, when it was time to do injections, J and I excused ourselves to the bathroom with our refrigerated bag of goodies. Eva (our almost 6-year-old niece), in her usual inquisitive nature, asked a bunch of questions about where we were going, what we were doing, and why. Justin’s mom told her that we had to give me shots in the belly. Of course, when I came back out to the living room, she made it clear that she knew what I was up to and asked me why I needed the shots, to which I responded, “well, we’re trying to have a baby and we need medicine to make that happen.” I explained that the needles were small and didn’t really hurt and that it would hopefully all be worth it soon enough. If only adults were so forthright with their questions.  J
At dinner (and at Eva’s request), we went around the table and listed what we were thankful for. Justin’s mom named several things dear to her like books and Rome (she recently came back from a solo trip to Europe), but cried when she mentioned how happy she was to have family with her. It breaks my heart because I know how sad she and the rest of the family are that we are planning to leave. I wish our life choices weren’t hurtful to the ones we love, and I don’t envy Justin having to feel the way I did when I left my sister back east. Pretty sure we’re done moving after this.
When it was my turn, I shared my thanks for modern medicine and the possibilities it offers, family that enjoys each other’s company so much, and the technology to communicate with my side from afar. After dinner, we watch the requisite Snoopy Thanksgiving special with the kids and Boris played the piano. I couldn’t have been more at peace and relaxed.

By Saturday, my E2 had climbed to 2750 and I had follies approaching 16mm, so it looked like we were getting close! Sure enough, Sunday’s ultrasound showed 6 mature follicles between 15 and 18mm and 9 others in a group of smaller ones that may or may not catch up. It was go time! I triggered last night with 5000 units of HCG and 450 of follistim and am scheduled for egg retrieval tomorrow morning at 9:30am!
Up until yesterday afternoon when I got the call with my lab results, I was purely excited. Now, I can hardly concentrate on anything else. I am queasy thinking about how much is at stake and worried about how many eggs we might get, if they’re mature or not, if they’ll fertilize and divide properly, and if they will ultimately give us a baby of our own. They tell you when you start an IVF cycle to just take one day at a time so you don’t get overwhelmed. Do I even know how to do that? How to not overanalyze and stress every little detail? I think I can. I think I can. I think I can.

Side note: As per our usual silliness, Justin has named the stim phase the “Lupron Fiasco” (a la the rapper, Lupe Fiasco) and called all of the dots on my stomach from the injections the “constellation”. Lol! You really do have to have a sense of humor to get through all of this with your sanity intact.

Monday, November 21, 2011

Fighting the Good Fight: Cue Rocky Theme Music!

And so the journey begins… Justin and I decided that due to age (I had just turned 33 right after our wedding in October 2009), we would start trying to conceive in January 2010. Silly us, we were actually nervous about getting pregnant right away, because a plan to move from Brooklyn, NY to San Francisco, CA was already underway. But, we figured we’d go with the flow.
The first month, we just winged it. I also stumbled upon an online community of other women trying to conceive (Getting Pregnant, or GP on, and quickly realized that I was clueless. Still, feeling overly confident in my fertility, I just added OPKs (ovulation predictor kits) to help us make sure we were timing things accordingly. Once we made the move to California, everything went haywire. Clearly, the stress of uprooting our lives had also wreaked havoc on my body (funny how that happens), and I had two back-to-back 40+ day cycles. After freaking out a little and wasting countless OPKs and HPTs (home pregnancy tests) because I really didn’t even know which was more appropriate to take since I had no idea what my body was doing, I knew it was time to take the plunge into temping.
Lucky for us, I like having control (big surprise), so making temping part of my morning routine was no big deal. It looked like I was ovulating regularly, and once we got settled into our new home, things returned to normal. Months went by with excellent timing, but nada in the baby department. After a year like this, I was totally frustrated and perplexed, so we decided we should see a doctor. Hitting that wall and accepting that you may not have that easy, magical time conceiving your child is much more difficult and emotional than I expected. You just want to be like all those other girls who get to say, “oops! I should have had my period last week. Whattayaknow, I’m pregnant!” That just wasn’t in the cards for us, I guess. It’s sad to let go of that romantic notion, but we had to be realistic.
So, I found a RE (reproductive endocrinologist). I did a lot of research on the clinics in our area and on particular doctors that work with our insurance and found Dr. Heather Huddleston. As is the case with any good specialist in a major metropolitan area, it was over a month and a half before she could see us, but we went armed with info I got from the GP girls / reading Taking Charge of Your Fertility (pretty much the bible for women of who are trying to reproduce) / my many months of charts. I knew immediately that I liked and trusted her, and it seemed to hit Justin that I knew WAY more than he did and he was instantly more grateful for my obsessing. She did a follicle check since it was early in my cycle and said that my count of 13 was slightly low for someone my age, but not to worry about that at this point. The follicle count is a good indication of ovarian reserve since each follicle can potentially release one egg per cycle, and a count of around 18 would have been considered "normal".
And so, we went about the barrage of tests: blood work for both of us (STD screening, genetic testing, hormone levels, etc.), the first of many semen analyses for J, and a HSG for me. The HSG (or Hysterosalpingogram ) uses a radioactive dye to look for uterine abnormalities and to check for open fallopian tubes. It was not fun because I apparently have a narrow cervical opening, but it was a mercifully short procedure. Oh, and the doctor was really cute and lives in our neighborhood. Awkward! At the same time as we were going through the testing, I had such a scary period that I ended up in the ER for fear I had lost too much blood. After 4 days of very heavy flow, complete with pains that were foreign to me, a frightening number of large clots (eek!), and waking up weak and pale, we feared the worst. They called it a “suspected early miscarriage”, but it was too late to tell by blood test and nothing they could do about it anyway. Let’s just hope we never have a day like that again, though we know it’s all too common.
Once all of the results came back, we met with Dr. Huddleston again, and she officially diagnosed us with the dreaded “unexplained infertility”. Kind of a relief to know nothing is “wrong” as far as the tests show, but also kind of irritating that there is nothing to fix to help us finally get pregnant. Next step, meds. We decided to take things slow and do 2 cycles with Femara and then move on to Intrauterine Insemination (IUI) from there, if necessary. We just weren’t ready for the invasive procedures just yet. The two medicated cycles came and went with perfect timing, as usual, but still BFN (big fat negative). As sad as it was to admit, we needed to try the IUIs. This involved using OPKs to detect my LH surge (the increase in hormones that happens a day or so before ovulation) to time the procedure. On the second try, we added a trigger injection to make sure any mature follies released their eggs at the right time. Justin gives his “sample” in the morning, and I go in the afternoon for my appointment with the stirrups. TONS of fun!  ;)  When all was said and done, and even though I responded well to the meds, four IUIs still didn’t do the trick. When the third one failed (I just knew early on, well before my period, that it was a bust), I had a complete and total meltdown. I REALLY didn’t want to have to do In Vitro Fertilization, mainly because I loathe needles with the passion of a thousand firey suns. Sure, I had turned to acupuncture several months before this and grew to love my weekly session, but this would be a whole ‘nother ball of wax. I was overwhelmed and depressed and in denial. We had our WTF appointment (yes, that stands for what you think it does) with Dr. Huddleston, and she recommended IVF instead of injectable meds because of the expense. Our insurance was great, but these drugs would eat of a lot of our coverage allotment, and for only a minimal improvement in success rates. Drat.
We took a “break” which wasn’t really a break, because that felt too much like giving up. It just meant that I wouldn’t have any more appointments for a few months (my boss had been extremely flexible with my schedule, but it was still tough to be out at random times), but I still took the Femara to keep my cycles predictable. We tried on our own and I even Oed on our anniversary weekend, so of course, we crossed our fingers for a surprise BFP so we wouldn’t have to go through with IVF (like I would have that kind of luck *sarcasm*). In the meantime, we saved our little hearts out, and when the time came, we jumped in with both feet.
That brings us to the present day. My IVF cycle officially started on 10/24/11 and for the first time in a long time, we are feeling excited again. It started by taking BCP (birth control pills) for 3 weeks to prevent me from ovulating on my own, and added Lupron (Leuprolide Injection) in the last week. Then, last Thursday 11/17, we had our baseline ultrasound to do another follie count, to make sure I didn’t have any cysts, and to check that my lining was thinned out. They also drew blood (my favorite) to see if my estradiol (E2) level was low enough to start stimulation meds (aka “stims”). Knowing that my follie count had not decreased and my body cooperated with the meds thus far, we were good to go! It’s been three days now of injecting myself three times a night. Justin preps the needles and I do the injection (once again, I need to have the control, lol!) I can’t believe I am actually doing this, and that it’s not that terrible! Other than a nasty headache when my E2 was at its lowest and some tummy issues, the side effects have been minimal. I swear, I can hear the Rocky theme music in my head and can take whatever punches are thrown at me (though of course, I want everything to continue to go smoothly from here on out). Another week of this and frequent ultrasounds and blood work and we should be ready for the egg retrieval soon! More on that to follow.
The one (maybe not so) surprising thing about all of this is how it has affected our marriage and relationship. We knew we were a good team and communicate well, but until that is tested, you really just can’t predict how you’ll respond in the face of adversity. I am so SO fortunate to have Justin by my side. He has let me cry on him when I needed to (even if he didn’t quite understand why I was so sad), read the books I gave him, and listened to my many ramblings on the subject. In a sense, he let me deal with this in whatever way I needed to without concern for himself. I’m sure he grew tired of hearing about making babies all. the. time. But other than the rare eye roll or scheduling snafu, he has been incredibly attentive and supportive. It’s impossible not to feel a sense of loss, a mourning for the simpler times when we thought this would happen easily, but dealing with those emotions together has fostered a new level of respect for each other. We’re fighting the good fight and I absolutely cannot WAIT for the day when I get to make him a father.