Friday, August 17, 2007

Now what?

R and I have been going around and around the mulberry bush, as they say, on what action to take next in trying to start our family. After many days of soul searching and lots of knock-down, drag-out tearful conversations, I think we have finally have a mutually agreeable plan, at least for the very near future.

The crux of our difference in perspectives is this: R is tired of watching his wife go through endless days and nights of shots and doctor's visits and emotional highs and lows. He is worried about the emotional (and physical) toll that 6 future cycles of IVF (if we sign up for Shared Risk) might have on my emotional well-being, on my very personality. He's ready for us to be parents, now. He is interested in pursuing something that offers certainty and security in terms of an outcome. He is frustrated by the unpredictability of IVF. When considering the prospect of spending over $20 thousand dollars, I think he feels much better about signing up for something that has a 100% chance of putting a baby in our arms at the end of it.

I, on the other hand, am clinging desperately to the idea of having another chance at a biological child, and pursuing that opportunity as quickly as possible. It's the only thought that keeps me from being well and truly 'depressed', as a matter of fact. I'm just not ready to let that dream go. I feel really desperate and out of control; I'm not sure how to change or channel these feelings.

Our endless and frustratingly circular conversations over the last week stemmed from the fact that I'm scared out of my wits that we are heading down a path that will breed resentment in the future. If R feels we should abandon treatment and pursue adoption, and I go along with that, will I wake up 10 years from now resenting that I didn't "try harder" or insist on further opportunities to try for a biological child? If I want to sink a huge amount of our money and our time into 6 further IVF cycles, to the tune of $22K, will R resent me when monthly financial decisions are impacted as a result of this expenditure? Or, if all 6 cycles fail, and the money has been refunded to us, will R resent the fact that we've then "wasted" potentially 18 - 24 months and we're at the starting gate to adoption at ages 39 and 41, respectively?

Bless R, for he is unbelievably supportive and open minded and kept reiterating that in spite of his opinion about being ready to move on to adoption, he respects the fact that it's my body, and will support whatever I want to do next - more treatment or otherwise. Ack! Why didn't I rejoice in this response? Because I want to come up with a plan that makes both of us happy and leaves no room for questioning or second-guessing or resentment at any point in the future. And that is IMPOSSIBLE. There is NO GOOD ANSWER to this dilemma.

From a financial standpoint, we've decided that we simply cannot afford to shell out the full amount required for Shared Risk right now. In the spring when we both receive our annual work bonuses, we could conceivably fund a $20K payment - either for a Shared Risk IVF treatment plan, or for adoption. But not until then.

However, we have almost $4,000 worth of insurance coverage left. If we did one more cycle in the pay-as-you-go format, after adding in all the "extra" treatment options Dr. G recommended (ICSI, Assisted Hatching, etc.) we'd need to come up with about $7K (not including the drugs, of course.)

I almost come out of my skin contemplating the idea of waiting for almost 9 months to try again. 9 months is a lot of time to "waste" when you are trying to get pregnant, especially when you are about to turn 37.

Ultimately we've decided to come up with $7K and try again as soon as we get back from our beach vacation. I'm on BCPs now, so if all goes as planned, I'll likely be starting stims around the middle of September.

I don't know what we'll do if this cycle fails. Wait until spring to try to find $22K (in addition to the $7K we just blew)? Abandon treatment and begin pursuing adoption? I don't know. But I've accepted that I can't make decisions right now based on what may or may not happen in the future. We can only make one decision at a time, based on the current situation and circumstances. At this moment, doing another pay-as-we-go cycle seems like the next right step. Maybe I will second guess this decision. Maybe not.

I'm scared to death that it won't work, again. I'm terrified to think that this could be our last attempt at a biological child. Right now I'm trying very hard to "relax" (yeah right), and am hoping to enjoy our vacation in a few weeks.

Sunday, August 12, 2007

Syringes and needles and vials, oh my!

Late last week I decided that I was tired of paying for the little miniature Sharps containers the pharmacy keeps sending me, so I decided that in order to reuse them, I would empty all the full ones I have (yeah, I'm stockpiling full Sharps containers, and I know I have a problem) and put the contents into a recently emptied extra-giant sized laundry detergent container.

So, I dragged all of my bursting-at-the-seams Sharps containers into my kitchen and dumped everything out onto my kitchen counter. (Yes, I know that seems sort of unsanitary, but I reasoned that I could bleach the kitchen counter afterwards...) Anyway, the more I dumped, the more morbidly fascinated I became. I felt a perverse sense of accomplishment looking at all of those spent vials of medication and used needles. (Yes, I know I'm cracked.)

Soon I found myself carefully sorting through the contents, almost feverishly piling syringes on one side, needles on another....

This, I thought, is what hundreds of needle pokes looks like. This is what ONE IUI and ONE IVF looks like. This is what thousands of dollars worth of drugs looks like.

And above, you can see for yourself what it looked like.

For the as yet uninitiated, clockwise from the top left: Empty vials of Menopur, progesterone in oil, and hCG; empty Follistim Pen cartridges; used Lupron needles; used needles; used Follistim Pen needle caps; and used syringes.

Planning for next time

So I managed to get in to see Dr. G this past Friday. He called me on Tuesday evening, the day I got the beta results. He said that he was very sorry that this cycle didn't work, and suggested that we get together as soon as possible to talk about what we could do differently the next time. He suggested meeting on Friday at 2pm, and of course I readily accepted. What a saint.

He recommended several changes for next time: he thinks we should try to shorten my stim as much as we can, bearing in mind that I'm prone to hyperstimulation. Apparently the vast majority of patients have stim somewhere between 9 and 14 days long. Mine was 20. He wants to see if we can shorten it down to around 10-12. He believes that the long stim MAY have resulted in some of my eggs being post-mature. He thinks that may have contributed to our poor fertilization rate. The plan for next time will be to start me off right away with the highest dose of Follistim that I was on last time - 225ius. He'll watch my E2 level closely, and if it takes off immediately and looks like we're headed for hyperstimulation, then we'll immediately back down the dose. But if all goes well, we'll hit the old ovaries with the higher doses right away and see if we can get them to perform in a shorter time period. The hope is also to get more eggs this time around. Dr. G said 14 was great, but 20 would be better.

All 14 eggs they retrieved this time were mature. He said that was great, and was a sign of good egg quality. Of those 14, only 11 fertilized, and 6 of them fertilized abnormally. I'm sure I learned this in some long forgotten biology class, but when the sperm fertilizes the egg, the newly formed embryo is supposed to "kick out" the extra set of chromosomes. In 6 of our embryos, that didn't happen, and so they had 3 pairs of pro nuclei present. Dr. G explained that this could EITHER be caused by more than one sperm entering the egg, OR it could be an egg quality issue. He thinks it was the latter, in this cycle, but he thinks the quality issue can be attributed to the post-mature state of some of my eggs due to the long stim - NOT an overall age-related egg quality issue. So, his second suggestion, to eliminate any possibility of having more than one sperm enter each egg next time, is to do ICSI (for anyone not familiar, Intra Cytoplasmic Sperm Injection).

His third suggestion is to perform Assisted Hatching on our embryos next time around. He explained that this COULD be the reason that our gorgeous, 8-celled, compacting embryo didn't implant this time around. Perhaps it had a little trouble hatching in time to implant?Interestingly, Dr. G explained that although studies have shown no measurable benefit of performing Assisted Hatching on embryos of couples undergoing their first IVF cycle, the data does show that it helps in subsequent cycles. So, I guess his theory is that we might as well give them as much help as we can, and apparently with their embryologist's sophisticated and practiced techniques, there is little danger of harming the embryos when they "chip" away part of the "shell" or zona pelucida before the transfer.

I think it is really mind blowing - all of these procedures they can perform (ICSI, Assisted Hatching, etc.) on these tiny few-celled embryos. I can't imagine being the embryologist responsible for inserting a single sperm into a single egg cell?!?!?! It's almost like science fiction.

What's even more remarkable, in my opinion, is that "natural" conception and subsequent birth ever happens at all!! Every star and planet has to be aligned and every cell in your body and your partner's has to do EXACTLY what it is supposed to do at exactly the right time in exactly the right way......when you think of all the things that can go wrong, it makes you wonder how we managed not to go extinct before the advent of medical intervention! The deeper my knowledge of fertility issues, the more I'm convinced that every child is indeed a true miracle.

So, anyhoo, now the big freakin' question is how the frick we're going to pay to continue with this shit. We only have about $3,000 worth of insurance coverage left. If you add in all the costs of the "extras" Dr. G recommends next time around, we'd have to cough up about $10K to pay for a single cycle. (Plus, we'd have to pay $2,500 for a subsequent frozen cycle, should we be so lucky as to end up with embryos to freeze, of course.) By contrast, $22K would buy us 6 further attempts and/or a guarantee of our money back. We've been talking about it, and we're leaning toward Shared Risk as the logical choice. But $22K is a significant amount of money - do we finance it with a personal loan? Should we borrow from our 401K plans? Should we borrow against the equity in our home? Honestly?...We don't really want to do any of those things, but at some point we're going to have to make a decision and move forward.....

As luck would have it, Friday when I met with Dr. G also happened to be the day that my period showed up. So, he told me I could go ahead and start the BCPs if I wanted to. No pressure though - he said we could "manipulate" the pills in order to start the Lupron whenever I wanted to. We're going to the beach the second week of September, and there's no way in hell I want to be dealing with either a period or Lupron shots while I'm on vacation. I intend to be blind drunk the entire time. So, at this point I'm thinking we may be ready to start the Lupron around the 3rd week of September. We'll see. I guess it depends on how long it takes us to figure out the financial part of the equation.

Sooooo, I'm still obviously very disappointed that we're not currently pregnant. But, thanks to the upbringing of my two wonderful parents I'm a fairly resilient person. I think I'm over the bulk of rage and bitterness that swept over me for most of last week. It's not the end of the world, for pete's sake. It's just another failed cycle. It sucks, but we'll try again, that's all. The way I figure - if no one is dying, then it's a pretty good goddamn day. Losing a parent to cancer has a way of helping to put life's trials into perspective. This is hard. Really hard. But R and I are still here, still putting one foot in front of the other, still loving and laughing and enjoying each other and dreaming of the future. I keep trying to focus on my innumerable blessings, and that really seems to help.

Tuesday, August 7, 2007


As expected. Still didn't make the news any easier to hear.

I feel like an empty shell. Metaphorically, emotionally, physically.....My heart feels permanently broken. But I know it isn't.

And in spite of being just SO fucking sick and tired of all of this shit, all I really want to focus on is trying again. I don't want to hear - oh you should just take some time and grieve and think and reflect, blah, blah, blah. No, I'm all out of patience. I'm all done with taking breaks and wasting precious time. I'll be 37 in 3 months. I want to start another cycle now. Today. This very instant! That's the only thing that would make me feel any better. Plowing ahead.

So you can imagine how I wanted to leap through the phone and strangle the receptionist when she told me in a semi-snotty tone that the earliest I could get in to see Dr. G to talk about what went wrong and what we can do next is August 31. There's no WAY I'm waiting an entire month. I emailed my nurse and begged her to cram me into Dr. G's schedule anywhere she could. I would meet him in the parking lot, call him on his cell phone while he's sitting in beltway traffic, meet him at 6am,9pm, the middle of the flippin' night, whatever it takes, just get me an appointment sooner than a month away!

I thought I had prepared myself and all I would feel today is more anger, more bitterness. Interestingly, I mostly feel sad and sorry for myself right now. Not angry, so much. More pitifully disappointed. I bet more of the lovely rage I've been experiencing will be back tomorrow though.

I also don't feel like "talking this out" with any of my best friends like I usually do. The only person I want to talk to is R, and he won't be home from work for another couple of hours.

What is there to say anyway? This sucks. That about sums it up.

Sunday, August 5, 2007

Hope's on her way out

Well, it's 13 days past my 3 day transfer, which translates to 16dpo, and nary a second line has been spotted. I think it's safe to say at this point that it's all over but the cryin'. It's been more than enough time to have seen a positive result from an HPT, but of course I'll go for the official blood pregnancy test on Tuesday.

My rage has sort of ebbed and flowed this week. I have good moments and bad. Today I had a pitiful trip to the grocery store - is it me or are there more pregnant bellies and mother-child parades per square foot at the grocery store than any other place on earth? Except for maybe, Disney World??? I was overcome and swiping tears off of my face in the frozen food aisle. I'm sure the other shoppers thought I was a wackjob.

But, I'm still glad I've handled things the way that I have - testing everyday so that there was a gradual and incremental grieving period happening each day. I still maintain that I couldn't have handled letting hope blossom and grow stronger and stronger for two whole weeks, having more and more fantasies about being pregnant, and then have it all crushed with one phone call. It's too much suspense, too much build-up, too much riding on that one call that I'd surely hyperventilate or pass out or scream or all of the above. As it is, knowing full well that Tuesday's news will be negative - I STILL don't think I can bring myself to answer the phone when the nurse calls. I decided a long time ago that I was going to let it go to voicemail, so I wouldn't have to make any conversation or say anything at all to the nurse.

I'm sure that Tuesday will still be very difficult, but I think, I hope, I've already processed a lot of my anger and sorrow over the loss of this cycle - which, I feel compelled to iterate, is just a nicer way of saying that our two embryos, our two maybe-babies have died. So, maybe I'm fooling myself, but I don't think I'll completely lose it when I get the news. I could be wrong I guess.

One small glimmer of an idea that is helping me to move on already, is that I just figured out that we may not have to make the big Shared Risk $20+ K payment immediately in order to continue treatment after this. I remembered that we should have at least a few thousand left of insurance coverage, since we didn't need to use anything towards freezing any embryos this cycle. So, I'm pretty sure that to do another cycle we would only need to come up with $4K or so, which is much less daunting than coming up with $20K. So that gives me hope that we can IMMEDIATELY start a new cycle and try again.

After 3 years of this, that's the only thing that makes me feel any better, is the idea that we can pick ourselves up, dust ourselves off, and try again immediately. I think part of the dread I was feeling about possibly failing this time around had to do with the knowledge that we'd likely have to wait for 6 months while we tried to scrounge up the money for shared risk.

I have to say though, I'm just really fucking tired of being patient. I've been patient for 3 years now. I'm sooooooooooo tired of this! What an understatement! It makes me want to jump out a window. The fact that we want this with every fiber of our very beings and there is not ONE thing I can do to exert any control over when it will happen. And in the meantime, I just have to roll with every punch, and keep waiting. Patiently. What choice do we have?

Wednesday, August 1, 2007

Pissed off to pitiful in 6 hours


No more spotting since that one little incident on Monday. However, every day when I test, and see that white blank spot staring back at me where a second line should be, it makes me more and more....angry. Good and goddamn well pissed off, is how I felt at 4:30am today when I woke up - having been dreaming as usual of being pregnant - and peed on a stick. Nothing, nada, zilch.

I climbed back into bed, and laid awake until R got up around 6am, feeling progressively more and more full of RAGE. It really scared me, how strongly that emotion washed over me. I was absolutely completely and totally sure that this has all been a giant waste of time, money, and emotions. And why? WHY??!!! Why couldn't this work out for us? IVF works the first time for lots and lots of people. Why not us, goddamn it?

I wanted to throw something against the wall and watch it smash into bits. I wanted to jump out of bed and have a screaming wailing fist-beating tantrum. I wanted hit something, someone, inflict some pain, make something or someone else hurt like I hurt inside all the time. I felt like I was going to fly into bits. I laid there with my heart pounding and pounding and with the blood ringing in my ears and I thought - what will happen to me when I get the final news after Tuesday's beta that this didn't work? And I was terrified.

And now, 6 hours later, I've talked myself down from the ledge, yet again. I've convinced myself that I still have a chance. That 9dp3dt could still be considered a little early for a positive HPT. That some people don't get positive HPTs at ALL, ever, and the blood test still comes back positive. (although the beastly voice in the back of my head says that this is the stuff of false hope and urban infertility legend, and not to believe it, because my blood test is a full 15 days past the 3 day transfer, which equals 18 days past ovulation, and there's only an infinitesimal chance that one wouldn't have HCG showing up in one's urine after all THAT time.) That I should hang onto hope, that there's no reason to think negatively, and that there's every reason to believe it worked, and that we have fallen on the joyous side of the 50% success rate that Dr. G quoted me.

And so, the rage having run it's full course this morning, now I'm feeling plaintive and desperate and pitiful:

Please stay, little embryos, little maybe babies. We love you so much already. You are already here, so just please stay.

We're in awe and spellbound over you already, and we'll be more so with every sonogram, every milestone.

We'll cry in joy and wonder at your birth, your birthdays, your graduations, your accomplishments.

We promise we'll give you our whole hearts, and everything you could ever want or need to the best of our every ability.

We have a room in our house for you already, it's here and waiting for you. We have a giant crazy wonderful extended family who's waiting to love you, too. And a dog who will lick your face and make you laugh. Grandparents who will dote on you and shower you with so much love you won't believe it.

We're all waiting for you, and we have been for so long.

We want you so much. We love you, already. Please, please, please - stay.