Thursday, September 3, 2009

I have been thinking for quite a while that I was finished with this blog. So it was surprising to me tonight when I felt an urge to document some things here. But, I have come back here on several occasions when I was reflecting on our infertility history and couldn't remember the exact sequence of events that led up to a particular milestone, or when I couldn't remember the date or time frame of an event. So, I thought that I'd probably regret it if I didn't get some of the details of our latest attempt chronicled here, if only so that I can read back through it at some much later date, and get whatever I need from it....

So - we started treatment again in July, and we decided to start from the beginning again. Since I have lost a considerable amount of weight, our doctor agreed that my body might react differently and with less medication than during our previous attempts, and that it made sense to perhaps start with the lesser expensive IUI treatments before advancing on to IVF again. So, I took 150 mg of Clomid along with a few low doses of injectable FSH medications (which were graciously donated to us by dear friends who are now 7 months pregnant with the fruits of their latest cycle) and we did an IUI procedure (our 2nd ever) on July 10. On July 24 we found out that it was unsuccessful. We started another cycle immediately, and had IUI procedure #3 on Aug 10. Here's what happened after that:

Saturday, Aug 22 - Unlike all previous attempts, this time I was nonchalant, completely sure that the IUI hadn't worked, and I did not pee-on-a-stick each and every morning for the last week of the 2 week window. I had been planning to only pee on ONE stick the morning of the beta, just because I couldn't deal with the suspense of having blood drawn and waiting for 6 hours for someone to call me to tell me my fate. But, on Sat afternoon, I went into the bathroom to pee and my last remaining pregnancy test was sticking out of a basket in my bathroom and it caught my eye, and I thought - well, what the hell, I'll just take this ONE test and then I won't have anymore in the house to tempt me, and I'll buy just one more on Monday night to take on Tuesday morning before the beta. So I peed on it, and immediately two lines came up, and reflexively, I almost threw it in the trash as I have countless other times before, thinking that it was negative, as usual. But at the last second, with the stick poised over the trash can, my heart leaped into my throat, and I thought - WAIT a minute. Two lines? Doesn't that mean something good? But, you know, on some of them you need a plus sign, and I couldn't really remember what brand of test I had taken, so I snatched up the instruction sheet, which I had thankfully saved, and tried to make sense of what I was seeing. My heart was pounding, pounding, pounding and the more I looked at the two lines the more I couldn't believe it. I raced down stairs and threw the test onto R's desk and asked him to read and tell me what it meant. He looked at it, and then he looked at me, and we stared at each other and I cried and we held each other for a few minutes, which was sheer joy, sheer elation, thank you GOD for this moment......And then I grabbed my keys and raced to the grocery store where I bought not one but 8 more tests. Because I couldn't believe it was true. I needed more reassurance. What if the one test I used was faulty? What if it was defective, had been in the humid bathroom too long, or I dropped it and broke it before I used it or what if it just LIED to me? I had to be sure, so I came home and drank 2 bottles of water and paced around until I could pee again. Then I peed on 4 sticks, all different brands, and every one of them came up immediately and strongly positive. No pussy-footing around, right away, clear as a bell. No squinting and holding the test up to the light, If you hold it this way it KIND of looks like a second line, right there? No, none of that. Straightaway positive as they could be.

The rest of Saturday, Sunday, Monday, Tuesday, Wednesday and Thursday morning passed in a joy filled haze. On Tuesday morning I went in for my first beta. I wasn't the slightest bit nervous, because I reasoned that 5 pee sticks couldn't possibly be wrong. I knew there was enough hcg in my system to ensure happy news when I got the phone call that afternoon. And sure enough, my nurse called and congratulated me, and told me my hcg level was 637. Holy shit! It might be twins! We fought the urge to tell everyone we knew. I felt like I wanted to take out an ad on the nearest billboard, After FIVE years, we FINALLY did it! WE ARE GOING TO HAVE A BABY! A BABY! Us! We are pregnant! We told WAY too many people. Family and all the people we really love, but still, I know now, way too many people. We were just so overcome with this news, it was incredible, unbelievable, we felt like we had won the lottery. We talked about things that we have NEVER allowed ourselves to talk about since waaaay back when, 5 years ago, when we first got married and naively thought that all we had to do was stop trying NOT to get pregnant and we'd get pregnant. We talked about what we'd do with all the furniture that is in the spare room in order to turn it into a nursery. We talked about possible names, we talked about child care options, we talked about what the baby might look like, whether each of us wanted a boy or a girl.....I started reading "What to Expect When You're Expecting" again, which I also hadn't allowed myself to read since right after we were married. I can't remember a time when I felt so thankful, so happy, so hopeful and was a magical week.

Thursday, Aug 27 - I was ridiculously sure of myself going into my second beta on Thursday morning. I knew that my levels of hcg were supposed to have risen at least by 60% in two days. I had calculated that meant my number needed to come back around 1050 or more, and I was honestly absolutely positive that I would surpass that number with ease. I wasn't even nervous. How are you this morning, the nurse asked me as I rolled up my sleeve. I'm FANTASTIC, I said, grinning like a cheshire cat. Supremely overconfident, and supremely naive and stupid, as it turns out. When my phone rang that afternoon to receive the results of the blood test, I was so excited to hear how my number had come back, and was anticipating going online to see if all the hcg charts still thought I was going to have twins. When Dr. G himself began speaking, instead of one of the nurses, I instantly knew it was bad news. He told me my level had only risen to 679. Not a good sign, he said. I could hardly breathe I was so shocked. I hadn't prepared myself AT ALL to hear bad news, hadn't even thought it could be a possibility. He went on to say that the level on Tuesday had been so high, and he thought it was possible that initially two embryos had implanted, but perhaps one of them had stopped growing, and that the other one was still fine. He said that they had definitely seen cases where that happened, and the remaining embryo went on to become a beautiful full term baby. That I shouldn't worry myself to death over the weekend, and that I should come back in on Monday for another blood test and an ultrasound to see what was going on in there, and hopefully my number would jump up and everything would be fine. I got off the phone, called R, and totally lost it. Was sure for about 3 hours that it was all over. Left work early, raced home to be with R who was also off that day, and laid in bed with him crying for over an hour. R is a steadfast rock of support in situations like these, and as he always does, he pulled me up out of it and helped me to see that there was every reason in the world to believe that it was just as Dr. G had said, our remaining embryo was strong and everything would be fine on Monday.

Monday, Aug 31 - after an eternity of time over the weekend, we went trembling into the fertility clinic for the 3rd beta. I was almost shaking I was so nervous. As I sat down in the chair to offer up my vein for the blood draw, one nurse asked the other, confirmed or suspected? My nurse answered, suspected, and then handed me a sheet of paper detailing the benefits of taking Methotrexate to dissolve ectopic pregnancies. What? Ectopic? huh? I hadn't even thought of that possibility until that very second, but gee thanks so very much for suggesting it. On the way down to the ultrasound room, I tried to explain to R why I was crying again, and why they seemingly suddenly thought our pregnancy could be ectopic, and then we both tried to figure out why they thought it prudent to provide us with the information and a consent form for methotrexate before we even had the effing ultrasound for christ sake. During the ultrasound, R stood there holding my hand while the doctor explained (not my beloved Dr G that morning, unfortunately) that although it was VERY early and they couldn't tell anything absolutely for sure, that she definitely saw what could very well possibly be, and most likely could maybe be, a pregnancy sac. But no, they couldn't rule out an ectopic pregnancy based on the ultrasound, bc it was really much too early, I was only 5 weeks that very day, and it's just so early to really tell anything definitively on ultrasound you see. Aaaaaarrrrrrggggghhhhh. R was steadfastly positive, as he always is, and focused on the fact that the doctor had ended on a positive note, "as far as I can tell, this is a pregnancy sac, and I would say that you definitely should NOT take the methotrexate at this point. We need to see what your hcg numbers look like this afternoon, and then we'll have a better idea of how we should proceed.." So, R and I both went off to work and I waited in horrible suspense for the next 4 hours for the fertility clinic's call. This time it was the nurse who called, but her news wasn't any more positive than Dr G's had been 4 days before: in 4 days, my hcg level had only risen to 713. She didn't offer any color commentary on the predictive nature of this number on our unborn child, but rather stated in a very serious tone that Dr G wanted to see me and perform an ultrasound HIMSELF in three days, and that he had arranged to meet me at the clinic on Thursday at 8:15, as long as that worked for my schedule. As if there were ANYTHING more important to me than this pregnancy! Sorry, getting my nails done at 8am, could Dr. G do 10, 10:30? yeah right.

Thursday, Sep 3 - I went by myself to the clinic this morning, feeling defeated and depleted. Dr G performed the ultrasound, and he was incredibly thorough. It took twice as long as it usually does. He said that he saw several cystic areas that might or might not be pregnancy sacs. He said that normally, at 5 and a half weeks, that he would expect to see white lines differentiating a pregnancy sac, which he didn't see on mine, and that he would also have expected the sac to be larger. The several areas that he saw in my uterus which MIGHT be pregnancy sacs were all quite small. Still, he said, knowing that this pregnancy is very much wanted, I want to give this every possible chance...let's see how the numbers come back this afternoon, and I want to see you on Monday, when you'll be 6 weeks, for another ultrasound. He said that at 6 weeks, on ultrasound he would expect to see a large pregnancy sac with a yolk sac clearly visible in it. If we didn't see that, and my numbers continued to creep upward, he would recommend starting the methotrexate. If there were any chance for this to be a viable pregnancy, he said we would have to see the numbers rise quite dramatically this afternoon, and we'd have to see that pregnancy sac with encompassed yolk sac on Monday. So, I left really feeling like there was very, very little hope. And more than that, feeling so terribly frustrated that this horrific suspense continued to drag on. The typical rollercoaster of infertility, only in a condensed way that I hadn't experienced before now. When the numbers came back this afternoon, 774, Dr G again called me himself, and said that given the lack of conclusive information from this morning's ultrasound, and the modest at best increase in my hcg level today, that he strongly recommended that I go ahead and take the metho injection. He told me that he felt there was almost no possibility that this pregnancy was viable, and that if we let it go on, there was a risk of my tube rupturing, if indeed it turned out that it was an ectopic pregnancy. He didn't feel there was any reason to wait and do another ultrasound on Monday. I cried, and called R, and drove myself bleary eyed back to the clinic. The metho injection is not only intramuscular, it has to be injected in two different injection sites in order to increase the absorption potential. Apparently the protocol for this is for the patient to assume the position, standing with trousers lowered and with palms braced on the examination table, while not one but two nurses armed with extra long needles face off behind you and stab you at exactly the same moment on opposite sides of your posterior. I had gotten intramuscular shots before when we did IVF, but R always gave them to me, and I always iced the injection site beforehand so that I never had to feel anything. Unfortunately ice wasn't part of the protocol this afternoon, and those two shots hurt like hell. I am proud to say that I didn't cry until well after the shots were over, when one of the nurses reached out and patted my arm and told me she was so sorry that she had to do it, and that she knew my heart was hurting worse than my rear end. That small act of kindness was too much for me, and I had to sit in the exam room with a box of tissues for several minutes before I could collect myself enough to walk out to the front desk, where I was told I needed to make a date for another two needles full of metho on Monday. That should make for a delightful Labor Day holiday - a trip around the beltway at 8 am to get two more intramuscular injections. Could this get any better?

So, there's the whole sad story. I feel completely wrung out now, and my eyes are are puffed up to the size of extra large marshmallows. Right now I wish more than anything that I could will my body to go ahead and get the mechanics of the miscarriage out of the way RIGHT AWAY. I'm told it could be two weeks or more before my body will decide it's finally time to expel the embryo, or materials of conception, or whatever I'm supposed to call it. I wish I could make it happen tomorrow, I would gladly stay here locked in my bed or bathroom suffering with cramps or pain or whatever may come, for hours on end, if I could only just get it over with right away. I can't stand the idea of walking around in this strange state. Still technically pregnant, but decidedly not. But like everything else about infertility, I have absolutely no control. My body will do whatever it will do, and I'll just be along for the ride.

Perhaps I will post more when this is all over. We're going to the beach in a week, I can only pray that I won't spend my one week's vacation this year dealing with the mechanics of an inevitable miscarriage.

Edited on 12/2 to add dates and corresponding beta numbers, purely for my own future reference:

8/25 - 637
8/27 - 679
8/31 - 713
9/3 - 776
9/7 - 507
9/10 - 324
9/15 - 91
9/22 - 0