As requested: Baby Making Update

Being a teacher, I can usually spot "an only" a mile away.  No offense to the onlys out there.  The oldest, the middle child, and the baby of the family each have their own set of hangups as well.  I don't want an only though.  I would like some built in lessons for Freddie in not being the center of the universe, because I'm not sure if you can tell, but it is very easy for me to fall into letting Freddie believe the world revolves around him.  Besides, our general feeling about family is "the more the merrier" but try to balance that with a realistic picture of how much our bank account can fund as well as our wanting to support zero population growth (seriously).

Anyway, I've confirmed our recent attempts to grow our family.  We've been trying for 8 cycles now.  We're having more sex than married people should have.  Not even the 1000 miles between us has interfered with our efforts to procreate. 

We had hoped that my body had learned from this whole pregnancy thing and the second time around things would be different.  So far not the case.  Of course I've been under a lot of stress recently and imagine that has contributed to the lack of 2 lines on the pregnancy test(s) each month.

As the stress of moving and all that goes with it fades into the background I am beginning to stress over getting pregnant.  I know you're not surprised.  I'm 36.  I've had issue of infertility in the past.  Are 8 bust cycles something to fret over?

This is nothing like the first time around.  We have Freddie.  I am a mother.  Charlie is a father.  But still, it definitely weighs on my mind. 

I've been analyzing the cycle I got pregnant with Freddie.  Yep, I can go back to my 2008 calender and blog posts and pontificate the cycle days and timeline.  

• I deduce that ovulation occurred on cycle day 18.  The ultrasound showed growth of umbaby was 4 days "behind" according to LMP.  I assume I ovulated 4 days later than I would have in a typical 28 day cycle.
• We were in Maine.
• I thought I began my cycle on day 29 as there was bleeding.  Was this really implantation bleeding on day 29, 11 days past estimated ovulation?
• Previous 3 cycles had been 30, 31, and 36 days long.

Don't ask me what this means or the relevance to getting pregnant now.  I'm just obsessive and research, read, research.  (Quite frankly, I *loved* rereading all of the posts from that time.)  The researching phase just kicked in over the last two months, most likely due to some time I've had on my hands.

I am keeping tabs on my fertility and my cycles seem pretty consistent.  LH surge and all the indicators of ovulation occur between cycle day 15 and 19.  I'm disappointed the living/moving situation doesn't really allow for me to make it in to see Dr. M and request he run labs to check a few things (estradiol, progesterone, FSH, thyroid).

We shall remain on course for another few months.  More updates after that.  But if anything changes, you'll be the first to know.

Our clinic

Our clinic (pre CCRM) shut down "indefinitely." Evidently there was a class action lawsuit filed in July because of mislabeling of embryos. Wow. While there is not anything yet in the news about embryos being mixed up during transfers, I imagine that there must be more of that going on around the country than I personally care to think about. Certainly there should be checks in place, but I hope this does not lead to regulation making ART more expensive or unattainable for families.

Thankfully there is no doubt that Freddie is 100% our genetic material, being conceived in glorious Maine without clinical assistance. And I suppose it is a good thing we're not fretting over frozen embryos stored there waiting to be transferred to my uterus, but all in all it does make me wonder about the level of care and attention of the entire process during our nearly 2 years of treatment.

Since I am on the topic of my eggs, Charlie's sperm, and such, please know that we chat almost daily about further expanding our family. The plan is to actively try on our own in January with the help of ovulation predictor kits. If after six months we have not had any luck, I'll head in to talk it over with Dr. M. In my 2 postpartum check ups I'd say he was our biggest cheerleader and didn't in any way try to hide his feelings that we should commence Operation UmBaBay Part Deux right away.

I imagine we may try a visit to Maine before worrying about examining embryo labels in 2010. We fully expect to visit CCRM sometime in 2010 but would be pleasantly surprised if lobster tails and chow-dah do the trick.

Worked up and worn out

Warning: Below post is not the most interesting. In an effort to keep record of appointments, tests, and results I intend to archive all information here for ease of retrieval and reference. Read on if you should so desire.

We made it home last night after nineteen hours in Denver. Our marathon day ended seemingly appropriately with us dashing through the Dallas airport with a very full bladder, knocking over old men to make our connection after a delay due to a tornado in Denver.

Overall, the seven hours we spent at the clinic went smoothly. We were both very impressed with the efficiency and competence of the staff. They were very accommodating and on the ball.

Test breakdown went like this:

• The ultrasound and doppler confirmed my thin lining and the work my body is doing to try to supply blood to the uterus. A high pulsatility index indicates poor blood flow to the endometrium. The pulsatility index value normally falls between 2 and 2.99. My left side was 3.2 and my right 4.2. The doctor is not convinced the poor lining is a deal breaker just yet, although it is associated with decreased pregnancy rates. He presumes that if he gets enough estrogen in me, the lining will respond. Removing caffeine from the body and acupuncture with points in the back are shown to increase blood flow and lining. So first plan of action is to resume acupuncture after a protocal is provided from an acupuncturist knowledgable about PI (pulsatility index) and kick the caffeine habit.
  
• The hysteroscopy revealed no real surprises, and nothing he feels would prevent pregnancy. This was very painful. My cervix had to be dilated to accommodate the hysteroscope, and there were tears. Thankfully it only lasted a few minutes.
• Semen sample was provided for anaylysis and testing of antisperm and antibodies, the sperm chromatin assay. The sample is being sent to a lab in South Dakota.
• In all we left 12 vials of blood. Some tests will be performed in their labs, and others will be sent out.
  
• Charlie's testing includes: cystic fibrosis screening (because of European descent), communicable disease screening, and a complete karyotype.
• My testing includes: screening for cystic fibrosis (European descent), sickle cell and thalassemia (because of Hispanic descent), Fragile X (because of age), and a complete karyotype
  

In our final conference with Dr S he implied if all tests come back normal, he'd recommend we proceed to IVF with an aggressive protocol of stimulation medication. He continued on that even if there are genetic or chromosomal issues preventing viable embryos, it is still possible through the wonders of science to get to a normal pregnancy and healthy child.

At this point we've decided, if all genetic and chromosomal tests come back normal, we will pursue IVF. Genetic and chromosomal abnormalities are a possibility though, and we won't decide what to do then until we get that information and speak with a genetic counselor.

We will conference with him in 3 weeks when all results are in and make a plan. In the meantime I need to have blood drawn on cycle day 3 and have it shipped to the lab. I'm thinking cycle day 3 may fall while I'm in Vermont, so I need a plan to get that done if we want to consider IVF in July. I also have to have some more records sent: most recent pap smear results, most recent physical results, and CBC and a thyroid panel.

And how am I feeling? Hopeful, confused, stressed...the usual. And as usual, Charlie is level headed, rational, strong, and calm. He feels hopeful, and thinks if we're going to get pregnant we're in the right place.

I would like very much to proceed with this in July if it is indeed going to happen, but like I've said before, there is just no convenient time. We are out of town until July 6th and I have a training the last week in July for a new part time job I've accepted (more cash and interesting work). So of course I am having doubts about why I took on another responsibility that may make this procreating thing more difficult, but at the same time I keep telling myself not to plan around it because it makes the sting of failure even worse.

Deep breath. It'll all work out one way or another...

Cross Coutry Work Up

We will be in Denver this week for 19 hours. And in that time I will undergo some testing, each of us will provide blood, and Charlie will hand over a "specimen".

It's not exactly the best time for us to do this considering we have a trip to Maine planned the day after Memorial Day and Charlie has been trying to plow through some writing and research before heading to Vermont mid June. And damn airfares are sky high. But sitting with a calender and counting potential cycle days made it evident that there really wasn't ever going to be a good time.

My body can't seem figure out how to get pregnant, so I am not sure why I had even considered it might provide cycles at convenient times.

Initially we decided that I'd make this appointment solo, as I do with my others (except when I'm too drugged to drive or sperm are needed), but he decided he should come. I'm a big girl and would have been fine for 19 hours and a few tests in another city by myself (wouldn't you know his parents had planned on being out of town that day). I am really ok doing it by myself. But there is a part of me that's relieved he'll be there....signing consents, asking questions, and hearing everything first hand. I think mostly because this is our last ditch effort at pregnancy.

We're going where there is the highest percentage of live births from embryo transfers for women in my age group. And somewhere in the back of my mind lies the very real possibility that after testing it may be recommended that we not attempt another IVF cycle at all because our chances would fall far below their success rates.

The clinic sent our schedule of appointments and fees:

• 8:00 am -- Ultrasound and doppler; I don't know much about this doppler thing, but my understanding is that it measures the blood flow to the endometrium. I am not to consume any caffeine for 72 hours prior as it supposedly diminishes blood flow. $600.00
  
• 8:30 -- Provide blood and semen sample for ASAB – Semen Analysis + Antibody Testing $370
  
• 9:00 -- Business office. I'm sure this is to discuss payment.
• 9:30 -- Break.
  
• 10:00 -- Nurse Consultation. This is to go over medicine administration and we will sign consent forms.
  
• 12:30 -- Hysteroscopy. A camera will be used to view the inside of the uterus, the fallopian tubes, and examine the endometrium. $625
• 12:45 -- Meet with Doctor. I suppose we'll discuss the hysteroscopy. $85. Funny how talking to the doctor about the procedure he just did isn't included in the price. I'd much rather they tell me the hysteroscopy was $710 than show me a separate charge for a 15 minute conversation.
• 1:00-- Break. This is our lunch break, but there are no food options available on site.
• 1:30 -- Labs. We will discuss which tests the doctor specifically recommends. We'll have to do communicable disease screening even though we did this twice before with our other IVF cycles, because they want it done at their lab. There will be some genetic testing done as well. Minimum fee is $620, if extended labs are recommended fee will be $1255, and other genetic tests may incur additional fees.
  
• 2:00 -- Review consents with the lab.

We are set to be out of there by 2:30, and have a 4:45 flight. We want to leave there informed, if not hopeful, but I don't think we'll have the full scope of things for several weeks, when all labs, both blood and semen, are completed.

And yes, the crazy train is once again leaving the station. Charlie's on board and holding on tight. It is what it is, as he likes to say, and thankfully we've got each other.

On edge

I've been happily distracted by involved in life with Charlie lately, doing things one can't necessarily do if she has kids. While I'd like to say that includes diving with sharks in Australia and indulging in botox injections in South America, it has been almost as exciting...drinking copious amounts of alcohol, spending money on myself rather than baby items, and planning trips to the east coast.

Life for the past two years has been about waiting...two weeks until ovulation, two weeks until pregnancy test, two weeks until the follow up and the new plan. And now we're adjusting to not living in those baby making increments. I've been trying to stop calling the front bed room "the baby room" even though that is what it is set up to be, but what I find the most difficult is to omit those comments that begin "when we're parents..." from our conversation. It's often the silence that follow those moments that make my lips tighten, my chin scrunch to a walnut (that's what Charlie calls it), and my eyes well up.

We're not really talking about our options of more treatments, adoption, or kid free living. Kind of tired of feeling like we have to go, go, go one way or the other and *make* something happen. Hard to do, for me in general, but even more so when I think of a birthday looming and limited cycles per year to even try to get pregnant.

But we did schedule a noncommittal consultation wit Dr. Surrey of the Colorado Center for Reproductive Medicine and had a nice chat with him today. You know, they're the clinic with the highest success rates around. Dr. Schoolcraft is the doctor I specifically hear so much about, as he's the founder. I wondered if I should have held out for an appointment with him, but you know, waiting is quite the issue.

To sum it up for you, the consult went something like this:

Given my age and health, he would chalk the past IVF failures up to one of three things: simply bad luck, lab error, or genetic abnormalities. One of the three would be the most probable cause so his recommendations are:

• Another HSG (hysterosalpingogram) I'd hoped to never, ever have to do another. Not a long procedure, but it's painful. It's an x-ray of the uterus typically used to detect blocked fallopian tubes and abnormalities of the uterus.
  
• karyotype screening, specifically to look for our potential of being cystic fibrosis carriers and any chromosomal translocation which could prevent the development of healthy embryos. I think Charlie was screened for CF right after we got married, so I need to track down those records.
  
• Sperm chromatin structure assay This detects abnormal DNA in the sperm. Abnormalities would not mean viable embryos are not possible, but sperm would have to be handled in a certain way to achieve successful results. The semen sample would be frozen and sent to a lab in South Dakota for this test.
• FSH levels. FSH testing on day 3 is a typical indicator of ovarian reserve. I assume mine was within average range for a woman of my age when we tested many moons ago. I've never asked and have never been told what my day 3 FSH levels are, so I only assume them to be normal.
  
• AMH levels. This is new to me. Completely. I've never laid eyes on this in all of my fertility reading. Evidently as this hormone's presence goes down, so does a woman's chance of pregnancy. This is one I'll spend some time researching tonight.
• And most likely, given testing comes back with no abnormalities, IVF at their clinic
  

Dr. Surrey wants the both of us in Colorado between days 5 and 13 of my next cycle (uh, maybe the cycle after next) to do a "work up." And then blood drawn in New Orleans on day three of the following cycle and shipped to their lab to get FSH and AMH levels. I wonder if he can do these in the same cycle as the work up.

Of course I forgot to ask him about my lining never getting to 8mm, but he had my records (some of them, anyway) and I had indicated the lining development on the patient info page which he had obviously read considering the questions he asked. But, I am starting a Word document with information and questions to arm myself with if and when we ever make it to CCRM.

He commented on my embryos being "slow growing" and really on the lower limits of fair quality because of this. He was very confident that a cycle with their lab would reveal if it was simply lab quality that affected our embryos. He apologized if he sounded "arrogant" (his word) but backed up his statement. Had I not had both cycles at the same lab, then there would be less of a chance of attributing it to the lab. That's reasonable to believe. But then he put out this...Success rates of women who had 3 previous failed IVF cycles at other clinics had the same rates of pregnancy on their first cycle at CCRM as other patients at CCRM in their first ever IVF cycle.

Now, I wonder if there is a way to verify this stat. Pretty impressive if it is indeed the case. I also think several women are "ruled" out as IVF candidates through the testing they do, so only those who have a fair chance of success further use ART (assisted reproductive technology). I wonder if we'd be ruled out. sigh

As if fertility treatment couldn't get more complicated, we are now considering jet trips to do it. Dr. S suggested I be monitored by Dr. C, my previous RE (reproductive endocrinologist) who was actually a fellow of his post med school, during the stimulation phase of the cycle. When egg retrieval neared, I'd then come to the clinic and stay through embryo transfer and bed rest.

I gotta tell you, I like a man with a plan. He brought back all those hopeful feelings of starting a new cycle. Then why all the damn tears as I type?!? Is this really what hope is supposed to feel like?

We really just hope to be a family of more than two one day. One day soon.

Experience

Yesterday I visited the ob/gyn. The trip was salt in the wounds. A waiting room full of women in various stages of their fertile glory; those with bulging bellies admiring the newborns with mamas waiting for postpartum exams. Going through my list of prescriptions from the last year with the perky nurse with the perfectly sized baby bump herself was what finally brought the onslaught of tears.

Are you still taking follisitm? trental? hcg? baby aspirin? menopur? xanex? medrol? vivelle dots? progesterone gel? progesterone suppositories? progesterone in oil? doxycycline? You'd think she got the picture after she cycled through the prescriptions once, but then continued to rattle down the list for what was prescribed again in January.

All this for a pap smear. Really, if I wasn't so fond of Dr. M, I'd be seeking out an ob who specializes in incontinence and menopause, so I wouldn't find myself sitting among the most obviously fertile.

And so the doctor's visit began with tears from the two of us and a long hug, complete with snot on his white coat. He wasn't a bit shaken by the tears. He didn't raise any eyebrows at or question any of what I expressed: the thinking that maybe we should try one more time because you'd think that it's just got to be the one, the feelings of guilt, always being on the outside. In fact he finished many of my sentences. He's been where I am. After 5 IVF cycles, he and his wife, gave up and adopted two girls.

He was honest about how he felt about trying to conceive and how it felt to close those possibilities. He said things that I'm not sure many people have the courage to say, because it wasn't any of that "I'm glad we did it...Adoption completed us" happy ending people like to tell you. He is happy. He loves his girls. But he'd be lying if he said now, five years down the road he didn't still have thoughts about being unable to conceive.

My biggest comfort from him was his promise that whatever it is that we decide and whatever the outcome should be, there is a life waiting for us on the other side of this. There is calm and peace.

Charlie and I are not expecting storybook. We joke with each other about this is the point in all those stories everyone likes to share with us of some infertile couple they know who amazingly becomes pregnant and lives happily ever after. We know for every one of those couples there are 10 others who make their way along some other path and still find that calm. We'd love to be Mom and Dad of Happily Ever After, but I think it's a safer bet to just put our money on the happily ever after.

Guilt

The beginnings of this "let's make a baby" mess were, believe it or not, more stressful on our marriage than the most recent past. Procreating became clinical rather than intimate. It was now us and doctors and nurses and ultrasound technicians and pharmacists and appointments and calenders and shots and pills. The stress, anxiety, and hormones mean edginess. I'm snappy. And he'd return the favor. But with time, we got better about that. Better about talking about how we're feeling. Saying "I'm sorry" or "I'm having a hard time" or "I need help."

The past 3 years, particularly the last 6 months, have put tremendous stress and strain on my body and my emotions. But thankfully, our partnership has only strengthened as a result, and as hurt as we are, we at least know how to comfort each other and recognize pain.

Regardless, I have a huge amount of guilt. I feel guilty for not being able to provide my husband with a child, a family. While I know he didn't marry me solely because of my child bearing hips, I know he has to be experiencing a certain amount of disappointment and sadness. Matter of fact, I know he is. As much time as we spend together, just the two of us, we haven't spent much time talking about how we feel lately. There are a lot of knowing looks passed between us, followed by hugs, kisses, sighs. He told me he too is grieving. He is angry. He too finds pain in the smiling baby at the park and those announcements of pregnancy in the first trimester without knowing pain of loss. And while this isn't surprising to everyone else but me, he doesn't love me any less.

And he wishes he could make it better. Fix things. Take away my sadness. And I feel guilty for that. Guilty for being sad. For crying in the middle of mowing the lawn or for the tears on my cheeks at breakfast. For not wanting to be with people.

It is ok. We are ok and you will be better one day. Give yourself time. We've been through a lot. You shouldn't expect to feel any differently than you do today, because I certainly I don't.

The man's love is unconditional. I know. No one's surprised by that one either, but you know, as much as I believed that myself before we married, it is still amazing to really feel that today.

A letter to X

Dear X,

Thank you. I can barely get out more than that. I am overwhelmed by you, your generosity, and it is with great emotion that I begin to consider your offer.

We had never considered seeking a surrogate, and never had it crossed my mind that someone would volunteer for the inconvenience, discomfort, and risks of pregnancy to help us realize our goal of parenthood. Your offer to place life on hold for 9 months, in many regards, so that we may have the opportunity to be parents, to love a child, surpasses any expectation of love and support from any friend or family.

Surrogacy is a route we have not discussed with our doctor and I am uncertain if it is even an option for us. At this stage, I am not sure we’re able to even consider surrogacy, emotionally. I’m still trying to work through the emotions of the last two failed IVF cycles and the past few years of trying to conceive. We don’t know what to do, where to look.

Thank you, X. There aren’t words to express my gratitude. Knowing you are watching our journey and empathize with our struggle is support enough.

With love,
Erin and Charlie

This will go in the mail tomorrow. We are still floored by this offer, that came out of the blue. I am not sure she reads the blow by blow accounts, but she's obviously got more than just the gist of what we're going through over here.

Although most people in our lives are fair game for blog documentation, I decided to keep X's identity confidential. She may very well have regretted such an offer the moment the words left her mouth and I'd hate for her to one day be on the spot. And there's also something about this that seems too personal, if there is such a thing.

Going without

An exchange between us a few weeks ago:

C: You haven't talked to A. in a while.

E: Nope. She's probably pregnant.

This is not an isolated exchange. A few names could be subbed in the place of A's. Any woman of child bearing age could easily be inserted in her place. When I haven't talked to someone, I assume they're pregnant and I can't bring myself to call and find out otherwise.

I'd stopped going to baby showers a year ago. And now it's family functions. The list of off limit places and events seems to be growing as this path of mine lengthens. As a matter of fact, it takes great skill to hum "da, da, da, I can't hear you" in my head during all baby related talk while still appearing engaged in the conversation. Maybe that's a bit of an exaggeration, but my heart is definitely guarded during those conversations.

I care, but I hurt. I hurt a lot. I actually daydream of moving, far away, so this self imposed isolation isn't so hard, and doesn't outwardly appear so cold and selfish.

Special Delivery?

My medicines for IVF arrived today. In a big box. And it was full.

Included are:

• 2 packages Ganirelix act 250mcg/0.5 ml
• 30 Pentoxifylline 400 mg tabs
• 2 Diazepam 10 mg tablets
• 20 18G 1.5 inch needle
• 14 27G 0.5 inch neede
• 35 3cc 22G 1.5 inch syringe
• 1 package children's aspirin 81mg tablet
• 2 packages Vivelle-Dot 0.1mg patch
• 20 Methylprednisolone 4mg tablets
• 10 Doxycycline 100 mg capsules
• 2 packages progesterone in ethyl oleate 50mg/ml
• 20 o.5cc 29g syringes
• 1 package Novarel 10,000 units vial
• 12 packages Menopur 75 unit vial
• 1 package Follistim pen
• 2 packages Follistim AQ 900 IU cartridges

And that doesn't include the medicines Charlie picked up for me yesterday:

• Yasmin 28 birth control pills
• 30 Dexamethasone 0.5mg tablets

It took me about 30 minutes to go through the box and check the packing list to make sure it was all here. It's all there. Thank goodness. I don't know if I can manage to pump all of this into my body and if there were more?!?

Looking at that medicine and the needles, I am sure you can begin to imagine my stress and anxiety. And the disappointment that potentially follows a failed cycle. It's not just the failing, but the process of feeding your body all of the above with no results.

Dr. Wu wouldn't be happy, that's for sure. He doesn't say so, but I can just imagine. I know he thinks western medicine has its place, and is effective, but this I am not so sure he'd approve of. Looking at it now makes me not so sure. Amazing what we go through for an end result sometimes.

I have pages of reading material on each drug that I'll read over tonight, and then take with me to our appointment on October 22nd when we sign the consent forms to get an explanation for the purpose of each. And this cocktail is just all a shot in the dark. There's no definitive diagnosis being treated, and that's the case for most women experiencing infertility. It's based on trial and error, what's worked before for others.

I've begun taking birth control pills and will then begin the other medication on October 25th, and I suppose I'll find out the exact regimen on the 22nd. Stay tuned for further updates. I'm sure it'll be an interesting ride.

Needle Treatment

Today, another visit to Dr. Wu. He looked at my tongue and checked my pulse. He also explained that soon my cycle would become that of a "younger woman," and to take notice. My eyebrows raised and I must have had a doubting look, because he further explained in Chinese and had his assistant translate. My eyes bounced back and forth from doctor to assistant as they discussed, and he finally smiled knowing I was watching and explained they were discussing the patterns of my body.

While the needles pulsed, I heard a woman and a baby speaking to the doctor in the next room. Before I knew it, she was at my side telling me her story. Every woman with infertility has one. They are pretty similar, but hers I've never heard before.

She was visiting from Washington and came to visit Dr. Wu to get a recommendation for a doctor and some herbs. She revealed that she was in her forties, and explained she had been a patient prior to the birth of her 14 month old daughter. She had spent 6 years and in excess of $75,000 at a local clinic. She knew my former doctor and nurse and relayed all of the "remedies" and solutions they advised, just as I had been advised. After 5 IUIs and multiple IVF procedures, she looked into alternative medicine, as she wasn't giving up.

In the year she spent with Dr. Wu, she got pregnant 3 times, after never having been pregnant before. Each time she was pregnant, before missing her cycle, when arriving for acupuncture treatment, Dr. Wu would take her pulse and tell her she was pregnant and therefore he would not administer the electrical therapy with the needles. Wow. He knew. He knew before she did. He knew just from the change in her pulse.

She carried to term in her third pregnancy as a woman over 40, conceiving naturally. And she seemed very confident that she'd do it again in the next year.

Dr. Wu. What a guy.

Not sure how my story will go, but Dr. Wu is now a part of it.

The next step

This week I spent some more time with our reproductive endocrinologist. He went through the past year of tests and procedures and made his recommendation: In vitro fertilization. An alternative would be to do some further testing, possible corrective procedures, and then reassess. He thought that money would be best spent towards IVF as even with testing and procedures, there is no guarantee that corrections can be made and it would be very likely that IVF would again be his recommendation after many dollars spent and several cycles past.

Charlie and I had decided that we'd like to try IVF, but were uncertain if we should seek the care of a specialist in a top rated facility. Our doctor agreed with my assessment of the clinics with the best statistics, Cornell and CCRM. We also talked about his statistics and how they compare to both the national statistics and the other local clinics. His rates are higher than the national average and are the best in the city.

We then talked pricing. Since I have had every test known to man in the last year, my "work-up" is complete, but it is questionable as to whether other clinics will accept my current results or require their own test. My contact with the other clinics leads me to believe that an additional work up and expense would be required.

Considering seeking treatment in another state will require 20-25 days in another city, the costs of another work up, and having to establish a relationship with another doctor, we decided that we would attempt a round of IVF with our doctor and clinic.

Today I had a "trial transfer" to be certain that embryos could be physically transferred via catheter into my uterus, discussed timing, medications, and previewed the consent forms. We are tentatively scheduled to enter into a cycle of treatment at the end of October with embryo transfer to occur in November. We were unable to begin sooner due to this rigorous travel schedule Charlie and I have been maintaining the last few months. October will come soon enough.

In the interim, I have medicines to begin ordering and Charlie has blood work scheduled. And of course, we'll just "relax."

Assignemnts in Enrichment

Infertility. Stress. Infertility. Stress. Which came first? Does one cause the other? Who knows, but I've got lots of both, and wish to be rid of them. We're managing stress and infertility, but sometimes I don't know how good of a job we're doing. I have an overwhelming sense of not belonging, not knowing my place, and wondering how to proceed, to either find or make my place.

Alternative medicine has been something I've come across in all of my internet searching, and I've noticed that many fertility clinics have staff trained in counseling, massage, and alternative medicine. Although our clinic doesn't connect patients to other resources in this way, I thought I'd seek it out on my own.

I've started to see an acupuncturist. Dr. Wu. He speaks little to no English, but what he does say seems quite wise in that old, Asian man way.

He asked few questions and wrote lots of notes, all in Chinese. Most of his questions dealt with my bathroom visits...how many times do I have a bowel movement in a day, how many times a night do I get up to urinate, how many times do I urinate in a day. He also asked about my daily routine, exercise, and looked at my tongue. He listened to my teary explanation of my IUI cycles and the anxiety I experience.

And then as I lay on the table waiting for the needles, he says to me something along the lines of ... American doctors will look at numbers. Chinese doctors, we look at ways to enrich your life. We work to enrich your life, and thereby enrich your uterus.

He then questioned my ability to have a job AND work out 5+ times a week. This tickled Charlie, who thinks I need to work more or take care of him more. He suggested dancing and swimming as exercise as well as listening to music, watching films, and sharing in the daily joys of life with my husband. And it all sounded so eloquent from a man who speaks in broken English with hand gestures and has an assistant translating.

He plucked needles in my belly and legs, hooked them up to electrodes, and put me under two lamps. He left me, with pulsing legs and tummy, for thirty minutes, feeling rather calm. He asked me to come back next week and take some herbs, which I will.

Now, there was nothing groundbreaking about his advice. I can't even begin to tell you the number of people who tell me to "relax" and everything will be OK. And is there merit to his practice? There's research to support the validity of acupuncture, and at this point, it can't be any less effective then what I've done so far. He has a waiting room full of patients and pictures of babies and letters of thanks on display.

I'm not counting on anything to solve our problems anymore. That's up to us. It'll happen. I know we'll get there.

Now What?

• Continue treatment?
  
• If so, should we remain with our doctor or seek treatment at the nation's most reputable clinics: Colorado Center for Reproductive Medicine or Cornell University?
• Continue to try without medicine or treatment?
  
• Neither try nor prevent?
• Seek help from alternative medicine, i.e. acupuncture?

We're talking about it, but can't seem to come to a decision. So much to consider. We meet with our reproductive endocrinologist in a few weeks, and certainly feel his recommendations should weigh in on what we decide, but we also think we need to work through our feelings and have some sort of plan before hearing what he has to say. Hopefully his advice doesn't directly conflict with what we decide.

But I have decided...

• to make reservations for a rafting trip in 2008, no more planning around what has yet to happen
• working with lead solder is currently not harmful and I can go ahead and finish that stained glass project
  
• to use my face cream with Retin A, diminishing my wrinkles
  
• Drink as many lattes as my heart desires
  
• Have wine with dinner whenever it suits me
• Head to the gym, attempting to lift has much weight as possible
• to try to let go of what my plan for my life has been and accept that the new plan will be just as good
  

Third Attempt

Negative.

Now what?

10 dpiui

Today is the tenth day after my IUI.

My symptoms from the hCG trigger shot have subsided, I have no pregnancy symptoms, and I have had 3 negative home pregnancy tests. I go to have labs on Wednesday morning. In the "natural' world of conception, a woman may not start to wonder until missing her cycle, but searching through the posts of women using assisted reproductive technology, it seems many are able to get that positive test and symptoms a day or so after the hCG exits the system, around 8 days after IUI.

So I am preparing for the worst, hoping for the best.

Waiting

Currently we are on day 3 of the 2 week waiting (currently referred to as the 2ww in the jargon of infertiles) period after what we have most likely decided to be our third and final attempt of medically enhanced fertility. I know you picked up on the "most likely" in that statement. It goes back and forth from "it will be" to "it will probably be" in my thinking and with each of our conversations. Thinking of it as our "last ditch effort" raises the angst associated with it to another level, but on the reverse side, this being the "last" is the first step on the road to closure which I have been finding ourselves heading towards.

Rationally I know we've already given Ochsner more money than many spend on a car without a single answer or result, and our time, tears, and emotion spent could fill the Mississippi. But acceptance is difficult, especially when you read success stories and watch so many others find just the right cocktail of medication or procedure. But holding onto that, keeping endless appointments, taking injections, having ultrasounds, and having it on the brain all the time is no way to live either. My prayers are for acceptance and strength these days.

Injections in the thigh each night are not fun. Pills that make me queazy are not fun. Undressing for ultrasounds every other day is not fun. Progesterone suppositories are not fun. But this "2ww" is agonizing. My days have been spent googling phrases...post IUI symptoms, pregnancy symptoms, hCG symptoms subside, symptoms 3 days past IUI, symptoms 4 days past IUI, hCG shot and home pregnancy test, IUI and implantation, follistim, poor endometrial lining with IUI. Believe me, the list goes on...I even wonder if I changing "3 days past IUI" to "72 hours 35 minutes past IUI" would turn up more relevant hits with just the answer to my question.

Crazy, right? Obsessive, right? Well, not really. Amazingly, what I have learned from doing this is that I am not crazy and nor am I alone. That there are millions of women out there thinking these same things, asking these same questions, and experiencing the same feeling of aloneness and do I dare say desperation. Not really the adjective that I like to put in the same sentence as my feelings, but that's what it is.

So not obsessively crazy, and it has given me some perspective into the lives of other women and couples faced with infertility, and has validated my feelings. And in the process of punching in these seemingly obscure terms into the search engine, I have found some "answers" to my questions. That tingly feeling I had three days after IUI wasn't implantation as that doesn't happen until day 6 or 10, but maybe that lower back ache and turning tummy mean I am pregnant...or maybe it is just what I had for lunch, but some woman can tell on a home pregnancy test nine days after, some ten days after, some eleven days after.

You get the picture.

No answers.

Just a two week wait.

Negative

We had decided to give the fertility treatments as recommended by the new reproductive endocrinologist a try this cycle. The regimen was much the same as the last: FSH shots over several days accompanied by ultrasounds to monitor follicle growth, uterine response, and potential ovarian cysts. Although not approved by the FDA for use in infertility, another medication was added to increase the chances of sufficient endometrial growth. And finally an IUI would be preformed.

We had (or I had) not discussed this process with as many people as the last time. Last round I naively thought it would be an end to our wait. This time I knew better.

Although a bit more cautious, we were hopeful. Things looked better this time. The numbers were where they needed to be in all regards: hormone levels, follicle size, and lining thickness.

Today the twelve day wait was over, and an HCG test was administered. I already knew it hadn't worked. I knew all weekend. But it was still quite painful to hear the nurse say, "I'm sorry."

Much to my surprise, the doctor would like to try another cycle of the same treatment. I haven't yet spoken to him about why this is the case or if anything will be different. I was expecting him to give up hope on this process, as I certainly am headed that way.

I feel sad. I hope that feeling will be short lived.

Thank you for thinking about us. I don't want to talk about any of this now. Talking doesn't seem to help anymore. Yes, we're still working towards adoption, but nevertheless hoped this would work out as well.

Waiting to see where we go next. But for now I'll eat a pint of ice cream, search the net for answers to our fertility woes and adoption paperwork, and make a pedicure appointment.

Treading Water

My little red car sat beneath eight feet of floodwater and needed to be replaced in 2005. Although we had just experienced a miscarriage, we were confident that a family car was the way to go, as we anticipated a growing family in the near future. We tossed around the idea of a minivan, but decided upon the four door Accord until we were at least a family of four. That decision was the first of many over the last eighteen months that have been made with our future family in mind.

Decisions are based on "next month" we will be pregnant. Discussions about vacations or whether to commit to summer work always take into account the "what if" we're pregnant scenario. The house we bought has four bedrooms. The job I accepted isn't demanding and requires little work outside the hours of 8- 3, and I dislike it, but what a perfect job for a mom.

So each morning as I finish dressing for work, I walk through a room ready for our family, complete with crib and baby furniture, and a box of maternity clothes sits in the closet with tags still on, never to be returned, because they'll be needed the "next month."

In these 18 months I have watched the development of unplanned, many unwanted pregnancies. There have been families we've watched grow from a family of two to three, three to four, and many are already planning more. We've watched our friends marry and have kids, and experience their life, while I feel we are here, treading water, waiting for that "next month".

We are no longer "trying" and we talk less and less about being pregnant. Rarely do I think about our list of baby names, except when our friends give their babies names that were on our list - don't they know that was our name.

So now, 18 months later, I am trying to let go of those "next month" discussions, and make decisions based on me, us, in the here and now. I've been giving away the baby items I've accumulated, and next will be the maternity clothes. Maybe the Accord needs to go. It's not easy, but neither is holding on.