Twenty Questions

Thanks to everyone for your wonderful thoughts and wishes for getting me out of my funk. I'm feeling much better now that I had a stress-less weekend and was able to have some good conversations with Sweetie (plus lots of snuggling).

We have our appointment with Dr. Uterus tomorrow to discuss what happened with this last miscarriage and we've been dutifully preparing our questions for him.

Here are some of the biggies (with my own commentary, of course):

- What really were the chances of this happening two times in a row?
I'm more and more convinced that this was probably more common than he would have led us to believe. I don' tremember exactly what he said, but I got the impression that it was very unlikely that it would happen twice in a row.

- Do we need to have additional testing on either us to see if we have 'sticky chromosomes' that predispose us to nondisjunction problems (which in turn cause those pesky monosomies)?
While this wouldn't be something we could fix except possibly through donor gametes, at least we'd know.

- What are the chances that PGS on our remaining six totscicles will destroy them?

- How successful is the PGS test in finding chromosomally abnormal embryos and can it be done on 5-day thawed blasts?
If it is only 30% effective, for example, it may not be worth it.

- Do we need to do any immunological testing, even though both miscarriages were chromosomal?

- What are our chances of conceiving naturally?
I want to this know because frankly, there hasn't been a time that we had a legitimate shot at pregnancy while we were trying naturally. The first year we tried, my tubes were blocked. It was like I had my tubes tied. Nothing was getting through. The two times I have gotten pregnant, it was through ART and the months that we were 'off' I was either benched with ovarian cysts or getting over a miscarriage (which does wonders for messing up your cycle). I want to know if we have a legitimate chance even though ART may be a faster process - if it works.

- What are the protocols for doing an FET (which we would likely do next)?

- What is the thaw rate that the IVF lab has for frozen embryos?
Just because we have six on ice, doesn't mean that all six would make it through the thaw which really kills me, but what can you do?

And, before I head back to the padded cell, I'd like to say a little word about statistics. Several of those questions up thar can only be answered with statistics. I have come to eye statistics warily and with much suspicion over these two years. Statistics really aren't that useful to me anymore because they really don't help predict anything with respect to me. I've had lots of things happen that statistically had a very low probability of happening and yet happen they did. So, while they're somewhat helpful, I tend to make decisions now based upon the worst case scenario, not the statistically predicted one.

They also set me up for even more disappointment when something that should have a low statistical chance of happening (like a second monsomy miscarriage in a row) happens. Not only are you grieving that you have lost another pregnancy, but you are angry because statistically, this wasn't supposed to happen (don't even get me started on the statistics of miscarriage after hearing the heartbeat. That to me is the greatest travesty of statistics of them all.)

So, while I've pretty much given up on statistics, they are a necessary evil. I'm also stuck with them since Sweetie, mathematically-minded guy that he is, lives for statistics. I may ask Dr. Uterus, though, not to give us any more specific predictions about the chances of us having another miscarriage. We tend to take what he says as gospel so when it doesn't come to pass, there's another disappointment to handle.

Are there any other questions that we should be asking? Any thoughts would be greatly appreciated!
image: Dom Dada

A Dark Anniversary

I was in the shower this morning when I remembered the date: April 16. Today, one year ago, I learned that our first pregnancy had ended while we were on vacation. I had gone to Dr. Uterus' office looking forward to seeing how much the little one had grown, hearing the heartbeat again - and maybe, just maybe, being released from his care and into the hands of an OB for the rest of the journey.

Instead, I got a stab of panic when he found that the baby was measuring small for the time frame. It was supposed to be my 11-week check-up and the baby was measuring at 9w2d. Then, I got abject terror when he couldn't find a heartbeat. Then, I got numbness when he said those two little words: "I'm sorry." It was a terrible, terrible day.

I know that today is not that day, but even a year hasn't dimmed the memory, the pain or the heartache. It is all still there, just under the surface.

image: Ashimjara

7,558

I wish I could say that this is how much we are getting in a tax refund (not even close since we aren't getting a refund at all and are actually providing a refund to the man), but instead I have to report that this is my HCG level as of this morning. I have to lose at least 7,553 more unit-thingys before I can be "pregnancy-free".* I did the math (well, I punched the numbers into a calculator which then did the math) and found that if the levels drop by half every 48 hours on the dot, it will take 22 days from today to get to baseline. Of course, nothing goes the way it is supposed to, so this is a wild guestimate.

I also made the mistake of looking at my records for my other D&C. A week after the procedure, my HCG was a whopping 350! Of course, the baby died about two weeks before we had the procedure, so during that time, I'm sure I did some serious dropping. In the end, it still took me 6 weeks to make it to below 5. Yikes.

Why does this bother me? Well, because even if we aren't going to see Dr. Uterus anytime soon, it would still be nice to think that there might be a chance for an oops. As long as the HCG is up there, the ovaries are not going to cooperate to make that happen. I know I shouldn't even be thinking about pregnancy, including an oops, but part of me just can't let go of the notion that I should be doing something to get knocked up even if that means just knowing that I might be fertile and having unprotected sex. Besides, part of me still dreams of being able to call up Dr. Uterus and say, "Guess what?! I'm pregnant and I didn't need you to get that way!" This is very indicative of how my day-dreams about pregnancy have changed over the years. I used to spend a great deal of time thinking of elaborate ways of telling my parents that I was pregnant. Now I fantasize about telling my RE that he's obsolete.

I did mention to the nurse that I haven't had a full-on period yet (just spotting) and she indicated that this usually equates to the levels going down faster. I won't read this as gospel, but it's encouraging. I go back next Monday morning for another draw. As a present to myself, I asked to be able to have all of my bloodwork after the D&C to be drawn at an off-site lab rather than going to the office each week and see all of the glum faces of the nurses who know what happened. So far, this has worked very well as the ladies at the lab don't know me, don't know my history and are extremely efficient. And, no glum faces. This and the Cadbury caramel egg I had after lunch totally made my day - well until finding out how high the level was. I think another caramel egg after dinner (which will also feature a nice Rioja from Spain) is definitely called for.

And, another benefit is that once the number goes down, maybe I can finally stop having hormonal rages (or "being pissy" as Sweetie calls it). Or maybe, I just won't be able to use that as an excuse for "being pissy".

*I won't bother to discuss how ironic this is. I'm at the point of just shaking my head.

The Flash

I had one of those moments today when a conversation caught me off guard and reminded me of how much I still hurt from the miscarriage. I was talking to one of our contractors who mentioned that he had not been in the office this morning because his wife took him with her to the doctor's office. She's pregnant, in her first trimester, and had started spotting. They went in for an ultrasound and saw the flash on the screen showing the baby's heartbeat. At that mention, my heart began to ache because I remembered when Sweetie and I had that amazing experience watching our own little one's heartbeat flashing on the screen. I had never experienced something so wonderful as that day, especially since we also heard the heartbeat for the first time. It is now particularly painful to hear someone else talking about having that moment because the baby whose heartbeat I heard so vividly (and can still hear) is not here and never will be. I still miss my baby.

My Failure Complex

I am the consummate overachiever. I was in all of the Gifted and Talented classes in school, I did the AP thing (although not the sciences - I'm not crazy), and I used my SATs to get into a very good school. I did very well in grad school and am doing well in my professional life. I even aced my driver's test when I was 16. In all of my 31 years, the only thing I have failed was a test in a stupid biology class. It was a horrible feeling.

Since then, I haven't failed at anything I have tried. Except this. And I have failed spectacularly. What is so galling is what a public failure it is. Your waistline never changes, your boobs never get bigger, you don't have The Glow. People who see you week after week know that you aren't succeeding. You begin to regret telling so many people when you started because you know that you will get The Question eventually and you will have to state the obvious (since you aren't huge and you don't have a baby in tow) and wait for them to ask the Other Question (so, what's the problem?). You begin to withdraw from those who you knew, particularly your friends who have managed to succeed in this particular endeavour.

I, like many of my peers, was always told that if you put your mind to it, you can do anything (or something to that effect). That's not really accurate because it assumes that you have control over what you put your mind to. How many writers have put their mind to writing the next Great American Novel but it never makes it to an agent? How many kids go to Hollywood every year trying to break into acting and end up doing porn? How many women think that it will be easy as pie to get pregnant and then wind up amongst the ranks of the infertile?

Failure has never really been an option for me because that would imply that I wasn't working hard enough, studying hard enough or putting enough of myself toward reaching a particular goal. I am doing everything within my power to get pregnant and have a baby and I am still failing. My inner shrink is saying that by focusing on just this one aspect, I am setting myself up for failure. I am succeeding in other areas of life - I have a wonderful marriage, two beautiful and healthy furry beasts, friends, a good job, a home, a nice car, etc.

I also know that getting pregnant is actually the easiest part of the journey. Having the child, raising the child, loving the child and parenting the child until you die are really the hard parts and where the stakes of failure are not just personal but arguably involve society as a whole. The failure of a parent to effectively raise their child results in terrible things everyday. The moral of the story, then, is that the consequence of getting pregnant and having a child raises the spectre of failure much more often and profoundly than the (probably temporary) failure to get pregnant at all. And, maybe it isn't such a horrible thing to fail once in a while.

The Whole Sordid Story, Part II

Dr. Uterus is a firm believer in using all available methods at his disposal to essentially get a girl knocked up. When I met with him after my surgery and learned that Sweetie's count was still too low to make natural conception likely, he said that intrauterine insemination (IUI) with stims was our best bet. And, he wasn't going to use some rinky-dink drugs. No, sir. He wanted to go straight to injectibles.

And so, I moved to turkey basting. I had no problem with the plan. I wanted to get pregnant as quickly as possible and this was the best way to maximize my chances, short of IVF. Once I got my second period after my surgery, I began my first IUI cycle.

Of course, the first step was learning how to give myself injections. I realized that I actually did finally have use for the term "meniscus" and I was immediately transported back to Chemistry lab in high school. I agonized over getting every last drop of medicine into the syringe and making sure I used the smaller guage needle, not the mixing needle for the final poke. I carefully monitored every twinge and made sure to follow the directions entirely.

I don't remember how many eggs I ultimately produced because I really had no idea what was going on. I went to all of my sonogram appointments and had a hard time making out individual egg follicles from the blobs I saw on the screen. I also didn't know what the numbers meant - a 15, a 16.5, a 14. It was all Greek to me. I just had my instructions for medicine and I followed them. I took the HCG trigger and about 12 hours later it felt as if my ovaries and fallopian tubes were on fire.

I finally made it to the insemination day. Sweetie accompanied me to the appointment and for the very first time I had ever been a "lady doctor" there was someone other than the nurse and the doctor in the room as I had my feet in the stirrups . It made me even more nervous and so I was already unable to relax. Relaxation, of course, is key when you have a piece of metal shoved up your snatch so, it was just a little uncomfortable. Afterwards, we went and had lunch, although I really just wanted to get back to work and try to have a normal day.

In the end, that cycle and the next cyle didn't work. By January 2007, I was really getting down. I knew that I needed to get some professional mental help, but I wanted to find someone who dealt with infertility. I was able to find someone who immediately began to help me understand some basic truths: we have no control over what happens to us. Being a control freak with obsessive compulsive disorder, this didn't sit well with me, although I knew that it was true.

We were also benched that month for the very first time since starting on injectibles which at first I was incredibly bummed about, but then realized that I needed a break. I continued to meet with my mental health professional and tried to focus on other things. In February 2007, we were back in business and the most amazing thing happened: I got pregnant. Dr. Uterus finally knocked me up. It was the most wonderful feeling in the world (aside from the nausea, mood swings, and general crankiness).

Unfortunately, it wasn't meant to be. After we got back from vacation on what was supposed to my 11-week check up, Dr. Uterus determined that the baby had died at around 9 weeks 2 days. I was by myself at that appointment. We figured that there really was no reason for Sweetie to go with me since it was just going to be a routine thing. I was numb until I left the exam room and it just swept over me. I made a beeline for the bathroom and bawled. I managed to drive myself home and Sweetie came home shortly thereafter. We were absolutely devasted. We had worked so hard to conceive this child and it was loved so much already. To have it taken away so suddenly was just awful.

I had a D & C a few days later and we elected to have chromosomal analysis done on the "products of conception" (their term, not mine). It turned out that the baby had a monosomy, meaning it had a deficient number of chromosomes. Approximately 4% of fetuses with this abnormality make it to live birth and are then determined to have Turner's Syndrome. Ours was one of the 96% that did not make it.

What bothered me a great deal in those first few weeks was that I had really thought I had made it through the rough patch. We had heard the heartbeat (twice!) and it was so nice and strong. That sound was just amazing. All of the statistics I had read convinced me that once the heartbeat is heard and its strong, you are doing pretty well. I felt cheated and robbed.

It's been six months since my miscarriage and I still hurt. I also feel as if we are even farther from our goal, not closer. I can get pregnant, but I just can't carry to term. I know the reality is that this could have happened to anyone and wasn't necessarily a problem with either of us. But, still, it's hard not to blame yourself.

We have since done two IUI cycles, both of them negative. Right now, I'm so tired of the rollercoaster, although I have no doubt that it is not near what IVF would be like. We still want to have kids of our own and it doesn't look as if we have any major obstacles in our way. It is just the daily grind that is so debilitating, so wearing down on me. When, when will it be our turn?

The Whole Sordid Story, Part I

So, how did we get here? We got married in 2003 and decided to start trying for a baby in 2005. By the time we left for vacation that year, I finished my last birth control pill and we were giddy at the thought of having completely unprotected, baby-making sex. Needless to say, we had a great vacation.

I realized when we got home, though, that I remembered nothing from 9th grade biology about how my cycle worked. After all, why did I need to pay attention before then? I had been on birth control pills for the previous 10 years. The most I thought about it was to know that I needed to refill my prescription. I recalled from my days on the Knot boards that there was a book that every girl who wanted to get pregnant should read: Taking Charge of Your Fertility by Toni Weschler. I dutifully got my copy and was wowed at how little I really knew.

I faithfully charted for several months and tried to figure out if I was ovulating. When I finally did ovulate, I was ecstatic! I told everyone, including my parents who promptly responded that they really didn't need to know that much detail. But, I still didn't get pregnant. Five months after we started trying, we moved to a new city and had to spend time getting acclimated.

By January 2006, I knew something wasn't quite right. I went to see a GYN and he promptly put me on Clomid. He told me at the time that if I didn't get pregnant on Clomid in six months, he would refer me to the infertility clinic across the hall, which sounded an awful lot like being sent to the principal's office. Of course, six months later, I wasn't pregnant. So, across the hall I went.

I didn't like the RE at all. I knew that immediately. He just seemed very disinterested and unsympathetic. I had met a neighbor who also went through infertility and she told me to visit her former doctor. That is how I met Dr. Uterus.

Late August 2006, Dr. Uterus performed an HSG and found that both of my tubes were almost completely blocked. This was a total shock, especially since before the procedure he opined that it would be very unlikely that I would have that particular problem. I was told that there were two options: surgery or IVF. Sweetie and I talked it over and decided that the best option was surgery, particularly since I had been diagnosed with endometriosis when I was 19 and I wanted to know if it had gotten worse. In early October 2006, I had laparascopic surgery in which Dr. Uterus completely cleared out my tubes and found no endometrosis. The most frustrating part was learning that the tubes were just blocked with debris but there was no particular reason why that would happen. I scoured the Internet searching for information on this happening and couldnt' find anything.

While I was healing, Sweetie went back in for another analysis, since he had also had low sperm count. It was still low, so Dr. Uterus advised that it was best to go with IUI with my newly opened tubes.

Part II: in which our heroine learns how to get a shot and tries out turkey basting 101.