Chez Perky

Too Funny

Back in March, I posted that I was freaked out because an online due date calculator which calculated all sorts of things from LMP to conception to IVF retrieval & transfer dates and even due dates for singletons, twins, triplets, and quads as well as dates you could have CVS, amnio, and glucose tolerance tests done had calculated my due date with triplets as September 19th. Since technically my 40 week due date was November 7, this completely freaked me out.

Hey, guess what? It was 100% correct! That's even freakier!

Followup to " Envy "

Some commenters say that my fertility envy will fade with time. Other commenters say it will never go away. Some say when I get to my ideal family size I'll feel better. Funny, I always wanted four children, which I'll have after this, but I never considered that it would be only one pregnancy. I suspect that it varies from person to person... there's no right answer here. And I definitely don't begrudge most people their pregnancies. Not even fertile myrtles. Not even, heaven help me, Michelle Duggar. But I grieve my inability to just BE pregnant. I grieve the freedom to say, as the Duggars say, that I'll have chilren until God tells me not to. I don't want 17 children per se. I want the freedom to make that choice. And I grieve the loss of that choice.

One anonymous commenter wrote:

It will fade, you will feel better over time.
For me pregnancy was almost the time to rehash and process all my infertility feelings. And of course, you're not a mother yet. Sure you wanted pregnancy, but what you REALLY wnated is the small head in the hollow of your neck, a baby nuzzling at your breast, a toddler shouting MUMMY and running over to hug you.
Those are the things that will heal you, not a terbutaline pump in the leg and bedrest.

The thing that struck me the most was : And of course, you're not a mother yet.

Oh but I am. If you're newish to my blog you may have missed it, but I have a beautiful almost-four year old foster son. He's not really a foster son, exactly, because he was a private placement, but I'm his legal guardian. I may not be his biological mother, but I've been his mother for almost 3 years. He knows no other mother. I could not love him one teeney bit more if I had given birth to him. I have no doubt that I could adopt a dozen children and love them just as much. I also know that I still would have grieved the loss of this pregnancy experience had I never gotten this far. Even though it makes no difference in how much I love my beautiful boy. J will probably be with us forever. He is my son in every sense except the legal sense. He knows no parents but us. There is no greater joy in this world than being a parent, and still, the pain of infertility is as raw as it ever was.

It's rare that it is someone else's pregnancy that brings out the pain for me. It's usually something far more personal, something intrinsic in myself. This time it happened to be someone else's pregnancy. Someone who got pregnant within six weeks of getting married. She certainly didn't do it to upset me. And it's certainly not her fault that it did. And most people in the community don't even realize that I COULD be feeling left behind in the child-bearing department. After all, we've been parents for three years. And now we're having triplets. So how could we possibly feel remotely out of place amongst those having their their third, fourth, fifth...?

It's true though... it's these babies that will ultimately heal me, not the terbutaline pump and the bed rest. The terbutaline pump and the bedrest do nothing but remind me that this is NOT a normal pregnancy and that I'm STILL set apart from most pregnant women. But I'll love these babies. Of that there is little doubt.

Envy

You'd think this would go away. This ridiculous infertile envy of mine. I'm pregnant for crying out loud. I know lots of people look at my blog, see that I'm pregnant and click away immediately, sorry that they accidentally stumbled on yet another pregnancy blog. I'm one of THEM. One of the traitors. No longer one of the team. But once a stirrup queen, always a stirrup queen, I say. Pregnancy has made me no less infertile. Pregnancy has made me no less capable of just deciding that I want to get pregnant and making it happen. Pregnancy has not created in me the freedom to make my own reproductive choices without the interference of a team of doctors.

Oh, but what's that, you say? Triplets? Why, oh why would I ever need to contemplate more children anyway? I'll tell you why! Because if I were fertile, I'd be ABLE to contemplate that without anyone asking me such a ridiculous question, that's why. Because never in my life did it occur to me that I would have one pregnancy and be done. Because it never occured to me that my only pregnancy experience would be a high-risk, bed-ridden, terbutaline-laden experience.

And where does the envy come in? I have a friend who got married in early February. On my husband's birthday, in fact. I was in the middle of a doomed IUI cycle, or so I thought. I had, in fact, that morning been to a monitoring appointment in which a doctor had given me yet another quizzical look and basically said, "Well, at least we know this is the last cycle, and we're moving on to IVF next cycle." My friend is a lovely woman, and she married a lovely gentleman, another friend of ours, and we couldn't be happier for them. But I was near tears all day. I'm not normally like that during a cycle. I normally take the ups and downs of a treatment cycle fairly well, but that cycle just kept going SO BADLY and I was so very tired. And it was February, which meant that the bride, beautiful and radiant, had plenty of time left in the year to get pregnant and have a baby before year's end.

And guess what? She's due to have her first baby in December. Which means she got pregnant a month after I did. (I had my IUI mid-February that month to get pregnant with the triplets). And I wouldn't wish infertiity on her. I really wouldn't. Not for one, single, solitary second. I wouldn't wish it on ANYONE, least of all her. But... but... couldn't she at least be due in January? Couldn't I have just been wrong once?

I am surrounded, and I mean SURROUNDED by pregnant women in my community. It's one of the pitfalls of being an infertile woman living in an Orthodox Jewish Community. One woman is due around the same time that the triplets should be making their debut with her first from her second IVF cycle and I couldn't be happier for her. The others, as far as I know had no struggles (they are all relatively newly-weds, or they are on their second, third, or fourth children in pretty short time spans). Between early July and the beginning of October, there are 10 babies (counting each of the triplets as one baby) expected (and now, if you expand to December, 11 counting this friend I described above) in a one mile radius. Four were born in the last 10 days. Three of us are expecting arrivals in late September (including me). You would THINK that with me being one of the pregnant ones for once, I wouldn't be jealous. But I am. I really am. And worse, there's a piece of me that just HATES that I'm not special, and a piece of me that LOVES that the triplets set me apart from all the other deliveries coming, because at least in that sense, my babies still ARE the special ones. Because I really AM that petty and childish.

You'd think I could just be genuinely happy for everyone else's good news. And usually I am. I truly do not believe there is a limited amount of fertility in this world. I don't believe that another woman's pregnancy takes away from my "chances" of a pregnancy. And yet, when I learned of my friend's pregnancy, I felt hollow and empty and mean. I wanted to leave the room and cry if I could, but I knew I couldn't. And no one, NO ONE, understands why it would matter to me. I mean, I hit the jackpot, right? Triplets! I never have to worry about having kids again, right? Except that I hate that people just assume it's okay to say that. "Well, at least you're done and you never have to do this again." What a horrible thing to say. What if I WANT this again? How exactly is having a catheter in my leg pumping medicine into me 24/7 a fun pregnancy experience? Why is it okay to assume that I'm just loving this "perfect" pregnancy from my bed or recliner from which I am allowed to emerge for a meal or for the bathroom or for a doctor's appointment, but for nothing else?

But it's not fair of me to blame fertile myrtles either. My friend never did anything to me. She isn't even the one that told me she was pregnant (I'm closer with her sister who told me because I talk to her far more often). She's never said "nanny nanny boo boo. it took you five years and tens of thousands of dollars of treatment, but I only took a month, so pbbbbt!" I'm sure it's never occurred to her. She's quiet and unassumming and beautiful and so unbelievably perfect. I'm not angry at her. I'm angry at myself for not being mature enough to just be happy for her. After all, I have everything that I wanted. I have an amazing husband. I have the pregnancy I begged and cried and prayed for (even though technically I prayed for a SINGLETON pregnancy). I have a beautiful amazing foster son. I have a home I love and a supportive community. I couldn't ask for more.

And yet, I still envy her, and I hate myself for that.

Miscellaneous

DC Get-Together
I think I posted that I was going to get together with some DC-area bloggers. I almost chickened out, but I decided to be a grown-up and just walk up to a group of random women who looked like they might just be a bunch of infertility bloggers. Thank heavens I picked the right group! There were nine of us there, and we really had a terrific time. I felt a little bit awkward at first, being the token pregnant-lady there, and it's not like I can even hide it at this point. I mean, I'm fat in the first place, but at this point, I definitely am visibly pregnant and I can't just pass it off as too many pints of Ben and Jerry's. Anyway, no one seemed too bothered by it. My husband had suggested I wear a nametag that said, "Hello My Name Is Myrtle" but I declined. ;)

At any rate, it was a fabulous group of women and I'm thrilled to pieces that I got over my ridiculous self long enough to take a deep breath and walk up to a group of strangers, because it was truly the most enjoyable evening I've had in quite some time. Even if I did have to get up to pee four times (and seriously, we could NOT have been seated further away from the bathroom!). Good thing I'd insisted on sitting on the end. What a fabulous group of women we were, though! I think we may have scared the waiter a little bit, but that's okay. It just means he earned his gratuity, right? It was a touching and hilarious night. Lindsay was so sweet and perfect, and such a doll for organizing the group in the first place. I hope we do this again soon! (though I don't know if I'll be able to make the next one... it totally depends on whether I do get stuck on real bedrest... we'll see) Maybe next time we can have pedicures and mojitos (virgin for me - oh the irony!) at my place. :)

Some Questions Answered

Are you going to find out the sexes? Most emphatically, no. I have no intention of finding out what flavor these babies are. I figure I should get to do at least ONE thing the old fashioned way! Plus, our lives will be upside down no matter what, I seriously doubt it's going to matter whether they're boys or girls, and it's likely that we'll have a mix regardless of how they're distributed. My husband, I think, would really like to find out. But, well, I kind of have veto power when it comes to the dildo-cam. Plus, his logic with finding out with a singleton was that it would be easier to plan. I don't think the logic holds with triplets. I don't think you can really plan for triplets, you just have to pray a lot! :)

When are you due? Heck if I know. I don't even know how to answer that question. I'm due November 6, technically. Except, that's never going to happen. I will deliver no later than September 26, which is exactly 34 weeks (also erev sukkot). I hope to at LEAST make it to September 12, which is 32 weeks, which I don't think will be a problem. My perinatologist gets almost all their triplet patients to 34 weeks, with very, very few exceptions.

When does bed rest start? Heck if I know. I was originally told that it would unequivocally start this week. However, that appears to be more flexible than I was originally led to believe. Apparently because I'm doing so well, I get to lead the decision on when bed rest begins. I believe most of why I'm doing so well is that with only a couple of exceptions, if I'm not at work, I'm at home on bed rest. The DC Get Together was one such exception. But I've otherwise gone straight home and curled up in a recliner or my bed and not moved until I have to (usually to pee! Gah!). I intend to remain relatively strict about this, because I do enjoy the flexibility to occasionally break my self-imposed rules. I would not be so cavalier about breaking doctor-mandated bed rest. So for the moment, I'm not on bed rest officially and won't be until I feel it's necessary or until the doctors get uncomfortable. And that's all I know.

Some Sad Googling

heavy bleeding contraction-like cramps: I'm going to assume whoever wrote this query is pregnant. Even if you're not pregnant, the best advice I can give you is to contact your doctor. It could be nothing serious. I hope it's nothing serious. But your doctor should know what's going on.

iui cycle failed: I'm so sorry. I've been there, and it's no fun. The best thing for me after a failed cycle was knowing what would be happening next. A new IUI cycle? An IVF cycle? Same Protocol? Change in Protocol? I liked to know all of that ahead of time, before it failed, not because I wanted to be pessimistic, but because it helped me take a failed cycle and psychologically turn it into a new beginning.

cyst in ovaries while pregnant: I haven't had this problem, and I know it's not uncommon. But there are so many ways this could be read. It depends on how big the cysts are, how many, what kind of cysts they are, etc. The good news is that you wouldn't know that you had cysts if your doctor didn't know, so I don't have to worry that you aren't under a doctor's care. I hope you are able to find out what your options/needs are from your doctor. If you aren't comfortable with your doctor's advice, please seek a second or third opinion.

triplet pregnancy blogs: This, of course, isn't one of the sad ones. You got me. I've definitely got a triplet pregnancy blog.

ovaries and kidneys picture with uti: I'm not quite sure what to make of this one. Anyone got any help on this one?

my ovaries hurts is that a sign that i might be pregnacy: More likely your ovaries being sensitive is a sign that you ovulated. The surest sign that you're pregnant is the presence of hCG in your blood and urine by about 14 days post ovulation. So wait a week or two and POAS.

ovary uncomfortable: That certainly sounds unpleasant, though I often wonder how women know that it is specifically their ovary that feels uncomfortable.

severe pain in my ovaries: Any time someone suggests "severe" pain to me, I suggest contacting your physician. Anything that far outside the range of normal should be reported to your doctor.

cramps near ovaries during early pregnancy is it normal? Yes.

menstrual cramps worse after iui: This is also normal. I didn't have cramping after all of my IUIs, but I did after a few of them, and it's very normal. Introducing anything into the uterine environment can cause it to contract, which will cause that cramping feeling. Now if what you meant was after a failed IUI the cramps associated with the subsequent period are worse than normal... well, that's normal too... especially if you were on progesterone supplements. It's really unfair.

Something that Shocked Me (in a good way)
I forgot to mention that at my perinatology appointment last week, I'd made a crack at Dr. G about being bitter that they weren't going to let me push these babies out the old fashioned way. I gave my usual shpiel about how I figure the babies are going to be so tiny that they'll just come right out, no problem!

His response astounded me. Instead of their usual bit about "fetal distress", "maternal hemmorhage", "healthy outcome" and all that rational, logical stuff, he said, "well, it's just that to do a vaginal triplet delivery everything has to line up perfectly and the odds are really low that it will, especially since you don't have a lot of room for them to move around in there, but I've done it. Both Dr. P and I have done vaginal triplet deliveries." Really? I mean, REALLY? Here I was just giving my usual joke figuring on the usual rational, logical answer, and I'm hearing that it STILL DOES HAPPEN?

"Look," he said, "when the time gets closer, if everything is lining up perfectly, which it probably won't, and you still want to talk about it, we can absolutely do that, but you have to understand how low the odds are of it happening that way, and you have to understand that we reserve the right at all times to tell you that we're not going to do it." I totally get that. But I mean... really? It could happen? Even just that 0.0000000001% chance? Really? Sure, but don't count on it. Especially if the previa doesn't completely resolve itself (it's moved significantly, but it's still in the way a bit).

Still, something about the c-section not being completely written in stone makes me feel a zillion times better. I have the absolute dumbest reason for not wanting a c-section. I want nothing to do with an epidural. Now, if I did a vaginal delivery, I'd still have to have an epidural in place, though I wouldn't have to have drugs running through it. But my fear of the epidural is two-fold: First, I never, ever, ever, ever, ever, ever want a needle in or near my spinal column ever. Second, I don't want to not be able to feel the lower half of my body. This terrifies me. I had a TIA when I was 23, and it was terrifying not to be able to move or feel my left side. I never want to purposely experience that again. So while I wouldn't get out of having the needle in/near my spinal column, I COULD get out of having to be numb in my lower half. I mean, it's NEVER going to happen. There is no possibility that I'm not having a c-section. But there's something comforting about being able to pretend for a few weeks that I have options.

Update: Carol mentioned that she'd been wondering why a c-section seemed to be the default for triplet deliveries on TV... e.g. is it because it's easier for the doctors or because vaginal triplet deliveries aren't possible? The answer is that in MOST cases, vaginal deliveries aren't safe for mother OR babies. Certainly it IS easier for the doctors (and less liability), but there's mostly the fact that very few triplet pregnancies really are conducive to safe vaginal deliveries. I'm very certain that I will not be allowed to have a vaginal delivery, but I still find it oddly comforting that my doctors are willing to consider the conversation if by some miracle everything really did line up perfectly and the stars were perfectly aligned and the moons were in all the right houses and I sacrified the right color goat...

Advice Sought re: Childbirth Class
Here's the thing. I feel like if I were a responsible parent-to-be, I would take a parenting/childbirth class. Except that they are largely geared toward women having singleton, vaginal deliveries, which, we all know, I am not. So there are multiples classes available, except not so much. The closest class to me that's a multiples class is in Baltimore and it's only offered on Saturdays, which doesn't so much work for me. (My rabbi doesn't seem to want to give me one of those "Get out of being Jewish for a Day" cards... drat!) Okay, so to heck with those options.

I COULD take a caesarean class. EXCEPT, honestly, those are basically about what to expect from the procedure, the anesthesia, and recovery. Oh, and you get to watch a video of a c-section. Now, I've seen LOTS of videos of c-sections. I have had surgery before. I am not freaked out or anxious about the c-section per se. My irrational fears of the epidural aside, I have no anxiety about this in the least. I know what is going to happen, I understand my role ("lay there and do what we say"), I know what recovery from abdominal surgery is like, and I know it will suck a lot more than recovery from having my gall bladder removed laproscopically. So what's the point? Even the nurse at the perinatologist's office said if I wasn't feeling anxiety about the c-section, I probably wouldn't get much out of any such class.

So aside from getting my infant-CPR renewed, which I'd rather do closer to the delivery anyway, what should I do? Should I just accept that you don't have to take some ridiculous class in order to be a responsible parent-to-be?

My husband also wanted to take a "Daddy Boot Camp" type class but every area hospital that has a Dads 101/Daddy Boot Camp/whatever you want to call it class offers it only on Saturdays, which, again, doesn't work for us. So now he's looking for some sort of book, but from what I can tell, all the dad-centric books are awful, so I think he'll just have to wing it, unless you all have any suggestions.

One more Google Hit Before Bed (Updated at the Bottom)

I'm exhausted, having been kept out way past my bedtime tonight, but I noticed a keyword search in my statcounter I didn't want to ignore...

heart surgery for treatment of migaines: For those of you who are relatively new to my blog, you probaby have no idea why this would have popped up my blog in a google search. But whoever did this keyword search should know that yes, there ARE currently three concurrent studies going on that involve heart surgery for the treatment of migraines. It seems that a large percentage of migraine sufferers have a "patent foramen ovale" which is a condition in which a small valve which normally closes at or near birth didn't close, so you've essentially got a small hole in your heart. This is generally not considered a huge deal and most people who have one never know it, but it is beginning to be associated with early stroke and with migraines. A recent couple of studies involving closing the PFO for stroke patients showed a surprising number of patients who had the lucky side effect of total or significant resolution of migraine symptoms after having the PFO closed. Thus, some new studies have been started and are currently in progress and recruiting patients.

I almost participated in one such study but was disqualified because I get too many migraines. Truth be told, I didn't try all that hard to qualify. There was a qualifying month in which I had to keep an electronic headache diary that I transmitted to the clinic every night. If during that month I had been extremely cautious about every single migraine trigger I have, and if I'd worked harder to sleep more and work less, I probably could have stayed under 14 migraines in that qualifying period, though it would have been challenging since I was just weeks post-miscarriage and in a very busy period at work. But I also knew that qualifying for and participating in the study would have meant taking a year off of the whole fertility treatment thing and I just wasn't sure I was willing to make that sacrifice, even if the payoff was the possibility of a life without migraines. Even the debilitating, life-altering migraines I get on a regular basis. It wasn't an easy decision to make, so obviously, my sub-conscious made the decision for me.

If you want to read more specifics about my experience with trying to decide what to do about the study, look at my posts from November 4-15, 2006. If you want to talk in greater detail about the studies themselves or what I know about them, please feel free to email me directly.

Edited to Add: I was just re-reading my posts about the migraine study and my decision-making process. I waffled a lot about whether to participate. It was a really hard process for me, because the bottom line was that if I'd qualified and decided to participate, that would have meant going on birth control for a year, which was a huge thing for me, shockingly enough. This post in particular, highlighted the conflict of emotion I was feeling through the process, but one line stood out above all:

And yet... I would gladly suffer migraines forever in exchange for a baby.

It's still true, you know. As much as I complain about the migraines... as insufferable as they are... I worked so hard, cried so many tears, suffered so much (and yet, not nearly as much as many of my fellow stirrup queens)... these babies are what I wanted. They are what I want. I wouldn't trade them for anything. Not even a life free of migraines. I'll take the heartburn and the sciatica and the nausea and the round ligament pain and the oxygen deprivation and the sleep deprivation and the anxiety and the contractions and the baby punching my cervix and yes, even the migraines. I'll take it all with a smile on my face when I can, because I want these babies so badly I can taste it. I love them already and I'm already terrified that I'm failing them as a parent by even thinking about the negative parts about this whole pregnancy thing.

The one thing that my children... all our children... will always know is that they were, above everything else... wanted. And THAT is what makes all this infertility bullshit worth it.

Just a Point of Clarification

No, I most certainly did NOT want quadruplets. I have a completely irrational fear, in fact, of having triplets or quadruplets. To be honest, for a first pregnancy, I'm even adamantly against having twins, even though I've always wanted twins.

To repeat: I'm positively terrified of high order multiples and even twins make me wary right now. So um, yeah. I was definitely joking about losing my chance at quadruplets (because even if I'd had four mature follicles... the odds of ending up with quadruplets were infinitessimal).

I've actually made it clear to my RE's office that twins are acceptable, but anything more than two is their responsibility. (JUST KIDDING ABOUT THAT ONE TOO!)

Limited Fertility?

A friend of mine has 3 kids: a 5 year old boy (conceived naturally), and one year old twin girls (conceived via IVF). She came over yesterday under the guise of bringing me some soup (she makes amazing soups, so I never turn her down when she offers soup) to tell me that she's expecting her (dear heavens!) fourth child in July. Conceived naturally. Complete and total "whoops, how did that happen?" baby. She, in fact, isn't even certain of the due date, because she wasn't paying attention to when she ovulated and besides, she's still nursing twins, so who woulda thunk it?

She was somewhat nervous about telling me, given that she went to the same fertility clinic that I go to and she knows how hard it all can be. I told her I really, for the most part, don't work that way. I don't believe there is a limited amount of fertility in this world. Just because another woman gets pregnant doesn't mean there's one less chance for me, right?

Wow, she said. "What a great attitude, because I know when I was going through Shady Hell, every time someone told me they were expecting, I just thought to myself: 'die, bitch, die!'" I almost fell over laughing. She's a very religious woman. Extremely intelligent. A doctor. Very logical. Rarely emotional. It was completely out of character, but oh-so-funny!

IUI Tomorrow

I rarely receive anonymous comments on my blog (for that matter, I don't get that many comments at all, but I love the ones I do get), but I did get one today. It reads:

I'm thinking good thoughts for you. May your level-headed expectations be rewarded with the best outcome. The conflict with work has got me wondering: What actually is the statistical difference in a situation such as yours between an IUI and well-timed intercourse?

I don't actually know the answer to this. As far as I can figure, for most problems, IUI doesn't raise the odds very far above well-timed intercourse. I suppose in cases where there are issues with not having EWCM, the IUI makes a significant difference, since it bypasses the cervix. I know that in normal, healthy, fertile couples, with well-timed intercourse, there is about a 20% chance per cycle of successfully conceiving a child. I also know that the odds of IUI working in any given cyle are about 20% per cycle. Further, this is even true in women with no fertility issues... 20% odds per cycle, period.

So what does IUI actually get me? Well, for one thing, it guarantees the timing. There have been a number of medicated cycles that we've had where we wouldn't have been able to make the timing had we been relying on "the old fashioned way". Most notably, we almost missed out on the timing this cycle because I didn't think I'd get to mikveh in time.** In a non-medicated cycle, I simply don't ovulate, so that doesn't help either. So there's that. The guarantee of timing.

Other than that? Not a whole heck of a lot, actually. It just gives a bit of peace of mind, I suppose. I suppose this is one of the reasons I'm not terribly interested in continuing to do IUI for much longer. On the other hand, over three years of trying the old fashioned way, even with Clomid assistance, yielded no results, but 8 months of IUIs yielded a pregnancy, albeit a short-lived one. So I suppose in the long run, IUI has been good to us, comparatively speaking.

That being said, tomorrow is IUI day, and for whatever reason, I wouldn't want to rely on getting our own timing right, and I'm just as happy that S was able to get his work schedule to accommodate. I'm actually beginning to wonder if we ought to have a, um, you know, sample cryopreserved... just in case we have another conflict, but one he can't wriggle out of. I dunno. I mean, I suppose there's always the chance that it will be a moot point, right? After all, it's theoretically possible that I could get pregnant this time. Right? Stop laughing! Okay, I can't stop laughing either, but after I peel myself off the floor, I'll consider shooting my doctor an email to see if it would be a complete waste of time and money to have a back up plan, so to speak.

---------------
**Mikveh is... well, it's hard to explain. Jewish law mandates that a Jewish couple separate for a minimum of 12 days starting the first day of a woman's menstrual cycle (well, the first day she sees blood, which may, or may not, correspond with the medical definition of CD1). At the conclusion of their separation, the couple does not resume relations until after the woman has immersed in a ritual bath, called a mikveh. That's the short story. If you want the longer story, I can point you to some links.

get over yourself

First: I decided to go ahead and keep my appointment tomorrow and continue under the delusion that yesterday was Day 1. I did eventually have enough, ahem, well, you know, going on that I think I can make a reasonable claim that yesterday had full flow, even though today it's all gone again. Whatever. Anyway, I think the point is for some reason I feel like I need to be at CD1. It's important to me to feel like I've moved on. For whatever reason, getting my period December 1 didn't make me feel like I'd moved on from the miscarriage... it felt like one step backward, because it was too soon to deal with a new IUI cycle (my hCG had only just bottomed out and I hadn't finished getting my infectious disease testing and all that re-done). Something just isn't sitting right with me.

Second: I'm not quite sure what my deal is or why I can't just get over myself like I should, but I'm really having bad days lately. And nothing is going on to make them especially bad. I just feel like I'm having a rotten day. It's obvious I'm a bit blue... but what to do about it? I don't feel depressed, per se, and I don't think this is anything but a transient feeling, so I don't see the need to go on antidepressants, but gawd I really need to get over myself.

Third: I still can't get out of my head thoughts that we'll just never achieve baby-status. Then I can't stop thinking about our foster son... we've had him for two years and it looks like we'll likely have him for the rest of his childhood and adolescence. He's three now. But... his birth monster could theoretically come back at any time and petition to have him returned to her. And I know that's her theoretical plan (though it's been her theoretical plan for a LONG time and she's never done anything about it). She hasn't seen him in over 8 months, nor has she called, written, sent a card, acknowledged his birthday, worried about him when he's sick (she wouldn't know he's sick if she doesn't call, right?), emailed, asked for a picture, or sent smoke signals in all that time. And I keep thinking about her taking him back and whenever I go down that road, I burst into tears, because MY GOD how could a woman NOT want to know everything about this sweet, precious, beautiful boy? How could a woman NOT want to know how tall he is, what his favorite food is, what his favorite color is, whether he likes dogs, if he's sick, what size he's wearing, how much his personal lexicon has expanded (exponentially, that's for sure)? How could she not spend every waking moment wondering about him? I used to feel sorry for her. I used to imagine how hard it must be to be in her position. Now I think she's selfish and cruel. She says she loves him. She says she wants him back. But she doesn't even know that he needs lactaid milk or soy milk instead of regular milk. And she doesn't know that if you don't read his stories in the right order at bedtime he won't go to bed. And she just... doesn't even appear to care.

Fourth: Tomorrow, being my Day 3 baseline ultrasound and bloodwork, also known as the day I get to resume sticking myself with a needle every night ought to feel like a step toward progress. But it doesn't feel that way. I feel like I'm now just going through the motions because I don't know what else to do with myself. Yeah, that's pretty much it.

Appointment with YAD/Dr. Amazing

So I saw Yet Another Doctor (YAD) today. I like him a lot and have always appreciated his care and explanations when I've seen him in monitoring appointments. He is well respected and is the practice director, I believe, and quite competent. I went in thinking that anything less than agreeing to IVF immediately was unacceptable and knowing that Yet Another IUI (YAIUI) was likely going to be the answer I got. In fact, I got a compromise answer, which I think I can live with.

But I'm getting ahead of myself. I left work at 4:30 and arrived 15 minutes early for my 5pm appointment. I had failed to bring a book and they have the lousiest magazines in the waiting room there, but I had plenty of things with me to keep me busy. I wrote some notes about things I wanted to talk to the doctor about, and read some reports that I'd brought from work, making corrections as I read. My nurse came out around 5pm and told me that YAD was running quite late and he was very sorry. She couldn't stay long enough to meet with me after the consultation, but she said she'd talked with him about me and given him some history and that he would let her know what needed to be done for my protocol in the morning and she'd call me and talk about it and mail me any forms I need. Fair enough. Mary and I work very well together via phone and mail, so I'm not worried.

At 5:25, YAD called in the patient before me. I knew he was running late, so I wasn't concerned. I had already called my friend who was picking up J to let her know I'd be later than expected. YAD did something quite unexpected, though... he sent the other patient down to his office and stopped to introduce himself to me and apologized for running late and said it would be about 20 minutes. No problem at all. I was not stressed, but it was exceptionally nice of him to stop and tell me personally what was going on.

At 5:45 YAD came to get me and brought me back to his office. And that's where the fun begins.

YAD had clearly reviewed my chart very carefully, because he referred back to things that I discussed with Dr. T. at my first visit with her a year and a half ago. It was nice not to have to retell the whole story. Again. He was a little surprised I'd made it so far in the pregnancy before I miscarried, but then, I've NEVER been on the good side of fertility odds. He talked a bit about my mother's history of miscarriage (she had 7 or 8 known miscarriages, and since home pregnancy tests weren't available back then, she probably had other early miscarriages that she didn't know about). Other doctors have brushed off my suggestion that I have a clotting panel done to rule out a thrombophilia, saying that unless I've got recurrent miscarriages, it's unlikely to be an issue. YAD, who I think I will soon re-name Dr. Amazing, said right off the bat that the two most common causes of recurrent miscarriage are balanced translocation and thrombophilia. Rather than getting pregnant and miscarrying again, he'd rather rule those out. Good for him.

Well, we already know that I don't have a balanced translocation because Dr. T. ran a full karyotype on me after my first consult. But doing a clotting panel is a brilliant idea. I'm glad someone thought of it. (You know, like me, half my infertile friends, and now an actual Doctor!) Fine. So now we have a first step:

Step 1: Get bloodwork done. Again.

Now, the next question, of course, was whether he'd consider skipping straight to IVF. I'm not eager to do IVF by any stretch of the imagination. It's no fun. I'm not looking forward to finding out just how much harder IVF doses of follistim would be on me than the IUI doses. On the other hand, I'm running out of time. Dr. Amazing (yeah, I think that will stick) listened to me and was sensitive to my concern. He reiterated what Dr. S. had said about the fact that since IUI worked, it's really for the best to return to IUI first. Dr. S. didn't know about the insurance factor, though, because that all came to light after I met with him. So Dr. Amazing didn't say anything too shocking there... yes, more prudent to return to IUI. No kidding. I'm 31, can clearly get pregnant eventually via IUI, no need to put my body through all that, right? Right. It certainly can't be said that this clinic pushes IVF as a way to raise their bottom line.

However, Dr. Amazing was quick to point out that there's a balance between working with the slow and steady and simple approach and recognizing the practical concern which is that the clock is ticking on my coverage. Therefore, he said, I clearly can't spend too much time on IUI. He pointed out that squeezing in two IUI cycles takes less time than two IVF cycles since they can be done back to back and IVF cycles can't be. I voiced my concern that I've tended toward very long cycles (case in point: my second IUI was on cycle day 33, when typically you'd expect it around CD 14-16). And he didn't brush me off, though he could have. He looked back at all four of my cycles and read the doses and notes about response. He remembered having met me in several monitoring appointments when things were moving at a snail's pace. And after reviewing everything he said what he would do is start me at a higher dose than the last cycle (every cycle I've had has started at a progressively higher dose, so this isn't a surprise). Since they know how I respond to tiny doses and such, he anticipates that they'll be able to manage mydosing schedule pretty agressively and have no more than 7-14 days of injectibles before the hCG trigger. That's a far cry from 30 days of injectibles.

The skeptic in me still wasn't loving losing all that time with YAIUI, but I didn't say anything. Clearly, though, he understood my anxiety about it, because he drew out a timeline. He suggested going in for pre-provera bloodwork on December 18th and assuming all is looking fine, taking Provera for five days, which would put CD1 around Christmas. Can I just tell you HOW MUCH I LOVE THIS MAN? Only five days of Provera?? That's awesome. Normally I do 10. Not because 5 days doesn't work for me... just because some doctors prefer 10 days, some doctors prefer 5 days. I'm not sure if Dr. Amazing noticed me doing my happy dance in my chair, but if he did, he was kind enough not to say anything about it.

Okay, so steps 2 and have come to light:

Step 2: Pre-Provera BW on December 18th.
Step 3: Provera 5 days

If CD1 happens around Xmas... worst case scenario (he did the math, I'm not going to repeat it), if I did two back to back IUIs and then started an IVF cycle, I'd be looking at an egg retrieval in mid-March. If, however, I went straight to IVF right now, I'd be looking at an egg retrieval probably in late January (maybe as late as early February). "So what you're really losing by doing two IUIs is about six weeks." Well, when he puts it like that, I can handle that. Six weeks I can handle. 12 weeks I cannot. He acknowledged that my per cycle odds with IVF are likely about double my per cycle odds with IUI. But he reiterated that it's so much harder on the body that if the simple approach can work, it's best to explore it.

For a brief second I wondered if I should simply go to another clinic who would do IVF without asking any more questions. But I realized by the time I could be seen by another clinic, do whatever preliminary things they wanted me to do and started an IVF cycle, I could be halfway into an IVF cycle at Shady Hell with the strategy that Dr. Amazing was laying out for me. And certainly, if the IUI works, well, I've saved myself a whole lot of trouble, expense, agony, pain, and irritation.

I asked if there would be any advantage to staying on Metformin for longer if I get pregnant again. He said in patients with no history of miscarriage, he takes them off metformin when they get a positive pregnancy test. But with a history of miscarriage, he keeps them on it through the first trimester since there may be a benefit and there doesn't appear to be much, if any, risk. He believes, however, that the bulk of the benefit of metformin on miscarriage rates occurs before implantation... that it aids in the follicle development process, and some such voodoo and what not. He acknowledges that there's some possible benefit to metformin in the first trimester, but thinks that metformin mostly does its job before implantation. I can understand this, but I appreciate that he gave me a serious answer. I wasn't questioning Dr. T taking me off of it. I don't think that was the cause of the miscarriage. But I figured it couldn't hurt to stay on it if I get pregnant again, and he agrees. So he's made a notation in my chart to stay on metformin for the first trimester. That works for me.

All in all, it was a positive appointment. I went into it knowing what answers I wanted, and what answers I was likely to get. I came out of it with a compromise, but also with a doctor who was truly sensitive to the practical side which has me twitching right now.

I love Dr. T and I want to stay her patient. But she's transitioning to practicing only at the Columbia office, and that's just too hard for me. I love her. I think she gave me excellent care. She treated me like a human being, like a person who mattered, and like a member of the decision-making team in my care. I felt like I got the same sort of vibe from Dr. Amazing. He's lovely, really. A nice South African Jewish man. Very soft-spoken. Very clear. Very likeable. And he made me feel like I was listened to.

Okay. So Step 4, assuming steps 1-3 work out...

Step 4: Start IUI#5 Late December/Early January

I can do this.