A Severance Letter to My Reproductive System

So I’ve been taking time to sort out all my feelings and such about the information presented to us: that I have a very very low chance of conceiving even with help and an even lower chance of carrying the baby to term. It’s been harder than I expected but I think I’m starting to get over the hurdle. Having to do so while coming off artificial hormones and being bombarded by natural hormones did not help. Basically, there was alot of the getting-weepy-at-kitten-commercials type of thing.

Apparently protecting my own feelings for a long time resulted in being rather cavalier in what I thought I would be cool with: i.e. not being pregnant. On some level I really thought that it would be fine if I was never pregnant as long as I did everything I could to try. In the end, that’s actually still mostly true. Our goal and desire to parent far outweighs our desire to biologically parent. But come on, I’m human, I guess more of me thought it’d be nice to have all the “pregnancy moments” than I thought. I’m doing okay though and moving forward. We are officially pursuing adoption, by which I mean we’re filling out the application for the adoption agency we’ve chosen.  There will likely always be lingering pangs of disappointment but as a few folks have pointed out, once there’s a baby in my arms we will feel complete as a family, despite coming at it from a different angle.

In talking with one of my dearest friends about needing to go through a period of mourning, she suggested that I write a letter to my body. In doing so I would not only address my disappointment with its failings but as she put it, “point out that my heart and mind are stronger and that my life goals won’t be defeated by its failings.”

And so, as part of my…..healings…..I write this letter, firing my body from certain responsibilities.

Dear Reproductive System,

Thank you for your dutiful years of service to the company but we will no longer be needing your full participation at this time. Please consider this letter as an immediate demotion to your previous position within day-to-day operations.

You have served us well in many of your functions but when asked to pursue a deeper commitment in our company’s overall needs and wants, you have not met the expectations that were set before you. The head of our company, in agreement with various other department heads, strongly feels that you were given far more opportunities and avenues to accomplish these goals than many other systems in similar situations. Certainly the systems at other companies have been able to accomplish similar goals without ANY outside assistance or intervention. It would seem that despite the assistance of various outside experts you have thumbed your nose at incorporating their expertise. The head of the company has every intention of moving forward with our overall goals and feels it best to terminate your participation at this time.

We are beginning the process of reviewing outside candidates who, while their origin will come from outside the company, are no doubt ideal candidates for the ultimate position we had to hoped to accomplish with your participation. As it turns out there are numerous other ways to reach the company’s overall goal. So there. Perhaps you were under the assumption that you were the end-all-beat-all way of accomplishing this particular plan of the company. You are not. We have begun to pool our resources and are focussing them on a different process by which we are hopeful and certain to have the success we have hoped for for quite some time. 

If you feel in the future that you would like to be included once again in the accomplishment of this particular goal you are certainly welcome to do so. At any time. Without notifying the head of the company. You may feel free to surprise us at any time in the future by announcing that you are intent on accomplishing the goal through your own devices. However, since we have been informed at this time that this is questionable at best, we will not spend any further emotional or financial resources running at the brick wall you have set before us. Again, you are welcome at anytime to regain the full status and potential your position entails but for now, we ask that you return to your day-to-day tasks and to do them with the normalcy and regularity that you have done so well in the past.

Your desk and all its accoutrement will remain in place for your continued day-to-day use.

With all respect,

Me

Head of Human Resources, Aging Baby Maker, Inc. 

Addendum:

Please read the above with its intended silliness: I fear folks think I’m crying in my soup. I’m doing really well and wrote the above tongue-in-cheek because humor is how I cope…..and because every thing about what we go through with all this is so fucking ridiculous.

Test Results Equal Shitty News

There’s alot happening all of a sudden – I’m going to break it up into a few posts:

Monday my husband and I sat down with Dr. Hail Mary thinking we were there to ask some last minute questions and then charge into IVF4: The Final Frontier. I had repeated the endometrial receptivity/Beta 3 integrin biopsy on March 31 and those results were already in.

Good news: the Beta 3 integrin was now positive. Bad news: my lining was still out of phase “despite aggressive treatment.” Dr. Hail Mary explained that this meant the cells weren’t getting the message from the progesterone and estrogen and therefore the lining was not receptive to implantation.

Think of it this way: my lining is Quantity over Quality.

Basically: there’s enough lining but implantation is highly improbable in that environment.

He said, “In this business we pay so much attention to egg quality that sometimes we disregard the environment we’ll be putting that embryo into.”

He figures this is the most likely reason I miscarried and have had 3 unsuccessful IUIs and 3 failed IVFs.

Y’all: my eco-system is off.

He doesn’t know why my lining is out of phase. He said it shouldn’t be an age issue and there’s every likelihood that it’s always been this way – meaning I may have had trouble whenever we’d tried to conceive. He’s not sure of that by the way, but it’s a possibility.

Oh and our fertility insurance runs out May 31 (it’s attached to my husband’s contract which ends May 31) so basically we have 8 weeks of coverage left.

It’s always somethin’ am I right?

The doctor recommends more testing cycles to see if he can figure out a) what may be causing the out-of-phase lining and more importantly b) if he can fix it. There’s some trial-and-error involved here since he doesn’t know why his usual methods didn’t fix things.

Given our waining insurance situation he suggested we proceed with our final IVF cycle (insurance covers 4), go through stims, see if there’s anyone to freeze, freeze them, THEN do at least one (if not more) cycle of testing to try to make my lining receptive and then hopefully move forward with a FET (Frozen Embryo Transfer) or perhaps use a gestational carrier (insert the giggles of two midwestern lower middle class people in their 40s with no retirement plan).

Basically we’re looking at a rough estimate of 4ish months (2 months for IVF, 1ish months for testing, 1 cycle for FET) before I can do that transfer….so end of July or August.

He was….not hopeful….pretty matter of fact….and honest in his confusion over why my body doesn’t seem to be playing ball. My husband asked if there’s the possibility that he might not be able to fix this phase issue to which the doctor said, “that is a real possibility.”

It’s not just my age anymore, there’s actual stuff keeping me from getting pregnant.

This pill is far more bitter and harder to swallow than I’d anticipated.

It feels like my already low chances of getting pregnant at 43 just dropped. Alot.

The doctor estimated that a woman with my ovarian reserve has approximately a 10% chance of GETTING pregnant. STAYING pregnant is another matter…..that number is significantly lower.

We’ve been talking alot and mulling over what to do….and I think we know what’s ahead of us.

More on that tomorrow.

 

Early Pregnancy Announcements: Ew.

Tuesday, a guy I know posted a photo on his Facebook with the caption:

so… it’s super early- and really, a lot could go wrong. but I’m too excited to keep it a secret. 
my wife put it best… “so… this happened today.”

The photo was of course of a positive pregnancy test:

 url

 So basically, they announced their pregnancy when they’re about a whiff’s worth of pregnant.

I’ve always been one of those “wait all the way through the first trimester” kind of gals. I’m superstitious and old-fashioned that way. Now that I’ve a) had a miscarriage, b) known folks who miscarried and c) found out just how common miscarriages are, I find myself even more superstitious and leery of letting the cat out of the bag early.

I mean, I’m happy for them, of course I am (though I won’t lie to you guys…..it also stings to know that JUST ONE MORE person is pregnant before me) but it just seems like SUCH A BAD IDEA to post that picture on the Facebooks when they’re all of what….4 or 5 weeks pregnant?

I feel shitty for this kind of judgment.

It’s interesting though – as a lady writing about her struggles and quests, I realize that if I get pregnant (IF, I said IF….I can dream) I’ll be telling the faceless online support group of fellow questers that it’s worked likely after the first few betas. But it sort of feels like we’re all in this together – the joy of one keeps a mess of us going in a way, “It worked for her, it could for me.”

There was a side thought to my seeing that photo:

They don’t know they’re rubbing their fertility in the noses of a mess of people.

Why would they?

Would I have known if none of this had been a problem?

No, I wouldn’t have.

There’s an innocence that I’ve lost. That many of us have lost. The innocence that tells us to shout out joyous news from the rooftops. That everyone will be happy. Who wouldn’t be happy to hear that there’ll be a new little life in the world?

However:

Between them they know like 900 people….the sheer law of averages means a few people on that list are having a rough go getting pregnant or worse yet, have lost one to miscarriage.

They’re excited. I get it. But take a breath.

And yes, I know I’m a bit of an asshole with this – but it’s my blog, and it’s a safe place.

 

Helpful Statements That Are Gut Punches

I had a great lady lunch with some friends yesterday that had one bump in the road. It occurred when I talked about starting our final IVF while also seeing an adoption process on the horizon. My dear friend, in trying to show she cared used one of “those phrases” that seem harmless but are in fact, full of harm:

“You know that once you adopt you’ll get pregnant.”

Because she’s my close friend I didn’t feel the need to mask anything and just said, “well actually all this testing is showing us why we’re likely not getting pregnant and it’s because I have a number of things that can affect implantation so as awesome as it would be to just get pregnant, it just doesn’t look like that would happen.” We talked it out and it’s fine, but it definitely showed me that when the time comes that we “go public” I can likely expect more of these statements.

Oof.

I did a quick google search of the phrase “what not to say to an infertile couple” and I got some juicy ones. Here are thoughts on just a few.

“It could be worse, it could be (insert awful disease here)”

Um, thanks? Why don’t we make a Pie chart of other things that could be worse: pooping my pants on an airplane, having 14 mosquito bites for a year in places I can’t itch, falling into a cactus while my naked lady bits are exposed…. This is a fun game!

“just relax and you’ll get pregnant”

I laugh alot, professionally and personally. I also knit, which is my own form of meditation. I like to cook and chop and stir, all very zen activities. Re. Laxed. And hey look, not pregnant.

“at least you’re having fun trying”

Am I? Infertility makes “trying” into math: when to try, when to abstain, when to try alot. Pee on this stick or take your temperature every day to check for ovulation. Plus, you’re tired! Tired for normal life reasons AND there’s something you really want that you’re not getting and that makes you more tired. So no, we’re not rampantly running amok “having fun trying” on top of all the tables and chairs and in closets morning noon and night. (Not that we were before….who do you think I am?)

There so many more ridiculous things that get said by the way – Google them and have a giggle (or a cry). Don’t get me started on the ones that involve God/supreme beings/what the universe wants.

Honestly, we dodged a big bullet by getting married in our 40s – I can count on one hand two fingers the folks who’ve blatantly asked “so, when are we gonna see some kids?” Apparently, getting married late = implied automatic shut down of parental endeavors?

I’ve been at wedding receptions and seen people walk up to the bride and ask “when are you having kids.” I wanted to throat punch on their behalf. (for the record: I didn’t). Btw, it’s usually a craggy old aunt who does the asking. Don’t be the craggy old aunt.

This is second friend who used the “once you adopt you’ll get pregnant” on me. My friends absolutely wanted to help, wanted to show that they cared (alot!), wanted to show that they were hopeful for my success….but just didn’t think about the fact they were saying these phrases to someone who’s been trying too long.

The sad thing is….before I was in this muck, I likely used these phrases, or at the least wouldn’t have thought about the full impact.

So, before you go throwing what you think is a helpful phrase around, consider:

Do you know if they’ve been trying? Do you how long? Do you know them well enough to deal w/the potential anger/sadness you might trigger w/your pretty friggin personal question?

No one MEANS to be insensitive, but man we all step in it sometimes without thinking.

Maybe just have the balls to say, “I’m really sorry. It must be hard to face all this. I don’t really know what to say.”

It’s likely gonna make you an even better friend.

But if I see you at a wedding and you walk up to the bride or groom and ask them….I will find you.

Test Cycle: Results Starting to Roll In

So I’m at the end of the test cycle and we’re starting to learn stuff. Lots of stuff is looking good and thus far there are 3 things that have indicated that I’ll need some tweaking to the protocol:

My protein-C levels are slightly elevated, as are my antiphospholipid antibodies (say that 3 times fast: antiphospholid, antiphopholidaliheid, antiphosphiliphosenfeffer……) thankfully also called APA. This means I have an increased risk of clotting and the elevated levels may cause difficulty with implantation, and could also possibly be a cause of miscarriage. I’ll take a blood thinner to help with this, likely Lovenox. So….yay, one more injection! (I realize that they are just words on a page but I want you to feel the sarcasm…the deep deep chasm of sarcasm).

Also, I have a methylenetetrahydrofolate reductase (MTHFR) deficiency. When the body is MTHFR deficient its ability to absorb folate (also known as vitamin B9), such as folic acid, is inhibited. Folic acid and B9 are both essential to the development and health of the fetus. So, treatment of this involves taking supplemental folic acid or folate and perhaps another vitamin (I didn’t get all that as I was standing in the middle of a grocery store taking notes on the phone – I think I did a fairly decent job otherwise).

It’ll still be another week or so until the last of the blood tests and the biopsy results are in, but so far no deal breakers, all manageable stuff. I did ask the nurse if the above elevated levels and deficiencies could have been part of why I’ve had three embryo transfers and no pregnancies and she said yes. It’s not a definitive answer as to why things haven’t worked yet but it’s at least information…..and information is good.

And, now we know we can do some easy stuff to try to have a different outcome.

Unrelated: I really want to see Non-Stop, the new Liam Neeson movie that comes out this weekend. That man can throw a throat punch and I like to live vicariously through that sort of thing.

 

 

 

The Endometrial Receptivity Test Can Suck It

Playing catch-up here – busy with a mess of work lately, which is awfully nice. I’m writing you from Phoenix where I’ve got some work tomorrow….it’s warm, and that’s like a reboot to the system after the Chicago winter we’ve had.

Last Thursday I had 2 biopsies taken for an Endometrial Receptivity Array (ERA).

As the name indicates the Endometrial Receptivity Array tests to see if the endometrial lining is receptive to implantation. (I encourage you to Google a more technical description to fully define the tests). Dr. Hail Mary wanted to run these two biopsies to see if anything was afoot in there since I’ve had three embryo transfers and no permanent residents. The test is done in the implantation window of your cycle (mine was done Day 23) following at least 5 days of progesterone (which I started taking back on February 14…..how romantic).

What’s the procedure like, you ask? Well, a speculum is put into place just like for a Pap, the cervix is cleaned off with a bit of iodine on what looks like a Q-tip on steroids, and then a pipette is snaked in. Once the pipette’s in place it’s moved around the lining and with a bit of a suction it gathers tissue for the biopsy.

It. Was. Not. A. Walk. In. The. Park.

Since I was having tissue drawn for two different test I had to go through this twice. (I’m not asking for your sympothy, just stating the facts….but it was a fucking crappy test). During the first one the nurse kept saying, “you are doing really great.” Now….I know that something likely needs to be said during these things, but perhaps me “doing really great” simply sprung from not swearing out loud like a men’s rugby coach or using my fists to punch at the table….likely “doing really great” mostly had to do with my ability to just lie still. I did get my deep breathing on – that was super helpful. If you ever have to do one of these just breath as deeply and as much as you can, it does make a difference – if not, you’re just…clenching, and that’s not going to do anyone any good.

It’s hard to explain exactly how it feels…..it’s loads of heavy cramping, for about 45 or so seconds, maybe a minute. Now I know that’s not a long time but if somebody had a pipette up your business and it was suctioning out bits of your endometrial tissue, 45 seconds is 45 seconds LONGER than you want that to be done.

The only ray of sunshine I can add is that 45 seconds really isn’t THAT long and when it’s over it’s over – instant relief. I think some Tylenol or ibruprofen would have helped if I’d thought of taking it beforehand….and afterwards I just had some lingering mild cramps (like a mild period) so I was fine. The tissue’s being sent off to a lab so it’ll be a few weeks before we know anything. We are of course aiming at a diagnosis of: Receptive. Though Not Receptive isn’t a deal breaker, it gives them info to work with and likely treat….so we’ll see when we see.

I’ll keep taking progesterone shots through the 25th – 1ml in the morning (right cheek) and 1ml at night (left cheek) – and then I’m to call them when my period ensues. Then it’s on the birth control pills, and if all these tests are fine then we’ll get started with IVF4 for reals.

IVF3 Negative, Dusting Ourselves Off

We had our Beta this past Thursday and it was negative.

Yep. Not what any of us wanted to hear.

I was pretty upset and just let myself cry it out….and I forgot how exhausting the act of crying can be. I’d start to get myself together and then it would start back up. I was so very tired the rest of the night – my body and my heart were just tuckered out.

I was actually surprised at the news….we both were…..we both just had this sort of….inkling that it had worked. That and I had experienced some new symptoms: nausea, cramping, insomnia….and supes gross, my pee smelled weird. (Sorry, but some of you might be interested in symptoms, even the icky ones). All of these symptoms can be atributed to the progesterone and estrogen supplements, but I had not experienced any of these symptoms before…..so you can understand my curiosity.

So we’ve worked through our disappointment – no irrational thoughts or blame, just a good old-fashioned case of the really sads….and while there’s still some residual blues that will linger for awhile, we’re doing okay. It’s taken me a few days to write about it tough.

And then we began to discuss our next step. I had already gotten a referral to another RE here in town (as a just in case) that some ladies in my support group recommended, so I called his office to make an appointment. The receptionist could not have been nicer and we have an appointment to meet with the doctor on January 21st.

We also started talking about the two different adoption agencies that we have visited here in Chicago so that likely over the next few weeks we can make a decision as to which one of them we will go with. I will also need to call both of them to see if I they’re cool with my doing an IVF cycle at the same time as the get-the-ball-rolling initial appointments/potential home visit business.

The silver lining is that we leave tomorrow for a 2-week vacation to visit alot of friends. We put this trip off twice before and I asked my RE this time if it would be okay to go in case I actually got pregnant. She said it’d be fine, so we made plans. We cashed in a mess of frequent flyer miles, had a friend who gave us a few more and we made our itinerary, which initially included Amsterdam and London and then I snuck in 2 days in Paris as a surprise Christmas gift for my husband. I used to live in Amsterdam so we’re staying with friends., another friend is letting us stay in her family’s flat in Paris, and my husband’s best friend now lives in London so we’ll stay with them.  So luckily we’re able to keep the trip relatively cheap.

We’ll land first thing Tuesday morning….which is New Year’s Eve and also, my birthday. It’s always been nice to simultaneously reflect upon a calendar year and a year of living. I’m glad to put this past year to bed – we’ve learned alot and grown alot, but youch it’s been a doozy.

We both need a break and we’re going to get it. It’s been a tough year. We’re hanging in there though. Hope you are, too.