The Loose Ends

Content note: I’m going to discuss our final two embryos and decisions related to them.  

Over the last few months, Arthur and I have an ongoing conversation that sounds something like this:

“If we were three or four years younger…”

“Yeah…”

“If we hadn’t had the infertility issues or the miscarriages or NICU…”

“Yeah…”

“But we did.”

“We did.”

“I’m tired.”

“Me too.”

It’s easy for me sometimes to focus on the good parts, those final easy months of my pregnancy with M that culminated in a term birth and a beautiful newborn and think, “oh, I could do that again”.  And if that was what was guaranteed, the answer would be easy.  Both of us had always assumed that if we hit the lottery (aka got pregnant and had a live birth on our own), we’d just be excited to try for a third child.  What – as the dust settles – we’re only now truly starting to account for in a meaningful way is how much the whole journey has taken out of us.

This isn’t a complaint.  We are fortunate beyond all belief in so many ways.  With some distance, all the infertility, IVF, miscarriage, and premature birth has ceased to be the constant it once was and has slowly begun to sublimate into the normal fabric of our life.  There are moments, of course, but there’s no doubt that it’s better.

Recently, however, I was reading a book where the miscarriage scene triggered a strong, painful memory of sitting in a darkened ultrasound room, pregnant, but not really any longer.  “I can’t keep putting myself through this,” I told my husband.  “I just can’t go through everything and then hold my breath for months.”

~*~

We met with the RE last week to discuss what to do with our final two embryos.  It’s truly a conversation I never thought we’d need to have.  When I went through the transfer that ultimately resulted in E, it was not a good day.  I’d had 22 mature eggs retrieved, 18 fertilized, and plenty of embryos growing beautifully on day 3, which pushed the transfer to day 5.  On the appointed day, we arrived at the clinic, got prepped and then handed a photo that I expected to contain our perfect blastocysts for transfer.  Instead, the photo showed two cavitating morulae.  Our best embryos out of 18 fertilized eggs were a full day behind.  Let’s just say there were a lot of tears that day.

I didn’t even think about the last few embryos the clinic had decided to continue growing to day 6 and see if there was anything to freeze.  A day or so later, I got the call that the lab had frozen two day-6 blastocysts.  Truthfully, I was so disheartened by infertility and circumstances I just sighed.  It was too much at the time to get excited.  We were more or less broke, emotionally and financially.

As the infertility cliché goes, though, you only need one good one (and in our case, a bizarre, stressful, high risk pregnancy), and E came into our lives.  At the advice of the perinatologist and my OB, we decided to try on our own for a year when we were ready for a second child.  Much to our immense surprise and joy, M came to us.  Which left us having the conversation I recounted above.

Like I said, none of this is a complaint.  We’re lucky and I don’t discount that in any way.

Neither of us feel as though we can discard the embryos.  The embryos have a form of dual existence for me.  They are somehow both not fully human and also, simultaneously, my babies.  I’m aware other people have different feelings about embryos, and that’s absolutely their prerogative.  I’m certainly not going to judge anyone for their feelings or what they choose to do with their embryos – it is such a difficult, personal decision.  This is just what works for us.

We finally determined that our best course is to find out, as much as possible, what we have frozen.  We know we have two day-6 expanded blastocysts with a “b” grade inner cell mass and a “c” grade trophectoderm.  The biologist at the lab described them to us as “average” – certainly high enough quality to potentially create a baby, but not top rated.  Due to my high-risk pregnancy with E (and the increasing trend towards single embryo transfers regardless of pregnancy history), the embryos have to be transferred one at a time, meaning we would potentially need to go through two FETs.

We don’t have the energy (or finances) to put into treatment that we once did.  The idea of going through another miscarriage (or worse) scares me.  Doing two FETs means a good bit of logistics to make them work just in terms of getting to the clinic as required, not to mention the expense and the two week waits.

This led us to genetically testing the embryos, which is a little cheaper than a single FET at our clinic by the time we add in medications and everything else that goes into an FET.  It means thawing, growing the embryos out overnight, having them biopsied, and then refreezing.  It’s not without some risks, but in return, we’ll have some idea of whether or not the embryos are euploid, and the refreezing will be done with a newer, better form of vitrification.  If one or both of the embryos turns out to be euploid, we’ll have a higher chance of implantation and a lower risk of miscarriage once we transfer.  If one or both of the embryos turn out to be aneuploid, well, we’ll save ourselves the cost of one or two FET cycles, the two-week-wait, and potentially a miscarriage.

It’s not an easy decision.  I’m aware that there’s definitely some controversy right now in the world of embryo genetic testing.  A couple of days after Arthur and I made the decision to go ahead with genetic testing, this landed on our doorstep:

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Not the most helpful coincidence.  I mean, I’m glad doctors and scientists are considering these variables, just sort of strange timing for us…

I’d be lying if I said that the idea of a lab making a mistake about whether or not the embryos are good doesn’t scare me.  However, given all of our particular variables, genetic testing is still our best option going forward.  We’re working on getting the consents signed currently.

And then…we’ll see.

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The Old Guard

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Arthur and I went to see the RE today to talk about the two remaining embryos we have frozen.  The embryos are a discussion for another post, but as we stepped into the clinic, I had this odd sense that I no longer belonged there the way I once had.  It reminded me of going back to my alma mater, walking around the campus, seeing the current students going to classes, realizing I was an alumnus now and that era of my life was over.

We sat in the waiting room.  A couple came in.  They seemed happy, and I watched as they were ushered back in the direction of the ultrasound room and suspected they were here for a pregnancy check.  Unless the routine had vastly changed, I knew ultrasounds for follicle counts were done much earlier in the morning.  I hope that they got good news.

Eventually, we were ushered back to talk with Dr. E.  As we discussed the remaining embryos, it was clear that we were no longer there with that mixture of fear, anticipation, and hope that we had originally come into the clinic carrying four years ago.  Instead of trying to begin, we were bringing the journey to an end, working to figure out the last steps.

I’m not nostalgic about IVF or treatment.  A few days ago when I went write about a particular experience during my first IVF, I was surprised at how p*ssed I still felt when reliving that memory.  I don’t miss the uncertainty, the worry, and the torturous waits for everything from follicle checks to the infamous two-week wait.

I am slightly nostalgic for that nervous but hopeful person I was when I first walked into the clinic.

Many of the times I’ve gone to the clinic, there’s been the sense of doors opening.  Of possibilities and plans and fresh starts.

Today, we walked out with all but the last two doors closed behind us.

Want more Microblog Mondays posts?  Head over to Stirrup Queens and check them out!  Thanks to Mel for originating and hosting.

Odds and Ends

A couple of weeks ago, E knocked my laptop off the coffee table accidentally.  In a freak sort of moment, it hit the corner of a heavy basket I keep next to the table and cracked the screen.  Since the crack didn’t affect the LCD part of the screen (it was a very surface crack), I groaned and figured I’d keep using the laptop for a bit while researching potential replacements and saving.

A few days later, M spit up directly into the keypad.  I turned it off immediately, wiped up what I could, and waited.  The laptop is mostly working now, but has some sticky keys and is clearly running even more obviously on borrowed time than before.  Arthur is researching alternatives and hopefully we’ll get one ordered in the next week or so before this laptop dies entirely.  I’m backing up all my files to the external hard-drive and getting ready to move my bookmarks and such before that happens.

It is telling that upon seeing the screen crack, my first thought was: well, this will most likely be less expensive to replace than two vials of foll.istim and definitely less expensive than a single IUI.

Infertility has clearly skewed my view of the term “expensive”.

~*~

Life is in that busy but largely pleasant mode for the most part these days.  I’ve been back to work since mid-June, which is going well.  I enjoy what I do, so while I’m tired (trying to readjust to working nights is taking some time), it’s great to have a chance to interact with my coworkers and take on some projects.

Arthur and I got to go to a fundraiser for the local zoo on Friday with his parents and a couple of his siblings.  It’s a sort of local “taste and drink” deal, where many of the restaurants and catering companies in town set up booths with small portions and typically a signature drink or two.  Because I have a terrible sweet tooth, my favorite is the artisan chocolate company.  It was a lot of fun, made more so because the animals were far more active at night than they typically are during the day.

~*~

E is almost finished with speech therapy.  We have one last session in September just to make sure she hasn’t regressed.  I’m not too worried at this point.  The other day, she walked up to me and started talking about the “botanical garden”.  Yep, with the word ‘botanical’ clearly pronounced.  We’ve come a long way from the 18 month who had what the speech therapist termed a “moderate to severe” speech delay.

She’s doing extremely well overall.  Still doing some physical therapy for a few motor issues, but we see improvement and hope that soon enough the gymnastics class I’ve got her enrolled in at our local YMCA will be enough.  We’re gearing up for a minor procedure for E in September due to congenital partially blocked tear ducts, but hopefully that will be her final surgery for the foreseeable future.

M is growing so fast!  Having a term baby after a very premature one is a totally different game.  She’s a happy, giggly baby who smiles and babbles a lot.  It’s strange not to be in a doctor’s office on a regular basis and to watch her outgrow clothes at an absolutely (to me) extraordinary rate.

~*~

Arthur and I scheduled a consult with Dr. E to discuss our two remaining embryos.  We aren’t anywhere near ready to make a final decision, but we need information to make some of those decisions, time to potentially save up financially, and a discussion of what’s even possible or advisable at this point.

~*~

We’re starting to make appointments to prepare for a house purchase.  We’ve been looking at various neighborhoods, narrowed what we are looking for, and decided on a couple of financial institutions to talk to for the mortgage.  It’s both daunting and exciting to get to this point.

A Long Time Coming

In the weeks and then months after E was born, we spent a lot of time at the hospital, first in NICU, then going back and forth to doctor’s appointments and tests.  Every time I made the trip to the hospital, the route took me through a nature preserve marsh area.  I’d often spot hawks, great blue herons, or swans.

One day, I saw a flock of white birds perched in the trees and logs.  At first, I wondered if they were seagulls or more swans.  They were quite a long way from the road, so hard to make out, but as I got a better look, I realized that a couple of them were wading in the water.  They were storks.  A whole friggin’ cloud of storks.  This realization elicited a rather dark-humored chuckle from me, given the association of storks with babies.

“Really?!”  I muttered incredulously to myself.  “This is where y’all have been hanging out all these years, huh?”

I continued to see the storks all summer, and the next spring, I kept an eye out for them.  Sure enough, the cloud of storks again descended on the marsh.  I would watch for them as I went back and forth to my OB appointments in those early, tenuous days of my pregnancy with M.  I saw them as I headed in with bleeding.  I saw them after good ultrasounds.  I got to the point where I was almost superstitious about it – if I saw the storks, everything was probably okay.

This summer, I waited to see the storks.  While I’ve seen a few of them on and off, it’s nothing like the last two years.  At most, I’ve seen three or four at a time, whereas in previous years, I’d see ten or fifteen easily.  I’m completely aware that this has something to do with changes in the migratory pattern of the birds, but it’s a sort of strange coincidence how it has almost perfectly dovetailed with the volume of my anxieties and feelings about infertility.

When I was first diagnosed with infertility, the one thing I wanted to know was whether or not the acute distress of not knowing and the horrible limbo of waiting would ever end.  I figured intellectually it would – and multiple bloggers/authors in this community with every manner of outcome testified to that – but there were days it felt emotionally like we might remain in the undecided, unresolved ether forever.  In some ways, that was one of the hardest parts of fertility treatment for me.  I could deal with the physical side effects, but the waits – waiting to start cycles, waiting for lab results, waiting for paychecks to pay for cycles, waiting for embryo reports, waiting for pregnancy tests, waiting for ultrasounds, waiting on those long weeks of hospital bedrest to see if E would survive – stressed me enormously.

For a long time, infertility has been a wound that has stubbornly refused to heal or even really scab over.  We still have two frozen embryos, and with my history of subchorionic hematomas and the concerns with whether or not something in the IVF process possibly exacerbated the first one with E, there are some loose ends yet.  Lately, though, I’ve noticed that while I’m not quite resolved, I’m starting to see that eventuality on the horizon.

One Project Finished

May and June comprised one of the busiest periods I’ve had in a long while.  As my BSN program drew to close and deadlines ticked down, I found myself running around completing a sixty-five hour practicum class that involved setting up and then interviewing community leaders on my chosen topic as well as doing the research for my classes to prepare for papers.  June finished out with an absolute orgy of writing as I wrote three major capstone projects totaling over seventy pages.  It was, to say the least, completely exhausting.

However, it was also rewarding as I got the notice on Monday that my final paper passed and my advisor recommended me to receive my diploma!

When I decided to go for the BSN, I initially rolled my eyes a little.  I already have a BA (in English) and I figured this degree would be more of the same.  However, with more and more push for RNs working in hospital settings to have BSNs, I knew I needed to go ahead and get the degree.  Otherwise, I risked a situation where, if I ever found a position I wanted to pursue in another hospital system or my system changed rules or ownership, I might find myself either unable to apply for a different position or told that I needed to complete the BSN within a certain number of years.

I was surprised at how much I learned.  While I definitely had a head start since my degree in English had taught me a good bit about research and writing, in my new coursework, I learned how to really evaluate scientific research.  I also learned about statistics and worked through the steps of problem-solving in a nursing setting.

In short, I know I’m better at what I do thanks to earning this degree.  Eventually, when I’m ready, it will also set me up much better to complete masters’ level coursework.

At this point, I’m looking forward to catching up with reading blogs, commenting, and writing here a bit more often.  I’m hoping to watch the documentary “Vegas Baby” about the Sh.er Inst.itutes IVF contest when it comes to Net.flix and read Belle Boggs’ The Art of Waiting.  I recently finished Kate Hopper’s memoir Ready for Air about the premature birth of her daughter and D. Knight Smith’s Letters to Ellie.  I’ve been thinking about infertility and NICU quite a bit.  It’s as though suddenly I’m really starting to process some parts of the experience that perhaps I couldn’t when I was going through them.

Clothing-Specific Memories

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Sorting through clothing is a funny thing.  I know people who do not become sentimentally attached to their sweaters or jeans, who cull their collections regularly and who don’t overstuff their drawers, but I am not one of them.  There’s some clothing I can get rid of pretty easily: things that are stained, that obviously don’t fit, basic tees or undershirts that have reached the end of their usefulness, but there’s a whole separate class of clothing that lives in my closet that presents a bigger challenge.

Apparently, I’m not the only one who has this issue, something I was reminded of when I ran across this article, poignantly titled “What Do We Do With the Clothing of Grief?”  As the author recounts the sweater she bought so hopefully during a lost pregnancy, I couldn’t help but think of my own “clothing of grief”.

In my case, it’s the brightly colored peplum boiled wool jacket I wore to the doctor’s office the day there was no more heartbeat.  The black fleece pants that I wore throughout my pregnancy with E and wore to the hospital the day my water broke at 21 weeks.  The olive-green dress with embroidered cranes I wore the day after my brother died.  I don’t know why it’s that dress, the day after, that I associate so strongly with that tragedy, but for some reason, the two are inextricably woven together in my memory.

Sometimes I wonder if I’m ever going to make a decision about those clothes.  I did sell one piece, the sweater I was wearing the day I was diagnosed with PCOS that lay crumpled in a drawer for years, never worn again.  The others, however, seem either too practical (the fleece pants) or too much difficult to reacquire pieces that I really like (the jacket and the dress).  What’s really strange is that I had memories in the jacket in particular that are fairly happy memories before that day.

Perhaps it’s too much to ask that the clothing of grief be repurposed into something truly neutral, but I do sometimes pull out the pieces and wonder if I can find the courage to start wearing them again, make enough memories in them to imbue them with both joy and sorrow.  Instead of the clothing of grief, make them something more akin to the clothing of memory.

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The jacket, on a much happier day (visiting the Hoover Dam in Nevada)

Thanks to Mel for hosting and originating Microblog Mondays!  If you want more posts, head over to Stirrup Queens to read.

 

In Which A Break Turned Out To Be Longer Than I Anticipated

Content note: Pregnancy mentioned

I didn’t set out to take a writing hiatus, but thanks to, well, life, that’s exactly what happened.  Of course, once the hiatus starts, it becomes harder and harder to go back. Where do I even start?

It has, indeed, been a full couple of months.  School has been busy, so perhaps it’s not so much a true writing hiatus as a blogging hiatus as I’ve written a fair amount towards that overarching project of BSN work.  My daughter had a couple of minor surgeries that thankfully went well, but one of which required several all-day trips in a relatively short time period to see a specialist out of town.  Arthur and I both blanched at the horrible election results.  We’ve lived under Pence for the last four years and to say that we’re worried and chagrined would be a gross understatement.  My husband’s work got busy and I changed my job position as well.  As of December 31, I crossed 28 weeks and 5 days pregnant, making me – out of four pregnancies – the furthest along I’ve ever been.  An anatomy scan at 18 weeks showed no abnormalities and that the baby is a little girl.

In many ways, we’re transitioning into a relatively good place family-wise.  Out of the normal has been our default setting for so long – starting with infertility and progressing to miscarriage, job losses, a high-risk pregnancy, PPROM, preterm birth and my brother’s death – that it’s almost a novelty to sit back and just breathe for the first time in about four years.

Sometimes I almost forget that a lot of people in real life we come in contact with these days don’t know the story since we moved in the midst of it and then spent a year in quarantine to let E’s premature immune system develop.  By the time we came out of hibernation, E looked a lot less premature (small, but not abnormally so), didn’t have her wires from the monitor any more, we weren’t in the midst of infertility treatment and then had a welcome, spontaneous pregnancy.  Recently, we were at church, going over future plans for the congregation and I objected to one point that talked a lot about “families with children”.  Which of course, seemed odd given that we are “family with children”.

“What you don’t see,” I explained, “is that we almost didn’t have children.  We did several rounds of fertility treatments and then IVF and had miscarriages.  My water broke at 21 weeks and by almost any calculation of odds, E wasn’t going to survive.  By that time, we were financially tapped out, emotionally exhausted, and if E hadn’t lived, we wouldn’t have had the ability to keep trying or pursue adoption.  We would have been a family of two.”  It heartens me that in that group of people I was talking to, everyone was kind, respectful and interested in being inclusive of family structures outside of the nuclear.

Another moment occurred when we went down to witness my niece and nephew’s dedication ceremony.  As all the parents and adorably dressed babies walked out onto the stage, the pastor briefly talked about the ceremony and then gestured to a white rose placed in the front.  He explained that this was in honor of those who had lost children, struggled with infertility, and for whom this was not a joyous or easy occasion.  While communities – religious or otherwise – still have a long way to go towards true, full inclusion and integration of those who struggle with infertility, do not have children, or do not have the families they longed for, such a gesture was a welcome sign that perhaps someday those changes may come with work and determination.

At these moments, I found myself almost in tears both times.  Certain aspects of infertility are slipping into the past for me and yet, others are still so much present in my life.  It informs so much of how I view family, parenting, and life in general.