Ticket In Hand

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We had our RE consult today and it did not take me long to realize that in the fast-moving world of reproductive endocrinology, I’m definitely a blast from the past.

When I did my first FET cycle in early 2014, I used Lup.ron, oral estrogen, PIO, baby aspirin, a short burst of Medrol, and valium for the transfer.  Today, the FET we’ll undertake in September/October will involve injected estrogen every four days, PIO twice a day (!), dexamethasone, baby aspirin, medrol, and predisone.

My response: “I JUST got feeling back in all the areas of my butt and now PIO is TWICE A DAY?!”

Apparently, this protocol results in much higher implantation rates.  Dr. E explained that there’s too much variability with oral estrogen to be comfortable – apparently some women really struggle to get levels high enough even with high doses – but with the injections, it’s been much more consistent.  The steroids lower the immune system a bit to allow the embryo to implant and the different types plus longer dose periods than before seem to really help this process more effectively.  No more valium for transfer either.  Two days of taking it easy, like before.

I asked how likely the blastocyst we have in storage was to thaw properly and Dr. E told us since it’s frozen with the newer cryopreservation methods, it’s around 98% certain that we’ll have a transfer.

I am…a little overwhelmed, to be honest.  Not so much by the protocol itself (though it certainly is different than any other fertility protocol I’ve undertaken) but simply by the fact that this is it.  As weird and f—ed up as this sounds, the RE’s office and fertility treatments and reproduction (or lack thereof) have been this huge part of my life for about seven years.  Whether or not this FET or anything else results in a pregnancy, my reproductive years are coming to a close.

I won’t miss the worry, the miscarriages, the fertility treatments, the incredible sadness of failed cycles, the two-week wait, or any of that stuff.  Infertility, high-risk pregnancy, loss, and NICU inflicted real wounds that are still healing and scars that still ache at times.

But there were silver linings that I couldn’t appreciate in the trenches.  Dealing with infertility and the associated complications also moved me from being someone who looked over her shoulder for another person when someone asked for an adult to someone who says “here, me, I’m an adult”.  I can battle with a ferocity I didn’t know was possible and also know when it’s time to walk away from a fight.  I know how to talk to an insurance company, how to marshal my resources, and who to call.

It’s more that I’m letting go of something that consumed vast amounts of time, resources, emotions, and despite the fact that this is, inherently, not a bad thing, it’s a change and a door closing.  It’s moving into an entirely different landscape – where I won’t chart my cycle, pee on OPKs, alternately (depending on where I am in an attempt to get pregnant) hope for or dread my period, or take pregnancy tests.  I’ll get rid of the maternity clothes and the baby stuff.  Labor and Delivery will go back to being a department with no more significance to me than Endoscopy or Medical-Surgical.  I’ll change into whatever lies ahead and deal with it, hopefully gracefully.

It’s strange, though, being here.  It’s like waiting in an airport, ticket in hand, and not knowing exactly where I’m going next or how many transfers or bits of lost luggage, but knowing that my flight will depart soon for somewhere.

This post has been a part of Microblog Mondays.  If you want more, please visit Stirrup Queens‘ blog.  Thanks to Mel for originating and hosting.

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Closing a Door

I made the appointment in late July after one particularly bad episode of bleeding and sadness. Then I almost cancelled it. Surely I was overreacting.

The spotting continued, on and off. Losing a little bit of weight – not ever easy for me – was even more difficult than usual. There was a decidedly tender, achy spot in my abdomen for several weeks, the pain suspiciously familiar, suspiciously similar to the time I’d had a couple of large cysts.

Finally, staring at my face in the mirror one evening, it was all but impossible to ignore. The acne, no matter what skin regimen I used or how faithfully I washed my face, was getting worse.

That was how I found myself in a new OB/GYN office this afternoon, staring resigned at the large pictures of newborns all over the walls, and still in half-denial that I actually needed to be there. I wondered if I should have traveled the hour back to my old town to see my usual OB/GYN, but recognized that this was impractical. Given my somewhat complicated OB/GYN history, I needed someone closer to our new home.

I was familiar with the doctor I’d chosen to see, as most of the OB/GYNs in town had rounded on me during my nearly eight week hospital stay. I still fidgeted nervously. I knew Dr. Z and I would get along well, but I wasn’t eager to discuss what I knew I had to bring up.

The PCOS was back and clearly out of control.

When Dr. Z walked in, once we had gotten to the reason for the visit, I simply gestured to my face. I’d left all my makeup off that morning so that I could show her exactly how bad the acne had gotten. It was obvious that something was wrong with my hormones.

“When was the last time you had your testosterone and other hormone levels checked?” she asked.

“September of 2012, I think, and then I had a glucose tolerance test in March of 2013. I’ve had a few checks of individual things along the way prior to my pregnancy, but not everything” I said.

Dr. Z told me that since pregnancy could change some of those balances, she wanted to re-check a number of hormone levels to see if anything was significantly different so that she could better treat the PCOS. Then we got to what I dreaded: the discussion about birth control pills.

I’d heard of women who got pregnant and essentially had their hormonal issues recede. Some of them even got pregnant again without intervention. I had – however naively – secretly fantasized that I’d be one of them. That my fertility would again be within my control and maybe we’d even do the not-trying-not-preventing thing and one morning I’d realize I hadn’t had a period in a while, do my test, and get to surprise my husband with tears of joy and excitement.

Acknowledging that birth control pills were the best way for me to get my hormone levels normalized as diet, exercise, and met.formin weren’t enough meant letting go of that. I’d always imagined us being able to try on our own eventually a year or two from now when we were ready or if our two frozen embryos failed, as we don’t plan to do any further fresh IVF cycles. Today effectively shut that door in so many ways. Sure, perhaps that could change, but the likelihood is my symptoms and the hormonal imbalances are simply too problematic to choose not to manage. The best way to accomplish that in my particular case is to use hormonal birth control.

It felt like being given an infertility diagnosis again in some ways.

But in other ways, it was completely different. I’ve gone through so much over these last three years. While there is definite sadness, there is also a little glimmer of light. By shutting that particular door, it brings us one step closer to the day that infertility and TTC cease to have so much power over our lives, finances, and family choices.

And I can’t help but think that in the end, for us, that’s a good thing.