…Go!

Well, I’m officially off and running on this final FET.  My start-cycle visit was Monday.

Back in June when I had my saline-infusion sonogram (SIS), Dr. E noted that my ovaries looked as though I had “mild” PCOS.  The “string of pearls” of small cysts that are one of the criteria for PCOS were evident.  I was ovulating based on seeing LH surges and having regular periods, but I knew that in SIS I had the cycle before I conceived M without medical assistance, my ovaries had shown no signs of the “string of pearls”.  I dug out my notes from that time and put myself back on the same medication/supplement regimen with a couple small tweaks (prior to this, I had been using lower doses of the medications/supplements that seemed to get me ovulating but obviously hadn’t totally cleared my ovaries of the cysts).  I hoped that with three to four months, perhaps my ovaries would fall in line.  I figured even if we were using the final frozen embryo as opposed to trying to conceive without medical assistance, the more in-line my hormones got, the better the chance for a good outcome.

I’m happy to say that when the ultrasound tech scanned my ovaries Monday, there were none of the little cysts.  My ovaries looked like normal, healthy ovaries.  It’s interesting – I had wondered if the cycle where M came along was a fluke, but it appears that possibly with the right combination of medications, I may be able to put my PCOS into a sort of remission.  I don’t know if that’s reality, since getting proof would mean serial ultrasounds/blood draws, but it’s certainly hopeful.

I took my first del.estrogen shot Monday night, and that is the thickest medication I’ve ever seen.  As someone who has injected an awful lot of oil-based meds into my rear, that’s saying something.  Not much fun, but at least it’s small amounts of oil (0.3 mL per dose) and only every 4th day.  I started the dexa.methasone Monday night as well.  So far, I’ve been able to sleep (steroids tend to give me insomnia) but I’m only two doses in, so we’ll see.

Next ultrasound/bloodwork is scheduled for Oct. 17 with transfer now tentatively scheduled for Oct. 23.

Fingers crossed.

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Ready, Set…

Last week, I called the RE’s office about a few assorted matters since the FET visits and meds should start fairly shortly (within the next week or so).  First up was my flu shot.  Due to my job, it’s not so much a question of if I’ll get exposed to influenza, it’s a matter of when.  As I’d read over the medication instructions again, it occurred to me that the steroids – designed to weaken the immune system to provide a better chance at implantation for the embryo – might cause my body not to form much of an immune response to the vaccination.

Based on my period-tracking app (which is fairly accurate for me), my cycle is set to commence this weekend, which also concerned me.  Weekends are the worst time to have to start things or call medical offices in general, not to mention I work on the weekends.  I wanted to make sure everything was squared away and I knew who to call and what to expect.

Turned out to be a good thing I checked in.  Dr. E confirmed that the flu shot did need to be obtained before I started the steroids and hopefully in enough time to give my immune system the time to build the antibodies.  That meant the day before leaving on a major trip I was calling pharmacies to see where I could get one.  The one that had vaccine was the one not in my insurance network, so I paid about $41 for something I usually get for free.  Add it onto my running infertility tab, I guess.  Better than getting sick later – if this cycle works, I’m on the steroids until I’m 8 weeks along, which puts me into December, aka flu season, based on the best information I have (the dark part of my mind is grumbling that this is ridiculously optimistic, why would I think this cycle is going to work at all?).

It also transpired that the local office isn’t staffed with a nurse on the weekends currently, just a lab tech and ultrasound tech, so start cycle visits have to go to the main office (around 2 hours away) on Saturday/Sunday.  “I can’t do that,” I said.  The nurse – who knows me well and was at the office through 2013-2014 when I was doing the majority of my cycles and IVF – said that since I know the protocol, can do my injections, and understand when to call if something gets strange, she could do my start cycle visit the week before my period is projected to start and then she’d leave word with the office that I could be seen locally for the ultrasound + blood work.

I’m not sure if I’m comforted by the fact that I knew to call in and check the finer details (because there’s always something) or a little unnerved that I’ve spent this much time doing ART.

Anyway, I had my start cycle visit Tuesday.  That went well, I nailed down the details of exactly which office to call at any point in the weekend if my period starts, and we mapped out as much of the cycle as possible based on my app.  At this point, it’s just a waiting game.

Current Cycle Status

Content note: Final FET feelings + already present kids mentioned.

Well, this cycle is finally starting to become real.  I’ve been going back and forth with the RE’s office to start pricing out drugs and nail down the slippery little details that I’ve discovered can really derail things quickly.  I confirmed that they still open at the same time they used to, that now they do Sunday appointments in my city (it used to be that they only took Sunday checks about 1.5-2 hours away at the main office), and got copies of all the paperwork.  When my period starts this month, I’ll call, get the prescriptions, and order the drugs in preparation for next month, thus outlaying the first actual cash in this endeavor.

I’ve noticed that I’m starting to have a more reasonable reaction to the prices again.  Maybe it’s that I’ve been out of the ART world long enough or that we’ve spent money on other things in the meantime, but I’m keenly aware that what we are spending on this cycle is going to be right around what we paid for our entire upstairs flooring in a high end, water resistant laminate including installation.  I remember when I paid for the flooring and called Arthur to give him the final bill remarking that while it wasn’t cheap, it was about what we’d paid for FET cycle past and – salient point – we weren’t paying for a chance we’d get a floor, we were actually going to receive a floor.

That last sort of sums up the mixed feelings I have bidding farewell to the RE’s office and ART.  I’m really grateful for the fact that IVF brought us older daughter and also cognizant of the immense emotional and financial costs that went into all the cycles.  One of the things that’s hard about ART and IVF is that beyond picking a doctor/office/lab and following the protocol, there’s really very little I could control in the cycle.  I was at once expecting my first IVF to fail (because I’m a defensive pessimist) and also completely shocked when I miscarried (apparently there’s some underlying optimism there after all).  I’ve known for a long time – working in the medical field – that modern medicine as a whole is extraordinarily powerful in some ways/instances, but also falls badly short far more often than some of the glowing articles and incredible stories would have people realize.  Even knowing this, I found it hard to stack up the hopes I had with the grittier, less successful realities.

It’s the end of ART for us.  One way or the other.  I’m almost 37 and it’s time.  Whether or not we see if something breaks loose on our own if the cycle fails is something we’re very undecided on.  Met.formin really does appear to regulate my cycles but in my late 30s, other concerns such as higher miscarriage rates are starting to tick up (and that’s making the enormous presumption that I’d get pregnant at all – certainly not a given with my history).  I’m not going to lie, I have a little bit of the ache these days at the thought of being done, I’d really love it if the cycle worked out, but I can’t tell if that’s a deep, ongoing thing or if it’s happening because I’m immersed in getting ready to try to get pregnant with the FET and if the beta is negative will dissipate with some time.  Despite the occasional achiness, I’m grateful for where we are now.  I have no doubt that regardless of outcomes, life is going to go on and I believe it’s going to be good.

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.

Luck

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Ever since I called my RE’s office to set up the series of appointments to lead up to the final transfer, it’s been on my mind a lot.

Like, a lot.  As in a truly ridiculous amount.

I think a big part of it is the unknown aspect to the thing.  I’m truly privileged in the infertility world with my kids and can be happy whatever way life takes me, but the not-knowing part bothers me.  The other part that tends to get under my skin is that – other than showing up and taking medications as ordered – I have no real control over the outcome.

On the spectrum between the laid-back people and the iron-fisted control people, I am definitely a control freak.  Some of this stems from anxiety (as in the diagnosed type).  My brain has a not-so-marvelous tendency towards getting stuck and panic attacks.  I like predictability, stability, and known quantities – and privilege has allowed me some insulation from the unpredictability of life in other areas.  This, I suspect, is why infertility in general has messed with my sense of self so much.

Earlier this week, I ran across an article about socioeconomic privilege entitled The Radical Moral Implications of Luck in Human Life: Acknowledging the role of luck is the secular equivalent of a religious awakening.  Author David Roberts states: “It’s not difficult to see why many people take offense when reminded of their luck, especially those who have received the most. Allowing for luck can dent our self-conception. It can diminish our sense of control. It opens up all kinds of uncomfortable questions about obligations to other, less fortunate people.”

Infertility is nothing if not one giant game of luck.  Diagnoses, lack of diagnoses, economic status to pursue treatment or adoption, one partner or both, what doctors/labs one has access to, the quality/growth of embryos, whether or not those embryos implant, miscarriages, emotional resources – none of these are really factors individuals have control over.  Heck, when pursuing treatment, I know I don’t even have control over when I have to be at the clinic during cycles.

Acknowledging how little control I really have over my life circumstances – and how much good luck has played a role – is a bit unnerving.  Roberts points out in his article that “I get why people bridle at this point. They want credit for their achievements and for their better qualities. As Varney said, it can be insulting to be told that one’s success is in large part a lucky roll of the dice.”

It feels like – given the sums of money, emotion, and time that are in play during treatment – the outcome should be more predictable.  That anyone who rolls the dice (or wants to roll the dice) at anything related to infertility should be rewarded commensurately.

This post is a part of Microblog Mondays.  If you want to read more, head on over to Stirrup Queens.  Thanks to Mel for originating and hosting.  

Mile Eleven

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About a month after my PCOS diagnosis and before falling fully down the rabbit hole of infertility treatments, I ran a half-marathon.  It was one of those “bucket list” kinds of things I’d begun training for in earnest shortly after we originally began trying to conceive in April because I knew deep down something felt “off” and didn’t want to face it.  I took my running habit, ramped up, and signed the papers to run in November.  If I was wrong, I figured, I’d walk or give my registration to someone else.  In the meantime, the long runs gave me something else to focus on.

The day of the race was a mildly overcast, cool but not cold November day – perfect weather.  I lined up at the start and took off with the other runners.  The first mile was great.  I was excited, my adrenaline was high, and it flew by.

The second and third miles were not so great.  This was the point where I began to realize what I’d gotten myself into and I fought the part of my brain that kept telling me I’d never make it 13.1 miles.  When I passed 3.1 miles, I wondered why I hadn’t just signed up for a nice 5K.  Then I’d be done.  However, as I kept running, mile four felt easier and I started enjoying the thing.

I ran through the countryside.  This particular race tends to be quiet, isolated, and doesn’t have the quantity of spectators or cheering that I’ve read others have.  I ran over country roads, admiring the farmland, enjoying the quiet.  I caught up with an old buddy and ran a mile or so with her, chatting.  Otherwise, however, I was by myself with my i.pod and loving every minute.  Seven miles passed.  I have this.

Then I hit mile eleven.

I really wanted to run the entire race without taking sections to walk.  But as soon as I got into that eleventh mile, it wasn’t merely that I wanted to walk.  I wanted – seriously – to lay down at the side of the road, quit, and let the race organizers come pick me up.  I hit the wall, and I hit it bad.

A combination of factors were probably at play here: eleven miles is a long way to run, it had been a bit since I’d had water or electrolyte replenishment, and in a 13.1 mile race, eleven is right at that nasty spot where I was close to the finish line and yet far enough away not to have the adrenaline rush of being “close”.  It did not matter.  It sucked.

A hill rose up in front of me.  You have got to be kidding me, I thought.  This wasn’t even a real hill.  I grew up in the Blue Ridge Mountains of Virginia, so I know hills.  This was more of a tuft of dirt but the placement infuriated me.  The irritation gave me strength.  I ran up it and finished out mile eleven.

I finished shortly thereafter, just in time to see the winner of the marathon cross the finish line, get some water, and celebrate with Arthur and a few friends and family who had come to cheer me on.  I was glad I had done it and I had managed to complete it my way – without walking a single step, and well under three hours.

~*~

Really, in the vast majority of ways these days, I’m fine.  Happy, really.  Not needing the support the way I once did.  At this point, I love where we are in life and it’s good.

There’s one more embryo, frozen.  Tested.  Waiting.

I’m procrastinating on calling the RE’s office even though Arthur and I have a reasonably solid plan because…well, it opens doors.  It reminds me that I’m not all powerful, that plans fall apart, that doing everything right can still result in heartbreak in both expected and unexpected ways.

I like feeling in control.  I know I’m not, but on a day to day basis, it’s really easy to pretend, to slip into the minutiae and let the illusion remain.  Calling the RE, putting in motion the final plan, means letting go.

It’s time to run mile eleven in this race.  Face the tuft of dirt.  Keep putting one foot in front of the other.

Because the finish line is somewhere close.

This (long-form 😉 ) post has been a part of Microblog Mondays, where the idea is to write in your space, usually a short post but whatever moves you.  If you want to read more, head over to Stirrup Queens!  Thanks to Mel for originating and hosting.  

Infertility Quirks

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When I first went to the fertility clinic to start injected medications, I remember literally choking on something I was drinking when I called the specialty pharmacy and they told me how much foll.istim cost.  It’s still pretty mind-boggling that I only did a spit-take over the cost and then more or less went, “okay, so where do I sign?”  (Back when I was going through it, a vial cost just slightly less than $1 USD for 1 unit of the drug.  And if I bought the smaller size vial, the vial was usually overfilled by about 30-50 units, so it brought the cost down slightly.  But yes, a *lot* of money.)

Anyhow, this induced a really bizarre association in my brain that persists to this day: I measure the cost of just about everything in terms of how much infertility treatment cost.

New couch?  About one to one and a half vials.

New flooring? Around the cost of the drugs for two fresh IVF cycles.

Chimney cap? About the cost of clinic fees for a TI cycle.

Down payment on a house?  About two fresh IVF cycles plus the FET thrown in.

This last was particularly good when the mortgage banker gave us a sort of startled look after he quipped about the down payment being the biggest check most people ever write and I just started laughing.  It wasn’t really funny, but it was either laugh or cry.

The kicker in all of this was that when we wrote the checks for house-related stuff, it was a guarantee – we were actually getting a house, the flooring had a delivery date scheduled, and we could look at samples and touch fabrics for couches.  We weren’t paying for a 25% chance that we’d get the house or a 30-50% chance that the flooring would come.

There’s still a sense of unreality about every check I wrote during infertility, especially now, pitted against the tangible things that money can buy.

This post is a part of Microblog Mondays.  If you want to read more, please head over to Stirrup Queens!  Thanks to Mel for originating and hosting.