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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Good Stuff

Content note: Child-centered post

Yesterday marked the first day in quite awhile that the weather was fine enough for a good walk outdoors.  The temperature was in the mid-40s, which, given cold this winter, felt downright balmy.  The sun shone and we took a short walk to the park down the street.  E rode her trike and collected rocks.  We came home tired and a little muddy (the trike tipped in a puddle) and it was wonderful to finally get outside again.

The girls will turn two and four shortly.  They’re no longer babies, but instead children who are more interested in running ahead, picking out tiny treasures for their various collections, and reading books.  It is, of course, a little bittersweet – after waiting so long for them, it feels like the days have sped up – but it is also marvelous to watch them grow and change and begin to fill in the contours of their personalities in demonstrable ways.

M waited a long time for words but suddenly now in the last few weeks began speaking in full sentences: “I want more milk.” “Don’t go that way.  Go there.”  “It’s time for snack.”  She’s almost discharged from developmental therapy (for the speech) and knows her own mind well.  Books are her favorites, particularly Paul O. Zelinsky’s gorgeously illustrated Rapunzel, along with almost any book that has flaps to open.

E also is doing well.  Every time I think about the tiny 2lb 8oz (1190 gram) baby in the NICU incubator and stare at this child who is still quite petite in stature but huge in personality, it almost makes me want to cry with happiness.  She’s at age level in most skills except for some gross motor that needs to finish catching up.  Her favorite thing is stickers and making cards for people that she happily scribbles all over and explains to me what she “wrote” there.

Together, as much as I dislike the term itself, the girls are the definition of “frenemies”.  A sample interaction: E yanks a toy away from M, who tries to push E but doesn’t quite manage to do more than brush E’s shoulder.  E flops on the floor and starts sobbing loudly.  M goes over and pats E, making soothing noises.  E yells at M and stomps off.  A few minutes later, both girls are cuddled on the couch with E explaining a book to M, who is listening with great attention.

In other words, they’re siblings.  But I also know how much they genuinely care for one another.  E worries about M, M searches for E when E’s not in sight, and they play together well a surprising amount of the time.

They’re small children and there are days that don’t look nearly this idyllic, but every day, I’m grateful. 

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.