The March of the Pills

Our first appointment ALSO entailed getting started on our pre-IVF drug regimen.  They won't pull out the big guns until I start my next ovulatory period, but in the meantime, we're doing the following:

Both of us:

• Ciprofloxacin - preventative antibiotic.  Even minor infections can dramatically decrease the chances of IVF success.

Just me:

• Metronidazole - a special antibiotic JUST for the ole bat cave.  It comes with a three feet long applicator.  Fun.  Toilet acrobatics.
• Baby Aspirin - increase bloodflow to the uterus and make sure that future home is super comfy and lush.
• DHEA - a hormone supplement to support my production of estrogen and androgen.  Hopefully, this will make up for my egg reserves, which look like they ought to belong to an old lady.  All I know is I'm crying at especially poignant television commercials and breaking out with the acne of a 15 year old boy. 
• Estradiol - basically, a synthetic estrogen.  Again, geriatric eggs. 

We also got some blood work done, basically to make sure we're not teeming with chlamydia and ebola (news flash: we're not).  Jake has to get his swimmers tested ONCE AGAIN, presumably so the lab techs can point and laugh at those poor little guys one last time.  I had to get my AMH and thyroid levels tested again, too.  AMH came back confirming the above mention egg problem.  Thyroid came back a little weird, but subsequent blood work ruled out the need for synthetic thyroid medication.

I'm now off of birth control and waiting for ovulation.  They want me to ovulate at least once before we get going on this, so I've been drowsily peeing on those ovulation predictor sticks every morning for about two weeks.  The big O is a tad elusive this month, which figures, since I normally ovulate like clockwork.  Side note, did you know you can actually urinate onto plastic incorrectly?  Because I am a princess and like my toilet routine to be as high tech as possible, I splurged on the more expensive DIGITAL ovulation predictor kit on my way home from our appointment.  Twice, TWICE, the message that appeared in the window was a picture of an arrow pointing to a booklet.  Thaaaat's right.  This pretentious piece of plastic told me to go back and read the directions as to how I might more efficiently or perfectly pee onto it.  Since going through a box of those with no coveted "smiley face" result, I have downgraded to the less persnickety but far more inscrutable CVS brand.  Now, I'm supposed to compare the density and pigment of two pink lines.  Who has time for this nonsense?

On a more grim note, being off birth control has been tough these past two weeks.  Why was someone infertile taking birth control, you may ask?  Well, endometriosis is an inflammatory condition that is triggered by the ebb and flow of hormones.  Staying on the pill kept everything nice and quiet for the last year, and I was able to get by with only a few advil and a couple of hours on the heating pad a night.  Now, it's a mental battle every day just dragging myself out of bed.  The pain makes me sleepy and depressed, neither of which I have time for right now.  Come on, ovulation!

If I have a legitimate cycle this month, we'll get started on stim drugs as soon as my period arrives, possibly the beginning of March (cue ecstatic squealing and clapping). If not, we'll have to wait yet another month, which, though I know is nothing in the grand scheme of things, will totally bum me out.

Decisions, Decisions

Another thing we had to do at our appointment was sit down with our doctor and go over some very important decisions.  Some were easy to make.  Use ICSI?  Duh.  Freeze any leftover eggs?  Of course.    Assisted Hatching?  No need.  How many embryos to implant?  Hmmmm....

Okay, so for a woman of my age, here is the textbook recommendation.  If they are good quality embies, put back one.  If they are less than ideal, put back two.  The doctor explain that we could be more conservative and only put back one, regardless of quality, OR we could be more aggressive and put back two, regardless of quality.  With the former option, our chances of conceiving at all are lowered.  With the latter, our chance of conceiving twins as opposed to a singlet is 1 in 2.  Jake and I stared at each other awkwardly for a few minutes and debated in our usual, snarky, hyperbolic style.  "You know how I feel."  "No, you said you want to do what's best.  That's not clear here."  "I want to do what's most effective."  "Well, most effective isn't necessarily best.  Putting back five would be most effective!"  The doctor jumped in here to make sure we understood that nobody is cramming five embryos into a 30 year old.  She must have thought we were getting heated, because she handed over the form and told us to think about it over the next few weeks.  She was staying out of it.

However, with a few minutes left to ourselves while waiting for our next meeting with the IVF nurse, we knew our decision: the aggressive course, two embryos, high possibility for twins.  Essentially, we just know that we'll regret it terribly if we don't conceive after only putting back one.  From that moment on, we've been sort of deliriously giggling and joking about how crazy our future life with twins will be.  Jake's been peering, with wrinkled forehead, into his cramped backseat, trying to picture TWO carseats shoved into that tiny M3.  I've been mentally rehearsing trying to get from the parking garage in our future Dallas high-rise to the apartment door with two infants and a single sack of groceries.  When we talk about signing up for insurance at his law firm, he'll say, "Well, it's cheap for me but more expensive when I add you and..." "The TWINS," I finish.  And we both crack up and whimper a little simultaneously.

Dear Lord, one will REALLY suffice, but I promise I'll be gracious if you double our pleasure.

Good Things Come to Those Who Wait...and Wait

It's finally happening.  Nearly 5 years after we started trying to conceive, three years after we were told unequivocally that we had no chance of conceiving naturally, after two surgeries on my endometriosis, over a year after applying for our scholarship through INCIID, 6 months after we raised $3,000 for their organization, WE'RE FINALLY GETTING STARTED!!!!!!!!!

I want to again thank all of our family and friends who donated to INCIID on our behalf.  We are truly blessed with an incredible network of support.  Many couples navigate IVF in private, keeping the dates and details to themselves.  This makes a lot of sense, of course, because, when things go wrong, you don't want to have to share THAT news with everyone.  While this sort of privacy is appealing, we know our journey will be a slightly different one.  We've made this project a public one from the start, and you are all a part of this process.  You've a right to know what we're doing and how we're progressing.  Additionally, there are so many people whose faces screw up with concentration and wonder whenever I speak about this procedure in broad terms.  I have gotten the distinct impression that people are deeply curious about how this whole thing works.  If you're not in that camp, read no further.  But if you're like 90% of Americans and delight in all things voyeuristic, do enjoy.

INCIID matched us with the Reproductive Medicine and Surgery Center of Virginia, pretty much the most ideal match we could have had.  The clinic is only a little over an hour away, and we are familiar with our doctor since she did our official scholarship testing, as well as performed my most recent hysterosalpingogram (running fluid through the fallopian tubes under x-ray to see if they work) and laparoscopy (minimally invasive surgery to look around the pelvic region).  The latter had been performed last April for the purpose of cleaning up my endometrial adhesions and removing my blocked (and therefore toxic) fallopian tube.  She managed to open up the tube during surgery, doing exactly what two previous doctors had attempted to do three other times.  As a result, I have two working tubes and a new hero.

We had our first appointment on Tuesday, and it was a doozy!  Not difficult, just a lot of new information and decisions.  First, we did a practice run of the egg transfer, basically mapping out the size and shape and tilt of my uterus so there are no surprises on the day of the real thing.  The most amusing thing has to do with the ultrasound, which they move on the top of the belly to guide the catheter.  Now, between the surface of your skin and the uterus is your bladder, so they basically use it as a window to look through.  The bigger the window, the better the view, right?  Consequently, I was told to come with a full bladder.  The appointment was at three, so I made sure I used the restroom for the last time at lunch and spent the second half of the day sipping water.  By the time I got there I was rather uncomfortable and proudly told the nurse when asked, "Oh, yes.  VERY full bladder."  Well, apparently in egg transfer world, "full" has a totally different meaning.  They were looking for ready-to-burst; I was told to aim for twice as full on transfer day.  I wonder how many women have had "accidents" in that waiting room.

After the trial run transfer was a saline ultrasound, basically just a look-see around the uterus and ovaries to make sure there are no polyps or cysts that should be treated before we proceed.  My lady-junk got rave reviews, and the procedure was a breeze.  This ship is ready for boarding!

More on our first appointment in the next entry...

Break out the Cake and Champagne!

We reached our goal of $3500 in donations made to INCIID!!!!   Jake and I would like to send out the warmest of thanks to everyone who helped us to cross this finish line.  In particular, we'd like to commend Frankie's Mexican Restaurant for their special support in the month of June, as well as Jordan Swim of Vestals Foods for catering a beautiful six course dinner for our family and friends.

Our next step is to wait for a match between our needs and a clinic willing to donate its services. We'll keep you posted on the details here, so if you want to follow along, be sure to subscribe or bookmark.

We are overwhelmed with love and gratefulness.  Thank you, thank you, thank you!

Infertility Etiquette

Though infertility can seem like a lonely row to hoe, I have managed to make some valuable and comforting connections with others who suffer similarly.  We share tips about how to ease the searing pain of intramuscular injections, agonize over ridiculously pale lines on home pregnancy tests, and empathize heartily when a long time friend or sibling turns up pregnant without even trying.  Sadly, many women I talk with have dozens of stories involving being hurt or offended by loved ones in regard to their infertility status.  I like to think that, in most cases, the faux pas was entirely accidental (and largely unnoticed), but we infertiles have a special set of sensitivities that many cannot anticipate.  I think the miscommunications can be broken down into three categories:

1) This is not a time for humor.  I know you're just trying to help and lighten the mood, but it feels deeply offensive and distasteful when you jokingly offer us your own misbehaving kids or tease "You sure you want kids?!"  Many of these women have experienced repeated miscarriages.  And those who haven't often liken the painful years of waiting, the disappointments, the ever widening gap, to a kind of death.  "It's like you're a mother," a friend told me one day, "but someone has locked up your child and won't let you see or meet him.  You walk around feeling like you're incomplete, bereaved, haunted by the baby you can't find."  If you wouldn't joke about someone's child dying, you probably shouldn't joke about their child failing to be born.

2) Don't minimize the problem.  The worst. possible. thing. to say is, "Just relax, and it'll happen." SHUDDER. Other vile variations on the same theme include, "Just adopt, and then you'll get pregnant," and "Lots of women have healthy babies well into their 40s."  Similarly, providing anecdotes of people on TV or someone's brother's aunt's boyfriend's hairdresser who had triplets naturally at 45 or who got pregnant as soon as they stopped treatment....not helpful.  We know our chances.  They're not good chances.  Shaking a lucky rabbit food at us doesn't make math and science go away.  It just tells us you don't get it.  Relaxation and dumb luck are luxuries for the healthy.

3) Don't tune us out.  If someone screws up the nerve to confide in you such an embarrassing, taboo problem, please be a good listener.  It's a big deal to reveal that kind of medical and psychological pain.  Yes, it may make you uncomfortable to hear about sperm or shots or ultrasounds, but think about how we must be feeling, facing all that invasive craziness mostly alone.  This is a good time to put other preferences to the side for a moment and listen with your whole being.  And finally, once you know, be sensitive about bringing it up again.  Yes, many women would be relieved to have a genuine, "How are things?" volleyed their way.   However, a brash text message like, "Hey, pregnant yet?! ;-)" is pretty much salt in the wound of a failed cycle.

If you're reading over this and thinking, "Whups!  I've done one of those," it's okay.  We forgive you.  (Donations are a good way to avoid a karmic shin-kicking, however.)  For those of you who've been awesome all along, and you know who you are, a million thanks.

The Birds and the Bees - Test Tube Edition

I have had a lot of questions and quizzical looks when I explain what we're signing up for with In Vitro Fertilization.  I thought I'd take a moment this week to break it down for one and all.

The first step is to make my ovaries go nuts making eggs.  On a natural cycle, several eggs start to develop at once until one finally releases, and the others quickly sit down and shut up.  (In the case of natural fraternal twins, two eggs accidentally release spontaneously, before the "I got this!" message could be sent around.)  In our IVF cycle, I will inject myself daily with drugs to make my ovaries triple this process of development while simultaneously taking another drug that shouts into a bullhorn, "Hunker down! Nobody let go!"  During this time, I'll need to go in for daily ultrasounds to monitor my hardworking ovaries and tweak my drug regimen.  If they don't develop eggs quickly enough, we may not have adequate material to work with in the next step.  If they develop too quickly, I can get a painful and life-threatening problem called Ovarian Hyperstimulation Syndrome.  So easy does it, here!

When my ovaries start to look really beautiful (or insane, depending on your viewpoint), they'll schedule the egg retrieval, and I'll take a "trigger" shot telling my ovaries to leggo my eggos.  The doctor will put me under, then use an ultrasound-guided needle to suck up all the good looking eggs he can find.  If we're all doing a good job, then we might get as many as 30 eggs!  Around the same time, Jake will need to give the clinic a cup of his "special" sperm.  Both eggs and sperm then go to the beauty parlor and get totally prettified for their big date on the petrie dish.

Now, with well-adjusted sperm and eggs, you can usually just introduce these gorgeous kids and let nature take its course.  They're in the prime of their lives, after all, and have never looked better.  However, Jake's sperm is too socially awkward for these subtleties.  They'd sit around all night just looking longingly at my eggs and wishing they were less homely.  So our doctors actually plan to pick up each sperm by the scruff of his neck and stuff him right into each egg.  I know.  So much for cellular foreplay.

After that, we put the newly created embryos in special "grow, baby, grow" juice and cross our fingers.  Within 48 hours, each should have multiplied into 6-8 cell organisms (many won't).  We can implant then, but if many are looking hardy, we'll wait until day 5 when we might have a few blastocysts (80-100 cells).  We'll select the very best of the bunch, and if there are some good runners-up, we'll put those on ice for another time.  The doctors will send our over-achiever up the birth canal and into the uterus where we hope it will find a warm place to burrow and sleep.  I'll probably continue with a few drugs to keep my uterine home nice and comfy for as long as the doctors see fit.  Then the dreaded two week wait.

The rest of the story is undoubtedly familiar to you: tests, celebration, reading, registering, showers, shopping, joy, pain, cuddles, milk, kisses, perfection.

Why Not Adopt?

One of the reason many couples fear coming out of the closet with fertility treatments is because the public is somewhat divided on that topic.  An acquaintance of mine who received an IVF scholarship from INCIID was interviewed on NPR, and the online comments from listeners were half supportive, half bitterly critical.  The latter half mostly griped that fertility treatments are the ultimate in upper-class, self-indulgent vanity.  "Why not adopt?!" they cried.  "Why spend tens of thousands of dollars trying to have your own baby when there are tons of babies out there that need good homes?  It's just selfish and short-sighted.  What a waste of money."

In some ways, I agree.  Ever since I was a little girl, I've dreamed of opening my home to little children in need.  I can remember driving around looking at Christmas lights in the opulent Highland Park neighborhood with my family, and as my mother and sister oohed over the beautiful homes, my ascetic 12 year old spirit turned up her nose at the decadence and swore to only own a house that large if I could fill every room with a homeless person.  I can recall listening to educational sermons in church about the value and necessity of foster parenting, especially older children who will soon graduate from the system at eighteen without an ally or mentor to guide them to true independence.  I thought, "Oh man, I hope I can marry a man who will want to foster tons of wayward teens with me."  For a long time, I was so passionate about adoption and foster parenting, I couldn't see any reason to go through all that messy childbirth business.

But then, I fell in love.  And something miraculous and mysterious starting working within me, just as it does nearly every woman at some point in her life.  I felt the deep, spiritual calling to create life with my partner.  I felt my love for him yearning and reaching to extend through new generations.  My admiration for his beauty and wit overflowed until I sought a likeness in his future children.  I wanted to give birth.  I longed to feel life inside me.  I literally dreamed of breastfeeding.  This baby would come from my flesh and his, I would bring it forth into life with my own body, suddenly flowering with all this maternal instinct and drive.  My body was so heightened with desire, we joked that I could sense any baby in a mile radius, without even turning my head.  It wasn't academic anymore.  It was physiological.

As for the money argument, it seems that infertile couples must pay a sort of tax for their reproductive failings.  Though IVF treatment, at around $12-15,000 per try, seems indulgent and ridiculous, consider that the average domestic newborn adoption costs between $25-35,000.  What about China, you ask, where they don't even want their little girls?  An average of $29,000 per child.  (Jake and I don't even qualify for most of those international adoptions because of our medical histories.)  But, at least adoption is guaranteed, right, unlike risky fertility treatments?  Nope, approximately 31% of adoption attempts result in the birth mother changing her mind.  I immensely respect adoptive parents and children, both domestic and foreign.  However, part of that respect is acknowledging that it's no cake walk to adopt a child.

I still plan to adopt and foster.  My passion for helping others that way has not diminished at all.  I just know that I need to try this first.  I want to experience motherhood, with all its varied delights and pains, just as women for millions of years before me have.  When I look into the beautiful faces of my friends' and relatives' children, when I see a flicker of likeness to mommy or daddy, it breaks my heart with the universal beauty and miracle that is "family."  Though our treatments eventually may not work and we'll never experience such miracles first hand, I would hope that our decision to try is understood and respected.