Starting 2016

I haven't been much of a blogger lately, but I have been slogging it out for awhile.  I'm entering my seventh year, though it has been much quieter around here since the kids were born.  It says something about my corporate job (and infertility too, I suppose), that the bulk of my nearly 600 posts came in those early years.  This outlet still holds a place for me that my other social media outlets don't and can't.  Facebook is not a blog (repeat after me) and neither is Pinterest or even Instagram.  And since I'm not selling anything over here (or anywhere), I have a little bit of a different take on each.

I'm finally getting around to reading "Quiet", which is amazing so far.  (Introverts unite!)  And looking forward to finishing it, so I can start on "When Breath Becomes Air" (you can read about it more on Cup of Jo and in the NYT) and then "We Should All Be Feminists" and "Between the World and Me".  One of my goals this year is to read more books...and actually finish them.  I've long been the queen of leaving books unfinished, and being on all the time for two busy preschoolers surely doesn't help.

The kids are doing great and we're all keeping busy.  We've done all sorts of classes over the years, but now we are trying to settle into a sport (dance for her since last fall, t-ball for him) and an instrument (piano for them both), though we'll mix it up come summer (tennis, soccer?).  We took a trip to the ENT to have Alistair's tonsils looked at and it turns out they are fine.  We are finally kicking whatever virus(es) have been plaguing us for the last few months.  Round and around it/they went...

If you aren't watching the last season of Downton Abbey, the last episode highlights that (spoiler alert!) having an incompetent cervix/infertility and cerclages are not new things.  And that others have had to move all the way to Boston to find themselves... I'm really going to miss that show (and yes I cheated and already watched the entire UK season online.).  Waiting for new Master of None and House of Cards (thank God for Netflix).

We just marked a decade in our house (and me in the burbs, the same amount of time I spent in Boston and Chicago combined), which means I've just now eclipsed even my childhood home for my longest tenured abode.  And we are finally almost done with the things we wanted to do here.  And in a few short months, it will be our tenth anniversary and my 40th birthday, which is all kind of crazy to think about.  So milestones and goals abound...

I still need to put together a post on our warm and wet holiday roadtrip to Nashville and NW Florida, so stay tuned!

Important Lessons

I read things all the time that I think about sharing, I really should just start of runner of article links in my sidebar (which I now have).  But this was too good (and hit way too close to home) not to share (original source).  It wasn't until I dealt with infertility (and loss) that I realized how my life up to that point had prepared me for the strength that I needed to get through it, and I wish there was a way for everyone to have the strength and wisdom that comes from a life of struggles, you know without all the struggles, but that is not how life works. 

Embrace the hard stuff that finds you, it is what makes you stronger and better than you were before.

#6: Everything is a MIRACLE

We love you Laura

My aunt Laura passed away earlier this week. She was a young fifty-five, always so sweet and cool and chic.  I idolized her when I was a kid, probably because she didn't have any reason not to be sunny, unlike my divorced working mom of four.  She had breast cancer that we'd thought she'd beaten, but then it came back and had spread to the muscles around her heart, and even all her fight and the best care in the world couldn't beat it. She and my uncle (my father's next younger brother) were married 30 years and lived in Palm Beach Gardens, after first meeting in Chicago.  They were quite a couple...  She the sorority girl turned travel agent (remember those?) turned SAHM and teacher.  My uncle the golf pro/model turned small business owner.  When I was a kid, we'd often make the long drive from WI down to visit them (usually in the hot hot summer).

She was the first person I knew to do IVF (in the late 80s, for secondary infertility after having a son promptly after they were married and waiting years for another child), though it didn't work and she subsequently got pg on her own w/her daughter (who just turned 21). She was also the first person I knew to build her dream house, which we got to witness (it was the summer my sister Em spent with them, so of course she did the same a decade later).

When I was dating a guy who lived in Miami (in college and just after), I would always drive up to visit them when I was in their neck of the woods. It was on one of these trips, about a decade ago, that I saw her last. I guess I had a bit of a falling out with my uncle, who is as terribly opinionated as I am though he is also a rabid Republican and racist and has a thing for grudges, and we just kind of fell out of regular touch.  My family is weird like that, which is sad.  I'd heard through the grape vine last year that she was sick again, but hadn't been able to get down to see her.  They weren't able to travel up to my grandma's big 90th party last May.  She, thankfully, made it long enough to see her son have one of his own, the same week the twins were born. 

With Mother's Day this weekend, which is already know as "Thanksgiving Day in May" at our house, we'll be thinking of her, remembering the good times and just how lucky we are to have our health and our family.

Autonomy

Though you certainly don't need to be a parent to understand the horror of what happened in Connecticut last week (and frankly as an infertile, I find the repeated illusion to this pretty offensive).  As I along with many other parents first impulse was to wish we could put our kids back in our wombs or at least locked in the house to protect them from violent evil in the world (which obviously is not a positive solution to a very sad and complicated problem), I was ironically simultaneously marking the end of our very long physical journey through getting my body ready to pregnant, trying to get pregnant, drugging up in hopes of getting pregnant, drugging up to stay pregnant, being confined to bed to stay pregnant, getting sliced open to give birth, and then nursing/pumping for the last twelve months while caring for two infants.  A good five plus years in all. 

And now I have complete personal physical autonomy, and it feels great, if almost completely foreign.  As I expected, my energy level rebounded almost immediately after I stopped pumping last week, thank goodness.  I ended up stopping a few days early as my transition down to one pump a day didn't last long as my supply dropped off the cliff.  I can only hope my cycles don't kick my ass when they eventually return.  My elder sister, the uber fertile with a nearly three decade history of gyne issues, opted to get a hysterectomy last week with her diastasis repair, as hers were so bad after her last pregnancy.

Even in the many months that I was getting full nights of sleep, the pumping was syphoning off every bit of extra energy that I had.  I was literally not able to eat or sleep enough to not feel like I was starving and exhausted all the time and I was eating a lot, all the time.  And while I know you can, and many do, drink while breastfeeding, I found that even a little wine would not only make me more tired, it would kill my supply, which was already an issue that we battled for so long.

Now I just need to set about getting back all the strength I lost from being on bed rest.  Honestly, going to the gym has been near the bottom of the list of my priorities.  I knew BFing and chasing after the kids this last year would make my 50 pound pregnancy weight gain evaporate, but I was often reminded of the fact that had I had the energy to devote to getting my strength back, it would have likely made my daily care taking responsibilities easier, or least less pain inducing.  I have been back to the chiropractor for awhile now, though I know that she can not fix what I need to do for myself.

Thankfully, there are many things I do well, but obviously the key elements of reproduction are not any of them.  How amazing is it that I/we live in a time when people with all my issues are able to become parents?  Truly amazing...

Marking days (and knowing your risks for PTL)

The kids are 8 1/2 months old (nearly eight adjusted) and have surpassed their time inside, 36w4d, with their time outside, 37w2d, and today is the one year anniversary of the surgery that kept them cooking past 21w4d and saved their lives. 

After losing my mucus plug last 8/19 @ 19w (and then having an OB clear me w/a long and closed cervix as we were heading OOT on vaca) and then six days later discovering my funneling cervix at our anatomy scan (which put me on bed rest), I quickly found an MFM that ordered that I be monitored more closely (and put me back on P4).  After a week of twice weekly checks showed that my cervix was stable and then much improved/normal, the third showed that I was beginning to dilate.  By the time I got into surgery that afternoon, I was already two cm dilated (with four cm being the limit for being able to be sewn shut).  It was one of our very worst and (in the end) best days...

Every day now, I look at the babies and know how lucky we were that my appointment just happened to be on that day and that my body failed so slowly.  We've just passed what would have been the first birthday of our first baby who we lost.  I am a very emotionally resilient person, as is DH, but I'm just not sure that I would have been able to cope very well with birthing three lost babies.  There is a limit to how much you can even imagine bouncing back from...

In an attempt to hopefully save others from a similar situation, I wanted to share the risk factors that I had (and should have put me on a short list for closer monitoring) and all the many others, so you can advocate for yourself and your babies.

According to the March of Dimes, I had all three of the greatest risks of having a preterm birth:

A uterine septum (or other uterine/cervical irregularity) can cause problems, even after removed.  In our attempts to get pg, I'd also had several surgeries (three over the course of 16 months) to address my septum and a polyp, which involved dilating my cervix (any D&C-type procedure increases the risk of having cervical problems or adhesions).  I'd also had a cervical cone biopsy in my 20s after an irregular Pap, which thankfully was benign, but left me with a little piece of my cervix missing, which also weakens it.

Though I was carrying multiples, a major risk factor, just having done IVF and being pg with one baby is sadly also a risk factor for preterm labor.

Since my first pregnancy ended in a spontaneous loss, this also put me at higher risk for another preterm loss (since the root causes, including low P4, were likely the same).  First trimester losses sadly garner little serious attention, so it was not considered a risk at the time.  Though if it had been several weeks later, it would have raised more red flags and I would have been a candidate for a preventative cerclage, rather than needing a rescue cerclage.  How sad is it that you not only have to lose babies to be treated proactively, they must be farther along...

Though I was nearly 35 when all this occurred and age (high or low) is a risk factor, I was very healthy and didn't have any of the other health related risk factors (preeclampsia, high blood pressure, diabetes, under/overweight, clotting disorders, other disease/infections/birth defects, etc.)

All the other/lifestyle risk factors actually ran counter to my situation.  These include race, socioeconomic status, marital status, working status, access to prenatal care, unintended pregnancy, smoking, alcohol/drug use, lack of social support, stress, domestic violence, and exposure to environmental pollutants.

If you are TTC or newly pg, please check out the list of risk factors (there are so many, but some intersect w/those causing IF, like PCOS) and see if any of them apply to you and discuss with your physicians.

And so it is finally September, when we also mark two years since we lost my FIL and my sister was dx w/cancer.  Those were some dark days...  Thankfully, my MIL is bolstered now by having my BIL back in India, a new DIL, and of course new grandbabies (which she'll be back to see in the new year).  And my sister is so far cancer free since her surgery and chemo last year.  Thanks to those who sent her cards and/or added her to your prayers.  We also get to mark another year of marriage (6!) and life (36!), opportunities that we cherish.  We know just how lucky we are and are very thankful, every single day.

If you are going through hell, keep going... -Eleanor Roosevelt

From supernanny to superpatient to supermom...

This time of year always reminds me of school and work, which for me have always been synonymous, until this year of course. I started working as a babysitter (gulp) 23 years ago, as soon as I turned 12, and it was a significant source of income for me for many years, helping me pay for travel in high school and work my way through college. It has been so long, in fact, that some of my former charges now have kids of their own. I started my first "real" job four years later, working at a local apple orchard in their retail store w/my sister E for three fall seasons, which I'm also always reminded of this time of year.

I remember being so excited to start babysitting as soon as my mother would let me. First for neighbors, then co-workers of my parents (half the drs. in town), teachers, and referrals (including the couple who owned our local athletic club, setting me up for a summer getting buff and working in their day care). I literally worked for dozens of families before I got out of high school. I've always loved kids and it was undoubtedly great experience for someday becoming a mother myself, and also for experiencing first hand how other households were run. I ended up continuing in college, almost by accident, when it came time to decide what to do for the summer. When I decided I wasn't going to NYC to intern on Wall Street, I lived in during the three summers w/two families in Hyannisport and also worked weekends during the school year for the same Boston area families. Exactly a decade after I started, I "retired". Had I been more entrepreneurial at the time, I would have started a business, like fellow babysitter extraordinaire/college classmate Genevieve Thiers, a fellow Chicagoan who founded sittercity.com. She's quite a dynamo, and is now ironically expecting twins herself.

So now for over a decade, after as long immersed in all things kids, I've been shaping my adult life and grinding in the corporate world in preparation for when I would finally become a mother myself. Sadly, the last three years we have also been immersed in the world of infertility medicine, but we are obviously thrilled to finally be planning in real terms for our kids/family to come this fall. Like most women, I always considered staying at home, but I don't ever think I ever really thought I would. IF (and now bed rest) definitely ended up forcing my hand, which like when I got sick w/mono at the end of that last summer in college, forced me to cull the unnecessary out of my life. Though I couldn't be more thrilled to be solely focused on our family, for now anyway.

Though the more I think about SAH long term, the more I think that I will end up going back to work at some point, either for myself or back in the corporate world. While it is certainly an honorable vocation, it seems many SAH either because that's all they've ever wanted or been able to do and/or because paying for care for their children is just more than they would make in the workforce, making it less of a choice. From my experience, I think it is really important for children to have positive interaction and myriad role models outside of the family, thus making room for mom to have other interests.  And obviously the resources that are brought to bear by working, provide their children opportunities that those living more simply to SAH are not privy to.

So after all this time, it is so wild to think that in ten or so short weeks, I will have my very own kiddos. :)

On not working

Thanks Linda for the post topic!  She was wondering about my decision to leave my job for our latest cycle.  This came after the decision to take an unpaid leave of absence for my fresh cycle last November, which I think helped me then. (see "what we did" post from December)  I apologize in advance that this is long and rambling, but as you can see it wasn't a decision that we came to quickly or without a lot a crap going down first.

Back when we were planning to cycle last Sept/Oct (after my last septum/lap surgery and before my FIL passed away unexpectedly delaying our cycle to Oct/Nov), I had spoken with my boss about what we were doing and that I'd like to take some time off to focus on our cycle.  He was very supportive, having a brother who with his wife had been through the IVF process as well (they now have twins).  I then had to spend a lot of time with HR to try to figure out how to make it work.  They wanted me to apply for STD, which I knew I wouldn't, and didn't, qualify for, as my RE would only write me out of work for ER and ET (two days).  I finally ended up taking a personal leave, when we got to cycling in November.  I gave up those weeks of my salary and that portion of the year's bonus, but I didn't have to use any of my PTO time, which I cashed out when I left the company.  After doing some research, I also requested that it not count against my 12 weeks of guaranteed time for FMLA, since it was obviously our plan to get pg and need that time for maternity leave, which would have been paid through STD and my saved PTO.

I found out I was pg over Thanksgiving and returned to work the next week.  I worked for just over a month before we lost that pregnancy.  My boss was then very understanding and let me take a week off (off the books) and then I came back to work partial days for the next.  After DH returned from India, we began our recovery and planned for our next/FET cycle with our two remaining embryos from our cycle, it became increasingly apparent to me/us that we needed to focus our energies even more on what we doing. 

Originally, I was meant to be on the road for work from late Jan-April (my 2nd tri for my 1st pg, which I thought would work out, though the pg didn't), but then in December found out that this would be delayed.  After I returned to work in January after our loss, it turned out that the powers that be were considering delaying the roadshow launch even further.  I had an honest discussion with my boss, my former boss (who was still leading the project, but was now on a new team), and my boss's boss about how our plans to cycle again would be our priority and that I would need to have someone fill in for me on the road if I needed to be home for appointments on certain days.  They were supportive, but honestly the project was so unstable at that point, that I think they were just agreeing to whatever I was saying because they needed me to stick around and help get it off the ground whenever that time came.

I don't remember exactly when DH and I started talking about me leaving my FT job completely.  I think I brought it up sometime after the new year.  I had been unhappy for some time and a lot had happened since I had started there in the fall of 2009, which was when we began our first treatment cycle.  I had completed a mini-MBA program in Feb 2010, which my employer had helped to pay for, so I was obligated to stay on for one year after that, to avoid having to repay those funds.  I was also looking forward to collecting my annual bonus at the end of March, which I was definitely sticking around for.  So this became our new target.  Sometime in late winter, they decided to cancel the roadshow for my project completely, which was somewhat of a relief, but also upset me given I'd devoted 18 months of my life to this project, and it was pretty clear that they were screwing up the launch.  I made it known that I didn't agree with this decision and at some point a new, scaled back launch plan was suggested.  I again reminded everyone that I would be available only to the extent that whatever schedule they came up with didn't interfere with what we were doing. 

It wasn't until mid-March that we were able to begin meds for our FET, given the time required post-m/c to regulate and get back on track.  By this time, I was counting down the days.  At the end of the month, I got my evaluation, bonus and raise, and after leading the training session that was to replace most of our roadshow, gave my two week notice.  I worked until mid-April, two weeks before our transfer.  Another reason why I was comfortable leaving without another job lined up, was that the consulting firm I had worked for before I went over the corporate side in 2005, said that they had work for me to do.  I did my first, and what has turned out to be only, project for them immediately after I left my FT job.  This was the intense project in Vegas that almost cause me to miss my grandfather's funeral in April.  After this and getting pg w/twins from our cycle, I have opted not to do much in the way of work which is good now that I'm totally out of commission, though I have been networking, with another consulting firm adding me to their roster of contractors.

We had used the rest of our $15K lifetime max for infertility treatments, through DH's work, on our fresh cycle, so we knew we'd be OOP for whatever came next, unless/until I found a new job with IF benefits.  We had saved up enough to do several cycles OOP, if that became necessary.  I also did a ridiculous amount of research and even applied to work for companies where IF benefits were available.  Given our age, history, focus on having a family (not having kids has never been a viable option for either us, and we have discussed adoption at length), and ability to live on one salary since we live below our means, while we figure out what is going to happen, it made sense for us. 

Though long term given my earning ability, which is significantly more than the cost of having someone else care for two kids while I work, I will likely go back to work in some capacity by the time the kids are two/in pre-school in order to help provide the comfortable lifestyle that we'd like to provide for our family.  Those 529s don't fully fund themselves unfortunately...  And unlike someone I was reading the other day in response to determining their family size, I won't expect my kids to just be thankful to be alive, even though there is no plan/ability to take care of them adequately.  This might be the single most ridiculous and irresponsible thing I've ever read, and I know all about this first hand.  They should expect some support from their parents in making something of themselves.  I don't expect them to start working at 12 or work three jobs through college, like I did.  But unless we have a family, the money really means nothing and the things that it can buy (besides IF treatments, of course) can wait.  But my biological clock doesn't stop ticking...

Now that I'm on bed rest for the rest of the pregnancy, I (and all my Drs.) are very glad that I'm not having to deal with an employer.

Lessons from the flip side

I know some of you are already moms and others of you are still working on it, and then some of you are happily neither and just following along.  I think a lot about how people cross over to the other side when they've dealt with infertility (and loss as well), as it can be a somewhat contentious issue among infertiles.  My stance has always been that no one (infertile or not) should ever feel guilty or apologize for their good fortune in getting pregnant.  I'm not just saying this because we have been lucky enough to get pregnant again, but because I've lived quite happily with other people's success, for years now.

For many dealing with infertility, getting pregnant seems like a huge accomplishment, which it is, but sadly the really hard work is just beginning.  Depending on your dx, and many don't have one definitively, pregnancy may be as easy as it can ever be and for others, not so much.  Which seems to reek of something amiss in the karmic space, but these are not necessarily unrelated.  I was, of course, very recently reminded of this, yet again. 

The key causes of my infertility, as far as any of our RE's can tell, are hormonal and structural.  My body goes easy on the making of estrogen and progesterone, which is no minor detail, though it strangely doesn't result in odd cycles.  And after a cervical biopsy 13 yrs ago and my uterine malformation (a giant septum) and two resection surgeries (and a polyp surgery w/a D&C), my baby carrying equipment is in a relatively sad state.  These are two things that unfortunately for me, don't stop being an issue just because I'm able to get pregnant with the help of IVF. 

Yes, my two giant placentas should be making lots of progesterone by now and are clearly doing well enough to support the twins, but not so much my body on its own.  I know that I am very lucky that I don't have other underlying health or immunological issues and neither do we apparently have any significant gamete (egg or sperm) issues.  These unfortunately often cause people to cycle repeatedly, going through lots of eggs, embryos and even babies before finding the winners and coasting to home plate in this all too insane game of reproduction.  We've only ever had five embryos (out of 7 mature eggs), four of which were transferred, and three of which made it to heartbeat, which I'll admit is an amazing hit rate.  So not so infertile, you might say, but touche, it's just not that simple.

As you may remember, there was no explanation for our loss in December, given that the vast majority of first trimester losses are a result of chromosomal abnormalities.  Everything looked absolutely textbook perfect, until of course, it was over in a matter of minutes.  This happened four weeks after I voluntarily switched from my course of PIO to Crinone, as I was given the option and was told there was no difference.  I was not allowed to be on Crinone for pregnancy support during my next cycle, a tacit admission by my RE that this had obviously not worked for me.  There was also concern that my septum may have been a contributing factor, which is why we had another invasive scan and surgery consult after our loss.

When I passed my mucus plug @ 19 weeks during this pregnancy, after what was an uneventful first half, it was again four weeks since I had stopped my ridiculously long PIO regime.  I was eager to stop, but part of me was very anxious that my body had proven that it didn't do pregnancy well without the proper hormone supplementation, regardless of what my body was supposed to be doing.  So within a week and a half, we were back on progesterone again in an effort to keep my hacked cervix closed and the babies inside cooking.

So let my tales of woe be a lesson for all you who are still in the trenches.  Getting pregnant may seem like the holy grail, but sometimes it's not.  Try to find out what is keeping you from getting pregnant, if you can, and then be diligent about following through on this after you get pregnant, since that BFP is unfortunately not necessarily the answer and end to all your problems.

Infertility math and twin guilt

Well now that we are out to everyone as expecting twins and are as sure as we can be at this point that we know what we are having (ty 3D u/s), I am getting the inevitable bizarro comments from people.  OMG, instant family! (three years later...)  One of each and done! (we'd be done, and content, after two regardless...)  Of course these usually come from people who have no idea what we've been through to get here.  These don't really bother me as much as remind me how much dealing with infertility for 2 1/2 years changes you, not that I would ever have said things like this to anyone. 

If I were a fertile myrtle and could get pg on demand, we'd have a two year old and another on the way.  So irony of ironies after all this, I admit we've sort of caught up.  My goal was to have two by 35 and we'll almost make it.  Except instead of enjoying a kiddo (and life generally) for the last two years (and having a nice down payment for a summer house), we've been slogging to various drs., having seemingly endless surgeries, taking myriad drugs, etc.  You get the idea, it's not the same.  But on the surface, all is seemingly perfect (so far anyway).  While this feels well earned, it also feels really awkward at the same time.  I've had people tell me they are jealous of us, which I'm kind of at a loss as how to respond to.

And don't get me wrong, I am beyond thrilled about our two babies (who are both squirming around like crazy as I write this :) ), but when it first sunk in that we were in fact having two at the same time (which obviously wasn't a big surprise given we'd transferred two embryos), I surprisingly didn't feel overwhelmed at all, I felt a little guilty. 

Guilty that only because of our IF would they each never have the time they deserve to be our only baby, that they would likely come early, be small, and would have a much higher chance of complications, etc.  All things that would almost never have been a possibility if we hadn't had to go through IF treatments to get pg.  Even my breeder sister, who will soon have four under five, told me after finding out that twins were her "worst nightmare".  Nice, huh?  (btw, I'd much rather be me than her.)  The thing about finally getting pg, which not everyone seems to realize, is that things are instantly no longer about you.  Something that I find profoundly refreshing after our journey.  It's one thing to go through these things yourself/as a couple by choice, but also because you have to, and then realize that your kids will be forever affected by what you've gone through.  It wasn't something that I thought about that much before, since even getting pg w/one baby seemed unattainable after so long, though we were very cognizant of making responsible decisions that weren't only based on our short term situation.

DH and I feel strongly that our primary job as parents is to do all we can to ensure our kids are able to live up to their full potential (and all that goes into that), and I feared that I was disadvantaging them out of the gate.  I am of course comforted by friends who've had big twins (my goal is >6 lbs/ea.), with no NICU time, who are thriving (though even the small ones usually catch up), but for an instant, I felt selfish for facilitating (and wanting) two babies.  I guess my mommy guilt got started early.

Wet and gloomy Earth Day

I am still so worn down from being sick, and this weather is not helping, that I'm not getting nearly as much done as I thought I would be being home just yet.  I went and got a massage and haircut this morning, which were very relaxing.  To kick-off National Infertility Awareness Week (NIAW), we are going into the city tomorrow to attend the "Fashion for Fertility" lunch at The Four Seasons to benefit Resolve.  We are both looking forward to it, especially since our plans to go out last weekend got cancelled due to having to work and finish our taxes.  Boo.

For those of you who don't already know all the minutia of our long TTC journey...

Infertility A - Z


A - Age at Which you Started TTC: newly 32, after our 2nd anniversary

B - Baby Dancing or Sex: Sex

C - Children Wanted: two, but we may end up w/one, we'll see...

D - Dogs/Cats/Fill In Babies: None, DH is allergic

E - Essential Oils/Vitamins: I take: Pre-Natal Vitamin, Vit D, Omega 3 & 6 fish oil, cranberry extract

F - Fertility Meds I've Taken: Clomid, Ovidrel, BCP, Follistim, hCG trigger, Crinone, Lupron, Gonal-F, Progestrone in Oil, estrogen patches, Prometrium, Premarin, and medrol, tetracycline, baby asprin and others I'm sure I'm forgetting.

G - Gain, What I have Gained from Infertility: Perspective, loss of interest in the unimportant and insignificant

H - HSG: I had one two years ago this month, when we first went to the RE and another after my m/c.

I - Infertile Pet Peeve: That insurance coverage is not universal and that for most people treatment decisions are often made based on cost.  I can think of no other medical condition that is treated this way.

J - Job Title: until I quit last week: Marketing Director, now: some would say unemployed, but I'm starting a consulting business.

K - Kids Names you are Afraid will be Taken:  I stopped caring about stuff like this long ago, plus I'm not really into trendy names anyway.

L - Length of Time TTC - 2 1/2 very long years

M - Miscarriages: One - our little Neela on 12/30/10 at 8 1/2 weeks

N - Number of Times you have Swiched REs: I'm on #5 at clinic #4...

O - Ovarian Quality: Good, as far as we can tell.  I like to say they are compliant, but not overly enthusiastic.  I O on my own as far as we know.

P - POAS or Wait for AF: POAS if we are cycling, otherwise I'm super regular.

Q - Quote from an Obnoxious Fertile: So many, it's hard to pick just one.  The most hurtful have come from close family and friends, though eventually I'm able to shrug them off as ignorance.

S - Sperm: Not spectacular, but not horrible either. Varies by SA, but thankfully there are plenty of them

T - Time you Tried Naturally - 6 mos. until first RE visit, then after surgery #1 (for a polyp), we TTC on our own until the one year mark.  Then again between cycles/surgeries whenever we were allowed to per RE.

U - Uterus Quality: I had a huge septum that took up most of my uterine cavity, but after two surgeries to remove it, it is now only 7mm and deemed to be a non-issue.

V - Vagina: yes ;)

W - What Baby Stuff do you Already Have: too much for someone with an empty womb, but not enough for someone who should have two in tow by now.

X - Xtra, Xtra, Hear all about it! How many people know about your TTC Journey:  immediate and some extended family, close friends/co-workers.

Y - Yearly Exam:  Of course.  I've been seeing the same gyne for over ten years, but sadly she no longer delivers babies, so I have a new one lined up.

Z - Zits: Hardly ever.  I put in my time as a teenager apparently.

A long time coming...

Well the big news is... I've quit my job. It's not news that I've been miserable for a long time, but there wasn't much that I could do about it, as I was basically an indentured servant due to my signing bonus and tuition reimbursement. I also wanted to stick around to collect the year end bonus that isn't given until March. I clearly didn't really know what I was getting into when I started, and sadly took a lot on faith to join former colleagues from my last job at my current company. A lot has changed for us too as I started the same month as our very first IUI, so we had no idea we'd still be struggling and now without insurance coverage. The sad thing is I could have left sooner if we weren't dealing with the quagmire that is IF. When will it end? How much money will we have to burn through before we get a take home baby? Unfortunately these are still unanswerable questions.

Lately there has been a lot of weird stuff going on that has accelerated my desire to leave from ASAP to yesterday. I won't bore you with the details, but I've known for a long time that I wouldn't be staying here forever, but it has just gotten worse and frankly pretty ridiculous. So probably a little late in the game, but we've been really saving our pennies lately to make this happen, so we've got plenty to do cycles OOP pocket if/when it comes to that.

Who gives up a "secure" six figure salaried job w/otherwise good bennies and a 10 minute commute when the economy is still puttering? Well, apparently this one right here does... Since our priority right now is my health, sanity, and getting and staying pregnant, I honestly don't really care.  We can live off DH's salary and I figure I've got 30 years to climb the corporate ladder, or more likely make a way for myself.  I've had a job since I was 12, and often more than one, so I've always had my own money, but now we're a family and we'll be spending our money differently than we have up until now. Though I think long term, we want to have two incomes to live the life that I/we want.

But I do have a new gig set up. Well, if what's old is new again. Almost six years ago, I left my consulting job to move over to the corporate side of the table. Then came commuting two years to a job downtown, another 2 at another company on the N. Shore, and then the year and half where I am now. I am going back to my consulting firm to do contract work. They would happily hire me full-time, but I will get plenty of work (or as much as I want) working hourly and just having some money coming in will be nice. They are also conveniently headquartered in Boston, so if/when we need IF coverage, I could opt to get on their rolls (as MA has an awesome mandate). I'm thinking I might do some freelance consulting before and after babies.

The only major drawback (since the firm and its quirks are basically a known commodity) is that I'll have to start commuting downtown again. I did this for nearly two years when we first moved to the burbs, but it's been awhile. I will likely take the Metra again (suburban rail) while I can for the hour plus trip, which is conveniently just a few minutes drive from our house, but can drive when I have appts. (though getting to Gurnee and then downtown during the AM rush will be interesting). Fortunately, the weather is warming up and the haul and walk across the loop will be less painful than it is in winter.

I can't wait to get out of here, as I know better things are on the horizon...

Normal

As much as anyone has told me this, there still doesn't seem anything "normal" about what we've been through. Normal people get pg on their own and carry to term. Both my RE and my long time gyne were adamant that "these things happen all the time", but as we all know they happen to a very very small minority of people (and we're already in a bunch of minority sub-groups already).

We got more test results back today. My TSH (which has been tested several times before) is normal at 1.83. Karyotyping for both of us also came back normal. We are still waiting on the APA, but I'm guessing all six of these will be normal too. This comes after a normal karyotyping on the baby, a normal ACA and LAC, and what was deemed an acceptable uterus.

The only thing that I've been definitively dx w/over the last 2 1/2 years is low progesterone, while not terribly exciting is not an inconsequential problem when trying to conceive and stay pg. It is called the "pregnancy hormone" after all. Though the baby could have already been gone for whatever unknowable reason and just expelled at the time of my m/c, it's not a coincidence that it would happen exactly eight weeks after my LMP, as I'm really that ridiculously regular. As an indication of this insane cycle, even though I bled for real 2 1/2 wks ago (after my beta finally went to zero after almost six wks post m/c) and the hysteroscopy was a wk and a half ago (w/none of the predicted spotting), I've been having PMS cramping/LBP and started spotting beginning Wed. night exactly eight wks after the m/c. I never spot, ever. WTF is wrong with me?

The only thing that keeps AF from coming when you are pg is progesterone, and until ten weeks it's entirely up to the mother's body to make it (then the placenta takes over) and apparently supplements don't always make up for someone with an existing deficiency. As much as I dislike it, I will of course be asking to stay on PIO for our FET, as I switched to Crinone after my BFP last time, since PIO is the only form of P4 that can be monitored w/blood tests, in hopes that this could potentially make a difference next time.

Counting weeks

It's now been eight weeks since I was eight weeks pg, but instead of 16 of course, I'm hopefully just two weeks out from starting BCP and nine weeks out from my transfer. Since we're a month behind where I thought we'd be, if all goes well, that puts us into January 2012 for an EDD instead of December. We'll be 35 and 36 by then... My goodness we've been at this a really long time.

So I guess I now need to start thinking about what to do with the seven weeks of vacation I've saved up (yet again), since another year (like the last three) has passed without me needing it for mat leave. If we get pg (and maybe if we don't) we are thinking about at least a week at the beach this summer and Italy for another (to celebrate our 5th wedding anniversary) this fall.

Then I'd need to decide whether to leave and cash out my remaining weeks late in the year or stay on through my leave (to get this year's bonus at the end of next March), and then resign.

A girl can dream... ;)

300 posts and randomness

I know it's been crickets around here for a few days, but my internet @ work has been on the fritz (the horror!). Anyway, I'm back for my 300th post. Wahoo!

Sara's Bear (since I'm an absentee sister).

Things have been beyond nuts. My sister Sara had her second chemo treatment yesterday (she goes every third Monday), and is losing her hair. My family is still strangely divided over whether she should even be undergoing this treatment, mainly because my sister E (the one w/all the kids) decided for whatever reason that in her opinion, it was a bad idea. In an e-mail to me, she said it would be a "long 5 mos. for poor Sara", so not exactly a compelling argument against potentially life saving treatment.

Honestly, I haven't even talked to her about it, because she is overly dramatic and the only thing that really matters is that the case was made (pt. #1: the oncologists recommended it) for moving forward given the change in her tumor grade. Chance of recurrence w/o chemo: 30-40% w/a poor prognosis vs. 10% recurrence w/the chemo. I have a strong feeling that it has to do with her own self-interest (hello no more free childcare) due to her surprisingly reactionary views on the treatment. Though the mere idea of denying Sara treatment that any of the rest of us would receive without question, goes against everything my family has ever stood for as it relates to her.

E and my mother are very close, and not only is she upset with my mom for proceeding as she did (not opening it up to some kind of family vote or letting her decide) but is keeping her kids completely out of the house (where they usually spend a few days a week) which is causing added consternation for my mom, Sara and my ailing grandmother. E apparently is under the impression that any exposure to someone doing chemo could be harmful to the kids (when the only guideline is to not share a toilet for 48 hrs. after treatment, which none of them would), and though it is clearly better for Sara not be around them all the time given her comprimised immune system (though they don't go to day care or anywhere where they would pick up anything on their own, they presumably only catch what mom and dad bring home from work), at this point it seems like a power play. Though she obviously has the right to do what she wants with her own kids, after the ridiculous way she treated me over the holidays, I'm about ready to throw in the towel with her completely.

The latest development in the saga was that my father (who has been divorced from my mom for almost 30 yrs. and E cut off a decade ago), who was aware of what was happening, but detached and self-involved as he often is, decided out of nowhere that he wanted to interject himself into the situation, and in my mother's mind, interfere with Sara's treatment. So she called me on Friday all upset.

So at dysfunction junction, what's my function? I get to play mediator, again. I should have kept studying for the foreign service exam and worked for the State Dept. (like I considered after college), as working for Mid-east peace has got to be easier than this. I had a difficult conversation with him over the weekend and explained to him that while he can certainly meet w/the Drs. to educate himself about what is happening after the fact that: 1) the decision has already been made, 2) it was my mother's to make - though he was informed (he is co-guardian to Sara, but has basically opted out, since her dx in Sept.), and 3) in my mind it was the right (albeit difficult) one to make. My mom is an RN and knows the Drs. well who are caring for Sara. I wish I had been able to keep my cool, but unlike most of the family spats of the past that were about hurt feelings and unmet expectations, this is actually important and I got upset. He respected my position and ended up calling my mother just before the treatment yesterday to say he wouldn't be making it to the appt. w/the Drs. after all. She was thrilled, as she hates dealing w/him, but I'd be naive to think the problem has actually been solved.

It's Sara's 41st birthday on Saturday, so we are going up for a quick visit this weekend. It is also E's 38th on Thursday and Ben's 4th on Monday, but who knows if they will even come by. My poor mother, between caring for my terminal grandmother, Sara w/her chemo, and worrying about us, not to mention all these unnecessary shenanigans, she's in a worse spot than any of us and regardless of what we think, she needs and deserves our support.

On the home home front, I finally took some time this weekend to tackle our huge piles of medical paperwork, in preparation for tax time. All told, we spent almost exactly $10K OOP on medical expenses last year, almost entirely related to IF, and have nothing to show for it. And we have IF coverage and a $250 deductible PPO. Between the IVF and IUI meds, acupuncture, embryo freezing, our uncovered mtgs. w/Dr. David, two surgeries, etc., etc., I guess it all adds up. We cleaned out our HSA (from 2008) by summer, but the rest didn't come close to enough to write off.

How crazy is it that if we had kids (like we planned) we'd be getting huge tax credits and if we adopted (this yr. anyway) we get huge tax credits, but since we are chipping away at a medical issue, no dice.... In 2012, if we are lucky. This year, we owe, a lot, again...

We thought we had a lot riding on our IVF cycle, but now it really all rides on this FET. And unlike in November when we had the luxury of time off, now I will be living on the road in April and May, 16 cities in 7 weeks. Encompassing all my monitoring appts, transfer, and 2ww. To avoid this would push us back at least two months. Since it is probably unwise to quit my job when we don't know where we are w/treatments, and as we are staffed such that there is no one to take my place on the road, that is just the way it's going to be, for now...

Ironically, we could get the IF benefits we need if I took even a PT teller job at my local bank branch, but the loss in salary makes this a pretty ridiculous proposition at this point. Besides applying for jobs where I know there is coverage, I just got a lead from a headhunter about a somewhat promising job in the city, but even with a comparable salary and the possibility of IF bennies (which of course I wouldn't know about until after an offer), the long commute and being limited to clinics in the city is obviously off putting. We are in this strange limbo, not knowing what will work (and stick) when (if ever) and for how long to be able to make reasonable decisions about the other aspects of our lives (though our lives are all about this now).

So I continue to look around, we continue to stock pile cash (no shopping, no vacations), and we continue to pray that come May we will be pg again, and it will stick and we can get on with our lives... I never really wondered what purgatory looked like, but now I know.

Fertility, infertility, and loss

Interesting article on fertility, infertility and pregnancy loss.

Excerpt...

Fertility, subfertility and superfertility

Put simply, pregnancy requires little more than implantation of a developmentally
competent embryo into the receptive endometrium. In many species, pregnancy is readily achieved and maintained. In humans, however, the prevalence of subfertility is high and increasing, affecting one in six couples in developed countries (Evers, 2002).

Fertility can be measured by the time taken to achieve pregnancy. Time-to-pregnancy (TTP) is expressed in monthly fecundity rates (MFRs), i.e. the probability of achieving pregnancy within one menstrual cycle. The average MFR in humans is, compared with other mammalian species, relatively low at 20% (Stevens, 1997; Viudes-de-Castro and Vicente, 1997; Evers, 2002). On the basis of this MFR, a simple mathematical model predicts that 74, 93 and 100% of normally fertile couples will conceive in 6, 12 and 24
months, respectively. Along the same lines, moderate and severe subfertilities have been defined by MFRs of 5 and 1%, respectively (Evers, 2002). At the other end of the spectrum, superfertility can be characterized with MFRs of 60% or more. According to this model, superfertile couples achieve 94 and 100% of pregnancies within 3 and 6 months, respectively. On the basis of the Tietze model (Tietze et al., 1950; Evers, 2002), it has been estimated that 79% of the population is fertile, 18% subfertile or infertile and 3% superfertile...

So yes my older sister E is officially a super duper "superfertile" with a 100% hit rate on four tries, and I am an infertile (oh no wait, I think I prefer "moderately to severely subfertile"). Sounds so much better... :/

Surgery consult

I went back to the clinic this morning for a consult with my surgeon, based on the feedback from all the scans we had done with our RE on Tuesday. Dr. D does not think that we need to do another surgery based on my 7mm remaining septum. He said there is no reason to believe that removing any more of it would make a difference in the outcome of future cycles and he didn't believe it contributed to our loss. He was open to going in again, if I wanted to, but he didn't recommend it as the closer we get to the top of the uterine cavity, the greater the risk of perforating it (a major complication). I guess that was a relief to hear, as I have no desire to go through the risks of the procedure, balloon, the high dose hormones, and any complications (not to mention the lost months) if there is no indicated reason to do so. My previous surgeries made IVF seem like a walk on the beach.

We did get to randomly talking about their shared risk program and he said that while the cut off for AMA is somewhat arbitrary based on various risk studies, that I would still have to pay the higher (35+) price once I cross that line (in Sept.), so opting in now doesn't really help us and he wasn't sure that based on having had and still having even a tiny remaining septum, if I would even qualify. Not so encouraging...

But if our upcoming FET fails, we are likely going to be doing one cycle at a time, or even better yet hopefully (fingers crossed) have some sort of coverage set up, so we don't have to start paying completely OOP. Something to keep me busy in the next two plus months until transfer. I feel like my whole life now is about waiting and wishing time away, which is pretty sad...

I thought Groundhog Day was two weeks ago

But we just keep living the same story over and over again...

My post m/c hysteroscopy, HSG, 3-D saline u/s were this morning and went fine. I've finally got the full bladder thing down now, after the disasters that were our mock transfer (not enough) and ET (too much). I just have to empty completely (multiple times) and then drink much less than they advise. It was painful as they put the probes in, but honestly at this point I think I have developed a ridiculously high pain tolerance.

What the veritable multimedia presentation did show was that my uterus is still quite V-shaped from my septum. It measures less than 1 cm, but Dr. S (who didn't do my last surgery) advised that since we've now had a loss, that we consider going in again, as it's a risk factor. He doesn't do surgeries anymore, just procedures, so I set up a consult w/Dr. D (who did my last surgery) this Thursday to discuss whether he thinks in light of our m/c, if we should try to remove even more of it, by having yet another surgery (this would be #4, #3 on the septum, in case you've lost count).

DH came along and we both got our blood drawn for karyotyping, and I also got another seven vials taken for the other six tests of the APA (after the ACA) and the TSH (thyroid panel).

If we don't end up doing another surgery, and proceed with the FET as planned, then I have to wait to bleed again normally. Assuming AF is on time in early March, then I'd start 10 days of BCP, followed by a few days of Lupron and another bleed after this two weeks. Then baseline in late March, followed by two weeks of estrogen, and a lining check in mid-April. Then a week of progesterone and another check, with the transfer at the end of April. Given that I'm supposed to be traveling nearly 100% for work in April/May, I guess doing another surgery, which would push back the FET until after Memorial Day would actually be easier to coordinate.

If my uterus is a/the problem, I'm not interested in gambling with more of our babies in there until it's taken care of. Though of course, we've been under the impression that it had been, the last two times... Lord please grant me more patience to deal with all of this nonsense.

Hysteroscopy #4 scheduled

Well, this one will be a little different than my others, which hopefully will be good. Just in-office, no hospital. But when they told me that there will be NO sedation of any kind, so no need to have a driver (DH), I was a little freaked out. I've had a general for two of them (one was a lap too) and a local (but was completely out) for the other, though these were surgeries where they were actually planning to remove things. I guess this one is diagnostic, which a chance of scraping. It's next Tuesday morning, so it'll be a really early morning. I'm taking the day off. Hope all is well in the ute and we can get this party started.

Dealing with Disappointment

The understatement of the century, right? Or maybe just the theme of my life? Rather the program I'm going to tonight at Pulling Down the Moon (featured in yesterday's NY Times) in the city... And late night meeting downtown + early morning meeting downtown = staying over downtown. :)

Description of DWD class from FCI/PDTM:

"The fertility journey can sometimes be a physically, emotionally and spiritually challenging time, particularly when we endure loss and disappointment through miscarriage, still birth or failed cycles. Weakened relationships, loss of hope and/or giving up financial resources can also be emotionally draining.

Seldom is there a forum to help you put closure to these feelings of loss or grief. Life moves quickly, a new cycle begins, we head back to work and to the rituals of daily life, yet sometimes these experiences (or their memory) just don’t seem to leave us. They stick around in our consciousness leaving us feeling sad, stuck, unable to move forward or indecisive.

If you are someone who feels you could benefit by “clearing” or putting closure to some aspect of your fertility journey, please join us for a special ritual.

Using spiritual techniques from the yogic tradition we will first talk about negative thought forms, then proceed to the yoga room for the ceremony and clearing. The ceremony will use symbols, mantra, meditation and prayer to help remove those negative thought forms to help bring about a sense of peace deep within your consciousness."

Still waiting for my body to get with the program... I'm in week six post-m/c, though I bled for the first three. Hoping this is the week that AF decides to show, though I'm guessing it'll be bad, and would prefer for it not to ruin our much anticipated weekend @ The Pen. But we are obviously not in control of anything that happens, so we'll see...

Educating fertiles, one at a time (for now...)

Lucy Kellaway on what makes a good employer in the FT... (N.B. British paper, U.S. edition)

A good employer offers more than Botox
By Lucy Kellaway
Published: January 30 2011

Last week, Fortune magazine published its latest survey of the 100 best companies to work for in the US.

As I have never worked at any of them I can’t offer first hand corroboration of the rankings – though in 1981 I did try to get a job at Boston Consulting Group (rated number two in the Fortune list), but was rejected after letting slip in an interview that I had no idea what a learning curve was.

In an announcement posted on the BCG website, the consultancy explains how it comes to be the second-best company to work for in the whole country. “An emphasis on employee development, a collaborative culture, extensive training, high-impact client work, progressive benefits, and a commitment to social-responsibility initiatives contributed to the strong performance,” it says.

This doesn’t sound quite right. I’m not sure what “high-impact client work” is, so don’t understand why employee happiness stems from it. I am sure what “extensive training” is – and am equally sure that it is quite low down the list of what thrusting professionals are really after. As for “social-responsibility initiatives”, I’ve never met a strategy consultant who could honestly say that such things were what kept them in the job.

The magazine states that its ranking is “the most extensive employee survey in corporate America”. Indeed, to compile it, an awful lot of questionnaires appear to have been sent out, requiring the employees to complete a “trust index survey” and employers to conduct a “culture audit”.

Many of the companies that come out top of this exercise turn out to offer some pretty fancy benefits. One company has a clinic that gives staff Botox in their lunch break. Another teaches its employees Zumba, “a Latin-style dance exercise”. A third offers on-site pet care facilities and a fourth makes its corporate jet available to employees when there is a death in the family. A fifth gives members of staff having trouble getting pregnant $25,000 towards IVF treatment. (my emphasis)

Some of these benefits are more alluring than others. If a relative of mine died, I’m not sure that I’d be in the mood to enjoy the corporate jet. And I’m so very allergic to the thought of a Latin dance exercise, I’d pay my employer money to avoid having to take part.

But even if these perks were all things I wanted, they would make no difference to my assessment of whether my employer was a good one. Such benefits, even the nice ones, are all pretty creepy. There ought to exist a boundary between employer and employee – between home and work – and Botox and IVF are a long way on the wrong side of it. (my emphasis)

The problem with Fortune’s rankings – and with all similar ones – is not that the exercise is a daft one. Actually, it is quite worthwhile. It is helpful both to prospective employees and to managers. The problem is that it makes an extremely simple thing seem fantastically complicated.

We all know what distinguishes a good employer from a bad one. A good one provides four basic things. First, it makes sure that everyone has a proper job to do. Second, it pays them fairly. Third, it makes employees feel that their efforts are recognised. And fourth, it gives them nice people to work with. That’s all: there is nothing else.

Fortunately, there is an easy way to measure whether a company is succeeding at these things. It doesn’t involve answering tiresome questions on long feedback forms. It does not require any examination of benefits or of corporate social responsibility policies. There is nothing subjective about the test at all.

It simply measures how long people stay with a company. This is the only consideration that matters. Anyone who is not happy with their job will eventually go somewhere else. If most people stay put for a long time, the company automatically proves itself to be a good place to work.

I suggest two modifications to this test. The first is to ignore departures in the first two years of service – sometimes people are hired who should not have been, and some people have ants in their pants and so move on quickly, however decent their employer.

The other modification is to allow only for voluntary departures. Any company that responds to a dip in its business by firing its workers is not a good place to work. It therefore does not belong in any ranking – no matter how much Botox or Zumba it supplies to employees who are still on the payroll.

lucy.kellaway@ft.com

Copyright The Financial Times Limited 2011.


I couldn't help but send her a little note to let her know how important IVF coverage is (in the U.S. anyway). People in other industrialized nations (including the UK) fortunately don't have to worry as much about it as IVF is typically offered (and # of embryos transferred controlled) by the national health care system.

"Dear Ms. Kellaway,
As a longtime reader, I very much enjoy your column and yesterday's was no exception. I do, however, have to argue with your notion that employers offering (and even touting their) IVF coverage are somehow crossing the boundary that exists between home and work, which as anyone today with a laptop and a Blackberry knows is very tenuous indeed.

Unfortunately, in the U.S. health insurance is most accessible and affordable when received through one's employer, blurring that imaginary boundary. This generally is mutually beneficial, as employees who don't have to worry about health coverage, can better focus on their work. And after one is diagnosed with a health condition, it is impossible to get coverage in the open market. Infertility is a medical condition, but only 15 U.S. states have coverage mandates, and these have many many loopholes.

Speaking as someone who suffers from this heartbreaking condition (as do 1 in 8 couples), IVF coverage is very much a vital part of a comprehensive insurance offering for those who need it, however much it may creep you out. Given the cost of IVF, this coverage can mean the difference between being able to have children and not, which is no small thing and would undoubtedly bring about high employee loyalty (your key measure). As a testament to its value, your friends at BCG offer unlimited infertility coverage (which is obviously market leading and highly unusual). Though if you were able to build your family the traditional way, I can understand how you would underestimate its value.

Keep up the great work!

Best, Kate"

Lucy's prompt response...

"Dear Katherine
Thank you for your message. I'm sure that you are quite right. If I had had the misfortune to go through what you are going through, I would see this very differently. I did not mean for one minute to dismiss the value of IVF by bracketing it with Botox. And I do know how expensive and harrowing it is, and so to have an employer onside would be, I'm sure, a very great benefit.
Apologies for what must have seemed a most insensitive article.
Best wishes

Lucy Kellaway"