Time is crawling

The good news is that I'm pretty sure I finally ovulated. Yay! Not that this specifically really matters, since we can't even try for real this month (I guess b/c of the hysteroscopy), but that does mean that in about 12 days AF will come (hopefully) and we can finally get this show back on the road already.

I can't believe it's almost March (and daylight savings time, yay!) but that it will still be another two months until my transfer. I don't understand how the med protocol for an FET takes longer than a fresh cycle, it makes no sense to me. I want to fast forward. I want to be pregnant again. Sick and tired and pregnant, as soon as possible and for as long as possible.

I just found out that my youngest sister is moving to NYC this summer (from Minneapolis) with her boyfriend, so now I have yet another reason to spend more time there. My eldest sister is managing chemo as well as can be expected, but with her hair gone, she seems much smaller and weaker than she is now. She will be done in May.

Summer can't come soon enough, this winter has completely and totally blown...

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.