An Infertility Journal

Happy Ending

2010-12-15T08:27:00.034-06:00

This is my infertility story. I hope it will inspire other women who are still in the trenches.

I started this blog in the hope that it would provide the ultimate success story for women with adenomyosis. When I was diagnosed, the little information available online was very discouraging... years of futile attempts to conceive, recurrent miscarriages, surrogacy as the only hope. I wanted to prove that women with this condition could have a baby naturally (because my doctor told me it was possible). But, that was not to be. Ultimately, we had to resort to IVF and surrogacy in order to have children. While this is not the success story I wanted it to be, it is still very much a success story. Three years ago, I would have found it unbearable if I had known we wouldn't be able to have children without the help of a surrogate. Today, I can not imagine a more miraculous way to build a family. The experience opened my eyes to generosity and kindness that I didn't know was humanly possible, and it has enabled me to feel gratitude more deeply than ever. Most importantly, it gave me the children I so desperately wanted.

I know how lucky I am to have reached my happy ending. Infertility does not always end happily. But, I hope everyone reading this will find the strength to conquer the challenges that their personal infertility struggle bring and reach their own happy ending, even if it looks different than you thought it would in the beginning.
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Home

2010-10-27T14:41:00.004-05:00

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After a 22 day (Baby A) and 23 day (Baby B) stay in the NICU, both babies have been discharged and we are preparing to return home tomorrow. Their hospitalization was about a week and a half shorter than anticipated and went as smoothly as we could have hoped. Aside from phototherapy for jaundice and PICC lines for supplemental nutrition, neither baby encountered any health problems. Both were breathing without assistance by the second day, they were able to maintain their own body temperature once they reached the appropriate weight, and they quickly learned to bottle feed with consistent growth. I had significant concerns about the babies going home before their age is considered "full term" and while they are still so small (Baby A weighs 3 pounds 13 ounces and Baby B weighs 4 pounds 15 ounces), but the doctors told us there was no medical reason to keep them any longer. I am excited to introduce them to their home and to take over full time responsibility for their care. I also look forward to bonding with them on a deeper level than has been possible with so many others sharing my role as "mom". However, I am scared about the risks that accompany caring for such fragile souls. I'm sure I would have felt these same fears even if the babies had been born full term at normal birth weights. But, I have grown used to the security of the NICU, with its team of round the clock experts to handle issues and heart/breathing monitors to constantly reassure me that the babies are alive. It is going to be scary to go it alone.
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Birth Day

2010-10-04T21:39:00.001-05:00

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Our twins were born today at 1:43PM. Baby A weighed 2 pounds 14 ounces and Baby B weighed 3 pounds 11 ounces. Despite their premature delivery and low birth weight, both babies are doing well. J is recovering after an emergency C-section and a blood transfusion.

J began experiencing contractions on Friday evening. While they felt similar to the Braxton Hicks contractions she had been experiencing for weeks, they were more frequent than her obstetrician had told her was acceptable. Thus, she called her obstetrician's emergency number, and the doctor on call advised her to go to the hospital. Neither she nor I were overly concerned, believing the contractions would subside like they had so many times before. However once she arrived at labor and delivery, a fetal fibronectin test was performed, and the result was positive. Although I knew this meant she might deliver within the next week, I believed the doctors could still be successful in preventing her from going into labor. Nonetheless, I tracked down my husband, who was playing a gig an hour away, and urged him to be on alert until we could better assess the situation. J was admitted into the hospital, and procardia to slow her contractions as well as steroids to speed maturation of the babies' lungs were administered. Her contractions responded somewhat to the medication, so she advised us to wait until the following mornng to make the trip to the hospital (three and a half hours away).

J's contractions continued through the weekend, but the medication was able to stave off active labor. Her obstetrician informed us that they would only continue the procardia for 48 hours in order to give the steroids enough time to work, but then they would "let nature take its course". On Sunday evening, just hours before they planned to stop the medication, her contractions worsened. The doctor on call gave her terbutaline to slow the contractions and a shot of morphine. The intervention was successful, and by the following morning her contractions were more controlled than they had been all weekend, despite the fact that she was no longer on medication. We began to think the worst might be over and were hopeful that J would be released from the hospital and we could return home.

We already had a growth scan scheduled for that afternoon, and it was a short walk from the hospital to the attached clinic for that appointment. At the ultrasound, J's obstetrician detected that Baby A was under severe fetal distress. He had gained less than half a pound in three weeks, and he was not moving. The doctor ordered an emergency C-section, and we were whisked away to be prepped for immediate surgery. I entered the operating room absolutely terrified about the condition in which we would find Baby A and how both babies might fare overall at 32 weeks gestation. Baby B came out first, and she looked and sounded healthy. Baby A was noticably smaller, but he cried immediately, and I was so relieved that he was alive and sensient. Both were taken to the NICU, and the neonatologist told us he would return with a full report.

I waited in J's room while she recovered. Shortly after the surgery, she began to pass large amounts of blood. There were some very tense moments as the nurses rushed to stop the bleeding. But by that time, she had lost enough blood that she needed a blood transfusion. She was admirably strong through the entire ordeal (including the c-section which she had hoped to avoid), but it was sobering for both of us to realize the degree to which she had put her life on the line in order to have our babies.

The neonatologist returned an hour later (!) and informed us that both babies were doing well. Baby A is on a nasal cannula but Baby B is breathing fine on her own. Their prognosis is excellent, barring an unforseen complication. We have been told to anticipate a five week stay in the NICU. Although we have good reason to be optimistic, we know that the coming weeks will bring highs and lows. We would appreciate your good vibes for the health and safety of our babies and a speedy recovery for J, whose sacrifice on behalf of our family is beyond measure.
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30 Weeks

2010-09-18T12:36:00.004-05:00

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We made it! Eventhough both babies' chance of survival is lower than average because they are measuring small and part of a twin pregnancy (and Baby A is male, which is an additional risk factor), they have reached the gestational age at which they would have better than a 90% chance of survival if born prematurely. I am breathing a major sigh of relief!

Here is the latest pic of J's belly. There must be two decent sized babies growing in there!

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29 Week Growth Scan

2010-09-14T14:42:00.002-05:00

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We had another growth scan yesterday, and although the babies haven't experienced a growth spurt per se, I am nonetheless reassured by the results. Both babies' abdominal circumferences
measured in the 2.5th percentile (which is a further decline for Baby B). However, Baby B's estimated fetal weight was holding steady at the 38th percentile, and Baby A's estimated fetal weight actually climbed three points to the 25th percentile. They are definitely holding their own, and most importantly, they are not falling further behind. The high risk OB even said that he is beginning to think the babies are simply small for gestational age rather than growth restricted! I never thought I would be so happy about my babies being below average, but after the past six weeks, I consider this good news. The positive growth scan combined with the fact that we are only days away from the point at which the babies would have better than a 90% chance of survival have me feeling more at ease than I have since before the subchorionic hemorrhage. I'll take it!
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Third Trimester

2010-09-04T08:43:00.016-05:00

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We have made it to the third trimester! I can hardly believe it! In so many ways, this has felt like the longest 28 weeks of my life. And yet at the same time, it doesn't seem possible that we are reaching the end already. A part of me is actually sad about it. J has become an integral part of my daily life, and eventhough I know our relationship will continue long after the babies are born, I also know it won't have the same level of intensity. She has her family and I will have mine, and constant texts, phone calls, and emails are not sustainable over the long haul. I will miss that. But mostly, I am so overwhelmingly excited about finally meeting our babies face-to-face! I literally lay in bed at night and fantasize about what it will be like. I can't wait to welcome them and shower them with the love that we have held in reserve over the past three years.

While 28 weeks is generally considered the "safety zone" because survival rates of babies born after this point are better than 90%, I have feared that average survival rates don't apply to our babies due to their small size. Indeed, I have read that the four factors most closely related to chance of survival are gestational age, birth weight, singleton versus multiple pregnancy, and the baby's gender (males fare worse than females). This would put both babies at increased risk, especially Baby A. I recently found a great study that considered all of these factors in calculating survival rates. The tables below present the data for male twins (top) and female twins (bottom).

Among both male and female twins that measured in the 10th percentile, the chance of survival didn't reach 90% until 30 weeks.

Another issue that I am concerned about is length of NICU stay. Eventhough babies born after 28 weeks have good survival rates, many still face an extended NICU stay, which I can only imagine is torturous for the parents. I recently found another study that examined length of NICU stay by gestational age at birth.

The length of NICU stay began to decline significantly starting at 29 weeks, eventhough it was still 60 days on average at that point.

Thus, while I am thrilled that we have reached the third trimester, I won't feel like we have really reached higher ground for another two weeks. Not much longer!
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26 Week Growth Scan

2010-08-24T17:23:00.018-05:00

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J has been undergoing weekly doppler studies, and so far, all have indicated that the bloodflow through the babies' umbilical cords remains good. However, we had another growth scan yesterday, and both babies continue to measure small. Baby A's estimated fetal weight was in the 22nd percentile and Baby B's estimated fetal weight was in the 38th percentile. Baby A's abdominal circumference was measuring in the 2.5th percentile (down from the 5-10th percentile at 23 weeks) and Baby B's abdominal circumference was measuring in the 5-10th percentile (down from the 25-50th percentile at 23 weeks).

I'm not sure what to make of this. The decline in estimated fetal weight and abdominal circumference suggests that both babies are losing ground in terms of growth and that both babies are now showing signs of asymetrical growth restriction, eventhough Baby B's abdominal circumference was still within normal limits during the last growth scan. However, the doctor's interpretation was that the babies are growing along the same trajectory, and he didn't mention any concerns about Baby B. He seems to put more weight on the doppler studies, and since those indicate normal placenta functioning, he doesn't seem excessively worried. I am trying to follow his lead. It is possible that we just have two small but otherwise healthy babies. Right?

I am also taking comfort in the strides we are making on the viability front. At 26 weeks, the babies now have an 80% chance of survival, and that number increases by more than 1% per day over the next week. Each doppler study we are able to get through with good results buys us another week for the babies to grow stronger. My goal is for us to make it to 34 weeks... just eight weeks away!
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Viability

2010-08-07T05:28:00.008-05:00

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The babies have reached 24 weeks, the threshold of viability. If they were born today, they would have a 50% chance of survival. And, that number increases by more than 2% per day over the next two weeks. While we are still months away from the date when I would feel comfortable seeing these babies born, I am so grateful that they have made it to a point at which they could survive outside of the womb if something tragic happened to this pregnancy. One step closer to bringing home two healthy babies!
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Another Reason to Worry

2010-08-03T06:38:00.002-05:00

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J had an ultrasound yesterday at 23w2d. Both babies were measuring behind, by 12 days and 4 days respectively. Baby A's estimated fetal weight was in the 28th percentile and Baby B's estimated fetal weight was in the 42nd percentile. The doctor told us that Baby A's abdominal circumference is lagging behind the rest of his body, which can be an early marker for growth restriction. He ordered a doppler study of blood flow through the umbilical cord and found that it is functioning normally at this point. However, he wants to monitor it weekly from now on. Although he gave us a 70% chance that Baby A would not become growth restricted, I am overcome with anxiety. I have worried about many other issues throughout this pregnancy, but this is the first time that the doctor has actually seemed concerned. At 23 weeks, it is far too early to identify signs of a condition that often necessitates an early delivery. I don't even want to think about these babies coming before 28 weeks, but that is five weeks away, and even then it is still so early! I am trying to keep this in perspective by reminding myself that the news could be so much worse. Baby A does not currently meet the definition of growth restricted, there is a good chance he never will, and even if he does there are treatment options available. There are so many more devastating diagnoses out there! But, I'm still going to worry myself sick through the weekly doppler studies and monthly growth scans. I can only hope that an upcoming growth spurt will render all of this a false alarm.
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A boy and a girl!

2010-07-13T09:59:00.013-05:00

.. J's 20 week anatomy scan was yesterday, and the results were positive. Most importantly, there were no gross structural abnormalities in either baby. They had strong heartrates of 153 and 144 bpm. Both measured behind, by 8 days and 3 days respectively, but the high risk OB said it isn't a problem unless they measure two weeks behind or more. I hope so! We also found out that Baby A is a boy (99% confidence) and Baby B is a girl (90% confidence). We have already chosen names, so I'm hoping we miss the 10% error rate on Baby B, but I feel certain I could roll with such a minor bump at this point! J started to feel the babies move last week, and she is now showing enough that she looks unmistakably pregnant. Half way there!

Resolved

2010-06-10T14:46:00.027-05:00

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J had another ultrasound yesterday at 15w4d. Both babies were measuring on target with heartrates of 153 and 144 bpm. Most importantly, the subchorionic hemmorhage was no longer visible. According to the doctor, this is either because it has resolved or because J's uterus has grown rendering the small SCH difficult to see. Of course I prefer the first explanation to the second one, but either way I'm pleased.

Here is the first pic of J's growing belly, which she snapped at 14 weeks...

Subchorionic Hemorrhage

2010-05-27T18:11:00.006-05:00

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It has been a week since J's bleeding episode, and there hasn't been any more blood since (knock wood). However she sent me last week's ultrasound report, which confirmed the presence of a subchorionic hemorrhage measuring 1.24x2.35x0.48cm. My googling has revealed that an SCH can be a pretty scary thing... risk of miscarriage, placenta abruption, growth restriction, the list goes on. Thus, it is clear that our problem is bigger than just a little unexplained bleeding. Most SCHs eventually resolve on their own, but until that happens (if that happens?), I'm not going to feel any sense of peace. J had a follow-up appointment with her OB today, and the babies were still alive and kicking. Yet, I can't shake the lingering pit in my stomach. I was going to worry through this pregnancy no matter what; I'm just sorry that we now have a reason to worry.
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Scare

2010-05-20T18:32:00.011-05:00

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When the phone rang at 11:37 PM last night, I knew it couldn't be good news. It was J calling to tell me she was bleeding. She had gotten up to go to the bathroom, and when she wiped, she saw a "good swipe" of bright red blood and more in the toilet. There hadn't been any more blood since, but she called her OB's emergency number and they told her to go to the emergency room. My husband was out of town on a business trip, and I wasn't able to reach him on his cell phone. I waited alone in that numb-but-panicked state that sets in during a crisis.

When J got to the emergency room, they found two heartbeats on doppler and checked her cervix to make sure it was closed. Then they sent her home with instructions to call her OB in the morning for follow-up. I was relieved that the babies were still alive, but I was also scared that the worst was not over. I barely slept the rest of the night. This morning, her OB asked her to come in for an ultrasound. The babys' heartrates were strong, and both had grown since Monday. They identified a possible subchorionic hemorrhage under Baby A's placenta and thought that might have been the source of the bleeding, but noted that the blood probably would have been dark instead of red. They also theorized that she might have an irritated cervix, although nothing had come into contact with her cervix over the past several days and I question whether it would start bleeding spontaneously. Either way, they were pleased with what they saw on the ultrasound and told her not to worry.

I wish I felt reassured by all of this, but my confidence in this pregnancy has been completely shaken. Just when I was beginning to feel secure in the health and viability of these babies, something like this had to happen to renew my fears that we could lose them. I haven't felt this vulnerable since the days immediately following our BFP when a pregnancy is still so tenuous. The worst part is that all I can do now is wait. It's going to take several weeks of no bleeding and a repeat ultrasound showing two babies alive and kicking before I will let my guard down again. Those are going to be some very long weeks.

Until yesterday, I had been trying to enjoy this time that my husband and I have before the babies are born... time to take a vacation together, time to get ahead at work, time to relax and do nothing... I know that our days for those kinds of activities are numbered. But now, I would give all of that up if it meant I could have our babies here safe and sound today. I would sacrifice my last months of freedom to know this is going to turn out alright.
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NT Scan

2010-05-18T07:20:00.013-05:00

Our NT scan yesterday at 12w2d could not have gone better. The babys' heartrates were strong at 160+ bpm, and both were measuring ahead of schedule this time. Best of all, the results indicate that there is a 1 in 2000 chance that they have Down's Syndrome and a 1 in 8000 chance that they have Trisomy 13 or 18. It appears that we have two healthy, viable fetuses.

As the first trimester comes to an end, I am beginning to believe that we might actually have two babies come November. It's surreal. The relief I feel that our infertility nightmare might finally be over is second only to the joyous anticipation I feel about meeting the children we have waited so long for. Yet, I am also beginning to feel scared about whether I am truly ready to care for two infants. I know they are going to turn my entire world upside down, but I feel confident that I can handle the challenge. After confronting the possibility that I may never have children, I don't know how I could ever take one moment of being a mother for granted.

However, my growing confidence about this pregnancy has not alleviated my constant worrying. My fear of miscarriage has been replaced by my fear of pregnancy complications, especially considering that a twin pregnancy places us at increased risk. As I slowly let down my defenses and open my heart to this pregnancy, my growing attachment to these babies reminds me that I have so much to lose. It's an absolutely terrifying feeling.

Graduation

2010-05-05T13:45:00.005-05:00

For the first time in almost two and a half years, I am no longer under the care of a reproductive endocrinologist. J (and by extension, we) were released to the care of her obstetrician after her bloodwork showed that she has successfully been weaned off of the medications.

We had another ultrasound last week at 9w3d. The babies' heartrates were 175 and 171 bpm, but both were measuring behind (by one day and two days respectively). I, of course, panicked about this. However, I have since read that crown-rump length measurements have a margin of error of plus/minus four days, and babies grow at different rates so what a baby should measure on a given day is merely a rule of thumb. I am trying to take comfort in that until our next ultrasound.

Two Heartbeats!!

2010-04-13T10:32:00.025-05:00

Our ultrasound yesterday at 7w2d showed two embryos measuring right on schedule with heartrates at 160 and 147 bpm. Yes, it's twins!

We are elated! I was afraid there would be no heartbeat at all, so two is such a gift! It has never been our goal to have twins, but I grew fond of the idea as our betas kept falling in twin range. I find it comforting that we have two embryos because if something were to happen to one (god forbid), this pregnancy could still result in a live baby. I know that sounds macabre, but after everything we've been through, it's hard not to fear that this miracle would be taken away from us. Most of all, I am happy for our children that they will have a sibling. We certainly can't afford to do this twice!

I'm a bit concerned about J, though. She has always been open to carrying twins, but I feel certain she would prefer a singleton. I know the risks for her and the babies are greater with a twin pregnancy and birth as well. As if I needed another reason to worry!

I feel like I am coming back to life. Despite my deep and nagging fears about what could still go wrong with this pregnancy, I'm trying to drink in the tremendous joy I feel right now. It's a level of happiness that doesn't come along very often, and in some ways I think is not possible without first experiencing equally intense sadness.

I have wondered so often why infertility has happened to me and what life lessons I am meant to learn from this hardship. I have in fact learned a great deal about strength and perseverance, about conquering fears, about personal relationships (both good and bad). But, the greatest lesson of infertility for me has been gratitude. I never would have expected that I would feel grateful after three difficult years, tens of thousands of dollars, and more heartache than I could have imagined. Yet, I do. I wish no woman would have to experience infertility, or at very least that every woman who sacrifices her health, financial security, and emotional wellbeing in order to have a baby would get one in the end, but the bitter truth is it doesn't always work out that way. I know how incredibly fortunate I am to be expecting a baby, not to mention two. And while I would give a lot to have avoided all the pain I endured to get here, I still feel profoundly grateful in spite of it all.

Beta #3

2010-03-31T10:55:00.002-05:00

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J's beta at 19dp5dt is 9712! Thrilled. Overjoyed. Ecstatic.
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Beta #2

2010-03-23T09:38:00.004-05:00

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J's beta at 11dp5dt is 450! We all are overjoyed. Another beta next week. Ultrasound is scheduled for April 12 at 7w2d.
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2 Years, 8 Months, 17 Days

2010-03-20T10:39:00.012-05:00

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That's how long we've been waiting to hear the news we heard today. J's beta at 8dp5dt is 136. She is officially pregnant with our baby!

She got a positive HPT on Tuesday and snuck in to her local clinic for an early beta on Wednesday. It was 41. But I had a chemical pregnancy after our first IUI, and nearly three years of infertility battle scars prevented me from completely believing she was pregnant.

I fluctuate between feeling so excited I could scream and feeling so scared I could throw up. We have a lot of hurdles to clear before we have a real live baby, and I hope I will be able to manage the daily anxiety. I also hope I can find a way to enjoy this pregnancy because, if successful, it will likely be our first and last.

Can this really be happening to me?
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Two Frozens (IVF#2)

2010-03-12T21:09:00.007-06:00

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The lab froze one 4AA blast and one 4AB blast today... a great conclusion to a great cycle. We are comforted that we have a safety net between this cycle and a third attempt, in case it comes to that.
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Embryo Transfer (IVF#2)

2010-03-11T21:24:00.009-06:00

We transferred a 5AA blast and a 3BB blast to our surrogate today. We have four more embryos that are being watched for possible freezing tomorrow. The embryologist gave us a 65% chance of success and a 25% chance of twins. Those are the best odds we've ever had.

I know the beta result will be the only thing that matters to me by the time the two week wait is over, but for now I just feel incredibly grateful that we had such a good cycle.

J arrived on Wednesday and is staying until Saturday. She will be on two days of bedrest this time, and she has had three acupuncture treatments while she has been here. She is doing everything in her power to maximize our chance of success. I hope she knows how much we appreciate her.

We have been the recipients of such generosity during this cycle. An acquantaince gave us 2700 units of Follistim completely free of charge. My acupuncturist was out of town today but drove 260 miles round trip to be here for J's pre and post transfer treatments. This cycle has truly been a collective effort, and I feel fortunate to have so many people pulling for us.

Day Three Report (IVF#2)

2010-03-09T10:32:00.008-06:00

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The embryologist wasn't planning to call today. However, after more than two years of working with me, the staff at our clinic have learned that I am an information junkie, and thus she agreed to call with the day three report. We currently have 8 embryos (1 arrested at the two cell stage). 6 are 8-9 cells, 1 is a morula, and the remaining 1 is presumably behind, but I am not sure to what degree. 4 are Grade 4, 2 are Grade 3, and 2 are Grade 2 (on a scale of 4=best and 0=worst).

We are pleased with this report. However, I am suddenly completely terrified. We had four good quality embryos during our last cycle, and to our knowledge, none of them made it to blastocysts. While this cycle has gone better than the last one by virtually every metric, I don't know that it is realistic to continue to expect better results from this point forward. If this cycle is going to fall off a cliff, it's going to happen now. What if we arrive for transfer on Thursday to learn that none of our embryos have survived?

I wish I could reach a point in this process where there is nothing left to worry about. But, I don't see that on the horizon.
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Fert Report (IVF#2)

2010-03-07T18:29:00.008-06:00

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We have 9 fertilized eggs. Nine! That is more than twice the number we had during our last cycle. And, it's three more than we need for a five day transfer. We are absolutely thrilled!

In many ways, the next five days are more critical than everything that has happened over the past month. Yet, we have already overcome some major obstacles during this cycle. We got a good response to stimulation, even on my left ovary which had been underperforming. We got a normal maturity rate, which I feared would continue to be a problem for us. And, we got a five day transfer. The last big hurdle (other than the beta, of course) is to see whether our embryos can make it to blastocysts.
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Egg Retrieval (IVF#2)

2010-03-06T16:23:00.014-06:00

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Egg retrieval was a success. We got 14 eggs. The embryologist's inital assessment was that 8-10 of those were mature. I begged her to call me this afternoon with the official count since my maturity rate was so disappointing during the last cycle, and she graciously agreed. She reported that a total of 11 eggs were mature, but three of those were resistant to ICSI, which indicates that they may have been overmature. We will know for sure tomorrow.

I was pretty nervous about the procedure, eventhough I knew what to expect this time. But let's face it, sticking needles into my ovaries through my vaginal wall resembles medieval torture, and I think I'm entitled to a little anxiety about it. I'm also much more sore tonight than I was last time. I've put myself on OHSS watch because my peak estradiol level was 6700+. Bring on the Gatorade.

Overall, we have a lot to celebrate. More eggs retrieved, a better maturity rate, the likelihood of more fertilized eggs, and we're still in the running for a five day transfer. I am grateful.
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Trigger (IVF#2)

2010-03-04T10:26:00.004-06:00

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The official count is 17 follicles, 8 on my right ovary measuring 22 mm, 19 mm, 18 mm, 17 mm, 17 mm, 16 mm, 15 mm, 15 mm and 9 on my left ovary measuring 26 mm, 21 mm, 20 mm, 20 mm, 19 mm, 19 mm, 18 mm, 17 mm, 16 mm. Trigger tonight. Retrieval on Saturday.

I think we will probably lose the 26 to overmaturity, and based on my last cycle, I think the 15s and 16s will probably be immature. It seems realistic to hope for 9-13 mature eggs this time. I would be thrilled with that number.
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Follow-Up Ultrasound (IVF#2)

2010-03-03T16:27:00.002-06:00

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Another great report today! I now have 16 follicles, 7 on my right ovary measuring 20 mm, 18 mm, 18 mm, 17 mm , 16 mm, 15 mm, 15 mm and 9 on my left ovary measuring 20 mm, 20 mm, 19 mm, 18 mm, 18 mm, 17 mm, 16 mm, 15 mm, 15 mm. My RE wants me to stim for another day, maybe two, to grow those follicles a bit more and hopefully improve my maturity rate. We'll see what tomorrow brings.
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Midcycle Ultrasound (IVF#2)

2010-03-01T20:14:00.014-06:00

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My midcycle ultrasound today could not have gone better! I currently have 14 follicles, 7 on my right ovary measuring 16 mm, 15 mm, 13 mm, 13 mm, 12 mm, 12 mm, 12 mm and 7 on my left ovary measuring 15 mm, 15 mm, 15 mm, 15 mm, 14 mm, 14 mm, 14 mm. Not only is this 4 more follicles than last cycle, but they are developing evenly which should help to improve my maturity rate, and my left ovary (which I had begun to fear was shutting down due to under-production) has kicked into gear this time. Good stuff!

Of course, this is an IVF cycle, so not everything can go right. J also had an ultrasound today, and her lining measured only 8.3 mm. While this is "adequate" (my clinic's word), it is short of the 10 mm that would provide the best home for whatever we might retrieve from those champion follicles. Transfer is still at least a week away, so hopefully her lining will thicken up over the coming days.

There is another victory for this cycle... I have started doing my own shots! I know that most IVFers do their own shots, so this probably seems like no big deal. However, you have to understand my history with needles to truly appreciate this achievement. Prior to infertility, I would hyperventilate getting an IV or blood test. While my previous IUI and IVF cycles desensitized me to injections, my husband still had to do them for me, and I would close my eyes, cringe, and wait for it to be over. So, sticking a needle in my own flesh with my eyes wide open is a huge step for me! I feel so empowered. If I can't conquer infertility, I will at least conquer my greatest fears that accompany infertility.
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Baseline Ultrasound (IVF#2)

2010-02-18T11:13:00.015-06:00

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I had my baseline ultrasound today, and I am sufficiently suppressed to start stims on Sunday. There were some visible follicles present this time, whereas my ovaries seemed much quieter at baseline last time. That could have been because I was coming off of 6 months of Lupron therapy. I'm hoping it means my ovaries are better primed for this cycle.

The mysterious growth on my right ovary was still there, although the RE and ultrasound tech had to point it out to me. It looked like it had collapsed, but it may have just been less visible on my more active ovary. It was 6 mm, so it had grown slightly since November, but it is still relatively small.

I will start on 450 units of Follistim and eventually step down to 225 units of Follistim and 75 units of Menopur. I've managed to lose 15 pounds in preparation for this cycle, which is 5 pounds short of my goal, but I'm hoping it will be enough to provide some benefit for my egg quality and maturity rate.

All systems are go.
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Here We Go Again (IVF#2)

2010-02-07T13:52:00.003-06:00

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IVF #2 is officially underway. J started meds today, and I start meds on Thursday. Please, let this be it.
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WTF Appointment

2010-01-13T18:56:00.000-06:00

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I went into this cycle saying I would be happy as long as we made two quality embryos. I was naive enough to believe that would indicate we were capable of having a biological child eventually. When none of our embryos made it to freeze, I began to glimpse the doubts that creep in despite seemingly good embryos. And, after we received the BFN, I realized that good embryos are meaningless unless they develop into a healthy baby.

Those early revelations were confirmed at our WTF appointment today. I had hoped our RE would praise the two quality embryos we transferred and tell us that, based on those results, she sees no reason why we wouldn't be successful on our next try. But, of course, that's not what she said.

Her first statement was that she is concerned because none of our embryos made it to blastocysts. I was certainly not expecting her to identify that as our biggest problem. We only had four mature eggs to begin with, and based on what I have read, a woman my age can expect only one in four eggs to be genetically normal. Thus, it would seem to me that we were simply on the wrong side of the statistics this time. If we are able to get more mature eggs on our next try, I would assume we have a better chance of getting some embryos that make it blastocysts. She agreed that she could not diagnose an egg or sperm quality issue after just one cycle.

I brought up my low maturity rate, which I perceive to be our biggest problem. She said she thinks the immature eggs were probably abnormal and thus unable to fully develop. I asked whether this would increase the likelihood that the mature eggs were also abnormal, and she said she does not believe so. However, she stated that if I continue to have a low maturity rate during the next cycle, she does not think there is much hope that we will ever be successful. I am confused by that statement. If it is possible to produce normal eggs despite a low maturity rate, then there should be no reason to believe that we could not be successful with persistence.

Ultimately, we agreed to try again in February/March. She plans to increase my dosage to "push my ovaries harder" but keep my protocol the same otherwise. She will also let my follicles develop longer in an attempt to improve the maturity rate. I requested a double dose of HCG for trigger, but she does not think that would alter the outcome. We can only hope the other changes will be enough to give us a better result.
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Reflections on 2009

2009-12-31T07:25:00.010-06:00

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If I had known this time last year that 2009 would end without a baby, I would have been devastated. The notion that during the coming year we would move to IVF, opt for surrogacy, and still be unsuccessful would have been unbearable. But for me, infertility has been a long process of getting used to things I never thought I could get used to. I got used to the needles and invasive exams that accompany infertility diagnosis and treatment. I got used to the fact that we would have to defer our plans and squander our savings in order to pay tens of thousands of dollars on IVF. I got used to the fact that I wasn't going to be able to carry my own baby and a perfect stranger was going to have to do it for me. I have even gotten used to the idea that having a baby is not going to happen on my schedule, if ever. This does not mean that these realizations have come easily for me. I violently resisted each one with a tremendous amount of sadness and anger. But, I eventually resigned myself to my new reality. As a result, I leave 2009 disheartened but not shocked that we are still childless. And, I enter 2010 more realistic about what the next year might bring.

We only made two attempts at having a baby during the entire year: a medicated IUI in January and IVF with our surrogate in December. The remaining months were spent on Lupron therapy, preparing for surrogacy, and waiting on our clinic to get their act together. At 36 years old, I certainly don't have that kind of time to waste. But, there's nothing I can do to change it now.

The only bright spot of the year came in the form of our surrogate. We matched with her relatively quickly and easily after an independent search that yielded a surprising number of prospects. The contract negotiations and medical/psychological screening went off without a hitch. We were naive enough to believe that maybe our luck was finally changing. Of course, once my body became involved during the actual cycle, everything went to shit again. Yet, eventhough our first attempt failed, we still feel fortunate because we have our surrogate.

I am proud of myself for completing my first IVF cycle. I have feared the physical and emotional burdens of the process ever since my infertility diagnosis. But, it wasn't as bad as I expected. The injections were a breeze after our initiation during previous IUI cycles. The egg retrieval was unpleasant but not torturous. The anxiety of the process wasn't even as intense as I expected. Coping with the BFN knocked me on my ass. But otherwise, it was survivable. And, that's a good thing since I'll be doing it again in Febraury/March.

For the first time, I am beginning to feel like my husband is my true partner in our battle against infertility. Our marriage withstood a very rocky period during the summer, and after reconnecting in the fall, we seemed to unite against infertility during our IVF cycle. Part of me feels bitter that he is suddenly overwhelmed by the disappointment and frustration that I have endured alone for the past two years. But mostly, I'm happy that we are finally on the same page. I need him beside me to get through this.

This was also the year that I reached my limit for the amount of crap I can take from my sister, and for all practical purposes, severed contact with her. I grieve this loss as my sister has historically been the most important person in my life. But, the simple truth is that this episode is just the latest in a long line that demonstrate I am not a priority to her unless it is convenient. And, a relationship on those terms is of no use to me. I have no idea what the future will hold, or if reconciliation is still possible, but I do know that our relationship as it once existed is lost forever.

As for resolutions... I would like to overcome the self-loathing that has slowly taken hold since my infertility diagnosis. I hate my body that can't even perform the most basic feminine functions and has left me feeling like a failure. I have gained 40 pounds as a result of infertility medications and depression-induced overeating, which makes me feel ashamed and unlovable. I live my life as if I'm waiting for it to start, and I lack a sense of meaning or purpose. Everything I do is tainted by sadness and anger about being infertile, which I'm sure does not make me very fun to be around. I know that a baby would cure these ailments spontaneously. But, in case that panacea doesn't materialize, I hope to make strides toward becoming a person I feel good about again and find ways to feel content in the moment eventhough I don't have everything I want.
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Negative (IVF#1)

2009-12-17T11:36:00.014-06:00

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I thought I was prepared for this possibility. I knew what our realistic chance of success was with IVF. Even with two quality embryos, I knew there were still a million things that could go wrong. But, the reality of a negative is so much harder than I expected.

I look at pictures of myself from when we first started trying, and I wonder if that person could have even comprehended the kind of anguish and despair that awaited her. The lyrics from a Sarah McLachlan song come to mind... "Hold on, Hold on to yourself, For this is going to hurt like hell."

I have thrown myself on the altar of fertility and willingly endured every painful, expensive, degrading thing it has demanded of me. Two surgeries, a year and a half of acupuncture treatments, three medicated IUIs, six months of medically induced menopause, one IVF and surrogacy. And in the process, the most important relationships in my life have been tried, and in one case, irrepairably damaged. Yet, there is still no baby to reward me for my sacrifices and help ease my pain. Whatever sins I've committed to deserve this, haven't I paid for them by now? Haven't I finally earned the right to have what most women attain without any effort? I don't know what more I can do.

I just can't believe we've reached this point. After my laparoscopy to diagnose and treat my endometriosis, my doctor told me she thought I would get pregnant naturally in six months. That was two years ago. This time we used the best technology that science has to offer, IVF and surrogacy, and we STILL weren't successful. I always knew and feared this possibility. But, it is surreal to be the couple who can't even get (their surrogate) pregnant with IVF. I feel like a lost cause.

We have exhausted yet another opportunity, and now there are only two or three more attempts between us and never having a baby. That terrifies me. There have been times when the thought of reaching the end of infertility treatments has seemed comforting, when the thought of no longer putting myself through the physical and emotional turmoil of this process has seemed like a relief. It doesn't anymore. I have no idea how I will ever move on with my life once there is no hope left that we will have a biological child.

Yet eventhough I can not give up, the thought of the next cycle fills me with dread. Knowing what is at stake, knowing how miserable it feels to fail, I can only imagine the fear and pressure that will permeate our next try. It makes me feel trapped. There is no easy way out of this nightmare.

Soon our surrogate's period will wash away our embryos and all the hopes and dreams we had for them. When I think about the potential beings that resided in those two little clumps of cells, it's almost more than my heart can bear. We were so close, but still so very very far away.
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None to Freeze (IVF#1)

2009-12-08T13:40:00.004-06:00

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The embryologist called this afternoon. Although both of our embryos had survived until yesterday and had developed into early blastocysts, neither of them made it to the freezing process today. I knew our chances of getting any frozens were slim given that we started with only four viable eggs. I was so happy to get two quality embryos that any frozens would have been a bonus. But, I still can't help being disappointed. I probably would have wanted to do another fresh cycle before we tried a frozen cycle anyway, but it would have been nice to have some back-up embryos. Hopefully we'll be successful this cycle, and we won't even have to worry about next time.
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Embryo Transfer (IVF#1)

2009-12-05T13:03:00.002-06:00

We transferred two perfect embryos to our surrogate this morning! They were both 8-Cell Grade 4, which is the highest embryo quality assessment possible at our clinic. The embryologist told us (unsolicited) that she thinks this cycle will be successful. We are over the moon!

We have two more embryos in the lab still going strong, both 8-Cell, one Grade 3 and one Grade 2. They will be frozen on Tuesday if they survive until day 5 and are good enough quality. I can hardly believe we might actually get some frozens out of this cycle when we started with only four viable eggs.

All I wanted out of this cycle was two quality embryos... and we got that! Even if this cycle is unsuccessful, we now know that we are capable of making quality embryos. With enough time and money, we should be able to have a biological child eventually. Although the low number of mature eggs I produced is still extremely disheartening, I feel reassured by the fact that all four of the mature ones fertilized, divided normally, and survived until day 3.

Our surrogate arrived last night, and we spent a very enjoyable evening and morning with her. How do you express the level of affection and gratitude you feel toward a person who is giving you this kind of gift? No matter what the ultimate outcome is, she will forever have a very special place in our family.

Hopefully our embryos are settling in for a nine month stay in her womb. I would like to think that noone could care for them better than I could, but they're safer where they're at. This is the best chance we've ever had at becoming parents. For the first time in a long time, I'm feeling optimistic.

Fert Report (IVF#1)

2009-12-03T15:14:00.002-06:00

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When the embryologist called this morning, she said "I've got good news, and I've got bad news". The bad news is that only 4 eggs were mature. Four! Out of 10! The good news is that all 4 mature eggs fertilized with ICSI. We are automatically out of the running for a five day transfer (my clinic's policy requires 6 fertilized eggs). Transfer will happen on Saturday.

I'm heartbroken. No one at the fertility clinic seems to understand why so few of my eggs were mature. Based on my follicle size and estradiol levels, there should have been many more. Could it be my endometriosis, the cyst, my age, or just general egg quality issues? No matter the cause, I have to believe there is something wrong with my ovaries that they can not produce a normal percentage of mature eggs. If that is the case, I don't have a lot of hope for the four eggs we have left. I am trying to take comfort in the fact that all four fertilized, but we'll have to wait and see what condition they are in tomorrow.

As we have prepared for surrogacy, I have hoped that the one and only reason I have never gotten pregnant is my adenomyosis. I have wanted to believe that we would have a textbook IVF cycle with perfect eggs and embryos, and when we transferred those to a healthy uterus we would finally get our baby. Instead, we have uncovered yet another problem. My uterus is already useless, and now my ovaries aren't cooperating either. How is it possible that my body is this fucked up? Why can't my reproductive system do anything right?

I researched this topic obsessively today, and it seems that women who have a low number of mature eggs in one cycle continue to encounter the problem in subsequent cycles despite changes to protocol. I am afraid that my worst fears are coming true. I am afraid this is the beginning of the end for us.
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Egg Retrieval (IVF#1)

2009-12-02T17:04:00.002-06:00

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I survived the egg retrieval, and overall it wasn't as bad as I feared. The "conscious sedation" was more conscious than I would have liked, and my ovaries definitely felt the needle pokes despite the local anesthetic. But, I'm not as sore as I thought I would be. And, the fertility clinic staff was great.

They retrieved 10 eggs, but the embryologist estimated that only 5-8 of those were mature. I'm pretty disappointed, but I'm trying to hold out hope for a good report tomorrow.
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Trigger (IVF#1)

2009-11-30T20:44:00.003-06:00

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My follow-up ultrasound went well this morning. I now have a total of 12 follicles, eight on my right ovary measuring 21 mm, 16 mm, 16 mm, 15 mm, 15 mm, 14 mm, 13 mm, 12 mm, and four on my left ovary measuring 18 mm, 18 mm, 17 mm, 17 mm. I am thrilled with these numbers. My RE sent me home immediately following the ultrasound for a final shot of Follistim. Trigger tonight, egg retrieval on Wednesday!
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Midcycle Ultrasound (IVF#1)

2009-11-27T13:43:00.005-06:00

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I was extremely nervous about my midcycle ultrasound today, but the results are promising. I have seven follicles on my right ovary measuring 15 mm, 14 mm, 11 mm, 11 mm, 10 mm, 10 mm and three follicles on my left ovary measuring 15 mm, 14 mm, 12 mm plus one smaller one that they did not measure but that may still catch up to the rest. I was hoping for 12-16 follicles, and I wish that most of the 10 follicles I have weren't on the ovary with the cyst (which I still fear may affect egg quality), but overall I am pleased. I'm 36 years old, and we weren't able to retest my FSH prior to this cycle due to the Lupron therapy, so we have been living with a great deal of uncertainty regarding how well I would respond to stimulation. I'm relieved that my ovaries still have enough life in them to give us 10 follicles, and based on these results, I feel confident that they could make it through another cycle or two if we don't have luck this time around. Plus, I wasn't able to see the growth today amid all of the follicles, so at least we know it hasn't grown into a ginormous monstrosity as a result of the medication. The news could have been much, much worse.
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Baseline Ultrasound (IVF#1)

2009-11-18T14:00:00.001-06:00

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I had my baseline ultrasound today. My uterine lining was thin, my ovaries were small, so it appears that my old friend Lupron is doing its job and I'm ready to start stimming on Saturday. I'll start on 375 units of Follistim and then step down to 225 units of Follistim and 75 units of Menopur. That dosage seems high to me and makes me wonder if my RE has reason to believe that I will be a poor responder. I'm nothing if not a worrier.

The mysterious growth on my right ovary was still there and had grown to 5 mm. My RE now thinks it's a dermoid cyst, which is the most definitive diagnosis I've received so far, and it's certainly better than an endometrioma. However, when I asked her whether she feels confident that the growth is not malignant, she grew extremely hostile and lectured me that no doctor can make that kind of guarantee. Her attitude was out of line and totally unprofessional. I'm so jealous of the women I read about on bulletin boards and blogs who have compassionate, forthright, supportive REs. I would like to take my $10,000 and go to a clinic where I can get that level of service, but since we have already jumped through countless hoops to get ourselves and our surrogate approved at this clinic, I don't feel like we have any choice but to stay. I hate being at the mercy of others, but unfortunately that is the reality of our situation.
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Auspicious Beginnings (IVF#1)

2009-11-02T19:25:00.001-06:00

Our cycle officially begins this week. J starts meds on the 4th. I start meds on the 12th. We are planning for egg retrieval and embryo transfer during the first week of December. If you've got some good vibes to spare, please send them our way.

We got Chinese take out last night. I found the following message in my fortune cookie. Fate may just be on our side this time...

Fleeced

2009-10-25T10:14:00.000-05:00

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The heavy-duty bills for surrogacy have started to come in. So far, the costs have actually been less than what we budgeted. However, that has not prevented me from feeling like others are more than happy to reap the profits from our misfortune. Here are some examples:

Our fertility clinic charges a package price for IVF with a surrogate. This includes the costs of bloodwork and ultrasounds for our surrogate during the cycle. However, since J lives four hours away, she will be going to her local doctor for monitoring prior to the transfer. So, I asked if we could get a rebate for the costs of monitoring services that our clinic will not be providing. They refused. This will add approximately $1,300 to an already exorbitantly expensive process.

Our lawyer charged us $2,625 to draw up the surrogacy contract (which includes $125 worth of "unitemized expenses"). Other than a few aspects of the contract that were individualized for our situation, it is clear that we paid her to simply insert our names into a template that she recycles for every client.

These experiences have only added to the resentment that has built as we have sought help for infertility. There was the $290 we paid for a half hour long second opinion consultation with a new RE who had not even reviewed our records prior to the appointment and instead read them while I was trying to talk to her. There was the psychologist who specialized in infertility that I had to stop seeing because I could not afford her $440 per hour fees.

The infertility industry serves young couples who have not yet accumulated much wealth and who are in need of expensive procedures that are usually not covered by insurance. Under these circumstances, rather than squeezing every penny they can out of us, I think a slightly more altruistic approach is warranted. These professionals provide very important services, and they deserve to be compensated accordingly. However, I'm sure there are ways to minimize some of the costs in order to make an already burdensome condition a little easier to overcome.
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People Who Don't Get It

2009-10-17T10:54:00.002-05:00

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I am consistently appalled by the callousness and insensitivity that some fertile people display toward infertility. I recently read a moving article about one woman's experience with infertility, and the various online comments suggested that infertility is a product of natural selection and thus we are unfit to reproduce, that it is selfish and vain to want to have a biological child and to undergo infertility treatment to do so, and that infertile couples should "get over it" and just adopt.

While my sister has never said anything so egregious, she has made numerous comments about my infertility that have been deeply hurtful. Perhaps the best example comes from a telephone conversation I had with her yesterday. Here is a condensed and paraphrased version of the discussion:

Sister: So, how are you feeling about the upcoming cycle with your surrogate?

Me: Well, I feel ambivalently about it. On the one hand, I'm glad we're finally moving forward. Regardless of the outcome, I'm ready to put this chapter of my life (infertility) behind me. On the other hand, I'm nervous. I dread the shots and the surgery. I'm worried that we will learn that my eggs are poor quality. And, most of all, I'm terrified that we will fail and I'll have to accept the fact that we will never have a biological child.

Sister: Why can't you just feel thankful that you have a surrogate who's willing to help you?

Me: I do feel thankful that we have a surrogate who's willing to help us! But, that's not what you asked!

Sister: Well, why can't you feel hopeful since IVF with a surrogate offers your best chance of success?

Me: I wouldn't be doing this if I didn't have hope that it would work. But, I also feel like I have to be realistic about our chances (40%) or I risk being completely devastated if we fail when I'm not prepared for that possibility.

Sister: Why can't you see this journey as a blessing and embrace the lessons that the universe is trying to teach you through it?

Me: I will never see infertility as a blessing! I will never embrace the fact that I have to sacrifice our financial security and jeopardize my health in order to do what 90% of the population gets to do without any effort!

Sister (screaming): THEN DAMN YOU! DAMN YOU FOR NOT APPRECIATING YOUR LIFE!

I don't think I can enumerate the multitude of ways in which her comments are out of line. Would it be appropriate to suggest that a cancer patient should see their illness as a blessing because of the life lessons they might learn?

But, to me, the most noteworthy aspect of the exchange is that the woman who backed out on her offer to serve as my surrogate, and then didn't contact me for over two months this summer while I was going through the darkest period of my life, is now quite literally attacking me for not reacting to my infertility the way she thinks I should. She has officially failed to support me in every way possible.

I am beginning to wonder if it isn't better for me to sever contact with her until we have completed treatment. I don't think I can endure any more of her ignorant and self righteous comments. I can't listen to her claim that she is experiencing problems as difficult and painful as mine, eventhough she is referring to a divorce that is the direct result of her decision to have an extramarital affair while I am struggling with infertility through no fault of my own. I can't listen to her claim that we are both equally in need of the inheritance that our stepmother robbed from us, eventhough she and her husband live comfortably enough for her not to have to work while my husband and I are struggling to save the minimum of $50,000 we will need just to have a baby.

She is, and always will be, one of the people who don't get it.
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My 36th Birthday Present

2009-10-05T06:34:00.002-05:00

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I turned 36 today. I don't think any infertile woman relishes growing older, but becoming part of the "infertile over 35" crowd is something I have particularly dreaded. It is especially ironic, then, that today was also the day that we reached a significant milestone in our effort to have a baby... we met our surrogate! I haven't blogged about our search for a surrogate because, after all of the bad luck we have enountered, I have approached this process with a healthy dose of skepticism, and I didn't want to jinx any prospects by writing about them here. The short version is: after a close friend's selfless offer that ultimately didn't work out for logistical reasons and another very promising candidate who unfortunately lived over 1000 miles away, we found J through a classified ad that we placed on a website for surrogate mothers, and we eventually decided to go with her in August. Since then, we have been finalizing the contract and preparing for her medical and psychological screening... which happened today. J and her husband drove four hours just to be poked and prodded, analyzed and evaluated, in order to help us have a baby. I feel so overwhelmingly grateful, humbled, and privileged. We won't know the results for about a week. The possibility that our clinic could reject J after the time and effort we have spent building a relationship with her, not to mention the significant amount of money we have already invested, is terrifying. But for today, I will just enjoy the fact that our first meeting went as well as I had hoped. It is perhaps the best birthday present I have ever received.
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The Ring

2009-09-22T08:58:00.000-05:00

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My sister's engagement ring is without question her most prized possession, not so much because of the sentiment behind it but rather because she always wanted a large diamond ring and this one definitely fits the bill. However, she recently lost it. I have certainly felt sorry that this happened as I know how much the ring means to her. Yet, I have been baffled by the juxtaposition between how my family has reacted to this misfortune compared to how they have reacted to my infertility.

My mom immediately went into full-on crisis mode over the missing ring. She made several trips to my sister's house (an hour drive away) to help look for the ring and reenact the events that might have led to its disappearance. She urged me to pray that the ring would be found. And, she told me she was "heartbroken" that the ring had been lost. There have been times during my two year battle with infertility when my mom has been invested in helping me find a resolution, but I have never felt like she approached my fertility problems with the same zealousness in which she has approached the disappearance of my sister's ring. When I was first diagnosed and my extensive research indicated that getting and staying pregnant with adenomyosis and endometriosis was going to be a significant challenge (which turned out to be true), my mom was dismissive of my concerns, telling me that I was overreacting and getting ahead of myself. When I was distraught over the daunting task of having to find a stranger who would agree to carry our baby, my mom chided me by saying that I had numerous options, including going to India and using a student who had offered to by my surrogate, as if both of those alternatives weren't fraught with problems. And, I don't think I've ever heard my mom say she was "heartbroken" about my infertility.

When I pointed out to my mom that what my sister had lost was just a ring, she retorted by saying that the ring is worth $20,000 (although it is insured). I had to remind my mom that each attempt at IVF with a surrogate costs close to $20,000, whether or not it results in a baby, and we don't have the luxury of an insurance policy that will reimburse us if the treatment fails.

When my mom called to tell me that the ring was missing, she said "you can imagine the state your sister is in". My sister is an extremely emotional person, and she later admitted to me that she was a mess over losing the ring. I was not there to see how my mom reacted to all of this, but I can infer from her comments that she was sympathetic. My mom has been sympathetic with me when I have called her upset about something infertility related, but there have also been occassions when she has displayed little tolerance for my emotional reactions. The best example is when I expressed my hurt, anger, and feelings of hopelessness after my sister decided not to be our surrogate, and my mom told me that I was being ridiculous and I had gone off the deep end. Apparently, my sister having a breakdown over losing an enagement ring is reasonable, but me having a breakdown over learning that my sister was backing out on her offer to serve as our surrogate is not.

A few days after the ring was lost, my sister called and left me a weepy message saying she was in need of some "sisterly comfort". This was just weeks after we had reestablished contact following over two months of silence, during which I was struggling with a number of issues including the fact that I would not be able to have a baby without a surrogate. My sister did not see the irony in the fact that she was seeking support from me because she lost her engagement ring, while she had completely abandoned me during the darkest period of my life.

The ring was later found. My mom cried when my sister told her.
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Lupron a Bust

2009-09-10T12:10:00.002-05:00

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The Lupron started wearing off a week ago. I got my period immediately, despite the fact that I am on birth control in the form of Norethindrone, and it usually takes months for a woman's cycle to return after Lupron therapy. The worst part is that my cramps are as bad as ever! Thus, I have to conclude that the Lupron did not effectively treat my endometriosis. How is it possible that I have the most invincible case of stage 1 endo known to man? I had a laparoscopy to treat my endo in January 2008... no pain relief, just unpredictable cycles afterwards. I just finished 6 months of Lupron therapy... no pain relief, but I had three periods during this so-called menopausal state. Every method that is supposed to treat the disease has not worked, and instead my body has reacted most strangely. I feel like I have to accept that my endo is probably alive and well (not to mention my adenomyosis, which I learned in June also was not being treated by the Lupron) and that the mystery growth on my right ovary probably is an endometrioma. I must be the only person on the planet whose conditions get worse rather than better with treatment.
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My First Award

2009-08-16T05:59:00.000-05:00

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Thanks so much to Sarah at Babies Everywhere But None That Call Me Mama for honoring me with this award. I am truly touched.

The rules of the “One Lovely Blog Award” are: Accept the award, post it on your blog together with the name of the person who has granted the award, and his or her blog link. Pass the award to 15 other blogs that you’ve newly discovered. Remember to contact the bloggers to let them know they have been chosen for this award.

Blossom and Her Fruit at The Making of a Family
Lost in Space at No Regrets
DAVs at Planet Davila
JJ at Love, Marriage, and the Elusive Baby Carriage
Allison at My Journey with Endometriosis
Courtney at Just Chill
Mrs. Amanda at Baby Bean
Faith at Mustard Seed Baby
Echloe at Elusive BFP
Lorza at Baby Making Journey
Jaymee at Our Surrogacy Adventure
Niki at My Journey to Myles and Beyond to Surrogacy
FET Accompli at FET Accompli
Hopeful and Heartbroken at My Infertile Journal
Mrs. Emilee at My Infertility Diary .
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The Last Lupron Shot

2009-08-06T11:16:00.002-05:00

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Although we learned in June that three months of Lupron therapy had not improved my adenomyosis, my RE recommended that I continue the therapy anyway due to the potential benefit it could still provide in treating my endometriosis and the fact that we had time to kill while we prepared for surrogacy anyway. Today I received my sixth and final shot, and I could not be happier. The side effects of the drug have been tolerable, but I have battled a number of mysterious health problems all summer, and I have wondered whether Lupron is at least partially to blame. First, there is the growth that has appeared on my right ovary (and unfortunately was still there during a follow-up ultrasound in July). Second, I had my first ever abnormal pap test, and in my subsequent panicked googling, I learned that low estrogen levels during menopause (and Lupron therapy) can cause this result. Third, I have experienced unexplained urinary and stomach/bowel problems. I am eager to get my body back and see if it returns to normal. Despite the negatives, though, I must admit that I feel good about completing a full six month course of Lupron therapy... I am hopeful that it will work in our favor during the upcoming IVF cycle with a surrogate.
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Perspective

2009-07-21T15:33:00.000-05:00

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It has been a tough summer for me. The Lupron not improving my condition. Having to resort to surrogacy so soon. Confronting the possibility that we may never have a baby. It's been a lot for me to process, and I have had some really dark days. But, lately, I have been working to live a life that is not dominated by infertility.

I am trying to enjoy myself. Rather than sitting home alone and feeling miserable, I have been forcing myself to get out more. To take advantage of the glorious summer weather while it lasts. To find activities that make me happy. To reach out to others.

I am trying to appreciate the positive things in my life. I have a career that brings me a great deal of personal satisfaction. I live in a home that I adore. I have a husband with whom to share the good and bad times.

I am trying to let go of the constant anxiety that has plagued me since my infertility diagnosis. I am doing everything I can to maximize the chances that we will have a child. That's all I can do. The rest is out of my hands.

I am beginning to imagine a life without children that is worth living. I know that should be a given, but I have struggled to envision how I would ever make peace with failed infertility treatments and move on with my life.

I stumbled across Emilie Lemmons' blog this week, and I was so moved by her story that I spent an entire day reading her three years worth of posts from front to back. She was a fellow infertile who went on to have two sons. During her second pregnancy she was diagnosed with a sarcoma, and after the birth she learned that the cancer had metasticized. She died in December at the age of 40, leaving behind the family she had fought so hard to build. This tragically ironic end to her life reminded me that there are fates worse than never having a baby. Perhaps more importantly, as the focus of her blog shifted to relishing the time she had left, her beautiful posts inspired me not to take my days for granted, difficult and painful as they may be at times.
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From IVF to Surrogacy

2009-06-10T10:42:00.000-05:00

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We made the official decision to cancel our IVF cycle and move straight to surrogacy. The chances of a healthy pregnancy with my uterus are slim, and we can't afford to jeopardize money we will desperately need for surrogacy on long-shot treatments. I think it was the right decision; I just wish I felt more at peace about it.

I have always coped with my infertility by telling myself that I will have a biological child, the only question is how much it is going to cost. We were going try to conceive naturally after the lap, and if that failed we were going to try medicated IUIs, and if those failed we were going to try Lupron therapy followed by IVF, and if that failed we were going to try surrogacy, and certainly that was going to work. Well, we've tried and failed at every treatment on that list except for surrogacy, and it is really scary to have arrived at our last resort. And eventhough I've been convinced that surrogacy would be successful for us, I feel like I am confronting for the first time the very real possibility that, due to my endo and age, it may not work. My greatest fear, that I will never have a baby, feels way too close for comfort. I know that isn't our reality just yet and that surrogacy offers the best chance for success we have had through this process, but I have always tended to focus on the worst case scenario. Just facing this possibility has plunged me into a very dark place. I honestly didn't know this level of sadness even existed.

Every step of this process has required me to give up a part of my dream of what having a baby would be like. First, I had to give up the dream that we would conceive naturally. Then, I had to give up the dream that we would get pregnant without destroying our savings and going into debt. Now, I have to give up the dream that I will be able to carry my own baby. That one has been tougher to accept than I expected. I have always been petrified of childbirth, and before my infertility diagnosis, I would have welcomed the idea that someone else would do it for me. But infertility had transformed pregnancy into something I deeply desire, a privilege that I could never take for granted. Now I know that I will never experience it. Infertility has also become my greatest adversary, one that has crushed my spirit and forced me to confront my greatest fears, and I really wanted to conquer it on my own. I wanted to get to the other side and be able to say "I did it". Now I know that I will have to have help if I am ever going to make it to the other side.

I have to focus my energy now on the very daunting surrogacy process. I am overwhelmed by the complexities and expense of what lies ahead of us. For the first time since my diagnosis, the idea of giving up has felt more comforting than the idea of forging ahead. But, I know that is only coming from a place of weakness brought on by emotional exhaustion. I have to pursue this, our last hope, if for no other reason than to be able to say that we tried everything.
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More Bad News

2009-06-05T15:38:00.000-05:00

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Yesterday was the worst infertility day I have had in a long time.

I had a saline infusion sonogram, which was the last test in preparation for my IVF cycle. I was nervous about it because I've had polyps in the past and didn't really want to undergo another surgery to have any new ones removed. I also knew this would offer the first clue about what effect, if any, the Lupron has had on my adenomyosis. There were no polyps. But, it was clear that the Lupron has done nothing to treat the adeno... if anything, it has made it worse. Very disappointing. Then we took a look at my ovaries and found a small cyst on the right side. When I asked for more information about it, my RE said she thinks it could be an endometrioma. Shit hit fan in my world. During my last treatment cycle in January, there was absolutely no evidence of a cyst on my ovary. Since then, I have spent three months on Lupron therapy to treat my endometriosis. So, why the hell would I suddenly have an endometrioma now!?!?

Ever since my first consultation with the RE who runs the IVF program at my clinic, I have been extremely worried about the quality of my eggs because she mentioned that endometriosis is known to adversely effect egg quality. These were not comforting words for a woman with a uterine condition, as my eggs are the only hope I have of ever having a biological child. Bad Uterus + Bad Eggs = No Baby. A surrogate isn't even a viable option at that point. So, I've spent the last three months trying to comfort myself with the constant reminder that mine is only stage 1 and that the Lupron is supposed to treat any endo that might have recurred since my lap. However, if the cyst is indeed an endometrioma (and I don't have much hope that it isn't since Lupron is supposed to treat other types of cysts), then not only has my endo gotten worse but it is now likely interfering with ovarian function. Not good!

I have always believed that IVF is a waste of money for someone with a defective uterus. During my CCRM consultation, I asked Dr. Schoolcraft what IVF buys a woman with adenomyosis. He replied that it offers the best chance of success during the very narrow window of opportunity that Lupron provides. That made sense to me. If Lupron is the only known treatment for diffuse adeno, and the effect of that treatment is very short-lived, then IVF is the most expeditious use of that time. However, in my case, Lupron did not successfully treat the adeno. So, what's the point of moving forward with the IVF cycle?

I'm right back where I was one year ago... surrogacy appears to be my best option. But, even surrogacy will only be effective if my egg quality is satisfactory, and that is now in question. It feels like the health of my reproductive system is deteriorating by the month, and I am rapidly running out of options. When will this nightmare end?
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One Hurdle Cleared

2009-06-01T09:31:00.001-05:00

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I had all of my pre-IVF bloodwork done on Thursday (except for my FSH which they unfortunately can't retest because of the Lupron), and the nurse called this morning with the results. For the first time, my TSH is on the very low end of NORMAL! I am so relieved that this is one less problem we have to contend with! Each step in this process is a potential roadblock to the IVF cycle or even ever having a baby, so every hurdle I clear feels like such a victory!
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Dread

2009-05-28T13:50:00.000-05:00

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I had my pre-IVF consulatation today, during which I made appointments for all of the necessary testing, received my protocol and schedule, and paid for the cycle. You would think that I would be excited about beginning this phase of treatment since it offers our best chance of success, yet I feel nothing but dread. I dread the physical demands of IVF, especially the needles and gynecological exams that I have grown somewhat used to but still hate as much as I did before infertility. I dread the constant anxiety inherent in this process: the fears that each test might identify a new problem, or that my ovaries will not respond adequately to stimulation, or that our embryos will not be of acceptable quality... not to mention the torturous two week wait. My life for the next two months is going to be consumed by IVF, and there's not a single aspect of it that I'm looking forward to.

I've also been feeling pessimistic about this cycle. Adenomyosis and endometriosis are not the easiest problems to overcome (although they're not the toughest either). I've placed a great deal of hope in the ability of the Lupron to treat these problems and give me a shot at having a baby. However I started my period again this week, after almost three full months of treatment, and I can't help but believe that if the drug is unable to suppress my cycles, it must not be doing much to combat the diseases. And, the fact that I'm 35 years old certainly doesn't help matters. It all feels insurmountable at times.

My husband is not exactly helping to keep my spirits up, either. When I was first diagnosed, I asked him to make some minor lifestyle changes to protect the quality of his sperm. Specifically, I wanted him to wear boxers (he did), drink decaf coffee (he switched to "half caffinated"), and stop riding his bike (he didn't). I've noticed recently that he is no longer wearing boxers, and when I asked him if he was still drinking "half caffinated" coffee, he admitted that he reverted back to regular several months ago. So here we are, one month before IVF, and he is doing nothing to maximize our chances of success. Given that I have spent the last three months in medically-induced menopause, and I am preparing to endure countless shots, repeated wandings, and minor surgery during our IVF cycle, I would think that wearing boxers and drinking decaf coffee would be the very least he could do to ensure that I have not gone through all of this unpleasantness for nothing. I would like this to be a team effort, but as usual, I feel like it's my burden alone.
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How infertility has changed me (for the worse)

2009-05-02T12:08:00.006-05:00

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I have been thinking a lot lately about my life before infertility and how different it was from my life today. I liked my old life much better. Now that I know people are actually reading this blog (thanks, by the way), I was initially hesitant to be honest about the nastiness that has crept into my life as a result of infertility... no one likes to admit their personal flaws, especially in a public forum. However, I think I owe it to myself and my readers to be open about the negative and wide-ranging effects infertility can have.

1. Infertility has made me cynical and bitter. Before my diagnosis, the heartaches I experienced consisted primarily of romantic rejection or the end of a relationship. While these experiences were unquestionably difficult, I healed from them and moved on to bigger and better things that ultimately made the original heartache seem insignificant. Infertility has been my first (well, second, actually) taste of how painful and cruel life can really be. It has shown me that you can encounter problems so massive that they alter your life from the course you had planned for yourself and can not be overcome. Worse yet, it has shown me that life is not so painful and cruel for everyone or even those who make bad choices, just the unlucky. Regardless of how my infertility journey ends, I don't know if I'll ever be able to go back to the carefree person I was before, who believed that everything happens for a reason and everything works out in the end.

2. Infertility has robbed me of the ability to dream and hope. I was raised to believe that I could accomplish anything if I tried hard enough. I now know that is a lie. I have tried harder to get pregnant than I have ever tried at anything else in my life, and I have failed 22 cycles in a row. I have watched from afar as women on blogs and bulletin boards have sacrificed more than anyone should have to sacrifice in order to have a baby and still come up empty handed. I now know that some dreams never come true, regardless of the effort one invests in them.

3. Infertility has made me a selfish person who is callous about the hardships of others. I have always believed that the citizens of a civilized society have a responsibility to take care of eachother in times of need. Yet, while I have always tried to help others in their time of need, there are precious few resources available to help me in my time of need. This has made me want to hoard my funds in order to take care of myself and my loved ones (since no else is going to), and let everyone else fend for themselves. It has made me resentful that the government taxes income we need for infertility treatment and gives it to others whose problems are deemed more important than our own. It has quashed my willingness to donate money to charitable organizations because the people those organizations help are in many cases at least partially responsible for the circumstances they find themselves in, while I did nothing to render myself infertile and yet even my own health insurance is unwilling to help me pay for treatment. I am not proud of this person I have become.

4. Infertility has taught me the tough lesson that I can not count on anyone except myself. I have documented elsewhere on this blog the profound sadness and disappointment I have felt by the lack of support my family has provided through my infertility. I move forward from those experiences with new insight into the limitations and weaknesses of the relationships in my life. It is an isolating feeling to realize that the people you love are incapable of being what you need them to be. But, that is the truth that infertility has revealed to me.
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When your children do not yet exist

2009-04-06T07:03:00.001-05:00

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Back in September, my mom told me she would pay for me to receive acupuncture. It was a generous offer. I wanted to try any treatment that would increase my chances of having a baby, but I thought our money would be better spent on more proven western methods. Her offer allowed us to do both. Now, six months later, she has stopped paying. She hasn't said anything about it; she just stopped sending me checks. I assume this is because of the bad economy and the fact that she and my step father live on a fixed income. Yet, she continues to pick up the tab for all kinds of extras for my sister's kids. This is part of a larger trend. At Christmas, my mom gives all of us money for our gift. My sister and her husband receive more than we do because they have the added expense of children and we do not. That was fair back when we were voluntarily child free, but we're not anymore, and I guarantee the costs we will incur this year for trying to have a baby will be greater than the costs my sister and her husband will incur this year for raising theirs. But, that doesn't matter. My sister's kids count because they have been conceived and born; my kids don't count because we haven't been lucky enough to have them yet.
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It begins...

2009-03-11T21:43:00.001-05:00

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I received my first of three monthly Lupron injections today. It's the first step in a thousand to hopefully having a baby via IVF. I'm holding on for the ride.
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It could be worse

2009-03-02T09:02:00.002-06:00

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When I complain about infertility to my husband, my mom, or my sister, they all frequently respond by reminding me how lucky I am and how much worse off I could be. I know this, I really do. I realize there are people suffering from life-threatening and debilitating health conditions. I realize there are people grieving the untimely death of loved ones. I realize there are people who have lost their jobs, homes, or life savings in this economy. And I realize how fortunate I am to not be one of them. But, that doesn't make the heartache of my infertility any less real, and it doesn't mean that this crisis feels any easier to manage than those others. I wish my family could acknowledge how difficult infertility is. I wish they could tell me that they are sorry I have to experience it. I wish they could praise me for the strength and courage it requires. But instead, when they just tell me it could be worse, they minimize what I am going through.

I am grateful for the things I have. Some of them, like my health, have been the result of sheer luck. But there are many others that have been the result of genuine struggle. My marriage, my career, and now a baby have not come easily for me, and I've had to work harder to attain them than most people I know. While I recognize that I could have it much worse, I am sick and tired of having to fight for basic things in life. Maybe that makes me self absorbed or immature or weak. But, it's how I feel. I don't aspire to be rich and famous; all I've ever wanted is my career and a family. I don't think that's too much to ask.
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Decision

2009-02-25T12:12:00.001-06:00

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We had an IVF consultation with our local fertility clinic today, and we decided to proceed with our cycle here rather than going straight to CCRM. I feel very much at peace with our decision. Our RE agreed to start with three months of Lupron therapy, which provides our best hope of minimizing the adverse effects of adenomyosis and endometriosis on IVF success. She advised that my baseline ultrasound would offer an opportunity for us to assess the effects of the Lupron on the adenomyosis and reevaluate whether surrogacy would be a better option. She also informed us that we could use any frozen embryos with a surrogate if we don't have luck on our first try. The success rates at the clinic are promising (50% for women in my age group), and their price is the most competitive I've seen. Plus, I have the added comfort of going through treatment three miles from my home with doctors and nurses (all female) that I know. So, I will begin Lupron in March and cycle in July. Everything is happening so fast! I really wanted some time to have a break from hormones, but Lupron therapy necessitates that we move up our timeframe if we want to complete my cycle over the summer. It seems surreal that we are here, that it has come to this, that I am actually doing IVF. When I was diagnosed with infertility, I saw this as the worst case scenario aside from never having a baby. The prospect that this might bring an end to the hell I have endured over the past year and finally give us a baby is what motivates me. But, the financial and physical investment required by IVF makes the possibility of failure all the more daunting.
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Letrozole+Menopur/IUI=BFN (IUI#3)

2009-02-13T06:51:00.004-06:00

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Next stop: IVF. I can't believe we've reached this point.
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CCRM consultation

2009-01-27T12:31:00.002-06:00

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We had a telephone consultation with CCRM last night. I went into it saying that I hoped I wouldn't get my heart broken, but deep down I felt certain a doctor at the best IVF clinic in the country would assure me that he could get me pregnant. He didn't. He said that he didn't believe medicated IUI is an effective treatment for me, which crushed my hopes of ever having a baby without very expensive, very unpleasant intervention. He estimated that our chance of success with IVF at their clinic would be "in the 40s", which is disappointingly low given their overall success rates of 60%. And, he suggested surrogacy long before I had a chance to inquire about it. I always knew we might have to resort to IVF or surrogacy, but I suppose I was counting on a miracle rescuing me from that fate more than I have admitted to myself. The thought that this cycle might be our absolute last chance before the exams, injections, and surgeries of IVF terrifies me, and the realization that the money we have sacrificed so much to save will be spent on long-shot infertility treatment rather than the plans we had for that money is gut-wrenching. The worst part is there is no guarantee that the personal hell and expense of IVF will even give me a baby in the end! It feels like a no-win situation. But, apparently I'm out of other options.
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Letrozole+Menopur/IUI=BFN (IUI#2)

2009-01-14T07:09:00.001-06:00

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Enough said.
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Good Riddance 2008!

2008-12-31T06:52:00.000-06:00

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I have had my fair share of bad years in the recent past. Both of my parents being diagnosed with cancer. Fighting a losing battle with the dissertation advisor from hell and eventually trashing two years of work to start over from scratch with a new topic. My step mother successfully plotting to rob me of my inheritance. After all of that, I naively believed I was due a long run of good fortune. Unfortunately, I only got a three year reprieve before hardship returned. 2008 has been the most painful year of my life so far.

I have tried to verbalize the despair that infertility has brought into my life, but I can't seem to find the words. I have been able to articulate some aspects and have found others in infertile women's descriptions on blogs and support group posts... the fear that I will never be able to have a baby and that the emptiness I feel now will never go away, the heartache of watching pregnant women and new mothers live the plans I had for my own life and not knowing when or even if I'll get my turn, the anger that so many other people get pregnant easily while I have to struggle and fight and sacrifice, the sense of inferiority that comes from having a defective body and feeling that nature has deemed you unworthy to be a parent, the guilt of knowing that you are the only thing preventing your husband from having a biological child, the exhaustion of finding the strength to get up and try again after month upon month of failure, the frustration of having to put your life on hold for doctor's appointments, or in order to save money for treatment, or just because you don't know what your life will look like a month or even a year from now... Yet, it seems that this is a case of the whole being greater than the sum of it's parts because even all of those things taken together don't adequately characterize the pain I've experienced over the past year.

Another burden of infertility that has been particularly difficult for me to deal with is the medical aspect. In many ways infertility has been my perfect storm... a condition that necessitates the two things I despise most in life: gynecological exams and needles. Over the past year, I have undergone 2 surgeries, 9 invasive gynecological procedures, 15 bloodtests and injections, and 16 acupuncture treatments. Any ONE of those 42 medical procedures would have crippled me with anxiety prior to my infertility diagnosis. At least I can say 2008 was the year I confronted my greatest fears.

While the infertility diagnosis has been the greatest source of pain for me this year, my family's inability to support me has been a close second. I have felt like they have left me to go through this crisis more or less alone. They have been quick to criticize me when they thought I was over-reacting or being too impatient, but they have been slow to praise me when I have shown incredible strength. My mom has come the closest to being what I have needed (as usual), but the times when she has been unsupportive have been so hurtful that they have negated the good she has done. Unfortunately, 2008 was also the year that I learned some hard truths about counting on my family.

My treatment plan has evolved significantly over the past year (I have to give my husband credit for being patient with me through my many changes of heart). After our disasterous second opinion consultation in July, I've researched many options for overcoming infertility due to adenomyosis. Lupron seemed like the most obvious choice, but my doctor was against us moving to that therapy before we had exhausted other possibilities, and Dr. Liccardi confirmed through his blog that six months is too much time to lose unless my condition is severe. Surrogacy in India also seemed like a good option, but my doctor has always believed that I can get pregnant, and when my FSH levels tested low again in August, I decided we had some time to keep trying. I have even begun considering IVF, eventhough I rejected that option over the summer as a waste of money with a defective uterus.

So, the plan moving forward looks something like this: We will continue medicated IUIs until May. If I am not pregnant by then we will move toward more aggressive treatment, but I'm not sure at this point whether that will be IVF, either at home or at CCRM, or surrogacy, either at home or in India. (Again, I have to give my husband credit for agreeing to pursue any avenue I choose... that is a tremendous gift of peace of mind). I can only hope that one of these treatments will bring us success in the coming year.

Welcome 2009. Please be good to us.
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Fucked by my fertility clinic (and I'm not referring to "the wand").

2008-12-19T16:35:00.002-06:00

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I'm on a new protocol this month, one that includes injectable medications, so I have been on the phone with the clinic nurses frequently... getting instructions on how to take the medications, coordinating my prescription purchases with their mail-order pharmacy, etc. When my medications arrived today, complete with three different types of syringes and other accoutrement, it was clear to me that telephone instructions would not suffice and I would have to get instructions in person. I called to make that appointment, but the receptionist wasn't at her desk (as usual), and I was tranferred to voicemail, which informed me of the clinic's "limited holiday hours"... closed on December 20, 21, 25, 27, 28, and January 1. This was news to me!!! I had scheduled my midcycle ultrasound for December 26, but noone bothered to mention that if I am ready to ovulate within the 2 days following that appointment, the clinic will not be open to perform my IUI! In my numerous telephone conversations with the nurses about my prescriptions, noone bothered to mention that I was spending $250 on medications that will go to waste if my cycle doesn't happen to coincide with their vacation schedule! And, it never occurred to me to ask about their holiday hours because, while I expected them to be closed on Christmas Day, I certainly didn't expect they would be randomly closed during the weekends before and after the holiday! I would never have even learned this information if the receptionist had been at her desk doing her fucking job! So, now we have to decide how we're going to handle the rest of this cycle... are we going to take the expensive medications and risk missing the IUI or are we going to forgo the expensive medications and risk losing another month? I am so angry that my doctor has put me in this no-win situation. A fertility clinic does not have the luxury of closing for 6 days in a 13 day time-span! My cycle will not wait for them! And, I cannot possibly be the only patient who has been affected by this! At very least, I had a right to be informed of their "limited holiday hours" BEFORE I started this cycle! My body is already working against me getting pregnant; the absolute last thing I need is my doctor working against me too.
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Letrozole/IUI = Chemical Pregnancy (IUI#1)

2008-12-10T06:11:00.002-06:00

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My period was due on Sunday. When it didn't arrive, I took a home pregnancy test, and the result was an extremely faint second line... certainly not anything to dance in the streets about, but by far the most promising result we have ever gotten. I tested a couple of more times during the next 24 hours and got the same results. While I didn't want to be disappointed, hope and excitement started to build. On Monday morning, I called the clinic and requested a beta. The result was positive, but my progesterone level was so low that I was told immediately that this would end in a chemical pregnancy. By Tuesday, my period had arrived. It will be more than a week before I have an opportunity to get more information from the doctor, and in the interim, I'm not sure what to think about it all. On the one hand, I'm excited that we actually conceived this month, and I'm hopeful that this means medicated IUIs are and will continue to be an effective treatment for us. On the other hand, I'm scared about the new problems that we may have uncovered. My progesterone level during my infertility workup was normal, so I'm confused about why it was so low during this cycle. I'm also concerned that the chemical pregnancy is due to a bigger problem, like adenomyosis, thin uterine lining, or something we haven't even identified yet, that will continue to present obstacles for us. The good news is that I'm starting a new protocol this month, and I have confidence that it is the most cost effective treatment for me.
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Getting through the Holidays

2008-11-28T07:05:00.001-06:00

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Ever since my first visit to the fertility clinic back in January, I have been dreading the holidays. Christmas has always been a time I have enjoyed with family, and in recent years I have spent it planning the traditions we will carry out with our own children. Since my family relationships are now strained and the future of our our own children is in question, I anticipate that this holiday season will be a wistful time. In years past, we have traveled to my husband's family for Thanksgiving and to my family for Christmas. This year, we spent Thanksgiving at home because we had to stay in town for infertility treatment and we wanted to save money for future treatments. Christmas will be a similar situation. So, infertility will play a central role in our holiday festivities whether we like it or not. (As a side note, my husband injected me with our first ever trigger shot after Thanksgiving dinner while we had guests waiting in our living room. It made for a marital bonding moment and a Thanksgiving I'll not soon forget.) We can only hope that by next Christmas we will have put infertility behind us and we will finally be carrying out those planned traditions with a new baby.
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BFN

2008-11-15T07:37:00.002-06:00

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I haven't written in a while, and I think that is a good thing. At some point this fall, between resigning myself to the fact that I have absolutely no control over this process (thanks to the polyp) and becoming extremely busy at work, I have been able to wrestle myself away from the deathgrip infertility had on my life. The unintended three month break from trying to get pregnant helped immensely too because I didn't have to constantly think about my cycle nor face the monthly disappointment of failure. But, we were back on the horse again this month... kind of. I took the letrozole and scheduled my midcycle ultrasound early since I had ovulated before my midcycle ultrasound the month before. On day 10, I had one egg but it was not yet mature, so we decided to save our money by monitoring from home with OPKs and trying on our own rather than doing IUI. It was a BFN. I wasn't surprised because I knew our chances were low this month to begin with, but the pessimist in me couldn't help wondering what another failure means and if I really am a lost cause. The good news is that my doctor has agreed to increase my dosage of letrozole next month. I am hopeful that I'll have more than one egg, in which case we will put the full weight of science behind us and do this cycle by the book.
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35

2008-10-05T03:59:00.001-05:00

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I turned 35 today. Getting older has generally not been a big deal for me in my adult life, but this birthday has been a tough one. I suppose one's sense of time grows more urgent for anyone battling infertility, but given that 35 marks the beginning of a rapid decline in fertility for women, I feel like the clock is really ticking now. Every cycle counts... one of a finite number of opportunities that is lost forever if it fails. This month's cycle was one of those lost opportunities. I was supposed to be back on track following the polypectomy, so I took the letrozole and went in for my midcycle ultrasound expecting to schedule an IUI. However, I had already ovulated. I was terribly disappointed, but infertility is teaching me how to roll with the punches. All I can do is move on to the next cycle and hope for better luck. At 35, I sure can't afford to lose many more.
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New Plan

2008-09-20T19:38:00.000-05:00

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I got my period yesterday, which marked a new beginning in our efforts to have a baby. The polyp and subsequent surgery were an unwelcome detour, but they motivated me to be more pro-active about my health and fertility. I started acupuncture yesterday. This was a big step for me considering my fear of needles, but the experience really wasn't so bad, and I'm encouraged by the research showing improved success rates for infertile women using acupuncture. I've also made some dietary changes, focusing primarily on fruits, vegetables, and whole grains. With the addition of some moderate exercise (which I'm having trouble squeezing into my work schedule), I feel confident that I will be doing everything in my power to have a baby.

We are also aggressively pursuing western medical interventions. I still feel that surrogacy offers our best chance of success, and I would have liked to make our first trip to India as early as this Christmas. However, my husband had reservations about moving so quickly, and the timing was less than ideal for both of our work schedules. When I had my FSH retested and the result came back as 5.9, I felt reassured enough to postpone surrogacy for a little while longer. This will also give the acupuncture/lifestyle changes as well as more low-cost treatments every opportunity to work. So, the new plan is to continue with letrozole/IUI for the next six months. If I'm not pregnant by next summer, we will make our first trip to India for surrogacy in May or June.

Finally, I have put some distance between me and my family. I keep my mom abreast of information on the medical aspects of my treatment, but I don't divulge much about my feelings. I no longer talk to my sister at all unless she contacts me. This has less to do with the fact that she decided not to be my surrogate and more to do with the fact that she has largely been absent through this entire process. (Case in point: I haven't heard from her since my polypectomy almost 3 weeks ago despite the fact that she knew I was dreading the surgery and one of the things they would be testing for is cancer.) I have decided that if she wants to have a relationship with me, she is going to have to make more of an effort to be what I need. It is really sad to me that it has to come to this, but both steps have insulated me from the insensitivity that my mom and sister have shown through this process, and I think I'm much happier as a result. I've also started therapy.
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Benign

2008-09-06T10:17:00.001-05:00

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After a saline infusion sonogram confirmed that the abnormal growth in my uterus was indeed a polyp, I underwent a hysteroscopy this week to have it removed. During the intervening weeks, my frustration about this latest infertility obstacle had rapidly given way to fear due to the small chance that polyps can be cancerous and the extensive history of cancer in my family. However, my doctor's office called this morning with the pathology results, which were normal. I am relieved.
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My Cross to Bear

2008-08-08T04:16:00.001-05:00

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On the morning of the ultrasound in which my doctor found the polyp, I got up early and took a shower. When I finished in the bathroom, I was surprised to find my husband still in bed. My appointment was in a half an hour, and I had assumed he would go with me. When I told him this, he got out of bed and got ready without complaint. But, it hurt my feelings that I had to even ask. I relayed this story to my mom, and she replied by saying, "This is your cross to bear". Why would anyone, especially my own mom, even think such a thing, let alone say it to me? It is true that I am the infertile one and that I am willing to go to greater lengths to have a biological child than my husband is. But, why should any aspect of the infertility treatment that might ultimately produce a child who is just as much my husband's as mine be my burden alone? And, why should my husband not be there in every way he can to support me through the unpleasantness of this process? Sometimes I long for the husbands I read about on bulletin boards and blogs that are as involved and invested in overcoming infertility as their wives. And, I long for a family who thinks I deserve nothing less.
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Endometrial Polyp

2008-08-06T11:09:00.000-05:00

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Endometriosis... check.
Adenomyosis... check.
Suppressed TSH... check.
Ovulatory Disorder... check.
Endometrial Polyp... check.

That's right. I can add a new problem to my growing list of fertility issues. I went in for monitoring today for what was supposed to be my first treatment cycle (Letrozole/IUI), and my doctor found an endometrial polyp. She said they are frequently caused by ovulatory disorders... yep, the ovulatory disorder I didn't have before the lap and that I hoped was gone because my last two cycles were normal. So, it's a double whammy. I couldn't be happier.

I'm feeling so overwhelmed. I can't believe there are so many different things wrong with me... everytime I go to the doctor it is something new! I don't know how we're going to overcome all of these problems and ever have a baby. There isn't any option that feels right anymore because there is no one treatment that will help everything I have. I don't feel like I can keep fighting this any longer, but I don't feel like I can give up on having a baby either. I just want my life back.
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Breakdown

2008-08-05T07:42:00.002-05:00

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My sister finally broke the news that she has decided not to be my surrogate. Eventhough I knew it was coming, hearing it from her was tougher than I expected. It felt like she was telling me that, eventhough she had the ability to help me out of this hopeless situation, she had chosen to turn her back on me and leave me to fend for myself. As we hung up the phone, it seemed as though she was returning to her charmed life with the children she had so effortlessly attained while I was left to pick up the pieces and figure out where I would turn next. It was perhaps the most alone I have ever felt in my life. I barely slept that night, and by yesterday morning, I had reached a personal low point. I felt abandoned by the people I had counted on and totally daunted by all of my remaining alternatives for having a baby. I made the mistake of calling my mom and sharing all of this with her. Her response was to tell me that my reaction was ridiculous and that I had gone off the deep end. Even if those things are true, it certainly wasn't what I needed to hear at that moment... not to mention that I think my feelings are warranted under the circumstances, and I deserve a couple of days to feel miserable. On top of all of this, my husband continues to resist my repeated pleas that he curb his extracurricular activities so I don't have to spend so much time by myself. My family's complete unwillingness to support me through this crisis has brought me to the point that I don't think I can cope on my own any longer. I need therapy.
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My sister's decision not to be my surrogate.

2008-08-01T14:30:00.000-05:00

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My sister hasn't officially told me that she has decided not to serve as my surrogate, but I know that is the case. She has indicated to me and my mom that, since my hypothetical need for surrogacy became an imminent reality, she has struggled with doubts about whether she is up to the task. She also hasn't called me in about two and half weeks, despite the fact that I am dealing with the biggest crisis of my life so far, and her avoidance of me speaks volumes about her intentions. I've had a difficult time sorting through my emotions about all of this, and I'm sure I'll cycle through a million more before it's all said and done, but here is what I've been able to make out so far.

Let me start by saying that, as someone who has spent my entire life (literally) petrified of pregnancy and childbirth, I can honestly say that I understand what a huge sacrifice surrogacy would be. Pregnancy demands that a woman give over her entire being for nine months, not just physically, but emotionally and spiritially as well. In the case of surrogacy, she is taking on this burden not for herself and her own child, but on behalf of someone else. It is a lot to ask of anyone.

However I also feel that, in a family that prides itself on being as supportive of one another as my family does, this is precisely the kind of sacrifice that a sister would make for a sister. Short of requiring a donated organ in order to save my life, I can't imagine needing anyone more than I do right now. I think it's fair to want and even expect the people who love me to step up during my time of genuine need and do for me what I am unable to do myself.

There are four additional factors that have made my sister's decision particularly difficult to accept.

1. My sister had offered to be my surrogate. There were definitely times that I sensed she had reservations, but we had several lengthy discussions about it, and she said it was something she was willing to do. It is disappointing anytime someone promises you something and doesn't deliver, but offering to be an infertile couple's surrogate and then reneging is an awfully big take-back. We are in a terribly desparate situation, and giving us false hope when our options are so few to begin with is nothing short of cruel.

2. Prior to my infertility diagnosis, my sister had told me and others that she thought she could be a surrogate. She had casually mentioned being a surrogate for a friend of hers who was suffering from recurrent miscarriage. Yet when I, her own sister, am diagnosed with a medical condition that necessitates surrogacy, she is unwilling to do it. How could I not feel forsaken under those circumstances?

3. I know how much my sister's children mean to her. The fact that she would knowingly deprive me of an experience that has brought such joy to her life leaves me feeling personally slighted and questioning how much she values my own children.

4. In the past, I have felt repeatedly let down by my sister. I always coped with those disappointments by telling myself that if I ever really needed her for something major, she would be there for me. I guess this has unintentionally been the ultimate test of what my sister is willing to do for me. And on this one, as in all those times before, I am on my own.
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Thank goodness for the internet and my mom.

2008-07-20T08:53:00.000-05:00

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I have managed to pick myself up from the latest blow and put a new plan of attack together, with the help of the internet and my mom. How did women ever get through infertility before the internet? They would have been almost completely dependent on their doctor's advice, but they couldn't have even known whether their doctor was good or not. I shudder to think.

Anyway, I thought I had found everything there was on adenomyosis, but when you spend 48 hours straight searching the internet, you're bound to stumble across more. Most importantly, I found an adenomyosis support group that was full of insights from women who are trying or have in fact conceived (!) with this condition. The majority of those who succeeded did so after a course of Lupron therapy, so it looks like that is in my near future, nasty side effects and all. Interestingly enough, few of them have even tried IVF. This makes sense to me because IVF does nothing to treat the condition that is preventing me from having a baby! Why don't we just flush $12,000 down the toilet?

I have also found numerous resources on the internet about surrogacy arrangements, particularly in India. Surrogacy is certainly not the ideal situation, especially since it is prohibitively expensive in the U.S. and ethically questionable elsewhere, but I am prepared to go there if I must. I was in discussions with my sister about her carrying for us, but that is seeming less and less likely. More about this in another post.

So, the plan of attack for now (I reserve the right to alter it at any time):
1. Try Letrozole/IUI for up to 3 months or until my doctor gives me permission to begin Lupron (she hasn't yet... funny, I thought this was my decision.)
2. Test my FSH again and decide whether I can afford to give up 6 months for Lupron therapy.
3. Begin Lupron therapy and continue Letrozole/IUI once the treatment is complete.
4. If my FSH is high or the Lupron fails, plan for surrogacy.

Another source of help for me this week has been my mom. I have been extremely hurt and angry by how my family has responded to my infertility, but since our bad news last week, my mom has really stepped up. She has offered emotional, financial, and strategic support, and she has said all the right things. I needed that!
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Bad News

2008-07-15T11:01:00.001-05:00

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We consulted a new RE yesterday for a second opinion on my diagnosis and for assistance in developing a treatment plan. I had read plenty of discouraging information about adenomyosis, but I suppose I was hoping that the new RE would agree with my current doctor that the condition does not pose a serious obstacle for fertility. She didn't. Based on the fact that we have no insurance coverage for infertility treatment, she advised us to move straight to IVF. However, she cautioned that, due to the adenomyosis, our chance of success is only about 30% (the overall success rate at this clinic is close to 50%) and that my risk of miscarriage is higher as well. We also do not qualify for a shared risk program. Although I had a strong suspicion that this would be the case, having my worst fears confirmed has been a crushing blow to me. I am left with little hope that I will be able to have a baby naturally, but IVF is not an appealing option either. A 30% chance of success and a doubled risk of miscarriage do not constitute good odds for a take-home baby, and at $15,000 per try, it seems foolish to move forward. To make matters worse, I did not like the RE or clinic, and the idea of going through a physically and emotionally draining procedure there is extremely daunting. It seems wiser to me to conserve our money and sanity by continuing with low-cost, low-tech interventions and beginning to prepare for surrogacy. Since adenomyosis is a uterine condition, surrogacy is often the best option for women like me. I had hoped that having a baby would be much simpler than that, but it no longer seems that is likely.
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Why it's not easy to stay positive.

2008-07-10T15:06:00.001-05:00

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My mom advised me today, as she has many times since my diagnosis, that I need to stay positive in order to improve my chances of getting pregnant. This advice is second only to "relax and it will happen" in terms of how much it annoys me. First, this notion demonstrates a complete and total ignorance about infertility. Mine is a PHYSICAL condition, and my psychological state has very little impact on it. I have been very optimistic during previous cycles but still did not get pregnant. Second, it demonstrates yet again that my family has absolutely no idea what I am going through. Over the past year, while my mom has gone on about her life, I have been tending to the daily work of trying to have a baby. I monitor my urine for signs of ovulation or pregnancy, I analyze the consistency of my vaginal discharge and other bodily changes, I have unsatisfying sex with my husband on a schedule not of our choosing, I educate myself about my diagnosis, treatment options, and the sometimes disheartening reality of what I am up against. She has the privilege of thinking about infertility once a month when I tell her I'm not pregnant; I have to think about it every day. After 13 months of investing this kind of effort only to have my hopes dashed with each negative pregnancy test, it gets harder and harder to believe that the next cycle will be any different. And, allowing positive thinking to get my hopes up would only make each failure more painful.

Here are some of the other emotional burdens of infertility that make it difficult to stay positive:

1. I am heartbroken by the possibility that we may never be able to have a child that is the perfect combination of my husband and me. Seeing myself and the qualities I love so much about my husband reflected in another person would be miraculous. I fear that I would forever feel robbed if we weren't able to have a biological child.

2. I am angry that we may have to spend our savings and possibly even go into debt in order to do what 90% of the population is able to do for free. My husband and I have made a lot of sacrifices to get where we are at financially. We should be able to spend that money on the things we enjoy like everyone else. Instead, we've postponed our remodeling projects and haven't taken a vacation in over a year.

3. I feel defective. Reproduction is a basic biological function; from an evolutionary perspective, it is the main purpose of our existence. And I can't do it. This fact leaves me feeling like an inferior human being.

4. I feel guilty for depriving my husband of the chance to have a child of his own. After all, he could have children if it weren't for me since I am the infertile one. Will he wonder what his family might have been like if he hadn't chosen me? Will he resent that we had to squander our money fixing my defective body? Will he see me as a less appealing woman and wife? Does he already?

5. I wonder whether my life will have meaning if I am not able to have a child. Many of the major personal and career decisions I have made in the past two years have been based on my plans to become a mother and the anticipation that it would be my central focus. I have no idea how I would fill the space in my life that I have reserved for a child if I could never have one.
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Ovulatory Disorder?

2008-06-28T10:16:00.002-05:00

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I had a follow-up appointment with my doctor yesterday to discuss my unpredictable cycles since the laparoscopy and my treatment plan now that the six month window she gave me to get pregnant naturally is coming to an end. She said that the changes in my cycles are unrelated to the lap, and instead she thinks I'm developing an ovulatory disorder. I am skeptical. My cycles functioned like clockwork prior to the lap, so it would be quite a coincidence if they spontaneously went haywire immediately afterwards. She ordered TSH, T3/T4, and Prolactin tests. I got the results back today. My TSH came back slightly suppressed, but my T3/T4 came back normal (which are the same results I had back in February). My prolactin was normal too. I am thankful for these results as the last thing I wanted is yet another fertility problem to contend with. But, I still have no answers about my cycles, although I think this lends more credence to my lap theory. She wants me to start on a low dose of letrozole to address the ovulation issue, but she does not think I would benefit from IUI. I fear this approach is too conservative. Since my six month window ends in August, it is time to begin fertility treatment in earnest, and the default starting point seems to be medicated IUIs. A low dose of letrozole will only really treat my supposed ovulatory disorder, but I wasn't able to get pregnant before the lap either, and ovulation clearly wasn't my problem then. I don't want to waste money and time on treatments that are unlikely to help my condition, but I also don't want to drag my feet when more powerful treatments are available. I am consulting a new RE for a second opinion this month, and I'm eager to hear what she thinks.
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Never Say Never

2008-06-15T16:23:00.001-05:00

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I have always said my greatest fear is acquiring a disease that requires painful medical interventions. I loathe needles, and after four childhood surgeries, I am terrified of scalpels. I have also always found routine gynecological care to be degrading and unacceptably paternalistic. I boycot annual exams, and I staunchly refuse to visit a male OB-GYN. My fear of doctor-induced pain and my disdain for gynecology have not subsided. Yet, I have spent the months since my diagnosis actively pursuing the exact procedures that I had spent my entire life avoiding. I have submitted to countless bloodtests. I underwent laparoscopic surgery. I spread my legs for a very invasive ultrasound exam involving a phallic shaped instrument. Such torments and humiliations would have been unthinkable to me before infertility. However, the prospect of never having a biological child has compelled me to set aside my fears, swallow both my pride and convictions, and do things I thought I would never do.
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12 Months

2008-06-01T17:18:00.001-05:00

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I got my period today. 12 months of trying to conceive with no success. I have now crossed every discernible marker into full-fledged infertility. I do feel sad and scared about meeting the clinical definition of infertile, but there is a part of me that feels validated by it. I have known since my first visit to the fertility clinic that having a baby wasn't going to come easily for me and that this problem wasn't going to miraculously go away. It has taken the people in my life a lot longer to come to that realization. At times I have felt dismissed as over-reacting or being too impatient. But, I think we all know now that it's time to take this seriously.
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