Highway TTC

Yayyyyyyyyyyyyy!

2012-01-11T13:58:00.000-08:00

Got confirmation that they've updated their plan description so that gay homosexual lesbians are now covered.

I am bouncing off the walls with gratitude and relief. Big Shiny Fertility Factory, here I come!

(yes, the picture to the right is what I imagine it's going to be like, except that instead of having a star on my belly, it'll be a baby in there.)

I have three big folders of information from BSFF in my desk drawer at work; I haven't wanted to look at them for fear that I'd be looking at what I couldn't have. Gonna take them home tonight.

Wheeee!

Fingers crossed

2012-01-05T10:30:00.000-08:00

The senior director for benefits at {my very large employer} is confident that it's a mixup, so I feel a fair bit better. I know I move to "what if" too quickly, but I'm just crappy at waiting and seeing, you know? Far more important to start freaking out immediately.

So -- there is hope. Everything crossed.

ETA: After the official email, the director wrote me a separate email, wishing us success and a baby in 2012. I'm all verklempt. I do love my workplace sometimes.

Errrrrrrrrrrrgh.

2012-01-04T13:17:00.000-08:00

The good:
Meeting with Big Shiny Fertility Factory doctor went well. I can work with him. He had some good things to say and wasn't put off by my knowing a lot of doctor-words. Some doctors hate it when you use doctor-words.

Not so good:
My insurance has kicked me back as not having IVF coverage, because I am not married and am using donor sperm. Now, I did check with my Benefits department in 2008 to make sure that this insurance plan covered the same as my other insurance plan (i.e., without regard to marital status or donor sperm). I was told that they did, which is why I switched my insurance. Now I'm being told differently. This is, quite literally, the $20,000 question.

If I'm not covered then. Well. I can wait a year, and switch back to my old insurance, on which I have one cycle remaining. Waiting a year is not a great idea when you're 38, not if you actually want to have a baby.

We could take out loans and pay out of pocket. This is, obviously, a major commitment, and not one that Her Indoors and I necessarily see eye-to-eye on.

We could try again at home, using sperm from a different donor. This would make me sad, because I'd love Small Boy to have a full genetic sibling.

I'm kind of in a blind panic about the insurance coverage, angry at myself for not double-triple-quadruple-checking, angry that this, this could be what determines our family size, angry that we are so dependent upon others, angry, angry, angry that the last pregnancy didn't stick around when maybe it was my last chance or close to it.

I've got an email out to the Head Benefits Muk-a-Muk. Until I hear back about that I'm going to be on the knife edge.

Did I mention angry?

Selective attention

2011-12-28T09:40:00.000-08:00

Everywhere I go I see pregnant women and tiny babies and brothers and sisters clinging to each other. It's okay, it'll fade, it's just such an odd phenomenon.
Her Indoors keeps dreaming that we lose Small Boy (literally, in a crowd or something). Last night I dreamed that he was kidnapped, but I beat up a building full of thugs and got him back. He ran outside to my getaway car (and old Jeep. I'm not sure what that means) and I worried about the lack of an approved carseat, but threw up my hands and drove away anyway. So in the end, I guess it was an empowering dream.
The bills from the D&C are rolling in and... I owe nothing! Turns out I hit my out-of-pocket maximum right before all that. It's surprising how soothing that discovery is.
All quiet on the uterine front. Trying to get my medical records (fruitless so far), waiting for my appointment with Big Shiny Fertility Factory.
Working up to a post on the subject of Ooops Pregnancies and the Infertile Blogger.
My health insurance was actually real sweet when I called them. I was armed to the teeth in Sarcastic Mode and they instantly disarmed me. The person at the other end of the phone apologized twice, and said "I'm sorry for your loss." It is amazing just how good it is to hear those words from an outside party. I remember when going over my history with the nurse who was doing our non-stress tests, I had to mention the first miscarriage, and the nurse said "oh, I'm sorry". And I was so grateful to her for just stopping for two seconds to acknowledge that. It really does mean something.
The last Saturday passed without notice. This is a good thing because it means I've stopped counting. I had to look at a calendar just now to confirm that yes, it would have been 9 weeks. But you know, it wouldn't have. That blast just didn't have what it needed to survive; there's no world where that particular embryo turned into our child. The aberration was that it implanted at all.

I'm on one of those birth-month boards and at least 80% of the posters have a second child by now, or are in the process of building one. Now I'm starting to see the posts from women who got pregnant at the same time I did, but with a happier ending. At first it was acutely painful, but as time goes on and our fates diverge, it starts to feel less personal. I was never on that road. I only thought I was.

Oh, FFS.

2011-12-22T15:22:00.000-08:00

Dear Health Insurance,

I approve of your proactive focus on wellness. It's innovative and no doubt cost-effective to start supporting pregnant women's health from the very beginning of their pregnancy. It's efficient that you don't have to rely upon your members to inform you of their pregnancy. What do you do, wait for something to be billed to the "prenatal visit" billing code? Clever.

But before you send out the glossy welcome material, before you send the box full of pregnancy-friendly snacks and coupons, plastered all over with pictures of tiny multicultural hands and feet and scrumptious pictures of weensy newborn babes --

You might want to check your records a little more closely and see if the person who recently filed a claim for prenatal services has, even more recently, filed a claim for hospital services for a D&C. You could maybe save yourself a little money that way.

Sincerely,
A distinctly unpregnant member.

8 days past D&C: the next act.

2011-12-21T09:14:00.000-08:00

I hesitated over the title of this post. When TTC, everything has an anchor: so many days since cycle day 1, so many days past ovulation, so many days post transfer. Now? I'm floating. Cycle day nothing, as Dr. Stewart once called it.

Thing're okay. I always underestimate how much of my pain and stress is due to being jacked up on hormones. The frisky hormones are nearly gone now; the line on my pee-sticks is almost invisible, a ghost of a line that only a crazy pee-stick-scryer could ever see. My estrogen and progesterone should have plunged, accordingly. I never had a hard bleed after the D&C, just a week or so of desultory spotting, and very little cramping. I've been lucky. I think Dr. Stewart did a very good job with the D&C, and got everything he needed to get.

I feel good about the medical care I got during the whole debacle. So good that I'm having second thoughts about switching clinics.

See, for the past few years, I've had insurance that only covered a very few practices, including Dr. Stewart's one-man show. We'll call it Dr. S's IVF Shack. I think Dr. Stewart is a very good doctor, and I personally like him immensely (as you can tell by the fact that his nickname is inspired by my beloved Jon Stewart). Dr. Stewart is smart, kind, funny, and listens to me. He treats Her Indoors well, and gives a very gentle pelvic. His practice is literally five minutes away from where we work and live. And Dr. Stewart got us Small Boy.

But. But. But. Dr. Stewart really is a one-man show. If Dr. Stewart is running late or has an emergency, then we wait, sometimes for more than an hour. Dr. Stewart's embryology lab is an unknown quantity, and seems to have uneven results. Sometimes they've done well by me, but then there was the time when it took seven vitrified embryos to get to two to transfer (most places have a 90% thaw success rate with vitrified). Dr. Stewart's ultrasound machine is old and fuzzy. Dr. Stewart does not do ultrasound-guided embryo transfers. All IVF practices have to report success rates to the CDC/SART for public reporting. Dr Stewart's statistics stink. Now, I really believe that this is at least partially because Dr Stewart does not cherrypick patients; I can't imagine him turning anyone away, no matter how hopeless their case. A lot of programs have restrictions so as not to damage their stats; won't treat women over a certain age, weight, FSH... I can believe that Dr. Stewart doesn't care about any of that.

But. But.

About 20 minutes away from me is another practice, let's call it Big Shiny Fertility Factory. As of January 1, my insurance will be one that is accepted by Big Shiny Fertility Factory. Big Shiny Fertility Factory has very good stats. I am sure that Big Shiny Fertility Factory has all the latest equipment. Big Shiny Fertility Factory is a group practice, and a friend who goes there says that it's a smooth-running operation with little wait for appointments or scans.

We have an appointment for a consult at Big Shiny Fertility Factory on January 4. Big Shiny Fertility Factory sent me a big, shiny packet of glossy brochures and welcome information. Big Shiny Fertility Factory has patient-appointment liaisons who reach out to you to guide you through the harrowing appointment-making process (I am not even kidding).

I don't know how I feel about all of this. Sorry to be thinking of leaving Dr. Stewart. Excited about trying something new. I guess I don't mind being sucked into the Big Shiny Fertility Factory Machine if I get spat out the other side with a baby.

A strong point in favor of Big Shiny Fertility Factory: I just called Dr. Stewart to make my post-op appointment. I was on hold for a while, and it was awful. The hold music at Dr. Stewart's makes me instantly shaky and nauseated; just thinking of it makes my eyes well up. I've just gotten too much bad news right after hearing that music. The thought of never ever hearing that music again is an uplifting one.

In which I catch a break

2011-12-14T08:28:00.000-08:00

Pathology is back; it was an intrauterine pregnancy. This is very good news. This means it's over.

I resisted the D&C so hard, but now that it's over I'm glad I did it. I hated analyzing every pain and every dizzy spell. I don't live well under uncertainty, and once there were no good outcomes possible, the best outcome was for it to be done with. I alternate between fits of cheerfulness and near-euphoria -- it's over, it's over, it's over! -- and dips of extreme sadness. Staying home today, lounging on the bed, catching up on Season 6 of Doctor Who.

My poor little blastocyst. It tried so hard, and hung on so long. It just didn't know when to let go. I can relate.

ETA: Doctor just called to let me know that there wasn't enough tissue for chromosomal analysis. I'm both disappointed and relieved. It would have been kind of nice to have any more information, but I know I would have totally lost my shit if I'd had to find out whether the fetus was male or female. Probably for the best this way.

Well, there's one off my bucket list.

2011-12-13T14:10:00.000-08:00

The D&C is over. It was far from horrible; the worst part was the endless wait. My surgery time was 11:30 and I was told to be there at 9:30. I was taken back at 1:30pm. Four hours is a long time to wait, especially when for three hours of it you're not wearing pants.

Good things:

My IV went in beautifully first try (I've had some traumatic IV insertions in the past).
I was afraid I'd start crying on the table, but I didn't. I was okay.
They didn't use general anesthesia after all; instead it was the same lovely, lovely IV sedation that I had for my egg retrievals. Apparently I take anesthesia fabulously well. According to the doctor I was in "fine form" and very talkative; I don't remember a single thing. I lay down on the table, and then it was over.
Recovery from the anesthesia was easy, easy, easy. I woke up feeling extremely mellow. Lay there, drank some juice, and went home.

Only dark spot was that we were unable to get a cab (WTF??) and decided to walk home -- it's barely a mile, very close, not a big deal -- but I had such a strong urge to be safely home, home, home that it was a bit harrowing. But we made it.

Now I feel pretty wiped out, but cramps are minimal.

I wondered if I'd feel devastated when it was over, saying goodbye to the last little scraps of what I so desperately wanted to be our second child. I don't, thought, not right this second. Right now I'm just so glad it's over. Based on details that I do not know and do not want to know, my doctor feels optimistic that the pathology report will show that it was an intrauterine pregnancy. We'll get the report tomorrow. Then this'll be truly over.

Why the D&C

2011-12-10T04:48:00.001-08:00

juliane2004said...: I don't want to freak you out but I would NOT do a D&C if my betas were going up (Unless I saw an ectopic). What if it was a twin that didn't make it?

Hi Juliane!

Since I did IVF, we know exactly when I "ovulated", and I should be 7 weeks pregnant right now. At 7 weeks, with a beta of 800, and with nothing seen in the uterus (and you wouldn't expect there to be with the beta that low) there is zero chance that this is a healthy intrauterine pregnancy. Zero. Average levels at this point are over 50,000. While there is a wide range of normal betas for any point in pregnancy, the range for 7 weeks is 36,000 to 72,000.

A 7 week pregnancy with a beta of 809 is either an unhealthy intrauterine pregnancy or ectopic. Unfortunately, there's no good way for us to tell since we can't see it on the screen. So I am doing the D&C solely so the tissue can be analyzed for the presence of placental cells, so we know whether or not it's ectopic. The fact that it will (hopefully) end this horror show is just a side benefit.

A lot of people would have just had the methotrexate shot weeks ago, just in case. I probably should have, but I just don't want to take a strong chemotherapy drug unless I absolutely have to. If the D&C shows no pregnancy there, the joke'll be on me and I'll have to have the shot anyway. But since chance favors it not being the case, I think it's worth it to try and avoid it.

You can get away with hoping after one bad doubling time, because the twin thing does happen. But after two bad doubling times, it's pretty clear what's going on.

P.S. Betabase.info does show six pregnancies that had a heartbeat and had day 30 betas of under 1000. But those are almost certainly data errors of one kind or another.

34dpo

2011-12-09T11:54:00.001-08:00

Beta: 801. Progesterone 10.6.

Scheduled for the D&C at 11:30 am on Tuesday.

Gonna be a long weekend.

6w5d? 33dpo?

2011-12-08T07:49:00.001-08:00

I don't know how to refer to myself. Thank goodness I haven't needed any unrelated medical contact, because I don't know how I'd answer the question "are you pregnant?"

Yes, but not usefully so?
No, in the sense that you should feel free irradiating me or giving me whatever teratogenic drugs you want, because the embryo no longer gets a vote?
Yes, in the sense that any test I'm given will instantly come up positive?

33dpo is good, I guess, because it's a reference to an event that definitely happened, rather than a state that implies something is going to happen.

No news. No spotting. Peesticks are mocking me. So, you wanted them nice and dark, huh? I get repeat bloodwork on Friday; if things haven't substantially improved, I'll have to book the D&C for Monday or Tuesday. I'm getting past the point where watchful waiting is prudent. If we could be certain it's in my uterus then waiting would be fine, but we're not. If I have the D&C we'll find out fairly quickly whether or not that's where my little zombie child has set up shop.

I called and ask a few questions, and I'm surprised? pleased? dismayed? to learn that they do D&Cs under general anesthetic. I didn't have a general for any of the egg retrievals, just a lovely, lovely IV twilight sleep. I had kind of thought and hoped it would be the same for this. I do like the idea of just really not being there for it. I've had friends who've had D&Cs under locals tell me in no uncertain terms that it is not a pleasant experience. OTOH, I've never had general; for my c-section it was a jacked-up epidural plus, I dunno, something else that made me super woozy but didn't actually knock me out. The general does make it seem like a bigger deal.

I've decided that I like the term pregnancy wastage. It sounds like what it is: a waste. A waste of time, effort, money, pain.

Things're okay. The last time I was in this position, in March of '08, it was pretty much "bottomless pit of despair". Now there's still some despair, but the pit has a bottom. I am longing for this to be physically over, all of the phone calls and hold music and blood draws and small pains and indignities and reminders and hormones. I know I'll feel better then.

6w2d: Zombie embryo

2011-12-05T12:57:00.001-08:00

Today's beta: 590, progesterone 18.

Poor little embryo. It doesn't know it's dead. Poor little thing just doesn't know when to quit.

I was offered a D&C tomorrow, but I just can't get myself organized mentally or physically for that. And there's still a hope that if I wait a bit longer my body will figure it out on its own. The danger is that, given the inconclusive ultrasound, we can't be 100% sure that it's not ectopic -- but it likely isn't.

I don't know what the right thing to do is. I'm scared of the D&C, but the idea of having this over with is very appealing. If (as is likely) Zombie Embryo is in my uterus, my hcg levels should go down pretty quickly afterwards. No more sore boobs, no more useless pregnancy symptoms. I could be good to try again in February or so. It'd be over.

On the other hand, the logistics give me a headache. I'd have to figure out about getting Small Boy to and from preschool, I'd have to take time off of work, I guess I'd have to take cabs since Her Indoors doesn't drive, I know the whole thing would end up costing a mint which, although I am blessed to say is not my primary criterion, adds a special insult. More, I think, the idea of lying there on a gurney in a hair-cover and gown is pretty awful. I'm afraid of it hurting. I don't know what kind of anesthesia they'd give me. I guess I could ask. I just want this whole thing to go away.

It's okay, little thing. Let it go. We'll try again, I promise.

Yep, nobody home.

2011-12-02T17:52:00.001-08:00

Had a scan this morning. You know, I don't much think about the costs of scans on the other side of IVF. We socked away the money, whatever, when the bill comes we pay it. But I resented the hell out of every dollar this scan cost.

It was pretty useless, too. Not much of interest to be seen. A thinnish lining of 7mm, I guess I just get to wonder what that means. Was it my lining that borked this up, after all? Seems unlikely, though. Embryos are pretty robust where linings are concerned; otherwise extrauterine pregnancies wouldn't be half so common. A bit of fluid in the uterus, a smear of something that might have been a gestational sac with a fetal pole but clearly was never going to call me mama. A giant corpus luteum/cyst on my right ovary. No fluid in my abdomen, so that's good.

My pee-sticks are dark, dark, dark. I hope that things turn around during the weekend and start to lighten up. Otherwise I get to go back to "empty the uterus". I do not think that sounds like a particularly good time. Rechecking bloods on Monday.

Things are okay, I guess. I'm frankly sick of crying. Sick of tissues and snot. I've got a rotten cold, too, and I feel like I've been in an achy-headed stupor for a week now. Thick, sore, foggy. I think I'll feel a lot better once this thing is actually out and my hormones can settle down. The moodiness, sore boobs, fatigue and intermittent nausea aren't half so fun when there's no prize at the end.

Today's beta

2011-12-01T12:09:00.001-08:00

560. Progesterone, 23.

Since it's not going down in an orderly fashion, I'm going in tomorrow for a scan. Hopefully, we will get some reassurance that whatever cellular clusterfuck is happening in my pelvis is occurring in my uterus, not in my tubes.

I'm just so goddamned sad. I didn't really think that things would turn around with this beta. I mean, I may have had this very complicated scenario in my head involving a disappearing twin, but I didn't really believe it. I just. hoped.

Just waiting, now.

2011-11-29T07:49:00.001-08:00

Thank you, everyone, for your kind commiserations. It really does help.

I'm pretty okay. I talked with my RE last night, and he agreed that there was no real reason to keep taking the PIO. We'll be checking my hcg again on Friday; hopefully it will be going down on its own in a peaceable, orderly fashion. Hopefully then my progesterone will also fall; even though I'm no longer supplementing it, since I did ovulate my body is likely producing some on its own and I won't bleed until it shuts down production.

Last night, I:

Had a glass of wine;
Let myself use my laptop in my favorite position, with it balanced on my stomach otter-fashion;
Did not have a 1.5" needle jammed into my ass.

So the evening was not without its redeeming features. This morning, I had real coffee, with real caffeine.

I don't know. Three chemical pregnancies, one with a barely-there beta, two with decent enough but non-doubling betas. Once might be misfortune, but twice starts to look like carelessness. Chromosomal issues? Immune issues? Does it matter? Should I just keep slinging embryos in there and wait for one to stick? Obviously one did stick, three years ago.

I'm tired. I'm sad. I'm displeased that I have such a strong feeling of anger towards myself for being optimistic, for believing that dark line 4dp5dt, for typing information into a due-date calculator. Part of me says "Oh, really, you knew better than that. An old campaigner like you should know by now that two lines on a pee-stick do not necessarily equal a gurgling infant nine months later."

But... I don't want to be that person. I don't think there's anything particularly evolved about being cynical and pessimistic. Optimism is the more difficult path, and the better one. I should be proud that I managed to be so excited and happy. But I can't help looking back and wincing at myself, shouting back into time shut up shut up shut up close that browser window, girl, you're not going to need that mei tai.

Maybe it's my Jewish cultural conditioning, the idea that rejoicing about anything is like waving a red flag at the evil spirits and saying "come get me". Maybe it's an ugly streak of my psyche that snottily finds anything preferable to being a fool.

Beta #4

2011-11-28T12:12:00.001-08:00

567, for a doubling time of.... 105 hours.

Yeah, it's over.

Thanks for stopping by, hope.

I guess, technically speaking, this will be a chemical, not a miscarriage. Hurts a lot more than the last one did, though.

I can't believe how well and truly fooled I was by that early, dark test. Bitter!me says: I can't believe I fell for that.

Now I just have to hope it's not ectopic.

I fucking hate the next few steps, to wit:

The passing of the physical products of conception
The bills for the failed cycle come rolling in.

Fuck.

Beta #3

2011-11-23T16:22:00.001-08:00

hcg: 255
progesterone: 65

Doubling time: 58 hours.

Not worse. Better. Still not perfect, but... better is better.

Hallo, hope. Is that you?

Heading out to get my blood drawn for beta #3

2011-11-23T05:21:00.001-08:00

I'm strangely reluctant. I haven't peed on a stick in 48 hours. I've been floating along in limbo, fairly peacefully.

Epiphany: a fool's paradise is still a paradise.

Here I go.

Beta #2

2011-11-21T13:31:00.001-08:00

Result: 144. Doubling time, 69 hours. (for those of you not on the crazy train, a normal/healthy doubling time is 48 hours). Coincidentally, 69 hours is the same doubling time as with the m/c i had in my first IVF.

Repeating on Wednesday. Looks like I'm chasing this unicorn, too.

14DPO Beta results

2011-11-19T10:37:00.001-08:00

Beta: 89.7
Progesterone: 88.5

Still holding my breath. I'm surprised it was as low as that, given my test sticks. For my miscarriage, my 14dpo beta was 74. For my successful pregnancy, it was 115. So this result is pretty much halfway between the two.

I have burned holes with my eyes looking at this chart. That chart is for 15dpo, and would give me about an 85% chance of live birth. My hope is just that this is a rising number, not a falling number. I got such a dark line so early -- maybe twins that resolved to a singleton? Or maybe twins that resolved to... yeah.

Someone just put me into cryogenic sleep until Monday afternoon, please.

Boy oh boy does blogger need a "reply" option...

2011-11-15T08:44:00.001-08:00

...or a blogger who either can figure out how to correctly install a widget. Or a blogger who can get around to picking up stakes and moving to wordpress.

Shannon recently commented
Doesn't the hormone concentration in your pee vary a bit with your fluid intake?

Why, yes. Yes, it does. Also, the dye concentration on pee sticks varies from lot to lot and even within a box. Also, it is completely insane to try and treat a qualitative test like this as a quantitative test. These are all things that would be at the forefront of the mind of someone who wasn't completely deranged.

Juliane asked
Do you think twins? When is your ultrasound?

My guess is that the U/S would be at 7w? That's assuming the betas come back anything worth writing home about. My beta is this Saturday, Nov 19, hopefully with a follow-up on Monday, Nov 21. Hilariously, I'm supposed to go on a 7 hour Thanksgiving roadtrip the next day.

As for twins... maybe? I don't know? It is awfully early for a line like that. But I'm hoping that it's just one bold, brassy, strong little embryo. Twins would not be a good thing for me. I'm 38, hypertensive, I was insulin-dependent during my last pregnancy, I'm really short, there's a laundry list of other reasons why that would be a tough situation. My first two IVFs were single-embryo transfers because I was so terrified of twins. But time went on, and I got sadder and more desperate, and it was a double-embryo transfer that resulted in our '09 son. For the previous and this FET, we transferred two. So... it could be. I'll think about that later.

Love to Lathany and Olive, too.

Tonight I'm going to try and figure out some kind of bloggy-reply-thingie fer sure.

P.S. Four hours after this morning's somewhat-disappointing pee stick, I tried again, with much more satisfactory results, the same as last night I think or mayyyybe a touch darker. Yes. Crazy is me.

5dp5dt

2011-11-15T04:29:00.001-08:00

Line lighter this morning? I know, I need to just put the pee sticks away and stand back. Breathe until the beta on Saturday.

But oh, the familiar familiar crazy. It's like my brain was just waiting to pop into the groove of the crazy-track.

Just gotta stay loose. HAHAHA. Just got to keep breathing. That I can do.

4dp5dt: photographic evidence

2011-11-14T15:36:00.001-08:00

It's... not really that faint, is it.

Oh, my. Oh, my. Oh, my.

4dp5dt

2011-11-14T09:38:00.001-08:00

My camera battery's dead, and I'm the last person in North America without a camera on her cell phone. So until I get home tonight and can charge my camera, you're just going to have to imagine:

A pregnancy test, with a faint but definite line.

I'm... just sitting here very very quietly.

3dp5dt: WTF, OHSS?

2011-11-13T09:21:00.001-08:00

So, I seem to have made it onto the very short list of people (possibly consisting of only me) who manage to develop OHSS while doing a FET.

Of course, it's reasonably common to develop it while doing an injection IUI cycle, and that's essentially what I did, minus the IUI. So logically it makes perfect sense. It's just absurd. Who the hell develops OHSS during a FET cycle? Me, that's who.

I'd be elated if it were a few day in the future and I could count it as late-onset OHSS, which almost always is a harbinger of pregnancy. But it is, sadly, too early for anything but early-onset, which is a harbinger of... larger pants sizes.

S'okay. It's mild, so far, nothing but a belly gone up one clear size in jeans since Friday. I lost a bunch of weight in the past year, so I don't even look too odd, just kind of back to normal rotundity. It's just... OHSS? Really? Really?

5 DPO: Transfer day

2011-11-10T07:16:00.000-08:00

They thawed the two vitrified embryos. Both of them survived.

I'm gobsmacked, and grateful. I dunno if they found the right button on the microwave or what, but I'm happy.

They both made it through in good nick, too, 4A. No, I don't know what happened to the second letter, and I wasn't in the mood to ask, so I didn't. I'm a bit of a skeptic on blastocyst grading now, anyway -- I miscarried a 4AA, and my little 2BB is running around in his wee sneakers right now.

So far, so good, I can't ask for anything more. I'm in with a chance, as good a chance as anyone's. Now -- I wait.

4DPO: a.k.a. the day before transfer

2011-11-09T11:47:00.000-08:00

I've swallowed the doxycycline, the methylprednisolone. The progesterone in oil (well, thankfully, in ethyl oleate) has been sunk deep into my gluteals each evening by my lovely partner. Transfer is scheduled for 8:30 a.m. tomorrow.

Nothing to do now but wait, wait for my uterine lining to be synchronized, wait for the embryologist to (please) coax those little frozen things into life.

Tonight we will drink a toast of pomegranate juice, and wish the Tiny Frozen Americans a safe journey from the dark frozen underworld into our world of light and sound.

Stims Day 10: The Rollercoaster Continues

2011-11-03T09:24:00.000-07:00

So yesterday, I was sad. I went to see my ~~spiritual adviser~~ acupuncturist, with whom I thankfully had an appointment that afternoon. She hmmmmmed and felt my pulses and needled me here and there and let me drip tears on her table. I love her.

She then advised me to do some visualization, eat red meat, wear some red, and soak my feet in hot water. I wandered down to a local hippie-dippy shop and bought some red candles and a red scarf. Then I went home and had a spicy dinner, soaked my feet, chugged 2 oz of wheatgrass juice, and went to bed.

This morning, my lining was 9.1-9.5, with a triple stripe pattern.

Who the hell saw that coming? Overnight! I don't know whether to credit the acupuncture, the wheatgrass, the visualization, or, you know, possibly the Follistim. I don't care. My lining is where it needs to be and I am delighted. One more hurdle, cleared.

The next hurdle: defrosting. I'm pretty nervous about that. Maybe I should eat pomegranate. I totally need someone to lead my embryos out of the frozen underworld.

E2: 964
LH: 31

CD 11, stims day 9

2011-11-02T07:31:00.000-07:00

Not so great an appointment. My lining has somehow magically shrunk to 7.5. Where did it go? A few follicles around 14.

I don't understand why I'm getting the craptastic linings lately. I hate this. I hate the rollercoaster. I hate the endless appointments, waiting and waiting and waiting in the doctor's office (40 minutes this morning, an hour and a half on Monday) and then waiting and waiting at the lab, I hate waiting for the phone call to see what my lab results are, I hate slipping into work after unexplained disappearances and hoping that no one noticed, blood draw after blood draw, I hate this, I hate this.

sigh.

It's okay. I know I'm actually lucky, super lucky that this is a torture I can freely choose, and have chosen. I just wish it sucked less.

E2: 648
LH: 7.7 (elevated)

CD 9, Stims Day 7

2011-10-31T09:11:00.000-07:00

Things are proceeding apace. On Saturday (CD 7/Stims day 5) my lining was 6.something, and I had about 5 follicles in the 8-10 range. Now, on Monday, my lining is 8 (yay!) but the follicles are still only 9-11. Depending on the bloodwork, I suspect that we may be jacking up the dose in order to hurry the follicles along.

All this rigmarole is for the sole benefit of my lining, so I'm glad that it looks like the stims are helping. I think my body's not a big fan of estrogen pills. I know my brain chemistry isn't.

Stims day 5 E2: 176
Stims day 7 E2:298. Raising Follistim dose to 150iu.

CD3: Hip hip hooray! FET #2.5 starts today!

2011-10-25T08:46:00.000-07:00

Before I start getting excited about FET #2.5, I have something marvelous to celebrate:

Goldie is here! Goldie is the daughter of Olive and Fern from Insert Metaphor. I've been 'net friends with them for years, literally years. Difficult years.

Olive first left a comment on my blog in February of 2008. We were embarking on our first IVF after a year of unsuccessful home insems and IUIs. They were just starting home insems.

After that, we traveled together. Our journeys have been so similar; they too moved from home insems to IUIs to IVF. Along the way, Olive has written beautifully and vividly about the grinding pain, isolation, and weariness that goes with measuring your TTC time in years. Looking at her old entries gives me the same lump in my throat that I get when looking at my old entries, when every word beat a tattoo of please. please. please.

So welcome, Goldie, and welcome to parenthood, Olive and Fern. Thank you for sharing your journey with us. The road was less lonely with you along.

* * *

Hokay, onto the cycle news! We start shooting up Follistim tonight. Yesteday's CD2 appointment went well: 13 or so antral follicles, lining 4.4 (is that a little thick for CD2? Does it matter? Probably not.), E2 43, FSH 5.9. All just ducky.

100 iu of Follistim every night for the next four days, then a lining check on Saturday. Wheeeee! I'm in a marvelously moodswingy up-mood. The only thing that makes my stomach drop is thinking about thawing the embryos, how my poor little two vitrified (badly vitrified?) embryos might or might not survive, and whether the five slow-frozen ones have much of a chance. Did so few of my vitrified embryos survive because they were badly frozen, badly thawed, or because for some reason I make embryos that just aren't very cold-resistant? Please let it be the first. It makes some sense; they were vitrified within the first three months of my clinic beginning their vitrification program. Maybe someone forgot to, I dunno, add salt?

Breathe. I can't affect it. All I can do is try and grow a nice cozy lining, and hope for the best. I'm chugging wheatgrass juice and trying to think plush, loamy thoughts.

Rock on, FET #2.5!

Canceled for bad endometrial behavior

2011-10-13T12:43:00.000-07:00

After four more days, my lining was... about the same, less than 7mm. I decided not to try the Viagra, given that the evidence was unconvincing and I was feeling kind of like cancelling this cycle and starting again, anyway. See, I always made not only decent linings but really nice linings before. Even if I could have eked it up to 8mm with Viagra, I want to roll the dice again and see if I can't produce something plushy and 10mmish.

New plan: low-dose stims. It'll be as if I were doing a fresh cycle, except with lower doses of FSH, no Lupron (ovulation suppressor), and no retrieval. Hopefully I won't hyperstimulate, given the lower doses, and hopefully my body will react to the estrogen produced by its own follicles better than the little green Estrace pills.

I keep repeating to myself: marathon, not a sprint, marathon, not a sprint.

CD 2,257

2011-10-10T10:58:00.000-07:00

Oh okay, not that bad, but it feels like I have been taking estrogen for. ever.

Things aren't looking too good for this cycle. After 20+ days on estrogen, my lining is... 6.9, a.k.a. "real skimpy". Giving it a few more days, then we'll probably cancel this cycle. I could pay $200 for some hits of Viagra and shove them up my hoo-ha, but I could also roll up $200 in cash and shove it up there with probably as much benefit (i.e., evidence is spotty for the use of sildenafil to improve endometrial linings).

I've never had lining problems before, so I can only think that

1) This is a fluke

2) My body simply doesn't like exogenous estrogen.

If I think it's option 1), we can just cancel this cycle and try again next cycle. If I think it's 2), we can cancel this cycle and try again with a natural cycle. That means some fairly harrowing monitoring/wondering/waiting/seething. But there's going to be monitoring and waiting anyway, And at least I wouldn't be crazy on hormones. I'd be crazy all on my own.

If anyone has any experiences or insight into this, please do share.

CD2: and so it begins!

2011-09-12T12:53:00.001-07:00

My rest cycle was surprisingly good.

Stuff I did during my rest cycle that I wouldn't have done while actively TTC:

a crazy cleansing diet ("UltraSimple" -- can't say I'd recommend it)
started and promptly abandoned an exercise program
went days at a stretch without thinking about my uterus.

Real life has seemed slightly crazy lately, crazy enough that I sometimes think and you want to add an infant to this? And the only answer I can come up with is yeah, yeah I do. So sue me.

My CD2 E2 was 38, very good. We're going full steam ahead. We'll have to jigger the schedule because, right around transfer time, I'm going to be at a conference in Las Vegas. The last time I was at this conference was 2008. I was nauseated there, from taking the birth control pills for my third IVF cycle. I wrote:

I was at a conference this week, in a discipline that's heavily female and, apparently, fecund. I overcompensated mightily, as always. If I'm ever pregnant, I wonder will I notice when a woman is smiling at me too warmly? I know I'll never be a belly-rubber, but I wonder if I'll see. Probably not. I can't see it on anyone else's face even now. I always feel like the only person whose eyes slide away.

Here I am, on the other side of the chasm. And now I know the answer to this question: no. I never did notice. As soon as I got pregnant, I was utterly inward-turned, utterly consumed with myself and my fetus and holy cripes look at me I'm doing it I'm doing it. I am 99% certain that I never was a belly-rubber, so that's something, but I don't know how I feel about my own obliviousness. On one hand, maybe it wasn't as obvious as I always thought it was, maybe my longing wasn't painted on my face in four-inch letters. On the other hand maybe it's as eggdance said in her comment to that post: we are invisible to them, I think.

If I had noticed, I don't know that it would have been much better. There was absolutely nothing I could have said.

Things will be different, this conference. This conference, I'll be on estradiol, not birth control pills. I hope I won't be puking (I didn't on estradiol, last time). I'll be by myself; last time I brought Her Indoors with me, to enjoy the local sights and ridiculously extravagant vendor parties. This time, she'll be at home, caring for Small Boy.

This is going to be the longest I've ever left them for. I get a lurch in my stomach when I think about it, so I'm not going to think about it.

Anyway! Here we are. Here we go. Here we go.

Waiting for the flood

2011-08-10T11:56:00.001-07:00

I stopped the progesterone on Monday. My RE called later that day, with a kind "sorry" -- I didn't need to hear it, but I appreciated it.

For next round, which will be in bloody October (well, the transfer will be), we're going to switch to IM progesterone. I don't believe that there's a strong reason to do so, but I don't mind. The shots hurt, but Crinone isn't exactly pleasant, and maybe it was the lack of a sharps container that interfered with the last cycle.

I've been thinking, too, about fresh cycles. Two weeks ago I was fat and sassy, sitting on my 14 frozen embryos. Now I'm down to 7, 5 of which are slow-frozen. I have a fantasy that maybe I'll be the one person whose embryos like slow-freezing better than vitrification (~~or the lab fucked up the vitrifying on my embryos~~) and that the five I socked away from my very first cycle will thaw beautifully. But chances are that they won't. That means that if the next FET doesn't work I'll likely be starting fresh again, at age 38 this time.

That's okay. It'd be less scary this time, since I know the process inside and out by now. But this time, unlike last time, I have limits. First time 'round I pretty much would have kept going until I fell over. This time I've got... more exit conditions.

Mainly it's about how well I can hold my shit together. I have Small Boy now, and he deserves to have both of his mothers firing on all cylinders. I'm willing to allow for a substantial performance hit, given that I believe that a sibling would be of long-term use to him, but there's a limit.

Right now it's in his best interest for me to try for quite a long time and not succeed, because apparently my BFN-coping mechanism is to buy Small Boy a buttload of stuff. His first train set -- clothes -- some DVDs of vintage Sesame Street -- if I don't catch promptly, this kid is going to be spoiled rotten. I did not budget for this when figuring fertility expenses.

That was mercifully quick.

2011-08-08T10:45:00.000-07:00

Today's beta = negative. I didn't ask, but I assume that means <5. Kinder, in a way, since I've no decisions to make. I'm stopping meds tonight.

I've asked about doing an endometrial biopsy this cycle. I don't know if that fits the doctor's definition of a "rest cycle" or not, but I hope it does -- at least it would keep me amused. And there's some evidence that endometrial biopsies increase implantation on the cycle that immediately follows. It's all pretty voodoo, but most of this process is.

The view from Beta Hell

2011-08-07T11:03:00.000-07:00

Second-guessing my decision to stay on meds. No matter what number I get tomorrow, it's not going to change the fact that the 15dpo number was 8.

Okay, let's think this through:

Option #1: chemical. The overwhelming chance is that this is chemical. If it's chemical, I'm simply prolonging the process. On the other hand, I'm not doing any harm to anything except my sense of serenity.

Option #2: miscarriage. The next largest chance is miscarriage; i.e., that it limps along for a few more weeks -- I get a number like 24 on Monday, and hey! it more than doubled! yay! Except that it's still only at 24. Then it doesn't quite double, goes up to, I dunno, 41. Okay, okay, almost a decent doubling time, and the doubling time's a range, right? Then the next beta is great. Let's say a 39 hour doubling time, woo hoo! This continues, a grab bag of mediocre and great results, until finally the doctor says "enough with the betas, come back for an ultrasound in a few weeks." I do and: there's no heartbeat. Or there is a heartbeat, and I get released to an OB. At 10 weeks I go in and... there's no heartbeat. Even if I'm lucky and it all passes naturally, it a) hurts and b) takes me months to get my period back so we can start again. This is the worst-case scenario, except for equally hideous

Option #3: ectopic. In this universe, everything proceeds exactly as with Option #2, except that at 6 weeks there's nothing in my uterus. I get a big fat shot of methotrexate, and wait for everything to work its way out (I'm not even running the mental simulation of if the shot doesn't work. Just no.) It a) hurts and b) takes me months to get my period back so we can start again.

Option #4: live birth. This is the unicorn I would be chasing by keeping going with my meds if tomorrow's beta has any sort of decent rise. This is the unicorn that all of us who google "beta hell success stories" chase.

#3 is out of my hands, right; even if I stop the meds, an ectopic would still keep going even without progesterone and estrogen. I just have to keep my fingers crossed for that one. Stopping meds promptly would cut short the tedious and unpleasant #1, and bypass the excrutiating #2. On the other hand, it would be eliminating the slim possibility of #4.

I just don't know. I'm not a gambler, I've never bought a lottery ticket in my life. Chemical + miscarriage = 90%. I could logic myself into saying that since it's so likely that I'm in the 90%, I should stop my meds. But... the truth is, I wouldn't be doing it out of certainty that I'm in the 90% of chemical + m/c; I'd be doing it out of fear that I'm in the 10% of miscarriage.

Prudence? Fear? The smart decision, or the pussy one?

Writing it all out makes me feel better, but I'm still not sure what I'm going to do if, tomorrow, the number has gone up in any sort of meaningful way.

10dp5dt:: Good thing I kept the receipt for those booties!

2011-08-06T10:28:00.001-07:00

Beta was

wait for it

8.

Doc wants me to stay on meds until Monday and re-test. I'm partially "wtf" but I guess it's not a big deal to give it another 48 hrs. I mean, 3% is not 0%, right? All I have to lose is a few days of time; I wouldn't give it two weeks, but I'll give it two days.

Now my hope is for a swift, clean chemical. No hanging around for weeks making unhelpful amounts of hCG and preventing me from trying again. And, for the love of god, please not ectopic.

In the "disappointing" category also: doc wants to wait through a cycle before doing another frozen transfer. I find the waiting-around cycles particularly grinding, and was hoping we could rush straight into another FET.

9dp5dt:: No beta today, weirdly enough!

2011-08-05T07:07:00.000-07:00

Morning pee-stick report: FRER (First Response Early Results, for those not on the crazytrain), faint but definite positive. Reputed to have a sensitivity of 12.5 miu. IC (that's Internet Cheapie, wondfro, to be precise): darker than last night, but still exceedingly faint. Reputed to have a sensitivity of 25 miu.

I'm not going for my beta today; I'm going tomorrow. It's not as crazy as it sounds. My doctor usually tests at 10dp5dt (15 dpo), but he offered me the option of doing it a day early because 10dp falls on a Saturday, and it's a bit less convenient to get to the lab on a Saturday.

Of course I assumed that neither man nor beast could keep me from my day-early beta. That is just not who I am. Like Pippin, I always have to look. But now... I'm strangely moved to wait.

For once, I have a feeling that this is out of my hands. Maybe I'm just reluctant to crack open that box and make the cat alive or dead. For whatever reason, I'm just sitting quietly at this crossroads for one more day.

8dp5dt: ambiguous, but perhaps still in the game.

2011-08-04T18:15:00.000-07:00

A very, very, very light line. Before anyone gets excited, a very low beta at this many DPO is... well... it's not a no, but it's definitely a keep-your-receipts-for-those-booties situation. To give you an idea, if my beta tomorrow is

Between 5-14
Approximately an 80% chance of chemical pregnancy, 10% chance of miscarriage, 7% chance of ectopic, 3% chance of live birth.

Between 15-28
69% chemical, 25% miscarriage, 5% ectopic, 1% live birth.

Between 29-45
This is where things get gooder -- about a 32% chance each of chemical, miscarriage, and live birth, remainder ectopic.

Between 46-66
I doubt this could happen overnight, but live births are into the 40s.

(for anyone else aboard the crazytrain, reference here)

Now, my test is going to be at 14dpo, and the above statistics are from 15dpo. So I might just promote myself a category. So we're thinking -- high 20s, friends. High 20s. Because a 32% chance? Would be like another shot, a whole fresh IVF cycle. I'll take it over a flat BFN.

7dp5dt:: a story

2011-08-03T16:57:00.000-07:00

I thought I saw a line, but I didn't. The end.

Wanna hear it again?

6dt5dt: the right way to get a BFN

2011-08-02T09:43:00.000-07:00

5:30 a.m. Wake up when 2-year old decides to join you in bed.

5:35 a.m. Lie awake trying to convince yourself that you don't have to pee.

5:36 a.m. Consider that this pee will be FMU (that's First Morning Urine, for any of you not on the crazytrain).

5:38 a.m. Pee. Test.

5:38-6:00 a.m. Stare at pristine white test, willing a shadow of a line to appear.

6:01 a.m. Give up, crawl back into bed.

6:02 a.m. Have toddler jam chubby arm around your neck, nestling fragrant head under your chin. Breathe. Think about how lucky you are to have this small, strange, snuggly person unfolding before your eyes every single day. Twine ankles with your best beloved, in your comfortable bed, with your healthy child between the two of you. Cry a bit from the happy, and also the hormones.

6:15 a.m. Drift off for a second sleep, smiling.

So... yeah. Still BFN. Still wish it weren't. But you know, I think I'm on to something here. I'm going to start scheduling my HPTs for right before a designated snuggletime. There's a depth I just can't plunge to when the Small Boy shoves his arm around me and sighs.

I have also been thinking a bit about the Slow Path. A year or two ago, I was sure that my struggles to conceive had done nothing but damage me as a person. I was more guarded, anxious, cynical, angry, bitter. Damaged. I thought that I was a worse mother than I would have been if I had traveled a smoother path.

But I've started to think that it's not true. I think that I genuinely have, to a great extent, healed. I can tell, because some of the patterns I feel myself bending into now are simultaneously familiar and unfamiliar: my brain bends that way, but it hasn't for a long time. And that's very, very good.

I don't know if I'm a better mother because of infertility, but I'm starting to cautiously think that I might not be a worse one.

5dp5dt:: BFN

2011-08-01T20:32:00.000-07:00

Sparkling white, glittering white, white like an Alpine peak, white like a Tea Party rally.

Some might say that it's early to feel pessimistic about this cycle, but I don't like to leave things till the last minute¹. I don't know. I've felt sort of off, grungy, a bit wrong -- I thought maybe it Meant Something -- but right this second I think maybe it means that I'm taking large amounts of exogenous hormones.

So I'm looking forward a bit. I can do probably one more FET. Just one? you might ask. But I thought you had a cool dozen-plus-two embryos on ice!

On transfer day, we had the unpleasant surprise of learning that seven embryos had to be defrosted in order for us to get two to transfer. This is an abysmal thaw rate; thaw rates (for vitrified embryos) are usually between 50-90%. I don't know whether there's something about my embryos that makes them freeze/thaw badly, whether the lab didn't do a good job freezing them, or whether the lab didn't do a good job thawing them. Regardless, I now have 7 embryos left, two frozen using the rapid-vitrification and five slow-frozen. Slow-frozen embryos usually have much worse thaw rates than vitrified, although much worse than 2/7 is *scribbles on piece of paper* approximately crap%. So... I don't have quite the bounty that I thought I had. I can probably get one more FET out of it, though. And after that, it's back into the fray.

¹This is a lie.

4dp5dt, 6am

2011-07-31T03:10:00.000-07:00

Woke up at 4, couldn't get back to sleep. At 6, got up and peed on stick. Result: a negative so white it could cause snow blindness. Took my glasses off, tilted it hither and yon. Not even a decent evap to entertain myself with.

So it begins...

ETA Lest it all sound too desolate: spending a splendid cuddly day with Small Boy. I set up a pop-up tent-tunnel combination that I scored at Value Village last year and have just now realized that he's old enough for. Later on we'll go to the library, maybe to Whole Foods. It will be a nice Sunday, regardless.

3dp5dt

2011-07-30T17:37:00.000-07:00

Symptoms: few. I swing between wild optimism and wild pessimism. Things that help: snuggling Small Boy, eating nice food. Things that don't help: reading various fertility boards.

I think I have a touch of PTSD over the last time we did this. I keep losing track of where and when I am now. The despair licks at the edges of my brain, and I realize that I've forgotten, once again, that this is not the same as it was. Once I look around and connect with the present, I feel a thousand percent better.

For my successful pregnancy, I got a (very faint) positive in the evening of 4dp5dt. For my unsuccessful pregnancy, it was 5dp5dt. I currently have in my possession 45 pregnancy tests (shut up. it's a long story. no, it's not.) Peeing will commence tomorrow evening. Who am I kidding: peeing will commence tomorrow morning. In fact, it's a wonder I'm not peeing on something right now.

Schrödinger's Fetus

2011-07-28T10:38:00.000-07:00

My uterus
contains two embryos. Quantum theory says, I guess, that they are neither alive nor dead. In general, this explains why quantum theory is something that I never intend to trouble my pretty little mind with in any sort of systematic way.

But right now, specifically, at this moment, I am a fan of quantum theory. I much prefer to spend the next few days thinking of the embryos as neither alive nor dead. It's painful to think that it could be all over already, and I just don't know it yet. Better to think that they are neither until the instant that first drop of pee hits the peestick.

Where we are
1 day past 5 day transfer of 2 embryos (both 3BB).

How we got here
For a while I'd been making noises about trying for another "starting around Small Boy's second birthday." He turned two on Tuesday. Wednesday we transferred two defrosted embryos.

Things that are true #1: this is nothing, nothing, nothing like the past three attempts.
I am in no way discounting the acute pain that secondary infertility causes some people when I say oh my fucking god so much better. Last time, failure was "dangling over the abyss." This time, failure is "not getting what I want". I mean, I know I would have survived, I would have had to, people do. But every time I thought of it, my brain just blurred into pain. Now? I'm not as flippant as I hoped I might be; I care. I care a lot. But... my worst-case scenario is not the abyss. It is (kinnehorah-inshallah-god willin-and-the-creek-don't-rise) only raising my funny, fascinating son.

I can never feel hard-done-by. I have him, and while I may not be grateful every day, I am at least grateful every second or third day.

Things that are true #2: this is nothing compared to the physical devastation of my fresh cycles.
Frozen embryo transfers are so low-key that they barely register. It don't mean a thing if it don't involve a sharps container, you know? Take some pills. Stuff some gel up your vagina. After a couple of weeks, stick a couple of embryos in there and see what happens.

C'mon. At no time during this cycle have I been able to say "breathing hurts". Calling that a win.

Things that are true #3: this is still amazingly nerve-wracking. Maybe it's the hormones; although there are no injections (my protocol was strictly Estrace - Crinone) there are still tons of hormones floating around my brain. Or maybe it's that it's impossible to ignore the magnitude of what we're trying to do and the difference it could make in all of our lives.

So the request I am making to the universe: please. I am so grateful for what I have. Can I have some more?

Procedural notes for record-keeping:
D3 E2 = 52 FSH = 7.9

Aftermath

2009-12-31T08:04:00.000-08:00

It wasn't until after the birth that I found out that the jerking? while I was on the table? that was the doctor and nurse yanking trying to get our son out of me. See, apparently 2.5 hours of hard pushing was enough to wedge him in there really really well. They tried to push him back up. Didn't work. They tried to get some turn on him. Didn't work. As tension mounted in the OR, apparently my sweetie was afraid that they were going to have to break my pelvis to get him the heck out. They ended up with the nurse and doctor each with one knee up on the operating table for more leverage, heaving. I was so drugged I only vaguely noticed.

Being in the hospital was pretty awesome. It was a safe, contained space for the three of us to concentrate on this new little creature and his requirements. I was not at all sorry to be there for the C-section mandated four days.

Having said that, I was in pretty rough shape physically. I don't know if it was because of the long labor or what, but I was flattened. By the time I was discharged I was still only hobbling slowly. I had the poor example of my best friend, who is, unlike me, a) in good shape b) tough as nails. She was bopping around days after her C-section, and I expected to be doing the same. Noooooo. I also blew up until my ankles looked like a Cabbage Patch doll's. I didn't retain too much water during pregnancy, so I was surprised and displeased by my giant ankles.

All of this is preamble to the next big chapter of Aftermath.

I got home on a Thursday. Friday was okay. I woke up Saturday morning feeling awful in every way, short of breath, and with the strong feeling that I was going to die. That was actually my most bothersome symptom: I was terrified. I felt like there was a siren wailing in my head. Get help, you are not okay.

I tested my blood pressure and it was the highest I'd ever seen it, 180/103. My pulse, normally in the 90s, was in the 50s. Off to the hospital we went.

After a few hours of testing, they sent me home. By the time I was there, my blood pressure had gone down to 140s/90s. My bloodwork (testing my liver enzymes) was okay. I wanted to beg them to keep me. I just felt so wrong. I went home. I cried a lot. I couldn't sleep because lying down made me short of breath and, more, I was afraid that I'd die if I slept. It was totally irrational but just so strong.

I got through Sunday somehow, but by Monday I was back in the hospital. By then my stats were more alarming; my blood pressure was staying elevated, my liver function was declining, and there was some fluid (although not a lot) visible in my lungs on a chest x-ray. This time, they kept me. The doctor who told me that I was going to have to stay spoke gently, regretfully. I could have kissed her.

The blood pressure and liver function was a gimme; they see it all the time. What wasn't so obvious was why my heartbeat was so slow. It was in the 50s, then started dipping into the 40s and even the 30s a few times. Alarms kept going off on my monitors. They kept asking me if the rate was normal, did I work out a lot? And I'm all HAHAH do I look like I work out a lot? I had minor tachycardia all through my pregnancy, with my heartbeat well over 100 resting.

They set me up in a room in labor & delivery. They really had no idea where to put me; I was too sick for the postpartum unit, too baby-fresh (and with too many other things going on) for the regular cardiac unit. So labor & delivery it was. I sent my wife and our 9-day old baby home. That was hard enough for me; I can't really imagine what it was like for my darling to be home alone, suddenly a single parent to a brand new baby, worrying about me in the hospital.

They gave me an EEG and an EKG and I don't know which was which; one was a pretty quick monitoring onto a strip of paper, the other an extensive ultrasound of my heart. The person who did the ultrasound was a tech, not a doctor, so couldn't give me any answers. I kept hearing odd shlub-shlubs and wondering is it meant to sound like that? really?

It was a long, long night. They gave me a high dose of diuretic, which was meant to help my lungs and probably my blood pressure. Over the next 12 hours I peed out 6 liters of fluid. So I peed. I watched TV. A M*A*S*H marathon got me through 2-5 a.m. I cried. I thought about dying. I thought about how badly I didn't want to die just now. Every time I dozed off the monitors would start binging that my heart rate was too low. I pumped a few times with a breast pump: not enough, not nearly often enough, but I didn't know that at the time (see My Long Lactational Nightmare, coming soon). I snorted oxygen. At about 4 am a nurse came into check on me and found me crying; she asked me why and I told 'er. I'm scared that I'm going to die, I said.

Nonsense, she said, cheerily measuring my prodigious urine output. If they thought you were going to die they wouldn't have you on this unit.

That bit of logic made me feel infinitely better. It made sense. They didn't want patients falling over dead in Labor & Delivery. If they thought I was going to die they would've sent me somewhere else. It was just those damn binging monitors that made me think of too many medical dramas.

The long night finally ended. My liver function had gotten no worse during the night. A cardiologist swanned in for a consult and told me, in short, that my heart looked fine and he had no idea why my heartrate was so low. I wasn't comforted that he didn't know, but I was comforted that he didn't particularly seem to care. Pregnancy is weird, he said. It'll probably go away.

He was right. They discharged me that evening; I could've stayed, but I didn't want to. After losing all that water, I looked and felt a million times better. I could breathe, I could move, my ankles looked like my ankles, and my overwhelming sense of doom was receding. By the time I left the hospital my pulse was in the 60s.

My milk supply was also almost gone, but that's a story for another day.

Birth story (long, like the labor)

2009-12-02T08:13:00.000-08:00

Friday: 38 weeks, 4 days.
I'm at work, trying to finish a project. Trying, but not succeeding. Can't concentrate. It's supposed to be done by Monday. Never mind, I'll bring it home and finish it over the weekend.
(insert laugh track)

Saturday: 38 weeks, 5 days.
6:13 am. I awake to the sensation of a gallon of warm water being dumped over my thighs. I utter the selfsame words that I said to my darling nearly nine months previously, when I realized that there were two lines on the pee-stick.

"Holy shit!"

She wakes and sleepily gropes over to my side of the bed. The water is gushing out of me. My amniotic fluid has been on the high end all through the pregnancy, and yes, there sure is a lot of it.

"There's not that much," she says. Then she reaches over another few inches. "Oh."

The bed is soaked.

She gets up, grabs a towel, I stick it between my legs and shuffle to the toilet, where I sit for a while and listen to the fluid cascade out of me. Holy shit. Holy shit. There will be a baby, today. I thought I was going to go late. Don't most first pregnancies? I thought that I was going to go into labor before my water broke. Almost everybody does. Yeah, well, not me.

We call the OB at around 7. Tell him there's water, lots of it, clear.

"Lots?"
"Yes, lots."
"Come on in, then."

What? Now? I thought we were going to have to struggle to stay at home as long as possible. That's the secret to a good labor, everyone says; don't go to the hospital until you're well underway. Stay home, take warm showers, meditate, listen to good music, take walks. Run around and finish packing that hospital bag that's been half-packed for the past two weeks. CDs, snacks, focus objects, all the niceties.

But nooooooooooooo. Nope, we're meant to go in nownownow.

Commence rushing around, rounding up the last minute packing needs, stripping and remaking the bed so that our dog- and house-sitting friend will actually have someplace to sleep. Luckily, we sleep with several layers of sturdy mattress pads.

Call said friend, who will also be our ride to the hospital. She immediately grasps the whole "there will be a baby soon" concept, with which I am still struggling.

9 am. Arrive at hospital. It's blessedly quiet. They take my insurance and intake information and tell me to have a seat. I lean forward confidentially.

"I'm leaking."

It's not long before I'm called back.

9:30 am. I'm triaged. I'm dilated two cm,which is pretty good considering that I'm only having very sporadic contractions. I explain that, although I know I'll need an IV (being Group B Strep +) I'd like to be able to move around as much as possible. The nurses shake their head and tell me that the doctor will never go for it.

The doctor on duty is someone I've never met before. He turns out to be an absolute peach. Young, almost definitely Jewish, almost definitely gay. I can work with this. He tells us that we'll likely be having a baby by 6pm. I like that thought.

Since my labor isn't well established, we decide to give it a while to see what happens. I'm warned not to move around too much, because in the presence of the definitely ruptured sac it will apparently increase the risk of cord prolapse, which is a real emergency. Oh. I'm a bit bummed about this, but rolling with it.

We hang out, listening to music, chatting gently, for the next five hours. The contractions are getting stronger, but failing to establish any regular pattern. I sit in various beatific yoga poses. The nurses come through and compliment my composure, and I feel smug and sassy.

2:30 pm. Contractions still aren't regular. I'm very aware of the enormous 24-hour clock hanging over my head, in red blinking digits. 24 hours is all the hospitals give you after your water breaks, lest your open flapping cervix let in infection. Mindful of this, I agree to some Pitocin to hurry things along. No, thanks, I'm doing so well, I don't want an epidural.

(laugh track)

They keep jacking up the Pitocin, and things get more and more painful. I breathe, I swivel my hips, I moan deeply, I keep my hands and my mouth soft, I do every freaking thing I can remember from my careful perusal of Ina May's Guide to Childbirth. None of it helps much.

8:00 pm. By now I'm exhausted. Pain is draining. I ask for a shot of Stadol or whatever the hell narcotic they've got going. If I can only get some rest, maybe I can cope a little better.

For the next hour I drift in and out of a drugged haze. The shot doesn't do much for the pain of the contraction, but it puts me to sleep in between them. This means the conscious experience is, effectively, of one long contraction. I ask what time it is and 45 minutes have passed. It passed quickly, but unpleasantly. Fuck this all for a game of soldiers.

9:00 pm. Epi freaking dural, please. I've hit my limit. Unfortunately, the anesthesiologist does not magically appear. It'll take him a little while. The next hour -- the hour after I hit my limit -- is one of the longest of my life. Except...

10:00 pm ...for the next hour. Still no anesthesiologist. The nurse calls to check. Oh, what? He didn't get the message? HAHAHAHAHAHAHAHAHAHA. By now I am holding back not at all, on the principle that the louder and more obnoxious I am, the faster they will get me pain relief. The nurse is looking unhappy with the situation; I have little sympathy to spare for her. I'm not typically a megabitch, but my personality is pretty much shredded by the pain. My own darling love hovers, eyes tender and dark with concern. "Sit down", I snap at her. She holds my hands.
"I believe that if you were on a desert island, you could do this."
"If I were on a desert island," I spit out, "I wouldn't have Pitocin on board."

11:00 pm .A full two hours after I had zero desire to do this anymore, the anesthesiologist arrives. He strongly resembles Tuvok. I find this comforting, although not as comforting as I find his cart full of narcotics and anesthetics.

A small prick from the needle. Some other pricks that I totally don't remember because who cares really. Then, suddenly, everything started to get better. There was a bunch of other stuff involving my blood pressure and my sweetie asking "is it supposed to be that low?" and the nurse saying "no, no it's not" but again, who cares. The important thing is that it does not freaking hurt any more.

Eventually they work out the blood pressure thing, whatever, cover me up with my quilt and I pass out.

Sidebar: one of the best things I brought with me to my labor was a quilt from our bedroom. It was untterably comforting to have that over me in the midst of the cold strangeness of a hospital room. Plus, the hospital blankets sucked. It is worth noting that the quilt we brought, we brought for my sweetie, but she yielded it to me. Next time: two quilts.

2:00 am. My poor sweetheart is asleep on the window seat, under one of the sucktastic hospital blankets. I'm staring at the contraction monitor. I'm not dumb. I know that what I see is not great. The contractions are strong, but they're still not regular. I stare at the monitor for a while.

2:30 am. I buzz and ask to talk to the doctor. If I'm cruising for a c-section, we might as well get it over with. The nurse comes in. I also mention to the nurse that I'm feeling an increasingly uncomfortable amount of pressure. "That's going to happen," she says, and I get the feeling that she thinks that I'm a wimp who thinks that all discomfort should be eliminated by the magic epidural. "Humph," I think.

The doctor arrives. I tell him my line of thinking about the contractions and the c-section and the getting it over with.

"I'll check you and we'll go from there," says he.

He checks. Turns out I'm fully dilated. Turns out that the strong, uncomfortable pressure I was feeling? That's the urge to push . That's having a baby. Who knew!

"You don't need a c-section," he says. "Time to start pushing!"

The mood in the room sharpens and lightens all at once. We're not waiting for something to happen anymore. Something is happening. I've been exhausted and dogged by a creeping feeling of dread, but suddenly I've got energy. Here we are! The finish line is in sight! We're going to have a baby soon!

Things get rearranged, our Qwan Yin statue gets replaced by a tray of instruments. The baby's head is right there. First time babies usually come after two hours or so of pushing, but his head is right there. This shouldn't take long.

(laugh track)

The nurse grabs my leg. My sweetie grabs my other leg. I can actually move quite well; Dr. Tuvok has given me a magic epidural which has eliminated the pain while largely preserving my ability to move. Whoopee!

Now, I thought I didn't want directed pushing. But when the time came I was very grateful for the involvement and the structure that directed pushing provided. I didn't have to worry about anything except for pushing when I was told to push. They chanted. I pushed.

...for two and a half hours.

5:00 am. By now I'm flagging. I've been giving it my all for two and a half hours. Really my all, because I really want this baby to be born. I really want this to be over. I'm trying my hardest, but I know that I'm running out of juice.

The doctor comes in, checks me. The baby's head is right there. Exactly where it was two and a half hours ago. Furthermore, the baby's starting to have some decelerations. I know, right? After all this, who could blame him? "We're going to get him out fast," says the doctor. I stare at him in disbelief. What am I going to do, push harder?

The doctor leaves the room. He's got to see to someone else, but he'll monitor the contractions and baby's heart rate via his magic computer screen. We are left to... push. Which we do. Nurse checks again. Baby hasn't budged. Despair is stealing into my heart. Perhaps this baby will never come out. Perhaps I will never leave this room. I am eager to move things along.

5:45 am. "I can support my weight," I tell the nurse. "Can I squat? It might move things along." After all, Ina May freaking loves squatting. She has line drawings of various indigenous peoples emitting various indigenous babies from various squatting positions.

The nurse, who may have read Ina May's book, is surprised and pleased. She approves of squatting. She helps me up. I squat, I push, and bam, baby has the worst deceleration yet. No squatting for me!

It's enough to get the doctor's attention. Another nurse comes banging through the door dramatically. "Stop pushing, turn off the Pitocin." We all know what it means.

I burst into tears of relief. I don't want a c-section but I really, really want this baby safely out of me, by whatever means necessary.

5:45 am. My sweetheart dons a blue bunny suit. She's wearing her blue rimmed glasses and looks pretty. She's told that she has to pile up and magically dispose of the ridiculously huge pile of belongings we brought with us, the pile that it took three people to bring into the room. I have no idea how she manages this, but somehow she does.

They take me to the OR and jack up my epidural. By then I'm shaking like a leaf and feeling generally crappy. They're pumping something into my IV, something that has made me more or less forget what I'm there for. Drifty, drifty. I'm not upset, though. Nothing is my problem; all I have to do is lie there and someone else will take care of things. Only now someone is pulling at my midsection really hard, and also sitting on me. My body jerks on the table, and again, and again. WTF? Luckily, I don't much care.

6:07 am. And then a crackling cry slices through the air, and my fog. It's a baby's cry.

A baby?

A baby!

I'm here to have a baby! That's a baby! That's our baby! He's been born! There's a baby!

I burst into tears, for the second time.

Sweetie looks at me, visibly torn. "Go, go!" I say. She returns, after not very long, I think. I ask his Apgar scores; 8 and 9, she says. I ask several more times, forgetting the answer each time. She tells me again and I'm glad each time.

Okay, I'm exhausted, although less exhausted than I was then. I am going to post this as-is and then have my sweetie check it for accuracy. I suspect that half of my memories are just wrong.

thanksgiving

2009-12-01T01:29:00.001-08:00

nothing which we are to perceive in this world equals
the power of your intense fragility:whose texture
compels me with the color of its countries,
rendering death and forever with each breathing
(...)

Our son was born four months ago, born squawking lustily despite a small amount of drama. I could say that I've been speechless with gratitude, or exhaustion, or joy, and they'd all be right but also wrong. I've simply been speechless and I'm not sure why. But here I am.

I once said that infertility was like being on the outside of a locked door, a door that opens for other people but not for you. And that nothing that anyone says to you can ever change the fact that you are on the wrong side of that door, and have no idea if you'll ever be able to pass through. I once said that I'd keep patiently trying to pick the lock until I got through, someday, someday, somehow, but more than once I suspected that I'd never have anything to show for it but bloodied fingers.

Here, on the other side, I press my hand to the door and say thank you. I know I got here through luck, not skill, and I will try to pay for it by being thankful.

Our boy is bright and beautiful. There have been some struggles (a.k.a. My Long Lactational Nightmare) but he is growing strong, and this marvelous boy has taken two callow flibbertigibberts and somehow made mothers out of us.

Birth story and more later; at my current breakneck rate of posting, expect something before the next Presidential election.

Deepest thanks to all who have followed along and given me your presence and encouragement throughout this journey. It's meant a tremendous amount to me.

Now back to bed, where my wife and my own wee lad await.

37 weeks, 1 day

2009-07-10T09:01:00.000-07:00

A bullet style post is always a good way to overcome the not-posting inertia. I think the bullets relieve me of any sense that I must make the whole thing hang together into some sort of coherant narrative. Either that or years of staring at contentless Powerpoints has reminded me that, if you have bullets, you don't need meaning.

So:

37 weeks rocks. I know there are no guarantees, but having made it this far puts a spring in my not-so-nimble-anymore step.
Being an insulin-dependent diabetic (that's "A2 GDM" as it's fondly known at the hospital) I now get twice-weekly non-stress tests and once weekly sonograms. This is a beautiful thing for the paranoid pregnant lady. I mean, throughout this whole pregnancy I've been convinced that our fetus is in terrible terrible danger and concerned about the fact that no one else besides me is panicking, probably because of some meaningless datapoints like "all test results are normal" and "low risk". I'm not happy that I'm high-risk now, but I must say it more closely matches my feelings. Now that the doctors are watching with some greater sense of urgency, I'm about 1000% more relaxed.
I am, officially, medically, scientifically speaking, huge. As in measuring 42 weeks, 5 weeks ahead. Strangely, Little Guy is measuring absolutely normal; 65th percentile for weight, everything else measuring within a week. My amniotic fluid is normal. I asked the OB why I was so huge, then. She shrugged and said "some women just get huge." OK then!
Since I am freaking huge, everyone naturally assumes I am about to give birth any minute. At the hospital yesterday *five* people commented as I was walking down the hall. Samples:

Stranger: Today must be the day!
Me: Nope, three weeks left.

Stranger: Not much longer now!
Me: Yes, three weeks isn't long.

(as I trundle slowly down the long hall)
Stranger: You gonna make it?
Me: Just rollin' along.

And, the oddest:
Stranger: Lucky you (in a downbeat, rueful tone)
Me: pause as I parse this What?
Stranger: I said, lucky you.
Me: finally figure out that she's being sarcastic It could be a lot worse!
Afterwards I wished I'd just sincerely said "Thank you. I do feel lucky." But I also didn't want to make her feel bad when she was just being sociable. I don't know. If anyone else says that, I'll be prepared.
I'm positive for Group B Strep. This is not uncommon, and all it means for the delivery is that I will have IV antibiotics. I still wish I weren't. I was hoping to avoid the IV and go for a heplock, but that won't be possible.

29 weeks: an upbeat post about diabetes

2009-05-18T12:35:00.000-07:00

Things I like about having gestational diabetes:

The snacking. Seriously, I love to eat. I am now mandated to have three snacks as well as three meals a day. For the health of my baybeeee. I always have another meal to look forward to really soon. The eating starts the minute I get up and have breakfast, and does not end until my bedtime snack. I was born for this task.
My glucometer. I love gadgets. I love pink gadgets. I love things that monitor other things.
The ritual of checking my blood sugar. It seems very magical. How many rituals nowadays include washing your hands, laying out your tools, and then making yourself bleed?
I am now of slightly more interest to my busy high-risk OB.
Abovementioned OB asking me how I was coping with the insulin shots made me feel pretty butch, since they are absolutely nothing compared to three rounds of IVF with injected IM progesterone.
I had ultrasounds at 12 and 18 weeks; I wasn't supposed to get another until 36 weeks; on the strength of the GD, I think I've managed to talk my way into one at 32 weeks. We are quite wild to see him again.

There are other things about it that are not so fun, but I'll leave those as an exercise for the reader.

In other news, 29 freaking weeks! I am so glad to be here, at a place where the little guy has a decent chance of coming out okay even if he's evicted early. My goddaughter and her twin brother were born at 27w3d and, although they came through amazingly well, gave all of us (but especially their parents) some terrifying times. Every day that passes is a gift.

26w3d: lilacs out of the dead land

2009-04-30T14:15:00.000-07:00

All month I've had the slightly itchy feeling I'll be glad when April's over.

Today is April 30, the one year anniversary of the end of my first pregnancy. I mean, it probably isn't the anniversary of the end; April 30, 2008 was a Wednesday, and the pregnancy probably ended the Thursday prior, which I guess would be April 24. But it was the end of my thinking I was pregnant, and that's the important part, as anyone with a blighted ovum or headless fetus could tell you. It's not what's there. It's the end of the dream, of what you want to be there.

The Maryland Sheep & Wool Festival is this weekend, again. We were planning on going last year, but by Saturday I was spotting and by Sunday I was bleeding and cramping but good. This year? I don't know. We love the Sheep & Wool Festival, but these days my feet get sore really fast. And we've got stuff to do, lots of stuff, tiny-guy's-room stuff.

I'm... I don't know. Breathing quietly through this day. The little guy has given me several reassuring thumps. If he were born today, he'd have about a 75% chance of survival and a 60% chance of escaping with no or mild neurologic disability.

The time between last April 30 and November 20 was the darkest I've ever had. Is it depression if it's about something real, and it goes away when the real thing goes away? Because since November I've had so many waves of realizing what a weight I was under during those eight months, how heavy and dark the hours were, how good it feels just to feel good, how light it feels not to be afraid of quiet time and my own thoughts. My joy has been so palpable not just because of what I have, my happiness and excitement for our life with this upcoming little boy. It's also about the lifting of pain. It feels so good when it stops.

Can't help but think about what this whole experience has meant to me as a person, as a parent. I am not at all convinced that it has made me a better person, but it has made me a different person.

This baby I am carrying, this tiny guy, my little fellow, our son: he is not better than our little solstice baby, the boy or girl or nothing that I was carrying, due December 23, 2008. But he is different. He is someone else entirely.

And the life that we will have together, kinehorah, is not the life that due-on-December-23-me would have had with Solstice Baby. But this is the reality we have, and I think it is going to be pretty damn wonderful.

I'm sorry that I couldn't be with your four-month-old self, little Solstice Baby. I really, really wanted you. But you couldn't be around, and that reality couldn't be ours. Now I am so very glad to be here with our little guy, our summer baby.

I thought that the solstice due date seemed so right: I was born in November, I love the fall and early winter. It's a time of year when I'm comfortable and happy. Summer makes me fussy and restless, trapped in our few air conditioned rooms, constantly scuttling away from the oppressive heat. But the baby we got is a summer baby. He is his own baby, and this will be his time, whether I like it or not. Maybe he will love the summer. Maybe he will love sports, or bagpipe music, or a thousand different things that I cannot even fathom being attracted to. He came along on his time, not my time, and he will be his own baby, and then, kinehorah (I have said that more often during the past six months..) then he'll be his own child, his own boy, his own man, someone I cannot imagine, someone I could not even make up.

I can't wait to meet him.

24w3d

2009-04-16T14:22:00.000-07:00

Hallo, internets!

I suppose it's kind of boring the way I start off all of my posts with "forgive me, internet, for I have sinned. It has been {insert staggering length of time} since my last post."

So I won't do that this time. Except that I kind of just did.

The news in a nutshell:

Things are good. They're really, really good. Can't ask for much more. My blood pressure has been low; a second-trimester dip is normal, and I got it. It will undoubtedly start to creep up again soon, when I enter my third trimester (kinnehorah-knock-wood-god-willin-and-the-crick-don't-rise).

We are having a wee boy. A boy! The 18 week scan was a story unto itself, which I'll type up soon. Suffice it to say that there are indeed minuscule boy parts attached to the minuscule boy. After reeling and having a few minutes of whaaa? what do I know about boys? we have plunged into an enthusiastic study of baby-boy-hood. And I figure anything else we need to learn we can google.

I am continuing to be enormous. We thought that maybe I'd plateau and end up a more normal size. Nope. My combination of wicked shortwaistedness + unimpressive abdominal muscles = spherical me. Of course I'm just as delighted as most people who have spent two years willing themselves into precisely this state would be. I am starting to feel a bit... unwieldy. My darling darted away from me in the supermarket the other day to go and grab the peanut butter (my peanut butter, that I craved). As I saw her slim, graceful frame slipping 'round the corner into the next aisle, I felt an impotent rage. I lumbered, huffing, behind her. "Don't just run off like that," I snapped irritably. With her usual vast good humor, she assessed my rolling, panting figure, petted me and gently said "okay, I won't."

Hey I got a new layout. In case there are any of you who actually aren't reading this through an RSS feed... I dunno, I'm a bit conflicted. I absolutely love the look of it, but is it less readable? Please feel free to weigh in, I won't be offended.

This day in history. One year ago today, I had just gotten the results of my second beta for my first, ill-fated pregnancy. They weren't great but weren't awful; 74 at 14dpo, with a doubling time an unimpressive 67 hours. I was heading into the really painful part of the OHSS.

OHSS symptoms: completely miserable. Can't walk, eat, or breathe properly. My stomach looks like I'm six months pregnant. In fact, when I got my blood drawn today (for the second time today, third time this week) the technician thought I was six months pregnant.

One year later, here I am, actually six months pregnant. The word "grateful" does not suffice. I am not just full of gratitude, I am saturated with gratitude. I have been pregnant for 157 days (okay, technically, for five of those days the lab down the street was pregnant). Every single freaking one of those days I have felt again the pure shock of gratitude at my own outrageous luck. Even more so, now that we're (just) past 24 weeks, and each day that passes represents a tiny incremental increase in our guy's chances of survival.

I would never say that the two years, three IVFs, miscarriage, untold number of dollars (I refuse to calculate it) and loss of so many other things from my life were "worth it". But I do wonder if, had this pregnancy not been prefaced by all of the above, I would feel my gratitude so very keenly and continuously.

I've had some severe mood swings, and when I say "severe" I mean "full on snotty hysterical sobbing." Usually accompanied by my wailing "I don't even know why I'm cryyyyyyinnnnnngggg." But even when I am full of dread and misery I am strangely aware that This is not real. My reality is happy. Soon I will be back to reality. And you know, I always am.

13w3d rambles

2009-01-29T11:52:00.001-08:00

I'm sorry for leaving this blog for so long, long enough that I've gotten a few kind email inquiries as to whether or not Everything is Okay.

Everything is Okay. I don't know to what I owe my powerful blog constipation, except perhaps that I am just sitting here quietly, gratefully, afraid to attract the envy of the evil spirits. We Jews are an extremely superstitious lot.

First trimester screening
Last Monday we had our first trimester screening. We got to see the wee babe on an ultrasound; for the first time it looked like a human being, not a blob in a snowstorm. That was a powerful moment, its power dimmed only slightly by the fact that omg I have never had to pee so badly in my LIFE. (note to the uninitiated: before ultrasounds, especially early ultrasounds, a full bladder helps to lift the uterus into better viewing position.) It was especially funny when the fetus would not assume the correct position and the ultrasonographer was thus forced to grab my ample belly and jiggle it forcefully. She was very sweet and apologized profusely, but whoah.

The ultrasound measurements are combined with bloodwork measurements to come up with a set of odds for Down syndrome and other chromosomal disorders. Our DS odds were, before the screening, 1:258; with the screening information, 1:5141. Other chromosomal disorder, baseline risk 1:452; after screening, 1:9021. These odds mean that we'd be crazy to do an amnio (miscarriage risk roughly 1:250), so we won't.

I am very grateful that there was such a noninvasive test that gave us the information to make this decision. Having the screening was a no-brainer for us, and there was no doubt that, if the odds had come back in a suggestive range, we'd have had an amnio. There are some disorders for which we'd choose to terminate and some for which we wouldn't, but in any case, I am a person who has to have all the information that is gettable. Sometimes I wish I were a take-it-as-it-comes person, but I never will be anything but an exhaustively-researching person. Sometimes this has served me well and sometimes it hasn't.

Work
I told my boss and my officemates. Only one person blurted out "How?" Everyone's been very sweet and supportive. Now that everyone knows I can stop wearing the baggy tops I've had on for the past ten weeks or so. I've been going around in plus-sized tops, which merely looked oversized and unflattering. Now I'm in properly-sized maternity clothes.

Wardrobe
Yes, I know that 13 weeks is ridiculously early for maternity clothes, but the sides of my pre-pregnant pants are not even in shouting distance of each other. Yes, I am enormous for 13 weeks, even now that my swollen ovaries have receded. No, I don't know why, except that I'm extraordinarily short-waisted and I guess it has nowhere to go but out.

On the subject of maternity clothes: must. stop. shopping. I can't stop buying them. Something in my leathery and scarred infertile soul softens and heals a little with every piece I buy. Luckily my shopping tastes run to thrift store and clearance racks, so I'm not spending too much. But I really have to stop at some point.

Most recent Value Village find: a pair of "H&M Mama" black combat trousers. Adorable and so comfy! I have no idea where it came from, as there are (sadly) no H&Ms that carry the Mama line anywhere near me. But for $3.98 they were all mine.

Doppling
In other news: I bought a fancy-ass doppler real cheap over Craigslist, and have been restricting myself to doppling every other day. Doppling is a mixed blessing because

I am blessed with a generous allowance of abdominal padding. I don't know if that's why, but I find the wee one extremely hard to locate. At 13 weeks we should be finding it no problem, but in fact there's always a sweaty and tense 10-20 minutes, and a good 40% of the time we can't find it at all.
Not finding the heartbeat stresses me out.
Finding it, on the other hand, is a glorious high.
Every time I do it my darling feels it necessary to yell "don't dopple me, bro!" and then fall over in gales of laughter.

On the whole the calculus is clear, because not finding it doesn't stress me out nearly as much as constantly worrying about missed miscarriage would. Every time I've not been able to find the heartbeat I've found it the next day or later that same day.

The body
Physically I am still reeling with gratitude about what an easy first trimester I've had. No puking. Minimal queasiness. Fatigue, but not crushing fatigue. Moodiness, but not -- oh, okay, sometimes crushing moodiness, but it's been pretty transitory. My blood pressure started in early on the second-trimester dip, so my monitor is showing lovely numbers that it hasn't shown in a long time.

What else? The OHSS is pretty much gone and has been for a few weeks. The tummy is no smaller, but it's differently shaped. Before it was a sort of diffuse swelling. Now it's higher and pointier. When I tense my abdominal muscles it gets very pointy and odd-looking indeed. Of course I do this like ten times a day just because it's so cool.

The mind
I know a lot of people really hate the expression so beloved of formerly-infertile-pregnant- bloggers, NBHHY -- Nothing Bad Has Happened Yet. It doesn't annoy me, though. I hear it with a wry smile, and the knowledge of how sometimes merely acknowledging a lack of badness seems like an invitation to destruction.

I am relaxing. I am learning to hope. And I am so grateful for all the people who have held onto my hope for me, when I was too scared to hold it myself.

wow.

2008-12-31T09:53:00.001-08:00

my sister just called.

she's pregnant. she doesn't know how far she is, being one of those crazy heterosexuals. between 6-10 weeks. she thinks probably 8 or 9.

wow.

9w ultrasound

2008-12-30T14:01:00.000-08:00

Yesterday was the 9w ultrasound, our graduation from the RE. The whole experience was less dramatic and less traumatic; I knew to tilt my hips immediately, thus avoiding the OWOWOW drama.

In short: there is a critter in there, it is the right size, it has a heart and (I am assured) a head. My sweetheart and the doctor both said they could see limb buds, but I think they were lying.

Here's the ultrasound, if you like that kind of thing!

It was best described as "fetus in a snowstorm". The enormous round thing off to the left (far bigger than the fetus or sac) is an ovarian cyst... doc thinks it should start to recede in a week or so.

We have an OB appointment next Wednesday.

Yesterday I was just shaking and exhausted and happy after having had every muscle in my body tense for a week or so, out of fear of the 9w ultrasound. And now..?

If I'm happy, is that arrogant? Does that assure that something's going to go wrong to knock me out of my smugness? I am haunted by this happy chirpy post I made the day before I found out that the pregnancy was over. Logically I know that the happy post didn't make that happen, but my brain is a small primitive animal that links proximal events and sucks at figuring out causation.

If I'm scared, is that ungrateful? So far there has not been one single thing wrong, not one result for me to point to and say "meh". I haven't bled a drop. What more do I want, really? Women would kill to be where I am right now. Shouldn't I just shut up and enjoy it?

I'm covering all my bases by having wild mood swings, from elated to terrified. I'm both gratefully happy and humbly frightened! Of course, that also means I'm ungratefully frightened and arrogantly happy. Welcome to my brain. Over the lintel, in old English letters, it says YOU CANNOT WIN.

I do feel like I can be grateful for one thing: I feel pretty damn good. Morning sickness has been minimal; some waves of low-level nausea, but no pukin', not even close. In fact, I'm eating like a horse; I'm hungry every hour or two. Some waves of exhaustion, but mostly I'm just enjoying the fact that I slip off to sleep easily at 10pm, as my non-pregnant self struggles with insomnia. My breasts are sore, but they don't bother me unless I poke them. Other than the swollen abdomen I'm having a picture-perfect time. This scared me when I thought it meant nobody alive in there, but now that I know it's possible to feel this good and have a good-lookin' fetus I'm grateful for how much I've lucked out so far. My body really seems to like this just fine. GF says I look fantastic*, and I'm inclined to believe her.

And that's the 9w1d story.

Love to all of those who surrounded me with warm words and thoughts on my last post. I love knowing that y'all are out there, and that this tiny scrap of proto-humanity already has friends.

^*She may have been looking at my mammary glands when she said that, I don't rightly recall.

7w ultrasound

2008-12-15T15:42:00.000-08:00

I will not tell this story with any sense of drama, because I hate it when news is buried.

So: we have a heartbeat. We have one appropriately sized embryo with a heart fluttering at the right sort of rate.

Now the tiny bit of story:

Of course I've been worrying steadily for the past ~~week~~ few days. After a fitful night, I hit the worrying-crescendo this morning. The doctor's visit started out differently, because now everything is different. I've been there for a thousand ultrasounds -- pants off, up on the table, see ya later. This time there I got my weight and blood pressure taken (rather ineptly -- the med assistant was clearly asleep when they taught "how to get an accurate blood pressure reading". No, the patient's arm should not be dangling by her side) and gave a urine sample. Then I waited on the table, cross-legged under my modesty drape, trying desperately to remember my yoga breathing. I watched the girlfriend knit and held her ball of wool, which was very soothing.

Finally he came in and I eagerly scooted down on the table, knowing that in a few seconds my suspense would be over. But it was not to be because OW OW OW OW OW OW OW. It hurt like hell. Even when I had 25 mature follicles a transvaginal ultrasound never hurt like that. I yelled and I think at one point I said "YOU HAVE TO STOP THAT RIGHT NOW" (he did, because he's a nice man and good like that). We tried three times and it hurt so much that I just couldn't lie there. Turns out that because of my swollen OHSS-y ovaries, my uterus is now located somewhere around my chin. My left ovary is so large that it is behind my uterus, pushing it forward into a very unhelpful position. This also explains why I look five month's pregnant still.

So everyone in the room is standing there, a little appalled I think, and he decides to try the abdominal ultrasound. And he gets a picture that, to him, looks like a flickering heartbeat. I am barely used to reading the vaginal ultrasounds, and what he was able to get on the abdominal looked like nothing to me. But he said "there's the heartbeat" and of course I burst into tears, which must have made the ultrasound jiggle, but I couldn't tell because I was crying. I pulled it together pretty quickly, though, and asked if we could give the transvaginal another go.

This time I squirmed down and, on some instinct, tipped my pelvis up (that's "bridge" to you yoginas). And this time it worked and was no more that somewhat uncomfortable.

Um, it's also possible that -- although it didn't feel that way to me -- my incredibly tense muscles were incredibly tensely spasming for the first round, and that once I got some good news they relaxed enough for the ultrasound to work. But I prefer to think that it was my clever pelvic tilt.

Anyway. He took four CRL (crown rump length) measurements; 6w4d, 6w6d, 6w6d again, 7w1d. All plus or minus two. Even the worst of those wouldn't send me into a frenzy. He eyeballed the heart rate and said it looked like around 130 to him, which is perfectly normal.

I am exhausted and I am so, so grateful.

I keep starting posts...

2008-12-12T12:47:00.000-08:00

and then abandoning them. There's nothing I can type that doesn't feel like a jinx.

I'm just sitting here, very quietly, making the time pass until the ultrasound on Monday.

24DPO beta

2008-12-04T12:49:00.000-08:00

3838.

Doubling time: 49.7 hours.

There's no progesterone because I wasn't due for another beta. I've been cramping a whole lot (no spotting though), and my OHSS suddenly got all better, and I was utterly convinced that I was miscarrying again. So I fished out one of the many beta lab slips from my last miscarriage (m/c betas don't care about progesterone). I just waltzed right in and gave it to lab and got my blood sucked. I figure what are they gonna do, put the blood back? Not tell me the results?

Anyway, the take home messages are

As of 8:30 Thursday morning, I am still pregnant and everything is still in normal range;
I have truly never been crazier than I am right now.

Really. Everyone else must be feeling really, really sane right now because I am using up all the crazy.

I'm going to go home and sob with relief and bury my head in Animal Crossing. I figure this set of results will give me 24-36 hours of relief before the crazy starts up again.

21DPO/16dp5dt beta

2008-12-01T12:35:00.000-08:00

1406.
Progesterone: 321
.
Doubling time: 45.28 hours.

For those for whom these numbers do not immediately translate: the all-important doubling time is good at less than 48 hours. Not okay, good. The overall number is normal, just a titch off the mode. The progesterone is crazy, crazy high -- first trimester numbers are supposed to be around 15-50; by the third trimester it can reach 200. I haven't been able to find much information about what "ridiculously high progesterone" means, but the doctor doesn't seem concerned... probably it just means that I had really a lot of follicles, which have left behind them really a lot of corpus luteum-ses, each one of which probably thinks it's the only one and so is pumping out P4 as fast as it can. Bless their little yellow hearts.

Me: relieved, grateful, still scared, officially pregnanter than I've ever been.

How my family took it...

2008-11-28T15:35:00.000-08:00

Well? They're excited? They were stunned? They're calling me every day? My mom read up on OHSS and quizzed me to make sure that I didn't have a severe case (I don't)?

I have such mixed feelings about having told them. Part of me wants to bask in the attention and approval, which I am finally receiving in buckets. The last thing I did that they really approved of was 12 years ago, when I enrolled in grad school. I dropped out a few years later, became a lesbian, it's all been downhill since then. They love me, and they try, but I can tell that they have to work really hard to be supportive of me and my choices.

I get tolerance, and I'm grateful for that. I don't get offended when they discuss, in front of me, what gift can possibly be large enough for them to give my sister and her husband for their upcoming 15th wedding anniversary (my darling and I have been together for 11 years, and no, I'm not holding my breathe waiting for a card). I reinforce them heavily every time they mention my partner's name or send her greetings or remember her birthday (which they have done two years running now -- major progress).

But yeah, I get tolerance. I don't get approval. Having it now is freaking me out a little, and maybe making me a little angry.

I didn't feel that I had much of a choice about telling them, since there was no way I could travel as huge and OHSS-y as I am. But I can't get past the thought: if I miscarry again, then not only will I be heartbroken but I'll have disappointed my parents.

In other news, keep staring at my taut abdomen. Whatcha doin in there, huh? Whatcha doin? Still alive? Gimme a sign, here.

11dp5dt/16dpo beta

2008-11-26T18:23:00.000-08:00

224.

Progesterone: 298.

Doubling time: 49.9 hours. Not rock-star, but well within normal range (as opposed to my last 14-16dpo set, which were barely within normal range).

In other news, I'm enormous, bloated and largely immobile thanks to OHSS. Accordingly, I had to cancel plans to fly up to Boston to see my folks for Thanksgiving, which I knew would disappoint them terribly. Accordingly, I told them why.

holyshitholyshititoldthem

it felt wonderful but so, so naughty.

just. I don't know. I'm sitting here very quietly, sipping my V8 and homemade electrolyte drink, trying to make peace with the hope that keeps flaring within my heart. It seems so very dangerous, but it simply will not go away.

9dp5dt/14dpo beta

2008-11-24T12:34:00.000-08:00

115.

Progesterone: 320.

Over the weekend I

peed on 1,214 sticks
convinced myself that the line was getting lighter, not darker
had weeping fits since it was clearly all over
gathered up all my peesticks and begged Her Indoors to hide them very, very well.

I think some of the leftover crazy from the miscarriage is bubbling over. I just can't help thinking of how high I was then and how fast and hard I fell. But that's the way of it, isn't it? There's no way to want something this precarious this much and not be in terrible danger.

I have been staring at the clock all day. These are the things I mentally rehearsed hearing:
Your results are back -- the beta was 8 and you can stop your medication.
The beta was 18
The beta was 26
The beta was 54

We're supposed to call for results between 3 and 4. At 2:59 I picked up the phone and the moments I was on hold I could have measured by the heartbeat pounding in my ears.

115 is a solidly normal beta. Not high, not low. Last time at 14dpo my beta was 74, on the low side, although not wildly so. 115 is a happy number. 115 is a healthy number. 115 is just fine.

In other news, no surprise, I have developed a mild case of OHSS. At least, I thought it was mild; when I went in to have my blood taken this morning, Inappropriate Lab Admin Asst took one look at me and said "You blowin' up again?" Me: "Looks like." Anyway, besides the OHSS, I feel pretty good. Not a lot in the way of symptoms except cramps, which don't concern me -- I figure it's just the embryo bedding down. No spotting at all.

Thanks so much for all of the good wishes and crossed fingers on my previous post. Really can't say how much it means to me that you are all out there rooting for us. I could never have anticipated the extent to which this has become a group project.

Next adventure: Wednesday's repeat beta. Since you all did such a splendid job with the finger-crossing for this beta, your next assignment is think doubley thoughts.

5dp5dt

2008-11-20T18:46:00.000-08:00

I'm grateful. I'm hopeful. I'm cautious, but... so far so good, right? Yeah. Ever since the brief time I was pregnant I've been missing this, longing to feel this again -- the humming, the sense of busyness within my body, strange and wonderful, explosive with possibility.

Right here right now I am so glad to be here again. Keep your fingers crossed for me, y'all.

2dp5dt: the roller coaster continues

2008-11-17T13:17:00.000-08:00

After the plunge from Saturday's embryo-quality news, I have been lifted up into the atmosphere again by the following news:

Eight of the remaining embryos turned into "very nice quality" (4AA or 4AB) by day 6 and were frozen! Eight! Eight! I expected to have nothing make it to freeze. And of course this is making me much more hopeful for the ones I have inside me. Maybe this batch of embryos are just slow but good-quality growers. That's okay with me.

Transfer day: another dose of mixed news

2008-11-15T11:49:00.001-08:00

Good: the spotting, which was only slight, stopped entirely!

Not so good: I had 16 good-looking embryos on day 3. As of today, day 5, I had a couple of mediocre-looking embryos. First round we transferred one 4AA. This time the best we could do was 2BB. No one knows why, of course.

We had such good results the first time that I was barely worried about the embryos between days 3 and 5. Since worrying is how I stave off disaster, obviously this happened because I failed to worry properly. This mistake will not be repeated.

It was pretty upsetting to sashay in there, full of confidence, and get the news. But just because the chances are somewhat reduced doesn't mean that they're zero; babies are born all the time from less-than-perfect embryos.

Well, it is what it is. It's all over now but the waitin' and the hopin'.

4 days past ER: mostly sunny with a few clouds

2008-11-14T09:43:00.000-08:00

Mostly sunny:
As of yesterday, the embryos were doing great -- 16 of the 19 were "doing well"; 8 of those were 8 cells grade 1. We're set for a transfer tomorrow. This is really really great.

Wednesday was my birthday, and it was nice.

A few clouds:
I've had slight cramping and spotting. I thought to myself "hey, nothing to worry about, it's so slight" but called the RE just to be safe. Apparently telling your RE that you're spotting the day before transfer wins: stat bloodwork, a pelvic exam, an ultrasound, an Estrace prescription at the ready, and the note that if you start bleeding harder to call right away and we'll cancel the transfer.

Erp.

I'm trying to stay cool. It could all be just fine.

Other slight clouds: the ultrasound showed some fluid sloshing around my abdominal cavity; although I feel okay, I haven't dodged the OHSS thing entirely. I'm to chug electrolyte drinks. Also, my good right arm vein is mostly used up -- guess it gets scarred after a while. The vein I have on my left arm is not very accessible, so if my right arm poops out they will have to start on my hands, which sounds unsightly and unpleasant.

And that's the news.

1 day past ER: all good news!

2008-11-11T06:54:00.000-08:00

Okay, this is just crazy.

It's Tuesday. As of last Friday I had five mature-looking follicles and we were still consdering cancelling the cycle and doing an IUI. As of Saturday, when I triggered, that number had doubled.

And as of Mondays' retrieval...

23 eggs. 21 mature. 19 fertilized.

19. 19. Where the hell did those come from? No one saw that coming. My doctor sure didn't, having carefully prepared me -- he was estimating 8-10, then revised his numbers upward to 10-15. I said I'd be ecstatic with 15 and happy with 10.

Of course there's no guarantee of anything, but the bigger the starting number the higher the chance of having multiple strong, healthy embryos.

The witches' brew of metformin - high stims - even higher stims - no metformin seems to have produced a bumper crop without making me sick as a dog in the process. As of today I'm sore and moving slowly, but I'm nowhere near the hit-by-a-truck shape I was in first cycle. I am lumbering to the bathroom all on my own, and it doesn't hurt to cough or, you know, breathe. I took three days off from work (vacation days, so I wouldn't have to have The Conversation) and I think that by Thursday I'll be in fightin' form.

Worrying will recommence tomorrow. Today I am just delighted.

Day 11: Trigger Day

2008-11-08T14:32:00.000-08:00

Almost all good news today! My ovaries are humming. A solid handful of follicles popped up overnight. We're now hoping for 10-12 total, much better than I'd feared.

Other good things: my birthday is on Wednesday, and today I went on a shopping spree and snagged the Wii Fit I'd been wanting, as well as a pile of Nintendo DS games. These should keep me out of trouble during any OHSS-related confinement. Which brings me to the only not-perfect thing, which is that my doctor wrote Get your electrolyte and protein drinks ready! on the bottom of my instruction sheet. Underlined. I take it to mean that he expects me to get OHSS again.

Well, we're reasonably prepared, and even if I do get it I expect the whole thing will be less traumatic second time around -- I'll be uncomfortable, but at least I won't be scared.

Oh! And when we were wandering around the mall, I saw this sculpture in the Pottery Barn window and was immediately drawn to it. I wasn't sure why -- according to the label it's a reindeer, and I don't celebrate Christmas and in fact have a slight Jewish-girl jealousy/aversion to Christmasphenalia. And the percentage of times when I walk by a store window, see something, and then go in and buy the thing in the window at full retail approaches zero.

But, as I was looking through the window, my darling reasonably suggested that this sculpture is in fact quite evocative of the Celtic stag-god Herne/Cernunnos. He's a powerful male fertility aspect. I bought the large one, with the leaves blooming from his antlers, and he's making me very happy. My eyes like looking at him, even though he's taking up half of the bedroom vanity.

I intend to hang necklaces on him eventually, but have been warned not to do so until I'm already pregnant, so as not to feminize the powerful male fertility aspect by making him look like a pretty pretty princess.

Update: I have triggered! I am now a ticking time bomb of superovulation! Whee!

Day 10: the good and the bad

2008-11-07T12:07:00.001-08:00

The bad:
At this point in the last cycle, I had 6 correctly-sized follicles. This cycle, even with more medication, I have 5. There is no way to know why my ovaries are so sluggish this cycle. For heaven's sake, on a lower dosage I got 21 mature eggs my first cycle. It could be the metformin, but I've never heard anyone else say that metformin ruined their response.

The good:
My estrogen is much, much higher than it was last cycle. This bespeaks of the possibility of lurking eggs. A couple more may well fatten up and surprise us. We're giving my ovaries another day to cook and cutting down the dosage.

Herein I enclose a table for my own record-keeping, enjoyment & convenience, because I find hand-coding HTML tables strangely soothing:

	E2
	Cycle 2	Cycle 3
Day 4	134	154
Day 6	445	491
Day 8	910	1401
Day 10	1938 (trigger)	3226
Day 11 (trigger)		4065 (trigger)

Of course, this also means that the risk for OHSS is going back up, but

It's less likely with so many fewer follicles, regardless of the E2;
I do not care.

Another scan tomorrow, likely trigger tomorrow night, for a Monday retrieval.

So that's the news. On the whole I'm feeling much much happier than I was a few days ago, when it seemed that even pumping up the dose wasn't doing anything to make this cycle different from last. At least things are moving. Or at least I'm high on estrogen.

Day 5 of Stims: not so good

2008-11-02T09:01:00.000-08:00

My E2 was pretty low on Saturday, as low as it was last time with my "poor response" cycle, despite the higher dose of stims. It must be the metformin.

We raised the dose and I quit taking the metformin. If I have <10 follicles on tomorrow's scan we'll cancel this cycle and consider converting to an IUI. If you know anything about the issues here, you know that this would be a hideously hilarious choice for me.

Most people would only cancel a cycle with <5 follicles, but this is my last chance, my last insurance-covered cycle. I want it to be everything it can be. I don't even care about OHSS any more. I just want a big old crop of eggs.

I will admit that my first thought about canceling the cycle and trying again was oh crap, not more birth control pills.

IVF #3: Day 3 of Stims

2008-10-31T11:26:00.000-07:00

Hey, I'm back!

Not a lot of excitement, other than the fact that the birth control pills made me vomit this time around. Yecchh. Sympathy to my heterosexual sistren.

They also, like last time, made me really, really depressed. I've been off of them for a week now and the miasma is finally starting to clear.

Anyway. Third day of stims, yeah. Having one underreponse and one overresponse under my belt, of course I'm eager to see where this one will land. We're using an "overreponse" amount of stims, but I'm on metformin, which will hopefully modulate my response enough to keep me away from OHSS.

I am also considering transferring two embryos. Maybe if I sacrifice my principles, the sacrifice will be deemed handsome enough, and I'll finally get to have a freaking baby. Don't you have to let go, open your hand, give up, ~~just relax~~ before you can get pregnant?

I don't believe any of that, of course. Of course.

A while ago, when I was trawling the internet for depressing videos, I found one called "The Slow Path to Motherhood". I can't say the video spoke to me, but the title has stuck in my mind. The slow path to motherhood. This is the path I'm on, and the implications of that tumble around in my head.

Is there some way spin it positively, to find meaning in the fact that I'm on this path? I've toyed with the idea that maybe I'll appreciate motherhood more, having arrived this way. But you know, I think most parents love their children pretty much to the max, regardless of whether it was easy or hard to get 'em.

I don't think it's made me a better person. I think it's made me a worse person. I liked myself a lot better two years ago.

In conclusion: the only lesson I think I have learned from this path is that this is the path I'm on. Gracefully or gracelessly, this is the path I have to stumble down, and hope that what's at the end is what I want it to be (hint: live squalling infant, stinky diapers, hysterical toddler, condescending teenager).

And if there isn't? That will be the path I'm on then. And I guess I will find some way to walk it.

CD8: No go

2008-10-09T17:13:00.000-07:00

Haven't much had the heart to blog -- last cycle negative, of course. I've started the birth control pills for my last fresh cycle.

Big love to all the kind and wise people who told me to step away from the Google. Now it seems a bit foolish to worry about multiple pregnancies, given that right this second being pregnant at all seems fantastical.

I've unsubscribed from several high-profile infertility bloggers, all of whom are now pregnant (nobody whose journal I've ever commented on, or who has ever commented here). It's just too much. Too much. I was at a conference this week, in a discipline that's heavily female and, apparently, fecund. I overcompensated mightily, as always. If I'm ever pregnant, I wonder will I notice when a woman is smiling at me too warmly? I know I'll never be a belly-rubber, but I wonder if I'll see. Probably not. I can't see it on anyone else's face even now. I always feel like the only person whose eyes slide away.

4DPO

2008-09-19T12:12:00.000-07:00

That's right, ladies and bois. I am 4DPO, which means that I did eventually O on CD25, after only 8 blood draws. I have reached the point where I don't even have to sign into the lab any more. They see me coming and automatically get my paperwork. It's very convenient.

Anyway, I'm rather thrilled that we managed a well-timed insemination this month, despite my ovulatory tardiness. For some reason the IUI was a bloody affair, which was odd because previous ones were almost all smooth as silk. This one didn't hurt terribly, but for some reason I bled. We had to stop for a while (with me cranked open mais oui) to wait for it to slow down so that he could thread in the catheter.

I don't mind though. Difficult embryo transfers are associated with lower success rates, but I haven't found any indication that difficult IUIs are less likely to work. I assume that the 5-10 days between insemination and implantation gives the endometrium plenty of time to relax and heal from whatever trauma is caused by the insemination. Plus, I'm pretty sure it was my cervix, not my uterus that was bleeding.

Still don't know what my plan is for next month if this doesn't work. Another IUI, au natural? IUI with clomid? or plunge straight into the final IVF? I just don't know. The clomid conflicts with my hypertension-induced terror of multiples, but as any pregnancy starts to look fantastically unlikely, so does the fear of twins recede. As far as I know, clomid carries a multiples risk of about 10% of pregnancies (my nieces are clomid twins). Injectibles carry a risk of 18-20%. IVF with double embryo transfer carries a risk of 25-33%.

I just don' t know. A chronic hyptertensive's pre-eclampsia risk with a singleton pregnancy is a terrifying 25%. My age and lack of previous pregnancies add to the risk. Getting pregnant with multiples would increase that even more.

Oh, god. I just read "The highest risk of pre-eclampsia was seen in nulliparous women with MAPs >85 mm Hg at randomization, where the incidence of pre-eclampsia ranged from 32% to 41%". I shouldn't do this at all, should I. I don't care. I have to try. But yeah, I'm seroiusly mad at myself for not doing this when I was younger and less hypertensive. Someone take the internet away from me right now.

Someone say something comforting kay?

CD21: Warning, this post is so long that it has footnotes.

2008-09-11T07:38:00.000-07:00

Today's subject: Why I Blame Republicans for my Infertility¹

I recently had a long and heated conversation with a dear friend, a a Democrat who is deeply committed to social justice. Distressed by the divide in our country, she called for a ratcheting down of the rhetoric of evil. Quit thinking of the Republicans as evil. They're just people like us who were raised with a different set of values. If we think of them as evil we'll never be able to talk to them.

Eminently reasonable, right? A fairly mild call to lay down arms. Who could object to that?

It turns out that I do. I know I can't have reasonable conversations with Republicans about their views. I can certainly have reasonable conversations with them about other subjects, and do every day -- but the party affiliation is an absolute conversation-killer for me.

The problem is that I take it all very personally. The Republicans are, to me, the party of institutionalized homophobia. They use the hatred of gays as a lever in the culture wars in order to advance their economic interests.²

I'm sure that as a femmey white bourgie I've suffered less than many from homophobia. But the path that led me to this blog is paved with homophobia.

I'm part of a binational gay couple. This has had a massive effect on my life: my partner of 11 years has no immigration rights on the strength of our relationship.

We were crazy in love from the moment we met, and probably would have been married within the year.³ I can't help but imagine how things could have gone differently had we lived somewhere that recognized our relationship.

Because of our immigration status, we've never had more than a few years of knowing for sure that we were going to be in the same place. I crave security like Palin craves ANWAR drilling. For the past 11 years we've shifted from one short term solution to another. I really cannot overstate how much this freaks me out. I never felt like things were stable enough to start to try to conceive. Finally, at age 33, I realized that stable or not I could put it off no longer, and that I would just have to deal with the strong possibility of moving to a strange country with a small child.

Or, as it turns out, not. I'm turning 35 soon. This has been harder than I ever imagined, and I'm fully aware that the hardest times may yet be ahead of me.

So yes. I blame homophobia for denying us the social and legal support that is so important to young families. Of course it's not totally the fault of homophobia. I could have been better and braver and bolder. If I had had that courage to start this at a younger age, uncertainty be damned, I might well be pregnant by now, like the many young lesbians I have seen zoom by me over the past few years. I save most of my blame for myself. But I reserve a portion of blame for homophobia and, by extension, for the party that has chosen to wave the homophobia flag.

SO yes. I take it personally, too personally. I take it very personally that we may soon have to sell our house (in an increasingly terrifying market) and leave the country that I love⁴. I take it personally that if I have an aneurysm in Florida, I might not be able to spend my dying minutes with the person I love the most. I take it personally that the Republicans actively oppose my creating, nurturing, or protecting my family.

I hate that homophobia has made so much of this wide, vibrant country seem small and threatening to me. Again, if I were bolder, more of a risk-taker, probably it wouldn't be so. Or if I didn't have or want a family, it'd hardly matter. Rugged individualism works great when you've only got your rugged self to protect.

And that is why I fail at civil discourse. I can't talk Republican matters without being overcome with a wave of you either think I shouldn't exist or you don't care that the rest of your party thinks I shouldn't exist. I have a special place of impatience for gay-friendly Republicans. I get it, you care about my civil liberties, you just don't care enough to quit supporting your homophobic party.

Of course, if I had my way and everyone who was gay-friendly quit the Republican party, then who would exist to change the party from within? The Log Cabin Republicans claim they're doing just that.

After having puzzled over the dilemma, I've come to the conclusion that the moral thing for those people to do would be to join the Republican party, advocate as hard as they can for Teh Gays, and then when they get to the voting booth, vote Democratic.

¹I've gone back and forth about whether to identify myself as "infertile" when it doesn't really describe the state of being a lesbian who has so far been unable to conceive. But in the end I've decided that "infertile" describes my experience even if it doesn't describe my physical state.

²To be fair, at least some of them hate gays sincerely and not as a cynical cultural ploy.

³ After we'd been together for a week, I went away for a week. She's said that she would have applied for a marriage license during that week. I don't think I would have put up with that, though. I want a big dress.

⁴ Even though I am a Democrat.

CD20: No beginning in sight

2008-09-10T12:37:00.000-07:00

I've had 5 blood draws so far this cycle. My estrogen is still low and no ovulation is in sight. My ovaries appear to have retreated into a defensive huddle.

Obama's polls are down and I'm not feeling that great either.

May there be new hope, new energy, and a shot of luck for both of us in the future.

CD12: In Which Yet Another Lab Tech Makes Me Cry

2008-09-02T07:29:00.000-07:00

In preparation for this month's IUI, I went in this morning for a blood draw to determine how close I am to ovulation and if we should start doing ultrasounds.

My blood was drawn not by any of the lovable cast of characters you've met so far (Chatty Phlebotomist, Inappropriate Lab Administrative Assistant, or Ultra-Sweet Lab Manager). This morning it was drawn by the guy that the GF and I just call "Crazy Guy".

Crazy Guy is also a phlebotomist. Crazy Guy is called Crazy Guy because he rambles constantly, half of it mumbling. The mumbling contributes to the incomprehensibility of the soliloquy. If he weren't wearing a lab coat you'd think about calling hospital security. But his mumblings don't seem to distress his co-workers, and he draws blood with perfect ease, so I have had no quarrel with him.

Until today.

Me: (being swabbed, having tourniquet fitted)
Crazy Guy: So, how many kids you got at home?
Me: None.
Crazy Guy: Ah, you will.
Me: Hope you're right.
Crazy Guy: Little girl.
Me: (thinks it's a question) Girl or boy, I don't really mind, I'd be happy with either.
Crazy Guy: No, I'm telling you, you're gonna have a little girl.
Me: (stares at wall silently, tries not to cry)
Crazy Guy: (witnesses tear-filled eyes with satisfaction) When people come here, I like to uplift them.

12dpt3dt: beta day

2008-08-20T15:05:00.000-07:00

It wasn't a big shock to me that the beta was negative. Of course I had been peeing on sticks all along, and although I know that some people get negative HPTs right up until their betas, that's rare. And rare things are... not common.

So here I am. It's amazing to me that I am now in the category of "two failed IVFs". Shouldn't I at least get partial credit for the miscarriage? Like, a D-? But no. Unlike horseshoes and nuclear weapons, close don't count.

I get one more try before my insurance runs out. One more try before IVF moves from "expensive" to "cripplingly expensive" and possibly "unfeasibly expensive".

I'm sore, emotionally and bum-wise. Over the past two days my bum has tipped over from "pretty much okay" to "owowowowow".

I'm sad. I'm scared. But this isn't the suckiest point of my journey.

Below I would like to submit My ratings of the suckiness of negative cycles, in ascending order ot suckitude.

6. BFN, home inseminations #2-8
5. BFN, home insemination #1
4. BFN, IUIs #2 & 3
3. BFN, IUI #1
2. BFN, IVF
1. 6w4d miscarriage

At least this time, unlike last time, I don't have the overwhelming sense of having been a sucker.

On the plus side, I managed to avoid both Chatty Phlebotomist and Inappropriate Lab Administrative Assistant and got my blood drawn by Ultra-Sweet Lab Manager. Also, after two months of metformin, I have effortlessly dropped 5 lbs. That might not seem like a big deal, but it's extremely difficult for me to budge even small amounts of weight without going all-out no-carb, and I'm pleased to have a bit more room in the ol' jeans.

Now I stop the progesterone and wait to bleed. Then a new cycle begins, hopefully without too much delay. I think I'm going to do an IUI next cycle, just to keep a hand in, y'know? Just a single IUI because I can't see blowing over $1200 on something with such a low chance of success (and yet, somehow, blowing $600 on the same chance seems perfectly reasonable. Hey, it's only half as crazy.)

The auguries were really great this cycle, too. Stupid auguries.

On that subject, I offer the following dialogue with The "Softscape" Promotional Magic 8-Ball that I got at some trade show:

Me: Why didn't the embryo implant? Was it something I did?
Softscape Magic 8-Ball: VERY LIKELY
Me: Is this ever going to work for me?
Softscape Magic 8-Ball: CANNOT FORTELL
Me: Am I going to lose my fucking mind?
Softscape Magic 8-Ball: PROSPECT GOOD

Maybe I've just been asking the wrong augurs. This one seems bang on.

7dp3dt: nope

2008-08-15T15:54:00.000-07:00

I was nervous and sickish all day, because the last time I got a positive on the evening of 5dp5dt, which equates to 7dp3dt.

Not this time. Stolidly negative.

I can't decide whether I should be holding on to hope or preparing myself for failure. I believe that attitude counts for bupkiss, so it's strictly a question of what will serve me better. Probably that means I should be steeling myself for the negative. After all, no one needs preparation to be happy.

Right now, in my progesterone funk, all I can think is I can't do this. But of course I can, and I will. I'm not close to quitting, and the alternative to quitting is marching on. My insurance allows three IVF attempts, but unlimited IUIs. I could keep going for a long time. I don't know what else to do.

4dp3dt: wild mood swings

2008-08-12T06:47:00.000-07:00

Things I had at this point last cycle that I don't have now:

Heartburn
Lots of cramps
OHSS
A sore bum from the progesterone shots

Things I have now that I didn't have at this point last cycle:

The ability to stand up straight
Possibly a few little tiny cramps that disappear in the surge of adrenalin as soon as I pay any attention to them
A numb bum/upper thigh from the progesterone shots.

Stuff I'm grateful for:

One of my 8-celled embryos turned into... wait for it... a 5AA hatching blast! It was cryo'd on Monday, I believe. I'm stunned and grateful. I really didn't think I was going to get anything frozen out of this cycle. As me old mam used to say, there's no security like embryos in the bank.
As I type, some sturdy young men are installing our new Ikea kitchen. So! excited! Soon we will have actual cabinet space, and counter space, and ev'rything. Cannot wait. It's wonderfully distracting. I may not be able to will the world into giving me a baby, but dammit, I can with certain success go out and get myself a kitchen.
All the people who left me "fingers crossed"-type comments. Knowing that there are all these people out there pulling for us -- it's. well. it's nice. Really nice.

I am careening wildly between believing that this IVF worked and being sure it didn't. Stared at the baby stuff in Ikea last night, but also planned in great detail how and where I'm going to cry if it's negative. On the whole, considering how batshit crazy progesterone makes me, I'm doing okay.

Compacting Embryo On Board

2008-08-08T13:12:00.000-07:00

Out of the four survivors, three were still chugging along. Two 8-cell grade 2, one grade 2 "early compaction".

No grade 1s this time. Last time I had 7 8 cell grade 1s on day 3, so who knows why the quality was down this time. Compacting is good, though, slightly ahead for the timeframe.

There was zero chance of going to 5 day. We transferred the compacting embryo. It's odd for me to imagine because a 3-day embryo needs 2 more days before it is ready to implant; right now, it's not attached to my uterus, it's just... hanging out in there.

I dearly hope.

Beta August 20, stick-peeing commences next Friday, August 15.

O.O

Fertilization Report

2008-08-06T10:53:00.001-07:00

The good news: 8 were mature.

The bad news: only 4 fertilized, even with ICSI.

Heading for a three day transfer, if one makes it.

God this cycle sucks. Do I have to chose between being having OHSS and barely/not making it to transfer?

I'm sure my mood will come around but right now I just feel so goddamn sad. Sad that this all has to be so painful and difficult and scary and expensive. Scared of what will happen when we run out our last covered cycle and have to look at raising (read: borrowing) the money.

And of course the chances are that we won't have multiple high-quality embryos, which will greatly up the pressure to transfer more than one, and I've already decided that we can't do that, we just can't. But it will make it all the more painful knowing that our chances are farther reduced from last time, and will torment me all the more if it doesn't work. 3 day transfers are less successful (possibly because people who do 3 day transfers generally have fewer embryos to choose from, fewer eggs, lower quality).

I don't know. I'm sore and I'm sad and I just don't know what to do.

Retrieval Day

2008-08-05T07:59:00.000-07:00

Still groggy, but I wanted to note that

- I feel a thousand, million, quizillion times better than last time. I thought that maybe I was a real wimp, but in fact getting 25 eggs sucked out while you've got OHSS is an entirely different experience than having 9 eggs sucked out when you're healthy.

- Right, 9 eggs! I don't think for a second that any more than the 6 we saw will be mature, but maybe I am hopeful that all 6 could be mature. Maybe?

- Anesthesia is truly a miracle.

- I'm kind of sore, kind of sleepy, but I can totally imagine getting dressed and going to work tomorrow. Did I mention SO MUCH BETTER THAN LAST TIME.

- It's only 11am, which means I have a long lovely day stretched out ahead of me involving naps, the last two episodes of House, Magnificent Seven, and Project Gutenberg (where I have been working my way through Horatio Alger's oeuvre. No, I can't explain it. Perhaps the exploits of boot-blacks and newsboys just show my current life situation to good effect).

Sleepy now! Hart to all of you who sent me lovely warm thoughts.

Day 10: And then there were six

2008-08-03T11:20:00.000-07:00

Six follicles at today's scan. That'd be Harry Luck that we lost, then. Didn't expect to lose one so soon, but the scriptwriters like to keep some surprises, don't they?

I trigger tonight at 8 pm. Retrieval 8 am Tuesday.

ETA: E2, 1938.

Day 8: still 7

2008-08-01T07:44:00.000-07:00

This morning's scan says that the Magnificent Seven are still, well, seven. Doc did mention that my over-or-low response is is not atypical for PCOS women. That means that for next time/if there's a next time I'll get to choose between a small number of eggs or overresponding. Yay.

Holding the dose steady at 150/75. I'll get scanned again on Sunday, which will likely be trigger day. That will make for a Tuesday retrieval and a Friday or Sunday transfer. Which one will be entirely determined by the condition of the embryos on Day 3.

In other news, I see pregnant people. Rode upstairs on the elevator with a genuine belly-rubber, enthusiastically polishing her perfectly round belly as if it were Aladdin's lamp. Stood in line at the cafeteria with a woman loudly proclaiming only three weeks left to go. I'm choosing to see all this as good omen and not the universe taunting me.

I am so ready for the weekend.

ETA: E2 - 910

7 follicles, 7 days of stim

2008-07-31T13:09:00.001-07:00

(note to Mel: no, haven't increased stims -- he felt that raising my dose at this point wouldn't produce more eggs, and he didn't want to speed development on the ones I have, which are already going kind of fast. 9-10 days is optimal, but at last check it looked like mine were going be be ready at 8 or 9 days. I'm hoping for 9.)

I've talked myself into a slightly better place. That better place is not in the general IVF boards, where crops of 15-20 eggs seem normal. No, that place is the Poor Responders board. There 7 follicles is doing well. Plenty of ~~starving children~~ ~~starving infertiles~~ people there would be delighted to have seven follicles. Seven's a lucky number, right? The Magnificent Seven is my darling's favorite movie, like, ever.

Chris and Vin want each other so bad. I'm just sayin'.

Okay, Magnificent Seven it is. I seem to recall that (spoiler alert, but it's a spoiler for a movie released almost 50 years ago, so boo ya) anyway, I seem to recall that three made it out alive. And three good strong healthy embryos would be just ace.

It's also struck me that I might not -- likely won't? get a 5-day blastocyst transfer. Have not really processed the implications of this. There's no good down that road. Never mind. I'm rolling with it. This is me, rolling.

As Vin once said

Reminds me of that fella back home who fell off a ten-story building. As he was falling, people on each floor kept hearing him say, "So far, so good." Heh, so far, so good.

Well. So far, so good.

I'm sorry to be so gloomy. I don't seem to be able to get out of that headspace right now. Recently a whole bunch of my friends-from-the-internets have gotten pregnant. People I really want to be pregnant. And to every one I've had the same reaction to the joyful peesticks: wincing and thinking to myself you might not want to be buying onesies just yet. I felt grimly sure that their parties would shortly come to an abrupt painful end.

But you know what? Every single one of those people is still pregnant and all look fain to have blessedly healthy babies. And I know that every single one of those people considered the chance of miscarriage and chose to celebrate the moment any way. Because that is what living is all about, innit.

It's the so far, so good. Because I'm going where gravity is taking me, so I might as well enjoy the ride. And you know, sometimes (maybe 30-40% of the time) there's a truck carrying mattresses driving by below, or a dumpster full of styrofoam peanuts, and the people who wailed on the way down are exactly as dead or saved as the people who didn't, except the people who didn't had a much better time.

So yeah.

So far, so good.

Day 6 of stims: word problems.

2008-07-30T07:58:00.000-07:00

Someday I will do something and not worry myself sick about it. Then the world will probably end. Feel free to finish your coffee, though, since it's not going to happen any time soon.

This IVF cycle is a whole 'nuther ballgame. The lower dose (150 Follistim, 75 Menopur) plus the metformin seem to have dialed my response way back. My E2 on Day 4 was only 134. I'll find out today's later on. We only saw 7 follicles on today's scan.

Reasons this is good:
Egg retrieval will likely be less painful/incapacitating
Very unlikely that I'll hyperstimulate and be painfully immobilized for two weeks

Reasons this is not good:
Fewer eggs is, well, fewer eggs. Last time: 25 eggs > 21 mature eggs > 16 fertilized > 15 embryos > 6 blastocysts.

This represents 84% mature, 76% fertilization, 94% make it to embryo, 40% make it to blast.

If identical numbers this time (leaving aside the absurdity of embryo fractions... believe me, you don't want your embryos fractured): 7 follicles > 5.88 mature > 4.48 fertilized > 4.2 embryo > 1.68 blast. If that actually means 6 mature > 5 fertlized > 4 embryo > 2 blast then I have one to transfer and one to freeze. But as you can see, there's very little wiggle room, a decent chance I won't have any to freeze, and even a possibility I won't have anything to transfer. If that happens I'll defrost one of my Tiny Frozen Americans, but it would be galling to have this cycle, the second of my three chances, be a bust.

ETA: E2 -- 445. Dunno. Seems low to me.

CD22, Day 21 of BCPs, Day 7 of Lupron

2008-07-20T12:05:00.000-07:00

There hasn't been much to report. This stage of IVF is boring, just weeks of preparing by taking birth control pills and, for the last third, Lupron. All of this is meant to lull my ovaries into ~~a false sense of security~~ a sweet slumber, so they will be well rested when we ~~blast high-decibel Metallica at them~~ begin the stimulation medications.

Once again The Apothecary Shop covered themselves with glory, sending

extra infinitesimally tiny Lupron needles -- 31 gauge! I can barely see the needles, much less feel them.
a nice styrofoam cooler which will in the future find itself full of ice and beer
instructions on how to give all of the shots. Not that we don't know how by now, but it's comforting, anyway.

Oh, and I forgot to tell them that I already had a Follistim pen and wallet, so they sent one along with the Follistim. The wallet's a nice hard-shelled case. It will not go to waste, however. It's a pretty good size for my Nintendo DS Lite.

Other than the reproductive stuff, things have been a bit crazy. Our beloved insane poodle mix got into some mouse poison, spent three days in the animal hospital, and nearly died. Research revealed that this all could have been avoided if the pest control company had, you know, followed the instructions on the poison and used tamper-resistant baits stations. I've sent a letter asking them to pay the nearly $2000 vet bill and swear to me that they've put safeguards in place to make sure this never happens again. If they refuse I'll have to sue them in small claims court and get state agencies involved. It's all stressful, but I don't see letting them get away with it, not when the next dog or kid could die if they don't start following the rules.

I thought that the BCPs and Lupron had been treating me pretty well, but then my sweetie pointed out that I've been on a bad bad headtrip for lo these ten days now. I take my last pill tonight, and we're all hoping that my mood returns to normal once the pills are out of my system.

Oh, and I forgot to report the conversation I had with Chatty Phlebotomist when I went in to have my blood drawn:

Chatty Phlebotomist: Wow, we see you here a lot.
Me: Yes, I'm a patient of Dr. Fertility's. Soon you'll be seeing me for blood draws every other day.
CP:Ohhh, Dr. Fertility. You know (leans forward confidentially) it'll happen when you least expect it.
Me: I don't think so.

CD2

2008-06-30T13:31:00.000-07:00

Today's bloodwork
E2: 34
FSH: 7.7

Last cycle, my E2 was 52 and my FSH was 6.5. FSH is the ticking time bomb of fertility, so seeing it go up is never thrilling, but it's still safely under 10. And I believe that E2 pushes down your FSH to some extent, so it's possible that I'm in the same boat I was last time when my FSH was lower but my E2 was higher.

Meds are ordered, and I'm starting birth control pills and metformin tonight.

On my last entry, the lovely & talented Emily asked why I'm going through stimulation and retrieval again when I am, in fact, the proud mother of five tiny frozen Americans.

I'm doing it because my insurance is generous but dumb. My insurance covers 3 IVF cycles but does not distinguish between fresh and frozen cycles. A fresh cycle costs about $10k and has about a 30-40% chance of working. A frozen cycle costs about $3k and has about a 15-20% chance of working. Therefore, it's in my interest to do three fresh cycles and then pay for frozen transfers out-of-pocket, if necessary.

It's kind of messed up, and not the decision I'd make if money weren't an issue at all. But I'm damn grateful to have coverage, however arbitrary.

Plus, at the ill-fated end of my last IVF, I could not imagine jumping back on that train any time soon. Well, my period took not the 4-6 weeks I'd been told to expect, but 8 weeks to find its way home. Apparently 8 weeks is exactly how long it takes me to forget physical unpleasantness. Right now I'm nothing but eager to begin.

56 days later... another openin' of another show!

2008-06-29T13:08:00.000-07:00

Man, I am impressed by those Endometrium pills. I admit that I was a bit skeptical that shoving them up my hooha twice a day could actually make a difference the way shoving a 1.5" needle into my ass did, but sure enough, it worked. The proof is in the luteal period; 17 days. I didn't get my period until almost 3 days after stopping the Endometrium. I've never had a luteal period longer than 14 days on my own. That's some good shit.

Yesiree Bob, that's right, I've started bleeding, which makes today CD1. Which makes today the first day of IVF #2. Tomorrow I go for bloods and, if all is well, I start birth control pills in the evening.

Tomorrow I will also start metformin. Doc read my carefully supplicatory-yet-insistent note and agreed that, on the basis of the paper I sent him, I looked like a good candidate for the protocol.
Either that or he glanced at the long paper and long note and thought "the quickest way to make her leave me alone is to write her a prescription for glucophage". Either way works for me.

To do:

Stop by SpunkMart and get some sperm. This time I'm going to buy the "ART" vials, which are (even) smaller and (somewhat) cheaper than the standard IUI vials. It's a shame they don't sell the sperm per each. Since we're doing ICSI we only need, like, ten.
Do the math, ask for a few days off around retrieval. Hopefully there'll be fewer eggs and no OHSS and therefore the retrieval won't knock me flat on my ass for five days the way it did last time. In any case, I'm going to try and pass it off as vacation time, not sick time. Everyone's already quite suspicious enough from my two-week bender in April, not to mention my constant needle tracks. Thank goodness I don't bruise.
Order meds from Awesome Online Pharmacy. Last time the doctor's office ordered the meds from a local pharmacy that seems to have a stranglehold on area fertility prescriptions. They'd never heard of my beloved ethyl oleate, and sent (and charged me for) crappy-ass syringes that B disliked so much that she swiped some better ones from her lab. Awesome Online Pharmacy not only overnighted me the P in ethyl oleate for half the price of the only local place that could or would compound it, they also sent, for free, decent syringes, alcohol swabs, and a sharps container. So this time I got the prescriptions myself and I'll be ordered everything from AOP. Actually, why be coy -- it's The Apothecary Shop. The eagle-eyed who know me in real life may be able to spot another random reason for my affection for this particular establishment.

In other ~~ordered lists~~ news, I have some good life distractions.

I got a fat promotion at work, which was extremely soothing to my soul -- at least my life is moving ahead in that way. Since the world has been generally failing to conform to my will lately, it meant a lot to me.
Not coincidentally, we're remodeling the kitchen, which has been in desperate need of help for a long time. We took Friday off from work and went to IKEA and just bought the whole freaking kitchen. It was very exciting. And I love shopping, so picking out the sink, faucet and cabinet knobs are all endlessly thrilling tasks. We're having it installed by the IKEA-branded contractor, mainly because I am unsure of my ability to hang the wall cabinets safely on our masonry exterior walls. Also because I would really like this done without lifting a finger, since my honey-do list is both long and neglected.

And that's all the list items I've got today.

CD54/ 15dpo

2008-06-26T16:16:00.000-07:00

Well, that last IUI didn't work. Had the blood test this morning, got the call this afternoon. It's okay, I knew what the call was going to say -- I've been assiduously peeing on sticks since 10dpo, and each one has been blanker than the last.

It was a long shot, anyway.

It means I get to stop the progesterone, which is good, because progesterone makes me strong with the crazy. I cried hysterically at Move On's latest ad. Guys now is not a good time to be emotionally manipulative mmkay. Particularly not by deploying ads featuring a besotted first time mother dandling her perfect cannon-fodder infant on her knee.

Hey, remember Inappropriate Lab Administrative Assistant? The one who told me I looked 6 months pregnant when I wasn't, and wanted to know what was wrong with me? I forgot to record our dialogue at the last visit:

ILAA: Baby doing good?
Me: Nope.
ILAA: Oh, you lost it?
Me: Yup.
ILAA: Sorry.
Me: Thanks.

The next time she saw me she started chattering about air conditioners, so I am glad to say that there will be no awkwardness between us.

So, back to the reproductive plans: we are embarking on IVF#2. To do list includes:

Fill prescriptions from mail-order pharmacy
Wait a suitable time for the baby aspirin to get out of my system and then have my anticardiolipin antibodies tested. Abnormalities in this area are a fairly common cause of miscarriage, and this testing is part of a recurrent miscarriage workup. Now, no doctor would send me for a recurrent miscarriage workup after one miscarriage, so I'm just ordering the tests on the internets and paying for them myself. It doesn't make sense to me to risk a $10k IVF in order to save $151 on a test. Plus, have I mentioned that I would really rather not go through that again? If I do have antiphospholipid antibody syndrome then it will actually be kind of good news -- it's easily treated with blood thinners. Big thanks to Hope for bringing this possibility to my attention.
Persuade doctor to give me some metformin once I start downregging (that's the lupron phase, for the uninitiated). I've sent him an article and a note, which I chewed my pencil over for a long time. I don't want to piss him off. He's my connection to get hooked up with my future children. But metformin shows promise in reducing both rates of OHSS and miscarriage. I'd swallow hedgehogs to prevent OHSS and miscarriage this time around. I hope he is okay with it and prescribes me the met. If he doesn't, I'm sorry to say that I will probably just get some from Mexico. I've satisfied myself that metformin's a safe drug in this context, and have I mentioned that I really, really don't want to have OHSS or miscarry again?
Start my period. Hear that, body? Please? I took a progesterone suppository this morning, but obviously won't this evening, and it remains to be seen how long it'll take my body to bleed. I'm a little tickled that I'm responding so neatly to the progesterone. A 15 day luteal period, huh? And not even any spotting. But I hope my body gets the memo right quick and starts bleeding. Once I do we'll really be starting the next cycle.

Cycle Day Nothing/6DPO

2008-06-17T13:53:00.000-07:00

Oh, my, it's been more than two weeks. Time moves strangely in the gap between the end of a pregnancy and the start of a new cycle. "Can I consider the day I started bleeding cycle day 1?" I asked the doctor.

"Nah," he replied cheerily, honestly. "You're on cycle day nothing."

So for the past few weeks I've been on cycle day nothing. I went in twice a week for blood tests, all of which showed that my ovaries were doing... nothing. Just ~~lying there sullenly like a pair of kicked dogs~~ lying there sweetly snoozing, dreaming of better days to come.

After the fourth no-action blood test results, the doc began to entertain the possibility that my ovaries might not be coming back on their own. He offered me a ten-day course of Provera, at the end of which I would have a period and begin a new cycle. I liked the certainty, but I didn't like the fact that it would put me probably 4 weeks out from ovulation. I decided to wait until (last) Wednesday and, if no action, start the Provera then.

Well, sure 'nuff, Wednesday's bloodwork revealed that... I should have had bloodwork done on Tuesday. My estrogen was over 300, and my LH was over 100 (45 or so is considered "elevated" and indicative of imminent ovulation).

By the time I was lying on the table we were 24 hours past that blood surge, and there was nothing left but a swinging barn door where the follicle was.

We insemmed anyway. This is probably what's known as "dumb" and also "a colossal waste of $530." Pretty much everyone agrees that the sperm has to be in the fallopian tubes before the egg's released.

I didn't care. I was (apparently) willing to spend $530 to feel like I have a chance and I'm back in the game.

So here I am at 6 DPO. Careful Googling has revealed that some doctors think that slightly post-ovulatory insemination is better for male-factor infertility, and using donor sperm is kind of like having automatic male-factor infertility, because the number of sperm you get are much fewer than in a normal shot. So that's a little hope, right there. And you know, I don't care. I'm waiting for something, I'm no longer just waiting. I needed to be back here.

So yeah.

Assuming I'm not pregnant this cycle, I will be starting birth control pills for my next cycle of IVF in approximately two weeks.

The auguries are depressingly negative. Apparently I don't believe in that stuff strongly enough to change my plan of action, but I do believe in it enough to feel badly about it.

Or maybe it's the Prometrium (progesterone supplements) I'm taking. Estrogen makes me high, progesterone makes me cry. Seriously, guys. I've choked up about twenty times today. I blame the gorgeous wedding pictures that keep popping up.

#$^&^%$

2008-05-28T07:19:00.000-07:00

Warning: it's Self-Pity Wednesday

It is now day twenty fucking five of this cycle and no sign of ovulation.

CD5: E2 33
CD18: E2 48 (LH 4.6)
CD24: E2 36 (LH 8.2)

That's right. It went DOWN. I'm waiting for it hit 100 before we can be reasonably sure that I'm on the path to ovulation. I had been encouraged by the fact that it rose a little between CD 5-18. But now it's practically down to the start. Those E2 levels are right about normal day 3 values. This means we are weeks and weeks from any action.

I just want to get started again. I just want to move on. I am unreasonably furious. I hate this. June, July, August. The world is speeding along and I'm waiting and waiting just to get another chance. Time moves differently for those who are pregnant, for those who have children. Time is not my friend.

I'm tired, I'm bored, I'm sad, I'm so, so angry. I guess the anger should be a clue that on some level I feel entitled, that I deserve this. Really I know that I don't, any more than I deserve my good health or ludicrous wealth. All the grazillions of people who conceived since I started trying, they don't deserve it, but neither do I. There is no desert, just dumb, dumb luck. Fertility rains on the just and unjust. I've been on the right side of dumb luck for health and wealth, so naturally I feel entitled to be on the right side of luck for this too.

Huh. I just looked up the "just and unjust" quote. It's originally from the Book of Matthew in the New Testament, to wit:

...He maketh his sun to rise on the evil and on the good, and sendeth rain on the just and on the unjust.

I'm not Christian (nor well-read in such matters), so I wasn't familiar with the original source -- I knew it only from the Victorian jingle

The rain it raineth every day
Upon the just and unjust fella,
But more upon the just because
The unjust hath the just's umbrella.
(somewhat uncertainly attribute to Lord Bowen)

I'm pretty sure that the rain in the New Testament quote is meant to be a good thing, in a agricultural sort of way, whereas by Bowen's time it's clearly an urban annoyance.

There's some philosophical nutmeat there but durned if I can be bothered to pick it out.

In conclusion, I still don't like Wednesdays.

I don't like Wednesdays.

2008-05-20T12:52:00.000-07:00

Reasons:

1) Wednesdays are what's referred to in my organization as "core day". That means you don't schedule any meetings outside the building, which guarantees that your day will be studded with meetings inside the building. Today I had meetings from 8:30-10, 10-11:15, 12:30-2 and 2-3:30.

2) Because I have a short attention span and most of these meetings are very, very boring, traditionally this has been the time during which I jot tiny calendars in the margins of my agendas, with arrows and circles to indicate ovulation, etc. This has not been particularly uplifting as of late. I don't know when I'm going to ovulate again, so there's isn't much for me to do except sit there and think about

3) the fact that Wednesday is my egg-retrieval-versary, and thus was my pregnantversary. Today should have been 9 weeks. I know I'll stop counting the Wednesday eventually, but eventually is apparently not today. It is also my unpregnant-versary, as it was six weeks to the day when I had that grim doctor's appointment.

Last Wednesday was pretty good, though. I escaped from meetings long enough to go for an ultrasound. I have two large (>21mm) cysts on my right ovary, but they're "inactive" -- not pumping out estrogen -- and thus shouldn't interfere with the next cycle too much. My left ovary was meek and quiet. My beta from the previous Friday was down to zero, a piece of information I was personally unable to extract from Bitchy Office Assistant. Thankfully, my doctor had better luck. Uterus looked empty, lining thin. Estrogen was low, progesterone was low. Peace reigned in the pelvic girdle.

He suggested that once I got my period in 4-5-6 weeks, I call the office and we'd make plans for the next cycle. We told him that we didn't want to wait and that we wanted to do an IUI this cycle. He was non-nonplussed and suggested that I come back for bloodwork in a week to check my estrogen and see if my ovaries are coming back online. He also used the word "miscarriage" several times, which I found oddly comforting. More than once I've felt like this whole crazy thing was in my head, how absurd to think that I ever was pregnant.

And my ovaries, they are coming back. I can tell, with my mysterious mucus-scrying ways. I've started peeing on sticks and I feel pretty sure that I'll be ovulating again before too terribly long. I'm so eager to start again, although the eagerness is no longer nearly as desperate as it was.

Right after the miscarriage I felt a tortured craving to be pregnant again, right this second. It was horrible, like I needed a drug that no one could sell me. I would have done anything.

That sensation has steadily ebbed, not coincidentally as my hormone levels have approached normal. Now I want to be pregnant again, soon, but there are things I wouldn't do to make that happen.

But you know what I would do? Stick a catheter up my hooha, that's what I'd do. Especially now that I've already maxed out my deductible, which makes all medical treatment FREE, that's right, FREE, I can go and get my ovaries scanned and it will cost my hapless insurance company but not me personally. So laissez les bon temps roulez!

Today

2008-05-11T15:01:00.000-07:00

Along with thoughts of my own much-loved mother, Mother's Day makes me think of all those who are sore and tender today: the motherless daughters, the might-as-well-be-motherless daughters, and of course the childless mothers.

So here's a special dose of love for all of those who had to learn to do without their birthright of mothering. And another again for those who are still ~~standing in the aisle with itchy feet and fading smiles~~ waiting to be mothers, whether they are waiting for the grand biological conjunction or some bureaucratic unraveling.

As for me -- well, I'm a lot happier than I was last week at this time. Last Sunday was physically my most miserable time, and I wish I could go back and tell myself that in a week I'd feel so, so much better.

The week was pretty good, distractingly busy, although Friday was a bad day. I finally went for the followup bloodwork I'd been putting off, to check that my beta has gone down to zero*. I was supposed to come in on Tuesday but whatever, I didn't want to get a beta of 11 and have to come back two days later. I had >10 blood draws last month. The crook of my arm is finally starting to heal up and all that jabbing isn't half as much fun when it's to verify only how pregnant you aren't.

Anyway, I've been reasonably chipper, but going back to that hospital was damn depressing. It's taken me most of the weekend to get my balance back.

Got an appointment for Wednesday. I just want to know what's going on in there. I want to know if my hugely swollen ovaries have slimmed down and migrated back to where they're supposed to be. I want to know if my uterus managed to expel everything it was meant to expel. Mostly, I want to know whether I can count today as CD8. I want to know how long till I can try again.

*I still don't know the results of the bloodwork due to my doctor's ever-bitchy office assistant. I'm thinking of scheduling a consult with another practice just so I don't ever have to talk to her again. I like my doctor a lot, but his staff is abominable.

Stuff that happened yesterday

2008-05-06T10:44:00.000-07:00

Kind of funny
One of my coworkers stopped me in the hall to tell me how fabulous I look after having lost all that weight. I was just boggled. I mean yes, I did lose ten pounds in about a week, but only after I gained ten pounds in a similar time frame. Maybe I can make big bucks selling my OHSS-and-pregnancy-loss diet.

Not so funny
Flicking open my Google reader yesterday and seeing a picture of an ultrasound, 6w5d. I would no more than have winced if it had been on one of the many TTC blogs I read, but it wasn't -- it was in a blog belonging to a high school friend, so I was totally unprepared. 6w5d... why does that sound so familiar? Oh, right. Yesterday I was supposed to be 6w5d. And what's that due date at the bottom of the screen? Yup. To the day.

Huh, thought I. So that's what the ultrasound was supposed to look like.

I think anyone who's ever lost a pregnancy is familiar with the "shadow pregnancy"^* problem. In my case it was easy to solve. I just unsubscribed to his feed. High School Friend and I haven't been close in the past 15 years, and I can live just fine without the blow-by-blow here.

I will admit that after I unsubscribed I went back and stared at the picture for a while. Oh. So that's what it was supposed to look like.

In other news, my pee stick was blank this morning. Mostly I'm glad, very glad; the swiftly falling levels mean that chances are excellent that my uterus is clearing out nicely all on its own. And the faster they fall, the sooner we can start again.

Still, I felt a tiny sigh. There is no longer anything pregnant about me.

Never mind. On the whole I'm feeling fine. I never would have believed you if you'd told me last Wednesday that by the following Tuesday I would be feeling pretty darn good (of course, last Tuesday I still thought I was pregnant). The situation sucks , but I knew the rules when I sat down at the table. The fluke was that I was pregnant for a little while, not that I lost the pregnancy.

I'm trying to be grateful for the glimpse I had during that little time. The world really was a different place, and it all seems a little cold and dull and mundane back here on the other side. But it's not, really, it's all just as warm and rich and wonderful as it was before. I just hope that it's not too long until I get to put on those emerald-tinted glasses again.

^*I believe that the term "shadow pregnancy" was coined by the ever-apt Bri at Unwellness.

My weekend

2008-05-04T18:07:00.000-07:00

Saturday
All day I kept eagerly rummaging in my nether reasons to see if I'd begun to bleed. Nothing, nothing, nothing.

Saturday night we went to Target. All week I'd been planning a trip to Target after the Friday ultrasound, after we heard a heartbeat. I was going to do a victory lap around the maternity clothes and even walk casually through the baby department.

Well, I love Target. I was not going to miss my Target trip just because I was suddenly unpregnant, dammit.

We went and had a good time. Bought dog biscuits and I'm suddenly unsure what else, but I know there were like five bags, so we must have bought some other stuff as well. Had a good time despite the fact that they clearly made a mistake letting me in the door, because every other woman there was visibly pregnant. One of the men looked a little suspicious, too.

When I stopped at the bathroom on the way out, I had begun to bleed, just a little.

Sunday
Woke at 7:30 cramping like a mofo. Hobbled to the bathroom and realized that I was beginning to bleed in earnest. The next four hours or so weren't pretty. I guess I'm lucky in that with my period I don't usually cramp that much, which is to say that I had no idea that cramps could be this painful. Naproxen and heating pads didn't make a dent. I had to just breathe through them. The nice part was that in between cramps, when they stopped, they were completely gone and I felt totally fine, until the next one hit.

Bled heavily until around 11:30. Being up and walking around made it somewhat better. B made us delicious buttermilk pancakes and bacon and we took it out on the porch.

The next part I am putting in invisible ink for my more sensitive readers, or anyone who simply does not desire to read about the contents of my uterus. Select the text with your mouse if you wish to see it, you gross thing you.

While eating breakfast, I felt something utterly unlike a period cramp -- a sharp lancing pain that made me gasp. I went upstairs to the bathroom and passed three clots each about half the size of my fist. Then I suddenly felt much, much better. Not just physically but emotionally. Can't really explain it.

After that the flow slowed right down. I've had intermittent cramping, but nothing like this morning. That can't be it, there wasn't enough, too easy -- but I feel like something happened, and for whatever reason I have been feeling much better, even a little peaceful. My sweetie's practical explanation is that my ridiculously high hormone levels have finally settled down. She might be right about that. Whatever the reason, I'm grateful.

Edited to add: I'm the luckiest girl in Girlville. Just walked into the bedroom to find that the woman I am blessed to call my own prepared us a spontaneous Beltaine feast, to be served in bed. Now she knows that I love eating in bed like I love ... well, there just isn't anything I love that much.

The food is so lovely I had to take pictures, which will be posted shortly. White wine, beautiful beets, this interesting clam-potato-fresh dill-homemade lemon mayo salad with avocado curls, and the prettiest fruit salad you've ever seen.

I am the luckiest asshole ever.

Gotta go eat.

No, wait.

2008-05-02T14:42:00.000-07:00

I had that completely wrong. My memory's never been fantastic.

My dramatic blood-draw swoon and doctor's visit was on Sunday, not Thursday. I don't remember Thursday's blood draw at all. I have no idea what I did for any portion of the day on Thursday. Probably watched some episodes of Scrubs and surfed the internet.

Goddammit.

Light reading for today

2008-05-02T13:53:00.000-07:00

Decline of Serum Human Chorionic Gonadotropin and Spontaneous Complete Abortion: Defining the Normal Curve.

Quadratic curves not really my thing, but the tables were pretty easy to read. It looks like the wheels probably fell off this thing last Thursday, the very day of the 1,111 beta. It does put a special spin on my Tuesday claim that "I'm glad to say that I am much much better -- I have been steadily improving since last Thursday." Well, duh. No wonder I was feeling better.

Can't help replaying the events of that Thursday. The night before was the height of my misery (also, not-so-coincidentally, the height of my hCG). By the morning I was exhausted and so sore. I crab-hobbled my way to the blood draw lab. As soon as I sat down everything started to swim and (apparently) I turned dead white. The very sweet lab manager got me a paper cup of water and suggested that I go upstairs and see my doctor. I assured him it was my very next step.

I wasn't on his appointment schedule, and he visibly winced when he saw me. We sat in the waiting room until all of his other patients had been seen. Then he sat down across from us and gave us the don't-ask-to-be-admitted peptalk. Telling us how if I could just tough it out it'd be fine.

He was right, because by that evening I was already feeling a little better. Ha. Ha. Ha.

Whenever this thing pooped out was probably not related to my swoony fit in the blood draw lab. I've had vagal events like that before. I'm sure the proto-placenta-trophoblastic-cells-whatever (embryology also not my thing) detaching was just a biochemical blip and I didn't notice its happening in any way. I kind of want to pretend that I did, though. I would like to have had that connection, at least.

Anyway, having the date and approaching another table in the paper tells me that tomorrow's hCG should be around 18-23. That perfectly jibes with this morning's faint-but-visible line (my tests detect 20 mIU). The last bit trails off slowly, but by next Wednesday I should be completely in the clear, with a level <5.

I know things don't always exactly go on schedule, but I feel better having an approximate timetable.

Why I Love My Peesticks

2008-05-02T09:16:00.000-07:00

When I peed on a stick Wednesday morning, I knew I was being naughty. Using a qualitative test to judge hCG levels is not recommended, and it was just a waste of a perfectly good peestick.

I am so glad I did. If I hadn't we would have gone in for the ultrasound this morning. The ultrasound would have been inconclusive -- something that looks like a sac and pole, but no heart beat. That's not at all unusual for 6 weeks 2 days gestation. Now, probably I would have asked for more bloodwork to test the progesterone levels. If I had I would have gotten The News via telephone in the late afternoon, or I don't know, maybe they wouldn't have given me The News over the phone, maybe they would have made me come into the office, and I would have known exactly what that meant and it would have been torture.

In another dimension, I might not have asked for repeat bloodwork. They don't do it routinely once you start ultrasounds. Since the ultrasound would have been inconclusive, they'd have had me come back in a week, or even two weeks. All that time I would have been taking progesterone shots, which would have kept my body from bleeding on its own. I could have easily spent another two weeks believing this was viable and googling "6w2d ultrasound no h/b sac". I am unutterably grateful that I did not have to go through that.

Of the possible worlds in which this pregnancy isn't viable, I am living in one of the best of them. Granted, it would have been even better if I'd peed on that stick on, say, Monday, or repeated my beta then; we could have seen it falling, and falling betas are never okay when you did a single embryo transfer (they can be less dire if they represent a disappearing twin/triplet in a multiple pregnancy). But I still did pretty well.

Next time you can bet your booty that I'll be peeing on one of those sticks every half hour. As it is, I don't have to give them up altogether. I'm still peeing on one every morning. This morning's was very light, maybe half the strength of the previous one. That's a good thing. The sooner my hCG levels fall, the sooner we can try again.

I don't know yet how we'll try again. I'm not going to do another fresh IVF immediately. I had no idea how hard it would be on my body. I can't risk OHSS and another two weeks off work again. I managed to excuse this last one with a vague "emergency minor surgery" (whatever that means) but I think it'd be a little fishy if I tried that again in 8 weeks. I think the next cycle will be IUI. Chances of success with an IUI are low, which makes it sort of a nice compromise between "doing nothing" and "jumping right back in".

Luckily I have some time to think. Next cycle will probably be minimum 6 weeks from the time I start to bleed, and lord knows when that will be. It's frustrating, not knowing how long I'll be benched. Hey I used a sportsball metaphor, go me. That's a little of the yang energy I need, huh?

Overall, I'm doing okay. I have been "trying to conceive and not pregnant" for 16 months. I was pregnant for 2 1/2 weeks. Really, the pregnant mindframe was the one that was a constant stretch for me. This feels familiar.

Here, I have a perfectly good highway metaphor in my blog name. It's metaphor time.

This is a little bit like driving around lost. You have a limited amount of gas and you have to be somewhere by a specific time. You're driving down this featureless highway and you think you're going in the right direction, but you might not be. Finally there's an exit. Whoopee! Except that it dumps you right back on the same road, which is exactly as inscrutable as it was before. What the heck. Better signage, people. What was the point of that exercise, exactly?