5dp5dt: the evidence for and against

Data that support my being pregnant this cycle:

1. I did a super good job of distracting myself. In fact, we decided to up and get married with two weeks' notice, which definitely took my mind off Things.  The planning was a bit crazy, but the wedding was lovely. And three days after the wedding, we transferred two blastocysts to my uterus.
    
2. My lining rocked, which is to say that it was over 8mm, which for an Asherman's patient is awesome.
    
3. It would be hilarious if I got pregnant the same week I got married, so people could count back and make jokes about shotgun weddings.
    
4. I have been chock full of symptoms. Heavy draggy cramps, sore breasts, I got 'em. I have been quietly Sure for days.
    
5. My acupuncturist said I had really good energy. 

Data that support my not being pregnant this cycle:

1. It's 5dp5dt, or 10dpo, and my test strips are stark, stark white. I have been pregnant four times, not counting the lame-o chemical. I have never not had at least a faint line by now. Good betas, bad betas, I always had something by now.

There are 5 reasons why I am pregnant this cycle, and only 1 reason why I am not. The mathematically-inclined observer will note that 5>1.

Sadly, though, I think that single piece of evidence against rather outweighs  the five votes for.

In Which We Receive Good News, but are Subjected to a Minor Annoyance

First and foremost: the HSG that I was so nervous about went really well. When I say "really well" I mean "did not hurt like a mofo" and also "had a good result."  I do think these two are related; I've had 3 HSGs in my life. Two of them were mildly uncomfortable, and deemed normal. One was excruciating and most definitely abnormal. It makes sense; stretching scar tissue is a lot more hurty than stretching a healthy uterus.

Anyway, the doctor said it was the best post-Asherman's HSG he'd seen, which made me feel a bit better about being so OCD about seeing a specialist, avoiding D&C, etc. Here's hoping it's a good sign!

The minor annoyance, on which I will of course expend a lot more text:

I went to have my teeth cleaned yesterday. I walked in and got my least-favorite hygienist, the one who seems to blame me for having a small mouth. As soon as she saw me she said "oh, are you pregnant?"

Me: ...no

Inappropriate Hygienist: Oh!

Me (coldly): I just carry all my fat on my abdomen.

IH: Oh, so do I, blah blah blah so hard to lose blah blah blah crunches blah blah.

Me:  You know, that's really not a good question to ask.

IH: I thought it was going to be a happy thing!

Me: I've had two miscarriages recently. I'd rather not hear that.

IH: Ohh... sorry. how are you doing? With all that.

Me (arctic): Fine.

IH: Do you have any kids?

Me: I have one, he's four.

IH: Well then, you're blessed.

Me: Yes.

IH: But you still want more?

Me (desperately): Can we please just not have this conversation?

IH: Oh.

IH leaves the room to get some supplies, comes back a few minutes later and asks about summer vacation plans. I spend the rest of the visit trying to pretend that she doesn't exist, which is pretty difficult considering that she's poking me with a sharp piece of metal.

The thing is, I do carry weight around my tummy. I have a Pooh-bear belly, and always have even at my thinnest. I mean, right now I'm less than 10 lbs over the NIH-sanctioned "healthy" weight, and I still have a gut. I ain't ashamed but I also don't find it particularly aesthetically pleasing, so I usually wear loose tops. This of course leads directly to pregnancy assumptions, because any woman wearing a loose top is probably pregnant, or at least would be pleased to discuss her reproductive status with complete strangers.

It's just one of life's little jokes that polycystic ovaries lead to both central obesity and difficulty achieving and maintaining pregnancy.

As the kids say on the internet, smh.

Here we go.

HSG is scheduled for tomorrow at 1:45 pm; I have to be there at 1 to rock the backless hospital gown.

I'm nervous as hell. Not only was the last one quite amazingly painful, but it was when I got the news about the Asherman's. It sucked. I'm not really looking forward to being in that room again. In fact, my last few visits to this particular hospital campus have not been the funnest experiences ever. Well. It already is what it is in there, it's just me knowing, right? And I always have to know.

In a few more months it'll be a cool two years since we started TTC #2. I won't say it's been a miserable two years, far from it! Over this time Small Boy has transformed from a toddling baby to a sturdy preschooler, full of ideas and plans and words and strategies. He's got enormous grey eyes and delts sculpted from playground tumbling and long, long legs on a rather short torso (sorry, kid, that one's all me). Sometimes it hurts how much I love him.

Other good stuff has happened. We got another four years of Obama, and my state got marriage equality, which means a tremendous amount to me.

It hasn't been the easiest two years, either. It's certainly had its moments. The ultrasound moment when the doctor said "I don't see a heartbeat. I'm sorry," feels like it's preserved in amber, but I hope that someday it will quietly dissolve.  The actual aftermath was not as terrible as that moment. In retrospect, it is something I'm kind of proud of. I worked, I researched, I stuck to my guns about the misoprostol. I was given a humane amount of pain relief and it was over quickly. I'm even glad I got to hold those two rather revolting little sea monkeys (although the positive nature of that experience was perhaps influenced by the aforementioned "humane amount of pain relief"). They were grody, but they were mine. I don't know if they were people. I know to some they would've been. But it's possible that they just weren't equipped to be people, they simply didn't have what they needed, there was no world in which they would've been people because they were just missing some vital ingredients.

I mean, it's also possible that they were perfect and my stupid Asherman-y uterus killed them, but whatevs. I can't know. I could've known, maybe, if I'd gone ahead and had the D&C so I could've had an analysis of the fetal tissue. But what would it have changed? I'd have been risking a future actual child in order to know more about what happened to these. So I guess I don't always have to know.

So here we are. In a lot of ways I'm in the best place I've been for two years. Calmer, happier, healthier. Ready to roll the dice two more times, and then, if I must, to put them down and walk away.

Gulp. Tomorrow I start rattlin' the bones.

Doom and gloom

So, there's a colleague of mine who for paperwork reasons became aware that I was doing IVF. She was really sweet about it, warmly wishing me luck. A few months later, she turned up pregnant for the first time (how do I know it was her first time? Because she announced it immediately. Women who've had a miscarriage don't do that.). She's in her mid-40s.

It was not a great leap for me to conclude that she had had fertility treatments, quite possibly donor egg, and that it was a long road for her to get there. She was due in November.

The other night, lying awake I suddenly thought "What ever happened to Nice Colleague's baby?  I never heard anything about... oh, god." I checked her online registry and only a very few things had been purchased.

And I lay there for a while, thinking about the fact that I don't know her well enough to sally up and say "hey, dead baby or what?" and feeling awful that at the end of what was probably a long journey, things turned out badly. And hurting for her for what it must have been like socially, given that she told everyone and then some.

So the next day I went to my friend who knows her a bit better and said, "hey, what about Nice Colleague's baby?" My friend furrowed her brow and said "Ummm... Ella? No, that's not it. Katie."

And that was that. Katie is fine. She was just low-key about it, didn't announce the birth to the whole world I guess, maybe had another registry someplace else or had friends who liked to buy things off-registry. She's fine. They're both fine. She and her husband are new parents.

I was staggered with relief. And then I thought huh, maybe I should try not to jump directly from didn't see a birth announcement  to oh, dead baby.

*   *   *

In other news, having an HSG next month to see if my pathetic periods are because my adhesions have returned, or because of who knows what. Please no adhesions. I would really rather not have to do all that again.

32 days later

I sort of got my period again on Sunday. It's so very, very light. Red when I wipe, otherwise nada. This is pretty much what my last one was like, and I thought it was just because it was the first one post-misoprostol. I guess not. It's not nice to have your heart sink every time you pull down your pants. I hope I'm not too broken.

Last night I dreamed that I was in a rowboat. There were lots of dogs swimming around, but I ignored them. Then a puppy¹ came paddling right up to my boat. I hauled him out of the water. He shook himself off and wriggled around and I thought "shit shit shit, I really wasn't ready to get another dog, but clearly I'm keeping this one."² I then noticed that the dog was female, not male, and was surprised.

My subconscious isn't too subtle, huh?

I am sort of conflicted about moving forward. If I try again, either I'll get pregnant or I won't. If I don't, it will hurt. If I do, then either I'll stay pregnant or I won't. If I don't, it will hurt. If I stay pregnant, either the baby will be okay or he or she won't. Etc. It's... just going to take me a little while to screw up my courage to go again.  





¹A swift google tells me that the puppy was probably a St. Bernard, possibly a Landseer Newfoundland.

²The last of our three dogs died not too long ago, and we've vowed to remain dogless for a while.

9 weeks: finding the reset button.

Today would've been 9 weeks. Last Wednesday I'd resolved to wait, zen-like, for my body to take care of this naturally, gently.

That decision lasted until the evening. I did a little research and found out that with misoprostol, it's frequently over within twelve hours. The old-fashioned way can take, literally, weeks. Weeks of bleeding, weeks of cramps, weeks of pregnancy symptoms.  I did the math (number of weeks multiplied by insanity factor) and by the next morning was super-keen to get the misoprostol.

Except it turns out that the misoprostol I was offered so lightly on Wednesday night was actually a pain in the butt to get. I called Thursday morning, with some idea that I could stop by the office on Thursday afternoon to get the prescription. Hahaha no.

I finally got a call back Thursday night telling me that someone would call me Friday morning. On Friday morning, the PA called and said she'd talk to the doctor and get back to me later in the day. At 5 pm she called me back and said "you'll have to come in for an appointment on Monday."  I'd dreamed that I'd be able get it all over with by the end of the weekend, and was bitterly disappointed to be denied.

Anyway, I dragged through the weekend -- I say "dragged" just because the pregnancy-fatigue was still going strong, along with the need to get up and eat a three-course meal at 2 am every night. Pregnancy symptoms are a lot of fun when you're going to have a baby. They're just an annoying inconvenience when you're not.

Monday morning I went in for my appointment. They'd mixed up the paperwork and had me down for an ultrasound even though I was only supposed to be there for a consultation. "What the heck," thought I. And maybe, just a little, maybe .05% of my brain thought what if it's all a mistake? What if it's a Christmas miracle? What if there's a little heart beating away in there?

There wasn't. There were two little embryos, measuring 6w2d and 7w4d, clearly sharing a placenta (i.e., identical). They looked like little packing peanuts curled up in there, two very quiet packing peanuts. I kind of wish I'd gotten a picture, but for some reason they don't offer you pictures of the dead ones. But in any case, I was still glad to have seen them again. Last week I hadn't gotten a measurement for Little Twin, so it was oddly satisfying to have that verified. 

The doctor's not a big fan of misoprostol. He gave a decent shot at trying to convince me to do a D&C. He assured me that they're "very gentle" and that they "only use suction" and "the chances of getting scars from a correctly-done D&C are almost nil". If I did a D&C it would all be over quickly. If I did a D&C I could have a chromosomal analysis done of the tissue. With misoprostol, 40% of women have to have a D&C anyway.

Unfortunately, I know that most of what he was telling me wasn't true. Don't get me wrong, I think this practice is very good at what they do, which is reproductive endocrinology. They don't know jack shit about Asherman's Syndrome. Yes, you can get adhesions from a properly-done D&C. No, using suction only doesn't prevent scarring.  No, a woman with Asherman's shouldn't get a D&C done unless there is absolutely no alternative. Misoprostol is more than 80% effective if you give it a whole week to do its work (this practice judges after three days).  I'm a walking dictionary of misoprostol trivia at this point. I spewed some figures and he sniffed and shrugged and said he'd go to get the consents.

He left, and then I cried. I wasn't really expecting there to be a living baby in there.  But seeing the pictures was still... hard. Little Twin was pretty indistinct, but Big Twin looked like such a perfect little fetus. Perfect, just dead.

I spent the next three hours getting my blood drawn (they require a hematocrit), waiting for the bloodwork to come back, waiting for this, waiting for that, waiting at the pharmacy. It was, apparently, lovely weather for a sleighride together with me. Also, I should have myself a merry little Christmas, and that's the Jingle Bell Rock. I did not stab anyone.

Four hours later I emerged with 8 200mg tablets of misoprostol, a strip of Zofran (anti-nausea), and a handful of Ativan, I guess in case the process made me edgy? I'd already filled a prescription for some painkillers.

I decided to wait until Wednesday morning. Misoprostol can be unpredictable, and if I were going to be doubled over/vomiting/yelling/cursing/hemorrhaging, I wanted it to happen when Small Boy was at preschool and not when the poor dude was trying to have himself a Merry Little Christmas.

So yeah. This morning I dropped him at preschool, went to the supermarket and picked up a party-sized pack of sanitary napkins. Went home, popped a Zofran and a Perc. Half an hour later I briefly dipped the misoprostol pills in 5% acetic acid, better known as white vinegar, and crammed four of them up the hatch (via my handy PreSeed applicator). I then waited for something to Happen.

An hour later I started cramping. Four hours later I felt like something was going to Happen. I shuffled over to the bathroom and then in a mighty rush, the entire universe fell out of my uterus.  In the space of five minutes I passed the gestational sac, the fetuses, and what Her Indoors was sure was at least some of the placenta (she's a biologist, so I have some faith in her identification).

Friends, that is some good stuff. I know everyone is not as lucky. Some women end up writhing and puking, and some women get no effect at all. But for me, it did exactly what it said on the tin. The cramping has been no worse than bad period cramps (admittedly, without the painkiller it probably would've been a whole lot worse). And holy god has it cleared a lot of underbrush out very quickly.

I've been bleeding briskly since this morning. The cramps have gotten better and worse, but the painkillers keep them bearable.  I won't know until Friday if the job's completely done. If it's not I'll likely have to fight not to have them "clean it up" with a D&C. But fight I will; if anything lingers, you bet I'd rather have another round of misoprostol.

Right now I feel wrung-out and crampy but so relieved, and grateful that the misoprostol seems to have worked for me. Fingers crossed that Friday finds that it truly is over.


¹The literature is a bit mixed on whether or not dipping the pills in acetic acid definitely speeds action/improves absorption. But I figured I'd try it on the grounds that at worst it would have no effect, and at best some studies have found it halving the time to completion (which otherwise averages about 12 hrs from administration). Since my uterus enthusiastically spewed four hours after inserting the tablets, I'm inclined to believe that it helped. It also makes a lot of intuitive sense to me. As soon as I dipped them they started to disintegrate. I was basically inserting a firm paste, not dry pills.  If any internet travelers stumble across this, I personally vote "yes" on dipping in 5% white vinegar.

Well, that's done.

Accomplished in the past week:

1) Re-elect President Obama;
2) Pass marriage equality legislation in my state;
3) Transfer embryos to uterus.


As you can see, I've been busy.

All kidding aside, it's been an odd few weeks. I've been tied up in knots upon knots about the election. It's not something I like to think about, but for the past 15 (fifteen. FIFTEEN) years we've been coping with the fact that Her Indoors is not an American citizen. We've patched temporary visas together legally so far, but with very little sense of security. If Obama manages to do something about DOMA during his second term, things could change for us in an earth-shattering way. I knew there was a zero percent chance of anything like that happening under a President Romney, so... I was pinning a lot of hope on this election. Not to mention the whole marriage equality thing which was/is incredibly important to me. So between one thing and another, the past few weeks have been a blur of anxiety and hopefulness.

On that subject: I have had major lining-related setbacks in the past, so I was pretty nervous about my lining check on Nov 5. I was delighted when they found my lining to be 8.79mm -- this is not rockstarish (back before Asherman's, I used to produce 11-14mm) but it's comfortably above the 8mm cutoff that my clinic uses. Previous cycles had settled down around 6.5mm. I know there are a couple of others out there struggling with lining issues, so here's a summary of what might have made a difference for me. There are details regarding vaginas below, but I figure anyone grossed out by that probably isn't reading my blog.

What I did

• Delestrogen shots instead of estrogen pills. I think this made a big difference for me. With my last two FETs we piled on the pills in hope of fattening my lining. This gave me a pounding headache, constant nausea, and a skimpy lining, though my E2 was >1000. Delestrogen, on the other hand, has given me physiologically reasonable level of 294, no side effects, and a decent lining. Totes worth the butt-shot every third night.
  
• Viagra. The doctor at Big Shiny Fertility Factory doesn't believe in Viagra to improve lining. I do. Rather than attempting to argue the point, I just quietly procured a passel of off-brand 25mg pills from an obliging Indian pharmacy and tucked one Up There four times a day from the start of estrogen to the first day of progesterone. Since the relevant study was done using suppositories, I first tried an elaborate scheme to construct suppositories with a pill-crusher, microwave, and cocoa butter inserts. This was tremendously messy and tremendously tedious. The next thing I tried was simply stuffing one into the relevant tract. Worked beautifully, with minimal muss or fuss. A tip to anyone trying this at home: it worked even better when I inserted it with 1ml of Preseed, the kind that comes in the tube with the applicator. Most effective method was to draw up 1ml of the Preseed, turn the applicator with the open end facing the ceiling, draw the plunger back a bit more, and balance the pill on top of the lube.
  
  Incidentally, I chose the Preseed not because I was afraid of some other lube damaging embryos or whatever, but because Preseed is pH-neutral, has no glycerin, and (most importantly) had just the right applicator to fit a Viagra pill into. $20 at Target.
  
• Vitamin E. For this I didn't actually follow the study protocol of 600 mg/day; I used Dr. Marsh's protocol of 1000 mg/day. Dr. Marsh is an Asherman's expert who's seen a lot of scrawny linings. I really believe this made a difference for me, maybe as much as the Viagra -- when I had my post-surgery hysteroscopy during an unmedicated cycle I had a pretty great lining (9 mm) and I wasn't taking anything but the Vitamin E then. But I typically do worse on exogenous estrogen, so I am glad I did both the Viagra and Vit E.

What I didn't do

• Acupuncture. I totally believe it can be helpful, but I was so busy that I just didn't get to this time round.
  
• L-arginine. I started out taking 6g a day (12 pills!). After 4 days I had rotten heartburn and decided to just give it up. Plus, its mechanism is basically the same as Viagra's (although it's taken orally), and I was afraid of Overdoing It.

Transfer was smooth. The receptionist said "Good luck, ladies!" as we walked in, which pleased me. We may be lesbians, but we're still ladies, dammit. Gauged the water/bladder fullness pretty well; I was uncomfortable, but not in agony. Was not offered a picture of the embryos, which was a bit disappointing, but which I have to admit is sensible. Blastocysts were fair quality upon thaw; I've not too fazed, though, considering the fact that my only take-home baby has come from the worst-quality embryo I ever transferred. Pretty is as pretty does, you know?

So now... we wait. And I eat pineapple, out of a sense of tradition and ritual. And bathe in the knowledge that, positive or negative, BFN or BFP, come Jan 1 we can get freaking married, and come Jan 20 we'll be watching President Obama up there on the podium. I've gotten two out of my three wishes for November. I'm hoping for a hat-trick, but no matter what happens, it's been a stonking good month.

Begin again

I keep starting posts and fading out.

The Asherman's surgery in May was, by all accounts, a success. Dr. Isaacson was lovely, in accordance with all the recommendations I got from the Asherman's mailing list. He found one major band near the cornu (where the tube attaches) and some minor adhesions near the cervix. He feels pretty sure that the largest adhesion was from the c-section; apparently, when they're done popping out the baby, they sponge down the uterus. And either I was sponged too hard or -- more likely -- my body simply didn't like being sponged, and reacted by forming an adhesion.

Learning that it was probably the c-section, not the D&C, is kind of mixed. On one hand, it's comforting to know that it probably couldn't have been avoided. If someone asked me if I would pay the price of Asherman's to safely have Small Boy, I'd agree instantly. At least I got something out of the deal, you know?

On the other hand, it means that Dr. Stewart missed the adhesions during the quite-hasty SHSG. And that last year's pregnancy never had a chance, and that those embryos might have well been flushed down the toilet, and that all that horror could have been avoided.

Second-guessing does no good in the real world, so of course I try to spend no more than 80% of my waking hours running mental simulations of alternate universes.

---

But all that's old news. See? I put a line under it.  It's old news because yesterday I had my first Delestrogen shot for my FET cycle. HOLY CRAP that hurt. I'm a spoiled little princess who's only ever done progesterone in ethyl oleate with slender 25ga needles. The 22ga was like sticking a fucking drinking straw into my glute.

Her Indoors was, as ever, both charming and useful. After giving me the shot, she eyed my prone, gasping form sympathetically.

Her: Does it hurt?
Me: YES
Her: If I slap you, it might help.
Me: SURE WHATEVER
Her: delivers ringing slap to my buttock, right where the shot went
Me: ... wow, that totally helped.

This brief domestic scene illustrates two points about our life nicely:

1) Her Indoors is smart about all sorts of things. There's an explanation having to do with the dissipation of oil in the muscle and circulation and nerve endings and stuff.

2) I trust her really a lot.

---

So yeah, new cycle!

If my lining does as it ought -- and that's a big "if" -- my scheduled transfer date is November 12. In 2008, on the cycle that resulted in Small Boy, my transfer was November 15. In 2011, on the cycle that resulted in the zombie pregnancy, my transfer was November 10. I guess this is just the time of year that I like to put embryos in my uterus.

Here we go!
Here we go.
Here we go...

Day 6 embryo report

Nine. Nine. Beautiful, beautiful nine fucking frozen embryos.

Two made the grade yesterday at 7 am or so; one more joined them at 10:30 am, so that's three frozen on day 5. An additional six joined on Day 6.

Day 6 have been sometimes found to be less likely to implant than are day 5; a 2001 study found a 50% reduction (from 60% to 30%) -- but a much larger 2006 study found almost no difference (32% vs 28%).  The fact that the 2001 5-day blast group had a pregnancy rate of 60% makes me think that their population must have been a bit unusual, anyway -- I don't know of anywhere that can claim a 60% pregnancy rate, unless all their participants were 20!

Anyway, even the worst represents a good solid pregnancy rate, and did I mention six of them fomg.

And -- I might need them. I freaked myself out yesterday by reading a lot about Asherman's Syndrome, and it sucks. Makes it harder to get pregnant, and makes miscarriage a lot more likely; one source reports a miscarriage rate of 45%. Just what I need, huh? But it's also easy to find stories of women with Asherman's who have three or four miscarriages and then a live birth. If I have the balls to keep rolling the dice, there's a decent chance I'll eventually win.

Basically, if I go ahead here, I have to be prepared that it may take a few false starts. I have to figure out how to not go completely mental the way I did with the other two miscarriages. I have to figure out how to stay sane. I probably have to stay out of the forums where people assume that a positive pregnancy test means a baby.

This all sounds grim, and I was pretty damn down last night when I thought I had two embryos, or just one try. But now that I have 9, which could well be four tries, I'm feeling much more hopeful.

I think I am tough enough for this. I think I can do this. It helps to know that I can stop any time. Her Indoors is more than okay with keeping our family the way it is -- frankly, she's indulging me on this endeavor. There will be zero pressure on me to keep going. If it's too much, I can pause or walk away. It's not like my family sucks the way it is, you know? Yes, the wordless longing of my heart is for one more. Yes, I feel like there's still someone missing. But really, I could be wrong. I've been wrong before. Maybe our family's the way it's supposed to be. I have to try, though.

For the historical record, our family roster now consists of:

Hatching blasts:
2 - AA Good
2 - BB Fair

Expanding blasts:
2 - AA Good
2 - AB Fair
1 - BB Fair


FWIW, I'm not particularly hung up on embryo quality. Have I mentioned that a little 2BB blastocyst (different rating system, but prob equivalent to the BB Fair) turned into our entirely acceptable son? And I have seen many perfect embryos come to naught. Anecdotal, yeah, but it's anecdotes that make up my story, so.

In conclusion, beautiful, beautiful nine!

Rallying, and making plans

Okay, I think I'm done with the wallowing-in-self-pity portion.


I have a plan. My plan is:

1. Go ahead with the scheduled IVF. We can put the pedal to the metal as far as stimulation goes, because hyperstimulation will not be an issue because
2. We'll be freezing everything.
3. Five days after my period arrives post-IVF, I am going to fly up to Boston for hysteroscopic surgery with Dr. Keith Isaacson, who is by all accounts one of the two best Asherman's surgeons in the US. I'm extraordinarily lucky in that he accepts my insurance, and that his hospital happens to be twenty minutes away from my sister's house. The surgery is apparently a quite minor one, although very dependent upon the skill of the doctor: no anesthesia, in-office, little to no recovery time.
4. If all goes well, several months later I should be cleared to transfer the frozen embryos.

My RE -- who is a good RE -- appears to be somewhat insulted that I don't want him to do the uterine surgery. I know this because he made a great show of telling me how much he's not insulted and how he has no professional jealousy and that surgeries like this aren't very profitable anyway. Furthermore, he feels my case is not very difficult, and he's never heard of this Dr. Isaacson I'm going to see instead.

I'm glad to hear that he feels my case is not difficult, but the fact that he's never heard of one of the very few experts who specialize in Asherman's tells me that I'm making the right decision by going to Boston.

Frankly, I don't care if he's vexed or pleased. I've only got one uterus, and I'm going to do everything I can to get it in tip-top shape.

@nutella, I'm pretty sure that my insurance will cover a freeze-all cycle just fine... it's just like a normal cycle except for the lack of transfer. I hope I'm not proven wrong about that, but I think it'll be okay. I don't see any exclusion in my policy. I am covered for three cycles, so in a way I'd be "wasting" a cycle by giving up the transfer, but under the circumstances I think the trade-off's worth it.

@lathany, thanks. I had never heard of it, either. Unfortunately this fits in perfectly with my anxiety disorder, which appears to believe that worrying about things actually prevents them from happening... because it's never the stuff you actually worry about, is it? Therefore, by worrying about everything, nothing bad will happen! Right?

@pajamamommas, it's one thing after another, isn't it? BTW, I keep going back to look at the pic of Tadpole asleep over the side of the bed. So. Damn. Cute.

@insertmetaphor, thanks -- I know you get it.

I didn't even know I was supposed to be worrying about that.

Turns out I have Asherman's Syndrome (a.k.a. intrauterine adhesions or scarring of the uterus.) Impossible to tell whether it was caused by the c-section and then went on to cause the miscarriage and subsequent D&C, or whether it was caused by the D&C.

There I was all worried about my estrogen and follicles, when I should have been worried about my uterus.

Well, fuck.

I'm not sure what comes next. The online Asherman's support group say that it's very important to be treated by an experienced surgeon. There's one a few states away, near where my sister lives. I could go up there, I guess. I don't know. Maybe I should do a freeze-all cycle first. I'm 38.5 and not getting any younger. I don't know. It's all so exhausting to think about.

I would just like one fucking thing to be easy, thanks.