Where do we go from here?

Merciful things: my hcg is below 5. I did not have to use my DIY Uterine Evacuation Kit. It is over, and was pretty painless.

That was my last shot on insurance. I have no idea what comes next. Crazy Al's IVF Shack? He has a clutch of my embryos from when I was a mere slip of a girl at 34. They're probably in better shape than my creaky miscarrying 38-year old eggs. Although it's possible the uterus is just broken. On the other hand, Al froze them in a second-hand popsicle maker, so the thawing attrition is likely going to be ugly. Al's documented success rate with frozen embryos is like 13%. If I wait until January I could have one more cycle covered at Al's, and out-of-pocket cycles are likely to be cheap because hey, Al.

From the clutch of 9 at Big Shiny Fertility Factory, I have three left. I could do at least one more cycle with them.  It would be out of pocket, and expensive. I'm a bit resentful about how expensive, considering that I now know exactly what the insurance reimbursement they received for the same cycle was, and believe me, it's less than half the amount I'd be shelling out.

Search terms recently typed into google

secondary infertility g-

Google helpfully supplies
secondary infertility guilt
secondary infertility grief
secondary infertility giving up

I don't know what's next. I didn't honestly believe that I'd be here. I somehow trusted in the narratively satisfying ending of my third attempt succeeding.  I am beginning to suspect that my uterus is not all that invested in my narrative satisfaction.

I would like to tag this with "moving on" but I'm not at all sure where I'm moving on to.

It's all over but the bleedin'.

Hcg 115. Game over.  Not too surprised -- after the bleed on Thursday night, on Friday I passed something suspiciously... embryo-like.  I had this wild fantasy that maybe it was one of twins (really, self? With those betas?) but yeah, no.  Honestly, I knew it was over then.

At least the timing is actually pretty good. I'm about to go to Vegas for a week for a conference, and now I won't have to bring shots. And I can drink coffee, and take the antihistamines I've been denying myself for the past two weeks. And it is blessedly not dragging me through beta hell, meandering across and down in a laggardly fashion -- that's a damn good sharp plunge.  Almost as if I'd, you know, passed the entire sac on Friday.  So I hope that's a sign that this will be over cleanly.

If not, though, I'm going to Vegas equipped. In my cosmetics bag I have a DIY uterine evacuation kit, leftovers from the last round: misoprostol, Zofran, painkillers. If this drags on in a painful way I can take care of it quickly. I probably won't use it, but I find it incredibly comforting that I have it.

Well goddamit.

Lots of bright red blood. I don't like this.

Beta #3: still truckin' along

952, for a doubling time of 44.23.  No complaints.

Ultrasound a week from Monday..

from 19dpo-22dpo:

from 16dpo-22dpo:

 

gulp.

19dpo: a surprise comeback?

Recap: After coming out of the gate strong with good pee-sticks, she managed to muff the first fence, scraping over beta #1 with a score of less than 100. Her form has improved considerably between the first and second fence. Beta #2 came back at a very respectable 308, for a doubling time of 44 hours.  She's clearly rattled by the first fence, but let's not write her off just yet. This one may yet have a chance.

Okay, I'll... stop talking about myself in the third person as if I were a horse now. I'm a little punchy and adrenaline-y. My heart was pounding as I clicked open that email.

So! Here I am. Her Indoors is going away on a trip and then I'm going away on a trip so I get to learn how to give myself IM injections. Thank goodness my bum's mostly numb by now.

I'm grateful. What I wanted was either

1) A clearly good results, like this, or
2) A clearly bad results.

And, of course, I rather preferred #1.

I dreaded getting a 180, a 200, something like that -- not quite low enough to pull the plug immediately, but far too low to be healthy. So I'm damn grateful.

Next beta on Thursday.

Various Items

Item: After finding the not-so-bad 60%, I then found this which puts it at 25%. Humph.

Item: As far as my personal statistics go:

Pregnancy #1, 16dpo beta = 120. Outcome: miscarriage.
Pregnancy #2, 16dpo beta = 224. Outcome: Small Boy.
Pregnancy (?) #3, 15dpo beta = 8.  Outcome: chemical.
Pregnancy #4, 16dpo beta = 144. Outcome: miscarriage.
Pregnancy #5, 16do beta = ~320 (calculated). Outcome: post-hb miscarriage, twins.
Pregnancy #6, 16do beta = 98. Outcome ?

Jeez, when I put it like that it doesn't look so great, does it.

Item: when I google "accepting secondary infertility" I'm deeply ticked to find out that almost all the hits are to articles/ posts written by women who struggled with secondary infertility... before going on to have their second or third child. Gosh, thanks, guys. That really helps.
  
Item: I once heard someone say "when someone dies, a library burns down."  I guess when someone isn't born a library isn't even built. I feel like I'm staring at a field, a space where a library will never be built, will never fill with memories and experiences. It will always just be... quiet. 

I don't feel like it's a horrible loss to the world. The world has plenty of people. I wonder how much of a loss it will be to Small Boy. He's occasionally expressed an idle desire for a sibling but nothing serious, and I don't think there's any reason that an only child can't have a perfectly delightful life. It's just me, mostly, maybe. I wanted to get to know another child. Small Boy has been such a revelation for me. I wanted to know what other revelations there were, to feel my heart stretch once again.  I guess I wanted to know how much richer life could get. A greedy wish, but mine.

16dpo beta

98. Not a complete disaster, but not great. Average is about 200 at this point. Assuming perfect doubling (ha! ha!) best-case scenario is a 15dpo of 75ish, which translates into about a 60% chance of live birth, 40% miscarriage/chemical according to my favorite oracle. It's not chasing unicorns, but it's certainly chasing... something that runs away, but is sometimes a catchable. A chicken? Fine, a chicken. Chasing chickens does have a certain "going in circles over the same ground" quality that seems appropriate.

I am so sick of this bullshit, I can't even tell you.

So now I'm passing the time until Monday. I was really hoping not to use the tag "beta hell" for this cycle.

The day before beta

Jest passin' the time. Every now and then I pee on a piece of cardboard, squint, and alternately decide

a) it's wayyy darker omg must start googling strollers now! now! how are we going to afford daycare? should I try for a VBAC?
b) it's wayyy lighter and I wonder if I'll get all the way to misoprostol, now my preferred abortifacient, or if it'll poop out on its own.

Neither of these reactions is either warranted or helpful.

I'm just not very good at sitting and waiting.

I'm going to be in a meeting for most of tomorrow. I've asked the nurse to email me the beta results. Probably my favorite thing about this practice is that they don't mind emailing results.  I have some serious PTSD from the hold music at my last REs. I'd be waiting and waiting and listening to the loop and my heart pound and pretty soon my blood pressure started to shoot up as soon as the music started. Plus I'm always afraid I'll hear something wrong or write it down wrong or something. With email there is only the barest pause between seeing that I have the email and seeing the results. 

So. Tomorrow.

6dp5dt (11dpo)

Annnnnnd we have a line!

Faint, but there. And while such a faint line is bad news at 14dpo, it's okay at 11dpo.  Just have to see where this one goes, if this little thing has what it needs to continue its journey.

Trying to stay quiet. Keep breathing, keep living, and if I do a bit of hoping, that's okay. One of the things I think I've learned on this journey is that almost nothing can dislodge a good pregnancy and absolutely nothing can save a bad one.  The coin is still flipping in the air as to which this one is -- but it hasn't landed yet, which means we're in with a chance. 

FET #5, the night before

This cycle has flashed by strangely. I haven't done acupuncture, and my wheatgrass intake has been quite erratic. I still got scanned with the best lining I've had since pre-Small Boy, so that's nice. I think it was the fruity pills.

I feel... quiet. Very quiet. Usually I'm frantically consulting auguries by now, but I haven't looked at a single set of entrails.  This is the last round for a while, at least. If it's not going to work, I don't want to know it quite yet.

Her Indoors can't come with me to the transfer tomorrow, as she'll be trapped at work. I actually feel fine about that. I'm not sentimental about the process at this point.  I'm just going to go in, have a couple of embryos transferred to my uterus, continue with my life. It sort of matches with the quiet I'm feeling now.

FET #5: estrogen day 4

Final grade for the NuvaRing: B+. It did eventually engender in me a certain amount of irritability (ahem) and sore breasts. The most distressing side effect was a cystitis-y bladder irritation. I was annoyed enough that I took it out on 2 am of the day I was supposed to remove it. Overall, though, a solid performance. OCPs get a straight D.

I think my favorite thing about the NuvaRing was the way it did not require me to do anything every day. I couldn't feel it, and for those 21 days  I could just forget about the whole TTC thing. Good stuff.


I'm now on intramuscular injectible estrogen. It's a small quantity, but since the carrier oil is very thick it still hurts sometimes. But it's only every three day, so no biggie.

I am also, following on the lining success of my past two cycles, taking via-oh-god-please-don't-spam-me-gra. Except when I ordered it from my grey market Indian pharmacy I did not order enough for three cycles. I guess I thought it would be... negative? Pessimistic? Evidence of a disturbing lack of faith? Anyway, I got enough for two cycles. But for various reasons, I have just enough now to scrape thinly over the third cycle provided I use the bonus "buy some get a free gift!" tablets, which were a higher dosage. I'm cutting them with a pill cutter, so fine. The funny part is that the free ones? Soft chews. So the ones I am cramming up my nether regions are fruit flavored.

Lining check on the 11th.

Three

Last night I dreamed that I was pregnant with triplets. I gave birth and as each one came out, I found out that it was dead. I kept thinking "surely the next one will be okay" and at the end I was sobbing with grief and anger and disbelief.

Three means a lot of things. My family as it is right now is three. This is my third FET at Big Shiny Fertility Factory. My insurance allows three attempts per live birth. I have had three miscarriages. When I was little, I always thought I'd have three children. I wanted to have my children three years apart. Small Boy has three donor siblings currently in utereo.

It's just a number. My fave bit from Foucault's Pendulum -- actually the only bit I remember much -- is when the protagonist's girlfriend, mother of his child, gives him the big ol' eye-roll for his numerological conspiracy theories.

We move on to the magic numbers your authors are so fond of. You are one and not two, your cock is one and my cunt is one, and we have one nose and one heart; so you see how many important things come in ones. But we have two eyes, two ears, two nostrils, my breasts, your balls, legs, arms, buttocks. Three is the most magical of all, because our body doesn’t know that number; we don’t have three of anything, and it should be a very mysterious number that we attribute to God, wherever we live. But if you think about it, I have one cunt and you have one cock, shut up and don’t joke and if we put these two together, a new thing is made, and we become three. So you don’t have to be a university professor or use a computer to discover that all cultures on earth have ternary structures, trinities.

She moves through all the numbers, the point being: all and none of them are sacred.

I'm on the NuvaRing now, getting ready for FET#5. It's all happening quickly, so quickly that all the bills from FET#4 haven't rolled in (and been disputed by the insurance company) yet. High, high marks for the NuvaRing so far. Only side effects are mild nausea and sore breasts, and vague irritability. Birth control pills give me severe nausea, migraines, and constant blinding rage towards the universe. It's better this way.

This round officially over

Official negative beta. It's not like I didn't know it was coming.

I was -- amused? -- to realized why I was so sure I was pregnant. It's because, prior this, I have had six transfers. For those six transfers, only one of them was an outright negative. One was a chemical, and the other four were positives.

Furthermore, my frank negative cycle was in 2008. So I basically have no idea what the side effects of progesterone are like in the absence of pregnancy. I mean everyone told me that "progesterone makes you feel like you're pregnant", but I rather poo-pooed that -- I mean by now I surely can tell the difference, right? Those heavy cramps and heartburn, that's totally a pregnant thing.

Yeahno. Everyone's right. It's just progesterone. Good thing to remember for the future, I guess.

8dp5dt: nope.

Game's pretty much over. For some insane reason, Big Shiny Fertility Factory likes to do their betas two goddamn weeks after a 5-day transfer. This makes zero sense, except in the respect that it save them the effort of even dealing with women with short-lived chemical pregnancies. By 19dpo, either you're showing up good and dark on a plain ol' urine test, or you're negative and have been for some time. Which means that you've spent at least a solid week getting painful, expensive, and unnecessary rump-injections. Worse, many women (not me) may have spent an entire extra week consuming neither alcohol, caffeine, nor sushi.

I delicately pointed this out to my nurse, who agreed to let me come in on Friday (15dpo). Much better. At least I can spend the weekend letting my glutes recover.

I'm okay. I'm starting to try to wrap my head around the possibility that this may not be the story of my difficult journey towards the family I have always envisioned. It may be the story of my journey towards letting go of that vision.

I have an embarrassingly large collection of beautiful high-end baby carriers. I guess when the time comes I'll sell them and buy myself something really, really pretty.

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.

Pills and newborns and ramblings

The first step to an IVF cycle is the taking of birth control pills, and believe me, the irony of this is lost on no one.

I hate this bit. They make me depressed, they make me nauseated, and I have the sneaking suspicion that they're not actually necessary. But I'm also apparently not interested in fighting it, so the little yellow pills I do pop.

I just got back from a solo cross-country visit with my best friend and her family, which consists of a husband, two preschoolers, a two month old baby, and an adolescent dog the size of a Shetland pony.

I had a great time. I was a bit nervous that my Crazy would boil over and get all over the newborn's sweet fuzzy head -- this is the baby that BFF was pregnant with while I was (briefly) pregnant with the Sea Monkeys, and I had so fondly imagined us being the mothers of newborns together.

But it was better than fine.  There was a certain leaning-on-the-bruise aspect, but it was far outweighed by the sensory delight of handling a tiny baby again. I got to wear him a good deal, and I love wearing babies. I smelled his head and stroked his wee crumpled hands and gave him bottles and it was not even bittersweet, just sweet with a side of wistful.

The only really painful moment was an unexpected one -- I was wearing him on my back and BFF and I were picking up the two older kids from nursery school. One of the other moms was chatting and airily said to BFF, upon being told that I was visiting "Oh, my best friend doesn't have kids either, it's great because they can help out, huh?"  It was a perfectly innocent thing to say, but I was just overwhelmed with ouch and couldn't say a thing back. I just froze. What felt like a year and was probably a few seconds later, BFF firmly corrected  her and said "no, she has a little boy at home with her partner".  And the world started again and everything was fine.

I mean, it wasn't a crazy assumption. How many mothers can just take off across the country to visit a friend? (Mothers of one who have a tolerant partner, that's who.) And how was she supposed to know, looking at me, that I am a mother? She couldn't see my c-section scar. I wasn't wearing a pin that said I gestated a child, ask me how!

I don't know why that spiked my grief, or why even remembering it now is so painful. Maybe because just for a minute it dangles me over the cliff of how close I came to not being a mother at all. It's becoming clear that my body doesn't love producing babies. Maybe our little guy was a complete fluke, a one-in-a-million. Maybe someone is going to show up and tell me that it was all a mistake and I don't get to keep him after all.  Nope. I don't care. I'm not giving him back.

This morning I was telling my boss about my trip and seeing the new baby. "It didn't give you ideas, did it?" she joked.

"Hahaha!" said I. "Ha! Ha."





It was a lovely trip. We ate stunningly good food, got massaged, got manicured and pedicure'd, and engaged in plenty of the activity I've missed most: chatting aimlessly with my best friend within hugging range. I'm awfully glad I went.

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.

Year of the Wood Horse

I possibly, sort of got my period last week. I had outpatient surgery the week before that and the preop bloodwork went off without a hitch, so I'll assume that my hCG is down to zero (they tend to get tetchy about operating on pregnant women). Which means I could start again, right now.

I'm not. For the first time since starting TTC, I am taking a voluntary break. Since I began (both the first and second time) I've always felt like there was a drill sergeant barking "GO GO GO" -- just imagine one wearing a hat that says "FSH" on it.

Well, that drill sergeant is in the freezer next to my embryos and several pints of Ben & Jerry's. My eggs aren't getting any older. My ovaries will never be called upon again. No matter what happens, I'm not going to do another fresh IVF cycle.  I am lucky to have a generous batch of embryos. When I run those out, I'm done.

Any other haste would be driven by a desire to control the age-gap between Small Boy and Smaller Sibling. I wanted three years, didn't get that. Won't get four years either. Does a few more months really matter? I think not. I think if the sole consideration is temporal spacing, a few months' rest is not significant.

And I really want a few months off. I want to live on my own schedule, not buffeted by hormones and nerves. I want to do house projects and snuggle my child and future-wife (fiancee?). I want to plan our wedding.

Interestingly, I have experienced the exact same phenomenon all three times I have miscarried: while my HCG levels were declining, I felt a burning urgency to get pregnant again ASAP, and despair over how long the time gap would be until I could try again. And all three times, after my HCG had faded completely, so did the suffocating need to get pregnant immediately. *shrug*

I will, kinnehorah inshallah god-willin' and the crick don't rise, start again at either the end of April or the end of May. Until then, I'm just going to enjoy living.

Either of these dates would put any possible delivery in the Chinese year of the Wood Horse. I think that sounds like a really nice year to have a baby. Wood Horses are warm, stable, strong. I like it.