Two years later.

A lot of women who miscarry have problems with anniversaries. Sure, I remember some dates -- the very first time I was pregnant, the due date was supposed to be December 21; for my second miscarriage,  August 1; July 31 for the third and June 3 for the fourth.

I remember these dates but they really don't have any heat in them. I thought I was pretty impervious to date-ghosts. But the other day Her Indoors mentioned this year's Christmas Tree Festival. Now, I'm Jewish, but I love a good Christmas tree festival as much as the next girl, and of course Small Boy adores it.

And it was like a sock to the gut. 'Cause the last time time we were at the festival, I had a backache and was walking slowly because I was easily winded in that weird early-pregnancy way. That was what turned out to be the Sea Monkeys, miscarriage #3.

Why hasn't the date of my miscarriages bothered me before? Because duh, I've always managed to be pregnant again. First miscarriage, 5/08; in 5/09 I was pregnant with Small Boy. Second miscarriage, 12/11; by 12/12, pregnant again, although to no avail.

But I timed it wrong this round. By all rights I should have put off the transfer for another six weeks, so I could have been pregnant on the miscarriage-aversaries and then had that miscarriage at the traditional time of year.  But nooooooo. I had to do it early, so this year's miscarriage was in October, and so for the Christmas Tree Festival I'll be walking around not only not pregnant, but not even in the middle of a cycle.

I can't believe I'm here a year later, not only not having made any progress but having made negative progress. I have fewer embryos stored and I'm at higher risk for miscarriage, having had three in a row.

But I guess in a way I have made progress. I'm further along the road I'm going down, and I know that road is not endless. I'm closer to the point where I give up and start to Deal. If I'm going to subject myself to years of this pain for nothing, at least those years are drawing to a close.

Right now I feel like I'm grieving in slow motion. Not really, just kidding, maybe a little, if I mourn properly does it mean I'll then get what I want? I don't know whether to hang onto hope or just let it go. I wish I knew which the operative cliche was.

 I find myself reassuring people, friends, medical professionals. "It's okay!" I chirp. "I got my little guy!" And it's true but it's also not true. It's what good infertiles say, grateful ones, ones who don't think I should get to have what so many other people have. I am grateful, every day, grateful beyond breath for Small Boy and how he's spun my life and heart right around like a record, baby, I am, I truly am. But at the same time I'm angry that I'm supposed to be grateful and content with what it seems like practically the whole fucking world takes for granted.

The other day I walked past a box of First Response Early Result Pregnancy Test with FREE Keepsake Due Date Calculator! And I audibly scoffed. A keepsake due date calculator, after the first pee stick? Getting a bit ahead of yourself, aintcha?  And that's assuming it's positive. How many of those suckers get bitterly tossed into the trash?

But then I realized it's not that ridiculous. Most pregnancy tests are probably purchased by women who already suspect they're pregnant. Most positive pregnancy tests result in actual children. A keepsake due-date calculator on a two-pack of FRERs is utterly laughable from my point of view, but my point of view isn't representative. It's just my reality.

Small Boy is four, and we're going on lots of kindergarten tours, meeting lots of other families. This is the age interval when most families are mid-spawn, or have recently spawned. Lots of babies, lots of newborns, lots of big bellies, lots of brothers and sisters. I suppose in another five years or so it'll all simmer down other than the occasional "oops". That will be easier.

It gets better.

Things are better. I'd have to look at a calendar to figure out where I'd be right now; it's fading, gently, covered with snow. Maybe not coincidentally, my hCG is falling, too. Two weeks ago it was 21. I have a recheck on Monday and expect it to be zero.

There have been a lot of babies around me lately. The lady in line in front of me at the thrift store had two huge baskets full of stuff. Checking her out took a while, so we had time to chat.

"How old are your kids?" I asked.
"One month, three, four, and five." She laughed and rolled her eyes. "How old are yours?"
"Three and a half."

I don't know. People don't get to choose the thing that's hard for them. This lady was, judging from her clothing and heavily accented English, a recent African immigrant. I'm willing to bet that the journey and adjustment hasn't been easy, even if she has had the best of circumstances. I don't know where I'm going with this. People don't get to choose the thing that's hard for them. A friend of mine, the thing that's hard for her is breathing. How is that fair?  I don't know.

But never mind, on to happier subjects. Her Indoors and I had been waffling about getting married until we knew the likely outcome of the pregnancy. I definitely wanted to be hitched before the baby was born, for the legal protection it'd give our family. That meant probably a small courthouse-type thing. But now that that is no longer an issue, the calendar opened wide up, and we could schedule it far enough in the future to give us time to plan the wedding we really want. So: next December! I am insanely excited.  I've been madly pinterest-ing and browsing for silk velvet and roses and sari fragments. I want this, and I can have this. I'm burying myself in wedding prep and it's really comforting.

I'm going to cycle again once I'm able, and maybe I will get pregnant and stay pregnant, and maybe I will be enormous and pregnant at our wedding. But you know what? I can't plan around it any more. I have to go ahead and live. If I get pregnant, we'll adapt.

Not 12 weeks

Today I'm not 12 weeks. 12 weeks, the last week of the first trimester, the time when most people start sharing the news. I'd be scheduling my nuchal screen.

I'll stop this self-pitying countdown eventually, I'm sure. I'll just forget one day, and not remember until Thursday or Friday or something. I'm not trying to be mopey about it. It's just Wednesdays are hard not to count.

My body is apparently remembering by offering a fresh bright red bleed. I guess it's good? I mean, action is good, right? And maybe it'll help my beta come down, in case there's a wee clump of trophoblastic tissue somewhere generating hCG.  My pee sticks aren't notably lighter, which makes me grumpy. Last Friday my beta was 467; recheck in two weeks.

Here is my riddle: how is a BFN different than a chemical pregnancy different from a 6 week miscarriage different from an 8 week miscarriage?  After all, they all end up in the same place: unpregnant.

I am not sentimental about embryos. With eyes focused on the bottom line (i.e. chances of success) I have always pushed for the production and cryopreservation of as many embryos as possible. If we have any left over, I will cheerfully donate them to Science.  If I am not sentimental about embryos suspended in cryoprotectant, then why be sentimental about embryos in my uterus, or no longer in my uterus?

There is a difference, and that difference is the difference between missing a bus by seconds, minutes, hours, days, weeks. How hard my heart was pounding, how much I thought I'd make it, how ferociously I clench my fists and dig my nails in frustration.

A BFN is missing the bus by weeks, I think. A pre-heartbeat loss is missing it by days, and a post-heartbeat loss is missing it by hours. I can only pray with all my heathen heart that I never experience missing this particular bus by minutes or seconds.

Not 11 weeks

Today I am officially precisely not 11 weeks pregnant. It's been two weeks since I took the misoprostol, three since the ultrasound where the RE said "I don't see a heartbeat".

Things are okay. I had a followup appointment two days after the misoprostol, and everything looked good and clear. That was the best I could've hoped for. My pee-sticks are still a lot darker than I'd like, but I guess it takes some women a really long time to clear out all the hCG. I can't start another cycle until my level is all the way down and I have another period, so I'm just spinnin' my wheels here. I have another followup on Friday. I imagine they'll start doing blood tests every week or two until I'm at zero.

Time floats by so aimlessly when you're unpregnant. Pregnant means that every day is an achievement, and is moving closer to Something Big. Unpregnant you're just waiting for something that may or may not happen. And if you can only conceive with fertility treatment, you're waiting to start waiting for something that may or may not happen.

I'm mostly back in the TTC mindframe (as opposed to the pregnant mindframe). I know how to do this; I've spent a lot more time trying to get pregnant than I have actually being pregnant.  But some part of me, maybe 10%, is still stunned and saying wtf happened here?  See, it all just seemed so right. The transfer was exactly on my birthday. The due date was exactly my mother's birthday. My BFF is pregnant right now, and we were going to be pregnant together. Some things are just meant to be, you know?

Some things, but apparently not this one.

A poem has been stuck in my mind: A Refusal to Mourn the Death, by Fire, of a Child in London. I don't know why. I have only a weak affinity for poetry, and almost none for Dylan Thomas; most of it just reads as word-salad to me. But this one has been drawing me back. I guess "unmourning water" is really a pretty good description of the resting place of those two tiny embryos, poor miniscule brine shrimp, released unto the municipal sewer system.

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.

Waiting.

The good news is that I finally, finally, finally got my period, a cool 65 days after the D&C.

The bad news is that my blood pressure has inexplicably gone crazy, and I can't start an IVF cycle until it's under control again. If my cycle goes back to being regular (please please) then that means probably another 32 days.

Waiting, waiting, waiting.

On the interesting side, apparently two miscarriages and a chemical pregnancy adds up to "three losses", which won me a karotype and a recurrent loss panel.  I had about a pint of blood drawn; we shall see if anything turns up. I'll be surprised if it does. I honestly think it's just been a bit of bad luck. I mean, theoretically I know that for some people the ratio of positive pregnancy tests to babies is 1:1, but... it seems like a frankly ludicrous thing to expect.

I guess I'll spend this month, I dunno, inhaling lavender and doing yoga breathing and drinking pomegranate juice and stuff. I let a lot go by the wayside in order to survive the whole becoming-unpregnant thing:I guess this month is my chance to get as sane and healthy as possible before I get back on the crazytrain.

Errrrrrrrrrrrgh.

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

• 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.