the closing of the year

So Al's IVF Shack shut down, or... was shut down, or something. The upshot is that Al's was no longer going to be offering the service of changing the ice packs and playing developmentally-enriching Mozart to my Tiny Frozen Americans. I had to get 'em out, and get 'em out by December 1.

They notified us in November, and it sent me into a bit of a tailspin.I have been moving towards making a decision... very, very slowly. Not with two weeks to decide.

Now here's the point at which this could be a different story. I could say, dear reader, we did a crazy whirlwind cycle, it was all a blur, my lining came up surprisingly well despite the lack of fussing and greymarket drugs, and surprise! I'm pregnant! and I didn't want to tell anyone until I'd seen a heartbeat!

But that's not what happened.

It was unseasonably warm and sunny on November 25. I called the lab and they agreed it was a fine time for me to come over. I went to the lab. I signed papers. They handed me an medical-supply envelope containing five tiny plastic tubes. The tubes were covered in frost when they handed them to me, but by the time I reached my car they were already just cold. I took them upstairs. I sat in Small Boy's room, which I had thought would keep being the nursery, as it's the smallest room in the house. I wanted to sit in the rocking chair but we had already sold it on Craigslist, to a nice couple with three small children who needed it for #4. I sat on the rug instead. I cried. Then I found the pack of wood-resin incense that I burned back when I was pregnant with Small Boy, praying with every cell of my atheist's heart that he would be okay. There was one stick left in the pack. I stuck it in the little bowl incense holder. I snipped open the tubes and emptied them into the bowl. Five straws of embryos made half a teaspoon or so of fluid. I had the urge to swallow it, to at least have it in me that way, but I'd talked about it before with Her Indoors and she reminded me that there are some serious chemicals that go into embryo culture medium, and I agreed that it would be an incredibly fucking stupid way to get sick. I lit the incense, and it burned.

And that was that.

I still have three embryos left at the Big Shiny Fertility Factory, three out of the nine. I'll have to make a decision about them in April or May. Or, more correctly, I'll have to make the decision about them in April or May. The evidence keeps piling up. I know what I have to do.  But oh, do I shrink from doing it.

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.

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.

Okay, breaktime's over.

I'm ready to start again.

It's been a good extra month. I am hypertensive, and there is a rather short list of pregnancy-safe medications (which of course I've been on temporarily for, oh, two years now while TTC). I was on a high dose of labetalol, which worked okay but made me super tired all the time and also dizzy whenever I bent down.

At the start of last month I thought "fuck it, I have to start living my real life, baby or no baby." So as part of the reclaiming-my-life project, I marched down to my GP and told her I wasn't happy on labetalol.  I've found an alternative (nifedipine) that appears to be working, and omg how much do I love not dreading buying something from the bottom shelf at the supermarket. I hadn't realized what a drag constantly trying to not squat or bend down was. I feel freeeeeeee!

My energy has come back, too. I'm in a positive feedback loop right now where because I'm not so tired, I'm getting a lot more exercise, which in turn energizes me. I've also put some major effort into upgrading my diet. Her Indoors was away for a whole week and I was rather afraid I'd starve, and so bought some meal-replacement spirulina-peatmoss-whatever protein shake mix.  That got me started on a smoothie kick,and I discovered that having breakfast and lunch smoothies seems infinitely easier to me than preparing and packing breakfast and lunch. I got a one-serve portable blender and have been going wild. For breakfast this morning I had coconut milk, soy butter, kale, and strawberries.  Lunch was avocado, kefir, spinach, cilantro, lime.  Nommm! I don't really do the protein powder shakes any more, but it's comforting to have them as a backup in case I just can't be arsed to cook (in the past, when I couldn't be arsed I'd just eat whatever random crapola came strolling by my desk). I haven't eaten this well in years, and I am actually approaching a so-called-"normal" BMI for the first time in about a decade.

And yeah, did I mention more energy? I've been taking Small Boy to the playground every day, which is awful good for both of us. Small Boy is an awesome small boy, and does something side-splittingly funny at least four times a day.

I dunno, things have just been good.  The last miscarriage is far enough in the past that it all seems like a dream now. Come on, what was I thinking? Pregnancy seems mysterious, remote, something that happens to other people.  Remote feels much better than just-outside-my-reach.

So of course, now that I'm feeling calm and happy and healthy, what I need to do is fuck it all up. Get back on that crazytrain of tests, hormones, appointments, waiting uncertainty, peeing on strips of cardboard, squinting at lines.

I'm expecting my period to start in the next few days. Between days 5-15 I'll have an HSG. If that looks okay (please) I'll start another FET cycle.

Really, with that much fun? How could I stay away?

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.

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.

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.

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.

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...

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.

8 days past D&C: the next act.

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

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.

Canceled for bad endometrial behavior

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.

Waiting for the flood

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.

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.

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

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.

12dpt3dt: beta day

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.

CD54/ 15dpo

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

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.