Tuesday, August 27, 2013

7w3d - Perfectly Crazy.

Being crazy is a sad affair. It's exhausting being irrational ALL THE TIME. But I must. I have no choice.

Today has been a freaking wonderful day. Chicago finally decided it's summer and is spitting out some decently hot weather. It's the type of day where I'd crack a cold beer on the porch were I not knocked up via petri dish emulsion fluid. No complaints, just saying. I'm very happy with my flavored sparkling water. We had our 7w3d ultrasound this afternoon and for the first time ever, our Dr. M proclaimed our rapidly growing blob "perfect." I haven't heard the word perfect once in this whole infertility rigamaroll. It was pretty dreamy. J and I left the clinic grinning like idiots. We know we're not out of the woods yet but damn it feels good to be a gangsta. Mixed metaphors just feel right today. While waiting for the elevator at the hospital (OB-GYN and Reproductive Endocrinology are on the same floor because they're super sensitive and awesome like that), J complemented a woman on her choice in strollers. Now, that's a completely bizarre thing for a man to do. But it's very J - he's an oddly observant and aesthetically inclined individual - and it warmed my heart. Our ultrasound today allowed us to think beyond the next week or so.

Here's where the crazy comes in. (Cuz it always does.) I'm texting Maggie about random nonsense and she tells me that one of her friends is pregnant. I know this friend, though not well, and would typically wish her no ill will. But my immediate knee jerk reaction? Bitch. I haven't had much practice as a pregnant woman and certainly almost none as a calm-not-worried pregnant woman but I have had years of practice as an infertile woman. And she came raging out. Why am I still annoyed that people can get pregnant by having sex? I don't know, but I am. I'm still in the only-infertiles-and-my-bestest-friends-are-allowed-to-get-pregnant stage. How long does that stage last? Possibly forever? More so than nausea, lingering malice towards the fertile is my least favorite pregnancy symptom.

Monday, August 26, 2013

Glow - A Fertility Insurance App?

S just forwarded me this article on Mark Levchin's (PayPal cofounder) new fertility tracking app, Glow.* My first thought as a seasoned infertile was probably the same as yours: there are already 37 fertility apps out there. Maybe 1,037. Frankly, from a tracking standpoint, Glow seems to be the same - you enter the average length of your cycles, date of your period, your basal body temperature, and - everyone's favorite - the consistency of your cervical mucus. You can also add comments about your stress level. One of the things that sets Glow apart is that it has an app for men. Basically it will share this information with your sensitive man. Said husband can also enter data about you, specifically whether or not you seem stressed. am stressed, you say. My uterus is all janked up and my husband's sperm swim backwards. But let's say your uterus isn't janked up, or you don't know if it's janked up or not. The microscopic contents of your husband's semen is a big sticky question mark. All you know is that you want a baby and you've heard unprotected sex is an effective method of achieving your new goal. Your choices are to A) have sex when you feel like it and hope for the best, B) order Taking Charge of Your Fertility on Amazon, learn about ovulation signs, and properly time intercourse with the help of a free app like Fertility Friend, or C) Pay $50 a month and sign up for Glow where you'll track the same info you'd track had you chosen Option B.

So why do it? Why pay to take your temperature in the morning and study cervical seepage? That $50 you pay per month goes into a pool. If you are pregnant within 10 months of signing up for the app then good for you, you bought the most costly app ever. But you get a baby. So stop complaining, it's not like kids are expensive. If you don't get pregnant within 10 months, the idea is that you should check into a local fertility specialist's office. (Naturally, Glow will direct you to one in your neighborhood.) Levchin says that at least double what you've invested in your Glow app - and much more in the future - will go towards the cost of your treatment. Maybe now that means covering the cost of your Femara or an IUI, but in the future it could cover the cost of a cycle of IVF. Levchin has already invested one million of his own dollars into Glow and has raised $6 million more. Essentially this is an insurance scheme. Most of us don't get in car accidents but when we do, we sure are happy that we've paid our monthly insurance bill and that the repairs are covered. Most couples don't need help getting pregnant but many do. Is $500 a reasonable risk to put down on your fertility?

Honestly, I'm stuck on this one. On the one hand, Levchin has publicly recognized what most states and insurance companies haven't - infertility is a legitimate physical problem with serious emotional, mental and social repercussions worthy of care and coverage.  The idea of elective self-insurance is exciting and could very well be ground-breaking within healthcare. I am concerned, however, that this app takes advantage of women's anxiety over their own fertility. While I consider myself an educated consumer, I'm embarrassed to admit that I have personally have thrown money away on ridiculous ebooks and programs "guaranteed" to improve my chances of conception. (I say ridiculous not because they didn't work for me, but because they were junk science marketed to very desperate women, like myself.) Also, with a $50 per month price tag, isn't Glow potentially offering a service to those that are better equipped to pay for assisted reproductive technologies anyways? True, $500 is a drop in the IVF bucket. Levchin states that he wants to use the data he farms on his app to shed light on various factors that can affect fertility, like weight and stress. That data may say more about the type of women that use the app; let me go out on a limb here - Type A, compulsive temperature checkers with a hunch that pregnancy might not come so easy.

I live in one of the very few states with an infertility insurance coverage mandate. Infertiles in Illinois and Massachusetts are very, very lucky. From a financial standpoint, I probably shouldn't take a stance at all. From an ethical standpoint, I'm conflicted. Glow is potentially exciting, certainly innovative as a healthcare funding concept. Maybe putting the idea out there is enough. (Well, the idea plus $6 million.) What do you think? I'm so curious to know.

*Interested to learn more about Glow? THIS INTERVIEW with Mark Levchin provides much more information than the article.

Tuesday, August 20, 2013

Flanders Fetal Pole Day

I've been a bad blogger lately because I've been so ding-dang-dobbly nervous. Really, it's a miracle that I only write like Ned Flanders because I feel like talking like him too. Such is my nervous energy. In the past week you could find me A) pretending that everything's normal and I'm not pregnant and therefor not headed towards the temple of doom or B) happily focusing on my low-grade nausea and poking at my boobs. There's not much to share about those varied experiences. I've had an absurdly short fuse with J which I feel both bad about and occasionally justified for. Doesn't he understand that I need to be completely immobile on the couch watching the Kardashians and knitting* between weekly ultrasounds? Doctor's freaking orders.

So, today was a big day. The day where everything fell apart last time (though things were admittedly completely in pieces long before that), the 6w3d ultrasound. This time however was so wonderfully different. There was a fetal pole with a heartbeat that you could see and hear. It was amazing. Now, as I said before, two pink lines + an ultrasound do not a baby make. But a heartbeat is a huge leap from where we were before and I'm doing my best to simply revel in it.

I also was asked the most beautiful questions an infertile can be asked, "Do you have an OB selected?" Who, me? Why would I need one of those? I don't even have a vagina, I have a convenient charging port for the ultrasound wand! I was told to make an appointment in one month because I could (still) be pregnant in one month. Son of a diddly. There's Ned again.

Poignant questions: Why is human gestation a million years? Is hysteria good for fetuses?

*No, I have not lost my infertile mind. I'm still knitting that summer sweater for myself despite the fact that it's late August. I'm not going to do anything reckless like knit a baby item. Geez.

Thursday, August 15, 2013

Small Victories, Not Ectopic

Ladies and gentlemen (like there are actually gentlemen who read this),
Breathe easy. It is not ectopic. Previously mentioned ectopic phase is over. Confirmed via ultrasound at 5w4d. Ocho Cellito is planted firmly within my uterus, just north of center. So, that's the good part. I don't know if there is a bad part but J and I left the clinic feeling like utter doomsday. It was a shitty appointment instead of the celebratory jig it should have been. It left me confused and completely freaked. Here's how it went.

This time, I specifically requested that I see my RE, Dr. M, instead of whoever was available at the clinic that day. After I checked in, a 15-year-old called me and introduced herself by her first name - Kristen, not Dr. Kristen - and said that she was Dr. M's student. Fine. University teaching hospital. Both my parents worked and taught at teaching hospitals. They incredibly important institutions, at the forefront of research, blah blah blah. All good until it involves my uterus. I'm asked to undress from the waist down, as per usual, and J pipes in "Me too?" to break the ice. I laugh. Less nervous. I casually remark to J that I'm feeling very que sera sera about the whole affair and I actually believe that it's true. Dr. M and Kristen come in and Dr. M says "I hope we get you off this roller coaster soon." I concur. I assume the position and Kristen takes the lead. She searches and searches with the dildocam and finds nothing. Not even something resembling a uterus. Dr. M remarks, "Having some problems finding your uterus," with a smile. "Pretty sure I haven't lost any major organs lately!" I'm fucking dying. Finally Dr. M takes over and quickly locates the large object attached to my cervix. In it, an obvious gestational sac and yolk sac. Excellent. It's much larger and more obvious than last time. Dr. M points to an invisible white dot that he says is most likely the beginning of a fetal pole. I couldn't see it. Ovaries clear. Sitting up sans violating wand, I asked Dr. M if everything looked ok. "Yeah," with a shrug. What about the size of the sac? He looks at the print out a while and after a while says, "On the small side of normal." Upon leaving, he said, "Well, we'll see what's going on next week."

That's it. That was our first ultrasound. Nothing terribly negative but no one passed out cigars, either. I don't think Dr. M smiled once. I left feeling horrible. Small side of normal echoed in my head. It sounded too much like my 6 week ultrasound with my first pregnancy - measuring behind. I should focus on the "normal" part. Everything that was supposed to be there was there. Why the doomsday approach? Why act like the search was for a malignant tumor instead of the hopeful beginnings of a baby? Was he underwhelmed by my betas? The petite gestational sac? Or was he just bashing me over the head with the fact that the 5.5 week ultrasound isn't a particularly telling signifier of pregnancy outcome? Two pink lines and an ultrasound does not a baby make.

I'm starting to get pretty fed up with my clinic. Yes, there are some stellar caregivers there but the overall attitude sucks. I feel like their motto is "Shit happens." Sure, but can we at least fake a tiny orgasm when things don't appear to be circling the drain?

Today I'm feeling better than yesterday. There's nothing I can do but wait it out and take care of myself both mentally and physically. My next ultrasound is scheduled for Tuesday, 6w3d. I've been holding out for that ultrasound as the one that leaves me feeling finally confident. I need to let go of that expectation. Every glimpse should be uplifting but its unreasonable to expect that a single event will make everything better.

Tomorrow my best girlfriends leave for our annual summer vacation. This year they're headed to Santa Fe, NM. Very sadly, I won't be joining them but for good reason. I know that flying is theoretically safe during the first trimester but I'd rather take a bubble wrap approach this time. Should I miscarry again, I don't want to have anything hanging over my head. I'm staying put for my sanity and my growing embryo. As I've told them, the only thing I'd rather do than be on vacation with them is get knocked up. Well, bitch be knocked up. On the other hand, my sister asked me to come up to our parents' cabin with her this weekend to celebrate her birthday. Just us and the hubbies. I don't think my nerves over my fledgling pregnancy will be soothed at all by three days spent around her jubilant, glowing belly. Also, I haven't told my family yet. I am waiting until things feel a little more settled. Maybe next week (see previous paragraph) if/when I see a heartbeat. I'm going to respectfully decline the invitation and tell some white lie about work. Or not. Maybe the truth. Undecided.

Physically - 5w4d, still pregnant. Waves of nausea that last for an hour or an afternoon with no rhyme or reason. Tender boobs.
Mentally - Juggling cautious optimism with unease. F-ing terrified to miscarry again. My brain and heart would explode.

Friday, August 9, 2013

Loving Jimmy Fallon

Here's a confession that is no surprise to anyone who actually knows me: I love celebrity gossip. I know it's dumb. I still love it. And I love stupid TV. So sue me. I can be an intellectual AND watch Princesses of Long Island at the same time. It's called mental multi-tasking.

As my fertility issues have dragged on, one thing that has seriously irked me is the glowing announcements of elderly celebrities just thrilled to be - surprise! - pregnant at the age of 85. Good for you! IVF donor egg confessions anyone? No, I didn't think so. You're naturally lean and muscled, love a good burger and got pregnant via sexual intercourse despite the fact that you're pre-menopausal. I one-hundred-percent believe everything you told People Magazine to print. So, when Jimmy Fallon announced that he and his 46-year-old wife had a baby named Winnie, my initial response was twofold: 1) Winnie is possibly the cutest name ever. Good work. 2) Forty six? What a flip-flapping miracle a la Virgin Mary Halle Berry. I decided to focus on the stellar name choice and moved on. Then, this morning, my beloved People.com published a story where Jimmy states that Winnie was carried by a surrogate and says, unapologetically, that they had struggled with infertility before turning to surrogacy. Bravo! Thank you! Thanks for being honest and not pretending that your lovely wife is one of the three women in the world (Halle) who has primo eggs in her mid-forties. I am forever impressed by people's honesty about infertility and miscarriage. It makes it so much easier for those of us in the trenches. If this kid sticks, I feel like I'll want to tell the universe how hard won it was.

A quick update. I am doing pretty well. Still bouncing among scared-anxious-thrilled-beatific. Yesterday was my "ectopic" phase. S assured me that I would go through an "ectopic" and "molar" pregnancy freakout before I accepted that I had an intrauterine pregnancy. Molar seems like a bit of a stretch but she was on the money with ectopic. J assured me I was mildly nuts. I told him that I felt twinges on my right side and he said it was only because I was thinking about twinges on my right side. Maybe, maybe not. Ectopics happen! Then again, so do brain tumors and bank heists. Not worth worrying over at this juncture.

Mental issues aside, physically I am tired, feeling generally "meh" and my boobs have varying degrees of tenderness throughout the day. I'm also having the craziest night sweats ever which, Dr. Google tells me, are due to fluxuations in hormones. It's disgusting or charming depending on whether you're into wet sheets.

Signing off, with much love.

Wednesday, August 7, 2013

Beta Three. Metaphor Addiction.

This embryo is incredibly consistent. From 199.3 to 367, another doubling time of just under 55 hours. Again, it's not the 48 hours my clinic would like to see but I'm still within the 48-72 hour zone. Enough math. I am satisfied. Clearly I wanted them to call with a beta number somewhere in the ballpark of a billion but I am happy to be steadily increasing. I have decided - with no science to back me up - that the consistency of my rising HCG levels is a positive sign.

A different nurse called me this time. She was less gloomy and far more encouraging. She assured me I was still "in the game."  That said, given that I didn't perfectly double, she asked me to come for a freaking fourth beta. I asked if I had to and she said "no." So, I'm not.  I think three betas gives them plenty of data to play with. These repeated blood tests are making me so anxiety ridden that I'm failing to rock the serene maternal glow that I had this past weekend. I want to get back there. That was awesome.

So, next step is an ultrasound next week. It will put me at 5 weeks 4 days. Part of me would like to wait for 6.5 weeks so that I could get a better sense of what was going on - heartbeat, measurement, etc. I don't know. I'm gun shy. Last time things looked good at my 5.5 week ultrasound (well, except for the horribly low betas and the excessive bleeding) and then shit fell apart at the 6.5 week ultrasound. Perhaps I'm trying to spare myself the roller coaster. Perhaps I should just accept that I'm already clearly on the ride.

(I am addicted to metaphors. And parentheses. There are far too many of both those things throughout this blog. But I like them and find them useful.)

IVF ladies, did you have your first ultrasound at 5.5 or 6.5 weeks? Just curious.

Lastly, I saw my therapist today. Yes, I go to a therapist. And an acupuncturist. And a RESOLVE group. And I have a blog. I also text and email my friends 40 times a day. It takes a motherfucking village. She talked to me about "graduating" to a normal OB. This was such as happy thing to talk about and made me feel so joyful. Life as a normal uterus would be wondeful.

Monday, August 5, 2013

Beta Numero Dos

Beta #1 (8/2) :  80.2
Beta #2 (8/5): 199.3

More than double Friday's beta, slightly under the "ideal" 48-hour doubling period. Before you post comments lamenting my upcoming death from swine flu or sluggish HCG betas, please know what I've been trying to drill into my head for the last few hours: anything between a doubling time of 48 and 72 hours is normal and dandy. This is according to The American Pregnancy Association and a plethora of other reputable sources. What could be more American than this petri-dish derived pregnancy fueled by mega-doses of synthetic hormones? My uterus is practically setting off fireworks, grilling brats and making jello salad. Of course my cranky university hospital RE clinic subscribes to the 48-hour-textbook rule and has asked me to do another beta on Wednesday. The nurse who called wasn't particularly negative but wasn't planning my baby shower either. Sigh, involuntary beta hell. Whatevs. Ocho Cellito is hanging on and clearly growing.

S, of guest blogging fame, went to see her OB today. She is (possibly romantically) in love with her OB and promised to ask her for feed back on my digits. S says that her doc "squealed" and said they were great. She said that a 66% rise in 48 hours is typical and that my numbers were strong. Strong like bull. Is it ridiculous to want to choose her as my future OB (hoping that all goes well)? Now what if you found out that she practiced in Boston and I reminded you that I live in Chicago? Yeah, a little nuts. But I love her optimism. She wrote my name and numbers in S's chart and said she expected updates. Love it.

I'm off to acupuncture this evening where I know I'll get another dose of positivity and relaxation. Nothing to do breath deeply, get stuck with tiny needles, and relax. No more google for you.

Or, Try Happy.

I hemmed and hawed over whether to write this before my second beta results or after. I chose before because que sera sera.

As you could undoubtedly tell from my post on Friday, I was completely terrified to be pregnant again. A friend of mine who has suffered from RPL (repeat pregnancy loss - due to male factor) and is now in her second trimester with a healthy baby, told me that between pregnancies one and five (this is five), she spent two through four miserable, "waiting for the other shoe to drop." For this pregnancy, she said she just let herself enjoy no matter if she miscarried or not. It sounded a whole lot more fun than my original plan - rocking in the fetal position in the dark, listening to R.E.M. "Everybody Hurts" for weeks/months on end - so, armed with the good news on the beta, I gave it a whirl. I practiced the fine art of happiness. It didn't come easy at first. The breakthrough came on Friday night up at the cabin when we told Vlad and Maggie the good news, tempered with the caveat that it was clearly insanely early to tell anyone and that they were only to pray and cross their fingers. Their response was completely joyous and had none of the fear and trepidation that I had been harboring. Vlad gave me my first ever pregnancy-high-five.

I woke up the next morning to the sun shining, birds singing, and cows mooing at the neighboring farm. My first lucid thought was, "I am so happy." And I let it ride. Still am, though I'm reasonably nervous for the results beta #2. No matter what the results of that beta, or whatever comes in the next few weeks, I've had a really incredible few days and enjoyed the shit out of this pregnancy however early and tenuous it may be.

Friday, August 2, 2013

Beta Day

And the beta is...
I'm pregnant. Again. And terrified. And happy. Mostly terrified.
I admit I've known since Tuesday night (7dp3dt) when I got a super faint squinter of a positive. I tested again Wednesday - slightly darker - and then J forbid me from taking any more tests.
I have already had some very light spotting which has me sick to my stomach. The IVF nurse says its most likely due to irritation from the Endometrin suppositories. God, I hope so.
F*$&#. Nervous. Holy shizzle.
I go back on Monday for a repeat beta. This weekend I'm off to to my parents cabin in the woods with friends for much needed mental and physical R&R.

And now, a prayer.

Dear Lord, please make this pregnancy successful.
Please give me a take-home baby from this here very pregnancy.
Please put me in a healthy, spiritually-induced coma for the next few months.
Please make wine completely safe for pregnant women to drink.

Thursday, August 1, 2013

Supporting Your Very Own Infertile

Today I depart from the usual and bring you a guest blog entry by S, my best friend and "gold star" fertile. I wanted to let her speak to the other side if this difficult equation: what it's like to support your very own infertile. What makes this all the more interesting is that S is pregnant with her second kiddo. What's more, I'm thrilled about it. I certainly cannot say that for all the pregos in my life right now. I think the secret is how we went about navigating this emotional minefield. I'll let S speak to that.

The other good reason for a guest blogger is that I'm too damn nervous for my beta tomorrow to write anything coherent.

With that, please enjoy...

Sitting down to write this guest entry makes me feel a bit like I’m in Fertility Anonymous; Hello, my name is S, and I’m pregnant.

I’ve known Amy - real name, practically out of the closet - for almost our whole lives.  She and I (and a couple other close girlfriends that she has mentioned previously in the blog) go on vacation every August. Except not this year. Amy will either be pregnant or not from her second round of IVF and right now I have such bad morning sickness I’m unable to shower, brush my teeth, or sneeze without throwing up (lovely right?)  

When she asked me to write a post on "supporting your infertile" I wasn’t really sure what to say. I have been exceedingly fortunate in my own grand experiment with one beautiful 19 month old girl and now another on the way.  I can’t imagine being helpful or comforting to Amy and her readers.  I’ve been by her side during this whole adventure but I in no way know how hard it is for her (and many of you.) I’m an outsider in the infertile community, but I do consider myself a very strong supporter.

Here is one thing I know. You probably all have friends, family, people who love you who are starting or growing families themselves. I can promise you that you are a strong presence in their minds.  When my first test came back with the two dark lines indicating positive one of my first thoughts was, “How am I going to tell Amy?" When I told my husband, he said, “Holy shit, how are you going to tell Amy?”  If I can offer anything of value to this chronicle it’s how Amy and I together made a plan for sharing this news, and how (I hope) that plan made it just a bit easier for her to handle.

Amy and I both have siblings.  Our husbands have siblings.  When we were younger and daydreaming about family life, we always talked about our (multiple) children.  She, Amy, expected that as Peanut got to be around 15 months old we’d be trying for another.  Given her struggles we both knew this wouldn’t be easy for her.  I had my own anxieties about if and how I would talk with her.  I can’t compare this to the hardship she has had, but it would be silly to pretend it didn’t cause me grief.  I felt guilty, of course, for being so lucky when Amy and others were so, well, not.  I didn’t want to lie to my best friend but I definitely didn’t want to cause her more anguish, especially now with IVF round 2 coming up.  She needed all her mental strength focused on that.

Luckily, Amy was mature enough and open enough to be honest with me about what she needed.  As this spring came around she asked me to tell her when we ‘pulled the goalie.’  Some may see this as an invasion of privacy or selfish or having “chutzpah” (a little Yiddish for you).  Let me assure you, IT IS NOT.  By telling me exactly what she needed Amy was not only looking out for herself, but for our friendship.  Selfishly, it also took a load off of me.  I know how incredibly lucky I have been to be able to start my family and watch it grow with little difficulty (except for a little---okay a lot---of vomiting, things for us have been very easy).  Besides watching Amy go through all this, I grew up with stories of how my parents tried to start their family for 7 years and the sadness surrounding my mom’s 4 miscarriages.  Amy’s honesty has taken so much of that guilt away from me and allowed me to enjoy these past 9 weeks (as much as I can outside of the vomiting) and for that I am so grateful.

The key was (and again, this may sound weird, but trust me) making a plan. I want to encourage you, both infertiles and supporters, to be as honest as you can with each other.  I promise it will help you both.  Amy has been honest with me about what she wants and does not want to know including but not limited to:  
1) when we started trying to get pregnant (yes)
2) when we conceived (yes, and as soon as I got the double line)
3) how she wanted to find out (via phone—although it ended up being via text)
4) when she is ready to see ultrasound photos (not yet).

No one is a mind reader and these are sensitive issues.  It’s unfair to expect them to just know how to navigate this type of situation; it’s an emotional mine-field.  It’s not like you get a lot of practice telling your fertility-challenged best friend that you’re having (yet) another child.  It’s kind of a once or twice type of thing.
And now, a random segue.  A few years ago my baby sister was diagnosed with a very rare and aggressive form of cancer. I hate to compare a diagnosis of infertility to cancer, but in so many ways I see similarities.  The diagnosis itself is devastating and for the next (weeks/months/years) you are living day to day.  Even with the best distractions, it is always there in the background.  I could not have survived that time without Amy helping me through.  And I try my best to provide that same support to her now.  After telling my girlfriends about my second pregnancy I received an outpouring of love and support.  But, in the back of their minds, I know every one of them was thinking about Amy (and just as they should have they all called her to check in after hearing the news.)

3 years later my sister is in remission. She is a much stronger, more mature, more confident young woman because of her experience.  You can always tell the survivors of hardship; those that have come out on the other side of some trauma.  They have gotten up off the mat and it’s inspiring.  I see this in Amy. She has always been strong, but the grit and resilience she’s displayed in the past 2 years is nothing short of extraordinary.