Trick or Treat!

Happy Halloween!

I am trying my damnedest to make this a fun day and banish infertility from any conversation I have with DH. Candy should assist in that task. Last night was a rough one at Casa de las Shoes. I truly think this progesterone is a big culprit. It seems that I weep about anything on these things.

Yesterday, I spoke with the patient coordinator at the National Embryo Donation Center in Tennessee. It was rather enlightening. She said that about half of the couples choose an "open adoption" where the embryo donors get to see the profiles and give a yea or nay and the other half is completely anonymous where the embryo recipient just sees a profile of the recipients. The fastest she has seen someone go from application to transfer is six months, but the average is 10-12 months. Also, I re-read the embryo adoption info from Bethany and it seems as if they may have a local program coming soon, a decision will be made in about three months. The prospect of doing this locally makes me much more willing to consider that option.

And DH talked to the urologist yesterday afternoon. Dr. M thinks it might not be white blood cells in the semen after all. According to Dr. M, microscopically white blood cells and immature sperm cells can look very similar. The only way to really tell the difference is by doing a specific test that also involves staining, which isn't something they normally do. Dr. M explained it as the the Clomid's way of cheating- it tricks the body into making more hormones and more sperm, but they don't fully develop. Back to andrology for poor DH.

Happiness Sold Separately: Barren Bitches Book Brigade

I had sort of a love-hate response to Happiness Sold Separately. I loved how real the emotions of the main character Elinor were, but I have to admit I hated the feeling that the author exploited infertility as a plot device. I resented that she seemed to use the cliches of infertility leading to infidelity, getting pregnant after failed treatments by not trying, and that the infertile couple is older. I wish there were more books or at least more attention given to the infertiles who are in their 20's, of whom there are many.

Anyhow, on to the questions.

Elinor's thought on page 47 really struck me: "When Elinor was paying attention to her career, she should have been paying attention to her biological clock. When she was paying attention to her biological clock, she should have been paying attention to her husband." It made me wonder: Am I paying attention now to the things I should be paying attention to now? Are you?

Now this one hits me where it hurts. I often worry about the time I am "wasting" with all of this struggle to have a baby. I know that I think about it way too often and it has paralyzed my ability to look beyond the here and now. I've already missed a good friend's wedding, passed up another friend's birthday party, we're not going to my family's for the holidays, so many moments I am giving up. I know there are certain friends I have "written off" because they are not the most sensitive to infertility. I am holding in the job that I have now for fear of losing insurance coverage and leave time. And I worry that these months (and soon years) will be a black hole of memories for me and DH.

Elinor takes up laundry and Ted works on the hutch. What new hobbies did you pick up or abandon during treatments?

I love to read. But for about the last six months, I have found myself having a lot of difficulty getting through a book. I am tired so much of the time (whether from the meds or the getting up early to go appts or just plain old sick and tired) that I read barely a page or two before falling dead asleep. One thing I have taken on as a project is making our Christmas cards. I'm not particularly crafty, although I aspire to be. Not sure what I will do when the holidays are over. The thing that usually makes me happy is baking, but with my desire to lose weight, I have to avoid too much of that.

Elinor finally finds out there's a reason for her pregnancy problems, "a balanced translocation," and finds "there's solace in learning that something is tangibly wrong." How does (or would) a definitive, action-able diagnosis affect your ability to adjust or come to terms with your infertility? How would it affect your emotional response? Would it provide some closure? Alternatively, if you're in the unexplained category how does that ambiguity affect your decision-making and desire to keep trying?

We had a confirmed diagnosis with less than a year of trying. I just knew in my heart of hearts that something was wrong and my doctor was willing to start testing after only nine months of trying. As terrible as it was to find out, it was so affirming to know I wasn't crazy and that something WAS wrong. I think I would go over the edge if we were "unexplained."

Elinor participates in a book club meeting following her miscarriage and finds that "no one gets her"...and thinks "why should they? She's a barren, bitter, self-pitying grouch. She hates this book club. She smiles and loosens the grip on the stem of her wineglass, afraid she might snap it in half." Do you find yourself having similar experiences? Would the infertility struggle be easier for you if you felt that people "got you" or not? Please elaborate.

I could really relate to this experience. Just last week, at my book club, we were discussing the (truly terrible) book Eat, Pray, Love. The author of that book leaves her huband because she realizes that she doesn't want to be married and doesn't want to have a baby (I am simplifying this a bit). In our discussion, I said I couldn't relate at all to the author and my fellow book club members derided my inability to empathize with a women who (unknown to them) was rejecting everything that I am killing myself to get. And I do wish that others "got me" when it comes to infertility. Often, I feel that not even DH understands how I am feeling about this. And if he doesn't get it, then how can I possibly expect my parents or his parents or any of my friends to really understand? One of my friends keeps telling me to lean on my friends, that is what they are there for. But I don't want to "lean" for fear that they will say the "wrong" thing and leave me unbalanced.


Hop along to another stop on this blog tour by visiting the main list at http://stirrup-queens.blogspot.com/. You can also sign up for the next book on this online book club: The Handmaid's Tale by Margaret Atwood.

Another for the locals

DH actually really wants to do this after seeing a flyer at the RE's. Even though it means getting up at nine o'clock in the morning on a Saturday. It's a half-mile walk in the Mall of America on Saturday, November 10, benefitting Midwest Resolve. So, if you're in the area or just want to donate to support the walk, you can sign up here.

It Takes More than One

I appreciate the support, but do realize that it does take more than one sperm to get the job done (unless one is doing ICSI).

Why? "The egg is usually covered by a thick layer of cells called the cumulus oophoricus that serve as a blockade to restrict sperm from getting into the egg. It may actually require an assault of many sperm to break down the cumulus sufficiently to let one sperm get through to the egg."

Ever so slightly better

Today's count was 400,000 and the lab was able to wash out enough of the white blood cells so that the sample could be inserted into the uterus. And boy am I ovulating- I feel like I am being sawed in half. I imagine this is the closest the sperm has gotten to my eggs ever. DH said a little prayer out loud as the nurse inserted the sperm.

God, I guess I wasn't clear?

I asked for three MILLION, not three hundred THOUSAND. Not an astonishing number, not even a great number, but that was my threshold for hope.

They should have called and cancelled. Just when you think it couldn't be as bad as before. Only 380,000 and still too many white blood cells to actually put in the uterus, so they just injected into the cervix. The nurse is going to call me after the doctor reviews and tell me if he wants me to even bother to repeat tomorrow. And scheduled the consult for the end of Nov. Since RE is on vacation for two weeks, that is the earliest appt. I pretty much think we're done though.

Update- the NP called and RE thinks it's worth trying tomorrow. So, we get to haul ourselves across town (only the main clinic is open on the weekends, not the smaller one I usually go to) on a Saturday morning for a real exercise in futility.

Genetic continuity and conception with a life partner

So, the next two losses the author (Patricia Irwin Johnson) of "Adopting After Infertility" addresses are individual genetic continuity linking past and future
and the joint conception of a child with one's life partner. I had never thought to distinguish biologically-obtained children in this manner. I pretty much lumped it together in my mind- biological children equates with continuing my biolgical line and also blending it with my husband's. But I can see the value in the distinction and, surprisingly, the second is more of a loss for me than the first.

Our family is fairly matrilineal. Yes, the women have all taken their husband's names and gone the traditional route to the outside world, but in reality, it's really the women who are in charge and the men have been sort of insignificant and mostly absent. Hence, why I had very little connection to my maiden name as it was my father's. However, I feel a very strong connection to the great-grandmother I never met and for whom I am named. From pictures, I know I have her eyes (which none of my siblings or my mother or grandmother have) and from stories, I know I have her temperment. Will that connection end if my child is not biologically related to me?

The author describes this loss as "losing the expectation that we will continue the genes of our families in an unbroken blood line from some distant past into a promisting future." I have always assumed that my baby would have blue eyes- my entire family has some form and mine are so distinct, it was a given, especially when I married DH who also has blue eyes. For some odd (perhaps, vain?) reason this is truly the only "biological connection" loss that I can identify. DH has no difficulty with not knowing his own genetic connection and really could care less whether he is biologically related to his children. Of the six losses, I can rate this one as the least significant for me.

But a child of our union or "conception with a life partner," as she terms it, that is where I really feel it. Even before we got married, DH talked of our future children and how we hoped that a boy would have his enormous height and a girl would not, how they would likely have vision problems because both of us are blind as a bat, how much I hoped for a little blond boy just like his baby pictures, and how he wanted a little brunette girl with soft curls like I had when I was little. We love each other so much and I want a tangible expression of that love to manifest itself in a child. Can we still have a child who is the product of our love by raising a nonbiological child? Yes, I think so. But all those dreams and memories of "when" have to be laid to rest.

Perceived Losses

The author of "Adopting After Infertility" lists the following six losses perceived to be a consequence of permanent infertility:

1. Control over many aspects of life
2. Individual genetic continuity linking past and future
3. The joint conception of a child with one's life partner
4. The physical satisfactions of pregnancy and birth
5. The emotional gratifications of pregnancy and birth
6. The opportunity to parent

I think each one of these perceived losses is so significant and I hadn't really separated them all out in my head- I was lumping all of them together, so I am going to take an effort over the next few days to discuss my feelings on each, as an exercise in understanding how I prioritize them and why. DH has made it pretty clear that the only loss he really would have a problem with is losing the opportunity to parent, which is something that can be cured by adoption.

CONTROL.
The author details how infertile couples can feel that infertility is the cause for a loss of control in every aspect of their lives. She gives the examples of what type of car depends on whether it will be carrying children, accepting a new job depends on how it will impact insurance or flexibility for treatment, social calendars driven by the menstrual cycle, even how much coffee to drink or what underwear to wear.

I realized yesterday that a treatment cycle even dictates my apparel. I don't want to wear a skirt and hose on days that I have an appointment because it's a hassle to get off and on while a nurse is waiting for one to undress and re-dress. And I prefer to wear shoes that involve socks just because my feet get cold in the stirrups.

And I hate the not being able to plan my schedule. I knew this week would be a myriad of appointments and it made it a real pain to schedule my every day stuff that needed to be done. And that doesn't even take into account timing for injects.

This loss of control has been harder than I would have imagined. The author points out a few pages later that adoption involves an even greater loss of control. My stomach dropped when I read that. I am already at my wit's end and adoption will be even more of the unknown. Truly, how much can I take before I go stark raving mad? And yet, on the other hand, what is the alternative? At least, I am doing something- whether it be injecting and inseminating or filling out adoption paperwork and preparing for a home study. If I was doing nothing, I would feel not only without control, but powerless as well.

Deal or no deal

Boy, did the dildocam hurt today. I know my left ovary can be difficult to find, but wow.

I decided to take a small gamble b/c the NP gave me a choice. My follicles are at 18.5 (20x17) and two 14s and lining is 8b and triple layer. She said I could trigger tonight and do insems Thursday and Friday. Or I could do another Gonal-F shot tonight and trigger tomorrow and give the 14s the opportunity to catch up. Waiting until Thursday to trigger gives us a 40% chance that at least one of the 14s will be mature. The only potential detriment to waiting is the slim possibility that I might ovulate on my own and miss the insem and only have the one follicle. However, today is only cycle day 12 and last month I didn't trigger until cd 13 when my lead follicle was 20 and my lining was a 10, so I think I made an ok choice to wait. On non-medicated cycles, I don't ovulate until cd 16, at the very earliest and usually more like cd 17 or 18. But I hate that I even attempt to second guess myself with these decisions.

Ah hell, it is what it is. I know very distinctly when I ovulate because I get really strong ovulation pain, so I guess I can always call if I start that process.

Adopting After Infertility

I picked up "Adopting After Infertility" on a recommendation from a few people who have adopted. I thought it might help me become more comfortable with adoption. On the contrary, I have been syrprised and it is helping me work through the decision-making of trying to conceive. The first third of the book is actually devoted to making these sorts of decisions and how much treatment to pursue and it has been remarkably helpful for me to more concretely balance all of the factors- potential loss of bio kids and/or pregnancy; importance of parenting; cost- mental, physical and financial.

As I go through the book, I am going to have quite a bit to post about. The first concept that has me pondering is that a fertile partner can "render" herself or himself infertile as a result of a partner's infertility. Although the diagnosis in our case is exclusively male factor, I have always thought of "us" as infertile. In medical reality though, DH is infertile and I have chosen to be infertile as a result of my commitment to having children with DH as my "reproductive partner" (as the book terms it).

More to come on decision making and grieving loss.

Change and reduction

I was going through some filing and came across a card with a bookmark that a friend had sent me a few months back (I am a terrible filer). The bookmark has the following quote by Maya Angelou:

I can be changed by what happens to me. I refuse to be reduced by it.

So, it got me to thinking how infertility has changed me and whether I am allowing it to reduce me.

How have I changed? Physically- I have gained weight because I put weight loss on the back burner thinking I would be pregnant and could just lose it with the baby weight; I have comforted myself through the disappointment that is ttc with food which has led to even more weight gain; the stress of getting myself up in time and to the myriad of appointments has made me feel like I am running on empty.

Emotionally-I have become one of "those" women (you know, the ones you never thought you'd be, who can only think about having a baby); I feel mired in the infertility merry-go-round every day; thoughts of how to resolve the lack of a baby consume most of my thoughts; I never know when I am going to be sad at the thought of not having a baby- it strikes me at the least convenient moments.

And spiritually-this is the most difficult struggle I have gone through in doubting my faith and God's love and plan for my life.


What I am still pondering is if or how I have been reduced by infertility. That is a post come.

Follicle scan

Cycle Day 10 and a date with the dildocam today was a bit disappointing. The right side has two follicles- 15 and 11 and the left has a 10. The NP thinks I might only get one follicle this month, perhaps, two. My lining is only 5b. Last cycle on CD 8 it was a five and by CD 11 it was a 7, so get to go back to the green grit of the estrogen tablets. Fun, fun. I go back on Wednesday and tentative insems on Thursday and Friday. I kind of wish they would push them out to Friday and Saturday.

Another option?

As if I needed to add any more choices to the mix. Ha!

Last night, I received some info on embryo adoption, which DH was looking at last night. He seems much more amendable to that idea than ivf. Unfortunately, the success rate is only 20 percent, equal to any FET cycle. It costs less than half of what an ivf cycle costs, but I would have to go to Tennessee for the transfer.

Something to think about.

How does one stop "trying?"

This was the discussion DH and I had on the drive to the adoption information meeting. I asked him that if we proceed with adoption, how do I stop "trying" to conceive? His response was we just have sex when we have sex and if some miraculous pregnancy happens, it happens. But even if I hang up my bbt and opks permanently, I know when I am ovulating. How does one step off the rollercoaster of trying and not let that little glimmer of hope sneak in every month? DH told me I needed to get a new hobby. That was pretty much the end of that conversation.

As for the info meeting, it was actually fairly reassuring. Most of the other couples there were interested in international adoption. For their domestic program, they place appx 60 babies a year, they allow 100 families into the program, wait is usually under a year, but the longest waiting couple has been in the book for 2.5 years.* Last year, they had no babies that were "reclaimed" during the legal waiting period and only two the year before. One thing that surprised me was that there is actually very little time between match and placement. Usually, the match is made only in the few weeks before birth and occasionally after birth.

Of course, after the meeting, DH and I had to have another discussion and it always results in the same ending- if trying ivf is that important to me, then he is willing to try it, but his strong preference is for adoption.



*As a total aside, I felt so terribly sad for these people and I don't even know who they are. How terrible they must feel not to be "picked." It's worse than being the last person standing for team picking in junior high.

Adoption information meeting

We are going to one tonight for one of the two local agencies that were recommended by the facilitator of the Resolve talk time group I have attended. I received the info from the one other agency in which I was interested, but its domestic adoption program is currently full and I don't want to even contemplate a waiting list in addition to the length of time adoption can take.

I'm not sure what I am looking to find out from tonight's meeting. When I asked him last night, DH said he just wanted to understand the process better.

If I had to describe my feelings, I would say I am feeling rather ambivalent. And thankful that the Clomid doesn't cause any emotional reactions in me.

Back on the rollercoaster

Got the green light at my baseline today, so here we go again. Now, I am just praying for better (not spectacular- just improvement) sperm results come insemination time. The nurse today repeatedly said how perfect my cycle went last time and how the RE was pleased. Well, my body doing the right thing really isn't that much of an excitement at this point, but it was a nice try.

Biology does not a good parent make

My in-laws are truly the best parents I have ever met. Not that they are perfect people, but there is no doubt in my husband's mind about how much he is unconditionally loved. He has no hang-ups whatsoever that can be attributed to how his parents raised him. My husband would not hesitate to call his parents if he needed something, financial or otherwise. And there is no doubt that they would lend whatever support they could and give all that they have. They are a constant. And this is how I define perfect parenting.

Meeting this family and coming to be a part of it has been a revelation for me. I had never encountered a family without dysfunction. I come from the generation of broken families and therapy. My own family is chaotic and critical. They love me, in their own way and on their own terms. I am the one who can be counted on to come through in a time of crisis. My mother isn't much on comfort because she is always going through something that is "much worse." My father is all about taking credit for my accomplishments despite his perpetual absence throughout my growing up. They aren't all bad and they try, but far from perfect parents. Our infertility journey has not been something in which they have been willing to participate, other than to make veiled negative comments about adoption and say that I have to make my own decisions.

The reason I took my husband's surname was not just because I wanted to be connected with him, but rather, that I wanted to be grafted into this entire family. From the moment I walked back in the door after my husband proposed to me, I have been a part of that family and I have been genuinely loved. My father-in-law opened his arms and said "Welcome to the family!" and told me how glad he was to have another daughter. And that is always how I have been treated.

Both of DH's parents love me because I love and take care of their precious son. I have been adopted into this family as well. Their ability to love and perfectly parent two nonbiological children, and now me, is a testament to why biology doesn't make a good parent. They are how I know that adoption can work. I hope that DH and I can be even half the parents they are.

Keep breathing

and no thinking, that is becoming my mantra. Just zone out and don't think about it. If you don't think about it, it can't hurt, right? Then, why won't the pit in my stomach go away? And not even a pumpkin spice latte does much to tide the PMSy tears that threaten to overflow.

We are going to an adoption agency information meeting next Tuesday. I think DH thinks that if I learn more about the process, I'll feel better about it. If that's what he's thinking, he is barking up the wrong tree. I am on information overload already.

He often tells me how beautiful my eyes are and doesn't realize why that makes me sad, how much I want to see my eyes in my baby's face.

Just rambling today. And trying to hold it together at work.

As anticipated

negative blood results. But off the progesterone.

Looks like I wait for my period and rinse and repeat. What worries me is that the nurse informed me that if the numbers are as bad this next cycle, the RE wants to do a consult. I don't think DH is ready for what the RE is going to tell us.

For the locals

From Midwest Resolve

COME TALK WITH LEGISLATORS...
Legislative Forum on Infertility and Insurance Coverage

Please come and lend support, listen to legislators, ask questions and
share information regarding insurance coverage and infertility.

Three separate panel discussions with legislators to talk about the issues of expanded insurance coverage for infertility will be held at:

October 10, 2007 7:00pm-8:30pm
Minnetonka Community Center
14600 Minnetonka Blvd.
Minnetonka, MN 55345

October 16th 7:00pm-8:30pm
Roseville Civic Center
2660 Civic Center Dr.
Roseville, MN 55113

October 24, 2007 7:00pm-8:30pm
Kelly Inn St. Paul
161 St. Anthony Avenue
St. Paul, MN 55103

Infertility is a medically recognized disease that affects men and women equally. It is defined as the inability to conceive or retain a pregnancy during a one-year period (6 months for a woman 35 years of age or older). According to the CDC, 1 in 8 couples of reproductive age are affected by infertility. When treated correctly, infertility has one of the highest rates of success of any disease - more than 80% of couples who complete treatment will succeed in having a biological child. Often patients select treatment based on what is covered by their insurance plan rather than what is most appropriate, forcing many people to have less effective but covered treatments such as surgeries for blocked fallopian tubes or endometriosis rather than pursuing in-vitro (IVF) fertilization, a non covered service, even though the cost is about the same and IVF is statistically more likely to result in a successful pregnancy. States with insurance coverage for infertility report a decrease in health care costs. Incidences of high order multiple births is decreased. Healthier pregnancies and babies are the result. Currently 15 states have infertility coverage as a required benefit within their policies. We would like to make Minnesota the 16th state that requires this beneficial coverage included in health care plans.

d. None of the above

DH and I had "the conversation" again. We have got to get off the merry-go-round of talking about it, I know, because I am driving him nuts. Essentially, we discuss what I have termed "the trilemma" of where to go from here if the IUIs don't work. As DH regularly reminds me, we have three choices- remain childless; do ivf; or adopt. His preference is for adoption, but he is willing to let me decide.

Remaining childless is not an option for me, so I wish he would stop even bringing it up. I can't seem to properly explain to him how conflicted I am about the other two choices. I go over the pros and cons of both in my head constantly. The biggest benefit of ivf is the possibility of biological children. But I am having a hard time getting past the expense (especially with no guarantee of success) and some of the moral issues I have with freezing embryos. As far as adoption, the benefit is that a baby is guaranteed at the end of the process. But the process itself is so long and stressful, I am really struggling with the open adoption concept, and I am so deeply saddened at the idea of the loss of all those expectations and dreams associated with biological children.

I want another choice. But there isn't one.

Meltdown- I am just going to blame the hormones

I can be quite emotional and often temperamental, yet I am not a public crier. I have always hated that and view it as a weakness. I am a "never let them see you sweat" kind of girl. This characteristic works well in courtoom. I rarely even cry at funerals. I am the one who keeps it together and gives the eulogy and makes sure everyone knows how to get to the luncheon.

But apparently I can reach a breaking point. One that is beyond just a little tear or some sniffles, but a near-hyperventilating ugly sobbing. In fact, when I cried in this manner coming down the aisle at my wedding, there was more than an audible gasp and several long-timed friends remarked afterward that they were surprised to see me cry (and certainly in that manner), including my new husband. He assumed my parents had said something mean to me (not an unlikely possibility). Rather, when they opened the doors to that church, I wanted nothing more than to just sit down. Not because I was hesitant, but becaue I was completely and totally overwhelmed by emotion. It all just bubbled up to where I couldn't get a grasp on it and all control was lost. I cannot even put words to the emotion that I experienced other than to call it raw and fundamental. I had never before and have never since had such an experience.

Well, that ended today. I was at small women's group at church, which I try to attend on Friday mornings. I am luck enough to be able to have a flexible schedule for about half of the year where I can either take off Friday or at least the mornings. This group is usually six to eight of us and all the other women are twice my age or more. I get so much wisdom from these older women. I often feel as if they are teaching me the things my mother should have, especially about God. A few know of our infertility, but I haven't discussed it much other than some vague allusions.

Today, we were discussing being honest with God in prayer. I was actually having a fairly good "infertile" day. I wasn't feeling down or even discouraged, just wanting this cycle to get over and happy that I didn't have to race off to the RE on a Friday morning for the first time in a month. I openly volunteered that this has been a time of faith crisis for me when I often feel that God is not answering my prayers and that I could understand the despair of Jeremiah when he alternatively complains and praises God.

And then out of nowhere, I lost it. I felt completely blind-sided by this overwhelming gulf of indescribable emotion and was more or less incapable of speech. Just wrenching sobs. And I was so dreadfully embarassed. I have led this group on occasion and here I was a big mess of indecipherable bawling. I was finally able to get some control over myself. Of course, they were all so lovely about it and comforting and I had to "come clean" and explain more of where we are. Thankfully, not one of them told me even a single "fertile" platitude. No one offered advice, they just told me this was a safe place and it was ok to cry.

I don't know where this emotional tidal wave comes from. I just know I want to avoid that beach.

Sick of the flowers

Why do they put little purple flowers on pantiliners? If one has to wear a pantiliner, one is not likely to be in the mood to be thinking about flowers. Especially if one is wearing it because of the drippiness of progesterone suppositories.

I want my vagina back.

Infertility's Common Thread!

Thanks so very, very much to dmarie, I received my own pomegranate-colored bracelet. I can't wait to wear it and promote awareness. Learn about the history of the common thread here.

Happiness Challenge- mostly a success

As I described here, the Happiness Challenge worked for most of the month- much to my surprise.

I have to admit that the final week of the month, I just couldn't get it together. I was supposed to be at the RE's four times last week although it ended up being only three due to the cancelled second insemination. I was jsut too spent to care about being happy, I wanted to just get through.