2017 Recap

3 IVF cycles

1 FET

1 D&C

Hundreds of tears

Thousands of dollars

Nearly a year ago I said hello to 2017. I'm happy to report that expectations were met or exceeded, considering I set them so low.

As for my resolutions:

• Set up an appointment with a therapist. Yes, this happened. My therapist wasn't so helpful but my husband's therapist was excellent and made a big difference for us. I only went to mine twice. I didn't dislike her but there was nothing for her to tell me. Working out my thoughts and feelings on the blog felt more cathartic and it was a lot cheaper. 
• Lose weight. I lost some; gained some. Net minus 5 after all is said and done, so... success. It's a work in progress.
• Dress for the job I want. Totally forgot about this one. I'm ok with that.
• Get a new living room set. For fun! Nope. I wanted to but I couldn't get a new set without redoing the floors and then if we're doing those we'd have to do the window treatments..... it ended up being way above budget. So it didn't happen.
• Figure out car situation We got a second car and it makes a world of difference.

I'm still working on a list for 2018. I like having goals to work on and get to look at a year later to reassess. January brings my blog anniversary to two years. I had no idea I'd still be in this two years later. I certainly didn't think I'd be writing about a seventh IVF cycle back in 2016. I'm not sure what 2018 has in store but I do know I'm ready to put 2017 to bed.

Wherever you are, I hope you have a nice celebration staying warm and safe.

Hysteroscopy

It looks like we're leaning toward doing the hysteroscopy. I asked my doctor why they choose that procedure over say an MRI to get really good images with a less invasive procedure. His answer was that the hysteroscopy is the golden standard and other imaging techniques such as an MRI would not pick up minor things. So basically either do it right or not at all.

The main reason we're going to do it is because I have to feel like we've done everything possible to help the transfer succeed. I don't expect them to find anything. If they do I would be surprised but hopeful that maybe that's the answer to why our transfers weren't sticking. When a transfer fails it's impossible to not feel responsible. It' would be even worse if there's something I could have done that didn't. So for peace of mind we're doing the procedure.

The other reason is because of insurance coverage. I was told that even though I'm keeping my same insurance, they still need to officially verify it before they can send preauthorization. All together it may take 4-6 weeks to get an answer back from insurance. Which means that Jan will basically be a dead month anyway with regard to treatment. I don't believe it will take that long to get preauthorization, it was really quick last year, but I would still rather plan for something else in the meantime so as not to lose the time.

I've given my nurse two dates: my first choice and a backup. Since this is an elective procedure it gets prioritized after egg retrievals and D&Cs, since those are both time sensitive. I understand completely. It's just annoying to not be able to plan with work.

As for my own calendar, since I'll be on birth control I was told I can do it at any time during my cycle. So I'm still trying to understand what that means with regard to a transfer. Does that mean if I schedule it toward the end of my bc pack, I can then do the procedure then have a period, then start meds for a transfer right after? Waiting to hear back from doc about that but we have time to figure out details.

Before a transfer

After speaking to my doctor today, we decided to nix the prednisone and lovenox for the next transfer. It was an easy decision. In my mind, it did more harm than good even though we'll never really know for sure.

He also confirmed that he recommends an updated HSG since the last one is 3 years old and there was miscarriage in the meantime, so I scheduled it for next week.

Now for the complicated decision: whether or not to do a hysteroscopy before a transfer. It would be under anesthesia. Not only so that they can get better pictures but also if there's actually something there they can remove it right then and there. I would have to take a day off and then there's the recovery. It would also mean delaying a transfer by a cycle because it irritates the lining too much. I asked if that's basically an endo scratch and the doc answered that it's way more irritating plus there's water that goes into the tubes plus risk of infection - long story short he wouldn't do a transfer the same cycle. He doesn't feel strongly that it's necessary. He said it was up to me if I wanted to feel like I'm leaving "no stone unturned" before another transfer. On a scale of 1-10, 10 being that it was absolutely necessary, he said he'd rank it as a 4. 

On one hand I really don't want to leave any stone unturned, especially when it comes to transferring embryos of which we have precious few. I also remember our second opinion doctor recommended it, but then again some docs do just because it's a profitable procedure that gets them interesting data. On the other hand it's surgery. It's not necessary, I'd be opting in. So I'm trying to use logic. The reason we did the ERA procedures is because it was unpleasant but I knew I wouldn't stop thinking about whether we're transferring on the wrong day if we didn't do them. It wasn't an easy decision but it was justified when we discovered we did indeed need an additional day of progesterone to get a "receptive" lining.

I don't think the decision here is as simple. Putting aside the fact that we'd be transferring a month later, which I hate but am willing to swallow, I'm worried about doing more harm than good. Obviously if they find something and remove it then I'll feel wonderful and vindicated. But there's a slim chance they feel there's anything there to find. The risks are pretty high: a tear in the uterus? Infection? Who knows what else. The month wait would be the least of my problems.

My gut instinct is to reject this procedure. Logic is trying to convince me otherwise because if the transfer fails this is where my mind will go -- regret that we didn't take this step before transferring. We have a bit of time to decide so I know which thought will be permanently set up in my mind for the next few weeks.

What would you do?

Holiday break

After last week's stress it was nice to enjoy the past few days off. Even though we don't celebrate Christmas I love this time of year and I enjoy seeing everyone's posts about the holiday and their vacations.

My husband went back to work today after the long holiday weekend so it was my first actual vacation day on my own. I made a huge list and started hacking away at it: donating clothes, cleaning out closets, taking care of other stuff. One of the items on my list was to return the extra menopur from the last cycle to the local pharmacy I got it from. The pharmacy happens to be in the same building as my clinic so I went there after to see if I can chat with my nurse. It was eerily calm - waiting room was empty, phones were quiet, there was none of the usual bustle that happens every morning with monitoring.

I met with my nurse. I made sure she has updated info for my thyroid; I verified what testing, if any, is coming up on expiring that needs to be updated; we went over a potential FET calendar; and I talked to her about the incident from last week. She apologized and sympathized. I debated whether to bring it up to the office manager.

After meeting with the nurse I asked to speak to the financial counselor. I got an email saying that the embryos we just froze are up for a "Upcoming Service Renewal" for nearly $2,000 for which they will just charge my card on file. First of all, cryopreservation was included in our global fee that we paid at the baseline appointment. Second of all, you don't just charge someone money without telling about it and having it authorized first! Wth?? The financial person wasn't available but the front desk person assured me that she would contact her and get back to me with an answer. And if it was automatically generated it doesn't inspire much confidence. They seriously need to get their shit together.

Before leaving I decided about talking to the office manager. What happened to me happened and is over, but if I speak up there's a chance to prevent the same thing from happening to another person. There's no reason it should happen to anyone ever. There is no room for carelessness in fertility treatment. Patients are going through enough without someone's thoughtless .

So there's still a little to do before a transfer. I need to redo infectious disease bloodwork. I may also have to repeat the HSG since it's been 3 years since I last had it with my initial pre-IVF workup. I need to order meds. We need to decide if we're doing the lovenox and prednisone again this cycle. We're still waiting for results of our embryos PGD testing, which I'm expecting to take a while because of the holidays.

IVF 7: stress

It's hard to put into words how stressful today was. Looking back, I am exhausted thinking about it all but I wanted to take the time to write it down to not only get it off my chest but also so that I can look back later and marvel at the insanity.

This morning around 8:25 am I got a voicemail from the clinic that they were still watching 13 and that I'll get an update report tomorrow. Huh? That confused me since we got a report yesterday that said they were watching 8. So I called the number the nurse left on the voicemail to get clarification a little before 9 and waited to hear back.

While waiting for her to call back, I went through a thousand thoughts. First, I was upset that they called it so early in the morning - why are you saying they're a no-go on Day 6 if the day barely started? Give it a minute. Then I was scared because if it's day 6 and they're were unable to biopsy any that doesn't bode well for the cycle. Another bust? Oh no. 

I didn't hear back from the nurse so by 11:30 I called again and left another voicemail, slightly less polite, slightly more panicked. My thoughts went to the worst place: no embryos made it and they don't know how to tell me. I was so wound up. I had to go to the bathroom but I didn't want to miss the call so I couldn't go. I was at work and being around people just frustrated me. I didn't want to deal with work stuff - everything seemed secondary to the crisis I was dealing with. I was on the verge of tears the entire day.

By 1:30 I still hadn't heard back and I couldn't handle it anymore so I start poking. I sent my nurse an email and got an out of office response: out until the 26th. I sent the backup nurse an email and got an auto response: out until the 27th. I emailed my doctor who I know is on vacation but he said I could email him with questions. I got an auto response from him too. I knew that whatever response he would send wouldn't be on any timeline I could accept. At that point I just said eff it and called the clinic.

I asked to get transferred to the embryology lab and they just transferred the call. Oh, that was easy; should've done this hours ago. My call was picked up by a bored teenager and I asked to get some results. She said they can't give that info out. I not-so-nicely asked to speak to her manager. She put me on hold and came back saying that the embryologist said that my nurse will call me back. I almost spat out that my nurse is out and the nurse that called me was giving me wrong info and I would like some answers. I asked to speak to an embryologist.

The embryologist came on the line. She was really nice. She was the calm to my storm. I told her my issue: that I was told this morning they're still watching 13 when my doc told me yesterday they're watching 8. Where did the extra 5 come from? Why weren't they able to biopsy any? First she told me that the nurse called prematurely before they even finished rounds checking the embryos. There was a feeling that came over me that I couldn't quite pinpoint: anger? relief? It was overwhelming and all-encompassing. It simmered to the top and started leaking out through my eyes. Then she explained that the 8/13 issue where the doc probably only gave me the number that were progressing normally but they are actually still holding on to all of them. She said she can't really give me more information beyond that and that she'll have a nurse call me with a report. Through sobs I was trying to explain to her that I tried calling the nurse all day but no one was calling me back and that I just want to know how my embryos are doing and if any of them made it to biopsy. She apologized profusely and repeated she can't share the info but she'll have the nurse call me back asap. She took a call back number and I tried apologizing for falling apart on her -- it's not her fault the nurse is incompetent. And I still need her to take care of my embryos.

So I hung up and got out of my car, where I had taken the call for some privacy. At that point my face was all blotchy and I was still recovering from sobs - you know that stilted breathing you get? So I took some tissues with me and prepared to walk around the building to calm down. As I walked I texted my husband a series of tests with an update. As soon as I hit sent the phone rang with the nurse calling. I picked up and she started by apologizing that she looked at the wrong date this morning when she originally called. Are you serious? YOU HAD ONE JOB!!!! Your mistake at looking at the wrong date cost me my sanity - I hope you're happy you stupid idiot. A fresh wave of sobs hit me and I tried explaining to her why it was so upsetting because clearly she wasn't getting it. Instead of listening to what I was saying, "It's ok honey, don't cry it's ok" which prompted me to yell back "No it's not ok!!! I spent all day worrying about this because I got wrong information! I called the number YOU told me to yet no one answered my calls all day!"  Whatever, I wasn't going to make her understand.

She told me that they were able to biopsy 3 today and there's a chance 1 may make it to tomorrow. Was that so hard? It's not a great number but at that point anything above 0 was a miracle. Now the wait for PGD testing.

After getting off the phone with the nurse I went to the restroom to wash my face. I couldn't stop crying. I considered leaving but I had a meeting at 4 I couldn't miss. I had to pull myself together but my face was not getting any less blotchy because the tears kept restarting. Eventually I went back to my desk and got started on a project that I was hoping would distract me enough that I would be able to stop crying. I took a few minutes to email an update to my doctor that I got the info I was looking for and to let him know that it was just not ok that not only did I get wrong information but that there was no one calling me back/answering my voicesmails when I called multiple times to clarify. I had to close the loop.

I picked up a pizza on the way home and by the time I got inside I was just drained. Just completely and totally spent. So much unnecessary drama. Such a domino effect from one careless mistake.

IVF 7: waiting

Today we're supposed to get a day 5 embryo update. I'm on pins and needles. At this time last cycle we were told there were 14 of the 18 embryos were still growing but the next day they were only able to biopsy two. It's a mindf*ck. You get your hopes up and then the numbers drop just like that. I know to expect attrition but that was unusual and incredibly devastating.

They usually call in the morning. I think in every past cycle they always biopsied on Day 6. So unless any of them are super-growers that can get biopsied today, I'll likely just get an update of how many are still in the running.

Update: got the call 10:30 AM. Eight are still being watched; none big enough to biopsy yet. I'm tense and on the verge of tears but there's nothing to cry about yet, I'm just expecting the worst.

Endocrinology update

Endocrinology report came back: My TSH came in at 2.96 and the doctor suggested starting low dose thyroid hormone.

My initial reaction: so many questions. What causes the number to fluctuate so much that this wasn't flagged earlier? Once I start medication, how often will I need testing? How do I know if meds are working? What if meds don't bring the number down? What are symptoms I should look out for? What, if anything, do I need to tell my RE? Does this mean I don't need to take the prednisone/lovenox next transfer? Would dosage need to be increased in pregnancy?  Is there a Vitamin D deficiency connection? Does the miscarriage make the number fluctuate?

Online research says that normal TSH is between 0.5 - 4.5, so I'm kind of skeptical to believe that with 2.96 I have "thyroid disease." I remember the doctor saying that while the general community sees 4.5 as the upper limit, she likes to see numbers below 2.5 for regular people, and under 2 for pregnancy.

I grabbed the following quote from here: "The study found that even mild thyroid dysfunction could greatly increase the risk of serious problems. Women with mild thyroid dysfunction had double the risk of miscarriage..."

Is it possible that this was what was causing the chemical pregnancies? It's such a small difference. Maybe it fluctuated even more during transfers? Maybe the fertility meds make it go higher and it was a greater difference during critical times? Maybe my body is just so sensitive? Maybe the developing fetuses just drained all TSH and my thyroid just couldn't keep up? If that's the case then why did the blighted ovum pregnancy not spontaneously abort like the previous transfers? Maybe it's not such a small difference if the optimal number is 0.5 - 1.5 for pregnancies. I don't know. I have more questions than answers but I don't think I'll ever really truly know all the answers to our five failed FETs.

I had a follow up phone call with the endocrinologist and she addressed all my questions. She will send a report to the RE and I'll follow up with her with an appointment before my next transfer so she can monitor my TSH before a potential pregnancy.

Here's hoping...

IVF 7: Embryo watch

Of the 21 eggs retrieved, 17 were mature, and 13 fertilized. Today, day 2, they're still watching 13. Last retrieval we had 18 at this point and only 2 made it to biopsy, so we're really working on managing expectations.

Recovery is going much better than last time. New this cycle, I started drinking electrolyte-infused water (Core brand) a few days before retrieval. I also took Colace proactively the night of retrieval instead of waiting for an issue. The first night after retrieval was pretty similar to past recovery, but other than that it's been a night and day difference. There's still bloating but not nearly as uncomfortable. There's no constipation at all. By today, two days post-retrieval, I'm feeling almost back to myself. I'm still really tired and there's definitely some residual bloating, but it's not the terrible discomfort I had in previous cycles. I hope the easy recovery continues.

Tonight is the 6th night of Chanukah. I barely had time to register the holiday and it will be over before we know it. We took on the minhag of screen-free time during the first half hour of the candles being lit. It's an effort to just be in the moment and enjoying the holiday which usually flies by in the blink of an eye.

IVF 7: Egg Retrieval

For the seventh time in my life, I went through an egg retrieval. I've been there so often that the OR staff already knows me. The anesthesiologist already knew my tricky veins. It was uneventful for the most part. The azithro wreaked havoc on my system as expected. My weight and vitals were fine. It felt like they were running late (waited in the waiting room 40 min, then waited for the IV to get started almost 30 min) but they ended up taking us back early and I was home sooner than expected. We made a trip to the store on the way home to pick up doughnuts and latkes for Shabbat.

They got 21 eggs. I tried really hard not to be disappointed with that number. I was expecting high-20s results, especially since my E2 was at 2988 on day 14. I totally thought I'd get 29-30. Part of this game is managing expectations and I let mine run away. I know disappointment isn't the right response; not at this stage anyway.

While I can hope they're all mature and all fertilize, I know that's unrealistic. So now the waiting game begins to see how many make it to blast.

I was worried about retrieval and going under so I'm glad the cycle on my end is over and I can work on recovery and putting this behind me, dare I hope maybe even for the last time.

Shabbat shalom and Happy Chanukah!

IVF 7: Day 14

There's a lot to keep track of in terms of what day it is and I'm struggling to remember it all. I know it's Day 14 of the cycle; Day 1 of Chanukah; and Day 5 of my cold. Other than that...??? Monday? Tuesday? Where are we in December??

According to my doctor I'm a Super-Responder. There are plenty of follicles and they're expecting a similar number of eggs as in past cycles. That doesn't mean anything really; not until we know how many embryos survive to blast and through PGS testing. I do know this translates to a difficult road ahead regarding recovery after retrieval. At yesterday's monitoring appointment the largest follicle was at 24.9 but they decided to keep stimming another day because there were several at 16-17 that they wanted to give a chance to catch up, which they do if the lead follicle is under 26. I had to reorder meds and had drama with Freedom again. I'm really starting to hate them. More on that in a minute.

I went in for monitoring this morning, day 14. My regular blooddraw person wasn't there but I gave a new girl a chance (as if I had a choice). She said she hasn't missed in 10 years and I told her I hope I don't break your streak and really meant it. She was good. Didn't hurt and only one stick. She admitted my veins are tricky. I'm just glad it worked.

I'm feeling my ovaries very much. It feels like they're bouncing in molasses, which is the only way I can think of describing it. Other than pressure around the ovaries I'm not feeling bloated. I think it's in part because I've been so nauseous that I'm not really eating. Yesterday at about 1 pm I was feeling so incredibly nauseous and weak... I realized I hadn't eaten since 6:00 pm the previous night and even then it was just a bowl of cereal. I had lunch and felt a little better. Mornings have been difficult this week: force myself to wake up early after not sleeping well, shower, dress, choke down two bottles of water, take the morning shot, and rush out the door to make it to monitoring. Every day this week. The cold water sits like cement in my stomach. It's a catch 22 with the water: I need to drink so they can get blood; but if I drink then the US hurts because it's so crowded down there there isn't room for a full bladder, which is guaranteed to fill up only when I'm already on the table waiting in the small room for the doc and not a minute sooner.

Since I'm running out the door it's usually without breakfast or lunch. I end up drinking tea at work for breakfast and then getting soup or a sandwich for lunch at the caff. But it's not just not having food already prepared - my cold also hasn't helped my appetite and I'm just not interested. Since I'm so congested I can't taste or smell anything so food just isn't appealing this week. I even opted not to have doughnuts at a Chanukah celebration last night. It just isn't worth the calories if I can't taste anything but it's very unusual for me to turn down delicious homemade doughnuts. This morning monitoring went so quickly that I was done with a few minutes to spare. I used the time to pick up an egg+cheese bagel on the way to work which I hope will hold me for the duration of the day.

My Freedom Pharmacy story, if anyone is interested in feeling frustrated vicariously, is that I called in my order for menopur and they forgot to apply the 20% discount one gets when initially ordering over 40 vials. I get an alert when a big purchase goes through on my card so when I saw the charge on my card 20 min later I called again to remind them about the discount. They told me they couldn't apply it because I'm no longer eligible. So I asked to just cancel the order. If I'm not getting a discount I'd rather purchase the medication locally at the same price where I have the option to return it if I don't end up using it. They said they can't do that either since the order already shipped. I got so upset and of course felt angry tears starting to sting my eyes. After talking to a manager she said that actually I am still eligible for the discount, they are super sorry they missed it, there were lots of orders on my account that the tech looking it up didn't see it, that I was given wrong information, and that they'll get the concierge dept to contact me the next day to figure out the refund.

Of course no one called the next day and I called back already upset. This new person also apologized profusely, saying that they're sorry I was given wrong info, that I should remind the next person of the discount if I order again -- to which I responded that I don't know I'll be ordering again because it's such a nightmare ordering from Freedom!!! The person also apologized for the original people telling me that I'll get a call the next day because it takes a lot longer than that to pull all the calls, coach the people who made mistakes, and then process the refund. She explained that they're in one department called Patient Care Coordinators and she's in a different dept--- I DON'T CARE! I don't care what department or whose fault or what your protocols are!!! When I call the number you're ALL Freedom and you're all responsible! Isn't that Customer Service 101?

While they're off teaching newbie employees how things work by reviewing all my calls (most of which I'm probably yelling at someone), I'm out several hundreds of dollars because I'm paying for everything out of pocket. She promised that someone will call and I basically said that at this point I don't even know who to believe any more because every time I call I get the line that they're "not sure why I was given wrong info but this is what's really going on, I'll take care of it." How do I know this isn't wrong info too? I've completely lost confidence in them. At the end of the call I was no closer to getting my refund but there was nothing I could do. I was tired and it was a long day and I didn't have the energy to fight anymore. They said they'll start the investigation first thing this morning (yeah right) and get back to me... eventually. I now hate the phrase, "I do apologize" which sounds sterile and insincere.

Trigger is very likely tonight. I saw my own doctor at monitoring and he confirmed. He also said he prefers to trigger with HCG since I'm not doing a transfer, even though the risk of ohss is higher than with lupron considering my numbers. He said he's open to changing it if I feel particular one way or the other. I understand the ohss risk but I agree with him about using HCG. Lupron isn't guaranteed to trigger and I don't want to risk a failure. I know they need you to come in the day after lupron trig to make sure it absorbed. I don't know what happens if it doesn't absorb but I don't want to find out. I'd rather do my best for the success of the cycle and take care of myself after to try to prevent ohss. I'll find out after 4pm today what time the procedure will be.

I was advised to start drinking electrolyte water now to try to have the electrolytes in my system before the procedure, in addition to drinking it after. I also stocked up on chips and gatorade and will plan to start daily colace starting tomorrow to try and avoid some of those symptoms too. I hope we have good results and an easy recovery.

Nighttime thoughts

It's 4 AM and I can't sleep because my cold is keeping me up. Or maybe the meds. Or maybe the anxiety of another blood draw in just a few hours. So here are a few thoughts, mostly unrelated, keeping me company at this hour:

In a few weeks this blog will turn two years old. We calculated that if our first transfer would have worked, our first baby would have been nearly 18 mos old and we'd likely trying for #2 at this point.

There's a part of infertility that feels like you're constantly being held back. The flip side is that you feel everyone else has moved on. No one I know is still in the trenches. No one in real life or in the blogosphere I've met over the past few years. I don't hold it against anyone for moving on - it's what we're all trying to do. But it gets lonely getting left behind. It's also making me wary of trying to connect with new people.

Ironically, the people that have little kids have more of an active social life because they make time to go out, "date night" style, to get a break from the non-stop grind of parenting. We turn in early partly because of our personalities, but in part because the treatment just wipes me out and I can barely keep my eyes open past 8 pm.

Someone posted a link on fb connecting IVF with breast cancer. Obviously correlation doesn't equal causation and I didn't click on the article to find out more because it's a terrifying subject to me. I already have so much history of it in my family - I can't imagine that adding all these hormones is doing good things. But what's the alternative? Another terrifying thought to keep me up at night.

I stopped doing my eyebrows. I'm not sure why. It started by wanting to have them grow out slightly because the lady did them too thin the last time. But when it was time to go get them cleaned up again I just... didn't. It looks horrendous but I'm not motivated to go get it done. I usually do threading and it hurts so I think I'm just being a sissy and not wanting to anything extra that would hurt these days. I'm not big into makeup and I've been blessed with good skin so my biggest maintenance is managing the facial hair. I'd never let the upper lip get this bad but the eyebrows are in a free-for-all zone. It's been two weeks. We'll see how long this lasts.

I've stopped watching what I eat. I'm nauseous again these days and I often forget or skip eating which can't be healthy. I need to get back on the wagon but between cough drops and tissues I don't have the energy to care. I hope this cold goes away before retrieval so I don't have to deal with both simultaneously.

I wasn't allowed to hold or kiss my nieces and nephews at a family party yesterday because no one wanted me to spread my cold germs. Most of the kids had runny noses from day care anyway, but I understand why people would want to be cautious. It broke my heart though, if I'm being entirely honest. Then again if my own kid was healthy and I had a cold I would likely try to keep the germs to myself so I do understand.

Every year during Chanukah I try out a new recipe, usually dessert. Last year it was homemade cannolis. The year before that it was a salted caramel chocolate cupcake. This year I'm thinking maybe cream puffs or eclaires. Still looking for interesting recipes.

We're in between shows right now. We finished watching all of the original Will & Grace from 1998 - they are my favorite characters of all time. We're caught up on all our regular shows like South Park and Last Man on Earth. I have a season of Survivor I saved for retrieval recovery. We try out different stand up comedy specials on Netflix every so often but we have a short attention span and if they don't catch our attention in the first five minutes they've lost us forever.

We still haven't decided about a trip in Jan. We're stuck between wanting to do the trip and not wanting to spend the money. We're worried Tr*mp will do something insane while we're there and we'll be unable to return to the US. Now that I've seen the endocrinologist early, we're no longer bound by that appointment to wait until February for a transfer. We're concerned about the uptick in terror due to the new announcement about Jerusalem status as capital. If we don't do an Israel trip, where's a comparable alternative that won't feel like a consolation prize, especially since anywhere beautiful is still questionable zika-wise.

I read an article the other day about student debt: The Great College Loan Swindle. I'm one of those people who signed on the dotted line not really understanding the long term consequences. My undergrad loan is under control. I pay less than $100/month and will be done in a few years. My graduate degree is another story. I have a crushing monthly payment that barely covers the interest, let alone the principal, so it never goes down. Part of the reason I stay in my current job is that it qualifies me for PSLF, Public Service Loan Forgiveness. Now I'm hearing that Tr*mp has called for the program's elimination by 2018. If that's the case I'm totally screwed. This, coupled with the new tax laws about not being able to deduct student loans or medical expenses, makes everything in my life a lot more difficult. I've never hated a president before because their actions never affected me directly as much as they do these days.

So that's it for now. Gotta try to get some sleep before starting the week again. It's going to be a busy one.

IVF 7: Day 11

I was due for my yearly cold and it came with a vengeance starting on Friday. Severe sinus pressure, congestion, sore throat; so many tissues were sacrificed for this cold. I wasn't able to sleep at night so when I went in for monitoring early this morning I was distracted and tired.

It wasn't until I was already two sticks in for bloodwork that I asked for someone else. My arm is so bruised and sore from all the bloodwork. I've really come to dread blood draws. They finally got it on stick #4.

After the appointment I went to a funeral. A coworker lost her husband. He was old and ill so it wasn't a surprise. They were married for several decades so it's sad.

When that was over I ran errands getting ready for the week, for Chanukah, and for a birthday party we hosted this evening. We have several December birthdays in the family so we combined them into one party for everyone. The original plan was for me to make most of the food for dinner but because of my cold I delegated to potluck style. Not only did I not want to spread my germs but it turned out really well because I was exhausted this afternoon and ended up taking a 3 hour nap after errands.

I have enough meds to last me through day 12 so if they plan to stim longer I'll have to reorder again. I'm assuming retrieval will be Wed, Thurs, or Friday. Next monitoring tomorrow.

Endocrinologist

A few weeks back I made an appointment with an endocrinologist. At the time I was told that the soonest available appointment is at the end of January. I made the appointment but continued to call every so often just to see if there were any cancellations.  Lo and behold, they had a cancellation for today and I was able to push up my appointment by nearly two months!

I met with the doctor and we went over my medical history. Based on the medical records I had transferred over that she reviewed, she started by saying that I'm right to want to double check. According to her she likes to see TSH between 0.5 - 2.5 and mine fluctuates way too often, sometimes as low as 1.91, sometimes as high as 3.81. Caused by what? Affected by what? I have no idea. But every time I test at the fertility clinic it always comes out under 2; everywhere else it's a gamble. She wants to test for anti-bodies because if those are positive then she wants to put me on a low dose thyroid med.

The other thing she wants to test for is insulin resistance. Apparently it's a symptom of pcos which I was never diagnosed with and have none of the symptoms. Because of that she said it's less likely but she still wanted to test for it. If both those come back within the normal range then whatever issue is that's causing the miscarriages, if there is one, isn't going to get fixed by endocrinology.

After chatting in her office, she took me to a medical room and took vitals: weight, blood pressure, breathing, checking for swollen ankles, etc. Everything looked good to her and she sent me to the lab to get blood drawn, telling me she'll be in touch in a week with results. They took 4x the amount of blood usually taken at monitoring appointments. I should have guessed they were going to take blood and loaded up on water but it didn't occur to me and of course they had to stick me twice before getting blood.

If I do need to go on any type of medication she said it's in my system within 3 days so it's not going to hold up any transfer if it is determined that I should go on those.

I wanted to hear what she had to say before pursuing another transfer so I'm glad I was able to get in earlier than end of January. I'm not sure what I'm hoping for. For there to be an issue so I can go on more meds? That this is the silver bullet? That I don't have a thyroid disease but then we're not any closer to answers for recurrent pregnancy loss? At this point we can only wait and see what happens.

IVF 7: Day 7

What a long, long, long day.

It started at the crack of dawn rushing out the door to get to monitoring appointment. I knew the person who took me back for bloodwork wasn't going to be able to draw - it's my upteenth cycle and she's yet been able to get my vein to date. I didn't have the balls to tell her I want someone else and potentially hurt her feelings. She stuck me once and it stung and hurt so much my eyes immediately welled up with tears as a reflex, and once those started to fall I was actually crying because I felt sorry for myself. She offered to have someone else draw and they were able to do it with one stick. I then waited in the smaller room for nearly half an hour for the ultrasound. I don't know what took so long; the waiting room only had two other people. I thought I had a full night sleep but I had such fatigue and brain fog that I couldn't keep my eyes open.

The largest measured around 8s and my E2 levels rose nicely from last time, but it's trailing a bit from last cycle. I don't think we'll get as many eggs but then again what did it help that we got 28 eggs if we only ended with two blasts and only one testing ok. It's not even a numbers game - it's basically all a gamble.

I finally got out of there and rushed to work where we had such a busy day. I got home close to 8 pm after a full day of non-stop event prep and then the event itself. Half the day I considered snorting coffee just to be able keep my eyes open. I had to constantly take a moment to refocus. It was difficult to stay productive all day but necessary because there was a ticking timeline and things needed to get done.

I had an epiphany regarding work. I did some research and found a title I want that I think may be considered. I'm excited about it and started keeping notes in prep for my review.

Today Tr*mp did more things to get his face on the news. I don't agree with his decision about Israel and Jerusalem and I don't think he realizes he doesn't have to get tv ratings up with wacky ideas and crazy shenanigans.

IVF 7: Day 6

It's the sixth day of hormones and I'm starting to feel the emotional effects. Not so much physically yet. Already snoozed several accounts on fb because of their copious baby picture posts.

I had my dermatology appointment yesterday. I go every six months as a preventive measure. Of course she found something to slice off. It made her feel better and it was on my leg and I didn't care so off it went. It took about 10 seconds and I'll get results in a few days.

Yesterday a new coworker asked incredulously why I don't have a higher title or position. She was trying to understand the culture and it was asked innocently. I wasn't offended - I completely hear what she's saying. I'm not tooting my own horn but it is weird to be in my position considering my education and qualifications. But seeing it from her perspective was a startling reminder about what we're giving up in the attempts to build a family.

The first reason is because it's comfortable enough to afford flexibility for treatment. The second reason is that it's because I work at a non-profit and people don't leave; they stay for 40 years and then retire, so basically anyone young needs to wait for a retirement party or funeral before a position in management becomes available. The third reason is that my ambition is channeled all toward success in treatment and I just don't have the energy to fight for it every year at my review or put in the effort to look for a new place.

I know they're lame excuses. I know I'm not stuck and I know I can start looking for another job today. Why don't I? Because in the back of my mind I'm also hoping treatment will work and then I'll need the flexibility for the duration of pregnancy and then when having an infant at home. I've gone back and forth in my mind about it a hundred times over the past few years and I always come to the same conclusion: I have the rest of my life to build my career but there is a finite number of fertile years and we'll never regret giving treatment the best chance possible. If I coast along for a few years in a job that offers less stress and responsibility so that I can focus on trying to build a family, it's a sacrifice I'm willing to make. It still stings though, especially when you realize it's obvious to the outside world.

But I can't tell all that to a new coworker. I came up with a plausible answer and left it at that. Every time I feel like I'm at peace with my choice something like this comes up and makes me second guess whether I'm making the right decision.

IVF 7: Day 4

Monitoring appointment this morning took less than an hour which is great for a weekend. Quick bloodwork with only one stick. Ultrasound showed 11 on one side, 15 on the other; too small to measure. Quick and painless for the most part. I picked up bagels on the way home and we spent the majority of the day chilling out at home. Toward late afternoon we went on a long walk trying to enjoy the last licks of beautiful weather before it turns cold.

Our friend hosted a pre-Chanukah party last night and it was so nice to see friends we hadn't seen in a while. Since it was an adult-only party, it was also nice to see friends without the distraction of their kids or pets.

The next few weeks are going to be really busy at work before the office closes for winter break between christmas and new year's. I tried to schedule this cycle around specific events, knowing the first few weeks of Dec will be more busy than the next few but it's still going to be tough to take a few days off in the middle. I plan to take two days off - day of retrieval and day after, but depending on how I feel and where it is in relation to the weekend I may take more or less.  There's no way to know in advance but I gave my supervisor a heads up that it's coming.

Full week ahead - have a great one!