Lifestyle changes update

I've done some more research on my glucose/insulin results and what I should be eating to go with my lifestyle changes in an attempt to avoid meds. My glucose levels were fine and well below normal levels. My insulin levels were borderline, and I use that term loosely because it depends on who you ask. Some sources say that my numbers are fine, other say that they're just a hair above the normal limits making them high. It doesn't make a difference to me about how to treat it, but I felt it was important to understand.

Of the research I did, everyone agrees to limit all forms of sugar if you're trying to control insulin levels. One drastic approach is the Blood Sugar Solution by Dr. Hyman. I found the cookbook at the library for some recipe inspiration and read a little about his approach. He recommends six weeks of eating just vegetables and lean protein, and eliminating sugar in all forms, white flour, and white rice. For the Advanced Plan he recommends limiting all grains as well as all fruit except for 1/2 cup of berries as a treat. I hear what he's saying and I'm happy to implement a few of the suggested ideas and recipes. I don't think being so restrictive is a good idea for me because taking on too much at once might backfire and I'll burn out too quickly, so I'll take on new changes slowly to help them stick.

Last week I saw a documentary called "That Sugar Film" (available on Amazon Prime) about an Australian actor who changed his eating habits to see what effect sugar had on his body. It was a very interesting film. Between that, my research, and other sources, I learned a few things:

• Sugar is bad for you. I believe it's ok in small, measured doses but that's rarely the case these days between processed food and take-out.
• Oatmeal isn't necessarily as super a food as I originally thought. I don't remember where I saw it but apparently it can raise blood sugar as well. More research needed.
• A calorie is not a calorie. To me this was mind-blowing. I used to think that as long as I kept my calories counted and under a certain number that it didn't matter what I ate. In terms of weight loss, maybe. But in terms of nutrition that's not true. For starters, eating 200 calories of avocado, for example, will give you nutrients and keep you full because of the fat. In contrast, having 200 calories of juice gives you a sugar spike which then comes with a sugar crash shortly after, which leads to cravings and overeating. 

I've made some significant changes to our menu but there's still a way to go. Breakfasts are either eggs with something (avocado or cottage, or some veg) or a green smoothie. Lunches are either leftovers, salad with tuna, or veg with hummus. Dinners vary and include some sort of roasted vegetables with salmon or chicken. There's room for improvement, especially with snacks and desserts. For shabbat I made a five lb dough for the bracha. I split it in two and made half into challah and the other half into seven babkas. Fresh, sweet baked goods are my #1 weakness and they were by far the most delicious babkas I have ever made or tasted in my life. I ended up giving away five of them - I just couldn't risk having them in the house, even buried in the freezer.  I also need to work on getting to my goal of getting at least 30 min of exercise four times a day. It's not a struggle of finding the time, it's looking for the motivation.

Food

I'm down six lbs from my heaviest April weight. That's still 3 more than my pre-transfer weight in February. When I reach 10 lbs down I'm thinking of maybe buying a new purse - I have my eye on a MK knock-off. After that my new goal will be the next 10 lbs.

We've been eating better lately than we have in a while. Home cooked healthy meals every day. It's been a lifesaver to plan the week in advance, including breakfast, lunch, and dinners. It takes the edge off thinking and if the groceries are already in the house it makes it that much easier. Since they're all fresh ingredients I have to make sure to use them up quickly before they go bad.

When I don't eat sugar my appetite is very steady and I don't have those insatiable munchies. I miss cereal but I'm never hungry. So much so that sometimes I'll feel fine enough to delay eating to the point of feeling light headed. Then I remember that I can't do that and go eat my prepared snack. Still learning. Also still waiting for the RD to call me. I followed up today.

My research online told me that oatmeal, cinnamon, and apple cider vinegar are good for lowering sugar. I still don't know what lowers insulin but apparently a low sugar diet is a good start. So now I'm eating oatmeal with cinnamon for some breakfasts. I'm still figuring out how to use acv.

I found someone selling dehydrated fruit and vegetables and in a moment of weakness I placed an order for $30 worth of snacks. There's no added sugar, salt, or preservatives, plus the produce is all organic so I figured it's a good snack to include. I'm excited for the zucchini chips.

Making the wait count

Things have fully transitioned to summer mode around here and the change has been nice. Things are slower at work, the weather is finally hot, and it seems like we're on our way to getting our summer projects started.

I'm still learning about insulin. I don't understand how my fasting and 2hr glucose are both well under the limits but my fasting/2hr insulin is high. I think I broke Google trying to come up with an answer because it doesn't seem to know. Beside that there are conflicting opinions about what to eat. Some say to strictly limit all forms of sugar while other opinions say that fruits are fine. Cutting out fruit entirely would be really hard for me so I'm not doing that yet. I have a call in to the Registered Dietician and in the meantime I'm working on cutting out white flour and refined sugar. I think that if I try to change too much too quickly then it will backfire so I'm focusing on small steps to help the changes stick.

This week's changes are to include at least 30 min of activity most days. That's up from 0-2 per week ever since the March loss. I'm also back to counting calories and, while not cutting it out entirely, limiting white flour and sugar. I found some recipes from an Instagram blogger that I'm excited to try. One is a lemon-garlic chicken and the other is a zoodles salad recipe. Very diet friendly and they both sound delicious.

The biggest challenges are going to be planning ahead and avoiding cereal. Planning ahead is crucial to having healthy food already in the house so that we don't resort to take-out which has been a major go-to in the past few months. Cereal is my food drug of choice in all forms and flavors. I can easily inhale two bowls for a snack, or instead of any meal of the day. It's not only a lot of processed sugar but there's also barely any nutritional value and it's a waste of calories. I'm not going to attempt to go cold turkey but it will have to be eaten sporadically and within small controlled portions.

In treatment news I'm getting ready for the hysteroscopy scheduled for the end of the month. I'm still on bcp so I can schedule my period around when it needs to be. The tricky part is with regard to mikvah since the procedure needs to be on a certain day of the cycle and will likely cause spotting. Hopefully the procedure will go smoothly with limited recovery which won't delay anything. After that I get a two week break while they get the results over to the RPL specialist and we all wait for the start of my next cycle.

If all looks good, we'll start an unmedicated ERA in that cycle. I've done two already but they were both with the medicated FET protocol. Per the medicated ERA results I need an extra day of progesterone for my lining to be receptive. The RPL specialist wants to see if I still need that extra day if I'm not on any meds. Obviously we don't want to miss the window if I do an unmedicated FET with an actual embryo, so we can't use data from a medicated ERA. I understand the reasoning, I just hate the idea of another uncomfortable biopsy.

I'm trying not to "bird view" the summer because thinking of all the things ahead makes me anxious, but it's helpful to think that if all goes well with the hysteroscopy and ERA then the next step is a retrieval. That finally feels like progress. It's also the biggest hurdle before a transfer, since we have nothing to transfer now. So while things are slowly moving forward, there are still a lot of steps to happen between now and a potential pregnancy.

In the meantime we're working on taking one day at a time. We also added a new project: enjoy the wait. The time will pass regardless of whether we're anxious or not, so we may as well do things that make us happy in the meantime. There's a time to be sad and anxious and worried, but it's not all the time. It's a gift to wake up every day and our time shouldn't be wasted harping on things we can't control. We'll work toward what we want and we'll put in everything we can in to it. But at some point it becomes up to Him and our job is to just wait. So why not enjoy the wait. It's easier some days than others but it's a mitzvah to be happy and it's worth the effort to prevent becoming depressed and bitter. We don't have money or PTO to do lavish trips around the globe but we can do outings and things on a smaller scale. Yesterday we went to see The Incredibles 2 (3D) and it was fun. Highly recommend.

Latest happenings

It's been busy at work and I haven't had much time to think or process. Now that things are slowing down for the season, I wanted to update on what's been happening.

On Sunday I took advantage of my lab being open and knocked out the glucose/insulin test that the specialist recommended. It's a smallish lab -- only about 20 seats in the waiting room -- and they're only open until 11 am, so knowing I had at least a 2 hr wait, I had to make sure to be there early. I thought it would be a slow day, but the place was hopping the entire time I was there. I signed in and it took almost 30 min before they got me checked in and did the first blood draw. Then I had the gross drink and waited an hour for the second blood draw. At the two hour mark they took final blood. While I was waiting I was totally a backseat driver in the waiting room: telling people where to check in, showing them where they are in the queue on the screen, getting someone who had stepped out for a cig that it was their turn. At one point I overheard a clueless guy tell the receptionist that his doctor at [old clinic] didn't give him a lap slip so I helpfully suggested emailing his nurse. I was helpful all over the place. I hope results come back soon and that they're all normal. In the meantime have a beautiful purple-yellow bruise to remember my time there.

After bloodwork I went to get my nails done - it's been a while and I had a work event the next day. I went with a pale pink on my hands (business) and smokey red on toes (party).

I also had my follow up appointment with my endocrinologist. My TSH has finally reached normal levels: 1.24. Hooray!  That means I don't have to keep coming back every 4-6 weeks to check levels. Now we're at 6 months checkups. She got the latest about what's happening fertility-wise and told me to keep her posted if my RE takes any labs that include thyroid, and when the next transfer is in case I get pregnant and the meds need to be adjusted as well.

I sent over the images from my hysteroscopy to the specialist and he said he couldn't see what he needed and recommended a repeat. So I need to schedule that for sometime in the next few days.

A few weeks ago I noticed a new trick my body likes to do which is make my heart race. At one point it scared me so much I went to urgent care and they got an EKG. My heart was beating at 100 bpm and my blood pressure was elevated but other than that they couldn't see anything wrong. EKG came back normal. Physical came back normal. I wasn't out of breath and didn't have pain anywhere. It was the Friday before a 3 day yom tov and right before my husband's surgery so they diagnosed it as anxiety. Maybe it was. It hasn't gotten as bad since but I have noticed the racing every so often, weirdly when I'm at rest. It never lasts more than a min or two and then I forget about it. I take my pulse often now to see where it's at, which is usually somewhere in the 70s. Every so often I'll feel it go back hovering around the 90s when I'm at rest. At urgent care they said as long as it doesn't go above 100 or 110 then it's not a big deal, especially since they couldn't find anything wrong. I mentioned it to the endocrinologist who said that it's not a side effect of the thyroid meds or any of the meds I'm taking. But she did say to look out for shortness of breath combined with leg pain, which is a sign of the bc pills causing clots, and (rarely) causing clots in the lungs which makes getting oxygen to the heart an issue. She did say that if it persists or episodes get longer that I should go back to the cardiologist. Maybe I'll do that anyway. I don't want to keep being the kid who calls wolf but I'd rather look dumb than have an issue, especially with a potential pregnancy on the line.

My husband sent me a picture of a bug he found in the kitchen and I panicked and called the exterminator for a full workup against roaches, mice, and all pests.  I googled roaches and the internet said if there's one there's likely hundreds more. Ewww. The guy took a look at the bug and said it was a beetle, not a roach. He searched the house and found not much more than a few spiders in the basement and couple of ants outside.

The weather has been unseasonably frustrating with lots of fog, rain, and humidity. There are mild patches of sun when we remember that oh yeah it's summer. At some point our roof started leaking. We called the roofer and got an estimate for a repair ($800) or replacement ($8000). So far we're putting out bowls when it rains and hoping that before we need to make a decision it will either repair itself or get so bad that insurance needs to get involved.

Another summer project I want to take care of, other than ttc, is decluttering. Every year I say I want to go minimal and I think this year I want to make it real. There are drawers of stuff that we don't need; closets of stuff we're storing and never look at; a storage area full of things we never touch. Why should they collect dust, and apparently spiders, when someone else can make use of it? If we don't use it on a regular basis, or at all, it needs to go. If I only manage to make a small dent in what needs to be gotten rid of, it's still a win. The ultimate goal is to feel like if we were to move tomorrow, I'd have nothing that I need to throw out. I'm still unsure what to do about thinks I know I'll never use again but am unsure about giving away, like my wedding dress. I guess I can start with the non-sentimental stuff and work from there.

Summer is upon us and I want to take advantage of the longer daylight hours. I want to get into a routine that includes better workout schedule and better food planning. I know it's just a matter of starting and I'm mentally motivated but need to get my butt in gear. My husband is on board to join in so that can be a big help if we do it together. Let's start with 10 lbs. I decided I'd get myself a present at the end of the summer if I'm successful. Maybe a bosch mixer or a new hairstyle.

Our 11 year anniversary is coming up. My husband's birthday is also coming up. This past week we sponsored kiddush in memory of our grandmothers, who happened to have the same birthday and died within a year of each other.

Happy summer :)

Hello 2017

It's the beginning of a new year. I've set my expectations pretty low. I have a list of resolutions, but more on that in a minute. 

As my husband and I complained to each other how awful 2016 has been to us, he took a minute to talk about how it wasn't all bad. That's true. We take for granted the things that are going well and get tunnel vision about the things that aren't going our way. We are very lucky and we are grateful for everything we continue getting on a daily basis. 

I took some time to be depressed. I was off work for winter break and figured that I can be as sad as I want. I really let myself sink. I cried when I wanted to. I blasted music when I felt like it. I got bored and lonely at times. I tried new things when I felt like it. Most importantly I didn't feel the need to justify anything to anyone or explain why I was doing what I was doing. I figured it was necessary to let myself feel the feelings I need to and get them out of my system before going back to work and facing a new chapter of fertility treatment. 

I can't say it was marvelous. It was fine. But it helped a lot. I realized that the challenges we've faced have made me stronger. Stronger in that I am able to keep my emotions at bay around people now. Stronger in that I am able to take bad news. Stronger because I resolve to not give up just because the path is difficult. I've kind of built an armor around my heart for protection and it helped get me through some rough times. 

But a side effect of that is that I've lost patience. I notice it in my earlier posts on this blog as it happens gradually and it was only recently that I realized what it is. I used to have a people-pleasing attitude and I just don't care about that anymore. In my mind, the attitude is that if they don't like what I'm presenting then that's their problem. This has become an issue because with the lack of patience I'm quick to get agitated. It's not a quality I'm happy about. 

I noticed it specifically with family members and coworkers. I have no patience for chit chat anymore. I don't care about how people's weekend was. I don't care about how their kid is doing in college. I don't care about their holiday company stories. I don't care to pretend to listen, either. 

When I do actually take the time to listen to someone it's because I'm interested. They have my full attention and I'm engaged in the conversation. It irks me to no end if someone else interrupts and starts with their own tale about a related topic. 

Now that I've noticed it, I'm not sure how to fix it. I don't know if it needs fixing, per se, but I recognize that it can unpleasant to be around someone so broody. I also don't need that kind of negativity in my head because it's not just me getting agitated - it translates into an internal conflict about how I would like nothing more than to snap at someone or bite their head off, and not wanting that drama so I keep it bottled up and implode later. 

Which brings me to my resolutions for this coming year. I'm not setting up any resolution that is beyond my control, so they are doable and achievable. By writing them out I can not only refer back to it and check things off, but also when it's written down I'm held accountable. 

• Set up an appointment with a therapist. I know there's a stigma around therapy. I also don't want to be medicated unnecessarily. But I do feel that it's beneficial to reach out for help, not only for me but also for my husband. I think we can both benefit from an objective outside professional's opinion about what we're going through. First step is to find someone good and I'm not sure where to start.
• Lose weight. I don't have a number in mind. I just want to be healthy. Tomorrow is day 1 for Medifast. 
• Dress for the job I want. I dress fine, but I know I could step it up. I usually stick to simple and comfortable and I've  always been and felt confident until recently (failure of FET 4). I was never into accessories or brand names or wearing a full face of makeup unless it's for a special occasion. I'm not trying to change, I'm just thinking it might be beneficial to put a little more effort in. 
• Get a new living room set. For fun!
• Figure out car situation

I will add to and adjust the list as necessary. 

In pre-IVF news, I was able to hold off my period and today was my last pill. I expect CD1 will be Tuesday-ish, with day 3 blood on Thursday-ish. First possible baseline is 1/24 but it won't get scheduled until insurance is verified. I'm not worried about the timeline because I'm planning to use the time to lose weight.

Deep breath. Here we go. 

Follow up and then some

Our follow up appointment this morning went as well as it could. Our doctor is a nice person and says the right things to make us feel comfortable. He tries, but he doesn't have answers. If it were up to him he'd say to just keep everything the same and try over and over doing the same thing until it works. If treatment was painless and free of charge, yeah maybe we'd go that route. But since it's not, I feel the need to research the hell out of our options and try something different if the first things didn't work.

We went over several options. He doesn't seem confident that any of them are our silver bullet, so to speak, but is willing to give anything a try. He was patient and answered all our questions. I never felt rushed or dismissed, but I also didn't feel satisfied that we have exhausted all of our options. Here's a summary of what we talked about:

• Blood thinners, baby aspirin, steroids, and anti-inflammatory medication
• Intralipid therapy
• Weight loss
• Fresh IVF or another transfer
• Hormone levels
• Age
• Next steps

Blood thinners, etc.

According to the doctor, the data isn't conclusive one way or the other. If it does work, there's no way to say this is why. He said side effects are minimal, if any. He said he would do both a bloodthinner and an anti-inflammtory combo. I asked about only using one because of the slight chance of side effects on the baby like cleft palate while on steroids. He'd be ok with doing only one, but his suggestion is if you're already gonna do it, go all in with both.

Intralipid therapy

He says that he wouldn't even know where to recommend going for this. The data is inconclusive and there is no current practice for any of the physicians in the clinic to recommend this. He knows about it but does not believe there is any value to this expensive therapy.

Weight loss

It's not the first time I'm hearing this. There's no way to know if this is a factor or not, but it's within my control (somewhat) and so I'm not dismissing it. I know it's the only thing he can come up with because everything else is testing normal. If I can lose weight I will, but I'm not pushing off treatment for this. 

Fresh or frozen

We have a unique challenge in that we need to have our embryos PGD tested. In a regular IVF cycle where you don't need genetic testing, you get to transfer on the 5th day after the egg reterival because your lining is primed due to the medication. Since we have one remaining embryo already tested, it presents with a few options: 

• Option 1: just do a FET
• Option 2: do a fresh IVF and transfer 6 days after the egg retrieval 
• Option 3: do a fresh IVF and wait a cycle before the FET

I originally went in thinking we'd do option 2, with a fresh IVF and then a transfer as soon as possible. The doctor said that there is a slight chance that the extra estrogen from the stim cycle might cause a decreased chance of success, so I think we might do option 3. I know it's only a slight chance, but regardless of how small, I don't want to risk it. We have some time to decide. 

Hormone levels

I asked the doctor to review all my hormone levels and double check if everything looks good. No anomalies spotted. Thyroid, prolactin, etc. all ok. If there is a problem it's not showing up here. 

Age

I'll be 33 in March. I'm feeling an immense amount of pressure to not only have a child, but also give it a sibling. Nothing we've done to this point got us any closer to that goal. Some people think that they want a baby. I don't just want a baby - I want a big family. Dreaming big, even if it seems greedy.

We talked with the doctor about doing another IVF before another transfer in order to bank some embryos. He seemed confused at first, so I explained that if we want to have more kids then the next transfer we do, if it works (big if) I'd have to take off about two years from treatment, one for the pregnancy and one for breastfeeding/recovery/having an infant to care for at home. If I'm ever lucky enough to take home a baby, I want to enjoy it as much as possible before having to worry about the next one. I said I was worried about my age and that isn't it better to bank some embryos at my current age rather than waiting?  I'm getting ahead of myself, I know. I should probably try to focus on just #1 before anything else. 

He responded that I don't need to worry about that until age 37 or 38, especially since I've been a good responder until now. I'm not sure how much I believe him about that. I get that he's the professional and he's used to seeing women in their 40s trying to get pregnant, but the only thing I have going for me right now is that I'm still relatively young. Why not use it to my advantage if I can bank some now? 

My other thought process is that iyh when we are trying for #2, we'll have a #1 running around. If I don't have to wait, I'd rather get an IVF/egg retrieval out of the way now instead of having to deal with it later with a toddler. Again, I know I'm getting way ahead of myself, but this is part of my thought process. 

Next steps

So now we have to decide what we want to do next. We have so many unanswered questions and too many unknowns. Here's what we do know: 

• We want to continue trying. 
• We have one healthy embryo in the freezer. 
• We know I can get pregnant. Embryo implanted and continued to grow. Therefore we will focus our efforts on keeping a pregnancy rather than implantation issues.
• We know our insurance coverage won't kick in until mid-Jan at the earliest. 
• We know that since insurance won't kick in before my next period is due, we're looking at a late Jan or early Feb cycle.
• We know that we are nearing our lifetime maximum benefits for fertility treatment coverage so a lot of our treatment moving forward may have to be out of pocket at the reduced insurance rate. 
• We know we want to bank more embryos before doing a transfer. 
• We know we want to wait after the IVF to do a transfer.
• We know we have two options for the next transfer: 
• Change nothing
• Add bloodthinner/steroid protocol
• We know that losing weight is an option. 

Based on that information, we will discuss in the coming days what we want to do and take it from there. 

To his credit the doctor is willing to discuss any option. He's seems mildly interested in helping us succeed, but he's a skilled clinician who is professional and efficient at his job. He told us to take our time to think about things and let him know if we have any questions, asking us to include a phone number in our email if we want him to call to discus anything. 

I think the temporary plan now is to wait for my next period, start an IVF cycle late Jan, wait a cycle and transfer in Feb with the bloodthinner etc protocol. In the meantime to try to lose weight. I'll let that pickle for a few days and if it still seems like a good idea and we both still agree then we'll go forward with that.

I'm a little bit over all this. I'm feeling deflated and drained. This last loss really took a lot out of me. I don't have the same hopeful optimism. The fear of failure is so great that instead of calculating due dates after a transfer, I calculate how soon we can try again in case of a loss. I don't think I'll ever have a sense of relief where it relates to pregnancy.

We spent a large portion of our 20s in debt and unemployment due to the 2008 recession and it took us a while to climb out of it. We're now spending the best time of our 30s suffering with infertility. I feel like we were late to bloom and we're wasting the best of our youth just trying to stay afloat. Where did we go wrong? What did we do to deserve this? More importantly, how do we overcome? If not overcome, how do we shift our goals and priorities to still lead happy lives?

I don't have answers. I just have an emptiness. When I start feeling happy a guilt creeps in. I don't know why or what for, but I feel guilty for trying to be happy. Maybe in a way it feels as though being happy invalidates all the sad things we're going through. I think I just need to not rush the time it takes to let things heal.

We talked about going on a trip to try to get a little space and fresh surroundings, but it's the same issue again that comes up. The more money we spend, the less we have for treatment. Our 10 year anniversary is coming up this summer and I've been saving for a major trip for almost 4 years. It now seems like we may need to use those funds for more treatment. It's unfair and it sucks, but I feel like I have to try everything before giving up. I don't want to live with regrets. We will iyh celebrate our anniversary wherever we are together, but there's only a finite window to build a family. I wanted to compromise and have a quickie getaway nearby, but anywhere nearby that's worth traveling to during this season still has zika issues. It feels like we can't win.

I feel like if we just can keep going we can thrive, not just survive.  We just need a little bit of luck to get through this latest rough patch. I also need to remember to learn to enjoy the journey. I feel blessed that we have the opportunity to try again. Our life is currently being made up of these memories and it is what we make it. We are so fortunate to have the things we do - I'm too superstitious to list them here - and I am thankful every day. 

Quickie update WL

Not much to report on weight loss. I've only lost half a lb since the last official weigh in. I lost my motivation when I realized the FET will likely be delayed because I may need a second ERA. I did pick up a bad habit: morning coffee.

I discovered it's a great breakfast to get out the door. It's quick. It has the caffeine for energy, a little bit of milk for protein, and it's warm and filling. It usually keeps me until 10:30 AM or later when I have my morning snack of sugar snap peas and baby carrots in hummus.

I never used to drink coffee and I don't think it's a great habit to get into so I know I need an alternative. I should go back to smoothies. Maybe I'll try that this week.

Updates

ERA results got held up because the lab was missing paperwork. My nurse is out of town and apparently the one filling in let something slip through the cracks until I called on Thursday and she followed up on Friday, so now they have everything and we'll get the results by early next week.

The mail situation is resolved, for now. The adrenaline rush and stress relief from taking out my pent up anxiety was more cathartic than any cry I've had in the past few months.

One of the resumes I sent stuck: I have a phone interview scheduled for tomorrow.

I've come up with an excellent compromise for my gym dilemma. I realized I was willing to spend the $99 to avoid being locked in for a whole year, but I still had the travel time issue. So I decided to buy a step to work out at home. I used points to buy it so it didn't really cost anything. It was one of the packages being held up in the mail so I only got it on Friday when I picked everything up.

The medication billing error was escalated to the director and they came back with a reduction of 50%. It makes me believe that they recognize the mistake is on their end. I appreciate the reduction. I'm undecided if to let it be and pay it or continue to fight.

I'm happy to report that my plan to lose weight is on track. I'm down 2 lbs from my 20 lb goal. That's 10% and I'm pleased. I'm counting calories using myfitnesspal.com and every day is hard but worth it. I weigh myself daily but only count the Sunday readings for official measurements because of expected daily fluctuations. Overall I'm two lbs down and happy with it. Next week I hope to report another two lbs down.

Lose to win

I stepped on the scale this morning and didn't like what I saw. I was supposed to lose weight, not gain it! I had an eff-it attitude last week about diet and exercise and this is the result. I'm annoyed with myself because I knew it was happening and didn't do anything about it. I'm up four lbs from last time I weighed in. I could say it's water weight or some other excuse but I know I didn't work out last week and I didn't bother counting calories. Sometimes I think it's good to take a break from strictness, but ugh... hate these results.

I feel great and am happy with how I look so I can't use either one as a motivator to try and lose weight. I have a lot of self-confidence and never struggled with body image issues, but I know that to be healthy and carry healthy pregnancies I need to keep losing weight. So the struggle continues....

I thought about trying South Beach diet for a week just to shake things up, but it's very restrictive. I do better with limiting calories rather than limiting full food groups. I've had past success using myfitnesspal.com and counting calories. I think I just need to reintroduce soups and salads into our rotating menu which are filling and low-cal.

I want to get to a point where I'm eating normal and healthy without constantly thinking about weight, but I don't think that's an option. That's why people gain back all their weight: they stop thinking about it and stop actively maintaining which is how the weight creeps back plus more. Over the past three years I've lost 30 lbs. I've managed to keep most of it off, oscillating with the scale plus or minus 5 lbs every so often, but not ever getting past a certain point up or down. It's good and bad: I haven't lost any more but I also didn't gain it back so I consider it a win. I was hoping to lose another 10-15 lbs, especially before a next transfer. I don't know if the hormones are playing a factor in this, but I'm sure they're not helping matters. I know I retain weight when I'm on pills and I can only imagine what the shots are doing. It's not an excuse, but I try to keep realistic expectations.

I used to have a gym membership but I got rid of it in favor of working out at home and outdoors. In the past few weeks I've been debating whether it might be worth it to go back. While I prefer walking/jogging outside in the fresh air and not dealing with driving to a gym, I miss working out in air conditioning and the group fitness classes. The gym has membership dues and I don't know that I'll use it enough to justify the cost. Plus, I know that staying fit and active is important but to lose weight it's the eating habits that need immediate change.

So I don't yet have a plan and tomorrow is my baseline appointment for the ERA biopsy test. At times it feels like there's so much waiting time between appointments and procedures and yet every baseline appointment seems to sneak up on me. We're at this again? Already?

I think I will start by making a menu for the week. Planning is three-quarters of the battle and if I set myself up for success I'm a lot more likely to do well. I'll also plan to wake up half an hour earlier and get in a walk before the day starts. If I really want to lose weight before a transfer, I have to get serious about it and putting it in writing helps make me accountable. It's a start. 

Follow up appointment

We left the appointment today feeling good about next steps. What our RE lacks in phone/email skills he makes up for in person. We talked for almost an hour this morning and at no point did I feel like he was distracted or impatient. He answered all of our questions and then some. Even though we didn't walk away with a lot of new information, we have a clearer picture of our options moving forward. The discussion included:

• Natural vs. medicated FET 
• Endometrial Receptivity Assay (ERA) 
• Endo Scratch 
• Thyroid, prolactin, Vit D levels, etc. 
• Hysteroscopy 
• Transferring more than one embryo 
• Immunologic implantation dysfunction (IviG) 
• Additional embryo testing beside PGD 
• RPL workup 
• Getting a second opinion 
• His phone skills 

In a natural FET there are a lot less hormones but a lot more office visits because you have to be very closely monitored. The risk is that they do not do transfers on Saturdays or Sundays so if you happen to ovulate at a time when transfer would be one of those days then the transfer gets canceled. They don't do enough natural FETs to justify staffing everyone over the weekend and so there would be no one there to transfer.

The ERA biopsy protocol is similar to the FET. Birth control for a few weeks, followed by shots as a "pretend transfer." They mimic everything you do at a regular transfer then instead of transferring an embryo, they take a biopsy of your uterus and send it off for testing. They're testing to find out if the transfer window they use for you is in fact correct. If it is, test comes back normal and you can transfer next cycle. If not, repeat everything again for another cycle except delay biopsy for a day. The idea is to narrow down the most receptive time for your uterus to accept a transfer. I asked what happens if after the second time it doesn't come back normal? He said he would have to take it to the panel of doctors at the clinic since it hasn't happened yet. So at the very worst we'd be delaying by two/three cycles while we do this testing. It is also expensive and not covered by insurance ($850 each biopsy).

Endo scratch is where they irritate the lining of the uterus a week before transfer. The idea behind this is that the uterus starts to heal itself and makes it more receptive to an embryo. There isn't sufficient medical data backing this up. He offers it if we want to try it but says he's skeptical that it actually works. Even if a transfer works he says he can't necessarily attribute it to this. There are no known downsides to this - it doesn't delay a transfer and insurance covers it.

We reviewed all of my hormone levels and all are measuring normal with no changes from 6 months ago, when they were also checked.

I asked about his opinion on getting a hysteroscopy (sticking a camera into the uterus to take pictures) and his response was that the benefit was so small and the risk was so high that he doesn't recommend it. I have no symptoms to indicate that there's any issue; usually they recommend this for someone with unexplained bleeding. It's not worth doing this minor surgery where the risk of perforating the uterus or finding something that not actually an issue is much higher than the tiny chance of finding anything the HSG or transvaginal ultrasounds have been missing.

He says there is too much risk to advise transferring more than one embryo. There is a higher risk for premature birth, pregnancy complications, and possible stillbirth. The only pro is that it's better financially because you're saving one FET by putting two in there. He said that the embryo quality is high for both embryos and whether or not anything sticks has to do more with uterine receptivity than the number of embryos.

We briefly discussed IID with IviG therapy but it's so beyond anything I could need at this point that it was pretty much irrelevant. This is something that's offered to women who have gone through dozens of procedures with multiple losses.

There is no additional testing offered beside for PGD. If there is any chromosomal abnormality with the ones we're transferring (or with me or my husband), there has not yet been a test created to check it. We're literally doing everything we can to ensure healthy embryos.

As a way to make me feel like we're not leaving any stone unturned, he offered to do a RPL workup which is a blood test offered to women who have had recurrent pregnancy loss. This is generally only offered to people who have had multiple miscarriages before the 10 week mark and tests to find out if there are clotting issues which might interfere with the placenta growth. It's easily treated with baby asprin and lovonox but they need to know it's an issue in order to treat it. This isn't something he necessarily recommends to someone who has had "only" three failed FETs, but I appreciate that he brought it up and if it's just a simple blood test I'm happy to rule anything else out. Why wait for more losses if this is just a blood test and so easily treatable? Did that this afternoon and results should come in about a week.

He brought up getting a second opinion saying that if we want to see someone else that he doesn't hold anything against us or get offended. I'm not interested in starting over with someone new at this point, but I think it's good to hear he wouldn't take it personally if we did. I don't know that there's anyone better and at this point I think it's too soon to shop around.

He apologized for last week's hectic schedule which didn't allow him to speak longer. I told him that I completely understand I'm not his only patient but that when he does talk to me I'd prefer if he was in front of a chart instead of trying to wing it from memory. I wasn't trying to make him feel bad or get an apology - I honestly just want to be able to get accurate information when we talk. I feel better now that I brought it up. I think it was important to me to not let it go unmentioned because it was a big deal and I don't want a repeat.

Overall we're feeling good about next steps. My husband and I are on the same page about wanting to do the ERA test. We're not totally in agreement about the endo scratch. Even though the endo scratch sounds like something I would try, I think it's pointless if we don't narrow down the transfer window first. He thinks it's a waste of time regardless. If we do the test and it comes back normal, at least we'll know we tried and will have no regrets moving forward with another transfer regardless of the outcome. If it comes back not normal then we'll get a possible answer as to why things weren't sticking. Either way it sounds like it's worth the pain, expense, and delay of another transfer. We can't do both: it's either the ERA or the endo scratch. Once you do the ERA you're mimicking the transfer so you can't throw in a monkey wrench into the system by introducing something new at the actual transfer. Since the endo scratch is unproven and we don't get an any answers from trying it, we're going to try the ERA and see where it takes us. 

This means that we're not transferring anything in July, possibly not in August either. So if I have the time anyway, I'm going to make an effort to use the time wisely working out and losing weight. Even 5 or 10 lbs off will help me justify the delay for the next transfer. I know I don't need justification, but for an impatient person such as myself, it helps keep my mind focused by having a tangible goal within my control. Exercising helps me feel good and eating healthy can only help. I'm going to set a goal for 10 lbs and reevaluate if I reach it before it's time to transfer (that should be my biggest problem!).

Feeling better

I made an appointment for Monday's bloodwork. Even though I usually skip this in person, I also scheduled what's commonly referred to as the WTF appointment to reassess before moving forward. The first available appointment my doc had was July 14. I asked if he was available sooner at a different location and got an appointment for July 5. Just goes to show that you should always ask.

I have been researching and making a list of questions and tests to ask about. Hysteroscopy, ERA, thyroid levels, prolactin levels, Vitamin D, natural FET, transferring more than one embryo, and endo scratch. I'm sure the list will grow by July 5. My husband can't come to the appointment because of work so I'm debating whether to go alone or bring someone with me to have a second set of ears in the room. Maybe my mother will come.

My BMI is within the acceptable range for treatment but from everything I've researched, there's a high correlation with miscarriage and high BMI. Since this is something within my control, I would like to lose 10 lbs before the next transfer. Ironically, I've been so anxious and depressed these past few days that I lost the last three lbs from my previous 10 lb plan. So I'm off to a good start. I'm considering joining the gym again even though I've been ok with exercising at home. Something to consider in the coming days.

I also spoke to my general gyn doctor who I've had as my doc for over twelve years. I love her. She's the best. I called her to bring her up to speed and get her opinion on where things stand. It's been at least a year since I last saw her so I started by giving a quick reminder of our situation and before I could finish the first sentence, she finished it for me. She not only had my chart in front of her but she'd also reviewed it before calling me - how refreshing! So different than my RE.

In short, she said we did "only" three cycles and while it's a bummer that it didn't work out that's no indication that there's anything wrong. For couples trying naturally, they're told to try at least a year (12 times) before assuming there's an issue. Even though we're getting high grade embryos and the chances increase with fertility treatment, they're nowhere near 100% and there's no guarantee of a take-home baby. Logically, I knew this is true but it was helpful to hear it from an experienced professional.

We chatted a little more and she was clear to tell me when things were beyond her expertise (like when I asked her opinion on doing an ERA) which helps me put more credibility on the opinions she does give. It made me feel better to speak with her because she's so professional and patient, even though she's not a generally warm and fuzzy kind of person. While I was on the phone with her I felt like I had her complete attention and that my questions were her top priority at the moment. I hope I graduate from the RE and move on to her soon.

I fell asleep exhausted last night at 7:40 PM and woke up several times at night to cry. I went in to work today because I have a deadline coming up, but everyone pretty much left me alone because they think I'm nursing a migraine hangover. Perfect, worked for me. At about 3:00 PM I started feeling faint, hearing people through a tunnel, really dizzy and nauseous. I realized I hadn't eaten since lunch yesterday and that was barely a string cheese and a banana. Luckily I caught it and ate before fainting. That would have been awkward to explain. I'm tired again and ready for the weekend.

I spent some time cooking for shabbat today and made vegetable lo mein, baked breaded fish, broccoli quiche, and chocolate cake. Then I took out some stress scrubbing the dishes. I'm looking forward to the weekend just being home recuperating and recharging.

Shabbat shalom.

Stalled

I've stalled on my diet plan. I wasn't as good watching my calories last week as I was the previous week, so while I didn't gain anything I also didn't lose anything. I guess that's also a win. So far I'm down 4 lbs of the 10 lbs I originally wanted to lose.

The truth is that while it's nice to lose the weight, I find that being strict on the diet helps me stay on track in other ways. One good choice leads to others which lead to a good healthy day. In contrast, I find that once I make a bad choice it's harder to switch back and make the other choices that day good. If I start the day out with ice cream for breakfast, there's a high probability that I won't work out that day and that I'll buy a high-calorie lunch or dinner.  But if I start the day by making my smoothie, I'll likely grab something light for lunch and make a healthy dinner, and make the effort to work out.

The biggest challenge is the prep. It's the thinking of menus and shopping for the ingredients and making sure the kitchen is well stocked with healthy options. It's an ongoing, exhausting process and as things get busier and busier at work I find less time and motivation to make it happen. This is why diets like Medifast are so popular and people stick to them even though the meals are disgusting. There is no thinking involved. There's also no enjoyment in any meals but at least there are quick results. I already decided that Medifast not for me so I have to make the effort doing it right, even if it takes more time and slower results. I know I want this to work and I'm powering through to prioritize good eating.

In other news, today I'm scheduled to take the fourth dose of del estrogen. It's been a while since my last FET and I didn't track much previously so I can't remember many of the details. For one thing, I'm seeing a lot of discharge that I don't remember from last time. Maybe it's new, maybe not. Another thing is that I had terrible memories of the intramuscular shots but in reality the del estrogen ones aren't so bad. It's still horrible to have to stick oneself with a huge needle in the thigh, but those shots are painless once it's over.  I was remembering the progesterone shots which go in the butt and are much more painful. The del estrogen is relatively pain free and is only administered every third day, so I kind of feel happy once it's done.

Later this week I go back for the halfway check to see if I'm ready for the PIO. Once that starts then transfer would be a few days later. Things are tentatively scheduled until the check up and bloodwork results come back from that appointment.  I scheduled a massage for the day before transfer. Transfers are usually scheduled in the afternoons (because the egg retrievals are always mornings) so I plan to go into work that morning and then leave for the appointment and take the rest of the day off, maybe the next day too.

We're still not in agreement about whether to tell people about a transfer. I want to keep it to ourselves. That's not accurate: the truth is that I just don't want to tell people who aren't going to care if it fails. Last time we told certain family members about a transfer and subsequent negative beta and I didn't get so much as a text or email of sympathy. I'm not asking for elaborate care packages or heartfelt handwritten notes (both of which are nice and always appreciated ;) but totally not necessary) but they didn't even call me or acknowledge the disappointment. I feel that there's no reason to give people like that private access to the ongoings of my uterus every step of the way. So while I would like to tell some people, I get that it's not fair for me to tell some people and for him not to, so I'm prepared to not tell anyone. There's still time to decide.

FET #3: Baseline

It happened and we're all ok! I was so anxious about the appointment this morning but of course it was fine. And I'm fine now that it's over and we've officially started the cycle. I don't even know why I was so anxious. Everything looked good according to the ultrasound, and bloodwork came back ok so we're good to start. First del estrogen shot tonight and again every third day until further notice. I'm ok with it. It is what it is.

The appointment this morning went well. I arrived at a great time so there was no wait. I got taken back right away, quick ultrasound, painless bloodwork. (My official recorded weight today was four pounds less than what they had for me at my last retrieval which was about a month ago. Weee!) Quick and simple. I was out the door so fast that I got to work earlier than I do on regular days.

There was a little drama last night when we realized the paperwork never got signed. I had gotten it from the nurse electronically, signed it, and it was supposed to be sent to my husband for signature but he never got it. So the nurse resent it to me and said "try again." I thought she had meant for him to try again and I forwarded that email to him. He kept pushing it off because he wanted to read the document in its entirety, so it kept getting procrastinated until I said last night that it needed to be signed. So he sits down to read and sign but he never got it still from the clinic and all he had was that email I had sent. There was no one to call in the clinic and I was so upset because I knew they would delay a start without signed paperwork and having him go down there was such a waste of time. Our plan was for me to go to the clinic earlier than my scheduled appointment, have them send it to him as I'm standing there, and I would text it to him letting him know to do it now so that I could move on with the rest of the appointment.

This morning I woke up and had a thought: what if the nurse meant to tell me that I'm supposed to sign first and then a copy gets automatically sent to him? I figured it can't hurt to try so I dig up her email saying to try again, signed electronically, and a second letter he get an email. Success! I can't believe it took that much drama to figure it out. So yeah, it was technically my fault he didn't get it but had he not waited until the last minute it wouldn't have been a big deal figuring it out. All's well and that ends well.

My next appointment is in June. She told me the date to come in and I asked if it was at all possible to move it up a day since I have a huge work project happening at the same time. She said she wanted a specific number of doses first so I said no problem, we'll make it work. Obviously. I'm not postponing it. So June will be a little hectic, that's fine.

The weather is being so ridiculous. I was in a sweatshirt outside nearly the entire last week. In May! Winter: you had your turn and you didn't take it!! If we're having no Spring I demand extra days be added to fall! But it is technically almost summer and I have plans for Summer 2016.  We're looking to buy a new car in June. I also want to plan a beach vacation or maybe something to a nearby lake. I put bedroom redecorating on hold while I'm busy with work. 

 I stopped thinking about zika because it's out of my control. I got my yard sprayed and bought tons of repellent. It's been too cold to wear repellent, but I have it and will wear it daily once it gets warmer, and that's as much as I can do. It won't do me any good to agonize over it.

I'm determined to try not to take any HPTs after the transfer. I hope I stick to that. I remember how agonizing it was testing daily, sometimes multiple times. The 2ww is such a stressful time for me and I know I need to prepare in order to avoid going bonkers. I'll have to work on that.

I'm excited for the weekend just to be home and veg out!!! Yay TV and sleep!

T minus 4 days

I've been dreading the start of the FET cycle. My baseline appointment is Friday and it seems like it's looming over me. I want to start the cycle but I'm nervous it won't work. I'm worried about the hormone-induced emotional roller coaster. I'm scared it will all be for nothing and that we'll lose another embryo. I'm anxious about putting so much into something and having it fail. I remember what it was like from last time and I really don't want to go through that again.

Work has been keeping me busy which helps me push these concerns to the back of my mind. It's only when I get home I remember that I'm one more day closer to the end of "normal." Regardless of how this turns out, whatever I have now will be over. Either it works and our lives are forever changed by pregnancy, or it fails and we're once again surrounded by grief and shattered hopes.

I need to get new hair products. I realized today that I have an association with the current hair mousse I use. It happened to be that during IVF 3 I got a brand new pricey bottle of Paul Mitchell Sculpting Foam. It's actually really great - it dries soft instead of that crunchy texture other products leave behind. It has a pleasant yet distinctive smell and during my IVF cycles, it happened to be that the mornings I was rushing out the door for monitoring appointments I would just put some product in my hair and wear it curly for the day instead of taking the time to do anything with it. Well, alone in those waiting rooms all those appointments and all I could smell was my freshly pickled hair... I started associating that smell with the clinic. So now I get a reminder of that feeling of blood draws and waiting and anxiety every time I smell it, so I have an unused half-bottle I'll probably be giving away soon.

I've been doing great on my diet. I knew 3.5 lbs was too good to be true and sure enough I was back up by 1.5 lbs at the end of the week, still netting a minus 2 so I consider it a win. Still counting calories, still using myfitnesspal.com, still feeling like I'm doing what I can to help this transfer.

Meds order is scheduled to arrive tomorrow and we need to finalize some paperwork. Other than that, just waiting. In other news, we have exciting plans to see one of my favorite comics later this week and this morning I had an almost pleasant encounter with Verizon about my busted charger! All in all, a good Monday.

What a week

I got the saddest news on Sunday. A friend who had twins in March lost one of the babies on Mother's day. Apparently there was no history of any medical condition and it was just sudden. Eight weeks old and they found him unresponsive in his carseat. It's every parent's nightmare and the absolute most devastating thing. He had a name and a sweet personality and a family who loved and cared for him. When the mom posted a tribute on facebook with pictures I just lost it at work and cried while my heart ached for this family's loss.

Yesterday was Yom Hazikaron - Israel's Memorial Day - which remembers the fallen soldiers who died protecting Israel and its people. It was cathartic to cry with everyone, not only for the fallen soldiers and the loss of their futures but for this tiny baby as well.

From darkness to light... and as the sun set on Yom Hazikaron it marks the start of Israel's Independence Day: Yom Haatzmaut. In Israel it's a national holiday and everyone celebrates with family, BBQs, day trips, and lots of music and dancing. I love this holiday and hope I get to celebrate it in Israel one day.

Work has been so busy and I've been coming home exhausted every day. It's our busy season which peaks the first week of June, just before a possible FET. Even so, I've been making time to work out and it's really helping my diet. So far I'm 3.5 lbs down toward my 10 lb goal. I've been sticking to my calorie intake and having lots of fruit, veg, and protein, with sparse grains and fats. Smoothie with fruit, greens, and yogurt for breakfast, salad for lunch, multiple snacks throughout the day, and a balanced dinner. I'm not depriving myself of anything, just keeping it within my calorie limit. So far I feel great, I'm not hungry, and I'm seeing great results. I think it's working because I don't feel like I'm missing out on anything. It might be "beginner's luck" and the first part was just water weight, so we'll see.

I placed the order for the FET meds and need to schedule my baseline appointment. While part of me wants to get to the next stage, another part of me is really enjoying "normal" life without hormones, shots, doctor visits, blood draws, or the emotional roller coaster. Not that I want to postpone anything, but I am dreading some parts of the process. Thigh/butt shots are so unpleasant and the last two times there was no light at the end of the tunnel; they both resulted in negative betas. Beside that I was an emotional mess complete with insomnia. I'd pay good money to skip forward to the 6 week ultrasound check!

Transfer preps

I recognize that there's not much I can do to guarantee the transfer succeed, but there are still some things I can do to help me feel in control.

I decided to try to lose 10 lbs before the transfer. I have a month and, if I have to wait anyway, I want to make the best of the time. I thought about doing Medifast since it seems to have good reviews for quick weight loss. The products are EXPENSIVE (almost $800/month) and look disgusting. I can almost guarantee I'll buy the products, try them, and then immediately not want to do it anymore. In any case, I should learn to make better eating choices for long term benefits. Not only that, but I don't think filling my body with chemicals right before a potential pregnancy is the right way to go.

So with those considerations in mind, I decided to try to do a low-calorie/high protein diet for the next two weeks, to start. I can pick and choose my own meals mainly based on fruits, vegetables, and lean proteins and as long as it's within my calorie range, it should have similar enough results to Medifast. I'll have to prepare everything in advance, which is a big difference than just taking a pre-packaged meal, but for $800 in savings I'm willing to give it a try.

My lower back has been bothering me. Last egg retrieval I had some unexplained pelvic pain around the same time frame as now and when I went to get it checked out they said it was nothing - and it did go away on its own a few days later. I'm wondering if this is more of the same, basically post-surgery . I was thinking it might be something with the mattress so we took a look at the frame and it was messed up. There was a piece broken so we took it apart and left the mattress on the boxspring until we have time to replace it. I was actually planning to do a complete overhaul of the bedroom over the summer and I haven't had a chance to do research yet, so I might just leave this until then and move up the timeline a little. I hope the frame bandaid helps in the meantime.

Tomorrow is Mother's Day and it's the first one I've thought about in terms of my own non-motherhood. I'm not sad or looking head or wondering or thinking about anything. A little numb, I think. Just a thought that occurred to me.