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!

NBC News

I'm not shy about my enthusiasm of NBC news shows, specifically TODAY and Nightly News. My jaw literally dropped when I heard the news about Matt Lauer this morning. It was 7:10 am and, while I'm usually watching at that time, today I happened to be in my car at that time and I heard the news on the radio. Like many people I was shocked. I also thought back to the 2012 Ann Curry debacle and couldn't help but think of that karma coming back around.

It's interesting that every Matt Lauer story is followed by a Meghan Markle story and her upcoming marriage to Prince Harry. What a weird transition. Then again they can't control the headlines.

I love Savanna Guthrie and she was such a class act announcing the news this morning, obviously while still processing it herself. I'm fascinated by all things TODAY to the point that I sort of want to get a job there just to be on the inside when these crazy stories break. I know I'll be following this story closely waiting to hear details.

And yikes about these sexual harassment accusations. How the mighty have fallen. I've always known women will take over the world, but I didn't think it would be because all the men were fired for being pigs. Who will be accused next??

Anatomy of an IVF cycle

Presented in a simple flow chart from my point of view.

Pre-cycle:

Anxiety > fight with insurance > coordinate finances > wait for period > worry > figure out timeline > wait > order medication > pay a lot of money


During cycle:

Relief that you're finally doing something > regret that you have to do it > Worry about all the things that could go wrong > inject > wait > bloodwork and ultrasound > wait --> repeat x12sh days > trigger > retrieval > recovery/anxiety


Post-cycle:

Results day 2 > recovery/anxiety continues > day 4 report > recovery/anxiety continues > day 5/6/7 blast report > breathe a slight sign of relief and/or crumple in disappointment at results > continue recovery and, if any blasts were sent for testing, worry daily about report > receive PGD results > rejoice at success or weep at failure

IVF 7: Baseline

It felt like things were going so slow this morning - they couldn't get anything done the first time around. When I checked in I planned to make my payment as usual. They couldn't figure out if the number I was paying included the credit I'm owed or not. I assumed it did already since it was the number I was quoted by the financial counselor but if they wanted to double check, who am I to argue. So I sat down without having that taken care of.

Then came bloodwork. They stuck me twice, no success. I reminded them they need to take my weight. They nearly forgot about it, and after I worked so hard getting rid of every ounce (currently 16.8 lbs away from my goal; 7.2 lbs away from clinic max)! Since they were having no luck with my vein they sent me for ultrasound and said they'll try again after. So didn't get that done either.

Thankfully, there was no issue with the ultrasound. After that I got stuck again in my arm but they weren't able to get blood, so they moved to my hand instead. It hurts SO much to get blood drawn from the hand.  Less so during, but so much after and then throughout the day. Both my arm and hand have nasty bruises. I hope this isn't any indication of what the cycle is going to be like or we're in for a bumpy ride. 

After blood draw I went back to the front desk to make my payment so that it doesn't hold anything up. They still couldn't figure out the credit situation so they said to make my payment less the credit and if there's any issue I'll get a call from the financial counselor. No complaints here: I got a 20% discount - maybe it's a Cyber Monday miracle!

I got the call this afternoon that bloodwork results are in and we're cleared to start. Shots start Thursday.

Thanksgiving 2017

Thanksgiving weekend flew by in a whirlwind of food, family, beautiful weather, new experiences, tv, lots of politics talk, and more food. We kept it low key, taking the time to remember the loss this time last year but trying not to get caught up in it. Sometimes we get bogged down with the things we're still waiting for, the unanswered (as-of-yet) prayers, so it's nice to have an opportunity to remember to look around and see the blessings around us.

Tonight is the last night of our break, with baseline scheduled for first thing tomorrow morning. We had a great run and a much-needed rest from treatment. I feel ready to tackle this next cycle head on and hope it goes by quickly, smoothly, and successfully.

Reasons

As baseline for IVF 7 approaches I've been getting a strong desire to do a transfer instead of a retrieval. I've got baby fever and just want to be pregnant and get the show on the road toward 9 h&h months and be over recovery and just enjoy my baby.

But I know it doesn't work that way. Not in my world. Transfer doesn't necessarily equal pregnancy and so we have to make decisions for the long run.

There are good reasons to wait for a transfer:

• First, if we do another retrieval then we potentially have more embryos. It's better age-wise and recovery-wise. Before winter break is the best time to do a retrieval so that I have time to recover physically and emotionally from the hormones.
• Second, I'm doing well on my diet and really want to give it a chance to get to my goal weight (now 19.6 lbs away). I've been yo-yoing back and forth for years and I want to hunker down and get it done. I know my weight will jump back up after retrieval when I don't have the energy to exercise any self-control -- especially since it will be right around Chanukah -- but I know I can do it if I focus, and what better way than using a healthy preg as motivation. I'm far enough removed from the last loss to let myself believe it's an actual possibility, not just an irrational fantasy.
• Third, I'd really like to give a chance to see the endocrinologist before a transfer if possible. Our appointment is scheduled for end of January. Originally that timeline was perfect when it included a Jan trip. Now that the trip may not be happening there's no need to wait until Feb to do a transfer.

Those reasons are what's keeping me from pushing for an immediate transfer. My husband believes retrieving now is better but would support a transfer instead, especially if I said I can't handle another retrieval now. I don't want to be the reason the retrieval is canceled so as much as I hate the process I'd rather not think about it too much and just get it over with. Sometimes knowing what to expect is good and bad. In this case I know it will suck, I know it will hurt, I know I will be miserable and emotional... but I also know that it will pass and that even though it will suck for a while, it won't be forever.

Grief

Over the weekend I went to a memorial for a high school classmate that passed away due to an accidental overdose. You hear about the "opioid epidemic" on the news but then a person you know falls victim and it hits home. I had not seen this classmate, or several of the other memorial attendees, since our high school graduation over a decade ago.

The memorial was held because the family wants to keep things quiet. They are sitting shiva but they did not want it announced or some people to attend. Over the course of the memorial it was made clear that the family doesn't want several friends of the deceased to show up at shiva because there are ill feelings of why the friends didn't do more to save the person. It's difficult to be friends with an addict and while I can't imagine the family's grief, I also think they're placing blame where it doesn't belong. I also disagree with their decision to sweep it under the rug but I can't judge them for grieving the way they believe is right.

I knew it would be a mini-reunion with everyone talking about their family and kids. I managed to not talk about myself and only winced a little when one person mentioned, "We're all parents..." Even though I haven't seen this person in nearly 15 years, I went because it was a tragic loss of life worth remembering and worth mourning. It's not always about me and at that time and place it was about remembering a light that was extinguished far too soon.

Ordered

I finally crossed "buy meds" off my list. Of course there was multiple hold times with Freedom and the person had to call me back. It's never simple with them. It is what it is.... bye-bye thousands of dollars.

I went back to read my blog from this time last year. It's so sad. I can't even think of anything I want to do less than go through that again. Yet here we are... starting another cycle.

I had a mini-career crisis today. It feels like I'm stuck in a position where they see me in a certain way and I have nowhere to grow. I do look around at other open positions and occasionally apply and interview, but it's not like I'm getting comparable offers left and right. There are also so many good things about my job that I don't want to lose if I leave.

After venting to a friend who used to work there and knows the dynamics of the place, I felt better. I realized I want to figure out a way to get ahead at my current place rather than give up and try somewhere else. A decade ago I was so ambitious but these days it feels like all my energy is spent on gearing up and recovering from cycles. Being aware of that makes me want to try to rediscover some of that ambition and try new things.

In diet news I'm exactly the same weight as baseline from IVF 6. That means I'm just under the limit but want to get more of a cushion. I've been at this weight for about two years +/- five pounds. My newest goal is to get to a certain number by transfer day, whenever that happens to be. Right now I'm 21.4 lbs away from that number. I have a little time until baseline but Thanksgiving is right in between so I'll have to be careful not to overdo it that day.

Hesitant

Does it feel like November is zooming by for anyone else? I feel like baseline is coming up faster and faster, and with it the end of our break.

I haven't ordered meds yet for IVF 7. No reason, just haven't. It sickens me to have to spend $5,000 on medication on a cycle that may or may not work.

I'm part of a support group on facebook and every time someone asks for tips about IVF or a transfer it sends shivers up my spine about what's ahead.  Someone just posted about a beta of 37 and it made me relive all the awful parts of a transfer and 2ww.

My sister wants to do gender-reveal cookies at Thanksgiving and asked me if that would be ok. What am I supposed to say? It's not like she can hide her pregnancy. I appreciate that she wants to be sensitive even though nothing helps the kick in the gut. Just because I'm being robbed of all the cutesy pregnancy-related milestones doesn't mean she has to be also. I told her it's fine but to not take it personally if I or my husband don't participate.

I'm worried and scared. Maybe it wouldn't be as bad if we knew it was going to work eventually, but I've lost that blind belief. At this point it's just faith and hope getting us through each day.

Stress, Endo, ENT

It's been a hectic week. My brother was out of town for work and I helped his wife with the kids over the week, which included a hospital visit for my nephew. I'm the default person in emergencies because I don't have kids at home so it's assumed I can drop everything and come, when in reality it's just my personality and I do that anyway even if I have a thousand other things going on.

It got so stressful at one point that I broke down on the phone when my husband called to check in. After spending the majority of the night in the ER with my sister-in-law and nephew, then running home to take a quick nap and shower to get ready for work, I was exhausted and stressed when I said that I was worried my lot in life is to just be an addendum to someone else's life helping everyone else. Long story short, my nephew was in the hospital for two days and we all chipped in to the best of our ability to take care of the other kids.

I also had a work event the same night, and tickets to see my favorite comedian, and guests for shabbat. I didn't know how I would get everything done, but when my husband asked, "Do you really have to be at work today?" on Thursday, the truth was that I didn't really. I could have taken the day off, my supervisor would have been super understanding, and I would have been able to cancel my guests and skip the show. But then what was left? I felt the need to purposely prioritize my own life so that I don't become just a supporting character in other people's lives. It may or may not be ridiculous thinking but in the moment that's how it felt.

Our next cycle starts the week after Thanksgiving so I'm back on my pre-IVF diet. I had some regrets about agreeing to do another cycle because I just don't wanna with the meds and the side effects and the retrieval ughhhh. But after discussion with my husband we're back on the same page that it's what we want. Plus "I don't wanna" isn't a legit enough reason to not do it. I don't think we're still as gung ho about an expensive trip in January, though. We've reconsidered the cost and just can't justify dropping so much money on a 10-day trip. As much as we want to go, we're terrified we'll need the money in the future and regret not having it.

In other news, I got an appointment with an endocrinologist. When I went for a second opinion in the summer, something in my thyroid got flagged in my mind enough to make me want to double check. Last week I searched on my insurance website for local endocrinologists that take my insurance. I then cross referenced the ones I picked with reviews online and on fb groups. After narrowing it down to top three, I started calling for an appointment. The first call I made took me on an automated loop ride for like 5 minutes before I got asked by a human if I can hold. I held for two minutes and hung up - can't deal with that. Second office I called directed me to a voicemail that instructed me, as a new patient, to leave a message and someone will get back to me within two business days. I left a message a day later I got a call back from the second office.

The provider I asked for is currently booking new patients in January. I could see someone else in the practice "as early as"  December. I asked if I can get on a wait list to get seen earlier if there's a last minute cancellation and she said she'd have to register me, book the appointment, and then she can add me to the waitlist. I agreed and she asked for my info. Then she asked what I'd like to come in to be seen for and I said thyroid checking. She said technically they don't take new patients that have not been diagnosed with anything. It needs to come from the pcp or a referral from another doctor who thinks there's an issue.

I said that I'm trying to get pregnant and that my doctors don't seem to think there's a problem because my numbers are ok for regular people but not necessarily for pregnancy. She suggested I try seeing an RE, to which I replied that I have one, and been tested multiple times but the number comes back different every time. While they don't see an issue I want to double check and before going through another transfer I want to get an opinion from a specialist. Her suggestion was to have my records transferred and have the endocrinologist review them before deciding whether I need an appointment. I said fine. She wasn't arguing with me but it was weird to have to justify the call. Just book the appointment. You'll get paid for a consultation whether I need treatment or not so what do you care? I can't get treatment without a diagnosis, but I can't get an answer about a possible diagnosis before I see a specialist. Ridiculous.

I was planning to follow up tomorrow, which would have been a week, especially since I didn't get any kind of form to sign that it's ok for my docs to release my records. I know I could be completely barking up the wrong tree and there really is no thyroid problem at all. But before transferring any more embryos I want to make sure I'm giving them the absolute best chance possible. I've got time before a potential FET so I may as well make the most of it. I got a call back from the endocrinologist's office saying that they got my records, the doctor reviewed them, and has approved booking an appointment. So on one hand, yippee - progress! The office staff person did what she said she would do and even had the doc review the notes and even called me back. I'm officially on the schedule for end of January, with the promise of being added to the waitlist if there are any cancellations. Even though I'm happy I got the appointment I'm now worried that the doctor saw something in my files that she thinks needs to be addressed. Or maybe she didn't want to just dismiss me offhandedly. I don't know. Hope I can get in sooner than January. Hope if she did see an issue that it's easily fixable.

In the meantime, I also wanted to get an opinion from an ENT. In the summer I went to see my pcp because I wasn't feeling well. I had been crying a lot after the d&c so the symptoms of a sinus infection were masked and it took too long to get it checked out. Lately I've been having similar symptoms. Even though they're way more mild I wanted to nip this in the bud before they get worse. In contrast to the endo, I called the ENT Wednesday and got an appointment for Thursday with the PA. She checked my ears, nose, and throat. Apparently I have lots of inflammation in my nose but ears are clear and she saw no signs of infection. Her best estimate was that it's "probably environmental." Allergies maybe? I couldn't go through my medical history without mentioning the fertility stuff, and she suggested that if I'm still upset often it may be a factor as well. I am, and it is. Since she didn't see signs of infection she didn't want to prescribe antibiotics, which is fine - I'd rather not take any if I don't have to. She made a few otc recommendations and sent me on my way. The hypochondriac in me is satisfied and I feel like it was an hour well spent.

In addition to all this there has been more crime in our neighborhood: break-ins to homes and cars, carjackings, muggings, etc. It's stressful to have this on top of everything else. The community watch-groups are trying to ramp up surveillance but it's scary.

Lazy Sunday thoughts

We've been on break since the last retrieval back on 9/10 and it's been amazing. Without the hormones or doctor visits or extra bills or spontaneous tears we can just pretend we're back to our pre-treatment days before we were even trying.

It's working so well that I even found myself being hopeful about the next cycle, even the next transfer. Like, it has to work, right? It's gotta finally be the one. Then I overthink it and bum myself out: It didn't work before, why should it work this time? Why would time time be any different? Then I start calculating how old I'll be if this next transfer works when my kid is born or at age 13 or 18 or getting married. Eventually it gets too depressing to keep the thought going and I try to distract myself with something else.

I try not to let our emotional baggage follow into every cycle. I consistently remind myself that every cycle has its own chance at success regardless of statistics or what happened in the past. I can't let previous failures weigh me down. But since there's so much more to failure than just a busted cycle, it's hard keep the negative thoughts from leaking over to future treatment.

My husband and I started including "v'et zaareinu" (translated as: "and our seed") during the section in bentching asking Him to bless us, our family, our home, etc. Most people use it to refer to their offspring, but we use it in reference to our embryos currently chilling on ice. We know they're not yet children but they're still important. They're potential life, our prospective family, our possible future. We can't hold them or see them but we love them already. It kills us every time a transfer doesn't make it, so yeah I think they deserve an honorable mention. 

Reading that back is heartbreaking. How sad are we that we're grasping at straws to find ways to include prayer for our unborn babies at every turn. It just goes to show how much it's on our mind literally all day, every day. I don't know if I'll ever stop waking up from the bad dream that we're back in the doc's office and they're telling us there's no heartbeat, or answer another phone call telling us beta numbers went down instead of up. I recoil at the thought of putting ourselves through it again. Maybe in some way this reasoning subconsciously makes its way into our pros and cons list when we opt for retrievals instead of transfers. 

Despite all that, I can't help but be optimistic. I have to believe it's going to work. I have these two conflicting mottos in my mind: "insanity is doing the same thing over and over and expecting a different result"; and "a winner is just a lose who tried one more time."

While I don't want to be one of those people who becomes obsessed with making this happen and keeps trying failure after failure, I can understand it when someone looks at our history objectively and says two chemical pregnancies and one blighted ovum aren't a reason to stop trying. The little negative voice says, "but they were five transfers from five tested embryos!! Why didn't they work??!"  I don't have an answer. Even the doctor says there's no reason to believe it shouldn't work. We've been on the wrong side of statistics and the only thing getting in our way of success is to stop trying. Even when we went to get a second opinion that doc said there's nothing medically to keep us from being successful that they can pinpoint. So the plan is to keep trying. As hard and emotionally challenging as it is, we take it one day at a time and hope for the best.

Emotional side effects

I recently had a tiff (via text because we're millennials ;P) with someone close who tries to be sensitive but misses every so often. My resentment started out leaking through my words via text over time and then escalated to near hostility. It was time to air things out and we had a discussion.  While I said a lot of things I've been holding back for a long time, I don't think she totally got what it is that bothers me. Part of the resentment is that she's currently expecting #2. Through no fault of hers, I've been comparing our lives since her first pregnancy announcement coincided with our first failed treatment. It's not her fault this is so hard for me. But it's hard to put into words what repeated compromise and resentment can do to relationships.

I'm not sure anyone who hasn't been in this situation completely understands. At the same time I'm fully aware that I'm hyper sensitive, and this is really hard. I realize that I'm expecting a lot from people and that when expectations are set so high I'm setting myself up for disappointment. It's impossible to expect people to read my mind and know what words or actions can help or hurt. When people talk about "infertility" as a general concept they have absolutely no idea how difficult it is from all aspects.

I feel like my options are to (1) distance myself and have no interactions so as to avoid hurt, (2) tell someone what bothers me, repeatedly as it happens, and risk resentment on their part and lack of action to change anything because they just don't get it, or (3) continue as is and not say anything while lowering expectations significantly. Until now it's been option 3 but with too high expectations.

I don't know what the right response is. I don't know how to correctly handle it. Is there a right way to deal with this kind of social interaction? It scares me to think how much longer we'll be in this chapter of our lives, dealing with the nasty side effects of an already awful situation.

There's a Bonei Olam event next week. It's a fundraiser for a non-profit organization that offers grants toward fertility treatment to couples who meet the criteria, with the program promising to be a "beautiful evening of inspiration and success stories" of couples who have been able to build their families. While we've never received financial assistance from this organization, I still think it's an important organization to support. I would also love to meet other couples like us who are still in the pre-Success stage and still going through it, and goodness knows we can all use a little inspiration. The problem is that I'm worried the "inspiration" will backfire and I might fall apart in a room full of people. My husband isn't interested in going and my friend whom I'd normally drag to these things has a calendar conflict. I don't want to go alone; I don't even know if I want to go at all.

Getting ready for IVF 7

Over the holiday my nurse emailed me to let me know she's moving positions and that I'll have to get assigned a new nurse. It took a few days of back and forth but then I involved my doctor and was finally assigned a new nurse. We set a baseline date around my work schedule and I'm working on getting a quote for medication from several different pharmacies.

In the meantime I also started getting information from our new financial counselor. I got us a refund for a portion of the last cycle because we overpaid for something that should have been submitted to insurance. It's crazy how on top of things I have to be - isn't that literally their job? They just don't care how they get paid. If payment comes from insurance great, if it happens to come from our pocket also great. It's a challenge to constantly be on the ball and know that if I miss something then we lose out.

I'm trying to not overthink this cycle. Whatever will be will be. IVF 6 kicked me in the nuts with recovery and results. I'm hoping that an upcoming Jan trip will be enough motivation to keep me happy and energized. Bottom line is that it's a hellish 3 weeks and regardless of results it too shall pass.

So how did we get to this decision? As I was thinking about what we want to do next, I tried figuring out how to do another cycle and another transfer before January. I don't know why that was a deadline in my mind. It's possible because the clinic OR shuts down the last week of December for their yearly scrubbing and they don't start any new cycles leading up to that week. No matter how I sliced it, I couldn't get the calendar to fit both an IVF and a transfer which meant we had to choose one. In the back of my mind I was also thinking that it would be nice to do a trip and take a real break.

My husband's work schedule dictates our vacation schedule and we calculated that it may be possible to take a trip in 2018. The more we talked about it the more we realized how much we both want to go. We decided to try to book a trip for earliest possible time in 2018. With that decision made everything else seemed to fall in place. We knew we didn't want to try to do a transfer before the trip which made it easy to choose the time in Nov/Dec for another retrieval. At this point the bar is set so low that the very least will be that we tried something and didn't waste the time, regardless of the results of the cycle. My office is closed for winter break at the end of December so I'll have a solid week for recovery.

Even though it's only mid-October I asked my new nurse to see if she can schedule the retrieval for early December. It gives me time to get back to some routine first and get my head in the game. It also allows me to take care of several work events between now and then without the stress of the cycle and meds. It also gives me the chance to enjoy the Thanskgiving break. It just makes sense overall. There's not much that we can control when it comes to treatment, but for the things that we can it makes a difference.

Boston

We did a quickie getaway to Boston for a few days. We used points for hotel and flights, so only ended up paying for transportation (Uber and taxis), activities, and food.

The itinerary included a whale watching cruise, guided Freedom Trail tour, self-guided fenway park stroll, and walking around Harvard and along the Charles River. We lucked out with beautiful weather. It was an awesome chance to get a change of scenery without using too many vacation days. We had a great time.

View from the boat, on way to Whale Watching

One way to see things

Street art in the park

Fall foliage

Cafe Eilat

Fluffy clouds

Feeling good

I talked a lot about redoing our bedroom and it finally happened. I bought the furniture we liked at a Labor Day sale knowing it would take a while to ship and it finally arrived. It's spectacular!  The room is still a work in progress but I'm happy to report progress. Next up is lighting, decor, and accessories.

After seeing what the architect came up with, I've decided against renovating the house to add a master bathroom within the current perimeter. Either we'll finish off the basement or we'll do an addition upstairs (or maybe both eventually down the line). I don't want to have tiny rooms and teeny bathrooms and pay out the nose for it. So that's on hold for now.

I've been talking with my new nurse about our next cycle. I'm trying to schedule retrieval around my work schedule. Things are going to get hectic in the next several weeks so I want to see if we can work backwards from mid-December. That gives me enough time to get mentally prepared and enjoy a few more weeks of normalcy. It will also give me a chance to drop the extra holiday pounds.

I've been enjoying our non-treatment break so, so much. It feels amazing to just be regular without discomfort or pain or fluctuating hormones making me crazy. It's incredible to be able to hold my emotions, something really difficult while on medication. It's so nice to be able to plan a few days in advance because I don't have to assume I likely won't feel well.

On one hand I hate having to gear up to get into this again for IVF 7, knowing the hell coming up. I also hate the idea of all the shots coming up for whatever transfers we end up doing, along with all the side effects that come with it. On the other hand, feeling like this makes me happy to know that whatever treatment hell has in store, it's temporary. It will be over eventually. It's not forever. There's a light at the end of the tunnel. I can and will feel normal again, it's just a matter of time and a difficult chapter to get through. The mere idea of all this being "in the past" and having gotten to the other side is exciting.

Over the past few weeks there was a significant change in my attitude: I've been happy and hopeful. I have energy and a spring in my step. I'm not sure what specifically to attribute it to. The break and lack of meds is probably a big factor. I know that the holiday season was incredibly difficult where we were reminded of our childlessness non-stop. At shul, at family gatherings, at holiday celebrations - triggers were everywhere. Before Kol Hanearim this year at Simchat Torah our rabbi read this prayer specifically geared toward couples dealing with infertility. It was special and gut-wrenching at the same time.

So maybe we hit a new low regarding feeling sad that there was only one way to go, which is up. Regardless of the cause, I'm glad to be feeling good and more like myself, making decisions and taking chances on things I may not have otherwise. For the first time in a while I'm looking forward to what's ahead even thought it's still scary and out of my control.

Next

The last days of the holiday were nice. We were home for all the meals and socialized with friends and neighbors in the afternoons. We chilled, relaxed, overate. It was good.

 

The working plan now is a retrieval cycle in Nov/Dec, trip in January, transfer in February. Details to follow.

 

Sukkot

The first days of Sukkot were tough. Our sleepover guests were exhausting and demanded all of our time and energy. I wrote up a whole post of what was difficult about their stay, but even in an anonymous post on an a supposedly nameless blog, it's still the internet where everything is public and permanent. Suffice it to say it was a lot of work and most of it felt unappreciated.

I used shul as an escape, which kind of backfired because that's where all the ladies with pregnancy bellies hang out (apparently) with their beautiful cute little families. There were triggers everywhere.

Over the holiday I received an email from my nurse that she's moving to a new position. This was our third nurse. Even our nurses get to move on from this hellish journey. I'll be assigned to a new nurse once we let them know we're off our break and decide what we want to do next.

We still don't know what we want to do.  We've been enjoying just being a normal married couple, talking about other things. There are a few days we took off at the end of October to take a quick getaway but we're still undecided about where to go. Florida is our first choice but it's still unclear if they're completely zika-free. We also got the Israel-trip-bug again and we want to see if we can try to make a trip work for 2018. On one hand we want to give treatment the best chance possible and really believe it's priority. On the other hand it's an expensive trip and we're sick of the merry-go-round. I don't want to postpone any treatments because I feel my age ticking but I also don't want to feel like I let life slip by while waiting for results.

I know I'm not the best version of myself these days. I feel drained and exhausted. I feel like I'm surviving, not thriving. Just taking it one day at a time, one hour at a time. I want to make changes to help make things better. Maybe it is worth spending the money on an expensive trip to get change of scenery and a fresh outlook on life.

Choices

The financial counselor that has screwed me over in the past is no longer there, thankfully. I took my questions directly to a supervisor to make sure I understood my options.

As we debate next steps whether to do IVF 7 or FET 6, I want to know exact numbers. What are the costs? What programs are available? Are we getting the biggest bang for our buck?

As I mentioned before, my clinic has several "Shared Risk" programs. One such program has the option of doing up to 6 fresh IVF and unlimited transfers from embryos from those cycles. They make you transfer every viable embryo from one IVF before doing a new cycle, up to six times. After six IVF cycles and all the transfers from those cycles have been transferred, if you don't have a take-home baby they refund 100% of the money (not meds, of course). Any embryos I have in the freezer right now wouldn't count toward the program. So while I can't count them in the "unlimited" transfers, they also won't hold us back from doing fresh IVFs. That's fine with me. Even though it includes everything except meds, it's a lot of money up front. There's also an additional fee if we want to do back-to-back cycles without transfers in between. Once you get a take-home baby the contract is complete, regardless of how many cycles you've done. Let's put a pin in that for a minute.

My insurance won't cover a fresh IVF as long as we have embryos in the freezer. Since we are interested in "preserving fertility," as they like to call it, we've opted to do fresh cycles even when there were transferable embryos in the freezer. At this point we have two embryos we can transfer (IVF 4, 4/16; IVF 6, 9/17).

I believe we overpaid for a combo IVF/FET which includes one transfer for every IVF in the global fee. I don't want to pay for the FET out of pocket; I want them to go get authorization for it from my insurance. Why should I pay for it if I still have benefit dollars I can use up? Insurance only denies coverage for IVF while there are still embryos in the freezer, but I still have coverage and the clinic should get authorization and use it!  For this last cycle I paid for a combo IVF/FET per the advice of the now-fired financial counselor. When I spoke to the manager I asked for a credit for the FET portion of the fee I paid. If we decide on a fresh IVF cycle, the credit will go toward a new cycle and I will only be charged for the IVF part of the global fee. If we decide to do a transfer, they will submit to insurance for authorization which they said they will as soon as they have a start date. How's that for fun?? I saved nearly $4,000 just for spending 15 minutes asking questions. Take that Geico.

While I feel like getting more embryos is the way to go, I'm not sure I feel that way for the right reasons. As long as they're in the freezer, they're safe and there's hope. In the past five transfers we've ended up with only disappointment and heartache so I hesitate to pick a transfer. I don't want to "waste" embryos. It's obviously flawed logic because if we don't transfer we have no chance at a pregnancy and baby which is the ultimate goal here. Embryos on their own are not babies. When we only had one in the freezer, the choice was easy: don't be left with nothing, keep retrieving. But now that there's more than one, does it make sense to keep doing IVF? I don't know anymore. The right path isn't clear when there's no guarantee one way or another.

In April 2016 when we got 3 healthy embryos to transfer from IVF 4, I thought it would be the last time we'd ever have to do a retrieval. Then this time in IVF 6 when we had 14 embryos on Day 5 I again thought we'd never have to do another retrieval but then only two made it to biopsy. Maybe I have to stop thinking that we're never going to need to do more retrievals. Then there's my age to consider and while I'm not old yet, at 33 the "advanced maternal age" of 35 is just around the corner. There's no way to know how my body will react to a pregnancy, if I ever get that lucky, and no way to know how many transfers it will take to get pregnant with number 2.


I've tried to focus on working on getting one baby at a time, but it's impossible not to think about the future. I know there are no guarantees, but with embryos in the freezer I would be a lot calmer to enjoy baby #1 before needing to rush back in and get started again to try for a sibling. I never thought there would be a specific number I have in mind of how many I need in the freezer before I feel comfortable transferring. I thought I'd be ok with having one. But now that there are two, I want to keep two. Knowing what I know now, I don't know if I'll ever feel content with anything regarding fertility treatment. There are just too many unknowns and things beyond our control.

We got results earlier than we anticipated, which meant that we could still decide to not skip a month. I wasn't so happy with taking a break. If we decide we want to do IVF I want to get it over with. But I recognize that we still need to live our lives. It's been non-stop for over two years.  We just need a break to be normal for a few weeks. Not be depressed, not be niddah, not feel nauseous, not be in pain or uncomfortable. We're aiming to do a small vacation end of October and that would've needed to get rescheduled if we restarted treatment earlier. In addition, my coworker who is now on maternity leave will not be back before December and I know there will be a lot of slack to pick up while she's out.

Back to the Shared Risk program, I don't think I'm going to want to do more than two back-to-back IVF cycles in a row. Maybe after the break we can do one more (at a reduced fee based on my conversation with the manager and the newfound credit on our account) and then start transferring. A transfer would be easier and if it fails we can always do the fresh IVF after.

If this journey has taught me anything it's that there are no guarantees and there are no wrong choices. If we do a transfer and it works then we have a baby and we've won. If we do a retrieval and get more embryos to transfer then we've won. We already know either one of those can fail, or worse start out hopeful and then crush our hearts. We've been there done that: high embryo counts that never develop into blasts; pregnancy that took but ended as a blighted ovum. So I don't know what the right path is; I can only hope that the one we choose leads us to our ultimate goal of having a family.

Just thinking. I don't have the answers, but these are the choices.


G'mar chatima tova.

One

It only takes one! 

We got PGD results back and of the two embryos we sent out, one came back healthy. Amazing!!! We had very low hope that anything would come back from this cycle and we're surprised and incredibly grateful that it wasn't a complete bust as we feared.

We're still debating between a fresh ivf and a transfer, but this gives us options. I have more to say about cost but another time. For now, it's a small sigh of relief: a high on this journey's roller coaster.

So what now?

Our next step is to decide whether to do another fresh IVF or to do a transfer. The next steps depend on the PGD results of the embryos we just sent out. I don't have high hopes, and I'll still be crushed if they're not transferable, but we still have to give it a chance to come back before deciding.

So for now we're doing nothing. Above all else I'm trying to fight the panic that missing a cycle won't matter in the long scheme of things. While I want to keep trying, I recognize the value in a much-needed break, so that's what we're doing right now. Giving a chance for the results to come in will let us make an informed, strategic decision moving forward. In the meantime I'm enjoying feeling good physically: no fatigue, no stomach issues, no headaches.

Timeline-wise, I don't know how we can do a transfer before January. Specifically because if we do another IVF we have to wait until after the holidays to start, so we're looking at a November IVF, and then the weeks of recovery. Before a transfer they still require several weeks of birth control and then they close the lab for cleaning the last week of December. It's only September but it seems impossible to fit everything in this fall. We'll see.

Our clinic has a shared risk program in which they offer up to six fresh IVF cycles for one fee. It doesn't include medication, but does include cryopreservation and unlimited FETs for any embryos from these cycles. They guarantee a full refund of the IVF fee if you don't take home a baby. The drawback is that they make you use all viable embryos before doing another IVF, so no banking. In addition, once you take home a baby the contract has been completed so it's a gamble because you may pay more for one cycle if it works the first time.

Why didn't we do this in the beginning? Honestly because it never occurred to us we'd still be doing this after so many cycles. I've said it before: I was sure IVF would work the first time. Every failure wasn't just a disappointment; it was also a huge surprise. We were also adamant about banking embryos for the future although now I'm reconsidering that part and just want to see one baby to start.

Pros of another IVF now:
- Banking embryos
- I'm still young enough to be a good responder
- I don't have toddlers at home during recovery

Cons:
- Expensive
- Painful recovery
- Delaying potential pregnancy

Pros of FET now:
- Potential pregnancy
- Less recovery, no time off work
- No added expense

Cons:
- If it doesn't work we're back to sq 1
- Back on a ton of meds: some painful (PIO), some bitter (anti-inflammatory), some bruising (blood thinners)

I haven't been able to read other blogs. I stopped participating in some groups on fb. It takes a lot of effort to answer emails and texts, and I have to fight the urge to ignore the phone when people call to check in. I used to find others' good news in fertility treatment uplifting but lately it causes me to retreat into a darkness that makes it hard to believe it will ever happen for us. Reading bad news makes me relive our own disappointments. I feel like a bad friend but I don't know how else to protect myself. I don't engage in small talk because everything feels like a trigger. Being on guard all the time is exhausting and isolating. Hopefully this too shall pass.

My coworker is on baby-watch and people keep coming up to me and asking me if there's any news. It's bad enough they keep asking; it's worse that when I say no they then go on about their own birth story. I don't know how to escape it. I feel like telling them my situation would just exacerbate the situation and make it horribly awkward, extending the issue longer than this particular news.

I can only hope that this is a temporary mood dip. On Sunday my husband and I watched the movie Collateral Beauty with Will Smith. At first I saw the trailer and thought it was too sad. But after watching the movie, the plot resonated with me. Even in the face of the most awful tragedy (losing a child), there is life after death. I'm the kind of person who needs the plot to wrap up at the end with a neat little bow with a happy ending. Even though the tragedy didn't reverse itself, the main character relearns to see the beauty and meaning in life after tragedy. The movie did a lot to life my mood. Partly it was removing my head from my own churning thoughts, but it was also because it made me take a second look at our journey. In the back of my mind I still want to believe we may have a happy ending - that it might still work for us. Hope is both my fuel and my downfall. 

RH recap

For the first set of yom tov I made 8 lbs of challah, 4 lb brisket, 4 lbs meatballs, multiple kugels (zucchini, potato, onion), honey cakes, sesame cakes, deli rolls, 4 lbs of stuffed chicken, fish, and salads. I have to figure out what's gone and needs to be replenished for next set of holiday. My husband's family is coming in for first days of sukkot, so I have to think of what to make. 

We had a good mix of social time and home time. When there's a three-day yom tov our guideline is 2 meals out, 2 meals with guests, and 2 meals alone which is a balance that works for us with our different personalities. For this particular set, we were out two meals, one potluck with neighbors, hosting one, and home for two. It worked out well and we were both happy. 

Over the holiday I got caught off guard with my period coming early. My trigger shot was on Friday night two weeks ago. For some reason I assumed it would start on Saturday. I don't know why that mattered when but I basically got caught unprepared. I didn't have anything in the house: fresh out of tampons or even pads. I could have gone to a neighbor or walked to a family member. It was day 1 of a three day YT and there was a long stretch before I'd see the inside of a store. I had an idea: I remembered that after every IVF procedure I'd get a little baggie from the clinic with a disposable heating pack, the pain killers prescription, contact sheet for emergencies, and a yellow little pad.  This is what the clinic offers: those old-fashioned Always-brand diaper pads in the yellow liners (aka medium). It's the worst but they have to offer something and I bet they offer this so people don't steal them from the rooms and bathrooms. Anyway, turns out I had 5 from saving the little baggies from previous cycles. Turned out to be a lifesaver. It wasn't my first choice but I preferred that than missing shul or going around the neighborhood to my pregnant neighbors asking for tampons. As soon as Shabbat was over my husband went to the drug store and saved the day. 

Shul ended about 1:25 pm both days. This year we went to the shul around the corner which was very convenient. Shul was over 1:25, we were home by 1:30. There were assigned seats and the women's section was completely full. The first day the person sitting next to me didn't show up so I had plenty of elbow room. The second day my seat neighbor came and it felt too claustrophobic to stay put so I moved to the back and stood. I couldn't handle being so squished for a long period of time. I get that they try to accommodate everyone who wants to attend. They're currently fundraising to expand the building. 

Davening was good. The chazzan was just ok. The differences between ashkenaz and sefard davening is significant even though it's mainly a similar davening so I missed the songs I grew up with. The davening itself was very emotional for me. Following my unprepared theme, I brought no tissues. I sobbed silently in my corner and just let the tears fall. Eventually the nose situation became an emergency and I asked the people behind me to pass a tissue (since I was trapped in my corner due to the sheer volume of people). I came better prepared the next day and with moving to the back of the room I had the windowsill to put things down.

Overall it was a nice holiday albeit a little long. With my period here I have to think about the next steps but it's too soon and with the holidays in full swing maybe we'll just take the cycle off. That gives us at least a little time to get results of the embryos from this last cycle.