What's the right way?

I've been trying to get together with a friend for several weeks. We got close last year when we started sharing our TTC journey. We have similar hashkafah and our husbands get along well too so it was a good match. We started going to each other for meals and meeting to chat and walk around the neighborhood every so often. We went out for coffee in September right before she got a new job with very demanding hours. In October were the holidays and everyone was busy. I reached out a few times after that. In November I invited them over for a meal and they already had plans, but she said we should get together soon. In early December I tried again but they were unavailable. Throughout the time, whenever I posted something on facebook she'd post something like, "Miss you!! Hope we can get together soon!" but then never committed when I followed up about a specific date or time. I started suspecting but didn't want to assume...

When the doody hit the fan after our last loss and then my sister giving birth early, with us trying to help as much as possible shuttling back and forth to the nicu, my life got too overwhelming to think about much else. Friends I'm close to continued to check in with me but I didn't do much reaching out so anyone who didn't contact me didn't really hear from me.

Today I found out from a mutual friend that this person is 20 weeks along. I had suspected, but still. The other person only told me because she didn't want me to bump into her at the store or in a social function and be caught off guard in public, which I appreciate immensely. According to the mutual friend, she's not yet really showing so I'm not going to mention it.

I don't know what the right way to reveal is in this situation. I assume this friend who is 5 months pregnant after years of trying is incredibly superstitious. I also assumed she didn't want to hurt me. I just don't think avoiding me until I find out another way is the right way to find out about her happy news. It is happy news. I'm so happy for her. I'm sad that she didn't feel confident enough in our relationship to share this news herself.

It stung at first, but I'm not mad. At this point I'm curious for the future. One day soon, I hope, it may be me on the pregnant side. I want to avoid making anyone else feel how I felt when I found out about this friend. So what's the right way to go about it? How would you have appreciated finding out about someone close to you expecting?

On Track

The suppression pills this cycle are giving me a run for my money. I've rarely had issues with the BC pills, often just a bit of symptoms the days transitioning to the hormones: nausea, headache, a little fatigue. This time it's been nonstop symptoms. I'm constantly exhausted. I've been having upset stomach every time I eat anything. It's not just a particular food or specific amount. I have a low grade nausea under the surface all the time. When I eat anything, regardless of whether it's bland or spicy or sweet or savory, I feel my stomach get unsettled and bloated.

I've also been having very mild cramping and spotting for almost two weeks. The cramping doesn't bother me but the spotting is creating a logistical halacha nightmare. As mild as it is it got to the point that I started to worry something was going on and I contacted my nurse. She said that it's normal and nothing worrisome. I was worried it would delay the cycle but apparently it's common.

My medication order came in. Finally. It was an ordeal to get it. They forgot to send the receipt so I checked that the order was paid for on my credit card and called them. I was told their concierge will contact me by Monday. 

In any case, we're on track to start as long as baseline goes ok. 

#CuteAnimalTweetOff

We interrupt your regularly scheduled selection of depressing news stories and dismaying tweets to bring you the most amazing thing that happened on the internet:

#CuteAnimalTweetOff

There's nothing quite like fuzzy baby animals to put me in a happy mood. Have a great day!

Soundtrack

The hold music on both Freedom's and Ivigen compete for the worst music in the world. Freedom has the added "helpful" messages about how they have info on their website and we may be able to get faster information there: a bigger lie has never been told. It's hit or miss with Freedom - sometimes they have reps available and other times, probably during the busy hours, one can wait on hold for 20+ minutes before someone picks up. When I try to call at work, I have to go in my car if I don't want everyone in the office hearing what I'm ordering, and there's only so long I can wait on hold before needing to hang up and try again later.

This was my life the past week. I verified with insurance and after going back and forth it was determined we had hit our lifetime max on fertility meds; it's not a yearly max. Another great surprise on this path. The meds are so expensive and I had to figure something out to pay for them. Turns out I had in my fridge some unexpired Gonal-F pens from my April 2016/IVF 4 cycle, so that saved a pretty penny.

It was frustrating to go back and forth between everyone to get a straight answer. Freedom could only tell me that the claim was rejected. The meds insurance (separate from my medical insurance) could only tell me what isn't going through, not what my benefits are. The benefits office at the employer from which we have this insurance had no idea what I was asking and needed to call me back three times with questions for clarification, but then that person went on vacation without resolving this issue so I had to start over with someone else. It happened to be that the someone else was much better equipped to answer the question and I had it within hours. Too bad it wasn't what I was hoping to hear.

Baseline is 1 week from today and I'm nervous for this cycle. I haven't really had a "break" like we did in the past with previous cycles. I kept thinking about things and figuring out options. It took a really long time to be sad about the last loss and the what ifs occupied my mind for a while after it was no longer physically relevant. I'm still not totally over it, but I think I'm as good as I can be at this point. It's been a long time since last treatment and I feel like we missed January but there's nothing we can do about that. I've stopped trying to hurry things up.

The other day I was randomly thinking about sleep deprivation and its effects on the body. Every new parent goes through it but no one knows what it's like until they've done it. I think that's true regarding everything about parenting. When they're babies it's sleepless nights; then there's teething and ear infections; then there's preschool and all the snot that comes with that because kids swapping viruses; then on to elementary school where they struggle with homework and birthday party dramas; after that is middle school and all the hell that comes with puberty; when they're finally out on their own after high school and all the challenges that come along with that, you don't get to stop worrying about them. They're on your mind forever. Anyone can see the challenges, but I don't think you can realize the benefits until you're actually a parent. I don't think any parent can adequately explain the feeling of why it's all worth it.

At some points I struggle with the "is this all worth it." I don't have an answer, but I also can't justify not trying anymore. Somewhere in the back of my mind I know I want to find out for myself what it's all about.

Insurance hiccup

Called Freedom to fill my prescription for the upcoming cycle. There's a snaffu with my insurance in that no one can tell me if I have a yearly maximum on fertility medication or a lifetime maximum. It took four calls and waiting on hold for a combined total of 2 hours to get to this point. Until they figure it out they consider no coverage at all. Never a dull moment.

In follow up news, we finally found a therapist and have an appointment scheduled. It was an ordeal to find someone that met our criteria, which wasn't even that picky. Needed to take our insurance, have evening hours, and preferably have one or two good reviews online. I searched online for recommendations but anyone that came recommended didn't take insurance and the rates were beyond what I was willing to pay (i.e., $350 for first session and $200/hr beyond that). Then I searched through the insurance website, but anyone who had a few good reviews wasn't accepting new patients or if they were taking patients had no availability until March.

I expanded my search parameters up to 20 minutes away and just started calling and leaving messages. I finally got someone to pick up the phone. He took our insurance and had an evening appointment within the month - WIN! I scheduled the appointment. In the meantime I got a few calls back so if we don't like this guy we have a few backups.

The meeting with my supervisor regarding my position and expanding my role went well. I have a follow up meeting with my boss in a few weeks.

I just finished my latest show on Netflix, 3%. The show is in Spanish and while I'm not a fan of subtitles I thought the concept was interesting. I'm usually not a fan of shows that don't have more than one season but I made an exception and glad I did. While we're in between shows we're watching reruns of Seinfeld and Nature with fuzzy baby animals.

Silver lining

I've been so stressed about the timeline and frustrated at how looooong everything seems to take. But I can't drive myself nuts trying to hurry things beyond my control, so I'm trying to reel in the impatience and try to take things as they come.

According to the timeline an expected egg retrieval is tentatively scheduled for some time around President's day weekend. I have off that Friday and Monday, so an egg retrieval any time around then would actually work out well. Best case scenario would be a Friday or Sunday retrieval. Least favorite is a Saturday retrieval but it is possible. I don't expect a Monday retrieval since I've never stimmed that long in the past.

Beside that, it looks like if everything behaves and I get my period when expected, we may be able to do a transfer over chol hamoed Pesach. If it has to be in April, may as well be at a convenient time for me, right? Most convenient is after all the prep but before we head back to work full time.

I'm getting ahead of myself again - who knows how my body will react this time. Experience has taught me to expect the unexpected with possible detours along the way. Even so, I'm determined to stay positive this cycle. I believe this can happen for us. 

Timeline

My nurse sent my timeline today. She had to extend the birth control pill phase because of the lab availability to do PGD. What I heard was that the embryologist who does the biopsies is on vacation and I have to work my life around it. I don't know if that's really it or if they're just booked for the week with other biopsies. Either way it doesn't change the fact that we're pushing off the cycle.

It puts the start of a cycle at a full week past what I anticipated. I know that it's not a big deal but I'm already upset that we can't do a transfer at the same time. Now that we're pushing this back everything else gets pushed back. 

She ended the email with "let me know what you think" as though I have a choice in the matter. I have no choice in any of this and it's all beyond my control. The whole thing sucks. I didn't want to do any of this yet here we are again.

Decision

I emailed our plan to my doctor yesterday and said we'd like to do a fresh IVF combined with a FET (instead of transferring a fresh embryo that has not yet been genetically tested).

Today I heard back and he suggested splitting the IVF and FET. The ERA results are applicable to the protocol used for frozen embryos and may be a different situation when being stimulated for IVF. So if we want to follow the recommendations from the ERA, we're down to two options:

• IVF only
• FET only

There's no guarantee that a new IVF will result in transferable embryos and the FET is less expensive and less painful and less invasive. But I was very conflicted about which path to choose. Even though I kept weighing the pros and cons I couldn't come up with one option that's better than the other.

I asked a few close friends and family members to weigh in and no one had any insights I haven't thought out. I bothered my husband at work to talk to me again about it even though we rehashed it a bunch of times. He clarified his preference and since I wasn't leaning in any particular direction, I agreed. So we're going with a fresh IVF.

I'm waiting for my nurse to send my timeline and we'll take it from there.

I feel tired and drained. I've been stressed and not sleeping great. To say I'm a little burned out from all this is an understatement. I think that in the back of my mind I know that the IVF is the better option but I was kind of hoping we wouldn't have to deal with it again just yet. It's not so much the physical pain; I can tolerate that. It's the anxiety of the entire ordeal. It's nerve wracking and upsetting every step of the way until we hear back the genetics report from any potential embryos that made it to blast stage. I hope and pray this cycle is successful and that the next transfer we do, whenever it will be, will stick for the long haul. Please, please let that be the case. IYH by us.

So Monday

No stories with my saline sonogram/mock transfer appointment this morning - just the way I like it.

After the appointment I went to visit my sister and her baby in the NICU. It was really warm in the room and I was feeling so faint. I worried I might pass out and the last thing I wanted to do was to make a scene and take away attention from the baby in the NICU. I had a snack and felt a little better.

I calculated what I ate the past few days and realized I need to be much more mindful of what I've been eating. When I started my diet over a week ago I planned to eat about 1200 calories per day. With the stress of the NICU situation I've lost my appetite and I've barely made it to 1000 calories per day, normally taking home most of my lunch to be recycled for the next day. Yesterday's fast took me even lower, at barely 600 calories, since my stomach was unsettled at dinner and all I had for the day was soup, pasta, and some ginger ale.

I want to lose weight but not at the expense of losing my marbles. I have to be able to stand in a warm room and not pass out. I'd rather lose slower rather than deal with this again. I'm planning to be more mindful of my calorie intake, adding more vegetables and soup into it for a filling high volume/low calorie option. I also stocked my purse with a few candies in case this happens again and I need a quick spike. I've never had blood sugar related issues, but I'll plan to ask my regular doctor at my physical in March just in case.

We decided to go head with IVF 5. It's hard to believe we're talking about a fifth cycle. Yikes. We're going to do a repeat of IVF 2 (December 2015) where we'll do an IVF cycle and then transfer the remaining frozen embryo instead of a fresh one, since it's already genetically tested. I hope we have more success with this protocol than we did with IVF 2. We're adding the anti-inflammatory and blood thinners for this cycle. There's nothing pointing us to believe that there's an issue with either of these but we're willing to try anything.

Blogaversary

Yesterday marked the one year anniversary since I started this blog! In honor of the occasion I refreshed the template and updated the About tab.

The outlet of being able to sort out my thoughts and vent my feelings has been so valuable. Every comment and feedback is appreciated and I so value the relationships that have blossomed over the year with people going through similar challenges.

It's helpful for me to have information about past cycles and treatment all written out. Even once we're hopefully past this time of our lives, I hope one day the blog and its contents may be helpful for someone else in the future.

Baseline?

I went in this morning for blood work. The CD3 bloodwork everyone kept talking about and saying they need to complete my file and submit to insurance blah blah blah. 

 

The day 3 blood is basically an annual baseline which I either completely forgot about from the past or it just blended in my memory with all the other appointments. I was so surprised when she asked to get my weight. I didn't know to expect it. I would have worn less bulky clothes! I definitely would have had less water this morning.

 

My vein wasn't behaving and I got stuck twice. It's literally only one spot on one vein that they can get to work. It took multiple minutes of rubbing, poking, smoothing, and squeezing my hand into a fist to finally get it on the second try. As she was finishing up, she told me which doctor will be doing my ultrasound.

 

Ultrasound? What ultrasound??  I'm on my heaviest day of my period. Gross! I didn't know there would be an ultrasound! I even walked in to the waiting room thinking "at least there's no ultrasound today" because I'm so crampy. And when I checked in I only circled blood work for today. I could not have been less mentally prepared for an ultrasound. I would have probably showered this morning instead of last night. I would have checked that my socks don't have holes in them. I definitely would have made more of an effort to get there early if I knew I'd have to wait for the ultrasound. UGH.

 

Thankfully not too long a wait - only 15 minutes. I made a point not to apologize for bleeding and tried not to be embarrassed by it. This is what my body is supposed to be doing. If the doc didn't want to see it he shouldn't have gotten into this field. Between the two of us, I'm the less comfortable one.

 

My ovaries aren't located in symmetrical locations so they can always find one easily but then have trouble with the other side. Looks like I have 12 on one side and 15 on the other. Perfect ovaries, according to doc. If only that's all it took.

 

I also needed to reconnect with the insurance IVF hotline. When I called to enroll last time it was 2015 and we had not yet done any procedures. This time, they needed information about what we're doing and why. The insurance nurse had a lot of questions, all of them personal. She needed to fill out her form, but I had a hard time with her sterile and emotionless tone. "How many times were you pregnant?" caused me to mist up. When I said there were two chemical pregnancies she asked, "And what happened?" which made me cry. I just said baby stopped growing. When she asked for more information I was like, Gee.... if we knew that I'd still be pregnant now and we wouldn't be having this stupid conversation.

Because we still have one frozen embryo available, insurance will likely deny a fresh IVF. The insurance lady said we can submit paperwork to see if the director would make an exception but it's against their policy and I feel like that's sending a lot of personal information around, dealing with a lot of coordination for paperwork between the clinic to insurance, and then getting a denial which we know is coming just isn't worth the aggravation. It's not like we'll lose the benefit dollars - we can still use them for FETs. Or future cycles assuming we don't have any embryos in storage.

 

It was an emotionally draining morning. We have to decide what we want to do so we can get on the schedule since it's filling up now. Hopefully I'll have an answer soon.

Shabbat shalom.

Intense week

On Friday night my sister had an emergency c-section after a week on hospital bedrest due to pregnancy complications. Her baby was born at 30 weeks and has been in the NICU since. It's been stressful and worrying and scary.

As this was going on, I started my diet on Monday. So far I'm down 4 lbs, which I gained over Chanukah, so really I'm just back to where I started. I haven't been hungry and I noticed that my mood has been pretty stable, even considering all the extra stress, so I'm overall pleased with how it's going.

Wednesday was CD1. I took my last pill on Sunday and it took over two full days for my period to come - good to note for next time. On Wednesday morning I was starting to worry it may not come until Thursday which would make CD3 on Saturday. Since we have to repeat day 3 blood work, it would have meant waiting an entire cycle to redo this exam. Luckily it worked out. Once it came, I let my nurse know and scheduled blood work for Friday. I also scheduled the mock transfer for Monday.

We had 5 embryos in the freezer, but they were PGD tested and only 1 is genetically normal. Today we confirmed the disposal of the genetically abnormal embryos. Even though we knew we weren't going to transfer them it was still a hard decision and weighed on us. They're still ours and we still love them. Even though I know they triple check, I was worried they'd accidentally dispose our one good embryo.

The blood work we both did in the last week of December came back and all looks ok. The only thing was my vitamin D was low: 21 when they'd like to see it at least at 30. It was recommended I take a supplement and contact my pcp to follow up.

Insurance was verified by Wednesday (two to three weeks my foot!) but they couldn't submit for authorization until after I do the day 3 blood work. They have the weirdest rules. My nurse also can't submit an IVF schedule until once day 3 blood work and the mock transfer are done, so a lot is riding on tomorrow.

Of course, inclement weather is being predicted for tonight and tomorrow. My car can't handle snow or ice so if the roads are bad in the morning I may need to uber to the clinic.

It's been a rough week and we're ready for the weekend.

Hello 2017

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

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

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

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

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

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

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

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

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

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

I will add to and adjust the list as necessary. 

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

Deep breath. Here we go.