Diet

Dear Future Self,

In case you need to drop 5 lbs again in a jiffy, here's what worked in the past:

• Use myfitnesspal.com to track calories. They give you an allotment of 1400 calories per day based on your weight but if you eat closer to 1100 you'll lose weight faster. Count everything.
• Drink water. I know you hate it but do it anyway. It will keep you full and away from snacks. It takes energy for your body to warm it up so you also burn a few calories with every sip. Plus, added bonus of getting in those steps walking to the bathroom hourly. It's a feature, not a bug!
• Choose healthy. I know you'll lose weight if you stay within your allotted calories regardless of what you eat, but if you make good choices for those calories you won't be as hungry. For example, when avoiding sugar and white flour you lose faster. When you fill up on veggies and proteins, using fruit as desserts, the lbs are less stubborn in coming off. Don't go nuts - stay within your calories even for the healthy stuff. It will help you avoid blood sugar crashes and even hunger pangs. If you don't start with the junk food, you don't have the taste and it's easier to avoid so just stay away.
• Soup. So what if it's summer, just do it. I know you'd rather eat Chinese food or doughnuts for dinner, but soup is filling and nutrient dense and lower in calories than anything else you'd fill up on. 
• Weigh in daily. Accountability is key and avoidance is not an option. It's motivating to see numbers go down. It's depressing to see numbers go up but necessary to stay on track.
• Go walking. The new app that maps out your run is more motivating than you can imagine. Even 20 min is better than nothing. 
• Find motivation. Something that speaks to you. Suddenly the cookie doesn't seem as enticing when there's a a fear of a cycle getting canceled. 

TL;DR Eat less.

Love, 

Summer Self

IVF 6: Day 4

Monitoring this morning went well with one stick for blood and no major wait in traffic or waiting room (30 min total). They counted 13 follicles on the right and 11 on the left.

Freedom pharm saga is over. More in a separate post.

IVF 6: Day 3

We're cruising along. I feel like this cycle snuck up on me. I had to downplay it significantly to face it and suddenly we're in the middle of it. Maybe I'm just used to this by now that it's not as overwhelming.

I was trying to guess what day retrieval will be. In the past I've stimmed 12-13 days, with trigger most commonly on day 14. It's only 16 days total, from baseline to retrieval. In the grand scheme of things that's barely a blip on the radar. It's really the weeks before and after that extend it so much. For example, the two weeks after retrieval, feeling bloated and trying to get back to yourself physically, are really rough. That's also the time waiting for the hcg to leave your body and the return of your cycle. For us, it's also the time we wait for results of our PGD testing. The cycle technically lasts 16 days but in reality it's closer to a month if we know it was successful.

The beginning of August was when I started feeling like myself again, specifically after I got my first period post-miscarriage. It was like waking up from a deep fog that had taken over our entire existence for the previous two and a half months. It was part of the reason I needed to postpone the cycle. I just wasn't ready to start all over again.

In the interim I feel like I've grown a thicker skin. So what if we haven't had kids yet. It may happen. It may even not. We'll do our best and see where life leads us. The losses were sad; very sad. But it happens. It was a medical disappointment that happens in the world. It could still end happily for us. The sun still shines, the birds still sing, the world continues. I totally got this.

But then I started hormones and my rose-colored glasses shattered. The back to school videos and pictures completely unfazed me last week, but this week I get a pang in my gut whenever they show up on my newsfeed. I cleaned up our guest room and found some crayons left by my niece and got a lump in my throat. What really made me tear up is that I convinced myself that a family member is likely to announce a pregnancy soon. Their kid got to be the baby in the family for a while until a cousin was born.  All these babies are growing up together and it bothers me so much that my kids are missing out because they haven't been born yet.

Which means I'm back to the danger spot of having hope. Hoping for success. Hoping it will work. Hoping this is it. The more I hope the harder the disappointment. This is only day 3... I'm going to be on a lot more hormones before it's all said and done.

So while it's "only" 13 days of hormones, each day feels like an eternity. Each minute is consumed with thoughts churning in my mind, alternating between what-ifs and worst case scenarios. GoT is over but I have reruns to keep me occupied. Conan is in Israel and his fb live posts are hilarious. I scheduled an outing with friends and am planning to get a mani/pedi for the weekend. I also got the cleaning crew to come scrub my house. I'm doing whatever it takes to stay happy and sane during these weeks, especially since stress-eating is not an option.

Speaking of diet news, I'm down two lbs from baseline, extending my cushion to 4.6 lbs. Instead of complaining about how much it sucks to diet right now, every time I get a craving I add it to a list and we'll party after retrieval. Looking forward!

Friends

I've talked before about the difficulty in making and keeping friends. My relationships with friends from childhood or school fizzled out as people went their separate ways over the years. When I did put in the effort, it didn't feel reciprocated. After a while of feeling like I'm the only one trying to keep things going I got burned out doing all the reaching out. I feel lucky to have the friends I do even if it is a small number.

I know making friends is hard for everyone. Harder still to find a couple you both get along with. A lot of people I know have friends because of their kids and the families get together all the time. If someone has the idea: "the kids are bored, let's grill and invite friends with kids so they can entertain each other!" then they invite people with other kids over. We're overlooked for invitations to birthday parties or shabbat meals. When there are limited seats around the table every seat needs to be maximized, and most times we just don't make the cut. To be fair I don't know if this is actually how people think - this is how I assume it works. One time I saw on facebook pictures from an organized walking group at the zoo with their strollers. No one though to include me because I didn't have a stroller. But they were just walking and it would have been nice to be invited. I gave them the benefit of the doubt in that maybe this was their version of trying to be "sensitive" but it hurt to not even be asked, just rubbing salt on an already painful wound.

I read this the other day. She writes: "I’m not sorry you have learned to be vulnerable with those whom you love. Sharing a private struggle like infertility can be terrifying, but vulnerability is not a weakness; it is heroic."

I don't know if I agree that it's heroic but it's definitely a vulnerability. I stopped hiding my treatment highs and lows from people because talking about it feels like I'm doing my part to remove the stigma. It's difficult to talk about and difficult to discuss loss. Once I do open up to someone I expect them to follow up and check in on me every so often. I don't know if that's an unrealistic expectation but I know that trying to to hold some people to that standard has left me disappointed in the past.

It seems people have their social circle and aren't interested in expanding or reaching out. You have what you have and that's it. No one wants to get to know new people; no one is interested or has patience to let someone new in. So unless you have an in -- like you're related or live next door -- you're SOL. I'm honestly curious how people make friends later in life.

My husband and I talked about this at length in the past. We've even analyzed sitcoms in comparison. For example, FRIENDS has six people. Ross and Monica are siblings. The rest came about from school (Chandler from college and Rachel from high school) and being roommates (Phoebe and Joey). They never make new friends! Even the people they've dated or worked with never stick around or make an appearance once that brief relationship ends. And this is in perfect TV-land where there isn't even such a thing as a bad hair day so you know it's the standard. Same with Seinfeld; same with HIMYM.

It's basically how life works: you choose a few people you like and invest all your time and energy into them. The problem is that when they start drifting away because life takes them on a different path, it's not so easy to replace them. 

IVF 6: Baseline

What a week!!! I had a mail-merge catastrophe at work where 94 letter templates needed to be edited in their entirety in two days. My whole office is out on vacation and I had an enormous and time-sensitive project to complete. I've been on an extremely limited diet in prep for baseline so I'm tired and hangry. And I didn't win the powerball lottery even though I bought two tickets. So ready for the weekend!

I went in for baseline this morning. It was ok and I'm working to process whether it was good or bad. Only one stick for blood: good. Pay out of pocket for a cycle: ouch. Ultrasound news: yikes.

It wasn't the ultrasound, per se, but the news the doctor shared during the appointment. My clinic has very strict bmi rules and apparently mine is too close to the limit. After our last loss in May I gained 12 lbs in addition to the 3 lbs of bloat I carried from the pregnancy. Looking back it was dumb to just let go but I was in no place to think about it at all under the cloud of grief. Once I got a grip, I was able to lose most of it but it's still not all gone. Would it be nice not to be so borderline? Sure. A lot of things would be nice, including the clinic not having such strict limits.

Technically speaking, I am under the limit and I am cleared to start. But I'm only under by 2.4 lbs. The concern is that the anesthesiologists at egg retrieval won't move forward if the bmi hits the max, which means that I only have a 2.4 lb cushion to work with. The doctor doesn't want me to be crushed if the cycle gets canceled if I go over, especially since some of it is beyond my control regarding bloat from the medication. For comparison, the other clinic we visited for a second opinion had a limit too, but it wasn't nearly as strict and I was 40 lbs away from it. Just saying.

It's up to us whether to risk it. If the cycle gets canceled before the retrieval we get an 85% refund from the clinic. The risk is that would be two weeks of hormones for nothing and of course there's no refund for the medication used, which was also paid for out of pocket.

The alternative is to wait to lose a few more lbs. The issue is that we're already on the border of the Jewish holidays which start 9/20. If we delay by a week I may lose 2 lbs but then retrieval will be really close to Rosh Hashanah, risking a holiday retrieval. So if we're delaying, it means delaying the entire cycle to after the holidays are done in October, which puts a retrieval at the start of November. I tried finagling the schedule to try to fit a cycle mid-holidays, but it's not possible. It's not just the egg retrieval day, it's also finding several consecutive days to go in for bloodwork every day and if I'm not driving because of the holidays there's just nothing that works. The only time it may work is risking a retrieval on yom kippur and that's just not an option. This is elective surgery and I can control the schedule - if I don't have to be in the hospital over the holidays I don't want to be there.

I'm on board to risk it. My husband wasn't so sure but eventually agreed. I prefer to go into it knowing there's a risk rather than waiting and doing nothing for two months. There's no chance I'll be able to maintain my strict diet over the holidays. There's also a chance that this cycle might be a complete bust and we'll have to do another cycle in October anyway - who knows!

I'll have to watch what I eat carefully for the next two weeks leading up to retrieval because excessive exercise is frowned upon when your ovaries are the size of tennis balls. It will be a hellish two weeks but then it will be behind us. And then I can celebrate with piles of Chinese food and doughnuts.

So... here we go. Shabbat shalom!

Eclipse day

We had beautiful weather yesterday and it was a perfect day to be outdoors. We had originally planned to go on a day trip but didn't want to fight traffic with all the people driving down to the eclipse path of totality. It wasn't even a question whether we were going to drive down to South Carolina to see it. Our area will see 80% eclipse and that's good enough for us. So instead we stayed local and got some sun at a friend's pool. It was awesome, up until the point when we realized my husband left his phone in his pocked when he jumped into the pool. Oops.

No big deal, it's just a phone. Just a hung of (expensive) metal. When we got home we ordered a new one online and he switched service to an old phone in the meantime. That should have been the end of it. But there was a snafu. He couldn't remember his email password. His email was logged into his phone with the password saved. Worse, he doesn't have a phone number linked for recovery. Even worse, he can't remember the password for his recovery email either.  This is unusual for him. He has creative and complicated passwords but he always has a way to keep track of them.

I would be devastated if I couldn't get into my email. I have everything in my email. I've had my email address for years - it's a time capsule of my life. Even though I back everything up, I also added multiple codes and backups just in case.

There's nothing I can say to make him feel better. Even if I wanted to yell at him for being irresponsible or criticizing him for being careless before jumping in the pool, he's already beaten himself up for all those things. But I don't want to yell and I honestly don't blame him for the mistake of getting his phone wet or the choices that led him to poor recovery options. I'm sad for him for losing his email.

He's submitted the form for help from google several times but if they can't verify his account the account is likely lost forever. He can keep trying password combinations, which we did for a few hours last night. One spark of hope is that we have a credit card linked to google play. But there's no one to call and no one to talk to about trying to verify it, so how does that help? He's so bummed about the loss of the account and doesn't have high hope to get back into it. Every time he remembers something else linked to it, it's a fresh wave of sadness.

I feel out of sorts with a pit in my stomach, knowing he's hurting. I can only imagine how he's feeling. Was this preventable? Maybe. But it feels like life keeps knocking him down; like he can't catch a break regardless of whether it's his "fault" or not. 

I hate that I can't do anything to fix the problem. I'm so sad that I can't help him. I'm so sad he's sad. It's just an email address but it feels like another way life is beating us down.

Game of Thrones

While I wouldn't say I'm a total TV addict, I have few favorite hobbies and watching TV ranks pretty high on the list. In July I realized that there are too many memes and references to Game of Thrones that I don't get. There were conversations in which I couldn't partake and jokes I didn't understand so I decided it was time to not be a dinosaur and watch the series. I'm totally up to date and can.not.wait. for the next season.

After watching six and a half seasons back-to-back it's nearly impossible to wait a whole week between episodes. I understand there are only - what, 2? - more for this season and after that not only is season 8 the last one, but there's a chance it won't come out until 2019???!!! Say it ain't so!!! 

At first it was too violent for me but after a while that stuff just blends in and I enjoy the complicated plot twists and excellent writing. In a world where there is so much unrest and disappointment, it's nice to get lost in a fantasy every so often. 

Treading water

I thought I was doing much better. I thought I was starting to get excited for fall: the weather starts to cool off, the leaves start changing, #pumpkinspiceeverything, and just an overall change. We're gearing up for IVF 6, and with it comes a fresh wave of hope. I know there are things still to be done before a transfer, like a hysteroscopy and making sure my thyroid is ok, but there's a path and a clear way forward. I thought I was ok.

But then shit happens and I feel myself being sucked under, fighting to not give in to depression.

• I had my formal review on Tuesday. While I can't complain, I'm disappointed. When I had my mid-year review in January I was told I'd tentatively get an 8% increase and a new title. I walked away with an excellent review but feeling punished because I didn't get what I expected. No new title, "only" 5% raise. I'm grateful for the increase and I know I'm lucky to be employed in a great place, but annoyed because I expected more. I was given the excuse of budget cuts. Please. I know I can start looking for another job, but it's not as easy as it sounds. The mental capacity needed to interview and make a good impression in a new place is just not something I want to focus on right now.
• A young family member went in for a colonoscopy due to bleeding in the bathroom. Waiting for results but they did find inflammation. Scary and worrying. Maybe crohns? 
• Trump is ruining the country. Not only politically, but people are literally dying. He's egging on North Korea into war. Not just any war: nuclear war. He's giving Nazis and white supremacists a strong voice. It's scary. I'm scared and worried. Not just as a Jew, but as an American citizen living in this country. We can't hide in bomb shelters for 3.5 years until his term is over, if he even makes it that long. I'm sick of seeing his face on breaking news alerts every single day.
• I found out a friend is expecting #4. She had her last baby Feb 2016. I haven't even had one yet. It's hard not to compare. Just when I think I'm ok, I hear someone make an announcement and it's like a punch to the gut all over again. It's demoralizing and sucks all the wind out of me, making it feel like I'll be on this merry-go-round from hell forever while everyone else moves on.

What's a gal to do. It is what it is.

I held my tears until I got home from work. I realize I haven't cried in a while - definitely been almost a month. I davened mincha. It was the first time I picked up my siddur since our loss back in May. I just poured out my heart, sobbing. Only He can make a difference. I can't control the things I can't control. Then I went for a 2 mile walk.

The prayer, cry, and walk were an incredible release. As I was wrapping up my walk I stopped at the store to pick up eggs and headed home. I was around the corner from my house when it started pouring. I didn't mind - rain doesn't bother me and it was great to cool off. Someone stopped her car and offered me a ride home. I said I literally live a few houses down but thanked her for stopping. It was such a nice gesture. Maybe the world isn't all complete garbage. Kindness goes a long way - she didn't even do anything, just the offer was enough to cheer me up. I decided I should aim to be more kind.

Thyroid

Doc from new clinic called last Friday regarding my thyroid testing with surprising results. The TSH came back at 2.98. Even though the normal range is up to 4.5 for regular people, both clinics like to see the number under 2.5 for women trying to get pregnant and during pregnancy. It's the first time my thyroid has been flagged at all abnormal.

 

Bright and early Monday morning I started stirring up some dust and placed calls to my RE, PCP, and OB/GYN to get values from previous TSH testings. It would have been mentioned  in the past if something was elevated or abnormal, right? RE nurse was first to call back and my number was 2.09 in January earlier this year. I asked her to send me a lap slip to get it retested so that current clinic has accurate numbers before we start up again and I went for bloodwork Monday afternoon.

 

PCP called back and said my level was 3.81 in March - yikes!!! It was 2.01 the year prior. PCP mentioned that anything under 4.5 is considered normal and that she wouldn't put me on medication for 2.98. She said it can fluctuate greatly between labs so she recommended getting retested to make sure.

 

IVF 6 baseline was supposed to be on Monday. I'm not ready. I don't want to start yet. We don't have finances straightened out, I didn't place my medication order yet, and I'm not ready for the pain and discomfort, and I'm still working on losing weight. I could use another month or two off. But we want to get a cycle in before the holidays so that we can rest and recover during that time, not to mention trying to enjoy the holidays.  I don't want to postpone a whole cycle to October but I also can't start a cycle next week. My nurse was out on vacation this week so I figured out the timeline with someone else. I needed an extra week. I wanted just a breather before we jump into it again. My RE said I could either do a 5th week of bc pills or have a mini menstrual cycle before starting which is what we chose. Even though it's a logistical niddah nightmare, I don't want to suppress too much before starting a stim cycle.

 

The summer is already starting to come to a close and I kind of feel cheated out of a break. We spent most of June and July grieving and recovering. I have a mental block in my mind about planning a vacation even though we could definitely use it and summer will be over before we know it. While I'm sad we didn't get to do any kind of trip or fun stuff, I'm kind of glad it's almost over. I need the pressure and questions of "are you going away this summer?" to end. There's no reason we can't plan getaways for the fall or winter or spring. Another post for another day.

My thyroid results came back from testing earlier this week: 1.91. So I guess it's not elevated? I'll bring it up to my RE before a transfer but it's interesting that there's so much fluctuation between labs. The tests were done 4 days apart.

IVF 6 baseline was moved to end of August, so we're gearing up to get started again.

Architect

Click for more info

Earlier this summer I talked about updating the furniture to our bedroom. It's all functional but needs serious cosmetic TLC. Instead of spending the money on furniture, I decided to hire an architect to give me some ideas on how to remodel my upstairs. A master bathroom is more important to me than furniture, and if I restructure some walls, I don't want to get into a situation where my new furniture doesn't fit right with the new room size.

Architect spent about an hour measuring last week. I'm excited to get drawings and see different options.  I'm not sure how much a project like that even goes for: $20k? $50k? I'm not thrilled about taking out a second mortgage and getting into debt for renovations. On the other hand I want to enjoy my house and I'm sick of making decisions based on fertility stuff (like holding off on renos in case we need the cash). If it comes to it that we need to sell the house to afford a cycle, we'll cross that bridge when we get there. I'm done living in the what-ifs and am focused on the things I CAN do now rather than what's on hold while we work on building our family.

Follow up with second clinic

This morning I met with the doctor from the second clinic to hear her opinions about our file. Between transferring records, her vacation, and getting an appointment on the books, it's been about a month since our first appointment. We've already decided we're not planning to switch because of the cost so it's not such a rush but I was interested in hearing what she had to say.

She read through my entire file and made a colorful spreadsheet summary to reference during our discussion. I definitely love her. We talked for about an hour discussing her thoughts on my file, differences she would do, pros and cons of scratch and other things. The major takeaways were two things: first, she recommended to retest thyroid. For some reason something specific she was looking for wasn't in the file and it was a simple blood test so I just did it this morning; results expected in a few days. Second, she recommended a hysteroscopy. She said it could potentially give valuable information and discover whether there is anything that is preventing implantation. The chances are slim that they'll find something but she said the benefits to make sure outweigh the risks. It can be done under anesthesia, in which case if they do find something they can just remove it then and there, or in the office as a regular appointment and if they do find something they would reschedule in the OR to remove. It's an interesting concept and I'm not opposed but there are risks and I'm not sure I'm ready for it. She said if I do it, it kind of doubles as a scratch since putting a camera (or anything) in there irritates the lining enough for it to count.

We're going to try to get a cycle in before the Jewish holidays which start with Rosh Hashanah on 9/20. Then take a break for the holidays, and hopefully transfer in October after all the holidays. Hysteroscopy would be after I get my period from the IVF but before a transfer so maybe between things during the holiday season. Apparently studies show that the scratch is effective within 60 days of transfer.

I feel like pieces are starting to fall in place with next steps: IVF, break possibly including hysteroscopy, then transfer. We'll see if anything comes back from the thyroid testing. As always, I want to go into the next transfer feeling like we did everything possible to get the embryos to stick. I'm comfortable with not making the decision right now.

One step at a time.  First up: IVF 6.