Time + Google = Anxiety

It was slow, lazy Sunday. My husband is traveling so I had a lot of time to myself. There weren't any house chores to do, there weren't any errands to run (it was rainy and gross so I wasn't going out anyway) so I had a lot of time to think and google. And snack. Not a good combo.

I read on Google that 6 day blasts are apparently not as good as 5 day blasts. What?? WHY. I think all our blasts were biopsied and frozen on Day 6. Is this something new I have to worry about? What now. Reading more -- and moving from message board to articles -- it explains that if an embryo reaches blast on day 6 the lining may no longer be as receptive as day 5 and so it's better to cryopreserve and do an FET rather than transfer fresh on day 6 if the lining isn't as receptive.

None of that is relevant to me because we freeze anyway and get lining set up to ideal with ERA results anyway. Beside that it really depends on the embryo grade and how it survives the thaw and hatching and a bunch of other factors. Still - reading it gave me a fright and bummed me out.

My state of mind is clearly very fragile these days. It's hard to want something to work so badly that you hold on to any strings of hope. It doesn't take much to shatter to facade of "I'm ok" and "this can totally work."

I spent the morning hanging out with some people and then watching movies in the afternoon in bed. For the first time I saw Star Wars (1977) and finally understood all the cultural references. I also watched Star Wars (2015) and started Star Wars (1980) before I had enough. It annoys me that they understand the droids and Chewbacca but we don't. It's like the opposite of Stewie on Family Guy.  I tried watching Louis CK but the news about him just made me not appreciate the humor anymore. It's a shame; he used to be one of my favorite comedians.

In other news I discovered that my thyroid meds have made my skin really soft. My upper arms used to be perpetually dry, no matter how much lotion I used. I googled that too and it seems like there is a connection. Finally; a side effect I can get on board with.

Winter Olympics 2018 and NBC

Anyone else watching the Winter Olympics? For Shalom Bayit purposes we got a second TV during the 2012 Olympics because I'm a fan and my husband is not. In past years I've watched a lot more but this year I just watch as much as he tolerates and then we move on to something else.

I'm watching the coverage for these games and it's amazing to me how the NBC morning anchors are able to shift from one story to the next. One minute they're covering the Florida shooting and then they discuss the latest and greatest moments of the action in Pyeongchang.

I find it hilarious that the announcers keep talking about Lindsey Vonn's age and how ancient she is at 33. Shaun White is 31 with a heart condition and no one is talking about his retirement. I know she's saying this is her last Olympics and she's very emotional about it but isn't it more that she's been through a bunch of surgeries and injuries rather than her age being the issue?

I'm very impressed with Savannah Guthrie pulling a double duty and anchoring Today and Nightly News while Lester Holt has the flu. I also followed Dylan Dreyer and her husband on Instagram and it was cute how excited they all were to have her home. I feel bad for Savannah and Hoda who have to be away from their babies for two weeks. They're working really hard and it seems like they're not so into it, especially since their news reports are peppered with updates from the Florida shooting. Plus there's a 14 hour time difference so they're shooting a morning show at 9:00 PM in the dark.

I'm not sure when I became an NBC loyalist. I started watching right around the time Meredith left. I watched the entire Ann Curry debacle unfold in real time and that's when I started disliking Matt Lauer #TeamAnn. Two years later, though NBC screwed over Conan O'brien and at that time I was definitely not feeling the NBC love #Team Coco but clearly I got over it.

Not only do I watch Today when I can, but most of my peers do also. Sometimes we'll discuss an outfit or a story we saw. No one I know watches GMA or CBS with whatever version they have. Even my clinic has it on in the waiting room.

I talk about these people like I know them which I suppose is exactly what their marketers love to hear. But I bet if I met one in person they wouldn't be nearly as excited to meet me as I would be to meet them.

Thyroid; no news

I had my freak-out appointment today with the endocrinologist. This was the appointment I made in the height of my anxiety because she figured it would be better to meet fact to face and this was the first available.

It was fine. I'm a rational person, nearly to a fault. I didn't need to make an appointment just for her to reassure me, which is basically all it was. She mentioned multiple times that she wasn't going to take blood because it was too early and it wouldn't give accurate numbers. I was fine with that - less needles for me. I didn't think it would do anything; it's not like she said anything new that I didn't already know. But it was helpful. She kept saying, "I don't want you to worry about this," and "if I thought there was an issue I would have told you."

I guess everyone appreciates reassurance once in a while. It was only slightly a waste of time for the appointment. I go back in two and a half weeks to get bloodwork and at that point we'll see if the increased dose did anything to budge the numbers. Until then, I'm to rest assured that if the transfer doesn't work, it's not because of my thyroid.

New day

I should know by now how much the weather affects my mood. The sun always comes out eventually. It's a new day and with it came fresh optimism.

In the afternoon after my meltdown my husband and I spent the rest of the rainy day doing a puzzle with one of Johnny Depp's Pirates movies on in the background and drinking hot cocoa. It was perfect. It did a lot to lift my mood but I was still mopey in the evening. I figured a good night's sleep would help, and it probably would have if I didn't wake up at midnight to use the bathroom and unable to sleep until close to 4 am. That's ok. I still felt a lot better the next day.

There's always going to be the baggage of the what-ifs and the ones that didn't work; but that doesn't mean I have to carry it with me into every transfer. Thank you also to the messages of encouragement.

I'm working on taking things one day at a time. Trying not to think about turning 34 in a few weeks. To some people that seems fine. If I was in a different place in my child-bearing journey maybe I'd feel that way too.

I still don't have a solution for Pesach but we decided we don't need one right now. We're taking things day by day. Today isn't the day to solve that issue. Tomorrow's not looking good either. I don't like procrastinating and it's not my personality to push off problems or be indecisive but for the sake of my sanity, we're just not dealing with it until it becomes necessary.

Pre-transfer jitters

Today I had a full-blown meltdown. Tears, runny nose, puffy eyes, sobs... the works. It started out as a conversation about Pesach plans and what we're going to do this year. For the past few years, ever since we bought our house, we've had my in-laws stay with us for the first days of the holiday. It's a lot of work and expensive to host them, and without a master bathroom there's a lot of space-overlap with me feeling claustrophobic toward the end of the visit. This is part of the reason I'm constantly talking about remodeling and adding another bathroom. Not inviting them would make them sad. More importantly, not having them would make my husband sad. In the past the issues have been discussed in passing but I've always just sucked it up because I'm a people pleaser and I wanted to make my husband happy. This year it's very close to a transfer and I don't want to risk the work and effort that goes into preparing a major holiday and hosting sleepover guests.

During the conversation, we discussed plans for a good-transfer outcome and a failed-transfer outcome. As we discussed different options and solutions for issues that have come up in the past I was getting more and more upset. I realized that just the thought of contingency plans for a failed transfer were incredibly upsetting. I want this transfer to work so badly and I've nearly convinced myself that it might. But speaking about a possibility of "maybe we won't want to host because I'll be depressed" made the whole thing immediately real. There's a chance it won't work and... holy shit... I don't know if I can go through that again.

Adding to it all is that my sister is due the week after Pesach so everyone is doing their best to accommodate her family and anticipate her needs. I don't hold it against her that she's growing her family. I know I'll love her baby regardless of when it's born. Yet here's another factor seemingly pouring salt in an already incredibly sensitive wound. Sure, I'd like to be due any day with a baby and have someone else make Pesach for me. Instead I get to work hard and possibly grieve another miscarriage.

So maybe I'm upset about the Pesach options, but more than that I'm really scared about this transfer and what might happen. What might not happen. I'm so sick of failure. I'm so sick of feeling stuck. I'm so sick of being stuck in the support-system phase. When do I get to build my own family. Why are the two mutually exclusive that I can't do both, helping my sister while also being pregnant? And if my transfer fails will it be complete torture to help her for the first few weeks while they adjust to their family with a newborn? Just thinking about it all makes me sick to my stomach and brings on a fresh wave of tears.

I'm getting ahead of myself because I'm projecting. I'm using bad memories from previously failed cycles and assuming the worst. My mood is in the dumps and the gloomy, rainy weather isn't helping. But that doesn't mean I have to anticipate the worst. I'm crying over nothing. Nothing happened yet. Nothing may still happen. In fact, there's even a chance good things may happen. So I need to get out of my own head, get off the what-ifs hamster wheel, and work on praying that this time we'll have a different memory from a transfer.

Thyroid: continued

It has been a long and mentally exhausting week.

Ever since I got my TSH results back, I've been researching and discussing. I sent emails back and forth to my endocrinologist. I asked to speak to her over the phone but she prefers email or face to face, so I scheduled an appointment at her first available which is next Thursday. I asked to be on the cancellation list as well if anything sooner opens up. I also looped in my RE. His response was that it's not an issue. That didn't sit right with me. Why. Why is it not an issue. I sent him links to the articles keeping me up at night and asked him to call me. What was I expecting him to say? I don't know. I think he knows me enough to know he couldn't convince me with anything he said, so he sent me a study to read. I went over it with a fine tooth comb absorbing all the statistics and information it had to offer.

As I understand the study it basically says there's not enough evidence to really say one way or another about the 2.5 - 4.0 range. There is fair evidence that SCH, defined as a TSH level >4 mIU/L during pregnancy, is associated with miscarriage, but insufficient evidence that TSH levels between 2.5 and 4 mIU/L are associated with miscarriage. So if several studies have found that elevated TSH levels in pregnancy are associated with an increased risk of miscarriage in patients without a diagnosis of hypothyroidism (>4), and studies show improved pregnancy rates in cases of what's considered the ideal range (<2.5) then, all else being equal, wouldn't it provide a better chance at success if my TSH was closer to the 2.5 level instead of the current 3.54? I understand TSH numbers can vary greatly and it's an inexact science but I've been getting these 3ish readings consistently since the summer and even after starting medication (albeit very low starter dosage) it's still stubbornly at that range.

The other thing that caught my attention was that the studies in the article were done later in gestation and there's limited information about early miscarriages, or even TSH rates and implantation. My chemical pregnancies didn't make it past six weeks gestation and while it's impossible to know why, I can't help but wonder if TSH was a factor. If the Endocrine Society recommends 2.5 as the upper limit of normal in the first trimester, and it's known that TSH tends to go up during pregnancy, I'm not understanding why a level at 3.54 is not an issue.

When I asked if 3.54 is as good as having a number in an ideal range or if there's a benefit to waiting to get my TSH number closer to "ideal" of under 2.5, this was his response:  "We in the practice have gone both ways in the past. I cannot argue with your goal. Different societies can read things differently."  Basically, he has no answer but also has no objection to trying to bring TSH lower to under 2.5. He doesn't believe that it will make a difference, but if it makes me feel better he's not opposed. There's certainly no harm to it.

So RE says it's not a problem. Endocrinologist says it's not a problem. My mind is stuck wanting to give the transfer the best chance but I'm willing to accept that it's my own hangup and can be convinced to move past it.

Enter new factor for consideration: I forgot about the endo scratch. The hysteroscopy was done on 1/26 and counts as having similar benefits of an endo scratch as long as a transfer is done within 60 days of the procedure. If I wait to lower my TSH to "ideal" then I lose the benefits, if any, of whatever the endo scratch did. There's no way I'm interested in doing a hysteroscopy voluntarily again, so if we want the benefits of it then transfer can't be delayed.

I reached out to the doctor we saw in the summer for our second opinion back in the summer. I really liked her and thought she had some good ideas. I decided to see if she has time to chat with me and get her take on it. If she also says that it's not an issue then I can comfortably proceed with peace of mind. She heard me out, got all the dates and numbers and basically said that if my thyroid anti-bodies are normal (negative) then she would recommend to proceed. In her opinion, getting the benefits of the hysteroscopy endo scratch were better than trying to get the TSH down to ideal, especially considering I'm already on meds and have already increased the dosage.

So there we have it. It's one thing to get the opinion of a doctor and disagree with it, but here there are three. Three medical professionals, trained endocrinologists, are all saying it's a go. I can't argue with that. Whatever will be will be, and hopefully this is the time it's supposed to stick.

I feel completely drained from all the anxiety and worry and questioning everything about this issue. But at the same time I feel satisfied that I left no rock unturned and no question unanswered. At the end of the day, my husband and I need to live with this decision and I needed to make sure I'm at peace with what we chose.

Shabbat Shalom!

Thyroid follow up

My first appointment with the endocrinologist was early December. Last week I went back for a follow up to see how my body is reacting to the dosage. I got bloodwork done and the results just came back that my TSH is higher.  My initial test back in Dec had my TSH at 2.96; last week it tested just above 3.

I don't get it. I've been taking the dose as recommended for 8 weeks. Why would my numbers go up? My doc is recommending doubling the dose from 25 to 50 and retesting in six weeks. I told the tech relaying this message that I want to speak to the doc because I have questions. Am I supposed to delay a transfer for this? It's too precious and expensive to transfer before fixing this, but in the meantime I'm not waiting six weeks to find out if it worked. If she doubles my dose I want to be on it for a week and then retest. If it's still not good then the dose needs to go up again. I'm not being impatient, I just don't think the endo doc realizes my timeline.

My doc answered some of my questions. First she said the number is within normal variation range so she would interpret the results that the TSH didn't change, not necessarily that it "went up," and the dose needs to be increased. Second, she said it takes a minimum of 4 weeks to see the full effect of a dose so she doesn't recommend repeating labwork within a week but would cut it down from six.

She did say that since my "TSH is in the normal range now, it will not cause a miscarriage or fetal demise so it would be safe to continue with the FET." Do I trust that? I don't know if I believe her. Every single article I read says that TSH numbers above 2.5 have a greater chance of a miscarriage.
I don't want to take Google's word over that of the trained professional doctor who is paid to treat my specific case but it's hard to argue with a study like this: First Trimester TSH levels between 2.5 and 5.0 are associated with increased pregnancy loss

Do I loop in my RE? I can already imagine that his answer would be "it's up to you." On one hand I definitely don't want to delay. Four weeks to wait to test seems like a lifetime right now. And then what if it's still high? That's another increase with an additional four weeks of waiting. What if this is just my normal and no dosage will help? On the other hand I don't want to risk it. I don't want to have found an actual issue and then just plow forward and ignore it. I know I would be devastated if the FET doesn't take and I will feel like we could've done something... like wait for TSH levels to get to the ideal range. But at the same time if we're increasing the dose and then checking it again soon (and possibly increasing it again due to a pregnancy?) then isn't that enough? Some women get pregnant not knowing their TSH levels are up and only add on thyroid meds once they're already in their first trimester. Is that a risk I'm willing to take?

What to do??

Support

Last year I joined a few infertility support groups on fb. One of them is an active group with over 300 members of Jewish women, some have seen success, others not yet; all of them still in the trenches. Questions range from relevant (i.e., "What has been your experience with the HSG?") to the ones that are not relevant to me (i.e., "I'm ready to start trying for my next kid but I'm still breastfeeding, what did you do?"). The questions that aren't relevant to me don't bother me. I find the group to be supportive and helpful.

I'm also part of a different group made up of women who are dealing with primary infertility and have no kids yet. This group is smaller and doesn't have as many threads or active users. The thing that doesn't sit right with me is that there's a rule that you need to leave as soon as you have a baby, some even leave when they start to show. The problem with that is the feed is basically full of "trigger warning" threads about people announcing their pregnancy.

The idea of being with people who completely understand every day struggles of living as a Jewish woman without children is comforting. The reality of the group is different, but maybe I'm not ready to give up on the idea. When I first started in the group I befriended the admin and we chatted online for a while. I wished her the best and knew that even though she's been struggling for nearly 7 years her time was coming. Sure enough within a few months of chatting she announced in the group that she's set in place a new admin because she's expecting and about to start showing. I don't hold it against her. I already know the drill: everyone I befriend on this journey is successful within months, regardless of how long they struggled before we met. I just need to figure out how to get that lucky charm to work on myself!

My hesitation to leave the group stems from wanting to feel connected to other people who still understand what it's like and not knowing where to find it otherwise. Thinking more about it, I know that if I'm not getting anything from the group I could cut the clutter and leave. I muted the group for a few days as a test and I didn't miss it, so if I'm not gaining anything from it I see no reason to stay.

Contented

The past few days I've been so tired. As in, unable to keep my eyes open past 8:30 PM tired. Maybe it's the weather? Maybe it's residual jetlag? Maybe effects of the flu shot from Friday? I don't know. The flip side of it is that I've been up before 5 AM in the morning. It's been getting better every day, now to the point that I can asleep until my alarm so I think we're slowly transitioning back to normal.

I've also been feeling really content. I don't know if I'd go so far as saying "happy" but I might be that too. I've been feeling optimistic about this upcoming cycle even though I know how dangerous that is. I can't help it, I'm naturally a positive, hopeful person. I feel like we've put some really good things in motion for this one, including adding the thyroid meds; doing the hysteroscopy which counts as an endo scratch; and since we've done the ERA, they've perfected the procedure - more on that in a minute. In addition, I've read old posts and found that when I take a vitamin D3 supplement the transfers have done better. I don't know if that actually does something but I've added it just in case.

I don't feel that we deserve for this to work, per se. It's not like it will suddenly be different because we've "put in the time and effort" so now it has to. But statistically speaking why shouldn't it? It has the same chance of working as it does failing so why can't I assume the best. I don't expect it to work; I'm hoping that it will.

Yesterday my nurse calls and asks if by any chance I remember approximately the time frame I took my PIO shots back in 2016 when doing the ERA protocols. I asked what she's looking for and she said that since I've had the biopsy done, they've fine-tuned the test so that they can give an even more specific time window for transferring. I told her I can do one better: I logged all my shots. In the beginning it was to help me remember which side the shots were done on so that I can remember to alternate, but it also helped me keep track of what meds needed to be taken when and eventually it became part of every cycle, even a simple mock-transfer ERA. I was able to send her the exact time and date of the shot they were looking for. It's nice to know I can benefit from the new technology without repeating the test.

I think I'm also excited to try again. Our last transfer was in April 2017 which was nearly a year ago. A lot has happened since, it's not like we stopped treatment, but we haven't attempted a transfer. I feel like there's only so much we can do on our end and eventually nature and Hashem have to take over but we do need to do our part and initiate a transfer.

There are a few dark clouds hampering my mood. First is the news of a friend's sister-in-law who was diagnosed with stage four breast cancer. In her post on a private fb group she said, "She waited so long to have a baby who's 15 months old; let her at least see him grow up a little." It broke my heart. It's literally my nightmare. It's not about me and today she needs prayers not my response of shock and terror. The other thing making me nervous is the flu. I'm not sure it's a rational fear. I feel like if I get the flu I'll be sick for a week and then get over it. I'm more concerned about the people I love and young people in my life, especially my niece who was born a premie over a year ago. It's hitting people hard and I'm worried. Yesterday a coworker was going around coughing into her hand and then using that hand to open doors and use the copy machine. I passive-aggressively went after her with a colorox wipe because I was too chicken to say something to her directly. Finally, the news. Russia investigation. FBI memo. Government shutdown. Disgraced gymnastics coach. Opioid epidemic. I'm done hearing about the leader of our country. I try to balance wanting to be informed and not wanting to be constantly bombarded by what's going on. There has also been some drama at work that isn't simmering down but it's become somewhat part of the background noise, even though it's enough to cause significant tension at my job.

So a lot of things to compartmentalize and balance. Happy but restrained. Worried within reason. Informed without getting consumed. And with that... we welcome in February.