Christmas 2018

Results came back and they're good.

ERA: as the two previous ERA tests have told us, my lining was pre-receptive and I need an extra day. This wasn't news, but we wanted to confirm since the past two were medicated and this was in prep for a natural cycle.

EMMA: no significant signs of inflammation from bad bacteria. While this is great news, it was surprising. Obviously it's good because we've already treated it multiple times so thankfully it's finally confirmed gone. On the other hand I kind of expected there to be a big announcement about what the cause is of the persistent inflammation that wouldn't go away, then use a cycle to treat it, then biopsy again to make sure it's gone... in short - I wasn't prepared for the all clear. It had taken time to accept the long delay that having a change in schedule, even for the better, kind of shook me. I'm just not mentally prepared to brace myself for another transfer and all the baggage that it reminds me of. We spent the past year doing one thing after another getting ready for this point but it feels like it suddenly snuck up on me. The past six FETs failed; four of them in miscarriages. I always knew getting myself psyched up for another try was coming but and I hadn't expected it to be time to start.

For a hot second, we had a conversation about possibly delaying a transfer. Talking through it I realized it's not what I want, but it crossed my mind when I panicked at the results. I also realized I didn't want to tell anyone the results because I was scared of the predictable next question: "so when are you transferring?"

My instinct is to respond with "well that's really none of your goshdarn business" but is that fair to someone who has been by my side every step of the way? When I call crying or I text with bad news to help spread the burden so that it doesn't crush me? I know I don't owe anyone anything, but shouldn't the support system that has been around all this time get to know the good news too? I don't want to tell people when we're transferring, but I know I'll be calling if there's another failure, so maybe it doesn't hurt to give them a heads up about good news for once.

For the time being I deflect by vaguely talking about the persistent endometritis and how there's just constant delays, and how everything takes forever because it relies on my natural cycle. Not lies; just not the full truth. As it stands now, my doctor wants me to use a probiotic. While the bad bacteria didn't register in any significant quantities, apparently the good bacteria was low also, so doc suggested a vaginal suppository. It doesn't delay anything because we still need to wait for my period. We missed this cycle because of waiting for results so even without any additional delays, I estimated a transfer in Feb. That's fine - that will give me time to get my head in the game.

Here's what else that has been keeping me busy:


Work

End of year is always a busy time at work and this year was no exception. Since my office officially closes for the last week of the year, I wanted to get as much done as possible before the last day. Things kept popping up with last minute emergencies which made the week really hectic but thankfully it all got done.

Saying yes

A few years back I read a few books about people saying yes to things (Amy Poehler, Shonda Rimes). At the time it was interesting reading but I didn't really make any changes based on them. More recently I noticed I was feeling like I was saying no to too much, to the point of not having much to do. I didn't immediately do a 180 and start saying yes to everything, but I made more of an effort to rationalize my no's to myself. Why am I saying no? Could this actually be a yes? Is this an opportunity I'm missing because I'm so used to automatically saying no? So I've taken on a bit more and already it feels like a huge shift, especially to an introvert, homebody such as myself. Even though I'm happy with the shift, I'm continuously monitoring to make sure I don't overextend and burn out.

Pottery

There are a lot of things that make me happy about this. It's not an inexpensive class, but I feel like I'm getting my money's worth. I've also taken to watching youtube videos of other potters making things to get ideas and watch techniques. There's more to it than just the evening of class because the clay dries out so there's also in between class visits to trim and glaze. It takes up time but I don't mind. I debated whether to take the same class again or try a different clay class. I want to get better at throwing pots but I also really enjoy new things. Turns out that as a paying student taking any class I can use the studio while there aren't classes in session and practice on my own. So for the winter session I signed up for a sculpting class and I'm excited about it. I do plan to continue practicing the techniques I learned this past semester and maybe take an intermediate class at some point once I'm more comfortable with the basics. I love the options. It was also really exciting to bring home my first items fresh from the kiln. Even between the very first bowl to the most recent mug there's already a huge difference. I can see that I'm getting better and it's really exciting.

The other part of this is that it is tiring. There are a lot of steps to get set up at the wheel - get water, get your clay (most times hauling out chunks of 20+ lbs), set up tools, adjust the wheel. Then sitting in the squat position leaning in really takes a toll on your body if you're not used to it. I remember after the first few classes I felt sore the next day, almost as though I've had a full workout. After throwing pots, you need to find a place to store them. Then cleaning up is a whole ordeal. By the time I put away my clay I'm exhausted. It's a great feeling. 

Beside all that, I enjoy the non-screen time of the activity. If you want to talk to someone, you just turn to them and talk face-to-face. Your hands are dirty so you can't pick up your phone anyway. I leave it locked up for the duration of my time in the studio and it's a relaxing, freeing feeling. This is coming from someone who greatly enjoys screen-free weekends every shabbat so it's not at all a new concept, but there's something about it being allowed and purposely choosing to do something else. 

Working out

I'm working on getting to the gym for 30 min three times a week. I've chosen a great gym with a six minute commute door to door and it's still a time suck. Why? It takes to psych myself up to get there and make sure I have clean workout clothes and schedule so that I have enough time to shower and dress after and eat something before working out, but time it correctly with the morning meds which need to be taken on an empty stomach and then no food for 30-60 min.

Once I'm at the gym, I'm good to go and have fun working out. Once I've gotten everything aligned, and it is getting easier the more often I do it, then it's a breeze. I like sweating. I like feeling stronger. I can already tell I'm not as out of breath as quickly. I even noticed a slight dip in my blood pressure, which is thankfully normal, but no longer starts to rise if I'm late with meds. I enjoy checking it off my list once I'm done  working out for the day. But it's still an effort and the transition of getting used to it takes time. I know it's lame to make a big deal of 90 min of exercise a week, but whatever it's my #firstworldproblem. 

That's the latest for me. Hope you're enjoying today, whether you're home or travelling, whether you're celebrating the holiday or just vegging out.  

ERA/EMMA

On Friday I went in for the biopsy. It was a short day and even though I took the day off work I crammed in a lot of errands after the appointment so I never had a chance to type it up.

My appointment was scheduled for 9 am. The waiting room still had a few monitoring stragglers but they seemed to be running on time. The doctor called me back herself, not a nurse or a med assistant. They first did the obligatory pee stick test to make sure there's no pregnancy. By the time we were settled it was about 9:30 am when the actual biopsy was taken. I've had it 4 times before (once while under during this past summer's hysteroscopy) so I knew what to expect.

As the doctor and nurse were getting things ready, we chatted about next steps and she answered a few of my questions. We went over paperwork, signed a few forms, and did the procedure. They needed to go back in a second time because there are several samples going out to a few places and they wanted to make sure to have enough. It's so uncomfortable and painful as they're doing it - the best I can describe it is getting so cramped up that it feels like you might have to poop even if you don't have to go. It's a weird feeling. As soon as they stop the pain goes away and is replaced with period cramps that get milder as time goes on. I didn't even cry this time from the procedure.

Then we talked specifically about the results. If it comes back that the inflammation is cleared up, then the next step is a transfer. If not, then we'll take the information the results give and apply it next cycle, pushing a transfer to late-Jan or later (depending on what treatment is needed). My doctor said that at that point she herself will be on maternity leave. I said congratulation and smiled - genuinely happy for her. She said she'll still be involved and will give me her cell number. At that point I started to crumble. It was partially a delayed reaction to the hurting procedure, partially because she just cares so much. I started to tear up, and when I knew the waterworks were coming, I knew I could no longer talk without going into full sobbing. She thought that I was upset because I was feeling abandoned but it was the opposite - I so much appreciated how much she cared. She said that if my transfer happens to fall out during her leave that she'll try to come in for it. I managed to squeak out, oh you don't have to do that. To which she responded that she wants to. That just made more tears come and all I could do was nod.

The doctor left and the nurse was finishing up with the packing of the biopsy. She brought me tissues and said she understand how hard this is because it took her six years to get pregnant. She said, "I was on that table 19 years ago." When she left I let myself cry for real while I got dressed. I took a minute to calm down and left. Cried some more in the car. I've repeated the story a few times over Friday and it makes me tear up every time.

It wasn't the physical pain of the procedure that got to me; it was 100% the emotional part. It's a really hard journey. Finding a doctor who is so committed and professional and exudes so much care at the same time is truly a blessing.

One second of the exchange with my new doctor was more compassion we've had during our three years at the old clinic combined. Speaking of, on Friday morning I randomly received a check-in email from my last nurse at the old clinic asking what's up. I'm debating whether or not to answer. I don't really owe them anything, let alone an answer. On the other hand maybe I want them to know that they missed such an important piece of my treatment.

So now we wait a few weeks for results and see where the path leads us next.

Natural cycle: continued

When I got the results from monitoring last Monday, things were going slower than anticipated. That continued to be true all week. Day 18 was Friday and I was called back for monitoring. It was swamped. There was only half the staff because of the holiday weekend but just as many people in the waiting room. The doctor who did the ultrasound measured the lead follicle at 17 and said "We'll likely see you tomorrow" but wanted to wait for labs to come back to make sure.

Coming in on a Saturday is tricky for me. Some people avoid it all together but I'll use whatever religious loopholes are available in order to keep the cycle on track and still keep Halacha. Just because I choose not to drive on Saturday doesn't mean I can't arrange for someone else to drive me. Because they were so swamped on Friday, I expected to wait longer to hear results, but after noon passed I was starting to get nervous. If I need to make arrangements then I need to know soon, especially since a lot of people were out of town and my default go-to person wasn't available. At 1 pm I called the nurse's line and left a message. At 2 pm I paged the nurse on call. All the while worrying about the what-ifs and different scenarios.

Worst case scenario, I do need to come in this Saturday and I don't have a ride in place. Best case they would tell me to come back Sunday for more monitoring. All the while keeping in mind that whatever happens this weekend, 6-7 days later is next weekend where not only do we again have a Saturday issue, but we also have plans to be OUT OF TOWN. Never did I imagine that the cycle would be this long or I would never have made plans to fly somewhere else.

Finally at 2:30 someone returned my calls. They were waiting for my doctor to weigh in because even though she was out for the holiday she still wanted to be informed on everything and decide the next step (isn't that amazing?). My doctor made the call that based on my blood work results, I should take the ovidrel on Friday and come in 7 days later, the following Friday, for the uterine biopsy. It took me by surprise because I thought the lead follicle needed to be at 20 for something to happen but I guess it didn't. Luckily I had ovidrel from my Aug IVF cycle that was still in my fridge. I took it at 3 pm and made sure to note the time in case it becomes relevant in the FET cycle.

So one stress averted - don't have to go in on either Saturday. The next stress is scheduling the actual biopsy. I was advised by the nurse to call the scheduler on Monday to make sure to get on the schedule for Friday. I've been calling all morning and left two messages so far and no one is responding. I'm assuming they're catching up from the weekend, but c'mon. You're a medical office and someone should be picking up the phone. I'll keep calling but it's frustrating. We're trying to see if they'll take us early enough that we can still make the getaway over the weekend. It's a slim chance but I don't want to cancel before I know for sure.

I know they likely won't have appointments before 9 am because of monitoring. The flight is less than 2 hrs but it's a short Friday. With unpredictable delays and getting through an unknown airport, even without checked luggage, I don't want to risk getting too close to Shabbat. I'm comfortable flying before noon, but there are no flights before 1:30 pm on the airline we're already booked on and switching to another airline will cost about $720 for one way. While I'm fairly certain we're canceling the trip I'm having a hard time doing that and letting everyone know before booking the actual appointment.

Natural cycle: day 14

There are a lot of things frustrating me and I need to vent so let's get right to it.

First of all, the natural cycle ERA is going slower than anticipated. They estimated day 14 for ovulation but the largest follicle is only 10 mm. So everything is pushed until until follicle is close to 20 mm. I have to go back on Friday for more monitoring. Not only am I annoyed that I have to wake up early and go in for monitoring on my day off, but I'm also annoyed that now the biopsy is delayed until 11/29 or 11/30, depending on when I finally ovulate. And what happens if they overshoot and accidentally miss ovulation? It's not a crazy thought but I know they are pros and know what they're doing so I'm not even going to bring this up.

We're supposed to travel the last weekend of November. Because sunset is so early these days, I booked the earliest flight out on Friday the 30th. If biopsy ends up on that day we will have to cancel our plans. I know this takes priority and I'm definitely not skipping an appointment, but I'm also really done with all this taking over our lives. Also, it was delay delay delay for two months and suddenly there's a 5 min procedure that might ruin an entire weekend.

I was annoyed at having 8 people ahead of me this morning even though I tried to make an effort to be there early. Between that wait and then the second wait for bloodwork, the appointment was nearly 90 minutes.

It's busy at work because of the shortened week and everyone is stressed. There's a specific person that gets under my skin and I have to work hard to not let it get to me. While I'm open to the possibility that it's me, I'm hearing issues with this coworker from other people too. I'm keeping my supervisor informed but I can't go complaining for every little issue, and there's usually at least one thing to complain about per day.

It's Thanksgiving season. It used to be one of my favorite times of year. Two years ago that changed with the Wegmans incident, where our fourth FET ended in another failure. It's family time and I'm feeling the weight of our losses on my shoulders. It's hard not to think of the what-ifs had any of our FETs stuck. I'm tired of the wait. I'm tired of the limbo. I'm tired of trying. I'm tired of failing.

They say you should count your blessings. I am grateful for each and every one. I try to focus on the positive. I try to stay hopeful. We've been through 8 IVFs, transferred 7 embryos in 6 FETs spending well into the 5 figures resulting in 4 miscarriages over 3 years in 2 clinics waiting for 1 miracle.

Natural cycle

We started the natural ERA/EMMA cycle. The protocol calls for an ultrasound on day 10, plus possible blood work. Once the follicle reaches 20mm in diameter, if an LH surge is detected, then biopsy will be scheduled 6 days later. If no LH surge, then I need to take Ovidrel and the biopsy will be scheduled 7 days later. Whatever we do for the ERA cycle will be repeated for the FET. 

It takes 15 days for the results but we won't start a transfer cycle until it's confirmed that the inflammation is cleared up. We'll need to wait and find out the results of the EMMA to see if there is still inflammation present and, if so, treat it correctly once and for all.

Over the weekend I got a text from someone telling me to keep a mutual friend in mind while she undergoes emergency surgery. Her baby was born two weeks ago and she's suffering from some unknown infection or delivery complication. I have no idea what specifically but the situation sounds terrifying. The more horror stories I hear about pregnancy and delivery the more I feel like I should be reconsidering whether it's something I want to fight so hard for. There's so much time to think that it's impossible not to let the mind wander to the worst case scenario. I don't think that's what would make me back out but it's very scary and has been preoccupying my mind lately.

Making the wait count

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

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

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

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

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

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

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

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

One at a time

Patience isn't one of my strong suits. I work hard to suppress this personality trait in my every day life: when talking to people and they have boring stories I'm not interested in hearing; when dealing with slow clients on the phone; when coworkers come for a chat I'm not in the mood for; when people have solvable problems they're whining about; the list goes on. There are times my impatience wins but for the most part I'm able to function in society like a regularly patient person.

It's been difficult to keep my frustration at bay with how long everything takes in fertility treatment. I was frustrated when we needed to see the urology specialist who scheduled us for May but ended up having a cancellation in March. I was further frustrated when we discovered we'd need to do surgery which would delay any IVFs for three months, and then even more frustrated when the first available opening was at the end of May even though we were seen in March. I almost lost my marbles when I found out we'd have to  wait to see the RPL specialist in October but then it worked out that we were able to go sooner and got an appointment in May. That was nearly a miracle. And now I'm realizing how stressful May ended up being.

It doesn't end there. The RPL specialist wants me to repeat the hysteroscopy because the images sent from old clinic didn't have what he's looking for. I'm not thrilled about another surgery. I'm really unhappy about it, actually. But beside the fact that it needs to get scheduled around a period, they also need to do some work to figure out what the stain test is because it's not standard protocol. So I was able to schedule it only based on next month's estimated period, not this month. This pushes back everything else.

In addition to all the waiting, the RPL specialist recommended repeated the ERA, this time unmedicated. I'm really not thrilled about another unpleasant biopsy, especially since I already did this twice at $800 a pop out of pocket. Unmedicated means no FET drugs or birth control. He wants us to go straight from that to a retrieval cycle. The reasoning behind that is to take advantage of the cycle of not suppressing the ovaries with bc pills and possibly needing less medication to stimulate. From there he wants to go straight into an unmedicated FET in the third month. All this needs to be timed so that the retrieval month falls out after the necessary recovery period of the varicocele repair.

Looking at it all at once is very overwhelming. I'm seeing a very frustrating summer ahead and I get annoyed and upset and frustrated at everything that needs to happen, at just the right time, for us to even start thinking about a possible retrieval or transfer. All things considered, we're know we're so lucky we were able to get in to see the RPL specialist sooner rather than later for obvious reasons. But this is rough. It's really rough to just wait. It's really tough to see my friends starting to think about bar and bat mitzvah celebrations for their preteens. We're not even any closer to having an infant.

In the grand scheme of things it's only a few weeks. I know that logically and most of the time I'm ok with it. I've been able to shove down most of my frustration and impatience under the guise of "doing something" with these appointments. But every so often something pops up and I get reminded of how frustrating it all is. I'm upset today because the hysteroscopy was scheduled for end of June instead of next week. But the reality is that a few weeks don't make that big of a difference. I'm thinking of it compounding and if everything takes "just a few weeks" then it builds up to months and months of waiting.

I know I can't think like that. I just won't survive. My blood would boil in anger at the injustice and then they'll delay things even more to treat my sky rocketing blood pressure caused by all the impatience and frustration.

My husband made me feel better by saying we should just take it one day at a time. I can't think of a better way to tackle this. We really have no other choice. Every other year the summer seems to fly by. So maybe if I focus on one day at a time it won't seem so long. While I can't help but be impatient, I can try to incorporate fun summer aspects sprinkled throughout to help it go by faster.

When thinking about the difficult aspects of infertility, there are a lot. The first ones that come to mind are the devastating negative betas, or the traumatizing miscarriages, or the emotional roller coasters during stim days and embryo development. I'd rank these waiting days among the top five as well. Waiting for each procedure, each test, each surgery, each appointment one at a time with weeks in between trying not to scream in frustration while attempting to go about your daily life as though this is normal is pretty mind boggling.

So I had a cry. I got some hugs from people I love. I got in a good laugh and made some food for Shabbat. And now we just wait #oneatatime.

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.

Official ERA Results

It was a really busy day at work and I almost didn't realize another day has gone by without results until my drive home. It really helped to no longer be angry; what a relief. Anyway, I figured it's been long enough and it was time to email the doc directly. 

So at about 5:15 PM I emailed a simple message: Hi Dr. X, We were advised on Thursday that you will review the ERA results and give us a call. Since it's been a few days I wanted to follow up.  Please let me know when we can expect your call to go over to the ERA results and discuss next steps. 

See? Not bitchy or demanding at all. I honestly just wanted an estimate.  

He responded a few minutes later:  Will call now. Send best number to reach you. 

Cool!  

A few minutes later he called. Turns out he took off the weekend and he apologized for not getting back to us sooner. Awesome. That's all I needed. It didn't even bother me anymore that it took a while to get back to us. I was happy he responded and that we got our results. 

So now... on to the results. The uterine lining came back as not ideal, in other words pre-receptive. As suspected, there are two options: option one is to repeat the test delaying the biopsy by one day to confirm "receptive lining." Option two is to do the transfer one day later without repeating the test. I asked what his recommendation is and he said it's totally up to me. I asked what do other patients who do this test do generally. He said there is no "generally" since they do this test so rarely. After I pressed a little more, he said if you're going to to do the test you should do it until you get a receptive lining. It's an optional test and an added expense, but if you're going to do it you may as well do it until you get receptive. I agree with that. 

My husband and I decided to do the second biopsy to confirm the exact day. We're not interested in wasting money, and I'm not thrilled about delaying another six weeks, and I'm certainly not excited about another biopsy. But. But I'd rather do all those things rather than risk wasting an embryo. 

I want to go into the next FET knowing that we did everything possible to succeed. If this is what it takes, it is what it is. 

I'm really ok with this plan. I hope I don't get worked up halfway through the cycle and freak out about wasting time/money/meds but know I probably will. 

The upside of this delay in results is that baseline is at the end of this week. Onward.

Weekend

This weekend had a lot of what I needed: sleep, unhooking from all screens, spending time with people I love, walking, and lots of delicious food.

We had a potluck lunch at my sister's for a family birthday and among other things, I was in charge of dessert. I brought fresh fruit, two mousse pies (one chocolate and one vanilla) which were divine, and the winner was the mini cinnamon buns with cream cheese frosting. I am a huge fan of baked goods already but these came out really out of this world.

Mini cinnamon buns.... with cream cheese frosting

They were perfect. Even though everyone was full from lunch and the relatively heavy mousse pies, we still finished nearly 2/3 of that 9x13" pan of cinnamon buns. If you like baking, or eating delicious baked goods, I highly recommend this dessert.

I also did a lot of thinking over the weekend. As much as I feel aggravated by the doctor and his lack of phone skills, I notice I still defend him when someone trash-talks his indifferent behavior. I know I technically CAN move to a different doctor if need be but I'm not ready. The trapped feeling I have is due to needing fertility treatment in general, not necessarily this particular doctor.

I worry that changing doctors may delay the next steps somehow, as though they'll insist on repeating all the prelim testing for which we already have answers, instead of moving forward and picking up where we left off with this doc. If I was unhappy with the medical care I was receiving, that would be an acceptable delay. But the part I'm unhappy with is the manner in which he communicates. He relies too heavily on the nurse to do the majority of the communication and when he's needed to step in, he doesn't do it on my timetable. I could change to a different doctor with a more hand-holding bedside manner, but will that get me to my goal any faster?

In full disclosure, I realize that this is a common theme with this clinic. Before January I was assigned to a different nurse. I felt like she was distant and had a robotic, detached demeanor. There were several mistakes that she made that I felt warranted a complaint letter. This happened before I started the blog so I have nothing to link to, but suffice it to say that I was ready to request a new nurse then. It happened to be that I held off with the complaints wanting to think it over and in January she was assigned to a new office and I got the nurse I have now, which I love. Fast forward to a few weeks ago, I was ready to request a new financial counselor because of all the things she did. The issues are real issues and my complaints are valid, but I'm noticing a pattern here. Either everyone is incompetent or I just have extraordinary expectations.

So I need to be prepared to keep going to this place and know that I have to keep a vigilant eye on things because they tend to screw up, or I need to cut my losses and start looking for another place.

I'm inclined to give this doc one more chance simply because I don't want to lose sight of the big picture, which is trying to get pregnant with a healthy baby. We finally have a thread to pull: we were told my uterine lining is pre-receptive. We just found out we have a variable we know was wrong in the protocol. Changing it may be the key to finally getting somewhere on the road to having a baby. Do I want to put the brakes on that while I yell at him for not calling soon enough? No, that's not helpful and will not get me what I want.

Is his manner frustrating? Yes. Could he be a better doctor? Probably. But I am willing to look past this so we can move on to the next steps. I don't want to hold a grudge, I'm not interested in being mad at him, and I don't need the added stress of thinking about switching right now. I know this is probably not the last time he'll disappoint me, but my wanting a successful pregnancy supersedes all the disappointed feelings.

Putting things in perspective has really helped calm me down. It's hard not to lose the forest for the trees, especially when everything is so emotionally charged.

I am a big believer in stepping in and advocating for yourself, which has proven helpful time and again along this journey. But I also believe in balance and picking your battles. There is a time to fight and there's a time to be patient, and right now is the time to put away the boxing gloves and sit tight.

Still no call

I haven't heard from the doctor yet. I read all these fertility blogs and they all talk about how their doctors go out of their way to make them feel comfortable and supported. I get none of that from my doctor. He's a world-renowned clinician but when it comes time for anything related to the phone, he's the worst. The most recent time I felt like he didn't give me the time of day was after the chem pregnancy beta results came back and I was a complete mess. I attributed that situation to my hormones, misplaced sadness, and extraordinary circumstances that were beyond his control.  After the wtf appointment I felt better.

Until now.

Now I'm angry.

Our results from the ERA were delayed to begin with. There was anxiety already. Finally on Thursday morning (five days after we were expecting the results to begin with), my nurse emails with the results and that "I put those results on Dr. X's desk for review and he will contact you to discuss." That was at 7:44 AM on Thursday. That evening, I emailed her back and said that I didn't get a call. Maybe I misunderstood?  Was I supposed to call him? Should I have scheduled a phone appointment? Her response came back at 7:53 AM this morning, "No need to make a phone appointment. He will call you." Yet, it's now Friday evening and still no call.

It bothers me that I've been on pins and needles for nearly 48 hours waiting for these results. It bothers me that I haven't allowed my phone to leave my sight for more than a few seconds for fear that I might miss the call when it finally comes. It bothers me that the earliest I'll hear from him is probably Monday, and even then there's no guarantee.

What kind of service is this? You'd think they were doing me a favor, as though I wasn't paying thousands and thousands of dollars for their services.

It bothers me that I feel trapped because it's the best clinic, and he's considered the best RE. It bothers me that I'm stuck with them because they have my embryos. It bothers me that I'm stuck with them because I still need them.

I'm so annoyed and frustrated. It's so unfair to keep people waiting like this. No matter what benefit of the doubt I try to give him, it still doesn't excuse this kind of treatment. If he's on vacation, or has a family emergency, or is swamped with patients... whatever the excuse is.... he could've told the nurse to pass on the message that he is unable to talk immediately and he may not call for a few days. What is this madness keeping someone waiting for results???

This whole ERA process was a cluster from start to finish. Everything along the way was awful - from the financial, to the scheduling, to the appointment itself, to the checking out of the appointment, to payment, to results.

It pains me to think that we have to go through this again. Or do we? I assume I know what are options are but I don't really know because the trained medical professional has yet to call me.

I know I need to calm down. I'm so frustrated and infuriated at this trapped/dependent feeling that we're stuck with him that I have hot angry tears simmering just below the surface. Should I switch doctors? Should I complain to the office manager? Should I just suck it up and wait to get pregnant? Are my expectations just unrealistic?

Let's say I write him an angry email. Then what? What am I expecting in return? He'll say sorry? He'll write back, "Oh I don't have your file, talk to you Monday." Anything he writes will make it worse.  But a thought came across my mind that what if he doesn't even know he needs to call me? Then I thought that of course he needs to call. We have a baseline appointment next week and we don't even know if it's for another ERA or an FET. Plus the nurse would have made sure that he knew. He knows. Maybe he's ashamed for being so wrong about nothing being amiss that that we should "just keep transferring." Yeah right.

It seems like he doesn't care at all. He's won awards for his work, he has 20+ years of success. He has a pristine reputation and has nothing to prove. What's in it for him to be a good doctor? He's got no incentive to see us succeed. He gets paid regardless. In fact, the more we fail the more he gets paid. He's basically got no motivation to keep me happy or help us get pregnant.

He'll apologize, come up with some dumb reason why he didn't call sooner, and then we all have to move on because we still want to have babies.

I'm so sick of this. I'm sick of this clinic and all their bs. I'm ready to move on from them but there's nowhere to go. I'm done dealing with the uncertainty of the unknown and the dread of the news of the next phone call. I'm done with fertility treatment and I just want to move on.

Shabbat shalom.

ERA Results

After multiple calls to the lab and being on hold for a combined nineteen hours (only slightly exaggerated) with the most awful tingy music of the 90s, we finally got the results of the ERA: pre-receptive.

I'm feeling a combination of relief and disbelief. I'm relieved because we finally have an answer as to why none of the embryos stuck. They were being transferred too early! It's like hosting a dinner party: planning a menu and shopping for ingredients and cooking for days and setting the table just so and then having the guests show up three hours early when you're in your bathrobe in a mud mask brushing your teeth. Not yet, it's too early! All that planning and prep for nothing.

We got the results first thing this morning from my nurse who knew we were anxious to hear them but they still need to be reviewed by the doctor. Once he does he will call to discuss next steps.

I believe our choices are to repeat the test until we get a "receptive" result OR to guess the new transfer date based on their recommendation and hope for the best. While the thought of waiting any longer makes me want to jump out of my skin in frustration, it makes the most sense to give our embryos the best possible chance to repeat the test until we get a "receptive" result.

This means that we're probably going to do the second ERA in the end of September and not transfer anything before November. I don't like it. I don't want to wait. But I also don't want to spend October crying about another failed transfer if we don't do everything in our power to help it succeed.

The doctor was so sure that nothing needed to be changed. He was so calm that it made me feel like an alarmist who was just trying to waste money for fun. I honestly thought that the results were going to come back normal/receptive and that I was looking for issues. This just goes to show that you should always trust your gut. It is so important to do your own research so that you can make informed decisions and know what questions to ask.

I'm trying not to regret the three transfers that failed due to this error. They were a kapara. It happened. At least we didn't take his advice to "just keep transferring" and wasting the last two as well. Some people don't get this information until after 8 or more transfers. I consider myself lucky to live in a time when it's even a possibility to test for this.

Hold on, tiny embryos. Maybe we'll be together again for Thanksgiving.

On the Road Again

Our doctor is convinced that we have great quality embryos, good lining, and just need a bit of luck to get one to stick. According to him it's a numbers thing and the more times we try the more likely one will work. Sure, he has 20+ years of experience and multiple accolades in his profession, and maybe he's right. But I feel like I have to DO something.

We had three FET transfers. Three. Each one had a perfect uterine lining and a top quality PGS-tested day 6 blast transferred. Each one was perfectly timed and medicated per protocol. Only one stuck and even that ended in a chemical pregnancy.

In my mind, that is unacceptable. Some may say that if we were a "regular couple" that's the equivalent of trying 3 months in a row and doesn't it usually take at least a year of trying? To those people I say SHUT UP. Not really. I actually say: people trying naturally aren't timing it to the minute. People trying naturally don't know what their uterine lining looks like or its exact measurement. Trying naturally also doesn't filter out the embryos that are by nature incompatible with life or otherwise not in top shape.

It can't be anything to do with diet or health because women across the globe get pregnant all the time. Women who smoke, eat fried food, allergic to pineapple, addicted to crack, have 100 extra lbs on their body, with cold feet, or high blood pressure all get pregnant. So it's clearly something else.

I get conflicting thoughts when I hear of someone else announcing their pregnancy, especially another person in the IVF trenches. On one hand it's enormous joy and a secret glee: "If it can happen to her with all her issues, it can happen for me!" On the other hand I'm thinking that's one less miracle baby available for me. As if there's a quota of babies upstairs and dolling them out means less for everyone else to pick from. Both thoughts are insanely ridiculous, I'm fully aware of the absurdity. It's not only narcissistic to think that my future is directly linked to other people, but that also the world revolves around me and every act affects my life. It may be insane, but then so are superstitions and we still can't help ourselves, but I digress....

At our last wtf appointment, the doctor listed our options but not before starting with saying that he thinks the protocol is accurate and nothing needs to be changed. He offered doing an RPL workup, the ERA biopsy, or an endo scratch. He strongly advised against transferring more than one embryo because of the risk of multiples. He gently suggested that getting to a healthy weight is always helpful. I get that. I agree that it's true and I believe he said it because there literally was nothing else medically preventing a pregnancy.

So do we continue "just trying" forever? No. We will try something different every time! My way or bust!!!! Not really, but it makes me feel better to think I'm in some control.

First, we did the RPL workup. It's a simple blood test and there's no reason it's not part of the prelim testing done before you even start. Done. No issues found.

Second, we agreed that spending the time and money on an ERA biopsy was worth it. There's no point in wasting precious embryos on a transfer if we have the day wrong. Even if we hear back that the timeline is correct, at least it we have peace of mind and not wonder the what ifs in case the next one fails.

Third, if the ERA comes back that the timeline is accurate as is, we will try the endo scratch. We have nothing to lose.

If the ERA comes back that the timeline needs to be adjusted, we will adjust based on the recommendation and not do an endo scratch in that cycle - you can change only one variable each time. Like a science experiment! With my uterus! How fun!

That's the road map. If we still don't get pregnant after that, we're back to square one and have to think about IVF #5.

No news

The crown won. My permanent crown was put in this morning while we're still waiting for results of the ERA.

I don't understand what takes so long. My assigned nurse is on vacation this week but I called anyway to find out if results have come back yet. The nurse filling in left me a voicemail and said she talked to the doctor and no results have come back yet. She also said that she'll call the lab tomorrow to follow up.

I'm trying not to think too far ahead. The problem with fertility treatment is that the highs are so high which makes the lows so low. It's scary to hope.  Even at the lowest low, it's hard not to think about the future and continue to keep the hope alive. It's almost an addiction. After every negative failed beta, one of the first thoughts is, "So when can we try again?" and mentally calculate the options. It's a survival tactic. It's a way to deal with the devastating losses.

But how many times will we have to do this? How many more lows? How many more 2WWs will we have to survive through? Will we ever make it to the other side?

There was an accident and a set of glass shot glasses we got as a gift from my husband's grandmother had a tragic meeting with the floor. My husband's reaction? "It's just stuff..." as he sadly swept it up. "The thing about going through treatment is that it gives you perspective. You start to value the things that really matter." He is wise.

We had three healthy embryos the last cycle. We've already transferred one and it's gone forever as a failed chemical pregnancy. I know what I hope for next. Hoping is dangerous and scary but hope is also the fuel feeding the fire. As long as there's a chance, there's hope. 

Total eclipse of my life

Simmering just below the surface is an underlying annoyance. Easily provoked by the slightest inconvenience, I'm on edge and everything is ticking me off.

Annoying things:

- I got into a tiff with my husband about something stupid. I find something to pick at and lash out. Getting caught off guard, he lashes back and it's on. Not being hormonal and moody, he gets over it long before I do and I'm left stewing.

- I applied for two jobs on Thursday and haven't heard back. I felt like the shizzle applying and not hearing back makes me question whether I should have bothered.

- We haven't gotten our mail since Friday. UGGGHH. If it doesn't come today I'll have to call the post office and the thought of dealing with USPS employees is too much.

- Not sure why I'm so anxious for my mail, since last time it came they brought me a bill for $3600 in a "medication billing error" that I'm trying to sort out. I spoke to the contact person, I followed up on Friday, I emailed, I followed up again on Monday, and now I'm waiting for a director to get back to me. I don't have an extra $3600 lying around, and we're so careful about spending, so this feels like a noose around my neck.

- My coworker is grating on my nerves. She likes to think out loud and make sound effects and ask me for feedback on her thoughts.

- The High Holidays are coming up and I don't have a plan for shul yet. Our shul situation is complicated and stressing me out. If going to my in-laws was an option, I'd choose that just to avoid having to deal with this.

- My butt hurts from the latest round of PIO shots. I'm also back on the BC and it's making me nauseous and is partially responsible for my mood swings.

- We need to buy another car and we're procrastinating because it's a big deal and we're overwhelmed with the options. We're also terrible at haggling and don't want to overpay.

- Waiting for results sucks. It's been 6 business days. They said 10-14 business days for ERA results.

- The facebook highlight reels are getting to me. People on adventures, taking advantage of the last summer weeks. Families enjoying each other's company. Beach, fruity drinks, sunglasses, beautiful sunsets, happy tanned faces. I want a family vacation. I want to have my own family to take on vacation. I want to have money to spend on vacation instead of "wasting" it on fertility treatment. It wouldn't feel like a waste if we had anything to show for it, but we don't. Not yet, and holding on to hope feels like a heavier burden every day.

- My new diet is making me hangry.


As I was thinking about all the things that were pissing me off last night, I was in my bathroom when I heard the rain pounding on the pavement outside. I took a moment to step out of my bubble of misery to recognize that I'm being partially ridiculous. I have a house and a roof over my head. We didn't lose electricity in the storm and I have air conditioning. I have food in the fridge and clean clothes. There are people for me to love and people who love me.

I complain that we don't have money to renovate the bathroom, but we can renovate tomorrow if I felt like going into debt for it. I grumble about not being able to afford vacation but we choose to spend that money in ways that are more important to us, like finding out if our FET transfer window is right. I'm intentionally making choices from the options we have available based on the priorities I've set. I can't be upset that it's taking time to reap the rewards.

Sure, things aren't where I want them to be, but that's why you set goals and work toward them. Just because I don't have everything I want doesn't negate all the gifts I've received until now. I'm working on accepting things beyond my control and working through the challenges as they come. I feel justified in my sadness about not being successful in having babies, but I can't let that be the only thing that defines me. While it's overwhelming and always on my mind, it shouldn't eclipse everything else in my life.

Tisha B'Av

Spotting started on Thursday evening with AF on Friday. I emailed my nurse to get an updated protocol for September. It's the same whether we do an FET or a second ERA but it's better to get on the schedule sooner rather than later because the lab calendar fills up and there's more flexibility the sooner you schedule. My nurse is on vacation this week but the nurse covering for her sent me the info and said we'll just tweak it if necessary, depending on ERA results. I didn't understand if that meant we're doing an FET regardless or if we'll tweak it based on the ERA results for when we repeat it. I didn't press the issue because that will be answered when we get ERA results.

Today is Tisha B'Av. I'm usually a pretty good faster but it's more difficult during my period. I feel drained and thirsty. It's also 100 degrees outside so I've been home avoiding unnecessary movement.

I placed the laziest grocery order ever. I went online on Amazon Prime Now and saw what they had available in my zip code. I was able to get almost my entire regular shopping: fruits, vegetables, milk, yogurt, some fun salad toppings, OJ, and bottled water. I was craving orange juice for after the fast but didn't want to go out which is what inspired the order, and then I had to fulfill the $20 minimum to get free delivery. So easy. It was at my door in ice packs within two hours.

Amazon also came out with Amazon Fresh but that costs more money where as Prime Now is included in regular Prime membership.  I think Fresh has more options but this was perfect for what I needed today. The groceries I bought were more expensive item-for-item (i.e., $4.19 for a 24-pack of water instead of $3.49 I usually spend) but overall I saved money from not getting extra things not on my list like I normally do at the store.

Last week I started applying for jobs. I've debated for a while about my job (see Leaning In and Weepy) and I think it's time to face reality. As much as I hope a pregnancy is just around the corner, it may not be happening that quickly. While there are a lot of perks to my current job, I just can't deny the fact that I'm ready for a change and I don't see room for growth.

If I were to get pregnant, it makes sense to stay put and have the flexibility in a job I already know. I still don't regret giving fertility treatment the priority over my career. I still have 30+ years of career ahead of me and I can afford to cruise for a year or two while I build up my resume.

A few opportunities presented themselves and I decided that it doesn't hurt to apply. I have a number in my mind that I'd be willing to give up my current job for and if the new job offers it, I see that as a win-win. I have no interest in wasting their time or mine with an interview so I am seriously considering a switch if it makes sense overall.  I know that they are interested in someone with my background and skill set and thought it might be a good fit. The job is a lot less customer-service oriented and more about numbers and spreadsheets -- definitely my cup of tea. I'm the nerd who took an extra statistics class as an elective in college. Just for fun.

So we'll see. There are a lot of pros to my current job and it would have to be a great opportunity to leave it, but I'd be dumb not to even consider something new just because of my current job's perks. I have my annual review coming up at the end of August. If I have a new offer at that point I can use is as leverage for a higher salary, but is that what I want?  I have time to think about it.

In other news, my palm started twitching weirdly at the base of the thumb. I googled it and of course the answer was hand cancer, epilepsy, or the start of Parkinson's. OMG relax Google. I decided to see if I'm doing anything specific to trigger it and realized I was using the mousepad on my laptop with my thumb as the anchor which keeps the muscle tight for long period of time. Stopped doing it and the twitching stopped. Thanks Google.

Challenged

I'm feeling challenged today. I had to go in to work because I have deadlines coming up but I think I could have benefited from another day off.

Physically I'm feeling fine, just a little sore. My jaw is sore from keeping it open for an hour and the numbing shot. I'm having some minor cramping but I think those are pre-period from stopping the meds rather than the ERA.

It's more of a mentally challenging feeling. I just wanted to zone out and quietly get my work done but people kept annoying me with needs and questions and thoughts to share. Someone came over to ask whether she should get a new stroller she found a deal for on a sketchy website. Not only was it not even work related, but I'm also really not in the mood to discuss strollers right now.

I'm stalled on a project because a coworker is delayed on their part of the project and I can't start mine until I have theirs. I also got an email asking me where critical documents due today were and I responded that I sent them on Friday but the coworker that was supposed to pass them on after review dropped the ball. None of these are actual issues on their own, but when I'm already agitated and annoyed, each one has been an explosive situation in my mind. So much so that I started looking at job listings late this afternoon.

It didn't end there. When I got home I checked the mail and got a letter saying we owe $3,600 for a medication billing error. I don't know what happened, and I plan to look into it and raise some hell, but it was too much to deal with and just tipped me over the edge into a sobbing mess.

It's a bad day and I'm on edge waiting for results. I know that logically. It's just all very overwhelming and challenging right now.

Big Day: Part II

Crown appointment done! It actually wasn't so bad. The whole thing took 55 minutes from start to finish, including getting numb and digital impressions and temp crown. It wasn't painful, only a little uncomfortable. In short, it was better than expected. I was told the permanent crown will be in in 10 days, so it's now a race between the crown and the biopsy results.

Speaking of the biopsy, I have an update. Turns out the financial advisor was wrong AGAIN only this time it was in our favor! Turns out the clinic part of the fee is covered by our insurance and I should never have been charged last week because that fee goes to the lab doing the biopsy. So it is actually the original fee quoted of $875 and all the drama was completely unnecessary.  Whatever. Yay!

My lip is still numb and I hate it but I know it will hurt as soon as it wakes up.  I'm exhausted. I feel like I took a beating today. It was a long day and I'm ready for a nap.

Big Day: Part I

Today is the big day! ERA is happening at 10:45 AM. I'm excited and happy: for the first time in weeks I feel like I'm doing something to progress toward our goal. I'll continue updating as the day goes on.

I left a little early this morning because I was jittery. I knew that I would find something to do or some errand to run and preferred to be early rather than late. It's a good thing I did leave early because there was heavy traffic and a trip that should have taken 10 minutes took 20. Beside that, the elevators at the clinic were being cleaned so only one elevator was working which also took a few extra minutes. I got there at 10:40 AM for my 10:45 AM appointment. Score one for me.

I can tell that the clinic doesn't do these very often because there were a few hiccups.

First, when I checked in the receptionist asked if I'm there for bloodwork and ultrasound. No, I'm here for a biopsy. She had to go check and see what paperwork I need. She found something and had me sign it.

Second, she asked me to report to the lab to give a urine sample so they can run a pregnancy test. I wasn't told to prepare for that and I had emptied my bladder right before. I chugged some water and squeezed something out.

Then they took me back to the room and there were three nurses helping because there were questions: about the paperwork, about which instruments are needed, about payment. Why are any of these things a question - shouldn't you guys know all this by now?

I had to fill out paperwork that goes with the sample itself and as I was filling it out, a nurse comes back and says that the doc is ready so I should get undressed and we'll figure out the paperwork after. This was 11:00 AM and I get that they wanted to keep him on schedule. Everything seemed very rushed. The doc seemed to know what he's doing so that was reassuring.

The ERA itself took less than 3 minutes. I chatted with the doc for a minute about his choice of a pink shirt for the day and then he requested a specific instrument from a nurse. Once settled he put in a speculum, which was uncomfortable but nothing I've not had before. Then cleaned out the cervix; again uncomfortable but familiar. A few seconds later I felt the scratching on the inside of my uterus and even though I was expecting it, it caught me off guard and made me tear up. It was only a few seconds worth of scratching, if that, but the cramps continued for another minute afterward even after I sat up. Hours later I'm still feeling period-like cramps. I was still tearing up when the doc was leaving the room and he said, "Oh I made you cry, I'm so sorry." I responded with, "It's not the first time..." trying to be funny but failing miserably because it sounded more like I was trying to get back at him for hurting me.

The nurses gave me a few tissues and the rest of the paperwork to fill out and said I can take all the time I need to clear the room. When they left and closed the door I took a minute to sob -- not because I was in pain but because I was sad that I had to go through this, and I was embarrassed that I cried in front of everyone, and because I knew that if I didn't then I'd be on the verge of tears the rest of the day -- and then filled out the rest of the paperwork and got dressed. I asked for a copy of the paperwork and went to check out.

Further evidence that they don't do this often was that at checkout I was asked if I know how much I owe. I said that I was told the procedure cost was $875 and I had paid it in full when I came in for the lining check last week. She was telling me that the cost to the lab was ALSO $875 and that I had to give my credit card info to submit with the paperwork in order for the sample to get processed. I already had a foot out the door and wanted to get out of there, so I gave her a credit card number and said I'll contact the financial advisor directly, who told me the exact fee (and which we based our decision off of). There's no way that the advisor quoted me $875 when the fee is actually $1,750.... right???

Turns out the financial advisor has screwed up once again. Here's the first time she messed up. It actually does look like the $875 is only on one side of the biopsy. The lab charges the same amount as well on their end. So we are being charged twice what we expected and only find out about it after the biopsy is already done which is too late to do anything about it. I'm so upset and I can't stop crying. I know "it's just money" but I'm so annoyed that this keeps happening! How can they be so callous about information to patients?! It's not only hundreds of dollars that I wasn't expecting to pay, but now that we've decided to go down this route if we need to repeat the test based on the results it's going to cost another $1,750!!! What are they thinking not giving patients the full information?

So, being pissed as all hell and hormonal to boot, I sent a scathing email to the financial counselor, her supervisor, and her supervisor's supervisor. I don't care - I'll escalate it to the President if I have to. This is an outrageous injustice and I won't have it. Her email basically insinuated that we should have known to call the lab to find out that there was an additional fee on their end. I don't even have words to describe the nerve of that statement.  We should have known? That's your freaking job!!!! YOU should have known to verify that before quoting us a price!!

No matter what the outcome of this is, I am requesting a different financial counselor moving forward. I gave her a second chance and she blew it. This process is hard enough without having these preventable issues come up due to incompetence.

So anyway... light cramping, minimal spotting, super hormonal, very upset. That was my morning. 

Crown appointment is up next in T minus 50 minutes. 

ERA and crown

Tomorrow is a big day. The last PIO shot is tonight and tomorrow morning is the biopsy. We should get results back within 10 days. I also have a big dental appointment tomorrow.

We've already discussed the ERA so I'll tell you about my tooth.  In the past few weeks I've had a tooth bothering me. When I was young I had lots of problems with my teeth because I didn't brush. Once I got braces they taught me how to floss and told me that if I don't brush the braces will ruin my teeth (or some such) and ever since then I didn't have any new problems.  So I haven't had a cavity or dental issue in nearly 10 years... until last summer. I go for my cleaning every six months and the dentist is like, ok see you in another 6!

Maybe it's related to the hormones, or maybe not, but the issues started last summer, right around when we started treatment. I've also noticed that ever since we started treatment my nails have been less strong than usual and I have to take special care not to crack or chip them. So could it be a coincidence? Maybe.

In September I went to the dentist with discomfort in my upper jaw. He said there is a start of a cavity in my wisdom tooth. All four of my wisdom teeth erupted at around age 15ish and were perfectly aligned. I had no issues with them until that point. Because of the location of the decay, he said that it's not possible to fix it and recommended getting the tooth pulled. Since I was getting the top pulled I had to get the bottom one pulled as well. And if I'm already getting those two out, he basically recommended getting all four wisdom teeth pulled at once. What?? Get 4 teeth pulled for a tiny not-yet-cavity? Are you serious?? So I went for a second opinion and also asked one of my good friends who happens to be a dentist specializing in TMJ issues for their opinions.

Consensus was that the best thing to do was to get rid of all four at once before they become a problem later on because, and I quote, "They will eventually become an issue." The one that had the start of a cavity couldn't be fixed and it would just continue to decay until it hurt. Not one to procrastinate, I got on it and made an appointment.

In October, at age 31, I got all 4 wisdom teeth pulled out. Because they were all erupted it was actually a simple procedure and took all of 5 minutes once the local anesthesia kicked in. I didn't get the laughing gas or whatever it is that makes you loopy. I had the procedure done on Thursday morning and by Monday I was back at work. Minimal swelling, some discomfort over the weekend, but nothing too traumatic.

Fast forward to June and I start getting some pain in my lower right jaw. It's not a shooting pain but I noticed I was favoring my left side to chew and got headaches more often. I knew it wasn't going to go away on its own but it came and went so I kind of forgot about it when it wasn't actively bothering me. More recently it started coming up more often, especially when I had hot or cold food. As inconvenient as it is to get it checked, there's no reason to push it off: if there was an issue it should be dealt with sooner rather than later.

On Thursday I went to the dentist to check it out. Prognosis is that, due to grinding, a tooth with an old filling in it cracked. The crack can be fixed by putting a crown on the tooth. Crown runs about $1,375. In addition, the dentist suggested a nightguard to prevent grinding and future damage, an additional $450. Insurance will cover about 2/3 of the cost.

It's a sucky thing to deal with right now, but avoiding it won't help anything. If I don't take care of it now, the tooth will continue cracking and eventually also need a root canal in addition to the crown, or worse, needing an extraction. At least now the tooth itself is healthy and doesn't need a root canal.

I took the day off tomorrow for the biopsy because I have extra vacation days that are use-or-lose expiring at the end of the month. I was planning to go to the biopsy in the morning and then veg out the rest of the day. If I'm off anyway, and will be uncomfortable anyway, I may as well deal with this crown and get it over with, so that's happening in the afternoon. The permanent crown takes about 10 business days to come in so I may have to deal with a temp crown and mikvah but I'm not thinking about that unless it becomes relevant.

I hate it when my mouth and lip are numb so I'm expecting to be miserable and complain-y most of the afternoon. My husband has already been warned.

As for the ERA, I was told it shouldn't be too painful but who knows. I took the day off because I didn't know what to expect. I'm working on keeping my mind off the what-ifs of the results. I know that logically we decided to do this for multiple reasons so I just have to keep reminding myself those reasons. If anyone ever asks me in the future about ERA, I'll refer them to these posts and tell them they better be sure because the mental aspect is a big challenge. It's helpful to have a list of reasons to refer back to when the second thoughts start creeping up.

I'd be lying if I said I wasn't nervous. I'm hoping everything goes well tomorrow with no complications. Right now I'm watching Survivor on the laptop with the Olympics on the TV in the background while I write up this post. I love the Olympics and see no reason to have to choose between the two.