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.  

FET 6: night before transfer (2/22/18)

This post was originally written on the date in the subject line. All posts for FET 6 were saved as drafts and posted together as a series on one day. Read more here. 

The house is clean. The pineapple is purchased. Shabbat is all prepared, including the table set. I'm post massage. It was nice but not relaxing. As I was getting ready to go I was annoyed I had to leave the house in the cold weather. Another sacrifice for the good of the transfer...

Took one last shot and all that's left is to do the transfer. This is it. We've prepared for months for this. We've done everything we can. Now it's up Him to help with implantation and a healthy pregnancy. Good luck to us!!

FET 6: T minus 2 (2/21/18)

This post was originally written on the date in the subject line. All posts for FET 6 were saved as drafts and posted together as a series on one day. Read more here. 

Two more sleeps until transfer. Scheduled the cleaning crew for Thursday morning. Scheduled a massage for Thursday evening. Transfer is scheduled for 1:15 PM on Friday so we're supposed to arrive by 12:45 PM. At noon I'm supposed to empty my bladder and drink 16 - 20 oz within 15 minutes and hold it until after the transfer. K.

I'm excited and calm. I'm worried and nervous. I'm simultaneously thinking "this is it" and "what a waste." I want to believe that this time it will be different and just can't believe it will be. We've been eating takeout almost nightly. Chinese food tonight; grill yesterday; bagels the day before. I don't know why, I've just been reluctant to cook and tired to shop for groceries. I don't think I'm trying to self-sabotage by pumping my body full of msg; I think I'm getting all the takeout cravings out of my system so that I can avoid it for the weeks after transfer. 

On Friday night we have guests coming and I plan to have literally everything ready before I leave for work. I plan to leave work at noon and meet my husband at home before we go to the clinic together. Once I get home I'll have time to take a shower and get to the clinic with time to spare. At least that's the plan.

Today I went for a checkup for my eyeballs. I saw this article and decided it's time to get my itchy eyes checked out *shiver* Thankfully no eye worms and my itchy eyes are just... itchy. She recommended some eye drops. I also mentioned the eye twitch I've been having on my right eye but she wasn't concerned: caffeine, stress, dry eyes, lack of sleep.... all possible causes. It's pretty minor and has been receding the past few weeks. I told her we're ttc with treatment and she's like, "Yeahhhh.... that kind of stress can take a toll." I didn't even know I was stressed.

FET 6: Lining check (2/16/18)

This post was originally written on the date in the subject line. All posts for FET 6 were saved as drafts and posted together as a series on one day. Read more here. 

On Friday I went in for the lining check. In many ways the FET protocol is so much easier than IVF. Less appointments, less medication, less of a roller-coaster regarding emotions and hormones. In general just a lot less anxiety overall. The FET protocol has four appointments:
- Baseline
- Lining check
- Transfer
- Beta

The whole thing is a month to five weeks from start to finish. There are two weeks between baseline and lining check, then a week after that is the transfer. The 2ww varies by clinic and some people wait as few as 8 days before getting their beta. My clinic is pretty set on a full actual two weeks so we wait thirteen days before beta. Sometime I want to wait more... just hold on to hope for a little longer. I never do because if it didn't work then waiting just means unnecessary butt shots of PIO for no reason. But I digress; back to lining check.

Friday morning was the first day off work for the long president's day weekend but I couldn't sleep late because I had an early appointment. I got to the clinic and there wasn't much activity going on so I assumed I'd be seen quickly. I made sure to drink a lot that morning to try and avoid any blood draw issues. The tech who called me back looked tense and worried, very different from her usual chipper self. It was also a tech that's usually in the lab drawing blood but sometimes they rotate so it didn't seem so out of place. I was concerned there was something wrong with my file or protocol but she just said they're going to do the ultrasound first and left the room. The ultrasound tech came in, checked the lining. Anything above 8 is good. Sometimes my uterus likes to be an overachiever and have 12s but anything above 8 is "excellent."

For comparison, my lining at previous Lining Check appointments:

FET 5: 10.37 mm
FET 4: 8.69 mm
ERA I: 11.70 mm
ERA II: 9 mm
FET 3: 10 mm
I didn't keep records for FET 1 and 2.

After that I went back to the waiting room to wait for bloodwork. I had just enough time to text my husband an update before getting called back. New person. Uh oh. I told myself I'll give her a chance before asking for the other tech who is more experienced with my vein.

She was very chatty and while I don't normally engage, this time it was interesting. She asked if I had a long wait time and I said not really. She said they had a girl almost pass out in the chair when the other tech drew her blood. I said that doesn't bode well for the duration of her stay at a fertility clinic. Good luck to her. It explained the worried look on the other tech's face when she called me back for the ultrasound. While we were chatting she was checking and rechecking my vein. She apologized for "being OCD" but I said I'd rather you check it a hundred times and only stick me once. I told her I drank a lot of water but that it's a tricky vein and not to feel bad if she doesn't get it. See what I did there? Setting the stage for calling in the cavalry because I'm too chicken to hurt her feelings even at the expense of my pincushion arm. She got it on the first draw. We all cheered. All told it was a quick appointment, 35 min total.

I got the call from my nurse later that afternoon. Lining is at 8.7 mm and E2 518 with low progesterone. Good to start PIOs, but with very specific instructions.

My nurse got detailed directions from the lab who said that they timed the ERA II results based on when I took the first shot that cycle and when the biopsy was. This was to calculate an even "more precise" transfer window. She gave me instructions that the first PIO shot had to be at 9:30 PM exactly on Sat night but the subsequent shots can be more flexible as long as they're within up to 24 hours of each other. Weird. But at the same time, I'll accept any supposed advantage I can get. I had plans to meet with a friend on Sat night. I didn't want to cancel but at the same time I had this PIO shot stuck in the middle of the evening. Turned out there was bad weather and no one felt like going out in the snow and ice so we rescheduled. My husband is a pro already and we did the shot on schedule without incident.

For the very first time, I organized the meds and all accompanying paraphernalia in a little basket. It's easier than having to haul out the big box it came in where I hid it in the closet like I've been doing for every single past cycle. This is so much better! I think I didn't want to do it previously because I didn't want it to become part of the "normal" landscape of my room but it so is and nothing I tuck away in the closet will hide that fact.

I had so much anxiety leading up to this week but right now I'm just super chill. I wasn't even worried about the lining check or bloodwork. I'm very much in the "if it's meant to happen, it will happen how it's supposed to" camp these days. The only thing I'm a little bit concerned about is that our transfer is scheduled for a Friday and we have guests coming for dinner that night. We scheduled it months ago based on their work schedule and babysitter availability (they're coming without kids). They're not the type to cancel unless one of their kids is sick... and even then probably not. I'm planning to make everything in advance and just chill and relax but I know myself and I know I'm going to want to be up and about taking care of serving stuff and clearing up, etc. I could cancel but I think it would be nice to hang out with friends and laugh and chill instead of anxiously channeling my inner couch potato worrying about every twinge.

T minus 5 days!

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??

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.

Embryo(s)

Ever since we started fertility treatment, the one constant has always been that we plan to transfer one embryo at a time. We did that for the first five transfers, even when there were additional embryos available. Our doctor is an advocate for eSET and strongly advises transferring only one embryo at a time. His reasoning is that if it's a healthy embryo that will attach then it's better to have two separate pregnancies rather than risk all the complications of multiples.

There is so much information online, pros and cons for both transferring one or two embryos. For every article that states transferring more than one is dangerous, there's another article that says the opposite. For example, here's an Article educating against multiple embryos vs. Why transferring two is the way to go. The thing is that the article educating against multiples is talking about first transfer success rates. Not sixth transfer. They're not taking into consideration someone who has tried single transfers multiple times without results.

In short, the pros to transfer one are a lowered chance of complications or NICU stay and having multiple chances at a transfer in case one time doesn't work (i.e., lining wasn't right). Pros of transferring two is that they "help each other out," there's a higher chance of pregnancy, and if they both stick, two kids for the price of one. I'm not sure these reasons are scientifically proven one way or another. To me it seems to be the opinion of people who have seen success one way or another. 

There are multiple considerations when deciding how many to transfer, such as maternal age, embryo quality and size, and PGD/PGS testing. For us, the embryos are all top grade PGD-tested. Maternal age is currently 33, and the embryos are all strong blasts that are even younger.

For all intents and purposes, we are prime candidates to transfer one high-quality, normally-tested 6-day blast. But we did that. Five times. Success rates statistically indicate a live birth for every 3 or 4 transfers of a high-quality blast. But here we are, five times failed and still no pregnancy, let alone live birth. 

We have two healthy blasts remaining in the freezer. The doctor said his part about recommending just one at a time but won't oppose if we decide to transfer both. I don't know what the right answer is. On one hand I don't want to risk the pregnancy in any way. The goal is to have healthy babies. A pregnancy complication at 24 weeks with sudden delivery and a prolonged NICU stay is not a success story. I also don't want to transfer two, get a negative beta, and feel like we're back at square one with nothing to show for all these years of trying. 

On the other hand, we tried transferring one and it didn't work. How many times can we do the same thing and expect new results? Maybe it's time to try something different. It's literally the only thing we haven't tried. We've done everything under the sun to make a difference. ERA? Check. Bloodthinners/steriods? Check. Hysteroscopy? Check. Thyroid? Check. At our second opinion in the summer, this was one of the things the doctor mentioned: transferring two may help. It could be that one doesn't secrete the necessary somethings to induce implantation but the other does (clearly I didn't catch all the medical jargon) which may help implantation. If she, as a medical professional, is convinced it can help then maybe it's worth considering.

I took the liberty of creating a simple flowchart for this dilemma. 

I don't want to end up with severe complications that could have been avoided. I'm worried about losing all the embryos and being left with nothing. I'm also at a point where I'm ready to try anything for the sake of building our family. Who's to say they'll even both stick? We don't have a great track record for that. If we transfer two and only one sticks and becomes our baby I'd totally consider that a win. 

I don't want to deal with this clinic anymore. I hesitate to make a change but more than that I don't want to leave while there are embryos in their care. I keep saying that as soon as we're out of embryos we're out of there. If we transfer two then regardless of the outcome we have no strings tied there anymore. We're free to chose another clinic if we so desire. The same is true if we transfer two but one at a time. The difference is the real issue of fighting against treatment fatigue and trying to hold on to stamina to keep going after continued failures.

I feel like we'll only know the right answer once it happens and we're able to see it with 20/20 hindsight. Until then, we get to weigh the pros and cons and hope that whatever we choose has the desired outcome. When discussing this with my husband I was grateful and relieved to come to a decision we're both comfortable with. In a situation where so much weighs on decisions we need to make, it's a blessing to be on the same page with regard to what to do. At the very least we know we're doing everything we can with the information and tools at our disposable.

Before a transfer

After speaking to my doctor today, we decided to nix the prednisone and lovenox for the next transfer. It was an easy decision. In my mind, it did more harm than good even though we'll never really know for sure.

He also confirmed that he recommends an updated HSG since the last one is 3 years old and there was miscarriage in the meantime, so I scheduled it for next week.

Now for the complicated decision: whether or not to do a hysteroscopy before a transfer. It would be under anesthesia. Not only so that they can get better pictures but also if there's actually something there they can remove it right then and there. I would have to take a day off and then there's the recovery. It would also mean delaying a transfer by a cycle because it irritates the lining too much. I asked if that's basically an endo scratch and the doc answered that it's way more irritating plus there's water that goes into the tubes plus risk of infection - long story short he wouldn't do a transfer the same cycle. He doesn't feel strongly that it's necessary. He said it was up to me if I wanted to feel like I'm leaving "no stone unturned" before another transfer. On a scale of 1-10, 10 being that it was absolutely necessary, he said he'd rank it as a 4. 

On one hand I really don't want to leave any stone unturned, especially when it comes to transferring embryos of which we have precious few. I also remember our second opinion doctor recommended it, but then again some docs do just because it's a profitable procedure that gets them interesting data. On the other hand it's surgery. It's not necessary, I'd be opting in. So I'm trying to use logic. The reason we did the ERA procedures is because it was unpleasant but I knew I wouldn't stop thinking about whether we're transferring on the wrong day if we didn't do them. It wasn't an easy decision but it was justified when we discovered we did indeed need an additional day of progesterone to get a "receptive" lining.

I don't think the decision here is as simple. Putting aside the fact that we'd be transferring a month later, which I hate but am willing to swallow, I'm worried about doing more harm than good. Obviously if they find something and remove it then I'll feel wonderful and vindicated. But there's a slim chance they feel there's anything there to find. The risks are pretty high: a tear in the uterus? Infection? Who knows what else. The month wait would be the least of my problems.

My gut instinct is to reject this procedure. Logic is trying to convince me otherwise because if the transfer fails this is where my mind will go -- regret that we didn't take this step before transferring. We have a bit of time to decide so I know which thought will be permanently set up in my mind for the next few weeks.

What would you do?

FET 5: T-1

I was holding a newborn today and got sad when I had to give her back. I look forward to one day when it will be my baby and I don't have to give it back.

The blood thinner medication has been interesting. I'm on Enoxaparin (turns out the brand name, Lovenox, isn't carried in any of the pharmacies around). First, this injection burns. BURNS. I've taken to swearing like a sailor as it goes in. The burn goes away within a minute or so, replaced by a bruise. That's my belly now. Beside the burn, I noticed something horrifying. The medication includes porcine intestinal mucosa. In other words, pig.

When I first realized it, I freaked out. I don't like animal products in my optional cosmetics let alone in my mandatory medication. But beside that, avoiding swine is kind of a big deal in Judaism. We don't eat pork. Even kosher animals have to be killed in a certain humane way in order to be considered kosher for eating, but pig isn't even a kosher animal. I freaked out. I ran crying to my husband, who was amazing. He reassured me and calmly explained the halacha. In short, injectable medication is under a different category than food or oral medication and therefore if there's a medical requirement then it is allowed according to all rabbis. Even so, I called the pharmacy to see if there was an alternative but there isn't. It still grosses me out and I still hate this injection, but we do what we have to do.

I went to get a pedicure today. I did my errands and some laundry. My massage lady was back in time to squeeze me in and I had my massage this evening. All that's left to do is the transfer itself. We did the shots, I took the pills, and we did everything possible in our power to help this little embryo stick. Now it's all up to Him.

We're hoping this is it and we'll take any prayers and good vibes anyone wants to send over. We're so hoping this is it.

Pesach 2017

It's a beautiful, gorgeous day and everything is calm and clean before the holiday starts. The only thing I have left is to do my nails. Well, whatever is left of them after the week of cleaning, shopping, and cooking. I love this holiday and I'm excited it's nearly here. 

I remember this time last year having similar thoughts about everyone with strollers and bikes taking advantage of the beautiful weather with their kids. Last year things were looking up: we had just gotten great news that our cycle resulted in 6 blasts getting ready to be genetically tested, three of which turned out to be healthy and transferable. Little did we know then that two of the transfers would result in miscarriages. It's been a heartbreaking year looking back. Disappointments over and over. At that point I was thinking that next year things will be different.

Yet here we are. Not much has changed. We are on the brink of transfer #5. Bracing ourselves for the best and the worst. Emotions are all over the place internally as I try to keep my composure to face day to day life. Work still needs to get completed; errands still need to be done; life goes on.

Everyone has their own struggle. I know that. It's impossible to compare one person's life to another. Just last month I met a couple who got married a year ago and already has a 3 month old baby. Just today I found out that the husband has tantrums where he just disappears for hours at a time. That's terrible. It's not better or worse than my struggle, just different. Each person has his or her own challenges.

I try not to let the triggers get to me. I know that when ignorant people say things, unknowingly painful, that they're just being dense.  The other day I figured it was time to change my fb profile picture - it was long overdue for an update. I chose a picture at random from previously posted pictures. It happens to be a nice picture of my husband and I (which is why I chose it) but I didn't realize it would be added to everyone's newsfeed and announce this change to the world. I got several compliments and Likes.  Then I got a specific comment from someone: "How have you both not aged in a decade?!" to which someone else responded: "It's bc they don't have kids! I, on the other hand, have aged 20 years in a decade!!!"

I know it was meant in jest. I know I shouldn't give it another thought. I know some people can't give a compliment without putting someone else down. But it felt like a punch in the gut when I read it. I don't even need to list all the reasons why it was hurtful. I rarely post anything personal on fb. Between friending work people and acquaintances rather than just personal friends I have no expectation of privacy. Anything that's posted online, no matter what security settings are set, is now online for anyone and everyone to see. When that was posted on my picture, I felt like it was opening a wound for anyone in my world to see. I felt like it was exposing the most vulnerable part of my life to everyone.

Rather than making a big deal of it, I left it up. It's a part of who I am. I'm not one to air my challenges out in front of everyone but I'm also not hiding them. It's a fact of my life right now, one which I hope changes very soon, but for the time being I'm not ashamed or afraid to talk about it. It is what it is. I left it up because I know that if I saw that on someone else's wall it would give me an opening to start a conversation and reach out to them. Maybe it will help someone else, maybe it won't. I think there's already so much stigma around infertility and childless people that there's no need to add to the secrecy. People suffer in silence unnecessarily and I'm not interested in promoting that attitude. So it stayed up. Even when women go on to have babies, their past losses and struggles are still part of who they are. It's not a secret and it's nothing to be ashamed about. Still, a little tact. Sheesh.

Lovenox injections start today. I have a chart written out to keep track of everything - it's getting complicated! We also got a shabbos lamp for our room to do the PIO injections there instead of the living room where we normally do it since we're having company for the first days of Pesach.

In preps for FET I've tentatively scheduled a massage for Thursday. My usual person will be out of town but she'll try to fit me in when she's back. Otherwise I'll go elsewhere or skip it. Other than shots and vitamins I'm not really doing much else. Staying relaxed and keeping calm. I've already stocked the freezer with prepared shabbat and second days meals so I can just chill after the transfer. We're staying home for second days. We told people we're not going anywhere because need to recover from our first days company but it's really because I don't want to add any unnecessary stress for the first few days after transfer.

I'm feeling very mixed about this next chapter. I'm a naturally optimistic person so I want so much to let the hope spring forth and take over. But I'm also a realistic person and the past four failures are weighing heavily on my heart. "If it didn't work then why should it work now" creeps into my mind often. Even so, I still want to believe that it will eventually work for us, and if that's the case then why not now? I'm fully on board this train. I know that getting my hopes up may make it harder if there's another failure, but for me being hopeful feels more natural and comfortable. There are times to despair but now is not it and until I hear otherwise I'm eagarly anticipating what comes next.

Busy

It's Monday! It's Spring! It's the first day of a very busy few weeks. It's also the first day of being more mindful of healthy eating and putting more effort into meal prep. I'm nervous about the next few weeks just thinking about it.

This week I have my annual physical scheduled and baseline for FET 5 later in the week. Both are making me nervous even though there's nothing specific to worry me. There are also a few important meetings and deadlines I have to hit at work.

Next week my friend is getting married and two days later we're co-hosting 7B so I have to cook and shop and prep a bunch of things. That week I also have a girls night out and the new therapist scheduled. One of the days next week is also a big day at work, getting ready for an event the following week.

The following week is the big event at work -- I'm looking forward to the event and looking forward to it being over. I'm the project manager and I need it to be behind me so I can relax mentally pre-transfer. There are a few other things happening at work that week, but not as big and the responsibility is split among some coworkers. I have one late night at work and one early morning - back to back, ugh. At home, that week I need to actually do the majority of Pesach preps - that's happening! It's coming up whether I'm ready or not so I need to start hustling and I probably won't have a chance to start until that week. Luckily I have help scheduled to come but I still have to get the house ready first.

So just a lot happening - very out of my comfort zone to have everything stacked, especially both personally and professionally. Among all this I'm still trying to track down a specific form so I can get my taxes filed. Let the juggling commence! My goal is to get through it with my sanity intact and dropping no balls along the way.

Happy Spring!

Ides of March

When I checked the calendar and saw that baseline is next week I kind of groaned to myself. Feels like we just finished the last of the IVF cycle recovery/period/mikvah and barely had a breather. We were also obsessing over whether or not to do an endo scratch and that took up a lot of mental capacity.

We know that any decision we make, if it leads to a failed transfer, we will wish we had chosen the other option. We can't keep thinking like that. We can't obsess about things beyond our control. We're trying so hard to predict a future no one can see. Nearly everyone we polled -- we were really struggling with this decision and asked for a lot of opinions -- said not to do it. If I was able to get pregnant twice then implantation isn't my issue. More importantly, we don't know what an endo scratch will do to the lining relative to the ERA results. I don't want to miss the transfer window, since we were led to believe that it's such a narrow time frame.

A crazy option is to do some more ERA tests. Repeat the test with an endo scratch on day 5. Repeat the test with an endo scratch on day 6. Is it insane? Sure. But at least we wouldn't be wasting embryos. We'd be wasting more time and money. In my mind it's better to waste $2k on more ERAs than $20k on another IVF for more embryos. But who knows what that would do to my lining long term. And ouch. We're definitely not doing that.

I had my annual gyn appointment last week and asked for her opinion since I was there already. Her first answer was to stop overthinking it. It isn't a silver bullet and there's no way to know whether or not it helps. She also said that some women aren't meant to get pregnant (she's practical and blunt like that, which is part of the reason why I love her) but that doesn't mean that may be me. She said if we weren't screening for a devastating disease and had tried naturally I probably would have several kids by now. In her opinion, she said she'd throw everything at it; in other words, pro. Her opinion carried more weight so her saying to do it kind of made me continue thinking about it even after we thought we had a decision.

I feel like the endo scratch is the last straw for people who don't know what else to try. It may or may not be so but that's my perception. There was also no information online or through my doctor's office for people who have done both the ERA and the endo scratch. I couldn't find anyone who had any experience with both, let alone a positive pregnancy after doing both.

Ultimately, based on the information we have and the logic we pieced together, we decided to skip the endo scratch this time. It's important for me to write this out so that I can go back to read it in case our transfer fails. I may blame myself if it fails again, but at least I'll know we really put the time and effort into making a thoughtful, intentional choice based on all the information we had at the time.

Beside for all that, I don't think my clinic does this procedure very often. They scheduled to take two biopsies because legally they have to send one to the lab for pathology testing. So I need to go through two uncomfortable biopsies within a week because of legal reasons? That's BS. Maybe that's just the procedure and it really is a double-scratch with a week healing in between but it sounds off to me. It's not only the pain and discomfort of the actual biopsy, it's also the emotional rollercoaster. So before committing to another procedure I'd need to understand more of what it entails. And if my clinic isn't fully equipped to handle it I'm not prepared to do it just because.

We have a week to breathe before we start baseline and shots again. The snow day was a great break from general routine. My husband worked from home but I was officially off. I did a few hours of work but overall chilled. I had Harry Potter on in the background while I was working so that was fun. I also caught up on Big Bang Theory and Last Man on Earth.

I met with a friend earlier this week. We reconnected recently, after I saw her in the hospital when I went to visit someone else. She was about to be induced with her first baby after a long struggle with infertility. She had multiple unexplained losses.  Her issue was staying pregnant. It was nice chatting with someone who gets it. Someone who is also Type A personality who needs to know and has to fix and wants to change. Someone who feels like they can if they just find the problem and address it. Her baby is less than 3 months old and she's already thinking about #2. She had a classic, uncomplicated pregnancy and yet she didn't believe they were taking home a baby until they strapped her in the carseat on the day they got released.

I had plans to drop some weight before this next transfer. But it's coming up so fast I barely had enough time to get rid of the IVF bloat I was carrying around from February. I have a physical next week and I'm getting routine bloodwork. I don't know if my reg doc can recommend anything but willing to ask. For a hot second I thought of maybe postponing the transfer so we can get a little bit of a longer break. We both quickly shot that idea down - neither of us like that. A break may be nice but we don't want to push off a transfer.

I'm worried about the next transfer in a hazy sort of way. It's constantly in the back of my mind yet I'm in denial it's around the corner. It's mixed in with Pesach preps so I have an easy distraction when the thought of it gets overwhelming. Part of me just assumes it will be another bust but I can't wrap my mind around another loss. I still haven't been back to Wegman's since the last loss. The idea of another 2WW overwhelms me and I quickly change thought patterns to something else. I want to be excited for it but I'm having a hard time imagining a different outcome than the utter disappointment we've experienced in the past. Four times we've had our hopes raised and four times they were crushed. It's more than just the physical toll it takes; there's an enormous emotional toll every time. We have to make a purposeful and mindful effort to keep our sanity and marriage together through each loss.

At this point it's taking too much effort to psych myself up so I'm not forcing it. I'm going to give myself a break from thinking about it until baseline. I'll have enough time to think about it later. Right now, I'm going to try to enjoy whatever is left of our "break."

Pre-transfer jitters

I finally broke out the aerobic step I bought a few months ago. It's embarrassing how long it took me to get motivated enough to actually use it. But I did and, along with a great YouTube video, I worked up an awesome sweat before work. They say one good deed leads to another and it's true for this too, because I even took the time to prep breakfast and pack a healthy lunch. 

My new diet philosophy is 5/2: eat well 5 days during the work week and then enjoy the weekend with less restrictions. I see the most results when I low-carb but it's hard to keep that up for too long at a time, so this might be a good compromise. I've definitely enjoyed the weekend so now it's time to do the 5 'good' days. I feel like it's easier to be more structured at work so we'll see how it goes. I'm also using the free app from myfitnesspal.com and it's really helping to keep me accountable.

Today the clinic called to give us the exact time for the transfer. They always have egg retrieval surgeries in the morning and then after lunch they do transfers. The schedule depends on how many egg retrievals they will do that day, and that depends on today's bloodwork from monitoring. From past experience I knew that the surgery schedule comes out around 4 PM.

Shots are going fine. I think my butt is getting numb quicker this time because of past damage to the area from previous PIOs. It used to alarm me when the area went numb after several shots, but now I'm just embracing it and trusting that it will eventually wake up again. I was hoping it would make shots less painful but it doesn't. #itiswhatitis

Last transfer I did a recap so I can remember what I did. I'm already doing most of it - trying to eat healthy and keeping active at least 3x/week. I'm eating pineapple because I like it, so it's part of my regular snack rotation. I'm debating whether to buy pom juice and nuts again... I doubt they did anything the first time and I didn't really enjoy them. I guess it will be a game time decision when I go grocery shopping tomorrow. I booked my massage for the day before transfer. I feel like it helped me relax so for that reason it was worth it. Whether or not it helped otherwise I'll never know, but I feel like I'm doing something proactive to try to help implantation. And then there's the added day of PIO before transfer, thanks to two ERA cycles, two biopsies, and nearly $2k later. I hope that this is the ultimate trick that helps this work.

I'm anxious and excited. It's hard to put into words how much I want this to work. It's hard to admit how much I want it to work because for some reason it feels like that much more of a failure if it doesn't.

Whoops!

In the relief and excitement of being cleared to start PIOs, and therefore locking in a transfer date, I accidentally took my delestrogen shot a day early on Thursday. In the three prior FETs and two ERAs I've never mixed up the medication calendar. This was a first!

I emailed my nurse in a panic. She told me how to adjust the schedule to move forward and said it was no big deal. She kind of made fun of me, saying that she's never had someone so excited about a shot. I didn't care, I was just relieved I didn't mess anything up!

We had a nice weekend so far. The weather has been gorgeous. We went to a friend's birthday party on Friday night. It was lively and so nice to hang out with friends. Tonight we went to see one of our favorite comics, Sebastian Maniscalco. I love seeing live comedy but sometimes I forget how much I hate crowds. It was still great.

Earlier in the day, we were sitting in the backyard chatting on the swing and it hit me that this time it's not a dry run. The last two cycles we did were for the ERA and after several weeks of shots there was a biopsy and that was it. We haven't had a transfer since June. But this is happening. The dreaded 2WW is nearly upon us. If things go well, the 2WW extends beyond that to more anxiety and milestones and life as we know it changing forever. That's best case scenario. If things don't go well, we're looking at a depressing Thanksgiving holiday coming up.

I hope this is it for us. I hope the information from the ERA is what we needed to succeed. I hope we have good news to share soon.

FET 4: Lining check

This was my day.... unedited.

7:30 AM - Lining check was this morning. Doc said lining was just at the minimum of 8 mm. What? Seriously? Of all my appointments ever, lining was never an issue. The last ERA cycle lining was close to 12 mm or something. Why is this happening?? Bloodwork uneventful.

8:12 AM - The appointment ended pretty quickly so I had about 20 min before needing to be at work. I was thinking of running to Starbucks but then had a better idea. Instead of standing in line at Starbucks, I went to the nearest early voting place and stood in line there! The lines were long but they were moving pretty quickly so I was in and out within 30 minutes. #MakingHERstery #imwithher #gotasticker

11:04 AM  - I'm trying not to freak out. I know that it's the minimum but I think it's on the right side of minimum. That's what Google says, anyway. I just really don't like being on the edge like that. They did mention it has the triple line so at least we have that. This was never an issue, why is this happening now? I'm so nervous about next steps. What does this mean? Will they cancel the cycle? Delay? Do they give it another chance to grow and then check again? If that's the case, what happens to my 6 days of progesterone? Ahhhh! I'm so worried. I can't focus on anything. They took blood to make sure I didn't ovulate so they're going to wait for results to call me.

11:53 AM - No update yet. Still thinking about it.

12:01 PM - I woke up this morning at 5:12 AM and am now reconsidering the decision to quit my newish 1-cup-a-day instant coffee habit cold-turkey.

1:43 PM - It's still early. They should call soon. On the plus side, "not thinking about it" translated into incredible productivity at work.

2:36 PM - Why haven't they called yet?

3:12 PM - THE CALL!  Lining is at 8.69 mm and E2 at 467.  Anything above an 8 is "excellent" and good to start PIO. YAY!!!  I asked about other cycles where lining was so much thicker and the nurse said that it can vary between cycles but as long as it's over 8mm it's fine regardless of how much higher. It's basically a pass/fail and I passed.

3:13 PM - decorating nursery in my mind jk

So excited! I know I should be guarded and protect my heart from another potential failure but I'm just jumping in with both feet. So until our first beta tells me otherwise, I'm happy to get this show on the road!!

 6:30 PM - PIO shot. Oh right, this again.

Thursday Thoughts

I'm feeling UGHGHGHGHGHGH. I don't know what I want.

We went straight from the holiday season into two events at work. Even though I work at a Jewish institution, nearly 90% of the employees are not religious. So while they know all about the holidays and everything they entail, they don't necessarily celebrate. For them, the past few weeks were vacation. Which means that they're ok with planning events on the day we come back.

For me, I'm exhausted. I'm getting over the holiday stress. I'm trying to catch up on work stuff I didn't do at home during the holiday season. I'm trying to catch up on laundry and dishes and getting the house back in order. I have a brain fog I can't shake and it's frustrating me.

We had the event last night and while I didn't mind working the event, I knew I had a million other things to take care of. I'm kind of over busy work. I don't want to deal with dumb minutia of someone else's ideas. I want to implement my own ideas and be excited about the tasks I'm doing because I came up with the path to do them.

It's times like this that I revisit the idea of getting a new job. I've talked about it before, here and again here. I want a new challenge, but I don't know what the challenge is. I want to have an interesting job that I find interesting and I can be proud of telling other people about it. If I think about it honestly, I don't really believe in the methods or agree with a lot of the organizations choices.

I like my direct supervisor who I work with on a regular basis. It's partially because of her that I've stayed as long as I have. My supervisor's boss, who is also technically my boss, is not someone I respect. I don't think I have any more to learn from that person. In fact, there are things I actually don't like that I want to make sure I don't learn, such as not respecting people's time.

I'm back to the age-old conundrum: do I leave and give up a lot of non-salary perks, like having a flexible work environment, many days off, short commute, etc. or do I try to find something more satisfying that has clearer potential for growth? It would help if I knew what it is that I wanted to do, or at least what my passion is. Ten years ago when I was in an entry level job I didn't think I'd be in an entry level job still trying to climb my way up a rung.

It could be I have a complex. I believe I am such a good employee that I should not only be getting promoted regularly, but that people should also be knocking down my door trying to recruit me to their company. I definitely think very highly of myself, rightly or otherwise. At the same time I am reminded of how grateful I am to be employed. On one hand, I have it so good that people are envious of my job and its perks. I am lucky and I recognize it. On the other hand, why should I settle? I could have it even better with a job I like, great perks, and an amazing salary!!! Right? Maybe?

I truly believe that I am able to accomplish anything I set my mind to. The challenge is getting started and figuring out what it is that I want to accomplish. What do I want? Do I want to stay in the same field? What are my priorities? Do I want to make lots of money? Do I want to work from home? Do I want to manage people? Do I want an anonymous cubicle job where everyone just leaves me alone?

I don't want power, but I want autonomy. I want repetitive work I can do while I zone out, but I also want exciting challenges where I get to be creative. I want to have responsibilities but only ones I like. I want a high paying salary. I want excellent health and medical benefits. I want an easy commute or the ability to work remotely. I want the opportunity for growth. I want to work as part of a team with a strong leader I can learn from. I want to manage competent, dedicated people. Am I asking for too much? Does this even exist?

When I was in college I knew exactly what I wanted.  I loved school and knew my exact path moving forward. I finished my degrees with honors.I finished my MBA with so many student loans but I didn't care because I knew I'd get a high-powered job and pay them off in no time. Somewhere along the way I detoured into the non-profit sector and kind of lost my ambition and confidence when we started treatment. 

The water-cooler rumors have it that there will be a major shift in my organization in the next 5 years. The details are vague but what I believe that means is that a lot of the higher ups will be retiring, opening a lot of positions in management. Is that enough to get me to stay? Am I patient enough to wait that long for a change? Will I be happy with whatever the change will be, assuming there's a lot more information that doesn't get trickled down via rumors?

Then there's the whole baby thing. Is it happening? Is it something to plan around? It's the proverbial elephant in the room. I started treatment thinking it will work eventually and so I should be patient because WHEN I get pregnant I'll want the work flexibility. But it's been a year. I've put my career on the back burner for a while now because of something that may happen. At this point I'm not sure it will happen so soon, if at all. I'm not sure I want to put things on hold for it anymore. If it happens, then I'll work it into my schedule, whatever that may be. I don't know that I want to pause life while I wait for my babies. In reality, I think I'm scared that I'll put 100% into having kids and if it doesn't work out, I'll not only end up childless but also in a career going nowhere because I waited too long to make a move.

I'm a believer in living life without regrets. I don't want to look back and say "should've" for anything. I know I will not regret putting everything I have into trying to have a family. I know I won't regret that. I want to make sure I'm making strategic moves for my career as well. I would definitely pursue an opportunity if it landed on my lap. The question is at what point do I go out and start pursuing a new challenge?

I think this transfer could answer a lot of these questions. The outcome may determine a few factors leading down a specific path. If I get pregnant, then the decision is made to stay put and keep the flexible schedule throughout pregnancy and until daycare starts. If it doesn't work, then I'll likely need to do more IVF rounds in the future, which means that I may as well start looking for another job with better health benefits that could cover future cycles. We'll see. Maybe there's secret option #3 I'm not thinking of that will reveal itself later on.

Open enrollment

In 2015 we nearly exhausted the benefits on my husband's insurance, so toward the end of the year we did our research about plans and decided I will go on my own employer's insurance for the year.

The start of 2016 was incredible stressful because we discovered that our financial adviser gave us wrong information. In short, she told us we would be covered for the reduced rate under my husband's insurance as long as he was still on it but I didn't have to be a patient on it to qualify. Turns out that was not true, and we were stuck the entire 2016 with very slim coverage for fertility treatment.

For 2017 I want to avoid a similar problem. It's worth it for me to switch back to my husband's insurance because not only are the monthly premiums more affordable but the coverage is better. In addition, there's a very slim chance we may have some fertility benefit left over. There is a lifetime maximum on fertility benefits which we were nearing at the end of 2015. When I sign up for benefits in 2017, I don't know if that counts as a new policy. If it does that means my benefits refresh then we'll get a new lifetime maximum. If not, then I'll pick up where we left off and just use up whatever is left over. Something is better than nothing.

I will try to confirm just so we know what to expect, but in either case I'm still planning to make the switch. Even after maximizing my lifetime benefits, there is still a reduced rate negotiated with my husband's insurance company and the clinic. So even if we are paying out of pocket it's usually 50% of the rate we would pay otherwise.

How do other people do it? Are there better insurance plans? Do most plans cover all fertility treatment?

I'm fighting for these benefits but in the back of my mind I'm hoping it will all be irrelevant. The maternity benefits are amazing -- covered at nearly 100% -- and I'm hoping that my focus will be on that in the coming year instead.