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.  

Monday update

Preliminary results from last week's biopsy were incredibly frustrating. On one hand inflammation seems to have cleared up -- but I don't put much stock in that because prelim results last time said the same thing but actual results had a different story. On the other hand, results also said that my lining is pre-ovulatory. WTH. I don't even understand what that means since it was literally timed with bloodwork and medication. Late last week my doctor asked me to come in for bloodwork to verify whether or not I already ovulated. A day later my actual period arrived, so doc was confident about timing. She said to wait for actual ERA results before being concerned. If results are inconclusive regarding ovulation/lining/timing we may have to repeat the ERA.

Chanukah was last week. It was a beautiful, low-key, high-cal holiday. We hosted two parties. One for family, one for friends. I attended two work holiday parties (including two gift exchanges) and we went to two additional parties. It was a lot. I had so many doughnuts and I'm not at all sorry.

My pottery class is winding down. I enjoyed it a lot and decided to take a second class in the winter session. I told a few people about it and they're like, "What? for that amount of money you could buy 10 vases!" Clearly these people don't get it. For me it's not about the end product, but about the journey getting to it. It's art. It's a hobby. It's something else to think about for three hours a week instead of worrying anxiously about the what-ifs. And at the end if I happen to get a vase or a mug out of it, all the better.

Since we didn't get to go to Atlanta because of the procedure, I'm trying to see if we can do a Florida trip in January. I need a change of scenery and now that we got our points back, I want to use them. It doesn't look like there's a transfer any time soon in our future anyway.

Some upsetting news about a family member thinking of moving. I know they have to do whatever is best for their family but my nieces and nephews are really important to me and I'll be sad if they end up moving away. It's not sad news, just a difficult transition for me.

I decided to pull the trigger and join the gym. It needs to happen. I have to work out more often and it's just not happening at home. My goal to start is to get in 30 min 3x week. Eventually I want to be working out 4-5x/week for at least 45 min each, but I know I need to work my way up to that because if I bite off more than I can handle I just won't go at all. Reaching goals start one step at a time.

Results and next steps

We got genetic results back. Of the four embryos sent for testing three are healthy and transferable. To say that was surprising is a complete understatement. I was so upset when they got "so few" eggs! I braced myself for another busted cycle even while hoping for the best. When we got close to end of the embryo growth stage and it was possible we'd have 4, even 5, embryos biopsied it was amazing. Even more amazing to get the genetic results back that they were 75% are healthy. Amazing. We're obviously thrilled with the news but we're very, very guarded. Embryos don't mean babies... we already know that. I'm really happy it was not a busted cycle after all.

My headaches have gotten less intense since I started the bp medication but they're not gone completely. I followed up with my pcp who sent me in for a CT scan. All looked ok in the scan. She said if they persist she'll send me to see a neurologist. I'm hoping that with the weather changing it will continue improving without needing any more intervention.

Today I went back for the CD138 stain retest. There's an 80% chance the inflammation cleared up. If not, then we go another round of antibiotics. My gut flora is already unhappy. I found some probiotic yogurt and hoping it will help.

If it is confirmed that the inflammation is cleared, we start the natural ERA next cycle. My doctor went over the schedule for the next few months. Each step gets us a little bit closer to a transfer. Embryos in the freezer contain so much hope and possibilities. But I know we need to risk one for a transfer. I know. Just scared it will end up like all the other transfers. My doctor is very optimistic and it's helping to keep me positive.

Insulin

I got a call from the nurse at the RPL specialist's office to go over the results from the bloodwork I took last week.  They tested for a bunch of stuff (9 vials of blood) and almost everything came back fine, including glucose, except insulin. She went over the numbers - they like seeing the 2 hr insulin under 40 and mine was just under 60.  In my mind that's not atrocious but I really don't know anything about it. Apparently high insulin levels are toxic to a developing fetus. She offered two solutions: lifestyle change or medication.

Lifestyle change:

• Low-carb, low-sugar, high vegetable diet. Lean meats. Whole grains. Limited fruit. 
• Exercise at least 30 min a day (if not there yet, work on getting there)
• Lose weight

I think if I do the first two, weight loss is inevitable. 

Medication: 

• Metformin

Now I understand message boards full of ladies talking about PCOS and pre-diabetes taking metformin and suddenly having successful pregnancies. It's not only to control sugar but it also takes care of insulin as a happy side effect without anyone actually realizing. Another simple blood test they can take at the beginning of fertility treatment to get information before waiting for a loss to occur. 

I asked the nurse if I was pre-diabetic and the answer wasn't clear. I understood her answer to say that I'm pre-pre-diabetic. In other words, if left untreated and things continue to deteriorate then I may become pre-diabetic and then eventually develop diabetes. 

I opted to try the lifestyle change first. I'd much rather eat healthier and exercise (something I should be doing anyway) rather than take more medication that comes with its own slew of side effects. I also want to address the issue instead of putting a bandaid on it. I always knew I could do better with diet and exercise but it's disturbing to hear that a blood test confirmed I'm failing at taking care of myself. Maybe it's not what the results say but that's what it feels like. 

Google isn't helping at all. Results all link insulin issues with high glucose and pcos but I don't have either issue. For the record, I also never drink anything nearly remotely similar to the vile drink they gave me so how accurate is that test anyway. I eat plenty of crap and I know that's a defensive excuse, but it still feels counterproductive. They should have me bring a regular breakfast that I'd normally eat.

I may contact a nutritionist for some clarification. I'm not planning to "cheat" but I want to understand what happens when I'm not on top of my food 100% of the time. Such as, if I go on an appropriate diet and then go out for a celebration dinner - will that kill a developing fetus? If I eat well, exercise, and possibly lose weight but my insulin levels still test high would that mean I still have to continue that diet AND go on metformin? 

The nurse said they generally don't retest but I requested having another test in a few months, before we do a transfer. Just so that we know. I think it's important to have all the information before risking an embryo. 

So... more things to make this summer interesting. Egg white omelettes, here I come. 

One

It only takes one! 

We got PGD results back and of the two embryos we sent out, one came back healthy. Amazing!!! We had very low hope that anything would come back from this cycle and we're surprised and incredibly grateful that it wasn't a complete bust as we feared.

We're still debating between a fresh ivf and a transfer, but this gives us options. I have more to say about cost but another time. For now, it's a small sigh of relief: a high on this journey's roller coaster.

Rough day

Today was a hard day. I worked late and got home around 9:00 PM. My stomach was bothering me and I was in and out of the bathroom all day. I ate just a plain yogurt (probably a bad idea in hindsight), banana, and apple all day. I wasn't hungry because I was busy and occupied.

I got the official timeline from my nurse. There were some notations on the bottom that I thought were just leftovers from the template she used for the last patient or something. I asked about them and she's like, "Oh, those are your biopsies." Wait, what? I had no idea what she's talking about. I asked about it and she said, "With the implantation failure we do perform 2 endometrial biopsies...The biopsy is meant to "wake up" the lining." Yeah, I'm familiar with the terminology what I don't get is why it's in my timeline and why is this the first time I'm seeing it? Did I miss something?? I was very confused. It took me completely by surprise. I remember discussing it at our WTF appointment in the summer after failed FET 3, but it was never decided that we'd do it. In fact, the doc wasn't even convinced that this would help and was just mentioning it as an option. He was  adamant about changing only one thing at a time though. So we went with the ERA option because it would give "concrete" information. We changed protocol for FET 4 based on the ERA results. When that failed, we added the extra meds prednisone/lovenox for FET 5. I'm still unsure where it was decided to add the endo scratch anywhere. My husband doesn't remember it being discussed after the July appointment either. I'm paying too much money for them to treat me like some statistic and randomly add crap to my timeline without asking or even telling me about it.

In addition, we got back PGD results for our embryos. One. It's hard to be upset at a beautiful healthy embryo. And yet I can't stop crying. I'm so, so grateful it wasn't a busted cycle with zero. But one? Just one? All that money and blood, sweat, and tears for one? We went through all that for one? I'm feeling guilty for being upset about the one. I know some people would love to get a healthy embryo from their own eggs/sperm. I know people go through multiple cycles just to get one healthy embryo PGD-tested and ready for transfer. Even so, knowing what I know about our transfer history I'm upset that this cycle resulted in only one shot.

And then since I was crying already, I couldn't stop. I cried for the failed transfers. I cried for the nights of anxiety. I cried for the years we've been childless. I cried for the unknown. I cried because my birthday is tomorrow and not only am I getting older, but the pressure of "what are you doing for your birthday?" has become overwhelming -- the answer is nothing. It's a regular day that happens to be the anniversary of when I was born. I should be calling my mom to say thanks and call it a day. The one thing I wanted to do was travel and we can't do that. I cried that we can't go on a trip. I cried that we don't have money for renovations. I cried because my husband didn't realize I hadn't eaten yet and ate all the good parts from the crockpot meal I put up in the morning since I knew I'd be working late. I cried because the tissues were rough. I cried because the president is a lunatic. I cried because I don't like feeling sorry for myself; I'd rather be a badass. I cried because I want to share good news with my parents so badly. I cried because I'm relieved we got a good embryo from the cycle. I cried because we only got one embryo from this cycle. I cried because I'm scared for the transfer. I cried because I'm worried for the future.

As I was crying I was surfing online and came across a line: "A winner is just a loser who tried one more time." We are not on an easy path. Hope guides us as we stumble along, trying yet one more time.

Revving up

Part of the reason it takes so long for me to recover after a failed FET is because it takes a lot of effort and energy to rev up to face it. I'm working on psyching myself up for FET 5. On one hand I'm trying to stay positive and get excited at the possibilities. On the other hand I'm trying to be realistic and not get ahead of myself by, for example, calculating due date (too late).

 

I purposely requested a specific transfer date because it worked out with both of our work schedules. It's a week later than the first possible window but there are so many things outside of our control in this whole situation that I may as well take a convenient option when it presents itself. It's only a week and in April that means the difference between pre-Pesach madness and post-Pesach calm. I'd rather go into it calm and fully prepared to give it the best chance possible.

 

I have days where I'm so pumped for this next try. I feel confident and optimistic. I calculate trimesters and figure out maternity leave. I'm so sure this will be it. Today is one of those days - it just feels like this is it for us. There are other days where I feel like there's just no point; this is only something magical that happens to other people and it may never happen for us and we should stop wasting money trying. On those days it feels like a failure in life and a failure in something we want so badly we can feel it in every aspect of our lives. It feels like all the sacrifices we made up until now were pointless and unnecessary. Those are really hard days. It's hard to look at our history of failures and continue to be hopeful. It's hard to look at the bank account and realize the what-ifs. It's really difficult to feel like everything is on hold, with no guarantees for a timeline or success or progress.  Which is why revving up takes so much effort. And why the failures feel like such a weight: another heavy burden to carry as we move forward. I try not to carry all that baggage from one cycle to the next but it becomes part of us. It's impossible not to compare cycles or symptoms or hold your breath as you near a specific milestone that held bad news in a previous cycle.

 

I hope that our PGD results come back with good news. Not only for healthy embryos, but now I really want to try this new MitoScore thing! It tests the mitochondria and rate of "stickiness" of the embryo. I think if we get results that indicate a good embryo with a good MitoScore (apparently lower is better?) we may prioritize that over the one in the freezer that wasn't tested for this. It's a new feature that wasn't available even just last year. Hopefully there will be a few good ones and we'll have a choice.

 

I can't believe it's already March. My birthday is on Wednesday. I'm feeling really mellow about it. My husband had roses delivered on Friday, which was my Hebrew birthday. It was lovely having the pretty bouquet for Shabbat. I'm not really expecting much else. That's ok. I know I'm the shizz.

 

I remember January taking F.O.R.E.V.E.R. but February flew by. Back in January when we were debating next steps I was so upset about waiting until April for a transfer and yet here we are with April just around the corner.  I really hope this is it for us. I really hope we find the solution to help our embryos stick. I really hope I get to share good news soon.

 

IVF 5: Embryos Day 7

They were able to biopsy two of the four that were still being watched. That brings the total number of embryos from this cycle to reach blast stage to 3.

I won't lie, there were tears. I was upset that it was "only" three. I am enormously grateful for these three, but I'm sad for the other four that didn't make it. They weren't bad, they just didn't grow to blast stage in the amount of time given, even though they were given an extra two days to grow.

I went into this cycle dreading it and it's proven to be just as agonizing as anticipated. We have to wait two weeks for the PGD results. We're hoping for the best possible outcome but we're realistic and know each embryo has only a 25% chance of being healthy/transferrable.

Staying positive and hoping for the best.

ERA II Results

Receptive!

Official report came in from the lab last night and I got the email from my nurse this morning. I'm so happy we did this. I'm glad we insisted on doing this now. I'm glad we insisted on doing it twice, to confirm receptivity. I'm glad the results came in and are what we want to hear.

I'm trying to not be angry or regretful about losing those three beautiful, healthy embryos because they were transferred too early. So much pain to get them, so much hope once they were transferred, so much devastation every time it failed.

They make one go through so many tests and procedures before they even start IVF. The ERA should absolutely be one of them. They may not change their protocol, but I've become an advocate. It's uncomfortable and expensive, but so worth it in the end.

So... pushing all those bitter feelings to the back of my mind, we're celebrating! Receptive!

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.

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.

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.

ERA: lining check

Lining check appointment today went well. There was very little traffic and even though the waiting room was crowded, I was seen pretty quickly.

I made sure to drink a lot yesterday and this morning and bloodwork went smoothly with only one stick. Results are back and E2 is at 409 with low progesterone. Ultrasound was also good: lining is at 11.7 mm.

So PIO starts Wednesday and then biopsy is on Monday. Moving along.

Patience

Bloodwork from the RPL workup came back all within normal range. I would have been surprised if we got any other news since we never had any reason to believe otherwise. I'm still glad we did it now anyway and got a definite answer.

I also ordered meds and got the timeline for the ERA biopsy. Originally the first date they had open was mid-August. I have a patience problem as it is, but even more so having to wait so many weeks for a non-transfer, delaying a potential transfer even more. My nurse said she'll try for an earlier date if the schedule allows and an opening became available in early August so we got that date.

I'm trying not to stress about time. I know I have a patience problem and stressing about it doesn't help. I'm working on it. It's been a long year with a lot of treatment so what's another month for the ERA biopsy. I've gone back and forth regarding pros and cons so many times I've started second guessing its necessity.

The reason we're doing this test is to verify the "transfer window." There is a window between days 4 and 6 of your [medicated] cycle for an embryo to stick, so all transfers happen on day 5 per protocol. For some women, their body responds differently and their uterus is more receptive on another day. The ERA biopsy will give one of these results: receptive or non-receptive. If we get back a receptive answer, then we'll know that the protocol has the ideal time to transfer. If we get non-receptive, the results may point to a more optimum timetable and the doctor will repeat the cycle again based on the personalized window of time to implant. Supposedly you're supposed to repeat the test until you get a receptive answer. My doctor said that he's never had to do it more than twice on someone. The paperwork I've read on it has stats that show 74% of women get receptive the first time, and 26% get non-receptive with a recommendation for a suggested window. About 1% of women tested get back an answer saying non-receptive without any suggestion for a new window to try.

Either we find out I'm receptive on day 5 and we can transfer knowing it's the right day; or we find out that we've been transferring on the wrong day all along and hopefully get a new chance at success with a modified protocol more adapted to my body. My husband and I, as well as everyone we've discussed this with, all agree that it's worth going through this process to verify the transfer window. It's worth the time, the expense, and the delay for a chance at piece of mind.

Some days I don't know what's keeping me motivated. Some days I wish we can go back to "normal" life before treatment, or fast forward to post-treatment and on to the next stage of our life that includes kids. Sometimes being in treatment, and thinking about all the what-ifs and playing out all the scenarios and pros and cons of the next steps can be mentally exhausting. Even so, or maybe partially because of that, I am motivated and determined to do everything in our ability to make this happen. The rest is nature, luck, and maybe a little smile from Hashem.

Three!!!

Of the seven embryos we sent for testing, there are three healthy embryos. I'm a mix of happiness and anxiety. These three tiny embryos are a scarce and precious resource. Right now we have three opportunities to get pregnant. Logically, I know that they have to be transferred in order to take advantage of that opportunity, but last time we transferred nothing happened and the opportunity was lost along with our hopes and dreams. It happened twice and it was devastating each time.

Three embryos doesn't mean three babies. There are so many things that have to go right for it to work. They have to survive the thaw. They have to stick at the transfer. They have to grow for 9 months. They have to make it through the delivery. Then it's a baby. That's when you know it was a success.

Even so, we're absolutely thrilled that we have three embryos to transfer and we're celebrating the opportunity that lies ahead.

The first IVF cycle we did resulted in two healthy embryos and at the time I completely took it for granted. Of course we have embryos - isn't that what this whole thing is about? Let's stick one in there already so we can move on to #2 faster. Well, neither stuck and we had to start all over. IVF 2... IVF 3... IVF 4...

Here we are, three cycles later and only now do we have something new to transfer. I'm definitely not taking these for granted. I know I'm doing everything to help them stick, but I also know it's ultimately not up to me. I can't blame myself if it doesn't work and I can't take the credit if it does. Each baby is a miracle, even the ones that people get for "free" and don't have to think so much about.

Someone on fb posted this article about why it's ok to be amused at these people's infertility announcements. They are kind of cute: spencerandwhitneyadoption.blogspot.co.uk and someone who has been through the treatment actually understands why it's funny. This couple ended up adopting and they seem very happy. The comments on the fb post from other people who experienced infertility were sad, like the one mom who said that she never got to surprise her husband with the pee stick. Obviously she's happy that she was able to get pregnant via treatment and have healthy babies, but people feel like they're missing out on something.

That used to be my mindset, but I don't think I have the luxury of being miffed at not having a youtube-esque announcement. I'll be happy if and when I get pregnant, overjoyed that it worked and anxious every second that it shouldn't suddenly end unexpectedly.  I know family members are waiting to hear results and part of me really wants to keep this a secret. Just our secret. That's another luxury we don't get. We expect them to be there for us to support during the bad times; it's only fair to share the good news too.

I think that's the rationality behind why I don't like telling anyone that we're trying. Not only because I hate sharing the news that we've failed, but I also don't want to feel obligated to share pregnancy success so early on. Again, may this be my biggest worry.... I hope I get to have a pregnancy announcement to share, regardless of how soon.

Results

Got the results from my mole: looks benign so no further treatment required. Great!

I also got a general voicemail over the holiday from the lab testing the embryo biopsies asking to give them a call. Since I didn't get it until after the holiday was over on Saturday night I can't talk to anyone until they reopen on Monday. My feeling is that they needed authorization to use the credit card on file, which is annoying because I had already given permission previously and had they ran it on Friday instead of getting permission we may already have the results by now. I get why they need authorization and logically I guess I prefer that they don't use my card without asking first, but now I'm anxious to find out results. At least I assume that's why they called.

Pesach is over. All that work and now it's done! Our guests left this morning and the house suddenly feels enormous. I love my house and I enjoyed spending my stay-cation here.

I started looking at options to go for a summer trip this year. In addition, I also started looking at vacation spots for a big trip for our 10th anniversary next summer. We never went on a honeymoon so I'm excited to spend time and energy planning one now.

In addition, I decided I need more hobbies in my life. I made a list of things I should try over the summer: tennis, clay wheel throwing, learn an instrument, yoga, running, camping, writing. I may or may not do all of them, but it's a starting point and I feel the need to stretch past my comfort zone. I asked family members to think about things I can add to my list. Willing to take any and all suggestions under consideration.

Embryo update

Out of the 27 eggs from yesterday's retrieval, 15 were mature and of those 13 fertilized. So there are now 13 on Embryo Watch 2016. I couldn't help feeling disappointed with that number. I know it's a great number. I know that we are so, so lucky to have gotten this number this far. I'm just worried about having enough make it to blast stage so they can be sent for PGD testing.

In the end I know it doesn't matter because in cycle 2 we had 6 make it to blast and none were healthy to transfer, so logically numbers don't actually mean anything. Still, I was unrealistically expecting something like 18 embryos to make it to this point. That's insane and I recognize that. I also realize that my hormones are completely swinging again and that's contributing to the exaggerated expectations.

Recovery is going really well, considering. Either my body is just used to it by now or I had a super gentle doctor, but I'm feeling so good compared to previous egg retrievals. At one point I told my husband that I'm concerned they lied to me or that I misheard about the number of eggs because it doesn't feel like I was poked that many times. I'm bloated, as expected, but I don't feel the same pain as before. It's possible I'm also a pro at recovery by now: keep hydrated to flush everything out, stay upright for the hours after, keep the heat pack on.

I've been conservative with the pain meds. I just don't feel like I need them, even the Tylenol. It's been such smooth sailing so far that I've literally had to hold myself back from doing things like carrying heavy laundry. I was ready to drive last night and my husband outright refused to "allow" it (tee hee, like he can stop me. I didn't drive because I would have felt guilty if I'd killed someone else, but I felt confident that I could). I'm forcing myself to take it easy today so that I can be more efficient in Pesach preps this week.

Next embryo update tomorrow. I know it's unrealistic to expect all of them to make it, but I still hope they do.