Better

Thank you all so much for your comments on my last post. It made me feel so much better to have other people who understand and share my righteous indignation! My DH didn't get it when I called him and just couldn't understand why it made me so sad. I keep going back and forth between OK and sad about it. I think the worst of it is that this second baby will, once again, see my parents as her pseudo-grandparents since her actual grandparents live a state or two away.

I haven't really talked with my mother about it -- we've been talking all week, but I've been too afraid to mention it. I'm afraid I'm going to break down. Maybe that would be a good thing, but lately I've just been trying to keep it together and I'm afraid what will happen if I completely open up. I'm leaving tomorrow morning to go back home and I don't see talking about it before then. I'm sure my mother doesn't remember that she never told me that they were expecting again. So, I feel like I would make her hurt more and that makes me feel worse. This doesn't feel like the best solution on my part -- I'm big on ignoring things and hoping they'll go away -- but I can't really do much else right now.

Things have been better since then. The next two nights were all adult events. Sometimes it's just nice to have grown-up conversations that don't revolve around chasing kids and pregnancies.

Today my mother's close friend (one of my favorite people) came over with my mother's other pseudo grandchild. My mother's friend (who has essentialy adopted the little boy's mother) even refered to my mom as "Grandma P" and my step-dad as "Grandpa S" when she was talking to him about them. That broke my heart a little. This little boy, though, could break through the worst mood and the worst jealousy. He is about 2 1/2 and must be the happiest, funniest, most adorable child I've ever met. We played on the iPad together for a while (he was fascinated and figured the whole thing out within 2 minutes) and I just couldn't stop laughing. He made me smile and I needed a kid to remind me that I do still love other people's children and I don't need to feel like I can't interact with them because I'm the "infertile" in the room.

Tomorrow (OK, today by the time you read this most likely) is my birthday. I've always been one of those weird people who actually looks forward to getting older. I think I feel like I get more authority or something? No idea. Anyway, I'm happy to turn 36. I'm not where I thought I would be but I'm ready to move forward with a new year. I feel like the combination of birthday and new year gives me a doubly clean slate to work with. This year has had some amazing highs and lows, but it is time to move on.

To everyone, I hope that 2011 brings you all much joy and happiness. I can't tell you how much you've meant to me over the past year. For all the pain and stress that 2010 has brought, one of the biggest bright spots has been becoming part of this bloggy community. I don't know where I'd be without you!

Can't wait to go home and hug my husband and my kitty.

(I'm going to stop now before the "sappiness" factor explodes...)

Blindsided

After two days of flight delays and cancelations, I've finally made it to my parents' house in Atlanta for a few days. (Atlanta does not handle snow well -- even just a dusting.) I've had mixed emotions about this visit. I want to see my parents and spend some time with them. I want to talk to my mother a bit more about what's been happening with us.

At the same time, though, I didn't want to talk about any of it. I didn't want to see the rest of the family that I will inevitably be paraded in front of. Yes, I know, it's a good thing that I have this family and that they want to see me. I appreciate them all. But, you know, sometimes I just don't want to deal with them. And, right now is definitely one of those times. I've been really low for the past two weeks or so and not handling other people particularly well. I just want to cocoon until this last-chance-to-be-pregnant-before-I-was-due cycle, this 2ww, this surgery, this unfulfilled EDD, this crappy year, this birthday are over. Maybe that's not the healthiest response, but it's what I'm feeling.

With all the delays, I managed to miss my mother's cousins' party yesterday. Thank G-d. It was a full day event of family. I don't think I would have handled it well.

I've had a migraine all day, but my mother and I managed to talk quite a bit about what's going on now and treatments and surgery, etc. I still don't think she really has any concept of how hard things are for me right now, but at least I've been open about it.

But then...

My stepfather's nephew and his wife wanted to go to dinner. This is the couple whose daughter is one of my mother's substitute grandchildren. I suppose I should have expected it. And, in a way it wasn't that surprising. Their daughter is almost two, after all. But, when we walked into the restaurant, what do you think I saw?

The mom is pregnant, of course.

I mean, I was wondering. But, I just didn't want to ask, you know? I figured my mother would tell me if she was. And, I figured if she was and she hadn't told me, yet, she couldn't be TOO pregnant.

But, no. She was seven months along if she was a day.

I was already bracing for an evening of my mother cooing over their daughter (who absolutely loves my mom) but I wasn't ready for this.

I appreciate that my mother probably didn't tell me when she first found out because it was shortly after my loss. But, really? In all the months since then you couldn't have mentioned it? Really? You thought the best way for me to find out would be when her giant damn belly hit me when I went to hug her "hello?"

REALLY?

F*** you. I don't give a s*** if you forgot you didn't tell me. I would think after a day of us sitting around together talking about IF treatments and my loss and my other cousin's losses and pregnancies in general (and even that damn Similac box) that you MIGHT have f'ing mentioned what I would see when we went to dinner. If you had just TOLD me then I would have been prepared. I wouldn't have stared slack-jawed. I would have actually participated in the conversation instead of having "she's pregnant, how far along, boy or girl, when is she due, why didn't you tell me, how could you not tell me, when did she get pregnant, was I still pregnant, did they have problems, was it easy, was it hard, he's such a great daddy, must act nice, must act happy, must keep smiling" going on a constant loop through my head.

When we were leaving, I thought "phew, I made it, I didn't cry, I didn't scowl, I smiled at them, I smiled at the baby, I did it." And then they started going on about how we definitely needed to get together again before I leave on Friday morning. Dinner again but at someone's house? We need more time to just hang out.

WHY?

While I sat in the back of the car with a headache on the way home, I got to listen to my stepdad talk about how cute the baby was and how smart and how he wonders how she'll be as a big sister. I think my mother finally started to get the picture because she sort of mumbled answers and didn't really engage the conversation or attempt to get me to participate.

I'm hiding upstairs, now. I'm trying to remember that the world isn't all about me. I'm trying to remember that every baby is wonderful and their having one isn't the cause of my not having one. I'm trying to remember that my mother didn't do it on purpose. I'm trying not to be so sensitive.

But, mostly, I'm trying not to cry.

At least, not too loudly.

Dear Similac

It's not that I'm ungrateful.  I'm not.  If I were actually due with a baby in two weeks then I would really appreciate the complimentary box of formula that was delivered with a bewildered grin and glance at my stomach by the mailman this Christmas Eve.  I'm sure I don't look like the typical woman he's dropped these off for in the past -- either "about to pop" or with a hungry baby.  I plan on trying to breastfeed, but I also know I may need to supplement or that breastfeeding might not work for us for a myriad of reasons and having a box of formula would be great. 

If I were pregnant.

But, I'm not. 

I waited until I was 7 weeks pregnant and had seen the heartbeat (low chance of miscarriage after that, or so they say) to register with two on-line "your baby week-by-week" websites.

I made sure to check "do not give my name to your partners," but you're so sneaky that you got it anyway.

When I lost my baby five weeks later I took my name off of all of those lists.  Not that it's easy -- you can't really check a box that says "miscarriage" on your profile.  You just do your best to unsubscribe or "change your due date." 

I got a few coupon books from you about four months ago.  It made me sad, but I figured that was all it would be.

But this early Christmas present, while very sweet, just reminds me -- in case I'd forgotten -- of what "should have been" right about now.  And that, instead, I'm preparing for surgery to be performed the day before I was supposed to be "due."

And, it does make me sad. But, at the same time, for the first time in a while I have a lot of hope right now. We have a new plan and I want to think it will be a fruitful one.

I wanted you to know, though, that I'll be donating that box, unopened, to the local food bank along with a check in memory of my loss.

And, believe me, the next time (and there will be a next time), I won't be registering on any of those lists.

Sincerely,

Rebecca

Updates and welcome ICLW!

Hi everyone and welcome any ICLWers. I kept going back and forth about whether I was going to participate in ICLW this month, but I thought I'd miss it too much if I didn't!

For anyone who is new, the details of our IF story are in the sideline. Briefly -- my DH and I have been TTC since October 2008 and working with an RE off and on since August 2009. We got pregnant after 20 months on a non-treatment cycle, but miscarried. We're now on our 6th cycle trying again after the loss. I just had my first appointment with a new RE (Dr. Smiles) last week and we're getting started on a new plan. See my previous post for an excessive amount of detail about that appointment! :)

I've heard back from the nurse and all the blood work came back normal. I don't have numbers (I'm going to get it next time I talk to them because I like numbers!) but the nurse said that the hormone levels were good and my vitamin levels were excellent -- Dr. Smiles was sure I'd have some vitamin issues as a vegetarian. Part of me wants to yell "Ha!" about that -- look, you can be healthy and a vegetarian!

This is, of course, a good thing. But anyone who has "unexplained infertility" can understand the slight disappointment that comes along with "good" results. I just want to know why this has been hard for us!

It appears that my insurance might actually cover the laparascopy since the fibroid is causing pain and is getting larger in comparison to previous scans. He'll look for endo or any adhesions while he's in there. I think that for my peace of mind I need to do it. We're waiting, now, to see if we get any sort of negative response from the insurance company. I'm not sure what we'll do if they say 'no.' I've been hurting a lot, lately, so I might push anyway. I think part of it is that whenever I have a cycle where I have a vaginal u/s, they push on the fibroid and my ovaries and then they hurt even more than normal. This cycle, I've had to stay on ibuprofen to keep from having shooting pain down my leg. So, yeah, I think I'd have to push for it no matter what. And, I think we are planning on doing a few injectable IUIs, so I think this will be best.

Right now, I have the surgery scheduled for Jan 5th. This would be ideal because classes start back on the 10th and I'd have several days for recovery and wouldn't miss any work. But...in order to make that date, I need to ovulate in the next day or two so that AF will show the day or two before then. My body is definitely heading that way, but it's a risk. If I don't ovulate soon (and, yeah, we're still trying this month because you never know...) then we'll have to put it off until the next week Monday or Wednesday which means I'd have to miss the first few days of the semester which I'd really rather not do.

So, if you could all send some pretty heavy duty ovulation vibes, I'd really appreciate it. Either I'll get AF in time or I'll find out I'm pregnant and skip the whole thing.

Can you guess which one I'm hoping for?! Hmm... surprise pregnancy or surgery? That's a tough one, really.

Happy anniversary to my parents!

Today is my parents' 29th anniversary. Now, some of you are going "hey, wait a minute, Rebecca is nearly 36 -- how does that work?" Well, when I refer to my "parents" I mean my mother and step-father. I haven't spoken to my actual father since I was 16 (that's a long drawn out story) but have never felt like I missed anything.

My mother and my step-father, S, first met when my mom was a kid. In fact, S taught her to drive when she was 15 and he was 22! At the time, he was dating her older sister. (!) I'm not sure how long they dated, but it seems like he was a pretty big fixture at their house for a while. My mother and father got married when my mom was only 20. At about that same time, S was getting divorced and had an infant son. S told me once that he ran into my mother and father at the library right before she got married and thought "she shouldn't be marrying him, she should be marrying me."

Fast forward 12 years -- my mother divorced my father when I was 4 and we moved in with my grandparents. A little over a year later, S, who had managed to date every unmarried Jewish woman in Atlanta by this time, ran into her at a party thrown by a mutual friend. Within a month they were engaged. Within five months, they were married -- after my mother asked her sister's permission, that is. At 6, I was my mother's maid of honor in long pigtails with a gap-toothed smile. My mother was 34, a year older than I was when I got married and a year younger than I am now. At the time, I thought she was old... :)

I feel like December 20th, 1981 is the day my family came together. I can't imagine life without S. We struggled when I was little and didn't appreciate him. My father was "cool" and S was trying to actually parent me. He was always trying to push me to be my best but was incredibly proud of me no matter what I did while my actual father just wanted to show me off and was disappointed in me more than anything else. My father just used me as a substitute when he couldn't find a date. S actually loved me.

And, most importantly, he loves my mother more than life itself. Their relationship is what made me understand that I could be loved and that true love was worth waiting for. Their relationship is what made me know that settling wasn't good enough. If my marriage can be as happy and stable and strong as theirs, then I am a lucky woman.

Anyway, I've been smiling all day as I think about them together. Just wanted to share.

To lap or not to lap, that is the question.

Hi folks!

I have so much information to process right now and decisions to make.  Most of the details below are to help me think things through -- there will be a brief summary at the end if you want to skip it.  :)

I think bullets will do it best:

• We really like the new RE (gonna call him Dr. Smiles).  He has a much better bedside manner than my old RE (renaming her Dr. Six-times -- Dr. Six) and seems to genuinely care about what he's doing.  Like I think he might actually remember who I am from appointment to appointment kind of "caring."  On first impression, the old office is fancier (i.e. more nicely decorated) and seems more "official" but the new one seems much more personal and the doctor is more involved in everything. (I think he knows how his office looks in comparison to the other one because he mentioned how he is building a new space across the street but that his office is state of the art. I think he almost feels like he has to defend himself against it.)  He is private practice while the other office is part of a school.  And, I honestly don't care what it looks like as long as it works!  I think his office is busier, though, and has far more cycles going on.  He, obviously, knows the other doctors (it's not that big of a town), and has mostly good things to say about them, but I think he understood why we were there.
• He seemed pretty surprised at how casually we'd been treated at the old office.  He felt like there were several red flags that were popping up in my file that showed that something was up and that we should be moving forward more aggressively than we have been so far. He was surprised that Dr. Six wasn't more aggressive when she did the hysteroscopy last year and was disappointed that she didn't investigate more to see what was happening with my left tube.  He asked with a quizzical look "So, this last beta in July is still from the pregnancy in April?  They just tested until it was zero?  And then just let you go?  Huh."  Yeah, that's what I thought, too.
• He started off essentially saying that looking at my chart he thinks there is a decent chance that I have some degree of endo. Which is interesting. He thinks it could be the cause of my intense mid cycle pain and pain during sex. When I've asked other doctors about this (basically every OB/Gyn or RE I've had since I became sexually active), they've brushed it off as ovulation pain that I must just be more sensitive to. Yes, I know it is due to ovulation, but it seems like it shouldn't be so painful that it can hurt to walk when I'm about to ovulate -- even when I'm not on fertility drugs.
• He did an u/s and talked a lot about what he was seeing. First off, can I tell you how much I appreciated that he did the scan himself and showed me what he was seeing and what it meant while he was doing it? I liked the u/s techs at the old RE's but I felt like I never knew what was happening. The tech would do a scan, I'd go sit in a room, the nurse would come to me with a report, some time later that day the nurse would show the scan to Dr. Six and sometimes I'd get a "correcting" phone call in the evening. I realize that they're all very busy, but I never felt like I had any idea what was going on.  And, obviously, Dr. Smiles won't always be able to spend that much time with us, but I feel like he'll always be willing to talk with me about what we're looking at.  He recognized that my DH and I are intelligent, well-educated scientists and that we can be trusted to understand medical terminology and statistics. (And, even if we weren't, I think anyone would like to be treated like they deserve to know what is going on!) 
• He found a decent sized fibroid that he says is in a "gray" area -- not a definite issue but could be. He said he was surprised at the number/size of follies I had while having an extremely thin uterine lining (would have expected there to be more estrogen present) and wants to do some blood work. He's concerned about my uterine lining in general and wonders if there is something hormonal going on.
• He took lots of blood for both hormone levels and vitamin deficiencies, etc.  (Woohoo for someone actually thinking data might be helpful when making decisions without my having to ask...imagine that.)  Hopefully results will be in tomorrow.
• He said that my DH's sperm count/quality is in the upper 3% of patients he has seen and that he should keep doing what he's been doing.  He said he seems to have contributed enough sperm in our previous 4 IUIs for 20 women.  (At least one of us is "excellent.") He said "you're having sex with a very fertile man -- something is wrong if you aren't conceiving."
• He doesn't seem too concerned about the miscarriage and is focusing on the positive side of it.  I am, too, at this point... at least I'm trying to.
• He's recommending injectable IUIs.  ("High octane" as he called them.) Surprisingly, I think I'm OK going that way. I felt more comfortable with his recommendation than I have with the info we've gotten from Dr. Six in the past. It seemed like he thought it through and thought it would give us a good chance. And, he knows the multiples risk and will be cognizant of that throughout.  But, he also seems to have a reasonable idea of how long we should try it before moving on. And, if we were to try IVF, we'd probably need to wait until the summer, anyway, so we might as well try this, now.
• He's recommending a lap because he wants to see what is happening with my tubes and investigate the possibility of endo.  He seemed less certain of the endo by the time he'd finished the examination, but still suspect.  I'm not sure what we're going to do there. If we can get our insurance to understand that it is for pain I will likely do it -- before we try any treatments because after that I'm certain they won't process it. But, we've had problems with my insurance before, so I'm not sure if it will happen.  For one thing, we've learned that they seem to refuse to pre-approve anything but might suddenly "un-approve" it after the fact. (There's also a possibility that our insurance company is about to drop the hospital he works for -- we're really hoping that a last minute negotiation keeps that from happening.) We can't afford to put all our money into a surgery that could very well find nothing and then have nothing left over for treatments. I'm not sure what to do.  I'm both afraid to do it and afraid not to do it.  (I was in this exact position about 14 months ago...)
• I like the staff -- the nurse was really nice and did an excellent job of drawing blood.  The rest of the staff seems really friendly, too.  
• There was a woman in another room that we could hear singing along to her iPod as she waited for something and Dr. Smiles and the nurse were both just really sweet about it.  They said "She's really happy and I hope that vibe gets to her ovaries, too."  I don't know, it just made the whole office seem really comfortable and made us all grin. 
• Did I get all my questions answered?  No.  Despite having them written down in front of me, I still managed not to ask some of them.  Yeesh.  I got so taken in by the discussions we were having with him that I got distracted and didn't manage to ask some of it.  But, I'll be talking to them soon and asking some of what I forgot. (Specifics about costs, pregnancy loss tests/differences "next time.")

My DH says that it's pretty obvious we should "officially" switch to Dr. Smiles.  The way he put it was that "He said everything you wanted to hear."  I asked him if that meant I was being taken in by a spiel?  (Dr. Smiles is definitely a good salesman.)  He doesn't really think so, but does think that it is obvious that I feel more comfortable with him than with Dr. Six.  So, I think that's where we're going no matter what we decide to do.  

Interesting side note -- his wife had five m/c in between their son and her current pregnancy (over 20 weeks after their fourth or fifth IVF -- he has all her u/s pictures on a board in his office).  I'm not sure if this makes him *too* understanding about this process or if it is a good thing.  I think it is a good thing.

I also realized I've come to a decision -- I'm willing to throw everything we can at this for one more year.  After that, I need us to move on with our lives one way or another.  So, it's time to be aggressive.

So, in summary: 

• We are happily switching to Dr. Smiles.
• We're waiting for some bloodwork.
• We're likely going to start doing injectable IUI cycles for a few tries.
• We may or may not be doing a lap -- any thoughts out there?  

Thanks to everyone for checking in on me! :)

Waiting, waiting, waiting...

Tomorrow is our appointment with the new RE.  I'm trying not to get excited about it because I just don't want to be disappointed again.

Anyway, I thought I'd write out what I'm thinking before I go to the appointment in the hopes that it will help me feel less flustered when we're there.  I don't like "first appointments" with doctors because I always get anxious and forget what I wanted to ask.  So, lists are a good thing.

What blood tests do you plan to do?
I was always frustrated that the only blood work my previous RE ever did was baseline FSH/LH but only after I forced her to do it about 5 months into treatment.  (She did TSH then, too, but there was little point in that since I'd had it done recently.)  When the FSH level came back "borderline high," she said she wanted to be more aggressive because of it but then never was and that was a year ago.  Also, if they are coded as "screening," blood work is more likely to be covered by my insurance.  So, whatever you can test that way, do it! 

Do you think my left tube has any issues?
My previous RE originally looked at my HSG results and said she thought there might be scar tissue at the end of my left tube.  After opening the right tube with a hysteroscopy (we know it's open, now, because I O'd from there when I got pregnant) she said all should be fine with the left and no lap was needed to check it out.  When we were starting to talk about IVF four months later, she said that she thought the left tube might be forming a hydrosalpinx and wouldn't do IVF without checking it out with a lap first (because hydrosalpinx can cause fluid to go back into the uterus).  Looking at the HSG images, it looks nothing like a typical "sausage tube" hydrosalpinx.  I'd really like a second opinion on this.  Hopefully it won't involve getting another HSG, though, because that was incredibly painful for me.  And expensive.

Do you think there is any pregnancy loss blood work we should do?
I know I've only had one m/c and most likely it was a genetic issue, but I really don't want to find out after another one that a simple change could have made a difference.  If it takes another year to get pregnant, I don't think I can handle it if I lose another pregnancy and then find out there was an obvious problem.

How many "tries" of each new treatment do you do before moving on?
My previous RE was of the opinion that you should try each new thing 6 times before moving on.  That'd be great if I were 25.  I'm not.  Time is a bit more of the essence here. 

What is your opinion on injectable IUIs vs. IVF?
At this point, I don't know where I stand with this.  The one thing I'm pretty sure of is that I don't want to go back to Femara-IUIs.  I just don't see the point.  But, I'm torn between the "eh" success rates plus higher risk of multiples but cheaper vs. better success rates but crazy expensive option of IUI vs. IVF.  This new RE has much higher success rates (and numbers of cycles) for IVF than my previous RE for my age group.  Before I got pregnant, I was heavily leaning toward IVF as opposed to inject IUI.  So was my DH.  Now I think I still am, but I'm pretty sure he isn't.

Do you have discounts for self-pay?
Probably should ask this one first.  My previous RE had great discounts for self-pay for ultrasounds and IUIs and, if this new office doesn't, I'm pretty sure we're going to have to crawl back to my old RE no matter what.
I can't think of much else.  I honestly just want to get on with it already and do something.  I just want to feel more secure with the new doctor than the old one.  I want to feel like he's paying attention and taking me seriously.  I want to feel like he at least bothers to look at my file before talking to me and is consistent when we speak.

Of course, I won't know most of that at the first meeting.  But, really, at this point if I just had a plan that seemed realistic, I'd be good.

Meanwhile, I just gave my first final of the week.  Time to focus on grading for a while to distract me.