Failed

As I was typing an email to Jo, my acupuncturist, I stopped myself mid-sentence.  I just had this flash, this moment, where I was about to type that all the work I’d been doing was starting to feel like a total loss.  And what more could I be doing?  Then I erased it.  It feels like I'm doing so much, putting forth so much and yet, it also feels like I've lost the focus.  So focused on getting pregnant, and losing focus on the why and what it results in.  I feel like I'm working, working, working - mentally thinking and focusing and it appears that it doesn't really work that way.  So the question isn't what more could I be doing, but simply, what the hell am I doing? Period. 

We rec’d our results from the Clomid Challenge this afternoon – I failed.  I started out well enough, a low score around 6.  But after the 5 days of Clomid, my FSH had increased to an abnormal level of 22.79.  They like to see it where it started or at least under 12.  Dr. B's nurse left us a message.  I sort of have an idea of what it will be.  Either they will tell us that getting pregnant with our own eggs is highly unlikely or that they won’t even work with us unless we use donor eggs.  Either one is not really the talk you want to have.

I’m bummed.  I’m depressed.  There’s this feeling that it is all out of our control, yet, I still have this bit of hope inside that keeps thinking “one good egg, one good egg.”  And then I feel like an idiot for hoping that we will somehow be the exception to the rule; the miracle amidst lost causes.  It was better when I just thought I was having random miscarriages than now, when the I have data to explain why and to tell me that it is likely I will continue to have miscarriages if we can even get pregnant again on our own.

I start to think about all the ‘work’ I’m doing to make this happen and then I realize that maybe I’m not even doing much work.  I think about the lack of will power I have and those stupid apple cider margaritas that I indulged in over Thanksgiving.  Or the three pieces of Halloween candy I ate.  The 2^nd glass of wine I’m on right now.  I start to feel guilty that I’m choosing a glass of wine over the chance to have a baby.  It sounds ridiculous, but that is where my head goes.  Every bad thing I eat, yoga I miss, sugar I consume – I start to feel entirely guilty.  I start to think how maybe I haven’t been working very hard for this at all and how I somehow don’t ‘deserve’ this.  As if anyone ‘deserves’ to be a parent or a mother, as if this is how it works.  It’s silly, I know.  It’s sad; I know this, too.  And yet, it is what it is. 

I guess my biggest fear is that Dr. B will turn us away – that he will consider us a lost cause.   Then what?  We will be without any hope, any help.  Then what?

Donor eggs, adoption – both of these have not really been on our radar and at this point, it’s hard to think about.  It’s that bit of hope that we can do this on our own I guess; the part that hasn’t given up yet. 

And maybe he will simply say, “If you are going to do IVF, then we need to move on this quickly.”  I hope this is what he says.  At least we then know that we haven’t been abandoned, yet.  I have already researched clinics that will work with high FSH and low AMH patients.  I guess if we are left without any options, that is something we could explore.   But the thought of that just makes me exhausted.  And the expense to travel to far flung places isn’t a big sell for us either.  And that’s when I start to think, “How much more of this can I take?” 

I will call Dr. B tomorrow morning.  I wish I hadn’t missed the call this afternoon. I wish I didn’t have to hear the message, “Dr. B would like to meet and talk with you. Sorry to leave this on a message.”  Ugh.  We’re sorry, too. 

The Challenge

It seems official – we seem to have entered the world of reproductive assistance, albeit in a lackluster kind of way.  We had our second appointment with ORM yesterday.  A simple ultrasound and blood work.  I should have had a period yesterday, today, maybe tomorrow? At any rate, so far nothing.  My hormone levels came back low, which they should be at the beginning of your cycle and I had a total of 11 follicles between my ovaries.  Average.  The nurse practitioners words, not mine.  Both blood work and ultrasound confirms my body should be having a period and is gearing up for another cycle.  So the question remains – where did my period go? 

We thought maybe we had lucked out and were pregnant, but that was not the case.  So we move on to the next step.  And the next step is literally one of the first steps in fertility diagnosis and treatment – the Clomid Challenge. If you’ve been reading this blog for a while, you’ll know this is my second type of ‘challenge.’  Earlier this year I did the Progesterone challenge and failed.  Then, the goal was to bring on a period after stopping the 10-day of progesterone. 

This challenge is a bit different.  Starting on Wednesday, I will take 5 days of Clomid, a drug meant to over-stimulate my ovaries into producing mature follicles/eggs and insure ovulation.  It also works to measure the Follicle Stimulating Hormone that your body is producing.  You want this level, the FSH level, to be low.  A low number means that the signal between your pituitary gland and your ovaries is working correctly and more importantly, tells your doctor a few things 1) whether your body is likely to have a positive response to fertility medications and 2) whether you have a low ovarian reserve/poor egg quality.  It is sort of the test they use to weed you out of certain fertility procedures and dictate what your next steps will be.

We will head back in a week from Monday for the 2^nd round of blood work to find out whether I met or failed the challenge.  I imagine we will also find out what our next step will be.  One thing that I truly appreciate is that at each appointment we have had, we leave knowing what will happen next.  They don’t leave us hanging, waiting to find out.  Yesterday, we had our blood work back after an hour and were told what to do next.  There is science here, a set protocol, and it feels good to know that they have the steps laid out for us given any number of scenarios.   Even though we have never been here, been through this before, they have been hundreds of times and know what comes next. It is like a real-life choose your own adventure. 

I guess that makes it sound exciting or at least tolerable, but I’ll be honest, it has been a hard week.  We really thought that maybe we might have been pregnant, and we are still hopeful enough in this whole process to feel crushed when it doesn’t happen.  Brett asked me yesterday, “Who did you use to be before all this?  What did you like to do before?”  We laughed, but then after thinking about it – it’s sad.  This whole thing is so consuming and it does feel like I am lost in it.  I don’t know what I used to do before reading books about fertility, reading other infertility blogs, researching how to improve our odds, doing this meditation, eating this or not eating that, taking piles of supplements…I’m exhausted.  Literally. 

Part of me just wants to sell our house, find a job overseas and move on to a different path, a different dream.  Hoping is holding on and holding on is hard work.  It doesn’t feel like I can be in both worlds – where this is all on the back-burner.  And please, if I can offer up one piece of advice, never say to a woman who is dealing with infertility, “Well, if you just relaxed about it, then it would probably happen” or “If you try to adopt a baby, it will happen.”  Yes, there are cases where this happens but for the majority of women, this doesn’t work.  Worrying is not our diagnosis, infertility is.   

This week, we will celebrate gratitude and I will try to find the things I am thankful for in this mess.  One big thing, after phone calls and conversations and checking and double-checking, is we’ve found out that our insurance company does cover 50% of the costs of diagnostic procedures and testing for infertility.  We think we meet the criteria and hopefully, all that we have paid so far will be reimbursed and the things we are currently doing should cost us half as much.  This is amazing good news and takes that added pressure off of us for a while.  That much we are certainly grateful for.  

So we press forward for now and I am going to try and set this on the backburner, background music to the rest of our life for a while.  Now that it feels like we are being taken care of and our issue is being paid some attention, it feels easier to relinquish some of that hold.  We are in someone else’s hands now, a trained specialist, who is going to do his best to help us because that is what we are paying him for.  There is something freeing in knowing that we aren’t the only two carrying this weight. 

Thanks for all your continued thoughts, prayers, and kind words.  More after our appointment on the 26^th.  

Headline of the week: Numbers, Stats and Luck

Friday morning we met with Dr. B at Oregon Reproductive.  All in all, it could have been worse.  I think the worse case scenario I had played over in my mind was the Dr. saying, “There’s really nothing we can do for you. Beat it. Scram.”  But he didn’t say that.  To be honest, we didn’t really learn a lot more than we already knew or suspected.  We had a number of tests done before we went in, but a few need to be redone on a particular day in my cycle.  So now, for the semi-bad news. The one test that did come back and did give us some information was the AMH test or Anti-Mullerian Hormone test.  This test lets you know about your ovarian reserve – or eggs in waiting.  I think they actually said something like primordial eggs, which makes me think they are from the beginning of time, dinosaurs and shit.  If only it was that cool.  For women my age, the number is up somewhere around 5-7, in fact, the higher the better.  Mine came back at a dismal 0.5.  This is not promising in terms of the time we have left to make things happen.  

Why is it so low?  Likely it is an unfortunate side effect of chemotherapy.  A classic example of I wish I had known then what I know now.  At the time, I could have had my eggs removed and frozen.  But, we did not know if my cancer was hormone receptive positive, which meant we wouldn't have wanted to feed the cancer by taking hormones to stimulate egg growth.  And, I didn't want to wait to have the cancer removed and start treatment.  

Plus, I would have been faced with the same financial hurdle back then and even less likely to be able to do something about it.  How would I have paid to have my eggs removed and frozen?  I wouldn’t have been able to and my insurance wouldn’t have covered it.  Plus, unfertilized eggs don’t do the whole freezing/unfreezing process as well as fertilized eggs, so we might actually have found ourselves in the exact same position anyways.  I imagine if we had tried sooner, that perhaps the number would have been higher and we might have been more successful earlier on.  As it stands, Dr. B thinks that it is likely my ovaries are more like a woman in her early 40s than one in her late 30s.  And where fertility is concerned, a few years can make all the difference. The good news is I know at least one over 40 who recently got pregnant the old-fashioned way and just had a baby.  So, if it can happen once, it can happen again, right?

The two tests we need to re-take will give us information about the quality of those eggs that I have remaining.   This test will confirm whether 6 months of chemo some 7 years ago merely diminished the number of eggs I have or if it permanently damaged most or all the eggs lying dormant in my ovaries.  If it is the later, it’s likely a good egg will be few and far between.  It's not impossible that a good egg will surface, but highly unlikely.  So hopefully, at the end of next week, we will finally figure out exactly what we are dealing with.

Dr. B didn’t belabor the fact that the odds are against us.  He didn’t Fox News us into fearing the worst.  In fact, the only statistics he showed us were their success rate with women in my age group, which was around 60% and that the likelihood of having another miscarriage wasn’t any greater after having two.  I thought those were pretty nice statistics to share.

I guess the good news is that we now know what our options are going to be given different scenarios and there are a few.  Again, it will all depend on whether we are dealing with a low number of eggs that are either of good or bad quality or a low number of eggs that are likely all bad quality.  And depending on which it is, we will know whether we will need to do IUI or IVF with my own eggs (hopefully this will be an option) or if we have to use donor eggs.  Dr. B said we would deal with the donor egg option down the road, when we crossed that bridge.  There was still a lot to do before we even have that conversation.

I asked him how normal people pay for this kind of thing and he rattled off a list of ways.  As Brett said, “Well, one shot is basically the price of a nice new car really.”  Too bad we already bought one of those this summer.  Guess that is just another bridge to cross when we get there – sure are a lot of bridges on this damn road.

But all of that aside, I think why we are both taking it so well (and by well, I mean, I'm not crying non-stop. And if I had to talk to anyone about all of this, instead of writing it, I would probably not make it through the conversation without crying.) is that all of this reproductive medicine is pretty f-ing amazing; the science behind all of this and what they can do for people.  It’s insane.  Seriously out of a science fiction novel.   It’s not just about boosting your egg production, taking those eggs, fertilizing them and putting them back.  That’s basically what we are able to do on our own. 

But now, once they extract as many eggs as possible, they make sure they are healthy and able to be fertilized, then they fertilize them and test whether the egg is going to be free of any chromosomal damage or defect before they try to implant that egg or eggs.  Basically giving you the absolute best shot of having a healthy baby because you know that everything is on the up and up.  It then comes down to the implantation and hoping that it sticks, continues to grow, and the cells divide.  It’s likely to go okay if all the chromosomes are okay.   High school science really came in handy while listening to him.  When Dr. B drew the chromosomes all lining up (yes, there were lots of drawings and illustrations), I knew exactly where he was going with this thing.  In fact, the first part of our conversation felt like we were getting 'the talk' about how you make babies.  When I have a teenager, I will record Dr. B giving 'the talk' and just play the video.  

If we do have to explore the IVF option, it is good to know this is possible and hopefully they will be able to get at least one or two good eggs.  We just need one! That’s all.  Out of the 400,000 damn, freakin’ eggs I was born with, we just need one damn good egg.  It doesn’t seem like a lot to ask of the universe, but she apparently is one stingy biatch when it comes to giving up eggs to the +35 set.  I feel like if we could just get one good egg it would likely stick given we’ve had two bad eggs stick in the past.  Sticking doesn’t seem to be our problem. 

But then, what do I know?  Right now it really just feels like it all comes down to luck.  Luck and age really. It’s hard to say whether we have good or bad luck.  I’m lucky that I had cancer early (who says that?!), met Brett, married Brett and after dragging him to a foreign country for two years still like him well enough to want to have his baby (haha), and we still have some time to figure this out.  I’m lucky that chemotherapy exists and that it apparently works really well at killing cancer.  I guess I’m unlucky that it works so well that it kills off poor bystanders, like primordial egg cells.  And Brett said, "You're lucky that you don’t look nearly as old as your ovaries are."  So I guess we’re also lucky that we still have our senses of humor. 

We've been pretty damn lucky so far.  Guess we just need some more luck. Prayers and good mojo (I don’t really know what mojo means, but I think it's like luck).  That’s what we really need.

We're off to see the Wizard

There are now two types of women in the world – those who have babies and those who are pregnant.  Most of them are young and that annoys the hell out of me.  Some of them seem older and they don’t seem to annoy me.  I keep going back to something I said in a much earlier post.  I try, as much as I can, to think that these women have possibly gone through a whole slew of mishaps and tragedies and that the baby they are holding or the pregnancy they are carrying is their little miracle.  It helps me to not feel so jaded, so envious, so pissed off and it does work surprisingly well.

Last night at a party, I met a very, very, very pregnant woman.  In fact, she is due on Thursday.  When she walked in, the first thing I noticed after her bulging belly was that both she and her husband had a little gray in their hair.  When I see that, I honestly feel a wave of relief wash over me, ‘Yay – they are old like us and look at that belly’!  After a bit of tiptoeing around her, I finally asked her how old she was, explaining that I knew it would seem odd, but that we are trying to have a baby and she looks about my age and I need some encouragement.

She was more than happy to tell me her story and it was quite a saga.  They had started trying to have a family when she was 36.  She is now 40.  After a number of miscarriages, they finally decided to go to Oregon Reproductive Medicine.  The problem was her egg quality (something that I wonder about for us).  She was given a 5% chance of actually conceiving and carrying a baby to term with reproductive assistance – these are not great odds, but they decided to go forward.  Well, after forking out $65k, enduring numerous failed IVF attempts, and 4 years later – they finally succeeded and their little girl will be here Thursday.  Listening to her I was filled with both hope and complete despair.  (A side note, they are naming her one of the names that we have been tossing around and hoping to use one day.)  

There are obvious parts of their story that I hope become a part of ours.  But there are many pieces of their story that I just don't see us being able to have.  

We had initially said we would wait until January 1^st before heading back to Oregon Reproductive.  But then last Thursday happened, marking a year since the 1^st pregnancy loss, and patience is just starting to feel like a pain in the ass.  Add to that the lack of success with the birth control pills to bring on my period and I just could not see the point in waiting a few more months.

We have an appointment on Friday at Oregon Reproductive to see a reproductive endocrinologist or The Repro Man as I like to say.  We had a round of blood work and ultrasounds done at my OB this week that will hopefully give The Repro Man some insight into our situation.  The good news is that hopefully he will be able to give us some definitive answers about what we are facing.  The bad news is that we are in no way, shape, or form able to cover the financial demands of an aggressive IVF protocol if that is what they say we need to do.   I’m not sure that we can even afford to pay out of pocket for the ultrasounds and lab work that would be needed and not covered under our insurance plan.  As far as my plan goes: no fertility treatments – diagnostic or otherwise.  Sucks. 

So, it is with a mixed heart that we head to our appointment this Friday.  We want answers, but some of those answers might just solidify the fate of our future family and it’s hard to think about that.  But not knowing is hard, too.  Brett is typically optimistic and I am being über realistic which really borders on cynical.  I want this to be easy for us for so many reasons and I’m just not sure that we have the wherewithal to face it if it doesn’t get a bit easier.  And by all accounts by those who have had to endure fertility treatments, it hasn't even begun to get hard.  

We really need a break, some good news, a reason to hope that this will happen for us.   Not sure Friday will bring it, but for now, no solid reasons to expect it won’t.  Wish us luck and buy us a lottery ticket.