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.

Hope for a Happy Ending

I just really want this to have a happy ending.  We just might have pulled this thing off.  On June 1^st, I was going out for happy hour after work, but I just had this nagging feeling that I should really take a pregnancy test before I went.  If by chance we’d had success this month, I certainly didn’t want to celebrate by intoxicating my developing embryo.  So I took it and it was positive.  We’re pregs.  The amazing thing is that in all honesty, it is the first cycle we have set out with laser focus to accomplish this and we did it!  At this point, Brett’s ego is ever expanding.  “Twice in less than a year,” he brags.

And so like most good news I’ve received during any of this voyage to Babytown, the positive feelings last for about a 24-hour period, until I find some tidbit on the Internet that throws me into a nosedive tail spin of worry and anxiety.  And so it has been since we found out I was pregnant.  I was reading another woman’s blog who had miscarried 5 or 6 times before she finally carried a baby to term and I just don’t want to be her! Please universe, god, whoever is sitting up there, please do not let that be me.  

She also pointed out a feeling I know all too well – I know more about what can go wrong in a pregnancy than I do about having a successful one.  I could be a real doomsday of information as far as that stuff goes.  I won’t, for my own sanity, go into it now but if you are interested, you should see about getting inside my head. 

I think that one of the sad side effects of having a miscarriage is that it makes it incredibly hard to be ‘excited’ about being pregnant again.  It is as if the innocence we had before, the naïve sense that the difficult part of actually getting sperm and egg to meet, was over.  I imagine that once we make it successfully past each little milestone and hurdle, we will feel more confident, more celebratory.  But until then, it is so very hard to feel sheer, unadulterated excitement and confidence.  

About two weeks ago, I started having some strange spotting business and immediately called my OB and demanded (Yes, that is exactly what I did) a blood test to measure my HcG levels.  This hormone, if it doubles over 48 hours in early pregnancy, is a good indicator of whether your pregnancy is progressing.   Unfortunately, the woman who ordered the blood test, did not order the correct one and so there was a huge snafu.  I had to wait another day for the number to come back and then had to return two days later to give blood again.  They will compare the two numbers to see how things are going.  My number was high for the first and although it wasn’t doubling, was increasing.  Once your numbers are over 6000, they stop doubling every 48 hours and take much longer.  So, according to my OB, things looked good. 

She asked if I wanted to come in for an ultrasound that same day.  I did and I didn’t.  I knew that if we didn’t see a perfect little sac and baby and heartbeat, I would be a bloodhound on the Internet searching for answers that are never there or if they are, never satisfying.  So I went in.  And there was a perfect gestational sac, measuring exactly 5w1d, but nothing else. 

“Looks exactly like what we should see,” she assured me. “Come back next week and we should see a lot more.”

However, I wasn’t assured.  And so we came back last week to hopefully see a lot more.  The gestational sac had grown over that week and was measuring exactly 6w1d.  The tech had a hard time seeing anything inside.  At one point, it seems like she might have finally found the yolk sac (where eventually we will see an embryo) but it is still very small and sort of wedged against the side so is hard to see. 

Our OB either has an amazing poker face or she really is hopeful.  She didn’t seem too upset by this, but rather said, “I’ve seen it go either way.” So we wait and we go again on Wednesday.  By then, we should see something for sure. If we don’t, then it is likely that I will miscarry this pregnancy, too.  Seems pretty cruel of the universe, but then I think of the other woman, with her 6 miscarriages and I think if she can do it, I can, too? Problem is, I just don’t want to. 

We had decided when I found out I was pregs that we weren’t going to tell but a very few people.  But as Wednesday approaches, I feel like I need all the hope I can gather in the universe from the folks who are keeping tabs on us as we go on this journey.  I just really want this story to have a happy ending, not only for us, but for any woman out there who has been through a miscarriage, worried about if she will be able to get pregnant again and once she is worry about staying pregnant.   I want to be hope and not despair.  So we will wait until Wednesday and continue to hope and pray that this baby is healthy and growing. 

Maybe you all could you do the same?

Not out of the woods...yet

It has been a little over 29 days and the joy and elation I felt when my period finally returned has seriously dissipated.  Our trip to Mexico was a wonderful reprieve from worrying about this ever-elusive baby and from waking every morning to take my temperature.  Instead, I tried to sleep in (despite the loud neighbors and roosters) and take it easy.  I felt optimistic that things were now ‘back on track’ and that we simply needed to get back on the horse.

Oh…how naïve.  This week has been tough.  When we returned from Mexico, I started temping again.  It appeared that I had just ovulated and I watched each day as my temperatures seemed to soar higher and higher.  In fact, the highest I have seen them since my whole adventure into BBT (basal body temperature) began.  I even noticed that my temps went triphasic, which can often be a predictor of implantation and consequently a positive pregnancy test.  However, I kept getting negative tests.  I realized, the morning my temperature dropped from 98.2 to 97.6 that we were definitely out of the game this month. 

  

But oddly, that wasn’t where things turned bad.  It was in the days following.  I had told myself that regardless of the outcome – pregnant or not pregnant this month – I would be content that things were progressing in a positive way.  My cycle had returned, my body was getting back into the swing, and in time, we would get that positive test and we’d be on our way to building this family.  When my ‘period’ did arrive this month it lacked all gusto.  I am only calling it a period because it arrived when it should have.  It’s punctual; I’ll give it that.  But what it said loud and clear to me was that things are still not right. 

I called Dr. Johnson yesterday after the one-day period and our plans for the hysteroscopy on April 30^th are back on.  Yesterday was hard.   I think it is all compounded by the fact that I turn 37 next week and it makes me wonder if I will have a baby while I’m 37.  Will it take longer than this year? Will it never happen?  Then what?  For the first time in decades, I don’t feel like celebrating my birthday.  I don’t feel celebratory at all – about anything.  I just want this birthday to pass, for the months to pass until we actually have good news.  Right now, nothing feels very good at all.

When I got off the phone with Johnson’s office, I did what anyone with half a brain will tell you not to do.  I searched the Internet to find any information about pregnancy after hysteroscopy with removal of adhesions, which, in my completely untrained opinion, is the diagnosis.  For once, the first link listed was a woman my age, asking the same question.  And unlike what you usually find when you play this sort of World Wide Web roulette, the responses were so positive.  Women saying that yes, the cycle right after their procedure, they were pregnant.  And it wasn’t just one woman saying that, it was many.   And although I finished reading and felt optimistic and hopeful, it still left me feeling overwhelmed with sadness. 

I know I keep saying it, and I keep telling myself, our time will come – it will.  It’s just getting harder to believe it when any time it seems we get close to our dream, it keeps moving further away. 

Where are you spring?

Spring is attempting to break through the last few weeks, as winter desperately hangs on.  The daffodils are in full bloom, the crocus are out, and yet the past few mornings snow showers were falling.  Temperatures remain in the 30s at night, rising nearly 20 degrees during the day.  But still, it is chilly. It is nice to know that in less than a week, we will be warming our bodies on the sands of Mexico.  A much needed relief.  

I am a weather junky, so it comes as no surprise to me (or those who know me) that when I heard about charting your own temperatures to keep track of your monthly cycle - I was all over it.  It is the aspiring forecaster in me.

I have become an expert on temperatures.  I take mine every morning at 6 a.m.  I purchased a special Basal temperature months ago and went through many phases of diligence.  However, since February, I have been a die-hard temperature taker.  In some ways, it helps me feel like I have a little insight into my body.  I took my temperature chart with me to my latest acupuncture appointments to seek a 2^nd opinion.  It appears that I might have ovulated this month.  And for the first time since December, my chart looks ‘normal.’  

Things you learn…Apparently, your basal body temperature is your lowest temperature of the day.  Women can actually chart their monthly cycle by looking at their waking temperature.  The temp readings are to the tenth degree, so it is quite subtle, but noticeable when you are desperate for some glimmer into your body’s inner workings.  Because I don't have a previous cycle to base my temperatures on, it is a bit difficult.  The only point I can go with is ovulation.  The short dip in temp and rise right after.  That is there.  Then, you hope the temps stay up for at least 10 days.  If you see this you know that 1) you have indeed ovulated, which means your body is producing enough estrogen to produce a follicle and 2) when the temperature rises right after, your body has released the egg and the follicle continues to produce enough progesterone to keep the uterus in prime condition to support a fertilized egg.  These are all things you want your body to do naturally and can see through your temperature - it's amazing to me.

Like the past 4 months, I am waiting to see what happens.  If all is well in my body, based on my temperature readings (another drop after the progesterone high), I should start my period any day.  What will be confirmed if I don’t is that there is most likely scarring.  I have heard it diagnosed as Asherman’s syndrome on the web and it looks like the hysteroscopy I will have in April is the procedure that will both diagnosis and treat it.  The odds are good that it will be successful and we will be successful in our hopes. 

I am hopeful and optimistic that this blasted period will come this month, but I am also trying to prepare myself for nothing.  I have the appointment scheduled; I know that if not this month, then in the coming months, blah, blah, blah.  But it would be so, so, so very nice if it did.   It would all at once give us a sense of closure and beginnings.  

I will continue to chant my affirmation - I am healthy.  

Where do we go from here...

The weekend after the D & C, we went to the coast with a group of friends and their kids.  I felt like I was in a daze, the fog had never cleared for me.  And truly, I felt empty.  It was like I had been on an adrenaline high since October and now I was crashing hard.  The future seemed bleak.

It wasn't easy for us as a couple either.  I was insistent on our next steps.  Sounding like Obama talking about his jobs bill - WE MUST GET PREGNANT...RIGHT AWAY.  Brett was less than enthusiastic.  We found ourselves at an impasse - I felt certain of the future I wanted, while he felt this was an opportunity to be circumspect about it and went back to a place of ambivalence.  In my head, it made sense, but in my heart, it sucked.  I knew that our experiences with the pregnancy were drastically different.  I had felt the hormonal and physical changes and they were interwoven with my emotions - tightly woven.  For him, the baby was merely an idea, a possibility that was yet to be a reality.  They say women become mother's the moment they are pregnant, men become father's when they hold the baby for the first time.

The first month was rough.  We got through Thanksgiving with a barrage of family and friends.  I had previously imagined this would have been the moment we told everyone that we were having a baby.  And now, we weren't only not telling folks we were having a baby, we weren't telling them we lost one either.  We were as quiet about that fact, too.  I'm not sure the reason, except to say that at that time, I couldn't talk about it without crying.  In fact, that is often true even some four months after the fact.

December 2nd rolled around, a month since the miscarriage.  I'd marked on my calendar that we would start trying again this month, as soon as my period returned.  But it didn't.  I called my doctor frantically, "Why hasn't it started? How long should it take?"  She advised me to wait 6 weeks before calling back.  I did and it didn't come back.  I called again, "It really could take up to 8 weeks. Give it some more time and call back."

I started to see an acupuncturist in the hopes that I could feel like I was doing something besides waiting around.  I kept taking pregnancy tests, thinking that maybe we would be the lucky ones who get pregnant right away after a miscarriage; but no such luck.  Jo, my acupuncturist, is a god-send.  She started me on herbal supplements - false unicorn root (hopefully it is as magical as it sounds) and vitex.  Two herbs known to help regulate your cycle and prepare your body for pregnancy.  But still no period.

After 10 weeks, we went in for blood work.  No thyroid problems, no hormone issues - all signs pointed towards a healthy body.  But still, no period.  She put me on 10 days of progesterone - lovingly called "The Progesterone Challenge." I failed - no period.  I went in for an ultrasound and a saline histogram.  There was the slight possibility that I had scarring in my uterine lining that was preventing regular cycles or any cycle at all.  Unfortunately, she couldn't maneuver the catheter the way she needed and so couldn't do the procedure.  She did notice, however, on ultrasound that my lining was about 1mm - very, very, very thin. 

So, she put me on a month of birth control pills to see if the estrogen would help boost my lining and bring on a period.  I failed this challenge, too.  Nothing.  We had another failed saline histogram, but she did notice that my lining had increased thickening - up to 5 mm, but still, very thin.

It is now, quite possible, that the problem is a scarred uterine lining that is preventing my cycle from returning and ultimately prevent us from getting pregnant as it currently is.  I continue to take supplements, downing raspberry tea like you can't imagine, boosting my herbal supplements, and hoping that it isn't scarring and that my cycle will regulate itself here soon enough.  I am losing hope of that solution each day.

Due to the failed histograms and the lack of cycles, Dr. Johnson has scheduled me for a hysteroscopy.  Not to be confused with a hysterectomy!  I will have to go under anesthesia while she uses a camera to visually look inside my uterus for scarring or other issues that may be at work.  During the procedure she will be able to remove any scarring and hopefully get us back on the train to babytown.

We had originally scheduled for March 23rd, the day before spring break and two days before we head off to Sayulita, Mexico, but we have decided to reschedule.  Although we want to get things going soon, we don't want to potentially ruin our vacation to do it.  So we will wait, something we are getting pretty good at.