Fertility Now!

Good omens?

So, after yesterday's "eh" blood results, I was in a bit of a funk.  Now, though, I have found what I hope to be three good omens:

• According to this helpful site, the average beta for a healthy singleton pregnancy 12 dpo is 36, with a range from 2 to 208. 
• I had another strong positive on this morning's HPT.
• Now introducing:  NAUSEA! (Weirdly, Steve is particularly thrilled by this one.) 

I am going tomorrow to get blood draw #2, though I'm guessing with the holiday, I won't get results until Saturday morning (my RE's staff only goes in on mornings of holidays and weekends). 

When I called the labs to find out which ones were open, the guy answering said, "But wait, are you sure you want to do this on your holiday?  I mean, can't this wait?"  Apparently, he's never met an infertile.  I just gently tried to explain that the timing of the test mattered, as I'm sure he was thinking this was just a routine random blood draw, and couldn't figure out why I was so hell-bent on doing it on, you know, our nation's birthday. 

So I will keep you posted, and hope that while the nausea continues enough to reassure me, it doesn't disrupt things too much.  (While I'm not really looking forward to seeing the in-laws tomorrow, vomiting on their shoes might be a tad excessive.)      

If only this were blackjack

My HCG was only 21, despite the lovely strong line on the HPT this morning. 

It is early, only 12 days past ovulation, and my HCG with Andrew (in a pregnancy which started out as twins) was only 65 at 14 dpo.  So it may just be off to a slow start....or it may be over before it's out of the gates, which would be tremendously frustrating.  My progesterone level, despite the supplements, was only 12--but there is a chance that because I'm taking them topically, the blood test might not reveal what's actually going on down there.  My shock and elation of this morning is obviously tempered quite a bit. 

Thank you for all the kind words and encouragement.  I'm going to go back for a repeat beta on the 4th--such fun!--and I'll let you all know how that goes.  In the meantime, I have no doubt that I will be freaking out just a wee bit until then. 

God in the machine

I wrote this the other day:

These days, I am slightly ambivalent about treatment.  While I have finally resolved my feelings about having a second--I am now firmly in the pro #2 category--I am mostly....annoyed about what I have to do to get there. We are lackadaisically going through the motions on our own, probably for another two months, after which we will jump straight into IVF--do not pass GO, do not collect $200, do not pause for a series of IUIs. 

I realized what, with this lazy attitude, I really must be hoping for:  King Louis XIV to descend from a throne and with a wave of his bejeweled scepter, solve this whole pregnancy thing.   

A few years ago, we went to see Tartuffe at the National Theatre in London.  I'd studied--and loved--French theatre, and seeing it live, professionally performed, was exhilarating.  The translation, a relatively new one, was witty and sly, and the staging was deliciously over the top.  But for me, the best part, the most fantastical element, was the finale, whereupon the deus ex machina--the improbably tidy resolver of all of those messy little plot points--was introduced.  In the final few moments of the production, Louis XIV, resplendent on a heavily gilded throne, literally descended from on high and fixed everything. 

The beauty, of course, of the deus ex machina, is that you don't have to write the resolution yourself; you can rely upon a benevolent third party to do your dirty work for you.  You don't have to play out for yourself all of the steps necessary to get to your happy ending; it just happens. 

Today I don't know yet if I've gotten my deus ex machina, as the only things appearing to descend from my ceiling are dust motes and tiny spiderwebs.  On the other hand, the stick I peed on this morning--12 dpo--shone brightly with two dazzlingly pink lines, much to my surprise.  So now I'm off for some blood tests, crossing fingers and toes tightly, continuing with my shot/supplement/pill regimen, hoping that this is the start of something even better than anything Louis XIV could give me. 

Grumpy

I am very grumpy today:

Grumpy that I spent all day Saturday working my ass off for my in-laws' 3 p.m.-9:30 p.m. anniversary party for 200 and got only a muttered "thanks" from my mother-in-law afterwards.  (Along with a self-satisfied, "Well, you all did so much work, and I just did nothing all day!") 

Grumpy that my parents, who were supposed to be guests at the party, instead spent the bulk of their day washing dishes and doing grunt work that none of Steve's family members would deign to do. 

Grumpy that at the party, my mother-in-law introduced Steve and Andrew--but not me--to several guests, even though I was standing right next to them. 

Grumpy that my mother-in-law fed my son toxic bright blue yogurt yesterday, and I've now had to face several neon-green diapers as a result. 

Grumpy that after all of that wonderful time together last weekend, my in-laws are coming on Friday to spend the weekend with us. 

Grumpy, too, to realize that I have no idea how to be assertive about increasing compensation at my job, despite the fact that I've been there a year and believe my boss is pleased with all I'm doing.  She's said nothing about a yearly review--do I ask for one?   

Grumpy that next week, my cousin will start her new job and Andrew will start going to an in-home daycare with 3 other kids, and I have no clue how he'll react. 

Grumpy that the Heparin shots continue to suck, and have now turned my belly into a constellation of purple and yellow bruises. 

Grumpy that my government cheese check appears to be lost in the mail. 

How early is too early for a nice glass of wine?  And perhaps more importantly, which wine goes best with a bag of Sour Patch Kids? 

Also, are you grumpy, and why?  Or, better yet, are you NOT grumpy, and why? 

Doubling back

Some time ago, I wrote of forgetting, of hoping there would come a time when my mind would be full of the blissful minutiae of child raising, instead of the dreary detritus of assisted reproduction.  I'm a bit stunned now to find that I've gotten my wish, and while emotionally, it is fantastic--I am such a happier person than I was three years ago--it can also be a bit impractical.    

This morning, 2-3 days past ovulation, I stuck a sticky note to my bathroom mirror:  "Heparin (2 x a day); Progesterone (2 x a day); baby aspirin; prenatal vitamin; levoxyl [thyroid med]; calcium supplements (2-3 x a day)."  I needed the sticky note, because I was a bit concerned that otherwise I might forget something in the laundry list.  Apparently, I've done this before, but you could've fooled me. 

I closed myself off in the bathroom and assembled all of the supplies:  pills, vial, needle, alcohol swab.  I saved the shot for last, and realized shortly thereafter that I'd also forgotten what I once knew about Heparin shots:  they really suck.  (Weirdly, the actual injection is fine; it's the burning, stinging and welting afterwards that makes me curse its name.) 

Back in April, when I was quietly berating myself for trying to get pregnant without any meds, I was able to stop myself short with the thought:  "but you weren't ready for all of that crap."  And now that I'm back on the regimen, I realize that it was okay not to be ready for all of that crap. 

It's not that the needles and pills and progesterone suppositories are all that odious--although, of course, they are--but more that the thought of doing several half-months of this makes me pause.  When I was doing it as part of an IVF cycle, it was all just part of the medical circus I made of my body, and at that point, I was willing to do nearly anything for the shot at pregnancy that IVF offered me. 

Now, however, as I'm only marginally "in treatment," and also facing much lower odds, I may have to go through many, many days of this rigmarole.  And while doing all of these tasks was an obnoxious but limited part of my pregnancy with A., the thought of doing this for multiple two-week stints followed by negative tests is a bit more daunting. 

Still, I am reminded when I look at my most precious boy why I'm doing this, why these temporary pains and inconveniences are but forgettable, inconsequential blips on my road to making more lasting happy memories, a small price for such inimitable bliss. 

Portrait of a boy

Today, I woke up to Andrew crawling into my bed, chirping, "Hi Mommy, hi Mommy, hi Mommy!"  A few moments later, I stumbled into the hallway and found several pantiliners he'd decoratively affixed to the linen closet doors.

This is two. 

At two, Andrew is fantastic.  He is cheerful, inquisitive, energetic, funny, affectionate and verbose.  He is also fiercely willful and at times fascinatingly irrational (the "fascinating" times are those when we at home; "infuriatingly irrational" is a better description of the public outbursts).  He narrates everything he--and we--do throughout the day; often I will turn around, distracted, to realize that the sing-song "my get the chair" he's been repeating for the past three minutes was, had I paid any attention, an excellent indication of the scope of his current nefarious scheme. 

Despite his growing facility with language, he still is full of humorous mispronunciations, many of which we persist in repeating, in hopes that he won't leave them behind someday:   "yeh-yo" for "yellow," "minkies" for "blankets,"  "ot-ange" for orange.  Already gone are "baba" for water, "tatu" for tangerine (and generally, the color orange).  TV is no longer "fifi," at least to him (I confess to slipping occasionally).  My mom is quickly becoming "grandma" instead of "manga," much to my chagrin and her relief. 

When we talk to him on the phone now, he carries on conversations--the other day when I was out of town, he called my parents on his own and told them about how his dad was in the bathroom, and what Andrew was planning to do.  He'll say, often unprompted, "I love you too, Mommy," and will even profess his love for Abby.  He loves to say "hi" and "bye," often when standing right next to you.  He loves jokes and pranks, and answers our silly questions ("does daddy's lawnmower blow bubbles?") with rolled eyes, an impish grin, and a drawn-out "noooooo!" 

Physically, he is about as stereotypically boyish as one could imagine, full of admiration for trucks of all kinds (garbage trucks being a particular favorite), construction equipment ("diggers dig DIRT!"), playing in the dirt in our yard, and trains and airplanes.   

He also loves, as befits my child, the alphabet.  For several months now, he has been able to identify all of the letters, upper and lowercase, and he continues to delight in pointing them out and attempting to draw them.  One morning recently, when I went to get him out of his crib, he greeted me with a thrilled, "Letter D!", brandishing the letter from his name that he'd taken down from the wall.  He counts to 11, although if you ask him to count how many shoes, or ducks, or whatever else he sees, he will rush from "one" to "ten," in his delight at shouting "TEN!", regardless of how many items there actually are. 

He is constantly on the move; while he loves playing puzzles or letters or blocks with us, he also enjoys exploring on his own, which can often be disastrous.  (My KitchenAid mixer is currently filled with cinnamon sticks, dill seed and an unknown spice which he dumped in there in a fit of culinary creativity.) 

He is beginning to understand the social niceties of interacting with other kids, and is learning to temper the "mine!" urges with the realization that sometimes, sadly enough, he has to share.  (He frequently recounts the story of the day that he shared the play shovel with a baby, an action for which I praised him perhaps a trifle effusively.)  He loves to meet new people (although he acts shy for about five minutes at first), and thoroughly enjoys putting on a show.  He is, for better or worse, fearless. 

He melts down, of course, from time to time, usually when he's tired, and he's beginning to realize his power when we're in public.  (What exactly do you do when your son is happily yelling, "Damnit!  Damnit!" in the grocery store?)  So far, though, he seems to respond to time outs, and lately, the disciplinary issues haven't been overwhelming.   

And although the sleep issues are far from fully resolved, we all are doing so much better these days.   Our home is just as messy and loving and full as I always dreamed it would be, and I am still astonished by my tremendous luck at getting to know and love this amazing little creature, so full of life and light and joy.   

I don't mean to start any blasphemous rumors...

So, as I mentioned in my last post, this was our second month trying with assistance.  Several months ago, I planned a trip for a church conference over this weekend--Thursday morning through Saturday afternoon.  I was going alone, with Steve and Andrew staying behind.  Of course, when I looked at a calendar, it appeared that the trip was particularly ill-timed in terms of my cycle.

But last month, if you recall, I was on progesterone supplements the end of the month.  And progesterone supplements allow us to fudge a bit with dates; while I am on them, my period won't come, and usually it takes 3-4 days after I've stopped them for her to show her ugly face.  So I took out a calendar, and did some math, and stayed on them a bit of extra time, so that I could guarantee that I'd be home when ovulation occurred.

You know where this is going.

For the past several months, I ovulated late--after day 15.  Last month, on the meds, I didn't ovulate til day 16 or 17.  So I figured that if day 12 fell on the day I was leaving, and I'd be back by day 14, I'd be fine.

The OPK of Thursday morning, however, disagreed vehemently. 

There was no way, really, to attempt to make use of that early ovulation (after having slept in til 7:30 for 4 mornings in a row, A. chose THAT morning to be up at 6), so this month was a complete wash. 

The good news, at least, is that there really is no way that the timing was even close to right, so I don't have to worry about my still-MIA heparin or my progesterone supplements.  And actually, I'm more annoyed/amused than upset--it seemed that perhaps I needed another reminder that my attempts to conform my cycles to my wishes were utterly futile.    I guess we'll just have to wait for next month. 

My friend and I were talking the other day about the stages of trying to get pregnant:  how, at first, you start noticing pregnant women everywhere you look--Stage I:  watchful benevolence.  Then, after a bit of time, you not only notice pregnant women, you watch them carefully, and a bit wistfully, trying to glean or absorb any special luck or knowledge they might have--Stage II:  hopeful interest.  Finally, you get to Stage III:  envious hatred.   

I'm still in Stage I--or maybe Stage II--so for now, I can shrug off this mild disappointment and pay more attention to all of those things in my life that do work out, and hope that next month brings better timing and better luck.   

Round II, Take II

These days, I don't feel nearly as obsessed with treatment as I did during the first go around.  I no longer feel like each test is fraught with meaning, each cycle day assigned its own degree of importance. 

Instead, I feel like someone has assigned me a series of annoying tasks I have to complete, in addition to all of my other obligations; a bizarre treasure hunt which will hopefully ultimately reward my perseverance. 

I took my second pill in my second round of Ar*midex this morning, after an uneventful though jab-filled first round. 

As I think I posted earlier, this last round (in addition to being a crushing failure) consisted of multiple trips to the labs for stabs and jabs (though not in cabs).  My progesterone was tested at approximately 7 dpo, and found to be a cruddy 10.7.  My markers for antiphospholipid antibodies had not only not magically disappeared, they had increased.  My beta was, of course, negative, and then on Tuesday, day 3, I donated eight (!) vials of blood to test my FSH, LH, prolactin, CBC, PTT (necessary for a baseline when I'm taking Heparin) and God only knows what else. 

Another series of obstacles arose in my first few conversations with Nurse #1, when she gave me the progesterone and blood disorder test results.  She told me that based upon those results, I would now take progesterone supplements and Heparin upon a positive pregnancy test. 

Even after I reminded her that I'd taken both after transfer in my IVF, she said, "well, this is the protocol now."  It seemed stupid to me to not have the drugs, or at least the prescriptions for the drugs, until I had a positive pregnancy test, as we know that two out of my three known pregnancies were pretty much over by the time the pee on the stick had dried.  Getting the medications when I was already halfway to failure seemed relatively pointless, and what I'd been trying to avoid by going back to the RE in the first place.  At the same time, I was too tired and too harried to pick a fight with this nurse, especially as I tried to squeeze in a conversation with her during my blood draw. 

So I scheduled an appointment for my injection class, a point I found highly amusing, as I'm fairly sure after the 200+ shots of IVF #1, I could teach such a class.  Luckily, however, Nurse #2 was doing this part, and she and I had a wonderful, long, frank conversation about when and how and why I should take the Heparin and progesterone supplements.  She agreed with me that it was stupid to wait until I had a positive pregnancy test, and got the doctor to sign off on me starting the injections after ovulation.  We also agreed that my progesterone levels were relatively uninspiring, and that I should start the progesterone at the same time. 

We also talked about the fact that this doctor's office takes the antiphospholipid antibody diagnosis seriously, and treats it accordingly, while many of the perinatologists in town think that it's some sort of voodoo medicine and sort of brush it away as "that silly doctor's pet project."  Even though I generally liked my perinatologist, the fact that she stopped me taking Heparin at twelve weeks now gives me pause.  As I read more about APS, more and more of the things I experienced with A seem to possibly be correlated--low birth weight, low platelets at his birth, problems with the placenta...It's hard, of course, to know what the relationship was between the placental abruption and the APS, but at the same time, it makes me wish that someone had paid more attention to the APS after those first twelve weeks.  If all of these bizarre machinations do result in a viable pregnancy, I plan to be quite churlishly obstreperous on this point.   

So I left the office with prescriptions for Heparin and progesterone, with the plan to start them post-ovulation, and began the next set of annoying tasks:  trying to find Heparin, while there is a shortage. 

The reaction from my regular pharmacy was fairly galling; after they had failed to get it in after ordering it (and not bothering to call me to tell me that it wasn't going to be there), they were incredibly rude to me when I went in to get it.  I hope they recognize that when people talk about patients abusing IV drugs, they do not typically mean anticoagulants.  They told me that they didn't have it, and couldn't get it, and there was a shortage, so much that even the hospitals were having problems getting it, and no, they couldn't suggest anywhere else for me to try.  They acted as though I was looking for the latest Birkin bag, and not, say, a prescribed and necessary medication. 

After several more phone calls, I finally located some, and hope to get it in my hands soon.  For now, I pop my pills, and wait til summoned to perform the next few rounds of this odd routine, hoping that at the end of the day, I have more to show for it than just an empty wallet and bruised belly.   

Announcing

The title line read, "What's Your Pregnancy Story?"

My first thought was, oh no, you really don't want to ask me that.  Yes, it had a fantastic ending, but the months leading up to it were often tense and full of far more hospital visits than I'd really like to remember, more a cautionary tale than fuzzy bedtime reading. 

But it got better.  Turns out the email was a shill for mass-produced (available in multiples of 25), heavy cardstock, cutely designed pregnancy announcements.  Yes, that's right--not baby announcements, but instead an opportunity to share your belly pics and ultrasound photos with dozens of your closest friends!  Oh yes, and some trite observations about silly pregnancy cravings and the befuddled, trying-to-be-helpful future father.

I don't know why my reaction to these was so visceral; as I've learned how to "pass" in the fertile world, I care less and less about smug fertiles vaunting their fecundity.  Yet this just made me ill.  C'mon, how narcissistic can you get?  Yes, people will be glad to hear you're expecting, and they'll probably be quite excited once the baby arrives.  But with how many people exactly do you need to share the news with a formal announcement?  I honestly fear I would vomit if I received one of these in the mail.

My other reaction was  to imagine my own line of such cards: 

"We saw two lines, but we're still hedging our bets.  So save your receipts!" 

"Once we make it to 26 weeks, we might start  thinking about buying a crib." 

"We sure hope we get a live baby out of this one!"

"We're pregnant!  Yes, I know, you've heard it from us before, but maybe this time, it will actually result in a baby!"   

Or perhaps for the narrative, something along these lines: 

"We were really excited about the pregnancy, until I started bleeding and we had to go to the Emergency Room.  But the nursing staff came up with the cutest nickname for me:  'the bleeder!'"

"One of the fun things we've really enjoyed about the pregnancy is using the Doppler every night to listen to the baby's heartbeat, to make sure it's still alive!"       

"The morning sickness wasn't much fun, but it was a breeze compared to all the side effects of the IVF meds!" 

"My OB said I got undressed and in the stirrups faster than anyone she'd ever seen!  She said I must have done that a lot!"

As for me, I certainly won't be sending out one of these anytime soon, if yesterday's snow-white HPT is to be believed.  Generally, I'm fine with it, but I am quite vexed by the thought of yet another blood draw, when I know what the results will be.

At least maybe I can use the waiting time at the lab to work more on my line of announcements... 

    

Well, crap

This morning I took a call from the nurse at my RE's office while getting my blood drawn.  It was a bit surreal, to say the least, though I feel like it adds another notch to my blood-draw nonchalance.  Done while entertaining a two-year old?  Check.  While talking about antiphospholipid antibody test results with the nurse?  Check. 

The results of my test were not terribly surprising.  Although APA syndrome can be transient, because it is an acquired disease and not genetic, three years after I was first tested for it, I still showed some markers that indicate the syndrome. 

Two markers are necessary for the diagnosis; that's how many I had last time.   This time, however, I showed three, and an additional two "borderline" numbers.  This means that, once again, twice-daily heparin shots will be a required part of any future (hypothetical) pregnancy.  I'm a bit concerned, however, because when I did the heparin during the IVF cycle, I did it throughout the cycle.  Now, they would only want me to start when I got a positive pregnancy test.  Unfortunately, as I seem to lose pregnancies nearly as quickly as I find out about them, I don't know how this plan will be tremendously helpful.  I was already taking a  baby aspirin daily during this last cycle, and that didn't make it successful.   

Of course, the other side to this coin is that I just had my progesterone tested today, and if it is not looking good, they will prescribe me supplements, which may very well also make a difference.  I just hate having to balance out all of these calculi against the slim probability of actually getting pregnant on our own.  It's odd, though, how I've fallen back into these routines--blood draws before work, looking for the 00000 on the caller ID that indicates it's my doctor's office, taking phone calls in strange, surreptitious locations.   

Today has also sucked, however, for another reason:  childcare woes.  My cousin, K, has been watching A. for the past year or so, from 8:30-1:30 every day.  It has been wonderful--she loves him, he loves her, etc.  It's pricy, but it's been entirely worth it.  K has been also attending school and working another part-time job during this time period; she's only 19, but really level-headed and sweet. 

We recently went through the pre-school application process with Andrew for next fall.  We looked primarily at three schools:  Montessori, Downtown, and My Old Preschool.  Each looked like lovely places, but we ruled out Montessori early as  too expensive.  Downtown is just a few blocks from my office, and a really nice space, and they can do 5 days a week, with a variety of schedules.  They did their registration in late March.  My Old Preschool is also in a decent location, and it was our favorite.  They only have 2 1/2 year olds go 2 days a week, and we were a bit hesitant about that, but I had talked to K, and she had told me that she was planning on sticking around and continuing to watch him in the fall, so we figured he would go Tuesday and Thursday mornings, and she would watch him the rest of the time.  Their registration was due in early March. 

So we were faced with this dilemma a couple of months ago--do we register him at My Old Preschool, knowing that the most he could go there would be two days a week, and if we don't register him there at the beginning of March, he will lose his spot?  Or do we not register at My Old Preschool, wait through the month, and find out where we are on the waiting list at Downtown Preschool, knowing that though I'd been on it for some time, there was still a chance that we wouldn't get in?   

We registered him at My Old Preschool, and were really looking forward to him going there. 

And then my cousin interviewed at a really good local photography studio.  And she's wanted for the past few years to become a professional photographer.  And he wants to hire her, and have her work 40 hours a week, and she wants to continue with school, and come August, we will likely not be able to have her work for us anymore. 

And we are now screwed. 

I put in a guilty call to Downtown Preschool today, just to see if there were any chance of still getting him in there for the fall, on a 5-day-a-week schedule, and was told that there's still a huge waiting list, and the director was "pessimistic" about our chances. 

I guess now it comes down to trying to find someone to watch him three mornings a week.  I know it's not impossible; it just seems like a daunting task, finding someone we like and trust enough to allow into our home to care for our most precious child.   At least we have a little time, but I dread the process.   

What a Monday.