Happy New Year!

We had our appointment with our RE on Friday morning. In a nutshell, we’ll be doing the IUI this month (as in January) and I’ll be starting Clomid likely around the 4th. I can always tell when my period is nearing - I gain weight and am crabby and emotional. So, yep, it’s likely approaching. I’m not thrilled about the Clomid - I was miserably bloated the last time. Any known remedies for terrible Clomid bloat out there?

My father is visiting and he’s been sick. Having my sick father wedged into my tiny apartment hasn’t been easy. He’s kind of a loan wolf - it’s likely cramping his style. Also, I think as we approach the IUI I'm becoming more and more stressed out. It’s difficult to leap into the fire. I’m afraid that the IUI won’t work and I am afraid that it will work and then I'll miscarry yet again. I’m trying to rest on the idea that we are still looking into adoption, no matter what happens. AND I'm trying, desperately, trying to THINK POSITIVE. Ugh.

I couldn't resist reprinting some festive New Year's quotes:

"The proper behavior all through the holiday season is to be drunk. This drunkenness culminates on New Year's Eve, when you get so drunk you kiss the person you're married to."
- P.J. O'Rourke.

"The only way to spend New Year's Eve is either quietly with friends or in a brothel. Otherwise when the evening ends and people pair off, someone is bound to be left in tears."
--W.H. Auden

"New Year's eve is like every other night; there is no pause in the march of the universe, no breathless moment of silence among created things that the passage of another twelve months may be noted; and yet no man has quite the same thoughts this evening that come with the coming of darkness on other nights."
--Hamilton Wright Mabie

Have a wonderful New Year and may it be filled with happiness and light.

Egg Nog, Christmas Cookies and Injectible Anticoagulants!

As the time nears when we may start trying again (and if this is confusing to you : Adoption? Yes. Trying again? Yes. Just think of my husband), I’ve been obsessively searching for data on those who have the MTHFR A1298C gene mutation, used heparin and had a successful pregnancy. What I found, mostly, were people who will be using it the next time. Of special note, however, were several people who began heparin therapy at cycle day 6 or at ovulation. Last time I met with Doctor Superman, he checked the incision sites and we discussed IUI versus naturally trying to get pregnant. He mentioned using progesterone the minute I get a positive pregnancy test but didn't specifically mention heparin. So, I said, "And heparin? Right, you’ll be using heparin?" He said yes, I could start heparin at the time of a positive pregnancy test. It seemed as though he was advocating for us to try naturally at first - and the husband and I discussed this and it seemed like a fine plan.

However, as I continued to read the message boards where most if not all were starting heparin before a positive pregnancy test I began to panic. I told the husband about the whole "cycle day 6" business and he suggested that I call Doctor Superman. But I just couldn’t. There were so many times during discussions with Doctor Wonderful (previous RE) where he seemed to dismiss everything that I said, that I just couldn’t muster the energy to go there again. I feel like I’ve been screaming since day one, "Something is wrong with me! This is just going to keep happening until someone figures it out!" And it has always fallen on deaf ears. All I heard, time and time again, from my OB/GYN, RE and everyone else, were the statistics regarding miscarriage were in my favor, that it’s a common occurrence and most women go on to have a healthy, normal pregnancy the next time around. I was still, unbelievably, told this after the fourth miscarriage. Doctor Wonderful’s (that name was always used with a touch of irony, by the way) mantra seemed to be, "Keep trying, eventually it will work out." It’s difficult, as a four time loser to sit back and think "everything will work out." I don’t necessarily believe that heparin is the magic bullet either - but I’d like to try everything. I mean, what the hell do I have to lose?

In the end, my lovely husband took it upon himself to call Doctor Superman and Doctor Superman discussed the three different "points of entry" for the use of heparin during pregnancy: 1) from the beginning of your cycle, 2) at ovulation and 3) at a positive pregnancy test. Doctor Superman doesn’t really see the point of starting heparin at the first day of your cycle and he wasn’t really sure why anyone would do "cycle day 6" but he was willing to start heparin at ovulation. It’s incredible, in a way, to me, oh, girl-with-the-needle-phobia that I am pushing for the use of heparin - but again, doing the same thing over and over again and expecting a different result seems akin to insanity. I suppose, however, if there were chromosomal problems in several of the pregnancies, and I was told there was only say, a 20% chance or even a 50% chance of the chromosomal problem occurring again, I may continue trying (that is, of course, until it continued to not work out (how many times? who knows) and then I would insist on IVF with PGD). But when virtually nothing has been found - it’s hard to just blindly fall of the cliff again and again. Heparin is my last ditch effort. So, I will be going on the lovely Clomid again (which I hated), and moving towards an IUI (do IUIs ever work?). One study, which I’ve mentioned previously, predicts that those with the A1298C gene mutation will respond poorly to the use of stimulating drugs, such as Clomid. And I didn’t exactly prove that theory wrong last time. I think the husband is somewhat dreading the whole escapade (who wants to do your business under the watchful eye of several dozen medical personnel - even if the bathrooms, and I’d imagine, "the Depositories" are beautiful and ready for a photo essay in a chi chi interior design magazine).

IUIs do make me nervous. It seems like a lot of effort when there's still a very real possibility that I won't even GET pregnant in the first place. Then I'll have given myself heparin shots for two weeks for nothing. I'm sure that this may be the doctor's thinking when they prescribe heparin at a positive pregnancy test versus earlier.

On a semi-related note, the husband and I put ourselves on a strict budget for Christmas shopping this year - we are trying to save as much as we can for Ze Adoption. Let me tell you, $100 sure doesn't go very far in this town.

'Tis the Season!

Baby W

While I was laid up post-surgery, my mother and I perused the mountain of adoption agency packets the husband and I gathered at the adoption conference in Jersey (in New Jersey! We drove to New Jersey - this is ridiculously perceived as a wild adventure for those who live in NYC and see no reason to go beyond its borders). One agency's packet contained a photo book of children waiting for adoption, many with special needs. One child, an infant, Baby W, was missing part of one ear. He had no other medical needs and his hearing seemed to be fine. My mother and I stared at this baby with the wild shock of black hair for a long time. Eventually, I e-mailed the agency and requested more information. This week, the coordinator e-mailed that I should be receiving his packet shortly. Today, however, I got another e-mail that he's been adopted.

I am thrilled for this family, of course. Mostly. There was a split moment, however, when I felt incredibly sad (and jealous). I'd already imagined meeting him for the first time. I'd thought about what milestones he may be missing if he's in an institution (which in this case, he may not be). I hoped he was getting as much one on one care as possible. I saw us going and getting him. I saw myself reviewing his packet of medical information with the famous Manhattan adoption doctor with the blue rimmed glasses. I imagined the husband videotaping our first meeting and he and I crying and Baby W just staring into our eyes, mostly confused. I saw his little hands. And I saw myself kissing his little face. I wondered how he would feel about being from a different race and culture than his adoptive parents. I'd thought about him searching for his birth parents when he was older. I'd thought about the two of us sitting down and writing letters together to send to his birth mother through his agency. And including his brilliant drawings.

I'd thought all of these things without even realizing it.

It should be noted that we have not applied with this agency - we have not applied with any agency. We're still in the very beginning stages of all of this - and I was getting completely, totally, utterly carried away, ridiculously, for just a few moments. And I recognize my ability to over-dramatize at these times - because, I suppose, everything is so rife with emotion when it comes to building your family in a non-traditional way (i.e., through infertility treatments or adoption or third party reproduction).

I'm beginning to get a small taste, however, that I may be leaving one area of uncertainty for another. Although thankfully, adoption, unlike infertility, guarantees you will be a parent in the end. But really, it's still going to be a damn roller coaster.

Shingle Bells

So, Tuesday my left breast was killing me - and the pain was radiating to my back. It was odd. And then a horrible rash broke out on my breast. I thought I'd wait a day or so in case it was just an allergic reaction to something (although I couldn't quite fathom what on earth my left breast had gotten into). When it persisted, it occurred to me that I could have shingles. My father had shingles when I was a teenager. It was an odd kind of pain - it didn't itch but felt like daggers in my chest and back. My back also spasmed and would jolt me out of bed. It felt viral, if that makes any sense, and not topical.

After consulting Doctor Google, I realized that if I indeed had shingles, it needed to be treated within 48 hours of the first outbreak. I began to panic. 48 hours from the outbreak was the night I was reading the information - at 11 PM. My post-op appointment was the next morning, and I thought maybe Doctor Superman could take a look at it.

Of course, Doctor Superman does not treat skin disorders and calmly told me he couldn't treat something that's not his area and didn't want to steer me in the wrong direction. Always the professional. He sent me upstairs for a consult with a dermatologist. Due to Doctor Superman's persistence, they agreed to see me today. Thank goodness - because I do have shingles and am now on the proper medication for it. Hopefully it should clear up in seven to 10 days. But I have to tell you, it hurts like a mother. When I asked the resident who was assisting the treating physician if I should tell people I work with to stay away from me if they haven't had chickenpox (shingles is the same virus as chickenpox and if an adult hasn't had chicken pox it's highly contagious - and worse for an adult to contract than a child - according to my mother) she looked at me like I'd lost my mind and told me that I shouldn't be at work, AT ALL. I was stunned. I'd already lost a WEEK of work due to the surgery. I have deadlines. I have discovery requests. I have a hearing approaching. I am essentially still working two jobs while they find a replacement for my old position (and P.S., shingles can be brought on by stress-interesting, no?). It's crazy. Anyway, the treating physician said that he would recommend missing Friday and Monday and to call if it looked like there was no improvement - it should cease being contagious at that point and I should feel better.

Anyway, back to the land of infertility: Doctor Superman said that everything looks good. The tubes are cleared and he removed the scar tissue from my uterus. And a polyp. He had me look at the incisions after he removed the bandages - I was astonished at how tiny they were. And because of there location, I'll likely barely notice them once they are completely healed. And yes, this is what everyone was telling me before the surgery.

So, at this point, he basically told me that we could go ahead on our own or go forward with the IUI. He said that because of my age, only 35 (I love this man), he feels comfortable in us going forward naturally. If no dice in the next couple of months, IUI. I told him I'd discuss with the husband. Also, he again reiterated that the moment I get a positive test I must contact him and he'll throw everything in his arsenal at me, including heparin. I'm so relieved - because otherwise, it's just doing the same thing, over and over again, expecting a different result. I' m a little disappointed, in a way, that he didn't want to march right into the IUI but it certainly makes things easier not doing one. We'll see.

And really, I'm normally a pretty healthy person. And not so whiny about pain. Normally. Really.

Back in the Land of the Living

First of all, sadly, and let us please all bow are heads, the belly button ring is no longer. Hacked off with enormous cutters by a marathon-addicted madman in charge of the OR.

As I was having the IV placed (sonofabitchthatthingfrickin'hurtlikeamother) and writhing in pain, Nurse Ratchet began asking me a series of fairly innocuous questions, "When was your last period, did you have anything to eat or drink after midnight, do you have any jewelry left on your person?" Why yes, Nurse Ratchet, I do. I have a belly button ring, but I discussed it with Doctor Superman and he preferred that I leave it in - something about infections. She actually whipped around, narrowed her eyes and bellowed, "I find that hard to believe." "Really? Well, generally I am in the business of LYING to medical staff because I am only SEVENTEEN YEARS OLD and don't want my mother, who happens to be in the next room, finding out about this piercing I had done ten years ago, but today, lady, I am actually telling you the truth." This went around and around for several minutes. She continued to ask the exact same questions and I continued to answer in the exact same manner, "Have you ever tried to have it removed?" "Yes, I have tried on several occasions, and so has my husband. I don't have a problem with removing it - I just have never been ABLE to remove it. It's supposed to twist off, but I have never been able to twist it off. This is why I asked Doctor Superman about it - because I figured I would have to go to a piercer to have it removed. " "Have you ever actually tried to remove it?" And so on. I implored her to call my physician, to at least verify that he did in fact tell me to keep the ring in. After delaying my surgery for over an hour, they sent in Mister OR Director (i.e., Marathon Addict), a youngish man who discussed his marathon addiction with me and tried the tactic of "relating" to the uncooperative patient by discussing his own past piercings in his left nipple and up his left ear. I kept repeating, "I don't have a problem removing it, I just don't know how to remove it, I'm afraid if you cut it, the sharp edges will cut my skin because it's a barbell." Etc. Etc. Etc. My doctor did come down and verified that he told me to keep it in - but the hospital was hearing none of it and wanted that thing removed. No metal in the operating room. Under any circumstances. Including, apparently, in one's mouth. I wanted to ask, "Do you actually pull out people's fillings?" All the while my mother was in the waiting room - watching them drag me and my IV and my layers of hospital clothes (I have yet to figure out which way the stupid pants were supposed to tie - front or back - both seemed decidedly wrong - but no matter, once I entered the OR they made me drop my drawers) from room to room. I was becoming increasingly agitated. I was already nervous and the IV continued to hurt - I just wanted the surgery to be over and done with.

When I finally got into the operating room - I jokingly apologized for the delay but said that I really enjoy making a ruckus and even more, enjoy being the center of attention and planned the whole thing when the anesthesiologist said, "Really?" and I said, "Um, no, that was a joke." Wow. No sense of humor. In a few minutes however I heard the anesthesiologist say to the anesthesiologist nurse, "I'm administering the cocktail" and then I was out.

I awoke in recovery with a nurse sitting in a chair between my bed and another's. I was quite surprised upon waking because I had envisioned waking without pain and the pain, if any, would come on gradually in the evening. That was not the case. I was in pain the instant I awoke and could tell precisely where they'd sliced me. I also woke with no feeling in my right arm. This didn't really bother me - but apparently it bothered the staff as I kept flapping my arm around for sometime. The medical staff was concerned and even Dr. No Sense of Humor came by, but eventually the numbness subsided.

The man next to me was an actor who kept telling everyone who would listen that he had been a professional actor for forty years and played plenty of doctors. He also didn't want any pain medications and despite staff trying to convince him otherwise, he knew what he was talking about, he'd played plenty of doctors, you see. I looked him up later and he is indeed a working actor who has played plenty of doctors. Obviously, he knew what he was talking about.

My doctor, it should be known, did tell me that I would experience some pain. He also told me that I really needed to take the week off but I thought he was being overly cautious. He wasn't. Although I thought my mother and I would be able to take advantage of my week off by shopping and running around the city catching movies and plays, I spent most of the week asleep. I didn't begin to feel normal until last evening. I still have soreness, but I am improving. Perhaps I am just wimpy, I don't know. But I think that cutting one's abdomen, no matter how small the incisions, and then stirring things around in there, doing a little repair here and there, is bound to induce a little pain. At least, that's what I keep telling myself.

Anyway, I hope everyone had a Happy Thanksgiving! I think I best go lay down for a spell.

Too Tired for Titles

In four more minutes I am not allowed to continue sipping this soda, nor eating, nor consuming any type of beverage, soda or not. Tomorrow I will be going in for the laparoscopy/hysteroscopy and repair (a little rotor rooter if you will) and am just trying my hardest to not think about it too much, just go in there, and get it over with. I was a little surprised when Doctor Superman began diagramming where the incisions, INCISIONS PEOPLE will be going. For some reason, it hadn't occurred to me that there would be any type of slicing. Small as those incisions are, but still.

I was also a little embarrassed when I had to ask about my belly button ring and whether or not it should be removed. That old thing was put in about ten years ago (when I was young and carefree) and I'm starting to feel a little ridiculous about it. I'm not exactly hanging out in bikinis these days. I had to lift up my shirt in his office so he could check out where it's located. That was fun. Oh, doctor, I run ALL THE TIME, I want to make sure that I can CONTINUE RUNNING. Oh, the flab all around my belly? Um, right, well, that's just something weird that's been happening lately. NORMALLY you see, I am very, very in shape. No fat all all. This is just a momentary fluke. Really.

You'll all be thrilled to learn, I'm sure, that removal is unnecessary.

The husband and I attended an adoption conference today. We are both exhausted. More on that later.

Happy Monday.

Becoming a Parent

I've been drafting a post for sometime now - but I'm having trouble expressing it all with any brevity.

I used to scour blogs for hours looking for women who had miscarried multiple times and went on to have successful pregnancies. Many of them have. However, for the most part, they had chromosomal issues in one or more of the previous pregnancies. Or they had Factor V Leiden and went on heparin. Or they had a correctable issue with their uterus. The other women continued to miscarry until they stopped trying to get pregnant with their own eggs or moved on to adoption. I feared these women. I didn't want to be them. I didn't want to give up and adopt. I didn't want the consolation prize.

My mind, however, is changing on that front. I read Dan Savage's The Kid (highly recommend) and am currently reading A Love Like No Other: Stories from Adoptive Parents. The husband and I have attended no less then three events about adoption in the past week. We are feeling good. We are feeling positive. It doesn't feel like a consolation prize at all. It feels like a godsend.

We're going to work with Doctor Superman, but we've given ourselves a deadline. At the deadline, we're marching over to the adoption agency and submitting the application.

We like the certainty of international adoption. In many countries, it's a fairly streamlined system. The wait is known, the travel time is known, the approximate age-range is known. At this point, we're leaning towards Korea - which has some of the best foster and medical care for their children who are waiting for adoption. We also have a good chance of knowing something about our son's (mostly boys from Korea) history - which is important to us. The husband and I are committed to attending Korean cultural events with our child, of sending him to culture camps during the summer, of trying to recognize, appreciate, keep a sense of where he came from. But we recognize our inability to completely do so. On that front, we've been joking around about our teenage son coming home with his friends and being mortified because his geeky very white parents are sitting around the house in traditional Korean garb, eating traditional Korean food and speaking to each other in Korean (learned from our intensive Korean language course at the New School, of course). As many internationally adopted kids are - he may have little interest in his birth country until he reaches adulthood. But we want those options out there for him.

It's the first time I've felt truly excited and happy when thinking about our future as parents in the past three years. For the first time, I've realized that with time, I will parent a child. And it feels fantastic.

From Fertile Infertile to Infertile Infertile

I just came back from several days spent in New England with my mother (she travelled north after spending the previous week with my father and Aunt and Uncle on a genealogy sojourn to West Virginia) and the husband. It was, mostly, a good time (the Husband and I found the Shelburne Museum creepy and weird. We half expected to find Mrs. Shelburne's embalmed body hidden behind a fake closet. My mother, of course, loved it.). Edited to add: For those of you annoying like my husband, who seem to think facts are important, there is no Mrs. Shelburne, her name was actually Mrs. Webb.

I then went to work for a few hours today until I had to leave for HSG numero dos. I was not looking forward to it. The last time I had it done, I found it extremely painful - during the procedure, not afterwards. The insertion of the the catheter had me writhing in pain. This time, I felt, nothing. Well, maybe not nothing, but only slight discomfort. When I mentioned this to Doctor Superman, he said that they use an incredibly thin catheter because it is "simply more humane." Apparently my previous doctor used a catheter the size of a mack truck. I am beginning to wonder if my previous doctor was something of a sadist. He wasn't exactly gentle with the dildo-cam either.

The good news: I have amazingly wonderful birthing hips! I have the pelvic bones of a fertile goddess! They are the perfect shape! The perfect size! They're like the wings of a butterfly!

The bad news: My uterus is badly scarred. And my fallopian tubes are now blocked. He indicated that this could be from the multiple miscarriages or the D & C (the uterine scarring, not the blocked tubes) or both.

Hide-your-head-in-the-sand-news: Apparently I have to have surgery to smooth out the uterus and unblock the tubes - and check to see if I have endometriosis. And I'll be having it the week of Thanksgiving.

Wonderful.

In other news, my friend from high school had his baby (well, he didn't, his wife did) and named him something akin to "Great Emperor" and another friend just e-mailed me today to tell me she's expecting her second. The first was born September 2006. When it rains it pours.

doctor superman

The husband and I decided to take a cab Friday morning. A decadence we rarely indulge. The cabbie wound his way through Central Park and to the East Side. We hopped out in the 70s and found our way to a long waiting room filled with female patients and their partners. We waited. And waited. And waited. I explored the bathroom - glass vase filled with smooth rocks, the new-fangled incense in oil, floating sink and walls covered with tiny glass tiles the color of sea glass. It was, likely the best, most architecturally modern bathroom I have seen in a physician’s waiting room. Ever. Appropriate to see in the pages of Town and Country or some such magazine. This place has money. A lot.

And still, we waited.

Eventually someone came out in brightly colored scrubs. Apologies all around. She sat us down in our new doctors “office.” It was clearly not his office. It consisted of a computer, a desk and three chairs. I learned later that his office is actually upstairs. Our doctor greeted us with a warm smile and handshake. Does he know that all my hope, my last bit of hope resides in him? I met much of what he said with vigorous nodding and tried in vain not to cry. When he mentioned that we were in a good place, really, the tears began. He indicated that since we’d had a “connection”, that there had been implantation, that that was a good sign. When implantation isn’t working, there is little they can do. It is a much trickier place to be when you have failed attempt after failed attempt with no implantation. Implantation, he indicated, is very mysterious - and they still know little about it. They can place the best looking blasts into the uterus and still no connection. And they don’t know why. He said that he understood that many who have repeatedly miscarried would prefer not to get pregnant at all but that the reality is that this, biologically speaking, is a better place to be. They just have to figure out what isn’t working.

He went through a list of tests he’d like to do. Including another HSG. Something I would prefer never to do again. But, I will.

He also said that due to the MTHFR coupled with the repeated miscarriages, he’d like to see me on the folic acid combo (B6 and B12), baby aspirin and heparin.

Heparin.

Again, tears.

He then discussed doing the FSH three day test. I told him that my FSH was tested and it was 9.2. His eyes widened. He didn’t like that result, not at all. He said that at my age it shouldn’t be any higher than 7. He asked what my previous RE told me about this result and I said that he said anything under 10 was OK. I didn’t mention that I had to ask him what it was - and this was approximately 9 months after it was taken. The FSH was taken in November of last year. The new RE wants to do it again. And on Saturday. I shoved forth a study that indicates that those who test positive for the MTHFR (A1298C) gene mutation have higher FSH levels and respond poorly to ovarian stimulation (fewer follicles greater than 13 mm). It also cites a study that found that folic acid had little effect on those with the MTHFR A1298C gene mutation. I’m proof positive of that, I think. It has great effect for those with the C677T mutation. The study does not outline treatment methods however, but seemed to imply that those with that particlur gene mutation need stronger meds for ovarian stimulation. All and all it’s not exactly the greatest study in the hope department - but it does, possibly explain, my poor response to the Clomid. He initially wanted to know whether or not the study had been published - I think perhaps in a way to dismiss its validity, its relevance, or to explain why he knew nothing about it. When I told him that it had been published in the September 2007 issue of “Fertility and Sterility”, he was surprised, a bit taken aback. But he wasn’t irritated or annoyed, he seemed slightly embarrassed. Which I appreciate. I want a physician who can be humble - and is secure enough in his abilities that there isn’t a lot of unnecessary posturing and that whole god complex crap. I think my old RE would have been completely pissed off and possibly dismissive (as he was when I asked about heparin). I actually don’t expect my doctors to spend time crawling through each and every study and article about MTHFR. That’s something that I can do. And believe me, I do.

When we were done and the husband and I reached the elevator. I burst into tears. Heparin. He’s willing to do it. He’s willing to try.

I couldn’t sleep the entire night before I had to go into get another FSH done. I’m not sure I want to know. I told the doc as much and he said that that wasn’t exactly the way to do things and my husband agreed. I understand that. I’m just dreading hearing the phrase, “donor eggs.”

Afterwards I forced the husband into Pottery Barn Kids. Why the hell would I want to go there, he asked? I said, because instead of making me sad, it makes me feel like it’s really going to happen for us. I know, that doesn’t make any sense. But the way I think about it these days is this: if we really want to parent a child, we will. It just may not be through the traditional route. And I’m trying to get myself to come around to that idea.

With that in mind, after my run yesterday, I went to a bookstore (stinking up the place, yes) and read through Cross-Cultural Adoption and skimmed through The Adoption Decision. I decided to buy The Kid by Dan Savage and A Love Like No Other: Stories from Adoptive Parents.

So, here we go. I’ve dubbed him, for now, Doctor Superman. I have to believe that he has super powers. Or else I can’t get on this train again.

mixed tape

I hate to make the equivalent of a mixed tape, but if there was one, this song would be on it, and I would be telling you how this, all of this, may be coming to an end - I'm not sure how much more of this I can take. I've encountered so many in similar circumstances, or worse, and they, despite the odds, still have all this hope, this knowledge, this belief, this certainty, that somehow, some way this will all work out in the end. I don't have that belief. From the first miscarriage, from the first, "this happens all the time, just try again" I knew something was seriously wrong. And over two years later, no one has been able to tell me what.

I have to take stock of my own life. And begin to move forward. I will always mourn what I have lost. I will never be who I used to be. I have to remember that we have a good life, my husband and I. I love my husband. That is more than so many have.

But I still, I still miss the person that I used to be. And I miss the little ones who I have carried, for such a short time, and what they could have been.

Don't you know that I'll be around to guide you
Through your weakest moments to leave them behind you
Returning nightmares only shadows
We'll cast some light and you'll be alright
We'll cast some light and you'll be alright for now

Crosses all over, heavy on your shoulders
The sirens inside you waiting to step forward
Disturbing silence darkens your sight
We'll cast some light and you'll be alright
We'll cast some light and you'll be alright for now

Crosses all over the boulevard
Crosses all over the boulevard
Crosses all over the boulevard
Crosses all over the boulevard

The streets outside your window overflooded
People staring, they know you've been broken
Repeatedly reminded by the looks on their faces
Ignore them tonight and you'll be alright
We'll cast some light and you'll be alright

--Crosses by Jose Gonzales

I saw the hematologist today. I really believed he would take one look at my medical records and order heparin, immediately. It was maybe my last hope, really. But no one seems to think that heparin is necessary. Not him, not my RE. Just try, try again. "Eventually", my sister says, the doctors say, others say, "just try, try, try again, eventually it will, has to, work out." I'm just not so sure. If someone could say you will have x number of miscarriages and on x pregnancy you will have a child - maybe then, maybe then I could do it. I could muster it up. I could soldier on. But no one can know that. Until they figure out what is wrong, I believe it will just continue - indefinitely.

I'm the friend that you could see adopting. You wouldn't be surprised, you would almost expect it. But here's the reality, at this point, right now, I don't want to adopt. I resent it. I resent that that's what I have to do to parent a child. I don't even know myself anymore. Who is this person? I think adopting is a great thing. I'm just not there.

I'm completely obsessed with myself and my own fertility. I'm a nuisance to the doctors who treat me. I trust none of them. I second guess everything they say. I do my own research. I decide based upon an article here, a study there, a blogger's experience, how I should be treated. It's practically all I discuss with my husband.

I looked at some donor profiles. I found a lovely girl. A college student who loves to write. She's interested in activism. She is short with brown hair and light eyes. She wants a family who cares about the arts. She's looking for a family who is open-minded. I liked her. And when I realized this, I woke my husband up with my crying.

I won't know what she was like at age three. I won't know if she used to draw for hours on construction paper while her mother did the laundry. I won't know if she used to tell the same joke over and over again. I won't know if she had a dog named Rascal or if she got jam stuck in her sleeves. I won't know about the time she slammed her finger in the car door or when she had her first kiss. I won't know any of these things.

I'll only have what I read on a few pieces of paper. Does she wrinkle her nose when she laughs? Does she salt all of her food? Does she always put her hair behind her ears? Does she listen to comedy albums over and over again? Does she spend her Saturdays at art museums?

I have two more appointments with two different REs. We will see what they have to say. And then, I need to reevaluate. I need to be thankful for what we have. I need to stop feeling like a failure. I need to stop feeling like I've failed my husband. I need to put this behind me.

Remind Me Next Time to Wear Pants

Quite sometime ago, due to the recommendation of an infertile friend (age 41, pregnant now from second IVF - due any day) I read Inconceivable by Julia Indichovia. My impression of the writer after reading it was that she was slightly cracked. Right - Chinese herbs and visualization (hanging out on her bathroom floor, apparently) and changing your sheets to red will lower your FSH level! Fantastic - I have a bridge over here . . . Anyway. I could only think that the change in her FSH and resulting pregnancy was due to the bodies natural inclination to change - to have one result one day and one result the next. However, she really did have an FSH of 42 and she really did go onto have a child. Despite the odds. So, now, in the face of this possibility, I think, what the hell? What do I have to lose? God knows I could benefit from a little yoga, a little acupuncture, a little diet overhaul just so that I might occasionally RELAX a little, despite the outcome (hey, by they way, if any of the gods are out there listening - looking for a positive outcome.) My sister and mother-in-law have already begun uttering the word, "adoption." Just to be clear - the doc did not say that I have diminished ovarian reserve - just that that could be a reason why I haven't really responded to the Clomid and why I seemed to have surged (LH) prior to there being properly matured follicles. This would also explain the repeated miscarriages. And this explanation was given to me only when pressed, repeatedly, and threatened with a pie-in-face scenario.

So, I called the YMCA (around the corner from my apartment) and wouldn't you know it but they had a yoga class in fifteen minutes. I ran out of my apartment and over to the Y. In shorts. Shorts that perhaps I shouldn't actually be wearing. Shorts that show my currently pale fatty legs. Oh, and please, please make sure that you have me bending down, backwards, with my head through my legs so that I can look up and accidentally see the back of my legs and my REAR in the mirror. Shorts are a bad idea for yoga. A VERY, VERY bad idea.

So, please, please remind me to go to that ridiculous store with the worst window displays I've ever seen and the twenty or so sales persons milling about the store with fake smiles plastered to their mugs with a tendency to hover over each patron out of sheer boredom in order to buy some damn yoga pants.

I'll be going once a week.

Don't let my chattiness about all this fool you. I am still terrified.

That is all.

The Challengers

Challengers

by

The New Pornographers

Yes I know it was late

We were greeting the sun

Before long

And you live with someone

I live with somebody too

Leave it there

For safe keeping

One of the west village in plains

That was the custom

Come dawn

On the walls of the day

In the shade of the sun

We wrote down

Another vision of us

We were the challengers of

The unknown

"Be safe" you say

Whatever the mess you are you mind okay

That is the custom

On down

Until I see you around

Until we clear the accounts

Leave it there

Leave it to us

We are the challengers of

The unknown

My husband looked at me the other day when this song came on and said that it always makes him think of us, that it has become for him, our song. My husband is one of the most sentimental people I know. For him to not father a child . . .

The physician uttered the words, "Diminished ovarian reserve." He does not know, but it could be. It could be. Explains the miscarriages, actually. Keep plugging along until we hit one that works. And in the end, that could be never. Didn't seem too keen on IVF - the "expense" he kept uttering. I asked what he meant by that and he said, "Not only the monetary expense but the emotional toll. It's a lot of time and effort and in the end, it could still not work out. " He said that for us to get a better picture we would need to do a Clomid challenge test. Up the dosage, etc. He also said we could abandon this road and go for egg donation. On the other hand, he said, "it ain't over until the fat lady sings." Even if I have a "diminished" ovarian reserve it doesn't mean that I have zero good eggs at all. Again, though, it's not enough information at this point to go on. My FSH was fine, normal in fact. He finds the size of the follicles in relation to the LH troubling. If I was surging in order to ovulate, the follicles should be around 20 mm. My largest was 15 mm.

This is the strange thing - I always thought I would have fertility problems. Even as a young kid. Why? I haven't a clue. Did I do this to myself? If I'd started at age 20 would this still be a problem? I started at 32. We'll never know, but it could be. Could be. My mother had me at 34. My sister had her last at around the same age. I also, later, imagined my husband shooting me up with fertility drugs for an IVF cycle. Pretty much from the first miscarriage. Perhaps it is just an overly worried, neurotic person who imagines such things from the first sign of trouble. My doc doesn't seem too thrilled with the whole IVF idea but I'm willing to go there. I guess I'd like to try all avenues and then in the end, I won't have to wonder if it would have worked or not. My doc seems overly concerned with the cost of things. I want to start yelling, "I DON'T CARE HOW MUCH THIS THING COSTS. DAMN IT!"

So, there we are. The Challengers. Yes, I know it was late but we were "greeting the sun. " We have another vision of us. One with children. Just one.

What the @#$)(*#????

My body has been slowly, very slowly, responding to the Clomid. After the day of bloat from hell, nothing major has been happening. This includes when they've done scans, blood work, etc. I'm just poking along. Today, however, it looks like two of the follicles have dropped out and one remains. It's not very large. Not as large as they'd like to see. The nurse read my blood test results over the phone:

Estradiol: 164
LH: 41
Progesterone: 1.2

I asked what these numbers mean. She said that the LH is running high. I asked what a high LH meant, and she hesitated, and then said, "I don't know."

Now, when a nurse tells you, "I don't know" I think this should read as, "I do know, but the doctor is the one who should tell you."

Normal results for LH women are typically between 6 and 30 U/L.

In women, "LH and FSH levels can help to differentiate between primary ovarian failure (failure of the ovaries themselves or lack of ovarian development) and secondary ovarian failure (failure of the ovaries due to disorders of either the pituitary or the hypothalamus). Increased levels of LH and FSH are seen in primary ovarian failure. Some causes of primary ovarian failure are ovarian agenesis (failure to develop ovaries), chromosomal abnormality, such as Turner’s syndrome, ovarian steroidogenesis defect such as 17 alpha hydroxylase deficiency and premature ovarian failure due to such things as radiation, chemotherapy, autoimmune disease and chronic anovulation (failure to ovulate) due to polycystic ovary syndrome (PCOS), adrenal disease, thyroid disease or ovarian tumor."

I know nothing at this point. Next appointment is the 9th. More blood work. More scans.

Things are looking bleak.

Zippo

So, the old bod isn't really responding to the Clomid. My ovaries look virtually the same as on Tuesday. My twice done blood work (evil, evil!) shows little change. My lining is a tad thicker (from 5 to 7?) and my doc's partner in crime (whom I've never met before, Dr. Bow Tie) said that there were three "baby follicles." Somehow, for some reason, I liked the term, "baby follicles." It sounds so nice. Cozy even. I suppose, I shouldn't have (or want) baby follicles. I should have (and want) big honkin' enormous, mature, hairy, motorcycle-driving follicles. Bring on the beer guzzling follicles, please!

Anyway, I started wondering if this poor response was another clue in the puzzle of my infertility. Do I actually have a luteal phase defect? Does this explain the miscarriages? Am I on the road to no longer producing eggs? WHAT'S HAPPENING?

I did a mad Dr. Google consult and found this:

"It is important to determine whether you have responded to the treatment (i.e. ovulated) by measuring blood progesterone levels around day 21 to 23 of the treatment cycle or performing an ultrasound scan. The starting dose of Clomid should only be increased if their is no response after the second cycle of treatment because of those women who will respond to 50
mg dose, only two thirds will do so in the first cycle. If the Clomid drug treatment is successful, ovulation tends to occur about a week after the last pill. "

Despite the fact that "there" is misspelled, I am taking some comfort in the above. My last pill was on Monday. I did a scan and blood work on Tuesday. Again on Friday (blood work) and Saturday (scan). According to the above, I shouldn't expect to ovulate until at least Monday. From what I'm getting from the docs, I should have had more of a response by now. The fertility monitor, however, finally showed, "high fertility" today. In a normal cycle, I would have ovulated yesterday.

I hope things start to whip up soon. Or at the very least, that it is not that unusual to show little response on the first round of Clomid. I really don't want to up the dosage anytime soon.

Any experience with this?

The husband and I spent the day kayaking down the Peconic River, eating pizza and playing with our dogs at the beach with some friends. We came home to two jazz musicians, a saxophone player and a trumpet player, practicing on the sidewalk on the opposite side of our street (they were about to go play in a club nearby). The sound was great. It was a nice (albeit exhausting) day.

Violet Beauregarde

No sooner had I typed the last word on my previous post was I overcome with a horrific, awful, no good, very bad, feeling of bloat. And pain. And nausea. That partially lasted (the bloat) until well into this evening. I have been feeling a tad Violet all day, basically. I thought it necessary to have someone roll me on home. Because I am a complete idiot, I was convinced that this was the result of a massive consumption of cauliflower earlier in the day. It did not occur to me, not once, that it may have been due to the Clomid. That is, until after I'd seen my doc and the write-up from the pharmacy spilled out from my purse onto my car floor. And wow, did it not say, "if you experience severe bloat or nausea, consult your physician." I mentioned the bloat, but not in any great detail because:

1) nothing has changed - my ovaries look identical to their scanned appearance last week, and

2) I have some fluid - apparently in my abdomen or in my uterus. When he said that I had an usual amount of fluid somewhere I shut down and started silently freaking out. He could have said it was coming out of my nostrils, and

3) My lining is the tiniest bit thicker.

I left there with a script for some blood work (progesterone, estradiol?) but no results as of yet.

As I was entering the lab, I scanned the bottom of the blood draw form, and was taken aback (as I always am) by the diagnosis checked off at the bottom:

"Habitual aborter."

What an ugly sounding term.

Are You There Heloise? It's Me, Alice

I love giving blood. I think it's so fantastic. I have to give blood tomorrow! How lucky am I! There's nothing I love more than having people (I use that term lightly) unable to get blood from a vein, try rooting around, switching arms, and then, as is par for the course, still unable to get but the tiniest trickle. I also enjoy watching the green, yellow and slight purple shades spread over the inside of my arms - in that, "Yes, I do a little horse now and then, what of it?" way. It's a great way to start your morning. Blood, coffee, more blood, bruising, more blood, fainting, etc.

Obviously the Clomid is scrambling the old noggin'.

I have to have a scan as well. I can feel things rumbling around in there - a little mittelschmertz here and there if you will. I think I may have been a touch more irritable than normal, and I was blasted hot the first night and afflicted with a rager of a headache, but since then, nothing really out of the ordinary.

The husband and I went on an exciting quest for a fertility monitor (I hate the damn sticks, I can never read them) which cost a fortune. And yes, I should have gotten one from the eversopopularauctionsite but didn't, because I can't get it together. We also went a searching for the magical, uhem, in anticipation of problems that may occur for those of us lucky enough to be on the Clomid. Of course, the easiest place for us to find said magical, uhem, was one of those stores where you know, people go, for you know, stuff, that has to do with, you know, (whisper) s-e-x. I do so hope that there's no need . . .

She lost her innocence there that day, people.

Not really.

Anyway, so I have the fertility monitor and again, because I can't get it together (see above) I neglected to set it on a proper day. Therefore I lied (i.e., it wasn't cycle day 5 when I said it was cycle day 5). So, this is going to be a problem. Luckily I have consulted with the internets and they tell me that I can reset it next month.

But on to really, the most important question of the day. How the hell do you get icky mold out of your grout in the tiles in your shower? I'm having little success and have become slightly obsessed. My landlord had a shindig over the weekend and I used his loo (to floss, actually) and the white grout between the white, white, white tiles in his bathroom was spotless. SPOTLESS. SPOTLESS!

My husband did point out that it's possible that our landlord has cleaned his bathroom tiles more than once in the last five years, but let's just let that slide (I was in law school, people! Then I had a heinous commute!) Seriously, who has time to get out an old toothbrush to clean grout?

Welcome to the Funhouse

For those of you who aren't in the know, part of the whole "CLOMID ODYSSEY" involves a postcoital test. Apparently once you and your partner are done having "relations", your doc (your male doc in this case - because really, isn't it more fun that way?) will pop up from amidst your bed sheets, straighten his hard hat, adjust his safety light, lick his pencil in preparation for his amazing note-taking skills and dive in to analyze your cervical mucus to see whether sperm are present and moving normally. He also may give you a few pointers as well, while he's down there.

"Within 2 to 8 hours after you have sex, your doctor collects and looks at a cervical mucus sample."

ARE YOU FRICKIN' KIDDING ME? How did I get on this ride anyway? I'm self-conscious enough as it is (really, forget the whole airport incident) and I have to contact my PHYSICIAN and say, "Right, so, we've just had sex, can I come on over?"

These funhouse mirrors sure are pretty. But I have to say, the whole sideshow thing is a bit dated.

Ah, Med Students

"Do you mind if a medical student observes your appointment?" Oh, um, well, um, hmmm, let's see. Do I mind? "Well, I don't particularly enjoy these appointments, nor do I relish the idea of having my va-ja-ja out there for all to see but considering the fact that I at one time contemplated medical school (very briefly, very, very briefly) and did a job shadow wherein I followed people around the ER and also observed a vaginal exam, I figure I'm due. " And she was a very young, innocent seeming thing, too. Which made me ask about my FSH level. I have not had the Clomid test for ovarian reserve but the one test that I did have on Day 3 of my cycle resulted in a FSH level of 9.2. Although he indicated that he doesn't become concerned unless it's over 10 and a more accurate reading would involve more than one test and Clomid, it still makes me freak out, slightly (but, what doesn't make me freak out these days?). I am thirty-five, people. And I started all this at age 32. So young and wistful. I remember reading about women who had tried for several years and several different avenues and I thought (in that completely smug way that one does when they haven't a clue what they are talking about) how crazy that seemed. I told the husband, "You know, I'm not going to crawl through the desert on my elbows in order to have a child, I'm just not. That's completely crazy! Lunacy!"

And, well, here I am.

Clomid starts Thursday.

Cycle Day 3

I have the "BIG SCAN" on Tuesday for Cycle Day 3. I imagine that shortly thereafter I will be marching down to the pharmacy to start taking THE CLOMID. What does all this mean? I am sans clue. Just following orders. Any idea why the heck I have to do a scan on Tuesday, on Cycle Day 3? What are they looking for? Little goblins? A sale on shoes? An umbrella? I can't imagine there is anything all that exciting going on in there right now . . .

Labor Day

I spent Labor Day weekend at the in-laws. I fought tooth and nail to avoid going because a) my sister-in-law has a new baby and b) I would have to be around said baby and c) I was asked to be the godparent of said baby and attend the (Christening? Baptism? The sister-in-law is a fly-by-night Lutheran -- so whichever) and d) I'd just miscarried - again.

Needless to say, I finally relented, due in part to a conversation with my mother who pointed out that it was an "honor" to be asked to be a godparent and this was probably placing a tremendous strain on my husband.

When the idea, however, was brought up prior to our excursion that I would BABY-SIT said baby while husband and sister-in-law cooked for a party, I began hyperventilating. Completely panicked, I cried, "I WILL NOT BABY-SIT THE BABY. I WILL NOT. "

However.

Saturday found me changing diapers. And seeing my husband with said baby in a Bjorn. And trying to soothe said baby while he screamed and wailed (that boy has some lungs). I handed baby to the husband and made a quick exit to go to the grocery store, promptly got lost, and cried for about four hours. Yes, we are not completely in that "moving-on" head space, no we are not.

It felt ridiculous and weird trying to avoid the baby. I don't want people to have to tiptoe around me. All the same, I would really rather have stayed home.

As of late (read: the last two years), the Husband and I have had frequent moments where we don't see eye to eye. He doesn't understand why I find attending a baby shower or christening heartbreaking. He doesn't understand how I absolutely want to stay as far away from his new nephew as humanly possible. He doesn't understand the fear of trying again. He doesn't understand my frustration with the doctors and medical staff. He's completely optimistic about our future. I am, well . . .

He has, very kindly, agreed to read several books on the subject. And although right now I find little solace in them myself as they outline so precisely my own feelings that I tend to relive moments that I'd rather suppress, they are helpful in bringing my husband to, if not a perfect understanding, some understanding. These are the books that I have read (or am reading) and that I have shared with the Husband:

About What Was Lost: Twenty Writers on Miscarriage, Healing, and Hope by Jessica Berger Gross.
I attended a reading at a local bookstore where several of the authors read from their essays. It was a very moving and very sad evening. I am grateful to them.

To Full Term: A Mother's Triumph Over Miscarriage by Darci Klein.
Klein insisted on cervical measurements, heparin and close monitoring (and spent almost the entire pregnancy on bed rest) during her fifth and final pregnancy. She had two early miscarriages and gave birth to still born twins at twenty weeks. She now has two children.

Coming to Term: Uncovering the Truth About Miscarriage by Jon Cohen.
I am finding some of the research that he weaves together fascinating. It is a good counterpart to Klein's book as they disagree fundamentally on many points. It is always disheartening, however, to read of all the possible causes, when you have none of them.

Clomid will likely start in about a week. I'd like to say that I am optimistic - as "70% of women who miscarry four times will go on to carry to term in their next pregnancy" but I'm generally just puzzled. Is Clomid just thrown at every woman who has fertility problems, regardless of the cause? Is Clomid really the best route? Is this just the hurdle I have to get through to get the white flag for IVF with PGD? My doc seems to believe it is helpful for those who recurrently miscarry-but I won't be ready for pom poms and streamers until we see some results . . . if you know what I mean.

Well the Fun Never Ends!

I recently met a very kind, patient woman who has six year old fraternal triplets. Two boys and one girl. One of the boys recently became obsessed with conjoined twins. He was quite panicky about the idea that he and his brother could have been conjoined. This despite the fact that his mother explained on several occasions that this was an utter impossibility--seeing as the boys came from two different eggs. Later she overheard him talking to his brother about the whole conjoined business. He ended the conversation with, "Wow, we really dodged a bullet!"

In the spirit of young Tad, "We really dodged a bullet."

Back in January, during a consult visit with Dr. Whoseitwhastit (aka "Dr. Wonderful") there was some mention that I was postive for antibodies against Rh-positive blood. Most people have the Rh (Rhesus) factor, a protein on the surface of the red blood cells. I don't. This would be fine and dandy if I wanted to procreate with an Rh-negative bloke, but as it happens, the Husband is positive. He is Mr. Everything's-Normal-Over-Here-Thank-You-Very-Much. Again, I am not. Everytime I come in contact with Rh-positive blood, by say, a miscarriage, I also must come in contact with a big jabbing needle of RhoGam. The great neutralizer. If I do not, my immune system will start to produce antibodies against the Rh-positive blood and I will become "Rh-sensitized." If I become "Rh-sensitized" the next time I am pregnant with an Rh-positive baby (I have a 70% of carrying an Rh-positive baby), those antibodies may (read: likely) attack my baby's blood. If this should happen, my child will develop Rh disease (hemolytic disease). My antibodies would cross the placenta and attack the Rh factor in my baby's Rh-positive blood as if it's a foreign substance, destroying his/her red blood cells and causing anemia. The disease can cause problems ranging from severe newborn jaundice to brain damage or, in extreme cases, even miscarriage or stillbirth. Treatments include inducing the baby early and blood transfusions in utero. It's a scary business.

During my last consult, I asked about the antibodies and Dr. Whoseitwhatsit said that he couldn't find anything in my chart that would indicate that I'm positive for the antibodies. But I was SURE he had said something about it at that initial consult. When I got back to my office in the city, I reviewed my chart from my OB/GYN. I forwarded it to Dr. Whoseitwhatsit for his review. He left me a voice mail and indicated that I was in fact positive, but it was "too weak to titrate," meaning that the amount is very small. It could be a false positive or a lab error. Or I could be positive. He also indicated that I don't need the RhoGam now because the last pregnancy ended so early that there were no red blood cells to cross contaminate - something we'd already discussed in his office.

I also called my OB/GYN (last seen in September 2006). He happens to be out of town. However, the other doctor in the office, Dr. Cranky Pants, called and we discussed it. He said that the test was more than likely picking up the antibodies from the RhoGam shot I had had in July. Apparently it lasts for 12 weeks. He suggested that I go in and get a blood test that evening. Which I did.

Dr. New (recently joined the practice) called me back - the result was negative. I am (we are) so relieved.

The use of RhoGam has only existed since 1968. In 1967 or so, my aunt, who is Rh-negative, gave birth to her son, stillborn. Just a few days prior to her due date he died. She had to wait to go into labor and give birth to him knowing this. My mother tells me that her sister, my aunt, has never been the same. My mother was terrified when she was pregnant with me, several years later. Luckily, both my sister and I are Rh-negative, just like her. My mother and I argue over his name, she thinks it was Scott, I think it was Brent. My mother should know - but we don't ask my aunt. She never got to hold him, there was no funeral. The cause of death? Likely hemolytic disease. But we'll never know for sure.

We really dodged a bullet.

Also . . .

I have been obsessing lately on the whole heparin/lovenox thing. I previously made appointments with two different REs - both only take one insurance, an insurance my employer happens to provide. My current RE is located quite far from my home, but is close to my old job. Since I'm somewhat convinced that I may need IVF, I thought I should begin the search for a new doctor due to the distance. Both of these physicians are considered fairly cutting edge (one uses cells from the mother's endometrial lining to grow the embryos--and has upped their success rate quite a bit and the other specializes in IVF for recurrent pregnancy loss). They are both frequently listed on "best" lists (best IVF clinic, best fertility doctor, etc.). I contacted the nurse of one doc and asked about heparin/lovenox. She stated that yes, he does prescribe heparin/lovenox for some of his patients. I am thrilled. She was quick to note that it does depend upon the individual circumstances, etc. That's fine - at least I know it's a potential option. The appointments are in October and November. Yes, November. I also got a call back from the other doc's nurse. He doesn't prescribe lovenox/heparin--but that's because he refers his patients to a hematologist who then may or may not prescribe it. I feel more comfortable with that than a blanket, "no."

In the meantime, I'm still on to Clomid with Dr. Whositwhatsit.

Seventy Percent

I received a "C" in civil procedure my first semester in law school. I was devastated. A "C". A rotten stinkin' "C". I cried. I wailed. I met with the professor. I couldn't believe it was happening. I seriously thought about dropping out of law school.

After four miscarriages, statistically, there is still a seventy percent chance of conceiving a healthy pregnancy even without any medical intervention. Whether or not I will fall on the good side of this statistic only time will tell. For now, I'm taking that "C" grade and running.

The Husband and I met with Dr. Wonderful this week. His first comment was something along the lines of:

"Well, I'm sure you want to know what happened. What you had is generally referred to as a chemical pregnancy. A chemical pregnancy is . . ."

The husband almost throttled him, "The woman KNOWS what a chemical pregnancy is - you've never seen a quick draw Dr. Google like this one over here in your life."

Except for the MTHFR, all tests have been negative. And my particular gene mutation (MTHFR A1298C) is more rare (read super special!) and therefore less is known about it and its possible effects on miscarriage. He was treating it the same as he does with his MTHFR C677T patients - extra folic acid. Heparin? Baby aspirin? I've been taking baby aspirin on my own since January. He doesn't use heparin or baby aspirin in his practice. His thoughts about MTHFR is that the problem is the absorption of the folic acid and that an anticoagulant does not address the problem. Of course I've read plenty of blogs out there where heparin is added to the mix and bingo! real live baby.

Running? I asked if running could have posed any risk. I asked this primarily because it is something that I can control, not because I want to blame myself (although that is perhaps inevitable). I ran a much greater distance than normal very early on in the pregnancy. He indicated that it COULD have caused problems but we'll never know. Dr. Wonderful said that he's loathe to recommend someone not exercise considering how many patients he's trying to get TO exercise but I can try walking next time and see what happens.

The plan? He recommends Clomid. Four cycles. Unfortunately I've read A Few Good Eggs which outlines the horror that is Clomid. Moody? Check. Fat? Check. Completely around the bend psycho? Check. Needless to say, I'm not exactly looking forward to it. His theory is that 1) if I have an ovulation problem that has gone undetected this can help and 2) the more eggs out there the more chances I have of a successful pregnancy.

If that proves unsuccessful we can move on to injectibles with IUI or without (he used the term, "relations" - as in we can have "relations" on injectibles versus an IUI - he really did).

If no dice there? We can move onto IVF with PGD. He explained the inherent problems with PGD in my case and that it's not exactly a perfect system. He also discussed a patient who just went through her second IVF with PGD - both times ALL of the embryos had problems. In that case, he said, the jig is up - it's time to move on.

His thoughts are that the recurrent miscarriages are likely due to "genetic problems" despite the fact that no chromosomal abnormalities were found in the husband, myself or the one embryo that was tested back in September. Further, he seems to believe that it's like the lottery, the more tickets you buy, i.e., pregnancies you conceive, the better chances you have of winning.

Wonderful.

My biggest fear was to walk in and hear, "Donor eggs." I can't tell you how many blogs I scoured subsequent to this latest miscarriage and read of donor eggs. Adoption. Living childless. It scared the absolute daylights out of me. Then a few days later I found several blogs of women who had had multiple miscarriages and are now about to give birth. No explanation. No found causes for all those losses. Many with little or no medical intervention. They just had to endure sometimes five, sometimes more than ten, miscarriages. Dr. Wonderful indicated that a lot of this has to do with patience--some people become "impatient" and need to move on to medical intervention even though with time it could and the chances are likely, that it will happen naturally. I'm not sure I would characterize not wanting to go through any more miscarriages as "impatience" but hey, what do I know?

Clomid, here I come.


P.S. Thank you all so much for all your comments. We haven't told many people about this latest miscarriage and the kind thoughts from all of you was incredibly helpful and made us feel a little less alone.

Idiopathic Recurrent Pregnancy Loss

idiopathic:
-adjective.
of relating to, or designating a disease having no known cause

recurrent:
-adjective.
that recurs, occurring or appearing again, esp. repeatedly or periodically

pregnancy:
-noun.
1.
a. The condition of being pregnant
b. An instance of being pregnant
c. The period during which one is pregnant
2. The quality or condition of being rich in significance, import or implication
3. creativity, inventiveness

loss:
-noun.
1. Detriment, disadvantage, or deprivation from failure to keep, have or get
2. Something that is lost.
3. An amount or number lost
4. The state of being deprived of or being without something that one has had
5. Death
6. The accidental or inadvertent losing of something dropped, misplaced, stolen, etc.
7. A losing by defeat; failure to win
8. Failure to make good use of something, as time
9. Failure to preserve or maintain
10. Destruction or ruin
11. A thing or number of related things that are lost or destroyed to some extent

FVCK

Beta hCG: 13
Progesterone: 4.8

Stress and Miscarriage

Yesterday I was EXTREMELY anxious, upset and stressed-out. The husband and I were fighting, I lost my cell phone (again-later found) and the hCG level made me anxious and stressed. So much so, that I began feeling crampy. Although I have yelled at my mother for even suggesting that stress might be a factor contributing to my recurrent miscarriages, I am beginning to wonder. I did some quick research on-line and saw several recent studies that found a connection between stress/anxiety and recurrent miscarriages: How Stress Causes Miscarriage, Stress and Early Miscarriage, Stress 'linked to miscarriages' and Mother's Stress Could Contribute to Early Miscarriage . The amount of stress/anxiety, however, was not noted. Is one episode enough? Does it have to be several? One study mentioned that three weeks is the critical time. My doctor believes I was about 3 1/2 weeks on Tuesday.

What do you think? Do you see a connection? Has your doctor mentioned a connection?

Results

I've been waiting all day for the results. Just about the time when I was going to throw my fist through a nearby window, the nurse called:

Beta hCG: 47
Progesterone: 22.4

Out of curiosity, I looked back at the test results from my last pregnancy. It's bizarre that it was just about exactly one year ago - although I believe I was a tad farther along then (although it could be mere days--I'll have to investigate):

August 16, 2006:
Beta hCG: 385
Progesterone: 14.1 (I'd just eaten--apparently that makes a difference)

August 21st:
Beta hCG: 2,261.7
Progesterone: 28.1

As a point of reference (for most of you this is old news, I suspect):

hCG levels in weeks from LMP (gestational age)* :

3 weeks LMP: 5 - 50 mIU/ml
4 weeks LMP: 5 - 426 mIU/ml
5 weeks LMP: 18 - 7,340 mIU/ml
6 weeks LMP: 1,080 - 56,500 mIU/ml
7 - 8 weeks LMP: 7, 650 - 229,000 mIU/ml
9 - 12 weeks LMP: 25,700 - 288,000 mIU/ml
13 - 16 weeks LMP: 13,300 - 254,000 mIU/ml
17 - 24 weeks LMP: 4,060 - 165,400 mIU/ml
25 - 40 weeks LMP: 3,640 - 117,000 mIU/ml

* These numbers are just a GUIDELINE-- every woman’s level of hCGfont> can rise differently. It is not necessarily the level that matters but rather the change in the level.

Progesterone during pregnancy:

First Trimester 9-47 ngfont>/ml
Second Trimester 17-147 ngfont>/ml
Third Trimester 55-200 ngfont>/ml

So, tomorrow another visit to the local vampire.

*Update*

I just checked the cycle days of the last time I was pregnant. The first blood draw, on August 16, 2006, was on cycle day 27. The first blood draw for this pregnancy, August 13, 2007? CYCLE DAY 28. Now I'm a bit worried.

*Further Update*

Thanks to Carey and Christina I reviewed my possible ovulation dates. My doctor believes that this time I ovulated on either July 30th or July 31st. Last year, I believe I ovulated on August 2nd or August 3rd. August 14, 2007 is then 14 or 15 days post ovulation. August 16, 2006, was likely 13 or 14 days post ovulation.

MUST LEARN PATIENCE . . . MUST WAIT FOR TOMORROW'S RESULTS.

Meanwhile, I've been reading one or two pages of the seventh and final installment about that courageous wizard kid -- perhaps the ending will distract me. That and BurritoVille. Not likely, however. But a good try nonetheless.

First Doc Appointment

So, the doctor's appointment with Dr. Wonderful was fairly routine. I made the appointment initially because of the whole not-getting-pregnant thing but didn't call prior to the appointment to inform of the latest "development." This was due, at least in part, to my fear that things will change at any moment. Hence the six pregnancy tests.

When I went in, I said to the receptionist, "So, um, I made an appointment initially because um . . . "

"You made a consultation appointment."

"Right, a, um, consultation, um, there's been a change."

"What change?" the receptionist barked.

"Um, well, um, well."

There I was, standing in the middle of a waiting room, filled with hopeful ladies. Everything went dark and a bullhorn was thrust in front of my face.

"Speak into this!" she said. "We want everyone to be able to hear you!"

I finally stammered, "Well, I think I might be pregnant?" It echoed throughout the room. And she eyed me suspiciously.

"Did you take a pregnancy test?"

"No, actually, I laid a hot rock on my stomach and watched to see if it changed colors."

"Well, in that case, go to accounts to pay your co-pay and bring this back," Miss Too-Much-Black-Liquid-Eyeliner said curtly.

So, the normal: blood test to detect the amount of Beta hCG. Another on Thursday. First results should be back on Wednesday.

We discussed running--which I really miss and stopped doing immediately upon the first test. Last time he told me not to run. He was somewhat ambivalent this time--until I told him that I had trouble last time keeping my heart rate under 140. He suggested that I walk. I hate walking. Well, hate is a strong word, I don't hate it, but when you are used to flying down the hill, walking just seems underwhelming. Running feels good. I enjoy it. It's a great stress reliever. Perhaps I will be forced to do a nerdy race walk instead.

According to Dr. Wonderful, I am likely only THREE AND A HALF WEEKS PREGNANT. Which means detecting the hCG last Wednesday is fairly astonishing. What's next? Detecting it the moment you and your partner's buttocks hit the sheets? Or the second the catheter is threaded through the cervix? Or the the egg is fertilized in the dish? Or the moment when a single sperm is injected directly into the egg?
No more waiting for the cells to divide? It's insanity people. Insanity. This means that gestationally, the little bugger is only a week and a half.

Makes me realize even more how fragile this all is.

And thank you. Thank you for all your warm thoughts and well-wishes. It means a lot. Especially since no one else knows about this--except of course, the doctor, his staff and the seventy-five women in the waiting room.

Sometimes You Feel Like A Nut

I feel slightly nutty that I went on a rant recently - not realizing that I may actually have been pregnant at the time. But that is the nature of infertility: a fun new adventure every second!

I won't know much until tomorrow's appointment, but at this point I have taken six different pregnancy tests - all with lines - some dark, some faint, some in the middle range. I have ceased running - which I am hating. The husband is out of town and I have spent much of it sobbing or in the throes of jubilation. I have looked at the calendar and thought about at what point I may need a D & C. Alternatively, I have envisioned the husband, the baby and I picnicking in Central Park next summer. I have gone into Baby Gap, "just to look around." I ate an enormous, nine dollar slice of chocolate cake at the Museum of Modern Art on Sunday because "I'm pregnant and I deserve it." I have been downing calcium enriched orange juice and ceased drinking the beloved diet soda. I have tried not to look at all those damn pregnancy books but I find myself flipping through them nonetheless. I have learned that if I really am pregnant, the current size of these wondrous dividing cells is half the size of the "o" on this web page. I have felt nauseous more than once--but wonder if it is psychosomatic. I have not had the, um, bathroom issues that I had in the previous pregnancies. Perhaps that is good--but perhaps it is not. I have had no more spotting. And I have begun to feel tired. But not terribly so. Not yet, anyway.

It is a waiting game. And I know the drill by now. Beta. Doubling? Sonogram. Heart flicker? Still there? Growth?

We'll see.

No cause for celebrations at this point - but hoping, hoping, hoping.

Hope

I've been attempting to ride my bike to work. So, far, however, I have only accomplished this lofty goal (it's not really all that lofty) twice. Once during my second week when I was feeling particularly energetic and once this week--due to a little rain. New York's subway system basically ceased operating, like dominoes, one by one.

I didn't particularly enjoy the ride there--the traffic was chaotic and I was stressed about the time. I was also worried that everyone else would have shown up to work in a more timely fashion and I'd be the only ass that couldn't figure out a better way to get to work. The last time this sort of thing happened, I also ended up riding my bike. Under dressed and in freezing cold weather. In December. In New York. And pregnant.

After I miscarried, I was somewhat convinced it was due, at least in part, to the hellish bicycle ride I took that December. Of course that is a ridiculous notion. Bicycle rides don't generally cause miscarriages.

So, on Wednesday, during my rather enjoyable ride home, I decided that once I got home, I'd take a pregnancy test. For the hell of it. My period was not due for several, and really, I mean several days. Like, next Monday. I might as well have been peeing on a stack of money. Besides, I wasn't feeling particularly pregnant. My breasts were hurting--but I'd learned that most symptoms I've felt in the last few months have either been the product of wishful thinking or premenstrual syndrome or a little of both. The last time, I just KNEW I was pregnant. I just knew. So, I took the test. And it was instantly negative. I chastised myself for doing something so idiotic--part of me, I know, had made that appointment with the Reproductive Endocrinologist because, I really believed that it could somehow bring us good luck - that I'd show up and be pregnant and NOT EVEN KNOW IT! And wouldn't that be hilarious? A real HOOT. The doctor would laugh, the nurses would laugh. We'd all grab hands and sing and dance in a circle around the stirrups. And all would be well.

But, it was negative.

I actually forgot about it fairly quickly thereafter and went about my business. I was somewhat exhausted and sweaty and disgusting. But I sat at the computer doing very, very important things. Like looking at furniture stores. And perusing silly blogs about clothes. And answering a few e-mails. I went to the bathroom to shower, and was about to throw the damn thing away when I noticed a faint second line. Yes. Very, very faint. I was meeting my husband and a friend of his out and didn't really know how to react. I really wasn't expecting it, at all. I took another the next morning. Faint line. One that evening. Line. Then this afternoon, I saw what I normally see the day before my period--a slight discoloration, brownish. I called the husband and told him it may be another chemical. I tested again. Faint line. Seems fainter. There isn't anything I can do--and I know that. And I just have to wait.

But hope springs eternal.

And bike riding? I'm trying to hang up the superstitions. Not a simple task.

It's Not a Freak Show, Folks, It's Just My Life

Step right up, folks. Step right up. It's cycle number twenty-four! That's right. Come inside the freak show and watch as Ali and the Husband attempt to get pregnant and STAY pregnant for the twenty-fourth time!

As an added bonus, if I can't guess your weight within five pounds, you'll win great prizes—like a used ovulation predictor stick! Or one of a dozen empty bottles of prenatal vitamins! Or perhaps fifty or so prenatal, postnatal, child-rearing, how to conceive, what-to-do-once-you-are-knocked-up-books, pamphlets or articles I have piled up next to my bed!

How long have we been trying, you ask? Two whole fun-filled years! What? Oh, right, you know someone who went through infertility, too? Your cousin's cousin who couldn't get pregnant for six whole months while trying for number three? That is awful. Really. Oh, then they took a vacation and bam! Pregnant? Yes, I've heard of that phenomenon before. Oh, right, another friend of a friend started adoption proceedings and then got pregnant? Right. Yes. Not sure why I hadn't thought of doing that previously.

Needless to say, feeling somewhat disillusioned. And fed up. And tired.

When I was in my early twenties I went backpacking solo through Ireland. There were moments of great bliss. I could get up whenever I wanted (pending the rules of the particular hostel, bed and breakfast, etc.), get tea where I wanted, visit museums and plays of my choosing, stay in a town I liked longer than initially planned, wander the streets taking photographs with my trusty Pentax K1000 at my leisure. No one becoming impatient. No one yelling that we would be missing the train.

However, there were also plenty of moments of utter and absolute nausea of spending another moment with myself. By the end of the trip I was completely, utterly, and absolutely sick of myself and my own company. Sure, there were many occasions where I met people, mingled, struck up great conversations. But there were just as many times when it was just me and me and well, me. Which generally is fine. I don't have to be around others at all times. I enjoy a little me time. But when it stretches on for weeks at at time, it becomes a bit old.

This is happening to me now. In that I am just sick of myself. And sick of this. Sick of what is going on or not going on. The continuous uncertainty. The worry. The vortex that is infertility. With that in mind, I made an appointment with my Reproductive Endocrinologist, a.k.a., "Magic Man", in the hopes that we can move on to the next step. Back in January, the next step (after trying on our own with the daily administration of Super Folic Acid!) was the fertility drug, Clomid and then, possibly In Vitro Fertilization (IVF) - do I understand why a recurrent miscarrier without any evidence of chromosomal deficiencies, issues, etc., needs IVF? Notwithstanding the recent dry spell? No, I do not. At this point, with the not getting pregnant at all, not sure where we might be headed.

So, that's me in a nutshell. Crabby. Sick of myself. Tired.

I did hang out with a friend last night at a great little restaurant (that she and her husband recently opened here in NYC). I banned her somewhat since my first miscarriage. Insensitive comments and all that. In all these many months since the first miscarriage, I have not uttered a single word to her about any of my fertility issues. Never discussed going to an RE, the many lovely tests, or the subsequent miscarriage(s). However, last night, she brought it up. She wanted to know if we were still trying. Perhaps because I'm not as raw as I once was, I just told her like it is (except that I said we were actually NOT trying). I explained that we are not trying, that I've had a chemical pregnancy and a miscarriage since the first one, that from what they've found, they think I have a type of blood clotting disorder and that although fairly benign for me, it is not benign for my offspring. I didn't really care what she said about it. I'm not going to feel like the pain of miscarriage/infertility is any less just because SHE doesn't think so. I was blindsided, however, by her reaction. She was very sweet. And she got a little weepy. I do not need her reaction to validate how painful this is, has been and will continue to be. It's just the path my life has taken. A completely, utterly, unexpected path.

But here we are.

And I say, onward, ho.