300

This is my 300th post.  Three hundred.  I looked back on my very first post from May 2010, written right after my miscarriage.  I was heartbroken, but still hopeful.  I could have never imagined what the next 299 posts would hold, or even that I would stick with this blog long enough to get to post #300!  By May 2011, I was finally mom to my beautiful little boy.  By May 2012, I was mom to a one year old cancer survivor.  Hopefully by May 2013 I'll be preparing for the transfer of an embryo created from a donor egg and the donor sperm (from Finn's donor).

I thought I knew what the future had in store for me.  I was wrong.

Aren't we always?

*****************

I had my phone consult with Dr. S at RBA in Atlanta today.  I've decided not to do a DE cycle with my clinic because the wait can be up to a year, there are less donors to choose from, and (since it's a fresh cycle) I'd have to sync my cycle up to someone else's.  RBA has an excellent reputation and uses frozen donor eggs.  That means I can pick a week that works for me, and (as long as my lining cooperates) I can be fairly confident that my transfer will happen during that time.  

My consult today was much sooner than I anticipated, but he had a cancellation right during my lunch break, so I had to take it.  We talked about my past history for a bit, and reviewed the labs and tests I've already had done.  He then told me about the program - how they choose and screen their donors and then how the entire cycle process works.  He cracked me up when he talked about my "drive by embryo transfer."  But it really is just that - my RE's office will be doing all the monitoring, I'll just go to Atlanta in time for a possible Day 3 transfer (though it will likely be a Day 5). 

We talked about meds I'd take to prepare my lining. He told me that they'd had some trouble recently with oral Estrace (turns out about 20% of branded Estrace on the market is actually generic from overseas...which totally explains some of the weird labs I've had with my male to female transgender patients lately) and so they prefer IM or transdermal estrogen.  I've decided to go with IM to save money. But when he gave me the option of IM progesterone vs Crinone?  I went with Crinone, as much as I hate it. I just don't want to do the IM progesterone.  It's worth the goop and the extra cost of Crinone to avoid it.  

We kept getting off tangent, and so I forgot to ask him a couple of questions.  The first was about endometrial scratch biopsies. My RE doesn't do them routinely, his nurse told me they didn't think they were beneficial, but they would do it if Dr. S asked for it.  But, she said, they're incredibly painful, "So if you have a choice, don't do it." Which is not what I've heard elsewhere.  I know the benefit of a scratch biopsy at this point is a matter of opinion, but what most people say is that it's no big deal.  I wonder if that's also a matter of opinion, or if it's because there's an endometrial "scratch" and then there's an endometrial "scratch biopsy" - maybe they are two different procedures? And I forgot to ask.  

So it looks like I have all my precycle screening done except for the psych consult.  As soon as I get that done and get the report to their office, I'll be able to get access to the donor bank, and choose my donor. 

A week ago I was mourning the BFN with my last IUI.  And today I'm talking about choosing an egg donor. 

I wonder what the next 300 posts will bring?

Joyful Anticipation

Since the day I first began to seriously consider trying to have another baby, my heart has been filled with anxiety and trepidation.  I knew it was going to be hard.  I was suspicious I might not be successful.  And I was worried I was going to run out of money before I ran out of options.

Since I made my decision to go forward with donor eggs, my anxiety and trepidation has gone away.  I am filled with excitement and anticipation - and not a little bit of surprise at how hard it was for me to make this decision.  As good as I feel about it now, I can't believe how hard it was to make in the first place.

I am looking forward to being pregnant again.  I am not the best newborn mommy out there, but I think I'll do a better job my second time around, and I'm looking forward to the chance to try.  I am excited to think of nursing another baby, and imagine that I'll nurse well beyond the age of one this time around.  I can't wait to see Finn grow into his role of big brother, and watch the dynamic of our little family change to accomodate a new little person.  One little part of me is a little sad that this baby-to-be won't share my genes, but it almost feels like it's an obligatory sadness that will pass soon, barely noticed.

The one thing that does truly make me sad is that my last 3 IUIs didn't work, and I'm now looking at spending a lot more money to try to complete my family.  It would be so nice to not have to worry about financing baby #2.  It would be nice to pay off my home equity loan.  It would be wonderful to not have to worry quite so much about money at all.  But in the grand scheme of things, it's not that big of a deal.  In 5 years my condo will have sold (I hope) and many of my financial worries will be a thing of the past.  I'll have a 4 year old and almost 7 year old who won't care what house they lived in the first few years of their lives.  I feel incredibly lucky that this is even an option for me - that's what I'm going to try to focus on now.

I talked to my RE's office today and let them know what my plans are.  The nurse, Libby, was incredibly supportive, and told me that they would do whatever labs and tests I need for my new clinic.  It looks as though I have all the requirements already met, except for a sonohysterogram and a psych evaluation, so the prep work should be easy.  I am waiting to hear back from the clinic I'll be using, hopefully I can get a phone consult set up for sometime in the next month.  I'd like to plan to cycle at the end of May, as my work schedule is pretty booked before then.  That gives me 4 months to get in better shape and lose another 10 pounds.  I'm currently 5 pounds lighter than I was when I got pregnant with Finn - if I lose another 10 pounds it will put me back to my preTTC weight.  That would be just about the perfect way to start a pregnancy.


Thank you for all the wonderful, thoughtful and heartfelt comments on my last post.  I am so blessed to have such incredible support.  Thank you.

Singing Fat Lady

There's a lot going on in my brain these days.  So much so that I'm finding it hard to even know where to start.

I guess at the beginning.  When I was trying to conceive Finn, my numbers were not all that great.  My FSH was almost 12, my antral follicle count was low and my AMH was 0.49 (a good number is above 1).  And yet, I got pregnant both times I used the combination of Gonal-F and Femara, the exact same protocol that hasn't worked the 3 times I've tried when trying for Baby #2.  This despite the fact that my FSH has been about the same as it was when I was trying for Finn (though I did have one outlier at 16 right back in August or September) and my antral follicle count has been about the same.

Thursday night I googled statistics for IVF success at my age (41 - will be 42 in June).  They were sobering.  I found, on average, numbers varying between 15-30%.  I already knew those numbers, but I figured I was not the average.  After all, I'd gotten pregnant twice just two years ago, with numbers that were pretty similar to what they are now.  I was sure one of these 3 IUIs was going to work.

Before I started, my RE told me that at my age, my chances were just as good with IUI as with IVF, especially since I had proven success with IUI in the past.  And then when we met again in November, he dazzled me with talk of using growth hormone as an adjuvant therapy when trying IVF, and though he was clear on the statistics, pointing out that the ASRM guidelines allow for transfer of up to 5 (FIVE!) embryos at my age (given the small chance of even one working), I was swayed.  Yes, I said, if my last IUI doesn't work, I'm going to try IVF.

And then my last IUI didn't work.

Suddenly I am faced with the thought of moving to IVF.  The cost is daunting.  I make a nice salary, but I have huge bills thanks to a condo that I can't sell and student loans that will be with me until I'm 60.  I do have the ability to pay for one round of IVF.  It will be a stretch, and it will mean that I won't be able to pay off my home equity loan in the next two years, as I'd planned, but I could pay for one round.  One round of IVF that has - at best - a 30% chance of working.

Yesterday I called my RE, and talked with one of the nurses to start the process for IVF.  While talking to her, I realized I'd never heard the results of my AMH level from last summer.  It was 0.17.  Horrible.  It means my ovarian reserve is tiny.  I might have one good egg left, but it really is just one good egg.

I put that information together with the fact that I haven't gotten pregnant in 3 pretty decent IUI cycles using a protocol that has worked in the past.  And the words from my RE that I probably didn't have much more of a chance with IVF than I did with IUI.  And the fact that I have said repeatedly this past year, "If only adoption weren't so hard. If someone offered me a baby today I'd stop trying to conceive and adopt immediately - though I would really love to be pregnant again, and to nurse a baby again."  And the reality that I have the resources to finance one more try.  Not two.  Just one.

My back up plan has always been donor eggs.  But the reality is that I can't afford my backup plan if I try with my own eggs.  There are no guarantees, but my chances of conceiving are drastically higher with donor eggs than with my own.  And the costs are relatively similar - donor egg is a bit more, but not much.

I now have a choice to make.  I can afford one more try.  Do I gamble all that money on a chance that has very poor odds?  Or do I go with the try that has a much better chance of succeeding?

How important is that biologic connection to me?  I think this would be a very different question, if I didn't have Finn.  But I do have Finn.  He is undeniably my son, and I love him more than anything or anyone on the planet.  I also know my love would be just as deep for my second child, whether that child is biologically mine or not.

But the thought of giving up on my own eggs....it's a hard one to wrap my mind around.  Last night I spoke with my friend Kyrah, who is a psychic (and also does amazing energy healing work), and she did a reading for me.  The message was clear from our reading that I don't have much of a chance with my own eggs, but I do with with donor eggs.  Not what I was hoping to hear, but exactly what I was expecting.

I went to bed but couldn't sleep, my mind wouldn't stop working.  Finally I drifted off to sleep, and woke this morning feeling lighter and more hopeful than I have in months.  It was when I was in the shower that I realized what had changed.

I have decided that what I want more than anything in the world is another child.  I want a sibling for Finn, and another child to share my love with.  I love being a mom more than anything I have ever done, and I want more.  I wish I had started earlier.  I wish I had the money to try one more time with my own eggs and then move to donor eggs if that didn't work. But the reality is that I will never regret moving forward with donor eggs.  I would always regret trying first with my own eggs if it didn't work (as it probably won't) and losing my opportunity to have another child.

When I realized that, I cried.  It's tough, letting go of the dream of how I envisioned my life would be.  But it would be even tougher to never have a second child.  So my plan is to not start birth control pills on Sunday.  I will call the clinic I plan to use for donor eggs on Monday to schedule a phone consultation.  And I will call my RE's office to ask if they will do the monitoring and other things as needed for my cycle there.

I can't quite believe that I've found myself here.  And while there is the chance that I may still change my mind, this feels right.  In my heart of hearts, I feel as though I am making the right decision.

To be completely honest, I considered not posting about this here.  But I started this blog to share what it's really like to be a single mom by choice, and what it's really like to try building a family as an older mom.  Not sharing this part of my journey would feel dishonest.  And it would not be helpful to those out there who are reading this at the start of their path towards single motherhood.

But, having a child with donor eggs is a lot different than with donor sperm.  There are many out there who will always think, "That child really isn't her child." There are people out there who will think of my second child differently than they do my first, if they knew.  And while I will ALWAYS be honest with my children about where they came from, the donor egg story will not be my story to tell to all those around me.

So, if you know me in real life and are reading this here - please do not share this information with others.  Know that I will love any child of mine with all my heart, no matter what the genetics may be.  Please respect my future child's right to his or her own story, and avoid sharing this with others.  I do not plan on sharing this with my parents, or with work, or with my casual friends.  It's not that it's a secret that I am ashamed of, I just don't feel as though this is something that is mine to share.

No Happy Dance Here

There was only one sad line on my HPT this morning.

No AF yet, so I guess there's still hope, but not much.  I have the phone number for the IVF coordinator.  I'll be calling her as soon as AF arrives.

Seventh IUI

I woke up yesterday morning to the beginnings of EWCM.  Which then had me worried that maybe I should have done that OPK on Thursday after all.  My ultrasound showed 3 follicles on the right that she measured (2 at 20mm and 1 at 17) but there was another smaller one there as well.  I figured one of the big ones and one of the smaller ones were my residual cysts, and so that meant that I had one good follicle and one that was too far behind to do much.

When I went out to talk to the nurse and told her about my EWCM, she looked at me and said, "Can you come in tomorrow?"  When I said yes, she went to talk to my RE, and the talked with the andrology lab and then came back to tell me to trigger right then for an IUI this morning.  It turns out its a very good thing I had forgotten to call in my Ovidrel when I called in my other prescriptions last week, because otherwise I'm not sure how I would have been able to get home and get my shot and still make it to work on time.  A quick stop by the pharmacy, and in no time I was shooting up in the car. I really did not expect to be triggering for an IUI on CD11!

I usually trigger 36 hours before my IUI, and usually I don't have any symptoms at all until the morning of my IUI.  But this time my ovaries were aching all day long.  This morning I didn't feel anything, so I was suddenly worried that I'd already ovulated, but as soon as I got up they started aching again.  And then when I went to the bathroom, I had the most amazing EWCM, so I felt a little better.

After a longer wait than usual at the RE's, I was back with the nurse and ready for my IUI.  She told me that my estradiol level yesterday was 236, so maybe both of those 20mm follicles really were follicles and the other two were my residual cysts?  When she put the speculum in she said, "Oh, your cervical os is so open it looks like a singing choir boy!" and then she went on and on about my cervical mucous, and even showed some of it to me.  "If the other two ladies I have for IUIs this morning have signs as good as this, we're going to be very happy in a couple of weeks!"

29 million swimmers on board!

My new lucky socks - thanks, Evie!

My ovaries have felt full and achy all day today, too, and I'm pretty sure I ovulated sometime this afternoon.  I've read that frozen sperm lives 6-12 hours, which means by now I'm either pregnant or I'm not.  Crazy that after over two months of a lower carb diet, lots of daily supplements, fertility massage, acupuncture and a session with my lovely energy healing friend, there is now nothing much I can do that will affect the outcome.  I'm either pregnant or I'm not.

I'm feeling cautiously hopeful, but also preparing myself for the thought that my next step is going to be IVF.  I guess I'll know for sure in about two weeks.

Christmas Follies

Finn and I were on our own for Christmas this year. My sister was out of town with her husband's family, and my parents stayed in Florida so my grandmother wouldn't be alone on Christmas Day, so it was just the two of us.

We invited ourselves over to my friend Lisa's house on Christmas Eve - only they had plans with her extended family in the evening, so we ended up just going over there for a few hours in the afternoon.  Finn had been out of sorts most of the day, and when we got to Lisa's he started to feel warm.  Even though he knows her family he clung to me for the first little bit.  And then finally Lisa convinced him to come to her - and he fell asleep within 5 minutes of being in her arms.  He definitely had a fever when we got home, so he had a dose of ibuprofen and was off to bed.

Sound asleep on Aunt Lisa

By the time he went to bed, the headache I'd been nursing all day turned into a full blown migraine. The kind that lasts for days, keeps me from sleeping and makes me feel awful.  So I pulled out the last ox.ycodone I had left from after my c-section and used it.  OMG.  That stuff is amazing. I have never had anything break a headache like that did.  I was able to sleep, and woke up Christmas morning with a sore neck, but no headache at all. That never happens. Must get a primary care doctor so I can myself some of those!  LOL  Finn got another dose of ibuprofen in the middle of the night when he was burning up again, but woke up fairly happy on Christmas morning.  I'd planned on us cuddling in bed for a bit, but I had a feeling his good mood wasn't going to last, so we went downstairs for presents.

I'm not sure he really got the concept, and without other kids to fuel the excitement, it was a pretty low key Christmas morning.  He loved his shirts from Santa and his Mickey Mouse pjs from Aunt Heidi, and while he wasn't too into them then, has played with his new car ramp and fire truck a lot today.  I had a few presents to open, too. After Finn didn't buy me anything for Christmas last year, I wised up and gave money to Nanny M for Finn to pick out a gift for me.  She said that she took him around Target, and when he saw my gift he pointed to it and said, "Mama!" I haven't taken a picture of them yet, but he got me a very pretty pair of earrings.  And some chocolate.  I also got some yummy lotion from Heidi and very cool statue that a friend of mine from med school made for me.  He's so talented!

Opening his first present

Mickey PJs

His stocking is as big as he is

Mommy and son statue

Finn was feverish and fussy most of the rest of the day, but my friend LB still insisted that we come over.  Unfortunately, I hadn't talked with her about what her plans for us were on Christmas day, and so I was surprised when we talked that morning to learn that she was planning on having us eat Christmas dinner at 2pm. Smack in the middle of Finn's naptime.  With him being sick, there was no way I was going to wake him up, so I ended up eating my Christmas dinner at her kitchen counter at 4:30 that afternoon while she prepared for a Christmas open house with her family about an hour later.  I hadn't planned on staying, but Finn seemed ok, and I felt rude leaving right when everyone got there, so I stayed for a couple of hours and then headed home.

It wasn't a bad Christmas - how could it be with Finn?  But it wasn't a great one.  It felt awfully lonely at times.  I'm so glad my parents are here now, and we have plans for a big family Christmas gathering with my sister and her family this weekend.  Let's hope everyone is healthy!

****

I had my (totally unnecessary) CD8 ultrasound and labs today.  I always have a cyst on my right ovary. It always measures about 18mm at the baseline scan, and then goes up to 23mm by CD10.  This cycle I also still have a smaller cyst left over from my IUI cycle in September to go along with it.  So today when we saw a 23mm and a 17mm "follicle" on the right, and two others around 12-14mm, I was quick to say those were my two old friends, the cysts.  The ultrasound tech agreed with me, but the nurse did not. She insisted the 23mm was a follicle and I should be prepared for an IUI on Friday.  I insisted she was wrong, so we agreed to wait for my labs.

I left feeling pretty bummed.  Not only was I worried I was going to have an IUI too soon, but my left ovary was completely quiet.  NOTHING going on.  My left ovary was the one that gave me Finn, and the first two cycles that didn't work when trying for him, my left ovary was quiet then, too.  Of course, my left ovary has been going to town with follicles the past two IUI cycles and no pregnancy, but I have it in my head that I'll only get pregnant with an egg from the right, so I'm a little discouraged.

But anyway.  Around 12:30, as I'm standing in line to get my lowish carb burrito bowl, I get the call from the nurse.  "Your estradiol is rising, but still not high enough, so you'll take 2 more doses of Gonal-F and come back for more labs and a scan on Friday." CD10.  The day I should have gone in for my ultrasound in the first place.  I was so busy not saying "I told you so" that I forgot to ask what my estradiol level actually was.  They're still concerned about this right cyst and so asked me to do an OPK tomorrow morning and call them if it's positive.  But I'm not wasting my money.  I've got no cervical mucous changes, it's only CD9 tomorrow, I've never gotten a positive OPK reading in the past, and I'm just positive that I'm not ovulating.  This cycle is already my most expensive IUI cycle on record, I really don't want to throw more money away.

So I'm guessing I'll be told to trigger on Friday night for an IUI on Sunday.  I'm not sure if I'm feeling all that optimistic, but I think maybe there's a chance this will work.  Oh, I hope it does.

****
Finally, Finn's next MRI is tomorrow.  He had a fever again this afternoon, so I'm hoping that's all gone now.  I hate MRI days.

Merry CD3!

It's just a few days before Christmas.  Thank goodness Finn is too little to really understand, because I'm just not ready.  There are about 20 ornaments on the tree...and the tree is probably safest that way.  I still have gifts to get (shopping with a toddler the weekend before Christmas is going to be so much fun!) My house is messy.  I never did get Christmas cards ordered, much less sent- though I did get stamps.  (I like to think of that purchase as getting prepared for next year already.)

But Finn is in awe of the lights.  He loves our tree, and the lights I cursed as put them up outside our house are now one of his favorite good night sights.  He walks around saying, "ho, ho, ho" and has no idea the tree is mostly bare.  And he certainly doesn't care if all the Christmas shopping is done, or that the presents aren't wrapped yet.  

yes, that's the ghost on the upstairs porch

We are having a very low key Christmas this year.  My sister is out of town with her family.  My parents are getting here the day after Christmas, as they're spending Christmas with my grandmother in Florida.   So we're going to spend Christmas Eve afternoon with my friend Lisa's family, and Christmas Day afternoon/evening with LB's family.  Christmas morning will be just the two of us.  LB invited us to spend the night on Monday night, so we could all have Christmas morning together, and I did consider her offer.  But there's something magical about spending Christmas morning together, just the two of us.  It won't be an exciting Christmas morning.  But it will be cozy and sweet.  This will be the last Christmas morning that he is too young to understand what it really means. Though I know he'll enjoy his presents, he's going to be most excited about spending 4 whole days in a row with me.  And I think that's what I'm most excited about, too.

******

Amazingly enough, AF showed up a few days early this week. I had been worried that she'd show up over the weekend, and I'd have to deal with on call doctors and crazy holiday hours.  Instead, I went in for my CD3 scan this morning.  My antral follicle count is 8-9 and my FSH is 12 - not fabulous, but not awful either.  I took my first dose of Femara before lunch and will start Gonal-F on Sunday.  A different RE than my usual doc reviewed my labs and scan, and so I'm going in for my first follicle scan on day 8 instead of day 10.  I'm sure that means I'll end up with another scan before my IUI, but what's the cost of another set of labs and ultrasound at this point?

Appointment Recap

Today's appointment with my RE went fairly well - he answered most of my questions before I even got to them, and spent 45 minutes with me, making sure we'd covered everything (though I still forgot to ask him about the Crinone, even after taking my list with me).  The plan that we came up with isn't exactly what I anticipated, but I think I'm comfortable with it.

We're going to do one more IUI with my cycle that will be starting about 4 or so weeks from now. Same protocol as before (and when I asked if they cycled over the holidays, he looked at me like I was crazy, "Of course!")

If that doesn't work, we're going to try IVF, doing a Lupron microflare protocol.  He has been using growth hormone with this protocol, and thinks it has helped improve success rates.  It's his opinion that adding the growth hormone gives IVF an advantage over IUI.  He doesn't anticipate me getting more than 5 eggs, and has told me (as I already know) that I shouldn't expect them all to fertilize.  Smart man, making sure expectations are realistic from the beginning.

He was completely willing to let me do as many IUIs as I want to do, but said that his gut feeling was that after 2-3 IUIs, I should try something different.  He gave me several articles (particularly about using growth hormone with IVF), and was fine with letting me take as long as I needed to made a decision.  After how disappointed I was with his nurses a few weeks ago, it was nice to be reminded why I like my RE so much.

This appointment counted as my IVF consult, so, if my next IUI doesn't work, I'm to call his IVF coordinator, and get started with birth control pills, and go from there.  It feels good to have a plan.

Questions for the RE

The appointment with my RE is on Monday morning.  I have a list of questions to ask him about what we should do next.  I'm actually bringing the list with me, because I know I'll forget at least one of them if I don't.

1. A few months ago he told me that - given my ages and labs - I had just as much a chance of getting pregnant with IUI as I do with IVF.  Given that statement, is there really any benefit to even considering anything but IUIs right now?  We know I can get pregnant with IUIs, so I'm not sure if there would be any benefit.
2. If he does think IVF is a better option than more IUIs, what kind of IVF cycle does he think would be best for me?
3. With both cycles that failed, AF showed up early - despite taking Crinone.  Does that mean Crinone isn't really doing anything?  Does he think I really need to take it?
4. I have a conference I'd really like to attend at the end of January.  There's a very good chance this conference would fall right around the first two weeks of the cycle after my next try.  I have to decide now if I'm going to attend - if I do go and I end up not pregnant after the next IUI, could I take birth control pills for a few weeks so I don't have to take another full month off of trying?
5. Speaking of birth control pills, someone mentioned to me that it might be a good idea for me to take them with my next cycle, the one before my next IUI cycle - what are his thoughts on that?
6. If AF arrives on time this month and next, my next cycle will fall right around the Christmas holidays.  Will they be open?  Finn's next MRI is 12/27 - if I have a monitoring appointment or IUI on that day, can they be flexible with the time and let me come in the afternoon (they usually only do morning scans and IUIs).

Any other questions I should ask?  I want to walk away from this appointment with a clear plan of what the next steps are, and no more "do 2-3 IUIs and then let's regroup" if I can help it.

I also plan to tell him how bad my experience was when I called after my last BFN - specifically how long I waited to hear back from the nurses, and the fact that they hadn't really listened to my message or done anything with it (such as give a message to him that I wanted to do another IUI cycle).  I'm also going to ask him about their policy of having to have a specimen onsite.  For the most part I've loved my RE's office, and like I've mentioned before, I think their success rates are better than their local competition.  But I'd have a really hard time telling any of my local single SMC-tryers to go there just because of that policy.

I'm doing a halfway decent job with my diet.  I've had a few cheats here and there, but I've definitely been more successful than not.  I currently weigh exactly what I did when I got pregnant with Finn (though the weight is definitely distributed differently!), it would be nice if I could actually lose a few pounds over the next 5 weeks or so.

Eating My Way to Better Eggs

I left something big off my list of good things about having a few month delay in trying to conceive: the chance to do something to improve the quality of my aging eggs.

Do an internet search on improving egg quality, and you'll find all sorts of information - some of it good, some of it crap.  But how do you know which is which?  Much of what you'll find is based off of anecdotal reports ("I drank tincture of mouse urine steeped with bay leaves every day for a month and I got pregnant!") but there is some hard science out there.  There's not a LOT of hard science out there, but there are more and more studies that are popping up that at least can give a girl a little bit of guidance.

I'd been thinking about a lot this week about the supplements I should be taking.  But then two things made me realize I was missing a huge piece of the picture.  The first was a conversation I had with a patient today, a patient who has infertility that is likely due to a pituitary tumor causing low FSH, LH and estradiol levels. She is also slender, and we were talking about why her gyn had thought the problem was her weight.  I explained to her how being underweight can cause a woman to stop having periods.  "Reproduction is not essential for survival, so if your body is being starved, or thinks it's being starved, it will stop ovulating, and you'll stop having periods."

And the obvious suddenly became clear - my diet is likely part of the problem. Now there's no way my body thinks that I'm being starved, but I'm certainly not giving it the nutrition that I need to make good quality eggs.  I've done a decent job of cutting out fast food, but refined carbohydrates have been my best friend the past few months.  Especially this past week (candy corn, anyone?) - I'm not eating anywhere near as healthy as I could be eating.

Of course, we all know incredibly unhealthy women who follow horrible diets that get pregnant naturally...but most of them aren't 41 years old.  And none of them are me.

When I first started to think about getting pregnant on my own I read The Fertility Diet.  It's a wonderful and easy to read book, and there's a great summary here. To be clear, this is a retrospective study that looked at the effect women's diet had on their fertility.  It did not look to see if changes in diet would affect the chances of an infertile women getting pregnant.  Instead, it asked the question, does diet influence your chances of infertility?

Not surprisingly, the answer was yes.  A diet high in simple carbs, high in trans fats and high in animal proteins increased the chance of infertility, while a diet rich in complex carbs, monounsaturated fats and plant proteins increased fertility.  Huh.  The same things that increase your risk of diabetes and heart disease increase your risk of infertility.  The body is an amazing thing.

And then a friend shared these recent studies presented at the American Society of Reproductive Medicine's annual meeting - there's a summary here, and a summary with comment from the experts here. In the first study, women were asked to give a dietary recall before starting IVF.  The women who had high protein diets had more blastocysts make it to day 5 and has significantly higher pregnancy rates.  The second study actually had 12 women who had prior failed IVF cycles change their diet.  They were instructed to increase their protein intake from around 15% of their daily food intake to about 27% of their daily intake for 2 months before their next IVF cycle.  This resulted in an increase in pregnancy rates from 16% to 81%.  I could only find blurbs about the study, and not an abstract, so I don't know the details - especially if these women were increasing protein intake using animal protein, or if they were using plant protein. And it's a small study.  But it is incredibly compelling.

I find myself inspired.  Inspired to completely revamp my diet.  To cut out refined carbs.  To increase the protein in my diet - from beans and lean meats primarily.  To increase the healthy fats and cut out as many saturated fats as I can.  To eat healthy.  To be healthy.

I've felt horrible all week with a headache and a cold.  And it's candy corn season.  I've felt like crap and I've eaten like crap.  But starting Monday that's all over.  Finn and I are going grocery shopping and stocking up on all healthy stuff.  And the stash of Halloween candy I've been keeping at home is going to the office.

It's going to be hard.  Thanksgiving is soon, and so is Christmas.  There will be temptations every where, every day. I will cheat. I'm giving myself permission to do so without guilt, simply because I know that when I do cheat, I'm going to make it count, and it won't be often.

I'm doing this to improve my chances of having another child. And I can do anything if it means I'm more likely to achieve that goal.

Good Things

This BFN was the hardest BFN I've had in the whole TTC business.  All along I was so SURE that I was going to luck out with my second try for #2; it really has felt like I'm mourning a loss instead of just a BFN. But at the same time I'm already so lucky to have Finn - it's a sadness that isn't tinged with the fear of "what if I'm never a mom?" that everyone one of us has when trying for our first. And for that I am incredibly thankful.  As sad as I am, I know I am so lucky to have the one little boy I already have.  

I've also had a two day headache accompanied by an irritating eye twitch that has me wishing I'd save the last of the narcotics I got after my c-section.  I could really use one (or two) of those right now.  The worst seems to be easing off now - I hope it really is almost gone.

Even though two months seems like forever right now, I know it really isn't.  And with all I have going on this month, it will probably seem even shorter than that. I'm trying to keep reminding myself of that. And I'm making lists - lists to help me feel better about this delay. My first list is the list of the good things that will come from the two month wait.

• Almost two more weeks of maternity leave.  I don't get maternity leave - just vacation time.  So in two months I'll earn another 3-4 days. They also allow us to transfer 40 hours of vacation pay into short term disability every year - and they match those 40 hours.  I've already transfered for this fiscal year, and now will be able to transfer another 40 hours next July. So another week there!
• Finn may be potty trained - or close to it - by the time baby #2 finally arrives.
• He will definitely be ready for the big boy bed. So I will be able to put him in the room that is currently the guest bedroom and new baby will get the crib.
• I won't be traveling 3 weeks in a row while in my first trimester.
• I'll have time to get Finn settled into a new sleep routine before I'm too exhausted from early pregnancy to be able to contemplate an evening walk every night.
• I can go shopping now for some new winter work clothes.  I'm SO tired of the stuff I have that I can wear right now but had been holding off, thinking I could move to maternity work clothes soon.  I don't want to spend much money, but getting 5-6 more shirts and a couple of skirts would go a long way and make me prettier and happier at work.
• I can take Aleve all I want for my headache.
• I know, beyond a shadow of a doubt, that I really want to do this crazy thing and have another baby.

I hope everyone in the Northeast US is staying safe from Hurricane Sandy!  We're just getting a lot of wind - and Boo the Ghost fell victim to Sandy's evil ways earlier today.  He was found in the neighbor's yard - luckily he didn't go too far, he's one of Finn's favorite people.

Wallowing

Yesterday was a bad day.  It was made so much better by my friends, especially the friends who commented on my blog, sent messages or texts yesterday and today.  Thank you.

I talked to a dear friend (Kyrah) last night and - while I'm not happy about it - I've come to peace with the fact that there's going to be a delay.  Many of you suggested going up to the clinic today or Monday, but I know it wouldn't work.  If my cycle had started on any day but a Friday, I could have called the andrology lab coordinator and worked something out. She's the one who makes the rules, and no one can break them but her.  But at this point it's just too late. I don't want to start stims on CD4, and that's what would happen.  It just doesn't feel right.

Kyrah is a psychic.  Not the "let me tell you your fortune" kind, she does energy healing and spiritual counseling.  I worked with her before I got pregnant with Finn (and one day I'll blog about it, if anyone is interested), and am convinced that the work I did with her is part of what helped me get pregnant.  So when I emailed her that this last cycle didn't work, she called me almost immediately.  We talked.  She listened, and she looked, and she told me that she thought a month off would be good for my fertility, but two months off would be even better.  And while I don't like it, I believe it.  It feels like the right thing.  Much more right that forcing the issue this cycle, or trying birth control pills to allow me to cycle the following month.  Those just feel wrong.

Yes, it's true.  I'm the scientist who wants cold hard facts to guide me in clinical practice, but then I completely contradict myself by going with my gut (and working with an energy healer, which some may think is crazy, but I know she's the real deal) both with myself and my patients.  When I listen to my gut, even when it contradicts science, I'm almost always right.  So I'm going with it.  Even if I don't want to.

I'm formulating a plan for myself for the next two months.  A plan to get my body and my life ready to welcome a second baby.  But not today.

Today I'm wallowing.  As much as the mom of a 17 month old can wallow, anyway.  For a day of wallowing, it was a pretty decent day.  Even if I did feel like I was about to cry the entire time.

Finn's last swim lesson was today.  We've been going for 5 months, and the current group of babies and parents are just wonderful.  I'm really going to miss it, but the drive was too much to continue, and it was taking up too much of our day every Saturday.  To celebrate our last day, the teacher let the babies go down the slide, which is not technically part of his age group's class.  Finn LOVED it.  He still isn't a fan of going underwater for swimming (though he will now hold his breath 4 seconds while he does it).  But the slide?  He slid down and I let him go all the way under the water.  He came up shuddering and sputtering while signing "more", ready to go again.  It was hilarious!

Our usual routine has been to then go to Panera for breakfast, then do our week's worth of shopping at Target.  That then puts him right at nap time, and he falls asleep on the way home.  I got to Panera today, ordered, and then realized that my wallet wasn't in my purse.  Of all the dumbass things to do.  I didn't want to go home right then, because I knew Finn would fall asleep way too early if we did.  So we ended up meeting up with my sister, her boys and my mom at WalMart, then we went to a little fall festival at the boys' daycare.  Finn had a great time, and then fell asleep almost as soon as we got in the car.

I had plans for his nap time, but when we got home, I crawled into bed, too, and slept until he woke up, over 2 hours later.  We went on a walk after lunch, and I took his fall pictures.  Last year I had visions of getting a picture of him outside in his Halloween costume, but never did it.  So this year I was sure to do it.  After pictures we played for a while, then made it to Target, then out for dinner.  I splurged and had lots of chocolate chip cookies for dessert.  Then I cried the whole way home.

The wallowing is almost done.  Maybe another day.  I need to grieve the loss of the pregnancy that wasn't.  And then I can move on.

Roar!

And then the day got worse...

After I posted about my BFN this morning I went upstairs to get ready for the day, but found myself unable to do anything but sit on the floor and stare at the wall.  I didn't cry, I just felt numb.  Then Finn woke up and I got back in the bed, "Give me a hug, Finn, I've had a sad morning."  He wrapped his little arms around me and that's when I cried.  I cried for myself.  And I cried for those who are still trying for Baby #1, who don't have little arms to comfort them.

One of the wonderfully crazy things about TTC is that when a BFN comes along, you have a few minutes to grieve, and then it's time to start looking at the next cycle.  As soon as I got in my car at 8:30, I called my RE and left the following message (after giving all my vital stats), "I'm 12dpIUI and got a negative pregnancy test this morning followed by starting my period, so even though it's early, I'd say this cycle is a bust.  Our plan had been to try 2 IUIs and then regroup, but because of my schedule at the end of November/early December, I was wondering if Dr. M would be ok with me doing one more IUI cycle and then going from there.  If that's ok, then I need my meds called in, thanks!"

I managed to act cheerful at work.  My eyes burned with the need to have a good cry, but I was able to hide it fairly well.  All the messages coming in on my blog helped.  Tremendously.  But by 2:45 I still hadn't heard anything from my RE, so I called again, because their voice mail message clearly says that any calls after 3 won't be returned until the next business day.  I told them I was calling for the second time, and reiterated my same message.  At 4:30 I still hadn't heard back, so I called the front desk, and they got one of the nurses on the phone.  It took her a minute to find my file and then she said, "Oh, we still had 6 people to call back before you.  What can I help you with?"

Really?  First, I called at 8:30.  THAT many women had called before me that at 4:30 there were still 6 ahead of me?  Second, did they not listen to my message at all?

So I again re-explained myself.  She then said, "Well, we have orders for 3 cycles, so we can go ahead and get you set up to come in on Monday.  Do you have a specimen here?"

And of course I didn't.  I had two vials left after Finn, and we'd just used up those two vials.  And that's when it all went to hell.

"Oh, well you can't try this month.  We don't allow anyone to start their cycle if they don't have donor sperm onsite.  It's for your protection.  What if you took all those meds and went to all that expense and then something happened to the specimen and you couldn't get your IUI?"

I couldn't speak, because I was too busy crying.  I shocked myself with the ugly cry on the phone, standing outside, with patients waiting for me in my office.  The one thing that had kept me going all day was the hope of starting meds again next week.  I was shocked and devastated to learn that wasn't going to happen.

I do understand the logic behind their policy.  BUT, how often do you hear of a specimen going bad like that?  Compare that with how often someone gets a BFN and has to start all over again.  If a woman wanted to buy a single specimen at a time (which is more expensive, since the shipping is the same no matter how many vials you buy, but cheaper if you only end up needing one), she'd have to take every other month off.

The RE's office I go to is the best of the two in town as far as success rates.  This isn't based on the self reported data that is posted online, but based on my own informal polling of OBs, other patients and former employees of both clinics.  But today's experience has left me feeling very disappointed in the clinic and the care I received from them.  Disappointed and quite honestly, disgusted.

To make matters worse, I am going to be out of town the 4 day weekend of Thanksgiving, three days the following weekend, and then Thursday-Sunday the weekend after that.  So unless my next period comes exactly 28-30 days from now, I won't be able to try next month, either.

I know that it's not the end of the world.  When TTC, there are always roadblocks along the way, unexpected delays, and it's not uncommon for someone to have to take a month off here or there.  But the two months is what's throwing me.

So decided to try to make the best of it, and in between my tears, I made an appointment with Dr. M for 11/19.  If I have to take a month or two off, at least I can go ahead and meet with him so I can hit the ground running when I can get started again.

In a few days I'll regroup.  I'll be able to look forward.  But right now my head hurts, my heart aches, my eyes burn and I'm just deflated.

12dpIUI

I am definitely not pregnant.  This morning's BFN was followed almost immediately by AF.

At least the bitch didn't keep me waiting.

I was so hopeful.  I had symptoms.  I didn't have that certainty I had with Finn, but my symptoms were enough to make me believe it was real. I'd already imagined telling my parents at Christmas with a t-shirt on Finn that says, "Big Brother."

I really don't want to do this again.



But I want another baby even more.

Swimmers On Board!

My new lucky socks

As of about 8:45 this morning, I'm PUPO (pregnant until proven otherwise) once again!  I waited for no more than 5 minutes in the waiting room at my RE's office before being called back by MA, one of the nurses I've known forever.  In no time I was undressed and in the stirrups.  I was told my cervical mucous was beautiful (it's possible I blushed) and the catheter slipped in and then 22.8 million swimmers were set loose to do their job.

Last night I (finally) did a little research on estradiol levels and Femara, and found some very reassuring information.  Bear with me for a little science talk.  Femara is an aromatase inhibitor, and works to prevent estradiol production.  When estradiol levels fall, the pituitary is stimulated by GnRH to make more FSH, which then stimulates the growth of follicles.  So estradiol levels are suppressed to get more FSH, which makes it sound like estradiol levels would be expected to be low in an Femara cycle.  I found lots of anectdotal evidence to support this, then found a study that confirms it.

The study was designed to look at women who were undergoing egg retrieval before starting chemo for breast cancer.  The study had the women treated with Femara and then a gonadotropin (injectables) compared to women treated with just gonadotropins alone.  The end results were similar fertilization rates and number of embryos obtained, but significantly lower estradiol levels in the Femara group: mean +/- sd 483.4 +/- 278.9 vs. 1464.6 +/- 644.9 pg/ml; P < 0.001.

So we're talking estradiol levels of roughly 480 in the Femara group vs 1460 in the non-Femara group with very similar outcomes in an IVF cycle.  That, plus the fact that my estradiol was 250 the cycle with Finn makes me feel MUCH better about my chances this cycle.  I just hope the timing was right - I was a little late with the trigger shot thanks to trying to get Finn to sleep...my good CM and easy IUI make me think the timing was fine, but of course I have to have something to worry about.

We celebrated by meeting my sister and her boys at a local farm for some pumpkin picking before lunch. We picked out the perfect pumpkins in the pumpkin field, then went for a hayride and saw some pigs, chickens and horses.  The boys had fun - and Finn really enjoyed spending time with his cousins.

And now the two week wait begins again!  

Follies and E2

I had an ultrasound this morning - and was a little weirded out by the fact that I wasn't at all bothered by the dildo cam this time - it just seemed like a pretty normal way to spend a morning.

My lining looks great - 12mm (which means that if an egg fertilizes, it'll have a great place to implant and grow).  I had one nice follicle on the left (21mm), and several on the right: the largest was 23, and is probably my old friend Sam the Cyst, and then there was a 21mm and a 15mm.  I was really hoping for at least one on the left, as the only time I ever had a follicle on the left in the past was the time I got pregnant with Finn, so I left my appointment feeling pretty happy.

Based on the ultrasound, it looks like I've got two possible eggs to be released in a few days, so I was hoping for an estradiol level of 400, as it's expected that you'd have a good 200 for each mature egg.  My estradiol was only 202.

I don't know how hard and fast that rule is.  And I don't know if it's possible to have a couple of bum follicles that don't produce any estradiol, and one with a good egg that's producing just the right amount.  I'm going to hope and pray that it is possible, and that I have one good egg on the left.  If it weren't for that damn estradiol, I'd be feeling really optimistic right now.

My IUI is scheduled for 8:30 on Sunday morning. I'd been given instructions to take my trigger shot at 8:30pm tonight.  And then Finn fought sleep, so instead of being done with our walk at 830 as planned, we weren't done until 9:20.  And that's just because I gave up.  He's still awake.  At almost 10:30.  I have no idea what his problem is these days, but I'm at my wit's end with the sleep thing.  I cannot stomach the thought of doing cry it out, but it's starting to look like that might be the only thing that works. I don't mind walking for an hour if he'll go to sleep, but to walk for an hour and then have a child who is still awake at the end of the hour and cries if I put him in his crib, or try to sit and rock him is ridiculous. This is my least favorite time of the day.                        

10/11/12

Finn was conceived on 8/9/10...how great would it have been if I could have had my IUI today and then actually gotten pregnant today?  Alas, I'm only CD9, so no IUI for me.  I do have a monitoring appointment tomorrow morning, and will hopefully find out if my IUI is going to be on Sunday or Monday, as anticipated.  I'm definitely feeling the stretch in my ovaries, but still feeling anxious about tomorrow's possible results.  And finding it hard to believe how quickly the time between two week waits goes, while the two week wait itself seems to last for months.  How is that possible?

One of the best things about blogging is being able to complain about something and get commiserating comments in response.  I was at my wit's end the other night, and while I did feel better after just writing it all down, I felt even better with every comment that was made.  So thanks.

We've been gearing up for Halloween around here.  I've decorated the front porch, and have a ghost to add to it, as Finn is currently in love with ghosts.  He can't tell you what a monkey or a horse says, but does know what a ghost says. (That's not my yard or my ghosts - it's one of my neighbors.  And I'm going to have to steal their ghosts.)

Yesterday he and Nanny M carved a pumpkin, and tomorrow they're going to a pumpkin patch (a trip he'll be repeating with me in the next week or so!)  He also loves pumpkins these days (but to be fair, he'll kiss anything you ask him to...including my Gonal-F pen.  Yes, I asked my baby to kiss my fertility medication.  Is that weird?)

As of today, he only has one Halloween costume.  He does have 4 (or is it 5) Halloween themed t-shirts though.  I can't help myself.

Game On!

Where is this sudden rush of excitement and optimism coming from?  I have no idea, but I probably shouldn't question it too much!

I had my CD3 scan and labs this morning, and was once again greeted by my old friend Sam the Cyst on my right ovary.  Sam has gotten a little smaller since last time - about 18mm, but he's been joined by a new friend who's about 11mm.  Which of course had me worried that this cycle might be canceled.  I also had some fluid in my uterus, but otherwise the lining was normal in thickness, and since this has been another heavy period, the fluid isn't too surprising.

I stopped by the pharmacy to pick up my meds and then waited for the call from the RE.  And waited.  And waited.  And waited.  They called by 3, but those waits always seem to last for days.  This time there was nothing but good news.  My FSH was 8 (EIGHT!) and my estradiol was 24.  If you remember, my FSH was 16 on CD5 with the second cycle I had after weaning.  It then dropped to 12, and now 8.  I know FSH levels can vary from cycle to cycle, and that the high number is still something to consider, but I'm so excited about an 8.  And since my estradiol wasn't high, the new cyst is nothing to worry about.  My antral follicle count was 9 or 10, I've already forgotten which.

It's nice to know my body is sharing in my optimism this cycle - let's hope it continues to do so!

One damper on my parade - I just realized that I left my Gonal-F in my fridge at work.  Thirty minutes away from me.  And I start it on Sunday.  At least tomorrow will be a beautiful day for a drive!

And one other piece of good news - the results from my partner's biopsy came back as benign.  They're going to keep an eye on things, but right now everything looks good.  Such a huge relief!

A Fresh Start

Aunt Flo decided to show up this morning, 13dpIUI, kindly ending the worst 2ww ever.  Funny, I've had a low grade headache for the past 12 days, but this morning I woke up and it was gone completely.  I hope that's a sign of good things to come.

I feel incredibly optimistic about this cycle.  Over the past few weeks I've gotten a lot of things done that had been hanging over my head, and feel like I have a good plan to continue to get things organized.  Unlike a month ago, I actually believe I can find a way to successfully have two young children and work full time. Of course I know that I won't always be the best I could be at work, and I know I won't always be the mom I want to be, but I actually believe I will be able to raise my kids and not get sent to jail for (accidental) tax evasion or have the power turned off because I forgot to pay the bill.

My body feels ready for this cycle.  I feel strong and healthy and ready to get pregnant! I allowed myself two days of eating not so healthy, but starting tomorrow I'm back on board with getting all my fruits and veggies.  I'm still walking daily with Finn, and I'm going to try to add some yoga in (though if I don't get it done, I'm going to be ok with that, too).  I bought a fresh supply of CoEnzyme Q10 and started back on my other supplements today as well.  I called in refills on my meds today, and will pick them up Friday morning when I go in for my CD3 labs and ultrasound.

I mentioned several times during my last cycle that I had a hard time believing I was TTC again. Well, I believe it now.  And I'm ready.  Universe are you listening?

Confirming my Suspicions

I had some pink spotting last night before putting in my Crinone, and was tempted to just not put it in, but then decided I'd better be on the safe side.  And then I got another BFN this morning, at 12pIUI and I really wish I'd skipped it.  My whole stomach is achy, and I'm afraid the Crinone is going to keep AF away a couple more days, which is going to be pretty uncomfortable if I continue to feel like this.  (For the record, I had lots of mild "day before your period" cramping before my BFP with Finn, but this is different, this is more like bad period cramping.)  I really want to take some Aleve, but I can't bring myself to do it, just in case I get a late BFP.  I didn't get a BFP until 14dpIUI with my first pregnancy...which isn't very reassuring, since I had a miscarriage with that one.

I wasn't feeling very optimistic with this cycle, but then I had cramping around the time that implantation might be happening, and I've been so nauseated the past week - it was enough to really make me hope that I had been wrong to start with.

This has been the worst two week wait ever, I was so hopeful there'd be something good to come of it.  It started with the stress of Nanny M being sick on the day of and after my IUI.  Then our newest doctor's father (who had been ill for a long time with metastatic cancer) took a turn for the worse last Tuesday, and died on Thursday morning.  She's been a mess, and my heart breaks for her.  My other partner, the doctor who has been there almost as long as I have, had a suspicious lymph node in his chest biopsied last week - he gets regular monitoring for his history of lymphoma a few years ago.  We get the results of that today.  It has to be good news, I just can't imagine anything differently.

I think I need an Aleve, a diet Coke, and a strong sedative of some kind.  Or at the very least a baby who decided to sleep past 5 this morning.

Thank goodness my fridge is fully stocked with cold diet Coke.