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Archive for February, 2009

Protected: On Being Adequate

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Staying Organized

My kids have reached an age where everything is fun to play with – even things that aren't toys.  They love to open drawers and dump things out of them.  I have drawers and drawers and drawers filled with cloth napkins (I have a "thing" against paper napkins – don't ask me why, but I hate them, so I have dozens, maybe hundreds, of cloth napkins), and one of Ellie's favorite past times is opening the drawers and flinging the napkins (and tablecloths, for that matter) all over the living room. 

They dump their blocks, books, toys, shoes, clothes, food, diapers, everything all over the place.  There is nothing more fun and exciting than taking something that was neatly piled and flinging it across the room and scattering it wildly about.  Especially if Mommy is there to clean it up so they can scatter it about right behind her. 

So imagine my delight when my Programming Co-chair for our Parents of Multiples Club suggested a few months ago that we have a program on Staying Organized with Multiples.  Of Course!  Brilliant!  Our speaker tonight was herself a mother of twin girls, and a Professional Organizer.  She had a lot of great suggestions for organizing both your physical space and your time.  I was delighted to discover that many of the things she suggests are things that I already implement in my daily life.  My downfall, simply, is consistency.  I get caught up with too many things on my to-do list and don't always stay consistent with my ability to always do the things she suggests.  I also, simply, get overwhelmed with the clutter in my house.  Since having kids the sheer amount of *stuff* in my house has increased exponentially. 

Today, the J-man's teacher asked if I'd seen something she'd sent home a few weeks ago.  I hadn't, as J tends to take things out of his backpack before I can get to it.  I came home from tonight's meeting on Staying Organized inspired to sort through some junk in order to find that item.  And sort through the junk, I did!  Why, I was a complete overachiever!  I cleaned off the dining room table, cleaned the sunroom, threw out a dozen magazines that I haven't gotten around to reading and I'll probably never get around to reading, sorted through all the school stuff that's come home in J's backpack that I hadn't gotten a chance to look at, put a bunch of baby clothes away (someone had given us a box of clothes for the girls that had been sitting in our sunroom waiting for me to get to), cleared off two shelves on a bookshelf so that I could use it for easy accessibility for toddler toys instead of my books, cleaned out a cabinet full of old materials from a banquet I'd worked on a couple years ago, put away a couple boxes of toys I'd weeded through a couple weeks ago, but hadn't actually put away yet, cleaned up the living room, cleaned off the dining room table, cleaned up J's bedroom floor, found three missing pacifiers, filed away some papers, and threw out a bunch of junk.  Oh, and I got J's backpack ready for school for tomorrow.   Go me.  (Oh, and I *did* find the thing J's teacher asked me about… eventually)

I.  Was.  Productive.

Seriously!

Seth came home in the midst of this and said, "So, I guess you decided to find out where we had some extra space laying around?" and I said, "I bet you'll never guess what tonight's program was on?"

And you know?  There's more to do (there's always more to do, isn't there?), but it's a great start, and now at least I know one thing is down. 

At least until Ellie pulls all the napkins out of the drawers again…

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Fall from Hope

On December 19th, the first day I started taking BCPs in preparation for my first IVF cycle, I wrote the following:

I know every woman starting an IVF cycle talks about the irony of taking birth control pills in order to get pregnant. I don’t think for me that I find it ironic. I’m struck with a profound sense of – change. This feels like a big step toward my new goal. Toward my new hopes of family building.

I fear that the fall from hope will be devastating.

So today I went in for my beta from that very first IVF cycle, knowing full well that my beta would be negative. I brought with me cookies for J (Marketing Supervisor Extraordinaire, who reports that he has not yet even had a chance to eat my delicious snickerdoodles!), SuperNurse, and yes, even SuperDoc. The receptionist at the front desk was tickled pink when I left the box of cookies for SuperDoc, by the way. It was pretty adorable. I almost felt badly that I didn’t leave any for her, but hopefully the good doctor will share (though rumor has it that he’s quite the cookie monster, so who knows!?).

Two hours later, I got a call from SuperDoc himself.

“I’m sorry to say, I don’t deserve the cookies. It wasn’t the result I was hoping for; unfortunately, your beta was negative.”
“Oh, I know that!”
“Really? How’d you know?”
“Please! You can’t trust your patients not to pee on sticks! Plus I’m mighty certain my period is going to start any second now.”
“Unfortunately, both of those were correct. I already had a cookie and then saw your results and felt guilty about it.”
“Are you kidding me? All the more reason you deserve the cookies!”
“Why’s that?”
“Because now you’re stuck with me! Seriously, you can’t get rid of me now!”
“Wow, when you put it that way, I think I’ll have to have another cookie…”

It shouldn’t bother me, you know? None of this. I’ve been there, done that. Why, it feels practically anticlimactic. After all, I would have probably passed out from shock if he’d given me any news other than a negative today. But there’s something very, very final about the quantitative blood test. There’s no going back from there. It isn’t so much a fall from hope as it is the end of this chapter – knowing that there really are only two more chapters left before the conclusion to this part of the story.

And so… what now? What’s the plan?

In a word, or three? I don’t know.

Originally SuperDoc told me that what he’d do is check my progesterone in three weeks, if I hadn’t ovulated (which he doesn’t anticipate that I would have, he’d put me on provera for 5-7 days to induce a period, start BCPs, and on day 19 start Lupron, etc. etc.

Gah, I said. That gets us into Pesach. No problem, he said, we’ll check your progesterone in 4 weeks, provera, etc, etc, we’ll be a week after Pesach.

I hate the timing. Hate it. I told him so. I hate waiting that extra week I hate waiting that long. I am not a patient person. I don’t want to wait any longer I don’t want to do it. A break isn’t a bad thing, he said. Yes it is! I countered. I was petty, I’m sure. Irrational, no doubt. I gave him no logical reason why waiting was not an option. He said he’d give my nurse a few options on timing and I could work out the dates with her and see what worked best with me on timing, but if I really wanted what I can do is start BCPs as soon as I get my period. Take BCPs for four weeks (rather than the usual 3), then start Lupron, etc. He said from an ovarian perspective, he had no issue with that and I hadn’t hyperstimmed this cycle so he didn’t think it would be problematic in any way. SuperNurse and I can review the calendar together and see what works best for my schedule. [Update: Talked to SuperNurse – I can, in fact, start BCPs on CD2. However, the trick to that is that sometimes it takes a while to get a period, so if it takes a few weeks, we’ll just have to push it off until after Passover anyway. Bah. Hopefully all these cramps are a good sign that this won’t be an issue regardless.]

Which brings me to the protocol issues.

Lupron. Yeah.

He is going to increase my Follistim (not as much as he’d originally planned – my estrogen rise was appropriate for once, once I got to 150IUs… and the accidental 300IUs that one day…). He’s also going to increase my Luveris to 50units (up from 37.5). And… the Lupron. He’s going to keep the Lupron at the same horribly high dose. I told him the headaches were absolutely unbearable and he said that they should have gotten better once my estrogen rose (they got somewhat better around day 9 or 10 of stims, that’s true), and that on higher doses of follistim/luveris, my estrogen rise should happen earlier in the cycle which should mean that the headaches are alleviated sooner in the cycle. I hope he’s right.

His logic is this (or something like this… I was juggling a lot when he was talking, so I wasn’t really taking notes): he feels that the best option is to get more follicles growing early on, while avoiding a dominant follicle. He wants to use the high dose of Lupron to heavily suppress in order to avoid the dominant follicle (and also avoid hyperstimming), but more Follistim to greater stimulate the ovaries into producing a greater number of follicles. I did ask about not using Lupron and using an antagonist protocol instead, but he was against it for a number of logical reasons. While he has had success with that protocol with other patients, with patients with MY profile, he has better success with a Lupron protocol.

There’s a piece of me that wonders if I’m just tying SuperDoc’s hands by forcing the eSET issue. But then I think back to my appointment on Dec. 15th with my perinatologist and his dire warnings about me and a twin pregnancy and I realize that it just isn’t a possibility. I simply cannot take that risk, even if it means I don’t get pregnant again. And it is that reality – the knowledge that it is my own determination to push forward with eSETs that may be my downfall – that humbles me, reminds me that hope is something I may just have to let go of some day.

And at the same time, I know that I am unendingly lucky, for I have smiles and hugs and snuggles every day from the miracles I already have in my life.

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Seriously, people!

Will 9:30 tomorrow never come? And why, oh why, did I not make the 6:45 appointment instead? What was I thinking?? (Oh, wait, that’s right, my husband has to be at work at 0630, so I couldn’t go in at 6:45 regardless… it’s HIS fault!) Yes, I totally get that tomorrow’s vampire draw isn’t going to change anything. But at least it’s something to do.

Bah.

In other news, I need a new blog layout. Seriously. And I’m not creative enough to make one. And I’ve searched for free blogger skins that I could modify and I can’t find any that I love. So I need help.

Help?

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Do you know the definition of insanity? Doing the same action over and over again, expecting a different result.

Why, then, do I continue to POAS? Is it insanity? Or, as Jody suggests, simply ritual?

Truthfully, though I don’t deny that I’m crazy, I don’t expect a different result, so I imagine there’s simply some comfort in the morning ritual, just as there is in the evening ritual of drawing up the PIO injection. At least I’m doing something.

It certainly won’t change tomorrow’s beta, that’s for sure. But after tomorrow, there won’t be anything to do for at least a few weeks. That time is interminable to me. I remember after my miscarriage in 2006 I had to wait a couple of months for my hCG to zero out, and then they still made me wait another month before starting a cycle.* That was absolutely the worst three months of TTC for me, ever.

I suppose I’ll use my break this time to make random drop ins at YOFC to check and see if that mobile has been hung yet. AHEM. What do you think, J – has it been hung yet?? Don’t think I’ve forgotten about it! I’ll cut off the cookie supply if it doesn’t get hung!

Just kidding. I’d never cut off the cookie supply. I’m too nice. Snickerdoodles tomorrow. They’re already made.

*Note, there are no scientific studies (that I can find) that support a need for a month off after the beta bottoms out (my OB/GYN supported my theory on this) – most doctors admit that this is purely because they believe it will help a patient emotionally. However, I believe that the 2 months it took my beta to bottom out was a sufficient break. Furthermore, my completely unscientific survey with a sample size of, oh, 6 or so, showed that being forced to take an additional month break without being consulted as to whether this month was emotionally necessary was, in fact, perceived as patronizing and was more emotionally harmful than helpful.

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Infertile Enough?

Because Infertile Myrtles aren’t neurotic enough, we like to find ridiculous things to obsess over. In my first go-round with fertility treatment, I often thought about the fact that I really just didn’t have it all that hard. I have a relatively simple issue to correct – anovulatory PCOS – which does seem correctable with the right combination of gonadotropins and hCG trigger.

My original (evil) OB/GYN ridiculed me – telling me if I just lost weight and took Clomid, I’d ovulate and get pregnant in a jiffy. I should just exercise more and eat less and I’d be pregnant in no time, she told me. I tried that, and I took her five prescribed cycles of Clomid, unmonitored, I might add, which I now believe to have been a dangerous course of treatment, but no pregnancy. I listened to her lectures. I took her berating stares, believing that this was really all my own fault. I discarded the facts of the case, I ignored the truth, which was that I had gained much of this weight not through my own fault but quite suddenly – sixty pounds in five weeks, due to a metabolic shift in my body that was out of my control, and the rest due to years on migraine-controlling medications such as Depakote (known as Depabloat, for a reason). I took upon my shoulders, instead, the guilt and the shame that she placed there, knowing that my simple problem was my own. If only I hadn’t done this to myself, I’d be pregnant.

Eventually, though, I realized that I needed more than stern lectures, and exercise pep talks, and cute little white pills for five days a month, and I self-referred to Ye Olde Fertility Clinic, where I met with a wonderful doctor who told me that this wasn’t so much my fault, that I had, at least on the surface, a common issue, that would likely be relatively simple to fix, but that Clomid was not my answer any longer. My OB/GYN at the time was pretty pissed at me for self-referring. She, herself, would have had me take one more round of Clomid before referring me over to YOFC. “But no worry! This is such a straightforward case that just the teeniest little dose of the heavy duty drugs and you’re going to be pregnant in no time!”

Nearly a year later, a couple dozen vials of blood, an HSG, many ultrasounds, and four IUIs later, I was, indeed pregnant, and in need of an OB. No way was I returning to that doctor. No. Way. So I got a referral from my RE to an OB who was actually even more convenient to me and (as it turned out) someone who a bunch of my friends see, and I was off. Three months later, I miscarried that baby, and I became thoroughly convinced that I had made the absolute right choice in doctors – he handled the situation with care and empathy and concern for my welfare. And back to YOFC I was, only to find my RE on maternity leave – and when she returned to work, she didn’t return to the office convenient to my home and work … but to an office far out of the way for me. So I switched to SuperDoc.

Even then, a piece of me felt that I just wasn’t that interesting or complicated a patient. I have this theoretically simple issue. I don’t ovulate. I have PCOS. Give the girl some drugs, give her an hCG trigger, a quick intimate moment in a doctor’s office in stirrups with an IUI, and bada bing bada boom – pregnancy (theoretically). Not a complicated case. I knew then, and I know now, that I don’t suffer many of the indignities of infertility that a lot of my fellow infertiles suffer. I don’t have thrombophilia. Er, not exactly anyway (I am borderline on one test… but not quite enough to make anyone worry). I don’t have recurrent miscarriages (yet, and I hope never to be able to say that I do). I don’t have natural killer cells. I don’t have fibroids or stage IV endometriosis (though it’s been suggested that I might have very mild endometriosis which does not in any way interfere with my fertility). I have never had uterine, cervical or ovarian cancer. At the time I had a completely unremarkable HSG with patent fallopian tubes. I do not have premature ovarian failure. I was able to do something that many of my fellow stirrup queens had never been able to accomplish – I had been able to get pregnant. And with only the “low tech” IUI, at that! I knew, really, that I had nothing to complain about.

I’ve written about it before, but for the sake of completeness of history, I’ll tell you the story again… I remember sitting in SuperDoc’s office at my second consult with him after another 2 IUIs and saying that I knew that compared to most women with infertility, I have it pretty easy. I have carried his answer with me ever since: He looked at me earnestly, paused, and said, “Let’s just say you’ve handled your burden with extraordinary grace.”

I shrugged it off at the time, as I am prone to doing. I wasn’t, after all, one of the “real” infertiles. I wasn’t hard-core yet. I’d never done IVF. I hadn’t suffered multiple losses. I’d only been at this baby-making business for about four years. I’d only had six IUIs at that point, for a total of 11 medicated cycles. After all – there were so many out there who had been through so much more.

Two weeks later I found out I was pregnant. And two weeks after that, I found out I had HOMs a-brewin‘. I felt exposed and vulnerable. And once again, like I wasn’t a “real infertile.” Why, I was so fertile, I’d gotten knocked up with more than I’d bargained for. WAY more than I’d bargained for.

But it DID start changing my perspective on infertility, quite accidentally. Because being pregnant with HOMs makes you the poster-child for infertility. Suddenly everyone assumes you’re an infertile. (Oh I feel so sorry for anyone who is pregnant with spontaneous HOMs – for they must forever be explaining that “No, these were a total surprise!” like it’s anyone’s business) I began to realize that at any stage of infertility, whether it’s someone who’s been trying to get pregnant for just one month without success, or someone who has given up trying after months or years of treatment (or anyone in between) – they have a story to tell, and their own burden to bear. People would come to me and say, “I know I haven’t been through as much as you, but we’ve been trying to get pregnant for six months, and…” And I tell these women that they should never believe that they’re not “infertile enough” to be legitimate in the infertile world. Each stage of infertility has its own burdens, trials, and tribulations. Each stage has its own challenges. And each set of challenges must be met with its own level of grace and humility. But we have a right to rage against each stage – to express our hurt, our anger, our outrage. We have a right to wonder, “Why me? Why now?”

And now? Now that I’ve been through IVF and probably failed a cycle, do I feel any more “legitimate” in the world of infertility? No. I still know that I have this pretty simple problem. This problem that should be pretty simple to solve. (Oh, except I do now have that blocked tube on the left side that may be real or may have just been a spasm, so who knows?) I have this problem that should be a simple case of “injections, IUI, bada bing, bada boom, BFP.” But nothing is that simple, is it? Most people do IVF because IUI doesn’t work for them. I’m doing IVF because IUI worked too well and I can’t take that risk again.

I don’t regret my infertility as many do. I know there are days that I am on medication when I am not the sweetest, kindest person I could be – and I regret those individual days. But by and large, I have reaped the benefits of infertility far more than I have suffered from it. I have met amazing women, experienced great joy, been introduced to a wealth of knowledge, learned about a plethora of intriguing scientific, ethical and moral issues that many people never even think about. I have become a stronger, healthier and ultimately happier person overall. I have become more sensitive to the needs of others, and recognized that you never know what is going on beneath the surface of another person, and I try to live my life accordingly. I know that the reason I’m going through this again is because I recognize the true gift and blessing of my children – and I know that (for me) I cherish them at least a little bit more for having had the wait (note, I don’t mean to imply that fertile myrtles don’t cherish their children, I only mean that I, personally, know that I view my children differently because of my experience)

I also know, now, that infertility is never about fault. I know now that infertility is a disease of the reproductive system. And I’ll never again let a doctor tell me again that a legitimate disease is my own fault.

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Just in case you were thinking that just *maybe* 14dpo might *just* be a little too early still and there *might* just still be a miracle waiting… let’s just assume that 15 and 16dpo is quite definitive, shall we?

I’m still bringing J and Co. Snickerdoodles on Wednesday (beta day). It’s not their fault my body sucks, right?

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