I'm stealing the name of this post from an excellent middle grade/YA novel by the same name. The novel has absolutely nothing to do with the theme of this post, but I always like to plug a good book.
Watch out, this one's a doozy. Thanks to Ned Ryerson for that.
I haven't written on this blog in just over a year, and I have obviously fallen way off in recapping Jeeves' and my adventure in France which was (jeez) almost two years ago now. Since that trip, we've been to Italy and Portland/Seattle/surrounding PacNW environs. Also little trips to Chicago and Cincinnati. I may get back to recapping the Paris trip at some point, but for the time being, I want to talk about something else.
Not sure what inspired me to start writing on this blog again, although the number of blogs I have been reading lately probably has something to do with it. Yeah, I've been reading a lot of blogs kept by fellow infertiles lately. But I have no desire to keep a blog solely focused on that aspect of my life. I understand why people do it, but when I'm in the middle of a treatment cycle, I really don't want to share the details of it with others, with the exception of my acupuncturist and a close friend who has dealt with infertility (and therefore knows what all the numbers mean and all the slang and abbreviations, and knows how I feel about everything before I even have to voice it because she's already been there). And since my miscarriage, I feel even more sure that when we eventually start treatment again, I'm not going to want to talk about it.
So here's my thought on the matter - I will periodically be posting about infertility here. I won't always be posting about infertility. I'll hopefully be posting again about books and articles and movies and restaurants and food (glorious food!) like I used to. I won't be posting details about my treatment cycles, although I'll surely still post about my feelings and thoughts and what not. For those of you who read this blog because you know me in real life and you're just following along, I promise I will try to limit the gory details.
Here is how we got here, if you don't already know: Jeeves and I have been together for over 7 years now, we've been married for just under 2. We both always knew we wanted kids. I went off the pill in April 2012. Got my first post-pill period in May 2012. In June, I started "charting" (that means taking my temperature when I wake in the morning every day and putting it on a little chart to determine if I am ovulating and how long my luteal phase is). Everything looked pretty good on my chart, it seemed like I was ovulating. In July, I started using ovulation predictor kits (OPKs). I was indeed ovulating properly. And if you're a fellow infertile, yes, I read Taking Charge of Your Fertility cover to cover.
By early September, still not pregnant despite everything appearing fine, I started to get really nervous. I was 34 and time seemed of the essence. My aforementioned friend who has dealt with infertility for many years wasn't far from my mind. I've never been one of those people who assumed I'd just get pregnant without any problems. So I made an appointment to go to a reproductive endocrinologist (RE). She recommended a battery of tests: general blood tests for both of us, a hysterosalpingogram (HSG) for me, a semen analysis (SA) for Jeeves, and a variety of cycle-specific tests for me (estradiol, FSH, progesterone) and anti-mullerian hormone (AMH) which can suggest if you have diminished ovarian reserve. Long story short - every one of my tests came back just fine. Totes normal. I was shocked. I was so sure if anything was wrong, it would be with me. Jeeves's SA showed an issue - fine volume, count, motility, but very low morphology. A follow up a month later showed the same thing.
Our RE told us it wasn't impossible for us to get pregnant without help, but that it might not happen without assistance. She diagnosed us as "unexplained infertility with mild male factor." She recommended we try three cycles of intra-uterine insemination (IUI), and if that didn't work, move onto in vitro fertilization (IVF). If you're wondering why I'm spelling everything out and linking, it's because I've found that the majority of people in my life honestly did not know the difference between IUI and IVF before I told them about it. We were okay with this because IUI is covered by our insurance, but IVF is not. Still, I've read several studies that indicate in women over 35 (I wasn't there yet, but close), with partners who have poor morphology, there was absolutely no benefit to IUI. I asked our RE about this and she said she still thought it was worth a try, but no more than 3 cycles.
We decided to take a couple more months and try on our own. Nothing happened. Beginning of February, I did IUI #1. Exactly 14 days after my insemination, I got my period (good old Aunt Flo, or AF to anyone who spends time on infertility boards). I was still charting at this time and had seen my temperature dip, so I knew it was coming. I went in for my day two baseline (for the non-IFers, when you are in treatment, you usually go in on day 2 or 3 of your cycle for a "baseline" blood test and ultrasound to make sure you don't have cysts, check your uterine lining, get blood drawn, and get your marching orders for meds). That afternoon, while shopping for baby clothes for other friends (Super fun. Not depressing at all. Right.) I got a call from my clinic - I could not start my clomid (that's the medicine I take to make sure I ovulate some pretty eggs) because my pregnancy test came back positive. "That's not possible," I told the nurse. "I have my period - and it's not spotting, it's a real period." Nevertheless, I would have to come back in and get my blood tested again in a few days. I realized immediately it was probably a chemical pregnancy. On the one hand I was sad, of course, but on the other, I thought - hey, my egg and Jeeves's sperm actually DID something! That's a change! Over the next two weeks, they tracked by hCG levels (aka betas). In a normal pregnancy, your hCG doubles every 48-72 hours. My next beta was in these parameters - could it be that this could possibly work out? Ha ha. No. Two days later, it had only gone up a a few points and my RE called to tell me this was not a viable pregnancy. Next beta then did double normally! Could my RE be wrong? No. After that, they fell. It was disappointing, but not crushing since I had always known having a full-on period, low basal temperatures, and crappy low betas was not a good thing.
IUI #2 was just a plain old big fat negative. Nothing to see here, folks.
IUI #3 started out disappointing - my follicles developed much more slowly than they had the previous cycle. We got through the insemination, and I tried really hard to not feel hopeless about the whole thing. In the meantime, I started researching IVF protocols so I would be prepared when meeting with our RE when this IUI cycle surely failed. But something happened - my temps didn't fall like they usually do before I get my period, and I started having pregnancy symptoms. At 12 days post IUI (12dpiui), I took a home pregnancy test (HPT) and it was positive! Jeeves and I were so happy. I took one every day after that, hoping it would get darker, and it did. My first beta at 14dpiui was 118! That's great! Great great great! My next beta few days later was 476! Beautiful! A doubling time of 48 hours - perfect! I should note that most clinics only require 2 beta tests and then they schedule you for an ultrasound a couple of weeks down the road. Not mine - mine requires, like, 4 or 5. Beta #3 was 856 - a 56 hour doubling time, so that's okay. At this point, Jeeves and I were feeling pretty good. I hate the beta roller coaster, but it seemed like we could maybe be happy now.
After Memorial Day weekend, I went for beta #4 and knew I was in trouble when the doctor called instead of the nurse. My beta was 2146, which is a 95 hour doubling time. Not so hot. The RE was worried about a possible ectopic pregnancy (that's when the embryo implants in your fallopian tube, or anywhere else other than the uterus). They wanted me to come in the next day, when I would be 5 weeks and 5 days pregnant (5w5d) for an ultrasound to rule out ectopic. That day was one of the crummier days of my life. Don't get me wrong, it's not up there with the day my mom died or the day Dad was diagnosed with cancer and had emergency bowel resection, but it was definitely crummier than most other days of my life. Definitely crummier than when we got bedbugs. Our RE (it's a group practice so on this day, the doctor I saw, who is very nice, was about 6 months pregnant herself.... the irony of that was not lost on me) basically was concerned that what turned out to be my corpus luteum was possibly an embryo attached to my ovary. In my uterus, she saw a small gestational sac, but she couldn't rule out that it was just a hematoma. So she sent me down the road for a high resolution scan at the snazzy high risk ob/gyn. The high risk OB thought it was stupid that I was there, said it was clearly a corpus luteum, agreed that he couldn't see anything in the gestational sac, but also said it was really too early to know anything.
Thus followed an awesome ultrasound roller coaster. At 6w5d, after making peace with the fact that this would probably be a blighted ovum (where the embryo implants but then never really forms, thus leaving an empty sac), our RE saw a yolk sac! Could it just be that my tilted uterus (yeah, found out I have one of those) was preventing us from seeing the bean? Possibly! No, dopey Megs, but it's cute how hopeful you get sometimes. At 7w3d, our RE could see the fetal pole, but there was no heartbeat and it was measuring at only 6 weeks. She was pretty sure this was not viable. She sent us back to the high resolution scan people and they confirmed at 7w4d - I had what is called a missed miscarriage, which means the embryo died, but your body is too dumb to do anything about it. I talked to my RE at length about what to do and in the end decided to have a D & C at 7w6d. It went fine. I'm glad I did it instead of waiting weeks for it to happen naturally.
Unfortunately, genetic testing of the product of conception (POC) was cross-contaminated with my awesome cells, and so we will never know if it was a chromosomal issue (most likely) or something else. In the mean time, my RE is having Jeeves and me karyotyped to make sure there is nothing wonky with our chromosomes, and I am having a whole bunch of blood tests soon to make sure I don't have an immune or clotting disorder that makes me more susceptible to miscarriage (aka, a recurrent pregnancy loss, or RPL, blood panel).
Today, just over 4 weeks since the D & C, my hCG level finally dropped down to 8, which is not quite negative (anything below 5 is negative), but means I can stop being a pin cushion at my RE's office for a couple of months until we start this bullshit over again.
Hopefully in September, we'll try IUI again. As you may have noticed, I have had 3 of these IUIs and my RE had said she would limit it to 3. But since I got pregnant 2 out of those 3 times, she thinks we should stick with this rather than move onto IVF. Works for me.
That is the story. I have been feeling all of the feelings since then. I know that if Jeeves and I get pregnant again, we will never get to be one of those happy pregnant couples. We will always know that one positive home test is meaningless, that two or three good betas are meaningless. Maybe if we get a heartbeat on an ultrasound I will feel happy, but I know too many other women who got that far and had miscarriages. We know how the sausage gets made now, there's no turning back.
The truth is, I am okay. I was really sad for awhile, and really jealous of every pregnant woman I saw for several weeks. The hardest part has been feeling like we can't move forward - we are stuck in this waiting room until my tests are done and I have a period or two. On the other hand, I realize that having a break is probably the best thing for me.
I had a couple of minor epiphanies about this whole situation this past week. I was reading an article in the Times about women in Ohio who were recently freed after a decade of captivity. They made a video to thank people for the support, and Michelle Knight said, "I will not let the situation define who I am. I will define the situation.” My first thought was, wow, that's a great sentiment. And it got me thinking about the labels we wear and how they define us. My husband and I are experiencing infertility and early pregnancy loss. But that does not define who we are. For me, I define myself as a wife, daughter, sister, auntie, friend, ginger, New Yorker, New Jerseyan (in my heart), erstwhile litigator, hopeful librarian. Those labels define me. Infertile does not define me. Does it influence how I feel and think about certain things? Sure. Will I remember all this stuff if we ever get pregnant? Definitely. Will I be honest about how hard it was for us to have a child, if we ever have children? Absolutely. But I am going to define this situation, not the other way around.
The other epiphany involved my mother. Mom died very suddenly of what we assume was a massive heart attack over seven years ago. We were very close. Her death was very hard on me (and did indeed define me for awhile). At the time she died, I was 27, which is still a pretty young age to lose your mom, even though I was an adult. I had only one other friend, Roo, whose mother was dead. And actually, seven years later, although I do know other people in my age-group who have lost their mom, Roo remains my only actual friend who is motherless as well. When you are in your late twenties and thirties and your mom is dead, life is different than it is for other people who still have their moms. When my mom first died, I was jealous of other people who still had their mothers. It passed. Of course I still wish my mother were here, but she's not. For better or worse, I am in that crappy exclusive club of people whose moms are dead. And our path is different. Lots and lots of people get pregnant with no trouble. Lots and lots of people never have a miscarriage. That's not my life. And there's no use pouting about it. My path is different. This realization made me feel a little less angry at every pregnant woman I saw. My friends who still have their moms? They didn't steal my mom. My mom isn't dead because those other moms are still alive. And I don't want someone else's mom - I want my mom. Likewise, those women aren't pregnant with my baby and their success is not my failure. And I don't want their baby - I want my baby. This doesn't mean I won't have bad, jealous moments, days or even weeks. But I realize my path to having a child is different, and hopefully we'll have better luck next time.