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Thursday, March 27, 2014

Spoiler Alert: Negative

Receiving the call was not a total surprise, but was still disappointing. How can you miss something that was never there? Nicole and I sulked a little but then were just eager for me to get my period so we can start again. We went out to dinner as planned, and it was really nice. Nicole’s sister had given her a gift certificate for her birthday last month for the local Italian restaurant that we LOVE right across the street from us. I suggested using it to go out and celebrate if we learned we were pregnant, and Nicole said she thought we should go no matter what. That way we wouldn’t feel extra punished after already receiving difficult news, and it would be something we could look forward to no matter what. I’m so glad she said that, and it actually ended up feeling like the start of a new beginning, looking forward to the next cycle and the next attempt.
And in the meantime, I’m going to enjoy a few things that I couldn’t while possibly being pregnant:

--a frozen Coke (check! Nicole brought me one when she picked me up from the train yesterday)

--a Frappucino on Friday morning

--a pedicure (Nicole didn’t want me going into a nail salon where there are strong vapors)


Those will be my three indulgences, and then we will get back on the horse.

Monday, March 24, 2014

Emotional Roller Coaster

Oh what a ride it has been...and I'm acutely aware that we're just at the beginning, and that couples can spend years trying to conceive. It's only been one cycle and we feel like we're going out of our minds!

A coworker I'm close with is also going through IUI (but with Clomid) because a recent accident left her husband with a low sperm count so they're having difficulty conceiving their third. We both started the same month, with her having experienced her first negative test result within days of when I was getting inseminated. I was telling her about the agonizing two-week wait because I knew she'd understand, and she said, "You know you can take a home pregnancy test days before that, though, right?" Ummm no, no I didn't!

Cue the crazy. (And yes, she said today she regrets having told me that.) I calculated within two days when I would likely be due for my period, which would be this Tuesday or Wednesday. I bought a Clear Blue Easy digital pregnancy test that is extra sensitive to hcg so it can detect pregnancy up to four days before your missed period. Saturday was four days before (if I was due Tuesday) and I couldn't wait any longer than that to take it. Nicole and I were huddled in the bathroom waiting so patiently for the little hourglass to stop flashing and to show a result. And it was negative. We were disappointed but then tried to remind each other that only 65% of positive pregnancies show four days prior (it goes up to 90% three days prior, I think) so it could be a false negative, and also what if my period was due Wednesday? But my mood was muted and Nicole was cranky the rest of the day.

That evening we started trying to find silver linings because we couldn't stand staying in that space. These included: avoiding a Thanksgiving/Hanukkah birthday; pushing my five months maternity leave closer to my mother-in-law's summer break when she could watch the baby for another few months; not being quite so uncomfortable at my brother-in-law's much-anticipated wedding way out on the tip of the island September 27; not putting my mother-in-law in the position of having to help plan a baby shower immediately after her son's massive wedding that is already stressing her out.

The silly thing is that none of that would actually bother us if we learned I was pregnant, but we did a good job in the moment of telling ourselves that we'd be better off with a January 2015 baby. Willing suspension of disbelief, as they say.

Then Sunday morning I felt a horrid compulsion to take the second test in the box. I knew Nicole regretted having taken the first one, but I had to know. And maybe today, farther in, there would be a more accurate result. And maybe even a positive to ease our minds! I figured if it was negative, I wouldn't tell her I'd taken it because I knew it would increase her anxiety and distress (and probably mine too, but I couldn't stop myself). If it was positive, I could jump into bed next to her with it and squeal excitedly, and what a nice surprise that would be for her.

I was so careful to be quiet. I got a new disposable cup from downstairs instead of using the one in our bedroom so I wouldn't alert her. Then I turned the shower on first to drown out the noise, and peed and tested while it was on. Then I suffered the disappointment, showered, and went back to the bedroom where Nicole immediately said, "Were you taking a pregnancy test in there?"

Then I asked her if I could drive myself to Hebrew class because it was silly for her to waste gas going back and forth both times, plus it was early and she shouldn't have to get up yet. She insisted on taking me but I pushed the issue. All so I could sneak by Rite Aid and buy another pregnancy test. I swear, I felt like an addict. I'm never deceitful with my wife, but I HAD TO KNOW. And if it was positive, she'd be happy, and if it was negative, I wouldn't tell her until after it was confirmed by a blood test, at which point I'd be able to admit to my crazy.

This time I bought First Response, which can detect hcg as early as six days before your missed period. I was only at two or three days before, so this would REALLY be accurate! I came home and Nicole was talking to one of our international students, so I slipped upstairs and took the test. Another negative.

Again Nicole said, "What were you doing up there? You didn't even say hello." And I had to admit that I'd bought another test. There is one left in the box and I agreed to wait until Wednesday morning to take it so that I don't keep going crazy and I can just know for sure before getting the call at work with the results of my bloodwork. But it is NOT easy. I'm thinking about it constantly, up there under my bathroom sink. What's the harm in taking it and then just buying another box, which I could then use for Tuesday AND Wednesday? But I promised. I'm taking the advice of not giving in to my anxiety and making it worse. And it is so, so hard. It's like I just want to keep peeing on sticks until one shows up positive - the very definition of insanity, no?

I keep thinking I feel something and wondering if it's my period coming or implantation. Then I remember that since I'm taking vaginal suppositories of progesterone three times a day (oh I didn't mention that my levels were a little low so I got to add in this messy, chalky game?), my period will probably be delayed AND its common side effects are the same as symptoms of pregnancy and menstruation (mood changes, tender breasts, etc.). So I can't even trust the signs my body is giving me. I feel so out of sorts. Emotional and disconnected from my own processes.

And stupidly, some part of me is still holding out hope that all these negatives are false and I'll be blown away by happiness Wednesday. Even as I cry and stress about why our vial only had 7 million when our friend who used the same donor had 12 million and what if we had done this or that differently, I cannot change that my personality and my soul, to its very core, is hopeful and optimistic.

Tuesday, March 18, 2014

The Waiting Game

We are soooo impatient!!!

The first couple of days after IUI, I was flipping-out excited pretty much nonstop, thinking of what was potentially happening in my body. I was so in awe of even the possibility of it. Then for a good portion of one day, I wasn't even thinking about it, and when I did, I flipped out even more at the idea that I had been just going about my daily life as if everything was normal when in reality EVERYTHING MIGHT BE DIFFERENT.

We research incessantly for any possible indicators. I push on my breasts several times a day to see if they're sore, but they're only sore because I keep pushing on them. I want to notice something, anything, to give me hope, even though I know realistically that it's way too early for any symptoms.

It's all we can talk about. We have other conversation for a bit, but it inevitably ends or is interrupted by "what ifs" and hopes and doubts.

Eight more days til my blood pregnancy test. Six more days until we can take an early-indicator home pregnancy test with any accuracy. I'm trying to make myself enjoy the process, even the antsy-ness, because if it takes us months to conceive, the excited nerves could turn to anxious, frustrated, fearful nerves after a couple of failed cycles. I'm trying to appreciate the anticipation and the closeness it has brought us as we dream together. But, please, please, please, can it be next Wednesday already???

Thursday, March 13, 2014

Conceiving Our Baby (hopefully)

We left the house at 6:45 yesterday morning to go out east to the clinic's site for reproductive procedures. It was strange going to a new location when I'm so familiar with our little branch. The place was in a very stark area, with nothing but corporate buildings for companies like Estee Lauder. The waiting room was modern and comfortable, and much larger than our local site. We had been told to arrive at 7:30 and that the "specimen" wouldn't be thawed, washed, and prepared until we had gotten there so that none of its shelf life would be wasted. So we patiently and nervously watched "The Today Show" after checking in. I got called back once by accident, because they assumed out of the four people in the waiting room, there was only one Rachel, and they didn't call out a last initial (and the correct Rachel must have been in the bathroom or something). They had me all set up to take blood when the woman said she wanted to verify everything. She said the doctor's name (wrong) and then asked what I was there for before double checking my last name and realizing her error. She was mortified, so I probably shouldn't have joked, "No one else's embryo is in me, though, right?" Back out to the waiting room I went, and she came back out a few minutes later to apologize yet again and to say they almost ALWAYS call the last initial and ohmigosh I'm so sorry.

Eventually we were called back to verify the vial of sperm. The guy that took us back was in a white lab coat, and he took the vial out of the little tank, with the dry ice visible in the air. It was so labby and scientific that my inner nerd got really excited. It was just cool to me. He had me verify the donor number and bank name on the vial, verify that it matched my form, and then sign to it. Then we sat in the waiting room again while they washed it and separated out the super motile sperm. (I felt giggly at the idea of the sperm getting a "bath" and preparing for their job!) We got called back to the same area a second time to verify again that it was our vial, and then it was handed over to me to carry across the building to the insemination rooms. It felt a little odd to be carrying this tiny, warm vial of sperm that was about to go in me! I guess they want to make sure there is absolutely no opportunity for it to be out of your sight and for you to later accuse them of malpractice. I was even instructed to put it myself into the "warmer" - a little box of about twenty little holes that the vial fits right into.

The nurse practitioner was very kind, but I did wish it was someone I knew already doing the procedure. I got into the stirrups just like I have every morning for the past few days, and quite a bit in the months before, and whispered a "Shehecheyanu" before the nurse came back in. She did a transvaginal sonogram first and said that the follicle had not yet collapsed and was at 19.5mm. (So I went from 17 on Monday to 18 on Tuesday to 19.5 on Wednesday - not bad progression, considering most people's follicles are at 20-22 when they ovulate.) Apparently after the egg is released, the follicle collapses and is no longer visible. The Ovidrel (hcg trigger injection) had only been in my system 12 hours, not the recommended 24-36, because I had surged a little earlier than they expected and was informed less than 24 hours prior to undergoing IUI. Having just taken the Ovidrel the night before and having a follicle at 19.5mm meant that I had not yet ovulated but that it was very imminent. So they recommended a second IUI the next morning so that there would be living sperm in me long enough to catch the full lifespan of the egg at whatever point it released - "if you have another vial and if you can take the time to come in again." I can't imagine saying, "No, I don't want to be late to work so I'll just do it today." Once over $3000 is sunk into a procedure, I'm in it all the way! Let's get this done!

After the sonogram, she put in the speculum (ugh) and swabbed my cervix to make sure it was clean and clear (ugh) before inserting a long, skinny catheter through my cervix and into my uterus (ughhh!). None of this was comfortable, but only the poking through my cervix was actually painful, and that was very minor, like a pinch. (I learned that your cervix is soft and open when you're ovulating, so if it hurts a lot and bleeds, you're probably being inseminated at the wrong time.) From there it took about ten seconds to inject the sperm and then pull the catheter and speculum out, and holy cow it was over already. She told me to lay there for a few minutes and she'd come back. Then she came back with post-IUI instructions which the PA had faxed over. She had written on it the date of the first IUI, and then under "second" she wrote, "if follicle not collapsed, 3/13/14". I guess if someone is willing to do a second no matter what, just a date would be there, but she made it clear that I only wanted a second if it was actually recommended and would be useful. (No need to throw away a $500 vial of sperm.) Then under that were my two follow-up dates: seven days later for a progesterone check, and fourteen days later for a blood pregnancy test. At the bottom she had written, "Good luck, Rachel!" with a smiley face.

We left and got breakfast to take home. We were home by 9:30, and I realized I could easily have gone into work late if needed, but was so happy we took the day off to spend together. Even though we knew it was silly because the sperm was already directly in my uterus and didn't need the help of gravity to make its way there, we still both felt the urge to have me laying down for a while and taking it easy. I put a pillow under me and lay on the couch, thoroughly enjoying my four-cheese souffle. Nicole and I were giddy all morning, talking and dreaming about our baby, the idea of which we shouldn't be attaching to already but we did. We are.

Then Nicole started getting irritable because one of our students (the ones we have had since September to help bring in extra income for babymaking expenses, which I wrote about in Opening Our Home) had stayed home from school and was just bustling around upstairs. She wanted us to have "just us" time, which we had expected to have in the middle of the day. So she spontaneously suggested getting a hotel out east near the clinic so that we could just be together and also be close the next morning. I eagerly agreed, and we packed a bag, left dinner for the boys, and headed out in the early afternoon. We had dinner out and then just spent hours together before going to sleep early. It was a lovely, beautiful, romantic, and relaxed day, and I love that if this cycle works, we will have spent our conception day like this.

Oh, one other detail I neglected to mention: I felt ovulation twinges about five times that day, starting mid-morning and going until late afternoon. I've felt ovulation twinges before, it's something I experience in general, or else I might have thought they were imagined. They were also stronger than usual, and most definitely on the right side. I got excited thinking the Ovidrel had finally kicked in and my egg must be on its way. Nicole and I kept trying to get reassurance from each other: "It has to work. It's working, right? I know sometimes it doesn't...but it has to be, why wouldn't it be!"

This morning we went through the same routine, but we were seen more quickly this time - and were much less nervous! This time I treasured carrying the little vial back with me, cupping it in my hands to make sure it stayed warm on the journey. This nurse practitioner was even friendlier than the first. She was so, so warm and sweet and I immediately felt comfortable. And boy was she quick! I practically blinked and it was over. Again Nicole and I went home and enjoyed the day together.

In my post from two years ago entitled Medical Romance, I spoke about how the idea of conception had become more about a medical process and I'd let go of the need to make it romantic or sexual. I have to say that the reality of it was very different than how I'd envisioned - we had two full days of romantic and sexual around the (fingers crossed) conception of our baby, even if that's not what led to biological conception. And it all felt so connected because all we could think about was how much we love each other and how much we hoped for a baby to grow our family.

I'm not even trying to protect myself from disappointment anymore. Honestly, I don't think there's anything I could do or any way of forcing myself to think that could keep me from being disappointed if the pregnancy test is negative. So I'm going to let myself enjoy the excitement and the scary attachment we are already feeling. Nicole started out more cautious, but by today was leaning over to kiss my abdomen as I passed by her on the couch. Oh we are in deep. 

Tuesday, March 11, 2014

Our (new, temporary) Daily Ritual

Friday was Day 9 and I went in for my first monitoring sonogram and bloodwork. They usually monitor at Day 10, but they wanted me to see Dr. K who has been doing everything with me thus far, and she's at that site Tuesdays and Fridays. It's funny, I saw her as stern and too all-business the first time I met with her, and now I have this weird attachment to her. I want her to do everything in this process. I trust her and feel well cared for with her. I think it's because she has been confidently and competently in charge of a life-changing experience from the beginning, including operating on me herself for the cyst. It reminds me of my "abnormal" (according to my friends) attachment to my rabbi, who also led/accompanied me through a majorly transformative and life-changing experience. She is brilliant and well-loved by our entire congregation, so it's not just me - but the way I hold her on a pedestal is probably not so typical. Apparently I'm quite susceptible to attachment when I feel I can trust and be taken care of by someone. Is this some sort of strange maternal transference? Maybe I shouldn't open that can of psychological worms in this post!

So Dr. K did my initial sonogram and told me that she could see a few small follicles. Definitely not close to mature, which is normal at Day 9 (ovulation is around Day 14). She said I shouldn't need to come back before Monday, but the bloodwork would confirm. I got a call around noon that I could wait until Monday to return. Oh what a weekend!! You'd think it'd be torturous but it was actually highly enjoyable because it was going to end with something exciting, not a typical Monday morning. I was so happy and relaxed.

Monday morning I saw the physician's assistant. I had met with her after my stitches were removed to discuss next steps, so I was glad it was a familiar face. (Sidebar: I found it interesting that the PA has to sheathe and lube the sonogram wand herself. For Dr. K it's always prepped for her when she comes in. Oh the differences in status!) She is more emotive than Dr. K and exclaimed, "Oh you have a wonderful follicle growing on your right ovary. And your lining looks just beautiful!" My heart soared. I'm guessing seeing a healthy, functioning system is not super common at infertility clinics, and her broad smile made me so hopeful. I was called that afternoon and told that I was just beginning to "surge" and should come in again on Tuesday. This means the hormone that indicates imminent ovulation was being slightly detected. This made me very excited thinking it could happen by Wednesday.

Today (Tuesday) I went in and again had the PA. (There are two other male doctors in the practice that I could have seen; I was relieved that it was still someone who knew me.) She wasn't saying anything for a while and I started to get really nervous because of how quickly she had reacted on Monday. My fears were not baseless, as she then said, "Your follicle actually looks smaller today, that's really odd. It was 17mm yesterday and now is 16mm." My heart sank. In a matter of seconds before reassurance followed, I thought, "What does that mean? How could that happen? Am I not going to ovulate this cycle? Will this happen every time???" And then she said, "Oh, I was at the wrong angle. It's 18mm." Oh geez, lady, don't toy with my emotions!!

I asked her how big the follicle is at ovulation, and she said generally between 20 and 22 so I would most likely need to come back the next day. I accepted this, but there was a flicker in the back of my mind saying, "How could it be another day when I'm already starting to surge?" The word "surge" sounds like a sudden flow, not like something that drags out over days. I just felt like it would be Wednesday and thought to myself that I would wait til the bloodwork came back before making any assumptions about coming back. And sure enough, I got a call around noon telling me to go out to the Melville office for IUI on Wednesday! It was the PA herself that called this time, not a nurse, and as soon as I knew it was her, I knew we were a go. She said, "Hi, Rachel, it's _____" and I just knew. I squealed in delight and she congratulated me before telling me all the details.

Nicole has begun to get nervous this past week, but as soon as she knew it was a go, she suddenly became really excited. I'm so glad she could allow herself to feel excitement! She kept sending me sweet texts the rest of the day, like one asking where I thought my "little egg" was right now. When I got home, she offered to administer my hcg trigger injection, but I knew she was terrified and just trying to be supportive. I didn't want her to have to go through that if I had more confidence in doing it myself. So she oversaw it, helping me read the instructions and standing inches from me as I did it. It was cold and the pressure was uncomfortable and I just kept repeating, "You're worth it, you're worth it."

Tomorrow we are taking off of work and relaxing together all day. If it doesn't take this cycle, we probably won't be able to keep up a pattern like that, as we will likely become increasingly stressed and anxious. But if it DOES take...I want to always remember what a special day it was, how our baby was made in an atmosphere of love and relaxation, not with us going our separate ways and rushing off to the craziness of our work days.

I know we have a lot going for us that hopefully combats the low IUI success rate: sperm that is proven to be motile and make a successful pregnancy on the first try; my ovarian function is good; I already got "exploratory surgery" while my cyst was taken out to check for endometriosis and fibroids that most people don't get unless the first few cycles fail; I'm taking a trigger shot; we're going to do back-to-back IUIs Wednesday and Thursday if they have any doubt that I ovulated Wednesday. But this is me being optimistic, and I really have no idea whether it will work or not. All I can do is try to stay relaxed and send up a prayer for success, comfort, health, and peace. I would greatly appreciate if you would take a minute to do the same.

Thursday, March 6, 2014

Exhausted (and we haven't even started!)

I had day 3 bloodwork taken on Friday. It was really day 2, but “Day 3” bloodwork can happen between days 2 and 4. They said it was to “check my eggs,” which I didn’t get at all and had to Google. (Do most people research this before they come in? Staff talk about it as if it’s understood; some things I ask about, but others I just go home and look up.) Apparently they can tell if your eggs are in bad shape by the hormones produced at this part of the cycle. Having normal hormones doesn’t mean your eggs are necessarily good, but abnormal hormones definitely indicate an issue that should be looked into.

I was told that the sonographer (I think) was not in to do a Chlamydia and gonorrhea culture, but that I should get it done before starting IUI so I could come back Monday. Really, people? I told them that I’d had to schedule a pap for Tuesday so I would just get it done there. Then the nurse gave me a prescription for Ovidrel, an hcg trigger injection to make sure I ovulate. She gave me a quick rundown of how to administer it and then provided me with a glossy color page of instructions and photos. I know these staff do this all the time, and most of their people are probably on repeat cycles and are already familiar with all this, but it’s unsettling how casually they tell me things like JUST GIVE YOURSELF A SHOT. As if I’ve ever done that in my life. As if it’s a totally normal, everyday activity.

Apparently the sonograms will just tell them when I should ovulate, based on the follicle size, but by the time you actually ovulate, it’s too late to inseminate. So the extra dose of hcg when your follicles are the right size help ensure that you will actually ovulate. I’m psychologically very resistant to doing this, since I was told by the doctor that I have all the signs of regular ovulation and I have tested for it myself. But I’m also not eager to spend $3000 (including sperm) and take any unnecessary risk of failure.

On Monday I called the clinic to ask if they could call in my Ovidrel prescription to the pharmacy right next to them that works with Aetna mail order, keeping the price low while still being able to just pick it up and order only one at a time instead of three. The woman said she would check and let me know. Last time they called in a prescription to that pharmacy (they’re the ones who told me about the place), I’d gotten a call from the pharmacy the same day. So when I didn’t hear back by Wednesday, I called the clinic again. They referred me to the medication coordinator in Patchogue. I called there and got her voicemail because she was on another line. I explained the situation, and she called back five minutes later. She said that Aetna wouldn’t cover the prescription unless the cycle is underway, which isn’t official until I’ve paid. I pointed out that Aetna isn’t covering me anyway since I’m not technically infertile, and she said the pharmacy still won’t release the prescription without confirmation from the clinic that a cycle is underway. Which the clinic won’t give until I’ve paid up. Then she pointed out that if Aetna isn’t covering my fertility treatment, they won’t cover this prescription either. She referred me back to the Lake Success office where I’d first called in order to speak to the billing coordinator.

When I called the billing coordinator, she asked if she could call me back in a few minutes. As soon as we hung up, my doctor called from the same location and I was on the phone with her as the coordinator was trying twice to call me back. The doctor told me that my day 3 bloodwork was normal, and that I do not have prediabetes. What a relief! She said my blood sugar IS still slightly elevated so I should continue to be checked throughout my pregnancy, but there is no reason to be on any medication at this point.

I called back the billing coordinator, who asked me if I was doing a Clomid or injectable cycle. I thought it was an either/or question, but apparently it was a yes or no question. So I said “injectable, they gave me Ovidrel” and she said, “Okay, so that will be $2900, how do you want to pay?” “That will be HOW much???” “$2900. You said you’re doing the injectable, right?” “Yes, Ovidrel, but they just handed me a prescription for it. No one said this would add $1000 to what we’re already paying. We can’t afford to do this, I don’t know what to do.” I was in shock, realizing we’d need to assess whether it was worth another $1000 for a trigger shot when we’re pretty sure I ovulate fine, but what if that’s what would make the difference and we end up having to pay for another cycle instead? It was too much to think about just a week out from insemination. She said, “Hold on, let me check your record" (could you have done that earlier??) and then came back to tell me I’m doing a “natural” cycle with just a trigger injection, which wasn’t what she meant, so that will be $1900. Oh, and $100 to thaw the specimen, do you want to pay that now or later?

The pharmacy then called an hour or so later to say they had my prescription, that will be $79.95, please, and when do you want it shipped?

The amount of office time I actually spent on work yesterday is questionable.