Trying Again

The meds have commenced.

The process of getting them in me the first night (Friday) would have been comical if it wasn't so stressful. Once again I ask, how is there not a better way than trusting regular people to mix medications and stab themselves with needles? It is ridiculous. Four years have passed and the whole thing was new again. And of course we got home late from an overnight trip and H refused to go to bed. Refused. I was sure he would come downstairs and see me injecting myself, and how would I explain my way out of that one? Even the cat went nuts, meowing her little cat head off just to add to the chaos and we'll-never-figure-this-out atmosphere of despair.

Anyway, we apparently figured it out, got the egg-making hormones in me, because I went this morning for labs and they told me to stay on the same doses. I also had a call with the PGD lab, during which they told me all the ways this could go horribly wrong and make it a hugely expensive and emotionally exhausting waste of time.

In spite of this, I think I'm doing okay -- managing. I think I'm mostly in denial, though it also feels like I have a low-level freakout simmering somewhere below the surface, threatening to jump out and terrify those around me at any moment. H's preschool teacher told me today that they went to Chapel for the first time and talked about the fact that God wants us to be kind to one another, and the thought of eight tiny people learning to be kind struck some sort of nerve and I welled up. I mean, should I just wear a t-shirt or sign like "Ask me about my IVF" so people know what they're dealing with right now?

Mostly this whole process is just reminding me of what it was like four years ago, when I was an entirely different person doing this. When I didn't have a beautiful, amazing, miracle of a boy already living under my roof. When I wasn't sure I'd ever win the battle and be a mama. I just think, What if it hadn't worked? Or what if the fact that it did was this incredible unlikelihood and we just lined everything up perfectly, every single thing, and that perfect combination of tiny things we didn't even know we were doing somehow made it possible? What if one of those things hadn't happened? Who would I be right now?

Right now I'm just a mama trying to see if I can do it all over again. I ask for nothing more than the same thing that parents all over the world get every single day, without trying very hard at all.

No Crystal Balls

Met with the new RE. Loved her. I've got my team. Now, assuming my post-surgery saline sonohystogram is clean tomorrow morning, it's time for the Hail Mary pass.

Started the Pill and already feel insane. Jittery, irrational, snappish as only artificial hormones can bring. My husband was trying to open a cellophane bag at one point when I was on the phone with the doctor's office today and I think my glare shot real laser beams through his core. I hope we both survive this.

A family member is pregnant, and there are all the complicated feelings -- you know. Another family member brought it up with me and I felt like she wanted me to be all unicorns and rainbows about it, and I tried to put on a good show. She acknowledged my struggle and told me I should be more positive about what's ahead. She said she had a good feeling. 

My ears are sort of dead to that at this point. There is no seeing, no knowing. Someone else's made-up optimism doesn't really do anything for me. I don't need optimism, pessimism, a fortune cookie, a rabbit's foot. What I need most of all is for you to tell me that no matter how the coin falls, you'll be there. To catch me, to whisper brave words. To distract me if it works, to bring a bottle of wine if it doesn't. To tell me it's going to be okay.

A Tale of All the REs

The balloon has landed, outside of my vagina. Gone is the plastic-tube penis. Alas, no Butterfinger or Jolly Ranchers fell out of it. It did, however, hurt like heck to have it taken out. FYI, if you ever find yourself going in to have a balloon taken out of your Queen Victoria, please do not overlook, as I did, the doctor's instructions to take some sort of painkilling or mind-numbing medication in advance. Because it's very difficult to try to relax, as they tell you to do, when they're yanking something from your uterus.

Anyway, the appointment went surprisingly well, other than the mind-blowing discomfort part. The RE who assisted on the surgery spoke very highly of my uterus. She feels it looks great, with really no signs of previous bouts of scarring. She didn't see any reason not to proceed as planned. The conversation, dare I say, made me feel something unfamiliar, something warm and fuzzy...something like hope.

Before we go any further, I feel like I need to bring you up to speed on where I am with REs. I've had some interesting recent consults that must be reported on. It feels like choosing the right RE could have lifelong implications, so I need you to help me make sure I'm not making a colossal mistake.

Let's start back in my old town, before my move this summer. I've spoken many times before about my devotion to the RE who helped us get to H. I first saw her back in the summer of 2008, when the first RE in the practice wanted to cancel a cycle. The nurses whispered to me that I might want to see this other doctor who would have more patience with the "low and slow" protocol required for PCOS patients. I'm sure it was against the rules for them to suggest another doctor to me, and I'll be forever grateful for their breaking them.

This doctor got me right away. She not only knows the medicine -- what was needed to get me to actually ovulate so I could get the IUIs done -- but she instinctively gets the hand-holding part too. I needed a coach, almost a mentor. I needed someone to say you can do this, someone to walk me through the tough parts, someone who saw me and believed in my quest for motherhood. Maybe it's not reasonable to need that from a doctor, but the good news was I never had to ask for it from her. She told me when I was being crazy, she gave it to me straight. But she never made me feel stupid or belittled my feelings about an intensely emotional process. She said the words I needed to hear, the right words at the right time, the words that helped me push myself harder and get through more than I thought I could handle.

And she did what it took, she came up with the formula needed to get us to our H. For that, my gratitude is and always will be beyond the bounds of words.

However.

After I found out the third post-H pregnancy (in November of last year) was another fail, I started to get itchy. My RE was standing by her sense that IVF wasn't the answer. I didn't know if she was right or wrong, but I wanted to try something else. If the definition of insanity is doing the same thing and expecting a different result...I just needed to mix things up. I got two opinions.

One was perhaps the most bizarre meeting with a physician I'll ever experience, so that one is worthy of a separate post. But the other meeting was with an RE at a well-known center that's made many of my friends mothers. He said the right things. He thought he could help. He felt IVF might be the answer. We decided to try it, and we wanted to fit it in before our move. But I wanted closure with my longtime RE so I had her do the post-D&C look at the uterus. She pronounced it clear and was incredibly gracious about our moving on.

I started the Pill. It made me sick. I was stressed about the move, and the whole thing just didn't feel right. I stopped the Pill and decided to wait until after we moved.

Then we moved, I found out I was pregnant again (who knew I am now one of those women we hate, except for the minor point that all my easy-to-conceive fetuses have died), and things got a little more complicated. I had to find an OB in a completely new town and state to track the pregnancy. I had to trust her to do the in-office D&C and not scar me. I met with an RE, liked him well enough to have him to do the post-loss sonogram, and then decided when he found something awry -- the new fibroid in the cavity -- that I didn't feel comfortable enough with him (or, more specifically, his fertility center) to have him cut my uterus.

What I've realized is that I'm just more comfortable treating this process like it's a medical condition -- i.e. going to a doctor directly affiliated with a medical center, or more specifically, an academic medical center -- than a standalone clinic. There's something more "retail" about the latter, something that feels a little less grounded in science, even though I know the facts don't really back that feeling up. It's just my gut, and after everything I've been through I just think my gut deserves to be heard.

So I ended up at a center that has that hospital/university connection, and a team of doctors that I'm coming to trust. One just finished her fellowship at another well-known university-affiliated program, and while she's new to the specialty, I love her energy. She is the one who talked me down from the ledge before surgery the other day, and when she removed the balloon on Monday she inspired confidence by knowing exactly what she was talking about. It does give me pause to work with someone less experienced, so I'm meeting with a more experienced colleague of hers in the practice next week to come up with a plan. Together, they're beginning to feel like a team that truly might lead me to another baby.

I don't know when this fibroid came up. I don't know if it was there when my long-trusted RE scoped me in March, though I do know that my new doctor told me they didn't see it in the OR when they initially went in with the hysteroscope -- only when they used ultrasound did they find it. It sort of tells me that maybe it was there, and maybe her policy of using hysteroscopy versus saline sonogram may be flawed. But that fact, all the steps I took to get to this point, painful as many of them were, is starting to feel less important to me than the steps -- the possibility -- in front of me. I'm taking that as a good sign -- something I haven't seen in a while.

New Methods of Vaginal Humiliation

I'm sick of feeling vulnerable.

I'm sick of laying down and putting my legs in stirrups and bracing myself for whatever they're going to find.

I'm so tired of being wheeled into yet another procedure, brought down the long, sterile hall, alone with the doctors and nurses, because it's my body that's broken and needs fixing, and no one else can go through the surgery for me.

I'm long over laying on the couch, losing another sunny day to feeling like shit, or bleeding too much, or crying the hormones out.

I don't want to worry anymore about heartbeats or complications. Can no longer handle being the 1% standard deviation patient.

I had the surgery, on Wednesday. They successfully removed my submucosal fibroid.

And now, having thought I'd suffered every humiliation possible in this quest for children, I learned but wait! There's more. There's something called a balloon catheter that they sometimes put in your uterus after something like a fibroid surgery. They blow it up with saline and shove it in there so the walls of the uterus won't touch and form scars. My witty friend S. suggested that perhaps they could put candy in it instead, so you could be a human piñata! That would only be mildly less humiliating.

Last night, the tube of this catheter fell out of my vagina, which they warned me may happen. So now? I have a long, plastic tube hanging from me. This feels nothing like the tampon string the doctors suggested it would feel like. They should really test these things out before they go making such declarations. What it feels like is a big, heavy piece of plastic hitting the inside of my thigh and shifting around every time I walk. I now know roughly what it would feel like to have a really skinny penis and it makes me sort of understand why guys are always adjusting themselves.

But back to the surgery. So I finally settled on a surgeon and center, though I still had reservations. It took me years to build enough trust with my old doctor to the point where I never questioned her, and surgery became if not comfortable, at least less panic-inducing for me. I'm still trying to process exactly what happened, but it seems like she missed the fibroid in the cavity when she scoped me in March, before the last pregnancy. That pregnancy was chromosomally normal. Did it land on the fibroid? Would I still be pregnant with a healthy boy if it had been caught? Was it indeed there, or did it surface during or after the pregnancy? I am asking questions about a doctor I adored and trusted wholeheartedly, and constructs of reality are being torn down. So I don't know exactly how to trust a doctor I really don't know at all.

I got my period last Friday, of course, the day we headed off with H for a much-needed mini vacation after a summer of moving and settling in. I called the office, scrambled in for blood work and the surgery was scheduled for Wednesday. And even after all I'd been through, every prior surgery that told me this one would be okay, I was terrified. We dropped H with a generous friend willing to watch him and then I was in my pre-op room, waiting.

I wanted my husband to do it for me. I wanted to run away. I wanted to pick up H and enjoy the sunshine at a park. They wheeled me in. I said I wasn't sure I could do it. They called in an anesthesiologist who "specializes in anxious patients." I asked the other guy if I scared him away. The row of doctors and nurses lined up at my bedside laughed. They gave me Versed, the edge was gone, and the last thing I remember is being told a random story about the anesthesiologist's first job.

When it was over, I couldn't wait to leave. I bounced up, relief overshadowing the need to move gingerly. I was standing in my friend's driveway talking about H's time with her when I felt the first gush.

I got home and assessed the damage. Lots of blood. Pad the heaviest I've ever seen, densely red. I called. They told me it's normal, it's probably less than I think, when you've been laying down a while it gushes out sometimes. You know what? I've been to this performance before. I know a pas de bourree from a pirouette. I know the difference between blood coming out and coming out in a way that almost hurts. They urged me to lay on the couch a while and see if it slowed. When I moved at one point and saw that my couch cushion looked like a b-grade horror film scene, we were back in the car on the way to the ER.

I sat on the toilet in the ER, giant clots coming out of me, and just thought I'm done. Worst-case scenarios whirled through my head. They tell you there's a risk of their piercing your uterus during surgery. Don't they say that because it happens sometimes?

That wasn't what happened to me. I was in a 1% complication bracket with the complication it was, but luckily it wasn't the kind of 1% that required more surgery or worse. It was a bleed at the site on my cervix where they put the tenaculum. Apparently bleeding at that site is common, but usually resolved at the end of surgery. Mine reopened and needed cauterization. Then I could finally go home to the couch, still dizzy from the meds. I slept on and off for two days straight. I felt like I'd had a run-in with a large truck. I'm still exhausted.

On Monday, the balloon catheter comes out. Then I meet with a doctor to determine an IVF plan.

I've known for approximately forever that I wanted kids. It's deeply part of the fabric of me, like feeling the first chill of autumn somewhere in my soul and loving Nora Ephron movies. I can't change that. I had a beautiful baby boy 3.5 years ago and it didn't cure me of wanting kids any more than winning the World Series makes a ball player pine for retirement. For some reason, the one thing I've wanted, more instinctively than anything else, is hard. Damn hard. Harder than anything I've ever done. And unexpectedly, despite all the time I've spent in this zone of fighting for it, I feel like I have fewer answers than ever about what it all means or where I'm supposed to go or how long I'm supposed to fight.

What's in a Name

So somehow I ended up moving to the fertility capital of the universe. No one told me this was the case when I was looking around. This was not a point included in my realtor's tour of my new town. But shortly after arriving, I looked around and realized that everyone -- my husband thinks this is an exaggeration but it is not, it is literally everyone -- has at least two kids with one on the way. Having four children here is not unusual. And no, I did not move to Utah. As you likely surmised from my last post, I have moved to the suburb of a -- perhaps the -- major metropolitan area of the country.

If this quest for number two is ultimately a failure and I remain a parent to one, I will rock it, don't worry. I'll take the money I would have spent on diapers, buy a Birkin bag and send around a birth announcement about my new baby that doesn't cry, poop or keep me up at night. But for now, now that I'm still trying to take down secondary infertility with everything I've got, it makes me feel like a bit of an outlier. I'm new to town, and I've got this baggage, this thing that may ultimately make me different from most everyone else here. It makes me feel, for the moment, just a little bit more alone.

The other day I met some very nice moms on the playground. As we were chatting, a nanny came over with her charge and as soon as she said her name, this mom chimed in and started asking her about it. The mom said that her sister has been telling her to use it if she ever has another girl. It's a relatively unusual name that you don't hear often, and it happens to be my girl's name. So much so that my husband and I use it in casual conversation to refer to a future child that may live in our house. As in, that would be __________'s room. In this conversation about the name, the woman went so far as to use the actual nickname we were planning to use, saying her sister wanted her to use that too. It was sort of like watching a horror movie that you somehow can't put on pause. I wanted to jump in and say that's my girl's name too! But for obvious reasons I did not. Because it would have made me look weird, because I may never have another child, girl or otherwise, because it was too painful to even hope that someday I may actually have the problem of having a girl, selecting this name, bumping into this woman and looking like a shameless copycat. So I stayed silent.

My husband doesn't get why this bothers me so much. He thinks it's ridiculous that I would even worry about using the name, even if I end up running in the same circle as this mom, which is unlikely since our existing children are different ages and what is the likelihood that I will have another child that happens to be the same age as the children this woman will obviously be having, most likely without difficulty or complication?

I'll tell you why it bothers me. Because I have a funny feeling that in a couple of years, when I'm running around town with my Etoupe Birkin bag anchored on my arm, I'll hear this woman calling after her newest charge, calling out the name I so wanted to use too, and it will sear my chest like an arrow. I'm bracing myself right now.

Good RE Hunting

I decided over the weekend to get a second opinion here. I like the new doctor we've seen, but I just wonder if I'm more of an academic medical center kind of girl.

If anyone out there knows anything about NYU's program and its physicians, please email me at goodegghatched@gmail.com.

Keeping the Dream Alive

I want this space to be about more than my continued battle with infertility and loss. I want it to be about playing in the sand with my H, and how sweet three is, how good it is to wake up every day and know I'm his mom. Because that's what my life is like, too.

But when you struggle to conceive and deliver, and you dare to wish for more than one child, there's this background noise of that struggle that won't be ignored.

I thought I was going for a routine saline sonogram today with my new RE, to make sure there was no scarring from the May D&C. I thought it would be straightforward, even if there was a small amount of scarring. But the truth is, and I never, ever say this, you know I'm a worst-case-scenario girl, I thought it would be totally clean and we'd be ordering IVF meds today. Instead, you know what was there? A new fibroid. In the cavity. That he wants to remove in the OR.

So let's review the deck stacked against our heroine at this point:
-PCOS/unexplained infertility
-Asherman's
-Recurrent/unexplained loss
-MTHFR
-Slightly hypothyroid
-And today, a bonus fibroid

I have a history of a few fibroids that until now, did not excite anyone. They were out of the way, and even as recently as in March when my longtime RE did a hysteroscopy, there was nothing inside the cavity. So of course I'm totally weirded out by this whole thing (where did it come from? did it move? how did it just spring up out of nowhere?) and since I hardly know this new RE and had years of trust built up with the one that got us H, I reached out to her. She was so lovely to call me and talk about it and look at today's images, which I emailed her. And then I asked her if she could do the procedure, and she basically told me it's time to cut the cord.

I know she's right. But sometimes I don't like the sound of the truth. I heard a lot of that kind today.

So where are we? Hell if I know. I'll tell you what it feels like: It feels like someone is trying to tell me something.

All I know is it's hard to keep on dreaming when the facts keep whispering to you that the dream is over.