Big G.irl Pan.ti.es and a Biopsy Question

After my meltdown a couple of weeks ago and the subsequent crankiness, I think I am finally getting myself back together.

A few years ago, at my previous job, one of my co-workers had a sign on her wall that said "Put on your big g.irl pan.ti.es and deal with it!" As silly as it sounds, that sign has stuck with me.

So, I have located said pan.ti.es** and am dealing with all the infertility crap.

We haven't made any solid decisions yet, but I am going forward with the biopsy next week. I figure for all the weight gain, bloating, acne, and mood swings these hormones have cost me, I might as well get a couple of test results out of it.

And speaking of test results, since half of the bloodwork I had done last time didn't produce results we could be confident in due to possible heat damage, I have decided not to risk shipping the blood again.

So, we are doing what we do best - medical tourism.

The lab is about 3.5 hours from my dad, and we haven't been to see him in about 6 months. So next week we're flying in to the airport closest to the lab after work on Wednesday, staying the night, getting blood drawn the next morning, taking the day off, driving a couple hours up the coast to San Fran, staying there for two nights (including working remotely the next day), catching up with one of my co-workers who lives there, going to the farmer's market at the Ferry Building (we're only to Saturday at this point, people), driving up to see my dad, staying the night there, and then driving the 3.5 hours back down to the airport and heading home.

How's that for a 96-hour itinerary?

I saw my therapist yesterday. She asked the last time R and I went somewhere on vacation - no medical stuff involved - just the two of us. And sadly, I had to reach back 5 years to our 10th wedding anniversary.

Surely we've gone on a vacation like that since then? But my hormone-addled brain can't remember.

Maybe we really haven't. And the 10th anniversary was not a full vacation, just a long weekend. And while we tried to avoid anything medical related on that trip, an adoption possibility came up in the middle of it and we wound up coming 'round a corner at one point during the weekend only to find foot-long giant sperm on the floor. (If you haven't been reading for that long - I can't even believe I've had a blog for that long! - you think I am making this up. I assure you I am not.)

I almost forgot...on to the question: What was your endometrial biopsy experience like? Did it hurt? Is the pain going to be so intense that I may be likely to reach up and smack the doctor? (Which I have been known to do in the past. But in my defense, I was 6 at the time.)

My uterus cringes each time I even think about it. And the thought "What the hell am I doing?" has crossed my mind more than once.

** I can only imagine what kind of visitors I'd get with that phrase if the periods weren't included!

The Perfect Symbol of My Mood

The estrogen pills are making me cranky. They're making me gain weight at the rate of about half a pound a day, which really makes me cranky, but somehow I tend to think that I'd still be feeling cranky even without that highly annoying side effect.

Unless the pills made me lose weight at the rate of half a pound a day. Then I would love them.

But they aren't, and I don't.

And to top it all off, they make my skin break out horribly. Clearly my hormone levels are now even more imbalanced than usual - how can this possibly be helpful for achieving a pregnancy?

So here I am, highly annoyed by everything going on in my world (I hide that fact well, don't I?), including pretty much everything that poor R says or does. Me on estrogen is almost as unpleasant as me on Clomid. But at least on estrogen I haven't locked him out of the bedroom. Yet.

Tomorrow morning I have to get up earlier than usual, to fight traffic earlier than usual, in order to go have a lining check to see if I'm on track for the endometrial biopsy. I usually have RE's office e-mail me the order so that I can print it out and take it with me, rather than having them fax it to local RE and risk the fax getting lost or misplaced.

Being the model of efficiency, I printed out the order a few days ago. It's been sitting on the dining room table (aka the dumping grounds where my purse, piles of mail, etc. reside). So this morning I come downstairs and discover that the printed order is covered in cat hairball puke.

Pretty much sums up how I feel about the whole thing at the moment.

Lest you think I am completely without humor, I have thought of another addition to the "You Know You're an Infertility Patient When..." list: ...va.gi.nal discharge the color of a smurf is a completely expected occurance that doesn't phase you in the least.

Example A - Why I'm Too Tired For 'Big' (aka Post #250)

I had the consult with the reproductive immunologist this morning. It did not go well. I don't think it went particularly badly, either, but then again, at this point my judgment on those sorts of things is probably a bit askew.

I did my homework. I Googled, I read a lot of info online. This guy is with one of the most prominent RI groups in the country. He had great reviews on Yelp. (Let's not think about what it says about me that I'm now basing medical decisions - at least in part - on a community review website.) So when they asked me if I had a preference of doctors, I decided why not, everyone seems to love him, ask for him. So I did.

And it's not that I hate him. Or that I need to love the doctor I'm working with - at this point, I'm far beyond that. But I think that's part of the problem - at this point, I'm far beyond pretty much everything, and apparently it is all annoying me.

Let's start with the fact that the first thing he tells me is that the tests run in his lab, which account for 15 of the 37 vials of blood drawn recently, produced really bizarre results, and he thinks the vials may have been damaged by the heat while in transit. So, he has no confidence in half of my test results, and I need to have another 15 vials drawn (along with another 5 from R).

Then as he runs down the list of other tests, which were run at a national lab chain, he proceeds to mention that those kinds of labs generally aren't as sensitive at detecting this as some of the more specialized labs are. (What was making him say this is that in the past, through a more specialized lab, I've tested positive for APAs, but this time I didn't.)

So if he has zero confidence in 99% of the test results, why are we even having the appointment at this point? Not a great beginning.

It didn't exactly get better from there. The appointment can basically be summarized like this:
- Based on the current (screwy) lab results, he recommends 1 round of LIT. Depending on what the re-test shows, I may not need LIT.
- Based on the current (screwy) lab results, it doesn't look like I need Humira. Depending on what the re-test shows, I may need Humira.
- Based on the current (screwy) lab results and past (more confidence-inspiring) lab results, I need IVIg. Regardless of what the re-test shows, I need IVIg. But those tests will be re-done anyway, because the current (screwy) lab results don't provide a baseline that he is confident in.
- I need Lovenox. It should be half the dose I've been taking, once a day, until positive pregnancy test, at which point the other half of the dose I'm taking should be added in via a second shot each day. Hematologists don't know what they're talking about when it comes to using Lovenox in pregnant patients. (RI's opinion, not mine. It was RE who told me to go to a hematologist in the first place; it's not like I wanted to add yet one more doctor to the mix.)
- I need dexamethasone, pre-transfer and through the first trimester. This will save me from having to remind RE that he very reluctantly agreed to prescribe it for me. So there's one small silver lining. I had to get out the magnifying glass to find it, but it's there.

Here's how I thought the appointment was going to go:
- You need IVIg. (Check)
- You need LIT. (Probable check)
- You might need Humira. (Check, as in it's still "might" at this point)
- You need Lovenox, baby aspirin, folgard. (Check, check, check)
- You need dexamethasone pre-transfer and through the first trimester. (Check)

So part of what annoys me is I feel like he's not telling me anything I don't already know. And isn't that what a doctor is for in the first place? But then again, that's not entirely fair - he did say something about also testing my seratonin levels, because seratonin plays a role in uterine lining development. (Or something like that - I admit, at that point I wasn't really paying attention to what it does, I was just thinking "okay, make that 16 more vials of blood that need to be redrawn...")

Then I made the stupid mistake of asking what he thought our chances were. (70%) He looks at my age and says "Well, you're dealing with 36-year-old eggs..." (which were actually 34-year-old eggs when they were retrieved, thankyouverymuch) "...have you thought about donor egg?"

Seriously. SERIOUSLY? That just floored me. Not because it's shocking that a 36-year-old would get the donor egg speech, but because it goes back to some of the themes from my previous post. We were 28 when we started this. Back then, every RE's office we sat in, they looked at us and said "What are you doing here? You're still just babies!" I kid you not, we heard the word "babies" - meaning the two of us, not the kid we were trying to produce - many, many times. (Part of it is because R has always looked very young for his age.) And now, we've been in this hell for so long that we've gone from "you're just babies yourselves!" to "you may need donor eggs".

I just made some sort of noncommital sound and moved on to another question. Because if I don't have the energy for something like LIT, there's no way I'm going to muster up the stamina for donor eggs.

When Continuing Hurts More Than Stopping

When R and I first started undergoing treatments and I was new to the online IF world, I'd see women ask "How do you know when it's time to stop?" as they were trying to figure out the next steps in their paths. And the answer, invariably, always came: When it hurts more to continue than it does to stop.

As a relatively naive newbie back then, I couldn't exactly wrap my head around that.

I mean, really, how could it hurt less to stop trying (and possibly not have kids) than it could to sit in a chair and listen to your doctor rattle off all the (medical) things wrong with you and your husband and conclude by telling you that it just might never happen for you?

I planned to fight like hell until we got to the other side, regardless of what it took. I would just keep marching forward, doing whatever we needed to do, until we made it happen. As if determination is the only essential factor.

So we went through a lot, and still, stopping wasn't even a consideration. And then we lost baby #5 through miscarriage #4. And for the first time I started to understand, at least on a very vague level, how continuing could maybe hurt more.

But still, I wasn't ready to consider stopping.

So we continued to march: through a disasterous retrieval, a shockingly good retrival, thyroid surgery, and my dad almost dying.

And slowly, during all of that, I began to think about how much time we have spent. How much we have sacrificed, lost, to infertility. Financially, emotionally, time-wise, other dreams and plans. All in the pursuit of a dream that is still just as elusive now - if not even more so - than it was when we started in 2003. And how if we stopped, we could stop funneling all of our bank account to REs, we could travel without a medical purpose as impetus for the trip, we could buy a smaller house with a smaller mortgage and possibly work a smaller number of hours.

Then we had the most recent miscarriage in May. And we decided to pull out all the stops for one last attempt - antibiotic treatments, consulting with reproductive immunologists, even a biopsy to confirm that I have the beta-3 itegrin receptor (which is a good thing), even though RE is already pretty sure I have it.

No regrets. It's the motto with which I vowed to approach this entire process.

To that end, in the past month, I've had literally 37 vials of blood drawn. Ovulation could not be detected, so now I'm on estrogen, soon to be followed by progesterone, so a little piece of my endometrial lining can me snipped out of my uterus in a few weeks, sans general anesthesia. On top of all of that, it has been the most insane month of work in my entire life, and the next three or four will be just as crazy.

So I'm cranky. I'm freakin' tired. Exhausted, really. Bloated like a balloon and gaining weight at the rate of about a pound a day, thanks to the estrogen.

Then yesterday, all of the immune test results (accounting for 35 of the 37 vials) arrived. And I looked at the results. And I know with 99.9% certainty at least one of the things the RI is going to recommend is LIT.

And I Don't. Want. To. Do. It.

More accurately, I don't want to cross a dangerous border into Mexico to get it, and I don't want to drain our bank account to travel repeatedly to someplace like Europe for it. It's not the actual treatment I'm against, just what is involved in getting it.

So R and I talked about it last night. We didn't reach any decision yet. But we - or at least, I - did reach that moment. The moment where it finally hurts more to continue than it does to stop.

I don't know yet what we're going to do. R's feeling is go big (including LIT) or go home.

I don't know that I have "big" left in me.