I Tested

And any sane, normal, rational person (i.e. R) will tell you that it is one very single, lonely line on a very solidly stark white background.

I, on the other hand, still ridiculously continue to cling to hope.

Because I swear there just may be something there. If there is, it's the faintest line in the history of faint HPT lines, even fainter than the time we were scratching our heads trying to determine if it was a line for pg #2, and the beta that morning turned out to be a 5. (I used a FRED then, and it was a FRED again this morning.)

But I swear I can see something if I turn it at just the right angle. I know a stark white background when I see one, the kind where you can't even tell where the line is supposed to be. And this time, I think I can see where the line is supposed to be.

But mostly I just smell pee. And clearly I'm not confident enough that I'm really seeing something to call RE's office and ask for a blood test to be ordered.

So instead, I'm rationalizing that if I ovulated late - which is entirely possible for me - maybe ovulation didn't occur until Halloween weekend, in which case I'm only 8 or 9 dpo. So maybe I just tested too early.

In other words, we're in for another round of this in a few days, unless CD1 shows up before then.

Meanwhile, the hourly boob checks (they're still sore - yea!) will have to be temporarily suspended when I go in to work this morning. There's a security camera right above my cube, and "Woman feels herself up at work while she thinks no one is watching" is not a video I want showing up someday on America's Funniest Home Videos...

I Chickened Out

Got up this morning at 6 a.m. to take the dog out, boobs were still sore but decided I'd rather crawl back in bed than stay up for a few minutes to pee on a stick. (Last week, I asked to take today off - I needed a mental health day.)

So I crawled back into bed, and when I got up two hours later, boobs were noticably less sore.

I figured it was over, decided what was the point in wasting a $10 test and starting my day off on a negative note (way to think positive, I know), so I decided not to HPT.

Then, of course, the soreness returned and I spent the day feeling very aware of them every time I ran up and down the stairs. (R and I were working on cleaning up/better organizing/rearranging the upstairs.)

The cramping returned this afternoon and evening. It's not my normal PMS cramping, but then again, it wasn't my normal PMS cramping back in August, either, and I'm not sporting a bump. So who knows what's going on inside my body? Clearly not me.

I'm just going to bite the bullet and take the stupid test tomorrow morning.

I think.

Maybe.

A New Idea for Motivation to Exercise

Today, I came up with a brilliant new motivation to get my lazy bottom up off the couch and exercise.

Well, at least, it seemed like a brilliant idea when it popped to mind, although given that said lazy bottom is currently camped on the couch, maybe it's not going to be as effective as I hope it will.

Anyway, here's the idea...for every mile that I run (without stopping, without any walking), I will credit myself $1 toward a massage.

I love to get massages, particularly from one specific massage therapist at a nearby day spa. But it's on the expensive side - $75-$80 not including tip - so I don't do it very often and feel a wee bit guilty whenever I do.

I'm hoping this will be a more effective approach than "if I lose 10 pounds, I'll schedule a massage" (or buy a fabulous new dress or make reservations at that new restaurant I want to try), because that approach hasn't brought much success in the past.

So I'm thinking $80 massage = 80 miles = I'd have to lose at least some weight after running 80 miles, wouldn't I?

Since I'm out of shape, I may start by 1 mile = $2 in order to get myself started, and then switch to 1 mile = $1 after I get a little more up to speed (pun intended).

On another note...guess who has mild cramping and unusually sore boobs, is on CD33, and has 3 HPTs in the bathroom cabinet taunting her?

Yep, you guessed it.

I keep vascillating between thinking I might as well wait another week because chances are it's just CD1 getting ready to make an appearance and thinking I'd better test now, because if it's positive, I'd need to start up the Lovenox, prenatals, folgard, etc., ASAP.

I'll probably test in the next couple of days. Apparently there's at least a tiny part of me that's still an eternal optimist.

Either that, or I just love to torture myself with false hope.

A Much-Needed Reminder

On my way home from a vet appointment with our cancer-stricken dog late this afternoon, I called my dad to check in on him. He went into the hospital on Friday for a more hard core kind of chemo than he's received in the past, and today's his third day of it. I asked him how he's doing, and his response made me laugh out loud:

"I'm feeling great, baby! Plus, this new chemo makes me glow in the dark, so it's easier for wifey to find me at night when the lights are off..."

It was a definite reality check. There are certainly things in our world right now that are painful and not how we'd hoped they would be, but my dad's attitude serves as a reminder that no matter what the circumstances, a sense of humor and positive attitude are still possible. If we choose them. So I'm trying hard to choose them.

On that note, updates about the three D's that are dominating our world right now...

The Dad - As I mentioned, the hard core chemo is underway. He has four more days of it. The oncologist decided to take this approach because the other chemo he had been on was only helping for a week or so; it wasn't keeping him in remission long enough to get the transplant under way. It sounds like he'll be in the hospital at least 30 days, and possibly longer if the transplant happens. He'll be keeping the nurses on their toes with his sense of humor, that's for sure.

The Dog - We got a follow-up report from the radiologist late Friday afternoon, and I met with our regular vet today to talk about all of this. It was a sad appointment, but a decision has been made. As painful as it is, I'm also at peace with it because it's the right decision for our "baby boy". The only criteria we used is what we think is best for him. And unfortunately, we decided that is palliative care rather than surgery.

R, my mom, and I had talked about it over the weekend and decided that if surgery seemed like a viable option, we would do it.

However, I noticed during the past couple of days that the dog's hind left leg (it's his front left one that is affected by the cancer) is starting to show signs of weakness. It's shaking a little bit sometimes, and he's sometimes starting to lean his right hip against things - walls, the kitchen island - to gain additional support, which he hadn't been doing before. So I think the cancer has probably spread a bit further than the MRI images can detect at this point.

Our regular vet did an additional exam of him today and is concerned about the same thing. Also, he explained some things I didn't fully understand last week. Because the first sign of trouble was that the dog was holding his left foot off the ground, I assumed it had started in his foot. I thought that if we had just caught this a few months ago, they would have been able to just remove his leg and we would have had a chance for a much better outcome.

But the vet explained today that the tumor started deep in his armpit area, between two major muscles. He said that's pretty much the worst possible place it could start. So even if we had caught it earlier, it still would have been difficult to remove; even then, it wouldn't have been a simple leg amputation - they still would have had to go in and take out a significant amount of under-arm tissue to get to it.

The other thing he explained - and maybe the vet last week also explained it and I just wasn't hearing her since I was in shock - is that this particular kind of cancer isn't encapsulated. Instead, it's as if it's growing along tree branches, branching out into increasingly thinner branches along the nervous system. So not only does the main mass have to be removed, but all of those additional strands of the cancer that follow those branches would also have to be removed. And removing all of the cancer cells with clean margins without damaging the nerves in the process is a very challenging thing to do.

As if all of that wasn't enough, the radiologist's final report indicated that we would have to remove not only the leg and a signficant amount of muscle tissue, but also at least one rib and possibly additional ones.

And odds are that in all of that, somewhere, some place, at least a couple cancer cells would be left behind. Which means that it would grow back, the dog would have a missing front leg, at least one missing rib, and would still lose the use of his hind leg on that same side. Given what we've seen with his hind leg in the last few days, it's possible that he could lose the use of it before he's even finished recovering from the surgery.

So instead, we're going to keep him as comfortable as possible until he's no longer himself, and then we'll make the tough call. In the meantime, we're having a pet photographer come over tomorrow to take pictures of the entire zoo, while he's still feeling well enough that we can get images of him as his usual self.

In the meantime, we continue to welcome all prayers and kind thoughts that you care to offer up, because sometimes sanity can be a very tenuous thing. :-)

The Doctor - Somehow, I managed to hold myself together very, very well during my annual physical over the weekend, which included filling out the medical report for the adoption recertification.

I decided to take the approach of being honest without oversharing.

The nurse reviewed my meds. They know I've been on anti-depressants, it's in my chart, but somehow this time when she ran down the list to ask me if I was still taking each of them, she didn't mention that one. Nor did the form ask specifically if I've taken them. And when the doctor listed my meds on the form, she didn't mention the metformin or low-dose aspirin, only the thyroid meds.

The form did specifically ask about diagnosis of mental illness (no), anxiety (yes), depression (yes), and a couple other things I don't remember. I pointed out to her that my previous doctor had diagnosed (and prescribed medications for) anxiety, but none of the meds worked and the "anxiety" went away when my thyroid problem was addressed. So she noted very clearly in two places that the anxiety diagnosis was actually a misdiagnosis and that the issue was actually my thyroid.

The depression isn't a misdiagnosis, but she also put down that it was situational and caused by multiple miscarriages and by all of the hormones I've taken, which is entirely true. Before we started ttc, birth control pills caused the first round of depression I ever had, and when I stopped taking those so we could start ttc, it went away. (Well, briefly, until we started getting all of the IF diagnoses...) And Clomid and progesterone also trigger it.

On the form we have to fill out, it also asks about professional counseling, so I wrote that we've participated in "grief counseling" after our 4th miscarriage, which was of a baby with a heartbeat that died, and that we've continued to participate "as needed" while we've gone through additional treatments and miscarriages.

My hope is that "grief counseling" (which is a very accurate description) sounds better than "treatment for ongoing depression because my body can't seem to hold onto a kid", and that the social worker won't feel compelled to make a big deal about that in the home study. If she doesn't, international adoption might still be an option for us. Time will tell.

It's Doggie Cancer, and It's Bad

I hate when medical people lead you off with what sounds like good news, and then lower the boom.

When I was a freshman in high school, an aunt of mine wound up in the hospital due to an accident, and while she was recovering we got a call asking us to get to the hospital ASAP. I remember standing in a stairwell of the hospital with my mother (apparently all the consult or "family" rooms were occupied) while a doctor rambled on and on and. on. about her various health problems.

It sounded bad, but like there was still hope. Finally, I couldn't stand the sound of his voice anymore, and I just cut in and said "So you mean she's still alive, right?" And then he said, "No, she's gone. She died about an hour ago."

Everything went black, and he reached out to catch me as I collapsed. To this day, I still don't understand why he kept rambling incessantly when she was already gone.

This afternoon was a little like that.

We got to the vet's office, and the front desk told us the doctor was preparing the instructions. One of the vet techs handed us a couple of bottles of pills. She sounded so perky and happy, not like she was telling someone horrible news.

One of the bottles was a steroid. The vet had said if it was the best case scenario, steroids would be what the dog needs.

There were instructions to give him the pills for 8 days and then call to let them know how he's doing. "If it was cancer, they wouldn't want a report on whether he's improving," I thought.

Hope crept in.

"For once, we're not landing on the rare side of the odds," I thought. "Thank God."

Ha. When the vet finally came into the room, she seemed perky for a few moments, too. Then she told us it's bad. Very bad.

He has a rare nerve sheath cancer. It's big, and it's spreading.

If it was just in his leg, she would recommend "taking off" (they use that term, as if it's just a piece of clothing) his leg without a doubt. She says it isn't the kind of cancer that recurs in multiple places, so that usually cures it. And he's a strong, mentally tough but very happy-go-lucky dog, so she thinks he wouldn't be fazed much by losing the leg. I agree with that assessment of him.

But. But.

The tumor has spread, and it's now involving a couple of roots along the spinal cord and it's touching the spinal cord (I think at the beginning of the cord).

If it was in the cord, they would recommend palliative care until progression to the point that it was time to say goodbye.

However, from what they can tell, it's touching the cord but not within it yet.

So there is another option, which is take off the leg and remove as much of the tumor as possible. But they're not sure they can get all of the tumor cells where it's touching the cord, and if they don't, it will grow back. In that case, it likely will continue to grow down the cord, and then he will start to lose function of his hind left leg. (It's the front left one they would need to amputate.)

Chemo doesn't address this kind of cancer, and she said that the amount of radiation that would be needed to kill all the remaining cancer cells after surgery would damage the spinal cord.

The vet thinks he has 2-3 months without surgery, and maybe 6 months with surgery if they don't get all of it. If they do get all of it, he could have a normal lifespan (he's a cattle dog, they often live to 12-13 or longer).

The surgery would probably be at least $5,000. Maybe 6 months. But how do you put a price on time with a being you love, even if it's an animal? He has such personality. He's such a sweet, loving, happy dog. He just wants to play all the time - you'd never think he was 8 years old. We have 4 dogs, and he doesn't care what place he's in in the pack. Even with the limp and the pain he's been enduring, there have only been a couple of days when he hasn't been his normal, happy self.

If we don't do the surgery, our choices are put him down now or wait until he progresses further. I wouldn't want to keep him alive just for us if he isn't having a good quality of life.

On the other hand, how do you put down a dog who, when he is just sitting there looking up at you, you would think is 100% healthy?

We've had to make the tough call before, and we knew when it was time. But in that case, the dog went from being fine and us not knowing anything was wrong to suddenly being very not fine. Watching a dog progress slowly into "not fine" is a whole other thing.

I don't know what to do.

$5,000 is a lot of money. We're going to have big bills coming up for our next transfer. But on the other hand (and I realize this is my 4th or 5th hand at this point), would I be able to live with myself if we didn't try? It would feel like we were saying he isn't worth it.

Is it fair to do that to the dog? Is he better off if we just do palliative care until the time becomes obvious? Or is it better if we say goodbye now?

In some respects, it would have been easier if it had been the very worst case scenario, where the tumor was already growing down the spine and surgery wasn't an option.

This is a special kind of hell. I am so devastatingly sad.

Not to whine and fall into a pity party, but just how much more do we have to endure?

I understand that dogs die. They don't live as long as we do. I get that, I really do. But with the exception of one, it seems that ours don't even seem to have normal lifespans.

Need Doggie Prayers

I think I've mentioned that one of our dogs has been limping. Mom and I took him to a veterinary neurologist this morning. He's undergoing an MRI.

He may have a very rare nerve sheath cancer.

It may be in his spine.

They may not be able to do anything about it.

We will find out in about 3 hours. He's the youngest of all of our dogs - he's 8. He's the only male pet I've ever had. I refer to him as our "baby boy". Out of the 3 dogs R and I have had together, one other one is still with us and the third one died several years ago of congestive heart failure when she was only 6.5 years old.

All I can keep thinking is "Are we destined to lose every creature we love like a child at an early stage? Does God really hate us that much?" 7 dead babies, 1 dead dog, possibly another.

I'm not coping well. And somehow, I have to pull myself together enough to attend a work meeting (thankfully over the phone rather than in person) in two minutes.

Gold Star Uterus

Beta 3 integrin results are in: I tested positive, which is good. So between that and the other endometrial biopsy testing that also produced good results, I guess this means that my uterus isn't the issue.

Mo and Libby, in answer to your question about what the other biopsy testing was - they were checking for CD57+ cells, which they don't want to see, and FoxP3+ cells, which they do want to see.

I had none of the CD57+ and FoxP3+ cells that were "adequate in number, suggesting adequate stromal regulatory activity" according to the report.

So I guess it's looking like my immune system in general is the culprit.

We also got the results of the repeat bloodwork. While the NK cell levels in my uterus were good, they were still slightly off in my bloodstream. Not a surprise, as that was also the case during the transfers we did for IVF retrieval #1 a few years back. IVIg is still recommended, no surprise there.

My Leukocyte Antibody Detection levels (T cells and B cells) were also low, so LIT is recommended. And one of my Cytokine ratios was high, so Humira was recommended.

So, what's the plan?

I'm not doing the Humira. It has an increased risk of cancer, usually lymphoma, which is in the same family of cancer that my dad has (leukemia) and that his dad had (multiple myeloma). R and I decided pretty quickly that it's not worth the risk, and that view hasn't changed. If Humira is what's standing between me and a biological child, so be it.

I think we're going to do LIT. I'm still afraid of crossing the border, but we did go and get our passports yesterday and requested expedited processing. Two rounds are being recommended (3 weeks apart), so hopefully we can do the first trip in November and second trip in December.

We also plan to do the IVIg. And hopefully transfer in January.

At the same time, I'm ready to be done with this and move on to the next step. (Or so I say now - I realize I may sing a different tune if we wind up with one single line in January/February.)

To that end, I've contacted a local adoption agency to request a recertification application, and I've scheduled carpet cleaners to come out in mid-November. I'm not going to obsessively clean, but we have 4 dogs and 2 (indoor only) cats, and our carpet is just embarrassing.

I also need to work on getting a pool fence installed, and once we get the application completed and fence installation scheduled, I'll contact the social worker to do the home visit. If we can get that done by the end of November, we should have our certification around the time we get transfer results.

We haven't totally decided which way we would go on the adoption front. I'm still hesitant to do international for fear of being rejected. What I've decided to do with the home study is give the health forms to our family doc and mention that certain things would possibly disqualify us, but leave it up to her whether she thinks they are a possible impairment to our ability to parent and puts it on the form or not. (I haven't seen the form yet, so I don't know if it's a very specific questionnaire or if it just asks for a general statement.)

Then during the home study visit, if questions come up we'll answer them honestly, but we won't go out of our way to point out things that the social worker doesn't ask about. Once the certification is done, we'll request a copy of the home study and review what the report says and decide whether we think it would knock us out of the running internationally.

We'll see what happens.

Good News - Not Sure What To Do With This

The results of the NK tests that were done on the biopsied tissue came in today. Apparently there are two types of cells they look for - one type is bad, so they don't want to see that in the endometrial lining, and the other is good, so they want to see lots of those.

It turns out I have none of the bad cells and lots of the good cells.

In other words, good news on one small front in the infertility fight.

It's been so long since we've gotten good news relating to infertility that I just sat there stupified for a minute. I don't think I trusted my brain to interpret what I was hearing, because I had to ask "You mean, my test results are good? Really??"

I'd like to think that this means my uterus isn't killing off the embryos, but I haven't heard the results of the other endometrial biopsy test (for the beta-3 integrin) yet, so I guess that thinking is still a bit premature at this point.

I sent an e-mail to ask the clinic when they think those test results might come in, so hopefully we'll also have that answer soon.

A Random Thought 'Dancing' Through My Head

This is completely unrelated to anything about infertility, but...

I'm catching up on last night's TV, and can I just say - I hope I can move like Florence Henderson when I'm 76 years old!

I couldn't even dance half as well today, when I'm less than half her age. That lady is amazing!

Survived the Biopsy

Apparently I should have researched the endometrial biopsy process a bit before undergoing it.

I was thinking that it involved literally snipping some of the uterine lining out, much like the sudden, sharp pain felt when a dermatologist uses that little tool to cut a chunk of skin out of your arm/leg/back/wherever to make sure it isn't skin cancer. At least, I assume it's a sudden, sharp pain, given the face R makes when it happens. Fortunately I haven't had occasion to undergo that particular form of torture.

Anyway, based on that assumption, I showed up to the appointment this afternoon more freaked out about a procedure than any other time I can remember in the last decade or so.

It wasn't fun, but fortunately it also wasn't as horrible as I imagined it to be.

Actually, for the first bit of tissue that local RE took, I just felt a little bit of mild cramping. Had the process stopped there, I would have classified it as "no big deal at all". But I'm having two tests done - the integrin-B (I think that's what it's called, too lazy to look it up at the moment), which RE is doing, and NK cell testing, which RI is doing.

Which meant that I had to have two bits of tissue removed, instead of just one. While the second bit was being removed, that was more like "lay in your bed moaning about really bad menstrual cramps" kind of pain. But I did a lot of deep breathing, and clearly I survived.

As soon as the second one was done, I took my feet out of the stirrups and sat up (probably subconsciously thinking that if I was in an upright position, he couldn't take any more tissue even if he wanted to).

Then he started to ask me about how many embryos we have, what protocol we used, what our next steps are. (Even though he's the RE I do all of my local monitoring with, so we've already covered this ground.)

But I tried to answer the questions anyway, and then I realized that my own voice was starting to sound a little bit distant and hazy and the room was starting to sway. Suddenly in the middle of a sentence about our protocol, I announced, "I think I'm going to pass out."

Fortunately I didn't, but they did have me lay back down and stay there for about 15 minutes. I don't usually get dizzy, and I've never fainted in my life, but I guess I had just stressed myself out about this so much that I got a little lightheaded with relief once it was over.

Oh, and after it was over, I found out that the tissue doesn't actually get cut out - some cells are sucked out with a pipette. If I would have realized that beforehand, I probably wouldn't have been so freaked out to begin with.

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.

You Know You're An Infertility Patient When...

...the lab tech knows you by your veins rather than your name. "Oh, I remember you, you're the one I have to draw in the top of your hand instead of your arm."

...early morning his-and-hers lab appointments count as a "date". "But honey, it'll be romantic, really - we'll get to see the sunrise on our way to the lab." (It was a good effort, but he didn't buy it. Apparently his idea of fun at 6 a.m. involves sleep rather than a needle being jabbed into his arm. Imagine.)

More to come later (hopefully this weekend), but I just wanted to make a quick post since I've been quiet the last few weeks. Nothing majorly exciting going on, just beyond crazy busy at work. Since I was in a humorous mood for the moment, I figured I'd share...

As I Said...

It's a week later. (Okay, 9 days, though I did actually test 2 days ago, so that part was exactly a week.) Anyway, as I said in my last post...still only 1 single line. And then CD1 showed up.

So, no big happy surprise.

I guess the cramping I was feeling just before we left for vacation must have been ovulation rather than implantation. I used to only have a few sharp pinches around ovulation time, but within the past year or so I've been noticing a bit of spotting around that time and cramping rather than pinching. I wonder if it means my ovaries are covered in scar tissue from all of the retrievals? They've each been poked with a needle more than 50 times, so I wouldn't be surprised.

Oh, and about the hot tub - thank you all for the advice. I decided to follow the prevailing vote and stay out of it. Oddly enough, no one else expressed interest in going in again all week, which was particularly surprising given the group we were with.

One thing I am happy about (in that odd way that only someone who's been dealing with IF for a ridiculously long time can be) is that at least my post-ovulation progesterone levels seemed to be higher than they usually are, given all the symptoms I had. So maybe my body is functioning in a semi-normal way in at least one respect.

And now, I need to cross my fingers that it continues to do so. I spoke with RI's office today. I'm still waiting for the test orders, but one of them will be an endometrial biopsy, which from what I understand has to take place at a certain point after ovulation. So I will be starting up with the OPK pee sticks in about 10 days. Given my ovaries' propensity to quiet down when I need them to work (and to work when I need them to be quiet), I could wind up going through quite a few sticks.

To that end - and since I kind of pigged out on vacation - I regrouped again yesterday to cut the refined sugar and caffeine out of my diet.

It's day 2. I'm hungry, I'm cranky, I'm sleepy, and I. Want. Sugar.

I've been eating fruit in an attempt to compensate - strawberries, raspberries. I cut up an entire watermelon last night. I eyed a banana as dessert. Of course, it would have been much better sliced up over a bowl of ice cream and chocolate sauce, but I figure I have to make it for at least 48 hours. :-) (Ideally, much longer.)

I know it gets better. It's just this initial withdrawl period that stinks.

I'm an Idiot

In more ways than one. And I have the receipt to prove it.

Despite all evidence to the contrary, I still cling to the faint hope that I can be like a normal person who has sex, gets knocked up, and pops out a kid 9 months later.

R discourages hip-propping after the deed, figuring that I don't have much of a chance of producing a normal, healthy egg sans fertility meds. But last weekend I ignored him and did it anyway.

So then on Thursday, I started having really bad cramps. As in, I-can't-remember-the-last-time-I-had-cramps-this-bad cramps. I even went home early from work.

And I was ticked, because we were leaving for a week at the beach yesterday, and the last thing I wanted was to be dealing with AF. But I didn't start to spot or bleed.

Then last night it occurred to me that my chest is sore, which rarely happens outside of pregnancy. This morning, the back pain started, and I've been having AF-like aching and pains all day long. Which I thought were maybe round ligament pains.

So I made R take me to the store to buy a test (first way in which I am an idiot, as proven by the store receipt for the test). Of course it was negative, despite my hopes to the contrary (second way in which I'm an idiot). And then after taking the test, it occurred to me that given that we had sex last weekend, I could only be a week out from conception at the very most, so if anything these are implantation pains and it's still way too early to test (third way in which I'm an idiot).

But now I don't want to hang out in the hot tub with our friends, and there are two more pregnancy tests stashed in one of the dresser drawers, mocking me and tempting me. And chances are 99,999 to 1 that in a week I'm going to be coming back on here to post that 1) AF has shown up, or 2) Still no sign of AF, but the tests still show only one stupid line.

In other news...I had a phone consult with an RE who believes in immune issues. She recommended IVIg - no big surprise there. I finally got myself together enough to send off my records to an RI as well, so I'm waiting to hear what tests he wants to order.

My dad is doing well enough that his oncologist now thinks he is a candidate for a bone marrow transplant. (The level of cancerous cells in his blood is low, but on the other hand his marrow isn't producing much blood, so he's still needing transfusions all the time - hence the recommendation for the transplant.)

So his siblings are getting tested, and we're waiting for the results. Our next FET is on hold until we know more about what's going on with him and whether I'll need to be tested as a possible donor.

My mother is having memory issues, not to the degree that I think it's dementia but still to a degree that is unusual for her and something to keep an eye on. She doesn't believe this, so we had another big blowout in which she: 1) accused my husband of lying, 2) accused me of trying to make her think she has Alzheimer's, and 3) accused me of making her upset enough to have a stroke. (This, despite the fact that I never raised my voice to her, even when she was shouting at me.)

We are still living under the same roof as her, but now all of our communication with her takes place through e-mails, which are sent to her and then printed out, logged in a binder kept in the kitchen, and I even go so far as to make a copy of the log sheet every time I add to it, so that I have proof in case she ever tries to remove an e-mail and edit the log, because that is something she would do.

And she thinks the problem is us.

I've also been doing some preparations for Plan B. More on that to come in a later post, but for now I need your thoughts - do I spend the next week staying out of the hot tub on the very remote chance that this may be implantation that I'm feeling, or do I throw caution to the wind, climb in, and say "Whatever will be, will be"? If you were me, what would you do?

(Also, Peaches, you commented a few posts ago that you'd be willing to chat about surrogacy, but I'm not sure how to contact you as your name doesn't seem to link to a blog?)

A New Post

There's a new post below. Thanks to Mrs. LC's comment on it, I realized that I had forgotten Blogger's quirky habit of using the date you start the draft as the posting date, even if you don't publish the post until a later date. So Mrs. LC, you didn't miss it at all - I just published the post last night.

Phoebe, totally agree with your comments about acu. I wasn't surprised in general that acu would be recommended - our first IVF RE recommended it - I was just caught off guard that current RE recommended it, because he doesn't seem to be the type that supports that kind of thing. (He's referred to some other alternative treatments as "vodoo" - his exact word - in the past.)

I've done acu immediately pre- and post-transfer for all of my transfers, and I've also done it for several weeks leading up to one of the transfers in the past, although not the most recent one. I was comfortable with that acupuncturist, but I have two friends who recommend another one, so I may try her this time around. Your point about getting established in advance is a good one.

Decisions (Sort Of)

I'm starting to calm down a little bit. (I think, anyway.)

We've made our first decision - we're going to give my uterus another try, probably in September or October. To that end, I've scheduled an appointment next week to talk with another RE about intralipids, and I'm probably also going to consult with an RI. Regardless of which one we go with, it means yet another out of state doctor, so if we do the full gamut of treatments (including the IV antibiotics), this will be a pregnancy that involves four separate states. Ugh!

I've also scheduled another appointment with RE. Last time, I was able to get in the next day, but this time the first available appointment was a full month out, so it won't be until the very end of the month. When we had our WTF appointment, all we knew at that point was that my numbers were low and looked like they had stalled. I want to know how likely he thinks it is that this most recent pregnancy was an ectopic and just bad luck.

I also received a somewhat surprising e-mail from RE's nurse. RE wants my most recent thyroid tests (taken in mid-May while I was still pregnant - they were normal), and wants me to get my thyroid levels retested 10 days before starting the estrogen patches. I asked her if he was thinking maybe that contributed to the loss, and she said he's routinely keeping a closer eye on patients with thyroid conditions.

The other surprising thing was that he also wants me to do acupuncture twice a week for the four weeks before transfer. I didn't think he was into any alternative treatments at all, so this was a bit unexpected.

Nurse said it was because my uterine blood flow during one of the one-day workups was low. I think that happened because I forgot the no caffeine rule and had caffeine both the night before and morning of the ODW. I was super careful to avoid it in the weeks leading up to the transfer, though, so I don't think that was really the issue. But I truly appreciate that he is trying to think of anything he can that might make a difference this time around.

I also met with ob/gyn last week. Surprisingly, he didn't think a laparoscopy is necessary in my case. He said even if I do have endo, cleaning it out won't really help with staying pregnant, it's more of an impediment to getting pregnant. But I've seen plenty of women mention being on dep.ot lupr.on for a couple of months before an FET to treat endo, so I'll mention it to RE and see what he thinks.

With regard to all of the surrogacy and adoption stuff, I'm still vascillating. I keep researching it all, and one day I think one option sounds great, and then the next day I see something about that same option that completely freaks me out. (Like a couple who got all the way to their court date in Ethiopia, and then the judge denied their adoption because the adoptive mom had taken anti-depressants for post-partum depression for a couple months half a decade before, even though Ethiopia is supposedly okay with anti-depressant usage from a couple of agencies I spoke with.)

The idea of just not mentioning our issues is tempting, but then I worry that if we do that, God will strike us down for our lie of omission by allowing R's heart to fall into an abnormal rhythm that triggers his ICD while we're in Ethiopia, most likely at the exact moment we would be standing in front of a judge. Because we have luck like that.

So for now, I've decided not to make any other concrete decisions about next steps. I will just continue to obsessively research while hoping that maybe maybe maybe the next transfer will be the one. Perhaps I should consider putting back 4 or 5 - you'd think out of that many, at least one would stick for the long haul.

(Yes, I am just kidding. Kind of.)

In the Wrong Club

I got a phone call this morning. I didn't recognize the number, but against my better judgment, I answered it.

It turned out to be a nurse from our health insurance company, calling to tell me that they had enrolled me in a special program. I assumed she was talking about a diabetes program, because I get calls like that from time to time. (I take metf.ormin for PCOS, and they mistakenly assume I'm diabetic.)

But this time, it wasn't about diabetes.

Oh, no. Instead, it was "I wanted to congratulate you and let you know we've enrolled you in the Healthy Baby Club program we offer..."

HA. HA HA HA HA HA.

I was tempted to say, "You know, I'm more of a Recurrent Pregnancy Loss Club kinda gal", but I behaved myself. I know it wasn't her fault - she just gets a list of people and is told to call them.

Apparently when they're generating these lists, they don't write algorithms to detect "fertility treatment codes followed by 10 hcg tests within a 5 week span, an ER visit and a very very early ob/gyn visit" and spit out a result that reads "WARNING: POTENTIAL PROBLEM. Call patient at your own risk."