Bittersweet Birthday

Tomorrow's my birthday. One more year until I officially hit "advanced maternal age" standing. I have mixed emotions about this birthday. I remember thinking when I was pregnant with Benjamin that when I turned 34 I would have an approximately one month old baby. Now I'm having another birthday with empty arms, and for some reason the birthday makes the burden harder to carry. For some reason special days like birthdays and holidays are rough. Our son's absence is felt more acutely.

But I do have some fun things planned to celebrate. I'm going out with my co-workers for a treat tomorrow afternoon. And Mr. Chop and I will be going out for a nice dinner and then we will celebrate with my family over the weekend. I know I am loved, and I have many people to love in my life. I am truly blessed. I just wish the blessings would extend to the baby I so desperately want.

Complaints Department

So, I need to get something off my chest.

The woman in the office next door to me is newly pregnant. She did IVF, and this is her first pregnancy (she is just over 40). While I'm glad for her, it sucks to be me and constantly hear about it. I mean, all day long. She's only about 8 weeks pregnant, and she should be happy to finally be pregnant. That's a wonderful thing. But she complains all day long about feeling sick. Not sick enough not to go mountain bike riding (WTF? after conceiving via IVF at an advanced maternal age?), but sick enough to complain. She's told just about everyone, whether in phone or in person. I know this because I can hear everything while I am sitting at my desk trying to work. Now, you'd think she'd be a little more selective about who she tells and when. But no.

W. actually said to me, earlier today, that I probably don't want to hear her complain about food not sounding good and "what she would do to have just one meal that tastes good". I just nodded and smiled. I went through all of that and worse, I was in quite a bit of pain and on bed rest. And what did I get? Nothing but a dead baby and a lot of grief. But she complains about everything she can't eat: sushi, blue cheese, coffee and wine. I really don't know how I'm going to deal with much more of this. And she is constantly eating pot.ato chips. Crunch, crunch, crunch.

I really can't stand it. Sure, she should be happy. She should be ecstatic. But please, enough with the constant complaints. And have some respect for me. And everyone else in this little tiny office space. I don't know how I'm going to stay at this job much longer. That is, without losing the little bit of sanity I have left.

Speaking of the job, I have little to nothing to do and have to do my best to look busy. I know I should be glad to have a job at all in this economy but it's just been so lousy here for so long. Unfortunately, the job market is the pits right now and I can't see looking for another job while I'm in the process of going through another round of treatments. It's just not that easy to slip away for appointments when you've just started a new job.

But, speaking of treatments, last Saturday I started the BCP which is the first step of my FET protocol. Here's my protocol (if I can get through it without my joints and lungs giving me too many problems):

August 1 Start lupron injections.

August 7 Take final BCP.

August 14 Suppression check. Transvaginal ultrasound to determine whether ovaries have cysts and that no follicles are being formed.

August 15 If suppressed decrease lupron and start estrace supplementation at increasing levels to mimic natural cycle. I will also be utilizing acupuncture to prepare my lining for hopeful implantation.

August 29 Endometrial lining check. Literally, my endometrial lining will be measured via ultrasound.

August 30 If endometrial lining is acceptable reduce estraceand start PIO injections.

September 3 Possible embryo transfer, if all goes well.

I'm feeling really scared about whether the estrogen will send me into a world of hurt again. And wondering how I will get through all of the minutes and hours between now and all that is to come, or not come, ahead.

Feeding the Good Wolf

I heard a wonderful story recently about dealing with the emotions of sadness, loss of control and wondering how things could have been different if only. . .

Self defeating thoughts go around and around my mind. And then they translate into other areas of my life, where I just can’t stop worrying. Worrying about whether I’ll ever get pregnant again. Worrying about if something happens to Mr. Chop or my parents. Worrying about whether I will ever physically feel well again, which I’m sure doesn’t help my health situation at all. And I am learning that worrying about something does not prevent it from happening.

So sometimes you need a good allegory to help you sort things out.

An old Cherokee Indian was speaking to his grandson:

"A fight is going on inside me," he said to the boy. "It is a terrible fight and it is between two wolves. One is evil--he is anger, envy, sorrow, regret, greed, arrogance, self-pity, guilt, resentment, inferiority, lies, false pride, superiority, and ego. The other is good -- he is joy, peace, love, hope, serenity, humility, kindness, benevolence, empathy, generosity, truth, compassion, and faith. This same fight is going on inside you, and inside every other person, too."

The grandson thought about it for a long minute, and then asked his grandfather, "Which wolf will win?"

The old Cherokee simply replied, "The one you feed."

I’m going to work on feeding my good wolf. Just consider me a work in progress.

Fourth of July

We had a lovely long weekend. Saturday we went to a friend's birthday/Fourth of July party and Sunday we celebrated my dad's special day.

I had a little meltdown on Friday, the day before the holiday. It seems that holidays -- any kind -- do this to me. I thought about how Benjamin should be here. I thought about how everyone we know seems to have a baby, or babies, or now children who are far from babies -- except for us. Somehow the reality of a holiday always makes our house feel even emptier. And our house always feels empty, because we have a house perfect for a family -- five bedroom, three bath with a nice backyard -- and totally inappropriate for a couple with four cats. And yet another holiday went by without having expanded our family.

But I did take some time to think about how lucky I am to have a loving husband and wonderful parents. And so much around me to be thankful for. And I tried to take some time to be hopeful, but that was hard. Because after four years of this, it's hard to imagine that our dreams of a family will come true. But we have to keep on trying.

Is Pain on the Horizon?

At my post-op this past Monday we were given the go-ahead to do a FET cycle after my next period arrives. I'm excited that we might, possibly, really be moving forward. But I'm also scared to death. Dr. S wants me on a protocol that includes estrace, and since I still have joint pain from my time on Premarin this winter I'm not keen on it. I'm really afraid that my joint and lung pain will intensify. Worse, I'm worried that whatever is going on, likely an autoimmune problem, will be raised from whence it sleeps and that it will create real problems for me.

After taking the Premarin I would literally wake up in the morning nearly unable to move my hands. I had the strangest sensations and my hands hurt intensely all the time. I still have joint pain but it is much less intense. And even though I've been told by multiple doctors that I don't have lupus or rheumatoid arthritis because I have had two negative ANA (anti-nuclear antibodies) tests and a negative rheumatoid factor, I don't believe it. Something is wrong with me and I fear that I will never feel as well as I did before my pregnancy with Benjamin. And I worry that it will get worse and I will be told I shouldn't get pregnant. Ever.

Mr. Chop and I learned that Dr. S prefers to use some or all of our Day 3 embryos. This was a surprise because we thought the four blastocysts would have better odds. On the contrary. Actually, blasts have a harder shell and have a poorer thaw rate than their junior counterparts. So I guess we'll be going with the Day 3 boys and girls.

So now we wait. And pray that problems won't develop. Oh yeah, and that the FET will work. And that a resulting pregancy will bring us that child we long to hold.

EDD

Benjamin's estimated due date was today. I feel so much sorrow, and there's nothing to do with it except to try to move on. Some days I feel like I'm moving forward. Not today. Today it feels as though I will always be in this place. So lonely.

I wish things were different.

Goodbye Septum

I had my laparoscopy and hysteroscopy late last week. And while my RE, we'll call him Dr. S, was expecting to find damage from my D & E or my D & C procedures in January, there was none. I feel really fortunate about that. What the doctor did find, however, was a small uterine sub septum or a versus arcuate uterus.

A uterine septum is a congenital abnormality of the uterus. In the most extreme cases, it can actually cause the uterus to be divided into two separate chambers. The above illustration is courtesy of a blog about Mullerian Anomalies and actually shows a full septate uterus. My septum was partial, and in Dr. S's opinion, was either a small septum or could have even fallen within the spectrum of a normal uterine shape. Septums can cause repeat miscarriages and be a factor in infertility.

In my case even though the septum was small, the doctor felt it created hostile territory for implantation. He likened it to trying to plant a seed in concrete. Septums can cause miscarriage because the tissue is nonvascular. Unfortunately Dr. S does not know whether it had anything to do with my pPROM at 15 weeks. But it certainly wasn't helping our fertility situation any, and I'm glad to be rid of it.

I've spent the last couple of days recuperating. I don't know if it's the anesthesia or my general health issues, but I have been absolutely exhausted. I took have a day off yesterday to nap. I could easily sleep 16 hours a day right now.

To "celebrate" Father's Day, Mr. Chop and I went to see the new Pixar movie, "Up". It is an incredible movie, but for those of you dealing with infertility and loss, and are in particularly vulnerable times, I would recommend not seeing it. At least not right now. Without giving the story away, there is a very poignant montage describing the love a couple have for each other and their inability to have a family. Ever. I spent much of the movie with tears running down my face and so did Mr. Chop. It is a wonderful movie that is well worth seeing, just make sure you're in the right mental space for it.

Organ Recital

Since the loss of our son, every time I go on estrogen supplementation my joints ache. I go from feeling like a relatively healthy 33 year old woman to a postmenopausal centarian. I'm taking a BCP to prepare for my upcoming surgery and my hands and feet ache. Yesterday my shoulder hurt, today it's my right knee. And then there's the chest pain, which is basically achy lungs that last for weeks. And fatigue.

And I've seen a rheumatologist, a perinatalogist, my reproductive endocrinologist, and my GP. None of whom think the estrogen is related to the joint pain but somehow, every time I go on estrogen my joint pain flares up, and that's the only time, other than immediately before my menstrual periods. The rheumatologist tested me for lupus and rheumatoid arthritis but none of the tests indicated an autoimmune disease. And yet my symptoms are very much like those diseases, and the suffering I experience is very real. It is very frustrating to hurt for months on end and have every doctor just throw their hands up.

My problem with estrogen is a real issue for a couple who can conceive only with the help of fertility treatments. I had no problem during the stimulation part of my IVF cycle last Fall, and had no joint pain during the pregnancy. So I will be in big trouble if estrogen is needed after my surgery next week. Which is very possible, especially if I have a uterine perforation.

And a frozen embryo transfer protocol always includes estrogen supplementation, unless it is unmedicated, which my clinic generally does not do. But I think I need to raise the topic again, because if I'm going to attempt another pregnancy, I need to shoot for being as healthy as possible.

Five Months

It hurts to live without you, Benjamin. It's been five long months.

Love,

Mommy

My Imagination

Sometimes I allow myself to think of what might have been. We could be preparing for a baby to enter the world. Our son.

Buying way more stuff than one baby could ever need.

Going to a baby shower. For our baby.

Stocking up on cloth diapers, wondering if we'll get the hang of it.

Painting and decorating our middle bedroom.

My breasts and belly would be swollen and my back would ache.

We'd be anticipating B.'s arrival, knowing that any day, we'd see his face, kiss his toes, marvel at his soft baby skin.

We'd proudly hand him to his grandparents. The first grandchild for all four.

Sometimes I let my imagination run away.

Because we'll never see our boy, never hold him in our arms. Never tell him just how much he means to us. That he is our world. That we waited and waited for him. That no baby was ever loved more.

June

June was supposed to be such a joyous month for us. Our long awaited, much loved son was due June 26. When we were told his due date I remember looking forward to June as a new beginning, the beginning of our time as parents.

Since our son died I have dreaded June. And now it is here. And rather than looking forward to welcoming our son, I am faced with surgery. And I don't know when, if ever, we will be able to try for another pregnancy.

I had a saline infusion sonogram (SIS) last Friday. A SIS is an ultrasound where the doctor pumps the uterus full of saline and examines the inside of the uterus to see if there are abnormalities. The SIS before I did IVF last Fall was completely normal. The one I had on Friday showed something very abnormal. The doctor suggested it could be one of three things: retained placenta from my previous pregnancy, scar tissue, or a perforation of the uterine wall. I will have a hysteroscopy/laparoscopy on June 18 to determine what it is and to try and fix it.

To say I am scared would be an understatement. I am completely distraught. Why is all of this happening to us? Why can't we manage to get a break? What if I'm told I can never have a baby? I just can't handle that. It's just too much.

And this is just the first day of June.

Trying Again

So it's been a hellish couple of months. I'll talk about it another time. When I'm in a better space.

We are ready to try again. Well, actually, we've been trying for a couple of months but we don't seem to be able to get pregnant through sex so. . . back to the clinic we go. It will be a frozen embryo transfer (FET) this time, using leftover embryos from our IVF last fall.

I will be doing a lupron protocol starting after my next LH surge. I'm supposed to use ovulation predictor kits until I show a surge, and seven days later I start lupron, then go to estrace, then progesterone shots. I'm really scared about starting this again. And I'm really scared that I will have severe joint pain again.

So, after the loss I was prescribed premarin to rebuild my uterine lining. A few days after starting the estrogen, I developed bad joint pain. I woke up in the morning with stiff, achy joints and they hurt all day. It was hard to do much of anything, my hands hurt so bad. Sounded a lot like rheumatoid arthritis or lupus. That and the pleuritic chest pain I still have. But my rheumatoid factor was low and I had two negative ANA tests and was told I therefore did not likely have an autoimmune disease. And none of the doctors I saw (my internist, my peri, a rheumatologist and my reproductive endocrinologist) felt that the premarin was a factor in causing the joint pain. So here I go again, back on the estrogen. Hoping I'm not doomed to have joint pain for months. Because as bad as infertility is, infertility paired with chronic pain is even worse. And according to the protocol, if you do get pregnant they continue the estrace and progesterone for ten to twelve weeks.

So I just hope for once there is good news. Lasting good news. Long awaited good news. A healthy pregnancy. A living, healthy baby. No more joint pain.

I would pray but I gave up on praying when our son died. Although I find myself unconsciously sneaking one in now and then.

Happy New Year

So we spent the early hours of 2009 in the emergency room of our local hospital. My nurse wore a "Happy New Year" tiara. Cute.

During an hour long ultrasound, I saw what had happened immediately. Our child looked like he was wrapped in cellophane. There was little to no amniotic fluid left. You'd think this would be reason for the on-call OB to come down. But no. The ER doctor said there was nothing they could do and I should go home and take it easy. Drink lots of fluids. That might help.

We were sent home with directions to call my obstetrician's office the next day. Or come back if something changed. Like if I started having contractions. Or if I developed a fever or other signs of infection. There was nothing they could do.

I drank obscene amounts of liquid. Slept on the couch. Only got up to pee. Leaked fluid like crazy on an irregular but frequent basis. No position helped, not lying down, not sitting up. We scoured the Internet. Even on line things appeared dire. I felt desperate. My husband continued to carry some hope.

On January 2 I finally got to see an OB. Turned out to be the same one who told me it would be "very unusual" to leak amniotic fluid at my stage of pregnancy. She said, I just talked with one of our perinatalogists and they said there's a very low chance of this pregnancy continuing. She said, I didn't have the number before but they said less than 2% for a healthy baby. Then she put the doppler on my belly. We heard our child's heart beating steadily, 155 beats per minute. She said, let me arrange for you to consult with a perinatalogist. We were then scheduled to meet with one.

The perinatologist explained the situation to us. No fluid means poor lung development and poor kidney development, let alone the distinct likelihood that other systems would also be severely affected. Unlikely to survive and profoundly disabled. The peri had been in practice for more than 40 years and had seen one healthy baby after a pPROM this early. And that pPROM was due to amniocentesis, not due to some random event that caused mine. And I would likely develop infection which could jeopardize our chances of ever having a healthy pregnancy.

We chose to end our child's suffering by not trying against all odds to take him home with us. We loved him too much for that.

Now I'm sure that there are people out there who have made a different choice than we did. That would be your business. We wanted this baby more than life itself and his father and I made the best, most loving decision we could make. The most unselfish. And while I miss him every day, I have never regretted putting his needs before ours. Even though sometimes the pain I feel is almost more than I can bear.

So keep your judgements to yourself.

Been There, Done That, Bought the Tee Shirt

It's been a long road for us.

Mr. Chop and I were married in 2003 but didn't start TTC right away. I wanted to go to graduate school. So we waited until I turned thirty in 2005. That means it's been nearly four years. For a long time we tried on our own, when that wasn't successful, we went through the process of testing and found that my husband has poor sperm morphology. Five intra-uterine inseminations later, we still weren't pregnant. Next step, IVF with ICSI.

I was what they call in the IVF world a great responder. Thirty-eight eggs were retrieved, 25 of which were mature. Two beautiful embryos were transferred into my carefully prepared endometrium on day three. Our clinic froze six three day embryos and four six-day blastocysts. After our two week wait, we got the positive result we'd waited for, a positive beta, followed by doubled numbers in beta #2. At 6 weeks 5 days I had my first ultrasound. One beautiful heart beat.

But we didn't get to enjoy the pregnancy for long. Three days after this amazing ultrasound I woke up from a Saturday afternoon nap to a nightmare. I was bleeding profusely, so much that I passed out and had to be taken to the hospital by ambulance.

At the hospital we were amazed to see that precious heart beating on ultrasound. Despite all the bleeding, our little one was still hanging in there. I was diagnosed as having a "threatened miscarriage" caused by a large subchorionic hemorrhage. I was sent home and told to take it easy. Only time would tell what would happen.

I went on bedrest. My mother-in-law flew two thousand miles to spend a week taking care of me. Ultrasound after ultrasound showed all was well, but that blasted hemorrhage was still there, a dark, constantly reorganizing reminder that my pregnancy was precarious. Over the next couple of months, I had almost constant uterine cramping. But every time I went for an ultrasound, baby looked great. I kept my activity level to a bare minimum and was on and off modified bedrest.

By January 31, 2008 I was starting to feel pretty good. I was 14.5 weeks pregnant, and finally starting to have an appetite again. That day I worked half a day and met a friend for lunch. I felt so good I went to the mall to exchange a few items. When I got home that afternoon, I got up out of the car and felt something leak. I felt panic rise as I rushed into the house. I had leaked some fluid that was tinged with dried blood.

I took a deep breath and called the obstetrician's office. It was 5 p.m. on New Year's Eve and I was forwarded to the on-call obstetrician. I asked what the fluid could be. Could it be amniotic fluid? "That would be highly unusual," she said.