Tuesday, July 29, 2008
Tomorrow, at approximately 1 p.m., I am leaving New Jersey and heading to Buffalo. I will take my last dose of progesterone tonight. After speaking with the RE's office, we determined that if I get a period on Thursday, I have to stay home for one more day to get bloodwork done on Friday morning so that I can start my injectables cycle. I'd have to stay put because Monday would be cycle day 5 at which point it would be too late and I couldn't start my drugs. I don't love the idea of staying home for another day as I generally only see my two best friends I am visiting once every year or two at best so I want to spend as much time as possible with them.
But, what if I get my period after I've left Jersey but still on Thursday? Do I turn around, pulling an illegal U-turn on the highway at 60 (okay, 75) miles per hour? What the heck do I do then?
And so this is why, period, you do not have permission to arrive on Thursday, July 31st between the hours of 1 p.m. and midnight. And frankly, if you could just not arrive on Thursday altogether, that'd be super. I think I've been more than accommodating for the last 76 days and I am only asking for 11 stinkin' hours (but preferably 24 hours).
What do you bet the whore shows up anyway? Sorry, I take it back. I didn't mean it. Please don't show up. Please.
On another note, I'm going to New York because it's my best friend's baby shower. I'm beyond excited for her to become a mom. Her journey to conceive a child has been long and difficult. She will be an amazing mother. So this is a pregnancy that I celebrate.
But....at the same time, I can't lie. I'm a little nervous for the shower. It's the first one I'll attend since trying to conceive my own child (I bailed on one a few months ago because a beyond understanding, wonderful friend of mine gave me the option after a particularly harrowing weekend). So I'm a little anxious about the few hours of baby toys, baby clothes and hopefully not baby questions directed at me, but this friend and baby are different. This one comforts much more than it could ever hurt. This one gives me hope.
Saturday, July 26, 2008
Often it takes someone else's words to help me articulate my own. I've been reading the Kite Runner, which in the first few days, I thought was a horrid book and debated giving up on it. The story of Hassan and Amir's childhood left me wanting to reach deep into the pages and smack Amir for the many ways he wronged his friend, no matter his intentions. But I stuck with it, other people's praises reverberating in my head....it's one of my favorites....I love it.....couldn't put it down.
Finally, I reached the point where the author switched to telling of the boys' adulthoods. Thank God. No more childhood atrocities. I smiled through Amir finding love in such a gentle, innocent way. I cried as he lost his father. And then....I groaned aloud
....as I read the words unexplained infertility. I tossed the book on the bed and gazed at the lazily blowing branches outside my bedroom window. I didn't sign on for this couple to be infertile. I was looking for an escape....from my own infertility.
After a few minutes, I picked up the novel again and began to read on, mostly because I was too lazy to get out of bed. Shortly after, I came across this paragraph:
"Sometimes, Soraya sleeping next to me, I lay in bed and listened to the screen door swinging open and shut with the breeze, to the crickets chirping in the yard. And I could almost feel the emptiness in Soraya's womb, like it was a living, breathing thing. It had seeped into our marriage, that emptiness, into our laughs, and our lovemaking. And late at night, in the darkness of our room, I'd feel it rising from Soraya and settling between us. Sleeping between us. Like a newborn child."
Somebody else's words conveying so eloquently the random thoughts and jumbled phrases that tumble around my head daily startled me. Somebody else summed up my marriage, my household and my heartache in one paragraph.
For the last two years, I've written a letter on our anniversary, just summarizing what our year has been like. I tuck them away in our marriage box for now but I hope to make an album of them for our children to read as they grow up and my memory becomes fuzzy. That first year, before infertility made itself comfortable in our spare bedroom that's meant to be a nursery, the words flowed off the page with ease, my love for my husband seeping out of every line. But this year, this year was different. I still love my husband in more ways than I could ever commit to paper and I'm beyond grateful for my marriage, but there's a hole, a hollowness that echoes in my joy. My infertility.
I have to say, infertility's a pretty sh!tty roommate. She doesn't do any chores, she's quite the Debbie Downer and she tends to invade my quiet moments. Let's call her Hannah because I always spell infertility wrong when I type and have to go back and fix it and also because, let's face it, she's a big part of my life. She warrants a name.
Hannah lounges about lazily when I attempt to do my school work. She interrupts incessantly as I try to meet a dealine for a paper. When I attempt my assigned reading, she wanders in and out of the office, playing with the highlighters on my desk and blowing hair from her face with her deep sighs. Anything to shift my focus back to her. Over dinner with my husband, she sometimes just sits at the table, begging to be noticed as I avert my eyes from her gaze. Sometimes, as I'm cooking, she peers overs my shoulder, her face closing in on my personal space. Worse, sometimes she stares at me when I'm alone with my husband, chiding me that no amount of time in the bedroom will make her pack up and ship out.
But sometimes, just sometimes, she leaves for a bit. Runs to the convenience store and I have a few minutes peace, a respite. Even better, on occasion she goes to see a double feature and leaves me a few cherished hours to enjoy myself and relax. But she always comes back and most of the time, she's quiet about it, sneaking up on me from behind and shouting boo! as she closes in on me.
These brief reprieves give me hope that one day she will leave for good.
Thursday, July 24, 2008
I should mention my husband fell asleep mid-meltdown while I was still in his arms. He was rubbing my shoulder while I cried, and it was getting slower, and slower, and slower until it stopped. He was asleep. I'll let him slide though. It was a school night. Still, it's a little funny.
Today, I went for my cycle day 70 bloodwork. Nothing routine about that, huh? So the usual nurse calls me back and asks me how I'm doing. I couldn't really...make words. Not at first. I just shook my head and managed to squeak out, "It's day 70" while fighting back tears. This spilled into something to the effect of me not knowing how much longer I could do this. She thankfully changed the topic to the newest Batman movie and, for that, I love her.
Don't get me wrong. I know it's only been just over a year. I know there are tons of women who have been on their infertility journey for significantly longer than me. I in no way feel as though I'm on the same level as them. But the thing is, I don't know how they do it. I try to imagine myself in the same spot in two years or even one year from now and the idea is unbearable. The emotional ups and downs of infertility exhaust me.
The RE's office called me back in the afternoon. They didn't bother to tell me that my pregnancy test was negative which I appreciated. She said that the doctor is doubling my dose of progesterone but I only have to take it for seven days rather than ten. Then she told me that the doctor said that, if I did not get a full flow, and only had spotting, that would be considered a period for this cycle. The doctor made a special note about this in my file so the nurses would be aware. Apparently seventy days makes you special.
In other cycle hillarity, I've been having egg white cervical mucus for the past four days. Ha! That makes me laugh while I choke back tears. I've been charting it on Fertility Friend and noticed that it started twelve days after my five-day-spotting-streak. Do you think that heavy spotting was a period after all and my jacked up body actually managed to ovulate? I have no idea since I've been waiting for my next cycle to resume temping, but wouldn't that be a kicker? Don't worry, we had sex. Just in case.
Wednesday, July 23, 2008
Talk with orthodontist:
Yes, you can come in and we'll make you a new retainer but you have no coverage for the retainer or your appointment. We'll see you Monday! (says the receptionist in a voice entirely too chipper for the mood I'm in)
Talk with RE nurse:
What? You're on cycle day 69? (stifle the giggle that sneaks out even though I'm frustrated and cranky) No, I don't think that progesterone you took is going to work. I don't see a period in your near future. Come in for some more bloodwork and we'll give some more progesterone. Let's see what a second round of it does. Maybe the doctor will give you a higher dose.
Talk with Primary:
Yeah, you tested positive for rheumatoid arthritis. It's mild but it's positive. It could be nothing but we still need to get it checked out. You're going to need to see a rheumatologist. (Sweet Jesus)
Stick a fork in me, I'm done.
Monday, July 21, 2008
I also wanted to post some blogs for you. This is the be-all-end-all list of blogs that are everything fertility related, categorized no less. Maybe someone else's voice can offer some small sense of solace.
For anybody else reading this, if you could leave some thoughts, prayers, dust or juju for "J", please do. Thanks.
Thursday, July 17, 2008
Besides my pregnancy tests, BBT thermometer and other assorted fertility/infertility items, there's another product I now require: a junior scientist kit to figure out this whole spotting versus actual period business. Can you picture me? I'd wear safety goggles with a lab coat and I'd have a microscope, magnifying glass and test tubes (I wouldn't really use the test tubes, that's just gross. I'd display them on my lab table next to me to look more science-y).
This past week has consisted of 6,000 trips to the bathroom to "check". I began spotting this past Friday. I am not one to normally spot, but then throw infertility meds into the mix and nothing is normal. So I'm spotting....and investigating, continually investigating. Is this considered a period yet? What about this? I continue to spot into the weekend. On Saturday, I wonder if I should call it a period. By Sunday, I feel like maybe I can call it a period. It's more than just a tiny bit of spotting. It's heavy spotting??? At what point does heavy spotting become a light period?
Monday rolls around. I'm worried about missing the window to start my fertility meds. Still having is-it-spotting-or-a-period? type bleeding. Can I officially call it a period now? What about now? How about now? I call the RE's office. I'm put through to Nurse Lisa, the same woman who had previously called me to tell me I ovulated twice...or not. Lisa asks me questions about color and flow. She puts me on hold and gets in a huddle with the other nurses and nurse practitioner. I can imagine them, like football referees, debating the play from each of their angles. I wait patiently on hold while they make their decision. Finally, after all the heads nod in agreement, Lisa steps out of the huddle, walks to the center of the field, smoothes her black and white striped shirt and announces their decision:
"Continue to hold, it is not a period, the color is not sufficient. 4th down, Jacki's ball."
Goddamnit! I'm the coach who dramatically throws my clipboard on the field and screams about how that call is bullsh!t. Ughhhhh...I have to wait another day or two to "see what happens" and I should call the office again either way. If I don't get a period, I can come in for more testing. Double ughhhhhhh....I'm sick of this cycle and all of the tests that have gone with it. As a consolation prize, Lisa calls the mail order pharmacy to order my injectables. If they are approved quickly enough, I can start shots instead of another round of Clomid.
Tuesday, spotting, not enough for a tampon, still the wrong color.
Wednesday, nothing. It's gone. Oh sh!t, was that my period and now it's over and I didn't start injectables or Clomid? I will freak, I tell you. This 60-some day cycle is putting me over the edge. I call RE's office again. This time I chat with Nurse Regina. Regina gives off an air of confidence. Like she knows exactly what's up with my vagina and if my vagina tries to disagree with her, she'll give it a piece of her mind. Her last name actually is Vagina. She's Regina Vagina.
"Look, your period will arrive within 14 days of taking the last pill. This is very common with progesterone. You start to spot, you think you're getting your period and then it disappears. It will be back. And when it returns, it will be a regular flow, red period. You should get it by the end of this week, mayyybe the beginning of next."
She's so sure, I'm surprised she didn't tell me that it will arrive on July 19th at 3:07 p.m.
So period, I'll be here, waiting, rather impatiently. Friday would be a great day to arrive as I will be home awaiting the delivery of my injectables (woot!). Or maybe I'll just see you on July 19th at 3:07.
Tuesday, July 15, 2008
Saturday, July 12, 2008
Mr. Jaguar and I sat there, waiting for the doctor while I reread the poster about IVF that I had previously memorized at my first visit. Joe kept cracking jokes about how we were waiting for the doctor to wake up from his nap and get to his first appointment. After a bit, Dr. PacMan came in and started off by giving the Joe the story of a (fertile) woman's cycle since he wasn't there for the first visit. He drew the same diagram I got when I heard the lovely tale of a (fertile, i.e. not mine) reproductive system while I sat there with my list of questions and pencil poised, ready to get to the important stuff.
I jumped right into the topic of this persistent corpus luteum.
"We have no way of knowing if it was an early pregnancy or a persistent corpus luteum. It's impossible to know for sure which it was." Huh??? I had already nestled myself into this comfortable conviction that it was not a chemical pregnancy and now we're flip flopping through this air of uncertainty? Why? The only reason I can think of is that he was talking to the sobbing version of me last week and was trying to provide me with some sense of comfort. But the bottom line, after prodding and poking the PacMan, is that we don't know what it was and we won't know it was. That does not sit well with me at all.
We shift into the injectables conversation and the doctor goes over a typical injectables cycle. I ask a lot of questions about risks, especially with my PCOS. I made a lot of follicles on both Clomid cycles (about 20 on each side the first time, and well over 30 on each side the second time). He explains that I will be monitored closely to look out for ovarion hyperstimulation. I question him about the discomfort I had after my ultrasounds and was it connected to producing so many follicles? He thinks it was probably more from the pressure of the wand on my ovaries.
The conversation circles a few times around the increased risk of multiples until I finally ask the question that nags at me from the corner of my mind. With a multiples pregnancy, at what point do you suggest pregnancy reduction? Saying the words aloud makes my stomach hurt. His response is no different than what I've read, we always recommend that a high multiples pregnancy be reduced to twins. The words hang in the air until I pop them with a matter-of-fact okay. I know I'm thinking far ahead at what is only a possibility and not a certainty, but the idea makes me want to vomit.
So what's next? Well, that is up in the air. I just finished my progesterone last night and so I'm waiting for my period. The doctor's office is getting the ball rolling on my injectables cycle. Plan A is to go straight to injectables if my insurance approves everything quickly and my meds arrive. But if my period arrives quickly and the insurance company responds slowly, Plan B is to go into another Clomid cycle while we wait for everything to get set up for the injectables. I'm hoping for Plan B (and ironically, now wanting this cycle to last even longer), but was disappointed to see that I was spotting when I arrived home from the appointment.
Joe and I went to Target after the appointment to grab some stuff. On the drive, I was mostly quiet, digesting all the information from the appointment. I was thinking about how I didn't really learn anything new at the appointment, like I just confirmed a lot of stuff that I've already read. That sort of bugged me because I felt like I wanted to get more out of the appointment. As we walked into the store, the first person we lay eyes on is a very pregnant customer. As I walk by, another woman is loudly saying to her, "You'll see when you become a mom...." Under my breath, I say, "Are you f*ckin' kidding me?" My husband says, "What?" My response, "Nothing." Then we turn the corner to go up the main aisle and the first thing we see is another very pregnant woman. My husband looks at me and bursts out laughing which sets me off laughing. Life is ridiculous sometimes. It was a nice moment. I felt very connected to my husband, like he got it.
I came home and looked over my packet of injectables information, reading aloud different portions of it to our summer roommate, Andy, who now knows more than he probably cares to about my vagina. "25% chance of twins..." Wait, what?! I had read it was 20%! Does it matter much? Yes. That's a 1 in 4 chance of multiples instead of 1 in 5. That's one less singleton marble to choose from in my little bag of pregnancy possibilities. Hmmmmm....
Later, I went out in the yard to think. I laid in the hammock, staring up into the tree branches, pondering all of today's developments and talking to God about this chemical pregnancy versus persistent corpus luteum business. And I came to the conclusion that I believe it was a persistent corpus luteum. I have no science to tell me one way or the other, but this one was decided between me and God.
Thursday, July 10, 2008
I'm nervous about the injectables. I'm nervous about my husband coming within 30 feet of me with a syringe. I'm nervous about my husband's enthusiasm for that task. I'm nervous about ovarian hyperstimulation syndrome. I'm really nervous about multiples. Scared is more the word actually. In making the switch from Clomid to injectables, the risk of multiples goes from 5% to 20%. Yeah, you read that right. 20%. Wow. Twins? Okay, I could roll with that and pray that we would all be healthy. More than that? It's frightening to me. Way more than that? I'm scared about the possibility of having to make heartbreaking decisions. The idea of having to take life to give life is one of the saddest things I can imagine. When I read about the details of reducing a pregnancy, it makes my chest ache. I want to hug anyone who has had to make that painful decision.
I'm way ahead of my self seeing as I'm not pregnant with a singleton or multiples and haven't even started the shots. So I'm trying to think about what questions I have for Dr. PacMan.
1. Would metformin help me?
2. Why do you feel it's time to move on from the Clomid?
3. What are your thoughts on the persistent corpus luteum cyst? Is it likely to happen again?
4. Is there a way to confirm a persistent corpus luteum, like does it show up on an ultrasound or can we only rely on bloodwork?
5. What's the schedule and monitoring for injectables?
6. What are the risks and benefits of injectables?
7. What are the success rates of injectables for women with PCOS?
8. Can we start this cycle or do we need more time to get my meds and learn how to give the shots? (I'm hoping I don't have to wait another cycle.)
Am I missing anything? Please let me know if you think of anything else. Thanks.
Sunday, July 6, 2008
1. lasting or enduring tenaciously, esp. in spite of opposition, obstacles, discouragement, etc.; persevering
2. constantly repeated; continuing or permanent
Today is cycle day 52. I'll attempt to recap this entire cycle with clarity but this last month and a half has been anything but clear so bear with me.
5/16 Cycle day 1
5/18-5/22 Cycle days 3-7, dutifully take my 100 mg of Clomid.
5/27 Cycle day 12, ultrasound reveals over 20 miniscule follicles in each ovary. Come back in a week. Hopefully something will grow, but we're not banking on it.
6/4 Cycle day 20, ultrasound reveals well over 30 still miniscule follicles in both ovaries. Let's consider this cycle a failure. Thanks for playing, come again on cycle day 30 when we'll rule out pregnancy and give you progesterone to get to cycle 7.
6/16 Cycle day 32, sorry, it's negative, you're not pregnant. However, we have a consolation prize! You ovulated. We don't know when because we had given up on you and your sh!t ovaries, but now you get to wait another week, come back again to rule out pregnancy and then we'll give you progesterone.
6/24 Cycle day 40, sorry, it's negative, you're not pregnant again. But your progesterone dropped which means your period is imminent, that's right, imminent. You don't need progesterone. Save $20 and move ahead 3 spaces.
7/1 Cycle day 47 where the hell is my period??!! Another phone call to the RE's office and I zip in on my way to work for yet another pregnancy test.
Are you ready for this?? Sit down because I am about to defy science with my super ovarian powers.
"Hi, Jacki. It's Lisa from Dr. PacMan's office. Your pregnancy test unfortunately was negative, but you just ovulated. So you're going to have to wait 2 weeks and then come in for a pregnancy test. If it's negative we'll give you progesterone to bring on your period."
What? JackiJaguar needs to change her name to JackiMedicalExtraordinaire because she has managed to ovulate twice in one cycle (yet still not get pregnant). This Clomid works really well!
The nurse and I proceed to stumble through a horrible conversation of me sputtering and confused explaining that I already ovulated some time before day 32 and it's now day 47 while she flips through my chart, completely thrown off her game. She, afterall, only called to give a standard, rehearsed message that she's given a million times before. She had no idea about the previous 46 days. I get off the phone upset and confused.
About 10 minutes later, after trying to create a logical statement about what just happened and failing, I call the office back. The receptionist tracks down the nurse (of course, I can't remember her name) who gets on the phone, immediately apologizes and tells me that she's been reviewing my chart with the nurse practitioner trying to make sense of all my labs.
She explains that back on day 32, my bloodwork showed that I ovulated but also indicated a possible pregnancy (which they didn't tell me back then and frankly, I'm glad because that's just messing with an infertile lady's head), so the standard protocol is that I come back a week later for another pregnancy test. Then my day 40 bloodwork showed that my numbers were back to normal non-possibly-pregnant numbers and so we were just waiting for my period. Now, today, my bloodwork shows that I ovulated again.
She questions me, asking me if I got any type of period in the last couple weeks. Nothing. I got nothing. The poor nurse, so nice, so sympathetic and so utterly confused at this point, doesn't really know what to tell me. Her only answer is that I could have had a chemical pregnancy shortly after day 32 and that I now ovulated again in a new cycle.
Chemical pregnancy. Those two words punch me in the stomach, taking all the air out of my lungs. The breezy, summer air in the room stops moving. My ears fill with the whooshing sound of blood rushing through my head.
The nurse goes on to explain that even the answer of a chemical pregnancy is still confusing because I should have had a period after it. She promises to talk to the doctor as soon as he comes in the office and that she or he will call me back to figure this out. I say thank you through my tears with each word catching in my throat.
Hanging up, I'm unsure of what to do now. How long do I have to wait for the doctor to call back? What do I do in the meantime? Could it be? Could it really be? Could I have been pregnant and now lost the one thing I want so badly when I didn't even know I had it? I let the dogs out and sit on the back step, the phone still in my hand, my heart heavy.
Since I can't really figure out what to do with myself, I opt to cry. I cry for the maybe chemical pregnancy. I cry for this stupid, frustrating cycle that seems to have no end in sight. I cry for my infertility in general. I cry for my approaching one year anniversary. I cry for each time I've heard the news that a friend is pregnant while I, still, am not. I cry. I cry. I cry.
Eventually, I head in the house. I attempt to study, but mostly stare at my tapping highlighter. I can't process anything I read with the words chemical pregnancy bellowing in my head. It's impossible to concentrate. I'd love to tell you what else I did while I waited for that phone to ring, but I don't even know. I think I mostly just sat, then wandered aimlessly around my house and then sat again all while crying off and on.
Finally, the phone rings. Dr. PacMan's voice immediately makes the tears come on full. He explains that he looked over my chart and starts recapping my cycle. I do my best at practicing patience and refrain from interrupting by screaming, "What is going on? Is it a chemical pregnancy?" which is the only thing I want to know right then.
He doesn't think it was a chemical pregnancy. He can't be 100% sure but he doesn't think so. He believes it is a persistent corpus luteum cyst. Here's what that means, according to Taking Charge of Your Infertility: "In this rare situation, the egg pops out during ovulation, and a corpus luteum develops, but instead of degenerating after 16 days, it continues to live."
So I'm rare. And so is my cyst. And since my cyst is persistent, it is sticking around, emitting progesterone, and messing up my bloodwork, making it appear that I either was pregnant or ovulated twice in one cycle. And it's also delaying my period which has to be fixed with my brass ring of this cycle, progesterone. And had I been charting, which thankfully I wasn't at the time, I would have had high temps that wouldn't have dropped and I would have thought I was pregnant. Thank you for small favors. At least I didn't have a beautiful, pregnant chart because that would have been devastating.
My infertility persists. But so do I.
Tuesday, July 1, 2008
I got my big fat negative on cycle day 32...no surprise because I had been told I hadn't ovulated. I was just there to confirm the negative and get my provera so I could move on to my next cycle. But then, surprise! I had ovulated, so I had to wait another week, take another pregnancy test, get another negative and then I would receive my provera.
Cycle day 40 rolls around, I go in and take my pregnancy test, get my big fat negative and then am told that my period is imminent so I don't need the provera to bring on a period. I can just wait and save myself the copay for the prescription.
But now it's cycle day 47 and I've been googling and now I'm alarmed (the dangers of google and webmd). Where is the period? How long can a luteal phase be? Do I have a luteal cyst which I now know is common with women taking Clomid (damn you, google!)? I call the RE's office this morning, explain that I ovulated sometime before day 32 and it's now day 47. They tell me to come right in, we'll do...you guessed it! another pregnancy test and then they'll give me provera to bring on a period. I'll believe they'll give me provera when I'm actually holding it in my hand. I just want to get this next cycle started already.
But what if....
I know, why am I doing this to myself? You're not pregnant! You know for a fact that your progesterone level already dropped. But I can't help it, I start daydreaming. What if I get to tell my husband tomorrow, on his 30th birthday, that he's going to be a dad? What if he opens his present and it's the special gift that reveals that I'm pregnant? What if, on the day of our 4th of July barbeque, I have horrible morning sickness? I imagine being in the midst of a conversation with my sister and suddenly it hits me. I rush to the bathroom with her following and while I'm puking, she realizes. "Oh my God, are you......" and I peek my head out of the toilet, smiling sheepishly and respond, "We weren't going to tell anybody yet."
What if, what if, what if.......I've had enough of the what ifs.