Immunology testing and other stuff

So I did the tests recommended by Dr. C. His clinic is huge, fancy, and totally faceless. I did not like it one bit, despite chocolates with his logo and fancy teas. The girl who was taking my blood samples had shaking hands, and looked decidedly uncomfortable and completely inefficient. Anyway, the results are in, and - surprise - my immunology results are totally normal. No elevated Natural Killer cells, nothing. The accompanying note said that based on these results, Dr. C recommends IVF. No surprise here: that's what they were pushing from the very beginning.
Now, yesterday we received a thick envelope with the financial information from this clinic. I went through it with a growing sense of dread and helplessness. There is NO WAY we could afford this. Just no way. Even if we felt comfortable enough with the idea of pumping me with drugs and risking another cyst or the same darling endometrioma growing... I don't know what to do now, I just don't.
I also started this "no gluten no dairy" regimen on Monday, and by today's evening, I felt thoroughly miserable. And hungry. What do these people on Paleo diet even eat? I cannot eat that much rice, I despise quinoa, I am not a huge meat-eater, I looove cheese and bread with everything basically. I don't feel full without it. So I caved in and ate some leftover pasta, with Parmesan to boot. I know you are not supposed to use food for comfort and solace, but what have I left? The atmosphere in our house is not a happy one currently.

Phone consultation

Our free phone consultation with the new doctor, let's call him Dr C, was rescheduled and took place today. He asked few questions, some of which I have already answered in their clinic questionnaire. He seems to think that the best way to go would be an aggressive stimulation IVF with immunology prep beforehand. He does not do natural IVF since he doesn't think the efforts required are justifiable with too low success rate.
He suggested that I cut out dairy (yogurt is thankfully okay), gluten (and I'd just had pasta for lunch), and alcohol completely (and he calls it a life). He also recommends to up the daily dose of CoQ10, Vitamin D, and to add Omega-3 and prenatals (I can't even describe how much I hate taking prenatals while not being pregnant). He also wants me to do blood tests for NK cells, cytokines and antiphosphilipid panel. He does not believe that my husband needs to do a Sperm Chromatine Structure Assay for his low (2%) morphology, as it was recommended by my second Dr (let's call him Dr J). He was quite adamant on this issue (but again, so was Dr J).
So, we're off for the tests on Monday. Depending on the results, we'll see whether we need IVF or we could treat immune issues and try naturally. Frankly, cards are stacked against us on all counts. We're dealing with female issues, male issues, immune issues, and we would probably have no money for IVF. And even if we had, having this endometrioma as an after-effect of Femara, I don't know if I want to risk anything like this happening again.

No good news

So yes, the endometrioma is back, possibly gotten a push from Letrozole, and is just slightly smaller than it was before the surgery in February. Not only that, but my CA-125 is higher than it was before the surgery. I am not back to square one, I am back to ground zero. I just cannot win. Such a neat double whammy: no pregnancy, but a bunch of potentially dangerous cysts, that threaten the whole possibility of me ever getting pregnant again.

I realize that all this time, I've been waiting for a miracle. Like you know, deus ex machina, light saving the darkest hour, this kind of thing. But apparently the miracles do not apply to us anymore. We had our miracle 6 years ago, only we did not understand just how great and singular it was.

And of course I am angry. At the surgeon - did she do her job well? At Dr who prescribed Letrozole - how could he not take into account my history, being told about it repeatedly? He said "you're in a good place right now", and then proceeded to put me in a much shittier place. At myself - if I wasn't so impatient, I would not have taken Letrozole, and maybe I'd have had another shot at miracle. At my body, which is failing me again and again.

Surprise surprise

Morning: pregnancy test negative. Evening: I've got my period. Two days earlier. This is ridiculous. I am upset and furious. This never happened before: my luteal phase used to be pretty consistent. Damn the Letrozole cycle, damn the doctors, damn my stupid old body.

Approaching a new clinic, and something about hope

Yesterday I emailed one of the local fertility centers which was mentioned somewhere as a good one to go for reproductive immunology issues. They have their first consultation free, which sounds just about right: we are in a tight money spot right now, and I would rather learn in advance what they can offer me, if anything. So I spent two days preparing my medical records and filling their extensive questionnaire, and getting more and more depressed by the minute.

What, realistically, anyone could probably offer me at this point? I honestly have no idea. I tried the anti-inflammatory protocol and failed. I tried Lethrozole and failed. Maybe some new twist on the first one could work. Maybe we could talk about the natural cycle IVF. Maybe it's just a matter of persistence and trying naturally, again and again. And hoping, hoping all the time.

Today, looking at the joyous faces and rainbow flags in the news, I remembered the famous Harvey Milk speech about hope. "You got to give them hope". At least someone didn't hope for nothing.

But me. Honestly, how do I even dare to hope. Me, with my 40th birthday just around the corner, with my shitty tests and 5 miscarriages, with first betas testing lower and lower every time? I know I need to stop obsessing about it, but when my Facebook feed brings new pregnancy announcements almost every day, I just can't. All those people getting their seconds, thirds, and fourths, but why not me? And my compilation of infertility blogs, which I made just few months ago, is full of happy reports, pregnancy complains, and ultrasound pictures. I am happy for everyone at these blogs, and I wish them all the best, I just want to be there myself as well. Hope is such a heavy burden.

Ultrasound results

So the results are in, and they don't make much sense - except for the confirmation that yes, I do have cysts, and I also have some "free fluid with debris" flowing around down there. Ain't it just peachy - I know I am full of awesomeness. Moreover, somehow the radiologist decided to compare the results with the ones I had in December, before the surgery. So his/her sorry exercise looked like: um, yes, the lesions got smaller etc. What. The. Fuck. S/he didn't even measure their sizes, how about that? And then my hurried surgeon emailed me "good news, your cysts are smaller and we don't have to do a follow up". Excuse me? Haven't you, you know, cut the whole shit out?! My OB/GYN said that "um, the endometriosis always comes back, so the cysts just had rearranged themselves". My uneducated take was that it's a few leftover cysts from Letrozole which could still go away, but no one seems to really think about it. They think that yes, this is the same old endometriosis back so soon. Which is very weird. Does it really, as the radiologist implied, has roughly the same configuration as before? How could this be?! Did they just forget to cut it out, having better things to do while I was sleeping? I don't know what to think, I am just pissed off and depressed even more.

The longest day of the year

I spent it checking my email every few minutes, awaiting the results of the ultrasound I had on Sunday to check the state of my ovaries after the botched attempt at Femara/Lethrozole. I haven't received any calls or emails, and I am exhausted from the whole imagination overdrive this is causing me.
Also, these past 3 days I have been: 1) drinking, 2) eating medium-cooked meat, 3) eating sushi. All during the two week wait. I think what this fifth miscarriage did to me was taking away hope - and thus maybe freeing us to go along with our lives. First small things, like drinking alcohol and planning vacations. Maybe bigger things will follow.
We are not completely done yet, though. We still plan on having a few phone consultations and seeing what we could do with our limited budget and travel opportunities. However, I have to get myself out of this limbo, which swallowed two years of our lives already. I have to. I don't know how, but I have to.

Random

Today I called to pay my bill for a Mother's Day ultrasound, and had a nice lady on the phone tell me that they do a 15% discount for infertility cervices. Her voice seemed so kind, so for some reason I started crying, and I am crying still. Meanwhile, my husband is dealing with all kinds of relatives/family friends at his mom's funeral, and fielding their questions about why haven't we got a 2nd/3d kid, why haven't we got a house, and all other shit older relatives normally ask. And yes, they also share their kids' stories around the lines of "oh and then they just miraculously discovered they're expecting their third, and they weren't even trying". WTF.

Feeling so down

I've been feeling incredibly down for the last few days. I've been testing every morning over the weekend, and the test line was getting paler and paler - until, on Monday, it wasn't visible anymore. I went for betas and spent an hour in a crowded lab waiting for my turn, thinking that I really didn't need to be there, since I already knew the answer. I haven't had breakfast, and might have been looking so miserable, that the technician offered me juice. This never ever happened before. Then she took a needle out too early and had to reinsert it, and I couldn't contain my tears.
The result was 2. My bitch RE didn't even say "I am sorry" (my OB/GYN, on the other hand, emailed me specifically to offer her sympathy). The other Dr. was uncharacteristically grim when I emailed him the news, and suggested we come and see him "sometime". His stupid office scheduled this "sometime" for August, and marked it as a "new infertility appointment". I am going to call to yell at them one of these days.
So, here's what I am dealing with now:
- I am feeling hopeless and helpless and desperate, because, once again, my chance to have a second child has evaporated. The bleeding came on Wednesday, and brought a new wave of grief and frustration.
- I am feeling sad re: death of my MIL, and having thoughts about the inevitability of this horrible end for people I love... everyone of us was someone's beloved baby, kissed and caressed and carried in arms, being read to and cooked for, and then fast forward - and there's no one to do this anymore; and then, this horror, and pain, and suffering, and then a cremation and a void.
- I am feeling alternately the immense comfort of my parents being here with me during this difficult time, and the poignancy of them getting older, frailer, and sadder. I am feeling guilty for not being able to cheer them up, and my heart breaks when I think that they would be leaving soon, and I don't know when I am going to see them again.
- My husband would be out of town for another week, and I miss him. Part of this time we would be alone with a kid, and this is going to be the hardest time - with all my grief and all bottled up tears.
- I am feeling like time just seeps through; my kid is having a graduation party this week, and this wonderfully safe cocoon her preschool provided would not be available anymore. With everything we've been going through the last two years she attended this place, it slowly became, in my mind, the embodiment of safety, the only constant place in her life. More constant than even her home, and safe from its pervasive sadness.
- I am feeling a horrible anxiety due to some health concerns; in the next couple of weeks I will have to face them and schedule some appointments. I am just so scared. I think somewhere in my heart of hearts I have this crazy idea that being pregnant is a miracle shield that keeps all the health issues at bay. I know it's not the case, of course, I am not stupid. It's just that I don't want to be thinking about tests and doctors if they are not related to be being pregnant - but I have to, and this makes me cry.
...And then I was folding the small girl clothes, new with tags, that someone in our household didn't get around to wearing. I was folding them to send to her younger cousin, and my heart was breaking again. It wasn't supposed to happen this way.

* * *

This is truly a horrible time for another chemical pregnancy to happen, especially with the implications that go with it - i.e. we are hitting the wall and not getting anywhere, and we are too freaking old to have another baby. I mean, 2 chemicals in a row is one thing; 3 chemicals in a row - bringing the total to five miscarriages - sound like a final sentence. And the thing is, my MIL died last night. My husband is beside himself with grief, and he is dealing with it and with all the rituals and bureaucracy surrounding death - and he is dealing with it alone, across the state. I am at home with a kid, and I am powerless. I did not tell him about the test, because I did not want to put extra pressure on him, and I did not want to put him through another round of beta hell. But the thing is, he remembers. He even remembered to ask me today, if I'd checked already - and I did not tell him the truth. I wanted my news to be a ray of light in an all-around bleak time, but now I fear it might as well be the breaking point.

This is truly hell. I couldn't help but Google happy endings for low HSG, but there were not much. Also, from my experience, if something doesn't look right and requires some elaborate mental scheming, calculations, and explanations like "sometimes it could still be normal", it probably is not right at all.

And yes, I've already thought about the name. Stupid old me.

And now, the drumroll

Faint positive line in the morning test. But... betas are at 7, so probably we are looking at another chemical pregnancy. I hate the sensitive tests with passion. I feel so devastated. 

Left behind

Have you ever had this feeling that everyone in your circle is moving forward - except for you? Of course you applaud your friends' successes, but then you come home and stare at the walls and ask yourself - but what about me?
I've been having that a lot recently. We have few couples friends that had their struggles with infertility - well, now they have the requisite two kids, they moved on. They have great jobs, they bought houses, they enrolled their kids in private schools... they are moving forward with their lives, they are shaping their lives the way they want them. And here we are, stuck in limbo - procreational, financial, emotional. The plan was to send the kid to preschool, have a second one, stay at home for 2-2.5 years, and then off to the workplace. Tell the Universe about your plans, make her laugh.
We've been discussing all this with my friend, who had a totally different dilemma in her life, but her limbo feeling was just the same as mine. Well, today she crossed over to the other side, so to speak - her problem had resolved to her and her family's great satisfaction. I am glad for her, I truly am. But there's a tiny voice in my head - but what about me? We were in the same boat, and now we are not, and there's no one left to commiserate with.
And since I am on the subject of friends, here's a story. There was a friend once, who, when I got successfully pregnant 6 years ago, was also really, really, really wanting a baby. I presented her with what was left from my supplies - ovulation strips, unopened PreSeed, etc. - and wished her good luck. She got pregnant soon afterwards, and told me that my gift gave her the luck indeed. Recently, she had her second baby (thus realizing my dream scenario, see above). She has her own stash of supplies left. Guess what - she never even offered them to me. She offers to sell them on some online board, spinning some yarn re: them being lucky... I don't care about $10 worth of strips, but could have used some luck, former friend.

CD14

Today, I feel so down and dispirited. What did this round of treatment done to me? Not much, given that I don't even know the size of these two follicles I did have, and I don't know the lining thickness. But I potentially have a cyst, which might prevent me from pursuing whatever other treatment options there are for a while. And I had spotting through CD12. Now, I have ovulation-like cramps on CD14, and, just you wait - a negative OPK. I know this attention to mundane details is useless and potentially damaging, but I cannot help but feel that Letrozole screwed up my body and my cycle, and for what?

Trigger shot dilemma

I am sick and tired of dealing with doctors. They basically run a conveyor belt system, where they hand you a protocol and expect you to get on with it. I cannot operate like that. I have questions, and I need answers, and I get frustrated not getting any. I cannot do things without getting an explanation, especially when my health is concerned.
Take this trigger shot situation. I emailed the Dr, twice, asking whatever brought this change of plan - were the follicles too small, or their amount too insufficient, and does he really think I need it? There was no reply, and we mulled it over on our own.
I was thinking about how, to get the shot, I need to get to the office and back in time to pick up the kid from the preschool. It's a half-day tomorrow, so it leaves a very small window to operate - the office is out of town. My husband would be out of town until Thursday and would not be able to drive me/pick up the kid. So logistically, it's a challenge. There are ways around it, but we need to plan these things in advance.
And then, of course, I've read about OHHS. I realize it's highly unlikely to get this particular complication with oral medication and two measly follicles. However, being a sole adult at home for a day and having even a slight possibility that things could go wrong... this is too scary.
So after some more Googling and seeing that many people don't do the trigger shot - and especially people who have no problems ovulating on their own, like me - we decided to skip it, at least for this cycle. I fully realize that we might not get to even discuss it the next cycle - if the cyst doesn't disappear, I wouldn't be doing any Letrozole.
I feel depressed by how things turned out. To get the answers, I have to ask the right questions at the right time, i.e. during appointment. But during appointment I usually don't know half of it - they arise later, after I receive the information, think it over, and do some Googling - and then nobody ever cares to answer them properly. I feel like I am playing catch up with the doctors, and failing again and again.
And yes, I received the Dr's answer around 9 pm. It was short: yes, he agrees with Dr who did an ultrasound, and he thinks the shot is a good idea. Nothing re: why. Nothing re: follicle size.
It's midnight now, and too late to change my mind anyway.
On a different note, somehow my parents got wind of us having been to a doctor's appointment. How? I have no idea, not me nor my husband told them. Anyway, my mom asked me what it was for, and I gave her the highly edited version of our visit to my RE. I've got sympathy and the requisite "be happy with what you have" spiel, and then I was fighting tears for the rest of the day. There was a reason I did not want to share my journey with her - it's too hard to look at it as it is, in all its hopeless glory.

Letrozole scan

Went for Letrozole scan. The Dr. on call who performed it gave me the impression of being quite pissed off because she had to be at the office on Sunday, and on Mother's Day, no less. She was professional, but brisk and unfriendly (and she refused to look for semen analysis kit, so my husband would have to drive there again to pick it up). She did not tell me the size of follicles, and I did not do my homework - so I did not ask. My impression was, they are not quite as big as she would want them to be, and there are only two of them. She outlined the protocol: few more days of Letrozole, trigger shot on Wednesday, BD on Thursday, estrogen and progesterone few days afterwards. I flat out refused estrogen. I questioned the idea of more Letrozole. I basically got very confused, since none of this was discussed as a possibility at my last week appointment, and decided I will have to think it over and talk to my Dr about all of it. As for my continuing spotting - she dismissed since my lining "looks good". 

Also, she told me there's a possible small cyst on my right ovary - the one that I had a surgery on. "Or maybe it's just the way your ovary looks after the surgery," she said, but I am so not convinced. She doesn't think this cyst appeared during the last 10 days. Does this mean they missed it while doing an ultrasound to rule out any cysts before starting me on Letrozole? Or is it a Letrozole sife effect? Too many questions, and no answers. 

There was a poignant moment today, while we were waiting for the Dr. to come and for the office to open. All three of us had to come to the appointment - the kid had a birthday party nearby to attend later, and we were going there as soon as the ultrasound was over. Another woman came to the door to wait. She was alone. She complimented my kid, we exchanged some platitudes about bilingual childhood. She mentioned that her husband was of different ethnicity. She mentioned her nephew. I just knew she was there for the same reason as me, but she had it much worse. And my heart was breaking for her, too.

It was also breaking for us. Two years. Two years, and we are visiting the same parties, same shows, same places. And I am still checking my freaking pantiliners and pads, peeing on sticks, and having nothing to show for it but few gray hairs. 

RE consultation

Yesterday we went for a consultation with our RE. On our way there, I was talking to my husband and feeling more and more frustrated by the minute. Frankly, I was feeling very confrontational and wanted so much to stick it out to her. However, as my husband correctly pointed out, we cannot afford a luxury of a confrontation. She cannot do anything majorly useful for us, but she can order routine tests, which are at least covered by our insurance. So we talked about that, and I agreed to try to be civil. My resolve wavered, though, when it turned out we still had to pay out of pocket for this consultation, since it's a repeat visit (wtf?!). I wanted very much to yell, "No way in hell I am paying that much to see this doctor! I'd rather pay for someone who's professional, dammit!" But we paid and we waited.
She started with a question along the lines of "what can I do for you", and I got very angry. I allowed myself to allude to her insufficient testing a year ago. Her response was, but then you were getting pregnant! Apparently testing for RPL is different from testing used for just plain infertility (yeah riiiight). Anyway, I asked what can we do now, given the situation we have. Basically she told us they can do two things: it is either IUI with Menopur and Bravelle ($3,000 - 5,000), or IVF with PGS ($25,000), using the antagonist protocol and ISCI. I asked why didn't she suggest donor eggs IVF. She replied that she remembered me being against it, and that the price is high, around $40,000.
By an unspoken agreement, we did not tell her we're seeing another Dr. and that I am on Letrozole. We did ask her about Clomid and Letrozole, and she told that my FSH is high and therefore more FSH does not make sense (and then I Googled and apparently Menopur and Bravelle work to elevate the FSH as well, wtf?). She also told us she does not do natural cycle IVF or minimal stimulation IVF ("I know about this, but we don't do that here").
And finally there was the icing on the cake. I asked her something about success rate for all the options she mentioned, and she said something along the lines of - oh but you cannot really do any of that, because your FSH is too high! This was priceless. Why did she spent so much time talking about the options that I cannot have anyway?! Her point was, I might have checked my FSH too early after the surgery, so let's recheck it in couple of months and see where we are. As much as I want to hope that there's some reason for this absurd number of 17.5, I cannot really count on that.
There were some relatively good news as well. As it happens, she did a follicle count in 2014 (she just chose not to tell me about it, and she did it on a day when I couldn't even tell where in the cycle I was - my period still hadn't returned after my 2nd miscarriage). I had the same 6 follicles I have now. My AMH is lower, but not "significantly", so it doesn't concern her as well. (I don't think she's concerned about my situation at all, though). So basically no drastic changes have occurred since the last year.
So, her advice is: go try naturally for couple of months, maybe try some acupuncture. Come back and redo the Day 3 tests, and then we'll talk.
What do I think about it? I am going to order wheatgrass and whatever shit there is out there to work with aging eggs. I am not sure I want to go to her even if my FSH gets down (because her estimate of IVF success is 10%, and while trying naturally we have just 2% chance - both numbers are too low for my taste). What we need is to find a clinic nearby (okay, at least in our state) which does natural cycle IVF, and talk to them about my options. I wish we could go to New York or Colorado, but travel is expensive (we hardly have money for IVF with PGS as it is), and there are some logistical considerations as well.

Defeated

Today I feel like someone just pulled a rug from under my feet. The results of my husband sperm test came in - everything is normal, except for guess what, morphology. It's at 2%, which is not good at all. Now our (formerly) optimistic Dr wants him to do a Sperm Chromatine Structure Assay; this test is relatively new and might pick up DNA defects in sperm which could account for multiple miscarriages, among other things. He also suggested few supplements.
So not only we're facing crappy deal with my eggs and uterus, we have sperm problems as well.
I am alternating between tears and fury. The thing is, nobody did any of these tests a year ago. There was no FSH, no AFC, no sperm test. Nothing was done. We were getting pregnant, right? So no one basically wanted to dig further. If only we knew the full picture then, we could have made different choices. Or maybe the choices would have been the same, but we'd have made them with our eyes open. Even now, I am basically wasting this cycle, and on medications, no less - and I'll be wasting then some, before the damned supplements even work. And now I feel like, why bother at all.
The whole process is so frustratingly chaotic. Oh you want to check this? Okay - ooopsy Daisy, bad results, let's do this! Or, you insist on this? Why would you? Okay, but look, here's another shitty result - um, whatever, let's add this! Why not do all the tests at the very beginning? I am not a fertility specialist, I don't know all the right questions to ask and all the right tests to request. But look where it got us. Two years, four miscarriages, no rest for the wicked.

The merry month of May

May is not an easy month.
Two years ago, on Mother's Day, May 12, I did a test and found out I was pregnant. I was happy, I was naive, I thought that positive test equals a baby in 9 months or so. It didn't happen. I had my first miscarriage on Father's Day, later in June.
My second miscarriage in the fall of 2013 had a due date somewhere around May 20th (I did not really look at the due dates at that point).
And then there was my third miscarriage, on May 9th last year.
I am writing all this down, and again I cannot believe this happened to me. How did all of this happen? How did all this happen to me? How did I survive all this, in one piece, at least physically? Would I ever be able to pick up pieces of myself and put them back together?
...And I cannot even drink anymore. 

Letrozole, rainbow & unicorns

So, I am on my 4th day on Letrozole. On Friday, I had my scan, got a timeline of pills, intercourse, and my next scan, and then I was on my own. Well, me and the mighty Internet, where I googled all kinds of things, starting with "Letrozole side effects". I got myself so thoroughly scared, that I couldn't even look at the pill bottle. I used to be a reasonably healthy person, and I don't have any experience with medications that are so serious and strong. Still, I took my four pills, and the next day I took another four... and tomorrow would be my last day on them for this cycle. I haven't had any adverse reaction so far, except for feeling out of sorts in the mornings, but this sensation goes away.
Today I went to see the Dr who prescribed it, the optimistic one, the one of the unicorns and rainbows. Last time when I've seen him, he was somewhat cavalier about my numbers and my age. "Your eggs are not THAT old," he told me. Since then, I turned 39. My big 4-0 is just 6 month away. I have high FSH, low AMH, and low AFC. He cannot ignore this anymore, not really. Yes, there is an age factor, he said. But considering what the surgery found - or did not find - you are in a good place, you are doing the right thing with Letrozole, let's try that for 3 months and see how it goes. If it doesn't work, let's add injectables; the next step is IUI. Of course, even after achieving the pregnancy, there's a matter of keeping it; Intralipids and Lovenox are his choice for that, as he said previously.
So there's that.
Wednesday would be the day of doom and gloom Dr, my RE.

Not crazy, just tired

Recently I started to wonder how do people, as they use to write in some novels, "cry themselves to sleep". Turns out I cannot do this (this and having a second baby, apparently). I cry while lying down, my nose gets all stuffy, which makes it impossible to breathe... so I don't get any sleep for a long, long while.

Since our second cycle since my surgery did not give us any positive result, my Dr. of "crappy uterus" theory suggested to try Lethrozole, and I am having a scan tomorrow to ensure there are no cysts on my ovaries. A scan on my heaviest bleeding day, sounds like fun, right? But anyway, good luck to me, my ovaries make cysts too often for my taste. 

Also, next week I am seeing the Dr. himself to discuss stuff, and then I am seeing my RE to listen whatever she has to say, and to try not to burn any bridges (I mean, this woman DID NOT TO SHIT for me, and I had to request most of my tests, while she could have done them a year ago and save me some heartbreak... and of course she does not believe in basically any form of treatment I've been reading about - except IVF of course). I am also making an appointment with an acupuncturist, though I am scared shitless of what needles can do to me.

I thought the arrival of AF will leave me crazy - throwing the dishes and cutting my hands crazy. Nothing of the sort had happened. I am just tired and don't really want to come out of my room, or have dinner. Just want to be left alone for a while.

And here is the TWW again

So, I am in the middle of another TWW, and I am slowly going crazy. Last time there were lots of distractions to take my mind off things, but now there are none - and predictably enough I've been having it all. Seriously. Back pain, pulling sensations in lower abdomen, breast pains and fullness... until it all just stopped today, and I am, of course, freaking out because it stopped. I already had my share of peeing on sticks, all negative, of course, and ordered a new bunch of Wondfo finest. I talked my RE into checking my 7dpo progesterone levels, and they came out surprisingly good - even "great", as my RE said in her email, which is very uncharacteristic of her (she's of doom and gloom, remember). 

I also had a talk with a friend, who, at 44, decided to give her kid a sibling and went for fertility check-up before starting in earnest. Her AMH is almost the same as mine, so it looks like I've got my Best Fertility Friend (or maybe not). Her Dr. did not check FSH, just prescribed her some Clomid and wished best of luck. I am sooo going to make an appointment with her Dr. and have a third opinion, just because.

The business with Best Fertility Friend is very confusing, still. First, it's not that easy for me to share too much personal information (blogging is different, isn't it?). Second, it's a precarious position to find yourself once one of BFFs gets pregnant... I personally am not sure I would be able to maintain contact if she gets pregnant and I don't. It's just too hard, and when we were talking and discussing AMH, Clomid, CoQ10 and such, I couldn't help but see it, this writing on the wall. Oh well. Please, please, dear Universe, let me have another baby, and let her have another one, too - so we can continue being friends. I've lost too many friends to this RPL shit already.

National Sibling Day

According to my Facebook feed, today is the National Sibling Day - another one of these days that are designed to break hearts of those who feel left out. Everyone, of course, is posting pictures of their kids together - brothers, sisters, looking at each other, holding hands, hugging, squabbling. I wish with all my heart and soul that next year, and years and years and decades and decades after that, my kid would have someone to share and celebrate this day with.

The tale of two doctors

The Dr. from out of network emailed me today - it's been more than a month since I've contacted him, but I am still glad he finally found time. I relayed the whole sorry story again, with the updates - my follicle count is at 6, as it happens - and he told me that he's going to update my supplements protocol, and also to give me some fertility medications to help me get pregnant sooner. He gives out an impression of such optimism and hope, that it's hard not to get caught in it. My spirits have certainly lifted somewhat, though I know how dangerous is to allow myself to hope.

This encounter made me think of how weird the whole scenario is. I have two doctors looking at the same patient with the same panel of tests. One is projecting doom and gloom and is probably going to push me hard into IVF (with donor eggs, I think). The other is - well, not exactly all unicorns and rainbows - but hopeful and wanting to make it work more or less with a natural cycle. And despite his communication flaws, I am under the impression that he actually works with me, instead of trying to fit me into some preconceived plan.

Coincidentally, yesterday I was trying to figure out if we need to go to some other Dr., to get the third opinion, just, you know, for variety. But I don't know where to turn. Most clinics in our area are specializing in IVF. There are two huge research institutions around with infertility programs, but their internet reviews are bad enough for me to not want to go there (I already have a Dr. with horrible attitude and IVF-pushing, thank you very much - and she's at least partially covered by my insurance). So I need to do more research - and to finally finish "It starts with an egg" (so depressing, makes me want to switch to some other read).

The results are coming in...

...and some are not good at all. Makes me wonder why my stupid RE did not bother to work with me a year ago. Instead of a whole year of prolonged heartbreak / hope see-saw, we'd get a clear picture much sooner. Yes, it could have been a bleak and hopeless picture. But we would have saved time, and money, and effort. We would have had more strength and more time to pursue alternative avenues - or to come to terms with being a small and close family of three.

I am very angry at my RE, and at the other Dr. too. But most of all I am angry with myself. I was so confident in my ability to get pregnant, that I did not really stop to think about the implications of my low AMH. Or those of my age, or of my two (now three) ovarian surgeries. I did not do my research, and for that, I am paying dearly now. Apparently, in infertility world, if you don't do your own research, if you don't insist on tests, if you don't push and press and yell and ask and demand, you get nothing. Nothing but measly thyroid pills, endometrin suppositories, and two chemical pregnancies - stuff like that.

So what's now? I've already made new appointments with both Drs, to see them in the beginning of May. Now I need to stop crying for a long enough time to collect the kid from a daycare and spend a pleasant evening together. To skim through "It starts with an egg" and to order all the stuff mentioned there. To do the follicle count tomorrow, and to do another AMH test. And then we'll see. Of course, there's always a chance for a miracle, but I am not holding my breath. Personally, I think our realistic choice is between a) accepting the 3-person family, counting our blessings daily, and moving on - or b) trying with donor eggs. This second option terrifies the hell out of me. I am not very comfortable with the idea of being a mere vessel to someone else's baby - even if one part of the genetic material would be my husband's.

Which brings us to the question of my husband. My husband, who's out of town today, and who is having a rough time now with his parents' declining health. My husband, who seems to close off and perceive my despair as a sign that I am giving up. He doesn't want to hear the stats, he doesn't want to face the reality, he just wants to keep the fuck trying. He wants to hear from me that yes, I am still up to it, to all of it - drinking lots of shitty pills, peeing on sticks, hitting the walls with my new and old psychosomatic symptoms, timing intercourse, hoping. He doesn't mention failing. We need a chance, he says. Otherwise the life is too horrible, he says. 

He is right. But I don't want to be always hoping for a miracle, and to build castles in the air. I want to have more solid foundation on which to build our plans, something more tangible, something less esoteric. 

* * *

This night, I took out a test I took yesterday evening, and there it was, hours later, a faint second line. I know that these tests are useless after a certain amount of time, but despite all reason, my stupid heart soared. I did not even notice how hope crept in. It stayed there even despite a negative morning test - until noon, when the cramping started and my AF arrived.  

I do not know how people do it. How do they live, day after day, cycle after cycle. How do they deal with all this - pain, despair, hopelessness, disappointment. I certainly cannot. If I did not have a kid already, I would have gone and done crazy things - and now I just cry. A glass of wine did not help, and I cannot have more just yet. My thoughts go round and round in circles: what if there's not ovarian reserve left anymore? What if my fall pregnancy (and Halloween miscarriage) was my last, my very last chance? What if there's no point of even trying anymore? This Sunday I am going to do a FSH test (they did AMH last year and did not do this one, but now I requested it), and then I guess I'll have to see my RE and talk to her. Except she does not talk to me, not really. She lectures (in person) and she yells (in emails). And our insurance does not give me much choice.

Two years. We had been at it two years next month, and it fucking hurts nonstop.

And the answer is...

...No. I am not pregnant. Cue despair.
I know it was preposterous to expect getting pregnant at first try after surgery - but I've been known to get pregnant at first try before (keeping pregnancy was another matter). And now I can't help but wonder what if I would not be able to get pregnant at all anymore; what if my ovaries stopped producing eggs altogether; what if the surgery robbed me of my last chance. This cycle felt different all right; I had nowhere as much cervical mucus as I had before, and this worries me.
Sometimes I understand teenage girls who engage in cutting and other self-mutilating activities. The hatred I feel towards my body at times like this... it has to go somewhere. It's scary and it's intense.

Two weeks

So, the dreaded TWW is coming to an end. It's different this time around. I no longer pee on the sticks obsessively on a pretense of "getting to know earlier so I'd get treatment sooner". I admit, I did one test on Saturday (why? search me), and it was negative, of course. And then I waited. And waited. And waited. Then I didn't want to spoil the family celebration we were having this week. Then I didn't want to do it on April 1st (no fooling around this one). It's like I don't even want to know. Not knowing makes me hope that there might be a chance for me. Knowing might take this hope away.

Just say NO to Philip Galanes' advice

Normally, I enjoy reading New York Times "Social Qs" column, but today it left me furious. A lady who'd apparently been struggling with infertility and finally got pregnant is asking how to break her good news. (I wonder who on earth, after going through the ordeal of infertility, does not know how NOT to handle this, but whatever). The advice Philip Galanes gives her? Priceless. "Share your intimate news intimately. Tell pals one on one, especially those you suspect may be struggling with fertility issues." So basically, the poor unsuspecting victim of the good news has nowhere to run and nowhere to hide, and has to put on a brave face and offer heartfelt congratulations? I don't think so. Give another person a space to process the news, give her a chance to cry in private, and then to congratulate you. Via email, again. Please. Don't do it face to face, ever. And if Mr. Galanes took time to look up hundreds of infertility blogs, he wouldn't have given such a cruel advice.

Silence

We used to be friends. Then I moved far away, but we kept occasionally emailing and generally keeping in touch. She was the first one of my friends whom I told about my second miscarriage. And the first. All in the same email, in a bleak December 2013 - and it was also about the deaths of my grandparents the very same year. Sort of "end of the year" report. I've never heard back from her. Soon, through a social media, I learned she was expecting her third child. Okay, I thought. Pregnant and preoccupied and having no time for my dark pit, I get it, totally. I decided to let it go and not to show how much her lack of reaction bothered me. 

Recently, she reached out again, after one of my sad musings online. Just a general "hey, thinking of you" stuff. Life, apparently, failed to teach me anything, so I dutifully explained that hey, third and fourth miscarriages, and then a surgery, what a charmed life I live.

She replied. She never ever acknowledged my losses. Like I never even mentioned them. This silence, this total ignoring of my pain - it hurts so freaking much.

Two strikes, you are out.

Just another day

In June 2013, we went to a 2-year-old birthday party. Later, the birthday girl's mom posted pictures of the event, and even now, I cannot look at them. Because this was the day my first miscarriage started. I was half-expecting it - the ultrasound scan did not show anything but the fetal pole on my 7th week - but still the spotting came as a horrible blow.
On this party, the birthday girl's mom asked the ladies present if they are planning to have a second child. Well, it's been almost two years. Every single fucking woman from that party is either pregnant of have had a second baby recently. Every fucking one.
Except me.
And I seriously need to go offline. Hate is not healthy and not productive, but sometimes it's the only thing I feel. And yes, I hate myself for being like this, too.

Hypochondria

Somewhere around this time three years ago I experienced my first anxiety attacks. First, I didn't realize what it was. I thought this was somehow a breastfeeding-related issue - I was drastically cutting down on breastfeeding, my breasts were sore, and I remember trying to explain a startled lactation coordinator this horrible feeling of a black cloud suffocating me. Few factors collided to become a trigger for my anxiety - my own health history, my friend's horrible diagnosis, and probably the partial weaning and the following hormonal shitstorm did not help matters as well. Since then, I've became a hypochondriac. I regularly feel symptoms, get scared, go to the doctor, receive simple explanation, breath out, symptoms vanish. I get a few weeks break. And then it starts again. And of course this next time I am completely sure that something is terribly wrong with me.
The recurrent pregnancy loss does not help matters. After three miscarriages, it became obvious that the idea of trying anew creates a new trigger for me. In September, before we were given a go-ahead, I had all kinds of psychosomatic issues - suddenly, my neck hurt, I'd have trouble emptying my bladder, my breasts hurt, etc. It felt like my body was protesting against whatever torture was ahead. In some way, my body was right - I did end up with another chemical pregnancy in October.
So now I started a new cycle and will be trying again soon, and of course my hypochondria is out, surprisingly not in full force, but still it's here and it's loud. Somehow successful pregnancy seems like a cure from it, but I know this is not the case. Rather, it would probably give my anxieties a new focus. Oh well.

Breathe

Today was one of those days... everything was seemingly fine, but I had to remind myself to breathe. Breathe, breathe, just try to get through it. No miracles, just you and your body. Please breathe.
Other random stuff:
1. Somewhere on the net there was a discussion of how do women announce their pregnancies, and it just broke my heart again. Just imagine the innocence of all these people, who assume their two lines would eventually lead to an actual baby. I so wish I still had it.
2. Another friend, whom I haven't seen in a loooong time, turned out to be expecting, due in a month. I must be developing a sixth sense where the pregnancies are concerned: I've seen her husband on a party in the beginning of October, and when I asked about her, he said that she was home sick. His smirk was somewhat incongruous, so I suspected she was not sick as in sick, but sick as in morning sickness sick. And it turns out I was right. Oh well.
3. We are a backup childcare support for another friend in case she has to have her baby earlier. The irony of it.
4. I am just not good in waiting. Now I wait until I recover from surgery completely, get my period, and start peeing on sticks and have baby-dance. Just doing something, anything, to get another chance.
5. I emailed the Dr. of a "crappy uterus" theory to update him on the surgery results. I asked him if any changes in my supplement protocol are in order. He never emailed me back. I realize he is busy but I cannot help but think he is just not interested, not having received any support for his original theory. And this is so disappointing - two of my friends recommended him as the best doctor they'd ever had. Guess I wasn't so lucky. Again.
Meanwhile, I am slowly reintroducing some of the supplements back again. However, I am not that keen anymore. Yesterday, I took konjak root (fiber), and now I finally know which one of my medications gave me the horrible gassiness all the way. This is one supplement I do not really want to take anymore.
I also Googled "supplements to improve egg quality". Some of these sound downright nasty, so I have to think which ones I am willing to tolerate, especially since there is no medical professional to guide me through the process.

Today

So the results are back, and they're good. My uterus is completely healthy and there's no indication of any problems whatsoever. So, does this mean I just have crappy eggs? That my luck just ran out? Yes, we did buy a Powerball ticket yesterday, and we did not get a single number right.

Oh, and our friends are expecting a baby. Their fourth. Two boys, two girls. I wish them luck, they are a wonderful family. But I am still in tears.

Surgery

So, my surgery was yesterday. It was a stressful week: what with a sick kid at home, me listening intently to every little nerve in my body and with us trying to sanitize the hell out of everything so I wouldn't end up sick too - which would have had cancelled the surgery, and frankly the thought of waiting another two months was unbearable.
Still, the day came, and there I was. I started crying when they started poking needles and inserting IV's and such - just out of sheer helplessness and the sad familiarity of this situation. In 2008, I've been in the same hospital, having to do pretty much the same surgery instead of getting pregnant and having a baby, as we planned. That fall was one of the darkest moments of my life, but then we got lucky. We got our baby, and now we want to give her a sibling - and look where I am, again.
The doctor didn't come to talk to me after I came out of anesthesia - the nurses told me she's going to call me today, but she did not, it being Saturday. She did call my husband after my surgery ended, though. Basically she told him that everything went smoothly, that there was nothing unexpected to be found, that she found "a bit of" endometriosis, but not much, and treated it, and that my tubes are clear. She took out the endometrioma, and "also something from the left side". The latter makes me uneasy. We did not discuss what to do if there is some other cyst on my other ovary. My ovaries tend to form cysts, most of them disappear within one or two cycles. Why would she take away some harmless cyst and thereby decrease my precious ovarian tissue even more? Why would she do that, especially since we did talk in detail about how worried I am about the ovarian reserve?! Was it something else, or is it just a reflection on how surgeons think - "let's cut out everything extra" - as opposed to normal people? I need to talk to her about it, but I feel quite aggravated now, when I think about it.
I am also childishly disappointed in this whole lack of answers. For some reason, I thought that she would find a lot of endometriosis there, which would have explained fertility issues, spotting between periods, weird sensations and basically all the symptoms in this particular area. Since it wasn't the case, and since nothing she found there looks like it could be the culprit, we are back to square one. Try, try again.
Once the results of all tests come back, I am going to start on the vitamins, supplements, and Doxycycline again, and if everything goes well, we will start trying next cycle. Hitting the same wall again, expecting different results - now this is what passes for sanity in our household...

Thumbelina

In the shower today, for some reason I thought about Thumbelina, a tiny girl from a fairytale. It occurred to me that this is sort of a miscarriage parable: there was a woman who wanted kids and couldn't have them. And then she got this little seed, and the girl who was born as a result was ever so tiny... So basically, in my warped mind, it goes like this: a miscarriage happened, and the baby was carried away by water, and the whole story is just a dream... that's why Thumbelina never returned to her mom.

Surgery consultation

So last week, we went for a consultation with a Dr. who's going to do my surgery in two weeks. Surprisingly, she talked mostly about things she would be doing to enhance my fertility: endometriosis removed, hysteroscopy done, tubes checked and flashed out (they did not get to tubes during HSG, since I freaked them out by freaking out basically), etc. She told us that she has 5 kids - and had 8 miscarriages ("and maybe more", she added, since there were probably some undetected chemical pregnancies). She was competent and reassuring, and I almost started to hope that maybe, maybe this would help. Then I remember my crappy AMH - and it was a year ago - and my age and all that - and also the fact that I still have to get through the actual surgery. I had two cystectomies before, and this is not much fun... and I don't even want to think about the whole "bowel preparation" protocol beforehand. And now we just have one bathroom. Oh joy.
I am also scared about having my kid here, witnessing the painful recovery process. We don't have family close by, and while the daytimes are covered with her preschool, she would still be home for the weekend right after the surgery, the hardest time.

A year

Today marks a year since the due date for a - what word should I use here? baby? embryo? product of conception? - which became my first miscarriage. Last year my cousin gave birth to her kid on this very day, too, and I was crying and thought my heart was breaking again. Little did I know. I went on to have more miscarriages, and now it's all on hold; I em expecting my surgery, and I am not sure I would be able to even get pregnant anymore after that. Sometimes I feel like a freaking Ancient Mariner with all this history piling up on my chest, and with this overwhelming urge to come to every FB entry of moms of two and more who complain about their hectic schedule and sleepless nights, and tell them how lucky they are. I have managed to keep myself from doing it, so far. I certainly need to get a life. Some other kind of life that doesn't involve online... or babies, or playgrounds, or baby stuff in our garage. An adult, post-fertile kind of life. I typed this, and then I remembered a 7-months pregnant woman sitting down next to me in sushi bar. Of all places.
I just need to somehow let it go, let go of all these - babies? embryos? products of conception? - and my dreams for them. Let it go, there's life to live and a kid to love and take care of, and a husband to love, and parents to email and call and Skype with, and all kinds of relatives I need to keep in the loop of my and my kid's life if I want her to have relationships with them. I just feel so painfully unable to reach out. Sometimes I feel I have nothing to say to any of them.