* * *

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.