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.

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.

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. 

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.

* * *

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.

Introduction

It feels a bit like throwing a bottle into the ocean, but anyway.

I am 39. I am a mother to a wonderful girl who just turned four. Last year, we decided our kid needs a sibling - to help her deal with parents when they get old and crazy, and anyway, we always wanted at least two kids and a loud, crazy, chaotic house. And that's where it all started.

May 2013: Got pregnant on our first try, went for an ultrasound, and there was an empty sack, too small for 6th week. Missed miscarriage. I was shocked beyond belief. I didn't think things like this could happen to me. I carried an ultrasound picture, the one with an empty sack, with me for months. I don't know why they gave it to me.

September 2013: Got pregnant on our second try, while on vacation. I always wanted to conceive on vacation. I was so hopeful that I even took a picture of the house where it happened, just in case. I was pregnant long enough to get to prenatal appointment, where a well-meaning but inept nurse practitioner told us there was a heartbeat. I wasn't convinced. I remembered how it looked during my first and only successful pregnancy - so much more pronounced and clear. But I made myself believe her, and I received yet another ultrasound picture.

Then I had spotting and came for another ultrasound. The baby was no more.

This miscarriage was longer, two and a half month of hell. This time it wasn't shock, it was despair: I thought before that my first miscarriage was a glitch. Not anymore.

February 2014: Went to see RE, who ran a panel of tests and concluded that I need to take thyroid medications and receive progesterone when get pregnant. Have to say - I hated thyroid medications. I used to be a reasonably healthy person and never before had to take pills every day.

April 2014: Pregnant again, for the whole of two weeks. Endometrin (hated it) and regular beta checks, all the way trying not to get too attached. (I failed). HCG started going down pretty soon, and I never got to even have an ultrasound. RE's explanation of what happened, basically: you are old and your eggs are crap.

June 2014: Went for a second opinion to a well-respected Dr. His conclusion: the reason for what had happened is immune, we need to fight inflammation in my uterus (translation: it's not my eggs, it's my uterus that's crap). He prescribed a ton of anti-inflammatory supplements and Doxycycline for three month, and then try to get pregnant again. These were long three month. I struggled with drugs schedule for a while, but got a hand of it eventually.

October 2014: Got green light to start trying, and progesterone after ovulation. Got implantation bleeding, had positive pregnancy test and betas of 24 - just to discover in two days that it's another no-go and HCG is not rising properly. My personal record two-day pregnancy. I told myself quite firmly that it's better that way, cut your losses early and all that.

Yeah, right.

I was incredibly angry.

I soon found myself crying hysterically in a shower and yelling "I can't do this anymore!"

I do realize we are so incredibly lucky. We have a child, who makes every day a better day. But still.

Every time my kid talks to me about how she wants "a real sibling".

Every time she plays with a doll and calls it her sister.

Every time I see a pregnant woman with a kid.

Every time I think how we always wanted two kids.

It hurts so much, but I cannot stop trying yet.

November 2014: We went to our docs again. RE is pushing for IVF with genetic screening (remember, crappy eggs). I don't want to do this. It's invasive, expensive, may endanger my health (I have a bit of a history) and the success percentages are about the same as my chances to successfully conceive and carry to term on my own.

The other Dr. insists my eggs are not the issue (remember, crappy uterus). He thinks we have to deal with inflammation, and suggests we send a few tests to a lab in Chicago and go from there - either continue with current protocol, or have more serious drugs, or have a surgery for endometriosis. Our current insurance covers my RE (though it wouldn't cover IVF) and doesn't cover the other Dr. and any of his suggested options - and since the RE is, to put it mildly, not very keen on the whole "inflammation" theory, we are on our own.