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.

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.

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.

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.

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.

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.

Holiday spirit

I cried myself to sleep the day before yesterday.
And I cried all day yesterday.
And I am crying now.
There was something weird going on over the weekend, so I requested an ultrasound - they repeat it every 6 months and was almost due for another one anyway. So now my ob/gyn wants me to have a surgery in January, to remove endometrioma that grew a bit too big and had almost taken over one of my ovaries. The good news is they would also check for endometriosis and remove it if it's there. The bad news is that doing all this shit with my ovary might leave me with no ovarian reserve to speak of. So yeah, I might end up with a nice clean uterus and nothing to put in. The good news is that the other ovary looks pretty good. Nobody knows, of course. But all this puts us out of baby-making business for another two months, at least.
So when I saw a woman complaining online that she's not having much fun this holiday season because she has a kid and she is heavily pregnant, I saw red. She doesn't even know how incredibly lucky she is.

Bad, bad person

I didn't even ask my pregnant friend how she is feeling, and basically didn't talk to her much. Now I feel like a horrible human being and a lousy friend. Apparently (she mentioned this in her blog, never told us directly) she's having some issues with her pregnancy and is being monitored by doctors pretty closely. It has to be nerve-wrecking, and I feel bad for her. I also feel my so-called self-preservation is making me - well, not myself. This is not a real me, this is not how I normally behave. This is all wrong. 

AF

Okay so there was no miracle. Despite my ob/gyn advice to wait one cycle, we did it without protection once - on a particularly grim day, when nothing looked good anymore. We did not plan anything, but then part of me started hoping that maybe this would be the miracle - you know, despite everything. So in 10+ days after, I tested. I tested every day, to be honest, and every day I decided that no, no more testing, let it be. And then I tested again. 

My period started, and it hit me hard. Not the period per se, but the fact that there was no freaking miracle and no July baby for us next year. And of course I was so convinced I have symptoms - I should know better by now. I was crying in Crate and Barrel because a year ago after another horrible November I was buying Christmas decorations there. I bought a little wooden doll family, and in defiance I bought four dolls. Mom, Dad, daughter and a baby. A baby. A year passed, we are at the same spot, just older and more hopeless.

The weekend ahead presents a challenge of sorts. A big playdate with many of kiddo's and our friends. One of them is expecting her 2nd and is irritating the hell out of me just because - because she got what I wanted, when I couldn't have it. Here I said it. I am a bad bad bad person.

And then a birthday party. For a 1-year-old. His mom (our kids are preschool friends) got pregnant a month before I did with my first loss. She told us basically the second after she saw two lines on a pregnancy test. Then I went on to have two miscarriages, and she went on to have her baby. Then I had two chemical pregnancies, and her baby is now one, and my kid still has no siblings. I don't want to go. I don't. I feel like I need to burrow deep into the blankets until - I don't know if this would ever be easier.

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.