Stranger Than Fiction

Each month, promising myself not to take home pregnancy tests (HPTs) too early is like promising myself I will avoid all caffeine and red wine. Last month I took a handful of HPTs, all negative, and those combined with some PMS symptoms convinced me all was lost from our IVF procedure. My pregnancy blood test at the clinic was scheduled for Friday morning, followed by a consult with Dr. Liu to discuss some test results for Jody.

Jody went for a general fertility workup in January, as we began to grapple with the thought that I may not be able to have a baby, and she may have to step in as our "pinch hitter". To her surprise, the doctor noted a cyst on Jody's left ovary that they said had probably been there for a while and could just be watched. A little tingle of worry and intuition prompted us to request a follow-up scan be scheduled for a few weeks later.

The day after our embryo transfer, Jody went to the hospital alone for a more precise ultrasound test. Jody thought the technician behaved strangely throughout the process, taking too much time, taking too many screen captures, consulting with the radiologist...and then sending Jody for an unscheduled 3D ultrasound. She was scared but trying not to panic me, given my potentially delicate condition, and I was scared and trying not to panic Jody by reacting to this news. I was at work, and felt paralyzed with fear. Not just worry, but "oh-my-God-is-this-the-end-of-life-as-we-know-it" fear. I just found her, we can't be tested like this already. When I told my mom and a couple of close friends what had just happened, their voices and faces reflected what I was feeling inside. Disbelief, and panic.

Jody's cell phone photo of her indecipherable scans

Jody's father died of cancer at the age of 56, when Jody was just 21 years old. Two years later, her brother also died of cancer, at age 32. We had good reason to be scared.

We were told it would take two weeks to get the results of the new scans, and had an appointment with Dr. Liu scheduled for Monday. But we recently received a call, asking us to come in on the Friday instead. Were they kindly saving us an extra two days of worry, and fitting us in to report the "all clear"? Or were they calling us in as soon as possible because the news was bad? It was the longest, most agonizing, two weeks of our lives.

As we got ready for bed on Thursday night, Jody half-joked to me, "Maybe tomorrow is the day we find out you're pregnant, and I have cancer."

I awoke in a fog on Friday morning, needing to go to the bathroom, and remembered just in time to pee on a stick. Just one more time. I waited, and waited, watching the blinking window.

Pregnant

1-2 weeks

was the message. I ran to the bedroom, and realized it was only 2:30 in the morning, and not actually time to start the day at all. I turned on the light anyway and woke my wife. Bleary-eyed with sleep, she grinned and said, "I didn't give up."

A few hours later, Jody left for work, and I was at the hospital for my beta blood test. Once it was done, I snuck into the pharmacy to purchase yet another, different type of HPT. I headed over to the fertility clinic, early for the joint doctor's appointment where Jody would join me, and went straight to the bathroom to get a second opinion.

YES+

I leaned on the wall of the stall, and started laughing. Then I photographed the stick, and sent it to my wife. It was true. In the face of what we suspected might be going wrong we had something happy to cling to after all.

Getting the news in a bathroom stall at Mt. Sinai  ©Shutterbug

I called my mom, who was waiting by the phone for news about Jody, and picked it up on the first ring. This made it clear just how worried she was, as picking up a call on the first ring was always a no-no in our house. My mom said she felt it "appeared too eager", and would make people think you didn't have a life. I could hear the smile in her voice when she reacted to my news, and we marveled at how the universe works sometimes. Jody arrived at the clinic just as I was ending the call, and we went to sit in the waiting room while a steady stream of nurses and doctors stopped to greet us. It was sadly lovely to be so well-known to all the staff by this point. I pulled the two positive pregnancy tests out of my bag to show Maddie, Rebecca, and Dr. Garbedian, who grabbed me and delivered a strong hug. She was confused why we had an appointment with Dr. Liu so early, however, and we watched the smile drain away from her face as she heard the reason. My stomach lurched.

Our heavy walk down the hall to Dr. Liu's office was surreal. She dealt with me first, asking how I was feeling and whether I had any symptoms this month. I mentioned I'd been cramping all week and had some slight spotting that made me assume the IVF hadn't worked, but then had the two positive tests. She looked grim, and told me that we would just have to wait and see what the blood work showed later in the day.

We turned to Jody, and Dr. Liu said she had the technician's report. She told us Jody's ovary contained a solid mass, not a cyst, and it was likely an LMP. This stands for low malignant potential tumour, which sounds promising in definition, however she went on to explain that this category of tumour could already be malignant. Pardon? And it could potentially have already spread. And she couldn't rule out the possibility that it was actually an invasive ovarian carcinoma, which took the life of a friend of mine a year and a half ago. She told us she was referring Jody to an oncologist at Princess Margaret Hospital, at which point I think Jody and I may have both gone slightly deaf. My best friend died there from colon cancer. Another friend died there of ovarian cancer. It is not a happy place.

As a preliminary diagnosis this was not the worst, but nor was it the best. Going forward it was going to mean more tests, more waiting, and too many options. Best-case scenario was Jody losing an ovary. Bad-case scenario was Jody losing all of her reproductive organs, and undergoing cancer treatment. Worst-case scenario was losing Jody.

Nurse Maddie saw us on our way out of the office, and hugged us. She pointed to the report in our hands, and said, "LMP - hang onto that." Jody and I held each other in the parking garage, trying to reassure one another but both of us scared and weeping. Too much sad history for both of us, and no idea how to tell Jody's mom what was going on. Now we both had to go to work. How to continue with our day after this? Another line drawn in our lives: that was before, and this will be after.

Jody drove away in her car, and I drove away in mine, feeling as though our responsibilities could not be postponed. I called my mom on my way to work, trying to relay the doctor's specific language in between my sobs. I heard my mother's voice break too, and I raged inside at the constant stream of bad news we were not only having to absorb ourselves, but were delivering to our loved ones. At my office, I stepped off the elevator in a fog, and there was my closest friend standing in front of me. She took one look at my face, and pulled me into the stairwell that we relied on for private conversations, the way Cagney and Lacey used the ladies room (betraying my age here). I fell apart epically, crying into her shoulder and saying, "I'm pregnant, and Jody has a tumour."

That afternoon, my blood test came back with a level of 26. Definitely pregnant, but well below the norm of around 50. My last pregnancy had clocked in at 90. We both Googled obsessively about both of our conditions the entire weekend, and I continued to have spotting. Jody said it could be late implantation, or it could be one embryo sticking while the other let go, or any number of things. The HPTs continued to reassure us YES+, and I tried to remain calm and control my stress, worried that my worrying would make my worries come true.

Monday morning I went for the all-important second blood test, and every minute of every hour of the rest of the day dragged by in slow motion. It was indescribably bizarre to await a phone call that would tell us whether this pregnancy was going to progress, or not. A higher number could mean the pregnancy was fine, and we'd be on our way to the next stage. A smaller number would mean it was just a matter of time. Sitting at my desk, I was trying to perform job functions that seemed laughably irrelevant, and trying to interact professionally with both clients and coworkers. At 4:30, the call came but the nurse said we'd have to wait one more day, because the lab had not processed all the results.

Tuesday morning, I was making breakfast in the kitchen when I heard Jody answer her phone in the bedroom. I stood at the sink with my hand frozen in mid-air, unable to move, heart pounding. This is it, this is it, this is it. I couldn't hear the conversation.

I turned when I heard Jody walk into the hallway, somehow knowing the answer when there was no joyful outburst. She shook her head, and began to cry. The answer was 6. One day later, it was definitely over. Again. Seven months ago today we suffered my first miscarriage, and one month ago today we suffered my second. Both Wednesdays. Both the 28th. Clearly not my lucky number.

We weren't sleeping much, but somehow life went on during the two-week wait for an appointment with the oncologist (what IS it with two-week waits?). As we arrived at the hospital entrance, it was impossible not to notice the massive sculpture of children out front, with the cancer clinic signage below....and the nurses in scrubs who were leaning against the wall right beside it, smoking. The disregard for their own lives and for the patients walking past them was infuriating.

Inside the waiting room it was busy, but very still. A gynecology oncology office meant all of the patients were women, though a few male family members were there. Most of the women had no hair. Bald heads and scarves were plentiful, and their situations were clear: this was no room for the faint of heart. Crooked posters taped to bland walls asked, "Did you get your My Cancer Journey binder?", and requests for study participants were scattered about. I could smell a mixture of hope, fear, and antiseptic, and it was suffocating.

Signage inside Princess Margaret Hospital   © Shutterbug

We were led to an exam room, where a resident took Jody's history in a thorough if somewhat nervous manner. Upon hearing about the premature deaths of her father an brother, his questioning took on a more serious tone, and he asked whether Jody had done any genetic testing. No. My seasick feeling returned.

About twenty minutes later, the star of the show literally swooped into the room, filling it with his big voice and big personality. Dr. Jason Dodge was not like any other doctor I'd ever met. In his 40s, bearded, and with a big smile, he settled into the chair next to me, leaned against my shoulder like an old friend, and asked Jody, "You don't mind if I cozy up to your wife, do you?" He asked us to explain to him what our understanding was of what we'd been told so far, and then said he would need to proceed with a physical exam of Jody. "Once you're back in your regular clothes, we can discuss my findings like equal human beings."

Dr. Dodge, the earlier resident, and a nurse were all present for Jody's exam. When I saw her in the stirrups, after my multitude of medical procedures, I said, "Is it wrong for me to take just a little pleasure in it being her turn to be the one on that damn table?" Dr. Dodge had a good laugh at that, and said teasingly, "You bitch!" He was relaxed and casual with us, trying to put us at ease, and not acting the way you would ever expect a cancer surgeon to act.

He told Jody to get dressed and promised he'd be back to have a discussion, but left the exam room with these parting words: "I don't think it's as bad as you've been led to believe." The door closed behind him, and Jody and I turned to face one another with shocked smiles, and the first faint glimmer of relief.

The exam room at Princess Margaret Hospital  © Shutterbug

The 45-minute wait for Dr. Dodge's return seemed much more bearable with his last words ringing in our ears. He strode back into the room, sat across from us, and fixed us with an intense gaze. He said he had "crunched his numbers" and came up with a 91% probability that Jody's tumour was not yet malignant. How specific! He said the removal of her ovary would be all that was indicated at this point, that it could likely be performed laparoscopically, and there was no reason our own doctor couldn't perform the surgery. The tumour would be biopsied, and we'd have to wait once again for final confirmation of its status, but this was as optimistic an outlook as we could have hoped. When asked whether timing was an important factor, and whether we should postpone our planned vacation, he vehemently assured us it was not. "Go!" he shouted. "Have fun!"

Nearly two hours after arriving, Jody and I made our way back through the packed waiting room, my knees now just as weak with relief as they were with fear. We felt guilty passing all of the other patients there without picking up a "My Cancer Journey" binder, or even stopping to make a follow-up appointment. How many others there would be as lucky?

Outside, we hugged on the front steps, not caring who was watching. There is still a surgery ahead for Jody, which is no small thing, and a biopsy result to wait for, but we have every reason to be hopeful. If love were enough to keep my wife well, she would outlive all of us.

I am so proud of her strength, her character, and her ability to care for others even in the face of her own deepest fears. I don't know how I got so fortunate. I don't take what we've been given for granted; I cherish every day that I get to spend with my best friend. There is just so much time to make up for, so much sadness to erase for both of us....we need more time. Much more time.

Happy Endings

My grandmother, age 19, 1932

My happy ending is not going to be what I thought it would be.

I still don't know what's in store for us: what portion, if any, of our parenthood journey remains to be travelled. Perhaps a baby from Jody's body will be in our arms one day. Perhaps a toddler will run through our house after exiting the foster system. Or, maybe the only little feet padding on our floors will be of the four-legged variety. I don't know. Maybe my happy ending is simply what I've already got; it's just not what I've been imagining for the last 42 years.

I have been so focused on the goal of pregnancy for more than two years now that I haven't truly tried to imagine my life without children. It would have been counter-productive. So here I am, closing the door on what I'd said would be my last attempt at a pregnancy, and trying to "go there" in my head.

Subconsciously, over the years, I have socked away experiences and lessons learned, parenting moves I disagreed with, childhood memories I wanted to recreate (involving the purchase of several seasons of The Carol Burnett Show, The Mary Tyler Moore Show, and M*A*S*H)...all with the expectation that one day I would use this information as I raised my own kid(s). What do I do with it all if there are no kids?

My wandering thoughts return to the spring of 2007, as my Nan lay dying at her nursing home in Markham. It was my first experience of being with someone throughout the process of dying, and I still feel it deeply.

Holding my grandmother's hand in the nursing home  ©Shutterbug

My grandmother suffered from dementia, and had in many respects left us long ago. What remained was the love, and I will never forget coming to this realization. She existed in the same state for several years, our visits consisting of gentle hugs with her frail body (which still brought such warmth to my heart), repetitive discussion of the weather, or the day's meals, and mindless television programs (often golf, a game she'd enjoyed playing for most of her life). And then, one day, she simply stopped eating. There was no rhyme or reason, we think she just decided she'd had enough - and who could blame her? This is the woman who, widowed unexpectedly at age 58, proceeded to travel with friends and take up new hobbies with abandon. This is the woman who, at age 68, accompanied us on a family trip to Disneyland, and gamely rode every rollercoaster with me. And this is the woman who, at age 69, decided to remarry and move across the country to begin a new life in Victoria, BC. Eighteen years of travel and adventures later, she found herself widowed a second time, and it soon became clear she was no longer able to live in the retirement community that had been their home. She was unable to find her way to the bathroom in homes she'd been in a hundred times before, and once in the bathroom, often didn't know what to do. She didn't want to be here anymore, and we would have to let her go.

My Nan sang her way out of this world. Music always played an enormously important role in our family, from my great-grandmother providing the piano soundtrack in silent movie houses, to my grandmother and her sister singing on the radio, to the whole family doing dishes in the kitchen and everyone singing their own part in perfect harmony. Nan's arthritic hands could still bang out a mean tune on the piano in her 60s, which spurred my interest in lessons as a child. At holiday gatherings, any member of the family could burst into spontaneous song in the middle of a conversation, if a word sparked a musical association. It was not only tolerated, it was encouraged.

As she lost her command of language, my grandmother began to sing her side of every conversation. Eventually this dwindled to her belting out just a few specific songs that had lodged in her foggy memory, one of which, for some inexplicable reason, was "God Bless America". You'd ask her a question, she'd smile, and answer in full-throated ninety-three-year-old song "GOD BLESS AMERICA, MY HOME, SWEET, HOME" in perfect pitch.

She began to disappear, to shrink from her already-frail state to someone I barely recognized. Her teeth began to fall out, which she handed to us with a confused and slightly irritated expression on her face. She began to sleep more, and exist in an in-between state, muttering things that made sense only to her, then pleading with us to "please let me go". My aunt flew in from Seattle to join my mother and uncle at their mother's bedside. We each took turns sitting with her, talking, reminiscing, and, of course, singing. I stroked her hair, and rubbed her feet, and told her that I loved her, feeling as though life absolutely comes full circle. Living with her until the age of 7 as I did, I could only imagine the number of times she did all of those things for me.

My grandmother holding me, summer 1971

I went to work sporadically, none of us sure when her laboured breathing was a sign, and when it wasn't, and spent a lot of time just sitting with her and thinking. And watching. Watching her three grown children, two of them now also seniors themselves, care for her so lovingly and do whatever they could to ensure she was comfortable. I remember thinking to myself that she had raised three (and a half) pretty wonderful people, and you could feel the love in the room. Nothing else mattered, and it felt like I was finally grasping something. Whatever money and possessions she'd had, wherever she'd gone, whatever she'd done...all that mattered in her last days was who was with her, sending her on her next journey with love. I felt the need to build my own family more keenly than ever.

She died on my 37th birthday. I woke in the early hours of the morning with a start, and an overwhelming desire to drive to Markham to be with her. When I left her side the night before, I kissed her head and thanked her for everything she'd done for me, and there was nothing left unsaid. Now I fought the urge to get dressed, drive to the nursing home, and lie in bed beside her, telling her it would all be okay. I talked myself out of it, worrying that it wasn't my place, that the practicalities of getting in there were too much, that I was being dramatic. At 6:00 a.m. the shrill sound of my phone woke me, and my mom choked out the words, "She's gone." I raced to the nursing home and waited in the parking lot for everyone to arrive. We sat with her for hours, holding her hands and feeling the warmth eventually leave her body. I watched as people finally wheeled her tiny shell away, the smallest bump I could imagine under the sheet.

What scares me is envisioning those scenes for myself one day, but alone. What if I outlive my spouse, and we have no children? What will bring me comfort in my last days, months, or years, by myself? What is the point of all the things I've worked towards, and all the dreams we had for our lives, if there is no one to share them with? Or what if Jody is the one to outlive me, and my beautiful, gregarious, wife is sitting alone in a home one day?

I am a photographer who has been cataloguing her life for years. I began a project to amalgamate all the beautiful historical photos I inherited upon my grandmother's death, and create a lasting record for all the members of our family. Suddenly all of this became so much less appealing at the thought that it's only for my own benefit, with no one to pass it on to. All my things, all my memories, will one day end up in a dumpster or some curio shop, like the many sad, dust-covered belongings I've poked through in similar shops over the years.

If family is everything, what does it mean when you cannot have one, through no fault or choice of your own?

And there is that. This is not my fault, and yet I feel as though I have failed. I have lost two more little lives that had actually begun, and taken root in my heart. I couldn't keep them here, and everything we've been through has been for nothing. All the needles, all the tests, all the pain, all the stress, the heartache, the money...has all been for nothing.

I don't know where we go from here.

Two

Ultrasound showing two spots of light floating in my uterus

We were never given one of these lovely ultrasound pictures when I was actually pregnant, so this is a first for us to hold some physical proof in our hands. This has suddenly transitioned from surreal to very real.

The last 4 days have been incredibly stressful, emotional, and tiring. Surgery on Friday, then waiting to hear what the final egg tally would be for this journey; the interminable wait on Saturday for the call to tell us what was happening with the eggs; the long wait on Sunday for the call to say if the two fertilized eggs were still dividing; to today, and having the actual embryo transfer done.

We were of course on pins and needles this morning, wondering whether something had happened in the last 24 hours to our two promising little embryos. I was taken to a back room to change, and wait for my procedure, so I new we must still have at least one to work with. We tried, as always, to prepare ourselves for any eventuality, but it's impossible to keep going without a heart full of hope.

Waiting/recovery area at Mt. Sinai   © Shutterbug

It was a very long wait with a very full bladder, since the embryo transfer is guided by an abdominal ultrasound. We were told Dr. Greenblatt would be doing the transfer, but this was wrong again - it was the team of Dr. Garbedian (we love her), and Dr. Arthur. She was even warmer to us today than she'd been on Friday, going so far as to put her hand on my back as she saw my eyes welling with tears during our walk down the hall. She said some reassuring things about it being straightforward, and that everything looked great.

Back in the procedure room (the same cavernous place where Patricia had butchered me in January), Dr. Arthur ran the ultrasound wand across my stomach and confirmed everything was fine. The embryologist came into the room with the lab report, which showed that one of my four original eggs was too small to perform the ICSI on, and was lost right away. One had ICSI but then failed to fertilize, and the two fertilized embryos were now 7 and 8 cells. She said they would both be graded "A" (I felt a small rush of pride in my 40+ body, like a student who turned in a great paper), and that things couldn't look any better. We were giddy with this uncommonly happy news.

The last step was for the embryologist to examine the embryos' shells, which they decided were a bit thick (a common age-related issue), and said they would benefit from the "assisted hatching" procedure: thinning a small area of the zona pellucida with a laser, to help the embryos actually emerge, and implant in the wall of my uterus. Who knows, perhaps this one small step was where the problem lay all along with our previous failed cycles. All we know is that we have done everything humanly and scientifically possible to make this happen.

Jody and I were both able to watch on a monitor as they guided the catheter into my uterus, and released the two little bright spots of light that are, for now, our children. They even took the catheter back to the lab for microscopic review to ensure that neither embryo had floated back into the tube when it was withdrawn. Dr. Arthur pointed out the landscape of my body on the monitor, and said the two spots now looked like one because embryos "like to stick together". I am suddenly deeply in love with both of them. I want them to have each other as they grow. Once my greatest fear, twins are now the only acceptable outcome. I can't lose either one of them.

Dr. Garbedian gave us each a big hug and wished us well, saying with a laugh that she hoped she never saw us again. We said we hoped she had the magic touch. Dr. Arthur was smiling, we were smiling, and I was told that I was now officially "PUPO": pregnant until proven otherwise.

Holding two views of my two embryos  © Shutterbug

For the first time in six months, my wife kissed my belly again today, and told our babies to stay put and stick. This has to work. I need to feel her love for my belly on a daily basis for the next nine months.

And we are already considered to be three days into our two-week wait.

Pricks

Fertility medications  (c) Shutterbug

This is just a small assortment of the paraphernalia we require for one month of attempted baby making. How I wish that a glass of wine and romantic music could do the trick. 

It was very difficult to make the decision to go in this direction after spending close to $20,000 already on other procedures, especially knowing the weak chances of success due to my age (41). It was also difficult to imagine suffering through more side effects and opening myself up to unknown repercussions of injecting all these hormones. Most of all, it was difficult to wrap my head around this truly being the last-ditch hope, bringing out the big guns and wondering how my body would respond.

An early ultrasound showing six potential follicles was encouraging, but then we were crushed to hear after a whole week of injections that only two were growing. Not enough to proceed with the IVF procedure according to Mt. Sinai's protocol; this cycle would be converted to yet another IUI. A very expensive IUI. It had cost $70 for the Clomid that produced two eggs in the past; this time it had cost us $4,000 for the same result.

My wife and I recently read the Stephen King novel "11/22/63". A favourite line that the author repeated for emphasis was: "The past is obdurate - it does not want to be changed." We feel in our case it is the future that is obdurate. How can we not be meant to be parents, when we have so much to give?

The hardest part of all this is the lack of answers; everything is gray. My body could produce a completely different response to the same medication in a different cycle. We could try a different combination of drugs. We may have chosen to gamble on what was simply the wrong month. We could second-guess ourselves to infinity, and into bankruptcy.

This cycle was a mess: a call on Day 11 to say that my LH was beginning to surge, which isn't supposed to happen with Puregon injections, and also could have been avoided if I'd done Cetrotide injections - medication we'd had to purchase but then were told not to use unless instructed. Now I had to take an Ovidrel shot immediately to trigger ovulation in 36 hours, but they were going to perform the IUI in 24 hours. That was fine with me, as I consistently felt the procedures were being scheduled late.

This IUI experience was the worst one yet. Half an hour past our appointment time we questioned the receptionist, who just asked us to wait some more. A large, imposing nurse named Patricia, who is apparently also a midwife, led us to a cavernous procedure room we'd never seen on the other side of the clinic. She informed us our sample was still not thawed and it would be yet another half an hour. We sat and went through my chart together to kill time, and reviewed some of the previous test results. My FSH level was 16 this month, basically in total ovarian failure, yet my estrogen level was 2500 - a very good indication I had produced two mature eggs.

Finally ready to proceed, we gave Patricia the usual information about needing a Cook catheter bent a certain way to do the IUI. She proceeded to injure me badly enough to require packing my body with gauze to stop the bleeding, and then said she'd better try the Cook catheter. We were stunned and I was speechless from the pain, wanting to throttle her but needing this time-sensitive process completed. Patricia fumbled with the sample and said aloud that she might not have "got it on right" and she hoped it wouldn't "leak out" of the vial. Absolutely unfathomable that this woman had a job.

It was hard not to cry openly from pain and frustration when it was over. The helplessness we feel at every stage of this process is ruling our lives, and it is a struggle to function at work and in social situations.

We are now three days into our two-week wait, and I am taking progesterone daily to preserve the pregnancy that may or may not be underway.

I have done everything I can do. It is impossible not to get ahead of ourselves, imagining every outcome. One baby? Twins? Another miscarriage? A negative test? The trouble is that if the procedure doesn't work, we have to decide immediately whether to try again or not, and by what method. 

Do I give up on seeing any trace of my family genes in our child? Do we start trying to have my wife carry instead? Do we give up entirely and focus on building a life without children?

How do we continue to have hope after so many disappointments?

And I thought I was crazy before.

Four positive home pregnancy tests in the last 48 hours. Still doubting, and worrying that the Ovidrel shot is the culprit.

Have never wanted anything so much in my entire life.

Waiting for the doctor to call to confirm blood test.

Always waiting.

Stress and Perspective

This week I had my (our) 10th IUI procedure, coupled with a consultation with a nurse to discuss our next steps should this month be another disappointment.

I can't change the facts with positive thinking, or lifestyle adjustments: I have a roughly 15% chance of success if we go the IVF route. Spending around $12,000 on those odds seems not only irrational, but irresponsible. Yet how do I give up? This isn't working, and we don't have the luxury of more time at my age, nor the money, nor the mental fortitude to continue on this quest much longer. We came to the tentative decision that if this procedure fails as well, we will start the ball rolling to bring in my wife as the pinch hitter.

The universe, however, was not done taunting me this week. As I was being told to reduce the stress in my life (the doctor laughing a little at her own advice, commiserating at how impossible that is for anyone undergoing fertility treatments) and think positively, my job was "eliminated" at my company after sixteen years. Unlike many of my less fortunate coworkers, I was offered a lateral move within the company to a completely different position, which means I can still choose to have a paycheque. The choice was obvious given our hopes of continuing with treatments for either myself or my wife, so I'm grateful on a few levels. I escaped four previous rounds of layoffs unscathed, and have come out of the fifth better than most. To say that yesterday was stressful does not begin to describe the emotion of thinking I might be out of a job, then adjusting to the mindset of starting a totally different job, and then guiltily watching long-time friends exit the building for the last time.

I just can't wrap my head around the fact that I don't have any control over so many major aspects of my life. I can't control my infertility, and therefore can't control what the future definition of our family will be. I can't appear to control my body, which has betrayed me by steadily gaining weight over the last year of fertility drugs, depression and stress. And now I don't have control over what my job will be next week. I suppose you could argue these points, since I guess I have the option of choosing not to have children and to turn down the job offer, but I feel trapped.

This is not where I thought I would be at the age of 41. I'm trying to focus on what is important and good in my life, and maintain perspective on what is not, but that is harder than you might think.

My wife remains my saving grace, my support system, my family, my best friend, and the love of my life. I know that having this relationship makes me one of the luckiest people on the planet, since many will never know the joy of finding their "person". I just wish love could pay the clinic bills.

TTC - Hurry Up And Wait

IVF injection training at Mt. Sinai  © Shutterbug

And so it begins again, the 2ww (two-week wait) that all of us on this journey dread, and dream of, and suffer through, and bargain with. It's been five months since I've stood in these shoes. I'm certainly older, definitely wiser, and struggling with both regret and doubt.

We crawled back to Mt. Sinai in March with our tails between our legs after our negative experiences at Create, and met with Dr. Liu again. It was shocking to discover she was nearly nine months pregnant and about to go on leave any day. There is something just unfair about going to a pregnant doctor for fertility treatments. She and an assistant (which was awkward) kindly spent a long time discussing our options with my wife and I. If we wanted to proceed with an IVF cycle, she stressed the importance of us attending an IVF "class", held bi-weekly, before going that route, and we resigned ourselves to more time away from work, and more feelings of isolation as likely the only lesbians in the room. 

We arrived just before the class started, on a weekday in late March. We could hardly believe it when the rest of the attendees continued to trickle in every few minutes until the class was actually half over. It was disruptive, and disrespectful to the doctor leading the class. It was, by the way, Dr. Ellen Greenblatt, who is the head of the entire program. Much of the information was common sense or we already knew from doing our own research, but there were a few surprises.

I was under the impression that the whole reason for taking fertility drugs, which I had purposely avoided up until now, was to increase the number of follicles I produced each month. This is not the case: they are designed to increase the number of mature eggs the follicles produce, but that number is still limited to the number of follicles I start with (called the "antral follicle count"). They cannot change that. If my body at my age is only producing 4 follicles, then the maximum number of eggs you can hope to grow, even with drug intervention, is 4. OMG. The antral follicle count can change each month, however it's unlikely to vary by much.

The other important things I learned were about the IVF process itself - how eggs are retrieved, scary statistics on fertilization or lack thereof, how the embryos are grown (could be 3 days in a petri dish, or could be 5), grading embryo quality and fragmentation (!), futuristic procedures like helping the embryo to "hatch" (do you know what a zona pellucida is? I didn't.)…the whole thing seemed surreal and clinical and cerebral to discuss growing your future child in a lab.

Despite the scary financial number-crunching (most insurance plans, mine included, have zero coverage for fertility drugs), we decided it was time to bring out the big guns and attempt a round of IVF in May. Likely the only attempt, given that the total cost for treatment including the donor sample, drugs, and various procedures could run close to $15,000. We were already closing in on that figure with what we'd spent on our 7 IUI procedures in the last year.

I nervously counted down the days to cycle day 3, when I would go in for the usual b/w and ultrasound, and would begin drug injections. Time seemed to move in slow motion as we tried to evaluate all of the possibilities in advance. This is what the IVF class makes you realize as well; you have to prepare for making absolutely critical decisions, so that if and when the time comes, there is no hemming and hawing. For instance, we even have to sign forms to designate what should be done with our embryos should something happen to me in the middle of the process. Happy thoughts.

The u/s news was not good. I had three follicles in my left ovary, and one follicle plus a cyst in my right ovary. A cyst?! Yet another thing I was unprepared to hear and hadn't researched. My mother had required surgery for an ovarian cyst at a very young age, so this panicked me. A helpful nurse named Donna asked us to wait for my blood results, explaining that my estrogen levels would indicate whether this cycle could be salvaged. We had decided that IVF would be off the table for this month now, since 4 follicles were not enough (4 follicles would likely mean a max of 3 good eggs, of which only one or two might fertilize - a lot of money to gamble on such a low number), but hoped to proceed with another IUI and not waste the cycle. Donna explained that sometimes an ovarian cyst can trick your body into thinking it's a mature follicle, you to ovulate too early and release immature eggs. A level of around 200 might mean a usable cycle, but anything higher and we would have to cancel. And so we waited in one of the exam rooms we knew so well.

The sympathetic look on Donna's face when she returned said it all, even before she announced "640". We were so dejected, and so tired of the process being out of our hands, and now were worrying about the cyst. Donna, bless her, spent half an hour counselling us and said my body would likely reabsorb it. After some discussion, we came to the conclusion that we may have jumped the gun with going to IVF at this point. If I had been afraid of taking fertility drugs because of the chance of multiple births (and side effects), yet I was only producing four follicles and willing to subject my body to IVF now, then perhaps it was worth trying a medicated IUI cycle for the first time instead. The (oral) drug they would put me on is Clomid, and if I did happen to produce too many eggs for an IUI (not likely), we could choose to abandon the cycle and try again another month. Nothing to do but wait for my next day 1.

My very regular cycle, however, became uncooperative. Day 30 came and went. Then day 35. I called the clinic, concerned this was related to the cyst, and was told to come in on a Sunday, my period now nearly two weeks late. We had a very unfriendly doctor we'd had once before, who was quick and businesslike. She said everything looked normal. I explained I had never been this late before in my life, and asked what could cause a period to be two weeks late. She looked me in the eye and said sarcastically, "Uh, pregnancy?" What a bitch. Thanks for that, after all the disappointment and emotions we'd been through, all the procedures we'd endured; thanks for calming our fears and helping us to understand the current situation a little better. It was three weeks of debilitating PMS symptoms before my period arrived on day 45.

Cycle day 3 we were back at the clinic for b/w and u/s, and again I felt rushed through the process. The doctor simply confirmed there was no cyst and everything looked normal, then said I should begin taking the 100mg Clomid pills that evening for 5 days and come back in on day 12. She did not tell me my antral follicle count, so I didn't know if the Clomid would produce 2 eggs or 10.

I took the 5 days' worth of pills, then suffered through another four days of waiting before we went back in to hear what the effect had been. The side effects were bloating and headaches that Tylenol couldn't touch, but everything was bearable because this time we felt in control. We were finally doing something to affect the outcome of this cycle.

Silly me, I am 41 years old. There were never going to be 10 eggs. The answer was 2. 2 follicles measuring 2.05mm and 2.15mm, perfect for a Clomid cycle (larger than normal). Uterine lining perfect. You will learn all of the numbers, all of the abbreviations, all of their meanings, all of their odds. The doctor doing the u/s was the same bitchy one from last cycle with the "uh, pregnancy" comment, but she was in a better mood. She reassured me this cycle was good to go, and I only needed to do b/w the next day.

The b/w technician was none too swift. She asked me my name, I gave her my health card, she asked me to confirm my name, and then she pointed to the computer screen and asked me a third time if that was me. Overkill! I sat down, rolled up my left sleeve and held out my arm, and she sat across from me and asked which arm I wanted to use. Seriously? As usual, when she saw the absence of veins she didn't believe this was the arm they would normally use, and I explained the right arm was worse. She asked, "Have you ever used the other arm?". I feel like I'm on Candid Camera.

As fate would have it, our IUI day fell smack into the middle of a long-planned cottage weekend with friends. We had no choice but to drive the 5-hour round trip back to the city and leave our friends to fend for themselves for the day. It was bizarre, terrifying, and exciting to know that this time there would be two eggs coming down the pipes. After months and months of emphatically stating, "I don't want twins", the thought of never getting pregnant now seemed a much worse fate. Suddenly, the very real possibility of ending up with twins felt like it could be a blessing as much as I'd thought it could be a curse. 

There is no way not to obsess, not to have all of this invade your every waking and sleeping thought. It is hard to focus at work, hard to have banal conversation with friends and family, and hard to not get your hopes up. We just resign ourselves to the process, sing a little Que Sera Sera, and hope for the best. Tiny nurse Bernadette did the IUI this time, and it was just as difficult and excruciatingly painful as always. Poor Bernadette apologized profusely for hurting me and for struggling for so long, and I apologized for my crooked cervix, and my wife apologized for me having to go through all this.

It is now 4dpo (days past ovulation), or 4 dpiui. I have obsessively checked the Internet for stories of early pregnancy symptoms, for percentages of twin pregnancies with Clomid, and for statistics of women over 40 with fertility treatment. It is not productive, and if I had one piece of advice for other women starting this process, it would be step away from Google. Step away from the forums, too. Although they can be a great source of support, there will always be someone with a good outcome, someone with a bad outcome, someone with an outcome you didn't even consider. It's not going to tell you how your story will end. You will spend precious hours looking for answers you can't actually find there, and in the end what you read will probably compound your stress levels. It certainly won't help you sleep better. 

I get overwhelmed with the number of stories that mention miscarriages, often multiple lost pregnancies, and often late in the game (10 weeks or even further along). At this point I can't even imagine getting a positive pregnancy test, let alone getting used to the idea of expecting a baby and then having the rug pulled out from under us. I know the chance of miscarriage at my age is high, and I know the chance of genetic abnormalities is also high, but it's impossible not to get our hopes up. This has to work.

I want to believe a happy ending is possible.

And so we wait. And we hope that we can add our photo(s?) to the baby board...

Evergreen Brick Works

On a recent Saturday morning, I made my usual trek to the farmers market at the Evergreen Brick Works, but with a different task at hand than obtaining the best lemon feta cheese in the city (truly, you have to taste it). Toronto photographer Edward Pond was hosting his first photography workshop there, free of charge, to anyone interested in hearing his approach to shooting food. The agency I worked for wanted someone to check out his talk, and I was happy to go.

Edward sharing tips © Shutterbug

Edward is a somewhat soft-spoken and unassuming man, rare in the industry to begin with but even more so when you consider the level of success he has achieved. Most of the people in the group appeared to be hobbyists of another generation, and I wondered how many of them actually knew of Edward. He began with a short, obviously unrehearsed presentation outlining his personal philosophies, which included the following useful tips: 1) Don't buy props and set up artificial scenes if you don't have to. Figure out how to shoot what's in front of you in an interesting way; include surroundings to tell more of the story and possibly find some humour. 2) Get in close to your subjects and try to engage them. Always be respectful and don't just "steal" photos of them without permission. Ask. 3) Think about and evaluate the light you're dealing with, move around the subject to see how the light falls from different angles, and try to consciously choose side or back lighting for addd interest. 

Edward even went so far as to fully answer each and every one of the litany of questions regarding his own equipment choices and preferred settings, offering a level of transparency that many professionals simply won't share. It's as if some photographers feel that by sharing their methods they are giving the competition a boost, whereas Edward seems to genuinely want to help people create the best possible photographs they can. Refreshing.

Lilacs on table  © Shutterbug

We made our way through the various stalls and vendors at the market, with Edward pointing out several objects that caught his eye. Sometimes we'd stick together in our small group and jostle for views at the same table, and sometimes we'd scatter to where our individual interests took us. I spotted a beautiful bunch of lilacs sitting on a table, and decided to start with this easy subject. It was a static scene that I could move around and experiment with my framing and exposure until I had what I wanted.











From there, I moved on to a display of the most unusual-looking radishes I've ever seen, with vendors who were more than game to allow us to descend on their merchandise and rearrange it for aesthetic purposes. I went in for a close-up that showed the beauty of the produce, then pulled back to show more of the surroundings, unattractive as they were. A cookbook publisher would only want a beauty shot, but an editorial article on the market or this farmer would want to include some "real" images that didn't appear staged. It was interesting to see how different everyone's take on the same scene turned out to be.

Radishes at Brick Works market  © Shutterbug

At this point I decided to separate from the group, who continued to poke through piles of lovely organic produce, and make my way to some of the stalls I normally frequent. The vegetables are indeed beautiful, but I'm more intrigued by the people who are selling their wares. One of my favourite booths is Ying Ying Soy Food, which sells organic tofu in a variety of flavoured marinades. The gentleman manning the table is quite passionate about his product, and has a small electric grill going with samples he excitedly holds out to people on toothpicks, demanding that they give them a try. He talks about how he created certain flavours, which ones are his daughter's favourites, and how best to enjoy his products. On this day my toothpick held something I hadn't tried before, which he offered as a blind tasting. As soon as I tasted it I exclaimed, "Oh! Tofu bacon!" He shook his head, explaining that he really didn't like the association with bacon, and named this particular product "Deli Slices". Smoked tofu. I got the distinct impression that he must be a vegetarian, and remembered to use the correct name when I went to make a purchase.

Ying Ying Soy Food table  © Shutterbug

At the end of the allotted hour, I thanked Edward for his time and his contagious enthusiasm, and made my way to a large display area at the far end of the market. A man by the name of Bernard runs his company ShelfLife Materials out of a workshop on site, breathing new life into old reclaimed wood. He is committed to sustainable building practices, and offers clients a wide variety of finished products in addition to supplying raw materials to other designers and builders. Today he had quaint little birdhouses, beautiful polished slate chalkboards, a filing cabinet I was already mentally placing in my office, and a stunning bench I could easily see in my garden. I had to hold myself back from just handing over my Visa. I'd love to follow Bernard through the process of creating one of his pieces…perhaps if I ask nicely he'd let me shadow him.

Bernard of ShelfLife Materials  © Shutterbug

Filing cabinet at ShelfLife  © Shutterbug

It was a productive couple of hours, and I'm reminded of why I love this city. You can travel just minutes, blocks, or even feet from where you live and find cool stuff, meet interesting people, and learn something new. And it doesn't have to cost a dime!

Have vet, won't travel.

Ebony after surgery  © Shutterbug

Oh, Ebony.

A friend once suggested I should have named this lovely Lab Paris, since her vet bill at the time was the equivalent of a trip across the pond. "Safari" is starting to sound more appropriate at this point.

Our latest adventure began with the sudden appearance of a cyst on her foot, which was clearly a candidate for surgery. I've started to make a game out of guessing the value of anticipated vet bills. I was a couple of hundred dollars shy this time, because we figured if she was going under the knife we might as well address the disfiguring lipomas on her torso. She was sent home with two unexpected, disgusting draining tubes hanging out of her main incision that the vet said "shouldn't leak much". Our carpet would beg to differ.

At least we're accruing air miles on the Visa towards Paris.