TTC - Onward

Pincushion  (c) Shutterbug

It is just seven weeks since we lost our baby, and here we are well and truly back on the TTC train. TTC roller coaster.

We trudged back into the Mt. Sinai clinic, dreading our day three scan and the chance of running into our now least-favourite doctor (Dr. Arthur), but we were in the clear. My blood work came back showing my hCG levels were back to normal, so we were free to start another cycle with Clomid.

5 days on 150mg of Clomid, the maximum dose available. Remembering to take it, dealing with the hot flashes and bloating and headaches, coping with the emotional instability that could be attributed to the drug or to the trauma...so goes our path to parenthood.

Counting down the days to Day 11 and the scan that would show us where things were at, it was difficult to focus on much else. By the time my name was called and I hopped up on the ultrasound table, I was nearly sick with anticipation. I had bet on three follicles this month; my wife on two. We waited while Dr. Greenblatt pressed unbearably hard on my ovaries, and announced in her very pronounced lisp that there was one follicle on the right side. My heart sank as I realized she seas not going to add anything else. I felt like the drug was useless and the effort wasted, but at this stage who is to say there would have been anything at all without it.

The blood work is always the real issue. Day 11 it took two technicians three tries to find a vein: both arms, and the back of one hand. Day 12 we were given a pass and got to sleep until a normal hour. Day 13 it took two tries by one clearly inexperienced tech, and Day 14 it took two tries by one obviously irritated tech. Sometimes I want to grab the needle and stab it into their eyes, is that so wrong?

Feeling like a human pincushion and totally fed up with the process yet again, I went in for my IUI on day 15. Nurse Kathy asked for the usual history, and took it all in stride. My eye kept going to the unusually thick binder with my name on it in front of her, and I finally asked to see the ultrasound photos that were taken during my pregnancy. I looked at them with a morbid fascination: despite the difficulty in making sense of them, they were physical proof of what I had, and what we lost.

Kathy proceeded to complete the easiest insemination of our entire history at any clinic. Did the miscarriage change my cervix in some way? Is this what IUIs are like for other women? I was shocked to hear that she seas done, since I had hardly felt a thing. I wanted to hug her.

This sperm sample was not our best; only a 3 million count compared to the previous averages of around 9 million (top count was around 18 million), but we keep telling ourselves it only takes one. One tenacious swimmer. We are not going to complain about the sample quality, even though it falls below the guaranteed count. Complaining just takes too much energy.

It is now 6 days past IUI (6dpiui), and I took a home pregnancy test to get a baseline negative. If it had come out positive then it would mean the hCG trigger shot was still in my system. Since it is negative, that means any positive result from this point forward is due to what's going on in my body, and not any of the drugs. 

It's hard to put into words the strain of this process. The mental, physical, and emotional drain and preoccupation; trying to remain hopeful and positive, yet not get our hopes up too high, and trying not to lose our minds.

I think I lost that battle long ago.

Are you there, God?

(c) Shutterbug

For a non-religious person, I sure have voiced a lot of little prayers over the last four weeks to an entity I don't think I believe in.

My life has changed so dramatically with my new/old job; there is no time throughout the day to contemplate my situation, or obsessively Google the week of my pregnancy, and my every worry. And there is now reason to worry.

We counted down the days to our first ultrasound this week, at exactly 7 weeks. We went to bed thinking about our baby, and woke up thinking about our baby. We watched videos of embryonic development, envisioned what was going on inside of me, and wrote notes to our future baby.

The ultrasound at Mt. Sinai was the typical clusterfuck. It was slated for the morning of Friday, September 23: the date we considered our anniversary prior to our marriage, since it was the night of our first date. We took this as a good omen. I booked a vacation day, and scheduled an additional medical appointment for the afternoon to maximize my time off. Then Mt. Sinai called to reschedule the ultrasound to the day before, requiring juggling, then called twice more to change the actual time of the ultrasound. It was finally set for 8:15 on the 22nd with Dr. Liu.

We arrived to face the usual packed waiting room, which conflicted with the nurse's explanation that my appointment was moved up twice to eliminate large gaps in appointments, seeing as how there "weren't that many". I checked in at the desk, letting the receptionist know I was here for my pregnancy ultrasound with Dr. Liu, and was informed that Dr. Liu was away at a conference. Say what now? Apparently Dr. Rebecca Arthur would be filling in, and we were directed to the same change room/waiting area as is used for cycle monitoring. The half hour wait annoyed me more than usual after the specific direction we'd received to be there earlier. Eventually a staff member moved us to the same old hallway outside the same old ultrasound room. My wife noticed there were spouses attending for the first time, so it became obvious that all of us waiting here were already pregnant, and not just the women having cycle monitoring scans. 

As the first couple went in, then emerged a few minutes later, I turned to my wife and said how inappropriate I thought it was to have the rest of us sitting directly outside the room. To say there was a lack of privacy would be a colossal understatement. What if someone received bad news? As soon as those words were out of my mouth, nurse Maddie came out and asked the couple behind us to return to the other waiting room until she came to get them. When our turn came to be led into the ultrasound room, there was no one else in sight. Our moment of truth had arrived, and my heart was beating out of my chest.

Dr. Arthur was waiting at the foot of the exam table, barely visible in the dim light. She asked if I had had any pregnancy symptoms, and I replied that I had increasing fatigue and heartburn, along with some minor cramping that had come and gone since day one. She prepared me for the test as if reading from a page, saying she would insert the ultrasound wand and then would be silent until she was sure of what she was seeing. I was nervous, scared, excited, and still wanting actual confirmation that I was actually pregnant - in addition to confirmation that there was just a single embryo in there! I wasn't sure what they could tell me this early on.

Dr. Arthur's silence stretched on, and on...and on. She moved the wand, pressed it to one side, pressed it to the other side, moved it some more, pressed some more, and squinted at the screen. My nervousness reached a fever pitch, then grew into a hard knot in my stomach that began to sink as it became clear something was wrong. Nurse Maddie stood up and walked around behind the monitor, looked at the monitor with Dr. Arthur, then they looked at one another, and then Maddie returned to her seat beside my wife, who was beside me. Just as I felt like I was going to scream, Dr. Arthur began to speak.

What she actually said is now a garbled mess in our brains. She used the words "abnormal", "reason to be concerned", and mentioned the proportion and amount of space. She confirmed she could see a "pregnancy sac", at which point my wife asked about the size of the embryo, and Dr. Arthur said it was what she expected. We weren't understanding the problem. The doctor herself admitted she wasn't exactly sure herself what she was seeing, and wanted us to go to the hospital in a week's time for another ultrasound. What?!?! She said it was just too soon to tell what was going on, which made me incredibly angry. Clearly she suspected something, but she wasn't saying.

There was a roar in my ears, and her words just kept repeating in my head, making it hard for me to formulate any questions. I finally asked whether she saw a heartbeat, and she replied that she saw "a flickering". What does that mean? She was giving us nothing to go on, and we were being ushered out of the room. Maddie briefly grabbed the back of my hand and squeezed it as she handed me my progesterone prescription, and told me to continue taking it for now. It was the only sign of compassion in the entire appointment.

We left in shock, and drove home in silence. Eventually we cried, ranted about our ongoing frustration with our medical care, and Googled like fiends at home. But there is no magic website that can tell you about your own unique situation, you can only read about how things turned out for other people. The outcomes range from miscarriages, to women talking about their now-toddlers that doctors had told them didn't exist.

With a day's perspective, our sadness and confusion gave way to rage and frustration. Anger at the slew of doctors with no bedside manner, the lack of individualized care, and lack of information. There was no way I wanted to go back to Mt. Sinai at this point, and no way I thought I could wait an entire week for any further news. I called my GP, who scheduled an ultrasound for me at her hospital, but it is still four days away.  In the meantime, there has been no call from Mt. Sinai to confirm the ultrasound Dr. Arthur apparently ordered there. There has been no offer of care whatsoever. I don't know what I expected, but I feel like a number with no relationship to anyone. 

And as today wears on, there is a dull ache beginning in my midsection. I just feel unwell, and for the first time in seven and a half weeks, a trip to the bathroom showed some spotting. 

I fear the worst, even as I sit here praying for the best.

TTC - Tomorrow, Tomorrow

Another ungodly early day on Sunday showed two perfect follicles (whew), but one dangerously thin uterine lining. It was 0.55mm where in the past it had always been 0.83mm or more. 0.6mm is apparently the cutoff for continuing with an IUI cycle - another measurement to learn and obsess about. Another side effect of the drug that was supposed to be helping me to conceive.

That afternoon my wife and I drank champagne and ate far too many delicious, sugary carbs at a friend's bridal shower. Enjoy it while I can, I figured. The next morning, for the first time ever, I forgot to set the alarm. I was slow to wake, but when I poked my wife in the arm she bolted awake and asked what time it was. Seven o'clock, I said, at which point she gasped that we had to be at Mt. Sinai in fifteen minutes. I don't think either of us have ever moved so fast.

We were just ten minutes late, and the blood tech hit my vein on the first try. Dr. Arthur laughed when she took my measurements during the u/s. "What did you do in the last 24 hours?" she asked. "This is an incredible difference for one day, your lining is now 0.78mm. I'm not just saying this, it looks beautiful." We beamed, and the details of this cycle began to sink in. I had two perfect follicles of equal size and maturity, one on each side. This meant there would be no losing half the sperm as they swam up the "wrong" tube, because we had a ticket for both routes. The lining would support implantation, my levels were all where they should be, and this will surely be our best chance yet.

Make that our last best chance. I don't feel that I can continue to put my body, my brain, and my relationship through this process any longer. I also can't keep flying in a holding pattern at my job at a floundering company, feeling as though I can't search for something new when my hope is to be pregnant any day.

I can hardly focus on anything else aside from this process, and my emotions are all over the place. My wife called me over to the sofa where she sat last night, and cautiously expressed her excitement and intense desire for this cycle to work out. We held onto each other and talked about our dreams.

I was the last of my friends to marry, and I will (hopefully) be the last to become a parent. I have seen friends, coworkers, and some strangers in the news who should honestly have never been allowed to procreate, pop out babies like it was the most natural thing in the world. I have had to be supportive and excited while hiding my own jealousy as woman after woman I know announced her pregnancy. I am filled with fears, and doubts, and longing.

Tomorrow is the big day. I am setting myself up for the biggest heartbreak imaginable, but I must believe this is my time. Our turn. The beginning of the next chapter in our life together. I want my child to come into being in an environment filled with love, and happiness, and hope. And so I will treat this once again as a done deal, and believe that tomorrow we are making our baby.

Come on, little one, just get here. We're waiting for you.

TTC - The Final Countdown

"Aunt Flo" arrived right on time this month, just as she has every other month for as long as I can remember. Trying to keep one's expectations low means less opportunity for crushing disappointment at this news, but results in more of a constant, low-grade depression.

Last month was not the first time I told myself it would be the last time I would suffer the pain, inconvenience, and indignity of all the requisite fertility procedures. I said I needed a break and I meant it, but when my seemingly inevitable day 1 arrived, I had to make the choice of whether to call it into the clinic or not. Suddenly I began to feel anxiety at the thought of taking a break instead of relief, envisioning one of my poor little eggs making its journey with nothing there to meet it. This is the reality of being in a same-sex relationship: there will be no happy accidents. It would be another lost opportunity; the slimmest of chances that this will be the month. And so I called it into Mt. Sinai, as I have so many times over the last year and a half.

My day 3 ultrasound fell on a Saturday, as so many of my procedures do, and the Mt. Sinai clinic was packed. My appointment was strangely late, at 9:00, and we could barely find seats in the waiting room. We were uncomfortably close to those around us; two couples who had each shown up with needy toddlers. A woman across from us recognized an older gentleman sitting nearby and proceeded to have totally inappropriate, top-volumme conversation with him about what he and his partner were going through. He took pains to be polite, giving ever-shorter answers to her barrage of questions ("So, are you in the middle of IVF?"), but soon appeared to be completely absorbed in his child's video game as a means of avoiding the interrogation. Some people have zero ability to read others, and zero filters.

A very tall, large, and intimidating black woman appeared in the doorway, swinging her long braids and demanding to know who was still waiting for blood work. She then began pointing at people, stabbing the air and grunting, occasionally demanding to know their names. "YOU!" she would yell. "BLOOD?" she demanded, scowling. When she came to me and heard I needed bloodworm, she grunted and pointed at the hallway, which I had to assume meant I should follow her. She didn't smile, and didn't talk other than to point at the computer screen and say, "That you?". Bracing for the test, I was unsurprised when her painful jab missed my vein. While pulling the needle in and out of my arm, changing the angle of entry to spear the uncooperative vein, she finally asked, "Does that hurt?". I was practically in tears, but had to laugh as I responded with What do you think? Once I was done, my wife and I proceeded to watch as she repeated this exchange with other people. How did this woman ever get her job? Surely you still have to interview and be chosen in the medical field, just like with any corporate job? Or as a nurse are you simply given assignments? Does no one care whether you have the shittiest job performance imaginable? There doesn't appear to be any accountability at Mt. Sinai. How could there possibly be so many incompetent people, month after month, doing a bad job with an even worse attitude? It crossed my mind that it was a teaching hospital, but these people were far too old to be students, and there was certainly no instruction going on that I could see.

This ultrasound was our first introduction to Dr. Rebecca Arthur, who we'd been told would be taking over our case during Dr. Liu's mat leave. She seemed nice enough, and spoke with confidence. When I asked about the follicle count, she told me not to worry about it from month to month, as it would probably not vary much given my age and test results (FSH/AMH levels). I think she said there were four this time. I asked about alternative drugs, since I was feeling like the Clomid wasn't having much effect, and she said injectables were an option for about $1,500 - but would likely not have that different a result. What?! I couldn't really process that news. Wasn't that the next step for an actual IVF procedure? Wouldn't those be the "big guns"? She offered to up my Clomid dose to the maximum 150mg to see if that helped, and we agreed to go with that.

This time the side effects included the usual fatigue, increasing mood swings and bloating, but also threw in some new insomnia, daily headaches, and daily nosebleeds. All this, and yet know that it's important to maintain a positive, stress-free environment for yourself to maximize the chances of conception. 

As I go about my daily life, I can't help but wonder whether anyone has used fertility treatments as a reason for actions of temporary insanity in court.