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?

Patience Is A Virtue

(c) Shutterbug

I am not sorry to say goodbye to 2011.

The year ended with two more BFN results, and the overwhelming feeling that we are trying to force something that wasn't meant to be.

I've viewed many different forums and read many different stories from people who've had it easy, and many who've had it a lot worse than we have. That being said, I'm starting to feel pretty dejected about our journey.

October 2009 - April 2010: monitor cycles, choose sperm donor, undergo mandatory clinic testing and counselling

April 21, 2010: IUI #1, BFN

May 18, 2010: cycle cancelled when ovulation not detected

August 29, 2010: IUI #2, BFN

September 25, 2010: cycle cancelled due to poor estrogen response

October 22, 2010: cycle cancelled due to required surgery

November 28, 2010: IUI #3, BFN

December 23 & 24, 2010: IUI #4 & 5, BFN

January 20 & 21, 2011: IUI #6 & 7, BFN

April 30, 2011: IVF cycle #1 cancelled due to cyst, decide to try medicated IUI

June 25, 2011: IUI #8 with 100mg Clomid, BFN

July 21, 2011: IUI #9 with 100mg Clomid, BFN

August 17, 2011: IUI #10 with 150mg Clomid, BFP

September 28, 2011: miscarriage at 7wk6d

November 16, 2011: IUI #11 with 150mg Clomid, BFN

December 17, 2011: IUI #12 with 150mg Clomid, BFN

It's hard to believe we've been at this for two years. This list of procedures can't begin to convey the emotional and physical pain we've endured, and the way our lives have adjusted to make this process the centre of our universe.

Each cycle involves sleep deprivation, daily trips to the clinic in terrible traffic, insane amounts of money in parking fees, physically painful procedures ranging from blood tests to ultrasounds to inseminations, discomfort and side effects from medications, stress from having to take time off work, stress from waiting for test results, and stress on my marriage as my wife and I both ride the roller coaster of emotions. As strong as our marriage is and as much as we love one another, no one could go through days and weeks of the hope/disappointment cycle without friction. It never lasts for long, but it is always a bit of a struggle to balance our moods when I am frustrated and dealing with hormonal side effects, and she is naturally an optimistic and positive person.

I shake my head at the arrogance of not wanting to shop for a wedding dress when we first started trying, so sure was I that I would be pregnant at my wedding a few months later. I am no longer even a newlywed, and there is no baby in sight.

I also shake my head at my ignorance of thinking I should do everything possible to avoid a multiple pregnancy. The fear of having to cope with twins is what kept us from using medication at all in the beginning, and kept us (in addition to the expense) from trying IVF earlier.

But now here we are, in the place I've tried for two years to avoid: drugged up and in danger of having multiples. Funny how quickly that goes from being a fear to something you would gratefully accept as an alternative to a childless life. 

Fertility medications for one month of IVF treatment  (c) Shutterbug

My wife has patiently and carefully administered the three daily injections into my stomach, where the site burns and then aches, and the drugs cause increasingly debilitating headaches and bloating. The drugs cost around $4,000, depending on the number of days required to reach the right levels, the donor sample cost $700, the procedures come in at around $9,000 depending on whether sci-fi treatments like ICSI and assisted hatching are required, and there are other incidental costs as well. This is not for the faint of heart or wallet.

My scans have shown that the most follicles I could develop this month would be six. Mt. Sinai believes in only doing an IVF cycle when there is the potential to retrieve five or more eggs. Four or less and they would want to convert to an IUI: a horrible prospect. You are to assume that not every follicle will contain an egg, that not every egg retrieved will fertilize, and that not every fertilized embryo will survive to transfer. There are so many hurdles, so many decisions, and So. Much. Waiting.

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.

Lost

"So...are you still bleeding?"

This was the first question I faced, on my first day back at work, from the first person I saw who knew what had happened.

"Are you going to try again?"

"At least you know you can get pregnant."

"It's nature's way of taking care of problems. It's probably for the best."

"Better for it to happen now rather than later. Imagine going through this when you are further along."

"My sister/cousin/friend/fillintheblank had a miscarriage, and..."

"How are you?"

I don't know how to answer this last one. Are you looking for an honest answer, or a polite "I'm ok"?

I am not okay. I find myself wanting to tell everybody and nobody what has happened. I resent insensitive comments from people who can't know any better.

For the past few weeks my last thought at night and my first thought in the morning were the same: "Wow, I'm pregnant." Filled with awe and excitement and anticipation. Now it is the opposite.

I go about my day. I get up, I let the dogs out, I step into the shower...and am paralyzed by the vision of blood splashing on the white tub between my feet.

I do my hair, I make my lunch, and I go downstairs to look after the cat...stopping at the litter box, then remembering it no longer matters that I scoop.

I eat my breakfast, then make a last stop in the bathroom where it happened.

I am mocked by the "What To Expect When You're Expecting" book on my nightstand, by my prescriptions in the bathroom, by my prenatal vitamins on the counter, by the pregnancy tests littered throughout our house, and by a thousand other small reminders of what we have lost.

I try to sleep in the bed I couldn't leave for a week as I suffered, and prayed, and raged, and grieved.

We try to make sense of it, and take turns being strong for one another. And we try to make plans to keep going.

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.

BFP Sinking In

Another week further  (c) Shutterbug

I had my IUI procedure done on August 17, and on August 19 my job was eliminated. So much for maintaining a stress-free environment full of positive energy.

I was luckier than most of the other people who received similar news that day, because at least the company wanted to find a place for me: back in a job I'd held fifteen years earlier. It was an incredibly traumatic and emotional day as I waited for hours to hear if I was among the coming layoffs, found out that I was, then heard there was an opportunity to stay, but it would be as simply a team member in a department where I had, a lifetime ago, once been the manager. A tough situation, but I knew I had to make the best of it with everything we were going through.

We got our "BFP" (big, fat positive pregnancy test) on August 28, and I started my new job the very next day. The news changed everything. I felt like I was floating, walking around with this wonderful new perspective and an entirely different future opening up in front of me. Work stresses suddenly seem so insignificant in the face of our life-altering news. In one instant I felt like a different person. It's been similar to the experience of getting engaged and married; suddenly knowing how that portion of my life story would play out. And now I get the chance at another role.

The road has been so long already that we've been afraid to get our hopes up: it's not like we don't know how many hurdles there are still to pass. I've taken a silly number of home pregnancy tests to convince myself this is happening, because there is so little tangible proof this is even real. My first beta blood test (to test the hCG level) was done two days early due to a clerical error, and came back at 90: a high enough number to make us think both eggs could be on the go. OMG. It is completely bizarre to walk around for weeks thinking first that there might be nothing, then knowing there is something, but still wondering if it is one baby in there or two. Beta two was 150, but it was beta three that was the most important. All we have to go on are these phantom numbers that hint at what's going on inside my body. It's surreal.

I had the blood test on Thursday, and my wife and I were hoping for the results yesterday. I sat at my desk waiting for the nurse to call, jumping at every ring, wondering how I would have a personal call with so many people around me. What if it were bad news? I was distracted the entire day, and finally left a message on the clinic voice mail asking for our results, but a call never came. Excruciating.

We were on pins and needles today, as each hour ticked past and we still didn't know if we were ok. One phone call. One number. The range of acceptable numbers is ridiculously broad, because it would not only indicate whether a pregnancy was on track, but could give an idea of how many embryos were growing. It was our understanding that anything over 500 was a "good" number. A high number of a few thousand would mean there was more than one baby. As the day wore on and still no call came we became convinced the delay was due to bad news. We kept ourselves busy and tried so hard to keep calm but the mind is a crazy place. 

The waiting ended in the mid-afternoon. Beta three is 774. It is perfect for one baby. We are on our way. There will be no more news now at all until our first ultrasound, scheduled at seven weeks.

My wife has spent time on several different online forums as we navigated this process; now that we've had success she moved to a baby bump group instead of an infertility support group. They create a time line for your pregnancy where each growth stage is represented by different seeds or fruits for the embryo's size. Last week our baby was a poppy seed; this week he/she is an apple seed. Next week a sweet pea. Sounds like a photo project waiting to happen. 

In the meantime we've started a journal to write notes to this baby we've so desperately wanted. I know we are not supposed to get our hopes up, but I want to remember everything. 

I've plugged all our dates into a couple of online calculators, and they say my due date will be May 10, 2012. Mother's Day is May 13 - whether the baby has actually arrived or not, we will be celebrating for the first time. I will be a first-time mother at 42. Not what I'd planned for myself, but sometimes the universe has other plans.

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.