TTC - The Final Frontier

At Mt. Sinai on the day of reckoning, March 9, 2012  © Shutterbug

It was never my intention for this blog to get bogged down with our infertility troubles, but it's taken over our lives. It IS our lives. 

The struggle to maintain some sort of perspective on the whole process continues. There are times when all you can do is laugh, and times there is nothing to do but cry. Sometimes my wife and I do both.

Our last IUI (converted IVF cycle) was another dismal failure, followed by having to hastily decide what to do next. Obsessive Googling produced conflicting opinions on whether injectable fertility drugs have cumulative benefits, or whether it was better to give your body a rest between cycles. We decided to go with our guts and our fear of my now-gonging biological clock, and just go for it again.

Another early morning trek to the clinic for another Day 3 scan, with the unhappy news that I had not one but FOUR significant ovarian cysts, which meant that cycle was out of the question. Interestingly, my feelings of frustration and angst over the wasted cycle were alternating with a feeling of relief at not having to think about it for a month. We slept more, exercised more, and lost a few pounds.

We were told to meet with Dr. Liu for a review, and she said there was little point in raising my already very high dose of medications. She increased the Menopur from 75iu to 150iu, but said anything beyond that was "just a waste of money". We asked if this time we could choose to proceed with the IVF procedure regardless of the number of eggs there were, and she said yes. We knew there were clinics out there with women who prayed to produce just a single egg, and had success. We still didn't know where we would draw the line, but at least we would be in control of whether to move forward.

This time around I was expecting the uncertainty, and didn't look for too many answers early on. My Day 3 scan showed six follicles and no cysts. My wife and I trudged down the hall to the billing office, and plunked down a few thousand dollars more for the vials of medication. 

So began the mixing and poking and bruising and bloating and headaches and depression. We still counted the days to scans, but I wasn't losing sleep over it as I had before. By Day 7 we knew I had two strong follicles on the right and 1 on the left, which was the most we'd ever had to work with.

Scans and blood work followed on a daily basis, and I added injections of Cetrotide to the other medications. Each day they told us to wait until they called with the blood test results, which contradicts the prescription information that the injections be taken at precisely the same time each day. There is no returning the meds once they are purchased, which at $750 per day is no small investment. So we bite our nails waiting for the call, then rush around trying to fill the prescription, then inject me as quickly as possible. But be sure to cut down on your stress, ladies! On Day 14 we found out a fourth little follicle had suddenly decided to join the party, and might be big enough by retrieval day. Wow.

Thank God we both have a good sense of humour and can laugh in the waiting rooms. We observe lots of really odd behaviour, we laugh at frustrations like long, loud cell phone conversations, and we watch newbies find their way around. We are greeted by name by all the staff, who often stop to chat with us. Our fertility clinic has become like our Starbucks, or local pub. Sad, really, because we never intended to be there this long, and yet there is a level of comfort in knowing all of these people are truly pulling for you.

I took a Cetrotide injection the night of Day 14, so it was shocking to get a call from the clinic after the next morning's blood work to say my LH levels were still rising. We had to drop everything, leave work, and rush across the city to pick up an emergency second dose. Ovulating through this medication and missing the egg retrieval would cost us $14,000, and there are no funds to try again. This is it.

Day 16 was show time, and I barely slept. I passed the hours between 2 and 6 a.m. watching reruns of The Golden Girls and home improvement shows. Thank God for extended cable packages. We were at the clinic by 8 a.m. and had an hour to prep before the procedure. The nurse, Theresa, carefully evaluated all of my veins, including using a tourniquet in various locations, before deciding to use my hand. I am resigned to being a "difficult case" now after having been labelled this by so many sources. Difficult veins, difficult cervix, difficult ovary...I can only imagine what my birth experience would be, should I get there.

Difficult veins  © Shutterbug

Jody in the waiting room with booties  © Shutterbug

We'd been told that our favourite nurse Maddie and Dr. Liu would be doing the egg retrieval, but this was not so. It would be Theresa and Dr. Arthur...the dreaded woman who had done my pregnancy ultrasound before my miscarriage, about whom I'd sent in a written complaint. This woman would now be in charge of the most important procedure of my life? Theresa saw the look of horror on my face and went to find an alternative, so it turned out that Dr. Kim Garbedian would be doing the retrieval with Dr. Arthur there to supervise.

To be fair, Dr. Arthur was friendly and professional and showed no sign of remembering us. However, the first thing she said to me as I lay on the table was, "I expect this to be a difficult retrieval, because your left ovary is high." Of course it would be.

The drugs that were supposed to put me in a "twilight state" certainly made me feel calm and slightly swoony, but did nothing for the pain. Nothing. I remember every moment of the procedure, and as the stabbing pain of them puncturing my ovary hit me I begged for more meds, which they apparently provided. Once again there was a lot of blood, enough that it splashed on the floor and on the doctor's gown. This is not supposed to happen.

They managed to get four eggs out. It was the best possible outcome we could hope for, and I was really proud of my wife and I for not giving in to the doctors' pessimism about doing IVF. It only takes one, and we had four. In my obsessive online research there are many clinics with women praying for just one or two eggs, and we had double that.

I was sent home a couple of hours later, and spent the remainder of the day in bed. I was surprised to find this much like other surgical recovery, in terms of abdominal pain, bloating, etc. It was another sleepless night, and a fairly unpleasant day today too while I recovered and waited for the phone to ring.

And ring it finally has, with the news that two eggs have definitely fertilized, and a third is still a possibility. The fourth one is lost, for whatever reason. My body did the best it could. It's hard to wrap my head around what's going on in a lab downtown right this very minute. It's hard to restrain myself from running down there to press my face against the glass of the lab, and watch and will a petri dish to grow our children. We imagine every scenario, every outcome, and have already begun the anxious waiting for tomorrow's call.

I hear the excitement and job in my wife's voice, and it is oh so contagious. Even my normally reserved mother told me to cherish this milestone, and be happy for what we've achieved thus far.

Come on, give me another shot at this.

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.

Blackjack

"OJ" aka Blackjack at THS  (c) Shutterbug

On November 17, I was sitting at my computer and procrastinating about work by checking evil Facebook. I have a variety of friends who are as certifiably crazy as I am about animals, and there were several postings that caught my attention and led to additional clicking. Moments later I found myself perusing the animals available for adoption at the Toronto Humane Society.

I found him in the "Special Needs" section. I don't know what it was that made me click there of all places, and I don't know what it was about him that reached out and grabbed me and wouldn't let go.

His story was short and sad. Seventeen years old, stuck in a cage at the shelter for two months since his owner died, and suffering from indeterminate health issues. He was so handsome, and we were so bereft of a male cat in the house since losing Taz.

My wife and I managed to sleep on it for one night, but the next day both admitted to our inability to get him out of our minds. Another impulsive decision was made. My wife and my house both came into my life this way, which gives a dangerous boost to my confidence in my impulses.

Friday, November 18 we raced to the THS after work, knowing the adoption centre is only open until 7:00 p.m. We arrived at 5:50, hoping that was plenty of time, but were warned at the front desk it may not be. We raced to the new "cat house" on the second floor, took a number outside the office, and waited. We met other people who were there to browse and to adopt, and everyone appeared quite shocked by our interest in this elderly guy. His age didn't phase us; he was exactly what our house has been missing.

Eventually we were seen, the paperwork was completed, a discussion was had, and a tour was given. They led us through the maze of cages to our chosen creature, embarrassingly named "OJ". Let's see, at 17 years old he would have been born in 1995, when a certain black male was in the news...ick. I don't care how old he is and how long he's had that name, he's getting a new one.

He had undergone some serious dental surgery upon arrival at the shelter, and was missing nearly all of his teeth. This caused his tongue to loll out of his mouth, and created a spectacular stream of constant drool, but his eyes were bright and clear, his coat was thick and shiny, and he was ready to get the hell out of that cage. The vet came over to caution us about his health conditions, which turned out to be nothing more than a thyroid condition and mild kidney trouble. A pill twice a day and some expensive food was all it would take to manage his care; a joke, really, after our veterinary issues up to that point. Our last cat had a thyroid condition, and I myself have a thyroid condition. Thyroid schmyroid.

The girls on staff were incredibly sweet, and stayed late to complete the paperwork that would send "OJ" to a good home. As of 7:20 p.m., he was ours.

On the way home, we threw around a few names related to the word "black" for his colouring, and the name Blackjack came to my mind. It's a casino game we love, and the name stuck. It was only much later when looking at the date that I realized it was my beloved late Uncle Jack's birthday, which made it all the more appropriate.

It took him just two days to settle into our home and start coming out of his hiding places. It took less than a week to introduce him to the dogs and have them all make peace with one another.

It took only a minute for us to love him, and know we made the right decision.

Blackjack at home  (c) Shutterbug

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.

Four Legs, Four Toes

Georgia post-surgery  (c) Shutterbug

I knew it was going to be trouble as soon as my wife spotted it.

Even though I am an experienced pet owner, I have given up trying to trim my dogs' nails. The dogs freak out, I'm unsure of how far back to cut the black toenails, and it's just easier on all of us to leave it to the professionals.

Georgia went in for her usual nail trim recently, which includes a difficult rear dew claw. Two days later my wife found a hard, purple abscess where her freshly trimmed nail appears to have cut into her toe, which has swelled to completely encompass the nail. Back to the vet, where my gorgeous girl's tail never stops wagging. She was placed on antibiotics and given a topical ointment as well, which I felt confident would be useless.

And so it was. More appointments and discussion ensued, and we came to the conclusion the only sensible thing to do was surgically remove the dew claw. No admission was made on the part of the vet techs for having caused this situation, which ticked me off.

Our vet had no surgical time slots for an entire week, which wouldn't work when I could tell my dog was in discomfort. Enter my lovely high school chum Dr. Jennifer Newhouse at the Taunton Road Animal Hospital in Oshawa (if you need an excellent vet in the east, do call her). She is an amazing veterinarian and a wonderful person, and she stepped up to fit us right in.

My wife drove Georgia all the way out to Oshawa in morning rush hour traffic to drop her off for surgery...and came home to discover that some brazen asshole had stolen our beautiful new e-bike from under its tarp on our driveway. We live on a main street, with neighbours on both sides who are home during the day, and I can hardly wrap my head around the balls and effort it took to steal this 400lb vehicle in broad daylight on a busy street. It's unreal.

Maybe this person did us a favour; I was very concerned about my wife being in an accident in downtown traffic. Perhaps an injury was in our future that has now been avoided. But it was ours, we had saved for it, waited for it, and treated it with care. People are just so disappointing. There have been workmen mucking around with a flip project across the street for months who park across our driveway and behave like assholes on a regular basis, so we think it must have been one of them. It really would have taken two people and a large truck to transport this thing away without a key.

We tried hard to keep it in perspective, and my wife fought rush hour traffic again at the end of the day to pick up our beautiful little Georgie, minus one toe. In the eight years I've had her she has cost me next to nothing and brought me boundless joy. I doubt I will ever know another creature like her; she is pure love through and through.

A $2,000 loss of the e-bike and another $1,000+ vet bill made for a very expensive day when we can ill afford it. Surely there is a winning lottery ticket in our future...

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.