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.

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.