The Things We Do

I sit here tired...no, not tired. Tired doesn't even begin to describe it. Exhausted. Bone-tired exhausted. I sleep every night. Sort of. I can get to sleep - a little quicker with a modest snifter of cognac, but I can't stay asleep. I wake up. Not just a slightly dreamy roll-over, full-on awake. Not just once, but three, four, five, six, sometimes even ten times a night. Every 45-60 minutes, I'm wide awake. I have to pee, my butt muscles are screaming at me to change positions, my shoulder is crying from the pressure of sleeping on it when it's still not healed. 

This morning we went to the reproductive endocrinologist again for another endometrial biopsy. This is the fourth? fifth? Honestly at this point I've lost count. I had one after the first failure, then I had several more trying to confirm that we'd gotten rid of a chronic inflammatory condition discovered after the first one, and then looking at whether the new drug protocol was working right in several trial cycles.

We did another two-embryo frozen embryo transfer IVF in early December and got the negative test on the 12th. We thought we'd cleared all the issues that we'd had going on during the fresh round and the cycles leading up to this.

The only thing I didn't know about the time, was that the doc wasn't entirely happy with what they saw on the last endometrial biopsy. Progesterone that occurs naturally or in our case, added through drugs, has several effects on the endometrial lining that make it an attractive place for an embryo to embed and begin growing. Apparently mine didn't look as happy and inviting as it should have last time - though all other signs were good, so he chose to proceed with the transfer.

I trust my doctor, so I don't know that I'd have made a different decision than that if I'd known, and honestly it's pointless to debate the idea.

We have one frozen embryo left. One last chance to get this done - or we're out. I don't have another $28-$30,000 to do another donor round short of winning the lottery, we've tapped all the resources we have access to at this point.

So this time around, we have to get things as perfect as we possibly can. So I've spent a full cycle on all the drugs, plus added Crinone - progesterone suppository gel, so nearly double the progesterone most IVF patients get during a cycle. Usually it's just intramuscular shots of progesterone oil, which is just a joy ride in and of itself. 1.5 inch 22 gauge needles in alternating butt cheeks at 4 or 5 in the morning, depending on when the Man has to be at work each day. I'm bruised and feel like I've been beaten repeatedly with a 2x4 across the ass every day.

I'm already on double the amount of trans-dermal estrogen with the patches (I wear two rather than one) - and instead of twice daily oral estradiol, I take it vaginally to help with absorption because apparently with my rearranged gut I wasn't getting enough of it through my digestive tract. Where a normal estrogen blood level for a pre-menopausal woman is 20-375, my levels have been running at 1400-2100 depending on how far we are into the cycle. The blood progesterone level isn't so much in question now although it's likely to be huge, but we're looking at the evidence in the lining from the biopsy today.

The sleep issues are, at least in good part, attributed to those massive hormone doses, and unfortunately sleeping pills are not an option during all of this. I spent quite a bit of time after the Nightmare sleeping with the assistance of Ambien, and dear God do I miss it. I'd trade 9 hours of my alleged sleep for 5 uninterrupted hours of Ambien-fueled sleep any day. 

So today I took another 3 inch needle internally for the local anesthetic before the biopsy - I'm thankful I don't have to see this part of it - knowing how long the ass needles are is bad enough. If the anesthetic really is reducing the pain, I'm not sure I'd want to know how much it really hurts, because honestly even with it, it hurts like a motherfucker. Hurt like a motherfucker squared is not really something I care to do.

So we wait now for the pathologist to take a look. The senior pathologist - since he and the doc reviewed my sample together last time. Doc is anticipating this will come in by Wednesday. Thankfully, I've been relieved of having to do the IM shots for the next few days, and I can give up the vaginal estradiol as well until the results come on. Should the sample be sufficient, we'll stop all the other drugs, let me have a period, and start it all up all over again. If the results are as desired, we'll do about 2 weeks on the two estrogens, another round of ultrasounds and blood work to check things out, and then both forms of progesterone again leading up to the final transfer.  If the results aren't as desired, he'll have to figure out another way to improve the progesterone action - which will mean another full test cycle.

In deference to my bruised ass, he did offer me a rest cycle, but there is something to be said for back to back medicated cycles that can encourage my body to get with the program and make a nice comfy nest for embryos. So despite the bruising and pain, I chose to have him go forward with whatever will become of the next cycle - another test or the real transfer.

I question my sanity in continuing this regularly - but I'd never stop questioning whether we could have success if we didn't see it all the way to the end.

I know success will ultimately lead to far more sleeplessness - pregnancy impacts it, having a newborn of course does, I just - I don't know. It's hard to consider it "worth it" right now - instead it's a barely tolerable side effect.

The things we do...

Faith, Denial, Hope or Despair

Otherwise known as someone has to be on the wrong end of a "great chance".

We got the call Friday afternoon. My quantitative HCG test was negative. More accurately, the value was less than 1, but effectively that's negative.I go in Wednesday for a consult on whether anything else needs to be done before we move on to round 2 with the frozen back-up team.

I spent the last week searching for some sort of sign - I should have felt differently, I should have "known". Any time you get a bunch of women together on the internet talking about pregnancy or trying to conceive, there's always the contests - who knew the exact moment that implantation occurred - no hints from a little bit of spotting, oh no, that's too obvious - but they felt it. Suddenly their life took on an beatific glow, and before they could take the time to drive down to the 24-hour pharmacy there was enough HCG flowing through their system that a single drop of urine would produce an unquestionable double line on the test.

You know what? They're full of shit. Sure, some women, even some women I know, experience some early symptoms, but not everyone does. Others do only through the rosy-pink glasses of confirmation bias. Others, though I find it nearly equally as incredulous, never know they're pregnant until they're about to deliver. Everyone's experience is different.

I know, though, that for at least a day or two, I had two viable embryos inside me.

I suspect the one on the left was our little over-achiever - the one that made 9 cells by day 3. I don't know why neither of them "stuck" - and I don't think that anyone will ever be able to tell us why. There were some things that the doctor may want to investigate in some manner, that's what the consult on Wednesday is about.

My husband held me while I cried - and then told me that there was no need for despair, because the back-up team in the deep freeze would do fine and in another month-ish I'd be pregnant. He had faith.

I had hope, and what it got me was another kick in the gut. Faith only seems to delay the inevitable disappointment. I suppose that firmly believing something will be true will make you happy while you wait, it could forestall any angst in the mean time, but is that really better?

Anxiety isn't fun. Though the Man does sometimes tease me about not being happy unless I have something to worry about, I don't really believe that's true. I need to guard my heart. We made the decision to move forward with this, knowing that the 80-90% chances we were quoted were good. But I also know there's no guarantee that we'd be one of those 8 or 9 out of 10 - that we could just as easily be part of the 2 - or even the single 1.

I need to know, that even if we're not successful with the reserve team that everything will be OK. Right now, I'm having a hard time imagining the finality of "no more chances". Well, I can certainly imagine that outcome, but I can't imagine what I'll actually do with myself.

For over 7 years now, we've been trying in one way or another. The interventions we had shortly after we got together, the time it took for us to decide that we'd become foster parents, the training, the waiting. The wonderful time we did have in that experience, and the stark disappointments of the reality of the whole process. The nightmare, the fallout. Hearing that my WLS may improve fertility, realizing that in terms of motherhood I'm fucking old.

I don't know what to do with myself. Almost everything has been cleared out of the bedroom the girls used to share. The only remnants are the shelves he put up, the chest of drawers in the closet, and the framed pictures of J up on one of the shelves. I had to put down the pictures of T, but I've been able to enjoy the pictures of J for what they are. But today I'm tempted to put them away, or close the door again. The black hole that hides behind two sheets of wood and a couple of hinges. It was closed for the better part of a year. We've been waiting to replace the guest bed until after we knew we'd need a new crib or not.

Part of me wants to be able to have hope, to have faith that the universe isn't so cruel as to say no to us again. I'll admit that a larger part of me right now says that to believe so is only to be in denial.

Maybe that room should be closed - otherwise it's where hope will go to die.