Retrieval

The alternate title of this post should be: Grow Embies Grow!

After my somewhat traumatic trigger, I had exactly 48 hrs to embrace the positives of this new plan:

  1. Extra recovery time: I was feeling pretty awful even though I was taking cabergoline to prevent ovarian hyperstimulation syndrome. I was so bloated that I looked at least five months pregnant (the irony!), and there was not a single pair of pants I could zip (seriously thought about digging out my Bellaband). I also developed constipation despite chugging Milk of Magnesia and staying hydrated as instructed by my nurse.  Having a month to detox before embryo transfer was starting to sound appealing.
  2. Acupuncture: I cannot say enough good things about acupuncture.  The best I had felt during this whole journey was those few months when I was receiving acupuncture alone or in conjunction with my fertility treatments.  Because I was enrolled in an IVF study, I was not permitted to do acupuncture simultaneously.  In fact, if you get pregnant through the study, they follow you all the way up to the birth of your child, and that means no acupuncture at any time.  As someone with two previous miscarriages, I had always envisioned doing acupuncture for miscarriage prevention. Perhaps being kicked out was the best thing that could have happened to me.
  3. FET success rates: At my fertility clinic, they prefer freeze-all cycles. In my age group, approximately 34% of fresh transfers with non-donor eggs result in a live birth. For frozen cycles, 40% of transfers result in a live birth, and the actual pregnancy rate is quite high (>50%).
  4. Consideration of single embryo transfer: The study required that two embryos be transferred on either day 3 or day 5 (depending on individual embryo growth). This made me a little nervous as I am not exactly confident in my abilities to take care of two or more newborns along with a pre-schooler. I told my RE that I would likely cry just a little bit if he told me I was having twins. I would, of course, come around eventually.  Two baby heads to sniff is quite a gift. But I would be terrified.  Ask my husband, and he will tell you differently.  Then again, I can probably count the number of poopy diapers he’s changed on my two hands. Hmmm.

IVFeggretrieval

I had my retrieval done at St. David’s Fertility Surgery Center, which is two buildings down from my fertility clinic.  We had to arrive very early, so J had a sleepover with her cousins.  I later found out that she had told her teachers that Aunt Liz had to bring her to school so Mommy could get her eggs taken out. Oh my! Will have to be careful what I say around that child.  The procedure itself was fairly easy.  My nurses were fantastic, and my anesthesiologist was the kindest man ever.  I was knocked out while my eggs were retrieved, and before I knew it, I was back in my room.  Any type of sedation knocks me for a looper, so I do not remember even talking to Dr. S after he performed the retrieval.  My first memory is of the embryologist coming in and telling us that we retrieved 17 eggs. Wow! I felt like a rock star.  High fives all around.

DH and I went home to rest before we had to pick J up from school.  I use the term “rest” rather loosely since we were in the middle of a whole home renovation, and those do not tend to be very quiet.  Fortunately, they were working on the other side of the house, but we were without a bedroom for the time being and sleeping on a mattress in the middle of my daughter’s play room.  Try as they may to let me sleep, the crew had to interrupt me several times to ask my opinion on one thing or the other (insert sigh).

We received our first FERT report the next day. Of the 17 eggs retrieved, 16 were mature, 13 fertilized normally and there was 1 more in culture that they were unsure about. On day 3, we still had 14 eggs in culture: 10 of acceptable quality and 4 that were fragmented or falling behind.  On day 5, two blastocysts of grade BC quality were frozen and they were continuing to watch 8 additional blasts. They embryologist felt that things were looking good for getting a few more frosties.  Then, on day 7, we received the DEVASTATING news that none of those 8 made it to freeze quality.  So of my 17 eggs, only 2 were normal enough to freeze.  I was disappointed to say the least.  IVF is a lot of work, and to have gone through this entire cycle only to get 2 embryos was a bit of a bummer.  But at this point, I was simply too tired to spend too much time lamenting.  I was just looking forward to being drug free for at least two weeks before I started my frozen cycle.

I.V. {Freakin’} F.

pregnancyinfantlossawarenessmonth

In October 1988, President Ronald Reagan proclaimed October as National Pregnancy and Infant Loss Awareness month.  In 2006, the U.S. House of Representatives passed a resolution making October 15th Pregnancy and Infant Loss Awareness Day.  Through my infertility journey, I have encountered many strong women who have dealt with some form of miscarriage or pregnancy loss.  These women (and their supportive partners) are your friends, your neighbors, your co-workers. Chances are, you have no idea they are even suffering because they are doing so in silence. Hard to believe when life is a blur of Facebook and Twitter, and everything seems so very Pinterest-ing. How is it that pregnancy loss is still so taboo? I don’t have the answer to that, but this month is for you, and I’ll be praying for your hearts to be healed. You see, I am one of you- having suffered four pregnancy losses of my own. During the month of October, I will be chronicling my IVF story in the hopes that it will be therapeutic for me and for others who have yet to share their stories.

*****

Weighing The Options

When I finished my infertility series, I had experienced an ectopic pregnancy after conceiving with the help of Clomid.  After that encouraging pregnancy and with the clock ticking down my 36th year, we hit the ground running with two more rounds of Clomid alone followed by Clomid and intrauterine insemination (IUI). My husband, especially, was bummed by our failed IUI so we turned to alternative medicine for help.  We did two months of fertility acupuncture (herbs and needles) followed by one month of acupuncture, Clomid and IUI.  My charts were encouraging. My acupuncturist felt all the signs were leading in the right direction. My reproductive endocrinologist said I was stimming beautifully! But still no pregnancy.

With my lining thinned from repeated cycles of Clomid and me about to turn 37, the next step in the treatment cycle was IUI with injectables. This involves injecting oneself with a follicle stimulating hormone (FSH) such as Gonal F starting on cycle day 2 or 3. As the FSH stimulates the ovaries more aggressively, more follicles are developed and there is the potential to ovulate more than one egg.  This increases the risk of multiples including triplets. Yikes! Suddenly, I had a flashback to Octomom, and I definitely did not want to be her. In my age group, the relative success rate for IUI with injectables is 15-20% per cycle, and the projected cost is $2500-$3500 including drugs, monitoring and the procedure itself. That’s quite a hefty price tag for one shot at a pregnancy.

Fortunately, the informative lady in the billing department of my RE’s office was kind enough to remind me of an IVF study for which I qualified. Dr. S had mentioned it to me eons ago when I was not at all ready to think about IVF. The typical cost of IVF including doctor fees, hospital costs and medications is $12,000-$17,000. This study cut the cost in half with a 30-35% chance of success for a fresh cycle and the chance to freeze any remaining eggs for future frozen cycles. The study’s goal was to prove that Afolia (a drug already being used for IVF in Europe) was just as safe and effective as Gonal F, the gold standard in the U.S.  The study was in its third and final phase before being FDA approved, so I felt it posed little risk to my personal health. Besides, everyone knows I love a bargain. Perhaps I would also be playing a small part in introducing competition to the marketplace, thereby decreasing the future cost of IVF??? One can only hope.

The Waiting Game

For the next few days, I ran around like a banshee getting multiple vials of blood drawn, yet another HSG, a pap smear and attending couples IVF orientation all in the hopes of qualifying for this study.  I passed with flying colors! Now the only thing standing in the way of me and my study money was an antral follicle count i.e. the number of follicles measured by a baseline day 2-5 ultrasound.  The study said I had to have at least 10 but no more than 20, and I had no idea what my number would be. To make things worse, the study coordinator could be reached only via email.  I would email her cycle day 1 and check my email obsessively for her response.  The first month, my cycle occurred too close to Thanksgiving, so I was only able to do more blood work, which also turned out great. The second month, my cycle occurred one week before Christmas, and the study coordinators had closed to study to further participants until after the holidays. Come on! I was getting antsy. The third month, I finally had a win. In January, I had my first study visit and my antral follicle count was perfect! I was promptly started on birth control pills to suppress my ovaries and allow the follicles to get in sync. Being in a study requires a lot of baselines so I had what seemed like a million tubes of blood drawn, but aside from that, the first month was easy peasy.

And So It Begins

Approximately three weeks after starting on birth control, I had my study 2 visit. There was another ultrasound to make sure I had no cysts and was ready to begin Lupron for down regulation. Lupron is a drug often prescribed to men with prostate cancer or women with endometriosis or fibroid tumors. It’s off label use in IVF is to shut things down, so to speak. You start Lupron injections approximately 7 days before your period is due and continue it throughout follicle stimulation to prevent ovulation. This would involve injecting myself in the belly every morning, and was rather intimidating. DH (dear husband) came with me to learn how to give the injections just in case I wimped out.  I did the opposite. I essentially stabbed myself thinking the needle had to go all the way in when, in fact, I only had to inject it far enough to release the drug.  Practice makes perfect.

DH and I also signed our lives away at study visit 2. Since IVF produces embryos- each a potential life- there are a lot of ethical considerations. You must decide whether you will send your embryos to long-term storage if not used within six months. You must also decide what to do in the event of leftover embryos that you do not intend to use- will you discard them or donate them to science or another couple for potential implantation? What happens in the event of death of one or both spouses? What do you do with the embryos if you, as a couple, decide to divorce? These are some heavy questions folks!

For the next 11 days, I gave myself a Lupron injection at precisely 6:50 AM every morning. Then, I had another ultrasound and more bloodwork to ensure my hormone levels were appropriate to begin FSH. On day 12, I was cleared to begin stimulation and was randomized to the control group. This would mean I would be getting injections of Gonal F- the tried and true FSH drug. While I did feel a little less important than had I been randomized to the experimental group, it was somewhat of a relief to be doing things the “proven” way. The big difference with the study protocol is that they require you to use a low dose of FSH for five very long days before the dose can be increased to the usual 450 units. This is to avoid study drop-out due to ovarian hyperstimulation syndrome (OHSS), a potentially dangerous condition I also wished to avoid. I continued to inject myself with Lupron in the morning and the Gonal F pen in the evenings. I was not a big fan of the pen method of drug delivery. You must dial the dose and then press the button pretty hard to release the medicine into your belly.  Once the dose is dialed, there is no going back.  I was so fearful of messing up that I pretty much watched the instructional video every time I did my injection. You can watch it here.

Though I alternated my Lupron and Gonal F injections from side to side of my abdomen, I was one big bruise by the time they upped my dose. I stimmed for a total of 12 days, and by the end, I actually had a small hematoma on one side of my belly- probably from pushing the pen down too hard. Injections suck. May I never get insulin-dependent diabetes! As I stimmed, I had several ultrasound visits to keep track of my developing follicles.  I was doing awesome.  My estrogen level was great. My lining was super thick. We were keeping our eye on 21 follicles by the last visit. Some would inevitably be too mature or too small by retrieval, but I was psyched. The study required that I implant two day 3 or day 5 embryos, and I was hoping to have leftovers to freeze. Come on frosties!

Trigger

When enough eggs are deemed ripe, you have more blood work to check estrogen and progesterone levels. The nurse then calls you with the results and the timing of your trigger shot. The trigger shot, called Ovidrel, is essentially a dose of the pregnancy hormone HCG. It tells your body it is go time. Egg retrieval is scheduled for exactly 48 hours after the Ovidrel injection so they can retrieve your eggs before you have the chance to ovulate.

When my nurse called me to give me the time of my trigger shot, she also had bad news. My progesterone level had prematurely risen to 1.8. It needs to be <1.5, or it is thought that the endometrial lining has gotten out of sync with the follicles and the chances of implantation are poor.  My fresh transfer would have to be cancelled, and this meant I would also be dropped from the study. A million thoughts were swirling around my head as my nurse attempted to give me my final instructions. My egg retrieval was still scheduled for that Wednesday, and I would convert to a frozen cycle after my next menstrual period. Were they going to take back my study money? No, she assured me. None of this was my fault, and all my information would still be included in the study.  We prefer frozen cycles, she said encouragingly.  Still, I cried so hard in telling my husband over the phone that he left work early lest I fall to pieces. To make matters worse, at this point, my belly was very swollen from all the developing follicles, and I was feeling pretty awful. They were fearful that I may develop OHSS, so they prescribed a medication to lessen the side effects, which would surely worsen after trigger. Did I mention that we were also in the middle of a whole house renovation, and I was presently sleeping on a mattress on the floor of my daughter’s play room and living out of her closet? I nearly wished for the earth to swallow me up whole and relieve me of this misery, but I could not. I had 48 hrs to pull myself out of this hormone-induced darkness and wrap my head around the change in plans. I promptly stabbed myself with Ovidrel and encouraged my follicles to grow, baby, grow.

I’ll tell you all about my retrieval next time around. For now, everyone else is sleeping, and so should I. . .

 

Ectopic

This is the final installment (for now) in my infertility series.  I have delayed in posting it because the emotion is  still raw.  I do want to pause to give thanks for the number of personal notes I have received in response to my writings.  There have been words of encouragement, stories of hope and similar struggles and gratitude for having the courage to speak out.  Writing has always been an outlet for me, and I am glad to have a made a small impact on others, if only for a moment.

For DH and me, our miscarriage experience brought to light the fact that we were “trying.” They say ignorance is bliss, and we certainly found this to be true.  We were well aware that we were taking no precautions to prevent pregnancy, and at least 15 months had passed in this manner. We probably should have been concerned, but I think it helped that we were terrified by the notion of a second child for at least half that time period.  The fact that pregnancy #2 occurred without overthinking it was, well,  lovely.

Now we were determined more than ever to give J a baby brother or sister.  I, for one, was not looking forward to “trying,” but it ended up being less stressful than I anticipated.  DH was 100% on board, and it was like an unspoken agreement between us. I charted only once to make sure my cycle had not changed.  My periods were still like clockwork every 28 days with ovulation occurring around day 15. Seemingly perfect. Twelve months went by without success, and my OB-GYN urged me to go back to the reproductive endocrinologist. I was, after all, 35 and the clock was ticking.  Fifteen months went by, and this time it was DH who was dragging me to the RE’s office. What pushed me over the edge were the results of a blood test my OB-GYN ran. Anti-muellerian hormone, or AMH, is a substance produced by early ovarian follicles. It is thought to be an indicator of a woman’s remaining egg supply, her ovarian reserve. The normal range is 1.5-4. My result came back at 0.6. Time to see Dr. Magic.

The RE was not concerned with my AMH value quite yet. He said, it being a new test, there was a lot of potential for error if not performed by a reliable lab.  He sent me for a very thorough panel of bloodwork via ReproSource in Boston. All my values, including AMH, fell within the acceptable range, and my egg retrieval score was good, meaning average for my age. On my 36th birthday, I had a repeat HSG, and this was also normal. DH’s swimmers were deemed plentiful as well. We were so normal that we were given a diagnosis of “unexplained infertility.” Our recommended treatment plan was either continue on our own or try fertility drugs in an effort to speed up the clock.

We chose Clomid, which I took one time while trying to conceive J. As you may recall, I hated it.  I experienced all the listed side effects- hot flashes, night sweats, bloating, headaches, breast tenderness, extreme irritability. It was an evil little pill, and I was not excited to give it a second try.  I started my 5 days of pills and waited for the ugliness to begin. I waited. And waited. And waited. Still, I felt nothing. I told the doc as much when I saw him for my follow-up ultrasound.  My ovaries told a different story.  I had several mature follicles in each ovary. Sneaky Clomid!

The protocol is to have extra friendlies every other day while tracking luteinizing hormone with an ovulation predictor kit. Once the luteal surge is detected, ovulation is anticipated to occur the next day.  They gave me a lab slip to go for a pregnancy test 2 weeks after my surge. Not one for unnecessary bloodwork, I called the office the day the lab was due and told them I was going to skip it as I had taken several home pregnancy tests in anticipation and had yet to get a BFP. The secretary agreed but urged me to go if AF did not arrive within two days.  I decided to take one more HPT, and this time there was the faintest positive. When I looked back at the previous day’s test, there was also a very faint positive I had missed. Oh glorious Clomid!

I quickly snapped a pic of my test and made J pose for this adorable picture with her Cabbage Patch Doll (mine from my childhood). The shirt was handed down to us by her cousin, and I was saving it for a time when it rang true. I sent the pics off to DH and hopped in the car to get my bloodwork done.  DH was ecstatic. I was cautiously optimistic.  The projected due date was Oct 9, the day before DH’s bday and a week before our anniversary and my birthday. How could this fail?

A slight miscommunication between the hospital and lab resulted in a delay in receiving the results.  The blood test came back positive, although the HCG level was low. My progesterone, on the other hand, was through the roof, indicating that I had ovulated more than one egg.  My second blood test two days later revealed that the HCG had more than doubled so I was cleared to go one week before my next blood draw. I was feeling pretty confident at this point. My breasts were sore and enlarged. I was having minor cramping in my expanding uterus as I had with J. My belly was hard and swollen likely due to all the progesterone on board, but I preferred to think of it as a little baby belly.

And then it all fell apart.  I received a phone call after my third blood draw informing me that my HCG levels had remained low and had not come close to doubling as expected. The doctor was concerned I may be experiencing an ectopic pregnancy and wanted me to come in for an ultrasound the next day. DH was out of town on business, and I had to break the news to him on the phone. I also had to arrange for childcare for J so I could go to the ultrasound by myself. DH and I stayed up late talking on the phone and googling “HCG not doubling” and “ectopic.” We clung to hope from stories of other women with low HCG or suspected ectopic pregnancies who had gone on to birth healthy babies.

When I finally went for my ultrasound, all hopes were dashed. Although my HCG was rising just a tiny bit with each new set of bloodwork, the number was less than 500, grossly below what one would expect at nearly 6 wks pregnant. The words “not a viable pregnancy” passed from someone’s lips and attention turned to determining whether the pregnancy was in-utero or ectopic. They were unable to make that determination.  Two doctors and an assistant probed me. They debated it while I held my breath and pressed my lips together hoping to hold back the tears for a few minutes longer.  I was sent home with firm instructions to call the doc on his cell phone and report to the ER if I experienced any severe right sided cramping. I was to come back in two days.  The worry was that if the pregnancy was in the tube and continued to grow, it may rupture my fallopian tube and cause me to bleed internally. This is one of the leading causes of maternal death and not something I wanted to experience.  Also, as someone who has a hard time getting pregnant, I could not afford to lose my right tube. I did not go home with a picture of my suspected ectopic, but it looked similar to this.

Because my HCG number was still rising, I  felt a glimmer of hope. Maybe this baby was in my uterus and was a late bloomer? I didn’t want to feel pressured to terminate a pregnancy if there was still hope, so I turned to my OB-GYN for further guidance.  I found her to be more personal and sympathetic than the RE. She took the time to explain what the HCG numbers meant, why mine indicated a failing pregnancy and my options should it turn out to be ectopic. Talking to her was like a breath of fresh air.  I may have mentioned earlier that my RE is slightly cocky, and he has every right to be. He is very talented at what he does. However, as appreciative as I was for the close monitoring, I was not ready to herald him champion for saving my tubes just yet.  I simply wanted him to pause for a moment and acknowledge my loss. Was this too much to ask?

DH accompanied me to our next visit which fell on Valentine’s Day. Seriously! DH has long been boycotting VDay as a commercial holiday, so I was not expecting candy and flowers, but this was ridiculous! They were still unable to make the call,  and the HCG number continued to creep up, so it was getting urgent. The recommended protocol was a shot of methotrexate. This is a chemotherapy drug that would effectively terminate the pregnancy to stop it from growing. If it became too large, I would require surgery and risk losing a tube. Still, no one wanted to inject me with a chemo drug if this was a natural miscarriage waiting to happen. So I was send away again.  I was told not to panic over bleeding as this was sure to occur, but to call with significant right sided pain. I experienced both and ended up having to call my doctor at home on a Sunday evening. Fortunately, the pain was not severe enough to be emergency-worthy, but my next appointment was moved up to 7:45 am on Monday.

We had arranged for childcare for J, but she woke up with a fever. So the three of us piled into the car- my pursed loaded with children’s ibuprofen and tylenol- and drove in silence to the office.  My HCG numbers had fallen significantly over the weekend. What was troubling was the spot that was still clearly on my right fallopian tube as well as the right sided pain I was having. I opted for the methotrexate shot and spent much of the morning waiting around to see if my liver was healthy enough to allow this option. Finally, I received not one but two injections and was sent home to rest. Except that I had a sick child, so rest was not possible.  In fact, all three of us ended up getting sick, which was a welcome distraction from the nightmare of the previous week.

As before, time was relentless in its insistence to march on and on and on. I may or may not have thrown a tantrum over planting some peach trees, which I refer to as my miscarriage trees. I remember reading somewhere that it was therapeutic, and I was planning on planting some fruit trees anyway. J named them Ariel and Belle. Please remind me never to ask her opinion on baby names or, surely, she will end up with brother Kristoff or sister Rapunzel.

DSC_0456

We are still trying, and I am not going to lie to you, it is the pits. Most days, I am ready to move on from this chapter in my life. Should God entrust us with another precious life, I will hold him or her to my bosom, breath in the heavenly scent of baby and cry tears of joy. And should we remain parents of one, I will look at my little J with pride and adoration, as I have for the last three and a half years, and know her love is big enough to sustain me.

* * *

Good news, my next post will be significantly more uplifting as I am going to write about J’s Ariel Pool Party (because every three year old needs a pool party).

 

Blighted

(`blit-ed): used as an adjective to describe something that has a condition that makes it weak or unable to grow

There is an old saying, “New house, new baby.” A coworker reminded me of this when we moved into This Old House at the end of May 2012. At the time, I thought perhaps she was crazy or, at the very least, oblivious to the absolute chaos surrounding our move. For a reminder, click here, but I will quickly summarize. In 4-6 weeks time:

  • My parents came to visit, which prompted a lot of home projects as a precursor to their arrival.
  • During their visit, nanny had to be terminated after she confessed to repeatedly stealing- get ready for it- vodka from our bar in order to self medicate. She claims she did this after hours, but this is clearly every parent’s worst nightmare.
  • Impulsively purchased a new house and began the whirlwind of home inspections, appraisals and mortgage paperwork that followed during the ten day options period.
  • Frantically prepared our beloved home to put on the market. Sold in less than 2 weeks time.
  • Also frantically searched for a new nanny, a process which took over a month.
  • Packed up entire house, mainly during nap time and the wee hours of the night and, often times, by myself as hubby was out of town on business three times during the month of our move.
  • Moved into new house and promptly began pool/patio renovations. Oh, and it seemed like everything else started to unexpectedly fall apart!

At the end of all this, I collapsed into a heap and DH and I were lucky to still be on speaking terms. It was a VERY stressful time, and procreation was the furthest thing from my mind. That is until, at the end of July 2012, I began to wonder if I might actually be pregnant. I was spotting at the time and had been for several days before my expected period. This was not unusual for me. I have seen multiple doctors through the years for breakthrough bleeding. This spotting went on for five days without turning into a full-blown period and was accompanied by breast tenderness, extreme fatigue and a strange cramping in my uterus. In short, I felt exactly as I had when I was pregnant with J. I hunted through my medicine cabinets for a home pregnancy test, held my breath and peed on the stick. I was struck by the ridiculousness of it all and was about to shove it back in its wrapper when I noticed two pink lines indicating a BFP. At this point, I nearly fell off the toilet. I felt such a rush of emotions.

Oh yes, a baby!

Oh no, what terrible timing!

Oh no, I’m bleeding! I must be having an early miscarriage.

I picked up the phone, dialed the OB-GYN’s office, described my situation and they wanted to see me right away to draw blood for a quantitative HCG blood test. Meanwhile, I scrambled to draw a picture announcement for J to give to DH and cried as I delivered the good/terrifying news.

DearDaddy

My blood work came back positive and my HCG doubled as expected in the first four weeks of pregnancy. However, my progesterone levels were lower than expected, and I was started on progesterone suppositories and scheduled for an ultrasound at week 8. In my case, the suppositories were inserted once daily at night. They were a bit messy and intensified pregnancy symptoms such as breast tenderness, nausea, bloating and night sweats. They did, however, stop the bleeding, and I began to feel more relaxed about this pregnancy. During this- the longest three weeks of my life- the pool/patio renovation continued, and I also flew to New England for my nephew’s first birthday party. I told very few people about my pregnancy due to the bleeding but broke the news to my sister ahead of time in case I needed to seek medical care while home. Unfortunately, the bleeding recurred during the plane ride over, and I spent several days on bed rest hoping for the best. My ultrasound was scheduled within a few days of arriving home, and I was realistic but hopeful.

I had a transvaginal ultrasound, and as soon as the results became visible on the screen, I knew the news was not good. My uterus looked like a big black abyss. There was no comforting heartbeat to be heard. My OB-Gyn politely searched my uterus while questioning me to see if I might be off on my dates. She knew I was not. There was a big black circle indicating a gestational sac, but no squirming bean inside. “I’m sorry,” she said, ” I don’t think it is going to work out this time. Looks like a blighted ovum.” She offered to recheck in a week and go over our other options once we had time to digest the news. I waited for her to leave the room and began to cry. Even though I knew this was wrong from the start, I could not stop the tears from falling.  I sat in the back seat of the car with J while DH called person after person telling them our sad news. I may have managed to croak out a few sentences to my Mom, but didn’t feel like speaking to anyone else.

blightedovum

A blighted ovum, or anembryonic pregnancy, is when a fertilized egg attaches to the uterine wall but the embryo fails to develop. It’s kind of like a house with an open door and all the lights on. You keep ringing the doorbell, but no one is home.  I went off my progesterone supplements and immediately started bleeding. I wish I could say I waited out miscarriage. I usually prefer to do things the natural way. But somehow, waiting felt morbid and disruptive. I had a D&C one week later.  It was a relatively quick procedure. I had some minor pain for a few days, bloating that made me look at least 5 months pregnant and night sweats that forced me to sleep on a towel until my body rid itself of all the pregnancy hormones.  Life went on. I continued to go to work.  I chased after an active toddler.  The only real change I had to make was that I could not go in a swimming pool.  This may not seem very devastating except I spend 50% of my working hours as an aquatic therapist, was accompanying my daughter to water babies swim class 1x/wk, and we had just completed an 8 week pool-patio renovation.  Bah humbug! The day after my D&C, we had friends over  to swim (clearly DH’s idea), and I dipped my toes in the water while covering up my bloated belly the best I could.

I had two very sad days surrounding my miscarriage- the day of my ultrasound and the day of my surgery. I spent most of those two days sleeping. And then, to my surprise, time carried on. It did not have the decency to stand still for me and my tragedy. I was as busy as I ever was. And I coped a little too well.  I did not give myself a whole lot of time to mourn, reflect or relax.  I talked about it, of course, with a few trusted friends and family members, but the rest of the world was unaware of my pregnancy, and now did not seem the time to tell them about it and its demise. I discovered that the subject is awkward and people- including myself- are not sure how to react. There are those who know but choose not to say anything lest it upset you. There are others who check in too often – “How are you feeling?” “Do you need to talk?”- to the point that you want to remind them that you still have a life to live if only they would stop bothering you. Except you don’t because they are just showing concern the only way they know how.  And then there are those who have been through it before.  Those are the best kind of people. They need say no more than, “I know,” and give you a reassuring hug or glance. And you know that they do know and that is the most consoling of all.

Of course, I would be remiss if I forgot to mention the large category of people who say, “Well, at least you know you can get pregnant.” This includes just about everyone. And while extremely annoying and not the least bit comforting, it is the truth. I could get pregnant, and I began to want to try again…

Determined

I must admit, the decision to set forth and procreate made me a little uneasy. What if I wasn’t ready to be a Mom? What if I was no good at it? I’m a planner by nature and wanted all the details to be perfect. I needed a little push, and it went something like this:

DH (a little over a year into our marriage): Hey, when are we going to have kids?

Me: I don’t know. Do you think we are ready yet?

DH: I don’t think we’ll ever be ready. Might as well bite the bullet.

And so, in January of 2009 we began trying to conceive- abbreviated TTC from here on out. Also, in case you were wondering, DH refers to “Dear Husband.” I’ve discovered that one must quickly learn a new code language when TTC.  Not sure if its tantamount to being in a special club or if all the extra friendlies leave little time for anything else, including full pronunciation of vocabulary. Anyways, I promise to keep you up to speed.

DH and I went on a ski trip to France in February of 2009 and had romantic notions of conceiving while on vacation. After all, vacation extra friendlies are quite extraordinary, don’t you think? Sadly, when we returned to the States,  I joined the Bump and discovered this thing called an ovulation calculator. The calculator tends to assume that all women have set cycle lengths with ovulation occurring smack dab in the middle. This is not exactly true, but still a good tool  for beginners or those who don’t have too much trouble TTC. The ovulation calculator told me that my fertile window actually took place when we arrived back in the US and DH had the flu. It was only our first month of trying, but already,  I felt the pang of missed opportunity.

By the second and third month, I had the ovulation calculator down pat, and had somewhat customized it to my own cycle. I was able to feel ovulation pain, called mittelschmerz, so felt like my body was on the right track. My period, referred to in the TTC world as AF (Aunt Flo), came every 28 days like clockwork. I had read that it is best to have extra friendlies, a.k.a. BD (the Big Deed), every other day during your fertile days. Naturally, this was exactly what we did. In retrospect, I approached it like an important job- which it definitely was- while sacrificing the usual romance. This determination is not unique to me. I had other friends who were TTC, and we were all completely baffled as to why our respective DHs were not always on board with this schedule. Is this not every man’s dream? Or is it really the chase?

By the forth month, at DH’s suggestion, I resorted to peeing on ovulation detection tests. These track your LH surge. Luteinizing Hormone, or LH, is what triggers the ripening egg to mature and break through the follicle leading to ovulation. This surge is detected 24-36 hours prior to ovulation and helps pinpoint the two most important days on which to BD. We were sure this was going to work!

By month 5, I consulted with a coworker, who I knew had also been struggling to conceive, and she helped me to begin charting. I purchased a basal thermometer, which you stick in your mouth at the very moment of waking, all the while trying not to make too much movement so as to accurately capture your lowest daily body temperature (BBT). It is the most accurate way to detect ovulation, as the BBT will rise on the day following ovulation and then drop off when AF arrives. I charted for a total of 6 months. I will hold off on going into the craziness that this caused me. It is a topic for a whole other blog post. Given how type A I am, I can guarantee that my charts were perfect and full of encouraging pregnancy signs until my period inevitably arrived 28 days later.

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By month 8, I visited my OB-GYN, who assured me that I would get pregnant, and it was too early to panic. I was feeling really discouraged at this point, and didn’t really have anyone to talk to about it. It is one of those things people don’t tend to discuss. Just the fact that you are TTC is TMI. DH was encouraging, but did not share my worry, and I was starting to feel very lonely in all this. By months 10-12, I slowly started to open up about it  and discovered a whole secret club of gals struggling to conceive. They did not simply tell me to relax and let it happen. They acknowledged my fears, shared with me their insight, and I was eternally grateful for the company. While, on the inside, I wept as friend after friend got pregnant with no problem, I really rallied for the girls in my club and rejoiced at their successes. It gave me hope.

On month 12, I revisited the OB-GYN who was no longer lighthearted about my lack of success. She ordered a hystersalpingogram (HSG),which is an X-ray in which they insert a catheter into your uterus and inject saline with dye in order to visualize your fallopian tubes. The radiology tech thought my uterus was locked down tighter than Fort Knox. After much trying and a lot of pain on my end, she was successful in inserting the catheter.   My fallopian tubes looked flawless.  With a negative HSG, I was started on a first round of Clomid on cycles day 5-9 and referred out to a reproductive endocrinologist (RE).  Clomid is a fertility drug which stimulates the ovaries in order to induce ovulation in those who don’t ovulate naturally or to enhance maturation of the follicles in those that do. There is a small chance of multiples, as it may encourage more than one egg to be released during a cycle. The Clomid gave me hot flashes and made me want to rip DH’s head off. I did not like it one bit, and it did not result in success, so I was a little bitter about the whole experience.

By month 14, I made it in to see the reproductive endocrinologist. He was charming and cocky and made fast friends with my DH. They talked baseball and business until I tapped my fingers on the desk and reminded them that the fate of my fertility lie in their hands. DH was sent for a semen analysis, and we both were put on an antibiotic Z-pack just in case.  As we were at least $1000 out of pocket at this point with no clear diagnosis, we held off on scheduling my follow-up with the RE until after my next AF.

Except, it never arrived! At month 15, I actually waited a whole five days until after it was due to discover that glorious + sign known as the BFP or Big Fat Positive.  My hands were trembling while I presented DH with a card and envelope containing the test. Except, I made the mistake of presenting it to him while he was working from home and had to wait an agonizing ten minutes before he opened it.

We held our breaths for nine weeks, suffered through two incidences of bleeding, and then finally saw our beautiful bean, beating heartbeat and all. At 37 wks, our perfect angel arrived, and all was forgotten. My unexplained infertility seemed a minute detail on the road to parenthood. Stress? First baby jitters? Who cares. I was a Mom and never happier.

 

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Changed

Recent events in my life have led me to this decision to blog about a personal matter.  You might say, why Nicole, you blog about personal matters all the time. You blog about your home, your daughter’s birthday-for goodness sake, you blogged about your septic. Who does that?

While discussing your bathroom habits (and publicizing it to all your Facebook friends) does demonstrate a certain lack of modesty, what I want to talk about is more heartfelt. I’d like to share my experience with infertility.  Before I begin, I feel like I have to issue a disclaimer. I feel that, because I do have a beautiful, amazing daughter, I have to tell you that my case is really not all that bad or uncommon. I have known women who have tried for 10+ years before having a baby.  Some, after much grief, give up this dream and never have a  child to call their own. I have known several women who have lost their babies late in their pregnancies, one who opted to carry hers to nearly full-term. Others are afflicted by heartbreaking repeat miscarriages never to discover why they could conceive but not carry.

I feel like I have to tell you how blessed I am, and that I have no right to complain. Yet, what I really want to say to you- those who are going through it like me- is that you have all the right in the world to feel however you want to feel. If you want to wallow in a box of Kleenex – Gray’s Anatomy style- please do so. If you want to kick and scream and loudly announce your anger at the injustice, be my guest. If you want to lie in bed forever, I wouldn’t blame you. Each person’s experience is their own.  Who am I to judge? Just know I’m rooting for you to get back up because YOU want to.

I know my experience has changed me. I can’t say with certainty for the better or the worse. I do know that part is entirely within my control. So I am taking a first step towards making it something positive by announcing my intention to share what I have learned.  I am somewhat of an expert on the crazy and not so crazy things you can do to boost your pregnancy chances. That is useful to any couple with baby fever. And for those of you who are trying and getting frustrated or dealing with a pregnancy loss, sometimes it is just nice to know there’s someone else in the same boat.

I hope you will bear with me on this journey, however long it takes.

Thanks,

Nicole

Gravida 3, Para 1

Nicole Austin, TX

This Old House: Say Hello To My Little Friends

I apologize in advance to my Mom for posting this as I know she is already hesitant to visit us in our new house after listening to all my stories about the critters I have encountered. Sorry Mom, details and photographic evidence are about to follow.

Amazingly, when we moved to our new house last summer, we only moved about 3 miles down the road. I am amazed mainly because those 3 short miles mark the difference between southwest suburbia and the outskirts of the hill country. I often feared I had taken a wrong turn and was headed straight to the boonies due to the change in topography and the fact that there seemed to be a lot of horses grazing in open fields. Since when did I live in the country?

On the first few trips to the new house, we encountered several deer, a fox and a road runner. All were completely unaware of how out of place they seemed in the hip, urban live music capital of the world. Hmmmm. Let’s say hello to a few of my little friends.

Striped Bark Scorpion

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This ugly creature was my first uninvited houseguest.  The movers pointed out a dead one as they were unloading our boxes, and it immediately struck fear in my heart. I dismissed it as a fluke- probably snuck in with all the activity of the previous owners moving out and us moving in. The very next day, our nanny ran into a live one in the kitchen and so it began. Apparently, the striped bark scorpion is a relatively common unwanted pest in areas of Austin abundant with trees and wild life. It is not dangerous like its cousin the Arizona bark scorpion, but as my husband can attest, delivers a powerful sting more uncomfortable than that of a bee sting. It is best treated with a paste of meat tenderizer and baking soda, and the pain typically passes in 15-20 min. Small children who are stung should be taken to the ER according to my pediatrician.  There may be residual numbness or tingling over the next 24-48 hrs.

I am on a mission to completely annihilate them from my home through a combination of pest control, natural remedies and fortification of all potential entry points.  I could easily dedicate a whole post to talking about this. They freak me out that much. Yuck! Here’s a picture I snapped of a dead one outside our garage a few days after a pest control treatment. Another one bites the dust.

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Texas Brown Tarantula

photo-12I was unloading groceries from the car when I ran into this not so little spider outside the garage. I quickly scooped up my child and closed the garage door as I would absolutely spend the night in a hotel if I thought this fella was on the loose inside the house. Apparently, I was overreacting a little bit as these tarantulas are quite docile and in the rare case that they do bite, it is not normally harmful to humans. Around here, people take care of them by scooping them up in a cup and gently depositing them back in nature. I plead the 5th as to whether or not this is what I did. Momma Bear tends to be overprotective of her young.

Texas White-Tailed Deer 

photo-15In Austin, deer are regarded as pests. That is because they can take down your landscape overnight and have a habit of wandering into the middle of the street without a care in the world. There were deer in our old neighborhood, although I never saw one in the vicinity of our house. I did, however, hit one on my way home from HEB. It was quite a surprise being in a commercial area, and I did not see him coming as he was racing uphill and did not make it into my periphery until too late. Fortunately for both of us, I was not traveling very fast and he rolled across my hood and went on his merry way. Both the deer and my car sustained minor damages. The deer here are tiny compared to deer up north. The drought leaves them looking emaciated at times and I thought the deer I hit was a greyhound dog at first glance.

We have a family of 8-10 deer in our new neighborhood. They do not speed up to cross the road when they see a car coming. You have to stop and patiently wait for them to get a clue. The male buck hisses at me when I shoo him out of the yard at night and shut the gate. We have planted mainly deer-resistant plants, but they have made it impossible for my knock out roses to get a fair start in life.  Once, we were awoken by an awful animal cry and ran outdoors to see a neighbor’s dog attempting to hunt a deer in our yard. Life is never dull in the woods.

Greater Roadrunner

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My favorite new friend is the roadrunner. I have seen several in the neighborhood and love to watch them run across the street or lawn. I was also surprised to see that they can fly and also scale our fence and run along it. J is as fond of them as I am. She is too young to know of the roadrunner cartoon character yet, but is readily amused by the real thing. As a bonus, they eat scorpions. Perhaps I should domesticate one? Our nanny snapped this picture of this bold little guy hanging out on the patio.

Gray Fox

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Another of my favorites is this beautiful creature. Dean discovered three of them hanging out by my garden boxes one morning. They surprised him and scared the dickens out of my nanny who kept J inside for the remainder of the day. A little research on google revealed that they are fairly harmless to people and were probably more interested in my compost pile than my vegetables. They resemble a dog but move like a cat. I had the pleasure of watching two play out in the back yard one day. One was chasing the other and they were running and leaping quite fast. All of a sudden one magically appeared on the other side of the wrought iron fence around the pool. Before I could fathom how that happened, I saw the second do the same thing and realized that they could make themselves skinny enough to run between the slats. Amazing! They seem unfazed by our presence, watching us cautiously but going about their business as if they own the place. I have yet to snap a picture of our foxes but found this one on the Visit Wimberley website.

Eastern Cottontail

eastern_cottontailWith the help of this little cutie, we were able to prove to J that the Easter Bunny is indeed always watching to see if she is being a good little girl. He was a frequent visitor to the yard for a while. I was a bit concerned after seeing the foxes. However, he has resurfaced unharmed since that time. We have had a creature digging shallow holes in our yard for some time. I was putting the blame on this guy, but have since learned that they do not dig their own burrows or dig for roots and bulbs. They are a pest in my neighbor’s garden but seem to leave my raised beds alone- even the carrots 🙂

Rio Grande Wild Turkey

turkeyNot to be outdone by my parents and grandparents in NH, we too have turkeys. Upon moving in, I kept waking up in the middle of the night hearing a strange sound. It sounded like the gobble, gobble of a turkey but I had no idea they were abundant in Texas. I thought perhaps I was crazy until I later spotted at least 40 turkeys hanging out in the open park in our development. I was unable to get a close up shot but if you squint you might be able to make them out roosting in the grass. Predators include our friend the gray fox, raccoons, rat snakes, feral hogs (more on those next) and bobcats. Perhaps we will not have to travel as far as Whole Foods to get a 20 lb turkey this year? Kidding!

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Wild Hogs

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While I have certainly not seen on of these creatures wandering around in my development, I did recently see a rather large one keeled over on the side of the road- presumedly hit by a car. In retelling the story to a patient, he said that wild hogs are terrorizing some neighborhoods as relayed in this Smithsonion article A Plague of Pigs in Texas.  The state of Texas estimates that wild hogs cause $200 in property damage per hog per year and have issued a bounty of $2 per kill. I certainly hope this is not my backyard digger. They are nocturnal. The holes we found, while plentiful, were pretty shallow, so my money is still on an armadillo. Either way, just the sight of one so close to home brings new meaning to The Other White Meat.

Armadillo

800px-Nine-banded_ArmadilloThese creatures are nocturnal, so I have yet to see one live in person. I have seen plenty as roadkill. They love to dig small holes in peoples lawns as they root for bugs and grubs. I think he is likely our little digger.  I just need to catch him in action. Some good tips on dealing with armadillo problems are found here.

Those are all my little friends at the moment. Have yet to run into a snake (aside from a garter snake here and there), but would not be surprised to come across a rattlesnake or coral snake some day soon. Yikes!