Just the Two of Us...For now...

Caution: TMI ahead. I have been reflecting on some past experiences lately. This is not a new thing obviously but the other night, all of these old feelings came rushing back. I was 9 days late this month. I usually have 30-32 day cycles but for some reason I occasionally will have an extra long cycle lasting around 45 days. We have not been actively "trying" simply because...well...it can be exhausting and emotional. Last month, however, I knew I was ovulating when we...ahem...baby danced and a little part of my brain thought, maybe.

Fast forward the two weeks after ovulation and no period. So, I took a pregnancy test just for kicks. Michael asked what I was doing and I told him, treating it kind of like a joke. I knew it would be negative...I really did but there was a part of me that couldn't help but be a little hopeful. Of course, it was negative and I was a little sad...really, only a little.

At that moment I was so grateful for being in the place we are. No more monthly breakdowns, no more staying in bed for two days, no more resenting pregnant women, no more wondering. Wondering why I wasn't pregnant, wondering what as wrong with us, wondering if it will ever happen.

As I reflect on the past, I realize how much support I have had from strangers.  Right when we officially started trying, I stumbled upon a discussion board on http://www.webmd.com/ only because it is the only website I have access to at work.  It was there that I found women who were going through the same trials and emotions I was.  It was, and still is an incredible support system.  We did not want to tell people at first that we were trying to have a baby and this was a way to talk about it without having to talk to family, friends, etc.  There are women on there that I have "known" for over 18 months now.  There is also a website that a friend suggested, http://www.2ofus4now.org/ .  It is an LDS infertilty website that offers support to LDS couples experiencing infertility.  Not to sound dramatic but I really don't know how I would have gotten through the last 18 months, particularly the first ten, without them.  There's a great article on there by Ardeth B. Kapp entitled "Just the Two of Us--For Now".  She was never able to have children and I have to admit when I first read it, I was not in a good place.  I rejected it completely, sobbing.  I have recently gone back and re-read it and the woman is incredible.  There was a particular piece that struck me:

"If I have any comforting message for you, it is this—Peace of mind comes from keeping an eternal perspective. Motherhood, I believe, is a foreordained mission. For some, this glorious blessing may be delayed, but it will not be denied. Motherhood is an eternal reality for all women who live righteously and accept the teachings of the gospel.

On the other hand, the characteristics of motherhood, which include concern for others, sacrifice, service, compassion, teaching, encouraging, and inspiring can be the noble labor for each one of us now, with or without children. The fate of each spirit in the eternities to come depends so much on the training it receives from those here and now who are willing to help another gain eternal life.

To participate in this glorious work gives meaning and purpose, great joy, and eternal blessings each and every day, even as we anticipate the promises of the future.

If you don’t think that will be enough comfort, let me close with this thought by President Brigham Young:

“Let me here say a word to console the feelings … of all who belong to this Church. Many of the sisters grieve because they are not blessed with offspring. You will see the time when you will have millions of children around you. If you are faithful to your covenants, you will be mothers of nations. … and when you have assisted in peopling one earth, there are millions of earths still in the course of creation. And when they have endured a thousand million times longer than this earth, it is only as it were the beginning of your creations. Be faithful, and if you are not blest with children in this time, you will be hereafter.” (InJournal of Discourses, 8:208.)

What beautiful and comforting words...I don't think I need to say anymore.

Alice in Fertileland

 I found this really funny story on an infertilty website.  It pretty much sums up my 'top ten list', humorously.  It's long but enjoy...

Alice In Fertileland

Once upon a time there was a woman named Alice. She was happily married to a guy named Fred. Alice and Fred really wanted to have children, but somehow it just wasn't working for them.

One day Alice realized Aunt Flo was a few days late with her monthly visit, so she got really excited. 'Maybe,' she thought, 'I'm finally pregnant!'

Alice dashed to the drugstore across the street. She looked for the pregnancy test with the most promises of accurate results, and then quickly returned to her house. When she opened the box, she realized there was just no way she would accurately be able to pee on that little stick, so she got a plastic cup out of the counter, then headed for the bathroom. After filling up the cup, she anxiously dipped the stick into the fluid for the required length of time. Then she lay the stick flat on the counter, and anxiously watched to see the telltale lines. As they slowly began to appear, she was elated to see that yes! She was pregnant!!!

Alice did the happy dance, and then headed for the phone to call Fred. Fred was excited, and immediately rushed home from work. They called both sets of parents, and all their brothers and sisters to share the good news.

The next morning, Alice woke up an hour before the alarm clock went off. She had a crampy feeling. When she went to the bathroom, she was horrified to see the telltale red stain that always indicated Aunt Flo's arrival. She began to cry, and couldn't calm down.

Alice called the doctor's office as soon as they opened. 'I took a pregnancy test last night, and it was positive. But I started bleeding this morning.' They made her take another pregnancy test, and then ushered her into the room to wait.

The doctor came into the room and said, 'Our results show that the pregnancy test was negative.' When Alice began to cry, he turned around and walked out. 'I'll send a nurse in to talk to you,' he called over his shoulder.

Alice left that doctor's office and never went back.

When Fred got home that night, he hugged Alice and tried to soothe her. Then they had to call both sets of parents and all their brothers and sisters to tell them they weren't pregnant after all.

Alice was so depressed that she felt she was living in a black hole where no sunlight could penetrate. One night, she had a dream.

She dreamed that she went to a strange place called Fertileland. In Fertileland, there were lots and lots of children and babies. She smiled to see their chubby faces. But when she held out her arms, they looked at her blankly.

'You're not my mommy,' one angelic cherub told her, before he scampered off.

She followed him, tears streaming down her face. He smiled impishly at her, before running through a door and slamming it shut in her very face!

Alice determined to go after him, but the door only came up to her knees. She looked around the room anxiously, and saw a mysterious bottle. There was a tag hanging from the bottle. 'Drink Me.'

Alice had been taught NEVER to drink anything without reading the list of ingredients, and there were no ingredients on this bottle. So she knew she shouldn't drink it.

But then a beautiful woman walked by. She was about 7 months pregnant, and her skin glowed with health. She smiled at Alice.

'Oh, please, ma'am, won't you tell me how you were able to get pregnant? I haven't been able to, and it's just killing me!' Alice said pleadingly.

The woman picked up the bottle. 'I don't know, my dear. It's just something in the water here, I guess.'

Alice snatched the bottle and drank it quickly. Then she sat down to wait.

Nothing happened.

After Alice had sat there for 14 days, Aunt Flo appeared. 'Follow me, my child.'

Alice followed Aunt Flo into a room full of pregnant women. She would have rushed out, but Aunt Flo gently caught her by the arm. 'Wait a moment, my dear. These women have something to share with you.'

A beautiful woman who was about 5 months pregnant stood up and welcomed everyone. Alice wondered what 'Personal, Home, and Family Enrichment meeting' meant. She quickly learned. It meant that all the women were talking about the children they had, the children they were pregnant with, and the children they were going to have in the future.

Alice sat there, clenching her jaw and trying not to cry. Then when the discussions were over, refreshments were served. Remembering the counsel of the first woman, who said that something in the water was making them pregnant, Alice eagerly drank a glass of a very peculiar pink punch.

Aunt Flo shook her head. 'It's not in the water, dearie. But why don't you try that cookie over there?'

Alice followed Aunt Flo's pointing finger, and picked up a cookie that had 'Eat me' written in pink frosting on top. Noticing all the other women were eagerly partaking, Alice ate the cookie.

Then she sat down on the floor. Aunt Flo waved a cheery bye-bye as she headed out the door.

Alice sat there for 28 days. And then Aunt Flo came back.

When Alice saw her face, her own face crumpled up and she began to sob. She lay on the floor and cried and cried and cried and cried. Pretty soon, there was so much salt water in the room that it began to fill up like an ocean. But Alice just kept crying. Then she started kicking and pounding her fists, and she swam away.

The current carried her to a beautiful green shore. She stood up and dried her tears, and then started walking. As she was headed towards a grove of trees, she saw a baby wearing nothing but a top hat and diapers. He held a pocket watch in his hand, and kept saying, 'I'm late! I'm late!'

Alice followed the baby to a tiny cozy little cabin in the grove of trees. As the baby went in, a beautiful woman who had been sitting by the hearth weeping jumped up and clapped her hands for joy.

'At last! My angel child, I have been waiting for you for such a long time!' The woman hugged the baby and rocked him to sleep.

'How long have you been waiting for him?' Alice asked timidly.

'Oh, a terribly long time. At least twelve months!' the woman said.

'But I've been waiting for five years!' Alice wailed.

The woman shook her head severely at Alice. 'You don't belong here in Fertileland, then.'

Alice knelt down by the woman's skirt, and held it in both hands. 'Please tell me how to have a baby,' she said.

The woman's frown smoothed out. 'If you do everything I tell you, you will get pregnant. Will you promise to follow my advice?'

'I promise! I promise!' Alice was eager to hear the secrets to fertility.

'Well, first of all, you have to relax about it. If you stop trying to have children, and just enjoy having sex with your husband for fun, it will happen.'

Alice raised a skeptical eyebrow.

The woman continued. 'Secondly, when you're in the sack with hubby, make sure you put a pillow under your hips. You know, gravity really helps!'

Alice raised two skeptical eyebrows.

'And I heard that if you and your husband will both take some liquid Geritol, that will really get the juices flowing.'

Alice stood up and started walking for the door.

The woman's voice wafted out after her. 'And don't forget the horny goat weed!'

Alice stopped and turned around. 'Horny goat weed?'

'Yes, I saw something about it on the news last night. It will make you and your hubby want to have sex a lot more often. And you know, the more you have sex, the easier it will be to get pregnant.'

Alice snorted in disgust and walked away.

The woman's voice softly faded out. 'In fact, why don't you two just quit your jobs and have sex all day long? Even if you don't get pregnant, you'll sure have a good time.'

Alice followed a curious path that looked like it went to an interesting place. When she was part way down the path, she saw a curious sight. There was a 3 year old toddler, with sunny golden curls, sitting on top of a giant mushroom.

'Who are you?' the child asked.

'My name is Alice.'

'Where are your children?'

'I don't have any children.'

The child stood up and raised itself to its full height. 'Then you must leave Fertileland!'

'But I don't want to leave Fertileland! I want to have children!'

The child sat back down. 'That's different, then.'

'But I don't know how. My husband and I have tried and tried and tried, and nothing's worked for us.'

The child smirked. 'Then I suggest you quit trying. Do it the easy way. Adopt.'

'Adopting is easy? That's not what I've heard.'

'Oh, sure, it's easy. You don't have to have a swollen stomach, your boobs don't hurt, no morning sickness. Just wham, bam, here's you're baby, ma'am.'

'What does a 3-year-old know about boobs?' Alice asked distractedly. 'And where do I go sign up for adoption?'

'I know plenty about boobs! My mother breast-fed me for two years,' the baby said haughtily. 'And if you want to adopt, you need to go see the Office of Officials. Keep following this path. You'll see it.'

Alice skipped down the path. Perhaps she was going to go sign up and get a baby today!

She saw a building ahead in the distance. As she got closer, she saw a large sign in front. 'Office of Officials.' She opened the door and walked inside.

There, behind a long counter, was the strangest looking man she had ever seen. He had long, prehensile fingers with which he was constantly pushing buttons on an old-fashioned adding machine. He wore a hat made of blotting paper. His soft cravat was floppily and loosely tied, and was covered with ink splotches. He looked at Alice. 'Yes, yes, can't waste time. What do you want?'

'I want to adopt a baby,' she said.

'Yes, yes, must fill out forms.' He rushed from one cubbyhole to another, grabbing papers. He finally lay down a 3-foot high stack of papers. 'Fill out forms, in triplicate, hurry hurry, mustn't waste time.'

Alice took the papers and sat down and started filling out forms. She filled out forms for hours and hours and hours and hours and hours, while the Official Officer punched buttons on the adding machine.

She finally finished with the forms, and took them back to the counter. 'Here are the forms,' she said. 'When may I have my baby, please?'

'Oh, not for at least 5 years,' the man told her. 'Have to review forms, have to do home study, have to have complete medical background, have to talk to your neighbors, have to fill out more forms.'

'Five years?' Alice gasped. 'But, in five years, I'll be 40!'

The man stopped punching buttons on the adding machine and gave her a dirty look. 'Forty? That's too old to adopt.' He picked up her stack of forms and started feeding them through a shredder. He was muttering under his breath. 'Selfish people, wasting my time, make me shred forms when they're too old to adopt.'

'But couldn't you just process things faster?' Alice said pleadingly. 'Then I wouldn't be forty.'

'No, no, must follow official procedures. Mustn't waste my time. Leave now. Good bye. Thank you. Come again.'

Alice began to cry as she walked out the door. She wandered aimlessly through Fertileland. She didn't talk to very many people, but they all said something to her.

'Maybe you're just not meant to have children,' one person said.

'Maybe God has a different path in store for you.'

'There must be something wrong with you. Because I never had any trouble getting pregnant. Did you do anything bad in your life? Maybe God's punishing you.'

'Oh, be glad you don't have children. It's just changing diapers and feeding them and cleaning up their nasty messes.'

'I wish I hadn't had children yet. It would be nice to have time to spend with just my husband and myself.'

In despair, Alice tried to leave Fertileland, but she couldn't get away. She was encircled by 20 pregnant women, bellies bulging, all telling her something different. They pressed in on her, drawing closer and closer, until finally she began to scream.

'Honey, what's wrong?' Fred was soothing her. 'You had a nightmare. You'll be okay.'

Alice got up and went to the bathroom to wipe her brow, that was beaded with sweat. 'Yes, a nightmare. That's all it was. A nightmare.'

Then she saw Aunt Flo. 'No, dearie, it's not a nightmare. You'll never wake up!' Aunt Flo cackled triumphantly as Alice ran screaming down the street.

The End?

Death and Taxes...

Ugh, taxes.  Do I need to say more?  I got a phone call from Michael while sitting in the JFK airport about to board an airplane to come home.  I was sad to leave but so excited to return home to my hard working hubby. The phone call was about our taxes.  You can probably guess where this is going.

Let me preface by saying money is very much on the forefront of our minds these days for obvious reasons.  We have tightened our purse strings, count every penny, and are constantly looking for opportunities to make or save more money.  Let me also say, I'm a planner.  I like to plan for the future and consider every possible scenario and option.  So, naturally I have mapped out how much money we could possibly save between now and the time we are ready to do our IVF.  Sparing boring details, I figured out between extra jobs, money already saved and our sure fire TAX RETURN we would be pretty close to having all $13,000.

The phone call was obviously not good news.  He finally had news about our tax return that I had been bugging him about for weeks.  I was excited...was it $2000...possibly more?  We had conservatively guessed that it would be at least $2000.  We received $1600 the year before and now we own a house and paid an insane amount of interest on it last year.  We have been told owning a home makes a huge difference when it comes to tax returns.  No, it wasn't $2000.  It was quite the opposite.  We OWE $1700!  What?  How did this happen?

Mostly my fault for not closely paying attention to my pay stubs but IHC failed to take out the right amount of taxes last year.  I claim ONE deduction and they only took out $175 in federal taxes!  Yes, I know my paychecks would have been a lot less if they had been taking out the correct amount but it just didn't occur to me that my checks were too big.  My mom could not understand why I was so upset and began to lecture me about how taxes work.  Yes, I know that if you do not pay enough in the year, you will owe and if you pay too much, they give money back.  She further tried to explain that there is no difference, I had larger paychecks so the money we have in savings wouldn't have been there if they had been taking the correct amount of taxes out.  Wrong.  Had I known they weren't taking enough out, maybe, we would have saved the money but I didn't.

Sparing more details of mine and my mom's argument here is the bottom line.  We were counting on that money to help reach our $13000 goal.  No, the money that is in our saving account is not from saving excess money that should have gone to taxes, it's been given to us mostly as gifts and from odd little reimbursements. To us, we feel that not only are we not getting the $2000 we were counting on but we also have to take $1700 from the little savings that we do have already.  So to us, it's like being down $3700.  I'm getting teary-eyed just thinking about it again.  We have been working so hard and we were going to be close.  It is so disheartening to know now we may not even have half of what we need, when need it.

Michael's second job has been a huge blessing to us.  We would never even have half if it weren't for his willingness to take care of his family.  It's a huge sacrifice he is making and we agreed that no matter what, we would not use that money for anything else.  Such is life.  We sometimes feel like there is one force working against us and one with us.  For every trial that we have faced regarding this, there always seems to be a blessing.  We pray that we will be able to recover from this and will continue to work toward our goal.

Caution: Science Ahead...

We get asked a lot about the process of IVF/ICSI and other fertility treatments and I guess I am not surprised that most people have no clue how involved, how expensive, and how emotionally draining it all can be.  I had no clue two years ago either, I was like everyone else.  Most people just say, "great...so when do you start that?"  No, no.  It's not that simple, at all.

First, you need the money.  I have mentioned this before but I will write another post about politics and insurance later.  Once you figure out how to pay for it, the other half of the battle is the actual process...

To understand the nuts and bolts of IVF, it helps to have a quick refresher of the ideal menstrual cycle. Cycle day one (CD 1) is always considered the first day of full flow. This is followed by several more days of bleeding as the lining of the womb (endometrium) is shed in the presence of low estrogen and progesterone levels.
The brain is able to sense the level of estrogen is low, and in response a hormone called FSH (follicle stimulating hormone) is secreted, causing several egg follicles in the ovaries to begin to grow and make estrogen. As the estrogen rises, the FSH falls and the follicles compete for the decreasing amount of FSH until only the strongest follicle is left.

This dominant follicle is ovulated at midcycle when it produces so much estrogen that it triggers the brain to send a large surge of LH (lutenising hormone). Once the egg has been released, the follicle becomes a corpus luteum and secretes progesterone (a hormone important in preparing the endometrium for a baby and supporting pregnancy, hence pro-gesterone).

The brain continues to send LH signals to keep the corpus luteum functioning until around 14 days post ovulation. If there is no pregnancy, then at this point the LH is withdrawn, the corpus luteum breaks down, estrogen and progesterone fall and the endometrium begins to shed. If pregnancy DOES occur, the HCG from the early embryo acts to keep the corpus luteum producing progesterone until the placenta is able to take over.

• Down-regulation

Down-regulation is the first phase of a standard IVF cycle. It involves, usually, several weeks on the oral contraceptive pill to both prevent ovulation and control timing of the cycle. In the last week to two weeks of the time on the pill a drug of a type known as GNRH agonists will also be taken. Common examples of these drugs are Lucrin/Lupron and Synarel. Lupron is an injectible medication whereas Synarel is sniffed and they have different dosing frequencies per day, but the net effect is the same. They both cause the brain to release all it's FSH and LH stores and keep them depleted so that premature ovulation does not occur and stimulation can be precisely controlled. Without down-regulation, as you can see from the previous paragraph, there would be a risk of premature LH surge and ovulation (a bad thing in IVF) since IVF creates more egg follicles than the normal number and consequently higher estrogen levels.

• Stimulation, a.k.a the dreaded needles. They're really not so bad. I have already practiced on myself while in lab for nursing school.  Many are subcutaneous, especially with the more modern drugs and come in fancy injection pens.

In the stimulation phase, the Lupron or Synarel continues to be taken daily, in order to prevent premature ovulation. At the same time, artificial versions of FSH are injected in order to stimulate the ovaries to make more eggs than usual. This dose can be adjusted based upon the results of blood tests and ultrasound scans during this phase of treatment to make sure enough follicles are going to continue with IVF but not so many that the woman is at risk of a problem known as OHSS (ovarian hyperstimulation syndrome). The average duration of this phase is 10-14 days. At the end of the stimulation phase, ovulation is artificially triggered using an injection of HCG (this can substitute for the natural LH surge because HCG and LH have similar structures and the same actions on the ovary). Because the timing of the trigger before retrieval is critical so that A: mature eggs are harvested, but B: are not ovulated and lost, it is important to follow your clinic's instructions precisely. The standard timing is to give the shot around 36 hours before retrieval.

• Retrieval

This is the part of the process that involves a minor surgery, usually carried out under sedation. Using ultrasound guidance, a needle is passed through the walls of the vagina and into the adjacent ovary. Each follicle is aspirated, and the eggs are sorted out from the fluid by the embryologist. The whole process takes about half an hour. The eggs will then be mixed with the man's sperm, or injected into each egg with ICSI.

• Transfer

Whether you have a day 2, day 3 or day 5 transfer largely depends on your country of residence, local protocols and is also influenced by the number and quality of embryos you have. As a rough guide, embryos should have about 4 cells on day two, 8 on day three and be a blastocyst by day 5. Pregnancy rates are higher for day 5 embryos than day 2 embryos as they are more likely to be genetically normal.

The transfer process itself is much like a pap smear, with a very fine catheter containing the embryo(s) threaded through the cervix and into the uterus. The embryos cannot fall out after transfer as they are tiny and settle into the endometrium.

• Luteal support

Since there has been a down-regulation phase, the body will (if left to it's own devices) fail to support any potential pregnancy because there is little or no LH to stimulate the ovaries to make progesterone. Therefore, progesterone is given after transfer in one of several forms (via pessary into the vagina or via injection into the muscles of the buttock) until a blood pregnancy test is carried out around two weeks after transfer.  Most doctors will want to continue progesterone until the end of the first trimester.

• Blood pregnancy test.

Piece of cake if you've cheated and peed-on-a-stick and got a positive result. Horrid if you know you're not pregnant.  This usually happens one week after transfer.

• ICSI

ICSI is just like IVF except for some minor details (and a few more bucks of course).  It is a treatment for more serious male factor infertility where either very low sperm count, sperm motility or sperm shape/morphology (and sometimes all three) are present in a man and normal fertilization of an egg unlikely or impossible, even in an IVF setting. It involves the manual selection of a single sperm by micropipette and injection directly into a harvested egg. Before ICSI there was very little treatment that could be offered to couples with severe male factor other than donor sperm or adoption.   Men with very low sperm counts do still occasionally father a spontaneous pregnancy, but the rate is much lower than in couples where the man has a normal sperm count. ICSI greatly increases those odds.

"The Things to Talk to Michael About List"...

We are three weeks into Michael's new job and it's a lot harder than we thought it was going to be.  I'm not sure what I thought it was going to be like, him working 60 hours a week, but I definitely didn't expect to have to write a "things to talk to Michael about list" on my Blackberry.  It's a list of notes I jot down when I need to tell him something but we can't talk.  We are pretty busy as it is and I guess I never realized how much of our relationship is spent on the phone.  We spend over 5000 minutes a month checking-up on each other throughout the day but with his second job, he can't be on the phone so we rarely talk to each other after 3pm.  Then, I arrive home at midnight and he is sound asleep. It's hard.  I can never remember what I have and haven't told him and I just plain miss him everday. The other night, I was fortunate enough to get off work a couple of hours early and we arrived home at the same time and plopped down on the couch together, exhausted.  We stared at each other for a few seconds and the conversation went like this...

Me: This is weird.
Michael:  I know, what should we talk about?
Me:  Hold on, my list is on my Blackberry...oh yeah, I have to tell you about the IVF refund program, we need to look at Hondas, my parents are coming this weekend....
(Michael puts his hand up and abruptly cuts me off)
Michael:  Umm, sorry, could you just email me? 

I have to say I am very grateful for Saturdays...the one day we have together and I am very grateful for a husband who is sacrificing all of his time to help his family.