Tuesday, February 27, 2007

Prerequisite: Infertility

I’m sure I’m being spectacularly unfair, but I’ve decided that nurses who have no experience with IF should not be allowed to work at IF clinics. Here’s why: If they have never gone through what we're going through, they just. don’t. get. it.

For those of you keeping score at home, yesterday, I spoke with the clueless nurse who showed zero understanding for the fact that not scheduling me for a 3 minute meeting this week with my RE would mean delaying treatment for an entire month. I was, needless to say, ticked. And, the more I thought about it, the more angry I got. She was just plain rude. Not only did she not even attempt to fit me in, but she acted like I was putting them out for even asking.

Because I was so angry, I ended the phone call without asking what, exactly, I was supposed to do this month. RE had initially given me a prescription for 2 months of Clo*mid. With the new lining data, did he expect me to continue with that? (I doubt it.) So, I called my “care team” (ha, ha) and left a message saying, “I’m sorry, I forgot to ask: since I can’t meet with doc this month, what exactly am I supposed to do once AF rears her ugly head?”

Magically, I got a message today from the receptionist saying they were able to “squeeze me in” at 4pm tomorrow.

It turns out that when the receptionist and nurse actually talked to the doctor, he said that of course he wanted to talk to me quickly before he went away.

Aha!

Now, do you believe for a second that a nurse who had gone through IF on her own would ever have been so dismissive without ever having talked to the doc? It seems to me that those of us who have been on this roller coaster would have at least said, “oh, you have a question about what to do next, and are closing in on the end of your cycle. Let me talk to the doctor to see what he wants to do, and I’ll get back to you.” Instead, my highly fertile* nurse dismissed me and only talked to the doc when she realized I wasn’t going away.

This pisses me off. I shouldn’t have to call so many times to get what should be clear guidance about what our next steps are.

What’s worse, this isn’t the first time clueless nurse has been so, well, clueless. After my last blood draw, she called me with the results. “Your progesterone level shows that you ovulated,” she said.

“Um, I know I ovulate. We established that months ago. Doc wanted to check my progesterone to make sure it was high enough at the right point in my cycle to sustain a pregnancy.”

“Oh. Usually we check progesterone to confirm ovulation.”

“Yes, well, we were looking for different information this time.”

No response.

During that call, I finally gave up and just asked the doc next time I met with him. But this is getting ridiculous. She clearly doesn’t want to bother talking to the doc if she can avoid it. Argh.

So, the good news is that I am meeting with the doc tomorrow before he leaves, which makes me feel a little better. But, now I have to worry that the nurses are all conspiring against me for being a pain in the ass. Win some, lose some.

*I happen to know that she’s highly fertile, since she told me on our first visit to the RE. Nice.

Monday, February 26, 2007

Enjoy your vacation, d*&$!

So, I tried to schedule a follow-up meeting with our RE. See, my lining responded quite pitifully to Cl*omid, and all of the doctors I met during this round of observation and IUI said that I would most likely have to move on to injectibles, since my endometrium doesn't seem to like the pills. So, I tried to make a follow-up, and the earliest they can take me is March 14. So, I kindly explained to the receptionist that by March 14, I'd be well into my next cycle, and it will be far too late for me to begin injectibles. She said, "well, he's going away, and only sees patients on Wednesdays and Thursdays, so I don't think there is anything we can do. Do you want to leave a message for your nurse?"

Yes.

So, my nurse calls back and says he's booked solid and they can't fit me in. I explain the situation, and she says, "have you started your period yet?"

"No, but I will in 2 days--after Doc leaves for vacation, so I was hoping to meet with him beforehand so at least we could get started with the next protocol without delaying a whole month." (Why didn't I just say yes?!?)

"Well, you can't start anything until you get your period."

"Yes, I realize that. I wouldn't want to jeopardize anything in the highly unlikely event that my pathetic uterus actually grabbed hold of an embryo this month. But, if I wait until I get my period, the doctor will be gone on his three-week vacation, and it will be too late to do anything this month."

"Well, injectibles will be the most likely next step, but you have to meet with the doctor."

"Yes. I KNOW THIS. THAT'S WHY I'M CALLING!"

"But he's booked solid..."

Who's on first?!?!

Is it me? I mean, everybody, including the clueless nurse seems to recognize that I should be moving on to injectibles this cycle. But NOBODY else can make the call, and they won't even schedule me for the 30 second meeting where the doctor can officially say, "yes, your lining is pathetic. Here's a prescription. See you in two weeks."

I'm so frustrated right now. Skipping my next cycle just seems cruel. Next month is the last month that a 2007 baby is a possibility. And, while I know in the grand scheme of things the difference between a December 07 and January 08 baby is probably very small, for an infertile who has been on this roller coaster for far too long, I need to hang onto to whatever ounce of hope I can. Plus, there just must be a better way to do this. This can't be the only time this happens--that a doctor is away at a crucial time in a woman's cycle. There are other doctors, why can't they make the call? In a field where 2 days can make the difference between forward motion and stagnation, and when it feels like there is SO much riding on every month, you'd think they'd have a back up plan. Particularly for a doc who only sees patients twice a week and is going to be away for three weeks in the interim.

This is so fucking frustrating.

Thursday, February 22, 2007

Catch-22

So, it's been a while since I've gone off on one of my feminist tirades. The last one was around our miscarriage last April. As I was going through it, I was trying to do research to learn more about what I might experience. And, I was amazed at how little real research there was out there. Even on major medical websites, etc. They lumped all miscarriage together, as if they're all the same. As if losing your baby at 19 weeks is the same (physically) as losing your baby at 5. It just made me so angry. Here is something that happens to--stats vary--a third or more of all pregnancies, and I couldn't find much outside of personal narratives about what I could expect. (And, I'm so grateful for those personal narratives, but so many of them were so scary that I was really hoping to read them alongside some medical stats, info, etc.) It just made me angry that women around the world were left to deal with this--often silently, and mostly on their own.

My latest feminist tirade is about the guilt I feel over trying to have a baby and thinking about taking a promotion at work. I was talking to my brother last night, and he basically said, "that sounds great, I would jump on it if I were you, etc. But, if you're thinking of having kids in the next two years, you probably have to put that on hold." He wasn't trying to be sexist, he was trying to be realistic. He said, "I'm sure by taking this, your bosses are assuming that you're not planning to have kids immediately."

Now, I'm not mad at my brother. He wasn't afraid to say what I and many others around me have been dancing around. That many women really do need to choose between career and family at some point. That sometimes it's damn near impossible to balance the two. And, that it might not be realistic for me to think I can "have it all" right now.

And that makes me furious. Last year, another colleague took the same job that I'm thinking of taking. His wife was pregnant, and he had a baby the first year in the job. And nobody blinked an eye. In fact, everybody celebrated what a family man he was, and how great it was that he was trying to work out a balance with the kids.

And, that just seems so unfair. I just DO NOT believe that the 6 weeks of maternity leave is the only reason for the double standard. Because, even if I were able to plan my pregnancy (ha, ha) to take maternity leave at a "convenient" time, I do feel a tremendous amount of pressure. I mean, obviously they won't (they can't) say anything. If I get pregnant, they'll just have to deal with it. But, I'm under no delusions that I won't have the disapproving looks.

And, what's worse, I think as a woman you get it from both sides. As many people as there are at work who aren't psyched about a woman trying to take a high-powered job while having small children, there are an equal number who think that women who deign to work outside the home that many hours a day aren't doing right by their kids.

It really feels like a catch-22. One that men simply do not have to deal with. With a wife and kids, a man turns from toxic bachelor to "family man" who gets the keys to the executive washroom. A woman becomes suspect. I'm 31, and have been married for 3 years. And, people I work with aren't even subtle about trying to figure out what our deal with kids is and what I am going to do about it. (No one wonders aloud about what hubby will do.) In fact, 31, schmirty-one, in my interview for my very first job out of college a decade ago, my employer asked me: "Do you have a boyfriend? Because I've lost too many young women to marriage and kids." !!!

I mean, I know we've come a long way, but I really feel like we've got a long way to go. Before I was born, Gloria Steinem once said something along the lines of, we know we'll have reached gender equality when men are asked how they are going to balance career with parenthood. To true...

Tuesday, February 20, 2007

Work/life balance

So, I’ve been really thinking a lot about this issue of work/life balance, and I really don’t know how high-powered moms do it. I know that’s a cliché, but really: How do they do it? Do they not sleep? Because god knows I need my sleep! Do they never see their kids? Do their husbands pick up the slack at home? I literally can’t wrap my mind around how this is all going to work, and it’s scaring me because, if I can’t find an answer, I don’t see how I can take this new position.

Essentially, the new position would routinely require 11-14 hour days away from home. (My job now requires that much, but I have more flexibility about where I do a lot of the work.) Sure, the vacations would be better—I’d get just over 7 weeks off each year—but 12 hour days. That leaves only another 12 hours for everything else: sleeping, eating, hubby, kids, dog.* That’s crazy, isn’t it? How would I manage it? I mean, I know people do it, but how?

And, now that we’ve been struggling with IF, would I just feel unbelievably guilty all the time? Like, oh, we worked oh-so-hard to have kids, then I desert them for 48% of our waking hours?** How can I justify it?

But, on the other hand, how can I not do it? I’ve worked so hard for so long, and I know what getting off the treadmill means. It means that my career will suffer, forever really. Yes, yes, I know we’ve made all kinds of feminist strides, bla, bla, bla. But, I’m a realist. I know what it means to slow your career down for family. It means—to just about all employers—that you made a choice to prioritize family over career. And, while they “admire” your choice, it means that you’re no longer the one they look to for promotions, big decisions, senior leadership, etc. It’s the dirty little secret that I feel like we all sweep under the rug because we don’t know what to do about it. There just doesn’t seem to be any solution. At the top, when you’re working 60-80 hours per week, you have to pick something that gets the short end of the stick. There just aren’t enough hours in the day/week.

So, am I really prepared for the family consequences of choosing career?

But, on the other hand, am I prepared for the career consequences of choosing family? I mean, I know I’ll work either way, but will my Type-A ass really be content watching other people get promoted over me and watching my career stagnate…even for a while?

Argh! How are we supposed to make these choices?!

* assuming we can ever actually have kids…
**and that’s assuming I only sleep 6 hours every night. (Yes, I did the math. I'm a geek.)

Monday, February 19, 2007

How do you make God laugh?

One of my favorite B-grade films is the 1995 "Kicking and Screaming." (Not the horrible 2005 movie about soccer, which I haven't actually seen, but can only assume is decidedly unfunny.) The movie follows a small group of college friends from graduation night through the year after college. It's a mid-90s Gen-X comedy/drama. At its core, though, the film is about the general malaise you feel when you're in an "in-between" time in life.

In the movie, the characters are caught somewhere between college, which they can't quite escape, and the "real world," which they can't/don't want to embrace. While that's certainly not where I am right now, I can't help but relate to their "we're just waiting for 'real life' to begin" angst. Even though I want to move on to the next phase in our life, I can't. (Literally.) And, because we can't, we don't know what to do.

I really feel caught.

Thankfully, Hubby's being great. He will be supportive either way, but is basically saying, "let's not try to plan around this anymore. Do what's right for your career. We'll make the family thing work whenever it does happen."

He's right, of course. Which brings me back to my favorite quote from "Kicking and Screaming." When talking to the main character, Grover, who is wondering what the "right" next move is for him in his relationship, Chet (the 10th-year-senior/bartender who has no aspirations beyond what he's doing right now) asks, "How do you make God laugh? ... Make a plan."

Of course, I see Chet's wisdom. And yet, I'm way too type A to really let go. I play and replay every scenario in my head. What if I take the more time consuming/less flexible job and we get pregnant at exactly the wrong time and it really screws things up? What if I don't take the job and it takes us another year or, god forbid longer, to even get pregnant.

So, what to do? I'm sure we'll wait until we get the results from this IUI cycle before I commit one way or another...which is silly, really, because even if the answer weren't as clear as day already (which I think it is), it doesn't make the decision any easier. Knowing myself, I'm going to take it. I'm 31, and don't think I'm ready to make a decision to put the brakes on my career (a little bit) because it would be easier.

Of course, would I feel different if I was pregnant?

And so it goes...

Saturday, February 17, 2007

IUI day 2

We went back to the dr this morning for IUI#2. Hubby's sperm count and motility actually improved since yesterday. Both days he had a count >100 million and yesterday 90% motility, today 95% motility.

Hubby is quite proud. Men are funny. I don't really understand why they feel such pride around sperm count issues. He was practically beaming. What a funny source of pride, no? I mean, my body created a perfectly sized follicle and I didn't find myself wanting to do an ovulation end-zone dance. (Go you sexy egg!)

So, we'll see what happened. The doctor essentially tried to forbid me from taking a pregnancy test for 14 days, which of course made me laugh. She's right, of course. Since I had an hcg shot, there is absolutely no point in taking a test sooner than 2 weeks. But, if it were that easy, F*irst Re*sponse stock would be doing a lot worse than it is. I guess what will make it a little easier this month is that my lining issues have mean that I don't have too much of a reason to be optimistic. So, instead, hubby and I are already planning our next move....

Friday, February 16, 2007

IUI neophyte

So, I got a call on Thursday afternoon. It was the fertility clinic giving me my "instructions," which were:

1. Between 5pm and 9pm give myself the Hcg shot
2. Come in for IUI #1 on Friday morning at 7am
3. Come in for IUI#3 on Saturday morning.

"But, I already had a positive OPK, do I still need to give myself the shot?"

"Yes."

"Should I be concerned that I'm ovulating earlier than we wanted?"

"No."

"And, the doctor this morning told me that my lining was essentially too thin to support a viable pregnancy. Should I be concerned about that?"

"No. It's a little thinner than we'd like."

Um. Great. Thanks, you've been a huge help.

So, I followed my instructions carefully and went in for the first IUI this morning. But, I have to admit that I couldn't help but think how futile it was to get hubby and me up so super early in the morning to do this when things don't look too great this month. And, since my insurance only covers four rounds of IUI, it feels weird to have what seems like nothing more than a "throw away" cycle. (Wow. I sound really pessimistic, huh?) But, I certainly didn't want to be the one to cancel. If there's any hope, I want to move forward.

I talked to the doctor this morning. (I should mention that I see a different doctor with just about every different procedure I have to do, so it's actually not the case that I keep having the same exact conversation with the same person over and over again. Of course, I can't say that I'm overly excited about seeing a million different doctors. It's a little strange--especially when they give slightly different answers to similar questions. But, I digress.)

So, I asked this guy what he thought of my lining, and he also agreed that it didn't look great, and that next cycle we may very well want to move on to injectibles. I'm not taking it as an overly positive sign that all of the doctor's I've talked to are already talking about what our next course of action will be.

Of course, as an added bonus for hubby, his swimmers looked awesome. Go little guys. Although, I have to admit to feeling a little less than adequate that I can't seem to provide them with a more hospitable environment to do their thing. Helas...

On a semi-unrelated note, there is a potential advancement opportunity for me at work and I can't decide what to do. On the one hand, I have a lot of flexibility in my current job that I'd be giving that up with the new position. On the other hand, I think if I want a more senior leadership position, I need to move on. Of course, that brings up what I suspect is a very typical dilemma for an infertile: do I give up flexibility for career, when I'm really hoping to be pregnant/have a kid soon? On the other hand, as an infertile, hubby and I are getting pretty f'ing tired of "planning" around the possibility that we might someday be pregnant. Especially since, in our wildest dreams, we never thought we'd not have a kid by now, let alone not even be pregnant.

So, there you have it. I'm faced with a lot to ponder this fine weekend: how to balance career and family. Infertility. And how to balance infertility with abstract notions of career advancements and family. And, how they all intersect to make one very confused woman.

Thursday, February 15, 2007

There’s nothing like a transvaginal ultrasound at 7:30am to start your day…

So, I finished my first round of Clo*mid last night, and it looks like this cycle may indeed be the resounding flop we all knew it could be. Here’s why:

This is how this cycle was supposed to work:
1. Take Clo*mid CD5-CD9
2. Get an early morning scan/blood draw on CD10
3. See a few lively fully grown little follicles
4. Give myself HcG shot to trigger ovulation
5. IUI the next day
6. See what happens.

And, here’s how this cycle is actually working…
1. Take Clo*mid CD5-CD9
2. Randomly take an OPK test on CD10 and have it come back positive
3. Go in for my early morning scan and see at least one fully grown little follicle
4. Tell the Dr. about the + OPK
5. Dr. asks if we got it on yesterday (we did—for fun. That’ll teach us. Stupid Valentine’s Day.)
6. They don’t like to do IUI the day after s*ex
7. We have to wait an extra day for the IUI, which is less than ideal
8. Oh, and my endometrial lining is a pitiful 5.8mm. (They like to see 8mm.)

Aces.

So, here’s an open letter to my RE, and all REs, really:

Dear Smug RE:

The next time you’re going to put an early ovulator on fertility medications, please give her much more guidance about when and how frequently she and hubby should get it on before the to-be-scheduled IUI. Otherwise, you risk wasting another entire month, which really defeats the purpose of going on the damn fertility drugs to begin with, don’t you think?

Also, please turn the heat up in the transvaginal ultrasound room. It's not as pleasant as you might think to be naked from the waist down in a freezing cold room just before having a freezing cold wand (which, as far as I could tell, had ice cubes attached to the tip) inserted in a very delicate area. Especially when it’s 14 degrees outside.

Thanks,
StickyBun
_______________________________________

Update…

So, I’m now waiting for my doc’s office to call me back. I have no idea what they’ll say; whether we’ll go through the IUI this month or not. I have been obsessively googling “endometrial thickness at ovulation” this morning, and have found some sobering, if unsurprising statistics. I’ll spare you all of the particulars and will sum up:

-- The chances of getting pregnant when the endometrium is <6mm at the LH surge is just about zero.

Awesome.

So, for those of you keeping score at home:

-- 85% of couples will conceive after 1 year of unprotected intercourse. We’re in the unlucky 15%.
-- 15% of women on clo*mid will have a thin endometrial lining while on the drug. Jackpot #2! (Thin is considered anything less than 7.5-8mm. To recap, I am 5..8.)

So, of the 15% of women who are infertile who then go on to use Clo*mid, I’m in the 15% of women who have a thin endometrium. And, of the miniscule 15% of women who have a thin endometrium on Clo*mid, I’m in the even smaller percent of women who’s endometrium is so thin that I basically can’t possibly get pregnant.

With luck like this, it’s a wonder I’ve never been struck by lightning.

Monday, February 12, 2007

Hoping for a snowy Valentine's Day!

So, I've been putting off doing mid-year reviews for my team because my boss was supposed to investigate an age-discrimination complaint from one of my teammates. Well, the long and short of it is that, my boss tried to talk to him, but the guy refused. I happen to think he's playing a crafty game of cat and mouse, and wants me to do the evaluation before he goes forward with the claim so that, when I give him a mediocre review, he can blame age discrimination. But, I'm also slightly paranoid. (Although, as they say, just because you're paranoid...)

In any case, I think my time is just about running out, and I'm just going to have to suck it up and get it over with. And, I am NOT looking forward to it. It's going to be awful. And frustrating. I hate confrontation as it is, but particularly with people who are looking for ways that you're trying to screw them (whether you are or not).

argh...

In other news, I've decided to do clomid+IUI this month. I hope to be one of those "I got pregnant my first month on clomid" people. But, since I haven't been that lucky yet in terms of my fertility, I'm not holding fast to hope. Time will tell...The good news is that, because we're doing IUI, we don't have to schedule s*ex the way we have for quite some time now. So, I'm looking forward to a nice, relaxing Valentine's Day. In fact we're supposed to get a ton of snow, so I'm hoping to get to stay home from work in my sweats and drink lots of hot chocolate with the hubby. I know that doesn't sound romantic...but to me, that sounds like the best damn V-day ever. :-)

Thursday, February 08, 2007

Choices...

So, I met with the RE today, and it seems that I have three choices:
  1. do nothing for one more month and hope for a post-HSG burst of fertility
  2. clomid + get it on
  3. clomid + IUI
Hmmm….so much to ponder. I think I’ve all but completely ruled out choice #2—I’m an all or nothing gal, I guess. That and it just seems to me that if we’re going to go for the Clomid, we might as well go all out with the IUI, especially since one of the side effects of Clomid is to make CM much less fertile. So, at least the IUI would sidestep that landmine entirely. As an added bonus, we could have a virtually stress-free sex life for a month. I like that idea, given how scheduled we’ve gotten.

So, I go back and fort between #1 and #3, but I guess right now I’m leaning towards #3. As much as I did *not* want to have to do something artificial to get pregnant, c’est la vie. Here we are. A year post miscarriage with no child in sight. And, I don’t really feel that another month is going to do anything. (Although, I do have to admit to having that—wouldn’t it be funny if we got pregnant right before we were going to start IUI/Clomid—feeling. Of course, I had that this month, too, and we all see how that worked out.)

Hubby wasn’t able to come to the appointment with me today, so we won’t make the call until tonight, but I suspect that he’s leaning toward the same option. It feels like the more positive of the choices—and it’s the choice that would give me the feeling that we had some control over all this….and, I miss that feeling.

Tuesday, February 06, 2007

CD1...again

Pass the beer nuts...

Thursday, February 01, 2007

hope...

"Hope? Let me tell you something, my friend. Hope is a dangerous thing. Hope can drive a man insane. It's got no use on the inside. You'd better get used to that idea."
-- The Shawshank Redemption

Once you get in the habit of reading multiple infertility blogs, you begin to see themes and patterns. I think that’s why it’s so reassuring for someone going through IF to read infertility blogs—because it’s comforting to know that you’re not the only one going through what you’re going through, and feeling what you’re feeling. It’s comforting to be able to hear someone say—and mean—“I totally know how you feel!”

And, because I've been lurking around IF blogs for a while now, I've read my fair share of posts that deal with the issue of "hope" and infertility. No matter how many battle scars you bear, no matter how long you’ve been at this, every now and again hope rears her ugly head. I suppose that’s why we haven’t given up yet; and I suspect that when hope leaves the reservation for good is when most of us will throw in the towel. Until then, though, we all have this unhappy push-pull with hope. We curse ourselves for being so naïve as to let her in, but let her in we do. We think, “maybe this month…maybe because I’ve been trying for so long, or maybe because I’m least expecting it, or maybe because it’s just about my time in the sun.” Of course, while it’s hope that keeps us trekking along on this journey, she’s also what makes it so unbearable when AF rears her ugly head every month. It’s not like we weren’t expecting her, it’s just that we *hoped* she wouldn’t come.

This month, I'm just under a week away from d-day and I can already feel hope eeking her way in. I can feel myself starting to think, "hmm...my breasts are sore, and just maybe I will be one of those people that gets a lucky burst of fertility the month of her HSG..." On the other hand, I have gotten more cynical than ever lately...Time will tell, I suppose.

In other news, my younger sister-in-law had a miscarriage on Monday. I could not feel more awful for her. While I was certainly having a hard time dealing with our infertility faced with two sister-in-law pregnancies, I would NEVER ever wish this on anyone. She was so excited to be pregnant, and I know she and her husband are going to be wonderful parents. Nobody should have to deal with miscarriage and infertility. Nobody. It's just so unfair.