Sunday, 29 September 2013

We remain true to who we are...

Whenever we inform anyone that both Husband and I are only children, we always receive the same response: "...interesting..." It is often held that only children are incompatible mates, but after sixteen years together, I've noticed that we were raised quite differently and we each exert our only-childness in individual ways. Perhaps it's a gender issue between raising a boy or a girl. Perhaps it's generational as Husband's parents are 12-15 years older than mine. Perhaps it's cultural between growing up in England or the States. It's just very different...

Husband's parents were in their very late 30s when he was born and he became the centre of their world. They were of modest means and he wasn't spoilt with material things, but they doted on him and practically waiting on him hand and foot his entire life. If he wanted a snack or a cup of tea, they'd fulfill the request at the snap of a finger. If a particular item of clothing needed to cleaned, his mum would run the machine right away. He could leave dirty plates next to the sink with the knowledge that his parents would do his washing. It has taken me years to break him out of this mold, and one of the reasons why it is so hard to visit with his parents, is that I am forced to watch him regress.

In contrast, I showed up in my parents' lives a day and a month after my father's 30th birthday and when my mum was only 27. They were the first of their friends to have a child and as they once explained to me; "We weren't going to be one of those couples whose lives revolved around their baby. We integrated you into our life." My parents continued to travel and visit with their friends and at a early age, I learned how to entertain myself. That was the first of my lessons on self-sufficiency. When I was 6 or 7, I started packing my own school lunches. At age 10, I was doing my own laundry and by age 12, it was my responsibility to mow the lawn and clean my bathroom. As a result, I've always appreciated the motto, 'if you want something done right, do it yourself!' To my own detriment, I don't like to delegate any tasks, even when I should.

Husband's parents arrived on a Monday afternoon. When I can, I'll go into work early in the morning, as I find I'm much more focused during this time. By the end of the day, I'm mentally exhausted and I struggle to complete my charting and other tasks. Not that night. I was in the zone; whipping through my notes and working through my results. I looked over at the clock. 7 PM. I needed to face reality: I was avoiding going home.

I texted Husband and offer to pick up some take-out on my way home. "No. Just come home." he replied. As soon as I got in, he announced that we would go pick up dinner. I clearly saw his motives; he wanted to stop for a beer while waiting for the food and he wanted to get even with me for arriving late. As soon as he closed the door, my house was filled with an awkward silence. I was listening to cars pass down my road, hoping each one was his.

My parents arrived two days later. They're a welcome buffer, but the contrast between his parents and mine emphasizes the awkwardness of the situation. Husband is very close with my Dad and the two can talk endlessly about baseball, DIY projects, beer, grilling...just about anything. My mother simply adores Husband. The four of us will engage in conversations while his parents quietly observe. You have to invite them to offer any dialogue, which is usually a single sentence containing a few words.

Nonetheless, we were anxious to have my parents serve as our 'wingmen' and we were disappointed to learn they had other plans. In the two days before we were to depart for Hawaii, my parents booked up their time with my aunt (my father's sister) and my cousin. Husband was especially upset as he was assigned to umpire a very competitive collegiate field hockey match (which was being televised on ESPN-7) and he really wanted his parents and mine to watch him. Despite explaining that we would be spending a week with my parents and that my Dad has limited time to visit with his sister and niece, Husband was still sulking. "This is my day" he whined "It's supposed to be all about me..." Thus confirming he's still the little boy who needs to be the centre of attention.

Meanwhile, I had the day off, although I went into to the office very early in the morning to wrap up some loose ends before going away for a week. On the rare occasion when I have a day off, I always try to swim with the noon group as a treat for myself. This day would be no exception. I arranged with Husband that I would drive his parents to the game when I came back from swimming, as he had to arrive at the field an hour before the start time. When we were both ready to leave, we realised we didn't have anything to offer his parents for lunch beyond leftovers.

Guilt consumed me as I drove to the pool. I'm selfish. I'm a bad daughter-in-law. I'm a bad hostess. I should have taken my in-laws out to lunch en route to the game. Despite acknowledging these feelings, I proceeded to my swim class (perhaps my coach sensed my guilt issues, as she delivered a rather punishing workout). I ducked out of practice early, but felt that the remaining sprinting sets would have been less painful than the upcoming car ride.

As I drove back home, I noted that although Husband and I are successful, confident reasonably well-adjusted people; we are flawed. He's an attention whore and I'm self-centred. As it is our strict intention to only have one child, what traits will we be passing on to him or her? Would I be too much my like my parents and raise a child who is distantly independent? Or after waiting so long for the opportunity, would be be more like his parents who place their child on a pedestal? How can we correlate the strongest aspects of our upbringing and mitigate the weaker ones?

My in-laws were literally waiting at the front door, ready to leave when I returned from swimming. I left the car unlocked and they packed the folding chairs into the boot while I changed out of my swimming gear. When I walked out to the driveway, they were both sitting in the back seat. That just says it all. I pointed out a few landmarks, but the drive was essentially in silence. Guilt ... eased.

Thursday, 26 September 2013

No Assumptions

I think each of us can share a story about a time we decided to open up about our infertility and found a kindred spirit experiencing similar issues. A few months ago, I was reminded once again that it is wise not to make any assumptions.

My mother is the oldest of three girls and my father is the much youngest of his siblings (there are nine years between him and his sister). So in addition to the isolation from being an only child, I'm six plus years younger than my paternal cousins, and 4 years old than the next grandchild on the maternal side. When we visited with my father's family, I was referred to as 'Baby Jane', while the youngest of my maternal cousins called me 'Aunt Jane' as I was taller than their mothers and other aunts.

When I was growing up, we probably only got together with my maternal cousins once or twice a year, and when we were younger my female cousin and I could easily play together. As we both grew older, we found that we had less in common. Oh, I'll just say it ... she was a band geek. We're talking Michelle from American Pie, "...this one band camp..." although I don't want to think about what she may have been doing with her clarinet. She was a member of her high school's state championship winning marching band and played in her University's pep band for her undergraduate plus graduate years. If there is a hell, and I end up there ... playing in a marching band will be one of my punishments.

When my Dad and I were driving my car cross country in 2007, we stayed with my aunt and uncle (my cousin and her brother were in their mid-twenties and were still living at home) for a few days. During our last night, my cousin started to open up to me a little. She mentioned she had been on a few dates with some who was pretty interesting, but her biggest hang up about him was that he had the same name as her brother. Two years later she married him. Late in 2010, I received a text from her, "Hi. I know this is awkward since we don't really talk, but I don't know who else to contact." Her period was two weeks late and she had a very faint positive pregnancy test. Unfortunately, she had just started a new job and didn't have insurance benefits yet. As she works as an ER nurse, she was able to get some beta quants drawn, which revealed she had a chemical pregnancy. It meant a lot that she felt comfortable reaching out of me, and I stressed that my door would always be open.

A year later, when I removed my IUD and was getting ready to start the procreation process, I took note that I hadn't heard a pregnancy announcement from her. She contacted me in May of 2012, as they were vacationing in the Bay Area and wanted to try to get together. It was the first time we assembled on our own, apart from a family gathering with our mothers or grandparents. Oddly, her younger brother was accompanying her and her husband on their vacation, which made it hard to get her alone to talk privately. Shortly after that holiday, I noticed that my cousin and her brother each had the same picture of the siblings as their Facebook profiles. I though it was unusual, but as Husband and I are only children, it could have been something I just didn't understand.

Earlier this year, I happened to be in the city where my cousin lives and I called her up to see if she was available to get together for a drink. It was the first time the two of us ever convened on our own. I thought about addressing fertility issues by saying something like, "hey, are you two having any difficulty conceiving? Us too!" Yet, it never really felt right to introduce that topic, so I didn't broach it.

A few months ago, I received an email from my mother:

Rachel and Ross have separated, will be getting divorced.
Sent from my iPad

I wasn't completely surprised, I thought there was something telling within her Facebook profile. Yet, I must also admit that I didn't quite see it coming. Looking back at our last conversation, she didn't say anything that indicated she was having marital problems; but actually, I don't think she mentioned her husband much at all. My Dad later informed me that they went through couples counseling, but once they agreed to divorce, she felt as if a weight were lifted and she could breathe again. I'm glad I didn't bring up the topic of having children. One of the other reasons for non-procreation other than infertility and deciding to be child-free, is relationship troubles. A good reminder to respect privacy surrounding sensitive issues, even if you suspect you're in familiar territory .

Monday, 23 September 2013

Out and Proud

I know it's an odd headline; as I haven't disclosed anything even to my own parents, I'm probably the most closeted infertile. I don't have the super vagina to be as out and proud as Aramis. (Brilliant observation from the great Betty White: "Why do people suggest that you need to grow balls when they want you to act tough? Testicles are soft and delicate. You want to be tough? Grow a vagina -those things can take a pounding!") While I'm not there yet, I'm made some strides in being a little more open about our infertility.

In the beginning, it was only Husband, Co-worker, my colleague who removed my IUD and I who knew our intentions. As I tend to be a rather quiet and private person, it was fitting with my nature. Only out of necessity, I brought my colleague's medical assistant into the loop. I needed her as an ally in order to maintain my discretion. Husband and I met with a genetic counsellor and did carrier screening before we started trying (oh, we had all the gear and no idea...) and I had her scan and then shred my results. However, she became a little too involved. She would often ask when my cycle was due and would try to figure out "when we should test" and then suggested a date that was way too early. I had to politely inform her that I appreciated her interest, but not her participation.

I've been trying to limit my disclosures to those who are on a need to know basis, as well as a few close friends and fellow infertility sisters. I had my first opportunity to try coming out when I attended an annual meeting for a professional association earlier this year. One of my former clinical instructors also attends and each year I get asked the same question:
"So Jane, ... any kids yet?"
This year I had an answer he wasn't expecting.
"No. We're infertile and I miscarried about six months ago."
"Aww Jane ... Jeeez!" Just in case I had missed the irony, he added, "and you're in OB aren't you?
...and I don't think he'll ask that question again next year! Being out and proud has some rewards.

Husband has also taken steps to create his support next work. He informed his parents, his best (local) mate, and a few hockey umpire friends. I had almost forgotten that he had disclosed to his best English mate, until Raj approached me at a quiet moment during the Arkansas weekend to ask how things were going. I don't remember too much of the conversation, as I was a bit tipsy; but I recall he was really supportive and wished us well without issuing any empty promises. Actually, as we later ended up doing cartwheels in the bar; 'a bit tipsy' is probably an understatement.

We had nearly made it through that weekend without anyone asking about our procreation intentions, until Robin approached the subject on the morning when we were all departing. I thought about giving the short and simple answers, "maybe" or "not just yet". I'm not that close with Robin as we've only met a few times and we don't have that much in common. So I'm not sure quite why, but I decided to share our entire story. I finished by informing her that we would be starting IVF next month. "Well, sometimes it can take up to a year. Sometimes you just have to stop thinking about it so much..." she offered.

Hand-slap to forehead. Ah yes, this is the reason why you don't discuss your infertility with others. The unsolicited opinions and advice. Had I not learned my lesson from dealing with Myrtle? It was astonishing to me that after informing her of the issues encountered during our two year plight, she thinks more time is all we need. Why are some in denial of infertility? It seems akin to describing that a gay relative "just hasn't met the right girl yet". There isn't anything wrong; conception just hasn't happened for you yet. Depending on the time frame, that is the definition of infertility. Even when you have an identifiable factor, others are still convinced there is a magic formula yet to be employed that will lead to a spontaneous pregnancy. I can only imagine how difficult it is for couples with unexplained infertility to describe their situation.

Sigh. This is the disadvantage of being out and proud. The burden of educating others. I dispelled the notions about needing to 'relax' and 'stop trying so hard', which she may actually accept because of my professional credentials. I decided to take things one step further, and I pulled up my post that was inspired by the father-daughter dance at her wedding. I'm not sure if I violated any rule by sharing the IF blogging world with a non-TTCer, but when she handed my phone back to me with tears in her eyes, I felt that I had succeeded in enlightening her about infertility.

A week and a half later, it was Husband's birthday. In addition to the calls, texts and facebook posts, he received this email from his friend Leonard: 'Happy birthday. You're nearing 40 mate, time to think about decorating the nursery'. Oh, a double Bozinga! Referencing his advancing age and worth less child-free status! Such is the argument for being out and proud. It may avoid insensitive comments from unsuspecting friends. His message was especially annoying as it took Leonard and his wife Penny over a year to conceive their first son. I used to send her copies of the quarterly publication Conceive, as almost none of the patients in the waiting room in my clinic seemed to be having any difficulties. Leonard later noted that Penny was irritated each time she received a copy in the post, not that she didn't appreciate them or find some helpful information. It just always reminded her why I was sending them to her. I can really appreciate that now. Unlike Leonard, who can no longer appreciate being in that situation. I guess, like my cousin, they figure that having a surprise spontaneous conception revokes their infertile status and induces an amnesia for their experience.

I've not thought about how I would reveal our infertility struggles if I were to become pregnant; as I'm not allowing myself to entertain such thoughts. If we come up empty, I've considered creating an infertility announcement card. Perhaps the front would have a picture of the two of us and the inscription would read:
We've been through all the procedures and tests,
and can truly say we've tried our best
Alas, a family of three,
Was not meant to be...

Recently, Co-worker came in to the office for her 6 week postpartum check, twins in tow. After fawning over the babies, Michael Scott asked her, "So, did you get cleared so you and [her husband] can start doing it again?" I should mention here that Michael Scott has a very inappropriate crush on Co-worker's husband and she was disgustingly flirtatious with him when he accompanied Co-worker for her visits. Co-worker just pointed to her double pram and replied "Um, that's how we got into this mess in the first place!"

I turned back to my computer screen and carried on typing. I don't want to judge any fellow infertile and I would never begrudge her for hiding something so private from such a nosy busybody like Michael Scott. Yet, my mind flashed back to one of the final scenes from the movie Flight where Denzel Washington was telling his story to fellow inmates at a prison Alcoholics Anonymous meeting.

"That was it. I was finished. I was done. It was as if I had reached my lifelong limit of lies. I could not tell one more lie. And maybe I'm a sucker. Because if I had told just one more lie, I could've walked away from all that mess and kept my wings, kept my false sense of pride. "

Someday I will be out, and I will always be proud.

Friday, 20 September 2013

Cringing in Silence

As I walked into the break room to refill my water bottle one morning, two medical assistants were chatting about where they take their dogs to be groomed. One I have already introduced.  Betty confided to Co-worker that she failed to conceive on her own, and by the time she went to an RE, she had a depleted ovarian reserve. It took her a long time even to acknowledge Co-worker's pregnancy and she revealed that even years after embracing her child-free status, she still found baby showers and other children-related events difficult to attend. When I joined the practice nearly five years ago, a few staffers revealed that Veronica was trying to conceive. Two years later, she disclosed to me that she failed to ovulate with 100 mg of Clomid and she decided not to pursue any further treatments. Her husband had a teenaged daughter from a previous relationship, and she had accepted her role as a step-mother. A year ago, she approached me and asked for an IUD, noting that she'd be pissed if she became pregnant at this time. I could appreciate her desires and understood that it was a painful process to arrive at that place.

Michael Scott, the office busybody, walked in the room and started listening to their conversation. "You spend how much on your dogs?" she gasped (as if she didn't engage in any frivolous purchases ahem, purses!) "That's ridiculous" she criticised. Betty was quick to react, "My dogs are my children!" she exclaimed as Veronica nodded in agreement. Michael Scott just rolled her eyes, "No they're not. You should have had real babies."

I nearly dropped my water bottle. While I would never actually resort to violence; on any given day, I could fantasize about hitting Michael Scott. Now I was imagining myself putting my weight behind my punch. I'm pretty sure Co-worker is the only one who knows about Betty's infertility history, but Michael Scott certainly knew about Veronica's story.

Her words stung like a slap in the face. They may not have been directed toward me, but I felt their effects. Such is the solidarity of infertility. Make an insensitive comment to one of my sisters and you hurt us all. I wanted to speak up. I wanted to say something to put Michael Scott in her place. Alas, I cannot. To do so would expose their skeletons as well as mine. Members of this sorority vow to honour each other's secrets. Such is the solitude of infertility. Alas, I'm cringing in silence.

Wednesday, 18 September 2013

Numbers and Figures

As we were wrapping our initial REI consult last July, my RE commented, "I think you have a good chance with IVF." "Forty percent" he estimated off the top of his head. I wasn't quite prepared to hear that we would need to consider IVF at that moment, let alone to comprehend that a forty percent success rate would be accepted as 'good'. I couldn't think of any other situation in medicine, or in life for that matter, where a higher failure rate is satisfying. It truly reflects the unique and precarious nature of infertility. "So, that means there is a sixty percent chance that IVF will not work..." I immediately countered. "Well Jane, that depends if you see the glass as being half full or half empty..." He replied, sounding a bit like my mother. "No. That all depends if you are drinking or pouring." I retorted with a saucy tone.

I hadn't intended to be a smart-alec, although it was an added bonus. I did have a point. I've always hated that simplistic test used to determine if one is an optimist or pessimistic, as it entirely depends on the situation. One cannot make an evaluation without any context. A mother who is trying to feed her baby is happy when the bottle is half empty. A pregnant woman taking her glucose challenge test is annoyed when the bottle is half full. A bartender is optimistic when he sees a half empty glass, as it means that the patron may order another. I become irritable if the night is getting late and Husband's pint glass is still half full as I want him to finish up so we can go the fuck home. As it is with so many things in life, it's not black and white.

The 40%-60% split stood out in my mind for another reason. Years ago, when I was talking a colposcopy training course, the instructor referenced a retrospective study from New Zealand. The researchers collected data on women who had high grade lesions on a Pap smear, but failed to comply with the recommended evaluations and treatments. Twenty years later, 40% were eventually diagnosed with cervical cancer. "Isn't it more impressive that 60% did not progress to cervical cancer?" I asked earnestly. The instructor chided that I could not view the results with "Pollyanna thinking." Thus, implying that 40% was still a significant cancer rate, and was irrespective to the fact that 60% did not develop cervical cancer. Maybe it reflects the fact that it's a difficult comparison between infertility and cervical cancer, but on the surface it still seemed odd. In one situation fewer patients gets cancer, but it's still considered bad; in the other, fewer patients get pregnant, but that's considered good? I suppose it helps to frame with ideals and realistic expectations. Ideally, one wants to have a zero percent cancer rate, and I think my instructor was trying to emphasize the role of intervention and treatment in this situation. Ideally, one would like all infertility patients to become pregnant, but unfortunately it's not realistic at this time. Forty percent becomes a significant number when you compare it to the fact that very few patients would be able to conceive without intervention. I also appreciate that 40% is a higher rate compared to couples with more challenging diagnoses.

If we were to take the laize-faire approach to conception, I would estimate our chances for success to be 0.1%. I am somewhat making these numbers up as I go along, with a preference for whole numbers to make my maths easier. I am basing that figure on the fact that even with my Clearblue Monitor, it is still difficult to determine when I will ovulate, and being able to schedule coitus during that time is another obstacle. Perhaps with proactive efforts, our chance of spontaneous conception would be around 1%. Thus IVF increases our chances by 40-400%. It is projected that an IUI only has a 15% opportunity for success in ideal conditions. My RE noted that the sperm count should be between 5-10 million (in the absence of male factor issues, there doesn't seem to be an increase in pregnancy rates when the count is higher than ten million). As we had less than half of the desired sperm count and if you round down a bit to adjust for my old age, we probably had a 4% chance for pregnancy. IVF increases those odds ten-fold.

The diagnosis of infertility really starts to hit home when you approach the data that way. Modest success rates are still preferred to the alternative of doing nothing. It's also helpful to frame your expectations. There is a greater probability that this won't work. It is statistically anticipated that I won't get pregnant with these treatments. Two out of three couples leave their REI clinic heartbroken. I haven't asked my RE to re-estimate our chances for success, and I don't plan to do so. I already know they're probably lower that what he conjectured last year. Just as I dismiss the platitudes proclaiming it will happen! as merely being meaningless words; statistics are only numbers, and they don't necessarily mean anything.

Monday, 16 September 2013

Initial Instincts

"Trust your initial instincts -they are usually correct." I recall many teachers offering those words of wisdom, but mind you those same teachers also advised you to "read every question carefully" and to "review your work." Often many exams were not necessarily testing your knowledge, but were evaluating your ability to find the best answer that fits a particular question. In which case, your initial instincts could be misleading.

When I first moved to California, I was planning to keep my Connecticut plates and my CT driver's license in order to maintain my New England identity.  I had always done so when I lived in other states for schooling and training. However, my Dudley-do-right husband pointed out that California highway patrol is strict about making new residents register their vehicles, and I would need apply for a California driver's license in order to facilitate voter registration. Still not able to let go of my Connecticut roots, I kept my old mobile phone number. My RE is one of the few who recognises the area code, as a reflection of the fact that ten years ago we lived in the same town on the other side of the country.

I had to take the written exam in order to obtain a California driver's license, and I was rather surprised at their primitive testing process. When I took the test as a teen in Connecticut, it was computerized. Each question actually showed you a little video and you judged your answers based on what you thought was appropriate in that situation. There were only 16 questions and you needed 12 correct responses to pass. I got my first question wrong, but then aced the next twelve and the computer stopped the test after I submitted my 12th correct answer. Fifteen years later, the much larger state of California simply issued a double sided sheet of paper with multiple guess questions and I think we had to supply our own pen. There was a designated testing area, which was merely a large counter and no one proctored the exams. One could easily cheat off a neighbour.

I thought that 15 years of diving experience and reading the California driving handbook the night before would be enough preparation, but I was wrong. I was truly struggling with the questions. The temptation to cheat was overwhelming, but I felt I had to maintain some integrity. I re-read one question and changed my answer by placing an 'X' though the box I had filled in and coloured in the one for my new answer. Later, I reviewed it once more and thought about what they say about your initial instincts. I placed another 'X' though that box and circled my original answer. Just to make my intentions clear, I added the words 'Yes' and 'No' next to my responses.

I handed in my test and watched as my paper was hacked with a red marking pen. "Five incorrect. FAIL!" pronounced the DMV employee as she signaled to the next person in the queue and handed my exam back to me. Humiliated, I walked out of the DMV as quickly as possible. I was devastated. While I can't say that I never failed a test in my academic career, it was a rare event. Now I had just failed one of the most fundamental exams in one's life. I got back in my car to drive home after failing my driving test and I looked over my paper. She had marked the question where I changed my answer twice as being wrong, but indicated that my original response was correct. I stormed back into the DMV, drew another number and waited to confront the disgruntled DMV grader. "How do I know you didn't just mark this now?" she demanded. I was tempted to mention that if I wanted to cheat I could have done so while I was taking the test... Instead, I pulled the "May I speak with your supervisor?" card. I plead my case and he believed that my initial intention selected the correct answer. "Always trust your initial instincts" He advised me. "They are usually right."

When I went into hypertensive crisis after consuming birth control pills for ten days, I expressed concerns to my RE about what this would mean for potential IVF protocols. He noted that he preferred to use microdose Lupron, and more recently when we started IVF discussion, he commented that a Lupron agonist protocol is standard. However, when he proposed my tentative schedule, he described that after giving it some thought, we could stimulate with a natural cycle. This makes me question which suggested protocol truly reflects his initial instincts?

I know my initial instincts were correct when we decided to pass on the original proposed time table. In addition to coinciding with the in-law invasion, it would have been really difficult to be out of the office while I've been trying to tie up loose ends before my vacation. There was one more disconcerting aspect about that possible retrieval date. It would fall on little Myrtle's first birthday. I know that I need to move past the fact that Myrtle conceived naturally on her second attempt while I am infertile... However, to be going through a procedure for assisted reproduction at the same time when everyone is celebrating the day her relatively easy pregnancy led to a textbook spontaneous vaginal delivery on her fucking due date and produced her gorgeous daughter; would be filed under the heading: Not Helping.

The easy solution would be to wait for my next natural cycle in October, but my RE will be attending the ASRM annual meeting during the approximate retrieval time. If we look toward November or December, we could be conflicting with the holidays. I don't want to wait until 2014, as when we met with my RE for a postmortem after my miscarriage, he recommended starting before that date. I'll be 38 that year, and success rates start to drop. Sooner is better than later. After trying to avoid IVF for over a year, I don't want to delay any longer. So we're back to the (original?) plan of a lupron agonist protocol. He's targeting a retrieval date of 30 October, so I'd start stimming around the 20th (Interesting that he picks the retrieval date and works backward).  Husband has no travel plans during this time, I may run a half marathon on the 20th, but then my competition schedule is clear until my 80s run mid-November. Not that it would be critical, but just an added bonus that my calendar happens to be free, and it seems nice to have some aspect working in my favour.

Husband couldn't resist pointing out the irony. Just before we started trying to conceive, we signed up for this holiday time share so that we could take family vacations with our little one. Not only is a trip with both our parents, my aunt and uncle, cousins and their estranged significant others not what we had in mind, it created a barrier for us to achieve the dream of having a little one. Alas, a reminder not to count your chickens before they hatch, but it also reflects how one decision can affect circumstances in the future. Yet, which ones are pivotal? Would the difference between the two protocols be akin to picking six of one or half dozen of another? Calling 'heads -I win; tails -you lose' on a coin toss? Or could this be a game changer? Whose initial instincts will be validated? Only time will tell...

Friday, 13 September 2013

Oh, Yes...I did.

Shortly after AF's arrival announced the failure of our final IUI, I sent a text to Myrtle.

20 bucks. In-laws set to arrive in ten days and I'm still not pregnant. It's contributions to my Mai Tai fund.

Her response: Ughh ok I will begrudgingly pay!

I wanted her to know that I didn't forget about her bet. A year ago, just before little Myrtle was born, we were texting about whether my in-laws would actually make the trip. "I'll bet you $10 they don't come" she offered. Then she added, "Actually, I'll be collecting $20 from you. $10 for your in-laws staying home and $10 for you getting pregnant." I was less than a year into my TTC and infertility journey, but it just seemed inappropriate to be wagering on my uterus.

I truly know that she means well and doesn't quite know what to say in this situation, but it just resonated that she's been wrong with so many predictions. When I first disclosed that we were getting off to a slow start, she confidently assured me "it will happen!". As I was still naive at that time, I didn't feel I had much cause to doubt her. After I informed her of Husband's diagnosis of moderate male factor infertility; she proclaimed, "I still think you'll conceive on your own." Her blind faith astounded me, but I couldn't help read into her emphasis on a spontaneous conception. Was she some how implying that there would be something inferior about a pregnancy achieved with assisted reproduction?

After I flew out to Connecticut to host her baby shower, she sent me a thank you card and included a note, "I know in my heart that I'll be throwing a similar event for you soon." Yeah, more than a year later is not exactly soon... although it's a moot point as I wouldn't want her (or anyone) to arrange a shower for me. Finally, on her Christmas card she wrote "...and now we ring in 2013 which will be your year!" To be fair, I think she sent it after I received my BFP and before my miscarriage. Her experience found that positive pregnancy test equals baby. She didn't know that you have to hold your breath for a few serial ultrasounds. Although 2013 has been my year to achieve some personal best swim times, complete two more half marathons, start cross fit classes and return to the tennis court; not that Myrtle ever asks about those events.

I wanted to prove a point. That predictions based only on hopeful thinking are not only irritating at the time the words are spoken, but they add to our ever present disappointment when they don't come true. Additionally, there is some concern that I could also be forced to hear her say 'See, I told you so!' if I were to become pregnant; you know as if she truly had psychic powers to back up her insight. Although I'd be willing to take one on the chin in that situation. It's simple; don't make empty promises -especially ones with a time frame.

Thankfully, Myrtle didn't point out that I did in fact spontaneously conceive, so technically she was correct with two of her assertions. I didn't want to counter that a pregnancy that didn't even make it to the first ultrasound appointment is not what either of us had in mind. A few minutes later, she sent another text asking if I had received an email from the Commish. A few years ago, a friend of Myrtle's husband invited us all to join an NFL elimination pool. Participants must pick a winning team each week (can only select a team once) to remain in the draw and the last person standing wins the pot. I don't have much interest in American Football, but I enjoy the strategic aspect of the challenge. Myrtle is actually much better at guessing NFL winners than she is at forecasting my fertility and usually stays in the pool the longest out of me and our die-hard football fan husbands.

I confirmed that I did receive his email and intended to participate this season. In his message,  the Commish announced that this year's contest is brought to you by the letter 'O' and the number '3'. "As in, Oops! We now have 3 kids!" Sheesh, not even an NFL elimination pool is safe from someone flaunting his fertility. Myrtle offered that she could pay my $20 entry fee. "Thanks, that would be great." I accepted, mentally thinking that I would be applying that earning on to a chance to win $4,000. That's the cost of my stims, GPD testing or a FET! Infertility treatments themselves are a gamble, is it so far fetched to be gambling for them?

Wednesday, 11 September 2013

Last Ditch Attempt

Oh, Gametes... if ever there was a more opportune moment for you...

This was our last ditch IUI attempt before moving forward with IVF. There were two co-dominant follicles and 4 million sperm with 75% motility and a progression score of 4. We led you to the Fallopian tube; all you had to do was fertilise, find your way to the uterus and implant. Is that really so hard? Have you seen some of the people getting pregnant out there? Did you watch Jersey Shore?

There were so many distractions in our lives during this 2WW that our gametes could have been happily doing their thing without us obsessing about them. The day after the IUI we jumped on the plane to head to Arkansas. A long weekend with the ex-pats (none seem to be planning for children at this time) provided a perfect distraction. The only trouble with spending a weekend away is that you don't get any chores done, so when we returned, our evenings were filled with laundry and cleaning. I was working 11 hour days to try to catch up after taking a couple of extra days out of the office.

As we're less than two weeks away from the in-law invasion, we've been getting the house into dress-to-impress mode (which is also operation hide everything procreation and infertility related). We had the hall carpet professionally cleaned a few months ago, but the beige colour still exposes the heavy traffic in that area, so we decided to replace it with a darker colour. This also gave us the opportunity to fix a defect in the subfloor. There was an 1/8th of an inch gap between two boards, which may not seem that significant, but if your foot caught it in the right place, you could feel yourself sink a little. A few applications of filler made it even. I can add "leveled subfloor" to my list of DIY skills. I also touched up all the trim paint. Additionally, we got around to hanging up some artwork on our bare walls.

We finally gave some attention to our much neglected gardens. We have to keep the front of the house neat, or else we'll be reprimanded from the Homeowner's Association, but the back garden hasn't seen a rake all summer. Husband pruned the way overgrown bushes, while I power washed our deck. It's still in a very sad state, but as Aramis would describe, at least it no longer looks like we're drug dealers.

When we first moved into our house and were still in the process of renovating, we didn't have the extra funds for a proper bed for the guest room. I purchased a double level air mattress from Target for $45 and left it up full time. For more than three years it has served as a decorative purpose, and many of our guests found it surprisingly comfortable. It would not be suitable for my in-laws who each have artificial hips, and as we've had the same mattress for just over ten years, we decided to get a new bed and move ours to the guest room. Husband had been complaining about our mattress for years, and while I thought it was fine, I didn't realise how bad it was until our new bed arrived. Additionally, I have a patient who works at Macy*s, who hooked us up with a sale on linens and bath towels. We also purchased a new sofa and loveseat, as ours were looking rather tattered. Love stores with the no interest financing plans!

My 2013 Challenge to see what would occur first -getting pregnant or finishing painting the cabinet and trim in out kitchen- became skewed toward the kitchen goal. Apparently, it became a deadline to finished the cabinets before the in-law arrival, and their visit led us to delay starting IVF. I completed a batch of five upper cabinet doors, and I've been painting in the evenings to try to finish the final two doors. I'm hoping my father can install the upper moulding for us during his visit. Then, I'll still need to caulk and install some side pieces of trim, which will need a touch of paint; so depending on how motivated I am, there may be a chance that a conception could win the challenge.

I had also been so busy at work that I barely had time to go to the bathroom, let alone to text Husband with quarterly updates. Finally, it dawned on me. Oh yeah, my IUI was two weeks ago... I hadn't been inspecting the toilet tissue, but there was no obvious sign of AF. I pulled my hair down and put the tie around my wrist. I was starting to hear some echoes from my patients:

"We had given up thinking we could become pregnant and lo and behold!" Snap.
"We were so busy, I had forgotten when my period was due!" Snap.
"We were going to start IVF next month!" Snap. Snap.

As Husband had to umpire a high school hockey match, I was on my own that night. I left the gym late and AF still hasn't made her presence known. It was 8 PM, if I could go another 12 hours, I'd be in uncharted territory. Then, whilst I was in a queue at Safeway, I had the feeling that she was imminent. When I arrived at home, my intuition was validated.

Oh Gametes, you failed to seize your moment of opportunity. As we're proceeding with IVF, I won't be as forgiving. You better be ready to perform. End of story.

Monday, 9 September 2013

You Can't Tell by Looking...

Although, I've been hopeful; I always tried to remain realistic about the low success rates with IUI treatments, especially with male factor issues. I especially felt that I wasn't naive enough to believe that it could work on our first treatment cycle. Nonetheless, after being sidelined for a few months, there was a certain excitement just to be back in the game, and the BFN after my first cycle definitely produced some disappointment. As soon as I got into work that day, I saw that my first appointment was a new patient, scheduled for an annual GYN exam and to discuss infertility. Personally, this was going to be tough as the last topic I wanted to discuss was infertility. Professionally, this was going to be tough as I was already behind schedule, and needed to cover a lot of ground without being rushed.

Fortunately, she was very prepared and had detailed answers for my questions. I always start by asking patients to describe their TTC efforts. I've learned not to make any presumptions, as I've noted over time that many people do not know how to anticipate when they ovulate. Some couples copulate too frequently and others not enough. A former colleague once had a particularly shocking case. They were a highly educated couple in their late thirties, and had been trying for two years before they presented for evaluation. They were convinced something was seriously wrong and pushed for a comprehensive work up. Multiple semen analyses were normal. Serial day 3 and day 21 draws indicated good ovarian communication and ovulation. Although her HSG showed patent tubes and no obvious cavity defects, she had a laparoscopy and hysteroscopy performed. When she came in for her post-op visit, the front office staff noticed she needed to update her health history form. A medical assistant reviewed it and discovered that she was listing 'condoms' as her method of birth control. "Why are you using condoms when you're trying to get pregnant?" The patient answered that she found semen to be "icky" and they didn't think condoms were effective as a friend become pregnant while using condoms. Rather than refer her to an RE, my colleague encouraged her to get over her "ick factor" and ditch the condoms. She conceived a few months later.

My patient had been tracking her cycles, which were very regular and was having unprotected sex at the correct times with appropriate frequency. She briefly used OPKs and received consistent results, but stopped as they didn't seem to be helping her get pregnant. Her history was pristine, and I couldn't identify any red flags for concern, so I thought there could be male factor issues or they could fall into the unexplained category. I reassured her that she was doing everything right, and it was time to evaluate. Knowing all the stupid 'tips' I received, I thought those were important words for her to hear. I placed all her orders, but as I needed to move on to my next waiting patient, I asked my medical assistant to review the timeframe her her labs and HSG. I still felt that I had rushed her, so I sent her a message on our online system encouraged her to let me know when she goes for her testing or to ask any further questions.

Three months later I saw an FSH and Estradiol for an name I didn't immediately recognise. She finally went for her testing. Her results (FSH 9.8 (E2 35) and FSH 1.08) gave me concerns for her ovarian reserve. She needed to see an RE now. A week later, I received her HSG results and was not prepared for the findings. Neither tube was patent. Without any risk factors present, she had a significant tubal factor to accompany her concerning ovarian reserve. Her husband is insured though Kaiser, so I didn't have any access to his results, but I hoped for their sake that his semen analysis was normal.

I felt reminded about how hidden and secretive infertility is. I used to counsel patients regarding the lurking threats of STIs, as most affected carriers have no symptoms. "You can't tell just by looking at someone" I warned. This situation feels very similar, you can't tell by merely looking at the surface and you won't know what you'll find until you look deeper. Thus, the recommendations to "relax" or "take a vacation" and "stop trying so hard" are not only inappropriate, but potentially detrimental, as they could delay a someone who is closing in on a narrow window of time.

I reviewed her results with her, describing a somewhat 'bad news, good news' situation. No one wants to hear that an abnormality was found, but sometimes it's comforting to have an explanation. I emphasized the positives; she is ovulating and IVF is a treatment to address tubal factor. She took the news rather well and quickly scheduled an appointment with an RE. I asked her to email me after her consult. A few days later, she replied that they would be starting IVF in somewhat of an excited tone.

There is a part of me that wants to reach out to her as a fellow IF sister. I want to let her know I personally know how much it sucks to need infertility treatments when your friends and family members conceive spontaneously. I know the difficulty of attending baby showers and birthday parties. There is so much more I could say to her, but I don't want to overstep my professional bounds. I wished her the best of luck and asked her to keep me posted. She replied "Thanks :)"

Friday, 6 September 2013

It's a Different World

In a previous post I described how the woman who is casually TTC is nearly oblivious to the 2WW that is such a dreaded experience for patients going through infertility treatments. It's more fodder for fertile envy, but it doesn't reach the same level as frustration as the 'I didn't know I was pregnant!' woman. This situation truly demonstrates how it is such a different world...

Our LVN approached me, a patient received a reminder that she was due for her HPV vaccine and scheduled an appointment. When the LVN asked about her last period, she replied "Oh, I think it was a few months ago..." She explained that she had a lapse in her insurance and stopped her birth control pills during that time. Her coverage was recently re-instated, so she wanted to get her shot and to restart her pills.
"Have you been using anything else for birth control?" the LVN asked
"Like what?"
"Condoms, spermicide, withdrawal, abstinence..."
"Do you think you could be pregnant?"

The LVN handed her a urine cup and briefed me on the situation. "It's going to be positive" she assured. "Maybe she has post pill amenorrhea." I countered, recalling my own experience of a delayed menstrual return after stopping birth control pills, although AF returned in less than two months for me and she was closer to four. We watched the test together -the blue test line lit up immediately. She measured fourteen weeks when I scanned her. "Maybe she should sign up for email messages reminding her when her period is due" I joked.

Except there was an aspect that it wasn't funny. I thought about all my patients with recurrent pregnancy losses or those experiencing infertility who hold their breath each day waiting to make it out of the first trimester. Here she was in the safety of the second trimester without experiencing any awareness of what those prior thirteen weeks represented. As she was young and this was her first pregnancy, maybe her obliviousness could be explained. Although I questioned if she did suspect she was pregnant and used the rouse of needing the HPV vaccine as a way of getting into the office. If that was the case, then she's a lot smarter than I previously thought.

It's fairly common that patients can't remember the exact day of their last menstrual period, but can produce an approximate range. I find that I often can't remember mine, as it becomes eclipsed by other dates, monitoring appointments, trigger time, the IUI itself and testing day. Maybe I'm not so different from unsuspecting fertiles. Often, I'll be satisfied if they can narrow it down to the beginning, middle or end of the month. This next patient would not be one of those cases.

I received report from our LVN "This is her fourth and it was an Oops!" she informed me "She wanted to have her tubes tied with her last pregnancy but her papers weren't signed in time.' I suddenly recognised the name "Bullshit. I signed her consents myself." I quickly checked her chart and my suspicion was confirmed. She went into labour before her scheduled C/section date and the on-call doctor didn't notice her sterilization intentions. "She thinks her period may have been sometime in May or June. You have your work cut out for you..." she warned.

"So, you're not quite sure when your last period was, but it may have been in either May or June?" I began
She just looked at me blankly for a few seconds and then offered,
"You see, my family is all girls and my sisters noticed I didn't have a period in July"
Oh, imagine having others who track your cycles for you! Oh wait -our partners and the staff at the REI clinic all do!
"So when did you suspect you were pregnant?" I asked
"Well, my mom looked at me one day and said 'I think you're pregnant'"
Oh, imagine having someone else spot your symptoms!
"When did you have a positive pregnancy test?"
"At the beginning of this month. But then I got my period."
"What do you mean..."
"I started bleeding for a week -just like my period"
You should have mentioned that earlier!
"That wasn't your period." I informed her "A period signals the absence of a pregnancy during each ovulatory cycle. You experienced a bleeding episode in your pregnancy."

The sight of blood would strike fear into the heart of a woman whose pregnancy was achieved with fertility treatments, one with recurrent losses or even an excited first time spontaneously conceived mom-to-be. The moment I spotted light pink blots on the toilet tissue, I knew that I was doomed. Yet a woman with an unintended fourth pregnancy can bleed for a week and merely attribute it as "her period". Didn't feel it was necessary to call or even to mention it earlier in the interview. I quickly proceeded with her scan. There was a viable single intrauterine pregnancy at 9 weeks without any visible explanation for her bleeding. Once we were done, I reviewed some of the causes for bleeding in pregnancy and explained why it was important to be evaluated during those situations. She reminded me that she doesn't want there to be a next time and asked again to have her tubes tied. I promised her that I would ensure it happens.

I've often commented how fertiles have no idea what it is like to walk in our shoes, how they can never appreciate what we experience trying to start a family. What is so elusive to us, is effortless to them. It's a different world, and just as they can't relate to our situations, we'll never understand what it's like to live in theirs.

Wednesday, 4 September 2013

Um... No.

Wow, things move fast in the world of infertility treatments when you mention the letters I, V and F. I was practically still cramping from my IUI procedure when I received a voicemail from my RE himself, as he was calling to discuss the protocol and tentative schedule that he had drafted. I was just finishing up with my last patient, but I called back about ten minutes later.
"Hi, this is Jane Allen. I'm returning a call from Dr Somebody that I Used to Know" I announced to the receptionist.
"I'm sorry" she replied "He says that if you have a lot of questions, you'll need to make an appointment to come into the office."
What the Fuck. Maybe I couldn't get away with that cheeky consult.
"Um. He called me." I informed her.
"Who is this again?" she asked
"J-a-n-e A-l-l-e-n." I enunciated
"Oh Jane!" she exclaimed "I thought you were someone else" Alas, the lifelong confusion when you have a proper name as your surname. "Oh yes-yes! He wanted to talk to you. Let me put you right through..."

"Well hopefully this IUI will be successful and you won't need to do IVF" he said for good measure, and then wasted no time getting right to the point. After some consideration for the fact that we haven't yet stimulated my ovies, we could try a short protocol during a  natural cycle. That sounded good so far; no Lupron, no birth control pills. I could even appreciate Husband's mind at work - less drugs = less cost. "So, we could start with your next cycle, which would give us a tentative retrieval date of 25 September. How does that sound?"

I checked the calendar just to be sure, but I knew what conflicted with that date. It was two days after my in-laws arrive and it was the day my parents fly in. I could just imagine the logistics of Husband taking me home from my retrieval and leaving me alone with his parents while he goes to pick up my parents from the airport. My heart started pounding and I had to focus on my breathing. The mere thought of going through this during the in-law invasion was inducing a panic attack. "I'm sorry, but that's not going to work, my parents and in-laws are in town." I explained. "Well, talk things over with Husband and let me know." He replied. Um, did we travel back to the 1950s where the man has the final say? Dude, I told you that date wouldn't work! Then I realised why it was probably hard to understand. I'm sure most patients probably arrange to have their relatives stay with them during this process. I hadn't intended to explain my family dynamics.

Let me start by saying that my in-laws are very sweet and generous people who have been nothing but kind to me from the first time we met, which makes me feels so horrible for harbouring the feelings that I have for them. Although, while they are pleasant on the surface, I know they resent the fact that I am the reason why their only child lives on the other side of the world. The fact that I didn't take Husband's surname doesn't endear me much, either. In addition to that underlying tension, they're socially very awkward. They don't have any friends. They don't travel. They don't have any hobbies, except my father-in-law follows Formula One and my mother-in-law loves Barry Manilow. That's it. They only thing we have in common is Husband.

Whilst in London last summer during the Olympics, we walked past Buckingham Palace and my mother-in-law commented, "Oh, I've never seen it in person." My jaw nearly dropped, which has been the response of everyone with whom I have shared that story. Seventy-four years she has lived in England, less than an hour's journey from one of the most famous landmarks in the world and never saw it up close. Really? Not on a class field trip or family holiday? I started to feel badly for her. Thus, many -my parents, Myrtle, my aunt and uncle and to some extent me- didn't think they'd actually make the trek for this trip. I think they only agreed to it, as it would fuel more jealousy toward my parents if we went on holiday with them. A small part of me is proud of them for finally noticing that there is an entire world to explore beyond their front door, but it seems a day late and a pound short.

Have you even been at a party or social gathering where you're struggling to make conversation with someone who you don't know well and you start looking for an escape? Scanning the crowd for a familiar face who can rescue you. Stalking the server with the cheese puffs even though you don't like cheese puffs. That's going to be my life for the fortnight during their stay. Now imagine going though your stimulation, retrieval and waiting for your fertilisation report during those conditions. Of course, I will have my parents to serve as a buffer, but I haven't factored how they would play into this hypothetical transfer date. My parents don't know about our intentions to conceive, let alone our difficulties. As it's the only aspect in my command, I will tell them on my terms when I feel it is the right time. I can just imagine dropping this bomb; "So guess what? We're infertile and we need to do IVF. In fact, we're right in the middle of it!" The most legitimate logistical issue is that we are due to depart for Hawaii on the day that would need to be reserved for a possible day 3 transfer. "Husband and I are just going to run out for an errand! It's having the embryo that could become your grandchild placed in my uterus. Everyone be packed and ready to go by the time we get back!"

Nonetheless, I did as I was told and talked things over with Husband. The look of terror in his eyes confirmed that he agreed with me whole heartedly. That time is most definitely not going to work for us. Besides, we are officially on a break.

Monday, 2 September 2013

What the Future Holds

This picture is of a 17 year old Bill Clinton shaking the hand of President John F. Kennedy during a Boys Nation trip to the White House in 1963. Regardless of your politics or feelings toward the Clinton presidency and legacy; you have to be impressed with this unique moment in history. The current president is looking into the eyes of a future president. I wonder if the photographer or any of the other boys were aware of what they were witnessing.

We ventured to Arkansas for the long weekend to attend a wedding and to tour the Clinton Presidential Library, which is a big deal for a political junkie like me. Husband is one of four ex-pats from his University in England who immigrated to the States. Each year they arrange to get together for a guys weekend, but for the past two years, we've gathered for the exchange of nuptials. After our first attempt at "officially" trying to conceive resulted in the first of many BFNs, we received a 'save the date' announcement for a wedding on a date that would have our due date. It became a silver lining at the time, but nine months of BFNs later, it felt strange to be at Barney and Robin's wedding and to not even be pregnant. A few weeks after our miscarriage, we received a 'save the date' flyer for another September wedding. We didn't have to say it out loud, but we both knew we wouldn't have been able to attend the wedding with a newborn less than a month old. Yet, we here were are; guests at the wedding for Marshall and Lilly, still not pregnant and preparing for our last hope with IVF. (For purposes of my analogy, Husband reprises the role of Ted and the previously named fourth Englishman, is Raj -borrowed from another series.)

I'm not sure why these weddings represent such markers for me, perhaps it is the not so subtle reference to the promise of children that is meant to follow after the honeymoon. True Story: when I was composing my speech to deliver at Myrtle's wedding, I was careful not to include any mention about having children. Although I knew she how much she wanted to have kids, I was aware of the infertility potential for a woman over the age of 35. You know the rest of the story; two months later she was knocked up and two years later, I'm still barren.

So far, this trip as called our attention to two facts. One, we are getting too old to take red-eye flights, although it is somewhat unavoidable when you live on the west coast. Two, we are at the phase in our life where we are attending a friend's second wedding. Marshall met his first wife while he was spending a year in America during a study abroad program. Before he left, he had declared his intention to immigrate and to eventually pledge alliance to the Stars and Stripes. Although she was very nice, they just didn't seem to fit together and many suspected this was a Green Card relationship. In fact, he was even assigned the nickname 'Gerard Depardieu' on a hockey tour. He obtained his law degree from the University of Arkansas and was granted a work visa from a local law firm, which allowed him to eventually pursue citizenship. Eight years into the relationship, they finally tied the knot. On the surface, they seemed really happy, but three years after their wedding date, he expressed concerns about their stability and a few months later, she confessed to having an affair.

Mere moments after his divorce papers were signed, his Facebook status announced that he was "in a relationship" with Lilly -a woman ten years his junior. It was widely presumed that she was "the rebound girl" and after meeting her, many of his friends expressed that notion.  I was introduced to her for the first time at Barney and Robin's wedding, but before I could formulate an opinion, they announced their engagement. This brings me back to the Clinton-Kennedy photograph: how often do we recognise the initial instant when we are confronted with our destiny?

How many of you recall the first moment you met your spouse -did you know then that he/she represented your future? My cousin claims she did. She had been in a two year relationship and was expecting to be asked "the question". Instead she received the statement: we need to talk. Her friends encouraged her to sign up for a volleyball league in order to lift her spirits and maybe meet someone. The night of their first match, she spotted a handsome man who arrived late from work. He was wearing a three piece suit and carried a volleyball under one arm and a six pack of beer under the other. As soon as his eyes met hers, she knew that he was the one for her. When I first met Husband, my thoughts were hmmm, he might be spongeworthy.... but mind you, I was motivated to end my dry spell before it reached the one year mark. Myrtle and I didn't notice each other much during nursery school, but one day we both brought the same Raggedy Ann doll for Show and Tell, and Kindergarden rules dictate you must play together under that situation. We were inseparable after that incident, and I have often wondered if the friendship would have developed if one of us had selected a different toy. Relating all this to infertility, I'll be trusting the embryologist to examine our 70-100 cell blastocysts and to determine which one is destined to be our baby.

Thanks to the recommendation of the concierge at our hotel in Little Rock, we dined at a local Microbrewery and ordered an eight flight sampler. As it has become customary to do, we were each updating our Facebook accounts. Husband posted this photo:

Boozing with my wife...
After we finished, I added this one:
Later, we both scrolled through our news feeds and saw the other's post and were amazed at how we spontaneously complimented each other. We started laughing so hard that we were both crying and the waitstaff approached our table to make sure no one was chocking. As we composed ourselves, I knew at that moment that no matter what our future holds with regard to conception; as long as this man is in my present...everything is all right...