Monday, 29 December 2014

A Year in Review

So, 2014 was definitely a tough year! I still laugh at how I feared that 2013 would be unlucky. Here is a look back at the good and the bad that transpired.

  • Ran two 10K races in an improved time. Find that Cross-Fit is allowing me to run faster with less training. Score!
  • Ran two Half Marathons.
  • Auto accident claims the life of a friend and co-worker. Miss her very much.
  • Compete in two swim meets. Relay teams earn two USMS Top Ten finishes.
  • FET#1 "The Chosen One" yields a BFN.
  • Days after my BFN, I learn that two other women in my office are pregnant and a male colleague's wife is expecting.
  • Run the final Across the Bay 12K. Will miss this race. It was one of my favourites.
  • Twins arrive a little early for Kimberly, but everyone is thriving! 
  • Travel to Nashville with my Dad to watch the University of Connecticut Women's Basketball team earn their record setting 9th National Championship. Unexpected highlight of the trip: The UCONN Men's team also wins the National Title. Second time in NCAA Division I Basketball history the Men's and Women's Champions are from the same school. Second time in history; it's UCONN.
  • Clean out the freezer with FET #2 "The Leftovers" to no avail. Officially nothing to show for our first IVF cycle.            
  • My aunt is diagnosed with breast cancer.
  • 90 year old grandmother fractures her hip.
  • Compete in USMS National SCY Swim Meet. Other competitors include Olympian Josh Davis, Olympic Gold Medalists Anthony Ervin and Matt Biondi, as well as the current 100 Metre Free Olympic Gold Medalist Nathan Adrain. Relay team just misses top ten finish.
  • Beloved cat Angus receives a fatal diagnosis.
  • A beautiful baby girl is born to The Gypsy Mama!
  • Second stim cycle produces a baker's dozen plus one. Seven blasts are biopsied and four are euploid. Regret that we didn't cancel the retrieval from my first cycle.
  • Hearts are broken as we say goodbye to Angus.
  • Recovery from stim cycle limits training for Long Course Metres Championship. Enter fewer events, but manage PB in 50 Free.
  • Maryland friend gives birth to her second daughter. She received the BFP with her firstborn the same month we started TTC. We have officially become 'lapped'.
  • Molly joins the Beloved Burnt Toast family! 
  • Fellow member of the 5 Transfer Club, Aubrey delivers twin boys!
  • Nearly decapitate the tip of my finger in a Mandoline slicer accident. Fortunately, it heals well.
  • My Jetta dies after nine years and 145,000 miles together. Find a great deal on a new used one.
  • Welcome kitty Tyler into our home and into our hearts. The only possible understanding for Angus's death is that it was to bring Tyler into our family.
  • Jessah learns she is expecting her baby sunshine thanks to a very special egg donor! 
  • Aramis brings home a unique souvenir from the Czech Republic - a Chalupa Batman!
  • Two outstanding new colleagues join our practice.
  • After a long and full life, my Grandmother passed away.
  • FET #3 "The Hopeful One" is yet another failure. We really suck at IVF.
  • Lilee Davey becomes 'that girl'!
  • Pass Re-certification Board Exam. I can keep working. Yay.
  • Amanda announces her exciting plans for adoption!
  • CCRM finds the right formula to bring My Lady Bits her first BFP!
  • Trip to the East Coast to visit my parents and Myrtle. Pleasant surprise as I get an opportunity to meet up with Maryland friend who is visiting her parents in Boston. Watch Husband umpire top level NCAA field hockey teams including defending (later to be repeat) Champions, UCONN.
  • Run 10 K and 5 K (post transfer).
  • A year after the painful loss of her twins, Conceptionally Challenged welcomes her Strawberry Baby!
  • A successful hysteroscopy helps put a plan in place for The Run Away Stork.
  • Urban Legend Torthuil gives birth to her baby girl!
  • FET #4 "The Kitchen Sink" produces a BFP!
  • My aunt completes her adjunctive cancer treatment just as a close friend and swim teammate is diagnosed with breast cancer at the age of 42.
  • At last, initial ultrasound reveals a viable fetus! We celebrate by attending UCONN/Stanford women's basketball game. Stanford prevails in overtime. How long are the odds of us having a good scan on the day when UCONN women lose a game? Must be a sign of the Apoclypse.
  • Run 10 mile race, a 10K and a half marathon.
  • Shay welcomes her baby boy!
  • A long awaiting BFP and viable ultrasound arrives for Maddie!
  • Meet up with Isabelle for lunch IRL. Toast the five embryos from her mini IVF cycles.
  • Pre-eclampsia brings an early delivery for Nina, but her little boy is a fighter!
  • My mother officially retires.
  • After two and a half years, I am finally able to leave my RE.
  • Run 10 K trail race. Blow past a young and fit looking guy. Tempted to tell him "better speed up your game bro, you're getting beat by a preggo".
  • While kicking for two, still manage a sub 8 minute finish in USMS Postal 400 Yard Kick for Time.
  • After many failed cycles, a close friend in England has a BFP to bring her baby#2!
  • Infertile Girl in a Fertile World has success with her first IVF cycle!
  • Thanks to a very special surrogate, Suzanne receives a BFP for Christmas!

Sunday, 21 December 2014

Post Graduate Life

I can understand why the transition from RE to OB is described as graduation. It reminds me of other times during my life when I've been technically qualified, but not quite sure I'm ready for the next step. I accept that I'm past the stage of infertility treatments, but I'm not ready to embrace the pregnancy. I feel my risk of miscarriage decrease with each passing week and we're very fortunate to have the reassurance from our CCS testing. We're still planning to pursue the Non-Invasive Prenatal Testing, but it is more of a formality. Mostly, I'm not ready for the reaction to my pregnancy. I'm not looking forward to the commotion and attention. I don't want to answer mutilple questions on how I'm feel-ling. I fear staff members will see me in the break room and wonder how much weight I'm gaining. I'm not ready to start slapping away wandering hands trying to touch my bump.

Myrtle recently asked when I would start telling people. I hadn't given it much thought. Husband is dying to start sharing the news, but I convinced him to follow the unspoken rule of waiting until the second trimester. Mostly, I admit that it's really just buying me more time to become comfortable with the idea of everyone knowing my secret. My friend Robin has been texting me often to discuss our pregnancies, as I suspect she's the first among her circle of friends to find herself in a family way. I mentioned that I found Zantac to be the next best thing since sliced bread (sliced bread is still retaining the top spot as my love affair with toast continues..) "Oh, I'll have to remember that with my second baby" she replied. Sigh. Suddenly it dawned on me that I'm just not ready to discuss my pregnancy with non-infertile people. Funny how I was initially so reluctant to join InfertileWorld, while so unaware that it would become my comfort zone.

I figured that I would tell my swim teammates when I start showing. Let's face it, there are some situations where you can run, but you can't hide. Plus, I don't really know how to drop the P-bomb into conversation. "Today's set was tough. I'm pregnant. Do you think we'll be sprinting again tomorrow?" Maybe I was feeling a little giddy about turning ten weeks, as I was contemplating telling someone as a way to celebrate making it into the double digits of gestational age.

Although I don't know if Summer and I would exactly call each other friends, I would say that I'm friendlier with her than I am with others. We've carpooled to a few meets, ran some races together and we're usually the last ones to leave the pool, so we'll often chat while walking to the car park. Actually, I could argue that I should tell her personally since I'm closer with her, but I decided I would wait until we were alone in the locker room. As I was gearing myself up to actually go through with it, Lena, a swimmer who joined our group a few months ago, described how she's been wearing larger clothes to conceal her pregnancy from her co-workers.

"Oh, you're pregnant! Congratulations!" I blurted out as I realised that Summer must have known already. I silently sighed. Lena had just wed in early October. I started trying to conceive nine months after I joined the swim group. I've had to watch five swimmers procreate in that time. Lena became the next pregnant swimmer in only a matter of months. I thought about using her declaration as a opportunity to reveal my situation, but it didn't seem appropriate to tack onto her announcement.

As I decided I would wait for another time, I walked over to the sinks, but I could still hear Lena and Summer talking. Quite predictably, she described how they weren't actively attempting to conceive at that time. In fact, she was trying to avoid her fertile window as she didn't want to be dealing with pregnancy related nausea on her wedding day. Wouldn't you know it, the stress of the wedding messed with her cycle and she was ovulating on the one night they had sex in September... "So, it happened much quicker than we expected, but at least we're not one of those couples who have to do infertility treatments. I could never do that." she explained as Summer agreed with her position.

You mean someone like me... I wanted to walk around the corner and confront them both by announcing that I was pregnant after multiple failed fertility treatments. Oh and it's so thoughtful the way you fertiles pity us. Yet, I didn't want to give up my news just for spite. I kept quiet and tuned out their conversation. Maybe there was something about being in a locker room that brought back the vulnerability of feeling as if I were back in high school and the popular girls were talking about me.

Her words stung and they haunted me for the rest of the day. Yet what hurt most of all, is that I had to acknowledge that if had gotten knocked up on my first attempt, I probably would have said the same thing.

Monday, 15 December 2014

Parting is such sweet sorrow

I've waited for this day with such anticipation from the very first visit with my RE, after I acknowledged that I wished that never needed to meet him in the first place. My final scan confirmed that our embryo's growth is on track and I heard the words, "you are released to your obstetrician." At last, I am free (or at least I hope). So many times I have throught, I can't wait to be done with this process... I am finished with waiting for AF just so I can coordinate my life around my fertility treatments.  I no longer need to sneak out of the office for monitoring appointments.

Yet, at the same time, I don't feel free. I'll be slipping out of the office next week, this time for my own new OB visit. I had to coordinate my NT scan within the designated window of time. My life will continue to be occupied with multiple appointments leading into my twice weekly NST sessions. Further activity and travel restrictions will encroach. This is all before the baby arrives. I hear they can be quite demanding and rather time consuming.

I acknowledge that it sounds so strange to say that I'll miss some aspects as it seems as if I'm exhibiting Stockholm Syndrome. Last year one of my elderly patients was transitioned to an Alzheimer's Care Facility. I gave her daughter my personal contact information and asked her to notify me when she passes. I saw her once a month for over four years. My only parents and relatives don't see me that much. I saw my RE at least once a month for the past two and a half years. I'll miss discussing interesting cases with him, even if the most challenging one, was my own.

There were things that I wanted to say, but I didn't know how to articulate. I wonder what, if anything, he feels he learned from my case study. Evaluate every possible septum even if it is slight and seeminly insignificant. Discuss CCS testing with more patients? (I once mentioned that REIs should feel obligated to present it as an option to every patient) Considering altering the estrogen priming in a patient with a thicker lining? I spoke the words 'thank you', but they felt so empty and inadequate. Yet, at the same time I don't know quite how to say thank you as I don't yet have the full appreication for the object of my gratitude. Even watching our baby moving on the ultrasound monitor it still seems so abstract. I think I'll fully understand my indebtedness if it ever becomes tangible.

Sometimes it still strikes me that over ten years ago, we lived less than a mile from each other on the other side of the country. We worked at the same hospitals, shopped at the same grocery store and frequented the same establishments. Maybe our paths never crossed during that time, or maybe we intersected as annonymous strangers. It seems to represent so much of infertility. It is such a silent and secreative disease. It does not discern or discriminate. Any man or woman, young or old, rich or poor could be affected and no one else could know. Through blogging and joining the IF community, I have found so much comfort from my followers who know the most intimate detials of my life, and yet, they wouldn't recognise me if we passed on a sidewalk.

He acknowledged that it has been a long jouney and wished us well. He shook my hand for the last time and held it a few extra seconds. I think that is as touchy-feely as he gets.

If we meet again, why, shall we smile?
If not, why, then, this parting was well made.
-William Shakespeare
Julius Caesar, Act V, Scene I

Monday, 8 December 2014

To Boldly Go Where No Embryo Has Gone Before...

8 weeks and 4 days. Well, technically, I was 8 weeks and 6 days by the time I had my D&C for my ill-fated second pregnancy. Ah, what a difference a year, two failed FETs, a second stim cycle, CCS testing, yet another failed transfer, Lupron, Labetalol, Laminaria, reduced estrogen and baby aspirin can make! My RE returned from his trip and I had my second scan on his first day back in the office. "Things could not look any better!" he proclaimed, as he tapped my leg not once, not twice, but three times during the ultrasound. He invited Husband to stand by his side as he scanned and he gave him a detailed tour on the ultrasound monitor, while I watched from the screen mounted on the ceiling. As Husband often felt left out during my visits, I think he really appreciated that Dr STIUTK gave him his own explanation.

Something else marked my venture into unchartered territory. Around six-ish weeks, I had brought leftover chicken curry for lunch, but the thought of it was making me queasy. I skipped lunch and not surprisingly, I was starving later that night. Yet, there wasn't anything that I wanted to eat. A persistent wave of nausea has invaded my life. I also have a weird metallic taste in my mouth. Although it has been to no avail, I've been brushing my teeth multiple times per day.  At least it may improve my next dental cleaning.

A few years ago, I participated in a panel discussion on nausea and vomiting in pregnancy. The facilitators presented a survey comparing clinicians' and patients' perception on this prevalent symptom. As anticipated, the clinicians rated their highest concerns over patients who were actually vomiting, as they could be suffering from dehydration, weight loss, electrolyte imbalances and ketonuria. Interestingly, patients expressed more distress over their nausea. Many reported that they actually felt better after throwing up. I have to confess that I've considered attempting a tactical chunder on a few occasions. Additionally, patients described that they experienced a loss of pleasure and enjoyment with eating during this time. A few participants on the panel described that certain aversions encountered during their pregnancies became permanent. A man commented that both of his kids are in college and his wife has never been able to return to Bos.ton Market. Another woman with grandchildren revealed that she still can't eat hot and sour soup.

I've discovered this is not necessarily a bad thing. I'm ashamed to admit that I had a bad Zero habit and I fretted over how I would be able to give it up when/if I ever became pregnant. Not a problem when you have absolutely no desire for it. I began to look at my symptomatic state as a way of doing my own 30 day reset. Unfortunately, I also don't have much on an appetite even for healthy foods. I have been able to reclaim some pleasure in eating by recalling some long lost favourites. In what can be considered my first craving, I braved the madness of shopping at Safe.way on the night before Thanksgiving to pick up a bag of frozen Tater Tots. I think the last time I ate them was when I was 10. Oh yeah, they are still so good!  I've also had to bring bread back into my life as toast has become the one and only thing I want to eat. I'll have a few pieces with a cup of Safe.way Organic Tomato Soup. It's become my go-to meal.

I hope I don't come across as complaining, as I'm very thankful to be in this state, and in a strange way, I appreciate my nausea. I know it's not necessarily reassuring, but it helps me remember that I am actually pregnant. Maybe, it might actually be for real.

Monday, 1 December 2014

Don't Start Believin'

It was the best of times, it was the worst of times, 
It was the age of wisdom, it was the age of foolishness,
It was the epoch of belief, it was the epoch of incredulity,
It was the season of light, it was the season of darkness,
It was the Spring of hope, it was the Winter of despair...
-Charles Dickens 'A Tale of Two Cities'

I've become convinced that Charles Dickens was describing the practice of obstetrics and not the political unrest in France and England during the late 1700s, when he wrote those words. I hate to admit it, but I start to get nervous when I see too many happy new OB visits, as I know that streak will be broken by a lurking non-viable pregnancy. What's worse, is that it always seem to come in threes.

New Girl acknowledged that she understood why we would still feel cautious, so she offered to be happy and excited for us. She went ahead and calculated our due date. It is in the middle of July. It is also the same birth day as Myrtle's older brother. Myrtle's brother is a total dick. There are several stories I could share to illustrate this point, but the most salient one is that in the mid 90s, he had a one night stand with a girl who went to high school with me and Myrtle. She was two grades ahead of us, but she was in our Algebra class. A baby resulted from that lone encounter, and a court ordered paternity test confirmed Myrtle's brother was the father. When he told Myrtle, he confessed 'we used a condom, but it broke...' Myrtle replied with the best line of her lifetime "That story may work on our parents, but there was no condom. I've seen you in the shower, you're not that big!"

He had child support payments garnished from his wages, but he never once even met his daughter, who is now nineteen years old. Myrtle's parents never told my parents and they have never acknowledged their granddaughter. It's a huge family secret. Myrtle and I ran into the mother about twelve years ago, and Myrtle decided to go over and talk with her. She had just wed her long term boyfriend and he was in the process of formally adopting her daughter. Myrtle's brother was only too willing to officially renounce his parental rights and was delighted that he no longer had to provide child support. She also described that her daughter really enjoys art and is quite talented -a skill inherited from her paternal grandmother, who is an artist. Fortunately, only 5% of women deliver on the assigned due date and it's likely that I'll be induced a week early due to my blood pressure issues. Actually I'll be very fortunate if I can make it to 39 weeks.

As I admit that I'm getting way ahead of myself, Husband and I also took the liberty to discuss how we might tell my parents. We both were considering the same concept, so we just need to agree on the final details. Although I wanted to take a one step at a time approach, out of consideration for optimal scheduling, I arranged my first OB visit and my NT scan. Co-worker offered that she would cancel for me if such a need would occur.

When I came into work the day after my first scan, one of my colleagues received a call from a radiologist. Her patient started bleeding the previous night, so the after-hours advice nurse arranged her to have an ultrasound first thing in the morning. She should have been 11 weeks and 5 days, but was only measuring 9 weeks and 1 day and no cardiac activity was seen. I recognised the name. I had just informed her that her early glucose testing was negative. Diabetes was the least of her issues.

I looked at my own schedule. My first patient was a couple who miscarried at 8 weeks earlier this summer, but conceived with her next cycle. I saw her at 6 weeks and again at 8 and everything looked perfect. Today was actually her originally scheduled New OB visit, which included her education session with our LVN. We chatted about her symptoms as I prepped the probe and I almost asked if they were planing to announce the pregnancy to their family at Thanksgiving, but for some reason, I held back. Once again, her scan looked perfect, except for one detail. The fetus was actually measuring a day ahead, but there was no cardiac activity detected. I find it is more traumatic for the patient to hear the futile attempts to auscultate a heart rate, so I use the colour flow application. Although as this patient is also a Nurse, so she knew what it meant to see red and blue flashes everywhere but on the baby.

Later that morning I had another patient coming in for a viability follow up. She was 41 and this was a surprise conception. I remember my RE once shared, "the statistic of only having a 5% risk for miscarriage after seeing the heartbeat doesn't apply to women over 40. The risk is probably closer to 50%."  It's an awkward conversation, and I really haven't really perfected it. Although you don't look like you're in your forties, women at this age are still at a higher risk for a miscarriage, so I like to scan my patients more frequently. You may consider waiting to announce your pregnancy until after the first trimester... I suspect that many are just so happy at that moment that they really aren't hearing what I'm saying.

She should have been 9 weeks at 3 days, but she was measuring a full week behind and once again, no flicker of cardiac activity was detected. I began to wonder if there were something broken with our ultrasound. I let patients decide if they want to have a formal scan to confirm. Some find reassurance with a second opinion, others would rather not endure a second procedure that won't affect the outcome. She elected to be scanned by radiology and my findings were confirmed. Although she had the highest risk for miscarriage of the three patients who received the diagnosis that morning, she was the most distraught. No matter how many times I explained that it most likely is due to an age related egg quality issue, she posed another theory. "Is it because I started prenatal vitamins late?" "Is it because I exercised?" There are some things that the mind just doesn't want to hear.

Days like these are really hard and I feel as if I hate my job. It's not too often that I encounter a miscarriage measuring at 9 weeks. I had to think back and the last one I recall was over a year ago. Now I had three within the same morning session! I know these situations pose no influence over the fate of my own pregnancy, but it shook me up a bit. Interestingly, all patients opted to do a chromosomal analysis on their products and my prediction is that at least two will reveal an abnormality. Even with an euploid embryo, I still feel vulnerable. I sent a mass text to all those in the know. All forward thinking and planning ceases with immediate effect. I didn't even bother to scan myself again, for it would only offer temporary reassurance. The message was received. Everything can be taken away from me at a moment's notice. I can't forget that.

Monday, 24 November 2014

See You Tonight

Maybe I'll see you tonight,
Maybe I'll see you tonight

Wherever the night takes you,
Maybe you'll see me too, 

The colder it gets, you won't see me anymore,
but there's still a chance I might walk to your door

Maybe the time is not right,
I won't be seeing you tonight,

Maybe I'll see you tonight,
maybe I'll see you tonight...
-Green Day 

Just a month or so before I removed my IUD to let this adventure begin, I was talking with a close friend and fellow gynae about how our profession would affect our pregnancy experience. "There won't be the same sense of awe and amazement during the first ultrasound, as I know what to expect..." Of course when I said those words I thought it would only take a few months to get knocked up and the initial scan would reveal a perfect viable pregnancy...

You all know the rest of the story, three years of infertility treatments, yada, yada, yada... here we were again, wondering what could be going on inside my uterus. As Dr STIUTK was away, his partner would be performing my scan.  "So did you transfer one or two?" he asked while prepping the ultrasound probe. Fantastic. He hadn't read my chart. It's usually a good idea when you're seeing a patient not familiar to you. This means he also didn't know that I've had two miscarriages, three failed transfers, and yes this was a single transfer with a euploid embryo.

As I answered, I thought about reminding him of what I do for a living, but I decided just to lie back and to remember that I was a patient. Yet, I couldn't silence the clinician inside my brain as he started to scan. Gestational sac is inside the uterus -phew, no ectopic. There's a perfect sized yolk sac with a fetal pole right next to it. Yes, there is the blinking flutter to indicate cardiac activity. I can only see one, the little bugger didn't split! I was also doing a little backseat ultrasounding. Pause it there! That's a perfect view for the CRL measurement! 

It was both the most overwhelming and yet underwhelming moment of my life. My aforementioned friend had told me that my experience during this ultrasound would be observing Husband's reaction. I looked over at him and he just looked puzzled and confused. He wasn't sure what was happening while the doctor was auscultating the heartbeat, while I thought that even at 130 beats per minute, it could have very well been mine.

As I had previously anticipated, Husband kept his stiff upper lip intact until the other RE and New Girl left the room, and then shed a few tears once the door was shut. At last, he had reached his quest of seeing a beating fetal heart on an ultrasound. Even better -it was ours! We shared a collective sigh of relief, while we also acknowledged that we still have a long way to go. We've never made it to this point before. The embryo's measurement was right on track. The word viable is being used to describe it. This was a significant milestone. Yet, at the same time, I can't help to look at that tiny spec and think that's really it?

I know that I sound like a spoilt brat, but the picture from the RE was really anti-climatic.

So I'm embarrassed to say, that I self-scanned for a better one...

Meet our little grain of rice! 

Monday, 17 November 2014

Keep Calm and Carry On

I think we told almost all of our close friends about our most recent FET, as well as the rest of our sorted reproductive past. It was touching to see how many infertility novices quickly learned the drill of beta doubling times and it was interesting to note that many seemed more anxious about receiving my numbers than I was. For record, my RE had me do a third draw, which came back at 2136. "I know you've probably already done this," said New Girl "I looked back at your prior betas and these are way higher." I knew they were, but I didn't make any direct comparisons, as there are so many differences between this FET and my first fresh transfer. I held this unusual sense of confidence as I casually waited for my results. After receiving the first and most critical one, I just knew that my betas would rise accordingly. Wow. I thought on a few occasions, this must be what it feels like for normal women... Then I remembered that most normal fertile women don't go through beta testing. I had to explain to Myrtle what it meant to have a beta of 175. I am not kidding.

Of all the money we have spent on this procreation pursuit, and it has been a lot, the $1875 for CCS testing has been worth every penny and more. Yet, it doesn't offer any guarantees. It only means that if my heart is broken with another miscarriage, a chromosomal abnormality will not be the cause. I keep reminding myself that my embryo is not infallible. My RE recently mentioned that he has been seeing more miscarriages in women over 40 who are found to have normal chromosomes on their pathology reports. "You're not over 40" Husband countered. True, but I'm not that far away. I had two patients of my own, both are in their early 30s, whose POC analysis did not implicate a chromosomal abnormality. One was found to have a large uterine fibroid and the other was found to have the triad of a high FSH, low AMH and low AFC, leading to the craptastic DOR diagnosis. Embryos can still be shitty even if they're genetically normal.

I'm in the ignorance is bliss phase. While I was a University student, I attended a lecture by a psychology PhD candidate whose research observed that people cannot disregard information presented to them, particularly if it is very emotional in nature. Well, I seem to be proving her wrong, as I often forget that I am pregnant. For three years, I've become obsessed with pregnancy and now it's expunged from my mind? I don't know how many weeks and days I am. I refuse to calculate a potential due date. I saw a pregnant woman in Tar.get and instantly filled with disdain, until the little voice reminded me, oh yeah... I'm technically pregnant too... 

Myrtle, who apparently is an expert in obstetrics after her textbook perfect pregnancy, had some advice for me, "just cuddle with your kitties or think of Angus if you feel anxious..." Thanks, but I don't actually don't feel anxious. I know whatever will be, will be. The die has already been cast. Nothing I can do can influence this outcome, and as mind blowingly frustrating as that is, there is really no point in stressing over it.  I'm not even meticulously inspecting the toilet tissue. I tried to find an explanation that Myrtle might understand. "Imaging as a child, you really wanted a certain toy for Christmas. It was the last gift you opened and you were absolutely elated as soon as you tore off the paper. But then you were told that you couldn't play with it. You couldn't look at it; actually, you weren't allowed to even think about it."

Maybe that analogy hit a little close to home for me. If I receive a gift from an out of state relative, my mother would hold it hostage on top of our refrigerator until I wrote a thank you note. To this day, that discipline has stayed with me, with the one exception that I once needed to cash my grandmother's ten dollar cheque in order to buy a card and stamp for my thank you note. Maybe it's why I have managed to keep thoughts about this pregnancy out of sight and out of mind. "So, are we ever going to be able to enjoy this pregnancy?" asked Husband with words that stabbed me right in the gut. "Hopefully..." was all I could answer.

This past weekend I ran into an old friend at the Farmer's Market. After we chatted for a few minutes, she cut right to the chase, "so, any news?" I immediately felt shitty as I forgot that she was in the loop and I realised that I didn't tell her earlier. "Oh, I'm pregnant again." I informed, suddenly acknowledging that it was the first time I said 'I'm [the p-word]' out loud, and I sounded like an asshole. I'm sure to anyone who overheard our conversation, I came across as one of those super fertile women, we were just talking about if we wanted to have a third baby, and I realised my period was late, so I took a test and it was positive! It's so easy for us, all we have to do is talk about getting pregnant and I'm knocked up! "Three pregnancies, nothing yet to show for it." I quickly added for the benefit of any eavesdroppers. No one looked up from selecting their desired produce. They were calmly carrying on with their day, and I should too.

Monday, 10 November 2014

The Only Thing We Have to Fear... is Fear Itself

A week ago, I woke up about half an hour before my alarm rang. It was another Monday, another start to the work week. Yet, this wasn't any other week. By quitting time on Friday, I would have my beta results, and my two week wait, which has really been a three year wait, would be over. As I tried to fall back asleep, I found myself thinking about The Monster at the End of the Book.

*Spoiler Alert: Although if you haven't read this book, you must add it to your reading list!* 

Grover, the most beloved Sesame Street character until Elmo was introduced, had received some inside information that there is a Monster at the end of the book you are reading. He begs and pleads with the reader not to turn any pages, which will bring them face to face with the Monster. When that fails, he attempts to tie the pages together and even builds a brick wall to thwart any further page turning. It was one of my favourite books as a child, perhaps because my mother could do a pretty good imitation of Grover freaking out.

I've previously noted that it's the final 48 hours of the two week wait that seem to be the hardest. When I hit 8dp5dt, I started contemplating testing. I researched my fellow bloggers and while there were a few exceptions; for the most part, women with a successful implantation had a positive result by this time, and women with negative results, often had a BFN or chemical pregnancy confirmed. Why drag it out any longer? I could pee on a stick and end the suspense.

Suddenly it made sense why I was randomly thinking about that book from my childhood. I didn't actually want the two week wait to end. Each passing day was like turning a page, and would bring me closer to the BFN Monster at the end of the week. I wanted to prolong not being not pregnant as long as possible.

For the record, I did hold out on testing. Husband reminded me that even when I was pregnant, my second line was so faint you had to squint as if you were looking at those 3-D posters that were all the rave in our college days. I also came across the episode of Seinfeld where George contemplates telling his girlfriend that he loves her. "Are you confident in the 'I love you' return?" Jerry inquires. "Otherwise, that's a pretty big Matzah Ball you've left hanging." As soon as I knew that I was most likely guaranteed a second line, I broke out my lone First Response Early Result test (a gift that accompanied the Endometrin, which I was also saving for when/if I became pregnant again). I didn't break Aramis's record of twenty seconds, but the colour in the test line came through before the control line. That had never happened to me before.

Obligatory FRER Picture
I had promised myself that I would break my POAS habit, but even after replaying Misery's voice mail three times, I needed something tangible to show that I was actually pregnant. I needed to erase any doubt that the lab had switched my blood sample, or perhaps Misery intended to leave that message for another patient. My second beta came back at 839. The Monster at the end of the book was none other than furry, lovable Grover himself. Thirty-five years later, I now understood the message to that story. You must face your fears; and sometimes, they may not be as scary as you thought.

Friday, 7 November 2014

The Writing in the Tablets

Although I am scientific minded and evidence based, I exhibit a bit of a contradiction; I am superstitious. After each transfer, I have made sure that I had just enough progesterone on hand to make it through to beta day, as I refused to order anymore until I received my results. Obviously, I feared that procuring an advanced provision of extra progesterone would some how jinx the outcome. Even thought I knew such actions exerted no influence, and wouldn't even be wasteful as I would need the supplies for my next transfer, I still kept to this ritual. A few days after my transfer, I started to count the number of tablets in the bottle in my bathroom, as well as the one I keep in my purse for on-the-go dosing. It turned out, I had exactly enough Prometrium capsules to get past my afternoon dose on beta day. Right to the point in time where Misery would be telling me to stop all my meds if my test results were negative.

My stomach twisted into knots. This was definitely a bad omen. Not a good prognostic indicator at all. I shared this news with my friend Isabelle, who asked if I were using Endometrin. No, I replied. I've been prescribed Prometrium, or whatever micronised progesterone the compounding pharmacy whips up for me. Suddenly, I remembered that I had received a box of Endometrin from a fellow blogger earlier this year. I used it for a few days during FET#2 and I found that I liked it much better than the Prometrium capsules. Endometrin comes with its own applicator, so I don't have to use the Pre-Seed Lubricant applicators. (Top Tip: Pap smear cytobrushes are the perfect tool for cleaning these applicators. They work well for cleaning the straw and spout of your water bottle too. Steal some at your next visit!) Best of all, I found that the Endometrin didn't muck up my underwear nearly as much as the Prometrium.  I didn't have too much hope with that transfer. It was a Hail Mary Grade 2 Blast to possibly avoid a second fresh stimming cycle. After a few days, I switched back to the Prometrium, as I decided that I would save the preferred Endometrin as a reward when/if I ever became pregnant again. What can I say? This girl knows how to pamper herself.

Now I had to acknowledge; was there something to be said for the fact that my preference for progesterone tablets and planned use in the event of a pregnancy aligned perfectly with the timing of my results? It sounds absolutely ridiculous as I type those words. Yet, these kinds of things appeal to the meticulous nature of my mind. I always try to look for patterns. I love palindromes. I get excited when I see a sequence of numbers. Why was something so silly giving me more confidence than the top grades assigned to my euploid beautifully expanding blast, which was placed perfectly by the skilled hands of my RE?

I can't explain it either. I went into the lab for my beta test with a surprising sense of calm, that I haven't had with my previous situations. After my first fresh transfer 'The Day 3 Desparation' I truly had no expectations. I felt over-confident with FET#1 'The Chosen One' as I was mentally clearing my schedule to return for beta#2 and my ultrasounds while waiting for the phlebotomist to call my name. I had an impending sense of doom with FET#2 'The Leftovers' and with FET#3 'Haven't Named It Yet'. I was merely going through the motions of having my vein poked in order to wait for a phone call to tell me something I already knew. This time, I didn't have that same intuition that forcasted failure. It's not the same thing as believing that I might have a positive result, but hey; I'll take it.

The call came in around 2 PM. I quickly cleared the alert from my phone and I refused to look at the length of the message to avoid applying the Thin Envelope Theory. Fortunately, I had a pretty busy day, which included dealing with possible treatment failure for a patient with an ectopic pregnancy. I was more preoccupied dealing with her beta results than my own. At last, after a long day at the office, Cross-Fit and waiting for Husband to come home from his hockey match, we played the message just after 8PM.

"Hi Jane, It's Misery from Dr Somebody That I Used to Know's Office." I've told both her and New Girl that I don't have any other contacts with their names, so they don't need the full identification when they call, yet I was trying to determine if I could pick anything up from the tone in her voice. "I'm calling with your test results, your HCG..." oh fuck, she's struggling to get the words out... "Congratulations. It was 175. You are pregnant."

All I will ever remember from that moment is the smile on Husband's face. I don't think he has ever looked more beautiful to me. As we've been through two loses, we know that beta results don't always mean baby, and I once tried to dismiss their importance completely. It has taken three failed transfers to resonate their significance. We got our break. We're still in this game.

Saturday, 1 November 2014

Lady in Waiting

I was scheduled to teach a contraceptive methods course in Sacramento on the day after my transfer, which meant I got to sleep in that morning. I rolled over and found Husband was already scrolling through his phone. As I rubbed my eyes, he presented a picture of Mrs Robinson and her twins. After a month in the NICU, everyone was finally home. "That will be you in nine months." he declared, "expect with only one baby" he added. When he delivers lines like these, I find myself loving him a little more, yet hating him at the same time.

After waiting for AF's arrival and hoping it would permit my baseline scan, laminaria placement and removal and follow up scan to coordinate with my trip back east, there was one more logistical hurdle. I had signed up to run a half marathon. When New Girl handed me my tentative schedule, my transfer was planned for a Monday, and the race was on Sunday. Six days post transfer and a day past the five day rest period. Of course, I should have been suspect that anything could align so perfectly. When I went back for my final lining check, Dr STIUTK asked if we could move the transfer to Tuesday, as he had a surgical case on Monday and as XYZ tends to be busier, they may not provide a time that would work for him. As I always do, I had snapped some pictures of my own schedule and it was actually easier to move my Tuesday patients. No problem, I agreed. I actually forgot about the half, until I received an email update later that day, and also noted that it was on Saturday, not Sunday.

So that would be on my fourth post transfer day... As the race location was a ninety minute drive away, I wouldn't have minded not getting up at 0430 on a Saturday, but the complicating factor is that one of my friends heard I was planning to do this half, and she signed up with me. Additionally, she took care of the cats while we were away and her requested payment was that I drive us to the event and pick up the tab at our post race breakfast. Just to hear what he would say, I asked my RE if I could run. "I'll leave that up to you to decide..." was his non-committal answer. Husband pointed out that he did not say 'yes', while I interpreted it as he did not say 'no'.

I just wanted an evidence based answer. Of course, I doubt there are any published papers about patients running half marathons and long distances after a transfer. There isn't any evidence to support that bed rest offers any benefit. In fact, one article I read performed a comparative analysis and noted similar pregnancy rates between bed rest and non bed resters, but the women who were on strict bed rest had a lower implantation per embryo rate. I've even heard some REIs wonder outloud if bed rest may have a harmful effect, that it's better for uterine blood flow to be up and moving. Just maybe not moving 13.1 miles.

I dug up my post transfer instruction that I received from my first cycle. As a five-time guest to the XYZ Embryology Suite, they no longer give me the hand out. I have been compliant with these instructions with all my previous transfers, and it didn't make a difference. "No strenuous exercise for five days". Strenuous is the key word. My ego wants to say that running 13.1 miles isn't strenuous for me. It only take me abut 4 weeks to train for a half. Yet, I've done this course before and found it to be tough, especially if it happens to be a hot day. Plus I haven't ran much in that last few weeks. And I'm recovering from a cold. Also, are you aware that this is your fifth transfer after three consecutive failures? "Jane, you and I both know that whether or not you run won't make a distance, but I don't want to see you blaming yourself if you run and it doesn't work." Husband offered.

The logical side of my brain agreed, as she tried to tell my ego that if it were an easier course, cooler temperatures and if I had been able to squeeze in a few more practice runs, then I could have done it. Then I received another email from the race organisers announcing that they decided to add a 5K distance to the event. It would follow the last three miles of the half marathon course. Now, that was something I could do!

They offered a shuttle service from the start of the half to the 5K start. While walking to the meeting point, I ran into a woman who I'm guessing is about 28 weeks pregnant. "I signed up for the half, but I obviously can't run it now." she explained. I decided to try being open about my situation "We're doing IVF and I had a transfer done earlier this week." "Oh. I had a friend who did IVF." she replied as she pulled out her phone and quickly became engrossed by it. Sometimes you can tell how fertile someone is by how uncomfortable they are discussing infertility.

I overheard two or three conversations on the shuttle to the 5K start, "so I was planning to run the half, but then I found out I'm pregnant!" I also caught a group of guys who had intended to run the half under the team name 'Sweating for the Wedding'. The Groom (I'm presuming) had written on his bib 'Hoping she'll love me the way I am'. Apparently they didn't realise how long 13.1 miles was and didn't train appropriately. So, this 5K distance would be composed of pregnant women and people who aren't fit enough to run the half marathon. I'm neither; but I'm feeling more closely aligned with the didn't properly train group.

After the shuttle dropped us at our start, we had to wait about 45 minutes for all the elite runners to pass. Those who keep a less than 7 minute mile pace and would clear the ten mile maker in less than one hour and fifteen minutes. We were able to hang out at a winery, receive shelter from the pouring rain, enjoy hot coffee and tea as well as indoor plumbing. It was starting to resonate that switching distances was a very smart decision.

I ran the 3.1 miles rather gingerly. I disabled my timing chip so that there would be no official record on how slowly I ran the course, but it was very slow. As I was waiting for the race to start, I received a text from Robin asking how we were doing. "You two are going to be amazing parents, whether it's in nine months or a little longer." Suddenly, I had a new perspective on the two week wait. I am merely waiting to see how long I will be waiting...

Tuesday, 28 October 2014

Serving To Stay In The Match

The tenth month in the calendar year has represented several anniversaries. Husband and I met in the month of October and we moved to the States in October. In October 2011, I removed my IUD so we could start trying to conceive, but I made Husband use condoms, least we be one of those couples who score on the first attempt. A year later, we fell asleep early and missed having sex on the night of my positive OPK. I thought we were the most pathetic TTC couple in the world. Ha! Little did I know we were still amatures at that time. Last October I started my first IVF cycle and here were are at the end of October in 2014, preparing for our fifth transfer.

As we arrived at XYZ Fertility Centre, the staff went through the familiar instructions for us. Husband and I both pointed out, not only is this not our first time at the rodeo, we're five-timers! I do realise this is not exactly something of which to be proud. However, I am proud of my pelvic floor muscles, as they came through for me and my mega full bladder. Dr STIUTK felt the transfer could not have been smoother. Sigh of relief. We spent some time talking with the embryologist about our embryo quality. As four of my embryos were frozen on day 6, I wondered if they were inferior in any way. I was prepared to hear the embryologist (donned in her Hello Kitty scrub cap) explain that while chromosomally normal, as my embies are formed from a 38 year old and a partner with male factor, they actually suck.

Well, apparently they are all grade 1, which is they highest grade assigned at XYZ. When they have CCS tested embryos, they rank them by the confidence report of the chromosomal analysis. Although both she and my RE disputed that the day 6 embies could be of poorer quality, the first two chosen for transfer, were the ones frozen on day 5. Interesting. She also described that the process of performing the biopsy acts as a form of assisted hatching. Finally, the the embryo thawed well and the expansion was "awesome". Fuck. I forgot to ask my RE to take the report with him. I made that request last time as I didn't want to add to my photo collection of unfulfilled blasts. He had already left by the time I made the discovery. Now this transfer has to work as I have the picture.

Meanwhile, while I was resting, Husband received a text from Barney. He acknowledged that he felt badly about sharing their news as he knows of our struggles, and he asked how we were doing. He also confirmed our suspicion; they were a one hit wonder. Barney thought it would take about six months and was hoping to enjoy a lot of 'practice'. Instead, he notes he'll be doing a lot of self-practice from now on. Barney may come across as a crass lad, but he is genuinely a caring friend. Husband brought him up to speed. Just transferred a Grade 1 euploid embryo. "Wow." replied Barney. "I just googled what that is. It sounds like you can't get much better than that."

This is exactly what I would want to hear. Well besides hearing the words, 'your beta is positive and you are pregnant.' I've been asking myself would I rather hear the embryologist (in her French accent) explain, 'Your embryos are shit. There's not a chance in hell that you'll become pregnant' just so I'd have an explanation if it doesn't work? Obviously not. It's just that I've heard all the favourable reports before and they no longer mean anything to me. Why should I go out on a limb and let myself beleive that this transfer could be any different? Yes, we made a few modifications to this time, but they were emperic. They may or may not have any effect. We've gone though some many rounds of treatments with the thought that this could be the one! It feels so daft to think that way anymore.

This line of thinking led me to confront another question. If I don't actually believe that this may work, why am I continuing to transfer my embies? I have to admit that after our last BFN, the temptation to just walk away from it all was enticing. If we're going to eventually be defeated by infertility, why not lose on our terms, our command. Yet how much time would pass before regretting that decision? Would the spector of our remaining embies always haunt me whenever I saw children and would think about what could have been? C'mon Jane, you're allegedly a rational person. Somewhere inside that pessimistic skeptical being is a shred of hope. If you really didn't have any faith, you wouldn't got through these procedures.

Yet at the same time, it also seems prudent to ask how many times can we torture ourselves with this process? How many times can we welcome that faint ray of hope, only to have it extinguished so quickly? The smart alec in me has the answer. We're just serving to stay in the match. Down a set and a break, and our opponent is dominating her serve. Defeat feels inevitable. In fact, we haven't even managed a point [of an HCG] during her last three service games. We're just trying to hold our own serve to prolong the game. Maybe make the final score look better to reflect our efforts. Sometimes it's just the message that holding sends. You may be en route to victory, but I'm not going down without a fight. You want this win? I'm not going to give it to you. You'll have to earn it on your racquet. So we hold. Pause for a few minutes as we change sides. Await for our opponent to deliver her first serve. Maybe, just maybe, we'll get our break.

Thursday, 23 October 2014

An Advocate for Stress?

I've previously written a few posts that have attempted to disconnect the association between fertility and relaxation, and I have been careful to mention that I'm not advocating for stress. Stress reduction has important benefits for mental and physical health, but a relaxed state will not necessarily enhance fertility. However, my recent conversation with Myrtle is making me reconsider my position on stress. She suggested that Husband and I take a trip to Hawaii after a transfer. Eye roll. Face palm. Head shake. God Damn, fertiles just cannot get off that vacation notion. Apparently, one must be on a sandy beach with a Mai Tai in hand in order for implantation to occur. Of course a fertile wouldn't understand how stressful it would be to try to coordinate a trip around the time of a transfer. Nor could she appreciate that it would be hard to fund an FET and a holiday in the same month.

Although many have commented about how tolerant I am of Myrtle; I have a bit of a confession. The academic in me really enjoys schooling her when she comes up with some pretty ridiculous shit. "Jane, your job is so stressful. What if you just took a few days off?" Once again, we ran that play last time. My transfer was on a Wednesday and I had PTO for the rest of the week. I worked on a presentation, which was more time consuming than a stressful task. To complete the relaxation cliche, I had a facial and a massage. Since XYZ won't assign a time for my transfer until the night before, I have arranged to take the entire day off, so that I'm not cancelling patients at the last minute, although on two of my transfers, I could have worked through the morning session. I've just wanted to avoid the clusterfuck that occurred with my first transfer.
When my RE called with my fertilisation report, he tried to assure me that we would be able to transfer on day 5, but I sensed he was holding something back. Three days after my retrieval, my cat Angus followed me from room to room and repeatedly meowed for no apparent reason. I know it sounds crazy, but I felt he was trying to tell me that I would be transferring that day. Shortly after I arrived at work, my medical assistant informed me that a radiologist was calling with a stat report. As I was the only provider in the office at that time, I had to take the call.

It was a patient who had recently miscarried and the radiologist suspected she had retained products of conception. My colleagues and I have often observed that the radiologists tend to over read retained products. However, this radiologist just wanted an answer, what did I want to do with her now? During this time my phone rang, displaying my RE's office number. Oh fuck. It was barely after 9 AM and he was calling as soon as he arrived in his office. This was not a good sign. I had to let the call go to voicemail. Meanwhile, I needed to deal with this patient situation.

I called my colleague who had seen the patient and ordered her ultrasound. It was her day off, but fortunately she answered her cell phone. She shared my skepticism on the interpretation and noted that the patient wasn't bleeding too heavily, so she thought she could be managed medically. I called in the prescriptions, had my medical assistant schedule a follow up appointment for her and asked our nurse to go to the radiology suite to review the instructions and plan with the patient. Surprisingly, this only took ten minutes.

When I was finally able to call my RE, he had already started seeing patients. I waited on hold for over ten minutes, before I hung up and called back to inform them that I couldn't wait any longer. I now had three patients waiting in rooms and I was running twenty-five minutes behind. "I'll pull him out of the room" Misery offered. Another bad sign. Five minutes later he came to the phone and delivered the recommendation to proceed with a day 3 transfer. I had promised Husband that I would call him as soon as I heard from my RE, but I had to start seeing some patients. Especially if I were going to be leaving the office early.

Fortunately, those first three patients were relatively straightforward and weren't too upset about the long wait. I brought Husband up to speed and then called my RE again. During my freak out over the possibility of twins, he let it slip that due to my 'poor prognosis,' it actually wouldn't be unreasonable to transfer three embies. I wondered if we should proceed at all. Disaster was written all over this plan. I told our office manager that I would have to leave for the afternoon to tend to a "family emergency," which was technically kind of true. I rushed out of the office leaving a mess of paperwork on my desk, phone calls unanswered and I only glanced at my results to see if anything was urgent.

Husband and I talked during the drive to XYZ Fertility Centre, which prohibited me from drinking the required amount to fill my bladder, as it wasn't sufficiently full by the time we arrived. The hottie embryologist described that our embies weren't too bad, if we only had more, we could have held out until day 5. I was questioning my decision to proceed with these two as my RE was placing them inside my uterus. My thoughts oscilated between panic about twins to fear that the entire cycle was a bust. I felt extremely tense during this transfer and it was the most uncomfortable of all four procedures.

For almost a year, I have been trying to understand how an abnormal embryo of mediocre quality could implant under unfavourable circumstances, while three superior quality embryos failed in an allegedly ideal transfer situation. Did the stress of that day have a positive effect? Was there something about my release of cortisol or endogenous adrenaline that helped implantation? I've argued against the "just relax" theory by pointing out that pregnancies occur in many stressful situations, physicial attacks, famine, war, etc...We often see a bump in the birth rate nine months after a natural diaster or other catastrophic event as people decide to do something life affirming. Once I countered that as Husband has decreased sperm production and I have a long follicular phase, we may be too relaxed!

I acknowledge that I'm absolutely grasping at straws, but it did spin some wheels in my mind. Should I try to induce some stress into my transfer day? I thought about not taking the day off work, maybe calling in sick for a morning transfer, or trying to work in the morning if I were scheduled in the afternoon. My conscience forbids me from doing that. I hate cancelling patients at the last minute. Instead, I looked through the schedule for the week and made recommendations for my medical assistant on where she could reschedule patients. Maybe we'll get delayed by traffic, although that's unlikely as Husband will be scouring the traffic reports and will build in plenty of 'oh shit' time. The fact that I have to keep a super full bladder is nervewracking. Not only is it physically uncomfortable, I worry my cup may runneth over. I'm scared that it will be another difficult transfer and I'll feel doomed right from the start.

Thus, I suppose the situation alone should represent enough stress. This is our fifth transfer within a year, and possibly the penultimate one. We running out the clock. Our enthusiasm, our patience, our resources and our hopes are all fading. I feel a particular sense of desperation that I didn't have a year ago. Maybe that's just the difference I need.

Sunday, 19 October 2014

A Trio of Announcements

Back in January, Husband was selected to umpire some top level field hockey matches on the east coast. The question of wheather I would join him on the trip was predicated by our first FET. If it had been successful, I would have been 34-36 weeks pregnant during that time. Not only would I not have been able to travel, Husband would have been worrying about being on the other side of the country during the late stages of my high risk pregnancy. Fast forward a second stim cycle and a total of three failed FETs later, I was holding my breath to see if this October trip would conflict with my up coming FET prep. Fortunately, I was able to take advantage of my clinic's 'if AF arrives after 4 pm, we consider the next day to be your CD1' rule, and everything fell into place.

Going back home is just so weird. I had to negotiate borrowing my mother's car to go visit Myrtle. I came home just after midnight and she and my father had fallen asleep in the living room. This took me back over twenty years: did I break curfew? Did I even have a curfew? Was I going to be in trouble? I gently shook my mother to let her know I arrived home safely. "Is my car okay?" she asked. Oh. She was waiting up for her car, not me. I hid my Lupron and related supplies inside the lining of my suitcase, an action Husband considered paranoid. Yet sure enough, my mother reached inside my suitcase, "can I see your travel case? I need a new one.." Um, it's a travel case. Use your imagination. Despite needing to conceal my meds, I never missed a dose.

Husband went into his company's New York office on the days when he was not umpiring, so he didn't have to use as much vacation time. He shared the news that one of his colleagues is pregnant. "They struggled for a few years and went right to IVF, as she had just turned 41. They conceived with their first transfer." I started to feel the familiar sensation of hapulosy. Any pregnancy is a victory for all infertiles. Yet perhaps because I've only met her on two or three occasions at thier company's holiday parties (although in that short time, I discovered that she is really cool, she will be a fabulous mother, and she looks amazing for her age) I found myself addressing a stronger sense of jealousy. Pregnancy rates are much lower after the age of 40, even with assisted reproduction, which makes it even more atypical that she was a first time success. Then again, I wasn't supposed to produce 14 mature eggs and have them all fertilise at the age of 38. In the end it doesn't really matter what your lab values and projected stats are; it all comes down to what can happen in the lab and in the uterus.

A few days later, Husband and I were enjoying a drink at a bar in Boston, when he received a text from Barney, a fellow ex-pat. Barney is an accountant for a large corporation, and his wife Robin does sound editing for a critically acclaimed TV programme. Last year, she revealed that she wasn't sure if they wanted to have kids, which made sense given the demands of their careers. This was after I told her about our issues and she advised me to "just give it some more time". There was a sonogram picture attached with the text, as it announced that Robin was nearly 12 weeks along. We joined in the messages of congratulations and well wishes, and went through the routine of discussing due dates, potential names and some very specific questions for me regarding genetic screening and ultrasound diagnoses. This should be us! We should be making this announcement! I just couldn't suppress those thoughts from my mind. Husband was right, we wouldn't be the first of the ex-pats to procreate. I also couldn't help feel frustrated that someone who wasn't sure if she even wanted to conceive, did it so quickly. Especially as she pronounced that I needed to be more patient. Is another year enough fucking time?

Then there was my visit with Myrtle. As Husband would be seeing her first, I asked if he could encourage Myrtle not to bring up the subject with me. "Nope" he replied. "I think that will make things worse. You two should talk face to face." As we were alone together, the opportunity presented. Fortunately, I did most of the talking, and she did more listening. There were a few cringe worthy comments, "why don't you shove all three [of my remaining euploid embryos] up there?" and a face palm or two "have you thought about going to Hawaii after a transfer? Think about it Jane, how many people become pregnant on holiday?" but it was a good visit. Even when I asked about Melissa.

Melissa was a mutual friend from our high school days. She can best be described as a chronic underachiever. She abandoned many projects and quit sports teams, but nothing was ever her fault. She always had some excuse or placed the blame on a coach or teacher who didn't like her. She was the type of girl who practised her signature with a guy's last name after their second date. Oh, and she had an attraction to losers who lacked ambition, but had mummy issues. I long lost interest in her when I left for college, but Myrtle kept in touch with her, although she admits it's mostly for my amusement.

Two years ago when I went back home for Myrtle's shower, I learned from another high school alum that Melissa (at that time briefly married to Husband #2, after a failed engagement followed her divorce from Husband #1) was having trouble conceiving. I wasn't too surprised, as I always suspected that she has PCOS. Yet, even though I had just learned about our moderate male factor diagnosis and it had only been seven months, I started to think, oh great, I'm just as much of a loser as Melissa! I can't conceive either!  "So..." I asked Myrtle "have you heard from Melissa lately?" "Well...I didn't want to tell you..." she hesitated, "she had a baby boy last year." Hmm. The news didn't bother me. I acknowledged that being infertile does not make me a loser, and just because she has a baby; she's probably still a loser.

When I first saw little Myrtle walking hand in hand with Myrtle, my heart melted. She's absolutely beautiful and a very sweet little girl. As soon as I entered their house, she invited me to play with her. She is remarkably well behaved for a two year old and shows gracious social skills. Myrtle and Mr Myrtle tought her to say "cheers" and she raised her sippy cup of milk as Myrtle and I clinked our wine glasses. Although jealousy will always be at my core, I felt an overwhelming sense of pride for Myrtle. She is doing an amazing job as a parent, even if it is still an adjustment for me to hear her address herself as 'Mommy'.

Some bloggers warned me to prepare for pain when visiting with little Myrtle. That occurred when Myrtle and her daughter came for brunch with my parents. The sights of little Myrtle reaching for my mom to pick her up, as well as my Dad crouching on his bad knee to play with her, both brought tears to my eyes. Fortunately, the moment was broken with laughter as little Myrtle called my parents' cat Sookie "Soopie". It's been interesting to process these different reactions and emotions. The same event of a pregnancy or birth announcement can evoke several different responses. Oh, there was something else that gave me a smug sense of satisfaction; Myrtle has a really big ass, and unlike mine, hers is not from sports.

Tuesday, 14 October 2014

Denial is Not a River in Egypt

A few years ago, I was reviewing the records for my New OB patient, Ida Know. She was in her late 30s and this was her forth baby. She had her first two in her 20s, but remarried another man and had her third child two years earlier. During that pregnancy, she developed severe pre-eclampsia and was delivered at 34 weeks. As I looked deeper into her records, she was actually noted to have chronic hypertension with super imposed pre-eclampsia. Six months before this visit, she went to her primary care provider for a routine physical and her blood pressure was elevated at 160/100. Ida expressed that she wanted to become pregnant again, and her doctor discussed the importance of controlling her blood pressure first. He increased the dose of her Labetalol and recommended a follow up visit in two months. Ida thought stopping the medication all together was a better idea.

Sure enough, she conceived quickly and she was 10 weeks at the time of her first visit. Her blood pressure was 180/120. I had to send her to Urgent Care for supervised blood pressure lowering as well as to her Primary Care to evaluate for end organ damage. She would ultimately require maximum doses of Labetalol and Hydralazine, but super imposed pre-eclampsia set in at week 29, and she was delivered at 32 weeks. Ida didn't really have an answer for why she stopped her blood pressure meds, except that she thought it would be better for her baby. An emergency early delivery at 34 weeks didn't teach her anything about the importance of blood pressure management? I ,walked into my colleague's office, and asked the rhetorical question; "why are people so stupid?"

After Dr STIUTK confronted me about my own blood pressure issues, I decided that I would not stick my head in the proverbial sand, but I did need more data. I started checking my own measurements everyday at alternating times and found my readings were in the low 130s/high 120s over low 90s/high 80s. While admitting that I do have mild hypertension, it isn't that bad. I began taking the Labetalol at 50 mg twice daily and found that my numbers hadn't changed much at all. I started to make the argument that I didn't really need the medication; it wasn't exerting much of an effect and my blood pressure wasn't that bad! My Primary Care thought otherwise, and recommended increasing to 75 mg BID. Around that time, I started my luteal phase Lupron, and noted that my readings had bumped up to 140s/100s. It was time to leave denial and start taking my medication like a good girl.

The medical assistant who works primarily with my Lead Physician recently asked how I was doing and what my next steps were. I brought her up to speed on the plan, including addressing my blood pressure issues. "Well, you know you'll eventually need to be on medication anyway, so you might as well start it now." she stated flatly. "Don't be like Ida Know" she added for extra emphasis. I truly respected her for being so candid and upfront with me. Mostly because I know she is right. " Yeah" I replied, "My birth plan will be getting sectioned for pre-eclampsia." We both laughed a little, but silently acknowledged the probable truth in that statement. The hardest aspect about admitting I have hypertension is that it makes me feel as if I am too old and too unhealthy to be attempting a pregnancy. I can't reverse time, but I can lower my blood pressure readings.

Meanwhile, I went into my RE's office for my laminaria placement. Laminaria are small sticks of seaweed that expand as they absorb cervical mucus and promote cervical dilation. They are primarily used to prep patients scheduled for a second trimester D&C procedure, and my RE felt placing one could help make my transfer go smoother. "Did you take anything?" asked New Girl as she ushered me to the exam room. "No" I replied, surprised by her question. I was only having one stick inserted in my cervix. I used to place 4 or 5 and I never pre-meded any patients, nor do I recall anyone reporting much pain. "Well, you might want to..." she suggested.

The placement was rather easy and practically painless. As I was forbidden from doing any exercise (which could displace the laminaria) I decided to take a glass of wine when I got home. A few hours later, the cramping took effect. O-M-G, holy mother fucker, it hurt. I took 800 mgs of Motrin. When that didn't touch the pain, I went with the Tylenol with Codeine tablets left over from my Hysteroscopy. Still no response, I tried the Vicodin which was prescribed for my D&C. Plus, I took my daily baby aspirin. I applied a Therma.Care heat wrap to my back and snuggled under a heating pad. Feeling nauseated from the pain, the drugs, or both, I popped a Zofran. I was still uncomfortable by 1 AM, so I downed two more Vicodin and finally fell asleep. I set my alarm for 5 AM, just so I would wake up to take another 800 mg of Motrin. By the time I rose to get ready for work, I was finally pain free.

So, maybe I'm not as tough as I think I am. While I never had any particular aspirations to do the whole unmedicated natural birth thing, there was something in the back of my mind that wondered if I could. After emptying my medicine cabinet just to get through a night with laminaria; not only is that answer a resounding 'no', but avoiding labour pains with a Ceasaerean delivery sounds appealing. Except the discomfort comes later during the post-op recovery, and no one offers you an epidural. You have to suck it up and care for an infant.

However, I may be (just maybe) as smart as I think I am. At the beginning of my cycle, I reminded my RE of our discussion to alter my estrogen priming. He started me off with only one 0.1 mg patch, rather than two. On CD 10, my lining was only 8.5 mm, which is more aligned with my fellow bloggers, and is less than all my prior measurements, which were above 10 mm at this point in time. I was planning to only increase my patches to two rather than three, which is what my RE instructed me to do. He is also having me come in for a final lining check before I start my progesterone. Even if it still doesn't pay off in the end, I feel really confident about the adjustments during this cycle.

Monday, 6 October 2014

If I Ever Lose My Faith In You...

A few days after my BFN from FET#3, my Lead Physician approached me to ask how I was doing. I gave her a run down of my RIF research and mentioned that I had contacted the other RE who has visited our office. "Are you going to switch?" she jumped in to ask. I paused a second before answering. Initially my decision to do some outreach wasn't so much about seeking another opinion; it was laziness on my part. I had to finish a presentation that weekend and I decided to outsource the task. Fortunately, my RE had to reschedule the appointment, which gave me time to do my own work when neither responded. I hadn't admitted to myself that maybe I was also looking for some words of wisdom from providers with more years of my experience than my RE. While I have no doubt that my RE is up to date with the most current litterature, especially as he doesn't seem to have much of a life outside the office; he was born in the same year as Louise Brown, while the other two graduated medical school around that time. Perhaps advanced age can provide an extra measure of reasurrance.

I wasn't too surprised by her inquiry. She almost exclusively refers her patients to his group. "Well, we already have the embryos..." I started to explain. Husband and I had discussed that if our second stim cycle was only projecting 6-8 mature eggs again, we would cancel the retrieval. We didn't have a follow up conversation, but I would have considered CCRM at that point. Call it huburis, but I just couldn't accept that with my AFC and AMH, that my ovaries couldn't produce more. My RE made all the right adjustments to my second cyle, and he managed it brillinantly. As he himself noted that an REI is only as good as the embryology lab, they could not have performed any better at XYZ. They fertilised all 14 of my 38 year old eggs with sperm from a man with moderate male factor. Changing providers would require transporting my embies, which involves additional costs and risks, unless I enlisted with an XYZ doctor. That would involve waiting to arrange a new patient consult and getting on to their schedule, just to transfer the same embryos in the same place.

Co-worker was not so subtle about sharing her opinion. After I brought her up to speed with her RE's recommendation to do the endometrail receptor assay, it was clear to her that I needed to jump ship. "You're had three failures, and your RE wants to take you in this direction," as she motioned with her hand "and my RE wants to take you in this direction..." she motioned her other hand in the opposite direction. I found her tone a bit patronising and I thought it was an over simplified description of the situation. I discussed the limited data within the study I read. "Pursuing the test is not a straight forward decision." I commented. "Well, you shouldn't have to make the decision." She quipped "The doctor needs to make the decision." I recall during her treatments, she described that he was very proactive, but operated on his agenda. I felt that I had a more collaborative realtionship with my RE.

"Obviously, I'm biased." She admitted. I have a bit of bias too. A patient that I referred to Co-worker's RE contacted me about switching to another provider. She was frustrated that he kept forgetting that she has Premature Ovarian Failure. Sort of an important detail to remember. Additionally, I was concerned during her final IUI, as she had at least 5 mature follicles and her partner has a billion sperm on his post wash TMC. She was very lucky not only that she became pregnant, but that it was only a twin pregnancy and not higher order multiples.

I've developed such a newfound respect for the subspecialty of Reproductive Endocrinology and Infertilty. There is so much scientfic application and skill involved, but at the same time, so much of their practice, their business, their reputation, is all down to chance. I never looked up any stats for my RE, because someone else's case doesn't apply to me. I never read any reviews about him, because the only opinion that matters to me is my own. One of my younger colleagues knows him from her residency (they're Facebook friends, which has made me mindful of what I post to her page) and I've noted that she doesn't refer many patients to him, although the location is an inconvenience to most of our patient population. I've been tempted to ask about her experience working him, but I doubt it would differ from my own observations: very serious, thorough and calculating, hard worker, bland personality.

It also seemss that we have a bit more invested. Misery is nice to me on a regular basis, and Husband feels we've both connected on a personal level with New Girl. "I think she genuinely cares about us." he observed. As she has texted me from her own phone on a few occasions, I imagine I'd keep in touch with her with an update or two, should I ever become pregnant. The prospect of starting from the begining with a new clinic just feels exhausting, although I know that's not a reason to stay. We've come so far with him, and he recently acknowledged how long and hard this process has been. We're ten yards away from the endzone. We could be just one transfer away from achieving what we want, although I know how naive that sounds, given that has been our motto for the past three transfers. If the next one does not take, and there is a good chance that it won't, I'll arrange a phone consult with CCRM and I may do the endometrial receptor assay, if for no other reason than to bide time until the new year. At times, it's just so hard to have any faith in this process. It's hard to put your faith in another person, but at least for now, I don't feel that my chances would be any better in any other hands.

Thursday, 2 October 2014

The Curse of Fertility

Recently, I was looking through FertileBook, (I mean Facebook) and found a not so subtle post from one of my friends back in England. "This time tomorrow...the start of a whole new world...eeks!" Mrs Robinson was a year behind me. A few years ago, after a devastating break-up, she started dating a man nearly ten years her junior "just for fun". He was truly lovely, and after enduring many cougar jokes, she eventually declared her love for him. Toward the end of last year, she became the last of our University friends to tie the knot. Fucking A, it must have been a honeymoon conception... I thought to myself as I mentally did the maths in my head. As I went to leave my comment of congratulations, I noted that some others were confused by her announcement. "Why?" "What's happening?" others asked.

Intrigued, I started looking through her previous posts. A few days earlier she reported that her last day of work was coming soon. She answered someone's inquiry by explaining that she was pregnant with identical twin girls and she had just passed 33 weeks. Suddnely, it all made sense. She had monochorionic, monoamniotic twins. This is the most high risk situation for a twin pregnancy, as not only are the twins sharing the same placenta, there is a high potential for cord entanglement. There is a 20% mortality rate.

I searched her page. She's a fairly frequent poster, but until this week there was no mention of her pregnancy (nothing on her husband's page as well). No one had tagged her in any pictures at a baby shower. I wondered if she even had a baby shower. How did they go through this pregnancy knowing that they could lose one or both babies? I was impressed that she worked up until her delivery date, but neither bed rest, nor hospitalisation with frequent survaliance offer any survival benefits. The hope is just to make it until 32-34 weeks and deliver via Caesarean section. No all natural birth plan for her. Then they place the infants in the care of the Newborn ICU and prepare for the challenges associated with prematurity.

I wheeled her out on the gestational calandar. She conceived in February -three months from her wedding date. Suddenly I felt guilty for presuming that she was a honeymoon conception. Actually, I felt guilty for resenting her fertility. Fertiles have their stuggles, too.

Sunday, 28 September 2014

The Second Opinion

While I was in research mode after my latest FET, I contacted two other REIs in the area. One has visited our office a few times, and I have corresponded with him via email regarding some of my patients, as well as my personal situation. The other was Co-worker's RE, as we also have a few mutual patients. I was hoping that I could take some of their suggestions into my WTF appointment, but neither wrote back to me. Not even with an, "I'm sorry you're going though this, but you'll have to schedule a formal consultation." I shared with my colleagues how disappointed I was with their failure to respond. It makes you realise just how lonely and isolating infertility is when you receive this type of treatment from your infertility specialist associates.

The next day, after slagging them both off to my colleagues, I received a message from Co-worker's RE. He apologised for the delay and expressed his empathy for my frustrating situation. Very little information is available about Recurrent Implantation Failure (RIF). The issue is either the embryo or the endometrium. Even with a euploid embryo, his observation is that the implantation rate is only 50%. Mere chance does explain our failures. He then introduced a new test that identifies the window of implantation from an endometrial biopsy. If my endometrium is found to be out of phase, I could pursue another single transfer after correction. If the endometrium is in sync, then we should consider transferring two embies. "Being responsible to limit twins is respectable, but I think you need to be more aggressive."

They say you shouldn't ask a question, if you don't want to hear the answer. I wanted a second opinion, just not after I had already established a plan. I needed some information on this new test, so I typed the name into The Google, which led me to the company's website. 'Recurrent Implantation Failure? We can help!' Okay...I'm intrigued. The test involves performing an endometrial biopsy 7 days past the LH surge in a natural cycle, or 5 days after starting progesterone in a medicated cycle. Apparently, 20% of women with RIF are found to have a displaced implantation window. The results will either indicate that the endometrium is receptive, and the transfer should occur at that time, or it will reveal that the lining is not receptive and the analysis will offer a recommendation on when the transfer should take place.

So, this was another test to assess endometrial capacity. We had dismissed two other testing methods for lack of reproducibility and ambiguous implications. However, this one could offer feedback on my endometrium, which seemed pertinent given our plans to alter my estrogen priming. Suddenly my head was spinning. I had to do this test! If my next transfer resulted in my fourth consecutive BFN, I'd be filled with regret. This could provide a possible answer for my failures as well as increase my chances for success! I can't risk wasting another embryo, not mention the cost of an FET. What did I have to lose? Besides the cost of the test, (~$1,000) there would be a loss of time. I could have the test done in October, but my RE is away in November and my parents are visiting in December, so I wouldn't be able to transfer until the new year. Although, there is the hypothetical loss that I could just proceed with my planned transfer, have it work, and possibly be done with this process without making things more complicated.

I read through the research article that was posted on this company's website. In the clinical trial, they evaluated 85 participants with RIF and 25 control patients. A receptive endometrium was found in nearly 75% of the RIFers and 88% of the control group. 29 RIF patients with a receptive endometrium went through a transfer and the pregnancy rate was 51.7%. A non-receptive endometrium was seen in 22 RIF participants, but only EIGHT went through a personalised transfer based on the recommendations from their analysis. Four became pregnant, yielding a 50% pregnancy rate. The author concluded that due to the low number of patients, these results should be considered preliminary.

I had become swept off my feet. The lonely and desperate infertile who was seduced by the latest theory promising answers and results. Yet, what if this was the one? I started stewing about how much I resent being in this position and needing to make these difficult decisions. "Just talk to Dr. Somebody that I Used to Know about it." advised Husband, who was keen to shut me up so that he could go to sleep. I already knew what we would say about it. Limited studies, lack of reproducibility, ambigious findings...Yet he'd be willing to go along with it if I felt so compelled. I reviewed the data and crunched the numbers again. 85 women entered this study and only 4 (less than 5%) benefited from the intended intervention. (15 women who had a receptive endometrium also became pregnant, so the pregnancy rate for the trial was 22%)

It feels like a rational decision, but there is something else contributing to the lingering doubts. At times, it just seems like every decision I make turns out to be the wrong one. A bit reminiscent of the episode of Seinfeld where George observes that every instinct he has is wrong, so Jerry deduces that the opposite must be correct. I shared with Husband that if we proceed with our transfer as planned, and it works, then our formula must have been right. "Yet, if it doesn't work, it doesn't mean that it was wrong" he quipped, displaying remarkable wisdom in his half asleep state. That is precisely what is so fucked up about this process.

Wednesday, 24 September 2014

A Day in My Life

0505  Wake up ten minutes before my alarm.
0506  Tyler senses that I am awake and begins to stir. He assumes that my first priority is to feed him.
0510  Drag myself out of bed.
0514  Feed Tyler, check Facebook to review Newsfeeds from England.
0515  I forgot to shut off my alarm, which wakes up a now grumpy Husband.
0535  Ready to leave the house.
0555  Arrive at the pool. No one has seen me yet. I could turn around and go home.
0635  It's an IM set. I should have bailed when I had the chance.
0703  Waiting for hot water in the showers.
0706  At last! Post work out shower feels so good!
0730  Locker room attendant has to leave, ushered to hurry up.
0740  Ready to depart from the pool with a little extra time on my hands.
          I could get a jump start on my day, or I could hit Starbucks.
0745  Starbucks it is!
0747  No eating or drinking in the new car rule is in effect for at least three months. Sit outside and overlook the Bay while drinking my coffee.
0810  Arrive at work.
1755  Day ends with giving a patient a diagnosis of herpes. I hate my job at times.
1825  Review Cross-Fit work out. Ugh. Burpees. Unfortunately, I've already been spotted. Too late to bail.
1955  Home at last after a minor car accident caused major traffic. Husband has already started dinner and notes that I am just in time to help him with laundry.
1956  A hungry Tyler is glued to my ankles as I set my bags down. Husband hasn't given him his  dinner as he "doesn't do wet food". Wonder how he'll handle baby related fluids if he can't deal with canned cat food.
1957  Feed the little bugger and concede that his food is pretty gross. Angus would only eat canned food that was in slices with gravy and it almost looked suitable for human consumption. Tyler prefers the pate. May try to change this
2000  Hang wet clothes on our drying rack.
2005  Make some zoodles by using a julienne peeler to produce zucchini noodles. Zoodles is much more fun to say.
2008  Look through mail. Misery sent me my prescriptions for next transfer. My surname is spelled wrong on one of them. Fucking A. I've been in and out of that office for the past two years and you can't spell my name correctly! Furthermore, I've pointed out to her that on multiple occasions I've discovered an incorrect spelling. Is this too much to expect? I am merely asking for sharks with freckin laser beams attached to their head!
2009  Glass of wine ends rant. Wonder if Misery is dyslexic.
2010  Dinner is served. Dine with Husband and his iPhone.
2035  Start to clear up plates.
2040  Husband accidentally turns off the kitchen lights while I'm washing dishes. I make a joke about how frugal he is. (Seriously, the guy is the electricity police) He gets insulted and announces that he's going to bed. Suspect his over-reaction is really a ploy to avoid clean up.
2100  Wash all the containers from my lunch box. Wonder if washing baby bottles will be as tedious.
2110  Throw wet swimming stuff in the tumble dryer.
2112  Pack lunch for tomorrow.
2125  Empty gym bag, hang up work clothes. Repack gym bag with workout clothes.
2130  Prepare consent forms for FET#4 at XYZ Fertility Centre. Prior to FET#2, I learned we had to sign a new set of forms with each transfer. Last time, I printed out four copies of the consent forms for each of our euploid embryos and I joked that we should sign a batch of these forms. This time, I decided to do it. I signed all three remaining three copies, but only dated one. If we have to face FET#5 or 6, we'll just have to note the date.
2200  Remove swim towel from the dryer. Select work clothes for tomorrow and pack into swim bag.
Double check to make sure I didn't forget to pack underwear. Arrange swimsuit and swim clothes for easy access in the morning.
2215  Plug iPhone into the charger
2220  Finally in bed at last. Husband is long been asleep, so I check in with email, Facebook and blogs.
~2300 Fall asleep.

Even before our experience with infertility, I was always annoyed with couples who would declare, "we're having a baby, but nothing is going to change!" Um, everything is going to change. Isn't that kind of the entire point? Nonetheless, my own parents told me, "we weren't going to be those parents who revolved their lives around their baby. We incorporated you into our life." I've become fascinated with these 'A Day in the Life' posts from new moms and I think they should be required reading for every expectant parents. Admittedly, they scare the shit out of me. Actually my own recount is pretty frightening, look how much organisation and effort it takes just to get me out of the house!

I haven't spent too much time thinking about how our lives with change with a little bundle of joy. After my second beta from IVF#1 Co-worker issued the warning on how much our life would change in the coming year. So far the only change is that now I'm prepping for a FET where I was stimming at this time last year. Yet, while not imagining any specific situations, I hold a few delusions that let me think I might be able to manage, you know, if this whole implantation and pregnancy thing is actually possible.

I'll want to do this!
I once told my mother that I had no desire to give up my precious sleep to tend to a crying baby, to which my mother countered "I loved you so much that I wanted to get up and take care of you." Effective way to induce a guilt trip. Will all our experienced make me appreciate these tasks and challenges more? Perhaps, but I can also see the novelty fading quickly.

It CAN be done!
In her book, Bossypants, Tina Fey described how irritated she gets when people ask 'how do you juggle it all?' While the question may sound complimentary, she feels the accusing eyes are really noticing 'you're fucking everything up, aren't you?' Still, I look for ways to make it seem possible. My swim group is going to start an evening session. While I was recently on an 8 mile run, not only did I see women and men with jogging strollers, I saw a woman in a boot camp class doing air squats with her baby snuggly attached to her chest.

I'll be MORE productive
I've heard some working mothers described that they've become more efficient at the office. When there's a task standing between you and your kids, or if your daycare centre charges by the minute for a late pick up, you don't waste any time. It's go in, get 'er done, and go home. Avoid the idle chit-chat in the break room. Pack a lunch and eat at your desk while you work. Presumably, this is after the sleep deprived state where one is napping under the desk...

I'll get some help
I know my options are very limited here as my parents live on the other side of the country and my in-laws are on the other side of the world. My aunt and uncle, who live nearby, are dealing with her breast cancer, and my cousins are busy dealing with their own kids. Although, in fairness, we didn't do anything to help with their arrivals, so we don't expect anything in return. However, my mother will be retiring next February, and my father is self employed, so they could come out for a good stretch of time, if they wanted. (Yikes, I feel old to describe my parents as retired).

I have some friends who expressed concerns about their partners' contributions prior to the newborn's arrivals...and then found their fears were confirmed. In particular, a few have commented that their husbands' lives didn't change much at all. I actually don't have such fears about Husband, and I'm not just writing that on the off chance that he's reading this. I know he'll be a very hands-on Dad, and will probably learn baby's patterns and routines quicker than I will. It's the remaining chores that give me concerns.

It has taken eight years of marriage for me to finally realise that Husband will never participate in meal planning. On time, I gave him a cookbook and asked him to select one entree, and I would shop for ingredients. He looked through the book and reported, "anything is fine." This led to a huge argument on whether or not he actually completed his assigned task. Earlier this summer, when I was extra busy preparing for a presentation, he offered to help with the cleaning. I figured he would identify something that is dirty and clean it. Apparently not. He had to be assigned specific tasks. I asked him just to vacuum and dust, but he decided to turn our kitchen inside and out to make it sparkle. I had to spend over an hour helping him finish, just so I could start dinner. I did appreciate all his efforts, but I couldn't stop thinking all you had to do was fucking vacuum and fucking dust... We've decided that our Christmas present to ourselves may be looking into getting a cleaning lady in 2015. Co-worker hired one after her twins were born. "She sucks, but at least she gets to the bathrooms!" She claims the $120 for her twice monthly services is worth every penny in terms of saved time and aggravation.

It gets better
Please tell me it does.