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.