Another Hurdle; or, One

Things are still looking okay. We spotted one gestational sac in the ute, measuring appropriately and right where it belongs. I had convinced myself that I would have and that I wanted twins, but I'll be quite thrilled to be lucky enough to bring home a healthy singleton, no question. No disappointment here, at all. Nothing but relief.

Dr. W said that everything looks good so far, but that it's still early and we just have to wait. Lawyer Guy insisted that I ask her about my boob size/pain concerns and cramping fears, and she responded that I should pay no attention to any of that because "it means nothing." The most important thing is to rest and relax and try to distract myself. There's nothing we can do right now (as I well know) but wait, so I might as well make the waiting as tolerable as possible.

There's also nothing I can do about my cough, though Lawyer Guy asked if it was okay for me to take some old prescription cough syrup with codeine he has lying around. (Dr. W and I looked at him like he had two heads. Um, narcotics are not really on the list of approved medications during pregnancy, sweetie). I might get a humidifier for our bedroom today, because the dry air hurts my throat with every breath.

Our next appointment is in a week. These upcoming two appointments (and these upcoming two weeks) are going to be especially hard, because starting around 6 weeks is where things began to go pear-shaped last time. But I can't go on torturing myself like this. It's not good for me or for Lawyer Guy or for the baby. I've got to do my best to relax and follow my good friend Egg's lead:

Zen zen zen zen zen.

Money, Money, Money; or, What Would You Do?

Lawyer Guy and I are facing one of the no doubt many practical conundrums we'll encounter as we move forward with ART. I could use some advice from those of you with more experience in these sorts of things.

So, to set the stage first for where we are right now, LG and I are doing a natural (i.e. break) cycle for the month of December. I'm on CD5 and unmedicated will ovulate anywhere between days 18 and 27, though it's usually more in the range of CD 21-24. I will most likely, then ovulate the week before Christmas (though earlier or later are always possible) and won't get my period until the first week of the new year.

In January, we begin our last Clomid+IUI. If that fails, we'll be meeting with Dr. W. in early February to discuss next steps.

Our options, as she laid them out to me briefly, are either to move to injections+IUI (which has an increased risk of triplets that worries her) or straight to IVF.

All of this is very hypothetical at the moment, and there's no reason to spend tons of time stressing or evaluating or deciding what we'll decide to do in Feb/March, when there are cycles to get through right now and conversations waiting to be had (and test results--from the RPL panel--that still haven't come in).

But there is a complicating factor at play. While our current course of treatment is covered by our insurance, we have zero coverage for IVF or injectible meds (the IUI procedure and all monitoring/testing/doctors' visits would still be covered). We have enough saved to handle the both routes for at least a few months and parents who we could turn to for help in a pinch (though that's a last resort scenario) but would obviously like to do whatever we can to keep costs down (and I don't believe our clinic offers any shared risk or other incentive programs).

LG does have a flex spending account for medical expenses. And his benefits coordinator just let everyone know that they need to specify the amount they want to put in it by December 20th. And, of course, whatever is unused in the flex account at the end of the year is lost.

So, how do you think we should handle this? As of now, there's still a chance that Clomid+IUI could work and we wouldn't need to go out of pocket for fertility expenses at all. But it's highly likely that we will be paying for medications at the very least in 2011. We don't know anything about the pricing of IVF at Cor.nell, since we haven't officially had a chat with Dr. W about that yet, but I'm thinking $12,000-$15,000 is pretty standard. And maybe $2,000-$4,000 for the meds, a little less if we're just doing an IUI? (Hard data on these figures would be appreciated.) If we knew for a fact we would be going the IVF route, I'd want to put in enough to cover one whole cycle, but since we don't know anything yet, it may be too big a risk to lose that money at the end of 2011.

Advice needed!

Too Much; or, Not Enough

Things have been quiet in Purgatory these last few days, but not because I don't have anything to say or anything going on. There's been too much of both: too much to think about, too much to plan, too much to do, too much to feel, and not enough time to do it all in.

Some of it has been dull: grading 40 papers and teaching classes and running three Junior League meetings in the span of a week.

But some of it has even been good.

On Sunday, Lawyer Guy and I cooked a Fakesgiving feast for most of my family (my parents, two of my sisters, and one sister's fiance). We used our All-Clad turkey roaster for the first time and made our very first turkey, a 12-pounder that turned out perfectly, succulent and juicy and golden brown. Go us! We also made two kinds of stuffing (sausage & sage and caramelized onions & herb), pureed sweet potatoes with molasses butter, roasted brussel sprouts, green beans in a mustard-bacon sauce, arugula salad with roasted butternut squash and cranberries, kale chips and fennel parmesean dip as appetizers, and a caramel cake for dessert. And we made every bit of it from scratch (except a pumpkin pie, which we bought, and the gravy, which my mom made). We had bourbon/apple cider cocktails and champagne and it was a great time, even if it took us four hours to do all the dishes (we did them together while I simmered a turkey-carcass stock in our giant 12-quart stock pot).

This was all made more difficult, though, by the fact that I had--and still have--a really nasty headcold: sore throat, hacking cough, sinus pressure, stuffy nose. We were supposed to go up to West Point with my family on Saturday for the Army-Air Force game, but my cold was at its worst so I stayed home to rest up and ideally recuperate. I am doing better now, but am still pretty uncomfortable. I'd love to take a sick day from teaching, but I've had to use them all for fertility related appointments.

Which, speaking of, I had another one of on Monday morning (CD 10). I'd been feeling really disconnected from this cycle--I feel like I'm still getting over the disappointment of the chemical pregnancy and haven't been enthusiastic or engaged in this current cycle at all. I also wasn't feeling the same intense ovarian reactions that I did last time (despite starting the Clomid three days earlier) so I wasn't terribly optimistic about how things would be going.

Turns out, I know my body pretty well: I had one (count 'em, one) follie at 14 mm on my left ovary. Nothing else over 10 on either side.

Ho hum.

I know one is better than none. And I'm glad that my lining was at 6.9, which seems okay for CD 10. But I couldn't get a good pregnancy out of last cycle, and I had two follies then. I don't have much hope for one. Plus--I fully admit this is irrational--both times I've gotten pregnant it's been from my right ovary. I have this feeling that the left is not capable of stepping up to the task (then again, both those pregnancies didn't last, so maybe the left side would have a better track record in that regard). I go back tomorrow morning for more monitoring, to see how things have progressed. Dr. Wonderful suspected the IUI would go forward this weekend, but she said if there hasn't been any progress at my next appointment, they'll give me another dose of Clomid and the egg will drop the weekend afterward. I'm feeling some sensations in both ovaries, so I suspect that some growth will have occurred, though I obviously can't predict how much.

After the ultrasound, Dr. W. sat and talked with me for about ten minutes about last cycle and how I'm feeling about everything. She is so amazing. She told me she definitely views last cycle's outcome as a positive. She said she knows that the psychological torture of waiting is the hardest part in all of this and encouraged me to embrace my hobbies and do whatever I can to help distract me during this time. She also said "There is light at the end of the tunnel. You are going to be pregnant." I really love working with her and I'm so glad we followed our instincts and chose her.

I've been a little freaked out, though, I have to confess, and it's entirely my own fault. I asked Dr. W. what comes next if this cycle doesn't work. While she said that she wants to go one cycle at a time and not get ahead of ourselves, she still gave me an indication of what she's thinking will follow: one more Clomid+IUI and then...IVF!

Ah! Those letters! They strike fear into my heart.

Now, Dr. W. said she would advocate for IVF as the next step because she fears the risk of triplets is too great for my case if we do IUI + injectibles. But she also said we'd have to talk about everything before making decisions about what to do. And I know how kind and lovely she is--if we tell her we're just not ready for IVF I think she'd let us make an attempt with injectibles/IUI just to see how it goes. And she's right, triplets are not an ideal outcome. My anxiety would be off the charts if I were pregnant with three babies, plus I'd likely have to be on bed rest for a very long time, which has complications of its own. And then, you know, three babies.

But the risk of triplets is only three percent (which doesn't sound like much to me). And everything in an IVF cycle (meds+procedure) would be out-of-pocket for us. We're financially capable of doing IVF at this stage, but not financially prepared: the lovely In-Case-of-Baby cushion we've rebuilt over the two years since buying our apartment would be reduced by jumping into an IVF. We'd need to talk about this a lot and save more money and possibly chat with our parents before embarking on such a step.

I'm also not even close to psychologically prepared. I still, if you can believe it, don't actually think of us as infertile! There are still many times when I think to myself that all this happened because I worried too much and put too much pressure on Lawyer Guy at the beginning and couldn't take things easy and (yup, here it comes) just relax.

I just have to cross my fingers and hope that one of these Clomid cycles will be the trick for us. I'll just have to pray that poor Lawyer Guy can hang on to his ever-fraying confidence and sanity and endure just a little bit longer. During a phone chat with him on Monday, I reassured him that "We are going to be such great parents because of going through this, and we are going to be so unbelievably happy because of how sad we are now."

And he replied, "Yeah, we've been telling ourselves that for almost two years."

So my consolations are a little thread-bare and my hope is definitely dented and my heart is very bruised. But my doctor says there's a light at the end of the tunnel and some days I almost think I can see it.

Patients and Patience; or, In Which I Become Yet Another Clomid Victim

I've been riding high the past week, so I suppose some sort of crash was inevitable. This crash is small and recent and nowhere in the vicinity of the dark, sad pit I felt trapped in for much of the summer. It's more of a go-kart upset than a 747 falling from the sky. Nevertheless, my exuberant optimism and hope of the past five days has definitely dwindled to a more depressing (and probably more realistic) level.

I have two follies developing on my right ovary, both at 14mm. Dr Wonderful said I was responding "perfectly" to the Clomid and that I will probably trigger at my next monitoring appointment on Sunday morning, IUI to follow on Monday (Tuesday at the very latest). This is all marching along quite swimmingly: Lawyer Guy has off on Monday for Columbus Day, so the IUI appointment will cause no problems at all if we can manage to do it then. And my experience with Clomid has been easy and uncomplicated. No mood swings, no hot flashes, no cysts (yet). Nothing but the occasional fleeting headache and a crampy twinge or two in my ovaries.

So what's the problem? you ask. Why have I gone from blissfully imagining bringing my twins (hello, two follies! Of course I'll have twins!) to my sister's wedding next summer to sighing on the subway as I contemplate starting this whole messy process over again next cycle?

In a word, I have fallen prey to the evil Lining-Devouring Monster that is Clomid. My beautiful 12-13 mm lining is only 5-something mm. I thought I was immune, but not even my overactive uterus can overcome Clomid's death rays. Sigh. Grumble. Moan.

I must point out that Dr. Wonderful did not appear at all concerned about my lining. She didn't mention it other than in an off-hand way as she was tallying up the stats during the ultrasound. In fact, I asked her about it after she finished the u/s and she gave me her opinion that, although Clomid does lead to thinner lining, it still increases the chance of pregnancy. Plus, I suppose there's a chance my lining could improve over the weekend with more red raspberry leaf tea. And there's the salient fact that all my months of perfect, plump, enviable lining did not get me pregnant, so who's to say something a little slimmer can't get the job done.

Still, it's a bit disheartening, especially to someone who's faced a lot more downs than ups in this babychase. I've resisted the urge to google anything about thin lining and pregnancy rates because I want to relinquish control over this to my doctor--that's why we're working with her, after all. It's just that it would be so amazing to be that lucky girl who gets pregnant on her first treatment, her first month of Clomid, and now I don't think it can happen.

Dr. Wonderful said to take a pregnancy test two weeks after the insemination. That will be the first hpt I've taken since last October. And, most likely, the first negative test I'll see since the last pre-pregnant one I took in June 2009. It's probably good that my hopes are tempered and my expectations diminished, given that I will need to pick myself up after seeing that one line.

Dr Wonderful said when she walked into the exam room that I won't be a patient of hers for long. But maybe to prepare me for disappointment, she told me before she left that I need to have patience during this process, because it will work for me even if it takes a little while. I said that patience is one thing I've learned over the past year, which are fairly grand words. I hope I can live up to them.

Dr. Even-More-Wonderful; or Results and Predictions.

I got confirmation today that I am indeed a smarty-smarty, because my haphazardly chosen nickname for Dr. Wonderful is turning out to be so, so apt. She is really wonderful. I have never felt such relief and comfort after having radioactive dye injected into my nether regions.

So first of all, the results of the HSG were all clear: no obstructions in uterus, tubes flowing freely, everything where it should be and looking good. I was SUPER nervous for the procedure, but Dr. Wonderful talked me through it, making sure I knew what was going to happen at each step, making little jokes to calm me down, and even switching to a smaller catheter when I seemed to be having a lot of discomfort from the original one. She was so great.

Then Lawyer Guy and I headed back across the street to the clinic to monitor my response to the Clomid and to talk about the results of last week's SA (because Dr. W called me, LG never got a chance to speak with her about them). My follies are all still really small, so Dr. W said to come back on Friday to check them out again. We may need to bump up an additional round of Clomid at that point if they still haven't grown much, but she's hopeful she'll be able to do the trigger then and schedule the IUI for the weekend. I hope it can work out that way!

Then before we all left, Lawyer Guy and I had a chance to ask her a bunch of questions. She said she's not terribly worried about his morphology results-- she thinks it's the least important factor in the SA and that while it could be contributing to the delay in our conceiving, finding it wasn't an "a-ha" moment. Then she actually said that she doesn't think we're technically infertile! She thinks the timing maybe hasn't been quite right yet, maybe there was a little mucus in the tubes that has now been washed out, maybe some little thing here or little thing there hasn't been matching up and that's why we've been having such trouble. She also speculated-- while cautioning us that less invasive methods will probably work but require a certain amount of patience-- that she thinks she will be able to help us get pregnant within the next six months!

As much as I am super wary of letting myself think that optimistically, it was such a relief to hear her speak with confidence. After spinning these doomsday scenarios in my mind of IVF with ICSI and months and months of saving and draining our accounts and spending years on this, six months sounds like a weekend! I have to laugh a little at how dire I once thought waiting six months to get pregnant would be, while now it sounds like no time at all.

I feel much better today than I have in months. I could be doing an IUI very soon. And while this cycle might not pan out, that's okay. We've survived worse and we can survive that. One of these days something is going to go right for us, and for the first time in forever I don't feel like I'm the one who has to make it happen.