Christmas Packages; or, What's in the Fridge?

Do you know what this is?

That's 2,400 iu of Gonal-F that's currently sitting in my fridge just asking one of my sisters or parents or in-laws to visit and get all confused and concerned about it. And I am freaking excited!

I mentioned a few weeks ago the upcoming conversation that Lawyer Guy and I will need to have with Dr. Wonderful about whether to go for an injects+IUI cycle or straight to IVF. I think I also mentioned that a lovely friend of mine from my loss/IF message board is now pregnant and was looking to unload some unused Gonal-f. In the beautiful manner of todays' interconnected world, these eight 300-iu Gonal-f pens made their way from one end of New York State to the other. I can't thank her enough for sending them. Our insurance doesn't cover injectible meds, so a stash this big would have cost us quite a lot.

You know, as sad as this may sound, I think this package of meds and needles may be my favorite Christmas present this year. As long as Dr. W. agrees, we can now afford to go ahead with one (and possibly more than one) injects+IUI in the spring at no cost. We've got some real options other than IVF, and options are what makes IF most bearable.

I'd be tempted to ascribe my jolly mood to the meds in the fridge, but truthfully, I've been feeling optimistic and happy and hopeful for several days now. This is unusual: I'm in a two-week wait. I'm set to get my period on New Year's Eve. This will be our 11th failed month of TTC since last year's miscarriage. And I've been a massive Grinch up until now, as has probably been clear from this blog.

But I ovulated! And we had sex! And even if that doesn't (and there's a 97% chance it won't, according to our docs) make a baby, it still means we're starting a new treatment cycle in less than two weeks. And that really might make a baby! And once we're done with the Clomid route in February, we've got the wherewithal to try something new! And we'll save all we can in the intervening month to lessen the financial blow of IVF, if it comes to that! This is really going to work for us!

I've finally caught a bit of the Christmas spirit. Thanks to a ziploc bag of needle pens I pray I'll never have to inject into my stomach fat.

Happiness Is; or, More Year In Review

Yesterday, Pissy gave me my first Peak reading of this natural cycle. (Day 18! Not bad for me unmedicated!) And last night, Lawyer Guy and I did what baby-making people do on Peak days. And two weeks from today, I think we all know what's going to happen:

I'm going to get my period on a beach in the Bahamas.

But at least I'll be on a beach. That will make me happy. And at least I'll have my bottle of Clomid close at hand and can start popping pills three days later with an actual sense of hope about my January cycle. That makes me happy, too.

As I think back over the past year, so much of it did make me happy. And not just the usual "Husband, Dog, Family" kind of happiness--some really great things happened in 2010! And whaddayaknow, here's a list of them:

- We got built-in book shelves and our pantry closet redone. Both of those things make me *so* happy. I open the closet and just stare at it sometimes or sit on the couch and look at the shelves. I love feeling like we are turning this apartment into a real home (and I love storage space in a way that only long-term New Yorkers can understand).

- I had the best birthday ever and the best birthday party ever! Turning 30 was kind of great-- good food, great party, lots of people who love me surrounding me, and the feeling that I am entering a new phase in my life.

- Lawyer Guy got a promotion at his firm. He had been feeling frustrated about aspects of his job the last few years, and this was such a reward. It helped restore his pride and sense of accomplishment at a time when he really needed to feel good about himself.

- I didn't fail out of school! I was actually productive and got some academic shit done! I have not yet permanently destroyed the scholastic dreams of any of my students!

- Two of my sisters moved to NYC, and I now get to spend so much more time with them. It's such a blessing to have them close by after years of being dispersed across the country.

- I spent lots and lots of time at the Metropolitan Opera, my favorite place in the city. Everything about being there makes me happy.

- We started working with a fantastic RE at a great clinic, and she helps me stay hopeful and optimistic by being confident in our future success and so damn competent.

- I got to go on a bunch of cool trips to cool places with my wonderful husband (our cruise; our Scandinavia trip, weddings in different parts of the country). I love traveling with him so much--we get to be a little more adventurous and spontaneous than in our normal lives. (We've also got some great trips in the works for this upcoming year that I'll spill about in a future post).

- I got to know some incredible women through the ALI community, to laugh with them and cry with them and know that we're all together when we succeed and when we fail.

- Okay, yes, and the husband and dog made me very happy, too.

There were also a lot of moments of quiet happiness this year not related to any specific events. Just times of walking outside and feeling at peace and feeling grateful for that peace because the memories of overwhelming grief were fresh. I think I'm coping better with all of this than I ever have before (or thought I could). And that makes me happy, too.

Looking Backward; or, Last Year's Wishes

I gave up on the idea of New Year's resolutions a year ago. The fact that nothing I wanted out of 2010 could be gained through resolving to gain it just showed up the emptiness of the concept. I want a baby. Obviously. More than anything. And I will do whatever it takes to get one. And that might not be enough. And I don't have much control over when it will happen, if it ever does.

Sucks. But that's life.

Instead of resolutions, I made a series of posts about my wishes and my plans for the new year. And I figured I'd look back now--just a few weeks away from flipping to another new calendar--to see how things panned out.

Let me be blunt. My wishes didn't come true. I did okay with some of the less specific ones (like wishing that I'd appreciate my body for the things it can do rather than what it can't), but I just threw those in so I wouldn't seem totally grabby and But-I-want-it-NOW-y anyway. The big stuff, the real wishes, those didn't come true.

(Well, I guess technically I did get pregnant this year, too, which was Wish #1, but considering I never even got to feel excited while looking at the pee stick, I'm calling that one a draw).

I'm not even going to bother with writing out a new list of wishes this year. Just look up the old ones and plug in "2011" for "2010" because they're all the same. Oh, but you can change the first wish to "Get pregnant with a healthy baby that doesn't die or have serious genetic abnormalities."

When I look back over my plans for the year, though, the story is different. I did pretty well! I broke the plans into two different categories: Intended Achievements and Intended Explorations. I purposefully set pretty modest goals for each category (not "Lose 20 pounds and Run a Marathon," for example). And I managed to accomplish almost everything I set out to do.

I completed all of the scholastic tasks I set for myself, with the exception of taking my oral exam. But I have a date set for that in May, so I'm feeling pretty good about my progress.

And I accomplished all of my Intended Explorations! I started a regular yoga practice--I may not be an expert yet, but I've grown stronger and more flexible and I've stuck to a work-out program for almost a year. I did go to Scandinavia with Lawyer Guy, and we made an effort to check out the Brooklyn culinary scene. Not bad!

Re-reading my hopes for the year and seeing that I was able to fulfill so much of what I set for myself is a nice little boost in a depressing season. My wishes didn't come true, but that doesn't mean I was unsuccessful in everything in my life. I'm going to make a similar list for 2011 in an upcoming post with similarly modest goals. I may not feel the incredible surge of pride that I would if I resolved to swim the English Channel or finish my dissertation by next year and then succeeded. But when what I want most feels so out of reach, it's nice to have a few goals I know I can accomplish.

Reminders; or, Fun with Pictures

From Busted Kate:

Christmas Ghosts; or, Two Is the Loneliest Number

As everyone in America with eyes, ears, and/or a brain has by now realized, Christmas is coming. I know I don't need to tell you how overwhelming and even depressing it can all be: the commericals filled with beaming babies, the orderly rows of children in the holiday cards on the mantle, the emptiness between the two stockings hanging over the fireplace. The trials of holidays for the barren are familiar and well-documented, and I'm not sure what I can add to the story.

Other than my observations of the differences between this year and last year. Last year was awful. I had miscarried only a few weeks before and was still dealing with crashing hormones for all of December and most of January (it took nine weeks for me to get a normal period after the d&c). Lawyer Guy and I were fighting, both so on edge with grief. I cried most mornings before I got out of bed and every morning in the shower. I cried most afternoons, too. During that winter break, LG would come home from work to find me huddled in a ball on the couch, my face red and swollen from tears and a permanent groove etched in the cushions from my refusal to move for hours at a time.

And yet, in some ways, this year is worse. My emotions are more settled, but less intense. I'm not aching with grief, but I'm also not buoyed by hope. Even though I was sunk in misery a year ago, I was also acutely aware of how beautiful Christmas was and how much I needed it. I took such pleasure in decorating my tree and listening to the Charlie Brown Christmas album on repeat and drinking hot cocoa in front of the fire and walking through the freshly fallen Brooklyn snow on New Year's Eve, listening to church bells ringing in the quiet and telling myself that a new year was coming with the promise of something better, that if I could just survive the awful pain I was in I would soon be rewarded.

At the end of 2010, I know that isn't true, and I'm terribly afraid that a new year signifies nothing except new ways to be disappointed. I force myself to go through the motions: pulling out my decorations, lighting Chanukah candles, trimming my tree, picking out gifts, and designing a holiday card. But it lacks the joyfulness I have always felt in the past at this time of year, that extra sparkle that gives life its special glint.

For example, the past three years, I have insisted we send out cards with our pictures, to show that we're a family just as much as anyone else. Last year I sent out a card with THREE pictures, taken on our vacations in Rome and London (my little "Fuck you, I get to go to Europe whenever I want" to everyone with babies). And this year, I just don't have the heart to pretend anymore. I can't find a single picture that I like-- I look fat in all of them, or sad. But that's not even the real problem, which boils down to the fact that every picture of the two of us is missing someone and looking at them reminds me of the fact. And every ornament I hang on the tree isn't one that I picked out for my baby. And every Christmas song I play on the iPod isn't one that I'm introducing to my child for the first time.

I guess right now I'd prefer grief to gloom because even in the depths of misery we know that it has to end, but lethargy and discontent can go on forever.

And yet I do have some hope, however flickering, a little candle's worth, that maybe saying the magic words "This time next year" will work. And I do like the card we're sending out, picture-free and everything: two little birds in a tree, all alone except for each other.

Past and Present; or, How to Handle a MTHFR

Thanks to everyone who commented or e-mailed me with your advice on last Friday's post. Your suggestions were invaluable and have helped clarify some things for me. I'm so grateful to have a community of women who have been in this position to turn to when things become challenging.

Lawyer Guy is going to find out the max allowance for the FSA today, which should help clarify matters. He's also going to confirm that fertility treatments are permissible expenses (I'm sure they are, but we want to be extra-sure). Additionally, a friend of mine from my message-board support group (who is currently pregnant) offered to mail me several unused gonal-f pens of hers, enough it seems to get me through one round of injectibles+IUI. Given all this, we're leaning really heavily to putting $5000 or so in the FSA (or whatever the max is) and trying to do at least one, maybe two IUI cycle with injects. If the meds are free for the first it will be quite reasonable to pay for both, and I agree with all my bloggies who said it's a good way to test out my response to the stims before the high pressure of an IVF cyle commences.

Obviously, this is all contingent on the outcomes of the next few cycles and our conversations with Dr. W. But I feel like I have some perspective on the situation and a plan, and that always helps.

Also giving us some clarity (though not as much as we'd hoped): Dr. W's office called with the results of my RPL testing today. I tested positive for hetero MTHFR mutation, but everything else was normal. The nurse said that Dr. W is not concerned about the hetero mutation and doesn't fall in the camp that associates it with higher risk of pregnancy loss. The only snag is that the lab didn't test my homocysteine levels, so I need to have another draw to test that when I go in for monitoring for my January Clomid+IUI cycle.

While I'm a little nervous about the hetero MTHFR, I'm beyond relieved that I have no translocations or abnormalities on my karyotyping (and that LG is also free of them). Hetero MTHFR seems to be very common, and I've seen many women identified with it who have healthy pregnancies, so I'm going to hope that it won't cause any harm and that my homocysteine levels come back normal-- or, if they don't, that there's an easy fix for that.

Other than some reflection on hypotheticals and a smattering of test results, not much is happening reproductively right now. I should be getting back together with Pissy in a few days. I think she'll be happy to see me again, but you never know with her. I'm still buried under a mountain of student essays to grade, and after I finish that comes the preparations for Christmas, and then our New Year's trip to the Bahamas, and then AF right when we get back. And then it's 2011 and a new year and a new cycle, and this time a new year is going to actually signify something new for us, dammit.

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!