Home and back at it

Irish countryside. 

We had a fantastic vacation.  The kind that really fills your cup.  I hardly thought about our infertility. We took a tour with a travel company and also explored independently.  We went to England, Scotland, Ireland and Wales.  We met some amazing folks on the tour and our guide was awesome.  We never thought we would be back to that part of the world so soon again, it felt like such a blessing.  The canceled cycle last month meant that we could take advantage of free flights because of some volunteer work that D does.  It sweetened the blow from last month significantly.

One of my favourite parts of the trip was getting to meet three people who have fostered children.  One couple from the USA and another from Australia.   Last month, D has asked me to consider this as an option again.  When he did, I shut him down.  It was a poor response.  The timing was off, I wasn't in the right frame of mind to discuss it after our last canceled cycle.

There are a few things that freak me out about fostering. In order, they are:

1.  When the the child has to be taken away.  By a country mile this is by far my biggest fear.  I feel like this is exacarbated by infertility.  It would be hard for anyone. After 5 years of desperately trying for a child, and my emotional bank account is very sensitive/low in this area.  I don't know if I could take the hit.

2.  Fear that I wouldn't have the experience/ability to handle the emotional issues that the child has in an adequate way.  That I would get in over my head.  Hmm... now that I really think about it, if I'm really honest, this fear is probably right up there with number one.

3.  Loss of my personal time, space and freedom.   I don't like admitting that, but it's real.

In talking with one of the other couples on our trip, I learned a few things.  The one couple has fostered many children over the years, including what they say were some children from high profile cases.  They've been through some difficult stuff.  What I took from our conversations:

1.  That when the first child leaves it is often the hardest.

2.  That you can stay in touch, and remain a positive influence on the child's life.  I don't know why this is such a revelation to me, it might seem obvious but for me, this was a huge weight lifted.

3.  That you can ease into this, and have an honest communication with the social workers about what you are prepared to handle and not handle in terms of emotional issues with a child.

4.  They take lots of breaks in between children.

5.  She talked about how she feels they are making a difference in the world.  She told me about how she gave an 8 year old his first ever birthday party.  This gives me a lump in my throat.

I won't say that I'm totally ready to move into fostering, but there was a huge shift that happened for me.   I've always thought that seeing different perspectives was one of the most enriching parts of travel.  Who knew it was going to be regarding foster care in a pub in Dublin?

I haven't discussed any of this with D as of yet.  I want to digest it on my own for a while.

Oh! And today is cycle day 2 again.  Baseline ultrasound revealed a cyst again.  It's likely the same one, but it about 1/2 the size as last month (1.2 cm x 0.80 cm).  My estrogen is low (in the 30s), so it's not an estrogen producing cyst.   I won't hear until this evening from CCRM about what the plan is.

To add a little complication to things, on cycle day 21 is the wedding that D & I are standing in.  Looking at previous cycle's instructions from CCRM, they estimated a tentative retrieval date of cycle day 11.  Which seems like a lot of leeway.  But, the only other time I did IVF at my local clinic, I stimmed for 16 days while on close to the max dose (300 units of follistim).  That cycle has many medication differences, a big one being that I didn't start stims until cycle day 6, and CCRM would have me start tomorrow (cycle day 3).

A lot will be decided in the next couple of hours.

Fertility frenzy

So, my period showed up on a Saturday.   I called my local satellite clinic and asked if I could come in for my baseline suppression check.  They told me that they can do the ultrasound but there is no one to do the blood.  I will have to go to another lab to get that done.  I say that's fine by me.

I try to pick the lab and verify their hours, but I can't dial any of their 800 numbers because I am calling from out of country.  So, I call the nurse back to ask for her help.  She says not to worry because the technician is going to come in for me.   Phew.

I have my blood drawn then go for my ultrasound.  And, she finds another cyst.  This time it's bigger than the last.  I try to remain composed until I leave the office.  I thank them for all of the organizing that they did for us.  They tell us they will see us next month.

I cry for the hour drive home.  The last time they cancelled the cycle my blood work was ok, but the cyst was over their maximum 15mm threshold.  I know it's over for this month.  Also we figure it out and think that July is likely a bust too because it's right around the time we would need to be at CCRM we are both in a wedding.

Cue a massive dose of feeling sorry for ourselves.  I feel like this is it.  This is the end.  This is all I can take.  I want to move on to greener pastures.  I am done with this bullshit.  I'm done feeling bad all of the time because of this.  I have very limited emotional strength left and I want to use it up on something that has a higher chance of things working.   Maybe we should donate the $5,000 of meds we have at home and move on to egg donation.   D starts talking about fostering.  I envision having a foster child, getting attached and then the child being taken away from us.   I snap back at D no way.

We got a call from CCRM that my blood work is showing as within the acceptable range.  My estrogen was 55 and my progesterone 0.5. Whoop-de-do.  Dr. Surrey has reviewed everything and if we can have it aspirated that day, or the next day we can proceed with the IVF.

Huh?

We're confused but happy.

We call back our local clinic to see if the cyst can be dealt with within the 36 hours.  The doctor that is supposed to be on call isn't there.  He apparently reviewed the clinic's cases and then went on vacation with his family because their was nothing on their docket.  I was not because I am a satellite patient and I did not call in to say when I was expecting my CD2 (which I was not asked to do, nor do I ever even know in advance).

The nurse tries to call back of the on-call doctor with no luck.  Then she tries to get a local hospital or OBGYN to help us.  Nothing.

We call CCRM back and ask if the cyst can just be aspirated within 48 hours, on Tuesday.  What's the difference of 12 hours, right?

CCRM says no.   She also tells us that there's a possibility of the cycle being cancelled within the first 3-5 days of starting stims if the cyst comes back.

We go and do a quick errand for a friend.  Then we laid around the house and felt sorry for ourselves.  In the process we made a big mess of our house.  Eating pizza.  Laying in bed.  Laying on the swing outside and reading/surfing.  Acting like complete pigs.

We thought up a new plan.  We call a friend whose wife is a physician.  Maybe she has some contacts that could help us?  They don't know about our IF, but we decide to disclose because this is important.  She does not.

We called our fertility clinic from three years ago.  We have their on call number and think maybe the doctors are doing procedures on Memorial Day?  Maybe they would consider this for us because we are previous patients?  We call but can't get past their after hours secretary.

Our satellite clinic calls back and suggests that they can do the procedure first thing on Tuesday.   We think about lying to CCRM and just doing it "our way" anyways.    We remember the little talk CCRM gives everyone on their one day work up about us coming to CCRM for a reason, and trying to follow the doctor's advice, if you want the doctor's success rates.   We decide that it's a bad idea to lie.

We suddenly think, "why can't we go to Denver for this?".  We call CCRM and they squeeze us in for an appointment at 10:30 a.m. the next day.  It's now 5:30 p.m. We tell them we will check flights and call them back.

There is one leaving in 1 hour 40 minutes.  But the airport is at LEAST a 1 hour drive from our house.  And it's a long weekend with city traffic.   The flight is not cheap either.  We decide we can't make it in that time frame.  If we had 20 minutes more we could have made it work.

We decide that maybe our local Canadian doctor's office might be able to do something tomorrow.  It's not a holiday on Monday.  Maybe that will work?

I call first thing in the morning, but my OBGYN on vacation.

I call a local fertility doctor.  Maybe he'll be sympathetic?  The secretary says they only do it in in an operating room, and there isn't one booked for today, so he can't.

We give up.  It's over for this month.

Pretty much if my period came on ANY other day this month it, or we had thought of traveling to Denver just a little bit sooner, we could have worked it out.

The only silver lining is that we have a sweet mostly free trip now booked.  D gets the trip because of a volunteer position that he holds.  We were going to skip it, but now we get to go.  England, Holland Luxembourg and Belgium here we come!

PS) Any favourite destinations there? We are taking suggestions!

Here we go again

Rolling the dice on CD 1 again.

Wonder what's in store.  Will it be a nice plump cyst for month #3? A plump cyst that produces estrogen? A small cyst?  Or a green flag from the doctor to attempt IVF #2 (procedure number 8.5 - who's counting though?)

While I'm glad my period did finally show up, it didn't come without a bit of drama.  It interrupts a weekend we were planning with D's parents.  I was already not sleeping well just thinking about this weekend.  I enjoy their company but I really need it in smaller doses.  They have some odd habits, including ones surrounding their cat (who travels with us!).

I wasn't totally geared up to go away with them yet.  So maybe it's a blessing in disguise.

I'm really glad my period didn't start late in the day today because that would added considerable stress to the situation, we would have been several hours in the opposite direction as our clinic.

Second silver lining...an entirely free weekend!  :)

What the doctor said about the cyst

He said that we have to wait until my next period.  That he doesn't want me to take any more medication.

They will wait until then to see if it goes away on it's own with my next period.  If it is still present they will address it.

The nurse said they wouldn't have seen this on the laparoscopy because it is likely inside my ovary.

She also said that sometimes they can linger for months.  She said that they shouldn't be growing because it's not a good sign.  I asked her what that could be a sign of and she said that it could "impact the ovary".

My friend had a cyst in her ovary and it ruptured, causing her to lose hers.  I wonder if this is what she means?  In a way if I lost both of my ovaries next month in some weird way I might also view it as a blessing.   These damn shrivelled up, barren little things have caused me nothing but unhappiness.

She said that there is nothing I can do to make it go away faster.  She said sometimes they give people birth control, but with me they just wanted to see if it would go away on it's own.  I'm good with that approach.

D & I had a big talk today about our next steps.  I'm mostly too exhausted to write about it here today.  Maybe in a few days.  I've been in IF overdrive and I need a break.

Thank you for all of your kind words of support.  Today it felt like all I had to hang on to.

April showers

My lovely D has been having a really hard time lately.  He's feeling really low.  As he tells me, all of his buckets are empty.  His career bucket, his spiritual bucket (largely because I've been very disconnected), his family bucket (he views as children), his health bucket (he views as how he is taking care of himself), his friendship bucket.

I try not to take it personally when he says this.  Especially because all I'm really thinking is "what about me? What about us? Isn't the us bucket good?"  It's kind of the one thing that I hold on too.  I've told him how I feel (similarly in many cases) but that it's the us bucket that keeps me going.  That if I didn't have him, if I imagine my life if we had never met, I would feel much worse than I do today.  I'm sure of it.

I've realized he thinks of the us bucket a little differently than I do - to him the us bucket is a lot about how I'm feeling.  Is this the old adage "happy wife, happy life". It makes me feel crummy that I can't be happier more often, for his sake.  I view the us bucket more about how in sync we are and how we are getting along on a day to day basis.

Last week was especially difficult for him because we were babysitting my best friend's two kids.  I've been encouraging her to go away with her husband since a year after her first was born.  They've only ever taken weekends away, and their marriage has been strained at times because of it.  They decided to take a trip, and I watched the children from 3pm to 8am.  During the day, they went to school and their baby sitter's.   D spent a few evenings with us and put the 2 year old boy to bed a few nights in a row.  The boy is cuddly, giggly and happy.  He has the brightest blue eyes and wavy blonde hair.  He's just starting to talk.

The little girl is the one who I measure our years by infertility by.  Her mother and I both started trying within months of each other.  She got pregnant right away.  I hate to associate something negative with such a beautiful little girl but it's hard not too.   She's in her first year of kindergarten this year.

I thought the boy liked me until I saw him with D.  He just loves being around men.  He cuddles with them, and wants to play with them.   My friend says he's a Daddy's boy.  So it's no surprise to me how much he loved playing with D.

They played so easily.  D even put him to bed was such a nice thing to watch.  It was also difficult from an infertility perspective,  as I know you can imagine.  This was D's most emotionally significant child care experience.  He told me that it made him realize even more about what we are missing.  And about what other people have.

On Friday, I went to my local clinic for my CD2 baseline blood work and ultrasound.  I've been doing the preparatory meds for a month and my blood work has so far been all been good.  I was feeling positive about the upcoming cycle.  I was thinking that this could be our time, maybe, just maybe.

During the ultrasound I was chatting away with the nurse.  I answered her questions about our new protocol.  I told her about our travel plans.  I wasn't even paying much attention to the ultrasound screen.  Normally I would have my eyes glued to it.  The nurse waited for a lull in the conversation and said "I think you have another cyst".

I looked up at the screen to see another large black hole on the ultrasound screen.  They took extra screen shots of it and sent me along with a package of information regarding the previous cyst and this new one.  It is on the same side as the last one, and slightly larger.

I was and am so confused.  I had the laparoscopy in February.  The doctor said he didn't see the cyst, that it had gone away.  I questioned the CCRM nurse about this and she said there is a possibility that the cyst was inside my ovary which is why he didn't see it.

I'm so pissed.  I'm wondering why they didn't do an ultrasound to confirm that it wasn't there. If it was why didn't they aspirate it?

My reaction to all of this is a hefty dose of numbness.  It's just another bump in the road.  I'm pissed and disappointed but not devastated. The nurse told me to wait until I got my blood work back to see if this was an estrogen producing cyst or not.   She said not to be so sure that the cycle was cancelled.

I came home and told D.  He was very angry and sad.  He told me (again) that he's done with all of this.  This time it was with an intensity that I haven't seen before.  Maybe that is because of how down he's been feeling, the babysitting, the other things going on in his life.  He told me he wants to foster. To do something.  Because in his mind this is not going to work.   Ouch.

That my friends, makes my heart sink more than anything.  He's always been more negative about all of these infertility procedures.  I've just accepted that as the way he copes.  And to be honest, he's been right.  Nothing has worked.  We've only been dragged through the mud for over 5 years.  Why should we think otherwise?  Why am I doing this to him?

Later in the day the nurse called back.  My estrogen was 33 and my progesterone was 1.3.  I regained a slight bit of hope.  When the CCRM nurse called though she said that the estrogen level was ok, but the cyst was too large to proceed.  Dr. Minharez (sp?) consulted on the case in Dr. Schoolcraft's absence.  She said that with a cyst over 15mm (this one was 17 x 21mm) that I can't proceed.  She officially cancelled the cycle.  We now are waiting for Dr. Schoolcraft to return.  Perhaps we will try a different protocol.  Maybe we won't.

Things I'm left wondering... Is this our final sign to move on to egg donation? Is D really at the end of his rope or was he just responding out of his frustrated and depressed state?

Sidelined

Well it's official, I've been sidelined.

The doctor says that cysts over 15mm will impair the way my body responds.  The nurse said that with my history we need "all our ducks in a row".  She's hoping it resolves itself by next month.

The good news - I called right away to get my laparoscopy/ligation moved.  And within an hour I got a call back! I'm tentatively booked for February 19th.  The coordinator just needs to double check with the surgical department before we book our flights.  Worst case scenario it will be later in the week.

Maybe they will be able to drain the cyst while they are in there taking a look around?  It could be an added bonus.

I feel like we've just dodged a huge bullet.  It's not what I obviously would have planned, but I'll take it.

This change of plans might also lend itself well for me having my aunt as a travel companion.  I'm trying to see the silver lining.

CD2 Labs

My CD2 labs are:

Estrodiol 302
Progesterone 0.4

I guess that means the cyst is an estrogen producing one.  I looked back at my last IVF labs.  On CD3 My Estrodiol was 3.5 and my Progesterone was 0.2.

They didn't ask for my FSH or LH to be run this time.  Weird.

I'm waiting for a call back from Colorado, to see what this means.

Fertility Karma?

Yesterday I was all "look at me, I've had 15 baseline checks and I've never had a cyst".  

Today, I spent 25 minutes on the second day of my cycle in stirrups at my local RE's office.  The first nurse (who I know well and trust) had a hard time locating my left ovary.  This didn't freak me out because it always hides.  She's a lazy-lefty.  It is only CD2, so I figured maybe it was just chillin'.  

After 5 minutes, Nurse #1 called for nurse #2 to come in and give it a try.  She thought maybe she remembered where it was. 

I offered that I thought they usually found it under my uterus.  I also mentioned that there were notes in my records because it likes to play hard to get.  She asked me if "I had ever had a cyst before?"  I told her "no, never".  Nurse #1 went to look in my file, and asked me if I was ok to hold my own magic wand.  I felt like it was a little right of passage at the clinic.  You know you've been around along time when you get to hold your own wand.   It was surprisingly huge.  I never really made eye contact with it while it was in me before.  It was a new level of awkwardness.  

Nurse #2 entered and took over to see if she could locate it.  

After a few minutes, I told her that I knew where it was in the medical records.  Nurse #1 brought me the chart and I found it right away.   It was written in really small print so I'm not surprised she couldn't find the note. 

Nurse #2 dug around looking for gold for.ev.er.  I held down on my abdomen trying to help things along at their request.   It wasn't uncomfortable, except for the fact that I am on CD2 and that is a long time for someone to be wiggling the dildo cam in there.  

Nurse #2 asked a question you never want to really hear.   She references a large circular black mass on the ultrasound screen, and asks "Is that her bladder?"  Ummm... ok.  I'll try not to be alarmed that you don't know the difference between my bladder and my ovary.  Nurse #1 says maybe it's endometria?  She asks me if I've had that before? I said no.  

I'm starting to get alarmed.   However, I didn't show it.  I'm as cool as a cucumber, even though I have a huge cucumber hanging out of my vagina. 

I tell them to "take as long as you need.  I'm comfortable and it's all good.  I know it's hard to find". 

They apologize and tell me they just want to get this right because the results are going to Colorado.  

After a few more minutes, they call in Nurse #3 from the neighbouring clinic.  She works for a different doctor. 

She grabbed the dildo cam and announces confidently "There's the right.  Oh, and yes.  There's the left.  That's a cyst.".  

<Insert my very foul language here>

A freaking cyst.   

Nurse #1 apologizes and says because of my history, she just didn't think it was a cyst.  It measures 1.7cm x 2.2 cm.  

I get dressed and they give me copies of the ultrasound reports.  We talk about what this means.  Cysts are new to me.  I don't speak cyst.  Other than what I've read on Resolve.org I really don't know much about them.  I haven't had to learn about them.  It's a whole new game. 

I ask her "is this is a big one?"  She says "yes, it's pretty big".  She tells me we'll need to see what my estrogen levels come back as.  That they will need to see if it is an estrogen sucking cyst (I think this is the gist that's what she said anyways, shock had started to set in and I stopped comprehending well).  They want my estrogen to be below 40.  She talked about aspirating it.  She didn't talk about cancelling the cycle.  She didn't have to because the writing was clearly on the wall.   I told her about the surgery I was planning for April.  I wondered if Colorado might just switch my surgery date with the IVF date.  

This wouldn't be the best plan because I had been priming for this cycle with DHEA, progesterone and CoQ10.  But maybe it could salvage this month?

On the way home I daydreamed about donor eggs, and freaked out about my Gonal-F expiration dates (BTW,  they are 2014, phew!).  I bought myself a decaf coffee and a buttery flaky tea biscuit from McDonalds.  I cried a bit and then thought f*** it.  I don't feel like feeling like crap today.