Coming Out/16 Weeks

When I last wrote months ago, J and I were in the second half of our last “natural” (aka clomid-assisted) cycle before we would make the switch to IUI. I was debating about whether to start Metformin (never did it). I was feeling pretty pessimistic. And then, at the very end of July, we got a positive pregnancy test. And despite the obvious burst of hope, I shifted from feeling pessimistic to feeling pessimistically panicked. I kept waiting to see blood. Or to see/feel nothing, but then go in for an ultrasound and not see a heartbeat. I had some minor spotting really early on and I was convinced it was over. But when we went in for the first ultrasound at six and half weeks, we saw a heartbeat. And again at 7 ½. And 8 ½. And then we made it past the points of the previous two miscarriages. And then we made it out of the first trimester. And now here we are at 16 weeks.

We feel incredibly grateful. But I still can’t get to a point of believing that this might really end well. Simultaneously, I can’t believe that it won’t – it’s as if my brain just won’t allow me to go to either place.

Each time we go to the doctor, which has been fairly frequently so far, but which is supposed to be only monthly for a while now if I can handle it, I manage to convince myself that we’re about to learn the worst. So far, thank god, we haven’t. We’re holding our breath – between appointments, until each new milestone – and I suspect that this is how we will continue. We’re not planning, or talking names very seriously, or telling anyone we don’t absolutely need to tell. I’m thinking of the end of 2012 as a turning point; if we make it that far, we’ll start trying to move forward and plan a bit for a baby.

At 16 weeks, my back is hurting on and off, I have occasional abdominal achiness, and fairly frequent headaches. My doctor is unconcerned about all of the above and I’m trying (and often failing) to trust her. I’m not showing, but my clothes are tight. Every time we have an ultrasound, we ask the technician (who is incredible and understanding) to turn off the large screen until she finds a heartbeat. And each time we see this baby (who really does look like a baby now) moving around in there, we are in awe. I’m just not able to trust the future of this pregnancy yet; hopefully that will come with time.

I apologize for keeping quiet for so long. I started the new, totally demanding job when I was just 7 weeks pregnant, so in addition to being hesitant to write/talk/think about the pregnancy, I’ve been pretty busy. I’m hoping to post more often now… and to hold onto the possibility that this pregnancy will be the one. But no matter how this particular chapter of our story ends, infertility and recurrent pregnancy loss have and will continue to shape me, my life, and the way I will one day parent.

Where I’ve Been

I’ve been waffling about taking a break from this blog, as I’m not entirely sure that it’s helping me to focus on my infertility and loss. I mean, I focus on it regardless (and god help you if you suggest that I shouldn’t focus on it), but I’ve definitely questioned whether this blog is making it better or worse. The jury is still out. Mostly, I’ve just been busy working two jobs and applying for a third. Such a long story, but I’ll be disentangling myself from the first two in the next couple of weeks and beginning the third in about a month. The new position is a step up and a good career move and all that and I’m optimistic about a fresh start, but I’m also a bit worried about the related stress of a new and much more demanding job. I know: stressing about being stressed…. this is highly characteristic, in case you were wondering.

In the way of updates, I had some non-fertility-related health issues (seemingly resolved now) arise over the past couple of months that forced us to take a break from medicated cycles for a while. So we are just now in the middle of our third Clomid/timed intercourse cycle, which will be followed (if I don’t miraculously turn up pregnant) by a switch to IUI.

As part of preparing to wrap up an unsuccessful three months of Clomid/timed intercourse, we had a recent meeting with the RE during which she mentioned the possibility of adding Metformin to my current regimen of Clomid/Progesterone/Baby Aspirin. Despite the fact that I would take anything that might prevent a future miscarriage, I’m hesitant about Metformin, which is (as far as I understand) used in women with PCOS and/or insulin resistance in hopes of preventing miscarriage. I was once somewhat carelessly diagnosed with PCOS. I don’t have polycystic-appearing ovaries. I ovulate almost every month (there have been three exceptions, ever). I do, unfortunately, have some acne… but I’m not obese or diabetic. I’m ok with a PCOS diagnosis if it is truly accurate, but every doctor we ask is uncertain about this diagnosis. I even convinced one doctor to undiagnose me. So why Metformin? We’re not sure and it seems that our RE isn’t sure either. She seems to have a it-probably-won’t-hurt mentality and honestly, I think she’s just trying to offer us something new/different, since I think we all sort of thought I’d be pregnant by now and clearly I’m not (or at least J and the RE thought so; I always knew that infertility was as much of a problem for me as RPL).

The Metformin prescription is waiting for me at the drugstore and has been for several days. I’m not sure what I’ll decide. And I’m not sure that it matters. I feel like acupuncture/prayer/luck/the weather are just as likely to positively affect a hypothetical future pregnancy as a drug intended to treat insulin resistance. We’ll see.

Meanwhile, we’re at day 16 of my cycle, having had a positive ovulation test on day 14 (how textbook of me). Tomorrow (Friday, the 13th…. of course) was the due date of my second pregnancy. July 21st will be the anniversary of my first miscarriage. And August 10th will be our fourth wedding anniversary. That’s all I have for now.

Waiting Game/Don’t Ignore

Clomid, take two.

And now we wait. Last month, I was nervous/excited/etc through the two week wait. This month, I’m dreading testing. In the old days (you know, pre-intervention), when I felt like this, I just didn’t test until a week or more after my expected period. Since I’m now taking progesterone, I won’t get my period until I stop the pills again, so I have no choice but to follow Dr. D’s instructions and test 14 days after ovulation. And no matter how much I brace myself for a negative result, it’s never easy. And despite the fact that I hope/pray/feel desperate for a positive, that’s not exactly a walk in the park either, given our history.

There were some positive signs this month. I got my first positive OPK ever and didn’t have to use Ovidrel to trigger. Dr. D identified two mature follicles. Our “timed intercourse” was pretty meticulous. There was at least a little bit of identifiable EWCM, despite Clomid’s ironically negative effects on such things. But you know as well as I do that it doesn’t matter how hard we try, how careful we are, how perfectly things seem to line up. In the end, it’s pass/fail. Effort doesn’t factor in.

So for now, I’m trying to perfect the art of expectation-less waiting.

Meanwhile, it’s National Infertility Awareness Week and this year’s theme is “Don’t Ignore.” As I started thinking about this idea, I realized that aside from J and one somewhat fickle friend who has a little bit of experience with infertility herself, I can’t think of a single person in my real life who doesn’t ignore our infertility and experience with recurrent pregnancy loss. They acknowledge it once (or a couple of times) and then, after that single exchange, it’s over for them. They switch gears with clever transitions like “On a brighter note….” and it’s like I never said anything.

I get that it’s awkward. I get that you don’t know what to say. But just say something, anything, to let me know that you give a shit about the hell we’re living through. Because I don’t go through a single hour of my life (arguably, this involves hours spent sleeping too, based on my dreams lately) without thinking about getting pregnant. Or staying pregnant. Or whether we’ve explored all of the options available to us at the moment. Or whether we should be turning our focus toward adoption. Or whether, if I have another miscarriage, I’ll have a D&C instead of opting for another natural miscarriage. Or how old our baby would be now, if I hadn’t had that first miscarriage. Or what the chances are that those two miscarriages were just really, really shitty luck. I could go on like this for quite a long time. But you know what that list would look like, so I’ll spare you.

I find that when people repeatedly ignore what we’re going through, I feel pressure to ignore it in their presence as well. Not mention it. Keep things light. I know that’s what everyone prefers and honestly, I don’t want to give you another chance to disappoint me with your lack of care/concern/understanding. So I often keep quiet. And I don’t feel great about that, but it’s a form of self preservation to avoid comments like “you need to focus on other things” or “are you still upset about that last miscarriage?” or “cheer up” or “kids aren’t all they’re cracked up to be, you know.” In our journey so far, self preservation has been key. In case you’re wondering what would have made it different (or could make it different in the future), I leave you with a list.

Things I wish people understood and didn’t feel the need to ignore:

• This is huge. It’s not some little issue to get over. It’s our future, our family, the life I’ve been waiting for as long as I can remember.
• I’m allowed to be angry, so don’t tell me not to be. You’d be angry too.
• It’s painful to be around pregnant women and babies. I know I have to do it sometimes, but you should understand that it often takes superhuman strength.
• I’m not unreasonably mean if I don’t enjoy those 8-pictures-of-my-new-baby-collage christmas cards.
• I’m totally overwhelmed by the ballsy-ness and hyper-confidence that people exhibit when they post photos of their positive HPTs on Facebook as soon as they get them (nevermind that this is just totally uncouth).
• I never stop thinking about IF and RPL.
• I am not at all the same as I was before. Please don’t expect me to be.

Clomid Cycle One = Fail

Progesterone (suppositories) are one of the meanest tricks I’ve encountered lately. My body and my brain have spent the past week entangled in a rather epic battle. My brain told my body that the side effects of progesterone mimic those of pregnancy and I was probably just feeling those side effects (not because Dr. D warned me of this, mind you, but because I googled it as usual). My body told my brain “Shut up. Listen, I’ve been pregnant twice before – I know exactly how it feels and this is it.” Yesterday, as you’ve gathered from the title of this post, when I finally took a pregnancy test, my brain won. Despite the breast tenderness. Despite the fatigue. Despite the consistently higher-than-usual body temperature. Despite the fact that I’ve been waking up to pee in the middle of the night. Despite the moodiness.

I’ve been on Clomid before. When I was (seemingly) misdiagnosed with PCOS, our first RE prescribed it to straighten out my cycles and I got pregnant in the second month. Last time, my Clomid prescription was pretty casual: wait for your period, start taking Clomid on cycle day five (for five days), have sex every other day around the time you expect to ovulate, wait to get your period again; if you get your period, repeat the process and if you don’t, take a pregnancy test. Pretty simple. And it worked.

This time, Clomid and “timed intercourse” are much more complicated:

• Come in between 7:30 am and 8:30 am on day 2-5 of your period to start Clomid (this involves a blood test to make sure you’re not pregnant among other things and an ultrasound to see how things look)
• If you don’t hear from the doctor’s office later that day to tell you there’s a problem with your bloodwork, take the first pill that evening (regardless of what cycle day it is)
• Take Clomid for 5 days
• On cycle day 11(ish), come in between 7:30 am and 8:30 am for an ultrasound and receive instructions for when to test for ovulation, when to have sex, and when to start progesterone
• Test for ovulation as directed and when you don’t get a positive (because you have never gotten a positive result with an ovulation predictor kit), give yourself (or make your husband give you) a $99 shot of Ovidrel to force ovulation
• Have sex as directed
• Start progesterone as directed
• Wait 14 days
• Don’t test for pregnancy too early, because the Ovidrel shot will cause a false positive (learn this on the Internet, because doctor doesn’t warn you)
• Don’t wait around for your period, because you won’t get it while you’re on progesterone (again, thanks to the Internet)
• Take a pregnancy test; if negative, start over

And did I mention that our RE’s office is two hours away? And that whole “come in between 7:30 am and 8:30 am” thing is not at all flexible? Yep. That sums up my past month. And now apparently we’re getting ready to do it all again. If I don’t get pregnant after three months of this, we’ll move on to IUI. And I’m exhausted. And I don’t really trust the process. We know I ovulate. I’ve been pregnant twice and I’ve never gotten a positive result on an OPK. Why do I need to take the Ovidrel shot? I feel like it might be screwing with things that seem to work on their own, no matter what the doctor says.

Thank you, Stirrup Queens, for describing exactly how I feel here.

Here we are, not pregnant again. Afraid of being pregnant, because my pregnancies (so far) don’t last. Even more afraid of not getting pregnant. I’ll take recurrent pregnancy loss or I’ll take infertility; I’m really fucking sick of the combination.

Random Gratefulness

Apparently I’m not going to do this every Friday….. just randomly, as the mood strikes. I should have known better…..

So here’s why I’m grateful today:

• I don’t know for sure that I’m not pregnant right now. I mean, I’m probably not, but it’s possible, though unlikely. And I’m allowing myself to hope…. just a tiny bit.
• J and I are going to the movies tonight. Sure, Friends with Kids is probably a terrible choice for me at the moment, but I want to see it anyway.
• We’re in the house! We may not own it and it may still be a mess of half-empty boxes, but we are no longer sharing walls (or ceilings or floors or anything) with anyone.
• This fake spring weather has been wonderful! I’m enjoying it very guiltily (I know it’s a bad sign that flip-flops have been a possibility in March, but I’m not going to lie and say it’s not pleasant).

Grateful Friday

• For the fact that I can telecommute and continue work part-time for the job I just left while I look for another job
• For the fact that S (our perfect/trouble-making puppy) is curled up at my feet as I write this
• For the fact that J and I are living in the same place again
• For the fact that J and I should be back in our own place by the end of this month
• For the fact that J took us on vacation while the first due date passed

February 20 and Other Thoughts

February, 20, 2012 was the estimated due date of my first pregnancy. You know, the one we finally achieved after more than a year of trying, during my second Clomid cycle. J planned a vacation, so that at least we’d be busy sunning ourselves in a tropical location while the date passed. And the date itself didn’t affect me as much as I expected. I’ve been living with this particular kind of grief for more than half a year now. February 20 came and went. As we were killing several hours in the airport, waiting to return from the aforementioned vacation, it did occur to me that if everything had been different, we might be bringing a baby home from the hospital right then, instead of eating gross fast food breakfast items in the airport food court. But I held it together.

And I continue to hold it together. There was a particularly bad moment, when I signed into Baby Center for the first time since we lost the first pregnancy. You’re wondering why on earth I would do such a thing, but I’ve recently discovered that there are some really helpful groups on that site of women in similar situations to mine, so I wanted to join them (and I’ve since connected with one very kind woman who is in her 30th week of a healthy pregnancy(!) after two early losses similar to mine). However, even before I could worry about dodging the baby photos and searching for the relevant discussion groups, I was hit with my own profile, which announced that I was the mother of a one-week-old baby…. and offered me tips on breast-feeding. It took me a solid five minutes to figure out how to delete the “living children” portion of my profile. But still, I held it together.

And in general, I am. Holding it together, that is. I’m ok. Sad, overwhelmed, filled with anxiety about the future. But ok for now. What scares me most is the not knowing. If I could know, without a doubt, that one day I would have a pregnancy that lasts and that J and I would bring home a baby, I think I could get through almost anything at this point. Maybe even another miscarriage, though typing those words is pretty terrifying. It’s the not knowing that is responsible for my darkest moments.

Meanwhile, I’ve decided to start a weekly list (maybe on Fridays) of things I’m grateful for at the moment…. since it’s been a struggle to remember those things lately. I’ve seen this done on some blogs (entirely outside of the ALI sphere, of course), where it seems that their sole purpose is to broadcast the details of the writers’ awesomer-than-yours lives. There’s probably no way that my lists could come across that way even if I wanted them to, but just in case, that is not at all my intent. I’m just looking for a concrete way to remember the things I have to be grateful for, at a time when my natural inclination is to rail against all of the things in my life for which I am least grateful. I imagine that there will be just one or two items on this list some weeks, but I’ll do my best.

MTHFR

Don’t the initials MTHFR look like they stand for something? Like maybe motherfucker?

After the battery of RPL tests, I’m amazed I have any blood left at all. I would estimate that I’ve had a total of 40+ tubes of blood drawn in the past three weeks. I had blood drawn twice for the thrombophilia tests, because the first lab screwed up the processing of it. Seriously? It’s not like I just want to give away my blood for fun!

Anyway, after all of that, I finally got a call from Dr. D (the new RE) today and the one thing they found was the MTHFR gene defect (I don’t have any other details about it, because she didn’t offer them and I didn’t know to ask). My doctor said not to lose any sleep over it; it’s pretty unlikely, she thinks, that this is related to the miscarriages I’ve had. She called in a prescription for Folgard and we have another appointment with her on Feb. 10 to talk about the plan for moving forward, but she seemed largely unconcerned. Not surprisingly, the Internet disagrees. Google thinks I should worry. And not only that, but Google also tells me that anxiety and depression are symptoms of this genetic defect; this is definitely consistent with my experience.

What now? I suppose we’ll learn more when we actually meet with Dr. D again, but right now I’m feeling like everything is uncertain and I am so tired of uncertainty. MTHFR may or may not be related to my RPL. I may or may not be at increased risk for future pregnancy losses. I may or may not have PCOS. I may or may not have a really hard time getting pregnant again in the first place.

I really am trying to keep all of this in perspective. Miscarriage is horrible. But other things are more horrible. Like losses later in a pregnancy. Or fatal illnesses. Or war. But sometimes I feel like I’m walking around with a blindfold on; there are all these (bad?) things we’re headed for in the future and I can’t see them, but I know they’re there.

Goodbye (and Fuck You), 2011. Hello, 2012…..

2000/2001 (my years were school years back then) wasn’t a great year. Both my grandfathers died. I was incorrectly diagnosed with a brain tumor (it was actually an imperfection in the film). I was correctly diagnosed with both Chiari Malformation and Compensated Hydrocephalus, neither of which resulted in any medical problems or treatment, but I spent a year in uncertainty following the diagnoses.

That’s the last really bad year I can remember. I’ve had not-so-hot years, blah years, treading water years, but no really bad years. Until 2011. I know many of you spent worse 2011s than I did and I have nothing but compassion for the stories I’ve read on your blogs.

For me (for now), 2011 wins my worst year award:

• May/June: My grandma goes into the hospital with excrutiating back pain and bounces between the hospital and rehab for 6 weeks
• June 15: First ever positive pregnancy test after more than a year of trying
• July 20: Miscarriage diagnosed
• July 21/22: Miscarriage via two rounds of Misoprostal
• August 14: J moves to New York for school and we start living apart during the week
• August 29: Roommate (my first in almost 10 years) moves in
• September 2: My mom has double hip replacement surgery followed by two blood transfusions and a week of residential physical therapy
• October 28: Positive pregnancy test after just one month of trying
• November 21: Roommate’s boyfriend arrives
• December 3: Miscarriage diagnosed in ER
• December 6/7: Miscarry naturally at home
• December 14: Roommate’s boyfriend leaves
• December 15: Roommate moves out

Unsurprisingly, then, I was anxious for a new year. I want 2012 to be our year, finally. I desperately want a third pregnancy and this time, one that lasts. But 2011 taught me that the control isn’t mine. It doesn’t matter how badly I want this; it will either happen or it won’t, all on its own.

So as a compulsive list-maker and goal-setter, I haven’t known what to do with these first few days of 2012. How do I start fresh with something over which I have no control? No matter how carefully I lay out my 2012 goals, there is nothing I can do to bring us closer to them. After eagerly anticipating this new year, I haven’t done much with it yet. I’ve been reading a lot, trying to enjoy our month-long stay in this tiny cottage overlooking the lake, beginning to wrap up my last month in my current job.

We have our first appointment with a new RE on January 13 (Friday, by the way…. I refuse to read into that). We’re hoping to demand a battery of tests that doctors have been refusing us thus far in favor of just telling us to keep trying. I want as much testing as possible before we just try again; if there is something identifiable causing me to miscarry, I need to know what it is and determine whether there’s anything we can do about it. And if not, then we’ll steel ourselves and try again.

So hello, 2012. No exclamation points. No huge expectations. I’ll just try to step into you quietly and with hope.

The Way I Do It

I would be seven months pregnant now with my first pregnancy. Or almost 11 weeks with my second. I was thinking about that in the shower last night – how different things could be right now (but aren’t). So I resign myself to more (seemingly endless) waiting. I’m impatient and angry and really, really sad, but in the real world, where the days keep unfolding one after another whether I want them to or not, there’s not much I can do about any of it. So as the world (my job, my parents, and even J, despite the fact that he is most certainly traveling this path of grief and hope with me) makes it clear that I have no choice but to pick up the pieces and keep going (or at least fake it), I’ve been thinking about how I do that. I did it after the last miscarriage and here I am, trying to do it again.

Though at the moment I’m moving forward with anything but grace, I’ve been thinking a lot about an email my mom wrote me after the first miscarriage. It was a long message, filled with everything from empathy to humor to inspiration, but it’s this thought of hers that keeps coming back to me: “I have come to the conclusion that life is mainly one long struggle for survival and what makes us human is the grace with which we navigate the paths we are given to travel.” This is the sort of view that I’m striving for. At the moment, I’m hopelessly far from achieving it, but at least it’s out there.

Meanwhile, in the messy day-to-day, I have ways of coping. I realize that others in my situation do this very differently and obviously there’s no right answer. We all grieve differently and find different ways to keeping going; this is just the way I do it (or rather some of the ways):

• I quit Facebook. I actually did this before I got pregnant the first time, because (among a million other good reasons) my “newsfeed” had become a long list of pregnancy announcements and baby pictures. We had been trying for two years at that point and I couldn’t take it. I’m glad to say I’ve stayed away ever since.
• I didn’t let myself believe the second pregnancy would work out
• I threw out the “Your Pregnancy, Blah, Blah” book the doctor gave me, but kept the ultrasound pictures from both pregnancies.
• We didn’t name the fetuses and I don’t have any regrets about this. They both stopped developing around 8 weeks and while I do have quite a lot of reverence for the fact that I was (however briefly) carrying the beginnings of two lives, they weren’t yet individuals to me.
• We read books aloud, watch lots of tv-via-Netflix, and keep a bottle of wine nearby; distraction is key.
• I accept that some amount of denial is inevitable.
• I also accept that the sadness goes on longer than anyone around me expects it to.
• I try to walk the often elusive line between hope for the future and an acceptance of the bleakness that is the current moment.
• I tell some people what we’re going through, but keep it from others.
• When I’m angry, I yell at J because he’s always here to take it, but I also love him more now than I ever have.
• I’m not sending holiday cards or gifts this year and I’m not feeling guilty.
• We’re simultaneously looking into adoption and options for future pregnancies.
• I started this blog, but so far I haven’t shared it with anyone who knows me in real life, except J.

Your list probably looks different. This is just mine and as much as anything could work for me right now, it does.