Monday, November 6, 2017

Study Time

Before the twins and my IVF journey to get them, I did months of oral medications to try to induce ovulation. With a diagnosis of PCOS, that is my problem: I have eggs! I just can't get to them.

When my twin sister had success on clomid I thought for sure I'd follow in her path within a few short months. I suffered through the side effects, which I remember including hot flashes and some mood swings (including an embarrassing emotional outburst at work). At one point I suffered with almost continuous nausea and frequent vomiting which I attributed to the clomid so was switched to its sister, letrazole (turns out it was actually the metformin I was also taking that caused the nausea), and I think eventually ended up back on clomid.

Between these two medications, I was on the roller coaster ride of hormones for about 9 months (much longer than most people try) without ever a sign of ovulation. Never. Not once.

After my failed IVF attempt this spring I felt I just couldn't bring myself to do more IVF. When the office calls to give the bad news they also want to know the plan moving forward. I think the nurse was surprised by the finality of my answer. "I think I'm done."

I mentioned I would consider maybe trying on my own for awhile, maybe with clomid again if that made any sense at all. I assured her I did not have any unreasonable hopes that this would work, but it would be something I would possibly consider.

Shortly after, I received a call from the head of Reproductive Endocrinology. He kindly apologized for the sad news. He mentioned a study he was heading on the use of clomid and letrazole used together. Content with the idea that I was done and might as well get used to the idea, I agreed "all in the name of science." I figured who better could they learn from than me, one who continued to puzzle them with my lack of unexplained success.

Taking the medication was a little FLASH from the past, or should I say, HOT FLASH from the past. Phew. Luckily I was on a relaxing trip to Vail, CO while Abe was at a conference because I didn't sleep a wink before 5:00 am four out of the five nights we were there. I also about had an emotional breakdown, which I realize now, was probably related. HORMONES!

During a follow up ultrasound we discovered I had indeed ovulated, the first time ever documented. Surprise! However, when I took the pregnancy test at the end of the one-month study, it was negative.

As I said before, I didn't have high (or probably any real) hopes for the study. After all, the success rates at our hospital for two rounds of IVF is close to 80%. To offer more perspective, the odds of pregnancy the good ole' fashioned way is only about 25%, even if you are Fertile Myrtle and whatever you would call her virile partner. And as I mentioned before, I was an experienced clomid and letrazole user with zero history of response. You could say I am the anti-poster child for these medications.

But, I had a suspicion. And instead of writing off my normally absent/irregular cycle as just that, about 10 days later I woke Abe at 3 am with this:


I have no previous experience with this but I think that's a positive


It truly is another miracle. I'm not sure which is bigger, the twins or this new rainbow baby, but I guess miracles don't need to be ranked or quantified. The fact this time was physically easier (and cheaper) doesn't discount the miraculous nature for me.








Tuesday, May 30, 2017

Yesterday Once More



May 22, 2017

Today was my blood test, the end of the infamous "two week wait."

Abe's mom came over early this morning and she helped me get Mister and Sister ready for a walk. We took our stroller to the hospital for a quick lab draw, met up with Daddy for a short time, and came home. On our walk Abe called with the results.

It was a familiar conversation.

Abe: "It came back negative."
Me: "Oh, okay.
(Abe: silence)
Me: "Well, not surprising I guess. Hmmm. (Awkward pause)"
Abe: "I guess I should go get ready for my next case."
Me: "Okay, I love you."

We have had this conversation 5 times now with only slight variations in the script. Maybe that is what made it easier to hear.

So how am I feeling now? I didn't have much emotion at first. I left the twins with my MIL to feed them breakfast while I took some quiet time to process. The tears didn't come until I told a few family members the news. I am so used to disappointment in this way that I feel pretty okay with not being pregnant right now. But the finality of it is something to mourn and for which I shed a few tears. I had kind of expected before the news at the transfer (that the embryo hadn't done well in the thaw) that this would work, that this cycle would work now that my body "knew what it was doing," and that we had a third baby ready to come join our family -- the baby we lost in the womb coming for another chance at a healthy body.

Taken by my MIL as I cried in my room
However, I also feel like God has been reminding me the past few weeks how lucky I am. I have two miracle babies who are wonderful and sweet and make me smile every day. I love how they sing "Twinkle Twinkle" wih a variety of lyrics, from singing about stars, ABC's, BAA BAA BAA's, EI-EI-O's, or even Ma MA MA's, and give each others sweet hugs and kisses. I think He has been telling me, "You have enough. You don't have to keep doing this anymore. You are already so lucky."

So I choose to have faith in disappointment. I would love to have another baby. Just one. (I don't need to get greedy!) Crazy as I feel saying it even to myself, I would love to experience pregnancy again (I guess with the hope it would be easier this time!). I am disappointed I will probably never get that amazing birth experience, meeting and holding my baby in the delivery room without the many negative emotions I experienced last time. I was hoping to successfully nurse without all of the frustrations of before. I am sad thinking I wont get another chance to savor the smell of my new baby or the amazing feeling of cuddling him as he sleeps.

I'm not sure where we go from here. There is a common mentality that I will probably just get pregnant on my own. I'm not counting on that (although I do personally know other IVF mamas where that has been the case). In many ways, it feels easier to decide that I am done. To cut my losses and exit the roller coast of emotions permanently. Or at least for now. If I decide I want to ride that wild ride again, I can always purchase another ticket. Right now I am already dizzy and nauseated and will probably feel like I am still spinning at home in bed for awhile.

Either way, I'm not sure I am ready to throw out all of my baby stuff just yet. Whether that is me holding out a glimmer of hope or for sentimentality's sake, I'm not sure.

Monday, May 29, 2017

Our Hail Mary

May 11, 2017



Our embryo transfer was today. 

At 9:45 am I was picking up Abe from work and I received a call from my doctor. He told me our embryo had split after the thaw and that it "wasn't looking too great." He wanted to give me a "heads up." In the meantime, we would see how it looked in a few hours.

My appointment was at 11:15. My favorite doctor and his fellow (the same one who got me pregnant before -- a good sign?) came in before I changed for the procedure. He sat on the bed (a bad sign, I thought -- a technique taught to doctors to build rapport or to be more personable when giving bad news). They showed us pictures and explained that sometimes embryos don't do well after thawing (we had been lucky up to this point to have all of them survive the thaw). We now had two embryos after the one split. I was hoping he would say they looked good and now we had the chance for twins, which I would gladly do again. (Also has me wondering if we could implant them at separate times and have identical twins with different ages. Weird! -- I don't know that they could re-freeze it.) However, they felt that one looked like it was degenerating and the other looked questionable. It didn't seem to be growing like they expected it would.


#1 shows the split embryos
#2 shows the questionable transferred embryo
#3 shows the non-transferred, non-viable embryo


They offered us to "cut our losses" and we could go home, or we could proceed with the transfer knowing it had a low chance of working.

We decided to try. The biggest negative was continuing with the shots. I reminded them I was an old pro and they laughed in a knowing and apologetic way. Abe said, "Well, we will give God something to work with!"

They gave us 5% odds.

I started to process the idea of a failure for the first time. When we got back in the procedure room I felt infertile. Again. I had forgotten those feelings for about 2 years. I felt bad I couldn't give Abe his big family. I felt sad that I felt like we "didn't even have a chance" this time. I felt broken. And I remembered the many times in this room full of excitement and the disappointments that followed so many times over.

I also felt more modest this time. Out of practice I guess. The procedure took less than a minute -- much easier to get the catheter that delivers the embryo in place than ever before. My uterus must have changed because they always commented before on the difficulty. My bladder wasn't as full as the other times so the five minute wait after the transfer wasn't unbearable as before.

After we quietly walked back to my room in my socks to change, we kept our tradition of going to an Indian Buffet for lunch. (I mention the socks because somehow that feels important. There is a vulnerability of being in a public building without shoes, but also a coziness and warmth of only wearing socks. Is that weird?)

I had the romantic notion of not telling anyone until I was pregnant and starting to show. After the procedure, we decided it was such a long shot we could use the prayers so we decided to tell our families. I think everyone is trying to be optimistic/hopeful/supportive so we got a lot of "exciting"-s and "congrats"-s. In the moment I felt this should be more like condolences since this was my last (perceived?) chance of growing our family but I understand their thought process.

As I have spent more time in the day I have thought of that little baby I assumed we would get. As hard as it was, I want to experience pregnancy one more time. I want to savor one more little baby and all of the precious moments that went so fast before. I want to have a normal delivery and feel the magic of meeting my baby without the fear and separation anxiety of the NICU. I want one more round, less rushed and frantic than two often was (although I understand maybe a mom of three never get that!).


But...

I felt at peace. I felt like an answer to prayer to see and experience the immense joy and wonderful personalities I already have at home, today more than other days. Their laughs and smiles at simple silly things like the name of dinner and their sweet and purposeful kisses today as if they knew I really needed them were like messages from God.




They are miraculous. And enough. If I don't get another baby we still have a perfect family.

Abe and I are putting it in God's hands, one more time.



Sunday, May 28, 2017

T-1 to Transfer Day

May 10, 2017

Do I really want to do THIS again???
I was HUGE and that was HARD.
We were at Costco last night and I picked up a bottle of pre-natal vitamins. The checker asked if we were having another baby. I wondered how he was on to me and didn't know how to respond (he was a stranger so I could probably be honest, but then again, what???) I realized I must look pregnant (something I have commonly been told/asked in the past), especially with my recent weight gain. Then I realized it was just the pills. Ha!

* * *

Tomorrow is the big day, my round #6 of IVF, FET (frozen embryo transfer) #5.

I still don't know what time I need to be there...I better double check this afternoon.

Honestly, I haven't thought about it much. I've been doing my progesterone shots since May 6. I dread them every night although they honestly haven't been bad and easier than before. (Tip: the cold of an alcohol swab on the adjacent skin is a nice distraction.) But besides my TID (three times per day) estradiol pills and the nightly shots I kinda forgot about it. Abe even mentioned something about "Thursday" and I literally said, "Oh yeah, Thursday!"

Am I blocking it from my mind in some subconscious defense mechanism? Am I such an "old pro" at this IVF thing it just doesn't phase me any more? Or maybe life as a working mother of twins is enough to keep my mind busy I haven't had time to ruminate on it all?

I don't know the answer but it is strange to think tomorrow I may be pregnant. And if I find out in a few weeks that I am not, then I am probably never going to be pregnant again. I don't know how I will respond when I actually process that.

So prayers that things go as they should tomorrow, whether that means God has another baby for us or not. And prayers I will be able to gracefully accept whatever that answer is, because right now either answer is a little scary.




Saturday, May 27, 2017

Needle Phobic People Beware



Injection target area for PIO 

April 23, 2017

After that initial day of feeling off, I seem to be doing fine. Phew! It seems like it is a really long build-up this time. I don't remember being on the estradiol this long before starting the injections. It must have been the same protocol before but it sure feels like a long time until May 1 when I increase the frequency of the estradiol and a LONG time before I start the progesterone shots on May 5 or 6. Luckily, I'm not super anxious about that!








May 6, 2017

More needles!

























I started my PIO (progesterone in oil) injections tonight. Back at it! The huge bag of needles
brought back the realization of how long I will be doing this again if it works (10 weeks!). I tried calculating out in my head how much of my life I have spent injecting a thick oil filled with hormones into a target on my butt (sorry, hip) and it comes out to about 5 months.

I feel less dread and emotion than I expected and it really wasn't painful like I remembered. But it did have that familiar strange and tight soreness that only injecting a mL of hormone impregnated oil can bring.

The medication is so thick it can be difficult to draw up.

The target areas are so different every time depending on which nurse you have.
I think these were the best so far... much less painful than any other cycle.


I can inject myself but I prefer the emotional support of having Abe do it for me.


I am on the estradiol pill TID (three times per day) now. You really should take all of the medications at the same time per day with a window of a few hours.  It can be hard to remember so I have to set my alarm, especially for my afternoon dose on days that I work. During the times I am in treatment it isn't uncommon for me to wake up night in a panic "realizing" I have forgotten to take a medication (usually for the entire cycle) and I must have lost the baby. Luckily, I haven't missed any doses yet in my conscious state.

I had my ultrasound appointment a couple of days ago. This is to observe the uterine lining and its response to the medications. It needs to be a certain thickness before proceeding with the actual transfer. They also checked my ovaries to make sure I haven't been shooting eggs out on my own (which could mean an unexpected multiple pregnancy if they transfer an embryo as well).

Fat chance of that, as who knows if I EVER ovulate. 

Things were looking good (my lining was thick and my ovaries were "quiet" as they say), so we are good to go ahead next week. I also met with the nurse who reminded me of the instructions (funny how it seems so fuzzy now).

I also turned in my "thaw consent." This has to be signed in the clinic with one of the staff acting as a witness, or it has to be previously notorized. I guess they have to take this eriously -- no creating offspring behind someone's back! This time was easy, "Thaw one embryo." No further instructions or decisions to make on that.

As for the hormones, I find myself very tired and unmotivated. And I am up about 5 lb --suspiciously similar to the amount of weight I gained last time! I look pretty bloated.  Maybe like I am pregnant already...?

Strangely, most of my IVF friends are pregnant now and another friend is doing her last few attempts at IUI (intrauterine insemination). Most of them conceived well before me in our journeys, so I am hoping we can all be pregnant together this time.


*I made some videos of the injections if anyone would like to see them. I have had some friends who feel pretty intimidated with how to draw up the medications, etc, so please contact me if you need help. I guess if you have a morbid curiosity, that works too.

Hormone-ee-e-es: Wow, just wow!

April 18, 2017


The medication schedule for IVF is so strict and complicated you get a calendar to stay on track!


24 hours after taking my first pills and I feel out of whack. Cranky and sad. Incredibly cranky and sad.

Nothing is wrong but it feels like the world is falling down.

It always makes you wonder if this is ME or just the hormones talking. If it is the hormones I'm in for a wilder ride than I remember!


Friday, May 26, 2017

Mum is the word

April 17, 2017

I already said this time feels different.

This time I am keeping quiet about it. This time I want it to feel like a "normal" pregnancy where I get to start showing and have people wonder if I am pregnant or just putting on the pounds. That I can simmer on my emotions by myself for awhile. That it can be my happy surprise to share or my disappointment to decide what to do with.

But I find myself a little nervous about not sharing. Last time I feel the prayers of many were on my side and I believe in the power of that. I feel like this last little embryo has to fight against the world for his spot in humanity and I have some worry without the legions of prayers he won't have as much of a chance. But I also trust that faith and prayers are strong and that God has a will. So the prayers of a longing mother and father I think have power as well and hopefully that will be enough.

I do find myself almost accidentally spilling the beans already, after just a few days, about to make comments about how I have an appointment or need to go take my medication, etc. We will see how far I can go. The transfer is scheduled for May 11. I may not have to keep this secret longer than that if we get negative results.

I am choosing to be optimistic that that won't be the case. However, it is a tricky thing to be hopeful and excited enough to have the courage to go forward with something as significant and life changing as a child. Plus, facing all of the unpleasant interventions to make it happen while trying to tell yourself to "not get your hopes up" or be "too disappointed" if it isn't in the cards, --or as I prefer to think, "God's will."

"God, grant me the serenity to accept the things I cannot change"





Thursday, May 25, 2017

The Final Round

Here's a peak into my journals for those of you wondering what I have been up to.


April 17, 2017



On a whim I decided maybe it was time to try for embryo baby #3 -- or actually, technically, #6. 

Who does that? 

Makes a major life decision like the possibility of having three babies two years and under -- without days, weeks, or months of thought and preparation?

Add to it the part about having to be pregnant. (Man that was hard!)

Why didn't anyone tell my I was this big?!
Oh yeah, and then there is the whole IVF part: 
The shots. 
The pills. 
The frequent appointments. 
And most of all, the chance for major and in this case FINAL disappointment --because if this works it will in all likelihood be my last pregnancy and my last baby; and if it doesn't work, well...yeah. It WOULD have in all likelihood been my last pregnancy. 

I guess that is why I didn't want to think about it much and to take the plunge thoughtlessly. (And now my mind is making IVF needle puns about syringes with plungers...)

So without much mental energy or emotion really, I called the IVF clinic last week to matter-of-factly find out what the protocol would be for a FET (Frozen Embryo Transfer). I figured it would be a bunch of appointments and weeks or months before they would be ready. Nope. We could get started right away and why not in just a few weeks? "Start by going off your birth control pill today."

Before I knew it, I was getting my first of many upcoming needle sticks with a blood draw for my thyroid levels. 

Nurse: "We need to get your blood drawn? When can you come?" 
Me: "How about now I guess?"

Things are already different this round as my TSH (thyroid stimulating hormone) was normal this time, which means one less hormone to add into the mix than I had last round. And so far, no news of starting any metformin, a medication usually taken to regulate diabetes. 

And then last night I started 2 mg of Estradiol (an estrogen hormone to help support the uterine lining for pregnancy) and again this morning. I was careful to set my alarm for morning and night so I wouldn't forget any of these important doses.

And then I came into my room and plopped onto the bed as it started to hit me what I had just done. Abe hugged me and we prayed, as I realized the seriousness of this newfound plan. Round 6. I have done this so. many. times before. I should be an old pro. This should be old hat. I can't help but wonder if that will make it easier? Or if it will make it harder? 

I felt the dread after swallowing the small blue pills. I wish I could remember with accuracy what these hormones were about to do to my body. To my mood. To my weight. I am amazed by what I can't remember after spending almost a year constantly putting myself through this regimen before Mister and Sister's arrival. And also what I remember is slowly flooding back -- the pain and the disappointment and the dread and most of all the waiting. 

Amazingly I didn't cry. But I questioned if I was strong enough and brave enough to do this all again. 

This time feels different. This time there is an endpoint in the near future. Before, I had the hope of six embryos securely in the freezer and a large family coming from them. Now I know how hard it was to get the two blessings I have. I know that the odds are more likely than not that I will not get pregnant -- it took 5 embryos to get where I am now, why will one lone survivor suddenly stick this time? It doesn't seem like the way to start the "trying" process -- without much hope.

Mister and Sister's first baby picture
So we will see what happens. Despite it all, I have hope there is a little brother or sister there waiting to join us. I also have the joy of knowing we already have an amazing family. 

There is some relief in the finality even though it is also scary. Some of the worst parts of the whole process before was wondering and having to ask God, "How much do I have to do this before I give up? Before I know it won't work?" This time I know we have one more shot. (Again with the puns, actually 2-12 weeks of shots... but one chance at a pregnancy.)

I am anxious to finally know if I can give away my baby gear. I am also terrified to think I may have to. 

So here's to my Hail Mary. Crossing my fingers it will work. And if it doesn't, that I will be okay with God's answer. 


Sunday, January 22, 2017

Why I am thanking Mr. Trump for his locker room chat

I was looking for the "feminist" photo to match:
perhaps the power suit? But then again, the mom in  pajamas
reading to/teaching her kids is a pretty close second!

I've long considered myself a feminist.

Equality and opportunity for women became a passion of mine since facing the challenges of entering a male dominated field, experiencing my share of discriminatory treatment, and more recently, becoming a mother. Unfortunately, I have found the connotations of the "feminist" label I proudly wear tend to bring a surprising amount of negativity, assumption, and sometimes ill judgement.

Thus, I am glad to see so many come out across the country to march for women this weekend! I take the appalling commentary on women from our now president as a twisted blessing. Today, we address behavior (that is seen and felt by women every day) publicly and head-on -- instead of silently and privately as women are told "stuff like that doesn't happen anymore" or "you are being too emotional" or "too sensitive."

I hope that after marching this week, we will remember to continue to support the women around us. Especially as women, supporting other women. We have so many issues to confront! Unequal pay, sexual harassment, birth control, sexual assault, the glass ceiling, maternity and childcare decisions, to name only a few. Unfortunately, I have found we as women are often our worst enemies. 

Because we haven't seen sexism, we won't believe it. 
Or because we accept it ourselves, we ridicule those who won't.
Because we didn't choose it, we will judge it. 
We often choose to harshly judge life choices that don't mirror our own instead of compassionately looking at the variables that brought those choices forward or to find a way to help. Instead of criticism, maybe we should ask, "What can I do?" 

Or we accept the objectification and sexualization of ourselves and our daughters. It is so prevalent we may not even notice. 
Or worse, we label it "female empowerment.

"Feminism isn't just bra burning; it shouldn't be man-hating; and doesn't have to be about abortion rights. I think it should be advocating for women. It should be respecting women and their choices. It should be refusing to expect or tolerate disrespectful treatment even when it may be as common place as over-sexualized marketing or even "locker room chat."

So thank you to Mr. Trump for your abhorrent behavior, because for once, I have found many women and especially men fired up about issues I have long cared about. But for many of us, this isn't new or unusual or even surprising talk or behavior.

And thank you marchers for your visible efforts. I hope we can all continue to march on because we still have a lot of work to do.




Thursday, January 12, 2017

The Big One

photo credit Chelsee Sheffield


As an adult, I feel the change of time differently than I did as a child. I remember when each year and each birthday seemed like a huge milestone. A new grade! New pants (to replace the ones that now hit above the ankles)! A chance to say my age as a round number instead of one carefully measured in quarters (wouldn't it be funny if adults did this? "How old are you? "-- "33 and a quarter")! 

Besides the big milestones -- 18! 21! 30! I don't see or even celebrate much of the aging or progress I must be undergoing, except maybe by the slow development of fine lines popping up on my forehead or the increased difficulty I have getting back in shape.


I have noticed myself hesitantly measuring my own progression in life by the growing children of my friends:

Our marriage is a 5th grader now! 

My career in private practice is walking and throwing tantrums. 

And my time as a mother is a one year old (well two one year olds)!




People act like this is a big deal. "You made it!" I wonder if there was ever a question. (Was there???) I'm glad we did -- instead of the alternative, I suppose.  

And it does feel like an accomplishment, maybe especially with twins. 

Our parenthood is now one years old, whether you go off actual birthday or due date. It is growing up -- as old as two babies feeding themselves (although still a pretty messy job), crawling all over and even taking steps. It is outgrowing infant car seats, communicating with simple words like "hot!" and "thank you." And is a combined 50 lbs. 

I know it is still rather early, but we have gone far enough I find myself giving advice to new moms as if I am a seasoned pro. (Does having two babies accelerate me on the path a bit?)



Isn't it interesting how time has a strange way of going so fast and yet so slowly at the same time? It seems like these babies have been with us for a lifetime, and yet I am amazed it has already been a whole year! 

I wondered how I would feel when we all hit this big one year milestone. Would I cry like the other moms warned? Would I mourn the loss of my two little snuggly babies replaced with toddlers on the move? Or perhaps relish the moment like most of the twin parents I know -- so relieved to have made it through the time most refer to as " a blur" or a time they can't even remember?





When the big day arrived, I found myself happy and excited for the progress we have made and the future ahead. So far I have loved every stage with its challenges and joys and look forward to the progress and learning that is ahead with excitement and pride. 

It is strange but exciting that now I can measure the passing of our lives in the progress of my own children. 


* * * * * * * * * * * * * * * * * * * * * * * * * * * 
Written Fall 2016, shortly after birthday #1!