Moving Forward

My m/c was three weeks ago today, and I am finding it easier to find joy in the daily things I used to, before this cycle began. I am celebrating the tiny things, like being able to exercise, have sex, not obsess about how an embryo is doing in or out of me every second, how each day is less and less a struggle to fit into my regular pants. I am also able to celebrate the infinitely great things, like playing with my kids, reading them books, snuggling with them. I cry a little bit when I admit to myself how hard these past months have been. And cry a lot when I think of what I have lost. But what I still have is admittedly so good, and it keeps me moving forward.

The end is near, but still so far away

It is November 1st.  Fall is typically my favorite season, but not this year.  

This year, I was surviving another round of IVF.  A frozen embryo transfer to be exact. I had so much strange anxiety as the summer began to wind down.  Typically I rejoice as temperatures drop, and kids go back to school, and pumpkins start appearing, but this year, those things held no joy, just mild distraction.  

My slump began at the end of July.  I had embraced the conclusion that surrogacy was not for me.  I had jumped into it naively thinking that outsourcing the pregnancy would also outsource all my grief and emotions about infertility.  The hoops I've jumped through, the failures, the tears.  Of course, through the break-up with Rachel, I learned that adding another woman to the mix multiplied everything about the experience.  I was only counting the multiplied joy, not the multiplied heartache.  

The disaster of the breakup emboldened me that I was in fact cut out for going one last round.  At the time the surrogacy contract was underway, I'd decided to pay the $4000 to have our 5 embryos genetically tested.  Two came back with multiple chromosome abnormalities that would have resulted in miscarriage.  Three were genetically sound.  Of the three, two were female and one was male.  In spite of caring deeply about my embryos, I fight to not turn them into my children.  It compounds the failures and in my mind, turns them into deaths.  I anticipated that knowing their sex would again, overly personalize and humanize the embryos, and it has. 

Doctor Faulk, who is avidly pro-life, and understands we are too, told me I needed to know that these are not humans.  They are simply cells, with potential, under perfect circumstances to become more, some of the time.  He gave me an irritating pep talk as I sat crying and broken across from him, that I could not let THIS, infertility, break me, because life had a lot more that was both hard and great ahead.  I tell myself this all the time, so it wasn't what I wanted to hear, but perhaps I needed a reminder from a third party.  He is right.  He is right. But that has never made applying the advice easy. 

I had my water ultrasound at the end of July, started my calendar, with injections beginning at the end of August and a transfer on September 21st.  We decided through the counsel of Dr. Faulk to do the "full kitchen sink" protocol that had magically resulted in Weyland.  This included the additions of daily injections of heparin, an ingestable daily steroid, and intralipid IV injections a week prior to, and after the transfer, as well as monthly until the 20th week.  We also threw in the Neupogen wash, that I have used since I have began my "success" of at least having chemical pregnancies, on the path to Weyland.  Some implantation is better than no implantation in my book, and there has been correlation between the wash and at least making it to chemical pregnancies.  With Weyland, I also insisted on duplicating the "Thrive" study by injecting subcutaneous Neupogen daily to 9 weeks.  I had had a failed fresh, single embryo transfer when I participated in the study in January-ish of 2014 (it was a free round of IVF!) but I stimmed very poorly, and still don't know if I was given the drug or the placebo.  Replicating that study was very expensive, at an additional $6000ish for nine weeks worth of drugs, and ultimately the study was cancelled due to poor response among trial participants.  In light of all that, the clinic recommended I not do that, and I decided to risk leaving that out.  

This was an incredibly difficult cycle for me.  We had decided to do a single embryo transplant of a female, leaving two in case I failed this cycle and decided that we were game for a surrogate for our very last round ever.  Part of me was sick that THIS couldn't be our last.  In many ways, I was hoping that more of the embryos had been chromosomally incompetent.  The thought of dealing with the two remaining embryos even with a happy pregnancy on this one, was not an optimal outcome for me.  It just meant prolonging my torture.  I have repeated many many times over the last few months, "I want to be done with this chapter of my life as much or more than I want another baby."

This FET worked, but my betas, though doubling as they should, were mysteriously low.  So I agonizingly tried to distract myself in between the every four day blood checks I had for the three weeks AFTER the harrowing ten day wait.   Wait.  Wait.  Wait.  The days ticked by in slow motion.  I have never felt so much grief and stress and dread.  Finally my seven week ultrasound came.  I went to it alone, and as the doctor found the black hole of the sac, I knew before she said anything that there was no heartbeat.  There wasn't anything.  I had a blighted ovum on a PGS embryo, which I thought should have been impossible.  The embryonic sac had formed and grown, but the genes inside, which we know were there, vanished. 

I hate to lose my composure in front of the staff.  They don't like the sad news either, and I want to make it to my car to cry as I need to, in privacy as I need to, but that sad black hole, where a flicker of a heartbeat should have been was too much to take.  I had been through hell.  For nothing.

I cried as we both tried to talk science and "what to do next".  Anne Marie Martin had been my nurse practitioner since I moved to Utah Fertility Center on my second try, back in 2008 or 2009, so she knows me well, and knows what I've been through.  I could tell she was really upset too.  There were actually two sacs, fused together, with a line down the middle, but this wasn't a fetal pole.  She didn't have answers for what this was, and said she had only seen it once or twice in her career.  I asked her is there was ANY chance a heartbeat would exist if we checked back in a week.  She shook her head to say "never" without having to say it out loud.  We discussed my options for miscarrying and I left the office with a prescription for Cytotec in my hand. 

This was Thursday October 20th, and I was flying to California with Lowell and the kids on Saturday for a Quickbooks convention.  I didn't have time to have a D&C, would have to pay for it out of pocket anyway, and didn't want the unknown of miscarrying at the convention.  I had my own prescription filled as I wandered, despondent, around Target.

I had miscarried at this stage before, but done so naturally, so I was scared of the meds and googled to know what to expect.  I set up a station in our hall bathroom with food and drinks and pillows and towels, and changes of clothes, and sad tupperwares to hold my miscarried baby that never was.  It was an impressive set up, and didn't even need to be fully utilized.  I took the pills vaginally at six pm, and began bleeding around ten.  I passed about five large strips of tissue, but none that resembled anything like the alien spawn that was my miscarried seven week fetus of the previous miscarriage.  I caught a few samples that are frozen in my freezer alongside some popsicles.  The pains were like labor in intensity, but I've never had the pleasure of taking as much hydrocodone as I could during real labor, and on this go around I didn't even try to hold back.  My only limiter was how much pain medication my stomach could tolerate.  It felt good to not feel.  It was a welcome break.

Here I am, two days shy of two weeks from the doomsday ultrasound.  Today I am grieving, but it feels as healthy as sickening sorrow can.  I am watching the 20 pounds I gained in water and snacks slowly slide off.  I am allowed to exercise again, and enjoying it.  Last Friday I woke up feeling strong and happy for the first time in months.  I had returned to being me, at long last.  I think the extreme stress and duress I felt in this cycle, coupled with the sledgehammer of hormones combined to create a similar situation to post-partum depression.  

Now I am waiting for my beta HCG to return to zero so I can start my next, and final cycle.  It was 3500 or so at my last test before the ultrasound, which in my gut I knew was foreboding, and yet when I expressed my concern, I was met with hopeful platitudes and assurances, by Tanya, my plan of care nurse who has also been through the weeds with me.  As of last Friday, I was down to 141.  Still a long way to zero, and I am now only spotting each day, but each spot, I hope, is getting me closer to zero.  My goal is to know whether I am pregnant by year end.  One, because I need to sign up for health insurance again, and pregnancy vs. no pregnancy is a huge factor in what type of insurance I need.  Secondly, and most important is that I would love to be done.  forever.  with the pain of infertility treatments.  I just had my 12 year anniversary of trying to conceive, and every part of me is aching to retire.  

I don't talk much about my sons here.  This is the repository for my pain, not the place where I count my joy.  But make no mistake, there is so much joy in my days because of those two boys.  I have already won the infertility war.  I am ready to exit the battle field, and start living life free from this hell of trying to create humans, and just focus my time and effort and money and heart on the two I have.  I am ready for the hard and the great lies ahead with the family I have today.

New Year. New IVF. New Mood.

I really wish I had kept up on the events of the past year as a lot happened.  Technically, most were bad.  But I also wish I had kept a journal of the small miracles that kept me going during this dog of an infertile year.

For the record my son is now 2 years and 4 month old.  We've been starry-eyed for baby number two since taking home the first from the hospital.  It was a dream come true, and I secretly bought into the common notion that having a baby cures infertility.  I have seen it happen to so many: Once the first baby/hurdle is overcome, siblings will follow.  Nature and universe will it to be so.  Perhaps the universe and I are on two different schedules.  Or more likely, I am still just a mule.

For the record, since my son was 10 months old I have endured the following:

August 2012.  FET. 2 embryos.  1 didn't survive the thaw.  Other didn't take.  Failure.

November 2012.  New shared risk contract.  Awesome stim, awesome embryos.  4 frozen. 2 Transferred.  Tiny, confusing chemical pregnancy, beta at a 7 for days. Failure.

Husband lost his horrible job.  I went back to work.  It was really difficult to switch roles and begin work right at the beginning of busy season. However our life has been better since he lost that horrible job.

January 2013.  Frozen embryo transfer.  2 thawed. 2 transferred.  PREGNANT.  Awesome betas.  Then weird betas.  Then no heartbeat at six weeks.  Check again at 7 weeks.  Still no heartbeat. Confirm on March 15th, an enormous tax deadline, on a 15 hour stress filled workday interfacing with a whiny client, that I have indeed miscarried.  I smiled and acted kind and professional to clients and coworkers that whole day with only one hour long break to sob silently in the public bathroom and dry out my wrecked face.  I would never want to relive the two weeks of hell I endured in limbo wondering if I had a live or dead baby in me.  But whenever I feel doubt as to my ability to survive hard things I remember that day.  I am strong.  And as future horrible events came to pass and I felt like I might lie down and die, I eventually remembered that day, remembered that I am the strongest person I know.  

A D&C would have been lovely, but I decided I couldn't afford the luxury of a day off work.  I would have chosen differently if I'd known that I would still be chronically nauseated even with a dead baby.  It was the bitterest of pills.  Nauseated to my fingernails 24 hours a day on a 70 hour work week.  I miscarried exactly a week later.  My sister coached me through what it would be like, and I planned to head home when the bad cramps and bleeding started.  Sitting at my desk my cramps were their very awful, but totally normal level, and I remember groaning in my head "if my cramps are this bad I hate to think what the miscarriage will feel like".  Then I stood up to go to the printer, and my baby fell out into the Depend I had been wearing "just in case".  Shocked, I walked to the bathroom, pulled out the Tupperware I had hidden in my purse to capture the baby for testing, dumped it into the container, stared at it for a really long, wide-eyed while, hid it in my purse and then went back to my desk to turn off my computer and leave.  It is VERY noticeable to leave work at 2pm in busy season.  I told a manager "I am going home because I am sick" and by the time I reached the word sick I was shaking.  My voice and body.  I told her I had a miscarriage sitting here at work and couldn't work another minute.  To her credit she covered for me professionally and kept it completely confidential.  She was the last person I wanted to tell, but in that moment I realized the ridiculousness of stressing about work to extent that I had gone NASA style for a week, and had miscarriage remains hanging out in my purse like leftover lunch.  

 Because this was technically a second miscarriage my doctor talked me into the full panel of genetic testing on me, Lowell and the fetus.  This $4000 testing would cover every scientifically known reason as to why this was happening.  Apparently very few people are as desperate as we are, so no one at my infertility clinic seemed to know what to do with the baby.  It was a horrible circus getting them to accept my Tupperware.  It took over two months to get the results back.  I tested negative for everything of consequence.  My doctor told me that I was in the fraction of the fraction of people who truly have a problem that science can't even test yet.  Yay.  

August 2013.  Another fresh IVF.  Surprisingly poor stimulation.  I have always been a rockstar at this part, and they thought they might even have to cancel the cycle.  They put me on the max follistim dosage allowed.  The "old lady" dosage.  This was depressing and brought about new anxiety, but in the end I had one great and one medium embryo to transfer.  PREGNANT.  But low Betas.  Spent another tortured week with young nurses telling me I should be hopeful, as I waited to hear what I knew to be more failure.  Finally on September 15th I found out that I had again miscarried.  This one was so early that I just had a normal sad period.  

At this point I have two frozen embryos and one more fresh and one more frozen attempts on my contract.  I am so emotionally wrecked and depleted even thinking about going through the torture of another round I cry at the very thought.  Technically I am supposed to use my frozens next, but it doesn't seem right to put my "children" in my poisoned body.  I decide to forgo my free frozen, and go directly to my last fresh round.  My last IVF ever. Thinking about the fact of this being the last is both simultaneously the most heavy and most relieving concept I've ever grappled with and my poor mind can't handle it.  My losses have accumulated.  I am disturbingly happy and functional in my day to day life, but just under the surface is pain so intense it scares me.  The doctor suspects that my endometriosis  is why the last stim went bust so I have the choice of a laparoscopy, or three months of Lupron injections.  I chose the Lupron.  I have started the drugs for my January 2014 round.  

As I retype I get lost in the awful parts, and I forget that I meant to document the lessons of this terrible time in my life.

I would have thought that I would be feeling the love during all of this struggle, but from my standpoint, God was noticeably absent this year.  That compounded my pain, and I frequently asked Lowell whether my past conviction that my life is easier because of my testimony in Jesus Christ was actually wrong.  I didn't question my testimony, I was just experiencing so much pain that had no relief, had prayed so hard, been so disappointed and was not feeling any help or love at all.  So in essence, I believed I had a loving Heavenly Father, I just was broken hearted that he was not loving me.  

It would be hard to pick which event hurt the most, but it may have been our August 2012 FET.  It was the most positive and hopeful I had ever been and when I unceremoniously picked up the beta from the hospital and saw it was zero my heart felt turned inside out.  Driving home crying and shaking my fist & yelling at God with baby Vincent happy in the backseat I was overwhelmed by rage and pain and decided I needed some radio to distract my thoughts.  Some lame pop song about sex or gansta rap was what I had in mind.  Instead I turned it to the sweetest, albeit weirdest song ever, Fireflies by owl city.  I love that song, but in this moment I was disgusted at my "luck".  I thought in my head how I loved fireflies in Texas, and how happy they made me.  How I don't have fireflies anymore, but I guess I have dragonflies and I do love those.  *Note that these are just the weird stream of thoughts that aren't significant at all, normally.  Quickly I found some gross sex song, felt marginally distracted, drove home and went about my life.  That evening I looked out the window and noticed about 20 dragonflies in the frontyard.  The backyard could have had 100.  Flying in beautiful squares.  I called Lowell out to witness them.  He loves them too and we stood there in amazement.  They were enormous and beautiful.  They were flying so deliberately, yet calmly and were so close I could see their patterns and colors as they passed.  It was other worldly.  Lowell loved the show and new it was a special gift from nature that probably would never be repeated.  But I knew it was so much more.  I knew my Heavenly Father saw me beating my fist in the air, heard me cursing him.  He heard my thoughts about fireflies and needed me to know that he was with me on one of the lowest days of my life.  I know.  

Unfortunately, as the dark events continued, that wonderful event served not to buoy me up, but to make me question even more.  "Why did You show me love in what to me was such a personal and undeniable way, yet continue to allow me to destroy my heart time after time after time?"  Having babies is a commandment!  It is a GOOD thing.  I am not asking for anything selfish or unnecessary.  I am not ungrateful for what I have.  Further, I would quit all this madness this very moment if I felt it were right to adopt.  That would be wonderful.  I am not being stubborn!  I will do what you want, when you want.  I consult with you every time I do this.  And I feel I get a "go-ahead" each time.   I just feel this major conviction that I need to go to the end of the infertility universe to make this next baby if that is what it takes.  But it is taking everything I've got.  In more ways than a person can imagine.  I know You know this.  So why the torture?  

As previously mentioned, I became fascinated and scared by how much I could function and even feel joy and fun despite the pain.  In the summer I had a 

Pain/Joy

This grief feels like it weighs 300 lbs.  And all of it is on my chest and shoulders. And heart.  So I am writing in the attempt to, almost literally, get some things off my chest.

I am back at the ugly place I haven't been in so long.  Where I am in so much pain, and so heartbroken and feel so much loss, that it is taking everything to just function normally.  I am back at the gross place of fearing that my sister is going to announce her pregnancy any minute now.  The announcement I was looking forward to just last week, because it would mean we would be expecting babies right around the same time again.  I hate when my pain threatens to stamp out my real joy.  

I experienced this duality of pain/joy after I had Vincent and was trying (and failing) for Weyland.  I discovered that joy does not vanquish sadness like people say.  You just learn to live and hopefully function with a divided heart.  Your eyes are opened to the fact that many people function this way, and it might in fact be more common than uncommon.  And the mysterious human heart becomes even more miraculous. It made me look at every person in the grocery store line differently.  Did they have a heavy heart too?  Were they dealing with extreme heart break while simultaneously out of milk?  It made me look at people who appear genuinely happy too.  Were they experiencing real joy while simultaneously mourning loss?  It gave me a greater appreciation for the human condition.  It helped me internalize those snippets you hear about being kind to everyone because you never know what they are really dealing with.  I'm tempted to call pain/joy duality "faking it til you make it" but there is nothing fake or counterfeit about the happiness and good parts of life that continue (thankfully) in tandem with the sorrow.  

I have a favorite family photo of me, Lowell and Vincent.  It floors me when I remember exactly how truly happy I was in that moment, and in my life at that time.  I also marvel at the picture because I remember perfectly what intense pain and sadness I was going through as well.    It was my first experience with pain/joy, and I remember that even though it was shocking to learn that joy doesn't eliminate pain, it was equally shocking to discover that the pain could not rob the joy. Not one bit. They were arch enemy superpowers doing their equal and opposite things, side by side in my heart, but not ever squaring off against one another.  Like they've known forever that they have to coexist, and it was me who had to quit expecting them to compete.  

So many days in the years since that picture was taken, I've glanced at it, and had the flood of thoughts above, and then realized I had in fact passed through those difficult days. I had made it. I was not "faking it" I was simply "making it until I could take it"  I'd learned a new lesson about life and came out the other side, not stronger,but feeling like I'd gained insider knowledge about the human heart.  I know, and don't want to forget, that joy always has a place in mine.

A Breakup

Long story short: I decided a gestational carrier was the new best move for me, and I found a wonderful person to carry my babies.

Gestational carrying felt like such a dramatic solution to my problem, perhaps overdramatic, and yet I felt like it was the best path to navigating my infertility Bermuda Triangle.  The three points of the triangle being: 1. The moral obligation I feel to give my embryos their best fighting chance at life.  2. Money  3.  The emotional cost of doing anything (including the emotional cost of doing nothing. Inaction is as much a burden as action, and Lowell doesn't understand that completely.)

Sad story short:  Me and the wonderful carrier broke up this weekend.  We had had an amazing first date.  We had both said how much we liked each other.  We were both giddy about the relationship.  We were both looking forward to the transfer in September.  And then she decided it was best for her young family that she not risk a twin pregnancy by transferring two embryos.  And I decided it was best for my family that I need someone to be willing to risk a twin pregnancy and implant two embryos.  And there you have it.  An impossible impasse.  And a very sad break up.

Someone posted a wise but cliche thing that went something like "If you would regret worrying about what you are worrying about if you died tomorrow, you should let go of it today."  Word.  But after some self assessment, this isn't something that I can let go of.  It is something that I will have to mourn.  And historically, my mourning has been allowing myself to get on the yacht chartered to Who Knows Where, with a path through the Bermuda Triangle.  You hope you land somewhere nice.  But the ride is out of your control, and sometimes you wonder and hope you won't die getting to the destination.