Tuesday, November 1, 2016

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.

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