Semester of Calamity, Semester of Worry

With the exception of the year I took between finishing my undergraduate degree and starting my Ph.D. program, time has been measured semester by semester, paced by the academic calendar and syllabus. My wedding? Spring Break. September 11? Classic social theory. My BFP? Corporate and government power. Another semester has nearly passed. I will forever associate it with hurricanes, earthquakes and infertility. It will be recalled as the semester of calamity and worry.

This is the last week of classes for me and I am worn down. Childcare issues, book deadlines, and infertility have worked their collective misery and it hasn't been easy.

My semester recap:

Childcare. I found a stay-at-home mother who wanted to keep another baby. She lives only blocks from campus, so that was a huge plus. Unfortunately, it did not work out. First, I had an unrealistic expectation of how many hours we would need childcare. I was working into the wee hours trying to keep up with my workload, but the other mom was not willing to increase her hours. Then, during the middle of September, the mom watching Baby E took a vacation the same week J was at a conference in Denver. I think I can pinpoint this as the week things went off the rails. In October, the mom decided she wasn't cut out for childcare. I ended up hiring a nanny. Two, actually. More on that later.

Book woes. In October, my publisher (AKA, the Enforcer) came to town for a working visit. This was a disaster. In addition to my being badly behind on the text, I was doing the Clomid Challenge. Hormones and mixed deadlines do not mix. It was an awful visit that ended in vague threats. More on that later.

High FSH. Two hours after my publisher left, Nurse Joy called with my FSH results. I lost it. Totally lost it. That is how this blog began. It was my attempt to get a handle on things. More on that now.

All things considered, I think I am in a better place than I was two months ago. Perhaps the shock has finally worn off. At any rate, I did not turn to pills or therapy as I threatened.

Childcare. So far the nanny thing is working out. Sure, we are broke (seriously, we are spending more than we earn), but E is sleeping well and is doted on all day*. She is surrounded by her own toys and sleeps in her own crib. I don't have to cart her around so she isn't hostage to my cycle. She is learning baby signs and verbalizing more and more. Then there is the bonus that one of the nannies went to cooking school. J says he think it may be legal in South Carolina for us to marry Nanny S. Hmm. . . I always wanted a wife.

The text. I am still seriously behind schedule, so nothing is new there, but I am less stressed about it. I played the worst-case scenario game and realized I could live with the consequences of failure on this. If I lose the contract, I lose the contract. Sure, it will look bad, but I am tenured and it would take more than this for me to lose my position. For that, I'd have to sleep with a student or something**. I am going to make a good faith effort to get a great deal of work done on the books during the month of December, but I am not going to stress over it. Stress is bad for fertility. Oddly enough, this take-it-or-leave-it attitude seems to be increasing my productivity ever so slightly.

Infertility. This is my single biggest source of stress these days. I spend hours I should be writing instead reading up on FSH, antral follicles, wheat grass, IVF protocols and acupuncture. I read infertility blogs. I read everything that tells me I am not alone in this. My phone consultation with Dr. F had to be rescheduled to this Friday. I can't wait. He is playing hard to get and it makes me want him more.

I feel a spark of hope going into exams. I will finish grading this rather large stack of papers***. I will get through grading exams. I will deal with the sniveling grade-mongers. I will start exercising more regularly. I will eat better. I will take my prenatals. I will dream of babies.

* E has a slot in a good child development center starting in May. I have sabbatical next fall so she won't be in full-time care outside the home until well after her second birthday. I can live with that.
** Shoot. I'm tenured. So sleeping with a student probably wouldn't do it. I'm in the Southeast, a real Red state. I could take dubbya's name in vain. That might do it.
***Should probably NOT be blogging right now.

Damn those OPKs

Have you ever noticed all the vocabulary we infertiles build? I was trying to explain where we are in our attempts to ttc #2 via email to a very fertile friend who has never had to think about getting pregnant. (She is so fertile she once got pregnant on the pill AND then got pregnant while nursing. What a show off.) The original email went something like this:

"We had a BFN last cycle. TTC is depressing, and I'm not pleased with my RE. He thinks my FSH is too high and my DOR makes me a bad candidate for everything except DE. He is willing to try a round of Follistim and IUI, but is not optimistic and will not try IVF. I'm hoping to become a SIRM patient because the A/ACP IVF protocol sounds promising. We are trying on our own this cycle, but it is already cd 20 and I don't think I have O'd based on my bbts. My OPK results have been confusing. A week ago, it appeared that I surged based on the FR and Target brand OPKs. However, I did not get this result with CBE. In fact it was very -. Because my temps did not jump, I bought two more packs of OPKs, CBE and Target. Today the CBE showed a surge and the test line was darker than the control line. However, the Target OPK was -. So we dtd again in case I am really going to O this time. I am praying for a BFP in the near future. In the meantime, damn those OPKs."

Now my sisters in infertility probably would probably understand most of that, but I realized before hitting send that my fertile myrtle friend would not understand a bit of it.

Have you noticed how infertility creates a wall of sorts between the fertiles and infertiles? The lingo is just the start of it. What strikes me is that the infertility subculture, while thriving, is largely hidden. Yeah yeah, I know there is some new dumb-ass television program about an infertility clinic, but I refuse to watch because I already know they probably make the REs seem god-like, the patients seem needy and desperate (OK-maybe they are getting that right) and the nurses seem like saints (and if you have read my previous post, you know how I feel about nurses right now.) And sure, we know Brooke Shields and Julia Roberts both conceived via IVF, but we know more about Brooke's PPD than we know about her infertility journey.

Why are we hidden?

Shame? I publish under a pseudonym for fear of colleagues or students stumbling across my posts and knowing way too much. Not that we should be wearing tee-shirts proclaiming "Natural Cycle- We DTD today!" but what is wrong with sneaking in an "as an infertility patient" into conversation once in a while?

Stigma? Perhaps being infertile calls into question a woman's raison d'etre. We can be very accomplished--a lawyer, a doctor, or a professor--but this still calls into question our self-worth. I grew up next to an older couple who had no children. They were like our surrogate grandparents, but I pitied them for not having children or grandchildren. My mother once told me, "Mrs. S couldn't have babies ." I have felt sorry for Mrs. S ever since. She is 90 and I still feel sorry for her. I have a child so I doubt eight -year-old neighbors will feel sorry for me when I am old, but I do get the feeling my friends look at me and feel pity when fill them in. I don't want pity. I want empathy.

Fear? Discomfort? One of my friends recently told me that I am probably better off with one child because it is easier. She ended that dialogue rather abruptly and we moved on to discuss something inane, but safe, like shoes. Or was it TV? This is one of my most loyal friends, but she is not an infertile and seems uncomfortable talking about what we have been through. Other friends behave the same way. Silent.

I revised my email message: "Things are not going well naturally, but we will start fertility treatment soon with hopes of making E a big sister. How are the kids? Bought any new shoes lately?"

Dr. Negative and Nurse Joy

I had a nice visit with baby Katherine today. She made tiny squawking sounds as she slept in my arms. My friend K was very generous to let me hold her and watch the parade of expressions flick across her face as she slept swaddled and capped in pink. I felt wistfulness to be sure, but ultimately it just felt good to share in K's happiness and marvel at the beauty of life so new.

Oddly enough, the visit was not the emotional landmine I had expected. That honor was reserved for Dr. Negative and Nurse Joy (her real name-I am NOT making that up). I called to say I wanted to try one round of injections and IUI. Nurse Joy called me back and, in the most patronizing tone imaginable, told me the following:

1. Dr. Negative strongly advises against it as it is highly unlikely to work. He has written this in my chart so now it is part of my permanent record. Better for the insurance company to deny coverage.
2. Yes, of course, there are a few women in that lucky 1-5% who succeed with numbers like mine, but there are 95-99% who don't and I should plan to be in that latter group.
3. I had 18 antral follicles that made it to one baby when I conceived two years ago. Now that I only have 9 antrals, what is the point?
4. I should really consider donor eggs. Really.
5. It is too bad that I am not, 15 years old, poor and black. Because I would get pregnant easily then (a racist, classist nurse-Joy!).

So the plan at the moment is to do one cycle of injections and IUI here. Really, I consider this to be a data gathering mission. I want to know how I respond to the stims so I can have the best protocol at SIRM. If I get pregnant during this fact finding mission that will be wonderful; if not, I'll head west to SIRM in the spring. Dr. S at SIRM wrote me a nice note tonight, so I go to bed with hope:

This is incomprehensible to me. At 37 with an FSH on day 3 of 6.7 MIU/ml in association with a low E2 and at least 9 antral follicles, you should have a reasonable chance of a successful IVF in my opinion. You could even be eligible
for the OBP (see below) at SIRM. A single abnormal CCCT change does not alter my opinion.

Baby Lust

A good friend had a baby girl today, almost four weeks ahead of schedule. Mom and baby are doing well and I am thrilled for them. I was, in fact, almost tearful when I learned K had gone into labor because I knew this would be the most important and wondrous day of her life. We talked for a while tonight and she gave me a funny blow-by-blow recap of the unexpected arrival. When K told her husband that her water had broken, he kept asking "What does this mean? What does this mean?" I guess at 5 a.m. impending fatherhood takes a while to compute. By 12:30 p.m. they were parents. What does this mean?

I remember the wonder and joy of Baby E's birth, of sobbing and telling her, "I have waited so long for you, my beautiful girl ." My world was forever changed; and for the better. While trying to conceive Baby E, I was propelled by a vague notion that having a baby would be meaningful and good. But I had no idea. And I want to do it again.

Tomorrow morning, I will visit K and baby in the hospital while my husband gives a crash course in car seat installation. Thursday, I will deliver a Thanksgiving meal. I will hold little Katherine, I will breathe her sweet baby smell, and I will hear her newborn sighs and moans. I know that seeing the baby, holding the baby, and smelling the baby will add fuel to my already burning baby lust. I'm very happy that Chris C. wrote today of the nostalgia and envy that accompany a visit to a newborn because I would feel ugly for expressing this craving and jealousy. Thank you Chris, for helping me realize I am not alone in my feelings.

I suppose that in the end, this baby lust is what will propel me. It will sustain me through the hormonal assault of fertility treatment, see me through each procedure, and give me strength when the odds seem low.

Things that suck about TTC on our own (that is, without the help of the RE who has given up on us):

1. OPKs. I am close to an LH surge, or maybe I have already surged. Yesterday I took three OPKs. The first, the Answer brand was +, the second, the Target Brand was +, the third, the ClearBlue Easy was -. Normally, I would say two out of three is pretty darned good, but my RE and nurse Joy (really her name) went to great lengths to impress upon me the superiority of the ClearBlue test. Problem is, that test was never close. Upon waking this morning I took the Target brand and it was no longer positive. Argh. Now I'm left wondering whether I caught O or wasted another precious month.

2. Conception Sex. It is bad. Just bad. Foreplay is reduced to "Honey, I think the lines are the same color." Each month I wait in eager anticipation on fertile cm and the LH surge. My chart stands by ready to document the rise in temps that follows ovulation. But. . . I don't want to have sex. Not for fun. Not for conception. Oh. I'll take one for the team on that less than one percent chance that I'll conceive, but there is no joy in Mudville. This is, I think, a cruel infertility trick, an inverse law of need and want--the more you need to have sex, the less you want to have sex.

3. No monitoring. Don't get me wrong. I do not enjoy the condom wrapped ultrasound probe any more than the next girl. However, I like scientific evidence that something is happening in there. I like seeing my follicles grow. Now that I am not being monitored, I have no idea what is going on. Is there a follie? Is it big enough? Has my lining recovered from last month's Clomid challenge? Are there any malicious cysts? How is that fibroid doing?

Well that blows. It really was like a date: I was stood up.

There was a SNAFU and Dr. F. did not know he was supposed to call me. I sat by the phone for 83 minutes and finally called the patient coordinator. She was very nice and apologetic. My name was on the master schedule and my chart was ready. Somehow that information just didn't make it down the hall. Unfortunately Dr. F is going on vacation and can't talk with me until December 2. Two weeks. Two long weeks.

That would be bad enough, but today was my annual exam. My goal was to be an OB patient by the time we needed to check my cervix and tits. But no, I was just a regular old gyn patient. The heartbeat doppler sat lonely on the counter of the exam room reminding me of what might have been.

My OB/GYN asked about the fertility front and when I filled her in she said, "but you have a beautiful little girl," as if that should be enough to make everything better. When I told her that Dr. Negative instructed me not to bother with IVF or to "chase" other doctors, I expected a little grrrl empathy ("don't listen to that-you know what is right for you"). Instead, she told me that, "he's an excellent doctor and acting in your best interest." That's what I needed: more medical paternalism.

I am unbelievably sad right now. Inappropriately sad, I think. I feel like hope keeps slipping away.

He hates me. He was supposed to call 53 minutes ago. What's a girl to do?

My phone consultation with Dr. F. is set for this Friday evening. Dr. F. has a great reputation among the high FSH crowd. Actually, he has groupies which I'll take as a good sign.

My records should be there by now--I requested that they be sent after last week's disappointing visit with my local RE. I'm curious if the local RE, Dr. Negative, wrote his "less than one percent" pronouncement in there. I wonder if he wrote that I "shouldn't go chasing other clinics because they play with their numbers." I wonder if he wrote that "you don't need IVF because you ovulate."

I'm excited and nervous about the consult with Dr. F. It has been 15 years since my last first date, but this feels like one. Will he like me? Will I like him? Will he like my records? Will I like his success rates? Will he push me too far, too fast? Will I sound too needy? Will he get me pregnant?

I have questions, so many questions:

• Is it possible that my cd 10 FSH was high two years ago when we were trying for Baby E?
• Is having normal FSH on CD3 promising or is the high cd 10 FSH more important?
• Will IVF give me a better chance than IUI?
• How much will this cost?
• What is this clinic's success rate for other woman who are the same age and have a similar FSH as me?
• What made my ovaries old?
• What protocol is used for high FSH women? How is this different from other clinics?
• Is there any way to avoid BCP before IVF (it makes me crazy)?

That is it so far. I would love suggestions for other things I should ask from anyone who knows more about this.

It was a small step to be sure.

I faxed my new patient questionnaire to SIRM. I am proud of myself for getting it done. Why proud of such a small accomplishment? I'm proud--self satisfied at least-- because it is my first babystep (no pun intended) away from my RE, Dr. Negative.

Normally, I would have used the fax at work, but the thought of being discovered sending fertility papers out was just too much for me. So yesterday I bought a plain paper fax for $29.99 after rebate (bargain!). I hooked it up and hit send.

Poof. My history, my hopes, my fears are on a desk somewhere waiting for a second opinion.

On the bright side, I love our nanny.

While the last few weeks have been difficult, and I am continuing to struggle with the concept of potentially never having another child, I feel it is worth mentioning a bright spot, Nanny S.

We have tried a number of childcare arrangements, some more disastrous than others. A few weeks ago, a bad situation came to a head, and I had to scramble to find care. Our current arrangement seems to be working. Breaking the bank. But working.

[Honestly, we don't earn enough for a nanny. However, I did not know to register Baby E. for a reputable child development center when she was just two lines on a stick. We have a spot for May 2006. Until then, we shall continue to pretend to be members of the bourgeoisie.]

One of the new nannies (they split the week) went to cooking school. Somehow while Baby E naps for two hours, Nanny S. manages to cook entire meals using things she finds in our refrigerator and pantry. I looked at the pantry and fridge this morning and thought, "Ah well, there is truly nothing she can fix this time." Wrong! She made corn chowder, cornbread (with a hint of cheddar), and shortbread cookies with strawberry glaze. Did I mention she used ingredients we already had? This is like the best party trick ever. I can't cook a meal unless I make a special trip to the store-- and even then I forget key ingredients and resort to cereal. Again.

For the record, she is not required to cook or clean. She said she gets bored waiting for Baby E to get up. Who am I to let her get bored?

Did I mention that she folded the laundry that I left running in the dryer today? This is almost like having a wife.

Baby E. likes her too.

It hit me tonight.

Baby E. was up needing a sip of water and a cuddle moment. Normally, I would be a bit annoyed to have my sleep broken up. But tonight as we rocked and she lay quietly in my arms, head on my shoulder, it hit me. I may never have another child. I may never have another child. I may never have another child.

When I was working hard to conceive Baby E, it never occurred to me that infertility, round 2, could cut so deep. My heart and soul are primed. But is my body able?

Moment of truth arrived today. We met with the RE at long last to discuss my dismal test results. He wore a sad smile as if to say, "This is the worst part of my job, not being able to help people." He is of the school of thought that I can't get pregnant (less than 1% chance) with my own eggs. The upshot of the meeting was that we can keep trying on our own, but we would come back to donor eggs eventually. He is willing to try IUI to placate us, but will not try IVF.

Not so fast, buddy. I am getting a second opinion.

My worries:

• Even if we find money for IVF, what if travel costs to a big city are too much.
• Even if we find money for treatment and travel, how can I take off for two weeks in middle of a semester?
• Even if we find money for treatment and travel AND find a way to take off in middle of a semester, what if it doesn't work?
• If it doesn't work, will I always regret having used money for treatment that could have been used for adoption?
• If I decide on adoption, will I regret not having tried with my own eggs?
• What if autoimmune disease catches up with my pancreas next? Or my pituitary? What else can it get?

I feel so. . . Shriveled. . . Used up. . .Old.

Warning to the next person who tells me of someone who got pregnant:

• as soon as the doctor said she couldn't
• as soon as she relaxed
• as soon as she ate organic wheat germ grown in her own yard
• as soon as she stopped stressing
• as soon as she made a big purchase and accrued debt
• as soon as she used cough syrup
• as soon as she adopted/ chose a surrogate/ gave up ttc
• as soon as she gave up her job

I will punch you. Zip it.