Wednesday, September 28, 2011

rock bottom moment

There is a metaphor I really like to use with patients in my work. It spoke to me very much in a time of crisis and it has continued to resonate to this day. It goes something like this:

When you jump into a deep swimming pool and you don't get all the way down to the floor of the pool, and you try to swim up, it's hard to do. Your body had momentum from the jump and reversing the direction to go up is very effortful. When you jump into the pool and get to the floor of the pool, you can push off and get back to the surface without much effort at all. Sometimes reaching the bottom helps you to get the momentum you need to get back up.

Now, don't think that I mean to say this is the actual rock bottom of my infertility and childlessness. I realize that things can get much, much worse from here. If nothing else, my experience thus far has taught me that lesson.

I was just having supper in my car a few minutes ago. Why? I was at work until 7:15pm and then wanted to spend time commenting on blogs and responding to email, so I had to visit the local mermaid-emblemed  coffee chain that provides free internet when you purchase a very expensive drink. Why would I not just do email from home? Well, I had to find another place to board in FTT for the last 7 weeks of my contract, and this place doesn't have internet access at the moment. Gak. So, instead of going home for supper, I got something from the gourmet grocery store adjacent to the coffee shop and ate in my car. Lentil soup and bow-tie pasta salad. And REM singing about the end of the world as I know it.

It's been a hard week. 3 days of 11+ hours at work and some crappy sleeps. That seems like the new normal, but it was on the heels of yet another very crappy weekend. And then Mr. A who could not sleep on Sunday night (it's usually me or Chicken who can't sleep on Sundays). He told me in the morning that he had been up all night thinking about 'life'. In the hour that I was at home on Monday morning (5:45-6:45am), I didn't have it in my to explore what was up. I just gave him a hug and then I had to go. When I called on Monday evening, he told me it was about us having children. He wondered whether we (me) were just too tired for children, whether we (me) were too depressed for children, and whether we (me) were too irritable for children. Oh fuck. Yes we are. But I don't know what the heck more I can do about it right now.

To be fair, he wasn't saying any of this in a blaming way. He was just telling me what he felt worried and anxious about. And he was looking to me to reassure him that things would get better. Based on my belief in impermanence, I do believe things will change. But I can't see a clear picture of how things will get better. I just have to hold out hope that they will. That seemed to help him, somehow. But it left me with a horrible sense of failure. He is right. I am tired, sad and irritable. Pretty much all weekend every weekend. All the chipper I have has to be saved for my patients, their families and my team members. My livelihood depends on it.
This evening, sitting in my car, eating my supper in the dark, I felt like I did not belong anywhere. I can't stand going to where I board. I can't stand being at work anymore for today. I'm too far from my home and I am worried about what is going to happen at home, what is going to happen if Mr. A doesn't want to keep trying to have children because he's not sure about my capacity as a parent. He did call me at work today to check-in and worried that he had made me feel bad with voicing his concerns on Monday. It was reassuring to talk a bit, but what he was raising was a worse case scenario for me. Maybe IF will also rob me of my marriage.*

My rock bottom moment in the car tonight felt similar somehow to another rock bottom moment I had when I was 20. I was admitted to the psychiatric hospital on December 13, and so spent most of the Holidays in hospital. I remember Being the only patient on the unit that Christmas eve, since all the other patients had LOA passes and I didn't. I remember wondering what my life had become that I was sitting on a bed in a psychiatric hospital, listening to Simon and Garfunkel on a Christmas eve. And as awful as that sounds, I remember feeling like it was a new beginning.

It's not that I want to call it at this point. That would be premature. But things felt awful just an hour ago in the car. And at the same time, the memory of Christmas eve in the hospital came back to me very vividly. They say shit happens. New beginnings also probably happen.

*For you Ani DiFranco fans out there, it makes me think of the line in her song Done Wrong: "how could you take almost everything and then come back for the rest"

Wednesday, September 21, 2011

yankee eggs?

There is much to be written on this here blog, but only so much juice left on the laptop battery (and the Augusta battery). The training weekend was certainly an interesting process. But I think I have to go reverse chronological on you, dear reader, and talk about Monday's RE appointment first.

Well, after waiting for an hour (again) we finally got to see Dr. RE. And just so we are clear, I don't mind waiting that long to see him because when we do see him, he takes the time to answer our questions in a thorough fashion. I am assuming he does this with all couples, causing to be him behind schedule. I prefer that to a jerk of a doctor who is on time. In a very funny, double-double negative (that makes 4, so that's positive, right?), Dr. RE said my lining was fine. No problemo with the cells in my lining. Also, the estrogen patch seemed to have done the trick in terms of thickness, according to him. He's happy with where we are in terms of lining and we can go ahead with what's next.

What IS next?

The options we were playing with going into the consultation were twofold:
1) Donor Eggs from Sattva
2) Donor Embryos from new Canadian program started last year

We started with number one. We talked about the possibility of taking up Sattva on her generous offer to go through the whole IVF process again. From an emotional standpoint, that is our first choice. We LOVE Sattva, and to have our family join with hers through DE is a dream that we wish could be realized. The miscarriage was awful on so many levels, the death of that dream not the least of them. The obstacle is Sattva's age, which introduces a great deal of statistical uncertainty into our baby making equation. I'm angry that this has to be a factor, but it just is. Sattva is a healthy woman who has given birth to healthy children in the past, but she is close to 38. It still makes her a candidate for pregnancy, but for donating eggs, it seems to be riskier. I think I am too afraid of it failing again.

Then there is the embryo donation program, where an existing adoption agency started a program that matches couples who want to donate their remaining embryos from previous IVF cycles to a couple in need. We are in need! The alluring aspect of this is that the couples have most likely been successful with their embryos before, since they are in a position to donate them. Also, we would have a connection to another family through this process, which is something that appeals to us very much. The cost is similar to the costs we just paid for the DE IVF, but most of it is in consultation and legal fees with the agency. We would have to do the embryo transfer at the donating couple's clinic, which seemed to worry Dr. RE. He felt that many Canadian clinics have set protocols to build a recipient's lining and they don't like to deviate from that protocol. And, as you know, I don't fit into a protocol very well (you will remember the supre.fact episode).  

Dr. RE's was pretty neutral, as he tends to be in his ethical, respectful stance. But then I asked him to help us weigh our options. To our surprise, the good doctor gave us his opinion.

You want to get the job done, he said. Which leads us to option 3:
3) DE IVF in the U.S. with an anonymous donor

It's not a new option. I haven't been living in a bubble here. I read your blogs. I know it's out there, it just never seemed to be for us. I dreamed about it privately, as it seemed it could be this high-probability-of-success-solution. But the costs are so prohibitive. However, Dr. RE's point was well taken. You can keep going with the Canadian system, which is partly funded, for a long while and end up with the outcome you want, but often after much trial and error, not to mention heartaches. The American system is fee-for-service with a greater focus on getting the job done the first time. Hmmm. I would like to get the job done. A take home baby is what we are aiming for here.

He talked about a specific large practice in the DC area with which they have had dealings with in the past. He seemed confident that the clinic in question would follow his protocol for my lining. And the young eggs. Oh, the young eggs. I hear they make good babies. Dr. RE suggested that we have a teleconference with this clinic just to talk about how it would look like. I better have a teleconference with my banker beforehand.

I must admit, the draw towards option number 3 is strong. Mr. A and I need to discuss it at greater length before we launch ourselves into that venture, ridiculous debt and all. But the draw is very strong.

Tuesday, September 13, 2011

adoption chronicles

 After our first consultation with the adoption counselor in July, I felt a great deal of anxiety about the expectation that couples should have resolved  their infertility before embarking on the adoption journey. Resolved. What. It doesn't even look like giving birth to a real life baby resolves it at all, how could NOT having a baby and starting the process of adoption bring you any closer? It seemed to be one more thing I could be angry and indignant about. How could the world conspire to prevent us from being parents?

I knew about this. We talked about adoption with the psychologist at our clinic, and he was clear in stating that adoption agencies sure don't like it when couples come to them like they are backed into a corner. This was another thing that made me nervous about starting the adoption process this summer, so soon after the miscarriage, and in such rough shape emotionally.

But the alternative to not starting the adoption process was killing me. Waiting around for the effing biopsy, and mulling over the same donor egg vs donor embryo question over and over again, bombarded with doubts about my biologic capacity to grow a baby inside my uterus, all felt like a passive way of wasting time. And yes,  I know it isn't passive to grieve. BELIEVE me, all that crying and raging, and insulting people in two different languages when I am driving in my car for no reason at all is very active. But active grief does nothing to get you a baby.

We started our home study on Friday, after filling out the mound of paper work and the police clearances and the medicals, et cetera. I get myself fingerprinted tomorrow. The parent training starts this weekend. It's a little funny that the child psychologist has to go hear about attachment for 2 entire weekends, but there are no exemptions: the training is mandatory.

When we met with our social worker/adoption counselor - let's call her Gretchen, shall we - she asked us to talk about our relationship, as well as our struggles with infertility. Like probably 90% of her clients do, I explained that our experiences have been very painful and have challenged our relationship.  We said we were at the point where we needed to diversify our efforts to include adoption. And then a couple of things surprised me. First, I didn't start bawling, which I am prone to do these days every time I have to utter the words infertility and miscarriage. Second, Gretchen shared that the philosophy had changed quite a bit within the adoption world and that she felt it made a lot of sense to start the adoption process even if fertility treatments were still a possibility. It's not that I expected her to say that it was prohibited to do both, but just that we would be considered as too fragile, too eager, not ready enough. She actually praised us for our efforts to go about our process in a systematic way, understanding that time is such an enormous variable.

Was it her praise I was looking for? Not really. I just wanted us to be considered, to be accepted as a couple in waiting.  I just don't want another door to slam shut in our face. We have so few doors left.

Anyway, I can't say that what I am feeling is hope. That would be overstating things by three football fields. I am just putting one foot in front of the other.

Tuesday, September 6, 2011

biopsy completed

The wretched biopsy happened last Friday. There was a small blessing to having it on Friday. As I've awkwardly described on this blog before, I live in Pleasantville, but work and receive fertility treatments in Fertility Treatment Town (FTT). 90 minutes of driving separate the two cities. The biopsy was supposed to occur on Saturday or Sunday, but at the last minute, got scheduled for Friday. This meant that I could just skip out of work 20 minutes before the procedure, make my way to the hospital and be right back at work within an hour or so, instead of driving home on Friday, and driving back and forth for the procedure on the weekend.

The rest, my friends, was pretty much pure awful.

It started on Thursday. I had to go to that hospital, the one where our clinic is located, for a matter unrelated to my fertility. New psychology interns were being welcomed and I was asked to talk to them about my experience as an intern in the program. I noticed that I was very anxious to be back at the hospital. I always get nervous about speaking in public, so I tried to explain away my case of nerves by that simple fact. But admittedly, I was also nervous about seeing a friend of mine who was scheduled to speak with me. I saw him last the night before I learned of the miscarriage and I wasn't sure if he had been told that I was no longer pregnant. I pictured a very awkward "you look great" statement, meant to refer to a pregnancy that is no longer there (and the ensuing embarrassment over the very unfortunate weight gain associated with it). Luckily, he had been told of what happened to me in late March.

I was nervous again on Friday, not surprisingly. I had a meeting at work, and something to write up for a conference I was missing at 11am while I would be busy spreading my legs a few blocks away. I took about 1000mgs of tylen.ol, knowing Dr. RE didn't want me to take That was of little help when the time came for him to tear a chunk of my insides, quite unfortunately. When I finally was called (around noon), I changed and stepped into the procedure room. The nurse settled me in and went to get Dr. RE. Very suddenly, I became overwhelmed by the objects in the procedure room. The u/s machine, the pictures of embryos, the little door to the lab, the computer screen. The last time I was in this procedure room was when we had ultrasound one and ultrasound two. I just started sobbing and as if on cue, the doctor and nurse came in, my sob momentum too strong to make the ugly crying stop. The doc said he would come back later and left me there with the nurse to compose myself.

He did eventually return and my crying stopped long enough to get the procedure over with. It hurt like jaw (I am borrowing shamelessly from Roccie's colourful repertoire of expressions) and continued to be crampy for a good hour, although the pain evolved in a merciful decrescendo (also, thanks to the addition of 600mgs of ibuprofen). I'm not sure what possessed me to return to work after that. I had another sobfest in the car and all the way back to work and again in my office. An hour after I returned - where admittedly, I just hid in my office and prayed no one would call or knock on my door - my friend the speech and language pathologist saw me in the hall. She took one look at me and said I was to go home immediately. She then came into my office and packed my stuff. This lady wasn't going to take no for an answer so I just got the car and drove back to Pleasantville.

That day seems like another nightmare in the series of nightmares I've been having. I've been reflecting on my reaction and of course, being a psychologist, I realize that what got me was the environmental cues. Those are pretty powerful suckers when it comes to triggering memories and emotions. I also had worked very hard to shove down any anxiety or emotions I had about the procedure to the dorsal chambers of my heart so that I could just not deal. Well, had I been this woman's therapist, I would have reminded her that things catch up, no matter how far back the emotions are shoved.

I asked about my lining, since it had seemed to displease him so in the past. He told the nurse 8.65 during the u/s, and then when I asked, gave me a noncommittal response that I think was in the neighborhood of not bad. I have a follow-up appointment on Sept. 19 to find out the results. I am not expecting much out of that, to be honest. I'm putting my money on inconclusive. I guess dismal endometrial cytology would suck royally, but would offer a clear direction in our efforts.