Just three years in...

Three years ago today, my husband vowed to be there in good times and bad, to wipe my tears, to comfort me with his body and spirit and nurture my best person and of course, not drink bad wine. We didn’t know what the future would hold or how much our relationship would deepen in the next three years. While we had already been introduced to UCSF, we were neophytes and had no idea how lucky we were to get away scott-free with a pregnancy on our first IUI.

I like to think of year one as Miles. Seven months after our wedding, our dear son was born via C-section at 5:47 am.  Ten weeks early and just three pounds, five ounces, Miles taught us quickly the challenges of parenthood. The 45 days he spent in the NICU were some of the toughest in my life even though his stay there was easy compared to many of his cohorts.

By our second anniversary, we barely managed a quick dinner to celebrate. Too exhausted by twice a night feedings, constant pumping and worrying about long term problems from Miles’ prematurity lingered. Everything seemed to sort itself out for a bit. Miles learned to crawl, turned one and I got pregnant easily. Then things fell apart. I lost my job, found out the baby had Trisomy 18, terminated and two weeks later, Miles was in the hospital with RSV. Miles had barely gained a few ounces back from his sickness when Dave lost his job on our second wedding anniversary in the middle of a costly home renovation. On a bright note, Miles was sleeping through the night by then and we enjoyed a great dinner and a full bottle of lovely wine.

We’d always wanted two children and assumed it would be easy to get pregnant again. This past year, we’ve watched month after month go by, one negative after the next. Escalating treatments from IUI to IVF in hope of getting there faster and still, an empty womb. We find ourselves on our third anniversary ready to travel to CCRM for a final try. At the same time, we bought a house in the burbs to be closer to Dave’s work and begin the process of selling our beloved San Francisco home.  The blessing throughout has been Miles, who turned 2, in November and is completely caught up to his developmental age. While he might try our nerves more than I like to admit, we never for a second forget our fortunate we are for his health and adorable spirit.

Tonight, I will break IF rule #1 and open a fine Brunello. We will toast our perfect little boy and the strength of our relationship, made so much stronger from what we have been through these past three years. And to the hope that the fourth year will bring Miles a little brother like the fortune teller saw and that next years anniversary be filled with sleepless nights.

They are everywhere!

I like to think of myself as one of the moms picking up my son at preschool. Dressed in my Lululemon work out gear, I rush in a few minutes before 12, make small talk, sip tea and wait for the door to open. And my son, just like the other children, comes bounding out with a huge smile, screaming Mommy! But today, I realized, I and my son are different.

I arrived a few minutes late and immediately was assaulted by three 8 month pregnant bellies. I overheard one woman, resting back on the couch, feet on the coffee table, moaning about not being able to sleep. The woman next to her, rocking her newborn in a carseat, nodded in commiseration. Another one brought her four-year old son along and the two discussed his own morning at school. I saw the nanny of my son’s favorite friend in class, and she too, wore a Bjorn with her employees baby daughter encased. I was alone. A mother of one. How easy she has it, they must think to themselves.

Times like this, I wish it was just a choice to have one. We could get on with our lives, fully content with the decision that we made. But as my therapist said, even if we find our way to that place, it will always be our second choice. How sad is that? And then I remember that my own dear husband was not my first choice nor I, his. We both married before and thankfully fate brought us together, giving us our second and in his case, third choice. So if we come to that, I am confident, we will look at it as we do each other, as the only way things could have been.

A new house

As if the stress of IVF weren’t enough, we decided to throw buying a new home into the mix. For the last nine months, DH’s commute has been a grueling 40 miles/90 minutes each way. And after months of searching for that perfect home in just the right school district, close to trails, with a walk-in closet, level and west-facing backyard and with just a little bit of character, we found it.

Today, as we poured through more than 200 pages of disclosures and inspections, I began to wonder if it was too big. Right now, we live in a three bedroom, 2 bath, 2000 square foot home in San Francisco. In Ohio where I am from, it is tiny, the size of the bathroom and walk in closet in my brothers home. But here, it is spacious, even enviable. Perfect for a family of three and still comfortable if we have our rainbow.

Again compared to the Midwest, our new house is compact at 4 bedrooms, 3 baths and 3000 square feet. When we looked at houses, 4 bedrooms was always the minimum along with the assumption there would be a second child. Yet when today, the new house still filled with the current owners belongings, 20 miles away, felt empty. I wondered if we jinxed ourselves by buying for what had not come easily to us yet. Should we have just settled for a smaller, more affordable 3 bedroom? What if it is just the three of us?

Dave said we’d grow to fill it. Either by us or through adoption. A concept he has been resistant to until today. I am still on the fence that I could handle the emotional and financial rollercoaster of adoption after enduring the one we have been on for the last year. At some point, life must move on with other things taking priority.

In the meantime, we’ve got work to do. I am gearing up for an April stimulation and retrieval at CCRM so am busy getting all the necessary tests and paperwork completed. We have final inspections and contigencies to remove on the house. Packing, and getting our current home ready for market. And I’ve decided it might be time for me to go back to work.

Worth the reputation?

So now I know what a “real” fertility clinic looks like. It is set amidst spectacular mountain scenery at the southern end of Denver sprawl. Doctors work out of a brown and gold brick building boasting the Colorado Center for Reproductive Medicine logo from both the streetfront and entry doors. It goes without saying that there is easy, ample and free parking – very important to San Franciscans. Nurses greet you with big, self-assured smiles and always make sure you pay before services are rendered. And American express is not welcome.

But really what matters is what goes on in the clinic. Our visit started on Friday. When we scheduled the workup, I’d been told that it was impossible to do everything in one day so Dave’s andrology (semen evaluation) and blood work had to be done earlier. Well, all of that took just 30 minutes and $950 and he no longer had to return with me on Monday. We were not off to a positive start.

I returned on Monday morning at 7:30 am sharp. Good thing for the coffee cart in the lobby but unfortunately, I was still off caffeine. After an hour overview of the clinic and policies with other newbies, I really got started. My $600 baseline ultrasound was performed by a nurse – at UCSF, it is always an RE or resident under supervision. While I sat in stirrups, I had a full view of my uterus and growing follicles on the screen in front of me. She showed me my c-section scar, the residuals from last months IVFs and the beautiful dominant follicle that might just might be my rainbow.

Next up was the $750 hysteroscopy procedure and my first chance to meet an actual doctor. Feet back in stirrups, speculum and a camera inserted into my uterus to get a closer look. All of three minutes later and the doctor announced that he saw nothing abnormal. We retreated to a consultation room for a 15 minute regroup where the doctor basically repeated most of what I heard on the phone during my initial consultation with the additional information that Dave’s sperm is great, if a little viscous (sticky).  I have unexplained infertility. I had a 75% chance of a getting a normal embryo and then a 60% chance of that embryo implanting – so we are back to 50/50. I wondered out loud about trying naturally – odds are 10-15%/cycle but given my age, there is a 40% chance of miscarriage.  Of course, if we don’t get a normal embryo, its unlikely we would with another cycle. That would be our answer. All for just $30,000. The doctor is smart and sure of himself while he watches the clock. After 20 minutes, my time is up.

I kept my pants on the rest of the morning as I indulged in dark chocolate, met with the business office, my primary nurse, got 10 vials of blood taken (another $1300), watched a video on CCRM’s  chromosomal testing and received consent forms to sign.  I walked out the door at 12:30 (an hour early) arms full with my information book, consent forms, prescriptions and a return box for another blood test in San Francisco.

Was I sold? Yes, if we decide to do another round. I cant get over the rigormarole we subject ourselves to just to have a second child. Shouldn’t my body be able to do this naturally?  Yet when I return to my brothers house where I have been staying and Miles greets me with “Wheres Daddy?” before chasing the cat, I know its something we have to do. 

And for what its worth, I was more than slightly peeved when a nurse let it slip that there tons of openings on Monday for Dave’s appointments and they could have easily accommodated us on 1 day. Like we didn’t have anything better to do than spend two extra days in Denver! As long as the doctors and embryologists know their stuff, I guess we can live with the admin's mistakes.

Oh the sacrifices

There was a time when the thought of giving up my wine and morning coffee and daily runs were good enough reasons to not get pregnant. I worried less about the weight gain, future sleep deprivation and just how I would juggle a baby and my life than giving up daily rituals. I never imagined that I might need to cut these necessary parts of my life just to get pregnant!

Sure when I was trying to get pregnant the first time, the doctor said I might want to drink less and cut down on the caffeine. But that was when Dave and I regularly polished off a bottle a night and I had not entertained any Decaf in my life. So I drank a quarter glass of wine and a half a cup of coffee but I never truly cut it out, even when I was pregnant. Even my acupuncturist agreed that a little was fine. The hard and fast rules weren’t meant for those people that cant control themselves.

Two failed IUIs and a hard-core Chinese acupuncturist set me straight. No alcohol. Not even a sip. By then I read an article that supported that even moderate alcohol decreases chance of pregnancy so I abstained. As for my coffee, which by then was a a quarter cup of half-decaf a day, that was a no, too. Both caffeinated and decaf. Something about an enzyme in any kind of coffee that disrupted blood flow to your uterus. And I was to eat pineapple every day, massage my uterus so it was less twisted and do acupressure on my pelvic region to increase blood flow to my uterus. And running was out of the question. Swimming, gentle yoga or light walking was best. I was also instructed to drink special herbs twice a day except when on IVF meds and the doctors forbade it. But most of all, I was instructed to rest. Let the dirty dishes sit in the sink, make my husband do the laundry, don’t worry about my sons birthday party, just take naps.

Because more than anything, I want to have another baby, during my first IVF, I followed the instructions to a tee. I suffered the caffeine withdrawal and actually enjoyed waking up without needing caffeine. Life was clearer without the wine and a lot less of a hassle when there is no workout to try to fit in. My husband stepped it up and I rested. And I didn’t get pregnant even though I barely lifted Miles for two weeks after the transfer, didn’t so much as walk to the park and ate my pineapple religiously every night.

For the second IVF, I made changes. I fired the hard-core acupuncturist, drank the herbs during treatment and let myself go about my normal life, workouts and all (save for the running, alcohol and coffee!). Perfect cycle, perfect eggs, and perfect embryos and still a BFN.

Looking ahead, CCRM asks no coffee or caffeine of any kind (goodbye chocolate) for 72 hours before the work up. Apparently, its policy as well during treatment so my last vice – dark chocolate – will also have to go. Many of the women there are also follow strict supplement regimens including DHEA, Royal Jelly, Baby Aspirin, Prenatals, extra folic acid and a host of others.

As we get ready to jump on the treadmill at CCRM, I wonder if its any of it makes a difference.  I cant count how many people who tell me some story of a woman who got pregnant without any of this crap. They drank, ran, over-caffeinated, and toted their kids around. They didn’t analyze their cervical mucous, cross of their daily vitamin checklist, eat extra pineapple or prowl the internet for the best fertility doctors. So maybe I take it to the extreme and maybe some of these things help but I am beginning to feel that its all a big crapshoot. You increase your odds with IVF or IUI but nothing is guaranteed and sometimes, when you sit out a round, you score big.

Not that I am ready to throw in the towel but the last week when I have allowed myself a couple glasses of wine and my morning coffee, it feels good. I felt like myself, more relaxed, more positive and hopeful. And that is something I want to hold onto.

Colorado, here we come!

"I will do 3-4 IUIs and if that doesnt work, I'll be done"

“Yep, I heard that before. Once you get started, its hard not to stop escalating until it works.”

“Not me,” I said, “I don’t like shots.”

That was my conversation with my doctor at UCSF in May 2010. Four IUIs and two failed IVFs later, we are now considering something I would have thought even crazier 10 months ago – flying to Colorado to get treatment at the illustrious Colorado Center for Reproductive Medicine (CCRM). IVF aint cheap to begin with and CCRM takes it to a whole new level. Throw in the travel costs and we’ll be well close to $30k for a cycle.

So what is it about CCRM that makes it so coveted? Since a college friend and RE mentioned it to me, I’ve been obsessed with finding out. According to sart.org, my chance of success at my clinic is roughly 50% per cycle but at CCRM, its nearly 70% per cycle!! During the 2ww, I scheduled a just in case consultation with Dr. Eric Surrey. Perhaps I jinxed myself because I was so excited after the call, I almost wanted the chance to go there for treatment.

Unlike UCSF, Dr. Surrey recommended that a comprehensive chromosomal analysis on all of our fertilized eggs. What that means, each embryo that made it to Day 5 (5 days after fertilization) would be frozen and then analyzed cell by cell for any abnormalities. Translation: all those insidious abnormalities that either lead to miscarriage or cause embryos not to implant wouldn’t not be chosen. Instead of an immediate embryo transfer either 3 or 5 days after the retrieval, we would do a Frozen Embryo Transfer (FET) with only “clean” embryos! Sounds great but the risk is that we might not even get any of those clean embryos.

Still, far better than more of the same, especially when UCSF didn’t even want to risk pushing my embryos to Day 5. Their philosophy is embryos do better in their natural environment of the uterus. But there really is nothing natural about IVF and for the record on Day 3 after fertilization, the embryo isn’t even in the uterus yet, its still in the tubes. But then again, I am no expert! It obviously works for a lot of people!

So there you have it. We fly out to Denver next week for our one day work up. Looking forward to experience their expertise!

Seven things not to say to a friend when IVF fails

When IVF doesn’t work, often times those closest to you say some pretty insensitive if well-meaning words of advice or consolation. Here are a few to keep in mind so you know what to avoid with those closest to you:

1)   “Stay positive”. Yes, we should all see the positive in a bad situation but when you just find out that you threw $17,000 down the drain, injected yourself full of hormones with unknown lasting impact and are one month farther away from your rainbow child, I have the right to feel sorry for myself for a day or two before realizing I am far better off than a starving child in Africa.

2)   Share details of your pregnancy. Yes, I am happy for my pregnant friends, even those that barely looked at their partners to conceive.  I am happy but its deep down and second to my own frustration so please hold off sharing your due date and excitement. Hope you understand, but don’t feel much like celebrating you right now.

3)   “You are lucky to have 1 already”. Duh! I know this but I want another. I just happen to fall into that 1% who happen to get a chromosomal abnormality. And just like the rest of my friends who wanted a sibling for their first, its more than okay for me to want this too. Throwing infertility on top of the loss aint no picnic!

4)   “Relax and it will happen”. Sure, I will take my mind off having another baby. I will try to forget that I am 39 years old and each month, my chances of a healthy pregnancy diminish. Again, not going to happen. If you want something, you work for it and for those that are lucky to just relax and have it happen, I hate you.

5)   “Stress isn’t good for you”.  OK then, I will stop stressing and get pregnant immediately. And then I will remind you of the rape victims who got knocked up. I am sure they were relaxed and doing acupuncture too!

6)   “You can adopt”. Wow, I hadnt thought of that one! It’s a weighty topic and until you have walked that road, you have no idea how you would feel about it. And for the record, its not exactly cheap or a piece of cake either.

7)    Question my treatment protocol. You only get to ask this question if you are a reproductive endocrinologist (RE).  But for the most of you that are not, you are out of line, even if you went through IVF yourself. Whats done is done. I don’t need an amateur Monday morning quarterback.

To be fair, many wonderful friends know just what to say. “I am so sorry. I hate that you have to go through this. I am here if you need to talk.”