The things we do

The desire for a baby has taken me down many roads I never imagined.  And today, I added one more. My friend, Suzanne, who at  41 was also dealing with secondary infertility told me about this woman in the Mission District who does a massage to lift your uterus. She’d heard about it from her cleaning lady who said got pregnant the first cycle after going to her. Her cleaning lady’s friend, another case of secondary infertility, also got pregnant after seeing her. Then Suzanne went and what do you know, she got pregnant the next cycle.

So when my cycle got canceled, the first thing I did was make an appointment. Suzanne warned me it was uncomfortable and the woman, Esther, didn’t speak much English. I imagined she worked out of her home and that it might just be like an abdominal massage. Unpleasant but manageable. Was I in for a surprise!

She led me down an alley behind her house to a small shack closed with lock and chain. The tiny room was filled with Mexican chotkes, two large display cases with vitamins for sale, and a large flat screen monitor on the wall. Her table was a plank held up on one end by a concrete block. In broken English, she referenced a picture of the uterus and ovaries on the large monitor and described how over time our uterus drops and there needs to be space for a successful pregnancy. Her job was to create space.

And creating space is not pleasant. In fact, it is excruciating. Using Bengay and Vaseline on my belly, Esther pushed and pushed, digging into my lower abs, coaching to me to relax when I screamed out in pain. Apparently, my uterus was very low because Esther had to work quite hard to move it up. I begged for mercy several times, just for a moment to breathe, but I focused on the end goal. The baby and if this is the pain I have to get through to hold him or her, its more than worth it. And it’s a whole hell of a lot better than shooting myself up with hormones!

After it was over, including an even more painful thigh massage, Esther wrapped up my belly in an old pillow case I’d brought. She instructed me to leave it on for 2 days, no shower and to take it easy (yeah right!). And then Esther proclaimed me okay and to call her if I was not pregnant in 2 months.  Fingers crossed!

Inconceivable by Julie Indichova

 I am not sure how I missed this book before but I am so glad I found it. Inconceivable is the true story of a woman who at 42, found herself with high FSH and little hope of conceiving a second child. Unable to do IVF, doctors pushed her towards donor eggs as a last resort. Instead of taking their advice, she followed her gut and made radical changes in her life – diet, yoga, cleansing, visualization –saw her FSH drop by half and eventually conceived naturally at 43.

After finishing the book, I was ready to swear off sugar, refined flour, dairy, meat and anything else that did not help better fuel my body. I committed to a morning, veggie shakes, half an hour of yoga a day, daily visualization and mind work to understand my mental blocks.  And reading through the glowing testimonials both on her web site – www.fertileheart.com - and Amazon, it appears that this approach works. One woman after another tells of attending one of Julia’s workshops or reading her book after years of IF and then getting pregnant within a month or two. The majority of the women are in the 40s and have been told by doctors that there is little hope for them. Thanks to Julia, they find the balance and mostly the belief in themselves that they, not the doctors, are in control and allow a beautiful life to be born inside them.

Thankfully, my FSH is not so high (7.3 and falling from 8.8 last year) but my womb is still empty.  Inconceivable struck a chord in me that I could do this, that my body is capable, that I don’t need all of these fertility hormones, that we can do this on our own. So when my cycle got cancelled, I didn’t feel the letdown I expected. Yes, I am turning 40 next week but somehow after reading the book, I believe it will happen. Not on the timeline I would like but I will be pregnant and I will deliver a healthy child.

Canceled

Before every IVF cycle, the nurse typically gives you a calendar telling you what to do when. When to start and stop your birth control pills, when to start Lupron and how much, when to start stims and how much, appointment times for the baseline ultrasound and rough estimates for follow up appointments and expected retrieval date. During my cycle, its my bible, at least until I start Lupron.

Somehow I forgot that change and flexibility are key elements of IVF. Just because the schedule says that you will get your period between Monday and Thursday and to schedule a baseline on Friday means that it will happen. It should happen but in my case, it did not, causing even the CCRM nurse to wonder what could be wrong.  Maybe my lining was thick enough from only 12 days on the pill to have a heavy flow? Maybe, just maybe I was pregnant already?

In true CCRM fashion, a different nurse, a different plan. The first one tells me to keep on waiting and just call when I get my period. The second orders me to immediately take a pregnancy test and if that’s negative, go to my baseline. “We have to see whats going on in there.” She said. And in case you were wondering, I am not pregnant so this morning, it was back to UCSF for my baseline and bloodtest.

The good news. My AFC is 12 and my lining is very thin. So thin that the UCSF doc does not think I will get a period. Happens, he says if  you aren’t on the pill long enough. The bad news I learn later. My estrogen is 78 and my progesterone is 18.  Even if my estrogen was close (they like it under 50), my progesterone needs to be around 1. Yikes! So what does this mean? The illustrious Dr. Schoolcraft who was on call this weekend recommending canceling the cycle, that is unless my period miraculously comes before Monday.

Surprisingly, I am relieved. I still take my meds through Monday but I have moved on.  Cycling this month in Colorado meant spending my 40^th birthday jacked up on hormones instead of celebrating with friends. I had opted on missing out on my best friends from college’s visit to San Francisco for the famous Passport wine weekend in Dry Creek valley. It seemed worth it at the time. If we missed this month, we wouldn’t be able to cycle until July with a transfer in September. So now I feel free. Free to indulge in a bite of chocolate, a glass of wine and truly enjoy the last days of my third decade.  I guess that is what my body truly wanted.

Here we go!

Three thousand dollars in meds (just to start), $200 plane ticket and way too much for everything else at CCRM, but we are on our way. I started birth control pills last week and two days ago, began daily Lupron shots and dexamethosone pills. The goal is to quiet my ovaries before starting the stim shots next Friday. My first two blood tests and ultrasounds will be at UCSF and then I fly out to Denver on the 27^th. Fingers crossed my body responds as well as the past cycle.

Turns out that all of those vials of blood were useful. CCRM found that I have elevated clotting levels (no idea what the exact terminology is for my diagnosis). What that means is I will be on Lovenox, a blood thinner, before the transfer and if pregnant, through the first trimester. Crazy but I am happy they found something and there is something that they can do about it! Much better than more of the same which would be happening if we stayed at UCSF.

Now that I am in cycle, caffeine (including chocolate), alcohol and high impact exercise can no longer be my friends. Same goes for the herbs my acupuncturist prescribes. (Full disclosure I took the herbs during my last cycle. Best response but no BFP.) I did sneak one square of my favorite dark chocolate last night (and another the night before). Whats life without a vice or two and chances that this is the deal breaker….well, I don’t want to think about that!

Its the lab, stupid

The bad news. I got my period or AF in girl speak. My hopes at a natural miracle gone, its time to get the next IVF started. But given that its me and I can leave no stone left unturned, I went to talk to Dr. Rosen one more time in the hopes that he might be able to convince me that CCRM wasn’t my best option.

I will say he came close. During our 45 minute chat (eons in doctor time), I truly felt that he would do everything in his power to get me pregnant and was confident that I would have another child. And I wanted it to be him. He begged me to put all of my stress on him so that I could relax more and enjoy my life. He even instructed me to drink coffee and a couple glasses of wine a week Wouldn’t that be nice? Dr. Surrey, by comparision, spent a short 15 minutes with me and confident as he was in my chances, I didn’t see him taking that kind of time to get so personally involved in my case. And I know wine and coffee are absolutely taboo at CCRM.

I left UCSF with a plan. We’d take off the month so I could celebrate my birthday. Drink, run, gorge on chocolate and forget about trying to have a baby.  We’d start in May and do a frozen embryo transfer in June. No chromosomal testing like we have planned at CCRM.

Then I remembered why I chose CCRM in the first place. I knew it was a factory, the doctors prescribed protocols but showed up only at retrievals and transfers and that I would have to be pushy to get the best care. On top of that its not convenient, its more expensive but there is a reason women from all over the world who have had multiple failed IVFs and are at the end of their ropes go there. The lab.

Only three clinics in the country offer the same degree of chromosomal testing and while we might not “need” it, it will certainly improve our odds. It doesn’t matter how much I like Dr. Rosen. What matters is that I want a baby, another child for my husband and a sibling for my son. And CCRM, bedside manner aside, is our best option.

Tests, tests and more tests

At last count, I’ve given 16 vials of my sweet red blood to CCRM’s exclusive program. I’ve been tested for everything from Vitamin D to AMH to the entire Thrombophilia Panel.  On top of that I’ve signed fifty pages of consents, many of which were opting out of even more blood tests screening for the most elusive chromosomal abnormalities. And this doesn’t include the tens of other tests I don’t need to have because they have already been done. Or the ridiculous amount of my past history that must be received before moving forward.

Every time, I think I have finally gotten them everything, my lovely nurse, Rhonda calls to remind me of what she has yet to receive. And it appears that CCRM, as competent as they are with fertility, cant seem to keep track of paperwork. It started from the initial phone consult back in February when I got a call the day before saying my records had never been sent. Infuriated, I took it out on the poor records lady at UCSF who swore she had faxed all 68 pages and probably in fear of my wrath, did it again (and again when CCRM couldn’t find it). This time I was at CCRM when the faxed was received and even confirmed it the sender. Two weeks later after Rhonda sent me orders for a 20 vial blood test which I swore I had had and asked yet again if she had seen the results and she brushed me off saying it was a different test,  lo and behold, it arrived on her desk and she called to tell me to hold off. And just in time, I was packed in the car and ready to lose a couple pints. Rhonda did say she was sorry and that I would need some more tests run – only 8 vials.

Its enough to drive you crazy! Add in the roller coaster of home buying  - I wont get into our loan process or the hoops I’ve had to jump through to get approved. And I will skip the details of selling the house in a declining market in which our agent now predicts our home will sell for $125k less than she estimated six months ago. Come on, this is San Francisco and there are very few homes on the market! I will also leave out Miles’ latest toddler antics in which Thomas and friends are constant sources of bribery.  So what if he only eats when he is planted in front of a Thomas video. At least he gets his veggies.

All of this led my very astute husband to suggest that maybe we are rushing into CCRM. Perhaps we could wait a month or two or three. Try the old-fashioned way, take the stress off and relax a little. If only it were that easy. The fact that I turn 40 in a month holds little sway. Somehow he missed that we, well I, have limited time before the window closes and each month counts. I try to figure out alternatives – an IUI here, another IVF – but in the end, each failure gets me back to CCRM but with older eggs. It wont be convenient, it wont be easy and from what I can tell, no one there is going to hold my hand through it but it really is our best shot.