Wednesday, September 30, 2009

turning the page

Earlier today, I received a phone call from a nurse at the fertility specialist's office, with a message from my doctor.

Apparently, he wanted me to go on THE PILL.

...HUH????

Yes; I was supposed to wait until my period, go on the pill "to thin the lining of my uterus before the procedure," and then have the hysteroscopy before day 10 or 11 of my next cycle.

Which - YES - would mean that I would lose another potential IUI cycle.

I was beyond perplexed/frustrated/pissed.

I told the nurse that Dr. ____ TOLD ME last Wednesday that he wanted to do the hysteroscopy ASAP so we COULD try next month. Why would he tell me that?!?!?

She didn't know. This is standard procedure, apparently, so he should've set my expectations accordingly. But he didn't.

I cannot tell you how maddeningly frustrating that was. The LAST THING I want is to go on BIRTH CONTROL when I'm trying to GET PREGNANT! Sure, it might help him see my uterus better for this procedure, but isn't this contrary to the ultimate goal of GETTING ME PREGNANT?!?!?

Aaaaaaaaaaagggggggghhhhhhhhhhhhhh!!!!!

I realized then that it was time to put a call into the Clinic Manager to share my concerns about the major detour my care has taken and my concerns about Dr. _____ continuing to provide that care.

The Clinic Manager was a godsend. She sat quietly and listened to me as I shared with her my concerns about the way things have gone over the past week, from the botched prep for my HSN last Wednesday to the complete miscommunication about how we would proceed from this point. She expressed concern - and rightfully so - over the iodine situation, and sympathized with me for how frustrating the process had become since the HSN.

I told her what I wanted.

- For Dr. ____'s partner (the head of the clinic) to review the sonogram from my HSN and give his opinion as to whether the hysteroscopy was really necessary.

- To know if I absolutely MUST be put under general anesthesia for the hysteroscopy or I could do "twilight" sedation, as was done for my colonoscopy, where I was awake but loopy and felt no pain the entire time. Or do an epidural and appropriate pain meds, as was done with my C-section.

- I wanted to know what the ACTUAL timeline of events is going to be from this point forward, and whether that is consistent with the standard of care or not.

- And, ultimately, I wanted to see if I could switch from Dr. ____ to Dr. Head of the Clinic.

The Clinic Manager assured me that she would look into all of it and get back to me, and she apologized for the direction things had taken, as she wants all their patients to feel good about the quality of care and their experience with the clinic. I felt better just to have gotten it all off my chest and to know that someone was going to DO something about it.

Within an hour, Dr. Head of the Clinic called me to talk about my concerns. I was floored.

We discussed his opinion of the HSN results and the need for the hysteroscopy (he concurs that it's most likely a fibroid inside the uterine cavity - as opposed to the uterine wall - and should be removed). We discussed my allergy to iodine and the mistake Dr. ____ made by prepping me with iodine last Wednesday - and my concerns about what might happen if Dr. ____ does my hysteroscopy and forgets about my iodine allergy again. We discussed the ACTUAL timeline of what will happen going forward, according to the standard of care. And I ultimately asked Dr. Head of the Clinic to take me as a patient to put my mind at ease, since I simply felt more comfortable with him and his style than I've come to feel with Dr. ____.

He said yes.

So, this is what's going to happen now.

I'm going to schedule a pre-op appointment with Dr. Head of the Clinic for next week, so he can meet me in person and we can go over ALL my questions about the hysteroscopy.

I'm going to wait until I get my period, then call his office to schedule the hysteroscopy. He is NOT going to put me on the Pill, because he prefers not to do that. Doing the surgery between days 7-10 of my cycle will keep my uterine lining thin enough for him to see adequately during the hysteroscopy.

I will have the hysteroscopy between days 7-10 of my next cycle, in mid-October, under "twilight" sedation. If it IS a fibroid, he'll remove it. If it's just a distortion in the wall of my uterus, then nothing happens and the procedure is over. Either way, I will still not have IUI in October, to let my uterus heal either from the removal of the fibroid or just from the trauma of the hysteroscopy.

Assuming the healing goes as expected, I will start my first FULL IUI cycle after I get my period in early November.

And - hopefully - I'll find out that I'm pregnant in early December, just in time to be the perfect Christmas present. I know that it may not go down that way, but here's hoping that it does.

Can I tell you how much better I feel knowing that I'm going to be seeing Dr. Head of the Clinic from this point on? I've spoken on the phone with the man twice now (he was the one on call when I called about my abdominal pain/bloating on Monday night), and just in the span of those two phone conversations I have such a different vibe from him. He DOES take the time to explain things, to answer questions. He's not operating independently of me and my needs or feelings, and he's still able to set my expectations realistically. Yes, this means I definitely WILL lose another potential IUI cycle in October, but he explained WHY that's in my best interests. I think we'll get along much better and that I will feel infinitely more comfortable in his hands than Dr. ___'s, particularly for the hysteroscopy.

So, while the train is moving again - albeit more slowly than I had expected - I believe it's now headed in the right direction. And now I'm just going along for the ride.

Hope is back, baby! Hope is back.

Yours always,
SW

Tuesday, September 29, 2009

frustration

I've been having a frustrating past couple of days. I sat down to write blog posts twice in the past three days, and ended up not being able to hit "publish" either time because I wasn't really saying what I wanted to say.

And what I want to say is this: What an effing rollercoaster ride this whole fertility treatment business is!

Sheeesh.

Where's this coming from, you might be wondering? Well, it's coming from a few places.

First, the Clomid has been messing with my body and my emotions for the better part of the past week. And I was under the impression that if I didn't experience any issues while I was actually taking the Clomid for those five days then I wouldn't have any issues after those five days were done. I had asked my doctor what I could expect on it and all he said was that I might experience menopausal-like symptoms (like hot flashes, mood swings), "but most people tolerate it fine." Well, the day after I stopped the Clomid, I was up in the middle of the night with hot flashes and feeling nauseous. I felt okay the next day, but as the week went on, I started getting bad headaches that Tylenol wasn't helping. Friday, Saturday and Sunday, I had bad headaches like that, and I was completely beat. I also had heartburn all of those days, despite not eating anything that would've been an obvious culprit. And I also cried at the drop of a hat all week long. It didn't occur to me until yesterday, when I was able to add consistent aching abdominal pain and bloating to the list of issues that it occurred to me that MAYBE it was the Clomid.

I got on Google and started trying to track down whether or not the issues I was experiencing were typical on Clomid. Everything I saw about abdominal pain and bloating indicated that a call to my doctor was in order, as there was a risk of OHSS (Ovarian Hyper-Stimulation Syndrome, which can be life-threatening).

It was 9 o'clock at night though. And I learned that my doctor was out of town all week when I spoke with his office earlier in the day (I'll get to that in a minute). Still, my nerves prevailed and I called the doc-on-call, who happened to be my doctor's partner and the head of the clinic. He said that all the things I was experiencing were totally normal - if unpleasant - side effects of Clomid and asked whether my doctor had gone through any of that with me. "Yeah - no - otherwise I wouldn't be calling you!" Nice.

Second, and this sort of ties in with the first point, I've lost some faith in the doctor I'm seeing. Things started off so well at our first meeting, and I was really on-board with how swiftly he was moving things forward after that meeting, but the experience I had at my HSN appointment last Wednesday - and the things that have happened since then - have really called my opinion of him into question.

For starters, something happened at the HSN appointment last week that surprised and concerned me. My doctor came into the procedure room late and apologized for being late, saying that he'd run into a "complication" with his last procedure. Within 5 minutes, my feet were in stirrups, he'd inserted the speculum and I could feel him swabbing my cervix. It occurred to me then that I ought to ask whether he was swabbing it with iodine, to which I have an allergy.

I asked; he said yes, he was using iodine. "Why?"

"Well, because I'm allergic to it, that's why. It's in my chart."

"Oh." He used some other solution (saline?) to swab off the iodine before proceeding, as I sat there freaking out a little, wondering if I was going to have a reaction or not. I didn't - thank God - but still. He must've been freaking out about it, too, because he gave me a script for Benadryl "to be safe."

That shouldn't have happened. And I can't help but wonder if it happened because he was flustered from the complication with his last procedure (which in and of itself is not cool) or if he makes a habit of NOT checking the file - or asking the patient - about allergies before beginning procedures (which is even LESS cool). That troubles me in particular because he wants to put me under for the hysteroscopy, and if I'm unconscious then who's going to tell him not to prep me with iodine?

The other reason I'm questioning his suitability to be the doctor who assists me in this journey is that he indicated when we were wrapping up the HSN last week that he wanted to get me in "as soon as possible" to have the hysteroscopy, so I'd have time to heal and we could proceed with IUI in my next cycle, and yet I still haven't been able to get the damn thing scheduled.

He had told me that if I hadn't heard from his staff by Friday, to call them to inquire about setting the date (remember, my HSN was on Wednesday). I waited, anxiously, until Friday morning, at which point I left a message saying we needed to schedule the surgery and asking someone to call me. No one called me. I called back late that afternoon only to find out that the person who schedules the surgeries went home sick earlier in the day. I was told to leave her a message and that she'd get back to me Monday.

I left a message. And then I waited until Noon on Monday for her to call me, and when she didn't, I called her. She proceeded to ask me if I was on birth control.

"Uh.... no? Because we're trying to get pregnant? That's why I'm at your clinic seeing Dr. ___!?!?!"

"Right..."

She then informed me that Dr. _____ typically schedules all surgeries for days 6-10 of the cycle, to ensure that the patient isn't pregnant.

Uh... come again???

I immediately objected, telling her that the doctor himself had told me that he wanted to get it taken care of as soon as possible so I'd be ready to try IUI next month and we wouldn't be wasting another cycle. And I specifically asked him if Super Man and I should "abstain from all activity" from that point forward in addition to Dr. ____ canceling our IUI attempt for this month, and he said yes. And I'm an instruction follower, to the letter, so I assured her that she had no need to fear that I gone and gotten pregnant on my own (that would've been the miracle to end all miracles, at this point). And I stressed again that I was very eager - VERY EAGER - to get this scheduled and over with so I could stop thinking and worrying about it and so that I'd be ready to go through the full IUI cycle next month.

Still, she said that she had to see what Dr. ___ wanted to do. "And unfortunately he's out of town this whole week, so unless I can reach him by email, we'll have to wait until he's back to see when he wants to do the surgery."

Uh... come again?!?!?! Are you freaking kidding me??!?

Now, I'm not saying that the man doesn't deserve to take vacations, or that he should plan his vacations around my cycle and my needs. (That would be nice though.) But are you KIDDING ME?!? He didn't say a word to me last Wednesday to indicate that he'd be unavailable to do the surgery he wanted to do "ASAP" until NEXT week, which is TWO WEEKS after the HSN! And I'm a little put off by the fact that he didn't tell the scheduling person to make it so I could get in for the surgery while I'm still in my current (already wasted) cycle, even if he couldn't do it this week.

You know, I realize that I'm not his only patient, but I have to admit, I have definitely felt like once it became clear that I wasn't going to be an IUI patient for this month, I fell off his radar screen entirely. And - I'm sorry - but I am entrusting this person to help me on what is one of THE most important journeys of my life, not to mention entrusting him WITH my life, so I expect him to be sensitive to that fact and treat me like I matter regardless of whether I'm actually having a costly treatment this cycle or not.

So now I'm waiting yet again.

But I may be waiting for different reasons now.

I'm considering asking to switch to the other doctor - the head of the clinic - instead. Considering the experiences I've had with Dr. ____ so far, and me feeling less-than-confident in his ability to treat me safely and expeditiously, I feel like I either need to see the head guy in the clinic or I need to go somewhere else entirely. And I'd rather not jump ship without seeing if the other guy is better. I just wish it hadn't come to this.

Anyway, that's where things stand right now. I have no idea when I'm having the surgery - or even IF I'll be having the surgery, as I now want the other doctor to weigh-in on whether HE feels it's necessary based on the HSN. If I DO have to go through with it, I don't know WHO will be doing it, or who I'll be seeing from this point forward. And the Clomid is making me feel like shit, all for nothing since I wasn't able to go through with the IUI attempt this month, and it will continue to make me feel like shit until I get my period. In nearly two weeks.

Needless to say, I'm not pleased.

Here's hoping that things will take a turn for the better very soon. Will keep you posted!

As always,
SW

Sunday, September 27, 2009

faith

We've been going to church every week for about the past month. This is odd only because - while we certainly have gone to church before - we usually make it only once every few weeks (or months). It's also odd because we've been attending a church that is not our own.

There's a reason why we've been going to a new church every week for the past month. (And, no, it's not because we've become religious zealots in our spare time.) It's because we wanted to enroll Super Boy in a Sunday School program, both so he learns more about what it means to be Catholic and to help prepare him for his First Communion next year. Unfortunately, Sunday School is no longer offered through our regular church (where Super Man and I were married and where Super Boy was Baptized), and because we didn't want to be hypocrites about "forcing" him to go to Sunday School while we slacked off in observing our faith, we're determined to attend church before (or after) Sunday School each week, too. We want Super Boy to really understand what he's learning and why it's important to his life, and to us as a family.

Super Man and I have talked about our lack of commitment to church attendance quite a bit over the years. After those conversations, we might occasionally get on a good streak where we'd attend more regularly than usual, but we'd eventually revert back to our old ways. So, yes, the impetus for this regular church attendance was the Sunday School thing, but I think it was exactly what we needed to get us to "do the right thing," so to speak.

Because, really, there's been no GOOD excuse most weeks for why we haven't attended Mass. Sure, occasionally someone is sick or we're out of town or whatever, but by and large, we're around, home and just sleeping in rather than getting up and going to church.

Anyway, as more frequent attendance at church often tends to do, I've found myself spending a lot of time lately reflecting on my beliefs, both those I've been taught and those I've acquired, and on my concept of spirituality in general.

While I can't really call myself a highly religious person, I consider myself a very spiritual person. I believe in God, a higher power, forces at work that we can't see or touch but that absolutely direct the path of our lives. And as long as I have that, the specific details of my religion - or any others - don't really bother me too much.

For what it's worth, I'm Catholic. I don't necessarily believe everything I'm supposed to believe in order to call myself a "good" Catholic, and I struggle with that, but I consider myself Catholic nonetheless.

Does it make me a hypocrite to call myself Catholic even if I don't believe everything I ought to as a Catholic? Sometimes I believe that it does. Then again, there are times when I think that it's not about exactly and precisely fitting the mold of a model devotee of a certain faith and is more about finding the faith with which you most closely identify. I believe that I'm most closely identified with Catholicism... then again, I must confess that I'm not entirely sure.

I was Baptized Catholic. I had my First Communion as a Catholic. But then my parents divorced and my mom - the one who had ensured we received religious education and took us to church every week - stopped attending church, so hurt was she that her church would turn its back on her because she divorced my father. So for years - like a dozen years - I either didn't attend church, or we went to a Lutheran church, because my stepdad is Lutheran, and theirs was not as exclusive as the Catholic church was at that time.

Needless to say, I didn't go through CCD or Confirmation with my Catholic classmates in high school. They envied me for not being forced to participate in a Catholic ritual they didn't really give two hoots about all the while I envied them for at least being a part of something spiritual.

It wasn't until I was planning my first wedding - The Wedding That Wasn't - that I had to really confront the question of my religion. My fiance at the time was a Confirmed Catholic, and in order to be married in his church, I had to be as well. I definitely wanted to be married in his church, but I wasn't sure whether I really wanted to go through Confirmation after having been "away" from the Catholic church for so long. All that I'd learned about Catholicism as a young child was virtually gone from my memory by that time, and a part of me felt like I'd only be doing it to get a green light to marry in the church. I didn't want to do it for the wrong reasons.

I had a few long conversations with the priest from the church and shared with him my conflicting emotions about the whole situation. He was a young priest, and fairly progressive for the late '90s, and he assured me that I was still Catholic despite having been "away" for so long. He also told me that it wasn't necessary for me to believe EVERYTHING the church felt I ought to believe, as long as I believed that Jesus was the son of God, and that he was divine. After much consideration, I ended up enrolling in the RCIA program and became confirmed at the age of 23, just in time for The Wedding That Wasn't.

Despite the fact that the wedding for which I'd gone through Confirmation wasn't to be, I was glad I'd ultimately made the choice to be Confirmed in the Catholic faith. And I was fairly good about attending church from time to time going forward, although I will be the first one to admit that I've never been an "I go every week" kind of gal. I will also be the first to admit that it was my faith in God, and my belief that He had a different and better path in mind for me, that I survived the very difficult choice to call off The Wedding That Wasn't, move out of the apartment I shared with The Man Who Was Not to Be My Husband, and move on with my life.

Through all of the difficult times in my life, I have turned to God. To be fair, I also turn to Him during the good times, to thank Him for the blessings I've been given. But I especially turn to Him when I'm facing challenges or I need help making decisions about something important. Yes, there have been times when I've felt that He wasn't listening, or wasn't helping, or had abandoned me. It's hard to maintain faith during those times, no question about it. But then I remember that even when I've not been able to see what He wanted me to see right away, the thing He wanted me to see always revealed itself in time.

When I called off The Wedding That Wasn't, I agonized over the decision. I loved very much The Man Who Wasn't to be My Husband, but it had gotten to the point where I felt physically ill at the thought of spending my life with him, only I couldn't fully articulate WHY I felt that way. I knew it wasn't just "cold feet" but I didn't know exactly what it was. I just knew that I couldn't go through with the wedding and I couldn't stay with him because I felt in my gut that we were not right for each other. I felt it in my bones even as my heart ached.

It was hell for the first few months, trying to sort out my life and figure out my feelings and come up with a new plan for myself. Should I stay in the city to which I'd moved for my ex-fiance or move back to the city I had grown up in, to be near my family? Should I leave the job I loved, or stay and hang on to that one thing that felt right about my life in the new city? I wanted God to show me the answers, and to do it quickly, so I could KNOW whether I was making the right choices or not.

Of course, He wasn't giving me answers on demand. He let me agonize and drift aimlessly for a few months. He let me be alone for awhile. And, see, at that point in my life, I didn't do alone very well. Frankly, it scared the hell out of me. I feared that I'd never find someone to spend my life with and that I'd always BE alone. But as the pain gradually lessened, and the fog that had become each day of my life started to lift, I started to feel semi-alive again. I wasn't just going through the motions day in and day out, but I was starting to feel normal and okay and, yes, hopeful again. I found myself feeling really glad that I'd chosen to stay in the new city, at the job I loved.

And then out of nowhere it occurred to me that I had managed to get through one of the hardest times of my life on my own. I hadn't run home to let my parents help fix it, fix me - I had toughed it out alone, and I was starting to figure out what was to come next in my life. So even though I didn't really get answers from God at a time when I thought I needed them, I got what I needed most from Him - some faith in myself. He was there all along; he just stayed quiet to let me figure out that I was going to be okay and that I could take care of myself.

A year later, after a few miserably failed attempts at dating again and when I least expected it and wasn't really looking, I met Super Man in a most serendipitous way. It was almost accidental, really - although I tend to believe (to borrow a line from the epic film "Kung Fu Panda") that "there ARE no accidents." I think God was waiting for me to stop waiting for someone, and then He sent me just the right person for me.

Maybe He knows that patience is unfortunately NOT one of my virtues, and this is His way of trying to teach it to me, the hard way. It's very hard for me to not feel like I have some control over my life, and I think it shows in my super-low level of patience. I actually think it's kind of funny that I am SO impatient, and yet I have this total trust in God to reveal His plans for me when He's ready, not when I want to know them.

I have to keep reminding myself of that lately, as I continue on this journey to have a second baby. I've found myself questioning whether God thinks I'm a bad mother, since He's chosen to withhold a second baby from me. I've wondered if maybe He doesn't think I'm ready yet, and He's just waiting until he sees that one thing that will show him that I AM ready. I've wondered if we haven't tried hard enough the ENTIRE three-and-a-half years we've been "trying," and thus He thinks we need to try harder. And, yes, I have wondered if He will punish me in some way for turning to science to help me get around the fact that my body doesn't seem to want to do this naturally.

Ultimately, I know He has a plan for me. It may or may not include a second child. Only time will tell. Obviously if it does, I will be ecstatic, and I will be thanking him again for another blessing and miracle. But as much as I would hurt if it turns out that I will not have a second baby, I also believe deep down that the reason for it would become clear eventually. And, as I have in the past, I believe that I'd see the reason one day and KNOW deep down that THAT was why it didn't happen, and I'd be able to make peace with it on some level. This is why I have said of this journey that I will survive it either way.

Because I know that - no matter what - even when I'm alone in body, I'm never alone in spirit. God is there with me, even when he's quiet. He's always leading me where I am meant to go, even if the path - and the destination - are completely foreign and unknown to me. And I also believe that the spirits of my family and friends departed are right there with us, every step of the way, as my guardian angels. I'm never truly alone.

Being reminded of that is one of the reasons why I really do like going to church on a regular basis. It's an opportunity for me to quiet all the chaos inside my mind and body and soul and just enjoy the peace of giving it all over to God. It reminds me to let go of the petty things that I allow to influence me from one day to the next and focus on the big stuff instead. It really brings me a sense of peace and well-being.

I hope that my son and stepdaughter are learning the true importance of having faith in God, both from what we teach and from what they learn in church and in their respective religious educations. I fear that they will end up, like so many of my peers did, feeling disconnected from it while growing up because it's been fed to them, not sought out by them. That was the only reason I felt "fortunate," if that is the right word, for not being "forced" to go through CCD and Confirmation as a teenager. Because I honestly wouldn't have gotten it then the way I did when I had to make the decision of whether or not to go through it as an adult. Regardless of whether the kids ultimately choose to remain Catholic or find their place in another - different - religion, I just hope that they will always be spiritual, and that they will always know that they are never really alone.

Peace and love,
Super Woman

Friday, September 25, 2009

a bump in the road

I'm a little late in putting out an update from my hysterosonogram (HSN) appointment on Wednesday morning, so I apologize if any of you were waiting for it. I just needed a few days to process the information from that appointment before I could write about it.

Obviously, based on the above AND the title of this post, we've hit a little bit of a setback, such that we will NOT be going forward with IUI this month. Understandably, I have some very mixed - and strong - feelings about this change in plans.

My reproductive medicine specialist believed going into the HSN that he'd get a good look at the supposed uterine fibroid that the radiologist saw during my HSG appointment in June, and that it would most likely be a non-issue since the radiologist said it was "small." I think both my doctor and I expected this to be a simple peek to make sure it wasn't a big deal, and then we'd be good to move forward with my IUI this weekend.

Unfortunately, the ultrasound didn't give him a very good or complete look at what is going on in my uterus, so it looks like I'm going to need to have surgery. The procedure is technically called a hysteroscopy, which basically means that the doctor will insert a scope with a camera on it into my uterus (transvaginally) to actually be able to "see" what it is that he saw on the ultrasound.

As far as I know, the question is whether it actually IS a uterine fibroid or it's just a distortion in the wall of my uterus, because apparently I have a slightly twisted uterus. I never knew that before, so that was new news to me. And since the appointment, I've come up with a bunch of questions about that, too, but I'll get to those later.

I presume that if it IS a fibroid, he'll remove it as long as he's in there. I believe that can be done hysteroscopically. And, frankly, if it IS a fibroid, I'd prefer that he get it out while he's in there, since I've been reading that fibroids can be very pesky pains in the butt, both during pregnancy and otherwise. No sense leaving it there if it doesn't have to be left there, as far as I'm concerned. If it is a fibroid and he does remove it, then I'll have to recover, and then - hopefully - we can start a real, full IUI cycle after my period in 2 weeks. And hopefully removing the fibroid will give me better odds of conceiving, as they can sometimes interfere with conception.

If it's NOT a fibroid, then I don't know what happens. If it's just a distortion in the wall of my uterus due to it being twisted, I don't know what that means in terms of my potential for pregnancy, etc. My doctor seemed pretty nonchalant about that being the case, so I presume that we'd be okay to plan on doing IUI next month, but I'm not positive.

But I find myself wondering about this whole "twisted uterus" business: Has it ALWAYS been twisted? Was it like this before, when I got pregnant with Super Boy? I didn't have any issues getting pregnant with him, and my pregnancy went swimmingly, so I'd have to think that either my uterus WASN'T twisted then or it was and it's just not a big deal. If it twisted since my pregnancy, how did that happen, and can it be... untwisted? Can they fix that? And DOES it matter in terms of my ability to get pregnant? Will or might it cause problems if I DO get pregnant? Any big risks I need to know about? I'm chock FULL of questions about that, so I definitely need to talk to my doctor again.

And then there's what I'm calling the third possibility: That the thing he's seeing in my uterus is neither a fibroid nor a simple distortion of my uterus. Of course, I'm automatically freaking out thinking "CANCER!" but I don't know whether that concern is warranted or not. It certainly crossed my mind, but I don't know if it has crossed the doctor's mind. I know it's not really worth spending too much time worrying about at this point, and I'm trying REALLY HARD not to worry about it, but it's hard. I'm a mom, and a wife. I'm 35. I'm not prepared for that.

Anyway. So, the surgery... I don't know if I've ever mentioned this before but I've never been put under general anesthesia. My only surgery was my C-section with Super Boy in 2003, and I was awake for that with an epidural and pain meds.

The idea of general anesthesia completely - COMPLETELY - wigs me out. There are risks with that. Bad risks. My worst fears are DYING while under (top worry), or waking up from the anesthesia but being sick as a dog with vomiting (many, many thanks to my vomit-phobia for that). I look at both as unacceptable risks!

And I find myself wondering if they can't just give me an epidural or do it the way my colonoscopy was done (with Versed and fentanyl), so that I can be kept conscious for the hysteroscopy but not feel anything or be stressed and anxious during it. Can they do it that way? MUST I be put under for this? Because I'm telling you right now, if they MUST put me under for it, then we better get the friggin' surgery scheduled SOON so I don't have too many more days to spend freaking out over it, and they'll probably want to put me on some anxiety medication leading up to it so I can keep from climbing the walls until the day rolls around. I'm dead serious about that.

The only - ONLY - upside to the procedure Wednesday was that the doctor was able to see how well the Clomid was working. Both of my ovaries had several visibly developing egg follicles, so I definitely responded well to the medication. That's a good sign. Assuming we're able to go ahead with IUI next month - or ever - that is.

In the meantime, Super Man and I have been instructed NOT to try to conceive this month on our own and the IUI has been postponed. I can't tell you what a let-down that was for me when I heard the news. Here I had already taken 5 days of Clomid and gotten all jazzed up over the good test results that were coming in, and then the brakes were slammed on the whole thing due to the HSN. If all had gone well on Wednesday, I'd have had my mid-cycle ultrasound this morning, might've gotten an hCG shot today, and would've been going in for IUI tomorrow or later this weekend. I might've gotten pregnant this month. It's SO HARD to not feel sad knowing that. My mind was ready and my body was ready, but for the stupid uterine thing.

But then I think about the fact that I've been waiting, waiting, waiting for nearly four years now. Thinking about it that way, another month isn't the end of the world. Not really.

Still though... it's hard. Because after all those years worth of months spent waiting, for the past few weeks things have FINALLY been moving forward, quickly and well. I have felt positively elated the past few weeks, filled as I was with new hope and optimism. It felt sooooo good to feel that way again...

For me, hope for another baby has become SUCH a fragile and rare and blessed thing. I have to have reason to hope, because without it, I feel so empty. I don't want to feel empty.

So I sit again and wait. Wait for the doctor's office to call to schedule the surgery. Wait to find out what the issue with my uterus is. Wait to find out if I can even keep trying to have a baby or whether we've hit the brick wall I've been dreading.

I wait.

Please, whatever good thoughts and prayers you can send, please send them. And I am begging - literally, begging - God to give me strength and patience and peace with whatever comes next.

With hope,
SW

Tuesday, September 22, 2009

something new

I learned something today that I didn't know before, despite the fact that the subject has been of increasing importance to me since about the age of 27.

Why 27? Because that's how old I was when I had my FSH (Follicle Stimulating Hormone) level tested for the first time. And I had it tested then because of my family history of premature menopause. See, Super Man and I planned to start trying to conceive the following year and I had spent the prior 12 years on the Pill, so my OB-GYN and I wanted to be sure I hadn't gone through premature menopause, the symptoms of which would've been masked by the effects of the Pill.

I've known all along that FSH is one of the best predictors of female fertility, but I didn't really understand what the numbers meant. When I had my first test at 27, I never thought to ask what my actual number was, only whether it was "normal" or "abnormal." It turned out to be normal (and, thus, we conceived Super Boy several months later). I didn't give it a second thought again, until we started trying for another baby.

I'm not sure what my FSH level was when I had it tested back in 2006; again, I only heard that it was "normal." Again, I didn't think much about it, because I thought that was sort of all set.

It's only been going through the process of a Clomid challenege that I've really started wondering WHAT DO THE NUMBERS MEAN?!?

My Day 3 result was 7.8, which my fertility specialist said was great, as they like to see values less than 10.2. I took Clomid from Friday of last week until yesterday (Monday), and had another FSH test - Day 10 - this morning. The result today was 7.4, and again, I was told that this was "great," and "exactly what we wanted to see."

But I didn't understand WHY this was great and what they wanted to see, so I asked. The nurse told me that the whole goal of the Clomid is to drop your FSH number by a few tenths of a point. They would've been concerned if it had stayed the same or gotten higher, but a drop is exactly what they wanted to see.

All of a sudden, this lightbulb went on in my head and I asked the nurse if a woman's FSH level steadily increases through the course of her life. She said yes. So now, of course, I'm wondering what my 2001 and 2006 levels were! I'd love to see how much lower my FSH was, especially in '01, to really get a sense of how much my fertility has declined in the past 8 years, from 27 to 35.

And it also occurred to me that the goal of the Clomid - in a way - is to cause your body to act more like it did during a more fertile time. Almost like turning back the clock just a tiny little bit. While the net effect was only .4, that could make all the difference in the world. It could cause my ovaries to release that one extra mature egg that will make the difference between me getting pregnant and me NOT getting pregnant. It's staggering, if you think about it.

It's frustrating though, because I'm trying to find some information on the Internet showing what "average" FSH levels are in women of different ages (say, from onset of menstruation through old age), but all I'm finding is that a result less than ___ (my doctor uses 10.2, but others say 9, and some even say 12) is normal, and then they talk about the approximate FSH levels based on the different "stages" of reproductive capacity. In a nutshell, by the time a woman starts menopause, her FSH levels will be around 30, and that will increase to a level that eventually tops off somewhere between 50 and 70, when menopause is complete. I never knew that bit of information either, so I guess I learned TWO things today.

I guess what I'm trying to say is that this business of assisted reproductive medicine is a whole lot more complex than I ever imagined. Sure, specialists do a lot of different test and ultimately what matters is a result of "normal" versus "abnormal," but it helps to understand the actual numbers and to get a sense of the big picture. And FSH is only one part of the equation; other hormones like LH (leutinizing hormone), progesterone, estradiol and prolactin also have their own impact on fertility. For my purposes, those numbers all look good for me, so that obviously makes me pretty happy. I just hope that it's enough to lead us to another baby for our family.

Next steps for me are as follows:

TOMORROW: Hysterosonogram to check my uterine fibroid AND I start using the Ovulation Predictor Kit. Assuming all is okay on the fibroid front, we move forward. If my fertility doctor feels that the fibroid has to come out, then the IUI is put on hold until next month and I schedule the fibroid removal surgery instead. Here's hoping it's the former and not the latter, as I'd hate to see this put on hold now that we've come this far!

THURSDAY: Day 2 of the Ovulation Predictor Kit.

FRIDAY: Day 3 of the Ovulation Predictor Kit AND a mid-cycle ultrasound to see how many egg follicles - and, specifically, mature egg follicles - are developing. That will help them assess whether the IUI is likely to succeed and whether my body is ready for a shot of hCG (human chorionic gonadotropin) to force ovulation to occur the following day. If the follicles are ready, I MAY get the shot and then we'd have our first IUI (intrauterine insemination) procedure on Saturday. If the follicles are not ready, then they'll give it an extra day or two, MAYBE give me the shot of hCG and then do the insemination the next day.

About the hCG shot: I really don't like to take any medications that I don't "need," so I'm hoping that my Ovulation Predictor Kit will indicate on Friday that my LH surge is happening the following day so that I'm ready for the insemination on Saturday WITHOUT needing the shot on Friday. That said, if I forego the shot on Friday and still don't have a smiley face on my Ovulation Predictor by Sunday, I'll have to get the hCG shot on Sunday and we'll have to do the IUI on Monday. And that will be a "must" by that point because Super Man has a business trip early next week and we could miss the very narrow window if we wait for me to ovulate naturally. We don't want that to happen!

SATURDAY or SUNDAY or MONDAY: IUI

So, whenever I actually end up having the IUI done, that's sort of the end of the action. And then... we wait.

Two. Long. Weeks.

I think I'm going to have to do some SERIOUS fall cleaning and purging and reorganizing during those two weeks to keep my mind and body occupied while I wait. Otherwise, I'm likely to drive myself and everyone around me bonkers. (You know it's true.)

Keeping my fingers - and everything else - crossed that this all goes the way we hope and pray it will. Will keep you all posted. And hey - thanks SO MUCH for all the support. Whether we have another baby or not, we are so blessed.

Love,
SW

my little experiment

So, I may have posted on my blog awhile ago that I was considering a return to school. Right? Hm... let me check...

Ah, yes - here it is.

When I last wrote about my little contemplation, I neglected to say what my desired field of study would be. Not sure WHY I was being all mysterioso about it, but whatever.

What I'm most interested in learning is graphic and web design.

Wanna know why? Well, the reasons are several.

First and foremost? Given that you're reading this blog that I write, I'd love to be able to make my blog look the way I REALLY WANT IT TO. Which is not the way that it looks right now. I'll be honest: I use the standard layout that Blogger provides, and then I get my free backgrounds from Aqua Poppy. I love the backgrounds (most of the time), but I really don't love the layout of the blog. I'd love to know how to write the code to design my own blog, and then also have the graphic design skills to make my OWN backgrounds, etc. I feel like a technological moron about these things, and I'm really tired of that. So, yes, making my blog TRULY reflect what I love and what I'm about is the primary reason I want to learn these skills.

A very close second is that I have a super strong gut feeling that learning how to create beautiful graphics and web pages would be one of the very few ways in which I'll ever be able to truly show my artistic side. Because I can't draw - or paint - for shit. And I mean that, literally. My 6 year-old son draws and paints better than I. But to have the power of the KNOWLEDGE of the mighty design software products on my side could unleash all the great works of art I've had pent up inside me for nearly 36 years. Alright, I might be over-dramatizing this just a smidge, but there is definitely a kernel of truth at its heart.

Third, I know that I will not be working in my prior field of study: Psychology and Social Welfare. I have no desire to go back to school for a Master's Degree or PhD at this point in my life. Which means that I need to think about what the next half of my career is going to be about. And I really can't imagine a more fun form of WORK than creating things that are artistic and new for myself and others. Not to mention that this is a great field for freelancers, and I'm all about the freelancing movement.

Anyway, I'm saying all of this in part to draw your attention to something NEW on my blog, something you haven't seen before. Something that I managed to create with my own mouse-clicking hands, after a brief software tutorial the night before from Super Man, the graphic design guru of my world.

Don't know what it is?

Oh, come on - sure you do! Look closely....

Got it?

My new TITLE LOGO!! Yes, friends, your old pal Super Woman made that. And I was SO proud of it after I managed to MAKE it and then figured out how to size it to get it to FIT in my header!

I started with a photo that I took of one of the mammoth sunflowers in my garden, Photoshopped it a bit to brighten it up, increase the contrast, and then do some more artistic stuff to it, and then I created the text and situated that in the picture the way I wanted it, and PRESTO - I was done.

I'm not kidding you, I was LITERALLY bursting with pride over this. I couldn't wait to show Super Man that I had actually learned something during his teaching session with me the night before.

So, when Super Man came home and I giddily dragged him by the hand over to my laptop to show him, his response was NOT what I expected.

He said that the picture looked great... BUT - I could sense the BUT coming even before he spoke it.

BUT you should never stretch a font ("Average").

BUT you should never use more than two fonts (I used four).

BUT you shouldn't constrain everything to a rectangular shape. (Self-explanatory.)

BUT you should've blocked out the red windowsill and other colors in the background on the lower left of the picture because they compete with the main image too much and draw the eye away. (Oh, shut up.)

My elation vanished. I wanted to stick my tongue out at Super Man. (Okay, fine, I actually did stick my tongue out at him.) I told him he was mean.

His signature brows shot up as he said, "Honey, if you want to become a good graphic designer, you're going to have to accept 'constructive' criticism! I'm SUPER proud of you for even attempting to do this, much less doing it - I just want to teach you the proper ways to design graphics, that's all."

My response?

"Well, for your information, I INTENTIONALLY used four different fonts, because I wanted the logo to reflect the eclectic, quirky nature of my blog and what I write about. And I personally LIKE the background colors in the picture - I think they add something to the photo. And I WANTED the logo to be a long rectangle, to fit nicely in the space of that yellow petal of the sunflower. And I LOVE the way 'Average' looks stretched. So leave me alone. Meany."

He hugged me and said, "But I still think you should try again, and just follow my suggestions and see what you come up with."

I said, "Fine. But not right now. I like this the way it is for now, I really do. Maybe next month."

"But why?" he asked, clearly not thrilled with my choice.

"Because it took me two and a half hours to do THIS, dude. Now get off my back."

So, here's to my little graphic design experiment. Whether you love it or hate it, I love it. And I made it all by myself. Good, bad or otherwise. :)

Maybe my October attempt will be more successful...? Then again, maybe not!

Peace out,
SW

Wednesday, September 16, 2009

7.8

7.8

That was my FSH level as tested yesterday, on Day 3 of my cycle. And that's effing AWESOME!

My fertility specialist wanted it to be below 10.2, or 12 at the very top, but we don't need to worry about that now, because my number was TOTALLY NORMAL. As were the other blood tests they ran yesterday.

What does that mean?

That means that Mama starts clomiphene citrate (aka: Clomid) tomorrow and takes it until Monday.

That means that - hopefully, if my repeat FSH next Tuesday AND my hysterosonogram next Wednesday both look good - we'll be doing IUI next weekend or early the following week.

That means that - hopefully - I'll be getting a plus sign on my pregnancy tests in about four weeks.

I don't remember who said it - Dickinson, perhaps? - but "hope is the thing with wings."

How true, how true.

Much love,
SW

Sunday, September 13, 2009

an ending and a beginning

I got my period today.

When it didn't come on the 28th day - yesterday - as usual, I caught myself feverishly hoping that I would be one of the lucky ones to which my fertility specialist referred at my appointment last week. Meaning that I hoped that my period wouldn't come because I somehow managed to conceive during the past month, that my body had been scared straight at the mere threat of fertility treatments after laying stubbornly dormant for three and a half years.

Eh, no.

My heart - dangling tenuously since last night on a teensy-tiny thread of hope - dropped when I saw the telltale red, and I closed my eyes and cursed my body for betraying me yet again.

But then I remembered that seeing red isn't so bad this time around. Because this time, it marks a new beginning.

The beginning of a new road that might - MIGHT - end without me seeing red next month.

Now that I've gotten my dreaded period, I can proceed with the tests the fertility doctor wanted me to get.

On Tuesday, I'll have the Day 3 FSH test, and if that goes well, it'll be checked again on Day 10, after I take a Clomid Challenge. In the meantime, later this week or early next, I'll have a hysterosonogram to check the fibroid in my uterus. And - if all of these things go well - we'll try our first insemination cycle later this month.

I could be pregnant at this time a month from now.

Hope is a dangerous, dangerous thing after all this time; believe me, I know that. But how can I not hope when the whole situation is going to be different this month? Besides, people are always talking about the power of positive thinking; if it's true that positive thinking can help attract what you most want in your life, then how could I do anything other than hope?

And so I'll embrace this unwanted red - this time. Because it marks this new beginning. The new beginning that will hopefully lead me to a better ending in October.

I pray, I pray, I pray...

Hopefully yours,
SW

P.S. I know that a vast majority of my recent posts have focused on my struggles with secondary infertility. I'm sure many of you are fine with that, but there are probably some who aren't, for whatever reasons. I can't apologize for that because it just so happens to be a major focus of my life right now, and my life is what I write about. I will, however, give you my word that this blog is NOT becoming a Capital I Capital B "Infertility Blog". It has always been - and will remain - a blog about a little of everything. So please have patience as I get through the next several weeks, and we'll see where we end up. Thanks in advance, readers!!

Tuesday, September 8, 2009

Secondary Infertility: First Doctor Appointment

First step: Done! Today I met with a fertility specialist for the first time.

Holy nerves, Batman! All morning I was a mess, anticipating both the best - and the worst - of what could've come from today's appointment. I didn't answer my phone, I didn't call my mom or my husband to speculate about what the appointment would hold.

Instead, I spent the morning (a) having a long - and tear-filled - conversation with God and (b) taking Super Dog for a good long walk to clear my mind and calm my nerves before showering and heading to the appointment.

Still, when I sat in the consultation room first meeting with a resident to go through my history and prior test results and then waiting for the doctor to come discuss my options (praying that he'd use the plural and not the singular - or worse), my palms sweat and my heart pounded while my lungs would not fully inflate. That's always fun.

When at last the doctor came in, I found him to be not overly warm, but definitely focused and straight-forward, which I appreciated. And here's what he said.

A large chunk of what may or may not come hinges on the results of one particular test: the FSH test. It's a test I've had twice before: first, in '01, the year before I conceived Super Boy, and second, in July of '06, a few months after we started trying to conceive a second time. Both times I had this test, it was to determine whether or not I had gone through premature menopause because, as you might recall, my mom and paternal grandmother both went through it very early, which may have a significant impact on my own fertility. Anyway, I'll be repeating this test early next week.

Assuming, that is, that my fickle reproductive system didn't suddenly decide to WORK knowing that my visit to the fertility specialist was imminent! Apparently this doctor has had that happen with two patients in recent months. Here's hoping I'm the third! We'll know this weekend, as my period is due on Saturday. (Wow, aren't you glad you know that about me? Don't worry - I'll wait while you go bleach your brain. ... Good? Okay, let's proceed.)

FSH, for those who are not well-versed in the language of infertility, stands for "follicle-stimulating hormone." FSH is a hormone found in the blood that helps control a woman's menstrual cycle and the ovaries' production of eggs, and hits a peak each month just before a woman releases an egg from an ovary. It also helps doctors determine a woman's egg supply, or ovarian reserve.

I'll need to have this blood test on Day 3 of my cycle. What we want to see is a number that is no higher than about 10-12. If the number is greater than that - specifically if it's a LOT higher than that, then we might be at the end of this journey to have a second baby short of trying IVF (in vitro fertilization), which we've decided we aren't going to pursue. If, however, the number is less than about 12, that's a GOOD sign. (This, obviously, is what we're praying for.) The doctor also wants to check my prolactin level, which seems to be the one blood test my regular OB/GYN did not order over the past few years. I think this will be done at the same time as my FSH.

If we end up with the GOOD FSH result, then the doctor will next do a Clomid challenge. This means that I'll be put on oral clomiphene citrate for about four days in the hopes that the medication will stimulate my ovaries to release a few good eggs during ovulation. Next, the doctor will re-check my FSH level at Day 10 and, assuming my level looks good, will then try IUI, otherwise known as "intrauterine insemination."

Think turkey baster! Well, not quite a turkey baster - more like a syringe filled with a "cleaned" concentration of Super Man's swimmers that will be injected straight into my uterus, bypassing the usual cervical route and giving the guys a better chance of hitting their intended target (... or targets!).

Yes, that's correct: The procedure could result in multiples. The doctor said it happens in about 7% of cases, with the majority of those being twins. Frankly, I'd be okay with that. I always imagined myself having three or four kids but Super Man and I agreed on two when we met and got married, because he already had Super Girl. So, if we end up with one more than we hoped to have, it's far better than the other alternative of NO more, and it's just an added blessing in our book.

One potential snag in the plan - aside from my FSH level being high at the Day 3 test - is the uterine fibroid that the radiologost found during my HSG (hysterosalpingogram) back in June. The radiologist said it was "small", but neglected to take or provide measurements on his report of the procedure, so the fertility specialist wants to take a better look at that by way of a hysterosonogram (a trans-vaginal ultrasound of the uterus following the injection of saline into the uterus). That will take place late next week or early the following week.

Apparently fibroids can interfere with conception if they're of a certain size, and depending on their location. If after the hysterosonogram the fertility specialist wants to remove the fibroid to improve my odds of conceiving, the IUI may be put on hold until next month so I can have surgery (laparoscopy) to remove the fibroid first.

That's all of my required tests/procedures, but Super Man has a little work to do, too. Although, as you might imagine, his "work" is slightly more fun than mine! ;)

Super Man has to provide a new "sample" later this week so they can verify the results from earlier this year (which were analyzed by an outside lab, not their own), and then - assuming all checks out as expected and he really does have Super Sperm - he'll have to provide another "sample" when they do the IUI. His good swimmers will then be separated out from all the other junk and injected straight into the Promised Land, where they will hopefully accomplish their intended purpose. So, yeah, the dude TOTALLY got the easy end of this deal! ;)

I can't tell you how relieved I am at this moment. I realize that this is not the end of the journey; and for that, I'm truly grateful. I'm just glad to know that we still have reason to hope. I tried my best to prepare myself either way, and we may still come to an unwanted end of the road. But that didn't happen today. And I'm so very, very glad.

Peace and love,
Super Woman

Wednesday, September 2, 2009

a step in the right direction

Next week marks the beginning of a new phase in my and Super Man's journey to have a second baby together: I'll be seeing a fertility specialist on Tuesday afternoon.

As you might expect, I'm a jumble of emotions right now as next Tuesday draws near.

On the one hand, I'm obviously extremely excited, hopeful and optimistic: These are the folks who have worked miracles for many others in our position. They know what to check for and what to do if they find fertility problems. Up to this point, all our tests have come back normal, so we don't technically have a specific fertility problem that they know of, but clearly SOMETHING is not right somewhere in the mix because I'm not pregnant! I want to put total faith in this doctor, and believe that he will give us another little miracle. I do. (I do.)

On the other hand, however... I'm scared. I'm scared that since these ARE the experts, and they WILL be doing more tests, they will find the thing that's not working right that will explain all of this. And I'm afraid that it won't be something good. Or fixable. In other words, I fear the worst.

It's like we've come to a fork in the road and while either path we wind up on will lead us to an end of the road, one of those ends is NOT the one we want to come to. That's the one where we have no more choices, no more options, where this decision will be made for us. The one that means our family is staying the size it's at right now. Only I want to be on the path that takes us to the GOOD end, the end that results in me conceiving and giving birth to another healthy and wonderful baby in the near future.

It's hard to think about that. And yet, there's a part of me that has grown weary of the giant question mark hanging over our lives. I've lived with that question mark for the better part of four years now, and I know I can't bear it much longer. I'm at the point now where I want answers. I need them.

Even if the news is not what I want to hear, I need to hear it so I can close this chapter of my life and move forward once and for all. I'm under no illusion that it will be an easy thing to do, but do it I will if that's the only option left.

But I hope it doesn't come to that. I catch myself day-dreaming about how this will all end, and in my day-dreams, the fertility doctor does a few more tests, says, "Oh, it's just _____, and we can do ____ to correct it, and you should be pregnant very soon!" And then I picture myself pregnant again, feeling a new little life move in my belly as my body grows round and lush, and I picture Super Boy welcoming a new baby into our family with excitement and love, and his excitement and pride at becoming a big brother. And then I picture myself happily packing up my maternity clothes for the last time and sending them on to the next mom-to-be.

Realistic? I can't say. But I can't help it. Without that hope, what's the point?

I beg you... please send prayers/good thoughts/baby dust this way that we will get the happy ending that we're hoping for. Please.

You know that I'll keep updating as I have more information. In the meantime, I thank you again, as always, for reading this blog and for sharing your comments, support and experiences. It means a lot to me to know that the things I write about here touch others in ways that are meaningful and useful, and I'm always grateful to find out that there are others out there who have walked in my shoes, whether it's with the fertility stuff, the blended family stuff, the wacky vomit-phobia, or anything else I've shared here. It's always easier to deal with something difficult when there's someone walking beside you. So THANK YOU!

Truly,
SW