Please forgive me if I leave you feeling uninspired

I think I found my infertility anthem.

I wasn't looking for it, but there it was.

We just purchased the Iphone 5. Yes, I know. The new one is supposed to be coming out in September.  But after all the problems we had with the 4s (which we bought when they were hot off the presses) we decided we'd rather go with the 5 and let them work out the kinks with the new one.

ANYWAY.

While transferring music to my new phone, I realized I hadn't listened to Eef Barzelay in FOREVER.

And then, there it was.

The song that so succinctly describes my nearly 3 year struggle with trying to have a child.

It's perfect.

The words, so poignant. So depressing.

The music, so upbeat. So rock and roll-y.

It captures the weird dichotomy of living life and accomplishing all kinds of shit while at the same time a constant hum of bitterness and frustration carries on in the background.

Listen, my friends.

And love it.

Didn't take long

'fore I found out
what people mean by down and out

Ah, Led Zeppelin.

They don't exactly take away the pain but they do make good company while going through it.

IVF #1 has been canceled.

Despite my best efforts at going all out with a protocol designed to keep someone such as myself from developing a lead follicle... I still managed to develop a lead follicle. There's a slight chance that if I continued stimming I may have had one or two follicles catch up. But that was a slight chance. And even then, that would be a grand total of two or three follicles which may or may not have contained mature eggs.

I've done a fair amount of crying over the past few days. Partly due to the bad news, partly because there is just no other way to release all this stress... especially if you are not partaking in a stiff drink (side note: I will soon be partaking in a stiff drink). My eyes are heavy and swollen. Emotional hangovers suck.

But how does that Bible School song go? Count your blessings one by one...

• We've only managed to lose out on about $1k and a bunch of gifted meds. We still have the vast majority of money we've saved for the purpose of procreating.
• I've learned that, unless my RE has some kind of brilliant rationale that I'm not anticipating, traditional IVF is just not going to work for me. It does work for some DOR women. And some of those women have even worse numbers than I do. But apparently, my ovaries do not care how much FSH you throw at them. It can be a little or a lot, but they're pretty much going to give you the middle finger and give you one egg. 
• I've also learned that minimal stimulation IVF is way cheaper than I thought. Turns out we have enough money to do two rounds of mini IVF. This is very good news.
• Good news because out of all of my various medicated cycles, I've done the best on low dose clomid. Which happens to be the cheapest of the medications. Like $7 vs. $6,000 cheap.
• So the plan now is to talk with my RE next week about doing two rounds of minimal stimulation IVF with clomid, testosterone priming, and saizen. Then freeze whatever we get and still proceed with doing two months of lupron before transfer.
• Now I'm back to trying to fit all this in around my travel schedule. And time is marching on. 
• But at least I still have hope. 
• For now.

Humor first. Then numbers.

Earlier this week I was at work and on the phone with my doctor's office discussing how I was getting ready to hand over nearly $13,000* to them the following day. Not a fun conversation, for sure. While we were working out the details, S. had already made it home for the evening and ran into a little problem:

When the first text came through, I laughed to myself and thought "Thank GOD I am not home or else I'd be the one dealing with this."

When the second text came through, I couldn't help letting out an audible laugh. He was panicking. I could tell.

And then when the photo came, I lost it. Tears were streaming down my face. I couldn't stop laughing.  For the first time, ever, I was so happy to be the one dealing with medical nonsense and NOT the one dealing with "poop butt."

*************

IVF Update

• Today is Cycle Day 5
• So far I have taken three shots of Ganirelix and Estrace 2xs a day during the final days of my previous luteal phase and into the first few days of this cycle.
• Cycle Day 4 I went in for baselines. Antral Follicle Count = 7 (roughly, there may have been more). Progesterone came back perfectly low at 0.something and E2 was elevated (we knew it would be, due to Estrogen Priming) at 62. I was given the all clear to move forward with this cycle.
• Today I started Microdose Lupron. I will administer that 2xs a day up until Egg Retrieval.
• Tonight I start Dexamethasone and will take that nightly through Egg Retrieval.
• Sunday I will begin Gonal-F and Menopur in addition to the Lupron. I will take this through Egg Retrieval. 
• I am anticipating, due to my DOR situation, I will be a "slow responder" and will likely stim anywhere from 13 to 15 days.
• It's quite possible that by the time this is all done, I will have given myself over 60 shots in the stomach.
• I have two major hurdles to cross due to my diagnoses.
• First, because of Diminished Ovarian Reserve (DOR, due to Endometriosis) I have an uphill battle when it comes to getting enough good eggs to make good quality embryos (hence the complicated protocol). I don't even know how many embryos to hope for. Any would be nice.
• Second, because of Endometriosis, I am opting to freeze whatever embryos I do get so I can do a two month treatment of Depot Lupron (medicated menopause here I come) to shrink the Endo, reduce inflammation that results from Endo, and to take care of any possible missing or reduced beta 3 integrin issues (all of which can effect implantation and/or lead to miscarriage). There are studies that show a drastic increase in pregnancy rates for women with Endometriosis after doing a course of Depot Lupron. Most women with Endo go on Lupron after a failed IVF. I'm trying to avoid failing in the first place since I already know I won't have a huge stockpile of embryos to return to. 
• Current worries: Will my follicles respond to medication? And if they do, how many eggs will there be? And, most importantly, will those eggs fertilize? And make it to day 5 blastocysts? 
• Remember that time when we just had sex and got pregnant? Ha. That was fun.

* Don't be fooled. $13,000 is not the total sum of all these treatments.

Working it out

I'm back in Hong Kong. This is trip number four in case anyone is keeping count. I'm currently curled up in my room at the Crown Plaza, drinking peppermint tea, listening to the thunder and rain, and doing my best to stay awake until an acceptable bedtime hour. Tomorrow begins three days of presentations and then I make the long (24 hours in total) trek back home again.

After four trips, I have finally settled on a few travel essentials:

• A well stocked Kindle
• Socks (since I like to wear flip flops for security line ease, socks for the plane ride are a must)
• An Economy Comfort bulkhead seat (the next best thing to first class if first class isn't an option). After you are safely in the air, you can put your luggage on the floor in front of you and use it to prop up your feet. This makes all the difference in the world on a long flight.
• Peppermint or sweet orange essential oil. This is to periodically rub underneath your nose as an alternative to smelling stale, nasty airplane air.
• Dried goji berries to snack on.
• A reservation for a Thai massage soon upon arrival. Perfect for working out all the kinks you will acquire on the flight.

***

In other news, I am inching ever closer to starting IVF. I finally feel like I have turned an emotional corner and I no longer feel panicked or overwhelmed by the enormity of it all. I think I have researched and prepared myself the best I possibly can and there really isn't anything left to do but let go and trust. It's a lot easier to trust when it's not blind and I think that is what these past few months have been about - preparing myself to jump into IVF with my eyes wide open.

I can sense a palpable shift in my energy. I'm hoping this holds up.

inside jokes

Mangalsutra, East Indian vs. Indo-Guyanese, Freakenomics, Downton Abbey  

The on and on-ness of it

(I do love Downton Abbey so)

I am one month and four days away from 37. I have been trying to get pregnant again since I was 34. This is getting old. And so am I, apparently.

Though, for what it's worth, I don't feel old at all. But I do feel tired. Emotionally.

I'm struggling a bit lately. I had a canceled cycle due to some oversights on my clinic's part. I actually had to be the one to make the call to stop treatments. I won't go into all the details here - I'm quite tired of talking about it, really - but suffice it to say I am still not where I hoped to be.

Infertility is a drain. And here is a short list of why:

• Florida does not mandate infertility coverage and therefore everything is painfully out of pocket. 
• Florida is also not known for the best options in reproductive endocrinology. I am going to the second rated clinic in the state (with number one being several hours away from me). When I get frustrated with their (lack of) service and clinical skills, I don't have the option of saying "screw you" and making an appointment with another place down the street. I could go out of state for treatment, many women do, but if you are at all familiar with infertility treatments, you know how involved they can be and how much you are at the mercy of your cycle. Going out of state for IVF means spending large chunks of time away from home (not to mention the added cost of hotel stays and airfare). And then when you travel for a living, that becomes even more of a barrier (keep reading).
• There are two Very Important Things you need when going through infertility treatments: Time and Money.
• The money comes from working. While S's salary covers the vast majority of our regular living expenses, my salary goes towards the "extras". And since there is such a hefty price tag attached to treatments when you have zero insurance coverage, it is in our best interest for my salary to be as high as it possibly can be. Thankfully (and eventually I will get to my gratitude list), I have the opportunity to earn decent (relatively speaking) money. But in order to earn this decent (relatively speaking) money, I have to spend a good deal of my time traveling both across and outside of the country. 
• This affects the second Very Important Thing: Time. Due to the unpredictable nature of the female cycle and the limited amount of time I am at home for the long stretches required for various monitoring appointments throughout the cycle... forecasting and scheduling treatments becomes a bit of a nightmare. And when Time is not on your side, and then having to watch as Time marches on as you do your best to earn Money to keep up with treatments... it can all be a little (a lot) stressful. 
• Oh, and stress is not good for conception. So, you know, you also have to work on being stress free while dealing with all of the above. No biggie.

Like I said, this is the short list. 

It's in my personality to look for meaning in everything. And to look for patterns. I am constantly looking for the lesson to be learned in whatever situation I am facing and I am constantly scanning my past to see what patterns are emerging and how I have previously dealt with having an unmet desire. My first instinct is to declare that this is the WORST THING EVER and there is just nothing to compare it to. But the truth is, there have been other situations in my life where I felt hopeless, and lacking control, and as if I would never in a million years reach my desired outcome. And, so far at least, those desired outcomes were all realized. Though never in the time frame I would have liked. The only wisdom I am able to glean from those previous experiences: keep trying and stay grateful. And that's what I plan to do.

The keep trying part includes another appointment today to nail down a protocol for IVF and a plan to prepare myself while I wait for my next travel-free window (end of April/May) to proceed. 

The stay grateful part means lots of reminding myself of the following:

• Infertility can make or break a marriage. I can gratefully (and humbly) say that so far it appears to be making ours. 
• I have made some really great friends through this process. And friendships are what I've been missing over the past few years. 
• Through these great friendships, I have been gifted unused medications totaling over $5,000 which will make IVF a bit more affordable. This is HUGE.
• I have finally found the "good" doctor at my clinic. She is a life saver. She listens and responds and even calls me to ease my mind (she was out of town during this last cycle so totally not her fault). She respects the research I have done on my own and lets me participate in planning protocols. This is a big deal. So much of what I am dealing with is not cut and dry, nor is it and exact science. 
• S and I have found ways to keep life fun in the middle of all of this. If I were doing this on my own, I would have surely crumbled by now. I have learned that I am so much stronger when I have him in my corner.

This is what keeps me going.

Keep Trying.

Stay Grateful.

This is my mantra.

Welcome 2013

It's my favorite time of the year - the end. And the beginning.

While I typically live my life in a constant state of evaluation and planning (with a lot of practice at being present thrown in for good measure) the New Year's holiday gives me extra permission to reflect and anticipate. And with that extra permission... bullets!

Reflection:

• Looking back, 2012 was my year for finding solid ground.
• After being in a constant state of flux since my move back to Florida in 2009, I'm finally feeling grounded, centered, settled, and dare I even say... rooted. I have roots, y'all.
• Just to recap: flux (in no particular order) = a three year process of reconfiguring/redefining my professional life, meeting/falling in love/marrying S, buying a house, moving three times since moving back to Florida and prior to buying said house, a miscarriage, a gut-wrenching process of coming to terms with infertility, watching two of my three bridesmaids (one on my side of the family/one on S's side of the family) go through divorce while trying to establish and define our own marriage, watching my father go through a very scary open-heart surgery, watching my family struggle financially, watching S's family struggle in a way I'm not really comfortable going into here, having my social life change drastically from being single with good friends in California to being married with acquaintances I rarely see in Florida... the list goes on and on.
• While 2012 did not necessarily see a resolution to everything I listed above, in the midst of it all I stumbled upon peace and acceptance and a level of trust in my marriage that existed in theory at the beginning but has now been tested and proven in a way that can only happen by actually going through that kind of stuff.
• This is not to say I feel like we've reached a place of marriage perfection - mostly because I do not believe that place exists. I spend a lot of time considering the dissolution of marriage due to both those who are close to us who are going through the process and due to clients I work with. I've come to the conclusion that in order to have a successful marriage you have to both understand that nothing, and I mean nothing in this life is guaranteed and at the same time you can't be afraid of that fact. It's what keeps you grateful for what you have in the moment without becoming arrogant, lazy, or acting out of fear.
• I laughed a lot in 2012. I want to laugh more in 2013.
• I found a niche in my work. I found a way to combine my education with work that is more lucrative and I finally have projects that I am proud of and am looking forward to seeing those projects through in the new year.
• I became a part of an amazing online community of women and will have the privilege of meeting one of them in Chicago in January.
• For years I used to dread finding plans for New Year's Eve. It always felt as if it should be something epic but it always ended up being meh. I am so grateful to be a place in my life where I am totally content with having family over, grilling out, playing games and being very much not epic. Man, what a relief.

Anticipating:

• I will start out 2013 with another IUI. This time with injectables (stronger medication than my last IUI). My new Reproductive Endocrinologist talked me into doing at least one more IUI before moving on to IVF. She looked over my response to my first and only IUI over the summer and said that I responded beautifully... it just didn't result in pregnancy. She thinks we should try to tweak a few things before going for the big guns.
• If that doesn't take then we will be moving forward with IVF.
• 2013 is going to be a scary year. This will be the year that we find out if we will be able to have biological children or if we will need to start considering other options.
• While I've reached a greater sense of peace that I will be ok with whatever life has in store... I cannot lie, I want biological children. So very much.
• I'm scared to go through the next few steps. The stakes are just so much higher and the possibility for disappointment will be great.
• And I will need to navigate all of this while still being present and on-the-ball for work.
• Sinking into depression is just not an option for me.
• Outside of trying to grow our family, 2013 will be the year of trying to get a better handle on finances.
• We make plenty of money and for that I am grateful. But we could stand to do better with our money management. Especially with either more fertility treatments or (God willing) pregnancy and parenting in our future.
• Like I said above, I want to laugh more in 2013. I think that is a worthy goal.
• I also hope to see those in my life who are struggling find some relief and even some joy.
• Peace, Love, Joy, Laughter and Miracles. This is what I look forward to in 2013.