Monday, June 17, 2013

Don't Fight It

I should probably make June "trust month" on my blog, because I keep feeling moved to write about it. It's been on my mind constantly; Trusting in God, trusting in my RE, trusting in what the future holds.

Things have been so up and down lately. I have days where I feel so out of control in the process of TTC; I'm grasping at straws to try to make sense of it all and think I can somehow change the outcome if I just try hard enough, follow all the rules, eat all the right things, take care of myself perfectly, and make sure all the i's are dotted and t's are crossed. We all know that ultimately we can't control the outcome, but damned if we won't try our best to anyways, right?

Then, other days I'm just totally unattached, like nothing I can do will make a difference anyways. It's either going to happen or it's not, and I'm not saying this in a negative way at all. Believe it or not, I do have days where I'm just totally at peace with what's happening, although admittedly they are fewer and further in between than either my husband or I would like.

I think my favorite pastor, Joel Osteen, was sent directly from God to speak to me personally sometimes. I haven't watched his sermons in a couple weeks and thought I'd watch one I had Tivo'ed from last week. Sure enough, it was like this sermon was sent directly from God for me to hear right when I needed to hear it most.

His message was "DON'T FIGHT IT." Anytime we're stuck in a place that's uncomfortable we try to fight it. When things take too long and our prayers aren't answered, we end up frustrated and fighting against what's happening. However, just because thing are uncomfortable, it doesn't mean it's not supposed to be happening. God uses difficult times to do works in us and to help us grow. Every time something uncomfortable happens, we should look at it like a piece of sandpaper. Sure, as it rubs against us it's uncomfortable, but it's being used to smooth away the rough edges in our character.

Joel reminded me that God knows more about our future than we ever could, even though we think we know what we need or want at the time. I'm sure most people have had at least one time in their life where they could actually look back and say, "I'm glad God didn't answer that prayer when I wanted him to at first, because now it's been answered in a bigger and better way than I could have ever thought of myself." The longer we're able to keep a good attitude in a difficult situation, the higher God will take us.

If you can use a reminder to be content where you're at and that God is in control, I encourage you to check out the video. Just click on the sermon from 6/9 #580 Don't Fight It. Watching his message is guaranteed to make you feel more "at rest" with the obstacles you're facing and have a renewed sense of peace. The more we can have a feeling of  rest, the more we're able to actually position ourselves for promotion into what we're seeking. When you're at rest, you're passing the test.

My main goal is to make those times of rest happen more often. I would LOVE to wake up every single day trusting that things will work out even better than we could ever imagine. How about going 24 hours without worrying things won't happen my way? I am constantly working on believing for the best, and even though it's tougher some days than others I do feel I'm making a very real and conscious attempt.

I think it's especially important to try to have a more restful presence for our spouse's sake too. I know my rough days are hard on my hubby, because he's expected to be "the rock." One of the hardest parts of infertility for men has got to be watching their wife go through all the ups and downs. It's hard on both partners to feel helpless over something completely out of our control, but it's doubly hard when we don't handle it with grace.

The more feelings of rest we can have with a situation, the more our spouses will feel that peace too. That is my ultimate be less of a control freak and just let go of things more, knowing that God hasn't forgotten about us and that he's at work 24/7 on our behalf. I mean, you'd think I'd know by now I can't control this thing called infertility! I've decided that I just need a Joel Osteen sermon everyday and everything will be just peachy! Ok, maybe I just need to buy a new Bible, so I'm motivated to read it.

In other GOOD NEWS:

Today is the 3rd day in a row I have done my Lovenox injection all by myself! Yes, I am pretty proud of this, especially after last week's failed attempt. It is getting easier to mentally wrap my brain around holding and stabbing myself with a needle, and better physically as well....less bruising and swelling at each injection site. So far so good and I'm feeling pretty empowered doing it on my own. I am so happy to know I'll be able to do this on my own throughout pregnancy without having to ask for help.

Update on our FET cycle:

Our transfer date has been moved earlier one day to this Thursday 6/20. We received a call from the nurse on Friday asking if we would mind moving everything up one day because they had a tight schedule the day we were supposed to do it. I was tempted to question it and bring up the fact that I'd like maximum time possible for my lining to develop beforehand. However, I did not. I just went with the flow and happily said, "Sure, we are completely flexible." I have confidence that they are looking at my file and see where my lining was at last appointment. If they feel comfortable doing my transfer a day earlier, then I do too. I'm not worrying about it or trying to control the process anymore. It's in their hands and in God's hands. So, about 72 hours from now we'll be transferring one beautiful blastocyst!

Friday, June 14, 2013

LESS Questions, MORE Trust

Letting go of control and learning to trust doctors is one of the hardest things to master along this infertility journey. Maybe it's because I got off on the wrong foot in this journey to begin with.

I started out in July 2011 with my OB/GYN, taking Clomid, only to be told "Your case is too complicated, so I'm referring you to a specialist." This is the same OB/GYN that I later had a 10 minute debate with on why doing a CD21 progesterone test would not show ovulation in my case, because sometimes I do not ovulate until CD21 or later. Clearly this would not be accurate, but she didn't get it.

I moved on to an RE, Dr. Burger, who seemed to be taking me in the right direction, only to keep finding mistakes and snafoos in her protocol.
My final cycle with her was spent arguing whether or not I ovulated or should begin Prometrium supplementation during the luteal phase. Even though I'd had a huge BBT temperature spike and I was having post-ovulation symptoms, she refused to agree that I ovulated.  I insisted on a P4 test which proved I did ovulate. Only then did she write me the Rx for the Prometrium, and I was able to start the medication as she had outlined in her own protocol originally. This is only one instance among others, but it just always felt like pulling teeth. Totally exhausting working with her.

Fast forward to the RE I see currently see. My first cycle with him was like a dream come true. I did not have to remind him where I was at in my cycle. We clicked. He predicted exactly how I would respond, and I did. I became pregnant my second cycle with him using Femara and IUI...unfortunately it was an ectopic pregnancy and a long drawn out process to finally move on from it. It was then that IVF was recommended.

Then, despite not becoming pregnant, my first cycle of IVF went really well! Despite having low AMH/DOR, we got 17 eggs, 14 mature, 12 fertilized naturally, 2 were transferred and 5 blastocysts of 150-200 cells each were frozen. Again, I responded just as predicted and then some. Unfortunately our first attempt did not work, but at least we have frozen embryos to try again.

When I think about it, even though we've been seeing Dr. Vaughn now for 10 months, which seems like forever because of the never-ending ectopic pregnancy, long IVF process and break period in between, we've only actually done 3 rounds of treatment with him total.  In that time, he has given us every reason in the world to prove his expertise and he has actually never done anything to give me any real reason to doubt him, even if his protocols aren't the most aggressive in nature (in regards to reproductive immunology at least) and even if we haven't had ultimate success YET.

Lately, I find myself questioning more; Questioning him more, questioning the process, questioning whether or not this will work. Why? For one, the months and years are passing by and we've yet to achieve a successful pregnancy. Plus, there is so much information out there about what "other doctors are doing." This field is not cut and dry like cardiology for instance. There are many different schools of thought and protocols, and it's maddening comparing oneself to others and others' treatment processes. Hubby and I are both becoming drained emotionally from the whole roller coaster of it all. Time passing is a scary thing, and when coupled with my already impatient and inquisitive nature, it makes for an extremely restless situation.

I didn't even realize this until hubby pointed it out today, but even though it's already mid-June, we've actually only had one full cycle of treatment in 2013. Furthermore, when you think about it, considering I've only done 3 cycles total with my new RE, we have made good progress during those cycle. I've been pregnant once and have gotten a nice haul of good quality eggs and embryos in those few tries. When I think of it that way, it's much easier to contend with.

There is definitely a good time and place for questions, but I can also see that some of my endless questioning becomes detrimental sometimes. Today's appointment for my lining check was a perfect example. Condensed version of our apt..

Dr. V:  "Everything looks great for your transfer one week from today."

Me: "8.1 mm? Is that it?"

Dr. V:  "What did you expect it to be?" 

Me: "Above 9. Double digits would have been nice. "

Dr. V: "Well in our clinic anything above 7 is considered good for an FET."

Me: "I am just having a hard time grasping why some doctors want above 9, some say 8-9 is "iffy" but you are happy with a 7. I feel like I'm at the bottom of the range. "

(que me covering my head in my hand and trying to hold back tears unsuccessfully)

Me: "We just really need this to work!" wahhhhh

A 5 minute discussion ensued as to why my lining is fine, but we were given the choice to wait another week to see if it will thicken more. BUT there is a small risk of ovulation and thus a cancelled cycle if we did decide to wait. Just what neither of us wanted in today's appointment...more decisions. If I could just trust what the doctor is telling me I know I'd save my husband and I both a great deal of stress and anxiety, but I'm always questioning EVERY little thing. Then when I get frustrated with the prospect of yet another decision and scared of making the wrong one, it turns into more frustration and tears.

Yes, I am a mess. Could it be the 3 doses of estrogen I'm taking daily? Could it be previous experiences with other doctors that have scarred my ability to trust them fully? Could it be that I cannot endure another failure and I want to make sure all conditions are as perfect as possible so that we don't have to endure another negative result? Could it be that I just learned of another friend's pregnancy only moments before my appointment?

It could be all of those things, but I need to take a step back and realize that HE IS THE EXPERT in this relationship and I have got to be more trusting. If he says my lining is good, I have to trust that it is and just shut the fuck up!  The live birth rate at my clinic is actually equal to what it was for my fresh cycle and according to my nurse their FET rates were closer to 70% last month. Here is the most recent SART data for 2011...

Worth mentioning that they had 918 IVF cycles that year, so it's not their first rodeo. My doctor has helped people like Lance Armstrong conceive all 3 of his children via IVF at his clinic.  I mean, if my RE is good enough for Lance, he should be good enough for me right?

I've said all along that I will fully trust Dr. Vaughn until he, God forbid, strikes out 3 times with IVF/FET.  If at that point, I am still not pregnant we will have other considerations to make, but for now I've got to give him the benefit of the doubt and just follow doctor's orders like a good patient.

Yes, I am still happy I am taking the Lovenox on my own accord, because in my case I think it can only help. However, I also respect my RE's perspective that there just aren't enough peer reviewed double blind studies on the efficacy of Lovenox during IVF to start prescribing it to all of his patients.  It is more of an experimental approach in all honestly, rather than something with extremely solid proof. When it comes down to it, all of this is one big ole crapshoot really.

Still, I know I'm in good hands. I have to believe that God put Dr. Vaughn in our lives for a reason and that he'll be the one who helps us have our baby. For my husband's and my own mental sanity, I've got to let go of the control a little more and just go with the flow. I am of course, trusting in God first and foremost,  but I've also got to trust the person He's given the tools to help us here on the physical earth. So, from here on out LESS QUESTIONS and MORE TRUST.

Monday, June 10, 2013

Not So Lovely Lovenox: A Haiku

Lovenox injections are in full swing for our FET cycle. Don't be fooled by the name. There is nothing lovely about these injections. As I mentioned earlier, I'm taking liquid fire ants....I mean LOVENOX this time around to counteract the thrombophilia (blood clotting issues) that I was so lucky to inherit. Hormones increase blood clotting even further, and Lord knows I'm all hopped up on those. I'm taking estradiol 3 times per day now to help my endometrial lining grow nice and cushy and become a perfect place for an embryo to snuggle in.

While my RE is not convinced taking Lovenox will make or break the implantation process during an IVF cycle (he only recommended I take it once a pregnancy is confirmed), my instincts tell me that it could benefit me. Plenty of other RE's and RI's out there take a more aggressive approach than my doctor.

For patients like myself with APA (Anti-Phospholipid Antibody) Syndrome, there are basically two schools of thought; Some doctors believe Lovenox is only necessary once pregnancy is achieved to prevent miscarriage. Others believe that thrombophilias and APA's contribute to miscarriage, infertility, and IVF failure all through the same mechanism; In short, the blood is not flowing freely enough to nourish the areas which need it most during all stages from conception through time of delivery.

The theory for Rx'ing Lovenox during IVF cycles for women with multiple clotting factors is that increasing blood flow to the uterus is just as good for implantation as it is in preventing miscarriage. If I'm supposed to take this stuff IMMEDIATELY upon a positive pregnancy test to prevent miscarriage, why wouldn't I also take it to help an embryo implant? Seems like common sense to me, and it can't hurt, so I began the injections on CD6 this cycle. My RE is in fact aware of this and has given me clearance despite his own feelings of ambiguity.

The only thing that's unfortunate about taking these "lovely" Lovenox shots is that the medicine itself burns worse than any other shots I've done...including Menopur. There really are no words to describe my contempt right now. However, I have written you all a lovely haiku to convey my feelings towards this wonder drug...

Not So Lovely Lovenox

Ice cold skin turns red.
Alcohol readies bullseye.
Deep breath in and hold.

Stabbing, Holding, Breathe!
Wincing, Tremble, Plunging Slow...

Nothing prepares me.
Liquid fire ants in my pants!
Make it go away!

No pills for this crap?
NOT so lovely Lovenox.
Bring baby or else!

You get the gist. I set a goal last week to master giving these horrible shots to myself, because WHEN I do become pregnant, I'll need to take them every day for 9 months throughout pregnancy. 

So far, I have gotten half way there. Hubby stabs me and I plunge the liquid fire into my belly. Today I tried doing the whole shibang myself, but it was soooo pitiful. I stuck myself half-way a few times, just enough to draw blood in 3 separate places, before realizing my love handles are made of rubber and jabbing the needle all the way in is not nearly as easy as I thought. I don't know if it's from the icing, but my fat is all hard and rubbery and it's like it repels the needle from going in. Blech!!! Gives me the heebie geebies just replaying it in my mind! Hubby says, "Just don't look." hahaha! Yeah right.

After multiple self-administer attempts, I was seriously about to have an anxiety attack. I couldn't breathe, got extremely lightheaded and ultimately began to cry. I can only compare my fear of needles to the fear most people have of public speaking or jumping from high places. I have zero issue with either of those things.

Skydiving from 10,000 feet in the air in Kauai, problem!
Not even a slight bit scary.

Needles, on the other hand, are a totally different story. After about 10 minutes of me pacing and repeating, "Ok I'm going to do it now. 1-2-3....Ugh! I can't do it! I can't do it!!!" I finally gave up. I took a breather, re-iced a whole new area and started all over again with our old routine...hubby stabbing and me plunging. I seriously don't know if I'll ever be able to do these shots 100% on my own. I am getting anxiety just blogging about it.

All I know is that I really hope the Lovenox lives up to it's name. There are no guarantees, but I feel much better knowing I'm taking something this round to deal with the clotting issues vs. doing nothing at all. I keep reminding myself how grateful I am that an anti-coagulant medication even exists and that my insurance covered it. Plus, there are no food restrictions whatsoever, as there are with other blood thinners. I can deal with any amount of pain in this world if it brings us our take home baby. We've got this.

Sunday, June 2, 2013

Is Age Really Just a Number?

It's a pretty important one where the ability to bear children is concerned. With today being my 35th birthday, it had had me thinking...more like dreading what it means. In case you didn't know, 35 marks the official milestone in the medical field known as AMA or Advanced Maternal Age. Fertility declines sharply, as do pregnancy rates, success rates for IVF and live birth rates. The only things that go up are risks (miscarriages, birth defects, gestational diabetes, cesarean rates, etc.) Someone hand me a kazoo! Happy birthday to me!

In reality, had I known ten years ago how fertility changes with age, I probably would have stopped taking birth control sooner. I was completely clueless! My mom, who was pregnant and married at age 16 and done by age 23 with 3 kids, put the fear of God into me my whole life that I better not have sex or get pregnant. I took a child development class in high school where they proceeded to scare the pants off of every teenage girl. If you couldn't even make it a week without your "egg baby" dying a horrific Humpty Dumpty death, then you obviously weren't ready to procreate. I thought I was being smart by continuing to take birth control until I was 30 and "settled down."

Talking about the risks of teenage pregnancy is a no brainer, but what about teaching young women about the reality of fertility decline past a certain age? I know I'm not the only one who was caught by surprise when my RE showed me that SCARY line graph that plummets along with quantity of viable eggs with each passing year. It actually baffles me that we simply don't teach young women in this country how fertility is increased AND decreased during certain years. Surely we can find a way to teach this without encouraging any increases in teenage pregnancy rates whatsoever. At least that is my opinion.

It seems that some experts in Britain are also aware of the need to educate their citizens. A new campaign called Get Britain Fertile is getting attention because of it's photo centerpiece....

Get Britain Fertile Campaign (doctored photo)

Their goal? To create a conversation surrounding the increasing number of women putting off motherhood. Check out this short clip from the Today Show talking about the campaign. Personally, I think it's great! I think whatever gets people to take notice that there IS an expiration date to begin with, is welcome. Maybe more women choosing to wait will realize that it may not end up being a walk in the park.

There have been other women speaking out on the topic of waiting (perhaps too long) to start their families. NBC's Rock Center ran a great piece on their show recently where they interviewed the former CFO of Lehman Brothers. Great clip if you have ten minutes to watch! In the episode, she talks very openly about her career and family planning choices. I thought her story was a breath of fresh air amidst all of the "Lean In" hoopla circulating in the media and corporate circles as of late.

It's kind of depressing to know we started TTC one month after I turned 33 and still nada. If my first pregnancy would have stuck, we'd have a one year old running around right now, but I digress. Leave it to my hubby to find the perfect way to cheer me up. Friday afternoon I came home to this...

My beautiful flowers- Yellow & white roses with hot pink mums!

Inside the bag was a BEAUTIFUL diamond cross and inside the card read an equally inspiring bible verse handwritten by the hubs...

For I know the plan I have for you,  declares the Lord,
Plans to prosper you and not to harm you,
Plans to give you hope and a future.
Then you will call on me and come and pray to me,
And I will listen to you.
You will seek me and find me when you seek me with all your heart.

-Jeremiah 29: 11-13

And yes, I bawled my eyes out.
He's such a sweetheart, and I am a lucky woman. Screw AMA! Nothing more I can be doing that I'm not already really. I decided to make the most of my birthday weekend! Saturday night we went out with a group of friends to dinner...

Wearing my lovely new cross and enjoying
some key lime margarita cheesecake.

And then bowling...

Fab 5 Ladies of Bowling

Such a blast! We had our own lane and the guys had theirs. I can safely say we had more fun that anyone in that bowling alley. haha! Today hubby and I finished out my birthday weekend with some relaxation and got 80 minute massages. Long live Travelzoo coupons!

In even better news, after a 44 day long cycle spanning April and May, Aunt Flo finally arrived on Friday! We went in for my baseline ultrasound; No cysts, lining is ready, and all systems are go to begin our FET cycle!!! I added a new tab at the top of my blog titled "FET Calendar" where you can find my schedule of meds, expected transfer and test dates. I will update with more as it unfolds.

In the meantime, I'd love to know what you think...
-Do you wish you had known how much infertility changes with age or your diagnosis?

-Do you think the gov. should include some form of education on this in schools or publicly?

-What do you think about the Get Britain Fertile campaign or other women speaking out in the media?