Thursday, January 26, 2012

Coming Out, Neighborhood Style

In my last post, I complained about people who can't go two seconds without talking about their babies.  What do they think about the weather?  Their baby likes it.  How do they feel about the big game?  They haven't cared about sports since Junior was born.  Thank goodness their lives have meaning now and such trivialities don't concern them anymore.

Whereas I can't relate to having a meaningful life—mine's still purposeless and insignificant, obviously—I can totally relate to their one-track minds.  I go through phases where getting pregnant is all I think about.  Before being consumed by basal body temperatures and fake pregnancy symptoms, I'd obsess about other stuff:  boyfriends (pre-husband), running, finishing my degree.  I was guilty of awkwardly turning conversations to my obsession du jour. 

One of my latest preoccupations, more of a semi-obsession than a full-blown one, has been to tell some neighborhood friends about our difficulty getting and staying pregnant.  Broaching the topic has proved tricky, though.  I hadn't been able to find an opening.  "How are you?"  "Ok, but my uterus isn't."  "Why didn't you come to the last party?"  "I was going through my second miscarriage.  Was there a keg?"  I just hadn't wanted to be a downer, you know?

Lately I've been ready to break my silence, though.  Last weekend after a glass of wine, I worked some conversational magic to turn a conversation from aging to infertility.  I said that aging hadn't bothered me until we started trying to conceive, and now my greying eyebrow hairs are constant reminders that it's just going to get harder for me to get (and stay) pregnant.  At the time,  I thought you could hear a pin drop after I said that.  I've known these women for years and I'm guessing they've wondered about my husband and me, the oddly childless ones.

In retrospect, the room didn't get silent.  A woman jumped in and started talking about her experiences with infertility and loss.  She's doing well now and has children, which is reassuring.  I felt connected, and the wall protecting my secrets came down a little more.  

Not telling can be a burden.  You miss out on support, for one thing.  You also lie.  For several weeks after my laparoscopy, I lied about why I had to miss my neighborhood yoga class.  Telling about the lap would have meant telling about endo, leading to questions about endo and fertility, which I wasn't ready for.  You also can't expect people to be sensitive if they don't know about your issues.  Maybe they'll still say dumb stuff after they know, but maybe they won't.  Maybe telling the entire neighborhood about our struggles will put an end to comments about how my husband and I must be rattling around in our house with its unused bedrooms.

I know there's a downside to telling, too.  I can't untell them and regain my privacy.  Telling people is addictive, though, and I'm going to enjoy this high as long as I can. 

Random thought of the day:  I get really excited when my work bathroom has new "Don't throw your tampon in the toilet" signs.  Someone else is menstruating and not pregnant!  Another possible sign of a fellow bleeder is hearing paper crackle in the next stall, although it usually just turns out the person changed the toilet paper roll.

Tuesday, January 24, 2012

Missing Filter

I'm blaming it all on the hormones I'm taking.  If they aren't to blame, who have I become?

I'm having trouble holding my tongue lately.  I just blurt stuff out.  Although this characteristic is sometimes seen as "just being honest" or "telling it like it is," it's not a quality I want to develop when the "honesty" is an expression of anger.  Particularly, when that anger is expressed at work.

So when I'm forced to interact with coworkers who turn every conversation into one about their babies—how do they transition that quickly from the Super Bowl to babies?—I'm genuinely concerned that I'm going to blow my carefully maintained workplace cover as someone unconcerned about having kids.  My irritation level is maxed out lately with supplemental progesterone and an upcoming treatment cycle, and I'm quickly losing the ability to coo for an appropriate amount of time over how cute their babies are. 

The progesterone baddie in me yearns to educate them.  To let them know how their constant baby talk feels to someone like me.  To tell them that I don't really want to know that they're about to try for #2 because I'm sure they'll get pregnant again quickly, just like they did right after my first miscarriage, and at this point I'd rather be hit with surprise pregnancy announcements than spend months worrying about impending ones.

My secret seems to be safe so far.  But once I start taking letrozole next month, watch out.

Note:  I wrote this post last week and I'm pleased to report that my irritation level seems to be decreasing.  I think. 

Saturday, January 21, 2012

My Baby

I've led my bloggie friends to believe that we're trying for our first take-home baby, but that's not entirely true.  Meet our first, Baby Dog.  Her name has been changed to maintain anonymity.
"But I'm not cold."

She's actually not a baby anymore but is a full-grown, elderly doggie.  I've had her since she was one.  She didn't have any puppy energy left in her at age one and was already kinda lazy and crotchety.  She's always completely lacked in any athletic abilities and will only run if she thinks she is in imminent danger.  Or if she thinks she's going to be fed.  She thinks playing fetch is a complete waste of time.  She also has the most intense, loving gaze that looks right into your soul.

My husband entered the picture when Baby Dog was middle-aged.  She was pretty set in her ways by then but decided pretty quickly that he was ok.  One incident early on when we were dating convinced her that he was The One.  We had guests over and accidentally left some food out on the coffee table when we went to another room.  Suddenly realizing our mistake, I leaped up to find her licking the cutting board clean.  She'd eaten a pound of cheese.  Amazingly, she seemed to feel great afterward and suffered no ill effects. 


My husband and I bought a new camera recently.  Our old one broke sometime after our honeymoon in 2007.  In the early days after it broke, I decreed that we couldn't buy a new camera until we had a baby.  You know, good old-fashioned bribery to get my husband on the trying to conceive train earlier.  Eventually our babyless state had zero to do with lack of trying and everything to do with legitimate medical problems, so I decided to stop punishing him with a cameraless existence.

Baby Dog has been the subject of more photos with our new camera than any other person or dog.  In a fit of unexploited maternal energy last weekend, I decided it would be hilarious to photograph her surrounded by hand-me-down baby paraphernalia that's collecting dust in our closets.  It was.

The worst part of the photo shoot for Baby Dog was when I tried to hold her.  She gets mad when her 2-foot bubble of personal space isn't respected.  She looks adorable in a baby hat but has very little tolerance for cuddling, being rocked to sleep, or being burped.


Sifting through the sadly unused baby clothes was the hardest part of the photo shoot on my end.  I did it for the sake of a few funny photos—you know, fine art.  When the clothes are sitting in our closets along with car seats and strollers, I can try to forget they're there.  Opening the vacuum-sealed bags and smelling their baby-ness (how do they retain that baby scent from years ago when my niece and nephew were little?) reminds me that my only baby smells like a dog and not baby shampoo.  For now, Baby Dog will have to be the sometimes unwilling recipient of all of my maternal impulses.

Looks like my letrozole cycle is getting moved up!  As you know, that never happens.  Cycles are always pushed back and never moved up.  Apparently muscle twitches are not a common side effect of taking estrogen, contrary to what Dr. Google told me, and my doctor instructed me to stop taking it and the progesterone right away.  She thinks I've been on the hormones long enough and can wait for a period, meaning I'll probably get to start letrozole a little earlier than initially planned.  Every little bit helps, right?

Tuesday, January 17, 2012

Closer to Fine: My Life on Prozac

I'm the first to admit that I'm not a happy-go-lucky kind of person.  Never have been, never will be.  I have a tendency toward melancholy and worry that probably starting showing in infancy.  What was diagnosed as colic or reflux was probably just my inner grump beginning to show. 

I took Prozac and similar medications, other selective serotonin reuptake inhibitors (SSRIs), all through my 20's.  My dose was probably too low to be optimal in retrospect but I managed ok.  Whenever I'd try to taper off, sadness would return and I'd go right back on the pills.  Before we started trying to get pregnant, though, I was determined to taper off for good.  I didn't want to expose my baby to meds and that was that.

I stayed off of SSRIs for two full years while we struggled to get pregnant and suffered our first miscarriage (or, more accurately, suffered a miscarriage early in the process and then had trouble getting pregnant afterward).  The months after my first miscarriage were bleak.  Much to my surprise, I could function at work, showing up on time and even producing, while I was severely depressed.  All of my relationships suffered along with me, including my marriage.  Instead of having a partner, my husband had a shell of a person sitting next to him at dinner every night.   My misery and isolation were overwhelming.

The depression let up a little after several months but still lurked.  It came out in full force when I'd walk past pregnant women and racks of onesies at Target.  I thought that because I was functional—I could work and socialize and even fix my hair most days—I was having a normal response to infertility and loss.

Depression wasn't my only ghost.  I frequently had panic attacks but didn't know what they were.  Wouldn't any baby-crazed woman burst into tears when she realized hot baths were going to annihilate her husband's sperm?  Although I didn't recognize the panic attacks, I knew I felt hyped up and generally miserable all the time. 

I became a self-help junkie.  Listening to guided meditations calmed me down a little, so I meditated two or three times a day.  I practiced yoga and journaled.  I went to individual and group therapy.  I spent time with friends.  It all helped...a little.  I still felt oppressed by sadness and worry.

My husband and I started discussing my going back on medication.   He admitted he wasn't entirely sure I was depressed enough to take a medication, whatever "enough" means.   I wasn't entirely sure, either.  I wasn't down all the time.  I was able to enjoy things sometimes and smile and laugh.   But I felt like something had to change.  The happiness I fought to feel and project wasn't fooling anyone.  I felt like I was constantly fighting depression not to pull me under.  Acting normal, you know, like not bursting into tears when a pregnant woman walked by, was so hard.  I was so tired of the act.

Before I went on meds again, we agonized about the safety of taking SSRIs for a gestating or nursing baby.   After a long Q&A session with a pregnancy-specialized psychiatrist, we decided to go for it. 

The timing was perfect.  I started taking Prozac again last spring and had miscarriage #2 in the fall.  Grieving that loss was a completely different experience from the first one.  My heart still broke into a million pieces, but the backdrop of anxiety and depression was gone.  It's been four months since the miscarriage and I can honestly say I feel ok.   Not on top of the world, "I'm gonna have a baby in 8 months!," but pretty good.   No more 3 a.m. panic attacks.   No crying at the drop of a hat.   In other words, very, very different from how I felt after my last miscarriage.

The difference can't all be attributed to Prozac.  I've changed and adapted over time, too, thanks to tons of therapy and support from friends.  I think Prozac is making a significant contribution, though.

In an ideal world, we wouldn't take any medications at all, especially when we're pregnant.  However, living med-free isn't for me, at least for the time being and probably for the rest of my life.  Off meds, I constantly struggle to stay afloat.  On them, I can begin to believe that someday, this will all work out, and the present isn't such a horrible place, either.

Friday, January 13, 2012

Hidden Expenses of Trying

My second miscarriage was a lot cheaper than my first.  I'm guessing it's not because my insurance company offers "buy one get one free" coverage for D&Cs, though.  Either they missed this last one, which is highly unlikely, or it's covered differently from the first because it was performed in an office and not a hospital setting.  In any case, I only paid a $20 copay.

I felt like I was getting away with something for a while after the cheapie D&C, particularly since my first one set me back $1800.  Mindful of not counting my chickens before they hatched (don't I know it), I kept an eye out for a bill in case it took a while to be processed.  My heart would stop when I received mail from my insurance company, but all of the envelopes contained harmless letters and not bills. 

Rather than opening the mailbox with dread every day, I could have called to inquire about coverage for the procedure.  However, I knew there was really no need to waste 30 minutes getting a noncommittal answer from a representative.  It was just a matter of time before some other medical test or procedure helped me reach my insurance deductible and coinsurance maximum. 

My surgery last month ended up being the big ticket item for this insurance period.  I've reached my deductible/coinsurance maximum each of the 3 insurance years we've tried, meaning that including copays, we've spent over $10,000 not getting pregnant.  Or, technically speaking, occasionally getting pregnant but not making it very far.

Everyone knows IVF can be expensive.  IUIs can certainly add up, too, making people wonder if they should have put the IUI money towards IVF.  What's blindsided me, though, is how much money you can spend on things that aren't IUI or IVF.  There's an array of fertility-related tests and procedures I hadn't considered before 2 years ago, from less invasive (but still expensive) uncovered lab tests to surgeries like laparoscopies. 

As far as infertility treatments and expenses go, we're in the minor leagues.  My heart goes out to women who have spent much, much more than we have and still do not have a baby in their arms.  Or those who have a baby but have suffered financially after expensive treatments.  Or who have gone through IVF at all, even if it was paid for.  I know I'm far from alone in all this.  My husband and I have been lucky so far to avoid IVF-scale interventions. 

I have to wonder, though.  How many more insurance years will I continue paying my maximum, not for prenatal testing, labor, and delivery but for infertility labwork and procedures?

Friday, January 6, 2012

New Year, New Regrets

I mistakenly thought I'd coast into my surgery last Friday with a limited amount of nerves.  Ha!  Guess you never really get used to handing your life over to strangers wielding potent anesthetics and scalpels.

Fasting, IVs, and anesthesia should be old hat to me after having gone through several procedures.  My first surgery several years back was completely unrelated to my reproductive organs, although like this recent surgery, it also involved a septum.  My nasal septum was veering off course and required some work to fix.  For the most part, it wasn't too traumatic, except when I nearly passed out from the horror of My First IV.  The My First Surgery Barbie would have a huge bruise on her arm as a badge of honor.  There is nothing normal or natural-seeming about having a needle sitting in you and feeling cold IV fluids enter and creep up your arm.  Disgusting.

Several procedures and a laparoscopy later, IVs are easy peasy.  I'm almost to the point of being able to watch them put it in.  Ok, that's a lie, but at least I'm not fainting anymore.

At my pre-op appointment, a resident gave me several prescriptions associated with the surgery.  Narcotic, check.  Hormones to promote healing afterward, check.  Misoprostal...wait a second.  Misoprostal is often used in lieu of D&Cs to induce miscarriages.  I had a visceral reaction when the resident casually mentioned I'd be taking it.  Apparently, in addition to inducing miscarriages, it can be used to prepare your cervix for procedures to prevent future miscarriages.

A lot of us have an unfailing memory for dates associated with our losses and infertility.   On 12/30/09, I started spotting with my first miscarriage.  On 12/30/11, I was on misoprostal and headed into surgery.

It was pretty uneventful physically.  I came to and said, "Is it over already?"  Cramps came and went for a few days afterward but were manageable.

I'm left with a lingering sense of regret and "should have knowns," though.  My doctor removed two things, a septum and some scar tissue, I feel like I should have explored further last year.  We'd been assuming the septum was too small to cause any issues, but maybe it was an issue all along.  The scar tissue, possibly caused by my first D&C, was hinted at during my HSG a year ago.  The tissue was partially blocking the opening to my left tube and I have to wonder if it's a coincidence that both of my pregnancies were from the right.  It pisses me off that this might have been missed by some previous doctors. The third item on my doctor's extraction list was a polyp.  I'm pretty sure it was a new development so at least I can keep it off of my guilt list. 

How do you find the balance between researching adequately—pursuing diagnostic testing and second opinions—and becoming completely consumed by it?  I want to believe that we've done enough experimenting recently on my body (ok, and on my husband, who had one vial of blood drawn after my last miscarriage) at this point to move forward with trying again.  My obsessive, scientific nature drives me to check out all options, though, and it's hard to find the balance between constant research and trusting my doctor.  I know that at some point, the data collecting has to stop. 

That's where I'm at this first week of 2012.  Wondering if we've covered all our bases, regretting that we didn't address some of these issues earlier, and hoping an embryo will soon make itself at home my newly renovated uterus.  

If all goes well with my recovery this month, we'll start a letrozole cycle in early February.  My first and only letrozole cycle to date resulted in a pregnancy so it's hard to not put all of my hopes and dreams into this upcoming cycle.  After being in a holding pattern for several months, I'm beyond ready to get this party started again. 

I've missed the Blogosphere this past month.  Work and the holidays have been just about all I can handle recently.  I've been trying to keep up with reading and commenting as best I can and hope to see everyone more this month.