Where I'm Supposed to Be

"You are exactly where you're supposed to be." 

My Dove chocolate wrapper just told me that.  Whoa.  After announcing to you guys, some family and friends, and myself that I'm done with trying, I appreciated the reassurance from Dove. :)

So, yeah.  Last week was a little crazy.  I can't remember what tipped me from "maybe I'll try again" to "no way in hell," and it felt weird putting it all out there.  But it also felt like a great release.  I've found that all kinds of good stuff happens when you open up.  Like finding people to talk about adoption with.  After telling my sister, she met an adoptive parent this week who is super pumped about adoption and would love to talk with me about it.  Yay!

The person who was probably most surprised about my decision is my husband.  Maybe before this week, I hadn't communicated clearly enough that this was coming.  That the pain has made me realize I'm really not cut out to grow a child.  He's reluctant to accept defeat and wants a doctor's opinion about adding a gestation to my pelvic woes.  He also thinks I'm just saying this because I'm miserable right now, and I'll change my mind once my body calms down.  It's possible but I doubt it.  I'm pretty close with my body, and it's told me in no uncertain terms that it doesn't want a uterine occupant.

Like I said before, it's not all about the 4 months of hellish abdominal pain, either.  I kinda wanted to stop trying after my second miscarriage last fall.  I don't want to ever go through that hell again.  I'm not convinced that my uterus is any more inhabitable than it was when it kicked that baby out.  Also, although one miscarriage doesn't increase your odds of another, two miscarriages start making you more likely than the average woman to miscarry.  Avoiding pregnancy started sounding very appealing at last fall.

I had some bad moments last week after my announcement, though.  Moments where I doubted that we'd ever have a child, that we'd never agree on an agency/birthmother/child.  But I think we'll get there.

In general, I feel happier than I've felt in a long time.  I keep thinking my body will reward me for the happy hormones I'm allowing it to produce, all the "I'M RELAXED SO YOU'D BETTER RELAX, DAMN IT" vibes coming its way.  But the pain is still bad.  I played hooky from PT for a while because I felt like it was making the pain worse, but I've started back up again.  I'm going into it a little tougher than before, more Jillian Michaels than Rodney Yee (yoga guru).  I'm due to call my pain doctor again this week and can't wait to interact with the oh-so-helpful triage nurse again. Fun times.

I feel like I've taken back my body and it feels amazing.

It's also nice to have a goal again.  I'm happiest when I have something to work toward, and there's much work to be done on the adoption front.  We know that if we chose to adopt, we'd do domestic, but we don't know a lot beyond that.  I went to a couple of adoption seminars last year so I'm hip to the lingo, but know we wouldn't use either of those agencies.

Hope you guys had a nice weekend!

Open-backed Surgical Gowns and Other Issues

Right before my first post-miscarriage D&C, the nurses had me walk from the pre-op area to the OR in an open-backed surgical gown.  Down a hallway, past other patients and healthcare providers, holding the back of the gown closed so I wouldn't show my butt to everyone.  It was completely humiliating and not what I needed while I was losing a baby. 

I've had lots of surgeries and procedures, especially recently.  I realize we have to tolerate certain indignities for the sake of efficiency.  And I'm all for efficiency...to a point.  I want the kind of efficiency that means a nurse will at least make sure I've tied the back of the gown correctly.

My husband took me to the ER two weeks ago as part of this whole post-op pain drama.  That was an eye-opener.  At first I thought the patients waiting with catheters in their arms must be in especially bad shape, but after getting an uncomfortable catheter of my very own, realized it was par for the course.  Going to the ER means you get to sit around with a catheter.  There's no mistaking the patients for the caregivers.

One of the most surreal parts of my ER experience occurred when a nurse handed me a urine cup while I was still in the waiting room.  She instructed me to provide a sample using the public bathrooms.  Not wanting the 100+ person audience in the waiting room to know I was providing a pee sample, I used my purse to transport the cup to and from the bathroom.  I know, ew.  Of course, my efforts to hide the cup were in vain, anyway, because I had to do a very public hand-off to the nurse in front of everyone. 

I'm not blaming individual nurses or even managers.  But it sucks.  I'm trying to retain some of my dignity through this whole stirrup-filled infertility odyssey, but I'm starting to feel like I've lost it.

Navigating work with post-op pain has been embarrassing, too.  I am so grateful for the outpouring of support I've received, but am having trouble just accepting it.  I've been shuffling around the hallways in obvious discomfort.  I start the day sitting at my desk and within an hour, am working from a couch in an unoccupied office because sitting up is too painful.  People fuss over me and bring me extra pillows.  Coworkers kneel next to the couch to discuss projects.  I hate it.  I know we're all sick sometimes and it's not a sign of weakness, but it's not the person I want to be at work.  I want to be vibrant and efficient and strong. 

The gabapentin I'm taking is definitely helping the pain.  It's just not helping quickly enough to suit me.  I'm adjusting my expectations of how long this recovery will take, but sometimes I want to pitch a temper tantrum and insist this all ends now. 

If you haven't headed over there already, stop by Cristy at Searching for our silver lining to offer your support.  She's going through her second miscarriage after an FET.  She is one of the kindest bloggers I've come across and I can't believe she's going through this again.

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.

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.

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?

Is My Grief Making You Uncomfortable?

I'm someone who wants to be asked about my miscarriages.  Ask me how I'm doing, tell me you're sorry—just acknowledge it.

On Thanksgiving Day, I saw many relatives I hadn't spoken to since my last miscarriage.  I'd initially told them about the pregnancy at 5 weeks because I couldn't contain myself when they were visiting at the time.  At 5 weeks, it was all smiles and congratulations.  Last week, 2 months after the miscarriage, it was radio silence.

I get it.  I don't know what to say to people who are grieving, either.  It's uncomfortable and awkward and there's always a possibility that they'll start crying.  Even with women who are going through losses similar to mine, I can't manage much beyond "I'm so sorry" or "You're in my thoughts." 

However, going through these losses has shown me just how much I want people to say something, even if it's the "wrong" thing (you know, like "At least you won't be pregnant during the summer!")  Yes, by saying something to me, you could make my eyes glisten or even cause a tear to fall.  It's ok.  You didn't cause me to be sad.  I'm already sad enough on my own.  I'm just touched and appreciative that you took a moment to brave a little awkwardness to show that you cared.

Once I figured this out about myself, I thought I had it all figured out.  Talking about grief = good, ignoring it = bad.  I decided to put this into practice when others were grieving—asking them how they were (at the appropriate time, of course), following up a few weeks later, etc. 

One day, I was talking about this topic with my husband and he rained on my parade.  To my surprise, he said that if he experienced a difficult loss, he would not want someone to acknowledge it, at least in person.  It would call too many emotions to the surface for him and he'd be irritated.

I get the impression that most women who have experienced miscarriage or infant loss (or another type of loss) want to be asked about it.  How do you feel about it?  What about your husband/partner?     

It's Your Turn...Maybe

Welcome, November ICLWers!  Here's a quickie version of my not-so-reproductive history:  trying over 2 years, 2 miscarriages (1 recent), currently pursuing repeated pregnancy loss testing and a surgery to remove a uterine septum.

After a disappointing appointment with my reproductive endocrinologist last week, I gave my mom the status report:  6-week wait until surgery and some unknown amount of time to heal after that.  My mom said hopefully, "Well, after the surgery, things should go fine."  Translation:  You'll get pregnant immediately, you won't miscarry, and you'll have a baby 9 months after that.  Some people tell you things will be fine to brush you off, but I don't think that was her intention.  I think she either actually feels optimistic or is trying to use the power of positive thinking on my reproductive organs.  She had a similar hopeful reaction after my first miscarriage almost 2 years ago, telling me she thought I'd have a baby by Christmas.  Of course, the timing would have been impossible unless I'd gotten pregnant immediately (ha!) and delivered early.

How do you feel about people telling you that surely your next [vacation/surgery/IVF] is gonna result in a baby?  I used to feel hopeful right along with them but admit I don't anymore.  Miscarriage #2 destroyed my sense that everything's gonna be ok.  During that pregnancy, I was sure it was finally my turn.  I thought I'd reached my miscarriage quota, that I'd put in my time with infertility and loss.  It turns out there isn't a limit to the number of miscarriages you can have.  There's no cosmic fairness meter doling out infertility and loss evenly—it's just unfair.  Optimism and a sense that it's your turn don't get you a baby.   

On a more positive note, part of you has to believe the next cycle will be The One or you'll go out of your mind.   I want to believe that removing my septum is the magic bullet—that I'll heal perfectly, get pregnant soon after, and meet my baby 9 months after that.  I guess the difference between my mom and me is that I don't dare voice that optimism—it's too hard when it doesn't work out.  It seems naive to say "things should go fine" from this point forward.  If it was as easy as saying and thinking that, they would have gone fine many, many months ago.

Normal Baby, Abnormal Uterus

Normal female.  It's incredible how two little words can bring back the pain of my last loss in such a profound way.  I didn't just have a random procedure that resulted in spotting for weeks on end.  There was a little girl in there.

My D&C was September 9 and we received the karyotype results on the products of conception—normal female—a few weeks after that.  (I confess I hate the phrase "products of conception."  Maybe it's the medically correct term but it's so dehumanizing.)  With normal female results, the cells they tested could have been the mother's instead of the baby's, so they performed an additional test (microarray) for me to see if they could get more info.  Yesterday at an appointment, I found out that the microarray confirmed normal female, so that's what we have to go on right now.

Since the fetal chromosomes didn't provide an explanation for the miscarriage and it's my second loss, we decided to move forward with the standard repeated pregnancy loss blood panel.  It's a good thing I'm getting to be a pro at blood draws.  My vein is a champ, apparently.  The nurse yesterday complemented me on how easily she stuck it and filled 9 vials in record time.  Despite my crappy mood, I was proud of my vein.  My uterus may be inhospitable but my veins are spectacular.

In addition to bloodwork, I had a saline infusion sonogram, or 3D sono for those hip to the lingo.  My doctor had wanted to check out a small septum that comes down from the top of my uterus.  The septum was potentially an issue with my losses or could become an issue later in a pregnancy.  Two other doctors have told me that it's nothing to worry about, that removing it and risking the development of scar tissue isn't worth it.  My current doctor wants to take it out and I'm (somewhat grudgingly) putting my trust in her.  I don't know what else to do at this point.

Going into the 3D sono yesterday, I knew my doctor would likely recommend removing the septum.  What I'd conveniently forgotten is that I will have to take the Pill for a cycle beforehand.  Then there's Christmas, and it turned out the earliest surgery date I could get was 12/30.  Balls. 

Before yesterday, I'd seen my share of uterine issues:  septum, fibroids, and endometrial tissue that migrates out and gloms onto my intestines.  Yesterday I got to add a polyp to the list.  At least the polyp can be removed at the same time as the septum.

I had been dreading the pain of the SHG yesterday but it turned out to be a cinch.  Way worse than the physical pain was the emotional fallout.  It was so hard hearing my doctor say that since the baby was normal, we really need to examine the uterine environment.  It brings back all those post-miscarriage feelings of being betrayed by my body.  The baby was fine, actually beyond fine.  It was a little girl.  Knowing the sex really makes it hit home.  My baby girl was fine but somehow my body screwed up.  Maybe the baby implanted too close to the septum that I had plenty of time to remove before the pregnancy.  Maybe my bloodwork will show some other way my body is screwing up.  It's so hard to forgive your body for letting you down in such a big way.     

Pregnancy #2: What I'll Remember

I found myself driving to Walmart at 6:15 on a Friday morning to buy pregnancy tests. A cheapie at 4 a.m. had shown a faint line, much to my surprise. After a year and a half since my last pregnancy, I hadn't counted on it happening again. Going back to sleep was out of the question. I finally figured out that our Walmart was open 24 hours and was off and running.

Two pink lines showed up immediately. My husband, hater of mornings, pulled off his eye mask and snapped to attention as soon as the words left my mouth. I spent the day on top of the world. Of course there was reason to keep my joy in check, just in case, but I'd worry about that later. I wondered if my coworkers could somehow tell that I was pregnant from the aura of fertility I was radiating.

We had a gift certificate to The Cheesecake Factory and decided to go that night to celebrate. I kept asking myself if the salmon I got was making me feel sick--maybe? We were both so ecstatic that my choking on a fish bone, gagging repeatedly, and nearly throwing up on my plate didn't dampen our moods. Afterward, we wandered into Crate & Barrel and cuddled like newlyweds on their couches. We started calling each other "Babymomma" and "Babydaddy."

I started writing this post intending to talk about the entire 3 weeks of the pregnancy after I found out. The beach trip when I was able to look at toddlers playing in the sand without getting a lump in my throat. The beginnings of horrible nausea that forced me to eat Saltines in the middle of the night. Buying new shirts to attempt to hide my humongous boobs. The anxiety of that first week of knowing about the new pregnancy combined with work stress.

But right now, the memories that stand out most for me, more so than even the nightmarish first ultrasound, are the ones of that first day. The euphoria of getting there again, of starting to grow a new life inside me, was part of it. A bigger part, though, was sharing the joy with my husband and connecting through our excitement. Feeling his giddiness combine with mine and draw us closer. Maybe I'm subconsciously choosing to remember the good and forget the bad, but I'll take that for now.

Me 101

Since this is an infertility/loss blog, I'll dive right into where I am with the process. I'm 34 and subfertile. Been trying to get pregnant for over two years, with two miscarriages along the way. This will be our first baby. My amazing husband is 40.

We found out I was pregnant for the second time a few days after my husband's 40th birthday. He was so happy that it looked like things were turning a corner for us, and thought it was pretty special that it was happening at such a milestone birthday for him. I know he was excited for the first pregnancy, too, but this time was different. We'd been trying for an additional 1.5 years, a surgery (laparoscopy), lots of fertility tests, lots of fertility sex, and finally, a medication to promote ovulation (letrozole). I'm sure the extra time had given him space to settle into the whole baby concept.

After going through many cycles with no pregnancies, we knew we were very lucky to get pregnant our first cycle on letrozole. To only have to take a few pills and not do a more invasive treatment was a huge gift. There was a fetus this time, an actual baby on the ultrasound. Our first pregnancy had resulted in a blighted ovum, which was a big fake-out. It's like the sac is playing this cruel joke about growing something inside it--"I'll give you all of the pregnancy symptoms but there's nothing going on in here!" After finding out there was no heartbeat this time, I started sobbing while the doctors continued trying to find something on the ultrasound. There was a little part of me under the shock and devastation that was happy I could see a baby this time. My self-congratulations were short-lived. The ultrasound doctor said that this type of miscarriage is more worrisome than the last. Once there's a fetal pole, stuff is less apt to go wrong.

But it did. And I'm dealing. It's been one and a half months since my D&C and I'm ok. In some ways this one has been easier to deal with. In my less confident moments, I attribute all of the difference this time around to the Prozac I started taking several months ago. But I think it's also easier because I've changed. My psychiatrist said recently that she doesn't think I'm avoiding the grief from this miscarriage, which was my concern. She thinks I'm making healthy adaptations to the heightened level of stress in my life.

I guess. I do feel better prepared to handle what life throws at me these days. I feel stronger, more resilient. But I also feel battered. And cynical. Like this will never work and my biggest fear will be realized: I won't be a mom. I keep reminding myself that chances are good that we'll get there somehow, but the fear still lurks under all of the reassurances I channel its way.

I'm brand new to writing like this. I'm a medical writer by trade, which gives me just enough understanding of medicine to pepper my doctors with a million questions at every visit, but not enough actual medical knowledge to really know what's going on. I guess we all have to eventually just trust the doctors, but it's so difficult. Anyway, blogging and writing about myself in a creative capacity is entirely new to me.

What am I looking for with this blog? A place to be a little creative. To express my frustrations and joys. To find and give support. Thanks for reading!