Racing Against the Clock

It has been a while since my last post, longer than it feels!  Partly, I've been busy (who hasn't been?!) but for part of the time, I just felt too crabby to write.  It all started on the eve of my week-long vacation, the day of my last post.

I could tell my period was going to start over the weekend so I called my clinic to ask if I could get one more prescription for Letrozole.  I was afraid that without it, I wouldn't ovulate until Day 17 or 18 of my cycle, and I had to be out of town for work on those days.  Not only would they not agree to more Letrozole, but they insisted I come in for a consult to discuss next steps before doing anything else.  I set up an appointment for the Monday of my vacation week, wedging the appointment into the end of my hanging-out-with-Grandma day.

My nurse practitioner is nice but very no-nonsense and veers toward the pessimistic end of realistic when talking about my changes of success.  I like her but she has a way of bringing me down!  The only words I could hear coming out of her mouth were old, poor quality, damaged, unlikely, age, limited, and IVF.  Basically, you are old, your eggs are old and likely full of damaged DNA due to their state of antiquity, and you should probably move to IVF plus genetic screening (in order to avoid transferring poor quality non-viable embryos).  This costs $26,000 out of pocket and no, we do not have a payment plan.  And ideally, you should use donor eggs or a donor embryo, given the aforementioned dismal quality of your own eggs.  And really, you have no time to spare so whatever you decide, you should ACT NOW, NOW, NOW!

I am the absolute worst under time pressure.  I hate games that involve those little hour glass timers or being told "you have ten minutes to brainstorm a brilliant idea" in a meeting or classroom.  Perhaps I was a bit too traumatized by a certain scene in one of my favorite childhood movies? A couple decades ago, I almost got fired from a cafe job for not preparing lunch plates quickly enough.  Never mind that my plates looked three times more appealing than those slapped together by my frazzled but speedy boss.  She kept me around for my other qualities and I left a few months later, vowing to avoid all jobs with time pressure from then on!  I just totally shut down as soon as there is any kind of time limit - i.e. If you don't get pregnant in the next two months, it will NEVER happen!!!!  I know the clinic is just trying to be realistic - she said, "I don't want another six months or a year to go by and you're even older and still not pregnant." - but the pressure is just not helpful.

That same day at the clinic, she suggested I get blood drawn so we could update my hormone levels plus she highly recommended I schedule a hysteringsalpingram (HSG) test to make sure my tubes were unblocked and my uterine cavity was in good shape.  I had heard of the HSG before and thought it sounded like not much fun.  She said, "It can be pretty crampy for some people so we recommend 800 mg of ibuprofen an hour before the procedure.  Some people just breeze right through it, though."  I have never in my life breezed through anything that involves a stranger sticking implements into my vagina.  I wasn't excited about the test and I was almost positive my tubes (or at least one of them) were open (since I've had implantation spotting once) but I figured it was best to be certain so I scheduled the test for the following Monday

Then I proceeded to freak out about it for the whole week, pretty much ruining any enjoyment of my vacation plans.  I was scared about the test, worried about the possible results of the HSG and the hormone tests, stressed about the pressure to opt for reproductive technologies that are far outside my budget, and just feeling doomed to a childless life.  I was worried about every possible scenario and felt my list of options getting smaller by the minute.  What if my eggs were too ancient and unusable?  Even if I did decide to go the donor embryo route, some donors won't allow their embryos to go to a single woman.  What if I'm not approved for the donor embryo program?  If I can't reconcile my concerns about the 'closed' nature of embryo adoption, then I start worrying about my chances for infant adoption.  Some adoption agencies won't allow the parent to be more than forty years older than the child.  And single parents are less likely to be chosen by birth parents than couples.  So my options there are narrowing as well.

Basically, I spent my entire vacation spiraling into depression and panic.  Not fun.  Fortunately, I had a grounding talk with a supportive friend and managed to slowly bring myself back to a point where I could at least google "increase egg quality" and start taking some action.  Which if nothing else, helps to lessen the feelings of depression and returns some semblance of control over my life.  I asked my nurse practitioner directly, "Is there anything Western medicine can recommend to increase egg quality?" and her exact word was, "No."  But a couple minutes later, she did say, "Some people find acupuncture to be helpful..."  Already on it.  But I realized then that it was going to be up to me to do my own research and to work with other practitioners who might have a broader view of the problem.  Modern American medicine is wonderful for what it can offer but it's not the only system worth listening to.

Since this post is getting awfully long, I think I'll take a break here and say, Stay tuned for next time when I go into my latest adventures in rejuvenating those supposedly crotchety eggs of mine...

Until then, wishing everyone the most youthful, gorgeous, fat and chromosomally beautiful eggs in the world,

E

The Ultimate Group Project

One of the most challenging parts of this whole experience is something I never really thought about before I started trying to get pregnant.  I was worried about the financial strain, physical discomfort, the emotional roller coaster of possibly having to try again and again.  But I never really thought about how much I would rail against the fact that I have to rely on so many other people to help me make this happen.

I am one of those people who groans every time I'm forced to do something as part of a "team."  I dreaded group projects in grad school and I have to give myself major pep talks in order to participate in group efforts at work without having a grumbly attitude.  Although I have loved ones who would be willing to help me with various tasks, I always prefer to do it myself.  I'd rather strap that full-sized Christmas tree to the top of my own car, lug it up three flights of stairs, and wrangle it into the tree stand all by myself rather than rely on someone to help me.  (Instead, I invite them over for cocoa and snacks to help me decorate - the fun part!)  Most of my furniture has at least one major ding in it from my struggle to get it from the antique store, into and out of my small car, and up to my third story bedroom all by myself.  I hate asking for help because I feel like people are thinking, "How sad!  She's single and all alone, so I guess I'll have to pitch in to help her."  Like I'm a little old widow whose kind neighbors offer to get her mail from the end of the driveway when it snows.  Probably I'm the only one thinking this, but it's a stubborn thought.  I don't want to be pitiful and all alone.

Recently, my boss pointed out, after first asking if I was the oldest child in my family, "It seems like you think you have to do everything yourself."  Without coming right out and saying so directly, it was obvious that he thought I needed to collaborate more with my colleagues in other departments to solve problems.  Given that I had come to him asking for resources to hire another person for my one-person department, I was not in the mood for such a comment at that moment.  But the more I thought about it, I realized he was probably (at least partly!) right and have since taken steps toward more collaboration.

But I've thinking about this whole idea of collaboration in other aspects of my life, too.  Several times throughout this process of trying to conceive, I have been frustrated with all of the logistics involved and with all of the scheduling required, with having to let so many people in on very personal information, with having the tools I need held by other people and having to beg and cojole them into letting me use them.  "I wish I could just get pregnant by having sex and leave all of these other people out of my business!" I have thought.  But I'm the one who decided this was the better route.  I could have tried to get pregnant the 'old-fashioned way,' but since I haven't met the person I want to raise a child with, that seemed like a good way to invite a lot of drama and heartache into my life and the life of my child.  So as much I sometimes hate it, I've decided to make this a team effort, inviting a full roster of helpers onto my journey:

• A young man I've never met generously donates his life-giving little gametes to the sperm bank. 

• A technician at the bank does some magic to turn them into a beautiful vial of healthy swimmers, which are then frozen.

• Someone at the bank processes my order on the back end and arranges delivery with the lab at my clinic.

• Meanwhile, I also give the lab a heads up and the lab manager documents everything, making sure all authorizations have been signed.

• One of the young women at the clinic front desk takes my call when a new cycle starts and gets me scheduled for a mid-cycle follicle check ultrasound.

• My nurse practioner's medical assistant discusses next steps and calls in prescriptions for Letrozole (to encourage timely ovulation, which has been off due to stress :-/) and an hcg trigger shot.

• A local pharmacist prepares the Letrozole and a pharmacy tech hands it over and takes my payment.

• An out-of-state pharmacy rep takes my call to order the trigger shot, takes my payment over the phone, and schedules the FedEx delivery.

• Another pharmacist prepares my trigger shot package.

• Several other pharmacy and FedEx workers are involved in delivering the package to my home a few days later.

• A driver delivers the sperm to the clinic where it is received by lab staff.

• Technicians at the lab make sure the sperm is kept frozen and correctly labeled.

• My acupuncturist inserts those tiny needles in exactly the right places to boost egg quality, blood flow, and overall awesomeness.

• My therapist helps me to process all of the emotions involved in trying to create a life.

• Front desk staff at the clinic check me in for my ultrasound appointment.

• A medical assistant escorts me to a darkened room and cheerily instructs me (as if I haven't been there fifteen times before!) to undress from the waist down.

• A nurse or sonographer searches for good follicles on her screen and instructs me when to trigger.

• The front desk staff schedules me for an IUI and directs me to the lab.

• The lab manager schedules a 'thaw' for my vial of sperm.

• A couple days later, technicians at the clinic lab thaw out my sperm and prep it for the big moment.

• The front desk staff and medical assistant herd me along again.

• In the grand finale, a nurse practitioner delivers thawed sperm right into my uterus, where they begin their journey toward that eager egg.

• And I haven't even mentioned all of the support being given throughout this process by friends and family members.  I have only told a few but those I've confided in have been loving and supportive and generous with prayers, cheers and open ears.

To state the obvious, this is pretty much the opposite of doing it myself!

But I think this is one of the lessons I'm meant to learn before a child comes into my life.  I think I'm supposed to learn that being a fully present and contributing human on this planet involves both giving and receiving, and it involves complex connections with others, and a willingness to rely on other people.  Much like the folks in that photo of the wall-climb, I need to be willing to let others push, pull, guide and encourage me on the path to my goal.  (I recently did a wall climb similar to that, though I can't find the pics, unfortunately.  It was a scary, painful, vulnerable and amazing experience!)  Whether on the ropes course or in everyday life, sometimes it's important to give up control and allow others to take on parts of the larger task.  Sometimes it means having faith that my partners in this project will not let me down - that the sperm will arrive at the clinic by the right day, that the prescription will be ready in time, that the providers know what they are doing when they say no more Letrozole.  As much I would love to have it all under my control... I don't think that's what God or the Universe wants for me.  I've faced this lesson before - on the ropes course, for example, or when I had a serious injury and had to rely on others to help me do everything.  But I've never really permanently learned the lesson I think I need to learn.

I'm really, really trying this time.  I have an appointment on Monday to 'check in' with my nurse practitioner at the fertility clinic about next steps.  I've used Letrozole six times already and they usually cut patients off after four.  I'm worried that my cycle will get longer again without the drugs, mostly because I'll be anxious about that possibility!  But I am trying to have faith that things will work out.  I have an amazing acupuncturist, who woke up my Rip Van Winkle-y left ovary after only two visits and has moved ovulation up to Day 15 (it had been as late as Day 22 when I was in full-on stress mode at the beginning of this process).  So, I am going to be open to what my ARNP says on Monday, and know that I will continue with IUIs regardless.  Sometimes, it's easy to focus so narrowly on one particular way of getting to a goal, and to panic when it appears that pathway may be blocked.  But I am reminding myself that there might actually be different paths that I haven't even considered yet.  Meanwhile, I'm going to try really, really hard not to let myself worry about them, one way or the other!

May we all be open to new possibilities and willing to receive assistance from unexpected corners,

E

Letting go of doing it right

Somewhere along the line, I think I got the idea that I have to work for this baby, that pregnancy is only going to happen if I do everything just right.  I must prove that I am willing to make sacrifices and put in the effort, like I'm training for the Olympics!  The internet encourages this mindset:


Eat the right foods 

Exercise - but not too much!
 
Stretch - but carefully!

Take supplements!

Drink herbs!

Avoid everything you enjoy eating!

Eliminate stress!  (Ha!)

Meditate...

Pray 

Deal with your emotional baggage


I seem to be surrounded by people who either get pregnant without trying at all or who only have to 'try' for a month or two.  And I'm not talking about twenty-five-year-olds either.  A relative of mine recently had a healthy and very unplanned baby shortly before turning 44.  The baby was so unplanned, in fact, that it didn't even occur to her that she could be pregnant until her fourth month of feeling 'off'!

Why does it seem to happen so easily for everyone I know but not for me?  For most of the ones I've actually talked to about this a little, it quickly became clear to me that it had never even occurred to them that they wouldn't easily get pregnant.  One person close to me even planned her kids' births for a specific month so she could have summers off for maternity leave.  Her first little one very accommodatingly decided to arrive right on his due date, on the first day of summer!  And the second was born almost exactly two years later.  And she doesn't find that at all out of the ordinary.  Why wouldn't you plan to have your kids when it's convenient for you?  And why would think you'd have any trouble making this happen?  This is the kind of attitude I need to embrace!

I'm definitely starting to wonder if trying to do everything perfectly is more crazy-making than helpful.  That photo above shows the teas, herbs, supplements, vitamins and other drugs that I am supposed to be taking every day on the advice of various health care providers.  A few of them I would be taking even if I weren't trying to get pregnant but fourteen pills plus raspberry leaf tea plus three doses of Chinese herbs?!  My doctor says the raspberry leaf tea "tones the uterus."  I don't even know what that means!  And some of these pills and teas are supposed to be taken with food but not at the same time as each other, and some are supposed to be taken hours before or after food.  It's crazy!  I actually contemplated getting one of those pill organizers with the little boxes for each day of the week, and making up a chart for what needs to be taken when.  That's when I knew I'd gone too far!

I realized that I was trying to engineer my life around my meals and drugs and teas and supplements to the point where I was starting to sound (at least in my own head) like an 87-year-old with numerous chronic conditions.  It felt like I was sending my body the message: "Red alert! Red alert!  It is critical that you take all of these things in exactly the right amounts and combinations at exactly the right times or you'll never get pregnant!"  It was certainly not helping me to relax and didn't seem healthy either.  It was like the worst version of a placebo effect: "Hey, if I'm taking all of these drugs and supplements, there must be something really wrong with me!"  After several months of this nonsense, I've finally decided, "This is ridiculous.  No more!"

I still take the four pills I have to take regardless plus the prenatal vitamins.  And I take maybe one additional supplement (occasionally two) or tea each day, if I remember and if it fits with my schedule.  But that's it.  I also exercise regularly, eat my usual healthy diet, and work on trying to minimize stress and on working through my emotional stuff.  But I'm thinking of it all in terms of being healthy overall.  Aside from the prenatal vitamins, most of these I plan to continue even once I'm no longer in trying-to-conceive mode.  Like, when I'm a healthy, happy, well-rounded mom.  I feel less stressed when I stop worrying about whether I'm doing everything I can to conceive. 

Here's my new motto: Boost your chances by making healthy choices most of the time, but let go of being perfect.  A bit wordy, but... gets the idea across!  "Letting it go" has become a bit of a cliché lately, but it's still a good idea most of the time.  I'm sticking with Idina on this one! :)

Sending love and a big dose of sanity to all,
 

E

What Are the Odds?

Are you ready for some creative math?

When I first visited my fertility clinic last spring, the nurse practitioner I met with told me I had a 5% chance of a successful outcome (e.g. taking home a baby) at my age - which was then 40.  She actually took back the paper she had given me earlier, with all of the general information about IUI (intrauterine insemination), and dramatically crossed out the printed 20% and scrawled "5%" above it.  She didn't want me to get the idea that I might be as fertile as someone who had the good sense to come in at age 27 or 33.  A few weeks later, after all of my lab results showed no menopause in sight, she increased the probability to 8%.

Now there are a couple ways you can look at this.  You can think, even if I put some top-notch sperm right up close to my egg at the most fertile moment possible, there's still a 92% chance that I won't be able to have a baby.  Here's what I say to that: unacceptable!   

Let's try again...

Okay, even a normal, fertile, young couple supposedly only has a 20% of getting pregnant in any given month.  According to a lazy Google search, The Bump says that by the time you reach 30, the odds go down to 15%.  The vast majority of healthy children that I know were born to mothers in their 30s, without much effort.  I'm going to embrace this availability bias  and decide that 15% is not bad at all, in real-world terms.  Given that decision, I'm only half as likely to get pregnant as a 30-year-old, right?  53.33% as likely, in fact.  And even if you take my advanced-age eggs into account, which decreases the odds of viability by about half, that's still over 26%.  Which is a happier number than 8%, by far.  Are you still with me?  Who says math can't be fun?!  The point is, look at all the millions of people in the world having babies left and right, many of them unplanned.  And the odds were only 15%! 

Sometimes I think data, facts, statistics, and even reality are overrated.  But if I do consider them, that also means I have to take into account all of the factors that haven't been calculated into that 8% by the medical professionals.  They never asked me about how healthy my diet is or how often I exercise or whether I'm taking vitamins or how much emotional support I have or whether I suffer from anxiety or depression or delusional optimism or anything else.  All of those are bound to have some affect on fertility, right?

When it comes right down to it, making predictions and assigning probability to a particular outcome based on what has happened in the past is a dodgy game at best.  As Philip Tetlock has shown, expert predictions on average tend to be only slightly better than random guessing.  Of course, the kinds of predictions his experts were making (about politics and world events) were different than medical predictions.  But if anything is as complex and mysterious as the modern political landscape, it might be the creation of a new human being.

How many times have you seen something happen that you never would have predicted?  

Just this morning, I came upon a flock of ten chickens in a neighbor's yard.  I've been passing this yard every few days for the last ten years on my neighborhood walks and I have never seen anything other than a stray cat or a squirrel.  It is actually illegal to keep more than three chickens within city limits.  These chickens totally shouldn't be here!  Yesterday, nothing could have convinced me to assign a high probability of finding ten chickens in this spot.  And yet, there they were!

And this: I am the kind of driver who always uses her turn signal.  I could be driving along a country road at two in the morning with no other cars for miles and I would use my signal purely out of habit.  But the other day, I made a last-minute lane change and flicked my signal on only momentarily.  And wham, out of nowhere, a motorcycle cop zooms after me and hands me a $136 ticket for not using my signal.  I'm not gonna argue with the guy, so I take the ticket politely, fuming internally.  But then I thought, "This just proves that crazy, unlikely events can happen out of nowhere even though there is no logical reason for them!"  If annoying unlikely events can happen, then miraculous and wonderful events can happen too.

You just never know.  The world is full of the unexplained, the unexpected, the never-thought-it-would-happen.  Impossible things are happening every day!  Today, whether its realistic or not, I'm choosing to believe I'll beat the odds.

Sending good luck charms and wildly optimistic predictions to all,  
E

Chillin'

I've been surprised by how anxious I feel about sending my thoughts out into the world.  I mean, first of all, I'm keeping it pretty anonymous.  Secondly, I've barely said anything yet.  And most importantly, no one is even reading this!  I am currently talking only to myself.  So, chill out, self!

That's something I've been working on for more than a year.  I went to this Tarot card reader last June, something I'd never done before (and haven't done since!) but my friend invited me, and I thought it would be fun to see what it's like.  It was not very mystical or magical, like in the movies, but she did seem to 'know' random things about me that weren't in the front of my thoughts and that I hadn't mentioned at all.  I did tell her I was hoping to have a baby and wondering if and how that might happen, but didn't give her any other details before she started shuffling the cards.  I started to get nervous as she laid the cards on the table - as if my fate were in her hands!  I don't know what I would have done if she told me there was no baby in my future.  Probably decided she didn't know anything! :)  But she said that she saw pregnancy in the cards (I think she would have interpreted the cards differently if I'd asked about something else but there were three pregnancy-related cards in the future section so I approved!).  She also said it was not going to happen within a relationship but instead through the use of 'tools' or something like that.  And finally, she assured me that I had already done more than enough research and learning and now was the time to "chill."  In other words, stop reading everything you can get your hands on about fertility, conception, pregnancy, etc.  And just relax!  From a Tarot card reader or anyone, that seemed like pretty reasonable advice.  I'm sure I was dripping with anxious energy and she probably would have suggested relaxing regardless of what the cards said.

Of course, relaxing is easier said than done.  And I can only relax so much or I won't remember to purchase sperm, renew prescriptions, take the drugs, give the shots and schedule and show up for all the appointments.  I'm sure relaxing and "not thinking about it so much" is helpful when it comes to the kind of conception that involves a penis and vagina in the same place at the same time, but I've got to think about it or it's not going to happen.  That donor sperm is not going to leap into my uterus on its own.  Still, stressing and ruminating is never a good idea.

I have calmed down considerably since last summer when I visited the Tarot lady.  But I know I've got a long way to go.  I think I'll start by making myself a glass of fresh-squeezed lemonade to enjoy on a beautiful summer evening...

Love and relaxing vibes to all,

E

Hello, Strangers

Am I really doing this?  

Yes, I'm doing this.  Starting a blog to chronicle my adventures in fertility and my quest to become a single, 40-something mother.  Without going completely nuts in the process.

I've been thinking about starting a blog for a long time, as an outlet for all of these feelings and frustrations and anxieties and hopes.  But every month I think, "Well, I might as well not start it now because I'll probably be pregnant next week.  Then what would be the point, right?!"  In other words, me?  Clearly delusional.

So, here goes.  The beginning of an account of all the ridiculous, embarrassing, comical, heartbreaking, awkward, painful and, let's face it, pretty undignified moments along the path to having a baby.  (I was going to say "I hope" after that.  But no, I'll leave it at that: to having a baby.)

Warning: I'm planning to share all kinds of TMI here so be prepared for some pretty blunt talk about things that might make you crinkle your nose and say "Ew!"  As supportive as my loved ones are, I've seen that look when I go too far.  This will be my place to spill the details, safe among strangers.  There may also be some talk about sex, faith, politics, death, money, and other opinions shared that I'm sure many potential readers could disagree with.  But isn't it more interesting when we don't all share the same values and views of the world?

So, this brings me to the subject of anonymity.  In order to feel like I can say anything here, I'm going to try to remain fairly vague about who I am in the 'real world.' I'm going to use just my initial and not my name, at least for now.  Not that I suspect my co-workers or neighbors are going to stumble on this blog.  But, just... you never know, right?

So, until next time, sending love and good wishes to all...

Love,
E