I have not abandoned this!

I am on vacation this week!!!! yippie for me but not so good for this blog because I am reduced to typing with 2 fingers and I am falling to the mercy of autocorrect.

I had an experience this morning that made me happy I wasn't a mom. Got to the airport about an hour and a half early. Security line was so long that the had to pull me out along with the other 6 am flight passengers got pulled to the executive line. Ended up sprinting to get to my gate and get on with the final boarding group asthma wheezing and coughing in all!

I never would have made it if I was pregnant or carrying a baby. So thank you silver lining.

I still don't know if injectable cycle 5 worked or not. I feel pretty good so it's probably a no go. I'm being a good girl this time and not checking until the two wk mark. But it's also so it will not ruin my vacation with the hubbie.

Will post more when a keyboard allows!

week one of distraction - done

I feel proud of myself - I have successfully distracted myself into not thinking too much about this cycle.  This of course will change as the days progress, but between taking call tomorrow night, giving a lecture thursday - probably sleeping straight to friday and then leaving town for the easter weekend - I may do okay.

Even in the face of 2 new pregnancies announced by friends in the past week - I am holding my own.  Floating, looking up at the sky instead of working to tread water.  I hope it lasts.

life's little lesson

I decided not to make a big deal about my birthday this year.  I just wanted to be surrounded by people I love and not advertise it.  I took my birthday off facebook, didn't mention it to work people and just kept quiet about it.   It wasn't a test of who would remember, but it was special to see how those close to me wished me a good day.
SO here were the best gifts ever:

My sister came to visit all weekend
My best friend called me with her girls and tried to get them to say happy birthday (but the 5 yr old got shy)
My husband came home post call, made me a cake, arranged a dinner, ate sushi which he abhors and stayed awake through it all (about 40 hr in a row)
My dad called me and sang to me
My boss sent me an email (and took my pager call)
My in-laws took me out to dinner when my hubbie was working
My aunt wrote me a poem
My other aunt called me and told me the story of my real birth day
My nurse brought me cupcakes

I just loved that everyone important to me was a part of my day.  I feel very special and full of love.  No matter if the wish I made comes true (especially since it was the same wish as last year) I should be nothing but happy with the amount of love in my life.

oh Martha . . .

One of the thins I do as a distraction is crafting.  You name it - I try to make it.

I have always had a little bit of a love/hate relationship with Martha Stewart.  On one side - I want to be her.  I can think of nothing better than living my life being an expert at everything for the home and sharing it with the world.  On the other hand though I find many of her recipes overly tedious and directions for crafting unnecessarily difficult.  (And I am someone who knows a thing or two about cooking already.)

As part of my personal therapy sessions though I spend a little time with the Martha Stewart show several times a week.  Except for the occasional craft for a baby or the "baby shower show" - (which I just outright deleted), she is remarkably devoid of pregnancy and babies.

That was . . . until her grandchild was born.  Apparently she has found her new inspiration and feels that she needs to mention it on each show  UUUUghhhh.  So much for my lack of baby time.

Thats okay. . . Nate Birkus - you are my new TiVO friend

even further proof that fertiles don't know we exist

So I went in for the insemination yesterday at an odd time.  We went when my husband got off work, and when you work 36 hr in a row that can screw up an insemination schedule - instead of the usual 8am IUIs, this was 2pm.  

Yes I had to wake up at 2 in the morning on tuesday to shoot up the ovidrel for a 2pm insemination

Yes the team came in for me at 2 pm when they only usually work in the mornings and Yes I am very thankful to them.

But as a side effect to the odd timing I got to wait in the waiting room during the midwife clinic.  Boy was that fun.

pregnant woman: "Excuse me . . . is that the blah blah blah diaper bag?"

postpartum woman: "well yes it is"

preggo: "oh my goodness - do you mind if I take a look inside? . .. wow its so wonderful"

preggo numero dos: "your baby is so cute"

grandmother: "oh thank you"

preggo #2: (baby talk insues and then preggo #3 gets in on it too)

receptionist: I'm sorry I don't see you in our system

rude preggo" well thats because I changed my name"

receptionist "Can you please go down the hall to get that changed with registration"

exceptionally rude preggo "I already did the last time I was here"

receptionist "well I don' think it went through so I am afraid I am going to have to ask you to go try again"

really rude preggo: "don't they know who they are dealing with?  I am full of hormones right now and going to get angry"

You wanna talk about full of hormones ... yup thats me.  And if only I didn't work there and could have potentially be delivering this woman's baby in the near future, I would have layed into her like hot knife into butter.  There is no excuse to be rude to the receptionist - She is a nice woman who is jut doing her job.  But I refrained. 

I was so happy when they finally called my name to get out of that waiting room.

Unfortunately of course I was being led into a room and I almost ran into one of the perinatologists.  He looked at me, recognized me and hurried out of the way like he wasn't supposed to see me . . .why?  Because what ever reason would I have to be a patient during the midwife clinic.  

Yup.

The rumor about me being pregnant will spread before I even am.

Fabulous.

thats okay - will all be worth it when I pee on a positive stick - and at least everyone else will know before I do.

2 eggs - check, millions of swimmers - check, pregnancy - check?

Okay - its in . . . . should I feel different if it worked?

I'm exhausted.  (But I think thats because I've been working too much)  I'm nauseated (but I think thats because I am eating too little on this diet).  I'm hormonally emotional (but I think thats my new baseline).

Am I pregnant?  Time will tell.  I am trying to think positively about this cycle.  My husband was there today for the potential conception - maybe it will work because of that.

And now we wait.

Eye of the Tiger

I am raring to go . . . ovridel is in . . . insemination tomorrow.  I'm like Rocky - running up the stairs with the sweatshirt over my head - eye of the tiger playing in the background - I'm ready for the big fight.

But I also feel like I already got beat up because I had to strong arm my REI into putting off the IUI by a day.  (husband couldn't do it today and they wanted to push it up instead of back.)  She was afraid I would ovulate first and miss the window - I really wanted a second follicle out of it.  (They're both on the closed tube side anyway.)

We have a saying in medicine about patients when "they know enough to be dangerous".  We generally refer to this when we are talking about patients that dictate their own care in a way that we would not recommend.  Generally this is a person who is intelligent, educated in a non-medical field and has their own ideas about exactly what should happen.  I'm not talking about people making educated decisions after talking with their physicians  - its more like husbands who want to deliver their own babies at home because they read a book on childbirth and saw how to do it on you tube.

Some people trust Dr. Google more than their physician.  There is nothing wrong with searching the internet and trying to gain education.  Goodness knows I've learned a lot about infertility from blogs and websites written by the people that have experienced it first hand.  But if someone is coming into my office I am tayloring my education and counseling to that persons specific problem.  Google gives the same information to everyone - and most of it is not quite accurate  - and some of it is just plain wrong.

Maybe its just me but I love it when patients come in with a list of questions that are burning in their head after their online searches - it gives us lots to talk about.   But I think we as physicians universally hate it when we feel that a patient is dictating their care in a way that we feel is unsafe.  (no sir  .. . I would not recommend delivering your baby at home . . .yes I understand you took an infant CPR class already but I am concerned for your wife and child's health because if something goes wrong it could be bad)

So I am wondering if I am being one of those people?  The poor infertility doctor literally has less time in practice than I do.  I was also quite a precocious medical student and resident when it came to infertility because thats what I thought I wanted to sub-specialize in.  (turns out I'm more of a surgeon and I was too tired after residency to keep going).  So in short, I know a thing or two about infertility - but of course I don't know nearly as much as she does.

I have had 5 cycles to figure out follistim.  She has had hundreds of cycles across many patients.  Who am I to tell her that I think the timing of the IUI is off or that I think we would do better if we waited longer.  I am to an extent dictating my own cycles.  Fortunately she is willing to listen to me and I her.  If she tells me strongly to do something I will do it.  I just hope I am not a pain in her rear and I also hope that I am not screwing myself.

I saw someone different yesterday because my RE is out for a week.  Someone who I went to residency with and who I like and respect.  I think she was seriously internally rolling her eyes at me for coming up with my cockamamy plan after dissecting the stats about ovulation timing and sperm survival from my infertility textbook from yesteryear and how that overlays and interacts with my husbands call schedule.

Does this make me crazy?  Partially.  Does infertility in general promote some degree of an anxiety disorder  - probably (but thats another post).  In the end though, I have to be happy with the decisions I made and how I prepared for the fight.  When I step into that ring tomorrow - win or loose I will at least know that I am ready.  There is something slightly empowering about it during an experience that has taken away all control.  Most of all though - I hope I am right.

further proof that fertiles don't know we exist

There is some benefit to going to an infertility clinic that is only an infertility clinic.  Unfortunately I go to a regular large practice OBGYN clinic that has ovulation induction in the mornings.

So this morning I am waiting for my sono with about 5 other infertiles.  I know this because there are only infertility appointments from 7-8.  Several people are carrying little white bags, some husbands come in and disappear for 10 minutes before joining their wives.  We all know the receptionist by first name and talk to her about her new puppy.  But everybody is quiet.  We don't talk, just sit there and looked pissed off but with the quiet recognition that we are all in the suckage together.

Today I was waiting longer than usual.  (seriously screwed up my entire day but thats besides the point)  So I got to be there as the regular obgyn patients came in for their appointments.  Apparently this was new ob day.  A woman walked in with her partner, clearly excited and asking all sorts of questions. . .  "They're going to do an ultrasound right?  Will my primary care doctor get a letter from this clinic about my pregnancy?  Oh my gosh . . . I can't believe my insurance didn't authorize my new pregnancy visit."

 Then the next woman walks in with what appear to be her 3 year old daughter and her mother.  "See honey, this is where we came when you were in my belly and today we get to see the new baby.  Aren't you excited to see your sister or brother?  Yes you are!"

So for all you new preggers - Please just keep your mouth shut.  Health care providers are required by law to protect your privacy - people should have to keep their voices down no matter where they are if they are around other people.  I'm glad you're excited but don't rub it in - even though you think the world is revolving around your uterus.  Do your part to keep your own privacy.  I really don't want to know - I just want to get probed and leave.

But alas - to them I don't exist.  Thanks.

human fecundity stinks even worse with 1 tube

and the sono says . . .
 2 follicles on my right (closed tube side)

darn it

oh well.  20% of ectopics occur on the opposite tube from ovulation so if you combine the 20 percent fecundity to the 20 percent tubal crossover with the fact that there are 2 eggies gives me about a 8 percent chance for the cycle to be successful.

this stinks.  I hate numbers today.

The joys of estrogen

Seriously I have got a lot of hormones going on.

This is the time in the cycle where I actually feel good!  Sure I have twinges of pain, but I am not a crazy person for once and physically I feel close to normal - even the depression seems to have started to lift.   Some people say that progesterone gives them a sense of well being  - not me . . . hate it because I am a basket case and I cry too much.  Its the time when I have my follicles producing so much estrogen that I actually feel normal, plus my shirts look good.

This makes me realize a few thing about my future:

1) PCOS gives me lots of unopposed estrogen - which is why I characterize this as "normal".  This could be dangerous long term if I keep my uterus (endometrial hyperplasia and cancer and such) . . . but after I'm done with it . . . cest la vie. (crystal ball says hysterectomy is in my 40's)

2) This also makes me realize - menopause will suck.  I don't think I will deal with it well - especially since I am not dealing with this very well. (but I guess I will get a trial of that when I hit IVF-land.)

3) I will have a great rack when I finally get pregnant.

Tomorrow I get to see how many follicles are really putting out this much estrogen.  Lets hope not too many!

birthday present

My birthday is coming up is a few weeks - I'm asking for a dog.

I've wanted a dog all my life but could never have one because of my dads allergies followed by a long series of rental properties with "no animal" clauses.   So we finally have our own place with enough room for a four-legged furry friend and we were planning on getting one as soon as we moved.  But then we thought it might better to have a baby first  . . .so we have been waiting . . . and waiting.

So I am done waiting - I want a dog and I want one for my birthday.  Its not like I have to wait to conceive one and deliver one - there are thousands out there that need a good home - and I could be a good doggie owner.   I've been looking on local rescue websites and I've found some great dogs out there and showing my husband. I don't think he's got the hint yet . . .but I am working on it.

So I am hoping and finger crossing.  Maybe I can be a mom in the near future after all.  I know it sounds rash because this is the first time I have said something but we've actually been planning it out for a while and its time to make it happen.  Yes its a substitution, but its the only one I can think of that will actually act like a substitution.

sono update

several little follicles this morning - nobody is owning up to dominance.  I am thinking left (good side) thoughts so I tried to be very liberal today.  Don't know if it will work but I am aiming for hippie zen.

practice makes perfect

I think I am finally getting good at the injections - I used to have bruises covering my belly but lately we seem to have found the magic spots that don't bruise and don't even hurt.  I am finding a happy medium with ultrasounds - helps that I now have 4 cycles of history to show how I have responded.  I've developed a little schedule to remember all my meds regardless of subQ vs oral vs vaginal routes.   I have even learned to ignore the cyst pain.

Dare I say I am getting good at this?  Dare I say that practice makes perfect?

We shall see if it is all working on tomorrows sono.  Theme for this cycle is "if at first you don't succeed try and try and try and try and try again."

Taxes

Why is it that people with kids have all sorts of tax breaks – what about us infertiles?

I am seriously spending more money on infertility treatments than most people spend on their kids and when we hit IVF-land It will be like paying our future embryo’s way through college – without them being any smarter for it or even a guarantee that they will even exist.

I am dumping money lots of money into the local economy.  I am supporting the jobs of multiple doctors, nurses, andrologists, office people.  The government should thank me for my generous hemorrhage of more money than I have ever spent on anything other than my house.

I just did my taxes and finally fell into the tax bracket entitled "totally screwed" which is really good because it is the first full year of a real income in my life (so I can finally afford this stuff), but bad because we got hit hard.   The problem is that we hit a little level called the alternative minimum tax.  I calculated it out earlier this year that if we had to do 2 cycles of IVF and we could fit them in before the end of 2011 that we would hit the minimum amount of medical expenses needed to deduct it on our taxes.  When you are taxed at 42% rate between state and federal, this return on IVF expenses is thousands and thousands of dollars.

Enter something I didn't consider (since I am not an accountant and doctors are terrible with money) the Alternative Minimum Tax.   I thought this was only for rich people, but not only did it keep us from deducting thousands of dollars we both spent on medical licensing and board certification, stopped the ability to deduct interest on our six-figure student loans but it also increases the minimum for medical deductions by more than we will be able to afford for IVF. 

I thought I was being smart about all this, but obviously there was an epic fail in my analysis, so don't take anything I have said on this blog too seriously.

Oh well, nice to know I am getting screwed by taxes so I probably did them right.  And for me getting screwed has never amounted to any bundles of joy so at least there is no change.