unfoldings

And I'm not talking about my winter sweaters, although those are frequently unfolding as well these days. We had a very short mini blizzard today, much to my delight. I am one of those silly Canadians who actually loves snow. Winter is on its way. Hello, cross country skiing.

There has been some progression since our return from vacation, both on the adoption front and on the fertility treatment front. We have actually completed our home study at this point. Our lovely social worker Gretchen has been to our house twice since our trip and we were able to wrap things up this week. It's just as nerve wracking as some of you have described in your posts to have the adoption counselor come over to the house. It was 2 days after returning from Cuba, and one day after starting my new job. I was frantic, but also reached a point where I had to let it go because there were too many balls in the air at the same time. The house was clean enough.  She noted a few things we need to take care of before a child can come into our home like cover the outlets, deal with the blind cords, secure some of the bookcases to the wall, but otherwise, she didn't write us off on the basis of an unkempt domicile. We like Gretchen very much and feel like we are in good hands with her. The next steps in the adoption process, given that we've completed the home study and done the parent training is to register with the private agency we have chosen, as well as some licensees in the region. We are not quite ready to do that yet, given what is happening on the other front.

Mr. A was anxious about having kids for a while in the fall, but he assured me that this anxiety didn't mean he wanted to call the whole thing off. He was in a slump, something I can relate to since I have found myself in various depths of slumps at different points in my life, and with offending frequency in the last 3 years. I can't say that at the time I was completely reassured. Maybe because I am still in slump territory myself, maybe because it's hard to trust that good things will ever happen, or maybe because that doesn't negate all the work we still have to put in to hope to become parents, but, you know, I didn't jump for joy when he said that. I just took it in quietly and thought "ok, then we'll work on our options."

The funding was a big issue for us, since it is not the kind of money we can tackle ourselves at the moment. Parents on both side have the means to help, but it was a question of stepping on our pride and asking them. On either side, we are the significant hope for bringing grandchildren into the family, as I am an only child and Mr. A has only one sibling who looks like he may not procreate. So, the answer was how much do you need and when do you need it by. That was a relief, a blessing. We have been in touch with the DC practice and even had a phone consult with the doctor on Tuesday morning. We are in the process of booking a time to go down for our one-day visit to the clinic for early January.

There is so much more to write here, but the clock has struck the 12 strokes of mid...(well, it's actually 9:40pm) and I am about to turn into a pumpkin.

Sending warm congrats to Roccie who has just welcomed little baby Jay.

Green Light

It's been a whirlwind since coming back from the trip to Seattle and I haven't caught up on all your news yet, but I have gleaned some of the main headings. I feel really sad for Roccie, for R, for Adele, for Lady Pumpkin and for Foxy. Their recent attempts at conception failed. There is no rhyme or reason as to why those valiant attempts failed. There rarely are good reasons, are there? Just shitty IF. That's all. Women, I hold you in my heart, hope that your next steps to motherhood lead you exactly there.

On the heals of our trip to Seattle was a trek to fertility treatment town for our follow-up appointment with Dr. RE about the egg donation. That was yesterday afternoon. As much as I ruminated about it last week, I did not feel nervous about it yesterday. I was just happy to spend time with Sattva. I like our treks over there because of the time it affords us to hang out. A 3pm appointment meant that the waiting room was empty and our bubbliness went unnoticed by absent somber patients.

The exam rooms are arranged for couples, and like I noted last time, it ill fits a group of three. Mr. August sat on the Dr.'s chair, and I wondered how that would go down when the doc walked into the exam room. Dr. RE showed me he was cooler than I thought by just sitting on the exam bed in a relaxed position. His poor intern however, just stood there by the door.

There seemed to be confusion at first on his part as to why we were there, as if he believed our decision had not been made and we were coming to tell him yeah or nay. It turns out we were expecting the same from him. He came out with it rather quickly that all things are well lined up for the egg donation. From a medical standpoint, Sattva is a good candidate to donate eggs. Her CD3 FSH levels were within normal, she had good antral follicle count and everything else seemed fine. He explained the risks to her and we talked about the time line. It looks like January or February is when this will happen. First, there are a few appointments with the psychologist, as well as an orientation for Sattva and I. Before the appointment ended, Dr. RE said we needed to settle the matter of how many embryos to transfer. This discussion seemed to make the intern laugh, which was nice. The last intern was really stoic, so it was nice to see some humanity. He said he would be willing to transfer three, but he wasn't a big proponent. He preferred 2, unless we were firmly opposed to twins. He thought one was conservative, which was what I thought as well. So should there be 2 viable embryos, 2 will be transferred.

A complex mixture of emotions is what I'm contending with this morning. I am excited and hopeful. This could work. Egg donation works. Not always, but it does. If it does, we will not only have a baby, we will also have created a new family. There will be a cousin for Sattva's children and bond between our families.

I'm also apprehensive. I feel like we have just met the height requirement to go on this gigantic roller coaster ride. Now we must go wait in line to get on and then the click of the safety harness will sound in our ears, and we will be off. Who knows in what condition we will come out of this ride. With any luck, one of us will come out vomiting.

Before the discussion with Dr. RE came to an end, I wanted to be clear on whether it was worth putting Sattva through all this; whether the end justified the means if you will. If he told us he thought the chances were pretty slim, I would for sure want to call this off. I wouldn't want her to go through this for a total shot in the dark. His answer, once again, pleased me. The word 'worth' caught his attention and he replied by putting much emphasis on discussing the worth of the endeavor.  He seemed humbled by the phenomena of altruistic egg donation (um, yeah, me too) and felt that it was worth it. He admitted to having gone through with the egg donation protocol with donors much less reproductively fit. He didn't go as far as saying it looked promising, but the three of us felt by the end that he thought this was a good idea. He's been doing this for decades and we feel that we can trust him on this.

So egg donation is a go.

The infertility clinic waiting room

What a phenomenon that is, the ol' clinic waiting room. A funeral face is required and eye contact is strictly prohibited. If you must speak to your husband (and you may only speak to him if you absolutely have to), you must do it in hushed tones, gaze averted, and a hand over your mouth would really be best. No talking is allowed, otherwise. Enter Augusta, Mr. August and Sattva (from Bodhisattva, aka our donor), an unusual constellation for the fertility clinic waiting room. Oh wait! They're breaking all the rules. They are chatting lightly about New Zealand. They are laughing. They are looking directly at each other!!! Chaos ensues.

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I'm sorry that the update from Friday did not come sooner. The weekend was filled with social events, which tend to tucker me out. Each chance I got, I sat on the couch, drank warm fluids and read the Globe and Mail, before having to go back out into the world and socialize. But I've been thinking of all of you very much. I look forward to catching up on all your news. Here's the report from our appointment on Friday.

I continued to work myself up for the appointment, although that being said, I was managing my nerves pretty well with a great game plan my therapist and I devised. I once again found myself calling on all of you. I had remembered that the night before, thinking that you would be there with me and I could draw on that for strength. As soon as we reached the floor of the clinic in the hospital, it was like you were all waiting for me when the elevator doors opened. Thanks women!

We picked up Sattva at 6:30am and drove to IF-treatment-town for our 8:30 am appointment. Sattva had to do all this paper work when we got there, but we still managed to shake up the waiting room, as per my introduction. I was called first for my sonohysterogram. I didn't like it one bit. It hurt pretty intensely, although it subsided after a little bit, even while the saline was still in there. Dr. RE said that my uterus looked good, except for a curve at the top. He said that if I had a history of miscarriages he would want to do a hysteroscopy or laparoscopy to check things out further and possibly work on that curve. However, since I don't have such a history (and with no eggs, how could I?), he doesn't feel it is curved enough to warrant that kind of intervention. I'm inclined to concur with him on that one. We agreed that surgery was not the way to go, and that we would go with the higher probability that this curve will not impact negatively on a potential pregnancy.

The three of us were then invited to sit in an exam room and wait for the doc. Sattva immediately commented on the waiting room experience. In a way, it was nice to share this whole fertility clinic scene with a good friend. She now knows what it feels like to be there without my need to describe it for her. It was also at that moment in the exam room that this all became very real. I just took in the fact that all three of us were sitting there and working towards the egg donation. The doctor came in with a student and thanked Sattva for being here. He went through her history and her family's history, and then reviewed Mr. August's family history. He gave her requisitions for blood work, some to completed that day, and another one for cycle day 3. And then she was brought in for an ultrasound and we went back to the waiting room, where we continued to break the rules by talking and looking at each other.

She came out and we left, heading downtown IF-treatment-town for her blood work. On the way down, she said that her ovaries were full of follicles and that Dr. RE thought that was very good. That was very good news to absorb. Plenty of follicles. Wow!

I am still so awed that she wants to do go through this egg donation process and wants us to use her eggs to bring a child into the world. I cannot find the right words to describe my gratitude. We gave her a little card and a bottle of wine from our trip last weekend as a token of our thanks. But really, how can we thank her? I feel so grateful to her for even just considering the egg donation, let alone starting the process.

I have more to write, but my dissertation awaits. Thanks for reading and for being here with me.

 

Next Stop: Egg Donation

I have not talked about IF treatments since the update on our appointment of August 19. I think I've been avoiding thinking about it, and instead chose to stew over it because that feels so much better (!).

We have our next appointment on Friday, September 17. For that appointment, our donor will come with us to the clinic and will meet with our RE by herself. We will also meet the three of us with the RE to discuss all the steps involved in the egg donation. And of course, our donor will be treated to the magic wand, and I will have the sonohysterogram.

I believe that this appointment will make the prospect of the egg donation very real. For now, it has been hypothetical, with some brief moments of realizing that it was part of a shared reality among a few people who know. I think it's mostly when I hang out with our donor (she is a good friend of mine) and we speak about it that it becomes very real. Her resolve astounds me. There is no amount of scaring her with descriptions of needles and early morning drives. She is steadfast. She wants to do this.

Why has it been so hypothetical for me? We all know the answer: it is because of fear. The reckless prospect of hope is prohibitive to us who have failed at fertility treatments. Why would this work? Why would there be a baby in my uterus at the end of this process? I've come to understand my decision to go ahead with the egg donation as prevention from wallowing in regret in 5-10 years, when I sit there childless and feel like there could have been so much more I could have done. I do not want to give myself more ammunition to be beat myself down for not trying hard enough.

I find my heart cloaked in an opaque, velvety wrap that seems at once comfortable and smothering. The cloak becomes visible to me when I talk about the egg donation with my close friends and they light up with excitement and hope. All I want to do is run my hand gently across their face to make the excitement go away, like a mime changes his face by the brush of his hand. Thankfully, I happen to have the best friends in the whole entire world, so they can hold me in my fear of hope. My darling friend Dragonfly just looked at me lovingly from her little skype window on my mac and said "I'll be excited! You don't have to be excited. You can give that part to me". Bless her heart. That was just what I needed.

I thought about this potential baby on my walk to school this morning. I think it as a girl. I gave her a name and thought about carrying her for 9 months. I usually can't envision it. Like Jess talked about in her post, I have had mucho problemo visualizing this process coming to fruition. I am of the same opinion as she is, that for something to materialize, one must first create it in the mind. It makes me nervous that I have difficulty believing this will work.

I realize that my history does not permit me to believe in pregnancy very much. Never having ovulated, never having had a pregnancy scare when I was younger, let alone a BFP, it has become fiction in my mind. I had all sorts of hopes and dreams about being pregnant until the treatments failed last October and since then nothing. My unconscious doesn't really let those images come to the surface in the form of dreams, by day or by night. But I also find as I am reading your blogs that I am missing something so fundamental that most of you have: a cycle of some sort, a history of at one point having ovulated, an experience of early pregnancy, or something along those lines. In my case, it will be this friend's egg mixed with Mr. August's sperm, inserted into my (tiny, chronically under-stimulated) uterus, and a whack of estrogen and progesterone support. And from that, a baby is what we hope for an outcome. My logical side can't digest it very well.

What is left is that there is also part of me that knows it can happen. I have always responded to estrogen and progesterone, and for my last cycle at this time last year, the lining got all nice and thick, ready for an embryo. So through magic, or miracle, or the best of science, there is part of me that believes it could be successful. I just wonder if that is enough. Do I have to leave the safe platform of my fears and leap wholeheartedly, believing unequivocally that this process will work. Is it reasonable to be afraid, and does being afraid mean that it will fail? Ah, the superstitious workings of an infertile's brain. I tell ya.

The August appointment

I had hopes about today. I was hoping it would go well. Just that we could go to this appointment, that I could avoid being completely stirred up like a snow globe, and that we could get news that would make me feel like we are going forward. I'm pleased to report that this was accomplished.

First, I had of course written down notes and questions to ask Dr. RE and when we were waiting in the exam room, I had narrowed it down to 2 categories: discussing my current hormone dosage and discussing egg donation. Dr. RE walks in, looks at us and shakes our hands, and then says: "You are here either to discuss the hormone dosage or egg donation. Which one is it?" "Both", I said, "which one should we start with?" He picked the hormones, which is how I had it laid out in my book (and he wasn't reading it!)

I've been feeling for a while that my estra.ce dosage was too low. Remember from an earlier post that my body does not produce LH and FSH, hence, does not produce estrogen and progesterone. So, I'm completely dependent on meds. You will also remember from my February post that he wanted to know at the last appointment if my mood was very low and could that be related to lower than optimal levels of estrogen. Well, I was in fact quite grief stricken still at that point, and really, let's call a spade a spade, I was depressed. But I couldn't really tell if it was the estrogen, because I've been depressed before while taking the bcp, so I couldn't parcel it out. But lately, I've been thinking I shouldn't really be feeling THIS crappy ALL the time. Again, it's not only the estrogen, but coupled with word finding problems and atrociously low sex drive, I was thinking maybe there was something to do. I didn't even need to tell him that. He just said "Oh, if you think it's too low, it is too low. We'll up it to 3mg and then 4mg if you need". I liked all that trust he gave me.

Then came the egg donor topic. Dr. RE is quite unflappable (perhaps one needs to be after working with infertile couples for decades...what with all that affect from patients), but I think in his range of expression, he was positively psyched to hear we had a donor. Ok, the cues were very subtle. He says we need to have an appointment with me and the donor to discuss it with her and start the testing. He want me to have a sonohysterogram to look at my uterine cavity. He thinks we can all do that in the same appointment (the hospital is a 90-120 minute drive from where we live). He explained that the rates of success are not those found in the literature since those data come from US clinics with strict criteria for donors. He did not say she was too old, but instead thought that the age of her last child presented as a good omen for her fertility. He did explain that she could be running low on her reserves, but that of course, we won't know if we don't try. He reported that they will attempt egg donation with donors who are 38.

Dr. RE also assuaged my fears about sustaining a pregnancy by explaining that supplementation with estra.ce and pro.metrium during the first trimester would sustain the pregnancy, and that after that, the placenta would take care of it. He said that without the meds, I would not be able to sustain it because my ovaries would not produce the estrogen and progesterone needed while the placenta develops, but that the medication would suffice. And then he said something that pleased me. He said "You're a healthy woman, so I don't see why you couldn't carry the pregnancy". For someone who visited death's door (when I had anorexia), being told I am healthy is really, really lovely. I take so much pride in my red cheeks, and love when my health is recognized. I have worked so bloody hard for it.

One last thing before I close and go hang out with some wonderful women friends. When I arrived at the hospital, I was starting to get the feeling of being overwhelmed. The environmental cues, the nervousness about the appointment, the coffee, were all contributing to a sense impeding doom. However, I went to the bathroom and once I was alone, I noticed that I was starting to feel off my centre. (warning: I'm about to get a bit sappy). And then I thought of all of you. And I felt your presence with me. I thought about Bunny having her IUI. I thought about Kelly's appointment at 11:30. I thought about what you have all gone through in the land of IF. This comforted me greatly by making me feel so much less alone. Thank you so much. Thank you to you who read my thoughts, and leave a comment or even those who don't leave a comment. Thank you for sharing your story and allowing me to share mine.

Anticipating Tomorrow

Tomorrow at this time, I will be driving to our appointment with the RE. As some of you know, the reason why we are meeting with the RE is that we need to discuss egg donation. A donor came forth in June, and we need to see whether this is possible.

It's difficult for me to feel positive. I wish I could. I feel like this process deserves my positive thoughts and feelings.

At the moment, all I am thinking of are the road blocks that would stop us from going ahead. Here is a sample of what goes through my mind when I think of the ED: 1) The donor will change her mind, 2) The clinic will think she is too old, 3) my RE will reveal that since the gonadotropin stimulation did not work for me, the egg donation will not result in a viable pregnancy 4) we won't be able to afford it in the end, 5) I am a complete and utter failure in every way including becoming a mother.

Ok, I agree, the last one is too harsh. But numbers one through four are worthy of my worry. And I guess the only way to assuage those worries, OR to confirm them, is to go to the appointment and discuss it with the one who has the medical degree and the decades of experience getting infertile women pregnant.

The other part that worries me is this one. The last time I went to the clinic in February (read about it here) it rattled me a great deal. It was the first time I returned after the last and final cycle, and not surprisingly, I had a huge emotional reaction. Tears are fine with me in general. I also encourage them in others, every chance I get. But somehow, crying when I'm required to be coherent and put together fills me with shame. I can just hear my mother yelling at me to get it together. So with regards to tomorrow's appointment, I fear what going back to the clinic will do to me. The added piece is that the hospital in which the clinic is located is where I did my residency. And that was such a great experience for me, and I haven't been that happy professionally since. So, there are losses associated with that place.

But chin up, Augusta. Remember this is hopeful. There could be a baby waiting for you at the end of this road.

Magnanimity and the grateful heart

A daily entry is something I strive for, but I have not reached cruising altitude on that goal yet. This mirrors where I am with my work. I have been working full time on finishing my PhD dissertation since July 19. I was trying to finish it part time while I was working since September 2009, but that did not get me very far. With the failure of our fertility treatments in October and the job, I did not have much left to give to the ol' dissertation. I quit said job on June 30, which I would describe as one of those 'I'm going to be on my own team' sort of decision. I'm very good at taking care of a lot of people, but it's taking good care of myself that I'm working on at the moment. So, I haven't reached my cruising altitude in either my blog entries nor in my dissertation work. And here is what I am trying to believe about that: It's ok: I will get there.

Before I get back to my statistical analyses (which are fun actually, as hard as that is to believe), I wanted to just share a dream I had last night. It is kind of fuzzy at this point, but it seemed pretty vivid when I woke up. In the dream, I had gone through the process of egg donation. The dream involved the minutia of every little step needed to go through it. I don't remember exactly what it involved, but I remember there were many, many steps. And then, it was over! I was pregnant. And really, really, really scared of having a miscarriage. I was scared to move or to laugh or anything. I kept thinking that a simple sneeze would take this gift away. And then I woke up.

I guess as we go ahead and plan for the egg donation, my mind is trying to wrap itself around what it will entail. I met with my friend who is offering to donate eggs this week and she is still fully on board. I was glad to meet with her and glad we had a chance to talk further about the donation. I feel so afraid of taking something away from her that is essential to her vitality. It's a big fear of mine that the treatments will make her uncomfortable or ill, and that she will be diminished by the process. She is such a beautiful, beautiful person. I wouldn't want anything, least of which something she does for us, to take away from who she is. So, as we talked I started crying, of course, and said it was too much to ask of her. And in her kindness, she said that I never asked and that she wants to do this. She explained that there are so many ways she would like to help the world, like volunteer in third world countries, or take in foster children, but that she feels she can't do those things (She's a professional and mom to 2 young girls). She said that donating eggs is something she CAN do to help the world, and help us.

Wow. That's a generous heart.

Because of my early history, I have always had such a hard time with needing something from another person. Egg donation is confronting me with this challenge in such a significant way. I need something that another person has and can give. And I won't be able to give something back to her that is commensurate. And I just have to let that be. So. Hard.

If hers is the generous heart, mine must be the grateful one then.

I guess I'll work on that when I'm taking breaks from my dissertation.

phoned it in

I have had a few posts running in my head, but couldn't quite put them down. One of the posts I was writing in my head ended up in my journal, which is ok. I may still write about that in sort of a top 10 list of worse things to say to an infertile woman. I had 2 doozies in 1 day last week and I was a bit stunned by it.

Today, I would rather leave this a complaining free zone and instead, talk about the brave step I took. I phoned the infertility clinic to make an appointment with our RE. Sounds quite banal, doesn't it? Except that the reason we want an appointment is that we need to discuss egg donation. (pause). (deep breath). A donor has come forward.

In the US, egg donation can be arranged through anonymous donation or altruistic donation. In Canada, it is illegal to pay for gametes, hence sperm and egg donation are more complicated. Egg donation is mostly done through altruistic donors, with a few Canadian agencies appearing to have found loopholes around the legislation and providing eggs through I'm not sure what means (I think some work with US agencies). In any case, a trip to the US for egg donation would be upwards of 20k and folks, if I hadn't mentioned it before, I'm still a grad student (but hopefully not for long) and Mr. August is an organic farmer. So despite the lure of young American eggs, the price is outside of what we can reasonably afford.

So, altruistic donation has been the one option that wasn't completely shut close to us yet (yes, I guess anonymous donation in the US was also not completely closed, if you count winning at the lottery or begging our parents to part with a good segment of their life savings as viable options). This past year, two of my most beloved friends have offered to donate eggs when hearing about the failure of our fertility treatments. Their offers touched me so deeply and taught me about what generosity means. Both offers were most sincere, but in each case, circumstances made the potential to consider the egg donation difficult.

Yet in early June, another beloved friend (Have I ever mentioned that I am blessed with the best friends a girl could ever dream of?), upon hearing of our "last option", very seriously and wholeheartedly said that she wanted to donate eggs. Several discussions later between her and her husband, between me and my husband, and between she and I, we are ready to take the preliminary steps.

I have been very fearful of this next step. I could have called our clinic 3 weeks ago and didn't. Instead, we went canoeing and I put off the phone call.

The risk of hoping looms large in my heart.

Am I ready to get back on the roller coaster? Am I ready for the potential failure of yet another infertility intervention? I'm not sure. But much like Jess wrote today , there is an imperative to keep hoping.

I made the pone call, anyway. Mr. August and I are going on August 19. I like that date. 19 is a great number for me.

I want to write more about this but my brain is shutting down. I was up late last night dealing with my kitty who got sprayed by a skunk.