Fertility: A Spectrum

This topic has been on my mind and bugging me for quite some time, but it's kind of hard to put into words. I'm going to try anyway, because I have nothing else to talk about these days.

Fertility and infertility initially seemed like simple ideas to me: fertile meant able to get pregnant and infertile meant not able to get pregnant. In my head, this was just a yes/no, either/or kind of deal. But I've come to learn that it's really not like that at all. Fertility doesn't start and end with the flip of a switch. At first it seemed you're either on this side of the line or that side of the line. But the reality is that there is no line, not really. Doctors have created a definition of infertility that hinges on the inability to get pregnant after a year of unprotected sex. If you do get pregnant you're in the fertile camp, if not, you're infertile. But seriously, the definition is pretty obscure. If you're 35 or older the definition suddenly changes to only six months of unprotected sex. And what about if you get pregnant (again and again) but you miscarry within that year, what then? It's a mess I tell you.

Part of the reason this topic is on my mind is that I get asked about infertility A LOT. And not in a "Hey, how are things going with that infertility nonsense?" kind of way, but in a "Hey, so I've been trying for 4, 6, 8 months and I'm not pregnant. Do you think I'm infertile?" kind of way. Part of the reason I get these questions (I assume) is that I appear fairly knowledgeable about this junk... why thank you (takes gracious bow). I've spent more time researching this than I put towards my undergraduate degree, so I feel like I should be pretty darn knowledgeable at this point.

The other reason they ask is fear. My story is like a train wreck... everybody's interested. But also, to girls in their twenties (and most likely thirties), my story is terrifying. And I totally get that. I hate hearing obscure, rare, awful stories of someone's terrible disease or circumstance because I'm automatically terrified that it will happen to me. It doesn't matter that the chance of a stroke caused by child birth is exceptionally rare... I heard the story and now I'm terrified it will happen to me. Rare cancers that strike young, healthy people with no symptoms... just don't tell me about it. I totally understand that hearing or reading about a girl who can't get pregnant at 25 (26, 27, and now 28) is kind of shocking and terrifying at the same time. So now as friends start trying, when it doesn't work in three months, they immediately think of me and go "on no, not me too!"... no shame, I get it.

But here's the thing I'd really like to get across: Just because your best friend got pregnant the first month and you still aren't pregnant after four, does not, in any way, mean you are destined to be me. Your best friend and I, we are literally at different ends of the spectrum. I'm thinking this calls for a diagram.

The Fertile Spectrum: a chart showing time and/or resources required to conceive

As you can see, this is not to scale.... at all. There are wayyyyyy more people on the left side of this little chart than the right. But there were just too many fun stages to put on the right for them to all fit. So when I say that I, who sits somewhere between "IVF: your only hope" and "Not Gonna Happen" is at the other end of the spectrum from your best friend, I really mean it. The other thing to note is that I didn't mark the "INFERTILE" line in there with a big red line. That's because the diagnosis of infertile will hit for some at different points along the spectrum. But here's the biggest point I want to make: your friend and I, we're opposites, but the odds are you (my just thinking about, starting to, looking forward to trying friend) fall in the middle. Again, chart is not to scale, so not the middle, middle, but the "middle"... meaning shacking up one time may not do the trick, but you're also unlikely to require IVF, or any treatment really. The average 20 something has about a 20-25% chance of conceiving each month... that's the average. Remember what we learned about averages... there are people above and below that. You've got me, who's tanking the numbers and pulling the average way, way down. But you've also got Suzie Q who gets knocked up every. single. time... she's definitely got higher odds than 20%.

Here's another thing to note: remember that ol' saying, "it takes two to tango"? Well it's true. You can be uber fertile, but if your partner is completely sterile, it's not going to matter. In the same way, your partner can have super sperm, but if you don't ovulate, his swimmers are lost at sea. You with me? So if neither of you are Wonder Fertile Woman and Super Sperm Man, then you will most likely not get pregnant in the hot tub with your bathing suits on. I know, it's such a bummer. If you're both closer to average, you'll have to have intercourse in the fertile window... and it might take a few times. If however, he really is Super Sperm Man, then the fact that you're more average will still work out pretty okay. And if he's lacking the cape, but you're rocking some super woman thigh high boots, then things will most likely be okay for you both too, The problems start when one of you is down on the other end of the spectrum. Or, if both of you are what my doctors like to call "subfertile" then it may take you both a little longer.

I used to HATE that word... subfertile. Ughhhh. I wanted to punch them all in the face. But now, I kind of get it. It certainly doesn't apply to me, but it probably applies to a lot of people. There's a third "category" if you will... it's not either/or. It's not fertile/infertile. It's fertile, less fertile, less fertile still, even more less fertile, infertile, super infertile, and not gonna happen infertile. So the fact that you and your honey have done the deed five months in a row, and you've peed on more sticks than you can count, please don't lose it. I know that my story is scary as hell, but your situation and mine are (most likely) vastly different.

Lets's take a second and look at each partner here. I found this image the other day and I think it's kind of awesome. Take a look:

Average 20 something ovarian reserve:
Red dots are bad eggs and green dots are good eggs

Okay, so we all know that a woman ovulates one egg every month.... Imagine with me, that you closed your eyes and selected just one dot. Is it green or red? If it's green, then you ovulated a good quality egg meaning it's mature, it has all of the chromosomes needed, and it has a shape/size/surface sufficient for fertilization. Good for you, you have a fighting chance at pregnancy this month. If however, you landed on a red dot, things are not looking so hot. Something is less than stellar about that egg and you are unlikely to conceive this month, even if your partner has super swimmers. Here's the thing: everybody has good and bad eggs... everybody. The more eggs and specifically good eggs you have, the more fertile you are. Some women have very few eggs, some women have tons of eggs. Some women have a high proportion of good quality, others have a crummy proportion of good quality.

What about the dudes? There's a spectrum for them as well. And the guys somehow get a less stringent grading policy, which I believe is part of the reason Male Factor Infertility is less common. Let's look at another high tech chart, shall we?

Super Sperm Man is on the left, Male Factor Infertility on the Right

You'll see that on the chart, I actually did put a red mark on this one. Again, I don't think there's a light switch here or an either/or system at work, but rather I marked the line to show that it is way, way, way far away from the middle. That's my estimate for where the Male Factor diagnosis comes in... everything to the left is "normal". "Normal" in no way means average... something Sam and I failed to grasp in the beginning. Take morphology for example: morphology is the shape to the sperm. Any two headed, two tailed, freakishly large, or exceptionally small sperm are excluded from the count. The criteria says that a man's morphology is normal as long as 4% or more are normal. But that's far from average. A man with 4% morphology is in the 5th percentile, meaning 95% of men have higher morphology rates... but he's still considered normal. It's weird, I know. But it doesn't take a rocket scientist to see that the guy way on the extreme left has better chances than the guy closer to the red line. They're both "normal" and neither likely need treatment, but they don't have the same odds.

So how do you know? When do you FREAK THE HELL OUT and when do you swallow a massive dose of chill and wait it out? Good question. The text book answer: if you're under 35, wait a year. If you're over 35, give it six months. However, I think most of my infertile sisters would say there should be a few asterisks out beside those guidelines. So here are your asterisks:

* If you don't have a period, you don't ovulate regularly. End. of. story. If you don't ovulate, you can't get pregnant. So, if you haven't had a period in some 130 days, run, don't walk to your OB. If your OB says everything is fine, find a new one. It is not fine, and it is not normal to not have a period. It doesn't necessarily mean that the world is over and you will never conceive, but it does mean your months are being wasted... you can't give it twelve chances if you only have a few periods a year. You get me?

** If your average monthly cycle is well outside the norm, you should probably pay attention and think about talking with your doctor. 28 days is standard, but if you're cycle is 26 days and then 30 days, don't stress. If however your cycle is regularly 20 days or 40 days you should probably mention that to your doctor.

*** If by chance you actually know when you ovulate (based on OPKs, BBT charts, or other body indicators) and you regularly only have 10 or less days between ovulation and your next period, go see your OB. The luteal phase (post ovulation) must be long enough to give an embryo a chance to implant and send signals not to shed your lining. In similar fashion, if you're regularly ovulating waaayyyy late, like after day 20 of your cycle, you should talk to your doctor. Your lining (and the egg) are most likely less than stellar after three weeks.

**** And lastly if you have signs of other issues like Endometriosis, PCOS, or Hyperthyroidism, you should talk to your doctor. All of these conditions can affect your quality of life and health even outside of trying to conceive, so it's important to get an accurate diagnosis and to treat the issue. But treatment will also (most likely) help you conceive if that's your goal.

My ultimate goal here is to say to those who are worried that they will end up just like me, the odds are small... so small. Infertility is fairly common, so feel no shame if you find yourself with that diagnosis, but even with the diagnosis, there's a lot of ground to cover before you're me. However, while I'd like to ease some fears, I don't want to say "don't ask, research, or question". I had a hunch way before we reached the year mark that something was up... no one believed me. So if you have reason to believe that something is wrong, tell someone. Like I said, there's no reason to wait a year for help if you know you have stage IV endo, only one tube, and you have abnormal cycles. If you think somethings wrong, find out so you don't freak out unnecessarily.

And I have a feeling my infertile friends will have a few more asterisks of their own to add, so check the comments!

The October Baby

I never talked about this on the blog leading up to or during IVF because it was just silly... it's still silly. I try not too read to much into signs (maybe for this very reason), but sometimes things just feel meant to be. Anybody else out there feel this way? IVF in January was one of those things for me. You see, a mid to late January transfer would yield an October due date. Even more specific than that, an October due date before my own birthday.

Why on earth does any of this matter? Well obviously it doesn't really, but for a moment, you have to step into my strange logic where this kind of stuff does matter. Maybe a little background will help you to better understand:

I distinctly remember being in college, head over heels about Sam, and planning out our future in an art history course (yawn). The key to success hinged on spacing all five of our children out appropriately. But I couldn't simply start two years after the wedding with baby number one. No, no. I had a deadline...29. 

Why 29 exactly? I don't really know other than that's how old my mom was when she had me. I guess as a kid, I always felt like my mom was kind of an older mom (don't laugh). I wanted to be a young, hip, fun mom, so I arbitrarily decided that if she stopped having babies at 29, I would too. Now of course, the dream has changed. Mathematically there hasn't been a way for us to have five babies before I turn 29 for quite a while, but somehow that date, that year still meant something. For some reason, I still hung on to the age 29... It just changed to: have A baby by 29.

Our IVF baby would have snuck right in with an October 2, 1014 due date (or so the handy dandy calculators tell me). More specifically, the October part seemed even more meant to be because October is a BIG DEAL around here. Apart from it being my favorite month, favorite season, and my own birthday month, it's also Sam's birthday month and my mom's. I can't really explain how or why exactly something that simple (and silly) made an October due date seem so appropriate, but it did. I was desperate to start IVF in December or January rather than February or March, not because one more month really made that much difference, but rather because once I had calculated and actually seen that early October due date, it just seemed too perfect. It somehow felt like the stars were aligning, and if I could just get that transfer to occur in the right window of time, all would be okay.

It was obviously not okay. Not okay at all. And now every time someone posts on Facebook or tells me that they have an October due date, I kind of cringe (i.e. wish I could stab my eyes out/rip my ears off). I fully recognize that all of this is silly. If we are blessed with a pregnancy from our upcoming FET, the due date would be somewhere around December I'm guessing. To pre-infertility Amanda, a December birthday seemed like a crime... "why would you do that to your kid? Ughhh, Christmas and birthday in the same month and then NOTHING for the next eleven?!?" To infertile Amanda, a December baby is amazing and a miracle and the greatest thing ever... that kid could come on Christmas day and I wouldn't care. Yet somehow, despite recognizing and admitting that this is all so silly, the loss of that October baby, it stings. I can't really explain it anymore than that it just seemed meant to be... but it wasn't.

Finding "The One"

How about we chat about something other than my uterus and the lack of habitation going on inside, shall we? It seems to me now that we're a week past Valentine's Day that we've arrived at a perfectly opportune time to talk about marriage. (You see it's opportune now, on a random Saturday in February to discuss because, well, because chatting about love and marriage should have zero to do with the date on the calendar... end rant.)

My church is finishing up my favorite series that Andy Stanley has ever done. If you haven't watched it, you should do yourself a favor and go watch all four sermons... they're that good. I first heard this series several years ago when Sam and I were engaged. I, like a lot of women (I like to think), was having a wee crisis of conscience. I knew that I loved this man I was betrothed to. I knew that he was absolutely, without a doubt my best friend. But I also knew that we both came from divorced families and that statistically the odds were even less in our favor than the average couple. And lets be honest, the odds of a happy ever after where you both grow old, and hold hands sippin' lemonade on the front porch are not that hot. It sucks, but they're just not. But our society and just about everyone who has been divorced will tell you that the reason for the divorce is that he/she was the "wrong one." So as my very own wedding approached I had this "how do I know if he's the one?" dilemma and I'm guessing I'm not the only one. In fact, thanks to this girl's very candid post about the moment she said I do, I know for a fact that I'm not the only one.

The Andy Stanley series, Staying in Love, allowed me to take a huge, deep sigh of relief. Strangely enough, it was the first time that I had heard a pastor discuss marriage and finding a spouse in terms of choosing someone and then deciding to make he/she "the one." All my life, I'd heard pastors, youth group leaders, Sunday school teachers, etc say that God would bring "the one," this perfect person that God created just for me into my life if I was just really, really patient. As we all know, patience is not my virtue. I naturally wondered how to know if I was actually ready or if I was hitching my wagon prematurely... was Mr. 100% perfect for me still out there?

Here's the thing: Sam is not perfect, and he's not perfect for me. I love him to pieces and I don't think he's the wrong one, but he's not perfect. And here's another thing: I'm not either. I'm not perfect and I'm not perfect for Sam. There are lots of areas in which we compliment each other: we like to laugh, we're both witty (one of us is a little more snarky, I'll let you guess who), we enjoy watching sports, binging on good TV, and we love to eat fabulous food. There are lots of reasons why I enjoy Sam and love him to death, but he's not a perfect man created just for me to compliment me exactly. I enjoy reading for hours... Sam doesn't read, ever, for anything. I can lie on the beach all day... Sam can last about 20 minutes before he gets antsy. I can easily save money for big things... Sam would rather spend his money on smaller, more frequent purchases. There are a lot of places that we bump heads... some are no big deal (you go swim in the ocean now, babe. I'll stay here.) and others are not so easy to tackle. I, like most girls, had my list of "criteria" that had to be met before I'd say I do… well guess what? Sam doesn't meet all of that. He got the tall and handsome part, but he's as white as they come… turns into a lobster at the beach. And there are things about Sam that I love, that I never knew to even put on the list. And I seriously doubt that if Sam had been the kind of guy to make a list, that I would have met all of his criteria (unless of course, it began and ended with: looks good in shorts). Regardless, my point is simply that we are not perfect for each other. But I'm still so thankful that I married him!

This notion of a perfect person, a soul mate, a partner specifically selected to match me exactly, kind of gets on my nerves.... and it gave me fits and anxiety attacks before I finally bit the bullet and said "you're the one." And sadly I think the church is just as guilty of perpetuating this myth as Hollywood. Movies and books and reality TV tell us that we'll know he/she is the one based on how we feel. But if those feelings go away... whoops! we chose poorly. Try, try again. We simply leave the "wrong one" in search of the "right one," or better yet, the "new 'the one'." Anyone who has been in a relationship long enough should be able to admit that this is bad logic... the feelings that come with the start of a relationship don't naturally continue. This is not Newton's First Law of Physics we're talking about... feelings of love, adoration, and butterflies in the stomach don't continue on without work. No, we're up against the Second Law of Thermodynamics, work is required to prevent the relationship from naturally moving towards chaos. I know, ultra bummer. How much nicer would it be if relationships required zero effort to continue and all the lovey-dovey feelings just multiplied exponentially? The truth is that when I said I do, I promised to make Sam my "one" and vice versa.

Unfortunately, this idea of waiting for Mr. Right is causing more and more women to wait later and later to get married (I don't think I need to explain the danger here, do I?). Now don't get me wrong, I get that some people simply don't want to get married, or don't find someone to marry until later in life. But statistics show a general trend of women (and men) waiting to marry later in life. And yes, I recognize that part of this is that additional schooling is now almost a requirement to survive in this society. But we have to admit that part of this change is simply a generational shift in how we view marriage. Now, if divorce rates were on a rapid decline, I might pause and question whether waiting later to marry might help, but unfortunately, Christian or non-Christian, young or old, divorce rates are awful. My point here is simply this: 22 or 28, 32 or 38, when you marry should have everything to do with feeling ready to commit to the partner for life. It shouldn't be delayed while you search for Mr. Right… he's not coming. Look at it this way: if you aren't married, and you're waiting for your person, your match made in heaven, would that someone look at you and call you perfect? If not, then I don't think it's fair to expect the man or woman you're looking for to be either. And if you are married, I'd challenge you to start thinking of your spouse as "the one," not because he/she is so perfect, not because she completes you, and not because he checks all the boxes, but rather because your wedding vows probably said something to the effect of "forsaking all others… till death do you part."

I don't for one minute feel like I've got this marriage thing all worked out. And I also don't believe I can judge why anyone would seek a divorce... believe me, I've had my reasons for endorsing divorce in the past, so if that's you, you'll find no judgment here. I know that marriage is not simply sunshine and roses, but I guess that's my point. Marriage isn't going to be perfect no matter who you marry. We are broken people with issues, baggage, learned behaviors, and all of that means conflict is inevitable. So my advice to anyone waiting to marry would be this: choose wisely for sure, but recognize that it's a choice, not manna from heaven. And no matter who you choose or when you choose, know that marriage takes work. For those of us who are married: my advice (to myself included) would be to be willingly to do the hard work required. Marriage can be beautiful and amazing... I'm so thankful for mine, not because it's perfect, but because I have a partner who is for me, and together we get to walk through life. There's really no greater gift. 

Missing the Medal Stand

I'm over the Olympics. I know, I know. So very unAmerican, unpatriotic, unsportsfan, uncool. But the truth is, I can't take the sadness. I'm not sure if we're actually worse this Olympics, or if it's all in my mind, but for whatever reason, it just seems like we keep. missing. the. medal stand. I can't take the disappointment.

Every time I watch an event there's some shoe-in who just botched their last chance for a medal... ever, because they're the ripe old age of like 32 and all their hopes and dreams are O-V-E-R. Or there's some newbie who no one thought even stood a chance, and they're oh so close, but no. Every time I turn on an Olympic segment the announcers are telling some incredibly sad reason why so-and-so needs/deserves a medal. Ughhhh. The tears, the sadness, the disappointment… I just can't take it.

Bode Miller after missing the medal stand in the Super Combined.
Photo credit: Huffington Post

I swear, if Lolo Jones doesn't medal, I'm done. I don't necessarily love (or don't love) Miss Jones, I have no clue if she's expected to win, or if we even have a chance in her event, but after three Olympics and such heartbreaking misses, after training for years and even switching sports, this girl deserves an Olympic medal. Just give her one already.

And that, dear readers, probably gives you some insight into my mind these days… I'm over disappointment. Over it. In some weird way, I can sympathize with these Olympians... I just completed the Olympics of infertility treatments. I trained hard. It cost us a fortune. It took us forever to get there. We sacrificed and sacrificed and sacrificed to get there. The build up and anticipation was huge. THE EVENT was finally here... and then it was over. Just like that, all the traing, all the saving, all the hope. Gone. Over. And it'll probably be four years before we can go again... literally. Every time an announcer says that this is probably the last Olympics for someone because they'll be 24, or 27, or 33 or whatever, I kind of want to stab my eyes out. I'll be 32 at the next Winter Olympics... that's a long time to keep your eye on the prize.

I'm probably showing a little of my Millennial generation status here, but I just want everyone to get what they've worked so hard for. It doesn't seem like too much to ask. I spent my entire childhood being told I could be anything. Astronaut, lawyer, surgeon, Nobel Peace Prize winner... my limits were supposedly only set by my focus, my determination, my drive. Yet here I sit with the most basic dream, the one most people don't even dream of, they simply assume it will happen, and it feels like no amount of focus, or determination, or drive will change my circumstances. Needless to say, that's disappointing. And frustrating and about 100 other non-desirable things, but ultimately, it's just really disappointing.

I think disappointed pretty much sums up my feelings at this point. I didn't necessarily think our first transfer would be a success going into IVF... I knew the odds. But now that it's all over, I can see that going into IVF, I believed we'd get a good harvest of eggs, and that surely, surely we'd get pregnant within two transfers. Now I'm not so sure. I now realize that I was betting on one egg retrieval bringing our take home baby and maybe, just maybe a sibling down the road. That seems very unlikely now. So yeah, I'm disappointed.

And I'm just over disappointment these days. And I know that sounds pitiful, and whiny, and childish, but that's the reality of the situation. I just want some good news. If not for me, then for my friends. Suzanne has her hysteroscopy at CCRM tomorrow, Conceptionally Challenged has an embryo transfer coming up on Wednesday, and Run Away Stork goes in for her first beta on Wednesday... really hoping for some good news ladies! No more disappointment!!!

Thinking Thoughts

Ummm, yeah so some parts of Georgia may have slightly overreacted after the last snow storm. Today brings "wave 1" of Snowpocalypse 2.0 which means that it's currently snowing sleeting raining here in Athens. But hey, I can use a good rain day. In everyone's defense, it's all about the temperature. I talked to my mom this morning who lives about 30 miles northwest of me and she said it's snowing (and sticking) like crazy, so I guess it's all about the temperature in your area. Sad trombones for us here in Athens. Hoping "wave 2" packs a slightly more serious punch when it comes through tonight. If it's going to be cold and gross, it better snow buckets!

Anyway, the real purpose of this post is not to update you on the Georgia weather… I'm pretty sure the national news is waiting with baited breath to see us look like idiots again anyway. No, of slightly more importance than the rain/sleet/snow falling from the sky, is the follow up consultation I had yesterday. It would be better classified as a "follow up chat" because it lasted a total of twelve minutes and I didn't get to consult him about anything. Mm hmm, you read that right. I managed to get together an entire page of questions and I got to ask exactly one of them, and I got zero answers for my hard work. Ughhhh.

Essentially, Dr. Duffy apologized for our failed cycle several times, which I guess is nice, but I don't know, it just seemed like a waste… lets move on, especially if I only have twelve minutes of your time. He also said that he didn't want us to give up after this one IVF which kind of let me see the writing on the wall… he doesn't think we'll be successful from the FET(s). He said he'd like to add in growth hormone to our next IVF cycle. I was kind of thrown for a loop… I was thinking different protocol or something like that, but he thinks the biggest issue with the cycle was not my response to meds (I do) but oocyte quality (and that too), so growth hormone should help. He then spent several minutes trying to explain why I shouldn't be upset that we didn't use growth hormone for the first cycle because "no one would have predicted a woman at my age, and with my AMH would have poor quality eggs"… umm, I'm pretty sure I predicted that, but whatever.

The only two things he said regarding the FET is that he wants me to discuss two things with Sam. A- doing a day 3 transfer of our two best vs thawing and growing all six to day 5. And B- doing an Endometrial Function Test before doing the FET. Both of those things kind of caught me off guard. As to growing the embryos to day 5, why would we do that when he recommended a day 3 earlier? And why would we expect grade 3 embryos to make it to day 5? I'm just confused about that… I'm thinking about it like he requested, but I'm not sure what I'm supposed to think. As to the EFT, it was so out of left field. I'd specifically asked about the E-tegrity test (the Beta 3 integrin biopsy that CCRM uses) at our first consultation and he said there was no need, but now he's wondering about uterine quality… why? Have mercy, but if we have to overcome egg quality and a hostile uterine environment, we should give up now. I can't imagine how many cycles or how many transfers it would take to get everything just right with both of those issues in affect…. more than we have money for, that's for sure.

So essentially, I'm thinking, thinking a lot. I'm just not sure what I'm supposed to think about any of this. My one question that I managed to slide in before he ended our phone conversation was "what are our chances with any of the transfers?" He refused to answer with anything other than, "our current clinic success rate for FETs is about 40%"…. umm, so not helpful. I'm beyond frustrated and beyond confused. Where do we go from here?

I think the snow rain day calls for a little break from all of this thinking though… off to take Erika's recommendation and catch up on Revenge.

IVF: A Recap

I've been meaning to blog about this for a long time. I guess part of the delay is that thinking back through IVF is kind of painful. There were a lot of disappointments for us along the way. And part of the delay is just that I'm struggling. Struggling to stay relevant, to stay present in this moment. Hell, I'm struggling to get up in the morning and care whether my hair looks like a frazzled mess or my eyeliner is on straight. Every moment of time spent awake I'm pretty much counting down the hours until I can go back to bed. But I'm pretty sure that my misery is a terrible, horrible no good, very bad blog topic, so instead I'll recap IVF.

I really want to recap IVF not because I need a summary but because I want to take some of the fear factor away for others who might be considering IVF. I've said multiple times before that IVF was terrifying to me. It seemed monumental... like some kind of Mount Everest type endeavor. I was scared to death of the shots. I was worried what the medications would do, side effects, etc. It all just seemed overwhelming. And while I'm certainly not here to say that IVF is no big deal, it wasn't as bad as I expected.

We'll start with the injections. I whined about injections until I'm sure everyone was sick of me. I don't like needles, don't like shots, and don't like whomever has the task of stabbing a needle into me... que dramatic circumstances for IVF. Luckily, every single one of my injections was subcutaneous. So I still can't vouch for any intramuscular stuff... if I have to cross that bridge, I'm sure there will be more whining and worrying. But the subcutaneous ones were really not that bad. Really. You heard it here folks. I did Gonal-F, Menopur, Cetrotide, and Lupron... Menopur was the worst, no doubt. It burned and I'll admit there were some curse words shared, but it wasn't that bad. Two minutes of burn and then it was over most nights. Also, I know this is going to sound crazy, but I was forced to do my own injections towards the end... it was better. So if you're scared of the injections, at least try it yourself. And ice... ice, ice, ice. No one said I couldn't ice the area, so I did every time. The one time I didn't I really regretted it. But regardless of your system, I guarantee that there is a system that will work for you... so don't delay or give up on IVF because of the shots. It's ten to twelve days for most… anyone can survive that.

Another fear was the medications and the effects they might have on me. I'd heard all kinds of stories... people passing out, ending up in the hospital, allergic reactions. And of course there's always the stories of breast cancer and other terrible issues that arise later in life. I obviously can't speak to the increased cancer risk quite yet, but I can say that I had little to no side effects. It's crazy and I still can't really believe it, but it's true: I had more side effects from 100mg of Clomid than I did on all the IVF drugs. No lie. Some people report moodiness, uncontrollable rage, tears that just won't stop... I had none of that. I think part of it may be the lack of stress... I was in Florida, not working, hanging out with my mom or husband most of the time. But still, no tears were shed, no freak outs occurred. I never felt like I was out of control or that my body (or hormones) were betraying me. In addition, I had very few physical side effects either. I find that really strange. On Clomid, I had 3-4 follicles and felt like I had a sack of potatoes in my abdomen. On Follistim, I had 5 follicles worth note (around 7 total) and I felt like someone kicked me in the ovary every time I sat down. Both Dr. Slayden and I were worried about IVF and the pain. If an IUI on 75 units of Follistim for five days brought me to an 8 on the pain scale... IVF was sure to do me in. And I have absolutely no explanation, but I was never really in pain. There at the very end I started feeling some discomfort, but it felt more like ovulation pain than stabbing, miserable, excruciating pain. Dr. Duffy hypothesized that maybe the difference was drug related... regardless the side effects were not as bad as I expected.

In addition, I really thought that I'd be at the doctor all. the. time. For hours and hours while they stole pints and pints of my blood. In reality, I went in for the IVF start date, three monitoring appointments, the retrieval, and the transfer. That's it… well, actually I had to swing by once to meet with the nurse about the retrieval and pick up my Lupron since I had ordered hCG from the pharmacy. But essentially it was a total of six appointments… My first IUI was four appointments and my fourth IUI was five appointments, so really not all that much difference.

Let's look at some overall wins, shall we? First of all, if you, like me, have suffered through test after test to find an actual diagnosis rather than unexplained, IVF may just be your diagnosis dream come true... or not. It's certainly not a "win" to know that my eggs are less than stellar and only slightly better than abysmal, but IVF did answer some questions we otherwise would have been unable to answer. A second win: weight loss. I know what you're thinking... huh? But it's true, I lost about 10 pounds leading up to and during IVF. I'm sure a huge part of it was the diet choices I was making... cutting carbs eliminated about 75% of my daily caloric intake... it was hard to put calories back in the form of protein. But I'm pretty sure I'd have lost a little weight no matter what... post retrieval I just felt like crud and nothing sounded good. There were a few days when the bloat weight started to make me think I'd gain it all back, but I finally deflated and settled at about 10 pounds lighter. Now, admittedly I haven't weighed since the pregnancy test, so I have no idea if post IVF has led to weight gain... Starbucks, a dozen chocolate chip cookies, Ben and Jerry's, and Steak N' Shake milkshakes don't lead me to believe I'm still 10 pounds lighter, but ignorance is bliss.

And because I can't end on too perky a note, let's look at some losses. First of all, IVF is a gamble, there's absolutely no doubt. Doctors can make all the predications they want, but there's no real way to know how any one woman will respond to the different medications. It's all just an educated guess. We went in with predictions of success as high as 70% per transfer and left with about a 35% chance for our first transfer... definitely a gamble. I think it's probably wise to think of IVF like this: IVF#1 is a trial run... you may get lucky, lots of people do, but you may also need IVF#2 to learn from the first round. Womp, womp. In addition, the medication ordering system is difficult to pinpoint. I ended up buying medications three times because I kept running out, but then right after I ordered the last round, I got the call that my E2 was too high and I'd be stopping stims soon. I ended up with five vials of Menopur, one syringe of Cetrotide, and one multi-dose vial of Gonal-F left over... even with the discounts, that's over $500 in medications. It's so hard to know how much you'll need, but you don't want to be stuck without it. So I guess, the negative aspects of IVF all circle around the unknown... you just have to bite the bullet, take the plunge, etc.

Reading back through this, I'm not sure if I'm actually doing a very good job of convincing anyone to go for it. Admittedly, I am not the poster child for IVF the doctors thought I would be. But I guess if I'm coming out of IVF with mega disappointments and a failed transfer and yet still vouching for it, then there's really no higher recommendation needed. If you're on the fence, I'd say go for it. Do your research. Know your facts. But don't waste years because of fear... it's really not that bad.

Plan G-K

Our Plan A went out the window a long time ago... we all know that. It was just over two years ago that we moved onto Plan B also known as Clomid, but it seems ages ago... like seriously, lightyears ago. But it is what it is; plans change and we have to adapt and change with them. When one door closes, you can either try to pry it open, or you can move onto the next one.

My dear sweet husband has calmed my ever increasing anxiety over our FET by reminding me that it won't, in fact, take half a year or more to save up the funds. I completely forgot in my absolute panic that we take money directly out of my check each month and place it into our health savings account... $500 to be exact. Add in the fact that Uncle Sam owes us big time, and well, the FET isn't too far away after all.

Speaking of tax refunds: whoa friends, itemizing medical expenses is about as much fun as a root canal. Seriously, it took us all weekend to do our taxes. And while we are getting a pretty decent refund, it was also immensely depressing to see where all of our money went last year. In case you didn't know, if you spend a large chunk of change on medical expenses, you can choose to claim those as deductions if you itemize your taxes. And by large chunk of change I really mean it. You used to be able to claim medical expenses if you spent over 7.5%, but of course that recently went up to 10%. I don't understand tax jargon, but the 10% is based off of your adjusted gross income... whatever that is. Sooo, all of this is to say that we spent almost 40% (37% to be exact) of our income on medical expenses in 2013. And no, I did not have chemotherapy, a boob job, or get a lung transplant. Nope, that's 99.9% infertility treatments and testing. Lovely. Oh, and that doesn't actually include our entire IVF... everything that we paid for after December 31, 2013 doesn't count towards that total... we're just getting a jump on next year's tax return. But like I said, at least there is a refund with our name on it. It won't make up for not having infertility coverage, not by a long shot, but at least it's something.

Anyway, moving on. The FET will (fingers crossed) be my next cycle... which should start the first week of March. If not, then I'm certainly hopeful it will be the next cycle. But as I've said before, I can't get too excited about the frozen embryo transfers. Not with day 3, grade 3 embryos... it feels like a long shot at best. To keep myself from spiraling into the abyss that is "woe is me" I'm trying to look into some backup plans incase IVF and all subsequent FETs are a bust for us. I know that the research doesn't actually do anything, but it eases my mind just a bit to feel like there's a plan. If I focus all my energy and hope into these precious embryos that struggled for just three days of life, I will fall into despair at the mere suggestion that they will fail. But if there is a backup plan, failure doesn't seem quite as hopeless. Make sense? No, I didn't think so.

So what would be next for us after these FETs? I feel like we've been here before... in fact, I'm pretty much sure of it. "The plan" was to do one IVF, if the IVF failed (which it did) we would systematically move through the available FETs. If all of those failed (which they might) we would move on to adoption. Eeek! Screech! Bang! That's me putting the breaks on. Six months ago I was ready to dive into adoption. But I suddenly feel anxious when I think about adoption... I've got to sort through my feelings on this before I can definitively say that it is our next step. I've got to think this through a little bit. And wouldn't you know, Mr. I Don't Know How I Feel About Adoption, is ready to move forward. But suddenly, adoption seems very scary, very foreign, and very overwhelming to me. I can't explain why exactly, it just does. But I'm not eliminating it, it's definitely still an option, it's just... there are other options.

Typically, lists start with A or 1, but let's be real... none of these are our first option for our first baby. We'll start with G, that seems about right.

Plan G: CCRM... I know, I just said one fresh IVF. One and done, that was our deal. Whoever said IVF was addicting... they were right. A small piece of me doesn't want to give up the dream of our baby inside of me. A bigger piece of me wants to beat infertility. Like knockout style. I don't want to go out on a losing note. Is that reason enough to haul our butts all the way across the country to a place where I will most assuredly be unhappy (I get the feeling CCRM and I won't get along) on the chance that they can do better with the dreadful eggs my body offers up? I guess that's to be determined. Cost for IVF at CCRM approx $26,000… not including travel.

Plan H: Donor embryos. For some reason, donor embryos have been on my mind a lot lately. I love the thought that I can save someone's embryos from being trashed. I don't love the thought that we might be buying embryos of poor quality. I know that you know the grades going in, but let's be really honest: those embryos are another infertile couples' leftovers. Everyone works through their embryos best to worst, so it is safe to assume that any remain embryos are the poorer quality of the bunch. I'm sure some are excellent and destined to be beautiful children, but some are most likely not. However, donor embryos is significantly cheaper than many other options, so it's probably the most feasible for us. In addition, it gives us the added bonus of experiencing a pregnancy. Admittedly, this is probably a little more important to me than Sam, but I think a pregnancy would be special to him too. Cost for donor embryos approx $6,000-10,000.

Plan I: Donor eggs. This would essentially solve our two greatest desires for Sam and I... genetic connection for him, pregnancy experience for me... at a cost. A significant one at that. I think the most likely scenario for us would be to return to RBA and use their My Egg Bank program with frozen donor eggs. The cost is significantly less than a fresh donor egg cycle, but you only get 6 eggs... scares the dickens out of me. Cost for frozen donor eggs approx $16,000-18,000. Cost for fresh donor eggs approx $30,000.

Plan J: International adoption. It was always part of my dream. And maybe it still is. I don't know. I think I kind of had a rose colored glasses type of perspective on international adoption. I still think it's beautiful, I'm just not sure how to ensure it's beautiful rather than painful, violent, or heartbreaking. Jen Hatmaker's series on international adoption opened my eyes and I can't close them back. And there's the price tag, and the hurdles like: we're not 30, and we haven't been married 10 years, or another 800 things some of the countries require... I don't know if we'd even be accepted into an agency at this time. And lastly, at least for our first child (looking like only) I really just want a baby, not an 18 month old, not a four year old, a baby. Cost for international adoption approx $25,000-40,000.

Plan K: Domestic Adoption. Again, the blinders are fully off. I've known quite a few people who experienced failed adoptions last year... it's not as simple as it looks. And if I'm being abundantly honest, I'm kind of afraid of what it would feel like to raise a child who wants to know their "real mom"... I'm afraid I'd constantly have to compete with "the other mom". And we're quite a number of steps between now and bringing home an infant via adoption... no social worker would clear us in our current living arrangements. So a house or a much nicer rental location is required before we could even start the process. Cost for domestic adoption approx $30,000.

So like I said: when one door closes, you can either try to pry it open, or you can move onto the next one…. we haven't decided which plan we're going with. We might try to pry open the stubborn door of IVF with our own eggs and sperm, or we might move on to a different door. And who knows, we might circle around the doors a few times knocking to see if there's a bring home baby behind one. But for now, I guess we're focusing on FET #1… and researching on the side just in case.