Thoughtful Thursday: Patient

Infertility has tried my patience, and it has made me more patient, but that’s not the kind of patient I mean.

What kind of patient are you? How has infertility changed that?

In all realms of life, I straddle a line between following directions and thinking for myself. My rejection of directions is usually based on some combination of logic, my own research, my assessment of the validity of the directions, and doing what I feel like.

This certainly applies to health care. For example, after I had my wisdom teeth removed, I followed all of the instructions for cleaning the extraction sites, but I completely ignored the prescription for narcotics. After the day of surgery, I didn’t even take any Advil.

During infertility treatments, I almost always followed directions to the letter, except when I thought they didn’t matter. For instance, when I was told not to eat after midnight prior to IVF #2 retrieval, I bumped back the time on my own because my retrieval was scheduled for late morning. I know the purpose of being NPO, and I also know that the midnight instruction is the same whether the surgery is at 6 a.m. or 11 a.m. If six hours of fasting is enough for an early morning appointment, then it should be enough for a late morning appointment, in which case eating something at 4 a.m. is fine.

My most egregious case of ignoring doctor’s orders occurred during the infamous IUI #7, in which we didn’t bother to have sex in addition to the IUI because in my mind the whole cycle was pointless anyway. Result: currently 31w2d pregnant with twins.

As a pregnant woman, I have been amazingly dutiful. I have followed doctors’ and books’ recommendations as much as possible (as a vegetarian, 100 grams of protein requires a lot of work but is feasible, but 150 or 200 grams just doesn’t happen no matter how hard I try). When advice has conflicted, I’ve evaluated the relative merits and acted on what seemed to be the most prudent course of action.

And then my cervix started shortening and I was put on bedrest. I followed bedrest instructions to the letter (didn’t go anywhere outside the house except the doctor, didn’t sit up for more than 15 minutes at a time for meals, etc.).

And then I went into preterm labor and I was admitted to the hospital.

This whole time, doctors have remarked on what a “good bedrester” I was and continue to be. They tell me how some other patients interpret bedrest as cutting down on housework or being quicker about grocery shopping. When DH said to the head perinatologist that a high-activity day on bedrest for me meant that I went up the stairs once to go to the kitchen, she laughed.

They’ve been pleased, and a little bewildered, at my openness to staying in the hospital as long as they deem medically necessary. They talk about patients fighting to be discharged — particularly those with other children at home, or those whose husbands are incompetent/unwilling with housework. When I told DH about the latter, he got a little defensive and said, “You told them I’m not like that, right? That I’m not one of those husbands?” I certainly couldn’t manage total inactivity without his constant help.

Doctors and nurses have remarked on my cheerfulness, and one doctor makes fun of me for being so cheerful. They applaud my wisdom when I give them my stock explanation for my compliance and good attitude: Better here than in the NICU.

How did I get to the point of winning some sort of Best Patient award? Sure, I try to maintain perspective in everything I do. But in this case, I’m a model preterm labor patient because I dealt with seven years of infertility, and because I read infertility and loss blogs. It took a hell of a lot of time, money, and work to get this far. The stakes are clearly higher for me than they are for the patients down the hall that the nurses roll their eyes about, the ones who are still smoking (WTF?). Because of the heartache of my bloggy friends, I know that not all babies turn out fine, and I know that some babies die. Often there’s nothing that the woman or anyone else could have done — but if there’s anything I can do to help these babies make it into the world safely? You’d better believe I’ll do it.

What kind of patient are you? How has infertility changed that?

Thoughtful Thursday: Affirmation

¡Hola desde España!

Today’s Thoughtful Thursday is inspired by my recent positive beta following Perfunctory IUI #7. As I have discussed before, this cycle carried none of the hopes of most other cycles, and therefore none of the anxieties.

Since the news, though, I am not entirely anxiety-free. Every trip to the bathroom involves examination of the toilet paper under a metaphoric microscope, for traces of blood and signs of danger. My wistful “what if” moments are tempered by doomsday “what if” scenarios and recollections of past miscarriages.

One thing that has reduced my anxiety is being on holiday. I highly recommend it. There was not a trace of anxiety, for example, when I was sitting at the beach yesterday looking at the Mediterranean. I was aware of being pregnant, but nothing about infertility or potential/past miscarriage ever crossed my mind.

Something else that has reduced my anxiety are positive affirmations. Some might call them mantras, but for me that conjures a meditation context. My little statements do not occur during moments of mindfulness, but more commonly during moments of freaking out. I also like to say affirmations sometimes during neutral moments, just to give myself a pep-talk.

Historically, aside from TTC, the affirmation that has helped me most in life is, “Just for today…” and then filling in the blank. Just for today, I will not be angry. Just for today, I will not worry. Just for today, I will let myself be happy. I like this because it does not deny emotions — it just compartmentalizes them. It gives me permission to experience them tomorrow. This affirmation actually involves playing a little trick on myself: by tomorrow, the emotion in question has often passed, and I can continue as before without having to have wallowed in that emotion.

Obviously, affirmations can apply to TTC, infertility, pregnancy, and beyond. Rife as this whole process can be with potential disappointment, waiting, frustration, and anxiety, affirmations are perhaps better suited for reproduction than for most other aspects of life.

Newly-BFP Fallopian ‘Tudes posted earlier this week with her own affirmation, “One day at a time.” Regular pregnant women seem to do a lot of forward-thinking, but those of us who have lost pregnancies in the past (or who had a hard time achieving pregnancy in the first place, or both) tend to white-knuckle it through each day.

There are a few affirmations that I have been using this week.

• “I am closer.” Whatever happens, I am closer to ending up with a child. If this pregnancy continues, I am closer for obvious reasons. If it does not, I will then have experienced my third loss, which will spur Dr. Full Steam Ahead into recurrent pregnancy loss testing.
• “Maybe.” Just maybe this will work. No guarantees, no setting myself up for a fall; merely a little hope.
• “Just for today…” Just for today, I am pregnant. Just for today, I will enjoy this. I don’t know what tomorrow may bring, but today if I feel like buying something that I may never be able to buy anywhere else, I will. Uncharacteristically, I have allowed myself to make a physical acknowledgement of the pregnancy by buying a couple of “gifts” for the baby during this holiday. You will see them at upcoming Show and Tells. These objects may take on other meaning tomorrow, but just for today, they are gifts for the “theoretical child”  — as DH likes to call it. Apparently he has his own set of thoughts that help him deal with the situation.

Do you have affirmations that have helped you through TTC/infertility/pregnancy/life? If not, is there something else that you say to yourself to get through difficult times?

Holy Fucking Shit

[Breaking news from Madrid airport]

Remember how Perfunctory IUI #7 was only done to satisfy the insurance company that I’d failed enough injectible + IUI cycles to qualify for IVF with the Trick Up My Sleeve insurance?

Remember how I used expired/ruined FSH?

Remember how we skipped the pre-IUI sex?

Guess who got a positive beta!

I am flabbergasted. Cautious, dubious, cackling with laughter at the irony.

Contest: Guess the beta (12DPO) and win a prize. Either a present from my travels or some of my new pottery.

Barren Bitches post coming shortly.

Liberation

Perfunctory IUI #7 occurred today (Tuesday, though it will probably be Wednesday by the time you read this).

It has opened up a whole new world of freedom. I expect nothing from this cycle, and therefore I cannot be disappointed.

Sort of like the birth control pill cycle before an IVF. Can’t possibly get pregnant, so the advent of your period means that the real work can commence, rather than the usual heartbreak. Also like having sex during non-ovulation times of the month. Or going on a job interview for a job that you have no intention of accepting. Or creating a piece of pottery just for the sake of testing something out. It cannot be more than it is, and that is a welcome change.

This IUI was more crampy than usual, but having had two IVFs and a hysteroscopy since my last IUI, my exact words during the worst part of the cramping were, “I’ve had worse.”

They had scheduled my beta during my trip to the land of Don Quixote. I don’t particularly want to lug progesterone suppositories around the Iberian Peninsula, so I convinced them to move up the beta date so that I can discontinue the progesterone when the beta invariably turns out negative.

It’s such a strange position to be in, compared to where most of us are almost all of the time. Expired FSH? Sure, why not, who cares. Negative beta? Of course, no problem, thanks for calling! Have coverage sex with my husband before the IUI? Naah, it’s not convenient, why bother. Liberating!

I’m not even going to POAS. There, I have committed. For the first time in all these years of infertility treatments, I am going to wait for the phone call.

Sure, it’s occurred to me that pregnancy from this IUI is not technically impossible. After all, miscarriage #1 resulted from clomid + IUI. As Dr. Full Steam Ahead pointed out, stranger things have happened. In the unlikely event that I actually get pregnant, it would mean one of three things.

1. “Man plans, G-d laughs”. If you plan not to get pregnant, you will get pregnant.
2. Miracles do happen, and my “healing” treatment really worked.
3. The advice to “just relax” was right all along.

Perfect Moment Monday: Sleepy

I had another cupcake moment.

Thursday was Cycle Day 1, so on Friday I went into the RE’s office Too Damn Early for bloodwork and ultrasound. I had been up past 3 a.m. working, so I was even sleepier than I usually am for early morning appointments.

I drove home to catch another hour of sleep before heading to my first meeting at Old Job.

During that hour of sleep, I had a dream. Highlights:

• I was driving home from the RE’s office. I was so sleepy (have you ever dreamed that you were sleepy? first time for me) that I drove into a wall of someone’s house — just nicked it, really — and sent their balcony crashing to the ground. I went into the house to explain the situation and apologize to the residents. They were very understanding.
• The little boy — around age 5 — in the family saw that I had several boxes of Girl Scout cookies, and asked if he could have one. (They looked like Do-Si-Dos, but we were calling them Tagalongs — some peanut butter Girl Scout cookie confusion. In real life we only ever buy Samoas and Thin Mints, but remember that this was a dream.) I said that he could have a cookie, then I remembered that I was saving them and rescinded my offer. It then occurred to me, “You just drove into their house. Don’t be a jerk.” I gave him a whole box.

Pictured: Tagalongs. Much better than Do-Si-Dos. I bought them to show you, but I don’t want them to go to waste so I suppose I’ll need to eat them.

• Back to the dream. I went home, eager to tell DH about the house crashing incident. Our house was incredibly full of his friends. (Echoes IVF #2 when half a dozen houseguests descended on our house from retrieval day through transfer day.) I could barely squeeze a spot onto the couch, and when I did, people’s elbows kept bumping me. (I really don’t like to be jostled.) I was trying to tell DH about the crash but couldn’t get a word in. I was still sooo sleepy, and wanted both to talk to DH and to take a nap.
• We then adjourned to the kitchen. DH’s mother showed up and declared her intention to have a barbecue. (IRL she constantly wants to have a barbecue, but it drives me nuts because I never get enough to eat. It’s possible for a vegetarian to eat enough at a barbecue, just not at MIL’s house.) She starts producing platter after platter of raw meat. (I don’t allow meat to be cooked in my house, and I don’t allow meat to touch most of my dishes. If someone wants to bring in a sandwich and eat it off of a designated meat plate, that’s fine.) Platter after platter kept appearing from nowhere. All sorts of raw meat — sausage links, steaks, burgers, whole chickens… I counted 9 huge platters before she switched to platters of raw seafood — entire fish from head to tail, filets, lobsters. I kept getting angrier and angrier, exhausted from lack of sleep plus revved up from the crash and frustrated by the inability to tell anyone. Once there were a dozen platters on the counter, I screamed, “Stop it, you fucking shrew whore!” (Mother-in-law issues, anyone?)

I was just about to get a response from my mother-in-law when the alarm went off, and I woke up. I was pretty riled up from the dream, but after a few seconds it dawned on me — none of the events in the dream actually happened. Immediate sense of calm. I was still sleepy all day, and I had all sorts of annoyances from the insurance company and a repairman. But, I kept reminding myself that the dream was just a dream. “There’s nobody in my house!” “There’s no meat in my house!” “I haven’t (yet) called my MIL any terrible names!” “I am sleepy but I haven’t crashed into any houses!” Compared to the dream, everything about the rest of the day was fantastic.

Lori from Weebles Wobblog is a dream come true. No, not this kind of dream, the good kind.

Show and Tell: Quixotic

Remember a couple of weeks ago when I showed you a photo I bought from Wall Blank and I gave away a Wall Blank print of her choosing to Anita from Hope.Faith.Patience?

The past week has been particularly good at Wall Blank. Anita has chosen her prize: an artistic rendering of the Japanese symbol for water, mizu. If you happen to like it yourself, it’s still available for a few more days — and the profits go to the Australian Red Cross to help victims of the bushfires in Victoria.

Hope you enjoy it, Anita!

I myself was smitten with one of this week’s offerings, Don Quixote and Rocinante in pen and ink. Also available for a few more days if you want to copy me. If you do, just be prepared, if I ever walk into your house, for me to point and exclaim, “Copycat!” But, I always show up at people’s houses bearing gifts, so it’s not all finger-pointing and name-calling.

I like it aesthetically, but it’s the subject that particularly calls to me. First, I’m headed to Quixote’s homeland next month. Second, I quite enjoyed the book, though it’s been almost 20 years since I read it. Third, I’ve been feeling a bit quixotic lately as I embark on Perfunctory IUI #7 (BTW I started stims yesterday) in preparation for non-Perfunctory IVF #3. I hope it’s not an impossible dream, but it sure feels that way sometimes.

To bear with unbearable sorrow
…
To try when your arms are too weary [from all of the blood draws]
…
One [wo]man, scorned and covered with scars,
Still strove, with [her] last ounce of courage,
To reach the unreachable star.

Interestingly, both of DH’s parents have prints of Picasso’s Quixote in their respective homes. As I considered buying this new Quixote, I wondered if the appreciation for the character had trickled down to DH.

Me: What do you think of Don Quixote?
DH: He’s stupid.
Me: Huh?
DH: Tilting at windmills is stupid.
Me: You know he doesn’t think they’re windmills, right?
DH: Yeah. He’s delusional.
Me: Have you actually read the book?
DH: No, I don’t think so.
Me: I think you’d remember — it’s one of the greatest works of literature of all time. Have you seen Man of La Mancha?
DH: I know that one song.

And so, in a rare turn of events I am ignoring DH’s otherwise-infallible opinion. I have employed my own judgment in coming to the decision to make another Wall Blank purchase. I’m building quite the collection of infertility-themed art.

I will leave you with my favorite version of “that one song.”

More metaphoric, symbolic, and literal beauty at Show and Tell.

Thoughtful Thursday: Hope

Welcome to Thoughtful Thursday! Three orders of business today, each accompanied by song lyrics.

You don’t know how lovely you are
I had to find you, tell you I need you
Tell you I set you apart
–Coldplay, The Scientist

First, giving credit where credit is due. I would like to introduce a new element of Thoughtful Thursday, The Intelligentsia. People who have commented on every Thoughtful Thursday post for a given month will be added to the Intelligentsia roster and will receive some sidebar bling. For January, our esteemed members are Wiseguy from the outstanding blog Woman Anyone? and Cat B., who makes up for not having a blog by leaving lots of excellent comments on others’ blogs. I hope they will have plenty of intelligent company in the coming months — please join them, if not in The Intelligentsia then with occasional comments. (And, for those of you who are all-or-nothing types, don’t think you need to give up for the rest of the month if you miss a week — thoughtfulness is its own reward.) For the record, every Thoughtful Thursday comment is appreciated — I just wanted to give a little extra bonus for diligence.

Nobody said it was easy
No one ever said it would be this hard
Oh take me back to the start
–Coldplay, The Scientist

Second, an update on my bizarre infertility journey. I went to see Dr. Full Steam Ahead last week to establish a plan for IVF #3 — the one that I hope will be paid for by the Trick Up My Sleeve (still in the works, so no details yet). Dr. Full Steam Ahead, living up to his name, set forth an ambitious plan which involves giving me the Old Lady protocol. Even though I am “so young” (33, to be precise, and not getting any younger), I did not produce as many eggs as he would expect from the IVF #1 and #2 protocols, and even fewer “good” embryos. So he wants to try microdose Lupron plus as much FSH as the human body will tolerate to encourage my ovaries to give a burst of excellence. My husband is pretty horrified at the doses and number of daily injections, but as I always say, “in for a penny, in for a pound.” Actually I’ve never said that before in my life, but it applies here.

But, before the Trick Up My Sleeve can take effect, it is extremely likely that the new insurance company will require me to have failed 3 FSH+IUI cycles. I failed two during 2008, then stopped because Dr. Full Steam Ahead thought it was futile and I might as well move on to IVF and “save some money.” I had numerous Clomid+IUI cycles in 2003-2004, but those apparently don’t count. (FYI, all IUI cycles in 2003-2004 and 2008 were paid out of pocket. Boo.) So…

My current health insurance (the one that was my primary reason for running myself ragged by taking on New Job in addition to Old Job) pays for IUI but not IVF. Trick Up My Sleeve won’t kick in for a couple of months anyway. Therefore, I proposed that rather than waste time later, we get the FSH+IUI cycle out of the way now (since it’s paid for by New Job insurance anyway), and pave the way for Trick Up My Sleeve IVF. Dr. Full Steam Ahead agreed with my plan, so we’re all set to do FSH+IUI whenever my body decides that it’s ready. It will be injectible+IUI #3, or total IUI #7 — I think. Seriously, I can’t keep track anymore. Let’s go with #7, that sounds right.

Some people might feel guilty for “using” one insurance company to do a useless IUI merely to satisfy another insurance company’s IVF prerequisites, but I just can’t feel guilty. I wouldn’t have to play this game that if New Job’s insurance covered IVF. And plenty of people while covered by New Job-style insurance would have done a bunch of free IUI cycles instead of paying fourteen-fucking-thousand dollars out of pocket for IVF+ICSI. I’ve only cost that insurance company one hysteroscopy and one upcoming IUI (plus one flu shot) during the five months that I’ve been insured with them. If anyone is going to feel guilty here, perhaps it should be the doctor who cost me $40,000 last year (that’s my rough estimate… I haven’t had the courage to add it up yet), or the insurance company who, despite receiving over $500 per month in dues from me before I switched to New Job insurance, wouldn’t even pay for my beta when I was pregnant. Assholes.

Dr. Full Steam ahead joked, “Who knows? The IUI might actually get you pregnant! Stranger things have happened!” Ha ha, motherfucker. Just keep laughing all the way to the bank.

No, actually I’m only saying that for effect. I’m not actually bitter about the IUI, though I am bitter about plenty of other things, including the water-under-the-bridge money. I’m actually at a place of true acceptance with the IUI. First of all, this IUI was my idea. Second, I consider it simply a necessary step before the next real try, albeit a step dictated by the bureaucracy of the Bureaucracy Masters: insurance companies. I have zero expectation that the IUI will work. Honestly, it’s no different to me than any other procedure that is necessary before doing an IVF cycle, like an HSG or hysteroscopy. I believe that there’s as much chance of an IUI getting me pregnant as a hysteroscopy. Technically that’s not accurate, but I really don’t think it’s far off from the true odds.

Questions of science, science and progress
Do not speak as loud as my heart
–Coldplay, The Scientist

This brings us to our third order of business, Thoughtful Thursday. This week’s theme: Hope.

Most of us have had cycles (treatment and do-it-yourself) where we were sure that it was “the one.” For me, the first cycle of doing something new has often been infused with extra hope. First year trying to conceive, first Clomid, first IUI, first FSH, first ICSI… Presumably somebody must get pregnant during a hope-filled cycle, but it’s never worked for me.

Many of us have also had cycles where were sure that it wouldn’t work. Maybe we forgot an injection or two, or we were horribly sick, or the timing of sex wasn’t optimal, or we’d just given up hoping. The upcoming IUI cycle fits into this category. Sometimes, thanks to the Murphy’s Law of Infertility, these are exactly the cycles that do work. Both of my BFPs (temporary though they were) have occurred during cycles where I had less hope than usual — miscarriage #1 was going to be the last Clomid+IUI cycle before we stopped trying for a while due to a depletion of energy and money, and miscarriage #2 occurred during IVF #1 when I should have had high hopes but just didn’t.

Unlike me, some people believe in the power of positive thinking. Some of those people even get pregnant by directing the positive energy with their thoughts (probably accompanied by sex or something… I don’t think thoughts are that powerful, at least in this universe… unless you’re one of those horrendous “I get pregnant every time my husband looks at me” fertiles). I have had many hope-filled cycles, especially early on, and it never did anything for me, but I suppose it must work for someone, right? How else would The Secret become a bestseller?

From a cosmic standpoint, I harbor a secret suspicion that positive intentions are good things. I like to imagine the soul of my baby being drawn to my irresistible good vibes, its microscopic body enveloped by my fabulous aura of love. I still think that The Secret is flim-flam, but the romantic part of me feels that hope is better for the universe than cynicism. At the same time, my soul seems to be losing the battle with reality. I have been let down so hard, so many times, that I may have used up all of my hope. Hope hasn’t gotten me anywhere so far, so now I’m substituting Guarded Almost-Optimism and Cautious Could-Be-But-Probably-Not-But-Maybe? in place of hope.

My question to you:
Do you believe that hope can actually impact your outcome? Specifically in terms of a cycle or a pregnancy, or in general if you prefer.

All of this assumes that one’s actions are the same with or without hope, and that attitude is the only variable. Obviously, if you lose hope and give up on treatments, that would likely have a different outcome than doing several more IVFs.

Oh, and after all of my talk about how I have given up on hope, you will laugh your ass off when I tell you where I’m going tomorrow. But that’s a post for another day.