Don't Know Why

As we have shared the news of Jellybean's heart issues with people, we've have two main questions:

1)  Is it the same thing Lil' Bit has?  No.  If it was, doctors would be writing this up in medical journals right now.

2)  Do they know why both your kids have heart issues?  No.  There are lots of factors that can play a role in children getting congenital heart defects (CHD).  Below is our best understanding of some of those risks and why don't seem to be applicable.

Family History
This is generally the biggest factor, hence the big jump in probability of Jellybean having a heart defect once we discovered Lil' Bit had one.  However, to the best of our knowledge, there are no cases of a CHD anywhere in either my or Phil's family.  So, although Lil' Bit's having one increased the chance Jellybean would also have one, Lil' Bit had no increased risks.

Anti-depressant Use
First, an interesting fact:  The fetal heart is fully formed by roughly 7 or 8 weeks gestation, which is generally long before most people know they are pregnant.  Thus, things that occur later in pregnancy have no bearing on whether there are CHDs.  However, because I was taking my anti-depressant prior to and during that time period, and there is a link between the anti-depressant I have been taking and babies having CHDs, we were concerned about this.  However, the drug I took (my doctor just switched me to something new) is linked to a very specific type of defect which Jellybean doesn't have, and I didn't take any anti-depressants during my pregnancy with Lil' Bit.  I have had at least seven different doctors reassure me that this was not the cause.

Uncontrolled Diabetes
Children born to women whose diabetes was not well-controlled are statistically more likely to have a CHD.  However, because my diabetes is gestational, it is less-likely to be the cause of any issues.  My doctors reassured me this is generally applicable to women who are diabetic pre-pregnancy.  In addition, my A1C test at 3 months gestation revealed a nice low average blood sugar level of like 5.5 (well in the normal range).  Because this test provides an average blood sugar level for the prior 3 months, to the extent that there was any chance I had diabetes prior to pregnancy, it could not even remotely be considered out of control.  This was not the cause of either child's CHD.

Chromosomal Abnormalities
There are lots of chromosomal abnormalities that are associated with CHDs and, because I was 34 at the time the embryos were created, my kids were at a slightly higher risk of such abnormalities than if I had been younger.  Because we are unwilling to risk a miscarriage to have an amniocentesis done, we won't know until after Jellybean is born whether he has any such abnormalities.  We do know, however, that Lil' Bit doesn't have any and, because her embryo and Jellybean's were created at the same time, there is no additional risk for him based on my increased age during his pregnancy--the risk is calculated based on the age of the egg, which was the same for both kids.

IVF
This is the biggy, and it's somewhat controversial.  Initially, there was a fair amount of research that indicated a link between IVF, particularly with the use of ICSI, and CHD.  Subsequent research indicated that the increased correlation could be because of the increase in multiples (twins, triplets, etc).  Other research has shown that although there is an increased incidence of CHD among IVF users, it is because there is an increased incidence for couples who suffer infertility, regardless of the fertility method used to conceive.  Thus, whether Clomid, IUI, IVF, or natural conception after years of infertility, the incidence rate appeared correlated with infertility, not IVF.  We had seen this research and thought that since our infertility issues were largely structural--the result of blocked tubes from a ruptured appendix--rather than genetic or hormonal, we had a lower risk.  Guess not.  In any event, the current understanding is that children conceived using IVF do not have an increased risk of developing a CHD.

So, there you have it.  The only risk factors for CHD that might have some application in our case appear not to be the cause.  And, in truth, I'm not sure it really matters what caused it.  If it turns out I did something to cause it, would being able to beat myself up about it change anything?  No.  Would pointing the finger at IVF help?  No.  I think we would have made the same choices because the odds of any child having a CHD are just so darn small.  So, to the best of our ability, we're setting aside the need to know why it happened and just focusing on what we do from here.  It seems like a much better use of our limited physical and emotional resources right now.

An Addiction to Hope

It's been a rough week for me as, every other day, I have learned of another friend, relative, or co-worker who is in their first trimester of pregnancy.  And, although it may not be my first thought, I am truly happy for them.  Knowing first hand how horrible infertility is, I don't wish it on anyone.  Still, hearing the news when I am still raw and not yet through this month of loss (next week would have been my due date with Oliver), I just get angry at the unfairness of it all. I also get cranky because I hate being told no.  I am one of those people who will stubborn my way through to anything I *really* want and being told "no" only makes me work that much harder.  All of which helps explain why, late last night, I was reconsidering our decision to stop IVF.

Now, please understand, cognitively, I have no desire to try again.  I hate the shots and the roller coaster and the waiting.  I hate not being able to plan vacations or use leave time in case I need it for maternity leave.  I get anxious at the idea of having to be pregnant while Lil' Bit goes in for another heart catheterization next spring.  But, being bombarded with all these pregnancies, on top of viscerally feeling the loss of Oliver, and, at least emotionally, all I want is another child.

Finding myself confused about holding both of these diametrically opposed positions, I consulted my "IVF Bible"--The Infertility Survival Handbook by Elizabeth Swire Falker [I highly recommend it for anyone suffering with infertility!].  In it, there is a chapter on how to know when to stop, and she points out that fertility treatments are addictive:  "[R]eproductive technology offers perpetual hope of having a child.  It's almost impossible to walk away from that."  And she's exactly right.  You are forever asking yourself if the next time would be the time that worked.  In addition, there are stories of women who have undergone six or more fresh IVF cycles, and however many attendant FET cycles, before achieving their goal.  It's quite easy, especially for those of us who want to push through and do whatever it takes to get what we want, to slip into a never-ending cycle of treatments.

As I tried to explain all of this to Phil this morning--not because I necessarily want to renegotiate our agreement, but because I wanted to communicate with him where I was (after all, he doesn't know unless I tell him!)--I realized that I was stuck.  I am having a difficult time releasing the energy I have invested in having another child.  However, I am fairly certain that once I have my hysterectomy, I will be able to let go.  There are no more one-in-a-million shots at a miracle child.  There is no more possibility of changing our minds and trying one more round.  I will be physically incapable of achieving pregnancy.  Period.  Then, and only then, will I be able to let go of the energy I have invested in having another child.  Until that point, I am, for better or worse, irrevocably addicted to hope.  And nothing, not our agreement, not poverty, not my infertility, not even common sense, will stop me from hoping against hope that something will change and pregnancy will come.  Which, unfortunately, also means that my real healing may not begin until then.  Instead, every month, until I am proven wrong, I continue to have unreasonable hope that I could be pregnant.  Is it rational?  No, but addictions never are.  And, it appears that nothing short of impossibility will fix it.  Until that time, I still have it within my power to try and to hope against all hope.  And, as long as there is something within my power that I can do, I can't give up.  That's just my nature.  It doesn't mean I'm not going to try to to heal until that happens.  But, at the same time, I have to be honest with myself.  So, this is me, being honest about where I am; about being stuck; about being addicted--to hope.

Marching Orders

[This post is going to look very similar to the one from January, because the protocol is identical.  We're mostly just changing the dates around.  Still, a plan is a plan.  So, here it is.]

This morning I had my blood drawn to check my estrodiol (estrogen) levels.  It needed to be under 50 and mine was 29.  Yay!  You might notice a discrepancy between the necessary levels for this test, and the one I talked about in January.  The difference is that the test can be run on cycle day (CD) 1, 2 or 3.  This time, I had the blood drawn on CD 1, whereas last time it was on CD 2.  The levels should necessarily be lower on CD 2, than CD 1.  Hence, the difference in the level I needed.

I contacted the fertility center and left the pertinent information in a message.  The coordinator called me back and we began calculating when my procedure would be.  We then counted back 18 days from that date to determine when I start my additional meds.  Why do it this way?  Because they only do FETs on Tuesday through Friday (because they have to thaw the embryos and give them time to grow and don't want people to have to come in on the weekend to do it).  So, they don't want people to begin taking meds on a day when their procedure would fall on a Monday or a weekend.  Go figure.  Anyway, we determined that the earliest I could start the meds was tomorrow, but then day 18 would fall on a Monday (the 17th), which is a no go.  The 18th was out because Phil had something on his calendar.  I didn't want Friday the 21st, because I need two days of bedrest (transfer day and the next day), which meant I needed two weekdays so  that Lil' Bit would be in daycare.  That left the 19th and 20th--exactly what I predicted back in June.  Am I good or what?  As I noted in that June post, this transfer date makes for a June baby--roughly June 13th, give or take how they calculate the age of the embryo and everything.

But, what this means for me more immediately is that I have only 18 shots left!  Woo Hoo!  *happy dance*  For those looking for technical details, the protocol is as follows:

• I cut my Lupron dose in half beginning tonight.
• On 9/3, I begin taking estrogen, with the dose increasing on days 6 and 10.
• On day 11 (9/13), I will have an ultrasound to make sure everything is developing appropriately for the transfer.
• Assuming everything is on track, I continue the Lupron and estrogen for 4 more days (including 9/13).
• On day 15 (9/17), I stop the Lupron, reduce the estrogen, and start progesterone.
• On day 16, I start taking antibiotics and steroids in addition to everything else.
• Day 18 = Transfer Day! Followed by the dreaded two-week wait (TWW).

The excitement is building.  We are only 3 weeks away from transfer!  Can you feel that?  It's the roller coaster slowing down as we near the top of the first hill.  Fellow travelers, get ready to raise your hands up over your head, scream as loud as you can, and enjoy the ride.

Politics, Religion, and IVF

As I've mentioned at least a few times before, infertility sucks.  It makes so many aspects of life much more difficult.  I feel fortunate, however, that when it came time to decide whether to move forward and how far to go, we were able to make our decision without any personal conflicts, such as religious or family objections. I know a number of couples who belong to religious faiths that prohibit use of ART (assisted reproductive technology).  While some of the couples elected to abide by that prohibition, others decided to move forward.  Some spoke with their clergy members, others did not.  Ultimately, decisions about fertility are uniquely personal.  Each couple makes the best decision they can based on their own situation.  And, regardless of the decision they make, they deserve to be supported.

This doesn't happen in the real world.  In fact, even when couples are successful and achieve their heart's desire--pregnancy--people sometimes still give them crap about the choices they made because it ran counter to the decision that person would have made.  For example, there was a woman at my workplace who told me that both my pregnancy and my child were "an abomination."  Now, I'm no expert in other people's faiths, but, at least as I understand it, children are always considered a gift from God, regardless of the manner of conception.  Even children conceived by rape or incest are beloved by God.  How anyone could judge a child based on how it was conceived it beyond me.  But, my personal experience very clearly illuminated to me that people do make such judgments.  Sadly, it is people like this who keep those suffering from infertility in the closet, preventing them from receiving the support they desire and deserve.  Infertility is hard enough without being berated every step of the way.

However, difficult as this may be, there are people who are attempting to make it impossible by making IVF illegal.  Now, I understand advocating for your own personal beliefs.  What I have a problem with is politicians, who are supposed to represent everyone, including those who hold different beliefs, who, instead, seek to impose their personal beliefs on everyone.  If a couple feels strongly against using IVF, then they should not use it.  They should not, however, be in the position to make that decision for other couples.  Making IVF illegal will destroy many couple's only hope at having a child.

Now, there are those who believe that adoption should be utilized, rather than IVF.  Here's the thing.  Adoption is not the fix-all panacea that people make it out to be.  This is not to say that it isn't a wonderful thing.  I know many people who have successfully adopted or placed children for adoption.  It is absolutely an option for becoming a parent.  However, it is neither equivalent to, nor a replacement for, IVF.  Prospective adoptive parents have to first jump through hoops to prove that they are better than many parents out there before they are even given the chance to be considered.  You can't do it, you're out, regardless of how amazing you would be as parents.  Then, they have to sell themselves to birth parents, hoping to be picked.  If they can't convince anyone to give them their child, they are out of luck.  Once they have been selected by the birth parents, they spend thousands of dollars on medical care for the birth mother, but still there is no guarantee.  Sometimes, birth mothers decide at the last minute to keep their children.  Now, the couple is out thousands of dollars and yet, remains childless.  Worse, there are women who deliberately mislead couples in order to receive medical care during pregnancy, although they actually have no intention of giving up their child.  This happened to a friend of mine, twice, and she was working with a reputable agency.  So, I reject the proposition that adoption is an adequate or acceptable solution if IVF is made illegal.

Furthermore, there are people who are just unwilling to raise a child that isn't biologically theirs.  I don't see any reason to deny these people the opportunity to be parents by outlawing the only viable method they have.  In light of the increased politicization of this issue, it will certainly inform how I will vote this election.  And I urge you to get informed about the positions advocated by your candidate of choice and make sure they align with your own.

Already?!

As you know, we decided to do one last round of IVF in September.  As it's still June (although just barely), September seems so very far away.  Summer just started; September means school.  That's forever away.  Now, I would be lying to say I haven't been thinking about our last time--it consumes much of my free thought--whenever I actually have some, and I keep getting frustrated that I have to wait so long.  But, this week brought me back to the now.  Because, you see, I had forgotten something.  Something that is both exciting and terrifying.  In the world of IVF, it's already time to start gearing up!  Ack!  I'm not ready!

I spoke to one of the IVF coordinators this week about getting the meds ordered and they will be sending me my folder and consent forms within the next week or so.  We're doing the long protocol again, so in roughly one month, at the end of July, we start the process.  Granted, the first 21 days are more waiting, but we have to actively and accurately count those 21 days.  On day 21 (roughly August 18), the shots start again.  Holy cow!  I am less than 2 months away from starting shots!  And I haven't even thought about what to put in my feel better bucket this time!  Breathe.  *gasp*  Breathe.  *gasp*  BREATHE! *pant pant* Okay.  I'm okay.

Ten to fourteen days later (last time it was 12), we start the additional meds and begin what they call "procedure month," i.e. the 18-day countdown to transfer.  Since they only do transfers Tuesday through Friday, we'll make sure that day 18 falls on one of those days before we start.  That means we're looking at a transfer maybe September 14, but more likely September 19, 20, or 21.  All of which means a June baby. June.  It's June now!  If we're successful, in less than a year I will have another child!

All of this is so crazy to contemplate.  I am so excited (you can tell by the fact that I got to plan out all those numbers up there)!  I'm also terrified.  Although I am still absolutely certain that this will be our last round, it's bittersweet.  It means we've reached the end of our journey in creating our family.  All of the time, energy, and resources we have been utilizing to make decisions and plans and take care of all the medical stuff necessary to make it happen will be over.  No more shots.  No more calendars.  No more agonizing decisions.  I can have my surgery and we can work on settling in as a family of whatever size--3, 4, 5(?!).  And whether that event occurs October with an unsuccessful try, sometime thereafter with a pregnancy loss, or next June with another baby, it's going to happen within the next year.  It means change.  It means loss.  It means growth.  It means time is moving on.

I know everyone always said that time moves so much faster as you get older and even more so once you have kids.  I am discovering how true that really is.   So, as I kick myself into overdrive, trying to lose that last bit of weight, planning things for my feel better bucket, and getting myself physically and mentally prepared, I want to also take a few extra minutes each day with Lil' Bit and enjoy her just as she is.  Be amazed at who she is becoming.  Because whether she's an only child or a big sister, change is coming, and it will be here soon.  In fact, it's almost already here.

One Last Ride

Well, it's official.  We've signed up to take one last ride on the IVF rollercoaster.  We've decided not to try until September because otherwise, either the shots, the procedure, or the due date would interfere with something else already on the calendar.  And, since we get to pick, why the heck not make it most convenient for us, right?

So, you probably have some questions.  Like, what made us decide we wanted to try again?  Or perhaps, how do you know it will be the last time?  Fortunately, we have some answers we're willing to share.  So, here goes.

When we did the FET (frozen embryo transfer) last time, we pretty much agreed that we would get what we get and be done.  So, if I didn't get pregnant, we would stop, but if we did, then we'd have however many kids we got and call it a day.  We hadn't planned on there being another alternative.  But, there was.  I can't speak for Phil, but for me, getting pregnant and then losing Oliver only made me really want to try again.  As heavy as the loss hit me, I knew that I wanted another child.  I reached my decision long before Phil did.  But, since this really isn't a solo endeavor, he had to be on board.  Otherwise, we weren't doing it again.  I was smart enough not to try to get a decision out of him during Lent/Easter or the few weeks thereafter.  But after that, we started to talk about where we were.  One problem both of us had was that we were so exhausted by Lil' Bit and the rest of our lives, we couldn't imagine having any energy for another child.  Then, as you may recall, I discovered anti-depressants.  Oh, brother!  I suddenly had energy for me, for Lil' Bit, for work, and some left over.  It was a freaking miracle as far as I was concerned.  Suddenly, I felt like I could handle another one.  At some point, Phil reached the same conclusion, and we moved forward and got our names on the calendar.

Another factor that played in to this decision for me was Lil' Bit's condition.  I finally broke down and asked her doctors what they thought her life expectancy was.  Obviously, because of her conditions, there is no real group of people to compare her with, but they both said the same thing.  Given how great she's doing and the fact that she has never showed any symptoms, they don't see any reason at this point why she won't grow to adulthood.  This was very important to me.  I didn't want to be having a potential "replacement" child, and I didn't want a child that would feel second-banana to a sick older sibling.  I also didn't think I could bring a child into the world knowing that they were going to have to experience the loss of their sibling.  Certainly, there is no guarantee.  There are many ways to lose a child, even a healthy one, long before they reach adulthood.  But that risk is inherent with all children and not unique to Lil' Bit.  So, it's one I was willing to accept.

And now we reach the million dollar question--how do we know this will be our last round.  Well, several reasons.  First, I am not willing to undergo another "fresh" cycle.  The cost monetarily, physically, and emotionally are more than I am willing to endure.  So what, you say.  You have seven frozen embryos left and you're only going to use two.  True.  But, given Lil' Bit's congenital defect and the high likelihood that Oliver miscarried because of a genetic abnormality, and given that the clinic always uses the best and strongest embryos each time, chances of a viable pregnancy with the remaining five would be slimmer each time.  Don't get me wrong.  There are people who utilize each and every one and get healthy pregnancies with "lower" grade embryos.  It's not a given.  But it's a percentages game and it's one I'm not willing to play.  So, this would be the last round I would want to use the frozens and I'm not willing to do another fresh.  (And, in case you're wondering, provided that the clinic is willing to accept them, our plan is to donate the remaining ones for others to use.)

More than that, though, is that whatever result we get, we'll be emotionally and physically done.  There are three possible results:  no pregnancy; miscarriage; baby.  If I don't get pregnant, we'd be looking at another procedure.  Even if we did another FET, there is a high physical and emotional cost and I'm not getting any younger.  As I creep closer to 40 and with Phil being five years older than I, it doesn't seem right to spend more assets on attempts for children that, if successful, would result in their reaching college age around the time we want to retire and, if not successful, simply depletes our assets when we have a child who requires ongoing medical care.  If we miscarry again, I will be done.  There is no way I could put myself through that again.  And any new attempt would invariably have that risk.  I am willing to take that risk once more, but that's all I can take.  Finally, if we get pregnant and have a baby (or babies), we'll be done.  We will have achieved our goal.  No reason to do it again.  Finally, attendant with each of these decisions is also the fact that, once we're done, I can finally have my hysterectomy and stop having all these problems.

So there you have it.  Why we decided to try again, but why this will be our last try.  Welcome to our one last ride.  Come along and join the fun.

Lightning Does Strike Twice

It's official--we're pregnant again!  Both betas are back and the news is all good.  Today was rough, though.  I had my blood test at 7:00 a.m.  Monday's results had come to me at 9:00 a.m., so I expected something similar today.  No dice.  I still had no call by 12:30 p.m.  I had just about decided I would call them around 2:00 p.m. when Phil called me to tell me there was a message on the phone at home to call them (they had never called me at that number before).  Well, they are closed from 12 to 1 for lunch, but I called and left a message anyway and said to call my cell.  Sometime around 1:15, I guess, I got the call.

Monday's beta was 68, so the magic number we *thought* we were looking for today was 136.  We got 119.  My initial thought was to totally freak out, but before I did, I managed to notice that the lady at the other end was still talking in a happy voice.  So, I managed to push down most of my fear and listen.  Apparently, they look for the number to "roughly" double, because the doubling time is 48 to 72 hours.  Because the beta tests were only 48 hours apart, 80% of the way to doubling is well within that range.  Yay!  I double-checked with the nurse that it didn't need to be higher and she assured me the numbers were fine.  However, she offered to order another test in two days if we wanted, but I told her I was willing to take her word for it.  [She has no idea how big a step that is for me!]  I texted Phil right away so he could put the news out, and I posted a picture of Lil' Bit in her new "I'm the big sister" shirt.  [We actually let her wear it to daycare today we were feeling so good about the news from Monday.]

The plan from here (because you must know by now that there will be a plan and I will share it) is that we have our ultrasound scheduled for March 1--which will be just over 6 weeks pregnant if I calculated correctly--at which point they can tell us if we're having twins.  My guess is no, particularly in light of my numbers, but you never know.  So, any betting folks out there?  Boy?  Girl?  Both?  A pair and a spare?  Before you ask, I have no preferences boy or girl, but my guess is that it's a boy.  I would prefer just one, but I will take what I get and be thrilled to bits.  For now, I'm just basking in the glow and totally amazed that we managed to have successful IVF cycles on the first try both times.  I am dumbfounded, but also truly blessed and grateful.

Mutant M

Unless you've just joined us, or have been hiding under a rock, you know I'm giving myself hormone injections.  As much as I am not a fan of giving myself shots, I must admit that I am still extremely lucky.  Why?  Because I don't seem to experience the side effects the way others do.  Yes, I got extremely emotional last time on the stims.  I went back and checked (thanks blog!) and, apparently, I got angry and irrational.  I'm not saying I don't experience any effects.  But, when I was originally researching IVF and what to expect, I was terrified of Lupron.  I read that it stung on injection, that it caused headaches, hot flashes, dizziness, nausea or vomiting, sleep issues, and all other types of issues.  Fortunately, neither last round nor this time have I had any such issues with the Lupron.  It never occurred to me that this was odd.  Every drug affects people differently and some people get side effects and others don't.  

And so it was, we were in to see my GP (general practitioner) last week for (yet another) ear infection.  I told him that we had elected to go forward with another cycle and that I was currently on Lupron injections.  He asked how the hormonal swings and other craziness was going and I said, "I don't seem to have any effects from it."  He looked over at Phil, as if seeking confirmation, in case this lack of symptoms was all in my head and I was actually a crazy woman.  "No, really," he reassured Dr. R.  "She's not having mood swings or anything."  Dr. R. looked back at me and pronounced me a "hormonal mutant."  After Phil and I finished giggling over this statement, I really wanted to ask whether Dr. R would certify my mutant status so I could qualify for the X-men.  After all, at heart, I remain a gamer and comic geek.

We Have a Plan

And there was much rejoicing (at least, by the piece of me that needs/yearns/longs to plan)!

I had my blood drawn this morning.  They were checking my estradiol (estrogen) level.  It needed to be under 25 and, as an overachiever, mine was 12.  I dutifully called the fertility center and left a message with the coordinator with all of the pertinent information.  She called me back and said I could start my additional meds today!  This is good news because it means:

• we're underway.  Always exciting!  
• I am, with minimal give or take, 17 days away from transfer day!  OMG!  That is freakishly soon!
• FEWER SHOTS!  Again, with minimal give or take, I now have only 14 shots left.  Can I get a "Woo Hoo"?!  That is like passing "Go" and collecting $200.  

Okay, now for the plus or minus caveats.  I am scheduled for an ultrasound on the 26th, at which point they will determine whether my lining is sufficient.  If not, they could push things out a little further, which would involve additional shots.  However, according to the doctor, it is unusual for things not to be spot on.  So, although there's a chance for a few additional shots and some pushback in the schedule, we're looking at a February 2 procedure.  As the person always thinking ahead, my first thought (and I'm sure your's too) was:  "What would this mean in terms of due date?"  I frantically scoured Google for the answer because, well, it's me.  It's what I do.  This really should shock none of you by now.  Anyway, the answer is, roughly October 22.  I say "roughly" not just because due dates are always estimates, but because I don't know exactly how the due date is calculated for an FET and the on-line FET calculators ask whether it's a 3-day or 5-day FET.  I *think* it will be considered a 3-day, but I don't know and, honestly, it isn't going to make that big a difference.  *Gasp*  Did I just say that?  Yes, I did.  Who am I?!  Well, likely, I'm still me because the truth of the matter is, they will tell me my "official" due date when the time comes, so this rough guesstimate is fine for now.

Finally, for those interested in the technical details:

• Today I started taking estradiol pills and tonight I will cut my Lupron (the shot) dosage in half.  
• The Lupron will stay the same, but the estradiol will increase on days 6 and 10.  
• On day 11, I have an ultrasound (the 26th for those paying attention from earlier).  
• If everything is fine, I continue the estradiol and Lupron 4 more days  (including the 26th, so through the 29th).
• On the 30th (day 15) drop Lupron altogether (NO MORE SHOTS), cut back on estradiol, and begin progesterone supplements.
• Day 18 (Feb 2)--Transfer day!

Now comes the hard part.  Now that we have a plan in place, I have to acknowledge I'm not in control!!  Gah!  Memo to me--plan does not equal control.  *Sigh*  At least I can maintain a semblance of control by making sure all my meds are timely.  Right?  Who's with me?  *crickets*  Fine.  But hey, we're on our way.  And not even my lack of control and burst that bubble today!  Woo Hoo!  

Dr. Seuss

In order to keep myself motivated, I have been posting the completion of each shot on my Facebook page.  My first statement was simply, "Shot one is done."  When I went to post about shot two, I decided I wanted to make them all rhyme for as long as I could.  Thus, I posted, "Shot two is through."  After shot four, a friend of mine asked whether this was a Dr. Seuss book.  I thought that was funny and irreverent and, therefore, the perfect thing for my blog.  And so, without further ado, I present to you:

Shots for Tots

Shot one is done.
Shot two is through.
How many self-shots can you do?

Shot three is history.
Shot four is out the door.
I can tell Phil didn't watch, he isn't on the floor.

I survived shot number five.
I kicked shot number six.
How much longer can I keep up with rhyming antics?

Shot seven tests my inner will.
Shot eight bring wishes for a pill.
Yet still I poke, and hope don't choke and, 'lo, improve my skill.

Still doing fine after shot nine.
Shot ten disturbed my zen.
But I press on, 'til meds are gone--again, again, again.

Eleven shots are now complete.
Shot twelve does not feel like a treat.
But for a baby on the way, these wretched shots are here to stay.

Unlucky thirteen's shot has come.
With fourteen we are halfway done.
It seems I cannot be more brief, and so we all wait for relief.

Shot fifteen turned out okay.
Shot sixteen has had its day.
But more shots come because until done my doctors I obey.

Although eighteen feels like the billionth,
at least we're in procedure month.

Nineteen, twenty, twenty-one
Would they be easier with a blowgun?

Twenty-two and three and four,
All the pain I must ignore.

Twenty-five and six and seven,
Almost done, that sounds like heaven.

Twenty-eight is finally here.
"No more shots," I shout and cheer.

Four more days until bed rest.
Then twelve more until blood test.

Shots are bad, but waiting's worse.
This whole thing feels like a curse.

If the phone call brings good news, I can go buy baby shoes!
If results are negative, moods will be much less festive.

But either way, I will have shown,
I'm so much stronger than I'd known.

And so concludes this counting tale.
Of what my FET entails.

And We're Off...

Well, I did it.  I just gave myself my first shot for this cycle.  It took a lot.  More than I expected.  Apparently, it made no difference that I had reached the point of being blase about giving myself shots by the end of the gestational diabetes thing.  Having had almost 14 months of not having to give myself a shot reverted me back to square one.  Well, not entirely square one--I knew I could do it.  I flinched when I did it, though.  Phil had come up to give me moral support and I couldn't do it with him watching.  Had to go to the other room.  But, I did it.  Yay!

I set up my calendar like last time and awarded myself my smiley-face reward.  I realized this evening that I have not yet made a feel better box.  I think part of why I forgot to make it is because of the sheer reduction in the number of injections I have to give myself.  We're looking at approximately 28 total shots.  That's like nothing compared to last time.  Still, I need to make my box soon because I know I will have hard days.  I will likely order most of its contents from Amazon because it's easier to have everything shipped to the house than go out shopping these days.  Don't know what I'll put in it this time, though.  No candy (drat!) as I am really trying to cut back on the chances of diabetes again and no books because I already have a stack a mile high that I can't seem to get around to.  Movies and clothes I suppose.  I'm open to suggestions.  But, I digress.  We're on our way!  Baby #2 (and 3?) here we come!

Once More Into the Breach

When we last left our intrepid parents, they were traveling home from family visits with a tired, precocious 13-month-old, trying to recover from a rather eventful trip while discerning whether they were crazy enough to have additional children....

Before we get back to that part of the story, I have to confess that I there is a rather large piece of the equation regarding our decision to have additional children that I haven't shared, but is a driving force behind my feelings of urgency.  That is, once we're done having children, I'm having a hysterectomy.  My body and I have never really gotten along in this regard.  Whether it was ruptured ovarian cysts, extremely severe Mittelschmerz, endometriosis, or excessively long and heavy periods, I have always felt at war with myself.  My cycles started when I was 9 and I was on birth control by age 16 to regulate my body and stop the cysts.  However, you (generally) can't be on birth control and have kids.  So, those years we were trying to have kids, without success, were particularly difficult for me because I was experiencing horrible physical pain in addition to the crushing sensation of failure each month.

Once we got pregnant with Lil' Bit, I had a reprieve that lasted almost 6 months postpartum, but it all came back with a vengeance.  There had been a chance that my system would regulate itself and some of the issues would be gone.  Sadly, it was not to be and each month I wait for the pain to begin all over again.  Every month that we postponed having another child was another month of agony for me.  I wasn't ready to say "no," however, because I knew that once we made that decision, it would foreclose the possibility for good.  And so I struggled.  I wanted to make sure we made the best decision we could for our family, but I desperately wanted to stop the pain which meant either having kids now, or foreclosing the possibility for good.

So, with that additional background, we find ourselves again in the middle of yet another discussion regarding additional children.  Only, it went nothing like I expected.  Today was our "drop dead" date for a February procedure because I would have to start shots tomorrow.  With that in mind, as we were driving home on Monday, I asked Phil whether he would prefer if we just skipped February.  In my mind, I was offering him more time to consider our options, the same way I had when I asked if he wanted to postpone the cycle from a January procedure.  So, imagine my surprise when the first words out of his mouth were, "I think I'm okay with February."  After I recovered from the mental whiplash I suffered upon processing his answer, I said something to the effect of, "Me, too."  Although I certainly had not been expecting that answer, I knew it was what I wanted, so I was going to take him at his word and get the ball rolling.

Still, I wondered how had we gotten here?  Only days before, we had both been leaning heavily toward not.  I can't speak for Phil, but I know what changed for me.  Mainly, I discovered that some part of my brain had been miscalculating the equation.  In the midst of all the frustrating and stressful parts of parenting, some piece of me got the idea that the difference between 2 kids and 1 was the same as between 1 and 0.  It isn't.  Once you have the first, stress and frustration are a given.  Not having a second child was not going to make my life stress-free.  Lil' Bit would still get on my nerves and warm my heart and do all of the things she does now, regardless of whether we had additional children.  Once my mind finally accepted that life was going to be stressful no matter which way we went, I was freed up to say "yes."

I also realized that one of the reasons I would like another child is the chance to pay better attention.  When Lil' Bit came along, we had no idea what we were doing as parents.  Everything was new and I was exhausted and overwhelmed.  Now, I fully expect that there will be periods where I am exhausted and overwhelmed if there are additional children in our future.  But, I get the chance to pay attention; to watch the baby grow and learn.  To love the newborn when all it is is a lump that needs so much love and attention.  I have spoken to or read accounts from many families where parents take great joy in the third or fourth child because they know it will be their last and so they savor every moment.  I want to do that.  I want to savor the moments because, chances are, this will be it.  And, I want to watch both Lil' Bit and the possible future children grow into fully-functioning adults.  I want to see who they become and watch how that happens.  I want to see how they are different and how they are the same.  I want to see them interact as siblings.  I can honestly say that I want to have additional children for those children.

In addition, I realized that the 1-year follow-up visits for Lil' Bit aren't set in stone.  Medicine is flexible.  If and when we get pregnant and have a due date, we can alert the doctors and make sure the visits occur either prior to my due date, or get any number of friends to help us out if we have a newborn or two to deal with.  Either way, we can manage it.  I have every faith in my ability to schedule and plan that we can make it work.

Suddenly, *poof*, like magic, all of the problems didn't seem like problems anymore.  And the decision felt right.  Unlike the overwhelming sensation of drowning I had when we were looking at a January procedure, I have mostly a sense of calm about a February procedure.  (I say mostly because I must admit to being slightly anxious about starting shots again tomorrow).

So, there you have it.  The long of it (because there really is no short here), is that we have decided to go ahead with a frozen cycle--starting tomorrow!--resulting in an early February procedure and the potential for an Oct/Nov baby.  Let's see what happens, shall we?

The Power of Routine

Last week, one of my friends at work noted that we must be getting into the groove with Lil' Bit's meds because I seemed much calmer.  I suppose that's true, although I don't feel particularly calm most days.  Glad I can still fake it :)  Anyway, her statement made me think.  There is something to the power of routine.  It's how we sleep-train kids-Bath, Jammies, Book, Bedtime.  Each night, once the routine occurs, they learn to expect what happens next--lights out, door closed, sleep time.  So, even though interrupting our day 6 times for mediation still is frustrating, as is waiting the additional 20 minutes each time to make sure the dose takes, we're much better at it.  We have something that resembles a routine and it has made life simpler.  That is not to say life has been anything close to simple.  All of this craziness on top of Advent was bound to be problematic--and it has been.  But we have managed to stay married and not to kill each other or lose any fingers or toes.  All in all, I think we're doing well.

In the process of working on things, we had a fascinating discussion last night as we were contemplating whether we were going to go forward with another IVF cycle.  Yes, dear readers, the lack of posts about shots and prep is not because we're being quiet this time around.  It's because we postponed it.  Knowing that stress is such a huge factor in whether a cycle is successful, and both of us feeling that we were in way over our heads, we called the center and pushed our cycle out one month, with the option to push it back further, if necessary.  We are now figuring out whether we are willing to go ahead this month, or wait a while longer, or do it at all.  In that vein, we wanted to wait until Lil' Bit had her follow-up appointment with her pulmonary hypertension specialist yesterday.

Before we get back to the fascinating baby conversation, take another quick detour with me as I summarize where we stand with Lil' Bit's treatment:

1)  We can finally stop one of her three meds (after weaning for 1 week).  Hooray!  Happy dance!  *Insert other related excitement responses here*

2)  Her two other meds are still 2 and 4 times a day, respectively, and can't be within an hour of each other.  So, meds still 6X per day.  Boo!

3)  Her pressures did not go down, but they also did not go up.  *Insert neutral response here*

4)  Her condition is likely chronic, but that doesn't mean she won't get off the meds.  There are generally no concerns for children with pressures where hers are currently, but they want to keep her on the meds for about a year to see if the pressures will go down further.  *Neutral response, maybe slightly positive*

5)  She doesn't need to go back to the doctor for 3 months and won't have to have a heart cath for probably a year!  Yay!!!! *repeat*

6)  She still has to have monthly blood tests for one of her meds.  Boo!!  *repeat*

7)  She can go back to daycare in January!  Woo freakin' who!!!  [This is, truly, what will save our lives!  As a brief aside--a giant thank-you to those ladies who have come to watch Lil' Bit at our house so I could go back to work!!!]

In sum, still lots to do, but generally good news.  Lil' Bit it doing great.  In fact, you would think she's on speed with all the extra energy she now has, which is, apparently, fairly common in children who undergo heart surgery.

We return, now, to last night's baby conversation.  *Spoiler alert*  We still haven't decided where we are.  But in the process of talking about it, something interesting came up.  Phil was talking about how difficult it had been to interrupt his day to have to come home and give Lil' Bit meds at various times.  We discovered that he was experiencing something akin to the frustration I had felt when I had to do all the pumping.  Before I moved to a 4 or even 3-a-day schedule, I had been pumping 6 times a day, roughly every 4 hours.  Count 45 minutes for prep and pumping and another 15 for clean up, and it honestly felt like all I did was pump.  I would just get started on something else when I would have to go back and pump.  Likewise, Phil would get started on a project and suddenly discover that he had to run home and medicate Lil' Bit.  5 minutes of driving, 10 minutes of prep, 5 minutes of feeding meds (if lucky), 20 minutes of waiting to see if they took, 5 minutes driving back and *poof* he was losing multiple hours each day.  In the midst of this discussion, we both became more cognizant of the toll things were taking on us.  He had a better understanding of how difficult pumping had been, and I had a better understanding of how coming home to give meds was affecting him.  And we both became aware that it was the disruption to our routine that was causing so much stress.  As we talked about what it would mean to have Lil' Bit back in daycare so that much of our routine could return, we began to see a light at the end of the tunnel.  Routine, it turns out, is important for more than getting babies to sleep.

Ultimately, it was a good and important moment in the conversation because we were both reminded that stress, frustration, and lack of sleep are mutual enemies, against which we must present a united front.  By recognizing that we are both "done," we are much better out being less snippy and not taking our stress out on the other person.  Don't get me wrong, we're far from perfect, but I think we're doing a pretty good job.

In any event, here we are.  No decisions on a second child and still somewhat stressed by the first.  But things are improving, and time is passing, and we're getting settled into a routine.  Which begs the question--do we really want to wreck our new routine when we're just figuring it out?  Stay tuned, dear readers, to find out if we're crazy enough to attempt it.

Mixed Emotions

It's been a strange few weeks here at the hospital.  As previously mentioned in other posts, Phil and I have been discussing having another baby, but we were waiting to hear the outcome of Lil' Bit's surgery to make any final decision.  Well, since everything was looking so good for her to go home on the 14th, we called the fertility center on the 12th and paid our deposit for an FET (frozen embryo transfer).  Of course, it was over the weekend, after we did that, the world went sideways.  Lil' Bit stopped holding down food and her discharge got delayed.  Then came the second-guessing.  Should we have waited longer to decide?  Ultimately, it doesn't really matter.  The decision is just as over as the Peloponnesian War.

So, this week I called the center and made an appointment for some tests I have to have this month.  If all goes well, I start meds around December 6 for a January procedure and September baby.  As excited as I am, there is some piece of me that keeps screaming in the background: "Are you crazy?!  You're not ready to do this again!"  And yet, even with all I have seen here and everything we have gone through with Lil' Bit, I want another baby.  I want Lil' Bit to have a sibling.  I want another child to help keep me from being over-protective of Lil' Bit--someone that will help me treat her like a normal kid.

At the same time, however, I have to temper all these wants and hopes with the fact that nothing is certain.  Just because it only took one round of IVF for Lil' Bit is no guarantee that things will work this time.  It certainly improves our odds, and I definitely feel more positive than I did last time that things will work.  Nevertheless, I have to remember that just because we have signed up to do another procedure is no guarantee of another child.  On the flip side, even if it works, there's no guarantee we'll only get one.  My dear friend keep threatening that we'll have triplets --a pair and a spare as she likes to say.  We'll cross that bridge when we get to it.  For now, all we can do is move ahead with our decision, knowing it's what we want to do.  Whether we get none, one, or multiples, we'll get what we get, and we'll deal with it when we get to that point.  For now, it's nice to have a little bit of excitement and hope growing in my heart as I (ever so impatiently) wait for Lil' Bit to get out of the ICU.

Insane Hopefulness

It is often said, though unknown who first said it, that the definition of insanity is doing the same thing over and over and expecting different results. By this definition, I am insane. Hopeful, but insane. Why? Because month after month I hold out hope that I can conceive a child the old fashioned way. That Lil' Bit can have a sibling without me having to get shots and be poked and prodded for three months before all the poking and prodding that comes from being pregnant. But, each month, I am heartbroken when I discover nothing has changed. Not surprised, mind you. Just heartbroken. And yet, I still hold out hope. Because, although it's improbable, it's not impossible. I personally know couples who had the same issue I did and managed to conceive. I know other couples who, once they used IVF, were then able to conceive on their own. I also know, however, thay my issues are somewhat different. Usually, those who successfully conceive after IVF are those who had unexplained infertility or miscarriages and whose bodies suddenly realized they knew how to work and did. When physical blockage is the issue, that's not something that usually changes. It can, it just usually doesn't. So, my logical, practical side knows that I am unlikely to conceieve without another round of IVF. And, if that's what we decide to do, we will. But the hopeful, whimsical, insane side of me thinks that maybe this time, we'll get a different result. For this month, there is no miracle baby. Who knows, though. Maybe next month. I just can't help myself. I'm suffering from hopeful insanity. Still, I think insane hopefulness is better than no hopefulness at all. And, don't forget, there's an equally prolific saying in my favor: if at first you don't succeed, try, try again. So, here I go.

Please Sir, I Want Some More

Yes.  I have just likened having another child with the quest for more gruel in Oliver Twist.  Still, it seems fitting.  After all, I am still finding it hard to believe, given how vocal and certain I was at the time of Lil' Bit's delivery that we were only having one, that I now find myself having passed the "serious consideration" stage and am actively contemplating another child.  Still, that's where we are.  So, I thought you might like some insight into how we reached our decision.

Last week, we went back to the fertility center and met with the doctor to discuss what doing another IVF cycle would entail.  (By the way, did we ever mention that the doc looks like Stephen Colbert?  We just kept waiting for him to hold out his hand and say, "Nation..."!  But I digress.)  Part of the need for discussion was based on the fact that this cycle would be frozen instead of fresh, so there is an entirely different protocol.

On the IVF side of things, we learned several important things.
1)  Frozen cycles are only about half the cost of fresh--maybe even less depending the meds my insurance will cover.
2)  There are waaaaaaaay fewer injections.  In fact, it appears as though there's only one med done by injection and everything else is pill or suppository.  It just keeps getting better.
3)  My success rates have not gone down even though I aged.  Because we froze my eggs before I was 35, my success rates are calculated from the <35 category, meaning we're still above 50%.  Also, we have an increased chance at success because we had a successful pregnancy from the same batch of embryos.
4)  Although my doctor would like me to lose 10-15 pounds to increase my chance of success, I actually already weigh 8 pounds less than I did before the last procedure!

All of this was good news, which is to say, it all helped pile us more firmly into the "yes, let's have another" column.  In addition, I got word last week that I got a promotion at work that not only came with a pay raise, but would be a career position that would not require my boss getting re-elected.  Permanency and pay raise also significantly favor the "yes" column.

Figuring out that we were both leaning fairly heavily toward "yes," the next question was when to do the procedure.  After all, since we get to plan this thing, we might as well make it as convenient for ourselves as possible.  Now, my "charge ahead first, ask questions later" personality said to go for it as soon as we could.  After all, there's nothing more frustrating to me than having made a decision, but not being able to move forward or do anything toward that decision.  Still, as we started talking about what certain procedure months would mean in terms of where vacations would fall, how much leave I would have saved up, when the baby would be due, when it would no longer be feasible to travel, and other similar considerations, we realized that waiting was better.  The further we pushed it out, the more leave I would have.  Plus, we would be able to visit family for holidays and go on a trip next summer that we've had to skip the last two years.  Waiting would also give me a chance to lose a little weight and develop some healthy eating habits.  My goal is to stick closely to a modified diabetic diet in an effort to prevent getting gestational diabetes again.  That way, even if I do get it, it won't require me to make too many changes in my diet at that point.

Still, I didn't want to push it too far out.  I really want my kids to have unique, separate birthdays.  Therefore, February was the furthest out I was willing to put the procedure given that Lil' Bit was an early March procedure.  Although, February would be a late October baby and that was really longer than I wanted to wait to move forward and the kids would have birthdays closer together than I wanted, I couldn't fight the seductive list of things we would be able to do if we waited.

Ultimately, the tipping point came when I realized that we were going back to the cardiologist in October to discuss our long term care plan for Lil' Bit with her VSD and missing pulmonary artery.  By waiting until after that visit, we should have a much better sense of the type of care Lil' Bit will need in the future.  That way, if it seems like she will need to have lots of surgeries, it may be worth it to save our leave time and money to properly care for her.  Also, I want to make sure any subsequent children will receive adequate time and attention from us, rather than always coming second because of the time and energy it takes to care for Lil' Bit.  My guess, given that she's asymptomatic at this point, is that she won't need much specialized care--just a lot of monitoring.  Still, since we have the ability to schedule when and if we have another child, it makes sense to wait so we can factor this information in.

Oh, and as for multiples and possible failure, we have decided to have roughly the same attitude we did with our first IVF.  We'll get what we're supposed to have.  If it's none, it's none.  If it's one, it's one.  And, God help us, if it's two, it's two.

So, there you have it.  Barring any bad news this October about Lil' Bit's healthcare, the plan is to reserve a spot for a February procedure, making for an October 2012 baby (or babies!).  More gruel(ing labor) anyone?