What to expect when you’re expecting a preemie?

I’m at Brigham and Women’s Hospital in Boston, staying the night with my dear friend R. who is 28 weeks pregnant after IVF and now hospitalized for the duration of her pregnancy. She had to be admitted after it was determined that she was having contractions, was four centimeters dilated, and that her membranes were bulging. With medication, the contractions have been stopped. And now she’s trying to eke out as much time as possible before the baby is born.

Once R. got to the hospital, it was also discovered that she has protein in her urine (BP is normal) so they are watching her for preeclampsia. She has received steroids to develop her daughter’s lungs. She may or may not be leaking amniotic fluid (two tests came back positive, two negative). They are estimating her daughter currently weighs approximately 3 lbs.

R. is a very good friend of mine from college. She miraculously got pregnant with this little girl with her own eggs at age 44 – from her first IVF cycle (I am only a little envious of her incredible luck and amazing egg quality). I am going to be her daughter’s godmother once she is born – which her doctors say is likely to be in the next week or two.

Considering everything, R. is doing pretty well. Her family lives a few hours away and can only visit once a week, so she is alone right now. She’s scared, bored, and a little blue after spending Christmas waiting for the impending arrival of her daughter. But she is resilient. And she is grateful to have made it to a great hospital with a good NICU.

This is R’s first – and will be her only – biological child. She hasn’t yet taken any birthing classes, doesn’t know much about breastfeeding, and doesn’t know ANYTHING about preemie births and what to expect after the birth.

So my dear readers and ICLW’ers , this is where I turn to you for advice.

Since I am nulliparous, I’m not even sure what specific questions to ask. And of course I realize that every week will make a big difference in the outcome for her daughter and that there is a lot of variability between one baby and the next, even when babies are born in exactly the same week. And I also know that based on some of your experiences, 28 weeks sounds pretty far along! That said, moms of preemies, can you give any words of advice to R? What do you wish you had known? What got you through the toughest times? Any recommended reading on dealing with the special issues presented by a preemie?

Thanks in advance for your thoughts, advice, book and website recommendations, etc.

Mo

The consult...a look back, plus a plan

So you saw our questions in the last post. Now we have some answers. Thank you for all of your ideas about what to ask - both those left as comments and those privately emailed. Will and I appreciated all of your thoughts.

The RE's main point was that we shouldn't lose hope. He feels our prognosis is still very good. That we had bad luck with the chromosomal abnormality and miscarriage our first cycle ("That could have happened to anyone"). And that we can't read too much into the failure of cycle #2 because we only cultured three embryos (freezing six others at 2pn stage) and only transferred one.

He still thinks we can succeed with our own eggs (and even said he would not allow us to use a donor at this point if we wanted to, which we don't). Surprisingly, he felt the embryo quality throughout the three cycles has been fairly good. (Could have knocked me over with a feather with that statement. I was like "Really??!")

He continued to say that PGD would do more harm than good and that CGH is still too experimental (he said he thinks that the technology is still years away). He said they don't do micro-dose lupron except in the case of poor responders ("and you're not a poor responder," which was nice to hear). He seemed so-so about assisted hatching (but I think we'll ask for it anyway).

In terms of what's next, he said we should probably do endometrial co-culture and he's changing our protocol, removing lupron, upping the dosages of the meds a bit, and adding Ganrilex and menopur.

We are on the cancellation list to try to get in to do a co-culture biopsy in late January. I'm going to stay on progesterone through Friday to delay my cycle starting (who thought I would ever agree to extra PIO shots?!). If we're able to get the endometrial biopsy done in late Jan, we'll be on to cycle again in late Jan/early Feb.

So it looks like we're on to (gulp) IVF #4.

I can't believe we have to cycle again. But since we do, it feels so so much better to have a plan.

By the way, it is freakin' COLD in NYC today. Like Minnesota cold. Those of you who live in northern climes (Canadians, I am talking to you), I applaud you. I don't know how you do it.

Thank you again for all of your encouragments, stories, suggestions on blogs to read, and medical advice. I never realized how interactive blogging can be. Your thoughts and comments have been an enormous help.

We are past the solstice. There is a bit more light today than yesterday. Hoping for brighter, warmer days ahead.

Mo

Blue Christmas

Despite white snow blanketing New York City, it looks like we're in for a blue Christmas this year.

Today is 11dp3dt. Beta would have been today except that my clinic doesn't do betas over the weekend. HPT continues to be negative. It's over.

Will and I have been wrapping our minds around the likelihood that this cycle was a bust for the past few days, so the unbearable sadness is already starting to give way to a grudging acceptance. This IVF is tougher because it feels like three failures is significant. Like maybe we aren't going to get through to the other side and have a child. Which is excruciating.

It seems fitting that today is the winter solstice: longest night of the year, shortest day. Am hoping that metaphorically this means things will begin to improve. That this will be our lowest point in the journey toward a child.

We will see the RE tomorrow to get his thoughts on where to go from here.

These are the questions we are considering for him:

1. What happened? Where do you think this cycle went wrong?
2. How did embryo quality compare to previous two cycles?
3. A year ago after the first miscarriage, you said our prognosis was "fabulous." What is our prognosis now?
4. What have you learned from this cycle about how to go forward?
5. Would more aggressive stimulation help?
6. How about assisted hatching and fragment removal?
7. Or endometrial co-culture?
8. When can we cycle again?
9. Would varicocele surgery help? How long afterward would we have to wait?
   

Anything we aren't thinking of? Please chime in; we're both a little numb.

Mo

9dp3dt

It's nine days post our three day transfer and I feel like the window of hope is closing. I continue to feel no pregnancy symptoms. I continue to test negative.

Will and I are both starting to feel pretty hopeless, not just about this cycle but about our chances of having a biological child in general.

As you know, I've had a bad feeling about this cycle for a while, first during the stimulation phase and then at the transfer when I saw how fragmented the embryos were.

I have loved all of your encouragements (they have really, really helped, thank you), and especially Nancy's that she got a positive very late in the two week wait (Nancy, I continue to hold on to your story as my singular hope), but I also know my body. I've been pregnant three times and I know what it has felt like for me. I also learned from the whole Hodgkin's experience that it is vital I trust my instincts about my body. To trust that sometimes I just know that something is wrong.

So I'm still not downing margaritas or stopping the PIO (although I've broken out in hives again - neck, arms, chest, back. Like some extra cruel twist of fate. So much for switching from sesame to olive oil). I'm going through the motions, but really, I think it's over.

Will and I are both feeling so strongly this way that we decided to pre-emptively schedule the WTF meeting with the RE. I realize this sounds maybe a little ludicrous, but the idea of sitting with all of our feelings with no information until after the new year seemed unbearable. We figured we could always cancel the meeting if I turned out to be pregnant.

So I called. And the RE's assistant said that he didn't have an opening to meet with Will and me until Jan. 20th. HA HA HA HA!

I got off the phone and hit bottom emotionally. I know our RE is a busy guy. I know he has probably more patients than he should because he is so good at what he does. And I know that their office is closing for the holiday. And that he's probably taking some vacation. I do realize these things. But honestly, I felt a bit abandoned. And a wee bit resentful. Like it's expected for Will and me to turn our schedules upside down but when it comes time for a 10-minute talk so that Will and I can try to have a decent Christmas, he's too busy. Too busy FOR A MONTH.

Can we all say progesterone-induced insanity syndrome? I'm not usually a nutty, entitled person. Truly I'm not.

Anyway, I spoke to Will, and he offered to email the RE to see if there was any possibility of something earlier. No drama, no pushing, just simply asking. And twenty minutes later, the RE emailed back and now we're going in on Monday afternoon, probably about 2 hours after we get the "official" negative beta. Thank God I have an MD spouse on the same faculty as our RE. I am grateful but slightly saddened that if we weren't fortunately connected we'd be waiting a month. Anyone in our situation deserves to get a chance to discuss matters in a reasonable amount of time (say within a couple of weeks).

Maybe we'll get a miracle positive on the hpt in the next two days but we are starting to accept that we probably won't. And it is a huge consolation that we can talk with the RE and come up with a Plan B (or is it Plan D at this point?) so quickly.

Mo

How the two week wait stole my sanity and replaced it with tiny pizzas

I haven't been posting because I've been too busy trying to stay sane.

I'm struggling to focus on work, which has received scant attention of late. I've been able to pull it together for my patients, but when I'm alone...not much productive going on.

Instead, I'm spending lots of time trying not to think about the presence or absence of every strange twitch and bloat in my body. You know the symptoms everyone goes on and on about: sore breasts, uterine cramping, light spotting, fatigue, nausea, urinary frequency?

Well, I have some of those. Maybe. If I squint my eyes and focus my mind hard enough.

And now I'm trying to remember back to my last "successful" IVF (by the clinic fellow's standards, at least). What was I feeling? I remember thinking I was going to test positive. Didn't I think that? I had uterine cramping. Perhaps. Not really sure. Definitely. Ugh.

But the more I think about it, the more I realize that all I know is I am jacked up on progesterone. Or maybe I know that I am pregnant. Or maybe (more often) that I'm not. As I monitor my insides repeatedly, I think: abdominal cramp. Must be gas, embryos implanting, nervousness, embryos implanting, intestinal blockage. Im-PLAN-tation.

My breasts? I roll over at night and two massive globular entities wake me up. Soreness! Will marvels at them, at the widening, darkening aureolas now the size of tiny pizzas. The boobages may be large, Will, but back off! They are made of glass. Sign of pregnancy? Sign of progesterone. Were they more sore last time, when I was "successful"? I think so. Maybe not. Definitely. Are they more sore than yesterday? Yes. No. Yes. Ugh.

And I'm a little nauseated. It's the fast food I ate. It's the progesterone. I am PREGNANT. I have food poisoning. Wait, maybe it's passed.

Happy Holidays. Miserable holidays. White Christmas. Blue Christmas. Criminy.

Why did we decide to do this right before Christmas anyway?

It's 6dp3dt. Tested negative this morning.

I can obviously conclude that (1) this cycle is a failure. Or (2) this cycle is a success but it's really early. Or (3) who the hell knows, but at least the HCG is out of my system.

The only thing I know for sure is that suddenly, I have a hankering for pizza.

Mo

Pics from the petri dish: Don't judge an embryo by its cover

So without further ado, here are the three embryos that are hopefully now nuzzling in and taking firm root in my endometrium. One 8-cell, one 7-cell, and one 6-cell.

The bigger circles are the cells. And all that smaller debris is fragmentation, which unfortunately is not such a good thing prognostically (the embryo on the lower right looks especially ominous).

I'm really pulling for these guys to make it. Truly, I am. But I have to say that as the staff handed me the picture and started oohing and ahhing over it in the OR right before the transfer, I was crestfallen.

When my RE had phoned earlier that morning and said, "Three look better than the rest," this was not what I was imagining.

I had pictured each embryo would look like this:

which is to say, perfect and 8-celled with minimal fragmentation.

Will and I joked in the recovery room that if one of these embryos turns out to stick and become a baby, h/she sure won't be winning any beauty contests. Which of course would be just fine. We just want a healthy baby (and we're not exactly winning any contests either, believe me).

And while I am worried and somewhat disappointed, I am also thankful that we have embryos to transfer at all. That we have our health. That we have each other.

I met a woman as I was waiting for the transfer who only had one embryo to transfer and who three months ago lost her baby at 20 wks gestation due to a fatal heart defect. Ugh. And do you know what she said to me? "My husband and I are just grateful that we got to have the pregnancy and feel the baby move inside me. Even if I never get pregnant again, we will always have that to hold on to."

I almost cried. I'm not sure I could ever find the silver lining in such a situation. But I admire her incredibly for doing so.

I am a lesser being, I think, one sometimes filled with fruitless anxiety and angst. That said, I am trying desperately to stay in the moment and remember that things could, just maybe, turn out ok. Just because they haven't before doesn't mean that they won't this time.

The beta is Monday 12/22. What will be will be.

Mo

Reports from the petri dish: Transfer

We received word this morning that the gang of eight are not looking strong enough to make it to Day 5, so we are going to transfer in a couple of hours.

Our RE said that three of the embryos are looking better than the others and will be transferred.

We had a lot of back and forth about whether to put back 3 or 4, but ultimately, the RE felt (and convinced Will and I) that our chances of pregnancy wouldn't be improved that much (he said only by 3%) by a 4-embryo transfer, while we would have a much increased chance of triplets of quads (18% chance of triplets with four put back, 2.5% chance of quads).

We are trying to be optimistic. I have to admit I'm not feeling so great. Had wanted to make it to a Day 5 transfer, so this news that we need to transfer today really throws me.

Will and I are both desperately hoping that we don't end up again in Pregnancy In-Between Land as we have the last three pregnancies (pregnant but with non-viable embryos/fetuses).

Now that we're at the transfer stage, all the old emotions of loss are welling up. We're both trying to focus on the positive, but it is tough because this pregnancy thing has just never gone in a positive direction for us. It's strange to be feeling this way, I keep thinking I should be elated. Instead we are hopeful but chastened. Cautiously optimistic but terrified.

So in two hours, we will screw up our courage, focus on the chance that this could actually work out, and head back to the IVF suite at the hospital.

Mo

Reports from the petri dish: Fertilization

Of the 12 eggs that were retrieved, 10 were mature. And of those, 8 fertilized without ICSI (Way to go, Will's little swimmers!).

Usually at my clinic they require a minimum of 10 embryos to consider a 5-day transfer, but the nurse who called today said that my RE wants to try to push us to day 5. She said to keep both Wednesday and Friday afternoons free. The clinic will call Wednesday morning to let us know whether the transfer will be later that day or Friday.

Feeling much better today physically and optimistic about how things are looking. We shall see what Wednesday's news brings.

Thank you for all of your comments and thoughts.

Mo

Egg retrieval

A normally stressful event was made somewhat easier by having our RE make an unscheduled appearance to do Mo's procedure today. He retrieved 12 eggs! Mo has been fairly uncomfortable (but very relieved) and resting most of the day. She will update on the fertilization report as soon as we get word tomorrow. We are very, very pleased.

More news soon.

Will

Cycle day 13 update: Trigger day

Will just gave me the HCG trigger shot and we're set for an early retrieval on Sunday. I can't believe we're here already.

Things have brightened since my last cycle update. There are now 7 large follicles and several smaller ones visible on ultrasound, so we are cautiously optimistic that things will go well on Sunday.

My RE did our ultrasound Thursday and said he will try to come in and do my retrieval himself, even though he isn't on call. We are thrilled and touched. Our IVF center is quite large, known for its clinical excellence but not necessarily for being a hand-holding kind of place, so his willingness to come in on his day off is especially meaningful.

We will keep you posted. Thanks, as always, for your warm wishes and thoughts.

Fingers crossed and full speed ahead.

Mo

The fate of the frozen embryo

Today's New York Times yields yet another infertility article, this one on the difficulty former IVF patients face in deciding what to do with leftover frozen embryos.

According to the article, more and more couples are struggling to decide what to do with remaining frozen embryos when they want no more children. They are choosing to do everything from freezing the embryos indefinitely (at a not insignificant cost) to donating them to other couples (rarely) to donating them to research to saying prayers over the petri dish when the embryos are thawed and destroyed.

It's difficult to know what one would do in this situation. Given our struggle to produce a single offspring, I find it almost impossible to imagine that our problem could some day become the potential for too many children. And we have learned very well, through hard won and bitter experience, that an embryo (even several embryos) does NOT equal a baby. Not even when you actually get pregnant with said embryo.

At the same time, we do not see these embryos as just a piece of cultured tissue. They represent the potential for human life. And in that way, they are (the words are loaded but I don't know better ones) somewhat sacred.

Will and I personally entered the frozen embryo debate when we met with the RE to tell him we wanted to do another fresh cycle this time (while having six embryos frozen at the 2PN stage from our last attempt).

I believe the RE's exact words were: "What do you want, a library of embryos?"

Ouch.

I suddenly felt like the RE thought we were aiming to collect vast quantities of our genetic material to keep in jars in various rooms in our apartment. Just to gaze at.

His words surprised us, and definitely gave us pause. After reflecting, we explained our reasoning (to ourselves and to him) thusly: that we want multiple children if possible - gosh, a whole family of them if we could. That we worry I am headed into premature menopause because of my chemotherapy treatment almost a decade ago for lymphoma. That we can actually afford another IVF cycle right now because I have - just for this year - a very generous insurance policy that has a special arrangement with my IVF center. We reminded him that we are Irish Catholics (lapsed and mortally sinning Irish Catholics because we're doing IVF, but still.) That for us, a family with several children would not be a bad thing. We'll be grateful for one, mind you, but a whole passel of kids would be fine too.

But reading the Times story today made me realize for the first time another major factor underlying our decision to do a 3rd fresh IVF cycle: keeping six embryos on ice gives us a sense of continued hope. These embryos dull the full keening urgency we feel about starting a family. Their existence gives us a sense (falsely perhaps) that as long as we have them, we still have the potential to be biological parents.

This article also made it clear that it will be much more complicated than we ever imagined should we someday encounter circumstances that compel us to not use these embryos and instead have to decide their fate. What would we do then?

It's a decision I hope we never have to make.

Mo

Cycle day 10 update

Today's ultrasound was kind of a bummer. I had the fellow I am not so fond of again today and when she did the scan, it was clear that there was only ONE large follicle on my right ovary, and just a few decent sized ones on the left.

This is a significantly muted response compared to my previous two cycles (where 21 and 9 eggs were retrieved, respectively). Needless to say, since going in this morning, I've been trying not to get discouraged. The fellow did say that it's possible some of the smaller ones could grow enough to contain a mature egg ("That happens sometimes," she said, chipper and clueless, while I tried to suppress my urge to growl audibly at her).

Despite the substellar follicular development, my lower abdomen is extremely crampy - much more so than with the previous IVFs. Very curious. Based on the way my belly feels, something is going on in there. Maybe it's not follicles under construction, maybe my body is putting in a line of new condos or something.

In other news, Rocketman's ship landed safely last week in South Dakota and the results are in. Sperm chromatin was normal (which was a huge relief), motility was lowish, and morphology was abysmal. All in all not so different from previous testings. And nothing that's too major since we will be utilizing a petri dish (and perhaps ICSI).

So I know that none of the information gleaned today is terrible, but I left the IVF center feeling slightly glum and rather less hopeful about the cycle. Fortunately, my feeling one way or another should have just about zero impact on the outcome, as long as I can rally myself for my injections and make it to the retrieval on time.

I keep trying to remind myself that I don't need a legion, I just need a few good eggs.

But any words of wisdom from you guys would be most welcome.

Mo

Infertility math

Yesterday I read the cover story in the New York Times Magazine by Alex Kuczynski about her use of a gestational surrogate to become a mother after 11 IVFs and four miscarriages.

One of the things that hit home was her brief description of "the terrible, wishful math of infertility." I'd never thought of it that way exactly, but I immediately recognized myself. And I recognized my penchant for Infertility Math.

I have repeatedly calculated how old I will be when I give birth if I get pregnant on X attempt, which is a continuously moving target. I also calculate where I will be in my academic training and career…along the lines of "If I get pregnant now, I will be on my internship… applying to post-doctoral fellowships… interviewing for post-doctoral fellowships…on a post-doctoral fellowship (probably true if I get pregnant this cycle)…on the academic job market," etc.

One of my most grueling versions of Infertility Math is computing the age and developmental stage our baby would be at if we hadn't miscarried the first time. I only do this with pregnancy no. 1- by the second and third losses I'd learned to not calculate due dates that might come back to haunt me.

With that first pregnancy, Will's older sister was one month farther along and now has a child (truly, a lovely child) who is a continual reminder of the fact that our baby is not here. Try as I might to NOT do this, when I am at my sister-in-law's, holding her beautiful son, it is almost impossible to not start the dreaded calculations in my head, subtracting one month from her baby's age and imagining what our daughter would be doing and how our lives would be so very different if she had lived.

Then I catch myself, and I stop.

Until the next time.

Similarly, watching friend after friend get pregnant and deliver, and then some of these friends get pregnant - how is it possible? - a second time, has become yet another barometer of loss. A painful reminder that Will and I are somehow out of step with time.

The holidays engender a particularly treacherous form of Infertility Math. Just yesterday, Will and I bought our tree and were securing it in its stand in the living room. Before I could stop myself, I reflexively thought, "This will be our last Christmas without a child."

Which would be fine, except that I think this every year.

And we don't have a child.

And (breath hitches in throat) I don't know if we ever will.

Infertility carries us along on a continuous cycle of hope and loss…followed by more hope. Hope that I can soon be a mother, hope that Will and I can seal our union with an oh-so-beloved child, hope that we can put this chapter of grief and loss and longing behind us and move forward into the future.

And at the same time that hope carries us into dangerous territory - dangerous and terrible and wishful territory - a landscape of unmappable days, of the uncharted and unknowable future.

That's the rub of infertility. And the peril of Infertility Math.

Mo

Cycle day 8 update

We are back from our trip. We had trouble communicating with our IVF center while we were out of town, with lots of balls dropped on their end about letting us know dosages and what monitoring to do. It was disappointing (and unusual as our center is usually so super-anal about everything) and culminated in our having to email my RE at 9pm at night (pros of having an M.D. spouse). Fortunately, my RE came through as usual and emailed us back that night and again the next morning to make sure we knew how to proceed.

I went in for ultrasound and blood work today and I seem to be responding to the Follistim, as my dose was dropped for tonight by 75 units. Physically, I can feel something happening: have had abdominal twinginess, and today's aggressive ultrasound probing left me cramping on one side for most of the day.

I had vowed not to pay attention to the details of how things are developing, but my acupuncturist wants updates so she can adjust my treatments. So much for avoiding obsessing! I think they said they saw 2-3 on one side around 12 and 2 on the other side around 11, with several smaller ones. But it all happened so fast, I'm not sure. Oh well. I can never figure out exactly how what they see on ultrasound translates into what happens on retrieval day anyway. So am trying to pay attention enough to tell the acupuncturist while not getting caught up in any specific expected outcome.

Mo

Thanksgiving

Mo and I are off to see her family. While visiting the in-laws is not always considered a holiday, both of us are looking forward to seeing her folks and spending some downtime. A little turkey and cranberry sauce mixed in will sweeten the trip.

We are on a plane right now, headed south. She's resting beside me, and I'm sitting here pondering the “thanks” in thanksgiving. My boss sent everyone on our team a Thanksgiving email cataloguing all he appreciates about each of us. Very unusual (unprecedented, really). It got me thinking about what I am grateful for.

So, here is Will's Top 10 List of things I am thankful for:

10. Fairway Market. This purveyor has been deemed combat shopping central. However, it is an excellent place to practice mindfulness and get great deals on fresh everything. I like it better than Gourmet Garage and the like.

9. New York City just after a rain shower or during a snowstorm. The natural beauty of the city really comes out during these times, maybe due to the effect of light and quiet. During these times I am reminded of the vastness of all this city has to offer. It is as if the rain has cleaned off the sidewalks and streets and announced a new beginning.

8. A smile from a stranger. New York is often described as hectic and filled with aggressive, rude people. True, but there are more nice people than mean. When I am late to work, the security officer always greets me with a smile and “good morning doc!” This brings a smile to my face even when I am feeling harried.

7. Fulfilling and exciting career. I love my work and feel like it loves me. I give my best and receive back much more.

6. Personal growth and awareness. This past summer was “the perfect storm,” as one friend put it: I got a major job promotion, was reeling from my father's recent diagnosis with a terminal illness, and then we had two miscarriages almost back to back. To be honest, I was overwhelmed with it all, and the resulting crisis led me to reconsider my life. It caused me to realize that I had not dealt appropriately with stress, going far back in time, and it became clear that I would need to make major changes to maintain my sanity and my marriage. The past four months I have done a tremendous amount of work to better define my dreams and aspirations and get grounded. This has resulted in an improved marriage and a better, more confident self.

5. Health. At my work I see a lot of patients similar in age to me with debilitating diseases, both physical and mental. I try to remember to be grateful for both my and Mo's health each morning as we get up.

4. Safety. This is a bit amorphous, but safety means that Mo and I have enough emotional reserve to weather storms. We have learned a tremendous amount about each other, sometimes startling, but all good to share. We also have stable careers which is very reassuring during this economic downturn.

3. Friends. I have not nurtured my friendships as well as I should. I hope in the next few months to pay better attention to this area of my life and am grateful for the presence of friends in my life.

2. Family. They may drive me nuts at times, but when push comes to shove, my brothers and sister have always offered their support to me.

1. Mo. Even sitting here in this airplane seat beside me, Mo offers me unconditional love. I feel it, I see it, I know it. I am a lucky human being to be able to walk on this journey of life with her. I think we are going to have a lot of fun and fulfillment in our love together. And hopefully, we can share that fun and fulfilment with a family of our own.

What are you thankful for in your life?

Will

-------------------------------------------------------
Mo here.

Wanted to say a quick hello. I am thankful for many of the same things as Will - family, friends, my health (knock wood) , and of course Will. I am also thankful that we live in NYC and have the emotional and financial resources to be able to pursue our dream of having a family together.

But I also wanted to pipe in and say how grateful I am to have found the blog community. When Will and I started this, we saw it as sort of a couples' journal of our IVF process, and it is. But neither one of us anticipated how meaningful it would be to hear from others in our same position. So that is one more thing we are thankful for. We read each and every comment. And honestly, we've been extremely moved by all of your stories and support.

Mo

Rocket man

I don't get many check-ups. Maybe since I am a doctor I think I don't need to have them, the "I know better" syndrome. Maybe I am scared of the unknown or of sharing my deepest secrets or most intimate body parts with a colleague. Maybe I think I know the limitations of medicine.

But with IVF, I cannot escape. Certain tests are dictated by our RE and others by my partner in crime, Mo. Deep down I want to be healthy, so the desire is also mine. And since Mo takes her shots and goes to her monitoring every day, I figure I can do my part too.

Which leads me to The Rocket.

My urologist wanted me to get my sperm DNA tested to be sure that a medication I'm taking is not affecting my swimmers. There is only one laboratory in the world that performs the test to detect damage in the DNA of sperm (aka sperm chromatin structure assay). And this lab is in - of all places - South Dakota.

To get my sample from New York to South Dakota, Fed Ex (for a cool $150) ships a sort-of-mushroom-shaped contraption that contains a white metal tank filled with dry ice. It is ridiculously bulky and even more ridiculously heavy - weighing probably 20 pounds. Mo and I took one look at it last cycle and christened it "The Rocket."

So when my urologist said I needed The Rocket again, I had it sent to my sister's apartment. Like I want my sister to know that I even have sperm! Sigh. But she has a doorman who will accept items like bulky steel rockets in the middle of the day. And Mo and I do not have a doorman (and with all we are spending on IVF, may never have a doorman).

When I heard The Rocket had arrived, I left work and headed to my sister's. I lugged The Rocket home and did my thing. The whole device is just...strange, with metal buckles, and pipettes, and whatnot. Adding to the effect is the fact that when you open The Rocket to put in the specimen, the dry ice inside emits a smokey fog. I felt like a mad scientist.

Next stop: Fed Ex. The curt woman behind the counter took one look at The Rocket, backed away, and said, "No way. I ain't taking that here. What is it?" I thought of being honest, but then decided that was probably a bad idea (plus, I couldn't bring myself to tell her the truth). So I told her a partial truth: that the tank contained dry ice. She stood her ground. "Sorry. I can't help you. We do not take dangerous materials at this Fed Ex." Now, I know dry ice is not dangerous, but I realized this was a dead end.

This exchange was repeated at three different Fed Ex centers. Picture me, schlepping this insane metal mushroom all over Midtown Manhattan, turned away at shipping location after shipping location.

I was starting to get annoyed. I was starting to feel a little sorry for myself. I considered shouting, "It's SPERM! OK? SPERM! Maybe with a DNA problem BUT SPERM!!!!" But I decided that would not be so effective. Finally, I went to Fed Ex's NYC headquarters where the clerk didn't even blink an eye. She acted like my rocket was the most normal thing to ship. In fact, she told me that there had been another guy there minutes before with a rocket like mine.

So just like that, when I was about to give up, The Rocket was launched. I picture it flying over South Dakota right about now.

I think it's gonna be a long long time
Till touch down brings me round again to find
I'm not the man they think I am at home
Oh no no no I'm a rocket man
Rocket man burning out his fuse up here alone

Mo starts stims Tuesday night. Wish us luck.

Will

Cycle day 3 update

Went in for bloodwork and ultrasound around (yawn) 7 a.m. this morning. Will came along and we signed all the consents and put the cycle on our credit card. Guess it's official.

The fellow did the ultrasound today. The antral follicle count was "more than five, less than ten" on each ovary. Good enough for me.

She then thumbed through my records. "So your first cycle was a success but your second was not."

I gazed at her and said, "Our first cycle was also unsuccessful. "

The fellow looked down at her notes for a minute and then back at me for a minute and then seemed to decide not to say anything more. I knew what she was getting at with her comment, but I couldn't let the teaching moment go. Note to fellow: a baby with double aneuploidy who dies in the first trimester is not exactly what I would classify as a "success." Certainly not the kind of success that we're looking for.

The IVF nurse will call tonight and tell us what dosage of Follistim to use and whether I start today or not. There's some question since we'll be away Wednesday through Saturday for the holiday. And although we'll be in a major metropolitan area with a fantastic medical center, the nurse made it clear this morning that our IVF center doesn't really trust us using any other lab. So they may delay my start date.

We'll see...I'll keep you posted.

Mo

Feathering the nest

We’re in the beginning stages of IVF #3, and after three pregnancies and then three pregnancy losses this past year, I’m frankly feeling a little detached from the whole process. I haven't hauled out the IVF books (still on the top closet shelf) and haven't scoured pubmed for the latest IVF research, like I usually do. I'm doing what I must: my shots, healthy-ish eating, and, yes, the one add-on of acupuncture. But I’m not engaging as much emotionally (at least I’m trying not to).

But my husband Will…well, he seems to be going a different way. As I looked around our apartment this morning, I realized that in certain ways, Will is taking a more active stance toward this cycle than I am.

I hadn't put it together before, as Will doesn't talk about IVF so much per se. But he has been quietly doing a number of things that taken together are quite striking.

For example, he just bought some kind of wireless radio/Internet thingie (he calls it the Squeezebox, I call it the Squawkbox) that will allow us to access to/listen to music all over the apartment.
(Me: "That's nice, honey.")

And he has been keen on putting wiring into the closet in our foyer, with the idea that we can move the printer, modem, router, and various other mysterious flashing electronic devices out of the second bedroom and into this closet.
(Me: "Huh? OK, whatever. Sure, fine.")

He also has been taking boxes and files and picture frames from the second bedroom closet to his hospital office all week.
(Me: Didn't even notice, actually.)

And then last night, he became downright insistent about getting to IKEA today to buy a third bookshelf-cabinet to match the other two in our foyer because, he says, we have to get organized. We’re renting a car and leave in two hours. There was really no talking him out of it.
(Me: Hmm...we're already pretty organized...this seems strange, but...ok.)

I don’t know how I could have missed the accumulating signs, but suddenly this morning it hit me.

Will is NESTING. Male nesting perhaps, but still.

This is a side of him I've never seen before. He may not talk about things so much, but there's a lot going on in that head of his.

It’s pretty sweet, actually.

Mo

How does your husband cope with IF/IVF? How do you wish he would? And any husbands out there, how are you dealing with it all?

Acupunctured

I went Thursday for my first acupuncture appointment. The practitioner seemed very nice. A good mix of soothing and professional. She asked several questions about my history of infertility, recurrent pregnancy loss, and menstrual cycles, then about my sleep and whether I'm generally hot or cold (as Will will attest, I'm usually freezing). She proceeded to prescribe hot ginger tea with cayenne in it and went to work.

The acupuncture itself was strangely stimulating and relaxing. More...um...penetrating...than I thought it would be.

A little like this...(except I have much less hair on my legs):


It felt like she was putting the needles in along the nerve pathways in my feet, ankles, calves, thighs, wrist, face, and head. She remarked that I was not reacting at all to the placement of the needles and I told her that between IVF and lymphoma treatment, she was going to have a hard time fazing me. After she placed the needles, she covered me with a thin aluminum sheet, dimmed the lights, turned on some soft chanting music, and left for about a half an hour.

I felt relaxed and alert. Not sure if it will help with our IVF cycle, but it was actually fairly pleasant. She wants me to return twice a week once I start the stims. I'm supposed to see her again on Monday.

Those of you who've done acupuncture, what was your experience like? Do you think it helped?

Mo

IVF science: the illusion of control

Not be a downer but I read this article a couple of days ago in the New York Times linking IVF to an increased incidence of birth defects.

Over the past few days, I've been trying to come to terms with what I think of it.

My rational side says the data is based on a relatively small number of women. And as NYU's Dr. Grifo points out, the risk of a problem is relatively small (even if increased). My husband Will echoed these lines of reasoning when we discussed the findings.

But then my other side (my Lupron-filled, emotional, crazier-by-the-day side) latches on to the research as one more thing to worry about (like I need one more thing).

In the dark of night I have even thought that maybe I am selfish to go to such great lengths to conceive a child (who based on this research might be more likely to have a birth defect). I think, if I were a better person, I would just adopt (and truth be told, we'd like to, but we'd also really like to have at least one biologically related child).

In the dark of night I also have other opposite but just-as-loony thoughts, like maybe I can convince our RE to put back one more embryo than he is planning to, and maybe then at least one will survive. Maybe if I stop eating Splenda and aspartame it will all be ok this time. Maybe acupuncture will do the trick. Maybe if I eat organic I'll get pregnant. Maybe munching that ice cream bar (ok, two ice cream bars) last night will mean I won't. Maybe these anxious thoughts will doom the cycle. Maybe maybe maybe. It's a vicious 3AM spiral.

IVF controls much of what is usually a mysterious process. All of this micro manipulation and monitoring make it tempting to start to think that if I just take this action or avoid that action, somehow I can influence the outcome. It also makes it tempting to think that if we don't get pregnant/lose another baby/have a baby with a problem, maybe there is something I could have done that would have prevented it. That maybe it is all my fault.

And then at some point, I catch myself, and say to myself firmly:

You are not in control. You are NOT in control. You've got great science on your side, but you cannot determine every part of the journey or every potential outcome. Relax. Go with the process.

Repeat as needed.

(which will likely be often)

Mo

The apple tree

I spent this morning with my parents who were in town for my nephew's birthday party. We had coffee and lunch and then parted. It was a nice visit, but after they left I realized all the things we had not discussed. As I age and as I travel through my marriage, I am becoming increasingly aware of how, growing up, there were topics that were either not spoken about at all, or that were mentioned but never fully fleshed out. I am sure this is not uncommon, but with Mo's three miscarriages last year, this familial tendency has become painfully clear on more than one occasion.

Mo and I had shared the news of our first pregnancy with both of our families as soon as we saw the heartbeat on ultrasound. Unfortunately, this meant that a few weeks later, we also had the share the terrible news when we lost the pregnancy. After the miscarriage and D&C, I telephoned my mother to tell her. She was sympathetic and tried to be comforting for a moment, but she quickly added that in "her day" those things happened "all the time" and women often "didn't even know" they were pregnant and just thought they had had a late period. Fair enough on the facts, I suppose (although frankly it's hard to imagine what women were thinking when they had morning sickness and no period for over two months). But my mother was really missing the human side of the truth - that her son and new daughter-in-law were experiencing a devastating loss.

My mother repeated a version of this line of reasoning following the next miscarriage. At this point, her inability to tolerate her own discomfort enough to acknowledge our loss really started to sting. Mo was terribly hurt by my mother's behavior. And I was left feeling conflicted. I felt strongly protective of Mo and resonated deeply with her upset. And my mother's words felt like a dismissal of my need to be comforted as her grieving son. But I also felt an inexorable pull to defend and rationalize my mother's disappointing behavior.

The third time around, Mo and I didn't tell my parents we were pregnant or, subsequently, that we had miscarried yet again. Not telling wasn't that hard for me. But not having the support of the two people who have always given me unconditional love was very difficult. It was also very lonely.

Back to this morning. After my parents left, I realized that I need to be completely open with letting my parents know my feelings in as much detail as I can. At the same time, I have to accept that they may be incapable of meeting my needs in certain arenas.

Mo and I will discuss and decide together exactly what infertility/pregnancy/loss news to share. (We are NOT sharing, for example, that we are currently doing IVF).

I'm also realizing that I need to take a deep look inward at my own insecurities with letting my emotions show (a tendency whose origins are becoming clearer and clearer - Thanks, Mom!). I am learning that I can strongly - and vocally - disagree with my parents' inability to reach out in a meaningful way and at the same time not be judgemental of them as the people I love.

The apple does not fall far from the tree. But this is no excuse for not stretching beyond my own comfort zones. The fact is that I long ago grew into my own tree. It is time for me to prune the branches and declare what is mine. To take the shape of the man I want to be in my life and in my marriage.

Will

Lupron days and restless nights

Three days into Lupron and I can definitely tell it's working. I feel downright...menopausal. Reminiscent of the first two IVF cycles and of my symptoms after the abrupt halt of my menstrual cycle caused by ABVD chemotherapy for my Hodgkin's 9 years ago (thankfully temporary - my cycles returned approximately a year after stopping treatment).

Needless to say, I don't have positive associations to hot flashes, night sweats, and the general all-over-achiness I am currently feeling. I spent last night sweating, tossing and turning, waking up poor Will repeatedly.

In my groggy attempt at positive reframing around 3AM, I thought, "Well, at least I know it's not a placebo." That's the best I could come up with in the pre-dawn hours.

This morning, I reflected on my ability to "forget" the harder aspects of IVF. Call it some kind of protective mechanism, I suppose. For me, Lupron is one of the more physically unpleasant parts of the process (that and the dreaded PIO shots). Note to self: I will start to feel better once I start the stims. Another note to self: Take it one day at a time. Stay sane. You can do this.

Mo

Why couldn't conception be like this?

Wouldn't it be great if there was a Fertility Easy Button?

I'd say it's unrealistic, but then again, I know a number of thirtysomethings who seem to get pregnant at the drop of a hat...and stay pregnant. Like one who said, "Once you pee on a stick and you see that second line, you know your life will never be the same again."* Really? REALLY?! You have sex and two weeks later pee on a stick and just assume you will have a baby? And then you do?! Unimaginable to me.

Or the one who told me she decided to wait until a certain month, and then had sex and actually conceived a baby who is now almost a year old. This same woman then turned out to not only be uber-fertile but also to think that this was something to be taken for granted, and gushed to me, glowing with her accomplishment, "It seems like our bodies are just made for having babies, you know?"*

Forgive me, but I looked this second woman straight in the eye and said, "Not really...[pause for effect]...we're doing IVF...[more eye contact]." I then hated myself a little bit when I saw the crumpling realization of her faux pas spread across her face. Was I being mean, as Greeneggsnham recently worried she was when speaking to a similarly clueless person? Perhaps. But I was angry and also (rationalization alert) felt a need to try to educate her a little bit so she might avoid this mistake in the future.

But enough sour grapes. Our reality is that we are here, facing IVF #3, hoping this third time will be the charm. Should we get out the other side of this with a baby one day, we will be blessed not only with that child, but also with a deep appreciation of how incredible a privilege that is.

And while we understand viscerally that - at least for us - there is no Easy Button for fertility, there are certainly ways that the IVF process can be made easier or harder. How do I try to cope while cycling? I enjoy running and will keep it up until I start the stims. I'm eating healthy-ish and trying to get adequate sleep. As I said in my last post, I start acupuncture next week. And Will and I will do our best to keep the lighter moments of our relationship very much alive.

And what do I try to avoid in the spirit of not making this harder than it has to be? I try to avoid (ha ha ha ha) obsessing and (ha -snort!- ha) worrying. I try to stay in the moment and not get ahead of myself. Will is much better at not obsessing, not worrying, and staying in the moment, but then again, maybe it's easier when you're not jacked up on hormones and having an ultrasound probe thrust up your wahoo every other day.

I bet there are many other things that might help make things easier if only I could think of them.

So now I turn to you for your expertise. What strategies help you to weather your ups and downs, your anxieties, your what ifs, your hopes and fears? What have you learned makes the process harder than it has to be?

And back to the beginning of the post, what idiotic things have been said to you recently? And how did you respond?

Any and all thoughts are most welcome.

Mo

*actual quotes of friend and acquaintance

And we're off...

First Lupron injection was tonight. It was a little harder than I thought it would be to stick the needle in. Not because it would hurt - I know from the last 1,000 IVF and cancer-related sticks that it wouldn't be that bad. I was hesitant because it meant climbing back onto the IVF roller coaster again. It meant accepting that we are fully committing to IVF #3 and all the excitement and dread that goes along with it.

I also surprised myself by booking my first acupuncture appointment for next week. I'm kind of a skeptic about non-western approaches to medicine as the research for and against seems equivocal. But I figured, it can't hurt. I want to make sure all my i's are dotted and t's are crossed.

Please please please let this cycle be the one. Wish us luck!

Mo

It goes where?! A husband's thoughts on IVF

Mo says that most of the readers of this blog will be women. I expect she’s right but am not sure why us guys are not more interested.

Is it that we are not engaged. . .or are we just afraid?

This leads me to ponder one of my greatest until-recently unspoken and self-ignored feelings - the sense of somehow being "left out" of the picture by IVF. I hate saying it, but truth be told the whole IVF process leaves me feeling a bit emasculated. I know it isn’t rational and certainly not externally imposed but somehow deep down I feel a little sidelined by IVF.

We started IVF as a solid two-person team. I am an MD working in academic medicine, so my work side liked the structure of IVF - you have a calendar detailing each step of the process. At the beginning, I was intent on coming to each appointment to tackle whatever challenge – blood draw, ultrasound, SIS, HSG, surgical procedure - that Mo faced. We would do it all together.

My enthusiasm dampened almost immediately. The hormones started kicking in quickly, making Mo's temperament…um…somewhat unpredictable. And my internal dialogue began to change: When Mo said, “I don't need you to come to today’s appointment,” I heard, “I’d rather go without you.” When Mo moaned quietly during a particularly grueling PIO injection, I’d start to think defensively, “It’s not MY fault that hurt so much!” As the days passed, I started to feel a seeping guilt that Mo had to go through the wringer every single day, while I was relatively unscathed by the process. I also started questioning just what my role really was.

And what IS my role, really in this whole IVF business? It comes down to my producing a single semen sample. I realize it’s an essential part of things, but it seems so…mechanistic. And so removed from me as a person.

In case you aren’t intimately familiar with the sperm collection process in IVF, let me walk you through my first time:

The morning started early with a careful scrubbing of the family jewels with Dial soap. Note to self: Make sure to use the cleanest towel!

I arrived at the hospital with Mo and found about six other couples in the waiting room. The women wore hospital gowns and those dreadful treaded ankle-high socks and the men wore the usual weekend uniform of T-shirts, jeans, and baseball caps. A vague tension filled the room - no one was really talking and everyone seemed particularly engrossed in old copies of the New Yorker. Each man got called (separately, Thank God) to deliver his sample.

The collection room was small and cold and sterile. A vinyl La-Z-Boy engulfed one corner and a TV hung on the opposite wall. Next to the lounger was a small table with a remote control and a stack of well- thumbed porn magazines. A small sliding window was set into the wall where I was supposed to put my completed specimen. I could hear the lab techs on the other side of their sliding window. Good God, they sounded so close!

I settled in to the lounger and carefully balanced the specimen cup next to me with the cap nearly unscrewed. Sorry to be graphic, but trying to coordinate that "moment we are all waiting for" is a bit of a challenge – it’s not like guys routinely catch their sperm in a Dixie cup at home. I turned on the TV and noticed a VCR (when was the last time I saw one of those?!). There was only one tape and by this time it was nearly at the end. I rewound it and pressed play.

The title was something like Rear Entry. Huh. The video itself was somehow both slightly boring AND slightly disturbing at the same time. And the soundtrack was pure 70s and blaring. I tried to concentrate on the task at hand…but I couldn’t help it, I started thinking

Can the lab techs just beyond the wall hear this terrible music?

What about the kind motherly nurse who showed me in?

What if I can't orgasm?

What if, what if, WHAT IF???

Thankfully, I was able to focus and - ahem - complete my assignment. I returned to the waiting room to be with Mo. They called her name and approximately 20 minutes later she was done, groggy and saying weird things because of the anesthesia, but OK. I tried to absorb the few things the nurse was telling us since I knew Mo would have some degree of amnesia. We took a cab home.

After the grueling two-week wait we found out that we were preggers!! I was thrilled. There was still much monitoring to go…days of Betas and ultrasounds and my part already long over.

And I really hate to admit it, but I started to feel that the team was shifting from

me and Mo

to

Mo and the RE.

This was not Mo's fault but my own insecurity and lack of insight. When we were released from the RE's domain to start a new chapter with our OB, Mo went to the first visit alone since I needed to be at work - she didn't really need me since we had just been to the RE earlier that week and the fetus had looked great – perfect size, perfect heartbeat - right?

But then I got a call from my secretary saying my wife had come to the hospital and was waiting in my office. When I got there, Mo was distraught - I knew what had happened as soon as I saw the look on her face. My heart sunk and my mind went blank. I felt hopeless and helpless. We talked in my office and then slowly walked across Central Park, comforting each other. I'll always remember that. We left each other near Strawberry Fields. We had lost our pregnancy but we had each other.

So what have I learned? I have learned that I need to involve myself in every step, both physically and emotionally. I have learned that I am not truly present if I limit my role to just being a support to Mo. I have learned that I need to be open about my own dreams, fears, and expectations so that we can truly be a team. Turning my emotional firewall off has been enormously helpful in connecting both with Mo and in increasing my ability to feel part of this crazy IVF process.

So now I turn to you readers:

Ladies, what advice do you have to help me be as present with Mo as possible… and dare I say it, not be so…hopelessly male…about this whole process?

And any male readers lurking out there, what have YOUR experiences of the IVF madness been?

Will

There's no time like the first time: Will's take

Reading over Mo's reflections on doing IVF again, I realize that there are major differences - both good and bad - this time 'round. I am not blase about this IVF cycle, but experiencing a healthy dose of apprehension about getting too excited. For this next IVF, I am cautious, but for the long-term, I know - and definitely have more confidence than Mo - that eventually we will be fortunate to have a child and that child will be a true treasure in our lives.

Mo mentioned that yesterday marked one year since our first miscarriage. To be honest I would not have known that unless she told me. I felt ashamed when she reminded me, maybe because I think we should both be thinking the same thing.

This brought me to reflect on the entire year. It has been extremely tough on both of us, with plenty of surprises. As was alluded in our first post, we coped with our loses as well as major changes in our jobs in very different ways. While this was not the first time I saw my wife cry, it was the first time that I had absolutely no idea how to make it better (as if that was my job, to somehow cure the pain). This was also the first time that I felt such utter loss. It seemed quite logical at the time to have a drink when I came home to relax. Unfortunately one drink quickly became two and so on. This absolutely pathological coping mechanism had the insidious character of carpenter ants. At first it just seems like there are just one or two, but before you realize it, the entire structure is infiltrated, jeopardizing its very integrity. If there is a silver lining, I am fortunate to have such a loving and caring wife who quickly found the best help possible for me. And now I feel that I am a much better husband. Mo's response to my selfishness has been nothing short of a blessing. Not the way I would have chosen it, and certainly the last thing my wife wanted or needed to handle.

So, yes, this time feels much different than a year ago. We have grown a tremendous amount. What a steep learning curve for our first year of marriage! I feel in some way we escaped from a burning building only to realize that we - thankfully - still have each other. I am optimistic and quietly excited to re-enter the IVF arena with Mo. This time I will be with Mo in every way possible.

Thanks to everyone who has visited - and especially those who have left comments. Please keep coming back. Also, Mo found out late today that she will be starting Lupron suppression Wednesday. Her persistent telephone calls evidently wore down the insurance folks and the meds will arrive tomorrow. Somehow it all works out, even if she doesn't believe it will.

Will

There's no time like the first time: Mo's take

I woke up early this morning and was partially dressed for the gym before I realized that I was supposed to get bloodwork at the RE's office to confirm my ovulation.

I had completely forgotten.

What a difference a year makes. A little over a year ago, Will and I were anxiously preoccupied with every detail of our first (and we were certain, last) IVF cycle. A little over a year ago, we were breathless with anticipation, buoyed with hope and confidence that scientific technology would make conception a breeze. A little over a year ago, there is no chance I would have "forgotten" to go in for a blood draw.

I realized after we posted last night that yesterday marked the one year anniversary of our entire world coming apart. Nov. 9, 2007 was the date of my D&C that marked the abrupt end of our first pregnancy. It is hard now to imagine the naivete, the head-over-heels eagerness we felt during that pregnancy. Our RE had warned us repeatedly "Don't get excited yet" so many times that I began asking at each ultrasound "Can we get excited now?" Finally he said yes and sent us off to the OB. We were flying high, filled with a sense of certainty that all would go as it should. That world came crashing down when the OB was unable to find the heartbeat and told us that the baby had died. It ushered in a new era in our relationship. One that left me weeping - big gasping animal-like sobs - for the next few weeks and that left Will also grieving, albeit more quietly, and unsure how to calm or comfort his sudden wreck of a wife.

It is striking to realize the vast emotional distance traveled between a year ago and today. Will and I are chastened, forever changed by our experience. Although I can't predict how I will react should I find myself pregnant again in the future, I know that our excitement will be greatly tempered by a visceral understanding of all that can go wrong, of the thousand treacherous miles that lay between conception and holding an actual live baby in our arms.

So I sat this morning in the RE's waiting area, a long rectangular room filled with well-heeled women that always reminds me of some kind of female airplane terminal, shaking my head that I had changed so much in a year.

And then I started wondering, could there be some upsides to this new way of being? Maybe it's not so bad that I "forgot" my blood draw, only remembering it as an afterthought this morning. I DID get there after all. And it's certainly easier on my nerves that I'm feeling more detached. We are having trouble with our insurance and it is unclear how long the pre-authorization process will take so that I can get the lupron I expect to start injecting on Wednesday. Is this causing me the faintest whiff of anxiety? Not really. I am just barely walking myself through the motions of following up - again - with the RE's insurance specialist. I figure something will work out. Or not.

Call it not sweating the small stuff or call it pathological numbness. But it's less of a roller coaster for sure.

Mo

If men are from Mars and women are from Venus, maybe babies are from Pluto?

Welcome. We're glad you're here...and no, we never thought we'd be here either. But since we are, we thought we might as well blog about it. They say life is circular and indeed we are again beginning the process of trying to start a family. This winter will inaugurate our new president Barack Obama and our fifth attempt at pregnancy in a little over a year.

Our story started normally enough. After dating for three years, we decided to get married. We knew we wanted to start a family quickly. We would both be 35 and Mo had had Hodgkin's lymphoma in her late twenties. We weren't sure about the impact the chemotherapy and multiple CT scans (we've now counted and she's had more than 30, plus numerous PET scans and gallium scans) might have on our fertility. We were so concerned that before we married, we made an appointment to be seen by one of New York's fabled reproductive endocrinologists. We didn't want to be making any decisions about life commitment without all the cards on the table. Everything checked out ok - low fsh, decent enough semen analysis - and the good doctor told us to get out there and try. Actually, he told us to start trying immediately. "We know Mo's ovaries took a hit from her treatments, we just don't know how much." We waited a bit - until we were several months before the wedding but close enough that we could conceivably semi-conceal a pregnancy bulge - and began trying in earnest.

....Nothing happened.

After returning from our honeymoon in Africa we still weren't pregnant and had been trying for more than six months. We went to see another fabled fertility specialist, this time covered by our new insurance. He told us that Will's semen analysis was in fact NOT ok at all, and that he wasn't surprised we weren't pregnant since Will's morphology was less than 1% and his motility hovered around 20%. We could try IUI, the esteemed doctor said, but IVF would give us the best chance of having a baby. Being overly ambitious Manhattanites, we barreled ahead, naive and eager, straight to IVF.

After lots of lupron and follistim and HCG and oh-so-painful progesterone in oil, a ton of monitoring, and a fair amount of hand wringing and obsessing, we found out that we were pregnant! We tracked the betas and then the ultrasound pictures, and then got to see the baby's glorious heart beating just as fast as it should. We officially graduated from the RE's office and were sent to our trusty OB. This IVF process was not so bad, we decided, instantaneously forgetting about the anxious days and Mo's bruised buttocks, which by then was so sore she cried out during each progesterone injection. Unfortunately, when Mo got to her first OB appointment then next week, 9 wks along, we found out that the baby had died. Later, after a gruesome unanesthetized office D and C (we now STRONGLY recommend the OR to anyone who will listen) and several weeks of waiting, we learned that our little girl had Turner syndrome and Down syndrome. "Bad luck," our doctor said. "But very common. Most likely your next pregnancy will be fine." We were beyond devastated, and back to square one, minus the glow we had carried from our honeymoon.

While many of the family and close friends we had told about our pregnancy were sympathetic, we also got the "don't worry, miscarriage happens all the time" talk. As if we were twelve and had just struck out at the plate. This might not be that uncommon, but it wasn't even remotely similar to anything else in our lives that had gone "wrong" (although Mo's cancer came pretty close in the shocking and devastating deparment). This was different and the ache in our souls was deep. Will tried very hard to be hopeful. Mo was a wreck, filled with fearful visions that foreshadowed doom.

Hesitant and hopeful, we tried IVF #2 three months later in February. And we got....

Nada.

But amazingly, a month after that, we were pregnant again, naturally. This felt like vindication, like some kind of cosmic do-over for the injustice that had come before. We tested the HCG levels ourselves (bonus of having an MD spouse) and saw the beta numbers doubling beautifully. We ever so anxiously waded through 7 wks of pregnancy until our OB would see us. And when he did, he breezed easily into the room. "How are you feeling?" he asked. "Terrified!" we both quasi-barked at him, and he looked puzzled that we should be so concerned after our last pregnancy loss. Then he slid the ultrasound transducer inside Mo and started looking at the screen. His expression changed. He said that the yolk sac was enlarged and that the gestational sac was measuring two weeks behind. The pregnancy was not viable. "This is just bad luck, very common," he pronounced, leaving the room (hmmm...this was starting to sound familiar...). We opted for another D and C so that we could run genetics on the remains. Unfortunately, the lab lost the sample and we were left not knowing what happened.

And then shockingly, we found ourselves pregnant AGAIN a mere month later. We hadn't been trying but hadn't acted to prevent a pregnancy either. But this time the beta failed to rise appropriately and within a week, the pregnancy was deemed a chemical. When Mo miscarried a few days later, she brought the tissue in and we found out that the baby was a boy and that he had trisomy 16.

Since then we have struggled individually and as a couple to come to grips with all that this past year had wrought. We felt beaten down and gutted with grief. We struggled to learn how each of us mourned and grappled with life's most puzzling questions so very soon after marriage.

For Mo this meant running many miles a week, researching everything known about recurrent miscarriage and infertility, and eating occasional bowls of cookie batter for good measure. For Will this meant compartmentalizing his own feelings of loss and despair while simultaneously trying to cheer lead downhearted Mo, and unfortunately for a time meant surreptitiously quaffing enough vodka to make a Siberian proud.

Needless to say, we decided to take a break from our relentless babychasing, stabilize ourselves, and then move ahead. Five months - and many therapy sessions - later we are starting to laugh again, to feel that lightness in our steps. We are turning toward each other instead of isolating in our grief. We now know that we can face great challenges as a couple and get through them. We are humbled in our experiences in trying to begin a family.

With great trepidation and cautious hope, we are about to begin our third IVF attempt as we were told this would lessen the chances for another miscarriage. And believe us, we would do ANYTHING to avoid another one at this point. Mo will begin lupron next week and we plan to blog our way - sometimes one or the other of us, sometimes as a couple - through the journey this time.

Our apartment is filled with the detritus of our previous IVF attempts. A closet shelf filled to the brim with syringes, needles, alcohol swabs - a junkie's dream. Long forgotten, nearly empty vials of meds in the back of the refrigerator (bottom shelf behind the cocktail olives). Infertility and pregnancy books line Mo's closet shelves (hidden away so as not to reveal to guests the depths of our obsession). And, sadly, ultrasound snapshots of two of the three pregnancies that slipped from our lives, but not from our minds and hearts.

Perhaps hardest to let go are the prematurely laid plans for Sundays in the playground, vacations, and everyday joys of having a baby in our home. We are hopeful that one way or another, these dreams will eventually come true. This blog is an attempt to record our thoughts and impressions of the (in)fertility process - as they converge and diverge, Mars and Venus, on the road to parenthood.

Mo and Will