Depot Lupron: what doesn't kill you makes you...hotter?

I just started month two of the dreaded Depot Lupron to treat my stage III endometriosis and presumed beta-3 integrin deficiency. I don't know about any of you out there who've taken this, but for me this stuff is poison to my body and my mind. It honestly ranks up there at the top of the list of all-time unpleasant infertility-related activities for me.

I feel just completely taken over by Depot Lupron. This time most of the first month wasn't so bad physically (which is why you haven't heard me whining before this). For the first three weeks, I didn't seem to have many mood effects and experienced really no hot flashes. If it hadn't been for the prodigious three weeks of bleeding, I would almost have thought I'd gotten a bum batch of the stuff.

But all that changed about two weeks ago. Suddenly, the bleeding stopped, and instead I felt...hot and sweaty...had heart palpitations....and felt a profound bleakness descend (as evidenced in my last post).

Because I struggled when I took Depot Lupron last summer, I asked Dr. Schl. if there was anything I could take that would help ameliorate the mood and physical symptoms (apparently there is something, called "add-back therapy" that replaces a bit of the progesterone that your body isn't making). I asked for it not just for my sake, but for poor Will's and Moxie's sake. Not to mention the sakes of my patients and of the populace of the greater New York City metropolitan region at large. So this time, once the hot flashes and blueness descended, I started taking small doses of synthetic progesterone. It hasn't eliminated my symptoms, but I think it does lessen them a tad (hard to tell, but I haven't had to change clothes in the middle of the night because I'm soaking wet, or gotten super irritated at anyone, or killed Will, or taken a mental health day...so I think so).

So these little white pills seem to be helping, but the original prescription didn't include enough pills to do this twice (originally, we were only doing one dose because we were planning to cycle with the egg donor in December).  Given this, I called my nurse. You may remember, I haven't been thrilled about her from the beginning of our donor egg adventures...

When I reached her, I asked for a refill, and she said ok. But she also said (1) that I am the only patient she has ever heard of ask for a prescription for add-back therapy at the Denver clinic, and (2) that she thought it might decrease the effectiveness of the Depot Lupron for dealing with endometriosis and beta-3 integrin deficiency (I can't remember her exact words on this, but she raised it as a concern of hers). So I asked her to check on this and please get back to me.

I got off the phone and realized I was left feeling vaguely uneasy after our call. Why tell me I'm the only patient to ever request this? Her comment made me feel like I was asking to be coddled. Once I realized that's what was brought up for me, I was annoyed. Why shouldn't I be able to take something to make this a little bit easier if it's out there? Why shouldn't all of us?

And then on top of that, why opine that taking the add-back therapy might reduce this awful drug's effectiveness? Because the only thing worse than feeling like crap while taking this damn drug would be taking this drug and feeling like crap for no reason. And why would Dr. Schl. have prescribed the add-back therapy if it could cancel out the effects of the Lupron treatment?

Sigh.

Yesterday I got an email from her that Dr. Schl. said all is fine, nothing to worry about, take the add-back, the Depot Lupron will still do its job. So really, was all that necessary?

It's been an occasional pet peeve of mine throughout my medical journeys, this implying you are high maintenance for asking to have something suck just a little bit less. When I had lymphoma in my twenties, I had a mediport surgically implanted under the skin on my left upper chest to receive my infusions. For every chemotherapy treatment, the nurse would place a needle (called a Huber needle) through the skin that covered the port and connect it to my IV line. You should check it out, folks, because this is no ordinary needle; it's more like a thumbtack. And so it hurt. Especially because it was done every other week and your tissue really doesn't heal well when you're getting chemotherapy. I knew that there was a new cream on the market, a topical analgesic called EMLA. So one day I screwed up my courage and I asked if it could be prescribed for me. And I was told "That's only for pediatrics. We never prescribe that for adult patients." Which silenced me immediately. I felt like a big baby.

Similarly, after our first and second pregnancy losses at 7 and 8 weeks, my then-ob/gyn advised that I should have my D&Cs in his office sans anesthesia or any pain control beyond ibuprofen. So I did, twice, because I felt like such a wimp asking to be knocked out, when he'd made it so clear after I asked for an OR procedure that it should really be fine - and his other patients didn't mind it. Actually, I found the in-office D&Cs to be terrible, both physically and psychologically (especially because one time the equipment malfunctioned and he had to manually scrape the lining of my uterus). And consequently, I no longer use that ob/gyn. But why make it so tough?

So, yeah, obviously this phone call touched a nerve for me. And Depot Lupron has the effect of exposing all of my nerve endings and making everything feel...well...hotter. This nurse isn't so bad, but I do wish she'd keep her opinions, especially when they aren't based on scientific evidence, to herself.

Looking forward to finishing the dreaded Depot in about a month. Really hoping my sister checks out and can cycle so we have something to transfer, and then hoping that these two months of suffering help implantation go at least a little better than it might have.

I wanted too to say thank you guys for all of your comments and thoughts on the last post. It helped, it really did, to read that you all get it, or that you might not totally get it but you realize that. It means so much that you've stuck with us even though the tough times, that you're still reading and rooting for us. We appreciate it more than we can say.

Mo

Click here to subscribe

Given your history

It's a strange phrase I've heard from my doctors - first in relation to my cancer diagnosis, and now in reference to our infertility struggles.

What does it mean, "given your history"? Well, I've learned that it usually means a pessimistic prediction is about to follow.

For instance, a couple of years after being declared in remission from Hodgkin's lymphoma, I felt a small lump in my right breast. Not irregularly shaped, or too hard, or matted into the tissue (things I knew from my go round with lymphoma were baaaad), but definitely there. I had an ultrasound, and the mass was solid, not fluid filled (so not a cyst). The doctor looked at the ultrasound and felt the small lump and said something like, "Well, in a woman under 30, we wouldn't really think much of this - it's almost certainly a fibroadenoma (translation: totally benign) - and we would probably just watch it over the course of the next several months...but given your history, I think we should do a biopsy."

Which was negative, thankfully.

But examples like this began to occur repeatedly. And at first, I was grateful for the careful medical attention. After all, I had lost trust in my body's ability to work properly, too. But over time, I learned to not go to the doctor and report a symptom unless I wanted something invasive done, because "given your history" translated in practical terms to something like, "You were really unlucky once...and so now we have a higher index of suspicion over ever cough, ache, and fever just in case it's another unlucky (and unlikely) event."

And knock on wood, in more than 10 years, nothing else has turned up. And my "history" has faded into the background...not a big deal anymore, but just something mentioned in my medical history and then tucked back again where it belongs - in the past.

Flash forward to infertility and it's been almost the opposite battle.

I had a bad feeling about our reproductive chances from the get go, which is kind of funny (also kind of sad) in hindsight. We actually saw an RE before we even got married to get a reproductive workup, because I was so concerned. Based on what? Gosh, nothing really, except maybe what you would call a (not yet) mother's intuition. And the RE gave us the all clear. Everything looked great. Go out and have unprotected sex. And well...you can see where this has gotten us.

As our infertility losses have accumulated, we've heard repeatedly that each miscarriage is just bad luck and our likelihood of it repeating very low.

This was comforting to hear after miscarriage #1. It was significantly less comforting to hear after miscarriage #2. Then somewhat puzzling to hear it again after miscarriage #3. By miscarriage #4, hearing that we wouldn't miscarry again was irritating. And by miscarriage #5, it was downright infuriating.

It seemed that in infertility, our lack of a history meant that the physicians were not able to imagine we could fall outside of the population statistics. For most women my age, a miscarriage is not a repetitive event. A live baby is around the corner.

So it is only now after three years of grief, we are beginning to hear the words "Well, given your history..."

And I find myself wanting to half laugh, half cry. I've been trying to get this situation assessed for what I've thought it was for quite a while now, and only NOW are the doctors also beginning to see a pattern?

It's a funny thing, this lens that medical providers see you through. A lens colored by your personal health bad luck or a lens filtered by population statistics. Either one may have a lot - or very little - to do with the actual truth of the matter.

Same as my own lenses on the situation, I guess, which are sometimes colored mostly by my fears about a bad outcome and on another day, filtered by my hope, my drive to see this through and out the other side to a child in our arms.

It will be a glorious thing when "our history" becomes just that, something we've moved on from. Something we can look back on from afar and say, Remember how hard and unending those days seemed! So wonderful it is to be out the other side! It will be a wonderful thing when we can have our infertility history tucked where it belongs - a thing of the past that we have overcome.

Mo

Ten years since diagnosis - a cancer story

A little break from my radio silence to mark an important milestone. Today is ten years to the day since I was diagnosed with Hodgkin’s Lymphoma. In this blog, I’ve referred to having had cancer many times, but I’ve never told “the cancer story.” So today seemed a good day to write it – one in which I am celebrating that this illness is a thing in the long-distant past.

The short version of the story is that I was diagnosed with a very treatable cancer. I received standard chemotherapy for my disease. I have not had any problems (minus a few scares) since. Unless you count the infertility. Which no one can link back directly to the chemotherapy but everyone agrees was bad, seemingly very bad, for my ovaries.

The slightly longer version of the story is that I was diagnosed with Hodgkin’s lymphoma at age 27. I had gone in to see my internist for something else, something relatively minor. But while I was there, I asked her to look at a swollen lymph node on my neck, a lymph node that had been there for at least three months. I was embarrassed to show her. I figured I was being one of those “worried well” types. She looked at it and felt it and excused herself. She came back into the room with another doctor whose lab coat said his name and then “Oncology.” I immediately disliked him. They said the lymph node needed to come out ASAP. They also said I needed a chest X-ray. Stat.

Once they started asking questions, it became clear that a number of other symptoms that I’d thought were unrelated and minorly annoying were in fact symptoms of cancer. I’d lost approximately 10 lbs. in the past few months (I thought this was great). I was tired and had stopped exercising (I thought I was lazy). I had terrible itching of my lower extremities (I thought that I needed to switch laundry detergents and was being “sensitive”). I had low-grade fevers (I didn’t think much about this at all).

This appointment happened late on a Friday afternoon, and by Monday afternoon, it had been confirmed (via excisional biopsy) that I had Hodgkin’s lymphoma in my neck and also had a 5 cm mass in the space between my lungs, in my mediastinum. Over the next several, excruciating days I learned that the cancer had not spread below my diaphragm (which was good) and was not in my bone marrow (which was very, very good, although painful to tap into my hip bones to find out).

After getting a second opinion (yes, even a decade ago I was a fan of the second opinion) and weighing different treatment options, I opted for ABVD (a combo of four drugs: adriamycin, bleomycin, vinblastine, and dacarbazine) mainly because it would mean that I might be able to dodge radiation treatment. From the research I had done, chest radiation in under 30s women is best avoided because of increase in breast cancer risk (also not so good for your heart and lung function). My doctor agreed to do the ABVD and take a wait-and-see approach on the radiation. Giving it only if necessary. Fortunately, it didn’t turn out to be needed.

So I underwent six months of ABVD treatments. One treatment every other week. And according to my medical records I sailed through unscathed. Most of the notes say “Tolerating treatment well.” And now that it’s almost 10 years out, I’ll agree. At the time, I found the vomiting, hair loss, fatigue, and nausea very difficult. But it got me my life back.

It remains uncertain if the chemotherapy impacted my fertility. All of the doctors I’ve consulted say that out of the options I had available, ABVD was the least toxic to the reproductive system (MOPP for instance, another regimen, would almost certainly have rendered me sterile). There is little research on subfertility, which is technically the category I fall into (I’m not in menopause/premature ovarian failure and I’ve been pregnant a few times now, but with abnormal embryos).

Despite the lack of research evidence, all of my doctors agree that the medications were not good for my reproductive health. I lost my period for over a year during and after treatment, which they say indicates that my ovaries were damaged (although able to recover). I just have to hope that there are a few good eggs in there somewhere.

At this point, the Hodgkin’s is a long-ago experience. One that has shaped me definitely, and influenced my career path, and that helps me understand patients who are grappling with a number of difficult medical realities. I really wouldn’t change having gone through it. Except for the fertility part.

I try to remember to not be greedy. I have my life, which I would not have without the treatment. And having gone through cancer has given me several gifts, including an incredible appreciation for my health and my strength, which is something I might not have learned for a long time.

But still. These days, four IVFs later, it's hard not to wonder what if. If I hadn't had cancer would I be a mother by now? And since I have had cancer, will I ever be? But I try not to linger there, instead trying to stay grateful for a decade of life now, since my diagnosis.

Mo

Sundays of grace #4

This is my weekly attempt to list a few of the things I am grateful for. It is easy to lose perspective and forget that there are many things going just fine and even better than fine, if I could only lift my head up long enough from the IVF crazy train to notice. These Sunday posts mark a commitment to remember the multiple people, places, and aspects of life that I am grateful for (Concept adapted, er...ok, stolen, with thanks, from Sprogblogger and Sassymama).

1. Sitting in front of a wood-burning fireplace with Will, watching the logs glow and crackle in the middle of winter. We don't have a fireplace in Manhattan, but when we go Upstate, this is one of our favorite wintertime rituals.

2. Long country drives: Another favorite weekend activity when we're in the country is driving down gravel roads in New England, seeking out Greek Revivals, Eyebrow Colonials, Shaker buildings, and old farmhouses. It's wonderful time spent together, witnessing the beautifully shifting landscape and seeing so many homes anchored in history and yet still present today in their simplicity and solidity. We hope someday to maybe own one, but for now (and the next several years), we find pleasure in just admiring these homes from afar.

3. Medical research and science: Medicine saved my life when I was diagnosed with cancer a decade ago, and recent research advancements have made it possible for us to try for the family we've always wanted. Fingers crossed that this technology can actually make it possible. At least it's given us a fighting chance.

Mo

Sundays of grace #2

1. A short run on a springlike day: Today is a balmy 60 degrees. Went out for the first run in a few months and remembered to be mindful of the wind on my face, the sun, the fact that I am able to run and be outside on a beautiful day.

2. Good friends and laughter: As this infertility journey has continued, I have been isolating more and more. Friday night, Will and I went out with a friend of mine and her boyfriend and had such a good laugh-out-loud time. It was so freeing, and dare I say it, somewhat cathartic? I am grateful that we all felt so comfortable around one another and just able to be ourselves. It was a good reminder of the importance of building and maintaining connections to others, even when going through difficulties.

3. My health: something I try to remember to never take for granted. One of the upsides of getting cancer in my twenties is that it really allows me to appreciate my physical well-being. I get so angry sometimes that cancer may have stolen my ability to have a child, but then I am struck by how fortunate I am just to have this life - to still be here. I remember lying in bed when I was sick thinking I will never take it for granted when I can walk up a flight of stairs without feeling winded. I will never take it for granted when I can feel hungry without nausea or indigestion. I will never take it for granted when I can be pain free and get through the day without fatigue. Of course at times I do take these things for granted, but then I catch myself, and I am overcome with gratitude.

Mo

"It's not your clinic, it's YOU" - reflections on a second opinion

We spoke with the head of the Colorado clinic last night. I presented our clinical situation, beginning with my health history and including our forays thus far in IVF. He was a very nice, articulate man. He gave us a lot of time, and a lot of detailed information, which we really appreciated.

But his opinion was sobering.

Bottom line, he thinks the Hodgkin's chemotherapy treatment and subsequent radiation from all of the imaging I have had done (more than 30 CT scans, gallium scans, PET scans) have damaged my eggs and are the culprits behind our multiple chromosomal losses. He said that it was pretty unusual to have a double aneuploidy and then to have another consecutive aneuploidy (and in our case two more consecutive), so he didn't think that was just random bad luck, as it has previously been explained to me by my RE and OB/GYN.

He also cited as concerning the fact that we have made many eggs and embryos during the past three cycles (40 mature eggs and 31 fertilized embryos), but only two blastocysts - all while at a top clinic.

He seemed to think our male factor issues, although fairly rough on paper, were not such a big deal since we've gotten pregnant occasionally on our own. And that it is good we don't have any uterine or clotting or other issues (all tested negative in recurrent miscarriage work up).

He said our best chance going forward is donor egg, but that "if you're not yet there philosophically," we have a couple of other options:

1. We can continue the IVF method we have been using - which he likened to a scattershot approach - hoping that eventually we will produce a chromosomally normal embryo and happen to transfer it.

2. We can come to his clinic and use a technique that is under clinical development called microarray analysis to see if any of the embryos we produce are euploid. He thinks we may find out that most or all of our embryos are abnormal. Microarray analysis would involve another fresh IVF with aggressive stimulation and attempts to grow the embryos to blastocyst (a little concerned that we've only ever had two blastocysts...but he seemed confident he could get a decent number). They would then sample the polar bodies or take a few cells from the trophoblast (part of blast destined to become placenta) and test for all 23 chromosomal pairs. It takes several weeks to complete this testing so all blasts are frozen using vitrification and those that are chromosomally normal are then thawed and transferred later (he reported a 99% survival rate after thaw). So far they've had 85 patients - mostly those who have failed other cycles - and a pregnancy rate of 70%.

Using microarray, he gave us a 25-30% chance of success. We didn't even ask about the likelihood of success with traditional IVF.

We were a bit shellshocked after the conversation (me more than Will, since I'm the defective one) but everything he said makes sense. My RE's continued optimism ("Your prognosis here is fabulous!") despite how things keep turning out has been a bit puzzling, but I have just been chalking it up to my own pessimism.

If we decide to go with the Colorado clinic, the whole process will take approximately (gasp) 4 to 5 months, beginning with a day of testing (lose a month, possibly two depending on if they need more testing) and working through the whole process of stims (one month), microarray analysis (4-6 weeks), and then a medicated FET (another month).

Daunting. We have a lot to think about.

Note to self: be careful about looking under every stone - sometimes you may not like what you find.

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

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

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