Where did the time go?

I've been quiet a lot longer than I intended to be. And I hope I haven't worried anyone.

It's just been hard, so so hard over here. I've been kind of shut down around this whole infertility situation, honestly, because things just feel overwhelming in that department. Every time I think of our situation, I just feel hopeless and I want to go back to bed, avoid, and give up, which is such a change from the hard-driving person I've been around all of this for the past four years. We've been trying faithfully on our own every month, but well...I guess I must really be infertile (!) because this timed intercourse doesn't really seem to be doing the trick.

This Spring, we came close to trying another transfer into my body with our remaining frozen embryos. Because logically that seemed to make the most sense.

And then I did the math again:

7 IVFs

110 eggs retrieved

17 embryos transferred

6 pregnancies

0 living children

And I just sort of lost it. This enormous sense of NO! NO! I CAN'T DO THIS AGAIN! came up in me. It seems likely that we know what the outcome will be. And it won't likely be a good one. I don't think I or Will or our marriage can take it. So we called it off.

We are still considering using the donated embryos that have been offered to us. We've found a couple of egg donors through agencies that we would be fairly happy with. And we've been talking to some folks about surrogacy of our frozen embryos. Adoption is not something that we're considering at this time.

But we haven't landed anywhere yet.

One relative said to me: What would you do if all the options were free? If you took money out of the equation? Good question, I thought (along with - easy for you to say!). But it got me thinking...

If money were no object, this varies, but today I would choose to use a gestational carrier for the remaining Mo and Will frozen five. Just to see...We've got 'em. We nearly killed ourselves to get them. And they are chromosomally normal so there should* be at least one kiddo in there.

*But of course that may not be true. That would be true for other people. For us, though, nobody knows what is going wrong.

So here we sit. But I at least wanted to pop up and say hi. I feel kind of sheepish for posting another post that I still don't know what direction to take, am still struggling, am still stuck. But I guess it's better than posting nothing? Hope so.

We're hoping to make a decision on what direction to take in the next month or two. Because time, it is a'ticking and we are beginning to feel strong enough to take another step. Stay tuned.

Mo

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Grieving miscarriage and looking ahead

We continue to just feel our way through this, try to figure out what path makes the most sense and feels right in our hearts. It's hard. Our history of multiple miscarriages is hard, and the possibility of more loss has sometimes felt unbearable.

Today I saw this article in TIME, which says that even if we succeed - newsflash - grief over a miscarriage doesn't necessarily disappear. And apparently, the number of losses matters, in terms of how hard it is to shake your sadness. Thirteen percent of women who had one miscarriage or stillbirth* before a live birth were depressed nearly three years later. This rises to 19% for those with at least two losses. And rises again to 22% for those with four losses before a healthy birth.

I'm glad this topic is receiving national press attention, and I'm thrilled it's even being studied, since the psychological impact of miscarriage is such an underinvestigated area. I know, because I'm a clinician and a researcher, and I've tried to read up on it as a way to comfort and educate myself. But truly, I find none of these data surprising. Was it expected that loss, and in particular multiple losses, wouldn't have a longer/larger impact?

Reading this, of course, leaves me wondering what the rate of depression is of those who have six losses before a healthy live birth.

And even harder, but on our minds as we consider next steps on our journey, the very real question:

What if you never have a healthy baby? What then?

Mo

*and seriously? the researchers combined miscarriage and stillbirth as though they are one and the same and can be collapsed together? Bad researchers!!

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Which way do we go? Meeting with the RE

The holidays are thankfully over and I am still in the process of recovering from a severe flu that I came down with Christmas day. Fever long gone but cough seemingly here to stay for a while.

But now that the holidays are over, it's time to begin to sort out options with this baby-making business. To get that rolling, Will and I met with our NYC RE to discuss the fact that this latest miscarriage was a chromosomally normal boy and what that means in terms of next steps.

He is so kind and met with us for nearly an hour, but unfortunately, we didn't leave his office having a sense of what the next step should be.

He said we are "getting closer" to a gestational carrier as a direction to take. But then again at other points in the conversation, he didn't seem to think we were necessarily there yet and said that many people lose a chromosomally normal pregnancy, so it's not really an indication that I can't carry a baby to term. If we had a second chromosomally normal loss (God help me), he said then we would be looking at surrogacy as the next right step. He also said that he felt that having a chromosomally normal embryo or two is great, but does not necessarily make a baby. He reminded me that my embryos were biopsied and frozen and thawed. He reminded me that my embryos didn't all develop on time (the late fertilizers, the day 7 blasts), which he thinks is a harbinger of doom for viability.

And I've started to look into gestational surrogacy, even though I am not happy about the idea. And Oh. My. God. It is so expensive. Breathtakingly expensive. And really expensive before you even know if the baby will really take or not. Like $25,000ish before she'd even be nine weeks pregnant (and I've lost babies past that point. Twice). Ugh!

My doctor also said that many women with histories like mine go on to use an egg donor (in their own body) successfully and that we are getting closer to that path as well. But probably not there yet either, since we have the five chromosomally normal blasts and one no result still waiting for us in Denver. On hearing that, I promptly went and picked two egg donors from two different egg donor agencies. They are both really smart. They both have light skin and very dark hair. Just like me. They are both in their early twenties, which I like. I see them as my ladies in waiting. But of course, the question is, can a pregnancy survive in my body? We don't know. Sigh.

Honestly, at this point, I just want to get out of this reproductive business and take whichever path is fastest to have a child. Still don't know what path that is, unfortunately. I wish it were clearer, so I could choose it.

One commenter after the miscarriage - anonymous, of course - stated that "Isn't it time you see the writing on the wall?" and that since I'd had the best clinic in the country transfer chromosomally normal embryos I should...actually she didn't say what I should do, because the solution is apparently so obvious to everyone but me, it doesn't need to be spelled out. Dear anonymous, I've tried and tried to read the writing on the wall, but I can't make it out. Do I conclude my body can't support a pregnancy? Do I conclude that despite the fact that I can make chromosomally normal embryos there is STILL something wrong with my eggs so that they can't make a baby? I don't know. And my doctors don't know either. And that is what sucks so much.

Both Schoolcraft and our local NYC RE think it is most reasonable for us to try another transfer with my embryos in my body. And while having my own genetic baby in my own body would be my dream come true, my only reaction is Ugh.

Will turned to me in bed recently one night and asked if I would be willing to do another fresh IVF with microarray so we'd have more normals to try with. That would be fresh IVF #8. Nine, if you count the frozen transfer. And I said no. At least for now. Which is a first. I have always felt I could go one more round. Ugh.

Ugh. Ugh. Ugh. Because I can't imagine succeeding. All I can see is more grief. More delays. More pain. With no end in sight.

So what do *I* want? I just want out of this bloody mess. I want to move on to having a baby.

Problem is, I still don't know how to get there.

Mo

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Placental pathology results

(pic brought to you by whywouldyouknitthat.blogspot.com)

Not sure if I mentioned it, but after our most recent miscarriage, my RE here in NYC recommended we send slides from the chorionic villi to a placental pathologist at Yale for review (the same guy who performed my endometrial function test).

So we did.

Once I looked into it, I found out that this placental pathology analysis would be covered by insurance, and so I decided to send slides from not only this miscarriage but also from the other four we've had tested.

Results just came back. All of the reports are similar in saying that there were various findings that provided evidence of chromosomal abnormality (including this latest one with the CCS normal blastocyst, which demonstrated trophoblast hyperplasia - it will be so interesting to see what the genetics come back as). All of the losses also demonstrated that maternal uteroplacental blood flow was normal.

All of the miscarriage reports also report what was NOT found:

• no evidence of immunologic rejection
• no evidence of bacterial ascending infection
• no evidence of thrombotic pathology

Not sure if I want this latest loss to be a chromosomal abnormality that somehow slipped through the cracks or rather have it unexplained. Pretty much would rather not be in this situation at all! I guess the best I can come up with is that it will be good to get the information back and then try to make sense of it.

On the placental pathology report from the latest loss, there was one section that has me a bit confused.

Any medical types are most welcome to weigh in...

On this last report only, the pathologist said "this patient and/or her spouse may also have an occult genetic abnormality. A genetic consultation, including high resolution karyotyping and array analysis of the parents, may therefore be beneficial."

Now what in the world is an occult genetic abnormality? I'm assuming here that word occult means "hidden," rather than "supernatural." Aren't one's genetics always hidden?

Is this different from a "regular" genetic abnormality?

And what is high resolution karyotyping and array analysis? is this different somehow from the type of karyotyping we've had done already? We both came up as genetically normal...

Anybody have any thoughts or knowledge?

Feel like I'm starting to emerge from my cave of sorrows, pick myself up again, and try to figure out next directions. Geesh, this loss and all else going on have been hard.

Mo

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Don't indict my uterus! Regroup with Dr. Schl.

Talked to Dr. Schl. today for a regroup appointment post-miscarriage. He said that it will be interesting to see if the baby was chromosomally normal or not once the cytogenetics come back from the D&C...um, yeah. I'd say it'll be interesting... he also reminded me that our microarray tests had a quoted 90% accuracy rate. He says that if the genetics come back normal, that would "change (my) history and complicate the picture but wouldn't necessarily indict (my) uterus." He says many women have one unexplained miscarriage. Most of my other losses were confirmed chromosomally abnormal (in fact, every one that we have had tested).

As for next steps, he said he would stick with the FET protocol and give it another go. He also said that it would be ok by him if we wanted to use a gestational carrier. And that he would even allow us to simultaneously transfer to me and to a carrier at the same time so that we could have a greater chance of success and also get through our embryos faster in case there is some other subtle abnormality that keeps them from making live babies.

One major plus, he said no more evil depot lupron needed until 6 months pass from the D&C. Phew. That stuff was terrible for me. The only other thing we need is a hysteroscopy to check that my uterus is scar-free and baby-free post D&C, and he said we could have our local RE here do that.

So lots to think about. Wish we weren't in this position at all. Not sure what we'll do next but good to get as much information as possible before we go forward.

Still hanging in there with the family emergency. Still completely terrible. Still hanging on to knowing that this can't last forever.

Mo

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7w3d ultrasound: it's over

Went to the RE, who didn't like what he saw and sent us on to a radiologist who specializes in OB at the hospital.

Just to confirm.

Both saw debris in the gestational sac. No yolk sac. Small subchorionic hemorrhage. No fetal pole, let alone heartbeat. Not sure what to think of Monday's reassurance ultrasound.

But it's clear now.

Pregnancy #6 is over.

They are adding me to the OR schedule for today.

Will and I can't believe it. We thought this one might be the one that made it.

Walking between the two doctors' office buildings, I thought, Maybe I haven't woken up yet. Maybe this is a bad dream.

But it's not. It's happening again.

Mo

*****

Update: Surgery rescheduled for tomorrow. I forgot completely that I'm on lovenox and aspirin. My RE wants to wait 24 hours for the lovenox to get out of my system and will fit me in tomorrow afternoon for the procedure.

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Hallmark reject #7*

*Another actual statement from a friend, who at age 38 got pregnant for the first and only time. Not even trying. Her son is almost six now.

Made me wistful to think that for many women, just seeing two pink lines fills them with confidence that a child is on the way.

After seeing pink lines five times now, not so much.

Two pink lines for me? Equals Elation + Absolute Dread.

Anyone else?

Mo

Move over Baby On Board! IF signs for every occasion

Prompted by you commenters pointing out the annoying "Baby On Board" signs (most frequently endured apparently by international bloggers), Will and I decided to create a line of "On Board" signs for the infertile driver.

Because every situation is unique, we've created a range of signs to fit several unfortunately common situations. Sure to warm the hearts of infertile drivers everywhere, as well as create discomfort and fear in the drivers around them.

So read through and enjoy. I'm sure there are many we haven't thought of, so let us know what we should add to the "On Board" line. We are always open to suggestions.

First off, there is just the general retort to the "Baby" signs. You've got a Baby on Board? Yeah?! Well, over here in this car we've got exactly:



But maybe that's too general. Maybe that makes it sound like you just don't want a baby or something, which isn't really quite right...

So we decided to be more specific...


For the infertile who's cycling, and needs to caution drivers that her medications may make her, how shall we say, a raving lunatic b*tch...there's this specific sign, both an announcement and a warning. Yes, Sprogblogger, we made this one just for you. Not that you're raving, but you are on this particularly yucky medication at the moment : ) Smart drivers should know to GET OUT OF YOUR WAY before you haul off and slam your car into them just because it's so sucky to take lupron.





Following transfer you may want to let people know that it might look like it's just you and your partner in the car, but in fact, you are not alone...you have:

Ever mindful of the guys, woefully neglected in the infertility world:

And for the man with azoospermia:

Or for those of us who unfortunately experience pregnancy loss, and for the really unlucky, multiple losses, this special sign:

And finally, this sign, for the infertile who's fed up with it all, after multiple cycles, heartbreak, angst, and financial hardship:

I think I'll pick the last one. You?

Surely someone will let us in if we've got this one stuck on our back window, right?


Mo