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

One-day work up - the second time's the charm?

As promised, here's some of the details from our one-day work up a week ago.

Objectively, the day was pretty uneventful. I had the expectation that the whole thing would be a breeze (after all, we've done this before), but I was wrong. The one-day work up was surprisingly draining. By the end of the day, we were wrung out.

I started the day with a hysteroscopy, which hurt more than I remembered, and which was normal. Met with the donor nurse, who seemed OK. I am not warming to her as much as I did my prior IVF nurse, but oh well. We don't have to be buddies. When going over the huge binder they give you (my new "donor" one is grey, versus the white "IVF" one I was given before), she instructed me to be in close touch with her and basically said she is not going to be the one to be on top of everything. "I have 79 patients, so it's up to you to keep me up to date on all the details." Hmmm...Ok. I don't love hearing this, but if this is the case, it is good to know.

Will and I both had lots of blood drawn for communicables and we're running some additional genetics on Will that hadn't been done before (CF, SMA, thalessemia, etc.) - didn't see the point since I'm not a carrier, but now we'd rather know.

We met with Dr. Schl. and discussed everything that might help with implantation. We went over all the somewhat scientific things he supports (e.g., depot lupron - ugh, and the Denver miscarriage medication protocol of Claritin, Pepcid, and prednisone) as well as the more fringe immunological things that have been recommended to me by others (e.g., IVIG, intralipids, lovenox) and he reiterated he won't prescribe any of that but is willing to collaborate with someone else if that's what we want to do. So we'll have to decide. I'm not much of a believer in fringe myself, but we're at the edges of medical science with our situation, unfortunately.

We all acknowledged that while this donor egg attempt is promising, it may not work for me. And so we spoke together about using a gestational carrier in the future if need be. The basic gist of it was a positive one: that between my uterus and a gestational carrier's, and my eggs and a 23-year-old donor's, that somewhere in that mix we would finally succeed. We told Dr. Schl. that we have had very preliminary communication with someone who, knowing our story, generously offered to be a carrier. He was very enthusiastic about this. She won't be available until later in 2012 and we would need to get to know her much better and see if she is even still interested (it's been a while since we chatted about it) as well as have her medically screened. She has PCOS, which we told him and he said that that is absolutely no problem, which was a relief to hear. Even though we're doing the donor egg cycle right now, it was so helpful to discuss this, because if we did need to go this route, I feel much more comfortable with this person than with any of the anonymous profiles we looked at. Hopefully we'll learn I can carry a pregnancy, but it was really nice to begin to talk to him about what might happen if I can't and hear his genuine enthusiasm about it. (And those of you who know him know that he is not a generally enthusiastic guy!)

We met with the psychologist for the psych eval, which was fine but not really helpful. She seemed to conclude about 20 minutes in that we are very well read on this topic and have thoroughly considered issues like integrating a donor child into the immediate and extended family and the what's, when's, and how's of disclosure. And we have thought a lot about this. But interesting at least to see what the eval entailed.

Will also gave his sample for new chromatin assay and semen analysis without incident.

And then last but not least were the off-the-books visits. These were my highlights of the day. We saw our nurse and exchanged hugs and news.  And we met up with Danielle from genetics. She admired pics we have of our donor and said visually the match is a very close one, one of the best matches she's ever seen. And in general, she just made it so clear that she is rooting for us. She said she's kept my file at her desk all year rather than refiling it with the not-in-cycle files, and that every time she saw it, she'd tell herself, "I know they'll be back." "I know they're going to have a successful outcome somehow."

Please let it be true.

Mo

Click here to subscribe

Our donor's one-day work up is TODAY

I know I still owe you guys a post about our one-day work up last Friday, and that's coming, I swear! I have been completely swamped at work, making it hard to post.

But in the meantime, I wanted to fill you in on a new development. As of yesterday, our agency donor cleared the initial screening process at the Denver clinic. It had been a bit delayed because she apparently had a blind cousin.

Blind cousin! We were nearly derailed by a blind cousin! Apparently there are several congenital causes of blindness and because this cousin died in a car crash (I'm assuming he was not the driver), he cannot be tested. But finally, after a lengthy hold up, the genetics counselor signed off on this cousin situation. Yesterday afternoon.

And then miraculously, our donor was immediately scheduled and flown in this morning to have her one-day work up.

That's right, less than 24 hours after passing the Denver paper screen, they are evaluating her in person. Incredible. Someone must really be looking out for us.

In fact, our donor's one-day work up is happening RIGHT NOW! (gulp)

She's undergoing:

• psychological evaluation (including MMPI-2) 
• baseline ultrasound
• physical exam
• pap smear/breast exam
• urine toxicology screen
• blood typing
• CBC/chem panel
• communicable diseases panel
• and genetic testing (karyotype, cystic fibrosis, fragile x, spinal muscular atrophy, and hemoglobinopathy)

I didn't think I would be, but I am really nervous she won't pass some aspect of this. Which would really stink, mostly because we're kind of in love with her and if we can't use her will be heartbroken, but also because financially we're paying steeply for her Denver work up and have also already sent her agency a considerable amount of non-refundable funds.

So fingers crossed. I promise to post shortly about our one-day work up experience - and will do the same about hers, once I receive any info. To give a brief summary, our one-day work up was much more stressful than we anticipated. Everything turned out fine, but Will and I both returned home exhausted.

More to come on this and other topics.

Mo

                     

Click here to subscribe

The Colorado genetic counselor rocks

Thanks for all of your blogoversary wishes. We are ready to look forward to the coming year - and hope that there are fewer disappointments and more successes - please! Loved your comments reminding us to focus on what's important - our love for each other, and to be mindful of the accomplishments the last year has contained. We're with you guys - may this be the last year that this is an infertility blog!
So, finally, to fill you all in on the rest of the Colorado visit...
Our last meeting of the day was with Danielle, the genetics counselor. I'll be honest - I really didn't want to go to this. I mean, I spent an hour and a half with an M.D. geneticist in New York just a couple of months ago. What could this counselor possibly add? That said, once we met Danielle, I liked her immediately. And what she had to say perked up my ears rather quickly as well. We were drawn to Colorado because of their microarray technology. She said, however, that after reviewing our files, she'd spent the day meeting with the scientific director and making calls on our behalf because she felt that microarray wouldn't be enough for us, given my cancer treatment history and the fact that our losses have included both trisomies and polyploidies (overachievers, us!).
Basically, she said that microarray can only detect trisomies. Apparently, the way the technology works, microarray looks for alterations in the patterns of chromosomes - so one more or one less of a particular chromosome, a heterogenous problem. Microarray does not pick up polyploidy - because in this situation, there is an extra set (or sets) of every chromosome. And so the test reads it as normal, since it's a homologous defect across the entire set.
Who knew?
But surely, we're not the first couple to ever cross the Colorado Clinic's threshhold who's had a polyploidy plus a trisomy? I asked this, and Danielle assured me that although it is unusual, we are not.
But she said in our case (lucky us!), they were worried the polyploidy problem (usually a 1 in 1,000 occurrence) might have a tendency to repeat.
Hearing this, part of me was like YES! Finally, someone agrees with us that there is something unusual here - that these silly population statistics may not apply to us! This part of the information was super validating and welcomed. At the same time, I also had a Oh no, we are so f*cked up sort of reaction.
Bottom line, according to Danielle, we will need to do both microarray and FISH screening (the type of screening they use in PGD) to look for both trisomies and polyploidies. Because they do not want me to transfer embryos back thinking they are normal and then find out that they aren't normal after all. So they want to do a single biopsy of each blast (should we be so lucky to get blasts), split the tissue from each blast and send half of it for FISH and half of it for microarray.
Sounds good, right? The only problem is that each of these tests costs approximately $5,000. So it would add an additional $10k on top of the usual ridiculous IVF fees.
Ha. Ha. Ha.
Before we both fainted, Danielle quickly said that the Colorado clinic would never expect us to carry all of this cost and that they were already negotiating with the labs involved to waive fees so that we could have both tests run for no additional cost. In fact, she waived her $150 fee that day to get us started down the road of savings and said they were going to figure out how to shave $5,000 out of things somewhere so we don't foot the bill.
This was our final appointment of the day and we after we finished speaking with Danielle, we got into our rental car and drove directly to the airport to catch our flight home. What a way to finish out the day.
Our final impression was Wow. They are really thorough and have thought about our specific situation and what would be best for us. They are really looking out for us. Needless to say, we were impressed.
We'll keep you posted on what they're able to work out for us.
Mo

Meeting with the Colorado wizard

The first thing that struck us as we walked in the front door of the Colorado clinic was the attention to detail - each magazine, every plant, every tile - down to those around the edges of the walls, was perfectly positioned. There was no clutter, not even on the receptionists' desks. Information flowed efficiently between staff members. It was obvious that someone had put a lot of thought into everything from the design of the building to the systems of how various levels of staff communicated and how patients were funnelled through the clinic to reach their appointments. It was quite something.

After meeting briefly with a nurse, we were led into a consultation room. One entire side wall was lined with copies of research articles available for patients to take. Immediately this gave the sense that this clinic desired us to be informed about our situation. In detail. Which is very different than my New York RE (who I love, but who tends to be rather vague on the details, leaving me to go dig them up myself in the medical library).

Dr. Schl. entered not long after we sat down, wearing scrubs beneath a lab coat. And he got right down to business. We filled him in on everything that had happened between the February phone consult and now. Two more IVFs, two more miscarriages, diagnosis and surgery for stage III endo, etc.

And he basically toed close to the line of what he had said before on the phone with us in February. Except he said now we have a bit more data from the two additional miscarriages. His basic message was that we probably don't make any normal embryos, and that whether this is due to my treatment for cancer or some other factor is something we’ll likely never know. He said that through cytogenetic testing, we've been able to demonstrate these abnormalities three times, but that the only way to know across the board for sure is to look at the embryos themselves.

He was complimentary of our clinic here in New York. Said he knows all of our doctors and has respect for them and that if we’ve done five cycles at the clinic we've been at with no baby to show for it then we probably won’t end up with a baby with him either, because they’re really good at my clinic. I appreciated the confirmation that our clinic is one of the top ones, but of course, hearing that we’re likely screwed was not exactly what I was hoping for.

He spoke calmly and in a low tone throughout the meeting. He seemed pretty unflappable. He wasn’t nervous, wasn’t trying to sell us. In fact, at first, Will and I thought he was trying to dissuade us. He said something to the effect of “You’ve done 5 IVFs. No one can say you didn’t try.” This meeting was the first thing scheduled in our day of appointments and we looked at each other and considered just calling it a day and catching an earlier flight back.

Ultimately, though, Dr. Schl. stated that it was reasonable to give things one more try and that this would give us very important data - and maybe a baby. He seemed to think it was much more likely that we would end up with data leading us to choose donor egg, but left open room for him (and for us) to be surprised. And basically he said we’ll have good information no matter what happens if we cycle. If we cycle and I don’t even make blasts, he says that’s our answer right there – go on to donor – our eggs are too damaged to even get to day 5. If we do get to blast, we can test them and then we’ll know what we’re dealing with. He also said that it was difficult in my case to know if I can get to blast because my clinic has only ever tried to go to blast the first time with my eggs (and that cycle I did transfer two blasts and get pregnant). Especially since we’ve done coculture the last two times, which can only grow embryos to day 3, we really don’t know what my embryos are capable of. Interesting. What I most liked to hear, though, was that if I have a good number of eggs and don’t make any blasts in the Colorado clinic, then we have our answer. Maybe not an answer we like, but an answer.

When we asked him his thoughts on doing a high dose IUI, he said he thought it was not a good idea. That if we didn't get pregnant, we wouldn't be able to pinpoint why and if we did get pregnant we were just rolling the dice again - and he suspected we would likely miscarry again and spend months in the getting pregnant, being pregnant, and becoming unpregnant process. He felt that with IVF with microarray, we can get a good batch of embryos, know that they've fertilized, and see what happens exactly. It was honestly helpful to hear his opinion on this. It was fairly convincing.

The other interesting thing that Dr. Schl. said was about our most recent loss, which was a triploidy (three full sets of chromosomes instead of two). Since this was most likely caused by two sperm fertilizing an egg, we were told here in New York by multiple sources that this is a totally random event that won’t recur and has nothing to do with our chances. Dr. Schl. disagreed, saying that it is still an egg issue and that my egg allowed two sperm to enter, meaning that it was defective. He also thought that given that this is coupled with our other aneuploidies, and given my cancer treatment history, we might be more prone to polyploidy than other patients. Great.

Throughout the meeting, Dr. Schl. only cracked a smile once. I told him that our clinic was aware we were headed out to see him and that they were willing to monitor my cycle in NY. And then, when I told him I thought they were probably more than happy to do the monitoring so that I could stop messing up their stats and instead start messing up his stats, he smiled. It was brief, but it was definitely there.

So that’s the what’s what. Not exactly hopeful. But it’s where we are at. It was sobering to hear Dr. Schl.'s take. Not as devastating as it was a year ago, and not unexpected. But it wasn't easy, either. The fact that we could even sit across a table from someone telling us that it is likely that we will not succeed and not burst into tears is amazing. Just a year ago, we were still so, so hopeful, and were devastated when we spoke to Dr. Schl. by phone. This time, we just nodded and sighed in resignation. What a difference a year makes.

Wow - this post turned out to be a lot longer than expected. Sorry about that.

More on the rest of the work-up soon, in particular the meeting with the geneticist.

Mo

Home again, home again: Back from the one-day work up

We've returned from the Rocky Mountain clinic, and I have much to say about our journey, which will likely trickle out over the course of a few posts.

While out west, we saw a brewery called "Rock Bottom" and I thought, that's fitting. That's why we're here - we've hit rock bottom in this Trying To Conceive business.


We're so close to our absolute nadir of hope that we flew halfway across the country for potentially our last shot at having a genetically related child. We have long heard of this fabled Colorado clinic and had done a phone consult with their director way back in Feb. 2009. At that point, he had been quite sobering in his opinion, but had recommended a comprehensive chromosomal screening called microarray as our best option if we wanted to try one more time with my eggs.

To recap everything between the phone consult and now, we've done two more IVF cycles at our NYC clinic, planned to go out to Colorado twice, but gotten pregnant both times, and subsequently miscarried both pregnancies. So it feels a bit crazy but really kind of cool to actually finally make it to the one-day work up. We brought all of our information with us, curious to see what this clinic and specifically their head doctor, Dr. Schl. would have to say.

What a whirlwind trip - there was really not a moment of downtime. Will and I were both pleasantly impressed with the Colorado clinic's professionalism and efficiency. And honestly, at this point, I'm a bit cynical and am almost looking for something to criticize. So it was quite something that consistently we found this clinic to be really on their game.

For example, throughout the day of appointments, everyone we encountered had read my chart and knew our history. This clinic definitely gives an impression of knowing what they are doing. And when we met with Dr. Schl., he was perfectly pleasant and very informed and articulate, despite his reputation for not having the best bedside manner. He didn't sugarcoat anything, not a morsel of it. But he wasn't overly harsh in the way he delivered what seemed to be his honest opinion either.

Below is our schedule for the day. It was pretty back-to-back and well-organized. Lots of information presented and many tests and some procedures done. I expected this to all be (yawn) redundant (and I therefore predicted I would be annoyed) and some of the things were redundant of course, but there were a number of interesting things we discovered (in bold below):

9:00 - 9: 30: (but it ran longer): met with Dr. Schl (will post details in a separate post. Very interesting chat).

9:30-10:00: met with laboratory people and signed many consents.

10:30-11:00: very detailed ultrasound for me, semen analysis for Will. Turns out I have three fibroids that won't affect anything. According to some kind of doppler scan, I also have blood flow resistance to my uterus - for which they recommended 8 sessions of electro-acupuncture before embryo transfer. Who knew?

11:00-12:00: met with IVF nurse for full hour of education on how things work at this clinic in terms of contact with staff, cycling, testing, etc. Cool to see how they do things as compared to my clinic (more on this later). Geesh - this clinic really wants us to be informed - they presented us with a full binder of materials and literature - this is more info than my clinic has ever given me across two years of treatments.

12:00-1:00: lunch (was supposed to be a half hour but they had mercy on us).

1:00-2:00: met with IVF nurse for another full hour for education on genetic testing required for heritable diseases, required communicable disease testing, medication administration, etc. Good Lord, these people are thorough in their written materials and presentations (hmmm...does someone on staff have obsessive compulsive personality disorder, perhaps? Across the board, the attention to detail was...actually a little scary...but also kind of comforting.)

2:00-2:30: lots of blood work, plus was offered and accepted the chance to get the H1N1 shot - cool! - it's not available at my hospital yet. Don't have it in front of me so can't remember everything that was ordered in terms of bloodwork, but at least two things were new: AMH testing and CMV antibody testing. Will be curious to see results.

2:30-3:00: office hysteroscopy with Dr. Schl. Hurt less than I thought it would. (Given that this cost $645, I was slightly annoyed that as expected, everything in ye ole' uterine cavity is normal). Structural problems are not our problem.

3:00-3:45: met with genetic counselor (thought this meeting would be totally redundant and annoying, but it turned out to be quite useful and surprising...so much so that I will tell you about it in a separate post).

We arrived home very late last night, picked up our puppy, and dropped like dead people into bed. Right now Will and I are trying to dig out from all that went on in our work while we were away and emotionally process everything we heard. As well as attend to Ms. Moxie who had to go to (gasp! she's just a puppy!) a pet sitter while we were away.

Everything we saw and learned gave us a lot to think about. I promise to post again soon when I can. Bottom line, at the moment, we are anticipating we will likely give this IVF with microarray thing a try. It may or may not help us, but at least we'll know. And maybe then we can move forward. Or, even better, although probably unlikely, maybe IVF with microarray will actually work and we'll end up with a baby. Wouldn't that be something.

Mo

Fruit cake and Endometrial Function Testing

So I went in to see my RE yesterday and had an endometrial biopsy done so the tissue could be sent to the researcher at Yale who pioneered the Endometrial Function Test (click the link to see him compare the endometrial lining to a fruit cake.) I've pictured my endometrial lining looking like a lot of things. But never quite like this:

The biopsy hurt, but not too badly (about the same as the coculture biopsy), and it was over in a minute or two.

The idea of this latest test is to get a sense of my lining and whether it is a receptive place for a little embryo to grow. So a snippet of my uterine lining is now winging its way to the aforementioned Yale researcher so he can look for things like the progesterone receptor, and mouse ascites Golgi mucin, and cyclin E (which shouldn't be there), and also to check and see if leukemia inhibitory factor, αvß3 integrin, HOXA-10, and p27 ARE there, because they should be. Got that? Me neither. Totally confused.

Apparently results will take a couple of weeks, so we'll see what said researcher thinks soon.

I have to say, I'm not holding my breath. Instead I'm moping around a little bit.

I do hope that something informative will come out of this, I really do. But at the same time, this is starting to feel a little bit like an exercise in the absurd. Know what I mean?

Mo

9 wks 2 days u/s: missed abortion

Thank you for all of your supportive and caring comments over the past few days.

We had our ultrasound this morning, and unfortunately, there was no heartbeat. The baby died sometime between last Friday and today.

Our wonderful RE is fitting us in for a D&C later today. Of course, we will have cytogenetics run to see if we can determine what went wrong.

Almost impossible to believe that we got this far only to have heartbreak again. How is it even possible to have five losses in a row? Incomprehensible.

We are shocked and deeply grieving. Please keep us in your thoughts.

Mo

Egg retrieval day: part II

Just got home from the retrieval. A little woozy, 'cause I ended up needing some morphine afterward, but fine.

Number retrieved: 6.

Trying to tell myself that this is ok, but I am really disappointed by this number.

Glad we're not doing PGD with only 6, and a blastocyst transfer is out of the question. Actually a "Hail Mary" transfer probably isn't necessary either. By the time we lose some to maturity, some at the fertilization stage, and some to embryo development, I'm just hoping we have anything left.

Of course if whatever remains is viable and we are able to get and stay pregnant, then it will all have been worth it.

Mo