The Treatment Diaries: Weighing our options, August 2000

The entries in my journal hint at, but don't entirely reflect, the emotional strain and turbulence that I remember dh & I were going through at this time. The results of our first two Clomid cycles hadn't exactly been encouraging, and the early-morning routine of clinic visits was already taking its toll. At the same time, Dr. RE hinted that better results could be had with injectables, and that was tempting.

We spent the first few weeks of August on vacation visiting my family -- & celebrating my parents' 40th wedding anniversary (without any grandchildren for the guests to fuss over, of course, which just added to my guilt & stress). August 10th, day 28 of my current cycle, I called Dr. RE's office to make an appointment to discuss our options & next steps. The appointment was for August 17th, which happened to be day 2. If we wanted, we had the option of launching into a new cycle immediately afterwards, with the routine day 3 ultrasound & bloodwork.

In my journal, I outlined some of the points & questions I wanted to cover during our visit:

• How do you decide which meds I should take?
• Which injectables would you recommend for me?
• What will it do? (Good/Bad?)
• How much $$?
• How taken? (Injectables = training?)
• How many days?
• IUIs/wash: want to try!!!

Our conversation with Dr. RE was the usual maddening mix of encouragement & discouragement. On the negative side, I said I hadn't responded very well to the Clomid, & that my LH & FSH numbers were almost inversely proportionate to what they should be. I was only producing half the number of follicles he would expect to see. Ovulating on day 21 was "way too late."

Taking injectables, he said, would be like "stepping on the gas." Even so, he said the success rates for a woman my age were only 6-10% -- "for you, it would be less than 6%." He predicted that we would be spending at least $1500 per cycle, including the sperm wash for the IUI, but said we could return any unused medications for a refund. He assured me that learning to inject myself would be very, very easy & loaned me a video that outlined what to do.

We took the video & a pamphlet & said we would think about it and let him know. In my journal, I recorded dh as saying, "On the one hand, pretty low odds... on the other hand, don't want you to have any regrets. Can't do this indefinitely -- but if it would make you happy, can max out the credit cards."

Below that, I pasted my horoscope for the day: "According to your solar chart, you are on the verge of giving up on something that you just can't seem to crack. What you don't seem to realize is that you are closer to a breakthrough than you have ever been before. Hold on a little longer -- if you give up now, you will always regret it."

!!!!!!

Still, we dithered. I have some notes in my journal, outlining what I wanted to say in a phone message I left on Dr. RE's voice mail that night: "We've decided we're really not ready to make a decision yet... we need some more time to talk this over. We've been away on holidays, we've just passed the second anniversary of our daughter's stillbirth, we've been out the past two nights, so we really haven't had the time we wanted to mull this over. We know that, at this stage, every month counts, but we don't want to be pressured into making a hasty decision that we might regret later. We're going to take another month off to explore this a little further and will call you once we've made a decision one way or another."

In my journal, I wrote these lists:

Factors

• on holidays
• parents' 40th wedding anniversary
• no grandchildren (alive) = GUILT
• 2nd anniversary of daughter's stillbirth
• out two nights last week
• out Wednesday night AND tonight = no time to really discuss
• period = v. emotional
• bad back for two weeks
• = this is no way to make a decision!!

Should we continue with injectables?

Pros/Yes/Positives

• increase our chances (however slight)
• keep hope alive...
• we haven't tried this yet, OR the IUI -- do at least once (= no regret)(could/should have done more...)
• would only do if the numbers were right (= maybe not that often)
• less expensive than IVF
• we could set a limit on # of attempts/$
• if we give up on drugs, do we give up altogether?
• biological clock: time is running out -- make the most of it while we can
• I WANT TO HAVE A BABY!!!!!!!!!!
• if I don't try at least once, I will probably regret it and always wonder "what if"

Con/No/Negatives

• 6-10% chance (more like 6% max) -- @ $1,200-1,500 -- a gambler wouldn't take those odds...
• setting ourselves up for more disappointment, if #s not right this cycle, or if we do it and it doesn't work
• cost factor (less than IVF but still substantial...)
• always the urge to keep going: when do we stop?
• more early mornings, dr's appointments, etc. -- STRESS & EXHAUSTION
• NEEDLES (YUCK)... feel like a druggie
• possibility of side effects (what am I doing to my body?)
• even if pg, no guarantee of a baby, esp. w/bicornuate uterus
• lack of support from husband? -- he'll do what I want, but... (enthusiasm lacking) = stress and strain on marriage

And below all this, a notation: "Dh agrees: see infertility counsellor, get neutral 3rd party perspective."

*** *** ***

Several months earlier, I had attended an all-day Saturday seminar on IVF, sponsored by a local infertility support group. The guest speakers included various local REs (including my own), embryologists & researchers, representatives from sperm banks, and a couple of infertility counsellors who addressed the emotional aspects of treatment and parenting after infertility. I was particularly impressed with one counsellor who seemed friendly & down to earth, and had some great, practical points in her presentation. I picked up one of her business cards at one of the display tables, which said she did individual & couples counselling, specializing in grief, loss and reproductive issues. Perfect. I mentioned her name to one of our support group colleagues and was told that we regularly referred clients to her for individual counselling, when they requested it.

So on August 18th, I left a message requesting an appointment for dh & me with the infertility counsellor, briefly outlining our story and how I had found her, including the fact that we were wrestling with the decision whether to move on to more aggressive treatment. Our first meeting with her was on August 30th. We left work early and took both the subway and a streetcar to get to her office, in a funky old building in one of Toronto's ethnic neighbourhoods.

The night before our meeting, I had a strange and vivid dream that I described in my journal. I was trying to decide whether to give myself the Gonal-F injections... and I decided to just try giving myself shots -- so I was drawing up fluid from Vitamin E capsules (!) & injected myself in the stomach with them. It HURT, & I had blood and Vitamin E oozing out of holes everywhere on my stomach. Yuck.

Then the dream changed, and dh and I were on a bus with all of my coworkers -- only instead of seats, there were beds up & down the aisle. We were in bed, & I woke up and started fumbling with my thermometer to take my temperature (beep, beep...) & with the stuff to inject myself with. Dh rolled over, got up and went to the bathroom -- came back, but walked by me and crawled into bed with one of my (younger) coworkers!! who patted him on the back!! I started crying & crying, and hissing at him (trying not to make a scene), "Come BACK here!!"

I woke up in a cold sweat. I figured it reflected my subliminal fears that dh would quickly get tired of all this infertility crap and move on to a younger, more fertile woman. :(

My horoscope for the day read: "Someone you work with or know socially can be of inestimable value to you today -- all you have to do is let them help you out. Not even a Capricorn knows all the answers, but you will meet someone today who has the one answer you really need. Listen and learn."

*** *** ***

We hit it off with the counsellor immediately. Besides having infertility in common, she was originally from my home province, and we discovered we even knew a few of the same people. She told us a bit about her story, and we told her ours.

She started off by asking us what we needed from each other, and what we feared. Dh said he personally was ready to call it quits, but he didn't want me to have any regrets. He said his greatest fear was actually another pregnancy. The counsellor told him that was entirely understandable.

I said that while I wasn't wild about the idea of further, more aggessive treatment, and I didn't think I wanted to still be doing this when I was 45, I didn't want to give up just yet. I wanted to try the IUI at least once and see if the numbers improved. My fears: (1) the money & stress, (2) what am I doing to my body?? & (3) the needles. The counsellor said that was a very common fear.

The counsellor commented that to limit ourselves to just one try would be putting a whole lot of stress on ourselves (all our eggs in one basket). She suggested three trys -- setting a limit, as Dr. RE had suggested at our very first meeting. By three trys, she meant three "good" cycles, where we actually got to go through the whole cycle & do the IUI. If we were unsuccessful after three tries, she suggested either moving on to IVF, or stopping treatment altogether. "Call me then," she said. "It will help in making the transition."

She recommended Alice Domar's "Healing Mind, Healthy Woman" to me, and suggested a website I might want to check out (I didn't write down what it was & I can no longer remember).

We left feeling MUCH better and that it had been an hour, and money, well spent.