The Treatment Diaries: 10 years later

So endeth The Treatment Diaries. When I first kicked off this project back in May, several of you wanted to know how going back in time like this made me feel, and how my perspective has changed over 10 years.

It wasn't easy to take this particular trip down memory lane. In some respects, my "1998 memories" series of posts (about my pregnancy with Katie & her stillbirth) was easier to relive. It was stressful writing about that stressful time in my life too -- but there is a part of me that loves to write/talk about my pregnancy & my daughter. She is still (& always will be) a part of my life and, on a certain level, it brings me a wistful pleasure to think about her, even if her story is ultimately a sad one. There's no real pleasure in reliving the details of my failed fertility treatments (except maybe the fact that I survived & am still here to tell the tale). Writing about the onset of anxiety, I could feel the tension in my body rising all over again, even though it all happened 10 years ago.

There were so many little details that I had forgotten, or hadn't thought about in years. When I look back now at all the little daily ups & downs, the 4 a.m. wakeup calls (5 a.m. on weekends!) to get to the clinic in time to join the lineup for ultrasounds, all the running around from train staion to ultrasound clinic to RE's office, and then the mad dash to MY office to put in a full day of work (sneaking in the side door & hoping my tardiness wouldn't be noticed)... I get exhausted just reading about it. How did we do it? And we only did it for a handful of IUI cycles over 1-1.5 years. How do other people do it for so many more cycles, of IVF, even, over many years??

I also found myself getting annoyed with Dr. RE all over again -- how he'd be hot about our prospects at one visit, cold the next. I realize the doctors aren't gods and they just call it like they see it from one visit to the next (and don't always read their own files or remember what they've told you at previous visits) -- but a little more consistency would have been appreciated.

As I read through the ups & downs (many, many downs) of each cycle, I found myself thinking that, really, the writing really was on the wall, almost from the very beginning, if we'd cared to see it. But we didn't. We (at least I -- dh was always a little more skeptical) didn't WANT to see it, at least not until I was forced to -- blinded by hope (& desperation) as I was. I'm really highly doubtful that IVF, in addition to the treatments we did, or instead of them, would have ultimately led to a different outcome. It confirms my belief that we did the right thing in getting off the merry-go-round when we did.

I'm not sorry we tried, even though the odds were stacked against us -- we gave it a good shot. And I'm not sorry that I've written about now at this level of detail, or revisited this time in my life at the 10-years-later mark. If you don't look back now & then, you sometimes forget just how far you've come.

But I'm glad it's all over and I don't have to do it all again. Once is definitely enough.

The Treatment Diaries: Aftermath & anxiety, June-July 2001

Monday, June 4, 2001: Negative, of course. :( What's more, my ultrasound showed a few large echogenic follicles. "He wants you to come back in a few weeks (Monday, June 18th) to monitor those large follicles and make sure they're going down," office manager K. said in a phone call to me later in the day. By late that afternoon, I was bleeding heavily -- the heaviest cycle I'd had in a few years. In 8 hours, I soaked through five maxipads, and was leaving large clots in the toilet.

I paged Dr. RE: "Is this normal??"

"I wouldn't say it's completely normal, but it's not unexpected," Dr. RE said when he called me back awhile later. "Your estrogen levels were very high, and your lining was quite thick." He told me I could take ibuprofen. He started talking about things we could do "the next time," but I told him we would probably be taking a break for awhile. (Maybe permanently.)

Tuesday, June 5th happened to be my annual physical with my family dr. I was 10 lbs heavier than I had been the previous year. :p

Later that night, I called my mother. She chose that evening, of all nights, to tell me about someone she knew who had adopted two children through the same agency two of my girlfriends had used. And now they had just gotten a third child, after a wait of just three weeks! "I just thought I'd mention it," she said brightly. "Your sister told me to leave you alone, but we DID sort of talk about adoption once, didn't we?"

My replies were monosyllabic. When I finally got off the phone, I burst into sobs & cried for more than an hour. My sister was right -- I knew my mother meant well -- she wanted grandchildren, and she had no idea the lengths we were going to, trying to get her at least one. But geez Mom, what rotten timing!! Dh was furious -- with my mother, for bringing it up, and with me, for not telling her what was going on. That didn't help matters.

The next morning, Wednesday, June 6th, I wrote in my diary:

I look like a mess -- woke up this morning, eyes sunken with huge bags underneath. I feel lousy, like I was hit by a truck. Eyes feel sunken (could hardly put in contacts), hard to even walk (a little short of breath?). I am so out of shape it's not funny (although I suspect some of this is psychological -- also compounded by general end of cycle/period fatigue).

My life is a mess. Dh is right -- we need a break from all this.

I didn't take my temps this morning.

Friday, June 8th:

I have been winded all week. Today, I noticed my ankles are swollen. Weight is up slightly, but it's evening, & I usually weigh myself in the morning. Health encyclopedia says symptoms of pulmonary edema/congestive heart failure. OHSS?? OH. GOD.

You can see I was beginning to work myself into quite a state. I called Dr. RE (again). He pointed out that OHSS symptoms usually show up within a week to 10 days after an IUI, and it had been almost three weeks now. "I would be very surprised if it showed up this late, unrelated to other symptoms." He pointed out that the weather had changed, that the body tended to retain fluids in hot weather. Also, I had just had a very heavy period, and my body might be trying to compensate by retaining fluids.

Then he added, "I guess we could have pushed you a little too hard with the drugs, so your kidneys & heart aren't working very well." Exactly the WRONG thing to say to a hypochondriac who had kidney & bladder problems as a child (and one kidney slightly smaller than the other) and a diagnosed heart murmur (albeit a very minor one).

I mentioned I had been to my family dr for a checkup. The blood results weren't back yet, but my EKG had been normal. "If there was anything abnormal, I'm sure he would have picked it up," Dr. RE said, but then reiterated, "You may have underlying problems that have been exacerbated by the drugs... you should get that assessed. You might be unique." Oh, I'm friggin' unique, all right... :p

He wound up by saying, "Don't be frightened... but don't dismiss things either. If you're really concerned, get to the nearest hospital. And call me, so the drs there get the full picture."

My next few journal entries obsess over the daily state of my ankles. :p They looked better, but I still wasn't sleeping very well.

Sunday, June 10th was our pg loss support group's annual picnic and butterfly release. It was a highly emotional day.

Monday, June 11th, I got up at 4 a.m. & got ready to take the early train into the city. Then I remembered -- I wasn't due back at the clinic until NEXT Monday, June 18th. I decided to take the early train anyway & head straight for the office.

I had a lunch date at a restaurant downstairs in my office tower with my college roommate -- she'd had a birthday recently & it was my treat. All morning long, I'd felt a certain tightness & discomfort in my chest. My bra felt tight, & before I went to meet her, I went into the washroom, took it off & stuffed it into my purse.

In my journal, I wrote (and I have no idea why I was writing in present tense...!):

As I settle into my seat, I think, "This is a mistake." But I chat, I laugh, I eat -- lightly -- tomato basil soup, salad, roll and Perrier. I do have a good time -- for awhile.

About the time the tea comes (1 p.m.-ish), I start feeling really funny. I nod and laugh, but I'm no longer listening. My chest is feeling tighter, my shoulders feel sore, I start to feel warm from the chest up, but my hands feel cold & clammy & weak. I reach for the leather folder to slip in my money, but I have to try three times before it opens. I try to take a sip of water, but I can't lift the glass.

"I'm not feeling very well," I tell my friend. I try to take a deep breath, but it's hard. She asks if I feel sick, asks me questions. Tears fill my eyes. "It's scary," I whisper.

She asks if I'd like to call my dr. on her cellphone. She tries to dial, but the phone doesn't work inside the restaurant. Somehow, I find the strength to rise slowly and leave. We go sit on a bench in the concourse outside. I call Dr. RE & the receptionist answers. I tell her I'm not feeling very well. She gets K. on the line and I tearfully tell her how I'm feeling. She asks me questions. Nausea? (No.) Bleeding? (No.) Cramps? (No.) She asks me to call back in five minutes.

When I do, I'm still not feeling great. Maybe I'm having a panic attack? I suggest. "Could be," she says. It's too far past the profasi shot for it to be OHSS, she says, "but you should get checked out at your family dr's or the emergency room." Gee, thanks. :p

I call dh & tell him what's going on & where I am. Decide not to call Family Dr., just go there. I call my boss & leave a message, saying I'm not feeling well and am going to my dr's. We slowly make our way to the escalator. Outside, there's a cab waiting -- thank God! I hug my roomie and thank her. She offers me her cellphone but I decline...

Not sure which is scarier, the way I'm feeling or the way the cabbie is driving. I feel like I'm going to pass out. I struggle to remain calm and take deep breaths. Dh squeezes my hand reassuringly and smile. I am so proud of him.

We pull up in front of the dr's office. Dh pays the cabbie and we go in. There's a delivery guy with the receptionist and the nurse (who is also the dr's wife), but no one in the waiting room.

"I'm sorry I didn't call," I sob, "but I'm not feeling very well." Within seconds, I'm led into an empty room and told to lie down. Dh uses my cardigan to make me a pillow. The nurse slaps a blood pressure cuff on me and pumps it up. She shakes her head -- it's high. She asks me how I feel -- chest pain? (Tightness, no pain.) Nausea? (No.) Headache? (No.) etc. etc.

I tell her about the fertility treatments, about Friday. I had actually called there just before lunch about my bloodwork. My thyroid was high (6.64, normal is 0.5-5.5), & hemoglobin a tad low (116 -- should be 120-160) but everything else, including my ECG, was fine.

The nurse takes my blood pressure again (and again). Still high, but falling each time, until it reaches a high normal range of 130/90.

The dr finally comes in. Same conversation as with the nurse. He listens to my chest & lungs and pronounces them fine. To ease my mind, he does another ECG. It's fine.... He also takes some blood to test for cardiac enzymes (it comes back the next day negative). He tells me it looks like a panic attack to him.

He leaves briefly and comes back with a little bottle. He shakes out a tiny white pill and offers it to me. "What is it?" I ask. He tells me it's anti-anxiety medication & will help calm me down. (He later tells me it's the receptionist's!) He writes me a prescription for the same thing, "just in case," only a lower dose.

I'm finally calming down. They send us on our way feeling better (the drugs are working!).

We go to a nearby drugstore to fill the prescription. Stop at a payphone to call people. Dh calls his partner at work, I call my best friend at work and then my boss, then my roomie (voice mail), then Dr RE's office (talk to K.). We take the subway to the train station & take the next train home (by now, it's almost our usual time to leave anyway). I lay on the couch most of the evening & go to bed at 8:30. I sleep soundly for the first time in ages. Dh stays awake until 2 a.m., listening to me breathe!!

Over the next few days & weeks, I experience what I think of as "aftershocks." The next day I was attending a training workshop out of the office. All was going well until about 3:30 p.m., when I got what I described in my journal as "a funny cold feeling... a little tingle/numb feeling going up the right side of my face that started to turn warm. Great, now I'm having a stroke??" I struggled through the rest of the session, wound up taking another pill and going to bed early again.

Wednesday, June 13th, I called the infertility counsellor we had visited prior to embarking on injectables & IUIs. She remembered me instantly, and we set up an appointment to meet Monday after work. The next day, I returned to Family Dr's for a followup blood test for my thyroid. "Well, you're looking MUCH better!" they all told me. He checked my blood pressure and listened to my heart while I was there, and all was well.

Eight years earlier, Family Dr had thought he detected a mild heart murmur. He sent me to consult a cardiologist, who ordered an echocardiogram. At that time, he said he saw absolutely nothing that concerned him -- on a scale of 1 to 6, my murmur ranked at about 0.5 -- but he added I might want to repeat the test in another 10 years just to check things out. Family Dr asked if a repeat echocardiogram would make me feel better, and I said yes, so he booked one for me. "I don't want to dismiss your concerns," he said, "but this sort of thing is almost always emotionally based and you've been under a lot of stress lately."

Monday, June 18th, I was back at Dr. RE's for ultrasound & bloodwork. The echogenic follicles were still there, but they weren't as big.

Later that evening, we met with the infertility counsellor again & told her everything that had happened since we last saw her. We acknowledged that we had said "three cycles" -- and we'd done three cycles. Were we ready to stop treatment? To stop ttc altogether?

Dh said he was ready -- he felt we had done all we could, and he was worried about my health, the stress on both of us, the possibility of multiples. He said we could continue to try on our own for awhile, but acknowledged he wasn't getting any younger.

I said I was 85-90% of the way there. "I know we could do more -- more IUIs, IVF -- but emotionally, physically, mentally, I'm not sure I can do it anymore. I said I still wanted to keep the door open crack. And I said I needed a holiday!!

The counsellor recommended that we take a break -- put away the thermometer. think about the surgery. "If you're going to do one more cycle, set a time limit, say, your 41st birthday in January." She recommended that, once we decided we were ready to stop, we should consider birth control (!!). "I know it sounds nutty," she acknowledged, "but then you won't be constantly hoping in the back of your mind." She also recommended performing some kind of ritual to acknowledge & mourn the end of this phase of our lives.

She also asked us, "What would it mean to give up on that dream?"

In my journal, I summarized my response: "I know in my heart we can have a good life with just the two of us. But I will always feel like I missed out on something special."

She asked us what we did for fun, to relax. I said, "You know what? I had fun tonight! We stayed downtown, had dinner, wandered around a bit until it was time for our appointment. Usually we just head for the train, go home and flop on the couch in front of the TV set."

"You had a DATE!" the counsellor grinned. "I'm going to prescribe a regular date night for you two. You should take turns planning it. Something different, not the same thing all the time."

[I loved date night. Dh was less enthusiastic. He confessed he was usually too tired at the end of the day & wanted to just go home & flop on that couch. So it didn't last long, but it was fun while it did, and it helped get us over that initial post-treatment hump.]

Besides a date night, she recommended yoga for stress relief. I did eventually start taking a weekly yoga class, which I loved. I also started getting regular mini-massages at a walk-in storefront massage clinic near work, on my lunch hour. "You're very tight," one of the girls there remarked as she worked on me.

Monday, June 23rd, day 23, I was back at the clinic. K. called me later in the day. "Looks like you're starting to surge," she said, advising timed intercourse -- every two days for the next week.

I returned Tuesday, July 3rd (day 31) I was back for bloodwork. K. called me later to say my beta was negative, and my results suggested I was having an anovulatory cycle.

I returned a week later on July 10th (day 38), My homone levels were still fluctuating wildly, & I was offered Provera to induce my period. I was almost ready to go on vacation. What would happen if I didn't take the Provera? K said there was no medical risk; it was just a way to end a "really long" cycle & wipe the slate clean. 38 days was not that unusually long for me, so I said I'd prefer to wait things out.

"Call us when you get back," K. said. "And have a good vacation."

I never returned.

The Treatment Diaries: IUI #3, May-June 2001

We embarked on our third IUI cycle -- my 27th cycle since losing Katie,and the final IUI cycle we had agreed to do -- on Friday, May 4, 2001. On Sunday (day 3), we were back downtown for the usual ultrasound & bloodwork.

Ultrasounds were now being done again at the clinic where we had first gone when we started treatment. However, since Dr. RE had moved his office in the meantime, this meant that clinic days now went something like this: (1) arrive at the train station & take the subway three stops, walk the short distance to the building where the ultrasound clinic was & get my u/s done. (2) Hop back on the subway & travel another three subway stops to Dr. RE's office for bloodwork, drugs, etc. (3) Hop back on the subway & ride 7 stops to the office. More subway tokens, more running around, more time. :p On weekends, we would generally go to Dr. RE's office first, then for the ultrasound.

Because it was Sunday, we decided to drive downtown instead of taking the train & subway. Perhaps not the wisest choice, since many of the downtown streets were blocked, either for a charity run/walk, or with construction (which made dh REALLY happy...!). Dr's office came first: then off to the u/s clinic. When we got there, the usual entrance was closed. We walked around to the other side of the building & had to be escorted in by the security guard. The clinic was already open and there were six people ahead of me in line.

Later that afternoon, Dr. RE called, said my baseline results looked good, & I could either (a) start taking Clomid & return to the clinic on day 7 for monitoring, or (b) skip the Clomid & go straight to the Gonal-F. I told him I didn't HAVE any Gonal-F; the girls at his office had only provided me with Clomid. So, Clomid it was (my 6th cycle using Clomid). He said I really should start straight with the injectables, though, that the Clomid really wasn't boosting my results that much and he acknowledged the side effects were nasty. He also said he wanted to do an ultrasound himself to determine whether my uterus was a true bicornuate uterus, or just a septum. He said he would have one of the girls at the office call to set this up.

I asked him about the Gonal-F dosage this time around. The possibility of OHSS the last cycle had scared the crap out of me, & dh too. He said we'd wait & see the day 7 results -- he didn't think he'd lower the dosage, but didn't think it would be necessary to increase it either. He did actually increase it, to 4 amps or 300 IUs nightly.

Thursday, May 10th (day 7): I'd been having all-day, dull headaches and eye strain the past several days, no doubt a side effect of the Clomid. I went to the office in the morning for bloodwork, left work slightly early that afternoon & returned to the office, where Dr. RE performed an ultrasound. While he wasn't able to see anything on my left side, he was flabbergasted to find that I already had 12 -- 12!! -- follicles on the right side. They were small, but they were there. "I didn't expect to see that," he said.

As for my uterus, he said there were definitely two horns there -- but the tissue in between looked fibrous & could probably be removed. He estimated that I had a 70% chance of pregnancy loss because of my uterus, and said this likely contributed to Katie's stilbirth. While there were no guarantees, of course, he felt that surgery could help improve those odds. "Your odds are already low -- your age, and you don't ovulate well," he pointed out (gee, thanks...). He explained what the surgery would involve, and said we would have to postpone ttc for several months while my uterus healed. When you're over 40, of course, every month counts, & the thought of having surgery and then losing more precious months in recovery time was not a happy prospect for me.

I left with my head swimming around 5:45, & raced to the train station to meet dh. He was in a bad mood already after a long day at work, and as I told him about what Dr. RE had said about the surgery, he snapped, "What's the point?" I was a little ticked myself that Dr. RE had waited this long to figure this out & dangle the carrot of surgery in front us. Shouldn't he have checked it out & recommended it right up front before we'd started treatment?? I felt we should get a second (Dr. Ob-gyn?) & possibly third opinion before going ahead with surgery. And of course, first, we needed to get this cycle over with.

I noted in my journal that I was feeling LOUSY -- stressed, flushed on my face & neck (even Dr. RE had noticed) and a constant headache. I was exhausted. But that night, before going to bed, I injected myself with the first three amps of Gonal-F. I woke up the next morning feeling much better.

Sunday, May 13th was Mother's Day. :(

Monday, May 14th (day 11) was a clinic day. K. called me that afternoon & told me to come back Friday; however, I only had enough Gonal-F to last me until Thursday, so I spent my lunch hour making a hasty round trip to & from Dr. RE's office to get more drugs. By Wednesday, I was beginning to feel uncomfortably bloated. My Friday visit showed some follicles developing, but not as many or as big as might have been expected.

I went back in for more u/s & bloodwork on Saturday. I was told that now Dr. RE wanted to see the film of my HSG from November 1999. I had to request a copy and spend another lunch hour that week trekking up to the hospital to retrieve the CD, take it up to Dr. RE's office & return to work.

"I just don't get it," Dr. RE said later Saturday afternoon when I spoke to him on the phone. "Your E2 levels are astounding -- 8700 -- I've never seen them so high. Yet there's only one or two follicles that I would call mature. There's a disconnect there. I don't understand where all the E2 is coming from. It's not very encouraging that your response is so unpredictable... You are a bit of a challenge and a mystery." Oh, just lovely.

I asked him whether such high E2 levels posed any risks. He mentioned OHSS again & then threw out another thing to worry about -- blood clots. But he, added, "your levels are high, and high for you, but not exceedingly so."

Monday, May 21st (day 18) was our Victoria Day holiday -- but it was no holiday for us. :p We were up at 5:30, at Dr. RE's for bloodwork by 7:30 and the ultrasound clinic at 8, where (once again) the tech had difficulty seeing my left ovary. Nevertheless, I now had at least three good-sized follicles (although Dr. RE said my E2 levels suggested I should have 13 or 14?!). "We could push you for another day & do IVF, although I don't know how good the quality of the eggs would be," he said. (Nevermind that we didn't want to do IVF -- unless he was willing to do it for the cost of an IUI cycle!)

We agreed: Profasi shot tonight, sample around 8:30 & IUI around 10:30 on Wednesday morning.

Wednesday, May 23rd (day 20) was my third (& final) IUI. We arrived at Dr. RE's office at 7:30 a.m., where dh produced his sample -- went to work (!) -- & then returned for the IUI at 9:30. I was feeling rather crampy, before & after, but barely felt a thing during the IUI itself. Dh's count this time was lower than the two previous IUIs, just under 8.2 million. "It's been a strange cycle -- I really can't give you the odds," Dr. RE said.

En route out, we received our bill:

10 Clomid pills = $62.40
44 amps of Gonal F = just under $3,000
1 Profasi shot = $65
Sperm wash = $350

Total for this cycle: just under $3,500

Later that afternoon, I was feeling extremely bloated & uncomfortable, & called the office. "You could be ovulating," K., the office manager said. She told me I could take a couple of Tylenol, but added I should weigh myself daily for the next few days and watch for anything unusual. A friend at work, who was also going through infertility treatments, said her RE had told her to drink Gatorade or Powerade, so I found a bottle at the newsstand downstairs & sipped on that. I found it very difficult to get comfortable in bed that night, and had an extremely restless sleep.

The next morning, I felt much less bloated, but I felt sore all over -- under my ribs and shoulder blades, through my back & shoulders -- "like I was hit by a truck," I wrote. I decided to call in sick, using the excuse that I'd had an upset stomach all night long. By Friday, I was feeling slightly better.

Saturday, May 26th, I was back at the office at 8 a.m. for bloodwork. Sunday (day 24), I felt crampy all day. Around 8:30 p.m., I noticed I was spotting. I immediately paged Dr. RE & he called me back within 20 minutes. He agreed with me that it was awfully early for my period, but added, "It may not be a bad thing -- it could be implantation spotting... It's unlikely to be anythign serious, so long as you're not bleeding or cramping heavily." To be on the safe side, he suggested I come into the office the next morning to have my bloodwork checked. In my journal, in capital letters, I wrote, "I AM TERRIFIED!"

Monday's bloodwork showed nothing amiss and although I was still feeling crampy, I was not spotting. I was told to come back the following Tuesday for my beta.

Friday, June 1st (cd #29, 9 days past IUI) I woke up at 4 a.m. to go to the bathroom. I felt woozy and nauseous, and staggered back to bed. I woke up an hour later & took my temperature. It had dropped almost four degrees.

Every time I opened my eyes, the room started to spin around me. Eventually, I threw up. Twice. I did start feeling a little less nauseous after that. Even though my temps had dropped, I felt deliriously happy (emphasis on the delirious, I think...!). I must be pregnant!! Why else I would I feel so crappy?? (In recent years, thinking about my symptoms, I have wondered: did I have some kind of a mini-stroke?? Was it some weird hormonal thing going on? Or was it a manifestation of the stress and anxiety I was feeling?) Dh fed me crackers & water and even made a trip to the nearby 24 hour supermarket to get me some apple juice.

I had already missed a lot of work recently. I didn't want to call in sick, so I called my boss & left a message saying we'd had a late start & would be in later. (I told you I was delirious...) I decided not to call Dr. RE, because I knew he would tell me to come into the office later that morning or the next, and I just didn't think I could haul myself in to work AND up to his office feeling the way I did.

Somehow, by shortly after 7, I managed to drag myself out of bed and into the shower. Thankfully, it was casual Friday at work. I put on a pair of drawstring capris and one of dh's polo shirts but didn't put in my contacts or apply any makeup. We made the 9 a.m. train into the city, and I arrived at the office around 10 a.m. By the end of the day, I was exhausted, albeit tired & with a dull headache.

Saturday morning, I felt much better.

Later that night, though, I started spotting again. It continued the next morning, and by the afternoon, it was in full flow.

I called the office and was told to come in the next morning for bloodwork & ultrasound.

I crawled into bed that night, turned out the lights, & proceeded to bawl my eyes out.

I let the cat out of the bag today...

I'm one of the first people to arrive at the office in the morning, and today, I got talking with two other early risers, before everyone else started arriving. One is about my age, in her late 40s or early 50s; the other, a young woman about 25.

The older woman was telling us about her daughter (her only child)'s wedding last year. "We're just waiting for the grandbabies now," she said with a smile. She went on to say that her daughter had, in fact, had a miscarriage in January at four months... "but you know, these things are so common, once you have one, everyone starts telling you that they had one too."

And that's when I opened my mouth. I said yes, I'd had a stillbirth, & my heart always goes out to anyone who's had a loss, no matter what stage of pregnancy.

I could tell they were both shocked, especially the younger employee (who is not only young but single & idealistic). "Oh, that must have been hard!" the older woman said. I added that I had been six months pregnant, & that we had been involved in volunteer work for a pregnancy loss support group until just recently. I didn't mention anything about infertility, although it's obvious that I don't have any (other) children. The older woman continued talking about her daughter's miscarriage, and the converation eventually moved on to another subject.

I guess it just seemed like a natural segue to talk about my own experience. I would have felt funny if I hadn't. It's not exactly a secret, & to NOT say anything at that point would have felt like it was.

But it's just not something that I bring up offhand in polite conversation, if you know what I mean. If people ask me whether I have children, I generally just say "no" & leave it at that. I'm old enough now that I don't get pestered with a lot of questions about "why" or "when," & with most people, I don't feel that any explanation is really necessary.

When people do talk about infertility or pregnancy loss at work, I have mentioned my own experiences in the past -- but of course, they don't get talked about very often, particularly in an office where so many of the current employees still aren't even married yet. Everyone at work knew about it when it happened, obviously, but that was 13 years ago now, and there are maybe 10 employees, max, out of a total department of about 50 people, who were around then & would remember what happened (and none of them who in my particular area anymore).

So I suppose there will be some gossip going on behind my back over the next little while, especially among the younger girls, who like to go for lunch & coffee together. Oh well. :p

The Treatment Diaries: IUI #2: February - March 2001

Sunday, Feb. 18th (day 3): the usual day 3 ultrasound & bloodwork routine. I was the first i line, with only a few others coming in after me. "Different tech -- brutal!!" I noted about my ultrasound. Also noted: the technician told me I had an echogenic or hemorragic cyst on the left side, and two small fibroids on the right.

At Dr. RE's office, I had to once again search out his lab technician and tell her I needed my bloodwork taken. She always seemed far more interested in puttering around the lab than attending to the patients -- I was not impressed. She left me a message later in the afternoon to tell me to start my clomid and return for bloodwork & ultrasound on day 7.

I left a return message asking to speak to Dr. RE. When he called me back, I asked him about the cyst and the fibroids. He said the cyst was evidence that I had ovulated, but said it was small enough and my hormone levels were low enough that it shouldn't have any impact on this cycle. Likewise, he said the fibroids were small and shouldn't make a difference.

Thursday, Feb. 22nd (day 7), there was a bag of Gonal-F waiting for me at Dr. RE's office. I was told it was essentially the same thing as the Puregon I'd used the last time, and was instructed to use three amps (225 IUs). In my journal, I noted that the Gonal-F dissolved better than the Puregon, and didn't hurt as much when I injected myself, although there was more bleeding from the injection site. Over the next few days, I noted the usual side effects of fatigue, dry mouth and hot flashes.

Sunday, Feb. 25th (day 10), back at the clinic. Dr. RE called later to say my numbers were definitely looking better than they had the previous cycle.

Wed., Feb. 28th (day 13) was another clinic day. Dh & I had booked off work to attend an RTS training session for our support group. Instead of taking the train, we drove downtown, & then drove out to our training session. I noted feeling bloated and sore.

Friday, March 2nd: My journal notes indicate the technician was having great difficulty getting accurate measurements. "It's very hard to see... there are gas clouds (?!) obscuring the view... the most difficult I've ever done (SIGH)," I quoted her as saying. :(

I spoke with Dr. RE later, and he was probably the most upbeat I'd ever heard: my E2 levels were almost 7300, more than double what they had been at this point in my previous injectable cycle. "This looks very good!" he said. I was to administer my hcg shot (Profasi) that night, and return to the clinic on Sunday, no earlier than 10 a.m. (he had another IUI at 9;30).

Sunday, March 4th, day 17: Feeling distinctly uncomfortable. Dh elected to give his sample at he clinic again. The waiting room was quite busy, especially for a Sunday. "U/s clinic closed??" I noted in my journal.

Dr. RE greeted us by saying, "Very good" but then undercut the optimism by adding, "but it took you a lot to get here." Dh's sample was better than last time: 12 million, with 86% motility.

He said he was slightly concerned that I looked "puffy," and instructed me to weigh myself every day. If I noticed I was gaining weight, I was to call him immediately: I could be overstimulated and retaining fluid, which could be dangerous. (Great....) I went home & devoured all the information I could find on OHSS and its symptoms.

The bill for this cycle included just over $1,900 in drugs, plus $350 for the sperm wash = about $2300 again.

By the next day, I noted I was feeling MUCH better physically (less bloated), although I was also finding it difficult to sleep ("worrying about multiples!" I wrote). As the week wore on, I began feeling crampy. I returned to the clinic for bloodwork on Monday, March 12th, and was told to come back in a week's time for more bloodwork (i.e., a pregnancy test).

I didn't make it that far. Wednesday, March 14th -- cd #27 or 10 days past IUI -- I started spotting, and the following day, my period arrived. Friday, I went to the clinic for bloodwork. As I already knew, it was negative.

I no longer remember why, but we had decided not to start a new cycle immediately.

Monday, April 9th (day 26), I went back to Dr. Ob-gyn. I made some notes to discuss with him: no sign of ovulation yet. Possible yeast infection? (Took antibiotics prior to dentist visit on March 21st.) Dr. Ob-gyn said he saw no changes from the last visit (and the lab results came back clear), and to return in 6 months.

Monday, April 17th (day 33) I called Dr. RE's office: my temps were still low and according to the many OPKs I'd been using, I still hadn't ovulated. The same thing had happened after the last IUI cycle I had done with injectables -- that cycle had lasted an interminable 58 days! -- and I had wound up taking Provera to induce a period. I was told to come in for bloodwork, and it was decided that I was having an anovulatory cycle. "Wait a couple of days, and if nothing happens, you may want to take provera again," I was told.

Friday, April 20th, my temps rose slightly. Monday, they jumped higher. I decided to wait things out. Thursday, May 3, I began spotting and Friday, May 4th, my period finally began (on day 51!).

The Treatment Diaries: The Clomid Capers continue, and the Big 4-0, December 2000 - February 2001

New year, new cycle. My period arrived on Jan. 7th, 2001. Jan. 9th found me back at the clinic for day 3 ultrasound & bloodwork.

As I wrote previously, as of Dec. 1st, Dr. RE had moved to new digs, another three subway stops further north of his previous quarters. He had switched ultrasound providers too, making arrangements with a facility a short walk away from his office. The building was very old and change room cubicles quite tiny. On the bright side, there were chairs in the waiting area where we could wait for our ultrasounds, instead of standing in line. The technician was very friendly and talkative but, as the other girls noted, very slow.

Dr. RE wasn't in, but the office manager provided me with Clomid, Puregon and some syringes, and told me to wait for instructions later that afternoon, after my bloodwork results had come in. The instructions were to start the Clomid, and then return on Saturday (day 7).

This time (my fourth cycle using Clomid, alone or in combination with injectables), I noticed some definite side effects: dry mouth & light sensitivity (especially in the morning), sore breasts, a jittery feeling, and extreme fatigue. But I felt better on Friday, January 12th -- a good thing, since it was my 40th birthday! I wasn't especially happy about being 40 and childless, but since there wasn't much I could do about it, I decided I might as well use the day as an excuse to enjoy myself. ; ) I took the day off work & spent the day getting pampered at the spa -- facial, massage, manicure & pedicure, including lunch. I loved it! Dh & I went out for dinner later that night.

The next day, Saturday the 13th, I got up at 5, and took the 7 a.m. train into the city. Dh didn't come with me this time, although I don't remember why, but I had company -- Cousin/Neighbour's neighbour, whom we saw occasionally, both at Cousin/Neighbour's house & on the train from time to time. I told him I had an appointment in the city, and thankfully, he didn't probe. I went to the clinic for bloodwork first, and then for my ultrasound. I wound up waiting an HOUR before I saw the technician. There was a lot of grumbling in the waiting room.

Also in the waiting room, one of the girls was chatting to another, & handed over her business card. I couldn't help but see the logo on it: it turned out she worked for the same company I did, in the same downtown location, in fact. We also exchanged business cards & had coffee together once to chat, but I rarely saw her after that.

I had about five small follicles on each side, each under about 5 mm. By about 10 a.m., I was back on the train, and home again around 11.

Later that afternoon, I had a message from Dr. RE. He bluntly told me this cycle wasn't looking very promising, and that the clomid had obviously not had a significant impact. My E2 levels were essentially the same as they had been on day 3, when he expected it to be up at least 100%. "I can't tell you how successful this cycle will be," he said, according to my journal notes. "If you want to go ahead with the injectables, I would have to increase your dosage substantially, to 300 or 400 IUs. Those are very high doses... You may choose not to go ahead this month, and discuss further treatment." He ended by asking me to have him paged.

When I finally got hold of him, Dr. RE went over the numbers with me again. "Your response was much poorer than I would have expected from a woman your age, given the dosage," he said. He told me I had two options: (1) forget this cycle (beyond the clomid I had already taken) and wait for a better one to try the Puregon again. "We can still monitor you, if you like," he said, "but I'd be very surprised if this cycle took off." This, he said, was his recommendation.

Or, (2) go ahead with the Puregon, but instead of the 200 IUs he was going to recommend, push my ovaries with 300 or 400 IUs daily. "If you don't respond to that, you really should consider your options," he said. "At some point, we have to talk long-term plans -- including, maybe, stopping." I reminded him that we had agreed to three IUI cycles using injectables.

The last cycle, he said, "was adequate -- but I want more than adequate." (What?? Hadn't he said at the IUI that it had turned out to be a good cycle after all??)

I agreed that, since the prognosis was not good, we should save our money for a better cycle, but continue to be monitored. He told me to come in next Friday to see what was happening.

*** *** ***

With this as a backdrop, I moved on to my next immediate challenge (wait for it...!): surviving a baby shower. My FIRST baby shower since Katie's stillbirth, more than two years ago now.

Back on Dec. 1st, on something like day 52 of my neverending cycle, we had arrived home, I opened the mailbox, and pulled out a small square envelope. Without even looking at the return address, I said to dh (a la Johnny Carson's Karnac the Magnificent), "This is an invitation to your cousin's baby shower -- and it's going to be the weekend of my 40th birthday." Nobody had told me. I just KNEW. His cousin was pregnant; I knew her due date was mid-February; logic dictated that her shower would probably be held about a month before that, and my birthday just happens to be in mid-January. But beyond logic, I KNEW in my bones. Of COURSE I would have to spend my 40th birthday weekend at a baby shower. That was just the the way my life seemed to be going these days.

I opened the envelope -- and of course, that's exactly what it was. My birthday was on Friday, the shower was on Sunday. I cried for well over an hour. Bad enough to be turning 40, crossing the rubicon, as it were, without a baby in my arms, while suffering through the indignities of infertility treatment -- but to have to spend that weekend at a BABY SHOWER added the ultimate insult to injury.

I didn't see an easy way out, so I RSVPd yes. The shower was near where BIL lived, so dh drove us there, and SIL & I went together. I don't remember a lot about it, except that it was (thankfully) a smaller shower than some I had attended, perhaps about 40 ladies in all, at an Italian restaurant. I sat at a table with SIL & some of dh's cousins, & (also thankfully), the conversation didn't entirely revolve around babies.

A couple of days later, on Wednesday, Jan. 16th, I noticed a funny rash that had broken out on my neck, just below my right ear. It tingled/burned, and was also itchy.

Dh happened to have an appointment the next day with our family dr and, on an impulse, I tagged along, hoping he would be able to have a quick look.

Family Dr took one look at the strange patch on my neck and immediately said, "That looks like shingles."

SHINGLES??!!

Family Dr gave me a prescription, saying that, since it seemed to be in an early stage, it might help to minimize the discomfort as well as prevent the shingles from spreading. And it did, although it took awhile to disappear completely. Thank goodness I decided to go with dh when I did. I used aloe vera gel to soothe the itching & burning.

When I got to work, I immediately started consulting Dr. Google to learn more about shingles. What I learned was that the chicken pox virus I (and probably you) had when I was a kid (pre-chicken pox vaccinations) never really left my system. It went underground, dormant and, most of the time, never resurfaces. But in some adults, for reasons that aren't entirely clear, the virus suddenly resurfaces in the form of shingles. I did read with interest, however, that one suspected cause of shingles is stress. Hmmm....

Shingles cannot be spread to anyone who has also had the chicken pox virus. However, if you haven't had chicken pox but get exposed to shingles, you could get shingles or the chicken pox.

Chicken pox can be harmful to pregnant women -- and the babies they are carrying. Reading this made me feel sick to my stomach. I called Family Dr back to ask him about it. He reassured me that it was highly unlikely, and reminded me that most adult women had been exposed to the chicken pox virus. But we should find out whether dh's pregnant cousin had.

I couldn't talk to her myself. I just couldn't. Dh made the call for me. Cousin hastened to assure me it was all right, she'd already been through this when her nephew came down with the chicken pox, and yes, she was immune. Talk about relief!!

*** *** ***

Friday, Jan. 19th, day 13, I was back at the clinic. Sitting in the waiting room at the ultrasound clinic, I struck up a conversation with a woman who had a little girl in a stroller with her. The little girl was about 3, her mom had a British accent. There was something vaguely familiar about her, so I checked the sign-in sheet on my way out from my ultrasound for her name, and I realized that, hey! I know this woman. Again, we both worked for the same company in the same location, & had belonged to the same lunchtime group awhile back.

I went back into the waiting room, called her by name and re-introduced myself. We laughed, and she said, "I won't tell if you won't!" She told me her daughter had been conceived through fertility monitoring; she and her husband were now trying for a brother or sister. I suggested lunch some day; she told me she never took a lunch hour: she worked through her lunch and breaks so she could shorten her work day & pick up her daughter from daycare. Daycare issues were also why she had to bring her daughter with her to the clinic in the morning. I marvelled once again at the lengths we go to in order to try to have a child.

Later that day, K., the office manager, called with the disappointing news that both my bloodwork & ultrasound were essentially at baseline. "We'd like you to come in to discuss what's next," she said. I told her about my shingles diagnosis and asked whether that might be having an impact on the cycle; she said it was possible but she didn't know for sure.

We returned to see Dr. RE a week later, on Friday, Jan. 26th (cd #20). He asked us what our plans were. I said we'd committed to three IUI cycles with injectables at the outset, and we'd still like to complete three cycles. "Obviously, if it's six months down the road, and the results have been such that we still haven't completed those cycles, we'd have to rethink our options," I said.

Surprisingly, Dr. RE said he thought that was a good plan, that "you probably should try three or four cycles of any particular treatment." (I guess it was a glass half full day.) He said I responded well to the previous cycle, and my initial FSH results this cycle had been encouraging. But he added, "If, after three or four cycles, you still aren't pregnant, I'd recommend you go on to IVF, or stop... you have better things to do with your life."

We chatted a bit about IVF & the dosages required. I reminded him he hadsaid the placement of my left ovary would make retrieval difficult, and he said, "Well, I haven't abandoned a patient yet!" (This sort of flipflop drove me crazy.) He asked me where I was in my cycle: I said day 20, & I'd noticed some nice quality cervical mucus over the last day or two. "Let's take your blood & see where you're at," he said. I noted in my journal, "Left feeling reassured & satisfied."

K. called later that afternoon: sex every two days for the next week, back on Friday, Feb. 2nd (cd #27) for bloodwork. I noted that my temperature still hadn't gone up. K. called me later with my bloodwork results: my E2 levels had dropped, although my LH was high and progesterone was up. "At this point, there's not much we can do, except wait for day 1," she said.

My period finally arrived on Friday, Feb. 16th, day 41 of my cycle. On to the next...!

The Treatment Diaries: Addendum to the last post...!

I didn't mean to hit "publish" on the last post... I did it accidentally.. and the problems I've been having with Blogger lately (grrr...!!) meant it wouldn't let me open & resave as a draft. I had to copy & paste in a Word doc, delete my post, then copy & paste back into Blogger -- then go through & clear all the weird formatting.

When I did it a SECOND time, I thought, "I give up!" :p I decided to let the post stand & finish it in a "part 2" if you will (even though I WAS almost finished, damnit...!)

Anyway -- AF FINALLY arrived on Dec. 8th -- day 57!! which still remains a personal record for me. (Woohoo.) :p

However, because it was almost Christmas vacation and the office would be closed anyway, I opted to wait until my NEXT cycle. I called the office and said I would see them in the new year.

Here endeth the longwinded saga of my first IUI cycle...!