(via: The Awl)

The fourth IVF cycle has begun with a fucking bang. On Valentine’s Day. Which Husband and I don’t celebrate so there’s really no significance there.

Lupron sucks.

This round is an Microdose Lupron (MDL) protocol which I’ve never done before.  When I asked the Kligster why we were doing this protocol, he said, “because we haven’t tried this one yet.”  Works for me.

Initially, I did my regular research only to find out that depending on who you talked to it was either great for poor responders or it was awful for poor responders(pdf).  Which is it then good or bad? You don’t know, huh?  Looks like Cornell is doing a study on this very question.  The results of which everyone who doesn’t agree with will question.

Then in the spirit I entered into in November I decided I didn’t give a damn and I’d just do what they said to do.

So I began the shots.

And then the craziness began.

Mind you my life is pretty depressing right now, even for me.  I have absolutely no self-confidence, feel like I’ve done nothing with my life of significance, I’m low, I’m down, I’m not at the bottom but only because I can’t drink myself into a stupor every night.  That’s how amazingly shitty I feel about myself.

And Husband and I are continuing to have some conflicts over general marital communication and what constitutes proper social behavior when entering back into a social scene and making new friends of the same and opposite sex.  The social rules are different when you are in a marriage/relationship and I’ve had to kowtow to them in the past and respect his feelings.  While I understand that in his profession it is important to “get out there” it would seem to me that the most important person in his life should be me but I have been feeling like the bottom rung of the ladder for awhile now. I’m feel like I’m not the one with whom things are discussed, I seem to be the last one to know. (update: we have had some more discussion about this and I *think* we are on the same page now, but it was happening when I started the post so I will leave it)

Then add to that mix Lupron…and you have emotional bedlam.

Here’s how the MDL protocol works (via http://www.advancedfertility.com/ivf-low-response.htm)

Flare Protocol, or Microflare for Poor Response Cases (also called Microdose flare, short Lupron, or short protocol)

In this type of stimulation, the Lupron (or other GnRH agonist) is started on cycle day 2 in the same menstrual cycle that we will retrieve the eggs - instead of starting it a week prior to the start of menses.

We are trying to take advantage of an initial “flare-up” response of FSH and LH release from the woman’s own pituitary gland that usually occurs in the first 3 days of Lupron administration. Continuing Lupron for more than 3 days temporarily suppresses the pituitary gland so that it has a low output of FSH and LH.

The FSH product (e.g. Follistim, Gonal-F) is started on the following day (day 3). The idea is that the Lupron will stimulate release of a large amount of FSH (and LH) that will jump-start (flare-up) the follicles so that we might have a better ovarian stimulation with more mature follicles and more eggs for IVF.

Birth control pills are usually given for the month before the flare so that there will not be a leftover cyst (corpus luteum) that could become reactivated by the high LH levels at the onset of the flare stimulation.

So your estrogen is being artificially lowered by the Lupron and you end up with some bitchin’ PMS symptoms.  For days. And days.  Weeping. Emotional (even if the events causing the emotions are valid problems). Anger. You name it, you get it.  But my RE, the Kligster, said that once the estrogen levels begin rising then you begin to feel more normal again.

Which brings me to my estrogen levels.  I’m updating chart four - IVF #4 Details and you will see on there that my estrogen was good and low at E2 of 25 on CD 1.  This is the value they are looking for.  Something in the range of 20-25 BUT you will note that after two days of stims (including 4 days of Lupron) my E2 went DOWN.  Yes, down.  And a decreasing E2 is never a good thing in the world of infertility.

So I emailed the Kligster who basically implied that I should chill the fuck out and that MDL is a longer protocol.  So, I did just that. Chilled.

Tomorrow morning we will see what’s going on with the ovaries.

Husband and I have a somewhat unconventional marriage within the trappings of a conventional one.  I’m not going to go into the details of that but I will say “It’s not what you think”. Our unconventionality is mostly related to the communication and emotions that a couple have with and about one another.

Our anniversary was a few weeks ago and despite the difficulties that we’ve had over the years before and after marriage, when we got married I felt that it was important to follow the ritual of acknowledging the anniversary with a gift.  A traditional gift. Nothing really big as it follows pretty closely on the heels of Christmas and is just a bit before my birthday.

For me, it is important to acknowledge the fact that we did get married and reflect on what marriage means to me. I don’t know what Husband actually thinks about my following the ritual of the anniversary gift, but he acknowledges it and participates sometimes, in his own way.

Marriage can be:
Obtaining a baby mama and house keeper (or bank),
Obtaining a baby daddy and bank (house keeper),
A source of sex,
A source of intimate sex,
A way to not be alone (I’m not saying not lonely though) in old age,
Roommates as spouse,
A true friendship,
A way to get citizenship,
A way to escape your parent’s house,
The desire to support someone you love and be supported,
Sharing or secretive,
Love and respect manifested in a socially & legally accepted ritual,
A legal contract for the exchange of property or money,
And many other things.

This anniversary was great.  The traditional gifts for 4th anniversary are fruit and flowers. Husband likes fruit and I love flowers (and like fruit too). How could you go wrong there?

I can say that I was absolutely beaming when I came home from work early and there was a delivery of flowers at the front desk. For me!! It was a bouquet called Hugs & Kisses (How twee, right? but cute anyway) and when all was said and done there were two vases full of purple irises and red tulips brightening up our studio.  They were beautiful.

4th Anniversary Flowers

Husband in turn received both pears and oranges which came in two separate deliveries at least a week apart.  Fortunately, the pears showed up around the anniversary. And Husband was kind enough to share the bounty with me.

Anniversary Pears

It was a very good day and it was good to feel happy and loved.

I’ve been taking a break from infertility, from everything. From my camera being stolen in July 2008 to the abnormal mammogram in November 2009, things have just kept happening despite my attempts to have a positive attitude so I decided to stop thinking for a little while and be neutral.

I used to be, and still am to an extent, an odd combination of glass-half-empty/granola-girl-look-at-the-pretty-clouds person. I haven’t had any problems smiling at the simplest things or finding joy in the moment. At the same time, I was always a worrier and a planner - planning for the “what if”. I remember telling a college boyfriend to “smile” (and yes, I know that’s annoying) and his reply was “I don’t always have to be smiling”. Funny thing was, he didn’t smile much and I think I smiled just a little less after that conversation. And before I met Husband, I was the uptight one in any group always finding the negative before the positive. I still often say “no” before I say “yes” at work because I don’t like the idea of being a Yes Man before I’ve had a chance to figure out the situation.

I’ve recently gotten on Facebook to try to reconnect with people who were important to me during important times in my life. Not surprisingly, the first thing anyone asks is “What have you been up to?” And right now, this is difficult question for me to answer because in many ways I feel like a failure because of my inability to finish anything, my stagnant career, and my lack of offspring/family.

As a young women in the late 80s we were told to go out and conquer the world but along the way someone forgot to tell us about the cut off for having children or for that matter basic information on our fertility. We were on birth control from college on. And then being women in men’s professions we had to either manipulate (which I couldn’t do) or appear tougher than we were. To appear as if we needed no help. It is hard not to be bitter about the choices we made or were made for us, but the fact is (as of yet) we cannot change the past and we do not know what the future brings.

Through all of the recent (2007-2010) events I have tried to be Pollyanna about things. I have tried to be centered, to find peace, to do meditation, to do research, to support others in their quest for children against the odds, to be there for others no matter what they are going through. To continue communicate with Husband , continue to work on the relationship. I’ve visualized sperm meeting egg and embryos traveling down fallopian tubes. I’ve been to acupuncture - which was a find in all of this - I love acupuncture and my acupuncturists. Well, most of my acupuncturists - one was pretty much out there to take women desperate for children for all they were worth. I have researched and shared a million and one topics related to infertility. So where does that leave me? Tired. I’m tired of thinking about this stuff. The funny thing was in November I was just going to go with the flow and guess what happened then? I needed an excisional breast biopsy.

Husband likes to point out that we have it better than most of the rest of the world. And yes, if you compare yourself then yes, it would appear that we do have it better than a vast many. However Husband does seem to be better at having empathy for the big picture more than for individuals. On the other hand, my mother says never to compare yourself. You are living in and by the constraints and privileges of your culture and no other. It is hard not to compare yourself though, whether against others in our Western culture or others in other cultures very different from our own.

Glad it was the fork & not my leg

But the truth is that in all of this, I have been lucky. My camera gets stolen and I can afford to buy another one a year later (a nice one). I get hit by a truck and by luck and skill I’m not horrifically hurt. I find out about my high FSH and get a preliminary consultation with an RE in two weeks (typical wait for preliminary consult is months). We’re having trouble conceiving but we have the opportunity to try IVF because my job has an IVF rider. The rider costs a lot of money, but I have a job. The cat gets sick, but I can afford to take care of her. I have a breast cancer scare but don’t have breast cancer. So my job isn’t the best in the world and I haven’t been able to save much and I’m not on the mortgage that I’ve been paying for 10 years but I can afford to take care of things and to save some. I have some wonderful friends and family who are there for me even if they are not physically close (and some that are).

So in terms of Maslow’s hierarchy of needs I’ve got the Physiological, Safety, and half of the Love/belonging levels covered. But the other half of Love/belonging, Esteem, and Self-actualization still elude me.

The path forward is mine to make and I need to fight my devils and begin to finish things.

The List

• Jan 2007 - July 2008 - Severe relationship issues and a lot of couples therapy. I learned a lot, can’t speak for husband. With the breakdown of a marriage and relationship it was impossible for me to focus on anything much. A year and a half of introspection, self-doubt, and anger.
• July 2008 - We decide to try to make it work and to start trying to have a baby. My camera gets stolen from luggage by the Jetblue baggage handlers at JFK. I get $50 for a $400 Nikon.
• August 2008 - I get hit by a van while riding my bicycle. Husband’s father dies.
• September 2008 - I find out that I have High FSH (from a hormone test in January-results never given to me)
• October 2008 - I see an RE - I have fibroids that need to operated on and my tubes are blocked. Get operation- fibroid gone, tube unblocked (one was actually fine), found and removed endomitriosis. Learned some stuff about Husband that really hurt.
• November 2008 - Recovering from surgery. Tooth dies after getting cavity filled. Need root canal.
• December 2008 - Get root canal.
• January 2009 - First crown doesn’t fit
• January/February 2009 - First IVF - BFN
• March 2009 - Second crown fits but gum swells up and hurts horrible. Well lookie here, you have a furcation and need gum surgery.
• April 2009 - Get cell sample for co-culture no IVF. Have gum surgery. Ick.
• May 2009 - No IVF by choice - Husband’s “stuff”. Try naturally - BFN.
• June/July 2009 - Cannot do IVF due to clinic’s schedule. Closed for summer break. Just my luck. Can’t plan vacation because just missed it both months. Try naturally - BFNs. Find out that I have abysmally low vitamin D (the new magic vitamin). Low, as in I haven’t seen the light of day in years low.
• August/Sept 2009 - IVF converted to IUI. Bummed out. BFN.
• October /Nov 2009 - IVF converted to IUI. Bummed out. BFN. Cat is sick - spend lots of money on cat.
• November 2009 - Had first mammogram. Showed microcalcifications - IVF canceled. Have needle biopsy - find two types (pdf) of breast cancer marker cells. Husband not very supportive - in the middle of his “stuff”.
• December 2009 - Had excisional breast biopsy. All clear!!!! (Good thing!!)
• January 2010 - Good friend tells me (at four months!!) she’s pregnant again (long story there). Get a really bad cold right before vacation that I am putting off IVF for. Get UTI right before I leave.
• February 2010 - Hoping for the best.

I had a bad day on Friday.

All due to my very first mammogram (and a lot of assholes riding the NYC subway Friday afternoon).

When I had my yearly physical sometime in the early summer, my wonderful doctor, Dr. Theiner, said that I should get a mammogram this year as I had turned 40 and to ask for the script for it from my GYN.

So I go to the GYN, this new guy (well he’s pretty up there in age but he’s new to me) and have the shittiest GYN exam ever.  First off, a man hasn’t done a GYN exam on me in probably over a decade.  Yes, I know that the dates with Wandy count as some sort of exam but it’s not the same.  Second, he would wouldn’t really answer my questions.  I’d ask and he’d didn’t really listen to the question.  For instance, I told him that I was probably just done ovulating and asked if my cervical mucus looked ok.  His response was that it wasn’t great for some one who was about to ovulate.  Ummm, I just told you I had just ovulated.  So that went nowhere.

Then, he was doing that thing where they look busy to get you to leave the office, I paused  at the door and asked him if I should have a mammogram as I had turned 40.  I mean, we’ve been told this our whole lives “Turn 40. Get a mammogram. Turn 40. Get a mammogram.”  He looked up and said, “How old are you?” Duh, it’s all over the paperwork.  And then said essentially,  “Sure, if you want,” and handed me the script for the exam.

So I put it off for a few months and finally last week I made an appointment for this Friday (the 13th if you care - I don’t, I was born on the 13th).  Like most women, I had heard that the exam was uncomfortable but not unbearable, plus I have a high threshold for discomfort. I had just asked a friend about the exam the evening before and pretty much expected things to go swimmingly.

The exam itself was a breeze.  The technician was wonderful and explained the process to me as she was going through.  Then she took my film to the doctor to review.  She came back and said that sometimes on first exams, the doctor wanted to look more closely at certain areas, so she did a few more scans and sent me to the waiting room.  There I talked to an older woman and well, felt calm and happy that this was almost over so I could head to work and get on with my day.

The Messengers tell Job of his Misfortunes - William Blake

And then the bomb dropped.  The technician told me that the doctor want to talk to me about my exam.  The doctor introduced herself, sat me down and brought up a picture of one of my scans on the screen.  She said that on my right breast I had a cluster of microcalcification.   She said that it could be something, it could be nothing but I should get a needle biopsy.   She (Dr. Solow) explained to me the birad level of defining “things found on mammograms” (my quotes not hers) and that on a scale of 1 to 5, 1 being the best, 5 being the worst that mine was classified birad4 - possible malignant. If the cells proved malignant then I would need to have a surgical biopsy.

Really? WTF? Really?

And so I asked what the chances were and she said 50/50 and that’s when the panic started edging into my voice.  “Really , that high?” I said.  And she asked the other doctor Dr. Rosenblat, what she thought and Dr. Rosenblat said more like 20/80 which made me feel a little better.  But then I started freaking.  Because I’m on BCPs and am supposed  to start stim drugs in a few weeks.  Freaking.  I just canceled a vacation for the second time to do the IVF because I’m running out of time and this is my last chance this year.  I just rearranged my Thanksgiving schedule to make sure I’m back here for the baseline scan.  I have to leave home on Thanksgiving evening to get back here.  Everything is in place and I’m actually not thinking about the whole IVF thing much as per my plan of not over analyzing things. And now this.

So Dr Solow goes to check on scheduling for the biopsy and it turns out that their radiology department is way backed up.  One is on vacation and the other has something going on.  So the earliest they are able to do the biopsy is December 10th.  Fuck. What? But I’d have to miss this chance for IVF.  So then I really break down on the poor doctor.  I’m freaking out because I have a potential malignancy in my boob, I won’t be able to check for this until after my window for IVF passes because of scheduling issues, I’m running out of time to try to have a baby.

I realize that this sounds like I’m complaining about the inconvenience of having a biopsy but put yourself in my shoes and realize that it’s not about inconvenience, it’s about the frustration of everything happening at once.  It’s the frustration of finally giving in and trying not to fret over every little thing, to relax about this IVF stuff - the thing that I have basically put my entire life on hold for for a year, have alienated friends over, have drawn into myself over - only to be told that a potentially bigger thing may be looming on the horizon.  So forgive me if I focus on something like a schedule in order to make the potential problem seem smaller.

Long story short, while I’m desperately trying not to cry, this wonderful doctor is trying to help me find another hospital to try for this biopsy.  She gives me the name of the hospitals, tells me who to call, tells me what to say.  Imagine this petite women doctor trying to give assistance without the whole hugging thing to a hulking, tear leaking patient.  That was the scene.

So I say thank you and leave and start walking off into the rain crying and trying to call my mom.  Moments later the phone rings and it’s Dr. Solow.  She realized that I can go to the radiologist associated with her private practice and that her secretary will call me.

To make a long story a little shorter, Dr. Solow and staff went above and beyond and made me an appointment for the following Tuesday, November 17th.  Her office manager Jane made the appointment and gave me the contact information.  The radiologist’s office manager, Cathy (sp), told me all the details.  By some feat of Dr. Solow’s the films were ready Friday evening so I picked them up to deliver to the radiologist doing the biopsy on Tuesday.  They have to be there on Monday so he can prepare.

I am extremely grateful to these women for everything they have done for me.  They didn’t have to do it and they didn’t have to be so nice. It was really amazing (amazing doesn’t do it justice) to actually feel taken care of for once.  I’m not used to people taking care of me (except for my mom and dad ) and being nice. OK - I’m used to my friends being nice and being there for me (THANKS EVERYONE - DON’T WANT TO POST YOUR NAMES ON HERE ) but not people in general.  Usually, office visits are neutral at best and confrontational at worst.

So there it is.  I have a needle biopsy for birad4 microcalcification on Tuesday, November 17th and will know on Thursday whether I’m clear or whether I have bigger fish to fry than being 40 and trying to get pregnant.

I have tried not to Dr. Google this and have, for the most part, succeeded.  I did look up general information on microcalcification and the percentages are about right.  I looked up the procedure and what to expect - I probably should have just waited to be surprised (I’m thinking something along the lines of Young Frankenstein when Dr. Frankenstein and Inga are up in that elevated bed). And I started looking up some random stuff but then stopped because it was forum stuff and some crazy shit about biopsies causing full blown cancer.  Do I need to read crazy stuff right now? Even for educational purposes? HELL, NO.