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.

My period (minus the dust) and in reverse order.

Source: http://www.bom.gov.au/climate/environ/drought-dust-deluge.shtml

I’ve made a decision. I am giving up Dr. Google.  I’m gonna be like an ostrich and put my head in the sand*.

While I’m grateful for the volumes of information I have learned over this past year from Dr. Google and various books and papers, it has become tiresome to always be questioning things. I know enough now to know when something is a SNAFU on the clinic’s part and I know enough to speak my mind to my RE, but I’ve pretty much had it with looking stuff up and comparing my experiences to others. I’m older, my body is doing shitty things but I don’t have to keep re-hashing that…All. Of. The. Time.

I actually started with the research and the Dr. Googling because I couldn’t get answers anywhere else.  My RE, Dr. He of Few Words was not about to give me information on the different protocols that are used on older women with high FSH much less actually explain to me how the whole process works.  And Nurse is so overworked that she barely has time to think much less give me answers to any questions that are not scheduling related.  She’s probably not allowed to give us any medical information anyway.

Be like an ostrich - bury your head in the sand.

So, in the beginning, 2007, I started out by charting my temperature online and joining TTC forums, Googling countless questions about BBT chart antics and pregnancy symptoms for x#dpo (x number of days past ovulation).  By October 2008 when I realized that I had pretty hectic, age-related issues looming I began reading books, joining the Fertile Thoughts community, and as my first IVF started, began Googling infertility related questions in addition to my normal obsessive Googling.  I’m a research freak, what can I say.

It’s hard to stop though because in a way, my Dr. Googling defines my role in the online infertility community. The TTC and IF communities out there on the forums and Twitter are wonderful communities. And I have spent a year plus now participating in them, even making some virtual friends whom I hope to someday meet in real life. I have met women who are now pregnant through fertility treatments who I can actually talk with. My main participation beyond the generic support we all give to each other has been to find answers for myself and for others.  To try to find actual information on a particular set of circumstances. I did this willingly for both myself and others and I will continue to look things up if other people post questions to the forums and Twitter but I will not (or at least try not to) look things up obsessively for myself.

(Disclamier: I did look up some yesterday about the bloody deluge that was my CD2 but I stopped, the internetz ain’t gonna tell me anything useful at this point.)

You see, what happens is you start out with a question about something medical. Now we’re not doctors (well, most of us aren’t) and most of the people who post on the internet are not doctors. I would Google things like…:

• blood on progestrone applicator
• bloody ewcm after trigger shot
• brown tinged ewcm
• can you be pregnant and have a cyst
• can implantation just feel dull
• clomid before stims
• clomid compared to menopur
• clmid lower estroen
• clomid slower stim
• clomid with injectables ivf
• do estrogen patches elevate E2 blood levels
• do estrogen patches make your period come earlier
• do progesterone supplements cause cloudy ewcm
• do you stim slower with dlomid
• does clomid lower estrogen
• does clomid make your temperature go up
• does clomid work lik follistim
• draining ovarian cyst
• e2 low and lh high
• ectopic 5dpo
• estradiol levels mcg menstruating female
• follicle size cd7 clomid
• graph of prgesterone blood serum on supplement
• graph of progesteon e prometrium
• how does clomid work
• how long does egg survive after ovulation
• how long is lh surgeiui 3 hours after ovidrel shot
• ivf after annovulatory cycle
• lead follicles tcm
• lh at ovulation
• lh flood level 47
• lh range for surge
• lh surge and ovulation temp rise at same time
• lh surge no cervical mucus
• lh surge no tem prise
• lh surge on day of ovulation

(A-L fertilitiy searches in the past 4 months)

…to name a few and the result was often hit after hit of forum posts by someone who had something similar to you or someone who is giving support to someone who had something similar to you and sometimes actual medical information in such a watered down format that all it does is tell you you have a problem.  Yeah, I knew that.

After the endless forum hits, the next stop is PubMed and scholar.google.com to try to peruse medical studies for insight.  This is where it gets really frustrating because 1) You can only see abstracts and 2) You don’t know what the hell they are really talking about anyway.   Sure, you can read the conclusions but do you really know what a double-blind study is and if oestrogen is the same as E2 is the same as estrogen is the same as estradiol?  If they are, are they all they all measured the same way?  You don’t see the data. You don’t see actual documentation that say, sometime LH surge and BBT temp rise is on the same day.  And even if you did, the study isn’t going to tell you WHY it happens, it’s just going to tell you it did happen.

That’s where our doctors are supposed to step up to the plate and where many of them are failing.  Maybe it’s because they are afraid to or don’t want to give any absolutes or facts because the facts can change.  I get that but would still like to know the current conjectures.  Hell, after going through all of this, I have realized that infertility treatments are basically like someone using a blowtorch to light a cigarette.  They really have no idea what makes us tick.

*The whole ostrich head/sand thing (minus the foolishly part):

“The English language is very rich and descriptive. Someone “hiding their head in the sand, like an ostrich” is said to be foolishly ignoring their problem, while hoping it will magically vanish….

Source: http://www.abc.net.au/science/articles/2006/11/02/1777947.htm

Source: http://blog.cleveland.com/health/2008/06/google_health_site_for_medical.html