Tuesday, 21 February 2017

Small victories

6:30am on a weekday, after a long weekend, seems like a good time to celebrate the small things that give me the courage to Carry On (to greatness, or just till the evening, whatever it's going to be).

On fertility: I had an ovulatory cycle, with no medication. I am as sure of this as I can be without lab testing: I had a sustained BBT rise, and positive OPKs around the time of the rise (but only for 2 days). After two anovulatory cycles, that feels like a victory (albeit one I had no control over). So, does the small victory mean there is hope of a bigger victory? This time, probably not. It looks like the BBT is dropping. But in the long game, just maybe. Also I'm happy that I avoided obsessive googling of symptoms and possibilities. I started reading message boards at one point, and then I thought: "I just don't relate to this stuff." And I actually stopped and didn't start again. Thinking about what it would take to stay in the long game, I think the best approach is to carry on TTC with emotional detachment and indifference. Is that possible? Probably not, but I can at least not feed the crazy. Much.

On family: Yesterday we took AJ to a local playground that she enjoys a lot. In the summer I used to take her almost every day. But it's been several months since we went (winter, cold, snow). It so happened that one of AJ's daycare buddies, "K", was also at the playground. They smiled big smiles at each other and waved. Interaction is still rather tentative, but you could tell they were happy to see each other. K's mom, I'll call her "Ana", and I engaged in some small talk, which felt increasingly comfortable. We started talking about communication. Ana shared that she had noticed how verbal AJ is. She then told a story of something she witnessed at the daycare.

There is a little boy in AJ's room, "J", who hits people. He has even hit me a couple of times when I was there to pick up AJ. From what I've observed, he doesn't do so with any emotion, but it's like he's picked up a habit of doing this to people, for whatever reason. I've seen him approach several of the children and swat or kick them. I saw him kick a child in the face who was lying on the floor crying, once. It always seems to be other boys although that might be because there happens to be more boys than girls. The daycare staff, from what I've seen, are prompt at intervening and giving the message that this is not how we treat our friends, we are not happy with our friends, we are sad, etc.

Ana shared her impression that J particularly picks on her son, who also happens to be smaller in physique. She told me that she had also seen AJ "stand up for" K. Apparently after one incident AJ had walked up to J and told him that "This is not how we treat our friends" (basically using the words the staff use). I was quite touched by that. I try not to read too much into situations, because we are talking about toddlers here, who are only starting to develop their social skills. But still, you hope as a parent that whatever age children are, they are getting the right messages. There are always going to be some negative and some positive influences. It meant a lot to hear that AJ is learning the positive. I know she has empathy, because I have seen her approach a crying child and try to comfort him, and she will pretend play sometimes with her toys where she is consoling them. She is also a cautious child, not one to take a lot of risks. But, even cautious people hope that when it is called for, they can face a challenge. So it meant a lot to me to hear that she stood up for K, both in terms of her development and how the situation is being handled at her daycare, as children learn by imitating.

We left the park with smiles for everybody and an invitation to K's birthday party next week. Wins all around.


Monday, 6 February 2017

#Microblog Mondays: The Ants Go Marching (and so does time)

Last night I was snuggling with AJ before putting her in her crib. She wanted to sit next to me in the recliner (not in my lap) and was asking for songs. She asked to hear "The Ants Go Marching".  This was a first: it's always been "The Wheels on the Bus" or "Old Macdonald Had a Farm," before.


I started singing, stumbled a bit remembering the tune, and then remembered that "The Ants Go Marching" was a song I sang to her all the time as a newborn.


I enjoy a good flashback. But those days already seem so unreal. Bittersweet.








Microblog Mondays

Wednesday, 25 January 2017

Reality is a bitch

But who can retrieve hope out of a 10 foot deep pit toilet? Who, you ask?

Me, that's who.

January is almost over. I'm fairly sure I'll survive the rest of it. I have almost finished the things I absolutely have to finish. I am still standing; I have most of my wits; and I feel strong: albeit a little smeared by the shit of circumstance.


Ah, let me back up a bit.

We had our follow up appointment with Dr. Cotter. I always have a sinking feeling anticipating these appointments, and it didn't help that I had to drive across the city in winter weather. I felt crazier trying to figure out the parking machine at the clinic than I ever felt while taking any fertility drugs. I narrowly restrained myself from cursing a blue streak at it and the bystanders behind me for the insult of existing and making demands on my stressed mind.


That was my mood going in, but I was quite prepared thanks to the detailed charts and notes I kept during my Clomid cycles, and the fact that I blogged about the matter and received some helpful comments.


Dr. Cotter chose, uncharacteristically, to open with a positive: "You ovulated several times!" (with reference to the first three Clomid cycles). She followed this with "We received some new information from the latest semen analysis." I allowed myself to briefly fantasize that this new information was good, even though I knew it wasn't.


Mr. Turtle's last SA (September 2016) showed a drop in numbers from 17 million (2013) to 1 million. That moves him from the "moderate" male factor infertility category to "severe."

Dr. Cotter was quick to add that "men's sperm counts go up and down like the temperature in [Western prairie-steppe city that has huge temperature fluctuations due to the Chinook phenomenon]. "Men can go from zero to millions in a few days," she elaborated, and said that this was true for men of all ages, including men in their 20s.

"With those sort of numbers," she continued, we would usually go to IVF, but we know you didn't produce any eggs on [very high dose of follicle stimulating hormone]. And you were three years younger then, so....[pause]."

"It does seem unlikely that we'd get a better result now," I mutter at Dr. Cotter and the indifferent universe.

"So the question is...." [pause to lean forward and make intense eye contact] "How aggressive do you want to go?"

There is another pause while some part of me registers that the last time I heard about aggressive treatment, it had to do with my dad's esophageal cancer. Also that at the moment I feel not very aggressive at all, but maybe this is one of those times that you fake it till you make it.

"Would you consider donor egg? Would you consider donor sperm?"

I stare at Mr. Turtle. "It's not off the table. But we haven't talked about it lately." Mr. Turtle adds, "Yes, we'd definitely have to have more conversations about that." He then steered the conversation back to his SA and recurrent lymphedema as a possible reason for it.  Mr. Turtle has Crohn's disease and is immuno-compromised because of the drugs he takes to manage it. Anytime he is fighting an infection, he gets a lot of swelling in the genital area which increases body heat, probably killing sperm or causing them to not develop properly.  We talked about how at the time we conceived AJ, Mr. Turtle had been doing lymphatic massage for drainage. He didn't think that at the time it made any difference, but maybe it had? Also his perception was that he was in worse health overall at that time than at present - but still managed to conceive a child, which is interesting. Dr. Cotter looked up his medical records on her computer, corroborating what he was saying with what his other doctors had observed.

Her recommendation after this discussion was to repeat the sperm analysis twice more, to see if there are any changes or if the low numbers seen in September continue. In between the analyses, Mr. Turtle can try what he can to reduce the lymphedema. He also has follow up with other doctors to get more opinions. So that's all good.

After we talked about that, I felt like I should bring the conversation back to my issues, although for a change, I was (sort of) the receiver of good news. I asked:

Assuming Mr. Turtle's sperm counts improve, would Dr. Cotter suggest trying Clomid again or look at something different?
Dr. Cotter reiterated that she feels Clomid is the logical treatment, because I did ovulate on it, it has been used for a many decades, and because "we know that Clomid at low doses works for women at the end of their reproductive lives." She seems quite positive on this point. She also implied that considering the one anovulatory cycle, she might increase the dose. She also talked about Femara/Letrazole as a possibility, but noted that it works in "a very different way" and she could not judge if it would be better than Clomid or not.

I asked if there was an advantage to going off Clomid for a while before trying it again, and she said yes, you need to take a break every four cycles. If we do try Clomid again, I will want to ask more questions, such as the short luteal phase on the ovulatory cycles and in what circumstances she would consider additional things such as a trigger shot/progesterone supplementation. But that conversation can wait till we know more about what's going on with the sperm and if improvement is possible.

I asked if there were any risks to taking DHEA over an extended period of time, and she said not that we know of, and agreed to give me a prescription for it for another few months. It shouldn't do any harm and it might do some good.

And then because I felt I should, I asked what were the options for donor egg should we choose to go that route.

Most of the donor egg information I already knewfrom asking the same questions three years ago. Two options:  fresh cycle with an (unpaid) egg donor, 38 or younger. Since we don't want to recruit a donor this isn't likely an option for us. Option 2, we can buy frozen eggs in batches of 6 from a US egg bank. The cost is $10 000 plus $1000 shipping cost, plus the cost of the IVF cycle. The donor eggs would need ICSI and assisted hatching as the freezing process makes the eggshells tough. (She actually said eggshells).  As Dr. Cotter was talking, I couldn't help thinking of all the things that could go wrong during this process.  Another wrinkle: Dr. Cotter said the egg banks might refuse to sell eggs to a couple with a low sperm count, because they would worry about it affecting their pregnancy rates and that's how they market themselves.

And what about donor sperm? Dr. Cotter had floated the idea of donor sperm with Clomid and/or an IUI as an option.

Dr. Cotter told us that "donor sperm is expensive" although the numbers she gave were in the hundreds of dollars, not thousands which is less expensive than eggs, at least. She then went off on a tangent about how sperm costs more or less depending on the race of the donor: Caucasian sperm is the cheapest, and Black/Hispanic sperm goes up in price with Asian sperm being the most expensive. Asians have low sperm counts and sperm donation is not a cultural norm. "There is literally one Asian donor in Canada and he is in high demand."  I don't know why she thought all these details were necessary since we are obviously white and not likely to seek out a different race donor but what do I know. She told us how sperm and eggs are flown all over the world and that is normal. At the end of this informative disclosure all I could manage was "It's an interesting world you work in."  "Oh yes, very interesting,"Dr. Cotter said breezily, as though she had quite enjoyed discussing professional business with us. Maybe this is her way of testing if people are really serious about "aggressive" treatment.

It's an interesting word, aggressive. A google search of "aggressive treatment" brings up this definition : "Aggressive care describes a particular approach to a life-threatening illness or condition. A patient receiving aggressive care will receive the benefit of every medication, technology, tool and trick that doctors can devise to treat his or her illness."  "Aggressive" usually (to me) has a negative meaning, such as a person who wants to pick a fight and threatens with words or actions.

But in the context of illness, aggression sounds kind of positive: Imagine soldiers of medicine fearlessly fighting the enemy disease! If you are aggressive, you must really be doing something. No more talk, all action! It seems cowardly to say, well shucks, maybe I don't feel like being aggressive. It rather reminds me of times in my life (mostly as a child) when well-meaning people kept telling me to be more assertive, maybe even more aggressive, with the stated or unstated implication being, if I didn't, the aggressive people were going to win or get all the good stuff. By the time I was in my 20s, I felt I had proven that I could have a good life without being aggressive, i.e. something I wasn't.  But the notion they planted still lingers in my thoughts: if I'm not aggressive, I'm not really serious about what I want, and I won't get it.


The thing is, at least with regards to infertility, I see aggression as illogical. Aggression implies an opponent. But who or what is my opponent here? My own body. So aggression means two things: I'm fighting my own body, or, I'm asking doctors to fight my body (while I passively watch? how is that a thing?). Neither possibility makes a whole lot of sense to me. Maybe the key piece here is self-image: I see myself/body as fundamentally good and beautiful. My body is not so much my property (I didn't ask for it and I don't get to keep it) as a sacred trust. To harm it or hate it feels deeply wrong and always has. In so far as "aggression" means harm or hatred, I can't go there. At all.


But you might say, it's just a word. Why not focus on the treatment options, not the words.  Well, because I think words actually do mean something. Words tell us truths about how we and others think, if we listen attentively. The words we use are not coincidental or accidental. They have histories. The histories tell the story of real things and real people. Real bodies. When Dr. Cotter calls DE/sperm IVF "aggressive treatment," she's telling a real story with real world consequences.


And whether I have another child or not, all my life I'll be telling my story. More than that, I'll be telling my child(ren) their story. What kind of a story do I want to tell?


That's where my thoughts are at. Not whether I can conceive naturally or whether DE IVF or some other treatment will "work." Those are valid questions, but I won't be able to answer them until I try, and when I get the answer, it may well be too late to do something differently, and thus the answer itself will be useless. So truthfully, none of those questions or their hypothetical answers will actually determine our course. The one that will is, What kind of a story do I...do we....want to tell?


So back to retrieving hope.


I'm actually feeling quite good. January is almost done. The days are getting longer. My daughter is beautiful and my husband walks with me on this path. We don't have to go back to The Fertility Clinic for another four months (after the second SA) and I'm quite happy about that. We can cycle unassisted. Or not. But we probably will.  We can talk about DE IVF and the other options Dr. Cotter floated. Talk is good.


Basically, I'm not being aggressive. And I feel just fine about that.

Tuesday, 17 January 2017

I need some suggestions

January is more than half done, hallejulah. I don't want to wish away a day of my life but January isn't my favourite month. It feels like everybody is making New Year's resolutions in December and my only thought is: please can I just get through January.


Anyway. We are at a turning point/checkmate/stalemate (I can't metaphor right now) with regards to trying to conceive #2. I'm not feeling very optimistic at this point, not going to lie. But optimistic or not, we still have to decide to do something, or nothing, which is still a decision.


We have completed our 4 cycles of Clomid, 100mcg. No pregnancy achieved. According to progesterone levels, I ovulated the first three cycles (levels were 11.3, 18.9 and 22.1 respectively). All 3 ovulatory cycles had a relatively short luteal phase, according to the charts I kept (about 9 or 10 days). Other than that though I was encouraged to see my charts looking mostly the way they are supposed to for a fertile person. My temperature was low prior to ovulation, then rose, with the highest point about 7 days after ovulation. From there it would plummet. I had one or at most two positive OPK's in each cycle (I stopped testing after BBT rise).


I did not ovulate on the fourth cycle. I didn't ask the number for this one. My BBT chart is basically flat and low, no temperature rise. I had positive OPKs starting day 9. They were positive for about eight days, went negative for three, went positive again. I have never had this happen before. I finally gave up because it was too frustrating. I had various kinds of cervical mucus throughout, some of which looked fertile but as previously noted there was no evidence of ovulation at any point. This cycle lasted for 34 days and finally ended with what looks like a pretty normal period. I was glad that I at least did not need to use the Prometrium to induce a period which wasn't something I wasn't anxious to do. I am now unmedicated for the first time since October. What I notice so far is that my BBT (follicular phase) is lower by 3-4 tenths of a degree than it was when I was taking the Clomid. (I didn't chart prior to taking Clomid so no idea what it was before).


We have the follow up appointment with Dr. Cotter this Thursday. I'm trying to think of what I should ask her / talk about. I don't know if we will be offered any treatment options after Clomid. Maybe she will interpret my 3 ovulatory cycles positively and be willing to try something else, maybe not. I'm also so busy this month I haven't had much time to research or think about things, and it's still hard to think past the disappointment.


From the little I've had the time to read, here are some possibilities I found for when Clomid doesn't work:
  • Keep trying Clomid at same or higher dose (we were given four cycles, but surveying the internet I see that some people have had it prescribed for up to a year ...!!!... )
  • Clomid with a trigger shot
  • Go off Clomid, go unmedicated or take birth control pills for a couple of cycles, try again with Clomid
  • Femara
  • "Injectibles" - not totally sure what those are....needles??
  • IUI (we were not previously considered candidates for this because of male fertility issues)
Does anyone have any ideas of what else we could ask about?


We will also get the results of Mr. Turtle's latest semen analysis. I mainly focus on the female side on the blog, because it's easiest to write about myself, but we are a double infertility diagnosis. So that could be very important information going forward.


I haven't officially been given the results of my salinohysterogram, either, but unofficially I was told everything looked good and I had follicles growing.


I plan to ask if there are any negative side effects to continuing to take DHEA/COQ10 and if not whether Dr. Cotter can refill my prescription for that. I don't feel terribly hopeful right now about "trying naturally." But neither do I feel ready to make the decision to stop.


There is also the donor egg option. Since I wrote this post and this post, donor egg IVF has not become any more appealing to me. I definitely don't have the desire to start that process right away; at the same time I can't yet shelve it permanently.


I took the day off of the appointment. I wish I could spend it relaxing, but I will be busy with individual program plans and report cards which are due this month. The nicest thing I can probably do for myself is get that work done so I don't have to do it on the weekend.


Any ideas to kick start my tired thought process are welcome!!


Monday, 9 January 2017

Microblog Mondays: This Child

I feel like I've been living a dual existence lately: caught up in the process of trying to make a second child (I'll update on how that's going another time: basically, Not Good), while being riveted by AJ and how she is growing.

She really isn't a baby anymore. Of course, I still call her Baby Girl, and probably will when she's 20 if she'll let me. There are moments where I fleetingly see the newborn in her (a certain sleepy, secretive smile, the shape of her head and way her ears stick out when looked at from the back, the way her face crumples up when she cries). Will I also still be seeing those flashes of the newborn when she's 20, I wonder? But most of the time, she's busy reminding us over and over again she's Not a Baby.

I have four photo collages up in the dining room, two big rectangles with 12 photos apiece and two smaller ones, 8 photos each. In theory these are supposed to be updated every year; in reality this job is procrastinated because sorting, printing and displaying photos is a terribly time consuming and therefore difficult and stressful. So the photos have not been changed since shortly before AJ's first birthday, and they are all of her in the first year of life. Lately, I'm thinking I really have to change them up, because she Does. Not. Look. Like. That. Baby. Anymore.

I don't know; those (not so) old photos have somehow brought it home in a way that everything else, even all the developmental milestones, haven't. The baby is a child.

In a way it's therapeutic: As AJ grows into an individual, she grows away from the whole process of conception and pregnancy and even birth and infancy. It's nice to be reminded that life is evolving and surprising and meant to flower beyond its (amazing) beginnings. Her growth and change is a reminder that the future is unwritten and could be very different from the past and from the future I imagined in the past. And that's.....sad and delightful and frightening and liberating all at once.

I savour the moments that I have with this child, this totally unique life.

Also here is the Susan Aglukark song with the same name as this post. Because.



 More microblogs

Saturday, 31 December 2016

Fortune Cookie

We went out for dim sum yesterday with my family and in-laws. AJ was moseying about being cute, and one of the staff gave her a fortune cookie (nobody else got one).

It said:
be prepared to modify your plan
Be prepared to modify your plan

I thought that was a very sound piece of advice for parenting, teaching, or life in general. Actually, I think it might as well be my resolution for 2017. The one thing I feel quite certain of is that I will have to modify plans. Remembering that also helps me to not worry so much about things that don't work out the way I envisioned at a particular point in time.

Happy New Year. Thanks for reading.

Friday, 23 December 2016

Generations

Last week I went with my mom to an ecumenical service called "Blue Christmas." My former colleague and friend attends a United Church, and she let me know about this service for people who were having a hard time getting into "the Christmas spirit" because of loss or hard times. My mom wanted to go, and I went with her, although I'm actually enjoying Christmas so far. But I'm very aware of the different levels of meaning it can have. My mom has talked about how sad it is to be reminded of the different things she did with my dad, such as picking out a tree, that she won't be doing this year. I try to remind her that it doesn't have to be the same, that we can miss the way things were while still appreciating what we have, etc. But obviously I don't have all the answers, and really we are making things up as we go along. It's much easier for me because I have Mr. Turtle and AJ. I have lost my dad but my daily life has not been radically changed the way my mom's has been. I have people to go home too; she goes home to an empty house most of the time. My mom, incidentally, did find a tree: a tiny live potted one. She tells AJ it's "her" tree because it is little.

The Blue Christmas service was quite well done. People were welcomed "wherever you are at" and the programme and atmosphere were designed to be accomodating to people of any religious background or more likely lack thereof. There was a very good band, and music was a constant throughout the evening, much of it non-traditional. A variety of people officiated. One of the female officiators reminded me, unfairly I'm sure, of Melisandre from Game of Thrones, because of her expressions and mannerisms and the way she kept talking about "light and darkness" in a very dramatic way. But overall I appreciated the essence of what was attempted.

There was a part near the middle which drew my thoughts away from Christmas and into the realm of infertility/subfertility. The speaker must have been in her 50s, and she told the story of losing her father to cancer this year. Obviously this hit quite close to home.  She described how she sat in the hospice with her dying father, knitting a baby blanket, because her daughter in law was pregnant with their second child.  She felt she was "knitting the generations together," as she watched one life fading while another was quickening.

It's a poetic image, but it sent me spinning into a different place, reminded of my darker thoughts around subfertiliy/infertility.  They sum up as: I will get older, watch people around me get sick and die, and experience my own body failing, but without the compensation of seeing new life growing. Since AJ was born, this fear has faded a bit: she keeps us enthralled with everything she is learning and doing. But AJ doesn't have siblings, or so far cousins, though she has/will have cousins once removed, none of which live in the same city. Basically, when our extended family gets together, there are a lot of adults from 30s to senior, and....one child. Something about this makes me uneasy. I'm bothered by it even while I selfishly like the fact that my friends and family are not very fertile, by circumstance or choice, because my nose isn't always getting rubbed in our difficulties.

It's all very well to be comforted by the fact that babies are born while old people die, but what if babies aren't being born? What if you want to have those babies, to see the generations knit together, but they remain out of reach? I don't want to diminish the speaker's situation by making comparisons; she had an important story to tell and she told it very well. But it reminded me mostly of my infertility grief.  Cancer took away the extra years my dad could have had with AJ. But subfertility took away any other grandchildren he might have known. And infertility may well take away grandchildren that my mom and other family might have known.

Of course, then we come right back to the un-quantifiable awsomeness of AJ. I would not trade her for any number of hypothetical children or a hypothetical life. Nor would anyone else. But still. Infertility shatters so many assumptions, so many human comforts that we assume everybody has access too, simply through the ability to create a family.

For the final part of the service, people were invited to light a candle in honour of someone. I have mixed feelings about candles, but I chose to participate this time. I know my mom lit hers in memory of my dad. But I lit mine to acknowledge the years of waiting for a child, and for this second child who dominates my waking thoughts, but has yet to manifest. One of the last things my dad said to me was that I should not feel too sad about his illness because "this is the way it should be," meaning old people die and the young carry on. But there are so many things that should be, and aren't. The vision of what "Should be" might get us started on the journey, but it's not where it ends.

Lighting the candle helped a little bit, I think.