A Blast to the Head

When the nurse called with the PGS results, I asked the questions I had written down beforehand, which were listed under two headings: "If any embryos are normal" and "If all are abnormal." Either way, I knew I'd probably be too stunned to remember my questions in the moment.

I scanned down to the second list. Deep breath. So … what were the exact abnormalities? (Combinations of fairly rare monosomies and trisomies, meaning that entire chromosomes were missing and/or duplicated.) What were the implications for the embryos? (Early first-trimester miscarriage, if they even implant at all.) What were the implications for future treatment? (My RE wasn't there to answer that last question, so we'll talk by phone on Monday.)

Future treatment. Is there any point? I don't want to make any grand pronouncements right now about being Done With TTC. But … am I done?? At some point, the relief of stopping must outweigh the pain of giving up.

I keep thinking of a song that talks about making peace with pain, because there's really no other choice. It mentions three levels of damage: a splinter in the hand, a thorn in the heart, and a shotgun to the head. My months of TI and IUIs were like splinters in the hand, constant but fairly minor aches. Miscarriage after IVF was a thorn in the heart. This latest news...

Sometimes a blast straight to the head can actually be a mercy, compared to death by a thousand splinters. You know? I'm thinking here of people I know online who've gotten such definitive diagnoses that all hope of conceiving their own genetic children was crushed in an instant.

But maybe they would still love to have even whatever small chance I still have.

It's just all so complicated.

* * * * * * * * * * * * * * * * * * * *

What's a person supposed to do after getting this kind of news?

I went outside and cleaned up the patio. It felt strangely similar to the last time I got awful news and reacted with, of all things, a crusade to pick up litter in the woods. What's going on here? Am I developing some sort of weird "grief cleaning" habit?

Then, while still cleaning, I started writing a journal / blog entry in my head, because words are how I try to process things. I watched myself doing it, trying to force meaning out of this mess, desperate to transform it into something good or at least something useful. Water and cleansing, renewal...

No. STOP. There's no meaning here, certainly not yet. There's just a person whose hands are continuing to operate automatically, while her head and heart are in fragments. Whatever may happen down the road, despite or because of the news that I just got, there is NO GOOD in the fact that these embryos will not survive.

And whatever may happen down the road, there are no shortcuts to get there, just cold water and dirt in this moment, then the next. So feel it, gritty between my fingers and splattering onto my toes. Feel it. It's a fucking mess. So feel it. That's the lesson for today.

PGS Results

Though I "don't believe" in magical thinking, you might notice how I kept that last, upbeat post as the final word during my wait for the PGS results. Coincidence? Nope.

It was a full two-week wait—my first one in many months. Thanks to a billing screw-up, it turns out that the lab has had my results for a while and was just waiting for payment. Good thing I called yesterday morning to make sure that everything was OK.

Several phone numbers and discussions later, the lab finally called this morning to collect $2,250 (thank you, MasterCard), and in return they finally released the report to my clinic. A nurse called 30 long minutes later.

Shakespeare it is.

Magical thinking didn't work. All three embryos are abnormal. Two have multiple problems, and none are compatible with life.

Out of Practice

Two happy posts in a row ... not a record here, but it's probably close! I hope that all the happy sharing didn't step on anyone's sore spots. I hope it didn't come across as crowing about my good fortune, because that would be obnoxious. When I say that I'm lucky, what I'm feeling is humbled, not proud; I deserved this good luck no more than earlier bad luck. More to the point, there are still no guarantees about the future. All I can do is try to take in the good when it's here.

I wish that I could savor it longer. One of the worst things about infertility, I think, is the relentless need to hurry. Already, we're moving ahead with the next step of PGS. The results will take up to two weeks, which reminds me: I'm really out of practice with the two-week wait! I've had cycles with nothing to transfer, and ones that were canceled due to weather and other issues. Now the stakes, and the anxiety, are rising.

After a winter frozen in this state of numb waiting, I'm out of practice with both positive and negative emotions. Not for long, though...

Moving On

Lately I can't seem to make decisions. Like, about anything. Maybe it started with burnout over medical choices, but now this indecision is filtering down to the smallest details.

In a store tonight, I was trying to decide which type of mouse toy to buy for my cat. There were only two choices, but the first style was kind of ugly, and the second style might be too small. It might get lost under furniture and doors. And who knew if my cat would think the first style was ugly just because I did? Also, BOTH types had small parts; could they come off and be a hazard?? No, probably not. But I still could not decide. I mean, what if I wasted $1.99 ON THE WRONG MOUSE?

Well ... what if I did? With that thought came laughter and instant release. I really don't have to obsess over every single thing, after all. I really can just toss the closest toy into my cart and move on, secure in the knowledge that my cat will be happy tonight and I won't have to waste any more brain cells on this choice. How refreshing.

After agonizing over last month's huge decision for a while, I'm finally moving on medically, too. I'm trying no-stim IVF with my other clinic again. They're the place that got me pregnant last winter. It was a scary choice, because this type of IVF goes against most conventional wisdom, but I think it's the right choice for me.

I've never responded well to stimulation, and the increased expense of full IVF just isn't worth the increased number of eggs produced (if any). More importantly, I'm afraid that the meds may harm what's left of my egg quality. Far better to have one good-quality egg than two bad ones at three times the price. Also, unlike IUI, IVF ensures that the sperm and egg meet. It bypasses problems with the egg entering the fallopian tube or the sperm penetrating the egg. Finally, I'd like to do genetic screening on the embryos, to help make sure that they're healthy before transfer.

This is going to be a long process. I'll do several cycles, do the testing, then—I'm hoping with all my heart—do an FET. Strangely, the fact that it will be a long process is making it feel less stressful, not more so.

The most stressful part is the commute. This clinic is in another state, and the drive there is at least a three-hour round trip (more if there are accidents) through two metro areas. Normally, I like driving. I've driven cross-country (2,000+ miles) several times, but this ... this just sucks. So I leave home at 5 AM to avoid the worst of the traffic. Thank God for audiobooks. They pass the time and calm me down. When I made this trek last winter, I was listening to The Worst Hard Time, a great book about the Dust Bowl and Depression. That sure put my stress into historical perspective!

five lanes going nowhere
(Yes, officer, I came to a complete stop before taking photos.)

Genetic Screening

Creating a Family posted an excellent program today on the latest developments in the diagnosis and prevention of miscarriages. You can listen on iTunes or right on the linked page.

They'll apparently be doing an entire program on genetic screening of embryos next month. Meanwhile, the discussion around minutes 42-44 and 59-61 of this program really caught my ear.

Here's Dr. Richard Scott from the Reproductive Medicine Associates of New Jersey:

I think at the current time there are now a number of randomized trials which show benefit. In fact, a study which is not out yet ... actually shows that it reduces costs of treatment to screen embryos genetically, because you do so many fewer cycles. I think that patients look at these charges, and … it's a great deal of money, and that has to be respected, but the reality is your pregnancy rates per cycle go up dramatically, the number of embryos you put back goes down dramatically, your multiple pregnancy risk can be virtually negated … It makes a 42-year-old's risk of an ongoing Down Syndrome pregnancy less than when they were 21 … If you screen the embryo genetically, you can do as well with one as you do with two. And so now, all of the sudden, you can have pregnancy rates which, even in women in their 40s, can be in the 50-60% range or higher from a single embryo.

Later, he addresses what concerns me most:

When a patient goes through a clinical loss, by the time they go through a cycle, transfer those embryos without knowing if they're normal or not, go through a pregnancy, have the miscarriage occur, have their recovery interval (letting their hormones come down and their body reset), the time before they recycle on average in our clinic … is almost six months. It takes about five months, because there's an emotional healing. For a patient who's 39 or 40 ... those six months are not free. So now, instead of treating a 39-year-old, you're treating someone who's 40, and if they have two or three of those, they're 41 or 42 ... you are actually intervening to lower her cumulative long-term probability of delivery.

Yes, I'm leaning toward stimulated IVF with PGS (if we end up with enough embryos to make testing worthwhile), for exactly the reasons above: mainly a preference for single-embryo transfer and fear of another miscarriage with no time to waste. Next week, I have an appointment with my previous RE (the one who managed the IUI cycles before the natural-cycle IVF). It's time to start writing some questions down.