Grief-Cleaning, IF-Junk Edition

One productive thing I did do this fall was clean out all the clutter that's magically appeared in my home, in the years that I've been pouring time and energy into other things. Like these things. (BINGO x 12! Yay—what prize do I win?)

Around that same time, I saw the image linked above and realized that I had every single one of these types of "infertility detritus." Even the "lucky" stirrup socks. (Screw you, socks. You're fired!)

The only square I cheated on a bit was the used pregnancy test. In the brief time I was pregnant, I went through a dozen of them—just to make SURE—and saved them for months. But they do fade and get yucky, so I took photos before throwing them out. Photos count, I think.

I'll probably always keep those photos. But why was I keeping three boxes of used needles in the bathroom and expired meds in the fridge? That one vial of Gonal-f way in the back expired 16 months ago.

Good times.

It was easy to get rid of some things, like the needles and the meds. Then I started on the boxes of IF paperwork by sorting them into 10 piles, including info related to finances, medications, cycle details, pregnancy, miscarriage, and so on, plus one pile about holistic strategies. That last one brought on a sad smile. Did I really once think that spicy foods and pigeon pose might get me pregnant? Apparently, I did.

Although I couldn't bear to throw away much of the paperwork, I did move it from the dining room table, where it had been the centerpiece for far too long, to a filing cabinet on the periphery. Maybe someday those files will graduate into the trash. Not yet.

Like the creator of the wonderful bingo card linked above, I've wondered whether "keeping a box of sadness is totally normal." After all, if I ever am lucky enough to get pregnant again, I'm sure the OB's office will gladly give me a new copy of their "Prenatal Nutrition" handout.

So why hold onto this junk now? Because I'm not able to accept the loss? Because these things document how close I came? Because the sheer volume of stuff bears witness to what a long and—whatever the outcome—life-changing journey this has been?

Yes. All of the above.

How to Look on the Bright Side (Part 3)

This is the part where I try to sum up a lot of thoughts about the "encouragement card" given to a woman by her clinic (Part 1) and the study that led to the card's creation (Part 2). Let's start with the obvious, alright?

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

The encouragement card (PRCI) did not work for me.

Apparently, I'm in the minority of women who—given only the two choices that were offered in the study—prefer the PMI affirmations over the PRCI card.

It's not that affirmations like "It's great to be alive" feel especially true right now. Actually, that's kind of the point. I see them not so much as true or untrue, but simply as ideals, maybe even fantasies where I can briefly escape. Living with them for a moment is all that's required. Because it's so easy to do, the affirmations somehow bypass the tangled hairball of thoughts in my head and just make it easier to breathe for a minute or two.

In contrast, the PRCI statements get my guard up right away. They tell me to do something that I don't know how to do, and they make it sound easy.

It's not easy. What ARE the "positive aspects of the IVF experience" or infertility in general? It hasn't brought me the closer relationships mentioned as an example (in Part 2). It has led to some wonderful new relationships, while putting others under strain.

I am aware that just being able to try "the most advanced fertility treatment" makes me compare "favourably with others who are less well off," and I'm grateful for that chance, but I'm also aware that it's only a very small CHANCE to do what most people do naturally. A chance is NOT (repeat, NOT) any kind of guarantee. And when it doesn't work, then what?

What have I gained? About 15 lbs. Also, several containers full of used needles. Possibly, on the best days, a slightly better sense of humor and awareness that everyone is fighting some kind of battle, whether it's visible or not. What have I lost? Most of my life's savings, half a decade of my time, and all of this.

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

The intention was so good that I hate to criticize the execution.

The introduction to the study (Part 2) does a good, detailed job of explaining exactly what's stressful about IVF. Because infertility can create so much stress and pain, I'm truly glad to see attention being focused on mental health in this context. These people recognized a need and made quite a serious effort to address it. That's great!

Also, just because the PRCI doesn't work for me doesn't mean it doesn't work. Other patients apparently do feel helped by it to some degree. Honestly, those results rattled me, making me question whether bitterness may be obscuring my judgment. After more thought, though, the way I see it now is just that different people prefer different tools, and the two covered in this study are by no means the only ones that exist.

Even if I can't think up "positive aspects" of IVF—the main way these researchers envisioned women using the PRCI card—it did help in one way. It prompted me to make my own encouragement card (in Part 1), remembering other methods I've used to look on the bright side more authentically.

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

But let’s be honest: there are problems with the execution.

I see two problems with the PRCI card and, to a lesser degree, with the PMI affirmations. The PRCI's vagueness and repetition (all the variations on "be positive") are the most obvious issue. Underneath is the unquestioned assumption that being positive should be an IF patient's main mental-health goal.

Isn't it important to maintain a healthy attitude? Well, of course. It's one of my main goals every day, and I'll always be willing to try any strategies that are aimed at genuine healing. ALL of them. The more the better! The thing is, I don't always equate "healthy" with "positive."

In Part 1, two commenters wrote about the need to acknowledge all of our emotions, dark and light, as the only way to get through them (not over or around them), and I agree. Forced positivity can invalidate people's real experiences. Positivity becomes forced, I think, when these impulses are at work in the person who's giving the advice:

• Enforcing a smiling decorum
  This mode prioritizes seeming good over feeling good. Some people are just uncomfortable with grief. They want us to feel better. They may think that by acting like everything's OK, we may come to believe it, or at least we'll avoid bothering anyone else. But it comes to feel draining and fake. Suppressed feelings tend to leak out anyhow, sometimes in more damaging ways.
• Lecturing with "at least" statements
  Saying that we can't be sad because someone else has it worse is like saying that we can't be happy because someone else has it better. Actually, it's possible to feel happy AND sad (or other emotions) all at the same time. Appreciating the good doesn't require denying the rest. Denial just makes a habit of disassociating from reality, which can also interfere with feeling good.
• Blaming circumstances on attitude
  Of course, the choices we make contribute to some of the outcomes we have. On the other hand, sometimes shit just happens. But if people can think up a "reason," they can feel smugly assured that similar things won't happen to them if only they don't make the same "mistakes."

I doubt that the people who developed the PRCI were motivated by the impulses above. They were, I'm sure, sincerely trying to help, and the tool they created was based in part on feedback from the study participants.

But I still worry that the shallowness of the statements in the PRCI promotes putting on a happy face (decorum) more than true healing.

One of the stated intentions was to help people focus on "comparing oneself more favourably with others" ("at least" statements), especially other IF patients. While it isn't inherently wrong, I guess, it hardly seems complete. What I hear is, Hey, we know the situation sucks enough that you need encouragement, but let's pretend it's not true by focusing EXCLUSIVELY on the 5% that's OK. That feels delusional.

Finally, acting as if a simple attitude adjustment is all that's needed may leave people blaming themselves (blaming circumstances on attitude) if they end up still struggling.

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

Can I frame all this in a more "positive" way?

My goal is to feel not so much positive as whole, which means somehow integrating the most unpleasant truths in my life without getting overwhelmed by them (lost in self-pity, depression, and so on).

How to do that? Well, I'll start by acknowledging that it's not easy! It's probably the work of a lifetime, in fact. Seeking that balance has been the driving force behind this blog for over 100 posts now, and it feels like I've made just the barest beginning. I'm nowhere near done.

And my personal "encouragement card" (Part 1) is not intended to be the final word. It's the result of one evening's worth of brainstorming. It's an attempt to start a conversation.

So again ... what would you add? What strategies have kept you relatively healthy and whole when dealing with the hardest parts of infertility? Also (and this is much harder than it sounds), can you summarize them in a few words that would fit in a pocket-size list?

What would be on your personal encouragement card?

How to Look on the Bright Side (Part 2)

Last time I mentioned an "encouragement card" that another woman received from her clinic. Now, as they say, here's THE REST of the story!

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

I've come to learn that the original card wasn't just one clinic's kind but quick attempt to be helpful. In fact, the card was carefully developed and evaluated as part of a double-blind study.

Researchers at Cardiff University in Wales were hoping to help women find effective ways to cope with the stress of IVF. The goal was to develop a "Positive Reappraisal Coping Intervention (PRCI)" card that was based on respected theories, inexpensive, simple to use, and generic enough to be used by other types of patients later. Here's what the researchers proposed:

"One meaning-based coping strategy that seems particularly likely to make (re)appraisal more positive is positive reappraisal coping, which may be understood as 'cognitive manoeuvres' or cognitive efforts ... that change the meaning of the situation. Finding positive meaning may involve appreciating the benefits that the situation has brought to one's life (e.g. closer relationships), comparing oneself more favourably with others who are less well off, or redefining the situation such that it seems more positive ... individuals may focus more on positive aspects of a situation rather than ruminating about (or conversely trying not to think about) negative and distressing aspects. Such efforts in the IVF context may involve focusing on the fact that the most advanced fertility treatment is being tried, or that a partner is especially loving and supportive."

The research subjects were women undergoing embryo transfer at a large urban hospital in the UK. Of the 55 women, 28 were given the PRCI card and 27 (the control group) were given a Positive Mood Induction (PMI) card. The women were instructed to read the cards at least two times a day during the 2WW, and then evaluate the cards' effectiveness. Here's the content of the two cards:

(source)

Sure enough, the PRCI was rated to be more helpful and suitable than the PMI, and to have more enduring effects. On the other hand, although the women rated the PRCI the highest of the two, their endorsement of it still seemed fairly lukewarm:

(source)

The researchers suggested that the PRCI may work because the "focus on positive aspects of the IVF experience" (using the PRCI) requires more cognitive processing than focusing on affirmations, which may or may not feel true to the individual (using the PMI).

When affirmations don't feel true, they may even be counter-productive. The researchers cautioned that the perceived benefits of the PRCI, in comparison to the PMI, may be due partly to this effect, and/or to the fact that the PRCI simply provides a distraction from worries.

Along with thinking of benefits and repeating affirmations, simple distraction is also a recognized coping strategy. While the researchers found the PRCI to be promising, they also allowed that different people prefer different coping methods.

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

Coming next: my attempt to sum up a whoooole lot of thoughts and feelings about this study.

How to Look on the Bright Side (Part 1)

On a private forum recently, a woman who's been TTC for a while wrote about receiving an "encouragement card" from her clinic. It was a pocket-size card that listed these suggestions:

1. Try to do something that makes me feel positive.
2. See things positively.
3. Look on the bright side of things.
4. Make the best of the situation.
5. Try to think more about the positive things in my life.
6. Focus on the positive aspects of the situation.
7. Find something good in what is happening.
8. Try to do something meaningful.
9. Focus on the benefits and not just the difficulties.
10. Learn from the experience.

Do you see a pattern here? Except for numbers 8 and 10, these tips all seem to be variations on "Be positive." (If there's a difference between "See things positively" and "Look on the bright side," it's too subtle for me.)

Several of us on the forum had the same reaction: after the second or third cliché, we started feeling put off, maybe even patronized. We heard echoes of the infamous "Just relax!" Because while everyone agrees on the need to, say, "make the best of the situation," the huge daily question is HOW.

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

Of course, to be used in this format, the "how" needs to be as brief and universal as possible. I know how hard that is, and I appreciate the clinic's effort, since (in the interest of being positive, not just pointlessly snarky), I took a shot at it myself.

How to translate platitudes into actions that I actually know how to DO? Here's what's worked for me personally, or at least as much of it as will fit into a tiny, pocket-size list. (Obviously, whole books could be and are written about each point, and your own points may differ!)

1. Focus on the things I can control, and act decisively.
2. Maintain balance by continuing to do non-TTC-related things that make me feel good.
3. Maintain perspective and connection by sharing support with others who are also struggling in some way. 
4. Allow myself to hope for success, to the extent that doing so feels more uplifting than painful.
5. Consider that what seems like a setback now may have some positive results that are not apparent yet.
6. Consider that, even if I don't have success, growth and joy are still possible in my life.
7. When good things happen, however small, pause to savor them in that moment.
8. Seek out things that make me laugh, not to put on a happy face, but because it feels freeing and brave.
9. Notice what tools help me feel and function better, and make them priorities.

I can only come up with nine points. Is there something you would add, to make it an even ten (or more)?

Also, coming next: some surprising background on the encouragement card!

More About Embryo Adoption

Most people who go through IVF fill out a form that asks what they'd like to do with any unused embryos, which might be left after a cycle succeeds and the family is complete. The choices are to thaw them without transfer, donate them to scientific research, donate them to someone else, or postpone a decision by keeping them frozen indefinitely.

I agonized over that question. I even asked about options like choosing not to fertilize all retrieved eggs, if I happened to produce more eggs than expected (HA!). In fact, one thing that appealed to me about no-stim IVF was the ability to control the number of embryos created (one at a time, with emphasis on quality).

Meanwhile, doctors all but laughed out loud, emphasizing that I would be lucky to end up with that "dilemma," that I'd more likely end up with no viable embryos at all. They were right about the odds, of course.

But I still think it was right to take the question seriously. While I liked the idea of donating any unused embryos to someone else who was struggling to conceive ... it was a BIG decision. Wouldn't I always feel some responsibility toward any child created from my genes and my actions? Well, yes. I would.

So I appreciate what people go through when they make this decision. I still think that embryo donation / adoption is a beautiful (if not always simple) option. And now, just maybe, I may be ready to take the next step toward the "possible recipient" side.


Types of Donation / Adoption

I'm no expert (so please point out and forgive any mistakes), but I'll try to explain what I've learned so far. This information is specific to the US. I'm not sure how much would apply in other countries.

First, some terminology. I think of "embryo adoption" as an umbrella term to describe this whole process. Legally, though, it's not really an adoption. It's considered to be more like a transfer of tissue, like sperm or egg donation.

"Embryo donation" and "embryo adoption" are sometimes used interchangeably, or used to describe two ends of the same process. On the other hand, "embryo donation" sometimes refers specifically to donations done through a clinic, while "embryo adoption" refers to those done through an agency or through individuals (who may know each other or meet on a website that matches them).

The arrangement may be anonymous, and it typically is when done through a clinic. It can also have some degree of openness, especially when done through individuals or an agency. The parties specify the type of contact they'll want to maintain.

As with traditional adoptions, agencies require home studies and take care of logistical and legal details. Recipients who don’t use an agency coordinate and pay for these things themselves.

Once a match is finalized, the recipients may ship the embryos to their own clinic or travel to the donors' clinic where the embryos are stored. Then a frozen embryo transfer (FET) is done, placing the embryos into the recipient woman's uterus.

Typically, anonymous arrangements through a clinic cost the least, and agencies cost the most. Costs vary quite a bit, though. They may include agency / legal fees, several months of the donors' costs for frozen storage, shipping / travel, and FET. Recipients do NOT pay anything for the actual embryos. For the whole process, I've seen estimates as low as $4,000 and as high as $17,000.

Benefits and Drawbacks

Frozen embryos that already exist get a chance at life. On the recipient side, the "adoptive" mother has the chance to be pregnant with the child. While she's not genetically the parent, she can make sure that the baby gets good prenatal care, and her body may influence the baby's epigenetics. They have that extra time to bond. Legal details are settled before birth.

However, there are far more people waiting to adopt than there are embryos available. (Most of the embryos in frozen storage belong to people who may not be done building their families, who don't intend to donate, or who aren't aware that donation is an option.) When recipients go through a clinic, a wait time of a year is typical. When individuals find each other, the wait time varies greatly; it may be much longer or much shorter.

When recipients don't use an agency, they need to coordinate details like shipping / travel and legal contracts themselves. It's doable; it just requires extra research and work on top of the normal steps required of fertility patients.

And like any fertility procedure, the FET has no guarantees. It may not result in a birth. It's possible that the embryos won't even survive thawing. Since the healthiest embryos are used first in IVF, the ones that remain are often not the most viable. After all, they come from other people who have used IVF to treat their fertility problems.

In cases where donor eggs and/or sperm were used, the information that's available about the donors may vary. Donors may be anonymous or known. They may have come from the most reputable sperm or egg banks, or not. They may have donated in other countries, where the screening requirements are different from those in the US.

Because of concerns about the embryos' origins, many clinics in the US decline to offer FETs with donated embryos. The recipients will likely need to travel farther to a new clinic.

My Thoughts

While the drawbacks are significant, so are the benefits. After looking closely at both, I'm still feeling drawn to take the next step and just see what happens.

My first fear was that finding a match would take an extra long time because I'm single. I also felt some resistance to being questioned on my "worthiness" as a mother. Of course, there will be questions galore (as there should be) if I choose to become a foster parent, which is another option.The resistance comes from years of fertility treatment, with its raised and then lost hopes, lost privacy, and need for a whole team of people to be involved in the most intimate matters. I'm just tired, you know?

But don't get me wrong—I think that questions are essential in adoption. If I were an embryo donor, I would have questions about the recipient(s), too! As a recipient, I would have questions I'd like to ask the donor(s). I would want it to be a dialog and a match that feels right for all involved.

As you can probably tell, I'd be happy with some degree of openness—whatever is comfortable for the donor family. I would also respect the preference of some donors to remain anonymous.

Looking through a website that matches donors with recipients, I was struck by the variety: hetero couples, lesbian couples, singles, secular, religious, very particular or very open about their recipients, wanting basically no contact, wanting to go on vacations together... I was also struck by the one thing they all shared: like me, they've ALL been through the infertility war.

I found myself relating to many of these people, even sincerely LIKING them. Fears of lost privacy gave way to excitement over what we might all gain.

I've always preferred to deal with people personally (for example, in college years, renting "in-law" apartments in private homes rather than in complexes, even if those situations were harder to find). So posting a profile on a website and responding to others' profiles feels like the natural choice.

I think I'm going to try it!

Four Options

Since my last cycle, the spring flowers have (long ago) come and gone, and April has evolved into the 90-degree days of mid-July. I can't stay frozen like this all summer. It's time to make decisions, or inaction is going to end up making them for me.

So … after letting go of these options for parenthood, at least for now, which ones are left? There are four that come to mind:

• Live without children and put my energy toward other things. I'm putting this one first to make the point that it doesn't have to be a last resort, a punishment I feel sentenced to by fate, but can be an actual choice. I can choose to step off the hamster wheel of trying and waiting. I can still be a mentor, a Big Sister, or a court-appointed advocate for children if I choose.
• Continue to TTC with my own eggs. Yeah, I know. Here's the thing (well, one big thing that's been a factor): I'm not just an only child, but the only grandchild on both sides of a close-knit family. The thought of it ending with me feels deeply wrong on a level that I've never felt before. I don't want to be delusional, though, to keep trying beyond all reason and at all costs. Let's just say that I'm very conflicted here.
• Look into embryo adoption. What a wonderful idea. There are concerns—the wait for a match, the cost, the need to research an entirely new set of issues. Also, I'd need to change clinics again. (Neither of my clinics will transfer donated embryos, because they believe there are too many unknowns about the embryos' origins.) That said, I may still sign up on a website that matches donors and recipients. If a match that feels mutually right comes along, well, wow. I would be unspeakably grateful! If it doesn't come along, I won't be up for more years of trying to make it happen.
• Become licensed as a foster parent. One thing that excites me about this option is that it can throw me into the parenting deep end right away. And while there's no guarantee of eventual adoption, the possibility is there. But I can't proceed until things are more settled. I don't see fostering as another path to parenthood so much as a separate thing, deserving of its own sincere commitment. And there are other hurdles. Let's just say that I'm very conflicted here, too. 

Letting Go of What I Can

A few weeks ago, I spent a weekend camping at a quiet spot along the river. Nature is my favorite anesthetic. This trip would be like a mini-retreat—unbroken time to make peace with some painful things, while sedated by sunlight, woodsmoke, and the sound of chirping birds.

It was lovely. BUT … how does a person make peace with letting go of such a deep desire?? Not in one weekend.

Anyway, it had to start with looking closely at the situation, meaning my finances and options for parenthood (which are closely related, of course).  Lots of hours and anxiety spent there. Then I sat by the river, just listening for any guidance that would come.

I didn't reach a decision about whether to keep trying or not. What I DID do is let go of acting now on two options, using donor eggs or pursuing private adoption. Those options aren't as time-sensitive as TTC with my own eggs, but I know that choosing not to act on them now makes it less likely that I'll have the resources to do so later. And it feels relatively OK.

Why? Long story short, when I think about those options, I feel myself contract. I sense my focus shift inward from the child to my own anxiety about making this happen.

There are two points I want to make here. One is that others' experiences may be different; those options may feel like the most natural ones for them, and of course I wish them well.

Also, no, I'm not signing on to the belief that "If things are meant to be, then they will be." My beliefs are more along the lines of "It is what it is." Can't argue with that, right?

Sometimes a fight is required. When it has to stop is when I feel momentum tempt me into drifting past limits I set years ago, or when I feel myself shutting down, diverting all energy into struggling even harder to swim upstream.

(source)

When You Least Expect It

Other things happened lately, too. For one, I haven't written about my taxes yet.

In 2013, I was very organized until springtime and the miscarriage. Before that, each receipt got filed promptly in its own labelled folder. After that, any mail—any thing, really—that didn't need immediate attention got thrown into boxes and shoved in the corner. This spring I've felt like an archaeologist, uncovering all the receipts and reliving 12 months of huge ups and downs.

There were receipts for the two pregnancy ultrasounds where I saw and heard a strengthening heartbeat, followed by the devastating one. Then paperwork from all the tests the clinic asked me to repeat because another year had passed.

Mixed in with those memories was the detritus that I couldn't be bothered to care about, like junk mail from eight months ago. There were abandoned self-improvement projects and notes about events that I didn't attend, because time, energy, and/or money always seemed to be too short. In the bottom of the last box, I uncovered a spring sweater that I'd long ago given up for lost.

Once they were excavated, I could transfer all these memories to black-and-white spreadsheets. Then it was time to meet with the tax preparer. When I brought up medical expenses, she was dubious at first, warning that now (in the US) people can deduct only the amount that's more than 10% of adjusted gross income—a pretty high bar for most families to reach. Let's just say that I am waaaaaaay over that bar. It's mind-blowing. Panic-inducing. It can't continue, obviously.

We actually had two meetings, because this has been the most complicated, stressful tax year ever. On the plus side, yeah, huge refund. Of course, now the chances for an audit are also high. I'm making sure to get everything super organized. (Tax tips: All my doctors have been happy to provide itemized receipts for all 2013 expenses, which have been very helpful. Also, did you know that you can deduct for mileage driven to and from medical appointments?  It added up to 2,355 miles for me last year!)

Before getting into those details, I had to explain some things about my situation. I braced for possible judgment, because the tax preparer was gray-haired and (I'm embarrassed to say this) "looked conservative." Of course, everyone in a tax office looks conservative; it's the uniform.

No judgment, though. Instead, she leaned forward and asked softly, "Have you tried [name of my previous clinic]?" It turns out that her son and daughter-in-law went through 13 years of TTC, including many years with undiagnosed PCOS, and my previous clinic was the one that finally helped them to have "their miracle twins."

We commiserated about the healthcare system and about infertility. She lived through it, too, in a way. "The night before my daughter" (as she called her DIL) "had her amnio during the pregnancy, I stayed up all night worrying. I just couldn't help thinking how awful—and how possible—it would be for them to make it all the way to that point and then have something else go wrong." How possible, indeed. She knew exactly how it felt.

She was wonderful—going out of her way to be helpful and, more than that, kind at a very stressful time. When we said good-bye, after three hours of crunching numbers and trading stories, we held hands for a long moment as she wished me well. "I’ll pray for you," she promised. I thanked her through tears.

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.

My Virtual Talismans

Have you ever bought baby items before being pregnant? Or set up a nursery before the third trimester? Does the idea of it feel more encouraging or terrifying, or both in equal parts? For the record, I don't believe there's any right or wrong answer; I'm just struck by all the layers of meaning behind these small decisions, which—for those who are effortlessly fertile—are barely conscious choices at all.

As Sadie from Invincible Spring says so beautifully in the first post linked above:

"For the longest time though, I never really allowed myself to imagine a a future where we would parent a living child, at least not actively or in too much detail. Items that so blatantly speak of babies used to hold a magical, dangerous allure for me, like mystical talismans the presence of which could somehow deter the very thing for which we longed. Like fire, I was almost afraid to touch."

And yet, fire brings light and heat, clarity and passion. I feel that allure, too. I feel the power in tangible symbols of "reckless, defiant hope," of determination and promise. Then I wonder, Isn't daring to believe that I'll use this object someday, somehow so presumptuous that I'm bound to be punished by fate?

No, it's not logical. We're waaaaay beyond that point. But I do have a logical compromise to this illogical dilemma: I collect virtual talismans.

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

I collect photos on my phone of child-related things I come across during the course of my days. And when I was briefly pregnant, I was even brave enough to go actively looking for child-related things to pin on a secret Pinterest board. I know. Living dangerously!

Of the snapshots on my phone, my favorite "happy snap" actually came from a friend, who sent it to me for good luck just before my first IUI. It stayed on my phone's background for a year:

This onesie, spotted in a store window on a walk after dinner, made me laugh:

You may recognize this picture from diaper-changing tables in a thousand public restrooms, but this one has special mojo because it came from the restroom near my RE's office:

This one requires a little background. A friend and I went on a one-day silent retreat held at a church that was connected to a school. We brought bag lunches and were told to find any corner on the grounds where we could take half an hour to eat. When it started raining, we ducked inside and stumbled into this cheerful classroom, where we silently, smilingly ate our lunch at the kid-sized table while flipping through picture books.

Here's one last example. It's a pop-up Mother's Day card from last year, showing Mama Fox and her family (right after I saw them in real life):

May the magical powers of my talismans bring us all good, fertile luck!

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...

Waiting

I love this time of year.

Many people find it hard to love, with its mud and mess, with their impatience to be done with winter already, and what's taking so long?? But other than June, with its maximum daylight and near-maximum heat, I like late winter / very early spring the best.

A friend and I just talked about spring. How, as lovely as it is, it can be a bit overwhelming. We're both introverts who like to take transitions slowly when we can. In the springtime, there's this sudden explosion of flowers and people outside swarming the parks. "Sometimes I want to tell springtime to just calm down a little," she laughed, and I laughed back, surprised and delighted that someone else feels this same way.

For me, a big part of the issue is that the fertility of spring sometimes makes me feel more barren in contrast. There are babies in strollers. Lambs with their mothers out in the fields. Ducklings on ponds. There's no escape from it all.

But February and March ... that's where I fit right now, in that resting space between seasons.

Even though we've had two more snowstorms during this cycle, they didn't interfere with my drives to the clinic, luckily. I can feel the sun gaining strength, this long and grinding winter releasing its hold so that something new can take its place.

Resting and waiting. Holding my breath. That's where I am now, and all of nature seems to be waiting with me.

What's ahead?

In TTC news, the egg did fertilize. A nurse from the clinic called the morning after retrieval, and from this point through Day 5, no news is good news. Each day the phone doesn't ring by 5 PM, I sigh with relief. Today, Day 3, I'm hoping that the embryo is 6 or 8 cells and growing, healthy and strong.

No, I'm NOT Pregnant Yet

No, I'm NOT pregnant yet, and I'm also not playing one of those awful April Fool's Day "jokes" with the positive HPT below. So please don't throw anything at me, OK?

The clinic asked me to test yesterday to confirm that I did Friday night's trigger shot correctly. HPTs measure hCG, a hormone that's present both in pregnant women and in the medication I used to trigger ovulation. A positive test just means that I hit the target.

Plus, well, I get to see a positive test. It's kind of fun to see those double lines even if it's fake, you know? OK, it's really fun; I probably enjoy it way too much.

May  I see a REAL one someday soon!

So we went ahead with egg retrieval this morning. They retrieved the expected single egg, and they'll call tomorrow with the fertilization report.

This is the part where I really hold my breath.

Trigger Shot Done

It's hardly the first time, but shooting up tiny amounts of expensive white powder still feels strange (as in, maybe I should keep an eye out for the police).

When so little of something costs so much, it can't be legal, right? Here's what $70 worth of hCG looks like. No, look closer. See a few flakes on the bottom of that one vial?

Maybe if you zoom in...

All these meds are expensive; it's just more obvious when I'm reconstituting powder meds and see how little of the active ingredient is there. And I say this just because it made me laugh tonight to see those tiny, lonely flakes down there. Overall, I'm really not in a mood to complain. 

With a no-stim cycle, this is the ONLY shot I need to do, and it went fine. I'm always extra careful with this one. What if I lose track of time and do it late? What if I don't hit quite the right spot (which, after all, requires a mirror)? God forbid, what if I drop and SPILL the stuff?! I've never had a problem, though (well, except for that one pair of pajamas).

The nurse told me to do the trigger at exactly 12:45 AM tonight—later than usual because the egg retrieval on Sunday will be a little later than usual. No problem. I'm just happy that it will be on a weekend, when there's much less chance of traffic delays.

It's getting real now. I'm excited.

Breaks

Spring is coming, which means that my commute to the far-away clinic will soon be safe again. In fact, it may be safe now. The worst of the snowy weather should be over, so I thought about going back this month. But there were some financial ... uh, to put it mildly, issues. Anyway, between the snow, finances, and family crisis, I will have missed three months by the time I get started again.

This winter hibernation is one of several breaks I've had since starting TTC. They've been both required (after the miscarriage) and semi-optional (after the breakup with my ex). I've missed a few months for abnormal cycles. There were also months that passed by when I was moving, researching protocols and clinics, doing the paperwork and tests required to change docs…

I know that lots of women find it refreshing and healing to take breaks. For me, what they've mainly been is distracting. And distraction can be either good or bad. It's a short-term relief when I'm feeling overwhelmed, and there's nothing wrong with that. But distraction is no substitute for doing something meaningful, even if—like TTC—it becomes very hard.

When things aren't working out, I have to guard against letting discouragement turn into doubt (Do I even want to be a parent, if thinking about it just fills me with pain now?), apathy (Why bother, when this will just fail, too?), and short-sighted indulgences (So why not take another month off from the clinic?). I've even had to stage an intervention or two to make myself face reality, to get out of that comfy but unproductive habit of distraction and denial.

Being stuck in limbo isn't really comfortable, not deep down. There's the sense of unease, vague but always present. There's the hesitation to make any plans, and the frustration of waiting. There's tension and guilt when short-term pleasures (eating junk food today while promising to make the tough decisions tomorrow, or maybe the day after that...) threaten deeply held long-term goals.

What I'm avoiding, even more than the daily work of TTC, is the ending. The ending is what scares me.

In an online forum this week, another woman put my thoughts about it into words. She wrote that leaving IVF in her arsenal, unused, gave her emotional protection. I feel the same way about my upcoming final cycle(s) and PGS. It's comforting to have these final options, but now that the time has come to USE them, use them NOW when every month counts ... there's a part of me that still hesitates. And there's another part that has to (lovingly) stand behind her and push.

What's your attitude toward breaks from TTC? How have you managed to make them refreshing, or at least not too disruptive?

The View Through the Windshield

Years ago, I lived in a very small town that was trying to draw attention to its "international" airport. It was international in the sense that, several times a year, a small plane used its single runway for travel to or from Mexico. The town held an "air fair" at the airport one year to raise publicity.

Because there's not a lot to do in small towns, many people came to check out the fair, me included. And because people in small towns tend to help out their neighbors (defined in the broadest sense), I got offered a free flight at the end of the day from a friend of a friend of a friend.

He was the pilot of a small plane. And by "small," I mean that he was able to pull his plane around on the runway using one hand. That was a little alarming, but I had just watched these planes taking off and landing all day without problems, so I climbed into one of the four seats and buckled my seatbelt.

It was totally different from any of my previous trips in jets. For one thing, all the instruments were right there. I could watch for flashing red lights, listen nervously for alarms... but no signs of danger appeared. As I relaxed, my focus drifted beyond the cockpit and out through that fabulous, huge windshield. Whoa, I could see everything! I noticed details I would never see from 20,000 feet. I picked out all the local landmarks. I waved at mountain bikers winding their way along a dirt trail.

Then we banked to the left, and the mountains filled the windshield like a wall. They were 10,000 feet high, so they'd been impressive from the airport on the valley floor. But from this midair vantage point, they seemed so much bigger. They went down for thousands of feet, and they went up for thousands more. They seemed endless.

----------

I thought of that flight lately when I wrote about the depressive fog of TTC for so long. Somehow, looking back to see how far I've come makes the path ahead feel longer, the obstacles more daunting, not less. They block out everything else on the horizon.

In TTC news ... well, there is no news right now. Things are quiet, actually. My next cycle should start early next month.

Wouldn't it be nice to see the outcome as clearly as I saw the peaks from that airplane, or to feel the excitement and expansiveness I did that day? Instead, I'll have to stick with this grounding reminder from Anne Lamott's book Bird by Bird:

"E.L. Doctorow said once said that 'Writing a novel is like driving a car at night. You can see only as far as your headlights, but you can make the whole trip that way.' You don't have to see where you're going, you don't have to see your destination or everything you will pass along the way. You just have to see two or three feet ahead of you. This is right up there with the best advice on writing, or life, I have ever heard."

IVF Scorecard

Right up front, here's the good news: although it didn't end up falling on a symbolic day, my egg retrieval did go well. It produced an egg. And, amazingly, that egg matured into a five-day blastocyst ... again.

Again, I'm shocked at this good news! And relieved that the choice to return to the far-away clinic seems to be working out. Here's my IVF scorecard so far:

• Nearby clinic: 1 IVF on max-dose stims  ->  2 unfertilized eggs
• Far-away clinic: 3 IVFs with no stims  ->  3 top-grade blastocysts

(source)

----------

Wow. I'd like to understand more about WHY these results have been so different.

My RE at the nearby clinic thought that the BCPs in the antagonist protocol may have "over-suppressed" me, making the cycle extra long and thereby damaging the egg quality.

As I understand it, some form of suppression is required at the beginning of a cycle, to keep the body from picking a dominant follicle and producing only one or two mature eggs at a time. On the other hand, too much suppression can make it hard to wake up the ovaries again. Choosing the right amount of suppression is always a balance. Maybe an estrogen-priming protocol would have been better in my case ... but each woman is different, and the only way to know what will work best for someone is to start experimenting.

For what it's worth, I've read lots of comments by women who believe that long, high-dose cycles "fried" their eggs. I've also come across this article (and another, similar one that I can't easily find now), which suggests that when high-dose meds are used, "the resultant eggs have a higher proportion of chromosomal abnormalities than would be expected in untreated women of the same age group."

That research is just getting started. But if high-dose meds are a concern, I wonder how much they can damage egg quality even in cycles much shorter than my epic IVF at the nearby clinic. And here's the main thing I wonder: if meds can damage egg quality AT ALL, then why wasn't I told much, much earlier? It was clear all along that I'd never produce many eggs. It was clear that the quality was probably already poor. Why not prioritize keeping what's left of the quality over (at most) slightly increasing quantity?

Medicated IVF maximizes egg numbers while—potentially—decreasing quality. Of course, no-stim IVF is not a perfect solution either, even for women with DOR. It takes a while to collect several eggs, and fertility keeps declining over time. Also, more egg retrievals will probably be needed than with medicated IVF, and retrievals have some risks. I just wish I'd been better informed about the egg-quality issues. With more info this summer, I probably would have made different choices.

----------

But back to the three embryos mentioned above.

The first resulted in my pregnancy and miscarriage last winter. The two from this fall have now been biopsied and frozen. There's still a very long way to go. I'll do at least one more round of no-stim IVF, then test to see if any of these embryos are chromosomally normal.

I can't forget that my first, doomed embryo looked "beautiful," too, according to clinic staff. It still looks beautiful to me, in the transfer-day photo I saved.

I should also remember that—even with the outcome so uncertain—the results of these last two cycles so far are as good as they could possibly be. They're the best-case scenario. They literally could not be any better.

For today ... let that be enough.

The Fog

After my recent burst of sunshine, I was shocked by how little time it took for the depressive fog to settle right back down. It's humbling. Whenever I dare to believe that I'm learning to live with or through it (if not "get over" it), there I am stumbling around, lost again.

Why now? No special reason, really. Winter is coming, with its darkness, cold, and relentless (family-focused) Christmas cheer. I just wrote another huge check to the RE. Right after that, the baseline ultrasound picked up a minor problem that meant I'd have to sit out this past cycle.

Of course, none of this stuff is tragic (well, maybe the check...) or new, so you might think that I'd be better at coping with it by now. After all, it's been five years since I started TTC. Then again ... it's been five years.

It just wears me down sometimes.

(source)

More Not-Awful News!

After the fertilization report, five more days dragged by. The nurse had told me that no news was good news, and each day I sighed with relief when 5 PM passed with no phone call.

I'd expected to feel excited and cautiously optimistic, as I did the one other time I've made it this far. That time, having a fertilized egg—the first ever—felt momentous. I felt responsible for it. Didn't like the thought of it being so far away. I imagined bringing tiny booties to the lab, fussing and brooding over it like a huge mother hen.

Seriously, though, I was desperately curious about this embryo, not just in terms of whether the cycle would succeed, but in terms of its identity. Who might it become? What wonderful tapestry was its genetic code weaving right now? The medical staff and I had set things in motion, but now came the most miraculous part, the part for which we hadn't and couldn't have written a script.

I remember that feeling of awe. During the last five-day wait, I had the excitement of a fresh transfer to come right afterwards, and the innocence of never having had a pregnancy loss. This time a longer road lies ahead, and I'm more aware of each step. This time what I mostly felt was tired and numb—preemptively depressed, as if feeling bad now could keep me from feeling totally wretched if the embryo did not survive.

I KNOW that this is pointless. There's a magnet on my fridge that says, "Worry is like a rocking chair. It will give you something to do, but it won't get you anywhere." I'm not even sure how much of what I felt this week was worry. It had even less clarity. It was more like defensive withdrawal.

----------

On Day 5 I knew that, whatever the outcome, someone from the clinic would call. It was hard to focus on anything else as hour after hour ticked by. I considered writing a post about the wait, then thought, If you write about it, you'll jinx it. I heard a song with sad lyrics and changed it, thinking, If you listen to sad songs, you'll end up sad. I thought of taking a break and calling the clinic myself. If you call them, it will be bad news.

Although I'm grown up, sane, and mostly logical, no, apparently I'm not above magical thinking now and then. I just try not to give into it, since it leads to nothing but more of the same fantasies of control in situations where, clearly, there is none. So I went ahead and called the clinic anyway. And eventually they called back.

Turns out there was more good news. The embryo made it to Day 5, and they were able to do the biopsy and freeze.

I'm in shock. I'm incredibly lucky.

It was Thursday evening when they called. I said a prayer of thanks but still felt mostly numb for hours. Then the tears came and, with them, the thaw. Slowly, the fog of preemptive depression has lifted. Now I'm able again to connect with the wonder that has been here underneath it all along.

Believe me, I know how far this stage is from a birth or even a pregnancy. A five-day blastocyst has, what, about 200 cells? I can't use the word "baby" to describe it, but all the same, these lines from the old nursery rhyme have been echoing in my mind and heart, putting words to the wonder that's there:

Where did you come from, baby dear?
Out of the everywhere into the here...

Into the here.