Pregnancy Guilt

(Written in December 2014 for Kveller.com)

After four failed cycles of intrauterine insemination, my wife and I conceived a few months ago. We’re elated, but during the time leading up to our pregnancy, we faced much uncertainty and anxiety. Before beginning insemination, I was tested for every possible fertility barrier and all of the test results were negative. This was a mixed blessing, since my insurance would have covered the $1900 per cycle process fully if I’d had even the slightest issue. But of course I was grateful for my health.

That was an incredibly difficult time, when hopes rose and fell. For support, we reached out to family and friends as well as our dear rabbi, who witnessed many tears and helped comfort and encourage us.

We also reached out to a couple of friends who, like us, were experiencing difficulty conceiving. We bonded intensely during that period, because we got each other. When a very close friend of mine became pregnant immediately, we struggled as we watched her abdomen grow every month and felt envious– like that’s where we should be too. With our friends who also faced difficulties conceiving, we were able to commiserate, share stories, and vent about our hurt.

And then we did get pregnant, and suddenly we were the ones struggling to figure out how to tell our friends who hadn’t yet conceived.

(Read the rest at the link below)

http://www.kveller.com/after-struggling-with-infertility-i-feel-guilty-about-being-pregnant/

Faith is Going to the Office Without Wearing a Pad

Alternate title: Inside the Mind of an Otherwise Easygoing Woman Gone Completely Mad

Tuesday marked the last of my progesterone suppositories. I had been so looking forward to that day because I was so over the experience! For eight weeks I had been inserting them twice a day, putting on a pad, and then feeling it as it dissolved back out of me, drying into a chalky substance that would stick to my body and my clothes. Miserable! At least this time it felt like a worthy investment since I was actually pregnant. The four cycles that I was doing them for a week and a half before finding out I wasn’t even pregnant created a little more bitterness.

But what I hadn’t anticipated was the anxiety about whether my body was really making enough progesterone now. I know I was never that low (though I wasn’t given a starting number, just the very high number after starting the medication) so I tried to trust that there was no reason my placenta wouldn’t be taking over progesterone production. Both my fertility doctor and my OB had stated that if my placenta did NOT take over, then it just isn’t a viable pregnancy. So coming off the suppositories was like holding my breath, waiting to see if my body would hold onto my baby without medical support. 

But wait a second – my sister was still not producing enough progesterone at this point and was on shots until 37 weeks. So how can two different doctors both just shrug their shoulders that the pregnancy isn’t meant to be if the placenta isn’t taking over? My beautiful niece Felicity would not be here today if my sister’s doctor had had that reaction. Maybe it’s because my levels were high enough that it would be a true medical anomaly for me not to produce enough to support a pregnancy, whereas my sister struggled with dangerously low levels even on supplements? But why wouldn’t they just check my blood to make sure? How could they not take this more seriously?

The fertility clinic is overly cautious because so much is at stake in trying to achieve pregnancy for their clients, so my “just slightly low” levels may not have been levels that would even concern a regular doctor. Maybe I would have been just fine pregnant on my own. But now that I had been relying on the supplements, they had become like a crutch, and I was so afraid of what would happen when I had to go without them. I toyed with the idea of just finishing the box (another week and a half or so) but then worried about going against doctor’s orders and what might happen if I had too much progesterone in my system.

I have also been worried about the bleeding, because they keep assuming it’s just irritation from the suppositories. That could be hopeful in that it means it would now stop…but it also gave me reason to be nervous if it didn’t stop, because then that would mean it’s from something else.

So I’ve been anxious about if I bleed again, and also anxious about an impending miscarriage now that I was testing out my placenta. After about two or three days, I felt my fear turning into panic. I knew it took less than two days to get my period after coming off the progesterone during the failed cycles. I kept thinking I was feeling slight lower back pain or slight discomfort that could mean impending miscarriage. I don’t cramp during my periods, but I do get lower back pain and like a discomfort or mild awareness in my uterine area. That’s what I kept feeling like I was experiencing, but it was mild enough that I wasn’t sure if I was imagining it or if it was a normal part of pregnancy.

I started researching when the placenta takes over, and got nervous when I saw posts by women saying their doctors told them to take the supplements until 12 or 13 weeks. I came so close to taking another one just in case, and wondered if it would be in time to save my pregnancy and if I should then just take one every couple of days to have a little boost of extra progesterone in case my body just needs a little help. Then I called my fertility clinic and left a voicemail with the PA asking what my initial levels of progesterone were, hoping that the number would be high enough that I would be reassured that I really shouldn’t be concerned.

I fretted over those things but didn’t do anything, and soon it was Saturday and I was still pregnant. I realized that if it had been four days and I was still okay, that probably meant everything was fine and my placenta was doing the job. I also hadn’t had any bleeding yet. So Sunday I braved it by going to my friend’s son’s christening without a pad. I had to stop wearing one at SOME point! And isn’t that supposed to be a benefit of being pregnant, that you don’t have to mess with that stuff anymore? I told myself that everything seemed okay, and I couldn’t just live in a state of anxiety, and that wearing a pad 24/7 was proof that I was not trusting my body to take care of my baby.

Just that one act feels like a leap of faith, because if I were to bleed like I did less than a week ago, it could cause quite the embarrassing situation. And maybe that will happen, but I can't tell you how empowered I feel just by dropping the crutch and stepping out on my own. We will be okay.

Empty Summer

I know I've been very absent the past month. Since finding out we weren't pregnant a fourth time, and knowing we'd now have to pay off the half of this cycle that we'd charged PLUS save up for the next, I've just been too emotional. It will probably be November-ish before we can afford another round. We're still in the paying-off stage, and then have about $4,000 to save up. So far $12,000 has been flushed down the toilet. Just gone in a blink, with nothing to show for it.

Since we had to switch sperm anyway (the only factor we can try changing at this stage since everything else has checked out fine), we decided to change banks while we're at it, because why not? What if that bank just doesn't do as good of a job at collecting or storing? It can't hurt. Except that it does financially, because our bank was the cheapest around. We're going from $470 a vial to over $700. Since we need two vials per try, that difference adds up, considering we were already struggling to save up what we needed before. We have also taken a break from being a host family for international students; the break has been wonderful for our marriage and our sanity while my wife starts a new job and we deal with the emotional fallout of this last failed attempt, but there is also much less money coming in now. That was a second job of sorts that is now on hold. We also just got bills for over $1300 in bloodwork from my initial work-up that are being denied by my insurance company. I already tried to appeal, and the denial stands.

I have a whole story to share around the donor I chose, but I don't want to expend the emotional energy in writing about it when we are most likely only giving it one shot. If I have several eggs and there is a good amount of sperm and it still doesn't work after changing donors, we are going to have to go a different route. I'm smitten for this guy, would love for him to be connected to our child and excited for our child to meet him one day. I have a really good feeling about him, more so than the last guy, whose biggest selling point was that we knew someone who had used him as a donor. We didn't have that bias this time so we had to choose just based on everything else, and I'm really excited about him. It even makes me feel like maybe the last guy didn't work for a reason - maybe this is the guy our child is meant to be connected to. But I don't even want to write about all that, how we chose him and what I love about him, because we are only giving it one shot with him. That's all we can afford. We can't keep throwing money into something that just isn't working, so he's got one shot. And that scares me. I'm already so attached.

I'm a disaster and could really use therapy, but the $40 a week copay adds up to more than I can afford right now if I ever want to save this money up. I've had two different people swear by acupuncture (improves blood flow to help healthy maturation of eggs and healthy building of the lining), saying they had trouble conceiving and ended up getting pregnant the first cycle after undergoing treatment. But I went for a consultation Saturday (she's an M.D. a five-minute walk from my house who specializes in fertility issues) and learned that the discount package is $600 for ten sessions. And for it to be effective, you need weekly sessions for three months leading up to insemination, and then three times the week of the procedure (before and after insemination, and then around implantation time). Everything I can do to help myself costs more money, and I feel frustrated, sad, and defeated.

My agency just changed its maternity leave policy, effective 9/15/15, so that you can only carry over two weeks of vacation into the next fiscal year. Currently, at any given point, you can hold your amount of vacation plus two weeks that you carried over before you start losing unused vacation. But as of 9/15/15 and then every July 1, you will lose all but two weeks going into that next year. I would have to get pregnant in August in order to be able to use all my paid vacation time that I've been so carefully hoarding so that I can afford taking my full leave (five months max). We can't afford to even try in August. So now I have to worry about how I will afford to take five months off if only three months of it are paid instead of the four-and-a-half that I'd originally calculated, or else have a total meltdown at facing going back to work before five months. And we used to be able to take a six-month leave prior to this year, so that's already been a blow.

I'm an emotional wreck these days, and am grateful for my friend and coworker (who just had an embryo transfer this week for her first round of IVF) because we go to each other's offices to break down all the time. It makes ALL the difference to have someone who gets it - and not from the other side just saying "it will happen, don't worry," but in it right now, knowing the anxiety and stress of it, feeling it daily and not just as a memory with the knowledge of hindsight and having answers.

I'm trying to distract myself. Much of the time I'm successful. Much of the time I'm overwhelmed in the chaos of my work, or absorbed in "Breaking Bad" and other such entertainment escapes, or spending time with family and friends and just feeling total joy at life and beautiful weather and people I love and the simple pleasures of watching my rosebush bloom and having a purring cat on my chest in the mornings. Because the very nature of who I am is just not able to be squelched, even by this, and  I am at my core a grateful and joyful human being. But I have moments in between those moments, brief as they may be, where I completely and utterly break.

This is how I've been distracting myself since the last negative pregnancy test:

Going with friends on a high ropes course, something I couldn't do if pregnant

Representing my synagogue at Long Island Pride - the first year and something we've been asked to keep organizing on an annual basis, so I feel like I was able to be part of something meaningful

Blissing out in the gorgeous Vermont countryside for my birthday, thanks to my cousins' generous offer for us to stay at their vacation home so we could afford to get away

Spending a few days with my sister, brother-in-law, and sweet baby niece

Gardening - enjoying both the process and the fruits of my labors

And enjoying the sweetness and affection of my two amazing little cats

I'm breaking, but I'm not broken. I'm resilient. I am grateful for what I have, and I'm finding and thoroughly enjoying opportunities to express and share love and to appreciate life. I'm also nurturing myself enough to allow myself the emotional breakdowns when they come, without feeling ashamed or rushing myself out of them. I let them pass over me like ocean waves, indulge in them as much as I need to for that moment, and then I continue on. 

Because what else can I do?

Breaking Up (or at least threatening it)

Dear Dr. ---,

Google is not at all helpful in giving me information on who "owns" or is CEO of Long Island IVF, but I eventually came across something that suggested you are the owner. If this is inaccurate and someone else is more appropriate for this to go to, please be so kind as to pass this on to them. This is not a complaint about any particular person, so please do not take it as such against any of the staff who have worked directly with me. It’s a complaint about the process and I don’t know who is behind each step of that. I just need someone to hear and understand my experience, someone who has the ability to make change within the organization, someone who can try to compensate for mistakes that have been made or at least help fix them for future patients.

I am a woman with a female partner; I did not come to Long Island IVF because we had been trying for years and were struggling with infertility, but simply because we needed assistance to get pregnant with donor sperm. Because the initial consultation led to the discovery of a 7cm dermoid cyst that had to be surgically removed, I was fortunate enough to be able to have all possible fertility testing done from the beginning; while in surgery, the doctors checked for endometriosis, blocked tubes, fibroids, etc. Everything has come back normal except that my progesterone is a little low so I have to take supplements. This gave us a confident start to the process.

After three failed natural IUI cycles, I met with my doctor who suggested Clomid. During the next cycle, I produced four eggs just on my right ovary (my left ovary was "hiding" and unable to be detected during that sonogram) and my lining had remained thick. We also learned that our vial of sperm had 15 million motile this time; the past few months, we'd had mostly 8 million and one vial of 10 million. This was all so promising! It seemed like we had our best chance, and knowing this gave us the confidence we needed to be able to decide on a different route if this didn't work.

But Long Island IVF did not give us our best chance, and our trust is badly shaken.

The first three cycles, the pattern has been this. My follicles consistently grow faster than expected. I'm frequently told, for example, "You're only at 16mm so we probably won't have you come back in for two days," only to be called that afternoon and told, "You're surging and need to go to Melville tomorrow" where I'm already at 21mm the next day. I’m told in that call that I need to take the Ovidrel and come in the next morning. When I go in, the sonogram reveals that I have not yet ovulated, and I'm told to come in the next day for a second round.

This time, our fourth cycle and the first with Clomid, I got the call on a Tuesday and was told to take the Ovidrel around 9:00 PM for a 9:00 AM IUI on Thursday. This was different than normal, but I was on Clomid and had several follicles at varying sizes, so everything was a bit different this time and I'm certainly not the expert here. I trusted my clinicians. I assumed Thursday would be my first IUI and Friday would be my second.

Imagine my surprise when the nurse did no sonogram. "Don't you need to see whether I ovulated or not and whether I need to come in tomorrow?" I asked in confusion. "No," the nurse said, "you were surging Tuesday and took the Ovidrel so you're ready now. There's no point in doing anything tomorrow." My heart sank. "So...today would be the day of the second IUI? I should have had one yesterday?" The nurse said, "You could request to always have two going forward if you want."

This isn't about indulging what I "want," it's about doing what will get me pregnant, and I tried to convince myself that if it was deemed that I didn't need an IUI the day before, then there was no point in it. They must know what they're doing...right?

But I had felt my familiar ovulation pains early Wednesday afternoon, like I always have the day following the Ovidrel injection. Except this time the egg would just be sitting there with no sperm waiting for it. Maybe the other eggs didn't release til that night or the next morning, but there was for certain one that was wasted, that would likely not be alive by the time of my IUI the next morning, and there was no reason for it to be missed.

When I went in for my pregnancy test, after having taken one at home to prepare myself for the negative, I asked the PA about it. She was very careful to protect her organization and to assure me that I should have been able to get pregnant with how this happened, but she did confirm after my persistent questioning that two back-to-back IUIs should be done if possible when using frozen sperm, simply due to its short life. I asked why this had not been done. Tears streaming down my face, I said, "I had the day off of work for Shavuot. I had a vial of sperm sitting in Melville. And I had an egg being released. Why was I not getting an IUI? Why was I not given every possible chance to make this cycle successful?" She could not answer me, stating only that she cannot tell from my chart how the decision was made.

I told her how disappointed I was, and explained that since I am not diagnosed with infertility, my insurance was not covering this and we are out of money. We did not think it would take more than four times to get pregnant since I had been cleared as healthy and fertile, and now we would have to take a break for several months to save up again. I told her how disappointed I was, how angry and upset, that this last cycle that we'd broken the bank with and had to partly charge on a credit card was not given every chance possible to be successful. That our over $3000 (including sperm, thawing, and medication) was treated so lightly while we now struggle to save that up all over again.

That afternoon, I got a call from my doctor. She was not even in my local office that day, so the PA must have called her about this, and I appreciate her concern and responsiveness. I appreciate immensely that she reached out. But she was reaching out to tell me that if money was the issue, we could apply for a grant for IVF, and that IVF would be a logical step after four failed IUI cycles.

We are not infertile - or at least, it is too soon to determine that. We are gay. We only have a clinic involved to help us safely and effectively give sperm access to my egg since there is no male partner. I am not ready to jump to IVF when we have only been trying to conceive for four months, and I've been saying this consistently. IVF is not only very expensive, but it's very intense and has some ethical implications that we would have to figure out our stance on. I feel like to the clinic, it's a shortcut to getting pregnant. You want your success rates, you don't want me adding to the statistics of how long it takes you to get a patient pregnant. You are probably very confident that you can get me pregnant this way and would rather skip all this other nonsense that has lower success rates. But I'm not here for a shortcut. What I AM here for is to be given expert and attentive service to give me my very best shot at getting pregnant with IUI, and I don't feel that this is happening.

How could the nurse doing the IUI say I was surging Tuesday and that's why it didn't make sense to come in Friday, but when I mentioned that to my PA, she says my record shows I was NOT surging? How does such opposite communication happen, and what/who am I supposed to believe? Why would the other person have said something different? If both my PA and my doctor admit that there should be two IUIs when using frozen sperm, how was that missed? Did someone just skim quickly over my record before calling me and not pay attention to the fact that I'm using frozen? That's a $3000 oversight. That's a waste of a vial that finally had a wonderful number of motile sperm, and a waste of the vial that is still sitting in a tank in Melville for no reason. It's a waste of my cycle, my money, my time, my roller-coaster emotions and false hopes.

Maybe I wouldn't have gotten pregnant anyway. But we'll never know, will we? The fact remains that I spent $3000 after three months of IUIs and did not receive the maximum opportunity for conception that I deserved. We feel betrayed by a clinic and by doctors that we have been pouring our money and our faith into. We don't know how to trust doing that a fifth time.

We have an unwelcome break for a few months while we save up money again for a few more IUI cycles or even IVF. I suppose this will be an opportunity for us to re-examine what the best route is now, and understandably Long Island IVF may no longer be part of that plan.

Thank you for your time,

Rachel L

Round 4 and Still a Mess

I was okay for a while, really. I was very optimistic that we'd given ourselves the best chance we could, but also knew that the worst case scenario still meant knowing what to do next. I haven't felt any symptoms this time - no nipple soreness or breast tenderness from the progesterone, which is a first. A little odd, and I guess that COULD make me freak out, but honestly I just saw it as, "well at least something's different this time!" and kind of let it go.

Then this morning my lower back started aching, and it got progressively worse throughout the day. Nicole and I took a walk through town after dinner since the weather is cool and gorgeous, and that eased it a bit, and then it got worse again after I got home. I'm over a week from when my period would be due, so that can't be it. And it's pretty severe.

So that's when I did The Dreaded Thing. The thing everyone warns me against, and that I know I shouldn't do.

I Googled.

I Googled "early signs of conception within one week of fertilization" and saw this:

"Backache
Backache is a similar symptom as cramping.  Some women just feel this aching in their backs.  When implantation takes place the egg burrows into the lining of the uterus.  This process can cause cramping and other aches and pains, like a low backache.  A backache around the time of implantation could be an early sign of conception. Early symptoms, the ones that happen shortly after conception, tend to feel like PMS but more exaggerated."

It's been seven days. Implantation occurs between seven and ten days after. It's just ever so possible. And yet I know that I have taken things as indicators in the last cycles that clearly weren't. I know that it's too early to really know anything. I know that I will never have an explanation for some of the other "symptoms" in previous cycles, so no matter how much I talk myself into this meaning something because it can't be random...it may mean nothing and just be random. I know all of that, yet I can't help it. My mind and my heart are made for hope, and I had quite a bit of it before this even happened. 

I'm approaching this with caution, of course. Part of me feels a sense of dread about even having something to overthink. I was more relaxed when there was nothing.

Clarity

As I wrote about Sunday, my initial Day 10 exam showed one egg at 13mm so I was told to come back Tuesday. The nurse did mention that I had an unusual number of immature follicles, about 22 on each ovary. She said 4 to 7 is normal and asked if I have polycystic ovaries. I said I had never been diagnosed with it, and she said that because my hormones are normal and I ovulate regularly and have regular periods, I probably don't have polycystic ovarian syndrome but could have polycystic ovaries which is different. I said that I would imagine someone would have mentioned this to me before now if I typically have that many follicles because I've had many, many sonograms by this point, and could it be the Clomid giving me more? She said that's possible, and that since this is her first scan, I should ask my regular sonographer what my baseline is, though there is nothing to worry about either way.

Well, apparently it WAS the Clomid. I went back in Tuesday and had FOUR mature follicles! They were at 10mm, 13mm, 15.5mm, and 21mm. And my lining was thick and beautiful. I'd had no side effects from the Clomid, but the lowest dose made me produce four eggs?? I was so shocked and just so, so happy because now we could be in a better place to figure out what direction we want to go if this round doesn't work.

I was also starting to surge, so the nurse told me to take my injection between 8:30 and 9:00 that night and to go in Thursday morning at 8:30 for the procedure. The last three times, I've been told to take the injection that night and go in the next morning, and then I end up having to go in again the following day because my egg hasn't dropped yet. So maybe they are starting to figure out my body's patterns and realized there was no point in doing IUI the next day and that I might as well give the shot its full 36 hours in my body before doing it. I was off of work for Shavuot and we had already bought the other vial, so I kind of wish they had just done me both days anyway, just in case!

babymaking tools

I felt ovulation pangs Tuesday afternoon, but it wasn't a surprise that the 21mm was ready to pop. I just kept hoping that the rest wouldn't be released for another day, and at their current size, that should be a safe assumption. There was no sonogram today since they didn't need to determine whether I should come in the next day, so I don't really know for sure how many eggs were still there or if any were already released.

Today was a simpler process than ever before. I got there a little early, as always, and this time they went ahead and started thawing it as soon as I got in instead of waiting until my appointment time. There was also only one other person in the waiting room, and usually it's half-full to full. I got in quickly and, because there was no sonogram, the procedure was quick. And I didn't even feel it, which has only happened one other time (not feeling anything is a good sign since your cervix is softest when you're ovulating). And the nurse let me know that there were 15 MILLION sperm this time! We have never had more than 10, and even that was only once. It's been around 8 every time.

With 15 million motile sperm and hopefully 3 viable eggs...I think it's safe to say that if this round doesn't work, we will be willing to consider switching donors. And really that's what I needed most: direction. We've been floundering trying to figure out how far to take this and what the next step should be. But our chances are really maximized right now, so we both feel pretty confident in trying something different if this doesn't work. Of course I've been praying for pregnancy, because how could I not, but I don't see God as a wish-fulfiller so I've prayed more for direction, for certainty in what we should do next.

Shavuot put me in such a peaceful and receptive place yesterday, and I have let the stress melt away. I went into this in a different state of mind and am hopeful and positive, both because we have an improved chance of pregnancy with these improved numbers, and because no matter what the outcome is, we know what to do next.

laying down on the ride home

So now what?

I met with the doctor two days after my pregnancy test, as scheduled, and she told me that she expected it to have happened by now, that I have been checked for everything that it is possible to check, and so has the sperm, so it should be happening. She recommended starting Clomid and went over the side effects with me, both the common and the rare but severe. She said that it would give more opportunities for fertilization, and then I should move on quickly if that isn't working either. She also suggested choosing a new donor, stating that it's possible that this sperm just isn't a match for my body. She said that she normally can't suggest this as an early-on solution because couples with a male partner would obviously not be quick to give up on his sperm. But we have "the luxury" of trying a switch there to see if that works.

I tried to explain to her, without investing too much energy into getting her to understand the emotional stakes, that choosing a donor was a very intensive process. We put a lot into it and it was very difficult to find the perfect one, and we're hesitant to give up on it and start all over with a donor search if we really just need to be patient for a couple more months. So she suggested doing one Clomid cycle with this donor, and then a second with a new donor if that doesn't work, and then if it STILL doesn't work, we should look at IVF. Of course this rushed plan assumes that my body actually responds to the Clomid and makes two to three eggs in each of these two additional cycles, which, spoiler alert, it hasn't yet.

I bristled at the mention of IVF. I just don't think I'm ready to go there yet. It's so intense and puts my body through so much - and while I won't hesitate to do it if I am truly convinced that that's my only way to achieve pregnancy, there's something about it that feels more artificial and disturbs me just a bit. Not enough to never do it, but enough not to want to jump to it prematurely as a shortcut. It's also super expensive, and since if I AM infertile it would be "unexplained infertility," my insurance won't cover it this early on. I just don't think I'm ready to be at my last resort. It's only been three tries!

I was taking one pill prior to this journey. ONE.

Another option is a recently offered known donor. My wife's friend's husband has always wanted to donate, and his wife said this would be the only way she would feel comfortable with it, if it is to help friends she knows personally. They live in Massachusetts and would be someone that our child could have access to but wouldn't grow up around or be close with. We could get a few free tries out of this (the cost of travel and hotel stay during a fertile week would still be so insignificant compared to our current fertility expenses), and if that didn't work - with a new donor and using fresh sperm as frequently as we need to - then we could embrace the "unexplained infertility" and discuss IVF. (We could even be saving up for that in the meantime, just in case.)

But this is STILL not something I just want to jump to. What if my body just needs a little more time? It's the doctor's job not to let people just put their money in a sinkhole without suggesting trying something different. That's their agenda. But my agenda is stubbornly spending more money than we have on something that hasn't been working. What is the middle ground? Who is right? I don't think there's any way to tell unless I could live in a parallel universe and try both options to see what works first. But we don't have that luxury, and we have to make a decision. At what point do we give up on our cherished donor? At what point do we give up on IUI? At what point do we give up on using a clinic and suck up the complications of using a known donor? We could make a sharp left turn and never know that that was the month it would have worked if we'd stayed the course. Every month that we have to decide whether to make a life-altering, future-altering change to our plans, we have the nagging question, "But what if this next month would be the one when it works?"

The pressure is more than either of us can stand right now. We feel at a breaking point. What I DO know is that, as per my sonogram this morning, this low dose of Clomid did nothing for me and I have only one egg to try with this month. So I'm trying to relax and do this "one more cycle" without worrying about the what-ifs, because if it doesn't work, we will unfortunately have a few months off to think it all through a million times over.

Hand-drawn Chinese fertility art that A&A passed on to us and is now hanging up next to our bed. Note the phallic image pointing right toward the empty tunnel, and the babies pouring out of the other tunnel. Classic.

Annnnnd the Envy Sets In

I was not surprised at this third negative pregnancy test, because the few symptoms that had started to give me hope began to disappear the weekend before. As my breast tenderness decreased dramatically within a few days, I could only assume that my natural levels of progesterone were beginning to drop, and that any residual soreness was due to the supplement. I was so convinced that I didn't even have that tough of a time waiting until the day of the blood test before taking a home test. And I didn't even cry. I felt disappointed and I felt sad, but it was a continuation of the disappointment and sadness that I'd been feeling for several days since I felt my body getting ready for a period.

I didn't cry for an entire week, until the night we went out to dinner with my friend Allyson and her husband and they announced that they were having a baby. Now it hit me. I smiled and squealed and congratulated her and kept talking excitedly in order to keep myself distracted and keep my bubbling emotions under control. She said that they were planning to do a big reveal at that Saturday's housewarming party but that she didn't want me caught off guard in a crowd because she knows how sensitive this is. I reassured her, because I really don't want to take away from her joy and don't want her to have to walk on eggshells around me because I'm not pregnant yet. I already know that when it's my turn, there are people struggling to conceive that I will have difficulty sharing the news with. I don't want her to feel that way, even though I know it's natural.

But this is the first time such news DID really hurt. I think it's because we haven't been in this place when other people close to us have gotten pregnant. I might have been emotionally ready, but we weren't financially so we hadn't started trying. Yes, I was impatient for it to be our turn, but I knew our turn was coming, and soon, so it didn't take anything away from my genuine joy for the parents-to-be. It never felt like it had anything to do with me. We hadn't started down that path yet, so it wasn't a race!

But this time, we have. No, it's still not a race, but it's not just a matter of "when." It's a matter of how, and how much, and what do we do next, and when do we draw a line and try something else, and will this happen before my agency's maternity leave policy drastically changes for the worse in exactly one year. And this is a friend who started trying at the same time as me. She came off of birth control the same month we first went for insemination, and we talked excitedly about raising kids side by side and even being pregnant together. She hasn't kept me updated since then, so I had assumed it hadn't happened for them yet either and she just didn't want to talk about it. But that wasn't why she didn't want to talk about it.

So she got pregnant the first time. She came off her birth control, made love to her husband, and conceived a child. Just like that. I've taken odd comfort in knowing that even for straight couples, it isn't so easy. That it isn't always a romantic sexual experience. That it can be frustrating and a lot of pressure and can up-end people's sex lives when they have to follow a schedule and consummate on demand. But my friend had the best case scenario, and I'm struggling to be happy for her. I would never, ever wish this on her, but I am feeling envious. And going to her party where half of their friends had babies with them did not ease it. My heart hurt and my arms felt empty. I felt sad watching her be welcomed into the fold of young parents and knowing our own circle is waiting impatiently with us for us to join them.

It's easy to say "be patient, your time will come" - but we are now $12,000 in and have no idea when this will happen. We've run out of money. We had to charge half of this final cycle, and if it doesn't work, will have to take a break for a few months to save up all over again for even one or two more cycles. There is a lot at stake that makes it very difficult to just let go.
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Can't Stop Myself!!!

I've been pretty chill for the past week. I've gone the majority of my days without thinking about this, and have been very productive and focused at work. My wife also was just offered (and accepted) a new job, so I've been caught up in helping her deal with indecisiveness and anxiety and insecurity and grief. I've been comforting her and reassuring her and encouraging her. In fact, I've gotten so swept up in actual life that it seems like my IUI procedure was WAY more than a week ago. All of a sudden I'll realize how many days I still have left before I find out, and it seems impossibly far away. Not even because I'm anxious, but simply because it feels like how could it have only been a week? It's such a distant memory!

So I've been good with not trying to think about symptoms etc. We set up a game plan for if it doesn't happen this time, and I've been in a place of mostly assuming it hasn't. A place of resignation. Even when I had a sharp pain in my lower right abdomen a few days ago that had me almost doubled over while walking down the hall at work. Because really, what could that be? Yes, it was in the right spot, but whatever is potentially happening in there is microscopic. So it had to be random. Then when I felt a pinching feeling there today, same thing. That's not something I've ever heard about, and it just doesn't make sense that I'd be feeling something like that.

Then today I was running down the subway stairs to catch a train and my breasts were so sore as they bounced. I'm an A cup, people. Bouncing is very minimal and doesn't hurt or bother me in the slightest. Even at home, as I walk around, they are sore. But not to the touch. I try pressing on them and don't feel much, but just moving around, they feel very tender. And oddly, much of the tenderness is at the sides, which is not a typical place I feel it when I get some sensitivity around my period. But I'm on progesterone supplements, so this isn't anything to overthink, and certainly not anything to trust.

So why am I starting to feel that dreaded glimmer of hope? I've done so well for a week!! And now the next week may slowly become torment again, followed by a horrible crash. I'm setting myself up to be a disappointed fool again, but I can't seem to help it.

Cycle 3

Last cycle, I ovulated earlier than expected. I went in for my first check on Day 11 and was already surging and ready to go on Day 12. So this time they told me to come in on Day 10 just to be sure we don't miss it since we cut it so close last month. Day 10 was on a Sunday, so we had to drive out to the Melville office 30 minutes east, as our location isn't open on Sundays. My follicle was only 13mm (remember, 20-22 is typical at ovulation, and so far I've been at 18 the day prior to insemination) so I wasn't surprised to get the official call with my bloodwork results and instructions not to come back for another check until Tuesday.

Today, Tuesday, Day 12, I went back in and my follicle was only 16mm. Last cycle I was ovulating on Day 12, and this time I wasn't even close! The PA told me I probably wouldn't need to come back until Thursday for another check, but of course they would assess for sure after getting my bloodwork back and would call me later in the day. So I understandably figured that meant IUI Friday and/or Saturday.

Well, we've learned a couple things now, haven't we. One, that the PA tends to talk before she should, and frequently has to correct herself after speaking too soon. And two, that my body is unpredictable and does whatever the frig it wants and we can't really base much on prior cycles.

So while I had already packed my Ovidrel injection in a lunchbox to take to work so I would never be caught without it when I got the call, I had actually felt silly bringing it today, knowing I was only at 16mm and would be bringing it right back home. I did not expect the call at 1:30PM saying that I was surging and needed to come in the next day. I said, "But my follicle is only 16mm!" and the nurse said, "but you're starting to surge so you're going to ovulate. You ovulated on Day 12 last month, and tomorrow's Day 13 so it's not so unusual." Well yes, except that the PA seemed to think it was a couple days off still due to my follicle size. I wasn't second-guessing it out of nowhere! She said, "Unfortunately, we can't get you in until 9:30." I said, "9:30 is fine." She said, "Really?? No one ever thinks that's fine!"

I guess that makes sense for people who can't take off of work and want to go in at 7:00 and get to work by 9:00. It's different for me because I work in the Bronx and have to plan to take the day off or else go in super late no matter what. But it made me realize how fortunate I am to have the option to take off time with such little notice in order to make sure this happens. As much as this baby-to-be is a priority and I barely blink at having to take off the day for its creation, I also know it's a privilege that I can do so relatively easily. If I was putting my job at risk by doing this every month, I'd have to think of it differently.

When I met with the PA this morning for cycle monitoring, she gently suggested that I consider Clomid if I don't get pregnant this cycle. She suggested I schedule an appointment with Dr. K for after the next pregnancy test (which I could cancel if pregnant) to sit down and talk about side effects, etc. I said, "Isn't that the higher case rate that's $2900? I get that we may need to try something different if it doesn't work this time, but we'd have to take some time off to save up for that." She said, "No, the case rate is the same. You're just buying the Clomid which is a hundred and something." WHAT?? This whole time I have thought that anything other than a "natural" cycle cost an extra thousand. If someone had been clear about that, maybe I would have resorted to Clomid by this third cycle, but now it's too late.

At the same time, though, I'm kind of conflicted. I feel like the obvious choice is Clomid because why wouldn't I want to double or triple my chances with each $3000 we're laying down? But some part of me is just so resistant to adding in drugs. I'm very aware of the irony of fixating on "natural" considering the procedures we have to undergo to conceive, but I felt so much more comfortable with the notion of a natural cycle. I feel so grateful for having a healthy reproductive system that ovulates regularly, and stubbornly I just want to be able to put sperm in there and make it happen because I feel like it's supposed to. It's sort of like circumcision; I'm resigned to what seems like the obvious choice and the right choice for me, but emotionally and psychologically I'm struggling with it.

Here's hoping I get pregnant this month and don't need to worry about it.

Negative #2

At least I took a home pregnancy test two days ago so that I had a couple days to adjust to the disappointment before getting the confirmation via blood test today. I cried my heart out in the shower Monday morning, just feeling empty and so disappointed. (It's important to note that I'm taking progesterone supplements, which keep you at a PMS level of progesterone for an extended period of time - probably not helpful to my emotional stability.) I carried that feeling throughout most of the day, then felt a little better Tuesday, so by today I felt relieved to have gotten it out of my system so that I could get through the day and not break down when I got the call.

Not so much.

The PA was the one to take my blood today, seemingly because they didn't have any sonogram patients but the phlebotomist was with another patient. (They know you have to go to work after these appointments.) She told me she was crossing her fingers and hoping for the best, and when I saw her sweet and excited smile, I started to tear up. I told her that I wasn't very optimistic because I'd taken a test that was negative. She said, "When did you take it?" and I said, "this morning," and she said, "...oh." Clearly she was not optimistic anymore either. So then I said I felt silly for having come in so confident that it wouldn't take me very long because they told me I seem healthy and fertile. She said, "I know it's hard to be patient," and I said, "and expensive, too." She said, "Yes, and expensive." Sometimes I feel the need to remind them that I'm paying out of pocket for this. My "healthy, fertile" state means I have no insurance coverage, and they're not used to that. Not for insemination, anyway. (IVF is a different story.) About 90% of me is disappointed about still not being pregnant when I'd become so convinced and felt sooooo excited and ready, and the other 10% of me feels the pressure of an additional $3000 for each attempt. It feels like $6000 has already been flushed down the toilet, since nothing came of those attempts.

I told the PA that the last two vials had only had 8 million motile sperm so now we have the additional stress of wondering whether we need to switch banks and donors. She said, "For you, 8 million is plenty. You're fine with that." What does she mean, "for me"? If I had different fertility struggles, would it be more important to have more? Is 8 million motile sperm a good amount for the average person? I don't know, but it was reassuring. She said to reach out to the bank to try to get some sort of compensation if it's less than their guarantee, but that she sees no issue with continuing with this donor.

All of a sudden I realized she was bandaging up my arm and I'd had no awareness of her taking blood. Having blood drawn is always a horrendous process for me. It hurts so much in a way that makes me squeamish, but I hadn't even noticed. Either she's just that good because she's a PA, or sobbing and having therapy during it kept me distracted!

I fought tears off and on all morning until I gave in around 10:30 and went to talk to a coworker who had revealed to me that she'd needed IUI to get pregnant. I felt comfortable bawling my eyes out to her because I knew she knew what it's like. She told me that it took her five cycles to get pregnant and not to get discouraged yet, though my emotions are completely normal. She said that she isn't sure whether this was too awkwardly spiritual for her to say, but that she tells herself her daughter wouldn't be her daughter if the pregnancy had taken at any previous cycle, and that she knows this child is who was meant to join her family. Our friends A&A said the same thing today when we sent a group text among the four of us. One of them got pregnant the first time, but it took the other five YEARS, and she said her son wouldn't be her son if it hadn't happened that way. It makes total sense, but without the kid here, it's difficult to find much comfort in that. But it IS a reminder that our baby will join our family when it's ready. And it's okay to cry here and there until that happens.

Meanwhile, as a general rule, if you see a fresh pedicure on my toes and a Frapuccino in my hands, you may want to tiptoe in the other direction.

Symptoms?

I've resisted writing about this for almost a week because it makes me quite vulnerable. I have no idea if I'm pregnant, if I'm imagining things or reading into them, if fertilization took place but implantation won't...I could feel like a total fool if I excitedly write a post about why I'm nearly convinced I'm pregnant and then have to write about how I was wrong. My initial plan was to write about this only if and when pregnancy was confirmed.

But then I realized that the purpose of this blog is to (1) describe my own experience so that I can look back at it later, (2) process my emotions and experiences as they happen since it is all a swirl, and (3) be a possible source of support and validation to others going through a similar process. By trying to protect my vulnerability, I'm not doing any of those things. And what's the worst that could happen? I certainly wouldn't be the first person to suspect pregnancy and be wrong. That's a real experience and it's okay for me to share that if that's what happens. This is supposed to be an honest chronicle of my journey, not a skimmed-over, carefully crafted narrative of the highlights. This is real and it's raw.

Saturday evening, which was three days post-ovulation, I noticed my nipples were very sore and sensitive. This is not something that just happens to me randomly, only the day or so before my period which would still have been a week and a half away at that point. This was suspicious. And now, seven days later, they are still sore, and my breasts have become tender too, all the way up to the sides. Saturday I told Nicole that they were sore but said, "There's no way that's related. It's way too soon!! ...Right??" We looked it up and found several valid websites that confirmed that nipple sensitivity and tenderness is the earliest sign of pregnancy and can be felt as soon as a day or two after fertilization. All I could think was how relieved I was that I felt something before beginning the next round of progesterone, because I feel like I can't trust my body's signals once I add that into the mix.

Since then, I have experienced: continued nipple soreness, increased breast tenderness, and increased cervical mucus similar to that at ovulation. (I freaked out thinking something was wrong, because why would it be like it is at ovulation?? and then later read that this is a symptom). Then yesterday I felt a tiny but distinct twinge in my lower abdomen. Anyone less in tune with their bodies than I am would not have even noticed it, but it was distinct enough that it wasn't imagined. I wondered briefly if implantation was happening, but then told myself I was crazy. How could I possibly feel that? Then I woke up at 4:00 this morning with severe diarrhea and had two terrible bouts of it before going back to bed. I think it's important to note that I have a stomach of steel and that nausea, vomiting, and diarrhea are extremely rare for me. I can't even remember the last time I experienced any of those. Years ago for sure. Today my lower back began to ache - again, something that only happens right before my period which would still be a week away. This evening I started having burps that just kept coming; this is usually only something I experience with soda, which I haven't had in months, and my dinner was a bland beef stew with white rice, not something that would or ever has caused any sort of reflux or reaction.

I started using a cycle tracker program today where you can check off different symptoms, fertility signs, the day you ovulated, the day you inseminated, and ultimately the result of your pregnancy test. The purpose is to help you track "symptoms" and whether they are really related to pregnancy. So if I'm not pregnant, then next month when I'm checking off "nipple soreness" on the third day post-ovulation, I'll be able to see that I did so the month previously as well and it clearly didn't mean anything. I'll be able to see if similar symptoms come at different times, or if there are new symptoms I didn't experience the previous cycle. It's just a good tracking tool to keep me in touch with the signals my body might be giving me. It also let me see a whole slew of symptoms that I've been experiencing (those noted above) that I wouldn't have connected to that, and it has various tools that are pretty cool, like the "implantation predictor."

Your Results

Ovulation Date: Apr. 9, 2014
Day Past Ovulation	Date	Probability of Implantation
6 DPO	Apr. 15, 2014	Less Common
7 DPO	Apr. 16, 2014	Common
8 DPO	Apr. 17, 2014	Common
9 DPO	Apr. 18, 2014	Most Common
10 DPO	Apr. 19, 2014	Common
11 DPO	Apr. 20, 2014	Common
12 DPO	Apr. 21, 2014	Less Common
13 DPO	Apr. 22, 2014	Less Common

April 18 is today, the day I experienced the diarrhea, lower backache, and strange burping.

Am I reading into things? Looking for things that aren't there? I really don't think so, because last month I was ridiculously excited (seeing a negative pregnancy test and having to start all over with a now-familiar routine quelled that, and I'm much more emotionally level this month) and constantly looking for symptoms and didn't find them. I kept saying to Nicole, "Shouldn't I be feeling something? I know it's so early...but shouldn't SOMETHING feel different?" and we'd reassure each other that it was indeed too soon. Our efforts to convince ourselves that I may be pregnant were all based in rationalization, that we had optimal conditions, etc., but not based on any physical changes, because they just weren't there. So knowing that while SO STOKED and convinced I would get pregnant I didn't notice any symptoms (remember my post about how I was poking at my breasts all day, wanting desperately for them to feel tender but they just weren't?) makes me more apt to trust the changes I'm noticing now. And if any of this is caused by the progesterone (excluding the nipple soreness which started before I took it)...well, it didn't cause these things last month, so what's THAT about?

I do feel more emotionally calm this month, more prepared for the reality of disappointment, so I don't think that I'm so convinced of pregnancy that I'll fall apart at the seams if it's negative. But I do think I will be very surprised, confused, and disappointed that I apparently can't trust my body. I also think I will be convinced that fertilization occurred and it just didn't implant, which would explain at least the nipple soreness (the one symptom pre-progesterone and the one symptom so strong and consistent that I can't be imagining it).

And so the roller coaster continues.

A Different Direction

We chose our sperm donor based on many traits, both ones that were desirable to us (good health, smart, productive adult) as well ones that we wanted to match Nicole (ethnic background, hair color, eye color). When naming these ideals to our friends A&A one night, they told us that everything we were saying matched the donor they used for their second child, and they offered to give us the donor number so we could use him as well. We immediately agreed, knowing that our preferences and requirements would only bring up a few options. It's difficult just to find a Jewish donor who is Open ID (willing to be contacted by the child when they turn 18), let alone the other, smaller details. We all checked in about whether it felt weird to any of us, and the immediate and unanimous reaction was that we felt it was a beautiful way to build families and connection.

We looked up his profile, listened to his audio interview, and looked at his baby picture. Then Nicole did some sleuthing with her genius detective brain and found his current Facebook and Linked In profiles so that we could see that he is a normal, successful adult. (Don't judge - this is a HUGE decision to make, choosing someone to provide half our child's DNA, and we also know our kid can meet this person someday without us there to protect them. This was the first tough decision that wasn't entirely clear or comfortable that we had to make in our child's best interest.) He is 5'11", brown hair and brown eyes, Jewish (Reform), of Ukrainian descent on one side and a Western European mix on the other, speaks three languages, went to a prestigious engineering school on scholarship, is athletic, loves to travel, is family-oriented, is easygoing, and most importantly, is in good health. He is also CMV negative, which is important since I am as well (which is pretty uncommon, apparently) and being exposed to the virus while pregnant could harm the baby. It also doesn't hurt that he helped make a super cute toddler whom we adore!

Our vial in the warmer, waiting patiently to fulfill its destiny.

Suffice it to say, we are completely sold on our donor and didn't anticipate any issues since our friend had gotten pregnant the first time using his sperm. During our first cycle, we were told the second day that the vial had 7 million, "which is a good number." It sounded a little low to us and we remembered the sperm bank telling us they guarantee 10 million motile sperm per vial. So when we went in for my progesterone check the next week, I saw the PA and asked her to look up how many were in the first day's vial because we hadn't been told. She said the first day was 10 million at 54% motility and the second was 7 million at 52% motility. She said the motility was on the low end of normal, but that anything over 50% is normal and good. I said, "So if we don't achieve pregnancy on the vials we have, should we be looking at another donor?" She said, "No, I don't think so. Those are still decent numbers, and you never know what will be compromised in freezing. It's not the donor's fault and it could happen to any specimen. These numbers are okay, I wouldn't switch."

We took that as some comfort, until we reached out to our friend who said she'd had 12 million!! What the heck?? Then yesterday, after getting the great news that my follicle was at 22mm (it went from 18mm the day before to 22mm the day of IUI, whereas last time it only went from 18mm to 19.5mm - optimal size at ovulation is 20-22) we were told there were only 8 million at 49% motility. Then today's vial had 8.3 million at 46% motility. What is going on here?? Why were three of our four vials below the guarantee of 10 million, and why did the last two have motility below 50%, putting them in the below normal range? The nurse practitioner doing my IUI today said that, while they like numbers to be a bit higher, these numbers are pretty typical for what they see with frozen specimens. I'm not sure if that's a comfort or not.

We're trying not to get too distressed, because if I'm pregnant it won't really matter. But if I'm not... I guess we'll cross that bridge if we come to it. We already knew we'd have to take a month off after two cycles to save up money for another two (we refuse to go into debt over this), so we could use that month to start over with a new donor and a new bank if we decide that's what's best. But before I jump that far, we're first sending in the specimen analyses to the bank we used so that they can look at it (they wouldn't tell me what they do if the specimen doesn't meet the guarantee, they just said to let them review it first) and we'll see what they offer. If they offered two vials for the price of one so that we can ensure we have enough sperm, then we'd keep using them. If they just refund us some of this, well that's nice, but we are also spending $2000 on each IUI itself, so we still wouldn't be using them again. I also want to talk to the PA and get her thoughts again now that she can see what's in the last two vials; maybe she won't be concerned. I'll wait til I hear back from the bank before I reach out to her so I'm armed with as much information as possible.

Here's hoping that I'm knocked up and won't have to worry about all this!

Update: Apparently the motility percentage is how much of the unwashed specimen is motile. So if the percentage was higher, then the number of sperm in the vial after washing would be higher since the washing separates out the motile sperm. Someone from the clinic told me that the bank might say they guarantee 10 million before washing. But I had specifically asked them what their guarantee was back when I first ordered, and I thought that was clear. Maybe I'm misremembering. But one vial had 29 million before washing, and another had 10.1 million. That's still a very alarming difference. And one vial only had .9mL when they're supposed to be 1.0mL, and the other three had 1.0mL. All questions for me to ask them...but it may not lead to us switching banks and donors if we can't guarantee getting anything better at another bank.

Thawing Out

I've been oddly numb to the idea of starting this process again. I haven't felt the crazy excitement nor the nervous anxiety that I felt the first time around. I was able to go on about my life and wait pretty patiently from the first day of my cycle to Day 11 when I was told to come back in for monitoring. It has felt more routine and less surreal. I figured this was normal, and it certainly felt self-protective and probably more realistic than my previous emotional approach, so I've let it rock. Though I missed the excitement I felt the first time around, I carefully let this be the way it was, figuring my mind knows what to do to keep me safe and not wanting to ruffle any psychological feathers.

Then today I went in for my first day of monitoring and learned it's already time to go! We were expecting to go Friday and Saturday based on my last cycle, but we're going in Wednesday and Thursday. My excitement is slowly starting to climb again, but in a containable way. I think it helps to know what to expect and to be better prepared for the real possibility of disappointment. But I'm still starting to get pretty excited.

But let me back up a minute.

I got into my old familiar position in the stirrups and was grateful to see that it was the physician's assistant who would be doing the sonogram. I've gotten very comfortable with her since she has done all but the first sonogram of the first cycle (which was done by Dr. K). It's nice to feel like people have an investment in you, that they are getting to know you and are excited for you and rooting for you.

So the PA did the sonogram and, after raving about how wonderful my lining looks, said, "It looks like you have a small cyst on your right ovary. It's small and shouldn't be a problem...unless it affects your hormone levels, in which case you wouldn't be able to start this cycle. Wait, what cycle day is this?" I tried to speak over my heart that was in my throat and said, "Day 11." She said, "Ohhhh, okay, I don't know why I was thinking it was only Day 6. That's not a cyst, it's a mature follicle. It's already 18mm." GEEZ, woman, can you think a little longer before you speak?? This happened the time she thought the follicle had shrunk a millimeter last cycle, and I had the same momentary freak-out where in ten seconds my mind went through a hundred questions and possible scenarios and implications. Why would I even be in there for a sonogram if it was only Day 6? And she had confirmed what day I was on when I first came in. But no harm done, and the surprising news was that I was already at 18mm on Day 11. Last time I was at 17mm on Day 12. So for some reason my body was moving much more quickly this time! She gave me a prescription for Ovidrel (the ovulation trigger injection) which I dropped off at a Bronx pharmacy so I could pick it up from work the next day and have it on me for whenever I received the call.

When I hadn't gotten a call by 2:10, knowing the office closes around 2:30, I gave them a call. The receptionist had to pull the PA out of a meeting about me. The PA got on the phone and said, "We are consulting with Dr. B about your case right now. You may need to come in tomorrow. I'll call you back in two minutes." As a clinical social worker, it was a really strange feeling to know I was the subject of someone else's case conference! The PA called back in less than a minute and said I was surging and needed to come in at 9:30 the next day for insemination. In an excited panic, I said, "But the injection won't arrive until tomorrow!" She said she had a connection somewhere that keeps it on hand, could deliver it today, and would only cost $60 instead of the $80 I paid last time. I assume there is a good reason that they didn't use this place last time??

I rushed in a vacation slip to my supervisor (who I've kept in the loop so she has been very supportive and flexible about all my appointments) and then left work so I could get home and take the injection as soon as possible. I was home by 4:30 but the pharmacist called and said there was traffic and she couldn't get it to me before 6:30. She asked when I needed to take it, and I said, "several hours ago!" so she said she would deliver it herself on the way home from work to get it to me more quickly than it would with the courier who had a list of deliveries to make. She pulled up outside my house and sent her pre-teen son up to the door to give it to me. Now THAT'S service!

And for $20 cheaper than the last prescription, it came with much more than just an injection in a cold package. This is what I got:

That is a tote bag which had in it the freezy envelope with the syringe on the left, a sharps container for the used needle, alcohol swabs, gauze, bandages, and Yogi tangerine tea for relaxation and mood. A BOX OF TEA. I didn't even get alcohol swabs last time and had to ask for some at the clinic! This setup made the money feel worth it.

So I'm all injected and ready to go. Excited but not out-of-my-mind Christmas-Eve-as-a-kid excited. I'm taking the day off, but Nicole is going to work afterward. I may go to a movie to relax, since that's something I love that Nicole doesn't enjoy doing. And it will be what it will be.

Here we go!

Spoiler Alert: Negative

Receiving the call was not a total surprise, but was still disappointing. How can you miss something that was never there? Nicole and I sulked a little but then were just eager for me to get my period so we can start again. We went out to dinner as planned, and it was really nice. Nicole’s sister had given her a gift certificate for her birthday last month for the local Italian restaurant that we LOVE right across the street from us. I suggested using it to go out and celebrate if we learned we were pregnant, and Nicole said she thought we should go no matter what. That way we wouldn’t feel extra punished after already receiving difficult news, and it would be something we could look forward to no matter what. I’m so glad she said that, and it actually ended up feeling like the start of a new beginning, looking forward to the next cycle and the next attempt.

And in the meantime, I’m going to enjoy a few things that I couldn’t while possibly being pregnant:

--a frozen Coke (check! Nicole brought me one when she picked me up from the train yesterday)

--a Frappucino on Friday morning

--a pedicure (Nicole didn’t want me going into a nail salon where there are strong vapors)

Those will be my three indulgences, and then we will get back on the horse.

Emotional Roller Coaster

Oh what a ride it has been...and I'm acutely aware that we're just at the beginning, and that couples can spend years trying to conceive. It's only been one cycle and we feel like we're going out of our minds!

A coworker I'm close with is also going through IUI (but with Clomid) because a recent accident left her husband with a low sperm count so they're having difficulty conceiving their third. We both started the same month, with her having experienced her first negative test result within days of when I was getting inseminated. I was telling her about the agonizing two-week wait because I knew she'd understand, and she said, "You know you can take a home pregnancy test days before that, though, right?" Ummm no, no I didn't!

Cue the crazy. (And yes, she said today she regrets having told me that.) I calculated within two days when I would likely be due for my period, which would be this Tuesday or Wednesday. I bought a Clear Blue Easy digital pregnancy test that is extra sensitive to hcg so it can detect pregnancy up to four days before your missed period. Saturday was four days before (if I was due Tuesday) and I couldn't wait any longer than that to take it. Nicole and I were huddled in the bathroom waiting so patiently for the little hourglass to stop flashing and to show a result. And it was negative. We were disappointed but then tried to remind each other that only 65% of positive pregnancies show four days prior (it goes up to 90% three days prior, I think) so it could be a false negative, and also what if my period was due Wednesday? But my mood was muted and Nicole was cranky the rest of the day.

That evening we started trying to find silver linings because we couldn't stand staying in that space. These included: avoiding a Thanksgiving/Hanukkah birthday; pushing my five months maternity leave closer to my mother-in-law's summer break when she could watch the baby for another few months; not being quite so uncomfortable at my brother-in-law's much-anticipated wedding way out on the tip of the island September 27; not putting my mother-in-law in the position of having to help plan a baby shower immediately after her son's massive wedding that is already stressing her out.

The silly thing is that none of that would actually bother us if we learned I was pregnant, but we did a good job in the moment of telling ourselves that we'd be better off with a January 2015 baby. Willing suspension of disbelief, as they say.

Then Sunday morning I felt a horrid compulsion to take the second test in the box. I knew Nicole regretted having taken the first one, but I had to know. And maybe today, farther in, there would be a more accurate result. And maybe even a positive to ease our minds! I figured if it was negative, I wouldn't tell her I'd taken it because I knew it would increase her anxiety and distress (and probably mine too, but I couldn't stop myself). If it was positive, I could jump into bed next to her with it and squeal excitedly, and what a nice surprise that would be for her.

I was so careful to be quiet. I got a new disposable cup from downstairs instead of using the one in our bedroom so I wouldn't alert her. Then I turned the shower on first to drown out the noise, and peed and tested while it was on. Then I suffered the disappointment, showered, and went back to the bedroom where Nicole immediately said, "Were you taking a pregnancy test in there?"

Then I asked her if I could drive myself to Hebrew class because it was silly for her to waste gas going back and forth both times, plus it was early and she shouldn't have to get up yet. She insisted on taking me but I pushed the issue. All so I could sneak by Rite Aid and buy another pregnancy test. I swear, I felt like an addict. I'm never deceitful with my wife, but I HAD TO KNOW. And if it was positive, she'd be happy, and if it was negative, I wouldn't tell her until after it was confirmed by a blood test, at which point I'd be able to admit to my crazy.

This time I bought First Response, which can detect hcg as early as six days before your missed period. I was only at two or three days before, so this would REALLY be accurate! I came home and Nicole was talking to one of our international students, so I slipped upstairs and took the test. Another negative.

Again Nicole said, "What were you doing up there? You didn't even say hello." And I had to admit that I'd bought another test. There is one left in the box and I agreed to wait until Wednesday morning to take it so that I don't keep going crazy and I can just know for sure before getting the call at work with the results of my bloodwork. But it is NOT easy. I'm thinking about it constantly, up there under my bathroom sink. What's the harm in taking it and then just buying another box, which I could then use for Tuesday AND Wednesday? But I promised. I'm taking the advice of not giving in to my anxiety and making it worse. And it is so, so hard. It's like I just want to keep peeing on sticks until one shows up positive - the very definition of insanity, no?

I keep thinking I feel something and wondering if it's my period coming or implantation. Then I remember that since I'm taking vaginal suppositories of progesterone three times a day (oh I didn't mention that my levels were a little low so I got to add in this messy, chalky game?), my period will probably be delayed AND its common side effects are the same as symptoms of pregnancy and menstruation (mood changes, tender breasts, etc.). So I can't even trust the signs my body is giving me. I feel so out of sorts. Emotional and disconnected from my own processes.

And stupidly, some part of me is still holding out hope that all these negatives are false and I'll be blown away by happiness Wednesday. Even as I cry and stress about why our vial only had 7 million when our friend who used the same donor had 12 million and what if we had done this or that differently, I cannot change that my personality and my soul, to its very core, is hopeful and optimistic.