Monday, January 30, 2006

I think I hate my RE.

I know that you* are shocked--shocked!--to hear this.

Went for my baseline US this morning. I got there at 7:40 and was not taken to an exam room until 8:30. Now, my clinic is terminally running late, and I hate it, but I don't fault them for the morning rush--monitoring is first-come, first-serve, arrival anywhere between 7 and 8, so there is no way for them to control how long it takes someone to be seen. However, once in the exam room, I was left to cool my heels until 8:50. Twenty minutes is a long time to wait when you're not wearing pants.

US was fine--multiple follicles <10mm on each side--and then Dr. S. asked me if I had my presciption yet. Uh, yeah, the letrozole prescription you wrote for me at my last appointment, back in December. Well, he said, there is a new study out that links letrozole to an increased risk of birth defects (which I already knew about; I got suspicious when at our last appointment he suddenly started talking about birth defects and letrozole, so I googled and found the study). He said the data was weak and that it was mainly women who got pregnant while taking Letrozole long-term, such as for breast cancer, and thus were taking the drug while actually pregnant--as opposed to for fertility treatment, when you take it just before you get pregnant. (Now, the reports I read didn't say, but since the doctor who authored the study is the director of the Montreal Fertility Centre, I assume he focused on women who used letrozole as a fertility treatment. Here's where I get suspicious of how well-informed Dr. S. really is.)

At any rate, Dr. S. said he was now giving patients the choice: letrozole, or Clomid. I asked him about the risk of multiples--pretty sure he'd told me before that letrozole had a lower risk of multiples (along with not having the risk of cervical mucus and lining issues as Clomid has). No, he says now, not enough data to know, but probably the same risk of multiples (my main concern with UU). "Well..." I hesitated, leaning toward Clomid, and he said, "I think you should take Clomid." "All other things being equal, yes, I think I'd prefer that," I replied. Now, I have NO problem with a doctor having an opinion as to the best course of my care--in fact, that is what I pay him for. So if there is an option that you feel is clearly better, don't give me this bullshit about giving me a choice. Tell me that one is a better option. I am enough of a grownup that if I disagree, I will tell you so. But I need your opinion to help me weigh the facts.

Okay, so we'll do Clomid. Fine. I get dressed and then go sit across the desk so he can explain the protocol--basically same as letrozole, I take 1 pill (50 mg) a day for 5 days, starting today, then go in next Tuesday for a followup US. Then I brought up something that had been on my mind: the risk of multiples, and his recommendation that if I did get pregnant with multiples, he would urge us to consider reduction. I told him that we'd discussed it, and that we were not comfortable with reduction and wanted to minimize the possibility. And I have to say, he was kind of a dick about it. He said, "Well, if you don't want any risk of multiples you really shouldn't be on fertility medications at all." He said that the only real option that would eliminate the risk would be to just "keep trying on your own, with the Glucophage." I got a little panicky--he was so abrupt, I almost thought I was going to get kicked out--and pointed out that I didn't seem to be ovulating normally on just the Glucophage. He said, "Look, on any fertility drugs, there's just no way to eliminate the risk of multiples." Fine, I get that--I'm not dumb. But, I said, "Can't you tell, during monitoring..." and then trailed off. (I am a very smart and articulate person who somehow gets completely tongue-tied around doctors, particularly jerky doctors.) "Well, but if you have a large follicle and an intermediate follicle, there's a chance that both could take," Dr. S. said. "Of course, if there's only one follicle, then you're okay." What I SHOULD have said then was, "Okay, so can we just decide that, if there is more than one likely-looking follicle on the right side, we will cancel the IUI, but if there's only one, we can go ahead?" Instead, I just said, "Well, can we go ahead with the Clomid and see how it goes?"

So that's what we are doing--going ahead with the Clomid and seeing how it goes. When we get closer to trigger time, I will have to bring this up again. I hate how doctors, especially jerky doctors, especially male doctors, make me lose all coherence. (Do I have weird daddy issues? My dad is a doctor--albeit the nicest, non-jerkiest, most mild-mannered guy you could ever meet, of whom I have no trouble asking any kind of question.) So yes, I could have communicated what I was trying to say better. On the other hand, isn't it Dr. S.'s responsibility as a doctor to work with me to find the best treatment options within my limits? Wouldn't it have been an OBVIOUS thing for him to say, "Okay, well knowing that, I would recommend that IF you want to continue with Clomid, we monitor you very closely, and if you have more than one follicle, even if one is dominant, we should not trigger/do the IUI. We'll only do an IUI if there is one follicle." Doesn't that make sense? (Especially given the fact that IUI and associated costs are fully covered by my insurance, so there is no downside, apart from time wasted, to starting a medicated IUI cycle and then cancelling it.)

Ugh. Anyone know a fabulous, compassionate RE here in Big City? (I'm sure you can guess of which Big City I am speaking. I don't know why I insist on being so coy about it.)

Just to add a little fillip of hilarity to the day, I had lunch with my boss. It was a lovely lunch, delicious food, nice to get to know my boss a little better. Except that (a) she asked me, "So, are your parents on you about having kids?" which I think was her nicely sneaky way of asking, "When are you going to have kids?" (I said, no, not yet.) and (b) I was sitting right next to an adorably pregnant woman, who ordered two desserts! Because she was pregnant! AHAHAHAHAHAHAHA! Oh, how we laughed!

I thought all the stories of being "pregnanted" were just paranoia--you don't really get more comments/see more pregnant people/etc. when you're infertile. But it is TRUE!

*all 0? 1? 2? of you who are reading this. BTW, I forgot to mention that I got my first commenter a month or two ago. It was the classic anonymous comment: "Ever think you weren't meant to have kids?" Needless to say, you will not see that comment anywhere below, because I have moderated comments and deleted it instantly. As proud as I was to get the comment--hey, you're not a real blogger until you've been insulted by an anonymous troll!--it was a full body blow to read that in my email first thing in the morning. Not fun.

Saturday, January 28, 2006

Gearing up again

It's very inconvenient when you're supposed to have a baseline ultrasound on CD2 or 3 and you get your period on a Friday night. What to do? I ended up calling my doctor's office this afternoon and the answering service said yes, this is just the kind of thing the doctor on call wants to be paged about on a Saturday afternoon! Seriously, they were not fazed at all and paged the doctor (not my doctor, Dr. S., but Other Doctor), who called me right away and said I could come in Monday morning at 7:30, when they do all the monitoring.

So here we go! I counted forward on the calendar and based on when I ovulated during my last (failed) Letrozole cycle, I could end up needing to have the IUI on a day when I have back-to-back meetings literally from 9 am onward. Whee! "Hi, I'm going to be late for that breakfast because I'm having my husband's sperm inserted into my uterus through a catheter. Thanks!"

Unrelated: Last weekend I saw a program on TLC about ectopic pregnancy, called "Pregnant for 4 Years." (It's going to be on again on Discovery Health.) They focused on two women who had their pregnancies implant in the abdomen. One was a woman in I think Morocco who'd carried the baby to full-term and had what she thought were labor pains but were actually pains from the baby being in distress and eventually dying. She went to a hospital but was so frightened at seeing/hearing another woman give birth that she ran away. The baby died inside her and her body gradually built a calcium barrier around the baby's body to protect itself. She carried the "stone baby" around inside her for 40+ years, and eventually had surgery to remove it. Ironically, if she had stayed at the hospital all those years ago and doctors had tried to deliver the baby via C-section, she probably would have died--surgical technology being what it was back then, especially in the remote area where she lived, they would not have been able to detach the baby from her internal organs without causing massive hemorrhaging.

The other case was a woman who became pregnant with triplets (spontaneous, not ART, IIRC). Two implanted in her uterus, the third implanted in her abdomen. She had a C-section and all three babies lived and are now thriving.

Anyway, there was no real point to that--just that the human body is capable of some freaky shit.

Tuesday, January 17, 2006


Nothing much to report. I took a pregnancy test Friday morning...and another one Saturday, just in case. Both definitively negative. I started Provera on Sunday (CD41) and will take it through Thursday; based on previous experience, I'll probably get my period within the week. And then the letrozole cycle, take 2, commences. Whee!

I spent much of the weekend checking out blogs I haven't read in a while and freaking myself out about bed rest--Miss W., who also has UU, wrote about how awful hers was, and I can't stop thinking about it. Just an example of my tendency to get WAAAY ahead of myself. Like, why don't we worry about, oh, GETTING PREGNANT first, then worry about making it to seeing a heartbeat, then worry about making it through the first trimester, THEN maybe worry about whether I'll have to go on bed rest. Sheesh.

Wednesday, January 11, 2006

Parallel universe

When we were newly married, my husband would frequently call me in the middle of the day or come home at night and say, "I saw our daughter today." He loved to imagine what our future children would look like, and was forever spotting little girls who looked like they could be ours--half-Asian and half-white, adorable and charming naturally.

Today I saw our daughter. I was on the train to work, minding my own business, and a woman sat next to me with her little girl. I don't normally find looking at babies and small children (very) painful, but this felt so parallel-universe, what-might-have-been that I was actually having a little trouble breathing. The mom was Asian (like me) and had glasses just like mine; she wheeled her baby up in an orange Bugaboo (yeah, I wish I could afford one of those); the girl had huge brown eyes and that gorgeous complexion that many hapa children have. She was probably just shy of two; I don't know, I'm pretty bad at estimating children's ages, but she had tons of teeth and wasn't quite talking. She was so well-behaved, but alert and curious; her mom was amusing her with some balls of PlayDoh, but she also kept looking around the train car at all the people, smiling and babbling little incomprehensible questions and proclamations. On the other side of her mom was sitting a teenage kid bopping away with his headphones on; the girl pointed at him and gleefully yelled, "Singing!" And of course she kept smiling at me and trying to talk to me, even though I was trying to read my magazine and not sneak too many peeks at her, for my own sanity.

Thirty minutes of this. I swear. It really made me painfully conscious of what is missing right now, and made me realize that it will be a long time before I have a little toddler like that, if ever.

I'm currently on CD37 and have been feeling this weird low-level nausea for the past 2 days. It is theoretically possible that I could be pregnant, I suppose, though I don't hold out much hope. I've been charting my BBT this cycle (because if I don't get my period by CD40 or so I'll take Provera to bring it on, but I don't want to take it unless I haven't yet ovulated) and it's been all over the place, so I'm inclined to think I haven't ovulated. I had a little bit of spotting over the weekend but nothing since then, and given the current state of our sex life it seems too soon to have been implantation spotting. But of course there is a tiny corner of me that holds out a little hope.

Wednesday, January 04, 2006

The secret sisterhood

Work is hell right now, so I shouldn't even be posting right now, but wanted to take a quick sec to get this down before I forget. Had my renal ultrasound yesterday--two kidneys, one on each side! Woohoo! But that's not what I wanted to write about.

For the US, I had to go to a special radiology center I had never been to before. The ultrasound tech, making polite conversation I imagine, asked me how I was initially diagnosed with unicornuate uterus, and I said I'd had an HSG because I was starting fertility treatments. Turns out she herself was an IF veteran--she'd had 3 rounds of IVF to conceive her first son, one fresh IVF and one FET to conceive her second, and is currently pregnant with an "oops"--"They told me it was impossible!" she said--due in May.

We ended up having a long conversation (as she probed my kidneys*) about IVF and clinics here in Big City. I asked her where she'd had her IVFs--she did the first few in the city, but went to a suburban clinic for the last few because her insurance wouldn't cover it anymore and the suburban clinic was a lot cheaper (but had similar or better success rates than city clinics). We commiserated about the difficulty of comparing clinics, even with the CDC data ("It's three years old!" she said) and she said she'd heard good things about the Top Clinic I'm considering going to if I end up getting to IVF. (She agreed with my assessment that if my insurance is only going to pay for one round, I should do it at the best place possible to maximize my chances.) "The thing is, there's so much to IVF that isn't science," she said. "With my second, we transferred two perfect embryos and didn't get pregnant. Then we had three medicre ones frozen, and only one of them survived the thaw. But that was the one that implanted and became my son. You just never know." At the end she took a quick peek at my ovaries, just for fun, and told me they looked great (I resisted the urge to ask her to count my antral follicles) and wished me luck. "Hopefully the next time we see you you'll be pregnant," she said.

I left there feeling strangely hopeful. It reminded me again of how big this secret sisterhood of the reproductively challenged really is, and how there are so many people walking around who have faced or are facing the same struggles. That woman passing you on the street? Maybe her head is down because she just got bad news on her bloodwork. The beaming couple with the adorable baby that it practically kills you to see sitting next to you at a restaurant? Maybe it took them 10 years to finally find their happiness; maybe they lost many children-to-be along the way. You'd never know, because we never ask, and we never talk about these things. But I'm glad to have discovered a portion of this sisterhood online, if only to remind myself that I am never alone, and that there is humor, and grace, and fellowship, even in the worst of circumstances.

*BTW, I actually had to take my shirt off for this US and leave my pants on! I was so surprised, I asked her a couple times, "My shirt? You're sure?"