Monthly Archives: April 2015

Thinking about the future

Sometimes these days I try not to, but most of the time I can’t help thinking about the future.  That’s what all this is about, right?  Future babies, our future as parents, the future of our families.  Trying to conceive is long (for us), pregnancy is long (in the best case scenario), and when you mix in a combination of infertility and pregnancy loss, it all gets even longer.  The future that we are hoping for keeps slipping farther and farther away.

One of the few things that makes this process bearable for me is setting milestones to work towards, so that the future becomes a little bit less blank, uncertain, and terrifying.  Today I had a milestone-setting conversation with my husband, and thought I’d write about it here.

The next milestone on my list is the appointment with our RE in about two weeks.  I made the appointment in March after we found out that our second try post-adhesiolysis surgery had failed.  Thinking about going back to the RE after only two tries was perhaps premature, but that’s part of the point — it’s not that I wanted to go back immediately, but rather that I wanted a date on the calendar so that the blank future of trying again didn’t stretch out forever.  I made the appointment for a date in the future that would be after four tries (the nurse I spoke to recommended 3-6 based on our history).  If I’d had to cancel the appointment because I was pregnant, I would have done so gladly (and only a little sheepishly), but since I’m not pregnant it’s been an immense source of comfort knowing that it’s coming up.  I don’t know if I can make it until we’re pregnant again (which might be never), but I do know that I can make it to the RE appointment in May.

Now that it’s only two weeks away, I’m already thinking about the next milestone.  Today I brought up the subject of an adoption timeline with my husband.  I tried to make it clear that no, I wasn’t saying we should start looking into adoption immediately, but rather that I wanted to think about the timeline on which we’d start seriously looking into adoption.  There’s a big difference in my mind.  (He understood, because he’s clever like that.) 🙂

I don’t know how most people decide to start seriously considering adoption as a way of building their family when biology fails.  Part of the problem is that there’s often no obvious point at which biology has failed — it’s more of a question of how much time, energy, and money you’re able and willing to invest in trying to make biology work.

Today, I started thinking about possible outcomes that included adoption.  Here are some possible outcomes, with my thoughts about them:

  • Outcome #1 (a.k.a. worst case scenario): Neither biology nor adoption works for us.  This seems highly unlikely, but possible.
  • Outcome #2: Both adoption and biology work out for us, and we wind up with two babies nearly-simultaneously, one biological and one adopted.
  • Outcome #3: Biology doesn’t work, and we adopt a baby (or two or three)
  • Outcome #4: Biology works and I give birth to a baby (or two or three)
  • Outcome #5: Both biology and adoption work for us, but at different times, and we end up with both biological and adopted children of various ages.

Of all possible outcomes, only one is a bad outcome in my view (Outcome #1), and that’s the least likely.  Outcome #2 is not ideal, but has advantages.  I recently found out that our across-the-street neighbors (one of whom is my coworker, so we carpool together a few days a week) built their family through egg donation, resulting in their adorable 5-year-old twin girls.  The twins are a handful, but they’re great playmates for each other, our neighbors enjoy being done with a stage once it’s over (i.e., no more diapers forever!), and clearly if we wound up with two similar-age babies we’d make it work (and count our blessings!).  A mixed biological/adopted family has its challenges, but as I’ve mentioned before, I’m very pro-adoption (I’m very close to my adopted cousin, who is also married to an adoptee), and I would be thrilled to build our family partly or wholly through adoption.  My husband is also positive about adoption, although he has a few more concerns, some of which I share (mostly related to the likelihood of special needs of various sorts).  But when I think about the options above, I feel quite positive about all but option #1, which makes me wonder whether it really makes sense to wait to think seriously about adoption — and to think that maybe it’s time to consider a timeline for when we might start taking steps towards building our family through adoption.

We talked about it some, and agreed that September seemed like a good time to evaluate our feelings about adoption and think about taking some proactive steps in that direction.  By September we’ll have been trying for about 9 months post-adhesiolysis surgery, so we’ll have a better idea about how bad the damage to my uterus has been and whether or not the corrections are likely to work.  (Some of this is also contingent on our appointment with the RE and any testing or treatment she might recommend.)  September will also mark two years since we started actively trying for a baby (as opposed to two years since I went off birth control, which is coming up next month), and one year since the death of our daughter.

Starting the adoption process only two years into the process of trying to conceive might seem fast to some people.  But I’ve already built up a laundry list of known fertility issues that make any path a long and rocky road, and since we both generally feel positive about adoption independent of biology, it seems like there’s not actually much of a down side to pursuing the two in parallel.  It’s not just impatience to be parents to a living child, although that’s part of it — it’s a recognition that parenting is more important to us than propagating our genes, and that going through a high-risk pregnancy after years of infertility and loss (which is simply the reality of what we’re facing at this point) might not be the best way for our family to grow.

So, that’s where we are right now.  I’ll admit, not being pregnant last month hit me hard, and I’m not even sure I can fully explain why.  But thinking about the future in a concrete way, and setting milestones for proactive behavior rather than leaving the future as a big blank uncertain fog, is helping me deal with the mini-loss of another unsuccessful cycle.  I’d be interested to hear how others have started factoring adoption or other family-building methods into their thinking about their future family.  What factors are important to you in setting a timeline?  When did you start to think seriously about alternatives to biology (i.e., wife’s eggs plus husband’s sperm), or when do you plan to?

No, Amazon, I do not want to subscribe and save.

Whelp, we’re a few days into a new cycle, and I’m running low on OPKs.  So I went to Amazon to buy another one.  Guess what it kept encouraging me to do?

Subscribe and save!

If a human being had actually thought about it for half a second, they probably would have realized that NOBODY, and I mean NOBODY, wants to subscribe to (bi)monthly purchases of ovulation predictor kits.  Especially not to save a measly 5% ($1.80) on a kit that actually lasts 4 months (at least when my period is not on the fritz).  Setting up a subscription to OPKs would be way too much like giving up and admitting that I’m going to need a boatload before this is all done.  It’s worth much more than 40 cents a month to me to stubbornly avoid clicking the “subscribe” button.

Where’s the “this is my last purchase of this product ever” button???

This short post brought to you by a very hectic week and a strong desire not to think too hard about the fact that I’m not pregnant again (my Google history will tell you a different story, but let’s just pretend).  Right now, the only thing I have to say about our pregnancy journey is that I’m both really looking forward to and sort of freaked out about our appointment with the RE on May 12.  We’ll give it another try in the meantime, but I’m not holding my breath.  Hoping everyone else is out enjoying the spring weather!

False Alarm

My BBT chart tricked me again.  Spotting last night, and when I woke up this morning my temperature had plummeted.  I’m not pregnant.  No baby in 2015 for us, and if this month doesn’t work, then no baby by the time I turn 33 (despite the fact that we started trying when I was 30).  Oh, and I’ll have to weather my first Mothers Day since the death of our baby with an empty womb.

It seems insane to keep getting my hopes up just to have them fall all the harder each month, but I just can’t help it — this month’s chart really looked just like my pregnant chart, and my temp stayed high as a kite for the full 14 days, whereas I can often see it start to drop on day 14.  Now, of course, I’m back to imagining everything that might be wrong.

What if my lining is so damaged that we’ll never get another blastocyst to implant?  What if my tubes were scarred along with my uterus and there’s no hope of fertilization anyway?  What if the scar tissue wasn’t actually corrected during the hysteroscopy?  (This is not a totally baseless fear — the doctor said that normally he gets a before-and-after picture of the uterus showing both tubal ostia clear, but he ran out of saline at the end and couldn’t get the “after” picture.  He said he had gotten it all, but now I’ve got this persistent doubt nagging at my mind.)

At least I know I’ve got the appointment with the RE a month from now — that’ll give us a chance to discuss all my fears with someone who is actually knowledgeable about this stuff.  Although of course now my fear is that she either won’t or can’t do anything to help us at this point.

Mostly I just want to know: how long is this going to take?  Is it ever going to work?  If not, we’ll just skip straight to adoption right now, thanks!  But imagining going through years more of this, and then potentially years of adoption work, makes me feel crazy.  I don’t know if I can do it.  But what choice do I have?  Living childless is not a choice that we’re willing to make.

OK, well, time to pick up the pieces and head off into yet another cycle.  May, here we come.

If I’m pregnant today, I’ll be pregnant on Saturday

chart_1

Is that not the prettiest triphasic chart you ever did see?

If I’m pregnant today, I’ll be pregnant on Saturday.  (And if that’s not true, I don’t want to know about it.)

That’s the mantra that went through my head this morning as I fought the urge to test at 13DPO.  It’s been an interesting luteal phase this month — I’ve pasted my chart for the chart addicts, showing a clear mid-luteal-phase dip followed by a triphasic jump.  Looks exactly like my chart from the month I got pregnant with my daughter.  That month I tested at 14DPO and got a clear positive result.

In case you’re interested, Fertility Friend has run analyses on >100,000 charts showing that mid-luteal-phase dips happen on 11% of non-pregnant charts and 23% of pregnant charts.  So not a sure bet by any means, but it flips the probability of pregnancy this cycle from 1/3 to 2/3 — I’ll take it. Similarly, they found triphasic chart patterns on 4.5% of non-pregnant charts and 12.5% of pregnant charts.  Which ups the odds even more.

So, why am I not jumping up and down?  Well, when I saw the triphasic chart start to emerge, I freaked out and tested at 11DPO — with a Target-brand test that had been sitting in my medicine cabinet for over a year.  It was negative.  Cue misery.  I’ve also been sleeping poorly this week, waking up at around 5am and then dozing until my alarm goes off at 6:30, so I might be fooling myself with the triphasic rise (your BBT can increase if you wake up and/or move around early).  One thing I have gotten very, very good at through this whole process is fooling myself.  So I’m trying to calm the heck down and be f**ing serene for a change.  It’s not easy.

Hence the mantra.  If I’m pregnant today, I’ll be pregnant on Saturday.  (And if that’s not true, I don’t want to know about it.)  If I am pregnant, I’ve got a long nine months ahead of me (in the best case scenario), so it makes no difference whether I find out today or Saturday.  And if I’m not pregnant, it’s silly to waste money on a(nother) test to tell me what I already suspect.  I’ll find out Saturday one way or another.  Either my temperature will drop or it won’t.  Either my period will arrive or it won’t.

And until then, I’m going to be f***ing serene.

D&E vs. Medically Induced Labor

This is not a blog post about abortion.

Deep breath.  This is going to be a tough blog post to write.

I am not going to get political about abortion.  No way, no how — that’s not what this blog is about.  But since I happen to fall into the <1% of women who have experienced second trimester pregnancy loss (in my case not an abortion, but rather a fetal demise or a “missed” late miscarriage), I was deeply shocked and appalled to read this week that Kansas has become the first state in the US to ban the D&E procedure in the second trimester. I feel that I need to help make sure that medically correct information is out there about the risks of D&E compared to its alternative, medically induced labor, and speak about my experience with medically induced labor in the second trimester.

A depressingly large number of women have experience with miscarriage in the first trimester, but odds are that you don’t personally know anyone who has experienced a second trimester loss (and by “know anyone,” I mean, “know anyone well enough that you’ve discussed it with them”).  Maybe that’s not true of people reading my blog — we’re sort of a biased sample, alas.  But with that in mind, I’d like to share a bit about what a second trimester termination is like, from the mother’s point of view.

After the midwife couldn’t find my daughter’s heartbeat, and her death had been confirmed by ultrasound, the doctor discussed with me what would happen next.  I asked if I had options for how to deliver my daughter; she said I didn’t.  I now know that to be false: the two options that are typically available to women in the second trimester for ending a pregnancy (either voluntarily or after fetal demise) are D&E (which stands for “Dilation and Evacuation” — a souped-up cousin of the far more common D&C, or “Dilation and Curettage”) and induced labor.  The clinical evidence is clear: D&Es are safer and have lower rates of complication than medically induced labor.  I later found out that D&Es require a very well-trained and experienced practitioner, which can be hard to find largely because the procedure is so rare.  My doctor was not trained to carry out this procedure, nor was anyone at my local hospital, but it would have been available to me if I had chosen to travel to an abortion clinic in a city half an hour from where I live.  In hindsight, I wish I’d known the relative risks and had availed myself of the option of having a D&E performed rather than blindly following my doctor’s recommendation of going through with medically induced labor, because I did wind up being one of the 29% of women who have complications from medically induced labor — whereas my risk of complications with a D&E would have been 4%.

In a medically induced birth, labor induction is started 1-3 days before delivery with the use of oral and/or vaginal medications.  We found out that my daughter died at 4pm on a Thursday.  My doctor had me take oral doses of cytotec every four hours between Thursday afternoon and Friday morning.  Thursday night was the worst of my life, physically and emotionally (well, Friday night would be worse, but I didn’t know that yet).  I was still reeling from the news that my daughter had died, and it was impossible to sleep while my abdomen was racked with increasingly intense, clenching contractions.  I came back to the office Friday morning so my doctor could check on my progress; at that time she tried to insert laminaria to speed cervical dilation, but I was already too dilated and she wound up breaking my water instead.  Once your water has broken, it starts you on a clock, since you’re then susceptible to infection (especially since in a mid-trimester fetal demise, infection is one of the likely culprits in the first place), so you need to deliver in the next 24 hours or so.  She upped my dose of cytotec, sent me home again, and told me to come to the hospital when I needed pain medication.  She said that she wouldn’t hold back on the pain medication, since there was no need for me to suffer through labor unmedicated (because my baby was already dead, although she didn’t put it so bluntly).

After more than 24 hours of labor induction, when the painful contractions radiated through my midsection like strange hula hoops (at the time, bemusedly, I compared them to electron orbitals) and I could no longer keep walking or talking through a contraction, I finally decided to go to the hospital.  I apparently waited a little too long, though.  When we got to the hospital they knew I was coming and led me to a room at the end of the hallway, somewhat isolated from the sounds of living babies being born.  However, they had no standing orders for pain medication, so they couldn’t give it to me until my doctor or midwife arrived.  I got changed and managed to get myself arranged in the bed, all the while experiencing by far the most intense pain of my life.  The nurses kept assuring me that the midwife was on the way.  I don’t know how long it took — perhaps no more than half an hour, but when you’re in labor, half an hour is eternity.  Finally I felt something shift inside me.  I told the nurse.  She told me it was probably the baby.  The midwife walked in as my baby entered the birth canal.  There was no time for pain medication, and I delivered a very small, very beautiful, but very dead baby girl without any pain medication whatsoever.  She was small compared to a full-term baby, but larger than I’d imagined — about the length of my hand from the bottom of my palm to the top of my fingertips.  There was a lull after she was born, but little did I know that the worst was yet to come.

The placenta.  It’s common to have problems with delivery of the placenta during the second trimester.  In fact, retained products of conception are the single most common complication of medically induced labor in the second trimester, accounting for the large majority of the 29% of women who experience complications with this procedure.  It happened to me.  For four hours, the midwife tried to get the placenta to come out.  First by tugging on the severed end of the umbilical cord, then with an injection that induced monstrously painful contractions — even worse than the pain I’d experienced while delivering my daughter.  Periodically she’d also “massage” my uterus (scare quotes because no massage has ever felt more like sadistic torture).  The longer it takes to deliver the placenta, the higher your risk of hemorrhage, so after four hours of agony she called in the backup doctor on duty.  They could not bring me in for a D&C at that point, since I had snacked in the afternoon before coming to the hospital (my doctor had told me to eat and drink normally, so my husband and mom had tried to convince me to eat something).  The backup doctor, whom I’d never met before he walked into my hospital room that day, was the kindest and most compassionate person I encountered throughout all of this horrific experience.  At that point, I was all but begging for them to make me unconscious.  I found myself clawing up the side of the hospital bed to get away from the pain, before I realized how illogical that was.  He immediately increased my dose of pain medication by a factor of five (I’d been telling the midwife I wasn’t feeling any relief, but she didn’t listen to me), and finally I was able to handle the pain.  He then removed the placenta manually, using instruments to reach through my already-dilated cervix from the end of the bed.  Once the placenta came out I was immediately relieved of pain, and as soon as the nurses finished cleaning me up I slept like I have never slept before.  (I’d be back two weeks later for surgery for retained products, which would leave me with scarring of the uterus that now threatens my fertility, but I didn’t know that at the time.)

THAT is the alternative to D&E. If I’d had a D&E, I would have been under general anesthesia and would not have experienced any pain until after I woke up and started healing.  I would almost certainly not have experienced retained products of conception, nor the scarring of my uterus that followed.

Banning the D&E procedure does not mean banning abortion — Kansas can’t do that, because for now, at least, it’s unconstitutional.  So the only thing the Kansas law accomplishes is to unnecessarily subject women to the nightmare of a second-trimester induced labor, to increase their risk of complication and possible infertility.  And even though there are exceptions to the law (saving the life of the mother, for example), as my experience shows, it is already difficult to find an experienced practitioner to carry out a D&E, and if it is made illegal in all but the rarest of cases, good luck finding a practitioner who can carry it out for that one-in-a-million woman.  I know abortion is a hot-button topic in this country, but I hope we can all agree that while it would be far better for there to be no pregnancies ending in the second trimester, if pregnancies must end, they should be ended in the safest and most humane way possible.  What happened to me was both less safe and less humane than a D&E, and it scares me, truly scares me, to think that women in Kansas will now be forced to endure the same thing.

Thanks, Miscarriage Memoirs!

Yay!

What a lovely surprise this week to see that Miscarriage Memoirs nominated me for the Sisterhood of the World Bloggers award. Thank you!

In the ~3.5 months that I’ve been actively blogging on this site, I’ve seen a lot of these awards pop up for my fellow bloggers, and it always makes me happy.  That said, it’s hard for me to think of a single blog I follow that *hasn’t* been nominated for one of these awards in recent days.  So I’ll do the nominations, because it’s fun to give some love to my favorite blogs, but will not expect my nominees to follow up. 🙂

Here’s what’s supposed to happen next:

1) Thank the blogger who nominated you, linking back to their site [check!]
2) Put the award logo on your blog [check!]
3) Answer the ten questions the nominator has set for you
4) Make up ten new questions for your nominees to answer, and
5) Nominate 10 people.

My nominator didn’t ask 10 questions, so I can’t do part 3.  But I can do part 5!  In no particular order, here are my nominees — or really, the blogs that brighten up my day when I see that they’ve posted something new.  I’m thinking about this nomination process as helping to spread the word about my favorite people posting stuff in the blogosphere.  (Several of these blogs don’t follow me, so they’re unlikely even to realize that I’ve nominated them!)  And without further ado, here’s my mix of favorite pregnancy loss / infertility / academia blogs:

1) Try, Try again – one of my favorite RPL bloggers. 🙂
2) Tenure, She Wrote – academia, with a beautiful diversity of guest bloggers and subject matter
3) Expecting the Unexpected – a Connecticut midwife dealing with neonatal loss
4) Adoptive Black Mom – journey of an adoptive mom who recently brought home Hope, age 13
5) Small Pond Science – doing science at a teaching-oriented, minority-serving institution
6) My Perfect Breakdown – RPL, and now international adoption.  What a journey.
7) Hope Jahren Sure Can Write – the title says it all! Female scientist, academia-oriented blog
8) The Sky and Back – secondary infertility and the death of her mom
9) My Missing Ingredient is Patience – relatively new on the infertility scene; check her out!
10) Adventures of a Labor Nurse – lots of silly listicles, some useful health info, interspersed with beautiful reflections on being present at the start of a new life. This is the post that made me love her blog.

A Funny Story that I Couldn’t Possibly Tell Anywhere Else

Dear Prudence: our advice column addiction

Oh, guys, this whole TTC journey is just so ridiculous, it’s a shame that it would be wildly inappropriate to share our funniest stories with people who know my husband and me in person.  But thanks to internet anonymity, I can tell you about the hilarious interaction that my husband and I had today.

We were sitting down to eat a delicious dinner freshly prepared by my wonderful live-in chef (i.e., my husband — we do approximately equal shares of cooking, and he’s really good at it!).  As we always do, we started telling each other about our days.  When I was done with my recital he said,

“Are you sure that’s all you have to tell me?”

“Um… yes?”

“Promise?”

“… Yes … ????”

Then he told me about his day.  At the end, he said that he’d been reading Dear Prudence (a Slate advice column that we’re both addicted to) and had found today’s column particularly interesting.  I said that I hadn’t read it yet, but would check it out tonight.

“Oh, really.  Are you SURE you haven’t read it?”

“Um… yes?”

“Promise?”

“I swear it on my life!”

He made me promise six more times that I had absolutely no idea what he was talking about.  I really didn’t!  I swear it to you now, and I swore it to him over and over again!

Then he told me about one of the stories in today’s column (the first letter on Page 2).  He spent the whole day convinced that I was the author!!!  It’s pretty funny, because it really does sound like it could have been written by me, and it describes our recent situation almost perfectly.  I’d even been contemplating how to bring up the possibility of discussing his ED with a doctor, and had been scheming to gently bring it up before our RE appointment in May.  Not that it’s been a huge issue for us — we’ve managed just fine in the end, thanks — but I know it’s been causing him stress (which is a familiar downward spiral to many infertility patients) and I thought it might take some of the pressure off to fill a prescription and have it around, just in case.

As ultimately positive as it was to have this discussion (it was a really lighthearted way to talk about something that is clearly a sensitive subject), I have to say that I’m relieved he took it so well.  He was clearly just amused by the whole thing, instead of upset because he though I’d aired our problem on a national news site that thousands of people read every day (my mom included — we’ve passed on our obsession to her!).  As we were laughing about it, we agreed that it was a shame that this wasn’t the kind of funny story we could tell to anyone we knew — but then I realized that I could tell it here!

So, that’s our absurd escapade on the TTC journey today.  Despite this new wrinkle, we timed things very well again this month and are now just sitting out the two week wait. I’ve recovered from last week’s daycare setback after a wonderful weekend of visiting family and friends leading up to a lovely Easter celebration with my family, and am feeling more like my old buoyant self these days.  I hope you’re all enjoying some springtime sun wherever you are!