Ch-ch-changes

Infertility affects your life in ways far beyond the most obvious.  I've been hinting (not so subtly) at the fact that we needed to decide how to handle our next steps financially before making them, but haven't been able to really talk about what our options were as everything was still very up-in-the-air.  I can now announce that Ian had his last day at Rdio on Tuesday of this week and will be starting at Google X on Monday.

And while, of course, congratulations to Ian are in order, I think it's really important to note, on this blog if anywhere, that he did not want to leave Rdio.  As he says on his webpage, he was not looking for a new job.  He was really happy at Rdio, working  in a city he loves and can easily commute to with people he respects on a product he cares about in a role that was exciting for him.

So, what were our choices?
1.  Ian could stay at Rdio and we could fund all of our own fertility treatment by either waiting until we could save up or going deeper into debt (we just bought a house) and in either cases making major lifestyle changes and sacrificing things like travel to visit family.
2.  Ian could look for a job at a company that was large enough to offer some benefits for infertility.

We talked about these options a lot (really really like a whole lot) and ultimately it had to be Ian's decision.  The first thing he did was try to find any way possible to stay at Rdio.  Ian's bosses at Rdio explored every option.  Everyone wanted Ian to stay.  But in the end, there was nothing, as a startup, they could really do that would match the benefits a larger company is able to provide in a situation like ours.  But I do love them so much for trying.  In a way, that makes the leaving even harder.

Anyhow, blah blah blah, yadda yadda yadda, among other opportunities that he explored, Ian interviewed at Google X (which is a part of Google) and was hired to work on Project Glass.  Google X is totally super cool!  It's like secret future magicland.  He'll be working with people he's really psyched about, and this will be the third company in a row where our friend Steve will be his coworker.  He really likes working with Steve.

Oh, hi, Supermodel Steve, modeling Glass!

So, this is no great tragedy, obviously.  It's a great opportunity and it's something really different for Ian and for us, as a family.  It is, though, a huge huge life change that was brought on due to our circumstances, as opposed to our desires.  Ultimately, that's how all choices are made, I suppose - based on changing circumstances creating differing needs.  So, we have different priorities at the moment than we did two years ago.  That meant making different choices.  I can feel sad about that because the cause of the different priorities is a little sad, but it's also how life works.  So, Ian will be taking a shuttle bus to a job that is over an hour drive away.   We don't know how it will affect the amount of time we have together, but we know his schedule will be far less flexible.  We'll be able to afford IVF, but he won't be able to come to my appointments with me anymore.  

We are so lucky that we even have this option and this opportunity.   More choices are a good thing, but that doesn't make them, always, an easy thing.  In this case, a good choice has been made, so now we are looking forward with hope and excitement and we feel ready for whatever this change will bring our way.    

Without going into great detail, the benefits Google offers are incredible.  This move will save us a vast amount of money in the infertility process, as well as the adoption process if we end up going down that path.  They also provide things that will make a difference in our lives once we have a child.   Not gonna lie, I have been dying to try one of those famous Google cafeterias for a long time, so there's that too!

So, what now?  Well, we met with Dr. Tran on Wednesday to go over all the different options, and have a plan of action in place.  Our goal is IVF with ICSI with a day 3 transfer of 3 or so embryos.  We'll see how I respond to drugs and take it from there.  (More on the drugs when I get them all.)  I'm not going into details about what factored into each of the decisions we made about our treatment, because it's just statistics and cost and our age and our test results and the length of time we've been trying put in a pot and then this is what falls out.  But if you are curious about what any of these things mean and the specifics of why we chose one option over others, please ask and I will happily share.  

When my period arrives (sometime in the next week) I will start on monophasic birth control pills which I will take for 21 days (all the active pills).  Beyond that, I don't have details of how my meds will work, but I have a phone date with Olga, my nurse, on Monday, to go over the calender.  So, I'll know more then.  And then I shall share again with you.  

Back on the Horse

Ok, well, so financial stuff is sorted.  I'll do another post one of these days to explain what we decided and how and all of that.  But in the meantime, just wanted to post a more basic update.   We're on target for starting the process of IVF on the first day of my next period (so about 3 weeks from now).  It's a 2-month cycle, so the first month will be me on birth control pills, primarily, and getting everything sorted and ready for the following menstrual cycle to include actual IVF.  IVF should happen around mid-October, if the cycle isn't cancelled and everything goes according to plan.  There are so many variables and it's all a little confusing and overwhelming at the moment.

For now, we have an appointment with Dr. Tran to talk about the details of what our IVF plan will be.  He'll go over the results of our most recent tests with us and tell us what he thinks.  I'm thinking that it'll be IVF with ICSI (where they inject the sperm directly into the eggs).  But we'll know more about that and about what meds he wants me on after our appointment, which is on the 22nd.

There are some medications (Z-Pak) that Ian and I will take ASAP (as soon as I get to the pharmacy to pick them up).  I'll also pick up the birth control pills right away so I have them and am ready to start them on day 2 of my next cycle.

I have a phone date with the nurse to go over an IVF calender that she'll have put together after our conversation with Dr. Tran.  Then she'll order us our medications and we'll take an IVF Injection Orientation and move on from there.

I'm not gonna lie - it's been really nice to have a break from all of this.  I have enjoyed not going to the doctor constantly and I have not missed the needles.  I have actually been able to think about other things, and to feel light and free and happy once in awhile.  But, of course, this has all still been in the back of my mind and I've been anxious to get back at it.  Because we still have no idea how much longer it's going to take before we become parents and how much more we have to go through.  So a couple month delay seems like not a big deal in some ways, but it also seems like a huge deal when I imagine the possibility of IVF not working - but us going through several cycles of it...then having to move on to other options, like adoption, which takes time time time as well.

tick tock tick tock tick tock.

In the meantime there's a whole new batch of people excited about the prospect of us potentially being pregnant at the same time.  I feel like I've missed two batches worth of people already, so I am not holding my breath.  But wouldn't it be nice if something just worked for us?  This time next year will I still be trying to figure this all out or will I be holding a wee new baby or something in between?  This time last year I certainly assumed something different for the right now than is actually happening.  Two years ago I thought I'd surely at least be pregnant a year later, let alone two years later.  Still hopeful.  We shall see.

Holding Pattern

I haven't posted in awhile, so thought I'd give a little bit of an update.  We're in sort of a holding pattern at this point.

My saline ultrasound went well and I have no issues in my uterus.  I was really sort of expecting them to find something - a polyp or fibroid or too much of the heart shaped part, like I mentioned in a previous post.  So, when there was nothing there, I was both happy and a little discouraged.

We got Ian's strict morphology results back and it turns out things aren't 100% copacetic there.  The short version is that they want to see 14% of the sperm as "normal" (vs all those funny shaped ones I posted the other day) and Ian had about 8% normal.  We are actually both kind of excited about this, because it's a problem we can solve.  And not only is it a problem that we can solve, but it's a problem we can solve that doesn't involve more procedures for me.  YAY!  Anyhow, this is not necessarily what the whole issue has been.  Many men with percentages lower than this get many women pregnant all the time.  But it certainly is a likely factor in the difficulties we've had.

So, this means IVF with ICSI is likely the plan.  The IVF cycle is about 2 months long with all the medications leading up to it.  We have decided to hold off on starting the first cycle until we figure out how we're going to pay for it.  In the meantime, we're doing everything we can to get ready, including both of the tests I mentioned above.  We went to an IVF Orientation and I've had some more tests done (genetic tests as well as infectious disease stuff).   So, while I'm off the medication, I am still battered and bruised in the blood drawing area of my arms.

Once we've made a decision, I'll let my nurse know that we are ready to proceed and at that point we'll have another appointment with the doctor to determine our exact course of treatment, they'll put together a calender for me, and we'll start on the first medication (which is actually hormonal birth control).   This is a good sample of what an IVF two-month calendar might look like. 

I don't want to talk too much about the financial things we are looking at until a decision has been made.  But I do think it's an important aspect of this process and I will, once we've made the decision, post about what our options were and how we decided.   And to the people (you know who you are) who went out of your way to try to help us figure this out, to provide us options, and to care enough to spend time and mental energy on this, I can't express how much that means to me.  

Big Head Sperm and the Monsters

Just thought I'd post a longer update on what's going on with us in terms of next steps as well as mind-state.  I like to think that this blog serves a few functions:
1.  To help me get my thoughts out, my feelings out, and to chronicle a hard journey.
2.  To keep friends and family posted without having to repeat myself too often, especially the lows.  It allows people to follow as passively or actively as they want, so there is no such thing as TMI because you are choosing to be here.
3.  A place for me to receive comments, kind words, information and insight.
4.  To help anyone who may stumble on this blog who is going through anything similar - friends, strangers, etc, with the emotional aspects and/or with actual information.

So, here we go.

On Monday I go in for my Sonohysterography  and trial transfer.  The trial transfer is just to get the exact information needed about size/shape/location of everything so when they go to do a real embryo transfer they can complete it successfully by making their way into tiny spaces accurately.  The Sonohysterography is the saline ultrasound that will tell them more about the shape of my uterus and what might be inside of it.  This will tell us if there is anything there that could be causing problems and preventing implantation, so we can fix it, if possible, before attempting IVF.  I am partially hoping they do find something, because then there is something to fix which might make me more hopeful for future success.  BUT at the same time, finding something wrong will equal a surgery for me (scary) and a delay in moving forward with IVF.  So, I dunno.  It's all information, and information is good.

Ian needs to call and set up his Strict Morphology.  When trying to find out more information about what that means exactly, I came upon this image, that I'm a little obsessed with:

He might have two-headed sperm!  Or giant-headed sperm!  Or super weird pointy-headed sperm!  Who knew all the weird wrong un-penetrating shapes sperm can be??!? If he has any of these creepy spermy-types in too large of numbers, that means we'd likely need to do Intracytoplasmic Sperm Injection (ICSI).  Basically, instead of letting the sperm find the eggs in a petrie dish, they will be injected directly into the eggs. Forced insemination.  INSEMINATING AGAINST THEIR WILL!  Anyhow, I don't know.  His sperm count and motility is really high, so I just assumed that meant the spermy mcsperms were fine, so it's strange, at this point in the game, to find out there is more that can be wrong.  

I like to imagine that a big-headed sperm creates a big-headed baby and a tiny-headed sperm creates a tiny-headed baby etc.  Truth is, I don't know if they would use those abnormal sperm or if they'd find the good sperm and only use those.  If it turns out this is a problem for us, obviously we'll get more information.    

We still have a lot to talk about and figure out in terms of how many IVF cycles we are willing to try.  There's a financial aspect to figure out.  There's how much I can handle physically.  There's how much we can each handle emotionally.  I am a planner and it's hard to not have a plan, but I am having to learn to take things as they come and to have no way to take control.  Ian and I are at different places in terms of imagining next steps.  What I require for coping is sort of the exact opposite of what he requires.  He needs to feel hopeful and trusting that whatever we are about to do is going to work for us.  I need to feel hopeful and trusting that when whatever we are about to do doesn't work, we know what is coming next and it is doable and OK.  Both of these ways of dealing with this process are fine, of course.  And so far we've always come together on any decisions and reached the same conclusions.  This is how our marriage works a lot of the time, in general, so it's no surprise that it's working this way now.

Ian has made sure that I understand that I have full decision making power over wanting to stop this process at any time due to physical concerns.  And I have made sure that he understands that changes he makes in his life for financial reasons are entirely up to him.  And we both know that we will come together and be on the same page about whatever decisions we make - and in some cases it may take time, it may take therapy, it may take tears, but we will be excited about whatever the future holds and whatever path we end up following to parenthood. 

So, maybe I'm ready to get excited about adoption just because I can't allow myself to get excited about IVF cause it's too near and too scary and too heartbreaking.   And maybe Ian isn't ready to give up on the "part me part you" aspect of a biological child because that's too scary and too heartbreaking.  And really, maybe this is actually the same thing - because we are both scared of being heartbroken and I still really really want to be pregnant and to have a baby that is genetically ours.  Otherwise, I wouldn't put my body through all of this.  I am also just ready to realize that I will be just as happy if that's not how it works out and that whatever child becomes ours will be ours no matter how it comes into our lives.  So, Ian and I - we'll end up in the same place when we need to.  And for now, we balance each other just right, I think.  

The Happiest Place on Earth

I got my period while wandering around Disneyland by myself yesterday, about 24 hours after I had already heard from my doctor that my pregnancy test was negative, which was a few hours after I had taken a home pregnancy test and saw the negative result which was 3 days after I had taken an early home pregnancy test (so Ian could be with me) and gotten a negative result.

Is it any wonder that I just don't believe I'll ever see a positive one?

Anyhow.  I didn't take it well any of those times I got the same news in the last couple of days.  This was my last try at IUI.  Things get way more intense from here on out.

And to add insult to injury - I have to take another home pregnancy test before my saline ultrasound, just to be super duper sure.  Can't wait to see another minus sign or "not pregnant" pop up!  Fun fun!

Thanks to my friends who were nice to me while I was going through this while attending a conference and away from the husband.  And also, I cried in front of people.  Which is some sort of a major breakthrough, I'm sure.  

Next Steps

Yesterday, Ian and I met with our doctor about next steps if this final IUI doesn't work.  I'll give you the short version.

* Another test, that sounds pretty painful (if anyone has had the saline ultrasound, lemme know.  similar to HSG?  That's what I'm assuming. I know you have, C.M.)
* Ian needs a fancier sperm test
* Potentially remove part of my uterus depending on what they see (I have a heart shape - perhaps it is too heart shaped and that is the problem and the peak of the heart will be removed.)
* Wait month for healing.  If no surgery, no waiting month.
* Move into an IVF Cycle, which we would likely try at least twice.  First time August or Sept depending on uterus heartness.
* At a cost of $10,000+ per cycle
* Maybe cheaper the second time if I have extra embryos to freeze the first time
* It involves daily blood tests during the time I am being "stimulated"
* It involves making 10-20 eggs ready to be "retrieved"
* A surgery (with general anesthesia) to retrieve them
* Fertilization in a petri dish
* Transfer of embryos (3-4 of them) to uterus.  Cross fingers that they implant
* There is about a 20% chance that any given cycle will be cancelled due to problems (over-stim, under-stim, eggs don't fertilize etc etc etc)
* There is about a 30-40% chance that any given cycle will result in a pregnancy
* There is a 25% chance of twins in any resulting pregnancy (with a 3 day transfer, which is what he recommends)

Am wondering if I shouldn't take a month off work during this.  Others who have gone through it, what are your thoughts?  How was the process?  What were the drugs like?  How did you feel?  How often were you in the dr office?

Dr. Tran says that the last two patients who had this consultation with him before their final IUI cycle was finished got pregnant in their final cycle.  I wish I had any hope left.

I am just so so tired. 

Boring Updatey Stuff and Things

I haven't been online much this week, thus haven't really been around here posting business and stuff.  My parents were in town, so I spent much of the week up in Napa with them eating and drinking wine like champs.  And then Saturday night I walked 18 miles overnight in the American Foundation for Suicide Prevention's Out of the Darkness Overnight Walk (wow, that's a mouthful).  I still hurt.  My poor right foot may never be the same.  But it was worth it and we raised a lot of money for a very important cause.  And later that day (post IUI) I did get to have an amazing hot stone massage and a great hot tub conversation with a friend right when I needed it, both physically and emotionally.

As for the topic of this blog - I don't have a lot to say right now.  We had our fourth IUI yesterday and it'll be our last try and marks the end of my time in the study.  Everything went fine, so we'll see in a couple of weeks if it worked.  We also have an appointment with Dr. Tran (our pre-study doctor from the clinic) on Wednesday just to talk about next steps and what we'll do if this doesn't work.  I am assuming IVF.  But there might be other tests they want to run...who knows?  Not I.  That's for sure.  I actually have scar tissue on my arm now from where they draw the blood every couple of days.  It isn't pretty - always bruised and full of holes and now scarred.  I have started thinking about how I might tattoo around/over/through that space when I reach the end of this all.  Closure in ink.

I'll be away when we find out if this try worked.  I think it'll be better for me than the time Ian was away and I was home by myself.  That month was also particularly awful with the chemical pregnancy and delay of my period.  This month at least I'll be busy with conference stuff and a little distracted.  But it also will be the end of our IUI attempts and the start of some other journey, so I'm not sure how that will affect me.

I'm definitely assuming the worst for this month.  I have become a bit gloomy about this all.  I think if I ever actually become pregnant I will have a very hard time believing/processing it since I've worked so hard at convincing myself it won't happen, so I am not so disappointed every time.  Will be interesting to see.

Today is my 5th wedding anniversary, so tonight Ian and I are going out for fancy dinner.  Back to work tomorrow - will be hard to get back into the swing of things after a week off, but it was a much needed break and I'm ready to return.  We have Ian's dad and stepmom in town this coming weekend and I leave for Anaheim for the ALA Annual Conference over the following weekend.  June is always a crazy busy month and this year is no exception.  I am hoping for a sleepy July.  With some time to regroup about the baby making stuff, along with everything else, one way or another.