Courage and Fear

This morning on my way to work I saw a sign on a church kiosk that read as follows ...

"Courage is being scared but doing it anyway."

Ever since reading this it's been playing over and over in my head. I feel like I live each day in fear. I fear that Myles will be our only child. I fear that a high proportion of the embryos we make are chromosomally abnormal. I fear that we "wasted" chromosomally normal embryos on my sub-optimal uterus. I fear that my eggs are bad. I fear that I won't get as many eggs in IVF #2. I fear that being 1.5 years older will negatively affect my egg quality. I fear that suddenly something will be wrong with J's swimmers. I fear that I won't have many embryos this time. I fear that our embryo quality won't be as good this time. I fear that I won't have embryos to freeze. I fear that if I don't do acupuncture like I did with IVF #1 that I won't have similar results in IVF #2. I fear that I won't have a surrogate to help make our dreams come true. I fear that if we get pregnant again we'll have another miscarriage. I fear that we will lose another baby if we are so fortunate to have one. I fear that we'll live our lives with completley broken hearts and aching, empty arms. I fear that I am fighting a losing battle. But, the thing I fear the most is not trying again and spending the rest of my life wondering what if ... So, I keep repeating to myself that "courage is being scared but doing it anyway."

Acupuncture Dilemma

As always I'm so thankful for all of you, my wonderful blog readers who are here supporting us and cheering us on! I honestly don't know how I'd get through all of this without knowing that there are others out there who truly "get it". You don't tell me that "it will be okay" or "it was probably for the best" or "someday I'll be a mother" (grr, that one hurts the worst). You don't ask me if we are "now going to adopt?" You tell me that you are sorry, that it sucks, and that it's not fair. You make me feel a little better in the midst of my sadness and despair. Today we're doing okay ... not good, not great, just okay. I put on my happy face and pretend for the world because when people ask me how I'm doing they don't really want to know! They want me to say I'm doing fine or preferably good, but honestly how on earth would someone who's struggled with years of infertility and who's just gone through miscarriage #5 with our wonderful surrogate be feeling? Um, to me the answer seems fairly obvious ... frickin' horrible!

So, I'm having a inner struggle regarding acupuncture. I did acupuncture for about 2 months prior to IVF #1 and continued it through the last FET I did with myself. I am a huge proponent of pre- and post-transfer acupuncture because the data is strongly in favor of it. I did it with all of my ET and K did it this last FET. However, I'm unsure of how much acupuncture really impacts egg quality and blood flow to the ovaries leading up to an ER. The data isn't very conclusive. Sure you can find some studies that support it, but in my scientific opinion many aren't very sound. Several are uncontrolled, have small sample sizes, and aren't replicated. I'm aware of all the anecdotal evidence that supports the use of acupuncture during IVF and completely agree that it helps to reduce stress, but really there are too many factors that determine egg quality (e.g., age, nutrition, stim protocol), which makes it nearly impossible to impossible to determine what's producing good results in an IVF cycle.

Now with that said I am a bit superstitious. I feel the need to do everything the same with the next IVF cycle that I did with the first that resulted in 8 blastocysts. I'm having my TSH tested tomorrow to ensure that it's between 1-2 because that's where it was at when I did IVF #1 (I have mild hypothyroidism and take Synthroid). Additionally, I am planning to go back on metformin again and plan to eat a diet high in protein during stims. Also, I will start doing guided imagery and meditation again. My problem is whether or not to do acupuncture again? If my health insurance covered it and we didn't pay out of pocket, I'd do it for sure. It costs me $65/week out of pocket on top of everything else related to IVF that we pay for out of pocket. I won't go into the details of all of those costs, but any of you who've done IVF can attest to the exorbanent costs associated with it! Suffice it to say that J and I have spent somewhere around $40,000 on IF stuff over the past 4 years and we are not rich!

So, I'm wondering if you did acupuncture during your IVF cycles, specifically leading up to ER, and what impact you think it had on your cycle. I'd love to hear from those of you that did it one cycle and not another. I'd like to hear if the results of your ER were any different in terms of # of eggs retrieved, # embryos created, the quality of those embryos, and resulting ET results.

This Thursday I have my post-IVF follow-up appointment with Dr. S. I'm anxious to hear what he has to say, but I can probably already predict it. I'm hoping that I'll have the pathology test results back from the miscarried embryo, so we can chat about what that means. My guess is that Dr. S will stick to his hypothesis that my uterus is sub-optimal, which resulted in me having early, severe PE and recurrent miscarriages, and that this miscarriage with K's perfect uterus was the result of bad luck (i.e., just happened to transfer an abnormal embryo). Even if it was "bad luck" it still sucks and was/is horrible for K and her family to have to go through.

Bleeding after D&C

Okay, girls I need you to share your experience with K regarding bleeding after a D&C. When I had mine I bleed for about a week ending with some spotting. As of yesterday K was still having a pretty heavy, period-like flow. She is worried that they did a poor job and that she has "retained products of conception", which will result in her needing to undergo a hysteroscopy. Of course I hope she's wrong and that the bleeding is normal and tapers off soon.

After my D&C I did need to have a hysteroscopy to remove "retained products of conception" that were left behind, which we discovered when my betas weren't dropping back to zero. Per my urging my ob did an SHG 8wks post D&C and saw "something" in my uterus. That something was removed during the hysteroscopy and was biopsied and found to be leftover tissue from the pregnancy. As soon as the tissue was removed my beta dropped to zero. For me that whole process added insult to injury and didn't allow me to have closure for the cycle and loss. I'm really hoping that K doesn't have to go through this as she's already had so much to endure. Please share with us how long you bleed after your D&C.

Please share with us your experience.

WHEN Bad Things Happen to Good People

NOT WHY Bad Things Happen to Good People. Last night I attended a speech by Rabbi Harold Kushner the author of the well known book that inspired the title of this post. The Rabbi wrote this book following the death of his son. My dear friend, M, who's also a babyloss mama invited me to accompany her and I'm so grateful she did. Thanks M! I was inspired by much of what Rabbi Kushner had to say, but have to admit that I haven't read his book in it's entirety. My dear friend, M, recommended that I read it following Myles's death, but when I noticed all the biblical quotes I immediately put it down. I just couldn't deal with one more person telling me that Myles's death was part of some bigger plan that I just couldn't understand. I wish I had known a year ago that this is the last thing that Rabbi Kushner would say. In fact last night he said that no one has a right to tell someone that something bad has happened for a reason and I couldn't agree more! Here are a few things that Rabbi Kushner said that resonated with me:

• All who have experienced any kind of loss have something in common, but the intensity we experience differs.
• When we experience a loss all we can do is cope.
• In the valley of the shadow is where the light finds us.
• Everything DOESN'T have a moral cause, but everything does have a physical cause.
• G.od doesn't give us a finished world, but rather a world that needs our intervention.
• Losing a child may make you more sensitive, compassionate, patient, but anyone who's lost a child would give that up in a heartbeat to have their child back.
• When you can help others the cloud of helplessness is lifted and you feel connected.
• Ordinary people do extraordinary things.
• Friends who abandon you (e.g., don't call, don't come to visit, ignore your feelings) in your time of need do so because they can't acknowledge your reality. They fear that acknowledging it will make it happen to them.
• When the wind blows over some of what you built, you learn to live and celebrate without it.
• Doubt is not the opposite of faith. The opposite of faith is certainty.
• Hermit Crab growth and development as an analogy to losing and finding faith: hermit crabs have a hard shell that protects them. In order to grow they have to shed their protective carapace and at this point they are vulnerable and without protection, but eventually their outside hardens and they are again protected.

Many of these thoughts spoke to my grief over Myles's death while others spoke to my 5 lost dreams and my continual battle with infertility. I feel like I should explain how these statements spoke to me, but quite frankly I'm still tossing things around my mind. I didn't walk away from Kushner's speech with all of my questions answered, but I never expected that to happen. However, I do think that Rabbi Kushner allowed me to develop a new perspective.

Along with Kushner's inspiring messages a wonderful, caring friend, S, grabbed my hand and helped me out of my dark hole of hopelessness. I see a small light flickering and I feel a little hope returning ...

Mexico--Our Escape From Reality

Deep Dark Place

This is where I went yesterday and am not sure when I'll return. Please beware that this is not a happy, hopeful post by any means. Today I feel hopeless and want to curl up in my dark place and not face the world with my fake happy face. The people IRL who read this won't understand how one goes to such a place and I'm too tired to explain it. Quite frankly I'm reaching the point where I'm just plain tired, actually exhausted is more like it. Like one of my dear blogger friends I too want off this horrible ride!

One of my closest friends, L, listened to me cry and go on for hours yesterday. She has to endure my constant questions about how the universe can put so much on one family ... about how unfair it is that others are blessed repeatedly and others are just beaten down repeatedly ... about how I don't believe in miracles. All of those beliefs went out the window when Myles died. At one point during this conversation L said that maybe this is hell? Maybe J and I are experiencing hell on Earth? My response was that hell couldn't possibly be any worse than the life we live, so I guess this is my hell.

I have reached a point when honestly I wonder if I'm in denial. Am I refusing to see the evidence that is stacking up in front of me? For as difficult as it is to endure the constant heartache we face it is even more difficult for me to acknowledge the real possiblity that I might not have another child.

(Please don't give me any trite platitudes or promises that I'll one day be a mother to another child. I really don't need that right now. I just need to wallow in my dark place.)

Now What?

Hmm, haven't you heard me say that before?! I feel like I've been sitting in this very same spot a million times before over the past several years, yet I seem just as lost right now as I was the first time I sat here. I hate the limbo! I hate the not knowing of what we will do next or what direction we will embark on! I like to know where I'm headed as it always brings me comfort. I'm not feeling like we don't have a travel destination, but rather just that we don't have the GPS programmed yet. I'm obviously anxious to get the GPS programmed, so we can head off in the right direction.

I've talked with K about all that's happened with the miscarriage and emergency D&C. Not surprisingly K's husband was scared to death when he receieved a frantic phone call that his wife was going in for a D&C because she was hemorrhaging. As a result he feels quite strongly that K can't go through another cycle with us again. I don't blame him for having these feelings. He wants to protect his wife, the mother of his children, and the logical way to do that is to end the surrogacy journey. Additionally K's husband has some other reasons for not wanting K to continue, which I won't get into here, but all of his points are very valid. I understand that both K and her family need time to process all that's happened in the last two weeks before they make any final decisions, so we are going to give them some much needed time and space.

K and her family know that we will be moving on with our plans for IVF #2 and that we do not presume that they will be a part of our continued journey. It is important for my mental health and well-being to keep moving forward, so that's what we'll do. I will discuss surrogacy as a part of our future, but I will not discuss who will be a part of it. I need to give K and her family time to decide if they will continue on this journey with us or not. Of course we are hopeful that K will continue this journey with us, but we understand if she is unable to do so.

I told K that it's much easier for us to bounce back from the miscarriage because 1) we didn't go through the physical part of it, 2) we've been through 4 other miscarriages and are familiar with the wide range of emotions that accompany such a loss, and 3) it's not nearly as emotionally painful for us as was watching Myles die. Plus, years of being battered by infertility and recurrent miscarriage has made us quite resilient. Like I said before we stumble along this journey, but we keep getting to our feet and we forge ahead. We are "walking through flames" to get to our child. I have to say that this fall was a pretty bad one for me, in particular, because I expected surrogacy to solve all of our problems. I should've known better to think that it would be a smooth ride as nothing about this journey has been smooth. Despite this HUGE, devastating blow I still feel strongly that surrogacy will bring us a child, so working with a surrogate will be an integral part of our future journey.

I have my WTF appointment (i.e., post-IVF consult) with Dr. S scheduled for 3/31 to discuss our next step, so that meeting should help set us in motion. I hope that Dr. S is ready for me this time because I have a million questions for him! I'm guessing our protocol for IVF #2 will be similar to that of IVF #1 because I had a good response. I stimmed for 11 days with a combo of Bravelle & Menopur. My estrogen levels were low the whole time and never correlated properly with my follicle count, but my RE assured me that there are a select few women (go figure I'm one of them!) who have mature eggs as indicated by u/s despite what the E2 level indicates. He was correct. Here are my stats from IVF #1:

-21 mature follicles at trigger
-2 empty follicles at ER
-19 eggs retrieved
-16 mature eggs that fertilized with ICSI
-8 blastocysts (graded A; all frozen due to lining problems)

I'm guessing that he'll have me do the same protocol: slow and low seems to work for me! I was thinking that stimming during the school year might not be the best idea and thought about waiting until June, but maybe I'll start near the end of the school year if it works with Dr. S's schedule. I figure that the worst case scenario is that we won't have a surrogate to transfer our fresh embryos to, but realize that if that's the case we'll just freeze the embryos until we can find a surrogate. In my dream world my uterine lining would suddenly do something miraculous and grow thick so we could transfer to me, but we know that is highly improbable and very unlikely to happen.