When your anxiety is as high as your estrogen

My husband called it “estroxiety.”

It is transfer week, which means it is crawllllling by at a snail’s pace. Aside from the side effects of my BFF Estrace — of which I have many — my mental health feels a bit like a teeter-totter. One moment: OMG I AM SO EXCITED THIS IS GOING TO FINALLY WORK ALL CAPS EVERYWHERE! The next:

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Actual footage of me?

Don’t get me wrong, not going into an embryo transfer blindly for once is a welcome change. I know my doctor (well, actually, not my Peyton Manning doctor because he will be on vacation) will place little PGS-normal 5BB in my now-optimized for receptivity uterus. Because my ERA test revealed that my lining is 12-hours pre-receptive, we’ve moved my PIO shots to the mornings, giving me an extra dose before the actual transfer. The same biopsy revealed no recurrence of endometritis either. So, basically, my uterus is as ready to grow a baby as it probably ever has been. I’m set up for success. Even my clinic’s internal stats on a a PGS-normal resulting in pregnancy and a live birth are killer.

And yet, the pressure is getting to me. My stomach is doing flip-flops. I’m not falling asleep easily and sleeping fitfully. My brain keeps telling me that normal embryos fail all the time. I’ve had anxiety before transfers in the past, but this is so heightened. I’m so hyper-aware that it could be successful and that’s just not my normal. I’ve had nothing but failure to point to; I’ve settled in and stayed awhile. As miserable as infertility makes me, it is my normal. I’m not resigned to it, but it is always there. It’s been the focus of my life for more than five years and it has become my every day. Popping Estrace pills morning, noon and night; the sore injection sites from the PIO; lying back and putting my feet in the stirrups for internal ultrasounds every few days. This is my life. It sucks so much, but there’s something that has become so comfortable, too.

Like many Type-A people, if I’m not good at something almost immediately I tend not to like it very much. I despise mediocrity in myself. When I was eight years old I played the saxophone for a little under a year. I was pretty terrible, and I quit because I knew I wouldn’t ever be first (or even second) chair in the elementary school band. Instead I did something I was much better at (cheerleading [current me still doesn’t fully comprehend how I was a cheerleader my entire childhood]), and spent the next 10 years engrossed in that. Captaining teams, winning an award or two and being pretty good at something like the Type-A in me wanted.

Somehow, I’ve never quit this. I’ve pushed through even though I am clearly terrible at creating babies. Infertility has taught me an awful lot about failure. And, in turn, resilience. It has absolutely shaped who I am as a 36-year-old woman.

With success as close as it has probably ever been, it is out of my hands now (and soon to be in my uterus). I have, officially, all the feels.

Also, f#*k you, Estrace.

Infertility grief

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Maybe you’re just too fat to have a baby and other things no one said but I heard in my head

I’ve struggled with my weight for much of my adult life. I was very active in as a kid and through my teen years, and with only a few exceptions of the low-fat lifestyle trends of the 90s, I didn’t think all that much about what I ate. I started pretty steadily putting on weight in college, but for much of my early 20s remained only about a size or two bigger than I was when I graduated. I wouldn’t call myself a yo-yo dieter, but an slowly-moving, unmotivated yo-yo is a fairly apt description of my weight after 26 or 27.

Three years into fertility treatments, the scale isn’t too kind to me. It started to tick up when I started Clomid, then exploded during the transition from IUIs to IVF. Much of this was related to the hormones pumping through my body. It is also more literally tied to eating ice cream to dull the feelings of unsuccessful cycles, miscarriages and feeling like I’m completely broken. I can own that. All total I put on about 35 pounds in these three years and, in October when I met with the doctor offering a second opinion, was the heaviest I’ve ever been.

Over the course of that conversation, the new RE suggested that because of my weight, I was probably producing poor quality eggs, resulting in poor quality embryos, leading to lack of implantation. I wasn’t shocked by this assessment, but I was taken aback. This wasn’t a factor on the table with my Peyton Manning doctor. He never once said to me that I should consider putting the spoon down. I’d certainly read a bit online about BMI affecting egg quality, but if I’d asked and my doctor didn’t think it was the reason for three years of ultimately unsuccessful treatments, then it probably wasn’t… right?

In the moment, I left that RE’s office feeling absolutely deflated (like Tom Brady’s footballs… [I’m just going to keep running with these weird football analogies, so roll with it]). It was a deep cut to hear that my weight could be preventing me from achieving success. He’d told me that to take me on as a new patient, he’d want me to first lose 20 pounds. Twenty pounds caused by Clomid and ice cream and Estrace and pizza and watching everyone else become a mother.

Over the last four weeks I’ve used every ounce of brain space that I once reserved for progesterone dosages and ultrasound appointments to retrain myself to eat. Knowing myself well enough to know follow-through isn’t my strongest quality when it comes to a new routine, I joined one of the medically-supervised weight loss clinics that seem to be popping up on every corner. The staff has been supportive and has helped me address the areas of emotional eating that are the biggest triggers and challenges for me. I feel better, and I’m doing really well on their program. I’ve said goodbye to sugar (again), and have actually started to like the taste of Greek yogurt. I belong in a Dannon commercial.

I’m going to tick that 20 pounds off and keep going until we’ve pulled together the financials for another stim round. I can’t be the thing standing in my way of being a mom, so I’m not going to be.

Second opinions

The rollercoaster of emotion hasn’t stopped since my chemical pregnancy. Although I’d said before going into this IVF cycle that it would be our last one, I’m reevaluating the options. I feel pulled to continue IVF because I’m emotionally very connected to a successful pregnancy when I’ve only experienced unsuccessful ones for no obvious reason.

Last week I met with my doctor as a post-mortem this third IVF cycle. He’s a lovely, obviously caring man who has more than 30 years of experience with infertility. He’s the Peyton Manning of reproductive endocrinologists. He’s got that time and many wins under his belt; he’s consistent. Then he has a patient like me. During our appointment he referred to me, albeit very kindly, as an anomaly and his personal project. He’s determined to make me a mother in the same way that Peyton was determined to come back after neck surgery and win another Superbowl. No, this metaphor isn’t over-the-top at all, I don’t know what you’re talking about.

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As I anticipated, there’s not yet a good explanation for why five perfectly normal-looking embryos haven’t resulted in a sustainable pregnancy. He showed me the math of it and it was incredibly depressing.

So how does he recommend we move forward? The simplest possible response is another biopsy to check for my old nemesis chronic endometritis, and while we’re painfully removing my uterine tissue, reserve a sample for the ERA test, too. My lining is, perhaps, optimal for embryo transfer too early or too late for the standard progesterone window. The ERA test has been growing in popularity in the infertility community (I’d actually asked about it prior to my chronic endometritis diagnosis), but my clinic has only performed the test three times to date as they tend to be pretty conservative on new tech and labs.

Given that we have one remaining embryo, Kristoff, he also suggested that I consider another stim cycle to create more embryos and PGS test the whole lot of them to weed out the shoddy ones. We considered PGS in our first go ’round, but the added cost prevented us from moving forward.

Again, none of these recommendations came as a surprise.

What’s next? We’ve decided to get a second opinion. I really like my clinic, my doctor, and of course the greatest nurse on the planet, but my husband and I both feel like we’d be remiss if we didn’t at least talk to another doctor before making a decision. So I’ll be meeting with another doc, who has successfully helped two friends get pregnant via IVF, in a few weeks. His clinic also has a great reputation, and I’ve heard their treatment protocols are a bit less conservative, too.

 

#TheStruggleIsReal

One week down.Ā 

As someone who struggles with depression, I often have to focus on how far removed I am from my trigger incident to move forward. It’s a coping mechanism I’ve had in place since I was a teenager to remind me that I can move forward.

I work for a large company where we have our own campus. During the workday I spent 99 percent of my time in one building. In the last week I’ve encountered seven new pregnant women. This is in addition to the handful I’d already seen in the cafe or milling about in the hallways. I can’t escape them as I’m slowing expelling my hopes and dreams onto a maxi pad. I’ve heard all of the “it’s in the water” jokes. Trust me, it’s not.

Sorry if that maxi pad bit was too morbid. I’m feeling a touch filter-less.

Emotionally I’m all over the place. My mood turns on a dime. I remind myself that it’s okay to be upset; not only am I grieving another loss, but I’m also facing an enormous decision about what comes next. I spend a lot of time feeling lost. A lot of time feeling jealous of every mom or dad who posted a first day of school photo on Facebook or Instagram. For as much as I want to believe I’ll make that same post someday, the reality is that I may not. And someday isn’t now. Or tomorrow. Or even next year.

I’ve had so much support in the last week that I should be bursting with gratitude. And I am. I am incredibly grateful for the well wishes and the amen, sistas. You all completely understand these feelings. This insane emotional rollercoaster that you both desperately want to get off and are too afraid to leave behind.

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Desperately positive and hopelessly negative

When you’re infertile, there rarely seems to be a middle ground in anything. Emotionally, I am certain that my next fertility treatment will be successful one moment, and I’m a dumpster fire of despair the next. Nothing will ever work, I tell myself as often as I silently say this is it.

Starting this last round has probably amped up these disparate feelings. I’m two days into my estrogen (Estrace) regimen to build up my uterine lining pre-transfer, and my emotions are already on 11. Plus, my feeling nauseous. I asked my husband last night if he remembered me feeling sick during my last FET cycle when I started the estrogen, but neither of us recall it. It’s funny how every cycle is just a little bit different. Funny in an oh lord what’s next way, not in a haha way.

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As I’ve written about before, I see signs in everything. There’s already so many in this last round. Despite my best efforts to plan, my transfer of Olaf and Anakin will be after my husband has left for a three-month new job training. One day after. This, of course, makes me sad. If the transfer does work, he missed it, and he’ll also miss almost my entire first trimester. Which means I have to get my own damn ice cream at midnight. If it doesn’t work, I’m alone to process it. If it works and then I miscarry again, then just commit me to the psych ward because I’m likely to break.

Another sign in the positive column is that my husband got this new job at all. He’s been stuck in a crappy job that he hated for years and no leads had panned out in a very long time. In fact, the last time he got a new job, we were also apart. Two days after our wedding he left New York to interview in North Carolina for his (still) current job, and less than two weeks later he moved here. We spent the next five weeks of our newlywed lives hundreds of miles apart until I could move South as well. Major life change seems to equal time apart for us.

The final sign is that, if this transfer sticks, my due date would be sometime in April. And previous Aprils have sucked hard. The birth of a rainbow baby would certainly have a lot of meaning during that difficult month…

Nothing can prepare you for this

When I was in my mid-20s I briefly considered donating my eggs. At the time, my motivation was primarily financial, although I was not ignorant to the idea that I could help give a baby to someone who desperately wanted one. I’ve always wanted to be a mother, and I had no doubt that being told you couldn’t have one “naturally” could be crushing to a woman.

After some consideration I deemed my motivations too selfish and my work schedule too hectic to move forward. I didn’t give egg donation another thought.

I didn’t give another thought to that woman I could have helped either. I wish I could rewind. I had no idea, ten years later, I’d be the woman struggling to force her body do the thing that it was built to do. No one ever thinks that it will be her. No one ever wants to be the one running out of time, money and options.

My husband and I began trying to conceive right around the time we got engaged, four and a half years ago. We weren’t naive that given our age, both 31, that we were shorter on time than some of our counterparts to build a family. We certainly didn’t consider ourselves geriatric, but we could do basic math. We planned a July wedding and I sincerely thought I could be pregnant before I walked down the aisle. As long as I still fit into my dress, I would be happy.

Two years later, after many life changes, but none of the baby variety, we reluctantly were referred to a fertility clinic. After the prerequisite testing, we were given an unexplained infertility diagnosis, and I began the first of several rounds of Clomid + IUI. While an unexplained diagnosis was intimidating, I was still so unprepared for what was to come.

In March of 2015, only a few months into fertility treatments, I wrote this:

When I wonder how much longer I can go on like this, in this state of mind, it makes me feel guilty. I would give anything to be pregnant. And Iā€™m trying to give everything I can. I am trying. But I am so tired, too.

I had no idea what it meant to be tired, then.

Less than a month later I would become pregnant for the first time. A month following the happiest moment of my life, I miscarried for the first time.

More than two years, another miscarriage, five more IUI cycles, two failed IVF rounds  and a bout of chronic endometritis later, I know what it means to be tired. I read “not pregnant,” again, on that little stick just this weekend.

When I wrote that early post I was still so full of faith in my own body. I knew I would get the job I coveted of mother, and it would all be okay. The bloated, achy, overly hormonal side effects of Clomid would be a distant memory as I rocked my son or daughter to sleep at night.

But it hasn’t happened that way. Our infertility story is much longer than we could have ever expected, and we’re still very much in the thick of it. Infertility demands so much of your time, money, body and brain space. No woman or couple has any idea just how tiring this can be.

It’s hard to see the forest for the trees sometimes. Without the child my husband and I so desperately want, I’m not yet to a point where I can say, yes, everything was worth it. I’m still waiting. I’m still tired.

We’re nearing a crossroads. I’ve given my body, my energy, our money and more than four years of our time to science. Soon, we’ll need to decide how much longer we can continue, if at all. Facing that decision is parts scary, parts sad, and a small part freeing.

My husband and I are supposed to be parents. No one could have prepared us for what that would take, when it comes to others so easily. But we will be what we’re meant to be, someday.

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