well, hello there :)

After a lengthy break, I am going to try to get back into the writing groove again. I know I have been pretty silent over the last few months, but I have been following along in my reader most days and thinking of all the courageous, strong, smart, and funny women out there. My grief does tend to turn me inwards for long periods of time and it is hard for me to write, but now that we are getting back into the concrete stuff, there should be more to write about than my sadness.

Where are we? Well probably pretty close to getting right back in the thick of things. After our long Canadian-style wait, we have 2 consults coming up the week after next. I am due to get AF in a few days and then I go to get my AMH drawn and the usual CD3 bloodwork. Y did a new S/A last week and he also did the DNA fragmentation test for the first time.

I have a SHG scheduled for the week after this coming one, right before we dive into the consults. The SHG will be important because we need to reach a final consensus on those damn fibroids before proceeding (the current leaning is no surgery, but we need to reach a confident decision) and because it will hopefully rule out scar tissue/adhesions.

My cycles have been a good deal shorter and lighter since I gave birth and the complications that came after, so the hope is that the shorter and lighter cycles are a good thing and not indicative of Asherman's Syndrome, which I am unfortunately at pretty high risk for due to my history of multiple D&Cs and retained placenta.

I am sure I will have lots to talk about when we look into both clinics we are considering. Both clinics have different options which could be interesting or useful to us -- Clinic A has a very well-regarded RPL specialist who conducts clinical trials in that area. They also do a lot of blastocyst transfer and offer PGS (need to clarify which type of PGS). Clinic B offers endometrial co-culture and routinely prescribes intralipids.

We might end up not going for any extra bells and whistles at all, but it will definitely be interesting to learn about the different possibilities and also to have a fresh set of eyes review our case. All that being said, I am still feeling ambivalent about getting back into cycling from an emotional perspective, not to mention the immense cost.

In short, these upcoming consults will hopefully be worthwhile and interesting but we are not yet 100% committed to cycling again in the near future. Also, the SHG results could be a big game changer -- potentially surgery vs. beginning the path of working towards surrogacy if Asherman's is an issue.

This past cycle has been somewhat of a hail-Mary-type (I don't think we have an equivalent expression in Judaism) long-shot attempt...since I am still unexplained and we thought it was uncanny that the 2/5 IVF transfers that yielded a positive pregnancy test were the only transfers I took Prednisone, we did a cheapy Clomid/Prednisone cycle this month just for the hell of it before we prepare to shell-out big time to re-enter the IVF circuit. I will of course let you guys know if anything comes of it, but it is a real long-shot.

Our IVF consult SUCKED

Today was the equal parts highly dreaded and highly anticipated IVF consult. It totally and completely sucked. The only thing we all seemed to be on the same page about is that moving on to IVF is the most reasonable thing to do at this point. At least there was that. I am so upset by the care (or lack thereof) I am getting, though, and it's difficult to know exactly how to proceed. I typed out all of my questions in advance so I wouldn't get flustered but since the whole appointment lasted literally, I kid you not, 3 minutes, I didn't get the chance to ask more than two or three questions and all of those two or three questions concerned only logistics.

Here are the facts: I left the appointment with orders for a bunch of tests that I already had done in the past, which could be easily accessed by looking up my ID number in the computer system or by opening (oh my!) my paper file. The 'notes' field of one of the orders read "secondary infertility", even though my one and only brush with pregnancy (after IUI#2) ended in a bloody mess induced by Cytotec at 7.5 weeks when no fetal heartbeat could be detected at my 2nd ultrasound. I left today's appointment with no start date for IVF #1, no clue as to what protocol we would be doing, and no script for BCP (RE says he doesn't believe BCP is necessary - maybe he is thinking antagonist protocol, but who really knows!?).

I was told that they are booked up for the foreseeable future for IVF cycles, so there is no chance of starting in April/May. At the beginning of May, I can come in for a clinic appointment and at that time they will set up my calendar. If everything goes well, I can start IVF #1 with my June cycle. However, since there is actually no plan and no protocol decided upon (that I know of, anyway), I have no idea whether that means I can begin the suppression phase (i.e. Lupron) at that point, or whether that means I can actually start stims at the beginning of June.

I was really hoping that we could start stims during my May cycle so that this wouldn't be competing head-first with my best friend's wedding at the beginning of July. I asked Y how he felt about postponing cycling until August/September so that we could still go to the states at the end of June/beginning of July, but he feels strongly that if he is postponing his fellowship 1+ year(s) in order for us to continue treatments, then it's not cool for me to selectively decide that I want to postpone cycling for the wedding. I understand his logic, but I am crushed and dreading discussing it with J. I am already missing my college reunion at the beginning of June, and I really had my heart set on going to the states for at least one of the two (I had picked the wedding), but now it looks unlikely either will happen and if I can indeed make it to one or the other based on the whims of my cycle, it will probably be super last minute. I decided what feels like a very long time ago that I wouldn't plan my life around TTC, but now, hypocritically, I feel that the stakes are so high that I must give in to have any chance of making this work for us. Does that make any sense at all?

I am so upset by how curt and unwilling to spend any time at all with us (not even enough time to refamiliarize himself with the very basics of our case) the RE was today. He was really great when I was pregnant and very compassionate when I had my miscarriage. Since I have been tossed around to quite a few REs in the clinic over the past 9 months and have had little continuity in my care, I didn't necessarily expect him to remember me, but I did expect him to give us a lot more information at this juncture, which feels very significant to us. Even Y, who is not so easily flustered, left feeling irritated, upset, and confused.

Not so much will be happening treatment-wise for me over the next month, but I will be doing some soul-searching as to whether I will be sticking with this RE (in reality, I will likely continue to be tossed around a fair deal during clinic visits, but just as I have been proactive about seeing this particular RE until now for the big decision making-type appointments, I can be more proactive about seeing someone else in this context). I am not willing to consider switching clinics at this point, since my current clinic is (a) at the same hospital where my research lab is located (can't beat that!) and (b) largely regarded as the best IVF clinic in the area. I hope I have more positive things to say next time - I am still waiting for my big break.