I'm back

That was quite the unintended lengthy hiatus. Moving across the ocean was a much bigger project that I foresaw. The good news is that after a few weeks at my inlaws we finally moved into our new apartment and we are now more or less settled (we FINALLY got internet set up on Friday). Y started his fellowship and I got my work visa and began work in the new lab.

I am doing okay but life isn't easy -- I still have many hard days, some incredibly hard days, and mostly a lot of in-between days. I wonder whether life would be a little more palatable with some pharmaceutical help, but truthfully, I am so distraught over the weight I haven't loss since giving birth that I am not sure I can handle adding antidepressant weight gain to the mix.

I never stop thinking about Aminadav and Naava. I imagine all the time what life would be like if they were here with us now and what they might look like and be like.

I get teary when I go through old pictures of Y or even myself from when we were both babies and toddlers. We were both really cute little kids -- I think both of us piqued in our looks around 3 or 4 :) I know the twins were really beautiful when they were born and I am sure they would just be so so cute now. Thinking about that never fails to make me cry.

And now here we in July, the month they were due. I suppose at some point the passage of time will make everything easier -- the memories gentler, the reality of life as it is less harsh, but for now I can't help but think time is strengthening the blow.

For some time after they were born but before they were actually due, the reality of our lives and theirs seemed somehow suspended in time, like we existed in some strange in-between where the twins were of course not here with us but they weren't yet supposed to be here with us.

I don't feel like that anymore -- I feel like our universe diverged into two roads, one the promising and happy path we were on and one the sharp and unexpected reality that came to be. I see all the new babies around now and think about how they were Naava and Aminadav's compatriots. How miraculous in some sense that they are here now -- so healthy and robust -- but I guess it is not so shocking after all, I mean isn't that what is supposed to happen? Supposed to happen for whom, though? Surely not for me.

I think that is what is so terrifying about moving forward with attempting to conceive -- the belief that I am somehow cursed, the belief that I am somehow different and every attempt at a live child will end in some permutation of something that is, well, not a live child.

To be fair this line of thinking is clearly not so illogical under my particular circumstances -- 6 IUIs, 5 IVF transfers, 3 pregnancies, 2 beautiful babies that my body wasn't able to support long enough, and 0 living children. It could be so much worse and I know I have many fellow comrades in the pity pool, but it is already an objectively abysmal set of statistics.

Y's grandparents met some woman with allegedly psychic powers who said I would never carry a pregnancy successfully unless I speak with her (she doesn't want money, she just needs to tell me a message). Despite their pleading, I can't bring myself to call her. I just can't. I guess to me it signifies 1) acquiescing that I am cursed 2) puts at least the illusion of personal control to change my situation back in my hands. The latter is a demon I have been working so, so hard to rid myself of -- the notion that any of this is in my control. If I say that yes, I do have control, the avalanche of self-blame that subscribing to this type of logic allows is limitless.

Also, just as a final update to my last saga, I thankfully ended up miscarrying naturally at 5w2d, bringing an uneventful end to my extremely short-lived pregnancy. I don't have any plans on the immediate horizon, but I do hope to set up a consultation at a clinic here in Toronto over the next few weeks. Realistically, it will take a couple of months to get in and then likely another couple months of repeating testing and making arrangements before I cycle again.

In the mean time, we are giving it a go the old-fashioned way…I have never had a naturally conceived pregnancy, but we have all of the right body parts, so I assume it is technically possible.

I would say that the loss of the twins is finally putting some strain on our relationship, not in a serious way, but it is something that wasn't there before that I feel now. Whenever I get really mopey and melancholy and ask Y whether he wishes things were different, he says of course, but he doesn't dwell on what was handed to us vs. what could have been the same way I do.

He even accidentally referred to the twins as "it" once a few weeks ago. He apologized and said he didn't mean it, but I couldn't look at him or speak to him for a little while after that.

When the babies came, we were truly one and together in a way I could never imagine beforehand nor articulate in a way that would do it justice now -- I am not big on soul-talk, but the best I can describe it is that our souls met somewhere above us and became one. It was a level of emotional intimacy that I had never experienced before nor will probably ever experience again.

Of course the flip side of such extreme intimacy is that it unsustainable and can pretty much only go in one direction after that. So I guess there is a bit of a rift now -- a sense that I still have so much intense sadness that can be overwhelming for Y. And whenever I feel bitterness I can't help but think it bad or dirty to feel that way, even though I know it is pretty normal. I know Y doesn't share the intensity of longing (not jealousy, I don't begrudge others for their good fortune) that I sometimes feel for what other people have.

The secondary issue is that I am feeling increasingly ready to accept adoption as a way of moving forward. This is in an abstract sense, because there are so many logistical issues that we would need to deal with. I would love to be pregnant again but having a child to love and to raise is more important to me than being pregnant again (of course with no guarantee that any pregnancy will result in a healthy living child).

Y doesn't feel even remotely similarly about adoption. Having a biological connection to the child is paramount to him -- he says he doesn't see what the point is if the child isn't his own. There is pretty much nothing to talk about there. There is no evidence to suggest that donor egg would be particularly helpful to us and while surrogacy may be helpful, with such a high price tag and in the absence of any super compelling reason why its our only option, that is off the table, too. In short, I think we will just continue to power on as we have before.

I just miss my sweet twins so so very much.

waiting

It has now been four days since I stopped the progesterone, estrogen, prednisone, folic acid and Omega 3s. Today marks 5 weeks and I am waiting for my body to do something, anything to signal that it is letting go of this doomed pregnancy.

In the mean time, I have:
gone on long runs, ordered in sushi (I lied and told the lady on the phone it was for 2 people when she asked how many it was for -- to be fair, I did eat the 28 pieces in two separate sittings), drank wine, consumed copious amounts of (unpasteurized?) goat cheese, ordered a large latte every morning at work, popped a few aspirin, and lifted many heavy boxes. While long runs historically cause me to spot bright red when I am not pregnant, running under these circumstances does not seem to produce the same effect.

I will get a beta drawn in the morning to see where things stand. In the mean time, this is beginning to feel a little ominous. If this isn't going to work out (it's not) I was really hoping it would at least be chemical and that my body would take care of things itself.

I can't help but think that it would be a signature A. move to be diagnosed with an ectopic the week we are supposed to move abroad.

short, but definitely not sweet

After a week of +hpts, beta #2 was the same as beta #1. My E2 and progesterone seem to still be going up, so I really hope this doesn't turn into a prolonged ordeal and that it's chemical and not ectopic. Damn, I really would have preferred a plain old BFN to this.

one year ago today

The ultrasound one year ago today: Broken. Didn't think one year later we would still be empty-handed. I suppose there are nicer things to reminisce about during the 2ww...

Post-Miscarriage Follow-up

Today I had my miscarriage follow-up appointment with Prof. L. It was my first time back to the fertility clinic since the miscarriage, and let me tell you, I don't miss that place at all. First, the receptionists gave me a really hard time for being there at all, since appointments during the morning clinic hours are generally reserved for women who are actively cycling. Interestingly, the receptionist giving me the hardest time was the one who scheduled the freaking appointment with Prof. L. right there, who told her to schedule the appointment for that time. Of course I wanted to pull my hair out and I was feeling extra sensitive in general since it was my first time back after the miscarriage.

The good news is that the miscarriage is complete - both the ultrasound and exam confirmed this. I never thought I would be so relieved by the sight of an empty uterus. I just stopped spotting 2 days ago, so now we wait patiently until AF arrives. The plan is then to do another Clomid/IUI cycle, since that's what worked last time. We'll also repeat CD3 b/w, as well as testosterone and DHEAS. Also, I was clearly a little upset, both by discussing the miscarriage and by the hard time the receptionists gave me, but Prof. L. was super reassuring as usual, and encouraged me to call him directly on his cell phone to keep him posted or with any problems.

Crazy IF thought of the day while observing the throngs of new moms with over-priced strollers bedecked with over-priced accessories during my visit to the Mother & Child Center for my ultrasound: If I'm not pregnant by this time next year, I'm buying Harriet [the cat] a Bugaboo frog for Chanukah...with a little parasol.

In other news, I have a nasty cold with fever and left work early. Really, it's just an annoyance, but I still feel like crap.

Space Camp

What has shocked me the most about our loss is how unshocking losing this pregnancy was, despite the fact that everything was going so well until it wasn't. I remember when I was little, whenever something I deemed to be very important occurred, I divided my life into the before and after based around that single event. Inevitably, I would find the after incredibly depressing - the let-down after a big trip or significant event and all of the anticipation that led up to it.

When I first became pregnant and then later when we learned that our baby didn't have a heartbeat, I came to believe that these events would be the same - defining points against which everything that followed would be subsequently measured - separations differentiating the old before from the new after. Perhaps if my pregnancy had been healthy and marked the beginning of the life of a child we brought into this world alive and into our arms, this would have been true. Instead, I have found it surprising that the loss hasn't really felt like a defining point at all.

Perhaps it's because I spent so long hoping and praying to be pregnant and comparatively so little time actually pregnant (just shy of 8 weeks when I was admitted to the hospital for Cytotec), but the pregnancy itself feels like a strange but hopeful dream I had for 10 minutes one night. Now that its been a week since the miscarriage, nothing about the pregnancy feels real anymore. More accurately, I've been asking myself, did it ever feel real?

Not really. In fact, the whole time I was pregnant, I felt like an impostor. Part of me could never actually believe it was true or that it finally happened. I kept repeating over and over again to myself, to Y, to anyone who knew and would listen, really, that it was too good to be true.

Sure, I clumsily stumbled through all the motions of being pregnant. I was starving for lunch every day at 10:30am and ready to go to sleep at 7. My breasts increased a full cup size and I finally worked up the courage to buy a copy of The Book - What to Expect When You're Expecting, which lay splayed open proudly on the couch, not tucked away in a drawer like infertility books. I ordered cooked salmon maki and veggie rolls at sushi and sipped Cokes and Shirley Temples at our friends' wedding. I turned down wine, quit coffee cold turkey, and when the bloat made it impossible to comfortably wear jeans, invested in 2 pairs of elasticized maternity pants. I secretly enjoyed it when people would stare down at my protuding little belly (in reality more bloat than bump) and wonder.

On the outside, I acted like someone who believed she would have a take-home baby and yet on the inside, I was just an opportunist - a little kid version of myself who wanted to take full advantage of this longed-for virtual reality experience before school was back in session.

That's because in reality, I felt like a nine-year-old girl who wants to be an astronaut when she grows up more than anything else in the world. Finally, she gets to go to space camp. She is delighted and squealing with excitement- how lucky she is to get such an authentic experience! But even as a young girl, she still knows in the back of her head that this is just make-believe, a token or morsel of her real dream. This is all a high-tech stimulation - she has yet to see the moon.

And so, ultimately, my brush with pregnancy amounted to a few weeks at space camp. In the end, the only moment of my pregnancy that stands out in my mind as being real was lying on the crinkly paper of that ultrasound table with three technicians and one doctor crowded around me, nodding and talking to each other about the body on the table and the image of a womb on a screen, not a single word uttered to me.

That's when I knew that my time at space camp was through. Catapulted back to the reality of Earth, I was no longer an astronaut or mom-to-be, but an infertile finally pregnant, but with a baby without a heartbeat. All of those prayers and wishes and dreams for that miraculous ball of cells, that splendid little life growing inside me, slipping further and further from my reach, like so many dreams of outer space or Orion descending. I am here in Jerusalem, Israel, Planet Earth. I am 238857 miles from the moon.

Harder than we imagined, stronger than we thought

The physical part of the miscarriage has been much harder than we thought. After reading the experiences of others with Cytotec, I knew it was a dreadful drug. In addition, a miscarriage in of itself, whether induced or natural is no picnic to begin with. Still, I think Y and I both underestimated the physical pain and the physical recovery.

I had it in my head that the worst of it (physically) would be over after 48 hours and that after that, the pain and bleeding would be similar to a very heavy period. In truth, the heaviest bleeding didn't occur until 3-5 days after the Cytotec and while the worst pain was definitely a few hours after they put the Cytotec in, I had intermittent severe pain that was completely incapacitating until today.

The mornings have generally been my good hours, with the worst pain in the late afternoon and evening. Luckily, Y has been home for most of the severe pain. Without him and his grade A back rubbing and culinary skills, I wouldn't be able to be manage. Finally, this morning (Sunday), which marked 7 days since the Cytotec, I was able to get up in the morning and feel functional.

Since I hadn't had a "good" straight 24 hours, Y thought I should take today off, too. In the end, I decided that today was a gamble but a week was enough, and it was time to tough it out and see if I could make it through the day. It was definitely the right choice. I made it through a hectic day and it felt right to get out of the house for the first time in 7 days and face the outside world.

Only 2 of my co-workers know about the miscarriage. The rest, including my boss, just know that I was out with some vague illness (however, my boss does know that I was hospitalized because Y called him to say I'd be out for the week when I was being admitted). In some ways, it feels odd that people think I've been out with "flu", but on the other hand, the ones who do know have of course managed to put their foot in their mouth ("You are so young and healthy." "At least it was your first." "It's not the end of the world." "You shouldn't worry." "Haha, now you don't even have an excuse to yawn.") You know, all the standard gems. Whatever.

Part of me wishes that I could muster up the gumption to respond and make them very uncomfortable. The truth is, I know people mean no malice. I have learned umpteenth times from the first "Just relax and it will happen" that many smart people are totally moronic when it comes to "consoling" or "counseling" those of us with fertility problems.

I think part of it stems from the fact that trouble TTC or IF is something that many fertile women think they can relate to, since to some extent it does fall within their spectrum of personal experiences (i.e. most women in a committed relationship have indeed gone through the life experience of trying to getting pregnant). They just sort of miss out on the nuances of how the experience might be completely different if you're, you know, broken.

Anyways...I am proud of myself that I went back to work and had such a productive day. Physically this has been much harder than we imagined but emotionally, I think we are perhaps more resilient than we thought. We'll take what we can get.

Broken

Baby G was never growing hands and feet or developing a brain or any of the things I wrote about in my 7w post, because on Sunday (7w3d, or 7w5d by LMP) when I went for my 2nd ultrasound, we received the horrible news that Baby G had no heartbeat. In the end, that slight brown spotting from last week was an ominous foreshadowing of what lay ahead. My cervix was still closed, my uterus measured 7w0d, and there was no active bleeding, so my body was essentially staying pregnant even though the pregnancy wasn't viable. This meant we had to make the horrible decision of how to complete the miscarriage.

The two choices were either a D&C or Cytotec. With the Cytotec, they place the medication in the cervix and contractions are induced. Since the process can take days to be complete and can be extremely painful and since there is only an 80% chance of "success", I decided I wanted the D&C, which would be over quickly and give definite closure.

Unfortunately, there was a 12 day wait for a D&C and I didn't want to remain pregnant carrying around a non-viable pregnancy for that long. That is how we came to choose the Cytotec. I was admitted to the hospital yesterday morning and had the drug administered. Just before the doctor put the Cytotec in, I saw 2 little drops of blood. I know this sounds silly, but seeing those two drops made me feel much more at peace, like my body was perhaps beginning to realize that this was not a viable pregnancy.

I felt nothing but mild menstrual cramps for about 3 hours. Then the cramps steadily worsened until they became full-on contractions with 5-10 second breaks in between. The pain was absolutely excruciating -- well beyond anything I had ever experienced before. I was in a room with 3 other women (two of whom were pregnant), and at first I felt really self-conscious about my moaning. Later on, this gave way to full-out screaming and wailing, which I had really no self-control over. I just remember screaming "Oh my G-d" over and over again. Y held me and rubbed my back and squeezed my hands. He was so brave for me. He was and is my rock.

The doctors and nurses kept referring to "performing my abortion" and "you're now in the middle of the abortion" etc., which really upset me. I know it is the medically correct term, but since they also perform elective abortions in the department, I really wondered how many of them looked at my chart and history closely enough to know that I was an infertile who lost her baby, not someone trying to undo a bad choice. It also upset me to think that the other women with whom I was sharing a room may have thought I was having an elective abortion if they overheard the doctors and nurses talking to Y and me.

Eventually, the worst of the pain subsided and I waited to bleed. It took a while for the bleeding to start, though it did pick up around 12am. By morning, I was still too nauseous to eat or drink so I got IV fluids and IV Zofran, which made me feel a whole lot better. They sent me for an ultrasound, which showed that the miscarriage was still in process. However, the gestational sac was no longer intact and we were told that the Cytotec was likely a success. Finally, I was discharged around noon.

Now we wait and go back for an ultrasound and a follow-up appointment in 2 weeks and we hope that I won't need a D&C. The doctor said that we can return to fertility treatments after I have one normal menstrual period. Hopefully, this will happen by the start of the new year. Speaking of the new year, it upsets me to think that we were 25 and 33 when we started TTC. In January, we turn 27 and 35, and still no baby or even viable pregnancy to our name. I have faith that some day we will have our healthy, take-home baby, I just spend a lot of time questioning how much pain and suffering it will take us to get there.