Urban Legend

April 5, 2010

In some ways, 2009 was kind of a rough year. I pulled together all our tax paperwork last week for our accountant, and I noticed, over and over again, all the bills for our medical expenses.

A large chunk of those expenses were for infertility coverage. There was extra insurance to cover the costs of fertility treatments in our state. There were extra procedures to figure out if we can have a girl without chromosomal defects. And sometimes there were extra costs on top of those procedures that aren’t always reimbursed.

That’s a bunch of extras.

And that doesn’t include the ongoing costs: parking and routine lab-work, co-payments and babysitters so we don’t have to schlep our son to these appointments. More to pay to get additional coverage at daycare and nursery school. More excuses. More guarded explanations.

Our three-year-old knows what it means when I say I have to go to an appointment. “What’s the doctor’s name?” he’ll ask. He hasn’t yet figured out which name signifies what medical issue is being examined.

So what exactly did we do in 2009?

* One fresh IVF cycle over the summer, that ended in an early miscarriage and D&E. (transfer July 4th. Try explaining to your friends who have come to your neighborhood to watch the parade in front of your house about why you are leaving your son with a babysitter while you and your husband are trying to sneak out of the driveway. To get to a clinic. That no one knows you are visiting. At 9 in the morning, no less.)

* One frozen embryo transfer in the fall that didn’t develop into anything. (Circa Columbus Day Weekend).

* One vaginal procedure to figure out if there was any scarring obscuring anything en route to the uterus. (The week of Thanksgiving. Some minor scarring, but only enough to direct future people to enter with their assorted medical tools and whatnot “at 7 o’clock.”

* Another fresh IVF cycle that started around MLK weekend, 2010, but ended in an even earlier miscarriage by Valentine’s Day.

We honestly didn’t plan any of this around holidays. It just worked out that way.

For my 40th birthday this spring, the insurance company gifted me with yet another test. To prove that my old lady ovaries were still working properly (and therefore, worth insuring for another round of IVF), I had to do a Clomid challenge. This entailed yet more blood tests, several days of taking Clomid to help amp up my ovaries, and then a vaginal exam to determine my uterus was still clean and clear.

The nurse who did the exam remembered me from an appointment last summer, when she confirmed that I’d need a D&E for a miscarriage/failed IVF. “How are you doing,” she asked mournfully. “Still trying to have a baby,” I replied, all matter-of-fact, with advice: “By the way, go in at 7 o’clock and use a tiny speculum.”

She did and she did. “I see one follicle in here,” she noted. “I’ve been taking Clomid,” I reported. When not being mandated by one’s insurance company to prove ovaries are still working right, Clomid is the first line of treatment when you aren’t conceiving. I’d taken it many cycles before, long before the IVFs and the IUIs, the workups and the endless bloodwork. It had never done much for me, honestly.

But maybe could it work now?

I went home with a new mission.

“Let’s have sex!” I told Mr. L. What did we have to lose? A follicle was in sight. Never mind that we’d been here many times before, so many times that actually having sex for recreational fun was something I’d nearly forgotten how to do. As I had many times before, I bought an ovulation predictor kit and dutifully peed on a week’s worth of sticks.

The ovulation predictor tests were never entirely conclusive, but the egg white mucous pouring out of me one day suggested it was all systems go. Once again, we tried to do what most of the rest of the world does to conceive.

How shocking—we were in a bed, just the two of us! For once, I was not draped in a hospital gown and a paper shower cap, my feet up in stirrups, Mr. L sitting at my side, both of us freezing in a clinical exam room, our eyes glued to a monitor as a pipette with fresh or frozen embryos were gently, carefully, guided through my cervix and into my uterus, as my full bladder threatened to leak all over the doctor doing the transfer, the nurse assisting, and the embryologist who was always there telling us which embryos looked the best for the procedure.

Romantic, no?

But this time, things were a bit more ordinary. The typical way the majority of people conceive.

Again, since I’ve been here many times before and have never gotten pregnant with just sex, without a round of fresh IVF, both the Mister and I carried on with the rest of our lives. My day-to-day blood sugars were okay, but not stellar. My thyroid levels were a bit low. The only minor change this time: I was taking Metformin, a drug my infertility doc recommended, not because my sugars were out of line or because I’ve ever shown any sign of having polycystic ovaries, but because it might “help my hormones,” whatever that meant. I continued to eat deli meat and drink diet Coke.

One week later, at a party, I ate a smidge of Brie cheese. Weirdly, after we were on our way home an hour or two later, I felt sick to my stomach. Mr. L had to pull off the highway so I could find a bathroom. I couldn’t tell if I had to vomit or sit on the toilet for a long time. Thankfully, I didn’t vomit.

“Maybe you’re pregnant,” Mr. L said, after I left the Gas and Go’s public bathroom, shuddering.

“Maybe. Wouldn’t that be something?” I said.

I didn’t have a lot of faith.

In the meantime, we met with a few other doctors. This included another infertility specialist to get a second opinion. She told us she would keep doing what we’re doing, but to stop using PGD, an expensive procedure that tells you the chromosomal makeup (and gender) of embryos before you they are transferred via IVF. We didn't have any history of chromosomal abnormalities, and the procedure might even damage healthy embryos, so it wasn’t worth doing, she told us. A nutritionist said I was on the right track. My endo told me my A1c was 6.1 and that my bloodwork, for the most part, looked fine.

“We did try this month, but I’d be shocked if it meant anything,” I told them all. “Good luck,” they all said. One medical assistant, who waited with me as I waited to see my diabetes endocrinologist, regaled me with stories of patients she’s seen who get pregnant on their own after years of infertility treatment. A friend I haven’t seen in ages told me a distant mutual friend, one I’d lost touch with over the past year, recently delivered her healthy son. The new mom was a woman who’s done as much if not more fertility treatment than me, and had conceived her toddler daughter after a lot of IVF. Her newborn son? Conceived naturally.

I’d always thought these stories were urban legends. You hear about them, but do they really happen?

We had our follow-up appointment with our reproductive endocrinologist on a Friday in April, about two months after the last IVF ended in another early miscarriage. We’d waited the appropriate amount of time. We’d had more bloodwork to see if there were chromosomal or genetic reasons why my last two pregnancies ended so prematurely. Nothing showed up. All we had to do was wait for my period to start and we were geared up to start the next fresh IVF cycle. I was all set to order the drugs the day my period started.

That weekend, my period never showed.

I bought a pricey digital pregnancy test that promised results in three minutes.
In less than one, we had our answer:


We’ve never been here. We don’t know the embryo cell count, the potential for implantation, exactly how many days post-transfer I am. How many were transferred?

That Monday, I went to the infertility clinic for a blood test. The nurse left her message on my cell.

Beta count: 165. “Very good. We want it to be anything over 100.”

Progesterone level, that indicates the uterus is prepping to support an embryo: 40. “It doesn’t get much better than that,” the nurse said.

How did I get here? The Mister and I actually had sex and get pregnant? And me at age 40, no less?

I honestly have no idea.

Blog Poll: Potential Author Photo

I didn't keep up with writing about all my fertility stuff because work got busy, but we had the embryo retrieval and transfer last week.

Now it's a waiting game, amid work deadlines, freezing cold weather, family stuff and ever-shrinking bank accounts.

My latest question occupying my mind is an author photo and hair texture: curly or straight?

I'm having a photo taken this week.

I've never run pictures on this blog for anonymity, but the truth is, people can find my photo online if they look hard enough.

So I'll make it easy.

Should I go straight, which requires more prep time, looks sleeker, and is what I did often before I had my kid:



Or do I go curly, which is my typical style these days, and maybe makes me look more like an "I can relate to her!" fellow mom with diabetes who has a child and doesn't spend an hour on her hair:



Of course, I'll be standing up straight, dressed appropriately, and not at a party (unlike these two shots) when the author photo will be taken.

And agewise, the curly shot is closer to how my face looks now, save for whatever retouching magic my photographer can wrangle.

What's your take?

Dude, Where's My Pump?

This morning was my fourth blood and ultrasound visit for this IVF cycle.

(For those of you not familiar with the infertility bandwagon, this was my fourth morning visit to my infertility clinic for a blood draw and a vaginal ultrasound with the ever-popular tam-cam. This giant tampon-like camera takes a photo so someone can manually measures the length of the follicles growing on my ovaries. Once the follicles hit a certain number, it's showtime. The next step is triggering ovulation (which will release the eggs growing on the follicles), and then mixing the eggs with the Mister's sperm in a dish to figure out if any of them look good enough to transfer back into me to see if this whole rigamarole actually produces a real pregnancy with an honest-to-God live baby.)

But I digress.

Because the ultrasound is done pants-and-underwear-free, I've been clipping my pump to my bra so it stays out of the way, and has a place to stay. Typically, I always just latch my pump to my waistband or put it in a pocket--don't you?

After the clinic visit, I did a few errands in a blissful morning of being kid-free. The Mister has been taking Toddler L out for errands of his own every Saturday morning--they call them "Boy Errands." This started when I was working this summer and needed more alone time to write, but the pattern has continued even after the work has ended.

Boy Errands typically include heading to Home Depot, the local recycling center, the local gas station (which Toddler L has taken a new liking to. We now drive on the highway and he'll shout out the names of gas stations. Mobil! Hess! Getty! Sunoco! Shell! Our kid knows 'em all). One thing that is not allowed on Boy Errands, Mister L tells me, is me.

This means I had the morning to myself.... and I went out to our local warehouse store so I could stock up on diapers and shelf-stable low-fat milk in individual servings.

But hello! What else is new? I felt low coming on, and my CGM confirmed it. I went to suspend my pump as a way to help bring myself up and.... couldn't find it.

Left pocket? No.

Right pocket? No.

Waistband? Nuh-uh.

Did I leave my pump on the bathroom sink while I was showering?

Oh wait.

There it is--clipped onto my bra underneath three layers of tank top, sweater, and bulky winter coat.

Confusion averted.

At What Cost?

My period's gonna come any day now, and that's when I start taking the drug that amps up my ovaries.

Until then, I almost feel like IVF hasn't really kicked off yet.

Oh, but it has.

I've been on the Lupron for about five nights now. As I've mentioned before, it's like injecting ten units of insulin. Been there, done that. I even need to time it to a certain hour or so each night, but other than that, I've sort of forgotten about it the rest of the day.

We have a stack of papers that I'm supposed to sign, along with Mister L., and send them off to our IVF clinic. In the past, I've been super on top of this and had everything in like a model patient.

This time, I've gotta go track down a notary to watch the Mister and I sign these things. My nurse tells me to get the paperwork in by the egg retrieval, which I know is more than a week away. (I'm too lazy to go and figure out what my estimated egg retrieval is right now, but I know I've got time).

I also wrote out another check to my secondary insurance plan--the one that pays for a majority of the infertility stuff since our primary insurance covers little. It may have been the Lupron working its hormonal magic, but seeing myself write out the amount of the check made me tear up.

Every other month, since last spring, I've written this check without a problem. Just like every other medical expense, I've told Mister L, it's been matter of fact.

Hundreds and hundreds of dollars in out-of-pocket expenses for diabetes medical supplies, doctor copayments and co-insurance until we hit the "catastrophic out of pocket maximum" our insurance says is the limit before they cover everything else? An amount we hit by April or so each year?

"It's just the way it is," I've told Mister L. Other people pay for their kids' braces, or their rehab stints, or their own health or money issues that may not be chronic like mine, but I know they're coming for everyone one day or another. We pay for health insurance and its assorted coverage for various medical expenses. (We also fund our retirement accounts as much as we can each year. Because although we may be poor by the time we actually make it to retirement age, fuck, yeah! we plan to live that long and enjoy life with whatever our dollars will buy by then.)

However, this week it hit me exactly how much I have paid for this secondary insurance. Along with other out-of-pocket things (parking at the doc's places, acupuncture before and after an embryo transfer, who-the-fuck-knows how much on juice boxes and sugary snacks and other crap to treat who-knows-how-many-insulin-reactions to keep my blood sugars in a tight range for pregnancy or potential pregnancy).

It struck me that all the money that's paid out for diabetes has a result: I am alive. My blood sugars are reasonable enough to get pregnant without worry. My eyes haven't fired up (too many) extra blood vessels and so my retinopathy isn't angry and my eye doctor and endocrinologist are fairly happy with me. Those dollars, to me, have been well spent.

The money for infertility insurance coverage, for genetic testing to figure out exactly what embryos will be viable, the acupuncture, for extra child care so I don't subject other people at the IVF clinic to my toddler running around in the waiting room, and more?

Gone with the wind, baby.

The Mister and I have heated discussions about expenses and where we can cut back and how I can bring in more freelance income. We've spent thousands. My bank account flirts with minimum balances.

So far, it's all been for nothing.

We spent a ton out-of-pocket to conceive our first child, and while it took more than a year from first-fertility-doc-appointment to Welcome-Baby-L!, there finally was an end. From today's vantage point, it was easily the best money we ever spent.

But here, in the midst of my third time trying to do all this again for a second kid, I worry that it might not end so well. Or maybe it will... but we'll have little to no money if and when we ever get there.

It's The Hormones, Duh

Yesterday, I made the decision to try to eat more fruit to round out my diet, and was pleased by the two clementines I had for a midmorning snack.

My sugars were good most of the day. I didn't think twice about what I ate.

Today, I just demolished a bag of chips. After my sugars have been high all morning.

What happened?

I started my first Lupron shot last night.

Googling "Lupron" and "food cravings" didn't bring me anything definitive. While writing the infertility chapter for my book, I only got people to say that "maybe" some of the IVF drugs could affect your sugars, and maybe they wouldn't. (Though I believe progesterone is linked to higher blood sugars). Needless to say, based on my own history over the years, I would say these drugs do something to make my body crave certain foods and to make my sugars act erratically.

I'm actually always surprised when I manage to note some kind of trend that shows that, hello! It's not just me: hormones are powerful things! Craving crap and thinking certain things about my body nearly always comes the day or two before my period does. My sugars are often so much more reasonable when I'm, say, off birth control versus on it.

Why should IVF drugs be any different?

Catching Up

Writing a book has a way of taking over all your free time. But now that the manuscript is in, I can get back to actually blogging again.

It's a bit weird now, because more people I know are aware of this blog, but with the book coming out based on my blog writings, it makes sense to keep on keepin' on.

This month also marks the fourth anniversary of when I began blogging. I sort of miss my blogging heyday when I had stuff to say regularly and lots of people left comments. I miss those comments, people! Then again, writing sporadically over the past few months if not two years will explain the (mostly) radio silence.

There's actually an upcoming event that lends itself to blogging: we're gearing up for another round of IVF.

Though I haven't blogged about it at all, we've been trying for kid number two for ages. People I know who have had their second children months ago conceived after when we first began trying. We did an IVF cycle this past summer, which got me pregnant, but things never progressed properly. The embryo stopped growing around week 5, and soon after, I had a D&E and was just eager to try again. Pregnancy loss that early is quite common, and it took me longer to chase my insurance company for reimbursement for certain out of pocket expenses I paid for up front than it did to recover from the entire experience.

(Jaded much? What can I say--nothing's ever straightforward when it comes to conception and me.)

We also did a frozen embryo transfer in the fall with two embryos that were created back in 2006 when Toddler L was conceived. We had sort of high hopes that since Toddler L is so fabulous, some of his embryonic siblings might be equally great. Alas, not to be: the FET yielded no positive pregnancy test. Our fertility doc told us that our the success rate for an FET is about 15 percent for a woman my age and with my health history, compared to about 30 percent for a fresh embryo transfer. So despite the fact that we still have a pair of 2006 embryos in storage, it's back to IVF.

The fertility doc put me on Metformin, with my Kind Endo's blessing, because he claims the Met helps my hormones stay in order. All I've noticed is that my blood sugars seem a lot less rollercoaster, particularly after meals and during the night. I'm loving Metformin, and I plan to ask my Endo if I can stay on it. Any other type 1 gals out there on Metformin?

Fittingly, my box of IVF meds *just* arrived as I am typing this post.

I'm not sure how many rounds of IVF I'm willing to do after this one. I'm at the point where I fully appreciate the son I have and wouldn't be crushed if he were my only child. I consider myself an IVF vet by now, but I'm pretty weary.

Let's hope the third time's the charm.

Back At It

The weeks of eating recklessly happen every two weeks now.

For two weeks of the month, I guzzle diet soda. I eat chicken sausage and don't second guess anything. Last week, I ate a ton of raw cookie dough.

I test my sugars every few hours.

And then, it stops.

I wonder if this is the month I've conceived, and my eating patterns try to fall into line.

I drink skim milk with my meals and cut out the caffeinated diet stuff altogether. I chill on the cold cuts. I eat more fruit and veggies.

I test my blood sugar an hour, two hours, three hours after a meal. And I try to get the one hour post number down.Down.DOWN.

Kind Endo told me last week that I shouldn't correct a high before three hours are up. But if there's something trying to thrive inside, I feel bad if my one hour post prandial shoots past 140.

And yet, I try not to stress about the rebound highs. Like the super high that happened this morning after I was 66 at 2am.

And there's a diet soda that's caffeine- and sugar-free that tastes so much better than flavored seltzer, but it has potassium benzoate in it, a preservative. So I try to limit it to one cup a day,

I'm sitting outside right now because a carpet cleaner is trying to eradicate the odor of Baby L vomiting on one of the rugs last week. And while the cleaner told me there's nothing harmful about what he's using to clean the rug, I immediately noticed my mouth tingling from the fumes and got up. What if there's some cluster of cells inside me? Hopefully these quick fumes won't rearrange anyone's cell structure (mine or a potential embryo's.)

(The carpet cleaner assures me he's healthy.)

Here goes another two-week wait.

Achieve to Conceive?

We're actively trying to get pregnant.

And since I may know you in real life, unlike the first time I started chronicling our experience, please keep it to yourself if you see me and want to know "How's the baby quest going?"

It's a lot of waiting.

Not that this is anything new.

I'm in the midst of month one of fucking for fertility's sake.

I dragged out this ovulation prediction software I bought the last time and got it set up on the upstairs computer. So every morning now, I take my temperature and chart it to figure out when I might be most fertile. Or about to ovulate.

The Mister has been sick for more than a week now. The first bout of achiness and sneezing and feeling like crap coincided with--whaddaya know!--with the month's prime time for getting down.

"Tonight's the night," I explained.

"I just can't," he said. "I'm sick!"

Sick, schmick! Do you know how much fine-tuning--of blood sugars, of thyroid levels, of menstrual cycles--it took to get me to this night?

But the guy really looked like doom.

I fumed about this for a bit before I realized that sex the next morning would still count as a BEST TIME! according to my fertility software. So he got the night off.

The next morning, he was up to the task. Still sick. But not incapacitated.

So now I'm about a week away from when my software predicts I'll get my next period. Or I'll feel like peeing on a stick not to check for ketones, but for a possible embryo.

My blood sugars have been all right. I'm trying to test at least an hour after eating, and I've tried to exercise or take a titch of insulin if they're above where they should be. But I definitely don't obsess if my waking blood sugar is, say, 112 instead of 70-90 mg/dl.

I'm slated to see my Kind Endo for a regular checkup this Friday. Around the same time when my period is due.

It would be mind boggling beyond belief if I were to actually get pregnant the first month of trying for Baby #2.

But for the next week or so, I'm willing to be boggled. I'm willing to join the bloggers I read who naturally conceived after doing IVF.

Stay tuned.

Like Yesterday, With An Addition

We met with my Kind Endo yesterday to talk about trying for baby number two.

It was so familiar, and yet different. The schlep to the Big City Hospital. The traffic jams. The calls that we'd be late. Parking. The look of the lobby. The waiting room.

And yet this time, we had Baby L in tow, pushing our crazy-big stroller and carrying crackers and pretzels and sippy cups and playthings to keep him entertained.

I've spent So.Much.Time visiting this particular doctor, in this particular part of the hospital. 

But this time, I had something other than banter to share with the office administrator and the receptionist and the phlebotomist who takes my blood expertly: my son. (Though Mr. L was there for the visit, too).

The visit itself was pretty uneventful. I am a pound under the weight I was after I got pregnant with Baby L. I offered to pee in a cup before sitting down. Kind Endo asked me a lot of usual questions about my health that I was thankful I could say no to. (Night sweats? Painful urination? Any chest pain? Coughs? Swelling? Negative.) A different twist with this visit: Baby L made himself known, pulling clean johnnies out of a drawer and practicing his walking by inching his way around the examining room, knocking patient paperwork to the floor, clutching someone's lab results in his tiny hands, and giggling. 

"Baby L doesn't know the intricacies of HIPPA yet," Mr. L explained and I wrenched the paperwork out of the boy's hands. Luckily, Kind Endo took it in stride.

As she paged through my meter, she noted that my bloods were erratic, but as I pointed out, I haven't been trying to get pregnant this week. I promised to fax over a week's worth of logging with blood sugars, carbs counted, basals noted, boluses written. Kind Endo said that once I start writing things down, my numbers usually come into line nicely. I'll find out my A1c later this week but it's usually pretty good--if it were based on just A1c numbers, I could likely start trying ASAP.

And oy, the trying.

We'll likely give it three months for the au naturel route, then ramp right back up to either IVF or a FET (Frozen Embryo Transfer) if any of Baby L's siblings are still around after being stored for two years. 

When I think of all the time spent previously--a year of going to the diabetes clinic to keep my numbers in check while Mr. L dealt with his own health issues, six months of sex without results (other than exhaustion), and another six months of the alphabet soup that encompasses infertility (HSG, ART, IUI, IVF, ad nauseum), I honestly hope that experience will cut out some of the waiting. I realize how lucky I am to even have such a fabulous son after all this work, but I hope some of life's past experiences might make this attempt an easier and quicker, but equally healthy one.

Particularly if I have to juggle pretzels and playthings for another certain someone at the same time.

Going for the Gold

I did it.

I asked a question at the doc's office that hadn't been asked before.

Since I tend to ask a lot of questions (and it was even documented in my chart, I learned yesterday), I often say things to reassure myself that I'm not the only crazy one.

"Surely I'm not the (craziest person you've seen/only person who's worried about this/the worst you've dealt with)?"

Yesterday, I was.

Week 28 appointments all jumbled together on a Friday morning: Kind Endo, the ATU unit, and the High Risk OB.

For the second time, High Risk OB was in the middle of an emergency procedure, so I saw the nurse practitioner, who I've seen many times before and like a lot. NP confirmed for us that the c-section is officially scheduled, and that things seem to be moving along. I piped up with something I've been concerned about since day one of this pregnancy.

"Since this is an IVF baby, is there a way to find out, right away, that this kid is genetically ours?" I asked. "I mean, I know the fertility clinic is renowned and all that, and if the kid comes out a different color or race, it'll be obvious. But really, even if the kid sort of looks like us, how do we really know? Is there DNA testing we can do right there?"

Nurse Practitioner paused, talked about paternity tests and insurance not covering such things, and that we'd have to look into such testing ourselves, and that if there was a problem, we'd have to approach the fertility clinic and take it up with them. Then she gave me a look.

"Surely others have asked this, right?"

"Actually, no. You're the first."

"But you hear about this stuff happening," I countered. It was a storyline on Desperate Housewives last fall.

Nurse Practitioner is a great nurse--reassuring, professional, and easy to talk to. She wants to be polite.

"Oh, you can be honest," I said. "I can handle it."

No one has ever voiced this concern to her, and while I'm the clinically interesting patient with the host of issues, this one is likely to put me in the Crazy Patient Hall of Fame.

Last month, when I was having odd leg cramps, I looked it up in a common pregnancy guidebook that's been criticized for being too alarmist, and it said if pain continued, it could be a blood clot that could CAUSE BAD THINGS and to call your provider's office. Nurse Practitioner took that call, essentially told me that if I had a blood clot that went to my heart or head, I wouldn't have had time to call her, since I'd be in serious trouble. Said pain disappeared a day later.

There you go. I had been a contender for the medal, and yesterday I took home the gold.

Earlier yesterday morning, before the NP visit, I had my first visit to the hosptial's ATU unit, which apparently stands for Antepartum Testing Unit. If post-partum is after the kid arrives, though, why wouldn't it be called pre-partum beforehand?

At the ATU, I had yet another ultrasound and the kid's head, abdomen and legs were measured to determine how much it actually weighs, and I was assured that the amount of amniotic fluid in my uterus is at an acceptable level.

As of yesterday, Baby L weighed three pounds, and everything was developing on schedule. The legs and abdomen were all a few days ahead of where I am in the pregnancy, and the baby's head measured nearly two weeks ahead.

"Does this mean my diabetes is giving the kid an oversized head?"

"No, actually, everything looks great. The abdomen is what usually indicates a problem with diabetes, and it looks fine."

Kind Endo later reassured me that diabetes tends to make the kid skulls smaller than usual, and that everything looks within normal ranges.

"I have an oversize head," volunteered the Mister. "Hats never fit me right."

The ATU nurse doing the ultrasound also noted the kid's activity, saying the baby's fist was clenched up and relaxed as it moved in front of the face. "Good fine motor skills," she said.

"So that means the kid's going to be a great engineer, right?" asked the Mister, a proud engineer.

(I've countered that this baby will grow up to be a Scrabble champion and a word lover. We'll see how the left-brain/right-brain fight will play out at home).

Finishing up the trifecta of appointments, Kind Endo saw me and made the usual adjustments to my ever-creeping higher blood sugars. Last week, I topped out at an even 100 units of insulin for just.one.day. It wasn't even a crazy eating day. Just the insulin resistance kicking in even more.

Now that I've passed 28 weeks, I'm starting to read about the possibility of going into premature labor. With all my general nuttiness, and the reassurance that I'm scheduled to have a c-section on a specific date (at a specific time!), premature labor would shake things up but good.

I just signed up for a bunch of classes through my hospital, all about infant care and breastfeeding and CPR and a cesarean-specific class. I haven't even thought about Bradley or Lamaze or breathing techniques because I figure I can skip all that.

But premature labor? Water breaking and contractions too early?

Oy.

I just gave myself something else to worry about.

Week Twenty-two Mishmash

Laziness? Nah.

Busyness? Sure.

I just haven't had it in me to blog recently, which makes me think I'm never going to win any OC award because I haven't given anyone enough new content to consider.

But honestly, sometimes I read people's posts about, I don't know, testing their blood sugars, or having a low or a high, or where they wore their pump today, and I think, "That's what people want to write? And more importantly, that's what people want to read?"

I just react to these events, which happen to me daily, and move on. I honestly don't think they're much to write about. I mean, my hypoglycemia unawareness is pretty fierce right now, but becuase I'm testing constantly, it doesn't surprise me when I start driving and see I'm 70 or 54. I just grab a few LifeSavers and keep going and the sugars always go up.

Instead, I think about how obsessive I was trying to pick health insurance for next year. How I quiz and question every rep that comes to my office, or who drops off marketing material at Mr. Lyrehca's office. And I don't really bemoan the rising costs of it all. I just accept it for what it is, and know that without it, I'd have no money at all to maintain anything.

Sort of similar to the cost of all the infertility treamtent over the past year: we agonized over it, did what we had to do to minimize the costs as best we could, signed up for a second insurance to cover a portion of what the primary insurance didn't cover, and just pay the bills, bit by bit, months later.

I mean, is that even worth blogging about?

My blase-ness even extends over to last week's big news about curing type 1 diabetes in mice. While I've seen hopeful posts and excited comments from people all over the diabetes blogosphere, I'm with some of the type 1s I've read who say, "I'll believe it when I see it in effective human trials." I mean, twenty-nine years of type 1 will do that to you.

In the meantime, I continue to take more insulin than I ever have before to maintain relatively good blood sugars, and my belly and uterus continue to expand. I'm 22 weeks today and while I wonder if the occaisional aches and gas pains I feel are really the movement of a healthy fetus, I know the kid is growing because I get bigger every damn day. A shirt I wore two weeks ago looked really bad this weekend when I attempted to wear it again.

What else? We started to look at day cares today, which is surreal when the student-in-question is still in utero. And yet, to guarantee a space for next fall, now's the time to check places out. It's all still up in the air about what I'll end up doing, but at least we're seeing what it's like at these day cares and what the costs are and how I might be able to swing working from home without my endless commutes and long hours of my current staff job.

And in totally unrelated news, I'm doing a ton of freelance work. I stayed home from my day job today to check out the day care centers, and ended up doing some freelance from home this morning and got emails from editors about picking up some other potential assignments. This is the sort of thing that thrills me--that people know I'm good at the kind of work I do and seek me out for freelance work.

The Wait and the Water

Unlike other blogs I've been reading, I have not been anxiously peeing on pregnancy tests this weekend to see if I can figure out I'm pregnant before my official doctor's pregnancy test this week.

Why tempt fate? Why get excited by a false negative? Or a false positive?

Or throw away money at CVS to go buy the tests?

So this week is it...I'll learn if our first IVF venture was successful or not.

I just made a list (in my insomniac state; it's 5am over here) about what I'll do next if the test is positive, or negative. If negative, start working out hard every day to take off the ten pounds I've put on since I've started trying to conceive and call the fertility doc to figure out what to do next. If postive: call my army of docs and figure out when to get the eyes lasered, when to see the endo next, when to see the high risk ob/gyn, and oh yeah, maybe read a few pregnancy books so I can overanalyze every bodily feeling.

Speaking of, despite some odd twitchings here and there, and another story I'll get to in a moment (and I apologize now for the TMI part of this post), I really don't feel all that different. Occasionally, I forget and pick up something not-all-that-heavy, and I get a little abdominal ache. I don't know whether to cheer silently and think, "that's our embryo! You grow!" or to freak out and think "Shit! Did something bad just happen?"

And diabetic-wise, sugars have been OK except for a few weird highs, along with some more lows because I've gone back to correcting highs (i.e., more than 140 an hour after a meal) with what I think is my own mental calculation of Insulin On Board (I still have a Minimed 508 pump), only to go low and snarf Life Savers a few hours later. And eating a shitload of Trader Joe's chocolate yesterday certainly helped contributute to my current insomniac state (I corrected a 227 at 3:30am). Ugh. Is the embryo, if it's still in there, choking on too much sugar? Did that chocolate craving just make my future kid's abdomen a little bit rounder? Just increase the kid's chances of being diabetic by 1 percent?

Working long hours all last week helped keep my mind off of things within, although frankly, the hours of my job are really annoying and make me resentful. I love the essence of what I do, the field I'm in, and the job title/publication of where I work, but working 'til 8, 10, or 11pm one week every month is truly getting old. My mother worries it's stressful to do so, but I'm not stressed because I know it's going to happen every month. I just wish I could make more money working out of my own home, being my own boss. (Send your lucrative freelance writing/editing/research assignments my way).

On Friday, however, I got some news. Working at 7:30pm, trying to finish up a very long week, my eyes blurring from reading some copy in a typeface that frankly, was hard to read, yet chosen by a pompous art director, I picked up the phone to hear Mr. Lyrehca's voice.

"We have a problem."

"What?"

Turns out it was a toilet on the second floor of our house. A toilet that, yes, had gotten clogged earlier in the day by someone who wondered if constipation was a positive sign of an early pregnancy. Although the toilet looked OK when that someone left for work in the morning, the toilet instead somehow leaked all day. Water flowed from the second-floor bathroom, to the first floor kitchen table (with all sorts of paperwork on it) to the basement and garage. For 12 hours.

Nice.

I finally got out of work (my boss seemed sympathetic when I told her and added "I hope we don't need a whole new kitchen") and got home around 8:30.

Driving home, I had visions of Hurricane Katrina floating through our house. Would we need to spend thousands of our (IVF!) money to renovate the kitchen? Was the bathroom OK? Was sewage floating through the house? Did I need to call in, among many other high-priced professionals, a feng shui expert to figure out why bad things were happening?

My husband is a handy man. Not officially. But we happen to own a wet-vac (yes, a vacuum for water), and he went to work sucking up the wetness on three floors. By the time I got home, I didn't see any water on the floor anywhere. Soggy papers, a water-logged library book and upholstered kitchen chair, and some paint bubbles all over the kitchen ceiling and walls, yes. Two feet of water, no.

Turns out my visions of Katrina were overblown, and that there never was two feet of water, but just wetness on three floors. And after we called in a flood disaster company to assess the scene at 11pm Friday night, they agreed that Mr. Lyrehca had done a great job cleaning up the (sewage-free, they confirmed) water, and that they didn't think they needed to break through the kitchen ceiling to see if there was any mildew. Instead, they left three humming fans and dehumidifiers, which have been blowing and drying things out all weekend.

As I pointed out to Mr. Lyrehca, while having a flood is annoying, a waste of our savings, and an effin' hassle, it was not what I pictured when he called and said we have a problem.

Nobody broke into our house and stole precious irreplacable things. We did not lose anything in a fire. No one died. As of right now, I can still think that I might be pregnant.

In the big picture, it was just a little water, water everywhere. Right now, there are more important things to worry about.

This Ship Is Approaching Land

Not sure where that analogy came from, but in short, things are actually working in this IVF cycle. Hopefully the island in sight is populated by fertile people and healthy infants and not the land of the childfree. But like anything else, I won't know where I am until I get there.

After two weeks of taking both ovulation suppression drug Lupron and follicle stimulation drug Gonal-F, and four different blood and ultrasounds over the past week, my ovaries have actually grown four follicles on each side that are considered the right size. The left one has follicles ranging from 14 to 20.5 mm, while the right has four ranging from 13-17 mm. The target number is "more than 18."

This means that tonight (yikes! In an hour, actually), I'm officially taking my trigger shot, which will tell the follicles it's time to give up some eggs. The Lupron and Gonal-F are over for this cycle.

It's odd to know that my body has actually done what it is supposed to. Oh sure, it took some pricey drugs, several early-morning visits to be ultrasounded downstairs, and months of doctor's visits. But like the diabetes, with a little outside pharmaceutical help and needles, things appear to be working correctly inside.

This means that on Tuesday at 7 am (and yes, I think I'm first because of my diabetes), I'm headed to the fertility clinic for the egg retrieval. They tell me that the follicles can continue to grow between tonight's trigger shot and Tuesday's retrieval, so I'm hoping things look good once I'm knocked out (because let me be clear; IVF is surgery and I'm getting anesthesia) and someone's scoping around inside to see how many eggs there will be. And please, please, let's pray things go well on Tuesday and there's something to retrieve and I handle the procedure beautifully.

Mr. Lyrehca and I have been doing assorted rounds of "Woo, Woo, Go Lupron" or "Woo, Woo, Go Gonie" for good luck. At this point, we're trying to be as positive as possible.

I know it's still way too early to know how anything might transpire. But I'm actually trying to feel cautiously hopeful.

And for whatever reason, my blood sugars have been just dandy.

Oh, Tuesday actually corresponds with yet another eye doc's appointment, but I'll be rescheduling. Retinopathy, schmetinopathy. This week's R condition is all about egg Retrieval and possible Reproduction.

Two Shots A Day? Check

I envy the people who blog more than once a week. My slacker self can only get it together to post weekly.

Thanks, Nicole, for asking if I'm OK. I'm OK. The IVF shots have increased to two times a day, and now I'm going for blood and ultrasounds every few days to measure how well I'm responding to them.

After about a week of Lupron shots, I added Gonal F to the mix, which is the stimulation drug. Not sure if I mentioned this before, but the needles on the Gonal F shots are so much sharper than the Lupron needles. They just sink right into my skin without a push, while the Lupron shots, well, need a little more force: "Get in there, you surly Lupron shot. Don't make me get up and smack you. Why can't you be more like your sister Gonal F?"

Side effects have been minimal, although they included a day of abdominal cramps like a period. It was reassuring to think the drugs were actually working. I also noticed a weird numbness on the back of my left calf. This immediately made me think "neuropathy has finally reared its ugly head," and sent me straight to Google to determine why a diabetic complication would choose this week to show up. Dr. Google noted that numbness is a Gonal F side effect, so I called the fertility doc's office to report this. The nurse said to watch it and to call if things got worse. The next day, it was gone and thankfully it hasn't appeared since.

(Who are these women that are like, "I didn't know I was pregnant until the baby popped out of me nine months later"? I can document every bodily twitch and ache down to the hour.)

After five days of shooting Gonal F and Lupron, I went to my fertility doc's office (at 8:30 am, considered a late appointment) for ultrasounds and blood work. Mr. Lyrehca called me at work later that morning to ask how the ultrasound went, "and did it make those wwuah-wwuah sounds like it does when they ultrasound a pregnant woman on TV," he asked.

"Um, the ultrasound wasn't quite like that," I said. "It was internal."

Pause.

"Oh, eeyah!" he groaned.

Yep, checking the follicles of your ovaries requires a vaginal ultrasound. This is akin to having a giant tampon pushed up downstairs. For me, this is actually less of an issue than having a duck-bill speculum inside one's orifice, but the first time is pretty, hmmm, I'd say unpleasant, but there have been more traumatic experiences in that area than this. Suffice it to say the first ultrasound had me staring at the plaster in the ceiling. You'd think they'd put something colorful to look at up there. A mobile, maybe.

The first ultrasound tech was sort of close-lipped, but did say I was responding to the stimulation drugs and that I should wait for an afternoon call from my nurse to get the specific results.

IVF basically stimulates your ovary follicles to grow big so that eggs can be manually extracted. As of a few days ago, I had one follicle that was big enough to be seen (greater than 12 millimeters), and several that were just under 12 that were likely to get bigger. This was happening on day 5 of my cycle, which is early in the game.

Yesterday, at the sunshine-happy time of 7:30 am (oy!), I had another blood and ultrasound experience. (The blood is measuring estradiol results, which are supposed to increase in tandem with the follicle growth). Yesterday I had three follicles on each side (left and right ovaries) that were measuring up well, and my Gonal F was actually reduced last night so that things don't grow too fast. And today, in an hour and a half, I am returning to the clinic on a Saturday to get another ultrasound. If things are growing accordingly, the nurse told me yesterday, the retrieval could happen early next week.

The retrival is outpatient surgery, so I definitely have to take the day off from work. I'm thinking that'll be more of a break in my routine than the multiple daily injections ("Heck, I'm diabetic. Taking shots is so old school.") or even the early morning fertility doc's appointments ("Multiple doctor's appointments? I'm diabetic. Been there, done that."

And yeah, in diabeticland, my blood sugars have been pretty good these days. I haven't noticed any specific changes based on the new drugs swimming through my body, but I have made a few food changes that seem to be making a difference.

One, I stopped buying peanut butter a few weeks ago. While I actually prefer eating natural peanut butter that has had most of the peanut oil poured out once I open the jar, the high fat content of peanut butter typically does a job on my overnight blood sugars, particularly when I spoon it straight from the jar at bedtime. My overnight blood sugars have evened out nicely.

Two, I've defected from my lunchtime sandwich of choice. Now, instead of a grilled chicken and Swiss with onions and cucumbers on seven grain bread with a dab of herb mayo, I'm now going to Whole Paycheck Whole Foods at lunch and creating my own veggie wrap. It's cucumbers, carrots, lettuce, onions and avocado with either Muenster or Monterey Jack cheese rolled into a whole wheat wrap. I'm still working out the carb count, as I've been going low in the afternoons, but it's fewer carbs than my chicken creation AND I feel good about eating a so many veggies at one meal.

And three, I made a slight adjustment to my 3am and 6am basal rate a week ago when a perfectly healthy grilled-chicken and salad dinner kept my blood sugars stable all night until 4am, when I woke up at 180, and things jumped to 228 three hours later. I upped both basal rates by a tenth. And since then, my waking blood sugars have all been within range. I'm pleased about that, since I have woken up with 200 blood sugars for years now. Overnights have always been my downfall.

Oh, this week a writer friend had lunch with her agent and told her about my diabetes and pregnancy book, which is still percolating along even when I don't blog about it. The agent told her that while a book like this is probably needed, she wouldn't represent it because the market is too small, and she thinks there are a glut of diabetes books on the market that aren't selling. There ARE a bunch of books on the market (and that's a future post I keep meaning to write), but I know I'm reading most of them. And honestly, there's a need for a patient-written type 1 pregnancy-only book. I just need to connect with the publisher or agent who agrees with me.

IVF, Week One

It's been a busy week filled with freelance jobs, my regular job, Mr. Lyrehca's company picnic yesterday, a hair color change, and oh yeah, Lupron shots.

Lupron has been a minor ripple, to be honest. It's just like taking a shot of 10 units of insulin, except that when I flick an air bubble out of the vial and notice a bit of medication bubble out of the needle onto the floor, I think, "Oy, that was expensive!"

Mr. Lyrehca has been very involved in the Lupron administering. Not in giving the actual shot, of course. But telling me to "wipe the top of the bottle with alcohol. Then withdraw 15 units of Lupron and return five units to the vial so that no air bubbles are in the syringe channel."

"Honey, I've been taking insulin for three decades. I know what to do."

"But this is different. Did you use a second alcohol swab to wipe your skin like the nurse showed you?"

Um, no.

And for any fellow diabetics out there, shooting Lupron is just like shooting insulin. The shots have to be taken at the same time each day, or within an hour of each other, and I've been on top of that. I've had a bruise here or there appear, but nothing that worries me. And despite what pops up on Google when you type in "Lupron and side effects," I haven't noticed anything different since taking it.

(Actually, I'm lying. Last week, I had some weird rash on my ankles, of all places. A quick call to the IVF clinic confirmed that my red ankles were probably heat rash. A Lupron-related rash would be more all over the bod. And a week later, the ankles look fine.)

In fact, considering the high humidity and temps over the past week, I've been more concerned that maybe the Lupron isn't working right. Last weekend, we went to a ginormous antique show/flea market and walked around in the heat for hours each day.

I carried the Lupron vial in my purse on Sunday, because by then we'd already checked out of the motel room where we were staying. I've been refrigerating the Lupron while at home, and keeping it in the meat-locker air conditioned motel room, but had to stash it in my purse (instead of in my hot suitcase in the hot car) as we searched for fun stuff to buy. (I like heart-shaped items and scored an awesome rhinestone-studded flower-shaped belt buckle; the Mister collects vintage telephones and picked up a cool U.S. military compass.)

So when I returned to work this week, I called the pharmacy where I ordered the fertility stuff and asked if the heat would bother them. Besides the Lupron, they sent the stimulation drugs (which have lived in my fridge for the past week and a half, per instructions), and two other meds that didn't have to be cooled (so they've been in the cardboard box they arrived in, in my unairconditioned-during-the-day kitchen).

The pharmacy assured me that everything should be fine, so I'm going to release my Type A tendency to think otherwise ("But it's been 90 degrees for part of this week. Are you sure the Lupron was OK inside my heavy blue leather pocketbook (now adorned on the strap with said rhinestone flower)?" and just see what happens.

The latest fertility event to happen is that my period arrived yesterday and today, right on schedule. While this has caused some negative energy in the past (see the "meltdown when the second IUI didn't work" post, or the "resignation, there it is again" past posts), the month-of-first-IVF-cycle period says to me "OK, we're moving on to the stimulation drugs. Here are the big guns."

So now I reduce my Lupron dose in half and also start Gonal-F, which hypes up my follicles to hopefully make some decent numbers of (and just plain decent) eggs. So while I'm annoyed about the extra trip to CVS to buy some tampons to replenish my stock (oy, I really thought I'd be done with those for awhile by now, months ago, when I bought what I thought was my last box of multiple-sized tampons), I'm pleased that things are moving along, IVF-drug-wise.

Once the egg stimulation begins, I'm not supposed to do things like train for a marathon or color my hair. While the training is something I wish I could say I'd miss (I haven't worked out seriously in ages, besides walking), coloring my hair will be a major life change. I've been enhancing my natural color, with various degrees of bleach, for a solid 20 years. As of Thursday, I was a typical over-processed, over-highlighted, roots-come-in-like-clockwork-every-three-months light blonde. And while I could see the hair colorists' concern that it was too light, too trashy-looking, too one-dimensional, and too drying for my hair, I just loved the look.

But on Thursday, I went back to my natural eyebrow hair color, which in the stylist's vernacular, is a "dark blonde." To me, it's just dark. Happily, no one's asked why, or even seemed to notice much of a change (which says that my natural hair color isn't all that dark, I guess) and Mr. Lyrehca said he liked it. The whole idea, though, is that should I actually get pregnant, I can avoid the whole should-I-or-shouldn't-I debate about hair color during pregnancy. Some docs forbid it, some say it's OK. Personally, I'd like to know how healthy Gwen Stefani's kid is, because I certainly didn't see her showing any dark roots over the last year.

Otherwise, this week was a nice blend of light work at my day job, and heavy freelance work from my side jobs. Oh, and my husband's company picnic yesterday, which I took a day off from work to attend. It was fine, and everyone was super friendly. One guy, though, who claims the Mister is like a grandson to him, came by to chat and wanted to know when we'd have "some crying around the office." I played dumb, and the Mister was similarly vague.

"You know, some little feet crawling around here," the guy pressed.

"Um, like cockroaches or mice?" I asked. "Hopefully not anytime soon."

He went on to talk about someone he knew who had adopted three kids. Which I appreciated. But at the same time, I certainly didn't need to get into a discussion about why we don't have children yet.

In the midst of all this, I was very clearly feeling some annoying cramps coming on, so I knew that the period was on its way. But because of all the IVF hoops, I knew that Advil wasn't recommended. So the Mister and I found a nurse at his company picnic who had access to Tylenol.

"I'm getting my period," I confided. "Do you have any Tylenol?"

"What about Advil?"

"I can't take it."

"Why not?"

"I'm diabetic and Advil's really hard on the kidneys," I purred. Who knew where that came from, or how I managed to say it without tripping over the real reason I was avoiding Advil, but I managed to get the nurse to give me the Tylenol. Blessedly, those cramps were history.

And now it's the weekend, where I actually have a free morning to blog without worrying someone's monitoring my computer at work. So enough about me; how are all of you?

Oh! I forgot about this because it's been up for a few days already, but Jenni at ChronicBabe featured my recent IVF post on Grand Rounds earlier this week, along with a few other diabetes blogging babes. Go check it out.

Erev IVF

I start my first round of IVF tonight.

Just like a Jewish holiday, this cycle begins the night of the first day. So right now it's Erev IVF, or the day before IVF.

There are four different drugs to take: Lupron, Gonal-F, HCG and Crinone. Three are sub-cutaneous injections, and one's a vaginal suppository. In a nutshell, they all prepare the bod to stop ovulating naturally, to stimulate follicles in the ovary to grow big, trigger the follicles to release said eggs, and then keep the vaginal lining cozy enough to support an embryo that's been placed back inside. This is all concurrent with having two outpatient procedures: a surgery where a needle is threaded up into the vagina laparascopically to retrieve as many good eggs as possible, and then another where a sperm-fertilized egg is shot back in to try to implant and start the road to fetus-hood.

That's a mouthful, huh?

This weekend, the Mister and I went over all our notes and paperwork to figure out exactly what would happen when I take these drugs, exactly how much we are paying for them out of pocket, and exactly when I'm supposed to take them.

We had a lot of paperwork.

We met with a nurse educator Tuesday who went through the details of each drug and how to take each one. In this case, I'm happy I've taken shots most of my life. Some of the drugs use the same orange-tipped syringes I know so well, and filling them is similar to preparing an insulin shot.

The Gonal-F comes in larger pens, pre-filled, and while I haven't taken insulin this way, I know many still on shots do and it seems easy enough to figure out.

After reading everything on Sunday, I looked at the Mister and said, "You know, I think this is sort of exciting."

The Mister, however, immediately pointed out how much this was costing us out of pocket.

I told him kids are expensive anyway and that at least for this first round, where we are going through a relatively "discount" pharmacy to get the drugs, that we're paying as little as we can.

(The Mister's comment was a bit different than usual. Typically, he's the one telling me to have a positive attitude throughout this whole infertility trip. Many times, my cynical and thinking-ahead-several-steps nature has surfaced. "Should we just sign up with an adoption agency right now?" I glowered at the infertility doc after the first IUI didn't work. "Do I need to sell stocks I have as long-term investments to have more money at our disposal?" So far, the answers have been "not yet" and "no." So feeling excitement at the upcoming cycle is frankly, a great departure for me.)

Of course, while it's impossible to predict specific days right now, it looks like the procedure for egg retrieval or embryo insertion may happen during one of my busy weeks at work. I'll definitely be out the whole day for the first procedure (which is akin to having surgery under light anesthesia) and likely out the day things are put back in. (This is also presuming, kinehora, that all goes well this round and there are no problems or reasons to stop the IVF cycle altogether.)

So there is someone at work who can do my job, at what point do I tell him, or my boss, that I'm having an outpatient medical procedure and that I need to be out? A week before? Earlier?

Also, my current boss is a woman who is filling in for my former boss, who left to give birth. The current woman is also pregnant, and her last days are sometime in August. Her replacement (another woman, not pregnant as far I can tell), is someone I'm friendly with, but ultimately, I don't necessarily want to tell anyone that I'm going through IVF cycles. Or do I?

I mean, heck, I'm telling all of you, cyber-readers. And that feels fine. But I don't want to be seen as someone not up to the job while I'm trying to get pregnant, a task that will certainly take me out of the office for some time should I actually have a child. And when I'm at work, I'm actually really into the job, and don't want to have conversations about fertility with people who may not necessarily understand what I'm going through. (This office appears to be pretty fertile, at least for others, since I've been working there. In fact, except for a handful, all the women who have left the job have been those who left to have kids and didn't return. It's not a particularly family-friendly office, if you didn't already guess from my worked-past-midnight post.)

If it doesn't work, frankly, I don't want sympathy from people at work as the Mister and I figure out if/when we'll do more round(s) of IVF. And if it does work, I've thought about keeping silent about it until I was actually pregnant for a while, like four or five months, until it was impossible not to tell. I just don't want to get prematurely public about a pregnancy that honestly, could go wrong in so many ways, having read blogs about miscarriages and terminations and other issues.

(Although, no, it's not like I'd have a reason to think this could happen to me, but then again, why am I dealing with infertility in the first place when the majority of the people I know are popping out kids or announcing pregnancies left and right?)

Tomorrow I have another endo appointment, and I want to double-check with her about whether any of these drugs will affect my blood sugars. I've heard they might and they might not. Looks like I'm back to keeping intense paper records of my every blood sugar. We're also going to go over the results of my week-long effort wearing a continuous glucose monitor a few weeks back. We'll see how that goes.

Broken Record

At times I've wondered if I should stop blogging because sometimes I feel like a broken record.

Once again, I found out last week that an IUI didn't work and that I'm not pregnant.

This time, though, it's official: we're definitely doing IVF this next round.

At the doctor's office on Friday, there was only one nurse working so I didn't see the usual suspects. The nurse I typically see is this fakey-sounding, too-cheerful woman whom I disliked pretty early on.

Friday's nurse listened as I asked some questions about early bleeding which I'd thought were implantation bleeding, but just turned out to be my period starting even before the scheduled pregnancy test.

She turned into a terrific resource, the Nice Nurse, as I began to break down and explain that every time I came to this office, I left with bad news, and that it was hard to have to keep coming here, and that now that we are about to start IVF and have to pay out of pocket for the drugs, we can't even get a simple answer about the cheapest way to actually pay for them.

(My secondary insurance, which will cover a good portion of the actual procedures with IUI and IVF, doesn't cover the medications. There are several places I can get them, but it's been hard to figure out where I can get them for the least money. This has led to some Google searches about ordering drugs from Canada, checking stock prices to see if I should sell a chunk of stock I own, and heated conversations with the Mister about money and how we need to save more for these down-the-road expenses.)

Nice Nurse found me an actual price list of the IVF drugs from some discount pharmacy, and took the time to sit with me and figure out exactly what my doctor had ordered and how I could order different combinations of things so that it would be the least expensive. This was the first time I'd talked to someone in the office who went out of their way to sit with me and figure things out, rather than just shuffle me through the office in a pre-measured time frame.

Nice Nurse told me she'd been through six IVFs and then ultimately adopted a cute Caucasian three-day-old infant through a local agency. The whole thing took less than a year, she told me.

I don't know much about the whole adoption process except through other people's experiences and hearsay. While I know it's too early to consider it yet, I also know that if faced with adopting, I'd really prefer to adopt a white infant over an international one or an older child, and I'd always thought that white infants were the toughest kids to adopt and therefore could take many years to do so.

Nice Nurse gave me adoption information for one agency along with the actual price chart of the IVF stuff and my actual medication amounts as written by the doctor. This way, if I have to call one or two other places to get pricing for the drugs, I'll know exactly what to ask for. And now with an actual price list, I realize that at least one round of IVF drugs won't bankrupt us and will actually equal a few extra freelance assignments. Then again, that's if we only go through this schtick once. Doing this over and over will surely wipe us out. Then again, we're hoping to switch primary insurances in November so next year we have a plan that actually covers infertility.

Sadly, Friday happened to be the Nice Nurse's last day in the office, so I won't get to see her again. She did give me her email and urged me to email if I had any other questions.

On the diabetes front, I've been wearing a continuous glucose monitor for the past few days to determine the cause of my overnight weird blood sugars. My bloods have definitely been all over the map so I'm eager to see what my doctor says about it. I did one of these a few years back with a different doctor's office, but it wasn't really helpful. My main complaint this time is that the shower bags you have to tuck the monitor into don't fasten properly, so I end up taping them closed with my own tape.

And now that I'm not pregnant over these next two weeks, my eating patterns will likely get worse as I start drinking a bit of diet Coke again or eating deli meats for lunch and frankly, I'm sure I'll gain weight and feel large(r). At least this month I'm probably not going to correct my blood sugars to such tight pregnancy levels. I mean, really, what's the point?

And yes, before you suggest I should see a therapist about this, I'm seeing one this week, one who knows diabetes and supposedly, infertility issues as well. The infertility people keep pushing this general mind-body class, too. While I typically love the idea of one-on-one therapy, the group class doesn't really speak to me. I'm already familiar with the topics they'll discuss, but the class is also far from my office, would require me to leave work early frequently, and it's frankly, more money out of pocket. I've been in group therapy before, and while that experience was terrific and I met some great diabetic women through it, I also just want to deal with my own infertility concerns, not the problems of five other couples also in this same boat.

I just read something about how 2006 is half over and how you should sit and think about what you've accomplished these six months so far. Unfortunately, all I can think of is that I've tried to get pregnant and haven't. I've written a book proposal about diabetes and pregnancy and how can I write more about it if I can't actually live what I'm trying to write about?

I sometimes get emails from long-lost acquaintances who ask how things are going, and I usually feel like I give a generic answer about how things are fine and work is busy. I think I sound boring. But the truth is, we've been trying to get pregnant and aren't. I spend a lot of time in doctor's offices for various health ailments that I don't care to discuss with most people. So like a broken record, I gloss over the details with most people and just sound dull: "All's fine, status quo. How are you?"

Return of the Meme and Other Goings-On

Several weeks ago, I responded to Shannon's question meme.

Shannon and Flmgodog responded, saying they wanted to be questioned in return.

I'm not so prompt with my end, but here they are, five questions back. Go 'head and post your answers.

1. Vanilla or chocolate? And if chocolate, what kind (milk, dark or white)?

2. In five years, what do you want to look back on and be most excited by?

3. What's your favorite season?

4. In 30 years, will you go to your high school reunion? Your college reunion? An elementary school reunion? Why or why not?

5. How have you been affected as a result of keeping a blog?

I know I've been affected by NOT blogging these past two weeks. Work deadlines, nicer weather, and taking advantage of sleeping in a bit later most mornings have cut into the time I'd typically be blogging. I tend to write in the early morning, or on weekends, and this past weekend I took advantage of the sun and hung out outside and gardened. Being a city girl, I've never had the opportunity to really worry about a yard. But the house the Mister and I bought has this gorgeous landscaped backyard, so I feel an obligation to keep it looking nice so it doesn't get overrun with weeds and leaves and become the house on the block everyone sniffs at.

And yes, we could hire a gardener to manage the upkeep, but once you own a house, there's always something else you could be spending money on. At least for now, I can manage the weed pulling and shrub pruning, while the Mister mows and fertilizes the grass. I did, however, just write a check to have someone come and prune and treat our trees for pests. Trees. I certainly never thought about maintaining trees when I lived in New York.

In a high school way, I've also noticed that some bloggers who have started blogging around the same time I did have way higher numbers on their stat counters. Is it because I don't update more regularly? Should I branch out to other readers besides diabetics? Comment on many more blogs than I already do? What's the secret?

And finally, in a topic that's actually germane to this blog's focus, the Mister and I held off on jumping on the IVF train. This month, and I apologize for too much information in advance (WARNING: BODILY FUNCTION TALK AHEAD. AVERT YOUR EYES IF SQUEAMISH), I noticed the most ovulatory cervical mucous I've seen in years. Like, honest-to-goodness egg white goop. In truckloads.

In the seven or so months that I've been charting my temperatures to see when I ovulate, I've rarely or never noticed any change in the mucous production downstairs, which is typically a key sign to figuring out when you ovulate. When I saw it a few days ago, I was like "Honey, we have to have sex right NOW!"

However, since I'd been planning to start an IVF cycle this month, we were instructed to avoid sex entirely this month and instead start taking Lupron, a drug that kicks off a two month process of drugs and egg formation and retrieval. The IVF regimen starts on day 21 of the cycle (pretty late in the game compared to ovulation and typical fucking for fertility's sake, which happen about a week before).

With the mucous truckload, I wondered if maybe this month I was actually fertile and producing an egg the way my body was supposed to. In months past, I've been told I've ovulated just fine, and for two months I took Clomid which was supposed to amp up egg production. But with this extra goop, I thought, "Maybe this is the month my body is actually behaving and producing a top quality egg. Let's not waste this opportunity."

So with many calls to my reproductive endo, we cancelled the IVF cycle and scheduled an unmedicated IUI instead. So in addition to our own canoodling this month, we tried the turkey baster method as well just for an added bonus.

And thus begins another two week wait.

But if the pregnancy test is negative, there's no more postponing the IVF stuff any more.

Yowza, who knew I had so much to say. Trees? Goop? I gotta blog more often.

Ten Observations

I've taken a blogging break for a week and there's so much to say.

1. We're moving forward with IVF, which means I've been reading a lot about fertility drugs and outpatient surgery procedures. It all starts later in June, so once again, I'm playing the waiting game 'til the right time of the month.

2. I've had several episodes of spontaneous tears and frustration, although they've abated a bit.

3. I've called a local therapist who actually has experience with diabetes and infertility, as suggested by my soothing endo. As much as I recommend a certain NY-based therapist to my Big Apple peers, I think seeing someone locally would be beneficial in this case. Like everything else, I'm waiting for the appointment.

4. Last weekend was a child fiesta, as the Mister and I went to several barbecue/parties where kids ran wild. However, in person I think I handled it well and in fact played with a few toddlers and a baby (not all at the same time) and enjoyed them. The Mister smiled a few days later and said it was clear I'd be a great mom, and that it was nice watching me hold our friend's infant and play with the baby on my lap.

5. I've gotten a form from my insurance and am going to submit several months of acupuncture bills to them to see if they'll pay for any of it. In the meantime, I'm taking a bit of a break from acupuncture until the IVF treatment officially starts.

6. My caring and calm endo, who I saw earlier this week for a usual check-up, gave me some suggestions about the diabetes care. Since September, the month we started officially trying to have a kid, I have gained a whopping seven pounds. This is clearly because I'm correcting any post-meal blood sugars over 160 with a small hit of insulin, and then either going low later or otherwise packing on weight when I probably wouldn't have before when my sugars ran higher. Kind Endo told me I shouldn't correct before three hours post-meal, and if I'm running higher before three hours, to adjust my insulin ratio for the meal. "What if I go high after the meal anyway," I asked. "Then we adjust your post-meal basals," she replied. It felt like hearing something I'd never considered before, so this week I'm chilling out on the corrections and figuring out whether my ratios should change.

7. Due to said weight, my shorts from last year just don't fit. While I am trying to exercise my ass smaller, I don't want to wait it out sweating in long pants every weekend. Yesterday I found a nice pair of shorts at Ann Taylor for $10 (yes, you read that right) that were actually comfortable. While I'm not pleased that I'm wearing a size that most Ann Taylor shoppers would swim in, I'm pleased that I didn't have to spend a lot for them, either.

8. I'm also making an effort to write down everything I eat (which has been sporadic this week, but I'm trying) in a modified Weight Watchers plan. I've only ever lost significant weight when I did WW and exercised, so Kind Endo suggested doing a solid 45 minutes of walking every day as well. This week it's been beautiful out so I just go walking at lunch, but today it's rainy so I'll have to get creative about walking. There's a mall near my office, so maybe I'll have to make a visit and walk in circles. Maybe I'll find another pair of $10 shorts?

9. The authors of several infertility blogs I've been reading/catching up on are either about to have their first children, or in the case of Persephone, had twins in the past day or so. Another blogger, Jill, just announced she's pregnant. So perhaps I'm entering into another lifecycle as well.

10. More administrative than anything else: my blog's margins are weirdly messed up and I can't figure out why. As a result, I'm consolidating my links to two pages that list, essentially, all the diabetes blogs and a huge number of infertility blogs, which will cut down on the margin mess-ups, I hope. If you know the HTML programs that Blogger uses, and have any idea why my right margins won't line up, drop me a line and let me know. Thanks. NOW AMENDED TO SAY the fabulous Kassie is not only an HTML goddess (thank you!) so that my margins now look fine, but my Kind Endo passed along a copy of Kassie's fabulous When You're A Parent With Diabetes book. I wanted to read it all before commenting, but suffice it to say that so far, it's terrific. I hope it sells a million copies and helps every single PWD (parent with diabetes) out there. Congrats, K!

A Post I Didn't Want to Write

My pregnancy test was negative yesterday after a second round of IUI.

Again.

For the last two weeks I haven't really noticed many physical changes, save for some heartburn and a few cramps a week ago. But otherwise, nothing.

I didn't bother buying an at-home pregnancy test, because I knew the infertility place schedules a blood pregnancy test exactly two weeks after the IUI's done.

So when I went yesterday, I asked the technician (a new chirpy one who I didn't like right away) if the lack of symptoms meant anything.

"You really can't ever tell," she said, or words to that effect.

A few hours later, a nurse I regularly deal with (my doc has two, and this one has an annoying syrupy sweet voice that I don't care for at all), called my cell. Last month, it went straight to voice mail, and I think I'm going to do that from now on when I get calls about pregnancy results.

I could tell right away that she didn't have a positive result, and started in with several "I'm sorrys." Finally, when she told me the result was negative, I said "No worries," and pretty much hung up on her as she was wrapping up her shpiel.

I then walked out of my office, called Mr. Lyrehca, and told him. My immediate thought was to scrap the third round of IUI that were are scheduled to begin when my period starts up, and get started with IVF. I mean, really, why fuck around with something that hasn't worked twice already?

He said that made sense to him, so I called the doc's secretary (NOT his nurse) and told her what we wanted to do. She said she'd have the doc or one of his nurses get back to me.

So the doc calls me at the end of the day, when thankfully, most of my office has cleared out (I work in an open office and have had to lock myself in a conference room to have a private cell phone conversation many times).

He agreed that IVF seemed like a logical next step, if we would be very disappointed if a third round of IUI didn't work (of course we would. Who wouldn't be?). And since my primary insurance doesn't cover this stuff at all, and my secondary insurance doesn't seem to limit what and when you can certain infertility treatments, it's ok to move straight on to IVF.

I know IVF is a lot more invasive, and fuck, plenty more expensive, than IUI, but not the specifics. A nurse is calling me to schedule an IVF orientation, and from the notes I scribbled while talking to the doc yesterday, we're supposed to wait until day 21 of this next cycle to start taking a drug called Lupron, which builds up my eggs or follicles. Then I wait til the NEXT cycle for them to be retrieved and all the science happens that month (so now we're talking July.)

"What if we try to conceive naturally this month and start taking the Lupron, only to find out I'm pregnant at the end of the month?" I asked.

"Well, I wouldn't recommend it, but it has happened. There have been no medical reports of problems of children who have been conceived through accidents that way."

My thought was, these couples are *trying* to have a baby. These aren't ACCIDENTS, you old man.

"So it would be fine, right?"

This doc is not one of my typical favorite doctor profiles. Since I've seen many in my time, I'm qualified to know who I like best. And I typically like women best. Caring, not cold women. This guy, while knowledgeable and kindly when he talks, is an older guy who will say one thing, and I'll say something else and he sometimes is swayed, and sometimes isn't. This was one of these times.

Essentially, what I got was that it wouldn't be a problem if I conceived naturally this month if I went on the Lupron in the middle of the cycle, but he couldn't give me the official go-ahead to do so because it's not the right protocol to do that.

(Oy, why am I talking semantics here? Why would I conceive naturally this month anyway? It hasn't happend in nine months of trying yet.)

So now I have to read up on exactly how IVF works, how many more shots of drugs I'll need to shoot in my ass, how many more trips to the stirrups I'll need as someone pokes yet another uncomfortable speculum up my anatomically-normal-but-otherwise-buried-too-deep, too-far-back cervix (learned that one at the last IUI).

Why do I want children again?

Oh, note to Julia, I went to Whole Foods after this news and bought a Five Star chocolate bar, as you'd once recommended. It was fine, and my sugars were surprisingly normal all afternoon, but there was NO NUTRITIONAL INFORMATION on the wrapper. I later found some of it online, but these days, I have no patience for a company that can't make it easy for me to figure out how much insulin I need to take. So I probably won't be eating it again.

Driving out to my acupuncture appointment last night, after the Mister and I had a discussion about the latest high credit card bill (bloated with medical expenses that I get reimbursed for, weeks later), I got to the office in a bad mood. No one's reimbursing us for these acupuncture appointments, and really, what are they doing?

I definitely feel more relaxed as I lie there, poked with needles, for a half hour, but couldn't I feel equally relaxed if I lay quietly in my own bed at home, without a TV on or anyone talking or a phone ringing?

I pointed this out to the acupuncture doc, who is typically a kind Chinese man who is friendly enough. As I was lying there, I started to cry and couldn't stop, as the tears ran down the sides of my face and into my ears. (NOTE TO Kevin, who emailed me a detailed email of what laser eye surgery is like: I thought of you, and how this is probably how my laser eye surgery would feel, whenever I have it scheduled, with tears pouring into my ears).

The acupuncture doc, unlike just about any Western medical doc I've seen, told me my tears were upsetting him, and that there was no guarantee that acupuncture would work, but that I was improving because I was going there, and that three months wasn't a long time, and that he would tell me if he didn't think I could improve from it any more. He also said that among his patients, he wanted me to get pregnant more than most, because of where I work, a well-known local media outlet.

"Yeah, I'll see what I can do," I said, "but you've got plenty of media attention around your office already. You don't need me."

He also has a lot of photos of babies and notes from grateful parents around his office, and he told me that's the most he wants to see from these patients. He's 68, and could have retired already, but he continues to do this because of how happy his successful infertile patients are when things work. This is what he told me.

Because I was still crying, he went to take care of another patient and left me for a few minutes. I thought, "I could run out of here right now and never come back." But would that be cutting off my nose to spite my face?

I stayed. I had another acupuncture treatment. I left and said I'd call to make another appointment (I ususally book the next appointment while I'm paying).

Last night Mr. Lyrehca hugged me as I told him I got upset at the acupuncture office. He's upset, too, but not as teary and mean as I feel.

I've been reading a lot more infertility blogs this past week, something I didn't really do before now. (I stuck mostly to diabetes and one or two cancer blogs, and one or two infertility blogs). The infertilty blogging world is much more vast than the D-blog world, and it's taken me all week (and a lot of not-doing-work time) to get through ...And I wasted all that birth control. Some of these women have been blogging for two or three years, and they're currently pregnant, or have lived through several miscarriages.

I've thought about whether I would want two unhealthy babies instead of one healthy one (The infertility doc seems insistent on implanting just one or maybe two embryos in me instead of more because he keeps harping on about the diabetes and the risk of multiples. Finally, I asked him if he knew what an A1c was, and that mine has been in a non-diabetic range for the past year, and YES, that meant my risk of birth defects is the SAME as a non-diabetic woman. He said he didn't realize that. "I'm a very compliant diabetic patient," I said. "I'm not what you're used to seeing.")[Translation: Enough with the diabetes already. Just get me pregnant with a healthy embryo or two and I'll worry about the rest.]

Because what's the point of implanting just one embryo at a time when others usually have several, since they don't all usually develop?

And NO, I don't want to have two sick children, or frankly, even one, but is that better than having no children at all? I can't answer that yet. All I know is that yes, I have dealt with more than a usual amount of health issues in my lifetime that weren't caused by anything I did or ate or smoked or fucked. They just happened. And I think I've managed, after years of living with these issues and therapy, to be OK with the diabetes and the cancer scare a few years back. And I'm trying to get through this infertility bout as best I can. So I think I deserve to think that I don't want a sick kid because I've dealt with enough sickness on my own.

The Mister and I are going out of town overnight, and then we have to return to a baby naming ceremony this weekend of a couple who are not my favorite people, although the Mister loves them. I asked him if I could get out of it by saying I wasn't feeling well, because I didn't want to deal with all the children that will be there. He asked if that was true, and it could be. (It could also be I just don't want to deal with the smarmy female half of the hosting couple). But we'll also have a lot of other friends there who I like more than the hosts (thought they all are either pregnant or with children, too) that I'd like to see.

I also thought, yesterday while driving to the acupuncturist's, just how cute my brother's kid is (conceived naturally by his younger, stick-thin wife), and how could I ever have as cute a baby if I had to adopt? Then I thought about Angelina Jolie's daughter and how cute she is. Then I thought about how I'd want a Caucasian baby because that's what the Mister and I are and we'd want to look similar to our kid. Is that being racist? Would I even be a fit mother having these sorts of thoughts? And how would we get to adopt a white infant when they're likely the toughest to adopt and that people wait years to get them, if they can at all? The Mister says I'm getting ahead of myself, but I keep thinking that adoption takes a long time, so why not get on the list and check out agencies just to see how things work?

Clearly, I'm not in the greatest mental state right now. I know some people do IVF treatments for years. I know some people (two of my own friends) who have done IVF for years and given up and have then gotten pregnant on their own (in their 40s yet). And I know I'm still sort of a newbie in the whole infertility game.

But I'm still allowed to feel whiny and cranky.