Thursday, 25 April 2013

Prescription: a long and winding road

That kind of sums up how I feel about our appointment at the subfertility clinic yesterday.

Starting off with the good stuff, I liked the feel of this clinic very much. When we were called in to see the doctor, having hardly waited at all, she had all the relevant information (including my misplaced bloodwork) to hand. She has already been in contact with the lovely OB/GYN regarding his investigations, and they appear to be genuinely well coordinated and organised here (unlike the nightmare that is my GP's office, and I am oh-so-relieved to not have to get further investigations handled there but at the subfetility clinic itself). Unlike our horrible experience with the last subfertility clinic we consulted, these guys will continue to monitor me closely with each new cycle, and develop a protocol accordingly. All good.

It's the current protocol they're suggesting that leaves me feeling a little deflated. In sum, she believes that my odd pre-menstrual spotting and general weirdness these past few cycles may indicate they have been anovulatory. On the one hand, I'm glad someone is finally paying attention to my concerns over this (shocker: I may know my own body as well as any doctor!), rather than fobbing me off with the usual 'these things can happen' auto response. But this also means that she wants me to complete two cycles with closely monitored bloodwork to first decide if I'm ovulating at all. If, from my progesterone levels, it appears as though I may not be, she then wants me to start three rounds of clomid. And then if, after three cycles, we haven't yet conceived, she'll refer us on for IVF. Once that referral is made, they promise a maximum wait of 18 weeks before an actual IVF cycle would go ahead.

This feels like a long and circuitous route to what I increasingly fear will be our only shot at a biological child. With this protocol, we're looking at four + cycles before even getting on the wait list. That means I'll be approaching my 39th birthday before we can even think about moving forward with IVF.

And then there's the rationale for this course of action: You've had three pregnancies, so you can actually conceive quite easily. (Easy obviously being very much in the eye of the beholder here).

I know it's terribly sulky and irrational, but right now it's hard not to feel like we're being penalized for having had three losses. Although I do realize that we're lucky to be able to conceive, to even ever have the chance to try on our own, (and although I know some women who have never had the experience of seeing a positive pregnancy test may find it difficult to relate), I would hardly call three miscarriages a spate of good fortune; yet, in terms of assisted reproduction, that's how the medical profession sees it. In terms of making babies that are too fragile or poorly built to even survive in the comfort of my perhaps openly hostile and not at all comfortable womb, as we all know, I am actually quite talented.

Logically, I know this makes some sense, this wait-and-see approach. (Doesn't it? Feel free to jump in if you have other ideas; I'd actually be grateful for the insight.) But there are so many things for us to have to process with this. I'm worried terrified about my age being an increasing factor with each passing cycle, so there's that. H's 'good' sperm analysis results have always been borderline good, so we know we don't have ideal conditions in any case. I admit that I continue to have substantial reservations about crazy juice medicated cycles; about the havoc they could wreak on my already wonky system, about their sperm killing properties (c'mon, we all know Yahoo answers is a perfectly reliable source of medical information). Also, seriously...we've been trying for three years. There comes a point when no amount of humour or prosecco can sustain a truly fulfilling sex life - or our sanity - through an indefinite period of super sexy no pressure let's have fun! timed intercourse. Our marriage, our emotional wellbeing and our psychological integrity need a break already. Please?

H and I are still thinking through how we feel about this, and whether we want to take any further steps in another direction; we have the time to contemplate these possibilities, it would seem. I also think this doctor is quite cautious in terms of wanting to go the least invasive route, which I can understand. However, with our history I don't think we really feel in a position to err on the side of caution with our timelines. Is it totally insane that my brain already calculates that, even should a pregnancy occur for us, we'd also have to factor in the time for another loss and the recovery that would entail? Well, yes it is insane, clearly; but there you have it. A serious mindf*ck


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I thought of using this picture to illustrate (all too literally because I'm lazy and uncreative with my metaphors) what it feels like - today at least - to be looking into our baby-making future:


It was taken several years ago on a summer hiking holiday we took in one of our favorite corners of Austria, a small town on a crystalline alpine lake, nestled in the countryside between Salzburg and Innsbruck. The area is home to an infamous stretch of circuitous, thrill-and-vertigo-inducing alpine road. The road is winding and you never know when the next curve will fly at you, seemingly out of nowhere, so you've gotta keep your whits about you. You're way high up, it's scary, and occasionally nausea inducing. Frankly, it's sometimes downright dangerous. Apropos, no?

Well anyway, then in the course of sifting through folders of old holiday albums on my laptop to get to this, I was reminded that about thirty minutes after the photo of the road was taken, as we reached our destination, there was another image. This is the view that greeted us:

Will the view at the end of the road make it all worthwhile?


OK, I'll give you a moment to groan inwardly at the schmaltzy, juvenile sentiment of this photo montage. Just go with it people; I'm trying hard to look on the bright side right now. I need to keep nurturing my invincible spring. Or, uhhm...maybe move to the Alps? I'll figure it out and get back to you.

24 comments:

  1. Haha, you know, when we think of moving countries we also think of the Alps (well Switzerland) (if not Mexico). (As you know I am struggling with working in my field and it seems I could have a better chance in other countries... one of the reasons for not moving yet is that we don't want to start all over again with finding a hospital, clinic, getting screened, finding doctors. And I can not even start on how blessed / grateful I feel that fertility treatments are covered).

    Anyhow, let's look on the bright side. We have to.

    Regarding your age, I have to find an article where I read it, but I think that at this point a difference of months will not make things worse. It can still happen, but I hope they put you on the IVF train soon.

    I am right there with you (and we seem to be at similar stages). We have an appointment at a different hospital for next month (that's where you get "upgraded" to when IUI does not work). And guess what? This month they did it again. Yes, they missed my ovulation because they would not give me a monitoring /screening appointment on Sunday. Saying come on Monday, it's CD 11, it will be fine. I go on Monday and all I had was 3 follicles all between 10 - 12 mm. At that moment I knew I had already ovulated , because by day 11 I am always ready for the trigger shot (at 20-22mm). But the doctor assumed this was a weird cycle and told us to continue stimulating. We go back today to find out I have a lovely corpus luteum, meaning yeah, I already ovulated, we totally missed my egg (s?) and there is nothing left to do. Those other follicles stayed at 10-12 mm, they were undergoing atresia (slowly degenerating as they were not the "chosen ones") since earlier this week. Talk about: "I may know my own body as well as any doctor!" (Or better!)

    I really really hope this will end soon . I think of you constantly and I hope the spring will have an effect on our bodies as it does on other animals. We really do need a miracle, but I refuse not to believe in them.

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    1. As usual, I know you understand what I'm talking about because we have so many of the same dilemmas right now. I think in the end, we'll stay put and move forward with this protocol (with a little tweaking, I hope) just because we found doctors we like and don't want to start the process all over again someplace else. It's really hard though to constantly feel like you are actively making a choice between pursuing something you love in life and having a family, but I guess that is nothing new for women. Sigh.

      Thanks for reminding me that age is not the only factor involved here. I tend to get a bit panic stricken when I focus too much on our outcomes, but I suspect you're right in that a few months here or there won't make the difference. I just have to keep telling myself that I'm otherwise healthy, am so careful with my lifestyle, and even at 38, I can do this.

      I'm really sorry you're facing the same frustrations with nurses who haven't listened to you and taken your expertise with your own body into account. I'm so angry for you! I hope just like you, that this ends happily for us, sooner than later. I continue to have so much hope.

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  2. God I love Austria. I want to be in your photos right now and just bask in the beauty. My heart is craving a holiday at the moment. I just feel a desperate need to be somewhere new, and warm and beautiful and to just relax with my husband. I have to wait two more months before I get that though. Time is crawling.

    I have no expert advice in terms of your appointment but here is my two pennies worth. I am a very impatient person and hate being told wait and see, but I know that sometimes that is the best we can do, hopefully the experts really do know best. I think you are right and three cycles of clomid seems like a lot considering your age and the fact they don't really know what is going on. If it were me I might be pushing to get more hardcore treatment, but like I say, I am impatient. I am also interested in what they plan to do if you do get pregnant. It seems to me a plan should be in place so that you have the best chance of keeping your precious baby. It is all very well for them to say 'well, you can GET pregnant' but if the issue is what happens next, what are they going to put in place. I am no expert, of course, but those are my thoughts.
    Thank you for your thoughtful comment. I am going to do my best to keep a supportive presence around here, I owe this community so much. What you said about being left behind is so true. I feel like a marine in a war zone, I don't want to leave a single one of you behind, I want to scoop you all up in my chopper and get you all the hell out of the trenches. No(wo)man left behind in this hell hole!

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    1. We are very lucky indeed that we have regular access to such a beautiful country! We try to spend a few weeks every year just hiking and rambling through the countryside :) It's likely we'll move there fulltime at some point, but for now we're focussed on the baby making stuff.

      Thanks for your thoughts. The staying pregnant part is phenomenally important for me, and one of the reasons I am probably happy to stay with this subfertility clinic is because, as I said, they are so well coordinated with the OB/GYN I've been seeing, and who I love. This means that there will be early and regular intervention in the event of a pregnancy (unlike the 'routine' system here, where you don't usually get a first scan until 10-12 weeks!). They've also got me on low dose aspirin during each two week wait, which would carry on through the first tri, as they've had good results with this for recurrent pregnancy loss. I feel like I'm getting thoughtful care that's attuned to my situation.

      Your comments are always so supportive. I don't think you 'owe' anyone, but I just want to reiterate that the presence in this space of other women who know what it's like (regardless of their 'outcomes') has been such a huge part of my coping. Thank you for your continued presence and support. Your wartime metaphore is very apt, and hilarious!

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  3. Those are beautiful pictures! I need to add that to my list of need-to-see sites.
    The wait and see approach is soooo hard for me to accept. I feel like I'm in a race here, so when a doctor tells me "it's only a couple of months" or something similar, I hear the clock ticking loudly in my head.
    Although I'm typically all for the least invasive route, I'm not sure I'd be happy with two cycles of "close monitoring" and then three with Clomid. I think I always ovulate on my own, but my RE seems to think Clomid will help me produce a more mature, higher quality egg. I'm not sure if that's true, but I'm hoping he's right. I might push for one monitored cycle, then a couple with Clomid? Or maybe you're not allowed to bargain with the clinic :)
    Either way, in the scheme of things, a few months probably doesn't matter. But personally, I'd probably try to push things ahead a little.

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    1. I can highly recommend Austria as a 'must see' destination! Not only the beautiful alps in the west of the country, but the cultural opportunities in Vienna, which is a perfect 'European' city, full of cafes and beautiful architecture and amazing museums. It really does have it all!

      It *does* often feel like a race, and like you I'm normally for minimal invasiveness and the less exposure to pharmaceuticals the better...so all this is not only a big challenge for me intellectually but a dilemma as far as how long to 'wait and see'. I have been doing some 'bargaining' and I think in the end we've decided on one month of monitoring and re-evaluation of the clomid's effectiveness with each round. If my progesterone levels, or H's sperm results come back poor, they'll move us straight to IVF anyway. I guess that either way, it's a waiting game to some extent. You'd think after nearly three years of two week waits I'd be a pro by now, but no, not really...

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  4. Those pictures are gorgeous. Thanks for sharing them. I know what you mean of knowing your body. I am very intouch with what I feel and can almost always pinpoint what it is. With a little research. I find it very important to me to find a doctor that will listen to you and not give you that "i know best b/c I'm an MD" attitude. good luck with your Oing!

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    1. Thanks for stopping by! Glad you liked the photos. I checked out your blog and am hoping that your upcoming IUI is *it* for you!

      It is really important to find a doctor who respects your experiential take on things, but that is easier said than done. I am very grateful to be under the care of my current OB/GYN who seems to be really good at not only taking my/our concerns seriously but advocating on our behalf.

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  5. I love your photo metaphor. Makes me want to go there RIGHT now. Wait. That's the point, isn't it? I can't imagine being told you have to wait. Again. Also, I understand them saying how "good" it is you can conceive. But does the doctor understand the pain that comes with that? Ugh.

    Anyhow, I think objectively and scientifically, 4 months shouldn't make much difference. Especially if you really like the doctor and feel good about her. That is worth it. If you change again, you could end up with a 6 month wait and a doctor you DON'T like.

    I really, really hope you find the mountain lake as soon as possible.

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    1. Yes, that's it right there: you can see the lake from afar, but it seems we've lost our compass and have no hope in hell of reaching it any time soon. And I *get* that clinically speaking it's a promising thing that we've conceived, but I think that people who deal with this all day every day actually find miscarriage quite 'boring', and the pain doesn't register for them at all. Thanks for recognizing that, and for reminding me that, in spite of my impatience and fears, a few months isn't the end of the world. We'll find that mountain lake again!

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  6. I love your invincible spring! It is so important to maintain a positive outlook when going through challenging times. I've found it makes life so much better that way. And the truth is, nurturing your ability to look on the bright side is a good skill to have in life. Even when we finally have our children, we will face other challenges in the future and being positive will help us to deal with all of life's other challenges. I hope you do take the time to think about your plans and options, and I wish you all the success in the world on this journey :)

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    1. So true, these aren't the first challenges I've faced and they won't be the last. I'm not sure how I managed before (with equally if not tougher life challenges), but it seems IF can sooo easily take over every aspect of your life. I really have to work sometimes to remind myself just to *be in the moment*, to laugh, dance, enjoy what I have. It's a constant struggle but it almost always helps. Thanks for being there, not only to remind me, but to listen when I'm not feelin' it! Your support is so appreciated.

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  7. I love your photo montage. It makes me desperate to jump on a plane and hot-foot it over to Austria right now! I hope gettting closely monitored and doing IUI works for your. IVF is no picnic - although I am sure IUI isn't either - but waiting is torture. Hope it passes soon and with a baby on board.

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    1. Thanks Ana, I hope so too! IUI doesn't seem to be a good option for us (since our record of conceiving is, ironically, quite ok), but we'll try a few medicated cycles and then move to IVF. I'm really hoping your next steps also bring you closer to your dream.

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  8. If schmaltz means more breathtaking photos of places I'd love to be hiking right now, bring it on. Also, what jerks - making you wait and all. I can completely understand the apprehension and frustration. Don't beat yourself up though. Sure, you can get pregnant, and yes, that's wonderful, but we all know what the end game is here and I sure hope these news docs can get you there. I hope you can negotiate for a speedier boarding of the various ART trains. Happy to entertain any and all Clomid related queries - pro tip: you'll probably only really dislike H for a couple days (or at least that was the ultra lovely form that my particular clomid cycles took. It was charming for everyone. That and my manic ovaries.) Sending good thoughts.

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    1. Yes, when I looked at those photos I realized it has been far too long since we did wandering of that kind, and I really need to get back in that clear air.

      The waiting, as much as I know it's somewhat inevitable, sucks. And as you say, this is just it: *getting* pregnant is all well and good, but however they want to clinically categorize me, my end result (so far!) is the same as any infertile: many many many cycles trying, and no baby. At least I feel like now we're on the right track. Thanks for the offer to be my clomid guru; I'll almost certainly email (screamingly) you for your expert advice at some point!

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  9. I'm hoping that one day soon you will have a precious baby in your arms, Sadie.

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    1. Thank you Gale, I hope so too. Thinking of you, James Jr and Reita.

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  10. I feel like we are at similar ages and phases. I also get less attention because we conceived twice-at least with our original doctor. Is it different in the UK because of your health care system? Sounds like it, since you have to apply for IVF, etc. Why didn't the doctor suggest IUI while on Clomid? Regardless, it sounds like this new doctor is on top of things. It's the waiting that completely sucks. Your pictures nailed it! Thanks for making me laugh. I needed it.

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    1. Yes, so it seems! Not sure why, but it always makes me feel reassured when I find other bloggers who are dealing with this at my age; I guess I feel less alone and less deluded for thinking we can do this...and WE CAN.

      I guess there are many differences with regards to the healthcare system here; most importantly, that our IVF and all prior treatments are covered by national health services. So we don't 'apply' for the procedure strictly speaking, but you have to go through a certain process before you get to that eventuality. If we wanted to go private, we could just start it now, I suppose. Because of my conception rate, IUI is not going to make a huge difference one way or another, but if either my progesterone levels or my husband's sperm analysis come back poor, they'll fast track us straight to IVF. Is it crazy that I still hope for a spontaneous conception before that?

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  11. Love the pictures!! You're making me crave a trip to the mountains.

    Couple of thoughts: First off, I understand the doctor wanting one full cycle to monitor you without meds to see if you are ovulating. This is important, because it may bump you straight to IVF if you're not. That said, it may be worthwhile see if 2 full cycles are needed to get this information. I don't know if you've been tracking your cycles at all, but if you have been that information may allow you to expedite things. Regarding Clomid, I would certainly discuss doing Clomid + IUI cycles. This will most certainly address any issues with sperm quality. Finally, remember that the plan isn't hard and fast. I imagine that with all of this there will be an opportunity to reassess. Also, they will be learning something. For instance, what if it's simply a matter of your progesterone levels being low and Clomid + progesterone supplementation is the key? I'm not familiar with your specific history, but sometimes it's just a matter of finding the right combination.

    Regardless, it sounds like you're in good hands. And I hope all future visits are equally fruitful.

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    1. Thanks so much for all your thoughts on this Cristy; as a veteran of all these treatmens, your wisdom and input are certainly appreciated. And you're right, it's not hard and fast. I think in the end we're going to do one monitored, unmedicated cycle, and then re-evaluate, after which we might be looking at two rounds of clomid. Again, I think the logic with not pursuing IUI is that, given my conception rate, it's not likely to make a huge difference, and if they find anything less than normal on either my next CD21 tests or my husband's SA, they'll just move us straight on to IVF, which I'm in favour of since I think at this stage IUI is a bit of non starter. Thanks for the thoughts on clomid + progesterone; it's definitely something worth looking into and I'm going to ask about it at my next appointment.

      The main thing is that we finally *are* in really good hands, with close monitoring, which is reassuring. Now, I just have to keep reminding myself to take it one day at a time.

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  12. The waiting is intolerable when it feels like you could be doing something. But if it means avoiding less invasive procedures, I get why your doc would want to err on the side of caution. Hang in there.

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    1. I think it's going to be an ongoing process of re-evaluating for the next few months. I feel confident that these doctors will do what's best for us, but it's so hard to be patient (especially when age is a factor). Like I said, I'm just trying to take things one day at a time and keep hoping. What other choice do we have, right? Thinking of you guys sooo much Daryl. Thanks for your support.

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