Tuesday, August 31, 2004

in a nutshell

In an amazing turn of events, Dr. Hope's stand-in nurse spent her entire day in a back and forth e-mail conversation with me. No longer do I feel neglected. No longer am I anxious and frustrated. No longer will I threaten to go off in search of a new RE.

The upshot of the situation is this:

1. My husband has a consult with a urologist scheduled for mid- September. Yes, he's already had a consult with a urologist, but that guy wasn't affiliated with our fertility clinic, so we start again.

2. My husband has to have a diagnostic biopsy. If they find sperm, they'll freeze it. Unfortunately, Dr. Hope thinks that the chance of finding viable sperm is low. Only 5- 20%. But that's better than nothing, right?

3. We can't have the biopsy at the same time as the consult because my husband's schedule and the urologist's schedule are not at all in sync. And we can't have it at the same time as an egg retrieval for IVF because Dr. Hope doesn't want me to go through all of the preparation for IVF for nothing. But we're hoping to schedule the biopsy for October. Early October.

4. Dr. Hope sees no reason why we couldn't start IVF soon after the biopsy- if they find sperm, that is. Or with donor sperm. Either way, it's a bit later than we originally hoped for, but still within a reasonable timeframe. Definitely okay by us.

I've still got a few questions, but the major stuff has been answered. And I'm more than a little relieved that we actually have something concrete to look forward to in this process, even if it's just a consult. And a lot relieved that I'm not being ignored by our docs. Baby steps. Baby steps.

working girl

I met with the principal of The School this morning and will officially start my new job tomorrow. The principal was warm, kind, and helpful and I think that I'll like working at The School. It sounds like I'll have a bit more responsibility than I originally thought, which is a good thing. The last thing I want is to be a superfluous addition to the staff, but the psychologist they had last year is now gone and so I will be replacing her- and will pick up where she left off.

My last job in social work was with a completely different population- inner-city adolescents and I hope that the adjustment to working with privileged elementary school kids won't be too difficult. From what the principal told me, most of the kids that get referred to counseling don't have major issues, but tend to need help setting limits and are seeking attention. A far cry from the non-stop crisis interventions I'm used to, and hopefully a lot less stressful.

Having met some of the staff and getting such a warm reception from the principal, and realizing that yesterday's mishap with the headmaster won't be the norm, I'm actually feeling excited about getting back to work. . .If nothing else, having something to temper my obsession with the infertility will be a good thing.

Monday, August 30, 2004

finally!

I never heard directly from the headmaster at the school where I'll be working, even after I made a ton of annoying calls to his secretary, but he stopped by my husband's office (whatever) to tell him to tell me to report to the school tomorrow morning to meet with the prinicpal. Something tells me the principal has no clue that I'm supposed to be working there this fall- I tried calling her directly and her secretary seemed very confused as to who I was and what I was calling about. We'll see what happens when I show up there tomorrow. I'm expecting a bit of chaos, but what else is new?

The good news is I finally heard from Dr. Hope's stand-in nurse and have some answers to my questions. Vague answers. Answers that leave me with more questions, but at least they haven't totally forgotten about me.

Dr. Hope wants my husband to have a diagnostic biopsy since his FSH levels are so high. From there, they'll be able to tell us whether or not we'll need to go with donor sperm. We can do the biopsy here or in DC, but likely won't be able to start IVF in September as we were hoping which sucks. I'm not sure what to think about all this- the reading I've done on the subject tends to suggest that with non-obstructive azoospermia, the biopsy isn't all that predictive of whether or not there will be sperm at the time of egg retrieval. I don't know whether to bring that up with Dr. Hope or if I should just go along with what he says. I don't want to be any more annoying than I've already been, but I also don't want to mess up our chances of using my husband's sperm for IVF.

I don't know what I was expecting in Dr. Hope's response to my e-mail, but after reading it, I somehow feel let down. I guess I was hoping that there'd be some explanation as to why we're proceeding this way. Some words of comfort, some success stories. But I just got a couple sentences that didn't say very much at all even as I tried to read between the lines. It's so incredibly frustrating.

I don't think I'll ever stop being amazed at how long this all takes. How each step in the process is so drawn out, how the waiting in between each step lasts forever. I'm hoping we'll be able to schedule a biopsy for my husband sooner than later. And I'm hoping my husband will agree to do it in DC so we can have some face time with our doctors and nurses there. I'm hoping too, that they'll find some sperm that is viable for IVF.

Tonight my husband and I will craft another e-mail to Dr. Hope, this time demanding some more thorough answers. And then we'll wait for a response. And wait and wait and wait.

just another manic monday

I'm back from Boston. The wedding weekend was busy, but fun. It's always nice to catch up with folks you haven't seen in a long time. We arrived home late last night and I'm still a little bit groggy, but had to wake up early this morning - it's supposed to be my first day of work at a new job!

Supposed to be. It seems like all of my normal communication systems (e-mail, the phone) have broken down in the last couple of weeks. Dr. Hope and the stand-in nurse still haven't written to me to answer my questions. And here I sit, at home, on what was supposed to be my first day of work because the guy who hired me, the guy I'll be working for, has yet to tell me when and where I'm supposed to report. I called and left a message with his secretary as soon as I woke up this morning and am waiting for his return call. Never mind that he was supposed to e-mail me while I was gone with the details and didn't. Or that I tried calling him at work the afternoon before I left for Boston (and the days prior to that) only to leave messages with his secretary that he never returned. And I tried calling him at home the night before I left but only got a busy signal (for over an hour). Then e-mailed him from the airport in the morning and again from the hotel yesterday morning. But when I got home last night- no messages. And somehow I just know that he's going to pin this on me, like it's my fault I didn't get in touch with him, that I'm not where I'm supposed to be right now. And I hate that. For a control freak like me, its the worst feeling in the world to have things so out of control and then to be blamed for it.

Late on my first day. This isn't like me at all.

The job? Well, I'm supposed to be doing counseling part-time at a bilingual school here in Mexico and working in the library there the rest of the time. My husband works at the university part of the school and I'll be at another campus of the same school- the elementary school campus. It's a made-up position. I haven't worked for over a year despite my efforts to find a job but with the cost of fertility treatments staring us in the face, it was really time for me to get back to work. I'm excited for the counseling part (I'm a social worker), but feeling more than a little weird about the nepotism involved to get me a job in the first place. It'd be one thing to be hired for an existing position that needed to be filled, its quite another to have your husband talk to the school's owner to see what they can come up with. So counseling and library work it is. If I ever actually get a chance to speak to the headmaster to figure out where to go.

I don't really want to work. Or I should say, I don't really want to work at this job. I'm used to getting by on my own merit, and this seems like the opposite of that. I know that it will be good for me to get out of the house and that it will be good to have something on my resume to show for the time that I've been in Mexico, but the idea that someone is doing me a favor in hiring me doesn't sit well. And I'm worried about the time off that I may have to take once our first IVF cycle is underway. And the stress of a new job combined with the stress of treatment. And since my husband is connected to the school, I worry that mishaps like this morning will reflect badly on him. The administration at this school has a reputation for being a bit kooky and I don't want to jeopardize his career because my performance isn't up to par.

But beggars can't be choosers and since my job search up until now has only resulted in a few frustrating interviews, this is my only work option. And I'll make the best of it. I'm sure once I get in there and start working with the kids, I'll be fine, even happy. But right now, I'm just sitting here waiting for the phone to ring. An all too familiar position over the past couple of weeks.


* * * * * * *
In completely unrelated news, the September Marie Claire Mexico is out on the newsstands and I'm in it (on page 65). In Spanish, my quote doesn't sound quite as idiotic as it did in English and despite the fact I hadn't showered the day they took the picture, I look presentable. Thank god for small favors.

Tuesday, August 24, 2004

leaving this behind

We leave tomorrow morning (early) to go to Boston for a wedding. My husband is the best man and I'm just a spectator. I'm pysched to see my best friend who will spend the day with me on Thursday hanging out and doing girly things. A pedicure is definitely on the agenda. And I'm looking forward to seeing my mom who will come down on Friday for lunch and a trip to the art museum. I'm happy to be getting out of Mexico for a few days, looking forward to eating fresh seafood, to drinking and dancing. But I'm slightly terrified to leave my computer- am still anxiously waiting word from Dr. Hope.

I've been catching up on my blog reading today and have been feeling strange about the controversy- I'm not sure where I fit into the picture as naively hopeful as I am about the route I'll be taking. Or the route I assume I'll be taking. I haven't experienced a loss other than the loss all of us infertiles undergo when we learn that having a baby won't be nearly as simple as we once thought. I wrote earlier today that I wished I was further down this path. And I do. In some (admittedly fucked-up)way, it's so that I can better empathize with those of you out there who have been through so much already. Mostly, though, its because I really want to be a mother. And I feel so far from that right now, not even knowing what its going to take for me to get there.

I've been thinking and thinking about this- how we all have different experiences with infertility and yet it is infertility that has brought us together (here in blogland).I think that it is important for us to be sensitive to each others' experiences, but also to be honest about our own. That can be a difficult line to tow, but it's how we learn and it can be a way to heal.

I have more thoughts on this, but am not sure that I can say them any more eloquently than what has already been said in other blogs. If nothing else, I'm grateful for this community.


next steps

Still no word from Dr. Hope. I have to keep reminding myself that I am not his only patient and that he was probably busy with back-to-back appointments yesterday, had other people's lab reports to read, and is taking his time to carefully read all of my questions so that he can provide me with the most thorough answers he can.

That makes me less anxious for all of three minutes until I remember that my husband and I are leaving tomorrow morning for a wedding in the States and won't be back until Sunday. No e-mail access while we're gone. I cleaned out my inbox yesterday to make room for Dr. Hope's message, but worry that by the time he responds it will be full again with spam. I really, really hope he writes today.

Last night at dinner, my husband said "I'm really glad we're going to use donor sperm instead of adoption. That way, we'll have a little you." And while I was happy for the sentiment, I worry that we're getting too comfortable with the idea of using donor sperm. "And a little stranger," I shot back. I mean, I know we need to be comfortable with that option, but I don't want to completely abandon the hope of using my husband's sperm. That is, if there are any to be found.

When I first blogged about the possibility that we might have to use donor sperm, someone sent me an e-mail and mentioned that sometimes the surgeon won't look as hard for sperm if they know you have donor sperm as a back-up. And while that makes perfect sense (in a way), it also scares me. Based on nothing but intuition, I'm pretty sure that my husband will be in that category of men who have all of 12 sperm hanging out in his testicles. And if they're hiding up there, I want to be assured that the surgeon will do everything in his power to find all twelve of them. And I'm not sure how you negotiate having the donor sperm as a back-up without your doctors knowing. Wait until they tell you "Sorry, we couldn't find anything." and then whip the vial out of your pocket and say "Well, can you use this then?". Do hospital gowns even have pockets?

Today my project is to look for more donors. My husband wants me to find as many as possible that fit our requirements and then together we'll narrow it down to two or three and order their full information packets. The task is daunting. When my husband asked me last night if I'd found any new donors since the ballroom dancer, I had admitted that when I first started looking, it was sort of fun- like reading personal ads in the paper. But then, when it dawned on me what I was actually doing, choosing a biological father for our future children, I freaked out. Suddenly the scenario changed from skimming the personal ads for entertainment to actually looking for a husband. And so I haven't been back since.

But today, I'll brave those waters once again- and this time will certainly be less flip about who/what I find there. I'm nervous, though. There's something about doing this over the internet that makes it seem less real. And the fact that we're working with our doctor long-distance adds to that. While I know its unrealistic, there's still a small part of me that hopes that I'll get pregnant without medical intervention. That my husband's tests were all a mistake, that this is all a bad dream. It's part of the reason that I'm so anxious to hear from Dr. Hope. While I never forget that we're infertile (believe me, it haunts me almost every minute of every day), we're still in the earliest stages of our journey and that can make it seem less concrete.

Envy is certainly not the right word, because of course I don't wish this on anyone, but I feel something about those women who have started their birth control pills, their injections, their husbands' sperm retrieval surgeries. I know that at one time they were in a place similar to the one I am in now, where there were a million unanswered questions and the path to motherhood was not at all clearly paved. And I know that they still have questions about whether or not this cycle will be the one, if the pregnancy will be viable, if they are any closer to being a mother now than they were a year ago, a month ago, last week. I know that they too, are anxious and nervous and hopeful and excited all at the same time. I know that no matter where you are in the journey, there are things to be scared about. And yet, I want to be there. Call it impatience (because, really that's what it boils down to), but I want to be a little bit further down that path. I want to take the next step whatever that might be.

So I'm keeping my fingers crossed that I'll hear from Dr. Hope before we leave tomorrow morning. Or that, at the very least, his e-mail will be waiting for me when I get home on Sunday. And from there, I hope that we'll have some answers, that we'll be able to schedule our next appointment and get things moving along.

Monday, August 23, 2004

family

My sister came to visit this weekend. The last time she was in Mexico it was for a beach vacation and she was frustrated by her inability to communicate. This time, my husband and I were on hand to take her around the city and translate for her. I have an itinerary for most of our visitors, but we didn't stick to it for my sister's visit. She's really into golf and skiing and as far as I can tell, not so much into museums or shopping which are the big draws here. . .So on Saturday we went to the Six Flags amusement park on the edge of the city and spent our day daring each other to go on rides that spun us every which way, made us dizzy, and dropped our hearts into our stomachs. We ate junky amusement park food and laughed until we cried, screamed until we were hoarse. I hadn't been to an amusement park since I left New York (there, I'd head to Coney Island at least once every summer.) And it really was a good time. My sister had fun. I had fun. My husband had fun. It'd been awhile since I felt so free to be silly. I didn't think about our infertility once- not even to make the obvious connection between the roller-coaster ride of hope and despair and the Medusa, our last terrifying ride of the day that gave me a stiff neck when I woke up the next morning.

Yesterday was a low-key day. My sister came with me to Kinkos to fax off my HSG report to Dr. Hope who returns from vacation today. We had a long leisurely lunch at the Italian restaurant down the street from my apartment. We played monopoly in the evening and had a late dinner at home. She left about an hour ago to head back home to her real life.

I have four sisters actually. And a brother. The sister who came to visit is the only one of them that I'm actually in touch with. It's a long complicated story, but essentially all of my siblings are from my dad's first marriage. Are half-siblings. And when he died, they sort of gave up on my mother and I. All of them except the one who came to visit.

She and I grew up in different households. She's 20 years older than I am- closer to my mom's age than to mine. But over sangria on Thursday afternoon- when I told her that my husband and I might have to use a sperm donor, she reminded me that she and I are closer, more alike than she is to her biological sisters. She reminded me that genes aren't everything. And of course, as an adopted child, I know that. I know that love transcends DNA and that family isn't defined by blood. I'm just anxious to get started.



Wednesday, August 18, 2004

with jesus at my feet

I survived my HSG. Thank goodness for Mexico and its cheap, powerful, available-over-the-counter pain medications. I don't know what it is that I took, but it was strong. The kind of strong where you can't control the smile on your face. The kind of strong where taking money out from the ATM seems an insurmountable task. The kind of strong where you finally get why people in Mexico seem to walk so slooooowly down the sidewalk- they're all on this medication and are afraid to lose control of their legs and feet. I'm sure I lost more than a few brain cells, but it was worth it. The cramping was minor. Nothing I couldn't handle. Nowhere near the worst pain I've ever been in.

I was definitely worried about going for the HSG. I'd read one too many horror stories on the message boards I frequent. Really, for me at least, the worst part was the anticipation. I managed to work myself up into a sweat just laying on that table waiting for the doctor to come in. I also made the mistake of watching the nurse lay out all of the instruments on the little side table. Not a single one of them looked as though it belonged in this millenium. Everything was sharp, metal, pointy. Nothing I'd normally allow anywhere near my vagina.

Because this is Mexico, there was a big painting of Jesus near my feet. He was holding a heart that seemed to be on fire. I think the painting was meant to give one comfort, but the fact that Jesus had a straight-on view of my cervix was more than a little unsettling. That, and the creepy smile on His face. Like He enjoyed it? Looking at the private parts of vulnerable women? Come on! Don't you have some miracles to perform? Go turn some water into wine or something. I'll need a drink when this is all over.

The whole thing lasted a bit longer than I expected. The doctor was writing up his little report in between takes of my insides. I'm not sure if that's how they usually do it, but if it is, I'd recommend taking the speculum and canula OUT of the patient before taking the time to write up your findings. It was: a little dye, take the picture, look at the film, type, type type. More dye, take another picture, look at the film, type, type, type. Turn me on my side, more dye, take another picture, look at the film, type, type ,type.

If your doctor doesn't do it that way, I'm not sure if I want to hear about it. Maybe, because then I'll go to your place the next time. But maybe not, because its already over and there's nothing I can do about it except get mad and feel a little creepy.

The good news is that everything down there seems to be in the right place. I do have a tiny, little flebolito on the left side, but the doctor thought that was nothing to worry about. Since I have no idea what a flebolito is, I'm remarkably calm about its possible implications on my fertility. My tubes are clear, my ovaries are small and cute. I could spend all day looking at my films. I'm so proud.

So what's my next task on this road to conception? I'm ready for anything. I've got my not-quite-full box of painkillers and Jesus at my feet.

Tuesday, August 17, 2004

unfair and unbalanced

Still no word from Dr. Hope or Nurse Helpful. So, they've either fired me as a patient after my last somewhat hysterical e-mail and have neglected to tell me or, Nurse Helpful is on vacation now too. The second is the more likely scenario as I seem to remember her telling me that she was going away the last two weeks in August. And sure enough, here we are in the last two weeks of August.

Just to cover all of my bases as the annoying patient of the year, I sent off another e-mail this morning to Nurse Helpful's stand-in. I cc-ed Nurse Helpful of course and asked the same gazillion questions that were in the original e-mail and added a couple more for good measure. If I haven't already been fired, I'm hoping that Nurse Stand-in doesn't have the authority to can me and that she'll have to answer each and every question in a thorough and timely manner in order to avoid getting canned herself.

So, while things in DC seem to be moving slooooowly, things here in Mexico are moving right along. I've got yet another appointment at the lovely Centro Fertilidad this week. I am so looking forward to having my uterus and fallopian tubes filled with dye, I can't imagine why I've never done this before.

Not that my husband having his naughty bits sliced into smithereens isn't nothing, but I do have to say that there seems to be something a little bit unbalanced about this whole male factor stuff. Supposedly, I'm not the one with a problem and yet I've had more blood drawn than he has. I'm the one who has to have the HSG. I'm the one who'll be injecting a hundred different kinds of meds into my butt, who'll have to live with his parents for three weeks. I'm the one who will go through the retrievals and the transfers. It seems like a lot for someone who is supposedly fine.

Now, I'm very aware that any problem my husband has with fertility is my problem too. It was right there in the wedding vows. "In sickness and in health, In fertility and infertility, 'til death do us part." And not that I'm keeping score (okay, maybe just a little), but I know that if I had PCOS, let's say, or some other condition that was affecting my ability to get pregnant, I'd still have to do all this stuff to achieve a pregnancy. Almost nothing would change for me. But for my husband? He'd be off the gurney faster than you can say "azoospermia", though he'd still have to give me my injections.

I'm simplifying it I know. Infertility affects us both because we are a couple. If he can't have a baby, then I can't have a baby and vice-versa. And while we tend to deal with the emotional aspects of it all very differently, we're still in it together. It doesn't really matter where the "fault" lies. And simple biology has to dictate the protocols of the procedures and the treatment, doesn't it? That's the reason that IVF will look pretty much the same from my point of view, from any woman's point of view regardless of whether its a male factor or female factor problem. And that's why we gals are the ones who (god-willing) will gain the weight and have the morning sickness and experience the pains of labor.

I'm sure I sound like I'm complaining about what's to come down the road. And I don't mean to be. The truth is, I'll do anything it takes to have a baby. Just tell me what I need to do and I'll do it. But please tell me before you go on vacation.

Friday, August 13, 2004

you can dance if you want to

(This post is dedicated to my husband who lost an extra ten minutes of sleep last night due to my uncontrolled giggling over the personal essay of donor 23897*. And for being secure enough to know that no matter what happens, our child could never love donor 23897* one millionth as much as s/he'll love my husband)

I found four new potential donors yesterday afternoon. Right hair color, right eye color, within the right height and weight parameters. I was even able to click on their answers to a few questions (for free!) and I have to say, donor 23897* really stood out:

What are your hobbies? ballroom dancing
Do you participate in any sports? I do competitive ballroom dancing.
What is your favorite movie? Strictly Ballroom
What do you consider your best qualities? I am a good dancer. Very graceful and agile.
If you could travel anywhere, where would you go and why? I have been to England and Italy for international ballroom dance competitions. I loved meeting ballroom dancers from around the world.
What are your long term goals? I find that I am personally fulfilled by dance and in ten years I'd love to become a professional competitive ballroom dancer or a ballroom dance instructor.

Every single question on the form was answered with some reference to ballroom dancing. Since my husband and I are neither graceful nor agile this donor did have some appeal. But we worried that our future child might spend his or her days sashaying around the living room instead of doing his or her homework. That he or she wouldn't want to take the scheduled family vacation because it conflicted with his or her dance classes. That our weekends would be spent at ballroom dance competitions. That we'd need an extra room in the house for all the ballroom dance trophies. That between the costumes and the classes and the entry fees and costs of traveling to competitions, we wouldn't be able to afford to pay for college. Not that our child would get in anyway being so singular minded. We dropped donor 23897* from the list.

(*Note: Donor 23897 is not his real number. All identifying characteristics have been changed to protect the dancer. Except for the fact that he loves to ballroom dance.)

Thursday, August 12, 2004

the plan

I finally heard from Nurse Helpful this afternoon. Her e-mail said:

Dear Gringa,
Don't get your panties in a bunch. Yes, your husband's FSH levels are high. And yes you think you're so smart with your search engines and your infertile blog friends giving you all sorts of medical advice, but I checked with Dr. Hope's stand-in and we think all that is a load of crap. The testicular biopsy will go on as planned.

Okay, she didn't really write all that. Her actual e-mail was only two sentences long. She said she checked with Dr. Stand-in and we're supposed to have a testicular biopsy as planned. But I can read between the lines.

What was supposed to be my "official" news of the day was more than disappointing. First of all, I thought the plan was to get my husband's bloodwork results and THEN make a plan. Apparently, I was wrong. Second of all, thanks to my search engines and infertile blog friends, I know that there is more than one way to slice up a testicle and you can get very different results depending on which way you do it. Third of all, we're coming from Mexico! and in order to have any sort of biopsy at all, we need to make travel plans and set up appointments. Nurse Helpful didn't bother with any of that.

I have to admit I abandoned all chances of being considered a "good patient". I wrote right back to Nurse Helpful (not so anymore) and asked her about 349072098 specific questions about "the plan". Is the biopsy diagnostic? Or will it be done at the time of egg retrieval? Do we need donor sperm for backup? What cryobanks does the clinic work with? Which procedure are they planning on using? MESA? TESE? Something else? Does my husband have to meet with the urologist before the biopsy? What about that ultrasound they mentioned at the last visit?Are we still on schedule for starting IVF in September? What else needs to be done before that? Can we sign up for an IVF class? Who do we talk to about the money stuff? Are you going to fire me as a patient for asking so many questions?

Needless to say I haven't heard back yet. And I probably won't until Monday at the earliest. Nurse Helpful has left the office for the day. And she doesn't work Fridays. And she doesn't check e-mail when she's not at work. And Dr. Hope is still on vacation.

Yeah. Hope is definitely on vacation.

jumping the gun

Dr. Hope is on vacation, so although Nurse Helpful received our bloodwork results yesterday, I won't hear anything "official" until later today once she's talked to Dr. Hope's stand-in. Needless to say, I'm more than a bit anxious.

Yesterday I managed to convince myself that we're not going to be able to use my husband's sperm and went on a mad search for donors that look something like him. I was surprised to learn that there aren't that many men out there with brown wavy hair and brown or hazel eyes who are between 5'8 and 5'11. And even fewer that have advanced degrees. Four to be exact.

The experiment was fascinating, but depressing. Because I didn't choose my husband based on the color of his hair or his eyes or his height. I chose him because he can make me laugh even when I'm dead-set against it. And because he's smart and stylish and loves to spend the day with the NY Times on Sundays. And because his smile is genuine and real and lights up a room. I chose him because he gets me (and sometimes that's hard to do) and because I get him. Because he's a good debater and loves to travel and likes my cooking. Because he's great with kids and is an excellent teacher and will make an even better father. I chose him because I love him.

The potential donors might enjoy running and canoeing and hold advanced degrees in neuroscience, but they can't make me laugh. I don't know what they look like when they're sleeping. I don't know if they'd be able to handle my moods. And while that doesn't really matter all that much in the grand scheme of things, it does make me wonder just what it is I'm looking for exactly.

Over dinner last night, my husband asked why I'm so hell-bent on having a donor that looks like him. And I didn't really have a good answer. I know that when we talked about adopting, we were both on board with getting a baby from China, so why all of a sudden do I have this need to replicate my husband's genes as best I can? I have no idea.

I'm hoping of course, that it won't come down to needing a donor. Lest you think I'm jumping the gun. . .okay I am, but its not unprecedented, just know that I had already picked out nursery bedding (both for a girl and a boy) and a diaper bag only a month or so into trying to conceive. I'd visited maternity stores online and made a list of "essentials" to buy just as soon as I got my BFP. And while those tasks were done out of hope, this latest donor shopping is my way of tempting fate. I had the diaper bag picked out and didn't need it, maybe if I choose a donor, I won't need him either.

One sperm is all it takes (didn't we learn that in junior high health class?) and if this reverse psychology works, that sperm will be my husband's.

Tuesday, August 10, 2004

the results are in

My bloodwork still won't be ready until tomorrow, but I picked up my husband's results this morning. And it didn't look good. Most of his hormone levels were in the normal range, but the FSH was elevated. It feels like I've read everything I could get my hands on (thank you google!) and the high FSH levels seem to indicate testicular failure.

I'm not sure exactly what the implications are for our treatment, but I'm imagining that the likelihood of finding sperm up in his testicles has decreased significantly. I'm no doctor, but the word "failure" just sends shivers up my spine. And while I thought that using donor sperm or adopting were viable options for us, now they just seem so, well, not what I want. At least not now. At this moment. But I suppose I'm still in shock.

Tonight we'll fax off the results to Dr. Hope with a carefully crafted letter letting him know that we want to know the reality of our situation even if that means breaking bad news over e-mail. And you know I'll be online all day tomorrow checking my messages. I won't know what else to do with myself.

I think though, that this new twist weighs in the favor of doing our treatment in the States. That's one less decision I'll have to make. Two steps forward, three steps back.

new addition

My mom called last night to tell me that my cousin had her baby. It's a boy. No name yet because he came a month early. Was delivered yesterday evening by c-section. Mom and baby are doing fine. A whole month early and the little trooper isn't even in an incubator.

I knew the baby was coming (although I expected him in a few more weeks), but I was completely caught off-guard by the way the news made me feel. Like a quick swift blow to the stomach. The same way I felt when I first heard back in January that my cousin was pregnant. We were on our second month of trying, and as I understand it, she and her husband weren't really trying at all.

I have a few friends with babies now. And a couple of them announced their second pregnancies soon after we started trying with our first. And somehow those announcements didn't sting as much as the news that my cousin was pregnant. I don't really know why. Maybe because she's family. Maybe because she is exactly my age, got married just a month after me (though she got engaged a full five months before I did). Maybe because it seemed so easy for her and I thought it would be easy for me.

I want to be happy for them, but I can't. Not yet, anyway. And that makes me feel like a rotten person. I'm already worrying about seeing the new baby at Thanksgiving when the whole family will gather as we have for the past I don't know how many years. I worry that the relatives will ask when I'm planning on getting pregnant- none of them know about our infertility, except of course my mother and my in-laws. And I worry that because they don't know, comments will be made that sound insensitive to my ears.

I dare to dream, of course, that by Thanksgiving I'll be pregnant too. If that miracle did happen that quickly (and I realize its a long shot), it'd be too soon to share the news. But that secret, in that situation, would be one I could live with. Something to hold on to in the face of all the oohing and aahing over the newest addition to our family. And so I continue to hope. Miracles do happen.

Monday, August 09, 2004

limbo

We were supposed to have the results of our bloodwork by now. I went over to the clinic last Tuesday and was told to return on Thursday- they still had a couple more tests to do. So, I called on Thursday and was told to come back on Tuesday (tomorrow Tuesday) and I am praying that those lab reports are ready to go. I don't expect any big shockers, but our doctor in DC is waiting for the results and we've found an IVF specialist here in Mexico who also wants a look. And until those results are in our hands, we're unable to move forward.

It feels to me like this whole process takes a non-linear path. It felt like we had made so much progress during our trip to DC. There were new decisions to be made, for sure, but now a whole new element has been added to the mix. Do we go through IVF here in Mexico instead of back in the US?

As with everything, there are pros and cons. I like that I would be home in my own apartment, in my own bed and not needing to stay with my in-laws for three weeks at a stretch. I like that my husband will be with me through the injections and the egg retrieval and the embryo transfer, that I won't have to report to him over the phone from 2000 miles away. The cost per cycle here is lower, as is the cost of the drugs. But in DC, we'd be participating in a shared-risk program so that if we didnt deliver a live baby after six cycles, we'd get all of our money back. Here, there is no such guarantee. And while the new doctor is perfectly bilingual (as is his receptionist), I'm not sure about the rest of his staff and how comfortable I'd be going through such a confusing process in another language.

Last week my husband and I sat down and made a list of all the variables. We added the possibility of me starting a new job into the mix (two possibilities- both of which start in the Fall). And while it was probably the most rational discussion we've had about the matter since we found out we'd be relying on ART to get pregnant, we didn't really come to any conclusions other than every option we toyed around with has its merits.

I suppose we're a bit ahead of ourselves anyway. At least until we get our labwork back and know for sure whether we're dealing with obstructive or non-obstructive azoopermia. And then the ultrasound for my husband and the testicular biopsy and my HSG will help to determine the next course of action. I just hope there are no new surprises, no new variables to add to the already very confused equation.

Thursday, August 05, 2004

a friend in need

One of my best friends called me yesterday afternoon. We hadn't spoken or e-mailed since I got back from my trip to DC and I figured she was calling to find out how that all went. And sure enough, that was the first thing she asked about. I explained to her that we had discovered the source of the problem, that my blood tests came back within normal range and that we now seem to have two options as how to proceed. As soon as I mentioned that we had a few more tests to do, one of which is the HSG to make sure my tubes are clear for takeoff, she interrupted me.

"What was that thing you had a few years back?"

"The bleeding?"

"No the other thing."

"The cysts?"

"Yeah, that. I have that."

And I suddenly realized that she was calling from work and knew perfectly well that I had had cysts, but couldn't say it aloud on the phone, fearing that someone would overhear her.

"Can you hear me?" she whispered. "I went to the doctor and he told me I have five cysts."

The word "cysts" was barely audible.

"He did an ultrasound and saw them. Have you heard of P-C-O-S?"

"PCOS?" I asked, pronouncing it as one word- peekos.

"Yeah. I looked it up online and there were pictures of fat bearded ladies all over the place."

"Well, not all women who have PCOS have those symptoms. And I have a hard time believing that your doctor could diagnosis you with just an ultrasound. Are your periods regular?"

"Yeah."

"Did he say anything about blood tests?"

"Yeah, I have to have my F-H. . "

"FSH, TSH, LH, Estrio. . ."

"Wait, wait, what was that last one?"

"Estriodol and Prolactin. Those were the ones I had."

"Okay, okay, I'm writing that down."

"Did he tell you to do the FSH on day three of your cycle?"

"No!! Wait, why? What is that exactly?"

"Well, let's say the first day of your period, the first day you see red blood, is a Monday. Wednesday would be day three. And that's when you should go in for the blood test. But make sure to ask your doctor, okay?"

And suddenly the conversation escalated. My poor friend was terrified that she had she wasn't ovulating, that she had PCOS, that she was going to be diabetic by 40, that she had a tumor on her pituary gland.

"Look, my cysts went away on their own after a couple of cycles," I tried to sound reassuring. "And most women have cysts at some point and many don't even know it. Often, they don't even cause any problems."

I read to her from "Taking Charge of your Fertility". I read to her from "Our Bodies, Ourselves". I promised to send her more information about cysts and PCOS. I assured her that having a tumor on her pitituary gland was not likely. But still she continued to panic.

This friend happens to be good at panicking. Years ago, having slept with one man, one time, with a condom, she took an HIV test and convinced herself during the waiting period that she was going to die of AIDS. Right after September 11, around the time of the anthrax scares, she was stockpiling Cipro and wouldn't take the subway to work. This past winter, she called certain that she was dying of a kidney infection, when in fact, she had just pulled a muscle in her back. I have mor examples, but you get the idea.

And while I put on my best social worker voice during our phone conversation and tried to give her the best information I have, I was feeling frustrated with her level of anxiety, the panic in her voice.

When my husband came home and I told him what happened, he reminded me how panicked I had been a few years ago when I first found out that I had cysts. He reminded me that just a few weeks ago, waiting for the results of my own blood test, I had been sure that I had PCOS. How easy it is to forget our own anxiety, our own crazy obsessions.

And the thing is, this friend is a great friend to me, to everyone. When I first told her about not being able to get pregnant, she asked all the right questions, she listened, she was supportive and kind. And I know that mutual friends of ours are going through rough times, have been through rough times and she was right there with them, holding their hands if they needed it, cheering them on if that was what was called for, being a true friend to them, just as she has been to me.

Before my friend and I got off the phone, I told her to call me if she had any more questions or if she just wanted to talk. She apologized for monopolizing the conversation and I told her the truth, that it was a relief not to talk about my own infertility for once and while I hoped that everything was fine with her, I was happy to listen to her worry aloud. I told her to call her doctor and discuss her fears with him. And she promised to do that. Promised that she would try to relax.

I got an e-mail from her this morning thanking me for being there, for giving her good information and advice. And she had already called the doctor, was planning a trip out of town this weekend to help her relax. "You're the best," she wrote. And all I could think was, "Isn't that what friends are for?"

Tuesday, August 03, 2004

disclosure

When I first told my mom about our infertility, she warned me not to tell too many people. "It's a private thing", she said "and you don't know yet what it's going to take to bring a baby into this world. The fewer people that know, the better."

Granted, my mom is one for keeping secrets. It wasn't until my junior year of college that I learned she had been married before she met my dad. And when I was twelve, she told me that my dad was in the hospital for tests when really he was having triple bybass surgery. But I listened to her advice on keeping the infertility stuff on the down-low and was careful about who I told- plenty of people online and anonymously, but in the real world only a smattering of my closest friends who I trusted would be both supportive and discreet.

That was three months ago.

Now, it seems the whole world knows that my husband is spermatically-challenged. Or should I say, my whole world. People I hadn't planned on telling at all now know not only that we're having trouble conceiving, but that the route of the problem lies in (or doesn't lie in, as the case may be) my husband's testicles.

It started out as a "don't ask, don't tell" thing. As in, if they don't ask, I won't tell. But the problem is that I was so excited about starting to "try" last December, so sure that I'd get pregnant in no time, that all my friends and aquaintances were privy to the fact that we wanted to have a baby and were working on it. And so, its natural that they ask me how the baby-making is going. And in this case, I find it hard to lie.

Over the weekend, a friend of mine who lives in Finland asked me about the supposedly upcoming trip to Scandinavia next summer. I put off writing back to her for as long as I could, but then yesterday wrote back and told her that we'd had to postpone making any plans as things are too uncertain right now. And then I spelled out the terms of that uncertainty. She's expecting baby #2 in a few weeks and it practically broke my heart to tell her that we won't be expecting our baby #1 for some time now. But I told her.

And yesterday, my best friend here in Mexico (really my only friend here in Mexico) returned from her 3 month trip to India where she was showing off her new baby to the relatives back home. She called to chat and to catch up and of course asked me how things on the baby front were and even though I had emphatically told my husband just a few days before that I'd never tell her what was going on, I confessed. And she was aboslutely supportive and wonderful and it somehow made me feel guilty that I had underestimated her reaction, her capability of kindness.

The thing is, despite my initial scare of bad reactions from friends everyone has been wonderful. And I'm glad I didn't take my mother's advice to heart. While I'm not running around shouting "We're Infertile!" to everyone I meet, I recognize the importance of being able to share this with my friends. For the most part, they're the kind of people who really mean it when they ask "How are you?". And even more than that, by telling I'm able to buy myself the freedom to be in a crappy mood, or feel fatigued, or bloated, or depressed. It explains away my soon to be more frequent trips to the States. Telling can help them to help me.

During our conversation yesterday, my friend here in Mexico gently asked if I was still willing to babysit for her. Just that she asked meant so much- that she was able to acknowledge that it might be diificult for me to make good on the promise that I had offered up before I knew that it would be a struggle to have a baby myself. I was glad then that I had told her. It made it easy for me to say "Yes, I'd love to." And mean it.

Monday, August 02, 2004

timing is everything

After a relatively low-key weekend (lots of reading in bed, renting movies, and ordering out), my back feels almost normal again. Investing in a hot water bottle was definitely a good idea, as was popping a couple of advil every few hours and sending my husband out on errands. I'm still not 100%, but I hope to feel normal enough tomorrow to head back to the gym where I haven't been in ages.

We spoke to my in-laws on Saturday evening and they were their usual too-optimistic selves. My father-in-law wants to continue to plan a trip to Sweden next summer, something we first started talking about before the whole infertility mess came about. He doesn't seem to get that things are so uncertain in our lives right now that its not really the time to make long-term plans, especially those that involve overseas airplane travel.

He kept quoting statistics to me over the phone, statistics I'm quite sure he made up on the spot since even our urologist didn't have any success rates to give us. "There's a 25-50% chance that the surgery will work and you'll be able to conceive naturally." Really? Because that's not what all the research I've read suggests.

"Everything is going to be fine, just fine." They kept repeating that as though it were their new mantra and while I'm glad that they're trying to be positive, just once it'd be nice to hear them say something along the lines of "We know this is hard, but everything will turn out fine." It's the acknowledgement of the stress and the anxiety and the uncertainty and the difficulty that I want. Not made-up statistics, not "You'll have a baby by next summer."

So by the time we got off the phone, I was riled up. Really riled up. Because my in-laws didn't seem to understand that even the experts haven't been able to tell us which course of action to take. Because they didn't seem to get that, even though we're relatively young, we want to have a baby sooner not later. Because they didn't seem to get the time involved (whether we choose IVF or variocele repair) or the possibility of it not working.

And so my husband and I had "the talk". The weighing-all-of-the-options-based-on-what-we-know-now talk. And I admitted that I don't want to be an "older mother" having my first child at 35. I worried aloud about the idea of moving back to the States next summer either pregnant or on my way to being pregnant, finding a job and then having to take off again for maternity leave. I fretted about taking one of two jobs that are coming up for me this Fall, only to let them down when I leave for 3 weeks to go to DC for my IVF treatment. No matter what we decided, it seemed, the timing was never right.

The thing is, I want a baby more than anything. And I want a baby soon. I want to be a mother, have always wanted to be a mother. And certainly my career is important to me too, especially since its been on hold for almost 2 years since I moved to Mexico. And I'm desperate to move back to the US, to be closer to my friends and my family. But it doesn't all add up. Doing IVF this Fall means any job I accept will suffer for it and I'll have the added stress of starting a new job while trying to focus on making a baby in a lab. If my husband has the surgery, we'll have to wait 6-9 months to find out if it worked and if it does, it means I'm trying to get pregnant at the same time that I'm looking for jobs in the states, doing an international move. And if doesn't work, we're right back where we started, only a year later.

I realize that none of these things are insurmountable, but I happen to be a planner, a control-freak. And suddenly, I don't even have control over my own reproduction much less the other aspects of my life which are affected by a pregnancy or IVF. It's confusing and overwhelming and even though, I really think that my husband heard me, really listened to all of my concerns during "the talk", the decision we're facing is a difficult one. I am at a total loss as how to proceed.