Bitter, party of one? Bitter?

This is my 17th cycle trying to get pregnant. This time, I took Femara (a breast cancer drug also thought to help with infertility) and had an IUI. Everything on the pre-IUI ultrasound looked fine, and my timing was good. If this try doesn't work, I'm going to IVF.

I always thought I'd do everything "perfectly" on my last try; I'd avoid sugar, I'd get lots of acupuncture, I'd stay relaxed, I'd eat my sweet potatoes and papaya and seaweed. Instead I'm baking like a maniac and my anxiety level is high. On Friday, in a tense meeting, I wrote the date in my notebook and thought, 'a year ago today I found out I was pregnant.' Later that day I attended yet another baby shower for someone who both conceived and will give birth after my pregnancy failed. My office just announced that Take Your Children to Work Day will take place in late April -- on the anniversary of my miscarriage. A close friend who also had trouble conceiving is now in her second trimester. I'm thrilled for her, and we've talked about it a lot, but it isn't easy (see Akeeyu's smart post about this).

There is so much riding on this try. If I don't conceive this time, I won't have a baby in 2007. I always thought that by starting at age 35, I wouldn't be an older mom. So much for that. And of course I'll be moving to a procedure that's incredibly invasive, time-consuming, and costly (even if I'm not paying for it -- thank you, magical insurance). Now, as I wait to find out if this the 17th try is the charm, it's hard to not scrutinize how I'm feeling each day -- what is my temperature doing, are my breasts more or less sore than last time, is my fragile emotional state meaningful or just the universe's way of offering me a gentle fuck-you?

Kinds of gratitude

I appreciated this post from Barren Mare, who's pregnant after years of struggling with infertility. (Her post about finding out she was pregnant during an IVF consultation is pretty priceless.)

Anyway, here's a bit of what Barren Mare had to say about being pregnant after all of her efforts:

Somebody said to me several weeks ago that one of the nicest things about being pregnant must be the great relief to know I'm not infertile after all. I've been thinking about this a lot since then. I suppose that, strictly speaking, it appears to be true, at least for the moment. But it's odd. It's odd to think that somehow getting pregnant can cancel out all the aggro and grief I felt during the years when we tried and tried and tried without success. During which we endured invasive testing and fertility treatment, without success or even answers as to what the problem might be. And even now, I have no idea why it suddenly happened. [...]

When something finally, miraculously occurs, it's undeniably lovely- but it's also kind of scary. Because if you don't know why or how it happened- luck? timing? an unusual planetary alignment?- then it's hard not to believe that this is your one and only chance. That lightning can't strike twice, so if something goes awry, you're cast out of the kingdom forever, with no way back. And having finally seen your way clear to safety on the horizon, it's impossible to fathom how you might ever recover from that.

So no, "relieved" is not really the word I would choose. I feel greatly, vastly fortunate, but also hugely wary. Much of the time I feel like this happiness is on loan to me, rather than a permanent keepsake. But that's one of the life-changing aspects of infertility- there is less inclination to take anything for granted.

I appreciate Barren Mare's realism and ability to recognize the universe's randomness. I wish her all the best. The same goes for Infertile Pediatrician, whose smart blog chronicles her experience trying to conceive "all the while working with those who are quite fertile and their offspring." IP is newly pregnant, and I'm crossing my fingers for her that this one sticks.

Anniversaries

Today is the one-year anniversary of when I got pregnant. I am "celebrating" by getting my first mammogram. Ironic, as I could not get a mammogram if I was pregnant or breastfeeding (as I would be now if I'd stayed pregnant), and as I am considered high-risk for breast cancer because a) my grandmother had it late in life, and b) I am 36 and have not given birth.

I got pregnant on the fifth try, and as I miscarried, I comforted myself with the thought, hey, I got pregnant pretty quickly, so I shouldn't have trouble getting pregnant again. Eleven tries later, I'm getting a mammogram. This cycle is my last IUI before moving to IVF. (I have incredible insurance coverage for IVF, so the decision to take that path is much easier.)

I have a lot of hope for my 17th try -- despite being a very rational person I have a strange superstitious streak when it comes to this stuff. Seventeen is a lucky number for me, and I really don't want to do IVF. First, I know I can get pregnant without it, and second, I'm worried about scheduling all of the shots, appointments, egg retrieval around my very busy job, as my bosses and most colleages doesn't know about the bun project. Furthermore, many of my friends who've done IVF have ended up with twins; that's not my first choice. So here goes number 17: this time with Femara, acupuncture, and now, yoga.

As the months have passed my brief pregnancy has felt like a dream, a fluke. I'd give so much to know and harness whatever magic was in the air on March 9, 2006, when two different ovulation predictor kits couldn't agree on whether I was ovulating, when an ultrasound showed imminent ovulation, and when a single IUI, performed apparently at the exact right time, knocked me up.

What I've tried

Here's a partial list of the things I've done to get pregnant:

- 12 non-medicated cycles of IUIs
- 1 cycle taking 100 mg of Clomid
- 1 cycle taking 100 mg of Clomid with an estrogen patch
- 1 cycle taking 50 mg of Clomid
- 1 cycle taking Femara
- 1 hysterosalpingogram. That's the delightful x-ray where you lie half-naked on a table in the hospital's radiology department, with your legs spread so far apart you have a whole new understanding of your hip flexors. Then it gets better: a radiologist squirts dye into your uterus, and everyone in the room watches the monitors to see if the dye behaves as it should and moves through the uterus and into the fallopian tubes. (It does.) The idea is that it both identifies any blockages in your tubes and also clears them out. I have (what turns out to be futile) faith in this procedure, as I was conceived after my mother had one.
- Several cycles with Acupuncturist #1 and three with Acupuncturist #2
- Used a mail-ordered speculum to monitor my cervical opening
- Tried three different sperm donors
- Rolled my body onto one side after an IUI when I knew which ovary had the golden egg
- Taken my temperature nearly every day for almost two years
- Tried to radically reduce the amount of sugar I eat, with limited success
- Taken Chinese herbs
- Taken up yoga
- Had tests to measure my FSH, LH, progesterone, and antral follicle levels (all fine).
- Avoided: hot tubs, wine, massage, running, abdominal work-outs, lifting heavy things.

It's funny how much more relaxed -- in a limited way -- I've gotten over time. It's 12 days after ovulation, and in the past I would have chastely turned down a margarita in the two-week wait. Lately, though, my attitude has been, I'll have the pinot noir. My alcohol tolerance is pathetic, so it's not as if I'm pounding shots. But I like wine, and I'm no longer interested in denying myself something that I don't believe will really make a difference. If I find out I'm pregnant, I'll stop drinking, and only then.

This cycle I didn't take any drugs and have been seeing Acupuncturist #1. I've decided I've got one more IUI cycle in me (next time with Femara again) before moving to IVF. Here's hoping I don't have to.

Things I love about the Bay Area in February

The only thing to fear...

The American tradition of instilling fear in people is thriving in the study of pregnancy. Eating fish may cause developmental delays -- but if you don't, your kid may have poor verbal and social skills. If you conceive in the spring, your baby may be premature. If you're black, you're three times as likely to have a preemie. If you do IVF, your risk of birth defects is higher. Heightened sensitivity to hormones may cause miscarriage, and remember that whole vaginal birth thing that's been working for millions of years? It may cause brain hemorrhages.

It's a wonder anyone gives birth to healthy babies at all -- except, wait, that's what happens the majority of the time.

All of this fearmongering (and I'm not exaggerating -- pretty much all of the stories linked above were published in the last 30 days) brings us to our latest subject of our book club, Angela Wu's Fertility Wisdom. I bought Wu's book when I started seeing Acupuncturist #2, and
at first found Wu's explanations comforting. She prescribes a strict diet, a lot of rest, Qi Gong exercises, and even wearing red underwear (if your constitution is cool, warm it up, etc.).

All interesting stuff, and Wu is highly regarded in the Bay Area for her ability to help women get pregnant. But it's easy to be scared reading her book -- she argues that you can't follow her plan just 75 percent of the way, as you can't be 75 percent pregnant. She tells the story of Marcia and Bill, who tried for 13 years to get pregnant. Wu told Marcia to cut out sweets, wheat, and dairy:

"Everything went well until the third month. It was Marcia's birthday and, frustrated after months of the 'deprivation diet,' she wanted cake. Bill gently reminded her of their priorities: Wasn't all the progress they'd made -- and the hope of the baby they'd wanted for 13 years -- worth more than cake? With Bill's help, Marcia overcame her craving, and by the end of the 3rd month, she was pregnant."

If you try everything Wu advises and don't succeed, she suggests that you look deep within yourself

"to your true feelings about having a baby. Are your Three Treasures -- head, heart, and gut -- powering your efforts, or might old feeling be blocking your access to the one resource every infertile couple needs: hope?"

That's right, I forgot -- it's always our fault. I feel so much better now.

Reading list, part 1

I’m really enjoying Peggy Orenstein’s new book, Waiting for Daisy: A Tale of Two Continents, Three Religions, Five Infertility Doctors, an Oscar, an Atomic Bomb, a Romantic Night, and One Woman’s Quest to Become a Mother. I first came upon Orenstein’s writing in this New York Times piece (Times Select required) about how she mourned her miscarriage in Japan. The story had nothing to do with me when it was published in 2002, but it stayed with me – so much that when I learned I was going to miscarry last year, I sought out the article and found new meaning in it. (The Buddhist divinity she writes about is the same one I mentioned here.)

It’s hard to feel sorry for myself when I read Orenstein’s story – diagnosed with breast cancer at 35, three miscarriages (one of which, a partial molar pregnancy, meant she couldn’t try again for a year), and several failed IVF attempts, including one with donor eggs. On the other hand, I don’t have what amounts to a own private sperm bank, as Orenstein did. I started trying when I was 35; she didn't have a child until her 40s. There's lots that's familiar in the book, too -- she begins seeing an acupuncturist who prescribes herbs that smell "like feet;" the book mostly takes place in the Bay Area; one of my doctors even makes an appearance.

I haven’t finished Waiting for Daisy – it arrived yesterday, and though I’ve already read 200 pages, I like to pace myself. Reading it is like eating chocolate: it's a tonic, and I can't get enough. At the same time, I already know the ending (the title tells it all) and I have to ask: would you buy an infertility memoir whose book jacket didn’t describe the author as living with her husband and child? If Orenstein had chucked it all and decided to try to live happily with her saintly husband in placid Berkeley, perhaps with a SPCA-special mutt for company, would she have gotten a book deal?

Frankly, I don't care. Because I identified with this section:

"I needed a baby to restore my faith in my defective body, heal my wounded sexuality, assuage my grief, relieve my feelings of failure--to make me whole again. At one time I would have told a woman like me that childlessness was not her problem; it was her inability to recognize the value in all that she had, in all that she'd built for herself."

Now, if you'll excuse me, I need to go pace myself some more.

Control

I started acupuncture right around the time I started trying to get pregnant. I'd never tried it before, but a friend swears that acupuncture made her second IVF attempt succeed. So I figured, why not? I found an American acupuncturist who'd worked in a fertility clinic and had special protocols for women trying to conceive. She prescribed herbs to take twice a day (two formulas -- one for before the insemination, and one after).

When I got pregnant, I had been taking the herbs she gave me. But I ran out just as the test turned positive, and by the time my new supply arrived, I felt intuitively that I shouldn't take them. So I didn't.

The acupuncturist also advised against going running after ovulation. I've heard this elsewhere, but my OB at the time (Dr. Unsympathetic) thought running was fine. After I found out I was pregnant, I went running a few times, because I really wanted to.

After the miscarriage, I tried a few more times and wasn't getting pregnant, so I decided to see a different acupuncturist -- a older Chinese woman whose ability to get infertile women pregnant was legendary. She had, apparently, a more traditional approach: you were instructed to bring a jar of urine to each appointment. She'd take the jar, shake it up, and assess you based on the bubbles. That's right.

Here are some of her suggestions:
Don't exercise: during your period, around ovulation, after ovulation.
Don’t eat: sugar, dairy, anything cooked in the microwave, beef and poultry if it wasn't organic.
Eat: yams, seaweed, papaya, shrimp, seafood, fruit.

She didn't prescribe herbs (they took too long to work, she said, but if you really wanted them, you could go see her sister), and she advised against taking a prenatal vitamin (I acquiesced and switched to simple folic acid). She also suggested I lose 10 pounds. (Whatever. Losing weight while trying to conceive is generally frowned upon.)

Acupuncturist #1's treatments were relaxing. Number 2's were downright unpleasant. They were painful, and there was a lot of yelling. "GET A COLOR. Cervix is LIGHT LIGHT BLUE. Uterus dark blue. Fallopian tubes light blue. Ovaries dark dark blue." Then she'd wiggle the needles -- nicely positioned around my uterus and ovaries -- in such a way that I'd feel a shock. "TURN TO GOLD!", she'd yell. I'd arrive home exhausted.

The hardest thing about #2's advice was following her dietary restrictions. I'm a girl who enjoys her chocolate cake, so avoiding sugar entirely was really challenging. And it was hard to reconcile the advice -- she wants me to eat sweet potatoes, but she doesn't want me to cook food in the microwave. If that's the only way I'm going to eat them, does the benefit of the sweet potatoes outweigh the cost of the microwave?

I actually did a pretty good job, for a while, of cutting way down on the sweets (though not cutting them out entirely) and eliminating some dairy. I found a seaweed snack I liked and a form of papaya I could tolerate, and ate seafood that's low in mercury. I definitely wasn’t perfect, but I tried. But with all of that effort, I didn't get pregnant.

During this journey, having new things to try, like acupuncture and Clomid, has been a real comfort. It’s nice to feel as if you can control the outcome, in truth, you can’t. When I miscarried, Dr. Unsympathetic was adamant that there was nothing I could have done during my pregnancy to change the outcome. I believe her. So at some point, as I spent weeks munching on seaweed and passing up brownies, I realized that the problem with Acupuncturist #2’s approach was that it gave me the illusion of too much control. When I miscarried, it wasn't because I went running, and if I didn't get pregnant, it wasn't because I ate a KitKat bar. While cutting down on the sugar is, for me, a good idea (I have a little bit of a problem with the chocolate-chip cookie dough), blaming my sweet tooth for my infertility isn’t. I mostly eat a healthy diet, but women across the country get knocked up eating junk.

A friend told a story of another friend, S., who was having trouble conceiving. S. had cut out running but eventually started up again, reasoning, ‘I’m not getting pregnant by not running, so I might as well run.’ (She eventually did IVF and has twins.) I didn’t get pregnant following Acupuncturist #2’s recommendations, and when I started on the fertility drugs, I stopped seeing her, knowing that she would disapprove.

I haven’t gone back to see Acupuncturist #1 in a while. (I never thought I was the kind of person who'd have not one but two acupuncturists.) It’s hard to schedule, especially given all the schlepping I have to do for the rest of the project. I still occasionally eat sweet potatoes and dried papaya, and the seaweed snack is a keeper. But I’ve given up the illusion that my diet will be the determining factor in whether a healthy egg meets a healthy sperm, fertilizes, continues to divide, and seven to 10 days later, finds a nice comfy uterine lining in which to implant. Sometimes it’s a relief to accept the things I cannot change.

Choices

At 19 I had a pregnancy scare. I had a boyfriend, the condom broke, and I spent $20 -- a huge sum to me at the time -- on a pregnancy test that didn't provide an intelligible result. Fortunately, I got my period a few days later. But I wouldn't have hesitated for a moment to get an abortion, even though my Catholic boyfriend told me later he would have been upset about it. My body, my responsibility, my choice.

Yesterday's New York Times magazine has an interesting and maddening article about an anti-choice movement that claims abortion harms women psychologically. The movement relies on debunkable, quasi-scientific studies that say women who've had abortions have more psychological problems than those who didn't. One of the main characters in the story is a woman who's had four abortions and mourns them; she now organizes memorials for aborted embryos. She has three daughters and didn't teach them about contraception, because, she says, "“Abstinence works better than birth control, really. It’s just that people don’t do it.” So, big surprise, her 17-year-old daughter got pregnant. It makes me crazy to think there's a woman out there who claims to be advocating for women's health, yet failed to teach her own children about contraception.

I deeply mourned my miscarriage -- a spontaneous abortion in medical parlance -- at eight weeks. It is possible I would have mourned an abortion when I was 19, but I can guarantee you that whatever psychological harm might have been induced by that procedure would have been far eclipsed by the harm -- both to me and to a child -- of regretfully becoming a parent as a college sophomore.

I don't disagree with Bill Clinton's position that abortion should be "safe, legal, and rare." Abortions will be rare when women are educated about birth-control options, when more men start being willing to wear condoms, and when both sexes have access to affordable, effective contraception.

Until that time -- and even after -- let's celebrate. Today is the 34th anniversary of Roe v. Wade. Here's to many more.

Datebook

If you're trying to get pregnant my way, you get a whole set of special tasks to handle each month. Let's take a tour, shall we?

Day one of my period: Call the doctor's office to tell them the news. Schedule ultrasound appointment. Call the sperm bank to buy some more sperm (sorry, I just can't call them swimmers). Refill prescriptions.
Day two: Pick up first prescription (Clomid), but learn that the insurance company won't refill the second prescription (for the ovulation-trigger shot) for another nine days.
Day three: Begin taking Clomid, at twice last month's dosage.
Day six: Call the insurance company to request coverage for the upcoming IUI. Convince partner to scribble authorization code as we drive through pouring rain the day after Christmas.
Day seven: Call sperm bank to arrange pick-up of giant nitrogen tank containing expensive sperm. Call doctor's office to arrange drop-off.
Day nine: Go back to the pharmacy to retrieve the second prescription.
Day ten: Go to doctor's office for ultrasound, which indicates a good number of good-sized follicles (which contain eggs). It also indicates a thin uterine lining, a side-effect of Clomid, which the doctor declines to do anything about (I used an estrogen patch to treat this at my last doctor's office, but this guy tells me "we only do that with IVF." WTF?) Doctor repeatedly warns of the risk of twins (from the multiple follicles whose presence is thanks to Clomid) and says, with absurd optimism, "it's very likely you'll get pregnant this time."
Get told to take shot, which I've brought with me in case a qualified nurse can be convinced to administer it. Get turned down, but learn that the pharmacy has sold me the wrong needles for the shot. Get the right needle from a nurse, drop the needle on the floor, get another one, do the shot. Schedule IUI for the following day. Then, leave the office, drive across town to the sperm bank. Pick up the nitrogen tank, which is supposed to remain upright yet tips over in the car, spewing white smoke. Panicking, find parking space. Carry (now very cold) giant tank two blocks to the doctor's office. After the lab removes the sperm, carry tank to car, and drive it across town back to the sperm bank. This little errand takes three hours to complete (minus the 10-minute detour for a croissant).
Day eleven: Go in for IUI.
Days twelve - twenty-five: Await news of success or failure, indicated either by continuing high temperatures or the arrival of blood. Try to avoid the temptation to take a pregnancy test before it's reasonable, as doing it too early is both expensive and nearly guaranteed to disappoint.