when it pains

Ummm...
Oh and did I mention that around the time we found out that IVF#2 had failed, we also found out that my mum was diagnosed with ovarian/endometrial cancer?

And did I mention that around the time we were coming to terms with the cancellation of cycle#3 while helping my mom with chemo treatments, we received the news that my brother in law had committed suicide?

And oh yeah... I was rear ended by a 16 yr old driver.
And a few days after that I learned of the death of my dear, sweet grandfather; my last remaining grandparent (1 year ago today).
2004.
It was an absolutely stellar year.

But wait there's more.
Did I also mention that funding for the program I work for was cancelled in Oct. 2004, leaving me with the prospect of unemployment. Yup.

I bumped into a friend about a week before Christmas last year. You look a little shellshocked she said.
No kidding. Really??

How I got here (third and final prequel)

Did you know that, unlike the USA, there are no Canadian statistics comparing the outcomes of various IVF clinics in Canada?
Did you know that in Canada infertility treatment is placed in the same category as cosmetic surgery (i.e. optional/lifestyle treatment)?
But I digress..

Let's get back to me.

I had left off things in November 2003. Depressed, dejected, turned away by the first IVF clinic we visited. Our sympathetic OB/GYN doctor refers us to a second clinic. This one is 3000 km away, but (apparently) has the best outcomes in Canada. The lovely doctor at this clinic (Clinic_2) does not take 9 months to get in touch with me. He calls me within weeks and gives me cautious encouragement.
And so it begins.

Feb 2004: Cycle 1
There are more tests to be done, protocols to be explained and drugs to be ordered. And, oh yeah, we must pay the $5500 fee for the clinic, plus an additional $400 for something called ‘assisted hatching’. The pharmacist calls a few days later. I need vials of Gonal-F and lupron. And, oh yeah, that will be another $5000. Credit card number please.
Three times a day my husband carefully prepares injections for me.
First one in bed at 8:00 am. We meet at home everyday at 1:00 pm for the second, and the third one is done at 8:00 pm. They can be done in the abdomen or thigh. I choose the thigh. After a few days, we go for blood tests (to monitor estrogen levels) and ultrasounds (to monitor follicle growth) ever alternate day.
Flights have been booked. We've told we should expect to stay there for 10 to 14 days. Luckily, I have a generous brother in the same city at the clinic. He has offered us room & board for as long as needed. We will have the added bonus of spending time with his 2 year old son- my wonderful, beautiful nephew.

The IVF nurse calls. She sounds concerned. You’re not progressing as well as you should have she says. Even with the very high dosage of Gonal-F that I’m taking, the follicles are not growing. If they don't see progress soon the cycle will be cancelled.
Now is a good time to panic.
Why is this not working. What is wrong with my body? What should I be doing?? We continue with the injections- and start injecting in the abdomen instead of the thigh.
Flights are delayed. The pharmacist orders more drugs (we need to continue the injections for a few more days) and I hand over my credit card number again. We do 13 days of ‘stimulation' and are finally given the green light.

Onwards to retrieval.
Stare at the ceiling. Try not to think about the fact that you are lying with feet in stirrups, with needles poking your ovary trying to suck eggs out of them. If this wasn't so pathetic it would be funny.
Eggs retrieved: 6
Not so many. We will need to spent another $1100 to 'ICSI' them.
But the eggs are not all mature. Only 3 can be injected with sperm.
2 embryos are created.
For this I paid $15,000?

We return home with 13 extra cells in my uterus.
Wait for 2 weeks.
Purchase and pee on home pregnancy tests: negative
Have a blood test to detect HCG: negative

Go directly back to Square 1. Do not pass Go. Do not collect $200.

The doctor calls to discuss the cycle. You didn't too well he says. I would put your future chance of success at 5%, if you want to try again, but I wouldn't recommend it.
We are foolishly persistent, my husband and I. We disregard his advice entirely.
By June we are ready to do this process all over again.

June 2004: IVF Cycle 2
New protocol (using an Antagonist)
Another trip to Clinic_2
Another 2 weeks living with my brother et al.
The results?
11 eggs.
3 embryos (they are lovely, according to the embryologist)
Pack 'em all in and head home.
Wait for 2 weeks.
Purchase and pee on home pregnancy test: negative
Blood test: negative

Hey....haven't we been here before?

Nov 2004: Third time's the charm (or so they say)

By now we are pros. I can do the injections myself. Abdomen always. None of those wussy thigh injections. I don't even care how many people are in the room when the vaginal ultrasounds are being done. The technician asks if a couple of trainees can stay in the room and watch. Suureee. Come on in. Make yourselves comfortable. What's a vaginal ultrasound between strangers?

By now it's same old, same old. Purchase airplane tickets. Lie to people at work about where I'll be for the next 2 weeks. Pack syringes and drugs carefully. Arrive at my brother's doorstep. Daily trips to the clinic. Bloodwork, ultrasounds. Everything looks good. Until one day it doesn't. I start spotting. The bloodwork shows Estrogen levels have plateaued, then they start to fall. The cycle is cancelled. Oh, and that same day I find out my sister-in-law is pregnant.

We meet with the good doctor. Various options are discussed. They have an embryo donation program. We are candidates. Do you have any Indian/Caucasian embryos? I ask. Uhhh, No...but apparently I can still receive a caucasian embryo. I mull over the picture of me giving birth to a blond blue eyed baby. There's always egg donation (almost impossible in Canada...I'll leave that to a future rant), adoption. We've heard all this before. Deja vu all over again.

February 2005

It's time for a new approach. Flying to a clinic 3000 km away is starting to take a toll on us in so many ways. My research efforts into IVF techniques and advances continues and I start reading about a clinic (much closer to home: only 350 km away!) that offers IVM: In vitro maturation. Immature eggs are retrieved, matured and fertilized. Maybe this is what I need. In both my first and second cycles we had eggs that were 'useless' because they were immature. Maybe this clinic (#3) would actually be able to use these eggs. More useable eggs = more embryos = better chance of success.

How much fun is this? Visiting IVF clinics all across the country? Using all my time-off and vacation days to get poked and prodded? Using all our extra cash to pay clinics and buy drugs? Soooo much fun. I feel like the luckiest brown girl ever.

Turns out IVM is not a great option. We decide to try it anyways. 3 eggs are retrieved (very very pathetic). I spend a day in hospital hooked up to anti-biotics. 2 embryos are created and transplanted.

You know how the rest goes. Wait 2 weeks. Test and test again: negative and negative. This time we have the added bonus of nightly intra-muscular projesterone injections. Oh I know. We thought the abdominal injections were fun...

May 2004: Gluttons for punishment

The clinic does not want us to do more IVM, but they are willing to try IVF. Why not? This has gotten to be such a routine part of our lives that it seems silly really to have months where we're not doing injections or dealing with the devastation of a failed cycle. I wouldn't know what to do with myself if I wasn't injecting something. A month without a vaginal ultrasound? Unheard of.

Cycle 5 will be a long-protocol micro-dose lupron cycle. Injections, ultrasounds, bloodwork, retrieval, ICSI, AH yadda yadda yadda. 6 eggs. 4 embryos (that's odd, the embryologist says, they're football shaped). Okay. fine. WHATEVER. Put them back in. 14 projesterone injections later and ... you guessed it!!!

Negative. Again.

Intermission

Where I offer useless information.

Last night's dinner: bitter melon, naan, yogurt, cucumber+tomato salad
Dinner tonight: tomato, basil, mozarella salad; baguette, raw milk cheese

# of bats killed this month (in our house): 5
age of our house: 110 years
# bedrooms: 4
# of occupied bedrooms: 1

Books read this month: A Complicated Kindness; BelCanto

Herbs currently growing in my garden: thyme, rosemary, parsley, tarragon, sage, basil (italian and thai), chives, mint, oregano

Vegetables currently growing in my garden: eggplant, bitter melon, tomato

How I got here (the second prequel)

October 2003
The visit to the IVF clinic is coming up and I am already (foolishly) imagining the possibilities. I start doing addition in my head. Let’s see- if we start treatment right away, I could be pregnant by December. Baby 9 months later in September! Or maybe we should get pregnant in March and have a December baby. The small bedroom will be turned into a nursery. Is it better to have a stroller or a pram? Maybe I should start calling day cares now...it's so hard to get a spot..

This little scene comes to a crashing halt with our appointment at the IVF clinic. Let me review the results of your tests with you, says Dr. IVF. He reviews my husband’s first. Blood tests…good… good. Sperm count excellent. Sperm mobility and morphology all very good (yeah!). Now my turn. He circles a number on my blood test report. FSH: 19. It means nothing to me. Yet.

Turns out I’m not so young after all.
This FSH (follicle stimulating hormone) reading tells Dr. IVF that I have ‘poor ovarian reserve’. Both the quality and quantity of my eggs is severely compromised. As I sit, stunned, in his office he proceeds to explain our options to us. You can try donor eggs, he helpfully suggests, and there’s always adoption. At this point I am staring intently at the tips of my shoes. I cannot bring myself to raise my head and look him. I have waited 9 months and driven 300 km to meet with him so that he can tell me something he has known for past six months since he received my blood tests. He will not take me on as an IVF patient. I will not have my September baby. I may never have a baby at all.

This shock and awe treatment is begining to take a toll. My reaction is predictable: I cry, I curl up on my bed in the dark, my mood swings between raging anger and helplesness.

I turn to my friend, the internet, to help me through this difficult time. I search PubMed articles and read hundreds of abstracts. I review statistics on the CDC website. I visit the univeristy library and peruse issues of journals such as "Fertility and Sterility". I decide Dr. IVF is an insensitive moron.

And you may find yourself in a beautiful house, and you may ask yourself well...how did I get here?

The Prequel (part 1)

I married at 32. We had been together for seven years, but my husband had wanted to wait (if it had been his choice only we would have waited forever- he did not regard marriage as the next step towards starting our life together. But for me and my East Indian immigrant parents it was essential). We moved in together and waited to settle in. ‘You can’t have a baby while living in a one bedroom apartment he said. Plus it’s a crappy apartment’ (it wasn't really). We began looking for a house. Another year went by. 32 is young he'd say, when I mentioned the baby thing.

August 2001
We buy a house. We elope. Now, yes now, we can start thinking about having a baby. One month after our wedding, I wake up nauseous and weak. My face is puffy. I am convinced I’m deathly ill. Well, says the doctor, you’re either pregnant (really!) or you have mono. We do a blood test. Everyone knows it can’t be mono. Mono is the kissing disease you get in grade 7. Noone gets mono when they’re 32. The blood test comes back. I am not pregnant. I have mono.

May 2002
I'm having weird cramps. They don't go away. I rush to the drugstore, and for the first time in my life, purchase a pregnancy test. That’s odd- it’s negative. Maybe it’s too soon. The next day I try the second test. Still negative. A few weeks go by and mild cramping turns to a dull pain that won’t go away. Another trip to the doctor. Mild pelvic pain is very common in women she says. It’s usually an ovarian cyst. They usually go away on their own. Just le me know if the pain gets worse.
“Watchful waiting” they call it.
The pain gets worse.
I am taking little blue naproxen pills every few hours. They do nothing. It takes months of this to convince her to schedule an ultrasound.
The ultrasound reveals a massive cyst. Aha! Time to get this taken care of, I think to myself. My doctor disagrees. Let’s wait she says. We’ll do another ultrasound. I increase my dosage of pain killers and, like a good Indian girl, I listen to my doctor.
I am a patient patient. I wait.
The pain in excruciating now. Another month goes by. The second ultrasound reveals the cyst has gotten even larger. You need to see a specialist, my doctor says. Silently I am wondering why she didn’t make this fabulous suggestion three months ago. It is September now. For five months now this thing has been growing inside me. It is now the size of a grapefruit.
The wait time to see an experiened OB/GYN in town is one year she helpfully tells me. I will be dead by then, I am sure of it. Luckily we have colleagues with connections who can help speed this process along (yes, it's called 'jumping the queue' and yes I was all too happy to do it). A friend calls Dr. OB/GYN and I have an appointment one week later.

Dr. OB/GYN schedules me for surgery right away. Nothing to worry about, just a minor laproscopic procedure. I won’t even need to stay overnight. Everything will be fine.

November 2002
It’s not fine. I emerge from the haze of anaesthesia in the obstetrical ward of the hospital. I am hooked up to breathing tubes, an IV, a catheter, and a morphine drip. The cyst was not a cyst- it was an endometrioma: endometrial blood and tissue collecting inside my ovary. The sugery was not a minor laproscopic procedure but a much more extensive abdominal surgery. My left ovary (“there was nothing left”) has been removed and both fallopian tubes are damaged. I have 25 staples across my abdomen and will not be going home tonight.

By the time I left the hospital I had learned that my chances of getting pregnant were greatly diminished. Our best route, we're told, is IVF. "You’re young and healthy" I'm told, "but you don't have time to see if you can get pregnant naturally". With one ovary and damaged tubes it’s unlikely anyways.

February 2003
In one year I have gone from a hopeful newly wed to infertile basketcase. We're referred to an IVF clinic 300 km away. Our appointment is scheduled for October (nine months away). We are not to contact them before our appointment (no phone calls, no emails, no faxes allowed). Just make sure you have done all the necessary blood and diagnostic tests before hand. We are tested for HIV, Hepatitis, etc. I have to undergo a hysterosalpingogarm- HSG- a procedure that pushes dye through your tubes to see if they are open. In their wisdom, the provincial government has decided that only women with two completely blocked tubes will receive OHIP coverage for an IVF cycle. Everyone else (including those with one ovary and two damaged but apparently open tubes) pays for all IVF costs out of pocket. Clearly the people making these policies are middle-aged men.

this is a test

This is a test. This is only a test.
Had this been my real life I would have been given clear instructions on what to do and where to go.

I am at a loss these days to understand my life.
It is a pleasant life, complicated (for the past five years) by infertility.
This is not the only infertility, quest to have a baby, journey through IVF, blog out there. It is unlikely to be the most interesting one.
But it's mine. And since I'm having a hard time talking to the people around me, I thought I would try talking to myself (and to you..whoever you may be).

More to come.