Blogiversary, beta update, and winter cuteness

After I posted our news on Friday, I got notified by WordPress that it was the four-year anniversary of my blog. That makes it five years – give or take – from when C and I first started trying to conceive!

That went by fast – sort of.

I feel a little bit sorry for that little newlywed me, who actually argued with my dashing new husband about when to start trying…so we could. Time. My. Maternity. Leave.

Obama

Mr. Obama finds my naive ideas about family planning hilarious!

But early pregnancy loss, life-threatening motor vehicle injury, crushing infertility diagnosis, and stillbirth notwithstanding, I still can’t help but focus on the positive.

  • I married a wonderful man who doesn’t have a self-pitying bone in his body.
  • We have a gorgeous son.
  • We have amazing friends and family who have supported us through everything.
  • Contrary to the predictions of three different REs, I have managed to get pregnant four times.

 

So while things have not quite gone according to plan, I’m proud of where we’ve come in the last five years, and hopeful for what the next five will bring!

 

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For those of you who are counting, my beta came back today at 370 mIU/mL. That corresponds to a doubling time of about 33 hours.

doubling time

Looks really good!

histogram 2

I take another test on Wednesday.

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Lastly, for your viewing pleasure, here are some sweet pics of C. Samuel from our ski trip to Park City over my Spring Break:

Look who has nicer ski gear than me!

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Enjoying the view from the lift.

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C. Samuel wanted to hold our hands while skiing. ❤

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Relaxing in the hot tub after a long day!

Bulletproof

My blog is semi-private; I try not to use names or give overtly self-identifying information, but I’ve also shared the blog with many friends and family ‘IRL’. This means that I sometimes have to make difficult decisions about what and when to share things on the blog…

Like when we find out that we’re pregnant.

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On Tuesday (10 dpo), I decided to take a pregnancy test. No line. Or maybe a whiff of a line. Could easily be residual trigger shot.

On Wednesday (11 dpo), same thing. Maybe a bigger whiff. Or maybe I was deluding myself.

On Thursday (12 dpo), same. Definitely not pregnant. But when I set it next to the previous two, and squint at it, I kind of see a line. I tell C. “Hey, we’re probably not pregnant, but there’s a whiff of a line. Pretty sure it should be darker at 12 dpo. It’s probably nothing, but I thought you should know.”

On Friday (13 dpo), there is a very faint line. Darker than the previous line, but lighter than I think it “should” be. I decide to use one of the expensive First Response tests. There is definitely a line. At work, I decide to email the nurse practitioner and Dr. Y to see if I should do the blood test a day early. Both reply and say I should.

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10 dpo (top) through 14 dpo (bottom)

In between afternoon meetings, I drive to Kaiser for a blood draw. Juan-the-phlebotomist draws my blood and explains that a courier will come and deliver my sample to the nearby hospital for testing, and I should get results in 2-3 hours. After drawing my blood, he lines the tape with a piece of gauze for pain-free removal later, and folds the tape into a little tab to make it easy to pull off. On my way out, I tell the receptionist that Juan is the absolute best phlebotomist I’ve ever had. I return to work and to my meetings.

After my meeting, I check my email and see that there is a new test result. My HCG is 66 mIU/mL. I check on betabase.info. It’s slightly below the median value for 13 dpo, but well within the expected range. I click on a link and discover for the first time that betabase has histograms of beta values for each day past ovulation! My beta value is comfortably in the middle of the distribution.

histogram

So, we’re pregnant.

Conventional wisdom says that we should wait to tell people, but how long?

  • Until we get a few beta values and see that the doubling rate looks reassuring? 
  • Until we see a heartbeat?
  • Until we get a ‘normal’ genetic test result?
  • Until we pass the first trimester?

 

We know better than most that none of those things are a guarantee of a healthy baby at the end. So do we wait until the baby’s out? Probably not practical.

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I thought of a scene from an episode of Speechless. (If you haven’t seen this show, go watch it on Hulu, or abc.go. It’s adorable – like Malcolm in the Middle with a special needs kid.)

Speechless

In the scene, the dad on the show (his name is Jimmy) is explaining to his middle son why he doesn’t care what other people think, and says that after getting the news that his oldest son will never walk and do other stuff, and then making it through and seeing that same son grow into an incredibly cool person…he’s kind of like, what’s the worst that can happen? Here’s the full scene:

 

I feel kind of like Jimmy. If we tell everybody we’re pregnant after the first pregnancy test, what’s the worst that can happen? We lose the baby and have to tell everybody our sad news?

Yeah, and?

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At this point, we’ve shared awful news with our friends and coworkers and family and bloggy friends. We (and they) survived.

We’re bulletproof.

Progesterone, 4 years later

The IUI went as planned on Saturday, and today I went in for a blood progesterone test. It came back at 15.1 ng/mL, not as high as my highest value back in April 2013, but well within the normal range. Yay!


I wrote about progesterone back then, so I won’t go into detail about it here. However, I did notice a significant packaging change since last time:


I like that the new packaging allows me to pack just the 6 suppositories I need for tomorrow’s trip to Park City. Now if I can just figure out how to keep it on the DL while sharing a fridge with all C’s residency buddies and their kids… (Not that I’m embarrassed about infertility; I just think it might be a tad awkward to explain that the bullet-shaped things next to their kids’ string cheese are going to go up my hoo-ha…)

Oh, and another fun fact: I recently learned that my trans friend takes progesterone as part of her hormone therapy. In each 28-day cycle, she takes 200 mg of oral progesterone on cycle days 14-23 (along with an injection of estradiol every two weeks). Yet another unexpected human connection, brought to me courtesy of infertility!

A bit of good news

Seven months after we lost Jane, it appears that my cycles have normalized somewhat, and we are on track for our first properly-timed natural cycle IUI. (Second IUI overall since Jane.)

Here’s a TMI TTC timeline:

Cycle start Notes Positive OPK Cycle length Ovulation?
July 24 Delivered Jane n/a 11 weeks ?
October  7 1st period postpartum CD8 and CD16 (!) 26 days In Europe, tried ourselves
November 2   CD24 35 days In Texas, tried ourselves
December 7   CD35 46 days IUI after positive OPK
January 22 CD15 26 days C out of town; office closed for holiday
February 17 Trigger Friday (CD15) ? This Saturday?

 

Our plan was to do as many natural cycle IUIs as Kaiser would let us get away with, but our travel plans got in the way twice, and my cycles got progressively longer and more difficult to anticipate (leading me to wonder if this is what perimenopause looks like…)

After a couple of disappointing mid-cycle ultrasounds, the nurse practitioner at Kaiser volunteered that I could call as soon as I got a ‘high’ or ‘peak’ reading on my advanced OPK, and she would squeeze me in to take a look. That’s how the IUI went down in early January (the day after an ‘oops’ positive OPK and same-day sonogram showing a mature follicle). And then Presidents’ Day went and mucked up the February cycle…

 

All that to say that this cycle things appear to be on-track:

  • On Sunday (CD10), I got a ‘high’ reading on my OPK.
  • I called Monday and got an appointment for a mid-cycle ultrasound today (CD13).
  • On ultrasound today, I had not one, but two nice-looking 16 mm follicles (one on each side).
  • My uterine lining looked “great” (9-10 mm?).

Since the clinic isn’t open Sunday, we scheduled an IUI for Saturday morning, with plans to trigger on Friday.

Wish me luck!

There Is No Good Card for This

This morning on my drive to work, I heard an interview with Emily McDowell on NPR. If you haven’t heard of her amazing Empathy Cards, stop reading right now and go check them out!

Seriously, I’ll wait.

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After I lost Jane, a coworker sent me this card:

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I went straight to emilymcdowell.com and ordered 20 cards the same day.

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I didn’t even realize until this morning that she has an infertility card too! (Although many of her other designs would also be perfect for infertility, pregnancy loss, or a whole bunch of other shitty things…)

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Anyway, the reason for the interview was that she just coauthored a book, titled – wait for it – “There Is No Good Card for This: What to Do When Life is Scary, Awful, and Unfair to the People You Love.”

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I live with my foot permanently wedged in my mouth, and have lamented the fact that I have been/would be pretty worthless at comforting a friend in the way my amazing friends (including several who read this blog) did for me.

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I just added this book to my Amazon cart. Can’t wait!

Staying the course…for now

My period arrived last Sunday. I emailed Dr. Y to double check our course of action.

In particular, I wanted to see whether he thought we should start using stims (like Clomid or Menopur) to stimulate regular ovulation. Since losing Jane in July, I’ve had exactly three cycles, which were 26, 35, and 46 days long. (This trend is not particularly reassuring…) We also did a progesterone test this last cycle at 7 dpo, which came back at only 5.7 ng/mL. (I’m pretty sure it’s supposed to be higher – say, 10 ng/mL or more. Previous values from when I was trying to conceive C. Samuel and Jane were 24.5 and 9.6 ng/mL.)

Dr. Y said we can try Clomid if I want, but he doesn’t think it will be any more effective than natural cycle IUI. He does however recommend supplementing with those awful progesterone suppositories. Given my ever-changing ovulation date, he said we could try waiting to schedule my next ultrasound until my advanced OPK gives a ‘high’ reading. So we’re staying the course for now.

On Monday, I spoke to students and faculty from the Biology and Chemistry departments about losing Jane Margaret (sharing what happened and what I did to cope during my leave). The talk forced me to organize my thoughts about several things, which should eventually find their way into this blog.

Tuesday was the 6-month anniversary of losing Jane.

Back in the stirrups

Nearly six months after losing Jane, life has returned to some version of normal. I started back at work teaching on Tuesday, and on Wednesday we were finally able to accomplish our first natural cycle IUI since the loss.

So here I am in another two-week wait. It’s a strangely comfortable place to be.

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Jane’s headstone at Christmas

Well, fuck!

That’s what I said when I read my most recent email from Dr. Y’s nurse:

“YOU DAY 3 LAB WORK CAME BACK AND THE RESULTS SHOW AND ELEVATED FSH AND THE AMH IS LESS THATN 0.03. IT WOULD BE BEST IF YOU CAME IN AND HAD AN APPOINTMENT WITH DR Y. I WILL NOT HAVE ANY APPOINTMENTS UNTIL AFTER YOU RETURN FROM EUROPE. PLEASE CALL ME AT xxx-xxx–xxxx SO THAT WE CAN SCHEDULE AN APPOINTMENT”

Yes, she writes her emails all in caps like that, as if I needed any more reason to feel alarmed.

My AMH is less than 0.03. I didn’t know the test measured amounts that low.

In what feels like another lifetime, I once wrote a long post about what AMH (and FSH and estradiol) mean for fertility.

Here’s a summary of my results the four times I’ve taken these tests. Prior to yesterday, 0.17 ng/mL was the lowest AMH of anyone I know in real life (including my Resolve support group).

  1/26/13 5/4/13 4/24/15 10/8/16
estradiol (E2) 24.6 pg/mL 27.2 pg/mL 23 pg/mL 20 pg/mL
follicle stimulating hormone (FSH) 13.7 mIU/mL 13.5 mIU/mL 9.7 mIU/mL 17.7 mIU/mL
anti-Mullerian hormone (AMH) 0.17 ng/mL 0.22 ng/mL 0.31 ng/mL <0.03 ng/mL

 

I’m feeling pretty hopeless at the moment.

At least I get to go to Rome on Sunday.

When to try again

And now we arrive at the last of our unpleasant decisions following Jane’s passing:

Decision 10: When to try again.

By way of background for those of you who are new to my blog: three years ago, after an early miscarriage followed by 6 months of unsuccessful trying on our own, I was diagnosed with diminished ovarian reserve. I’m a non-responder to stims, having produced only a single egg during medicated IUI, and IVF cycles. Miraculously, we conceived our first rainbow baby C. Samuel spontaneously in between IVF cycles. After C. Samuel was born, we decided to try for #2 via natural cycle IUI. On the sixth month of this, we conceived Jane Margaret.

Some conclusions from our adventures in infertility:

  • I have precious few good eggs left. (One of my doctors predicted that I would go through menopause before age 40…I’ll be 38 next month.)
  • I consistently ovulate one (and only one) egg per month, with or without stims.
  • When we’ve been lucky enough to have one of C’s supersperm catch a good egg, the babies that result are beautiful and perfect (though I can’t say the same for the resulting placentas).  😦

Contrast that with the following advice re: trying again after stillbirth:

  • The American Pregnancy Association recommends waiting several months up to a year to try again after a stillbirth.
  • Dr. R recommended waiting 3-6 months before trying again.
  • Dr. R mentioned a study suggesting that shorter time between pregnancies may be correlated with shorter umbilical cords (part of Jane’s perfect storm), though she acknowledged that the study wasn’t especially compelling.

Having discussed all of these considerations and more, C and I quickly agreed on a decision:

We want to try again as soon as possible! 

We both find the egg scarcity argument more compelling than the emotional self-care concerns. What if I ovulate my last good egg on one of the months that we’re “waiting to try”?!

As it happens, my own body forced a bit of a compromise, since it took 11 weeks for my period to come back after Jane’s passing. My bitchy Aunt Flo showed up on Friday, and on Saturday I got my blood drawn to repeat my CD3 (in this case CD2) bloodwork. Unlike last time, my FSH went in the wrong direction (up to 17.7 mIU/mL). :/

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At least C. Samuel is optimistic. He busted this song out during a recent visit to Ong Ba’s (Grandma & Grandpa’s) house. Neither C nor I had ever heard it before.

 

The Rainbow Song lyrics:

Red orange yellow green blue purple,

red orange yellow green blue purple,

red orange yellow green blue purple,

makes the rainbow bright bright bright!

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[Deep breath] Here we go again.

Can we possibly have enough luck left over for another miracle?

How to memorialize Jane

In the first few days after we lost Jane, we were inundated with more beautiful flowers than we knew what to do with. So when I started drafting a Facebook post about what happened, my mom wisely recommended that we select a charity for people to donate to in lieu of sending flowers. C and I talked briefly about a children’s dental charity or organization that supports parents of stillborn babies (either locally or nationally), but we couldn’t agree.

Then C had the idea of starting a fund for a permanent memorial to Jane. He investigated fundraising sites and selected youcaring.com (since it charges lower fees than the more popular gofundme.com). We set up the site with a goal of $2,000 (to cover the cost of a park bench at a nearby city), and shared the sad news about Jane on Facebook. And the money, along with incredible messages of love and support, rolled in…

To date, 149 people, including family and friends and colleagues (and some complete strangers!) have given almost $12,000 in support of Jane’s memorial fund.

We were blown away by everyone’s generosity.

Which brought us to Decision 9: How should we memorialize Jane?

We felt a solemn responsibility to Jane – and to all the people who donated – to choose a meaningful and (semi-)permanent memorial. We investigated several options:

1) A memorial bench. C contacted our city’s department of Parks & Recreation and learned that they “don’t do benches anymore”. It seems the cost to maintain the benches exceeded the income from the benches. (Why not just raise the price of the benches? I guess there’s not a lot of incentive to raise money for park improvements…)

In any case, we moved on to the next city north of here. They have a memorial bench program, at a current cost of about $1600 for a bench. The catch: there are no benches (or spots for benches) currently available. They put us on the waitlist (#32 on the list), and said they’d call us when they get to our name, probably in a few years.

The next city north had benches immediately available, including one “beach site”. The price was about the same: $1650. But we weren’t exactly excited about the idea of driving 40 minutes to sit on Jane’s bench…

Major Research University, where C went for undergrad and I did my postdoc, is only 3 miles away, in the same direction we have to travel to get to the freeway. A handsome and well-dressed young man in the development office was happy to show us what they had available: 9 benches with ocean views available for naming, each at a price of $15,000, plus any required maintenance or repair costs. C and I, along with my mom and sister and our friend R visited each bench and liked several. Our favorite was this one:

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Our favorite option for a memorial bench for Jane

I also investigated memorial bench options at the Small Christian University where I work. They proved to be more flexible and economical with their bench options than Major Research University. Basically, we could pick any spot on campus (including ocean views) and select the style of bench we want, for about $6,000. The downside was that the campus is 11 miles from our house in a part of town where C rarely visits.

One thing we learned is that none of the memorial benches (or indeed any of the memorials) are truly permanent. Naming rights on benches at Major Research University are guaranteed for 8-10 years, with the possibility of longer. At Small Christian University, they didn’t give a promised timeline, but pointed out that other benches have been around for 20+ years. In both cases, when the bench needed to be replaced, we would have ‘first dibs’ to repeat our donation and get a new one.

2) Our local aquarium. C. Samuel LOVES the aquarium, which is 3 miles from our house (adjacent to, and affiliated with, Major Research University) so that was the next place we investigated. They also had benches available (with the same pricing as the university ones), in addition to a number of other options ranging from a ‘permanent’ sea star plaque ($1500) to a plaque on any of the tanks (prices varied from around $1,000-15,000…per year), to naming the soon-to-be remodeled “aquarium nursery” (the tanks where they display the baby fish; I think she estimated $15,000 for this; I didn’t clarify how long the naming rights would last).

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The current aquarium nursery. We have the option of dedicating the new nursery in memory of Jane.

The (large) downside to the aquarium is that friends and family members who donated to Jane’s memorial fund would not be able to see her memorial without purchasing a ticket. We moved on to other options.

3) The library. At this point, C decided we could use some help. He messaged our friend M, who works in philanthropy for the public library. She is AWESOME and replied that she would come meet with us the next day with some ideas. Naturally, she first mentioned our local library, which had a variety of naming opportunities, ranging from a reading nook (for $15,000) to the new high tech public laboratory (which includes a walk-up molecular biology lab and 3D printer; for about $100,000).

4) County Parks & Recreation. She also had printed out a 24-page booklet of naming opportunities for the county Parks & Recreation Department. These included baseball fields, playgrounds, hiking trails, sports arenas/courts, amphitheaters, skate parks, splash parks, swimming pools, and community gardens, at prices ranging from $2,000 – $200,000. Awesome and extensive as the options were, they were all 30 minutes or more from our home, in residential areas in unincorporated parts of the county, which we are unlikely to visit regularly.

5) A play structure. M also asked about our local park. We told her how C had called the city already about the bench, and found them pretty unreceptive to memorial gifts. M suggested that she might have better luck, given her position at the library, and asked if we knew what we might want. We told her that we would love to plant a tree at our local park, and/or to replace a play structure. There is a little fire truck play structure that C. Samuel especially loves, and that has seen better days… She said she would try to get through to the right person to see what our options are.

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C. Samuel, in the fire truck at our local park. Notice the peeling paint and chipped wood.

A few days later, M called us. She had found the ‘right’ person – Tyler at Parks & Rec, and had discussed several options with him. He had told M that the play structures at our local park could use a good paint job, and that if we wanted we could purchase supplies and organize a team to come and sand and paint the structures. C and I were both less than enthused about that idea! Fortunately, he also offered that C. Samuel’s favorite fire truck play structure could stand to be replaced. We also could plant a tree, not in our first choice location (the playground), but in another lovely part of the park. The catch was that our city Parks & Rec does not allow memorial plaques, and would not be open to names or even initials on the new structure or tree. Tyler offered a possible compromise: we could have imprints of Jane’s hand- and footprints embedded in the new play structure.

We loved the idea!

The company that makes the play structures (Kompan) is located in Denmark and gave an initial rough estimate of about $12,000, possibly a bit more. Manufacturing will take a couple months, then they’ll ship the parts here, and Parks & Rec staff will put it together on site. Tyler estimated that it will be put in place in early 2017. To plant the tree, we just need to get approval from the city arborist, and pay the cost of the tree and labor to plant it. Since they don’t do memorial gifts, we will have to purchase the structure directly from the company, rather than making a tax-deductible donation to our city Parks & Rec. They also won’t guarantee a length of time that the play structure will remain in place, but Tyler pointed out that the current structure has been in place since 1996, and that while the current structure is painted wood, the new one will be made of a special composite plastic that should last much longer. He imagines that the structure won’t move until the entire park is remodeled, which there are no plans to do, and several obstacles in the way of (including ADA compliance issues and a very strong local resistance to change).

So, that’s the plan! Here’s the rendering we just got from Kompan showing what the fire truck should look like. We can’t wait!