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.

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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). :/

.

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!

.

[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!