An excerpt from the holiday letter I wish I'd written

As usual, 2009 has been an eventful year.

In January, to kick off the new year, we embarked on a series of invasive testing at a well-respected local fertility clinic. After multiple canceled and rescheduled appointments with our very popular doctor, having been told that he could find nothing wrong with either of us except that my eggs are "old," I started using traditional Chinese medicine and acupuncture in an attempt to achieve pregnancy without medical intervention. Three months later, after spending thousands of dollars and enduring weekly sessions with acupuncture needles and three-times-a-day teas with the foulest tastes and smells imaginable, we resigned ourselves to having to use the fertility clinic's services.

As you can see only MM, the dogs, and I here in our family photo, you have probably already guessed that, despite the months of fertility drugs and frustration and thousands of dollars spent, we are still childless. (And no, I am not pregnant in the photo, just fat.) In early August, just a couple of weeks after the dogs' drug overdose (more on that later), I got my first-ever positive pregnancy test, only to find out within the same day that I was having an early miscarriage. We hope it is not the only positive pregnancy test we will ever see, but who knows?

On a related note, I'd like to extend my congratulations to the twelve people who announced their pregnancies this year--one the day after my miscarriage was diagnosed--and the fifteen people we know who welcomed their first child into the world in 2009. And especial kudos to the two friends who managed to accomplish both the birth of a child AND another pregnancy this year! You know who you are. . . .

I am a little late to the party with this topic, but wanted to share my thoughts nonetheless.

I know my fellow ladies struggling with infertility can relate to the mixed emotions associated with receiving friends' and family members' holiday greetings. On the one hand, I genuinely love hearing from everyone, finding out what they have been up to, and seeing how their kids have grown. I actually like getting photos with my holiday cards. On the other hand, the newsletters and especially the photos can be a painful reminder of what we don't have and may never have.

Oh, and by the way: I hate it when my friends, the parents, only send out photos of their kids. Yes, I get that you are probably unhappy with your figure after having given birth and that you'd prefer to hide from the camera. . . and yes, I want to see your kids looking cute and Christmas-y and see how they have grown since last year's card. BUT I'd also like to see a picture of YOU, my friend, even more than I'd like to see a picture of your offspring, especially if we don't often see one another during the year. Ahem.

Our "family" photo this year was a picture of MM, the goldens, and me. It was a very nice photo (thanks, BFF), but I'll admit that I wondered whether it would seem a little pathetic to my friends and relatives with children. "Oh, look: S has been married for over a year, and she and her husband still just have those big, hairy dogs, two of them now. Guess they aren't having any kids; she is getting kind-of old."

I've decided that for Christmas 2010, I am going to make a concerted effort to make sure that I get a good photo of MM and me on each trip we take. (We already have our first, to Las Vegas, planned for the third weekend in March.) Next year's photo greeting will be a collage of us in all the fun places we visited. That way my friends with small children can envy ME the way I currently envy THEM. . . . I doubt most people who are parenting small children get to take 3-4 trips a year just for fun.

Yes, I am being a little snarky, and my intention is somewhat inappropriate for a time of year that is supposed to be filled with joy and good cheer. Oh well. I guess I'm just a horrible person. (Hey, maybe that is why I've been cursed with infertility!)

Happy New Year! I hope 2010 is a better year for us all.

Done

Our latest cycle was a bust: AF arrived four days ahead of schedule last Saturday. It was no surprise that it didn't work--the definition of insanity is to keep doing the same thing and expect a different result--but I was surprised and annoyed to get my period four days earlier than I'd expected it. Seems that the drug regimen for this past cycle screwed up my body in more ways than one.

Because I started having cramps and spotting on Friday afternoon and knew that AF was on her way, MM and I had a long talk Friday night about this "journey" we have been on these past 20 months of TTC. To summarize our discussion, we have agreed to stop doing intervention. We both feel that the toll it is taking on us, physically (on me), emotionally and financially, is too much. And given our "unexplained" diagnosis, we don't even know for sure that the treatments are necessary or helpful.

We re-visited the IVF option and once again agreed that it isn't for us. We agreed that we still feel that adoption isn't for us. MM does not believe in prayer, and I have been having my doubts on the subject myself.

If no "miracle" occurs in the next two years, we may consider pursuing donor egg IVF at CCRM at that time. It would be a compromise in a lot of ways, but we think it is a compromise that would be worth our consideration. Unfortunately, the price tag is high: around $30K per cycle.

I know there are a lot of people who are willing to go a lot farther, spend more money, and do more to try to achieve a pregnancy. MM and I agree that we have done about as much as we can reasonably do at this point. (He sagely pointed out that what we have already done is far more than most of our friends who have children ever had to do.) We don't intend to go into debt, or push me to the brink of my sanity, or allow our entire lives to revolve around TTC any more than we already have.

Since our discussion, I have felt relieved that I will no longer be closely tracking my cycles, taking injections, doing OPKs, and the like. I'm relieved that I won't have to think about TTC and that I can focus on other things again.

I have not found, however, that our decision has made my inability to have a child of my own any more easy to bear. In fact, though my primary emotion about my childless state is currently grim resignation, I am still angry and sad, too.

I think the holidays and the focus on families that is even more prominent than usual this time of year is enhancing my feelings of loss and grief. (I'm sure those of who reading this who are in a similar situation can relate.)

So that's where we are. I may still post on here from time to time about my emotions about our infertility, which I'm sure are not going to go away any time soon, but I will no longer be writing about my experiences with treatments because I won't be having any.

I see that a few people have already stopped "following" this blog since my last post, and I anticipate more will stop reading once I post this entry. I understand; we are looking for others who are sharing our experiences, and insofar as the pursuit of treatment goes, I will no longer be sharing the experiences of most of those who read this blog.

I have been trying to focus on the fact that the majority of my life is very good. I am relatively healthy; I still have both my parents and a sister and a nephew; I am married to a terrific guy; I have lots of friends; I am gainfully employed in a job that I enjoy (most days).

Somehow, though, knowing that I have all these things and more does not take away the pain in my heart because of what I don't have, what I probably will never have.

I hope this gets easier to accept as time passes. We'll see.

Hiatus

I don't think I'll be posting much for a while. Of course I will let you all know if--by some miracle--this cycle results in a BFP, and I will continue to read all the blogs that I follow regularly and comment where appropriate.

Although I first started this blog to have a place to vent my feelings and to connect with other women going through similar experiences, I am beginning to view it as one more way in which I have allowed myself to become fixated and obsessive about our inability to have a baby. Though I enjoy writing here and reading and responding to comments (which, by the way: I cannot email a response to a commenter if her blogger profile is private), I think these activities are just giving me more opportunity to dwell on things.

(Arguably, reading others' blogs is also adding fuel to this fire, but I have become oddly attached to the writers whose blogs I read and don't want to lose track of their stories.)

I just don't think that I currently have much to say that I haven't already said before. I still find myself constantly assaulted by others' happiness about their pregnancies and children; I still find I can't be happy for any "fertiles" who conceive. I still have envy, anger, grief, guilt, frustration and all the rest. I just feel like I've said it all before and don't have much new to share in terms of feelings.

So. That's where I am. I didn't want anyone who has been reading even semi-regularly to think that anything bad had happened to cause me to stop posting, and I don't plan to abandon this blog entirely. I just probably won't post again for a while.

Transition

Though nothing has really changed since I had my mid-cycle u/s on Sunday, I have had a shift in my thinking which makes it feel like I am going through some sort of transition. The thoughts that popped into my head about the futility of our continuing to do IUIs have not gone away; in fact, they have multiplied and intensified. I think it is time for a change.

MM and I have not discussed any next steps in depth for some time--the most he's said on the subject is that I can "stop whenever [I] want" and that he is still opposed to IVF--and this decision is obviously one I won't make on my own. Having said that, any thoughts I express here are mine alone, not his or ours.

The more I think about it, the more I am becoming convinced that it doesn't make sense for us to continue using drugs to stimulate my ovaries and doing IUIs. Because I already ovulate regularly on my own, I don't truly need ovarian stimulating drugs. IUIs are an empiric treatment for us anyway, since we are "unexplained." There is no documented problem with my cervical mucus or MM's sperm count that would make the procedure a must for us.

I am in the midst of completing my fourth cycle with Clomid, and two of those cycles have also included Follistim. None of these drugs have produced the desired effect, a pregnancy. One might argue that, aside from this cycle, they have produced the desired effect of stimulating my ovaries, since I have had at least two mature follicles every medicated cycle but this one. But my ovaries don't truly need stimulation, and merely producing eggs that don't result in pregnancy isn't exactly the goal.

Given that IUIs and ovarian stimulation have not worked for us, the logical next step would be IVF. But we are not going down that road, for all the reasons I've already discussed here.

Putting aside all my objections and hesitation about IVF, MM's main one is the money. (Not surprising, given his debt aversion and the fact that he will not be the one experiencing the physical and emotional side effects of the procedure.) MM once made a passing remark that he would be willing to do IVF if the odds were better, say greater than a 50% success rate. Even CCRM can't guarantee a success rate of over 50% for someone in my age range, let alone our RE's clinic. (I stand corrected: a quick search of CCRM's website shows that their success rate for women 38-40 using their own eggs was 50.7% in 2007, though that was for pregnancies and not for live births. I'm pretty sure MM means a success rate for live births.)

The only procedure I am aware of that can consistently offer a >50% success rate for someone my age is donor egg IVF. Believe it or not, based on my current limited knowledge, I might be more willing to do a donor egg cycle than a standard IVF cycle simply because I would not have to go through ovarian stimulation. I am aware that I would have to take other drugs, including injections, and that they would have their own side effects. But at least to my uninformed mind, it seems like being a recipient of a donor egg would be a little easier on the body than a standard IVF cycle with one's own eggs. (I welcome anyone who knows different to educate me on this point.)

One huge problem with donor egg IVF: the price tag. A little preliminary poking around reveals that it is in the neighborhood of $25-30K. I know MM would balk at that. . . . though perhaps a little less once he learned that the anticipated success rate can be as much as 70-80%, depending on the clinic.

Using a donor egg would involve giving up my own genetic link to our child, but at least s/he would be genetically related to MM. And because the vast majority of people assume that when a woman gives birth to a child, that child is her own, the only people who would know otherwise would be those whom we chose to tell. . . a distinct difference from adoption.

I know that the cost of adoption is similar, and I know that MM sees adoption as a true last resort option. . . last resort in the sense that I believe he might opt to live child-free rather than pursue it. He, even more than I, has a real sense that he wants a biological link with the child he raises as his own.

Honestly, probably the best thing for me to do at this point is to take a little break and get clear in my own mind about what I want to do next. I have been talking for some time about seeing a counselor to talk about my feelings related to our infertility, and I should. It's just hard to make that a priority with so many other things going on at work and in my personal life, not to mention the expense. (Our insurance is VERY limited in which counselors it will pay for, and I haven't found anyone who is anywhere near my office who is "in network" and has experience in counseling people with infertility, so I will likely end up paying out of pocket for someone qualified.)

I'd be interested to hear what those of you who are still TTC have to say about my thoughts. I find that the perspective of people who are pregnant or parenting is just different enough that I have a difficult time relying on their advice. For obvious reasons, no one can imagine choosing a child-free life once they have already had the experience of parenthood. Unfortunately, I don't have anyone in real life to whom I can turn for advice: at this stage in my life, only three women in my circle of friends are childless--one of those by choice--and none of those have experienced infertility.

[On a quick physical note, given when I took my trigger shot, I should have ovulated sometime yesterday or early this morning. The resolution of the near-constant pressure and discomfort over my right ovary which I'd had since around Saturday would lead me to believe that I did, in fact, ovulate. MM and I dutifully had sex both Sunday and Monday nights. So I should start feeling back to normal physically in a day or so.]