Monday, December 31, 2007

Christmas ate my life

Sorry for the radio silence. Christmas is a tough time for posting -- there's traveling, and family, and more family, and then I throw a party every December 30th. We're spending New Year's Eve alone at home tonight, as we often do, because we're just flat worn-out.

So, the interesting question at hand was what happened last cycle. Turns out it was a mixed bag: I got my period twelve days after the progesterone draw was taken, so that probably was the real O date, and that's a decent P4 level for that point in my cycle. On the other hand, that means I O'ed on CD 24, which is awfully late in the game, and the ovulation process is long and drawn-out and bodes poorly for things like egg quality. And, well, I got my period, so the cycle was a bust, and that's obviously teh suck.

However, if you happen to find out you're unpregnant on Christmas Day, a shiny new iPhone takes out some of the sting.

So, where to go from here? Well, Dr. Boss's opinion is that I "probably need a little Clomid", so it looks like we're heading back down that path. However, because my husband is a stubborn mule iPhone giver, it won't be this cycle. We're going to monitor me more aggressively this cycle, with temping and OPKs and an ultrasound or two as needed. I'm going to shell out for the new schmancy digital OPKs -- somebody finally got smart and invented ones that have clear indicators rather than making you play the how-dark-is-it-really game. I'm going to ask for an ultrasound when I think I'm starting to peak, and then another if I do the same second-peak thing as last month. After that, assuming I don't actually get knocked up, we'll probably start a Clomid cycle. Maybe it'll even work. Wouldn't that be novel?

I don't know where I'll be this time next year. Will we still be a family of four, or will I have a new baby arrived or on the way? I do know that it'll be OK, though. Admittedly, we only qualify as secondary infertile under a generous definition -- we haven't been at this very long, and we're just getting to jump the queue because I have a medical history. However, I'm already handling it much better this time around, and I think that will continue even if this drags on for a while.

I want very much to get the reproductive show on the road, so that we can either get pregnant or give up and accept that we've done what we could. I don't deal well with uncertainty, and I'm not very patient, and I'm personally pretty dubious that things will work out without medical intervention. I hate to stand around twiddling my thumbs waiting until the requisite time period has passed for us to be declared REALLY infertile. Why not just skip over all the months of failed cycles and start addressing the problems we know to exist? But after that, after we've put as much energy and money and tears into it as we have to spend, I think we can walk away.

Two years ago, I started the IUI cycle that turned into Claire and Katherine. I love them more than life itself, and if they're all I get, that'll be OK. I'll be sad -- I won't lie and say that I'm not already a little sad to be back on this particular horse -- but failing to have a third child is not such a tragedy.

Monday, December 17, 2007

Test results

It took them until today to get around to running the progesterone from last Wednesday, because of a broken machine, but I got the results a little while ago: 4.27. Per Mom, this indicates some level of ovulatory activity, but it's somewhat tricky to evaluate because of the two LH spikes.

If the first peak, on CD18, was the "official" one, this was not a good ovulation, and is not sufficient to sustain a pregnancy. On the other hand, if the second peak on CD24 was the "real" one, it's better news. This isn't a bad result at all for just after ovulation, and would probably correspond with a reasonably good peak level. However, the egg quality could be dicey, after a previous near-peak and long growth cycle.

Rather than do another draw, Mom thinks we should just wait to see when my period shows up, and work backwards to decide which day was the correct one. If the total cycle length is around 32 days, the first case applies; even if the second peak was the real LH surge, we'd be talking about an 8-day luteal phase, which is problematic. However, if it's more like 38 days, the second peak was the real one.

In either case, we're almost certainly going to do monitored cycles for the next month or two, so that we can know what's going on throughout the cycle rather than getting a single-day snapshot. After that, Clomid is the next step, although I don't know how quickly we'll go there -- G is expressing what we will politely term "reservations" about "rushing" into treatment, and about the risks of multiples. That's a subject for discussion in and of itself, but worrying about it at this point is premature.

ETA: Thyroid results are back. TSH is suppressed and free T4 is 1.09. That's within normal limits, if somewhat low for me -- I'm usually more like 1.5. The suppressed TSH is normal for me, since my variety of hypothyroidism is hypothalamic in origin.

Wednesday, December 12, 2007

We interrupt this important dilemna...

... to discuss an entirely different one: Infertility 2.0.

You know how I've been thinking I've been ovulating a bit later in my cycle, based on OPKs? Well, yesterday was CD23, and while I'd thought I'd O-ed on CD18, I was having some symptoms that made me suspicious, so I used another OPK.

Positive, on CD23, six days after a positive on CD18. Or, at least, what I *thought* were positives. Of course, I immediately thought, what if I'm pregnant, and the OPKs are picking up the hCG instead? Well, that turned out not to be the case, so I tried again today, with a different brand of OPK I had lying around. This one was negative, but middling negative, not what you ought to see the day after your LH surge, or a week after it.

So, of course, the next thing I did was to pick up the phone and call my clinic's head nurse, better known to me as Mom. (It's so helpful sometimes, having a mom with 20-plus years as an RE nurse...)

My mother said that 1) Answer brand OPKs (the cheap 20-pack you can get at Walgreens) suck -- their patients get more false positives and false negatives with those than any other brand. They recommend ClearBlue. 2) if they were legitimate readings, not stick errors (which the middling negative I got today supports), something's not right.

Mom says that late ovulation is usually bad news. If I'm really legitimately ovulating today, on CD24, the egg is probably not going to be very good quality -- long cycles, with long periods of hormone activity, cause them not to mature very well. On the other hand, if I ovulated on CD18, it might not have been a very "good" ovulation either. Even if a follicle released an egg of OK quality, I may not be producing enough progesterone, or there may be something else wacky with my LH/FSH.

If it's just the one wonky cycle, OK, fine, that's how they go sometimes. However, it also calls into question the legitimacy of all those other "ovulatory" cycles. This one isn't especially different -- I just happened to retest even though I thought I'd already ovulated.

My mom said, maybe you just need a little bit of Clomid. Now, Clomid and letrozole both were complete failures for me the last time around, but things are at least somewhat different now. I'm having regular cycles, and there's some kind of ovulatory activity working, even if it isn't completely right. There's reason to think it's a reasonable option.

I went into the clinic for a progesterone level today. If I did O last week, it'll be elevated, though possibly not enough to sustain a pregnancy. If I didn't, it'll be negative, and we'll recheck in a week to see if I'm ovulating today. Either way, it's time to at least think about doing some monitoring next cycle. After that, who knows?

I dislike the thought of Clomid. I didn't enjoy it the last time around, and I'm unhappy at the idea it might have come to this. We'd talked about how, if we need more aggressive treatment, we'd wait a while, maybe a year. We know that ART comes with downsides for us, namely high risks of OHSS and multiples, and we haven't yet sorted out whether we'd try another IUI cycle or head directly to IVF. And now, we're talking about starting up the "gateway drug". If Clomid doesn't work, will we be able to say, no, let's sit on it for a while before deciding to move down the path?

Lots of questions, and not a lot of answers today.

Friday, December 07, 2007

Working hard for the money

So, I've got a dilemna I'm trying to resolve about going back to full-time work.

I'm not sure I ever really posted about my decision to stay at home after the babies were born. Prior to the infertility, I had spent four years working as a freelance computer programmer, but I'd gotten burned out even before adding the infertility upheaval into the mix, and I took a full-time job a couple months after I started blogging.

I stayed with that company throughout my pregnancy, and sometimes wish I could have continued. I really liked the job, especially in the first few months, loved what I was doing and the people I was working with. Later, the new VP of Operations brought a different atmosphere, but not really a bad one, just more corporate and less free-wheeling. This is pretty common for tech companies moving out of the small startup stage, but it's a bummer if you *like* the startup approach to life, which I mostly do.

The most notable change was that the programmers, who had previously been free to work from home or in-house as they chose, were now required to work mostly in the office. Initially, this didn't affect me that much, because I actually liked going into the office, and getting dressed up and interacting with people, after years of barely leaving my house. Ironically, it was not long after that point when my doctor strongly encouraged me to begin working from home, due to the uterine irritability issues. I worked from home the rest of the pregnancy, and if I could have continued to work mostly from home, I would probably have stayed with the company after the babies were born.

However, that wasn't an option, and for me, going back to an office job wasn't an option either. I was nursing, and I was very hesitant about leaving my tiny babies with a non-family caregiver, and frankly I just didn't want to leave them. So I turned in my notice, didn't work at all for a couple of months, and then went back to freelancing on a very part-time basis. I meant to work just a couple hours a week, in the evenings and while the babies napped, enough to bring me in a little bit of extra cash while allowing me to basically be a SAHM.

This worked well throughout the winter, when the babies slept a lot. It got harder in the spring, as they became more awake and demanding, and by the start of the summer, I hired a college student to babysit in-house for three afternoons a week. When she left in August, I found a high-school student, who comes (theoretically) every afternoon for three hours. In a lot of ways, this is ideal, and I'd recommend something like this to any mother of twins, even if you're not working from home. It's really nice to have a few hours to go to the grocery store, or to pay the bills and run errands, or to go and get your hair cut, without hauling a toddler or two around all the time. The babies also go to Mother's Morning Out twice a week, and I take my laptop to a coffee shop and work while they're there.

However, my work situation has gotten more and more demanding. My old clients keep handing me more work, and my business partner's gotten us involved in some new projects which require some very specialized skills -- I literally don't know of anyone else in town who's capable of doing the work. I worked nearly full-time in the weeks after my knee surgery, when I had a babysitter there anyway, and I think that also encouraged everyone to pile work on me.

The upshot of it all is that I have enough work to keep me busy for at least two months, realistically more like three, if I bill as much as I reasonably can with my current child-care arrangements. And it's not like I'll finish that and be done, either -- I expect more work to come in while I'm taking care of this stuff. The nature of the freelance business is to have ups and downs, but for the foreseeable future, there's as much work available to me as I feel like doing. On top of this, I have some school commitments necessary to complete my master's degree this spring.

I have enjoyed being a SAHM. I like spending time with my children and doing motherly things, even the not-very-exciting ones like laundry and baths. I like the freedom of being a SAHM, the ability to go hang out with my mom friends and their kids, to go have lunch with Daddy any day we like, to go to the park because it's a beautiful day and there's nothing else I have to do.

The part-time work was the optimal situation, because it's a little bit of intellectual stimulation and some extra cash, but it wouldn't interfere with my lifestyle too much. At least, that was the theory. I'd still have every morning and two afternoons a week to spend with the babies... or, every morning... or, now, Tuesday, Thursday, and Friday mornings. They nap from roughly 12 to 2, the babysitter's here from 2:30 to 5:30 or so, and then it's pretty much time for supper, baths, and bed. I've essentially turned into a full-time working mother without quite realizing it. I'm still pretending I'm a SAHM and can do SAHM-type things, but underneath the denial I know that's not really the case.

Part-time isn't working any more. I knew this would probably eventually happen, because that's the nature of the freelance industry -- work tends to expand to fill all available time. So, I've got to decide whether I'm going to go back to full-time freelancing, with an in-house full-time nanny, or to hang it all up and be a SAHM. My mother's found a potential nanny, and I've been chewing the idea over for weeks. I think I've more or less made a decision, although I can't say I really like it, but I don't see what else I can do.

So, gentle readers, what do you think that decision is?

----------------- to be continued -----------------

Thursday, December 06, 2007

You know your day sucks when...

The dog throws up on the floor...


and the children find it before you do.

We teased my sister for years about how she liked to eat dog food when she was a baby, but my children have just taken it to an entirely new level. At least M didn't eat pre-digested kibble...