Tension, Anyone?

Last night I had a nightmare in which my Dad kept sticking a rattlesnake into my face in spite of my repeated refusals. I eventually punched him. (In my dream.) In real life, I apparently punched my peacefully sleeping husband as he lay alongside me in our bed.

Who knew you could punch people while you sleep? Do you think perhaps I'm a little tense?

Attempting to Blog, Take 2

I'm going to give this blogging thing another go. I've been spending a lot of time in the last year reading about various infertiles and I think the time has come to get some of the nastiness going on in my life out of me, so maybe typing it out will help. I took a quick look at my previous posts and I see I had just started thinking about trying for child #2 and seen Dr. Favorite to start Metformin. Since then we have:

(1) had a consultation with our perinatologist to see what he thought our risk of preterm labor would be if we tried again (30% or so)

(2) had a consultaion with our RE regarding possible problems related to my not having resumed having periods in the 14 months since having D

(3) discovered the RE was much more concerned over the possibility of scarring to my uterus from the emergency D&C I had after nearly bleeding to death from retained products of conception 5 weeks postpartum (a story for another day)

(4) had saline injected through a catheter into my uterus to look for said scarring (none there- hooray!)

(5) started having periods again after about 9 months of not nursing, 9 months on the Pill, and 6 months on Metformin

(6) stopped taking the Pill

(7) immediately got pregnant

(8) 3 days later became un-pregnant (miscarriage #2 for those keeping track, if we call chemical pregnancies miscarrages, which I think we should)

(9) got pregnant again the next cycle (I realize for someone with PCOS to get pregnant this many times is pretty disgusting)

(10) immediately called the RE for a beta, E2, and progesterone checks. Progesterone was low, started suppositories. Beta was 26. They were not optimistic.

(11) Second beta 2 days later. Doubling time 23 hours. Optimism seeded.

(12) Third beta 4 days later. Doubling time 49 hours. Optimism flourished.

(13) First ultrsaound last Thursday. (6 weeks 0 days since last mentral period) Gestational sac in uterus: check. Yolk sac: absent. Fetal pole: absent. Odds quoted by RE of this pregnancy continuing: 50%.

Since then: pregnancy symptoms are dwindling. Period remains absent. Belief that this will continue is pretty much gone. Memorial Day Weekend desire to drink heavily in order to grieve doomed pregnancy was hindered by the tiny possibility that pregnancy is not really doomed. Who do I think I'm kidding?

Mostly I worry that my chance to conceive without serious intervention by my RE is ticking away. I don't believe I ovulate on my own unless I have recently come off an extended period on birth control pills. So far in my life I have conceived four times, all within 4 months of coming off birth control pills. I'm terribly afraid my body's ability to ovulate without fertility drugs is wearing off while we wait around for another miscarriage.

A note here: I have no problem with fertility treatments. If I need to use them to have another child I will. But, I was in the hospital for nearly three months during my pregnancy with D. I nearly gave birth to her at 24 weeks 4 days. I have been told in the strongest language that I need to avoid conceivng multiples. My RE thinks my best chance of conceiving a singleton (using fertility treatments) is with IVF with a single embryo transferred. My insurance does not cover IVF. So here we are.

The next ultrasound is at 9:30 AM Thursday. Never has time passed so slowly.

A Red Letter Day

Wow, I just got my first comment. Thanks Kiernan! I feel so validated!

Haven't been posting much due to:

1. Obsessive reading of blogs by Jo Leery Polyp (in progress-- just got to the birth story!), Julie A Little Pregnant (finally finished... wow, what a story. Plus, I'm finding her thinking regarding child #2 very relevant) and Erin PCOS Baby (ditto on the relevance).

2. Unexpected loss of hours of my life at a stretch (see #1 above).

3. Week long snotfest involving D's nose (icky).

4. Husband at weeklong conference on East Coast.

5. 1+4 = no sleep = bad combination

6. Cranking up Metformin dosage = yuck.

7. Trying to write exam for my lecture course on a computer connected to internet... leads back to item #1 above.

Does anyone know where I might purchase some self-control? Shouldn't finishing the coursework I am paid to do be a higher priority to me than reading blogs? Sigh. Must go grade homework assignments. I'm at least 90% of the way done writing the exam.

Am also wondering how long I should wait for periods to resume while taking the Pill and Metformin. I'm on my fifth pack of pills and nothing happening yet. Only on the fourth week of Metformin though.

Resisting the call of the blogs and OB/Gyn Appointment

I am beginning to see that this blogging thing could expand to occupy a large amount of my already nonexistent free time. I tend to wander along, peeking at this blog here, following that link there, when Boom! I am sucked in and must read someone's entire blog from the beginning. The first one to get me was Julia's. I just finished Thalia's today. And I am just shattered that she's decided to go quiet for a while. It certainly gives me extra incentive to do my best to stay anonymous.

Anyway, I must come up with some way of balancing updating my own blog with reading other people's. How on earth do people manage this? Something to think about later.

As for me, we're getting moving with the medicine. I had my annual checkup with Dr. Favorite on Monday. Now, I should mention that I patronize the practice that I do in spite of their less than stellar support staff. I rarely feel good about anything after trying to phone the office, and I am occasionally reduced to tears. I often have to wait a very long time for appointments. Example-- Monday. My appointment was for 9:45. Being quite type A, I arrived early. I also had to bring my daughter (let's just abbreviate that to D from now on, shall we?) since my husband (similarly let's call him H) unexpectedly had something important going on at work and couldn't go in late. So, I have a one-year-old with me who hasn't been allowed to take her morning nap due to the unfortunate confluence of H's work thing and my appointment time. I came prepared with her favorite toys, books, blanket, snacks, etc. I HATE skipping any of her naps. I hardly ever do it-- usually only on days we fly somewhere. Anyway, wait time before being called into exam room: 30 minutes. Wait time after stripping and donning paper wrap, etc: 25 minutes. But then, wonderful to see Dr. Favorite again. I haven't seen her since 8 weeks after D was born. The reason I keep seeing these doctors is that they were so wonderful during my last pregnancy. She thanked me for bring in D as they love to see the babies and know how difficult it is to bring them in.

Dr. Favorite is getting a referral going to let me go talk to the perinatal specialists that we worked with last time when I was hospitalized while pregnant with D. The referral is good for three months so I imagine we'll go in sometime just before or just after the holidays. I was amused my her reaction when I brought it up. She quickly interjected, "This is just to formulate a plan, though" meaning that of course I wouldn't be taking my messed up body over there in its entirely, would I? I wish I knew if they were hesitant to refer me over there permanently because (a) they love me to death because I am so delightful, (b) they don't want to see one of their more interesting cases go out the door or (c) I am quite the cash cow for this practice. Some of the hospital bills from last time... whew. Since D was born, Dr. Favorite and her partners have moved their office next door into a brand new medical building, hired a fourth partner, and hired a plastic surgeon and bought a hair removal laser to go with the new surgeon. Dr. Favorite said her other PCOS patient has been using the laser and is pleased with the results, and Dr. Favorite herself just had her underarms treated. I'm not quite ready to go down that road just yet, thanks very much. Anyway, I wonder how much of this D's birth funded?

The not-so-calm after a storm

Well, I wrote in my first entry that my daughter was about to turn one. That milestone is now behind us. What a week. We had my mother, my grandmother, my sister-in-law, and my 2 year old niece all staying in the house for 8 days. Plus my daughter, husband, and me, and our very grouchy cat. Then there was the party-- about 30 adults and 15 kids. Including my mother-in-law and her new boyfriend, and my father-in-law. It's not a party if we can't get all of them in the same room!

Yesterday was the day the last of our houseguests departed and my husband and I were looking forward to reclaiming our space and enjoying a quiet weekend at home. But, being me, I decided to fill the laundry sink (which is upstairs) and after plugging the drain and turning on the water, I of course got distracted and walked away. Today, instead of our quiet weekend, we now have three dehumidifiers and about 10 industrial strength fans blowing air around our radically rearranged upstairs and garage. Carpets were pulled up, soggy carpet pad and wet drywall ripped out and hauled away, doors and wood molding removed, and appliances (most notably our clothes dryer) taken out of commission for the weekend. Nothing like not having a dryer when you've not only soaked every towel in the house in a panic after flooding your upstairs, but have four houseguests' worth of towels and bedding to wash and dry.

I need a vacation.

Monday I have an appointment with my OB, Dr. Favorite. I have to say, having just spent more than a week with a 2 year old in the house, the idea of having another child at this point is considerably less attractive than it was 2 weeks ago.

A little bit of backstory

Well, what relevant information ought I to tackle today... Let's start with the PCOS, shall we?

PCOS stands for polycystic ovarian syndrome. I hit puberty and started to look like a cross between the bearded lady and a linebacker. My periods, when I had them, were all over the place. My mother took me to our family physician, who did some blood work and said all my hormonal levels were within the normal range, though unsurprisingly my androgen levels were a little high. Anyway, they told me I was fine and to consider myself lucky that I didn't have to deal with periods very often. Ha, ha, ha. Great. In their defense, PCOS wasn't well-described back then.

Flash forward to college. Fed up with the endless monotony of depilatory creams, tweezers, and creme bleach, I talked my parents into footing the bill for laser hair removal. It worked pretty well on parts of me and not so well on others. I also discovered SCUBA diving. I loved it immediately and spent a couple of years underwater. This, it turns out, is not only great fun but a tremendous amount of exercise, which is what my messed up, insulin resistant body needs to be reasonably fit. I lost 50 pounds and people from my freshman dorm started to not recognize me when we met on campus.

Then graduate school, which is how I wound up living in this city and where I met my husband. I read an article in a weekly news magazine about PCOS and it was one of those lightbulb moments. I have this, I said to myself. I have this. Well, of course I was right. We also discovered I have hypothyriodism on top of the PCOS. Years of symptoms started to make sense. I got on a low-carb diet and things improved even more. I was running for 45 minutes three days a week. I was finally attractive and fit. (And let me tell you, I was neither of those things for a VERY long time, and all claims of fitness were pretty thoroughly obliterated by my pregnancy.) I was terrified I wasn't going to be able to have kids, but we figured that was going to have to wait to be dealt with until after my husband and I finished graduate school. That took up most of our twenties.

At long last, finally we were both done. My husband got a good job and I started teaching a little at the college I teach at now. We decided it was time to try for a baby. In my mind this was going to take years of infertility treatments and thousands of dollars. Don't borrow trouble, says one of my more understanding OB/Gyns. (There were three in the practice back then. We've met Dr. Favorite already; let's meet the rest of them later.) Her advice-- start prenatals and metformin for a month, then quit birth control pills (which I had been taking since my PCOS diagnosis) and have lots of fun with the husband for three monhts. After that, my own hormones would probably kick in and spoil the ovulation party, and at that point we should come back and discuss further options.

So off we went. I was certain there wouldn't be any ovulating going on in MY messed up body. I'd seen those ovaries in an ultrasound. I had pictures of them. Bags of cysts don't make nice eggs and send them off into fallopiantubeville. 14 days into the first cycle-- boom. My temperature rose. And stayed up. For more than 14 days. Hmmm. Peed on a stick (okay, several sticks), and there we were. Pregnant. First time's the charm, right? Not so much. I miscarried at 7 weeks. We hadn't told anyone except my best friend J, so we were spared spreading around that particular bit of news. To this day few members of my family and none of my husband's family know.

To gloss over a very dark period, we grieved. But we had a valuable bit of knowledge. We had conceived once. It would surely happen again. And it did, three cycles later, again just with Metformin. Who knows, maybe I would have conceived without even that. Anyway, this was the one that took. We got to the end of the first trimester, and then we spread the good news around. We were through the dangerous part, right? I breezed right over a lot of descriptions of preterm labor and other complications in my pregnancy books. That won't happen to me, I thought. I've had my trouble. I imagine anyone reading this can see right where we were headed.

Anyway, that's the prologue to my pregnancy story. So, I'm not really infertile, though for years I thought I might be, and I still identify with a lot of what the IF people blog about. I took any and all pregnancies around me as personal attacks, etc. I won't describe my reaction when my brother announced his wife's pregnancy during this period. It's possible that I harbored some uncharitable thoughts when I miscarried during their pregnancy. I own a lot of books on infertility. I still worry that I won't be able to conceive again without the benefit of coming directly off six years of nice, synthetic birth control pill hormones that repressed expression of my unique cocktail of reproductive hormone soup. However, I realize that imagining problems which I might have had to face, or may face in the future, pales in comparison to what a truly infertile couple goes through. So, I guess I fall in a grey area in the middle. Neither infertile nor normal. I suppose I have a somewhat unusual perspective on both.

Current state of affairs

I suppose I ought to summarize our current yet tentative plan for sibling creation. I always had this vague idea that any children I had would be about 2 years apart. I have a sister who is 2 years older than I am as well as a brother who is a little over 2 years younger. I suspect this might have had something to do with my vague intentions regarding spacing any children I had during my life. Now, of course, I'm looking at this with an entirely new perspective. I'm 30. Five years or so before I'd like to be done having kids. So my age is somewhat of a factor, if by some miracle we decide to have three kids. I would like to go back to work full time (right now I only work a little bit) once any and all kids are in pre-school or kindergarden, and the longer we space them the longer it will be before I go back to work. We sure could use the money. California is a freakishly expensive place to live (I'm not originally from here, as you might guess). Shortly after our daughter was born, we moved to Development Land. Not really a suburb; more of an exurb. We're way out here. It's the only place we could afford a single family home on a street with lots of other little kids. And I'm using the term "afford" rather losely here. Anyway, so there are some good reasons to have another one sooner rather than later.

But what if I land in hospital prison again? My daughter would be two. She won't understand why her mommy had to go away. Lots of the other inmates, er... I mean patients, that I met in the hospital last time had kids at home already and I heard terrible stories about how they felt as their children became increasingly attached to their substitute caregivers. Would it be easier if my daughter were older? I have no idea. The sum total of my experience with children is with my daughter. The older ages mysitfy me. I have no idea what to expect and when. On the plus side, I seem to have lucked out and ended up with a freakishly good-natured and easygoing baby. I'm sure any separation would be much harder on me than on her, especially since my granny-lust-ridden mother has offered to fly down here and live in our house and look after my daughter if anything goes wrong. She loves her two granddaughters to death (my brother has a little girl, too) and would like many, many more! She's been amazingly helpful over the last year and a half.

Anyway, I'm definitely srarting to think about it. My husband is considerably less ready to even turn his thoughts in that direction. That's another post for another day. I have my annual exam/pap coming up in October with the OB/Gyn who delivered my daughter and, incidentally, was the one who confirmed my drastically shortening and funneling cervix last time and was on the phone with a perinatologist within about 20 seconds. But that's also a story for another day. Anyway, my OB (let's just call her Dr. Favorite.) and I discussed "any future children" when my last pregnancy went south and she said when we were ready to think about trying, she'd refer us to a high-risk group to go and discuss the options. I'm assuming we're talking about a cerclage and obsessive monitoring of my cervical length, with bedrest and tocolytics at any sign of trouble. Anyway, I intend to get that referral in motion when I see her next month. Now... How to nonchalantly introduce this plan to my husband? He still suffers from what I term post-pregnancy stress disorder, and rightfully so.

We shall see.