Taken February 21, 2008, at 33 weeks and 5 days pregnant, just 2 weeks before Devin’s birth/death. I never thought a round face could be so beautiful.

On the way to the RE’s office with DH I tried explaining to him why I was nervous. Scared that I’ve had so much hope and that certain beliefs have been a “safety net” for me – that’s not exacty what I meant, but I couldn’t find the words to explain. What I meant was, I was scared that they were going to take my hope away. I wrote to friends yesterday:

And that’s precisely what happened.

::

We waited for about 45 minutes again. This seems to be par for the course, as every consult I’ve had at this office has required a 40-60+ minute wait. A nurse did take me back for a height, weight (140.0 – with clothes on) and blood pressure check (108/68), but then it was back to waiting. While walking back with me, she said very cheerily, so you’re returning, huh?!” I gave a half-smile and let it pass.

Finally we were called in by the Doctor… and a Resident. Resident sat in the consult room with us and went over my history. Well, actually, she started with something along the lines of, “So you’re back! How old’s the baby?” I don’t really get too upset by comments like that, although it seriously pisses me off that no one reads my fucking chart. THAT bothers me. Should they not be reviewing it FIRST? But I politely pointed out that, actually, it was a stillbirth. In march. She expressed her condolences. It was a little irritating, to be honest. But then we went over the rest of my history questionaire. I just wanted to get it over with so I could talk with the doctor.

So yes, we get to the IVF part and I give her a very brief overview of my two previous IVF cycles. 24 eggs, 2 embryos, no implantation. 13 eggs, 1 embryo, stillborn baby. “Oh wow,” she says. “That’s aweful.” Yeah. You don’t know the half of it, lady. Finally she leaves so she can discuss it all with the RE before he comes in.

Now don’t get me wrong, she was a nice woman. She’ll probably make a very nice doctor some day. But after dealing with two crap IVFs and a stillbirth I’m really tired of explaining my situation. I just wanted to see the RE and get some answers.

So finally (after another significant wait) he comes in. He immediately offers condolences on our loss, with lots of, “It’s so horrible when things like that happen. It takes a long time to get over that. A long time. Are you getting support? Seeing a therapist? You should, I mean, it’s a big deal. It takes a lot to deal with this sort of thing.” And, okay, I know he meant well. But I really wanted to just snap, “Look, I know all this, I’m not here to talk about my loss, I’m here to talk to you about getting me pregnant. Can we PLEASE move on now?” I didn’t. But I so wanted to. I was polite and cordial and nodded a lot. For a moment I was really scared he was going to tell me that they wouldn’t treat me so soon after a “huge loss,” that they required me to have time to grieve. I really was scared for a minute, the way he was talking and pausing. This is the first time I’ve ever met with this doctor, so I didn’t really know what to make of his manner. (He’s a pauser. Long stops between sentences/thoughts. Drives me a little batty, to be honest.)

Finally we got down to business.

Once I knew we were on the same page about the IVF cycles and that he was familiar with the stats I basically put it out there… what the heck happened??

I did confirm that it was indeed an egg maturity problem, not a fertilization problem, as communicated to us after IVF#1. It is also not an FSH/declining ovarian reserve/egg quality issue. However I had mistakenly started thinking that it was due to the meds protocol, that it would have a simple answer. That someone screwed up and that we’d have a clear idea about what to do next IVF cycle… even what to do before even hitting IVF. I was wrong.

Basically he told us that what I have is “very rare, actually.” The problem, he said, is that there are no answers. No one in the reproductive world knows what to do in cases like mine. There has been no research. There is no data. And there is no known cure or treatment. He said he actually wrote a paper on me – or rather, my IVF cycles – that he’s going to present at a big conference sometime soon. I guess what happened spurred them to do some of their own research, and discovered that not only is it rare – he said they looked at 1000 cases, and only 12 had immaturity problems like mine – but that’s when they noticed that there is no published data. No research at all. No suggestions. I told him I’d like to get my hands on that paper of theirs. He warned me that, “There are no answers in there.” They raised questions, they did not find answers.

He said they did see that some of the women with this problem have slight chromosomal abnormalities. So he wants a full workup on me, and Den too. Just to see if there’s anything they can detect. If so, they might have to do a biopsy to check into my chromosomes further.

I asked if this immaturity problem is why we haven’t conceived naturally in all the cycles we’ve done. “Possibly,” he prevaricated. I got the sense he really didn’t want to commit to any answers about it because he couldn’t back anything up. He wasn’t going to tell me it is definitely the problem if they don’t know for sure. But to me? To me it sure seemed like a big fat, “Yes.” Most women do NOT have this response in IVF. It does not seem to be a meds issue. So what are the chances that this is NOT having an impact on the eggs I ovulate every month on my own?

All of that pretty much made my next questions pretty moot, but I asked them anyways. I acknowledged that they don’t know, that they have no real suggestions. But I asked, could we at least try clomid? Injects? Anything? I mean, insurance pays for it. Anything but ART right now. Maybe it’s a waste, but at least it’s something. And it increases the number of eggs, so maybe one would be okay right? He gave a non-commital, apologetic shrug. No answers. No direction. He suggested we wait until after the blood tests come back, meet in a month to evaluate and decide where to go from there. I pressed on, asking if there was anything I could do at all. He replied, “Eat well, exercise, be healthy.”

He walked to the nurse’s desk and got her to do up some lab slips for us. He also wanted her to check to see if the doctors had done any kereotyping on me after our loss – I know they’d done it on Devin (and he was chromosomally perfect), but I didn’t know about me. So Den and I sat in an exam room while she phoned around to find out.

I just sat down and started crying. Den still doesn’t get why I’m so upset. How can I explain? I’ve been carrying around this hope – this belief – that our screwed up IVF cycles were a protocol problem. Right from day one I’ve held the very strong belief that next IVF they’ll be able to do something different to increase our odds. And I certainly expected to walk out of this appointment with a plan in place. And since Devin’s death I have held hope for a little miracle, that the next one would just happen.

And all of that was dashed. We’re looking at getting the same crappy results every time we do IVF. No frozen embryos, ever. The doctors are stumped. We have no plan, other than, “Do what we did last time and hope it works again.” My hope in a naturally conceived pregnancy is pretty much dashed.

Like I said, Den doesn’t understand why I’m so upset. “We got no new information,” he points out. “He never said we have no chance at getting pregnant naturally. And we know IVF works.” And he’s right, for the most part. There have been times when I have suspected all of that. But there’s suspecting, and there’s knowing. Knowing is a punch in the gut.

There is something very wrong in my body. And they don’t know how to fix it.

::

This afternoon I finally connected with the woman at the bank. She offered me the job. 20 hours over 3 days per week, at a semi-close location, with benefits. I did a little happy dance when I hung up. I just felt so beat up after this morning that it was a welcome mood. I have not confirmed that their offered health insurance will cover IVF or what it will entail, but I do not see how a local bank could get out of the infertility mandate in this state. (Den’s insurance gets around it because it’s federal, not state.) It is a HUGE relief. November I should have coverage. We should be able to start IVF. My only worry with that is getting the time off, when needed, for monitoring and retrieval and transfer, when I am still so new to the job. But I’ll deal with that when it comes.

So right now I’m balancing between being totally upset and being thankful that we WILL get to do IVF and hopefully get pregnant in 2009. I guess I just need to keep my eyes on that and relinquish my ideals and hopes and dreams. I really think I’m just going to throw in the towel on this TTC thing while we wait. Maybe I’ll change my mind, but right now I’m just… done. If there was something more than a shred of hope, then fine. But now? Knowing that we do everything right and it will make no difference? There’s really no point to me tracking my ovulating and making sure we have sex on the right nights, to winding myself up in the two week wait, convincing myself that somehow this time it worked.

I have a new job to focus on, I’ll be working most of the week now. Either Mon/Tues or Mon/Wed at one job, and Thurs-Fri-Sat at my new job. Hopefully that’s enough to take my mind off everything. Hopefully it’ll give me enough extra money to go out and do something good with my life in between. I know three months is just a blip in the big picture… but every day spent waiting just hurts.

::

I start orientation at my new job on August 18. She told me that there’s a 90 day/3 month probation period before benefits kick in. Curious, I calculated what exact day the probation period would end for me, what day at the earliest I could get insurance. November 16.

It was November 16, 2005, that I got my first period after stopping the pill. November 16, 2006, was the day our insurance officially considered us infertile (our appointment with the RE was on Nov 17.)

November 16, 2008, the day I am eligible for IVF benefits, will be our three-year mark.

I am trying to read and process things. Doing a lot of googling.

Some people online with this problem (very poor egg maturity during IVF) wrote that their doctors say it’s linked to PCO and insulin resistence. I have symptoms for neither of those. I do have a high antral follicle count and I am a very high responder in IVF, but there were no cysts, I have no cycle issues, and none of the other long list of symtoms other than acne. Insulin resistence… now I would think, if that were the case normally, that my pregnancy GTT would have shown something. My numbers were very low, not even borderline.

I found the article my doctors wrote. It was in fact not about me specifically, but about a woman with a very similar condition. After her karyotyping they found she has Turners mosiac X syndrome. That makes me twitch a little. I’m now quite interested to see if anything turns up on my karyotyping.

IVM (in-vitro maturation) is still experimental. To be honest it makes me a little nervous because we DID get one good embryo. And one good embryo is better than none. And, despite my slight OHSS symptoms, the whole IVF cycle wasn’t all that difficult. I’m more inclined to try experimental stim protocols to try to increase the number of mature eggs they get from me.

This study seems to indicate that normal fertilization in vitro may give better outcomes than ICSI, for cases like mine. This is a concern Den has. Ever since I found out that our first cycle flunked IVF 101 due to the eggs being immature (and, thus, un-ICSI-able anyways) I’ve considered ICSI on our second try to be superfluous. Den’s argument is, “But if we only have one mature egg, I want to make DAMN SURE it gets fertilized!” And, okay, he has a point. My only hesitation is that I don’t really like to be messing around with the things if it’s not necessary (they’re having a bad enough time as it is, stop poking them! They’ll get mad!), but if insurance is covering the cost I’m not really going to argue against it. I’ll discuss with the doctor when we get closer to actually cycling.

You know what annoys me the most right now? The fact that you have to subscribe to these journals in order to read the full article! Obviously, as someone who is just a patient searching for answers, I cannot afford to shell out hundreds of dollars on some articles to read. So, what, I have to comb forums for answers from other patients who likewise have no actual real clue either? I want facts. I want numbers. I want real research.

Apparently I should have become a doctor. Or at least an embryologist. As my dad said… hindsight.

I would really like to thank all of you who jumped in with suggestions!! I am certainly open to anything right now. And thank you so much for your help in accessing full articles… whether it’s from someone online or someone that Den knows I’m determined to get them. :lol:

Another article: Maturation arrest of human oocytes as a cause of infertility: Case report. I have yet to read the full text, but it is free so I will be doing so at some point (possibly not tonight, as it is already 11pm!) This article finally gives me a name for my condition: “The recognition of oocyte maturation arrest as a specific medical condition may contribute to the characterization of the yet poorly defined entity currently known as ‘oocyte factor’.” This is very very interesting to me. I’m so very glad I’m finding info about my condition, even if it’s not much. Anything to understand it better.

I have a feeling when I walk into my RE’s office next time talking about oocyte maturity and how such-and-such study suggested that maybe we try x, y and z he’s going to be a little taken aback. I have a feeling I’m going to have to be blunt about it and tell him that I prefer to be an educated patient, I want full explanations for everything and I want to be an active participant in my care. I want to help them, and I’m willing to basically be a guinea pig for trying things that may help me (and others with this problem). I also want to make clear to him that I know that they don’t have research showing them what to do and I know that they cannot make me any promises. I am not looking for them to swoop down and make it all better. I understand that’s simply not going to happen. However I expect them to try. Something, anything. With my full knowledge and consent that it’s experimental, I’m okay with that. But I want to be progressive and proactive. If he wants to just play it safe and shrug his shoulders and say, “Well, I don’t know…” then I will go elsewhere.

A few people have expressed to me that I should get a second opinion. And I don’t disagree with that notion, exactly. However at this point my doctor has told me the truth. He wasn’t being obtuse or idiotic when he told me he doesn’t know how to treat this cause of infertility, it’s just that no one knows how to treat this. Maybe there are some doctors trying new things, however, if they are it appears that none of them have published their findings. As of now this condition is not understood by the medical community. So, while there is one other IVF center nearby, I highly doubt they’ll be able to tell me any more than my RE did. (Now if my RE drags his feet and doesn’t put out effort, that’s another story. I’ll know better after our second meeting.)

So far I’m going to ask him about insuline resistence testing, androgen level testing, and one other thing that I can’t currently remember. (Fantastic, Natalie.) They already took blood to test me for chromosomal defects and clotting disorders. I realize I need to get a copy of all my lab tests and everything from the past. I have some of them, but not all. I like to be thorough. I also want to get a copy of my file from my labor and delivery… not sure why, I just want to read it. Another piece to hold onto, I guess.

::

I had to have a little chat with Den about allowing me to feel frustrated and upset and hopeless once in a while. Bless his heart, he hates seeing me being so negative and down on myself so he spent all of Thursday trying to cheer me up an show me the bright side. Sometimes that’s a good thing. But sometimes? Sometimes you just want to CRY, you know? So I told him that… that some days I just want to feel bad, and yes, wallow in self-pity for a little bit. Then the next day I’ll get my feet under me and march off in a new direction (or at least take a few wobbly steps). But I think I need that day in the mud. I just need to let it all go and “give up” for a few hours. Holding on top hope is tough. It hurts sometimes. And I simply need to put it down once in a while.

I’m giving up on the TTC thing. I didn’t think it would be this soon, and I probably would still be counting and hoping if it weren’t for that appointment and the knowledge that, more than likely, something is wrong with my eggs. I walked out of there feeling like a fool for setting myself up for yet another huge disappointment. So at this point I know that I probably ovulated this month, and the timing was good, but I can’t remember how long it’s been… and I’ve been intentionally not trying to figure it out. I believe I’m about halfway through my LP. I have a ways to go. We’ll see if I end up breaking down again or if I can truly manage to let this go.

I don’t think it’s a bad thing for me to give up on conceiving naturally. That won’t affect whether or not it will ever happen – I just don’t understand why so many people (not my husband, but mostly other relatives) insist on pointing out that, “You never know! Never lose hope!” …. Ummm, why? Does having hope have any effect on anything? No. What it DOES do is make for one horrific crash every single goddamn month. And now that I’m looking at the full situation in front of me I just know I can’t keep doing that. I need to pull myself together and move on mentally… stop obsessing about being pregnant, getting pregnant naturally. If it happens, GREAT. If it doesn’t… well then I’ll be in line for IVF. No harm done, and I’ll have saved myself significant emotional grief.

I was thinking about likening it to, say, someone living in government housing. Say you’re comfortable. The little place is paid for. But you really really really want a house. Everyone else has a house. It becomes overwhelmingly important to you. So what would you do? Buy a lottery ticket every month and then become hysterical when you don’t win? Or get a job and save your money for a house? Let’s assume for the sake of an argument that a job is fairly easy to get. It’s not pleasant, but it’s not terrible either. I think, were you to do the former, people would start looking funny at you. I highly doubt people would tell you to “keep the faith, you’ll win that lottery some day!” This is how I look at my infertility. I may win the lottery, but it’s not very damn likely. I am not going to plan my future around winning the lottery. I’m going to do IVF.

::

I dreamed last night that I was pregnant. Halfway through. The hospital called to tell me that the level II ultrasound went well and that it was a boy. My Lucas. I was so happy… mostly relieved that everything was okay. I thought to myself that I was glad I didn’t have to be there, watching, during the ultrasound… that it was so nice to just know that everything was okay. It didn’t occur to me until I woke up how absurd that was… I was pregnant, and I wasn’t there for the ultrasound? Some things make far more sense in dreamland.

I’m searching in medical publications for articles that may help us. I decide on a whim to search for amniotic band syndrome. This is what I found:

http://www3.interscience.wiley.com/journal/119415481/abstract

Go me. I totally won the lottery. WTF.

In a way I’m glad it’s so rare so I really really don’t have to worry about it happening to us ever again. But on the other hand I just want to scream, “ARE YOU EFFING KIDDING ME?!”

This is me, stomping around, wanting to kick something.

I am reading the full text of this article right now:
http://humrep.oxfordjournals.org/cgi/content/abstract/17/6/1604
There are some very interesting bits to take from it.

* They noted some other reasons this may occur, such as a bad hCG injection or clinic-specific issues. But all 8 patients in this study had multiple IVF cycles in multiple IVF centers – all with the same result.

* It is normal to have a small number of immature oocytes in an IVF cycle. But they noted that when the number of immature oocytes became greater than 25% the IVF outcomes was greatly reduced.

* They don’t know how often this happens.

* There is some evidence (in other mammals) that such problems have a hereditary link. I obviously did not get this from my mom. But will I pass it to my daughter? (One can hope that by then they’ll know what to DO about it.)

* They tried extending the time between hCG and retrieval; increasing the hCG dose; and extended the culture time. All failed to have an impact on the egg maturation. IVM is a suggested possible protocol. Donor eggs are the best option and has very good success rates.

Note that this paper includes only 8 women who have total oocyte immaturity. No good ones like I had. It seems very clear to me that I am incrediby lucky to get one or two mature eggs out of my cycles. This gives us a lot of potential. Even if my next cycle goes exactly how my last one did, that would be GREAT. These are cases where a woman has no mature eggs – not even after several cycles.

This is why I’m so scared. What if it gets worse? What if we get nothing? What if Devin is the only biological child I’ll ever be able to have? In some ways that feels so very much worse than never having any.

I must stop this line of reasoning before I hyperventillate.

I want to find out what stage my oocytes were arrested at. Not that that will really help me much, but… eh. Maybe it will.

I hate that there is no real data. I hope this spurs the doctors to look into this more. I don’t know how much they can do, and I know I can’t lay the responsibility of fixing this huge issue at my clinic’s feet, but I hope they learn something. Maybe I’ll be the breathrough case or something, finding something new that can help others.

::

I’ve been getting worried about how IVF will conflict with my new job. It was never an issue with my current one because it’s so flexible… I can push things off for a day, or plan ahead and take some days off. I can go in “late” (though I’m never really late, because I go in when I decide to go in) with no issues. So this whole having a traditional job with a set start and end time is a little nervewracking for me. I haven’t started training or anything yet, so it’ll be a while before I find out what kind of person my boss is and if there’s any flexibility at all.

Obviously this won’t be an issue during my probation period, because we can’t start IVF until I’ve completed that and get health insurance. But I still fret about it. (Den says, “Just like you, to worry about something that is months away!”)

I dug out the old IVF binder from my clinic and read through to when their monitoring times are. M-F they do monitoring from 7-9. Weekends it’s 7-8. And the work schedule I was given is Thursday start at 10:45, Friday start at 9:45, Saturday start at 8:15. So really the only day that will be an issue is Saturday! What a relief!

Obviously there’s egg retrieval and transfer days, but there’s nothing I can do about that. I’ll have to figure that one out later.

::

Today I pulled out my old “charting” binder – that at some point became an infertility binder. It has all my notes and doctors visits and other info in it. All my charts, some of my lab results. I hefted it in my hand. “I never thought this would get to be so… big,” I said to Den. “I just thought it would be a cute little keepsake for my child.”

Oh how things turn out not the way you expect them to.

Skip to the end for the very very good article. I’m so excited I’m practically bouncing. Is it possible that I found some research my RE doesn’t know about? I guess I will find out.

::

I’m reading the case report published by my IVF clinic about the woman who had low oocyte maturity and was subsequently diagnosed with turners mosaic. A couple of points:

* She had a much higher oocyte maturity rate as compared to me (32% to 8%, respectively) (average maturity rate at my clinic, btw, is listed in the article as 82% with a standard deviation of 15%), yet never got pregnant after 4 IVF cycles which, combined, yeilded a reported 7 transferred embryos, 5 of which were labelled as “high quality.” I got pregnant within 2 cycles, with 3 transferred embryos. (I honestly don’t know if either of the embryos from my first IVF were considered high-quality, but I want to find out.)

* She did the usual preview to IVF: 5 clomid/IUI, 3 inject/IUI. The RE, when I was talking to him, at one point asked me to clarify how I got to IVF. As in, he was confused as to why we had done only 2 clomid/IUIs, then jumped to IVF. I explained insurance, but I kind of wanted to say that we had pushed for it, suspecting that whatever was wrong was not going to be fixed with clomid or injects. We happened to be right.

* The patient then underwent three IVF cycles with ICSI (due to low sperm count), all with low oocyte maturity. Now, granted, she didn’t have as many immature eggs as I did. But it still disturbs me that they did THREE cycles before deciding to investigate it and discovering the turners mosiac syndrome. Maybe they thought the maturity rate wasn’t low enough to warrant investigation, maybe they thought she should still get pregnant with what they had. But still.

* The article does not specify what protocol they used on this woman or whether or not they modified that protocol for the second and third (and, later, fourth) attempts. This would be very interesting to me.

I’ve said before, I am not going to be a typical patient (is there such thing as a typical infertility patient?). I will be going in with data in hand, with a pretty good idea about what I want them to try next, as they have never seemed very proactive on their own. I don’t know if I can blame them for that – I think most IVF clinics will typically proscribe the “standard” treatment ladder steps for unexplained infertility patients. And I guess that’s the smart thing to do, in many cases. But something in my gut told me to skip to IVF. And I was right. Whether that is hindsight, I don’t know. But I trust my gut when it comes to this.

I assure everyone that if I do not get satisfactory answers I will seek a second opinion, though really we don’t have a lot of options around here; the clinic I was going to switch to after my second “failed” IVF may be too far away to really be possible with my new job. But right now I am just waiting to see what the RE comes back with and how willing he is to work with me. And, really, even if we do the exact same thing as last time… that worked, right? That wouldn’t be too horrible. I just wish we could raise our odds a little, that’s all. Maybe make some progress on figuring out oocyte maturation arrest… give others a tiny bit of hope.

So we shall see. We have a ways to wait. The appointment isn’t until Sept 15, which irritates me. I hate waiting. Granted it irritates me less now that I know we won’t be doing injects or anything in between now and IVF. I mean, I guess we could try it, but it doesn’t sound like it’s really worth our time or effort… or mental capacity. Do I really want to do monitoring and injections and trigger and required actually thinking about my cycle and timed intercourse… all knowing it’s not going to work? My idea of ignoring my cycles until IVF sounds more and more tempting every day.

But then I think about how the next three months are going to be three months of learning a new job (always stressful, being new) and then I want to start thinking about something else, like babies……

It’s a vicious cycle. No wonder TV is so popular. Mindless entertainment and time wasting. Do I really want to just skip over the next three months? ….. Maybe I shouldn’t answer that.

::

Ohhhh, lookie what I found!!! This is a randomized study published in 2006.
http://www.ncbi.nlm.nih.gov/pubmed/16828475

In plain-speak: In patients with a high number of immature oocytes they tried triggering earlier than normal before retrieval, with a group that triggered around 38-39 hours before and a group the triggered at the normal 35-36 hours before. They had no incidences of ovulation occuring before retrieval. And they significantly increased the percentage of mature eggs after retrieval. Significantly, as in, they averaged a 76% maturity rate in the group with an earlier trigger!

Freakin’ fantastic. So now I know what we need to try, and I have the medical literature to support it. Take that, REs. No medical research available, MY ASS.

(I just woke Den up to tell him about this. I asked, “Why doesn’t our RE know this?!” he mumbled back, “You think they spend hours combing through research?” ….. Well, they should. Especially if it’s about MY condition. Hmph. I get the feeling he currently isn’t as excited about this as I am. Wonder why… *glances at the clock*)

Today I printed out that article on delayed hCG and oocyte maturity and poured over the details. And then, when I was done that, I looked up the articles it referenced, to see if any of them would be helpful to me. I spent a while looking things up, downloading, jotting down notes.

Den came up behind me and suggested I take a break. “You should take a break before you crash. You do that, you know.”

I looked at him blankly and blinked. “That’s why I need to get this done before I crash.”

“Well, maybe you could avoid crashing if you take some time off from the researching….”

I stared at him. He stared back at me.

He sighed. “I forgot who I’m talking to.”

I went back to reading.

::

He is not wrong, though I see it as less of a “crash” and more as me reaching the end of my objective and moving on. This is how I do things. Maybe it’s not entirely healthy, but it’s effective. I’ve learned to take advantage of it and push until I reach the end. It’s how I clean. It’s how I learn. It’s how I get things done. I have tried doing a little at a time, spread out so as not to overwhelm me. It just doesn’t work well… I waste time, I get confused, I totally lose motivation. I do my best work when I’m kicked into high gear, invested thoroughly into whatever project I’m doing.

I am also doing everything I can to avoid thinking about where I’m at in my current cycle. I have not touched my chart – or opened it – since our appointment. I have not written anything down. I have not checked my cervix. I have not counted days on the calendar. This, I realize, is my way of avoidance. I figure if I stuff enough things into my brain it won’t have the time or capacity to be conjuring up images of a surprize BFP.

Staying focussed on my IVF cycle really has done me a world of good. It’s shifted my mental energy over and set my sights on the future. I am now working towards something, not just drifting aimlessly waiting for “something” to happen. I now have a timeline I can work with. I have some real hope.

I remind myself that it could take two cycles to get pregnant again. That would suck, but it would not be the end of the world.

I’m really struggling with the idea that I won’t be pregnant before Christmas. And thinking that it’s possible I might not even be pregnant by Devin’s birthday. I know, I know – stop worrying about things until they happen. But we’re not getting insurance until mid-november, and knowing insurance it’ll take some time to kick in, so hopefully starting IVF in December. Transfer in Jan or Feb. :( This makes me so upset. Maybe in a few years it won’t matter so much, but the waiting just really seems to magnify our loss. A whole year without Devin, and without any baby. If we’re not pregnant by his birthday… I just don’t know what I’ll do. It won’t be pretty.

Before I was mourning my loss, and hoping I wasn’t still infertile. Now I feel all the old anger and frustration of being infertile come rushing in on me on top of the loss grief. It makes me so damn angry. I can deal with one. I can deal with the other. But for fuck’s sake, don’t give me both at once.

This is why I bury myself in research. No time to sit and feel sorry for myself… and it allows me to have hope in this, that this will all work out. I need to keep busy these next three months, or I am going to go insane. Oocytes and embryos and hCG and meiosis… so very much easier to think about than the fact that I do not have a baby.

I want my little boy so bad. I want another little boy. And I know I will be happy with whatever I get – sex seems like such a petty thing to be upset about – but oh holy hell I want a little boy so very badly. Not to replace Devin, never to replace him. But I got used to it. I looked forward to it. And seeing Devin’s little brother toddling around would help heal my heart a little bit.

It’s been 5 months today. It hurts less. It’s become more of a dull pain. Always there. You kind of get used to it, in a way… you forget how it felt like to not have this ache always with you, tucked in your pocket next to your heart. And it feels more unbelievable every day. Speaking of loss becomes commonplace. The world is so different now… my world is so different. I say things like, “I want at least two live children,” and, “After we lost Devin.” There’s only a slight pause now. It becomes a part of your vocabulary. Your life gets re-defined in a major way and, somehow, us humans get used to it.

I don’t like to think about time, at least not beyond planning for the coming week, and yet it seems to take up a good portion of my thought processes. The time since Devin died, the time until IVF. Sometimes I forget, and then I see something, hear something… how BabyH is 2 months old. That means it’s been 5 months for us. I look at BabyH and realize how she’s changed already. Time is forward, time is cumulative… time reaches towards her future. For me time diminishes, it takes away. Time takes me further from him.

There are a lot of unimportant things in this world. When my bosses were freaking out and I had extremely tight deadlines, I shrugged, got to work, and finished what I could. I did not worry. It wasn’t a big thing.

What is a big thing? Devin’s tree is a big thing. And that tree, it is dying.

I cannot handle this. I CANNOT handle this. I went to the garden store with photos begging for help. She’s going to pass it on to their expert tomorrow and let me know what to do about it. But I am terrified – TERRIFIED – that it is too far gone already.

I am scared what will happen to me if it does die. I can tell you it will not be good.

I decided we’re going to hire an arborist to take care of the tree. Screw this, I’m not fooling around with it. If it was “just a tree” then fine, I’ll play around with it. But I’m terrified I’m going to screw up, and I am seriously worried at this point about what that would do to my mental stability. I really had an unpleasant mental freak-out this afternoon, complete with weeping and rocking in the fetal position and a strong desire to start smashing things. Some wispy thoughts of quitting everything and running away back to Canada. I really think I had a bit of a mental break with reality, and it was very not cool. (Only Kel got to see most of it, and I actually erased a couple sentences from the email I sent her, lest she’d freak out and call the cops to come check on me. I know better than to say some things, even in the midst of a really really bad day.)

So. That is the plan. I’ll talk to the “expert” at the local home and garden center to see what I can do in the meantime, I already have an email in to a local arborist, and then I’m going to pray (no, not to g-d… how far gone do you think I am?). Please let this tree live. Please let this be soon enough to reverse the damage already done.

::

I am left feeling a little dazed from the day. Just having trouble focussing on anything. Yesterday I was pouring over research; today I have to read the same sentence three times, and I realize I still didn’t quite get it. It’s just that my brain has turned off… perhaps in self-preservation.

I have hopes to do more with the research… and I have ordered copies of my records. Not because I am going anywhere else (yet), but because I want all the data to go over before my appointment. There is still more I want to look at and hopefully will come up with a good plan. It occurs to me that perhaps it’s strange that I’m coming up with my own protocol for IVF, and normally I like to let the experts do what they do, however I am not very encouraged by the doctor’s shrugs and inability to suggest, umm, anything. I really wish I had a biology background. I’m bummed that the college doesn’t have the intro biology class in the evening this semester or I’d definitely be in it.

Oh, and about IVM – in vitro maturation. IVM involves removing oocytes very early in the cycle, after only a couple days of medications, then maturing them in vitro. This is certainly a promising avenue of research for people with oocyte maturation arrest. However there are two problems with it that have made me scratch it off my list. First being that it is still a new procedure and the summaries I have glanced at cite that results have thus far been disappointing. Currently we were able to get SOME mature eggs out of my body harboring them, and I would hate to take a step backwards. It is something I would consider if we had NO current options, for sure, but right now I think the best success will be found in making small changes to what we did last time. The second major problem is that it is experimental, and thus not covered by insurance. I do hope they are able to make progress with it, however, and find a way to help those women who have total oocyte maturation arrest (no mature eggs). Currently in those cases the only solution is donor eggs.