When the Going Gets Tough

Today I took my first Lupron Depot injection.  A few months ago when we were trying to prevent me from ovulating, I took small doses of Lupron every day subcutaneously.  Today’s shot was the big sister – a 30-day supply of Lupron in one hip shot.  The idea behind this new protocol is to cut off my body’s estrogen supply since estrogen feeds the endometrium.  We’re hoping that by giving the endometrium both inside and outside (that’s the endometriosis) of my uterus a break, then it will respond much better when we gear up for another transfer in 2018.  Lupron’s job is to tell my pituitary gland to stop releasing luetinizing hormone (LH), which triggers ovulation and the release of estrogen.  So what does no estrogen mean? You guessed it! An induced menopausal state for the next 2 months. Thank God a cold front is moving through.

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I have to admit that at first I was hesitant to start the Lupron protocol right away.  After our last failed transfer then the biopsy, I wanted a break from everything.  Our doctor gave me the option of taking as much time off as I needed, but we decided to move forward with this new protocol beginning in November since it only meant 2 shots for the rest of the year.  Still, a part of me was worried that I had let my impatience get in my way and had committed to this plan prematurely.  Sure it didn’t mean I had to take daily injections or pills, but I was still doing something infertility related.  “Does this really constitute a break?” I thought.

Then this weekend I realized…there is no such thing as a break.  Infertility, it’s just what we do! Seriously though, why did I even think that after 3 years of trying to get pregnant, I could just put that desire to be a mom on the back burner for 2 months?   Physically, yeah, we’re taking a break, but emotionally…I’m not sure we’ll ever get one.  In fact, despite the odds being stacked against us for so long, I still had a little bit of hope this past month that maybe we would be one of those stories people told about their friends who tried for years to get pregnant and did “IVF and everything” and then it just happened unexpectedly.   But Aunt Flo’s arrival this weekend shot that to hell. So no, there is no break, because every month is a reminder of what we are…childless.  And honestly, the closest I can get to a “break” right now is to shut down my ovaries for two months.  So with all that weighing heavily on my mind, I had a meltdown Monday night.

I was tired from traveling 5 hours for work that day.  Other than that, the evening was off to a good start.  Brennen harvested his first broccoli plant, so we were having fun documenting his suburban gardening milestone.  Then, we came inside to watch DWTS (Brennen, don’t kill me).  I was reaching across the coffee table to get my computer when the weight of my right arm knocked one of the loose boards out of place and I fell through the middle of it.  It’s ok to laugh! I did too, at first.  Then I realized my arm hurt pretty bad and that Brennen was still laughing.  I was embarrassed. I can’t remember the last time I felt like that in front of him.  With tears in my eyes like a 5 year old I said, “Stop laughing at me.”  And like always, once I started crying, it was hard to stop.  Forget the embarrassing fall. I wasn’t crying about that anymore. My tears turned into those of anger. I’m tired of constantly failing.  What gives? Why us? How much longer? And with every question, I cried harder.

Afterwards, I sat on the couch and stared at the TV with that all-too-familiar heaviness.  Today, I’m better. Still down, but better. Sadness hits me suddenly like that. And like I’ve said so many times before, when it does, I recognize it but then say goodbye to it.  Unfortunately, lately it’s getting harder to say goodbye. But I’m trying…little by little.  Things are tough right now on the infertile front, especially with the holidays approaching, but we’ll make it through. If being upset at Aunt Flo’s arrival means anything, it’s that we still have hope. And today marks the first day of a new plan and a new hope.

Hey, you know what they say! When the going gets tough, the tough get menopausal!

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Hanging on a “However”

Last week I had an endometrial biopsy and, y’all, that hurt. I didn’t read up on them beforehand.  I knew I wasn’t being put under or given any pain medicine for the procedure so I didn’t expect it to be much of anything.  Then, surprise!

Based on my recent experience, an endometrial biopsy involves inserting a skinny stick-like instrument through the cervix into the uterus and jabbing around a few times to collect pieces of the endometrium (aka lining). Man, when the uterus realizes some foreign object is just hacking away in there, she retaliates. I had sharp pains that made me almost jump off the table.  I kept looking at Brennen and asking with my eyes, “Is it over yet?”  He shook his head no, and the doctor asked me if I was up for it one more time.  Then again.  Finally, it was over…or so I thought.

IMG-3428I sat up, and we began talking about what this test would tell us and then how we would proceed from there.  I didn’t catch much of Doc’s plan because, after a couple minutes, the only thing I could hear was a voice in my head saying, “Don’t throw up. Don’t throw up.” I got light headed, hot, sweaty, and finally interrupted the conversation with, “I need a trash can.”  The next thirty minutes were a bit blurry, but I know they consisted of vomiting, extreme cramping that radiated through my legs and back, and trips back and forth from my room to the bathroom, barefoot with my pants unzipped.  I hurt so bad that I didn’t even care.

Brennen went to the car to get some leggings for me to change into.  The skinny jeans I wore to the clinic that morning were not going to work for the trip home!  After he helped me change, I laid there on the bed squeezing his hand. Every 5 seconds he would ask, “Are you ok?” and then follow up with, “I’m going to ask you every 5 seconds.” He wasn’t kidding.  (Note from Brennen: I thought she was going to pass out.)

Finally, my uterus calmed down, and we could leave.  Doc gave me something for nausea since we had a 3-hour drive home, and I spent the rest of the evening lounging in bed and binge watching Gossip Girl (again).

One week and one season of Gossip Girl later, the results were in! My doctor called me at 8:30 am Wednesday morning, and of course, I missed it. In fact, I didn’t even notice the missed call until an hour or so later. I was so mad! Then, I saw where he had left a 3-minute voicemail.  My hands were shaking as I hit play. I listened and jotted down notes.  I was excited and relieved to hear that the Beta 3 integrin was present in my endometrium which means my lining is receptive to an embryo. This is a big win for us! He then went on to say my lining was “out of phase” and tested positive for BCL6.  I figured that wasn’t good. The 3-minute mark quickly approached, and the last thing I heard was, “You’re lining is receptive to an embryo, however…” And it cut off.  That was it. I was left hanging on a “however.”

I immediately called the clinic back and left a voicemail.  That “however” stayed with me all day long.  What does this mean for us? Is there a treatment? What’s next? Is this the end? Should I make sure my sister is still on board to be a surrogate? Has it come to that?  My production at work was spotty to say the least.  I couldn’t get “out of phase” and “BCL6” off my mind.  I did a little Googling but stopped myself.  With what little information I had, Googling was only going to make things worse.  Finally, Nurse Memphis called me back that afternoon with a protocol.  Sweet relief! And today, I talked to my doctor.  It’s difficult for me to put into words what the results mean, what we know now, and what we’ll do next because my brain is still processing all the information…and it’s a lot.

So in a very large nutshell…

The good news – My lining seems to be receptive to an embryo.

The not so good news – My lining was “out of phase” meaning it wasn’t where it should be in my cycle.  My biopsy was on day 21, but my lining was already beginning to break down for a period. Day 21 is right around the time an embryo is implanting, while my lining is breaking down, that’s not a good at all.

More not so good news that we sort of already knew – I tested positive for BCL6, which is a marker for endometriosis. Duh, I have endometriosis. But this test showed us that my endometrium is inflamed, and the likely culprit is, of course, the endo.

The plan to tame my uncooperative endometrium is to suppress my system with Lupron instead of birth control.  Birth control is estrogen, and estrogen feeds the endometriosis. Lupron, on the other hand, cuts off the body’s estrogen supply and puts me in an induced menopausal state. Now I’ve been on Lupron before, but it was a small dose in a subcutaneous injection. This Lupron shot will be a 30-day dose administered intramuscularly.  The first shot will be in November. The second in December. And as planned, we’ll start preparing for a frozen embryo transfer in January. This works out because it gives us the rest of the year to chill. Well, I hope I can chill considering the hot flashes that are coming my way!

So…there’s that. We have some answers thanks to this biopsy and can find some ironic comfort in knowing what we know now, even if it’s not all good news.  At least we have a plan though. Silver linings, right?  Still, I can’t help but think that we have an answer to a question that wasn’t really a question until recently.  That question – why won’t my lining thicken? Then again, maybe endometriosis has been our problem all along, and it’s starting to show its teeth even more so now with these lining problems.  Who knows! I try to stay positive and feel like we’re moving forward (more on that later), but overall, my mind just feels like…I don’t know…a bunch of scribbly lines.  I’m still processing and trying to straighten things out.  I just hope that this new protocol works because, even though I now know what the rest of that voicemail was going to say, I still feel like I’m hanging on that “however.”  That’s what this process has been for us all along.

Your cycles are normal.
You are young.
You are healthy.
Your husband doesn’t have male infertility factors.
Your hormone levels look good.
Your tubes aren’t blocked.
Your prolactin is under control now.
You respond well to ovarian stimulation.
You had an excellent retrieval.
You have multiple embryos frozen.
You did have implantation of an embryo.
You are capable of a thick lining.

However….you still aren’t a mom.

Hopefully, we can let go of that “however” in 2018.

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Post-Op Report

Last time you heard from Breanne, we were on our way to Memphis for an unexpected surgery last week.  As my mother-in-law reminds us, “Y’all can’t do anything easy.” So after work last Wednesday, the “crew” (Breanne, her mom Connie, her sister Caitlin, and me) loaded up the car and headed North.  Connie wanted to come along because her daughter was going under anesthesia. Understandable. Caitlin…well…she said she was just there for the barbecue. As we headed up I-55, Breanne pulled the surgery card and convinced us to make an impromptu trip to IKEA.  Sorry, Cait, but the barbecue would have to wait.

Let me preface this by saying that none of us had ever been to an IKEA, so when we pulled into a parking lot that reminded me of Wal-Mart on steroids, I knew I was in trouble.  The next hour and a half were a blur, but I have to admit – IKEA was pretty impressive.  And Breanne was right at home.  I have a feeling we may be taking a U-Haul with us to Memphis when we come back up for the next transfer.  After a quick stop at Central BBQ, we finally made it to the hotel.  Then, I had to turn around and go get some nail polish remover from Target.  Breanne said she didn’t need nail polish on in case the doctor needed to check her circulation by pressing on her fingernails or something.  Even though I was convinced this was something my hypochondriac wife picked up on Grey’s Anatomy, I made the late-night trip to Target trying to look as unmurdery as possible as I paced through the nail care section.

We arrived at the surgery center early Thursday morning. After prepping Breanne for surgery, Dr. Memphis called me in to see her one more time before heading to the operating room and to discuss the procedure with us.  In short, Doc was going to perform a laparoscopy to remove the two cysts seen on her right ovary at her ultrasound the week before and burn off any endometriosis tissue that had appeared since her last surgery in 2015.  Then, he would do a hysteroscopy to remove the mass in her uterus, which he figured was a blood clot or leftover products of conception.  He then took the time to discuss with us our next transfer, showing us pictures of our frozen embryos. Every visit with our doctor reminds us that we made the right call by coming to Memphis. He’s always so straight forward and open with us.  Once we finished our talk with the doctor, she gave me an awkward “we don’t kiss in public” peck on the lips, and they wheeled her off.

About an hour and a half later, we got the call that the procedure was a success! Evidently her two nasty cysts had resolved themselves, so no need to remove them.  The doctor also reported minimal endometriosis and only had to burn off a few new spots. More great news! It gets better.  The mass in her uterus was leftover products of conception, which he easily removed with no major bleeding.  Now all we had to do was wait for Breanne to pee before he would discharge her. Or so we thought.

As she made her second attempt to use the bathroom, Breanne noticed a hard knot forming under one of her incisions.  The doctor was worried she might be bleeding into her abdomen. Again, “Y’all can’t do anything easy.” They rushed her upstairs for an ultrasound.  If it was just under the skin, it would probably resolve itself, but if it was leaking into her abdomen, another surgery would be necessary. Son a b*****.

On the elevator ride up for the ultrasound, Doc commented on how pale Breanne was looking and grew concerned.  “Is she always this pale?” he asked.  Connie and I both nodded, which got an anesthesia-labored eye roll out of Breanne.  Then as the doctor pinched her unpolished fingertips, I could feel her giving me an “I told you so” face.

We finally made it to the ultrasound room. Good news – the bleeding was superficial! Whew! No additional procedures needed.  On our way back downstairs, the Memphis team wheeled Breanne through the fertility clinic’s waiting room.  As Breanne rolled through, pale and under a blanket with an IV bag hanging from the back of her wheel chair and a team of medical professionals by her side, I couldn’t help but notice the faces of the couples in the room.  I could feel them thinking, “What in the hell have we gotten ourselves into???”

After a few more minutes of monitoring and finally a successful pee, the doctor gave us permission to head back home.  There was no angry tweeting at C-Spire on this ride home (unlike the post-retrieval ride), but there was a very low tolerance for stupid, as she so lovingly put it. The nurse sent us home with a basin in case Breanne got sick.  As we pull into the neighborhood, Breanne says, “Bring the basin inside and put it by the bed for the night.” I responded, “Oh, in case you get sick?” She glanced at me with that go-to-hell look that she has perfected over the last 29 years and said, “No, Brennen, in case I wake up in the middle of the night and decide to wear it as a hat.” For better or for worse, right?

Breanne’s recovery is going well.  She’s still sore but getting better (and happier) every day.  Now, we wait for her next cycle to start in 4 to 6 weeks so we can begin preparations for FET #2.  Until then, we’ll have our Disney trip to keep us occupied along with the to-do list Breanne created on post-op day 3 titled “The Spring Purge.” Prayers…