Habitual aborter without current pregnancy.

Hello, my name is Ember, and according to my Reproductive Endocrinologist (RE), I have a habit of aborting my children--the knife twist in the gut to it being that I am also currently "without child." Nice to meet you, too, Doc.

This tear-inducing diagnosis was received last week at our first consultation with a fertility center that specializes in in vitro-fertilization (IVF). I guess I should be happy that I am not technically considered "infertile." I just like to kill my babies is all. That's not so bad, right?

If only for the sake of being more than just a little bit overwhelmed and confused, I've put off writing about this appointment, and--even before that--the events led us in this particular direction. I guess I have some catching up to do, and I might as well spew it all out now, while the wounds (and tears) are still fresh. You might as well grab a snack or cup of tea, folks. This is a long one...

First, remember when I told you our last cycle was unsuccessful? I also mentioned then that we would probably continue the same course for a couple more cycles...that is, until my body would require a break from the fertility drug Clomid. Well, I was wrong. Shortly after we learned of the failed cycle, I received a call from the nurse of the doctor we'd been working with saying that she would no longer be prescribing  me the fertility drug and that she wanted to refer me to a different doctor, a fertility specialist (reproductive endocrinologist) that she had worked with closely in the past.

"OK...," you say. "So what?" Well, for us, you see, this turn of events was all completely abrupt and without warning. Just two weeks before, we'd both been sitting in the examining room with her during my mid-cycle ultrasound. We laughed and joked as usual. We really liked our doctor and had formed a great relationship with her. A month before that, we'd sat in the office with her discussing how we planned to move forward after my second miscarriage in December, and she seemed touched that we wanted to stay the course with her to keep trying. We completed a whole new round of blood tests (an infertility panel) and added some additional drug regimens to our repertoire--experimental drugs that we hoped might work toward preventing future miscarriages. We were all set to try again. But then, one failed cycle and we were done. We were left reeling, wondering what had changed on her end...why she no longer wanted to work with us.

Basically, we felt dissed.

Even though Drew, I'd say, was the one who was even more attached to the doctor than I was, I have to admit that I took this news very hard. As with everything that has happened during these three years and three months of trying to conceive, I feel responsible for everything happens. I am the one who has bounced from doctor to doctor, trying to find one who can help us. I'm the one whose body is broken. I am the one who couldn't keep her children alive. I'm the one who keeps the best man ALIVE from being the best FATHER alive. It is my fault. (You might notice that I'm a teensy-weensy bit ATTACHED to this whole process.) So, anyway, as soon as we got the news, as you might imagine, I felt like I was a failure. She was willing to work with us, she said, but (in hindsight), she was only willing to work with us if we turned around and succeeded in getting pregnant again right away. But I couldn't make it work. My body failed me again. It's MY fault that my doctor "dumped" us.

After spending some time feeling that way, my feelings of failure morphed into feelings of anger. "What a DAMN MINUTE," I thought. "She promised to help us. Then, she dumps us, in essence, through her nurse, without WARNING? She doesn't even call us in to tell us she's DONE with us in PERSON?"

Ugh, conflicting emotions. And this is just the beginning of the conflicting feelings we've experienced over the past few weeks, folks. After we were dissed by my doctor, we took a few days to talk, research the fertility clinics in Grand Rapids, and decide whether or not we felt ready to set up consultations. We decided, in the end, that we needed to at least go and see what they had to say about our particular situation. If we didn't try, we'd never know, right? And I, for one, couldn't live without knowing if there was something more that could be done for us. I'm not ready to give up. Yet.

Through friends, friends-of-friends, and colleagues of our own, we had heard, on the whole, good things about the fertility clinic we'd decided to go to. Good enough, we thought. <Deep breath.> Let's do this.

On Thursday, we both took most of the afternoon off to drive the 45 minutes to Grand Rapids for our consultation. The office itself looked welcoming and comforting when we entered. An older couple and younger couple were both sitting in the waiting room when we walked in--nice to see the couples there together, and definitely a far cry from my shameful waits among protruding bellies and babies at by OB/GYN clinic. We filled out many forms, answered even more questions from the nurse, then proceeded to wait in the tiny, hot examining room for 45 minutes. The doctor finally burst in and told us to follow him as he seemingly jetted to his office down the hall. Once in his office, we exchanged a few (very few) pleasantries before he jumped into the slew of questions. Prior to the visit, I had filled out no less than five pages worth of my medical history including family history, menstrual history, cyst history/emergency room visits, prior pregnancies, prior diagnoses, prior surgeries/procedures, all of my infertility/hormone blood panels, and all of the current medications I'm on, including all dosages and length of time I've taken each. During his line of questioning, I was asked to recall the past 3+ years of my history of trying to conceive, much more specifically than I was prepared to do from memory. I kept thinking, "Dude, you're the one holding the five pages it took me hours to complete prior to the visit, YOU tell ME the answers!" My OB/GYN clinic hadn't sent over my medical records in time for the consultation, either, so I remembered as best I could, but felt a bit miffed that all that work and calling my old clinic several times to remind them seemed to have been for naught.

After the questions seemed to lessen, he said, "OK, so it seems our main task at this point is figuring out how to keep you pregnant."

Agreed.

He went on to mention that both Drew and I needed to be tested for the lupus anticoagulant (sperm antibody) as well as any chromosomal defects, either (or both) of which can contribute to my "habitual tendency to abort."  In addition, he wanted to schedule me for an endometrial biopsy to see if my endometrial lining is capable of supporting a pregnancy. I told him I was almost positive my doctor had performed this procedure along with my laparoscopy, hysterosalpingogram, and hysteroscopy last February (so, yes, we'd established my lining was A-OK), but he said that he'd like to repeat the procedure to see if "conditions have changed" at all.

After he discussed the tests we need to undergo, he delved right into "the plan" for our next cycle. He recommended Follistim, which are daily, self-injectable Follicle Stimulating Hormone (FSH) shots that he said are a "more natural," yet potentially riskier (risks = ovary hyperstimulation and higher risk of conceiving multiples) and more potent way of inducing ovulation (basically, a substitute for the fertility drug Clomid I'm so intimately familiar with). My doctor and I had discussed Follistim several times before, but had decided against it, in the long run, because of the tremendous cost difference per cycle (think: less than $100 for Clomid vs. more than $1000 for Follistim...and that's just for ONE MONTH).

At that point, he led us into yet another private waiting room, shook our hands, and said that if we have any questions, the nurses are very knowledgeable and should be able to answer them. Then, he was gone in a flash...just as quickly as he came. In the "holding cell," Drew turned to me, eyes wide. "I am NOT happy right now," he said. And I immediately knew that would be true for him. The doctor himself was rather cold, clinical, and (obviously) rushed. From seeing other specialists for different reasons, we both know that the lack of bed-side manner is a common trait in specialists, but we were taken aback by how much the consultation was...well...not really a consultation. Besides answering his direct questions, we didn't really have much of a chance to get a word in edge-wise. We hadn't necessarily given him any indication that we wanted to leave the office that day with a plan of attack, but we got one, like it or not. We felt (still do feel) completely overwhelmed by what was discussed, the price list we were given showing the costs for all of these tests/procedures/medications (which, have I mentioned?, aren't covered by insurance), and the time commitment involved in driving back and forth to Grand Rapids several times per week during a cycle (for blood tests, ultrasound monitoring, etc.)

The good part is that the clinic had some "extra" Follistim injectibles sitting around (left-overs from a cycle in which another patient conceived and no longer needed it), which means that for our first cycle on injectibles, we only have to pay a portion of the cost. And...I have a feeling this place gets results. It's what they do, after all. I have read through the success rates for IVF on the clinic's web site, and although the doctor agreed that we're not in the category that needs to consider IVF (yet, at least), it was somewhat comforting to see that they pride themselves on getting the job done. Before he walked us to our "holding cell," he did say to me, quite definitively, "We're going to get you there, young lady." I'm not sure if that's something he says to all the girls (hehe) or not, but I wanted to believe him. I wanted to believe that this rather aloof, yet uber-intelligent fertility specialist MEANT it when he said it to me. Not based on trying to inflate my hopes or optimism, but because, from looking at the data before him, he logically thinks it's possible.

This week, I will have my endometrial biopsy done on Friday, and Drew and I will complete our chromosomal tests that day as well. Next week, we plan to do the lupus anticoagulant testing. I'll try to keep you posted on test results, when this next cycle is set to begin, and any hilarity that ensues as I try to learn how to give myself a shot in the stomach every day (just kill me now!). Though we are still feeling a bit overwhelmed from being dumped by my old doctor, bombarded by the new doctor, and having a mountain (literally, you should see our kitchen counter) of information thrown at us in such a short period of time, I still want to believe that this Soup-Nazi-of-an-RE is going to get us there.

Please, God, help get us one step closer to kicking this disgusting habit of mine.

-Em