Four of us

Today my husband and son are at a Renaissance fair a few miles out of town. I told him to go ahead without me, so I could get some rest before the scheduled embryo transfer tomorrow morning.

Truth be told, I'm appreciating the silence, but I have not really stopped moving since they left the house this morning. Two loads of dishes, then fixing the kitchen sink, making sourdough pasta dough (and later, cranking it out into fresh mafaldine), making lemon zucchini bread loaves, making protein pudding cups, creating the Boy Scout troop monthly newsletter, and cleaning and organizing along the way.

My body is a lot like my brain right now: just unable to slow down. I can't believe this is about to happen! I thought the IVF process would be much longer and more drawn out, but because of the specific conditions of our infertility, it's actually been a very quick turnaround. After the egg retrieval on Tuesday, they told us that seven of the eggs were fertilized - most common scenario, we would lose half of them by day three and more still by the day of the transfer. But when they called on the third day after fertilization, we still had seven embryos dividing! My husband Daniel and I cried so joyfully when we got the news.

Interestingly enough, the date of our transfer tomorrow will be June 1 - and like I mentioned earlier, we always say "rabbit, rabbit" on the first of the month. On May 1, a couple of rabbits crossed my path on the university campus. Tomorrow, I will be pregnant. It may not last, it may not stick, it may end up being a failed cycle. But at least tomorrow, I will be pregnant. And that is such a wild, emotional thing to process.

Even though the process of IVF has felt quick, the infertility journey has been long and emotional and deeply complicated. We've wanted this for so, so long, and it's incredible to think that we are as close as we potentially are.

Tonight, I've got to do my best to try to get good sleep. We've got another long drive to San Francisco in the morning, and will be starting out even earlier just in case we hit more traffic, although this one is not as specific time restricted as the egg retrieval was. I am anticipating a lot of the happy tears, especially when my husband is holding my hand and we can see the transfer happen on the ultrasound screen.

The only thing I am sad about is that my son can't be in the room with us, because I'd love to have him holding my other hand or even just his hand on my shoulder. He's wanted this just as long as the rest of us - pretty much since he realized he wasn't the only little person on the planet, he's wanted to be a big brother. But I'm still glad to have him with us for before and after. The four of us, even if it only lasts a day.

Retrieval

It's been a while since I've written anything, but that's not for lack of activity - just significant lack of time. Things have been very busy in the last few days, with three round trips to San Francisco and another one scheduled for this Sunday. The first was to pick up my husband from the airport, and for his sperm cryopreservation the next morning so we would have a back up on the day of the retrieval if he was not able to provide a live sample that day. Then I went back for another ultrasound and blood test to see how the stim injections were progressing, and everything was looking very good. 

At that appointment, the doctor counted 18 follicles - a tremendously good sign, in our eyes, because 18 is a special number in Hebrew, because it sounds like the word for life. They scheduled the egg retrieval for the following Tuesday, and the night before the procedure, we celebrated with a special lamb stew with plums from a Hunger Games recipe, and a beautiful cake we ordered to kick off what promised to be a busy and emotional week and beyond.

The trip to San Francisco on Tuesday morning was very stressful. For the cryo appointment, there was a little bit of traffic and we got there exactly on time with not a minute to spare. So when I went back for the ultrasound and blood draw, I left an hour earlier and there wasn't a lick of traffic at all so I ended up killing time at a department store outside the city. On a good day it's about 2 1/2 hours drive, so we gave ourselves 3 1/2 hours on the day of the retrieval just in case - about an hour into the drive, the estimated time on the GPS jumped up significantly and said we would show up about 15 minutes late for the appointment.

We were supposed to arrive at 9:15 AM, for the retrieval at 10 AM - the retrieval is very specifically timed, exactly 36 hours after I had given myself the trigger shot. we did the shot at 10 PM on Sunday night, so if there were any issues on the drive there, it would be problematic. 

I called the doctor from the road and let him know that the GPS was saying we would get there closer to 9:30 or 9:40 AM, and he reassured me that it was fine, that there's a little bit of a buffer built into the schedule, and that I would still be plenty ready for a successful retrieval.

We made it to the clinic a little after 9:30 AM, and I immediately went to the bathroom with a nervous stomach, after being so anxious on the drive there. I was more anxious about the traffic than the procedure I was about to go through!

Before I headed in for the procedure, I got a hug and a kiss from my husband and my son, who stayed in the waiting room for me. My son leaned into me and said "I love you like all-fire," another special reference to the newest Hunger Games book. It's a special series for us, we've read it together a couple of times and it's something we get very engaged with together. It was exactly what I needed to hear heading into the procedure.

I don't remember the procedure itself at all, as I was under anesthesia - not a full anesthesia, and they said I might remember some things although I wouldn't feel any pain. But I just remember being awake and then being awake again and in the middle, apparently the retrieval happened! I really wasn't nervous about the procedure at all. I was even looking forward to it a little? Partly because of all the built-up pressure pressure in my lower abdomen from the growing follicles, but also just looking forward to a anesthesia/medicated nap for a few minutes after having a lot of restless moments in the last few weeks.

There was a little digital counter in the embryologist's window, and when they brought me out of the procedure room to the recovery room, I could see that the count was already at 11 eggs retrieved! So that was really relieving also. I didn't know how many we would end up with, but I was hoping for double digits so we would get as many possibilities as we could.

I was a little bit sore the rest of the day, but overall pretty fine. The hardest part was waiting for the phone call from the clinic the next day to hear about the final count on the eggs, as well as how many were mature and able to be fertilized. The nurse told us that the final count at the retrieval was, in fact, 11 eggs retrieved. Nine of the eggs were mature, and seven were fertilized! Those are very good numbers, I've been reassured, although I don't know that I will stop being nervous until there's a baby in my hands, and I know from the first time around that even that doesn't stop the worrying.

So now, we've got a couple of days until the embryo transfer on Sunday morning back in San Francisco. In the meantime, I am walking as much as I can but also taking it easy because I'm still a little bit sore. I'm staying hydrated with electrolyte drinks, no plain water they said. That's been one of the toughest parts of the recovery! I hate Gatorade. Especially after my bariatric surgery, it just tastes sickeningly sweet to me, even the sugar-free one. And I've been trying to have salty meals and snacks, which they said are good for avoiding ovarian hyperstimulation syndrome, which they predicted I would be at a moderate risk for. My weight jumped up about a pound and a half right before the retrieval, but it has stayed at the same exact weight ever since, so that's a good sign - sudden quick weight gain is a sign of OHSS, so stability is ideal right now.

Invisible progress

I've taken four sets of the stim injections so far. Each one is technically two medications, but the nurse at the fertility clinic showed me how to combine them into one shot so I only need to have one needle prick per night for now - as we get closer to the retrieval, we will add more medicines into the cocktail, but for now this is just what it is.

To be honest, I'm not sure if I can tell any difference yet. I don't know if it's because it's too early or because of my body or if it's not working, it's hard to say. I was having a conversation with my son the other day about how this happened in my pregnancy with him also. He was conceived without IVF, but even still, I spent a lot of my pregnancy struggling with body dysmorphia and trying to figure out what was happening when my body didn't quite look like any of the example images in books or online. A body that is eight weeks pregnant "should look" like this, but mine didn't, because of my body type and especially my apron belly skin after my weight loss. It took a long time for me to look pregnant, and even then I felt awkward - obsessed with wondering if I just looked large or if my condition was apparent.

The perk, I explained to my son, was that because of my awkward body shape, I got extra ultrasounds to make sure he was measuring properly, because they couldn't do it with a simple measuring tape like with someone with a regular stomach. So I got to get little glimpses at him before he was born, more than most folks get to see.

Right now, there's nothing to see. In preparation for the injections, I sought out information from folks who had gone through it before, wondering about side effects and symptoms. One person said she looked several months pregnant because of the swelling, that her ovaries were distended like baseballs.

If there's anything like that happening now, I can't see it or feel it. I mostly just feel tired, but even that is not necessarily related to the injections - there's also my usual end of semester tiredness, family stress, parenting stress, and anxiety about this process and the next few weeks of updates and information.

My friend Natalie said that IVF is "the most hardcore lesson in patience you'll have," and I get it. It's so hard to have faith and trust that everything is happening the way it should even when you can't see or feel any progress. But I'm trying.

Nutrition

I had two phone appointments yesterday. 

The first was with my therapist, who is such an amazing clinician and is so phenomenally helpful with helping me sort out some of my mental chaos. It was good to talk through some of my recent anxieties about the IVF process and just life in general, and to be reassured and supported and given strategies to help manage and calm the mental storm.

The second was with a prenatal dietitian, which was arranged through my insurance and the division that deals with infertility specifically. I was very nervous ahead of time, because I've had mixed experiences with dietitians, between my history of eating disorders and my experience of bariatric surgery. I didn't quite know what to expect from the appointment, but spent some time in advance jotting down notes on some of the things I am worried about as I prepare for not only the IVF process but hopefully a successful pregnancy.

After a lifetime of dieting, I had bariatric surgery about two years ago, and it has been remarkable and life-changing and the tool that I needed all along. My only regret about the surgery is not getting it sooner, being too proud and too scared and just generally unsure about that type of medical modification. 

But after being on one diet or another for about three decades before the surgery, it's still hard to quiet that diet-obsessed voice in the back of my head. The one that begs me to over-restrict after overindulging, or ties myself worth to specific numbers on a scale, or that obsesses over calories and portions and certain measurements.

At my baseline appointment on Wednesday, after I was given a demonstration of how to prepare my injections, I was told a few things about what to expect. It's all pretty standard: mood swings and emotional changes because of the hormonal shifts, constipation because of pressure from the enlarged and swollen ovaries, and a couple of pounds of weight gain due to fluid retention.

It's embarrassing to admit that the mention of weight gain was scarier to me than the needles I'll be injecting myself with nightly.

The main objective I had going into the dietitian appointment today was mitigating my weight concerns and trying to mentally make peace with necessary weight gain. Recognize that it's temporary. Celebrate that if I'm gaining weight, that means it's working. Consider it creating the soft, warm, healthy environment for my baby to grow. And please, please, please - don't fall into the same disordered eating habits of my first pregnancy, when I was being emotionally abused and constantly falling into a binge and restrict cycle.

The dietitian was very knowledgeable about nutrients and meal planning, but was not necessarily as aware of disordered eating and I'm going to keep looking for a dietitian who fits my needs a little better. The good news is, though, that the dietitian today had nothing but praise for all the work I have done with my weight loss and how I eat, especially in preparation for the egg retrieval and embryo transfer. I have a good understanding of how to properly fuel my body, and also what foods are best to optimize my health. 

One thing I'm especially proud of during the phone call was when she asked about calories, and I insisted on not using calorie numbers. I had explained to her that after two years of active weight loss, I've been trying for the last month and a half or so to just maintain my weight so that I have a set point to be able to see if I'm gaining due to the medications. And she asked what my calories were for maintenance, and I told her that I do not count calories at all. That my entire life, I was on some sort of diet that had me counting points or calories or measuring things obsessively, and a big reason why I opted for bariatric surgery was not wanting to count calories ever again. I wanted eating to become intuitive, and that's where I am right now. I know what my portions should look like for weight loss, and I know that for maintenance, I should make the portions a little bit bigger and/or add some healthy snacks. But I'm not going to be obsessive about any numbers, because that has historically been more damaging than positive for me. She mentioned calories a few more times, but I always went back to focusing on the nutrients. And I'm very proud of that, because I have not always been assertive about my health needs, and this was a very big one.

She said the insurance covers a few more phone calls so we scheduled a follow up in about a month and a half. I agreed, even though I'm not quite sure how necessary it is - I figured, in that time, I'll either be successfully pregnant or will have failed the first cycle, and we can reassess from there. She also suggested a couple of books for me that I ordered, and hopefully those can provide some insight as well. I just feel very confident, though, in saying that if this doesn't work, it's not because of my eating. I'm taking tremendously good care of my body and will continue to do so throughout pregnancy and beyond.

Shehecheyanu

My goal for this week has been rest. I took out my birth control ring on Sunday in preparation for my baseline appointment and starting the stimulating injections on Wednesday, and went to the office on Monday and Tuesday to finish up my grading and meet with any students who had last minute things to turn in. At the appointment on Wednesday, my period still hadn't really started, so they did an ultrasound but advised me not to start the injections until after I had a flow.

So Thursday, I took advantage of no work and no appointments and napped for almost the entire day. It was glorious and perfect and beyond necessary - i've been so stressed about a million things, it was nice to take a day and just be a complete vegetable. I napped until my noon medication alarm went off, took the meds, and went right back to sleep until the alarm to pick up my son from school. And I felt so, so good after, and didn't even have any trouble falling asleep that night which tells you, I had been pretty much running on fumes. I needed that rest so desperately.

At the ultrasound on Wednesday, the nurse pointed out my uterus looked like it was ready for my period to begin within a day if not hours, and she was right - not even 12 hours after the appointment, I felt a cramp and voilà, there it was.

I messaged them in the morning and they told me to start the shots today, Friday. I was a little nervous, even with an explanation of how to mix the medicines and demonstration of how to combine them so I'd only have to do one shot. But I was brave and got it done, focusing on the outcome and keeping in mind what we want most in the end. It helped also that my son was right next to me and my husband was on a video call, and as I did the shot, they said a special Hebrew blessing for the first time of doing something - the Shehecheyanu.

My husband will be home on Wednesday, and on Thursday he has an appointment at the embryology lab in San Francisco so we will have a frozen sperm sample as back up for the day of the egg retrieval. I'm very ready to have him home, for some more rest and someone else to handle some of the stress. But also, because it means we're at such an exciting point in this process, and as scary and nerve-racking as it is, there's no one in the world who makes me feel safer and more comfortable and more cared for.

My firstborn

My son turned 12 on Tuesday, and it's hard not to get emotional around his birthday. I'm so tremendously proud of the little person that he is, even on the days when he is difficult or frustrating. He is so bold and tenacious, but with a deeply empathetic and sensitive side as well. I always say that his two favorite things in the world are everything and everyone, and it's very true. He is such a joyful person with tremendous passion for life and curiosity about absolutely everything.

Ever since he was old enough to realize he wasn't the only little person on the planet, he has wanted a sibling. There's been a tremendous amount of guilt about not being able to give him that, first that he didn't have it at all but now also even if we are successful, that there will be such a significant age gap. I know the love will be there and it will be significant and no matter what, he's going to be just the most phenomenal incredible big brother in the world. But it's hard not to feel guilty that he didn't have someone closer to his own age to play with and to be little kids together.

That said, I've done everything I can to make sure that he thrived, no matter what. For several years, I didn't have a partner and he didn't have siblings, but we had each other and it was everything and it was enough. We went camping and hiking and explored and adventured. Part of why he's so creative and independent is perhaps because of necessity, and how he's always been good at imaginary play and making up games and situations on his own because he was often playing by himself.

It reminds me of a conversation I had with my therapist a little while ago, where she said she was proud of me for being so resilient despite all the things that I've had to face. And I told her, alright but I'd rather not be resilient. I survived these things because I had to, there hadn't been a choice. I'm not tough because I want to be, I'm tough because situations forced me to become this way. And I appreciate it being seen as a positive by others, but it's not necessarily a trait that I feel particularly proud of.

I suppose part of what I'm working on in my therapy is learning to be proud of the person I have become, even if it is the result of things I would not necessarily have chosen for myself. And perhaps that is a way to see my son's situation as well. He's independent because he had to be, but it will make him a better person in the long run. Skills and abilities he was able to develop as a long-term only child are benefits that he may not have had with siblings closer in age. Plus, I think back to my own experience being oldest sibling with two years in between my second sister and I, and two more years before the third, and the conflicts and the issues and the personality clashes that came from sharing bedrooms and going to the same schools and other complications that come up with close age gaps.

There's no use wondering what might have been if things had worked out differently or earlier or anything else. All we have is what is, and we're going to do the best we can with the situation we have. In the same breath of frustration at an age gap, at this point I would be so grateful for even the opportunity to say "there's a large gap between my children" because that would mean that this worked and that we've got another person in our family to love.

Rabbit, rabbit

The small city where we live is not tremendously built up with a significant suburban residential area, and the university campus is on the outskirts of town getting more rural. Our county is incredibly rural, with tons of agricultural businesses. So it's not uncommon to see animals on campus, particularly at various seasons. Right now, for example, there's a pair of great horned owls that return to nest every year on a window ledge of one of the academic buildings. This year there are three owlets, and there's a barrier set up to give them a safe bit of distance from the faculty, staff, and students. Lots of geese and various birds, and there used to be a tremendous number of small frogs but they have been less visible since the solar panels went over the parking lots. And occasionally, there are some small rabbits hopping around the various fields.

In New England, where I grew up, we have a bit of a peculiar superstition on the first day of the month. As soon as you wake up, before you step a single foot out of bed, you're supposed to say "rabbit, rabbit!" And that will bring you good luck. It's not exclusive to the area where I was born, but I've lived and worked in many other states around the country and everyone's always thought it was either hilarious or bizarre, and certainly unheard of.

I'm not tremendously superstitious most of the time. We've had a lot of conversations lately about superstitions, particularly Jewish ones surrounding pregnancy, and I am trying hard to do whatever I can to get all of the good vibes and well wishes of the universe on my side as we head into this complicated process. 

The morning of May 1, I was adamant about making sure I said the lucky words - it was so important that I even remembered to do it at 2 AM when my alarm went off to take one of my medications. Later that morning, when walking across campus to my first class of the day, two small rabbits hopped across the main walkway just a few feet in front of me. The first ones I've seen so far this season, and a providential sign, for sure.