Thursday, April 26, 2007

And then I'd sit, and think some more

Several years ago, I spent a few weeks on the Perhentian Islands, in Malaysia, just sitting on a beach, contemplating my life. I was on a break from graduate school, was in Southeast Asia anyway, and was recovering from a broken heart. I think that I thought that if I sat on the beach long enough, the waves would somehow wash away my pain and confusion.

There is very little to do on the Perhentians. The name comes from the Malay for "waiting", and that seems to be the main activity there. My hotel had basically no amenities (there was a water shortage, so even bathing was a hit or miss proposition), so within a few days, I found myself chatting with other denizens of the hotel. They were a motley crew, including two absolutely adorable American college students, a soulful German seeking enlightenment, a sweet Danish couple, and two kind but odd South Africans.

The oddness of the South Africans became clear one day when I was having a swim in the warm, blue-green ocean and they came paddling up on inflatable rafts that they had clearly brought with them. Having cornered me thus, without any further ado, one of them suddenly asked "are you a believer?" I was utterly flabbergasted, and spluttered out something like "can you be more specific?" Their answer made it clear that their question related to my opinion about the literal truth of the Christian bible. Well, I'm a woman of many moods, and certainly have a lot of opinions about many things religions, but the literal truth of any text written thousands of years ago is not high on the list of things in which I hold a lot of faith. Upon discovering this fact, they seem to have adopted converting me as their mission. Under normal circumstances, I would have found this offensive, but having nothing at all better to do at the time, it resulted in many interesting conversations. During that time, I learned many things about myself, including the fact that I had been harboring an irrational fear of people with views different from my own, which had been cutting me off from wonderful sources of support and inspiration. I will forever be grateful to them for that lesson. Thanks A & M!

One day M and I were talking about something having nothing to do with religion, and he suddenly changed the subject, by saying "you know, I've been talking to you for days now, and have noticed that you have a wonderful head, but also a good heart, but that you always seem to listen to your head when making decisions. I think you need to stop thinking so much!"

I remembered this incident yesterday, when I finally got the chance to visit some of my favorite blogs, and saw that Sarah at For the Flavor has nominated me for a "Thinking Blogger" award. Well, so many bloggers are wonderful thinkers that I am beyond flattered to be singled out. I was also relieved to finally be given a logical explanation for the headache that I've had throughout much of my pregnancy. I must be thinking too much!

Anyway, the purpose of the award seems to be to encourage others to follow the trail of nominations, and therefore to "meet" some new wonderful bloggers. So, I am now tagged to nominate five more bloggers for the "thinking blogger" award. I love this idea, and have put a lot of thought into my nominees.

Before I open the envelope, I'd like to explain some of the logic (or illogic) behind my nominations. Given that I have an infertility blog, and that most of the bloggers that I visit regularly, and that visit me regularly, also have infertility blogs, I wanted to mainly nominate blogs that are relevant, yet off of the beaten path. So, I'm not going to nominate wonderful thought-provoking blogs by bloggers with enormous readerships, since that really wouldn't help to point anyone anywhere new. I'm also not just going to nominate my five favorite underappreciated IF blogs. Rather, I've decided to branch out a bit, and also nominate some blogs that deal with some of the other sides of fertility and infertility.

I have always been very interested in adoption, and continue to consider it as an option for my own family. There are some wonderful adoption blogs out there, but the following two particularly stand out in my mind for the ways in which they've helped me to think and rethink the complexity involved in building a family through adoption. I haven't listed these blogs on my blogroll, as they aren't IF blogs, but I visit them often to see what's going on.

I wish that Lorrie at Clueless in Carolina lived next door to me. She is smart, kind, thoughtful, and absolutely pee-in-your-pants hilarious, as well as being both an adoptee and the mother to two gorgeous little girls that she adopted from China. If you haven't "met" her already, go check her out. You won't regret it.

Shannon at Peter's Cross Station never fails to teach me something new whenever I visit her blog. She's the busy mom to the adorable Nat, and has her hands full with a variety of things, but she makes a point of constantly educating herself and others about adoption and all manner of other topics.

You really didn't think I wasn't going to include infertility blogs, did you?

Whenever I get a comment from Thalia at Thalia's Fertility Journey, it invariably includes something that makes me think "that Thalia is so smart!" Her blog is the same way. She's a lovely writer, and also always has something interesting to say. If you're not already one of her many fans, go pay her a visit.

I love to visit Marie-Baguette's blog. Not only does she diligently update almost every day, but you never know what you're going to get. Some days it's an update on her pregnancy, other days it's the most recent medical research on any one of a number of topics. On really fun days, it may be music recommendations, or even videos. Great stuff!

Finally, I discovered Watson via the International Infertility Film Festival and am now hooked. If you like to laugh, you'll LOVE Watson. She's thought-provoking too. Really. Check her out.

Wednesday, April 25, 2007

Graduation day

Yesterday was a big day for me. I reached 11 weeks gestation, and officially "graduated" from my RE. I had mixed feelings about this, as on the one hand, I love my RE, and on the other hand, it's nice to all of a sudden be a "normal" patient. I still don't feel normal, but maybe that'll come one day.

To mark the occasion, I had an ultrasound, which was AMAZING. I saw little arms and legs flailing, a big head, and the spine. Those little legs were kicking so fast, I couldn't believe that I can't feel it from the outside. All of a sudden, the blob has turned into an actual baby! I couln't stop grinning.

The only fly in the ointment was getting the results from some lab work that I had done two weeks ago. Apparently all is well with my urine (good thing, since I pee every 30 seconds these days), and most of my blood results were good. However, they ran my rubella titers to check my immunity, and the results were on the low end of "indeterminate", just one point above "negative". So, I'm potentially at risk for rubella, and it's now too late to get revaccinated. The RE was quick to reassure me that all will be well if only I avoid children. But how on earth am I supposed to do that? If a kid is sitting next to me on the subway, shall I pull out a gas mask? I was screened for immunity to rubella last year by my old RE, and the results were fine, so if I've lost the immunity, it's just happened in the last year. How typical.

Today, I had my first appointment with my new OB/GYN. I've transferred to a big hospital that is only about a 10-minute walk from my apartment, so it's really convenient. They also have a big international clientele, so they have a whole clinic set up for non-Korean speakers. My new doctor was really nice, and spoke perfect English. She did look like she was about 12 years old, but I'm trying to convince myself that's a good thing. If she's just finished her residency, then she should be chock full of information about the latest greatest advances in the field, right? The most amazing thing was that I got to keep all of my clothing on for the whole appointment. I didn't know that was possible! I'll have to get back into the stirrups next week for a pap smear and the nuchal fold translucency screening, but still, it was nice to meet the doctor fully clothed.

Two things came up that made the appointment a little stressful. First, she really encouraged me to have amniocentesis. I'm really struggling with that issue. On the one hand, I really do want to know if there's something wrong. On the other hand, I really don't want to risk my baby's life for some information. I guess I'll decide after the nuchal scan next week. It's hard to know what to do.

The other worrisome issue came up when I asked her about my plans to travel to Indonesia for work in June/July (have I posted about that?) She said that flying is fine in the second trimester, but that I'm at risk for cervical incompetence because I had a LEEP procedure (removal of abnormal cervical cells) about 15 years ago. So, she discourages me from having any real exertion after 16 weeks! I was planning to try to exercise regularly throughout this pregnancy, but I guess that's out. Well, at least now I have a doctor's permission to be a fat lazy slug.

And speaking of fat, I've already gained almost 3 kilos! Aargh!

Thursday, April 19, 2007

The lost ones

I had big plans for a post about how I made decisions about my infertility journey, treatments, etc. today, but now I'm too sad to even think about it. Today I found out that TWO of my close friends have had miscarriages. My heart is aching.

H has been a dear friend since college. She met her wonderful husband a bit late, and started trying to conceive at 36. Then she had a cancer scare, which forced them to stop trying for a while. They started again the next year. After six months of nothing, they saw an RE, and got the awful news that her husband's sperm had 0% normal morphology, and that their only chance of ever conceiving was IVF/ICSI. They started IVF at the same time as my first round, and were the lucky winners of the IVF lottery, scoring the daily double, boy/girl twins. Two weeks ago, the membrane of the little boy ruptured at 19 weeks. She lost him a few days later. Her little girl held on for another week, but was born two days ago, and lived for only three hours. Rest in peace, little ones.

S is my closest friend here in Korea. She had a daughter 7 years ago with her first husband, and two years later lost her husband to cancer. She remarried last year with an absolutely wonderful man, who is the best stepfather ever. I suspected that they wanted another child, but being infertile myself, would never dream of asking anyone that question. S is the only one at work that I was actually looking forward to telling about my pregnancy, and I had decided to share the news today. AFTER I told her that I wanted to speak with her privately, because I had big news, and needed her advice, but before I actually told her the news, she told me that she'd had a miscarriage while I was in the US (this was the first time I'd seen her since I got back). I felt like such an ass when I then had to tell her that my big news was that I'm pregnant (while choking back tears about her loss). I wish that I was quicker on my feet and could have thought of some OTHER big news to share, but I'm just not a good liar. She was an absolute angel about it, of course, but I'm just so sad for her. Sad for her loss, and also sad that if everything goes well with my pregnancy (please please please), it's going to be a constant reminder of her own loss. Our due dates were only about a month apart.

Tuesday, April 17, 2007

10 weeks

I have now been pregnant for one-fourth of the time that it takes to gestate a full-term baby. I'm having a hard time getting my head around that. Every day I still wait for the other shoe to drop, but so far, it seems planted firmly in the air.

I do FEEL pregnant now. I'm tired. So tired. It's amazing how tired I am. Not a bad kind of tired, just a very, well, tired kind of tired. I'm sleeping about 9 hours/night, and still having barely the energy it takes to lie on the sofa after I get home from work. I am still managing to go through the motions adequately at work, so nobody seems to suspect anything yet, but I suspect that I'm going to have to fess up soon, lest my boss begin to suspect that I've been replaced with a lethargic pod person.

I'm also a wierd combination of hungry and nauseous. The only thing that keeps the nausea at bay is eating every hour or so, so I'm constantly snacking. My belly is already growing, but I'm positive that's because of the vast quantities of food that I'm consuming, not because of fetal growth.

Being pregnant has put me into a wierd place, mentally. I'm thrilled to be here, but still can't really begin to take active steps that relate to expecting a child. I did get a few maternity things while I was in the US, but otherwise have made no concrete preparations. So, while it physically feels real, it's still hard to realize that the end product may (if I'm very very lucky) end up being an actual baby.

Really, I guess that when I look what I just wrote, it seems that I'm actually in a pretty good place. Heck, anyplace pregnant is a good place, isn't it?

A housekeeping note--I just realized that most of the blogs on my blogroll now link to pregnant infertiles or new mothers. This tells me two things:

#1) I might have to rething my policy of not creating categories. While I don't like the idea of having to decide when someone "graduates" from being infertile, it does seem to me that referring infertile readers to a list where they have a 90% chance of hitting someone pregnant without fair warning is a bit unkind.

#2) I've been a bit slack about seeking out people who are still in the trenches and need support. I'm going to try to do better about that.

Friday, April 13, 2007

Can't I just take the SAT again?

Recently, the always-thoughtful M-B asked me if I planned to have CVS. It seems like a simple question, but somehow the question has unleashed a torrent of conflicting thoughts and emotions.

The short (and easy) answer to the question of whether I'll have CVS is that I don't know yet if it's even an option. Being in a new country means that I am not certain of the standard offerings available for a woman of "advanced maternal age" (oh how that phrase makes me long for the days when being "advanced" was a good thing!) If CVS is rarely offered here, then I don't think I'll sign up to be one of the rare training cases offered at the local medical school. However, if it's standard operating procedure, and the doctors doing the procedure have a lot or experience and low rates of complication, then I'll seriously consider it.

Practical issues aside, however, I am really struggling with the deeper dilemmas involved in the decision to proceed with a "needle test". This comes as an enormous surprise to me. I had always thought that of course I'd sign up for any available test. I'm addicted to knowledge. I love to know what's going on. I remember being 30 and being annoyed at the thought that amnio was only standard for women over 35. I thought it was unfair that if I got pregnant I wouldn't be offered the level of knowledge and control that technology made available for older women. However, that was before I realized how little control I would have over every aspect of my reproductive journey.

Here's the essential dilemma for me: is it worth accepting the (relatively low) risk of actually causing a pregnancy loss to find out if the growing, apparently healthy fetus has detectable medical problems? The correct decision for any couple will depend on a number of things, including: whether knowing that there is a problem will cause them to take any actions that they wouldn't otherwise take, whether they fear loss or a sick child more, and their ability to handle uncertainty.

I have had several friends who refused all testing because they said that they'd carry the pregnancy to term regardless of what the testing revealed. I don't feel that way at all. While I respect the fact that some people's personal/religious beliefs are such that they could not deliberately terminate a pregnancy, I think that I would decide to terminate under certain conditions, especially if the child was diagnosed with a condition that would cause it chronic pain and certain early death with no hope of treatment. For me, being a parent means being able to put the child's interests ahead of my own, and I think that bringing a child into this world knowing that it would find nothing but suffering here is not a decision that I could make in good conscience. However, I also realize that if I were actually in the situation, my thoughts might be different. If there's one thing that infertility has taught me, it's that you never really know how you would feel about something, or what you would do in a situation, until you actually are IN that situation.

Personally, I believe that knowledge=power, so I very much WOULD like to know if there was something wrong with this pregnancy as quickly as possible. What I would do with this knowledge would depend on the actual diagnosis. However, after working so hard to become pregnant, and knowing that at 38, I will probably have limited opportunity for additional pregnancies, the thought of doing anything that would increase my risk of loss, even slightly, fills me with abject terror. As awful as it would be to be blindsided with a seriously ill child on what I hope will be the happiest day of my life, I think that it might be even worse to have to live with losing a child as a result of my own decision to proceed with CVS or amnio. A friend's sister had an amnio-induced miscarriage (of a fetus that the amnio found to be healthy) a few years ago, and this undoubtedly has affected my feelings about these tests. I know that they're usually safe, but I keep thinking "what if I do the test, have a miscarriage, and then never get pregnant again?"

Then there's the issue of uncertainty. Can I really go through the next seven months not knowing for sure? Won't I be a nervous wreck? I don't know. I am spectacularly impatient, but infertility has been good training for living with uncertainty, and I'm certainly better at it now than I was a few years ago. While uncertainty used to feel like a crisis, now it's more of an annoyance.

So, my plan at the moment is to talk to my doctor (I won't be released to an OB/GYN until 11 weeks), have nuchal fold translucency screening, and then make a decision armed with a bit more information.

Tuesday, April 10, 2007

News from the blob

I arrived back in Korea last night after 20.5 miserable hours on an airplane (well, 1.5 of those were actually spent in the San Francisco airport on a layover, but those were no less miserable). I had only had about 3 hours of sleep the night before that flight, and I don't think I've ever been so tired. Still, it's good to be home.

Of course being tired didn't stop me from rushing off to the RE the second her office opened this morning for a scan. When the probe went in, the first thing she said was "it's really big!" The blob is still a blob, but now it has a discernable head, rump, and tail, and is measuring on target for a 9 week embryo. I don't think I've ever seen anything more beautiful. We could see and hear the heartbeat loud and clear. You should have seen the look on my husband's face. Priceless.

Saturday, April 7, 2007

My dad

My father's surgery was on Monday. If you're new to my blog, he had been diagnosed with early stages of cancer of the esophagus, and had to get the majority of his esophagus removed. I'm happy to be able to cut to the chase and report that he handled the surgery really well, and that the pathology report shows that the cancer was caught so early that there is relatively little risk of a recurrence. We are all ecstatic.

Still, it has been a hard week. While the surgery went really well, it wasn't easy on my poor dad. He's not a spring chicken anymore, and this was a pretty major surgery. He has been very uncomfortable, unable to do much for himself, and worst of all, having trouble breathing. So, my mother and I have been by his hospital bed day and night, trying to keep him as comfortable as possible, and to call the nurse/doctor/whoever-the-hell-would-respond when necessary. I had the night shift, so I haven't done much but tend to him, or grab a few hours of precious sleep during the daytime. It has been an exhausting, but also an interesting experience. I realized a few days ago that this is the first time I've ever really been able to do anything for my dad. He's always been there for me, but he's never needed anything from me before. It felt good in a way to be able to take care of him for once. It was also interesting to see how he handled the situation. He's never been a whiner (I got that from my mother), and as usual has been fairly stoic, even though he's utterly miserable. He is also a really private person, so I've been amazed at how gracefully he's handled situations like his daughter taking him to the bathroom, or spending a whole week in a skimpy gown that doesn't quite cover him to his satisfaction. I really can't imagine being as pragmatic about such things as he has been able to be. I am now determined to be a bit less of a wimp the next time I have a paper cut and am considering phoning the paramedics.

I'm scheduled to start my long journey back to Korea later this afternoon. I can't wait to see my sweetie and to FINALLY get that scan to make sure that the blob is still alive and growing. Still, it will be hard to leave with my dad still in the hospital. I guess that's one of the down sides of living on a different continent from your parents.