Thalia's fertility journey

On our way

After a ridiculously hectic few days, including a large pile of shit being dumped on me by a colleague yesterday morning which involved much weeping and wailing on my part as I desparately tried to get it done before our offices closed at 12 noon and all the admin staff left for 10 days, we are 45 minutes away from leaving for the airport. H is a little anxious, as he always is when he's got a plane to catch, and I'm quite excited although pretty tired.

We went to see Billy Elliot the musical last night, which was stupendously good, but given the day that I'd had I was just ripe for all the emotional stuff to rip my heart out and shred it into little tiny pieces. This was then exacerbated by the drama of trying to get to my seat. When I came in just as the first song was starting, having been held up at the box office by a fuckwitted manager who didn't want me to bring my shopping bag into the theatre but who equally wouldn't let me put it in the cloakroom as she said it was too full, the guy sitting at the end of our row wouldn't let me in, so I was left looking gormless, standing in the aisle while the cast's voices rose in song. Eventually, after trying the other end of the row and realising it was worse, I came back and managed to persuade him, and reached my seat, already on the verge of tears. So when Billy and his (dead) mother sang a duet about always being there for each other and how much they love each other, I became a basket case and sobbed messily but at least quietly for the rest of the act. Oh I am so ready for a holiday.

I look forward to seeing some of you on the 28th. It's a little out of our way given our itinerary, but I'm 90% sure H is up for letting me drag him the extra 2 hours of driving to see you all. In the meantime I hope you all have a great few days, and, if you haven't already, go and congratulate Nico, even if it's hard not to hate her a little. 

Degrees of hope

Thanks for all your kind thoughts on the last post. I didn't mean to sound as if I'd lost hope completely, it was about losing hope that we can conceive on our own. I haven't lost hope to the extent that we won't try this month, for example, particularly since we'll be cuddled up in our lovely Christmas hotel, but I was musing on why I didn't feel more sad and desolate this month when I found out we weren't pregnant, and came to the conclusion that I don't really believe we can get pregnant the old fashioned way, so it's no longer a sad surprise when we don't. It's sad, yes, but not a surprise.

Posting has been hard for me recently. First because I've been going like the clappers at work, second because having had all the drama of a cycle and its aftermath to talk about, it's hard to know what to talk about, I've got so much less material, particularly since I won't write about work. Except to say that I bailed on both my work Christmas parties, and I feel good about it. I just couldn't have done the "How are you?" "Great, how are you?" "Great!" thing with any honesty this year, so I just didn't. Guilt there was, but not enough to make me go.

Guilt is such a powerful force in my life, I wish I could let go of it. I'm basically only going to work today out of guilt. Originally I was planning to take this week off, but there are urgent client demands to deal with, and I feel that I should step up given that I had that week off in November for the IVF, and that everyone was very understanding of my need for time off for doctor's appointments etc., all through the year. I do have a good excuse to be off today in that I was gripped in the vice of a horrible headache yesterday, and spent the afternoon throwing up, eventually retreating home at about 4pm after having contaminated the wastebin in my office. I think it was a migraine, since I'm pretty much ok today, just feeling rather fragile and a little nauseous. I was severely tempted to call in sick today, but there's a big meeting I am probably better off being in because then I can shape the work for January, so I've struggled in and am just waiting for the meeting to start.

I was feeling quite chirpy on Sunday, and decided to indulge in a spot of baking. I ended up making five batches of cookies, all of which are lovely (so I hear, I haven't tasted most of them). I made:

• Almond and Orange biscuits (Stephanie Alexander)
• Chocolate decadence cookies (Alice Medrich)
• Cranberry and white chocolate chip oatmeal cookies (Nigella)
• Chocolate fudge drop cookies (Alice Medrich)
• Coconut macaroons dipped in dark chocolate (Nigella)

I packaged them up in some lovely boxes that I bought at Fortnum and Mason, and they've gone down very well. If only I had the use of the lovely digital camera that I've bought H for Christmas, I'd post you a picture, but for now you'll just have to cope without one. Virtual cookies go to all of you for your general loveliness and supportiveness. May you have many delicious ones over the next few weeks.

A New York interlude

I really seem to be quite obsessed with the food stuff right now. And it's all very dull so I promise, no more food posts - or rather, wacky infertility diet posts - until the New Year at the earliest.

New York was lovely. I had a wonderful time over the weekend with the fifth member of my group of university friends, the Editor, and her family. She has two daughters, both conceived using IUI, which was successful on the first try each time. Despite her relatively early pass out of infertility hell she does get it - the most of any of my 'real life' friends. She was the first person I spoke to about what H and I were going through, and it was at her encouragement that I went to the doctor for the first time. So even though I was in the middle of a happy family weekend in a not very big New York apartment, it was a fulfilling and renewing time.

The editor and I were allowed out for the evening on Saturday as her husband said he'd babysit. We went down to the meat packing district and got a table at 'Spice Market' and had a lovely meal while pouring out our hearts to each other. Because the Editor is off in New York, this is the way we have a friendship right now - we don't see each other for six months, and then we have an intense set of conversations over a 24 hour period, and then it's back to quietness, and the occasional email and phone call. I think it has actually made us closer, emotionally. I wish she was closer geographically, but then I bet we wouldn't get into the depth of conversation that we do now. It's also amazing to me that 20 years after we first met, we are still finding out new things about each other.

The weekend was also enriched by my meeting with the lovely Anna. She and I met over salads in Saks, and managed to quickly eat up an hour and a half in catching up on the bits of life that never make it to the blog. This was my first blog meeting in real life, although a long time ago when I was part of another online community I met people from there, too, so I'm not a complete novice. Anna and I spoke in particular about what it takes for people to 'get it.' Anna has been through a lot, despite the fact that she's not actually infertile, and I certainly consider her to be a member of this community through her experiences, if not through her messed up girly parts. She gets it, she understands the longing for what you can't have, and the sadness of being pregnant, and then not being pregnant, and of deep, deep frustration at biology.

Anna and I talked a lot about a friend of mine who doesn't get it. This friend is very dear to me, but I just can't seem to get her to understand what it's like on this side of the infertility divide, and I'm a bit frustrated with trying. Having talked to Anna about it, I'm thinking that maybe I just need to let her not get it. It's not up to me to enlighten all around me about what infertility is really like, and maybe everyone I know doesn't have to develop the empathy gene just because H and I are suffering right now. I want her to get it, but it's clearly for my benefit and not for hers, so maybe I need to let go a bit? It's not doing me any good getting regularly frustrated with not being able to explain it well.

The weekend didn't end well, unfortunately. I had an inkling on Sunday night, and it was confirmed on Monday evening just before I got on the plane. I am not destined to be the woman who gets pregnant on her first cycle after a failed IVF. I didn't cry. Well, actually I did cry a little, lying on the airplane seat trying to get to sleep, I felt very sorry for myself. But I didn't cry much. I think I'm close to no longer believing that we can get pregnant on our own. When do you give up hope?

Coffee while trying to conceive, and other complex issues

So the stream of comments on my coffee lament made me go and check up on the facts about drinking coffee while trying to conceive, and (at some point, please) while pregnant. The answer is, that actually a moderate amount of coffee (i.e., less than three cups a day) is probably ok. However, it's hard to feel good about this when there are studies that show an increased rate of miscarriage, when women drink more than a certain amount of coffee a day (in this case, 3 cups) for example.

As to decaffeinated coffee - well, first I don't think it tastes very good. Many of the flavour compounds are harmed during the decaffeination process. Second, some of the scare stories (and yes, I fully acknowledge they are scare stories) say that even decaf coffee still contains some compounds that impair fertility, and there is evidence that decaf is not good for your heart, so I don't think it's worth it.

Note that I'm not swearing off caffeine altogether. For its anti-oxidant properties, I do drink one cup of green tea a day, despite recent evidence that it might interfere with folic acid uptake and lead to an increased risk of babies with neural tube defects. There's only so much deprivation that I can cope with. Given that I'm taking prenatals and always eat an astonishing amount of spinach etc., I think I'm ok on folate with just one cup of green tea a day.

The other dietary restriction is due to the endo. However, while I'm avoiding wheat, I'm not avoiding sugar (can't give up chocolate) or dairy (I'm having a hard time convincing myself that yoghurt is really bad for me - and in fact many of the endo diet sites say in one breath, no dairy, and in the other, yogurt). However, the suggestion for endometriosis is to do without all three, as well as without coffee, meat and eggs. The rationale is that meat, dairy and eggs stimulate the pro-inflammatory prostaglandins that women with endometriosis already have too many of. Wheat is thought to be a problem as it may raise levels of estrogen in the body, as is soy (there go my beloved edamame).

Basically the diet and endometriosis advice falls into three categories.

• First, things that have been shown through research to increase the incidence of endometriosis (red meat) or reduce it (fresh, organic fruit and vegetables)
• Second, a set of ideas that come about due to extrapolating from alternative medicine: "sugar and meat acidify the body, fruit and vegetables alkalise it" - my doctor friend would say that nothing you eat can substantially alter blood chemistry given the strong homeostatic mechanisms that work to keep everything in balance
• Third, ideas generated by extrapolating from fragments of scientific knowledge: the fact that increased fragments of natural killer cells are found in the peritoneum of women with endometriosis has led to the suggestion that women with endo don't have a strong enough immune system to kill off the endometrial cells that 'naturally' end up there each month due to 'normal' retrograde menstruation. This article debunks that theory (although NB there are four major competing theories for how endo happens, so any debunking has to be taken with a pinch of salt. It's the retrograde menstruation/insufficient immune response theory that contributes to the 'no wheat, dairy or sugar' discussion as it's thought that by not eating these items you'll reduce your immune system response to what you eat, and therefore enable better killing of endometrial tissue.

Having just read a bunch of stuff to write this, I'm left confused, and wondering why I'm denying myself anything. Coffee is not that bad for you, and not eating wheat is based on a couple of strongly extrapolated theories with lots of holes in. I sort of knew this before, although I hadn't written it down so clearly. So why am I doing it?

As Vivien suggested in the comments to my last post, It's basically because I feel like I have to do SOMETHING. I can't leave any stone unturned, and I must do whatever it takes to get pregnant. If that means giving up coffee, yes, I'll do it! Wheat, Yes! Sign me up! Butter? Ok! Dairy? I'll cut back - no more milk for me! Chocolate? hmmm...not so much.

Clearly I'm not able to take the minimalist aesthetic as far as maybe I should. I'm sticking with the no wheat because it's stopping me from eating food that I know is bad for me. I'm sticking with the no coffee - or almost no coffee - because I can't bear the thought that that might have made all the difference, only I didn't do it. I'm not going to give up all dairy and sugar because it's too hard. I don't eat much meat anyway, so that one's not hard. I like eggs and can't see the problem, so I am continuing to eat those. It's not logical, it's not my usual way of doing things, but it gives me something to hold onto. So I'm clinging on for dear life.

New York meeting

New York coffee klatsch is on for Saturday afternoon (sorry mm and mellie, I can't do Sunday). I think that means Anna, InSpring/Avonlea, and S can make it. What I need now is a venue - can someone email me and offer a suggestion for somewhere midtown-ish? I intend to go to Saks and do a bit of suit shopping so anything around there would be great. I suggest mid-afternoon, about 4pm. MOMA? The cafe at Saks? Just to avoid the wierdos, can you email me at [email protected] and let me know if you have any venue ideas and I'll send out an email to everyone comfirming where and when sometime tomorrow, Friday.

I did have more to say but the day is running away with me. I'll be back.

A post about nothing in particular

First things first. My line: "day 5 transfer doesn't improve success rates per cycle started, although it does improve success rates per transfer," caused a lot of confusion. I'm sure I'm not writing it accurately, but let me spell out what I think Dr Candour said. What he said was that if you look at cycles started, there is no improvement in pregnancy rates if you compare those cycles with day 5 transfers to those cycles with day 3 transfers. But if you start your numbers at the day of transfer, then there is some improvement for pregnancy rates if you compare day 5 transfers to day 3 transfers. The reason being, presumably, that a lot of embryos conk out between day 3 and day 5, and so those cycles are cancelled, and hence the rates per cycle started don't look that good. Implication is that some of those embryos that didn't make it to day 5, would have survived if they'd been in the uterus. However, if embryos get to day 5 outside the uterus they're pretty robust and so, as a population rather than as individuals, are a bit more likely to implant than a population of embryos looked at on day 3. I don't want to get into drawing normal distribution curves, but for those of you who do stats, the mean of the day 5 population is to the right (where right=likely to implant and survive), but the tail of this population goes all the way over to the left, same as the day 3 population.

Still no? The answer is, if you have six or more good looking embryos on day 3, it is worth going to day 5 to see if they survive, then putting back those which do - and it is likely that you will have some left on day 5. If you have fewer than six, you're better off putting them back into the uterus on day 3, since if you wait to day 5, you might have nothing left to transfer, but some of the ones that died might have made it had they been inside you. That's the best I can do, I'm afraid.

Okay. On with the show. I'm still incredibly grumpy and am annoyed with myself for being grumpy. Feel like I should be in a better mood by now. I am in a slightly better mood, some of the time, but as noted earlier, it comes and goes. H and I went on a date last night - we went all the way to the East End to go to an Indian restaurant that Zagat's recommended, and it was just what it said on the tin. Small, cramped, very friendly, very authentic. Of course it kills me not to be able to eat the bread, but I guess the sacrifice is worth it. Is it? We then had a lovely walk though the east end and the city at night, including visiting the Lloyds building close up, which I'd never done before. We then went to an old friend's party near Chancery Lane, which was rather nice actually, even in my anti-social state. Then we went home on the tube. We commented throughout the evening on how nice it was to be out together and how we should do it more often. And I was quite happy. So I can be in a good mood, it just doesn't last that long.

I have been incredibly good about the wheat thing. I basically haven't eaten any for two months. The bits I have eaten are:

• A taste of the mixture when I made banana muffins last monday morning for H for his breakfast
• Half a slice of the banana bread I made a few weeks ago (when I made it). Although I ate none of the chocolate cake I made the same day.
• (presumably) a bit of wheat in the batter of some fried green leaves I ate at a restaurant at lunch today
• (presumably) small traces in other restaurant meals

I have also cut back on dairy, but not cut it out completely, and cut back on sugar, but only because I'm not eating cakes and biscuits. I'm still eating chocolate, but it's medicinal so that's ok.

Honestly, I don't feel at all different. And I don't feel different on the days I do eat a little wheat, or the days after. However, I'm pretty sure the endo is back as I've had a lot of cramping this month - both during my period and since. So I don't know whether I can keep this up. On the one hand, it is helping keep my weight down since I'm not snacking so much and much of what I want to eat when I'm after comfort food is out of bounds. But on the other hand I do just want a pizza sometimes. Or a roti (last night). We'll see if I can stick to it.

But the real hardship for me of the last year has been giving up coffee. It's killing me. I love coffee. I love the paraphenalia, I love the process, I love the taste, I love trying all the different beans. I do allow myself a few sips when I make H his coffee on Sunday mornings, but otherwise that's it. And I miss it. I did expect to also miss Diet Coke, but actually, it's been ok. It was my sweet substitute post-lunch when I was losing weight last year, and it's been hard to find an alternative, but I'm coping without the substance itself. But oh do I want a cup of coffee.

One time I'm planning to take a break from the wheat fast at least, is over the Christmas break. H and I have booked a holiday, and we are coming to the land which most of you frequent. My airmiles are buying us first class tickets, flying into DC on the 24th, then out of Philly on the 4th. On the 24th we'll drive to the Inn at Little Washington, and we'll spend Christmas Day there, eating their gourmet dinner in the evening. On Boxing day (or the 26th December to you Yanks) we plan on visiting Monticello. Not sure where we'll stay on the 26/27th, but we plan on staying in the Mountains, weather permitting. On the morning of the 28th we'll drive to DC so I can go to the infertiles luncheon, organised by the outstanding Flicka, that day (don't worry, we'll put H in the corner with a beer. No really, we'll send him off somewhere. Anyone got any suggestions?). Then we'll go down the coast for a couple of days, returning on the 30th or 31st to Arlington, where we'll spend a few days with friends. Then to Philly, also to see friends, and so I can show H my old haunts, from where we fly home. Not bad, huh? I was pretty excited when I booked it, but now I'm slightly nervous about the cold and the hassle of getting ready to go away...I usually love catering for people at this time of year, and it will be odd not to be doing that. Well, it's an experiment. We'll see if we want to repeat it.

Oh, and I'm going to be in NYC next weekend. For real, this time. Anyone want to have a coffee?