Monday, May 20, 2013

Seeking a temporary home without a newborn baby (unless its mine)

HOME…it’s where I feel safe and comfortable…with my husband and kitties.  BUT…next year I’ll be working 1.5 hours away from my home (hence the frantic race to the finish with my RE—who is GREAT).  So…the plan had been to stay with a good friend “N” and her husband during the week and then drive back home on the weekend.  Well….N (who is 41) is now very pregnant….yeah.  (of course I’m happy for her…especially given her age but of course it’s just one more flag of failure waving in my face).  N is an amazing friend and knows about our struggles.  As of right now she assumes I’m going to move in to her home in 1.5 months.  I just don’t think I can do it.  It’s bad enough that I have to ride the sad ups and downs of infertility.  Bad enough that as of this moment I’ve left the amusement park empty handed and heavy hearted.  But now…to imagine living in a home with a newborn that isn’t even mine.  Uhhh NO!  I can’t do it.  I know that I do not have the mental and emotional capacity/stability to handle that.  I hope that N can understand.

The past six months I’ve just kept thinking “oh I’ll be pregnant by then” (pre IVF and FET fails).  It gets even better…when we first started TTC I actually thought I’d have given birth to a baby before I had to start this out of town job.  Hahahaha (manic laughter).  Really I thought that.  I don’t think that way anymore.  If the holy grail of IVF didn’t work...I sometimes worry….maybe we’re just F@*KED.  I don’t WANT to think this way…I don’t LIKE to think this way…but with NO real diagnosis and two huge strikes against us it’s hard to get too hopeful (thanks Debbie Downer).  I know a lot of it is self-defense.  My pattern is always to get exuberantly excited the first time I try something “new”.  First clomid + TI, first IUI, fresh IVF, first FET…totally excited.  But after that…I don’t get so excited by doing the same thing again and expecting a different result.  And “yes” of course…I know that part of it is a “numbers game”…but with that logic…I shouldn’t even BE is this position.

So…where am I going to live for a year?  I can’t really afford to establish a second home/apartment, even for a year.  I “could” have a 3 hour daily commute…doesn’t that sound like fun.  I have another great friend (A) who’s put an offer in on a house in the neighboring town.  She’s in a dating relationship, and therefore it’s super unlikely that there will be a newborn living at her house (never say never).  But right now don’t know what I’m going to do.  Too bad ignoring your problems don’t make them go away. :o)

Friday, May 17, 2013

MD to RN? Why not?

So when it comes to a “career shift” I should make it clear up front that I must have a J—O—B under ALL circumstances.  Even if it’s not making much…I must contribute financial support to my household…or my household will be foreclosed upon.  That’s my reality and the reality that most people live with.  Not that I’m hating on people who are wealthy but I think that in the context of a blog entry about career change this is an important point to make.  The reality and fear of a wealthy housewife starting a new business is quite a bit different than a working class person taking a dook on their current career path and starting anew (not better/worse…just VERY different). 

One option that I’m seriously considering is nursing.  I really do miss direct patient care and I think I would make a great nurse.  Obviously I already have a heads up on medical training since I survived medical school.  I could put my time in (3 twelve hour shifts) and make enough to be okay and still have the life I want.  And it seems like nursing could open other doors like into nursing management and administration (if I became so interested).  There will of course be some self inflicted pain during the transition period, including working (at least part time) will getting a RN (full time) and then 2nd or 3rd shift work in the beginning (gotta put your time in).

SO…a few weeks ago I continued my investigation into nursing as a new career direction (shift).  I have found a local university that offers an “accelerated BSN” program (if you already have a bachelor’s degree and have completed prereqs).  The program lasts 13 months starting in January.  I spoke with an assistant dean of admissions and it was an amazing breath of fresh air.  They really seemed interested in me as a candidate.  I was concerned I would be discounted as overqualified and not taken seriously.  The program is designed for second careers and would have professionals from various fields.  They said they would accept my previous course work towards the prerequisites.  I’d only need one course which I can test out of as a CLEP (College Level Examination Program).  The assistant dean of admissions said that they’d even had foreign doctors come through the program (which made me feel a little bit better).  All of this sounds great.  WOW!  I have an option!  After the meeting I felt really excited.  I’m under contract until June 2014 and so couldn’t seriously consider the program until January 2015.  It seems so far away….

I’d also have to have a JOB for those 6 months (June to Dec) and a part time gig during the nursing program.  That might be tough…but I hope not impossible.  I’m considering temp work.  I’m also looking at getting a CNA (Certified Nursing Assistant) certificate as a possible source of a job during this transition period.  The pay wouldn’t be great…BUT I’d be making some money, using some skills that would apply to nursing, and meeting other nurses.  I’m so thankful there are options for me!

Wednesday, May 15, 2013

Infertility is such a MTHFR (C677T mutation, homozygous)

Oh my gosh!  I actually have “something” diagnosed.  Not that I’m happy to have something “wrong” but more like wow…there is something that MAY be contributing to our inability to conceive.  When I texted my HB that I had a “MTHFR mutation” he thought that “MTHFR” was an abbreviated curse word—reasonable thought.  I’m a mutant! This is my basic explanation of what that heck this is.

What is MTHFR?  It’s an enzyme whose given name is methyleneTetraHydroFolate Reductase.  This enzyme is responsible for several important actions in the body including (but not limited to) converting homocysteine (bad—protein building block) to methionine (good) and it is also responsible for processing B vitamins into usable forms (including folic acid and B12).  So I have a homozygous mutation which means that I have 2 mutated copies of this gene.  Heterozygous means “different” as in you only have one mutated and one normal copy of two different mutated copies (called compound heterozygous #2 below).  My mutation is located at C677T (there are several common locations on the gene that can be mutated).  Here are the most common mutations from most severe (mine) to least severe (no treatment needed).

1. C677T & C677T (Two C Copies – C677T Homozygous)
2. C677T & A1298C (One Copy of Each The C & A – Compound Heterozygous)
3. C677T (One C Copy – C677T Heterozygous)
4. A1298C & A1298C (Two A Copies – A1298C Homozygous)
5. A1298C (One A Copy – A1298C Heterozygous)

This is a common mutation in the population and roughly 40% of people are carriers (heterozygous) of a mutated copy (my parents are AT LEAST carriers because each gave me a mutated copy).  12% are like me, homozygous for C677T.  Even fellow bloggers, such as Emily at Eat Love Procreate has been found to have this mutation. 

What does it mean?  Well in heterozygous (carriers) mutations the enzyme still works but is reduced by about 40% and in homozygous C677T mutations the enzyme activity is reduced by about 70% (so some still works).  So basically there are two main problems with having this mutation (related to the original activity of the enzyme).  1)  Homocysteine can build up and cause problems.  Examples related to TTC are mainly increased clot risk and potential toxic effects to the embryo (unknown mechanism).  High homocysteine is also linked to increased risk of cardiovascular disease and has been associated with many other things (Alzheimer’s, autism, cancer, etc).  2)  Increased risk of neural tube defects because folic acid is not processed into a usable form. 

What can I (you) do about it?  I had my fasting homocysteine levels checked (more blood work) which came back normal (many people still have normal levels despite the mutation).  If the levels had been high then I am guessing that I would have needed to be put on lovenox (to compensate for increased clot risk) during the next FET…this is my own conclusion from reading lots and lots of forums.  But…since my levels were normal I’m expecting just to continue with my usual baby aspirin (which I have done throughout ART procedures).  Also, I’ll need to start taking mega doses of B vitamins.  There are apparently many prescription forms that contain multiple B vitamins (including folic acid).  This is necessary to overcome the defective enzyme.  In reading scientific articles/blogs/forums MTHFR mutation is treated in a variety of ways depending upon your individual RE/doctor.

So there’s something!  This result came about after I pushed for additional blood work from 3 “perfect embryos” failing to implant.  From what I’ve read…this is very very unlikely to be the one and only “answer” for why we haven’t conceived in 2 years (only one chemical after last FET).  But it may be a piece of this very complex puzzle and I am very glad to know this result…especially given that there is an increased risk of neural tube defects as well as other long term implications on my own health.

Other labs that were tested and normal include:  1) Factor V Leiden, 2) Factor II 20210 mutation, 3) Protein C activity, 4) Free protein S antigen, 5) C Reactive protein, 6) Cardiolipin IgM, IgG, and IgA antibodies (IgM result was lowest value possible for low positive), 7) Beta-2-glyco IgM, IgG, and IgA, 8)  Antithrombin III, 9)  Lupus inhibitor, and of course 10) MTHFR

So in about a week and a half I’ll start taking oral estrace and wearing my patch.  Let's GO!

Monday, May 13, 2013

(much) younger brother’s pregnancy announcement (Ka’boom)

Ahhh yes…the Ka’boom heard around the world…but really just reverberating between my two ears.  It happened over Easter weekend.  It’s a little bit funny…I had somehow expected the “big announcement” over Christmas...I don’t know why.  They’d been married over a year and I had prepared myself for the impact.  But by Easter I had kind of forgotten about it…until it happened.

In slight preamble, I love my brother and sister-in-law and I’m very lucky that we have a great relationship; especially given how small our family is (the only child in our family right now is a 12 YO second cousin—seriously).  Anyway…it started with my brother saying “we have an announcement to make”.  Everything after that moved in like a slow motion sitcom.  I could feel my parents (whom we’ve told about our infertility) and HBs eyes train upon me in quiet suspense.  And then he says it “we’re pregnant”. 

They announced at 6 weeks (immediate family only)—wow.  What it must be like to announce a pregnancy (at all) but at 6 weeks—I really cannot imagine.  My brother is 6.5 years younger than me and this will be the first grandchild for my family, and those things sting a bit.  BUT…this is partly my own doing.  Family member of my SIL have been “trying” and they’re delaying telling them until later.  Because of my own need for privacy my brother and SIL do not know about our infertility…so we were rewarded with the early announcement.  But even if we had told them it would just have just delayed the inevitable.  At this point I’m kind of glad they don’t know.  I don’t want them to have to tip-toe around me. 

I think that I handled it well…congratulated and asked appropriate questions.  I didn’t break down under the concern of my parents stare (which is what they were fearful of I’m guessing).  My brother’s announcement got even worse my dear readers.  He said they’d been trying for “awhile” and that “it’s not as easy as it seems”.  Yes….by this time I wanted to melt into a puddle in the floor like the wicked witch of the west…but I didn’t.  I’m pretty sure my Mom wanted me to come clean at that moment.  “uhh yeah right”.  No need to ruin such a happy moment.  I’ll swallow my sobs thank you very much.  At a point afterwards my brother even asked if we were trying…I gave some stock excuse and changed to subject.  Of course…I am happy for them.  This is a really big deal to have a baby in our family so I’m excited.  And they’ll be no self imposed pressure to have the 1st grandchild now (well…at least not on my side…HB’s side is a totally different story).

This past weekend of Mother’s Day (over a month later) my Mom still wanted me to tell my brother and SIL about our infertility.  But…I just can’t do it.  I don’t want to taint the seemingly normal conversations we are now able to have as a family about childcare, car seats, and prenatal care.  I just want to be seen as normal and not make anyone feel awkward around me. They gave Mom a Grandmother card....her first.  Everything will be the first.  As I'm almost 7 years older than my should have been mine to give and share.  But it may never be.  Concerning baby names, my brother totally did it right, because he loves me.  He told us what names they were going to use but said that our Grandmother's name, which I love and have always planned to name my one day daughter, is still mine to use :o).

So….I’m going to be an aunt at the beginning of December…is that like a second place Mom? *Deep sigh*