Wednesday, December 30, 2009

Goal setting primer

I decided that I'm taking a different approach this year. I'm not setting resolutions. I'm defining a goal. In my work, I've done training on goal setting for managers and leaders, and I often apply these to more informal coaching sessions as well. When I talk of writing goals, I break it down into its parts, and I'll encourage you to consider what you want to achieve, how you're going to set about achieving it, why it's important, and how you're going to measure your success. Let's start with these pieces first.

What do you want to achieve? This is the goal itself: the outcome you're looking for. Often, it's helpful to include why you want to achieve the goal.

Is losing 15 pounds a goal? Not really. There's usually some reason you want to lose 15 pounds - whether it's to feel more energetic, or to lower your blood sugar or blood pressure, or even to be able to wear all your kickass skinny clothes.

What are some ways to get to that desired outcome? How will you achieve your goals? In a broad sense, or a big picture, these are your strategies. You might have one or two or five strategies under a goal.

To continue on the weight loss thread, one strategy might be to eat better and another one might be to move your body more. These are not really specific, but in broad strokes, these are the ways that you'll achieve your goal.

Specifically, what are you going to do to make those strategies happen? Here you'll come up with very specific, manageable, measurable, doable tactics. Often you'll have several tactics under each strategy. The key is to make them something to strive for (so, not too easy!) but not impossible. They should be challenging yet realistic. These tactics can change over the course of your plan; for example, for the first few weeks it might make sense to exercise at the gym twice a week for 30 minutes each, but as you progress it might be more realistic to go four times a week for 45 minutes each time. Tactics should also be things that you personally have control over. So, "get my husband to listen to me when I talk to him," is not a good tactic.

Some examples of your tactics might be: I'm going to walk 30 minutes a day during my lunch break at least 3 times a week, I'm going to eat fresh vegetables at least twice a day, or I'm going to sign up for and attend all sessions of a weekly yoga class.

Lastly, you'll want ways to measure your progress. How will you know if you've succeeded in your goal? These are your metrics. You'll probably have more than one metric.

Here's where the 15 pounds comes back in! So a metric might be to lose a specific amount of weight, to be able to run a 5K, to fit back into your skinny jeans, or to bring your blood pressure to an acceptable range.

To summarize:
Goal - outcome
Strategies - the approach (or approaches) you're going to take to achieve your goal
Tactics - specific sets of actions
Metrics - measurement of your progress and success

If you include all these pieces in your new years resolution - or goal! - it'll be more meaningful, easier to track, and hopefully in the long run will be more achievable for you.

Next up: my new year's goal, and an outline of my strategies, tactics, and metrics.

Saturday, December 26, 2009

Thanks Grandma

We had a fabulous Christmas (and another installment to come tomorrow, thanks to splitting time among the different branches of our families), but rather than bog your Reader or feed down with another Merry Christmas post, I will just share with you what my husband's Grandma wrote in our Christmas card.

And I quote (though yes, I'm changing our names here):

Merry Christmas and Happy New Year! To William, Billy, Stephanie ... AND ?????

I asked my husband if she thinks we're pregnant, or maybe just hoping.

WTF?! I can only laugh at this point.

But really, in all seriousness, I hope you're all enjoying your time, and to my fellow empty uterus infertiles, I hope the Grandmas of this world are kind to you this holiday season.


Friday, December 18, 2009

A lot to consider

I met with Dr. D today, to talk about what went wrong, next steps, and options. What went wrong? One thing: my eggs. "You just can't get around egg quality," he said. I asked what my highest FSH was ever with them, and he said 14. Terrible, right? Except that 3.5 years ago, I had an FSH of 13, and got pregnant with IUI and tamoxifen. My first IUI, by the way. He responded that an FSH needs to be considered along with a woman's age; so, an FSH of 13 in a 34-year old is a much better consideration than an FSH of 14 in a 38-year old.


I asked if there was anything else to try, anything that might lead to a better response, and he said no. They started me at a fairly high dose of meds already for this IVF, and unfortunately there's just no other combination or protocol that he thinks would lead to me producing more eggs. No tricks up their sleeves. I was sort of hoping for another shot, but honestly - truly - knowing that IVF is off the table is a good thing for me. At least I know.

Then he said what I was secretly hoping to hear. He said, "we could try more IUIs. I have no objections to that, and in fact, what if we tried an IUI with tamoxifen?" (Tamoxifen, for those of you who aren't familiar, is like Clomid, but a much smaller dose.) Then he said, "now, wait, I know you're going to say that this is like taking a step backwards..." Um, no. It's exactly the option I was going to ask him about next. I told him I'd been thinking of that, and asked him if maybe there was a benefit of fewer eggs in response, like maybe there'd be higher quality with less quantity. He replied that he has never seen any data to support that, but that his embryologist swears that the outcome she sees is better for women with high FSH on Clomid rather than injectibles.

I also asked him about my tubes. What if they're blocked? What if my endometriosis came back, but more this time? I had an HSG and a laparoscopy previously (when I got pregnant with my kiddo), but this time around I've only had an SHG. We talked at length about this, because I had a terrible experience with the HSG (I swear it hurt worse than my epidural-free labor and delivery). He said that the clinic's Physician Assistant does all the HSG's, and "she's rather good; of course I'm sure you'll feel some pain, but I would guess that it's not going to be like what you felt before." I wouldn't be surprised if it were a walk in the park compared to the one I had before; that guy was an oaf, twisting and turning me on the table, cursing my cervix, and generally acting like an ass. Dr. D even reminded me that some believe that fertility is enhanced in the few months following an HSG.

We also talked a lot about the option of donor eggs. I told him we were absolutely open to the idea, but it was the cost that was prohibitive at this point. He advised that I talk to his insurance person, because she could outline the costs more specifically - taking into consideration my awesome insurance coverage (albeit without donor coverage) - so that we can make an informed decision.

In the end, he kept repeating that there's nothing to suggest that I can't get pregnant. He told me that they've had women with an FSH over 20 who got pregnant successfully. But, he also said a few times that IVF is not going to be the way to go for me. He said something like, "It's too much to go through, too much stress on your body, your time, and your wallet for you to go through that." Apparently for women like me, IUI has about the same chance as IVF (which, yes, is very small, but still a chance), so he wouldn't recommend IVF at all any longer. I asked him at what point he'd cut me off from treatments, and he replied that we could try the HSG and then one - maybe two - IUI's, and that would be all he would recommend. He even stressed that we could be that rare couple that gets pregnant on their own. I liked his attitude - stressing to me that it's not impossible, but yet reminding me to be realistic about our chances.

Clearly, we have a lot to think about. I'm no less confused about our next steps than I was before, but I have to repeat that it's a relief that we know what roads we won't be able to go down. I plan to get through the holidays, and decide what happens after the new year.

Monday, December 14, 2009


It's amazing how one phone call can pull me right back in.

Land of IF: Population, Me.

I have been doing really well the past couple weeks. No, I haven't been perfectly content, and I have been so conflicted about our next path that it's downright confusing at times. But I have been calm. I've enjoyed the feeling of being done with treatments - if only for a time - just the feeling of not having to schedule appointments, spend a quarter hour mixing meds and jabbing myself nightly. It has felt nice. Easy. I have distinctly *not* felt infertile, at least for the past couple weeks. I thought about our next steps with a sort of detachment, thinking the whole time that whatever works out will be for the best ... no, that we'll make the best of it. I will even say that I have spent more time being happy with feeling done, and less time being sad about what we're missing.

Then today. Today I did something that's been on my "to-do" list since this day. One month ago today I learned that my IVF wasn't going to happen, because my ovaries were sleeping on the job. I knew when my cycle was converted that I'd have to sit down with my doc and talk about our options. I knew it would eventually be time to figure out what happens next.

So I called today to schedule time with the doc for what we infertiles sometimes call the "WTF appointment." As in WTF went wrong? WTF do I do now? As I said, I went into this phone call with a sort of centered calm. It is what it is, whatever will be, will be, and all that fun stuff. Within minutes of the call I was crying. (Frankly I'm lucky I held out until I hung up the phone.) I was internally cursing my body, angry and feeling broken. Guilt. Tired. Again, again, again.

The appointment is Friday.

I'm scared.

Friday, December 11, 2009

Naughty and nice


Aetna. My plan has an "infertility program" that is mandatory if you're undergoing IF treatments. This means I need to call them every month when my period starts, tell them what I'm doing that month in terms of treatments, and then they send me a letter in the mail with what tests or procedures I'm approved to do that month. So they know full well I'm dealing with infertility. Yesterday, I received a nice little flyer in the mail from them, touting the benefits of their "Beginning Right Maternity Program." They included enrollment information, so that I can make the most of their maternity benefits. Thanks a bunch Aetna, way to kick a girl when she's down.

Mother Nature. It's in the teens here. Biting, frigid, teeth-chattering cold. Not a fan.

The mall. I have to head there this weekend to do most of my christmas shopping.

The chick in my training class this week. After a cutesy announcement in the middle of the introductions that she was 4 months pregnant with her first (and she looked all of 97 pounds soaking wet), I overheard her tell someone that she had to get pregnant quickly again after this one comes, because she really wants her kids close together in age. Grrrrr.


Sleep. I had the best nap ever today. I love having a day off a week, just me and the kiddo.

My husband. He rocks, seriously.

Toddler logic. My kiddo funny of the day was centered around my son not wanting to sit on the potty. I found him peeing in the tub (not more than a minute after he got down from the potty and got into the bath). When I asked him why he didn't go in the potty, I added in something like, "don't you want to be a big boy?" He responded, in all seriousness, "I don't have to go potty to be a big boy. I'm already a big boy." I laughed and then he continued, "Anyway, my bedroom is too messy, I can't go pee in the potty." Mmmmkay, thanks for the explanation little man.

Christmas music. Scratch that - holiday music. I love the stuff. I'm so corny I even play it in other seasons. Speaking of which, where is the Adam Sandler Hanukkah song? I haven't heard it once yet. But Target was playing the Dreidel, Dreidel, Dreidel song this morning, and my son was singing along.

Being home. I'm a big, big fan of this place.

Thursday, December 10, 2009

New perspectives

I'm traveling for work this week, and I'm staying in a really trendy (sort of oddball, in my opinion) hotel. The bed is quite comfortable, but I'm prone to allergies, and the entire bed is wrapped in down: the 23 pillows (ok, so I exaggerate just a bit, but trust me there are plenty), the comforter, the featherbed. I thought I was sleeping in a goose's embrace last night, minus the honking. Then there are concrete walls (yes, inside my hotel room), a bathroom with a wall that doesn't quite go to the ceiling, and in the lobby there are chairs that look like a broken egg. Remember the chairs in Men in Black? Except in this hotel, the egg chairs hang from the ceiling.

But here's what's good about the place. This is the showerhead:

Heavenly. Like standing in a warm rainshower.

Except for the full length, full width mirror in the shower stall. Yes, a mirror in the shower. I stepped in and thought, ok, I'll just face away from that thing. At some point, of course, I had to turn around. Not terrible, I thought. Could be worse. Honestly, I look way less (terrible, gross, just plain fat) - scary - than I expected I would.

Within a few minutes, I was wishing my husband were with me. Now that would be a fun use of that shower and its mirror. Instead, I got to see that my butt cheeks turn bright red in a hot shower.

All in all, I'm looking forward to coming home tonight.

Saturday, December 5, 2009

A verbose state of speechlessness

I really am speechless. I have no idea what to think, or say, let alone what to do, so if you wish to bear with me and read my swirling thoughts, here they are.

My husband and I have not really talked about this - not since Wednesday. The closest we've come is that we'll each make tentative little statements about being a one-child family. Like this morning, our kiddo was being his normal silly adorable self, and I said, "you know, if we are only going to have one, then he's really the right one to have." He's made one or two similar comments recently as well, about positive aspects of this "choice" we're facing. It's almost like we're dipping a toe in, testing the water to see how it feels. Will we jump in?

I have truly never been so conflicted in my life. One moment (or day) I am relieved to be done with treatments - and I fantasize about my life with no more treatments - and the relief I feel is indescribable. I think about simple things, like signing up for a yoga class that's 10 weeks long, like losing the 15 extra pounds I've put on, like not having to worry about fitting doctor's appointments into my work schedule and upcoming trips. The problem with quitting treatments is of course that the net result is that I do not end up pregnant.

Then the next minute or hour I want another child so much I can taste the feeling. I have spent these moments - sometimes full days of this - daydreaming about adoption, donor eggs, even pursuing a more aggressive IVF cycle. (If there even is such an option, which I doubt.) We've talked about foster care, mostly because my sister has had a great experience - she adopted her two children from foster care, after deciding to stop pursuing IF treatments after the Clomid stage. It's worked out well for her in the end, but the road of course was full of heartbreak when a couple other children were taken from them after their respective parents decided to ... well, to parent. That's the part that stops me with fostering. And overall, the problem with all of the family-building paths that I know about, is that they're mostly expensive, and none of them have a 100% success rate.

Anyway - I can't get into all my options now - partly because I honestly don't know what they all are, and partly because it's going too far down a road that I'm not sure about right now. How do I express how I feel about pursuing a donor egg cycle when I don't even know how I feel about pursuing *any* further road to another child?

It's kind of like going to a diner. I live in NJ, and diners abound. I always take three times as long to figure out what I want to eat at a diner, not necessarily because there are more choices, but because there are more *kinds* of choices. If it's 12:00 noon, and I walk into a diner, my first choice is: breakfast or lunch. How can I compare a chicken caesar salad with french toast with strawberries? It's impossible until you decide if you want lunch or breakfast.

And wouldn't the decision be 100x more difficult if you were starving, and if the choices were the following:
1) A 100% chance of getting a shrimp caesar salad (and you have a shellfish allergy), $9.00
2) A 10% chance of getting strawberry-topped belgian waffles, and a 90% chance of getting nothing, $100
3) A 5% chance of getting a mystery plate, 95% chance of nothing, $250.

Oh and by the way, everyone else at the restaurant is ordering what they want, for the usual price, and getting what they want. Except the woman at the booth behind you, she complains nonstop that she's pregnant with a girl and she reeeaaaallly wants a boy. You're allowed to drop your iced tea on her, by the way.

Going too far down that analogy road?

Ok, now you see how conflicted I am. My main problem is that I'm comparing apples to oranges. (Or strawberry-topped belgian waffles with a chicken caesar salad.) I'm trying to decide between stopping treatments (which is a foolproof way to *not* have another child), and pursuing treatments or some other road (which is not a surefire to end up with a child, but rather just an opportunity for one. And an expensive opportunity at that.)

How does one even make that decision?

Wednesday, December 2, 2009

Game over

I'm speechless.