Six months later...

Today would have been Peanut's due date. Yesterday was my 6-month followup to the boobie business of last fall. I'm not an overly emotional person, and in the face of Bug looking great, I can't find in it my heart to dwell on the negatives too much but I did want to remember today.

As a reminder and for those who didn't read "The Noodle" six months ago, here's a (very long) recap: in June of 2009, I did my first IVF cycle. I had an atrocious response and went into ER with a single follie. My crazy RE did not cancel me, as every other RE would have, but left it up to me to decide whether to do IVF or IUI. Because my insurance was already counting it as one of my covered cycles, I went ahead. They would up getting 3 eggs at retrieval, though the other 2 were surely immature and I got to a 3-day transfer with a single, spunky high-grade embie, 8-cell HIP. In retrospect, looking at that photo, it looks little too fragmented to me to be graded as HIP, but what do I know? Anyway, we transferred, I had some hope but not a ton and AF showed up 12 days post-transfer, despite progesterone.

NoodleGuy and I had decided to take the summer off regardless of the June IVF outcome, so when it was a BFN, we told the RE that we'd wait until September to attempt IVF#2. The summers are short and fleeting in New England and we wanted to be able to enjoy the nice weather without scheduling or syringes. We had a long weekend to the beach at Cape Cod booked for late July and a Caribbean cruise in August and were looking forward to a summer of fun. I also took the opportunity to get a mammogram immediately after the BFN, as I was overdue -- even though I'm under 40, I've had issues with lots of cysts in the past (all benign) and got one annually. I always had a hard time scheduling mammos because I was always in a "not sure if I'm pregnant" mode, so now was the time.

At the mammogram, I mentioned to the technician that I felt something in my right boob and she really tried to image it, but thanks to my extremely dense breast tissue (great for perky boobs, horrible for any sort of breast imaging), she couldn't find anything. It was policy at the hospital that if a patient felt something palpable, an ultrasound was ordered along with the mammogram, so in I went. On the u/s they saw nothing at the site I was feeling (turned out to be "hard tissue"), but happened to notice a small mass nearby. They thought it was probably benign, but gave me the option between a biopsy or watching it for 6 months. I probably would have opted to watch it for 6 months if I hadn't known that I'd be fully immersed in ART again at that point and just felt it was better to get this issue over and done with asap.

So, 10 days later I have a biopsy. For those who never had one before (I'm hoping that's most of you), it wasn't that bad. They numb the ara with lidocaine first, so you don't really feel anything, just pressure. And with these dense breasts, it was ALOT of pressure. The radiologist had to climb up on the table with me and use both arms to get the needle to the area, believe it or not. Anyway, when she reached it, it deflated somewhat, which is a good sign for a fluid-filled cyst. But she took a sample and sent it off for analysis and I was to hear from my PCP with the results in 2 weeks.

I go about my way, DH and I have some fun-time sexytime mid-month, not temping. Trying but not obsessing. In essence the rare, spontaneous fun for long-timer IFers. In late July, we head off to Cape Cod. In the back of my mind, I'm aware that AF is late (a rarity for me) but don't disrupt the vacation with running to a drugstore for an HPT, we just chill out, I drink lots of beer and pina coladas and go for mountain bike rides. And don't mention a peep to NoodleGuy. On the day we got back home, AF was 3 days late, and as soon as NG left for work, I took an HPT. And holy shit, it was positive!! A natural pregnancy! Me, who was given a 2% chance of that ever happening! It was 2 hours before my clinic opened, so I just decided to drive the 45 minutes and camp out there until they agreed to give me a beta. After some arm-wrestling with the receptionist, I got her to agree to speak to someone actually informed enough to make a decision and the on-call nurse gave me the green-light for a beta.

Later that morning, I was thinking that it had been over 2 weeks since my biopsy, so I decided to call my PCP. After several rounds of back and forth between the PCP and radiology department, who each kept claiming that the other was responsible for passing on the results, it was finally determined that my PCP would tell me. And she told me that abnormal cells had been found on the biopsy - atypical hyperplasia. She happens to be foreign-born, with a heavy accent, and explained it all very poorly and to top it off I found out that these results had been in for a week and no one called me, so you can imagine how quickly I later skedaddled to a new PCP. Anyway, within an hour of getting this call, I get the call that my beta is a spectacular 299 (at 15dpo). So feast and famine within an hour. Imagine the happiest news ever, tempered with the scariest. NoodleGirl's brain shuts down.

I waited until NoodleGuy got home to tell him both bits of news - it was really surreal. We were both thrilled about "Peanut" but very scared over the atypical cells. I made an appointment the next day with an excellent breast health center in Boston, for a week later. The doctor I met with there was incredible, explained everything really well. She said the condition I had was sometimes called "precancerous" but she liked to explain it more as "juvenile delinquents". She said it was unfair to portray to patients that this would later become more serious, when in reality, yes, those cells could grow up to be criminals, but they also could get decide to straighten up and go to college, law school and become tax attorneys. She said that her recommendation would be a surgical biopsy to remove the entire area, and some surrounding, but being pregnant, it was up to me, I could also wait. After consulting with my RE, we decided to proceed with the surgery in early October, when I would be in the 2nd trimester. I decided to relax, hope for the best and just enjoy the rest of the summer and Peanut. We went on our cruise, and then to a good friend's wedding over Labor Day weekend.

At my almost-10 weeks ultrasound (having been released from the RE after a fantastic 8-week ultrasound) on September 8th, I found out that Peanut had no heartbeat. The next day I called my breast surgeon and moved up the surgery. So, I had a D&E on 9/11 and then the breast surgery on 9/24. I figured that I was already devastated, why not get these cells out of my boob sooner rather than later, because at least I could be doing be something proactive while grieving. The one happy thing in this whole ordeal is that a week after the surgery, my breast surgeon called with the good news that they saw absolutely no abnormal cells in any of the tissue they removed. I think that call was actually the one I cried over the most out of sheer relief, even after losing Peanut, I still had this thing hanging over my head, so I was finally able to move on, for good and bad.

So, fast forward to now. Peanut's EDD was today, should he have survived (it was a boy, with undetermined chromosomal issues). I still have some tickers out there with his due date, so I've morbidly been reading the 40-week updates this week. It's sad but not nearly as much as it would have been without Bug.

Not so coincidentally, I had a follow-up breast ultrasound and appointment yesterday to check on the surgical site. After 45 minutes in ultrasound -- during which I actually fell asleep on the table when left alone for 25 minutes! -- where I was mauled by two radiologists and an u/s techs (dense boobs strike again!) -- they saw nothing of concern, just a couple of small cysts and the scar tissue from surgery. Then I headed up to the doctor's office where I met with the nurse practitioner, as my doctor is on maternity leave (of course!), who was great. She discussed that the results looked very good and my long-term care plan. My risk of developing breast cancer one day is twice the average woman, a simple formula just based on the finding of the atypical cells. Average women have a 12% chance, mine is now 24%. Thanks to that, I will continue to have yearly mammograms and yearly MRIs, spaced at six months intervals. I'm actually someone who prefers more aggressive diagnostic treatment, so this sounded like a great plan to me. I'd rather do the occasional unnecessary procedure and feel safe than not do things and possibly miss something. MRIs and mammograms both find different things, so I am very happy with the idea of getting each every year. The NP mentioned that we could do the mammogram in July (the one year mark for last one) and said you can get it done while pregnant (surprise to me) but I decided to wait until after Bug's due date and am scheduled for October. I liked that plan because it'll give me 6 months to breast feed Bug (Sept-March) and then 6 months of trying for baby #2, which is the window NG and I have discussed before closing the door on ART for good, before the next mammo. Additionally, if I were not pregnant/planning on breast-feeding/planning on TTCing another, they would put me on Tamoxifen as a preventative measure - it's an estrogen binder than has shown very good results in reducing breast cancer rates. But clearly playing with estrogen is something I would want to wait on until after any thoughts of babies are out of my head.

Anyway, phew - I did not mean for this post to be so long. I mostly wanted to acknowledge Peanut and how surreal it seems to me that, in a different world, I would have a different baby in my arms right now.