It's better to feel pain, than nothing at all.

The Human Palillomavirus, or HPV, is a DNA virus with approximately 120 different human-specific strains, 30 to 40 of which are transmitted through sexual contact. Most people (>85%) have one strain of HPV or another; it's very, very common. The majority of HPV strains don't cause any symptoms, however some do cause infections such as warts, papillomas, and some types of genital cancers. In particular, HPV strains 16 and 18 are linked to upwards of 70% of cervical cancers.  I have the strain that causes cervical cancer.

In 2010, after a routine PAP, they detected abnormal cells on my cervix. I went in for a follow up colposcopy, where the biopsy showed High Grade Squamous Intraepithelial Lesion (HSIL) - pre-cancerous changes in the cervix. The treatment was a cone biopsy (similar to a LEEP, but deeper). Follow up colposcopies showed that the cone biopsy had removed all the cells and my cervix was healthy, and I was back on the every year to 18 month PAP schedule.

Earlier this year in about February or March, I went in for a routine PAP. Again, the results came back abnormal. My colposcopy was scheduled for November 3rd, causing some significant emotional turmoil right when we were gearing up to move forward with our FET. We chose to focus on ourselves while we waited and had a wonderful summer, hopeful that the colposcopy would show that the abnormal cells were insignificant. This hope was bolstered when, during the colposcopy, the doctor agreed that the abnormal changes in my cervix were minimal and would only require monitoring through ongoing PAPs. Based on this, I called the fertility clinic and re-opened our file in anticipation of a February/March FET.

Unfortunately, four weeks later the colposcopy clinic called and told me that it was again HSIL and I required a LEEP. Typically, the process after a LEEP is to follow up with a six month and 12 month colposcopy before being given the all clear. Based on that, we would be looking at yet another year of delay. This sent me in to an emotional tail-spin and I was ready to ask for a hysterectomy, have the embryos destroyed or donated to science, and finally move on with a child-free life. I was done.

Today was my LEEP. A number of crappy things happened leading up to it (parking ticket, forgot to take proactive pain pills so I cramped very badly afterwards), but here is the good news: we don't have to wait a year. I explained the situation to the doctor and he stated that the concern with pregnancy following a LEEP is related to the strength and health of the cervix, nothing else. As long as the biopsy comes back with clean edges (they were able to burn off all the pre-cancerous cells), he felt that by three months post-LEEP, my cervix should be back to normal and good to hold a pregnancy (if we are so lucky).

I haven't had a full conversation with Derek about this yet, and there are other considerations, but it is good to know that we could move forward soon if that's what we decide. As well, please take this as a PSA to vaccinate your daughters AND sons against HPV - I am what can happen. I wish I could go back in time and get the vaccination. Of course the whole infertility issue compounds it all, but I wouldn't wish all these invasive and painful procedures - colposcopy, cone biopsy, LEEP - on any woman. Protect your children and yourself, if you qualify.

So to wrap this TL;DR up, we continue to be challenged. I am almost at the end of my emotional rope with all the waiting and delays. I am thankful for so many things in my life, and we continue to move forward with the understanding that these types of roadblocks shape who we are individually and as a couple - this will make us stronger. Strangely, a song that has a line that really resonates with me played on the radio while I was on my way to work this morning. The line that almost always brings me to tears (even now as I type it) is "it's better to feel pain, than nothing at all" and follows up with "the opposite of love's indifference". It's a song about love, but it's also about the importance of facing and dealing with adversity. I'm thankful I still feel hope, despair, agony and anger, even if it's painful and causes so much heartache. I'm thankful I'm not indifferent.

How I spent my summer

When I last posted, I was a couple of months in to putting TTC fully aside and really living life this summer. It had been years since I had just lived - we were either TTC or I was in grad school. So, here's what I did this summer.

I graduated from grad school with a Master of Arts in Environment and Management

We went for a few hikes in the mountains.

We got a new foster dog named Silver, an approximately five year old Siberian Husky originally from a puppy mill in California.

 I rode my bike. I raced as much as my schedule would allow.

I spent every weekend on the road.

It was therapeutic.

And then I crashed my bike at the beginning of August and broke my elbow.

And had to have surgery to repair it. Most of August is a bit of a blur.

But I did still get to spend a week with my niece (thanks mom and dad for bringing her), who is definitely going to be a Firefighter like her Uncle Derek when she grows up.

And tomorrow, September 7, will be the first day of winter for Calgary, with an estimated 5 cm expected by mid-morning (don't worry, it'll melt!). So while I did spend a good portion of my summer being true to my plans to focus on myself, now that the seasons are starting to change, I can feel the anxiety building. Less than two months from now, I will have the colposcopy and better understand how much more of a delay we are looking at before we can do our FET. And while I am still generally ok on the whole, I can't deny feeling that hope again each month, and feeling that painful emptiness in my heart on occasion. Taking it day by day is all I can do right now, being patient, biding time.

What it Means to Finally Live

It's been two months since I last posted, and though I think about updating on at least a weekly basis, I've been putting it off. Why? Because I've been really busy with work, travel and leisure, but also because it's hard to put on paper where we are right now, and what direction we will go.

A week or so after my last post, where I said my PAP came back abnormal and we'd be on hold until I could go in for a colposcopy (estimating June or July), I got a call from the clinic. While I feel comfort knowing that I live in a country with universal health care, in many areas that means wait times for procedures. When they told me my appointment was November 3rd, I couldn't reply for a moment, I was in shock. When my mind caught up, I asked if there was a cancellation list, and was told there was not. November. Cue break down.

The cycle of emotions we have gone through during this whole process wears on a person, and it wears on a couple. We have had difficult times, and we have become stronger by working through them. My perspective on life in general is different now than it was even three or four years ago. I remember a time (and I'm sure many of you reading this are in the same space) when I would put everything on hold "just in case". Just in case I got pregnant. Just in case I was about to ovulate. Just in case we couldn't have sex at the right time. There will be a point in your journey, if you make it as far as I have, where you realize you can't do that any more. So you start to live your life a little more, but it's still there, you still think of it every day, you still wonder if this month is the month. You still plan for your next fertility treatment, and you still take your high folic prenatals, your Omega-3's and your Vitamin D3. And then there will come a time when you just can't do it any more.

That call, with the realization that we were looking at a minimum of a year wait until we are good to go again (much more if I need to do a LEEP), was that moment for me, and for us. I stopped everything TTC, and decided to really, truly live. I will never forget Derek's words to me - he said "You haven't lived your life for over seven years because of this, and when you did take a partial break, you were in school. Maybe it's time you just lived your life?" It broke my heart at the same time it started to mend it. The last couple of months have been the most relaxing, carefree, REAL months I've experienced in a long, long time. I stopped all supplements, stopped tracking my cycle, and stopped scheduling sex. I started running harder, riding my bike more, and spending time doing the things I love. And it's really nice. Nice enough that if I'm totally honest, I would admit that I'm to the point now where I'm almost done. I say almost because we still have two frosties, and I don't know what to do with them. I guess we have at least 9 months to decide, but for now, I'm just going to live.

Crossroads and Roadblocks

I am struggling at a crossroads. Right around this time seven years ago, we started actively trying to get pregnant. Seven years. Sometimes when I think of how much time that actually is, I get a sick feeling in my stomach. Even more upsetting, we have never used any form of birth control. Derek and I have been together for 13 years and have never had a successful pregnancy. It's really staggering, actually, and the hope that I still hold on to month to month seems wasted when I think of our entire journey.

Getting my period, even after a month of trying, is easier. I remember a time when I could not think of never having a child without breaking in to tears and changing the subject. The deep yearning to be a mother is still there, but it's easier to bear. Time does heal, it does get better, but it will never be gone.

I (we) waver back on forth on what our path forward is on a weekly, even daily basis. Some days I feel like I will never give up, we will keep going until we have a biological child or we can not try any longer. Some days I think we should stop after the FET and pursue adoption. Some days I just want to give up, have our embryos donated or destroyed, and try to move on. I have fears that my time is coming too soon - my cycles are changing and are not as regular as they used to be. This scares me, but could also be a relief, maybe. Some days I think about overpopulation, and how the world is changing, and wonder why I would bring a child in to this? Then I realize I'm perhaps overthinking, being irrational and dramatic. Perhaps there's a bit of rationalization there.

I suppose this is a bit of a vent in the face of another roadblock. I went in for a PAP about a month ago. Two weeks later, I get a letter from Alberta Cervical Cancer Screening Program. My results are abnormal, though not severely so. Abnormal enough that I have to go for a colposcopy. Abnormal enough that we can't do our FET until this is all sorted out. The referral is sent and I should have my appointment date in the next couple of weeks, with a high probability that the appointment will be in June or July, maybe August. The results will go one of two ways - either they advise me to 'keep an eye on it' and continue PAP's every six months, but we can go ahead with the FET. Or they will send me for a LEEP or cone biopsy (I had a LEEP about four years ago - same situation). If I need a LEEP or cone biopsy, I need an all clear before moving forward. So, we'd be looking at about a year or so of more waiting.

There is no use getting upset at this point. I suppose I'm getting used to this, even philosophical. I have to remind myself that this isn't the Universe telling us something (there really isn't such a thing), that maybe the best things come to those who wait. But it's that ongoing struggle, the one I think about every day, every night as I'm falling asleep, every moment I'm alone. It's that struggle that makes me want to stop; it's the hope that keeps me going.

Guest Post: What it means when you offer to be a surrogate

First of all, no major updates for us. We were offered a cycle (you call in with AF each month, and if they have room for you to cycle, they call you) but had to turn in down because the predicted transfer date is smack dab in the middle of a work trip to the U.S. So boo, but I'm ok with it.

Fairly often, especially after a blog post, I receive emails and private messages from friends and distant acquaintances offering to be a surrogate for us. Fortunately, I am now at a place emotionally where I can see that these offers are coming from a good place and overlook the infertility faux pas these women are making. Three or four years ago, if I had received these offers (which I did on occasion), I would have cut the conversation short, said no without elaboration, stewed about it, and probably would have had a few good cries over it. Why? Two simple reasons in my case: 1) We had never, at that point, brought up that surrogacy was an option for us (it most definitely wasn't for us at that time) so it was a huge assumption on the part of the offerer, and 2) For me, it was the end of the line, the last option for a biological child, and a huge reminder of how I am a failure as a woman, which was further reinforced by those willing to 'do my job'. Through this struggle and with the passage of time (which really does heal the soul), I can deal with these offers more graciously. I can understand that they are coming from the heart, and I can offer advice to those who are interested in surrogacy though it's not in the cards for us right now. But please remember this when you offer surrogacy to the next woman you meet who is struggling with IF - she might not be ready for that offer yet.

Lucky for me, I have some wonderful women in my online community to support me, one of them being a surrogate herself. She graciously offered to address some of the key questions that come up during discussions about surrogacy, and outline the process she went through to be a surrogate (all specific to Canada, but would mostly apply to the U.S. as well). A huge thank you goes out to AG for her offer to educate, her quick response to my questions, and the level-headedness and levity of her answers.

Can you briefly describe the details of your surrogacy situation

I am the surrogate for one of my best friends since grade 9 and his husband. Obviously, being of a two-penis household presents with some difficulties when it comes to reproduction. At first they had discussed adoption, but then had decided that surrogacy was a better option for their family. They had mentioned trying to find a surrogate in Canada and some of the problems that it presented, and I made the offer. About a year and a half passed, and they had contacted me again to ensure that this was something I was seriously entertaining, and that my husband was also on board (essentially, they gave me an "out" so that if I wasn't sure I could revoke my offer, no hard feelings because they are understanding that this is a large commitment). My husband and I seriously discussed the impact it would have on our family (we have two young children), and decided that the positives outweighed the negatives. In fact, he deferred to the logic of Jay and Silent Bob and said "A woman's body is her own fucking business". You see why I love that man?

In your experience, what were the primary steps and how long is the process from the offer to be a surrogate to actual embryo transfer?

I received the "are you SURE sure?" email in spring of 2013, and from then things ran fairly quickly. The first step was for my family doctor to send a referral to the clinic that the fertility clinic IPs (Intended Parents) had chosen, as in Canada specialists require a physician's referral. We had decided that fall was ideal in regards to really beginning the process in earnest, as summer was busy for all of us, and I knew that monitoring could mean significant travel on a frequent basis to the clinic that was approximately 6 hours by car (or two flights) away.

Then I had to do several medical tests to ensure that physically and hormonally I would be an ideal candidate to be a surrogate- as pregnancy in and of itself is a risky endeavor, and there are some factors which can increase the risk to both the carrier and the child.

In September of 2013 we met with the clinic in our province, which is affiliated with the clinic in the United States that we were using for the transfer. They conducted more tests, and also did some testing on the intended genetic father. We met afterwards to discuss the results, and it was determined that we were ready to proceed.

After that the rush was to complete the legal legwork (the clinic, myself, and the IPs all had separate lawyers), finalize the details of our surrogacy contract, and also complete the mandatory physical and psychological screenings (for both me AND my partner). Our monitored cycle began in November 2013, and the transfer was in December 2013.

What is the legal process for surrogacy in your jurisdiction?

Legally speaking, in Canada the laws have not yet caught up with the technology, and unlike the United States, legally you can only reimburse your surrogate for expenses occurred as a result of the pregnancy- you cannot compensate them for the act of surrogacy. Also, there is the potential for a surrogate to attempt to parent the child afterwards, as it is assumed that the birth mother is the parent, regardless of genetics.

Our surrogacy agreement is almost 40 pages long, and covers every possible situation or outcome that one may encounter, including what type of testing both parties agree to, presence at the labour and delivery, and under what conditions both parties would be agreeable to the termination of the pregnancy. My husband and I had to agree to not have intercourse during the FET cycle, and also to sign an affidavit after the birth of the child to this effect. Our agreement went back and forth a few times over some details, and items that I never gave much thought to when I was pregnant with my own two children became things that necessitated more thought, as it wasn't just myself and my husband making the decision, there were two additional people who had their own concerns and preferences. Thankfully, we are all pretty reasonable people and came to agreement very quickly- however, if any parties have strong feelings in regards to termination, invasive testing, or even nutritional preferences there could easily be several problems that can arise.

What kind of medical and psychological tests did you have to undergo?

My husband and I both needed to get STD tested, despite being in a monogamous relationship for over 8 years. We also needed to get an assessment from a registered mental health worker (psychologist, psychiatrist, social worker, etc.) to ensure that we knew what surrogacy entailed, and that there were no red flags that could cause any issues down the line in regards to our mental health. She also wanted to ensure that our expectations were in line with surrogacy, and that we didn't have the expectation that we were going to be an additional set of parents.

In additional to passing the psychological testing, my husband and I had to give the clinic a fairly detailed medical history, including any mental health issues we may have had. Some of this information was shared with the IPs, which is fair considering they needed to make an informed decision as to whether they still wanted to undertake this process with us.

I had to do a complete physical and hormonal profile, along with a Sonohysterogram to ensure that my uterus did not present any abnormalities. On the month of the transfer, I had to travel to the clinic that was chosen once a week for the entire month, to do ultrasound and blood tests to ensure that no problems would present itself for the transfer. Each trip necessitated four flights (two there and two back), and took up almost an entire day. I was able to schedule these for Saturdays, however if this is not possible for your clinic you would need to take a day off work/find childcare. You may be lucky and be able to work with a clinic that is local to you; however depending on where you live this may not be possible.

Prior to the transfer and for several weeks afterwards, I had daily injections of progesterone, and twice-a-week injections of estrogen, to ensure that hormonally my body was prepared to sustain a pregnancy. The side effects of this medication included rapid weight gain (about 15lbs directly in the stomach area...put on pre-pregnancy), and, as my husband states, a case of the mega bitches. I offered to call him a waaaaahmbulance, but he declined.

Did/do you have any fears about the surrogacy process, and if so, what were they?

My main fears revolved around the fact that if the pregnancy was not successful, that I would feel some guilt, even though logically I am aware that in the overwhelming majority of cases there is nothing you can do to prevent miscarriage. Also, though the IPs are friends of ours, there is always the potential for butthurt, as pregnancy can be a psychologically difficult process for all involved. I am really thankful that we have really great IPs, who always put my needs first and are fairly flexible. However, it must also be very difficult for them, as they do not live in my city, and thus have even more limited control.

We did have a major scare at 6 weeks that involved significant bleeding and a trip to the Emergency Department- this drove home the notion that there are more complicated emotions involved when you are carrying someone else's child, as you have to then process your own feelings and be concerned for the feelings of the baby's parents, who are essentially helpless in this situation. As a result I was on some physical restrictions for the following few weeks, which included no housework, no exercising, and no lifting (as the ultrasound noted a fairly large SCH)- all as a precaution. This not only affected me, but of course our family. We were lucky that we had a contingency as part of our surrogacy agreement that covered housekeeping services and snow removal in situations such as this- but it still put a lot of strain on my husband as when I got home from work I usually spent the evening resting and he had to do the bulk of the parenting, as we have two young very mobile children.

I also find that my husband is (understandably) less involved with this pregnancy, as I know he doesn't want to build an emotional attachment when it isn't his child. It doesn't present a problem to me, as I have great support from our IPs and I have to respect his boundaries- however, if you more of a touchy-feely person who NEEDS more support at that level, it can be problematic.

How is it going so far? :-)

Everything is going very well- I am currently almost at the halfway point in pregnancy with a little boy, and the IPs are ecstatic and very grateful for our help in adding to their family. I have no regrets, however I must admit that if it was for anyone else we likely wouldn't have offered to be a surrogate and make the sacrifices that it entails.

It is also an exceedingly expensive process, that isn't necessarily accessible to many people. While we pay nothing out of pocket, all expenses occurred as a result (medical costs, legal fees, travel, maternity clothes- even a portion of our grocery bill) are covered by the IPs, which makes it a more expensive option that either adoption or ART on its own. Please, if you know someone who is struggling with infertility, do not offer to be a surrogate unless they have mentioned that they want to pursue this as an option. I know it likely comes out of a good place, and that you are looking to help, however it may not be an accessible option for them, or emotionally it may not be a good fit.

Pre-FET Appointment

Yesterday afternoon I snuck out of work to meet with Dr. Foong and go over the plans for our upcoming FET. She had a resident with her, which seems really common (I've had residents at two other appointments as well), and I always sort of feel bad for them. One of the last residents was male, and you could tell he was awkwardly trying to display compassion and sympathy, but was sort of uncomfortable with the whole thing. The resident yesterday was female and she didn't utter a word, just stared at me, which I could see out of the corner of my eye. AWK-ward!

So here's the DL: it'll be a totally typical FET protocol. I call in with AF and at some point in that cycle start on Suprefact nasal spray to suppress everything. I should have a bleed, and then I start taking estrogen to build my lining. After a few blood tests and ultrasounds to confirm everything looks as it should, I start the progesterone to further build up my lining. If all is good and there is a nice cushy home for the embryos, they do the transfer about five or six days after starting the progesterone.

We have two day six blasts. The fact that these two made it to blast is a good sign, however because we know I probably have egg quality issues, they may still have issues with thaw and implantation. Dr. Foong gave us an 80% to 90% thaw success rate, which is pretty good. She's recommending we transfer both (I would push for it if she didn't suggest it) and gave us a 30% chance of success.

Derek and I have discussed the option of doing Rob's Cocktail/CCRM Immune Protocol with this FET. We're still going to do a bit of research, but he's mostly on board if the risks are low. This would be something we do on our own, as the RFC does not address immune system issues with any of their programs. As well, I'm committing to at least six weeks of gluten free eating to calm everything down (which is easy because Derek is Celiac, so no gluten in the house).

It'll still be a couple of months before we're at the point of transfer, but it's coming! Hopefully by early summer we have a different future to look forward to.

Vacations, vacations, and an FET

Derek and I had an amazing Christmas and New Year in Hawai'i with my parents, and one of my sisters and BIL. I spent a relaxing three weeks there, while Derek was able to leave a week ahead of me for a full month in paradise. We brought our road bikes along so were able to spend some time riding, and I somehow continued training for my half marathon while trying to acclimate to the heat (only 30-ish Celsius, but coming from a winter wonderland makes the transition somewhat interesting and sweaty). Surprisingly (or maybe not), the excitement of running in a warm location cut almost five minutes from my 10K. Now to hold on to those gains while running on ice and snow!

I'm back to the grind, as is Derek, but only for a short while. We head to Playa Del Carmen on January 31 for a wedding (I'm in the bridal party) just before I return to run my half marathon on February 8 (brrrr - that's why they call it the Hypothermic Half!). I'm seriously considering running a full this summer, but I'm sort of scared of the commitment. Being in Kona, the Ironman Championship hub, had made both of us seriously consider training for a destination Ironman. We've both done local Olympic Triathlons, but how awesome would it be to do an Ironman in a warm destination? Warm water swim anyone?!

Of the fertility front, there are some developments. We both agreed that once I was done school (check), and after our vacations early this year (check and almost check), we would pursue our FET. We have two frozen embabies at the fertility clinic that have been shivering away for about two years . Well, I got AF about four days ago and made the call to re-open my file. I have an appointment with the RE on February 11 to review my file and figure out a game plan. This means that we *could* be looking at a February/March FET.

The Calgary Regional Fertility Clinic does not pursue treatment of immune system issues as part of their fertility treatment plans, so we're on our own (just to refresh, I'm not diagnosed with anything, just a suspicion based on my medical history). In preparation for the FET, and because Derek just recently found out he's Celiac (!!), we're both eating gluten free. I've also eliminated soy from my diet, and will be getting back on Omega 3 and Vitamin D3 this week. I'll update once we have the appointment early next month and come up with a schedule.

Fingers crossed this works - we're going to give it our all - because if not, we have some big decisions to make about our future.