Knocked Up...Knocked Down

Hysteroscopy and endometrial biopsy update: OUCH!

First of all, thank you to each and every one of you who commented on my last post; the information and support that you provided were invaluable, and I greatly appreciate it.  You are the best!

Here's the short version of the update regarding my appointment:  Dr. S, the recurrent miscarriage specialist in a Distant City, performed my hysteroscopy and endometrial biopsy on Monday as planned.  (Side note:  OUCH!)  The hysteroscopy revealed a shiny, pink, perfectly formed uterus with no scarring and WIDE OPEN ("cavernous" is the word that popped into my mind) entrances to my fallopian tubes.  (I was on the lookout in my ute for an elusive little guy with glasses and a red-and-white hat, but he was nowhere to be found in there and thus the mystery of Where's Waldo  remains unsolved.) I guess it's good news that my uterus is normal; if something had been found to be amiss, surgery probably would have been required to fix it, and surgery isn't on my top ten list of fun activities. 

In about two weeks, I should be notified of the results of the endometrial biopsy.  As I type, little bits of my uterine lining are at Yale, studiously awaiting the endometrial function test.   (Do you think I can put it on my resume that my endometrium went to Yale?)  If the results of the endometrial function test are normal, then the cause of my miscarriages will remain unexplained...and that would stink.  Therefore, I suppose that I am hoping that the results are abnormal because it would be nice to finally have some sort of answer, to be able to say "Aha!  This is what is wrong and this is how we are going to fix it."

Here's the long version of my appointment update:  After a weekend that was spent at the office on a heinous ASAP assignment that unexpectedly landed in my in-basket late Friday afternoon, on Sunday I hopped on a plane to Distant City.  My flight was uneventful and my longtime friend who lives in Distant City picked me up at the airport, then we had dinner and wine at a charming Italian restaurant in her neighborhood.  Later, she dropped me off at my hotel (I can't stay at her house because I am severely allergic to her dog), and I got snuggled into bed, watched the end of the Super Bowl, called my husband (who was at a Super Bowl party) to let him know that I was safely tucked in for the night, then prayed and read the Bible for a little while before drifting off to sleep.   

The hotel was built in the 1920's, and although the decor was charming and up-to-date, the heating system was not.  It consisted of a large radiator in my room that periodically made a loud, alarming clanking noise that repeatedly jarred me out of my restless sleep.  The night ended with the bedside clock radio unexpectedly jangling me awake at 6:30 a.m.  Apparently, the alarm had been set by the previous tenant of my room.  So, I started the day off exhausted.

My friend, who had kindly taken the day off from her busy job as a tax attorney to spend time with me and to take me to my appointment, picked me up and took me to a cafe with high tin ceilings and exposed brick walls where we had breakfast.  We prayed together about my appointment (we just prayed that the procedures would give me an answer, but I think we forgot to pray that they would be painless--Duh!), chatted, and leisurely ate a tasty meal capped off with hot beignets. 

Later we drove to the hospital where Dr. S runs her recurrent pregnancy loss clinic and arrived about an hour an a half early.  I checked in and we went to lunch at a nearby Au Bon Pain, returning to the waiting room a half hour prior to my appointment.  As instructed, at that time I took four Advil.  I also took half a Vicodin (which was left over from a surgery I had last year) just in case the procedure turned out to be particularly painful.  Immediately afterward, the door to the inner sanctum opened and a nurse called my name.  Apparently, the patient before me had canceled and they were going to do my procedures a half hour earlier than expected.

I was weighed and my blood pressure was taken, then I followed the nurse to an examining room containing a chair that looked similar to a dentist's chair except that the leg rest was very short and it had stirrups.  The ceiling above it contained a back-lit panel depicting a park-like scene with a fountain in the middle of a small pond surrounded by flowers and trees.  Sounds of soothing music interspersed with ocean waves emanated softly from a nearby CD player.  I was instructed to go into an adjoining bathroom, empty my bladder, and undress from the waist down.

By the time Dr. S, a med student, and the nurse entered the room, I was in the chair with a sheet covering my lower regions.  Dr. S introduced the med student, a pretty brunette with a kind demeanor who was learning how to do the hysteroscopy and endometrial biopsy. 

I asked Dr. S several questions, which she briskly answered.  She confirmed that a hysteroscopy can reveal things that an HSG can't.  She also said that the range of normalcy in blood progesterone levels varies greatly and that you can have "normal" blood progesterone levels and still possibly have a uterine level of progesterone that is inadequate for proper endometrial functioning (i.e., the ability to foster implantation and sustain pregnancy).  She is not concerned so much with the length of a person's luteal phase as with how the endometrium is functioning, which can be determined by subjecting the tissue obtained in the endometrial biopsy to the endometrial function test conducted by the doctor at Yale.  (Here's a link to the patient information about the endometrial function test in case you are interested in reading more about it.)

I was instructed to put my feet in the stirrups and the chair was reclined slightly.  The doctor did a manual pelvic exam then inserted a speculum and did a pap smear (because I hadn't had one in over two years).  She then sprayed something on my cervix to sterilize it.  I think the spray was also supposed to anesthetize my cervix somewhat, but I'm not sure.  At this point I think she inserted something into my cervix and filled my uterus with a saline solution to expand it for purposes of the hysteroscopy.

[After this, things turned ugly.  There might be too  much information ahead, so stop reading here if you are squeamish.  I don't want to scare someone who is going to have a hysteroscopy or endometrial biopsy, but I'm going to tell it like it was.]

Apparently my uterus didn't appreciate being bloated up with saline solution because it began cramping severely in protest.  Meanwhile, the doctor was having a difficult time inserting the hysteroscope, which seem to be about half the diameter of my pinky finger, through my cervix. 

As it turns out, my uterus is shy and didn't want anyone poking around it with a camera.  It therefore hung a "KEEP OUT!" sign on my cervix, and my cervix obligingly clamped shut like a vise.  The doctor kept murmuring "It's closed so tightly...I've rarely seen anything like it...so tight" as she struggled to insert the hysteroscope.  That was not reassuring.  This entire time, not only was I having severe cramps in my uterus, but I was feeling excruciating pain in my cervix.  I tried to concentrate on breathing deeply.  The pain was so extreme that I began to sweat, my legs started to shake, and I became very nauseated.  The med student patted my leg sympathetically. 

At some point, the doctor pulled out a looooong, huge needle that I think contained a local anesthetic, and stuck it into my cervix.  I felt the sharp pinch of the needle, but my cervix still wasn't numb afterward.  I was in a blur of horrible pain.

To give you an idea of how bad the pain was, my mother-in-law has had kidney stones and has gone through natural childbirth.  She said the kidney stones were a little more painful than the natural childbirth.  I have had kidney stones and, on a pain scale of one to ten, with ten being the worst, I would rank the kidney stone pain as a 9 or 9.5.  I would rank the hysteroscopy/endometrial biopsy at least a 7 and maybe even an 8.  For me, it was about a thousand times more painful than the HSG, which I found to be merely uncomfortable or slightly painful. 

I am not much of one to moan around or be dramatic when I am in pain, so it occurred to me later that the doctor might not have realized how much pain I actually was in because I was just trying to breathe and get through it.  I didn't make a huge fuss.  It also occurred to me that the Advil and Vicodin probably didn't have time to take effect before the procedures began.

The struggle with my cervix (and the accompanying pain) went on for at least 25 minutes, maybe more, before the doctor said, "I can't believe this.  I can't get your cervix dilated.  I don't think we can do the hysteroscopy today, but I would like to keep trying a few more times.  Is that okay, or do you want me to stop?"  I gritted my teeth and told her to keep trying.  I didn't want to fly all the way to Distant City and go through all this pain for nothing.

She finally got through my cervix, and an image of the inside of my uterus suddenly appeared on the video monitor near my head.  It was pink, shiny, and had two cavernous openings to my fallopian tubes.  Everything was normal.

Next, I think the doctor inserted some other tube into my uterus and, in addition to the other pain, I felt several sharp pinches as tissue was collected during the endometrial biopsy.  The sharp pinches only lasted a minute or two, then it was all over.  In total, I think it took close to an hour, about twice as long as normal.  The doctor mentioned that I was bleeding.

I sighed in relief as the sharp pain subsided and the cramps greatly lessened, but I felt light-headed, woozy, and exhausted.  The med student said "You're so pale...can I get you some juice or something?"  I refused, because I still was trying not to hurl and the thought of juice almost pushed me over the edge.  They told me to stay still for a few minutes and left the room. 

About ten minutes later, the nurse returned and told me that I could go into the adjoining bathroom and get dressed.  She handed me some sterile paper towels to clean myself up with in the bathroom. 

[The next paragraph is gross, sorry; I'm giving you advance notice so that you can skip it if you prefer.]

The paper pad on the chair underneath my bottom was soaked with blood, and my nether regions were covered in it.  When I stood up, I felt a gush, and there was another gush that filled the toilet with blood when I tried to go to the bathroom a few moments later.  I did my best to clean myself up and put on a maxi pad.  I got dressed and went back to the room with the chair.

The nurse handed me a closed plastic jar containing tubular samples of my endometrial tissue in a preservative solution together with some paperwork and instructed me to go to the Fed Ex counter at a Kinko's that was about a mile away (literally) in order to overnight my sample and the paperwork to the doctor at Yale who is going to perform the endometrial function test.  I had to include a hefty check with the paperwork.  Before going to Fed Ex, I had to stop at the reception desk to schedule another appointment with Dr. S.

It seemed like cruel and unusual punishment to have to run to Kinko's on an errand in my drained, woozy condition, but somehow, with my friend's sympathetic help, I managed to get it done. I decided that I wanted to go home.  NOW.  I was afraid to stay in the hotel room alone that night, because I was bleeding a lot.  (When I had my tonsils out at age 4, during the night after the surgery I hemorrhaged and almost bled to death, so that fear is always in the back of my mind.)  Plus, I was exhausted and wanted a good night's sleep, and the clanking radiator in my hotel room loomed menacingly in my mind.

I called the airline on my cell phone and changed my reservations to a flight that was leaving Distant City in about two hours.  I called my husband to let him know so that he could pick me up when I arrived. The receptionist at the doctor's clinic printed out my new boarding pass for me, and my friend took me to the airport, handling my suitcase for me until I got to the security checkpoint.  She's a peach.

Five hours after my appointment, I was walking into my husband's outstretched arms at the airport in my hometown.  He took my suitcase, tucked me in at home, and got me take-out from my favorite restaurant for dinner.  By that time, the bleeding had almost stopped and the cramps were gone (I had taken four more Advil).  I was glad to put the day and its pain behind me.  It was miserable.

If the results of the endometrial function test are normal, the cause of my miscarriages will remain unexplained, and I will have to have one more office consultation with Dr. S at which she will give me a protocol for trying again and tell me my odds for success. 

If the results of the endometrial function test are abnormal, I will be treated with progesterone and will have to have one or more subsequent endometrial biopsies.  When the biopsy indicates normal endometrial function, I will be cleared to try again for another pregnancy. 

What have I learned from all this?

1)  If I have to have another endometrial biopsy, DEMAND DRUGS TO KILL THE PAIN!

2) If I have to have another endometrial biopsy, arrange to have my husband go with me like he offered to.

3) Being a recurrent miscarrier can be pretty miserable (oh, wait, I already knew that).

(P.S.  About a day and a half after the procedures, I started a new cycle [complete with bad cramps--isn't being a woman fun?].  For what it's worth, my luteal phase in my most recent cycle was 10 days.)

Questions and more questions

Hi there.  As I mentioned before, I am scheduled to have a hysteroscopy and an endometrial biopsy on Monday, Feb. 6.  I have a few questions about the procedures and related issues and thought I should post them just in case someone who reads my blog knows the answers.  Here goes:

1)  Have you had a hysteroscopy or an endometrial biopsy?  If so, was it painful?  If it was painful, how long afterwards did you continue to feel like crap?

(I know that Kath recently had a hysteroscopy and said it was a piece of cake, but Stephanie just had an endometrial biopsy and said that it sucked.  I am feeling worried because I am flying alone to another city to have the procedures done.  A dear longtime friend who lives in that city was kind enough to offer to take the day off work so that she can take me to my appointment, which is great.  I really appreciate it because the doctor said that someone needs to be with me to take me home after the procedures.  However,  I can't stay overnight at my friend's house because I'm severely allergic to her dog, so I am staying by myself in a hotel the night following the procedures.  I have started to fret that I'm going to be miserable and in pain and all alone in an unfamilar hotel room far from home and that I am going to end up lugging my suitcase all over the airport by myself while I have bad cramps.  The more I think about it, the more I worry that my uterus is not going to take kindly to having bits of its lining ripped off.  I'm feeling a bit small and scared and am wishing that I would have arranged to have my husband travel with me instead of acting like Ms. Independent Woman.)

2)  Since I already have had an HSG, I assume that the hysteroscopy can reveal things that are not revealed by an HSG, correct?  What sorts of things?  For example, would a uterine septum show up on a hysteroscopy but not on an HSG? (I should have asked the doctor or her nurse this, but I forgot, so I'm asking the Internet instead.)

3)  Here's another question that I forgot to ask the doctor:  Does a luteal phase defect always correlate with low progesterone? In other words, can you have a fairly severe luteal phase defect that screws up your uterine lining but still have consistently good progesterone numbers from blood tests?  (It is beginning to look like I have a luteal phase defect, but almost every time my progesterone has been checked via a blood test, regardless of whether it was during a time when I was pregnant or during a time when I was not pregnant, my blood progesterone levels have been good.  The only exception was the one and only time I took ovulation induction drugs, which occurred during my injectables cycle last September; at that time my blood progesterone level was unusually low despite supplementation (I didn't get pregnant during that cycle).  I was on progesterone supplements from the very beginning of my fourth pregnancy on the "can't hurt, might help" theory, but still miscarried.  All the rest of my pregnancies were sans progesterone supplements.)

I would greatly appreciate any insight you can give me, especially with respect to question #1.  Thanks!

Testing, testing, 1, 2, 3

Well, I have been quite the neglectful blogger lately, haven't I?  I have a fairly good excuse, though.  I just finished writing a very long and tedious document at work that had me burning the midnight oil for the past couple weeks and almost destroyed my will to live.  (Just kidding about that last part...sort of.)  Anyway, the very last thing that I felt like doing when I found free time was sitting at the computer to write,* hence my recent bloggy absence.

Since I last posted, I have dutifully been using my new handy-dandy electronic fertility monitor each morning to track my cycle.  It involves taking the monitor out of my nightstand drawer as soon as my eyes pop open in the morning and shuffling, groggy and bleary eyed, to the bathroom with it clutched in my clumsy hand, where, when the monitor politely requests a peestick, I then proceed to fumble to open the foil wrapper of said peestick  so that I can sleepily pee on it (and sometimes, accidentally, on my hand) with the requisite first morning urine.  Then I put it (the stick, not my hand) in the monitor. 

(As for the groggy and bleary eyed part, have I ever mentioned that I am NOT a Morning Person, so much so that when I was younger two separate people bought me T-shirts with "I DON'T DO MORNINGS!" emblazoned on the front?   I would like to be left alone to sleep or to slowly emerge from my stupor until about 9:00 or 10:00 a.m., but alas, it is not meant to be.  I am a Night Person stuck in a Morning Person's life.)

But I digress.  Back to the fertility monitor:  once a peestick is inserted into it, it spends five minutes "reading" it, then it indicates whether my fertility that day is low, high (deduced from a rise in estrogen) or peak (deduced from the luteinizing hormone (LH) surge prior to ovulation).  The purpose of using the monitor is to accurately determine what my luteal phase is in normal cycle.  It should be 14 days, counting from ovulation to the start of my period.  My fertility mocked me with readings of low fertility until about day 12, followed by three readings of high fertility on days 13, 14, and 15, before I finally, on cycle day 16, got a peak fertility reading indicating my LH surge, which happens 24 to 36 hours before ovulation.  My cycles typically are 24 days long.  You do the math.  It looks like my luteal phase is royally screwed up.  It must be way shorter than the 14 days that it should be, which adds credence to Dr. S's theory that there may be something wrong with my uterine lining.  (Duh.  How could I not have realized this before???)

I am about to find out for sure, because I am scheduled to fly back to Dr. S's clinic and have a hysteroscopy and endometrial biopsy on February 6, one week from today.  Wish me luck.

In other news, the results from my blood tests came back, and they were all completely normal.  That's right:  ten huge vials of blood, testing for about a billion things at a cost of over $4,000 (thank God for my health insurance, which should pay for a good chunk of that), and the results were all completely normal.  I have no immunologic issues or clotting disorders.  That is good news and  I am grateful, but I am also disappointed to have not yet found a definite reason for my losses.

A bright spot is that my FSH and estradiol numbers were pretty good.  My FSH was 6.2 (under 10 is good) and my estradiol was 23 (under 75 is good).   According to the nurse, that is better than average for someone like me who is pushing 38 years old.  So, that would lead one to assume that my ovarian reserve is decent and that I am not staring down the barrel of perimenopause just yet.  Unfortunately, although it is an indicator that my eggs aren't crap, it's far from a guarantee.

So, next up:  a hysteroscopy and endometrial biopsy.  I'll keep you posted.

*However, I did feel like learning how to make sushi.  A fellow infertile girlfriend came over to my house on Friday night while our husbands went to a hockey game, and she taught me how to make my first California roll.  It was fun and now I feel quite exotic.

Second opinion update

Thank you for all of your good wishes concerning my appointment with the recurrent pregnancy loss specialist, Dr. S, last week.  I returned home over the weekend, but have been so busy with work that I haven't had time to post an update until now.  Even now, things are so hectic that I fear that this post is going to involve much more medical information and jargon than good writing, so I apologize in advance.  Hopefully the medical information will be helpful to someone else in my shoes who reads this.

My consultation with Dr. S was worthwhile, productive, informative, and encouraging.  I am so glad that I went.  She clearly is up-to-date and involved with the latest research on recurrent pregnancy loss, plus her bedside manner was friendly and reassuring.  She thinks that it is possible that my losses have been caused by an egg quality problem, but she suspects that I may have a problem with my uterine lining, and she also wanted to do more extensive tests to rule out certain immunologic problems that involve clotting issues (such as antiphospolipid syndrome).  My RE did initial, rudimentary tests to detect such clotting issues that did not reveal a problem, but Dr. S said that more sensitive tests are available and worth pursuing. 

Therefore, the day after my consultation, I went to a lab to have ten large vials of blood drawn for those purposes.  It just so happened that it was the appropriate cycle day to draw blood in order to test my FSH, so I am anxiously awaiting that result.  My FSH hasn't been tested in two years.  At that time, when I was 35, it was 4.9, which was better than average for my age, but that could have changed a lot in the meantime.

Dr. S also asked me to buy an electronic fertility monitor so that we can learn more about my natural, unmedicated cycle, which has become increasingly shorter in the past few years to the point that it now averages only about 24 days.  Nine to eleven days after the monitor detects an LH surge, which occurs prior to ovulation, I need to see Dr. S again in order for her to perform an endometrial biopsy, the results of which will be sent to a researcher at Yale who recently has discovered that certain biochemical markers are present in the uterine lining of women who have early recurrent miscarriages.  If those biochemical markers are present in my biopsy specimen, then I will need to be treated with progesterone supplements to the extent that a subsequent biopsy indicates that the biochemical markers are gone, at which time I would be cleared to try again for another pregnancy. 

At the time of the endometrial biopsy, Dr. S also wants to do a hysteroscopy, which involves looking around my uterus using a little camera in order to determine whether any scar tissue from my D & Cs or other potential problems are present.  After we have all the test results, she said that she then will be able to tell me more accurately what my odds of success in a subsequent pregnancy would be.

Dr. S reviewed my five miscarriages with me and pointed out that four of them are considered to be very early losses occurring prior to 6 weeks (as calculated using the last menstrual period, rather than 6 weeks gestation).  Although one of those four was a blighted ovum that turned into a missed miscarriage ending with a D & C at 8 weeks, the fact that no embryo developed to the 6-week stage still qualifies that loss as a very early loss.  Dr. S pointed out that research has shown such very early losses to be caused by a random chromosomal abnormality about 70% of the time.  Dr. S is a big proponent of doing chromosomal testing on tissue from a miscarried pregnancy whenever possible and often provides her patients with supplies and instructions on how to properly collect a tissue sample, but unfortunately it usually is not possible to obtain an adequate testing sample from a very early loss.

One thing that I found interesting when talking with Dr. S is that she is opposed to the use of ovulation induction drugs to treat recurrent miscarriers like me who ovulate on their own and don't have trouble becoming pregnant.  She said that my RE's theory--that if I potentially have an egg quality problem then it would be beneficial to increase my odds of hitting a good egg by using Gonal-F to cause me to ovulate multiple eggs per cycle instead of just one--seems reasonable, but the most recent research has proven that theory to be wrong.  Basically, they are finding that nature really is the best at choosing the egg in any given cycle that is most likely to be able to result in a successful pregnancy.  (Plus, the drugs can negatively affect progesterone levels, which is what happened to me during the injectables cycle that I did last fall.)  According to Dr. S, when ovulation induction drugs are used, resulting embryos actually seem to have an increased risk of being miscarried.  Therefore, ovulation induction drugs, although beneficial to women who otherwise wouldn't be able to ovulate or become pregnant, can actually increase the miscarriage rate for recurrent miscarriers who can ovulate and become pregnant without medical intervention. 

Furthermore, Dr. S said that my odds of achieving a successful pregnancy from a cycle of IVF with PGD are low.  PGD appears to result in a lower pregnancy rate than IVF without PGD.  Most importantly, a recent study showed that IVF with PGD actually was not proven to be beneficial in lowering the miscarriage rate of miscarriers like me who have suffered recurrent unexplained losses. 

So, Dr. S advised that I not do another injectables cycle and that I take the option of IVF with PGD off the table, because their risks do not outweigh their benefits in my situation.  They haven't been proven to be an effective treatment for unexplained recurrent miscarriages.  I must say that hearing her advice made me breathe a sigh of relief because I did not want to do another injectables cycle after experiencing the mood swings, bloating, and failure of my first injectables cycle.  Likewise, for a number of reasons, not the least of which is the fact that it is expensive and my insurance wouldn't pay for any of it, I really didn't want to do IVF with PGD.  And now a specialist has told me to not even consider it, so hooray.

I told Dr. S that we were getting very near to the end of the road of trying for a biological child and that we are in the process of filling out the initial application for a domestic adoption.  She said that's great, and that we should go ahead with that if that's what we want to do, but that if we wanted to keep trying for a biological child during the lengthy adoption process, she thinks that I still have a good chance of carrying a baby to term at this point, even if the cause of my miscarriages remains unexplained.  At the end of the appointment, she looked at me, smiled, and said, "The bottom line is that if you still want a biological child and you can stand it emotionally to keep trying, don't give up.  Not yet."

At which point a little hope crept back into my heart.

(Later that evening we met a friend--whom I met through my blog and who had recommended Dr. S to me--and her husband out for dinner at a fabulous restaurant.  Although it was the first time we had met in person, the conversation (and margaritas) flowed and we had a fun time over a delicious meal.  She is just as warm and charming in person as she is in her writing.  It was the perfect end to a good day.)

Seeking a second opinion

A while back I think I mentioned that I was planning to take a trip to another city to see a doctor who specializes in recurrent pregnancy loss in order to get a second opinion regarding what might be causing my miscarriages.  Well, my appointment is on Thursday.  Even if the doctor is unable to uncover anything new and the reason for my losses remains unexplained, it will feel good to know that I didn't leave any stone unturned in seeking an answer. 

As an added bonus on my trip, I am going to meet in person for the first time a kind and supportive friend whom I met through my blog .  She recommended the specialist to me, and we are going to get together for dinner after my appointment, so I'm looking forward to that.

I must keep this post short, but when I return from my trip I will give you an update.

Holiday recap and New Year wishes

Hi!  Remember me?  Sheesh, it has been a long time since I have posted.  Actually, I wrote two extensive posts, one right before Christmas and one right after New Years, that never saw the light of day because my Internet connection crashed just as I was finishing them.  That's always fun and not frustrating at all (and yes, that's a note of sarcasm that you are detecting).

I hope that you all had happy holidays.  My holiday season started out sadly, with a miscarriage--my fifth--at Thanksgiving, and at that time I wanted to crawl in a hole and hide until January 2, thus avoiding all the holiday social obligations and forced merriment.  But as the days went by, I started thinking about all that the miscarriages have robbed from me:  not only children to love and raise, but also joy and good memories that are not related to children.  When I look back over my mid-30s, they are mostly a blur of recurrent miscarriage grief and stress.  Other than some vacations, I have very few good memories from my miscarriage years. 

I have retreated within myself and in large part have abandoned inviting groups of friends and family to our home, which was something I used to love to do.  The cooking and preparations for hosting a get-together, which I used to enjoy so much, and putting on a happy hostess face just seemed like too much trouble.  So our house, which often used to ring with merriment and good times, has been unusually quiet.  It has become a sad house.

During the past two Christmases, we couldn't even bring ourselves to follow our annual tradition of trekking to a nearby Christmas tree lot to choose a real tree from among the frosty rows of leaning evergreens under the perimeter of glowing holiday bulbs.  We were too sad that we would have no baby to gaze at it in wonder.  Instead we put up a small, pre-lighted, artificial, table-top tree, a symbol of our surrender to grief.

The general lack of happiness and good memories over the past few years is truly sad, because there are no "do overs" in life.  I will never get to live my mid-30s again.  The more I reflected on this, the more indignant I became and the more determined I became to do my best to enjoy the 2005 holiday season and to make some happy memories.

Thus, I dived into the holidays and did the whole shebang:  I wrote and sent Christmas cards, baked and decorated cut-out cookies, shopped for and wrapped gifts.  More significantly, my husband and I resumed our tradition of putting up a real Christmas tree.  We chose one that was so tall that we had to clip a few inches off its highest spire to keep it from scraping the ceiling in our living room.  I bought boxes of extra lights to festoon on it so that it would shine more brightly.  From the basement we pulled our boxes of treasured ornaments, each one of which has special memories and significance,  and carefully hung them on the branches.  At the very top presided our glowing angel in her ivory satin dress.  The tree was a symbol of our resolution to resume living and to make good memories again, despite heartbreak.  Christmas, which to me as a Christian is all about celebrating the entrance of the light of Jesus into a dark world, seemed a fitting time to make such a resolution.

And we did make some happy memories.  My family came for an overnight visit for which we cleaned and dressed up our home in all of its holiday finery.  I spent a whole day cooking in preparation, and I put the extra leaves in my dining room table and set it with flowers, candles, and my wedding china and crystal.   We talked, laughed, and enjoyed hot spiced cider; appetizers of crackers, cheese, grapes, and baked Brie garnished with honey and almonds on baguette slices; a huge feast of ham, noodle kugel, whipped sweet potatoes, cranberry salad, green beans with butter and lemon zest, fresh bread, and mixed greens in raspberry vinaigrette with candied pecans and dried cranberries followed by a dessert of a chocolate mousse torte, all made from scratch by moi.  The next morning we got up and opened Christmas gifts in front of the tree and had a homemade breakfast of red bell pepper and cheddar cheese strata, fresh fruit, and sausage. 

I truly enjoyed having a special time with my family in my home, especially since earlier in the year I had concluded that my 78-year old father, who had four surgeries in 2005, would never be healthy enough to make the trip to visit me again.  It was a blessing to see his smiling face at my dining room table and to spend time with my mother, sister, and nephew.  Since both of my parents are elderly and have survived heart disease and cancer, among other ailments, I don't take their companionship for granted, and I am thankful for each remaining holiday that we get to spend together.

I thought about all of the people whose parents or other loved ones are no longer living or are seriously ill or in other danger, people whose families have been split apart by divorce or strife, and people who don't have health, cozy homes, or enough food to eat, and I was humbled and grateful for all of the blessings that I can count, even though the blessing of having a child is not among them.

However, I'm not saying that my Christmas was perfect.  The night before my family arrived, my husband spent the wee hours violently, repeatedly throwing up (we suspect he got food poisoning from take-out hummus, which I did not eat).  I was awake with him for just about the entire time, and his illness continued well into the morning.  The poor guy was wretchedly miserable.  At around 5:30  a.m., I shuffled through my dining room on the way to the fridge in the kitchen to get some unexpired, prescription anti-nausea medication that was leftover from one of my kidney stone episodes, and I paused to survey the shadowy china, crystal, and flowers arranged on the table as I heard yet another inhumanly loud hurling yolp emanate from the the bathroom.  I felt very sorry for my sick husband, but I couldn't help but laugh a little bit at the incongruity between my carefully orchestrated dining room ambiance and the bathroom sound effects. 

Between hurls, my husband valiantly kept murmuring that he didn't want to ruin my family's visit.  But, bleary-eyed, at 7 a.m. I called my family to warn them that my husband was sick, and that although we suspected that it was food poisoning, it potentially could be a contagious stomach virus.  Although my husband had not helped to prepare any of the food or touched any of the dishes, I was worried about my family catching an illness from him.  However, knowing all of the work that I had probably done to prepare for their visit, they gamely decided to come anyway, and thankfully, none of the rest of us got sick. 

But I was soooo tired from all the work and cooking and dishes followed by the wakeful night and from playing nurse to my husband, who finally stopped vomiting but remained queasy and exhausted in bed during all the festivities.  The poor guy couldn't eat a bite of all that food that I cooked and that he was looking forward to so much.  After having a miscarriage basically ruin our Thanksgiving, I was totally disgusted with our luck, but I determined to make the best of it, and I managed to truly enjoy my family's visit.

There were also times when I thought about the miscarriages and our childlessness and was overwhelmed with tears.  In fact, tears were very near during the whole holiday season and often unexpectedly spilled down my cheeks.  Plus my husband and I had one rip-roaring, door-slamming fight that was quickly smoothed over and forgiven later that day, but that was hard while it lasted.  Despite the puking and the tears and the strife, I still wrestled a lot of joy from the holiday season and have some cherished memories, such as cuddling on the couch with my husband listening to Christmas music in the soft glow of the Christmas lights.

After my family left, there were other holiday festivities.  We spent Christmas day and the day after at my in-laws' house here in our city and had another flurry of opening gifts and feasting.  On New Years Eve, we had three friends over for a dinner party:  an infertile couple and a single woman who, like us, have suffered major disappointments lately and are missing out on the blessing of having their own families. I made a huge roast chicken stuffed with lemon wedges, garlic, and fresh herbs; roasted garlic mashed potatoes; green beans with butter and lemon zest; bread; salad; wine; and a warm apple crostada with vanilla ice cream for dessert, and it seemed to be greatly enjoyed by all.  We played games and ate snacks until midnight, and then rang in the New Year with laughs, champagne, noise makers...and hope.  Despite all of our collective disappointments, we greeted 2006 with more anticipation than trepidation.

On Monday, with melancholy, we took down the Christmas tree that had brightened up our home during the holiday season.  Now it is bare and its forlorn carcass has unceremoniously been dumped on our curb lawn to await trash collection.  But we are carrying the resolution that it symbolized into our new year--the resolution to wrest some good memories from even dark times, the determination to live with gratitude and to count the blessings that we do have instead of focusing on the blessings that we have been denied.

Here's wishing you all a 2006 filled with much more peace than turmoil, much more joy than tears, and the fulfillment of your hearts' desires.

*clinks champagne glass*