This blog is about my life and my struggles with infertility and recurrent miscarriage. If you dont want to hear me whine about my struggles then you probably shouldnt read it

Thursday, December 22, 2011

It's been a long time.....and some news

Im a horrible blog updater. But since my last entry we did 1 cycle of Clomid, Bravelle injections and a trigger shot. Which resulted in 2 follicles and............................

A pregnancy.

I swear I would be fertile myrtle if my ovaries worked right on their own.

So I'm 6 weeks and 5 days pregnant. With an EDD of 8/11/12. Those of you reading, shhhhhhhhhh!! It's a secret! I've told select family and friends but haven't announced to extended family or FB yet. I have my first ultrasound tomorrow. I may announce to the world on Christmas. But I really want to keep it a secret until I lay my eyes on a living and breathing baby. I don't want to hear all the "stay positive" and "everything will be fine this time". No one knows that. No one can guarantee that. And it's hard to stay positive when all I've experienced is a negative outcome.

Am I excited you ask? No not really. Now this is just part of the process. I get pregnant. Try to pretend I'm not and just wait to make it past the first trimester. My first US is always good. Then the next is where it all goes bad.

I've been feeling very depressed. The holidays are hard when you don't have children. Even though there may be one growing inside me, I don't see the light at the end of the childless tunnel. I think I have PTSD from my other losses. All I can think about is having another miscarriage. I'm stressing over what is going to happen if my US is on a Friday then I'll have to wait all weekend for a D&C. I'm dreaming about being on the OR table and waking up in recovery. My dreams always end bad. I never get to dream of a delivery with a healthy and full term baby. I'm not coping very well with my emotions right now. I should be enjoying pregnancy. Instead I'm counting the days until its over. Whether that be next week or 8 1/2 months from now. I just want to fast forward. I want a crystal ball. I just want to know this baby will make it. But there is no one who can give me that guarantee.

Monday, September 26, 2011

A few Hawaii pics.

A Hawaiian sunset

Brandon and I at Waikiki Beach

The view from our hotel balcony (that is Waikiki Beach)

Waikiki beach sunset

Brandon and I at some blow hole thingy (can't remember the name) 

Brandon swimming at Kailua Beach park (one of Oahu's most popular beaches)

Pretty pink hibiscus

View of Honolulu from the top of the crater at Punchbowl (a war veterans cemetary)

Some really weird hybrid hibiscus

Pretty yellow hibiscus (can you tell I like hibiscus?)

oh I almost forgot!!

Hawaii came and went and it was wonderful, spending time with my DH with no one else around. No treatments, doctors appointments, work or stress. It was heavenly and I am sad to be back home. I'll add some pics later

Coming out of the depression

has anyone ever heard that doctors and nurses are the worst patients?

Its true. Absolutely true. I think I have mentioned before that I am diabetic. Type 2, but I have been on insulin since my first pregnancy over 2 years ago. I go through periods where I just don't care, and I stop taking my insulin and let my eating go to hell in a handbasket.

Since my loss in June, I've been going through one of those periods. I saw my primary doctor almost 2 months ago, I confessed my bad behavior and depression causing me to just not care anymore. I know the consequences of diabetes, I see them at work every day, but for some reason I feel like I have no reason to care, I may never be a mother, the one thing I want the most, so who cares if Diabetes kills me? My primary doctor ordered some labs and changed my insulin. I never had the labs done, never went to my follow up appointment, but I did fill my prescription for new insulin. But I didn't take it.

My husband has been on my ass lately about taking my insulin. Annoying to say the least, when I was first diagnosed as a diabetic, he used to criticize everything. I used to call him the diabetes police. So last week I started being good about taking my insulin, I took my Lantus each night and remembered to take my Novolog with probably 80% of my meals. This weekend my husband told me how much it bothered him that I wasn't taking care of myself. He said "why are we spending so much time and money to have babies when you probably won't be around to take care of them because you don't take care of yourself". WOW. He is right (damn it!) and I know he is.

So now the change starts. Starting Oct 1st I will be on a diet. I am already tracking my calories on myfitnesspal, although I am going way over my calorie goal. It will also allow me to track my carbs like I am supposed to. I am continuing to take my insulin as I am supposed to and I will start checking my blood sugar an hour after I eat like I am supposed to (I am so bad about taking insulin then not monitoring my blood sugar). We will exercise, at least 3 days a week minimum (I got the Couch 2 5K app). And NO MORE SODA! Ack.... I am a horrible REGULAR soda drinker. Only 1 a day but still so horrible for a diabetic.

This is not going to stop me from my treatments. On Oct 5th I have my repeat pap and once the results come back my RE will give me the ok to start treatments. By my calculations it will likely be November before we get started, so that gives me a good month to get my shit together with my blood sugars and to lose some weight. I will also continue to lose during treatments, I did it in the spring, I can do it now.

Tuesday, September 6, 2011

My break from life is almost here!

4 more days and I will be in Hawaii!!! I can't wait to get away from my life, infertility, loss and everything.  A whole week of no work, no family, no doctor's appointments and no stress. Just me, my husband and lots of sand and water.... and a few alcoholic drinks.

I'm struggling right now with not doing treatments. I swear these infertility treatments are like crack or something, highly addictive. Or maybe its the drive to have a baby that is highly addictive? I don't know. I keep trying to tell myself I have my vacation coming to keep my busy and then only a couple more weeks until my pap and then another week or so until I know if my TTC break will end or be extended.

I should be worried about my pap.... it showed squamous cells, which I know is pretty possibly cancer. I'm more worried that it is going to interfere with my TTC plans than it being a potential health hazard.

Tuesday, August 23, 2011

Update on my RE visit

So I thought I would update after my RE appt.

My Husband does not have a balanced translocation. He is a genetically normal male karotype. His semen analysis was great (309million sperm count, this made him proud)

So as far as answers, we have none. My RE brought up IVF with PGD, but said if I could get to where I can view losing pregnancies as part of the process, it is a waste of money.

I'm not sure how I can ever view losing babies as a process, but I guess in a way it is. With no answers linking my losses it is basically keep trying and see how many babies have to die before I get a take home baby. I do feel that I could go through more losses. It breaks my heart everytime but it breaks my heart more to give up on my dream of having a child.

So the plan is.....go back on my Clomid/injectables sequential protocol. But not until around November. I don't want a break, but my pap smear in June was abnormal and I have a follow up pap on Oct 5th. My RE wants a clear pap before I start TTC again. So I guess we wait. It's been 4 months since my last treatment cycle and it's killing me to not do anything.

On a happy note....we are going to Hawaii on Sept 10th. I can't wait for a break from the chaos of my life

Friday, August 5, 2011

Back to the RE

So in light of our recent results on what caused our most recent loss, I made an appt with our RE. I dreaded it... which is odd. I usually look forward to going, but that is because I know each time I go I am making progress towards my goal. Now I feel that when I go I will just get bad news and told there is little they can do outside of IVF with PGD. But I did it. We will go together to meet with our RE on Aug 16th.

I am glad my husband is going. I think he needs to hear first hand what we are dealing with and how we are going to be able to get a living baby. But I am so afraid they are going to tell me that IVF is the only way. And right now that just seems so far out of our reach.

Tuesday, August 2, 2011

And the results are in....

My baby (the most recent loss) was a girl, and she had Turner's Syndrome 45X. Same diagnosis as my second baby.

TS is supposedly a somewhat rare genetic disorder, although as most babies with TS are lost in the first trimester it is thought it may be more common since many first trimester miscarriages do not undergo genetic testing. But it is cause for concern for my OB and RE that I had 2 babies with this genetic disorder. The statistics say it happens in 1 in 2500 pregnancies. Oh how could I be so lucky to have it happen twice?

I don't know how I feel about these results. I knew it would be something genetic. I am blown away that it is the same damn thing that killed my baby girl last March, but I am also sad because it still leaves us with no answers. As much as I hate to think something is wrong with me that is causing this, having a diagnosis that can be treated is a lot easier than just "bad luck"

I don't know where we will go from here. I have to make an appt with my RE and discuss our options now that I have the test results back. Likely he will recommend IVF with PGD (preimplantation genetic diagnosis) which of course comes with a HUGE price tag. But I feel that it is really the only way to make sure this doesnt happen again.

All my life I have always wanted a baby girl. What woman doesn't? But it is extremely hard knowing that I for sure could have had 2 but lost them. I am wondering if there is some truth to the theory that some people just can't have one sex or the other as far as babies go? Of course I would be happy to have any baby, but I have a feeling I may end up with only my baby girls in heaven. But I will take some baby boys on earth!

Tuesday, July 5, 2011

3 weeks tomorrow

3 weeks ago tomorrow I found out that I lost my 4th baby. I've been doing ok. Mostly existing. Going to work, hanging out with friends pretending like everything is fine. I must be doing a damn good job because no one has mentioned anything about my loss. I go through everyday with a fake smile on my face and every night when my husband is asleep I cry. I don't want him to be sad. I just want him to move on.

Some people I work with still don't know. On a daily basis I still get "how's the baby?" questions. I seriously want to slap some people, I know its not their fault but with each pregnancy question, I feel like a knife is being wielded farther in my heart.

My RE called me a couple weeks ago. Brandon had a chromosomal karotyping done on his blood and a semen analysis. I doubt those tests will tell us anything though. We basically do nothing and wait for test results. He once again assured me he reviewed my tests for recurrent miscarriage and everything is normal and nothing was missed.

Still waiting for the chromosomal karotyping on the baby. That will tell us the real story. I had my follow up appt with my OB last week. Physically normal and all healed fro my D&C, but the emotional scars will never go away.

I don't know where this journey is going now. After all the test results come back I have to go back to my RE and discuss our options as far as treatment.

I'm really starting to wonder how much more of this I can handle. 32 months now. 32 months of nothing but heartache. Its like a roller coaster that I can't get off. I wouldn't wish this on my worst enemy. Sometimes I wonder if I need antidepressants, but I don't think any medication can numb this pain. It controls my life, in every aspect. We are talking about a trip to Hawaii in the fall. But I can't book it now because I don't know what my treatment plan will be. I can't chance booking the trip only to find out that I have to get an ultrasound that week. Infertility is running my life. And I don't know how to stop it. I don't think there is any way to stop it.

Life is so unfair. Mother's kill their babies and don't even get punished (Casey Anthony) and people like me or my friend Tiffany who lost her baby boy at 38 weeks the day after my loss, have to suffer through a loss of a baby that we would have given our lives for. It's just not fair.

Monday, June 20, 2011

It just keeps getting better

Well I haven't updated in awhile. Mainly because I was keeping a secret. On Mother's Day I found out we were pregnant. Our last treatment cycle worked! The best thing is my due date was 1/18/12. The same due date as my first baby, just 2 days later. That had to be a sign that things were going to be ok.

I had an US at 6w6d and there was indeed a wonderful baby growing inside of me with a HB of 133. I was so excited. I felt like this was it for us and all the pain and heartache of this journey would be cured by this baby growing inside of me.

Last Wednesday we made the trip back to my RE's office in San Francisco, I was 9 weeks pregnant. I was nervous of course, but hoping this would be my last trip to the RE. Everything was going to be fine and then I could be released to my OB.

As I lay down on the table for the ultrasound, I could feel my heart beating all over my body, just nerves I tell myself, I felt the same 2 weeks earlier and everything was fine. The NP begins the US. She doesnt say anything for a few seconds, then she says "I'm just looking for a heartbeat". Here is where I start to get worried. See at 9 weeks pregnant, the baby should be moving all over. I know this from my first pregnancy. So after a couple minutes that felt like hours, she says the words I have heard all too many times before "I'm sorry I can't find a heartbeat". At first I didn't even cry, I've heard these words 2 other times before. Then I look at my husband standing in the corner, he was so excited for this baby, he was much more attached than the other 2 because he also thought this time was for real, there is no way we would be forced to go through the same punishment of losing a baby again. I just lost it.

After I composed myself it dawned on me, what are we going to do next. Of course most people who just found out they lost a baby wouldn't immediately be thinking about trying again. But for someone who has spent the last 31 months suffering through losses and infertility, it is the first thing you think about. This time was especially urgent for me. I have had every test to determine the causes of my miscarriages. Everything is normal. Apparently for some reason we have such bad luck that every baby has some freak genetic problem. How much bad luck can one person have? I want an answer, I want a cure, a treatment. But there is none.

The NP says, some people this just happens to. Some people have 10 or 12 losses before they have a healthy baby. Well there has to be an alternative. There is no fucking way I can go through this again. 4 is enough. Much more than one person should have to experience.

I had my D&C on last Thursday. It was sad that I knew everyone at the hospital. The same nurses I had during my last D&C were there and got me ready for surgery. I mean honestly, who the fuck has to do this procedure 3 times in 2 years?

So as of now the only option is likely in vitro fertilization (IVF) and they can genetically test each embryo and only transfer the genetically normal embryo's to my uterus. Ok great. Unfortunately it is sooo expensive. A single round of IVF is around $10-12K. It's not a 100% guarantee. Average is a 45-50% pregnancy rate. And there is no guarantee any of the embryo's would be genetically normal. I could pump myself full of hormones. Stimulate my ovaries to produce 20-30 eggs. Go under anesthesia to harvest the eggs, only to have no normal embryo's grow. There is no way to predict the outcome.

So for now we are waiting for the chromosomal karotyping of the baby to see if there was a genetic issue and what it was. From there I am sure we will be seeing the geneticist at my RE's office and likely will do some testing on Brandon.

My emotions are different this time. I am so incredibly angry. The anger I feel is like nothing I have felt in my life. I feel like I am being punished for something, but can't figure out what I have done for this punishment. People keep telling me I am so strong. But I'm not. I may seem like it on the outside but I am dying inside. I can't walk around everyday crying and depressed. It makes people uncomfortable. They don't understand. So I suck it up and go to work and hang out with friends, all the while inside I can guarantee you there isn't an hour that goes by that I am not thinking of my babies I lost or my struggle to have a healthy baby. Everything reminds me of it. Every where I go I see pregnant women, or women with babies in tow. Constant reminders that they are mothers and I am not and may never be one. I may never give my husband the joy of being a father, or my parent's the joy of another grandchild. Even being wheeled out of the hospital after my D&C a hugely pregnant woman steps in the elevator with me. I'm sitting there in my wheelchair, trying to hold in my tears and thinking "is this a fucking cruel joke?" I mean honestly, what are the odds? That after having my dead baby scraped and sucked out of my body that I would have to sit in an elevator at eye level with a huge pregnant belly. That is just my luck apparently. Call me bitter, call me a pregnant woman hater, I don't care. That's what I am. I know people that have had 2 babies in the time I have been trying for one.

I feel so depressed about the uncertainty of our infertility journey. I think that is the hardest for me this time. I don't know how we are going to overcome this "bad luck" as they tell us it is. Infertility treatments can handle almost anything. But there is no defying genetics. We could very well pay all that money for IVF and end up with no genetically normal embryos.

So what do we do. For now I guess we have to wait for our formal appointment with my RE to discuss what he feels is our best option. I don't think that will happen until after the karotyping of the baby comes back (which I think took about 3 weeks last time). We also put off buying a new car, since our quest to have a baby is likely to get more expensive. Our potential baby will be our car payment. I also have to go and get yet another date added to my angel baby tattoo. And I have to put on my happy face and go back to work in 5 days and pretend that I am ok and my life is wonderful, when in reality my life really sucks.

Wednesday, April 27, 2011

National Infertility Awareness Week

This week is National Infertility Awareness Week.

^^^ That is the NIAW home page on is the ONLY advocacy group for infertility. Check it out. Link it to your FB and break the silence. Infertility is such a hush hush disease. And yes it is a disease. Speak up, break the silence. Let people know it exists and it is rampant. Maybe the insurance companies and government will hear us and start making it easier for us infertiles to afford treatments to expand our families. Reproduction is generally a god given right for most women, for those who are infertile it is often a financially driven privledge. If you dont have the money well then you dont get to have a baby. Its not right and it has to change.

Check it out and show your support.

Getting better with the updating

lets see where did I leave off...

Well I think I said that my first cycle of my new treatment protocol was a bust. If I didnt say that now you know.

So we did the same thing this time. Clomid 100mg CD2-6 and Bravelle 75 units injections starting on CD7. I went for my CD10 ultrasound fully expecting to have a mature follicle like I did the first cycle. Negative. I had 2 13mm follicles, one on the right ovary and one on the left ovary. So home I went to take 3 more days of Bravelle and have another US on CD13. So Monday (CD13) I went back to UCSF for another US. The follicle on the right ovary had grown to 17.5 mm and the one on the left was 13mm still. I was....disappointed, to say the least. I know one follicle is better than none, which is what I usually get on my own. But I am spending all this money and time and all this stress, I was hoping to have both follicles mature and give us a little bit of an increased chance of pregnancy this cycle.

So I was sent home to take one more dose of Bravelle and take my trigger shot on Tuesday (CD14) night. They said the 13mm follicle on the left ovary *may* mature and release an egg but its not likely. Follicles mature at a max of 2mm a day with stimulation, so at most by Tuesday it would be 15mm, the trigger shot may mature it another 2mm but at 17mm it is still not likely to release an egg. But predicting follicle maturation is not an exact science and they sometimes grow as fast or as slow as they want so there is a chance (very small) that it could mature enough to release an egg. Yay if it does. Hopefully it only results in 1 baby, but if it results in more then we will deal with that later. We knew it was a risk.

So now we are in the actively part of trying to make a baby, if you know what I mean. An a couple of weeks we will know if we were successful or if we are moving onto another cycle.

I've been thinking of going to an infertility support group. The nearest one is in Sacramento. It is a peer led support group through I may check it out. I feel like a bipolar person. One minute I am up and excited and the next minute I am down and depressed and convinced that nothing will make this happen. I hate feeling like that. And no one who hasnt been through it understands.

Tuesday, April 12, 2011

I know, I know...I'm a bad blog updater

But here it is. My last cycle was Clomid 100mg CD2-6, Bravelle 75IU CD7-10, ovidrel trigger shot and prometrium after ovulation.

I went for a follicle check US on CD10 which showed 1 17.5mm follicle. I took my trigger shot on CD11.

The waiting was horrendous, as it always is.

14DPO, 16 days past the trigger shot and the pregnancy test was negative (that was yesterday). Of course I tested prior to that so I had a feeling it was going to be the result. I stopped my progesterone as told by my RE and now I am waiting for my period to start so I can do this all again.

My frustration levels are so high. I dont understand why I expected any different result. Everything all this time has been a failure, why would this be anything different?

Oh and my saline sonogram was normal. My uterus is perfect. Not even any scar tissue from my D&Cs (thanks Dr. Carol!). So we are back to square 1 with the recurrent miscarriages. 3 babies lost with no connecting cause.

So once again I am just waiting.....I'm going to really start exploring the options that UCSF has for financing IVF, because I really think that is the direction we are heading in. I think once I know when my next appointment is there I will schedule an appointment with their financial counselor and see what our options are as far as financing that $25K it will cost.

Monday, March 7, 2011

Update on my RE appointment

So last Wednesday I had my consultation with my new RE at University of California San Francisco. Other than the 2 1/2 hr 1 way drive it was awesome!

The office staff has been nothing but helpful and understanding. They make me feel like I am important to them and that my treatment matters. I didnt feel that with the asshole doctor I saw before.

The doctor was wonderful, he respected my knowledge I have as a nurse and someone who has spent countless hours researching infertility. He took my concerns into consideration. He was happy with the testing I had so far. He concurred with my diagnosis of PCOS. He urged me to work on losing weight to decrease my risk of miscarriage, as well as keep my diabetes controlled.

He felt that IUI was a waste of money, he said that there are no sperm issues and it isnt necessary and wont increase our chances. He also felt that going straight injectables was a little extreme as he is really concerned about multiples.

The plan is to take 100mg of Clomid CD2-6 and then 75IU of Menopur or Bravelle starting on CD7  with a couple ultrasounds to monitor follicle development. Then trigger the follicles with Ovidrel and have timed intercourse. Great news is he is willing to use up my Menopur and Bravelle that I have at home, I have enough for 3 cycles. The Clomid is cheap, under $10. So the costs will be much less than what I paid before. I will also continue on Prometrium.

The diagnosis of a clotting disorder by the other doctor was dismissed by my new doctor. He said an increased protein C activity does not make you at risk for clots. A decreased protein C activity does. He told me to stop the baby aspirin, I dont need Lovenox when I am pregnant. Unfortunately I am back to having no link to my miscarriages. But he said that all 3 have their own explainations and they were likely just bad luck. My diabetes, PCOS and being overweight all increase the risk of miscarriage and I just have to be ok with that to proceed with the treatments. As much as it would kill me to lose another baby, I cant give up just because of that. I can survive another loss, I cant survive giving up and never knowing if I could have been a mother.

All in all I am very happy with my new RE. The only further testing I need is a Saline Sonohysterogram to check the anatomy of my uterus, that can be done concurrently with a treatment cycle. My next cycle should start in a couple of weeks and then we will get started

Wednesday, February 23, 2011

Oh its been awhile

Well it's been awhile since I updated. I've been trying to busy myself and stay distracted from the fact that I'm infertile and I have a better chance of hitting the jackpot in Vegas than becoming a mother.

Anyways, the distracting didn't help much but here is what's new with my journey to beat infertility.

So after the crazy ass doctor dumped me I began the search for a new Repro Endo (RE). After multiple battles with my insurance company I finally got an appointment for a consult. I have to go to the University of California San Francisco Center for Reproductive health. Awesome infertility center yes, but very far away. It's about a 2-2 1/2 hr drive ONE way. Not too bad until you think that I could potentially be making that drive 2-3 times per week. Not to mention the stressful Bay Area traffic and driving on the Bay Bridge (which I HATE). Well I guess just one of the many sacrifices I will be making for children.

So this process to my consultation has been unfolding over the last 6 weeks or so. My appointment is next Wednesday, March 2nd. It seems like I've been waiting forever!!

So what have I been doing to pass the time? Well I did get one cycle with ovulation on my own where we actually got to try and make a baby. Although the trying was fun, it didn't result in a baby. Not sure why I was surprised. That is the usual outcome. Other than that I've been working, shopping and that's it.

My husband can't get the day off for my appointment o my mom is going with me. She was worried about me driving to San Francisco alone, not sure why, it's going to happen eventually. My husband isn't going to be able to go with me to every appointment. But she wants to HO so how do you say no to a mom who wants her daughter to giver her a grandchild more than anything in the world? Answer, you don't say no. So Mom's coming. I lobe my mom and I know it upsets her to see me going through all this but it's a little awkward talking to the doctor about the methods in which you have had sex in an attempt to make a baby In front of your mother. Oh well. Guess I have to get over it.

Mostly I'm excited about my appointment. I'm very nervous though. I've been very wronged by a doctor I trusted and I feel like I'm just walking into another bad situation. I'm nervous this doctor will want more testing done, I know that there are probably more tests we should do just in case, but tests take time and I'm so tired of giving up more time!!! I've waited long enough.

I'll update with the details of my appointment. And I'm sure you will see some very emotional posts coming soon as my baby girl's "angelversary" approaches on March 10th.

Thursday, January 6, 2011

I wanna kill someone!!

AHHHHHHHHHHHHHHHHHHHHHHHHH!!!!!!!!!!!!!! So finally yesterday was CD1. I started spotting on Tuesday and tried to get ahold of my RE to find out when to bring him my injections to mix. The office told me he was on call and they would give him the message when he was back in the office on Friday (he was going to be in another office Wednesday and Thursday) I was a little irritated, I mean last time I started my injections on CD2. Friday would be CD3 or 4. So yesterday I called the other office and left a message.

I received a call back from the Medical Assistant. Informing me that my doctor would no longer be treating me. He didnt have the time to monitor me and recommended I see another RE like at UC Davis or something. Nice HUH?? On Monday I called him to get Provera to induce my period, he had the MA call and tell me to start it and to call to drop off my injections and schedule my US when I started my period. I never took the Provera because I started spotting. Then 2 days later he says he doesnt want to treat me.

So now I am on CD2 with $1300 in injections in my cabinet and no doctor to do my treatments. I spent weeks arguing and appealing my insurance to cover part of my IUIs and ultrasounds. Now those authorizations are invalid, they cant be transferred to another doctor. I have to get new authorizations for everything.

The asshole doctor didnt even have the balls to call me himself. I know he doesnt want to treat me because I question him too much, I am very knowledgable in medicine and infertility. He didnt like that. On top of that now that I am not a fully self paying patient, they arent going to make much money off of me.

I wish he would have told me this after my first cycle, instead of telling me to order injections and get ready for the next cycle. Or even better tell me at the consultation I had 4 months ago that he didnt have the time to do my treatments. Instead he wasted 4 months of my time and thousands of dollars for nothing. I could have already seen another doctor and been pregnant by now.

I am beyond angry and frustrated. This process is emotional and stressful enough, now I have a stupid doctor that did nothing but waste my money, lead me on and cause me more stress and frustration.