Packing it All Up

Last night was spent packing up all of our TTC/IF/IVF “stuff” yet once again.  Over the years, we have boxed up all of this “stuff” up and put it away time and time again for things like failed cycles, pregnancy losses, etc.  Since our FET cycle has officially been called off, I figured it was time to do a quick sweep of the house and find all the items we had been planning to use starting this week but won’t be and get rid of them.  Here is what I found so far…

Item 1: 

Lovely TTC Crate shipped to me with lots of special goodies inside. I actually just got this package, and as I started to tear it open, I decided against it. I will save it for when we (hopefully) start TTC again one day.

Item 2:

Crinone leftover from previous fails, that would have been used this time around.

Item 3:

You probably can’t even tell what this is from the picture, so let me tell you. This is a DEEP box with folders, binders, receipts, loose papers, cards, etc. all pertaining to TTC. I threw in some more papers to top it off before it goes back into its closet.

Item 4:

LH strips, HCG strips, and urine cups. Won’t be needing these anymore!

Item 5:

Circle + Bloom Audio CD’s purchased for the upcoming FET and possible pregnancy…neither have ever been opened.

Item 6:

Although we did not need this for our FET, we won’t be using it at home anymore either. It’s not safe for me to get pregnant at all right now.

Item 7: 

A book that I prayed would help me get through a pregnancy should our FET have worked.

Out of sight, out of mind, right? I wish it was that simple! Even though it’s a lot harder than that, I still can’t stomach to see all of this “stuff” just laying around for months and months.  Maybe God-willingly one day we will be able to bring it all back out, but for now…it’s bye-bye.

Decision Time

We have been praying for peace about which RE to go with, as we wanted to make our decision by the end of this week. Enough dragging it out already, we are ready to be done with this step and move on.  As you very well know (and may be getting sick of hearing about), we have been unsure of whether or not we wanted to stay at our current clinic.  While there are many things we love about them…Things We Love there are also things we don’t… Always Room for Improvement

Earlier this week, we met with the new RE ( New RE FET consult ), and he reviewed his plan for a future FET, the results of our HSG, and did a lining check where he saw the “something.”  I failed to mention the FET protocol he prescribed in my prior post.  I think I was too worked up about the “something”  to go into much detail at the time.  Anyways, he was not for a natural, a.k.a. un-medicated cycle.  His reasoning was that he feels that they can do better than I can do on my own. Hmmmm, I don’t know about that.

Anyone who has been following along knows we ideally want to be as drug-free as possible due to our negative experiences on the meds, especially the estrogen.  When I told him that taking it can feed the growth of masses he argued that my body is producing it anyways.  But if you ask me, the estrogen I am producing naturally is not the same as the synthetic stuff he wants me to go on that I have been on before.  So basically, the protocol would be the same at his place as it had been for our previous FET’s.  Although the protocol would be the same, the price is still $1,000 more than our current RE.

Today, we met with our current RE (where our 3 frosties are housed) for an ultrasound, and FET consult.  Going into the visit, we felt like it was almost a last ditch effort.  We wanted to see what she would want to do differently moving forward, if anything at all.  Many of you are aware of my anxiety, and a major fear of mine is how I would feel being at the same place in the same rooms where I have lost our 5 babies.  Needless to say, I have been carrying around my homeopathic anxiety drops, and I was pretty sure I would need them going here.  Heck, I needed them earlier in the week as I sat in the waiting room for the new RE so why would it be any different today?

We were greeted pleasantly upon arrival.  We know the staff very well, and it’s been awhile since I have seen them all.  Before being called back, the nurse handed me a rough draft of a letter that my RE wrote for us.  This letter was required for the financial grant we want to apply for.  Our paperwork (all 21 pages) is ready to go, with the exception of this letter. I asked for the letter a few weeks ago through email, and even though we weren’t sure which clinic we would end up at, I wanted to get the ball rolling just in case.  I know this may sound a little child-like or game-like, but I didn’t want to ask again about getting this letter after my first request.  I wanted to see that they would do it without being hassled for it.  I wanted to be handed it today, and I was. The nurse asked me to look it over, and if it was to my liking, they would sign it and type it up on letterhead for me.  I thought it was great…here it is…

  
About an hour into the visit, I was pleasantly surprised when I realized I had not felt any anxiety or any need for my drops. We started off with the ultrasound. I am currently in the Luteal phase after ovulation, when the progesterone my body naturally produces should have compacted my lining a little.  In other words, it wouldn’t normally look as thick as it had before or during my LH surge.  This made me nervous.  How much thinner would it be?  Well, the good news folks is that even compacted, it still measured an 8.5!  Talk about exciting.  Thank you, God!

The not so good news is that she did see the “something” in my uterus as well.  Although I don’t want this “thing” there by any means, it was additional reassurance that both her and the other RE are on the same page with what they see.  When two sets of eyes see the same “thing” at different times, you know it’s got to be “something.”  She also said she was not sure what it could be like he did.  Her recommendation was to do another Hysteroscopy to explore it.  I figured this much.  After loss 3, we agreed that before we ever did another transfer again we would do a Hysteroscopy before it anyways.

I got dressed and went into her office for the most important part–the plan for moving forward.  We started off the discussion with how I have been–my visits with my therapist and my family Dr.  She was very pleased to hear that I have been seeing Dr. G for therapy, as some of her other patients do too.   

Soon after, we jumped in to the protocol for a FET.  I thought I might be hearing things when she softly said, “I know in the past I have not been all for an un-medicated cycle, but I really feel like a natural cycle would be best for you now.”  Wow! What? I hadn’t even mentioned the thought of an all natural cycle to her in months upon months. My hubby and I both assumed she would hand us the same old calendar with the same old BC, Lupron, E2, and progesterone on it, but thankfully we were wrong; we didn’t even have to initiate the discussion of what we wanted.

Of course we asked her why she felt this way now.  She explained that based on how we have been tracking my lining it seems the best idea. My lining gets thinner on estrogen–the exact opposite of what it is supposed to do when on it during a cycle.  We have checked it for 3 consecutive months now, and it has been thick enough to be considered ideal.  When on estrogen, and we are talking aggressive amounts, it is thinner.  Plus, she agreed it can feed growth of masses and with our history it doesn’t seem like a good idea to chance it.  I cannot begin to tell you how elated we were to hear all of this. 

She went on to say that we are not the typical patients, and that what works for the majority isn’t working well for us.  In addition, she provided literature on new studies that are showing all natural FET’s are quite successful, especially for a patient who has already been pregnant off IVF each time they transferred (ME!).

We talked about transferring 1 embryo versus 2 and all agreed on 1 as the best bet at this point.  We conferred about who would do the monitoring ultrasounds should we choose to move forward, another important factor for us.  We would only be getting them done by the RE herself-no nurses. At the other RE’s clinic, the nurses would be doing them for us, not the RE. I should note that it’s not like we don’t trust the nurses at these clinics…we just feel that having the person who will be transferring that embryo looking at my uterus each time is better.  We did have a slight problem arise in the past that has influenced this way of thinking.  

Another topic of discussion was in what case a natural cycle could get cancelled. The great part about this awful thing (cancellation of a cycle) is that when it is natural, no meds have been wasted or much money spent at all.  Plus, the overall cost of an un-medicated cycle is much cheaper to begin with anyways (about half the cost of a medicated FET).

We sat down to look at calendars next.  We didn’t get the generic calendar handed to us that we have in the past.  Instead, we sat down with 3 blank calendars, August-October, in front of all of us. 

  
At the other RE’s we did not look at calendar’s, it was verbal, and I tried to input as much as I could into my cell phone as they told me dates.  Anyways, we compared doing a September transfer versus an October.  An October transfer was the only option at the other RE if we wanted him to do it, not any of his partners (the 6 partners rotate transfers and his week isn’t until October again).  We decided that September would be too soon for us, especially getting another H/S done beforehand.  This being said, regardless of clinic, October will be our month.  Yes, you heard me right, we will be transferring our future baby in October!

It could have only been God watching over us today.  As we sat and went through the dates and times for things, everything was falling into place.  I will barely miss any time off, and not by my doing; it just happened that way.  We do not have a “set date” for a transfer, something we hated having in the past and would still have at the new RE’s if we want him to do it. 

Since we are un-medicated, we cannot nail down an exact day until we get much much closer.  My body is in charge this time, not the meds.  We do have an idea of the 2 week time frame the transfer will be in, but that is all for now.

As we left today, we felt total peace and a sense of joy, just what we prayed for! Most importantly, we feel confident in our current RE’s hands as we move forward.  In no way do we regret getting a second opinion at all–in fact it has helped us to feel the confidence we feel today.  

As you can see, we have made our decision to stay where we are at.  We welcome all the positive vibes from our wonderful friends and family about our decision! We are so excited for what our future has in store– Jeremiah 29:11

Lining Check #3, 2WW, & “Somethings”

This cycle I ovulated later than the prior 2 months. I got a positive OPK starting on day 16 and it lasted until day 18. Usually my positive test has been lasting only a full day at most, starting on day 14. I was happy about the longer window! 

Day 16 far right

On day 17, I felt the ovulation pains many of you have experienced. I havent had them in a such a long time, I almost forgot what they felt like! As many of you know, last month hubby and I baby danced everyday, twice a day, for 4 days straight (ugh lol!) We did NOT do that this month. The month before that, we BD’d every day, once a day, for 4 days straight. We did NOT do that this month either. Instead we tried to take it easy, and BD’d only every other day, for a total of 4 days. We will see how this worked out in about 10 days…currently in the 2WW. 

Anywho, I got my third lining check and it measured over an 8 again!! Whoot whoot!! Thats 3 months in a row of thick (enough) lining on my own, with no help. Remember, anything an 8 or greater is ideal (some RE’s even say a 7). That said, we are very pleased about my number! I could also see the triple stripe which is great news. My antral follicle count (aka egg reserve) still looks good, about 9 or so on each side.  

  

I got the lining check at the new RE, as our meeting with him just happened to fall during my ovulation  window. We also discussed my HSG more in depth as planned. If you recall correctly, the HSG last week went well overall, but he did say that day that he saw “something” small, which he thought could be scar tissue. 

Well, since he saw “something,” he wants to do an SIS to identify if its scar tissue or perhaps a polyp of some sort. If its a polyp *in the uterine cavity* we would need to do another H/S to remove it. Im not sure how I feel about this. Meaning, I dont know if I am willing to do all this again right now. I asked if a balloon would be involved in this removal, he said it was unlikely, but of course possible. No surprise there, I learned ahwile ago that anything is possible and nothing is guaranteed with all this. 

Then I told him–if it is a polyp or fibroid or whatever AGAIN, obviously they are going to just KEEP coming back. Shit, I just had one removed in May! He begged to disagree with me. He seemed confident that this “something” isnt a huge deal. Easy for him to say right? He hasnt miscarried (potentially with a fibroid as the cause) or been operated on numerous times.  He said the images of the HSG show my uterus looks “good” shape wise, tube wise, size wise, etc.  with the exception of the small “something.” 

The ultrasound lining check also showed “something” unusual in the cavity. So annoying and not what I wanted to hear after getting positive news about my lining.  Whatever this “something” was, I clearly saw it too. He has been practicing for 30 years and he said, “very unusual” and I replied with, “of course it is.”

I probed on whether or not this ultrasound “something” is the same “something” showing on the HSG. Unknown at this time, but he is leaning towards no. Again, not what I wanted to hear. Now we possibly have 2 “things” that may not be related. 

On the ultrasound, this “something” looked like mucus he said (not fluid, polyps or fibroids) which is rare for the location I guess. I was really frustrated and started to tune out at this time. I didnt care to ask about this odd “mucus” if its even harmful, why its caused, or how it goes away. He is hoping the SIS will provide further clarity. Anyone here who has had similar mucus like this, please feel free to share your experiences…I am a feeling like my listening ears are back on now.  I have had fluid, but not mucus, and supposedly there is a difference. 

If we choose to move forward with this new RE, our transfer will be in October sometime. We reviewed the calendars and logistics of it all as our 3 hour meeting came to a close. 

Feeling a little annoyed with the fact that the HSG and ultrasound couldnt look picture perfect at this point.  In June, it all looked just fine. Starting to wonder if my body is just failing and not able to do what it needs to do to even move forward with a FET.  Maybe I am not cut out for this.  

One Step Closer

Yesterday we had our HSG and mock transfer at the new RE.  The morning didn’t start off the greatest.  I woke up, ate a light breakfast, and took my antibiotic, which may I add that I have taken sooo many times before. 

I started vacuuming and about 20 minutes later, I found myself sprinting to the bathroom to puke.  As I was puking, I thought “how ironic? I am puking my guts out, couldn’t it at least be because I am pregnant?” Well, we all know that’s not the case, as I just finished my menstrual cycle not even a week ago.

I laid back down after the vomit, feeling like crap.  I was dreading the fact that I needed to take 3 Valium’s in a few hours before the procedure.  Usually, when feeling good, I wouldn’t mind the well-earned, loopyness that IF treatments bring, but feeling sick and taking them isn’t ideal.  I hoped I wasn’t coming down with something, and thankfully, I wasn’t because within a few hours I felt better.

A few hours later, my mom picked me up and we headed to the appointment.  When I arrived, they took a urine sample right away to make sure I wasn’t pregnant (Ha!).  I popped my Valium’s, changed into scrubs, and waited.  The nurses were all quite friendly, which is great because I was nervous about this, being at a new RE’s office and all.  They took me back into the procedure room and the RE came in right away.  By now, I was feeling pretty “drunk”–anyone who has had an HSG done before knows they aren’t exactly what you consider fun, so I can’t complain that I was out of it.  This wasn’t my first rodeo either, more like my 3rd.

  
He did the mock transfer first, and it went down without any hiccups. The catheter went in easily, he made some comments to the nurse about the measurements, she put them in the computer, and we moved on to the HSG. The room was set up with big screens all around so I could clearly see what was happening during the procedure.  At my old RE’s office, there is only one screen facing her during procedures so it’s more difficult to view what’s occurring.  I liked that I could see being as anal as I am.  LOL.

The RE injected the dye and right away I could see it flowing out of both of my tubes on the screen.  He confirmed both of them are wide open, no blockage at all….phew!  He tilted me to the right, then to the left.  No fibroids, polyps, or masses seen…hooray! Next, he pointed out an area where it appears that I may have some scar tissue.  Of course, I freaked out (the most I could while under the influence).  He reassured me that it is minor, and that we will discuss it further at our sit down appointment next week.  Then he told me that I should leave feeling that this went really well with no major worries. Those words made me a happy girl! And I need to keep repeating them in my mind. 

I must say pain wise, on a scale of 1 to 10, the procedure was only a 1 (maybe).  By far, the easiest HSG I have ever had done.  I would have rated my first HSG an 8 and the second probably a 6.  This time, I had cramping for maybe a minute (not even) and the worst part was most likely the speculum going in.

In other news, I am feeling optimistic about moving forward with our next FET.  I ordered two products off Amazon this week, both for if I become pregnant again.

  
  
I am hoping these will help me feel a little bit more empowered, along with my therapist, prayer, and other self-care tactics.

Always Room for Improvement

Right off the bat, I should say that I know no person is perfect, and no IF clinic is perfect either. Perfection should never be the expectation. However, in any profession, if you aren’t reflecting and trying to improve or do better, that could be a problem. Experience only makes you wiser if you learn from it and apply it to future situations. I know this from being a teacher the past 5 years.

This being said, we have made a list of things we think could be improved upon at our current clinic, or any clinic for that matter.  Here is what we have so far:

  1. The most advanced uterine tests should be performed on all patients before IVF. This means a Hysteroscopy should be done on every patient prior to IVF.  You heard me right.  That is our opinion after the hell we have gone through. We are proof in the pudding that an SIS and HSG aren’t always enough.  If we had done this procedure from the start, there would be no questions in our minds or our RE’s if that fibroid had truly been around for all 3 losses or not.  
  2. PGD should be offered to all patients before they begin IVF.  Looking back, we were never informed of this option & I wish we had been. We cannot do PGD testing now with our remaining frozen embryos, as it can only be done in the days following the retrieval.  We never knew about this option until we miscarried and started searching the web. Suddenly, we started seeing all of these women who did PGD before transferring.  I mentioned it to my doctor at that point, and found out it was too late to genetically test our embryos.  Since we looked good on paper (under 35, appropriate weight, etc), perhaps it was assumed we would succeed & not need this expensive option added on. If we were to miscarry again, I do not know if I could go through another transfer. Instead we have discussed a surrogate. How much more confident we would feel knowing we were transferring a genetically normal embryo into a surrogate than not! While I get that PGD is not 100% accurate, it should be offered to the patients if it is a service the clinic provides.
  3. RE’s should discuss the worst case scenarios upfront with their patients before they begin IVF.  When we began IVF, we were so set on it actually “working” that we didn’t think of anything before that point or after that point. We didn’t discuss that only embryos making it to day 5 or 6 would be kept.  We never talked about the chances of chemical pregnancies, miscarriage, or RPL.  We had no idea we would go through the torture of beta testing and what would need to happen with all that if we ended up pregnant.
  4. The RN’s should not do all of the ultrasound monitoring during an IVF cycle.  This is probably common at most clinics simply due to the amount of patients undergoing treatment.  It was never an issue to us before we miscarried either as we do trust our RN.  However, our nurse ended up missing something early on in one of our cycles that our RE probably wouldn’t have if she had been the one doing the ultrasounds to begin with. Moving forward, we have told our RE we will not be monitored by anyone other than her and she has agreed this is best.  If our RE would like to have the nurse with her for another set of eyes, great! Bottom line…I want the person who will be transferring those embryos into my uterus monitoring it before hand. No exceptions.
  5. All viable embryos should be considered for transfer.  At our clinic, only embryos that make it to day 5 or 6 are transferred.  On the day of the retrieval you are handed a piece of paper that says “be here on day 6 at _____ am for embryo transfer.”  I know several women who have had successful day 3 or 4 transfers, so I do not think it is fair to limit to just a day 5 or 6 transfer. Thankfully, our 8 embryos made it to day 6, but what if they hadn’t?
  6. After retrieval, the embryologist should provide daily updates on how the embryos are doing.  I never once talked to the embryologist for an update. I received a voicemail the day after retrieval with a brief summary, but that was it. Those days after the retrieval are sooo stressful as it is, and remember we had to wait until day 6 not knowing anything. In my opinion, not knowing anything until you show up for the transfer is adding a lot of unnecessary stress to the situation.
  7. Get input from the patient about their IVF treatment plan.  Sit down and show patients all of the different “protocols” available for an IVF cycle. Short, mini-stim, antagonist, un-medicated, etc. Tell them the success rates with each. Explain what type of patients you have seen do well on each type of protocol.  Understand that this should not be a “one-size-fits-all” approach.  Ask them questions about their bodies, and act like they are educated. Through this process, I have learned that I know my body better than anyone. Just because Susie did well off all of the drugs you gave her, doesn’t mean I will. Show me what is available, whether it is your preferred method of treatment or not.
  8. Clinics should disclose what will happen if you do get a positive beta post IVF.  We never talked about the cost to continue a pregnancy if we achieved one.  We had no clue we would be spending thousands more on medications after the actual IVF cycle itself ended.  Medications are only paid for up until the beta test in case you get a negative.  If you get a positive, you will need meds for 6 more weeks, at least.  That adds up to thousands more.
  9. Designate clear roles within the practice.  Since it is so easy to communicate with everyone at the practice (listed as a perk yesterday!), you never know exactly who to talk to about things. For example, we have had prescriptions not called in, called in twice by different staff members, etc. It would be great if each person had a clearly designated role or each patient had a clearly designated go to person.
  10. Wellness services should be provided at clinics. Everyone goes into treatment hoping it will work the first time.  But, that is not always the case.  Actually, majority of the time it is not the case.  After all of the emotional and physical trauma, we wished that our clinic offered things like acupuncture, counseling, etc.  Don’t get me wrong, when asked, they provide recommendations, but we have ended up finding our own specialists in these areas.  It would be great if clinics started including these in their treatment packages.

Hind sight is always 20/20. But we hope this list is helpful to those searching for a clinic to call home!

Finding the Rainbow After a Storm

Today was our post-op appointment after the hysteroscopy done last week.

The pathology results from the biopsy came back with 2 findings: 1.) chronic inflammation, & 2). placental plaque, or tissues.

The chronic inflammation is probably due to all of the zillion procedures that have been done.  The placental plaque or tissue, on the other hand, was not what we were expecting. Somehow, someway, there is still placenta left in my uterus from a pregnancy. Don’t ask me how.  In fact, it was not even able to be seen on the hysteroscopy, it was only detected through the biopsy.  If something “rare” were to happen, you already knew it would.

So, the plan is to remove, or try to remove this “invisible” placenta when we try to remove the Adenomyoma in a few weeks. Removing the Adenomyoma will go something like this: Under general anesthesia, the doctor will once again enter my uterus with a camera through the cervix, locate the mass, and “shave” it down with a special tool, that she called a “wand” at one point. A wand! Ha! Like this is a fairy tale or something.

After she shaves the mass down enough to where it appears flush with my uterine wall, she will inject Vasopressin into my uterus to make it contract.  The Vasopressin will force any “hidden” Adenomyoma to seep out.  Sounds disgusting, I know.  I guess entire Adenomyomas are not always fully visible, which brings us to the next point.  Our doctor said, and I quote, “there is a chance I may not be able to safely remove the entire Adenomyoma” or that “the cavity will appear normalized at the time of the surgery, but there will be residual tissue left that can grow back.”

She will take get out as much as she can safely, without damaging my uterus, and send it out to pathology to confirm that it was indeed an Adenomyoma.  She will also insert a balloon in the place where the mass previously was (in order to prevent scar tissue from forming). The balloon will stay in my uterus for about a week as it heals (maybe I’ll fly away). Of course, she said I won’t even feel it, but I doubt she ever walked around with a balloon in her va-jay-jay.

About a month after all this jazz (in June sometime), we will have to do another diagnostic hysteroscopy/biopsy, just like the one last week.  This will confirm that the Adenomyoma is fully gone, along with the placental tissue.  It’s hard for me to think about not being able to fully remove it.  I guess because we know it has to come out entirely, or we cant even consider getting pregnant.  And even if it is fully removed, there is always the chance another one will grow back.  And there is not timeline as to when, or how quickly.  This is very frustrating to say the least, especially since there is a pretty good chance this caused us to miscarry the last time.  You know I don’t believe in percentages, but if I had to give you one on whether this mass caused the loss or not, I’d say I’m 90% sure it did.

The doctor thinks that this Adenomyoma has probably been festering for a little while now (at least before the last transfer). In fact, the “fluid” that popped up back in December, that almost cancelled our transfer, we can most likely thank Mr. Adenomyoma for.  Fluid can be related  to many things, among them, less commonly, an Adenomyoma. Of course there was no way in knowing this was the relationship then-I saw every single ultrasound, SIS, and HSG with my own eyes, and this mass was not visible. So how can we not help but ask why, God? Back in December, we prayed and prayed for that transfer to be cancelled if it wasn’t right.  Maybe we didn’t see the signs.  I don’t know.  I’m not sure if we will ever know.  But, we can’t keep looking back, we can only look forward and hope.  Looking back hurts.  And getting angry doesn’t help either.  I know God never wastes a hurt.  My mom reminds me of this frequently.  If we can help one person, or couple out there, then at least some good can come out of this loss.

We received this card not too long ago, when we least expected it, from someone we do not know on a close basis at all.  It made me cry.  Tonight, when nothing seems to make sense, this card makes me remember how God is using us through this journey to touch other people’s lives.  Knowing that makes me feel better about “why.”  

Hysteroscopy

Despite everything we have been through, I must admit, I am still extremely nervous to get this hysteroscopy done today.  I suppose it’s been a while since I have had a “first” so to speak.  I know what to expect when I get a HSG, or a SIS, egg retrieval, transfer, or even a D & C unfortunately. However, I do not know what to expect with this hysteroscopy/biopsy business. Reading about it, or hearing how it was for someone else, isn’t the same.  At least from my experience, it always seems to differ.

I’ve spent some time trying to put my finger on what else could be making me so nervous, other than it being a “first.”  I know it can’t be the fact that I will only be in a twilight state, rather than completely knocked out.  I was in a twilight for our first d & c and I survived (although being asleep is definitely preferred).  Of course, I pray not to remember anything or feel any pain, just like any normal person would.

Perhaps, it’s the biopsy part that is freaking me out.  Whenever I think of a biopsy, I think of someone who is being tested for cancer.  I picture the doctor slicing off a piece of you, almost like a piece of meat.  Sorry to be so graphic, but it’s the truth.  

Or maybe I am just frightened because this is a last resort for us.  There are no more tests to be done.  This could be the missing piece to the puzzle, or so we hope. Honestly, my fear is probably a combination of all of the above.  So, today, I will keep trying to remind myself of what my mom has always told me, “there is nothing to fear except fear itself.”  

Fear-is-nothing-more-than-an-obstacle