Saturday, 30 November 2013

Deja vu, all over again

Although it wasn't a critical detail, part of my strategery for wanting to do a freeze-all cycle and a transfer on a later date (perhaps in the new year) was to avoid the potential for pregnancy on the anniversary of our ill-fated spontaneous conception. As it turned out, my transfer was only a few days before that one year mark. Obviously, I'm relieved that the transfer succeeded in producing a BFP (I finally had a true positive pregnancy test on 17dp3dt) as I'm sure it would have been much more painful to reflect on those memories while nursing a BFN. At the same time, I feel like I'm merely reliving my experience from last year. If (American) Thanksgiving were later this year, I would be squinting over my pee sticks during the long Thanksgiving weekend again. Random fact: last year Thanksgiving was on the 22nd -the earliest day it can ever be. This year it's on the 28th -the latest day it can ever be.

I ran the same 10K race on Thanksgiving day (with a m-u-c-h slower time). I found a place to stretch so I could avoid watching the Little Turkey's 100 yard dash, but I was still wiping away tears. I feel a little more confident that we'll eventually have our own little turkey competing in that race, but I acknowledge that I might not yet be holding my little turkey by this time next year. I went to my aunt's house for dinner and evaded my cousin's husband's questions about our plans for children. Last year, it was ironic that I was secretly pregnant while I was denying my intentions to procreate. This year, I was let in on the secret. I decided I could play the 'most other women don't know they are pregnant at this time' card and allowed myself a half glass of wine with dinner.

There are other events this time of year that conjure memories. Last year during our field hockey league play-offs, I informed my captain that I was 5 minutes pregnant and asked her to run penalty corners for me. Even though I knew it was okay to play, I was distracted the entire game and played really poorly. I started spotting the next day, which I know has nothing to do with the fact that I played. Yet, I just couldn't sign up to play at this time around. Pregnancy aside, I've only played in a few games this season, I've had conflicts with some swimming and running events as well as being excused for infertility treatments. I don't feel like I've been enough of the team to represent us in the play-offs.

My swim team is planning our annual holiday party. Leading up to the event last year, I was contemplating how I would hide the fact that I wasn't drinking. Cranberry juice and Sprite as a mocktail or secretly empty a bottle of Rolling Rock and refill it with something else? By the end of the week I was able to drink what ever I wanted. We've started training for our kicking time trials , which was a helpful distraction after my miscarriage last year. Myrtle called me on a Saturday morning while I was at the farmer's market. My mind flashed back a year ago when I received a call from Myrtle while I was at the farmer's market; "Is everything all right?" she asked "I was starting to worry when I hadn't heard from you in a few days." "As far as I know everything is fine, but we'll know more after our ultrasound on Wednesday." I replied, unaware that we've never make it to that ultrasound appointment. I decided it was best to let her call go to voicemail this time.

I had a dentist appointment to get a filling replaced, and as I sat in the waiting room, I wondered if I should inform them that I'm five minutes pregnant. Part of me felt it was just due diligence, but I also knew it wasn't exactly germane for them. The procedure is safe during pregnancy, and I knew they wouldn't do anything differently based on that information. Last year, as a woman fresh off her first ever BFP, I couldn't resist sharing the news with my hair dresser when she asked if I had kids. Although I doubted that she'd remember me at all, I couldn't go back to her. I decided against telling my dentist and his assistant. I didn't want to hear any coos of 'Congratulations!' over my protests that it's still so early and most women don't even know that they are pregnant at this time. I have another appointment in two weeks and I wouldn't want to have any additional people to inform if this pregnancy is non-viable. I'm not prepared to answer any questions such as, 'when's your due date?' and although I want to explain that we did IVF, I want to know if we're dealing with twins before I make that announcement.

I suppose that is the one variable that makes our present situation different from last year. Knowing that I barely could muster one mature follicle and with Husband's anemic sperm count, I felt completely confident that we would not be having twins. Yet, the thought crossed my mind when I started spotting, as sometimes that can be a sign. When I went in to be scanned, I had an initial sigh of relief when I only saw one sac. That was before I noticed that it was rather small, empty, irregularly shaped and in the lower segment of my uterus... Still, there was only one... My beta on Wednesday came back at 440. Okay, slightly more than double from Monday, but I did go to the lab a little later, so this was at 51 hours.

"I know you can't always tell from this;" I asked New Girl, "does this seem more consistent with a rise for a singleton?" I sensed that it was, but I needed someone else to confirm. She replied that in her years of working in REI, "when it's twins, the numbers are crazy high." I didn't ask how she defines 'crazy high'. New Girl just has such an articulate way of describing things. When she first reviewed my protocol with me she noted, "you are on a ton of meds..." A ton of meds. Awesome. It seemed like a typical regimen to me. I was wondering if she were brand new to this field, and thus perceived it to be a lot of medications, but apparently she has worked in other infertility clinics for a number of years and is just new to this office. I asked if I could have one more done, just for my own piece of mind. "Sure" she answered "But we're closed on Friday and won't be able to give you your results." Not a problem. I had the lab tech fax a copy to our office. So, while everyone else was trying not to get mauled at the mall on Black Friday, I was alone in my office catching up on charting and waiting by the fax machine. This is how everyone should received her beta results. 970. Just a little higher than doubling, but once again the draw was done at 50 hours after the previous one. Still, it's not 'crazy high'. Starting to release a slight sigh of relief...

Yet, I can't imagine how difficult this is for anyone who has had more than one miscarriage, or for anyone who progressed beyond six weeks. These milestones that are supposed to be reassuring have previously betrayed you. How can you trust them again?  It feels so eerie to be going through going through this process again at the same time as last year. It echos the notion that we've been down this road before...and serves as a reminder that yeah...things didn't work out. I know it doesn't mean that history is bound to repeat itself, but is also doesn't mean we're guaranteed an alternative ending either.

It was also last year during the long Thanksgiving weekend that I debuted my blog. I often wonder how we functioned before the internet, but I especially can't fathom how infertile women navigated through their treatments without Google. I merely wanted an outlet to express my thoughts, which has been cathartic in itself, but I never imagined that anyone would be interested in following my story. I've often commented that I feel that many of us would be friends in real life; infertility and blogging are simply the vectors that brought us together, but I now appreciate that many legitimate friendships have developed. Thank you all for your interest, your comments and all the support you've given me. I've not only survived the past year of dealing with infertility, thanks to you -I've thrived.

Wednesday, 27 November 2013

The Bad Stuff is Easier to Believe...

In the postcoital bliss, after Vivian violated her 'no kissing on the lips' rule; she shared with Edward the turn of events that led her to become a hooker on the Hollywood Boulevard. Despite the fact that she made good grades in school, her mother was convinced that she would end up with some loser. "People put you down enough, you start to believe it." she explains.  Edward Lewis begs to differ by describing her to be a very bright and special woman.  Vivian isn't buying it. "The bad stuff is easier to believe. You ever notice that?"

As I was only 14 or 15 when I first watched Pretty Woman, my fragile teenaged self esteem could totally relate to that line. Now more than twenty years later, I am an accomplished professional who generally holds a healthy degree of self confidence. Yet with regards to the prognosis for this pregnancy, I find myself falling into that trap: the bad stuff is easier to believe.

Perhaps some of it is bias from my own work experience. The bad stuff is easier to believe because I've seen so much of it. I've had hundreds of couples in my exam room, excited and hopeful about seeing their baby on ultrasound, only to have their dreams crushed after I discover a non-viable pregnancy. A little less frequent, I've received abnormal genetic results, and have prepared the expectant parents for some difficult decisions. Even more rare, an anatomy ultrasound reveals serious abnormalities to an unsuspecting couple who were hoping just to learn if they are having a boy or girl. Sometimes unthinkable tragedies occur without explanations. I know so many bad things are possible as I've witnessed them over the years. Why should I think that I'm immune to any of it?

Two days before my beta test, my aunt called to confirm what type of pie I would be baking bringing to Thanksgiving, so she could coordinate with what she would have my cousin make. The mere mention of my cousin immediately conjured jealousy and resentment that they were a first time IVF success which yielded a healthy and happy baby. The statistics started flying though my head: she was older -39 at the time of oocyte retrieval, but they were considered to be unexplained. We have a diagnosis of moderate male factor and my ovaries under-performed. I started to question how many embryos they transferred and when. I think they transferred more than one as I recall her husband expressing relief that there was only one baby when she announced her pregnancy. I wondered how many fro-yos they had. I know their numbers and experience hold absolutely no bearing on our potential for success or failure, but damn my curosity! I'm only five minutes pregnant, still far away from being considered a first time IVF success.

At the same time, what evidence did I have to suggest that this cycle wouldn't be successful? I am dubious about our embryo quality. My RE noted that he would have liked them to be of higher quality, but followed by describing that he has that wish for most patients in an, 'I'm never truly satisfied' way. Although I'm still paranoid about the possibility of twins, I'm not sure if either embryo can go the distance. Recently, when I expressed my concerns that IVF may not work to Myrtle, she mused "doesn't it always take a few rounds with IVF? I know people who went through it multiple times to get their two kids." This was after she asked me if there was an alternative treatment to IVF that I could employ. You see, Myrtle knows people who have gone through IVF...

The possibility of multiple treatment cycles is something you can only discuss with a fellow infertile. It was really intolerable to hear someone who conceived on her second attempt convey to me that it would take a lot longer and cost a lot more to become pregnant. Based on what? This arbitrary notion that it just takes multiple rounds of IVF to get a take home baby? That's just the way it is. It just takes multiple attempts. Based on Myrtle's vast and extensive experience with her infertile friends? It seemed just as injudicious as when Myrtle's friend forecasted that it would take six months for her to become pregnant. (That same friend also conceived during her first cycle off the pill).

As Husband has built his own support network and has shared our IVF journey with a few friends, I discovered that he has his own version of Myrtle. "No. Much worse," he describes. J is a fellow hockey umpire and he and Husband spend a lot of time together. When Husband first shared our fertility struggles, J humbly admitted that he couldn't relate as he recalls that at least two of his kids were conceived on the first or second time without condoms and he doesn't think they tried more than three months for their third. Fortunately, he never offered any foolish words of 'advice', but he couldn't grasp the concept when Husband informed him that we were barely pregnant. He would make himself available to cover for Husband in any of his games if I went into labour early. He volunteered his oldest daughter for baby sitting. He offered that he could have his mother make us some meals for when I'm postpartum and don't feel like cooking (which is different from now...how?). When Husband dropped him off at his house after they returned from a tournament in Santa Barbara, he sent a text: "thanks for driving, say good night to Jane and the little one for me." (Yes, me and my little faintly positive pee stick...) I'm going to go out on a limb and presume that J's wife went 3 for 3 with her pregnancies.

The bad stuff may be easier to believe, but it doesn't mean I'm obligated to believe it. Feeling optimistic or hopeful is hard, but it doesn't meant it's not worth trying. I may not be as confident about our outcome as J (who is probably already planning the baby's first birthday..) but I don't need to be so consumed with self doubt. I found something to be excited about: whatever happens around the end of July/early August next year, I am cashing in on that promise for J's mother's cooking. Authentic homemade curry... now that is seriously good stuff...

Monday, 25 November 2013

The POAS Diaries

Shortly after we listened to Misery's voicemail; Husband, anxious to demonstrate how fluent he is in infertile-speak, exclaimed "You got a BFP!" That was my cue to see for myself. I had no urge to POAS during the lead up to beta day. As Gypsy Mama recently described, I couldn't bear the sight of another negative pregnancy test; which would also be followed by tortuous hours of second guessing and holding out for the eventual beta HCG. Now I could succumb to my curiosity. I ran a test and left it out on the counter while I was getting ready to go out to dinner. I didn't time it, but I estimate that I came back to check it about 5-7 minutes later. The slightest hint of a line was present. Honestly, I wouldn't have been surprised if it were negative, as most tests only detect levels about 25 and mine was 36. I also should have thought to collect my urine when I first arrived home and had at least a three hour concentration, thanks to rush hour traffic. I told Husband that it wasn't so much a Big Fat Positive, as it was a Barely, Faintly Positive.

Ah, but once you start, you can't stop. I decided to test again the next morning, expecting to see a bit more of a defined line with a first morning sample. I kept an eye on the clock this time. We teach our medical assistants that a positive result will usually show within a minute, and that you shouldn't read a test after a full three minutes. Although most of the patients we test in our office are actually past due for their cycles. Am I even considered late, as my RE had me test rather early? My iPhone app thinks my period is two weeks late. I need to enter a fake date to put an end to the reminders.  At the three minute mark, my test looked completely negative. I think around 5 or 6 minutes, I could start to make out the blue line, and yes it did look a little darker than my previous test. Accordingly, my HCG increased to 65.

Saturday morning and I tested exactly 24 hours later. This time I used the stop watch feature on my phone to time. The control line appeared within 30 seconds.  Three minutes -totally negative. Five minutes -still totally negative. Eight minutes -nothing. 10 minutes -maybe barely something. I started running a second test. The second test also appeared negative after ten minutes, but I could start to appreciate a faint line on the first test, which had now been sitting out for nearly twenty minutes. I know the limitations with urine testing, but I didn't feel that I could justifiably consider myself to be pregnant when standard protocols for urine pregnancy testing would interpret my tests as being negative. I'm still an impostor. I'm only pregnant on paper.

I didn't share any of this with Myrtle. While it pains me a bit to exclude her, I decided that it's best to keep her outside of the circle of trust for now. I know she has no comprehension for the science, nor my perspective. She peed on a stick once, got a positive result and had a gorgeous, healthy baby girl. I had to explain to Husband that she never had serial HCGs drawn; it's not routine practice for fertiles. I'm not excited. I'm cautious. I'm realistic. It just doesn't seem logical that we could be a first time IVF success, that yields not only a (true) BFP, but a single, chromosomally normal fetus (who will later escape my threat of pre-eclampsia and arrive into the world at term and healthy). I'm not naive.

It just doesn't feel like this is meant to be 'it'. Maybe I've consumed too much of the Day 5 Embryo Kool-Aid and I have too little faith in our day 3 embies. Despite my RE's attempt to offer reassurance to the contrary, I still regarded this transfer as a Hail Mary pass. I viewed it as a 'practice' transfer before we could proceed with our voted more likely to succeed day 5 blastocysts. Then again, if our day 5 blasts are so great, why didn't they look better on day 3? Who is to say that our day 3 over-achievers wouldn't have made it to day 5? I'm still so skeptical. I question if I'm just trying to prepare myself for a bad outcome or if I intuitively sense that this isn't going to work.

I'm managed to make myself emotionally numb; as if I've administered an epidural to my brain. I want this to be it. I am hoping that this is the one. Yet, if it's not, I want to know as soon as possible. Fail fast, fail cheap. Well, not cheap in financial terms, but before we make any emotional investments. If you're not meant to be our baby, please do me the favour of declaring this as a chemical pregnancy. Do not fuck with me by progressing to week six or beyond only to devastate us with the discovery of absent cardiac activity. Thus I can look at these low betas and barely, faintly positive tests with both concern and relief.

Hi, my name is Jane and I'm addicted to POAS. [Hi, Jane!] At first I was just curious to POAS, just to see what would happen. Before I knew it, I was POASing every day...

I know there is no information to be gleaned from determining how long it takes for a pregnancy test to become positive. Although in theory, if my hormone levels are increasing, then the test should be positive quicker and the line should be getting darker. I need to keep reminding myself that I am so early compared to when most other women test. I just felt that I should be collecting data, even if were irrelevant. On Sunday morning, (12dp3dt) I could barely see a line after ten minutes. It was a little more noticeable after fifteen minutes and present, although still very light after thirty minutes. I know this merely indicates that my beta is still pretty low, which I already knew. In the interest of the scientific process, I decided to re-test in the afternoon. Familiar scene: negative after three minutes, negative after five, negative after ten. Still negative after twenty...thirty...forty five minutes...an hour later and not even a hint of a blue line. Like any junkie, I needed my fix, but this time I needed something stronger. I went out to the pharmacy to pick up a digital test. Still pregnant according to the display. Time to stop testing for today, as like any addict, I needed to hide the evidence of my habit before Husband came home. Of course, I would lie if he were to ask if I had POAS'd.

Monday morning (13dp3dt) hours before my beta draw, the test was still negative at 3 minutes, but a faint line appeared around five minutes. After 10 minutes, the line had not become any darker. I also ran my other digital test. It took over two minutes for the monitor to declare that I was still technically pregnant.  I shared with Co-worker that I felt completely prepared if I were to learn that this was a chemical pregnancy. "Why are you obsessing over these pee sticks?" she asked. Why? I wanted to pee on a stick, see two lines and declare myself to be pregnant like any other woman. I still feel as if I'm literally grasping at straws; pathetically squinting to identify a blue line in a manner similar to looking at those 3-D posters. Ultimately, as I know from my prior experience, these faint blue lines may be all I have to show for my pregnancy and I want to capture them while I can.

My blood was drawn at 8 AM, so I had hoped that I might have some results by lunchtime. Previously, I had been called around 3 PM. It was now quarter to four and still no message. I figured if it were bad news, they would wait until the end of the day. Minutes after 4 PM, there was a voicemail message on my phone. I presumed that if the message were to 'call us back to discuss your results' or if it were my RE himself calling, it was likely bad news. To my surprise, New Girl's message revealed that my beta was now 183 and my RE was pleased with how it was rising. I needed to do another draw in 48 hours, but she had tentatively scheduled my first OB ultrasound.  Husband and I had been treating each one of these beta tests as if we were clearing one individual hurdle at a time. We've passed 3 of 4 so far, but it still feels like there is so much ground to cover before getting to our ultrasound. Thus, I'm still pursuing this challenge of getting a true, normal, positive back office pregnancy test. Alas, my name is Jane. I am addicted to POAS.

9dp3dt -Beta HCG 36

FMU 10dp3dt -Beta HCG 65

FMU 11dp3dt (top after 20 min bottom after 10)

Mid Afternoon 12dp3dt -Totally Negative

13dp3dt -beta HCG 183

Friday, 22 November 2013

Well...sort of...

I remember when I first saw the episode of Sex and the City where Charlotte receives a phone call from her doctor and then relays the message to Harry that their IVF cycle failed. I thought to myself, that's not how you find out if you're pregnant! I couldn't understand why Charlotte wouldn't just take a home pregnancy test like any other woman. Now I know that someone on the SATC writing staff must have had personal experience with infertility.

Fortunately, both Husband and I were pretty busy in the final days leading up to test day. It wasn't until we were both sleepless during the wee hours of Thursday morning that the nerves set in. I felt haunted by a ominous premonition that my test would be negative. I decided against swimming that morning, as I wasn't too keen to have any more time alone with my thoughts. Conveniently, I was already scheduled to be out of the office that day, as I had to teach another contraceptive class in the South Bay, which meant another two hour drive -each way.

This time, the class started a little later, so I was able to make it to the lab and didn't have to draw my own blood again. The drawback was that I would still be teaching around the time my results would be ready. Husband would be umpiring a hockey match at that time. I decided that I wouldn't want to be alone when I learned the results, and I wouldn't want to hear them at a time when I couldn't call him right away. I wanted us to be together when we received the news. Even if it meant prolonging the wait. I emailed my RE's office explaining that I wouldn't have access to my phone all afternoon and I requested that someone leave a detailed message with my results. I received a response from my RE himself noting "will do!" I chuckled to myself at his use of an exclamation point as I figured it was added for assurance that I wouldn't call him on his personal phone again.

I finished my class and checked my phone. Missed call and voicemail message. I went from anxiously waiting by the phone to ignoring it. I trudged through heavy traffic for the next two and a half hours with the message with my results right by my side. My mind wavered between preparing for disappointment if the beta were negative and panicking about the potential for twins if it were positive. Finally, three hours after Misery called, Husband and I listened to her message. "Hi Jane, we received your HCG results and it's 36... So you are pregnant. We'll need to repeat it on Friday, so let us know where we need to fax your lab slip."

My first thought: that seems a bit low. This could be a chemical pregnancy. Why are they having me repeat it in 24 and not 48 hours later? Husband and I shared a collective sigh of relief and hugged each other before we left to grab some dinner. I thought about other couples who go out to celebrate after discovering they're expecting. They probably gush about decorating the nursery or propose possible baby names. We were looking up expectations for HCG levels on our phones. This is what infertility and pregnancy loss does to you. I collected data from my pregnant bloggers and compared their values to when they tested. Mine was much lower, but it seems that my RE had me test a bit earlier at 12 days post retrieval (9dp3dt).

I decided that I could come to terms if this were to be a chemical pregnancy. It would feel a little more encouraging than a total BFN; and if this is to be a non-viable pregnancy, I would prefer to have it resolve as soon as possible. My second beta came back at 65. It was drawn nearly 27 hours after my first (performed on a Friday to avoid the weekend). If we were to project a doubling rate in 48 hours (which would bring it to 72) then it should have been around 54 after 24 hours. Seemingly within range. Then again, I had perfect doubling with my first pregnancy. It's reassuring, but at the same time doesn't really mean anything. Yet, this is where we are right now. I'm pregnant. Well...sort of...

Wednesday, 20 November 2013

An Element of Luck

Woody Allen's Matchpoint is probably one of my favourite films, despite the fact that no one taught the actors how to properly hold a tennis racquet. The opening lines provide some much insight into the film's pensive objective:

The man who said "I'd rather be lucky than good" saw deeply into life. People are afraid to face how great a part of life is dependent on luck. It's scary to think so much is out of one's control. There are moments in a match when the ball hits the top of the net, and for a split second, it can either go forward or fall back. With a little luck, it goes forward, and you win. Or maybe it doesn't, and you lose.

I've often observed that good fortune seems to follow certain people, and others seems plagued with misfortune. People who always seem to be in the right place at the right time. Those who win raffles and other games of chance. My Australian friend Kylie has a former colleague who fits into that category. She and her husband were considering moving to LA to be closer to his family. At a conference, she ran into someone who offered her a great job in that area. The starting salary was already a sizable increase from her current income, but within a few months they gave her a pay raise and an expense account for clothes. I don't doubt that she works hard, but she doesn't necessarily put in more hours than others in her field who were taking pay cuts just to hold a job in the ailing economy. They bought their house on a short sale and got a steal of a deal. She conceived from a one hit wonder and delivered a healthy girl. It just always seemed that when Kylie was providing an update on her friend, she was announcing even more good news.

Then there seem to be others who live under a black cloud. No matter how hard they work, they seem to be haunted by unfortunate occurrences and events. They suffer setback after setback and can't seem to catch a break. In a crowded car park, the run away shopping cart will hit and dent their car. If there is a rare medication reaction or complication, it will happen to them. They seem to find themselves on the adverse side of long odds. This includes those who experience infertility and pregnancy loss.

Yes, no one can deny that an element of luck that operates in one's life, and as the quote notes, people seem reluctant to admit just how much of a role luck plays in their lives. We started the IVF process believing that we were reasonable candidates and felt that we had a decent shot. Although I've felt that notion has been challenged at times, both my RE and embryologist have reassured us that there is some room for optimism within rational expectations. "If you get pregnant, I won't be surprised. If you don't get pregnant, I won't be surprised." My RE summarised with a description that feels like that tennis ball bouncing on the net; only that split second is 10 days until we learn which side the ball lands.

Post transfer it seems as if it is all down to luck at this point in time. I feel I've been served with a reasonable amount of good fortune in my life, has my luck run out? Or does my inexperience with infertility and my miscarriage represent enough bad luck that I'm due for some good karma? It feels as if I am asking a lot from luck right now. I want this treatment to succeed in creating a pregnancy, but I only want it to yield one baby. Is it too harsh that I'm rooting for one embryo at the expense of the other?

I know what you're thinking. "Did he fire six shots or only five?" Well, to tell you the truth, in all this excitement I kind of lost track myself. But being as this is a .44 Magnum, the most powerful handgun in the world, and would blow your head clean off, you've got to ask yourself one question: "Do I feel lucky?" Well, do ya, punk?

Monday, 18 November 2013

The Waiting is the Hardest Part

The first night after my transfer, I dreamt that I was pregnant with twins and my bump was so big I could barely stand up straight. Then my water broke at 25-26 weeks and the doctor caring for me was one of the perinatologists I worked with while I was living in Connecticut. He came into my hospital room and said, "Twins, Jane?" with the same irritated tone and look of disdain that I received if I answered a question incorrectly during morning report. I am somewhat taking this as a good sign, as none of my other pregnancy related dreams have come to fruition and for that matter, I never did sleep with my Kiwi crush. I wonder if he has a nice deck...

Animals are so remarkably perceptive. My cat, A, would sit near me as I was administering my shots and he snuggled by my side while I was recovering from my retrieval. I think he knew before the embryologist and my RE that we would be doing a day 3 transfer as he was really chatty and especially clingy that morning. I somehow felt that he was trying to alert me. Our other cat, K, just enjoyed playing with the Q-caps.


I've had a few cramps and the odd wave of nausea, but I am not going to apply any meaning to any symptom. I figured if I could have been misled by inserting progesterone suppositories into my hoo-ha twice a day, then inserting them three times a day and injecting PIO into my hutt every other day has the potential to have the same effects.

If this transfer doesn't work; I can allow myself to be disappointed, but not devastated. It does not render a verdict that I will never be pregnant, just that it wasn't meant to be this time.

I shouldn't think this far ahead, or think this way at all; but if at some point IVF succeeds in producing a take home baby, then I'm entitled to an 'Infertile Women are Smug' moment. I can show Myrtle the first photo of our baby as a 9-10 celled embryo and ask, when did you first see your baby? 8 weeks and 4 days? ...yeah...I WIN.

There is a new nurse at my RE's office (creatively named, 'New Girl') who is much more personable than Misery (although she has thawed quite a bit). When she called to review the instructions for a tentative day 3 transfer, she asked how I was feeling and I expressed that I wasn't encouraged by our numbers. She didn't say anything cliche like, 'it only takes one!' or recount a case of a patient who had a million to one odds and got pregnant. I don't think anything she said to me that was enlightening or particularly poignant. It was just comforting that she listened to me. When I called her after my transfer to detail when and where I would be doing my HCG, she greeted me; "What's up Girlfriend?" While I really appreciate her warmth and personal touch, I wasn't sure I was ready to be addressed as 'Girlfriend'.

My post transfer instructions noted 'No intercourse/orgasm for 5 days'. I waited until exactly until the end of 120th hour to lift that restriction.

After watching many progesterone capsules wash down the sink as they slipped from my fingers while holding them under the tap; I finally noted that it would be a good idea to close the drain.

If I needed to distract myself from thinking about what may or may not being going on inside my uterus, I would watch this video. Warning: It contains some inappropriate content and slightly mocks the New Zealand accent.

I went out with a few friends to a club in the city that was featuring an 80s night. There was a woman who looked to be about 6 months pregnant who was dancing away. I looked at her and thought, perhaps that could be me.

I've been refusing to consider myself Pregnant Until Proven Otherwise (PUPO). Although technically accurate, it still feels like I'm tempting fate.

Watching our embryos being placed in my uterus was really fucking cool.

I was so hesitant to pursue IVF because I feared weight gain. I dreaded the thought of putting on ten pounds before I even became pregnant. I actually lost one pound during my stimming, and although my weight crept up three pounds on the day after my retrieval, I was down four pounds by the time of my transfer. I was especially fearful that the IM PIO would pack on bulk, but I somehow lost more weight and went under 150 for the first time this year. I stopped swimming two days before my retrieval and haven't done any exercise since my transfer. What gives?

Sixty hours from having my blood drawn for my beta test and I have absolutely no idea which way this could go...

Saturday, 16 November 2013

Somebody to Shove

And I'm waiting by the phone
Waiting for you to call me up and tell me I'm not alone
Yes I'm waiting by the phone
I'm waiting for you to call me up and tell me I'm not alone

Cause I want somebody to shove
I need somebody to shove
I want somebody to shove me
Yes I want somebody to shove
I need somebody to shove
I want somebody to shove me

I never understood those lyrics until now...

Among all the things I resent about infertility, I hate the way it keeps me waiting by the phone. I feel like a desperate single woman who is hoping that the guy she met at the bar last night is going to call. In particular, this feeling is a little raw for me as I was that woman while I was dating my RE's doppelgÀnger. Every time I walk past my phone, I have to press the button to see if I missed a call. I check the signal strength to make sure I'm in an area with good service. I'll make sure the ringer is not on silent. I'm hyper vigilant to any noise that sounds like my ring tone.

To my RE's credit, he has been very prompt with disseminating critical or time sensitive information. After our transfer, he stated that the embryologist would wait until day 6 to determine if any of the remaining embies are freezer-worthy, and I would hear from him on Friday or Saturday. I didn't. receive a call on Friday. I figured maybe the embryologist was holding out a little longer. I appreciated there was less urgency with this update as it wasn't affecting our current management. However, we were still curious. While we were eating dinner that night, Husband noted that he'd be pissed if we didn't hear anything on Saturday. We've technically paid for these embryos and they are our investment. In particular, our fees covered having ten embryos in cryostorage. Ever since it was projected that I would only produce 6-8 mature eggs, Husband has been anticipating getting a refund. An evil thought came to my mind. Last Sunday, when my RE called with my initial fertilisation report, he used his personal mobile phone (which also still has an east coast area code). I still had that number in my phone..."No, you're better than that." Husband admonished.

I decided I could enjoy a leisurely Saturday morning as I waited by the phone. I poured a cup of tea and fixed a few pieces of toast. I settled in at our breakfast bar and caught up with my blog reading. I wanted to make some fresh squeezed orange juice, so I placed my phone on the counter, just in case I missed hearing it over the noise from the juicer. It was now 10:00. One of my mentors taught me not to return calls in between scheduled patients. "Don't keep someone with an appointment waiting." Unless there is something really pressing, I try to hold to that, although I use our email system a lot as I find it easier and quicker to reply to patient messages in between visits. I figured he would want to get patients in and out of the office and let the staff members go home. I decided I would take a shower, figuring that would prompt the phone to ring. It didn't.

Then I remembered I could be a Rules girl. I didn't have to wait at home on a Saturday night for a guy to call, I could call the embryology lab myself. Except as I suspected, they wouldn't give an update directly to me. I proceeded with my chores, thinking that vacuuming might tempt a call. At last! I finally heard a ring from my phone. I ran to pick it up, only to discover that it was my formerly infertile until she went to Hawaii and relaxed cousin requesting to Face Time. My cousin was on the east coast visiting her husband's extended family and they were spending a few days in Connecticut with my parents. Firstly, I hate Face Time. I find it incredibly awkward. Secondly, if it wasn't hard enough seeing photos of my parents with her kids on Facebook, now I could watch it live?  While I was waiting for an embryo report? (not that she remembers those days) Potentially tying up the phone line? (I'm not sure if it does, but I didn't want to take any chances) No fucking thank you. Face Time request: de-nied.

Damn it! I just wanted to know if we had any fro-yos! As I returned to my cleaning, I began to acknowledge that we probably didn't have any. If there were any surviving embryos, they would have called us with the report. I could only imagine hearing Misery or New Girl explain that they didn't want to stress me with any bad news. Then, randomly, the lines from that Soul Asylum song came to mind. Not only did those lyrics suddenly make sense for the first time, but I felt that they were directly speaking to me. I was waiting by the phone. I wanted somebody to shove. I needed somebody to shove me. It was now 11:30 and time to shove.

I quickly rationalised that although it was going to be inappropriate to call my RE on his personal phone, it should at least be done by noon. I picked up my phone and scrolled through my received calls. I found his number and nervously pressed send. It rang a few times before the iPhone default voicemail answered. As I was leaving a message, my phone beeped to alert an incoming call. He must have just missed my call. "Hi Jane, it's__________" he greeted while addressing himself with his first and last name. He's referred to himself by his first name a few times before, I think as an attempt to be collegial, but I've never been able to call him by his proper name as he shares the same name as Husband. "I'm sorry to call you on this number," I began. "No, that's fine." was his calm, unflappable response. "Two made it to become blastocysts and they both look good" he announced. I don't remember much of what he said after that as the cellular reception at our house is shit and I was trying to get Husband's attention to show him that I was holding up two fingers. I zoned back into the conversation to hear him say that he was optimistic. "Okay, thank you very much!" I replied. "Enjoy the rest of your weekend Jane." "Same to you." ...and press 'end'.

I was so happy with this information, I could easily overlook the unorthodox means I used to acquire it. I decided to attribute it is as one of my RE's absent minded professor moments. Although he's brilliant, I've noted he can be a bit scatter-brained. His staff seem to play close attention to his instructions as he tends to confuse dates and he made an error in his own notes with my progesterone in oil dose. Anyway....we have two embabies on ice! This cycle is granting us three attempts for a pregnancy and possible baby. Husband quickly did the maths and noted that two FETs would be less than half the cost of another fresh cycle. Almost a third of the cost if you include the price of meds, not that anyone was counting; but oh yes, he was.

Husband observed that we seemed to have been on the borderline for so many aspects of this cycle. If we didn't have any that progressed to blastocysts, or only had one; it would have resonated that I made the right decision with my day 3 transfer of two embies. If I had three or more that made it to the blast stage, I would have wished that I held out for a day 5 single transfer. We have two; still oscillating in the in-between territory.  It helps prepare for my upcoming HCG test. If it's negative, we have embryo insurance. Two reserves; to be transferred one at a time.

You're a dream for insomniacs, prize in the Cracker Jacks
All the difference in the world is just a call away

Thursday, 14 November 2013

Life happens while you're making other plans...

Every now and then, I'll encounter a patient who has an elaborate or unrealistic birth plan; and I'll gently remind her that she'll need to be flexible and ready to roll with the punches. Labour and delivery is so unpredictable and situations can change without a moment's notice. It somewhat amuses me when patients seem to have a script for their birth performance. Although I obviously have no personal experience, I'll often mention that the lack of personal control during the birth is only heralding the absence of order that will accompany the arrival of baby chaos. I haven't even made it past six weeks gestation, but I've been discovering that nothing related to procreation is mine to command.

Pausing for a brief moment to recall that my procreation plans originally included conceiving early so that our baby would be born in 2012 and could be a leap year baby like me. I wanted to avoid having a baby born in the unlucky year of 2013 (wish granted!) and I'm not holding out for 2014. Although the Universe has been ignoring virtually all my requests, I will mention that 3/14/15 would be an awesome birth date as it's Pi Day out to five places. Until Husband pointed out that technically it's not, as the full date is 3/14/2015 and that it's American Pi Day, as the proper way to write the date is 14/3/2015.

Perhaps equally ridiculous, is the fact that I thought I could plan my first IVF cycle. My RE mentioned a few times that you don't know how things will unfold during a cycle until you start the process. Non Sequitur Chica offered sage advice when she described her first IVF attempt as a diagnostic cycle. Yet I thought I was still operating within reasonable expectations. I knew I wouldn't be a chicken that would produce twenty or more eggs. In fact, I accurately predicted the dozen oocytes retrieved (I just underestimated their maturity). I was surprised when my RE initially expressed concerns for a possible over response.
     
"What is his rationale?" Husband asked, "I need to see the maths." Here is where hubris would get the best of me again. I've felt that I've been sitting on a goldmine in the form of my AMH of 4.53 (Day 3 FSH 7.1). When I first received that result, I questioned it as an AMH >4.0 can be suggestive of Polycystic Ovarian Syndrome (PCOS) in the presence of clinical features. I emailed another local RE to get a consult for a "patient". I listed my age, lab values and noted how much exercise I do to explain that my near overweight BMI is due to muscle mass. He replied: you can reassure "your patient" that she has a good ovarian reserve. (Air quotes were not actually used, but I'm sure they were implied)

My RE was actually the one who initially suggested doing a freeze all cycle. When I asked him about PGD testing, he responded, "You're a good candidate for it" as he noted that he often has patients who are in their early 40s who ask for it, not realising that they won't have enough embryos that will progress to that point. The unknown variable with our cycle would be how my eggs would fertilise given that we are dealing with male factor issues.

Thus, I felt that I had it all planned out. I would produce a decent yield of eggs for an old bird, and hopefully a good number would fertilise and could be biopsied before being sent to the freezer. The PGD testing would allow us to transfer euploid embryos only and thus could prevent the heartbreak from a miscarriage due to a chromosomal abnormality. I even got greedy dreaming that we could select a female embryo. Most of all, we could only transfer one embryo at a time and nearly eliminate the possibility of twins.

From the moment I heard my RE project that we'd only obtain 6-8 mature eggs, I became discouraged. I knew we'd be working with fewer embryos. Although there were concerns about fertilisation, Husband's boys were up to the challenge. His Wank In a Cup (WIAC) results boasted a concentration of 29 million with post prep at 9 million, higher than any of our IUIs. It was his best sperm day ever. His motility was unusually low at 30%, but who cares when you're doing ICSI!

Seemingly, all my plans went out the window when I heard my RE recommend transferring two embryos on Day 3. On a minor detail, I was looking forward to having the stimming and retrieval and the transfer and waiting to be two separate events at different times. I had just refreshed my lingerie collection and wouldn't even get to wear my new underwear once before they would get yucked by progesterone suppositories. Dare I even think that we could select the time for our FET and chose when we wanted to try to get knocked up. I wasn't going to be able to do PGD testing to select a normal embryo for my transfer.  I was being asked to surrender my intention for a single embryo transfer.

I believe my RE was very perceptive when he forecasted that I would regret a day 3 single embryo transfer if it were to fail. He was right. I would know that the lone transferred embryo was a dud and I would wonder if a second one may have implanted. If my beta is negative, then at least I can feel relieved that I'm not facing the possibility of twins. If I am pregnant with twins; I will be pissed. I will be pissed at myself for not sticking to my resolve on a matter that was so important to me. My RE commented that even when we were attempting conception with intercourse, there was still a risk of twins. I smirked. Did he not note how pathetic we were at trying to conceive the natural way? This is part of the reason why we're here. Even with ovulation predictor tests, I couldn't figure out when I was ovulating and whether we could manage coitus was another obstacle. Still, there is a difference between an occurrence of twins as a random event in nature and acknowledging that I uttered the words, "we'll transfer two..." to the embryologist.

I'm ashamed to admit that I had a bit of an outburst when my RE first reported the embryo status and his recommendations. While I appreciate that the ultimate worse case scenario would be not having any embryos to transfer or freeze, I still needed to lament frustration about this cycle. It was more than petulant whining that things weren't going to plan or that I wasn't getting my way. I felt that I had failed to meet expectations. I had to transfer my embryos earlier and in greater quantity as their prognosis was poor. "Jane, Jane, Jane...Jane!" My RE tried to avert me from going off the deep end, although it was a bit too late.  "A Day 3 transfer is not a desperation measure," he reassured. Really? Then why did it feel as if it were. It's never easy to discover that you're not as good as you thought you were.

Even as I'm finally accepting that I have little control over this process, I can't resist trying to plan our next steps. I'm curious to hear my RE's postmortem analysis of this cycle. Would I have been able to produce more eggs if I didn't have to reduce and sometimes hold my stims?  Going forward with another cycle, would it be better to start off at a lower dose and then increase? Would Husband be able to equal or better his awesome WIAC performance? If we have any fro-yos, when would we want to transfer? I'd like to attempt endometrial injury prior to an FET, can I have one of my colleagues do my endometrial biopsy?

Then again, maybe life is what happens to you while you're busy making other plans...

Tuesday, 12 November 2013

Increasing Efficiency

At the end of our initial consultation, my RE explained that he likes to review the mechanics of reproduction with every patient, regardless of their education level or prior experience with infertility treatments. I turned and gazed at the window to conceal my eye roll, although Husband listened intently. He summarised his birds and bees lecture by noting that human reproduction is very inefficient. Despite the reputation of rabbits, mice are actually one of the most efficient reproducing species (fortunately, he didn't go into further detail...) The female human only has a few brief fertile opportunities each year, while the human male wastes millions of gametes (sometimes recreationally). "Maybe from a standpoint of population control it is very effective, given that humans consume the most resources" I replied, truly intending to make a good point, while enjoying the added bonus of coming off as a smart ass.

When I first had the IVF talk  with my RE, he pointed out that IVF provided a more efficient means of human reproduction. I felt that he was trying to be somewhat consoling; 'I'm sorry that infertility has dropped you in the bottom of the heap'. Yet he did have a point, after you get past the injections, retrieval and fertilisation in a Petri dish , IVF does offer a lot more opportunity than the average romp in the sack. Of course, that thinking is presuming you have a good retrieval, good fertilisation rate, good embryo development and enough embabies to stick on ice.

To a certain extent, we have achieved the goal of increased efficiency. In one cycle, I produced eight mature eggs. Five fertilised. To our knowledge we only had one other episode of fertilisation, and we all know that didn't work out too well. Yes, we're way ahead of where we would be without intervention, but is it far enough? It's so interesting how quickly your perspective can change. Eight mature eggs seemed meek compared to twelve oocytes retrieved. The number eight seemed robust compared to five fertilised eggs. I had the feeling that by my day 3 report, I would be longing for the number five. A week ago, my RE was looking at our number of follicles and at my E2 levels and described that things looked "good". Now our prognosis seems anything but good. I shared some of my concerns with him just before my retrieval. Six to eight mature oocytes meant we'd be working within narrow margins. "When you're pregnant, you won't remember these details" he replied with a hand patting my thigh. I wondered if he was just trying to shut me up before the anesthesiologist did it for him.

I commented to Co-worker that if all five (realistically, at least four) of our embryos made it to day 5 and we could complete our intention for a freeze all cycle, I would consider this attempt to be a success from an efficiency standpoint. She reminded me that my goal with this treatment is to have a baby, not necessarily to have a collection of embryos. She is correct, we only need one to work as we only want to have one child. If we succeed, we really don't need to have any embabies on ice, so maybe this cycle could be deemed efficient in that respect. However, if we only end up with one (or two) embryos to work with, then it's hard to argue that IVF is increasing efficiency, but rather compensating for a defect.

After reading my initial fertilisation report, my RE thought a day 3 transfer was less likely and he seemed confident that we'd make it to day 5. I couldn't escape feeling that the entire process seemed like a long shot. More so, I started to fear that if we couldn't produce a decent yield of embryos would it even be worthwhile to consider pursuing a second IVF cycle? I projected that if at least four embryos survived to day 3, we could proceed with our Day 5 freeze-all. If there were three or less, we would need to do a day 3 transfer. Then I remembered these are our embryos! They have our genetic material. They have Husband's stubbornness and my determination. Progress to day 5? Challenge accepted! Bring it on Bitches! It was the first time I acknowledged any attachment to them. Is it odd that I felt a sense of pride?

My RE called with my embryo update while I had two patients waiting in rooms and I was on the phone reviewing a stat report with our radiologist. As soon as I spoke with him, he wasted no time giving the report and recommendations. Embryo quality wasn't bad, but wasn't good. He was advising transferring two embryos now. If we decided to wait until day 5, we may only have one or two, or worse case, none. I quickly rationalised, that if I were going to lose some embryos anyway, it was better to put some in my uterus. I felt really defeated. It was frustrating enough to acknowledge that we were pathetic at trying to conceive on our own, now we sucked at IVF too.

Here was the situation I desperately wanted to avoid. Transferring more than one embryo and potentially facing twins. Although I was also questioning if our possibility for pregnancy was so low, was I being daft for even fretting about twins? My RE had noted that based on my age, I nearly fell into the 'poor prognosis' category when it would be recommended to transfer three embryos. At the same time, I couldn't deny my fears. I don't want to be another IVF twins statistic. I don't want to have people look at me and think to themselves, 'she should have known better.'

I spoke with my lead physician. She suggested that if he was advising transferring three, than I should at least go with two. Very reluctantly, I agreed. It would increase the efficiency of the transfer. My RE revealed that if he were talking to me about one of my patients [with our details] he would recommend two. If I were a member of his family, he would recommend transferring two embryos. Nearly every REI clinic would advise a transfer with two embies on board. It's so hard to go against such strong recommendations, but at the same time, no one making such suggestions has to live with the consequences. I do. He discussed the potential for regret if I elected to transfer one and it didn't work. Would I wonder what may have happened if we transferred two? Perhaps. I just hope I don't come to regret transferring two.

It turns out that our embryos weren't too bad. We had six that contained seven or more cells (we picked up a straggler!). Three actually had nine cells and one had ten. Yes, those are my over-achieving embryos. However, only three received a grade of 'good', two were 'fair' and one was 'poor'. I think they transferred my good nine and ten cell ones. I have one 'good' embie, two 'fair' ones and another 'poor embie that will try to make it to day 5 and to the freezer. The embryologist noted that if we just had a few more in the 'good' category, we could held out for a day 5 transfer. That was reassuring to hear.

I signed up to participate in Risa's  sock exchange, as I wanted to have socks from another infertile for my frozen embryo transfer in a month or two; but as we all discover, things don't go according to plan. Socks are a little bit of a sensitive topic for me, as that was one of Myrtle's conception tips. "If you wear socks after sex, it will help blood flow to the uterus and will help make things stick" Um, it's all about the boys and their swimming ability at that time. Implantation doesn't take place until 5-8 days after fertilisation, but thanks for trying to apply some scientific theory! I decided that it couldn't hurt, but I wanted to put my own twist on it and went with my compression calf sleeves.




Sunday, 10 November 2013

The Deafening Silence

It was little Myrtle's birthday just over a month ago. I selected a present that would be fun, educational and easy to ship cross country. "Is this a gift that you would like to have wrapped?" the sales clerk dutifully asked me. I knew it was a routine inquiry, but it just seemed to remind me that I wasn't making a purchase for my own child. I looked at the selection of wrapping paper and acknowledged that I didn't have any at home. Whatever she would charge for the service was justified by the fact that I wouldn't have to buy some cutesy wrapping paper that would just sit in my closet.   Plus, I figured this would help earn me points for being the good Auntie Jane.

It started to dawn on me that I haven't been that good a friend to Myrtle to support her during her first year of motherhood. I've kept my distance in order to protect my own feelings. I tend not to ask too many questions and I haven't been too available for her to discuss her experiences. A few days after the birthday, I called Myrtle and invited her to talk about little Myrtle's first year. Myrtle recounted the terrifying days of little Myrtle's ICU admission after birth, which was followed by many frustrating sleepless nights once they brought her home. She described that over time she started to gain confidence and felt more comfortable in her new role. She's enjoyed watching little Myrtle's personality blossom as well seeing her reach her developmental milestones, which recently included her first steps without assistance. "People are starting to ask me when I'm going to have my second baby..." she noted (apparently, this happens after the first baby reaches the one year mark) "I'd like to have another one... I'm just not sure if I'm ready yet."

I know there is no handbook or manual for how to deal with your friend who is infertile, but I'm sure if there were; there would be a chapter on not causally discussing your plans for a second child. It was just so striking how she could discuss the possibility with such confidence. There was a part of me that wanted to advise Myrtle that time is passing for her and she may not get knocked up straight out of the gate again. Yet, selfishly I fear that if I give her such a warning, she'll go off the pill and be pregnant within a month. Although Myrtle has no known biological limitations; the three of them are living in a shoe-box sized one bedroom condo, and their prospects for moving to a larger house are restricted by the fact that her husband is only getting part time work through a temp agency. Then again, it still seems more plausible that he could find a permanent full time position and they could move to a less expensive area.

I haven't spoken to Myrtle since I started this IVF cycle. During my IUIs, she couldn't understand the concept of having ultrasound monitoring to track follicle development. How could I explain the process of controlled ovarian hyper stimulation, oocyte retrieval via a needle inserted into my vagina, intercytoplasmic sperm injection, fresh versus frozen embryo transfer and possible chromosomal testing? Lentil once commented, 'why do I bear the burden of needing to provide education just because you don't know your science?' Seriously, there is this thing called the internet that lets you learn all kinds of stuff. Is it too much to expect her to Google IVF? Or maybe read the infertility primer I wrote up for her last year?

However, reading about IVF on Wikipedia only details the process when everything goes according to plan. It doesn't explain the situation of a poor response, disappointing fertilization rates or the unexplained BFN that follows a transfer of perfect looking embryos. Even my Ob/Gyn colleagues are also seemingly unaware of those situations, as their experiences involve caring for the success stories resulting from IVF.

I know it is not intentional and merely coincidental, but Myrtle always seems to send me an update on her baby just at the time when I've received some disappointing news. As I was walking out of my RE's office, upset over the prospect of only having 6-8 mature follicles after twelve days of stimming, Myrtle texted me a photo of little Myrtle. I probably should have sent a one line response to acknowledge that I received the pic, but instead I chose to ignore it. A few hours later, Myrtle nudged me, "did you get the picture that I sent?" Yes, Stan's Dad, I saw your bloody photo...
"Yes, she's adorable" I wrote back and I informed her that I had just received some information which indicates that IVF may not work. "Sorry to hear you got bad news about IVF." she replied "Is there some other treatment you can try?"

Now, I don't know if this was Myrtle's way of asking the 'have you considered adoption' question, or if she really thinks that science and progress may have other methods beyond IVF available. (I suspect the latter) I thought about explaining the option of donor eggs or embryo adoption, but I replied that we still are reasonable candidates for IVF (at least we were at that time) but it may take more than one cycle. Besides, as I was now reminding myself, we weren't out of the game with this cycle just yet. I was merely in the holding pattern waiting for my retrieval and the fertilisation report.

In my groggy post retrieval state, I heard my RE say "twelve". He was able to retrieve a dozen oocytes. As we were getting ready to leave, the embryologist announced that eight were mature. Even before I started my stims, I projected I would produce twelve eggs, and he was spot-on with his forecast on their maturity. I would have been ecstatic (pun: egg-static) to have 9 or 10 mature eggs, but I was very happy to be on the upper end of his prediction. Husband looked online and found that the lab has an 87% fertilisation rate, so he thought that would translate to 7 fertilised eggs. I estimated that we'd have a 50-75% fertilisation rate, which would yield 4 to 6. Well apparently, I am really good at predicting this shit, as we ended up with five fertilised eggs. Now we await the next match report. I have no conjecture on what it might bring, but I'm preparing for a fresh day 3 or day 5 transfer and possibly having nothing to freeze.

As intended, I did go swimming the day after my retrieval. I felt fine as I started my first warm up lap until I went into my flip turn. The process of crunching my lower abdominals combined with pushing off the wall sent me into agony. I think I screamed underwater. I finished the workout, but it was really uncomfortable and I was truly miserable. Alas, some things you have to learn the hard way. Such as discovering that you should have done IVF a year ago.

Friday, 8 November 2013

Measure Twice, Cut Once: IVF DIY

After we bought our house, our addiction to HGTV was replaced by our infatuation with the DIY network. Our favourite guilty pleasure was (and still is) Renovation Realities. This low budget production simply films amateur homeowners as they tackle various home improvement projects. Although a few are successful, most have disasterous results, and it is often a cautionary tale of what not to do. After describing their plans, the participants reveal their budget and estimated time for completion. Husband and I always burst out laughing as almost everyone grossly underestimates the costs and time frame. After multiple projects, we've learned to always double the projected length of time and to overestimate the budget as unexpected costs are inevitable.

So far, our first IVF cycle is following the suit of many of our DIY projects. (Yes, I'm still in the process of painting our kitchen cabinets and should have some updated photos soon) If I were to offer any advice to anyone embarking on this process, it would be to really clear your schedule, and to have extra meds on hand. While it's not desirable to have unused meds, it can cost less in the end than having to arrange for overnight shipping, and is much less stressful. I cannot emphasise the much less stressful aspect enough.

I was quite frustrated at the start of my stimming cycle, when I felt that I wasn't receiving a clear picture of my monitoring schedule. Now I understand how truly day to day this process is. My RE originally projected that I would stim for 9 days and retrieve on SD11. I knew this would be tentative and I would have to be flexible. The original retrieval date was on a Wednesday, so I arranged to have the day off. Husband was scheduled to leave on Friday afternoon to officiate at a hockey tournament in Southern California, but we thought it was unlikely to conflict.

After my visit on SD7 noted 10 follicles and high estrogen levels, my RE noted there would be a slight possibility of triggering on SD9 (Monday) and that a retrieval on Thursday or Friday was more probable. (On the off chance I were to trigger on Monday, I had to order Lupron from a supplier in Southern California, who could deliver in time, but at twice the cost as Freedom Fertility) I figured it would be Thursday, as that was the most inconvenient day for both Husband and me. He was umpiring a highly competitive hockey match (which was televised on ESPN11) and I was scheduled to teach a contraceptive methods class in the South Bay. I made arrangements to have someone else cover for me in the event it would be egg hunting day.

My estradiol level reached 1162 by Monday and I picked up one more follicle on each ovary to bring my total to twelve. "Don't focus on the number of follicles," my RE warned "it only matters how many are mature." Yeah...yeah... I acknowledged to myself. I was budgeting for fewer mature follicles, but whoo-hoo! I was up to a dozen! He was now projecting the ER to be on Friday or Saturday. This was good news as I could fulfill my teaching assignment, but it would mean Husband would have to delay leaving for Santa Barbara. He knew the collegiate umpire coordinator was scrambling to fill as spot for a Friday night game, so he volunteered to do that game, which indebted him to the coordinator. I was so proud of his resourcefulness.

I had to request to take Friday off and I needed to move my patients to Wednesday. I updated my colleague on my status. "Are you getting excited?" she asked. No, I thought to myself. I'm terrified that this is going to be a huge waste of time and resources. Instead, I just nodded quietly. "Just let us know if you need us to see any of your patients" she offered, a gesture I truly appreciated. Two days later, I was back in the stirrups. I was counting the follicles as he was measuring, but I wasn't paying too much attention to their size. There were now 4 or 5 on my right and I think I was up to 9 on the left. Could it be that I have 14 follicles?

It was Wednesday and my Estradiol level was now 1503. My RE thought the follicles might need a little more time to mature and was now projecting triggering on Thursday or Friday for a retrieval over the weekend -Saturday or possibly Sunday. Oh, was this cycle ever going to end? This now meant Husband wouldn't be able to attend the tournament at all. We had been walking ourselves through multiple contingency scenarios based on when the retrieval would be. "So, we'll need to see you back here tomorrow" he instructed "Same time?" I had been arriving at the office as soon as they open to have my blood drawn at 8:30 and then was returning at noon for my scans. It meant a lot of driving, but allowed me to discretely leave the office and most importantly, I didn't have to reschedule any patients, although I was late a few days due to 'traffic'. "Um, I can't come in for my blood work tomorrow morning" I explained that I had a two hour drive for my class. "Do you absolutely need the estradiol level?" I asked while knowing the answer; if he didn't have it, there would be a reason why he'd want it. "We're this close to the end, Jane..." he said in a tone that was reminding me of my priorities.

He left the room and Misery looked over toward me and asked the question that I was thinking. "Do you have good veins and can you draw your own blood?" Yes and yes, I replied. She gave me some supplies and I would have Husband run the vials down to the office. I must admit I was a bit nervous as I can't remember the last time I performed a venipuncture. At least better to do it on myself than someone else. I drew my own blood. That bears repeating. This time with the F-word. I fucking drew my own blood! I started dancing around the house proclaiming, "I am awesome!"

Oddly, that would be the high point of my day. Although my class went well and it's a good thing I didn't crash during the long drive, especially as I was on the phone with Freedom Fertility Pharmacy to secure another overnight order for my antagonist. That's the other unexpected aspect of living day to day in your stimulation cycle. Special shout out to Jen S of Overworked Ovaries who delivered her leftover Ganerelix at the last minute for me. Infertiles truly come through for each other!

I noticed that he didn't count all the follicles this time, just the larger ones, but I wasn't keeping a tally for myself. The decision to trigger was led by my estradiol level, which had plateaued at 1500. "So, I think we'll get 6-8 mature oocytes" he projected. There it was. The let down I been anticipating. The slap in the face from reality that I needed when I was getting excited about the number of follicles. It didn't seem like it would be enough to adjust for the male factor issues to produce a workable yield. All my decisions about PGD and single embryo transfers seemed moot.

"You seem subdued today" he commented and asked me three or four times if I had any questions. I was struggling to keep my composure. I had many questions, but none in particular came to mind at that moment. I figured we'd have our answers in the next few days after the retrieval and fertilization was complete. I'm sure there were other questions I didn't ask as I wasn't ready to hear the answers. I did have one question: can I swim the day after my retrieval? "Well, it's a vaginal procedure, so I'd advise against it..." he replied probably acknowledging to himself that I wouldn't comply.

Misery actually put her arm around me and gave my shoulder a little rub as she reviewed my ER instructions. It was a comforting gesture; one I really needed at that point, although it did give me pause to wonder if she thinks we're fucked. I went to watch Husband's hockey game and sat far away from the crowd. Tears were streaming down my face. Now I understood the blame Husband had assigned to himself. I was the one letting us down. My ovaries were supposed to come through for us! Double the length of time and overestimate the cost... I felt it was time to acknowledge that we may need to do more than one IVF cycle. Nothing like feeling defeated before the game even starts.

Wednesday, 6 November 2013

In the Water, They Can't See You Cry

The first time I had an infertility related cry was the morning after the 'failure to launch' episode that occurred during my parents visit. Between work and playing hostess, the only moment I had to myself was the fifteen minute drive to swim practice in the morning. Not only did my car provide quality alone time, but at that time of year, it was still dark at 6 AM. I avoided making eye contact with anyone as I walked in and quickly donned my cap and goggles. In the water, they can't see you cry.. I thought to myself as I dove in and started my warm up laps.

The pool would extend the sanctuary that was provided by my car. Free from external stimuli and alone with my thoughts (I've composed many blog posts underwater) I discovered the analogy of focusing on my own lane. Then one week during this past summer, a former 6 AM swimmer returned. She had  moved to the South Bay two years ago, but was visiting her mother who lived nearby, and as you do on a visit, she came to attend a 6 AM class. She was 35 weeks pregnant.

"I'll put you in lane 5 with Jane" my instructor told her. "It's perfect. You're about the same interval pace and if you go into labour, Jane can perform a water birth!". I smiled at them both. There was one more detail she omitted. I had received a BFN from IUI#3 that morning, so it was perfect to put the pregnant woman right next to the infertile. I dove in and tried to swim to the other side without taking a breath so I could avoid all the commotion over her baby bump.  My sanctuary had been infiltrated. Yet still, in the water, they can't see you cry.

At least she was only visiting; and I couldn't help think that I might be the next pregnant swimmer in our group. Nope. Wrong yet once again. This past week, I walked in from the car park with Amanda, a swimmer who is in the lane next to me. I'm a faster sprinter, and she's better at distances, but we often challenge each other. I noted that I hadn't seen her since our meet a few weeks ago. "Just been really tired. It's so much harder to get up as it's colder and darker now" she noted. As I was adjusting my goggles, I heard her talk to the instructor about how much longer she could go before needing to buy some larger suits. "I'm pregnant" she announced.

I went through the obligatory "Congratulations! You must be so excited!" although I did sincerely mean it. She's a sweet girl and her husband has attended a few meets and seems like a genuinely nice guy. They will make great parents. These are the type of people who should be breeding. "Thanks, fourteen weeks!" she announced. I have fourteen follicles...does that count? I quietly asked myself while simultaneously answering. No, it does not. I'm merely in the process of trying to get pregnant. I still have so far to go.

Now I've lost my escape. I can't rely on the water to shelter me anymore. It makes it hard to focus on my own lane when there is a pregnant woman right next to me. If it's not enough that I'm surrounded by pregnant woman though my work, I now have an extra hour of exposure each day. Every day watching her expanding baby bump. Every day another reminder of what I want and what is so elusive for me. I needed a distraction. Fortunately, Jason started coming to the morning sessions again and swims in the lane on the other side of me. I can indulge myself with some impure thoughts about what his undulating hips could be doing to me... Hey, sometimes you have to do what you can to get through the day..

Saturday, 2 November 2013

Cluelessness abounds

How do you respond when faced with the question, "So, do you have any kids?"

I recognise that most people perceive it to be an innocuous inquiry as a mere attempt to engage in a simple conversation; but for infertiles, it's like navigating through land mines. Aubrey at Two Hearts and One Dream recently commented that after more than two years of working through infertility treatments, she still doesn't have a good answer to that question. I thought about how I reply. If it's a stranger who I'm not likely to run into again, I like to be completely blunt and reveal that I'm infertile and that I've had a miscarriage. The sadist in me enjoys watching them squirm awkwardly, and my hope is that it makes someone think twice before asking the question again. If it's a more regular acquaintance and I don't want to out my infertile status, I simply answer "not yet..." I've developed a certain tone to my voice and telling smile to convey the message; don't ask me any further questions. Some people are able to read between the lines and end the conversation with a line such as "Ah, you're still young" or "Well, you have time." At least my ego appreciates the perception that I look younger than I am. More so, I'm grateful for the person who acknowledges that I don't want to talk about this subject rather than the one who follows up by asking, "Well, what are you waiting for?"

A few weeks ago, our swim team gathered at a local microbrew after a swim meet to celebrate our second place finish. I saw sitting across from Jason, a guy who is a year younger than me; and one I would probably fancy if I were single, as he has the shy quiet type thing that I find appealing. Although I don't think we'd ever manifest anything more than a physical relationship as apart from swimming, we have nothing in common. I figured Jason was the type of guy who enjoys a beer or two every now and then, so I was a little surprised when he handed the beer menu back to the waitress and noted he'd be fine with just water. In particular, (I know this is horrible stereotyping) as Jason is originally from Vermont, I figured he might be into home brewing his own beer, and would want to at least read about the offerings at this microbrew. Maybe not, and maybe he just didn't feel like having a beer.

Just after the waitress served our first round of drinks, my friend and former lane mate, Peter arrived. As the waitress was really busy, he announced that he would be going up to the bar to get a drink. He spotted the glass of water in front of Jason and asked if he could bring him back anything. "No thanks," Jason politely declined. Peter returned a few minutes later and inquired about the beer I had selected. "That was my second choice" he commented "Do you mind if I have a sip?"
"Go ahead," I replied handing my glass to him. I then asked Jason if he wanted to sample.
"No thanks, I gave up drinking and smoking weed three and a half years ago." he announced.

Peters eyes found mine and with one look we acknowledged what we had both concluded. Jason probably had a problem with alcohol. It all clicked together. Declining to look at the beer menu, using the words gave up drinking, knowing the exact duration of sobriety, refusing even a sip. As Peter and I were frantically thinking of a way to change the conversation, the woman sitting next to Jason, who had been listening in our conversation asked, "So, what do you do for a vice?"

I tried to kick her, but the table was just too wide for me to reach, and after swimming ten events in two days, I barely had any kick left in my legs. Jason admitted to having a cheeky cigarette now and then, and Peter introjected with a question about his work before Nosy Nora could ask anything else. I dawned on me that cluelessness abounds. The same clueless people who ask annoying questions about procreation intentions and aren't receptive to your hints that you'd rather not talk about it, probably operate that way in all situations. I could only imagine that Jason probably gets bombarded with intrusive questions such as, "Why, what happened?" or "Are you an alcoholic -are you in AA?" Social graces are not always universally understood, and common sense is not actually common.



Because they are hard

"We choose to go to the moon and do the other things...
not because they are easy, but because they are hard"
When we first moved to California, Husband and I befriended Kylie though a field hockey league. Kylie was a 34 year old Australian who had just moved the area to start a three year work visa.  She soon developed a friendship with one of her work colleagues. Although they were biologists, there was a strong chemistry between the two, but they were both too shy to make a move. Enter a little too much al-kee-hol at the staff holiday party, and they were inseparable following a drunken snog. After a year, they started discussing their future together. He hadn't proposed, but took her shopping for engagement rings. One day she mentioned that she wanted to marry sooner rather than later, so they could start trying to conceive right away. "Oh, I don't want to have children." He announced. "I've been thinking about getting a vasectomy."

That was a deal breaker that ended their relationship right then and there. She boxed all his belongings from her flat and delivered them to his desk at work the next day. A few months later, he left the company for another job and she started looking into artificial insemination. Her visa would be expired by the end of the year and she knew it much harder for a single woman to acquire donor sperm back in Australia. She asked me to help her select a donor. It was one of the greatest honours I've been given. (Although I would have been happy to go to Australia with her to help select a live donor..) She conceived on her first IUI and gave birth to a beautiful baby boy. When I told my parents about Kylie's pregnancy, to my surprise, my Dad was a little judgmental.

"I just don't see why anyone who chose to be a single parent. It's just going to be so hard to raise a child on your own." he commented.
"Well, she really wants to be a mother and doesn't want to run out of time." I informed him without going into the details of her age (37) or issues of acquiring donor sperm in Australia.
"Besides" I countered. "When something is really important to you, do you become discouraged just because 'it's hard'?" I could see his face softening a little. This was actually starting to become fun. "In fact," I continued "Aren't most things in life that are worth achieving the result of hard work?"
He smiled. "Who taught you that, Jane?"
"Oh, I don't remember... this guy in my life... he calls himself my Dad... thinks he's pretty wise..."

We all know how this process is so much easier for fertiles. Samantha Bee from The Daily Show with John Stewart described that she can't even use the same bar of soap as Jason Jones without becoming pregnant. Eve at Infertile in the Garden on Eden has a friend who practically conceived via FaceTime. It's as almost if they're living in one of those Viagra adverts; when the moment is right for conception, their house magically transforms into a rainforest, or some other romantic setting and invites them for a procreating romp. Total cost: maybe a bottle of two buck Chucks. Sometimes not even that much. Observational studies note a spike in the birth rate nine months after a widespread blackout, as more people are engaging in coitus due to a lack of other entertainment options. There was also an increase in the birth rate in July 2009 -nine months after Barack Obama's electoral triumph. By the way, the easiest place in the world to get laid is at a campaign victory party. I had five offers on the night of Ned Lamont's successful primary challenge, but I am seriously digressing...

We all accept it's going to be a much tougher road, and may discover that it's even harder than we first perceived. I decided to approach the process in stages. Pre-stimulating ovarian suppression, stimming, retrieval and fertilization status, possible CCS testing, then transfer prep leading up to an eventual transfer and two week wait. So far, it was the first stage that was the most miserable. In order to avoid going into hypertensive crisis on the oral contraceptives, I started myself on Labetalol at 50 mg twice daily. The Labetalol worked beautifully to control my blood pressure, but it killed my swim times. In the last few days of practice before our big meet, I was feeling exhausted during warm-up and had no energy to sprint.

I held my morning beta blocker on both days, so that I could compete. My times were a little slower than I wanted them to be; but I'm trying to remind myself that as a sprinter, I'm fretting over tenths and hundreds of seconds. I did improve my times on my distance swims and it was encouraging to know that my interval speed on those events, was my 100 yard sprinting speed two years ago. I was also able to carry this post from Aramis for extra motivation:

You think you're in pain during this 100 m butterfly? Wait until you go into labour, then you'll know pain. SUCK IT UP AND SWIM BITCH!

Quit breathing. When you go into labour, you can breathe all the air you want. 

Oh, and my coach may have issued the ultimate throw down to my uterus when she mentioned that I should work toward entering the 200 Fly by next April.

Acknowledging my unfair advantage, stimming was pretty easy as I'm adapt at administering injections; although I did inflict myself with one small bruise. Four days in and I was feeling fine. My weight was actually down half a pound. What the Fuck? Were these meds even working? Apparently a little too well, as my first estradiol level came back at 317. I was instructed to decrease my Gonadal-F. My first ultrasound found that I had four follicles, which was judged to be "not bad." The E2 was still trending high at 471 and I got to skip out on Gonadal-F'ing myself. Wow, I don't think I've heard of anyone else having to hold meds. Day 6 E2 was 714, I now had to half my dose of Menopur. Man, that stuff burns like a motherfucker. As an atheist, I was happy to have less reconstituted nun-pee in my body. Husband was having too much fun teasing me about whether I was feeling the Holy Spirit or having visions of the Virgin Mary...

I went into for a scan on day 7 and found the number of follicles on my left side had doubles and had quadrupled on my right ovary. I had a total of 10. Ten follicles. My RE seemed pleased with my yield so far. I saw on his notes that he was anticipating a retrieval of at least 10, so I'm pleased to have met his expectations. I anticipated I may produce a dozen, so that seems within reach. It's hard not to feel encouraged at this point in time, but I need to keep bringing myself back to reality. It's like Annie's warning to the newly engaged couple in Bridesmaids, "Awww, you two really love each other...that will go away!" Not all oocytes will be mature, not all with fertilise, not all will be euploid. Yet, I need to be thankful for with what I have to work. I can't realistically ask for anything more.

Of note, I never received any specific instructions on what I could do or couldn't do during my stimming cycle. Not that I would have followed any rules. I kept swimming each day, although I did move myself to a slower lane. I attended Cross-Fit classes, but on day 6, I informed my instructor that I needed to modify box jumps. "Sure honey, is everything alright?" she asked. "Let's just leave it at that I tweaked my groin.." I explained. "O-oh..." she commented with a knowing smile. I may have given the impression that I sustained a sex injury Score! Plus, I got to modify burpees with some air squats and regular push-ups Double Score! I played tennis and I went to a yoga class. I did excuse myself from my field hockey match. Interestingly, I played hockey the day before I miscarried (which I know had no influence) but I wasn't going to take any chances with my ovaries!

I've been thinking about President Kennedy's description about the prospect of going to the moon and how we can't be daunted by challenges just because they seem hard. It's so amazing to acknowledge that only a mere 7 years after Kennedy made that pronouncement, Neil Armstrong was walking on the moon. I often think about Kylie and all the difficulties she faces a single mom. It makes the action of administering injections seem so insignificant. Yet, this part seems easy because it's in my command. I am taking all my meds like a good girl. I am getting my blood drawn as scheduled and attending my appointments with the vag probe. Once things are out of my command, it will feel so much harder...