8 weeks and 4 days. Well, technically, I was 8 weeks and 6 days by the time I had my D&C for my ill-fated second pregnancy. Ah, what a difference a year, two failed FETs, a second stim cycle, CCS testing, yet another failed transfer, Lupron, Labetalol, Laminaria, reduced estrogen and baby aspirin can make! My RE returned from his trip and I had my second scan on his first day back in the office. "Things could not look any better!" he proclaimed, as he tapped my leg not once, not twice, but three times during the ultrasound. He invited Husband to stand by his side as he scanned and he gave him a detailed tour on the ultrasound monitor, while I watched from the screen mounted on the ceiling. As Husband often felt left out during my visits, I think he really appreciated that Dr STIUTK gave him his own explanation.
Something else marked my venture into unchartered territory. Around six-ish weeks, I had brought leftover chicken curry for lunch, but the thought of it was making me queasy. I skipped lunch and not surprisingly, I was starving later that night. Yet, there wasn't anything that I wanted to eat. A persistent wave of nausea has invaded my life. I also have a weird metallic taste in my mouth. Although it has been to no avail, I've been brushing my teeth multiple times per day. At least it may improve my next dental cleaning.
A few years ago, I participated in a panel discussion on nausea and vomiting in pregnancy. The facilitators presented a survey comparing clinicians' and patients' perception on this prevalent symptom. As anticipated, the clinicians rated their highest concerns over patients who were actually vomiting, as they could be suffering from dehydration, weight loss, electrolyte imbalances and ketonuria. Interestingly, patients expressed more distress over their nausea. Many reported that they actually felt better after throwing up. I have to confess that I've considered attempting a tactical chunder on a few occasions. Additionally, patients described that they experienced a loss of pleasure and enjoyment with eating during this time. A few participants on the panel described that certain aversions encountered during their pregnancies became permanent. A man commented that both of his kids are in college and his wife has never been able to return to Bos.ton Market. Another woman with grandchildren revealed that she still can't eat hot and sour soup.
I've discovered this is not necessarily a bad thing. I'm ashamed to admit that I had a bad Co.ke Zero habit and I fretted over how I would be able to give it up when/if I ever became pregnant. Not a problem when you have absolutely no desire for it. I began to look at my symptomatic state as a way of doing my own 30 day reset. Unfortunately, I also don't have much on an appetite even for healthy foods. I have been able to reclaim some pleasure in eating by recalling some long lost favourites. In what can be considered my first craving, I braved the madness of shopping at Safe.way on the night before Thanksgiving to pick up a bag of frozen Tater Tots. I think the last time I ate them was when I was 10. Oh yeah, they are still so good! I've also had to bring bread back into my life as toast has become the one and only thing I want to eat. I'll have a few pieces with a cup of Safe.way Organic Tomato Soup. It's become my go-to meal.
I hope I don't come across as complaining, as I'm very thankful to be in this state, and in a strange way, I appreciate my nausea. I know it's not necessarily reassuring, but it helps me remember that I am actually pregnant. Maybe, it might actually be for real.
Monday, 8 December 2014
Monday, 1 December 2014
Don't Start Believin'
It was the best of times, it was the worst of times,
It was the age of wisdom, it was the age of foolishness,
It was the epoch of belief, it was the epoch of incredulity,
It was the season of light, it was the season of darkness,
It was the Spring of hope, it was the Winter of despair...
-Charles Dickens 'A Tale of Two Cities'
I've become convinced that Charles Dickens was describing the practice of obstetrics and not the political unrest in France and England during the late 1700s, when he wrote those words. I hate to admit it, but I start to get nervous when I see too many happy new OB visits, as I know that streak will be broken by a lurking non-viable pregnancy. What's worse, is that it always seem to come in threes.
New Girl acknowledged that she understood why we would still feel cautious, so she offered to be happy and excited for us. She went ahead and calculated our due date. It is in the middle of July. It is also the same birth day as Myrtle's older brother. Myrtle's brother is a total dick. There are several stories I could share to illustrate this point, but the most salient one is that in the mid 90s, he had a one night stand with a girl who went to high school with me and Myrtle. She was two grades ahead of us, but she was in our Algebra class. A baby resulted from that lone encounter, and a court ordered paternity test confirmed Myrtle's brother was the father. When he told Myrtle, he confessed 'we used a condom, but it broke...' Myrtle replied with the best line of her lifetime "That story may work on our parents, but there was no condom. I've seen you in the shower, you're not that big!"
He had child support payments garnished from his wages, but he never once even met his daughter, who is now nineteen years old. Myrtle's parents never told my parents and they have never acknowledged their granddaughter. It's a huge family secret. Myrtle and I ran into the mother about twelve years ago, and Myrtle decided to go over and talk with her. She had just wed her long term boyfriend and he was in the process of formally adopting her daughter. Myrtle's brother was only too willing to officially renounce his parental rights and was delighted that he no longer had to provide child support. She also described that her daughter really enjoys art and is quite talented -a skill inherited from her paternal grandmother, who is an artist. Fortunately, only 5% of women deliver on the assigned due date and it's likely that I'll be induced a week early due to my blood pressure issues. Actually I'll be very fortunate if I can make it to 39 weeks.
As I admit that I'm getting way ahead of myself, Husband and I also took the liberty to discuss how we might tell my parents. We both were considering the same concept, so we just need to agree on the final details. Although I wanted to take a one step at a time approach, out of consideration for optimal scheduling, I arranged my first OB visit and my NT scan. Co-worker offered that she would cancel for me if such a need would occur.
When I came into work the day after my first scan, one of my colleagues received a call from a radiologist. Her patient started bleeding the previous night, so the after-hours advice nurse arranged her to have an ultrasound first thing in the morning. She should have been 11 weeks and 5 days, but was only measuring 9 weeks and 1 day and no cardiac activity was seen. I recognised the name. I had just informed her that her early glucose testing was negative. Diabetes was the least of her issues.
I looked at my own schedule. My first patient was a couple who miscarried at 8 weeks earlier this summer, but conceived with her next cycle. I saw her at 6 weeks and again at 8 and everything looked perfect. Today was actually her originally scheduled New OB visit, which included her education session with our LVN. We chatted about her symptoms as I prepped the probe and I almost asked if they were planing to announce the pregnancy to their family at Thanksgiving, but for some reason, I held back. Once again, her scan looked perfect, except for one detail. The fetus was actually measuring a day ahead, but there was no cardiac activity detected. I find it is more traumatic for the patient to hear the futile attempts to auscultate a heart rate, so I use the colour flow application. Although as this patient is also a Nurse, so she knew what it meant to see red and blue flashes everywhere but on the baby.
Later that morning I had another patient coming in for a viability follow up. She was 41 and this was a surprise conception. I remember my RE once shared, "the statistic of only having a 5% risk for miscarriage after seeing the heartbeat doesn't apply to women over 40. The risk is probably closer to 50%." It's an awkward conversation, and I really haven't really perfected it. Although you don't look like you're in your forties, women at this age are still at a higher risk for a miscarriage, so I like to scan my patients more frequently. You may consider waiting to announce your pregnancy until after the first trimester... I suspect that many are just so happy at that moment that they really aren't hearing what I'm saying.
She should have been 9 weeks at 3 days, but she was measuring a full week behind and once again, no flicker of cardiac activity was detected. I began to wonder if there were something broken with our ultrasound. I let patients decide if they want to have a formal scan to confirm. Some find reassurance with a second opinion, others would rather not endure a second procedure that won't affect the outcome. She elected to be scanned by radiology and my findings were confirmed. Although she had the highest risk for miscarriage of the three patients who received the diagnosis that morning, she was the most distraught. No matter how many times I explained that it most likely is due to an age related egg quality issue, she posed another theory. "Is it because I started prenatal vitamins late?" "Is it because I exercised?" There are some things that the mind just doesn't want to hear.
Days like these are really hard and I feel as if I hate my job. It's not too often that I encounter a miscarriage measuring at 9 weeks. I had to think back and the last one I recall was over a year ago. Now I had three within the same morning session! I know these situations pose no influence over the fate of my own pregnancy, but it shook me up a bit. Interestingly, all patients opted to do a chromosomal analysis on their products and my prediction is that at least two will reveal an abnormality. Even with an euploid embryo, I still feel vulnerable. I sent a mass text to all those in the know. All forward thinking and planning ceases with immediate effect. I didn't even bother to scan myself again, for it would only offer temporary reassurance. The message was received. Everything can be taken away from me at a moment's notice. I can't forget that.
It was the age of wisdom, it was the age of foolishness,
It was the epoch of belief, it was the epoch of incredulity,
It was the season of light, it was the season of darkness,
It was the Spring of hope, it was the Winter of despair...
-Charles Dickens 'A Tale of Two Cities'
I've become convinced that Charles Dickens was describing the practice of obstetrics and not the political unrest in France and England during the late 1700s, when he wrote those words. I hate to admit it, but I start to get nervous when I see too many happy new OB visits, as I know that streak will be broken by a lurking non-viable pregnancy. What's worse, is that it always seem to come in threes.
New Girl acknowledged that she understood why we would still feel cautious, so she offered to be happy and excited for us. She went ahead and calculated our due date. It is in the middle of July. It is also the same birth day as Myrtle's older brother. Myrtle's brother is a total dick. There are several stories I could share to illustrate this point, but the most salient one is that in the mid 90s, he had a one night stand with a girl who went to high school with me and Myrtle. She was two grades ahead of us, but she was in our Algebra class. A baby resulted from that lone encounter, and a court ordered paternity test confirmed Myrtle's brother was the father. When he told Myrtle, he confessed 'we used a condom, but it broke...' Myrtle replied with the best line of her lifetime "That story may work on our parents, but there was no condom. I've seen you in the shower, you're not that big!"
He had child support payments garnished from his wages, but he never once even met his daughter, who is now nineteen years old. Myrtle's parents never told my parents and they have never acknowledged their granddaughter. It's a huge family secret. Myrtle and I ran into the mother about twelve years ago, and Myrtle decided to go over and talk with her. She had just wed her long term boyfriend and he was in the process of formally adopting her daughter. Myrtle's brother was only too willing to officially renounce his parental rights and was delighted that he no longer had to provide child support. She also described that her daughter really enjoys art and is quite talented -a skill inherited from her paternal grandmother, who is an artist. Fortunately, only 5% of women deliver on the assigned due date and it's likely that I'll be induced a week early due to my blood pressure issues. Actually I'll be very fortunate if I can make it to 39 weeks.
As I admit that I'm getting way ahead of myself, Husband and I also took the liberty to discuss how we might tell my parents. We both were considering the same concept, so we just need to agree on the final details. Although I wanted to take a one step at a time approach, out of consideration for optimal scheduling, I arranged my first OB visit and my NT scan. Co-worker offered that she would cancel for me if such a need would occur.
When I came into work the day after my first scan, one of my colleagues received a call from a radiologist. Her patient started bleeding the previous night, so the after-hours advice nurse arranged her to have an ultrasound first thing in the morning. She should have been 11 weeks and 5 days, but was only measuring 9 weeks and 1 day and no cardiac activity was seen. I recognised the name. I had just informed her that her early glucose testing was negative. Diabetes was the least of her issues.
I looked at my own schedule. My first patient was a couple who miscarried at 8 weeks earlier this summer, but conceived with her next cycle. I saw her at 6 weeks and again at 8 and everything looked perfect. Today was actually her originally scheduled New OB visit, which included her education session with our LVN. We chatted about her symptoms as I prepped the probe and I almost asked if they were planing to announce the pregnancy to their family at Thanksgiving, but for some reason, I held back. Once again, her scan looked perfect, except for one detail. The fetus was actually measuring a day ahead, but there was no cardiac activity detected. I find it is more traumatic for the patient to hear the futile attempts to auscultate a heart rate, so I use the colour flow application. Although as this patient is also a Nurse, so she knew what it meant to see red and blue flashes everywhere but on the baby.
Later that morning I had another patient coming in for a viability follow up. She was 41 and this was a surprise conception. I remember my RE once shared, "the statistic of only having a 5% risk for miscarriage after seeing the heartbeat doesn't apply to women over 40. The risk is probably closer to 50%." It's an awkward conversation, and I really haven't really perfected it. Although you don't look like you're in your forties, women at this age are still at a higher risk for a miscarriage, so I like to scan my patients more frequently. You may consider waiting to announce your pregnancy until after the first trimester... I suspect that many are just so happy at that moment that they really aren't hearing what I'm saying.
She should have been 9 weeks at 3 days, but she was measuring a full week behind and once again, no flicker of cardiac activity was detected. I began to wonder if there were something broken with our ultrasound. I let patients decide if they want to have a formal scan to confirm. Some find reassurance with a second opinion, others would rather not endure a second procedure that won't affect the outcome. She elected to be scanned by radiology and my findings were confirmed. Although she had the highest risk for miscarriage of the three patients who received the diagnosis that morning, she was the most distraught. No matter how many times I explained that it most likely is due to an age related egg quality issue, she posed another theory. "Is it because I started prenatal vitamins late?" "Is it because I exercised?" There are some things that the mind just doesn't want to hear.
Days like these are really hard and I feel as if I hate my job. It's not too often that I encounter a miscarriage measuring at 9 weeks. I had to think back and the last one I recall was over a year ago. Now I had three within the same morning session! I know these situations pose no influence over the fate of my own pregnancy, but it shook me up a bit. Interestingly, all patients opted to do a chromosomal analysis on their products and my prediction is that at least two will reveal an abnormality. Even with an euploid embryo, I still feel vulnerable. I sent a mass text to all those in the know. All forward thinking and planning ceases with immediate effect. I didn't even bother to scan myself again, for it would only offer temporary reassurance. The message was received. Everything can be taken away from me at a moment's notice. I can't forget that.
Monday, 24 November 2014
See You Tonight
Maybe I'll see you tonight,
Maybe I'll see you tonight
Wherever the night takes you,
Maybe you'll see me too,
The colder it gets, you won't see me anymore,
but there's still a chance I might walk to your door
Maybe the time is not right,
I won't be seeing you tonight,
Maybe I'll see you tonight,
maybe I'll see you tonight...
-Green Day
You all know the rest of the story, three years of infertility treatments, yada, yada, yada... here we were again, wondering what could be going on inside my uterus. As Dr STIUTK was away, his partner would be performing my scan. "So did you transfer one or two?" he asked while prepping the ultrasound probe. Fantastic. He hadn't read my chart. It's usually a good idea when you're seeing a patient not familiar to you. This means he also didn't know that I've had two miscarriages, three failed transfers, and yes this was a single transfer with a euploid embryo.
As I answered, I thought about reminding him of what I do for a living, but I decided just to lie back and to remember that I was a patient. Yet, I couldn't silence the clinician inside my brain as he started to scan. Gestational sac is inside the uterus -phew, no ectopic. There's a perfect sized yolk sac with a fetal pole right next to it. Yes, there is the blinking flutter to indicate cardiac activity. I can only see one, the little bugger didn't split! I was also doing a little backseat ultrasounding. Pause it there! That's a perfect view for the CRL measurement!
It was both the most overwhelming and yet underwhelming moment of my life. My aforementioned friend had told me that my experience during this ultrasound would be observing Husband's reaction. I looked over at him and he just looked puzzled and confused. He wasn't sure what was happening while the doctor was auscultating the heartbeat, while I thought that even at 130 beats per minute, it could have very well been mine.
As I had previously anticipated, Husband kept his stiff upper lip intact until the other RE and New Girl left the room, and then shed a few tears once the door was shut. At last, he had reached his quest of seeing a beating fetal heart on an ultrasound. Even better -it was ours! We shared a collective sigh of relief, while we also acknowledged that we still have a long way to go. We've never made it to this point before. The embryo's measurement was right on track. The word viable is being used to describe it. This was a significant milestone. Yet, at the same time, I can't help to look at that tiny spec and think that's really it?
I know that I sound like a spoilt brat, but the picture from the RE was really anti-climatic.
So I'm embarrassed to say, that I self-scanned for a better one...
Meet our little grain of rice!
Monday, 17 November 2014
Keep Calm and Carry On
I think we told almost all of our close friends about our most recent FET, as well as the rest of our sorted reproductive past. It was touching to see how many infertility novices quickly learned the drill of beta doubling times and it was interesting to note that many seemed more anxious about receiving my numbers than I was. For record, my RE had me do a third draw, which came back at 2136. "I know you've probably already done this," said New Girl "I looked back at your prior betas and these are way higher." I knew they were, but I didn't make any direct comparisons, as there are so many differences between this FET and my first fresh transfer. I held this unusual sense of confidence as I casually waited for my results. After receiving the first and most critical one, I just knew that my betas would rise accordingly. Wow. I thought on a few occasions, this must be what it feels like for normal women... Then I remembered that most normal fertile women don't go through beta testing. I had to explain to Myrtle what it meant to have a beta of 175. I am not kidding.
Of all the money we have spent on this procreation pursuit, and it has been a lot, the $1875 for CCS testing has been worth every penny and more. Yet, it doesn't offer any guarantees. It only means that if my heart is broken with another miscarriage, a chromosomal abnormality will not be the cause. I keep reminding myself that my embryo is not infallible. My RE recently mentioned that he has been seeing more miscarriages in women over 40 who are found to have normal chromosomes on their pathology reports. "You're not over 40" Husband countered. True, but I'm not that far away. I had two patients of my own, both are in their early 30s, whose POC analysis did not implicate a chromosomal abnormality. One was found to have a large uterine fibroid and the other was found to have the triad of a high FSH, low AMH and low AFC, leading to the craptastic DOR diagnosis. Embryos can still be shitty even if they're genetically normal.
I'm in the ignorance is bliss phase. While I was a University student, I attended a lecture by a psychology PhD candidate whose research observed that people cannot disregard information presented to them, particularly if it is very emotional in nature. Well, I seem to be proving her wrong, as I often forget that I am pregnant. For three years, I've become obsessed with pregnancy and now it's expunged from my mind? I don't know how many weeks and days I am. I refuse to calculate a potential due date. I saw a pregnant woman in Tar.get and instantly filled with disdain, until the little voice reminded me, oh yeah... I'm technically pregnant too...
Myrtle, who apparently is an expert in obstetrics after her textbook perfect pregnancy, had some advice for me, "just cuddle with your kitties or think of Angus if you feel anxious..." Thanks, but I don't actually don't feel anxious. I know whatever will be, will be. The die has already been cast. Nothing I can do can influence this outcome, and as mind blowingly frustrating as that is, there is really no point in stressing over it. I'm not even meticulously inspecting the toilet tissue. I tried to find an explanation that Myrtle might understand. "Imaging as a child, you really wanted a certain toy for Christmas. It was the last gift you opened and you were absolutely elated as soon as you tore off the paper. But then you were told that you couldn't play with it. You couldn't look at it; actually, you weren't allowed to even think about it."
Maybe that analogy hit a little close to home for me. If I receive a gift from an out of state relative, my mother would hold it hostage on top of our refrigerator until I wrote a thank you note. To this day, that discipline has stayed with me, with the one exception that I once needed to cash my grandmother's ten dollar cheque in order to buy a card and stamp for my thank you note. Maybe it's why I have managed to keep thoughts about this pregnancy out of sight and out of mind. "So, are we ever going to be able to enjoy this pregnancy?" asked Husband with words that stabbed me right in the gut. "Hopefully..." was all I could answer.
This past weekend I ran into an old friend at the Farmer's Market. After we chatted for a few minutes, she cut right to the chase, "so, any news?" I immediately felt shitty as I forgot that she was in the loop and I realised that I didn't tell her earlier. "Oh, I'm pregnant again." I informed, suddenly acknowledging that it was the first time I said 'I'm [the p-word]' out loud, and I sounded like an asshole. I'm sure to anyone who overheard our conversation, I came across as one of those super fertile women, we were just talking about if we wanted to have a third baby, and I realised my period was late, so I took a test and it was positive! It's so easy for us, all we have to do is talk about getting pregnant and I'm knocked up! "Three pregnancies, nothing yet to show for it." I quickly added for the benefit of any eavesdroppers. No one looked up from selecting their desired produce. They were calmly carrying on with their day, and I should too.
Of all the money we have spent on this procreation pursuit, and it has been a lot, the $1875 for CCS testing has been worth every penny and more. Yet, it doesn't offer any guarantees. It only means that if my heart is broken with another miscarriage, a chromosomal abnormality will not be the cause. I keep reminding myself that my embryo is not infallible. My RE recently mentioned that he has been seeing more miscarriages in women over 40 who are found to have normal chromosomes on their pathology reports. "You're not over 40" Husband countered. True, but I'm not that far away. I had two patients of my own, both are in their early 30s, whose POC analysis did not implicate a chromosomal abnormality. One was found to have a large uterine fibroid and the other was found to have the triad of a high FSH, low AMH and low AFC, leading to the craptastic DOR diagnosis. Embryos can still be shitty even if they're genetically normal.
I'm in the ignorance is bliss phase. While I was a University student, I attended a lecture by a psychology PhD candidate whose research observed that people cannot disregard information presented to them, particularly if it is very emotional in nature. Well, I seem to be proving her wrong, as I often forget that I am pregnant. For three years, I've become obsessed with pregnancy and now it's expunged from my mind? I don't know how many weeks and days I am. I refuse to calculate a potential due date. I saw a pregnant woman in Tar.get and instantly filled with disdain, until the little voice reminded me, oh yeah... I'm technically pregnant too...
Myrtle, who apparently is an expert in obstetrics after her textbook perfect pregnancy, had some advice for me, "just cuddle with your kitties or think of Angus if you feel anxious..." Thanks, but I don't actually don't feel anxious. I know whatever will be, will be. The die has already been cast. Nothing I can do can influence this outcome, and as mind blowingly frustrating as that is, there is really no point in stressing over it. I'm not even meticulously inspecting the toilet tissue. I tried to find an explanation that Myrtle might understand. "Imaging as a child, you really wanted a certain toy for Christmas. It was the last gift you opened and you were absolutely elated as soon as you tore off the paper. But then you were told that you couldn't play with it. You couldn't look at it; actually, you weren't allowed to even think about it."
Maybe that analogy hit a little close to home for me. If I receive a gift from an out of state relative, my mother would hold it hostage on top of our refrigerator until I wrote a thank you note. To this day, that discipline has stayed with me, with the one exception that I once needed to cash my grandmother's ten dollar cheque in order to buy a card and stamp for my thank you note. Maybe it's why I have managed to keep thoughts about this pregnancy out of sight and out of mind. "So, are we ever going to be able to enjoy this pregnancy?" asked Husband with words that stabbed me right in the gut. "Hopefully..." was all I could answer.
This past weekend I ran into an old friend at the Farmer's Market. After we chatted for a few minutes, she cut right to the chase, "so, any news?" I immediately felt shitty as I forgot that she was in the loop and I realised that I didn't tell her earlier. "Oh, I'm pregnant again." I informed, suddenly acknowledging that it was the first time I said 'I'm [the p-word]' out loud, and I sounded like an asshole. I'm sure to anyone who overheard our conversation, I came across as one of those super fertile women, we were just talking about if we wanted to have a third baby, and I realised my period was late, so I took a test and it was positive! It's so easy for us, all we have to do is talk about getting pregnant and I'm knocked up! "Three pregnancies, nothing yet to show for it." I quickly added for the benefit of any eavesdroppers. No one looked up from selecting their desired produce. They were calmly carrying on with their day, and I should too.
Monday, 10 November 2014
The Only Thing We Have to Fear... is Fear Itself
A week ago, I woke up about half an hour before my alarm rang. It was another Monday, another start to the work week. Yet, this wasn't any other week. By quitting time on Friday, I would have my beta results, and my two week wait, which has really been a three year wait, would be over. As I tried to fall back asleep, I found myself thinking about The Monster at the End of the Book.
I've previously noted that it's the final 48 hours of the two week wait that seem to be the hardest. When I hit 8dp5dt, I started contemplating testing. I researched my fellow bloggers and while there were a few exceptions; for the most part, women with a successful implantation had a positive result by this time, and women with negative results, often had a BFN or chemical pregnancy confirmed. Why drag it out any longer? I could pee on a stick and end the suspense.
Suddenly it made sense why I was randomly thinking about that book from my childhood. I didn't actually want the two week wait to end. Each passing day was like turning a page, and would bring me closer to the BFN Monster at the end of the week. I wanted to prolong not being not pregnant as long as possible.
For the record, I did hold out on testing. Husband reminded me that even when I was pregnant, my second line was so faint you had to squint as if you were looking at those 3-D posters that were all the rave in our college days. I also came across the episode of Seinfeld where George contemplates telling his girlfriend that he loves her. "Are you confident in the 'I love you' return?" Jerry inquires. "Otherwise, that's a pretty big Matzah Ball you've left hanging." As soon as I knew that I was most likely guaranteed a second line, I broke out my lone First Response Early Result test (a gift that accompanied the Endometrin, which I was also saving for when/if I became pregnant again). I didn't break Aramis's record of twenty seconds, but the colour in the test line came through before the control line. That had never happened to me before.
I had promised myself that I would break my POAS habit, but even after replaying Misery's voice mail three times, I needed something tangible to show that I was actually pregnant. I needed to erase any doubt that the lab had switched my blood sample, or perhaps Misery intended to leave that message for another patient. My second beta came back at 839. The Monster at the end of the book was none other than furry, lovable Grover himself. Thirty-five years later, I now understood the message to that story. You must face your fears; and sometimes, they may not be as scary as you thought.
*Spoiler Alert: Although if you haven't read this book, you must add it to your reading list!*
Grover, the most beloved Sesame Street character until Elmo was introduced, had received some inside information that there is a Monster at the end of the book you are reading. He begs and pleads with the reader not to turn any pages, which will bring them face to face with the Monster. When that fails, he attempts to tie the pages together and even builds a brick wall to thwart any further page turning. It was one of my favourite books as a child, perhaps because my mother could do a pretty good imitation of Grover freaking out.
Suddenly it made sense why I was randomly thinking about that book from my childhood. I didn't actually want the two week wait to end. Each passing day was like turning a page, and would bring me closer to the BFN Monster at the end of the week. I wanted to prolong not being not pregnant as long as possible.
For the record, I did hold out on testing. Husband reminded me that even when I was pregnant, my second line was so faint you had to squint as if you were looking at those 3-D posters that were all the rave in our college days. I also came across the episode of Seinfeld where George contemplates telling his girlfriend that he loves her. "Are you confident in the 'I love you' return?" Jerry inquires. "Otherwise, that's a pretty big Matzah Ball you've left hanging." As soon as I knew that I was most likely guaranteed a second line, I broke out my lone First Response Early Result test (a gift that accompanied the Endometrin, which I was also saving for when/if I became pregnant again). I didn't break Aramis's record of twenty seconds, but the colour in the test line came through before the control line. That had never happened to me before.
 |
| Obligatory FRER Picture |
Friday, 7 November 2014
The Writing in the Tablets
Although I am scientific minded and evidence based, I exhibit a bit of a contradiction; I am superstitious. After each transfer, I have made sure that I had just enough progesterone on hand to make it through to beta day, as I refused to order anymore until I received my results. Obviously, I feared that procuring an advanced provision of extra progesterone would some how jinx the outcome. Even thought I knew such actions exerted no influence, and wouldn't even be wasteful as I would need the supplies for my next transfer, I still kept to this ritual. A few days after my transfer, I started to count the number of tablets in the bottle in my bathroom, as well as the one I keep in my purse for on-the-go dosing. It turned out, I had exactly enough Prometrium capsules to get past my afternoon dose on beta day. Right to the point in time where Misery would be telling me to stop all my meds if my test results were negative.
My stomach twisted into knots. This was definitely a bad omen. Not a good prognostic indicator at all. I shared this news with my friend Isabelle, who asked if I were using Endometrin. No, I replied. I've been prescribed Prometrium, or whatever micronised progesterone the compounding pharmacy whips up for me. Suddenly, I remembered that I had received a box of Endometrin from a fellow blogger earlier this year. I used it for a few days during FET#2 and I found that I liked it much better than the Prometrium capsules. Endometrin comes with its own applicator, so I don't have to use the Pre-Seed Lubricant applicators. (Top Tip: Pap smear cytobrushes are the perfect tool for cleaning these applicators. They work well for cleaning the straw and spout of your water bottle too. Steal some at your next visit!) Best of all, I found that the Endometrin didn't muck up my underwear nearly as much as the Prometrium. I didn't have too much hope with that transfer. It was a Hail Mary Grade 2 Blast to possibly avoid a second fresh stimming cycle. After a few days, I switched back to the Prometrium, as I decided that I would save the preferred Endometrin as a reward when/if I ever became pregnant again. What can I say? This girl knows how to pamper herself.
Now I had to acknowledge; was there something to be said for the fact that my preference for progesterone tablets and planned use in the event of a pregnancy aligned perfectly with the timing of my results? It sounds absolutely ridiculous as I type those words. Yet, these kinds of things appeal to the meticulous nature of my mind. I always try to look for patterns. I love palindromes. I get excited when I see a sequence of numbers. Why was something so silly giving me more confidence than the top grades assigned to my euploid beautifully expanding blast, which was placed perfectly by the skilled hands of my RE?
I can't explain it either. I went into the lab for my beta test with a surprising sense of calm, that I haven't had with my previous situations. After my first fresh transfer 'The Day 3 Desparation' I truly had no expectations. I felt over-confident with FET#1 'The Chosen One' as I was mentally clearing my schedule to return for beta#2 and my ultrasounds while waiting for the phlebotomist to call my name. I had an impending sense of doom with FET#2 'The Leftovers' and with FET#3 'Haven't Named It Yet'. I was merely going through the motions of having my vein poked in order to wait for a phone call to tell me something I already knew. This time, I didn't have that same intuition that forcasted failure. It's not the same thing as believing that I might have a positive result, but hey; I'll take it.
The call came in around 2 PM. I quickly cleared the alert from my phone and I refused to look at the length of the message to avoid applying the Thin Envelope Theory. Fortunately, I had a pretty busy day, which included dealing with possible treatment failure for a patient with an ectopic pregnancy. I was more preoccupied dealing with her beta results than my own. At last, after a long day at the office, Cross-Fit and waiting for Husband to come home from his hockey match, we played the message just after 8PM.
"Hi Jane, It's Misery from Dr Somebody That I Used to Know's Office." I've told both her and New Girl that I don't have any other contacts with their names, so they don't need the full identification when they call, yet I was trying to determine if I could pick anything up from the tone in her voice. "I'm calling with your test results, your HCG..." oh fuck, she's struggling to get the words out... "Congratulations. It was 175. You are pregnant."
All I will ever remember from that moment is the smile on Husband's face. I don't think he has ever looked more beautiful to me. As we've been through two loses, we know that beta results don't always mean baby, and I once tried to dismiss their importance completely. It has taken three failed transfers to resonate their significance. We got our break. We're still in this game.
My stomach twisted into knots. This was definitely a bad omen. Not a good prognostic indicator at all. I shared this news with my friend Isabelle, who asked if I were using Endometrin. No, I replied. I've been prescribed Prometrium, or whatever micronised progesterone the compounding pharmacy whips up for me. Suddenly, I remembered that I had received a box of Endometrin from a fellow blogger earlier this year. I used it for a few days during FET#2 and I found that I liked it much better than the Prometrium capsules. Endometrin comes with its own applicator, so I don't have to use the Pre-Seed Lubricant applicators. (Top Tip: Pap smear cytobrushes are the perfect tool for cleaning these applicators. They work well for cleaning the straw and spout of your water bottle too. Steal some at your next visit!) Best of all, I found that the Endometrin didn't muck up my underwear nearly as much as the Prometrium. I didn't have too much hope with that transfer. It was a Hail Mary Grade 2 Blast to possibly avoid a second fresh stimming cycle. After a few days, I switched back to the Prometrium, as I decided that I would save the preferred Endometrin as a reward when/if I ever became pregnant again. What can I say? This girl knows how to pamper herself.
Now I had to acknowledge; was there something to be said for the fact that my preference for progesterone tablets and planned use in the event of a pregnancy aligned perfectly with the timing of my results? It sounds absolutely ridiculous as I type those words. Yet, these kinds of things appeal to the meticulous nature of my mind. I always try to look for patterns. I love palindromes. I get excited when I see a sequence of numbers. Why was something so silly giving me more confidence than the top grades assigned to my euploid beautifully expanding blast, which was placed perfectly by the skilled hands of my RE?
I can't explain it either. I went into the lab for my beta test with a surprising sense of calm, that I haven't had with my previous situations. After my first fresh transfer 'The Day 3 Desparation' I truly had no expectations. I felt over-confident with FET#1 'The Chosen One' as I was mentally clearing my schedule to return for beta#2 and my ultrasounds while waiting for the phlebotomist to call my name. I had an impending sense of doom with FET#2 'The Leftovers' and with FET#3 'Haven't Named It Yet'. I was merely going through the motions of having my vein poked in order to wait for a phone call to tell me something I already knew. This time, I didn't have that same intuition that forcasted failure. It's not the same thing as believing that I might have a positive result, but hey; I'll take it.
The call came in around 2 PM. I quickly cleared the alert from my phone and I refused to look at the length of the message to avoid applying the Thin Envelope Theory. Fortunately, I had a pretty busy day, which included dealing with possible treatment failure for a patient with an ectopic pregnancy. I was more preoccupied dealing with her beta results than my own. At last, after a long day at the office, Cross-Fit and waiting for Husband to come home from his hockey match, we played the message just after 8PM.
"Hi Jane, It's Misery from Dr Somebody That I Used to Know's Office." I've told both her and New Girl that I don't have any other contacts with their names, so they don't need the full identification when they call, yet I was trying to determine if I could pick anything up from the tone in her voice. "I'm calling with your test results, your HCG..." oh fuck, she's struggling to get the words out... "Congratulations. It was 175. You are pregnant."
All I will ever remember from that moment is the smile on Husband's face. I don't think he has ever looked more beautiful to me. As we've been through two loses, we know that beta results don't always mean baby, and I once tried to dismiss their importance completely. It has taken three failed transfers to resonate their significance. We got our break. We're still in this game.
Saturday, 1 November 2014
Lady in Waiting
I was scheduled to teach a contraceptive methods course in Sacramento on the day after my transfer, which meant I got to sleep in that morning. I rolled over and found Husband was already scrolling through his phone. As I rubbed my eyes, he presented a picture of Mrs Robinson and her twins. After a month in the NICU, everyone was finally home. "That will be you in nine months." he declared, "expect with only one baby" he added. When he delivers lines like these, I find myself loving him a little more, yet hating him at the same time.
After waiting for AF's arrival and hoping it would permit my baseline scan, laminaria placement and removal and follow up scan to coordinate with my trip back east, there was one more logistical hurdle. I had signed up to run a half marathon. When New Girl handed me my tentative schedule, my transfer was planned for a Monday, and the race was on Sunday. Six days post transfer and a day past the five day rest period. Of course, I should have been suspect that anything could align so perfectly. When I went back for my final lining check, Dr STIUTK asked if we could move the transfer to Tuesday, as he had a surgical case on Monday and as XYZ tends to be busier, they may not provide a time that would work for him. As I always do, I had snapped some pictures of my own schedule and it was actually easier to move my Tuesday patients. No problem, I agreed. I actually forgot about the half, until I received an email update later that day, and also noted that it was on Saturday, not Sunday.
So that would be on my fourth post transfer day... As the race location was a ninety minute drive away, I wouldn't have minded not getting up at 0430 on a Saturday, but the complicating factor is that one of my friends heard I was planning to do this half, and she signed up with me. Additionally, she took care of the cats while we were away and her requested payment was that I drive us to the event and pick up the tab at our post race breakfast. Just to hear what he would say, I asked my RE if I could run. "I'll leave that up to you to decide..." was his non-committal answer. Husband pointed out that he did not say 'yes', while I interpreted it as he did not say 'no'.
I just wanted an evidence based answer. Of course, I doubt there are any published papers about patients running half marathons and long distances after a transfer. There isn't any evidence to support that bed rest offers any benefit. In fact, one article I read performed a comparative analysis and noted similar pregnancy rates between bed rest and non bed resters, but the women who were on strict bed rest had a lower implantation per embryo rate. I've even heard some REIs wonder outloud if bed rest may have a harmful effect, that it's better for uterine blood flow to be up and moving. Just maybe not moving 13.1 miles.
I dug up my post transfer instruction that I received from my first cycle. As a five-time guest to the XYZ Embryology Suite, they no longer give me the hand out. I have been compliant with these instructions with all my previous transfers, and it didn't make a difference. "No strenuous exercise for five days". Strenuous is the key word. My ego wants to say that running 13.1 miles isn't strenuous for me. It only take me abut 4 weeks to train for a half. Yet, I've done this course before and found it to be tough, especially if it happens to be a hot day. Plus I haven't ran much in that last few weeks. And I'm recovering from a cold. Also, are you aware that this is your fifth transfer after three consecutive failures? "Jane, you and I both know that whether or not you run won't make a distance, but I don't want to see you blaming yourself if you run and it doesn't work." Husband offered.
The logical side of my brain agreed, as she tried to tell my ego that if it were an easier course, cooler temperatures and if I had been able to squeeze in a few more practice runs, then I could have done it. Then I received another email from the race organisers announcing that they decided to add a 5K distance to the event. It would follow the last three miles of the half marathon course. Now, that was something I could do!
They offered a shuttle service from the start of the half to the 5K start. While walking to the meeting point, I ran into a woman who I'm guessing is about 28 weeks pregnant. "I signed up for the half, but I obviously can't run it now." she explained. I decided to try being open about my situation "We're doing IVF and I had a transfer done earlier this week." "Oh. I had a friend who did IVF." she replied as she pulled out her phone and quickly became engrossed by it. Sometimes you can tell how fertile someone is by how uncomfortable they are discussing infertility.
I overheard two or three conversations on the shuttle to the 5K start, "so I was planning to run the half, but then I found out I'm pregnant!" I also caught a group of guys who had intended to run the half under the team name 'Sweating for the Wedding'. The Groom (I'm presuming) had written on his bib 'Hoping she'll love me the way I am'. Apparently they didn't realise how long 13.1 miles was and didn't train appropriately. So, this 5K distance would be composed of pregnant women and people who aren't fit enough to run the half marathon. I'm neither; but I'm feeling more closely aligned with the didn't properly train group.
After the shuttle dropped us at our start, we had to wait about 45 minutes for all the elite runners to pass. Those who keep a less than 7 minute mile pace and would clear the ten mile maker in less than one hour and fifteen minutes. We were able to hang out at a winery, receive shelter from the pouring rain, enjoy hot coffee and tea as well as indoor plumbing. It was starting to resonate that switching distances was a very smart decision.
I ran the 3.1 miles rather gingerly. I disabled my timing chip so that there would be no official record on how slowly I ran the course, but it was very slow. As I was waiting for the race to start, I received a text from Robin asking how we were doing. "You two are going to be amazing parents, whether it's in nine months or a little longer." Suddenly, I had a new perspective on the two week wait. I am merely waiting to see how long I will be waiting...
After waiting for AF's arrival and hoping it would permit my baseline scan, laminaria placement and removal and follow up scan to coordinate with my trip back east, there was one more logistical hurdle. I had signed up to run a half marathon. When New Girl handed me my tentative schedule, my transfer was planned for a Monday, and the race was on Sunday. Six days post transfer and a day past the five day rest period. Of course, I should have been suspect that anything could align so perfectly. When I went back for my final lining check, Dr STIUTK asked if we could move the transfer to Tuesday, as he had a surgical case on Monday and as XYZ tends to be busier, they may not provide a time that would work for him. As I always do, I had snapped some pictures of my own schedule and it was actually easier to move my Tuesday patients. No problem, I agreed. I actually forgot about the half, until I received an email update later that day, and also noted that it was on Saturday, not Sunday.
So that would be on my fourth post transfer day... As the race location was a ninety minute drive away, I wouldn't have minded not getting up at 0430 on a Saturday, but the complicating factor is that one of my friends heard I was planning to do this half, and she signed up with me. Additionally, she took care of the cats while we were away and her requested payment was that I drive us to the event and pick up the tab at our post race breakfast. Just to hear what he would say, I asked my RE if I could run. "I'll leave that up to you to decide..." was his non-committal answer. Husband pointed out that he did not say 'yes', while I interpreted it as he did not say 'no'.
I just wanted an evidence based answer. Of course, I doubt there are any published papers about patients running half marathons and long distances after a transfer. There isn't any evidence to support that bed rest offers any benefit. In fact, one article I read performed a comparative analysis and noted similar pregnancy rates between bed rest and non bed resters, but the women who were on strict bed rest had a lower implantation per embryo rate. I've even heard some REIs wonder outloud if bed rest may have a harmful effect, that it's better for uterine blood flow to be up and moving. Just maybe not moving 13.1 miles.
I dug up my post transfer instruction that I received from my first cycle. As a five-time guest to the XYZ Embryology Suite, they no longer give me the hand out. I have been compliant with these instructions with all my previous transfers, and it didn't make a difference. "No strenuous exercise for five days". Strenuous is the key word. My ego wants to say that running 13.1 miles isn't strenuous for me. It only take me abut 4 weeks to train for a half. Yet, I've done this course before and found it to be tough, especially if it happens to be a hot day. Plus I haven't ran much in that last few weeks. And I'm recovering from a cold. Also, are you aware that this is your fifth transfer after three consecutive failures? "Jane, you and I both know that whether or not you run won't make a distance, but I don't want to see you blaming yourself if you run and it doesn't work." Husband offered.
The logical side of my brain agreed, as she tried to tell my ego that if it were an easier course, cooler temperatures and if I had been able to squeeze in a few more practice runs, then I could have done it. Then I received another email from the race organisers announcing that they decided to add a 5K distance to the event. It would follow the last three miles of the half marathon course. Now, that was something I could do!
They offered a shuttle service from the start of the half to the 5K start. While walking to the meeting point, I ran into a woman who I'm guessing is about 28 weeks pregnant. "I signed up for the half, but I obviously can't run it now." she explained. I decided to try being open about my situation "We're doing IVF and I had a transfer done earlier this week." "Oh. I had a friend who did IVF." she replied as she pulled out her phone and quickly became engrossed by it. Sometimes you can tell how fertile someone is by how uncomfortable they are discussing infertility.
I overheard two or three conversations on the shuttle to the 5K start, "so I was planning to run the half, but then I found out I'm pregnant!" I also caught a group of guys who had intended to run the half under the team name 'Sweating for the Wedding'. The Groom (I'm presuming) had written on his bib 'Hoping she'll love me the way I am'. Apparently they didn't realise how long 13.1 miles was and didn't train appropriately. So, this 5K distance would be composed of pregnant women and people who aren't fit enough to run the half marathon. I'm neither; but I'm feeling more closely aligned with the didn't properly train group.
After the shuttle dropped us at our start, we had to wait about 45 minutes for all the elite runners to pass. Those who keep a less than 7 minute mile pace and would clear the ten mile maker in less than one hour and fifteen minutes. We were able to hang out at a winery, receive shelter from the pouring rain, enjoy hot coffee and tea as well as indoor plumbing. It was starting to resonate that switching distances was a very smart decision.
I ran the 3.1 miles rather gingerly. I disabled my timing chip so that there would be no official record on how slowly I ran the course, but it was very slow. As I was waiting for the race to start, I received a text from Robin asking how we were doing. "You two are going to be amazing parents, whether it's in nine months or a little longer." Suddenly, I had a new perspective on the two week wait. I am merely waiting to see how long I will be waiting...
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