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 

Just a month or so before I removed my IUD to let this adventure begin, I was talking with a close friend and fellow gynae about how our profession would affect our pregnancy experience. "There won't be the same sense of awe and amazement during the first ultrasound, as I know what to expect..." Of course when I said those words I thought it would only take a few months to get knocked up and the initial scan would reveal a perfect viable pregnancy...

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! 

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.

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.

*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.

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.

Obligatory FRER Picture

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.

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.

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...

Serving To Stay In The Match

The tenth month in the calendar year has represented several anniversaries. Husband and I met in the month of October and we moved to the States in October. In October 2011, I removed my IUD so we could start trying to conceive, but I made Husband use condoms, least we be one of those couples who score on the first attempt. A year later, we fell asleep early and missed having sex on the night of my positive OPK. I thought we were the most pathetic TTC couple in the world. Ha! Little did I know we were still amatures at that time. Last October I started my first IVF cycle and here were are at the end of October in 2014, preparing for our fifth transfer.

As we arrived at XYZ Fertility Centre, the staff went through the familiar instructions for us. Husband and I both pointed out, not only is this not our first time at the rodeo, we're five-timers! I do realise this is not exactly something of which to be proud. However, I am proud of my pelvic floor muscles, as they came through for me and my mega full bladder. Dr STIUTK felt the transfer could not have been smoother. Sigh of relief. We spent some time talking with the embryologist about our embryo quality. As four of my embryos were frozen on day 6, I wondered if they were inferior in any way. I was prepared to hear the embryologist (donned in her Hello Kitty scrub cap) explain that while chromosomally normal, as my embies are formed from a 38 year old and a partner with male factor, they actually suck.

Well, apparently they are all grade 1, which is they highest grade assigned at XYZ. When they have CCS tested embryos, they rank them by the confidence report of the chromosomal analysis. Although both she and my RE disputed that the day 6 embies could be of poorer quality, the first two chosen for transfer, were the ones frozen on day 5. Interesting. She also described that the process of performing the biopsy acts as a form of assisted hatching. Finally, the the embryo thawed well and the expansion was "awesome". Fuck. I forgot to ask my RE to take the report with him. I made that request last time as I didn't want to add to my photo collection of unfulfilled blasts. He had already left by the time I made the discovery. Now this transfer has to work as I have the picture.

Meanwhile, while I was resting, Husband received a text from Barney. He acknowledged that he felt badly about sharing their news as he knows of our struggles, and he asked how we were doing. He also confirmed our suspicion; they were a one hit wonder. Barney thought it would take about six months and was hoping to enjoy a lot of 'practice'. Instead, he notes he'll be doing a lot of self-practice from now on. Barney may come across as a crass lad, but he is genuinely a caring friend. Husband brought him up to speed. Just transferred a Grade 1 euploid embryo. "Wow." replied Barney. "I just googled what that is. It sounds like you can't get much better than that."

This is exactly what I would want to hear. Well besides hearing the words, 'your beta is positive and you are pregnant.' I've been asking myself would I rather hear the embryologist (in her French accent) explain, 'Your embryos are shit. There's not a chance in hell that you'll become pregnant' just so I'd have an explanation if it doesn't work? Obviously not. It's just that I've heard all the favourable reports before and they no longer mean anything to me. Why should I go out on a limb and let myself beleive that this transfer could be any different? Yes, we made a few modifications to this time, but they were emperic. They may or may not have any effect. We've gone though some many rounds of treatments with the thought that this could be the one! It feels so daft to think that way anymore.

This line of thinking led me to confront another question. If I don't actually believe that this may work, why am I continuing to transfer my embies? I have to admit that after our last BFN, the temptation to just walk away from it all was enticing. If we're going to eventually be defeated by infertility, why not lose on our terms, our command. Yet how much time would pass before regretting that decision? Would the spector of our remaining embies always haunt me whenever I saw children and would think about what could have been? C'mon Jane, you're allegedly a rational person. Somewhere inside that pessimistic skeptical being is a shred of hope. If you really didn't have any faith, you wouldn't got through these procedures.

Yet at the same time, it also seems prudent to ask how many times can we torture ourselves with this process? How many times can we welcome that faint ray of hope, only to have it extinguished so quickly? The smart alec in me has the answer. We're just serving to stay in the match. Down a set and a break, and our opponent is dominating her serve. Defeat feels inevitable. In fact, we haven't even managed a point [of an HCG] during her last three service games. We're just trying to hold our own serve to prolong the game. Maybe make the final score look better to reflect our efforts. Sometimes it's just the message that holding sends. You may be en route to victory, but I'm not going down without a fight. You want this win? I'm not going to give it to you. You'll have to earn it on your racquet. So we hold. Pause for a few minutes as we change sides. Await for our opponent to deliver her first serve. Maybe, just maybe, we'll get our break.

An Advocate for Stress?

I've previously written a few posts that have attempted to disconnect the association between fertility and relaxation, and I have been careful to mention that I'm not advocating for stress. Stress reduction has important benefits for mental and physical health, but a relaxed state will not necessarily enhance fertility. However, my recent conversation with Myrtle is making me reconsider my position on stress. She suggested that Husband and I take a trip to Hawaii after a transfer. Eye roll. Face palm. Head shake. God Damn, fertiles just cannot get off that vacation notion. Apparently, one must be on a sandy beach with a Mai Tai in hand in order for implantation to occur. Of course a fertile wouldn't understand how stressful it would be to try to coordinate a trip around the time of a transfer. Nor could she appreciate that it would be hard to fund an FET and a holiday in the same month.

Although many have commented about how tolerant I am of Myrtle; I have a bit of a confession. The academic in me really enjoys schooling her when she comes up with some pretty ridiculous shit. "Jane, your job is so stressful. What if you just took a few days off?" Once again, we ran that play last time. My transfer was on a Wednesday and I had PTO for the rest of the week. I worked on a presentation, which was more time consuming than a stressful task. To complete the relaxation cliche, I had a facial and a massage. Since XYZ won't assign a time for my transfer until the night before, I have arranged to take the entire day off, so that I'm not cancelling patients at the last minute, although on two of my transfers, I could have worked through the morning session. I've just wanted to avoid the clusterfuck that occurred with my first transfer.
                 
When my RE called with my fertilisation report, he tried to assure me that we would be able to transfer on day 5, but I sensed he was holding something back. Three days after my retrieval, my cat Angus followed me from room to room and repeatedly meowed for no apparent reason. I know it sounds crazy, but I felt he was trying to tell me that I would be transferring that day. Shortly after I arrived at work, my medical assistant informed me that a radiologist was calling with a stat report. As I was the only provider in the office at that time, I had to take the call.

It was a patient who had recently miscarried and the radiologist suspected she had retained products of conception. My colleagues and I have often observed that the radiologists tend to over read retained products. However, this radiologist just wanted an answer, what did I want to do with her now? During this time my phone rang, displaying my RE's office number. Oh fuck. It was barely after 9 AM and he was calling as soon as he arrived in his office. This was not a good sign. I had to let the call go to voicemail. Meanwhile, I needed to deal with this patient situation.

I called my colleague who had seen the patient and ordered her ultrasound. It was her day off, but fortunately she answered her cell phone. She shared my skepticism on the interpretation and noted that the patient wasn't bleeding too heavily, so she thought she could be managed medically. I called in the prescriptions, had my medical assistant schedule a follow up appointment for her and asked our nurse to go to the radiology suite to review the instructions and plan with the patient. Surprisingly, this only took ten minutes.

When I was finally able to call my RE, he had already started seeing patients. I waited on hold for over ten minutes, before I hung up and called back to inform them that I couldn't wait any longer. I now had three patients waiting in rooms and I was running twenty-five minutes behind. "I'll pull him out of the room" Misery offered. Another bad sign. Five minutes later he came to the phone and delivered the recommendation to proceed with a day 3 transfer. I had promised Husband that I would call him as soon as I heard from my RE, but I had to start seeing some patients. Especially if I were going to be leaving the office early.

Fortunately, those first three patients were relatively straightforward and weren't too upset about the long wait. I brought Husband up to speed and then called my RE again. During my freak out over the possibility of twins, he let it slip that due to my 'poor prognosis,' it actually wouldn't be unreasonable to transfer three embies. I wondered if we should proceed at all. Disaster was written all over this plan. I told our office manager that I would have to leave for the afternoon to tend to a "family emergency," which was technically kind of true. I rushed out of the office leaving a mess of paperwork on my desk, phone calls unanswered and I only glanced at my results to see if anything was urgent.

Husband and I talked during the drive to XYZ Fertility Centre, which prohibited me from drinking the required amount to fill my bladder, as it wasn't sufficiently full by the time we arrived. The hottie embryologist described that our embies weren't too bad, if we only had more, we could have held out until day 5. I was questioning my decision to proceed with these two as my RE was placing them inside my uterus. My thoughts oscilated between panic about twins to fear that the entire cycle was a bust. I felt extremely tense during this transfer and it was the most uncomfortable of all four procedures.

For almost a year, I have been trying to understand how an abnormal embryo of mediocre quality could implant under unfavourable circumstances, while three superior quality embryos failed in an allegedly ideal transfer situation. Did the stress of that day have a positive effect? Was there something about my release of cortisol or endogenous adrenaline that helped implantation? I've argued against the "just relax" theory by pointing out that pregnancies occur in many stressful situations, physicial attacks, famine, war, etc...We often see a bump in the birth rate nine months after a natural diaster or other catastrophic event as people decide to do something life affirming. Once I countered that as Husband has decreased sperm production and I have a long follicular phase, we may be too relaxed!

I acknowledge that I'm absolutely grasping at straws, but it did spin some wheels in my mind. Should I try to induce some stress into my transfer day? I thought about not taking the day off work, maybe calling in sick for a morning transfer, or trying to work in the morning if I were scheduled in the afternoon. My conscience forbids me from doing that. I hate cancelling patients at the last minute. Instead, I looked through the schedule for the week and made recommendations for my medical assistant on where she could reschedule patients. Maybe we'll get delayed by traffic, although that's unlikely as Husband will be scouring the traffic reports and will build in plenty of 'oh shit' time. The fact that I have to keep a super full bladder is nervewracking. Not only is it physically uncomfortable, I worry my cup may runneth over. I'm scared that it will be another difficult transfer and I'll feel doomed right from the start.

Thus, I suppose the situation alone should represent enough stress. This is our fifth transfer within a year, and possibly the penultimate one. We running out the clock. Our enthusiasm, our patience, our resources and our hopes are all fading. I feel a particular sense of desperation that I didn't have a year ago. Maybe that's just the difference I need.