Vacation!

We're off to Yosemite! I'll have to do without my weekly scan, but I think it will be worth it...

I still don't feel much of anything, physically. Maybe a little teeny bit of stomach blah, definitely more tired than usual (but also busier than usual). Somehow, I look four months pregnant already. And, somehow, it doesn't help - I just feel awkward and lumpy.

So, I'll be the slow lumpy one on the snowshoes. Or maybe just the lumpy one by the fire with a big fat book! 2008 has been fraught with hope and change in so many ways for me - I am looking forward to a year which holds so many happy new possibilities! A truly Happy New Year, this time. And I wish the same for all of you.

Labs and Other Tests

Luckily, I've managed to get an ultrasound once a week so far - this one with my regular OB, who called me on Sunday after she got my message so we could schedule an appointment as soon as possible. She completely understands the IVF-pregnancy panic, so I'll get to see her more often at first. Between her office and the last few visits to my RE, I'll be able to stay on the weekly u/s until the nuchal translucency scan!

The only bad news is that my thyroid levels are off - and the nurse who left the message didn't even tell me in which direction. And googling anything like this just leads to disaster - the first three things I read were dire reports of lost motor skills and lowered IQ. I am (for now) assuming that my levels can't be too bad since the nurse said they just want to retest in a few weeks and it should be fine...

...........................................

Meanwhile, maybe I shouldn't worry too much about lowered IQ. Since my daughter is so unhappy at school, we began to wonder if it wasn't more than just feeling alone and disregarded that was the problem. Because she'll be in the sixth grade next year, we have a lot of options as far as school choice - there are so many charters, magnets, private schools and permit-entry public middle schools that start in sixth that we thought it would be good to look into moving her early.

As we researched, we found out that most of the charters and magnets are LA Unified schools, and since we don't live in LA proper she can't even apply to those. There are some state charters open to anyone, and we found one we like. It is on a lottery system, though, so you have to just cross your fingers and hope to get in. The other options are magnet-charters that she may be able to get into at the discretion of the district at the start of the school year (depending on enrollment) - yikes! The local middle school seems mostly fine - not much gang activity, good music program, great theater program. But there are no gifted classes. Since my kid's whole problem is that she has a hard time really finding friends who have "interesting things to talk about and are really smart and funny" I am not sure about the no-gifted program arrangement. I'm sure those kids can somehow find each other, but at her current school finding those kids isn't the problem - the fact that they're not in the same class is what really ruins it.

All of that is a long backstory to this: we are looking at private schools. Which means that we have had to study for the ISEE (a sort of mini-SAT) which is required for the admissions process. And she has been IQ tested, the results of which were unattainable. Yep - the modern IQ test apparently doesn't go high enough to measure my kid's IQ. Which just serves to infuriate me even more when her current school says that they feel gifted is an arbitrary designation, and it doesn't really have any bearing on the classroom situation.

Anyway, I always knew my daughter was bright. But she is not one of those kids who knows everything there is to know about micro-organisms or Greek mythology or whatever. I knew that she was happier when she was in class with her three friends who are also really bright, but I hadn't fully put it together that it isn't just social. She just misses having someone to talk to about whatever they are doing in class. I thought it was more about having a friend to chat with in the "in-between" times, but maybe I was missing the bigger picture.

I think that the ISEE prep is actually great - it's more homework than she gets from school, and she seems to love it. I've also been carving up my work schedule into little ribbons of time just so I can manage ultrasound appointments and playdates with the kids she likes, and it does seem to be making a big difference. She has two semi-friends in her class, but doesn't want to see them outside of school. (She has known them for years and always liked them peripherally, but the few playdates us moms arranged were never really great for any of them.) So, I just make sure to have as many kids over as she wants, lots of sleepovers and lots of cookie-baking.

Anyway, that's my long update on my daughter - private school interviews in January, charter lottery in April, magnet-charter maybes in late August, if we can hold out that long. All I know is, any school is probably better than one that thinks gifted (and, by the way, I hate the word gifted - there should be some better term that denotes specifically cognitive/associative/comprehensive agility) kids don't need any specific consideration at all.

July 20th

I had another ultrasound yesterday, and the RE told me I could stop worrying about an early miscarriage. He hastily added that there are no guarantees, etc., etc. - but of the few things they look for (heartbeat, growth, condition of yolk sack, no hemorrhaging behind the placenta) all are just fine.

I could see the head vs. body differentiation, and even a little twisty movement and head bopping. Of course, on the little picture it all just looks like a blob, but I swear I saw that blob shrug, as if to say "It is what it is, lady. Just chill." So, okay, I get the message.

Here's the blob, with the head at the top, in profile. The round thing by its (eventual) feet is the yolk sac.


I did go on a drawstring-pants shopping spree, and also got some drapey tops. One of my best friends is getting married Christmas Eve, so I have to find some kind of fancy loose outfit. And I'm thinking of actually telling her that I'm pregnant, instead of making up some kind of reason for not drinking the champagne. How's that for throwing caution to the wind?

Meanwhile, I made my first OB appointment. My RE likes to have an overlap of care, just a week or two. Then, the nuchal translucency scan in the first week of January. Suddenly, it all seems real. It's impossible to remain detached and neutral through all of this, anyway. I can't be invested enough to eat really well and avoid all the bad things and generally try to be a good pregnant lady while also trying not to get too invested in the pregnancy. I am just not that psychologically complicated.

I think the real story now is all about being pregnant and old. I know that over women over 40 may have increased risks for growth problems, preterm labor, preeclampsia, high blood pressure & gestational diabetes. But I'm just not up for worrying about all that too much. It's not that I'm putting my head in the sand - I'll make sure to exercise (at least a little bit) and have any weird symptom checked immediately - but somehow making it past your own personal infertility hurdles is exhausting enough. Fretting about hypothetical problems is just too much - I'll cross those bridges when and if I come to them.

Of course, I'll still be nervous for the nuchal scan, the triple screen, the big anatomy ultrasound. But it seems somehow like normal-person worry, not desperate-infertile-worry-which-
mourns-the-wretched-injustice-of-it-all. I might even buy a bib or something, if it's on sale. (Although I do have pre-planned escape routes for any early purchases - pregnant sister, pregnant cousin, pregnant dear friend. One boy, one set of boy-girl twins, one unknown. I figure I can re-gift pretty much anything.)

Stomach Problems

I am possibly feeling the teensiest bit of nausea, which I am taking as a good sign. Although maybe I just ate something funny, because one day of stomach weirdness could be anything, really.

Mostly my stomach feels bad because it is uncomfortably squeezed into my pants. As anyone who has gone through a medicated cycle can tell you, there is some kind of bloat that has nothing to do with anything that may or may not be growing inside you. The bloat is some kind of fat-collecting, fluid-retaining, muscle-slackening deterioration that makes fitted pants a very unfortunate fashion choice. I can only imagine what might happen in back-to-back cycles, but maybe there is some kind of bloat threshold.

Part of it is the lack of vigorous exercise, because of course the hormones make you feel terrible and then the taking-it-easy is such a good excuse to skip the gym. Plus, the steroid I'm still taking does tend to cause puffiness. I know I need to get myself back into some kind of regimen. But I think the IVF bloat, added to the fact that I am not some young thing at this point, means that I am just not going to be swanning around in cigarette pants and a halter anytime soon. (Which is fine, because honestly, I don't swan much anyway...)

Floppy pants are not really a problem - I'm happy to need them, happy to be in this situation at all. But it's funny how many little things are different with a pregnancy after infertility. There's just a lingering sense of doubt and failure that's hard to shake, a habit of not expecting too much. I keep thinking it will ease up as time goes by, but maybe I haven't given it enough time.

I did, however, order two pairs of fancy stretchy pants and one of those wrap-around sweater contraptions. I may look like I'm getting fat, but at least I'll be able to bend over.

Hooked

Thanks to Nikki for the lovely compliment of this award! It is especially pertinent to me because of the tiny houses in the picture - since I am a landscape architect, I am more or less always thinking about houses (unless I am thinking about getting pregnant...)

In the tradition of passing it on to two more blogs, I can only say that I am not somebody who reads a jillion blogs - I really love all the ones that I keep in my reader. But there is a special place in my heart for the stories of my fellow 40 +ers, so I will pass this on to Sky and Egged. Along with my continued best wishes, of course.

............................................

Anyway, today I started allowing myself to think I might actually be pregnant. Just briefly. I am not ordering any crib sheets for a long while, but I may buy another pair of stretchy pants this weekend.

Other than that, I haven't really thought about anything like when to tell and what to worry about. For me, the heartbeat has been such the focus of my anxiety that anything past that is uncharted territory. I guess I should concentrate on the normal things like eating well and getting some kind of exercise, but it seems so odd to stop worrying about death and start thinking about calcium deficiency.

Alive and Well

By which I mean myself, and one little embryo.

We saw a good heartbeat, about 149 bpm. The little blob is one centimeter long, which is exactly on target for 7w2d. I am so relieved I don't even know what else to write. I'm sure I'll have nine hundred other things to add to this later (when I'm not at work, for example), but for now I will just say that I am extremely relieved and full of gratitude and hope.

Wimp

It wasn't so much the actual stabbing or any kind of fear of needles or even the welts and bruises. But when I began waking up so many times every night in pain - whenever I rolled over, or my husband flopped his arm against me - I decided I just couldn't take it any more.

So, against my superstitious better judgment, I am switching from the PIO to progesterone suppository. I know there is a sort of hard-core IVF badge-of-honor tradition to the agony of the PIO injections. And sure, I get that after all it takes to even make it to this point, I should be willing to do whatever I have to in order to support a positive outcome. But waking up whimpering in pain six nights in a row has done me in.

It really wasn't so bad at first. Even though that needle is long, you don't feel anything past the surface nerves anyway. It's the swelling - and possibly a mild allergic reaction - that was my undoing. I could massage with a hot washcloth until I was sure there were no lumps of oil coagulating in my muscle, but there wasn't much to be done about the general swelling. I rotated sides, of course, and used different spots each time. But after a few weeks there just isn't any undamaged tissue left to puncture. The last few days I have had large pink spots on each hip, swollen tissue that is so sensitive that I have to wear soft elastic-waist pants and pretend I am just on my way to a yoga class all the time.

I know the suppositories have a bad rap - they leak, they itch, they ruin your panties. They can cause irritation that can lead to bleeding - and, thus, panic - and progesterone levels can't be reliably measured with a blood test since the effect is so localized. I was hoping to talk to my doctor about Claudia's secret sub-Q progesterone alternative, but since my appointment was canceled I decided I just couldn't go another week without a switch.

I've read a lot of studies that show no difference at all between intramuscular and intravaginal progesterone. Then there are studies showing that one is better, and studies proving that the other is better. There are even studies suggesting that no supplementation at all (past a positive beta) is just dandy. It's ultimately impossible to make the right decision based on all this vague information. Even though I used to be paranoid about changing anything or doing anything that might possibly cause some kind of disaster, I've been worn down by exhaustion and worry and the business of trying to stave off hope. So, I don't know. But I'm damn glad that I'm not icing my ass while I type this.

Waaaahh!

My ultrasound got rescheduled. Now I am feeling very bah-humbuggy about this holiday thing, and the fact that my doctor actually seems to want some time off. Hmph! And because of my own guests and then some big client meetings that can't be moved around, I will have to wait another week. Just when I thought I was almost kinda maybe going to make it until the 26th!

I know I should just be happy that so far things at least haven't taken any dramatic turn for the worse. But it also seems that, for all of us, reaching whatever milestone was the one that wasn't reached before is so emotionally fraught. A first-heartbeat ultrasound is still so early in the game, it doesn't guarantee anything, really. But my last two pregnancies more or less ended on that murky screen, so this is especially nerve-wracking for me. I'm sure that, if all goes well at this stage, I would go on to panic over the nuchal-fold test, the "big" ultrasound, reaching viability... none of us can take any of those things for granted after everything we know. But this has been my particular obstacle, and the anxiety is making me crazy.

It should be a good sign that I haven't had any cramping or bleeding, but I have never miscarried so obviously. Mine have been "missed miscarriages". Weeks without a heartbeat, and nothing ever happened. I had the D&Cs because it was just too hard to wait any more, just impossible to think about anything else at the time. When we decided to have the pathology work done it did show a chromosomal defect, and I am grateful to have that information. Some kind of explanation is better than just not knowing.

Anyway, in a convincing feat of pollyannaism, the nurse did tell me that at 7w2d the scan would be more definitive - before 7 weeks it might not be possible to see the heartbeat as easily. So, there's that - a more conclusive result. As long as the result is going strong, a tiny flicker in a grainy image.

Meanwhile

Time is so not flying that I can't believe this is only Wednesday. What happened to those crazy days that run together in a blur? I thought the only reason we all know what "tempus fugit" means is that it's been so true for so long. But - at least for me - tempus dragit is more like it (how's that for five years of Latin?) and I feel as though I will rot and mold before next week even manages to show up.

I have absolutely no symptoms, except for the sore PIO boob effect. No nausea, no dizziness. I am still bloaty and blob-waisted, and I've been exhausted by mid-afternoon for the last few days... I want so badly to take those as actual signs of continued well-being, but I definitely had those problems before my last miscarriage.

I was recently at an appointment with an educational psychologist (to discuss my daughter's ongoing misery at the idea of going to school) and she asked me if I was going to have any more children. I was so unprepared for that question at the time that I'm sure whatever I managed to say had all kinds of odd implications. I think I said something like "Well, you never know...", but honestly I can't remember.

People used to ask me that all the time, back when my daughter was still really young. Now that she's ten I guess it seems obvious that we either can't or don't want to have any others. These days I'm more likely to get comments about the hazards of raising an only child. Which is even worse than the baby questions, because someone may not know that we have infertility issues, but it's certainly clear that we can't go back in time and create siblings.

So, another week will crawl by. I know that the bottom line is that there is no way to second guess any of this. It is what it is. I just hope that it is what I want it to be, too.

Thanksgiving

Eleven days until the first ultrasound. That seems like forever, but I do have a trick for making the time go by more quickly: houseguests.

My dad and ... his wife? My stepmother? Mrs. W? I never really know what to call her. I usually just use her first name, but when referring to her I get flummoxed. They got married after I was out of college, so she never had much of a mother role in my life. But I really, really like her, so it isn't that I don't want to use any variation of the "mother" word to describe her. In fact, I have a much better relationship with her than I do with my real mother. Anyway, they are coming for the long weekend.

We are not groovy enough to abandon all tradition and just make a great dinner. We'll be having turkey, stuffing, cranberry sauce, brussels sprouts, some kind of potatoes, some kind of other vegetable, and some kind of pie. My husband will smoke the turkey all day, after it has soaked overnight in a cider and spice brine. I'll probably make a few different kinds of potatoes in the next week to test possible options (which is silly, since we will inevitably go back to the mashed potatoes anyway). Plus, I'll have to try out something that will result in gravy since the smoking method doesn't make pan drippings. And there's always the sweet potato conundrum - if you already have potatoes, are they really necessary?

So, I can keep busy for the next eleven days. I have to finish a project at work which involves a mini-waterpark as part of an over-the-top backyard pool renovation. The research alone should occupy me for at least a few days, and the drawings will probably take forever, so it's possible that the 26th will just creep up on me and I won't notice the time going by at all. Right?

159

Doubling time of 1.54 days.

Which could mean all kinds of things, given a x3 transfer. There could be one overachiever going strong or some combination of success and failure amongst the three. I'm just crossing my fingers for the one really good one, and since I won't have any more beta testing before the first ultrasound, there's not much else to do but sit tight and hope for the best.

The last time I was officially pregnant, the time that ended in a pathology report of trisomy 17, I couldn't shake the feeling that something wasn't right. I felt really ambivalent about being pregnant, and I questioned everything about my decision to go through so much to have a child and then feel so lackluster about the pregnancy. Of course, I realize now that it was just a defense mechanism, that I was probably willing myself to be detached from the experience just to keep myself from completely falling apart if it didn't work out. And it didn't work out, and I fell apart anyway.

I feel much more able to accept whatever comes now. I'm not sure what the difference is - but I know that having read the stories of so many women in the IF blog world, I don't feel so alone and ashamed and unsure. It has been really meaningful to know that there are amazing women out there who are facing the same obstacles that I am - and just the fact that they can so beautifully express and clearly reflect the experiences of infertility has made me stronger and more resilient to the insecurities of the process. Thank you for sharing this with me and giving me what I never had before - a sense of understanding in the midst of what seems mostly unfair and unlikely and desperate and embarrassing.

I have managed to make at least one egg that fertilized to the point that it could implant, and it's hung on long enough to make satisfactory lab test results. That may not mean anything in the long run, but for now there isn't really any more I can do one way or the other. I'll go to acupuncture, take my vitamins, no coffee, etc. - but other than that, the die is cast. From now until the 26th (first u/s appt.) I'll try to just appreciate the fact that things have progressed to this point, to be happy for what might be.

Toad Lady Strikes Again

At least I nabbed one of the four metered spaces right in front of the hospital this morning. But the lab experience was as Kafkaesque as the last time. I had to fill out all kinds of paperwork that for some reason hadn't been necessary on Monday, and then there was some big argument about whether or not the tests could be ordered "stat".

Apparently, "stat" means there is some kind of emergency involved, and Toad Lady decided that a second beta doesn't constitute anything dire enough to be called an emergency. The blood was drawn at 9:10 am and as of 6:00 this evening (when my nurse called to say she was on her way home) it hadn't even been sent to the main facility. This is a main branch of Quest, right next to a big hospital. It seems crazy that they can't just run some bloodwork by the end of the day!

Toad Lady was slightly more efficient today, but she did call my name and then stand right in the middle of the doorway while having a conversation with the other person in the waiting room about how wearing ten-year-old shoes is perfectly fine as long as they were resoled as needed and the stitching was very high quality. The other person then took off her ugly perforated pink sandal so they could inspect the stitching together. It was decided that the shoe, being German-made, was a good candidate for the ten-year-plan. Yay! Congratulations on your ugly, worn-out shoe, lady!

The only consolation in all of this is that the FRER this morning was significantly darker than Monday's. That's not as scientific as actual doubling numbers, but I'll take what I can get.

Lull

It's been an odd day. I am so conditioned to keep any kind of hope thoroughly squashed down that I haven't even let myself think about tomorrow, much less anything beyond that.

The lab where I had my draw yesterday is in a medical building next to a hospital. Absolutely no parking except for the seven-dollars-per-twenty-minutes lot next to the ER. And of course the woman at the front desk of the lab was like a Coen brothers version of a receptionist: thick stubby older woman with a giant flattened bouffant and thick mad-scientist glasses. After I gave her my lab slip she went to the back of the office and stood with her back to me shredding documents for a good five minutes. I kept checking the clock, thinking of that parking total.

When she finally shuffled back to the desk and entered my information on the computer I figured we were almost done - there was nobody else waiting, so I assumed I was next. She was clattering away on her keyboard for a while, and nobody had come out of the back for a long time. It seemed weird, because most lab tests just need a quick vial of blood or a cheek swab or maybe some pee in a cup. It had been a half hour and nobody had come or gone. The receptionist had turned the back of her lopsided bouffant to me and was busy going through some mail. I began to wonder if the phlebotomist was out on a break.

Except, then the bouffant lady called my name and trudged around the side of the office to open the door for me, and suddenly it was she herself pulling on gloves and a mask and getting out the tubing and the vial. Her? The crazy toad-in-a-housecoat character? The receptionist lady was going to draw my blood? What?

I had to pay $21 for parking because I was there for almost an hour. And in the scope of an IVF cycle that's nothing, really. But the whole thing was so pointless and bizarre. Tomorrow I'm parking at the Rite-Aid and walking six blocks. And hoping that Toad Lady has the day off.

65

The clinic coordinator called me this afternoon to find out where I had gone for the draw. They had ordered it stat, which is supposed to mean they get the results in 3-4 hours, but they hadn't heard anything. Somehow, she tracked down the paperwork and called me back this evening to let me know that first number.

65 at 9dp5dt is not bad - not as bad as I feared. It just goes to show that you can't play lab director in your own bathroom with any degree of certainty. I was prepared for a low number along with cautionary advice about falling betas, etc. I'm still giving myself all kinds of cautionary advice, because I've been in this exact same position before - normal beta, good doubling, nausea, etc. - and then the first US showed a slow heartbeat and it was all just a matter of time after that.

I know better than to get any kind of hope up at all (but thanks for the capital H, Shelby!) at this point. I'm not even nervous for Wednesday. I'm kind of in shock that any part of this has appeared to have worked at all. Isn't it funny how it's hard to just be happy for something that you really want if you think you might not actually get it?

Maybe

I know enough to know that it doesn't look good. Accounting for doubling time, a positive beta without a faint line yesterday would be very very low - not a good sign. But I can see some kind of a faint faint line today, the palest wisp of pinkishness. So, there's a maybe in there somewhere.

The maybes are where that faint faint line gets blurrier. Maybe it's a chemical. Maybe it's just a later implantation - the morula instead of one of the blasts? Maybe there's a chromosomal problem. Maybe I just have overly diluted morning pee? See - I can come up with a reason to support almost any conclusion.

Lab test in exactly 58 minutes.

Top Ten Reasons and Excuses

1. Technically, the test was expired. Although only by two months. But maybe those tests are really sensitive to being old? But probably not.

2. 7dp5dt is really early. But not unthinkably early. But early.

3. I have had negative tests with actual pregnancies before.

4. Yeah, but those pregnancies didn't turn out so well...

5. It's too early.

6. It's better not to get any hopes up. All pregnancy symptoms are just the side effects of the PIO. Hope is that thing with 1 1/2 needles poking you in the hip every night.

7. Don't test tomorrow - it's just a waste of money. The lab work has to be done anyway.

8. Maybe tomorrow there will be a faint faint line? It would be so nice to have some kind of idea before going in for the lab work. Although even if it is negative I'll still hope that the blood test is positive, so maybe it doesn't matter...

9. It is what it is - testing doesn't make any difference.

10. I shouldn't have tested.

Spit Shine

I have one real-life infertile friend. She has been trying to get knocked up for about three years, to no avail. They don't have insurance for infertility (surprise) and have been trying to save up for treatment. They really live on the edge of every paycheck, so it's been a long process for them. She couldn't even figure out her cycle with the OPKs since she was so irregular and she couldn't afford to keep buying the kits. She did get one of those saliva-monitoring tests, though, and she watched her ferning pattern for weeks. When it finally kicked in, they just spent two days in the sack and - voila! Pregnant. After looking at her spit.

Of course, it's early days. You or I would know better than to announce a pregnancy before a satisfactory ultrasound or at least a good rising beta. She is six weeks pregnant and thrilled to the eyeballs - and was very gracious about telling me. And I am ecstatic for her- she will be an amazing mother. She is truly a remarkably compassionate person. But, damn - spit? Really?

The stories about eating whole milk products, timing sex with the phases of the moon, tying red string to the end of the bed - the fact that these ever work at all has got to be purely coincidence, and yet they persist. And I know the ferning is more scientific than that - it does give some kind of useful information - but it's one more story about how all you have to do is ___________________ and all your problems are solved.

The real kicker is that I would so love for us to be pregnant at the same time. We live so far away from each other, but it's still like time has never passed whenever we manage to get together. But try as I might, I don't feel pregnant. I feel hopped up on progesterone, but I know enough not to confuse sore boobs with an actual pregnancy. At 5dp5dt, I feel bloated, tired and frustrated, but I don't feel at all pregnant. I know it's too early to make a definitive statement, and of course I would love to be proven wrong, but I've been pregnant enough times to know that I usually have some kind of early inkling.

I have never been much of a POASer. But I may have to break down and do it just to prepare myself for the lab results on Monday. I think a negative is easier to take if you aren't holding out hope. That said, my clinic doesn't even call with the results until after the second beta - the theory being that until the numbers rise it doesn't mean much anyway - but I think I can have the lab call me directly with the results.

Luckily, I have an incredibly busy weekend booked, maybe I won't have time to think about not feeling pregnant...

And Then There Were Three

For some reason I only have a photo of two of them. There was a certain amount of hemming and hawing about how many to transfer. It seemed obvious to me - the 7-cell had stopped growing yesterday, so we were left with three. The day-3 10-cells had become compacted blasts, one of them being a quite nice grade 2 and the other a slightly raggedy grade 3. The day-3 8-cell was still a morula (day-4 stage) but looked good enough to be graded a 2. So, the good blast was a shoo-in, but it was impossible to decide which of the others might have a better chance. I really didn't want a single frozen blast left for a FET, so we decided to go for all of them.

This really barely raises my chance of multiples - maybe by 1% - but it does increase the chance of pregnancy by 10%. Seems like a no-brainer, really. We had the requisite discussion about selective reduction, and apparently I gave the reasonable answer and that was that. Now, I know that stranger things have happened, etc. etc., but after everything we have gone through to even get to this point I just have to plan to cross all other bridges when (if) I come to them.

I have my lab request for two betas, 11/10 and 11/12. In the meantime, PIO at least until the first ultrasound (if, of course) and then maybe onto Claudia's secret sub-Q progesterone. Plus, I get to add an estradiol suppository starting tomorrow. Other than that, time will tell. It's going to be a long 2WW, even if it is only eleven days.

Night of the Living Embryos

Day three report: all four are alive and well. There are two 10-cells, an 8-cell and a 7-cell. As of now, I am scheduled for an 8:00 am transfer Saturday morning. Which is no longer officially Halloween, but at least my daughter will still be away at a sleepover.

So - the next two days are all about the genetic material from the sperm. Since sperm develop over a 72-day cycle, I spent the last few months desperately trying to keep my husband as healthy as possible. He was very agreeable about the supplements and no bike riding and getting plenty of rest, etc. etc. But then he was in an accident in which he broke two ribs and tore his rotator cuff. I have to say, he tried to live with the pain, but in the end he took carisoprodol and vicodin for two weeks. I almost canceled the whole cycle, but the doctor told us that these drugs may affect morphology, but the ones that do make it should be fine - it's an all or nothing effect, and has nothing to do with the genetic material. Hopefully.

So - more waiting. My assumption is that we'll transfer all of them - or whatever is still there Saturday - but that isn't official. When we were sitting in the office talking about theoretical embryos the doctor said that at my age he would go for three or four. It doesn't make sense to freeze a lone embryo, and the chances of all of them surviving till transfer are still low. I am still feeling very realistic about this cycle, my hopes are not up at all - but the fact that they aren't all dead is really satisfying - maybe my eggs weren't as crappy as I thought they were?

Either/Or

So, the report is basically fair-to-middling. Out of twelve eggs, seven were mature. Of those seven, four fertilized. I was nervewracked all day since I couldn't actually call them back at work. I have taken so much time off for all of the appointments that today I had back-to-back meetings, including lunch. I couldn't even sneak off to the ladies without someone coming along. I did manage to leave work by about 4:00 and call the clinic on my way home, but they had all left for the day. Gah!

On the off-chance, I emailed my doctor just to let him know I would try to call early tomorrow. He emailed the report to me at 7:30 tonight, which was so sweet. And so much better than tossing and turning all night, wondering if all my eggs were duds. My initial reaction was really mixed - relief that some of them made it, and disappointment that there weren't more. In the end, it is what it is - the percentages are against the older eggs, so now I just have to hope that one of those four is the winner.

One other thing that he mentioned is that we could do a day-3 or a day-5 transfer. I am extrapolating here, but I think that means either a) with four we will just put them all in anyway, so no need to wait for day-5 to help us with selection, or b) there may be nothing left by day-5, so get them back in there A.S.A.P. In a way, I want to wait for the day-5, even if there aren't any left. Supposedly at that point the genetic material from the sperm kicks in, and if that gives us any helpful information it may be worth it. There is such an emotional desire to get those little cells back in the human body, but in fact day-3s would (in a non-IVF conception) be still traveling in the tubes, so the uterus may not be the best place for them after all.

We were approved for the three-for-two package, by the way. It was contingent on how many eggs were retrieved - I think it had to be nine - an apparently my husband settled all the paperwork while I was still zonked out. So, now we have two more tries already paid for if this one doesn't work. Obviously, I would be happy enough if it turns out that the first try is it, that I paid way too much for this cycle, but oh, well. I'm forty - I can make money later, but making eggs is another matter. If this cycle doesn't work, I am willing to view it as a fact-finding mission and hope that we can figure out what other issues we may be dealing with.

I should know more tomorrow. Meanwhile, the PIO wasn't so bad. Kind of a production, with the ice pack and the heating pad, and the massaging. It took me about 20 minutes in all, but maybe most of that was procrastinating...

Retrieval

They got all twelve! Although I don't have any lab information yet, so I'm not sure what that means. The likelihood that they are all mature is rather low, but you never know.

I can honestly say that the worst part was the IV. It felt like a railroad spike in my elbow crook, and it's still sore and red. I was completely zonked for the actual procedure, so I can only assume nothing drastic happened. The crampiness has been minimal - I guess that's one benefit of not having 37 follicles - and I haven't had much spotting. So, in general it went well.

The bad news is that I have to start the PIO today. My doctor had originally told me that the difference between the suppositories and the oil was so minimal that I could do either one. So, yay suppositories! But today he said that he wants me to try the injections and see if I can manage them, since there is a tiny advantage in the studies and blah blah blah. I can't have Maureen drive over every day (it's a twenty-five minute drive in no traffic - in traffic it can be over an hour) and my husband is the world's squeamiest man, so - I guess I'll just try it myself. I've watched all the youtube videos, and maybe it won't be so bad...

Now, we just wait - lab report tomorrow!

Trigger, Happy

Three cheers for Maureen! While my husband cowered in the bedroom, she expertly administered the trigger shot. It actually didn't even hurt at the time, although there is some lingering residual soreness.

Since we had to wait until 10:00, we made a night of it and went to see The Changeling first. It's a heartbreaking movie, and maybe not the best choice in my overly-emotional state. But it is superbly detailed, so even though I thought I would throw up during most of it I still recommend it in general. I like to see movies when they are first out, in a packed house so that there is that palpable audience reaction at work. People in the theater were gasping and cringing in their seats. The story is so brutal that it's impossible to say that I'm glad I saw it, but it was incredibly powerful and the audience reactions reinforced that.

All in all, not the usual girls night out - but I had a great time and it was nice to know that I was in the capable hands of an actual medical professional. Thanks, Mo!

Boo!

So, I am scheduled for a Monday retrieval, which will mean a day-five transfer on Halloween. If all goes well. Since I am smack in the middle of that looking-for-harbingers-of-fortune phase, I will take this as a good sign - Halloween is basically all about kids and a sense of the macabre, and that pretty much goes for IVF, too. What with the affidavits regarding our deaths, and all.

I am going to stim for one more day. I have six follicles in the acceptable range (18-20mm) and four that are almost there. An extra day of growing may mean that I have 30% or more additional eggs to work with, so it seems worth the extra $300 of injectables. I'm not sure where I'm going to put those last three needles, but a few more bruises at this point won't really make much difference.

By the way - here's my advice re: ganerelix. The 250 mcg prefilled syringe can be split into two 125 mcg micro-doses. That means you have to shoot the pre-fill into an empty vial and then withdraw half of it back into a tiny lupron syringe. The second dose goes in the fridge for the next day. Easy-peasy, except for sucking the last few drops of liquid money out of that little vial, which requires a lot of squinting and keeping the end of the needle right at the rubber barrier top.

To make it easier, my pharmacy will compound the ganerelix into separate doses, each in their own little vials. It was much easier to get the right amount out, since they always seemed to overfill it a little bit. Except - they diluted it! So the 125 mcg - which is equivalent to 25 IU on the lupron syringe - was now mixed with 25 IU of sterile water! So I was only injecting half of the dose! To stop pre-retrieval ovulation! After injecting myself with over $2,000 worth of drugs!

Okay - enough with the exclamation points. I am just incredibly relieved that it seems to have made no real difference. My point is, I guess, double check and re-read and question everything. If I had read the teeny-tiny label on the itty-bitty vial that said "125 mcg in .5 ml sterile fluid", and done the math to convert .5 ml to IUs, I might have wondered if there wasn't some kind of discrepancy. Maybe.

And, finally, to Maureen - if you're reading this - please please please say you'll come to my house at 10:00 Saturday night to give me my hcg shot. My husband is too pathetic to even look at a needle that long, and you are my only real-life friend who even knows anything about all this. Plus, it doesn't hurt that you're a licensed EMT. Girls night out? Dinner and a movie? What else is there I can bribe you with?

Slow Going

So, my six bigger follicles are growing verrrrry slowly, up about 2mm each in the last two days. Typical growth is 1-3 mm per day, so this is at the low end of the spectrum. One of the six smaller ones may end up getting its groove on, but the others look kind of dormant. The doctor says six is fine, that what we really want is quality, blah, blah, blah.

All of the injections have finally added up to enough damaged tissue that I really can't find a place to inject anymore. The first 24 or so needles seemed to glide right in, but now I have to hunt around for some fresh skin. If I inject too close to an area that hasn't had time to recover I just get a giant bruise now. Today the nurse told me to disregard that little drawing that shows the injection site as the semi-circle under the navel and just stab the needles in anywhere flabby. She warned that the inner thigh is really sensitive, but anywhere else is fair game. So, maybe I won't be completely grayish-lavender by retrieval.

The doctor is estimating a Sunday retrieval, although we won't know for sure until the next US on Friday. The good news is that my lining is 12mm, which means it should be nice and fluffy by transfer time (should I be so lucky) and I don't have a dominant follicle. I have acupuncture tomorrow (if she can find a place for the needles!) and I'll just drink a vat of green tea and choke down some more wheatgrass juice and cross my fingers. Either way, I'll know in just over two weeks.

Crampy Bloaty Blah

So, I'm strung out on enough Follistim to create viable eggs out of old fingernail clippings and a single drop of sweat. My pants are barely able to stretch across the first giant bruise of this cycle. I am too grouchy to be allowed to answer the phone.

I have a monitoring appointment tomorrow and I'm just hoping for growth from all six of the bigger follicles. If a few of the stragglers catch up, great. If not, whatever. I wish I could just take the fentanyl now and not worry about any of this until it's over. I have definitely developed a bad attitude, but it seems there is nothing to be done. I blame it on the hornet-sting of the Menopur.

I actually talked to a woman in the waiting room at my last appointment. She was so excited and optimistic - her first IVF. I just kept thinking that she has no idea - but some people really do just sail through all this and go home happy, no reason it can't be her. Probably will be her. See? Now I am grumpy about a perfectly nice lady's possible first IVF baby. What is wrong with me?

*******

In school-world, we met with an educational psychologist today. It was fascinating to get actual answers to questions about what is right for your particular child's learning needs. These days, it seems like all kids already know their learning style. Somehow, it doesn't really go farther than the label - my daughter knows she is a tactile/kinesthetic learner, but she has almost no information about how that will impact her academically. For instance, today we were told that sciences can be incredibly important to tactile learners, and I've never thought of her as especially scientific. But now the whole wanting-to-be a-chef thing makes so much sense. (Although I honestly thought that was only because we had watched the old "Sabrina", with Audrey Hepburn at the Cordon Bleu.)

Six Of One, Half a Dozen Of Another

So, CD9 US today. The good news is that I do have some potentially good follicles. "Enough to work with" is how the good doctor put it.

There are three 11-12 mms on the right, as well as a few 9 mms. The left has three 13-14 mms, and a few 10-11s. Out of twelve measurable follicles, six may make the cut. The smaller ones are still antral, but there is always the possibility that they may catch up.

Today I added Menopur to my regimen - just a little LH to kick in at the quality-over-quantity phase. I am bloated and tearful and tired of everything, but at least I am not canceled. At least there is still hope - but it's lackadaisical hope. I don't even care if I get approved for the package deal - I can't imagine voluntarily doing this again.

Two days and we'll check again - we are hoping for a weekend retrieval, although I may need a bit more time for these slow-growers. My doctor always goes for a 5-day transfer, on the theory that the extra days are in and of themselves a test of viability. So, early next week plus eleven days of waiting. Maybe not caring so much anymore means it will actually work this time.

In Praise of the Follistim Pen

I have done a lot of medicated cycles. My poor ovaries have been both gently encouraged and whipped into a frenzy by most of the various options available. Depending on the protocol (and which pharmaceutical companies were offering buy-two-get-one-free specials), I have used Gonal-F, Bravelle, Menopur and Follistim. And I can tell you, the fact that none of them actually worked has no bearing on which ones I actually hate to use.

I think the Gonal-F is the worst in terms of the actual injection. The mechanism is just not as smooth, which obviously has nothing to do with how well the medication works - but it was usually painful and almost always left a horrible bruise. The Bravelle and Menopur - which I used in combination - had a nifty mixing-top which allows all the doses to be mixed together into one injection. The mixing was somewhat time-consuming, but it was great for traveling since the vials don't have to stay refrigerated. I did get some hefty bruises, though, no matter how careful I was.

The Follistim pen is hands-down my favorite. The needle is teensy - I usually can't even feel it - and the ratcheting mechanism is smooth and easy to control. There is almost never anything more than a microscopic red dot left - I haven't had a bruise yet. Since I am doing up to three injections a day, it really makes a difference. Lots of bruising means that there isn't much area available for the various needles, and since the bruises can last weeks it's easy to run out of navel-adjacent flab. The thigh is always a little more sensitive for me, so I try to avoid it unless I have no choice.

Anyway, that's my pitch for Follistim. "Because infertility is painful enough already." (It's also nice that there is always extra left over, so if you really want to economize you can usually add the dregs together and come up with another dose.)

Other than that, I have no news. US on Monday to see whether or not anything actually managed to grow yet. My last IVF had a paltry few follicles, so I'm just hoping to have enough that I won't be canceled. I have to have nine in a similar range as a requirement of the three-for-two package, so that's really all I'm hoping for. But honestly, if I have only six but they all look great, I'll be happy. I have definitely entered the bargaining-for-ridiculous-things phase of the cycle.

********

Meanwhile, my daughter and I have started to look at other schools. Her teachers are fabulous, and I know that the librarian and her former third-grade teacher are also really looking out for her. But I need to trust that the place I choose for my child to spend so much of her early life will truly have her best interests at heart, and I don't feel that way now. Nothing will really make up for her feeling of being excluded, and I had so hoped that she wouldn't learn to think of herself as an outsider, define herself as separate and feel that there were reasons that she was not included in the group of kids she identified with. She fairly easily lapses into that definition of herself anyway, so trying not to reinforce that was one of the big goals, supposedly.

In any case, I have realized that part of my bargaining-for-ridiculous-things phase includes this crazy notion of accepting another failed cycle if only the child I already do have can be happy. If only things would work out well for her, if only I could know that, in the long run, I was making the best decisions for her, I would happily give up on the idea of another baby. And I'm grateful for that feeling, for knowing that my emotions haven't been completely hijacked by desperation. Of course, I would love to have it all, but in terms of ridiculous bargaining, it's nice to have options.

Insomnia & Irritability

So... I am trying to cast this as a "good sign" rather than just a collection of annoying side effects. In my past cycles I have had almost no reaction to any of the meds. No headaches, no hot flashes no foul mood, no weight gain, no irregular heartbeat... the list of possible adverse reactions is fairly all-encompassing, but I never had anything but a circle of bruises around my belly-button. I also never had a baby at the end of the process, so I'm willing to put up with a little problems in the interest of solving my big one.

This time I have a whole smorgasbord of side effects - I am insanely irritable, up until 3 or 4 every night, headaches round the clock, racing heart, bloated midsection. I just had a giant breakdown which ended in some very dramatic she-devil yelling on my part. Even as I shrieked I was appalled - but there was really nothing I could do about it. My husband just doesn't get that being supportive and understanding at some point mid-morning does not let him off the hook for the rest of the day. We are supposedly in this as a two-person team, but as long as he still thinks his part involves a cup and a magazine, we are not going to get along very well. (In his defense, he is theoretically very committed to being emotionally strong for me during this cycle, but I think he just keeps forgetting what that might actually entail.)

Tomorrow I start the stims - follistim 600 for a few days, then stepping down to 375 with monitoring. 600 means two shots a day, which doesn't really bother me in terms of the injections, but it is a lot of drug. I can only imagine what new side effects will crop up - but I'll take them all, and cross my fingers that it turns out to be just part of what it takes to make this cycle work.

********

Meanwhile, I have to work on my calm pleasant demeanor for the teacher conference tomorrow. It turns out there there is a whole blog-world that revolves around gifted children - I have honestly never googled anything about this before, but it has been a wealth of interesting information and I feel like an idiot for not doing this research years ago. But, my kid isn't some overwhelming genius, so... I don't know.

Parenting is a separate struggle. I have found so many amazing women in this IF sphere - I think I really need that for the gifted-child struggles, too. And I remember that when I was first reading blogs I could tell that everybody loved Tertia, but I literally couldn't read her posts because they were all about her toddlers - I couldn't take it, and I already had a child! The emotional aspect is just too intense. So, I'll have to figure it out as I go - maybe I need a separate blog, but things are about to get really dramatic because we finally got her test scores from the first "practice" standardized test last year. I always knew she was a smartish kid - but I guess not wanting to focus on it exclusively may have backfired in a way that makes me feel like I have really failed her, and being sad and irritable and exhausted is not helping me figure out what to do next. Grrr....

Onward

I had my baseline US and bloodwork today - everything looks good and there are at least five or six antral follicles per ovary, so I am officially cleared for this cycle. I have had light bleeding for a few days, even while I was still taking the bcps, so I had been dreading... something, although I'm not even sure what, exactly. The doctor was very informative about everything, very attentive and helpful with even the kind of problems my old RE would have sloughed off onto a nurse. I really feel that I'm in good hands - which of course nudges me towards optimism, which is ruining my neutral relationship with the emotional aspect of this cycle.

Hope usually builds during the cycle - it actually seems to be directly correlated with the stims - and my strategy was to just keep it at low levels for as long as possible, thereby avoiding an overabundance of it at the end. We'll see how long that lasts. If I am feeling some kind of optimism at this point, I am probably doomed to hopefulness by the end of next week.

I am now on just the dex and also ganerelix, the antagon part of the protocol. The ganerelix just keeps ovulations from happening during the stim phase - it's the opposite of the hcg trigger shot. According to my calendar, I should also start taking prenatal vitamins now - I had to laugh at that one, since I've been taking them for over ten years. Clearly, a lack of folic acid is not my problem. Of course, I am also taking all my wheatgrass/fish oil/green tea/CoQ 10/zinc supplements, and having acupuncture twice a week. If this cycle works, I will probably never know what the magic ingredient really was, but of course it won't matter then.

********

In other news, thanks for the kind emails and comments regarding my last post. I still can't figure out how I would have felt about the situation if it weren't for the lupron craziness, plus the dex, which is kind of like downing seven espressos at once, but I do know that I will have to have come to a less emotional equilibrium before the first parent-teacher conferences of the year. My daughter loves her teachers, one of whom she also had last year and is particularly fond of. I certainly don't want to collapse in some kind of hormone-induced puddle while we talk about all this and make them feel terrible. Luckily, I don't start stims until the day of the conference, so I think I might be okay...

I'm going to encourage her to try some after-school activities that involve more kids. Currently she takes piano at home, and has rock-climbing with a friend one day a week and yoga another day. I think something like theater or a music thing with a group would be good, something with a lot of interaction. Rock-climbing and yoga are both group classes, but they are fairly solitary pursuits in general. Meanwhile, I'll just book up on playdates and sleepovers, and try not to think too much about the whole idea of middle school...

Lupron Doom

Lupron has never really affected me before. No hot flashes, no headaches. I can usually even manage to leave only the teensiet dot at the injection site.

Maybe this time is only different because I am already dealing with a really difficult and emotionally draining situation on top of this, but I am a complete wreck. I am pretty much moments from tears at all times. And I have no control of it at all, no "not now" face to put on to at least get through the day before collapsing into a disastrous heap at home.

I never really wanted to write about my daughter in this blog. Not because I don't think she is actually the most fascinating part of my life, but because she is old enough to want to have her life to herself. But I should say that as much as I have hoped for another child, this one is the perfect one for me. She is usually described as "old-fashioned" or "an old soul", and she doesn't participate in most of the manufactured tween culture that girls her age tend to get caught up in. She does love to read the fug girls, and she has an ipod full of music - but it's Blondie and Abba and the Go-Gos, which most other kids have never heard of. And of course, that's the problem.

It's just so hard for her to find kids she really relates to. I think all parents start out thinking that kids should be allowed to be themselves and not get sucked into a clique mentality. But the bottom line is that if kids have a natural clique - the sporty kids, or the game-boy nintendo kids, or the miley montana wannabes, or the horse-riding girls, etc - then they have a group that more or less forms itself and becomes a circle of friends. Kids who watch Alton Brown and want to be Shakespeare for Halloween are just nerds who get left alone - unless they find their nerd people and then they can spend lunchtime rewriting their math book in iambic pentameter.

My daughter is in a class this year with only four other girls in her grade (in a mixed grade classroom). Those four are two sets of best friends who have known each other since preschool. Because she has already skipped a grade, the older girls are really two years older than her, at an age where two years makes a big difference. The teacher tells me that she is really quiet and withdrawn, that she goes through the day just waiting for PE, when she can be with her friends, who were all put in the other class. I tell you, it is just not natural for the nerdy child to desperately look forward to gym class!

I know I'm not the most objective observer, but it's not as if there's anything wrong with her. She doesn't pick her nose or smell weird. She has great clothes, she is unbelievable funny. When she's with her real friends she's animated and silly and happy. I can't figure out why they ever thought it was a good idea to organize the class placement in this way. My poor kid is basically doomed to a year of loneliness. This is a small school, so there is no reason that this couldn't have been foreseen. But the thing is, I can't even call the teacher back because I can't stop bursting into tears.

Even though I know that I am so wildly overreactive, that it's all about the pill and the Lupron and the pressure of the do-or-die cycle, I am really unable to function like a regular human being. Maybe I can pull it together over the weekend, invite some of the other nerdly children over to play, and stop feeling that everything is so unfair.

Anonymity

In general, I think it would be great if more people were more open about infertility. Awareness would certainly go a long way to dispelling the mythology surrounding early losses or the inability to conceive. I wholeheartedly support and admire those who are able to be completely open and up-front about your lives. And yet...

Family prejudices are different. Some of my family is religious enough to believe that there is a Reason for everything. The rest of my family is so stoic that they just think you should take what you get and be happy that it isn't worse. The Irish side of the family is bolstered in their beliefs by one of those stories that is rare but true, and they have taken it to illustrate their point of view about family planning.

My cousin married a lovely woman and had four perfectly adorable children. After the fourth was born, he and his wife consulted with their priest and all agreed that a vasectomy would be acceptable under the circumstances. He had the procedure done, it went well and that was that. Except - he never bothered to go back for his follow-up appointment. It was almost two years later that his wife went to the doctor complaining of exhaustion and nausea. The fifth child is a miracle, of course, and a lesson to us all not to presume to know what is best for us.

The fact that my cousin then went back to the urologist, made absolutely sure that there wouldn't be any more "miracles" and hasn't had any more children isn't really a part of the story. The story only serves one purpose, and it has nothing to do with following your doctor's orders to come back in six weeks for a post-op visit. Over the years, I have heard many quiet stories of miscarriages, lost twins, and barren aunts. There are also plenty of hurried weddings and very young brides. Managing fertility is not considered a task for mere mortals to concern themselves with.

The thing is, I love these people. They are the dears of my heart. But the only way for us to all happily get along is to keep certain topics completely off limits. So, they probably think that the reason I have never had another child is because I waited too long to have the first one (silly me, with that grad school nonsense) or maybe just because I am some heathen infidel who doesn't deserve to get what I want. Either way, if they knew I was trying IVF and then it failed, it would be forever just a poor sad example of the fact that everything happens for a Reason, and why can't I learn to accept that. My cousin and I would be flip sides of the same story.

The rest of my family isn't especially religious at all, but my mother has said, on several occasions, that my cousins are ridiculous in mourning their early miscarriages - that all women experience those and it certainly doesn't deserve to be treated as a cause of grief. Needless to say, I have never spoken to my mother of either my early losses. I had pursued the issue with her when she told me about a cousin's recent second miscarriage, but the contempt and dismissiveness that she used in describing the exaggeration of my cousin's reaction was enough to clinch my silence on the matter.

Reading other blogs has made this journey so much easier than it would have been if I had always felt as alone in this as I did a few years ago. So, I will share my story on the off chance that it helps someone else. And maybe someday I'll feel brave enough to put a real photo in my profile.

Tag!

Yes, it's true - Shelby has tagged me and now I must describe seven wacky things about myself. I figured this would be easy, since I am generally a bit of an oddball... but narrowing it down turns out to be the hard part.

..............

1. I have a rather large wardrobe of hats. Being a pale frecklish redhead in sunny LA, I don't go anywhere without a hat and sunglasses. I like plain canvas bucket hats or tightly woven straw ones. Absolutley no floppy flowers, no peacock feathers, no grosgrain concoctions.

2. I am one of those people who writes to their congressperson. Not sure if it makes much difference, but I like to think it might occasionally have an effect.

3. Even the thought of pumpkin pie makes me sickish.

4. I have desperate cravings for Pellegrino Limonata. I love the tart fizziness.

5. I almost never remember my dreams. I also never remember to keep a notebook by my bed so I can write down a dream in case I do happen to wake up vaguely remembering one.

6. I don't like products that have a smell. I don't want a scented lotion, scented conditioner, scented soap, scented dryer sheet, scented hair spritz - unless somebody is going to take a very intimate sniffing tour of my various regions, it is just going to be an herbal flowery stew of various marketing ploys. I do use lemon-verbena fabric softener, but it sort of just smells clean.

7. My belly button is such an inny that I can't see the 'bottom' of it.

..............

I'll have to tag some others later, since I haven't read far enough back in any blogs to see who has already done this one. But I promise to do it soon! Meanwhile, I am working on an explanation for my need for anonymity, and a fertility story that has become an instant legend for the rest of my family...

ETA - I hereby tag Claudia, whose blog gave me hope when I really, really needed it.

The Giant Bag

I had my calendar review yesterday and picked up my giant bag of supplies today. It feels like things are getting underway.

This giant bag had so much more in it than I am used to getting. This time I am following an aggressive protocol that requires lots of follistim with ganerelix to thwart ovulation. I do start with just a bit of lupron, and then there are a lot of subtle adjustments along the way, including some menopur as the cycle continues. I will also be taking a steroid, an antibiotic and an E2 suppository. Basically, you could put all this into a man and he would probably cough up some decent follicles.

I am still doing really well as far as maintaining my faux-blase (hmm, two French words in a row - I am practically bilingual, non?) attitude about the outcome. This is merely a scientific experiment, I tell you. Success is a possibility to be considered at a later time.

But the thing is, I know how much that's going to change. Those hormones have a devastating emotional effect on me. I become so desperate with hope that I can barely make it through a day without collapsing into my own sense of doom. I have read my journals from the times of other cycles, and it's like reading the diary of an insane person. It's not depression so much as hope, a hope that rises up because you are flooded with the very chemicals of hope.

I know that what's in that giant bag can change my life, can give me what I have wanted for seven years. But it will also crumble the buffers I've created to protect myself from seven years of disappointment and sorrow. I can tell myself that I am smart enough to know that my chances are slim, that being aware and being prepared will protect me from being disappointed. But I know it doesn't work that way.

Whiling Away

Tomorrow I have a one-hour call scheduled with the clinical coordinator to discuss my plan. I got all my calendar and lab work information, so I'm sure we'll go over that - but there must be more to it. At my old RE's office I was lucky if they could even find my chart, so I'm not used to this level of attention. Of course, if things had worked out at the old office, I wouldn't have cared a bit about their disorganization.

The differences between the offices are striking for two reasons: personalities and success rates. As a first-time IVFer, I chose an RE with whom I felt a personal, intellectual connection. We had both gone to school "back east", liked similar cultural activities and had traveled to many of the same places. We had oodles to talk about and I would have loved to meet her at a cocktail party.

I think she was generally very knowledgeable, but as an "unexplained" infertile, things were murky from the start. I did get pregnant with my very first medicated cycle, on something like a half dose of the smallest stim usually used. That probably complicated all my further treatment there, because after I miscarried - actually, it was technically a "missed miscarriage", meaning that although the heartbeat slowed and then disappeared after several weeks - my body never got on with the unpleasant business of expulsion. After a D&C, she said she had every reason to believe that it was just a matter of time before I was pregnant again. Pathology had shown a trisomy 17, which is not inherited, so she upped my stim dose and sent me on my way to try again. We muddled our way through a few more cycles and then moved on to IUI. The same thing (more or less) happened again, and we then we fumbled through two IVF cycles and somehow two years had passed.

If that was the boutique fertility clinic, this new place is the major department store. The new RE seems like a perfectly nice guy. If I sat next to him at a dinner party it would probably be fine. Maybe not scintillatingly memorable, but certainly not awful in any way. The thing is, I don't care any more. He seems dedicated, research-oriented and willing to discuss all concerns and options. The clinic has one of the best labs in the country and a thoroughness that tries to account for every possible reason that might thwart success. Of course, that's no guarantee, but it's better than wondering if maybe, if only, if possibly...

I wish I had known enough three years ago to just start here. I may never have another baby, and I'm trying really hard to maintain some kind of objective reality about that, but at this point, it's just nice to think that my chart probably won't be lost this time.

Smoosh!

I am stuck in the Doldrums of this cycle, the ongoing nothingness of waiting. Sure, I'm trying to maximize everything by taking the appropriate supplements, going to extra yoga classes, trying to get lots of sleep. My to-do list is full of cycle-related things, but they are usually the same every day - vitamin, wheatgrass, exercise.

I did finally get my first mammogram. I've heard that "it's not so bad" compared to the mammograms of the past, but I didn't really know what to expect. I went to a semi-fancy outpatient imaging center instead of a hospital, which automatically made things better since it didn't smell like pee and antiseptic. It was more like a spa, with orchids in the dressing room.

The mammography room itself was very clinical. The machine has an adjustable platform with a motorized control - like a dentist's chair- that the technician positions just at boob level. Then a top plate - also dentisty- comes down and very gently flattens you into a nice boob paillard. It only takes a second and the tech releases the plate from her station the instant the imaging is over, so you don't even have to wait for her to come back and let you out of the contraption. After doing each side in a sort of flattened out birds-eye-view, the tech adjusts the platform to a 45 degree angle and gets a diagonal view, too. That one squishes the chest muscle, squeezing the armpit-adjacent area. But again, it's quick and the release from the remote station should be given some kind of engineering award.

Since it was digital, the technician let me see each image as soon as it came up on screen. Of course, I'm not an expert, but there weren't any areas that looked particularly different from the rest of the image, which I figure is a good thing. The tech actually said that the doctor would send me an all-clear report in a few days, which surprised me since techs usually maintain completely inscrutable attitudes and defer all questions to the doctor. I figure it's pretty safe to assume that all is well, and relief to know that at least my boobs aren't malfunctioning.

Now I can go back to cajoling my other womanly parts into forced compliance.

Stagnant & Chaotic

I am officially grumpy after a week on the pill. Grumpy and nauseous, a winning combination. I know the only thing to do is just try not to think about it, but my stomach is practically twisting itself into a nifty balloon animal - not so easy to ignore.

This month is, predictably, going very slowly. The excitement - Needles! Follicles! Fentanyl! - won't really kick in for a while. And my natural cycle coincided with the October cycle at my clinic in such a way that I have almost four weeks of this holding pattern. So, I'm doing what I can to make the most of this time, and that includes a visit with a new acupuncturist.

My former acupuncturist moved last year, and I haven't managed to bother finding a new one. It just hadn't ever really made much of a difference. Nice to relax in the middle of the day, but I never felt it was much of a remedy for anything. But I have read so much about acupuncture and fertility, and this is my go-for-broke cycle, that I figured I'd find someone who really specialized in IVF treatment support, and see what happens.

This practitioner will work directly with the RE to optimize the cycle. She did find the same general problems that my last practitioner found - apparently my liver channel is stagnant and chaotic. Seems contradictory, but here's the thing: when she put the needles in for those areas, I felt a sizzle zip through my body - I can't deny she was onto something. I have had acupuncture for pain after a car accident, for allergies, and for migraines - but I have never felt partially carbonated before.

She also told me that migraines and infertility are significant in Chinese medicine. My migraines are few and far between, but I do get partial loss of vision and severe nausea and vomiting. In some ways, it would be easier to explain my infertility in terms of blocked chi . I've always been "unexplained", and as the years went by "advanced maternal age". The idea that my stagnant liver is the problem - that stagnant liver can be fixed, more to the point - sounds just dandy to me.

Other than acupuncture, I am trying wheat-grass juice, restorative yoga, and Cheyzn - a zinc-iron-copper supplement that I get from my chiropractor. Kinda moonbeamy, right? But, after all, I am doing high-tech IVF with all the synthetic femininity modern science has been able to concoct. I figure if a shot-glass of oozy green sludge might help, why not?

Middle-Aged Uterus

Teen-aged skin.

HATE the pill - must go find out if they still make clearasil.

Raining Down in Texas

Probably the closest I've come to actual danger was a Texas flood that my family was caught in when we were on a car trip across the country back in 1981. I was thirteen years old - grown-up enough to sit in the front seat while my mother dozed in the back with my little sister. It was dark and we were still a few hours from the motel we had booked for the night. We had stopped a few times to see if we could get another room, but there weren't any vacancies. The rain was strong and steady, but the roads were flat and wide, so we decided to push on.

We kept the radio on and drove slowly - the visibility was terrible but there wasn't much traffic. There was a flash flood watch in effect, but we were on the interstate, with steep embankments on each side and miles of asphalt in either direction. It seemed unlikely that rising water would be a problem for us - we were more worried about traffic hazards or car trouble. I kept an eye out for exit signs and my father drove slowly through the sheets of rain. I remember thinking it was like a drive-through car wash gone out of control.

Everything was fine until we got off the interstate. In those days before gps and map-quest we had find our own way with fold-out maps from the triple-A. We followed the main road to the one leading to our motel, driving further into residential neighborhoods. We were only a few blocks from the turn-off to the motel when we saw people running towards us. My memory confuses the scene with a night of trick-or-treating. I'm sure there weren't any costumes, but it had a similar quality - families out in the dark together, moving slowly cross the street and holding hands. We didn't know that we were following a creek, that the creek had jumped the banks and was flooding the homes on that side of the road. But we knew something was wrong, so we stopped.

My mother had woken up and was shaking my sister. There was some kind of quick argument about whether we should just go on or get out of the car. I think we were going to try to keep going, but when my dad tried to start the car the engine was flooded. We could see the water rising as if it were a playback of time-lapse photography. In the time it took to figure out if we could manage to take anything with us the water started to come in the the car. When I opened the door it was so heavy I thought I would have to go out the window, but as I pushed the current flung the door outwards.

We only had to go about fifteen feet to higher ground. All of the yards on that side of the street rose up steeply to houses with lights on, silhouettes of people moving in the curtained windows. Some of the people who had been wading from the low side were being welcomed into a nearby house, so we tried to make our way there, too.

The minute I stepped out of the car my feet were swept out from under me. My mother later said that if I hadn't grabbed the car door she would have had to let herself be dragged after me in the hope that the current would carry her to find me. (To this day that is the single most maternal thing she has ever said to me.) I had already let go of whatever I had been carrying - I think it was a little blue canvas zipper bag with a rainbow sewn on the pocket, although honestly it could have been something my parents told me to carry. My shoes were swept off my feet, which somehow made it easier to walk through the rushing water.

I tripped on the curb, but the lawn rose so steeply that I more or less crawled up onto it, and suddenly I was safe. My mom was leading my sister towards the house with all the people on the porch, and my father was looking back towards the car, which was slowly heading off down the road without us. I never saw that car again, but when my father found it the next morning everything had been washed out of the interior - the seats, the steering wheel, the radio. All of our luggage from our trip was gone. My mothers purse, my rainbow bag of lip glosses.

For me, everything changed that night. It was the first time I had ever known real danger, felt at risk of something more than a scrape or a scolding. Before that I had felt that danger was something you prepared for - we did duck-and-cover drills in school, and I knew where to go if there was a tornado watch - but I hadn't realized life could change in an instant, just when you least expect it. As an adult, I realize that the most change is often catastrophic and unexpected, that the changes you plan and work for aren't so much changes as evolutions.

I've been checking on Hurricane Ike all night, thinking about that Memorial Day trip and hoping that all is well in the morning.

It's Official

Sometimes it's hard to know when an IVF cycle really starts. I took the first BCP today, so I am officially tinkering with the system. My transfer is supposed to be at the end of October, with a chance that it will actually be on Halloween. So, it really is going to be trick-or-treat for me this year. I wonder where I should put the big bowl of candy?

Speaking of candy, I am already nauseous. It started about fifteen minutes after I took the first $2.50 pill. I can't believe these things are so expensive and completely not covered by my insurance. My last RE gave me three months of free sample pills - although, she also failed to do much investigating into our possible problems. I guess I'm happy to pay for the little things if the fancy RE takes care of the big ones.

In other weird 40+ news, my clinic has decided that I am not actually 40+. Since I am only just barely 40 they have waived all of the over-40 requirements. I have no idea how this works - I figured you are either under or over - maybe on your actual birthday you can claim to be neither, but... whatever. It's nice not to have to wrangle big tests out of my primary care doc. I'll still do the mammogram since I have never had one. 40 may be the new 30, but it's still the old recommendation for a baseline boob-smoosh.

I have at least a month of these damn BCPs, so it's going to be a long cycle. I can already tell that it's going to be hard not to get my hopes up.

Getting Ducks, Putting in Row

There is a very long list of pre-cycle testing at my clinic. On top of all the regular tests and bloodwork, there is an "over-40" set of general tests. I have been ticking the boxes - pap smear, saline ultrasound, communicable disease panel. Now I have to have a chest x-ray, an EKG, a mammogram and more bloodwork. The trick is to figure out how to get these tests covered under some other lab code sice my insurance won't pay out for anything related to infertility treatments.

Today I finally got the results of the day 3 hormone test - the one I've been dreading. Anything under 10 qualifies for the package deal at my clinic, and since I have already been through two failed IVFs I really wanted the safety net of an extra cycle if I need it. Plus, as silly as it seems, the idea of being deemed too risky for the shared-risk group depresses me. It's a psychological boost as much as a financial one, really.

Anyway, I just squeaked in under 10 - 9.6. My last one was 6-ish, but that was a few years ago. Maybe it's just a technicality, but that .4 means a lot to me. I just feel a teesy bit less doomed - not exactly optimistic, but hovering around neutral. Which is, all things considered, not so bad.

Who, Me?

I know I'm lucky. My daughter was conceived easily, I had an unremarkable pregnancy and a birth that went mostly as planned. I was never especially concerned about any of the possible complications that could have arisen. I took my prescription vitamin and went to pre-natal yoga classes and stayed away from oysters.

I was blissfully unaware that there was much of anything to worry about. I was the first of my group to have a baby, and I was much more concerned about how to manage life after the baby was born than anything that might happen before that. My friends would ask what I was going to do about stretch marks and whether or not I wanted to have an epidural. It all seemed so mysterious, but I never thought of it as fraught or perilous.

The very idea of infertility was so peripheral to my life that I didn't really wonder why I wasn't pregnant again until years had passed. During that time my mother-in-law had become very ill and my husband had to split his time between work and flying home most weekends. Then I was rear-ended by a school bus and could barely move for months. Actually doing any of the things required to get a baby going was completely out of the question. By the time I finally asked my OB if we should run some tests or something, my daughter was five. We had never used birth control.

Somewhere, in the back of my mind, I knew something was wrong. Even though my OB was sure it was just a matter of hectic scheduling - she sent me home with an OPK and said I'd be pregnant in a jiffy - I was beginning to suspect that the second time around wasn't going to be such a cakewalk.

Like Buying Socks

So, I've anted up for the next cycle. I still don't know if I'll be allowed to play in the three-for-two game, but the package deal for 40-and-over isn't really one of those money-back plans, anyway.

If I qualify (after a clear HSG, genetic testing and an acceptable recent FSH) I can pay for two cycles up front, and get a third (should I need it) for free. If I only need one, I just consider myself incredibly lucky and am given a small, ceremonial refund. If I only need two, I am grateful and go on my way. If I need three, I try to be happy that I have one more chance without paying anything else. If all three cycles fail, too bad for me.

My old RE didn't offer package deals, so I've never had to make this decision before. But maybe it makes sense, considering that the idea that it will work the first time seems so unlikely. I have never had an IVF work, so I'm actually at a point where the idea of paying double for a successful first cycle sounds pretty good to me.

I should get the latest FSH results next week - I think that's the one I have to worry about.

One Last Time, Again

Well… it's been a year since my last failed IVF cycle.

Back then, I couldn't have imagined then that a year could possibly pass at all, that so many days could somehow just go by. Or that I would stop thinking about my whole life in relation to my cycle schedule. But, somehow, it just happened – I took a break to figure things out and I never went back. I got off the IVF rollercoaster and lived a normal life.

Mostly, I decided that it would be great if I could just move on. After all, my husband and I already have a child together. I love my relationship with my daughter, and I think we all function very well as a family of three. She is older now, the days of diapers and tantrums and neverending games of ring-around-the-rosies are behind us - why not be happy with things as they are? And I am happy, but…

That twinge of longing never really went away. And every time I hear that my best friend is (whoops!) pregnant again, my cousin is expecting twins, my sister is pregnant immediately after going off the pill… I can't help thinking that it's not too late. Not really – I may be old, but I'm not ancient yet. I think I'll always regret it if I don't give it one more try. Just so I don't always wonder.