Thursday, October 30, 2008

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?

Tuesday, October 28, 2008


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...

Monday, October 27, 2008


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!

Saturday, October 25, 2008

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!

Friday, October 24, 2008


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?

Wednesday, October 22, 2008

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.

Tuesday, October 21, 2008

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.)

Monday, October 20, 2008

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.

Saturday, October 18, 2008

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.

Sunday, October 12, 2008

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....

Thursday, October 9, 2008


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...

Friday, October 3, 2008

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.