way #456 in which It Could Always Be Worse

So my psychiatrist thinks that no matter what happens in the next few months (in an effort to be more superstitious, I’m intentionally leaving the possibilities vague), I must not delay IVF again.

And (you might think this would lead her to take less of a hard line approach to the situation, but you’d be wrong) she thinks it’s weirder than I do, the whole fertility mortality situation (or rather, assisted fertility treatments concurrent with imminent mortality). I guess that’s a more direct way to put it. I think it’s not so weird at all. If the sandwich generation is taxed by the bizarre situation of taking care of their children and their elderly parents, it stands to fallow (follow! follow!) that there should be a subset of that generation who are still trying to have those children. I think that most of the friends I made as an adult have married and had their children in their thirties- and many of them haven’t even started trying yet. So this sort of thing is probably going to be a whole lot more common. And maybe it’s because I’ve been so wrapped up in the weirdness of it (by that I mean thinking about it objectively, constructively, a development for which I am grateful beyond words,) for, oh, say, the past month or so (thank you Nayla), that I haven’t noticed how in this month a whole other subset of friends seem to be having the proverbial mid life crisis, a process which hasn’t seemed to exclude any of the traditional behavioral caricatures (new car, new spouse, in one particular case, a weird obsession with roller derby and a –unrelated, I’m sure- switch in sexual orientation). So, I’m not going to say too much more about this, because the situations are obviously agonizing and not funny at all to the people going through them, but it did occur to me that those of us who put the Clomid in a separate cupboard from the one where we kept the Xeloda and post chemotherapy Compazine, are probably not going to buy outrageous new cars or have a marital crisis predicated on some guy who mucks out horse stalls and isn’t even old enough to drink, for goodness sakes. I’m trying to figure out if mail order fertility medication is cheaper (but how exactly are those FedEx trucks temperature controlled…because I know what happened once to a batch of measles vaccine in Sierra Leonne and it was not good), while my best New York friend is bemoaning his alimony payments and booking a trip to Fiji with a pole dancer (hi Jay).

The Great Needle Reprieve of 2009

Just as Courage the Turkey has been offered pardon by President Obama, so I have been offered reprieve from the terrible progesterone-in-oil shot.

Ever since my first progesterone shot, I have developed a fever of between 101 and 102 every day from 5 pm to 11:30. The kind of fever that makes me want to layer on four sweaters, fleece pants, a coat, gloves and a hat. I alerted my medical professionals to this on day one, and they responded that the fever had nothing to do with anything they were doing. This went on and on for four days, and then Tuesday, my husband came home and found me under the traditional pile of outwear and blankets and declared that this was not normal and that possibly I had the swine flu. He called the doctor and persuaded him to "have me evaluated the next day."

The next day, I went in, and the nurse evaluated me, came to the conclusion that I did not have the swine flu, and said that she had never seen anyone have a fevers like this in reaction to progesterone-in-oil injections. But they agreed to let me switch to a different form of progesterone supplementation after just one more shot. To stop my constant complaining, I suppose. So now, even though I had that last shot yesterday, and spent my evening shivering on the couch, a delight to all in the family, and even though I still have welts on each of my butt cheeks, I am free of needles for the time being. Hooray!! I am also apparently free of fevers, as it is now 6:17, and I am tired and nauseated, but not shivering.

I am thankful for alternatives to progesterone-in-oil shot.

Happy Thanksgiving!

refined carbohydrates, leisure time, and the mentally ill

In our town there is a small Italian pastry shop and cafe, where as a condition of admittance you must relinquish at least three hours of your life. Generally, this amounts to spending the next one hundred and eighty minutes with a foamy cappuccino and one of their outrageously delicate caramel glazed palm leaf shaped cookies. My husband loves this place, it is his own Pyrenees in Marin County. I have anxiety issues and must be productive at all times, so it doesn't work out so well for me. But I do have a counterpart just a block away, my own little enclave of the upper West Side, and this is in the cozy office of my psychiatrist. BlueCross PPO, I love you. Dr J is whip-smart, beautiful, doesn't suffer fools, and I envy her for her wardrobe. She owns the cutest jumpers I've ever seen. And she says all the right things, like the time when my in laws were planning an extended visit ("if my mother in law was coming for three weeks, I'd take a shotgun and blow my brains out") or the time when I complained that my husband's friends do tend to drink, and drunk grown ups make me uncomfortable ("sweetheart, if I had to sit through one of your vegan raw foodist events, I'd light up a joint too.") Usually, I walk into her office pretty much convinced that I am a crazy person, and by the time I leave, that craziness has been downgraded to an only slightly abnormal response to a bizarre world. So today, in spite of the fact that my mother is going on her fourth week of weird non specific back pain, I left her office today with relatively little teeth gnashing and hair tearing. And then waved at my husband, still in front of the pastry shop.

straight from the mouth of...Christopher Buckley?

While Nayla is on her two week couch rest, I have resolved to only say and write happy pleasant things, sunshine and roses (dasies, dare I say)? But at risk of bringing up illness and mortality and also outragously good natured humor, I need to post a link to a book I wish I'd had in hand this time last year.

Ok, two links. Two too good reviews.

New Public Service Ad

The full bladder trick, in foot tall letters, on the sides of municipal transport buses.

Ah, the progesterone shot. I’ve seen pictures of the progesterone shot. Specifically, I’ve seen mobile phone pictures of a particular surface area of flesh, very bruised, very traumatized. I now understand this to be the “hip,” post progesterone shot. I didn’t ask to see them, but a very likely, very well meaning person took it upon himself to share this memory from his own IVF files. Certainly, needle counts are one thing. Photomontages, outtakes on the Blackberry, in the middle of an office, for goodness sakes, are something else entirely.

Which isn’t to say that I don’t understand how it happened. I get that you can go through your whole life without any GGW digital media skeletons in proverbial closets. In fact, two months ago, I found myself taking a few self-portraits to show my neurologist that a specific vein in my face does protrude during a certain kind of migraine, scary indeed, and weird enough to justify photographic evidence.

It’s raining here, which doesn’t change much. After looking at pet food ingredients for the first time ever, my husband is in revolt against the dog’s feeding regimen (ingredients: beef, beef hearts, carrots). We discussed the way in which the dog behaves toward the squirrel (aggressively) who has taken up residence outside the living room window, and how not even ghee and basmati rice will quell the dog’s aggression. No, this is just the normal state of things between dogs and squirrels, and it always has been. The dog and the cat are my husband’s first ever pets, but he grew up in the south of France, where his family slaughtered their own hogs, and where his first job was in a chicken processing plant. So I expect him to be a bit wiser in the ways of this particular world.

I am going to bake cookies because Thanksgiving and Easter are the only holidays when it is socially acceptable to whip up vast amounts of yellow frosting, and I swear that yellow frosting tastes much better than any other color, except for pale, pale, blue. My sister agrees precisely. It’s a weird sort of synesthesia. And that, I suppose, will be the extent of the excitement here today.

Today I am Thankful for...

Today I am thankful for Erin, who was the first person who advised me I might be more comfortable when medical professionals stick things up my cervix if I take a valium or two.

Yes, today was transfer today.

Before we left I took the puppy for two long walks in the hilly neighborhood. It was a sunny morning, and I tried to soak up the vitamin D.

Just before we left the house, I drank 8 oz. of water with 5 mg of valium. I drank another 12 oz. in the car. Apparently, if one drinks at least 24 oz. of water, one's bladder will be full, and this makes the actual transfer easier on both one's doctor and one's cervix, though not one's bladder.
When we arrived, I iced my right hip with a bag of frozen edamame. (I used our hot and cold pack yesterday for my left hip and forgot to freeze it.)

Then I went into an examination room, and a nurse gave me the progesterone shot and took my vitals, and then my acupuncturist came in and gave me a treatment. Then I took another 5 mg of valium and drank some more water for good measure.

Then I put on a gown over my sweater, and booties over my socks, and one of those really attractive surgical shower caps that is so attractive it will soon be worn by people such as Gwyneth Paltrow (who got pregnant by accident, and not through a process involving over 100 needles.)

My husband dressed in scrubs and booties, and he got a little cap like surgeons wear, and it gave playing doctor a whole new meaning.

But then the doctor came in waving a photo of three clusters of white circles on a black background and a detailed chart listing the health, progression, and quality of our embryos.

I won't bore you with the details of the chart, but I will say that the photo was of three of our best embryos. One of them looked like a daisy, which the doctor explained was really lucky photography, since all of them were close to perfect, and all of them develop in three dimensions.

We had already decided to only transfer two embryos, and we again reminded the doctor of this, so the third one in the photo will be frozen along with several others.

Then we went into the "procedure room" and they got me all set up in the stirrups, which was somewhat painful because now both of my ass cheeks were hurting, and then the doctor whirled around on his stool and revealed a window behind him.

"Before you lie back," he said, "we're just going to talk to Matt for a minute." Matt is the embryologist.

The doctor pulled up the blind covering the window and pulled the sliding glass door to the side.

"Two embryos for Nayla Joseph," he said.
"Just two?" asked Matt.
"Just two," said the doctor.
In case you were wondering, the answer is yes, it was almost exactly like the transaction at a drive-though fast-food window.

Then they did their transfer thing, with a "special catheter" and ultrasound visualization. The doctor and nurse complimented me on my very full bladder, and then applied pressure directly on that spot.

I looked at the ultrasound image on the screen and saw what I have learned is the thickened uterine lining. Then, as they threaded the catheter in, I saw two bright spots in the center of the lining.
"There they are," the nurse said.
"I see them," my husband said.

The doctor lowered the head of my table and raised my legs.
"This is the voodoo," he said. "There is no evidence it makes a difference, this raising your legs and putting you on couch rest, but it makes me feel better."

After my husband and the doctor discussed his prescription for a Caribbean vacation for us, I was allowed to empty my praiseworthy full bladder and head back to the examination room for the second acupuncture treatment.

So thank you, Erin, for the suggestion of valium.

And now, back on couch rest...


Needle Count
Take original total of 98, then add;
2 progesterone-in-oil shots
14 acupuncture needles for pre-transfer treatment
15 acupuncture needles for post-transfer treatment

Total so far- 129 needles.

A Pain in my Ass and Other Obsecenities

I went to my doctor's office today to have my first progesterone shot. Most IVF women have their partners administer this intramuscular shot, but I chose to leave my loved ones out of it, largely because the instruction to insert the rather thick needle in the muscle of my upper outer buttock with a sharp, dart-like motion made me nervous. I didn't want to be anyone's guinea pig for this kind of stabbing.

The nurse had me lie down on my side, drew up the progesterone and did use the previously mentioned sharp-dart-like motion into my left "hip." (Hip is the euphemism of choice for upper outer buttock.)(If you are really interested, you can see the actual injection process by clicking on the Intramuscular Injection Lessons video at Village Fertility Pharmacy.) It felt like what I imagine a wasp sting might feel like. The pain dissipated after a moment, and I thought that was going to be it. I made plans with my husband and mother to go out to dinner after one last pre-transfer trip to the gym.

I went home and didn't think about it for a while. My mother was also feeling the stir-craziness I mentioned earlier today so she suggested we go to the local mall. It was three o'clock, and already getting dark. It was raining. None of these things were helping with my mood.
But for whatever reason, at 3 o'clock, roughly 5 hours after the shot, my left hip began to hurt. It started as an ache, as though I had done too many lunges, but by the time we go to the mall, it felt like someone had punched me. I could barely walk. I sat at a coffeeshop, drinking decaf for two hours, while my mother enjoyed some well-deserved time away from the house.
On the way home, my hip was throbbing. The GPS suggested, politely, that I take the highway instead of a regular road, and I screamed FUCK FUCK FUCK while laughing and crying simultaneously.

My mother was unusually quiet.

We pulled into the driveway at the same time as my husband, so I let him carry everything inside. Then I took off my raincoat, went into our room, and changed into the following outfit:

1. brown fleece pants
2. pink Ugg boots
3. red wool sweater
4. aqua cashmere robe
5. sheepskin-lined gloves

I was still cold. This may be a symptom of living in Oregon, and not a symptom of progesterone-in-oil.

Then I took two extra strength tylenol while my loved ones discussed the better method for supplying a heating pad.

My husband reminded me that I acted with the same level of crazy last time I went on progesterone. I have only the vaguest memory of this. Perhaps someone was slipping me some Versed.

Retrieval Day

Wednesday was Retrieval Day. To describe what happens on retrieval day, I will quote from The Couple's Guide to In Vitro Fertilization by Liza Charlesworth:

"A special syringe is inserted through (the) vagine and it reaches to her ovaries. Then, guided by ultrasound images, her RE gently sucks the mature eggs out of their follicles."

I quote because unlike Erin, I did have the benefits of Versed. I remember going into an examination room and changing into a gown. I remember my husband leaving to go do his thing, and returning to comment on the poor quality of magazines. I remember the anesthetist coming in and putting the IV in on the first try. (For this, I recommend insisting on a local anesthetic before they stick you.) I do not remember how I got into the operating room, but I do remember being there, and everyone saying hello and then the next thing I remember is that my mother and husband were there.
"What are you doing here?" I said, "You're not supposed to be in the operating room."
They both laughed, and the nurse laughed. The edges of the room were blurry, so I didn't feel any particular motivation to keep my eyes open.
"We're not in the operating room," my husband said. "It's over."
"She probably won't remember much of this either," said the nurse.
"So now's the time to admit anything you don't want her to remember," said my mother to my husband.
"Honey," he said, "I have a confession. I am having an affair. With our puppy."
My mother laughed. "You know that the shepherds in Sardinia used to have affairs with their goats."
That is when the doctor walked in.
"We are talking about having sex with goats," my husband said.
"Oh, well, now is the time, if you don't want your wife to remember," said the doctor, not skipping a beat.

Other Retrieval Side Effects:
--Some pain, but nothing terrible. Kind of like really bad cramps. I only took one Tylenol 3 and was then able to switch to extra-strength Tylenol.
--A profound craving for pineapple juice and mashed potatoes.
--A dream set in a combination gas station/Indian restaurant in which one of my husband's colleagues was paying me in hundreds for the cryopreservation of his embryos. He only had the first hundred because they were going through a divorce. (Is this the equivalent of Erin's Aaron Neville?)
--Craziness of the Stir Variety, brought on by my mother's panopticon-like enforcement of my doctor's directive that I be a "couch potato" for 24 hours after the procedure.

The puppy, barometer of my emotions, has started running around like crazy, jumping and nipping and failing to observe the established conventions of excretion. Or maybe he is trying to claim my husband for himself.

in keeping with the theme of the day...

I have been in an exceptionally good mood today, because Nayla is having a long awaited happy procedure, and I think I am experiencing vicarious relief at it (the procedure) being over. I hope it has gone well. The last time I was faced with being given Versed was for an upper endoscopy (this visualizes the upper esophagus, which is very roughly located a little above the sternum.) About a year ago, I had decided to undergo this fascinating procedure after one episode of vomiting blood, combined with my mother’s diagnosis (a few months later) of esophageal cancer. Spoiler alert, but there was no problem identified with my esophagus. We suspect I was taking too much Alleve for a running injury, and not eating enough…food. In general. But in retrospect, I like the vomiting blood incident, because this, combined with the whole pupil dilation thing that happens with my migraines, does put me in the prime category of mild demonic possession. All I’m missing is a penchant for the uncontrollable eating of spiders.

In any case, the procedure itself, which involves swallowing a thin tube that contains a camera, isn’t painful, but it is distressing to many people. But I found the idea of Versed, one of the drugs routinely administered during the procedure, far more distressing than swallowing a silly tube. Versed is not really a painkiller, and it doesn’t really induce unconsciousness. Instead, it’s an amnesiac, and here I have to pose the question: what is it that is going on that one might not want to remember, and if such things are occurring, shouldn’t one be given more anesthesia, local or otherwise. An upper endoscopy is not supposed to be painful, and a *just in case* dose of intravenous Percocet is generally administered, but if some horrible slip up is going to happen, or if I’m going to find myself in a disturbing amount of pain, then my goodness….I don’t want to repress it. I pay regular visits to a psychiatrist for the very purpose of ensuring that any and all trauma in my life is highly visible and addressed. A friend of mine who knows about such things insists that this is one of the great human fears, the inability to recall conscious moments of one’s life, and that idea certainly terrifies me.

In the end, the procedure was uneventful. I took the reasonable route and explained to the doctor that I did not need Versed, because I don’t tolerate it well. That seemed like a good explanation and was mostly true, in the existential sense. She wasn’t wild about the idea, but judging from the goodwill I suddenly felt towards everyone after the IV insertion, I think they bumped up the Percocet level. Not only did I not have Versed, but I remember watching the entire procedure on the television monitor, and that Aaron Neville was playing in the procedure room, and dear God, I am grateful to not have that floating around in my subconscious.

Nayla, if after today you have any previously unknown songs in your head, it’s not a side effect of the fertility drugs. And I’m hoping things went well, and we hear from you soon.

98 Needles

Some doctors like to make conversation while they are doing things that make you physically uncomfortable. I always thought this was to distract you from the unpleasantness, to relax you. Apparently some doctors are just bored, or particularly curious about their patient's presentation of the human condition. Because on Monday, while I was having a particularly uncomfortable transvaginal ultrasound (physically), my doctor was asking my mother a series of detailed questions about my father's illness, medical care, and death. He asked about our end-of-life decisions, and whether the doctors involved approved of them, and he asked about my mother's concept of life-after-death. All while using that transvaginal ultrasound probe to measure and count the number of mature follicles. As you can imagine, it was all very relaxing, just like the week in the Caribbean I deserve.
Well, at the end of the appointment, my doctor gave the instruction for me to give myself a trigger shot of HCG and scheduled my egg retrieval for 9 a.m. Wednesday. That is tomorrow.

I spent part of today stocking up on ginger ale and crackers. Blessedly, while I did have acupuncture today, I did not have to give myself any shots. Such freedom.

Send fertile thoughts, if you have them to spare.

As of today, the needle count is as follows:
24 Lupron shots
5 blood draws
11 Repronex shots
9 Follistim shots
48 acupuncture needles (in four visits)
1 HCG trigger shot


Total to date: 98 Needles.

tapeworm, yes, diapers, no

After spending the weekend in a tiny high altitude Nevada mining town where all of the grown-ups were drunk and attired in period costume (a little like the renaissance fair, except with sidearms), where the highlight was a visit to a medical device museum in the basement of a Chinese restaurant, yesterday we retrieved our pets from my mother, who has now started to refer to herself as “grandma,” in the third person, in reference to the dog, as in, “grandma took you shopping for new toys at the PetSmart, didn’t she?” or “you are going to miss grandma reading to you, aren’t you,” and even, “your mama doesn’t cook for you like grandma does, does she?”
I texted my sister immediately. Filial consensus: this must stop right now.
There was silence in the car on the drive home, and it was not the comfortable, easy silence of a happy reunion with one’s pets. Instead it was a silence of deep discomfort. I know my mother is driven to behave this way believing as she does that for the indefinite future, her babysitting subjects will take heartworm medication and stalk houseflies. And all day, I’ve considered calling her to discuss our pending IVF plans (we haven’t talked too much about them since my father died), but the truth is, I would much rather just be pregnant, and not discuss the details with her. Mostly because in the past, she’s not exercised discretion in her conversations with others, and her lapses have resulted in near strangers asking me about my cervical patency and my husband’s semen analysis. Ok, maybe not near strangers, but I have certain cousins who don’t even know what my natural hair color is, for goodness sakes. Ones who have strong suspicions that infertility is linked to the consumption of organic produce, or maybe living west of the Mason Dixon line. I don’t know. If I don’t find a form letter, Dear Parents, We are undergoing IVF, please neither ask nor disclose details, on Google soon, I’m drafting one myself….

IVF: The Musical

I'm not kidding, IVF: The Musical is in progress. This is what my doctor told me today as I was sitting in his office wearing a sweater and a square of paper. He has commissioned two local artists to write a Broadway musical about IVF. We spoke at length about artists and what motivates them and why it might possibly be taking them more than 18 months to complete the muscial when they are being paid by the month.

While 90% of today's conversation was about said musical, I did get some information about my IVF protocol. My estradiol level, which, when someone is not doing IVF, should be 34-400 at mid-cycle peak, is over 3000. The doctor seemed to think this is good news. It may also explain why I feel like I am carrying a carton of chicken-eggs on each ovary. We are still on schedule for a Wednesday retrieval and a Saturday embryo transfer.

As of today, the needle count is as follows:
22 Lupron shots
4 blood draws
8 Repronex shots
7 Follistim shots
36 acupuncture needles (in three visits)

Total to date: 77 Needles.

Death, Dog, and Taxes

After unsuccessfully trying to explain to my husband why he really does in fact want to drive fourteen hundred miles to BrokenArrow, Oklahoma, for Thanksgiving, in our not overly large car with the dog and a wife who once managed to leave the entire state of Texas off an itinerary to which it rightfully belonged, he was able to pull the trump card of, well, employment. (And no, this was not an excuse. My husband likes my family, in a Margaret Mead/Noam Chompsky sort of way).

And so because in the estimation of United Airlines, the dog does not fit under the seat in front of us, and because we waited too long to use one of the three boarders who are recommended by friends just as neurotic about their animals, we are spending Thanksgiving alone. Well, not technically alone, but it will be the first Thanksgiving I have not spent with my parents. I have tried to forget the one last year, when my mother couldn’t eat anything, not even strawberry Ensure, when I caught her halving her Xeloda dosage, because half of the chemotherapy regimen, she reasoned, would be better than no regimen at all. I still have somewhere the phone that I broke, very intentionally, on the tile of my kitchen floor. An interesting fact: there is a California misdemeanor code that addresses the intentional destruction of an electronic telecommunication device, geared, no doubt, to situations in which one is calling for help, not necessarily where one is calling their sister in Chicago, warm and removed from the craziness at hand, for help of a different sort. After that, I took Family Medical Leave, and watched my mother take the prescribed dose of her chemotherapy. And mercifully, I’ve almost forgotten about the pale green plastic tray with the Thanksgiving dinner in the palliative care unit, where my father was staying at the time. There is nothing more soul smothering than institutional holiday food.

So in light of the memories of yesteryear, I suggested to my husband that we take the time to go somewhere else, a neutral place with no memories of Thanksgivings past, a brand new rat cage in lab parlance, but that was gently vetoed, too. That’s because my husband is starting a consulting business next year and needs time to put certain things in order, which is actually a great thing, for about ten thousand mind numbing reasons that I’m not going to go into, but the upshot is that it makes infinitely better sense to do IVF after January 1, in the next tax year. And actually, the clinic we are going to use closes for two weeks in December to do something to the embryology lab- clean it, recalibrate the instruments, I don’t like to think too much about the details and the variables regarding what might not correctly put back together, and I’m too superstitious to schedule something immediately before or right after, so….fine by me.

Needle Count

Erin suggested I actually keep count of the number of needles involved in this cycle of IVF instead of just waxing poetic (or whining) about it. She and I intend to use this as cocktail party conversation. Perhaps this sort of inclination has something to do with why we spend our time corresponding on the internet instead of getting invited to more cocktail parties.
So, as of today, the needle count is as follows:
18 Lupron shots
2 blood draws
4 Repronex shots
3 Follistim shots
26 acupuncture needles (in two visits)

Total to date: 53 Needes.

I was all set with today's post

about my French husband’s thwarting of our Midwestern Thanksgiving plans, and how this time last year I broke one phone and at the same time a CA misdemeanor. But then I read Nayla’s post.

It’s so hard to do something to honor the those who are not here, because you never really know what someone else would want. Years and years ago, my mother picked out hymns, flower arrangements, New Testament passages - but that’s my mother. Other things I’ve come across this year…Jane Kenyon has some wonderful and beautiful works, such as this, and my God, especially this, a poem one of my father’s friends sent me just two weeks ago, one so deeply personal and relevant, I might be able to say more about it in thirteen years or so. But therein sort of lies the difficulty, it’s almost impossible to find something appropriate. Finally, I wanted to post Leonardo Alishan’s The Black City, but the text is no longer on the internet; (and maybe that’s a good thing- I think it’s a beautiful and hopeful poem, but nobody else has ever agreed). So Nayla, I could not think of the right thing to say, and I have to tell you- I’ve been reading a lot of this sort of thing lately. It’s difficult to find the right balance of sadness and beauty- and to know what honors a person’s memory. And then I remembered something I read last night in a writing workshop, something with airplane travel and crankiness and curly brown hair, and it has been on my mind ever since, that and your initial post, about dying and being alone, and what I want to say to you is that what I read last night was about a family that was the opposite of alone. They were separated in some ways, but they were not alone. And I bet there is room for friends. It was about many other things too, but this is the thing that stands out today. I can imagine how difficult it was yesterday to read and reread and then post that work for Week 2 on the same day such sad news came, but I think that it’s sort of a gift to them that you wrote it, and maybe in ways less easy to define, a gift to you too.

I am not a Chemist

I admit, I did not appreciate my belly. It wasn't always perfectly flat, or perfectly toned. But it was mine.
Now, my belly is unrecognizable.
It started with my surgery, which left a set of scars and a belly button that looks like it is frowning. The belly button is frowning because the doctor went in laparoscopically, and the way they minimize the total number of scars is to go in through your belly button. There is no scar on my belly button, but the skin did not heal the way it was, and now my belly button is sad. It is pessimistic. About four inches below my belly button there is a one-inch scar, like an upside-down crescent, which also looks like it is frowning. There are two small scars about eight inches apart, and between my belly button and this new upside-down crescent. If you connected the three scars and the misshapen belly button, you would make a diamond. And unlike my emotional state, which can be brightened temporarily by, say, a puppy with an ice cube, these sad scars are permanent.
And now, my three-shot a day regimen is furthering altering the tectonics of this landscape.
Allow me to get you up to date. In the mornings, I am taking 150 iu of Repronex. I wipe down all the vials with alcohol preps and unwrap one very long needle-syringe combo and one short needle. Using the very long, and, I must say, intimidating needle, I inject 1 ml of sodium chloride into one vial of powder, and I let that dissolve, and then I suck that mixture up with a needle and inject it into another vial of powder and let that dissolve. Then I twist off the long needle and twist on the short needle. At various points in between, I am holding my needle and syringe up to the light and whacking it with a pen, trying to get the air bubbles out and thinking of the movie Trainspotting. I am not sure what would have happen if I missed an air bubble, but I am sure I do not want to find out, especially since there was an episode of House that posited that such a thing could kill you, even if you previously gave voice to Darth Vader.
Every time I do this mixing and wiping and switching needles, I think of my tenth grade chemistry teacher, who told my mother that I was a terrible multi-tasker, and that this meant I would never be a chemist.
This Repronex shot seems to be the one my body likes the least. I have now given myself three shots. I am supposed to give myself a shot somewhere in the region below my belly button, avoiding a two inch radius of the four points of the diamond of scars, which, as you will recall, includes the belly button. The problem is that every time I give myself one of these shots, a raised, red, swollen patch develops, measuring about 4 inches in diameter. I have three of these so far. For Erin's amusement, I took out a tape measure and measured the available terrain. From hip to hip, I've got 14 inches. From belly button to crescent scar I only have 3.5 inches. And every night, I give myself two more shots, the previously mentioned Lupron, and 225 ius of Follistim. These other two shots don't seem to be causing any problems at the injection site, but if these raised, red patches don't start to subside, I'm going to run out of willing injection sites.

Will Someone Die Every Time I Do IVF- Part Two

Currently available evidence suggests the answer is yes.
Just two weeks ago, I found out that my friend Virginia (better known as Gigi) was going into hospice. I asked the question "will someone die every time I do IVF" because it seemed ridiculous that, after finding out about my father's terminal cancer the week of my first IVF retrieval, yet another loved one would succumb to cancer while I try to create life.
Gigi died tonight, peacefully, surrounded by her nephew's family.
I'm finding it difficult to access any additional grief. As my mother put it, when the tide is already so high, a little more water doesn't even matter.

Come to think of it, I should have asked her a question or two

Last night I met a French psychic. Not to be confused with the Northern California garden variety, who tend toward natural fabrics, billowing jumpers, sage scented shampoo, this one had deal with the devil shiny hair, weighed about as much as my bichon, wore Jimmy Choos, and if she has a crystal ball, I'm betting it's a Swarovski. Myself, I was wearing brown with black (again) and the ergonomic utility of my boots was unambiguously reflected in their aesthetic. I was lugging a brown paper REI bag that contained two packages of tube socks and one recent guide to the Pacific Crest Trail, and this sort of get-up is a good example of what usually happens when I meet any of my husband’s cosmopolitan friends, but so be it. Nobody has died yet. In any case, I was overwhelmingly relieved to hear that my new friend shared none of the similar pretensions I’ve grown used to, having been born in Northern California in the mid 1970s and having lived in a county that hasn’t easily parted ways with that particular era. We discussed a nearby mountain, rumored to be a place of high spiritual energy. But it’s cold this time of year- did she find hiking a problem? Doesn’t hike. Do they have to reserve the campground in advance? Doesn’t camp. I couldn’t tell you why, but I like these things in a psychic. Which isn’t to say that I have an opinion on the matter of mind reading or prediction, and then something interesting happened. The other three people at the table were discussing Sarkozy the newlywed, and his rumored affair with a cabinet member, a forty-four year old woman and the mother of a small infant, paternity undisclosed. My French is not passable for navigating the cheese isle in the supermarket, and as far as champagne goes, I buy what is cheap and cold, but I managed to follow the conversation, albeit four steps behind (which I recommend doing some time because it makes for an interesting narrative), when my new friend turned to me and said something to the effect of, “...she (mistress to the French president) is forty-four. You are a woman, you know. A woman over forty does get pregnant accidentally,” except she said it with a voice that would liqufy concrete.

And shortly thereafter we were all distracted by my ability to drop daal, roti, rice, from three dishes, nearly simultaneously. I blame telekinesis.

Cold Feet, More Needles, and the Idea of Eleven

A few days ago I went to my first appointment with my new acupuncturist, and was contemplating the number of needles to which I am willing to subject myself to have a genetically-linked child. If I had a more mathematical bent, I might actually try to estimate this, but instead, I like to think of it as the overwhelming number it is, like stars in the sky or plankton in the ocean. Actually estimating the number might make it seem less overwhelming for some people, but I prefer to simply forget about the needles until just before I have to deal with them. This must be why I forgot about the number of blood draws there are for IVF. I forgot that the skin on the inside of my elbow starts to form a little scar on the phlebotomist's favorite spot.

I have been giving myself shots of Lupron for two weeks now, and I am scheduled to begin the follicle-stimulating drugs tomorrow, so I had the pleasure of going to the doctor to have my ultrasound and bloodwork.

Today was only my second blood draw of this cycle, and I have a lot more to come. I find it comforting that the phlebotomist is friendly, and named Rihanna, and admits to being afraid of all needles that do not leave a ink or a piercing behind when inflicted on her. I also appreciate that she remembers to use a butterfly for the blood draw, because no matter what phlebotomists say, the butterfly method is less painful and results in bruising less often.

After the blood draw, I went into an examination room, where I undressed from the waist down while my husband sang what he says is the music one find in porn. This, as you can imagine, made me feel very sexy, particularly as I left on my socks on, climbed on to a very erotic examination table and covered what the truly educated term the vajayjay with a square of paper.

And to be honest, I considered getting off the exam table and putting my Ugg boots on over the socks, because my new acupuncturist reminded me that cold feet are very bad for fertility, particularly for someone like myself, with a cold nature and too much dampness in my system. My acupuncturist in California said this meant I needed to wear socks constantly, and that was California, where it is temperate and dry most of the time, and the question is, if I just had to wear socks before, what will it take to stay warm, dry, and fertile in Oregon?

Before I could act on this idea, the doctor came in and the three of us had a conversation about various parts of the protocol while I modestly crossed my legs. Now, dear reader, if you have not been through fertility treatment you may find this a little strange. Let me put your mind at ease At this point, so many medical professionals have had a look at my vajayjay, I didn't even think about the square of paper until the doctor moved to the side of the room so as to better address both me and my husband, and I realized that my backside was fully exposed, because I was wearing a sweater and a square of paper, and not a robe, or some other garment. Anyway, I chose to let this issue go, because what with the infertility, and the death of my father, and the fact that my mother is now staying with us and my in-laws are visiting, and the chemical menopause symptoms of persistent headaches and weepiness, the indignity of a bare backside is really not worth my time.

After we had our conversation we went on to the real reason for the doctor's appearance: the ultrasound. (This is the thing that Erin's doctors should have been doing to monitor her during all her IUIs.) This is how today's ultrasound went: The doctor pushed a special ultrasound probe up the aforementioned vajayjay and the three of us took a good look at the ultrasound image of my ovaries and the associated follicles. No ovarian cysts, which is good. And eleven developing follicles on each ovary. "You seem," said the doctor, "like a woman committed to the idea of eleven."

This afternoon, I got a call from the nurse saying my bloodwork showed a level of estradiol of 38, which means I'm ready to decrease my Lupron for today and start my follicle-stimulating shots tomorrow. Next appointment: November 11.

A Tale of Two Clinics

There are two large fertility treatment centers in the large metropolitan city in the neighboring county. The first is affiliated with a large teaching hospital, and the second is a private fertility clinic. Their ranking in most areas is the roughly the same, and the price of treatment is also similar. I am insured by two excellent PPO insurance carriers, (who probably won’t be sending me holiday cards this year) but neither plan offers fertility coverage.

My initial fertility work up and first round of IUIs were done at the large teaching hospital, mostly because my primary care doctor belonged to the IPA affiliated with the hospital. There are a lot of good things to say about that center- the staff physicians were excellent, the lab was excellent, and a wide range of specialists collaborated with the center to provide ancillary tests and analysis. As I progressed through treatment, however, I encountered some issues that were so serious that my husband and I decided to leave the large hospital and pursue treatment at the private center. Specifically:

Teaching hospitals have a dual purpose: to treat patients and to train physicians, (also to conduct research, more on that in another post) and those activities generally amount to the same thing, as far as patients are concerned. You know the doll who gets yanked off the shelf for the community CPR class? Congratulations, you’re that doll. And while I am the first person to appreciate that physicians have to start somewhere, my personal experience, as a CPR doll was, how to say not exactly, exquisite. Here were two problems that could have been avoided:

- I researched my Reproductive Endocrinologist (RE) a lot, and luckily enough, she accepted me as a patient. So far, so good. However, she was not the clinician who performed most, or any, of the actual procedures, and probably more importantly, she was not the physician who monitored my progress. Or, at least, not until I developed multiple cysts after several months on Clomid- cysts that should have been monitored prior to every procedure, and were not.

- There’s a new commercial for a pregnancy test (I have no idea if it’s a new pregnancy test), with the byline “1 in 4 woman can misread a traditional pregnancy test.” Ok. Fair enough. I suppose that under the right circumstances, 1 in 4 people can misread nearly anything, so I’m not going to deconstruct that statement. But the Ovulation Predictor kits suggested by my RE….good lord. Now that was rocket science. I need to devote an entire post to explain why this was so. But in any case, it is for this reason that the private clinic doesn’t use them at all, instead relying on ultrasound monitoring to appropriately time IUIs. Also, the private clinic uses ultrasound monitoring to look for the development of cysts. Also the private clinic uses ultrasound monitoring to ensure that CLomid hasn’t decreased the ovarian lining to a thickness that would not be conducive to implantation. For those three reasons, my IUIs at the teaching hospital were pretty much pointless. I think I should devote another blog post to why exactly one probably doesn’t want to go through pointless IUIs, with the adroitly named TomCat catheter.