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16 December 2010

Oranges are not the Only Fruit


The big news: I am pregnant.

Fourteen weeks ago, I went to CCRM for a frozen transfer of two blastocysts.


About ten days later, I started feeling very nauseated 24/7, and blood tests confirmed that I was pregnant. I have stayed nauseated ever since, so nauseated that I had to get a few different medicines from the doctor to stop losing weight. (Note to others who might experience this: zofran and phenergan are safe in pregnancy.)

Nausea has been my primary preoccupation. I have done almost nothing more than sleep, take my nausea medicines, try to eat, and cuddle with my dog, who is very happy I am home all of the time. (I did teach a class this semester, and I wonder if my students have figured out why I started bringing lollipops for all halfway through the semester.)


Meanwhile, I check on the status of the contents of my uterus via the book What to Expect When You’re Expecting, the Mayo Clinic Guide to a Healthy Pregnancy, and the iphone app Pregnancy Companion. All three sources like to compare the embryo or the fetus to some kind of food, which is particularly difficult to think about if you are dry heaving at the thought of brushing your teeth. On occasion, these sources mention other food items, but usually, fruit is the comparison of choice.

This week, the fetus is the length of a large lemon. Previously, it has been a plum, an apricot, a lime, a cashew nut, a cherry, a macaroni, a blueberry, a grain of rice, and an apple seed.


Week 15, which starts in two days, the fetus will be the size of a navel orange.

04 October 2010

On Death and Dying and Harry Potter


Or, more accurately on grief and caregiving.

Once again, this blog has been more about fertility than mortality for some time. I guess that's because I spend more of my time feeling hopeful, or at least helpful, rather than dwelling in grief. And that's good, right?

I still read every article on death and dying, and grief and caregiving.
Today I stumbled across two interviews, one the Oprah interview of J.K. Rowling, and the other an interview with Arthur Kleinman, director of Harvard's Asia Center.

The Oprah interview touches on the death of Rowling's mother, and how the grief and depression Rowling suffered influenced everything about the writing of Harry Potter. Kleinman talks about caring for his wife at home for 7 years after her Alzheimer's diagnosis.

And while we're on the subject of Harry Potter, I should mention that during bed rest, I looked quite a bit like Bellatrix LeStrange. Except in pyjamas.

29 September 2010

Bed Rest


Bed rest is not easy. It sounds like it should be easy, what with the terms "bed" and "rest", each of which on its own conjuring up pleasant associations. (I guess I should acknowledge that usually these associations are with things that are optional.) When mandatory, and when in concert, "bed rest" is quite difficult.

First of all, after you've had your first luxurious nap, you want to get out of bed and stretch, or run around, or get your own glass of water. These things are not allowed. You can get up to go to the bathroom, but then you have to got back to bed, and refrain from jumping up and down on the way. If your bed rest is after the transfer of two genetically normal blastocysts, and after 2 miscarriages, one chemical pregnancy, 3 fresh IVF cycles and 4 IUIs, then you have some incentive to follow the doctor's instructions, policing yourself and trying to practice yogic breathing whenever you feel like you might jump out of bed and run around the room in circles.

After the transfer on Monday, the nurse wheeled me out of the clinic while my husband brought the car around. Following the nurse's instructions, my husband reclined the front seat of the car until it was flat, and I carefully climbed in, letting them buckle me in for the ride. As you can imagine, I felt ridiculous. Then we went back to the hotel, where I thoroughly enjoyed every step toward the elevator and down the hall to our room.

If the biggest challenge of bed rest is the actually staying in bed, then the second biggest challenge is eating and drinking while reclined. I recommend you acquire a bendy straw to avoid dousing yourself in your beverage of choice. Unless you are into that kind of thing.

N.B. Bed rest is more pleasant if you have a fluffy white dog to keep you company.

27 September 2010

Transfer Day

A Brief Summary of the Past Month:

22 Days of Lupron

8 sessions of electro-acupuncture (Imagine someone running an electric toothbrush up and down your sciactic nerve.)

25 Vivelle patches

15 Endometrin vaginal suppositories

1 new class prep.

And here we are--transfer day.

I go in at 9 a.m. for some acoustic acupuncture. At 10, I will swallow a valium and begin drinking 16 or so oz. of water so that I can fill my bladder, and thus straighten out my cervix.

At 11, the doctor will transfer 2 genetically normal blastocysts into my uterus.

And then we hope for the best.

26 August 2010

The Magic Number

Six is the magic number.

As you may recall, we did CCS genetic testing on 11 blastocysts 2 weeks ago at CCRM. We have been waiting for the results ever since, with no small amount of crying and cuddling my small dog like the baby substitute he is.

Wednesday night we got the call from Dr. Surrey. We have six normal embryos! Of the 11 blastocysts tested, four have genetic abnormalities incompatible with even a positive pregnancy test, and one is still a question mark. And six are normal and of "more than high enough quality to result in a live birth."

We are relieved.

FET approximately September 27.

19 August 2010

A Hypothetical FET

Sometime next week we will get the big news about our blastocysts. The doctor has not given us an appointment, so it could be anytime and anywhere: 9 a.m. at the kitchen table, 2 p.m. at the grocery store, or just before the first class I teach this semester. It could very well be the good or bad news that will make my birthday complete.

If there is one thing I have learned in the past two years, it is to prepare for the worst. That said, I have started the meds for the next possible Frozen Embryo Transfer (FET), and I have the schedule for the rest of the protocol.

I am going to share this protocol now, in case it is of use to someone else. If I don't have normal embryos, I suspect I will not be in the mood to type this up later.

So here it is:

August 18: begin birth control pills
August 30: start Lupron 10 units per day.
9/3 last birth control pill
9/6 new cycle begins
9/8 1 Vivelle patch
9/10 1 Vivelle patch
9/12 1 vivelle patch
9/14 1 vivelle patch
9/16 2 Vivelle patches
9/18 3 Vivelle patches
9/20 4 Vivelle patches
9/12 ultrasound
9/22 4 vivelle patches, endometrin 3 x day, stop lupron, tetracycline 4 x day, medrol at night
9/23 endometrin 3x day, tetracycline 4 xday, medrol at night
9/24 endometrin 3x day, 4 vivelle patches, tetracycline 4 x day, medrol at night
9/25 endometrin 3x day, tetracycline 4 x day, medrol at night, Travel to Denver
9/26 endometrin 3x day, 4 vivelle patches, tetracycline 4 x day
9/27 Embryo Transfer: endometrin 3x day
Strict Bed Rest 48 hours
Return home.

In addition, I will need to do electro acupuncture 2x week for 4 weeks and give up decaf coffee and chocolate.

DH calls it the Scorched Earth Protocol.

12 August 2010

The Idea of Eleven

Longtime readers of the blog may recall that during my second IVF cycle, my Reproductive Endocrinologist described me as a "woman committed to the idea of eleven" because I had about eleven follicles developing on either ovary.

Well, my current embryologist agrees.

To review, of the 32 eggs retrieved, 28 were mature, and 26 fertilized normally.
Of those 26, 18 developed normally to Day 3.

Of the 5 embryos who journeyed to Colorado in a tank, all 5 survived the thaw.

Day 6, yesterday, the CCRM embyrologist call to say that of the 18 from the fresh cycle, 9 embryos grew to good-quality blastocysts and of the 5 frozen, two continued to develop to blastocyst.

So that makes 11 blastocysts total.

Committed.

These blastocysts are now made up of about a hundred cells apiece and have already differentiated themselves into the fetal pole and trophectoderm, or what will be the placenta. The embryologist biopsied 2 or 3 cells from the trophectoderm and sent those off for the Comprehensive Chromosome Testing. (They do this with PCR at CCRM.) The embryos themselves have been vitrified.

So now we wait.

The good news is that I have lost four pounds of water weight since I came back from Colorado, so I think am safe from the dangers of hyperstimulation.

06 August 2010

Fertilization Report

I got the call from John Stephens, the director of the lab, this morning.
of the 32 eggs, 28 were mature, and of those, 26 fertilized normally, with ICSI.

Now, on to eat more salty foods, as prescribed by my doctor.

05 August 2010

Retrieval Day or 32 Eggs and Then Some

I'll write down a bit of what I remember from today, since I hear I have one or two readers new to IVF.

I got to CCRM at 8 a.m. and a very nice nurse named Jennifer set me up in a room to change into a gown and start an IV. I have had some bad experiences with IVs, so I was nervous, but she used all the tricks I have heard of, including wrapping my arm in a warm moist towel and injecting lidocaine under the skin of the back of my hand before putting in the actual IV. Close to painless.

Jennifer let my husband into the room, and soon after, the anesthesiologist came to talk with my and have me sign the consent for general anesthesia. (Note that I had been fasting since midnight.) For this procedure, I was not intubated, but they put in a device to keep my airway open. My only moment of nervousness was when the doctor told me that since they were running short of Versed, they were trying to conserve it, so I might remember being scrubbed in preparation for the procedure.

A few minutes later, Dr. Minjarez came in. My main doctor at CCRM is Dr. Surrey, but I have only met him once, during my day-of-tests. Various nurses convey all of his instructions. I technically have one main nurse at CCRM, but I have only seen her once since I arrived in Colorado. All of which is to say that I did not have a real relationship with any other medical professional, and thus was not disappointed to see a new doctor. I liked Dr. Minjarez immediately, especially when she said, "I go by Deb."

Dr. M instructed me to come back for an ultrasound tomorrow, and then to drink lots of water and eats lots of salty foods for the time being. She also said that I should avoid exercise for at least the next week, and that my hyperstimulation symtoms should go away completely with my next menstrual cycle.

After Dr. Minjarez left, the anesthesiologist came back in and turned something on in the IV, and that's the last thing I remember. I guess she found some Versed.

While I was in the retrieval, DH went off to do his thing.

I awoke to the sound of beeping. I looked up and saw that my heart rate was 46. I wanted to go back to sleep, but the beeping continued, so I could not. Jennifer brought DH to the recovery room.

32 eggs retrieved. Jennifer was impressed. It was nice to feel like I was good at something related to fertility. DH has been referring to me as the ovipositor, which, thanks to Google, I learned is both an organ used by some insects for laying eggs and also an ongoing experiment in groove versus dissonance. So the lab will work with these 32 eggs, and they will also defrost the 5 embryos I had shipped here. Before anyone gets too excited, the number of embryos that fertilize AND make it to blast AND test normal will be a good deal smaller, like one fifth of that at the most.

But back to retrieval day itself.

Before I left the surgery center, I had 2 extra strength tylenol and one can of ginger ale.
I slept for most of the rest of the day, and I am ready for more sleep now.

Tonight:
Tetracycline
Dostinex
Cetrotide by injection

04 August 2010

Triggers and Bonus Medications

Yesterday, at 5, I got the word that I would need to take a trigger shot that night.

The nurse confirmed that I was still hyperstimulated, and that my estradiol, at 6,774, was too high.

So last night, in addition to lupron, dexamethasone, and, and the intramuscular trigger shot, I also had to stick a pill called dostinex up my vagina. I will have to take this for 8 nights. (This is exactly what the nurse said, "Stick it up your vagina,")

Starting tomorrow, I will also have to inject myself with cetrotide.

If you are scared of having your loved ones give you intramuscular injections, note that you can pay an RN to drive to your home, or, in my case, your hotel room, where she will mix and provide the injection.

My retrieval is with Dr. Minjarez at 9 a.m. tomorrow.

If you happen to be reading this at 9 a.m. Mountain Time, send thoughts of quality embryos.

02 August 2010

A Different Sort of Two Week Wait

Today we spent the morning at CCRM. I had my IVF physical at 9, and then ultrasound and bloodwork at 9:30.
At 10, I had an excellent massage right in the clinic.
At 11, we met with a new genetic counselor, Mary. (She is not to be confused with Danielle, who helped me through a misunderstanding during our last consult.)

Our meeting lasted an hour, and, because my brain is not working, I am not sure I remember everything she said, but the big news is that on July 1, CCRM has changed its method of Comprehensive Chromosome Screeing from CGH (Comparative Genomic Hybridization) to something called PCR. While the CGH testing would have taken 6 weeks, the PCR testing will only take 2 weeks. So we will know whether any of the embryos are normal in 2 weeks!!

To review, CCRM will let all the embryos grow to blastocyst, biopsy them for testing, and then vitrify them. I will go home to Oregon and wait for the results. If there are normal embryos, I will come back for transfer at a later date.

This afternoon, the nurse called to tell me my estradiol level, at 7200, was too high, so I need to "coast" for another day with no stims. According to various sources on the internet, my estradiol should be between 200 and 600 per mature follicle (those over 18 mm). I think the ultrasound tech said that I have around 27 follicles nearing that size.

This explains why I feel so nauseated and bloated.

Good times.

Tonight: 5 ml Lupron! Trigger tomorrow.

01 August 2010

Another Reason to Move to Chicago

For the past few days, I've continued on the doses of 75 Gonal-F, one ampule of menopur, and 5 units of lupron, along with dexamethasone, folgard and prenatal vitamin. I am starting to feel nauseated and uncomfortable. The good news is that when the nurse called this afternoon, she said I did not have to give myself any stimulation shots tonight or tomorrow morning.

This morning, when I went in for my ultrasound, there was a new tech, and she gave me the option of guiding the transvaginal wand myself. Now, if you having done a few rounds of fertility treatments, as I have, you may be tired of having people poke things in your vagina. It is actually nice to be given the choice to do it yourself.

The tech told me that she can always tell the patients who have traveled from Chicago, because they always reach for the want themselves. Apparently, this is standard practice at a few major clinics in that fair city.

Tomorrow:
9 a.m. IVF physical
9:30 Ultrasound, bloodwork, and meet with nurse
10 massage (!)
11 genetic consult

30 July 2010

And Mortality

The mortality part of this blog has been underrepresented of late, so I am linking to an Open Salon piece about the last days of an Alzheimer's patient. Not for the faint of heart.

Suitcase Update

Suitcase has arrived. Dexamethasone ingested 1:26 a.m.!

29 July 2010

A Cautionary Tale

I am sitting in my hotel room with my dog, waiting for my suitcase. They say that it will arrive by 12:30 a.m. so I am going to stay up until 12:30 a.m. to see if they are telling the truth.

The truth is that I made a mistake. I put my pills in checked baggage. It was a direct flight. How could they possibly lose my luggage if the luggage and I were on the same plane?

Well, apparently it is possible. Apparently one of two things happened.
Either
1) United lost my luggage in the Denver airport or
2)The flight had too much checked luggage and someone decided my suitcase was less important than someone else's.

When I called United this morning they told me I would have my luggage by 6, so I did not redorder my pills or buy new underwear. Then, at 6, after CCRM was closed, they said the suitcase would arrive my 10:30p.m. At 10:30 p.m., they said it would arrive by 12:30 a.m.

So now I wait.

In other news, this morning I went into CCRM for my bloodwork and ultrasound. The follicles are still growing: 10 on each side within a similar size. Dr. Surrey lowered my Gonal-F dose to 75 tonight, and my Menopur to 1 ampule tomorrow morning.

Things I miss from my suitcase:

Dexamethasone
Clean underwear
the sleepmask that lets me sleep past dawn
my daily disposible contact lenses

28 July 2010

A Little Something Extra


Well, I have arrived safely in Denver and have given myself my evening shots. Unfortunately, my suitcase did not arrive. This is a mystery to me, since I took a direct flight. But the airline people have no idea where my suitcase could be.

On the bright side, it is surprisingly easy to travel with medical liquids and needles. I just put them all through the scanner and no one said a word about it. For my purposes, this was a great relief, but I didn't necessarily feel safer in my air travel.

At least the Enterprise Car Rental people are on top of things. Not only did they rent me a car, but their rental car airport shuttle is ready for any emergency, including Bloodborne Pathogens. I wasn't aware that this was a problem on rental car airport shuttles, but I am happy that Enterprise is ahead of the game.

25 July 2010

Like Soup

For some reason, I haven't been able to stop thinking about an episode of the cancelled sitcom Arrested Development entitled Beef Consomme. In the episode, teenager George Michael, who suffers from a secret attraction to his cousin Maeby, asks his grandmother whether they are really related.

NARRATOR: George Michael, having failed to get the information from anyone else, made the ultimate sacrifice and went to visit the keeper of the family secrets.

[Cut to the penthouse kitchen, where George Michael stands on one side of an island. On the other side, Lucille prepares tea.]

GEORGE MICHAEL: So, uh, it's about Maeby.

LUCILLE: Oh! That's a lost cause. But you get what you pay for, eh?

GEORGE MICHAEL: Yeah. Wait, what? What do you mean, "pay"?

LUCILLE: Fertility tests, lab fees, donors and implants. She's not real. She was made in a cup. Like soup. (pours tea) A hundred and thirty-thousand dollar cup of soup. How do you like them egg rolls, Mr. Goldstone? All I know is it took an extra year before we could add a den.

GEORGE MICHAEL: So are you saying we're not directly related?

LUCILLE: I'm saying she already spent her inheritance getting here.

Watch the whole glorious episode here.


24 July 2010

High Anxiety

Earlier today, I was looking for some instructions on how to mix Menopur, when I stumbled on this preface to the requisite document:

At Ferring, we understand that having to mix and administer your own medication may seem overwhelming, and increased stress and anxiety levels can potentially hinder your treatment. We want to make it as easy and stress-free as possible.

In a survey among members of RESOLVE, The National Infertility Association, patients who were prescribed multiple injection methods (needle and syringe plus pen) experienced higher levels of anxiety when handling, preparing, and injecting their medications.

And in fact tonight, as I prepared for shots #2 and 3, I did feel stress and anxiety.

Shot #2 was 300 of Gonal-F. It's a pre-loaded pen, so it does not require any mixing. But I found it difficult to push the button that administers the medication, and once I did push it, the result was more painful, in a stinging way, than any of the other meds I am taking this cycle. I have a vague memory of repronex also being painful in this way.

Shot #3 was Lupron, down to 5 units.

So for the day:

a.m.

One Folgard pill

Two vials of Menopur, injected

p.m.

One Folgard pill

One prenatal vitamin

One baby aspirin

One dexamethasone

5 units Lupron, injected

300 Gonal-F, injected.

3 squares Green and Black Organic chocolate



Ready, Set, Go!


Yesterday I got the word that the cyst had disappeared and I was ready to move forward with this IVF cycle.

So this morning I started my first stimulation shot of IVF #3--Menopur.
I added a photo of the Menopur paraphernalia at right. You will notice three small vials in addition to the Menopur box and the two needles. Two of those are the Menopur powder, and one is the sterile diluent, which I think is just a fancy way of saying saline solution, which in turn is just a fancy way of saying salt water.
The Menopur comes in powder form and I have to add 1 ml of diluent to one vial, using a long needle, and wait for it to dissolve before sucking the mixture back and adding it to a second vial of powder. Then I suck that mixture back up, and unscrew the long needle and screw on a short needle. Then I ice my belly, wipe a spot down with alcohol, and inject.

It has been nine months since my last fresh IVF cycle, and once again, this morning, as I was mixing these powder and very nearly accidentally stabbing myself with the wrong needle, I remember why I am not a chemist.

Tonight, Gonal-F.

22 July 2010

What IF?

Keiko Zoll won a Team Resolve award for this video:

What IF? A Portrait of Infertility from Keiko Zoll on Vimeo.

21 July 2010

Thirty Days of Lupron


I remember the days when I was starting my second IVF cycle and thought that two weeks of lupron was torture. I was naive then.

If my current cycle goes as planned, I will be on Lupron for 30 days.

But let's review.
As you may remember, I started lupron back at the beginning of June with the idea of doing a retrieval at the end of that month. Sadly, my period did not arrive on schedule and thus, I ran into the one week of the year they close the lab, and I was unable to move forward. So that was 11 days of lupron for nothing.

Now, I have been on lupron since Day 24 of my cycle, which was July 6, and since my body decided to gift me with an unprecedented 38-day cycle, I have now been on Lupron 16 days, and I have not even started my stimulation shots. AF came yesterday, so I called CCRM and we set up a "calendar" and I bought my ticket to travel there on Monday.

This morning I went in for an ultrasound, looking forward to starting my stimulation shots and generally getting on with my life.

The ultrasound showed plenty of follicles: 14 on the left side and 12 on the right. The local doctor said he also saw an old, ruptured cyst, but that it would not affect my stimulation. I got my blood work done, and started waiting for the phone call from CCRM.

The CCRM nurse said that the cyst was borderline and my estradiol was slightly high at 66, so, while they weren't going to cancel my cycle at this point, I would have to stay on Lupron until Friday, when I will have another ultrasound and bloodwork to see if the cyst has shrunk. If it has not shrunk, it would interfere with the stimulation, so they would cancel the cycle.

The protocol calls for me to be on Lupron all the way until I take my trigger shot, approximately 10 days after I start the stims. So if my math is correct, that's 30 days of lupron. And that is not counting the 11 days from my last failed attempt.

I am tired of being on lupron. I am tired of shots, and I haven't even started the thrice daily regimen of lupron, menopur, and gonal-f.

I put in a request with Bear for some of his fool-proof puppy play therapy, but he, too, is tired of the effect Lupron is having on the mojo of the house, so he chose to rest on this chair instead.

Tonight, more Lupron, more dexamethasone.... Wish me luck!

19 July 2010

The Sound of Silence

Great article in Self about women's silence about IF treatments. I have certainly thought a lot about this in terms of my desire to hide in my closet on my birthday and my inability to return the calls of my pregnant friends. (Hi Friends, I'm sorry!)
I had not considered the implications for changing health care policy. If you are going through IF, I hope you will join or donate to Resolve.
The thing I'd really like to know is why the article's statement that the interviewee might work "behind the scenes" in infertility links to this article. Really, what am I missing?

14 July 2010

Lupron Left, Lupron Right

I started my shots of Lupron 8 days ago, and yes, I am cranky. I also have a headache. This is the third time I have been on this particular drug. The first time was during my second IVF cycle last fall. The second was just a month ago. That cycle was postponed, so I took an extra 11 day of Lupron for no reason. Good times.
Every night, I give myself the shot after icing my belly, and I record the event in my calendar. Sources say that you should alternate the side of the belly you inject every day. This isn't a huge deal with Lupron, because the site itself isn't very bothered by the liquid, but it becomes more important when you add in the other shots later in the cycle because they cause redness and irritation and large welts that span the valley of the oblique muscles. All I can say is, I don't know how anyone does this without an ice-pack.
For now, it's just a running line on the bottom of my day planner: Lupron Left, Lupron Right, Lupron L, Lupron R. And I wait for AF, so I can add more needles to my repertoire.

09 July 2010

Desperation IVF

This essay, about the decision of a husband and wife in their early 30s who decided to go through IVF to freeze embryos to use when they are financially stable, is causing quite a stir in the fertility chat rooms I frequent.

The article refers to IVF after 35 as Desperation IVF, and IVF before 35 as Preservation IVF.
Her language does trigger a negative reaction in me, but I'll admit that she may not be as smug as I perceive her. It may be jealousy, or the lupron, or the desperation.

In short, yeah lady, I do wish I'd vitrified some embryos when I was 30. I also wish I'd fallen in love with my husband earlier. I also wish we'd gotten pregnant when we started trying.

But how nice for her that this worked out.
And if I had a daughter, I would show her this article so she would know about her options.

05 July 2010

On Friendship

I've read a number of memoirs over the past year, including those of Joan Didion and Elizabeth McCracken. The latest one to inspire me is Ann Patchett's amazing tribute to her friendship with the late Lucy Grealy. Every page was gorgeous and heartbreaking, but this quote in particular has stuck with me:

"Even when Lucy was devastated or difficult, she was the person I knew best in the world, the person I was the most comfortable with. Whenever I saw her, I felt like I had been living in another country, doing moderately well in another language, and then she showed up speaking English and suddenly I could speak with all the complexity and nuance that I hadn't even realized was gone. With Lucy I was a native speaker."

I had the opportunity to see some old friends this summer, and I had this exact feeling. Thank you, Ann Patchett for describing this so perfectly.

P.S. Erin, I miss you.

04 July 2010

Nicest Rock Star Ever


Since we are still on a break from all shots and hormone-altering substances, my husband and I drove up to Portland to see his friend Rhett Miller who was doing a show with his band the Old 97s.

I've only met Rhett a handful of times before, and I had already concluded that he was the nicest rock star ever. What I wasn't expecting was that over dinner, the three of us would have a really frank conversation about all of the troubles my husband and I have had over the past year, and that Rhett would say all the right things about my father's battle with cancer and our fertility deal.

So, if you like alt-country, or if you just want to see a great show, check out the Old 97s tour schedule.

P.S. This is the first time I have had dinner with someone while other restaurant patrons are surreptitiously snapping photos of my dinner companion with their iphones. I asked for permission to take this one.

My husband is the one on the left.

Who would you say is the nicest rock star ever?

20 June 2010

Better Luck Next Time

A week ago, AF arrived, 4 days too late for me to catch the June cycle. That was the bad news, the the whole thing was delayed another month. The good news was that I was able to stop taking the lupron and the steriods, and I feel one hundred percent better. So for the past week I have been dealing with the logistics of delaying my trip to Colorado.
I have been visiting my mother in Florida for the past few weeks, and so another portion of my time since I went off Lupron has been spent trying to make up for my behavior while I was on lupron. Good times.

Today's agenda:
1. Visit cemetery in honor of Father's Days
2. Fly to Dallas (with puppy) to visit in-laws and my husband's grandmother.

12 June 2010

Waiting for Aunt Flow, on steroids

10 shots of Lupron later, and 10 pills of dexamethasone, a steriod. I am not at my best.
I have a constant headache. I am short-tempered. I am uncomfortable. The pageantry of World Cup Soccer is making me cry.

(And speaking of World Cup Soccer, this display has triggered a long-buried memory of being in Italy in 1982 when Italy won. My mother and her friends took great pleasure in wrapping me in as many items of green, red, and white clothing as possible and parading me down the street. I was ten. Luckily, all of the Italians, even the shy ten-year-olds, were also wrapped in as many pieces of green, red, and white as humanly possible, so no one paid any attention to me.)

But I digress.
The sad thing is that the 10 days of Lupron and dexamethasone may be for naught because my body is refusing to cooperate. To fully explain the way in which my body is refusing to cooperate, I will now avail myself of one of the abbreviations common to fertility chat rooms: AF.
Apparently Aunt Flow is an American colloquialism for menstruation. On fertility chat sites, it is abbreviated as AF, which was absolutely baffling to me for the longest time.

I was supposed to start AF on Thursday, but I did not. During any other week of the year, this would not be a problem, but this month, the lab at CCRM is closing from June 27-July 3. On this protocol, I would start my controlled ovarian stimulation shots on Day 3 of my menstrual cycle and continue them for 10 days, then have egg retrieval 2 days after that. Then the eggs and the sperm would do their things, and have 4 or 5 days to grow to blastocysts so they can be tested for viability. If I had started AF as expected, my embryos would have just made it in time for this closure.

I am still waiting.

I spoke to my nurse yesterday, and her solution was to keep taking the lupron and the dexamethasone until AF arrives just in case the lupron itself actually causes my body to delay an entire week. If I am so lucky as to have a week delay in the arrival of AF, I will simply skip over the closure and take advantage of this month's cycle. In that case, I will be on Lupron a total of 25 days, because did I mention that I have to stay on it throughout the controlled ovarian stimulation as well?

The alternative is that AF arrives sometime before Thursday, and that I have to start the whole thing over again on Day 21 of the next month.

So, for now, I wait.

07 June 2010

The Birds and the Bees

Check out this series of videos.

03 June 2010

And So It Begins


Dear Reader,

Yesterday, I received the Big Box of Needles and Drugs.

Yes, this means that everything came out fine with all the tests and that I am starting my third IVF cycle tonight. I will do my best over the next few days to fill you in on the things that happened since the meeting with the genetic counselor.

Tonight, the first Lupron shot. Wish me luck. And more importantly, wish my loved ones luck.

17 May 2010

Mars and Venus in the Office of the Genetic Counselor

This is part one of my account of our Day of Tests at the Colorado Center for Reproductive Medicine

We flew to Denver on a Thursday afternoon, March 22, our puppy slightly sedated and stowed safely beneath the seat in front of me. It was an hour’s wait at the rental car agency, before we got a car, and then, when we’d loaded our bags and the puppy and ourselves into the car, we discovered it wasn’t working, so we had to get a new one. Then it was a 45-minute drive to the hotel, and takeout for dinner, and then we were ready to get some sleep before our big day. Except that I couldn’t sleep at all until 6 in the morning, and then the puppy wanted to go out at 7, so I was not at all rested when it was time for our first appointment at 9. And since I had to give up all caffeine in preparation for my uterine blood flow Doppler ultrasound, including decaf anything and including chocolate, I was really running on adrenaline.

Oh, one more thing, before I came to CCRM, I had the idea that it was going to be both technically amazing and also patient friendly. I had an image in my mind of arriving and meeting my nurse and then being talked through everything that was going to happen and then having that nurse check in with me throughout the day. This is not the way it works. When we woke up, there was snow on ground. So my first experience of the day was of watching my puppy trying to figure out where all the grass had gone. And then we crated the puppy and got in the car for the 1.5 miles to the clinic. Between my inability to navigate properly using my iphone and the snow-related traffic, we were late to our appointment, so my husband dropped me off right in front of the door, and I stumbled through the slush to the front door. When I opened the door, I saw a large, pleasant waiting room, with a water feature in the middle of the room, water streaming over a long granite slab that read Colorado Center for Reproductive Medicine. On either side of the room, there was a long desk, and women sitting behind the desk and men and women in line in front of the desk. But there was no sign explaining the division of labor between the desks. So I went to the one on the right, the one with the shorter line of men and women, and when I got to the front of that line, a not-particularly-friendly woman told me to go to the other line, so then I stood in that line, and finally was able to check in. Whereupon I learned that 1)I needed to pay for each appointment as I went along during the day, and 2) that I had left my wallet in my hotel room. I convinced this woman, also less-than-friendly, to let me pay for my first appointment after lunch, when I could retrieve my wallet while running back to the hotel to walk the puppy.


Our first appointment was with the genetic counselor, Danielle. She had been through our files and knew we were interested in the CCS testing, so she explained it in detail, even more detail than the Schoolcraft book. In addition to the CCS testing on the embryos, which is basically done to count all the chromosomes on all the embryos to make sure we don’t have extra chromosomes that cause fatal genetic abnormalities and thus result in miscarriage, we talked about all the potential genetic diseases my husband and I might be carrying, given our ethnicities and family histories.

Here’s where the fun began, with the family history. When she asked my husband the cause of death of his paternal grandparents, he reported that his maternal grandmother had ALS, and his paternal grandfather had Huntington’s. Now, I had just heard about the ALS this fall, when I saw it on his family history form for our last round of IVF. And that was enough of a shock, since I had never heard about it previously in our 3.5 years of marriage or 3 years of dating prior to marriage or 15 years of friendship prior to dating.

But, okay, it was on the form that both his paternal grandmother and paternal grandmother died of ALS. What was done was done, and we moved forward.

But now, we were sitting in front of the friendly blonde Colorado genetic counselor,and my husband has just told us that his paternal grandfather died of Huntington's disease. And all of a sudden we are talking about whether my husband’s father is exhibiting any neurological symptoms and I am thinking about the character on the television show House who has Huntington’s and how it is clearly a very life-changing piece of information, and whether we will find out whether my husband has it and does this mean he will die early, and what will I do and where will I move and My God I wish I had a double latte, and the blond genetic counselor is still talking and suddenly my husband says, “Excuse me, can I just say that I made a mistake?” And I turn and look at him, and the blond genetic counselor says “Yes, please! It’s not Huntington’s, is it?” And my husband says, “No, it’s Parkinson’s.” And the genetic counselor says, “I am so happy to hear that.” And I say, “Yes, so am I, especially since this was the first time I’d ever heard anything about Huntington’s.” And the Genetic Counselor looks at me and says, “Wow, I really have to give you credit. You didn’t bat an eyelash.” And I turn to my husband and say, “And what is this about Parkinson’s? I thought it was ALS?” And he says “No, I asked my mom, and she says that my grandfather had Parkinson’s.” He takes my hand in his and says, “I’m sorry.” And he turns to the genetic counselor and says, “I’m so sorry. I’m actually not an idiot. I’m actually very smart. I just haven’t had my coffee today.” And the genetic counselor just seems extremely happy not to have to counsel us about Huntington’s, and does not suggest that we go to some sort of remedial marital communication class to discuss our inability to communicate about our respective family histories of genetic disease.
And thus concluded the first half hour of our day at CCRM.

Surrey with the Gene on Top

Two weeks later, on April 13, I had my phone consult with Dr. Surrey of the Colorado Center for Reproductive Technology. He had a very frank but reassuring manner. He did not mention donor egg OR advanced maternal age once. I really appreciated this. Perhaps he realizes that if you've come this far, you already understand how being over 35 leads to fertility issues, and that you don't need to hear it any more.

He said I am the perfect candidate for genetic testing. He said, most doctors don't like to talk about bad luck, but it is possible that my three miscarriages are the result of that very thing. He said that it is also possible that we are producing a greater number than usual of abnormal embryos, (his nice way of talking about the dreaded Advanced Maternal Age) and so CCS/CGH genetic testing would help us select the right ones.

He said, "Now if we do test the embyros, and all of them turn out to be abnormal, then you will be two very unhappy people, but you will be two very unhappy people with a lot more information."

Again, I really appreciated that he acknowledged that finding that out might actually cause those things we humans like to call e-mo-tions. Maybe these CCRM doctors take some sort of class on human/fertility patient interaction. Maybe that's the next big money-making thing--training your medical professionals to talk to patients. It sounds crazy, but it just… might… work.

But I digress.

As soon as I could, I asked about the chances of a woman my age not producing any normal embryos.

They have done CCS/CGH testing on 49 women in my age group 35-37. Of those, 1 out of 49 has had zero normal embryos. Now, I would not be surprised if my particular brand of bad luck caused me to be patient #2, but I guess that number is lower than I actually expected, so that might be considered good.

At this clinic, they do the CCS/CGH testing of Day 5 blasts, which enables them to biopsy a 60-70 cell blast instead of an 8 cell embryo. (At OHSU, for example, they take one cell out of an eight cell day-three embryo.) Because there are more cells, and they can take more than one cell per embryo, they avoid the risks of mosaicism. In fact, they are actually biopsing the trophectoderm, which becomes the placenta, instead of the part of the blast that actually becomes the baby. I still don't understand why this method takes six weeks, but whatever--- these people seem to know what they are doing. He said that actually, they've been getting their results back a little faster lately. There is a thorough explanation of this testing method in the Schoolcraft book, If at First You Don't Conceive.

He also really made the argument to get all the embryos vitrified and let my body get back to normal before any transfer. He talked about some study that showed a much higher rate of implantation for a uterus that has been properly prepared and has not gone through stimulation and retrieval that cycle. It was something to do with egg donors and egg recipients. It was like 70 % implantation in the egg donors themselves, and 85% implantation in the egg recipients who had not gone through controlled hyperstimulation in the same cycle as the transfer.

Here is the only statistic that stuck in my husband's head--
For those who transfer a CCS-tested blast, the miscarriage rate is 4.5%

Tests for me:
FSH
AMH
Antral Follicle Count
hysteroscopy (the kind where you are awake)
doppler blood flow analysis

Tests for DH:
Sperm Chromatin Assay
Karyotype
screen for Ashkenazi genetic diseases

Sadly, none of this information was conveyed in song.

But a girl can dream.

13 May 2010

We now return to our regularly scheduled programming.

I seem to have left you with a very depressing blog entry in January. My apologies. Every week since then, I kept thinking I would write, and then something would happen, and I wouldn't write, and then the prospect of catching you up on everything that has happened proved daunting, and nothing would get written. So now, I'm going to do my best to tell you what has happened in the last few months. It may take a few posts.

After my Christmas miscarriage, I tried to regroup. I went to the San Francisco Yoga Journal conference, where I tried to make friends with my body again. I saw my wonderful Bay Area friends and checked in with my Palo Alto doctor. I had a whole bunch of blood (15 vials) drawn for a recurrent miscarriage analysis. I went back home and prepared for a transfer of two of my frozen embryos by eating well, doing yoga, and playing with my puppy. The recurrent miscarriage testing showed that I am heterozygous for a clotting thing called MTHR, and so I add folgard twice a day to my baby aspiring and prenatal vitamin regimin.

I got pregnant from that transfer, but the pregnancy only lasted a few days. They call this a chemical pregnancy, the kind of pregnancy you wouldn’t even know about unless you were in fertility treatment and were getting blood work done early and often.

Immediately after the news of this third pregnancy loss, I went into full research mode. I remembered that a friend of mine had mentioned that a clinic in Colorado had the best IVF numbers in the country. I started reading all the fertility boards I had been avoiding for so long. I figured out which clinic was the famous one. I called to make an appointment, but since it was already 5 pm in Colorado by the time I found out I was losing the pregnancy, I had to leave a message. During that weekend, I did not feel depressed. I did not feel sad. I just felt compelled to find more options. I did a lot more reading about adoption, both domestic and international. I ordered two books on surrogacy and two books on adoption. (Apparently Amazon is one of the primary beneficiaries of my fertility woes.)

I found a local acupuncturist. I ordered the book the Colorado clinic had just put out, and read the chapter on genetic testing of embryos. That book mentioned a book on Traditional Chinese Medicine treatment of infertility, and so I bought that book as well.

On Monday, I was ready to make some calls. The first call was to the Colorado clinic. The receptionist gave me the first available phone consultation—6 weeks later. I learned that I would need to send all of my records for review before that consultation, and that then, I would need to go to Colorado for a full day of tests about a week after the beginning of the next cycle after the phone consult. And then I wouldn’t be able to start an actual IVF cycle until two or three months after that.

I felt the beginnings of that state of angry and sad and overwhelmed that my lack of fertility has periodically brought up. I tried to line up other options for the interim. I asked my local RE when I could do another frozen transfer. This clinic does their IVF in batches every other month, so I knew that the next retrieval month would be in May. The nurse said I would probably miss that one because my HCG levels would probably not go down to zero in time, so I would have to wait until the next cycle in July. JULY! So then I went to my next best option, exploring the idea of shipping my frozen embryos to another clinic, this one in Portland, to do a frozen transfer earlier than July. The nurse there gave me the first available appointment-three weeks away. This nurse and I had a very amusing conversation in which she suggested it would be best to pick up the “cooler” from my current doctor’s office, and drive my embryos to Portland myself. Ah, the comedic possibilities.

So then I called an adoption agency, and they told me that they ask prospective adoptive parents to stop all fertility treatments when they start the adoption process, because they say one needs to mourn the loss of her fertility before one can bond with an adoptive child. I get this, I really do, but when the wait for a child is over a year, and the wait for an IVF cycle is 5 or 6 months, it seems cruel to not allow me to start the paperwork while I am waiting for something, anything, to happen. Anyway, all of these frustrating phone calls released a great tidal wave of emotion in me. I got back into bed with my puppy at my feet, and I cried and cried and cried for a few days. Then I got back out of bed, and went to my first acupuncture appointment with a new acupuncturist, to the gym, and a few weeks later to the doctor in Portland.

The doctor in Portland was super-nice, but he had not reviewed my records before I arrived, so we spent a good deal of time going through my medical fertility history. He made notes on a stack of blank, unlined paper with blue pen, and when we were done with our dialogue, he said, “Well, I see the problem.”

“Oh, good, I thought.” This dude has noticed something that no other doctor has noticed. Now he will tell me to make some minor lifestyle change, like sleeping on my right side instead of my left, and then I will get pregnant and carry to term.” Okay, I didn’t really think this. It was more like, “If I were naïve, I might think that this man is going to be able to help me in some non-invasive way, but really what he’s saying is that if I haven’t gotten pregnant by now, with all the interventions I’ve had, it’s because things are really messed up.” And in fact, he started listing things on his paper: the endometriosis, the miscarriages, the trisomy 7, the chemical pregnancy, and at the bottom of the list, he wrote the number 37, my age, and next to it Advanced Maternal Age.

“As you get older, the number of aneuploid, or irregular, embryos increases,” he said, circling the number several times.

“So I would recommend doing genetic testing to see if you can generate any normal embryos at all. Because if we do another round of IVF and we test the embryos, and because of your Advanced Maternal Age, none of them are normal, maybe you want to move to donor egg.
Now, in fact, I did not even know that this clinic did the kind of genetic testing I was interested in, and I had intended to go to Colorado for my day of tests, and use the Portland clinic to do a frozen transfer of my existing embryos. And the last thing I intended to do was to use a donor egg. So I said so.
“Yeah, I don’t actually want to do donor egg,” I said. And I was about to say, “I will move to adoption if IVF with my own eggs does not work out,” but the doctor gently interrupted me.
“No one wants to go to donor egg,” he said. “But it can be a really great option, particularly if you have a younger sister or cousin.”

“But I don’t have a younger sister or cousin,” I said.

As many of you know, I am an only child, and my primary goal in building my family is to acquire more than one child, especially since not having any siblings has been particularly difficult for me in the wake of my father’s death. And you will notice that I am putting the words Advanced Maternal Age and Donor Egg in bold. This is because that is what it sounds like to me when people use those words, like they are shouting, even when an impartial observer might say that they are speaking in a normal tone of voice.
And the doctor said, “Are you sure? Because all women are worried about using a donor egg but if you have a younger sister or cousin, you’d be surprised by how much DNA you share. My brother and I, for instance, are very similar, because we share so much DNA. It’s just a great way to preserve your genetics when you are of Advanced Maternal Age.

It was at this point that I decided I could not work with this doctor. He was very nice, and very competent, but I cannot deal with something who does not listen to me, and who insists on praising the glory of genetic connection, while at the same time making me feel like a shriveled old crone and reminding me about my lack of siblings.

We continued our conversation. I asked polite questions about the genetic testing, and we decided that the next step was to have my day 3 FSH (follicle-stimulating hormone) tested.

“I suspect it will be high,” the doctor said. For those of you who don’t know, high FSH is bad.

“The last time I had it tested it was 4.7,” I said.

“Well that’s too low,” the doctor said. “That’s almost anovulatory.”
My heart started to sink, but then my brain started working. “But I just did a round of IVF in November, and I produced 32 eggs,” I said.

“Oh, yeah,” the doctor said, standing up and walking toward the door. “That’s pretty good. But I expect that it’s gone up since then.
I drove back the 2 hours from Portland to Eugene and fell into one of my now-patented angry, crying funks. That one lasted a few days, and by the end of it, I was certain that I needed to move on to the Colorado clinic.

Nayla

03 January 2010

Me in the Year 2010

This new year has been strange in a million ways: the fact that my father is lying in the cold ground under a Christmas-decorated tree, the fact that I am not pregnant and have no children, and the fact that I am not an ethnobotanist.
Perhaps I should explain that last one.
When I was in my 4th grade gifted class, I had to draw a picture entitled "Me in the Year 2010." Of course I can't find the masterpiece now, but it was the kind of thing I saved, along with my brilliant pre-adolescent poetry and my endless conjugation of romance-language verbs.
In the picture, I was living in a bubble with my husband and four children. (Yes, even as a child I was obsessed with dystopias, which perhaps explains my profound love for the literary talents of Margaret Atwood.) And, because I developed a very detailed story around my life in the picture, I remember that I had projected that in the year 2010 I would be an ethnobotanist.
I was telling my husband about this in the supermarket just before New Year's Eve. He asked, "How were you studying the uses of the plants of other cultures if you were in a bubble?" I had to think about this, but I think I remember that other families lived in other bubbles and we could get from bubble to bubble in some sort of walkway system, which presumable led to places where people had not yet ruined the environment and had important things to teach us about the medicinal uses of plants. I'm not sure. But I am sure that my services as an ethnobotanist were in very high demand, VITAL to the health care of the dystopia of 2010. And that I projected that I would have four children of various ages well before this year.

But that's not what happened.

Instead, on December 23 of 2009, I learned that the embryo I was carrying had died in my uterus.



So we canceled our plans to go visit my in-laws, and scheduled a D &C for December 29.

This is what I wrote the day of my surgery:

Most of my dreams last night were about food, specifically not eating it.
In a few hours I go in for a D &C. That’s right, those of you who know what that means. I was pregnant, but now I am not. Since the day before Christmas, I have been in a between-place, where I know the embryo I am carrying is no longer alive, and I carry it around to church on Christmas Eve, to decorate the trees around my father’s grave, to the gym, and I wait for this day, when my dead embryo will be taken from my body to make room for someone new.

So, as usual with anesthesia, I cannot have anything to eat or drink today, and, as usual with my sub-conscious, I processed a variety of my anxieties in my dreams.

-I dreamt I was in an Italian restaurant and ordered a beautiful plate of pasta, a delicious salad with balsamic vinaigrette, and when it arrived, I remembered I was having surgery and had to apologize to the chef and leave the restaurant.

-I dreamt I was in a car being driven by a friend who has just had her second child. My husband was sitting next to me in the front seat and there were three or four people in the back seat (No, I do not know what kind of car it was.) My friend announced that she was pregnant with her third child, and everyone in the car was looking at me to see how I would react, so I said, “Well, you should give that one to me to even things out. And everyone frowned and shook their heads. “It’s a joke,” I said. “I’m trying to make a joke.” And even my husband shook his head and said, “that is not appropriate” and that is when I knew I was dreaming.

-I dreamt I was walking through a stone courtyard filled with fine green grass. I was walking with my father. We were in a hurry to get somewhere, but since I realized I was dreaming, I stopped and turned to look at him. He was at a healthy weight, not emaciated as he was at the end. He was wearing a black and yellow plaid shirt, and a brown suede jacket over brown pants. And I wanted to look at him forever, to memorize every detail, but I realized I was dreaming and might not have this chance again, so I hugged him tight and I said, “Daddy, I love you so much. I’m going to miss you so much when you are gone.” And he said, “There will be plenty of time. We don’t have to talk about this now.” But I knew we didn’t have time, that we would never take the time, that we would run out of time. And then I woke up, and there were tears on my face, but those moments with the dream of my father were the best Christmas present I received.


Me the in Year 2010.
No baby, no ethnobotany. And a great deal of grieving still to do.