Adventures in Fertility and Mortality

Living Childfree

2011-10-22T12:01:00.000-07:00

Another interesting essay in the New York Times Motherlode section, this one on life after choosing to stop infertility treatments. "Every woman facing infertility has to decide when she’s had enough, when she has reached her ethical, emotional, and/or financial edge."

I am very happy with my decision to continue fertility treatments through three round of IVF and genetic testing, but I can totally see how liberating it could be to make the decision to stop.

The article also explores the minefield entered by asking "why don't you just adopt." I was impressed by the author's bravery in articulating, among other things, her ambivalence toward parenthood in the wake of failed infertility treatments.

The image at right is a still from the movie Julie and Julia. It is not from the moment described in the introduction to the essay, in which Julia feels the pain of infertility, but from another, happier moment in her marriage.

Resolve Needs Your Name

2011-10-09T11:59:00.000-07:00

RESOLVE has prepared a letter requesting that infertility treatment be considered an essential health benefit which will be sent to Secretary Sebelius on November 1.

Consider signing this petition.
Note: The Essentials Health Benefits are not an insurance mandate and will not force employers to include infertility in their existing coverage. But this is a vital first step to ensuring that infertility treatment be covered by health insurance for everyone.

Fertility Reading

2011-09-26T11:56:00.000-07:00

When I was still trying to get pregnant, a close friend had success with her own fertility treatment and tried to explain why she still knew what I was going through even though she now had a baby of her own. "Once infertile, always infertile," she said.

I wasn't sure what she meant, but now, even though I have a baby who requires a great deal of attention, I still read all the articles about infertility I see, and I still check on my favorite fertility message board at Resolve and answer questions about the treatments that helped me.

So, here are some article that have caught my eye of late, an article in Self about fertility over 40, the article in the New York Times to which it refers, and piece from NPR about the risks of having twins.

Healthy, Hungry Baby

2011-07-21T12:52:00.001-07:00

On June 14, 2011, I delivered a healthy baby via c-section. The past 5 weeks have flown by, largely because the baby is hungry every 2 or 3 hours and this means we are all sleep-deprived.

I am so grateful for all the doctors (and therapists!) who have helped me get to motherhood. This includes all of my friends and readers who have acted as supplemental therapists over the years.

I may post again soon, and I apologize in advance for the probable incoherence of all future, sleep-deprived communications.

Due Date, Revised

2011-06-13T21:19:00.001-07:00

C-secton tomorrow at this lovely hospital.

For those who are interested in the nitty-gritty medical details, my Bishop Score was a 3 or 4, so we decided against trying an induction with a low chance of success.

Send healing thoughts and prayers!!

Due Date

2011-06-13T00:20:00.000-07:00

Saturday, June 11, was my baby's due date. If you know me, you will not be surprised to learn that my baby did not arrive on time.

From the beginning, my doctors have been clear that they do not want me to go too far past my due date because of the risk of stillbirth in women over 35. On Monday and Thursday I had special antepartum testing, including a non-stress test with a fetal monitor.

If I don't go into labor on my own, I'll need to decide between a c-section and an induction. There is something called a Bishop Score, which takes various factors like whether your cervix is effaced and dilated and how far your baby has descended into the birth canal, and predicts the likelihood of success of an induction. As of Thursday, my Bishop Score was low, meaning my cervix was closed up like a fortress, and the baby was way high up near my chest, so I elected to wait a few more days.

In the meantime, I must count fetal movement twice a day. If I have 10 movements in an hour, then everything is okay. Usually I get 10 movements in 10 minutes.

Today, though, my baby was lazy, or sleeping, and so it took more than an hour to get the 10 count. I worried about it and worried about it, and finally called the doctor, who said, "Come straight to the hospital. No goofing around!" I tried to remain calm. I did not want to panic my mother, or my dog, or my husband.

Once there, I did another non-stress test and the nurse said everything was absolutely fine, at which point I began to cry.

We see the doctor again on Monday.

PETA Celebrates Infertility

2011-04-01T10:38:00.000-07:00

No, I am not kidding. PETA has launched a contest to "celebrate, not lament" National Infertility Awareness Week.

From the press release--
"One lucky man who has his dog or cat neutered between March 28 and April 27 will be reimbursed up to $500 for his own vasectomy.

"The human population explosion is draining water and land resources and causing huge pollution problems," says PETA President Ingrid E. Newkirk, who was "snipped" years ago and highly recommends it. "Volunteering not to add to the crisis for man or dog helps future generations to avoid scrambling to survive, and spaying and neutering can spare millions of dogs and cats from homelessness."

You can read the press release here, and the details of the contest here.

I'm not sure where to begin. It must have been nice for Ms. Newkirk to have the choice to "volunteer" to be "snipped." I just hope that she doesn't think that celebrating a disease that takes away a woman's ability to choose whether or not to be a biological parents makes her a feminist.

Girls on Film

2011-03-28T21:52:00.000-07:00

At long last, a photo of Nayla and Erin, on the occasion of Nayla's Baby Shower.
I don't get to see Erin very often, as we live in different states, so I was honored she was able to attend my baby shower on March 12.
For those of you who don't know, Erin is enjoying life with a baby girl, who was born this summer.

In the days before the shower, I was very worried about my emotional reaction to being around a group of women who were happy about my pregnancy. Not that I myself wasn't happy about it, just more that my post-traumatic fertility disorder might make me cry continuously or run out of the room.

But the shower was just perfect, just my mother, mother-in-law, and 8 of my close West Coast friends. I am lucky to have such great support and understanding.

The Road Not Taken

2011-01-01T10:28:00.001-08:00

Today I am 17 weeks pregnant. It is difficult to wrap my brain around that fact, even though I am definitely sporting a bump these days, and the ultrasounds all confirm that the bump contains a very wiggly baby.

During my previous 2 pregancies (or 2.1 pregnancies, if you count the chemical pregnancy of last winter) I practiced positive thinking. This did not get me anywhere, so this time around, I gave myself permission to keep thinking about Plan B. Plan B, as is in, what will I do if this pregnancy does not result in a baby?

DH and I have talked all along about adoption, and about gestational carriers, and even, briefly about egg donors, after a particularly bleak consultation with a doctor in Portland.

We didn't get very far in our discussion about egg donors, but I have kept up in my reading about them, because I understand what it is like for anyone for whom living child-free is not an option. As for gestational carriers, we talked a lot about them. DH was nervous about the whole thing, but I had lost such confidence in my body, that I felt like literally anyone off the street could do a better job of gestation than I could.

Meet the Twiblings is a great article in the New York Times Magazine about one couple's journey to parenthood by using one egg donor and two gestational carriers. I love many things about this article, but today I will share one passage that really struck me about how one might choose a genetic stand-in:

I decided the Fairy Goddonor was the person I would have been had our family stayed in Los Angeles; had my hair stayed blond; had I grown up as a sunny outdoorsy California person instead of a brooding indoorsy East Coast person. And if there are brooding genes I prefer they die with me. She was athletic and played tennis and surfed, as I imagined I would have done, and would still do if only I didn’t suffer from the chronic pain condition that I wouldn’t have if I were her — and wouldn’t then pass on to my children. There was an air of appealing gaiety about her. She seemed reasonably, but not excessively, introspective. She did not seem like someone who stayed up late every night writing in her diary for hours, as I did at her age.

Meanwhile, last night my husband brought home a bottle of sparkling cherry juice, and we wished our wiggling fetus a happy new year. Maybe, for us, positive thinking will make a return appearance. Plan B will still be out there; other people are working out the kinks.

Oranges are not the Only Fruit

2010-12-16T12:34:00.000-08:00

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.

On Death and Dying and Harry Potter

2010-10-04T10:30:00.001-07:00

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.

Bed Rest

2010-09-29T16:39:00.000-07:00

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.

Transfer Day

2010-09-27T06:40:00.000-07:00

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.

The Magic Number

2010-08-26T09:43:00.000-07:00

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.

A Hypothetical FET

2010-08-19T16:49:00.000-07:00

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.

The Idea of Eleven

2010-08-12T10:02:00.001-07:00

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.

Fertilization Report

2010-08-06T10:35:00.001-07:00

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.

Retrieval Day or 32 Eggs and Then Some

2010-08-05T18:22:00.000-07:00

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

Triggers and Bonus Medications

2010-08-04T20:22:00.000-07:00

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.

A Different Sort of Two Week Wait

2010-08-02T17:42:00.000-07:00

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.

Another Reason to Move to Chicago

2010-08-01T22:03:00.000-07:00

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

And Mortality

2010-07-30T09:23:00.000-07:00

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

2010-07-30T00:26:00.000-07:00

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

A Cautionary Tale

2010-07-29T22:15:00.000-07:00

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

A Little Something Extra

2010-07-28T21:52:00.000-07:00

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.

Like Soup

2010-07-25T09:45:00.000-07:00

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.

High Anxiety

2010-07-24T21:31:00.000-07:00

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!

2010-07-24T14:23:00.000-07:00

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.

What IF?

2010-07-22T10:54:00.000-07:00

Keiko Zoll won a Team Resolve award for this video:

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

Thirty Days of Lupron

2010-07-21T12:39:00.000-07:00

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!

The Sound of Silence

2010-07-19T12:49:00.000-07:00

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?

Lupron Left, Lupron Right

2010-07-14T10:14:00.000-07:00

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.

Desperation IVF

2010-07-09T10:42:00.000-07:00

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.

On Friendship

2010-07-05T15:00:00.000-07:00

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.

Nicest Rock Star Ever

2010-07-04T09:56:00.001-07:00

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?

Cribs vs. Beds: Parenthood's all-out war

2010-07-03T11:50:00.000-07:00

I am not a parent, but I found this hilarious.

Cribs vs. Beds: Parenthood's all-out war

Better Luck Next Time

2010-06-20T07:06:00.000-07:00

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.

Waiting for Aunt Flow, on steroids

2010-06-12T14:05:00.000-07:00

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.

The Birds and the Bees

2010-06-07T10:58:00.000-07:00

Check out this series of videos.

And So It Begins

2010-06-03T13:41:00.000-07:00

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.

Mars and Venus in the Office of the Genetic Counselor

2010-05-17T15:45:00.000-07:00

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

2010-05-17T15:37:00.000-07:00

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.

We now return to our regularly scheduled programming.

2010-05-13T16:57:00.000-07:00

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

Me in the Year 2010

2010-01-03T17:04:00.001-08:00

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.

what with leg waxing, migraines have to do, or how to consolidate pain

2009-12-10T11:35:00.000-08:00

So, a few weeks ago, Nayla asked me what I will do about my migraines if ever I am pregnant. Well, although I doubt I'm pregnant, there is going to be, at least until the big drugs and needles and pricy doctors are involved, that week before the most expensive five inch plastic stick to ever grace a drugstore shelf can tell me whether or not it's ok to take a Relpax. And because apparently I STILL haven't learned not to tempt fickle fate, I didn't plan ahead and therefore found myself with a minor migraine on Sunday night that by Tuesday night was a six flag ringer, complete with flashing lights and hours of vomiting and even a near constant right eye watering trick that has never happened before, but emerged with this migraine like one big unwelcome party trick. And I did not take my Relpax, surely the worst of the worst teratogonic drugs, right up there with thalidomide and DDT. (Just kidding. Actually Relpax is a pregnancy Class C drug, which means that nobody knows the effect on a developing fetus). But as anyone who has ever gone to Catholic School, much less sat through an embryology class knows, spinal cord and limb development happen in the precarious first few weeks, usually before the majority of the non fertility obsessed population becomes aware that they are pregnant.

Wednesday morning I broke down and called my neurologist. I was immediately transferred to "Jennifer," a nurse who is truly an angel. If I was the boss of the world, I would make every medical professional take lessons from her. I explained my situation and she offered to give me a blood HCG draw STAT. If that came back negative, I could take my Relpax with impunity. If it didn't, they would give me the regimen they usually prescribe to pregnant woman, which is Tylenol-3, Tylenol with codeine. Between two and four tablets, adjusted for height and weight. Safe during pregnancy? Perfectly, apparently. Actually I was going to wait out the results of the HCG test and then stick with the Relpax, but then I found out that the lab draw center, which sends samples out for analysis, considers STAT to be 4-5 hours. So I picked up the T3 prescription and drove to my office, where I sat through not one, not two, but four meetings. But that was perfectly fine. Because I work in a state building, the bar for general cognition is not set high.

And the verdict? A most effective pain killer. Next time, I'm going to multi task those pain killing properties and schedule a leg wax for the same day. If I can just get past my fear of phthalates in the wax.

Way #457 in which trying to get pregnant is going to be the death of me

2009-12-04T12:38:00.000-08:00

I am typing this while periodically checking the tip of my left index finger, which won’t stop bleeding in the way that skin sliced by glass often does not. All because this morning I tried to take my temperature, a project that involves keeping in one’s mouth- not a digital thermometer, the type sensible people use because otherwise it really sucks to bite down on one of the glass ones, an unfortunately likely scenario if you:

a. are preoccupied, because the key to an accurate basal body temperature reading is taking your temperature before doing anything- getting up, talking, cognition, and so

b. might be therefore prone to forget that you also have small protruding orthodontic attachments, which then cause you to bite down and shatter the stupid thing in your mouth.

As far as a way to start the morning goes, I can’t recommend it. I was taking my temperature in the first place because this is my first month off birth control, which means that I am morally obligated not to consume my usual pharmacological pharmacopoeia in the second half of my cycle. A precaution no doubt pointless, but I don’t tempt fate. There’s this great line in the memoir by Christopher Buckley, referring to his sick father’s medication schedule, and says something to the effect of “enough to give Hunter S. Thompson pause.”

Although certainly not the type to elicit his post mortem envy, consisting as my intake does of:

-Claritin (the real stuff, with pseudoephadrine and not that silly phenylephrine (sp). Here “sp” refers to spelling, and not some sort of fancy time-release capsule. I need somebody to please explain to me how it would be cost effective for the methamphetamine makers to buy Claritin at nearly $16 a box, distill the pseudoephadrine down, and then sell the final product as street crack for what, five bucks? It doesn’t make sense. Even if methamphetamine dealers aren’t the savviest group. Honestly, fellow allergy sufferers, I could take this straight to Capital Hill.

-Wellbutrin SR, which I weaned myself off a month ago but is nevertheless a dearly missed friend, and last but not least

-Relpax. Relpax is the only thing, short of a medically induced coma and general anesthesia, that touches my migraines.

And therein lies the necessity of knowing exactly where things stand, ovulation wise.

My husband considers the ability to tolerate otherwise easily medicated medical conditions to be a barometer for personal character. I disagree. I don’t abuse drugs and because I have severe control issues that require me to be aware of everything all the time, I never have. But I have no problem taking them when indicated, which leads to weird juxtapositions like being perfectly happy to gulp down an entire endoscope, yet taking a Xanex or three for certain pelvic procedures. Which, in my mind, is perfectly acceptable. Certainly I suffer from vestigial psychic heebe geebes regarding these procedures, and that’s for me to work out with my therapist if I so chose, not to be gotten through with a brand new OB/GYN resident and the dreaded tomcat catheter.

But at the moment, I was more concerned about my mouthful of broken glass. Luckily, I knew exactly what I needed to evaluate the pieces of glass, but unluckily, we don’t have any of those black velvet covered jeweler’s flats lying around the house.

Several things happened at once. I opened the door, and the cat (who waits at the door, no doubt certain of the eventual inevitability of a day like today) darted into the bedroom, a place where her presence is strictly forbidden. The dog barked wildly in his crate, my husband slammed the door to his study, and I stubbed my toe on corner of the bathroom sink, causing me to speak one or two words that I normally do not.

In the end, after a careful forensic reconstruction of the thermometer (Germar, Mercury Free, printed on the back, the mercury free substance being in any case encapsulated in a separate container within the thermometer), it appeared that what was missing amounted to glass dust, probably lost in the bed or in the exclamations that followed after I stubbed my toe. I did confirm that the broken shards were glass and not, in fact, safety plastic, if there is such a thing. I figured this out by jabbing my index finger with one, an act that was, I have to admit, not too clever.

But in any case, I don’t really know of anyone who has actually died from eating glass. Come to think of it, the only instance of death by glass eating I am familiar with occurred in a V.C. Andrews book. Nayla, please take note. If I do die and you decide to capitalize on that with a ghost ridden Coordination and Fertility Impaired Flowers in the Audi, please take note: I am a fourth generation Daughter of the American Revolution and lots of bad karmic legacy stuff already happened to my family. Please, please don’t lock us in any attics.

more on this later

2009-12-04T12:27:00.001-08:00

Star Trek and the Two Week Wait

2009-12-04T11:34:00.001-08:00

As some of you already know, I am a big fan of Star Trek. It was through an episode of the original Star Trek series entitled Mirror, Mirror that I first learned of the concept of an alternate reality. In the alternate reality of that episode, Spock had a goatee, and Lt. Uhura was dressed in a very slutty ensemble, and torture and assassination were legitimate means of career advancement.

You may be wondering what this has to do with my current situation.

Well, today I had the blood draw that determines whether I am pregnant. I will not be posting the results of this test on this blog for a while. So, for you dear reader, there will exist two realities, the one where I am not pregnant and am very sad, and the one where I am pregnant, and am not sad, but worried about miscarrying, as happened last time.

A few days ago, my mother asked me whether I felt the same as the last time I was waiting to find out whether I was pregnant, and I had to remind her that the last time I was waiting to find out whether I was pregnant, my father got his terminal diagnosis. Maybe that is why I feel a little sad, a little angry, and a little tired, all at once. It has been a difficult nine months since that time.

So for now, I offer you the two realities. And if it amuses you to picture me pregnant, and in a slutty Star Trek uniform, so be it.

The Christmas Spirit Will Not Be Taking Calls This Afternoon

2009-12-01T05:12:00.000-08:00

The Christmas Spirit Will Not Be Taking Calls This Afternoon

After a day of firing off emails to my sister (first empathetic and gentle, later accusatory and cheapshotish, a word that I really would like to see translated into German or some other sturdy case language), I received confirmation that the rumor I heard from my mother was true- “K” is not coming home for Christmas. I wasn’t surprised but I wasn’t happy, either. Christmas, in our family, has not been a particularly life affirming holiday for the past several years, and last year was downright miserable. But this year my mother has already volunteered to work at the hospital on Christmas day, and my husband and I just spent Thanksgiving in a restaurant, and I don’t care how nice the restaurant or how well executed the menu, there are only a few good reasons to eat out on Thanksgiving and Christmas. Personally, I think that trusting oneself around people not immediate family is one of them, but I do now get why at the Grateful Dead shows there was always an area cordoned off for the “sober” people. Sometimes it helps to be with people in the same situation. In my situation, that would mean a table full of seemingly normal individuals who at any given moment break out into tears and scratch their faces. Clearly it is too early in the morning for me to be writing this.

But my sister has a medium good reason for not flying from Chicago to California, and then back again, and that reason is that she is leaving on December 27th to go to Mexico City. For…vacation? I’ve been told that it’s tacky and disrespectful to joke about the illegal organ traffic of other cities and so I’m not going to do that anymore. This trip follows on the heels of her recent fall “bicycle tour” of Detroit and nascent interest in outsider art, and I have to wonder what might be next. Birdwatching in the DRC? I attribute some of this to the fact that our father was a bit overprotective, when it came to physical security, but I keep telling her that there has to be a happy medium, and because I am seven years older and she doesn’t have to listen to me, well, she doesn’t.

In other news, the annual state employee office nativity scene reenactment is under way.

way #456 in which It Could Always Be Worse

2009-11-29T08:50:00.000-08:00

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

2009-11-25T17:56:00.000-08:00

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

2009-11-25T14:03:00.000-08:00

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?

2009-11-23T12:48:00.000-08:00

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

2009-11-22T09:56:00.000-08:00

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...

2009-11-21T19:10:00.000-08:00

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

2009-11-20T20:11:00.000-08:00

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

2009-11-20T10:59:00.000-08:00

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...

2009-11-18T16:28:00.000-08:00

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

2009-11-17T23:08:00.000-08:00

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

2009-11-16T14:39:00.000-08:00

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

2009-11-14T14:46:00.000-08:00

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

2009-11-10T21:18:00.000-08:00

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

2009-11-10T14:07:00.000-08:00

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

2009-11-09T20:25:00.000-08:00

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

2009-11-09T11:10:00.000-08:00

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

2009-11-08T23:11:00.000-08:00

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

2009-11-08T08:18:00.000-08:00

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

2009-11-06T14:23:00.000-08:00

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

2009-11-05T08:03:00.000-08:00

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.

The Bitch is Back

2009-10-31T18:48:00.000-07:00

I remember hitting puberty early, hitting it like a great brick wall of rage. My mother could offer me a cracker, and I would retaliate like she was hiding WMDs.
And here I am, back in a tsunami of hormones, and my mother and I are living in the same house again. And I have one piece of advice. Learn, if you please, from my poorly-behaved example:

Do not start Lupron and then have your mother move in with you the next week. It will not be good for your relationship.

death and the goldfish

2009-10-31T15:13:00.000-07:00

I’ve been thinking a lot about something Nayla said in an earlier post, about how she isn’t sure whether it’s grief or Lupron that has caused her to forget how to open her front door. This is a completely bizarre time in life, and I wonder how uncommon it is. The mid to late thirties are, I guess, considered to be at end of the childbearing spectrum, but certainly still in the range of childbearing years. And most women will not experience infertility, per se, and in population groups where women have many children, childbearing is normal even into early forties (google search: Mennonite, childbearing). I suppose the difference here is that those women often already have several children, so are not dealing with the possibility of having no children, of never having children, at the same time they are dealing with ill or dying parents. Maybe it’s a little like ear piercing for children- everyone prefers to do both ears at the same time, so nobody has second thoughts halfway through. If I hadn’t already decided to have children before my father got sick, I don’t know that I would have the resolve to go through fertility treatment at this point in the game, not when I’ve seen what can happen, so to speak. Which is also bizarre, because it’s not as if I’m a four year old who doesn’t understand about death and what happened to the family hamster.

A bird in the hand is worth two in the bush

2009-10-30T10:45:00.000-07:00

aka

A living dog is better than a dead lion, Ecclesiastes IX

Yesterday, my small bichon frise found a (considerably smaller) bird on our front porch, in the same area where several other small birds have landed after flinging their small bodies against the unshuttered window on the back door. I would’ve liked to have taken a picture of Henri lightly prodding the little thing. It was sort of like something out of a Walt Disney movie, but it probably could have gone Tarantino pretty quickly. Luckily, disaster was averted and the bird, able to hop and flap his wings, but doing something with his head that was concerning way probably had some sort of head injury. You could almost see the little Tom and Jerry cartoon concussion stars. And luckily, bless their 501C3 tax status, Wildcare was accepting small patients that day.

Ok, I’m not the sort of person who would wrestle a bird, even a lovely little songbird, from the paws of a coyote. Nature is, after all, nature, and she must do things for her own reasons, or however Faulkner put it, but this wasn’t an act of nature. This was an act of my stupid plate glass window, one that isn’t clean enough for my neighbor’s aesthetic but apparently not dirty enough to prevent small winged animals from smashing into it. A plate glass window is the natural predator of absolutely nobody.

We didn't name the bird. I have no idea what type it was, a sparrow or a songbird or a waxwing. It was a brown bird. There are no ornithologists in my house.

And I guess today I’m overly sensitive, especially towards small and probably dying things. At the risk of disillusioning the many medical insurance companies no doubt clamoring to insure me, I’m going to come out and say what my friends, family, postal service carrier, and Primary and Secondary insurers already know: over the past few months, I have taken anti depressant medication, and today
is my eleventh day of not taking Wellbutrin, prescribed for depression, what with all the infertility and dying over the past two years. Obviously, nobody should put that sort of information on the world wide web. Although, I’m certainly not alone- a pretty non trivial percentage of my demographic will utilize some sort of psychiatric medication intervention. And in my case, while the collective benefits of 300 mg. of Wellbutrin outweighed the side effects, the withdrawal period has sort of thrown me for a loop, or at least that’s the best way I can describe what seems to be going on in my head, the sense of balance turned around and around in a spherical spiral pattern. My equilibrium normalizes and then just as quickly falls away; so far today I have walked head-on into a concrete pole and missed two porch steps. The ability to focus is there, and then it is not. I have two small patches of neuralgia, one on my lower rib cage and one in the exact middle of my spine, and even the brush of my cotton shirt is painful. But mostly I'm more emotional than usual - not on the level of crying while line at Rite Aid, or pulling out old photo albums, but I’m doing what I can to avoid the evening news and have definitely put aside The Lost Dog, None of this is to say that the withdrawals detract from the collective benefit of taking the drug, and no way would I have wanted to go through Wellbutrin withdrawals while dealing with chemically induced menopause, no thank you, psychotropic medication withdrawal and Lupron are, in the parlance of pharmacologic epicure, lattes and pinot noir and altogether bad news in the same sitting.

Now, this was the right decision for me (and, presumably, for the recipients of the 118 million antidepressant prescriptions given to Americans in 2005). It was also my personal decision to avoid getting pregnant while taking that drug. And I’d like to say right here that plenty of women make different decisions, who do take MAOIs and SSRIs while pregnant, and the literature is not conclusive on this. My own psychiatrist believes that outside of the precious first trimester organ formation period there is negligible harm done with certain anti depressants. Although this recent Medscape article sort of disputes that. I’m not saying that another person couldn’t have gotten through a similar experience with prayer, or yoga, or meditation, dowsing, interpretive dance, whatever. I won’t interrogate the subject further.

Instead, I'll settle for being the living dog.

Addendum: the intake worker at San Rafael's Wildcare reports that the small brown bird of the morning is a Thrush

Yet Another Reason to Eat Candy Corn

2009-10-29T22:59:00.000-07:00

I was so pleased to see Erin's post about National Candy Corn Day just after I received a package full of fancy Halloween candy from my in-laws. I think this series of events sparked my epiphany about why my shots have been more painful this time around--I am too skinny.

I am not bragging about my current weight. The last time I started fertility treatments, I felt stronger and healthier. My posture was better. I was also several pounds healthier. I started losing those pounds during my three days in the hospital during my miscarriage, when the doctor kept me on a regimen of morphine and ice chips because of the possibility of emergency surgery. After I left the hospital, I did not exactly maintain an appetite while watching my father vomit from chemotherapy and waste away. And finally, for the last ten days of my father's life, my mother stayed in his room with him around the clock, relying on the kindness of strangers (and friends) to bring us a meal or two a day.

(Note that I do not recommend this as a weight loss strategy.)

I am not the healthy, strong, toned person I was before I started fertility treatments the last time around. And most importantly, I do not have the same amount of belly fat.

So when you give yourself the subcutaneous injections, what you are doing is pinching the skin and fat of your belly (avoiding a two inch radius from your belly button). Today, I finally realized that I just don't have as much to pinch, and that is making the process more painful. So I will now feel free to eat a little candy corn on Halloween, in the hope that by the time I am up to three shots a day I will have gained a little more belly fat without increasing my risk of gestational diabetes.

October 30 is National Candy Corn Day

2009-10-29T11:45:00.000-07:00

No, really, it is.

Partly because Nayla started this with her previous alliteration, and partly because I just like the sound of the word, "twinning," (a nice combinating of turning and swimming, sort of uterine verbs), and I'm sure not in small part because the RE keeps quoting at me the new and fantastic success rates for single embryo implantation (with is at least one embryo too few, by my faithless standards), I've spent the morning reading this site, derived from this study

which posits that environmental factors might actually influence twinning rates.

No, by environmental factors, the study does not mean daily injections of gonadotropins.
I think this is an interesting reversal of those studies that use twins, who have the same genetic makeup, to measure the degree of influnces of an environmental factor.

And then in other news, my next internet search will involve the impact of vast amounts of Brach's mellowcremes on luteal cycle length. Corpus luteum is Latin for yellow body, which is accurate for cows, but not for human women, in whom the corpus luteum is actually orange.

the follistim pen and the feline

2009-10-28T16:33:00.000-07:00

Follistim: the interpretive ballet

The Big Box of Needles and Drugs

2009-10-28T12:57:00.000-07:00

The Big Box of Needles and Drugs arrived today. I cleared out a drawer in the refrigerator so the drugs would not get mixed up with the arugula and the milk.
Here is what is in the box:
Follistim
HCG
Repronex
About a million needles and syringes
Packages of individually wrapped alcohol swabs.
One container of very large capsules of antibiotics.
One container for disposing of needles and syringes.

I called American Express to confirm that they had accepted the charges for the doctor (nearly $9,000) and the latest shipment of medications (over $3000).

I do not want to swallow those pills. I do not want to give myself those injections. The puppy, barometer of my emotions, has retreated to his crate.
But, for the chance of having a baby before I am 38 years old, I will do it. I am committed.

Puppy Therapy

2009-10-27T22:58:00.001-07:00

This afternoon, I was standing in front of our house, and I suddenly forgot which key opened the front door.
I kept trying the purple key, and finally my husband took out his keys and opened the door. And I said, "But I use that key every day!" And my husband had to take my keys and show me that it was the yellow key and not the purple key that opened the door. And then I suddenly remembered that in fact, I use the yellow key every day, and every day, it unlocks the door.

To what do I attribute this? I looked up the potential side effects of Lupron, and memory loss is not among them. Is it the grief? Is it fatigue? Is it a side effect of the persistent headache that is a side effect of Lupron? Is it the fact that last night's Lupron shot, which previously seemed fairly painless, was painful, even with use of my trusty icepack? Or is it the fact that today, I read a chapter of a friend's novel-in-progress that was all about the painful death of a parent from cancer and I spent the day having flashbacks of my father's last days?

But there is a great treatment for all of this sadness and discomfort and awkward, splayed hope.

There is a puppy.

We adopted him from a shelter a few hours away just before the first appointment with the only fertility specialist in town, after a really terrible few days of feeling sorry for myself. The puppy displays the typical exceptional cuteness of his kind, even while doing mundane things like sitting on a bookshelf or chasing a ball. This kind of entertainment is enough for the usual level of stress and sadness.

But for my case, I have self-prescribed a special kind of therapy. I give this puppy an ice cube, and hilarity ensues.

fertility work-up: the second time is twice as nice!

2009-10-27T10:30:00.000-07:00

Nearly three years have passed since I last went through a fertility workup, and I am due for a repeat. The standard workup consists of a battery of tests. All things being equal, in terms of number of tests, simple blood analysis make up the majority. I couldn't give you an exact number, but I have learned that it's best not to count the number of vial labels that the lab tech exchanges for the lab requisition slip (one label per tube, at least three tubes per work up). Also-note that the pre test instructions are not theoretical. During my first work up, in my mid twenties, I made the mistake of having an FSH analysis (I think it was an FSH analysis, anyway) shortly after taking a dose of Clomid. I wouldn't recommend that particular course of action unless you are the bizarre sort of comedian who wants your ob/gyn to think you are a candidate for premature ovarian failure.

Certain other tests, including follicle counts with the craftily designed transvaginal ultrasound, (in the interest of not getting booted off Blogger, I’m not going to include a link) do not exactly rank high on the fun list, but can be gotten through. Others, such as the HSG, are rather unforgettable and I will in no uncertain terms drink bleach if I am made to repeat that particular test again. I will say, with regard to the HSG, that I object to the idea far more than the actual procedure, which was uncomfortable but not painful. Luckily, the only tests I need to repeat are the labs and the follicle count.

Because no test has ever indicated a definitive cause of infertility, there's not a good reason for me to worry about the results, which doesn’t mean that there aren't plenty of other shoddily constructed and weakly articulated reasons. I'm one of those people who subscribes to the idea that if you don't believe in the principle of induction, (not to be confused with a similarly named step in the IVF procedure) the principle of induction doesn't apply to you, much like ghosts for children or hell for athiests. I am absolutely aware that people who go around verbally articulating these things are irritating to be around, but by God, I've earned it, what with the rare cancer lottery and all. So just because a test has come back normal five out of five times, doesn't mean that, say, the sixth time, it's not going to indicate that I am not only in full-blown premature menaupause, but have contracted liver flukes and will any day now express a latent gene for supernumary teeth, because I've always had sort of questionable orthodontia.

All this is to say that I’m not having the tests re run until my next appointment with the endocrinologist, which will be in approximately 33 days +/-.

Long Long Lupron

2009-10-25T22:12:00.000-07:00

And now a bit of the practical. I have started the Long Lupron IVF protocol.

For most people, this protocol begins with going on birth control pills, and I had already started to take them after a surgery I had to remove uterine fibroids in August. (The fancy name is a laparoscopic myomectomy.)

I have recently moved to a small town in Oregon, and there is only one fertility doctor in town. He uses the birth control pill and and an injectable called Lupron to get everyone in the current protocol on the same calendar. This allows him to organize his time so he can do all the egg retrievals and embryos transfers in the same week, which apparently leads to better results.

If you don't count the time on birth control, I am on day three of my protocol. If you want to know the nitty gritty of the process, here's my current nightly fertility regimen:

The birth control pill
A prenatal vitamin
A baby aspirin (the purpose of which is, I think, to increase blood flow to my ovaries.)
10 units of Lupron in shot form (with a needle, not a glass.)

The idea is that this use of Lupron puts you into chemical menopause for two weeks before you start the other shots, the ones that stimulate the growth of the follicles that produce the eggs. Erin, are these the right verbs to use?

Chemical Menopause: "Egads," you exclaim. "The whole point of this is to beat menopause! To outsmart my infernal biological clock!" You might be agitated, and cranky, and you have not even started the Lupron yet. Well, I will share that so far, chemical menopause has not been as terrible as I feared. I don't know about you, but I mostly associate menopause with hot flashes. What I have had is more akin to the feeling you might get from a warm brandy. This is not a problem right now, as I am adjusting to a cooler, rainier climate here in Oregon and have not had alcohol since the day my father died. (One token glass of white wine with my mother at a restaurant, when she couldn't bear to head home to an empty house.) But the warm brandy flush might be alarming if you were not expecting it, or if you were giving yourself Lupron shots in Texas in August. The only other symptom I have so far, which has little to do with the weather, is a headache. Not a migraine, not a sinus headache, nothing too out of the ordinary. Just another hormonal headaches like all of the other hormonal headaches I have had in life. Irritating and persistent, but manageable. I have not had the crazy mood swings or nausea, or any of the highly unpleasant symptoms other women have reported on other blogs. But there is still time!

After all, it must be called the long Lupron protocol for some reason other than the charms of alliteration...

Will Someone Die Every Time I do IVF?

2009-10-25T12:48:00.001-07:00

As you may recall, my father was diagnosed with stage 4 pancreatic cancer just after I went through my embryo transfer for IVF. And, as I started this process again, and tried to articulate the particular strands of trepidation I was feeling, the thing I was not telling people was that I was wondering whether someone would die every time I did IVF. To be clear, even though I am an only child, I don't really believe that everything in the world revolves around me. But I know about the circle of life, both from the Lion King and from that movie where death takes a holiday, and I know that usually, someone, somewhere is leaving this mortal plane when someone else is arriving via birth. Really, God, I get it. It does not have to be illustrated for me with such a direct connection as it was in the spring.

But apparently God, or the Powers that Be, or the Great Narrative Arc of my life feels otherwise.

Because I started my Lupron shots on Friday night, and today I have learned that another loved one is dying of cancer in the very near future.

Last Thanksgiving, while my parents were visiting us in California, we found out that a close friend of theirs, Virginia, was diagnosed with lymphoma. She had started treatment, but, with a variety of pre-existing conditions (including congestive heart failure), no one thought she had long to live. When I started IVF and my father was diagnosed, my mother and I were really not able to call or help or even really think about Virginia's condition. Luckily, she has a nephew who really stepped in. While my father was on life support and in his final days, the nephew moved Virginia to an assisted living facility near his house.

Now, Virginia has not had an easy life. Her first husband was a fighter pilot, and was MIA in Vietnam. She remarried a squadron-mate of his, and they had a son. When their son was 8, he was killed by a drunk driver on the sidewalk in front of their house. We met them a few years after this, and Virginia and her husband Bob took an instant liking to me. They took trips with us, to Hawaii, and the Caribbean and France. They wrote cards and called and spent holiday after holiday with us. And then, in 1991, when I was caught up in the whirlwind of college, Bob died of cancer. Virginia was alone. She did not have any siblings. She had lost both of her parents. Really, her nephew was her only relative. And we were the next closest thing.

A week after my father's funeral, I drove my mother down to see her. We had a terrible dinner in her assisted living facility, but she was happy to see us. She complained about her room; she complained about the food; she complained about how old and boring and lifeless her new house-mates were. Honestly, she didn't even seem sick anymore. She sent us out to buy some bottle of wine and some Doritos. And then my mother and I drove back up to my mother's house to continue the strangely sad and technical work of executing my father's estate, writing a new will for my mother, and preparing for the other major life transitions I was about to go through (including a surgery and a move to a different state.)

And now, just as I've started the long Lupron protocol for IVF, Virginia has moved to a hospice. There is a tumor in her spine and possibly one in her brain. She told her nephew that she is not afraid of dying, she is only afraid of dying alone. And he has promised her that he will be there for her.

And I will continue my protocol. I will not make plans to fly across country to see her, because, as my Reproductive Endocrinologist reminded me, I am not as young as I was six months ago.

And if Virginia does die alone, I will always feel I have failed her.

Nayla, by way of introduction

2009-10-25T12:28:00.000-07:00

Nayla is a rare sort of person, clever and beautiful and uber articulate. I remember reading her fiction writing (even when my head was full of Clomid, a feeling not dissimilar from the one you get after eating confectioner’s sugar straight from the box) and being enthralled by it. These were during the days when a single digit countdown to atomic war could have put me to sleep.

Still, Nayla and I should probably not be friends. For the past two years, we have shared the same misfortune, one after the other, from fertility treatments to fathers with similar cancers. We've even had the same weird and complicated miscarriage. I mean, honestly. If I happen to get a rash on my face, or she hits a deer with her car, under no circumstances should either one of us share that information with the other, because the next week we are likely to find ourselves exchanging auto repair resources or the best type of antihistamine. It’s true that she’s lovely and charming and one of the most intelligent people you’ll probably ever meet, one of those people so clever and beautiful that you really don’t expect for them to be a nice person, in addition to everything else, but for the past two years, eerily similar crummy luck and statistically improbable travails have followed us. For that reason, and because she’s a more proactive person and certainly a stronger person, and going through active treatment right now, I expect her to change our luck substantially. No pressure, Nayla.

I’ve never met either one of Nayla’s parents, but she has a sort of generosity about her that you either have or you do not. My husband, who is French, translates that attribute “to be educated correctly,” and what he means by this is to be educated about the general way to go through life, how to look at people with kindness, and to remain gentle in the face of obstacles. I bet Nayla would tell you where she gets that from, and I’d agree with her, which I suppose touches on what we are trying to get at in these entries.

So while we’ve shared some past experiences I believe we both could have lived without, I’m grateful to be going through this particular one with her.

when you hear hoof beats

2009-10-25T12:21:00.000-07:00

Don’t look for zebras. Unexplained fertility is a misnomer. It is a transitory point in time that comes after the failure of fertility treatments based on the educated guess of the moment. It’s the fall back when the injections, hormone replacement, hormone suppressant, radioactive dye insertion, catheter procedures and prodding and altogether too much poking around, fail. Sometimes there is a post treatment regroup, and it comes after this too, after you’ve tried the acupuncture needles, the boiled seed pods and east Asian herbs and possibly, if you haven’t disclosed your vegetarian status, gecko. It comes after you, a lifelong agnostic, have visualized your uterus to be a metaphysical white glowing nest of life, after you have publicly banned your husband from the spinning bikes at the gym, after you’ve taken the drain from the bath and placed it in the linen drawer, where it can’t be used to take hot water baths, that mortal enemy of male fertility. Behind every unexplained fertility diagnosis are the best guesses of the OB/GYN, endocrinologist, andrologist, urologist, mother, mother in law, inquiring neighbor, well-meaning friend. Unexplained fertility exists to prove Hickam’s dictum. And now, I can bid that diagnosis goodbye, good riddance, certainly a well-earned good luck, because a little over a month ago, I turned thirty-five, which puts me unambiguously in the infertility category of “advanced maternal age.”

How do you like them horses?

Infertility hasn’t consumed my life. In 2006, just as I was in the middle of a series of IUIs, my father, then sixty, who was probably my closest friend in the world, was diagnosed with adenocarcinoma of the ampulla of Vater. This is a bad cancer, a rare cancer, so rare that there is no real treatment protocol, a bona fide fascinoma. The current course of treatment for ampullary cancer follows the one used for pancreatic cancer. After a few months of the roller coaster that Nayla referred to earlier, my husband and I decided to delay our fertility treatments. And why not, after all? I had plenty of time. We adopted a shelter cat named Lola, and two years passed.

In the summer of 2008, three weeks before my appointment to resume fertility treatment at a large medical center in the neighboring county, my mother asked if I wouldn’t mind taking my sister to the airport. Our mother had a medical appointment that day, and might not be feeling so well after. My mother, a non-smoking, non-drinking, near vegan, has never been less healthy than a horse (that mythical creature) so I didn’t think too much about it. One week and a few days later, she was diagnosed with second to third stage squamous cell esophageal cancer, a rare cancer seen most often in heavy drinkers and smokers.

I am a congenitally pessimistic person. I’ve never quite been able to convince myself that lilies will bloom at room temperature, so I either buy them past the bud stage, or worry the petals until they turn a filthy brown and then lop over. Even so, I did not see this coming.

During the next eight months, my mother went through chemotherapy, radiation, and a certain surgical procedure colloquially referred to as “the mother of all surgeries,” while my fathers’ health declined precipitously, as the cancer metastized to his spine and meningeal layer. One morning in December, as I sat in traffic on Highway 101, my mother, in the passenger seat, vomited into the small plastic container that now followed her everywhere. I dialed AT&T directory assistance, and asked them to patch me through to the local hospice agency. That morning, on the two-hour drive to my mother’s chemotherapy appointment, I arranged for in home hospice.

Outside of the bay window of my parent’s house, there is a hummingbird feeder that has created a generational welfare state among the birds of our street. It’s a lovely thing to see in summer, above the green lawn, the American Beauties and the plum tree, but in winter we let the lawn go fallow, and bright red plastic of the feeder is something garish against the brown grass and bare thorns. Still though, I believe that the easy availability of sugar water has offset normal avian reproductive constraints, because hummingbirds visit the feeder year round, or at least they did that winter, when I spent plenty of time staring out the bay window, at the hummingbirds on the other side of the glass, the dead lawn and the desiccated rose hedge, the county road that is never quite maintained and the field beyond that, the jackrabbits and the pheasants and even, like an awkwardly timed joke, the Appaloosa horses kept by our neighbor. After my mother and I returned from chemotherapy that day, we moved a hospital bed into the living room, moved my father to the bed, and that is where he died six weeks later.

There are two separate ways through which I measure time; the first is the thirty-five year mark, an alarmingly red chronological demarcation line that increases medical costs at the fertility clinic and decreases odds of conception. The second is in the passing of time since last winter, in they way I’m never quite sure what month it is, whether I should look for potholes in the road, or replace the air conditioner filters. In sense, I’ve not moved past last January, while my body, consistently uncooperative, has moved on into another, more precarious phase. So it is with some misgivings that I am going to be starting fertility treatments. Some. But less than I would have had, had I not met Nayla.

I’m sorry, how rude. Let me provide an introduction:

Comrades in ART(s)

2009-10-24T22:00:00.000-07:00

Two years ago, I started trying to get pregnant. And then, because I was 35, about six months later, I started fertility treatments. In January, I amped up the intensity of that project by starting an IVF cycle. This is an intense thing, with lots of shots and appointments and nausea, and maybe that’s why I was able to ignore the frequency with which my mother was taking my father to doctors to address his fatigue. Maybe.

In March, the doctor retrieved a bunch of eggs, and my husband made his contribution, and then, like magic, there were these embryos sitting in a cryopreservation facility in San Jose California. My parents were thrilled. They talked about their hypothetical grandchildren as long as I can remember. Three days after the creation of these embryos, I went back down to San Jose and the doctor transferred two of them back into my uterus. A week later, while waiting to find out whether I was pregnant, my parents told me that my father had stage-four pancreatic cancer. He had between six and nine months to live. I was devastated. I was also, unbelievably, pregnant. Nine months, I thought. Nine months for my father to live. Nine months of gestation for his grandchild. Could I beat that deadline?

I spent the next few months in Florida with my parents. I went with them to the doctor appointments. I went with them to chemo. And one day, I drove myself to the emergency room and found out I was probably having a miscarriage. I went into the hospital for three days, because it was not a normal, routine miscarriage. And then the normal terrible series of events of cancer unfolded. My father died on May 31. I did not beat the deadline. I did not give my father the grandchild he had talked about all of my life.

And now I have started round two of IVF. Is it a sad, tragic time? Is it a hopeful adventure? I have no idea. What I do know is that in the books and blogs on fertility, they like to talk about a Fertility Journey, which makes it sound a lot more like a Carnival Cruise than the malarial jungle trek that it has been for me. Which bring me to the top three reasons for writing this blog, right here, right now, with Erin:

I am a Compulsive Information Gatherer: When I started IVF the first time, I went on Amazon and purchased a whole bunch of books. I did random internet searches, and scared the estrogen out of myself with those. I kept hoping to find the source that would tell me exactly how to give myself the shots, exactly what they would feel like, exactly when it was okay to feel hopeful, and exactly when it was okay to be annoyed that I have to go through all of this crap. I read all the books, and they gave some modicum of information about the process, but Erin was really my go-to person. As a bonus to her natural intelligence and writing skills and her personal experience with fertility treatments, she also has a medical background, so she actually knows how things work.
Erin is Entertaining: I find conversations with Erin to be endlessly witty, informative, and fascinating. Other people should have the opportunity to be entertained by her posts. Especially women going through IVF, who need all the entertainment and understanding they can get. And especially, especially women who are going through IVF after the recent loss of a parents, because, well, life just kind of sucks for them in a very particular way.
Comrades in ART(s): When my father was dying of cancer, I started to get the feeling that I didn’t want to be around people who hadn’t gone through a tragedy. Not that that there weren’t lovely, empathetic people who supported me through my first round of IVF and then through my miscarriage, and then again through my father’s hospitalizations and death. I was blessed with an amazing set of friends all through all of that. It’s just that the people who had lost a loved one, they really knew. It made me understand why people who go through war together have such a bond, because no matter how empathetic or well-read or a good listener, no one else really understands. And to add to that the Big Crazy that can be a result of Assisted Reproductive Technologies like IVF, well, it makes Erin my comrade in Assisted Reproductive Technology and Grief, it puts me in her elite Special Forces Unit of Fertility and Mortality.