Living Childfree

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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.