A Ferris Wheel

From: http://www.tumblr.com/tagged/devil%20in%20the%20white%20city?before=17

Recently I read: The Devil in the White City: Murder, Magic, and Madness at the Fair that Changed America, an intriguing, historical novel about the World's Fair in Chicago in 1893. While I will spare you even a brief review (ok fine, for the most part I liked it - there are you happy?), I was fascinated to get the history behind the wonderous Ferris Wheel - a staple to every decent fair I have ever known. In this well researched story, the Ferris Wheel, though only briefly mentioned, so perfectly captures the feelings that I am going through right now. From the build up of delays and potential problems to the exhilarating ride to horrible possibilities of things that can (and do) go wrong to the remorsefulness that comes with loss and success.

Similarly,
I'm nervous.
And excited.
And scared.
And guilt-ridden.

Who knew that after getting our initial hCG values (and good ones at that), that I'd still feel like a bundle of nerves? In the Land of IF*, a positive pregnancy test really is just extending the anxiety from the 2ww. Yay we are pregnant with a good hCG! Oh crap - I hope it doubles in two days. Yay it went over double! Oh crap, I hope it grows as expected by next blood test. Yay! It grew as expected! Congrats - you get a new 2ww till ultrasound, where hopefully, you will see a heartbeat. It feels like every milestone comes with new nerve-shattering waits.

But I'm also excited. For the first time ever, I'm considering shopping. On the surface that seems like a trivial thing, but as fellow IFers** know, it really isn't. There's always the thought "What if I buy something and then something goes wrong?"  In March, we have a HUGE, local community mom consignment event coming up, and if everything is still ok, then I'll feel like I can purchase some things. Not big things, but SOME things. A pleasure I have completely avoided on all of our tries (with the exception of 1 book last year). There are other things I am excited about, but the idea of allowing myself to shop is a pretty big deal.

Being scared is another emotion all together. There are so many things to worry about. Will the pregnancy make it? What if there are twins? What if there are more??? What if the baby(ies) are born early? What if there are medical problems afterwards? As the pot grows bigger, it feels like any loss would be that much more.

Lastly, I feel guilty. Of late, I have not read as many success/pregnancy/baby blogs as I normally do and even ditched a baby shower a few weeks ago that came smack in the middle of my 2ww. I just needed a break from everyone else's "Woo hoo". Quite frankly, I was trying to simultaneously prep my self for a bad outcome, while still holding out some hope. Now we have had a few "woo hoos" of our own and I think of all the other individuals out here in blog land, men and women who have been through so much more than me, still waiting. And that makes me sad. And it makes me feel guilty. Like a weird survivors guilt where circumstances could change and put me right back were I was before. Guilty for my current feelings of success that happened while I was shamefully avoiding other's.

The ride of infertility is much like that first ferris wheel created in 1893. Not only does the ferris wheel go up and down on it's circular ride, but the details before, after, and in-between can't be ignored. The marvel of it all staying together, even when massive numbers of nuts and bolts fly off, is awe-inspiring. On so many levels, each successful turn is to be admired.

*When I refer to the Land of If, I mean it from a metaphorical perspective. I am not quoting the book, but I do like to place a link to it because I feel in this phrase, Melissa Ford so perfectly captured the seclusion often felt by our community: people dealing with infertility. As such, I like to give her credit.

**IFers: people dealing with infertility. 

Don't Bring It.

We received our 3rd beta test result today. For those of you keeping score:

January 27th: 130

January 29th: 365

February 2nd: 2268!

I have no idea what that means except that our nurse says our numbers are fantastic. On Tuesday we asked about singleton versus twins - the nurse I spoke with said right now they are considering it a singleton, but we won't know until the ultrasound. So what did we do? What any reasonable hopeful-parents-to-be would do: pestered our favorite nurse. 

"It is very, very difficult to know whether there could be more than one from bloodwork alone - and I have been wrong enough times to wait until the ultrasound rather than guess."

Fair enough. I guess I can stop obsessing with Dr. Google.

http://veterinarynewshub.com/wp-content/uploads/2012/09/Dr.Google.jpg

Oh who am I kidding? Just a few more peeks. Apparently we've reached a small milestone with our hCG of 2268. Between 1000-2000 you can see a gestational sac on an ultrasound. 

According to this IVF calculator, we are 4 weeks and 6 days pregnant with a due date of October 6th. 

If this was a normal milestone or challenge in my life, I'd be all 

"WOOOOOOOO HOOOOOO! We've made it this far - BRING IT <insert challenge here>!"

I think this time I will be all "woooo hooo. Don't bring it. Unless by "IT" you mean baby in 9 months. Or 10 months. Or whatever weird counting system they have going on these days that will result in a crying, pooping, bundle of joy". 

Wonder what my 14 year old self would have thought of that statement from my 40 year old self? Probably just happy I'm still all weird. 

Sunny with a Chance of Rain

Amazing photography by zznzz
http://zznzz.deviantart.com/art/sunny-rain-259517795

130!!!

That's the hCG test results at day 12. Our GC's progesterone is 20 and estrogen is 830. That's a good solid number for 1 baby with a possibility of twins. (Could we even dare to hope?) Everything is looking great.

Well, almost everything. Shortly after the blood test this morning, our GC started spotting. I know that it's not uncommon, and it may mean nothing, but it's still scary. Add to the fact that my age group has something like a 35% miscarriage rate. Doctor's recommendation is for GC to drink plenty of fluids and rest.

I'm not going to dwell on any of that today. Today I am going to be happy. Cautiously happy - but happy happy happy.

Hoping for an uneventful 2 days followed by correct growth rate in 2 days. Stay tuned and wish us lots of baby dust. You know - the good stuff; not the cheap, crappy stuff. We need all the help we can get.

Tomorrow is the Day: Random Thoughts the Day Before

Work has been wicked busy (and good), thus I haven't had a whole lot of time to perform my usual obsessiveness during this period. With the weekend here and time so close, it's starting to creep in. I flip between wanting to look at baby stuff and then quickly switching to something else.

Tomorrow night we are celebrating my son's birthday - 21. (Holy crap - when did that happen?!?) His actual birthday is not that day, but he already had plans on his birthday (free sporting event tickets with great seats!) and I had a choose a different night. It didn't occur to me that I was choosing the night that could be either a very sad or very happy one for us. I'd hate to steal his thunder or put a damper on such an eventful birthday. Though now that I think about it, he would be thrilled at the good news. When I mentioned my poor date choice to my husband he became slightly surly and thought I was already thinking negatively; I quickly assured him I was not. 

Add dinner to tomorrows schedule of things, and then I saw that friends need help sewing costumes with a recital they are having next week. I was supposed to be in it, but I bowed out of the recital once I realized that it would be too hard with to do with the IVF cycle. Still, I had to explain that I probably couldn't help with the sewing aspects tomorrow either. I hate that, but it is what it is. Almost no one in that group is aware of our infertility problem and I can't imagine getting the phone call in the middle of all of that. Not to mention I'm sure my husband wants us to be together for that moment. 

By far this has been our best cycle and some part of me wonders if we had had the opportunity to do it here earlier (instead of India), if the results wouldn't have turned out better for the other cycles. We will never know for sure, but I suspect it may have. The cyst probably killed my first cycle and we would have waited if we weren't already in India. After the second cycle we found out that BCP lowers chances in women my age, something that is hard to avoid when you have to fly across the world and time everything. Actually, had I known that prior, I probably would have just flown out earlier and not taken any. Maybe. I'm not sure if we could have been that flexible with my husband's schedule. Who really knows except that this last cycle, which should have been the worst, was my best. By far. 

Sad to think that this is our last cycle with my eggs. Not to be Debbie-downer (I am hopeful), but if it doesn't work then we are in limbo for awhile. We will go to egg donation, but who knows when we will be able to do that or the logistics of it. While I won't feel a disconnect from any future baby we have that isn't biologically tied to me, I will feel a disconnect from my husband and his family. I don't know exactly how to explain that statement and any attempt to try would probably muddle it up even more. 

Plus , I so genuinely want to see what a mix of our genes would produce. Like most couples, I think we will/would make beautiful babies that will/would go on to do great and wonderful things. I would miss seeing the flicker of mischievousness from my Grandfather,  the possibility of light blue eyes (that have never changed due to any marriage mix), and the beauty and intelligence that I could point out from so many that came before me. Children are wonderful no matter where they come from, but there is something longing in me that wants the physical reminder of my loved ones that have passed to carry on in our future child. 

Sad to think it's our last cycle and a relief. Cycling is harder than I imagined and you have to put so many restrictions on yourself. So grateful to be able to resume wine, regular caffeine  and long hot baths. To not take a daily dose of supplements that make me rage/cry/get acne/grow more facial hair/etc.. Grateful not to have to pump more hormones and all the fun things that go with that. To not have to worry about gaining more weight; wondering if I need to buy a new wardrobe or just put my body on hold for yet a few more months. This week I was finally able to make appointments to get a cavity filled (anesthesia) and see my dermatologist (where most things Rx'd are no-nos for IVFers).  

My eggs are literally all in one basket. It can go either way. We transferred many embryos, but not more than the embryologist felt comfortable with. On one hand that makes me excited because it gives us a higher chance, on the other hand it makes sad thinking that our chances are so low to begin with that it's ok.  

Deep breath. 

Off to take a bath and think happy thoughts. If happy thoughts don't come, there's always my fallback: Grey's Anatomy. That sh#t's addictive and engrossing. Have lots to keep me busy today, so I need to get off the computer and try and dive into that. Tomorrow is the day and hopefully we will have great news. 

60 Second Update

Embie we didn't transfer didn't make it. They left a message on my phone and I didn't feel the need to call back. It didn't upset me - not one bit - totally expected.

Tomorrow I go in for my check up appointment. I've been a little worried because I am still cramping, but I guess I shouldn't be surprised since I'm prone to infection AND I didn't take my doxycycline the night before my transfer like I was supposed to. Told the nurse on the day of transfer (when she asked about it). Completely slipped my mind to take it even though I told myself probably 20 times (and my husband at least 5)! Had to take it after dinner and dinner was after the reminder alarm went off. Damn you ADD. Oh well. I guess if I had to forget one medication -that was the one to forget.

G.C. says she is doing great except for a sore bum. LOL. I feel so bad for her. She told me that the night of the first shot that she kept procrastinating when her husband tried to give it to her. Made him keep practicing on the orange an hour past the time she was planning on taking it. Then when she finally got the shot she couldn't believe that she had been so worried over it that whole time. That it was nothing compared to what she had built up in her mind. Still, too many shots will give anyone sore spots. There wasn't an unbruised spot in my prime belly-shooting area by the time I was done. Hurt to wear pants. Sans pants (or skirt) probably isn't good for the office. Now that I think about it - why didn't I wear a dress???

That's it for now. Tomorrow is checkup for me and Sunday is prego test for G.C. Some moments I don't think of it at all and other times I wonder how wise it is troll craigslist for my dream crib. Well "troll" as in window shop, not as in act all douche-y. Why am I explaining myself? You all knew what I meant. I starting to ramble which means I need to hurry up and get to bed. Still a ton to do.

Night all!

The Day of Transfer

Day of transfer was Tuesday, not today (or tomorrow). We decided after a lot of careful research and serious talk, that waiting 5 days didn't buy us anything odds wise, but it did offer a bigger chance of loss. Results are pretty comparable with success rates overall. There are a few examples here and here. There are actually a ton more scholarly articles (many that are more recent) that pretty much bear out the same thing in our specific case, but that was soooooo Sunday/Monday and I'm not digging them up again.  

Rates are often viewed as higher because the result set of blastocyst are skewed with young women's eggs. I had to face facts, some embies that could make it to 3 day and be viable, may not make it to 5 day. 

Tuesday came and it was a moot point anyway, because there were clear leaders in the embryo pack. Very clear. Day 5 wasn't going to make it any different except that we could lose some that would have been perfectly fine. 

In their system, Grade 1 is the best, 4 is the worst. I've listed them in order of their quality. 

Here was the breakdown:

#1: 8 cell embryo - grade 2

#2: 8 cell embryo - grade 2

#3: 8 cell embryo - grade 3

#4: 7 cell embryo - grade 3

#5: 6 cell embryo - grade 3

#6: 5 cell embryo - grade 3

No perfects, but I can't say as I was really expecting any to be. #1 & #2 look pretty good. They won't make the cover of Embryo Monthly, but that is fine since I just made up that magazine name anyway. Now that I think about it they TOTALLY could make the cover, as long as I create the magazine and approve the cover. So not perfect, but still they look good. (I'll try posting pics of them later in the week.) 

#3 was ok. If I had to guess, I'd put it at a 3+. Almost a 2, but not quite. 

#4 was a disaster. I honestly don't know how #3 and #4 are even in the same grade based on the fragmentation.  My only assumption is that grade 4 must be when they start to darken. We didn't have any grade 4s, but since #4 was so sad, we didn't need to see the other 2. 

What ever we didn't put in they were still going to try to grow to blastocyst and then try and freeze, but we were essentially told, "don't really even consider that happening." I guess tomorrow I will call and ask anyway, but I will feel foolish doing so. But for the same reason I can't stop watching a movie even when it's bad (curiosity), I will be compelled to call. At least I know what to expect. 

That's it. Transfer went great. I was in the operating room holding my GC's hand as they implanted. She was a champ. Both the embryologist and the doctor were very pleased with the transfer. Very clean and without problems. 

2 week wait - here we come. Except I'm not sure if it is 2ww, because they are doing it at the 12 day mark. Weird. I've warned my GC that she may have to come back for a second if the one on the 27th doesn't give us enough info. 

Oh well - back to this:

Thanks for all the support and well-wishes!

6 Embies

We have 6 embryos. We will see how many continue. (4 of the eggs were immature). The embryologist said if they do well, then they might consider doing a 5 day transfer instead. We told her that we are not sure if we want to take that risk and to have the doctor call us tomorrow when we know more on how they are doing. 

Pros of going to 5 day: out of the embryos that survive, you can choose the very best ones to implant, resulting in a higher rate of pregnancy.

Cons of going to 5 day: embryos that could result in a pregnancy may not make it to 5 day outside of the womb. We could lose them all and have nothing to transfer. 

Trying to get less excited. It's hard. 

Holy Crap

All of my past complaining of IVF in the US (especially in comparison to India), is suspended. Hopefully indefinitely.   For today I had 13 eggs retrieved. You read right. 13. I didn't even have that many follicles called out 2 days ago, though I suspected that the smaller ones on the left ovaries weren't called out simply due to their size.

Up until today, I've remained relatively flat regarding our outcome. Neither over excited nor pessimistic. Part of this is due to the busy schedule I have had to keep, part of it has been less time to obsessively research, and part has been that it's my 3rd cycle. People who have undergone multiple cycles know exactly what I mean by that last part.

Today I cried when the doctor told me. My husband wasn't there yet, and even though I clearly heard the doctor when he told me, I asked him to repeat himself. I asked the nurse again when she checked on me and told her I might cry. She brought me a tissue.

I'm tearing up as I type this.

Today I don't feel flat. I'm somewhat scared about how much hope I have right now. We have no idea how many will fertilize, but I'm still in shock over how many we have. For the first time "freezing embryos" and "blastocyst" are suddenly possible options for us.

UPDATE: Now I'm nervous again. Just realized that 13 doesn't necessarily mean 13. Some times eggs don't/aren't mature and your original number goes down. We've never run into this prior - the number we got was always the number we got. Sigh. Why does this always have to be such a damn roller-coaster?

Day 11 - Trigger Night

Same disclaimer as Tuesday regarding this post. Half of this was written quickly at work just to get the stats up and the other half was written quickly at home where I have a zillion things I need to do. I don't have time, patience, or the general "sit down and write pretty" warm and fuzzies tonight. (Still want to post the info though.)

Let's us begin...

Ultrasound done by doctor today. I don't remember this doctor's name, but she reminds me of tall Jennifer Garner. It's kinda funny. Funny weird, not funny haha. (I've always loved that phrase.) I've met her before and she is the new doctor at the practice. 

Lining is grade 1 at 7mm. (This doesn't matter in my case except to show that my hormone levels are good.) 

Note: they looked at the right ovary first this time.

right ovary:

14mm

17mm

19mm

14mm

3 that are <10mm

left ovary:

18mm

18mm

16mm

17mm

18mm

Looks some were hiding on the right that have perked up. One of the small ones on the left decided to join in the game as well. 

Depending on my blood levels, we may wait another day before the trigger shot. Will know this afternoon. 

I was out of meds and so my nurse gave me some from the office. Said if I don't have to use them, to bring them back. They didn't charge. 

--Evening update

Triggering tonight. My progesterone is 1.3 and my estrogen is 1779. The nurse explained that when the progesterone starts rising and gets above 1, it indicates that the eggs are getting ready to release (something I did not know previously.) My hCG shot is scheduled for midnight. Haven't watched the videos for that one yet - better get to it! Dose is 10K. 

Tomorrow morning I go back for another appt. They are taking blood and going over the pre-op instructions. Not sure if I get another ultrasound, I was in my car about to leave when they called. 

My GC will start her progesterone shots tomorrow night (ouch.) I still cringe knowing how her shots are big and intramuscular. Super suck. Our transfer is slated for Tuesday. Not sure why we are doing a 3 day instead of 2, but I've put it on my list of questions. 

I've asked 2 other questions that I am awaiting answers on. 1 is regarding assited hatching: do they think it is warranted in our case. The other was about ICSI. I was surprised to find out that they did not have it planned for us. That's a bit startling given I have a low ovarian reserve and we've used it both times before. I've asked for clarification. If there is little downside, and a potential upside, then I don't want a small fee standing in the way. Plus, I've read studies where it can significantly impact small follicle/egg success. 

As good as my numbers look, I was reminded on how good they looked last cycle. In fact I had 12 good sized and 14mm one; only 4 eggs were retrieved. I guess I have to hope that they will have better equipment/process/tweaks of protocol here to release good eggs. Hate to put it that way because quite frankly, my last cycle in India was waaaaayyyyy less stressful than this one here in the states, but a little part of me is hoping that something will be better here. 

My post-op visit (that's new!) is scheduled for the 22nd. Our pregnancy test scheduled for the 27th. That seems kinda early, so I told our GC to expect that she may have to come in for a second one. With her starting a new job only a month ago, it's better for her to know the possibiliy of these things in advance. Heck, I know I would want to know that too. 

Saturday is retrieval day. I've been so busy, I haven't had time to worry [too much] with google or otherwise. Our appointment is at 11am, but we have to go in at 10:15 to speak with the doctor. It's weird to see all these different doctors and nurses. I haven't even seen our doctor since our cycle started, and now she won't even be doing the retrieval. Sigh. I know the other doctor is considered awesome and I've met him once before, but it's still hard. In India I saw my doctor and the same nurse every day. 

That's it. Gotta go hussle and get things done. Haven't even had dinner yet. Wish me luck!

Begin at the Beginning...

From: http://aliceinwonderland.wikia.com/wiki/King_of_Hearts

“Begin at the beginning,” the King said very gravely, “and go on till you come to the end: then stop.” 
~Alice in Wonderland

I feel so behind on blogging about what is going on.  Ok. Let's start at the beginning. Or at least the beginning highlights of IVF cycle #3.

Christmas Day I starting on my Viville-dot .1 estrogen patch. The instructions were to change it out every other day until I started my regular cycle meds. Once I began those, I was to leave the last patch on for 3 days. 

Day after Christmas I started my protocol of injecting Ganirelix 250 mcg for 3 days. 

Friday night (12/28) my period started, and that brought me into the ACRM office on Sunday morning to do our baseline ultrasound check: 11 follicles. 

Monday (12/31) I started my Bravelle (6 vials of 75UI) and Menopur (2 vials of 75UI). You can see my discussion about that process here.

Friday I had my ultrasound and was introduced to my new nurse. Our old nurse/third party coordinator was promoted to Director of Nursing (or some similar title) and I was a little apprehensive of having to start with a new nurse. Even though our old has frustrated me a few times. Both nurses were there on Friday and I was actually pleasantly surprised with our new nurse. My fear was that she was going to be a total noob, but I couldn't have been more wrong. Apparently she was the former Director of Nurses took 6 months off, and was coming back as the new third party coordinator. She instantly made me feel at ease with her knowledge and bedside manner. Brava because I was very irritated with my clinic that day. 

The ultra sound showed 6 follicles growing on my left ovary and 3 on my right. All in the 10mm category. She explained BEFORE the ultrasound (which was really smart in my opinion) that it was very early and the number we were going to see that day could change. Not to worry if we only saw a few. At 9, I was pretty happy. 

After the ultrasound, I requested to meet with the financial coordinator. She was supposed to have called me back on Wednesday after speaking with her manager about a mistake they made, but did not. This meeting ended up with manager joining us and I will save that for another post. Suffice to say, I was not pleased about a mess-up and I let them know. 

The rest of the day saw me at work, running around trying to get required IVF forms notarized, and finalizing the attorney items. A busy day indeed. The mountain of forms you have to go through is staggering. 

Saturday my GC had her ultrasound and mock transfer. All went well, but neither one of us was informed before hand that she would be having this mock transfer. I'm guessing it was a bit of a surprise for her. 

Which brings us to today. (Shew.) Another ultrasound and blood work. Lining (where I have it) is striped and at 7mm. There are 4 follicles on the left that are 10mm or greater, and 3 on the right. Several smaller ones that may still be recruited. We will know more at my ultrasound on Tuesday. Blood results came back this afternoon and estradiol is looking good in the 500s. As long as it was in the 300's that was a good sign. 

That pretty much brings everyone up to speed. Well, everyone that reads this anyway. Not technically "the end" but a good place to stop for tonight. :-) 

Time Out for this Message about Meds

I'll freely admit now that despite what one might think, doing IVF with surrogacy in India was much easier for me. Administering meds is a prime example. I simply went to the clinic every morning, laid on a cramped patient table, and let them stick a bunch of needles in my belly. Some days hurt worse than others, but overall not too bad and the security of having someone who does this every day for years was great

Here in the US, you do it all yourself. The ordering, the mixing, the injecting. The day of my first ultrasound I was supposed to have injection training, but then I found out they wanted to charge an extra $160.00 for the training. Our pharmacy has online videos for our specific meds, so when they told me of the extra charge, I declined. Chances are I wouldn't remember what they said  when I got home anyway and would have to pull up the videos and instruction sheets. I ended up watching a bunch of videos from a bunch of different websites and then picking the best one to show my husband so he could watch me and make sure I was doing it right.

Video from my pharmacy on injecting Menopur.

This gives you a bit of an idea, but I had a lot 

more vials

Basically the process is:

• sterilize counter and tops of vials 
• wash hands thouroughly and carefully
• get syringe and remove the big needle
• attach a q-cap
• add a little over 1mm of air to the syringe
• puncture sodium cloride and push in air. This helps draw out the needed +1mm of liquid back into the syringe
• puncture vial of Bravelle and add liquid from syringe. Make sure everything dissolves, but don't shake too much. Add back to syringe, making sure to get all the liquid
• repeat with adding the newly mixed liquid into the next vial of Bravelle. 
• repeat with all vials of Bravelle and Menopur. Should still only have about 1mm of liquid in the syringe when done, but all 8 vials will now be dissolved into that 1mm of sodium chloride.
• remove q-cap and attach smaller needle for subcutaneous injection
• alcohol wipe your belly, make sure no air is in syringe, pinch a fatty area of your belly, and insert needle at about a 90 degree angle. 
• slowly inject medicine. 
• make ouchy face

No one really warns you that some medications in the vials dissolve better than others (no rhyme or reason) or that liquid can get caught in weird places in the vial. They don't tell you about your heart skipping a beat when you almost drop a syringe full of $500 meds. They don't tell you that it will cross your mind on several occasions "shouldn't someone more qualified be doing this?" They may have gone over this in the $160 training, but somehow I doubt it. 

Cycle Limbo Part 2: Return of the Cycle

UPDATE

Nurse called. As long as my SIL can come in tomorrow and get an ultrasound - then we are proceeding as planned. Whoooooooooooooooooshhhhhhhhhh.

When the nurse initially called, she kind of presented it as my option with the knowledge that if my SIL's lining isn't thick enough upon transfer day, than the transfer won't take. Normally they want 11-14 days of the estrace to insure a thick lining, but they don't want to start the estrace until a untrasound and blood work on her confirms everything is a go (eg, no cysts, hormone levels good, etc..) My last cycle gave me only 12 days before transfer. She asked me if I wanted to go forth.

At first I asked questions about how would we avoid this next time if we waited. She said that normal protocol was to control the GC's cycle with BCP/Lupron overlap. Then I asked the follow up question that surprisingly, I think was a bit unexpected: why did we not do it this time? This was a little harder to answer, but the short of it was - they/she didn't want to start medications (including BCP) until all the initial testing had been completed. Of course my logical reply was: Does BCP effect the testing. Answer: No.

So getting past all that, I realized she expected an answer from me about whether I wanted to start or not. Here is where I lost it. Crying the cry only someone that is mildly dehydrated and still slightly sick can manage. My guess is that over the phone it sounded somewhat like a choking horse.

Normally when I get really upset, my sensibilities leave me, but they did not this time. I put the question back to her: "What you are telling me is that I have to choose between my chances lowering further from waiting a month, or take a chance that the lining won't be thick enough." She said she would speak to the doctor and call me back.

I laid the options out like that for a couple of reasons, but the main one was that I really didn't know which is riskier. One would think that a month wouldn't make a world of difference, but women in my age bracket know differently. My AMH dropped drastically in a very short period this year. Conversely, I don't recall our surrogates getting estrate (or similar) that long in India prior to the transfer, so I'm not sure if it is a booster/fail-safe thing or what.* From a medical perspective, since my GC and I started menses within 24 hours of each other, one would think at 29 years of age, her lining would be reasonably thick for ovulation at the proper time anyway.

After speaking with the doctor and both reviewing my records, the nurse called back. She stated that as long as my GC could come in for ultrasound tomorrow (she can), then we would continue the cycle as planned. We nailed down a few of the other details (like when I would start my big gun meds) and now I feel a crapload better than I was feeling. Earlier I was trying not to let panic surge, but I was having a hard time. I would have waited another month if I had to, but honestly, I am ready for this to be over and done with. The emotional and physical, even things you don't let anyone else see, is astronomically draining.

*Originally I thought the Indian surrogates did take meds from the beginning (from my own research of surrogacy), but I had my husband ask the Indian lady directly and she said that she only been told to start medication a few days prior to the transfer. My husband and I now debate if this was a protocol thing, problem with the surrogate, or other. 

Day 1 - Or Something Like That.

I overthink things.

The other day I wrote a blog post titled Day 1.5. Honestly I didn't really know how to number it. Technically, since it was pre-cycle, it should have been a negative number, but since I didn't know WHAT day my period would start on, I couldn't very well guess on what negative number to give it. Anytime I try to predict what day my period falls on, it makes a liar out of me. If I was wrong, then the numbers wouldn't line up and that would DRIVE ME CRAZY. (No comments from the peanut gallery please.)

This made me wonder on how to properly account for it. Using a positive number, should I add BC (before cycle)? Nah, too religious. What about PC (pre-cycle)? Well then we've gone all political. Not good either. I get enough of both of those on Facebook  Incidentally, one of my NY resolutions is to not post and comment on these (and other) controversial topics. This would be a huge challenge for me, but GREATLY rewarding as I usually end up regretting it. Fortunately  I have a decent record for following through with NY resolutions. (Note: I wrote "decent", not "perfect".)

Where was I? Oh yea. What number notation to use? What number....Hmmmmmmmm. What to do? What to do?

Period started. Crises averted. Or starting. Whatevs.

Let the Cycle begin.

Running and Running

Yesterday was a day that started with me waking up in the middle of the night - running to the bathroom. Several times. I couldn't even see what time it was because the clock was slightly obscured and I was afraid any movement would have me running back to the cold tile.

Course that's the kind of thing that makes you afraid to sleep. So there I was, wide awake, trying my best not to do that little gaggy-thing you do before you throw-up, in fear that the muscle contraction would make me poo in my PJs. I had my Hello Kitty's on after all. Fortunately nothing like that happened and I was able to keep running when needed. By 7:30am, I was exhausted. 

During this time I was wondering to myself (and to my husband, whom had much pity on me), how this could have happened. My son had a violent bout of stomach problems for most of the day 3 days prior (and of course I was with him on Christmas), but my husband didn't seem to think that sort of thing was contagious. I remembered differently, but I wasn't exactly in a state to argue or even think straight. More than likely, he mused, it was the Thai food I brought home the night before. 

A little voice inside me feared it was a reaction to my Ganirelix. I've never had it before and wouldn't that be a disaster if we had to figure out a change of meds at the last minute? While I've never had quite the exploding reaction to any other meds (unless you count the time my mom made me take cough syrup and I instantly barfed), I still have a weird history of medicine reactions. Can't take anything from the Cipro class of antibiotics. Well, I guess I COULD in an emergency, but I would be freaking out and asking my husband repeatedly why he was looking at me funny (paranoia is only one of the lovely reactions it causes.) 

Turns out I just had my son's stomach flu. Spent most of the day in the bed (and bathroom), but by 5pm (and a forced dose of  1-2 mg of Melatonin to make me sleep), I was able to come downstairs and eat. (BTW: Melatonin is supposed to help us infertiles, but golly it sure does pack a wallop with me.) Was weak as all get out, but I feared shot #2 less than I thought I would. Perspective I suppose. Now a day later, EXCEPT FOR MY STUPID PERSISTENT COLD, I'm all better. 

Kinda makes me wish I had these:

Photographer and story behind pic here:
http://www.flickr.com/photos/mararie/2137142469/

P.S. If you are a regular reader of my blog and are wondering about the answers to the questions I asked my nurse the other day, I updated the post to reflect the answers. Here it is: Day 1.5. I thought that would be better than to write an entire response post that are a few short sentences. 

Day 1.5

Yesterday Santa brought me a nasty cold. Wee! I managed to make it through the morning's festivities, but alas, was couch bound for the rest of the day. (On a separate note, the movie Mulholland Drive sucks - don't let anyone tell you differently.)

Nevertheless, I began my pre-cycle meds as described in my RE schedule. Namely I started the Vivelle-dot 0.1mg patch (estrogen), which I take every other day. Tonight I will add on to the patch and start a 3 day course of Ganirelix 250 mcg injections. Double wee!!!

I tried to think of a time in my life when I gave myself a shot and came up empty. Even with my couple year course of allergy shots as a kid. Even with my 2 previous IVF cycles in India. Ugh - I guess I should have checked for extra practice needles in my box, although now that I think about it, who the hell wants to take extra shots, practice or not.

Next step is "Await period Day Of Cycle 1 = First day of continuous menstrual flow (spotting is NOT day 1)". Great. Many times my periods are only spotting (due to my previous cryoablation surgery.) How should I determine that? So in typical "omg" last minute panic and realization that I have new questions, I sent the below email to my nurse. Hopefully they will get me some answers today.

UPDATE: rather than write a separate post on my nurse's answers, which were prompt, I'll just type them in red by each one. Nurse ended up calling me directly when I was at work, so my responses are just a quick summary.

P.S. Clearly I don't know how to count...But at least I caught it before she did. 
---------------------------------------
1.) Started the vivelle-dot today. Do these have to be changed out the same time (every other day) or can I change it out with my nightly shot (I put it on in the afternoon)? -->yes - that's fine

2.) It looks like I am suppose to start the Ganirelix tomorrow, but I am not positive because the date is wrong on your documentation (I think we may have previously discussed this on the phone, but I'm not positive now.) Please verify and send an updated copy. Also, please let me know if there is anything special I need to do/know regarding the shots. For some reason I thought we were going to have training on it, but we never did.-->tonight. around the same time. 

3.) I have been battling a very minor cold the last 2 weeks, but yesterday it took a turn for the worse. Today it is in full fledged mode. Please notify the doctor and let me know if there is anything I should or should not take for it. -->Take lozenges, any Tylenol line, robitusson but no DM, sudifed

4.) Last week I wrote you regarding an approximate drop-dead date for when the surrogate's cycle could start (and thus you would have to have a contract in hand.) Haven't heard back from you on this - please let me know. The lawyer has submitted the rough draft to us. --> earliest Friday. You have 2 1.2 weeks before her injections start. If she hasn't by Friday, call Mikesha on Friday. 

4.) Dr. Carpenter approved my taking supplements for the last few months. I need to know if and when I need to stop taking these. In particular the DHEA (75mg per day) as it is a hormone and I don't want it to interfere with the other hormones I am now taking. -->yes --continue taking all

5.) My 2 previous cycles I had cysts prior to the start of cycle. The first IVF cycle, we had to aspirate the cyst as it was interfering with my hormone levels (and consequently would have ruined the cycle.) I need to know if we need to do an ultrasound or blood tests to make sure this isn't occurring again. Dr. Carpenter is aware of my previous history with this. -->will come in on day 2 or 3 for ultrasound and bloodwork. Check it then. 

6.) My blood tests are complete. The FDA ones should be faxed to you directly from Quest. The remaining ones were done at Emory. Please let me know if I need to sign a release for you to get them. I believe you already have it on file, but since it is a new doctor, I am not positive. -->need to fill out a record release for emory to send over to ACRM. She will email. Email back to her or fax.

7.) The ACRM email system appears to remove emails after a certain period. This is very confusing and I worry that I might miss some documentation. It is also difficult for me to log on to the ACRM email system when I am in the office. If possible, I would prefer to use regular email rather than your website email system. Please copy my husband on return correspondence as well (his email is included in the CC line.) -->yes - that's fine. 

Thank you and I hope you had a great holiday.

Mad Dash to the Finish Line

I don't know who Mr. Pipo is, but this image rocks.
You can get it here: http://commons.wikimedia.org/wiki/File:Mr_pipo_clock.svg

Yea, yea, yea. The ole "I've been a blogger slacker" post. The "I've been too busy" post. The "Too emotional with all that's going on in the world" post. Whatevs. Get to it.

We are on full throttle for surrogacy to start next cycle - which means hopefully the end of this month. (Crap - no drinking on NYE!) I've been a mess trying to get everything done in time, but we really wanted to pay as much as we can this year for tax purposes. Since I didn't work for 8 months this year, much more is applied. 

Plus, let's be real, every month for me counts now. My AMH is like .7 and my FSH is 12.7. Not good. Not horrible, but not good. This will be the last shot with my eggs - period. If this doesn't work I'll crawl into a hole until we are able to consider the donor egg option. 

I have to say that having my first 2 surro cycles in India did not prepare me for the complicated mess I would  have to endure here in the US. In India we just had to show up and they directed us for everything else. Here we are on are own and have to stay on top of things like a frenzied squirrel. Crimmy, I'm even going to have to give myself shots. With my ADD, this is not encouraging. 

Some of the things I've been juggling: 

• Coordinating 4 individual schedules with tight deadlines on when specific things have to be done. Guess who's schedule always gets the shaft (to be expected.)
• Countless phone conversations occurring middle of the day, for a length of time, that has me leaving my trusty cubicle to go hide talk in a conference room. Lest my cube mates get to hear me go on-and-on about the FDA required STD tests I have to take. "Yes, I need you to add Chlamydia  Gonorreia  HIV, Hepatitis  PPD, ... to my blood order. Oh I'm sorry, you want me to repeat that LOUDER for the 3rd time? Ok."
• Working with 3 different pharmacies to find out which can give me the best price, without sacrificing reliability/comfort level of getting all the right things at the right times. All of this again on the phone during business hours. All pharmacies have been given the Rx by doctor and are ready to ship ship ship. "Yes, I'm confirming the order. OH WAIT, you are with whom?"
• Phone interviewing lawyers with experience in surrogacy to see who can meet our tight deadline (are you sensing several themes yet?) 
• Going BACK AND FORTH with my new primary care physician office to try and convince them to add STD blood tests to my blood order for my physical. This way there is a chance insurance will cover it, but I had to go back and forth with them for about 2 weeks. Otherwise it's a couple grand out of pocket.
• Getting a physical so that additional items will be covered under insurance that wouldn't under my RE.
• Multiple doctor visits. Blood drawn yesterday AND today because I had to use 2 different labs. Trying to juggle all these without raising a flag (hopefully) at my new job has been an incredible feat. I'm a contract employee and want to go perm when my contract is up in April. 
• Psych evals - and while I appreciate the "concern" over my emotions, it really was a total waste of time/money for my husband and I. Everything that was discussed in the group session we had already discussed with them privately. I totally "get" why you would want to have one with the surro and the surro spouse, and even a group one, but I don't think every IP couple needs to have this done. Especially if you've been through the process before (even in another country). Thankfully the doctor put the ones for hubby and I as a "family counseling" code - hoping insurance will at least cover that. 
• Trying to get surros insurance documentation to make sure there is no surrogacy exclusion. Not their fault, but company's fault it is taking so long. 

There is more I am sure, but between balancing that and everything else in my life, my brain is kinda fried at the moment. I still have Christmas shopping to complete. Hell, I haven't even gotten all my cards out yet. 

On a Happy Happy note. Insurance covered a HUGE portion of my fertility medications. The pharmacy (Village Fertility) checked on a whim for insurance coverage (even though I told them it wouldn't be covered) and apparently a big chunk was. Had to pay just a little over 1K out of pocket - which is awesome since it was looking to be about 6.5K. She explained that even though we have BCBS for medical (THE SUCK for infertility treatments), the pharmacy is different and is quite good. Covered under Medco, formerly Express Scripts. I guess the lesson is: always check to see if insurance will pay. Even when you are sure they won't. 

On an unhappy note - I had no idea that the attorney was going to be so much. 2500 for the surro agreement (REQUIRED) and then another 4K if we make it to the second/third trimester. They have to go to court and petition that our names are put on the birth certificate. Otherwise we would have to adopt our own child. GAH! Oh well, I guess we should totally HOPE/PRAY/RAIN DANCE that we are so fortunate as to get to shell out the money in the future. That would be a good thing - right?

That's it for now. And to prove how busy I am at the moment, I'm going to publish this after only "checking" it once for mistakes. That's HUGE for me. Normally I read it and change it 10x. THAT'S HOW BUSY I AM. Or crazy. You choose. 

Money, Get Away

"Money, get away
Get a good job with more pay
And you're OK."

Clearly The Pink never went for infertility treatment. Which is weirdly funny given their nickname.

We are entering our third and final cycle with my eggs and with a person close to us doing the surrogacy (without charge). Approximate cost: 35-40K. That's not a typo. That's how much it will cost us out of pocket. Paid in full by months end. In addition to all we have already spent.

And now, all of a sudden, a little voice inside me is very scared. To spend this much money and use my long shot eggs. Actually I'm quite terrified.

On Feeling Alone

I know that there are TONS of folks that face infertility, but damn it, sometimes this path feels so lonely.

• The hormones.
• The feeling less of a woman.
• The weight gain and the realization none of your clothes fit. 
• The money. (You can't even think of buying new clothes).
• The daily meds or supplements.
• The feeling of failure.
• The limitations of what you can eat/drink/do to make sure you have "the best chances".
• The no baby. 
• The doctor visits
• The pretending everything is fine.
• The pretending like you really want to hear and be invited to every baby event.
• People asking "so when are you guys going to have kids?"
• The CONSTANT reminder that you are old (or at least your eggs are). 
• The roller coaster that just won't seem to stop no matter how long you've been on the ride. 
• The worry that wanting to use your own eggs raises the chance of health issues in your child. 
• The worry that I'm becoming obsessive or annoying.
• Worrying about my in-laws
• The invasive procedures
• The worrying over every little unknown pain will cause a problem
• The money (yes, this is big enough to write twice).
• etc...

My BFF is a guy and I don't think he can completely relate. Actually, I take that back. His situation is worse.
Me: "This sucks. I can't carry a baby. My eggs are getting old. And we pay a fortune just to be on this stupid roller coaster ride."
BFF: "I think my MS, being single, no chance of kids, and the eventually that my walker requirement will turn into a wheelchair requirement triumphs. My insurance alone is over $900 a month and I can't work."
Me: "touche. Let's go grab lunch. It's on me."

My second BFF just had a baby, so it's not like I want to rain on her parade or have her feel like she's walking on eggshells. She's so totally awesome and her baby is as cute as cute can be.

My husband, though tremendously patient with me, doesn't alway understand how this physically and emotionally this affects me. And as many of you know, it's a doozy  Nor do I, having been a parent before and not from a culture who puts the highest importance on having children, understand all of his internal turmoil. On dealing with the emotional side of IF, we probably both stuff it down in order to appear brave for the other.

If I tried to discuss things with my mother, then she would be incredibly sad worrying about me. That would only add to my stress. No thanks.

In blog land I sometimes worry that I am offending others. In my posts and sometimes my comments; both farthest from what I am actually trying to do. Just trying to convey my thoughts at a particular moment in time. Or trying to avoid feeling sad. Or trying to be helpful. Or funny.

In work and with friends, I'm limited to what I can say. Sometimes because I'm trying to protect myself (lest I am fired for going through IF like I alluded to here) and sometimes I just don't want everyone knowing my business. Nor do I have the desire to be the discussion of gossip as can happen when you have a large group of friends. Nor do I want to be the person that constantly complains and whines as that drives me crazy. Little bits are fine, but when you run into that person who has had problems for soooooo long, it becomes exhausting to talk to them. I certainly don't want to be "that" person.

Yet life goes on. Everyone is busy discussing their kids, sharing fun photos, and doing fun family projects. I'm sure it's a grass-is-greener type thing (after all, we've had some AMAZING travel adventures over the last 4 years), but if I see one more Luvs commercial on Hulu, I'm going to scream.

Backscatter and IVF

Every since we've started IVF, I avoid the backscatter machines like the plaque. Even a tiny bit of radiation is too much risk in my head. My husband does as well, but for totally different reasons. Turns out I'm not the only one: The New York Times wrote X-Ray Scans at Airports Leave Lingering Worries back in August and it seems to back up my position. Nothing really definitive, but enough to make me continue my avoidance of the backscatter machines. If you are trying IVF (or pregnant) and flying, it may be worth the read.

Interestingly enough, I almost ran into a problem with this on our return flight from India in the Amsterdam airport. They have long had scan machines* in place and from my experience, it is EXTREMELY uncommon for people to opt-out. Caused a bit of commotion last time when I was trying to opt-out and the agents were trying to convince me it was safe. I kept repeating "my doctor specifically told me NOT to go through those." I hadn't really talked to any doctor about it, but it was all I could think of at the moment. The agents then tried to explain that the metal detectors were a higher risk than the backscatter machines (I have found out since then that this is not true in cases of pregnancy; I can't vouch for other medical issues.)

The female of the duo agents finally stated "they are even safe if you are pregnant" to which I gave a notable pause. "Even IF you are pregnant? Because my doctor said NOT TO." Apparently my long pause, semi-panic attitude, and adamant stance made HER pause. "Are you pregnant?" I had to think quick. The line from GhostBusters hopped in my brain "If someone asks if you are a God - YOU SAY YES!" And so I lied. "Yes, I'm 40 years old, high risk for miscarriage, and my doctor told me not to go through those."

At this, the female agent waved off the male agent, pulled me to the side, gave me a pat-down, and said congratulations. Did I feel bad for lying? Yes. No. Maybe. That congratulations was a bit stingy, but ok. I'll take it. Way better than me worrying about the alternative.

Woman are born with a finite set of eggs. We make no  more. We have to protect what we have. There are no long term studies on the effects of these machines and in many cases they aren't calibrated/tested regularly. If something went awry, you would probably never hear about it. When you get an x-ray, even if it is faaaaarrrrrrrrr from your ovaries (like an ankle x-ray I had a few years ago), they place a little protective pad over your abdomen to protect your ovaries. As far as I'm concerned, that pad is there for a reason, and I'm not lowering my chances one single bit.

* The Amsterdam airport is said to use a different technology than the normal backscatter machines we have in the US. They call it "Security Scan" and it uses millimetre waves that bounce
off the skin and do not enter the body. To my knowledge, long term studies have not been performed on them. 

Another option

http://www.robinurton.com/blog/2008/05/belly-cast-painting/

The other day I received a shocking offer. One that could solve a lot of problems for us. Maybe. If we are lucky - and that's what it usually boils down to in the end. In a Tim Burton kinda twisted way.

Someone close to us has offered to be a surrogate here in the States. 

Interestingly enough, my husband and I had 2 different reactions. He was ecstatic and slowly realized that I... well... wasn't. Don't get me wrong - it will be FABULOUS if it works out, but just a mere offer doesn't turn into a done deal and I guess that's what has me a little nervous.

This person is very close and dear to us. I love her completely and I nearly cried when I read her email. BUT, I'm afraid to get my hopes up.

Today my Atlanta Clinic called and they had my AMH results back: .86. Not good. Not good at all. Not horrible (like in India), but definitely not good. It has dropped over half from January. So I'm fairly certain this will be our last try with my eggs. And that's IF ACRM will even take me now. I'm hoping that the fact I had 3 good embryos last month will help convince them.

The idea of using someone close to us make me nervous for so many reasons. What if we plan everything, go through IVF, and then she decides she can't do it? I would understand why, but that would kill me. What if she isn't approved medically? She smokes, how do I know she will be able to quit? That's a HUGE thing. (I'm guessing she quit 5 years ago when she was pregnant, but I didn't ask.) And how much time to we have to wait for all of these things to align?

Also, how will she feel giving the baby to us and seeing the baby all the time? One commenter on my carrier's perspective story made me feel better about that, but is that the norm? So many questions. We are meeting with her and her husband this weekend to discuss everything.

We also had a super close friend (2 actually) offer to be an egg donor for us. (Yes - we are surrounded by truly phenomenal people.) Not sure if those offers are genuine either, and more importantly, thought out. Am I being too pessimistic? Am I letting MY personality traits (agree to things before really thinking about them) bleed into how I think others would react? I don't know. I just know I can't take much more of the roller coaster. Sadly, it's a roller coaster no matter which way we choose. Isn't it?