All is Well - Hard Things to Think About

Ramble Warning. 

Depressing Statistics for Women with AMA Warning.
VERY Uncomfortable Discussion about Chromosomal Abnormality Warning

I wrote this over a week ago, but was afraid to post. It's been on my mind for awhile and still is. Since this is a blog about my experience and feelings during my journey, the honest thing to do was to post it. 

After a year of infertility treatments and tut-tuts about my age from a multitude of medical professionals, I've become a little more sensitive than usual regarding my age. To compound the problem, a years worth of infertility treatments (3 IVFs in 8 months!) and the stress that goes along with them has left it's physical and emotional mark in more ways than I care to mention. Now I am faced with the added realism of doctors constantly calling me 41 BEFORE my 41st birthday, because they have to consider the age of the embryos  when they are born. Why you ask? Because that is what counts for problems that may arise.

In the land of infertility, 41 is old and can cause a multitude of issues - age related things that most of us women with AMA didn't think of when we started down the dreaded infertility path. Besides decreasing our ability to get pregnant, our miscarriage rate increases, as does the chance that there will be a chromosomal abnormality. This last part is the current worry area we are visiting. Depending on where you look, our odds of having a baby with a chromosomal abnormality is somewhere between 1 in 13 and 1 in 15. (Note this is with fraternal twins, much different for singleton pregnancies.)

On the upside, the odds that both will have an chromosomal abnormality are about 1 and 900. 

If you've gotten this far and are totally against fetal reduction in all cases - then you should stop reading here. I will have total respect for your beliefs and how they pertain to you, but I ask the same consideration for me. All of us in the land of infertility go through our own personal hell, and we really don't need judgement heaped upon us for the litany of hard things we have to consider every step of the way.

Since I am of "advanced maternal age" AND we are having twins, we are considered a high risk pregnancy and our surrogate has to see a perinatologist. We visited the new OB/GYN a few weeks ago (who won't be our actual OB/GYN, but that is for another post) and had our first visit with our Perinatologist last week. Building up to that visit, both my husband and I researched the heck out of the tests we would need to consider.

The consultation did not go well.  

While I didn't think about it before, our Perinatologist must be a part of the same religious medical group as the OB/GYN practice (not uncommon here in the south). This essentially means he Was. Not. Happy. when we were trying to get information about options if the worst case scenario happened and one of the fetuses has a chromosomal abnormality (CA) that we feel we could not deal with. These can range from things that would result in a stillbirth to death after a few weeks of life to some that we feel the quality of life would be extremely poor. Termination is somber idea for us who have fought so hard for life. 

At the doctor's appointment when discussing the CA tests, I uttered a question about "termination" and the doctor stopped short and very ADAMANTLY told me they DO NOT do that there. (Even our OB/GYN didn't act like he did.) Based on his attitude after that, we all began to have a genuine concern that he was misleading us on several counts. Tests he up-sold recommended to us (instead of amniocentesis) that we later found out may not be recommended for twins or donor eggs (which in this case, my eggs would be considered the donor eggs.) This is especially odd since I'm sure twins takes up a large part of his practice. Additionally, based on information we knew, some of his numbers for risk were off. (Example of that is below.) Finally, he suggested dates for the amniocentesis that would not allow us to get the information back in time (for GA law) should it be one of the items that we would consider termination. 

When I asked him directly about risk percentage of CA for what he was recommending - cell-free fetal DNA that tests for 3 types of CA - versus and the difference of the additional CA items discovered with amniocentesis, he assured me that miscarriage through amniocentesis was greater. (We do not have confidence that he was honest here.) 

My hubby says this is confusing how I say it, so I'll try to clear it up.

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(Chance of any CA (for 1 baby) in my age bracket with twins = 6-8%) - (Chance of one of the 3 types of trisomy that his test is for - variable X) 

Is this > (Risk for miscarriage for doing an amniocentesis (.3-1%)?

or 
is 7%-X > 1%

So theoretically, if the cell-free fetal DNA tests only 4% of the CA's, that still leaves us with 2-4%  untested risk. In my mind, that is a higher risk than the .3-1%  from amnio. This isn't even including the other things amnio tests for that are non-CA. That 4% is probably pretty close estimate. 

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All of this is a major problem, but to get a new specialist would could cause us to run past the time period that were are so precariously balancing in at the moment.  

Don't get me wrong, this is not something either of us takes lightly. I shouldn't even have to justify it as everyone has their own limits - and yet I still feel an overwhelming need to do so. We have gone through so much and if we had to make a decision like this, it would be horrific. But that said, both my husband and I are on the same page on what we would and wouldn't do when faced with certain results for certain tests. And our SIL/surrogate agrees as well.

Not only do we have to consider what we could handle at the birth of a child (death being a major one), but also as we age. Both of us have had a lot of experience with people important in our lives that have some very severe issues - both young and old. Enough that we wonder what will happen when everyone is much older and unable to physically care for them. With our siblings (and us) all in an older age group, the option of family being able to step in probably would not be available to our babies. Unless I left the burden to my son, which I don't think is fair at all. 

A child born with a severe chromosomal abnormality can have devastating effects. More than likely one parent will have to not work, which can be a big blow in income. Add the costs of medical and 1000 other things normal people don't think about, and any savings could be wiped out in a very short time. It only money right? Yes and while that may be true, older parents entering their 70's and 80's may have zero money left over to care for their child when they no longer can (much less themselves). They are then faced with the VERY REAL probability of a mentally and physically disabled child that will be sent to a state run facility. Knowing the child will spend the rest of his/her life potentially living in hell is just not something we are prepared to risk. 

So while I absolutely despise that we have to think about things like this, I guess I feel it's important to share. Because I think it's important we all know these things before we jump in.* That may not change our minds, in fact I can almost guarantee in most cases it won't, but maybe if someone is on the fence about other decisions (such as donor eggs)** then the information will be important to them. We all get so caught up in the idea and worry of having a baby, that we forget some of the other, very real, life changing concerns.

In my mind, there is no right or wrong answer with these tough decisions. I place no judgement on those of us that don't even want to know about things like this. Nor do I judge those who decide things differently than we would. In the end, we are all left with our own decisions and we must choose what we can live with 1, 5, 40 years from now - not what matters to outsiders looking in.

Sigh. I told you this would be a rambling post. We had such a small chance of getting pregnant. Heck, our chance of miscarriage was higher than our chance of getting pregnant. If we can just make it past the amniocentesis, then I will be able to breathe. For a little while at least. 

*In our experience, which is A LOT of different medical professionals, we really did not get enough information about all of the risks for my age. Really the only one that was relayed to us was our lower chance of getting pregnant. I'm not sure if we would have made a different decisions, but I think medical professionals need to do a much better job of informing their patients about these risks. 

**Even this does not guarantee that all will be fine and dandy as many here in IF blog land can attest. 

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. 

Where Can I Get My Drugs?

No seriously. Who has the hook up? I need advice on who the cool [read: GOOD], reliable, fast online/mail order companies for fertility meds? Fairly certain that the email I just read from our clinic was saying that I will need to order mine (and our surrogates) in the next few days.

Here was the reply when I asked about getting the meds:

Once you are ready to get started, I will send this prescription to a mail order pharmacy and they will call you to set up payment and shipment of the medications.  You will need some of them within 14 days of starting a cycle.  The others you will need a few weeks after that.  I would recommend getting the meds as soon as you are ready to proceed.

Honestly I don't know if that means 14 days before my next cycle or 14 days after my current cycle start - which now that I think about it, is the same thing really. Since my period started on Sunday, that means I need to get the full list and make the purchases.

I hate having to rush rush rush everything, but it looks like that's where we are now. Have no idea about what happens with being able to claim this on taxes for anything that spills over to next year. I know you have to reach a minimum percentage of your income to claim medical, but can you only claim what is OVER that percentage, or do you to claim the first part too? I'm trying to figure out how vital it is we make our Dec 31st deadline. It's vital from an old eggs perspective, but I don't know how much it will end up costing us if we can't claim it all on our taxes this year.

Any tidbits you guys can throw my way I would really appreciate. The last two days of trying to balance 4 individuals' schedules for treatment, make sure everything is asked/answered for our upcoming cycle, work, getting a plumber out (yay! We have water!), make a community meeting that we will be a named plaintiff in, more work, AND cart my 12 year old Min Pin back and forth to the vet for dental surgery (9 extractions!) has my head spinning.

(BTW - my Min Pin is a total hillbilly now. All of his front teeth, bottom and top, were rotting due to age and not enough space, and had to be removed. He won't show me now and is working the cheese angle.)

No wonder I need a good hook up for meds. Give me a heads-up and I'll keep it on the D-Lo. 

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.

Weekly Update: A Job, Land of IF, Being a Proud Parent

So many things, so many things. I've forgotten half of them already. Let's just hit the highlights and see what else I can remember.

Hi Ho, Hi Ho, It's off to Work I Go.
Had to go back to work. Money is just too tight right now. Me not working for 8 months has finally taken a toll on our finances and if we want to continue in this Land of IF, then we can't do without my paycheck.

My first week of job hunting was really me just talking to recruiters. I figured I had put enough off during my travels to India, that now was the time to dig deep. That's always an adventure, but by week 2 I had a job - fortunately my area of expertise has an extremely low unemployment rate. It's a contract to perm position in IT, doing what I have over a decades experience experience in. I will be making over 10% more than what I did at my last job and for a company that has a big name all over the world.

What about my dreams to do some sort of humanitarian thing in the non-profit industry? Selfishly, our dreams of a family rates higher on the scale, thus I had to give up on a career choice that would pay just over 1/3 -1/2 of my current salary. All is not completely lost as the project I am working on helps people from 9/11. At least I can believe in the project. Some of the companies that wanted me to interview were BLECH. (Have had enough of soul sucking from my last job thank you very much!)

Speaking of Land of IF...
1.) Just starting reading the book Navigating the Land of IF: Understanding Infertility and Exploring Your Options by Melissa Ford of Stirrup Queens fame. Only on chapter 3 (have had to study for work - <sad face>), but it is pretty awesome. Have my own mini-collection of IF books, but this is the one that most interests me right now. Probably because it's not all doom and gloom fact based. Melissa does an excellent job of making the reader far more relaxed over a very NON-RELAXING subject and everyone is included. It's a hard road and the recurring theme is that we are not alone. And that it's ok to be all emotional. I'll write a full review when I'm finished.


2.) Our friend and her husband who offered to do surrogacy for us are "both feet in". YAY!!! That's the first hurdle. We've consulted with our local clinic and there are a couple of things we have to address, almost all of which we expected. Then there is the insurance issue. We don't know yet if her insurance has a surrogacy clause. Trying to find that out without sending up red flags. They aren't known nationally to cover these things...One step forward, two steps back.

The item I had not thought about was that my doctor wants to retest my FSH. It was high last january (12.4) and with the decrease in my AMH, she wants to make sure that it hasn't shot up to the high teens. I know, I know, it's a Big If. Wish me luck. If it comes back too high, then we could be in holding pattern for years for the DE as I've previously mentioned here and in other places.

Proud Parent
Some of you might remember that I have a 20 year old son. What I don't think I have ever mentioned is that he is in seminary school. Which is perfectly natural since his father is Jewish, my husband is an ex-Hindu, and I have had a lifetime of "trying to figure it all out". (Try not to laugh.) Anyhow, my son has a religious podcast now and I am very happy to see him do something he enjoys so much! Of course as the proud mama I had to listen to it right away and I was tickled in doing so. He was great! Very few people in life get to have the career that they absolutely love and I think he will be one of the lucky few. We have the best discussions and I'm thrilled that not only am I his mother, but also his friend. He dives into projects where he can bring help to those who need it and I am so incredibly proud of him.

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Well, that's all I can remember right now. Still recovering from the flu, which is interesting with starting a new job. I'm exhausted.

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?

Failed again

The Beta hcg levels went down to 15: chemical pregnancy, ie. failed cycle.

I knew before I even read the email. I knew when my phone went off at 2:55am to let me know that my BFF's baby made its debut. I knew yesterday when I made my limbo post yesterday, I just didn't want to believe it.

This is the part where I feel like a failure.

My husband and I hugged each other for a long time this morning, but then barely spoke after he got out of bed. As hard as this is for me, I think it's harder for him. I have a son - he does not. He has wanted children from the very beginning and I had to disclose the problems we would encounter (my cryoablation) when we had only been dating 3 weeks. His only question then was if I still produced eggs...

He can't console me and I'm not sure how to console him. A selfish part inside wants me to yell out "you can still have a biological kid - it's ME that's the problem". I wonder if his family, or even he, thinks that marrying me was a bad idea. An illogical part of me whispers that he will leave. What do I bring to the table?

I feel broken.

I can't even do the basic function of a woman.

I haven't cried and just walk around pretending everything is fine. My mom says she is devastated and wondered if this is just what clinics do to get more money out of you. I have to be the strong one and explain the plain fact that clinics in India get more money on successes than failures. Not to mention attract more clients.

Last week I signed up for a seminar tonight at my clinic here in Atlanta. It's a seminar to discuss infertility options, get a free AMH blood test, and get free one-on-one with one off the doctors. I'm curious about my AMH since the one test in India came back so low, thus I will go. Talking with a doctor will help too. I'll probably avoid sitting next to the peppy people. Shouldn't be hard. I've noticed that everyone avoids people with recent failed cycles. I guess it's like the pregnant girl in high school - they don't want to "catch" it. 

New Advances in Infertility

Each of these mouse pups was born from an egg scientists created using embryonic stem cells. 

On thursday, NPR had a fascinating story on a breakthrough discovery for infertility. Even more fascinating  they did it with induced pluripotent stem cells (as opposed to the controversial embryonic stem cells). If they can do it for women, then not only will it reduce/eliminate the biological clock worry, but also provide a solution for the dreaded "unexplained infertility" diagnosis that plagues so many women. This will be a game changer for future generations of infertile women. There are even great implications for men with sperm issues, as well  as the many hurdles faced by the LGBT community.

Alas, this will not apply to many of us currently in the throes of infertility. All is not lost. Many doctors are currently working on various cell technologies that apply to infertility. Autologous Endometrial Coculture is one example of a technology promising encouraging results. What does all that fancy wording mean? The short of is that they take cells from the lining of a woman's uterus and use them as a more natural environment for fertilized eggs than the previous methods. Studies have shown that in certain cases embryo development is improved, as are IVF success rates.

Dr. Patel's clinic in India is working with a similar concept: certain clients can qualify for the case study in which natural cells from the IVF patient are used to surround the egg pre-fertilization. They are seeing an increase in fertilized eggs and while it's too early to determine if this results in actual healthy babies born, I can say I was very impressed to learn that 3 out of 4 of my eggs were fertilized with this method. There is more to this method than I am [purposely] describing, but that is better left to the professionals or perhaps, when I can be less emotionally attached to the subject matter.

I have no idea if this will help the quality of my eggs/embryos in the long run, but it is still very exciting. My first cycle ended up with 2 eggs and only 1 of those fertilized. That 1 egg took over 24 hours to fertilize. On my second cycle (with the new protocol) I had 4 eggs extracted and out of those 3 fertilized. Like my first cycle, one of those was a late bloomer, but maybe it's the one implanted now and thus causing a lower hcg. Apparently my case is not an anomaly as the Akanksha Infertility Clinic is seeing really encouraging results with women that qualify for the case study. Even if it doesn't work for me, I will be really excited if this helps improve success rates for women in general.

Science is so cool. 

Day 1 and 2 with the doc

Some of my meds

Yesterday was my first visit with the doctor. We thought we were going to have to aspirate my cyst, but Dr. P thought we should check my hormone levels first. We would only aspirate if the hormones were off.

 Last cycle I had a 3cm cyst and my estradiol was way off. I only had 3 follicles and we had to aspirate in order to proceed and get my hormones back in line. Once it was aspirated (general anesthesia - ACK!), we saw 14 follicles. Not exactly sure how that works (were they hiding???, why were we able to see more later on the unaffected ovary?), but that made the initial panic of 3 follicles easier to deal with.

This time I knew I had a 5cm cyst walking in. Turns out it had reduced to 2cm, but I only have 5 follicles currently showing. 4 and 1. My hormone levels came back normal, so we opted not to aspirate. Dr. P ordered an AMH test, and I get the results back tomorrow. Truthfully, I am a bit horrified to get the results back from that one. The follicle thing I can not worry about and simply hope more "appear", but a bad AMH right off that bat will crush me.

We are starting off with a stronger course of meds this time, though the Gonal F is at the same range we started last time (we increased it halfway through last time). 4 shots to the belly right now. Here is the breakdown:

gonal f - 375 IU

luveris/lutropin - 75 x .2

lupride/ leuprolide - 1. mil IU

human chorionic gonadotropin (hCG): HOCOG - 1250 IU

I started researching some stuff yesterday and then I just stopped. It was too depressing and I don't think it is doing me any favors right now. Hopefully my AMH has not tanked (it was 1.7 in February) and then I can be cautiously hopeful. Not even sure if cysts can affect AMH, but I'm too afraid to keep looking. 

Today I'm ok. Got shots in the belly and then socialized a bit with some other patients. For some reason, buying dog food to leave for homeless dogs (I especially worry about the lame ones) made me feel better. I don't know why, it just did. Maybe because it gives me a little bit of control or maybe it's because I feel like I can do a little tiny something to help. Right now I need a super simple way to make myself happy and that did it. I'm sure there are plenty of more laudable things I could be doing right now, but that comes with such complications at times and often tons more stress. 

I'll confess that in the last few weeks, I have, on occasion, semi-prayed. Given my atheist/agnostic ideology, this is quite complex to me internally. Not posting this because I want I bunch of comments regarding religion (quite the opposite), I just thought since it is part of my journey that I better fess up. If you are religious and are reading this, feel free to send your prayers, good vibes, or whatever else my way. I need all the help I can get. :-)

That's it for now. 

Special Lady Cocktails

When I first was swept up by the internet infertility tornado, I remember reading forum posts from other hopeful women. Falling on a theme (as I often do), I obsessed over the ridiculousness of women taking all kinds of crazy pills - usually without having a doctor recommend them. OMG! DO YOU JUST TAKE ANYTHING YOU FIND ON THE INTERNET??? Some posts swore by the helpfulness while others confessed that they worried it may have hurt. Once discovered, some doctors gave full-on lectures how it was not appropriate for the poster's situation, only to find out that someone else (usually another doctor) in their clinic had told them to take it. Truthfully, I was personally affronted that such naivety and desperateness could drive women to arbitrarily take anything in an attempt to conceive.

The picture above is from MY house. That's right, Ms. Holier-than-thou is ...well, the same as everyone else.

At first it started small. My first pill was THE PILL, and I was told I would have to take it by my Indian doctor to make sure I was synced properly for my IVF treatment. Fair enough. I called my OB/GYN and promptly got a prescription. Let me mention here that I do not like taking birth control pills (bcp) as not only does it make me gain weight and experience occasional nauseousness, but sometimes I experience additional glum side effects (depending on the brand). Fine - whatever - I set my alarm on my phone to give me a daily reminder; particularly because my history of remembering to take medicine on a daily basis is pretty dismal. Especially BCP. Our local IVF doctor also advised to add a pre-natal vitamin (another item bound to make me nauseous) and I immediately relented as I ran to our local Publix.

Baby aspirin and acupuncture were added to the regime - the latter being something I normally would have scoffed at a year earlier. Doctor semi-recommend it and so I shelled out the cash. My husband gave me the big-eye, but I'm guessing he recognized my fervent look and said nothing. 100 bucks a pop for 6 weeks = not cheap. What can I say except I wanted no regrets.

IVF treatment #1 was dismal. 2 eggs retrieved, only 1 fertilized. Even that 1 took a damn long time to fertilize.

Now I am prepping for treatment #2. In typical fashion, I have been obsessively researching similar cases. Not just blog posts, but academic papers and any type of current research I can lay my grubby little eyes on. A clinic in India recommended 25mg of DHEA for 3 months. I rush to pull up the scientific documentation and realized all of the research is really based on a tiny Tel Aviv study. The study showed a significant difference in live birth rates with women who were poor responders and took 75mg of DHEA for 40 days vs women who did not. A follow-up study had additional encouraging results. Screw the 25mgs -I only had about 40 days till cycle, I was going to go full boat - 75mgs it is! [I would like to make a note here that I was not able to take the full 75mg initially because of side effects. I had to build up and even now I have minor side effects.]

Next I read how melatonin could also help woman with poor ovarian reserve and immediately I was hunting down more articles and recommended amounts. 3mgs seemed to be the magical number, but that amount knocked me on my butt. Still 1-2mg was doable and thus it was added. Combining it with the DHEA means I sleep really well, but I'm groggy as all get-out when I wake up. Heaven help me if I don't get a full 8-9 hours. Oddly enough, my friend says she takes 10mg all the time and it barely helps her sleep. What can I say? I'm a lightweight.

Did I stop there? Heck no! I was on a search that day and after reading some articles (which I can not find at the moment) regarding myo-inositol, my amazon shopping cart increased. Among other things, myo-inositol was suppose to help women with cyst issues and a giant cyst almost caused a no-go last cycle. My OB/GYN found a cyst last year and I began to wonder if some of the pain issues I had felt over the last year were cyst related. GIVE ME MYO-INOSITOL NOW!!!

There were a few other things on the list, but these 3 new items had good scientific data to back them up and they applied to women with similar (if not exact) conditions. The other pills I noticed my fellow women-at-arms were taking were either less scientifically regarded or didn't apply to me. Besides, as I mentioned before, I'm a light weight and I wanted to see how I was going to handle this new concoction.

Which brings me to last week. I'm not quite sure HOW I ended up at the Rainbow (read: hippie) Grocery store - but all of a sudden I found myself at the cashier's stand with CoQ10, some fancy fish oil supplements, and yes even some Royal Jelly that was well hidden in a jar of honey. And some awesome low-sugar dried mango. And a yummy nut mix. And Activated Charcoal that I told myself would be good to have on hand if my dogs ever get into something they shouldn't. Somehow I think my subconscious was trying for an easy excuse to get some for me. You know. Just in case.

"Just a spoon full of sugar..." (or honey) 

Decisions, decisions

While we already know we want to cycle again as possible, it is very hard deciding where. There are so many pros and cons to the different locations - have to decide quickly. Due to my age and low previous response, it is imperative that I choose someone that has a high success rate for MY given situation. That's harder to determine (outside of US) than one would think. 

First day jitters

Our nice A/C waiting room is for IVF peeps only. We waited only a short time (by universal doctor standards) to have our initial consult and then blood drawn. After which, we grabbed some lunch at The Rama Hotel's Thalis restaurant. Both my husband and myself enjoyed it very much, although it was on the sweeter side of his preference - typical of Gujarati cuisine according to him.

After lunch, we came back to the clinic as directed. After another short wait we were able to see Dr. Patel. She was concerned about a high estradiol level and we went over the dreaded "you're 40 speech". I appreciate the honesty, but that is one "tut-tut" I've grown weary of, regardless the source. We followed up with a scan that gave us more bad news: only 3 follicles and a 2cm cyst. The cyst would have to be aspirated to insure the highest chance of success. Come back at 5:30pm. Eat or drink nothing.

"Ok!!!! Wait what?" We had 3 hours to burn in the heat of Anand (currently at 104 F) and I was instructed not to drink. Fine. We took a rickshaw/tuk-tuk (my first ever!) to the famed Big Bazaar (BB) where even the girls in Bedazzled burkas stared at me. The BB here is like a really tiny Walmart with food items. Even though the drinks were in a refrigerated area, the want to drink was too much and I walked back over to the skin lotion aisle. The Nivea whitening lotion I bought is a testiment on how well marketing works (I've seen the commercial 30+ times now, and it has convinced I'm covered in spots from skin damage, even though I'm not positive that's what the Hindi spoken commercial says.)

After BB, we return to the hotel for an hour, and then back to the clinic. At the clinic, in a not so A/C area, I'm handed a consent form to sign. I ask what it is for and I understand it is for the anesthesia; it's at this point I realize I will be getting GENERAL anesthesia and not local. Ask my husband to confirm this and he does. Crap. I'm not known for doing well under general anesthesia. I prepare myself (and others) for the liklihood of puking.

Fortunately, I did not puke when they woke me up, but my husband was asking me what the class of antibiotics was that I have a problem with. Once we figured that all out, an older lady in a white sari added a yellow liquid filled syringe to my empty IV. They let me rest till I was good and ready to come back downstairs.

Dr. Patel informed us that once the cyst was aspirated, she could see 14 follicles. Yay!!! I had to confer with my husband that I understood correctly. Not because any language barrier, but because I still felt a little loopy. He said yes and I was jubilant, if not completely dexterous.

That pretty much was the end of our first day. We went back to the hotel for me to rest, which really turned into me going to bed for the night. My poor husband missed dinner for the second night in a row.

If I were a fertility clinic, I would...

buy a billboard. Or a commercial. Or maybe both. And explain to anyone who would listen:
"if you are a woman over 30 that wants the chance of pregnancy - freeze those eggs baby".  Seriously. Why don't they tell us how DRASTICALLY our odds decrease as we women age? They'd make more money if they did.

Sure, sure, sure, we hear about "our biological clock ticketing", but I never even thought of what that meant. I've spent most of my adult life trying to make sure I didn't GET pregnant. When people talk about a woman's biological clock, they don't even put an age with it. I though it meant there was some internal biological EMOTIONAL clock that tells childless women they want babies as they age. Had no idea it meant "your eggs will turn craptastic with every passing month."

I swear if we are lucky enough to have a baby, I'm going to post those age egg charts all over facebook and google + as a PSA. Normally I wouldn't because I don't like people knowing my biz, but this is serious. Wish someone had done it years ago when I was first married.