Amniocentesis and another 2WW.

From: http://www.webmd.com/baby/twin-pregnancy-types

Thursday we had our amniocentesis. What a nightmare. It was really important for us to have one, but holy crap that stuff is scary.

The doctor certainly didn't help. It was that same irritating douchey specialist from the other week.

I guess I should back up a bit since I've been MIA.

The cell-free DNA test ended up coming back inconclusive. That's right, the test that the doctor recommended and then we found out afterwards that the manufacturing company doesn't always recommend for multiples or donor eggs (and since this is surrogacy, my eggs are considered donor) - came back inconclusive. Shocking. They wanted my SIL (our surrogate) to come back in for another. She called me and gave me the update. The nurse was really pressuring my SIL to come back in for another try at this test that is only partially covered by insurance.

After thinking about it, I told my SIL not to get it. It didn't make sense. Why should she have to take extra time off from work for a test that was not going to tell us anything different than the amniocentesis that we had already decided we were doing. Why should we pay even MORE money for a test that didn't give us anything different? Why should we put her through an unnecessary poking that could very well end up being inaccurate or inconclusive. I told her to not worry about going back for the test.

And then she called back. The nurse was EXTREMELY insistent that she come back for this test. At this point I because very irritated (not at my SIL, but at this Dr.'s office.) It was clear that they wanted us to do this test to try and convince us against the amnio. I told my SIL not to stress about it and I would straighten everything out with the Dr.'s office.

Ready to rage war, I started making phone calls. First I called our old fertility clinic ACRM. Our nurse that took over our case when our original nurse was promoted was nothing short of awesome, and I wanted to ping her for her advice. Then I walked outside my office, took a deep breath, and called the specialist's office.

The nurse that spoke to my SIL was not available, but another person in the office was able to call me back fairly quick. That conversation did not go as expected. Actually - it went quite well. The nurse (I think she was a nurse - but we will call her one anyway) was awesome. She is similar in age to me and she confided that she would consider the amnio if she was in the same situation. She explained why the other test was inconclusive and agreed that if we were going with the amnio, then it was not necessary to get the cell-free DNA test - especially so close together. We talked for quite awhile and she restored my faith in this part of the process.

Hubby and I decided that maybe it would be better to have the amnio done at an office closer to us. Maybe staff at a Decatur/Atlanta office would be more professional that some of our previous encounters at the Fayetteville office (like the bad nurse my SIL talked to). Heck, I'll bet the Fayetteville office, even though quite modern and large, has never even seen a mixed Indian/Caucasian couple, much less one using surrogacy. It would be the same doctor (groan), but hopefully no sight of other staff members with similar issues. (Atlanta is completely different than most of the rest of GA.) We would still do the regular appointments closer to where my SIL lives, but we felt safer with the amnio in a more diverse setting.

Fast forward to Thursday: amnio test day. Meep.

We knew that my hubby would be about 15 minutes late due to work constraints, but we really wanted the time to be more convenient for our SIL and let her set it. So when the doctor came in after the initial ultrasound, hubby had not arrived yet. The doctor started off with "are you sure you still want to do this?" and I had to resist the urge of having a fit. Both SIL and I answered in the affirmative.

The doctor then explained that since there were twins, the first injection would have an add-on of dye. The barrel part of the syringe is interchangeable and thus one needle can be used to insert dye, screwed off, and another barrel placed on to gather the amniotic fluid. This insures that you are hitting the same place and that you don't have to puncture multiple times. The purpose of the dye is when they go to do the second amnio on twin B, they make sure they get the fluid from twin b and not twin a again. Apparently the sacs can be all over the place.

Guess what happened? 

Removing fluid for the second amnio showed blue dye. The doctor stopped and asked us if we wanted to continue. By now my husband has arrived and we have to explain what the blue dye is and what it means. It also, all of a sudden, occurs to me that 2 punctures to the same sac means we have just doubled that baby's chance of miscarriage. And the doctor says that if he hits it a third time it will triple it. And if one miscarries, then it can make the second one miscarry.

I sat shaking. Oh - and I haven't even MENTIONED how horrible this looked for my SIL. The first one didn't look painful until they removed the needle, but the second one definitely looked painful. What to do what to do? I felt paralyzed. Secretly I wished my husband would make the decision for us, but I knew that wasn't fair. My SIL turned to us and said she was fine if we wanted to continue. She continuously amazes me.

While the doctor started rambling on about some of our other options, I quietly thought to myself. There was a pause and I explained to my husband again, because I felt it had been glossed over, that the second puncture had increased the chances of miscarriage and a third would triple it. I stated it again to make sure my understanding was correct. The doctor said it was and my husband started asking more questions. Again I reach internally and quietly thought to myself.

What I realized was that my initial fears of chromosomal abnormality had not changed. I still couldn't deal with certain outcomes, but now I was increasing the chance of making a good outcome bad. And I didn't have my comforting statistics on hand to let me know what was optimal. Ultimately I internally decided that I felt we should continue. And to nut punch the doctor if he pierced the wrong sac again. My SIL reiterated she was fine to continue today.

I overheard the doctor saying we could try again in a week or two. This made ZERO sense because then you would definitely be piercing the twin A 3x (because you would have to do the dye again) and the timing would be off if we had to make other decisions. My husband turned stonecold at this point and told him "Just do it now." Hubby looked at me and I nodded my head yes.

The doctor found another area that he sounded more confident with injecting. Complete opposite side that had not been available (baby moved) previously. My husband asked him "between 0 and 100% what it your confidence rate that you won't hit Twin A a third time?" The doctor replied "Oh you can never be 100%" and didn't answer the question. Hubby repeated the question again and doctor replied "I'm very confident". Which of course we followed up with "how much is VERY???" His reply: "At LEAST 50%." Facepalm.

The doctor had to get into a weird hand position to access the third location. The dye check occurred and this time it was clear. We all breathed a big sigh, but the room was still incredibly tense. I could tell it was painful for our SIL. I watched as the doctor withdrew the amniotic fluid and saw his hands visibly shake the entire time. I have no idea if it was because he was old, nervous, or just because his hands were in a really awkward position. I decided that it would make the situation worse to announce "WTF is wrong with your hands?!?" mid-withdraw, so I stayed silent. (I did tell hubby, mommy, and SIL later.)

It was over. We were done. We asked SIL if she was ok. She said she was. Hubby ran downstairs to pharmacy because the doctors office didn't provide any after pain medicine and we didn't want her hurting on the long drive home. Tylenol was fine the staff said. SIL said she was fine, but hubby ran to get some Tylenol anyway.

My mother was waiting in the lobby when we were done. She had graciously volunteered to drive my SIL when we realized the night before that she shouldn't drive herself. Doctor's office failed to mention this. Hubby ran back downstairs and got drinks and Reese's peanut butter cups for everyone. We talked for about an hour to make sure SIL was feeling ok, before the long drive home.

At the end, we scheduled our appointment for the next ultrasound. We decided that Fridays would work best for everyone, rather than Thursdays. The front desk lady informed us that we would have a different doctor if we went on Fridays. Without getting mad, or causing a scene, I simply replied "GOOD" and she made the appointment. 

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. 

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!

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. :-) 

Third Party Coordination Goes Awry - Meds Edition

A few weeks ago I had to figure out where to order my and my surrogate's meds from. ACRM recommended 3 pharmacies and called the Rx in to all 3, allowing me to compare prices and such. One of these pharmacies, Village Fertility Pharmacy, actually had the forethought to test my insurance coverage even though I told them it wouldn't be covered. Thankfully I was wrong, so we went with them (a huge bulk of mine were covered!) I ordered both mine and my surrogates meds, shipping to our respective homes. Mine took 1-2 days. 

Since we paying ACRM extra money (~$3100) to do "third party coordination", I naturally thought that if I ordered the meds, that they would do more of the "coordination" and stuff. Honestly, they have not done a good job with this. Repeatedly I feel like I'm running around like a crazy person doing the bulk of the coordinating. With my ADD and new job, this is terrifically difficult for me. 

When my GC came in for her appointment on Monday, they gave her a written Rx for her meds and told her to fill it. No one thought "hey, we've already placed an order with the IP a few weeks ago, maybe we should check on that." The reason I found out? The nurse copied me on an email to the GC that said "You don't need to pick up the Lupron in your original order." All of a sudden I was like "Is this a double order???" The nurse emailed me at first and said that maybe the fertility pharmacy sent the Rx to Kroger. I asked my GC, and she said no - no one told her  about the previous med order and ACRM just gave her the Rx when she went for her baseline ultrasound. She was suppose to start meds that day and not one red flag was thrown up. A few back and forth emails, and it was apparent that no one on their end was really keeping tabs on this. 

Truthfully I should have checked that her med order went through smoothly weeks ago when I got mine. I had informed my nurse that I had received mine, but then got violently ill and forgot to double check if our GC got hers. I had no reason to believe she didn't and I guess with all the balls I am juggling, that was another one I dropped. I'm terrible at organizing these types of things, which is why I didn't mind paying the extra money to the clinic to do so. And I really don't consider $3100 a small fee to do this. As I am sure you have already guessed, our GC did not receive her meds from Village Fertility and it upsets me that I feel like I'm having to do the bulk of "third party coordinating" while paying them a chunk of extra cash. (Yes, I know some of this goes towards the medical aspect, but we were also told it goes towards things like this.)

All of this resulted in frantic phone calls, in the middle of a workday, with my very public cube, to multiple people. This is sucktastic for me to have to do at a new job. Village Fertility Pharmacy said they did not ship the GC order because they had left 2 messages to set-up a profile for the GC and she did not call back. My GC said she never received the messages and I 100% believe her. I asked Village why they didn't call me when they couldn't reach her, and they admitted they should have. (As a side note: I am very forgiving when people admit mistakes and then do whatever they need to do to correct it - Village did this.) Village apologize and after I altered the order (minus the no longer needed Lupron and minus the already procured Estrace), they were able to ship out overnight. 

In the long run, I think the mess-ups of everyone (me, the clinic, and the pharmacy) saved me money, but that still doesn't give me a warm and fuzzy. Especially mid-cycle. I'll write more later on my HUGE upset about a screw-up in charges. It's a freaking shame because we adore our doctor over there. 

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 1.5

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. 

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. 

In Today's Surrogate News...

image from: here

The long awaited surrogate news is here! 

Our surrogate and her husband are still gung-ho - YAY!!!! Ms L went for her hysteroscopy and HSG testing Thursday and Friday. We haven't heard the official news from the clinic yet, but she is under the impression that everything came back great. Double yay! I'll let myself have that little bit for now.

On the flip side, my surrogate and her husband, both whom are very close to us, are having trouble quitting smoking. If she doesn't quit soon, then it will be a no-go. Quitting smoking is super-tough and she feels awful that she hasn't been able to quit yet. Was there myself once-upon-a-time and it sucks.

We went ahead and asked them if they wanted to try Chantix (we'd pay for it) and made sure with our clinic that it would be ok for them to take. They both wanted to give it a shot and we were happy when our RE said it was ok. We were about to go meet them on Saturday when our water heater expansion tank sprang a leak. Fortunately showered just minutes before the leak was discovered... 

Anytime you find a large puddle of water on your floor you should probably be concerned, but honestly I was more concerned about meeting with Ms.+ Mr. L. We called a friend and my dad to ask some questions, turned a faucet valve that was connected, let hot water run out in the sink, placed a bucket under the leak, and left to go meet them. 

Meeting went great - picked up Chantix Rx and then grabbed dinner with both of them and their little one. Afterwards we had a get-together at a friend's house where it was pretty paramount that we show our face. It's a close friend (he introduced us!!!) and we think we weren't invited to his wedding a month ago because we have been soooooo MIA - we hadn't even met his now-wife until last night. They had been dating for a little over a year. When we returned home much later we found the leak still going strong. A little digging around outside and in the garage led to the discovery of another valve to turn off ALL water. The first one turned out to be just for hot water. 

I hope the Chantix works. It helped me quit smoking years ago, but I know some people report serious side effects and can't take the medication. Chantix is not covered under their insurance either, but Mr. L's doctor gave him a $75 coupon. Oddly enough, Ms L's only have her a $40 one. Weird huh? We were able to use the $75 one. 

Now we go full speed for the other things. On the schedule of phone calls tomorrow is lawyer (required by our clinic), blood work for all, and psych tests for all. Wait what was that last part??? Yea, our third party coordinator said that we would have to ALL have a psych eval. Having a psych eval doesn't bother me (it probably should!), but after 2 failed surro cycles in India I really don't understand why it is necessary. I sent an email to our third party coordinator asking about the necessity (ie. requirement), of this for my husband and I. If it isn't required then I really don't see the need to spend additional monies on it. We didn't have it in India and I don't feel like we need it now. (The surrogate did have one in India and I understand why it is required here.) 

And I'm not sure how we haven't really talked with the financial coordinator at our clinic thus far, but I guess we need to schedule that as well. Sigh. At least then we will know better what to expect. Our original information from the clinic did not include costs for surrogacy. That becomes an entire new list of line items. 

I don't know how I'm going to take off all this time from work. All day psych evals? Appointments at an attorney office? More medical stuff? I don't know how our surrogate is going to be able to take the time off either - though of course we will give her money for any missed work. She starts a new job next week and while we are both super-duper tight with her boss, I think it's still awkward to take time off when you first start at a company. Even if the boss is totally ok with it. 

Sigh. So that's the update. Prior, I steeled myself to expect the worst with her hysteroscopy/HSG tests and now I feel unexpectedly elated. Even after feeling all doom-and-gloom about the cigarette stuff for the last week and a half. I'm still going to be cautious about getting too excited with regards to that, but I've let myself be hopeful for the weekend.

Course not having water it beginning to suck. Guess I should put "plumber" on my list of phone calls for tomorrow. Wouldn't that be funny if that was the phone call I forgot to make tomorrow? (I refused to pay Sunday plumber rates.) My BFF called earlier and said we could take a shower at her house if necessary. Since she could smell me all the way from there... She's a keeper. :-) 

You have questions...We have answers

Actually I need your answers, so if any of this sounds familiar please post your experience/knowledge in the comment section.

On Tuesday night, I attended a seminar at my old clinic ACRM, here in Atlanta. I described some of it here and also pinky-swear promised to post the questions I posed to the new doctor during the Q&A session. (Ok, I didn't really pinky-swear, but I wrote I would, which is almost like the same thing.)

So here are the questions I asked.

1.) Can endometriosis affect the outcome of an IVF cycle if the woman is using a surrogate?
A.) Yes it is possible. [Sadly I have forgotten the reason behind it. I believe she did mention that there could be an effect on the eggs in a follicle and thus less eggs retrieved, but for the life of me I can't remember if she said certain things or if I am confusing it with stuff I have read.]

2.) Besides cost, what are some of the downsides of using ICSI?
A.) There have been studies done of the offspring conceived by ICSI and it was noted that the male children had a higher rate of sperm problems. Whether this is a cause of the ICSI or due to genetics (ie, the father having sperm issues thus ICSI was used) is unknown. 

[This one I already knew the answer to, but I wanted to make sure there wasn't anything else I didn't know about. Primarily because our clinic in India uses ICSI as a default with no extra charge (unlike here in the States).]


3.) How long after a laparoscopy, do you need to wait to start an IVF cycle?
A.) Generally the recovery time is short and we like to do the next cycle as soon as possible. Especially if the woman is older.
[I know they can't do it the same month as IVF, so I'm guessing that means you just have to wait until the next month.]

I'm getting conflicting statements about #1 and I'm a little concerned about it. Everything I read regarding endometriosis and IVF revolves around the woman carrying the baby, there is very little info for women using a surrogate.

My new OB/GYN did not seem to think that endometriosis would be a problem for me (with regards to lowering my IVF success rates) since we weren't using my uterus. In fact he thought there was a low likelihood that I had it since some of my symptoms were relieved with my cryoablation. He advised for me to find out if the cyst I had aspirated during my first IVF cycle was a chocolate cyst. He did mention at the end of our lengthy consultation that he did not specialize in reproductive endocrinology, so I'm guessing that was his out if he was wrong. The only surrogate cases he probably has is if someone walked into his office who IS a surrogate and already pregnant. Also this WAS before they locked me in the bathroom.

Conversely, Dr. GS on SIRM's forum indicated endometriosis could cause a problem in my case, but it was hard to tell if he understood that I would not be CARRYING the child. Even though I definitely mentioned it. (I am awaiting on a response for that clarification.) He mostly pointed me to articles that either talked about the problems in the woman's lining (and toxins activated in it) or in one case a long article he wrote with one tiny sentence that suggested a gestational surrogate would be a better option. That seemed to contradict his reply to me. Anyhow, I've awaiting clarification.  [UPDATE: Dr. GS did reply and state he missed the part about gestational surrogacy. He said that in the case of immunologic implantation dysfunction, it wouldn't apply to me, but an endometriotic cyst would affect egg quality.]

The REASON I'm even asking is because I don't know if I should be tested for it. We have decided to cycle again, but this may be my last one and I want to optimize my chances. If endometriosis can affect my eggs pre-aspiration, then it seems like a good idea to be tested and get any problems fixed. On the FLIP side, scheduling and doing a laparoscopy  plus recovery time could add a couple of months to the process - thus lowering our chances. PLUS some doctors advise against laparoscopic surgery for poor responders as it can further lower your ovarian reserve and raise FSH levels.

What to do, what to do. Time to go have a real one-on-one with our ACRM doctors again.

As I said at the beginning, feel free to chime in. 

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. 

Good article about surrogacy in India

Not familiar with this news source here in India, but the few articles I perused were done quite well. The article they have on surrogacy is here: http://gulfnews.com/life-style/general/india-s-rent-a-womb-industry-is-booming-1.1073056. Though I don't particularly care for the first picture they have in the slides, the article is a positive one none-the-less. Worth the read.

Note: the article is a bit confusing when it is referring to clinics . Even as a person who knows a ton about my clinic, I had some confusion when they flip between some details about clinics. For example, on page  1, the author writes "Parvati works for – Akanksha Infertility Clinic" and noting earlier that is is located in Ahmedabad. Then they flip to "Dr Kamini Patel, the director of Vani IVF Centre, in Ahmedabad". Even though these two clinic are in Gujarat and both have a Dr. Patel, they are two completely different clinics. The article flips back and forth between quotes from Parvati and quotes from Dr. Kamini, that it sounds like they are the same clinic. I actually wonder if they just misprinted which clinic Parvati was with. 

Also, while the Vani IVF Center they refer to frequently and write as having 48 surrogate babies born, I do want to note that Dr. Nayna Patel at the Akanksha Infertility Clinic has had over 500 surrogates born as of June of this year. I know this because I was here for the HUGE celebration, flanked with media from all over. I include this information because I can see that the most people would confuse the two clinics when reading the article. 

Spot Check Part 2: Calming down

Right now I've calmed down enough to realize my spotting yesterday may  have been caused by the sonogram on Thursday. It has happened before with a sonogram. I don't know why it didn't occur to me till this afternoon when I was at a baby shower and was relieved to see no blood on a ladies room break. (Sorry to be so graphic.)  Or it could have been a minor nick on the cyst. I think if it had burst at 5cm, then there would have been a lot more blood.

Must have been pale as a ghost last night and my wonderful hubby helped calm me down. All I could think of was how I had some how messed up my last chance. I'm still a little worried, but not massively freaked out like I was last night. Tiny, tiny spot this morning, but then no more blood today. I was so freaked out last night I took an extra BCP. I may take extra ones till the 5th just to be sure.

Thinking that my side effects (like dizzy) may be merely from the cyst itself. (Or the freak out!) Not surprised that I had one as I had started cramping on occasion. I'm not bleeding today, so I'm hoping and hoping that the sonogram caused it. If I'm ok till Monday, then I will be able to breath a sigh of relief. If I'm not, I will contact Dr. Patel in India. As long as I am not bleeding, I will try not to worry.

In other news, if all goes well, I will have my cyst aspirated in India. Not ideal (will be alone initially and I will have to undergo general anesthesia), but I don't have much of a choice. Was able to confirm that my OB/GYN had been talking about laparoscopy and Dr. Patel said that she would have to cancel the cycle if I did that. Dr. I's staff (and he) were using laparoscopy and aspiration interchangeably (they most certainly are NOT) and after a series of confusing discussions with his staff, I was finally able to clarify with him on Friday morning. Apparently he DOES NOT aspirate, and told me that an infertility clinic would have to do that.

We have a really good infertility clinic here (ACRM) that we have used for all of our initial tests, but the chance I would be able to get an appointment in time are very slim. Not to mention that it most certainly WOULD NOT be covered under insurance. My old company insurance covered some things, but my husband's BCBS covers next to nothing for infertility. The mere fact something is done at an infertility clinic usually means they won't pay for it. The money we have spent at the infertility clinic does not even go against our yearly deductible.

Just as well. My husband did not have a warm and fuzzy about my having it so close to international travel. And my travel to India is not direct - it usually takes about 36 hours of travel time. I don't sleep well on planes, trains, or automobiles (all of which I have to take), so it's best to do it in India. Dr. Patel said she would do it and she did it last time. Pretty sure she didn't even charge us extra. Hopefully it doesn't affect the cycle.

Please keep your hopes/prayers/warm wishes for me that it was just a result from the sonogram and that I will have a successful cycle in Anand. 

Simple Cyst

When I woke up this morning, I wondered if I should just stay in bed. Was trying to get 8 CONTINUOUS hours of sleep, which is nearly impossible in my house due to the fact that I stay up too late and my husband gets up early. A bad dream woke me up after 6 1/2 hours. I tried to go back to sleep until my husband's 7am alarm, but I never really did.

I should have just stayed in bed the rest of the day. Already I felt weepy.

At 9:20 am I had a followup appointment at my OB/GYN's office (Dr. I) to check for cysts. I didn't even have to ask this time, the big black space on the monitor told me everything. Then I met with the doctor, where he informed me that I have a minor "simple cyst" and not to worry. Except I do worry. And then I asked the size... 5 x 4.1 cm. Look, I may not be a doctor, but that's not small. I think the one that threw off my cycle last time was smaller than that and that we had to aspirate before proceeding.

I reminded Dr. I that I was starting IVF in September and that a cyst was a problem last time. He said we could check in a few weeks, that it would probably burst on it's own. Without losing my shit, I explained I would be on a plane next Thursday. He still seemed mighty casual about it all and said that if we wanted to PUSH to remove it, then I would have to undergo GENERAL anesthesia. Still keeping my cool (I'm not sure how), I informed him that I had to have general anesthesia in India to have it aspirated anyway and that I would much prefer doing it here, then letting it mess up my cycle. He was nice about it and all, but hellz balls I'm frustrated.

Initially I thought I would ask my doctor in India (Dr. P) what to do (which I did), but I also wanted to go ahead and schedule my appointment here. In India they immediately gave me anesthesia and aspirated, in the USA you have to have appointments way ahead of time. After returning home, it occurred to me that he had really been saying laparoscopy removal when he was talking about general anesthesia. I have NO IDEA why he didn't just suggest aspirating it as that is what I told him we had to do last time.

Months ago I had asked my Indian Dr if I should get a laparoscopy to check for endometriosis or just get some sonograms to check for cysts. She only wanted me to do the sonogram and distinctly said no to the laparoscopy. When I called Dr. I to schedule it (had to calm my mind down and go home first), I asked to have it aspirated. If Dr. P wants me to wait till I get there, then I can always cancel. I don't even know if it will be covered on insurance here.

When I come back from India, I will be having a laparoscopy to test for endometriosis. After today, I may want to try to find a different OB/GYN. I miss my old one (had him since I was 15!) and his small practice ways. There is something to be said about a doctor and his staff knowing you every time you walk through the door and remembering everything you tell them.

Waiting for the flood gates to open. If I cry now, then I may be ok when I see hubby later.

I guess the myo-inositol didn't work. 

An argument, a wedding, and a memorial

from: http://www.ghank.com/sad-pictures/

Last week had it's ups and downs that melted into this week.

1.) An argument
Hubby and I had a big fight about if we will try again with my eggs after my second treatment in September. He's of the opinion that if I don't have a significant change in number of eggs retrieved, than it is pointless to even try. I'm of the opinion that it takes at least 2 cycles to even know the best treatment path. Truthfully, I see his point, but we really didn't need to GO THERE until we see if I improve at all. I need the hope right now.

We are going back to our original clinic. We had to make a decision and truth be told, our other India option did not get back to us with information promised; even after reminded. In fact, after the reminder I was basically told that the original person that was getting the information just had a baby and no information on if someone else would be getting the info or how long I would have to wait. I'm 40 years old and I really can't wait - hoping that they will get back to me. Every month lowers my chances. It's a shame because I really thought we would be going there instead. Maybe we will if they ever get back to me and IF I show improvement; two big ifs.

2.) A Wedding
My little (half) brother was married last weekend. The only reason I put "half" is because of the #3 part of this post. He is not part of that side of the family, even though he 100% part of mine.

Any how, the wedding was great and I could not be happier. He asked me to be the photographer and I happily acquiesced once it was known that I only "play a photographer on TV". Expensive equipment != good wedding photographer. The wedding was small, but really wonderful and I was able to spend time with family as well as people I have not seen in a really long time.

I spent the two weeks prior practicing with my camera and now need to spend a fair amount of time editing the wedding pics I have. Very critical of myself, but I hope they like it.

3.) A Memorial
My father died when I was 3. I won't belabor all the wah-wah tragedy of how it affected my life, but I will say this: with the exception my Grandparents and 2 others, the rest of that side of the family (which is large)  has pretty much ignored me most of my life. What is that saying? "The opposite of love is not hate, but indifference."

Last fall my Grandfather died and I was fortunate enough to be able to say my goodbyes by flying over to Sweden a few weeks prior. My Grandfather was the closest thing I had to a dad growing up. There was a funeral in Sweden, but half of the ashes were kept to be delivered to the US, as all of the children and grandchildren live here. In typical fashion, my family consulted neither me nor my older brother about availability for a memorial date. We were told last week that it would be in Sept.

While I tried to explain that I would be in India for medical reasons in September and asked if it could be rescheduled, I was informed that reservations had already been made by others (only a day later) and the date was chosen because it had the best weather for NC. Great - now I fall below weather. For the first time in my life, in a long, but respectful manner, I told them that their lifetime apathy towards my father's side of the family (my brother and I) was unacceptable. As the good little, quiet girl, I'm sure it has sent ripples throughout the family.

I don't pat myself on the back for adding grief during a hard time (as one Uncle put it), but for my own sanity it had to be done. Grandpa died last fall and they have had plenty of time to contact us instead of "oh freaking well - this is the date we choose - too bad for you." My grandfather told us we were to be considered as the stand-in for my father, and we have never been given that respect.

Maybe since I've finally said it, I can move on. Maybe this is the wake-up point where I tell myself that I need to make sure I'm not an absentee family member to my nieces and nephews. Maybe I won't keep myself up at night wondering why the hell so many didn't give a damn for so many years. Maybe I can accept that is our role, I've had my say about it, and concentrate on those around me that have CONTINUOUSLY SHOWN love as long as they have known me. Maybe. 

Open letter to The Hindu (newspaper)

Thanks to Douglas over at Just One Out of Seven Billion for bringing an article by The Hindu, to my attention.  Below is an open letter to the editor based on a similarly emailed letter.

-------------------------------------------------------------------------------------------------

Regarding your article here: http://www.thehindu.com/news/national/article3640405.ece, I am surprised and saddened to see such a bias-based article written by The Hindu. There are several misrepresentations that I will list for your consideration.


1.) Thanks to the emergence of surrogate motherhood as a multimillion-dollar industry in the country, the clinic is doing a roaring business. What is the success formula? An unending supply of poor and illiterate women and the absence of laws have made the trade the fastest way to make money.

No source referenced here (a mainstay of good journalism) on how the author came to the conclusion that this specific clinic's success is based on [the uteri] of poor/illiterate women. No mention on how the clinic in question has put a lot into the community to educate the surrogates and their children. No mention of the trust fund set up to assist current and previous surrogates to further themselves and their family. A simple query into the community will show you that Dr. Patel is highly revered for all she has done to help the women in her care. Simple research into print editions of The Times of India (Ahmedabad edition) or Hindustan Times would have shown this as well. Had the author inquired into proof of how the surrogates have had their lives changed by this clinic, then Dr. Patel would have been able to provide this.


2.) Another inmate had four foetuses in her womb, two of which were aborted as the couple did not want so many children. There is no clarity on whether two foetuses were aborted for medical reasons. 

Using the emotional term "inmate" aside,  a woman carrying 4 foetuses to full term is in extreme danger, as are the foestuses. A rudimentary check with a few respectible obstetricians would have enlightened this fact. A woman's survival rate and the babies survival rate is seriously compromised and often considered not worth the risk. A doctor that WOULD allow this should draw much more concern as in cases where it is allowed, it would appear that the woman's health is not the priority.


3.) A commissioning couple can get a surrogate for half the price in India compared to the cost in the U.S. or the U.K., where surrogacy is not allowed or permitted only in special cases. European countries do not allow surrogacy at all. 

While I could lament on the economic differences between these countries and how comaparing them is extremely misleading, I will simply point out the cost of the average 1000 sqft flat in Vastrapura (located in the state of the clinic mentioned in this article) to allude my point: the [current] equivelent of 12-16K US dollars. To find the same home in the US at 3x the price would not only be almost impossible, but would most definitly require additional large funds to be habitated. That aside, this statement by the journalist, Aarti Dhar, is also false: surrogacy is most certainly allowed throughout the US. A few states may have particular laws disallowing it, but all one has to do is find a surrogate in a different state if there is any concern.

The statement on Europe is equally false as there is more than one European country that allows surrogacy, though like India, some do not have specific regulations in place. Even for the majority that do disallow it, the US has long been a place (much longer than India) for Europeans interested in surrogacy. Legal problems that were encountered in the US initially, such as the 1986 Baby M case, have been resolved by using gestational surrogacy only versus the traditional surrogacy.


The core principles of journalism dictate truthfulness, accuracy, objectivity, impartiality, fairness and public accountability. Since this article is not listed under the Opinion section and instead falls under the National section, it fails on all accounts. We can not address how women are being exploited in these circumstances, and I believe there is a high liklihood that they are in many places, if our newspapers do not give the information accurately and without bias. More importantly, we can not attempt to fix it. Very disappointing that The Hindu, with such a illustrious history and excellent reputation, failed on such a basic level.

Tick Tock - you don't stop.

from:  https://homes.bio.psu.edu/people/faculty/bshapiro/research.html 

My husband told his family recently that we are considering other clinics, but that he was leaving the final decision completely up to me. That said, we have to make our decision very quickly now. Time is of the essence and even though I promised him I would have one for him last night , I did not. Primarily I am waiting on some information from 2 clinics, but if I don't get it soon we may just have to make a decision without them. 

I'm 40 years old and every decision has to be done quickly to optimize our chances. Not only because my eggs age with every passing month, but also because I am not working while we go through this period. As I had a very good salary previously, that becomes a huge hit with every month that passes. Especially when you factor in all the extra expenses. Not to mention I'M 40. Sigh. 

My husband knows my proclivity to procrastinate when weighing all the options (I obsess over details) and  has a "super-power" to know what I want before I even voice the finality of it. If I don't have an answer for him in the next few days, he will take the lead and decide based on the facts I have given him. Knowing it's what needs to be done, I won't mind a bit. 

"Assume" makes an...

When I first started reading IVF blogs, I came across an elegantly written piece about why adoption was not the choice for everyone and how the poster was sick of people suggesting it. It was long post, and I wish I remembered who wrote it, but it was good. Really, really good. The post outlined perfectly why not only was it not an option for them and the reasons why it was not an option for many, but also how the constant mention added hurt to an already very difficult time.

That's what I felt like yesterday with yet another hint that we should consider donor eggs. 

I'm sure it wasn't intentional, the person probably thought they were being helpful - they weren't. At this time, egg donation is not an option for us. Period. Maybe that will change if I have additional failed cycles and other things fall into place, but 1 failed cycle does not = go straight to donor eggs for us. 1 failed cycle that I may add, produced a high grade embryo. I may not have responded as well as we had hoped, but that's what 1st cycles are all about - right? Learn how you respond and adjust.

Both my husband and I are educated people and we know exactly where we stand with odds. We are fortunate enough to have access to published information that is reserved for academics in the field, are avid researchers, and even have access to data that very few others are privy to. If anything, one can say I have analyzed data to death as data is my field of expertise. We do not even look at data the way a layperson does because we have a statistical and data background that let's us read beyond sheer numbers. We are well aware of EXACTLY where we stand. 

Besides the warm and fuzzy of having your own genetic child, we have bigger issues on why it's not an option: my husband is not a US citizen. We live in the US. An egg donor means our child would not be a US citizen and we could run into some very serious issues of not being able to return to the US or a child visa expiring while we are in the US. There are 20 things that could go wrong and quite frankly the added cost of it all (me not being able to work while this thing sorts out) is too much of a limbo for us. To badly paraphrase the great Jack Nicholas, "Go sell limbo somewhere else, we're all stocked up here". 

We could wait for my husband to become a citizen, but that can take a lot of time and his international travel could be limited during the process. That may or may not cause issues with his work and it would certainly cut out travel to India, something we would prefer not to do at the moment given his parents are elderly, have had health issues, and live in India. 

There are a TON more issues of WHY we choose to try to use my eggs right now and quite frankly I don't feel like listing them all at the moment. Between a baby shower and a email yesterday, I'm spent. The email was from a popular clinic and even though I have never worked with them before and have only had 1 failed IVF, there was a blatant suggestion that I consider the egg donor route. I'm sure it wasn't meant this way, but it felt the same way that all of us IVF'ers do when someone suggests that we quit being selfish and go adopt a needy child. It's not one of our current options and people shouldn't assume that it is. 

I seriously thought my tears were going to flow in front of everyone when I naively and happily opened that email from the clinic. In the middle of the baby shower no less. Let me clarify that I think the egg donor route is an excellent option for many people and I fully support that decision, - but for now it is not for us. 

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.