Yo - What's the Haps?

It's a tale as old as blogs. I've been MIA. I've even started posts offline, only to never finish them. (Ok, technically it was only one - BUT I've thought of a bunch of others.) I've lurked. Not on purpose mind you, but the feeder app on my iPhone doesn't do a great job of posting comments and so neither do I of late.

Ya, ya, ya - so what's the haps? Current status: GREAT. All scary tests have come back normal. YAY!!!!!

We are at 21 weeks and 4 days and everything is lookin' good so far.

Surro is having major stress with other family stuff, but she is holding up like a champ. She's a GD saint and all I can say is that I wish a plague on the horrible person causing her pain - except that plague would hurt other people I love, so I guess I really don't. But maybe I do because that person always hurts other people and she's sure to hurt the people I love again. Shew. Life sure is complicated.

We manged to live through our announcements. First we told family and any close friends that weren't already in the know. Ok - that's a lot, but the response was generally good. Oddly enough I didn't really get much response from my Dad's side of the family that lives here in the US (Dad died when I was 3), but got great response from the ones in Sweden. All of hubbinez's family was super-duper-uber excited. So was my mom's side of the family - but most of them already knew.

Next we made the dreaded FB post. That actually went WAAAAYYYYYYYY better than expected.

At first I posted this video:

Mostly because I love Min Pins and this cracked me up as a baby announcement. Apparently no one viewed it or "got it" but that was ok because seconds later...

.... hubbinez was so excited about making the announcement (he had been telling people all week) that he made me do a joint word post, where we hit the POST button at exactly the same time. Because we are corny like that. It went something like this:

"On Mother's day it is fitting that we make our announcement that we are expecting twins. This would not have been possible if it wasn't for another wonderful mother, my SIL <insert name here> . Unable to carry our biological children myself, and after unsuccessful tries elsewhere, she selflessly offered to be our gestational carrier. Words can not express our gratitude over this incredible gift."

Hubbinez was as giddy as a school boy.

I haven't told my work yet, but that's because there has been a snafu with converting me from contractor status to employee status. Technically I am now an employee, but everything isn't final in all the systems, so it makes me nervous. I'm going to feel like an arse when I have to tell them about taking time off - which incidentally the due date is 1 day off from my boss' new wife. I'm sure he's going to freak, but because of my last disaster with getting fired when I told them about starting a family, I want to at least be protected by law this time.

In other haps - I am doing a sleep study next week. I've always had problems with not feeling like I get enough sleep (even when I do!), so no time like the present (ie., pre-twin birth) to try and figure this stuff out. We are off to a good start. Initial blood work from PCP showed that I have a big vitamin D deficiency.

That's a big one with sleep and immune problems, which makes sense since I've been sick so many times in the last year I lost count. With Vitamin D the doctor is looking for any number above a 29. Mine was 18. :-/  Apparently all that sun block wasn't so great for me. Except the whole wrinkle thing. I'm ok with the past trade off, but had to find another option for the future. Yay for supplements! 2000 IUIs a day! At least the past year has prepped me for that.

Srsly, I have to be the only girl whose doctor tells her to go get some sun WITHOUT sun block. Ok, maybe not, but it's not something I have ever heard before. And so I went out in the sun the other day without sunblock on anything except my face for the recommended 15 minutes. Then I slathered on the sunblock. The glare from my legs are still intact!

That's it for tonight. I need to post right away, sans editing, lest it fall by the wayside. Holy crap - it's 11:30pm. Gotta go take a bath and go to bed. Night all!

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. 

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.

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

(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. 

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

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. 

Testing... 1,2,3

Yesterday we went to the new OB/GYN with SIL.* Excited in our anticipation for another ultrasound, we weren't prepared for the possibility of NOT having one and were a little disappointed when it didn't occur. Not sure if it was because the appointment ran long, if the doctor felt it wasn't necessary, or she was holding off because she knew the perinatologist would want to do one. You know....because of all the testing coming up.

Testing? What testing?

Since I am of AMA, there are about a zillion tests that should be done to test for chromosomal abnormalities. Great another reminder that if something goes wrong, it's probably because we used my old-ass eggs. Thursdays doctor was not the first doctor to count me as 41, even though my birthday is not until the end of April. Seriously - I am waaaayyyyyyyyyyy over hearing the tut-tut regarding my age.

We elected not to do the chromosomal testing on our eggs/embryos. Not sure why, but it was one of the things I just didn't focus my laser (some say obsessive) research skills on during the IVF process. A part of me thought that a small biopsy could endanger our chances of implantation and thus we weren't really interested in lowering our chances (no matter how small) or spending extra money unnecessarily. Now, unlike congress, our proverbial bill is due and it is time to pony up (i.e. take all the tests).

Here is the nice handy-dandy chart for us to stress over for the next 6 or 8 weeks. Look a bit overwhelming? Yea, me too. Fortunately some of them overlap, so it's not like we have to do all. But we DO have to weigh the pros and cons of each and decide which we think is best.  Right now we are weighing more towards the amnio vs the CVS. Hubby says CVS is slightly riskier for miscarriage and the doctor mentioned something about loss of limbs(!!!). I haven't had the heart to look.

RISK ASSESSMENT CHART FOR DOWN SYNDROME AND TRISOMY 18 Screening parameters First Screen 11-14 weeks Integrated Screen Combines first screen & Quad Quad Screen 15-18 weeks Amniocentesis After 15 1/2 weeks CVS Chorionic Villi Sampling 10-12 weeks Down syndrome detection rate 83% 92% 81% 99.9% 99% False positive rate 5% 5% 5% 1% 1% Trisomy 18 detection rate 80% 90% 80% 99.9% 99% Biochemical Markers PAPP-A Free Beta hCG PAPP-A AFP hCG uE3 Inhibin-A AFP hCG uE3 Inhibin-A Diagnostic evaluation of hundreds of types of chromosomal anomalies Early Diagnostic evaluation of  chromosomal anomalies Nuchal Translucency NT NT NT *** *** Timing 1st Trimester 1st & 2nd Trimester 2nd Trimester 2nd Trimester 1st Trimester Open Neural tube defects Detection Rate *** 80% 80% 99.9% *** Fetal Nasal Bone presence Preliminary results/ significance *** *** *** ***

All this and we know we are at higher risk because of twins. I should be celebrating and instead I feel like a big bag of worry. At least the appointment went well.

*I never know whether to put SIL or surrogate. Some days it feels more appropriate to put surrogate for a number of reasons, but other days it seems so impersonal for such a great thing my SIL is doing. Bear with me. 

Still Here

And so are the twins. Yay!!!! Growth rate in both is great and heartbeats are great.

Our surrogate has been officially released to her obstetrician with special instructions to also see a perinatologist.  Her obstetrician will recommend a perinatologist that she [the doctor] is familiar with so they can work in tandem. Our clinic was very happy with our surrogates choice in obstetrician. Everyone is so excited for us. 

I'm excited too, but still very nervous. Twins increase everything, including risk. If I think about it too long, I will drive myself crazy.

More later - just wanted to drop a quick update. Crap it's late. Night all. (I can't believe it's after 1am - sheesh.) 

Cupid's Gift

Artwork by Setsiri Silapasuwanchai

Purchase here

Today could have been the best or worst Valentine's: this morning we had our ultrasound. Originally it was supposed to be on Saturday, but we realized that there was a miscommunication and that they don't do non-required-cycle ultrasounds on Saturday. That's a story in itself that at this point bores even me, so I will spare you the details.

I think I may have held my breath as the ultrasound began. My husband has never seen an ultrasound, which seems incredulous now that I think about it, so it was a completely new experience for him. (I've lost count on how many I've had in the last year alone!) After what seemed like forever (really just a few seconds), the big black circle came into focus. With a little white circle (yolk sack) inside. And a blinky heartbeat that measured at 129 beats per second. The doctor said it was perfect.

And then she showed us #2... Equally perfect.

A Ferris Wheel

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

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

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

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

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

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

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

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

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

**IFers: people dealing with infertility. 

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. 

Backscatter and IVF

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

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

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

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

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

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

Another option

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

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

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

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

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

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

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

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

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

Day 8: Yay! and try not to freak out.

Had another sonogram today, more shots, met the surrogate, and went over some preliminary paperwork.

Sonogram showed 13 follicles (yay!). 5 really good size, 6 average, and 2 small. Hopefully we will get some good eggs and then embryos out of these. Right now we plan on extracting on Thursday, but Dr. P said she will confirm after my sonogram tomorrow. 

Starting to get a little worried with the timing of my husband's arrival. I recall when we were planning this trip that I commented we didn't have much buffer room for mess-up (time wise), but I didn't think much more of it. Don't think I even thought of the timing for HIS arrival at all. Saturday I realized how short we were cutting it with his arrival. He gets here on Thursday - right now I'm tentatively scheduled for egg retrieval that day. That means he will not be there when I go under, something I am NOT happy about. Think "scared" is more the word I am feeling around for. In case of emergency, we do have 2 backup samples from last time, which is  good to know, but still don't like the idea of possibly having to use them if ANYTHING goes wrong with his travel. 

Try not to freak out, Try not to freak out. 

Last time we had to go a day earlier than expected. We expected 10 days of shots (not including the trigger) and ended up with only 9. If I go on Thursday, this will mean that I only had 8 days. I think the average person goes 9-12 days. I'm hormonal and irritable at my husband right now. Even more at myself for not looking at his schedule more closely and insisting on better buffers. 

Try not to freak out. Try not to freak out. 

Ok, got that out of my system for now.

On a different note: met the surrogate today. The surrogate is 28 years old, 121 lbs and 5'3 (I think she's 5'2 1/2). She has a brightness to her eyes and is ready with a smile. Sadly, she is going through a divorce and wishes to have enough money to get her own house and have some left over to go towards her son's education. 

When people talk about exploiting the poor, I really wonder if they think of things like this. Many months ago I looked up Gujarat house/flat prices and I remember being amazed how low they were. A surrogate in the USA could NEVER buy a house for what a woman could here in India. Sure, it may be a small house/flat compared to what we are used to, but so are most of the homes I have been to here. Even in very well to do homes. A woman could not earn the equivalent of 10+ years salary for surrogacy in the USA and they could not have left over funds to educate their children. When you see the lives here that have had such a positive impact due to Dr. Patel and surrogacy, it's easy to see why she does not let her critics affect her. 

Ok, got that out of my system for now.

Please let this take this time. I don't think we could come back again for another try with my eggs. Please please please. 

Hopefully this cow gave me her blessings. I gave her and a baby cow some of my leftover Malai Kofta and rice. Actually I gave it to the calf, but then she came and took it over. I'm ok with that. Maybe I'll get double blessings. 

Boss cow

Baby cow eating bushes after a few bites of delivery

Leavin... On a jet plane

Yea yea yea, I'm very non-original today.

On my plane to India. I hear there are potential floods.

Women in front of me across several rows are going on about one of them who adopted a baby from Russia. I'm not sure how the conversation even started since no one seems to know each other, there aren't any babies, and the women aren't sitting next to each other. I think someone else recently internationally adopted or is about to. That's my guess. I wonder if I would ever feel comfortable about taking to total strangers about my ordeal. Well, EXCEPT YOU GUYS! But that's totally different. :-)

Feeling better today, but sad I will be without my husband for a few weeks. It's just setting in. I really hate being without him. Especially during sleepy time.

Plane is hot. They said one of the vents are having issues, but it will be resolved once we take off. Someone near me is a smoker and it's making me a little nauseous. In a non-drama queen way.

Prepare for take off.

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. 

What makes the elephant charge his tusk in the misty mist, or the dusky dusk

Dorothy meets the Cowardly Lion, from the first edition

From The Wizard of Oz,  by the Cowardly Lion
Courage! What makes a king out of a slave? Courage! What makes the flag on the mast to wave? Courage! What makes the elephant charge his tusk in the misty mist, or the dusky dusk? What makes the muskrat guard his musk? Courage! What makes the sphinx the seventh wonder? Courage! What makes the dawn come up like thunder? Courage! What makes the Hottentot so hot? What puts the "ape" in apricot? What have they got that I ain't got?

When I went to India in June for my first IVF treatment, a few people remarked how brave I was. Truthfully, it didn't feel brave. At all. Not even a tiny bit. I have been to India twice before and besides family living there and being able to check things out for us, my husband (who is Indian) traveled with me. He's fluent in Hindi, the national language, and knows several other languages. He can tell by listening to someone where they are from in India and of course is familiar with many customs. When I see others take this journey to India, I feel far less brave than them. Even if the illusion from those here at home is something different.

What I realized last trip, is that I used my husband as a crutch - as did many of the locals. Most people preferred speaking to him in Hindi and it seemed an effort (and slightly rude) to constantly interrupt them with "hey there! English please!" (Note: this was never a problem with our doctor, who always spoke in English and spoke equally to both of us.) I'm sure part of it also had to do with the patriarchal society over there that some are more comfortable with (and no that is not a ding against India as we certainly have our fair share of it here in the US).

The funny part is that I have back-packed through Europe with my 9 year old son before - with only a multi-lingual phrase book, rail pass, basic necessities, and a loose plan that wasn't adhered to. I've been to countries all of the world and navigated myself without too much hullaballoo. I'm more inclined to seek different and daring adventures when on my own, then when not. Let's just say that "impulsive" is a much better adjective to describe me than "overly cautious". Incidentally, this makes my husband a great balance for me when I might otherwise do something truly stupid.

Oddly enough, my husband tends to see the more reserved me when we travel. Especially in India where I'm more reserved around him and family lest I make some huge social gaffe that could reflect upon him or make my in-laws question my good sense. Of which, I tend to have very little of at times. His family are relentless teasers, something which I don't wish to arm them with more fodder and something I really didn't have a lot of growing up. (My step-dad is a relentless teaser as well, so I am getting used to it.) What this amounts to is a less daring attitude when I am with my husband abroad. This actually can be a good thing such as the following conversation will allude:

Me: "Oh look! MONKEY!!!!!" (start fiddling in my purse so I can get either piece of fruit to feed it or my camera)
(Large monkey looks at me for a second from 10-12 feet away.)
Hubby: "Walk away NOW"
Me (whining and walking away): "But it's a MONKEY. I hardly ever see monkeys. And never this close." (wistfully look at monkey while still digging in purse.)
Hubby (trying to get me to hustle): "If monkeys make eye contact, they sometimes attack. Many carry rabies. You can't randomly go up to wild things - especially in India."
Me (pouting): "But I like monkeys..."
Hubby: "Yes, I know. Come on."
(Monkey ducks down alleyway with several of his friends.)

The point of this post? My cycle in September means I will be traveling to India alone. My husband will meet me there after 2 weeks, but before that I am on my own. Well, except for the part of family meeting me at the airport to drive me some portion of my trip. For some reason, hubby and family were freaking out about that and I acquiesced. They wanted someone to stay with me the entire time, but I told my husband "no". I love my Indian family, but it would be far more stressful for me to have one of them there at all times than to just be by myself. Being super hormonal and trying to impress in-laws is just too much pressure. I'd rather fumble around and deal with the frustration of being alone in a foreign land. I'm introverted anyway and that is my comfort zone.

Am I scared? No and Yes. My impulsive behavior tends to make me forget about being scared until I am in the moment, or until I deeply think about it: "ummmmm, maybe this wasn't such a great idea.Opps. Too late now." Especially about things like traveling, or jumping off bridges into who-knows-how-deep water, or walking my dogs at 2am because I figure we all need the exercise. More so what scares me is when other people have fears - then it can bleed into my veins. (That and interviews - those things terrify me!)

However, using a crutch over the last few years has made me more into a cowardly lion. Maybe part of it is having someone else speak the problems that I don't consider. Maybe part of it is knowing my impulsive behavior can get me into trouble. Maybe part of it is that I haven't done things alone in the last four years. Somehow I think it is all of this, and much more.

This time, I will be embarking on a real adventure in India. The idea of it makes me feel braver, something which I really need of late. I have great admiration for all of the bloggers who have gone this route alone, and without incessantly whining, they embrace a totally different culture with only a nod or a joke to frustrations they encounter. Hopefully, I will muster the courage and grace that I have seen radiate many before me.

As Dorothy once hinted at to The Cowardly Lion, "You were courageous all along. You just didn't know it." Let us hope so. 

"Shot to the heart" - er no

Tonight I get my big bee sting shot in the arse at 11:30PM. Ack! The belly shots have been bearable (mostly), but I've been a little apprehensive about this one.

(BTW: 6 follicles for those of you keeping score. Ranging in size from 16-22.)

Maybe if I sing Jon Bon Jovi's "You give love a bad name" song (in my head), it will help. I can hear it now "Shot to the butt, and you're to blame..." Hmmm, maybe giggling while a needle is coming towards me isn't such a hot idea. Oh great. Now I'm going to have a giggle attack. Those always come at the worst possible moment.

Wish me luck!

UPDATE: It was a shot in the belly and it was easier than one of the daily shots I had been getting. Easy-peasy. I had gotten myself so worried over the butt-shot from a IVF memoir book I read (said it was like bees stinging you all over your body and that one woman punched her husband in the nose after receiving it), that the idea of it was 100x worse than the reality. I did manage to embarrass myself by laying on my belly ready to expose my bum when the nurse kindly told me to turn over. Very typical of me. My husband grinning ear to ear. :-)

Playing catch up and one week to go!

Historical clock in downtown Prague

Sorry for my absence. I've actually been keeping up with most things going on (thank you Flipboard on iPhone), but my data is limited on my iPhone for international travel. So much going on in the IVF-surro-blogosphere!  Very exciting stuff! I've been reading every few days, but posting comments and writing posts from my phone was not as easy as one expects. Next time I will have it down better.

Husband had an additional surprise for me earlier this month and took me on a world-wind trip. Apparently he had been planning this one for a long time as well. He told me that this is it for our vacation plans for a long time now. He originally planned and paid for this before we knew the costs of IVF/Surrogacy and before I lost my job. Oh and before we got a big fat unexpected tax bill yesterday. But never mind all that - we had a wonderful time in Venice and Prague. I really have the best husband imaginable. I'm fairly certain I took close to 800 pictures. Both cities are beautiful and incredibly romantic.

Now I have a week to get ready for our IVF treatment in India. I'm nervous to say in the least. I had to start talking BCPs again (need to be in sync for treatment start and surrogate) and that has been a bit of a pain. Often I am sensitive to medications and I am remembering why I stopped taking oral contraception many, many years ago. (Had nothing to do with wanting to get pregnant!)

The last 4 or 5 days I have felt bloated and nauseated. I ache easily and I'm testier than normal. If this is what a little BCP does to me, than what can I expect from the IVF medications? Since I actually had to start my birth control a week late and will have to continue the active pills for an additional week, I can only imagine the battle my body is going through. Bleck.

India. One week. I'm nervous like I have never been before. I've been to India before and never felt as nervous as I do now. So many things racing through my brain. More later.