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. 

60 Second Update

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

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

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

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

Night all!

Day 11 - Trigger Night

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

Let's us begin...

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

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

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

right ovary:

14mm

17mm

19mm

14mm

3 that are <10mm

left ovary:

18mm

18mm

16mm

17mm

18mm

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

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

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

--Evening update

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

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

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

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

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

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

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

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

Begin at the Beginning...

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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. 

Running and Running

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

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

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

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

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

Kinda makes me wish I had these:

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

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

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. 

"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. :-)

Plus 2 Minus 1

Yesterday we were given the good news that the two tiny follicles were responding well to the increase in meds. That means we were up to 6! Today we were told that I have 3 on one side (responding well) and 2 on the other. Down to 5. :-(. On a good note, we'd probably be down to 3 had we stayed the course as the 2 on my left side were the tiny ones.

On a separate issue, we are going to have to retrieve on Sunday instead of Monday. Normally the doctor is not at the clinic on Sundays, but one follicle has grown so large (23mm!) she fears we will lose our chance if we wait. So a Sunday retrieval it is.

We met our surrogate yesterday and she is quite lovely. 34 years old with 2 boys and had a successful surrogacy 4 years ago. She is a half inch shorter than me and is the weight I was when I was pregnant so long ago. In my IVF book, with the exception of 38-40 IP mothers, gestational carriers have a higher rate of pregnancy for all ages. Sometimes over 10% higher. For 38-40 it's about even. This sounded pretty interesting to me even though it currently doesn't apply. Here's a pic of the chart (keep in mind the picture and blog post is from my phone. The darker line is for those who used a surrogate / gestational carrier.)

A New Day

Yesterday sucked. Really really sucked. We had our Day 6 scan and it revealed only 4 follicles maturing on one side and 2 tiny ones on the other one. Basically I'm a poor responder.

If you're keeping score, at my original appt in the US, I had 16 follicles. 16 put me right at the next level of a better success rate. Not the highest, but still fairly good. On our first appt here in India, my initial scan only revealed 3 and a big cyst. Aspirating the cyst revealed 14. 14 put us in the fair range, but it was a hell of a lot better than 3. I don't know if they'd even go through with 3. Crisis averted.

But now we are down from 14 to only 4 responding. I expected 70% (as that is what is the norm) and thus 4 is crushing. 4 combined with my age drops us down again. Immediately I started ferociously pulling up stats I have saved to my iPhone, and then I stop. I don't want to know anymore. Neither my husband nor I am religious and it is times like these that I wish I could be. For the moment, hope has left me and and the realist in me wishes I had not let the excitement of the process overcome the knowledge of the likelihood of success.

How do women go through this roller coaster over and over? I'm not sure how many times I can, knowing every month our chances decrease as I age. I'm not sure how many trips to India we can do with me not working. I'm not sure if I can get an exception to my visa to return in a month (I have a 10 year tourist visa from 2008) or instead try for PIO cardholder status (husband is still considered Indian citizen). I'm not sure of so much.

If this seems early to have lost all hope, then realize these were my thoughts and feelings of yesterday. Today is a New Day. The doctor has doubled my dose and I am cautiously optimistic.