Saturday, March 30, 2013

Um...What? Sort of happy, WTF.

I am not not pregnant. I am a little bit pregnant. Which is a lot more pregnant than I have ever been before.
My HCG beta came back at 25. Over 100 is ideal. 25 is really low, possibly/probably a chemical pregnancy. So I am maybe pregnant. On Monday I will go back in for another blood test to see if my beta has doubled. I pray that it does.
Here is the good news: my body can possibly get pregnant. It can happen. I wasn't sure that it could. No matter how this turns out, I can take that piece of very good news with me. The other good news that I should not forget between now and Monday is that there is a small chance that this might work. It's not terribly likely but the chance is there. As I said in a previous post, "maybe" is a very happy place for me.

Thursday, March 28, 2013

The last real day - 8dp3dt

I am considering this the last real day before my blood test. (I honestly can't bear using the words "pregnancy test." Perhaps I'll pretend I'm being blood typed or something as I sit in the chair with my favorite salsa dancing lab technician. I don't know his name, he probably knows mine or my patient ID. All day he listens and sings out loud to old school salsa. I love it. It's much easier to distract myself while he croons.) I say the last real day because A) I am a child and have a warped sense of time and B) tomorrow is Good Friday and I have the day off of work. Tomorrow will be a fun day to simply fritter away. I might get my bangs trimmed and visit my grandma. It might be that wild and crazy. That is, after I complete the Stations of the Cross. Um, not really. I don't actually even know what that means in a practical sense. I figure it would require prayer and walking on my
knees on stone flooring.

My single goal for today is to be productive at work (good start, eh?). This is a formidable task since I spend much of my day sitting in front of the sickly glow of Dr. Google. Don't google today. There is nothing to be found. There is no magical combination of search terms to tell you if you're pregnant or not, or what medications you should be on next time if there is a next time.

Is it horrible to admit that I think there will be a next time? And that I'm not all that upset about it? Not really. I just expect it. When you've been on such a long road, it's very hard to imagine that you'll ever get to pull over and take a nap. Long distance trucking is an absolutely apt description for infertility.

On this last real day and last real blog post before my blood donation, I wanted to do a little product placement. Here's to you, Tylenol! The only drug I can take during IVF and pregnancy. Cures about 7% of what ails ya. Seriously though, this fertility haul has made me look a lot at my diet. I never ate particularly unhealthily but I have made a few real changes to my diet. First, I scrapped my dependence on caffeine. It hurt. Terribly. But just for a little while. I went from 2-3 cups of strong coffee a day to zero with an occasional cup of decaf to get me through the shakes. I weaned myself slowly going from full blast to half-caf to decaf and then nada. I drank green tea for a while, mostly decaf, but got really tired of it. It is an uninspiring hot beverage and, according to my acupuncturist (yep, I've gone all crunchy granola these days), too cooling to the body. These days I'm allowing myself black tea or homemade chai with almond milk in the morning. It's caffeinated but pales in comparison to a grande dark roast. Product placement #1 - Lipton Yellow Label and Twinings English Breakfast.
Another change has been my full acceptance of the fact that I'm lactose intolerant. No more grilled cheese sandwiches with creamy soup. Worst of all, no more ice cream (well, a very occasional treat). It's remarkable how grateful my digestive system is. Product placement #2 - Almond milk. Any brand. Thank you.
The most difficult change has been avoiding gluten. I don't eat completely gluten free. I don't have the patience nor the ill-effects of a true gluten intolerance to inspire me. While I'm certainly not any shade of Celiac, I have learned that gluten is an inflammatory and is thought to affect fertility. And since my fertility is certainly affected, I thought I'd give going gluten-free (or gluten-limited) a whirl. I don't know if it's affected much of anything. If anything, it's kept me from being so carb dependent. I know that this is not a change I'll incorporate into the rest of my life but it gives me a sense of control for now. One of the hardest things about infertility is the feeling that you can't control your treatments and the outcome. Diet is one productive thing to grab hold of. And with that, product placement #3 - a shout out to Ancient Harvest quinoa spaghetti, Udi's Gluten-Free breads, Pamela's cookies, herb bread from Marie Catrib's of Grand Rapids, MI and rice crackers. Ok, looks like I'm just as carb dependent as before.
Finally, phyto-estrogens. This is sort of a minefield and one I choose not to drive myself crazy with. I've got plenty of crazy. Soy is a phyto-estrogen and can negatively impact your hormonal balance when consumed in large amounts. So I simply limit my tofu and soy milk intake. That's it.
Is any of this making a difference? Who knows. All of the changes I have made simply feel like healthy ones. I haven't lost any weight and have only seen digestive benefits. I'll spare you the details. Much of this won't all stay with me when infertility is behind me. I miss coffee and bagels too much. Together and separately. Coffee and bagels, I will come back. Just not yet.

What diet and lifestyle changes have you made to reach a goal, fertility related or otherwise?

Tuesday, March 26, 2013

In between, almost there - 6dp3dt

This is such an odd, in between kind of time. I'm so close to the official end of this cycle and so far from where I started, popping birth control pills in February. And yet Saturday, the big blood draw, seems quite distant. I am alternately sure that I'm not pregnant, 10 minutes later thinking that maybe there's a chance, and later that day feeling very positive. I can't stay negative, I'm not letting myself. Notice I don't say that I feel sure I AM pregnant. I don't know how to feel that after 15 months of negative pregnancy tests. Uncertainty is positivity to me. "Maybe" is a very happy place.

My symptoms are nil. No waves of nausea, boobs are no more sore than normal on progesterone, no particularly interesting twinges or cramping. Nothing significant. I want projectile vomit and boobs on fire. I want something dramatic and sure. Like the results of a blood test. Saturday. Breathe, wait.

I think I will feel relief either way the test goes. I will be really sad and frustrated if it's negative. I plan for a Starbucks and a bottle of wine in that case. And I'll be thrilled and mostly shocked if it's positive. Either way I can stop holding my breath for this cycle and move onto the next challenge, whichever it may be.

Sunday, March 24, 2013

The Survivor - 4dp3dt

Today I feel like time is finally starting pass normally. Not as painfully slowly as before. The work week is ahead of me and as gruesome as that can be, it typically passes in a blur. Part of the beauty of having an unmanageable workload.
Downton Abbey is playing a large, nay enormous role in my time management. I'm a total junkie. If Maggie Smith and I aren't smirking then it is simply time wasted. Netflix is so crucial to a bearable "two-week-wait." TWW in TTC lingo. There is an hilarious amount of verbiage associated with the IF (infertility) online community. Your husband is your DH - darling husband - and your children are your DS and DD - darling son & darling daughter. There's more, loads more, but the required prefix of "darling" is the one I find the ickiest. A typical post on a TTC form look like this:
DH and I went to the RE yesterday while DS stayed with my MIL. After TTC for 2 years, a diagnosis of PCOS and 2 failed IUIs, we're on to IVF. I'm most nervous about the PIO shots and, gulp, of course the HCG beta!
I'm not translating. It's best that you have no idea what that means. I have never ever called my husband "darling." He is hairy and sometimes farts in bed. While he has many endearing qualities, I could never pin the term "darling" on him.

I did end up getting a call from the embryologist yesterday. Of the 3 embryos we were waiting on, 1 made it to blastocyst stage and was frozen for possible future use. The other two didn't make it past their day 3 development. 3 viable embryos out of 7 mature follicles and 11 total follicles is nothing to write home about. Should this cycle not work out, I have to have a discussion with my doctor about changing medication protocols to encourage better quality embryos. I may never have the best eggs in the hen house but there are medications that tend to work better for those of us with quality issues.
All of this said, I was actually very encouraged by my talk with the embryologist. I had the opportunity to ask about the two 6-cell embryos that were transferred. Both of them had zero fragmentation (parts of cells breaking off) which is excellent. One of them was a Grade 1 (all cells equally sized) and the other was a Grade 1-2 (slight variation in divided cell size) which she assured me was not problematic. If my lone survivor cell was able to keep growing into a blastocyst then why not the healthy (if a little slow - like me) embryos that were actually implanted? No reason. No reason at all. Focus on growing, implanting and hatching. Yup, even human eggs hatch.

Saturday, March 23, 2013

Waiting - 3dp3dt

3dp3dt - fertility lingo for "3 days past 3-day transfer." Good lord time is passing slowly. They should send you on a mandatory vacation during this wait. I am trying to visualize my embryos growing, cells continuing to divide and latching on to my uterine wall. Hard things to imagine.

I have come along way in 3 days from my sorry state on Wednesday, transfer day. When the doctor told me that my so-so embryos could be the reason for my not getting pregnant, it made me feel like a complete failure. All along, trying so hard, restricting everything in my diet and my eggs could have been bum the whole time. I'm sure my body is glad to not have guzzled Starbucks and labored over digesting dairy for the past year to several months (depending on which phase of my diet shenanigans we focus on) but it's hard not to think that perhaps I could have had a coffee now and then and not made a bit of difference. That said, I haven't reintroduced any of my vices. Old sad eggs made me feel awful. Proving annoyingly that there is a Sex and the City episode for all of life's situations, I felt very much like Miranda when she is diagnosed with a lazy ovary. "Those ovaries went to Harvard!"

I started mourning much too early. At least that's what my loving and supportive friends, family and, shockingly, Google, taught me. My B - B+ eggs, the ones that were transfered were 6-cell embryos. Ideally, they would have been 8-cell. So they're a little on the slow side. So's their mama, as I was reminded. My dear friend S immediately recalled that my first grade teacher told my mom and dad at the first parent teacher conference that I would never learn to read. Ever. Didn't have the capacity. Not only that but I "just wasn't going to make it." In life? After knowing a first grader for 6 weeks, can you really sentence them to an illiterate adulthood spent jobless living in their parents' basement? Mrs. Farmer felt that was exactly the case. Surprisingly, I am not dictating this to my transcriber. I am typing this myself. Because I can read. Quite well, actually. By second grade I was a voracious reader. I just started out a little slow. My mother pointed out that I didn't learn to walk until I was 17 months old. And then became a pretty decent ballet dancer. I have a tendency in life to take my time and get things right instead of rushing in and falling down. This is the hope for my embryos. They are like their mama, starting out slow, taking their time and then getting it right.

Dr. Google is typically a very evil thing. I should know since I received my medical degree in part from Google University and in part through osmosis by hanging out near my doctor dad, nurse sister and psychologist mom. It is a wonder no hospital will hire me with my credentials. Google tends to get me all anxious as I sift through every perfect search term with various combinations of infertility, unexplained, embryo, endometriosis, psychosis.  In this case, when I searched the term "6-cell embryo" I found encouragement both dependable sites written by fertility centers as well as crazy baby forums willed with posts by unstable, mentally-frail women. Fertility centers look for embryos to be between 6 and 10 cells on day 3 with 8-cell being ideal. I don't need ideal. I just need a fighting chance. And it looks like I have one. I have to stay positive and know that they embryos that were implanted were in the range that fertility doctors hope for.
As for the others, 2 5-cell embryos and a 4-cell, they were to be cultured in the lab until Friday or Saturday (today) and then either frozen or discarded. I was supposed to get a call by today with the news but never got one. I'll stalk the embryology lab down on Monday.

I also shall continue to remember that Miranda and her lazy ovary made a baby. In additon, I'll try not to feel like too much of a typical white, 30-something urbanite quoting Sex and the City. Ewwww.

Wednesday, March 20, 2013

Transfer Day

It is 11:37 am, I was supposed to arrive at 10:45 with a partially full bladder. Now, nearly an hour later, my bladder is preposterously full. They're running late. At this point my day 3 transfer may turn into a day 5 transfer merely due to the office backlog.
Breathing. Not peeing on myself. The upside is that rather than getting myself all anxious about the health of the embryos and the actual transfer, I'm instead focusing on my bladder. I have a handy-dandy diazepam (sweet, sweet muscle relaxant) ready for the actual transfer. Lets hope that it doesn't have the effect of relaxing my bladder during the procedure. Although it would serve them right.

Fast forwarding...
That didn't go as I had hoped. I know I am not the only woman to cry on the exam table during the required 20 minutes on my back. My eggs are, in technical terms, "meh." By today, they were supposed to have divided into 8 cells. Only 2 of the 5 made it to 6 cells. The doctor, not my usual, said that he would expect to see better quality embryos at my age. Me too. He also said this may explain why I haven't gotten pregnant. Regardless, he said these embryos gave me a "reasonable" shot at pregnancy. That's the bright side because until today my chances have been unreasonable.
I have not given up on this cycle but I am really, really sad. Sad for my future, the certain decline in quality of my eggs as I continue to (prematurely?) age.
Switching tunes, I need to try to be positive and encouraging to myself and my average embryos. I should probably sing.

Tuesday, March 19, 2013

Signs Everywhere. Simply Everywhere.

I am really into signs. Good and bad omens. Frankly, almost anything can be a harbinger of what's to come. My mother and grandmother share this unshakable belief in signs. I think its the benevolent Puerto Rican witch in each of us. And perhaps a failure to excel in science and statistics.
This morning, I was driving to a job site just across the border in Wisconsin. The day was going well enough, sunny and clear, and I was very close to being on time. In the right lane, there was a truck with a four-leaf clover logo - a shamrock, if you will - and the name "Luckey Transfer." Now, the name alone seems like good luck, right? Literally. But there's more.
A) The shamrock refers to our St. Patrick's Day retrieval.
B) "Lucky" is the name that J and I keep using to refer to our someday baby. J says, quite morbidly, that he will be lucky to be alive. I prefer not to think like that. Also note that J refers to our hopeful future child as "he." I've been coming back to Lucky because of how lucky we'll be to have a child. That's much sweeter.
That has insanely-good-omen written all over it. Luckey Transfer and our lucky transfer is tentatively tomorrow (assuming we go for the 3-day embryo transfer, standard at my doctor's office). Minutes later a truck passed that said "Mills Transfer" on it. That is not an omen at all. Simply a truck.
On my way back from Wisconsin, I listened to a podcast of "Here's the Thing" with Alec Baldwin. His Guest? Quarterback Andrew Luck. I understand that's not quite the dancing leprechaun that the truck was but it can't be overlooked either.
This post alone could have me committed. Or at least my meds increased.

Monday, March 18, 2013


I'm sober now. I was blogging while intoxicated yesterday. I keep thinking about how conscious sedation or "twilight sleep" was used during labor. It's hard to believe. I was so out of it during the procedure, I could have no more clapped my hands than assist in getting a baby out of my body. My memory of the procedure is as follows: I asked the nurse how long it would take to feel the effects of the sedative. She replied between one and two minutes. She left the room. Then the ceiling started moving. Then I was dreaming but could also hear the nurses and doctor talking. I could vaguely feel some action going on in my nether regions. At some point the nurse asked me to roll over for my progesterone shot which I miraculously did and thought that it really didn't hurt that much. I woke up back in the recovery area and decided that I'd rather be asleep. I vacillated between sleeping and waking until I was forced to pay attention, dress myself (honestly with the help of J), and float on out of there.
Yesterday I napped and watched The Best Exotic Marigold Hotel. LOVED. I adore India and Judi Dench and these two were wrapped up into one.
Today I got the dreaded/highly anticipated call back from the embryology lab: of the 11 eggs, 7 were mature and, of those, 5 fertilized normally. I gotta say, after all of those drugs, constantly feeling fatigued and mildly crappy, 5 doesn't feel like all that many. I have to remember that I don't need a million eggs. Just a few of good quality and only one to implant. So I'm not disappointed, just not elated.
Here's the thing that is lingering with me today. My ass is killing me. The whole upper third of my left glute (a large, vast swath I assure you) is so blindingly painful that the muscles have been rendered useless. I feel like I'm dragging that leg behind me. This is all from that progesterone shot. For those not in the know, progesterone is suspended in oil (typically peanut if you're curious) and then injected intramuscularly into your buttock or thigh. Many women going through IVF give themselves this injection once a day for up to 10 weeks if they get pregnant. I'm lucky in that my doctor prescribes Endometrin, a vaginal suppository. I think the fact that I just typed that I felt "lucky" to have thrice daily suppositories shows how far I've come. Anywho, I'm either a giant baby and cannot deal with the pain of a single intramuscular shot OR I'm having a bad reaction OR the nurse hit a nerve. Maybe all three. But this is brutal. I crouched to pick something up today and then had a really hard time getting up. I told my colleagues I had pulled a muscle as I fought back the tears. Of all the bullshit I've dealt with during this IVF cycle, this is right up there. I'm going to limp away now.

Sunday, March 17, 2013

Retrieval Day

I write to you from the groggy land of post-retrieval malaise. Everything went as planned. I went in, got sedated, and woke up to the nurse and doctor giving me important information. Eleven eggs retrieved. My doctor had originally said he was aiming for between 10 and 15 so I'm happy with that. The real test will be seeing how many of those actually fertilize. I'll find that out tomorrow morning.
For now, I intend to take a nap, knock a few shows off my DVR list and then probably nap again. It's going to be an exciting day, folks.

Friday, March 15, 2013

Stim Days 9 & 10 - Follicular Vocal Therapy Success Rates

Someone needs to conduct a new study here. Singing works. Scientific facts:
A) On Wednesday I sang to my follicles.
B) At my Thursday ultrasound, they were bigger and more plentiful, my uterine lining was thicker and my estradiol level had doubled. You may think it was the carefully monitored doses of medication but I believe that my crystalline voice and heartfelt, awkward lyrics greatly contributed to my ova-uterine accomplishments.
I realize that I am a small sample group of one but I'm convinced there's something to what I shall call Follicular Vocal Therapy. Yesterday the head IVF nurse called to tell me that things were looking good and that we would most likely do retrieval on Sunday. I can't believe I'm almost there. I thought I'd be shooting up at my kitchen table forever. I did not have the 20+ follicles that I've heard about women growing but instead 9 lovely plump follicles at or above 10mm and 5 of those were over 14mm. I went in for another ultrasound today and hopefully, one or two more will scoot over the 14mm mark. Quality over quantity. What would I do with 20 children anyways? I live in a small, 2 bedroom apartment. There is simply no room.
In order to ensure another dazzling show at today's ultrasound, I continued my Follicular Vocal Therapy this morning. This time, J chimed in. We sang and sang in the bathroom. Our lyrics were impressive, the accoustics impeccable.
Scientific fact "C": It worked again. The nurse just called back. I now have 12 follicles at or over 10mm, 7 of those are over 14mm. And my uterine lining is 10.5mm. That is huge. My uterine lining has never gotten over 7.1mm and that was with medication. I usually roll in the 5-6mm range which, in bagel terms, is the endometrial equivalent of a "shmear." Embryos do not like to nestle into a mere scraping of lining, they like to cozy into something nice and cushy. And today, ladies and gentlemen, my uterus is cushy.
My apologies to any gentlemen reading this. It is highly unladylike to speak so freely about one's uterus. You know what else is unladylike? What I'm about to tell you. I'm embarrased. My leading side effect of the medication has been fatigue. All day, all night, can't get out of bed or spell my own name fatigue. My ultrasounds take place in the morning before work and I am typically less than chipper. I have gotten way too used to lying in that ultra-exposed position. Today I was exceptionally tired with 18 days of Lupron and 9 days of Follistim and Menopur stored up. As I lay on the paper-covered exam chair, my feet in stirrups, my head on a foam pillow, and a wand up my hoo-hah, I started to fall asleep. I didn't actually fall asleep but definitely started heading in that direction. With a stranger with a foreign object probing in my lady bits. This is a new low. So low. Pretty horrifying, completely embarrasing, and now for you to ponder and me to forget.

Retrieval is officially scheduled for Sunday, St. Patrick's Day. May the luck of the Irish be with me and may it actually be true that everyone is Irish on St. Patrick's Day.

Wednesday, March 13, 2013

Stims, Day 8 - Sip that medicine up, girls!


I have hit a new high. Or low. Not sure. This morning I sang to my growing follicles. I have either reached a new height of adorableness or creepiness. Hard to tell. It sounded like a children's song. I urged them to grow and invite their friends, to have a party, yada yada. "Yada yada" as though one could guess the trajectory of a follicle-growing song. My refrain, though I didn't song it at the time, should be "Sip that medicine up, sip that medicine up!" Doo-wop girls will sing it. Or possibly the Andrews Sisters. I digress.

I started a journal in a notebook but honestly I handwrite too slowly to accurately get my feelings down. The slog of it makes me anxious and then I write sad, sad things. Anyone who read it after me would remark what a wonder it was that I didn't commit suicide mid-cycle. That's not really how I feel at all. Yes, I have many moments of sadness, fear, uncertainty, etc but I have just as many moments of cautious excitement, pride in my near mastery of my injection protocol, and twinklings of "it could happen..." And that it might not. Ay, there's the rub.

I am on Day 8 of my stims - a cocktail of Follistim and Menopur with a dash of Lupron. The meds have the effect of replacing my once reasonably quick-witted brain with cat food. I also would like to nap at least twice a day. I might cry a little while I nap just for a little extra release. What a freaking emotional roller coaster. I am so ready to get off and get on with things. God forbid this medicine should have the side effects of making you feel energetic and extra witty. Perhaps a heightened sense of self. "I am an incredible dancer and am shockingly pretty!" That would be really sweet. Like cocaine, so I hear. Yet another thing that's verboten during my cycle. That and alcohol, caffeine (tragic), sex and exercise. But please, enjoy yourself! I do dabble in the caffeinated arts. I can't help myself. One indulgence a day usually in the form of black tea. Yeah, I know, I live right on the edge.

Sidebar - there's a completely amazeballs dress at Topshop right now. Writing this as I ride the bus to work along Michigan Avenue. Street of "you probably shouldn't buy that because babies are expensive and one day there's a possibility that you might get pregnant via petri dish. Save your money indefinitely."
Tomorrow I go in for another blood test and ultrasound, my third this week! The lab and ultrasound techs totally know me. I am an excellent patient. I do, however, annoy the ultrasound techs every single time I'm in when I ask to see my print out with the promise that I expect no interpretation on their part. I'd just like to see it so that I can see roughly the number of follicles I have growing and my uterine lining thickness. Otherwise I have to squirm while I wait 3-4 hours for the blood work to come back and the nurse to call me. They never say yes. It's against policy to look at images of your own body, apparently. "The nurse will call you and explain everything later!" They tell me this every time. I know that the nurse will call me. She always does. I would, however, like to leave the clinic without a giant question mark hanging over my head. I excel in pessimism. I am always sure that I either have ovarian hyper stimulation syndrome or have grown absolutely zero quality follicles. It's never anywhere in between. I go straight for the worst case scenario. It's a gift. This could all be avoided if I could just see that damn print out. Perhaps tomorrow I'll go all AA and "let live and let God" and not ask to see it. I'll just patiently wait for the call back, smiling beatifically. I'll let you know how that goes.