Frozen Transfer | Laughter Through Tears

Mother’s Day

Mother’s Day. A day that brings mixed feelings for Mom’s who worked a little harder to build our family than most. Its a day of celebration for those of us who longed to receive a flower at church or breakfast in bed courtesy of a proud, flour covered child. We are finally part of it, rather than being on the outside looking in.

But it is also impossible to forget the pain and loneliness we felt in the days when this day was just another reminder of that title we had yet to earn. For the infertile woman whose heart is aching to be a Mother, this day and all its sappy commercials in the weeks leading up to it can’t come and go fast enough.

For me, Mother’s Day is even more conflicting because of what it means to us. You see, Spork was transferred to me as one of three microscopic embryos on Mother’s Day three years ago. She had been waiting in cryofreeze for over a year for me to finally bring her home. 12 days later I learned I was pregnant for the first time. For that reason, Mother’s Day will always be magical for me. It’s the day I was literally reunited with my first and only child after years of infertility and three previous embryo transfers.

But I have not forgotten what this day meant to me before I became a Mom. I can’t forget my friends who still desperately want to become a Mom. And of course I cannot forget those who lost a pregnancy, infant, or child of any age.

Today I am praying for all women, not just Mother’s. I am praying that those who have never known the pain of infertility and loss never do. I pray that the wait ends soon for those that are still waiting. I pray for peace and healing for those who are reliving a loss today. I pray for all mothers who gave their child and adoptive family the greatest give you can give. And I pray in great thanks for what I have and for the people and processes that made it possible, because I do know what I have. I do.

Peace and love to you all. May the world be kind to you today and may our Mother’s Day story bring those that need it hope instead of pain.

Hello, Goodbye- Part 1

It has been a busy, hectic, and emotional week. In fact we almost haven’t had time to process what happened last Friday.

Almost.

While I felt guilty in the moment, looking back I do not regret caving in the 11th hour and taking the home pregnancy test. Testing before the official test allowed us to leave early for our weekend of water sliding and cleared Friday night for much needed time to discuss the sad news and what would come next.

Our discussion that night was one of the most challenging in our marriage. Bill and I process bad news in different ways which often leads to disagreements during times when we should be most supportive of each other, like the night of a failed pregnancy test. Especially this failed pregnancy test.

After eight procedures, twenty embryos, one miscarriage, and putting all our hopes and money into the Celebrity Miracle Clinic for one full cycle, we were both reeling and not at all in a position to give to the other what was needed that night. The weight of a disappointment of that magnitude could crush even the most perfect of couples.

Because so much of the IVF process centers on me, it is easy for me to forget that we are both invested in this. We are both elated when we are at a peak and devastated when we are in a valley. I have often made the mistake of expecting Bill to be there to take care of me, to put me back together when I am falling apart, only to realize that he may not be whole himself. This was the case Friday night.

Adding fuel to the fire, we were not at all aligned with what we wanted to do next. I decided long ago we would go back to Celebrity Miracle Clinic for one more attempt at creating a baby with my own eggs. Who cares that we didn’t like our experience there? I reviewed statistics for the best clinics in the country and determined that Celebrity Miracle Clinic was the place to be for an old lady with egg quality issues who was serious about getting knocked up.

Bill, on the other hand, has a deep seeded dislike of Celebrity Miracle Clinic and suggested in a less than subtle way that we consider alternatives.

Cue massive, explosive argument.

Throwing a wrench into the recovery plans of a hormonal Type A infertile woman is bound to cause a wee bit of a problem. It was a long night. Hurtful things were said. The evening culminated in our holding each other at 2 AM seriously discussing whether or not we could go through IVF again at all.

In the physical world, some explosions are devastatingly destructive. Others are critical steps toward building something new and breathtaking, like an expansive tunnel to the other side of an enormous mountain. I feel that Friday night was creative destruction, the clearing of one set of ideas and mental debris that allowed us to find a new path through this huge obstacle in front of us.

The truth is I don’t care for Celebrity Miracle Clinic either. Take for example what happened Saturday. I went for my blood work at 6AM mountain time. At 12:41 PM a nurse from the clinic called me to see if I had done my blood work. I told her that I had. She was then supposed to call the lab and call me right back to give us the results. Five hours later, there was still no call and no results. I eventually called the after hours answering service and had to demand to speak to the on call nurse because I was told “lab results are only discussed during normal business hours.” After five phone calls I finally received a call back with the results of my long awaited pregnancy test.

This type of thing happens all the time at Celebrity Miracle Clinic, but I explain it away and suppress my feelings about it because they supposedly have the best lab and results in the country.

Bill’s suggestion that we consider going back to our old clinic, the one that gave us Spork, made me angry at first. But the more I thought about it, the more it made sense to me.

We initially went to Celebrity Miracle Clinic because we didn’t know if we were still making chromosomally normal embryos. While our old clinic can do genetic testing, they do it at an early embryonic stage that can damage the embryo to the degree that makes it less likely to survive and implant.

Celebrity Miracle Clinic uses technology that allows the embryo to be biopsied at a later stage and therefore does less damage to the embryo, using only a small number of cells from the part of the embryo that will become the placenta.

I debriefed with my Celebrity Miracle Doctor on Monday. He said that we had three genetically normal embryos that were of good quality and we were just “unlucky” this time.

Hmmm… maybe. Maybe it’s a little more than just bad luck.

In our cycle at Celebrity Miracle Clinic we had 5 embryos make it to the blastocyst stage. Of those five, the initial genetic test results came back with two embryos as genetically normal (euploid), one abnormal (aneuploid). The remaining two embryos had to be retested because the tests were inconclusive.

What? Retested? What does that mean?

That means Celebrity Miracle Clinic achieved a 40% failure rate on their amazing state-of-the-art testing and we had to do it again. After retesting, one embryo came back abnormal and the other embryo was Blob. In order to be retested he had to be warmed and biopsied a second time, removing even more cells from his 100 or so to support the test.

When Blob was frozen the first time he was a 5BA blastocyst which meant he was still in his shell. During the second biopsy he completely reanimated, expanded, and even shed his outer shell. Then he was flash frozen again.

After that he was never the same.

Embryos are supposed to fully expand after being warmed. In fact, re-expansion is the most important indicator for a successful implantation. Blob barely had a chance once he was warmed again and only slightly expanded.

What Blob looked like at transfer

What Blob should have looked like at transfer

Had the test worked the first time, or had Blob not been tested at all, he could be happily growing inside me. There is no way to know, but the testing could have been too much for him. It could have been too much for the other two normal embryos that didn’t implant in January as well.

My new/old clinic transfers embryos at an earlier stage, generally untested but also undamaged. Now that we know more than 25% of our embryos are likely to be chomosomally normal, we can go back to the new/old clinic and continue with some confidence that it will likely just be a matter of time and patience before one of those embryos sticks and becomes Spork’s sibling.

While we do run an increased risk of miscarrying an abnormal embryo that wouldn’t have been transferred at Celebrity Miracle Clinic, as well as an increased risk for Down’s Syndrome or other chromosomal issues, these risks aren’t higher than any other 38 year old who gets pregnant and are still relatively low. The trade off is that we put the embryos back to their natural environment without damage sooner, which bodes well for delicate embryos.

Armed with this knowledge, today we said goodbye to Celebrity Miracle Clinic. I sent the official form from new/old clinic requesting all my medical records. I called my nurse to tell her voice to voice. It felt a little like an overdue break-up, like severing a slightly dysfunctional but at one time mutually beneficial relationship that is no longer beneficial.

We said goodbye to more than just a clinic with that call today. At our first consultation with them back in July we were so filled with the hope we would wind up on the right side of their jaw-dropping statistics. We were mesmerized by their program and amazing facility. Today we are no longer awe-struck. We said goodbye to that child like wonder and the certainty that Celebrity Miracle Clinic would swoop in and fix what was wrong.

We also said goodbye to Blob today. Even though I knew at transfer he had a slim chance, I fully believed he would make it. The start of my period today underscored the fact that he did not, something I have known since Friday but becomes so real when this time comes, the time when a cycle officially comes to an end and a new one begins.

While a little saddened, we are also turning a page. I received a call with the plan from the new/old clinic today thus taking our first steps through the tunnel we blasted into our own personal mountain. While the pain of goodbye is still fresh if I dwell on it like the pain of a fresh break up, there is nothing like the promise of a new relationship to help the memory fade.

It’s already time to look forward.

And so it is with infertility as it is with so many things in life.

Three Theme Songs for The Two Week Wait

Image via Goff/INFphoto.com

Two Week Wait Theme Song #1

Amy Winehouse- Rehab

Last night on my way home from work Bill called me and told me he was stopping at a pharmacy to pick up some cold medicine for my sister. Apparently she didn’t call me because she was worried I was too busy. Busy, yes? But I was only 200 yards from Walgreens and it would have consumed all of about 10 minutes of my time, a small contribution to help my sick niece get well. Especially since it was my sweet little petri dish of a daughter who passed along this nasty cold.

Still, I declined. My workload had nothing to do with it. I didn’t take it off my husband’s plate because I am a wimp on the verge of completely caving at any moment. I ~~fear~~ know if I walk into any institution that sells or contains pregnancy tests I will walk out with at least one, if not more.

I need an intervention.

Image via nydailynews.com

Two Week Wait Theme Song #2

Ozzy Osborne- Crazy Train

I awoke yesterday morning feeling total normal. The tell-tale exhaustion from the day before was gone, my “girl”s were a little sore but not tingly anymore, and the tightness in my lower abdomen disappeared. After being convinced for several days that the symptoms I experienced meant a Big Fat Positive (BFP) was just around the corner, I felt sad and dejected. The feelings of sadness and dejection made me think maybe I had PMS. I was spiraling out of control and I needed company. I immediately texted a friend, my sisters, and my Mom to share the insanity.

Keep in mind, I am only 3 weeks and 4 days pregnant. Even in the best case scenario any HCG in my system would be minimal. Any symptoms I have are much more likely to be caused by hormones I am taking than a pregnancy at this early stage.

By the end of the work day I was yawning mid-sentence when talking to one of my employees about a client. I almost hurled when I walked by the Keurig we have in our lobby. Coffee was my only aversion when I was pregnant with Spork. It was so bad Bill had to brew his morning cup of joe in our garage.

So now I am sane and hopeful again, even though I know it means nothing. All aboard!

Image via wikipedia

Two Week Wait Theme Song #3

Carly Simon- Anticipation

I love Carly and this is one of my all time faves. The ballad begins:

We can never know about the days to come
But we think about them anyway
And I wonder if I’m really with you now
Or just chasing after some finer day.

Anticipation, Anticipation
Is making me late
Is keeping me waiting

This beautiful little ditty goes on to describe the longing for a lover, but this first verse and chorus makes me think of Blob. Are you still with me now, Blob? Are you still living and growing?

Or is this cycle just a step toward a finer day when we will have another baby in our arms?

Whatever the case, I am more than eagerly anticipating the days to come. Specifically Saturday when this part of the wait will finally be done. With any luck we will be done waiting for pregnancy test results forever.

If you had a theme song for how you are feeling today, what would it be?

Prodigious Progesterone

It’s a slow news day. Day two after transfer is creeping slowly along like most days between now and the blood test will.

That means its time for me to get all nerdy on my readers again and explain a bit more of the science behind this miraculous process. In previous posts I’ve described the role of lupron and estrogen. Both hormones are pretty awesome and make it possible for Blastocyst Blob to grow into a bonafide baby. However now an even more captivating hormone is in play.

Prodigious Progesterone.

If all the IVF hormones and drugs were characters in the movie Grease, Progesterone would be Danny Zuko. It’s one slick dude and most definitely the leader of the pack.

Image: John Irving Via Flickr

For the last several weeks my reproductive system has been in a holding pattern. The lupron injections stopped ovulation. The estrogen patches and pills helped build the uterine lining. Theoretically this could have gone on forever with no effect or change, but of course that’s not the point.

Once the lining ultrasound scan and blood work checked out okay we added our final drug, progesterone. That is when things really heated up in this radical game of chance.

Blob needs a perfectly prepared endometrium in order to nestle in and grow into our bundle of joy. For this to happen, my lining must be receptive and ready for him to implant. Amazingly, there are only a few short days in which Blob and the endometrium can make a love connection. Progesterone starts the clock on this critical time frame.

Progesterone changes the lining, making it slightly thinner and replacing the triple layers seen on an ultrasound with a white cloud-like appearance. Whether in natural pregnancy or through assisted reproduction, progesterone gets in the game 5 or 6 days before implantation begins. Administration of progesterone for IVF is timed when ovulation when ordinarily occur in a natural cycle. In a natural cycle it is secreted by the corpus luteum and eventually by the placenta.

During the five and a half days prior to transfer of the embryo, progesterone helps the endometrium develop tiny little finger-like structures called pinopodes. Those pinopodes typically appear 5 to 7 days following ovulation, right around the time the blastocyst hatches from its shell and begins to excrete enzymes which will allow it to attach. The fingerlike pinpodes are only present for two to three days and it is theorized they must be present for implantation to occur.

If you research implantation, you will find many studies show the window can be as much as 6 days or even more, but its solely a function of not being able to pinpoint exactly when all these necessary steps take place. The true implantation window is likely equal to the life of the pinpodes. This time frame has to be matched with a blastocyst that is hatched, healthy, and ready to go.

If the blastocyst is too slow to develop, game over.

If the blastocyst develops, hangs out, and then dies before the lining is receptive, game over.

Image: Mykl Roventine via Flickr

This sliver of an opening is occurring inside me right now. For me to meet Big Blob someday, at this moment I need to have pinpodes that are closing in on Blob who has re-expanded and continued to grow to the point where he is burrowing in and about to excrete enzymes.

If Blob doesn’t make it, the absence of HCG will tell my body its time to begin the process of shedding my lining in which would normally occur in a week or so.

Isn’t it mind blowing that anyone ever gets pregnant?

Isn’t progesterone one bad mamma jamma?

Progesterone for IVF is also like the young and spunky Travolta character in that it can be a little oily.

Image: Thom Wong via Flickr

There are three ways to administer progesterone, by pill, vaginal suppository, and injection. The pill metabolizes inconsistently so only the suppositories and the injectible are used in IVF. The injectable is progesterone suspended in oil and astutely called “progesterone in oil” (PIO). I am taking both because my doctor likes to hedge his bets.

The PIO injections are hands down the most painful in IVF. Intramuscular injections, progesterone shots cause bruising and soreness in the hip area where administered. Many women need to ice the area prior to the shot and comfort the target area with a heating pad and massage after. This process helps alleviate some of the discomfort.

Endometrin (a disolvable insert), Crinone (a gel), and Progesterone in Oil

Side effects of progesterone are pregnancy symptoms which are experienced when taking the hormone at high levels whether pregnancy occurs or not. This totally messes with the mind of a hopeful momma wannabe as she ponders continuously;

Is it pregnancy or progesterone???

These side effects include bloating, abdominal pain, nausea , breast tenderness, headache, drowsiness, mood swings, irritability, and vaginal discomfort. Of all the drugs it mimics pregnancy the most, but for me at least it seems to balance the effects of estrogen and I feel better when I am on it.

Outside of its reproductive role, progesterone boasts many other riveting attributes. Progesterone relieves water retention in cells which is why some of my bloating from other drugs subsides for a short time when I begin taking the hormone. Most interestingly, progesterone inhibits the breakdown of the feel good neurotransmitter serotonin. As a result, the hormone has been proven to successfully treat addictions like nicotine and cocaine. The hormone is also being tested as a treatment for multiple sclerosis, certain skin disorders, and cancers.

Finally, it appears a reduction of progesterone is associated with cell death and scientists theorize administering the hormone could slow the signs of aging. Yes! Its a well deserved upside for those of us who have been on and off the hormone for years.

Our eggs may be getting older and we may not easily get pregnant, but at least we get to sip more than our share from this hormonal fountain of youth.

At least there is that.

Image: Sarah Veale via Flickr

UPDATE- This post was written yesterday during my long wait at the airport. Today we are three days past transfer so Blob should already be nestled in tightly. Now he should be dividing into two layers that will eventually become the baby and placenta. Unless of course he divided into two identical twins or is a little on the slow side. I am feeling a little crampy and bloated which could be a good sign. Unless its just the progesterone.

It will be at least another day and probably more before Blob is producing enough HCG to turn a pregnancy test positive.

Not that I am thinking of testing…. I am not thinking about that at all. Nope. Not happening. Really. It’s not. Never.

Knocked Up

It’s done!

And yet it begins.

“Blob” as we are calling him (or her) is now resting peacefully at home, preparing to burrow into my lining and take root for the next nine months. It was a harrowing, exciting, and ultimately pleasant experience which began with our wondering whether we would be transferring Blob at all.

Blob’s First Baby Photo

Yesterday at the top of Breck’s Peak Six, I picked up a call from the clinic asking if I could come in right away for a cautionary ultrasound. It seemed the doctor was concerned about my cyst and the pain from the night before. Rather than blow our day of boarding we opted to arrive very early this morning to check on the status of my temperamental reproductive system. Until about 7:30 this morning we feared we would be coming home empty handed (or in this case empty “uterused”). Luckily the lining, ovaries, and vitals all checked out fine and we continued with the embryo transfer.

Our first hurdle overcome.

Next up was the transfer.

Because our ultrasound and lab appointments were at the break of day, we had time to kill before the 11:45 transfer. We spent it at Target where I picked up these groovy lucky socks. These socks were so perfect they jumped into my shopping cart and I was wearing them before we left the parking lot.

Fertility green and orange with the luck of the Irish thrown in for good measure.

So far the knee highs worked their magic.

Ease of transfer is one of the many critical factors that lead to enhanced odds of success. A fundus (top of the uterus) touched by the catheter used to transport the embryo is a lousy precursor for implantation. Much effort goes into making sure the depth and shape of the uterus is understood before the procedure so the doctor can avoid the edges. It’s like that game of Operation we played as kids, except on a fuzzy black and white ultrasound screen with no buzzers to tell you when you screw up.

Image by Mykly Roeventine via Flickr

The doctor gracefully guided our little bundle of cells to the exact right spot without a single hiccup. Dr. S navigated Blob to the sweet spot with the precision of a fighter pilot landing on a aircraft carrier. What makes this feat more impressive is the embryo can barely be seen by the naked eye. Try landing that in a tiny little spot on a computer screen with only a bit of guidance from an ultrasound tech.

Way to go Dr. S.

Catheter releasing Blob in the perfect spot

Another hurdle overcome.

Blob was a busy little fellow this morning and hatched completely out of his shell prior to transfer, earning a final grade of 6BB. When the lab flash froze him after genetic testing back in January the embryologist graded him a 5BB. He’s overachieving already.

You can see the incubator holding Blob who is waiting in the background while we prepare for transfer

Blob’s incubator in the background

You may be wondering, what the heck do those letters and numbers mean?

Embryo grading is a complicated process, but essentially this means Blob was at stage 5 when he was frozen. This is the final blastocyst stage right before he hatches and burrows into the lining. The letters are grades for the inner cell mass (ICM) and the Trophectoderm Epithelium (TE). The ICM is a clump of cells that will eventually become a baby. The TE will grow into the placenta which will replace all the hormones I am taking between 7 and 10 weeks.

6BB is a good quality embryo. 6AA would be perfect. Both are fully capable of becoming future Rhodes Scholars.

Blob as a Rhodes Scholar

Typically an embryo reaches stage 6 on the fifth day after fertilization. Blob started slowly and took six days to get there. This is the main reason Dr. S gave Blob slightly lower odds than other genetically normal embryos. However, Day 6 blastocycsts like Blob fair much better with a frozen cycle like ours. This is due to the surprisingly short window in which the lining is receptive. Unlike in a fresh cycle, in a frozen cycle the doctor can control the timing of the lining receptivity and match it to Blob’s developmental stage, increasing the odds he will stick.

While our overachiever was quick to break out of his shell, he was slow to expand. If you have ever taken a balloon from a warm place out into really cold weather you know it shrivels up and loses its fullness until warmed again. Embryos are the same. They compact when frozen and then begin to expand when warmed. We are slightly concerned that Blob didn’t expand more prior to transfer, but encouraged that he is still developing. Most important, every last one of Blob’s cells survived the warming process.

A final hurdle overcome.

Post transfer I remained on bed rest for an hour before being wheeled to our car. We are now at the hotel where I will spend today and tomorrow at a 45 degree angle, able to rise only to powder my nose. Butler Bill enjoys this part of the process because it is the time he is most involved in IVF. I enjoy abusing my personal butler and make the most of being cared for by the love of my life at this sensitive stage.

If you look hard enough you may be able to see all the way to Blob through those nostrils.

If you look close enough you may be able to see Blob through those nostrils.

Butler Bill will bring me food, water, and medicine for two solid days. I will read, watch stand-up comedy, blog, goof off on the internet, meditate, and try not to obsess about possibilities. I am allowing myself only a half hour with Dr. Google to see what I can learn about slowly expanding embryos. After that half hour I am firing that negative jerk in order to relish being pregnant.

Pregnant.

In the IVF community we describe this part of the cycle as being PUPO (Pregnant Until Proven Otherwise). I am so done with the uncertainty implied by “until proven otherwise.” This mama has decided she is straight up knocked up. I plan to prove it on March 22nd.

Our countdown begins anew…

Making the Most of It

We made it.

We are finally in the same state as the 100 celled baby we are taking back home on Saturday.

Even though real romance is a no-no at this stage in the process, we are making the most of it by tagging on two days of snowboarding prior to transfer. This is our fourth trip to Colorado for fertility purposes and we are infusing some fun and sport into the journey. On the last trip we ventured to Vail. Now we are giving Breckenridge a go. We both love boarding and are paying for the flights, so why not? Especially since I hope to be done with boarding for the next nine months.

We discovered a rustic mountain lodge only a few miles away from Main Street and were upgraded to a mountain view suite without even having to play the “we are here to get pregnant card.” Sweet.

We arrived just in time for some grocery shopping and a leisurely dinner last night. We hit up the local Safeway to pick up a prescription, beer for Bill, and water for me. Turns out the labs from Sunday yielded low estradiol levels, again. Now I am on four estrogen patches and also talking estrace orally twice a day. Holy estrogen overload!

Once again, this shouldn’t be an issue as long as we fix it by Thursday morning. The lining is nice and thick and my progesterone levels are right where they should be to make a cozy home for baby.

When the clinic called to relay the need to pick up more meds, we also learned that Bill has to have blood work done prior to transfer. They want to make sure he hasn’t picked up any communicable diseases before they send us home with a baby. The sadistic side of me is eagerly anticipating him getting poked too. Its only fair.

But today we put all the meds, labs, and procedures in the back of our minds as we enjoy two pristine days on the slopes.

Breckenridge is crawling with people, its one of the busiest weeks of the year. The first board rental store we stopped at was completely sold out of boards and bindings for Bill. We start the search anew today. Worst case scenario, we will buy new ones. Both of our boards back home are more than 10 years old and its past time. Still, the trip to Breck is stretching our already taught budget and we hope to score rentals.

Despite the crowds and not having a reservation, we consumed a delicious dinner without having to wait. Tonight we aren’t risking it and made reservations at an upscale, gluten-free, vegetarian restaurant. Simply perfect for our pre-baby making meal.

I booked an apres ski couples massage in the hotel spa today. Between shredding the hills today, the massage tonight, and the clean dinner I am doing the best I can for my body and should be toxin free by Thursday.

As far as how I am doing, physically I feel amazing. Stopping lupron has done wonders for me. Emotionally, I continue to feel unusually optimistic about this cycle.

On the plane yesterday I meditated multiple times. I visioned all the cells in my body breaking apart and joining with all the matter in the universe, including all the cells of our chilly little embryo. Then I imagined bringing those cells back into me. It was beautiful. I feel as though my body is calling our baby home. I have felt this way before, but this time is more profound.

Only two more days and we will be reunited with our baby and will hopefully be done with trips to Colorado for “medical purposes.” While we appreciate writing off the travel expense on our taxes, the next time we come back we hope it is as a family of four.

There still may not be much room for romance then, but that will be okay with us.

Friends in Low Places

Image by Treacle Tart via Flickr

Like Garth Brooks, I have friends in low places. Or at least one friend.

Don’t get me wrong, my friend Kristy exemplifies class and style, it’s just today she was literally in a low place.

Low meaning that she was sandwiched between a pair of stirrups below my waistline. She was there holding a wand while looking up at a video monitor to assess the size and pattern of my endometrium.

Kristy and I met and instantly became friends almost three years ago at a pre-natal exercise class. Everyone who meets Kristy instantly becomes her friend. She is a sweet social butterfly who never met a person she didn’t like and you’d be hard pressed to find someone who didn’t like her. Our kids were born only a month apart. We quickly formed a small play date group that gets together to drink a beer and let the kids run wild.

I love our little clan and Kristy is the glue that holds us all together.

Before I met Kristy my local monitoring was done by a hometown infertility specialist who partners with more remote clinics. She was nice enough and always willing to come in on weekends, but I never connected with her. So for baby number two I switched to Kristy for monitoring at the local hospital.

Trans-vaginal ultrasounds take a friendship to a whole new level. Moments like that shared among friends connect you for life. I remember how nervous I was the first time I went to see her. I am sure she was the quintessential professional, but I felt a little strange.

Fast forward a handful of scans and we gossip and carry on as she inspects my innards like we are knocking back brews on my deck in July.

Switching to her was a great decision and not only because she is a friend. Kristy is excellent at what she does. You may not realize it, but follicle monitoring is tough stuff. Its difficult for the tech to count all those tiny circles across the surface of our imperfectly round ovaries. Kristy is a whiz at this, arguably as good as techs at clinics that do it all day long and able to carry on a conversation at the same time (I’ve seen more than a few who can’t).

As good as she is, the best part is the friendship and that hit home today. After I left the appointment the obsessing began and we had the following text exchange:

Me: You are sure you saw three layers, right? They weren’t as obvious to me this time and we won’t check again before transfer.

Kristy: Yes, three layers and measuring 9mm

Me: Is it okay if I use your name in the blog? You might want to read tomorrow.

Kristy: I always read your blogs, your writing is funny and informative. Even though we don’t have infertility in common its good because it lets me know how you’re feeling and how my patients are feeling.

See what I mean? Sweet, right? I regularly freak out and text after appointments and she is always there to talk me down. You can’t get that from a stranger. She lies about my writing being funny and informative. She loves her patients and wants to understand how they are feeling. (Side note- this his smart on her part because Kristy can get pregnant by merely thinking about having a baby. A mutual friend and I are throwing her a small “sprinkle” for baby number 2 on Sunday.)

All of this is great, but here is where she did me in, where she sealed her fate and got stuck with me as a friend forever. As I am leaving she says to me:

Oh! I forgot to tell you, I wore my orange underwear for you today.

If you have read Orange Panties and Green Toes you know why that makes her the best friend and sonographer ever.

Thanks Kristy, it worked. Everything looks good and we are go for launch. Unfortunatley they increased my estrogen but that’s on the lab and not ultrasound. I guess we need to talk the phlebotomist into wearing orange panties too.

Now please just let me drink out of your glass on Sunday…

A Subtle Change of Theme

Image: Opus Moreschi via Flickr

The self-discovery I experience as a result of IVF never ceases. When I began this blog, I had every intention of posting something humorous about infertility every day. I vowed to readers I wouldn’t complain. I promised to not provide gory details of ultrasounds and other tests. And above all I promised no pity parties or rants. My goal was to bring a little levity to an otherwise heavy topic while also reminding myself to stay positive and laugh.

What was I thinking?

Positivity and humor are still great goals and I am not planning to dive head first off the deep end, but I am only on day two of estrogen and I am already throwing in the towel on trying to be funny every day. I don’t know how I forgot about the effects of that nasty lupron and estrogen cocktail. It’s like having a never-ending hang over. The headaches are constant and pounding. Fatigue has wracked my body. The moodiness is already wickedly bad.

The scary thing is that it is only just beginning. I am wearing only one estrogen patch at this stage in my cycle. By the time I fly out west to reunite with my long lost embryo I will be wearing four patches. Tears will be flowing and fights will be picked. I know myself and my body and its inevitable. Comedy writing on a daily basis is not in the cards.

You can already see the effects of the drugs in my writing. My posts have grown longer and just a wee bit darker as the injections have worn on and the patch was added. What I am learning is that there are just times when I am not a funny person. There are times when I barely feel like a person at all.

Freaking out and worrying are also tell tale signs of successful progression in an IVF cycle that are sure to make humor elusive. Yesterday I was convinced I hadn’t shed my old lining and that I shouldn’t start my patches until I did. I pleaded for an ultrasound to confirm that it was gone and I was getting a fresh start on developing fertile ground for implantation. As expected the ultrasound was fine. Despite the good news, I still dialed up my clinic twice today for no good reason to ask a couple of questions that don’t really need answers until March, if ever.

The questions were about the odds of success of our lone embryo. The doctor already told us the embryo had about a 35% chance of making it to a real life baby. But yesterday I spent some time with Dr. Google, never a good idea, and began wondering what factors went into the creation of that number. Did the doctor take into consideration that the embryo had to be thawed and retested because the first genetic test was inconclusive? What are the impacts of an extra thaw and biopsy on our delicate embryo? What are the odds that we will get all the way to our clinic and the embryo won’t survive the warming process?

I pestered my clinic with these questions even though I laid in bed late into the night last night reminding myself that the answers are irrelevant. The clinic has a 95% survival rate for thawed embryos. And even if the odds were lower, its not as if we aren’t going to go through with the transfer. What would this information change? Nothing good can come from this knowledge. I have already been meditating on the only statistics that matter, my very own 100% success rate. I visualize a SART data report with my name on it and in every column my results are 100%. Why would I want to mess with that image and its mojo by finding out what some doctor thinks?

One word, hormones. Hormones make the sane insane. They make the intelligent foolish. They make the happy sad. And above all else they make the confident worried. I don’t like worried.

Worry is a meditation on shit.

Worry and hormones aside, there is another reason that I am having troubling channeling my inner comedian.

The real self-discovery has been that its not only that I am not always capable of humor, I have also discovered that I want to try a variety of types of writing. I don’t just want to tell cute stories about IVF, I want to pour my heart and soul out on a page and see what it looks like in black and white. I want to hear my emotions and deepest thoughts roll of the tongue of the voice in my mind. I want the therapeutic jolt of liberation I feel when I hit publish on something I have created. The writing process won’t allow me to limit my life to one genre.

With all this in mind, I made a little change to the Laughter Through Tears subtitle today. Yesterday it read “for those in search of the lighter side of infertility.” Today its simply “In search of the lighter side of infertility.” It’s a subtle change, but its recognition that I can’t promise anyone levity every day, especially not myself. I can’t always be funny and witty. However I will commit to always being in search of the lighter side. For you and for me.

Shoot Em’ Up

Tomorrow is the day. This addict is tired of only popping a measly little birth control pill every morning. Thankfully the waiting for the good stuff is coming to an end. Tomorrow I begin the real work that will take us towards our March 13th transfer date.

Yes, the time has come when I start shooting up.

I have been waiting with anticipation all weekend for the morning when I start taking Lupron injections. Even though the are small, they are mighty, and the shots are a critical stepping stone that will lead us to the Promised Land.

As I discussed in Addicted to IVF, there is just something about this phase in the cycle that makes the long time IVF gal get excited. Heck, even if it is your first IVF it is thrilling to take that first shot, albeit a little frightening. After all you have so much time, money, hope and energy invested into this part of the process.

And best of all, you finally get to put your Baby in a Box to good use.

What is this Baby in a Box?

When you go through IVF you require a number of different medications for different phases of the cycle. These medications are not your average, every day, run-of-the mill medications. Your local Walgreen’s does not keep them in stock. Therefore they must be ordered through the mail, typically through a specialty pharmacy.

When we start an IVF cycle, all my meds are sent to me in one big box which happens to be about the size of a very large baby. If the meds do what they are supposed to and your body complies you will have a baby in about 10 months or so.

And there you have it, a Baby in a Box.

There are a lot of drugs that do a lot of fun stuff in the box. What you see above is only a portion of it because we are currently only doing a portion of the IVF cycle.

The first phase of an IVF cycle is the stimulation phase. This is what we did back in November when we amped up my body with hormones to help it develop many eggs instead of the usual one per month. The stimulation phase is without a doubt the most grueling part of IVF. It can be quite uncomfortable and culminates in an invasive surgery to remove the eggs. Stimulation is also the most expensive part of the cycle and I am glad for that reason among many others that it is behind us.

Many clinics go straight from stimulation to transferring a fresh embryo back to Mom anywhere from 2 to 6 days after the eggs are retrieved. This is called a “fresh cycle.”

But that is not what we are doing. Not this time.

We are doing what is called a “frozen cycle.” We had the embryos genetically tested which means we had a great big pause between retrieval of the eggs to the part of the process we are now entering, the frozen embryo transfer.

Our embryo is 6 days old, chomosomaly perfect, and is just chilling out in cryofreeze waiting for us to come and get him (or her). Lupron is the first shot we take that will help us prepare to do just that. Its a small dose with a tiny little needle in my belly. This one I give myself because it is pretty painless and easy to administer. It does eventually make my tummy look like it has freckles all over it from the small scars, but those are battle wounds of which I am deeply proud. They do fade eventually.

Lupron, like most hormones involved in reproduction, is a weird dude. It’s short for Leuprolide or Lutenizing hormone (LH). Male and females both use LH to regulate the pituitary gland and control secretions of other hormones like follicle stimulating hormone (the stuff that makes all those eggs develop in the first IVF phase), testosterone, and estradiol. What makes LH weird and kind of cool in my opinion is that in small doses during certain points in a cycle it will down regulate these hormones. Shuts them right up. Quiets the body and limits the hormones secreted.However mid-cycle a large surge of LH (LH surge) will actually trigger ovulation and the resulting production of hormones. This surge is what will cause a home ovulation kit to have a smiley face or a dark line. I find its dual and seemingly contradictory functions fascinating.

Because LH in regular, small doses will slow the production of hormones that can feed certain types of cancers, it is often used in treatment of those cancers. And here is a super fun fact, high doses are sometimes used to chemically castrate sex offenders. Yep. You read that right.

Isn’t that lovely? As if we need another way for fertility treatments to impact the libido, and this one a scientifically proven one. However its somewhat irrelevant because the birth control pill I am on has already zapped what little libido I have at this stage in the process. Ironic that a birth control pill would do that but it does for me and always has.

For me, the main side effect of lupron is uber bitchiness. I mean, “stay out of her way” bitchiness. The mood altering effect of the drug is my primary side effect , but it also causes weight gain and headaches. Massive, horrible, headaches. The weight gain and headaches of course form a mean pair that further fuel the uber bitchiness. It’s not pretty.

Given all this you would think I would be dreading tomorrow, but in fact I am looking forward to it like a kid at Christmas. The Lupron shots I start tomorrow will shut my reproductive system down. This is so my doctor can take over and manipulate it with still other many other hormones that are to come. Its a little like computer that has been rebooted after new software is installed. When my reproductive system comes back online it will have a new operating system controlled by my RE. One more step toward bringing home baby. When you look at it that way, its pretty damn exciting.