two week wait | Laughter Through Tears

Confessions of a Sister and Fellow Infertile

Image by Alison young via Flickr

I always thought I was different than many of the women I know when it comes to infertility and jealousy. I never struggle in the same way others sometimes do when I learn of someone’s pregnancy or happen to walk by a glowing Mom-to-be on the street.

Like anyone trying to conceive, my awareness of pregnant women and babies is elevated when I am actively cycling. I am human after all. Because I am in the middle of the two week wait, I currently feel trapped in a fictional and terribly done B movie that plays in my head called “Invasion of the Baby Makers.” Pregnant women and infants are everywhere I turn, and of course I feel that tiny pang in the center of my chest when I see them, especially when I am unprepared to bump into… well… a bump.

But that’s it. The good fortune of strangers as evidenced by their tight round bellies rarely elicits more than that little stab of feeling that sinks rapidly and deeply into my heart but fades as quickly as it came. You may recognize the feeling, it lasts only a moment. And that feeling is about the extent of it. I do not have break downs, cry, or break out the Ben and Jerry’s when I find out someone is pregnant or receive an invite to a baby shower from a lucky friend or acquaintance. I never have.

I always remind myself that I don’t want their baby, I want our baby. Besides, I tell myself, I don’t know what version of hell they may have faced or demons they had to slay to achieve their blissful full-bellied state. For all I know the path they tread could have been as long and hard as my own, so I generally just let it go.

Generally. There are two notable exceptions. Family and fellow infertile women.

I will talk about my illogical envy for other infertile women in my next post, Follicle Envy, but my issues with family members who get knocked up is really quite strange and deserves a post all its own.

Of course the baby blessings of my family members genuinely make me happy, but a few years back when I learned of my sister-in-law’s unexpected pregnancy only a few days after a failed cycle, I sobbed in Bill’s arms until I ran out of tears. I did this despite the fact she was 37 years old and I had been mortally terrified up until then that she would never have the kids I knew she desired. To this day I still do not know why it upset me so much, but it did. It was probably as simple as timing, as well as the fact that it came so easily to her when we tried so hard for so long.

Then there was my middle sister’s first pregnancy. She literally got pregnant as soon as she started trying and announced it to me and the rest of the immediate family in a pretty dramatic an unexpected way while we were in the two week wait of our very first IVF cycle. I am sure its not a choice she would make today knowing what we all know about infertility and IVF. Back then we were all so naive so certain IVF would work and work quickly.

Once again, I was happy for her but I ached at the thought that I was the much older sister and should have been first. I also envied the confidence she had which allowed her to announce her pregnancy with such utter excitement at only 5 weeks. I already knew then that any pregnancy I had would always have a small cloud of fear over it that would prevent my joy from emanating so purely.

In the back of my mind, I also wondered if she was deliberately trying to beat me to the punch since she knew we had just completed our first cycle. I know now that wasn’t the case, she was just expressing unbridled bliss of the greatest news any hopeful mother-to-be can receive, but try to tell that to a hormone crazed woman in the two week wait. It was painful. The experience was almost as painful as being invited to her shower for her second child while I was going through my first and hopefully only miscarriage.

I already had my daughter then, but it still stung and made me want to crawl under the covers and sleep through the nightmare of her pregnancy that was timed so inconveniently with my loss.

These three pregnancies are the only ones ever to cause me real pain or tears. I am sure there is some psychological reason why only those I am closest to make me to feel the jealousy and despair my other infertile friends seem to reserve for catty women at work that they didn’t like that much in the first place.

Maybe it is as simple as proximity, knowing I would be reminded of what they have and I couldn’t every time I connected with them or anyone in the family. I don’t know. But it ached. Thankfully I think its done for awhile. I am happy for that. But I am even happier to have my beautiful nieces and amazing nephew.

While it was hard at the time I would never consider having it any other way.

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?

Pitch Drop Experiment Vs. The Two Week Wait

My post yesterday about the mysteries of IVF reminded me of another great Radiolab episode that helps put the torturous wait for our pregnancy test results in perspective.

It could be a lot worse.

It could be like the Pitch Drop Experiment.

Nine days of waiting feels like a really long time, especially when a healthy chunk of retirement savings rides on the outcome. The wait is painful and and requires great patience. However it doesn’t begin to compare to the patience practiced by the late professor John Mainstone.

Sadly, the revered researcher went to his grave without ever seeing the results of his test. Those results are due at any time now, and were estimated to arrive last July.

But still, we wait.

John Mainstone Watches and Waits

The experiment began under the supervision of another scientist in 1927. Eighty-seven years later researchers are still longing to see the results, making my 9 days pale in comparison. However just like my pregnancy test, the wait will end in a fraction of a second creating a mesmerizing moment where time that has lagged dramatically slingshots into high gear, moving at the speed of light toward what comes next.

The contrast is fascinating.

What is this intriguing and insanely lackadaisical experiment?

Pitch is a substance that is technically viscous, however if you hit it with a hammer it will shatter. The experiment is all about attempting to observe the substance’s liquid like properties and take note of what happens in the moment in which pitch drips out of a glass like a viscous substance should.

To accomplish this, a sample of pitch was heated and poured into a funnel shaped glass. Once the pitch settled, a process that took three years, the bottom was cut from the funnel.

Then the wait for the pitch to release a drop commenced.

Slowly but surely, the pitch began to stretch and prepare to drip. Over the last 87 years it has lazily dripped 8 times, an average of once every 10.87 years. However, the drops have never been observed. The experiment began before it was feasible to use cameras to monitor the pitch and the researchers consistently missed the fraction of a second they patiently anticipated.

Capturing that moment is exceedingly difficult. How do you observe something that happens anywhere from every 8 to 13 years but in a blink of an eye?

At one point, professor Mainstone was monitoring the pitch at a time when it was crazily close to dropping. He went to get coffee and when he returned, the pitch had dropped. Imagine his frustration! I am sure it was far worse than a two week wait, especially considering the experiment had to have grown to feel like “his baby.”

The last time the pitch dropped, there were was a camera on it but it malfunctioned.

Seriously, this poor dude was doomed.

Today the pitch has three cameras trained on it and there is a live video feed on a special website set up by the School of Mathematics and Physics at The University of Queensland where the experiment began.

Click to go to the live feed of The Pitch Drop Experiment

There are people hopelessly addicted to watching the live feed, wanting desperately to see with the naked eye what no other human has ever seen live. I too was sucked into the obsession when I first learned of the Pitch Drop Experiment, but soon realized that you could waste your life away by devoting it to following the imminent drop.

This is another way the experiment is like a two week wait. You can obsess about it non-stop, but it won’t make the moment arrive sooner. Wasting your time and energy thinking about it is pointless, but its amazingly difficult to avoid.

Thankfully there is no chance I will wait for nearly a century for my results.

So Dr. Mainstone, I tip my hat to you for your patience, fortitude, and resolve. I am so sorry you will miss it, again.

Personal Update: Feeling more pregnant than ever. With Spork I didn’t have much morning sickness but I was so exhausted every day I came home from work and would fall asleep on the couch before dinner. Its way too early for real pregnancy symptoms, but I did feel that tired yesterday. I am hopeful Blob has stuck and is already putting his Mama to the test!

How Old Is Blob? And Other Confounding IVF Questions

I am 5 days past our embryo transfer, which means Blob is 11 days old.

Or is he?

Blob was conceived on November 11th of last year. Technically he has been on this planet as a viable life for 4 months.

After Blob was whipped up in a Petri dish, our precious little ball of cells grew and divided for 6 days before an embryologist removed all of the fluid from him and flash froze him. In an instant, he stopped growing. And stopped living?

I don’t know. He was sure enough alive when they warmed him up a few short days ago.

Even more confounding, our daughter Spork was over a year old before she was transferred and I became clinically pregnant with her. While Spork is advanced for her age as any child of ours would be (gag), she is still very much two years old, not three.

All this ocassionally makes me ponder when life begins. I sporadically question when soul and spirit develop if I think about it too much.

I try not to think about it too much. Infertility adds enough uncertainty to a couple’s life without having to perfectly resolve feelings on the universe and life’s purpose.

Image: Don McCrady via Flickr

My mind first started swirling with these universal questions when my wisdom teeth were removed as a teenager. Going under and then instantly waking up with no sense that any time had passed made me question where the identifiable inner “me” went for that 30 minutes or so. I experience the same thing when I go under during egg retrieval.

It’s freaky deaky Twilight Zone stuff.

Image: Allen via Flickr

If I had more time and energy, I would explain what scientists are learning about the “block box” experienced when a patient is down for the count. Maybe someday when I am feeling less pregnant I will “nerd out” again and tell you all about it. Until then a Radiolab podcast I recently heard does a fine job of beginning to peel back the layers on the mystery of anesthesia.

If you have never heard of Radiolab, it is the best podcast out there for amateur geeks like me. If you carry a dweeb gene you should definitely add it to your Stitcher favorites.

Click to navigate to Radiolab and stream live audio of “Black Box”

Now back to IVF.

These are just a few of the many reasons why IVF can be so controversial. It touches on some ultra- sensitive subjects. Embryo freezing is the tip of the iceberg. There are other touchy topics like embryonic research, the morality of gender selection, selective reduction of multiple pregnancies, embryo destruction and donation, and now the over-blown and largely misunderstood concept of designer babies.

Speaking of gender selection, my clinic already knows whether Blob is a boy or a girl. They won’t tell us until we are 12 weeks in order to avoid possible legal and moral issues associated with gender selection. I tried to convince my nurse to come out for a couple of giant margaritas so I could pull it out of her, but she swore that only the embryologist knew.

I tried but he wouldn’t talk.

Image: Bradley Gordon via Flickr

All we want is a healthy baby, but of course there are those on the fringe that push the moral envelope of Assisted Reproduction Technology (ART). Debating IVF issues is not my agenda. If you wonder why, simply read the title and subtitle of the blog. Heated spiritual and moral arguments don’t fit with my mission.

I just like to think about it all from time to time.

Personal Update: As I mentioned, I do feel pregnant. I am bloated and have tightness and subtle aching in my lower abdomen. I am totally exhausted. “The ladies” are a little bit sensitive. These are all good signs, but could also be the high levels of hormones or the start of PMS. Oh Saturday! How I long for you…

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.

To Pee, Or Not to Pee

Once upon a time, many cycles ago, there was a naive wife and banker who never ventured outside of her simple yet pleasant little northern village. Life for this young wife was easy. She developed a blossoming career and married a prince of a husband. The merry couple traveled, played, enjoyed friends and family, and nestled into their quaint little corner of the world to live happily ever after.

Then one day this wife decided she needed more. Something was missing and she knew just what it was and where to find it. Thus, the determined wife and her doting husband set off on a sojourn to the Kingdom of Parenthood.

The merry couple knew others that made the trek many times without event. Therefore the couple was confident they would safely arrive and be warmly welcomed into this coveted community. However, along the way the happy pair was tragically lost.

The merry couple awoke one day shocked to discover they were stuck in the Land of Infertility.

At first, they tried to find their way to Kingdom Parenthood with only the help of the doctors. But after a few wrong turns, the wife eventually met and was warmly taken in by the Royal Family that rules the Land of IF…

The Queens and Princesses of Pee.

Image by Scott Andress via Flickr

Bill and I didn’t try to conceive for long prior to learning my tubes were blocked and IVF would be the only way for us to have a baby. In fact, by the time we started IVF I took more pregnancy tests hoping not to be pregnant than I took praying for those two magical lines. As a result, after our first IVF it never occurred to me to take a home pregnancy test. I simply assumed the clinic knew the exact date your pregnancy test could be positive and taking a home pregnancy test before the scheduled blood test would be futile.

WRONG.

Once that first cycle failed, I did what any type A overachiever would do and began surfing the web in attempt to understand what happened and how I could fix it. Four years later I still don’t have those answers and never will, but what I do have is a community of women, and a few men, that I can lean on for advice and support. These strong people are my close neighbors in the Land of Infertility.

Among women living in the Land of Infertility there are two distinct groups:

Those who POAS (Pee On a Stick) during the two week wait, and those who don’t.

Most women are fanatics either way and actively try to recruit other infertiles to their side. Self titled “Pee Princesses” are the worst of the bunch and among them are a few higher ranking queens. These Queens of the Pee are so hooked on home pregnancy tests they aggressively work to convert other hopeful infertility sufferers to their cult. I assume The Queens are attempting to live vicariously through aspiring Pee Princesses when they themselves are between cycles and can’t get a fix.

By the time our third transfer rolled around, I decided to dip my toe in the water and give peeing a try. For me, an over-thinker and worrier, the choice was devastating. I started testing at 9 days past retrieval which is not the earliest you can get a positive result, but its close. At 9 days you are still more likely to get a negative result than a positive.

Of course my test was negative. And so it went for days 10, 11, 12, and so on. I was a weeping mess by the time of the blood test. A horrible, negative, stressed out, depressed, weeping mess.

I promised Bill I would never do it again.

The next cycle gave us Spork and I kept my promise not to pee after the last emotional disaster. Instead my blood was drawn as scheduled at a random clinic in South Carolina while I was there for 10 days on business. I learned the best news I ever received by listening to a voicemail while on a break from a meeting. I was finally pregnant! Of course after the call I immediately went out and bought several pregnancy tests just so I could see that beautiful second line for the first time in my life.

Spork tainted my pee and turned pregnancy this test positive on May 19, 2011

Two years later in our effort to give Spork a sibling I forgot my promise to Prince Bill and dove head first off the pee wagon. I even went so far as to buy 50 cheapie tests from the Internet for our fresh cycle last spring. When those ran out I ordered 50 more and eventually used every last one of them.

Its not pee stick related, but who doesn't like funny cat photos?

Its not POAS related, but who doesn’t like funny cat photos?

During second cycle for baby number two, our miscarriage cycle, I was testing three times a day or more to assess whether the lines were darkening. I lined all the tests up chronologically and glued them to a piece of paper to review the progression, writing my HCG levels next to them on blood test days. I compared my obsessive little chart to others on the Internet, attempting to divine the outcome of the difficult cycle with the erratic blood test results. I tested every day for TWENTY days.

These are only the best of the tests.
I took a total of 44 over the course of the cycle.

For our most recent cycle in January I had only 5 tests remaining from the original 100 and vowed they would be the last sticks I would ever douse with my pee.

Every test, every day was Negative. Negative. Negative.

I would stare at the tests under different lights and even go outside to see if I could spot a line in natural light. I revisited tests several hours after I took them, examining the result area closely for what seemed like hours. I even fished tests out of the trash the next day to make sure that a line didn’t develop overnight.

I spent countless hours on Countdown to Pregnancy, my favorite Pee-Aholic site. It is one of literally hundreds out in cyberspace dedicated to fueling this horrible addiction. The sites will tell you how likely you are to score a positive result by brand of pregnancy tests and by number of days past ovulation. You can post pictures of your pee sticks and have others weigh in on whether they see a line. And so much more…

Who knew such a network of pee stick pushers existed? Sadly, I became one of their highest ranking members. I was a full on Queen of the Pee and I needed to kick the habit. It was hard on me and it was even harder on Bill. His hope was also dashed with every negative test, but he had the added bonus of dealing with my sadness every time my pee would let me down.

This cycle I am turning in my crown, stepping down from my throne and going back to life in the other camp of infertiles.

No more pee sticks for me. Not now. Not ever.

Make no mistake, there are advantages to peeing on a stick. The miracle second line could appear, showering you with exultant joy and taking the edge off the two week wait. Additionally, for long time inhabitants of the Land of Infertility, learning that you are pregnant the “normal” way is quite appealing. So much of what we go through to get pregnant is is clinical. Learning through a home test instead of yet another blood draw just feels so natural.

Finally, some women let their pee flow because they like to be prepared mentally for the phone call from the clinic, especially if it is bad news. Its no fun crying to a practical stranger over the phone. This was a primary motivator for me, as much to make it easier on me as to make it easier on the nurse calling me. No matter how many times they do it, I know those calls are hard for the nurses.

So there are many arguments for peeing prior to the HCG test. I do not begrudge any princess her tiara. It would be hypocritical for this reformed abuser to do so. Unlike many recovering addicts, I also refuse to push my new perspective on anyone else. I’m not saying my way is the right way.

Its just the right way for me.

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…

The End of the Internet

Totally exhausted from three days of travel for work and estrogen overload, I created something a little different for my IVF friends today. Years ago I ran across an “End of the Internet” cartoon and have often thought about it when I go on one of my IVF information binges. These binges are especially common during the two week wait when I scour the Internet to see if I can divine what will happen based on statistics, anecdotes, and real life stories. We have all been there…to the end of our sanity and near the end of the Internet itself.

Enjoy and good luck to you. May you find what you are searching for in life if not on the web.

Our Division of Labor

I told a great big public lie and its time to come clean. My transgression ocurred yesterday when I posted the above photo to Facebook with the following caption:

“Thank You winter storm. After eight years of shoveling we finally broke down and bought a snowblower for Valentines’ Day. I would hate to see it go to waste after shoveling our way through the Worst. Winter. Ever.”

I hit submit and immediately felt like a great big fraud. I don’t shovel. I never have and never will. I limit my shoveling to a an 8 foot path to our hot tub and the top of the hot tub on rare occasions. The only reason I even do this minuscule amount of cold, hard, labor is that I am the only one who likes to use the hot tub which means I am sometimes responsible for its upkeep.

All of the other shoveling? The driveway, the mailbox, the long path to our house and our neighbor’s house? Bill has toiled away for thousands of hours over the last 8 years shoveling us out from under Northern Michigan’s worst wintery white blankets. Saying “shoveling our way though” in that Facebook post was a gigantic fib from a total phony. A poser.

But as much as I have never earned a callous or blister from the handle of a shovel, we are in this together as we are in all things in life.

That is the way it is in our marriage. He shovels. I balance the check book and pay the bills. He cooks and does the dishes. I do all the laundry and straightening. He hangs pictures and puts things away in the attic. I frame the photos and organize the junk that goes into the attic. He takes care of scheduled maintenance on our vehicles. I take care of the license plates and our taxes. We have a division of labor in our house that works like a well oiled machine. We never discussed or planned it this way, we just fell into it based on our natural talents and needs of our family. The invisible hand of marriage created a near perfect process that satisfies both of us most of the time.

This division of labor started me thinking about how shoveling is for Bill like going through IVF is for me. Even though we are both impacted by this process, the heavy lifting is all on me. I take all the shots, undergo surgeries, experience side effects, schedule and attend appointments, cut all fun and taste out of my diet, organize travel plans, and resolve issues that develop. Bill is involved and concerned, but for the most part he just shows up when and where I tell him and does as I say.

Good husband.

Its not as if Bill doesn’t do anything. He does one BIG thing in that tiny little cup to contribute to the cause. He also cut way back on drinking from August until November to get his swimmers in tip top shape. During that time he remembered to take his supplements most days. Yes, I often laid them out for him and had to remind him but that’s okay. That’s what I do. Our beautiful Christmas cards would never go out if I left it up to Bill, just like he wouldn’t remember to take supplements on his own. It is what our family unit needs to work.

Bill’s real work begins after the transfer when he morphs into the most caring man on the planet. He takes care of me while I am on bed rest for two whole days. He waits on me hand and foot and scolds me if I break the rules. While we are in our 9 day wait he becomes Spork’s primary caregiver since I am not supposed to lift more than 10 pounds. This means he changes all the dirty diapers, plays with her, feeds her, washes her, dresses her, puts her to bed, and takes her to and from daycare. He becomes a single parent of two for those nine days.

But for the most part, during the long months of preparation, its all on me.

Little problems arise every now and again from this arrangement. I haven’t ingested a smidgeon of alcohol, gluten, or caffeine since the beginning of this cycle. So when Friday night comes after a long week at work and I hear him crack open a beer jealousy envelopes me and begins to fester. When I sit for nearly two hours in the parking lot at work because the FedEx truck didn’t make it there with my Lupron before we closed, I become aggravated that I am there alone. When Bill accidentally wakes me up at 5 AM while he is getting ready for CrossFit, I am ready to wallop him because not only do I want to sleep off the effects of the meds I am taking, I also would love to be able to go to CrossFit.

I know I am not alone. This is a common issue among the fertility challenged that threatens marital bliss. And why wouldn’t it be?

Take any woman. Give her nearly all the responsibility for something of great magnitude that will equally benefit her husband. Make sure her husband needs to do almost nothing to support the process. Just for fun, throw in some hormone induced mood swings. What you have are all the ingredients needed to fuel a marital Battle Royale.

Largely, the responsibility of fixing this imbalance rests with me. I am in this alone because as a classic control freak I don’t ask enough of Bill in the process. I worked to begin to change that with our last cycle. It is not that he doesn’t want the responsibility, its that he needs to know how to help and even when he tries I often don’t let him.

I inject my medications myself and always have , even the difficult and painful intramuscular injections in my hips. We started out with good intentions of Bill doing this part, but I travel often enough for work that I had no choice but to learn to do it myself. Once I was comfortable going it alone I stopped asking him to help. Why should I wake him or distract him from what he is doing?

In our last cycle, he gave me all the shots he could. It was a way for both of us to feel like we were actively doing something. It allowed us to feel more connected to each other in our quest to make a baby. I changed other behaviors as well. When we had the little snafu with the Lupron delivery, Bill called the pharmacy for the tracking number and information to help us work through the issue and find the errant driver. In the past I would have taken care of it myself only to become annoyed with Bill later when he didn’t display enough sympathy during my post-problem rant.

This cycle, I am recognizing that while his efforts in the process are less life altering and painful, they are still there and a necessary part of our success. I am consciously asking for more from him when I have a bad day or don’t feel well. He will continue to be my own personal phlebotomist and problem resolution department.

My goal is to change my perspective and bring a little balance into the process. Perhaps by doing this we will avoid our historical estrogen fueled battle and bring about some good luck that will break our current IVF losing streak. In the end, we are in this together and I couldn’t do it without him, even if I almost could. Almost.

The truth is we needed what was in that little cup back in November to make this happen. But even more essential, I need him to grab his shovel and dig me out when infertility dumps its worst on us. He is always there with his calloused hands and his quiet strength to save us from the heavy, cold, worst of it.

Please watch for the debut of “His Perspective” tomorrow. Bill’s will publish his first blog post, yet another way he supports us in our battle with Infertility.

Waiting- Part 1

Image: Denise Curran via Flickr

For many, waiting is a as much a part of trying to conceive as sex. When sex is removed from the equation for the couple trying to conceive through IVF, waiting becomes the single most frequent conception act. Waiting, just like its more provocative cousin, can come in many flavors and is done throughout the IVF odyssey.

The big waits are obvious. The most mammoth is the wait between the time the embryo is transferred and the results of the Beta HCG pregnancy test. In our case, this wait spans nine intolerably long days. Time moves very slowly over the course of what is commonly called the two week wait. I’ve often heard women say it would be just fine to be unconscious during this time and awoken only after the results are received.

March 13th is the date of our transfer which means on March 22nd we will have the eagerly anticipated results. The date is circled on the calendar. The hope and anxiety are already building.

The torture of the two week wait is followed in magnitude only by the wait a couple experiences between the egg retrieval and the final fertilization report. Money, hope, health, and mental well being are all riding on discovering whether the eggs fertilize and grow to a stage and quality acceptable to transfer and make a baby. Being sadistic people by nature, we chose to extend this period at our new clinic by throwing a little genetic testing into the mix. The time it took from retrieval to receiving the call that we had genetically normal embryos to transfer extended over 3 weeks.

Waiting for the genetic results is further broken down into waits that are much smaller. We experienced almost immediate gratification after retrieval and waited only two hours to learn that 22 eggs were retrieved successfully. The clinic then called 24 hours later to tell us that 12 of those eggs were mature and 11 fertilized. These were minuscule intervals in comparison to what came next. For the next six days we patiently but eagerly waited to be told that 5 of those embryos made it to the blastocyst stage and were good enough quality to be genetically tested. Next we waited two and a half weeks to learn we had two genetically normal embryos and two that needed to be retested, therefore requiring yet another two week wait. Our embryos were on my mind every spare moment during this time. Ultimately we ended up with three genetically normal embryos. Our last is the one we will transfer in March.

The longest wait of all was this summer and fall while we waited to work through a long process at our clinic that would culminate in our embryo transfer just last month. We first called in June and were able to meet with our new doctor in July. This was followed by another month long wait to get on the calendar to visit the clinic for our work-up to make sure we had a green light to begin our cycle. By November my ovaries were finally percolating and we flew back to our clinic again for egg retrieval surgery. After retrieval the wait was another two months as we completed testing on the embryos. In the months preceding retrieval we used the time to get our eggs and sperm ready to do their life’s work. We each took different supplements, limited alcohol, exercised moderately and ate healthy. At my peak I was taking 19 different supplements a day and Bill took 11. At least it helped us pass the time.

Tiny little waiting periods pepper the whole IVF process. Since our failed cycle back in January I have waited three days to get my period, three more days to start birth control, another 13 days to start lupron, and five more days to once again stop the pill. Each step takes us a little bit closer to our fate, whatever it may be. Though small in terms of actual time, these steps feel gigantic. When they come early, it can be unequivocally thrilling. And that is what happened today.

If you read a Deeply Disturbing Fascination with Toilet Paper you know a little bit about the waiting for that happens for a woman who is getting ready to start a frozen embryo transfer or other cycle. Since Saturday I have been a devoted student of TP. Today I hit pay dirt and was able to call my clinic to check off a critical step that will take us to transfer. Two days from now I will begin estrogen patches that will prime my uterine lining. I continue administering lupron daily but cut the dosage which should help with the headaches and other symptoms. Sadly the bitchiness caused by lupron will only be replaced by the emotionality of estrogen. The end result for me is about the same. Say a little prayer for Bill who catches the worst of the mood swings.

My call to the clinic today was a full day earlier than we all expected. However, no changes will be made to the transfer date. The lupron I am injecting keeps my reproductive system suppressed and on schedule. The extra day may only serve to give my lining just a tad bit of extra thickness to welcome our embryo home. A nice, thick, cozy lining should help that embryo want to stay for the long haul. With a little luck we will then be waiting for doubling HCG levels, morning sickness to pass, a myriad of ultrasounds, and ultimately a scheduled C-section date.

Even though meeting today’s milestone early will have no impact on when we actually get pregnant, it is a rare event to have something, anything come early. I’ll take it.