Tuesday, August 7, 2012

Next Steps

We're doing our treatment at the same large university hospital where I was treated during my pregnancies with Sam and Eva. It has a reputation for being both innovative and impersonal, and I've definitely been painfully aware of their "take a number and move to the left" approach to managing IVF patients. At the same time, I understand that the reason the RE practice operates this way is so that the maximum number of patients can make their way through the system. If I was getting all the hand-holding and open-ended appointments I'd like, someone else might not be able to get an appointment. So I'm making peace with it, while also making an appointment for a consult at a smaller clinic.

To his credit, though, my regular RE did call me twice last week, once as a purely "social call," as he put it, because he knew we were disappointed, and then again to tell me that the team had reviewed my cycle and decided that it would make sense to give me another shot at IVF with my own eggs using a slightly different protocol. I'll have more details about that next week when we meet with him in person, but I appreciate that a) he took the time and b) they haven't given up on me yet. He also said that we should discuss "other options," including donor gametes, which I expected.

Meanwhile, I've started taking 2.5 mg of Melatonin, 75 mg of DHEA, and a prenatal vitamin each night and 400 mg of Coenzyme Q10 and some fish oil each morning.I'm also embarking on a calorie restricted diet. Because when this is all over, I need to be able to tell myself that I did everything I could.

I'm a little concerned about the Melatonin because I hear it can have a dampening effect on your mood if you're at all prone to depression. But I'll try it for a few weeks to see what happens.

One thing that certainly didn't help the mood: We did a consult yesterday with another doc (I am being nothing if not thorough). This guy didn't come particularly recommended, but he is affiliated with my health plan so I didn't have to get a referral to see him. And I'm not sure if he was trying to discourage me so as to not blow his stats with another 41-year-old marginal responder on his rolls, but he couldn't have been less optimistic for us. "You were on the maximum dose of stims," he said, "And I would've done the same protocol with you, but if you want to do another cycle, we can do that, just so you can say you tried your best." I wanted to talk to other docs to see if they would suggest different stims or a different protocol, but this guy had nothing to offer. And I cried a lot last night, feeling like it's time to grieve the end of my fertility.

But maybe it's not time quite yet. I'm going to make a deal with myself: I may well end up having to grieve for that, but not until later this fall when I have more info. And I'll try to be hopeful until then.

Meanwhile, we'll have to decide if we should try to cycle in September or in October, when the supplements, accupuncture, and diet will have had more time to take effect.

Sunday, July 29, 2012


Both Sam and Eva were Kell-positive. We know this. Ironically, the two embryos we got from this cycle were Kell-negative. But they both were chromosomally abnormal, so there was no transfer today.

We had a moment of feeling hopeful...they looked great on Friday when I called for an update. 7 and 8 cells each respectively. High quality. But the PGD report came back this morning and it is as my doctor probably assumed it would be. Old eggs, bad chromosomes. I feel so defeated and pathetic. I'm grieving for the fertility that may well be gone now. And I can't quite believe that it's over. But how can we win this numbers game if I can't produce enough embryos? We can't. To start with six and try to produce one embryo that's both sound and Kell-negative? I'm guessing that when we meet with the RE sometime in the next couple of weeks, we'll be having the donor eggs talk. And I just want to lie in bed and cry.

Wednesday, July 25, 2012

And then there were...

Two. Turns out I got it wrong: 2 of the eggs were immature. Only 4 were mature. One was fertilized by 2 sperm. And one disintegrated. So now we have two.

I'm not destroyed by this news, but a mild depression has settled in. I'm probably having a better day than Kristin Stewart, so that's something.  I am  happy that only 1 of them actually old-lady-disintegrated. But I also know that this is just day 1, and the chances of ending up with a healthy Kell-negative embryo by Sunday are pretty damn slim. My RE was the one who called, not his nurse, a sure sign of bad news, and he said that it was an option for us to freeze the two embryos and save them for the next cycle. But what's the point? Freezing destroys embryos much more than biopsy. So if we have 2 to biopsy by Friday, we'll do it.

Tuesday, July 24, 2012


Six follicles, six mature eggs. Just like Seven Brides for Seven Brothers. Of course, I was half-hoping that a couple of the larger follicles would have 2 eggs each, but I'll take it. Now I'm just going to pray that at least half of them make it to biopsy.

The procedure itself wasn't a walk in the park, but it wasn't terrible. On the scale of difficulty/inconvenience, with 1 being easy and 10 being agonizing, I'd say that the shots were 1 and the egg retrieval was a 6. The pain wasn't terrible, but I do feel quite tender. And I'm just not a huge fan of the whole "procedure" thing, the arms out like Jesus, the cold room, the people in masks, being put under, the needle up my vagina. For the few procedures/surgeries I've had, I always cry beforehand. And of course, this is the first real procedure I've had done at this hospital since I delivered Eva, so that kicked up some feelings.

And since there always has to be one asshole at every big hospital occasion, the anesthesiolgist kindly played the part. Don't they always? As he gave notes to the nurse in front of me, he said, "well we had another dose of Fentanyl ready, but there weren't many eggs, so we didn't need it." Thanks, dude.

In summary: ER not too bad, but not something I want to do more than a few times. On the other hand, if it brings us a baby at the end? Worth it.

Sunday, July 22, 2012


So Adam just gave me the hCG shot, which didn't hurt at all, despite the scary needle. And so that's that. How we did joke, btw. His one chance to poke me to get me pregnant, hah-hah.

Final tally: 6 mostly mature follicles, one additional follie that may or may not mature by Tuesday, my retrieval day. Sizes: 23x14, 17x14, 19x12, 23x19, 19x14, and 16x6. The other one is at around 12.

This isn't great for a PGD cycle. But right now I'm just grateful to have made it this far. At least I didn't get cancelled, right? If we don't end up with enough embryos to biopsy, we can at least try and freeze the ones we have and try again. I guess the worst case scenario would be if none of the eggs fertilized. That would really suck. My intuition is that if we do get one decent Kell- embryo to transfer, I have a decent shot. But that isn't so very likely.

There is one man who works at the hospital's ultrasound lab on weekends. He is so unbelievably kind, and at 7:30 in the morning. He has the manner of a good priest or rabbi. Women are so often beat up by this  infertility grind. We endure so many moments of despair, of feeling kicked in the stomach by some friend's pregnancy announcement or some party where all the conversation is all about kids or should I have a third? And this man treats you like he sees the bruises on your soul. It means so much.

Friday, July 20, 2012

Day 12

Five whole follicles today, with a few more in the works. I don't know if they'll get big enough to mature by the time the other follies are ready to go, but I went for more acupuncture today to try and help nudge them along. Estradiol is just south of 800. So I guess I'm just happy that this isn't a complete and total bust. I can live with "not stellar," "not great," as long as I still have a chance. In an ideal world, I would prefer to not earn the "poor responder" label if at all possible, but that's out of my hands.

Of course, I have no idea how viable any of these eggs are, but the ultrasound tech (herself an IVF grad and so very understanding) said that sometimes a slow stim can lead to better fertilization. Who knows if that's true. This is all so new to me.

Oh, and my lining is great. I guess it's at 8mm so far with 3 distinct layers. So I excelled in one area. Yay!

God, can there be anything more navel-gazing than doing IVF? I'm literally staring at my navel all the time, silently wishing for everything under it to kick into gear. And then I come here to report what's going on in there.

Wednesday, July 18, 2012

Hope Springs, Day 10

So after yesterday's acupuncture session, I felt a bit restored. My doc was so kind and upbeat, and she gave me such confidence in my awesome kidney pulse fluttering away so fertilely. I began to think that maybe all hope wasn't lost...

And then a little later I felt hopeless again and cried. I got a bit of work done and sent it to my boss. I focused on snuggling Sam and feeling that mama love all over my body. I made dinner, watered the garden, did my shots. I took my supplements and listened to a fertility meditation on my headphones in bed. And while I was visualizing my secret fertile garden and the child who visits me there (Sam, plus a faceless glowbaby), I imagined my abdomen (can't bear to type "womb," blegh) as a place of life and not death. I imagined the black dust of death that has settled in there and pictured blowing it away and starting fresh. And I prayed for one more chance, please. Just one more good egg.

At today's scan there were 3 larger follicles as before, but a bunch of new ones on both ovaries are starting to take shape. I should've asked for an exact number---Damn those rushed nurse calls---but it sounded like several on each side. My estradiol is only up to 400, but that's double what it was 2 days ago. Maybe my ovaries will be capable of meeting all this aggressive stimulation with more than a cough and a wheeze. At least there's still some hope. It's not over yet. Next ultrasound on Friday.

Tuesday, July 17, 2012


I'm on day 9 of stims and off to a very slow start. Estradiol is rising slowly and I only have 3 follicles as of yesterday morning. I'm doing all I can...adding acupuncture, CoQ10, melatonin, and fish oil to the routine to give my body any advantage I can. But if you happen to be reading this and could send some prayers my way, I'd be grateful. I don't know exactly what I believe about God or a universal order anymore, but I'm praying anyway. Praying for just one more little life for us to bring forth and cherish.

One possible bright spot: the nurse says that even if this cycle doesn't improve, they can freeze any embryos that we do get and then do another cycle to try and produce enough for biopsy and PGD. So at least this cycle doesn't have to be a total waste.

Saturday, July 7, 2012

Why I Call It a Stillbirth

I realize that technically Eva's death, at 19 weeks, was still considered a miscarriage, but my feeling is that when you birth your child and then hold her, kiss her head, look at her perfect little hands and feet, and have to decide when to hand her body over to the nurse knowing that you'll never see or touch her again, that's more than "just" a miscarriage. And having had two of those, I'm not making light of that loss, either.

Hail Mary Pass

I injected my first dose of Lupron tonight. I'm scared. It has been 21 months since E died and we have achieved some degree of normalcy and happiness and now we're wading back into the water for one last Hail Mary Pass at having a baby through IVF with PGD. It's our best shot at having a biological child without losing him or her to Kell again. So after months of recovering from our loss and then more months of waiting for the genetic testing to be done and all the minor tests of my uterus and blood, I injected the Lupron.

There is a lot in this process that could unsettle me. The potential mood swings from the drugs themselves. And then the potential trauma of an IVF cycle that fails, or succeeds but ends in miscarriage, or succeeds and results in a high-risk pregnancy in some other way. Even a healthy perfect pregnancy will certainly rake up a lot of sense memories of my last pregnancy. And that is an unlikely outcome anyway. I'm so old now, relative to the fertility world. I'm 41. My FSH numbers aren't great. It has been 6 years of trying to build a family with 2 kids in it and here we are.

So why not just stop now and be grateful for Sam? Oh my God, I am grateful. Every day I am so grateful for him. I could settle into being a happy family of 3 and move on. Why not?

But I'm just not done. I just snuggled Sam to sleep and that Mama bliss is what makes me soldier through this. I want more of it. I want more of the physical experience of pregnancy and nursing, if I can have it. Maybe I can't. But we have this chance and I need to give it at least one try. And if we try and still can't have it, we'll look at our options. But it would be nice to not have to work through that loss. And that's also the most likely thing. But if there's a chance, we have to try.

So here is this bag of drugs sitting next to me on the bed, as daunting as anything I've ever owned. I am so lucky to have access to these drugs, so lucky, and they scare the crap out of me. But we move forward. Second Lupron injection tomorrow morning, followed by the baseline ultrasound.