Test, test

Hello there! I am writing from the present because I thought of this blog today and then I thought about how I always hated it when blogs just ended before you could know how things worked out for the writer.

It has been almost six years since I last wrote. Since then, our son has grown into a beautiful 9-year-old boy. He remains our only child. We had no success with IVF. We moved on to donor eggs, but that process was seemingly cursed from day 1. Every step of the way, whatever could go wrong went wrong. Test results were misinterpreted, the first donor we set our hearts on suddenly became pregnant, phone calls weren't returned, and then the next donor we chose threatened to quit because our hospital was moving so slowly and making so many errors (despite being named one of the top RE centers in the country). And finally, when we had persuaded the donor to stick with us and everyone had done all the required tests and the donor was one week away from beginning stims, we got a last-minute test result back...a screen that no other clinic had done in her (multiple) previous cycles. And that test showed she was a carrier for a really terrible fatal disease where children die before their third birthday. And at that point, we were done. We had already been ambivalent about the whole experience, but that nailed it.

We moved on to private infant adoption. The home study process was fairly painless, but when we began to be presented with possible matches, the number of red flags we were seeing with the cases and the pressure to make instantaneous decisions was overwhelming for...well, it was more overwhelming for my husband than it was for me, but no one was feeling good about it. Here's one actual example, though I've changed some details to be safe...

"Hi Anna. So we have a possible match. Mom is 35 weeks pregnant but says she just found out about it. She has three other children but doesn't have custody of any of them. Her drug screen did come back positive for amphetamines, but she says she took cold medicine, so that could explain it. Anyway, we need your answer by 5, byeeee!"

So we walked away from that, too.  But today we got word that, after a lengthy, oh so lengthy process of training and form-filing and home studying, we have finally been approved to adopt from foster care. There is a long story to how we came to choose this path, but that would require betraying the privacy of a little boy who has become our godson. He has a parent to care for him, but we provide backup. Knowing him opened our hearts to the possibility of another child who might not have a family member to take care of him. And the process has really been fairly painless. Slow, sometimes scary to contemplate, but also doable.

Given the nature of foster adoption and the need to protect privacy, I'm not sure how much I'll post here. We may not even find the right match. But if there is a worthwhile update to share, I'll figure out a vague-enough way to share it.

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.

Over

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.

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.

Six

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.

Triggered

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.

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.