Cautiously optimistic

Sorry to keep you all on pins and needles all week long. I've heard from many of you who've been dying to know the outcome of our IVF...

Holy pee sticks, Batman! Also, they don't make 'em like they
used to; the battery on the first digital test only lasted a day!

Yes, it's true...we are officially pregnant! I wasn't going to test at home until Monday morning, the day before beta, because a) that's when I got my first BFP with the twins (13dpIUI that time) and b) I take my high dose weekly prescription Vitamin D pill Monday mornings and I'm not supposed to take it I'm pregnant.

Plans are fine...but late last week I started counting on my fingers, comparing how many days post-transfer I was to how I remember feeling/acting that number of days before BFP last time. It wasn't so much a physical symptom thing; after all, I'm on Crinone (8% progesterone gel) and Estrace (estrogen, 3 times daily), so those would heartily mask and/or mimic pregnancy symptoms. Still...I noticed a certain edginess one evening, wigging out a bit over something that really wasn't so important, then remembering that I did the same thing five days before we got our BFP with the twins.

(That time was a little more important, since we'd arrived late to a hotel after driving for hours, exhausted, and having argued over where to eat on the way, only to find that they'd given up our promised/reserved king-sized non-smoking room and had only a single queen room for us. Enter stern words, followed by anger, followed by meltdown. "You mean I have to perch on the edge of a queen-sized bed all night while my bed hog husband takes up the whole thing?! There is a reason I specifically requested a king. Thanks a lot for ruining a decent night's sleep." [I actually got an e-mailed apology from the hotel manager later, and felt bad, because by then I knew why I was so sensitive.])

Saturday I felt a little off...cranky, not really happy to see Paul when he got home, hungry, achy, just off. I'd been having lots of mild, persistant crampiness around my ovaries and uterus, sort of a vague, can't tell exactly where it's coming from, not really middle, not really one side, just everywhere. (I guess that's enough to make a girl pissy!) We ended up going out for a late dinner after spending the afternoon with our inlaws and baby Finn at the pumpkin patch (fun!!) (because I'd been jonesing for pizza and he was too late the night before to make that happen), and Paul said, "You want to stop and buy pee sticks on the way home, don't you?" Yep.

We hit the home front with two boxes of HPTs in hand (3 First Response Early Result (FRER) pregnancy tests, which are super sensitive, and 2 Clear Blue Easy (CBE) digitals, which aren't as sensitive). I chose a FRER first. It took the requisite three minutes of waiting, but an unmistakeable second pink line appeared, though faint. I showed Paul, and while he could see the second line, he thought it was too faint to be real. (Any second line is a positive, folks, but ok.) I said, "Fine, I'll get up with you in the morning and pee on a CBE, and we'll see what it says."

So, I did, I got up at 5:30 a.m. Sunday morning (he was going hunting, thus the early rise), peed on a CBE, and just like with the twins, I had a "Pregnant" result in less than the 3 minute wait time. I marched into the bedroom with that test and showed him, and all he could do was grin.

Obviously, you can tell I made my way through both boxes of tests over the next few days. I was thrilled as punch to see the much darker line the morning of my first beta.

First beta, Tuesday morning: 74. Dr. H. called with that result in the afternoon, and I was sort of underwhelmed, having been hoping for at least 100 (with the twins it was 227 at that same gestational point, but that was with two babes in there).

Second beta, Friday morning (yesterday): can I just whine about how long we had to wait for this?! I got this one drawn at Dr. M.'s office because the lab I used Tuesday didn't get the meaning of a "STAT" order. Well, Dr. C. runs the bloodwork and he wasn't coming in until 1:00, and Sierra, Dr. M.'s medical assistant, said she'd call with results as soon as she faxed them back to UW. By 4:55 p.m. (they close at 5:00), I couldn't take it anymore, and called Sierra. They had my results...

512!

Holy crap. That's a doubling time of just 27.23 hours, faster than with the twins. Way to go, E2!! I had a momentary plea with God to please not have let E2 twin (there's an increased risk with blastocyst transfer in IVF). Dr. H. called within 20 minutes to let me know the results (that I had to pretend I didn't already know!) and was very pleased. She said a nurse would call to set up my first ultrasound for my 6th week of pregnancy (I am 4 weeks 4 days today), and if we see a strong heartbeat, they'll cut me loose to regular OB care then. (Nurse E called me less than 10 minutes later and got me scheduled for the morning of 11/8, the same day we see a genetics counselor and my MFM - who I've decided to have co-manage my case with Dr. M. for the long haul.)

And then, just before 6:00, Dr. M. called, too! He gave me my beta results (for the third time!), recalculated my due date (also for the third time, July 2nd, folks), and congratulated us. He said he'll look forward to seeing us return to his care.

So, there you have it. Our rainbow baby is on the way (as Nurse E. said, and we agree, "...we are "cautiously optimistic..."). Our last ditch IVF actually (knocking on wood) worked, at least so far. It's super early, of course, and things can happen...but we know that while our little E2 has a chromosomal issue, it's nothing that increases risk of early or late loss, or will be fatal later in life. It's just a challenge is all.

Speaking of, we have decided to keep the baby's sex and actual chromosomal issue to ourselves for now, save for family. To that end, I've also turned off my blog's Facebook feed, so if that's how you normally get your updates, please bookmark my blog address. I won't likely turn the feed back on until we formally announce our pregnancy to the world at large, sometime after the 14 week mark (for obvious reasons). So please, please, don't post anything pregnancy-related on my Facebook wall or mention me in any of your posts.

Here we go!!!

No vacancy

This second day of being on pins and needles was almost worse than yesterday. We were grateful for the extra time yesterday and last night to really research and consider what our hearts felt the right decision for us - and for this potential child - would be.

On our way to our leased cattle pasture late yesterday evening on our way to bring home our calving kit (we have a calf due between now and October 22nd), we agreed...if this emby made it through the night, we would transfer it. We choose this child.

I was near tears as we sat and waited to meet with Dr. Z. this morning, my bladder full and Valium already in my tummy. We saw both of our nurses at the coffee stand before we went upstairs, and I (ever hyper-aware of the moods and reactions of others) thought I caught a sympathetic vibe from Nurse J. My mood crashed.

Upstairs, the medical assistant made it sound more like we'd be going downstairs to the procedure room, so... ?

Soon enough, Dr. Z. came in and said that not only had Embryo 2 continued to develop well, but it was already hatching - totally sticky and ready to implant. We confirmed we wanted to proceed, and after just a bit more waiting, it was time!

I changed into a gown and Paul into scrubs, we put booties and caps on, and walked into the procedure room. Within minutes, we were underway, the ultrasound wand on my belly guiding the placement of the catheter through my cervix and into exactly the perfect spot. The embryologist came in with the embryo loaded (in something I didn't see but that was attached to the catheter), and the ultrasonographer switched the machine to full color view so we could watch the "package" (embie in some special sauce) land. One check of the catheter under the microscope and a shout of, "All clear!," and we were done!

My instructions are to alternate laying down two hours with being up two hours, but nothing strenuous. I'll be back to work on Wednesday.

Dr. Z. confirmed what my research on the syndrome we're facing showed...symptoms are highly variable and may not all present. We know as early as is possible and we will have time, should we actually get pregnant, to prepare and intervene when/if necessary.

There still are no guarantees we'll get pregnant this time (Dr. Z. said normally 40-50%, up to 60% in his experience). Everything is in our favor for the moment, and for that we are grateful.

And...we feel like the fact that transfer was today, October 15th, National Pregnancy and Infant Loss Remembrance Day, a day when our beloved firstborn daughter and son are so close in our thoughts, and a day when Dr. Z., who really made this all possible, was on duty for transfers...well, could that have been more perfect?

Tears and decisions

Today was not what we had hoped. We should have known, I suppose, when the medical assistant, just before leaving the room (after checking my BP - 140/84), pushed a little box of tissues toward me and said, "These are for you guys." I immediately thought, "Oh, shit." Paul thought she meant they were for him, since his allergies had him sneezing his head off all morning.

Nope. This time, I was right.

All three of the Three Amigos are chromosomally abnormal. Dr. H's face said it all when she entered the room, when she touched my knee. There was one, though, she said, that she needed to talk to us about, but it would require us learning the sex, something we hadn't wanted to know. We agreed, all things considered.

But first...the abnormals. Embryo 1 was a very, very abnormal male, fatally so (several missing chromosomes, single copies of others, and possessing one sex chromosome in each of the two cells tested instead of two). Embryo 3 was an abnormal female...Downs Syndrome, which we would gratefully handle, but also two fatal monosomies (there were two chromosomes of which she had only one copy, not the required two). Neither of those two would result in implantation after transfer, so would result in, at best, BFNs (big fat negatives)...and at worst, could potentially implant and then cause miscarriage. Both embryos looked abnormal enough on Friday when they biopsied, based on how they were growing, that the embryologist sampled two cells from each rather than one.

And then there's Embryo 2. Embryo 2 has, with 75% certainty, a chromosomal abnormality that's actually fairly common and is not fatal. However, there is a likelihood of a variety of issues, including potential learning disabilities, growth/development issues and infertility. Not all patients with this abnormality have all of the symptoms, and many don't even know they have it at all until adulthood. But still.

Embryo 2  (and we do know both the sex of this little one and the disorder, but at this point, we're choosing to keep both largely under wraps) isn't likely to cause a miscarriage. However, this little one also wasn't developing quite quickly enough to warrant a transfer today. So, amidst our tears, we settled on going back up to Seattle tomorrow for another transfer appointment, at which we'll learn whether development has continued or arrested, and if it's continued, make the final decision whether or not to attempt pregnancy.

Obviously, this is so not the news we were hoping for. At the risk of sounding like I blame myself (and I really don't; I'm just not surprised), the abnormalities for both Embryo 2 and Embryo 3 are related to the quality of my eggs, which is directly related to my age. (Embryo 1 is so messed up that Dr. H. said those abnormalities are likely the result of a bad sperm/egg combo...but I'm certain my egg contributed there, too.)

This is such a difficult decision to have to make. *We* know that we will love and desperately want this baby, if we make it that far, but there are some little concerns about society at large, whether we're being selfish and would be making the right decision for this child should we have the opportunity to transfer the embryo tomorrow...it's just a lot.

Thank you all for your continued support, love and prayers. We feel it, truly, and are so grateful.

From Saltbox House

 





Rollercoaster

Today was egg retrieval day, and what a day it's been...full of anxiety, stress, anticipation, disappointment, sorrow, and then, finally, some relief.

Egg retrieval itself was at 8:30 sharp. We had to be there at 7:30. We arrived with zero minutes to spare (after locking the car keys in the motel room - of course after turing in the room keys!), Paul's sample in its sterile cup shoved between my boobs to keep it body temperature. Nurse A., new to us, met us and took us downstairs to the pre-op room, where I changed into a gown and had my vitals taken and an IV placed in my hand. (She was wonderful, as have been all of the nurses we've met. We love that!) The anesthesiologist came in, gave us a run-down, and promised he wouldn't use Demerol on me (!). Dr. H. came down and checked in at about 8:26, and promptly at 8:30, Paul kissed me and off I went. I was out fairly quickly.

The procedure took only 30 minutes. Dr. H. went and got Paul and brought him in just as they were removing my oxygen mask. I awoke quickly and felt good...until I asked how many eggs they got. Three. I couldn't stop the tears. (In February 2011, our first stimulated IUI cycle converted to IVF because of "too many follicles", but out of six, they only retrieved two eggs. One fertilized. We transferred the Little Blastocyst that Could on Day 5, but it didn't implant. It was devastating.)

Soon enough, Nurse A. had me eating crackers and was happy with the amount of water I was drinking, and once I peed without falling over, she sent us on our way...to wait for the maturation report from Dr. H. We missed the call (I was napping and Paul didn't hear my phone), so had to wait for her to call back. We sat there in silence, both positive we were about to get bad news (because she hadn't said anything at all about the eggs in her voicemail). But no, good news: all three of those eggs are mature and are going to be fertilized via ICSI! She'll call tomorrow mid-morning with a report on how many of those three successfully fertilized, and then we'll wait until Friday to hear how many made it to biopsy for the PGD. My embryo transfer, provided we have at least one normal embryo, will be Sunday, and my blood pregnancy test (scheduled today, even though I'm not even pregnant yet) is October 24th.

We're so relieved that Paul, who couldn't nap today due to stress and anxiety, promptly walked down the hall to our bedroom and crashed. He's still there two hours later, poor guy. :)

I really am feeling so much better this time around. No nausea, no vomiting (!), minimal pain (Tylenol after I woke up and that's it so far), normal appetite (fish for dinner!)...it's just so much better than our previous experiences. I hope that trend continues.

Perfect timing

Today's SD11 monitoring appointment was amazing! I'm still a little shocked, especially since it started with me getting stuck in the elevator for a few minutes before I got it to return to the first floor...where, apparently, I was supposed to have gone first, but the security guard hadn't put the sign up to tell me that, so... Yeah. Apparently it happened to someone else yesterday. Dr. H. wasn't amused. Neither was my blood pressure: 160/100 (but rechecked later at 132/85, whew!).

After that stellar BP, I was stone silent, waiting for the sky to fall as Dr. H. started the scan. Then I heard, "Right ovary: Twenty. Nineteen. Nineteen times two. Nineteen times three. Seventeen. Sixteen. Left ovary: Thirteen. Ten...no, wait, scratch that one, too small. Endometrium 11.2, trilaminar." My eyes were wide by this point...because what began sounding ominous turned into OMG! She said, "Amy, this is really good!"

My estradiol (E2) was 922, also great. For reference, I conceived the twins with a peak E2 of 867, which sucks for a peak. I will have my E2 rechecked tomorrow and it should be higher yet...like, normal. Normal? Me?! Holy cow!

So...Paul is to give me the trigger shot tonight at 8:30 sharp smack in the Sharpie target Dr. H. drew on my ass (the only shot in the ass this time, WOOHOO!), I go in for a quick blood draw first thing in the a.m. (Monday morning Seattle traffic, oh, joy), then we'll go in for egg retrieval at 8:30 a.m. Tuesday! (We're going to spend the night up in Seattle so we won't be late. We have to be there by 7:30 a.m. if we spend the night in Seattle and he provides his sample in our hotel room (I have a sterile cup for it, which I then have to stick in my bra to keep the little soldiers the right body temperature), otherwise, we have to come in 1.5 hours early so he can provide a sample at the clinic.

(One aside, as I told my mom this morning: Given IVF pregnancies are calculated based on egg retrieval date (as sort of a medically-induced ovulation), I had resigned myself to watching the calendar turn to a new gestational week of pregnancy every Wednesday again, like it did with the twins. I wasn't looking forward to that, but it was what it was...except now, it isn't! With ER on Tuesday, gestational week changes will also be Tuesday, a day that holds NO historical/emotional weight for me. Double WOOHOO!)

I did ask Dr. H. about the drugs they'll use, and she assured me that not only do they not use Demerol (just Propofol and Versed), but she's never had a patient get sick like I was after cyst aspiration. I also asked about anti-anxiety meds prior to surgery, which were suggested by the MFM last week, and she said while she doubts they'll let me have anything orally, she'll touch bases with the anesthesiologists tomorrow and ask them to give me something right when they take me back. I don't need to go scaring anyone with my anxiety-fueled high blood pressure!

Tangled (15 months)

This week was such a juxtaposition of emotions: fear, anguish, hope, anxiety, sorrow, anger, guilt.

Thursday and Friday were yet another anniversary of the events that broke our hearts: the deaths and births of our babies. Babies who should be sitting up, eating solids, babbling, taking toys from one another at nearly nine months old. Those thoughts are so heartbreaking to me. My heart hurts.

This was also my monitoring week for this IVF cycle, and that in itself has been a roller coaster of emotions and such a whirlwind of appointments and details that it's made grieving for the life we're supposed to have had, and for our babies we miss so terribly, and for the girl I used to be and will never be again, really hard. It's difficult to feel those feelings when current life is overwhelming everything else.

On Wednesday I went up to Seattle for my stim day 5 (SD5) monitoring appointment. The appointment was at 7:15 a.m., technically 1 hour and 45 minutes away. I gave myself two hours, stopped and got gas (losing about 5 minutes), but with heavy traffic from Tacoma to downtown Seattle, I barely made it on time. I got up to the 4th floor and had to pee so badly it was making my stomach hurt, but I had to check my watch: I had two minutes before my appointment. I took them, literally willing myself not to pee my pants as I frantically unfastened them (in the interest of full disclosure, the zipper no longer stays up on for some reason, and so these pants are partially fastened with a twist tie, a bitch to undo when you're doing the potty dance). I made it into the clinic right at 7:15, glanced at the whiteboard and saw that only Dr. H. was on (Dr. Z.'s female colleague, who I'd never met), head full of anxiety over what this ultrasound might reveal (this is where things started going sideways in December and April), and was whisked back into a room to have my blood pressure taken.

Not surprisingly, it was high: 137/104. The medical assistant asked, "Are you on medication for your blood pressure?" I said no, that my blood pressure has always been great, but I was a little stressed at the moment. The assistant said she'd try again before I left.

The ultrasound rooms are teensy, and nearly as soon as the medical assistant left, she was back with Dr. H. and the day's IVF nurse, Jeri Lynn (who, thankfully, I'd met the week before). Crowded into the room, they started the ultrasound of my ovaries, screen turned away from me (Dr. M. has a little screen that patients can see during all ultrasounds), calling out numbers for recording. I had eight follicles total...but only seven worth measuring, and six were in the right ovary. My left ovary, which had harbored 4-5 pre-antral follicles just two weeks before (when my large ovarian cyst was discovered), had only one. WTH?? My endometrium (uterine lining) was great, as per my usual. Dr. H. noted that three of my follicles were substantially larger than the others...not a good sign. She said she may need me to go home and get my Cetrotide out of the fridge and bring it back to work with me, in case she called and needed me to start my shots right then. (That would be another hour I was not at work, since I live 35 minutes from my office, but ok...another hit to my annual and sick leave.)

I went next door, and Dr. H. came in by herself to discuss my blood pressure. Things quickly began to unravel when she implied that losing the twins could be the result of my high blood pressure. I objected, saying my BP was always totally normal, even during my pregnancy, when the increase in blood volume a multiples' pregnancy brings on could have caused concern. I explained the (several) factors that led me to feeling stress that morning. I felt like she wasn't listening. (I fully admit to baggage around doctors not listening to me, given that my concerns were dismissed multiple times during my care with our (former) HMO's obstetrical department...the one that insisted I wasn't really high risk, that bleeding was normal for twins, and that it was fine for me to have my first appointment with an actual OB at 16w6d - which is bullshit and still makes me SO angry to this day...and has caused pretty severe trust issues for me with medical professionals.)

Dr. H. said she wanted to consult with UW's expert in maternal hypertension and see what "he" thought, that "he" might want to see me by the end of the week. Ruh roh. I said, "Can I ask who "he" is?" She said, "Dr. E. He's amazing." I replied, "That may well be, but I have a fellow twin babylost mama friend who had a very, very bad experience with him. Dr. Z. agreed this man can be very abrupt. Frankly, tomorrow is the 15-month anniversary of my daughter's water breaking, and Friday is the 15-month anniversary of our twins' delivery in the hospital, and I am not going to see someone who may be insensitive to me at this particular time." She objected, but I stood my ground. She said, "I understand your concerns, I do, but I want you to be checked out so that if there is a problem, we can get you on blood pressure medication before egg retrieval. I have to tell you, if you show up for egg retrieval next week with high blood pressure, the anesthesiologists may not play. It would also be good to have another opinion on your pregnancy and loss history, since so many factors were in play that it's hard to tell what could have caused it all. If your blood pressure was an issue, we want to fix it now so that you can have a healthy pregnancy." She left to consult with a female colleague of Dr. E's...and the tears started.

By the time Jeri Lynn came into the room to discuss Cetrotide shots, I was on the verge of full meltdown. I shared with her that it's an anniversary week, and she got it immediately and was very apologetic. She stayed extra long with me...exactly what I needed. By the time Dr. H. came back in, I was under control. Dr. H. said the maternal fetal medicine specialist (MFM) that she consulted with agreed I should be seen, and that they would be in touch to let me know when. I finished up with Jeri Lynn, got my blood drawn for estradiol testing and got the heck out. (Aside: just my luck that I would hit I-5 just as it was being closed for the passage of the First Lady's motorcade on its way to the airport. Awesome. Tick tock...my leave is leaving me so quickly!)

I shed so many tears on the way back to my office for so many reasons. (Another aside: I risked it and went straight back to work, deciding instead that if I needed to start Cetrotide that afternoon, I'd absorb that time into my lunch hour rather than burn yet another hour of leave...a good call, as it turned out.) The Maternal Infant Care Clinic called me that afternoon to let me know they reserved a 3:20 p.m. appointment slot for me to be seen the next day, Thursday. My head (a dangerous place to go alone) started telling me that maybe my blood pressure was to blame, that maybe my blood pressure would disqualify me for egg retrieval next week, and that maybe this would be yet another time where my pregnancy and loss story were dismissed. (In hindsight, holy cow...shut UP, brain!)

Thankfully, Paul was able to come with me Thursday, and he was in full goofball mode, which really helped keep the mood light. (It’s hard not to smile when your husband says, as you get into the car to leave for a two-hour trip in unknown traffic, "Step inside my rocket ship!") We arrived so quickly (thank you, carpool lane!) that we had plenty of time to get some lunch and be mellow. The MFM also ran 40 minutes late, so we sat by the fish tank in the lobby - on the opposite side of the room from the other pregnant patients. (By the way, this is the same office where we had our near-perfect NT scan with the twins in late July 2011.) The MFM's nurse was my age and sassy, which I liked (and needed). The appointment itself was fine...and despite my thinking that this MFM (who we both really liked, Dr. C.) was going to want the full run-down on my twin pregnancy and loss story, she didn't! The appointment was solely focused on my blood pressure history and risk factors (slim to none). My BP at the start of the appointment was 137/84, but at the end it was 118/76. (HA!!! I told you so!) While there's not enough evidence to suggest I have hypertension, Dr. C. said I could have pre-hypertension, so she wants to see me again on the 18th, when I will leave a 12-hour urine catch sample and some blood in the lab, and come armed with a list of my daily BPs. Cool.

I went back up to UW again yesterday, Friday, for my SD9 monitoring appointment. This time, I allowed 2.5 hours travel to my 7:30 a.m. appointment, but ended up an hour early.(Seattle traffic is so unpredictable!) My BP was only slightly elevated (137/83). I now have 8 good follicles in the running (16mm, three 15mm, two 13mm, two 11mm, plus a 7mm that won't likely do anything and a couple of tiny ones that definitely won't). This is the most I've ever had! As instructed, I gave myself a Cetrotide shot (brought it in a cooler on ice), got my blood drawn (E2 476, awesome!), and headed back to Olympia for another stressful day of work. I don't go back to Seattle again until tomorrow morning (SD11 monitoring), and then I'll likely go back Monday (hopefully to receive instructions to take the trigger shot that night), Tuesday (for E2 blood work), and then Wednesday for egg retrieval. Paul and I both feel so hopeful now that this cycle appears (so far, knock on every wood we can find) to be going well...and hope can lead to expectations, and expectations can bite you in the ass. (No pressure...not like this is the first and only time we'll drop this kind of money for a fresh IVF cycle, the last time I have a chance to conceive my genetic child(ren)...oh, wait, yes it is. Damn. Danger, Will Robinson...)

Interestingly, with all of this going on, I completely forgot this is the first time the 4th and 5th days of the month landed on Thursday and Friday again...those two days of the week that haunted me for the first several weeks of grieving. Yesterday we received the quarterly newsletter for one of the two support groups we've been attending for over a year...and Aliya and Bennett were left out of the August "remembrance" list. Nice…happy 15-month anniversary to us. (I actually left a note on the group's Facebook page so they could know they made a mistake. They've had our forms for over a year. Not cool.) Then, reading a friend's blog about their special anniversary, I felt pangs of jealousy as I read about the great support they still receive from friends and family nearly 2 years later. We don't really have that, we've really never had that, and it hurts. It's not unusual for babylost parents to be forgotten (or at least not acknowledged) at special, painful times, but still. Then last night we had a late dinner out with my uncle and his friend, who are down here to hunt this weekend, and the co-owner walked in; he was my ER nurse the night my water broke. We've seen him several times and I've never mentioned it, nor did I last night ("Hi, remember me, your neighbor who you had to do a bladder scan on to see if it was full enough to finally, six hours later, perform an ultrasound the night our twin daughter's water broke?"). Seeing him during an anniversary was surreal. (Thank God he was not wearing scrubs, just street clothes!)

I feel guilty to have my heart and head split between remembering and missing my babies (and our former innocence) so, so terribly, and hoping beyond hope that all our efforts, all my shots (four drugs per day now), the daily headaches Paul and I have from the Cipro we're both taking, the hours of work leave I'm burning to get to and from appointments (8 hours this week alone), will bring us another pregnancy, one that maybe this time will last to term (or close to it) and result in our third - first living - child, and, fingers crossed, enough healthy frozen embryos to make a second (and maybe third) living child.

Checking the list

Ding, dong, the Beast is gone! I had my monster of a cyst aspirated late yesterday afternoon, and I'm still amazed that sucker didn't cause me more pain than it did. Dr. M. drained 40 mL of fluid out of it! That's insane...it's enough to fill a urine specimen cup, he said. Holy cow. The procedure went off without a hitch and was pretty quick, once they got me drugged and my catheter placed (owie!). Paul  thought the actual aspiration took only 4-5 minutes.

The after-effects of those drugs, though? Wow. It took me awhile to feel mostly coherent, and, like the last two times, that Demerol had the effect of causing me to take really slow, shallow breaths, so there was a lot of "Breathe, Amy!" from both Paul and Sierra. Total flashback to last fall. :)

The Demerol did more than that to me, though...it made me horrifically dizzy so that once I did finally feel like I might be stable enough to stand and get dressed, I had to immediately lie back down on the bed with my shoes on! I got nauseous, too, so Dr. M. had Sierra give me a Zofran. We finally left at about 6:15.

As soon as we started to drive out of the parking lot, the vomiting began. Thankfully, I keep a plastic cereal container with a tight-fitting lid in my car as a garbage container (thanks, Pinterest!), so I ripped the top off and dumped the contents on the floor just in time. I cradled that damned thing in my lap the whole way home, and was puking again as we pulled into our driveway. It didn't get much better...Paul fixed me some chicken broth, Saltines and ginger ale, but after several "fine" moments, up it came. Multiple times. I finally gave up on having anything in my stomach and went to bed after retching again several times.

This morning I still felt "buzzy" in the head and a little shaky, but I got dressed and made it to work. Within an hour, though, I realized that probably the best place to be, and I was headed back out the door 1.5 hours into my work day. I've spent the rest of the day trying to hydrate and eat some bland things (so far, so good), and now, 24 hours later, I'm finally feeling pretty good. (I e-mailed Dr. Z. to let him know how the aspiration went, and also to request something to be given to counteract Demerol if that's what they use for egg retrieval. I cannot - will not! - vomit all the way home for two hours after egg retrieval!)

Now that this is over with, I can earnestly look forward to starting meds on Saturday. I pulled everything out to inventory what I have and compare it to The Plan (B, since A was scrapped thanks to the cyst). Ready to see this? (I have no idea how to stay organized with all this stuff...)

Got IVF meds?

From left to right (and in order of appearance in the schedule):

3-900 iU pens of Gonal-F, recombinant human follicle stimulating hormone (rFSH): I will start with 225 iU of this nightly to stimulate my ovaries to produce more eggs (dosages may be adjusted).

3 boxes (20 ampules, 75 iU per amp) of Menopur, a combination of FSH and lutenizing hormone (LH): I will start with 150 iU of this nightly, also to stimulate my ovaries (dosages may be adjusted).

Ciprofloxacin, an antibiotic: Paul and I both will take this twice daily for 10 days, basically to kill any infection either of us might be harboring within (apparently it's also helpful against inhaled anthrax, in case that becomes an issue).

3 sharps containers: because the pharmacist didn't think one would be enough. (No more slumming! In our previous four stim cycles we've discarded our used needles and syringes in either a Costco-sized soy sauce bottle, or a used laundry detergent bottle. How sad that I just finally (because I found the duct tape!) sealed and discarded those puppies two weeks ago.)

Cetrotide: this is an antagonist that will prevent my body from releasing the eggs prematurely...that would be tragic. Not sure what the dosage will be or when I'll start, or even how many days I'll take it, as it all depends on how my ultrasounds and bloodwork look next week (stim day (SD) 5 and either SD7 or SD8), but I'm guessing not before SD 7.

Saizen, the recombinant human growth hormone (rHGH): this the magic bullet that might help my ovaries behave less like those of an old woman, and more like those of a younger, more fertile woman. I will start these shots at 0.5mg SQ daily beginning SD7.

Novarel, the hCG trigger shot: this will be the only shot I have to take in the butt (yay!!!). The shot will be carefully timed to be 36 hours before egg retrieval, tentatively on SD10 (10/8), but all subject to my bloodwork and ultrasound results in the preceding days.

Medrol (a steroid) and doxycline (an antibiotic): these I'll start the day of retrieval and continue for 5 days. I'm not sure what the steroid does, but the antibiotic is to prevent infection given they've just accessed my ovaries vaginally with a really big needle.

Hydrocodone: I don't plan on taking this pain pill. I'm not a fan, and will hopefully be able to manage my pain with Tylenol.

Crinone, progesterone cream: I'll begin taking this the day after egg retrieval, and if pregnant, I'll continue at least until 11 weeks (although Dr. M. may want to keep me on it until 16 weeks).

Estrace, an estrogen tablet: I'll begin taking this the day after retrieval, too, to help build my uterine lining and get it ready for an embryo.

Valium, the chill pill: I've been instructed to take this 1-2 hours prior to the scheduled embryo transfer (tentatively 10/15 if we a) get embryos and b) any are reported genetically normal by the lab doing our PGD). They need me to be very relaxed and perfectly still so they can get the IVF catheter in proper position to drop my embies off in exactly the right location for implantation. (Please, no placenta previa this time!)

In front, various needles, syringes and alcohol wipes for my injecting pleasure. :)

I have videos I need to watch so I can get the hang of the Q-caps on the Menopur (no more filter needles, woohoo!) and also see if there are any tips I should have (had) for proper SQ injection technique of the Gonal-F and Cetrotide.

It appears my right ovary has three to four antral follicles (Dr. M.'s quick look), so along with the 4-5 Dr. Z. counted in the left on Tuesday, we should be starting with 7-8 follicles. That's *awesome* for me! The most I've ever seen is 9, and that was at a cyst check in March before our terrible April stim cycle. I'm thrilled to be solidly in the 5-8 follicles range that Dr. Z. prefers to see in IVF cycles like this one.

I'm holding onto that optimistic, it's-out-of-my-hands feeling I've had the last week or so. Who knows, this could possibly work!

Back on track

Our appointment with Dr. Z. this morning -yawn - went very well. Zzzzz...oh, sorry. I am exhausted! Getting up at 4:30 a.m. So that we could hit the road by 5:30 for our 8:00 appointment in Seattle has kicked my ass and taken names. Paul had a nice nap on the drive home, but here I am, still awake, awaiting the arrival of dinner so I can go to bed! This commute thing is going to be tougher than I thought...but I'm getting ahead of myself.

So, the cyst is still there, but had decreased by 20%, and my estradiol has dropped to 22. Great news! Dr. Z. pointed out that we can now see my right ovary instead of just the massive cyst, so that's a huge improvement. He also showed us three - possibly four - antral follicles on the right, and said there could be others hiding under the cyst. We will be starting with at least 7-8 antral follies, well within the 5-10 he likes to see.

He gave us four options for moving forward, with pros and cons for each. Two of the options would likely delay us another 6 to 8 weeks (staying on birth control to shrink the cyst, or letting me ovulate naturally and rescanning after a cycle). A third option, leaving it alone and stimming with it there, providing it wasn't still producing estrogen, also had more cons than pro.

Option 4 was the best, so tomorrow afternoon Dr. M. will be aspirating the beast in his office (saving us lots of hassle and money over doing it in Dr. Z's operating room). Since this is a medical issue, insurance will cover both ultrasounds and the aspiration (and anesthesia).

Then...drumroll...I stop BCPs on Thursday and start my stims - 225 Gonal-F and 150 Menopur - Saturfday evening! I go back again at *gulp - kill me now* 7:15 a.m. On Wednesday the 3rd for another ultrasound and E2 check, then on Thursday, when I will likely add the Saizen (growth hormone) and Cetrotide (antagonist). Egg retrieval is tentatively scheduled for 10/10, embryo transfer 10/15, and because today I do feel hopeful and optimistic, first pregnancy ultrasound will be (see how I did that?!) November 14th, with a due date of July 3rd. (Now, instead of anxiously hitting that dreadful 14 week milestone over Christmas, we can now potentially happily anticipate just reaching the start of the second trimester at that time...although also cerclage. Hmm.)

Anyway, we are happy to be moving forward. Tine to go watch those drug mixing/injection instruction videos!

On the Pill again

What a long day, awaiting the call from Dr. Z.'s nurse with instructions for dealing with "The Beast".

I'm now back on birth control pills until next Thursday, and Dr. Z. wants to see me for another ultrasound and more estradiol blood work to see if the thing has shrunk any by then. If so, Nurse E. said, he may start me on my stims next Saturday.

A week's delay?! I have a hard time believing my body will only delay this process by a week, but we'll see. My job is to take the Pill. I can do that.

But wait...

Today was my baseline appointment. We thought we'd get the green light to start stims on Friday as planned.

There's just one not-so-little thing: the giant cyst in my right ovary.

So, huh. We should have been concerned when Dr. M., who did my baseline stuff locally, said that my estradiol, drawn this morning, was 313. That's really high, waaayyyyy too high for a baseline. Dudes, my peak for our December cycle wasn't much higher!

This sucker is truly massive, 2"x2"...more than twice the size of my normal left ovary. Dr. M.'s assistant was shocked that I haven't been in serious pain. I have had some painful twinges, but nothing constant.

So, because my ultrasound was at 5 pm and Dr. M. had to fax results, I won't find out what Dr. Z. wants to do about it until tomorrow. I dug my sole leftover birth control pill out of the garbage tonight in case another 20 days of BCPs is called for. I personally would rather have it aspirated, but I'm not known as a patient woman, so there's that.

I *am* glad I no longer need to worry about potentially reaching that horrifying 14th week of pregnancy over Christmas. And, both Paul and I, while bummed, trust in Dr. Z. and his staff and feel like somehow this will be ok. Let's hope that once this cyst is resolved, I will still have at least five resting follicles in my left ovary (today's good number), and an equal number in the right. For me, that would be an awesome starting point.

Timeline (IVF power post)

As time trudges forward, I am finding myself with so much to say, but no ability to say it. I don't know what that's about...too much at once, I suppose. Here's where we are now:

Tuesday was the 13-month anniversary of losing Aliya and Bennett. The actual day itself was so highly focused on IVF that neither of us really had any time to reflect, but I can say with assurety that between losing Roxy's calf the Thursday before and knowing that both 13 months had gone by and we were about to really kick this IVF into gear, I was feeling a lot of feelings. My manager asked me on Wednesday, the first day I was back in the office, how my long holiday weekend was, and did I have fun? All I could say was, "Um, well, I cried a lot." There isn't much fun to be had in my life in general, and certainly not that particular weekend.

On Tuesday, we spent six hours at University of Washington, and what an eventful and yet disjointed six hours that was. It started with Paul's appointment in the urology clinic, where he had to leave a sperm sample to be frozen as a back-up in case we need it after egg retrieval (like, if that day's sample doesn't fertilize anything). It's always good to have something in the bank, right?

After that (and we were about 45 minutes early, so that was a lot of sitting around), we headed over to the Roosevelt clinic for our other appointments. It was a little confusing as things didn't happen in the order we were told to expect, and everything got off to a late start, but really, it was all good. We met with the financial coordinator (who thought we had to pay cash for my saline-infused sonohystogram that day, which, um, NO!!!, and yeah, we don't have an extra $700 laying around for something we were told insurance would actually cover!), forked over the $622 for my mock transfer, and then waited some more, before being led into an exam room...where we waited. Not sure what got them so backed up, but it reminded us of Dr. M.'s office, and we laughed.

Dr. Z.'s nurse finally came in and went over the plan briefly before Dr. Z. came in. He did my mock transfer first, and that was really good. He talked us through everything he was doing and seeing, and made sure we could both see the screen and the titanium-tipped catheter in my uterus. He marked the test catheter so he knows exactly how far in to bend it 60 degrees (my cervix isn't straight) and then where to stop so our embryos land in exactly the perfect spot in there. Then he switched gears and did the SIS. It hurt, but it wasn't terrible. I had taken 600 mg of Tylenol beforehand as instructed. He was very happy with what he saw; no signs of any polyps or fibroids or scar tissue. He printed off two photos and asked me to give them to Dr. M. so he can see what a great job he did during my surgery. :)

After that, he took Paul across the hall for his exam while I dressed and headed down to the pharmacy to pick up my drugs. We weren't expecting to do this, but it turns out they want me to have my baseline monitoring done down here rather than making me come back to Seattle, but that meant I'd have to get my drugs this week. Oy. We weren't expecting to drop $1,133.54 on meds that day, but it turned out ok. I left with a brown paper grocery bag stuffed full of drugs (10 different ones for me and 1 for Paul), needles and syringes, and sharps containers.

So, here's the plan:

**I'm on 21 days of birth control pills, ending 9/19. The purpose of these is to keep my ovaries quiet so that I don't start developing a lead follicle. (For those of us with diminshed ovarian reserve, our internal chemistry - the workings of estrogen and follicle stimulating hormone, or FSH - is wonky, so the negative-feedback loop doesn't work right and our brains tell our system to make more FSH...which in turn causes follicle development to start right away. The last several ultrasounds I've had, there was a lead follicle already forming on cycle day 3. Sucks, man.)

**I will have my baseline estradiol (and progesterone?) bloodwork and an antral follicle ultrasound done on 9/19 at Dr. M.'s. This will allow Dr. Z. to fine tune my medication dosages (and, of course, give us a cancellation point if I have any cysts.)

**I will start my stims on 9/21 - 225 iU of Gonal-F and 150 iU of Menopur...get this, ALL subcutaneously!! (Cue the angels singing!) I can mix my Menopur myself and give myself both shots in the belly, under the skin, in the evening (yes, once a day!). No more big ass (pun intended) shots in the butt twice a day, and no more getting up, bleary-eyed, with Paul so he could give me those shots. Woohoo! Paul and I both also start a 10-day course of antibiotics this day.

**I'll have repeat bloodwork and another ultrasound done on 9/25, stim day 5, up at UW. My dosages will be adjusted as needed.

**I'll go up for bloodwork again on 9/27 and start my Cetrotide (antagonist, so I don't ovulate prematurely) and recombinant human growth hormone ("Saizen"), and will continue with the Gonal-F and Menopur.

**I'll probably have bloodwork daily.

**Trigger shot of hCG on 9/30, depending on how I respond to the stims, Cetrotide and Saizen. This shot is usually done late at night, so that egg retrieval happens near-exactly 36 hours later. The stims (except the rHGH) will stop this day.

**Bloodwork again on 10/1, and last dose of Saizen. We're to stay the night in Seattle this night.

** Egg retrieval on 10/2. I'm to start my second antibiotic and a steroid pill this day for 5 days.

**Fertilization report on 10/3, followed by the start of daily Crinone (progesterone).

**Start Estrace (estrogen) 10/6, three days post-retrieval. This day, too, the lab will suck a single cell out of each of our embryos and send the biopsies to a lab in San Francisco for genetic testing (PGD).

** The morning of 10/7, I pop a Valium 1-2 hours prior to transfer, we find out how many of our embryos had normal gene sequences, and one or two normal ones are transferred back into my uterus.

**On 10/16, I will go back up to the office for a beta (blood pregnancy test), to find out whether or not all of this worked.

The dates are subject to slight change after 9/27, since everything depends on how my body responds to the protocol. Also, there are several points at which this could end in cancellation:

1) I don't respond to stims and we cancel prior to egg retrieval (we'd get a partial refund here).
2) We make it through egg retrieval and no healthy eggs are retrieved, or none fertilize via ICSI.
3) We do have fertilization, but none make it 3-day biopsy.
4) We do make it to biopsy, but none are normal, so none are transferred back.

I honestly almost expect one of these to happen (especially #1, given my history), so I'm definitely not getting my hopes up about any of this.

We had tons of questions about all of these processes, and thankfully had everything answered. I had to sign a shit-ton of disclosures and consent forms (this is surgery, after all), and go over the lab order for eggs and embryos with Dr. Z. Have I mentioned before that we love him?! Swoon! (Paul and I later learned that we each told him - unbeknownst to the other - what a pleasure it is to work with him and how wonderful his staff is!)

The coolest thing is that Dr. Z. had a fabulous solution to our dilemma of not wanting to know the sex of our embryos after PGD. (Apparently, we are in the minority...most people want to know, and some want to transfer a specific sex, or want to have a boy first, etc., but as I pointed out to Dr. Z., most people probably haven't lost one of each and only want a LIVING child...it's selfish to choose sex when alive and breathing is the most important thing!) So, if we end up with more than one healthy embryo after PGD, they will do a random number assignment for transfer. If we were to transfer more than one (which we apparently can still choose to do, but he doesn't recommend it to help avoid twins again, although one can still split into two after transfer), then he'd transfer healthy odd-numbered embryos (say, #1 and #5, if #3 was unhealthy). If we only have two, then we'd either transfer just #1 and freeze the other, or transfer both (and have nothing in the bank). We're both really happy with this suggestion.

It's really hard to have an appropriate measure of hope when, 59 cycles later, my brain is in full self-protection mode. So many times it's felt like having hopes (not even expectations, just hopes!) has led to self-hatred as everything fell apart. I did peek ahead, because I can't help myself, and noticed that if this cycle works, not only will I be 14 weeks pregnant during the week of Christmas (how's that for a mind fuck?), but I'd likely be in the middle or tail-end of bedrest post-preventative cerclage. Huh. (Oh, and this would be a June baby, the most popular birth month in Paul's family.) I have both of these observations in my brain, but I refuse to write them - even in pencil, as I've done so many times in the past almost 5 years - in my dayplanner. Less to erase...and be pissed at myself for. To be honest, once I am pregnant I'm not sure how much I'll be willing to write down, but don't worry, I'll be hyper-aware of 13 weeks (2nd trimester), 14 weeks (OMG!), 24 weeks (earliest viability), 28 weeks (high viability), and then every week past then. Breathe...breathe...breathe...

Where

I'm too tired and drained to post much right now...we had a farm tragedy last night that resulted in the stillbirth of our first calf of the year, and that after two years of cow infertility at our place. Given our personal infertility and our two dead babies last year, it's a lot to f*cking take. It's very hard not to take it all personally. And that on top of news earlier this week that someone in our babyloss community lost her husband to a tragic accident. To say life is unfair is an absolute understatement. Life makes no sense to me at all sometimes. Our hearts are so broken for this woman and her children, who have already been through more than enough.

*******

We are proceeding forward with the IVF...although times like this, I have a hard time believing that it'll work, that we'll EVER have a living baby in our family. Last night I told Paul, "I love you, but I hate our life." It's been a very true feeling for me lot of the time over the last year, coming and going...right now it's here again. I never asked for any of this shit; neither of us have. And what the f*ck did we do wrong in a past life to deserve all of this? If all the bad wasn't concentrated around our and our cow herd's infertility and now babyloss, I wouldn't feel so doomed, but for God's sake, this cannot be coincidental. I just want to rip out all my hair and scream. Maybe it will help.

Anyway, because I'm going to move forward in the hopes that some miracle will overcome us and stop this ridiculous, beyond-unfair run of really bad luck, I will take my second birth control pill tonight, the first step toward IVF. The BCPs are to synchronize my cycle and give Dr. Z. "control" of the timing (but we all know how medical control of my body has worked in the past, right?). My recominant human growth hormone prescription is ready and waiting for me at a pharmacy in Maine; I have only to call them and give them my credit card number and confirm shipping plans before it arrives on our doorstep in mid-September.

Tuesday we'll go to University of Washington for three appointments: two for Paul and one (duo) for me. We've decided to bank a frozen back-up sperm sample in the event whatever eggs they get from me (provided they do) don't fertilize the first time. I will have a saline sonohystogram and a mock transfer to make sure my uterus is properly healed from my hysteroscopy last month and to give Dr. Z. a chance to get to know the lay of the land, so to speak.

If all is well, I should finish the BCPs on the 19th and start the stimulation protocol on the 21st with Menopur, Gonal-F, Cetrotide and the rHGH. With any luck, we'll get decent follicle development and make it to egg retrieval the first week (thereabouts) of October.

We have decided to go ahead with the PGD. Therefore, if we get any eggs and any of them fertilize and make to day 3 embryo stage, each will be biopsied and a single cell shipped to a lab in California for DNA testing to see if we have any that are normal (i.e. not too many genes, not too few, not the wrong kind in the wrong places). The results would be made available on the morning of day 5, and a single normal embryo - if we have one - transferred into my uterus, probably right around the due date of our next calf (October 8th, oh, the irony).

As I researched the PGD a little bit and saw the type of results other couples have gotten ("Fragile X - XXY, female"; "Trisomy-21, male", "Trisomy 13, female"), I realized that we would hear the sex of each embryo before it was even available to transfer. Do we want to have to choose, potentially, between a male or female embryo? Would we want to have to decide whether to try and bring a son or a daughter into the world? Paul and I talked and decided absolutely not, so I called Dr. Z.'s nurse and asked her to note that we won't want to know the sex of the embryos. Too much information. We'd both rather have the opportunity most normal people get these days to learn through an anatomy scan ultrasound at 18-20 weeks pregnant...if we get there.

So many ifs...

Contemplating PGD

In yesterday's post, I mentioned that Dr. Z. lost me during the PGD part of his recommendation. After the appointment, Paul and I talked and preliminarily decided against PGD because of a) the cost (another $5,000-7,000 on top of what we'll already pay), and b) because "it doesn't matter" (since we were only going to try this once, knowing whether our embryos were normal before a BFN (big fat negative pregnancy test) wouldn't change anything).

On the way to work this morning, though, I started thinking about this more. PGD samples a single cell from each 6-8 cell embryo on day 3. This sampling has no impact on a healthy embryo's ability to continue growing and dividing (but can ruin abnormal ones). The results are returned from the outside lab (in Nevada) on the morning of day 5 (embryo transfer day). One or more embryos that tested normally and are high quality are transferred; any extra normal ones that remain can be frozen.

If we do PGD, only those healthy embryos (those free of the main genetic disorders, like Downs (not fatal), Turmers (usually fatal) and Potters (always fatal) chromosomal disorders) would be transferred to my uterus. There's a chance we'd have no healthy embryos, in which case we'd be out the entire $15,000-18,000 for the cycle. At the same time, if we did have healthy embryos and were able to freeze extras, all may not be lost...a BFN the first time could lead to a $3,000 frozen embryo transfer (FET) of one or more *known* genetically normal embryos the next time...therefore knocking our anti-PGD reason "b" out of the water.

PGD is 95-98% accurate. There's a tiny statistical drop in the number of PGD embryos that survive thaw for FET (92-95% versus 97-98%). There is a significant decrease in the miscarriage rate for normal PGD embryos versus regular IVF embryo transfer. Due to my age, it's possible a big portion of my eggs are abnormal, so PGD is actually warranted.

It's too early to say what route we'll take. At this point, Paul is completely unaware of where my brain is on this topic (although I wouldn't be surprised if he's having the exact same thoughts!). I do think further discussion is in order...

Last ditch

Thank you all for your kind words and encouragement. It's really meant a lot to me/us!

Our IVF consultation today went well, all things considered. We both LOVED Dr. Z. and his staff. From the second we walked onto the floor, we were treated very kindly and with respect and compassion...so unlike our experience with "that Portland clinic". We literally liked Dr. Z. from the second he set foot inside the exam room. He's very easy to relate to, interested in what we BOTH had to say, and very knowledgeable. He taught us some things we never knew - after all, this guy has been practicing reproductive medicine since 1982 (when I was in second grade!), and was one of the pioneers in reproductive medicine, and was the President of SART, the Society of Assisted Reproductive Technologies (he helped set up the national standards that all accredited clinics use). He really knows his stuff. He drew pictures, he talked in plain talk (with funny but appropriate analogies)...no intimidation tactics, no ego, no attempts to discredit anyone. He was just plain great.

My fertility - combined with Paul's - is what it is. There is no miracle to be had, as far as treatments go. The stats for diminished ovarian reserve plus my age plus Paul's sperm issues just aren't very good. He started recommending pre-implantation genetic diagnosis (PGD) to see what the genetic quality of our embryos is as a way of helping us decide how to proceed going forward. This is where he pretty much lost me. See, as I've noted here before, I am SO over trying with my own eggs. My goal is to conceive my husband's child. I really, truly don't give a shit anymore whether that baby comes from my own eggs or not. What I do know is that the clock is beyond ticking (heading toward ticking time bomb at this point, given my diminished ovarian reserve coupled with my age) and my window for having a take home baby is growing increasingly short. I want the best possible chance. I told Dr. Z. this, and said that this is where I am...but not where my husband is.

This led to an intense but carefully managed conversation between the three of us. He could honestly articulate both of our concerns to eachother; even though he noted he is not a counselor, he certainly has experience with the emotional aspects of infertility. We really appreciated that.

At this point, he agreed that I am correct in that our chances would be better with donor eggs, but he wanted to let us know about an experimental treatment regimen that seems to be showing some success in the 38-40+ age group for women with diminished ovarian reserve: the use of recombinent growth hormones. That is the route he recommends for us...IVF with ICSI (where they physically inject a single sperm cell into a single egg cell in the lab) using Gonal-F and Menopur, as before, probably with estrogen-priming like Dr. M. did in April, but with the addition of 7 days' recombinant growth hormone. If this doesn't work, then he recommends moving on to donor eggs...knowing we'd given it our college try.

The other thing we're both struggling with is he wants to only do a single embryo transfer in hopes of avoiding twins. Research shows (even in the packet of info we were given) that for women aged 38-40, the national recommendation is no more than 2-3 high quality or up to 4 lower quality embryos transferred. Dr. M. would do 3 if we were under his care (but he doesn't do ICSI, so that would be 3 if we got 'em) and has no concerns about me carrying twins again, although he does want to do a cerclage between 12-14 weeks next time in case I did have incompetent cervix. Dr. Z. does not want me to conceive twins again, and recommends that we meet with a perinatologist for another opinion in what went wrong with the twins and what should be done differently. He suggested two different guys at UW (ha ha, A.S., one was your doctor, whom he said is VERY opinionated, and I let him know I will not be seeing him based on your experience!). I have a recommendation for one in Tacoma, so I'll probably follow through with that. This part of the conversation solidified for both Paul and me that while we know a singleton pregnancy would be the safest and least risky for us, we do both would like the opportunity for a do-over with twins.

We've decided we're probably going to go ahead with that. Dr. Z. penciled us in for an October IVF cycle, just to get us on the books (he said it's much easier to cancel an appointment with the University than to make one). We will have an out, such that if we get to even the day before egg retrieval and things aren't looking good (i.e. we aren't reaching our pre-determined "go/no-go" follicle count), then we can cancel and get most of our money back. Having an out is good, and something we wouldn't have likely gotten at a private clinic.

So, our next steps are to figure out how to pay for this ($10,170 including ICSI and 1 year's cryopreservation of extra embryos, if any...but not including the meds, another $2500 or so, including the growth hormone, or PGD, $5000-7000 more), and to go forward with the next phase of testing (a repeat saline sonohystogram for me to check on how I'm healing from last month's surgery, a mock transfer for me, and an exam for Paul to see if there's anything that can be done for his count/motility/morphology issues).

I'm concurrently attempting to book my free 30-minute consultation with the donor egg bank director of the clinic we'll use if we need to go that route so that I can get my questions answered. It sounds like that conversation will happen on August 16th. Must cover all bases, right?

I think we both feel satisfied with the plan overall, me because it's finally the last shot before we move on, and Paul because he gets one more chance for us to try to conceive OUR genetic children. I am relieved that he has agreed to only one shot at this...and also relieved that we're starting couples grief counseling next weekend so that we can work through - finally - all the emotional shit the last five years of heartache has brought us.

Polyp-free - for now

Last Friday's surgery went well. I was surprised to be as calm and peaceful as I was that day, although I did find myself wishing Paul was already home as the scheduled time got closer. (He flew in from Alaska while I was in pre-op and was in the waiting room by the time Dr. M. came out to tell him how it went, so that was good.) I'm super grateful to have had my sister-in-law with me. We had a great time in pre-op, laughing and talking about sex (I'm sure the nurses were wondering why we were laughing so much!). It was all good.

One month after losing the twins last year, a hysteroscopy in Dr. M.'s office revealed two polyps and a "ridge" in my uterus, but the one we were blaming the miscarriage on at the time was gone. Last week, Dr. M. found only one polyp in my uterus and removed it. Paul thought he said he'd also removed three from my cervix, but at my post-op appointment today, he wouldn't commit to that. He said, instead, that my cervix has the beginnings of many tiny polyps (there was a term for it, but I can't remember what it was).

Great. This does not at all make me happy. I'm sure I don't have to explain why. When I asked him about, he agreed with my reaons for being concerned.

So, next step: we're going to University Reproductive Care in Seattle on August 7th (yeah, two days after our one-year anniversary of losing Aliya and Bennett...maybe not the best move ever). Dr. M. seemed happy with this decision, and reminded me that he's happy to provide monitoring or whatever we need if that can be arranged. (LOVE!) I'm to ask the doc we're seeing - who comes very highly recommended - about his thoughts on my cervical polyp issue, just to get his opinion. (Dr. M. is curious, I think...this other doc actually taught him how to do transvaginal ultrasounds back in the day, he said.) We figure if anyone is qualified to give us a really good idea of our success probability with IVF using my own eggs, it'll be this guy.

Ironically, one of my big hang-ups about Dr. M.'s has long been that we'd have to find our own outside financing (i.e. bank loans) to pay for IVF, and it turns out to be the same case with UW! I had no idea. Oh, well. We'll see what happens.

And, if the answer is unfavorable, which I'm (so far) very much ok with, then we'll move on to donor eggs.

My goal is to be pregnant again before the end of 2012. We'll see how that works out.

Apprehensive

There's so much going on, so much on our plates (especially mine), and yet I feel unable to put it all down coherently on the page. It's a big, messy jumble in my head, a massive run-on sentence when I speak of it all out loud...ideas and issues and timelines running into one another.

Here it is in a nutshell (bullet point style):

• I did the Clomid Challenge test last week, and had my anti-Mullerian hormone (AMH) retested. I expected to fail miserably. I had the tests done partly so we could say that yes, we'd had them done (in case another clinic requires it), but also to help Paul hop on board with the donor egg thing. I truly expected to fail both tests miserably.

• I'll be darned if the results weren't really that bad. My combined FSH (the sum of the two draws) was 16.2...not great, but not the miserable failure I was hoping for. And that AMH? It actually went up from last time. I'm now at 0.8, which is Low Normal. I can no longer claim "Poor Prognosis". That old 0.28 result was blown clear out of the water.

• I suspect that my husband somehow knew this would be the case, and that could explain why he hasn't been gung ho about donor eggs like I have been.

• I was supposed to have had my repeat hysteroscopy this past Monday, but it turns out that Dr. M. has never done an operative hysteroscopy in his office and wasn't prepared to do so (and Lord knows neither Paul nor I want ME to be the guinea pig!) Said procedure must be done in the hospital under general anesthesia.

• All was not lost, though...I also needed to have a PAP done within the past year, and my last one was a year ago mid-August, so Dr. M. did that along with my pre-op exam. Killed a different bird than expected, but hey, it works.

• Um, is my husband the only one who has not only seen his wife's cervix - like actually seen it (eek!) - but also witnessed her having a PAP and breast exam? Anyone? I'm sure he'll be traumatized for life with all the female business appointments he's now been involved in.

• I had to push a little bit to get Dr. M's staff to schedule the appointment for me, since they didn't believe it could be done this week. I insisted...if not this week, then we'd have to wait a full month. Miraculously, they called yesterday morning and got me an appointment for tomorrow night.

• I am having surgery tomorrow night. This is only the second surgery of my life. The first was my D&C for retained placentas...consented to because I understood, through the drugs and the shock and that f*cking oxytocin coursing through my new mother (of dead babies) body, that it had to be done. This is the first ever full surgery I've ever fully, coherently consented to. OMG.

• I am forbidden to eat anything after midnight or drink anything after 6:00 a.m. I don't check into the hospital until 3:00 p.m. My surgery isn't until 5:00 p.m. That's going to be a very long, miserable day...

• Topped off by the fact that I have to shove 200 mg of Cytotec up my hoohaw at 8:00 a.m. This is the same drug that was used to induce my labor. I have issues around this, for obvious reasons...not the least being holy crap, Cytotec again, nearly a year after a Cytotec-induced horror? (Also, Cytotec causes cramping as it dilates the cervix...last time I had a Dilaudid pump, but this time I get nothin'. I'm hoping the low, single dose means cramping won't be bad.)

• Can you imagine how much fun I'm going to be tomorrow? I mean, starved for 17 hours, dreaming of liquids I can't drink for 9 hours, and a cramp- and flashback-inducing drug in my system? Oy. (I will be staying home from work tomorrow. I figure that's best for everyone involved.)

• Also, this impending surgery, fear of the unknown (and Cytotec) has brought my grieving up full force the last couple of days. I also met a new twin babyloss mama tonight in support group, and that fed right in...I cried through her whole story. I hate that anyone else has to go through this (even though babies die every.single.day), and yet I was glad I was there to offer some experience and resources.

• Side note: Paul's not here. He's in Alaska. His flight should land at SeaTac as I am checking into the short stay surgical department. He plans to drive straight to the hospital, and I'm assuming he'll drive us home, but with baggage claim, having to get his truck in Tukwila and then battling Puget Sound Friday night traffic, I'm betting he won't arrive until 6:30 or so (when I should be in the recovery rom). (Our sister-in-law, bless her heart (hi Amanda!!) is driving me there and will wait in the waiting room.)

• I had an appointment Wednesday with a local naturopath who specializes in fertility and got a surprise referral to a reproductive endocrinologist (RE) at University of Washington. I suspected - and was right - that Paul would be happy about this. We'll probably go for a consult there, given my newly improved/not awful ovarian reserve test results, and see what they say about IVF using MY eggs.

• I'm back on the fence...donor eggs are a much surer bet (although there's no 100% guarantee that anything we do or try will get us a take home baby), but Paul's more interested in having our genetic children, not just his, and now there's a possibility, so...yeah. What was black and white for me is now very, very gray.

• I don't like gray.

Better left unsaid

I alluded to it in my last post, but our appointment Friday was a disaster...like, the kind I wish we could erase from our memories. It was bad enough that I went through my old posts and stripped out the clinic name. If I was an Italian nona I'd spit on the ground, as if to say, "Never again."

We were early, having left home at 12:30 p.m. to beat any potential Memorial Day weekend traffic heading south, so we arrived with an hour to spare. We hadn't eaten, so we found the cafeteria at the adjacent hospital and had a quick lunch.

The second we stepped onto the floor where the clinic was located, we were instantly confused. There were no windows in the corridor, just plaques on the wall to indicate which business was behind each solid metal door. Not terribly friendly.

Inside, it was very dimly lit and sort off-putting. The walls were painted in heavy browns and blues with sterile artwork on the walls and Newsweek and Time magazines on the coffee tables...no images of women and children, no pregnancy books, nothing to suggest we were anywhere other than perhaps a proctologist's office.

We didn't wait long before we were ushered back by a nurse to, "Stand right here, oh, you can sit in this chair so I can take your blood pressure, no, wait, I need your weight first, ok, now you can sit, oops, I need a photo of the two of you for your chart, stand together right here." WTH?? Get it straight, lady! It turns out, after all that, the doctor wasn't ready for us so we were sent back into the unfriendly waiting area to wait a little more.

Finally, the doctor came to get us. It went downhill fast from there. Between his apparent need to debate why he thinks we lost the twins; to his overt attempts to discredit most everything Dr. M. has done and said the past two years ("I see your doctor has your medication dosages here in this little handwritten calendar [waves hands around dismissively], but why don't you tell me what your dosages are...this really doesn't make sense to me..."); to his snide remarks about how they have patients fly in from Dublin, Ireland and China so several drives per week to and from Portland really shouldn't be too much trouble for Paul and me, to his overall arrogance...let's just say I was seriously pissed off within 10 minutes of being in his office. (I'm still not very good about standing up for myself in the moment...if I'd had my wits about me, I would have said, during his goings on about the twins, "You know what, today is the one-year anniversary of our positive blood pregnancy test...it's a little tender, so if you wouldn't mind, please move onto another topic. And, no, we DON'T need a third (actually, fourth) opinion by a Portland MFM. Give me a break.")

Personalities aside, we did learn some things:

• I need to have a Clomid challenge test done to check my follicle stimulating hormone (FSH) levels. This involves an FSH blood test at day 3 of my cycle, five days of Clomid pills to "test drive" my ovaries on days 5-9, followed by a repeat FSH test. If the results come back high, I cannot do IVF with my own eggs. Period, end of story. They charge $500 for this test, and I have to do it in Portland (i.e. two back-and-forth trips).
• I need a repeat hysteroscopy done, and if there are still polyps, I must have them surgically removed or they will not do IVF at all, with my eggs or anyone else's.
• I am too old to qualify for a multi-cycle discount, so we would need to pay the $15,000-16,000 per cycle as we go. However, I will qualify for the discount if we use donor eggs (less risky for the clinic because the success rates are so much better). The quoted amount (apparently, although we have nothing in writing) includes intercytoplasmic sperm injection (ICSI) - which is a must between my assumed poor response and Paul's sperm issues - and the freezing of any leftover embryos.
• DHEA is "a thing of the past" and he doesn't like to see his patients on it. The CoQ10 I started taking two weeks ago is fine, but I should discontinue the DHEA that Dr. M. prescribed.
• It's "doubtful" the Metformin has had anything to do with my poor response, but since I don't have PCOS, it's not necessary for me to take it.
• Dr. M. didn't stim me correctly for IVF, in his opinion. With patients like me, you have to start with the maximum dose right out of the gate, not step up. (That's good information to pass along to Dr. M. if we decide to go back...maybe he can do something different.)

In all, the whole visit left a very, very bad taste in our mouths. We had to stop and pay the $350 consultation fee on our way out and I could not get that over with fast enough. The more I think about the whole thing, the more upset I am. Paul left completely overwhelmed, mostly because he needs time to process information and didn't come into the appointment with as much background on IVF as I already have. He awoke the next morning and said, "You know, the more I think about it, the more I think he was really just trying to say they don't need our money." Exactly. Seventh in the nation for my age group absolutely does not trump asshole-ishness.

So, where does this leave us, besides wanting to run, crying, back to Dr. M.? I know, that sounds insane, but really, wow. Anyway, I will be calling Dr. M.'s office this week to find out whether they do the Clomid challenge and how much it costs (it's bound to be less expensive there). I purchased the book, Making Babies: A Proven 3-Month Program for Maximum Fertility a couple of months ago after it was recommended by my hypnotherapist, and we've decided to take the next three months to try and get my body into tiptop shape using the techniques in the book, which include both Western and Chinese medicine along with dietary changes. If the Clomid challenge isn't too expensive, I'll have it done soon, otherwise, we'll wait until the three months are up. That way, if my FSH does come back high, we'll know we did all we can to improve it, and hopefully the decision to adopt or use donor eggs will come more easily. I'll also have Dr. M. repeat the hysteroscopy, and if he can't remove the polyps in his office, then I'll schedule surgery closer to home.

Past that...I think we'll be looking for a third clinic option. Dr. M. doesn't do ICSI ("Oh, I didn't know there were still clinics around the U.S. who didn't do ICSI," said Dr. Asshole, as if to say how disturbing/charming that was). Now that the Portland clinic is out, that leaves clinics in Seattle and surrounds (and possibly OHSU in Portland). We can cross that bridge when we come to it.

It would have almost less disappointing to hear, "Sorry, it's too late to help you" as my dream predicted than experience the sheer arrogance and dismissal we got at our appointment.

Feeling peaceful

One year ago today, my doctor confirmed what Paul and I had discovered the night before: we were finally pregnant.

This afternoon, one hour shy of the time I got that long-awaited call last year, we will meet with a new fertility specialist in Portland to see whether we may ever get to experience that amazingly gleeful feeling again.

Wish us luck, please...

Past

I am currently sitting in my car, waiting while Paul gets a quick haircut at the shop of the little Asian barber he used when we lived in this city. I sit across the street from our old house, the 1910 Craftsman I bought as a single woman, one tiny room, tucked under the second story gable, where I planned to set up the nursery for the baby I'd planned to conceive -as a single woman - using IUI with donor sperm because I'd given up on finding love. The room had already been a nursery, painted in a beach theme with seagulls and beach balls and a puppy on its sand-colored walls.

Then I met Paul, we fell in love, married, remodeled the house and sold it, those nursery walls painted over with a sensible taupe.

Sitting here, waiting, always waiting, I am struck by how much everything has changed. Back then, life was pretty simple. Back then, we were eagerly trying to conceive our first child, unaware that 4.5 years later, where there was hope, there'd be heartbreak, no idea that infertility and babyloss were in our future.

So much has changed.

Waving the white flag

I have, in the last hour, come to the realization that my depression is getting to the point where talk therapy and acupuncture may not be helpful enough anymore. The daily burden I carry in my heart and thoughts has me underwater more often than not lately. While I'm no stranger to antidepressants, having taken them for 7 solid years during my 20s, I never thought I'd have to consider them again.

This is not something I take lightly. A dear friend, who has known me since junior high school, expressed surprise when I admitted several months ago how much I struggled with being on antidepressants back then, how inept I felt. She said I handled that time in my life with grace, which couldn't be less how I saw myself then.

Now is no different. In fact, it's probably worse. But I have to face the fact that I mostly feel like *I* am getting worse. I know we've been warned to expect 18-24 months of hard grieving for the loss of our twins, but I can't fathom plodding along for another 9-15 months the way I am now.

A search of Dr. Google indicated at least two meds are safe to use during ART and pregnancy. My counselor had surgery and has been out, so I'll have to wait until next week to talk this through with her.

It doesn't make me happy to consider meds again, but a) not much does make me happy right now, and b) I know that, as a tool, meds can help. I need to do what I can to help myself.