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Archive for March 8th, 2009

Another Trip to Playwise Kids

Posted in Picture Palooza on March 8, 2009| 3 Comments »

We went to Playwise kids today to meet up with some friends, and got the first family photo that we've had in 4 months taken. It's always difficult squeezing all six of us into a photo, but this one wasn't too bad!

The kids had a great time, though the triplets were definitely tired, having skipped their morning nap, and since we were there during their normal afternoon nap time… but it was worth it, as usual. Some quick highlights:

Abby getting ready to go down a slide

J-man having fun with sand.

Sam was not nearly as enamored with sand as the J-man. Sam was PETRIFIED of the sand and quite mortified to find it sticking to his hand. He was quite offended by it and didn't like it one bit. I felt a tiny bit guilty taking this picture before comforting him, but it was worth the guilt.

Ellie was the only one who really loved the sand pit. Abby spent the entire time in Abba's lap, but Ellie dug in the sand, and had a grand old time.

And here's Abby – where she spent the entire duration of her stay in the sand pit – in Abba's lap. My little adventuress.

Sam-man showing off.

J-man built this awesome T-rex.

Brotherly Love. Sam had a great time sliding down with the J-man. The triplets fought over the opportunity to have a slide trip with big brother, and big brother couldn't get enough of the attention, either.

Ellie flying!

Abby posing.

Once we reached the melt-down stage at Playwise Kids, we packed up the monsters and headed toward home. The triplets napped enough in the car that we were able to stop for dinner and when we got home, the babies went down for bed at their normal bed time, not even noticing that daylight savings time had snuck in so their normal 6:30 bedtime was really 5:30 on their natural biorhythm. They were tuckered, regardless!! Thank goodness!

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Dangit

Posted in When did I turn into this evil crazy woman??? on March 8, 2009| 4 Comments »

So last summer I went for my, uh, we’ll call it annual physical with my PCP. Yeah. Annual. That’s right. Something like that. And I was pronounced in good health, post delivery of HOMs. My weight was down significantly from my pre-pregnancy weight (though, of course, I could still stand to lose weight, my doctor was thrilled with the weight loss and never ever tells me I need to lose more – I love her), my cholesterol was down, my triglycerides were down, my blood pressure (as usual) was low, I’m not diabetic. The perfect picture of health.

So when she asked if I had any other questions, it would have been easy to just skip right on out of there and go on with my life… but something odd had been happening every month, like clockwork. Since delivering my babies, I’d been having a period every single month. As if that weren’t odd enough, for the 10-12 days before my period would arrive, I was … not myself. Raging lunatic would be a better way of putting it. Crying, depressed, incapable of coping with even the tiniest disruption in my expectations for the day. Screaming at my husband. Big, fat, rolling tears at every little thing. Sensitivity to every change in routine. This wasn’t a little PMS. This was PMS on crack.

Without even a little hesitation, my wonderful PCP diagnosed me with PMDD – premenstrual dysphoric disorder. Now, I’d never really noticed it before because except for the medication-induced periods, I’d had very few periods in my adult life. But you know? Come to think of it, before each treatment cycle began before I finally got pregnant? I did pretty much fall apart – screaming, fighting, rip-roaring angry for no good reason, crying at the drop of a hat, etc. All about 10-14 or so days before I’d go in for CD3 monitoring for each of my cycles. I always worried that my husband would say, “That’s IT, clearly this is all too much for you, we’re not doing any more of this crap, we’re DONE! because that would have just made everything that much worse!”

Fortunately, I have the world’s most wonderful husband, who would never suggest such a thing and he just sits there and takes it. Mostly.

And here I am, a few days before I start Lupron. About a week before I’m going to get my period, and where am I? Crying. Screaming at him. Unable to cope, pretty much at all, with every little change in our projected schedule for today, and NOTHING worked out today the way I’d anticipated. Everyone melted down, including and especially me. Surprise! My old monster of a friend, PMDD. I’d forgotten about her. That dark monster who lives inside me. That black, gooey friend who seeps into every pore of my being and doesn’t let go until the last second.

I never did anything about it last summer because I was breastfeeding and usually you treat PMDD with SSRIs (e.g. Prozac) and Prozac and breastfeeding are… well, not necessarily incompatible, but not really great either. And then I stopped breastfeeding the same week I met with the Doc at the Hatchery, so it wasn’t really the best time to do anything about it then either. And then I started my IVF cycle, and that seemed like a really bad time to start it then, because what if I get pregnant? And really, if I get pregnant, problem solved anyway, because it’s really only those 10-12 days that I need anything regardless (many women with PMDD take SSRIs all the time because they can’t predict their cycles, but most take them only for the second half of their menstrual cycle). But then the cycle failed. But it’s on to the next one, right?

It’s a vicious cycle. How many cycles are going to fail before I do anything about this, do you think? I wonder what SuperDoc would say about me starting an SSRI. Will I have the cojones to ask him about it? Probably not.

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Hello? Back to Me!

Posted in IVF#2, The Waiting Game on March 8, 2009| 5 Comments »

Yeah, so enough about politics and ZIFT and whathaveyou. Really, this blog is allaboutme! Duh. Though, really, you wouldn’t know it, because there’s seriously nothing going on here in PerkyLand. Still taking the BCPs. Still getting honkin’ huge headaches. Shocking, I know.

I almost cancelled this cycle. Er, postponed I suppose would be a better word. Anyway, I had an absolutely ridiculous week that involved one child in the hospital, one car getting rear ended (with me and another child in it) and another car breaking down (with my husband stranded). Seriously, you can’t make this crap up. It was a bad week. It didn’t seem particularly prudent to be looking down the barrel of that gun they call Lupron Week.

But hey! Lupron week isn’t until next week! And I just know that if I put this off, I’ll be kicking myself later. There’s nothing I abhor more than a break. Nature abhors a vacuum; Ms. Perky abhors a Treatment Break. God Love Tertia and I loved every single word of her book, but the one piece of advice I didn’t find myself nodding along with in her final words was to take breaks between cycles. Not me. No way. No how. Nuh uh. Nosirree. Maybe I’ll be eating my words later and tweeting her with my tail between my legs, but I doubt it. I just think we’re all different. Me? I need to push forward. I’ll be miserable if I don’t.

I just thank HEAVEN that I was not taking Lupron this week. Because if I had been? All hell would have broken loose.

Meanwhile, I have horrifyingly bad cramps. I can’t help but notice that ever since I started the pill I’ve had pretty sharp pains in my right ovary. I have a tiny (growing) voice in my head that keeps wondering if maybe it’s a tiny (growing) cyst. Can you feel cysts? I hope not. Is this all in my imagination? Golly I hope so. But I do definitely have cramps. My period is imminent. As soon as I stop these BCPs, I’ll be getting it, no question. I start Lupron (whee!!!) on Wednesday. Can you imagine if I’d already been on the Lupron during Hell Week? Dear Heavens!

Given all the stress this week it seems a reasonable time to address Lori’s question (and barren’s followup comment):
Have you ever considered adding some stress reduction techniques to your next cycle? I know how stressed you were last time. My clinic believes so strongly about it they have their own stress reduction program.

It is rarely the cycle itself that stresses me out, just so you understand, but rather that my life is so frickin’ nonstop (I know, I know, like having another kid is going to make that any easier?). The truth is that until this past December I was actually a pretty relaxed, calm(ish) person, and then my life kind of went to hell with the successive disasters of several of my friends. One friend had her house burn down with her triplets inside (the triplets, thank heavens, are fine now, but were in the ICU for several weeks). Another friend lost her infant daughter to SIDS a couple weeks later. Another friend’s father was diagnosed with incurable cancer (he died this week). Auditors showed up at my workplace. Then my kids got the plague. Then a set of quintuplets were born nearby and I started helping them because I’m insane. More auditors. Then I got sick. Then the IVF cycle started. Still more auditors (this is normal in my field of work – not a sign of anything bad happening, but does mean an increased workload). Then the IVF cycle failed. Then my daughter went into the hospital (she’s out now, and fine), I got rear ended, my husband’s car broke down, you know, things just haven’t stopped for us, really. Actually, now things are pretty calm. We’ll see if they stay that way. Here’s hoping.

Now would seem like the perfect time to take a break, now that I think about it, wouldn’t it?

Except that it’s NEVER a good time to plan a pregnancy. It’s never the perfect time. And if I wait until my life calms down? Well, forget about it.

So what about stress reduction in the meantime? Well, funny you should mention it. My birthday present from my mother in law was a 60 minute massage. I loathe massages, actually, but I’m going to give it a go, at a strategically placed point in my cycle (I haven’t figured out when that is – suggestions welcome). As for other stress-reduction thingies… I actually do a lot of directed imagery, breathing exercises, and biofeedback techniques throughout my day, paritcularly when I’m in the middle of a cycle. I went through years of biofeedback training as an adolescent because of my migraines and it worked wonders (less so now, but still does an amazing job if I catch a migraine early enough and can take the time to really focus in on the techniques).

My clinic also does feel very strongly about state of mind/state of being affecting cycles, so they have recently established an afflilation with a center for alternative therapy – accupuncture, yoga, various nutritional voodoo, etc. They are a wonderful center that does a lot of wonderful work. So don’t think I’m knocking the suggestion.

I won’t ever do accupuncture because it makes me feel terrible. I tried accupuncture a few times for migraines and it made me feel like I was going to throw up every time. I did give it a fair go, but I felt awful and it left me with this horrible ICK feeling all over when it was done for HOURS. And Yoga. Don’t get me started on Yoga. Yoga does not relax me. Yoga makes me feel fat and awkward and dumb and I spend the entire time wishing I were somewhere else. But breathing exercises? Focusing inward? Personally working toward an inner zen? I’m all for it. Finding a therapist? Might even be all for that. Listening to music before and after my IVFs? Frankly doesn’t make a difference to me whatsoever and wouldn’t ever make me feel like I was doing anything proactive at all. Stabbing myself in the stomach (or bum, as the case may be) feels far more proactive, personally. But to each his own. I think everyone has those things that work for themselves. Me? I could use some good book recommendations for the waiting room. Got any?

Finally, do remember that part of what happens in the blogosphere is that you hear/read what gets transmitted in writing. I don’t spend my whole day focused on the minutiae of my cycle, but when I sit down to write a post about it, that IS, of course, what I’m focused on. Truthfully, I was pretty zen about the whole thing right up until transfer day when SuperDoc said he was going to transfer 8. (he was joking) That sort of broke my zen.

But it’s all good.

Hey, what’s the worst thing that happens, right? The worst thing that happens is this cycle doesn’t work and I’ve blown some more money, some more time, some emotional collateral, and some more energy baking cookies for SuperDoc, SuperNurse, and J, Marketing Supervisor Extraordinaire.

That’s not so bad, right? After all. That would still leave me with one covered cycle on my insurance before having to switch back to The Hatchery.

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Your Question Answered

Posted in FAQ's on March 8, 2009| 4 Comments »

Anonymous asked:
Any comments on 5 embryos being transfered into a 40+ y/o woman using intra-fallopian transfer?

Well, Anonymous, I’m glad you asked if I had any “comments” vs. “opinions”. Because obviously I don’t know the specifics of the circumstances, so I’ll comment, but only because you asked, and please do bear in mind that I know absolutely nothing about the situation at hand.

Now that I have that out of the way, there’s another important thing to point out. You don’t say if this was Gamete Intra-Fallopian Transfer or Zygote Intra-Fallopian Transfer. Actually, I take that back – you said embryos. So I guess it’s Zygote. Though, do bear in mind that with ZIFT the fertilized eggs, as far as I understand, are transferred into the fallopian tubes immediately after fertilization, before they’ve had any time to develop in the laboratory environment.

You say that the woman is 40+ y/o, but you don’t give any additional information. Were they HER eggs used? Had she had previous ART failures? What is the reason for her doing ZIFT vs. IVF?

I’ve actually never known anyone to do ZIFT for any reason. I don’t know why anyone would. I do know people who have done GIFT for various reasons – the primary reason being religious reasons that bar in vitro fertilization, but would permit fertilization to occur within the woman’s body where medically chances would still be greater by going through egg retrieval for whatever reason. Still, GIFT and ZIFT are becoming a far less popular. Many clinics don’t even offer ZIFT at all (and many also don’t even offer GIFT either). Actually, even the people I know who have had GIFT – well, I don’t know anyone who’s had a successful GIFT cycle (and like I said, I don’t know anyone who’s done a zygote transfer at all).

My quick little bit of research with Dr. Google suggests that the “normal” number of embryos to transfer in a ZIFT cycle is between one and four. So five is out of that range, but not significantly. Further, the success rate with ZIFT is approximately 26% and the chance of multiple gestation if you do get pregnant is 35%. My guess is that there’s also a slightly higher rate of ectopic pregnancy with ZIFT than with IVF also, but of course IVF raises your rate of ectopic pregnancy over spontaneous pregnancy anyway.

Frankly, I can’t find a single article via Dr. Google that suggests any reason for doing ZIFT over IVF. Does anyone know? I can understand the reasons for doing GIFT, but ZIFT? It’s more expensive, more risky, less successful, has a high rate of multiple pregnancy when you do have a successful pregnancy (not very often), involves invasive surgery, and doesn’t have the advantage that GIFT has of having fertilization inside the body thereby avoiding the ethical/religious issue that IVF has for some people. So what gives?

Oh! I *just* found one thing suggesting a reason to do ZIFT. ONE! From the Huntington Reproductive Center:

The use of ZIFT is not that widespread. However, at HRC we have leaned towards performing ZIFT on a select group of patients because early on we noticed an increase in pregnancy rates especially amongst older patients and those with unexplained infertility.HRC’s overall take home baby rate for 500 egg retrievals performed for ZIFT is 48%. This elivered rate includes 81 egg retrievals performed on patients over 40 years of age.

The above data suggests that at our center patients who have had multiple failed IVF cycles or who have patent tubes but are older should consider ZIFT/TET as a treatment option. It is possible that the fallopian tube may have the capacity to rescue “marginal embryos” as well as allowing the developing embryos to remain in the tube and then as in a natural pregnancy move into the uterus at the appropriate physiological time for implantation.

At last! A reason!

Okay, so let’s assume this 40+yo woman has had multiple failed IVF cycles and she has marginal embryos. Let’s also remember that the ASRM/SART guidelines for IVF (and I can only assume that they’d be the same for GIFT) for a woman that age is to not transfer more than five embryos in a cycle. So five embryos is within those guidelines.

Would I do it? Would I take that risk? No. But I’m 33, and I already have kids, so it’s easy for me to say, isn’t it? I’ve also had a set of HOMs and I’m flat out petrified of that happening again, but the risk of HOMs in a woman over 40 is much lower, because, frankly, the pregnancy rate is much lower. So I don’t have the same circumstances.

SO… all that being said – I’ll have to assume that this mystery 40+y.o.’s doctor was acting responsibly with her best interests in mind with the best available medical literature at his or her fingertips. And I wish her the best of luck and a healthy SINGLETON pregnancy as a result.

I’m filing this under “FAQ’s” even though, clearly, this is not a frequently asked question.

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