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Archive for April, 2009

Starting Over

CD1
BCPs start Tomorrow
Lupron starts on Day 19
Let the Games begin!

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Hiatus

You’ll have to pardon my brief blogging hiatus. I’m busy reading Mel’s book and saying “Yes, Exactly!” periodically.

That’s far more important than telling you all about the fact that I’ve had what feel like menstrual cramps since the day before my cycle was cancelled, despite the fact that there is no sign of my period (and why would there be? It really shouldn’t be here until at least Tuesday!).

It’s also far more important than telling you about how I said to my husband that I want to run a marathon next year and he said, “Okay” and didn’t laugh at me. I looked at him in shock and surprise and he (being the best husband in the world) said, “I know you can do anything you decide you’re going to do.” I told my friend who actually does run marathons that I was joking about running a marathon next year and she said, “While you’re pregnant?!?” Yeah, um, if only I had that much faith. (That being said, she did say that even wimpy, fat me could run a marathon. Um… she didn’t call me wimpy OR fat… that’s all me… she’s much nicer than that)

But back to Mel’s book. Because really. That’s more important than my bitching about the fact that I have a UTI I can’t do anything about because I can’t get to the doctor or the fact that I hurt my shoulder and the cortisone shot I had in it isn’t fixing it well enough. Because honestly? I’m Lupron-free right now and the truth is, a Lupronless life is actually pretty good!

Happy Reading!

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Suckitude Continueth

Now, honestly, there's a lot of good going on in my life, so don't think I'm not aware of that.   But just in case someone's keeping score…

  • Sam had a 104 (F) degree fever all day Sunday and was screaming like a banshee most of the night that night.  I know a fever isn't really that big a deal, but I took him to the doctor this morning anyway.  Ear infection and a perforated ear drum.  Poor kiddo. 
  • I hurt my shoulder last Thursday, but I didn't think much of it.  But it's not getting any better, and my range of motion may actually be getting worse, so I went to the doc's office this afternoon.  My nurse practitioner thinks there's a good possibility that I tore my rotator cuff.  She's sending me to the orthopedist.  Fortunately, they can see me tomorrow and can even take the xrays IN the office.  
  • I fell asleep pretty early tonight, thanks to the wonders of pain medicine (see aforementioned shoulder pain).  But then woke up rather abruptly in an extraordinary amount of pain in the lower left quadrant of my back.  I also really felt like I needed to pee.  But… I really couldn't much, and it REALLY hurt to try.  I'm fairly certain that I have either a raging bladder infection or a kidney stone.
  • Seth gave me percocet and I fell asleep (bless him!).  I woke up itching all over (side effect of the opiates – this often happens to me.  Now I can't sleep.  But at least I'm in less pain?

That being said, I will say, I have the world's most wondermous husband, and gosh darned cute kids.  I have so much to be grateful for.  I have a nice (though small) home.  I have an amazing support structure when I need it.  I have a terrific community.  I have flexibility, for the most part.    Though things have been harder these last six or so months than I ever really expected to have to handle, I do have to admit, I pretty much have all of the things I ever really wanted – a wonderful loving family, a community (both IRL and in the blogosphere) who supports us when we need them, and stripey socks.

It would be greedy to ask for much more than that, wouldn't it?

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Escape Artist

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Check out that mug shot.  She looks so sweet and innocent, doesn't she?  She doesn't look like a criminal who can escape from a sophisticated prison.  But this adorable little girl… don't let her fool you, she's tricky.  She may be little.  She may be quiet.  She may be cute and cuddly.  But she is an escape artist.

I came home around lunchtime on April 3rd and SuperNanny told me that she wasn't able to let the triplets nap that morning because shortly after she had put them down for their nap, she heard Abby screaming bloody murder.  She went in and discovered that Abby had climbed out of her crib and was hanging on the outside of her crib absolutely terrified to let go, but unable to get back in. 

Gosh, and I had always thought Sam would be the first one out.

I immediately called my friend Michelle, mother extraordinaire to the "trio of terror" as she calls them – adorable triplets who will turn three this summer.  They're gorgeous and sweet, and just recently moved into "big kid beds" after having been in cribs with crib tents for a good long while. 

"Tell me everything there is to know about crib tents."
"They saved my life.  What do you need to know?"
"Are there different kinds?  What should I get? Etc?  I need to go buy one.  NOW.  Abby climbed out of her crib."
"I have one left. Come get it."
"You're an angel.  I'll bring the Starbucks."

Michelle warned me that eventually her kids learned how to unzipper the crib tents.  "But don't worry, it'll take a long time before Abby figures it out!"  It took Abby about three days.  I do not think that's what Michelle meant by "a long time."  Fortunately, Michelle also told me the solution to unzippering – safety-pinning it closed.

And so, this is what Abby's new prison cell crib looks like:

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Morbid Anniversary

It’s odd, because I never think of this. But if my first pregnancy hadn’t ended in miscarriage, I’d have had a two year old right now, rather than three 19 month olds right now. I wouldn’t give my babies up for anything, that’s for sure… but I could have lived without that loss, too.

Ya know?

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Nineteen Months

I typed a beautiful and eloquent post about my kids at 18 months in Word… copied it to my clipboard and saved it… and *poof* it disappeared from everywhere.  No traces of it, not even on my clipboard.  No doubt, this post will be a sloppy attempt at recreating that post, and will not have nearly the finesse of the original.  I hope you'll forgive my clumsiness.

It's hard to believe that so much time has passed since our family expanded.  It was just over two years ago that I learned the news that there were three passengers on board.  It was nineteen months ago that those three passengers made their entrance into the world with their first tiny cries.  I thought the first year would be the hardest.  I had envisioned a life of absolute misery and beyond our ability to cope.  But, although our first year was full of challenges and a lot of hard work, it was nothing compared to the nightmare I had envisioned.  Why, it was downright easy compared to the nightmare I had envisioned!    We not only survived our first year, our family thrived. 

I look at our family today and I am astounded at how far we have come.  From three tiny babies to three toddlers on the go.  From one big brother timidly approaching his little brother in an incubator, to a vroombunctious five year old fearlessly tumbling with his toddler siblings, and complaining when they touch his toys.  I am thrilled with the way our family dynamic has evolved and in awe that it has stayed together through all of the challenges that we face each day.

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The most common question I get these days is, "Well, is it a lot easier now that they're older?"  Wait, what?  In whose world could this possibly be easier?  A year ago these babies weren't even crawling!  They weren't eating real food.  They slept much of the time.  They had simple demands on the world still – eat, sleep, poop, eat, sleep poop… with a little time on the playmat thrown in for good measure.  Now?  They are into everything (especially Ellie).  Now they are running in three different directions at all times.  They have wants and needs and they make sure we know it!  They eat real food, which means preparing three home-cooked meals for them each and every day (something I don't even do for myself!).  They want to be engaged at all times.  They are transitioning from two naps per day to one nap per day, which means their sleeping schedule is erratic. 

Really.  In whose world is this easier?  But it is also incredibly rewarding.

Each of their personalities is truly beginning to shine and they are healthy, thriving toddlers now.  Abby was our last holdout, but she, too, is toddling away along with the others.  At 17 months, she finally gave up on crawling and starting walking.  Six weeks later, she's still so proud of her accomplishment.  The most amazing thing about her walking is that once she started walking there was a drastic reduction in the number of temper tantrums that she was throwing each day.  She used to throw several per hour, but now she's a much happier baby.  She giggles all the time, lifts her shirt to have her belly tickled, flashes her great big grin and brings you toys to play with her.  She works through things that used to frustrate her into a huge temper tantrum and is so much more pleasant to be around.  Walking was her key to happiness!  Obviously she still has temper tantrums, but not with nearly the frequency she used to.  It's awesome.

All three babies were declared healthy at their eighteen month check up.  The pediatrician told me that we can start to shift our frame of thought from thinking of the triplets in terms of their adjusted age as we've been doing up until this point to now thinking of them as mostly typical eighteen month olds with only a few remaining developmental delays.  But they have caught up on the growth charts.  They have caught up with gross motor skills to their actual age milestones for the most part. They are almost to actual age milestones for fine motor skills.  

The only area in which there remain significant delays are expressive and receptive language skills – all three of them are behind even their adjusted age, which the pediatrician noted at their fifteen month appointment and recommended that we have them evaluated by early intervention from the county for speech therapy services, which we did, and they have been receiving speech therapy once a week ever since and they have made such great improvement, especially the girls!  Sam still doesn't say a word, but he's at least starting to respond to his name – which is a great relief.  He had actually been the greatest concern because he responded to his name when he was about a year old – he would look back and make a cute little grunty noise every time he heard his name, but then he abruptly regressed for months.  Last month he started to turn his head consistently to his name again, which makes us all very happy. 

They all have such distinct little personalities and they are really starting to learn how to interact with each other.  Abby, in particular, seems quite in tune with the others' emotional states, even though for the most part she wants nothing to do with them.  If Ellie or Sam is crying, she will go find their loveys (Ellie's are a green bear and a fuzzy blanket and Sam's are the elephant blankets and lately also a lovely knit blanket from a friend of ours) and she will bring the lovey(s) to whomever is crying.  Sometimes Ellie will do the same.  But as in tune as she is to that – she's the one who most consistently steals Sam's pacifier, thus guaranteeing to devastate poor Sammy and leave him screaming in shock and despair!  She is also the most likely to pick a fight with Sam.   But, then, Sam is the most likely to pick a fight with her, too.  They are always fighting.  They are always in each other's space and Abby can't stand when other babies are in her space.   She's going to have a really tough time in life.

Ellie is still, by and large, very laid back, but she's starting to assert herself more, and she does NOT like it when another child takes a toy of hers, or if she always has to wait to be the last for something.  She is also starting to become my pickiest eater.  Until recently, all of the kiddeos would eat absolutely anything, but they are beginning to be more discriminating than that, particularly Ellie.  She is the least likely to try new foods and the most likely to reject foods, even if she's eaten them in the past.  Still, she does love her food, and when she wants food, she makes it known.  Her first word was "cracker" and she makes it very clear when she wants her beloved crackers!  Also she asks for cups (either water or milk cups) when she's thirsty.  She is quite clear about her desires and gets upset if you're eating something that she wants and you're not sharing.  It's nice to see her asserting herself more; I would have hated to see her getting walked all over forever.  Still, she is still her loving, giving self.  She loves to share – she will bring you her toys and share them, or even her crackers and cups.  She expects you to share right back, of course, but she's all about the sharing.

Sam is still a bit of a brute – but it's not malicious, he's just completely unaware of physical space and the fact that there are other babies in that physical space.  He is, by far, the cuddliest of the three babies, though, so I know he's got a loving soul.  Though Abby is the one that likes to be held the most, I'm certain this is largely because she's trying to get away from having other little people in her space.  With Sam, he likes to snuggle right into your space and be held.   But he's also very busy, so after he gets his snuggles, he wriggles right back out and goes back to the business of playing.  It's serious business, you know. 

Sam just started liking cars and trucks and the girls just started noticing baby dolls and purses.  It's really cute that they're starting to notice that there's a difference between boys and girls, but it does make things more complicated for mommy!

The J-man is still an exceptionally good big brother, and about as patient as you can expect a 5 1/2 year old to be with three intrustive toddlers.  But the strain of being a big brother to three 19 month olds is definitely starting to get to him.  He's starting to notice that they like to get into his stuff and they like touching his things.  Which, you know, is kind of his fault.  I mean, they can't get into his room (there's a baby gate blocking their entrance into his room), so if he'd stop leaving his toys all over the living room, they'd stop touching his toys.  But I know it seems unfair to him that they touch his things.  So we try to find ways to let him keep things private.  He also seems to think that the babies have a lot more stuff than him.  Which, um, I have to say, isn't quite true.  First of all, a lot of the stuff they have is hand me downs from him.  And second of all, um, hello?  Have you SEEN how much stuff he has?  Plus, there's three of them and one of him.  But if he gets 10 toys for, oh, say, Passover, and they each get one, he thinks they get one, he thinks they got more than he did.  It's a hard life.  Poor kid.

I'm sure this isn't the end of them annoying him, but I'm also sure there will be more stages of happiness and joy.  I can't wait to see how their personalities emerge.  Seth said he hopes that Sam's and Ellie's personalities stay much the same and that Abby learns to chill out a bit.  Just as he said that, she started to shriek because one of the others looked at her funny.  Or something.  I wouldn't count on her chilling out anytime soon.

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 Ellie and me at Jessica's house.

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Abby

IMG_3579   
Sammy

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Not So Bad

You know, cancelling the cycle was probably for the best.  I mean, I didn’t want to be really pregnant in the middle of summer anyway, right?  My new schedule puts my transfer in the second week a June – a lifetime away. 

So much can go wrong between now and then.

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Thanks to all for all your kind thoughts and well wishes. I’m fine. The decision to cancel this cycle was a mutual decision between my doctor and myself. He would have been okay with pushing forward if that’s what I had insisted upon, but that’s not a position I want to be in, especially with coverage running out with my insurance.

Several of you said it seemed so sudden given how well things seemed to be going… but that seems… odd to me, because the thing is that nothing had gone quite right yet. My Lupron Evaluation wasn’t where they really would have wanted it, with my estrogen nearly double what it should be (mine was 89 vs. optimal should be under 50), but they let me go ahead anyway because it just seems to be what I do these days.

Sunday’s monitoring appointment was… okay, but not brilliant. Four measurable follicles? (and a bunch of others that weren’t measurable yet.)When supposedly the greatest risk for me with IVF is OHSS? Last cycle after a few monitoring appointments, I had what looked to be four, maybe five follicles that were promising (but also a definite lead follicle that they were going to let fall off) and several others that had some possibility of catching up. We ended up with 10 in the end, but nothing to freeze after an eSET. The goal with this cycle was to have increased the medications such that I would have a much more significant response with the stim cycle and have 14-15 follicles growing from the start (no more than that). That would have given us more to work with.

So when I went in on Tuesday for more monitoring, I had 5 measurable follicles, and while they were definitely growing – there weren’t any others to be seen. Five. And while I tried to push my anxiety aside, knowing that I’m not the doctor and I didn’t have all the information in front of me… five isn’t… what we were looking for. I usually had more than that at this point in an IUI cycle and this is usually where they started talking about whether or not some were going to behave and drop off or whether I was going to have to cancel my IUI cycles. And that was on 1/3 of the doses of Follistim (but no Lupron).

I typed a long, long, long, long post to finish this all off…. and lost it. As I highlighted the post to copy it to the clipboard before posting it (just in case), it disappeared. This was as far as blogger saved it. I frickin’ hate blogger. I’m not going to try and reconstruct the whole thing. I’ll give you the cliffs notes version.

SuperDoc called me in the afternoon. Never a good sign when it’s the doctor that calls rather than my nurse. I told him so and he agreed. He said that he’d been hoping some of the smaller follicles from Sunday would have caught up, but they’ve disappeared, and we’re left with 4, maybe 5, if we’re lucky. Last time we had the same thing at this point and we got 10, but he said last time was a slightly different situation where we were seeing 4-5 plus a bunch of smaller ones and I had a definite lead follicle that they just let fall away. This time I have a maybe lead follicle, but possibly not, and no smaller follicles anymore. Odds aren’t looking so good that I’d have another 10 follicle retrieval in this case. Plus, the goal had been to get a 14-15 follicle growth cycle this time, and we’re not there.

That being said, SuperDoc wasn’t jumping to cancel. Yet. He said with this cycle, he’d give me a 30% chance of pregnancy. If we’d gotten the optimal cycle he’d been hoping for, he’d give me closer to 50% chance, and he didn’t think that differential necessarily warranted cancelling in and of itself. He said he didn’t want to test my patience by cancelling again after having already had one failed IVF and one cancelled cycle. But… to me, that’s not a good enough reason to move forward. So although he was leaving it up to me, I ultimately left the decision up to him. I wanted him to make whatever decision he felt was the right decision, medically. And he said that if I was giving him a mandate to maximize the possiblity of success, particularly given that I have only two cycles covered under my insurance left, he felt that the best thing to do would be to cancel. So that’s what we did.

As for moving forward….

I took the hCG trigger Tuesday night with dire warnings not to have unprotected intercourse, lest I end up with twins (or worse). Got it. I should expect my period in 2 weeks or so. I will start a 21 course of birth control pills (whoopie). I will start 20 units of Lupron on Day 19 and will continue with 20 units of Lupron after I start stims. I’ll take 225 units of Follistim and 75 units of Luveris.

I told him I wasn’t trying to play “back seat patient” but wanted to know whether there would be any advantage to trying the antagonist protocol.. He said no. He would use Ganirelex if he absolutely had to, but that in my case he believed that it would, in fact, put me at a disadvantage. He believes it would produce a worse cohort of follicles and would give far less control over the cycle. Though it may be testing everyone’s patience, he assured me that they are learning more and more with each cycle that passes with me. The problem is that they are walking a very fine line with my “goldilocks ovaries”… too much and I’ll hyperstim, too little and… well, I get cancelled, because it’s just not worth doing all this for so little again. But hyperstimming isn’t anyone’s goal – the last thing anyone wants is to see me in the hospital getting liters of fluid removed from my abdomen, right? Of course right. So caution is good in this case.

By the way, he took me being a back seat patient really well. I prefaced my question with a big huge caveat about not questioning his knowledge and that I would NEVER bring it up if … well, anyway, so he said to please feel comfortable asking anything I wanted and I did ask about the antagonist protocol and he gave me his very thorough answer (which I’ve only paraphrased here). And I told him that was totally fine and I reiterated that I was NOT trying to be a back seat patient and he said, “It’s absolutely fine. When I’m 0 for 2, it’s a perfectly justifiable time to ask if a different approach would be appropriate. But I do think that as long as you think that your patience isn’t being tested to much and you think you can hang in there for a bit, we are getting there.”

And I believe him.

I just.

You know, this IVF thing was supposed to be “easy.” I was supposed to be doing the IVF thing not because nothing else worked, but because IUI worked…. too well. And… now I’ve had one failed cycle in which not a whole lot went right aside from a retrieval that went a million times better than we expected. I’ve had one cycle that got cancelled before I even got to stims. And one cycle that got cancelled after stims, but before retrieval. This was supposed to be “bada-bing, bada-boom, you’re pregnant.”

But now? Now I’m the interesting patient he uses as an illustration to his interns and fellows (no, really! I’m serious!). I don’t want to be interesting. I want to be textbook boring.

Since I started my original IVF#2, nearly all of my original cycle buddies on cyclesista have finished their cycles and gotten their results (many of them BFPs!). And in that space of time… I’ve had two cancelled cycles. Heh. Well, just time to move on to the next one, right? In about five weeks.

Now what to call the next IVF… IVF #2 (take 3)? Or just scrap it all together and call the next one IVF#3?

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And… Cancelled

Cycle cancelled.

More details to follow later?  Maybe? 

 

The last days of Pesach start tonight so I’ll be offline for a couple days.

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After being up far too late last night, I dragged myself out of bed this morning to go to Ye Olde Fertility Clinic. It wasn’t easy, let me tell you. But I checked my email first and discovered that SquarePeg got two lines yesterday! So that was the first sign that maybe today isn’t going to completely suck!

And then I managed to get out of the house on time (with a shower, even!), which was the second sign of the apocolypse that maybe today wouldn’t completely suck.

Despite the fact that it was raining, I managed to make it to YOFC without too much trouble and I arrived at my appointment on time. (Third sign of the apocolypse, perhaps? Nah. I’m usually very punctual.)

I had a very short wait before I was called back by Dracula (definite sign of the apocolypse AND that today would not totally suck – I should have *known* that today was not going to totally suck). They drew my blood without too much trouble. Apparently I hadn’t had enough to drink, so it wasn’t easy but they managed.

When she was finished, she said, “I’m afraid you’re in room 1 again today.”
“Fine. No mobile in there, still, right?” I sighed dramatically.
“No, I’m sorry.”
“You know, Dr. S. and I are going to have a TALK, he and I.”
“I know…”
“Don’t think I won’t!”
“I’m sorry! They said they ordered one…”
“What. Ever!”
I stalked off to room one (jokingly, of course – it’s not HER fault!) and walked into Room 1.

And.

I looked up.


And I let out an ENORMOUS SHRIEK of Delight!

“SURPRISE!” she shouted!

Ohmygosh, HOORAY!

For three, count ’em, THREE years I have been petitioning for that mobile. I put myself out there in the public eye for that mobile! I waited for two and a half months after those embarrassing television interviews for that mobile to appear! I have endured random people who I never expected to have seen the evening news (I mean, really? WHO WATCHES THE EVENING NEWS ANYMORE??) come up to me in all sorts of places and say, “Hey, I saw you on TV talking about that fertility thing!” to get that mobile!

And it was worth the wait, ladies. WORTH THE WAIT.

The picture was taken with my cell phone, so it doesn’t do that beautiful mobile any justice at all, but it is gorgeous, really gorgeous.

I snapped a photo of it, disrobed, hopped up on the table, and while I was waiting, I emailed it to my husband with a simple note: “Hooray!” The message was still sending when M (sonographer extraordinaire) and Dr. S. walked in the room. I was still elated and overflowing with joy at the sight of that beautiful mobile. Dr. S. truly outdid himself. He told me he didn’t care if it took two hours that morning, I wasn’t getting any other room today, I was getting room one! Oh yeah, baby. Oh yeah.

As for today’s monitoring results? I dunno. Dr. S. says I’m on the every day plan, now. My lining was 10.1. On the left, I’ve got a 16.3 and a 15.2. On the right, I’ve got a 17.7, 12.6 and a 10.4. My fears of a lead follicle are evaporating, thankfully, but there’s nothing else to be seen. And I feel like – the whole point of shifting around protocol this time was to avoid another scenario where we were looking at 4-5 follicles at this stage of the game. I know I’m being greedy. And I know last time we were looking at four and ended up with 10, so all is not lost yet. But this is my 2nd of 3 tries at this clinic and then I’m done. I’m feeling anxious about it, even if I know it’s unfounded. Better not to worry until I hear what my E2 and LH are, which I should know later in the day. I’ll keep you updated.

Meanwhile, I feel like I have finally accomplished something. Now, all women who come after me to Ye Olde Fertility Clinic and are in the Stirrups in Room 1 will have something pretty to look at. And maybe, just maybe, that will ease their anxiety just a little. I feel like I did something for many, many infertiles to come. 🙂

At least, I hope I did.

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