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Archive for June, 2009

I’ve had a really hard time with this cycle, and Barren just “gets” it when a lot of other people just… don’t. I feel guilty about it, to be honest. I feel like I should have an easier time dealing with infertility by now. I’ve been there, done that. More importantly, I’m on the other side of it. I’ve got a beautiful family, as many people feel the need to remind me. Often. As if that means I should simply be satisfied and be done with.

And yet – I have not resolved my infertility. I have not come to terms with it. Every setback, every failure, every loss this time around hits me as hard, maybe harder, as the first go-around. I think this is partly because this time was supposed to be “easy”, or as easy as IVF ever is. And what we’ve found is that things just aren’t as straight-forward as we thought.

The point is, Barren gets me. She doesn’t try to placate me with “it only takes one”[1] and other such platitudes. She doesn’t tell me I’m being ridiculous. She doesn’t point to my children and suggest I should be satisfied with what I have. She recognizes that the pain I have the second time around is just as real as the first time around. She tells me to stop apologizing for complaining at her. She brings me wine so we can whine over wine together.

So I suppose it should have come as no surprise to me when a beautiful, flowery package arrived in my mailbox today, and I saw that it was from my wonderful friend. I opened it up and found this:

The note made me a little sniffly and teary eyed, and though I haven’t asked her permission to reproduce it here, I’m going to take a gamble and do so anyway:

Dearest Perky,
Thank you again for your friendship and generosity. I hope that someday soon I will have the chance to return the kindness with more than a bottle of wine and the ability to eat your delicious dinners.
I know you aren’t feeling hopeful about this cycle, but if a tiny bit of hope (or
curiosity) creeps in, I want you to be prepared.
Love,
Barren

I knew what would be inside the beautiful, dragonfly wrapping [2] paper, but I burst out laughing when I opened it up:

Thanks, my friend. Laughter truly is the best medicine. I don’t promise to use those lovely (but very tempting) tests. But I promise to pass them back to you if I don’t. Or maybe use them next cycle when I can muster up the hope to think it’s worth wasting a precious FRER.

Barren, you truly are the best person in the entire universe. So… dinner Thursday? 😉

———————
[1] Coming soon: a Barren-inspired post on the “It Only Takes One” math and how flawed it truly is.

[2]How did she know that dragonflies are one of my favorite things in the universe? I swear she and I are just the same person. Except she’s way cuter and always has an adorable pedicure, and I’ve never had a pedicure in my life.

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Because it’s fun for me, every time my husband is trying to annoy me (even jokingly), I say, “No! You can’t do that! I’m gestating!” And I melodramatically throw myself down on the couch, clutching my abdomen protectively, to ensure the safety of our precious morula.

All joking aside, this exchange belies my true feelings about this cycle. Usually, I’m skeptical that a cycle could have worked, but there’s always a piece of me that can’t resist interpreting every twinge, every smptom, every sign. Usually, even though I won’t say it out loud, there’s a piece of me that is shocked when I inevitably cave, pee on a stick, and see a sea of white where there *should* be a second line. Even in my sixth IUI, when no one, not even my doctor, thought it was going anywhere – the cycle that was doomed to fail (but resulted in an HOM pregnancy instead) – even then, I thought there was a chance, even though I wouldn’t admit it out loud.

But this time I simply cannot wrap my brain around the possibility that this cycle has any possibility of ending well. I don’t have even the smallest bit of hope. SuperDoc is heading out of the country for 2 1/2 weeks, and he’s leaving before my beta happens. I’m devastated by this, which is ridiculous, but there you go. I never claimed to be rational, and I’m sure the copious amounts of estrogen and PIO aren’t helping matters. Anyway, I’ve made an appointment for a follow up consult with SuperDoc for the first week of July – right after SuperDoc gets back. I figure that way we can talk about where to go from here, because clearly something’s gotta give.

Sigh.

I hope I eat my words, but I just… I’m not counting on it. I’m really not asking for platititudes. I can’t handle them, really. they won’t make me feel better. All I need now is to just … get from point A to point B.

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I know it will shock you all to hear this, but… none of my little buggers made it to the freezer.

I’m … well, I suppose on one level I am upset that I can’t seem to make decent embryos (though I do know that my clinic has really high standards for freezing embryos). But on the other hand, I’m incredibly relieved that I’m not being faced with a $1300 cryopreservation bill that I really don’t have the money for right now.

Well, you know? I suppose there’s always the possibility that George, Jr. will just stick around and this will all be a moot point, right?

Um. Yeah.

My buddy Barren asked when I start peeing on sticks. I hope I don’t. I’m just not sure I can deal with the neurosis, the hope, the devastation, the rationalizing, the maybes (maybe it’s too early, maybe it’s a dud stick, maybe I should try another brand, maybe, maybe, maybe).

I’m sure I’ll cave. I have, after all, a pile of the internet EPTs in the bathroom cabinet. How could a girl truly resist?

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Couple Quick Things:

1. I am still angry about the doc yesterday. I thought I’d be over it by now. I clearly gave myself too much credit.

2. No, I have no idea what’s going on with email subscriptions, bloglines, google reader, or my feed in general. I’ve even tried re-burning the feed all together and that hasn’t fixed the problem either. I’m about read to ditch Blogger all together and just use my defunct WordPress Account instead. Blogger seems like more trouble than its worth – especially as related to privacy, since you can’t password protect things (esp. individual entries) – you can only privatize the entire blog and then you’re limited to 100 readers, which is why I opened my blog back up.

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The phone call from SuperDoc on Day 4 explaining the outlook and the options. The apologetic tone in his voice. The determination to push forward. The sense that maybe things aren’t quite as perfect as he’d like them to be. I feel like I’ve lived this life before. I’ve been down this path, I know where it leads, and it doesn’t lead to the perfect single embryo transfer on Day 5.

In fact, that’s pretty much what SuperDoc told me this morning. Things looked “great” on Day 2, but apparently not so great on Day 3, and even less so on Day 4 (today).

Embryo #: Day 2 Report: Day 3 Report: Day 4 Report:
1 2 cell, no fragmentation 4 cell, no fragmentation 6 cell
2 2 cell, no fragmentation 4 cell, no fragmentation 4 cell, no change
3 2 cell, no fragmentation 4 cell, no fragmentation 6 cell
4 2 cell, no fragmentation 3 cell, 15% fragmentation 8 cell
5 4 cell, no fragmenation 4 cell, no change 4 cell, no change
6 4 cell, no fragmentation 4 cell, no change 7 cell
7 4 cell, no fragmentation 4 cell, no change 4 cell, no change
8 4 cell, no fragmentation 6 cell, uneven growth compacting embryo

Note, SuperDoc gave me no information about fragmentation – but said that the embryo quality today wasn’t nearly as promising as he’d hoped. He believes that we’ll likely have a [singular] good quality blastocyst to transfer – but he thinks it is unlikely that we will have it by tomorrow and that I’ll more likely be pushed to a Day 6 transfer.

This seems to be a chronic problem of mine – the slow growing embryos. This is the same thing that happened to me last time, essentially. By Day 4, I should pretty much be looking at morulas. I should have had 6-8 cells on Day 3. The reason that clinics don’t do Day 4 transfers (usually) is that it’s difficult to differentiate quality between morulas, so they let the morulas mature to blastocysts by Day 5. But it’s unlikely that my almost-morula (Embryo #8) is going to be a blast by tomorrow (Day 5). It’ll need the extra day. This is the same thing that happened last time. I did end up with two blasts on Day 6 (none on Day 5), but one was clearly the winner. None of my 9 embryos in IVF#1 made it to freeze. None. It is unlikely that any of these 8 will either.

So what do you do about slow-growing embryos? Not much. According to Dr. Licciardi, from NYU Fertility Center, they really don’t know what to do about it. They’ll try different things in the protocol to see if it fixes anything, but they never know whether it was the change in protocol that fixed the slow growth issue, or whether it was just luck. Probably just luck.

Since we’ve always known that PCOS isn’t my sole issue with getting (and staying) pregnant, it makes me wonder whether my slow-growing embryos contribute to the issue. But then again, maybe they’re only slow growing in a lab. This is one of those places where the science is simply too immature to help answer these questions. We just don’t know. So we keep trying.

I have long said that I am grateful to live in a time when the science and the medicine have reached a point that I know, with a reasonable degree of certainty that I can get pregnant with assistance. I went through five years of infertility, countless monitored cycles, 11 medicated cycles, 6 IUIS, and a late miscarriage before having my beautiful babies. But a hundred years ago, even fifty years ago, I wouldn’t have been able to push through all of that knowing that there was always a next step available to me. There just wouldn’t have been options (regarding getting pregnant, that is), period.

I am incredibly grateful that I live in a time where the science and medicine are so advanced. But I think it bears noting that we are still in the (pardon the pun) infant stages of this research. We have so far to go before we really understand how a lot of the embryo development works. How and why certain embryos are more likely to implant than others. Why, in the absence of chromosomal abnormalities, killer cells, a clotting disorder, etc., recurrent miscarriages occur. It is important to recognize and appreciate how far we have come … but also to recognize how far we have to go to ensure that our sons and daughters, grandsons and grandaughters, friends and families have less heartache and more hope.

I have hope that we’ll have a little George, Jr. on Day 6 this cycle. And that George, Jr. will want to cozy on up and stick around until 40 weeks gestation and make his or her appearance into the world. I have hope that this will be the case.

But I am also making plans. A girl needs to make plans, you know. I’m making plans to start my next cycle in August. It will be my last covered at YOFC. I wonder whether I’ll need to use the category, “IVF#3” in my blog posts. I hope not, but I’m making my plans, just in case, because that’s what I do.

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So you know how when you’re giving an IM shot, you’re supposed to pull back on the plunger to see if you get any blood in the syringe before you shoot yourself up with the contents of said syringe? And you know how you always think that it’s a stupid thing to bother with because after 47 shots, you’ve never ever had any blood appear in the syringe, so what’s the point?

Well, so tonight, my husband was giving me my PIO, and he pulled back on the syringe and I wasn’t even paying attention and he said, “Oh, I got blood, I’m sorry.” I thought he was done with the shot and he just meant I was bleeding from the shot. Nope. He meant there was blood in the syringe.

“Okay, well, I think you have to take it out and we’ll start over.”

I don’t know – is that what you’re supposed to do? I think so. Isn’t that the point of finding out if there’s blood? I think so. I honestly can’t remember. See, I’m in a lot of pain right now (I have a migraine plus I think I need a root canal, but who has time for that?) so I’m drugged and tired, so I can’t really think straight.

So he pulls the syringe out of my derriere and says, “And now there’s blood on the floor.” I handed him a piece of gauze. And then another when that one wasn’t enough. He handed me the syringe which… wasn’t reusable. Or maybe it was, but gosh there was a lot of blood in it. I don’t know, can you use it again? I’m thinking no, but I dunno, who knows. I’ll ask my nurse tomorrow.

So while my husband is trying to get me to stop bleeding, I drew up a new dose of PIO. And then he successfully gave me the PIO without incident. Whew.

Um. So does anyone have any ideas about how to get blood out of beige carpet?

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Here’s what my Embryos look like today compared to yesterday:

Embryo #:

Day Two Report

Day Three Report

1

2 cell, no fragmentation

4 cell, no fragmentation
2 2 cell, no fragmentation 4 cell, no fragmentation
3 2 cell, no fragmentation 4 cell, no fragmentation
4 2 cell, no fragmentation 3 cell, 15% fragmentation
5 4 cell, no fragmentation 4 cell, no change
6 4 cell, no fragmentation 4 cell, no change
7 4 cell, no fragmentation 4 cell, no change
8 4 cell, no fragmentation 6 cell, uneven growth – not looking great.

So … pretty good. We can probably say goodbye to #4 and #8. But that leaves us with 6 embryos with good potential. There’s some concern about #’s 5-7, but they still have time to continue growing. Embryos 1-3 had a slow start, but they clearly got the message that they should get a move on. I’ll get a call tomorrow with more news and a time for Saturday’s transfer.

And then on Saturday I’ll probably get a call moving my transfer to Sunday, just for kicks. 😉 I told that to my nurse while saying, “I hate to be such an optimist and all, but…” and she said, “Yeah, but you know, when you’ve been around the block a few times, you know how this works.” It’s all good. So far, the news is far better than IVF#1’s embryology reports were. Why, these are downright positive embryology reports!

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Things are looking up. My day 2 embryology report in IVF#1 was not promising at all. One of the reasons I was concerned that my fertilization report this cycle wasn’t as good as the fert. report with IVF#1 despite 40% more eggs retrieved was that I was concerned that I’d be facing the same fast attrition that I had faced with the subsequent embryology reports. But, so far, my fears appear to have been unfounded.

Today’s embryology report revealed that I have four 4-celled embryos and four 2-celled embryos. There is no fragmentation in any of them (unlike IVF#1).

So I’ve been moved to a Day 5 transfer.

Shabbos. Of course.

So I have to figure out the whole, you know, getting to the clinic on Shabbos thing. AGAIN. But other than that, I couldn’t be more thrilled.

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