Archive for the ‘Infertility’ Category

Jul
01
Filed Under (Infertility) by catharine on 25-04-2007

Again, we’ve been silent on the subject of our IVF–sorry.  It’s just that it takes me a while to grasp concepts.  We started getting positive HPT’s (home pregnancy tests) on the Saturday after our egg retrieval, but we didn’t realize that until Sunday when they were undeniably positive, and still didn’t really accept it until Tuesday when we had solid beta evidence in the form of an hCG (human chorionic gonadotropin, a.k.a. the pregnancy hormone) level, 95!  That sounded good to me, and based on all my extensive research (www.betabase.info) we were average–right at the top of the bell curve.  Of course I would have prefered to be above average, well over the bell curve, but finding ourselves right in the midst of the longest line on the bar graph had its own reassuring qualities–we were in the majority, among good company, normal.  All was good despite our over-achieving perfectionistic tendencies which we now try to hold in check in a perfectionistic way that says, we will be the best recovered perfectionists there are!  Thank you very much, cognitive behavioral therapy.

From what I understand, in a normal pregnancy, normal women the western world over buy an e.p.t, get a positive test, joyfully call their OB/Gyn’s and are told to hold their horses and come back in 8-12 weeks, during which time they blissfully and ignorantly progress through their first trimester, hopefully.  Those of us who required a little extra assistance getting here are considered “at risk,” however, so after the initial pregnancy test at the equivalent of 14 dpo (days post ovulation), or 9dp5dt (9 days past 5 day transfer) in my case, they bring you back for a second test two days later, 16 dpo or 11dp5dt–are you catching on to the lingo?  They want to check the doubling time.  Wherever your hCG starts, it is supposed to double every 48-72 hours until it reaches a certain point (far above where we are currently) when it slows down a bit. 

This is how they monitor the health of the pregnancy–or so they say.  What will they do if they discover something is wrong?  Nothing.  So why monitor?  To increase the stress level of the parents, apparently, while continually asking them things like “are you taking it easy?” and “are you staying calm?”  “Cramps you say?  Well, you are drinking enough, aren’t you?  How many glasses of water did you have yesterday?”  Translation: “Oh, that’s bad–it’s probably you’re own fault, though–if you miscarry it will be because you didn’t drink enough water.”  Needless to say, I am not calm.

So, we went back to Houston, another 5-hour round trip drive, to get a few ounces of blood drawn (again, you get what you pay for), and learned our second beta was 163.  Here, I need to back up.  Even though everything in print says doubling time between 48-72 hours is normal, all you ever hear is that 48 hours is the standard.  So, our doubling time was 61 hours.  Again, off I trotted to my on-line encyclopedia to discover that we had dropped one standard deviation below the curve on the bar graph.  We took a few soothing deep breaths to quiet the perfectionists within that were screaming “Not good enough!” and told everyone what the nurse told us on the phone: “Our levels doubled adequately.”  And we waited for the third blood test….

Here we are, five days later, and we’ve had our third and final hCG.  Like all over-achievers the world over, we had calculated what we needed to get on this hCG ahead of time in order to meet our 48-hour doubling goal–the very thing I tell my students not to do–it’s about learning, not the grade!  Well, anyway, I won’t tell you what we calculated because it was ridiculously different from what we got, 556.  Our doubling time is now 68 hours–a little too close to the 72-hour cap for our comfort.  The conversation with the nurse went something like this:

Nurse–Hi, your beta is 556.
Me–Oh, that doesn’t sound so good.
Nurse–It’s good–it’s supposed to double every 48 hours. It’s increasing and that’s good.
Me–But it’s not doubling every 48 hours.
Nurse–Yes, it is.
Me–No, it’s not.
Nurse (getting snippy)–Look, when were you in last? The 26th? What was that, 4 days ago?
Me–5.
Nurse (sounding annoyed like she’s explaining a very simple concept to a child)–OK, it was about 160 on the 26th, so it should have been 320 on the 28th, then……(long pause)….um, 640 on the 30th….(another pause as she apparently does the math)…okay, so it’s not doubling, but it’s rising…(another long pause) …..rising is still good…..it’s not rising at 60%…..so it is rising slowly.   
Me–Is that bad?
Nurse–We can’t tell you why it’s increasing slowly. You’ll have an ultrasound next week and can find out what’s going on then. Call us if you have any questions, okay? 
Me–um, okay…..thanks.

So, once back at the ranch, off we trot to the internet again….now we’ve slipped quite low on the bell curve–in fact, we’re well below average at this point.  But, we are still pregnant.  Hopefully our offspring, who should look something like a trilobite at this point, is simply trodding his own path.  This article says that 75% of women with hCG levels similar to mine at 16 dpo continued their pregnancies.  We’ve had far worse odds in the past–in fact, those are the best odds we’ve ever had–but, I’m jealously eyeing the over-300 crowd, all of whom are apparently destined to continue their pregnancies. 

Anyway, who am I to complain?  We are pregnant and have a chance many don’t, and our results put us in the you-have-no-right-to-complain category in IVF land.  I know I am not feeling the same stress as those who have no frozen embryos, particularly those who know they aren’t likely to be able to make more.  However, please stay tuned for the results of the ultrasound next week, when we should see a heartbeat.  This will place us in an entirely different category where, according to this slightly less reputable article, we will have a 96% chance of continuing the pregnancy. 



Jun
16
Filed Under (Infertility) by catharine on 25-04-2007

A lot has been happening this past week, and I haven’t had a chance to post about any of it, although I’ve sent and received so many e-mail this may all be old news to you already.  So, as the title of the post implies, I am relieved to report that I am not in fact an old hag as I had feared.  My ovaries heard the battle cry and rallied rather triumphantly, and last week they drugged me silly and retrieved 33 eggs!  I was a little surprised to say the least.  I’m not an expert and am sure there are others who’ve produced many more eggs than this, but that’s a lot of eggs!  But, let me back up and fill you in since our last IVF lesson.

The original plan for us, since we were “unexplained” (yes “were”–stay tuned for the exciting conclusion), was to give me twice the normal dose of drugs to start with and then do ICSI (intra-cytoplasmic sperm injection).  In normal IVF, they just put the eggs and sperm in the same room, let them spend the night together and sort it out for themselves–this is like normal dating.  You go to the bar, meet someone, have a conversation, decide if he’s worth a second date, and nature takes its course.  With ICSI, the whole process is more like using match.com.  The embryologist looks through the super-powered microscope and picks out a likely candidate, wacks it over the head to stop it from swimming, and injects the poor sap unawares into the egg, where, against his will he becomes a father.  I don’t think match.com works exactly like this, but stay with me here as I expand the analogy.  You see, if they didn’t wack the little dude over his head to stun him before they injected him into the egg, apparently he’d still be swimming around in circles inside the egg the next day just happy to be where he was but not having actually done what he was there to do because he wouldn’t have had to work his way through the shell on his own–you see where this is going, don’t you ladies?  All that stuff about free milk and a cow that our grandmothers told us is actually reflected at a basic cellular level!

So, as I said, they drugged me up to retrieve all those eggs, and I’m proud to report that it takes quite a bit of anesthesia to stop me from talking.  I know you’re not surprised to read this.  As I came to, I discovered I’d been having a very interesting conversation with nurse Lisa about how she could have been my mom had she been a ‘ho’ in high school because she was just 16 years old than me–I recall that this was her observation, but Cliff recalls it differently.  However, he’s had surgery before and we know he’s a light weight, whereas I was told I should join a drinking contest, so I’m sticking with my version of the story for now. 

 In the process of retrieving these eggs, they also discovered that I have “chocolatey cysts” on my ovaries, or endometriomas, which is endometriosis. I don’t know much more about this other than the fact that this is now our diagnosis.  Apparently my ovaries have been “corrupting” my follicles all along.  Have you read Plato’s Apology? This is a looooong stretch, but in my drug-induced state receiving this news in recovery, I could only think about Socrates being put on trial for corrupting the youth, but that’s really where the similarities end with that train of thought.

Anyway, of those 33 eggs, 24 were mature, and after submitting their bios to the ICSI version of match.com, 14 fertilized.  This is also a lot.  I don’t know how much in a technical sense, but it’s more than we were prepared to deal with.  Over the next several days Todd the embryologist called to report on their progress, how they were behaving, getting along with each other, that sort of thing, and of course, as everyone believes of their own offspring, our embryos are all above average, ready to negotiate peace in the middle east and all that.  So on Sunday, they put back two embryos, and ultimately we froze 11 of the 12 others.  One petered out and didn’t make it to blastocyst stage, so ultimately, we’ve ended up with a bakers dozen!  Did I mention that was a lot?!

My family is talking about a football team, my husband is shaking his head and muttering things about me being the one who wanted a big family, and our embryologist, Todd, (Todd who apparently came of age in the 80’s and embraced this decade fearcely) continues to speak to me in his monotone with AC/DC blasting in the background telling me that our results are impressive, although his voice communicates anything but that he’s impressed.  But then I’m fairly certain I mooned Todd just as they were injecting me yet again with valium at our embryo transfer, and he’s probably just concerned for the future welfare of our potential children because I inisted on continuing to talk with him while they were doing the transfer–just let them try to put me out with injectible meds.

Todd: “Of your 12 remaining eggs, we froze 11.”

Me (fighting valium): “What happened to the other two?”

Todd: “11 of 12 made it to blastocyst stage; and we froze 11 of 12.”

Me: “Oh, what about the other two?”

Todd: “What do you mean?  We froze 11 of 12.”

Me: “There were 14 eggs, what happened to the other two?”

Todd: “They’re putting them in you.” (this, delivered dead-pan)

Me: “Oh, right–yeah, that’s right.”

Cliff: “Shhhh, babe, just be quiet.”  Like I was impaired or something by the valium–phhft! 



May
24
Filed Under (Infertility) by catharine on 25-04-2007

So far so good with the Lupron–I have not cried uncontrollably at Weather Channel commercials that imply children may be swept away in their school buses by uncontrollable floods, nor have I fantasized at length about taking my husbands golf clubs and pounding a hole in the livingroom wall (I didn’t do these things while on Clomid last year, but someone I knew did, and it sounds terrible, doesn’t it?  poor girl–I feel sorry for her.).  I’ve even managed to stick a needle in my stomach every day for the past three weeks.  It doesn’t seem to be getting any easier–it doesn’t feel “normal”–but I manage to do it without much delay, so I feel triumphant.  I could be an IV drug user if I wanted to be, and now that I know I have that option, well, it’s just one less barrier.

You see that I put quotes around “normal” above.  This is because I have learned that infertility (IF) treatment has probably forever altered my perceptions of certain things.  What I used to find romantic has been forever altered–or at least expanded to include scenarios that formerly would have solicited only pity.  An on-line acquaintance told a story about her husband’s recent experience in the “collection room” that brought this into sharp focus for me.  The “collection room” is probably the sole reason the Vatican denounces IVF, but I think others have explained it better than I could since it’s primarily a man’s domain, so if you’d like a first person account, I’d suggest this one.  In fact, I recommend the entire blog–but let’s not get off topic.  So, the collection room is the obstacle course all men in infertile couples must successfully negotiate, and apparently it’s not as easy as it sounds.  Actually, this makes me happy.  I like to think that most men’s sexuality has more depth and substance than a 6X6 dingy room with a few used articles of porn.  That entire scenario seems like a cross between thirteen-year-old boys finding a stash of someone else’s Penthouse magazines in the bushes of some undeveloped housing project, and what I imagine is going on inside those tin-sided, windowless XXX-buildings that are tucked away in the trees off the side of the highway, miles away from everything else.  I assume the boys and men in these scenarios are hoping for something more, someday, and since the men in infertility clinics have presumably achieved this for themselves, I can imagine their chagrin. 

This is partially why my on-line friend’s story struck such a romantic chord with me.  They had arrived at the clinic separately, and he had been ushered into the infamous room to do his thing when she got a series of desperate calls from him–was she on her way, how far off, could she hurry up, he needed her, Now!  She arrived and attempted to be directed to him quietly, but the nurses in andrology labs are a unique breed–they’re hardened, caloused if you will–in fact, don’t date an andrology lab nurse–they ask painfully blunt questions without lowering their voices or batting eyelashes–they don’t even blink–it’s scary.  Anyway, she was loudly and publically ushered to her husband, whom she found dressed, collection cup in hand, looking disgruntled but grateful for her arrival.  They only had one old magazine and he couldn’t do it like that. 

Are those of you in normal relationships still waiting for the romantic conclusion?  That was it.  I know, I know….we’ve been permanently damaged, or maybe our standards have just been lowered…or warped.  I don’t know.  All I know is that I was not the only one sighing romantically at the story’s conclusion–so sweet.  They got to be together in that 6×6 dingy porn room.



May
17
Filed Under (Infertility) by catharine on 25-04-2007

Well, IVF has begun.  I thought I would post about it before the drugs run roughshod through my brain and I can’t think straight anymore.  I am doing the Long Lupron protocol, which, according to everything I’ve read, is not what someone with an elevated FSH such as myself should be doing; there’s a risk of over-suppressing the ovaries.  But, I’m in a study, and that’s what we’re all doing, and, well, you get what you pay for.  So, this protocol consists of several weeks of birth control pills that overlap partially with several weeks of Lupron shots, for a total of about 4 weeks of suppression before stimulation (don’t skip ahead, I’ll tell you all about the stimulating part shortly, but it’s not nearly as exciting as it sounds).  The suppression stops your ovaries from working.  Why this helps with IVF, whose main objective us ultimately to hyper-stimulate the ovaries, is not clear to me; it seems to be something akin to wiping the slate clean.  The reason it doesn’t work for folks like me is the risk of over-suppression.  Apparently my ovaries are heading towards retirement–they see the light at the end of the tunnel already, and if given the chance to sit and rest too long, may just decide not to stand back up again, as far as I can tell.  I can understand this.  This is the way I feel every time I go running.  Maybe this is why I have been making myself run lately, sometimes twice a day.  I’m trying to set a good example.  See, ovaries, I’m running too–if I can do it, so can you.

The reason I will soon be crazy is because of the Lupron.  Like Clomid (an evil drug I used a year and a half ago), it screws with your brain.  It’s part of the category of pharmacology called “brain screwing drugs” and I highly recommend avoiding them.  Anything designed to prevent your brain from being able to tell what’s really going on with your body, or otherwise trick your brain is going to make you feel weird.  The doctors will bury these side effects somewhere under “headache” and above “death” and you’ll either assume they’re exaggerating about all of it because if you really thought you’d die you wouldn’t be taking the drug, would you–but they’ve warned you so you can’t say they didn’t tell you–or your eyes will glaze over after the first several benign side effects and you won’t even get to the warning about it making you want to divorce your husband whom you thought you loved more than life itself two days ago, dye your hair black and move to Mexico–really, really want to do this, even while you cry about it.  My husband knows what to expect; that’s why he built me a deck.

deck railingYes, he’s outside now putting up the “safety railing.”  This, ostensibly, is to meet safety codes so my 13-month-old niece can safely play in our backyard, but really, he’s making sure I won’t escape.  Classes are over, summer is here, and I have nothing to do for the next several months but get barefoot and concentrate on getting pregnant, which will look to the outside world like reading books on the deck.  I think the deck furniture is his best attempt at simulating a Mexican hacienda, and who knows, after two weeks of Lupron, I may actually think I’m in Mexico. 

After my personality is suppressed into a quivering puddle of my former self, I will begin “stims.”  This is where you switch gears, stop tricking your brain into thinking there’s nothing going on here, nothing to see, go on about your way people….and start cracking the whip.  Yes, just when my ovaries think they have finally arrived, have kicked up their little follicle heals and started sipping on that margarita they’ve been eyeing the past 15 years or so, they’re going to get the shock of their lives and be expected to produce approximately two years’ worth of work in one month.  No more of this taking turns, you produce a follicle, I’ll produce a follicle, now one for me, one for you.  No, my daily injections will then switch from brain screwing drugs to ovary stimulating drugs–these I can deal with.  Better them than me.  And really, they haven’t been holding up they’re end of the bargain, have they?  Or so recent tests seem to suggest.  We’ve been ambiguously labeled “unexplained” but we’re all getting a little suspicious lately, what with the FSH (see previous “old hag” post) and all.  So, I can’t have too much sympathy.  You want an early retirement, fine, but you’re going to have to do a little over time now, buddies!  So, I will be injecting myself (or possibly my husband since he seems to enjoy this task, oddly, for one claiming to hate needles) with twice the normal dose of Follistim (FSH) and with Menapur (FSH and LH) for about a week and a half.

This should land me in Houston sometime mid-June.  I’ll talk more about that later.  There’s sure to be some unexpected twists in the road between now and then, so there’s no use laying down too many expectations.  In the mean time, I have stocked up on fluffy summer reading and am heading out to the deck to enjoy myself.



Apr
19
Filed Under (Infertility) by catharine on 25-04-2007

young lady or old hag?So, what do you see?  A relatively young 31-year-old woman, or an old hag with aging ovaries?  Deceptive isn’t it.  Apparently so am I.  On the outside, I am young enough to occasionaly still get carded at the grocery story (though not at restaurants or bars, which probably means that the younger clerks at grocery stories just can’t estimate age very well, but I’ll take what I can get), but on the inside I have the hormones of a much older woman.  Flattering, I tell you. It’s doing wonders for my self esteem. 

Since this has all come to light, I decided to submit myself as a guinea pig for study.   Those of you who knew me in grad school are thinking, “oh no, here we go again,” but fear not; although I will be taking copius amounts of drugs, I will not be getting paid for it, but it is going to reduce the cost of IVF from about $12,000 to about $2,000.  This has come about because new bloodwork has revealed that I have elevated FSH levels and a high FSH:LH ratio, hence the old hag photo above.  We were told that we don’t have time to wait to do IVF; it’s now or never.  Maybe this is why we’ve never gotten pregnant?  We’re about to find out when all our genetic material ends up in a petri dish under the microscope.  On the one hand, we’d like to know what’s wrong, on the other hand, even though the fact that there is a problem is obvious, being told the problem is still shocking.  I don’t know why–it’s not logical, it just is.

Sooo……since we apparently don’t have time to wait, and since this opportunity to do it so cheeply presented itself, we decided to do IVF.  The state, however, does not allow you to do both  IVF and adopt–this apparently is too stressful.  We could adopt a sibling group of five if we wanted, no problem, but adopting one child and being pregnant at the same time–that’s a big no-no.  Apparently also, they think we would give back our adopted child once delivered of a biological child, no matter that the adopted child would be nine, while the biological child would be an infant–hardly interchangeable.  Never mind the fact that we had planned to adopt before every trying to get pregnant in the first place; this is not significant.  After spending a year getting our adoption up and running, this feels very much like finding out you’re infertile to begin with–can’t conceive, can’t adopt.  I’m being a little melodramatic, but humor me if you will.

In the mean time, we are in no way anticipating IVF.  I don’t know who we’ve told or not.  I assumed we’d told our family, but when talking with my in-laws this weekend it was apparent we had not.  I just mentioned it to my sister-in-law, and apparently it was news to her too.  I wonder if I’ve told my parents?  They read this blog, so they should know before we begin in any case.  It’s a matter of days now; I estimate that we’ll begin drugs on April 28th, so we’re looking at having this process behind us by mid June.