My Uterus Hates Me: CD1 Arrives

So I've been wondering when AF is going to start being that I had my last PIO on Friday morning. AP said that hers came 4 days after her last PIO shot. Mine followed suit for last night at 11:30pm AF came to visit. And with a vengeance. My uterus must really hate me: this has got to be one of the most miserable visits from AF I've had in a long time. Super tampons combined with those pegasus-sized pads with wings can't keep her at bay. Seriously folks, my hematocrit is going to drop below 30 with this visit.

J thinks that it's because I also started taking DHEA again - but I don't really think that's the case. It's probably the aspirin. The heparin is long gone from my system, so it doesn't explain it. But, I started taking the DHEA on Saturday afternoon. As soon as I got word that my HCG had plummeted to 0.9, I figured it was time to go "balls to the wall" with being proactive. (Like all of the shit that I did in my first IVF cycle wasn't proactive!?) The DHEA headache started right on schedule. I could barely sleep Saturday night...my head felt like someone had my jaws in a vice grip. Not a migraine sort of headache, or sinus pain on the front of the head, but just pressure on my jaws. My head literally felt like it would implode if the pressure didn't let up, or that I might clench my jaws and crack my mandible. Gives me the willies just thinking of that. It lingered on into Sunday and then on Monday I had a TMJ episode that nearly dropped me to my knees. Ice pick sensation in the left TM joint. Or so it felt like it.

So clearly yesterday I still wasn't ready to eat another one of those nasty little pills, but today I popped another. I thought: "Okay, maybe the DHEA isn't giving me the headache. Maybe it's because I'm depressed, crying too much, something else. Maybe I'm not drinking enough water?" Well, I gave in to the scientist in me that wanted proof. I love proof, and to keep the skeptics at bay who might think I'm just being a hypochondriac (speaking directly to TV here) I took another 25mg pill at 9am today. Felt fine for most of the day, I was coasting, everything fine, but then right about 4:00pm, I'm driving in the rover heading to Home Depot and lo and behold: that fucking headache is back. 7 hours for it to kick in this time. Feels the same, smells the same. It makes me irritable, unable to focus, impatient. Only this time I've got nausea too. I don't get it. How the hell did the woman in that DHEA study eat 75mg/day? Was she suicidal from the pain of her aching head? No comprendo. Really, it's beyond me.

So tonight, I'll be riding the couch as well as the "big white horse". Me, my heating pad, and netflix. It's a miserable date, for one.

Peace out.

HCG #2....IVF#1 Comes to a Screeching Halt

I went and visited my OB, Dr. G to get some feedback on things. I wanted to see what she thought about my having reconstructive surgery on my tubes, to see what she thought about Dr. Z doing a day 10 HCG, and whether adding LH to my next cycle would result in improved egg quality. She said my tubes are so far gone that surgery couldn't help them at all. She also said that she trusted Dr. Z and that he really is among the best as well as the folks at Nova. She said she trusted his judgement on doing a 10 day beta and that they were probably just trying to keep from prolonging the inevitable. And about the LH..she said "No" to that, too. It would NOT help my egg quality at all. Sigh.

Off I went to Hunter labs for my 2nd beta and TSH test. They wondered why I was back for a second test. They must have thought my results too dismal to retest. The results came back rather quick this time. My beta dropped from 2 on Wednesday to 0.9 yesterday.

Crash and burn. No baby for Linda. Nada.

The reality really is sinking in now. We just sunk $13,000 into a dream, a hope, and there is nothing at all to show for it except an armoire shelf full of needles and leftover drugs, the bruises on my stomach, and the needle puncture marks on my hips. Oh yes, and a picture of our six embryos that makes my stomach go queasy. That is what $13,000 bought us.

I desparately want to try again, and soon...before I lose my nerve. J isn't so sure but he was a bit overly optimistic going into this cycle. He kept saying, "...but OF COURSE you'll get pregnant! You're so healthy!" without realizing how much against the odds that would have been. He accused me of being pessimistic. But I think I was a bit in a protective mode...trying to not get too excited about any of it. We tried to talk a bit last night about what to do next, but it was too soon for this discussion...the pain is still too fresh to be able to see this clearly. We'll talk again this Wednesday when we have a free evening.

So the folks at the Georgia facility emailed me to say that they ONLY allow PCOS patients into their IVM program...that it simply doesn't work for others. Unless I am producing 30 to 40 eggs, my god, I wouldn't be a good candidate. Hmm...they didn't tell me this at McGill, and the folks at McGill are "the" leaders when it comes to IVM. Perhaps I missed something? I know I told them quite clearly, "I am not a PCOS patient. I produce a measly 12 to 16 follicles". I guess I'll have to call them again on Monday to figure out if I can even do IVM there or not. If not, I'll have to take a closer look at the Genesis facility in Vancouver. Their IVM process is $5500 CAD which is more like $4300USD or something. $1000 in drugs from my friend Holding Pattern, airfare, plus ICSI and assisted hatching...and we can squeeze in a trip to Whistler so that J won't feel that it's all money out the door once again. The only downside about being in Vancouver for the IVF is the **COLD**. I'm already freezing in the current house, feet are like icicles here, and I can't imagine I'd be a lot more comfortable there.

Maybe in the end we'll wind up cycling again with Dr. Z...but something tells me we'll either do Nova for IVF#2, or we'll be elsewhere. Canada? Chicago? No telling. But to blow $13,000 on a single round of IVF and to not even had a chemical pregnancy was, well, simply devastating.

I wish I could drink today.

Crash and Burn: On the Fringes of the Bell Curve

The call about my beta never came yesterday. I had to, in fact, call THEM at Dr. Z's because my results were sitting around waiting for him to review them, THEN he would have to confer with the nurses, THEN they would call me. But by 3:30PM, I had it with waiting. I was a ball of nerves, stressed out. My heart was beating so hard between 12PM and 3:30PM that I had to focus on breathing deeply to try to calm down. I phoned them.

I was put thru to Nurse J. "I'm sorry I don't have good news for you" was followed by an explanation that my HCG level came in at 2. TWO. Progesterone was fine at 33, but all I could hear was that resounding "2" buring a hole into my brain.

She went on to explain that it's rare, but sometimes a "2" can turn around and turn into a pregnancy. So I get it to mean this: I've had implantation, but it's either dying, or it's just started to attach. My gut instinct is that it's on the way out because of the timing of my cramps would seem to imply that it tried to attach last Wednesday and Thursday. By now, if it were successful, the numbers would be somewhere closer to 100. Not 2.

Nurse J recommended that I stop taking all of my meds and to do a pee-stick HPT in two days. This baffled me. I think I said something like, "Wait. You want me to stop taking progesterone, which is the baby's lifeline at this point, and then to test in two days with a pee-stick?? Even if my HCG doubles everyday from here to then, a pee-stick won't be able to pick up the result!" She pondered this and then said, "Well go ahead and take the meds for two more days, then take a blood test and we'll see where you're at. I'll let Dr. Z know you are continuing on with your meds"

Aha.

Now this made more sense. If a 2 really could turn around and turn into a baby, I'd be damned if I was going to cut off it's supply of progesterone and then rely on a test near guaranteed to miss its presense. Now we were on the same page. But despite all of this, the reality of not really being pregnant, or should I say, being "safely pregnant", hit me like a tidalwave. By the time I clicked "end" on my cellphone, rivers of tears were already flowing down my face. By the time J picked up the call I immediately made to him, I was close to bawling.

J must have IM'd our friend JM pretty quickly because he mentioned that she was somewhat baffled that we were doing a pregnancy test (beta) 10 days past our transfer (aka, 10dp3dt). Her test was on the 14th day past transfer (I do wonder if she's remembering this clearly tho). Maybe, maybe not. She felt we were testing way too early. Well, if her memory is correct, maybe we did test too early. We'll be testing again tomorrow, but it will still only be on day 12 past the transfer, so it might STILL be early. J let me cry into the phone until I was spent. He went back to work and my next call was to my best friend, JS, who said she was going to leave work immediately to come over and sit with me. While waiting for JS, I had a call from my cycle buddy AP, who also cycled with Dr. Z. She had received her devastating news a day prior. It was good to hear from her and she, like no one else, could understand exactly the pit this news had carved out in my heart.

It is comforting to have people to talk to during this hell.

But last night things didn't get better. J suggested that maybe I should have spent part of my time in January taking stress management classes. OMFG. I spent, what, $800 on acupunture sessions that were designed to help me with stress (as well as infertility and low back pain)? I came out of my acupuncture sessions feeling absolute wonderful. But if I dared to make a call to J to talk to him, he would find some reason, some detail to pick on me about and my feeling of calm would disappear in an instant. I told my acupuncturist about how talking with J would destroy my sense of calm and told her, "Maybe you should just leave the needles in my head permanently?" I am normally so unstressed, so calm, and most people who know me, know that the ONE thing, the one person who can stress me out to no end is "J" himself.

I realize that stress is defined as "One's reaction to their environment", and I've been hating my environment since we moved into this new house: boxes everywhere, our bedroom is a shambles, our guest room is a shambles, I have an arms length list of things that need fixing, my old car STILL doesn't have a garage space (but I'm paying for it?), our office is a sheer disaster site to the point I refuse to work in it. Yes, my surroundings are a constant source of my stress. I will admit that. And the fact that "J" doesn't have time to "fix" these things is also a source of stress. (Well my opinion on this is that he chooses to do things away from home such that he doesn't have time to finish the things that need fixing...but that's another source of stress to recount this today). My only way of dealing with any of this right now, since I am still not supposed to pick up heavy boxes, is to ignore it all as long as I can. But that only works for a while as JS will tell you. At some point you flip out and run away to Umbria to herd goats. We're headed there, I tell you.

So at some point yesterday, I found a website called the BetaBase that posts the beta scores of women who went on to have pregnancies where a heartbeat could be visualized on an U/S. According to this database, the lowest reported HCG value for a women at 10dp3dt (or 13 days past ovulation) would be 5. And I'm at 2. But I'm eternally optimistic. I wonder how many women with 2's have been told to "Stop taking your meds" and they just follow the doctor's orders and "give up"? How many 2's would make it to form viable pregnancies if only the women forged on and gave it their best shot? I figured that the answer might be, "Too many", and decided that we would give it antoher two days to see what might happen. Another two days of heparin, progesterone in the ass, and steroids. But what the hell. We've come this far. I'm not giving up until my HCG plummets.

There was also some comforting reading on Advanced Fertility Center of Chicago's website with respect to HCG values in early pregnancy:

HCG is first detectable in the blood as early as 7-8 days after ovulation by very sensitive HCG assays (research assays). In real life, blood pregnancy tests will be positive (> 2 mIU/ml) by 10-11 days after HCG injection or LH surge.

In general, the HCG level will double every 2-3 days in early pregnancy.

85% of normal pregnancies will have the HCG level double every 72 hours.

HCG levels peak at about 8-10 weeks of pregnancy and then decline, remaining at lower levels for the rest of the pregnancy.

There is a large variation in a "normal" HCG level for any given time in pregnancy.

Pregnancies destined to miscarry or to be ectopic (tubal) pregnancies tend to show lower levels (eventually), but often have normal levels initially.

Some normal pregnancies will have quite low levels of HCG - and deliver perfect babies. Caution must be used in making too much of HCG "numbers". Ultrasound findings after 5-6 weeks of pregnancy are much more predictive of pregnancy outcome than are HCG levels.

It was that last line that stood out to me, and also the 3rd to the last about there being a lot of variation in HCG numbers. So there is a sliver, just a teensy sliver, or hope. Four women on that betabase site had numbers around 3 on the same day that I am testing. I've always been a bit of an oddball. Maybe I'll be on the fringes of this bellcurve as well.

Beta Day

The nurse at Dr. W's phoned about an hour ago. (Dr. W is the urologist I saw last Friday when I was sure I was having another bout of UTI). The urine culture came back and it was totally negative. Not a thing grew in there. Wow. So the wild cramping I had on Wednesday and Thursday might actually have been implantation cramps. I had it again the last two days, and it was quite fiece last night and J and I saw on the couch eating our Valentine's dinner and watching "Never on a Sunday" (cute movie I might add).

I do have a single pregnancy test left...one of those First Response Early Detection ones that are supposed to be so good that they can test as little as 12mIU of HCG in urine, which makes it about the best money can buy outside of doing a blood beta test. I am too stressed to use it though. I can handle the definitive test, the blood test, which makes no mistakes, but I don't believe I can deal with a drug store test which leaves room for error, and false positives/negatives. So it'll sit under my bathroom counter.

In a little bit I will be off to find a laboratory that can do my beta test on the spot so that I won't have to wait a day to get my results. Besides, I'm nearly out of progesterone in ethyl oleate and I'll have to get Dr. Z to write a new prescription, and I'm nearly sure that he won't unless I've got a positive beta.

Maybe once I have my official result I'll break out that First Response test just to see what it would have said.

Wish me luck.

PIO Haiku .:. Valentine's Day

PIO Haiku

needle slides in fast
relax my butt, bite on hand
dot of blood leaks out

Happy Valentine's Day to the man I love: the man that puts 25 gauge needles into my hip each morning, loaded with 50mg/ml of progesterone in ethyl oleate. It must be love, because although he nearly faints at the sight of blood, and is to queasy to even watch me pop a zit on myself, he's given me eleven, count 'em, ELEVEN hip shots so far and he's done a fabulous job at it. No pain. Not a bit. Just a tiny prick when the needle goes in, but nothing else.

In fact, I have never in my life had a single butt, or hip, shot, any intramuscular shot in fact, that I didn't recoil in pain from...until now. I haven't had to use ice, a heating pad, or any of the other methods I've read about online. It's really uncanny and, just to make it interesting, I have threatened him with exposure. I think I should post an advertisement on all of the infertilty and IVF boards that "Man in Los Gatos will give you your progesterone in oil shots. FREE. Guaranteed to be painless as long as you buy the PIO in ethyl oleate." I'm not sure if he feels complimented, excited at the prospect of seeing so many women's bare hips, or shudders at the fear of so many shots. But I can see them lining up in droves. :-)

Happy Valentine's Day sweetheart.

Dr. Gian-what's-his-face

Called my mom this morning. They've got 20 inches of snow and F (her husband) was setting off, in snowshoes, to get the snow blower I can only assume from a neighbor. Out here on the west coast it's gorgeous. Warm, birds chirping in the garden, weather atypical for February..what a contrast.

So I called her to ask her about her symptoms in early pregnancy. I was feeling anxious because of my cramps that have been coming and going like the tide, stressed because I have no clear indication either way of what my body is doing.

So in reply to my, "What sort of signs of pregnancy did you have?", she paused and said, "I didn't have any". "At all?" I asked. "No, nothing until the last trimester when I had some nausea while in San Diego, but it was really short and then it was gone." Whoa. I drilled her.

"Did you have cramps?" (No.)

"Did you have any breast tenderness?" (No).

"Did you feel anything at all that made you think you were pregnant?" (No).

"So what made you think, finally, that you were pregnant?"

To this her answer was something like,

"Well my period didn't come for a couple of months so I went to get an examination. You know, in those days they didn't have pregnancy tests like they do now."

A COUPLE of months? I would be flippin' out if my period was four days late. She did admit that she was really naive about this at her young age, so it was just par for the course.

"Really?" I remarked. "What did they do back then?"

"You would have to have an examination."

"Interesting."

She mentioned then that she remembered the doctor's name. Gianfarco, Gianfranco, or something like that. (I'm willing to bet it was the latter). He wasn't an OB/GYN, but a regular MD. He had an office over on Farmington Road, which was close to her work (which I'll assume was in Hartford). She had chosen to go to him, not because she had ever seen him before, but because his office was close to her work and it would be convenient. Fit it all in during the lunch hour or something like that.

So Dr. Gian-what's-his-name examined her manually and declared that she was indeed pregnant. And before she left to go back to work, get this: He asked her out for a drink.

What a letch.

Was he thinking, "Hey, here we have this young, attractive, unmarried woman who is obviously having premarital sex...maybe she'll shag me, too? Oh, and the bonus is that if she does, I won't have to worry about knocking her up!"

I am apalled. But this was 1964. I'm sure things were a lot different back then. But here is my mom, 18 years old, from a strict Polish-Catholic family, pregnant and alone, probably scared to death of what all of this would mean. And this jerk tried to prey on her.

Bleh.

But what this whole story does do is to make me feel a lot better about not having any symptoms of pregnancy. I'm a lot like my mom in many ways: we look alike to the point that people have asked if we are sisters, we talk alike in meter and accent, we have many physical ailments that are similar, our hands look identical.

And I would not be surprised if I don't have a single symptom of pregnancy, because I am just like her.

Peek-a-Boo Cramps

So I was all in a panic over my bizarre cramps that I had going on yesterday. They were so disturbing I went to see Dr. W...and as you know, they found nada in my pee sample. Just normal things floating around here and there (mucus is normal? blech!). I was pretty conviced, by the way it felt (similar to a recent UTI back in October), that it was yet another UTI brought on by the oozing progesterone suppositories.

But last night it disappeared. No pain. Not a bit. How strange is that?

But this morning, on my way to have coffee with Holding Pattern I noticed a twinge of cramping yet again. It persisted the two hours that we chatted, was a bit distracting at times, but it wasn't as fiece as it was on Thursday night, waking me at 2:30am. After coffee I drove south to Ikea and tried to buy drapes and hardware for the master bedroom and the office. My bladder/uterus area felt really heavy and continued to cramp. Still not as bad as Thursday night. Try as I did to pinpoint the area where the discomfort was coming from, I simply couldn't.

So as I write this, it's 9:00PM, the cramps are gone yet again. It's like this cramp is playing peek-a-boo with me. It's there. Now it's gone. Oh, it's back again. This is strange. One would think that if this were really a UTI, left untreated as it is, that it would have progressed into something really nasty, and probably accompanied by a fever of sorts. But no. This is truly strange.

J says I'm being negative and pessimistic in thinking that it's just a UTI and that I'm not pregnant. I'm not sure why he feels so certain that I'm pregnant. I know that I can't tell the difference between UTI cramps and uterine cramps....and I know he is being supportive, and I love him for that. I just don't feel pregnant. It's been many years since I was last pregnant, and actually, both times I don't know if I had any symptoms at all, except for a lack of AF. My mom said that when she was pregnant with me that she didn't have any morning sickness until she reached the third trimester. That is really odd. But, if there is any similarity at all between her and I, then yes, maybe that would explain some of my weird symptoms.

Back to baking that batch of brownies...

Off to Provide a Pee Sample

I could barely sleep last night due to the cramping feeling that I had been hoping was the sign of impending implantation. About 12:30am I made my trip to the bathroom, did the progesterone suppository thing, and lay down to crash for the night. J was still out in the garage making noise.

Then he started the shop-vac up.

I mean, "What the hell was he thinking?" Images of neighbors banging on our door yelling at us to "keep it down" immediately came to mind. I dashed out of bed, we won't mention what the suppository was doing at this point, and grabbed my cell phone. Hell if I was going outside at this time of night to tell him to cease and desist! I called him on the cell and told him he had to cut the noise out immediately, and "What ARE you doing outside at this time of night?" I am convinced that the neighbors hate us already. It's not enough that we have three vehicles and a horse trailer screwing up the visual on our quaint Los Gatos street, on top of the fact that we have the ugliest yard on the block...but now J has decided to do home improvement projects in the middle of the night. I'm sure it won't be long till the "post-it" notes start to arrive. In our last home the first note arrived after two days. We've been here two weeks, so we're pushing our luck at this point. Okay, I've digressed enough.

So, after calling J and complaining about his noise, I realized I had to pee yet again. I made a second trip to the bathroom then back to bed. Sometime around 1am the noise emanating from the garage woke me again. This time it was a banging noise. Was he hammering? Throwing things? I again called J on the cell and flipped out on him a second time. (He does keep forgetting that I'm on a pretty decent dose of steroids...so why he is so provocative is beyond me). He came into the house shortly thereafter and started to get ready for bed. I noticed that I had to pee yet again, and that the cramps had really intensified. Then at about 2:30am, I awoke to even worsening cramps. What the fuck? I got up, rifled through the bathroom cabinets looking for Cipro. Nada. Not a pill. But I did find an empty bottle that says I've got 5 refills left on my Cipro from Dr. G and then a full bottle of macrobid (nasty stuff). By this time, my progesterone suppository was likely long gone, trickled into my pj bottoms by now, and I was totally awake, frantic even. Freaking out over the cramps, I fired off a midnight email to Dr. Z asking which UTI meds were safe to use and whether I should increase my progesterone shot in the AM since I'd lost most of it in 2.5 hours after inserting it...and then headed back to bed. After this trip the pain was pretty much gone. Odd.

This morning I had an email from Dr. Z saying to get to the urologist's and to not take anything until they've checked out a pee sample. And, no, don't increase the injectible progesterone, and go ahead and skip the suppositories for the next 48 hours. So in a few minutes, I'm headed to the urologist's office, Dr. W, to provide a pee sample, have them spin it down on the spot to look for traces of bacteria. I'm pleading with the fertility gods for a negative test because then my cramps might be more indicative of implantation, rather than some pesky bacteria that set up camp in my urethra.

But at the point I am doubtful. There hasn't been a single sign of implantation bleeding, and I do realize that something like only 8% of women even HAVE implantation bleeding, but hell, I would like something, some sign, that this is either working or not. Now I realize what all of the fertility boards have entire areas devoted to "the two week wait" (aka, 2WW). Waiting is hell.

I Dream of Implantation Cramps

You could set your clock on this one. Right on time, precisely within the statistically average of 6.6 and 7.4 days post IVF transfer, I started to cramp. Right in the middle of my uterus. And just a tiny bit. So small it could even be in my head. It started last night while I was IMing with JM over in Scotts Valley. It stuck around for a good half hour or more and then it was gone. This morning after I made my morning visit to Narnia (aka "the bathroom"....our toilet has a huge hole in the drywall underneath it that I plug with toilet paper to keep the cold air from blowing in...JS and I imagine that it's the hole to Narnia and, thus, all bathroom trips in this house are deemed "visiting Narnia"). Okay, that was too much information, I'm sure, but you'll understand what Narnia is from here out. ;-)

So after visiting Naria this morning I notice that the slight cramping is back. And this morning it's a bit disturbing. It's on the left side, kind of where my ovary is. I'm really sure about where my ovaries are these days..what with the FSH turning them into organs the size of oranges and the cramping that ensued from that. But that pain had already subsided...disappeared entirely. So I am doubtful that it's my ovary still stressed out from the ER process. And I'm also hoping, to high hell, that one of those little guys didn't go and get lost in my left fallopian tube and decide to make a nice little cozy home of it.

Statisucally speaking, I am now smack dab in the middle of the time zone when I should be implanting and with this I find myself now becoming paranoid about all the things I might have done to fuck this up. You would think I'd give myself six more days until I freak out, at least wait until the first beta is done (next Wednesday). But I can't wait that long.

Woops. Missed the Soy Phytoestrogens

Interesting study. I missed this one when prepping for IVF. I had also read that the genestein (sp?) in soy reduced fertility in both men and women, so an isolated compound would be indicated.

More Help with Fertility

By Kimberly Beauchamp, ND

Healthnotes Newswire (January 20, 2005)—Infertile women may improve their chances of becoming pregnant by supplementing with soy phytoestrogens when undergoing in vitro fertilization (IVF), reports a study in Fertility and Sterility (2004;82:1509–13). Phytoestrogens are compounds found in certain plants that have hormone-like activity in the body. Isoflavones derived from soybeans are one kind of phytoestrogen.

The new study investigated the effect of phytoestrogen supplementation on pregnancy rates in 213 women undergoing IVF for infertility. After the retrieval of the eggs, the women were assigned to receive either 50 mg of progesterone plus 1,500 mg of isoflavones derived from soy per day, or 50 mg of progesterone per day plus placebo until either a blood test for pregnancy was negative or an embryonic heartbeat was seen on ultrasound. The women were assessed for rates of embryo implantation, biochemical pregnancy (based on levels of hormones in the blood), clinical pregnancy (based on seeing an embryo with a heartbeat on ultrasound), miscarriage, and ongoing pregnancy and delivery.

The women receiving phytoestrogens had significantly higher rates of embryo implantation, clinical pregnancy, and ongoing pregnancy and delivery than the women receiving placebo. Among the women supplementing with phytoestrogens, 30% gave birth, versus 16% of the women in the placebo group. There were no adverse effects noted by any of the women taking the phytoestrogen supplement.

The results of this study suggest that phytoestrogen supplementation is a promising adjunctive treatment for women undergoing IVF for infertility. Further studies are needed to determine exactly how phytoestrogens exert their effect on the reproductive system.

To Bromelain or Not to Bromelain: That is the Question

Okay. There are hundreds, maybe thousands, of women online who think that bromelain is a panacea for implantation problems. "Just eat a lot of pineapple every single day!" I cackle everytime I see some silly young thing post: "I'm eating a half can of pineapple a day..." without realizing that bromelain is an enzyme and needs to be consumed FRESH. Also...I've read online (no scientific study to back this) that fresh pineapple without the core section, if eaten in excess, can actually CAUSE miscarriage. Whoa. So part of the fruit is good, and part of the fruit is disasterous.

But the science geek in me says, "Show me the study!" I've looked high and low for something, anything, that will tell me the following:

1. Bromelain is safe to take when trying to conceive,
   
2. This is how much you should take, and
   
3. Here is the study that verifies all of this.
   

Dr. Z thinks it can't be too harmful to take the stuff, but he admits that he hasn't seen a shred of data to support its usage. I also fired off two separate emails to Dr. Randine Lewis (author of "The Infertility Cure") as she had posted on one website chat board that it did indeed help with implantation. Another person on fertile thoughts said that Dr. Randine claimed that bromelain helped to create the receptors in the uterus that the blastocyst requires for implantation. Again I say, "SHOW ME THE STUDY!"

So I am wearying of much of the crap that I am reading online with respect to infertility and pregnancy. There is just too much (dis)information out there (or assvice as Julianna would put it) and the bad information seems to propagate like wildfire. I do feel for these women who are grasping onto to anything to push the odds in their favor just one percentage point more. Hell, I AM that woman! I admit that I will do just about anything, so long that is is safe and sane, to get pregnant. But I want a study that says, "Yes this works", or something that is "close" to a study. Even anecdotal evidence is better than a plethora of unsubstantiated postings.

Day 6 Arrives

It's noon and it's officially the beginning of day 6 post transfer. Statistically speaking, if implantation tends to occur between day 6.6 and 7.4 post transfer, then my little embies should be getting ready to do their thing in the next 12 to 36 hours or thereabouts (assuming one SD?). In the absence of any compelling studies to show that bromelain is unsafe I have thrown my hat over the fence and have been swallowing 500mg of bromelain a day for the last three days. Is this enough? Too much? Hell if I know.

Gorgeous Day Outside

It is a stunninly beautiful day outside here in Los Gatos. It's the dead of winter yet it feels like spring. We have these two silly brown squirrels at the new house that play just like puppies: they chase, frollic, bounce off of trees. They haven't yet discovered the hidden pockets of peanuts that we've left outside for them but hopefully in time they will. Amazingly the roof rats haven't found them either (what on earth DO they eat besides the roof joists?)

Waiting for implantation...

Today is my 3rd day of light activity...JS said maybe I should do SOME moving around to help the little guys lodge into the uterus. Maybe she is right. I was just reading that implantation normally happens on days 6.6 to 7.4. Interesting snippet:

http://www.advancedfertility.com/cryo.htm

When does implantation actually occur in IVF or normal cycles? (We're not focusing on the "window" anymore, but on when real implantation does occur)

A very good study of implantation was published in 1992 by Bergh & Navot.

They studied 33 pregnancies from ovum donation or frozen-thawed cycles with serial HCG levels on the mothers to find the time of "first embryonic signal". The HCG assay used can detect very low levels.

Average first detection was at an embryonic age of 7.1 +/- 0.28 days (range 6.6-7.4 days).

This correlates with the studies of Hertig and Rock in the 1950's (hysterectomy studies) that showed the day of implantation to be day 6.

Thursday about noon would be 7.1 days for me. YIKES.

The Dreaded Two Week Wait

It begins today: the dreaded two week wait. Except in my case it's not really a two week wait, per se, but a 10 day wait. If that even. Tomorrow is day 5: the embies will be 5 days old in the morning...assuming implantation happens ontime, I might see some sign of it occuring anywhere from tomorrow to Friday. But realistically it could happen even later than that. But since we had assisted hatching done to all of the embies that may or may not change the date for this since we've "dicked" with the outer shell (Dr. Z's lab has switched from burning an acid hole in the zona to using a laser...says it's more precise?) This is happening fast. I have become paranoid about standing up or walking across the house. I have this fear that the embies are going to slide right out of me. I have stifled at least three sneezes today, literally holding my nose and focusing on NOT sneezing. (Gosh do people sneeze in their sleep? I hope not!) How do women get through this time? I had a tiny bit of spotting today and I nearly freaked. Looking at the toilet paper, I actually paused for a second AS IF I would really be able to discern if there was anything there. I am losing it.

Today I hugged the couch all day long and watched mindless documentaries. My chinese acupuncture team said to be careful about watching TV as it might make me tense (especially watching dramas or suspenseful movies) but I figured how tense could I get watching wildlife documentaries and the Travel Channel? I know a good creme brulee will really get me going but I don't think it will be dangerous. If anything is dangerous, it's probably from the radiation this damned laptop is emitting in my general direction.

G and M came by tonight to visit and brough a nice Chinese dinner from ABD Chinese in Scotts Valley tonight. It was sweet. We are still frazzled by the move and with me hugging the couch it couldn't have come at a better time.

Tonight is the beginning of the slimy progesterone suppositories. Dr. Z said to keep them in the refrigerator so that they wouldn't get all mushy when I went to insert them. Something tells me, though, that an ice cold suppository in one's "baby kitty" would not only be uncomfortable, but it might be a bad thing for the embies to get a shock of cold. Think I'll let mine assume room temperature despite the good doctor's advice.

Good night little embies. Hope you're all up late dividing like crazy.

Six Little Embyos Settle in for the Night

Today we made the journey to Daly City once again and had our embryo transfer at Dr. Z's. We met with him at 11 to go over the status of the embryos. Since we had last spoken with the nurse on Friday, one of the embryos had only made it to 3 cells. Dr. Z said that 3 cell embryos are nearly always abnormal. They would watch it a while longer to see if it would divide further but it was his feeling that it would not.

So of the remaining six we had one Grade I (at 7 cells) and five Grade II (one at 4 cells, 2 at 6 cells, one at 7 cells, one at 8 cells, and one at 9 cells). Dr. Sher wrote in a chat transcript that day 3 embryos with 7 to 9 cells are the most successful at reproducing, so that Grade II 4 cell guy might not make it. Amazing that there is data on even this.

For the rest of the evening I've been destined to an evening of bedrest, only rising to pee. J has been great, even impressing JS: he made dinner, turned the heat on high for me, doted on me throughout the night. JS came by and spent many hours laying in bed with me, thinking up amusing and not so amusing names for our six little embies. She's still worried, concerned, that I'll name of the boys Basile.

My hips and stomach ache from laying in bed for so long. Tomorrow morning we'll try out the new, smaller, 25 gauge needles that apparantly work well with my progesterone in ethyl oleate (as opposed to sesame/peanut/soy oil). J's been great administering the progesterone in oil (aka: PIO). He was queasy about the first injection, but after the first he's gotten less worried about it. The first two shots were with the 22 gauge needles that left a gaping hole in my butt cheek.

Me and the embies are off to bed.

Egg Retrieval Day

Today was our egg retrieval day. I barely slept all night...awoke at 5am to whatever it is that lives in our attic and layed in bed imagining how many rat traps I'd have to put up there to kill the blessed thing that dared to disturb my sleep night after night. One of the reasons we moved into this house was the noise at the other house. It was constant. Now we have a rat that is constantly chewing on the rafters above. Ick, ick, ick.

In my paranoia about missing our 9:30am appointment with Dr. Z, I set 7 alarms: the one next to the bed, three on my phone, three on my ironman watch. They started going off at 6am but I was already wide awake, having plotted the demise of the attic rat for nearly an hour. John was amazingly patient and forgiving for my slew of alarms and he rose, showered, and dressed without much prodding on my part. I was relieved.

By 7:25am we were out the door and on our way. 5 minutes earlier than I had hoped for. The traffic person on the radio said there was a 12 car pile up on 280 just north of our destination. I panicked. They claimed that it had been "cleared" but my first thought has that the damned "rubber neckers" would probably cause the traffic to back up for miles before that. We drove on, me with my Thomas Guide map on my lap the entire way, keeping an eye out for possible escape routes off of the freeway.

We arrived right about 9am, which made me glad we'd left so damned early. I'm constantly early, or on time, and J is perpetually late. Kind of like J and D's marriage. She's always on time, and he is always late. As couples we both wind up deferring to the partner who is late. It can be a point of frustration and embarrassment. But not today. We were ontime for once in our lives.

J ordered breakfast from the downstairs restaurant, and I tried to keep my mind from running amuk over how many eggs they would recover. Playing imaginary tapes of what Dr. Z would say as he conveyed that there were no eggs. The pain from my swollen ovaries helped to keep me from doing that too long, though. After a few minutes, I realized sitting still was futile so I went upstairs and checked in.

My ER was scheduled for 10:30am, but by 10:45 the good doc had still not arrived. He was still performing an U/S on someone upstairs who had no idea I was a floor below, stressing on my gurney. I told the anesthesiologist, "My eggs surely have popped by now." He laughed and said that in all of his years working, it was very rare for that to ever happen. Even one of the other nurses said I probably had another 4 hours left before they did it on their own. I was somewhat relieved. Dr. Z arrived a few minutes later, cheery and upbeat as usual. I wondered, "How on earth is he so constantly positive?" I've yet to see him frazzled. I faded out and came to only remembering him saying something about my having to be on reduced fluids for 5 days. I feel back asleep for probably an hour or so. What nice nap that was.

About 1, Dr. Z came by and told the patients next to us that they had recovered 7 eggs in her right ovary and none in the other. I remember Nurse J saying that someone with 9 follicles was scheduled before me. So they didn't get 2 of their 9. Not too bad. He next swung by our gurney. Still upbeat and positive, and with excellent bedside manner. Hard to imagine how he stays so positive considering he never takes a day off of work.

No beating around the bush. He came right out and said, "We got 10 of the 12." I was elated but still pined for the two that got away. I felt greedy even wishing for them considering I had more than the other two ladies who were also doing their ER this very day. I had visions, for days, of him coming to me and saying something on the order of, "I am very sorry but we weren't able to retrive ANY eggs. Are you sure that you administered the HCG correctly?" or some other horrible thing. But no sooner than we heard what we considered good news, my mind turned directly to, "I wonder how many will fertilize!!!???" It is uncanny how one's mind turns from one thing to the next. We put our ducks of worry in a row and we go after them one by one.

One thing that does concern me truly is that I hope that I have eaten enough calcium since I started on my heparin. My instructions said to eat 1g of calcium in addition to my prenatals, but how much calcium is in a prenatal? They all vary so much. Some have 200mg, some have 1200mg. Mine have 1000mg and I get some extra calcium in other supplements that I eat, but was it enough? One nurse said to me that I should get 1200mg a day total. If she is right I'm doing okay. But if that was what my prenatal, alone, should have, then I am in trouble. I really do not know how much is required for optimum egg development but, of course I have convinced myself that I was lacking. Another worry duck. I could kick myself for not having eaten more of the stuff. It also didn't help that the instructions didn't just say, "Make sure you're getting 1200mg overall calcium" and not even mention the "in addition to your prenatal" part. Another thing my mind has set me up to worry about. See? I've got my worry ducks all in a row. One after the other.

Tomorrow between 10am and 12pm we are to call the office and find out how many of our eggs fertilized. More worry. I am truly frightened to make that telephone call. I am so fearful that they will say, "We are so sorry. But nothing fertilized. Perhaps you'll have better luck in your next cycle". But if they do have good news tomorrow, I'll again be elated for a few short seconds while my mind turns to a new worry, for on Sunday we'll find out how many of the fertilized eggs made it to become day 3 blastocysts (or are they morulas at this point? I forget). Then I'll get to worry over the impending beta test. Then the NK Assay test and possible IVIg. Then the U/S for the heart. Then the amniocentesis or CV tests. It won't stop. I'll always have something to worry about. This is the beginning of a lifetime of worry.

My mother warned me that parenting would mean this. Constant worry.

And I didn't listen.

11 Hours Left & "Why is J Abstaining?"

I took my HCG trigger shot last night at 10:30pm. All day yesterday my ovaries hurt like motherfuckers. Today they're not so bad. Still tender but not as terrible as yesterday. This has me a bit worried. I would think that the HCG would cause increased swelling as it readies the follicles to do their thang and that the swelling would, in turn, cause increased pain. Not that I am a glutton for pain, mind you, but those twinges are a bit of a reminder to me that things are a'working' down there.

J mentioned to me tonight that he had abstained since Sunday. You would think that I would know this. But with all the hormones I've been injecting, sex has NOT been on my mind in the least. But why do I mention this? Well, if he has abstained since Sunday it means that those little swimmers of his are all backed up and many of them are 3 or 4 days old. I was blown away that he hadn't taken care of business at all in the past few days. But rather than say, "Sweetie. I'll take care of that right now" he instead argued with me and tried to make it sound like it was my job to remind him over and over (after EACH of his four semen samples) how utterly important it was to not abstain too long. I think Dr. Z cites two days as being ideal.

So I insisted he "out with the old, in with the new" for the sake of the eggs. I think I rattled off something like, "Do you really think I want my 12 brand new eggs that we spent $13,000 creating to be fertilized with your four day old sperm with possible DNA fragmentation at this point?" Yes, it was harsh. But dammit, what the hell WAS he thinking. Was he not thinking (really) or was it a case of passive aggressive behavior? I tend to think it was a little of both but I'll never really know.

24 Hour Wait

My ovaries are aching today. I sneezed a few times this AM and thought I might pop a follicle. I'm sure I'm being paranoid beyond all reason. This time tomorrow I'll be laying in a bed with an IV trailing out of my arm, praying that Dr. Z retrieves each one of my 12 eggs successfully. J will be upstairs in the "Jungle Room" tuned into Rocco doing this thing with an orgy of women. Dr. Z really must buy a DVD player...J comments each time he is to produce a sperm sample how frustrating it is to have to navigate an antiquated VCR and try to remain turned on at the same time. I've done nearly everything possible in order to make this work out. I'm sure I missed things. I could have done more yoga, meditated more, taken more walks and just exercised more in general. I could have eaten salmon for breakfast, lunch and dinner. I could have used my juicer as I had planned to do. There were the wheat grass tablets that I could have substituted for fresh. I'm sure that if this IVF doesn't work I'll ponder on each of these "I could haves" and drive myself completely batty. But not yet. For now I'll try to remain as optimistic as I can possibly be.

Ultrasound #2 & HCG Shot

Went to see Dr. Z by myself today as J was in Arizona working. He'll be back tomorrow morning and definitely in time for the egg retrieval. I was a bit worried about being a single woman in the waiting room, but there weren't many people there today. I didn't stand out as a woman, alone, trying to get knocked up without the support of my "partner".

They took more blood for E2/Prolactin tests as well as a new NK test to see if my levels are stable. If they are not, I'll be doing an IVIg infusion this week. Test results for the NK will be in on Thursday...tomorrow...same day as my egg retrieval. TOday I start my BLue Cross PPO insuance covered by J, so I am thrilled. It will cover my IVIg at 60%. Thank god. Otherwise it would have been $2015 CASH.

Then they put me into the U/S room. I was pretty tender from all the huge follicles. 2 on the left side were at 18mm and all four on the right side were as well. So 6/12 were big enough to go. He didn't bother to look at the others, or to reverify my uterine thickness. My uterine thickness was just under 9 on Sunday so it would surely be fine today. They upped my steroid to 16mg a day, cut me off of the FSH and lupron, and told me to take my HCG shot at precisely 10:30pm tonight.

One of the nurses said that prolactin is a stress hormone and they want to see the number under 30. Mine was at 17 when they took it last Sunday so that is a good sign.

Went to RWS after the appointment and bought a stove, then to Ikea to look at draperies to warm this ice box of a house, and then to acupuncture. I pleaded with them to not make me lay on my front as my ovaries ached too much. They complied. When I got out there was a phone message from Nurse J saying that I was to do my HCG shot at precisely 10:30pm tonight. Oh, and that my E2 levels had gone up to 1886! Holy shit. If they only wanted 100 per follicle, I'm definitely in excess of that. I wonder if there are more folicles lurking about that Dr. Z did not view on the U/S today? Hmmm.... Or maybe it's just that my follicles are just productive as hell in terms of E2? Well we'll know for sure tomorrow.

So at 10:30am tonight I took my HCG shot. Very nerve wracking to have this all end in a tiny shot. I was panicked. Was it the right day? The right time? Did I use the right vial? I overwhelmed myself with doubt. But my sidekick JS was here and she photodocumented the entire momentous event. We double checked everything. We triple checked everything. It all went off without a hitch and I even sold our old washer and dryer between my heparin and HCG shots. What an evening. Glad JS was here to hold my hand like the doting buddy she is.

E2 and Prolactin

Got a call from Dr. Z's office today. My E2 level was just over 900 and my prolactin was at 17. They want to see 100 units of E2 for each follicle. So mine can still rise a bit.

Ultrasound #1 & Our FSH Angel of Mercy

Sunday. J and I drove to Dr. Z's for our first ultrasound since I started the FSH shots. They found 12 follicles when we thought there was only 10. Thank god. Every single extra one helps us just that much more. Their size was closely grouped which was a good thing. Uterine lining close to 9mm, which is the thickness required in order to do the egg retrieval. So it would appear that I'm responding well to the drug. Dr. Z said that a 41 year old woman normally has 6 to 10 follicles. That seems high to me, but I am grateful that I have as many as I do. I only hope that the quality is as good as the quantity. There is always something to worry about with IVF. It just doesn't let up.

They took blood to test my E2 and prolactin levels. Results should be in tomorrow. I'll have to return in two days for another ultrasound, but J will be in Arizona so I'll have to make the drive myself.

So we're not sure yet if I will need more FSH. Holding Pattern was our angel of mercy and offered to sell me her extra Gonal F pens for a very reasonable price. I don't know what we would have done otherwise. Well we would have had to buy extra and the inflated price of $60+ for each 75iu. I figure at Dr. Z's prices that would be something like $360/day for FSH alone. Gulp. So we met Holding Pattern at a Starbucks on the Penninsula and chatted a bit about things. She is adopting a little girl from overseas and is embarking along her new path. She has gone through more than most of us can ever imagine in the realm of IVF so it will be heartwarming to see someone like her attain her goal of motherhood.

Aching Ovaries...

Okay, in my last post I crazily wondered what the hell was up with my not having a single symptom of the FSH. I must have jinxed myself. The very next day I started to have a bit of a twinge in one ovary. Kind of like an ovulation twinge. But that's impossible. The 20iu of lupron I'm shooting up morning and evening is doing the job of making sure that (ie, ovulation) does not occur.

So today I went to acupuncture and while I was laying on the table, Dr. Liu softely pinched my cheek and poked my belly and proclaimed, "You've gained weight! Your cheeks are looking chubbier!" Interestingly enough I haven't felt like I've gained weight, but okay, maybe a pound or two did sneak on. But what really got to me today is the feeling of heaviness, achiness in my ovaries. They literally ACHE today. Gosh. Are those 10 follicles finally filling with fluid? I am anxious to hear what Dr. Z will find when he does the U/S tomorrow morning.

So retrieval is scheduled for sometime between February 1 and 4, and the transfer sometime between February 3 and 7. I'm close to running out of FSH, maybe 2 days plus 4 vials left. So that makes 2.5 days left. One of the crones has some 450iu Gonal F pens left for sale so I'll hit her up for a few of hers. Thank god that she has them. Dr. Z wanted $60+ per vial, or $180 per shot...$360 a day.

Health Net Sucks Ass:
Got a stack of letters from HealthNet today. I opened up the biggest one. HealthNet has denied my appeal that they should pay for the anaesthesia for the surgery I had in October. I don't get it. My doctor was contracted with HealthNet. My surgery center was contracted with HealthNet. But the anaesthesiologist WASN'T? On further investigation, it turns out that HealthNet PPO isn't contracted with ANYONE in our county for anaesthesia services.

Mind you, there are still FOURTEEN other letters to open. If that isn't scary/stressful, I don't know what is. I imagine they're a stack of, "Sorry but we're not going to pay for a single lab test that you've had" letters. I don't know if I should even bother opening a single one of them until I know if this cycle is successful or not. I don't think the stress of fighting an insurance company is good for me. They're a wretched insurance company and I plan on fighting them in arbitration as well as at the state level. Bastards.

Lack of Symptoms is Distressing

So I've been on my FSH since last Saturday...which is kind of hard to imagine. The box still looks so full of vials each time I open it up that I start to wonder, "My god...did I miss a couple shots or what? How can this be?" But I am sure I've been on top of my injections.

I have not had many reactions to the medication though. When I started the medrol, and added in the doxycycline, I had a bit of a tension headache, but that is gone. My appetite is sporadic, sometimes there, sometimes not. Not sleeping too well, but we just moved so that isn't really surprising. But I had read all of these reports of how woman's ovaries become literally LADEN with follicular fluid, that they have weight gain, skin changes, all sorts of things. I haven't had any of this. If anything, I might have lost some weight. How can this be? Are my drugs okay? Did I make a mistake buying my drugs offshore? Maybe I'm not really injecting myself with FSH each day. Kind of distressing that I would feel better if I were experiencing SOME sort of side reaction. But I'm not. I should be appreciative, but I'm not. I'm paranoid.

Adding Urofollitropin to the Mix

So today was my first urofollitropin/FSH shot. I didn't do too well at this one. My water vials were actually glass ampules and my instructions were in French. So Nurse S's injection 1 on 1 training didn't prepare me for that. I tried cracking off the first one and I literally shattered the top. I went back to my instructions, tried to interpret as much as I could in French. It was no use. I wound up calling a friend who speaks pretty good French (he's Canadian). Also, his wife did IVF so he's up on technique. He tried to open an ampule and sliced his right thumb open. Blood everywhere. I felt so bad. Guilty even. But as it turns out, my interpretation of the instructions was as good as his, so we were no better for him showing up. Third time we were able to get the ampule to crack correctly. My god. What an ordeal. But then Nurse S didn't tell me about inverting the mixed solution to draw it up...or about the little area for pulling the needle head into in order to get the last drop.

We lost some of my injection to the kitchen floor and ceiling because, despite injecting some air into the vial, we still wound up with a vacuum. It was a bit of a mess. I can only hope that this won't matter "too much" considering that we only lost part of the first vial, and the other two were fine. I honestly think it's less stress to take 3 FSH shots and forget the whole process of trying to fit three vials into one shot. I had to follow up with an insulin needle...sucking out as much of each of the 3 vials as possible to get every last drop (especially since we lost some to the kitchen!) Egad.

I put in a call to Dr. Z's office about my snafu with the needles at 9:30AM today and didn't hear back from Nurse A til about 3:30 or 4:00. Sure took them a while. So Dr. Z said that since I lost 1/3 of one vial (of three vials total) that at my evening dosage he wanted me to do FIVE (!) vials. So I did. But I told Nurse A that it sounded excessive considering I had only lost a tiny amount. But she said that the first days are really important for "recruitment of follicles" - I didn't know this....interesting. One would assume that the "antral follicle count" is the definitive assessment of how many eggs you have. So does this mean that it's not really that true? Maybe my glitch will mean I'll get a few more eggs in the end? ;-)

One can only hope.

Day 1: Lupron

Morning regime:

Baby Aspirin
7 pills of Wheat Grass Juice
Herbal tea to wash it down with.

And now.....drum roll.....we shall add lupron to the mix.

The first shot was scary. Did I swab enough alcohol on both myself and the vial containing my lupron? Was it 20 or 25 units? I read the instructions at least 5 times. It was 20. Definitely 20. Okay. I could do this. Hell, I gave my precious kitty, Kiki, insulin shots for months before she passed away from diabetes complications. But why was THIS so scary? Really it is such a tiny needle.

John even offered to do it for me. No. That is scarier them me giving myself a shot. I declined. He layed in bed next to me, warm under his blankets, while I pondered the dreaded needle.

I pulled up the skin on my abdomen, near my right hip bone, and made a little flesh tent, like I did with Kiki, so many years ago. I took Julianna's advice and aimed for a little red freckle and I struck near to it. Tiny little burning sensation that didn't get worse. Not bad. I depressed the plunger. No increase in pain. No fluid came spilling out. Amazing. I feared that it would all leak out of me...all that precious lupron, gone. But it went in and I pulled out the insulin needle. Lupron back in the refrigerator, and the needle dropped into the empty red-colored sharps box with all it's biohazards warnings written all over it. I reckon, if the Urofollitropin shots are as easy, this won't be a problem.

That is, at least until we get to the big-assed intramuscular progesterone ones. I'll need a shot of vodka to do those.

Baseline Ultrasound

Today we went to Dr. Z's office for our baseline U/S. I thought he was going to recheck my antral follicles to make sure they were still there, but I guess that is not part of a baseline U/S, but more that they're looking for "quiet ovaries" and that my uterine lining is thin, as it should be at this part of the cycle.

They did two blood draws. One for a CBC and one for an estrogen test. Apparantly after I came off of the BCP's my estrogen should have dropped to less than 20. It did. Amazing. So I'm good to go on my lupron in the AM.

At the end, J and I had our injection training class with Nurse S. The tiny needles look easy enough, but it's those big honking progesterone ones that have me scared. My god. They are huge. And Nurse S said that if I do get pregnant, I'll have daily, yes DAILY, shots of progesterone until I'm through my TENTH week of pregnancy. I count that as 70 shots of progesterone, plus those that I take after ET. So At least 85 of them. I despise IM injections and I don't know how the hell I am going to get through that.

Programmed my new Timex Ironman watch to remind me to do my shots at 9AM and 9PM. Very nifty little thing if only it weren't so bulky and U-G-L-Y. I do wish they made these a little more feminine?

"Immunology Support" My Ass

Okay, so I joined this immunology support group that I found mention of on Fertile Thoughts. I read their files, perused their databases and, okay, I'm really impressed. They've done their homework on the subject of reproductive immunology to the point that they actually direct much of their own care through argument and persuasion.

So I crafted an initial, "Hey I'm new and infertile, too!" email...posted my NK assay scores, which APAs I test positive for, etcetera and I waited. And I waited. And then I waited some more. And I continued to read their posts chock full of "baby dust" and "warm wishes". Now I know what one of the crones meant by "choking on baby dust". I must concede that all this "baby dust" shit IS pretty infantile when you think about it.

But to continue, no one wrote back to me even if to say, "Hey Linda, welcome to the group!" Not a single person. So in my waiting, I pinged a few gals offline and struck up conversations with two of them. Real decent gals - but I wonder if they would have spoken to me at all if I hadn't pinged them offline? Hmmm.... I even posted replies to a few posts by some women, but they went unheeded. And late last night I posted an email with an "Yo Jane!" sort of email header hoping to hear from the reproductive immunology guru herself. But nothing. What the fuck?

So now I am left wondering why the heck these women bother to call themselves an "immunology SUPPORT" group? I just don't understand what it takes to break the ice with these women. It baffles me. But no matter. I'll keep reading their files, postings, etcetera. They obviously don't welcome outsiders and I sure as hell can't count on any support from them.

So much for the SUPPORT part of "Immunology Support."

Stress.....

Today I went to East-West University in Sunnyvale for my acupuncture treatment. I try to go three times a week but here it is Thursday and it's my first visit this week. The New Year holiday really threw me off schedule.

I've been seeing the clinic supervisor "Liu" and two ladies that are studying to be acupuncturists (I-Shen and I forget the name of the other, the latter of the two is graduating and I won't be seeing her much more). They're a wonderful group of ladies and they've really taken my infertility situation to heart. They are trying to ready my body for the IVF procedure in general and today I asked them to try to suppress my immune system (Dr. Z's advice) in order to get my NK levels down. They also treat me for stress and my constant low back pain. Today I had probably 5 needles in my head, I think those are for stress...and there was a trickle of dried blood left in my hair...very Frankensteinish. But after one of these treatments (for stress) I feel so calm and relaxed. It is as if someone slipped a valium, or two, into my mouth while I wasn't looking. If I avoid stressful situations the feeling can last me a few hours. Otherwise, it's gone within an hour max.

I'm not normally a total stress monkey. I do run a bit "high strung". I'm great at multitasking, optimizing, getting a shitload of stuff done quickly and efficiently. This ability to move at high speed is often interpreted by others as me "being stressed out". This isn't stress, to me. But talking or dealing with J can send me over the edge in a nanosecond. He knows how to push my buttons much too efficiently.

Me: "When you speak to me in that tone it sounds like yelling to me. When you yell at me I get stressed out. I'm not used to living with people that YELL."



J : "I'm not yelling! I'm just trying to be ULTRA CLEAR!!!!!"



Me: "Well, tell that to your face, why don't you?" Grr...!"

More stress:
Dr. Z's office, just today, decided to change my calendar without reason or warning. Oh my god. Okayk, so they don't know that we're in the middle of trying to move into a new rental, orchestrate the move of my 88 year old mother up here, and then J's got a gig in Arizona RIGHT at the time my frigging eggs are due to be removed, and they just went and changed the whole schedule by a few days!?!?!? I mean WTF? <<>> Then J's lab tests are all screwed up. He has Kaiser insurance so we took Dr. Z's lab requisition to them and asked them to run the tests. Today, over a week later, we found out that they didn't do the cystic fibrosis test, they ignored the sperm test, and for the sperm culture tests they stuck a rather painful q-tip up his penis to collect who knows what, and it turned out that this was, ahem, the incorrect way of gathering said specimen and now it will need to be redone. But the burning question that I have is this:

What the blazing hell did Kaiser do with my lover's semen??? Don't these idiots have any accountability for the human products that come into their laboratory?

Well, anyone with an IQ of 100 could look at the lab requisition from Dr. Z, look at the results from Kaiser, and infer what is missing from the Kaiser results. But, NoooOooOoooooOo, J won't do the calculation himself. He won't let me do it either. I asked him twice to fax me the results. He refused. He wants to fax the results and the requisition from Kaiser back to Dr. Z and have them tally a new test requisition. Well, we've got that, miraculously, but how long is it going to take him to get anything done.

Maybe DAYS later he'll finally get to doing his tests.

We hope.

All I know is that I've got a refrigerator drawer filling up with drugs and I do NOT want to have to do a 10 day course of doxycillin ONLY because J's semen cultures are missing.

More Stress.....

Today I went to East-West University in Sunnyvale for my acupuncture treatment. I try to go three times a week but here it is Thursday and it's my first visit this week. The New Year holiday really threw me off schedule.

I've been seeing the clinic supervisor "Liu" and two ladies that are studying to be acupuncturists (I-Shen and I forget the name of the other, the latter of the two is graduation and I won't be seeing her much more). They are trying to ready my body for the IVF procedure in general and today I asked them to try to suppress my immune system (Dr. Z's advice) in order to get my NK levels down. They also treat me for stress and my constant low back pain. Today I had probably 5 needles in my head, I think those are for stress...and there was a trickle of dried blood left in my hair...very Frankensteinish. But after one of these treatments (for stress) I feel so calm and relaxed. It is as if someone slipped a valium, or two, into my mouth while I wasn't looking. If I avoid stressful situations the feeling can last me a few hours. Otherwise, it's gone within an hour max.

I'm not normally a total stress monkey. I do run a bit "high strung". I'm great at multitasking, optimizing, getting a shitload of stuff done quickly and efficiently. This ability to move at high speed is often interpreted by others as me "being stressed out". This isn't stress, to me. But talking or dealing with J can send me over the edge in a nanosecond. He knows how to push my buttons much too efficiently.

Me: "When you speak to me in that tone it sounds like yelling to me. When you yell at me I get stressed out. I'm not used to living with people that YELL."



J : "I'm not yelling! I'm just trying to be ULTRA CLEAR!!!!!"



Me: "Well, tell that to your face, why don't you?" Grr...!"

More stress:
Dr. Z's office, just today, decided to change my calendar without reason or warning. Oh my god. Okayk, so they don't know that we're in the middle of trying to move into a new rental, orchestrate the move of my 88 year old mother up here, and then J's got a gig in Arizona RIGHT at the time my frigging eggs are due to be removed, and they just went and changed the whole schedule by a few days!?!?!? I mean WTF? <<>> Then J's lab tests are all screwed up. He has Kaiser insurance so we took Dr. Z's lab requisition to them and asked them to run the tests. Today, over a week later, we found out that they didn't do the cystic fibrosis test, they ignored the sperm test, and for the sperm culture tests they stuck a rather painful q-tip up his penis to collect who knows what, and it turned out that this was, ahem, the incorrect way of gathering said specimen and now it will need to be redone. But the burning question that I have is this:

What the blazing hell did Kaiser do with my lover's semen??? Don't these idiots have any accountability for the human products that come into their laboratory?

Well, anyone with an IQ of 100 could look at the lab requisition from Dr. Z, look at the results from Kaiser, and infer what is missing from the Kaiser results. But, NoooOooOoooooOo, J won't do the calculation himself. He won't let me do it either. I asked him twice to fax me the results. He refused. He wants to fax the results and the requisition from Kaiser back to Dr. Z and have them tally a new test requisition. Well, we've got that, miraculously, but how long is it going to take him to get anything done.

Maybe DAYS later he'll finally get to doing his tests.

We hope.

All I know is that I've got a refrigerator drawer filling up with drugs and I do NOT want to have to do a 10 day course of doxycillin ONLY because J's semen cultures are missing.

Let's Usher in the New Year with some Good Ol' MTHFR

Comcast was down for 4 days prior so today is a day of extreme catching up. Over 250 emails came pouring into my outlook inbox and it took the better part of the day to sort it all out. Oh how I would love a big juicy red to sink my teeth into right about now. But no....we're being "good". For as long as possible.

So my last test results FINALLY came in today. Health Line did the venipuncture for my MTHFR test on 12/16/5...after having botched the first test on 12/6/5 when they didn't draw enough blood and then to top it off, their main lab didn't bother to tell anyone about it. So a week went by and no test showed up. Lucky for me I've got the investigatory gene and the gripe gene and I figured out that something was amiss.

So they agreed to "comp" this test...thank GOD. It would have been something like $650 and I can see Health Net having a major cow over this one. So after about a week of trying to wrangle the test results out of them.

HN: "Oh we faxed you the lab results..."

Me: "But you didn't put any both tests on the page and there's no data for the one that you did send."

HN: "But it's right there where it says Test: MTHFR C677T/1298C Genotypr"

Me: "No that is not the result. That is Specialty Labs telling you what test they are running."

HN: "So you are the patient?"

Me: "Yes."

HN: "Well we can't fax you the test results."

Me: "Then what am I looking at?"

As you can see, we didn't get very far. But they did agree to fax the results to Dr. Z's office (I should have told them my fax number just so I could get a copy of my own test results!). Dr. Z's office emailed about 4pm today to let me know they'd finally arrived. I do test positive for a mutated version of the A1298C allele, but it's not a nasty assed version, or even the dreaded double helping. But it does mean that I'll have to supplement with Folgard...no Lovenox for me. No sirree!!

Oh, also accomplished ordering most of my drugs today, with the exception of the Bravelle and progesterone in oil that will be coming by way of the International Pharmacy in Middlesex, U.K. I wasn't sure if I sure if I should use www.IVFMeds.com or the International Pharmacy, but Modern Millie seemed to have researched the latter to the point that I am going to trust her judgement on this one as she IS the WOman when it comes to this sort of thing.

I will be so relieved when all of my drugs are ordered and in my hands so it will be one less thing to worry about....besides the fact that Kaiser screwed up J's sperm cultures...ggggrr.....

Overwhelmed by IVIg

I have spent the better part of the day faxing my prescriptions from Dr. Z to every pharmacy in the country on his list. The quotes are starting to pile in and it's becoming more and more clear to me that I'll have to order my Bravelle from www.ivfmeds.com or from www.theflyingpharmacy.com. I just can't afford these steep American prices. Anecdotally, the pharmacist of the latter commented that he's getting loads of patients from California. Maybe we can't afford our IVF meds and the high cost of real estate? Hmm... So the microdose Lupron kit will have to be compounded (it's a specialty item) so I'll go for the best stateside pharmacy I can get. Amazingly, my heparin isn't going to be covered unless it's administered by a nurse. Imagine that. They'd rather pay a nurse to shoot me up twice a day than allow me to do it myself and save all us a rather tidy sum of cash. Well no one said that the health insurance industry made any sense. Did they?

So last night while perusing the threads on FertileThoughts I found an immunology support forum on yahoo. These ladies know more about immunology and IgG's than most of the folks at IIC do. I also spent a lot of time reading the material at SIRM and at Dr. Beer's website. I must say that I am floored at the complexity of research that has been done in the field of Reproductive Immunology. With this much known about RI, why on earth aren't more RE's testing for these disorders? I can't help but think that the RE's that aren't testing are banking on repeat customers and, oh yes, the added $$ that these repeat customers pose to bring to them.

Today I spend some quality phone time with Chris of Medical Associates Infusion Center in Los Gatos (Dr. Beer's office I presume?), who told me that IVIg is often covered by Health Net PPO under two conditions. (1) Your doctor must first preauthorize for the IVIg by phoning Health Net, and getting their preauth form, and (2) Specifying that the IVIg is to be provided by Curascript (who only provide Gamunex as their IVIg brandname). In my case, I test positive for both APAs and NKs so the relevant CPT codes in my instance are 279.4 (primary immunodeficiency) and 795.79 (anti-phospholipid syndrome). Test results go along with the preauthorization and are sent to Health Net. Upon approval, a copy of the preauth is sent to Curascript and SVIG. Then off I go into infusion land.

It's a trifle unnerving to think I might have the pooled blood products of hundreds of people injected into me. Ick, ick, ick. When I worked in immunology at IIC, we'd often have to take huge vats of pooled human serum and process it (can't explain much further...those recipes are top secret!). We'd start by taking out the big proteins like fibrin...disgusting. The fibrin clots looked so much like chicken breast meat that I had a really hard time eating chicken for a very long time afterwards. I have a pretty high tolerance for things, a high "gross out" factor if you will, and the sight of fibrin clots in a vat of pooled serum nearly made me vomit on more than one day. I exaggerate not. So the idea of injecting something similar to that which I worked with kind of turns my stomach in a way that only another lab rat could understand.

It's midnight and my leg o'lamb roast is still in the oven roasting...maybe I'll get dinner shortly after midnight? Long day...

Viagra for Infertility? Who knew!

Finally Viagra has a purpose, a greater purpose I might add, besides inflating the flaccid penises of men whose penises should have long ago been laid to rest. Okay, okay...I'll admit that there *are* younger men that really do need the stuff, there are some genuine malfunctions of the penis to be had, but we have ALL heard of the horror stories of men in their golden years with perpetual hard-ons chasing their ladies around the house...ugh...woops, I've digressed.

The folks at SIRM have discovered a new use for viagra. It would seem that vaginal viagra suppositories can increase blood flow to the nether regions, leading to improvements in endometrial linings, and boosted IVF success rates. According to the Randine Lewis (author of: "Infertity Cure"), increased blood flow to the ovaries is a "good thing". One would imagine that increased blood flow would result in better quality eggs.

Hell, where's that box of blue pills TDL bought us in Mexico....

First it's APA, now it's IVIg!? WTF?

Okay, it was bad enough that my APA's tested high enough that I'm doomed to two shots of heparin a day, but hell I can top that. I just got word (just today) that my NK Assay (Natural Killer Cells Assay) came in and I'm "not normal". What does that mean? Well, on a scale of 0 to 5, 0 being normal, and 5 being the worst Dr. Z has ever seen, I am a "1".

What the fuck?

So I've done some very meager IVIg research and know that this means I have to get an injection of immunoglobulins...but damn, can't I just do this myself and skip the ever-so-expensive fancy assed clinical setting with the IV pump? This is just insane. The cost for IVIg here in trendy Los Gatos is somewhere in the neighborhood of $2000. But since IVIg is administered in units based on one's weight I am surely doomed. I weigh 162 most days, more than many women as I'm tall (5'10"), so I'm sure that they'll insist on some extra IVIG just because of that. OMFG.

There is no end in sight to this hell.

Excellent reading on IVIg here. Essentially: if you're +NKa, you have a 4% chance of conceiving without IVIg, and a 50-55% change of conceiving with IVIg. I'm sold.

Watch Where You Stick Those Needles!

Just stumbled onto a thread where an acupuncturist seems to think that a woman's choice of "injection site" might be interferring with her fertility.

The thread is here:

Question: today doc. give hormone shots around the bellybutton everyday ,sometimes the woman is instruted to give her self or her husband. --? a needle at CV5 is said in many ancient text to cause infertility. can this be the problem. i recently have 3 cases of women that for 3 yrs. have been through this , now they came to me . thank you for this site ,:Larry

Answer: Yes it is possible if it is given near Ren-5 a point which does have a history of use to cause infertility. However, the reason is also the hormonal manipulation itself which damages the ovaries. Giovanni

Actually, I've seen instructions from Dr. Z's office that say that you should place your injections in a semi-circle around your belly buttom so as to not overuse an single injection area. Using this instruction, one would eventually wind up hitting a few acupuncture spots here and there...even ones that might cause infertility or even miscarriage. I guess I'll be seeking the advice of my acupuncturist team at East-West to get a "body-map" of where I can inject safely. Damn...just ONE MORE THING to be aware of. Who would have thought?

The Day After

It's the day after Christmas and I'm feeling like a bit of a sore throat might be coming on. J & D's 23 month old was ragingly sick today and we were with them last night. I didn't spend a lot of time with him, but he was coughing a bit. 24 hours seems like too short of an incubation period so I'm looking backwards a bit more...maybe to Christmas Eve. I am willing to bet one of our guests was sick and didn't mention it. Sigh. I really wish people would stay home when they're sick.

Well, it's lots of Chinese herbs and turkey soup for me. Hopefully this one goes away really fast. We've got a terrible flu going on in our area called "The Silicon Valley Flu". Apparantly it's the one that nearly everyone in California is sick from. I read somewhere that getting the flu when you're pregnant is correlated with having schitzophrenic children (or something equally disasterous). Hopefully there's no effect to antral follicles when sick.

Oh...Dr. Z wrote today and said that the EPO and vitez (chasteberry) won't interfere with the functionality of my birth control pills. Good to hear. He even encouraged me to keep on taking them. :-) BMT was up today to 98.3...so the BCPs have kicked in.

Spinning Calvin into Existence

JS has said that she is certain that I will get pregant and have a boy. She assures me that she has a 100% success rate in predicting the sex of people's children. I'm not pregnant, she warns me, so making a sex prediction before I am actually pregnant has it's risks of being wrong. But she insists that I'll be a mom. (I just hope it is with this one IVF cycle...and not after the 6th or7th!).

So she has a premonition, if we will call it that, that I am going to have a boy remniscent of Calvin. Yes, THAT Calvin. The Calvin of Calvin & Hobbs. A strawberry blonde devil boy with much too much gel stuck in his hair who will do things that will make me shudder as a mom. This morning in an IM thread, we "spun Calvin into existence" kind of like how the three Witches of Eastwick spun Jack Nicholas "into being" as their ideal man.

Of course, we'd need a fluffy orange cat for his sidekick. Kubla will suffice if I can pry him from the clutches of his current owners who don't let him on the couch, don't snuggle with him, and put up barricades so that he can't socialize when company is over. I'd give that kitty bubble baths and a pillow on my bed. He'd be spoiled beyond reason as I mush up his face and plant kisses all over his orange head.

Mrow.

Christmas wish...

Christmas wishes to each of my 10 follicles to grow strong and hang in there for the weeks to come.

APA - Antiphospholipid Antibodies are NOT my Friends

I got my APA tests back yesterday, along with a plethora of other labwork that Dr. Z ordered. I had three positives and 2 borderlines which means they'll be adding heparin to my fertility cocktail mix. 3 ampules of Bravelle or Gonal F in the AM and a heparin chaser, and repeat in the PM. 4 syringes a day at minimum. Ouch. I will no doubt feel like a human pincushion after a short while. Sadly Nurse J said that if I was to get pregnant...that I'd have to continue the twice daily shots of heparin until the end of the 1st trimester and then they'd retest my APAs. If they were still showing up it would mean another 4 to 6 weeks of heparin...repeat.

Now the heparin is a rather inexpensive substance...lots of people take it for blood thinning as I've read online. But from what Nurse J said, if I am so unlucky as to test positive for MTHFR, then I might have to use Lovenox instead of the Heparin, and it is quite pricy. I didn't quite catch the significance of the three different allele patterns for the MTHFR. It's either aa, ac, cc. I'm not sure which of the 3 positive allele groups call for lovenox, and which call for extra baby aspirin and folic acid but I'll have my test for this back hopefully by next Tuesday and then they'll know which injectible blood thinner I'll be using.

And I was nervous about the AM and PM Gonal F shots? Sheesh....

Antral Follicle Count Today.....

We went and saw Dr. Z today. I had 10 antrals...last month at Nova I had 16. I was really bummed to have that many fewer. I did find an article online that said that taking aspirin can boost follicle/egg production, and last month I "was" eating a daily aspirin after my IUI "just in case". Kind of makes me simultaneously wonder and kick myself for not having had the sense to do that again this month. Grr.....

But in response to my shock at the number TEN, Dr. Z said "this is very good" and that if we had fewer that 6 then he'd worry. So I wonder if 10 is good, normal, or bad at the ripe age of 41. I have so many questions it's driving me batty. Can you actually have more or less follicles at the next checkpoint that were found on the antral scan? (I think he alluded to a "yes" with respect to their being more). Last summer my FSH was perfect, 7.5 with an E2 of somewhere in the mid 50's. Couldn't ask for much better. But since October it's been hovering about 11, dropped to 7.5 but my E2 skyrocketed to 92.

So today I was out in the garden taking in the wonderful sun, thinking "how can my FSH levels be so whacked out" and I had this eureka moment. I wonder if anyone has done a seasonal study on women's FSH levels? I mean this: most animals only breed in the spring...humans are thought to be animals that breed year round. But what if we're not completely ? What if we are indeed subject to some seasonal ups and downs in terms of women's FSH levels? FSH might only be high enough to reproduce in spring and summer months, and then it plummets back down a bit in fall and winter. Of course this would be very easy to check by looking at cumulative numbers for birthdates throughout a year and determining if there was a seasonal pattern. Hmmm...

Aspirin Increases Egg Counts!?

Aspirin & Infertility

Damn, last month after we did our IUI I took prophylatctic baby aspirin (81mg a day) just in case I did get pregnant. Right after that my AF came and I went to Dr. S to have my antral follicle count done on CD5. I had SIXTEEN antrals: 9 on the left, 7 on the right. Dr. S said that was "high normal" for my age. I was intrigued, and elated. But then just last night I found this article and read the following:

Some IVF patients are treated with aspirin and heparin or immunoglobulin to prevent pregnancy loss. Aspirin and heparin therapy is used for some women who have had repeated spontaneous abortions, even without APA problems. Doctors at the CER Medical Institute in Buenos Aires compared 149 women undergoing IVF treatment and who took 100 milligrams of aspirin daily with 149 also undergoing IVF, but who did not take aspirin. Study results showed that 45 percent of the women who took aspirin became pregnant compared with 28 percent of the women not taking aspirin. The study also showed aspirin appeared to contribute to increased egg production. Researchers retrieved an average of 16.2 eggs from the women taking aspirin compared with an average of 8.6 eggs from women not taking aspirin.

So I should have stayed ON the baby aspirin throughout my cycle to ensure a higher egg count. Drats. Why did I just find this right now? Why isn't this advertised EVERYWHERE? I probably should have stayed on the DHEA, too, but I was fearful that it was the reason my E2 levels doubled last month.

Sigh.

Labwork Hell

It's bad enough that Health Line laboratories mislabeled & lost my Mycoplasma/Ureaplasma and other miscellaneous cultures from back in October, but just last week, their phelbotomist failed draw enough blood to do all of my tests (what, 7 vials wasn't enough?). The lab person said that one of the vials was halfway full. Hmm...I know she was having a busy day, but the needle was hanging out of MY arm...I wasn't going anywere til she was done. So my MTHFR (methyl tetra-hydrofolate reductase) test slipped by. Methyl tetra hydrofolate reductase. What a mouthful.

Yesterday I called Dr. G to see which results had came in. They said, "They're all here." Well skeptical me wasn't too sure about that. Me and the PA compared lists....and lo and behold, the MTHFR was missing. Also missing were the APA (Antiphospholipid Antibody) test and NK (Natural Killer) Assay that Dr. Z requested. So I went back to Health Line laboratory today and they redid the MTHFR test and offered to do it gratis. Okay, I'm happy. After hearing that it's normally a test that costs close to $700, I won't bitch too much more.

So I called the lab that did the APA test. The results were faxed to Dr. G on 12/8? But again, I'm feeling like a Doubting Thomas: I just called Dr. G just yesterday and they weren't there.

I next phoned the lab that did the NK panel. Luckily these folks have their act together. They said that the test was about to be mailed off but that they'd be glad to fax it today, yes today (!).

Long story short: Health Line has seen better days, but I guess they redeemed themselves a bit by comping the way too expensive MTHFR test. So I should have all of my labwork in by Monday or Tuesday and I'm sure by then I'll be knee deep into negotiations with the anaesthesiologist over my October surgery bill. Another week, another mindless crisis.