The Day After

I successfully spent the entire day absorbed in my work, trying as best I could to not dwell on what happened yesterday, or more accurately, what DIDN'T happen. I am pretty much cried out to that point where my eyes felt heavy and sticky, the only solution is to just sleep through it all.

I think I am still in shock. I'm nearly sure I am, for I ignored what would have felt so good...sleeping...and instead of sleeping, I threw myself into putting my mother's house on the market. I started at 9:00AM and it's now 2:00AM, and I just finished the final touches on the faxes which have to be sent a mere six hours from now. Selling her house is closure on our lives in LA. It's a rather big deal for her since she moved into the house in 1953.

So I threated that I was going to LA if this cycle didn't work. There was something about wanting to lay in the sun and soak in rays. And as promised, I am leaving for LA on Wednesday...I have a Broker Tour on Thursday, Open Houses on Saturday and maybe Sunday, and will be back on Sunday, or maybe Monday. Mom wants to take Highway 1, passing through Big Sur, but that's a drive that needs to be started early in the day to appreciate...which means maybe leaving on Monday if we hold the house open on Sunday. I'm not sure if I'm looking forward to this trip, but I think Millie's advise about just getting away and keeping my kind off of things is right on target. (But then again, her advice has always been awesome. :-)

You who visited and offered kind words and support...thank you...you'll never know how much that means to me. Especially because all of you have been here, on the receiving end of this shitty beast called infertility. It breaks you down, kicks you. It is unforgiving and unfair. I cried last night about the wretched crack whores and their myriad of babies...and the utter unfairness of it all.

But on a brigher note, I know I'm going to get to see a bunch of you at the picnic on June 4th, and I am so looking forward to being with people "who can relate".

Drinks, Anyone?

I've had wonderful uterine cramps for two days, so bad, that I told my friend JS, "There is so much going on in my uterine area that I will be blown away if we're not pregnant."

Blown away, I am.

Beta: <1.0

Not pregnant.

Kind Nurse C said that I am welcome to come back in two days and do another beta "If you'd like to". That would be on 12DP3DT. Like, let's be totally serious. Is there really any chance in hell that a beta less than 1.0 on 10DP3DT would "come around"? Do they say things like this to torture us? Give us a shred of hope where there is none? But let's entertain this just for a second. How late can implantation BE? I'm at 10DP3DT right now, and we're already at the far end of the spectrum, or so I would think so.

If there is a chance in hell, please tell me.

I feel like an idiot for even asking this question.

And to make it even more confusing, she says to me,

"You need to stop the heparin, the parlodel, the PIO, and the suppositories. If you want, you can do the second beta here or you can do a HPT at home."

Me: But a HPT is only sensitive to 25mIU HCG.

She: Oh, some of them are more sensitive than that.

Me: No, that's as sensitive as they get. So if I stay home, but the most sensitive HPT, it would still show negative even if my beta did miraculously go UP. I mean, betas double, 1 would turn into 2 or 3. Not 25, which is what a HPT would need in order to pick it up.

She: Silence.

I don't think she was getting how utterly inconsistent what she was saying was. Okay, I really think a lot of nurses rock, but really...they hand out RN licenses with only introductory chemistry required in this state. Not exactly rocket science.

And to boot, if there WAS a chance in hell of my beta turning around, why the fuck would I even consider stopping my PIO or heparin? I mean, those sweet chemicals are designed to keep my embryos alive.

So, her advice: "Cut off their lifeline, but if you think you might be pregnant, go ahead and come back in two days (or do a HPT)."

Egad. As sweet as she is, I'm not sure what the hell is going on in the lovely head of hers.

So after this conversation, and after JS had left me as consoled as I could be, I dialed up J on his cell with the news. He was working a sound gig in Marina today and wasn't able to be here for the depressed event. He was more shocked than I. I cried as I explained Nurse C's insane dialogue with me and what I saw might be some of the things we'd want to do before the FET.

Ever the optimists, we immediately started looking for "what on earth went wrong". There's so much. Really, there is. So many tests that Dr. Moustache could have done but he just didn't see them as necessary. J said that since we've blown nearly $13,000 on this cycle that there really is no harm in continuing PIO until the second beta RECONFIRMS (ahem) that we're not pregnant. I would tend to agree that it's not over til it's over but, ladies, aren't we just playing in the realm of fantasy and dreams at this point? Someone please tell me if I should be taxi-ing over to the Black Watch Pub for a round of pint sized kamikazes.

We had six beautiful, grade 1 embryos. Why didn't they implant? What the hell is so toxic with my uterus that nothing can grow there?

Where do we go from here....?

We are optimistic, but we are drained as well. Emotionally. Financially. Physically. We're wondering, at this point, if we shouldn't follow, no, RUN, in Statia's footsteps and take our embryos to Dr. Next. I am feeling extreme guilt at this moment for having such incredibly fucked up tubes and immune issues. I feel guilty for spending so much of our money trying to have a child that we could have spent a couple of SUMMERS in the south of France. How does one get over this guilt? J has been an angel to entertain my incessant yearning to be a mother. But at what cost? J said he could live a childless life, but honestly, I haven't made that peace with myself just yet. I've always seen myself, sometime, somewhere, with a child of my own flesh and blood. It's always been a distant "something I'll get around to doing....sometime."

When do we say, "Enough is enough"? I don't know where my limit is. I'm pushing 42 and my time is short and I'm utterly depressed that I had blinders on my whole life, thinking motherhood would be something I'd do on my terms. "When I'm ready."

What was I thinking?

Answer: I wasn't. Thinking, that is.

We're beaten down, but we're not dead, yet. Even if we feel like it. I think we're both so shocked that this failed that rather than give up, we still have hope. I am so sad that Dr. Beer has died. I think that man is, was, our hope. And he's gone. Dr. Moustache is one of the only doctors in the area that even comes close to following his protocol, and he falls way short of really following it.

And Dr. Beer's office isn't taking new patients until the replacement doctor shows up sometime at the end of the summer.

How are we supposed to wait that long to START our in-depth immunological testing and treatment? And I already know that Dr. Moustache will put up a fight to do the in depth testing. He'll tell me to see Dr. T, whom I have a deep disdain for after he charged me over $200US for a friggin' consult.

So we're making our own list of things to explore before our FET. Most of it hinges on completing Dr. Beer's immunological testing and, maybe, even Dr. Toth's, but I don't know how we're going to get the tests ordered, or interpreted, in the absence of Dr. Beer and with Dr. Moustache hostile to me asking for them in the first place.

I'm all cried out for the time being. It's hot and although drinking sounds good on the surface, I tend to get further depressed when I drink, as J pointed out. He's right. Drinking when I'm down, just takes me further into despair.

I don't know what heals this sort of pain. I just don't.

10DP3DTBeta Day

Last night before going to bed, I read over at Thalia's that the brave girl POAS and got a BFP. This is the first good news I've read in a great while and I was so excited. This morning I checked in and read that she's started to bleed. I pray that it's only implantation bleeding and that all will be well. Please go on over there and give the girl some much needed support.

Today is Mother's Day here in the States, and it's my beta day.

I am nervous as all hell.

So off to shower and dress...and then a 50 mile drive to the clinic. I could have done the test closer to home, but since I am still classfied as "infertile/non pregnant", the test wouldn't be covered by insurance and would cost something on the order of $300US.

J is working today and so my closest friend, JS, has offered to drive me to the clinic. What a godsend that is. I haven't driven since my retrieval as our cars are all manual transmissions (except mom's camry, of course). But it's a lovely drive on a highway that meanders through hills, the bay on one side, and a mountain range on the other. It's what one might call a meditative drive, so I'll zen myself into a state of blissful betawaves and I'll be home before I know it.

9DP3DTThe 2WW becomes the 24hW

10:21PM
Stuffed to the hilt on Chinese Five Spice Chicken and Seafood Delight in Garlic Sauce, we waddled through the Borders in Los Gatos, trying to find last minute Mother's Day cards for our respective mothers. J was successful, but I was not. My mother only reads cheap paperback romance novels and I seriously wouldn't know which one to buy or not. None of the more interesting books on Mother-Daughter relationships would have captured her attention for more than a nanosecond. So perhaps I'll take her to lunch or dinner instead. I feel like a terrible daughter...but I think that is about all I can muster up at this late hour.

If it weren't for my horribly aching ovaries, I would have declared my attempts at not thinking about my nether regions a succcess. But I failed and so I am off to bed.

7:24PM
Bills are paid. By some strange miracle, PG&E actually owes me $125 so we didn't have a gas/electric bill this month. I'll take that as an omen of more good things to come.

Cramps actually picked up a bit ago, along with a racing heart, and just an overall feeling of weirdness and uneasiness...but in typical fashion, they're gone again.

Heading out for Chinese to distract me further.

Dr. Moustache's office emailed to verifiy that I willl have my results tomorrow. On Mother's Day of all blessed days. Some friends and family have commented on this coincidence with, "Oh, your test is on Mother's Day. You'll definitely get pregnant then!" Talk about pressure to perform.

Tomorrow will either be the first Mother's day gift I'll ever receive, or it'll be a constant reminder of my failure.

Let's hope for the former. (Knock on wood, spit, throw salt, and make signs against the evil eye).

2:26PM
We hit Whole Foods for Omegas, Ace Hardware for chain and ceiling hooks, and Trader Joe's for vegan cookies and bananas dipped in chocolate.

I would have shopped longer but mom, at 89, is a madwoman behind the wheel and I could not take a moment more of her driving. I think my life flashed before me a few times. It is, also, amazingly difficult to get in and out of a Toyota Camry when your stomach is bloated from heparin injections, and you've insisted on cramming yourself into your slim fitting jeans. I had them halfway zipped down, very tacky, but no matter, it just didn't work.

There is something to be said for the ease at which one can enter and exit from a Landrover Discovery. It's like sitting in a nice lazy boy chair. I may have to tell J that we're taking ours off of the market.

10:30AM
The 2WW has evolved into the 24hW...and the butterflies in my stomach have evolved into creatures the size of flying saucers.

Maybe I'll go and pay bills?

That's guaranteed to get my mind off of my uterus.

8DP3DT: Luteal Day 12

J's mom, DC, who lives in Sonora, came to stay with us last night on her way to Monterey, where she plans on spending a few days with a couple of her girlfriends. I'd hoped that she would have stayed longer than one night with us, but she promised that she'd stay longer on her next trip out.

DC is a certified massage therapist, and she has practiced for the last 20 or so years. But she decided, recently, to give it up, and so yesterday she brought us her massage table. It's an older table, but it's fairly lightweight and easy to break down and move. It has an older vinylish cover on it, kind of a baby barf color, that I think I'll replace with an offwhite or sky blue color in a similar fabric. A project for another day though. She folded it out in our bedroom, showing me how it "goes together". Simple enough. I can do this. I'm not sure what we're going to do with in the meanwhile but, hell, we now have a massage table.

DC gave me a nice & relaxing massage, a brief one and only on my front side as I didn't think that I could bear laying on my stomach for a long period of time. I'm just too bloated. Honestly, I could pass for someone in her second trimester right now. I know that it's a consequence of the heparin shots, and maybe some lingering fluid retention from the ER.

One thing I noticed yesterday is that, at some point, my cramps really backed off. This distressed me. I actually found a bit of solace in those cramps because it made me think that SOMETHING was going on in my uterine region. My first paranoid thought was that the massage might have been a bad idea. My acupuncturist said there are plenty of acupressure points one has to try to be aware of, and to avoid, while pregnant. Because of this, I told DC to just give me a very light massage, nothing even close to deep tissue for me yesterday. There were a few moves that gave me cause for concern, but I might be carrying her grandchild, so I'm sure she was careful. But of course, because my cramps kind of backed off yesterday, I looked at the timestamp correlation between the two events and immediately started to conclude that the "massage caused that" to happen. I know that's just paranoid fantasy and I tried earnestly to push that thought away.

Late last night, about 3:30AM, the moon was so full and bright that it shone into our bedroom patio like a spotlight. We have very sheer white tab curtains that hang in our bedroom, so the morning sun, and now the moon, really lets in. I guess we have not before noticed how bright the moonlight could be in our bedroom because the last time we had a full moon we were likely still in our 40 day onslaught of rain. We've only been here since January, so we've mostly experienced cold weather and rain here.

But the moonbeams were shining in through a separation in the curtains, and directly into my face. It was a bit surreal. Sleep would be impossible until the moon moved below the edge of the patio cover. So I laid there, unable to sleep, obsessing about my lack of cramps, wondering to where they had gone. At some point I drifted back to sleep.

This morning the cramps were there for just a second and then they vanished once again. I mentioned to J's mom that this was really distressing me and she said that maybe implantation cramps are fleeting in that they literally only hurt during implantation and once that process is over, there is no more pain until the next process begins.

She has a point.

Now you see why I am a bit bummed that she only spent a single night with us. She is fairly level headed and can wade through any situation and find some logic. And comfort.

I think I will peruse FertileThoughts.com and see if I can get some of the fertile ladies there to substantiate this. But my guess is that DC is right on target. She often is.

So much for my attempts at not obsessing. :-)

IVIg: The New Botox?Progesterone: The New Viagra?

All I know is that ever since I did IVIg last Wednesday, my skin has looked great. I've arisen to rosy cheeks each and every day. And get this: my eyelids even looked taut enough yesterday so as to temporarily dissuade me from upper eyelid blepharoplasty.

Strange, but true. I did a double-take in the bedroom mirror yesterday afternoon. I felt like shit, bloated and bruised from the heparin, but hell my skin looked rather good!

The first day after IVIg, I felt rather warm, overheating even, so I discounted the rosy cheek thing. But it's persisted long enough that I've started to wonder. But at $2015 a pop for the IVIg drip, I don't think that ladies will be running out to get this in droves.

TMI Warning

In my first IVF cycle, Dr. Moustache distinctly told me, "No sex, or orgasms!"

A cruel joke has been played on me by the RE. I am convinced that progesterone works like viagra. In both of my IVF cycles, as I get towards completing a week of the PIO, I start to get, well, rather RANDY.

Okay, I feel rather weird, and a bit extroverted, telling the world that progesterone seems to make me horny, but, there you have it. I'm sure someone else out there has had this experience. Please do pipe in and share. I would get some solace knowing that I'm not the only progesterone perv out there.

So, the NO SEX order has been handed down by Dr. Moustache. But I did ask my fav nurse, Nurse A, at Dr. Moustache's, "What happens if I, well, have a dream and the EARTH SHAKES while I'm asleep? It happened last cycle, you know. It actually woke me up. What then?" I wondered, "Do the embryos all dislodge and die?"

The nurse was rather amused, laughed a bit, and said it was probably okay but I fear the directness of my question might have unnerved her enough to not give me an entirely honest answer. Funny that we can talk about the stringy crotch snot that emanates from our respective nether regions, but when it comes to orgasm, everyone gets queasy.

So yesterday I became a bit concerned because it seems the progesterone is starting to work its magic. Little I can do if I've served up a dream with Christopher Noth. I'll be helpless.

Oh, and the cramps reappeared last night. Just when I started to think, "Damn, I guess they've all been in my head", they came back. They were there this morning when I woke up, through my morning PIO and bathroom routine, and they're still there now. I swear, it's either the evilness of the Progesterone, once again, making my uterus think that it's pregnant, or maybe, just maybe, something is going on down there.

We're focused on the latter. :-)

6DP3DT: Luteal Day 10

Things are Piling Up
I am supposed to have lunch with an old friend today, but I'm not quite sure I am ready to go out and mingle in the fertile world just yet. They're so naively optimistic that I would rather sit home and channel surf then endure the unknowing comments. I shirk from this interaction. I appreciate their upbeatness, but it's hard to counter the voices in my head that keep spewing out statistics to each cliche they spew out:

"You just need to relax!"
"Maybe you need to drink some wine?"
"Maybe you two just need to take a vacation?"
"Don't worry, it'll happen in time!"
"Maybe you should adopt...everyone seems to get pregnant after adopting!"
"You put how many embryos in? What if all of them grow!!!???"
"Don't worry. It'll happen when the time is right."
"Are you SURE you really want children?" (This one kills me. We've spent $25,000 trying to have a baby. YES, we are SURE we want a baby for chrissake!)
"Why don't you just get a cat instead?" (This came forth out of the mouth of my biological mother. Now you know why she gave me up for adoption?)

Each time I meet with someone and happen to mention our fertility ordeal I obtain yet a new unsettling comment to add to the list. They can't possibly know how our hopes were chopped up in little pieces in the first IVF cycle. We were naive then. We thought, no hoped, that first cycle would work. I guess we all go there, though, don't we? Julianna echoed this sentiment perfectly on her blog when she said, paraphrasing, "Everyone thinks they'll get pregnant on their first try."

I've also a tentative meeting, sometime today, with a lender friend who is going to teach me how to do loan processing, a means of filling in the dead time between house sales, but that, too, seems a bit much right now. He is more sympathetic to the cause...he seems to have a heartfelt viewpoint on the situation and takes care to not make comments that offend. But I still feel like invisible ropes have me chained to my computer chair and, when not there, to my sofa.

And although I have been laying low for six days, you think I would have kept up on things business wise. I have a home office. I should be able to get things done rather effectively. But no. I've got bills to pay, insurance issues to deal with, and I haven't touched any of it in the last week. I have been reckless.

My desk has a stack of EOBs from Health Net that are rather curious. A lady by the name of Julie Field is a patient over at Rosalind Franklin University, the lab that Dr. B uses for his tests. So Julie's lab bills and other things have been forwarded to Health Net using my subscriber ID number. I cancelled Health Net as of March 1st, but RFU continues to submit bills to Health Net on her behalf. I keep calling RFU about this, sending them faxes with copies of the EOBs, trying to help resolve this situation...but the EOBs keep showing up. The poor girl must be wondering why none of her bills are being paid. I'm sure she is near to freaking out by now.

And that's not the only weirdness. A doctor or provider by the name of Mher Babajanyan, of Diagnostic Service Group in San Jose, is now billing my insurance for $1900 worth of radiology work. Who this man is, or his company, I have no clue. But I am starting to feel that I'm being subjected to some bizarre form of health insurance identity theft. Imagine if you will, that you're a person that needs some tests to be done, or a procedure, and that you don't have any insurance. You don't care if you have a long relationship with the provider. You just need a test, a prescription, a quick fix, and you're off and running. But you're lacking insurance. No matter. Just run off and steal someone else's health insurance information and get the work done? Doctor's often don't bother to ask for identification. It's an easy scam. I only wonder if that is part of what is going on with my insurance.

On the 2WW side of things...there are still no overwhelming symptoms of impending pregnancy other than a mild cramp here and there and I wonder if that is all in my head at this point? My friend JM said that she didn't really have any signs at all with her first one until about 14 or 15 days and then it was some nausea that hit her right after she got the pregnancy test results in. She wonders, like me, if it was more mental than anything due to its timely appearance after the phone call.

Coloratura said she didn't have any symptoms at all for the first FOUR WEEKS.

One can go mad reading the posts on the boards of women touting their oh-so-obvious signs of pregnancy...and then looking at oneself and concluding, I can't possibly be pregnant because I'm clearly lacking, sign A, sign B, and sign X..."

So I am going to try to stop obsessing and just go with the process as much as I can. I don't feel that I'm stressing, but I do tend to be oblivious to my own stress at times. I don't think it's there, but I think I've lived such a stressful life that when it eases up just the tiniest bit, I suddenly feel "stress free", but in reality it's still there.

Not obsessing doesn't mean that I'm going to stop laying low and taking it easy...but it does mean that I'm going to try analyzing the hell out of every twinge.

We'll see how far I get.

I'd really love to see some serious spotting right about now.

5DP3DT: Luteal Day 9

Statistically speaking, implantation should have happened sometime in the last day or so. I'm not sure what the 1st SD is for the data I posted a few days ago, but I realize that "they say" that it can happen as far out as 10 or 12 days. But what "they say" isn't really backed up by solid data, for which I had a great admiration and love (I did two senior theses in data analysis in college...just for the fun of it. Now you see whereof the madness derives?).

Luteal day 8 has arrived, and my cramps have come and gone, and then meekly returned and then left again. No spotting, no uterine tugging, no sore nipples, no nothing. I attempt to keep my hopes up and remember that my own mother had no signs of me until I started to kick wildly about three months or so along the way. I started kicking very very early, she alleges, and never let up once I got started. So if I am to be like my mom, perhaps there will be no sign of my little one(s) arrival until they, too, start to get tired of their cramped surroundings.

I'm tired of being a couch potato...but each time I feel a little twinge in the vicinity of my uterus, a voice in my head says to move slowly...take it easy...just a few more days. My acupuncturist said for me to move slowly, no jumping, no fast movements, to lay down often. In her words, "You are older! You need to really take it easy right now for the baby!" I listen to her. My butt has left a near permanent impression on the couch. The pair of ottomans are pushed up against the couch, and covered with an ultra thick blanket, so as to form a huge makeshift bed in front of the fireplace and TV.

And that is where I am headed.

4DP3DT: Luteal Day 8

abc7news.com: Technique Guarantees Embryo Implantation

www.westcoastinfertility.com

A doctor in Beverly Hills is apparantly and successfully implanting embryos directly into the uterine lining of women and getting them knocked up at astonishing rates.

Too good to be true?

Well yes, actually. Modern Millie just pointed out that his 2003 CDC stats are "abyssmal" to say the least (this is a year after he presented this technique at ASRM), and that a 50% rise in his rates means, well, nothing. Weird that he's getting so much press about this.

And I was just about ready to board SWA from SJC to LAX with a big metal cannister full of frozen embies.

The device he uses is patented. Bastard. I guess this means Dr. Moustache won't be doing this anytime soon because we know he's a cheapskate. (Have you SEEN the shitty old VCR in his semen collection room?) But this technology in the hands of someone with stats that are decent could be mind blowing. Hopefully he sells the patent, or it's just easy enough to do with a hysteroscope or similar device.

On the uterine front...mild cramping here and there. It might just be the progesterone still. We're hopeful, but I'm slightly pessimistic and J's pissed off at me for it. I'm trying to visualize and be as positive as I can...really I am.

It's hard. I keep looking for "the next thing".

Sunday is like forever away.

3DP3DT: Luteal Day 7

Warning: Graphic Post
Implantation can happen anytime from today to day 12...so I'm just waiting, on pins and needles for something, anything, to happen.

I've been having cramping on and off since yesterday, but it is likely just the progesterone making its presense known. But I ignore this simple possibility and, instead, imagine that my little embies are boring their way into my uterus, little trophoblast feelers sticking into the lining, draining my blood like little vampires.

I'm still riding the couch for the most part. I put a poll on Fertile Thoughts in the pregnancy section to see what women did after their transfer, if they indeed got pregnant, and an overwhelming number of women said that they stayed put and didn't do anything for days on end. Dr. Moustache may say that there's no data to show that staying still helps, but my informal poll shows that most respondants that got pregnant stayed put and rode the couch for days on end. So I'm going with what I've found. I'm feeling totally lazy, but I want those little guys to have every tiny little advantage that I can give them.

The worst part of this 2WW is that I'm scared to death to fart or crap. Everytime I go to the bathroom I shudder to think that they've possibly slid out with the waxy progestrone pussy pop stuff. My spotting is gone...I told Dr. Moustache that seeing it made me worry that the embies would somehow slide out with it. He reassured me that it wasn't coming form the uterus, but from the 18G or so needles that they used for the ER procedure. He kindly gave me a sterile rinsing out on the table in the OR (in front of J no less), transferred the embies, and then confirmed that the cathetar was totally clean, no uterine lining residue on it. I haven't seen a smidge of spotting since then so I guess he was right. I'm glad he gave me the rinse because I would surely be freaking out if I was seeing bits and pieces of tissue at the point in the game.

I think I should have nabbed some of those valiums they were handing out in the OR on ET day.

Back to the couch for me. There's a Jane Fonda special on this morning and Barbarella has already started. Classic!!

2DP3DT: Luteal Day 6

J finally scanned the pics of the embies at work yesterday. There are four 8 celled, one 9 celled, and one 10 celled embryos. The top two are 8's, the next 2 are, left to right, a 9 and an 8, and the bottom two are, left to right again, an 8 and a 10 celled embie. I don't know how they can tell after about 7. But my favorite one is the upper left. It looks a bit like a flower.
:-)

Last night J didn't get home from a gig in Salinas til nearly 1:30AM or 2:00AM, and didn't get to bed until 3:30AM (surfing the internet til the wee hours of the morning as usual). I woke him at 8:30AM to do my PIO shot. He groggily rolled over and stuck my left hip like an expert and then went right back to bed. How he has learned to accomodate this infertility regimine into his life. J, mind you, who near to faints at the sight of blood, who can't watch a phlebotomist stick him in his own arm, now is able to stick ME in the hip without being fully awake or without contact lenses in. I have to say I am totally in awe at his transformation.

So we're at two full days past transfer. According to Advanced Fertility in Chicago implantation should be right around the corner:

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.

They did not find any evidence to support the concept of an embryonic diapause in humans.

So according to the above excerpt, the earliest we could expect this festive event to kick off would be tomorrow,(Sunday) and the far edge should be later Monday afternoon. Dr. Moustache thought it likely that I had a very early implantation failure last time due to my HCG not being "0" at beta #1, so maybe my little guys try to implant earlier rather than later? The studies mentioned above might be a bit more interesting if they had looked at implantation rates against variability of cell numbers of blastocysts and morulas. Obviously a 10+ cell blast is going to implant sooner than a 5 cell blast.

Don't cha just love data?

Interestingly enough, and maybe it's the power of suggestion, that whole body-mind thing, but I've got some cramping going on today. It comes and goes, but doesn't really mimic the posts I've seen of precisely placed pain right above the pube bone. But of course I'm totally focused on this and am laying low for a few more days. It's still day 5, so a bit early for me to freak out.

But that won't stop me.

1DP3DT

We knew we had 14 embryos a few days ago, but it wasn't until transfer day, yesterday, that we knew how many made it.

All 14 were viable, but 2 were likely stuck at the 3 cell state. 12 were left and they were split 6 grade 1, 6 grade 2. Last time we had one grade 1 embie so this was a huge increase in good embryos for us. After a few minutes of discussion with Dr. Moustache, we agreed to transfer the 6 best, and freeze the other 6. The 3 celled embies would be watched for a few more days and if they caught up they'd be frozen as well.

Here's the results:




In the OR, Dr. Moustache showed us the photo of the embies that were being put back in. One of the 9 celled ones had been reclassified as a grade 1, so it was being put in. So we put in four 8 celled, one 9 celled, and one 10+ celled embryos.

As I was being wheeled out, Dr. Moustache said our embies were "beautiful" this time and was really amazed at how the number and quality had changed from the time previous. With 12 to choose from, it now made me regret that we hadn't done PGD. How were we to know which ones were good or bad? There was no way of telling. He asked me, "What did you do differently this time?" I mentioned my wild drug mixing, my omegas, and that I stopped taking vitex/chasteberry and EPO. I could have told him more but they were wheeling me away, and beside, the valium was still in effect and all I really wanted to do was first pee like a racehorse then sleep a bit.

But back to how to choose the embies....PGD would have cost us $3500. A price that we freaked out over. But a FET and freezing would cost basically the same, maybe more due to the drugs that I would need. In retrospect, I would have done the PGD at this point just so that we would be able to make a educated decision this time around. As it stands, we might have picked 6 good ones, but maybe not. Our good eggs might be in that second batch of grade 2 embryos, but we're going to lose a few to freezing/thawing, and hopefully our good ones aren't lose. Again, I really think that with this many embies, PGD really was the way to go.

So yesterday I stayed in bed for 24 hours, as per the doctor's orders. It was hard to do. My body ached from lack of movement, the room got muggy and warm yesterday and I dozed off and woke up a bit too warm. I panicked that I cooked the embryos. My temperature read 98.7. A bit higher than normal for me, but the progesterone also makes one run a bit higher. I also woke up at 3:30AM sweating a bit. I tossed off the covers and had J open up the slider. It probably dropped to the high 50's in the bedroom, but god it felt good.

This morning I noticed that my temp runs warmer if I stay in bed, 98.7 to 98.8 but drops to my normal 97.7 once I get out of bed and go elsewhere in the house. So I'm going to stay out of the toasty bedroom in fear of cooking my little guys. I only hope, no pray, that they're all okay, that the small change in my temp didn't do them in. Part of my erratic temp is likely also due, in part, to the IVIg that I did on Wednesday...but I'm only guessing. Anyone else feel overheated after transfer???

I know I'm panicking over every little thing though. It's hard to sit for a moment without thinking about them. I just can't help myself.

They also confirmed. Beta #1 is scheduled, ironically, for Mother's Day. That scares the beejesus out of me.

Transfer Day

J is still sleeping, twisted all over the mattress, oblivious that I'm already up and feeling nervous. Showers, tea, and two shots are all that stand between us and the highway to the IVF clinic.

I'm still spotting from the retrival, which makes me nervous. Little bits of brownish tissue. I'm not sure if it's coming from the needle entry points from the ER, or from the uterus itself. I pray it's the former. I will ask Dr. Moustache for something to keep it at bay if it's uterine. I know it will otherwise worry me to go to the bathroom as I'll imagine my embies being wiped away with each trip. I'll also be afraid to cough, to sneeze.

Thank you to everyone that's sent in good wishes for today. I won't feel so alone in that OR knowing you guys are thinking of us. I'll try to post something later on before my 24 hours of mandated bedrest.

Day Before Day 3 Transfer: IVIg

Got up ultra early and jetted over to Dr. Beer's office. It sounds strange saying "Dr. Beer's office" now that he's gone. They were wonderful and squeezed me into the last place with absolutely no notice at all. One of my online friends, TS, whom I never met in real life up to this point, was there bright and early and it was great to finally meet her.

I had to pay $2015 upfront for the IVIg. They wouldn't let me swap the Gammaguard that I had on order from Columbia for their Gammunex, thereby saving me $400. That sucked, but the fact that they squeezed me in last minute was so appreciated that I sucked it up and said nothing further on the matter.

My NKs were only at 16.9, but the second dilution it dropped to in the 9's, which signifies that if IgG was added to my blood the level of NKs dropped to 9 something. Last time I did a NK test it was at 15 and it barely budged when the IgG was added. This time my blood seems more responsive to the addition of IgG, so hopefully it wasn't done for nothing. 16.9 isn't a high NK number by any means, but Dr. Moustache has anyone at 15.0 or above to an IVIg. So infuse I did.

The IV nurse was amazing with her skill of placing a needle into someone that hadn't eaten breakfast, or drinken much fluid at 8 in the morning. I basically had no veins to speak of. She hooked me up to a 10gram bottle of Gammunex, and then a second, and me and my 3 companions settled in for a 3 and a half hour infusion.

The worst side effects for me was that my left arm, that one that had the needle in it felt so cold, chilled to the bone, and the right one was nice and toasty. The left side ached nearly the entire time, but it was bearable. I massaged the lower part of the arm during the infusion and it helped to relieve the pain. My friend, TS, was there on her second infusion and she said that she got a headache from her first one that lasted four days. Four days. That is an eternity when you have a migraine. So the IV nurse gave her a needle full of benadryl into her drip line and she eventually slouched down into her chair and nodded off towards the end.

I didn't know that you're supposed to bring loads of fluids with you to an infusion, and that you should also bring extra strength tylenol, but since I was on restricted fluids today, I was lucky that I had the insight to bring my measley 0.5 liter bottle of gatorade. I worried that it might not be enough to get me through the session.

My other two companions were a young German gal, who also nodded off, and a nice woman of 43, a patent attorney for the gaming industry, who was attempting her first ever IVF with Stanford. It was an interesting mix of company, and they made the trip enjoyable. As enjoyable as it can be when hooked up to a IV for the entire morning.

So tomorrow is our big day. We have our consult with Dr. Moustache at 10:00AM and the transfer is slated for 11:00AM. The nurse that called me to give me the time said that it is going to be a busy day there in the OR, to slate about 3 hours total for everything, but that I'd be the first transfer of the day. (I guess he does all the retrivals first, 8:30, 9:30, and 10:30, and then the transfers begin at 11AM. At least that is the pattern I've noticed). I've got my bag of pineapple ready to go (for the bromelain...supposed to help with implantation) and my bottle of propel. I'm not sure what else I can do or take at this point to help things along. Maybe I could direct the Feng Shui of the recovery room from my bed or something?

We have no idea how many of the embies have made it to this point but I'm hoping at least 10 made it. Even if we get 10 good ones, I don't know how many I'd put back in. I know I'm going to be a basket case tomorrow.

Hopefully they're handing out valium in the waiting room tomorrow.

Interlude From my Fertilization Rate Joy

A member of the Yahoo Immunology board emailed me today and said that yesterday morning, Dr. Alan Beer, Reproductive Immunologist, passed away.

It's a sad day in the infertility world to see a man such as he leave this world.

Here's the post for those of you that aren't members of the immunology board:

It with deepest and heaviest heart that I pass along this update to the group: Dr Beer passed away Monday morning, suddenly and unexpectedly. Dr Beer simply did not show up for his California clinic as he usually does. Only after the the next of kin were first notified, could the public announcement officially be made.

Chris wanted to reassure everyone that despite this devastating blow, "The program will go on". Patient prescriptions will be filled by Dr Trobough (who works next door to Dr Beer) with Chris' guidance until a replacement doctor is organized (and this is in the works).

So please no worries. Prescriptions etc will be filled for current patients as needed. In the interim, while the program goes through this transitionary
time, the clinic will not be taking any new patients. But this will change once a permanent doctor is established.

To avoid being inundated with phone calls, the staff requests that patients please do not phone to pass along condolences. All of us feel common sadness this includes the staff, who are also feeling the grief (many who have been working for Dr Beer for a decade) Please restrict phone calls to immediate medical issues to keep the
office functioning in the best way it can.

Funeral service announcements are still pending. I am on close communication with Chris, and will post all updates here at Yahoo as they come in.

Ofcourse we all mourn this great loss deeply. Dr Beer gave his "all" to his patients like no other. He answered thousands of email every day of the year, at a speed unmatched by anyone, nights, weekends and holidays. He saved babies and gave life and hope and an arm to cry on He fought for truth, endured years of controversy and will always be remembered for the powerful pioneer that he was..

We all cry great tears for him.. I know I do, as a thousand others who feel the great loss of this genious of a man.

Dr Beer, we will miss you.

Nobody can ever replace you...ever.

Forever missed ..We love you so much.

Jane and Chris

Two Days To Transfer: Fertilization Report In

Good News, Bad News
The call just came in from Dr. Moustache's office. It's a mixed bag, the news. I prefer bad news first so here goes.

My NK Assay came back and I've had a flare. The 1:50 dilution value is at 16.6 so an IgG infusion (IVIg) is in order (anything over 15 warrnts IVIg according to Dr.Moustache, and I think Dr. Beer, who isn't my doctor, recommmends IVIg when it's over 10.0) . My insurance pays 60%, which means we'll have to come up with 40% of $2200, or $880. Ouch. I've hardly worked this year so it's yet another check out of my savings. I can only hope that once I've met my deductible they'll pay 100%. I haven't checked into this yet but it's on my list. It might also behoove me to send in every single receipt that I have from Dr. Moustache's office in order to get my yearly "cash out of pocket" up there so that they'll be more likely to cover these infusions.

Okay. Good news time. Good news after bad news is kind of like a yummy dessert after a wretched meal. It leaves a nice feeling in ones mouth and compensates for the crap that preceded it.

Here goes.

Of the 15 eggs retreived yesterday 14 of them were mature.

All fertilized.

100% fertilization rate.

Breathe in, breathe out, breathe in, breathe out.

I am just trying to comprehend the idea that we have 14 embryos. They still have to get to Thursday, our transfer day, but already I'm counting my chickens. Got to stop that. It's bad joujou.

But that doesn't stop me from imagining that we might be able to transfer 5 or 6 the first time, and freeze the rest for a future FET. See, I'm counting embies that might not make it to Thursday....I've got to stop this insane line on thinking.

I would never, in a million, gazillion, years even think I would have enough eggs for a FET, not at 41, but if enough of our embies make it to Thursday, it just might be possible.

Retrieval Day

Retrieval was scheduled for 9:30AM, but we needed to arrive by 8:30AM. This meant getting on the freeway by 7:00AM in order to beat the traffic, and getting up at 6:00AM so that I could shower, make J a latte, pack my gear, and go. Amazing how much time we needed to allot in order to get there on time...and to also ease my worried mind about arriving late.

So....here's the skinny on the egg situation:

15 eggs were retrieved

5 from the right (6 follicles previously found here)
10 from the left (9 follicles previously found here)

So somehow the left ovary was hiding a follicle because they got an extra egg there, and the right side had one follicle that didn't give anything up. Or maybe he simply miscounted the number of follicles on the right side? He is usually very conservative in his counts so it's likely a follicle being tight with its egg.

Needless to say, we are blown away. Utterly blown away.

I was praying for 10. "Give me 10 and I'll be happy because it will mean I might, just might, get 5 embryos." Also, this morning I was telling one of Dr. Moustache's nurses that I was concerned because this time I wasn't "as uncomfortable as my last cycle at this point."

"Really, I don't think I'm hurting enough. I know this sounds weird to hope for more pain, but heck, shouldn't I be reeling in pain from all of those follicles? Last time I had less follicles and it hurt more."

Did my follicles not mature? Did I botch the HCG shot?

But 15. Fifteen? I'm 41 years old. I have an elevated FSH. How on earth did my body make 15 eggs? I am stunned, happy beyond belief, and grateful, not yet beyond words as I can't stop talking about how relieved I am. I just hope that most of them are mature, chromosomally and structurally fine, and that they all take to being fertilized.

We do not yet have any information as to how many of these guys are mature. I inquired about whether it was possible to freeze the immature ones for future IVM. No. They've already been subjected to a massive dose of hormones over the last week or so and they didn't do anything. So they wouldn't be responsive in the lab under IVM conditions. Drats. Dr. Moustache said they let them rest for a few hours before doing ICSI on them and then in the morning they'll call us and give us the scoop on the number of mature eggs, and how many fertilized.

And yes, despite chatting with him for a while on the merits of the CDC data, and whether we should do "rescue ICSI" (him: "You can nearly count the number of live births with rescue ICSI on one hand"), we wound up again agreeing to do ICSI. Sigh. I'm looking for an edge. Any edge to give us a couple percentage points more chance.

So today is a day of relief for us. But in saying that, I know it's a short-lived relief, as I'm already worrying about egg maturity and fertilization rates. And right around the corner, I can nearly see them already, are my worries on implantation and betas. If we are so lucky as to get a positive beta, I know I'll then be angsting over heartbeats, number of embryos, and chorionic villus testing.

Time to make an appointment for acupuncture and have them stick a few extra needles in my head as a preemptive measure against worry and stress.

Limbo: The Madness Between Trigger & Retrieval

The scariest part of an IVF cycle, for me, is the time between trigger and embryo retrieval. There is something very unsettling about having given yourself a shot of HCG, which starts the process of maturing and releasing the eggs. Essentially, within about 38 to 40 hours each of my follicles will have gone **pop** if they aren't first surgically removed. Once this shot has been given, there's no turning back. A process is spun into place. And it's unstoppable. At no other time in an IVF cycle are we more out of control than we are now.

This is where the horror starts.

Let me share with you the madness that is currently mine:

What if Dr. Moustache gets into a car wreck and doesn't make it to the surgery center on time? Or at all?

What if we get into an accident, ourselves, on the way to the surgery center tomorrow morning?

Was I totally certain to do the shot at just the right time? Is today the 29th? Is the time correct? Did we remember to change all of the clocks in the house during the last time change?

What about those few drops of HCG that I wasn't able to get out of the vial? Damn. Did I really need them? (I sucked them out with a second needle. No worries.)

What if he goes in there and none of my eggs come out?

What if he gets my eggs out okay, but none are mature enough to fertilize?

How come I'm not feeling more fullness and pressure in my ovary region like I did last time?

I feel like I'm getting a cold. Is this going to kill my eggs?

It goes on and on. The list is endless. And in the 11th hour, we're also starting to question the soundness of doing ICSI. The CDC data shows a reduction in success of 20.3% when using ICSI for my age category (40-41) when there isn't male factor infertility, and a drop of 23.5% when there IS male factor infertility. [If you visit the CDC links, click the graphs to see the discussion on each of the two graphs.]

This doesn't make sense. Something has to be amiss with the data. ICSI is supposed to help people with male factor infertility get pregnant. Not hurt their chances. A 23.5% drop in success rate is, well, rather significant! I fired off a late night email to Dr. Moustache asking what to make of the data, and also, "What does your data look like?" Skipping ICSI not only might be a wise move in terms of increasing our chances for success, but it would save us something like $1800 on our tab.

I don't think I'd skip assisted hatching, as my eggs ARE 41 years old and the zonas are probably really THICK...but if there was ample data showing it, too, was questionable, I might skip it, too.

Lupron: Day 10. Trigger Day

Warm, beautiful day out there. It started off with gray and while clouds looming over the hills of Los Gatos, and they still lingered as I returned from my 9AM acupuncture appointment. Little white pillows, dotting the sky, are all that remain. It is simply gorgeous out there.

On the way home from East/West Acupuncture, I noted a bunch of people on 85 with bikes in tow, heading for places to ride and spend the day....and an oodle of garage sales as well. It seems everyone is out "doing" things, but I haven't really figured out what to do.

There's a Cherry Blossom Festival going on over in Cupertino, chock full of Taiko drums, arts & crafts, and even a Koi Auction. Perhaps that is where we'll wind up. It sounds the most promising of what is available today.

Trigger shot is tonight at 9:30PM.

Yikes.

The white knuckle ride is just about ready to begin.

I'm getting nervous.

Lupron: Day 9. Stims: Day 7

U/S #2
Went to see Dr. Moustache for a second U/S this morning. Okay. So I had things a bit mixed up yesterday, as in which follicles were on which ovary.

Today's count:

Follicles: 15 (2 may be cysts)
Left: 9
Right: 6

E2: 2689 (Holy smokes! It was 1543 yesterday)

He said that each ovary has one follicle that is somewhat bigger than the others, and that sometimes these are just cysts, without eggs, and to ensure that we're not stopping meds too early, for the sake of mere cysts, he suggested we ride one more day on the Gonal F. I agreed - anything that increases the number of mature eggs is fine by me. One cyst is peculiar...it's a "follicle within a follicle". It looked a bit creepy on the U/S monitor. Like bubbles on my ovaries. Dr. Moustache said that the other follicle often doesn't have an egg in it, and that the inner one is usually the true follicle. I wonder what sort of weirdness cooks something up like that in my body?

I asked about embryo glue. He said he did 200 transfers with it, interspersed between regular ones. Not even a single percentage point difference. He said, "If it worked, we'd be jumping all over it in a second." It would cost $300 to $400 to order the elixer. I'm not afraid of the expense, if it works, but since he's done a bit of a study, I didn't press for it to be used.

Prolactin: they call this a stress hormone. I asked: "Why is my body producing so much of it this time? I don't feel particularly stressed out." He said: "You estrogen is higher this time around (1543 yesterday versus 900-something) and that can raise your prolactin levels." Okay. So that explains it. So it has literally nothing to do with my personal stress levels, per se, but it's a positive feedback loop. Pop half a Parlodel in the baby kitty and it's all better.

After the U/S I went off with a nice nurse to go over the instructions for the meds for the next few days as well as how to do the trigger. I noticed a "suggestion box" on the wall and while she was out I slipped in a suggestion: "The specimen room needs a DVD player with a working remote!" Hehehehe....can't tell you how many times J has had to wrestle with the remote while wrestling with....well....you know....

So tonight's my last shot of Gonal F. I'm bummed that I'm going to have to use up half of a pen for just the one shot. It seems like such a waste of medicine.

On the good side. A Monday

How to get the last bit of urofollitropin out of a Gonal F pen

It's frustrating to see how much Gonal F remains in a pen after you've used up the prescribed amount. I had 450iu pens for this cycle, but the box says that they have something like 568iu in each box. Hell. That's a waste of perfectly good Gonal F.

How to get it out of those blasted pens?

Well, you can't turn the knob to 125iu and get anything out. I tried that. I even tried, 75 and 37.5. Nothing. You simply can't pull the plunger out to load the syringe. At least I wasn't able to discern a way to do it.

What's a girl to do?

I had four "empty" pens sitting about. All I needed was 0.375CC of Gonal F to make my 225iu morning shot and I sure as hell didn't want to waste an entire pen for my last shot. Well here's what I did, and do note that this is against the advise of most medical personnel.

Take yourself a sterile 3cc syringe with 27.5g needle (something small). Wipe off ends of each of your pens with alcohol. Holding Gonal F pen upside down (plunger in air), stick insulin syringe into Gonal F pen, drawing out the leftover Gonal F. Miraculously, the plunger will down move to aide in evacuating the solution. Repeat with remainder of pens.

At this point I'd loaded slightly more Gonal F into the syringe than I needed for my morning shot. I emptied the entire syringe into an evacuated and sterile 0.9%NaCl container (same stuff you mix the dried variety with) and then using a sterile 0.5CC insulin needle, I drew out 0.375CC of Gonal F.

Swabbed off the injection area with alcohol and I was good to go.

Worked for me!

Lupron: Day 8. Stims: Day 6

My Date with the DildoCam

First monitoring U/S was moved from Friday to today after I sent off an email about how much my ovaries were aching.

Good thing I did.

I'm nearly ready to pop.

13 follicles
8 on the right
5 on the left

And there might be a few more lurking about, says he. 14? 15? I can only dream I'll get so many. I had a 50% follicle to transferred embie rate last time. So this mean that we may have 6 or 7 to transfer, and let me tell you this: they're all going in. I ain't freezing anything.

He saw one that was already at 19mm and a couple others were hovering in the 16 and 17 vicinity. All I know is that I'm wondering if this speed can be attributed to my switching from Bravell/Urofollitropin to Gonal F? I mean, that is the precise day the twinges started.

So I am going in for one more U/S tomorrow. He wants to do one more U/S, just to be sure, and especially since I am SO damned early, but he said he is 99.9% sure I'll be triggering TOMORROW. Which, of course, means a Sunday retrieval and a Wednesday transfer.

And John is working that day. [growl].

Other data I got today:

E2= 1543
Prolactin = 30

The prolactin should be below 30, as in 29 or lower, and because I'm just over that threshold, I now get to add Parlodel to the daily drug cocktail. (Directions: "Take 1/2 tablet at bedtime as directed". What it really ought to say is, "Crack tablet in half and stick it in your coochie".)

So I'm early folks. Those eggs were growing fast and all that aching and griping I was doing wasn't all in my head.

Lupron: Day 7. Stims: Day 5

It's a mixed bag of a day. It's gorgeous, warm, and it feels like spring, but after reading about Millie's ectopic pregnancy it feels like winter just settled back into our souls for a while longer.

How the hell does a transferred embryo get into a tube and then OUTSIDE of the uterus in the first place? I just don't get it. When I was afraid to move after my embryo transfer (IVF#1), Dr. Moustache said something like, "Think of the uterus as a peanut butter sandwich. It can't go anywhere. It's stuck."

R I G H T

Stuck my ass. Like I'm going to believe that anymore?

I think I'm having Dr. Moustache use embryo glue for the next transfer.

Lupron: Day 6. Stims: Day 4

Aching Ovaries
Yesterday it felt like my ovaries were two burning coals wedged low in my abdomen. I could distinctly feel each one of them, it was creepy, and definitely NOT a good thing.

At some point yesterday, I caught a sideshot of myself in the mirror. I looked 5 or 6 months pregnant. But being that I haven't been blessed with pregnancy, my reaction was more like, "Holy fuck, Batman!" It was clearly swelling or massive water retention, brought on by either the Lupron or the Gonal F, as there was no way I chowed that belly into existance.

About 10:30pm the ovary burning sensation didn't go away so I sent over an email to the in-cycle nurses at Dr. Moustache's. Today, this very morning in fact, I got a call, yes, a TELEPHONE CALL (!), from one of the nurses there. I was shocked. They are usually impossible to reach. I chalk it up to her being new and she hasn't yet been tainted by the bad attitude that permeates the rest of the staff. She said she conferred with Dr. Moustache and he thought I should come in a day early for my first U/S. So instead of Friday, I'll be there on Thursday. Whew. Because if this swelling returns as it did before, I'm sure to freak out (again).

Enough of my ovaries.

So my question today is what the hell is up with this unending shitty weather?

I have had it with bleak days, gray skies, and my PG&E bill being in the triple digits. I had so looked forward to doing this cycle in WARM weather...thinking the change in temperature would be good for my disposition...but it just doesn't seem that there is any end in sight. This constant gray sky BS is making me feel like I life in Portland or Seattle...where one would expect this sort of shit.

I swear. If this IVF cycle doesn't result in a positive beta, I'm heading to LA to sell my mom's house and I'm going to sit in the backyard naked and sun myself until I can't stand it anymore.

Folgard 2.2
Finally got the formula for Folgard 2.2 from my pharmacist. I only have a $10 copay for the stuff over at Costco, but seriously folks, they're just VITAMINS. A molecule is a molecule is a molecule, so the components in the prescription stuff can be hand for much less elsewhere. So here it is:

2.2 mg (2200mcg) of folic acid
25mg of B6
500mcg of B12

That extra B12 is good for me since I'm not a huge meater, but gosh...at these prices I can formulate my own from vitamins bought at TJ's or WF's.

If you've got two helpings of the mother fucker MTHFR gene you are probably going to be doing Folgard 4.4.

Lupron: Day 5. Stims: Day 3

Loving those Gonal F Pens

Broke out my first of eight Gonal F pens today, courtesy of an angel Crone that was selling off her unused stims after moving on down the road toward adoption. :-) I'm doing 450iu a day, and each pen has 450iu (and then a bit to spare), so I've got precisely 8 days left of stims.

I was a bit intimidated by this whole pen business. They're a bit intimidating with their dials and multiple pen tips. The instruction page that they come with is also daunting...so many instructions that if they're all that you have to go by, you are nearly sure to fuck it up.

But my Crone friend drew me out a nice little schematic and that, along with the cheat sheet from Dr. Moustache's nurse, made it damned easy. One thing that is disconcerting is that the medicine in the pen is CONCENTRATED: 450iu/0.75ml. I'm used to mixing 1ml (or 1cc) of diluent into 3 vials of FSH to make 225iu/1ml. So with the pen I'm only injecting something like 0.375 of an ml into myself at a time. It feels like a drop in the bucket as compared to what I'm used to.

So here is what I've surmised is the way to use these things, hopefully I've got it right (*see caveat below):

1. Wash hands well.
   
2. Remove large white pen cap from pen.
   
3. Wipe threaded area with alcohol. Keep this area clean.
   
4. Take out a needle tip. Peel off the back and carefully screw it onto pen tip until it's secure.
   
5. "Prime" the pen (first use only):
• Turn dial to 37.5
  
• Pull plunger out till it's out as far as it'll go (you'll hear a click)
  
• Holding pen upright, tap to get bubbles to tip (if there are any).
  
• Depress plunger (into air). You'll hear a click and should see a drop of fluid at the needle tip. If no liquid comes out, reprime the pen till it does.
  
• The pen is ready to be programmed for your dosage now.
  
6. Turn dial to the number of IU's that you need. Line up number to black line. MAKE SURE THIS IS THE CORRECT DOSE!
   
7. Pull plunger out as far as it will go. You will hear a series of clicks.
   
8. Look at the plunger side. There are red numbers. This number should match your dosage. If it's smaller, that's all the medicine you have left in the pen. Two things you can do here: break injection into two so that you don't waste what's left in the first pen OR just get a new pen. If what is on the smaller dial (with red numbers) is MORE than you wanted this means that you dialed in too much the first time. Eject the entire amount into a sterile container and get a new pen. Key: You can dial in too little and get away with it, but if you dial in too much you've just wasted that entire dosage.
   
9. Okay, you're ready to dispense.
   
10. Swab the area where you're going to inject the medicine with alcohol. Let it dry so you don't get a sting when you inject yourself. Avoid the area close to your belly button, and areas directly below it. (There are acupuncture spots all around this area, so be careful where you're injecting. Talk to your acupuncturist about where the safe injection zones area).
11. With clean fingers, grab a chunk of clean skin and make a tent (ie, upside down "V") with the skin.
    
12. Inject needle at 90 degree angle (ie, perpendicular) to skin. (Helps to inject into the area inside the "V"). Don't jam the needle base into your skin.
    
13. Depress plunger slowly. You'll hear a series of clicks.
    
14. Hold needle in place for 5 seconds to makes sure medicine is all in there.
    
15. Pull needle out carefully and dispose in safety box.
    
16. Optional: Wipe injection area with alcohol pad and gently massage.

CYA Caveat: This isn't intended to replace the advise of a doctor - it's more for entertainment/blog value than anything. I'm not a doctor and take no responsibility for the instructions here. This is just what I did for my injections and although it worked for me, it might not work for you. Please refer to the instructions your Gonal F pen came with.

Now, the box says (on a 450iu pen) that each pen contains 568iu in order to deliver 450iu of medicine. So there's an extra 118iu of Gonal F (ie, recombinant urofollitropin) in each pen. Holy smokes. That's a shitload of extra medication in each and every pen. 118iu * 8 pens leaves me an extra 944iu of Gonal F leftover. That's two entire days dosages in those pens, and then some. Whoa. Very cool. Even though my nurse didn't recommend my doing this, I plan on extracting those last IUs into leftover sterile Bravelle vials and saving them for a rainy day. Why the hell not? It's valuable stuff. Liquid gold! Think of it this way. A single 75iu vial of Bravelle (brand name urine derived urofollitropin) costs $75 at the local Costco. Gonal F is even more expensive than is Bravelle or it's generic cousin because it's recombinantly formed from genetically engineered bacteria that pump out the isolated stuff in vats. Gonal F is purer than Bravelle or the generic urofollitripin (aka Follistim in the UK). Dr. Moustache said to me in January 2005 that the recombinant is just as good as the urine derived. But is it?

I found one paper that cites that, "recombinant FSH is more effective than urofollitropin for controlled ovarian stimulation in women undergoing ART". No references were given on that site. And yet another paper [pdf] says that,

"Recombinant human FSH has been shown to be more effective than urinary FSH in IVF/embryo transfer treatment. Compared with urinary FSH, a significantly lower total dose of recombinant FSH is required and for a shorter period. Furthermore, a significantly higher number of large follicles, oocytes, and embryos are obtained with recombinant humans FSH, which results in significantly more ongoing pregnancies."

This paper has references that I'm not going to recite here, but this gives me reason to pause. This time I've used urine derived FSH during the first two days (a crucial time when follicles are being recruited) and now that I'm onto day 3 I've switched to the Gonal F, the Big Guns. The order was at Dr. Moustache's direction (use the dried urine derived stuff first) and now I'm wondering if I should have gone for the better, recombinant, FSH first in order to get more follicles out and running.

It's always something. Isn't it?

The Lupron Speaketh

And lest you think that I'm truly impervious to this lupron crap, my ovaries just started to ache about an hour ago. Big time. As in, they both feel like they're on fire. I didn't have symptoms like this till I was near to retrieval last time. WTF? Is this the superior kick-ass Gonal F doing its work? Oh yeah, and I just bitched J out over lunch for being out of town on work next Wednesday because there's a chance, a very good chance I will add, that I might be doing my transfer that very day. You see, my first monitoring U/S is on Friday, and if I'm "good to go" on Friday, retrieval will be on Sunday and transfer on Wednesday. I'm totally peeved that he might not be here to:

1. Drive me TO the transfer (J: "You can drive yourself to it, can't you?". Me: "Yeah? But how do I get home Einstein? Dr. Moustache said NO ACTIVITY whatsoever. Bedrest doesn't include driving."
   
2. Drive me home (J: "Can't your mom drive you back?" Me: "She's 89. Are you insane? She'll get lost unless I'm guiding her the entire time...and I'm supposed to be prone."), and
   
3. Keep my mom at bay while I'm recovering. She can't hear very well and having to speak LOUDLY to convey the most simple information stresses me out to no end. I can be talking loudly, not in anger, but just trying to convey information, but somehow my body perceives this as stress. My pulse rises, my blood pressure surges upwards, and I suddenly feel like I've flipped out. Just for having to speak loudly. Weird, but true.
   

But what is the probability that I'll be ready on my first U/S? Last cycle I was ready on the second U/S, but then I only used the urine derived urofollitropin. According to the second article I mentioned above, I should be ready earlier, hence, a Sunday retrieval and a Wednesday transfer. Grrr....... I wouldn't doubt it if I'm ready earlier anyways. I've responded quite differently this time 'round, so anything is possible.

And I thought that this cycle was going to be stress-free. I prayed it would be stress free and that J would be 100% THERE. There for any disaster or emergency that came my way. There in the OR when the embryos were being put in. But there are no guarantees with J. I think he's having a disconnect, a problem with priorities. That is all that there is that can explain this. I just don't understand how a man can blow $11,000 on a cycle and not want everything to be perfect. It's beyond me. It's just so far out there I cannot fathom it or comprehend where he is at today.

Yes, the lupron rose it's ugly head today and hurled out some miserable things. I thought I was going to be impervious...alas...no. I'm not.

This cycle is going to be a fucking white knuckle ride until it's over.

Sigh.

Lurpron: Day 4. Stims: Day 2

It's a gray overcast Sunday. A cold morning with a bit of a breeze and a chill that makes me think we're in for another 40 days of rain. Ugh. So much for my morning jaunt to the farmer's market with my sunglasses, sandals, and shorts on. It'll be sweats and tennies, I won't fit in with the Los Gatos beautiful people. I never do actually. But who gives a damn?

Today is day 2 of my stims. I've been using up the old UK urofollitropin from IVF#1, some leftover Bravelle from my cycle buddy AP, and tomorrow I start using the Gonal F pens that I got from yet another friend. This cycle certainly has been patched together with a smorgasbord of drugs. I was so fearful in my first cycle of buying any drugs from infertile women selling their leftover stims online. I had to have everything perfect. New drugs that hadn't touched the hands of non-pharmacy staff. Everything had to be "just so". Even my injections were timed to the clock. Morning injections precisely at 9:00AM. Evening injections at 9:00PM. I doubt I was ever 15 minutes off in my first cycle. A lot of planning and precision. A lot of good it did me.

This cycle I notice that I am definitely feeling a bit more relaxed, less stressed, but maybe a bit more pessimistic (or is that realism knocking on my brain?). I'm sure much of this has to do with the fact that we're not in the throes of a move...that my mom has been moved out of house she was living in down in Los Angeles...that said house has basically been renovated and all that needs to be done is slap a "for sale" sign on it by yours truly. (That will be done as soon as our beta is in...no stressing over a house sale right now).

This time I'm also okay if my injections are a half hour or so off. It doesn't even register or raise my blood pressure even the tiniest bit. I bought and borrowed drugs from friends. I wasn't panicked by questions of, "Did you store these correctly the entire time you've had them?" or "Gosh, I wonder if it's okay to mix Follistim, Bravelle, and Gonal F?" I'm almost to the point where I might even do something so drastic as to lower my own dosage of FSH just to see if it would yield better quality eggs. But I did say ALMOST. I'm not there yet. But I AM close to it. What is also interesting is that I haven't yet encountered a night of hotflashes, sweating through my PJs, as I did in the first IVF. So far, this has been quite a different cycle, and I say this fearful of invoking the jinx...so far it has been much better.

Now what is paradoxical about having all of these feelings of "calm" is that I have been running around the house and yard Fung Shui-ing the high hell out of everything. How is it that on one level I can feel so calm and relaxed about this cycle, but on the other hand I've resorted to chopping down tree branches, removing shrubberies, relocating potted trees, rearranging furniture, etcetera, all in the effort to get that damned Qi ("Xi", as my acupuncturist spells it) to come into my house, and into my uterus. It doesn't make a shred of sense unless we agree that my feelings of calm having nothing to do with logic. It's an Alice in Wonderland sort of thing. But much of it is very tongue in cheek.

As I was telling Pamplemousse,

I was having great joy yesterday saying, in a very matter of fact voice: "You know dear. That branch on that tree is just going to have to go. It's blocking the good Qi that's trying to get into our house."

He cut it off and would say to me, "Can you feel it? The Qi? Can you feel it rushing in now?"

We had a great laugh at it and actually got the yard a bit cleaned up. Anything I wanted fixed around the house is now addressed as being "having bad Fung Shui".

"Sweetie, the book says sticky doors are bad Fung Shui. Can you please fix that?"

My friend over at A Velvet Cage said I should put in 8 red fish and a single black into the fountain...Supposedly the black one absorbs the negative energy or something. (Yeah, okay....) Very silly. But we need fish...so it'll be 8 red, and 1 black. And why not? They'll be a conversation piece when people say, "Oh, you have just one black fish..." and I'll have a witty story about Feng Shui ready for them - J will roll his eyes and run for cover.

Off to acupuncture...

Lupron: Day 2

The first two days are easy...just lupron, aspirin, and a handful of vitamins. It's not until we add in the FSH and medrol that things get really messy on the chemical level.

I don't feel like I'm wigging out from the ill effects of lupron just yet, although I did have a blow out with my mom yesterday...and I hand edited my registry after not being able to uninstall a bloated corporate version of Norton Anti-Virus...but honestly, 1 shot of lupron does not a lunatic make. I was a bit warmer than usual last night, but no full blown night sweats as of yet.

Feng Shui-ing the Courtyard

I was at the local real estate board a few days ago and noticed some books on Feng Shui for buying and selling homes. I didn't want to blow $18 per book, so I headed over to the library to see if they had the same titles on hand. They didn't. But they had a couple of 1 hour videos on the subject, which I quickly snatched up along with a 5 hour docudrama on Charlemagne, and a few others.

So yesterday morning I settled into the Feng Shui videos with my decaf tea. They were really cheesy documentaries, poorly shot, obviously very low budget, but they were...well...Interesting. Something about it all got a bee in my bonnet to make a few changes. I started by rearranging the living room, put the couch adjacent to the fireplace instead of in front of it. I discovered that whomever it was that last moved the couch lifted it by one of the arms and tore out the fabric where the arm meets the body. Nearly unfixable. Grrr..... So much for Feng Shui making me FEEL better. I was pissed, but I was determined to Feng Shui the house. That being done, I set my sights on the courtyard entry.

The Feng Shui video said fountains are a good thing. Okay. No problem there. I have had the makings to build a fountain in our brick planter for quite some time now. But something about Lupron and the video gave me a kick in the ass to actually BUILD IT. And build it I did. I bought a fountain kit from Home Depot...it came with a 10'x12' liner that was just way too big for the planter...I cut it in half and then it fit pretty well. The hardest part was folding the liner so that it would fit perfectly into a 1-1/2' deep rectangular planter box - and it's not a perfect fit. I'll still have to fold the black PVC under to hide the excess, but that's a job for another day.

J came home for lunch around 1PM and found me in sweats, covered in dirt, water, and on the throes of filling up the fountain. I think he was slightly impressed that I was FINALLY getting around to this project. By the time he had to head back to work, the fountain was done. DONE! I was amazed at how easy a project this was to complete. (I've got a 6'x10' swatch of leftover PVC if any of you Crones want to make a fountain).

The last thing I did before showering off the soil and mud was, as the videos recommended, was to put a mirror behind our stove top (it faces a wall). Funny that it recommended this because I had done just this in our last apartment...thinking it would make the kitchen look a bit brighter. Okay, their reasoning here is something about increasing the number of burners (even if only in a reflection) will increase your luck and you wealth. Hell, I could use more money after that check to Dr. Moustache. So the mirror stays.

Anyways...after my much enjoyed shower, I sat down to check email and did a quick google query [feng shui ivf] and was taken aback, stunned?, to see one of Julianna's posts show up in sixth place on the first page. Damn that girl has done it all. Okay. So I'm not the only infertile to turn to turn to Chinese Mysticism in my quest to have a baby. I felt relieved.

Read a bit more about it last night and according to the Feng Shui folks, I should move the crape myrtle in front of the fountain out of the way as it's blocking the door, and hence the Qi to the front door. In fact, according to these people, I ought to have a clear line of vision from the front door to the street. Hmm...I guess that means that two or three wretched looking, and stunted, Italian cypruses are going to have to go. No problem there. They're butt ugly and look like rats would fester in them.

But what to tell the landlord? I mean, we're renting!

Well...they ARE in terrible condition, he's old, so maybe he won't mind too much so long as I put in something nicer (and shorter) in their stead. I can only imagine the conversation this might lead to on our move out day,

"Mr. Landlord, you've got to understand. I was pumped up on Lupron, FSH, and steroids when I did this. And besides, the bushes were blocking the path of Qi to my front door, so it might keep me from getting pregnant, so they really did have to go. There was no question about it. I hope you can see this."

So since we've basically cancelled the trip to Tahoe this weekend, maybe we'll have time to remove those old cyprus bushes and put something "nice" in their stead. I can only hope that he entirely forgets what was originally planted there.

But back to my Feng Shui extravaganza. I will not be distracted.

I made a 10:30PM dash to Walgreens last night. Despite 14 days of spotting, I had enough lining left for a visit from AF, and I was well into day 2 of it. Bleh. I had hoped it would be the last of it, alas no. So off I went to the drugstore...and ironically, right in the front door was an entire display of good luck bamboo planters. It was too coincidental. Here I was in full Feng Shui mode, and the local Los Gatos Walgreens has, for the first time ever, an entire bevy of bamboo.

What's a desperate consumer-driven infertile on Lupron to do?

Buy one, of course.

And I did. A cute planter with frogs circling the base. Okay, I would have probably bought one of these anyways one day as I've been coveting Dr. Moustache's collection of bamboo in his office...but I know that the real impetus is that the video told me to do it. Oh yes, and I'm a desperate woman. I want a baby. And if I have to rearrange furniture, make a fountain, chop down trees, and hang strange things from my ceiling, I'll do that, too. In a second. I'm a near to devout atheist, but if you told me rubbing the feet of some random Christian statue has been reported to get infertile women pregnant, I'd do it in a second and without much thought given to it.

I may be close to losing all reason.

Yakking it up at Yakko Sushi

J owed me a dinner "out" last night after I sold some lighting trusses that had been hanging in our garage for far too long. The buyer came and picked them up about 6PM...and was long gone by the time J came home from work. I kidded J that he should owe me a broker's fee since I'm selling his business gear for him. "30%!! That is what the other brokers get!" He kidded, "But you'd have to be a broker to get a commission". "What, do you forget so soon...I AM a broker, silly J!" In the end, I lost out on the commish but I won on the dinner.

Or so it would seem.

We drove to Mountain View to pick up yet another piece of J's business gear. It's frustrating that as soon as I sell one obscenely large item, he finds a new one to stuff into the garage. It never ends. And in this case, he was buying the new item within the hour.

We retrieved his item and headed downtown for dinner. We hemmed and hawed over our fav noodle house, Ryowa, but as we were parking I noticed a Japanese restaurant that I had heard tale of from a good friend. I suggested, "Let's try something new...why not? And besides, you owe me a nice dinner for having sold your crap!" :-)

So we moseyed across the street to Yakko.

Yakko Japanese Restaurant
975 W Dana St
Mountain View, CA

I am not one for writing restaurant reviews. I'll leave that to my friend FoodMuse as she does a spectacular job of such things (I have no patience for such things these days). But this place just wasn't immediately impressive. More of a "mom and pop" sort of sushi joint, tables sparsely populated, small sushi bar in the back. I hadn't yet noticed the line of tatami rooms on the way to the bathrooms, but there were quite a few. Now I have no prejudice against small "hole in the walls" as I've found many a great meal to be found in them. In fact, one of my favorite Japanese hole-in-the-walls, Mitsuru in Whittier, has been a favorite haunt since I was a teenager. But this wasn't exactly what I was hoping for. I wanted "nice", this was just average. We both wondered why my friend thought the restaurant was so good and tore into the menu.

We ordered from a Japanese boy who seemed like he might barely be 18 years old. He was polite, took our order, and disappeared for the next 15 or 20 minutes without making further eye contact. Everyone around us received their food before us. Not a good sign.

Finally our dinner arrives, and then our handrolls which I had hoped would be appetizer. No explanation for the lengthy wait ensured. We quickly set into our meal. Everything appeared to be in order, or so it seemed, except that the sukiyaki had an unusual aroma. J said it didn't smell quite right to him, but I noted that there were quite a few shiitakis in the broth and that they can sometimes lend an off smell to things, especially when they are of the dried variety. No matter, I dove in anyways, ignoring a tiny voice in my head that wondered if J was right.

Big mistake.

4 o'clock in the morning. I am suddenly wide awake. Very awake. And hot. I tear my night clothes off. My stomach is pissed off to high hell. I nudge J and say, "Hey, you awake?" He grunts. I feel like an idiot. Of course he's not awake. I say, "I think I'm going to barf...my stomach feels really bad." J jumps into action, rare for a man that sleeps through the loudest alarm known to mankind. I'm truly impressed by his swiftness. He dashes into the bathroom and returns with a trashcan and sits it next to the bed next to me. (Note: Our bathroom trashcan is a metal flower bucket...I cringe at the idea of yakking my innards into something so narrow. I envision quite a mess ensuing on the carpet).

So I get out of bed and head to the bathroom. It was one of those surreal moments where I turned on the light, looked at the toilet, and began to barf up my sukiyaki, all in one very fluid motion, which by the way was still rather undigested. I noticed that the smell of sesame oil was, well, uhmm....rather pervasive. I wondered if it was really the sukiyaki that had gotten to me, but maybe it was the side of stir fried bean sprouts, in sesame oil no less, that looked so innocent on the side of my plate. Whatever it was, it was gone, and quite vacated from my stomach.

The major cramps were gone, but I still didn't feel quite right. I went back to bed and stayed there even through J's awakening at 8:30AM, and on until 11:00AM when I got up only to IM my friend JS that I would NOT be making it to our lunch date today. Then it was back to bed for me. I felt like a total slacker sleeping the day away. My mom even commented that she was, well, kind of bored. I apologized and told her about the 4AM barfing episode. Her boredom turned to concern and she asked if she could do anything. I said now and headed back to bed where I stayed there till nearly 1pm, just getting up long enough to steam J a batch of tamales for lunch. And then back to bed until 5pm. Unfortunately I'd forgotten that I had to get up to take my mom to a diabetes management class at Kaiser at 5:45PM. My god. I had a difficult time staying awake during the class...and I'm only staying up long enough now to blog about this unfortunate incident and get right back to bed.

I am amazed at how totally fucked up I feel after what seemed like a rather innocent looking meal and as Pamplemousse mentioned...it really sucks to spend good money on a meal and then have to suffer for it. I think this is the first time that I've ever had food poisoning from a Japanese restaurant...and hopefully it will be the last.

smudgedy smudge

Today is the last day of my birth control pills...and I've spotted near continuously for the last fourteen or so days. (As Coloratura would say, if you're just tuning in, this IS an IVF blog, so reader beware!) It's never turned to a bright red sort of spotting, but has lingered in that disgusting smudge state, or should I say, sludge. I think that traditional chinese medicine would say that this sort of blood color is old blood...not a good thing. Dr. Moustache's office seems unconcerned about this at all. Modern medicine would say that this is lining. I'm disgusted at any rate. I wish it would turn into a flow, or something more definitive.

This prolonged thing with this spotting is raising the concern bar higher and higher in my head. I wish there was a data set out there that I could ping and ask the question, "How many women who get pregnant via IVF experienced quite a bit of spotting before their baseline U/S?" Researchers have looked at just about everything under the sun in terms of what works. From seasonality studies, to whether caffeine, alcohol, to whether licking the asses of endangered South American tree frogs might alter ones chance of success. So why not a study looking at symptoms experienced during the medication/stimulation portion of an IVF cycle? Why not, indeed.

Okay, so enough about my investment in panty liners and stain remover, I'm off to file my extension. I don't know why the IRS has us pay taxes in April. It's spring for chrissake! April is always so incredibly busy for me, and with this IVF cycle, I am not even going to stress myself out trying to navigate through last year's receipt pile. Not a chance. Maybe by August I'll be ready to comtemplate taxes and the huge assed check I'm going to have to cut them. Maybe.

How are your taxes coming along?

Pondering childless lives

Something rather frightening dawned on me in the past few days. It has been sitting at the back of my mind, not really brought into full consciousness, but in the last two days it came out.

You see, two of my favorite pastimes are doing genealogical research on my and J's families, and collecting antiques (okay, wine is in the top 3 but since I can't drink right now, we'll just gloss right over that one). I have always envisioned that one of the reasons I spent months doing this research was so that I would have something substantial to leave to my children when I died. I am an adoptee and I spent years tracking down my birth father. I spent entire weekends in the library basement at UC Irvine, pouring over telephone books on microfiche, looking for anyone who might be my father. I swore throughout all of this that my children would know everything about their families that I could humanly give to them. I didn't want my child(ren) to even have to wonder where they came from.

But now that I'm at the point in my life where I don't know if I will ever be graced with a child of my own, now this is all suddenly thrown into question.

Why have I been doing this research?

If I adopt, the child won't care a hoot about mine or J's respective heritages.

Why have I been accumulating "things", like the car and my antiques, and attempting to accumulate wealth?

If we don't have children at all, the last thing we want are things that will hold us down and keep us from traveling and doing the things that we love.

It was an awakening moment. Realizing that some of the things that I love to do, I've done with this idea of leaving them for my children.

But what if there aren't any children?

What then?

I hadn't pondered this question until two days ago. And it cut through my psyche like a red hot knife slicing through fresh meringue. I remember stopping what I was doing. My jaw might have even dropped.

My collection of French antiques.
My silver.
My jewelry.
My bank accounts.
My old Mercedes.
The house.
The house in France that we're considering.

WHO WERE THESE THINGS ALL GOING TO?

My next thought was,

"Well hell. If we don't have children, why the hell should we hold onto all of these things? Things hold us back. They need maintaining. They need to be moved when we move. Things will keep us from living if we're childless. If we got rid of all tangible things, our lives would be freer. Why should I work my ass off selling houses to save money for the future? What am I saving for anyways?"

These thoughts were coming out in a panic. I was looking at everything that was important to me and suddenly seeing my motivations a bit differently. I also noticed I'd quickly swung the pendulum from one side to the other - something I've always seen as psychologically unstable. From "accumulate" to "get rid of", in one quick thought. But then reason eventually started to kick in. We'd still need a house to live in. And even in old age we might do a reverse mortgage in order to live on should our retirements turn out as bad as we predict them to be.

But the idea of not having a son or a daughter to leave my life's collection of possessions was an eye opener.

I've read that infertile women who finally make the decision to not be parents, to live childless, often find that their lives change in profound and dramatic ways. They start new businesses, travel more, start painting, do things completely unforseen to others, and sometimes even to themselves. It is almost as if they've put off doing things until that time that they were parents and the decision to be childless is a pivotal anchor in shifting their life's direction. It's not to say that I think people put off living until that time that they've had their children, or maybe even until that time that their children leave the nest. But I think it's perhaps that they find newfound vigor for living after a deep disappointment of not being able to be parents. Are they filling the void with "things"? I don't know.

I wonder what J and I will do differently with our lives should we make the decision to be childless?

Irate over Dr. T's Bill

It isn't enought that RE's are raking us over the coals for money. But today it would seem that my new OB/GYN, a-RE-wanna-be, Dr. T, is doing the same.

About two months ago I went to see Dr. T for a consultation. I was a bit tired of my old OB/GYN's office staff. Her office staff continually lost my labwork, didn't return calls in a timely manner, misquoted my surgery fees by thousands of dollars, etcetera ad nauseum. Although the doc herself is fab, a wonderful surgeon to boot, I just couldn't take it anymore and so I was seeking out a new OB who would also be an advocate for my reproductive immunological issues. (Previous OB wouldn't help me to coordinate IVIg when Dr. Moustache thought that I might need it). I met with Dr. T for about 30 to 40 minutes, gave him a copy of my entire gynecological history, as I have it, we discussed a bit of RE and RI, and left.

In February, after my IVF cycle failed, I again saw Dr. T for an U/S to count antral follicles and check on things. We also did a blood draw for a chlamydia test so I could have "closure" as to whether a nasty infection had caused my tubal scarring or not. While there, I provided him with the study out of Chicago on DHEA and asked him if he would please call or email the doctor who is doing the study to find out what sort of protocol they were finding was effective for increased follicle production.

Shortly thereafter it was discovered that Dr. T's office botched my chlamydia titre test - they didn't do the chlamydia test...but tested me, instead, for pneumonia. Also, the doctor never got back to me on the DHEA protocol. It would seem that I had left Dr. G's office, with the shitty office staff, for more of the same.

So today I received a bill from Dr. T's office. It was for my two office visits and although it looks like they pinged my insurance companies for these two visits, the total was still more than $400. Bills are fine and all. They're even expected. I don't expect services to be free, even with insurance, but this one really pissed me off.

First. Dr. T charged me for a mere consultation. Maybe some of you are fine by this, but for me consulations are about me checking out a doctor...seeing if we might "work together in the future". No advice is really given, no examinations are done. It's all about seeing if there is a fit. A meeting of the minds. I've had many consultations in my life and this is the firest I was charged for without knowing there would in facgt be a charge. Since 2000, I've met with maybe 5 or 6 plastic surgeons, and only one charged a consultation fee. However this doctor was very upfront about the fee BEFORE our appointment. Why Dr. T didn't come clean before the appointment is beyond me, but it leaves a bad taste in my mouth. When consultations are normally free, wouldn't one think that doctors that charge for them would feel obligated to say something upfront?

Second. Dr. T billed out my U/S for my antral count and it was coded as something that smacked of infertility. That is fine. I don't have infertility coverage with Blue Cross of California. Dr. G would always run my U/S, whatever the real reason we were looking in there for, as checking on my ovary (which required surgery last year). But since the office ran my insurance before I arrived wouldn't it be prudent of them to reaffirm with me before the appointment, "Love, we've checked with your insurance and by the way, this U/S won't be covered"? One thing that drives me a bit batty about disgnosis codes for "infertility" is that I'm not longer being diagnosed for infertility. We know I have blocked tubes - that is the reason I'm having trouble conceiving. So if you strip it down to brass tacks, we're no longer diagnosing, per se, when we do an U/S for antrals. We're not really treating either. We're just looking and collecting data. I understand that it's just a matter of semantics when doctors' offices do their coding and such, or it may also be the inability of insurance companies to come up with a better way of coding things. But I'm certainly not being diagnosed or treated, in the literal sense, for infertility when we do an antral count.

So I have a $400+ bill before me and a huge chunk of it is for a consultation, which really should have been comped, and an U/S, which I'll take the blame for. All the same, I'm going to ask Dr. T's office tor reduce my bill to what the insurance company would have made me responsible for had it been a covered expense. I've done this in the past when laboratory bills have caught me offguard and 9 times out of 10, the lab will allow you to pay a lesser amount. If Dr. T's office balks, it'll be my last visit to his office. I really want a doctor that is an advocate for me - not someone that is out to get every last dollar out of me.