Disintegration

At 10AM sharp today, nurse J emailed me to tell me that my embryos had started to disintegrate. Now seriously, are any of us surprised?

I am still stunned that she really thought that my embryos had any chance of turning around. Two days and no growth and suddenly they're going to have this miraculous growth spurt and divide at twice the speed of a HEALTHY embryo? REALLY? I want some of whatever she is smoking. Nurse J has hereby been renamed Nurse Pollyanna from here on out.

So it's been a day of indulgences: dark chocolate dove ice cream bar, a small lemon coconut tart, chips and salsa for dinner, and a glass of red from my 2004 trip to Bergerac. Of course I'll eat my vitamins later. I'm not THAT careless. :P

Sugar, dairy, alcohol. One day of excess doesn't hurt.

Tomorrow we commence the diet to remove this evil steroid weight.

More Confusion

So I wrote to Dr. Italian last night questioning why I should call their office back today at 10AM to get an embryo report.

Here's what I wrote:

Hi Dr. Italian,

As you know my embryos arrested.

Nurse J told me to call her at 10AM tomorrow to “see if anything changed”.

Six day old embryos with less than 20 cells….would you really transfer them if there IS a change? I can’t imagine my lining would be prepared to “hang around” in the proper state of receptiveness while it waited for these embryos to grow to blast and hatch.

Any thoughts on this?

His reply:

Day 6 lining is fine..we have done many tx on day 6...the limiting factor will be your embryo. if it blasts by tomorrow it is worth transferring, and i have seen it happen enough to know you never give up until the end of day 6.

And me:

Each had 6 and 7 cells today (same as on day 3). If a blast has 70-100 cells, each cell needs to divide 4 times within 24 hours. Is that possible? I can’t seem to find anything online about speed of embryonic cells.

Hoping against hope I stuck a needle of PIO in my hip last night before going to bed.

And Then There Were None

On day 3 I had two grade 2 embryos: 1 at 6 cells, 1 at 7 cells. Anything over 6 is considered "good enough" to progress onto a 5 day transfer.

Today, is day 5. Transfer was due for today at 3:30PM. It's 6:00PM. You can see where this story is going, can't you?

I was at a conference in NYC when the email and call came through from Dr. Italian's office.

Neither embryo divided further. Both arrested at 6 and 7 cells. Transfer was canceled.

The nurse actually told me, "Call me at 10AM tomorrow (Thursday) morning and we'll let you know if anything has changed." I said to her, "Even if both divide and double their cells, they'll be at 12 and 14 cells on DAY SIX. They're still not viable." Let's not even talk about endometrium lining, which would be totally out of sync with a embryo that hasn't even gone morula. Could they do anything to keep my lining squared away until a late transfer? I seriously doubt it. I also doubt that I will subject myself to another fucking shot of PIO in my ass tonight just because the nurse wants to torment me with such silly nonsense.

I canceled my acupuncture appointment. Maybe I should have gone for a stress treatment? I then left my conference early - I'd already told my manager and coworkers that I was leaving for "minor outpatient surgery" and handed off my pass to another coworker who wanted to attend.

I don't know what to think. It's just another fucked up cycle at this clinic. I've had a string of them. For this particular failure, I don't know if I can blame the laboratory, the Dr. Italian for triggering me too early, or what.

But I am done ladies.

I am taking my IVF insurance back to the last clinic to cycle with Dr. Indian at the other famous clinic here in the Big Apple. In October of last year, this other clinic found 4 follicles, retrieved 4 mature eggs, all fertilized, and 3 transferred. This was just six months ago.

Great numbers IMHO. Granted they did a 3 day transfer. Maybe they ALL died on day 4 at the last clinic and I wouldn't be any wiser for it if that was the case. But I'm going back there and I'll ask for 5 day transfers and we'll see. If I do three cycles there and they're as dismal as this, then I'll quit for good. I'll know it's just hopeless. But if my cycles are back to normal with near 100% numbers across the board, then I will know that Dr. Italian's clinic is seriously lacking.

I know my #1 problem is age. I know this. But I'm still making so many good follicles. My FSH is normally quite fine and hovers around 9 save for this cycle when it hit 33, probably due to my doing back to back cycles. (Repeat: I know it's my age).

Outside of my age are bonafide issues though: I do believe without a doubt that Dr. Italian's measurements with the U/S are questionable. 14mm lining cycle after cycle? Maybe. But in October at the other clinic they didn't see that. I also got triggered too early 2 out of 3 cycles and lost ALL of my follicles in one cycle, and 4 in this cycle (2 unretrievable, 2 immature).

So, I'll be swinging by the clinic in a few days to get a full packet of my records and we'll just call it a day. Insanity is doing the same thing over and over and expecting a different result. I'll call Dr. Persian in California tomorrow or on Friday to see if I can squeeze in a Da Vinci lap in the next two weeks or so, too.

I hate how I watch myself planning on "what to do next" (eg, cut out dairy/gluten, lose weight, see Dr. Persian, cycle again). In the last hour, I've cried, I've hugged my cats and have covered them with my tears, but I don't feel like I've emptied myself of this terrible feeling of loss. In the back of my mind I find myself thinking that I should be screaming and pounding on the walls. I should be having a fit of the highest order. It reminds of the feeling of having eaten too full a dinner the night before and you feel full for days afterward, carrying a bloated stomach with you. I feel like I'm literally bloated with pain from this ceaseless cycling and failing. A purge is due.

Fert Report

My clinic just called.

Of the 4 eggs they got, 2 were mature and both fertilized.

So the two lower ones didn't catch up. A day would have helped them.

I'm pissed. I can't help but think I am continually being triggered way too early. If this cycle fails, I'm going to have a heart to heart WTF session with Dr. Italian about this. If he won't push out my triggers a day if I think I need it I'll be moving back to the last clinic in the Big Apple with Dr. Indian (think that is what I called him).

The BF tried to be helpful and offered up, "Well at least you got two."

Not helpful.

Neither is the "it only takes one" comments that always seem to come forth.

What if "my one" was one of the two that wasn't mature?

If that is true, then I'm screwed and this is all for naught.

CD9 Interlude: A Call for your "Just Adopt" stories

Last week while I was in California, my elderly mother took me to drinks at her friend Claire's house. On the way she tells me, "Please don't mention to Claire you're adopted. I don't want to have to answer questions about it to her". I have never met this Claire person in my life, but I agreed to keep my lips sealed.

We get to the friend's house and sit down. I've been sitting down no more than a few minutes when Claire smiles a big grin at me, clasps her hands together, and says, "So do we have any good news to share?" She's grinning like the Cheshire cat. Does she know something I don't?

First of all, I had no idea this stranger knew my private business. Secondly, what gives with my own mother telling me to keep my mouth shut about MY ADOPTION but it's OK for her to tell someone about my infertile status?

I told her quietly, "No, it looks like I lost it. It was a very early loss."

Then, the unforgivable rolled off of her lips.

Yes, she said it.

"Well you can just adopt!"

I was already dead inside from the failure I had just went through, but I was pissed that my mother shared this information with this stranger. Especially after she'd just asked me to keep my lips sealed about my own adoption.

I would have loved nothing more than to say, "I don't want to adopt because it was HELL being an adopted child!" but I didn't. I love my mother. I don't want to hurt her feelings. But let me tell you that it was no cakewalk being adopted (for me) and my experience plays a huge role in my decision to not adopt.

So drinks continued for a bit and then we left.

On the way home, I told my mother how disappointed I was that she told me to keep my mouth shut about my adoption but that she felt it was OK to share my private history with infertility. A two hour long argument with my mother ensued. In the end, I promised I'd share with her why it was so infuriating by way of printing out loads of "just adopt" rants.

She apologized. No small feat. My mother has a horribly hard time ever saying she is sorry for anything. But she did. A few tears were shed on both sides. I felt bad for being so upset with my mother. I felt so insulted. How dare this stranger tell me that my yearning for a child of my own could be so casually discarded with the wretched, "Just adopt!" Did she adopt HER child? Was that even a consideration for her? Not a chance. It so pisses me off when people who have their own biological children let this roll off of their lips with such ease. If it's so easy, if it's THE SAME, why don't they all run out and do it BEFORE they even consider one of their own?

So ladies, if you have posts or bookmarks to posts about the dreaded "just adopt" insult, please point me at them. I would like my mother to read these for her own edification on why I was so insulted by what Claire said. Maybe she'll also take these to this Claire lady so that she "gets it".

Back to my centrifuge.

It's LIT day. :-)

CD4: WTF?

Day two of femara.

I got a call from my clinic with my cycle day 3 blood work.

So, as a preamble, just keep in mind that December 29, 2009, by FSH was a decent 9.7.

Yesterday, these were my values:

FSH 32.8
E2 46.39
bHCG 0
LH 7

FSH was THIRTY TWO POINT EIGHT?

You have got to be fucking kidding me!? WTF?

I wrote to Dr. Italian and his reply:

I think this maybe somewhat falsely elevated from recent cycling.
I would move ahead rather than lose a month.

SOMEWHAT falsely elevated? A 300% increase is SOMEWHAT ELEVATED?

Have any of you ladies heard of FSH values going through the roof when cycling back to back? This is the first I've seen it and I am totally freaked out.

What is really weird is that I definitely had antrals...maybe 5 or 6 of them in all. So potentially a better "looking" cycle this month, but the FSH readings make absolutely no sense.

I am baffled.

I start stims tomorrow. Do I dare waste potentially $8K worth of drugs?

Do I wait a month and risk getting another cyst?

I'm screwed no matter what I do.

Beta #2? Seriously?

Amazingly, my RE wants me to do a second beta to see, as the nurse put it, "if it's going up or coming down".

Alrighty then.

I was prepared to bring a bottle of red to my hair appointment today to drink with my hairdresser as she did my highlights and new cut. She's has recurrent losses (secondary IF) and knows the drill.

Given that I had to test today and still don't have the results, the bottle of wine stayed at home. Sigh. Maybe it's better to not drink and dye/cut? ;-)

Oh well, I'm sure we'll be cracking it at dinner time.

I've been in California since Monday. Today is our first day of sunshine. OMG, it is so wonderful to soak in the rays today. I'll be back on the east coast tomorrow night...apparently it's snowing where we're at.

Ugh.

So not looking forward to the cold, but I miss the BF and the cats terribly.

Night Before Retrieval

Interesting tidbit of information from the altar of reproductive immunology @ AEB:

Stop lovenox 48 hours before retrieval and start up again 12 hours after retrieval.

It keeps changing but this is the latest.

As for me? I'm feeling typical cramps...left arm hurts pretty good from last night's trigger. I'm getting a free acupuncture consult tomorrow before my retrieval - if I like him he'll do my acupuncture before/after transfer....of course that is if there is anything to transfer. (I always feel I need to throw that caveat in there).

I also got on the phone with Dr. Persian at Stanford and have a lap surgery ready to go if this cycle busts. Points at which it can bust?

- No eggs retrieved (Wednesday)
- Nothing fertilized (Wednesday)
- Nothing makes it to day 3 (Monday) or day 5(Monday)

So the earliest I'll know if I'm doing a lap is tomorrow - the latest, Monday. I'll call Dr. Persian by Thursday and schedule my surgery. You know me: I ALWAYS have a contingency plan.

Dr. Italian in NYC said he doesn't think I should do a lap and that it could ruin what I have left. He said one of his patients did a lap and her FSH went from 10 to 17. Well, OK. I'm willing to bet that she didn't see Dr. Persian though.

I don't know if I believe him. I just don't know. I weigh it in my mind as: "What benefit could it be to him if I do or don't do a lap?" Time spent healing from a lap is time I'm not doing an IVF...which is time I'm not spending money in the clinic. I have a hard time thinking any physician would be so shallow as that. But maybe he's right? Or maybe he's only familiar with hack-endo-surgeons that aren't on the same level as Dr. Persian? I wish I knew the basis of his beliefs.

At any rate, it warrants a flight to the SF Bay Area to meet with the god of endo laps and see what he has to say.

IM Deltoid Trigger

OMFG...just did my first HCG trigger IM in my arm. I have never injected myself IM.

I nearly bit through my lip doing it.

OMG. OMG. OMG.

I am going to have to do some progesterone shots before my man gets home. I don't know how on earth I am going to do it myself.

IVF keeps pushing me beyond my limits.

Trigger Night with the Thickest Lining on the Planet

It's a dismal cycle.

2 follicles and a cyst on the left. Nothing on the right. I was right: the RE's initial Dx of 9 follicles was way out of line. Do I know how to read an U/S by now or what? H-E-L-L-O????? I can tell the difference between a fluid filled follicle and a blood filled one (endometrioma). Why can't my RE?

Sigh.

And get this. My lining is at 14mm. No, that was not a typo. FOURTEEN. Holy crap. I know it is because I didn't get a full menstrual cycle last AF and so what was left in there has been built upon. I have never had a lining this thick. My gawd. If there is anything to put back in there, it will sure be cozy!

Left side:

1 @ 17mm
1 @ 22mm
cyst @ 23mm. We doubt that the cyst will have anything in it, but you never know.

Lining 14mm, triple striped

Right: NADA!

So I'm trigger tonight at 3AM - retrieval is on Wednesday at 2:30PM.

I am going to do a 5DT no matter what I have. I know that research is now saying that if an embryo can't make it to day 5, they're simply not viable to begin with. I'm not sure it's true, but enough REs are saying this that I am going with the crowd on this one.

I don't want to endure the 2WW and progesterone shots for nothing. The 2WW is hell. Progesterone shots are hell. So, we'll let them grow and see what we have in the end.

What would you do? Grow them 3 days and stick them back in the oven? Or go for 5 days?

CD7: Living Life Without Regret

I saw the best quote over on Endo-a-Go-Go:

Regret for things we did can be tempered by time;
it is regret for the things we did not do that is inconsolable.
--Sydney J. Harris

That is precisely why I keep doing IVF. I cannot bear the thought of what it is to reach my golden years and wonder: what if I'd done one more cycle while I had that darned IVF benefit? I know that I would torture myself with that guilt, that heart break.

I also cannot imagine what it would be like to reach my golden years without a child.

CD6: Aching Ovaries

It's always sorta amusing in a cycle where one second you feel nothing, and then moments later you feel a twinge with one ovary, then the other, then you realize that the gonadotropin juice is working. Mine just kicked in during the last hour.

I'm hoping that my right ovary is actually producing SOMETHING this time 'round, as the doc suggested with his follicle count of 4 or 5 on that side.

Anyways, first monitoring ultrasound in two days and an intralipid infusion following immediately afterward the U/S. I am guessing that my trigger will probably be next Tuesday or Wednesday with retrieval on Thursday or Friday. This time I am going to make DAMNED SURE that my follicles are BIG ENOUGH before I trigger. I hope my dates get pushed out a bit more so that transfer happens by the time my other half is back at home. He's out all week from Monday to Friday - horrible time to be by myself during a cycle, but at least I'll have lots of "calm" while I'm alone. I can do my own trigger shot in my tummy, but no way in hell I am going to do the P4 in my own hip. No way in hell. I don't know how some ladies can do that. I think I'd pass out from fear of hitting my sciatic nerve. Oy.

CD4: Outta drug money

I knew it would happen, but not that it would happen so soon.

I've exhausted my IVF drug benefit. Holy crap. Somehow I've blown $25,000 worth of infertility drugs over the last 3 cycles plus the one that I'm currently in. Really? How can that be? I guess it works out when you figure what a single Gonal-F 900iu pen goes for.

But STILL!!!

So rather than this cycle's meds costing me about $450, it'll be $1050. I was within $1200 of maxing out the benefit but still needed 8 Gonal-F 900iu pens (valued at over $8000, according to the insurance company). They somehow figured that if a patient is within $1200 of their maximum benefit that the patient only needs to pay a portion (they said 30%?) of the remainder. Well somehow that 30% winds up being $791 to me. I don't know how they figure their math but 791 is NOT 30% of 8000. It still is a good deal for me, obviously, so I'm not griping, but I am shocked that this much money has been spent.

Now, by comparison, I've used $7900 of my $50,000 IVF benefit during the same time.

So $25,000 on drugs, and $7900 on 3 IVF cycles.

How can drugs cost 3 times more than the actual procedure?

It just doesn't make sense.

So on my call with the prescription drug carrier, they suggested I call my insurance company and ask if future drugs could be paid for through the major medical portion of my insurance company...that sometimes insurance companies will do this. It seems that I have a benefit for a procedure which requires medications, but no medication coverage. It's a conundrum.

My next call was my insurance company. I explained the situation to them and they said that they needed the "J codes" for my medications before they could tell me whether they'd be covered under major medical. It also might be that the drug money would come out of my remaining $43K benefit. OK. That works for me. I know that I can get meds for 4 cycles with $25,000 and that $7900 will do 3 IVF procedures. That's $33K total. I'm sure I could get 4 or 5 full cycles done for $43K. Maybe I need to negotiate a "frequent flyer" discount card with my RE? Buy 3 IVFs get one free?

I quickly fired off an email to the IVF clinic asking for the J Codes but it's after closing so I'll just have to call in the morning.

The craziness of IVF never seems to end.

------------------

Endnotes: J-Codes are for injectible meds only (not oral). Here are the J-Codes for infertility drugs (all are "Status F", whatever that means) or you could look here.

Gonal-F: S0126
Ganirelex acetate 250mg: S0132
hCG 10K iu: J0725 (Novarel, Ovidrel, Pregnyl, Profasi)
Menopur: J3490
Follistim: J3590
Lupron: J1950

CD 2: Owwwww

I went to the clinic today for my baseline U/S and bloodwork. I had a thirty-something millimeter sized ovarian cyst on the left side. We already knew I had a cyst there, but it had grown since the last ultrasound.

So he tried to aspirate me on the table. No anesthesia. But it was just too painful to have forceps, an ultrasound wand, and the needle holder all crammed in there. I was recoiling in pain. He said that he felt we should do this under anesthesia. Yep. I quickly agreed ("Just get that stuff out of me already"). So I went and busied myself for 2 hours while the anesthesiologist showed up for the day's retrievals.

It was a fast procedure but I feel a bit torn up down there. I have clear vaginal tears, both inside and out. They burn. Owww. My skin is thinner down there with age, so tearing happens more often, but this just smarts.

So I'm riding the couch tonight. Got a few movies on the DVR and I'll just drink my nettle tea and cozy down with the cats. I start taking femara today (5mg/night) and on Sunday the Gonal-F starts. Following Friday I do an intralipid infusion after my first monitoring ultrasound and then we inch closer toward retrieval.

But the good news I've saved for last.

The results of my baseline U/S showed 9 antral follicles. 4 on the left (where the cyst was) and 5 on my crappy right ovary that had all the endometrioas (that were removed by needle aspiration/sclerotherapy in December).

9 is amazing for someone my age (45). I think he might have been looking at the same ovary twice though: my ovaries tend to get stuck next to each other behind my uterus. It wouldn't be the first time someone did this.

But even if there are only 4 or 5, it's still not that bad.

My vote's for the 9 though. :-)

CD1: Welcome AF

Took my last BCP yesterday. I'm supposed to call them when AF comes, but she's been here since last Saturday or Sunday...so that makes today CD1 by my reckoning. (U/S and bloodwork scheduled for tomorrow. Yippee.)

I have an 11-13mm cyst on my left ovary that will need to be aspirated before I start meds. Otherwise we saw 3 follicles on the left. Dr. T said that he saw "maybe" 3 on the right, but I've seen enough ultrasounds to know that they weren't follicles....just his wishful thinking to keep me from throwing in the towel. More reasonably, I think that they might have been remnants of the small endometriomas that he drained in December. They certainly weren't follicles.

I think it's time to call Dr. Persian on the west coast to schedule a lap. I have a hunch that this cycle isn't going anywhere. I haven't even ordered my meds yet, if you can imagine. I'm not being reckless here....I have enough Gonal-F and Ganirelex to get through half the cycle, I just need femara to get started and that is easily available in any pharmacy worth it's salt.

Dr. T advised against a lap, but my right ovary is toast. It's just dead. Nothing's happening there. I had 4 follicles on that ovary month after month until recently....and the last two months, nothing. So what damage is a lap to look at it going to do at this point?

Probably very little.

So here we are, February 3rd. I have $50K in IVF coverage, $25K in infertility meds. I've used up only $7K of the IVF coverage over two cycles (amazingly) and my insurance runs out the last day of July. I don't see that I'll be able to use all of my coverage. I am currently interviewing at a company that has $20K in IVF benefits and no cap on medications. They're listed on the 50 top companies to work for in Conceive Magazine. Fingers crossed that there aren't age limitations for IVF with them and that, after I turn 46 (the cap that most clinics have) I can switch to this new clinic that I discovered where a woman got pregnant with her own eggs at the ripe old age of 49. It's a world record so that should tell you the clinic if you Google it. I'll just refer to him at Dr. Amazing to keep things straight. ;-)

So there's not much hope for my right ovary, but there IS hope that I can keep on trying.

Now, off to call Dr. Persian and get that ball rolling.

Poignant Paragraph

I picked up a copy of the Winter 2009 Resolve publication for the North East Region. Usually these pamphlets speak on a really top level, noobie level. I don't tend to find much that resonates for me anymore in these materials. I kind of feel like I've "read it all". But, surprisingly, a particular article jumped out at me, "Pregnancy Between Infertility Friends", by Anne F. Malave, PhD, p. 6.

This one paragraph really grabbed me on an emotional level (I hope they don't mind my including a paragraph here):

"The experience of infertility plunges people into contact with the outermost reaches of their humanity. Infertility is a profound crisis that threatens identity, relationships, and continuity. It threatens one's sense of the world, it disturbs beliefs and assumptions, and it belies safety and security. It is an emergency that uses up coping skills, and depletes resources; people start to run on empty as their chronic stress levels move into the area of trauma. Infertility can shut people down emotionally, it necessarily limits and narrows; people are functioning in "emergency mode", a black and white vantage point that oversimplifies for the purpose of survival. This is not the best place to understand the complexities of human interactions, or the perspective of the "other": this is a time to survive, and everything else may feel inessential, a luxury."

I don't think that there is any more clear way of expressing how infertility has made me feel. My beliefs and assumptions about getting pregnant, of being a mother, have been ripped to shreds. There have been times in cycles that NOTHING ELSE MATTERS. My eye is so "on the ball" that I turn totally inward, tunneling into doing everything to cycle.

That article expresses my innards so well. I can't read it without tears.

Aftermath

I'm still not quite right from an emotional standpoint after this cycle. I vacillate between feeling numb, angry, and extremely sad. It took so much out of me to do this cycle. I was on freaking BCPs for 5 weeks before this cycle...I could have cycled within a cycle for how long it took to get to this cycle. And now I have to wait 4 to 6 weeks to heal from my sclerotherapy before I can go onto another cycle? I spend more time waiting than anything else. I just hope that the sclerotherapy took. I'm still having pain in the right ovary, the one that had the three endometriomas. Maybe it's residual pain from the procedure. I'm going to ask for a follow up U/S at 2 weeks post sclero to verify that the cysts are gone. I'm on deproprovera tabs for two weeks so that my AF will come on time. My ovaries should be nice and quiet the next two weeks. If they're not, I'll know that something's amiss.

I emailed Dr. Italian after my dismal retrieval...I asked if we could please test my hCG levels to see if it the levels that remained would be considered normal for how many hours I was past trigger. I just can't understand why this cycle didn't work. At all. The geek scientist in me wants, NEEDS, to know WHY. I want closure.

So I went to the clinic at 11AM today, precisely 3.5 days after trigger and had them draw my blood. There's a normal range for how much hCG is left in your body after trigger given the known half-life of hCG. This excellent article, "Bioavailability of hCG after intramuscular or subcutaneous injection in obese and non-obese women" demonstrates the declining normal ranges over time.

I had my blood drawn at precisely 84 hours after trigger (3.5 days). The value, if normal, should have been around 100. It was 110.

So the quality of the hCG was fine. The injection site (my upper arm) was fine. What I am thinking at this point (and a number of you readers have echoed this point) is that I triggered way too early.

My lead follicle was 18mm the day before I triggered. It should probably have been more like 22mm, which would have given the stragglers more time to catch up. I guess my question now is why he didn't have me take couple days of of Gonal-F and ganirelex and then come in for another U/S?

Grrrr.

At least it makes sense now. I know what to be angry about and that helps tremendously.

Crash and BurnWith Added Paranormal Kids Flava?

Retrieval was today.

4 follicles. 1 immature follicle retrieved.

I have nothing. NOTHING! Nothing to fertilize.

How can this be? I had a 18mm follicle two days ago. There is nothing about that follicle that could remotely be considered "immature".

How could this cycle have gone so wrong? I just don't understand it. The only things that were different were that I took resveratrol/pycnogenol and I took my HCG trigger in the arm (rather than the hip).

That the largest follicle wasn't mature (and three didn't detach from the follicle wall) tells me that there must have been something wrong with the HCG trigger. What else could it be?

Anyone know what sorts of things cause follicles to just not mature?

I'm having a very hard time emotionally with this failure. The last one was bad...but to have nothing is just heartbreaking. At least with my first failures, I had my ex to lean on. A shoulder to cry on.

This time 'round, I'm on my own, despite that I have an uninvolved partner who doesn't want further children beyond the three he already has. Hence, the DS. He's being terribly detached, hasn't checked in on me once to see if I am OK physically or emotionally. Not once. He didn't even ask how it went when he picked me up from the clinic. I'm stunned. Shocked. Hurt.

I can't express how utterly alone I feel right now. I'm going to become dehydrated if I don't stop crying soon.

On the bright side (AS IF there could be one today), the sclerotherapy on my ovaries was a successful procedure. So the anesthesia went to a good use. Dr. Italian removed 3 endometriomas on my right ovary and 1 on my left. He said that the one on my left gave him a bit of trouble and that he had to "break it up" to get it out. Ick, ick, ick. I don't even want to know what that truly means in terms of process.

I've been put on best rest for the rest of the day as my empty endometriomas were pumped full of a tetracycline solution and they'll slowly absorb over the next few days. I'm not to be "jostled" by the kids...so no jumping on me, crashing into me, etc. No small feat for these guys to be THAT well behaved. Seriously.

Dr. Italian wrote me a Rx for DepoProvera tablets that I'll take orally for 14 days then my period will start like clockwork the day after Christmas or the day after that. When that happens we'll do a follicle check on CD3, E2 test, and we'll see if things look good enough to start cycle #6.

I asked him about doing an "agonist antagonist conversion protocol" next cycle and he said that we could do it. I'd need to get a progesterone test on CD21 and if it was high enough I'd start lupron.

Scary thing is that I will probably be in Zurich, Switzerland at that time...so how the hell I'll get a progesterone test done remotely, and in a foreign country, is utterly beyond me. I'm sure I can get a test done, it's just that hopefully the test results are in English and in units that Dr. Italian can convert from.

But back to today...and what happened after we left the clinic.

After he picked me up from the clinic we drove back home across the river and headed out for brunch. My treat since he had to sit in wretched traffic in the tunnel to get to me. I explained to the kids the rule about not crashing into me. Out of the blue, the older kid said aloud, "She had an operation and she's never going to have a baby. She can't have any children EVER!!!" (Paraphrasing). He kept going on and on about how I would never have children. Mind you, he's 5. I'd have backslaped him if he was a teenager. I turned to his father, holding back tears as best I could, and asked, "Did you guys have a conversation about this before you came to get me or what?" and he said "NO!". Talk about hitting me with the lowest blow I could have ever had. Ouch. And where the hell did he get such an idea? They have no idea I am trying to get pregnant whatsoever. It's just not talked about at all when they are around. Their dad finally told the older boy to "shut up", sensing that it had me on the verge of total freakout. What the hell got into him, I have no idea.

Even weirder. The little one (also a boy), who is four and I am completely bonded to, wants to be a girl when he "grows up" (because, in his words, "girls are nice"). He has this alter ego named "Sophie" that he likes to assume. He'll put my curtain drawback cords on his head, for hair, (they're silky rope with long silky tassels) and then morph into Sophie. What's sorta strange is that Sophie is the name I'd give to my daughter if I ever had one (actually Sophia, but Sophie for short). I was almost named Sophie by my mother so it has a soft spot in my heart. I told him one day, "If I ever had a little girl, I'd name her Sophie, too!" Then, just last night, at dinner, he turned to me, out of the blue, and said very matter of factly, "Maybe you'll get to be Sophie's mother."

Eerie.

What's with these kids?

Back to my box of kleenex. :-(

Trigger Day

Yesterday's E2 = 750

Wow, nearly doubled. Lab error or what? Hmm...

There are four follicles. One's ready to go at 18, the other three are all under 15. I forget the values but there's a chance that two MIGHT be big enough at trigger. I sorta doubt the 4th will make it at all.

So 1 for sure. Maybe 2 or 3 if we're lucky. And if we get 4, I'm heading out to buy a lottery ticket.

I had to take the S/O's two kids (4 and 5) to the appointment. Ugh. They behaved horribly...huge mistake. I felt bad for everyone. Whereas the nurses had previously said it was OK to bring them and that they'd watch them while I had my U/S, at some point it was clear that the offer had been revoked and that I'd have to bring them into my exam.

The kids have known me since the day they were born, they walk in on me while I'm going to the bathroom or bathing. They've seen me naked. But having them in there while the blessed dildo cam is out and about was unnerving. Luckily they were positioned behind me in such a way that they could only see the U/S screen. Whew.

All I know is that I'll never do that again. Ever.

Triggering tonight at 11pm with 10,000iu of HCG in the shoulder (oww!!). WTF is up with the shoulder? They said that they've found it absorbs better in the shoulder. Really? Wow.

Sorta feels like a bit of a waste to be moving forward considering how bad it all is, but there's so little time left. Canceling a cycle now, no matter how bad almost feels sacrilegious.

Stim Day 8

Just got yesterday's lab tests:

Prolactin: 11.4 (down from 14 in October)
E2: 397

I don't remember how to calculate E2. This seems low to me though. :(

Did one shot of ganirelex last night and another this AM per instructions. Still feeling laden with my swelling ovaries, but less so than yesterday.

I so bet I am losing my follicles again.

I'm back at the clinic tomorrow for monitoring U/S #2. I have to take the boyfriend's kids with me this time as they were little terrors at his office yesterday. I hope that the other patients don't hate me for bringing them in.

Stim Day 7Cycle Going Bad

Today was my first monitoring U/S with Dr. Italian. The results were dismal.

One large 18mm follicle on the left side, two or three smaller (12mm, 9mm, etc). And NOTHING on the right side save for a few endometriomas.

It's bad. Real bad. It's my fucking age and it's also the endometriomas. But it might also be that I'm on 600iu of Gonal-F which is more than I've ever been on so I might be overstimmed. I get my E2 & prolactin results tomorrow. If we're over 3000 on the E2 then we KNOW that I'm overstimmed. Prolactin was at 14 before I started stims. It'll be interesting to see where it is now. I've got an old bottle of bromocriptine in the armoire that I can pull out if necessary.

So he said that I don't really have time to be choosy about cycles at my age (45) and that we should proceed with the cycle. I agree. If it weren't for the fact that I'm doing a sclerotherapy on my ovary during this retrieval, I'd cancel this cycle and try again in January. But doing the sclerotherapy means that I wouldn't have there wouldn't be enough time for my ovaries to heal between now and the January cohort anyways. I'd be looking at a February cycle date. So it's February for the next cycle no matter how we slice it. No pun intended.

So I'm reluctantly moving forward.

I don't expect a damned thing to be retrieved at this rate but what else can I do at this point?

Next time I'll reduce Gonal-F to 450iu on my own as I know that in my case, "less is more". I hate having to self-medicate but it really pisses me off when our RE's don't listen to us. After 5 actual IVF cycles, and many "tries" (ie, cancelled cycles) I KNOW better than any doctor how I am going to respond to the meds. I'll also be asking for hGH.

Last cycle I lost ALL of the follicles on my right ovary when I started taking the ganirelex. I wouldn't be surprised if it happens again and I lose them all this time.

All I know is that I want to pour myself a huge glass of red wine tonight and chalk it up to a failed cycle. It makes me so sad that a few years ago I was churning out 10 and 15 follicles/eggs a cycle.

Now THIS?

Fuck!!!!!

Stim Day 6

I read a few sources online that say that taking resveratrol and anticoagulants (NSAIDs and maybe things like lovenox, arixtra, etc) can increase the chance for bleeding.

I believe it.

I'm taking 250mg a day of reservatrol and 40mg of lovenox, and unlike previous cycles, I am bruising more than usual.

Tomorrow is my first monitoring ultrasound. I'm quite curious to see how large my follicles are.

Stim Day 5Feeling the Pain

Today's stim day 5 and my ovaries are aching and feeling laden. I'm still not convinced that 600iu of gonal-f a day is going to have me ready to trigger when I go in for my first monitoring u/s on Monday afternoon. I told the doc that 600iu was a lot for me and he didn't seem concerned at all. He ordered me 5 syringes of 250mg ganirelex, which I'm supposed to take at some point to keep from ovulating, but I suspect that I'll get in one shot on Monday evening and MAYBE, just MAYBE, a second shot on Tuesday.

My money is on my being ready to trigger on Monday and retrieving on Wednesday.

We're proceeding with the sclerotherapy on the endometriomas on my right ovary immediately after retrieval. They'll be taking two 250mg sterile vials of pure powdered tetracycline and rehydrating them with sterile saline (or other) ... they'll drain the blood from my endometriomas, refill with tetracycline solution, and then redrain near completely. Hopefully they'll heal while I'm in my 2ww and the two weeks following that.

I'm feeling terribly bloated and tender and I'm already looking forward to retrieval. It's hard doing two IVFs in rapid succession. I didn't get a chance to lose the weight from the last cycle and I'm just so incredibly uncomfortable. Also making me feel a bit icky is that yesterday I did an intralipid infusion at my hematologist's office which pumped 200ml of intralipids and 500ml of saline into me. Hmmm...no wonder I'm feeling a bit, plump?

Forgetting CDs

Let's just skip what cycle day I'm on. I'm on BCPs, downregulating, so CDs are sort of a thing that doesn't really apply right now.

I'm supposed to hear from the clinic on Monday whether we'll be doing the sclerotherapy on my right ovary next week. I hope so. I want this to be done with so I can put my eye on the ball of another IVF cycle.

I feel so impatient, like a horse waiting to take off at a race. It's like that, waiting for an IVF cycle to begin. It always feels like time drags so slowly and that it takes forever for everything to fall into place, for the doctor to finally give the go ahead to start stims. I so hate this feeling. This waiting. It's like nothing else matters...time just needs to move faster so that I'm trying again. When I get into this frame of mind, I realize that I am too invested in this...everything else pales in my life. I get hyperfocused.

I dislike that.

I want to be able to go about my life without dwelling on the next cycle, when it starts, what it looks like, and how I get to it.

I think I am probably horrible to live with when I am this hyperfocused. Arrgh.

CD6Day After Surgery: Ranting About The East Coast

The doc wasn't able to do the sclerotherapy procedure on my right ovary as they weren't able to get the medication that they use in time. Apparently, the compounding pharmacy in St. Louis that packages the medication that I needed failed to renew their NY state licensing in time and so they're out of commission for another week to week and a half. Ugh.

All it is is pure tetracycline in a sterile vial - my doc would reconstitute it with sterile saline and use this to flush out my ovary once the blood had been aspirated away.

Amazing that there seems to only be ONE pharmacy in the entire blessed country that can do this. Ya know? I bet there are other pharmacies that can do this. Really. It's got to be an east coast madness thing. More on this later.

So they weren't able to do this procedure.

Upon waking up, the doctor said that they also didn't aspirate the cyst on my left ovary as it had already popped.

So, the last RE clinic (Columbia) had essentially postponed my cycle for NOTHING. NOTHING! I could have easily cycled right away. Damn!!! I have loved the doctors there and they have a top notch embryology lab, but it's just frustrating that they have a cookie cutter approach to IVF. Even my cycle was cookie cutter, using ganirelex on me when I am nearly 45. Ugh.

So he did the hysteroscopy, the only thing he COULD do considering the circumstances. He found some flimsy sorts of adhesions in my uterus, which he removed. I had some good cramping afterward and have bee spotting since then.

Bummer that I have to do another procedure the week of November 9th because of the pharmacy. That just bites.

So I am going to be doing cycle #5 in December unless I am able to get them to cycle me out of the December cohort. I am going to beg for that. Hopefully they'll relent and let me proceed earlier, but they do close for holidays so they wouldn't be able to monitor me during Thanksgiving as no one would be there. Maybe I could at least start my stims then and monitor right after the holiday?

We'll see.

It's so hard to be patient when I have so many damned setbacks like this.

Along the surrogate route, I placed an online ad for a gestational surrogate. Three gals have written so far. Wow. I'm a bit scared to go this route, but I am seriously considering this if I wind up getting the job that I am currently interviewing for. I can't afford a surrogate without a job that pays really well as it'll cost me at least $18K for her fees and, at most, another $6K for the attorney's fees to draw up a contract. Add in her travel fees and any other expenses and it's easy to imagine that a surrogate would cost me $30K. At least.

I would love to find a local surrogate to cut down on fees but also that I would simply want to be close by while she is pregnant - but chances of that are slim as you can't pay a surrogate in the state of New York. It's illegal here. Can you f*cking believe that? I simply don't understand why it's illegal for me to literally "rent" a woman's uterus in order to have a child. Also, why shouldn't she be able to provide this service for others? It's her body for cryin' out loud. Some women love to be pregnant and are thrilled to provide this service for others. It's their right to be able to do this! I don't understand our country's laws. We're so behind. We're in such a dark age when it comes to how we deal with fertility, the LGBT community, etc.

It's not illegal in the state of NY to have a compassionate surrogate (unpaid) so I have a few family members that I will ask to see if they might help. I am not hugely close to either side of my family, so asking one of them to help is very uncomfortable for me. Also, because I have immune issues that might be hereditary in nature, a family member might also have the same issues that would cause her to have repeated implantation failure as well.

Why can't the law realize that there are very good reasons for our need for paid gestational surrogates? We need access to women who are willing to do this for us who have had children of their own, or have been surrogates before - women with a proven ability to bear children. At least California doesn't have such silly laws. Paid surrogates are fine. Having the intended parents' names on the birth certificate is fine too. Sheesh.

I am so frustrated with all things east coast today. No offense to anyone who reads this on the east coast. But even the act of buying a bottle of wine in this blessed state (NJ) means that I have to hit up a "liquor store" in addition to a grocery store when I am out shopping. Same for NY, CT, and other surrounding states. The east coast is so puritanical. Anti anything that is outside of the box. State lobbyists say that allowing liquor sales inside stores will cause mom and pop stores, and wineries(!), to go out of business. Really? I don't think so. Opening up your market to new customers would increase sales. Multi level marketing. It's marketing 101 folks.

I've stopped being mad about this one - well almost. I just order my wine from California now and have it shipped here to NJ. Screw this stupid state and the horse it road in on. My dollars are going back to California where it is SANE.

CD4Day Before Surgery

So surgery is scheduled for tomorrow morning at 11am. I'm due to arrive half an hour early, empty stomach, sans contact lenses, jewelry, etc. The BF will pick me up in the car at some point to be determined.

They're going to aspirate the cyst on the left ovary, asprirate the endometrioma (chocolate cyst) and flush it with a tetracycline wash to assist it in healing, and then they are going to do an HSG to see if the fibroid that we partly dealt with in late July is in fact still behaving.

I'm still sorta stunned that it all came together as fast as it did.

I guess the fibroid is the limiting step. If it's still there, I'll continue with the cycle but I'll freeze everything and then head to SF in November to do the full blown surgery. I'll return and do another course of IVF or two, banking embryos as I go.

When I have enough, I'll do CGH testing to determine which are good and then I'll transfer those.

As a side note, I'm currently interviewing for a dream job in NYC right now and I am thinking that if I get it, it might make sense to go the gestational surrogate route rather than fight my immune system AND the stress of a new job.

I posted an add on one of the surrogate websites to see what I could get. If I could find a gal outside of an agency, willing to carry my embryos for $20K, I think I'd do it in a heartbeat. But NYC has rather inhospitable rules/laws with respect to surrogacy. Surrogate contracts that include compensation are not valid in the state. It seems that you need to look to the state in which the surrogate lives in order to determine which laws come into play. Here in the tri state area it gets confusing as there are many states in distance of each other. I live in NJ, but I will likely be working (and cycling) and delivering in NY. PA and CT are within two hours of me. They have their own rules and regulations. It gets confusing. I'm just now starting to seriously consider this route and it's daunting. Agencies and lawyers all want a cut of the action (ie, money) and that's just so incredibly frustrating when I've already spent a small fortune when I didn't have IVF coverage.

So, I am starting to feel that I might be at a crossroads...I will likely have to decide in the space of a week or so if I am going to get serious about a gestational surrogate.

13DP3DTAKA CD1, Well Sorta

I woke up this morning to the sound of the BF's kids screaming, about 9 or so, and went to the bathroom and lo and behold saw a flash of brown/red on the TP. So soon? Gosh I didn't take progesterone last night...and here comes AF already. Panic about logistics set in.

If today, Saturday, becomes CD1, then Monday would be CD3...and I need to see the IVF clinic on CD2, not CD3 in order to start another IVF cycle right away. Fuck! I'm way out in Philadelphia with the BF and his kids...and we're not due to come home til late tomorrow night (on CD2). So I'd be back at the clinic on the morning of CD3 (about 7am). I want to cycle again, but I also don't want to go to NY tomorrow AM at the crack of dawn.

What to do?

Should I just go on the morning of CD3 and lie to them and tell them it's CD2 and hope that my blood tests don't give anything away...then, rather than take my meds that night, I could take them around noon (or earlier?) so that it's closer to what it should be for where I am in my cycle? I could take subsequent injections an hour later each day until my injections were at 7pm on the 7th day. Would it matter? I don't think so. I think it's worth the risk actually. I'm going to try for it. I just really don't want to drive nearly 100 miles to NY tonight, and then back tomorrow AM, and then back again tomorrow night. It's just too much. Or I guess I could take a train home tonight...and just stay there. I'll have to think on it. I might make a split last second decision but that's how things sometimes go.

So, back to the cycle at hand. I called the nursing like at 11:30AM as directed and they weren't there. Arrgh. They said they'd call back as soon as they could find the nurse.

We took my BF's boys to breakfast and after an hour I was antsy to find out for sure. My AF had picked up steam by noon and it's pretty clear that AF is here. I picked up the phone and dialed the nursing line again and just as the phone started to ring, the call came in. The call center patched me over to the nurse.

Beta was less than zero. Definitely not pregnant. But the writing was on the wall.

Back to square zero.

Walking back from breakfast I thought it might be a nice night for a drink. I stopped in a wine shop and perused the wares but at the last second realized that drinking right as I'm going into a cycle is probably not a great idea. So I walked out empty handed. The BF looked at me oddly - he was probably looking forward to a glass of wine tonight, but I'm just not in the mood.

When we got home I promptly telephoned the doctor in Nevada to see if she'd fax over a letter to Dr. Persian in the Bay Area so that he could do my endo surgery and also asked if she would share the HGH protocol that the SoCal doc uses so that I could give it a try next week. I just don't know where the hell I'll get my hands on some HGH unless I get an Rx for it.

It's always something, isn't it?

12DP3DTBeta Day

I got up at the crack of dawn and went to the clinic to do my beta. I did a urine test before leaving and it was negative...so I wasn't expecting much out of it. They make you pay for your visit before you do blood work or see a doctor. I went to the cashier window and she said, "You have a balance due of $500.". I figured it was for my cycle, the part not paid for by the insurance company, but...no...it was a $500 fee for the 2nd tube of sperm that they didn't use.

I said, "Really? You're charging me $500 to store a $200 vial of sperm? That's crazy. Just toss it! I'll buy more when I need it." She: "Well it's for handling your sperm and for freezing it for an entire year." Me: "You guys told me to buy two vials, I only wanted to buy one, and then you only use one and you don't tell me so I don't have a chance to say "toss it"?" This doesn't make sense."

She: "Well your sperm arrived on October 6th and it's nearly November"...then she stopped herself and realized it's only been two and a half weeks. But she didn't say anything more. Only that I'd have to argue the point with someone in accounting. Fine. Sure. I'll do that.

I spent the rest of the day in the city and didn't get home til nearly 3pm. I checked my phone periodically to see if any calls had come in. Nothing.

By 5:30pm we were on the road to see the kids in Philly and I noticed that a call had come in. It was the clinic and they said something like:

"Hi this is the clinic calling about your pregnancy test. Please give us a call back before 4pm to discuss your results. If you can't call by then please call back after 7am on Monday".

THAT WAS IT.

No, "Please continue your meds". Nothing. So, I'm nearly 100% sure that I'm not preggers, but talk about a nagging question hanging there in the air. Hellllllo?

What really sucks is that I drove to Philly without my progesterone, lovenox, or anything with the assumption that the cycle had failed and that they would have left a message for me to confirm the obvious.

I just chatted with the on call nurse who said that they will leave messages about everything except pregnancy results and that it was something that was covered in the IVF class (that I didn't take).

Oy. You would think that this "caveat" would be on the forms that I signed that said "It's okay to leave messages on my cell phone."

What the hell?

Why is this such a cluster fuck?

I'm to call the clinic back at about 11am in the AM to get the results. In the really offchance that I'm knocked up, I'll have to drive 80 something miles home to get my meds. Sheesh.

Stay tuned.

11DP3DT

This morning I switched from the nasty POAS that say "pregnant" or "not pregnant" to the ones that just have one or two pink lines.

Only one line.

Tomorrow's the official beta day. I don't expect anything miraculous to happen obviously.

Ordered a case of wine from Cameron Hughes in preparation for the news. I don't think it'll arrive by tomorrow, but just knowing that I have a case of wine coming from California is a mood altering fact in and of itself.

Endo surgery is tentatively scheduled for Wednesday, December 2nd, with Dr. Persian in Palo Alto. I've got to get my records and doctor's notes (ultrasounds, prior surgical reports, etc) to his office ASAP. My calendar show that I've got time to do a cycle in between now and then, so if the Big Apple docs will let me go right into another cycle, I will.

More tomorrow.

10DP3DT

I've been POAS every single day and it's just BFN after BFN. I've been continuing to do my baby aspirin, lovenox, dexamethazone, and synthroid...but I'm back to 200mg progesterone. I'll keep up my high dose vitamins, pycnogenol, resveratrol and I might even stay caffeine, dairy, and alcohol free.

My official beta is Friday morning, less than two days away. It's not exactly 14 days after transfer, more like 12. But any viable embryo would be able to churn out at least 25miu of HCG by now and make themselves known. Seriously. Just check the Beta Base. I'm not being reactionary. If I get a positive on Friday that is 5 or 10miu of HCG it won't be a strongly viable fetus.

I'm trying to keep my chin up. I knew going into this that my chances were really low and that it was a needle in a haystack chance that I'd get pregnant. But it's still hard to look at those BFN morning after morning. They're all taped up on the mirror in sequence so that I can see if there are changes. There aren't. I was in Shop Rite yesterday and Phil Collins was crooning, "There must be some misunderstanding, there must be some kind of mistake", and all I could think of was, "Yes, there must be some kind of mistake. I am supposed to be a mother dammit!! What the fuck!?" I lost it. Tears streaming down my face in bloody Shop Rite of all places. The littlest things seem to be setting me off and I'm sure that a lot of it can be attributed to the hormone fluctuations I've gone through in the last few weeks, so I try to not dwell in my sadness too much. It'll get easier.

So I am gearing up to either go straight into another cycle (and yes I will be doing HGH with or without the support of my physician - but where am I going to get my hands on HGH without a Rx?)...OR...to get my beta integrins tested (and take a month off to also do surgery on my fibroids, endometriosis, and endometriomas)...OR...to just do surgery and skip the beta integrins. The beta integrin issue seems to be highly correlated to the presence of endometriosis, so if Dr. Persian can get rid of my endometriosis, shouldn't the beta integrin issue resolve itself if it does in fact exist?

So many questions I have...lots of calls to make tomorrow to see if I can get my surgery squeezed in next week.

6DP3DTProgesterone, Bloating, and Pinopodes

6 days past transfer. This morning's POAS looks lighter than yesterday's. The ones I am using are the ones that most doctor's offices use - they're thin strips of paper rather than the huge plastic things with windows. So to keep track of them in an orderly fashion, since the kids are here this weekend, I taped them all in sequence and stuck them on the bathroom mirror. I can only imagine with the BF thinks of this but I didn't ask.

It's been a bit of a day - my abdomen is all bloated and distended. A quick check with Dr. Google says that bloating is normal for progesterone. Lovely. I don't recall having this effect so much before, but perhaps it's mostly due to my increasing myself from 200 to 400mg a day of the stuff.

I wish I could say I've had huge twinges indicating something's going on down there, but I know just about anything I'm feeling is due to the progesterone at this point.

I found a rather interesting article tonight on how endometrial pinopodes (little structures that blasts adhere to) show up earlier in stimulated cycles (1 to 2 days earlier) than they do in natural cycles and might be the reason for repeated implantation failure in some patients. So put into laymans terms, if you put in blasts that are ready to attach but your pinopodes are on the way out or area already gone, you're screwed. There's nothing for them to attach to. I haven't figured out if there is a way to delay pinopode formation...but surely someone's studied this. I wonder (bet?) that this is part of my problem. It feels intuitively right. I suspect that perhaps delaying progesterone a bit could help my lining "catch the wave", to use Dr. Harvey Kliman's term (however out of context - apologies to Dr. Kliman for the liberty).

Anyways, I've got enough progesterone to last me through Tuesday but I just don't know how I'm going to stand this bloating. I seriously look 3 or 4 months pregnant, easily. Don't I wish?

3DP3DTPanicking Over Temperature (TMI Alert)

Last night I went beyond the call of hydration duty and drank quite a bit of water...reading how important good hydration is for an IVF cycle. Makes sense that they're in a nice, cozy moist environment. I put in my progesterone capsule and went to bed only to be awoken three times during the night to pee. After one rather forceful pee, I felt that I'd pushed out my progesterone capsule so I put another in. Then I laid in bed panicking that maybe that was the wrong thing to do. Maybe a huge surge in progesterone would screw up the lining I reasoned? Ugh. Why isn't it ever easy. Third pee, I removed as much as I could, worried that I'd overdone it and might have compromised my lining. I doubt it though...Dr. S said that 200mg is the MINIMUM and I'm sure that some women do loads more.

I awoke about 7am to take the BF to NYC to catch the LIRR and get to JFK, and my task being done, I then checked out an Indian Spice Shop over in Murray Hill. (I've found the mecca of all spice shops by the way). All the while I could feel cramping going on down under, progesterone or otherwise. It's silly but the cramping, from whatever source, is oddly comforting. It's as though you know something is going on down there.

I headed home, exhausted, and surfed a bit then decided to nap for an hour or so and get up to do my taxes. (This is ONE THING I procrastinate on). I should have undressed first as I woke up a few hours later and I was hot and clammy. I remembered what the clinic said about not letting your core body temperature get elevated and I just panicked. I took my oral temperature. 98.7. But I felt so hot. What to do? I stripped off my clothes and hopped into a fairly cold shower...trying with desperation to get my body temperature down. Of course, that being done, I envisioned my acupuncturist freaking out that I'd immersed myself in the cold water...telling me how bad it would be for my Qi, my yin/yang balance, whatever.

I took my oral temp again: 98.7. But not trusting the number as my mouth felt fine, it was my body that was the problem, I dared to take my nether region temperature...much like one would do with a toddler...and it was 99.9 or so. Now sheer panic set in. I sulked that I'd again killed off my embryos by cooking them to death. But reason set in, thank god, and I went and consulted Dr. Google on the matter. Apparently we're rather efficient creatures at thermoregulation and our nether region temperatures are 0.5 to 1.0 degrees F higher than our oral temps are. Likewise, axillary or armpit temperatures are about 0.5 degrees F lower than are oral temperatures. So unless you have a nether region temperature of 100.4 or above, you most certainly don't have a fever or anything to worry about. 99.9 is just fine.

While I feel that this means that I shouldn't have anything to worry about, my panic was pretty intense all the same. This isn't the first cycle that this has happened to me. I tend to get really cold at night and want loads of covers on top of me when I go to sleep but I routinely wake in the middle of the night sweating and hot. I know a bit of this is due to the progesterone that I'm taking (and perhaps the steroids as well) but it's just a total mind fuck during an IVF cycle.

What is really eating at me right now though, is that ever since I woke up I've had nary a cramp. It's as though I went to bed all crampy and hopeful, and awoke with an empty uterus. I know I'm probably over-reacting but I can't help but think I've fucked up my cycle by not being much more cautious. I was just so tired, and that bed looked so warm and cozy considering that it was in the low 50s when I'd returned home.

But I keep trying to calm myself down by realizing that our cores are very hard to heat up above that 99.9F as our hypothalamus ensures that we're at a constant 98.6 or so. Otherwise we'd be baking our eggs, our sperm, and no one would ever be conceived under a toasty warm down blanket. Just to be certain, I took the nether region temp one more time about 10 hours later. 99.9F again. So it's been consistent since my inferno embryo-cooking episode earlier today.

Sigh of relief. And wasn't that a small cramp that I just felt?

The embryos should be hatching today...fingers, toes, and everything I have crossed.

2DP3DTFun with Resveratrol & IVF

I'm in the 2WW...not really feeling anxious except for one thing.

I was reading online today, trying to figure out if taking Resveratrol during early pregnancy was OK to do. Dr. Italian at the other clinic said to take it before a cycle but didn't say when to cease.

So this morning I popped my dex, my synthroid, and a 250mg pill of micronized Resveratrol. Then I pondered that I should ask Dr. Italian when I should stop taking the Resveratrol. I fired off an email to him and then continued to look online. Meanwhile, I found and read this research from The Chinese University of Hong Kong.

The abstract reads as such:

Estrogen is crucial in preparing of pregnancy, and its role in the maintenance of pregnancy has yet to be elucidated. During the course of pregnancy, the placenta is responsible for the provision of estrogen. The hormone biosynthesis is catalyzed by cytochrome P450 (CYP) 19 or aromatase. In the present study, we screened several common dietary components and identified the grape polyphenol resveratrol to be a potential inhibitor in the hormone synthesis. In a recombinant protein system resveratrol inhibited the aromatase activity with an IC50 value of not, vert, similar40 μM. Subsequent analysis was performed in the human placental JEG-3 cells, and 25 μM resveratrol significantly reduced the mRNA abundance in these cells. Since the transcriptional control of CYP19 gene is tissue-specific and the proximal promoter region of exon Ia has previously been shown to be crucial in CYP19 expression in placental cells, we also evaluated the promoter activity of this gene. Reporter gene assays revealed that resveratrol repressed the transcriptional control of promoter Ia. The present study illustrated the possibility that dietary supplementation of resveratrol interfered with the normal functioning of placental cells.

While I was reading the article above, Dr. Italian's first reply came back that I should just continue on until pregnant. I replied back immediately with the article link asking if I should be concerned. He didn't write back as fast as he replied the first time so I dashed off to the bathroom and yakked up my mornings meds just to be safe.

It wasn't until well after my breakfast and meds were flushed away that I realized that the article was about "placental" cells, not endometrial cells or embryos that haven't yet hatched. My 5 day old embryos are still encapsulated by the outer shell and won't hatch til tomorrow or the next day and even then I don't think they will have anything which one would refer to as placental cells. Wish this was something that we'd covered more deeply in college Anatomy/Physiology class. As I don't know the half-life of Resveratrol, I felt that yakking up my last pill was the safest thing I could do, just in case.

Stomach in a better mood, I retook my dex and synthroid - if the first dose was absorbed, I'm sure a double dose will do just fine. Nice way to start the day. I am going to hold off on taking anymore Resveratrol until Dr. Italian has had a chance to reply to my email. If he doesn't I will play it safe and abstain.

CD14: IVIG Day

Long day.

The kids are now on their morning "school schedule" and woke us up at the crack of dawn. Arrgh. It was 7:30 by the time I dared ask what time it was. The alarm was set for 8:00 so there was really little hope of catching any more sleep.

Got up and made the kids breakfast, dressed, and ran out the door to catch the light rail to the infusion center. My infusion appointment was at 9:30 or 9:45 but I was really early and showed up at 9:15. I don't know how I was SO early but I was kicking myself for the lost sleep.

I waited for TWO whole hours for them to finally hook me up to the IV and then it took another THREE hours to drip the 30g of IgG into my arm. By 3:00 I was back home, ravenous, on edge. Also contributing to my edginess was the fact that I started taking steroids again a day or two ago. I hate these things. I react so terribly to them. I've already caught myself snapping and second guessing myself for having moved to the east coast.

Breathe in. Breathe out.

Blue in. Red out.

Had a leisurely lunch and then headed to the pharmacy to pick up some low dose steroids and thyroxine, courtest of the reproductive immunologist. I said I'd never do steroids again, but I think I'm losing my senses at this point.

I'm really sorta edgy to find out how many embryos survived these last few days. If I have all four left I'll be totally shocked. But wouldn't that be great?

The Hysteroscopy

The Eastern Clinic is highly efficient. I saw them for the first time last week, and there I was on the OR table yesterday, nary a week later, undergoing a hysteroscopy.

But their efficiency doesn't end there. They told me to arrive at 9AM for a 9:30AM procedure. That's sorta typical. But I actually woke up on the OR table, snoring, at 9:30, completely done. Is that crazily efficient or what?

So one of the good doctors swung by my cozy reclining chair/bed when I was all done and said that there was something pressing into my uterus that was too large to remove and, yes, it would probably cause some implantation problems. But they didn't know if it was a fibroid or adenomyosis. I would THINK that if it were a fibroid that it would have shown up on the ultrasound last week. But they didn't mention anything at that time. So my vote is that it's adenomyosis. It's not something I WANT to vote for, but it just seems to make sense.

So I have an appointment for a followup and then I'll be scheduled for a transvaginal surgery to remove whatever it is that is impinging on my uterine cavity space. Ugh.

So I don't think I'll be cycling next month. Maybe the next month, unless it's the adenomyosis....and then all bets are off.

This makes me nervous. I'm 44. It's not like I have a lot of time to sit around and do a shitload of procedures. Let's get started already, ya know?

Stay tuned.

Big Apple BluesCD3

"D" and I moved to Jersey City about 4 weeks ago. He got transferred here...so we're holed up in corporate housing for another month while we search frantically to find our own place. But...that's another story.

I went to my new Manhattan clinic yesterday for the first time. I adore my new doctor. We'll call him Dr. East since this clinic, and he, are both eastern.

I wasn't able to find my last FSH test result showing that my FSH came in at 10 or so, and I didn't realize until it was too late that I'd handed them the one showing my FSH at nearly 16 (which is their cut off). Of course they wanted to update this figure so they did a blood test for FSH, E2, and MIS (Mullerian Inhibiting Substance, which is supposed to be a much better test of ovarian reserve than is FSH/E2). Fingers crossed that I pass the blood work. I just came out of a bout with strep and was weak, dehydrated, and felt a bit like crap. I tend to test poorly on days like this, I think, due to low blood volume.

Anyways. It wasn't all good. On the table, Dr. East did his wanding, found the dreaded endometriomas on my left ovary (now 2cm large - 3cm and they'd do surgery to remove them), a good number of follicles (he didn't do a count), and then asked me if I'd ever heard of "Adenomyosis", which is a proliferation of endometrium in the uterine layer. Apparently my ultrasound appeared to have found this, and it might explain why I've never gotten pregnant in any of my previous cycles.

Moving right along, he said that he'd like to do a full blown hysteroscopy on me, send a little camera in to make sure that there aren't other functional reasons why I'm not getting preggers, so I'm going in on Monday morning for the procedure.

All I know is that these guys move FAST and I like that. No messing around at all at this clinic. My hat's off to them. I hope they figure out for me once and for all if I should try to cycle again. It would be good for my mind to know where it's all at.

I telephoned the ex today to tell him about the results, but he got off the phone in a hurry. The new GF doesn't care for my calling him, but too bad. I think he has a bit of a right to know why we spent nearly $50,000 and never had a child to show for it.

As I settle into this new life living on the edge of NYC, I wonder if I still have it within me to bear and raise a child. I'm not 100% clear on this. It's just one day at a time. I guess I'll know on Monday if I have any say in this or not.

Ya know?

They have a 16% success rate in women over 40. One of the best I've seen. I've got 5 tries left if they give me the green light.

More on Monday.

Update:
Lab results came in later on today.

FSH 8.15
E2 54.3

It's a go! MIS test results will come in a few weeks from now.

Sperm Donation: On Donor Profiles

When you're in the market to buy sperm, anonymous or open, you can nearly always pay a fee to download a profile. California Cryobank, as of today, charges $17 to download what they call their "long profile". It contains SAT scores, medical information, and a few extra details outside of the short (free) profile.

One has to wonder how truthful these profiles really are. How many of these 20-something men really know their ethnicity or family's medical history accurately enough to convey it to women trying to conceive? These guys are being paid about $100 a shot (sorry) for their sperm and what is the incentive to spend hours filling out medical history forms in order to do this? "Grandma, I need your medical history so I can donate sperm and get $100 a load. Can you please help me out?" I'm sure these conversations rarely happen and so I have to question to validity of the data that these donors provide.

One donor, whose information I paid for, when asked why he was donating honestly said that he was doing this for the money, plain and simple. I appreciate his honesty. I really do. But I'm a prospective buyer and I would plan on buying the entire packet of information for my child, and in there my child would read that their genetic father donated sperm for money.

For money.

At least adopted children have a better story than that. So my child would be greeted with the idea that the impetus for their existence amounted to little more than a couple hundred dollars in their father's pocket?

I am sorry but no matter how good the donor looks on paper, I would never want my child to read something so base, so unfeeling as that, for the reason for their existence.

Another donor that I considered, because the clinic said that he was quite attractive, said that he had smoked pot EVERY DAY from 1999 to 2006. The profile showed that he applied to be a donor in 2007. Oh really. So he decided to stop smoking COMPLETELY in 2007 just so he could donate sperm? Seriously, we're supposed to believe this? THC, the active ingredient in pot, is absorbed by the fat in one's body, and can wreak havoc in the body for a period after one has ceased to smoke. And so when I give my child THIS donor's profile, and s/he asked, "Gee mom, why did you pick this donor when he was a druggie?" what on earth would I say? Scratch this one, too.

After reading profile after profile, paying $17 for numerous profiles, I realized what a gimmick this sperm bank crap was. They really need to do drug testing and make a subscription model so that us prospective parents can do a thorough screening of the sperm donors.

I don't trust these young men's profiles. They're being paid. They're anonymous. I question their motives. There's no accountability or liability should they have lied that known genetic mutations run amuk in their families. And most of them probably don't know the difference between Serbian and Slovakian when citing their ethnicities.

It's so scary to be in the position of having to rely on donor sperm to become a parent. Truly, it is. I applaud Sweden and other EU counties for doing away with anonymous donor sperm and only hope that the U.S. will wise up and follow suit.

CD6: Canceled

I've been having anxiety attacks over this cycle.

I have been waking up at 4AM many nights unable to get back to sleep. My pulse has been racing for weeks. Literally WEEKS. I'm not exaggerating either. It has been horrible. I typically have very low blood sugar and when my BP came back at 110 over 70 the other day (rather than my typical 90/65 on an empty stomach) I knew that I was just going over the edge with this.

I guess I should fess up here.

I was prepared to do this cycle with donor sperm. My last partner and I broke up and he refused to donate for me. Left without options, I reserved a vial of anonymous sperm. But in the end, I just couldn't do the anonymous thing. I grew up not knowing my father and not meeting him until I was in my 30's. I realized that I was about to potentially put a child through the same hell that I went through.

I couldn't do it.

Why this reality didn't hit me earlier? I'm not sure. But in the last few days it came crashing down on me and the stress was overwhelming me.

I woke up today and decided that I couldn't go forward with this cycle. So I called the cryogenic lab and canceled the sperm delivery. The young man (gah!) on the other phone asked me why I wasn't using their sperm. I nearly sobbed into the phone and just managed a "my cycle is being canceled". Then I phoned the IVF clinic and reached the bitch nurse and told her I'd decided to cancel this cycle. She didn't ask me any questions about "why" I'd chosen to do this. She knew. Nor did she offer me any apologies for the crap that happened (which I haven't written about because it's too terrible to write about), just a "we'll be billing you a $500 cancellation fee" and that was it.

I won't be returning to this clinic despite their great rates with women my age. I have an appointment on the East Coast at a clinic that is one notch lower than the IVF shrine of the Rocky Mountains (we all know this place, yes?). I'm meeting with a doctor there the end of April but I might move the date up a bit sooner so I can get the next cycle on board. They said they would let me cycle right up to my 46th birthday, so there is a shred of hope. A shred. I'm not done yet, I can promise you that much.

This is a very sensitive topic, anonymous sperm donation. And this cycle had a lot of twists and turns that I haven't written about and some of them will have to remain private, perhaps forever. I hate being private, I am the queen of TMI, but because this involves others I'll bite my tongue. I could write volumes on the emotional ramifications of anonymous sperm donation and I probably will at some point. But right now I am sad for the loss of this cycle, the 9 follicles that aren't going to represent any sort of hope for me to become a mother this month.

I'll dig into this another time.

CD5 - Feeling Apprehensive

CD5, stim day 4.

I'm not sure I want to go through with this cycle. Wish I could say more, but it's a cluster fuck beyond all compare.

Trust me on this one.

I'll shoot up my stims tonight, but I fear that tomorrow will be the end of this one.

CD2: The reluctant cycler

AF arrived in all her glory and here I am on CD2. Today was my baseline appointment with the dildo-cam. I drove the hour and forty-five minutes to the clinic way up north and paid my $15 copay. They wanted me to prepay the entire cycle before my baseline and I protested, "Can't we just make sure that I'm even going to cycle before I pay?" The receptionist agreed and smiled. She was nice.

They weighed me on the way to the room. I tossed shoes and sweater, trying to get anything off of me that would add weight. I hate the scale. And recently I've felt a bit heavy so I just wanted to avoid that entirely. I came in a few pounds lighter than my last visit. Weird. Maybe the scale needs calibration?

Escorted to the room, I waited yet another 20 minutes whilst sitting on the exam table, bleeding onto the pad they left me. At this point I realize my meter is running out in 20 minutes. I grabbed some towels to shove between my legs, wrapped the paper drape around me, and stuck my head out the door. And waited. Finally a nurse came by and said, "We're running behind. One doctor! You're next." I signed and said something about my meter running out in 20 minutes and could they please try to get to me...

Back on the table for another 10 minutes or so...they finally arrive. Comments went around about how much I appeared to be bleeding. "Uhmm...yes...you did say for me to come in on cycle day 2 and this is pretty much what it's like. Always. For the last 30-something years." Heh.

So the young girl doctor (not my usual RE) found 6 follies on the right, and a mere 3 on the left. I have a 12mm endometrioma (blood filled cyst) on the left ovary that has persisted for a few months now and will require surgery to remove should I ever want to go back down that route again). 9 in all. I should be pleased that at 44 I'm still making eggs, but I am a bit reluctant about trying again after having given up for so long. I really can't say why at this point but I have very specific reasons for my reluctance (the point is secrecy for the time being - as there is a chance that my partner's ex is reading this and looking for some sort of bait or weapon to bludgeon him with - wouldn't be the first time - so I write with a bit of caution these days. Just a bit.)

*snark*

Anyways, I paid my portion of the bill on my way out. $1356. I felt tremendously guilty that my portion was a meager 10%. I'm so used to paying cash for my IVF cycles that, finally having insurance, I felt awkward. But also elated at the same time that I wasn't breaking the bank to do this yet again. And get this: PGD and co-culture are covered by my insurance. As is cryofreezing. I think I have died and gone to IVF heaven.

So tonight's my first shot of Gonal F and medrol.

Let the good times roll.

A Note About my Cycle Numbers

I know my cycle numbers are confusing. I may fix this one day. But for now, here's the scoop:

I did 2 fresh IVFs and 1 frozen with Dr. Moustache (I'm calling these IVF#1-#2 - there was a FET in there though but I guess I am not really calling this anything. Maybe I'm remembering incorrectly - I'll have to go back and check).

I then cycled with Dr. Pompy. They had me on lupron for a month or more. Holy fuck. You can only imagine my mood. This was the decline of my relationship with my boyfriend. We had near yelling matches in front of the receptionist when it came time to pay our bill which was 50:50. I went from 11 or 12 follicles down to 7. I freaked and canceled myself about two days before retrieval. (I count this as IVF #3 as it was hell enough).

I then cycled with Dr. Generous - one cycled canceled (#4 due to cysts) and then we did a full cycle (#5) that resulted in a measely 3 embryos, one of which looked like a football. It was my most miserable cycle ever. The boyfriend and I fought all through this cycle. When it was done, we were done. I couldn't stay with someone that had been so terrible to me while I went through what were the most terrible days of my life.

Then I gave up on IVF completely. The emotional strain was too much. The financial strain was killing me. My relationship with my boyfriend was over. I said unless I was hired at a company that paid for IVF that I'd never try again.

So I went on with life. I went back to work as a contractor and was wistful that my work compadres had insurance and I did not. They didn't need it either. They came to work pregnant and rubbed their bellies casually. It hurt. One girl actually said out loud one day, "Everyone I know who did IVF has twins." What? Helllllooooooo? Where are MY twins goddammit???

Two gigs later, I landed a FT job at a swanky software company but they didn't have IVF coverage. No matter. I'd given up. I was 43. It was done.

The end of October I saw that in the open enrollment forms they were adding on IVF coverage. My 44th birthday, weeks away, I decided, "WTF!? How can I NOT try if someone is giving me another chance?"

I went to see Dr. Italian, the most recent doc, and he said "no". So I'm off to see the esteemed clinic at the university in parts north. What to call this place? I need an alias. I'll think of one. But the doctor I'm slated to see on Monday shall be known as Dr. Red.

So here I am. 44 years old. Onto clinic #5 and what I am calling IVF cycle #6. It's really IVF #4 but the cycles that didn't work got so close to retrieval and I went through so much fucking hell that I am not going to casually dismiss them.

They sucked. They get their own number.

Happy New UTI

Shoot up humira on day 1. Get a UTI the very next day.

God this is nasty stuff.

Happy new year everyone. (Seriously!)

Ranting on the Irony of it All

I've been in a purge mode in the last few months. Cleaning out the spare odd terra cotta pots and saucers on my patio, donating old clothing to the local thrift store, and last week I offloaded off the bulk of my IVF pharmaceutical regalia. Oh, and I now have chickens. Yes, 5 chickens. They were bought in a moment of anti-purge, but I'll write about them another day.

Today, I had a wild hair up my derrière to call two of my RE's just to see where I was on their embryo donation list. I didn't get an answer right away as it was early in the AM.

About 5pm this evening I noticed a voice mail on my cell. It was the last clinic I cycled at. Apparently they move their embryos rather quickly because I'm #9 on the list. Nine. I nearly choked. The embryologist explained that I could expect to do my transfer as early as 3 or 4 months out.

And the irony of this? Last week I sold off my fertility drugs, tomorrow I'm having surgery to remove my abdominal surgery scar that went hypertrophic because I figured I'd never have that c-section my ob/gyn promised me (narrow hips) so why not get rid of it?

But that's not all of it. I've lost 25 pounds in the last year (mostly IVF weight) and haven't done a damned thing that us infertiles tend to do when cycling. I've been eating meat, the occasional dairy, coffee and tea with caffeine, and I haven't done much to stay on top of my vitamins as of late. Wheat grass? What's that? In essence, I'm not physically ready for an embryo donation. I'm also not emotionally ready for an embryo. But how am I supposed to wait? I mean, this is what I was working for the last few years. Things are about to change, shift. Why am I not jumping up and down for the joy of it all?

As for J and I? J and I are still living together but it's more like he's a roommate than a partner these days. Everything turns into an argument. There's barely any affection left between us and let's just say, that had I fallopian tubes left, there would be precisely zero chance of my getting knocked up the old fashioned way. It's sad what infertility led to, but I know we're not the only ones stressed by this.

Life's changed quite a bit since our canceled cycle with Dr. Pompy last March. J and I have drifted apart and I'm sort of seeing someone ("D") who has kids of his own (as well as a vasectomy and little desire to sire more children, although I reckon he might help me out if I begged and promised to not make him responsible for yet one more mouth to feed). He's in a similar predicament as I: he lives in a guest cottage over the garage of his wife's property as his children are young and he needs to be there. I totally get where he's at. But there's no affection between the two of them and she's moved on as well.

So a little tube of embryos on ice somewhere in the Bay Area is earmarked for my uterus. And I don't know what the hell I am going to do. It's quite clear that if I proceed I am signing up to be a single parent because I don't assume that anyone will be on this ride with me. I've started a new job and I can afford a child and a house on my own at long last. My mother, who is 91 and healthy as a horse, lives with me and would make a great nanny. Everything is in order. But apparently my brain is NOT.

*help*

Waiting on Enbrel

Starting this enbrel business hasn't been a walk in the park. After my second shot I came down with a lovely case of "nether region-itis" that was so severe that it took 4 doses of diflucan and two boxes of the dreaded white waxy crap to get rid of it. I only started feeling better yesterday so I'll likely pop another pill just to make sure the critters are at bay.

Dr. Google says that this is typical crap "that I must endure" when taking enbrel. What's more, I had a pretty good injection site reaction going on that made me wonder if I was indeed allergic to the mouse proteins in the injection. Injection site number 2 turned into a red blotchy triangle with 4" long sides. I shit you not. It nearly consumed all of Q3 on my lower abdomen. It came up about 4 days after the 2nd injection so it was immediate. Injection number three produced a faint, itchy, oval shaped blotch about 3" or so in its longest dimension. Both are basically gone, but they bruised quite well before starting to exit.

So there's not a whole lot to report on my IF journey at this point. I inject my enbrel weekly. I eat mass quantities of folic acid (folgard and the predigested form), fish oil, and other random vitamins....when I can remember. My BMI is stable and low. So I stay on my good behavior and I wait. And wait. I guess I should wait another two months before attempting another IVF cycle in order to really make sure that the NKs in my uterus are dead and buried. If I was really doing things right, I'd order an endometrial biopsy to doublecheck. But god those hurt. What IS it with doctors who say, "Well there aren't any nerve endings in your uterus|cervix|whatever." They're on crack if they think we can't feel it when they suck out flesh from our uterus or scrape us to death during a pap. On crack. And, if you've gone through the endo biopsy before, you'll likely agree that after that torment, here's nothing like SEEING chunks of your flesh packed into a clear container, bobbling around as you walk it to pathology. Ick, ick, ick.

So I'm waiting. Sort of patiently. In the last few weeks I've spent a bit of time with a friend and his two very small children. It's clear that he and the missus are both frazzled to death by their two children, mostly due to lack of sleep but also, I reckon, because they both work from home, telecommuting, and it seem that they have a hard time getting work done while the little whippersnappers are running around. They have nannies up the ying-yang, but unless the nannies take said children off of the premises it doesn't really do much to keep the noise levels down.

Let's just say that such experiences while I am waiting for the next cycle to begin make me wonder if I really want to sign on for this. I know that, personally speaking, I'm in a transitory phase in my life. J doesn't want to do another IVF with me. Heck, I don't know if J will be living here, in the same house as I, from one day to the next. While the shit-fan spews forth it's mess, I'm trying to get hired on at a new company F/T so there will be some stability in my life. And then I think, "My god. Why am I trying to get pregnant? My life is anything but normal, stable, and child-proof!!" Seriously folks, there's a part of me deep down inside that really wants a child in my life, but today...today...I can't seem to find that part.

I'll keep shooting the enbrel in the meanwhile. It's good for my psoriasis, which is on the decline, and if I wind up finding that part in me that wants to do the next IVF cycle I'll be ready on the immune front as well.

Until then, I think I may join Coloratura in the upper west side for a few days of museums, walking, wining & dining, and trying to catch glimpses of our favorite locals.

Newbies

As one that has literally been through the IVF mill a few times, and considers myself a fairly active blogger and reader of IF blogs, I find myself trying to limit myself to only reading the blogs infertile who have been through at least 2 IVF cycles. I do read one newbie blog, religiously, but for the most part I find it incredibly difficult to read the blogs of the "new to IVF".

My heart really does go out to the newbies. I read of their hope, their angst over whether they'll get pregnant this first cycle. They write about how often they'll do acupuncture, how they think their REs walk on water, how they are "doing everything" right so that this first time will work. I read how they have switched from drinking 5 colas a day to diet soda and I cringe at the amount of aspartame that they're ingesting. Or the girls that stop binge drinking the day before they start taking stims. I have to wonder, sometimes, how serious some of these women are. I know that when this first one doesn't work for some of them that the shock will be unexpected. The pain deep. They'll look for reasons as to why this cycle didn't work. Many will analyze each step they took. Each meal. Each supplement. Whether that pitcher of margaritas the day before transfer had anything to do with it. They'll drive themselves batty with self blame.

When I follow the blog of a newbie and they aren't successful that first time, I feel their pain so intensely because I was there once. (Hell, I still fret over the silly shit!) The pain is so familiar that I dare not venture to their blogs too often. When I read of what their REs are or are not doing in their cycles I want to butt in with my SWAG (ie, scientific wild assed guess), or perhaps you'd call it my assvice. Whatever.

I want to write to them and tell them what I think of their REs, their protocols, their diets, their BMIs, their binge drinking, and to ask if they did "this test" or "that test" before they considered IVF or their RE. "Didn't your RE tell you to stay away from Ginkgo Biloba, Echinacea, and St. John's Wort????" I want to butt in. Sometimes I do, and I always fear the "thanks for stopping by but please back off" note. I haven't received one, yet, but I'm sure it's just around the corner. But for the most part, I try to read and move on, and better yet, I try to read the blogs of my fellow veteran sisters...those who have had repeated failures and have had their newbie blinders removed from their eyes.

I hear many women say that when they become pregnant that they move on and stop reading the blogs of the IF world. I'm not sure that I could ever do that if I were to become pregnant. I think I would still continue to follow my cycle sistahs and check in on them from time to time and offer up my SWAG whenever I felt so moved.

My Infertility Books, now..........Yours?

Meredith over at Someone PLEASE knock me up inspired me to do a bit of IF housecleaning.

Here's a few things I don't ever plan on reading again:

Fertility & Pregnancy Guide for DES Daughters & Sons

Inconceivable. Julia Indichova

The Fertility Guide: A Couples Handbook For When You Want To Have a Baby (more than anything else). John C. Jarrett II, MD and Deidra T. Rausch, PhD.

Experiencing Infertility. Debby Peoples, M.S.W. and Harriette Rovner Ferguson, C.S.W.

A book by Dr. Moustache. I'm neither writing his name or the title of his book here as I don't want anyone in his office stumbling onto my blog. It's the updated paperback version. He's a brilliant doctor, but he's also a brilliant marketer. Take it for what you will.

If I had tubes or any of the generic problems these might have helped. I really think Julia Indichova's book was inspirational to me to clean up my act and eat right. The others weren't as helpful. The DES book is something that came into my hands from an Infertileblogapalooza luncheon back in December 2005. I don't have DES but I wanted to learn what it was that a fellow blogger was going through.

All free for the asking.

11DP3DT - 16DP Trigger

As I suspected. Negative.

Beta < 2.0.

20 embryos over 1.5 years and nothing. Not a single BFP. My eggs are either rotten, or my body is one helluva lean mean embryo killing machine. I believe it's the latter. My CD3 FSH was 5.6 two months ago, and E2 was quite low, both indicative that egg quality hasn't yet taken a nosedive for the worse. (Yeah, yeah, yeah, I know that this isn't 100% proven...but what the hell IS proven in ART? Not much, eh?)

Yesterday on the way to work, I stopped at my reproductive immunologist's office (Dr. S's) to do a blood draw. I already pretty much knew I wasn't pregnant, what with the row of glaring white HPTs stuck to my bathroom mirror. I'd already surmised that if I were to cycle again, it would be will full blown immune treatments. Dr. Hungarian's theories argue against using immune supressors, but you know, I really am starting to believe that my immune system is the problem. Besides, what's to say I can't combine immune treatments and antibiotics?

While at Dr. S's I asked his chief med tech person, "C", if I could get an r/x for enbrel, said I'd seen articles online that said that enbrel had been FDA approved for patients with plague psoriasis. She said she thought that it was only for patients with psoriatric arthritis but, no, I insisted that I'd seen articles that people like me were now able to use enbrel. (Enbrel and Humira are TNF-a inhibitors. Well, actually, they bind to receptor sites on TNF-a and this keeps TNF-a from necrotizing cells, and embryos). I have psoriasis (auto-immune), uterine natural killer cells, and I rarely get sick. J, on the other hand, is constantly sick. You think I'd at least catch something from him while he sneezes and coughs in bed next to me? Not a chance. I could eat off his place, him with a full blown cold, and I'd be fine.

So last night I emailed "C" the articles, my insurance company's preauthorization form, and asked her to get me set up on an embrel program. Dr. B, whose office Dr. S now runs, said that one needs to be on this stuff for 17.4 week in order to see maximal effects. Four months. That's exactly the time that it takes for effects to to be seen in eggs that are being pulled up for recruitment. J thinks that enbrel is a risk. The reports I've seen are controversial. Some say there are no side effects. Minimal sides effects. Some reports say that risks of malignancies and MS are elevated with enbrel and humira. What to believe?

J also feels, rather strongly, that I should go back to my hardcore diet regime (see the right nav bar for details on this). No coffee, no alcohol, no dairy, only organic meats, wheatgrass juice, little or no wheat, sugar, cold foods. No nightshades. (Great, I have a garden chock full of organic heirloom tomatoes just screaming for buffala mozarella and basil). Weekly acupuncture. Meditation. Keeping BMI low. He is convinced that my hardcore diet reproduced better results. My hardcore diet IS correlated to two IVF cycles with vastly better results, but I reminded him, "Yeah, but I was 41 when I did all of that. I'm 42 and a half right now and things change fast at my age. My god, do you realize you're asking me to go into the Christmas holidays alcohol free? Ugghhh!"

But by golly, if this man is going to stand next to me during another cycle with its associated lupron-induced fits, the least I can do is to give these embryos the very best. Even if my friends think I'm extreme.

So we're looking at December for our next cycle and tonight, just tonight, I will eat my organic heirloom nightshades covered in buffala and basil, and my last bottle of vintage port.

Onwards and sideways.