Buckle Your Seat Belts; Turbulence Ahead

Picking up where I left off, we were solidly into Fall with littles getting excited about Halloween costumes and Trick-or-Treat adventures. In the last week of October, the bean was at 22 weeks, measuring just a little bigger on fundal height, and generally, growing like a weed. I had been feeling movement for several weeks, but around that point, he was getting much more forceful in his kicks and rolls, enough that Scott and the kids could feel it on the outside of my belly too. Everything was progressing nicely... until is wasn't.

I woke up on November 5 with that annoying pressure/pain feeling indicating that a UTI was setting in. It wasn't extremely painful, but I wanted to get on top of it before it got out of hand. I'd had a UTI get out of hand in my first pregnancy that landed me in the hospital on IV antibiotics due to the bacteria not growing on the culture medium and leaving the doctors working blindly to try to treat it. They weren't able to tell which antibiotics to use until we tried them and they didn't work, switch to a different one, lather, rinse, repeat. After a week of no relief, it had spread to a kidney and required IV antibiotics. It was a scary situation, and not one that I wanted to repeat. So at the first sign, I headed off to the office of Lovely Outgoing OB and Partner OB. I was in an awkward position, in that Lovely Outgoing OB had left 5 days prior, and I hadn't ever had an appointment with Partner OB. Regardless, I peed in the obligatory cup, which was very cloudy with an abundance of white blood cells, Partner OB called in an antibiotic and we went on with our day. I was swamped with procedures and meetings over the next 2 days, so I gave little attention to the fact that the pain was not subsiding. By the middle of the day on the 7th, however, I was startled to see blood in my urine to add to the pain/pressure. I called the after hours line for Partner OB (it was Saturday by this time) and she quickly called me back. She told me that she was out in the wilderness with her family, so she couldn't look up the culture results, but that I should go somewhere to be seen that day given that it wasn't getting any better with the current antibiotic. So Scott chauffeured me to a great little stand-alone ER that we have close to our house. More obligatory peeing in a cup. Urine looked clear, as it should after 2 days on an antibiotic, but presumably, the infectious bacteria was resistant because symptoms were getting worse. That meant that this poor ER doc was going to be working blindly to treat, much like the first pregnancy UTI debacle. ER Doc #1 was great though; very thorough, attentive and conscientious. He gave me some Azo to alleviate the urethral pain that was increasing, then tried a new antibiotic IV. I headed out the door, hopeful that we had tackled it with the new antibiotic and ready to watch my favorite college football team domina.... er... take it in the shorts.

By Sunday morning, the pain was increasing and Scott felt that we needed to take a more direct approach. We talked about it at great length and decided that we needed to go to an ER that had a vast network of specialists because we may need a urologist at this point. We decided on the hospital that Partner OB is affiliated with so that we could ensure some continuity of care and information sharing. Admittedly, I was aware that Partner OB was still out in the wilderness with her family, but hoping that this strategy would allow the other professionals ease of access to my history, notes and results. ER Doc #2 was a stark contrast to ER Doc #1 in that she was much more direct and a bit brash, but she was very intellectual and her approach to solving the problem was very outside-the-box. Yet another cup of urine was collected, and again, it was as clear as one would expect after 3 days on antibiotics. This made ER Doc #2 think that the problem wasn't an infection, but rather a bladder spasm. Interesting... At that point, I was open to any thoughts/suggestions/treatments, because the pain was getting too intense to handle on my own. ER Doc #2 called Partner OB who said "As long as she's not having contractions, it's pretty much out of my field." So ER Doc #2 called the on-call urologist who said "Not really anything we can do for it. Just give her some pain meds and send her home." On that note, we left with bed rest instructions and an order to see Partner OB two days later to follow up.

Throughout the day on Monday was more of the same, but the pain meds took the edge off, so I was just trying to make it to the follow-up appointment on Tuesday at 1:00 pm. Instead, I woke up at 3:30 am with contractions that were regular and 5-10 minutes apart. In addition to managing the pain, I was lying in bed thinking that we really needed to *not* have a 24 week 2 day baby! I called the OB's office, drank a ton of water, laid down on my left side and thankfully, the contractions subsided within an hour. Partner OB's nurse called me and told me to come in at 11:00 am which was as soon as she would be out of surgery. Going in, I was so eager to finally get some relief and find an effective treatment after 5 solid days of this. Unfortunately, I didn't get anything like that. This was my first time ever meeting Partner OB in person, and I was shocked to see a twenty-something walk through the door. This made her accomplishments and awards all the more impressive, given that she's obviously only been working in her field a short time. She quickly ordered a fetal fibronectin test and ultrasound view of my cervix to rule out preterm labor. Both looked perfect (cervix length was a solid 4 cm), so she was pleased and told me I was good to go. I was caught a bit off guard when I asked about the pain and she shrugged her shoulders and told me she was baffled by it. She suggested I see the urologist, with the first available appointment being Wednesday at 10:00 am. Ok. On to day 6, again, eager for this physician to finally help resolve this situation.

I arrived at the urologist's office well ahead of the scheduled appointment time (did I mention I was eager??), with my best friend, Jamie, in tow. Scott was at work and I didn't think that he needed to keep taking half days off just to chauffeur me around. The medical assistant that called me back was very soft-spoken and sweet. She directed me to empty my bladder then took me to a patient room where she started to do a bladder ultrasound to determine how effective my emptying was. As she approached me, she said "Have you had an hysterectomy?" I said "No, in fact, there's currently a fetus taking up residence in my uterus." Clearly thrown for a loop (apparently didn't read the referral notes from Partner OB??), she quickly excused herself from the room without doing the ultrasound. At this point, Jamie started to question why we've been struggling with this issue for 6 days and no one, neither ER Doc #2 nor Partner OB, thought to visualize the bladder via ultrasound. Who knows, as she noted, maybe there's a stone in there irritating it or something. Certainly taking a look could be worth the time and effort. But that was definitely not in Uro Doc's plan either.

Uro Doc charges into the exam room 30 minutes past appointment time and says "You know, there's not a whole lot we can do with you while you're pregnant. You should really come see me after you have the baby." I'm sitting there silently, a bit confused. Is she saying that this pain is going to outlast the pregnancy?! Because I am absolutely certain at this point that I *cannot* do this for another 15.5 weeks! I told her that my goals for this appointment were to identify a cause of the pain and to discuss what options we have for treating it. She scoffed "Yeah, that's not going to happen." I literally laughed out loud when she said it. Sometimes I have a nervous laugh when I'm so stunned by how brazen someone is with what comes out of their mouth. This was one of those moments. She then tells me to drop my pants and proceeds to give me the most awkward, jabbing, pinching examination of my lady parts that I have ever experienced. At the conclusion, she says "Well, there's nothing that I can do for you surgically, so although you're experiencing some discomfort, it looks like you're going to have to just ride it out." Did she just use the term "discomfort" to characterize the hell that I'd been living for 6 straight days?! Here's the moment where the pregnant lady can no longer hold in the tears of frustration. What, exactly, do you do when you have been battling pain strong enough to cause contractions for 6 days, and every doctor that you see says "I'm not sure what it is, but it's not my problem." I couldn't even look this abrasive woman in the eyes anymore. Instead I fixated on the cabinets in the corner of the room while she continued to tell me that maybe the pain wasn't even real, just a figment of my imagination. She briefly stepped out to call Partner OB, then came back to say that they had decided it was bladder spasms and they would prescribe a muscle relaxer.

I went home feeling completely defeated, miserable, and somewhat out of options. I took the muscle relaxers as directed, and promptly slept through the entire day on Thursday; a side-effect of the medication that I simultaneously loathed and appreciated. Waking up on Friday morning (day 8), things had taken a serious turn overnight and I now had excruciating back pain on the left side. There was no relief and I told Scott that we had to do something, go somewhere, find someone that would actually *do* something. After a bit of tense back and forth on what to do, he buckled me in to head to a different, full-service hospital ER  close to our house. By the time I got there, it was difficult to walk and I was a blubbering mess trying to relay to the ER nurse what was going on. Once I mentioned the pregnancy, they wheeled me on up to L&D for monitoring and for the OB on call to handle the case. There was yet another round of pee-in-a-cup, but this time, this lab did something none of the previous ones had: They actually assessed the bacteria load in the sample. They didn't just look for white blood cells, blood, color, clarity, etc.. They came back and told me that there was a very heavy bacteria load, which they would not expect to see after a week on antibiotics. They were also monitoring the baby's heart rate and contractions while they ran a few more tests. While the contractions weren't strong enough for me to time them, they noted that my uterus was very irritable. I couldn't blame it... pretty much all of me was getting to the point of 'very irritable' by day 8! In the meantime, Sensible OB thought it would be a good idea to review some of my records to see what antibiotics had worked in the past. She picked one (again, working blind to what bacteria it actually was), and within 4 hours the pain was nearly gone. I seriously could have kissed her! She sent me home with a prescription to continue that antibiotic, and by the next morning, I felt like a brand new woman. I jumped out of bed feeling like I could do anything!

Throughout the 8 days of UTI hell, I was very careful in how much I relayed to Mandy and Wes about my pain. Without them being there, I knew that they would be very concerned, and I didn't want them to get worried when there wasn't anything that they could do about the situation. I made sure to let them know with each passing day that little belly buddy was doing great and that the doctors were still working on finding a treatment that would work. Mandy was so sweet and checked each day to see if I was feeling better, but I just couldn't lay the weight of my daily struggle and frustration on them. Still, we all shared the immense sense of relief when it was finally resolved. Mandy then broached the subject of questioning the treatment choices of the previous physicians, including Partner OB. I had been thinking the same thing, so it was nice to see that we were on the same page. We agreed to find a different OB for the remainder of the pregnancy, and who better than Sensible OB that looked at the situation and thought "If it walks like an infection and talks like an infection, chances are, it's an infection." She saved us from being admitted for IV antibiotic treatment by catching it as we were on the brink of a serious kidney infection due to the spread. So it was a logical choice to schedule our next appointment with her and cancel the end of November appointment with Partner OB. As the scheduling gods would have it, our first appointment with Sensible OB would fall on the same morning as the 3D/4D ultrasound in the first week of December.

Second Trimester: The part where the waters are calm and sailing is smooth

Let the flogging commence: This blogger has seriously neglected the duties required of the position. Let me see if I can make up for it by penning a thoughtful and (hopefully) somewhat humorous update of what life has been like while incubating the fetus since my last update.

We left off at 12 weeks 1 day with the anticipation of our 14 week regular OB appointment on the horizon. The appointment seemed to come up quite quickly on the last day of August, with the new OB and I having another engaging 15 minutes while she checked out my little belly buddy. All was well with the little guy, and she scheduled me for the next routine appointment 4 weeks later. Almost in passing, she also mentioned that she hadn't told anyone yet, but she was going to be leaving at the end of October, so I should probably start thinking about who I might want to switch my OB care to. I tucked that little nugget of information away to process later for a couple of reasons. First, I was really disappointed because I had so enjoyed the appointments that I'd had with her over the short 6 months that we had a doctor-patient relationship, and I loathed the idea of trying to find another OB that I would have the same rapport with. In the 11 years that I have been seeking and receiving OB care, I have found that there are a small handful that I have loved, several that met the needs but didn't knock my socks off, and another handful that should consider a career change. Aside from the tedious nature of trying to pin down a new OB love, my second reservation was that I didn't want Mandy and Wes to stress about the change. This is the first baby and their first ride on the OB merry-go-round, so I didn't want this news to be upsetting to them. So with 60 days to go before I had to do something about it, I thought it best to just put it on the shelf temporarily. Next appointment was set for the last few days of September. In the meantime, one of my co-workers delivered a beautiful baby girl at 40 weeks and 6 days. She kicked off the year of babies in our department. There are 4 of us that do the same job; she delivered her baby the first week of September, I will deliver the bean in late February, and one of our other teammates will deliver her first baby in early April. Needless to say, we have no shortage of estrogen flowing in this hallway! *Cue all of the "there must be something in the water" jokes. With Babypalooza in full swing, along with it comes an almost steady stream of maternity leave. So September through the end of November have been packed even more full of making sure all of the projects are properly managed and moving forward.

Along came the end of September and our 18 week regular OB appointment. By this time, Mandy and I had been having a conversation about the hospital and our delivery plans, which provided a perfect segue to relay issue of the pending OB transition. Letting her know about it was the easier of the two tasks; actually identifying and committing to a new OB was a job that I still wasn't ready to tackle just yet. Instead, I just showed up at the appointment and went on with the usual routine. Lovely Outgoing OB did her usual assessments of the babe, determined he was doing great, right on track, and set me up for an appointment 4 weeks later. Falling at the end of October, this would be the last one where we would get to see her, but she let me know that any of her partners would be happy to take on my care. I tried to probe a little further with her to see if she had some insight that would help me make a solid match with one of her partners, but she just gave a me a sweeping "they would all be great and do a good job for you" statement. Still, I had another month to figure it out, and an anatomy ultrasound coming up in between at 20 weeks, so I didn't dwell on it too much.

The big ultrasound day arrived a short 2 weeks later in mid-October. Although feeling a bit buried by the amount of work I had been juggling, I was very excited to take a quiet morning to spend with Mandy and Wes (albeit over Skype) for the ever-anticipated anatomy scan. I enjoyed being able to share the experience with them, although, admittedly, it was a bit anti-climactic. Everything measured perfectly, even about a week ahead (recall that this little guy has been an overachiever all along). The technician confirmed, decidedly, that belly buddy is, in fact, a boy. Mandy and Wes watched and listened throughout the scan without saying much. I was hoping that they were enjoying the glimpse of their little man. We had a nice long phone call after the appointment where they told me they were relieved that everything looked good, and we talked about the 3D/4D ultrasound that we scheduled for the first week of December where they would get a really good look at his face, features, and adorable little toes. They now had even greater anticipation of seeing him on that upcoming scan. They also asked me about scheduling a fetal echocardiogram, as is common in IVF pregnancies. Seemed easy enough, right?? Famous last words...

I called the OB's office the following week to inquire about the fetal echo. The nurse (medical assistant? not sure...) that I spoke with told me that they don't routinely do a fetal echo on their patients, so I shouldn't worry about it. Now, maybe it's the pregnancy hormones, but there's something about the way this conversation went that drives me bananas. If I call a professional's office with a professional question that is decidedly outside of the norm of their day-to-day activities, I expect a professional to weigh the question and respond based on their acquired skills and knowledge in their field of practice. I don't expect (and don't even want, in fact) one of the paraprofessionals on the team to dismiss the question without due consideration. In this case, I more explicitly asked the person on the phone to discuss it with Lovely Outgoing OB. A week went by without a response, so I called again. This time the person on the phone seemed very annoyed to be asked a second time, but said she would call me back with an answer. Five minutes later she called to say they were not going to order it and that we didn't need one. I asked why they don't order them if it's common practice for IVF pregnancies in light of ACOG's support of fetal echos at 24 weeks following IVF based on statistically significant increases in heart disease and heart conditions in IVF babies versus naturally conceived. Again, I got annoyed stuttering and an "I'll call you back". Ten minutes later she called back and this time seemed to relay Lovely Outgoing OB's irritation with being questioned. She told me that the request was specific to IVF and if we wanted it done we should get the RE to order the echo. Ouch. I hung up, sufficiently hormonal, unsure what to do with that response. First, I let Mandy know what they said, then I went to work as I always do when I need to gather solid information: a review of scientific literature. I was happy to find, among the plethora of documentation of rationale for doing a fetal echo around 24 weeks for IVF fetuses, a study of several hundred IVF pregnancies that showed that although that is true, there were no findings of cardiac irregularities in patients that first had a normal anatomy scan. So that's to say that all of the IVF babies with cardiac disease or abnormalities also showed those on the 20 week scan prior to the fetal echocardiogram. With that information in hand, Mandy and I talked it over and decided not to push the issue further based on the bean's normal cardiac findings on the 20 week anatomy scan. Whew... crisis narrowly averted. On the other hand, I had to go back to see Lovely Outgoing OB in a couple of weeks, and I wasn't entirely sure what her demeanor would be like when we were face to face.

Two more weeks rolled by and we were back to see Lovely Outgoing OB for our 22 week appointment. She started by asking me what we decided on the fetal echocardiogram issue. I was impressed that she just jumped right in with that, and that she acted like we somehow had a choice. Definitely not something that her office staff relayed to me over the phone a couple of weeks prior. Regardless, ready to move on, I told her we were good with the anatomy scan results and were not planning to pursue the fetal echo. She gave a long, detailed explanation of her lack of experience in RE medicine, but that she felt the push for echos on fetuses that demonstrated a normal 20 week anatomy scan was motivated more by RE's and Maternal Fetal Medicine specialists that are so accustomed to visualizing their patients through ultrasound that they get into a rut of thinking they need it when sometimes they don't. Fair enough. I appreciated the professional opinion and rationale rather than "the answer is no and if you don't like it, get someone else to order it for you." Both content, we went on with our usual business; a few questions, a little measuring and a couple of jokes to round out our final appointment. When she measured my fundal height, she noted that it was a little big for our dates. I asked by how much and she said "1 cm... I could call it 2, but I don't want to freak you out. It's about 1.5 over the 22 cm we're expecting." I filed it away, knowing that I had a gestational diabetes test coming up at the next appointment and secretly praying that I wasn't measuring big because I had GD making the baby larger than normal. To wrap up the appointment, she asked me who I would like to see for my next appointment. I had decided to switch to one of her partners that I had heard good things about and had great online reviews. They scheduled me for an appointment with Partner OB for 4 weeks later at the end of November, although that appointment would be scrapped before we ever even got close to Thanksgiving.

Like a Butterfly Emerging from a Cocoon

I'm alive!! This stork has not fallen off the face of the Earth, nor been run over by a bus, never to be heard from again. No, it was not some ill-fated adventure or injury that has kept me from my blog, but rather a tiny little wombmate that has been sucking all of the life energy from my entire body for the past 8 weeks.

As you may recall from my last post, we had very strong positive home pregnancy tests, and the transfer appeared to be successful. We had only transferred a single, PGD-normal, male embryo, so our dark lines on the home pregnancy tests gave us the impression that he was snuggling in nicely. Around that time, the pregnancy exhaustion hit me with full force, and has only given me a couple of reprieves since. The morning sickness came with it, although the nausea was quite predictable; arriving late-afternoon each day and hanging around until sometime into the night. I would wake each morning feeling well rested with a calm stomach, just long enough to be productive for a few hours and get some food into my system. By the time 2:00 pm rolled around, I had to close my office door for a brief siesta just to get myself through the afternoon, and any chance of productivity was shot for the day. But today is one of those blessed reprieves, so I'm taking full advantage of it to fill you all in on how things have developed over the past couple of months.

At our first blood draw 10 days past transfer, my beta-HCG (human chorionic gonadotropin - pregnancy hormone) result was 221 mIU/mL, which is a great starting number. With the goal of doubling the amount of HCG in my system every 48 hours as a healthy embryo should do, we tested again at 12 days past transfer where our result was 542 mIU/mL. Far better than doubling, this little bean was really taking off in there. The clinic scheduled the first ultrasound for the following week when the pregnancy was 5 weeks and 2 days along. Mandy, Wes and I knew that we wouldn't be able to see much on that ultrasound other than a yolk sac, as the fetal pole doesn't develop until the end of week 5 and the heart doesn't start beating until early in week 6. Much to our surprise, the bean measured 5 weeks and 4 days (2 days ahead), and had the beginning of a fetal pole forming. It was great to see we were right on track with a little overachiever on board.

Our next ultrasound was scheduled for the end of the following week when we were 6 weeks and 5 days. I was surprised when I showed up that morning with quite a flutter of nerves in my stomach. It felt like the weight of the world rested on this ultrasound and whether the bean was able to get that heart beating or not. As the sonographer lit the screen up, she immediately moved past the bean and there on the screen was the undeniable flutter of a fetal heart. My eyes leaked a little as I was so relieved and awe-inspired by the work that we had done to get that point. I immediately sent Mandy the pictures, which elicited the expected exuberance that also made my eyes leak a little. Aside from what I predict will be an amazing feeling when they hold their baby for the first time, this was one of the greatest moments of this journey. To help these wonderful people to finally be able to achieve something that they have dreamed of for so long breathed pure happiness into my soul.

The final RE ultrasound was scheduled for 8 weeks and 1 day, and again showed the bean growing like a weed, still measuring 2 days ahead. The nurse coordinator emailed me to say that everything looked perfect, that I was to transition to my OB, stop my progesterone shots that day and start progesterone suppositories for 13 days until I was 10 weeks pregnant. After 2 days of the suppositories, I was deeply regretting the switch and wishing for a nightly injection of progesterone into my backside. The suppositories caused some irritation and light spotting, as is common for many women that use them. Mandy and Wes, however, were panicked by the spotting and requested that I see the OB. I was able to get a quick view on ultrasound to let them know that the bean was still doing fine with a perfect heart rate, and we set our first regular OB appointment on the Monday after we hit 10 weeks.

The first OB appointment was great fun. Mandy and Wes are not currently stateside, so they likely won't be able to attend many appointments. Such was the case with this first one. The nurse, the OB and the staff all seemed to really enjoy having a case that's a little new and different. We joked around and had a great time, as well as running through the usual first appointment information. We got yet another peek at the bean on ultrasound, where he was still outperforming expectations. Our next appointment is set for August 31 when we'll be 14 weeks. We're now 12 weeks and 1 day, and I'm just starting to emerge from the exhaustion and nausea cocoon of the first trimester. Here's to increased energy and keeping the blog updated!

More Monitoring, More Results

We've progressed to pre-transfer monitoring, round 2. At this point, we are 16 days into the medication cycle and exactly a week after the last monitoring appointment. We will have one more monitoring appointment in 3 days, and then we'll transfer in a week and a half (June 12).

As with each monitoring appointment, they drew a vial of blood and did another ultrasound this morning. The things that have changed since our appointment last week are that I finished shedding old lining, the RE cut my Lupron dose down to 5 units per day instead of 10, and added oral estradiol at 1 mg twice a day. After the first three days of that change, he upped my estradiol to 2 mg twice a day. The effect that we hoped to see at this appointment was increased estradiol levels in my blood, my endometrium starting to thicken up (goal thickness at transfer is > 8 mm) while the ovaries should still be quiet (no follicles over 10 mm) and progesterone levels should still be low.

Results
Endometrial thickness: 9.3 mm
Right ovary: 6-7 follicles < 10 mm; 0 follicles > 10 mm
Left ovary: 8-9 follicles < 10 mm; 0 follicles > 10 mm
Additional findings: Small pocket of fluid in the uterine cavity
Estradiol: 228 pg/ml
Progesterone: 0.5

Things look great. My lining is already past our goal and we have no rogue follicles trying to impede our progress, so we're in great shape. We're going to keep plugging along toward our next monitoring appointment on Friday. The RE didn't say anything about the small pocket of fluid, but I'm hoping that it'll be gone by the time we do the next ultrasound.

Sneak Peek

Today was our first pre-transfer monitoring appointment. This is an aspect of IVF that I really enjoy and look forward to in each cycle. When couples are trying to conceive naturally, there are a lot of days that pass with no news or no indication of what's going on down in the land of babies. The two week wait is notoriously excruciating because of the lack of information. In the IVF process, however, doctors are getting all up in our business on a pretty regular basis, so I'm very up to speed on how things are progressing during each cycle. I like knowing things. In spite of the magic wand they have to use, this state of knowing things makes me happy.

The routine is pretty much the same at each pre-transfer monitoring appointment. They draw a vial of blood to be tested for the pertinent hormones of the week, then I head to the ultrasound room for a quick look at my inner girl bits. First stop on the magic school bus ride is the uterus where they measure the endometrial thickness (lining) and look for any pockets of fluid. Next they head on over to one of the ovaries, count the number of immature follicles (less than 10 mm), document and measure any developing follicles (greater than 10 mm), and check for any cysts. They repeat that procedure on the other ovary and we're done. I put some pants on and head back to work to await the results.

At this first appointment of the cycle, the goal is a thin lining (around 3-5 mm), two quiet ovaries (no follicles over 10 mm) and low estradiol and progesterone levels.

Results
Endometrial thickness: 5.9 mm
Right ovary: 6-7 follicles < 10 mm; 0 follicles > 10 mm
Left ovary: 8-9 follicles < 10 mm; 0 follicles > 10 mm
Additional findings: None
Estradiol: 34 pg/ml
Progesterone: 0.6

Stork 951, This is Ground Control, You're Cleared for Take Off

I think I've kept you all in suspense long enough. A month ago I was on the fence between the local IPs through the agency or the independent match IPs on the East Coast with the picky clinic. After much discussion with Scott and the East Coast clinic, I decided that the independent match was the way to go, and the medical screening date was set. The IPs, Mandy and Wes, already have 4 frozen PGD tested embryos, so once we traverse the gauntlet that is screening and contracts, we'll be ready to transfer.

After a thorough review of my records, the clinic called to schedule the medical screening. Scott and I flew out there last week with 3 of the 4 kids in tow. We met up with Mandy and Wes on the first night that we arrived and had a wonderful dinner together. This was the first time meeting in person, and they were as sweet and wonderful as they were over Skype. I'm really quite happy to be working with such a wonderful couple. While still in their early thirties, they have had multiple unexplained early losses that led them to visit a few reproductive specialists who determined that several auto-immune factors were to blame for the losses and that Mandy would not be able to successfully carry a pregnancy. That prompted them to act quickly to locate a surrogate to carry the embryos that they had already created. Those efforts led us all to the clinic last week where their RE did a saline sonogram of my uterus, took 7 (yes, SEVEN) vials of blood, and we all sat down for some psychological evaluations and group discussions. It really was an interesting day, and we all enjoyed seeing each other again. As we left, Mandy gave me a box of the medications that she had been sent in preparation for her own transfer prior to learning the results of her infertility testing.

When we got back to the hotel, Scott asked me how we were going to get the box back with us because it was full of needles and we had only traveled with carry-on luggage. I decided to ship it rather than deal with it at the airport - seemed simple enough of a solution. After printing the shipping label and preparing the box for shipment, we took off for the airport. Not being natives of the East Coast, we were unaware that we really couldn't get off of a turnpike once we got on it, and this particular turnpike dropped us at the airport. No problem, there had to be some FedEx drop box somewhere in the airport, right? Wrong again. At this point, we only had a little over an hour until our flight left, so my options were to carry it on or check it. The airline counter was swarming with passengers checking bags, so I asked if I needed to check it based on the needles, or if I could carry it on. They told me that I could carry it on as long as there were prescription labels on the medications. Great!

Off to security we went with 5 rolling bags, 3 kids and a suspicious looking box. At every opportunity, I told the TSA agents "I have medications including needles, how do you want me to proceed?" They were all great, said "No problem" and scanned everything as usual. We passed through the metal detectors to the swabbing area where everything that was swabbed was normal except the box of medications that lit up their machine like a Christmas tree. The agent, again, very nice, did a full pat down on me, swabbed me and the box again, and came up with the same electrifying result. Awesome. She then tells me that the protocol dictates that they call in the explosives expert who arrives about 10 minutes later. He goes through the course of events with the TSA agent, explains to her that there are certain medications that will produce a false positive, then tells me that he has to do a full search of my luggage and person.

While he removed and photographed every item in my bag, the TSA agent did a very thorough body search, then they sent every item through the scanner again. Interestingly enough, they never opened the box of meds and actually looked inside - only scanned it twice. Once he had everything documented, he thanked me for my time and sent me on my way. We ran for the gate where we saw the last few passengers boarding. Whew, we cut it close on the time, and am I ever glad that I did the online check-in the night before!

A week later, we're home and back to our regular routines. The clinic called a few days ago to say that everything came back negative/normal, and we're ready to go once we have a signed contract. Lest I bore you all to death with the tedious details of the contract process, suffice it to say that Mandy and Wes' attorney doesn't have the same sense of urgency with the contract drafts as the rest of us do. We finally decided that the best way to make progress was for the three of us to have a long conference call to make all of the final decisions on the modifications that had been proposed, and then send them to their attorney to incorporate as the final draft. We did that 3 days ago, and are now waiting for her to send it back to all of us for final approval and signatures. Here's hoping we have a signed contract next week. If so, we'll be right on track for a transfer in the last week of May.

More Discussions, More Decisions, More Waiting

 Spring Break is almost here! Another couple of months have passed in the life of this stork, and as usual, they have been filled with constant activity, decision making and change. When we last caught up, Ellie and Matt were in the process of grieving the loss of their second and last embryo, and I was in a state of uncertainty about where that left us on this stork adventure. A couple of weeks after my last post, the three of us sat down on for a Skype chat to discuss where we were at and what direction we were going. Ellie and Matt had a call with the RE earlier in the week and were able to ask all of the questions that they had to try to wrap their minds around how they got to this point. In my second-hand version of that conversation, it sounded like the RE told them that they were victims of bad luck. He told them that the success rate of PGD normal embryos is about 70%, and that he didn't see any reason for the two failures other than being unlucky enough to fall into the 30% group both times. He offered to perform a wide range of testing on me if it would make them feel more comfortable before the next transfer. I later was able to have a call of my own with him where he told me that he thought such testing would show that there's no definable explanation, but rule out any fears that they may have about my ability to carry. As I understand, the testing is quite expensive, but I told Ellie and Matt that I would be on board with any testing that they may want the RE to do. They told me that they wanted to take some time to consider all of their options. When they started this journey, they never imagined that it would take more than one transfer to get pregnant. When the first transfer failed, they were certain that the second one would succeed. So when the second embryo miscarried, they found themselves in a situation that they had not at all expected or planned for, emotionally or financially. They asked me if I was willing to wait a few months while they investigated other clinics and protocols, and saved some money for future retrievals and transfers. Later in the conversation, Ellie eluded to an estimated November or December transfer which was a bit longer than I had anticipated.

Afterwards, I was talking to Scott and wondering if I would go stir crazy waiting nearly a year for the next transfer. In the meantime, I received a call from my previous agency asking if I was currently working with any IPs and suggesting a couple that they would love to match me with. Omph! Here was a tough decision. I love Ellie and Matt, and want nothing more than to help them build their family. But as you know, I was not blessed with an abundance of patience. I decided that the best way to determine the next steps was to open the topic up to Ellie and Matt to see what they thought. I wasn't sure if they really were hoping for a December transfer, or wanted more time but were afraid that I wouldn't hang on for longer than that. I presented them with the idea of terminating our current contract and reactivating it when they are ready with 12-18 months in between where I could help another couple in building their family. After thinking about it for a while, Ellie let me know that she and Matt agreed that it would be a good idea for everyone if we went that route. Rather than terminating our contract though, we are amending it to be on hold until we reactivate it at a later date.

That brought me to a point of deciding which couple I would be working with. The agency had called me about a specific couple, but I really would like to work with a couple that is at the same clinic that Matt and Ellie use so that I don't have to repeat the medical screening and psychological evaluation. I also would like to work with IPs that have frozen embryos and are ready to transfer quickly. I found a couple that are very kind and sweet with 4 high quality PGD tested frozen embryos. My first instinct is that I would love to help them, but they are very set on their clinic on the East Coast. I dipped my toes into the water to see if their clinic would at least accept my medical screening and/or psychological screening from the previous clinic. They were not open to that, so I am a bit reluctant on this match, although I did send in my records for review with their clinic. As I understand it, their clinic is extra picky about the surrogates that they approve in order to maximize their success rates. This also makes me a bit reluctant in thinking that we could get a couple of months into this process only to have the clinic decide that they won't work with me for some reason. In the meantime, I connected with a set of IPs with 9 frozen PGD tested embryos at the clinic in TransferCity. I spoke with them over the phone and had a pretty good conversation. In the following week they were in touch to say that they would really like to match and move quickly, but only if I was willing to pay for expenses incurred at the IVF clinic because my insurance wouldn't cover them. I politely bowed out of the matching discussion and wished them well. This week, the agency called me to say that they have another couple that they would like me to meet. This couple is local, and we had a great phone conversation last night. At this point, I'm not sure if I'm leaning more toward the local couple or the East Coast couple, but I'm going to have to make a decision and go with it soon. I'm keenly aware that the longer the matching process takes, the longer the break is for Ellie and Matt.

A Transfer for Christmas

Holy buckets: December was pure insanity in this stork household! My last post was just a week into cycle meds and only 2 weeks before our date with sun and sand. I promise that I didn't stow away in some beach villa in the Caribbean, although now that I think about it...

The last week of November brought great news on the stork front. I had my baseline monitoring appointment to ensure that the Lupron was doing it's job before we started adding Estrace to the mix. The ultrasound showed a nice thin lining of 4.7 mm and two quiet ovaries. The amount of relief I experienced from those ovaries being quiet was immeasurable. Able to breathe easy again, I headed back to the daily grind with a little more estrogen in my system and a vacation on the horizon.

The week before vacation got a bit harried at work. I had a project that HAD to move forward before I left for a week, but the stars seemed aligned against it. I pulled every string I could get my hands on, threw my minuscule, low-ranking scientist weight around, begged those that would listen, and miraculously managed to get things moving at the very last second. I was full of profuse appreciation to the technicians on our team, and overfilled with TUMS from the heartburn of trying to pull it all together. With the project all safely tucked in for the week, Scott and I took off for a land of no cell phone reception or internet connections.

On the morning of our departure, we received a notification that the ship was delayed coming into port due to heavy fog. We took this as a sign that we needed to do more pre-vacation shopping and proceeded to buy entirely new vacation wardrobes. I couldn't help myself - all of the beachwear was calling out to me from under the flashing "CLEARANCE" signs in each of the stores we ventured into. Armed with our now overly-stuffed luggage, we boarded the ship in the late afternoon and promptly located a fruity drink.

At this point, I would love to tell you that we had a whimsical, care-free vacation over the subsequent 6 days, but that would be a lie. There were many wonderful moments, but the medication wasn't very friendly to me on the trip. I spent most of it feeling very nauseous, and at times, extraordinarily emotional. No one really wants their vacation to be outlined in fluctuations of feeling irrational frustration and hyperventilated sobbing. Lesson learned: I will avoid scheduling future vacations during periods of cycle medications. Just to be safe, I'll probably add two postpartum months to that list as well.

The day we arrived home, I had my second (final) monitoring appointment to see how my lining was doing at thickening up to receive the stork babe, make sure the ovaries were still behaving, and to check my hormone levels before starting PIO shots. Again, we received great news: my lining was perfect at 12-14 mm thick with a distinct triple stripe and two quiet ovaries. My hormones looked great as well, so I started PIO shots on the 14th. With only 5 short days to our transfer on the 19th, I wrapped up the last of my research tasks for the year(!) and headed out to TransferCity on the evening of the 18th.

This transfer was much different than the first: In August, we were doing a fresh transfer on day 6 (a Tuesday) while waiting for PGD results to come back on the embryos. The PGD results were delayed causing the transfer to be delayed into the evening, and the middle of the week schedule meant that I would be heading back to HomeTown and work the next afternoon. This time, we transferred a frozen embryo on a Friday, which meant an extra day and a half of relaxation in TransferCity before the long drive home. The transfer went perfectly, and the embryo looked fantastic. Everyone was impressed with how the embryo looked, and by mid-afternoon I was back in my hotel watching a movie and letting the little bean get settled in.

Now that we've done two transfers, I'm starting to get a handle on what to expect. In the weeks leading up to transfer, I have mild nausea, lets call it a 4/5. On transfer day, they put that lively little bean in there and somewhere around 6-8 hours later, we're at an 8 - the serious puking begins, heartburn ensues with any food that has flavor, and I'm so exhausted that I can fall asleep in mid-sentence. This was somewhat more intense following this transfer, so no one was surprised when we ended up with a nice solid positive line on the home pregnancy test 4 days after the transfer.

 For fun I did another one the next day too, which popped up noticeably darker as you can see. Day 6, the day after Christmas, brought our first beta hcg blood test with a nice solid result of 71 mIU/ml. On the 7th day after the transfer, we packed up the kids and went to a family Christmas party. I told Scott that I was starting to feel less nauseous and less fatigued, and that worried me a bit. Day 9 was Monday, the 29th, and our second beta hcg which yielded a result of 140 mIU/ml. Ideally, with a doubling time of 48 hours, we would have been looking for the result to be about 210, but some embryos have lulls and bursts in their development, so the clinic called me back for another test on the 31st to track how the bean was growing. The result was 70 mIU/ml - devastating. It seemed even worse that we were headed to the last family party that day, all the kids were gathered around closely and enjoying the holidays, so I didn't really have much for a quiet space to just feel bad about it. When the nurse called, I let a few tears out while I talked to her, but then quickly pulled it back together. I could only imagine how heartbroken and defeated Ellie and Matt would be when she called them.

It's now been 5 days since that call. The reality has sunken in: We have two failed transfers with two PGD normal embryos, and there are no more frozen embryos. I don't know what Ellie and Matt are considering, and I don't know if the RE is planning to do anything differently to try to find success moving forward. I'm sad and frustrated and worried. I want nothing more than a successful pregnancy for Ellie and Matt. I'm hoping that our clinic will give us something to hang our hope on.

Round 3 - Ready, Set, Go

It's that time again - needles, syringes and vials by the fistful. I started the third round of meds this past Monday, so today is day 5 of Lupron. The last time it took about a week before the side effects kicked in, so we'll see in a few days if the hot flashes, insomnia and weight gain will return with this cycle. Today I met a brand spanking new side effect that didn't pop up last time; nausea. To be fair, nausea is my catch-all 'something's off in my body' symptom. Some people get headaches, I get nausea. Especially when hormones are involved; even your run-of-the-mill birth control pills will make me nauseous on a daily basis. When we did the first round of meds in July and August, I was actually pretty lucky that the nausea side effect didn't show up until we added the Estrace and then it was pretty intense. I cursed the Estrace a bit for it, but I guess there's a chance that the Lupron was equally to blame. On the bright side, I didn't need to hold onto those extra calories I ate at our office holiday lunch anyway.

So we're about a week into the cycle with exactly 4 weeks to transfer. I'll go in for a baseline monitoring appointment next Wednesday and if everything looks good, we'll start the Estrace on Friday and work on building a nice thick lining for the next monitoring appointment in December. Scott and I are going to sneak a nice little Caribbean getaway in between to get some rest and relaxation in before I get called up for stork duty. We're now 2 weeks away from vacation, and I'm looking forward to a fruity drink in my hand and some sand in my toes. Here's hoping that the tropical sun will help clear my hormonally-induced pukiness.

Decisions and Planning

Another month has come and gone, with little-to-no activity in the stork department. Ellie and Matt decided that they would like to skip November as a transfer month and set their sights on December instead. I had mixed feelings about it initially, knowing that December is a notoriously busy month at work, and not wanting to delay the process even further. However, the break from the medications has been wonderful, and as an added bonus, my December projects have been delayed to January. So it looks like a December transfer is going to be ideal, especially in light of the IVF clinic scheduling the transfer on a Friday. That will give me an extra two days to hang out in TransferCity and let the little bean snuggle into a cozy spot for the next several months. In hindsight, I'm really glad that Ellie and Matt decided to wait, and that I was able to step away from the shots and calendars and counting of days. Fertility processes can make a person crazy. I've officially had 5.5 weeks off and now the December transfer is looming on the horizon.

I called the pharmacy and the monitoring clinic this week to ensure that our medications and monitoring appointments are all in place. The shipment from the pharmacy will arrive today and I'll start Lupron injections in just over a week. I'll have two monitoring appointments leading up to a December 19 transfer of the one precious embryo that Matt and Ellie have on ice. If all goes well, this little storkie will have a due date of September 5, which will likely result in a delivery within a week of my birthday and Scott's birthday. A birthday week delivery would be all the more exciting and special.

So what have I been up to in all of my stork-downtime, you ask? That's a great question! A month of free time can be dangerous for an overachiever/perfectionist type like me, and it happens to have come at a time when I am not very pleased with my current employer. To give you a little more insight, I came to my profession by way of avoiding the professional course that my family wanted me to take.

In undergrad, I dutifully fulfilled the requirements of my BS as well as the pre-requisites of the professional school that I was expected to attend. The thought of being mentally beat down for another 4 years didn't seem appealing to me when I graduated, so I took a break, got married and had a baby. It seemed like a good time to fit those details in, but the naive 22 year old that I was had NO idea what kind of life chaos that baby would bring! I worked a good job, stressed constantly about juggling the baby and work, and tried to engage my emotionally MIA partner at the same time. Life was hard, my husband was growing more angry and violent by the week, and I knew that it was time to get back to school to finish my education to be able to adequately provide all of the things that I had dreamed of for my sweet little. I also knew that I still didn't want to go to the professional school that I was being pushed toward, so I applied to grad school halfway across the country. It was a top ranked program in a field that seemed like it would be a great fit. Two years into it, I had an MS, my husband seemed to have found his mind that he lost around the time the little was born, and it was an easy decision to keep going into the PhD program. Oh, and while the sailing was smooth, it seemed like a good time to add another little to the group.

I was about 3 months pregnant when husband again lost his mind. Family seemed like an overwhelming proposition, while friends and drinking and all-night activities seemed like great fun. Old habits reemerged, new habits formed, life was hard and I was gestating a fetus on top of it all. By the time another 3 years had passed, I was at the end of my program (ABD), had an unpleasant divorce under my belt, was single-parenting two littles, and had an ex-husband that was actively evading payment of any child support. I took a teaching position at a university that I really enjoyed, but alas, adjunct-style teaching doesn't go very far in paying the bills. The other side of doctoral work is research, which comes with a much greater salary. I was still pretty shell-shocked from grad school though, so I wasn't sure if I hated academia, or just needed some time away to love it again. In the meantime, I had a great offer from a research institute at my previous university that involved no academics, just research. I thought it would be a great opportunity to fall in love with research again, and allow my aspirations of greatness to blossom. I've now been at the research institute for about a year and a half.

The first year of research was truly amazing. I settled into a position where I was able to soar and achieve great feats. I worked closely with the director of the facility, and he quickly became a trusted mentor. He laid out a two year plan that would catapult my career, and I couldn't have been more ecstatic to be here and doing this work. Suddenly, at the end of my first year, he had to leave to follow his wife's career across the country. I couldn't blame him; when I looked at the aspirations of greatness that I had for myself, his wife is a total embodiment of that vision, 25 years into my future. The rest of the administration worked hard to alleviate everyone's concerns, a new director was appointed, and research was still being done. However, things have not gone well under the new director. He has run off all but one of our lead scientists and only shows up to the office for about 5 hours per week. He has no intention of hiring new scientists, so our institute is on the brink of major collapse. The rest of the administration is either turning a blind-eye because they don't want to deal with it, or pursuing a self-benefiting agenda which is an added insult to the demise of the unit. All of this has led me to a place of unhappiness which has resulted in a great amount of reflection in an effort to decide what I'm going to do next.

Logic would hold that I schedule my dissertation defense and find a different position in teaching or research. While wrapping up the degree is on the schedule for the coming months, I have yet to find an area of this career that I enjoy. Instead, I have found that my happiness in it is limited to positions where I have outstanding mentorship, and mentors like Former Director are few and VERY far between. I also have a close friend here that is a projection of me in 10 years (scientist with aspirations of greatness), and I can't say that I like what I see. She is brilliant, funny, and has found ways to somewhat cope with the stress of this career, but it's always lurking just under the surface. Former Director's wife took off for a different position for the same reason; trying to find a place of peace in this field of work. No doubt running from one stress vortex into the arms of another. That's when it hit me: The struggles that I have in my career today are not resolved 10 or 25 years down the road. The things I hate will not get better. So with that in mind, I've decided on a career change, and I've spent the past month pulling together everything that I need to get started on that track. As I said, a month of free time can be dangerous for an overachiever/perfectionist.

Houston, We Have a Problem

As you may have guessed from my estradiol-induced grumpiness in my last post, Matt and Ellie decided to go ahead with the October transfer, so meds were started on September 16. I was very happy to hear from the nurse coordinator that we would not have to do Lupron in this cycle because it's a frozen transfer and we are starting so close to my own cycle day 1. I quickly learned that Estrace alone with no Lupron to balance it out did not love me. I have been irritable for the past 3 weeks straight - God bless Scott for putting up with me! But I can certainly put up with some irritability to get to our transfer and find the success that we've been waiting for in this stork adventure.

My first monitoring appointment to gather baseline information was on September 15. Ideally, we want to see a somewhat thin lining (2-5 mm) and little or no ovarian activity. My baseline for the August transfer was perfect, so I was hoping to hear the same at this one. Unfortunately, the ultrasound technician pointed out a follicle on my left ovary that was developing quite well, already 13 mm. A mature follicle will ovulate when it's grown to somewhere between 20-30 mm, so this one was well on it's way. As I've said before, this is a problem because we want to make sure that Matt and Ellie's bun is the only one baking in this oven. The number one rule of being the stork and not the mommy: DO NOT OVULATE (unless you do natural cycles and are into that kind of thing). The RE looked over the lab results later in the day, noted that the follicle wasn't producing high-enough amounts of estrogen on its own, and reassured me that the high-dose estradiol would stop that little booger from getting any bigger. So, like the first round, we all kept busy with work and kids while the days passed.

My final monitoring appointment before transfer was on October 1. Ideally, we would like to see a thick lining (8-12 mm) and little or no ovarian activity. However, based on the previous ultrasound, I knew that we would have some ovarian activity, so we hoped for at least no growth. I watched intently as the ultrasound technician did the lining measurements: 7.74 mm. Hmm, that isn't quite what we were looking for. Although she rounded it to 8 mm, my final lining check before the August transfer was 10.24 mm, so this one is considerably less, and borderline for what the RE wants prior to transfer. She then panned over my right ovary; nothing there, as expected, so on to the left one. I literally held my breath until she moved the transducer to the right spot, and the image was undeniable. She hadn't measured it yet, but that was one of the biggest follicles I've ever seen in real-time.
I started to ask questions so quickly that the words were getting jumbled. I knew that nothing good could come from this. It measured 25 mm, and she pointed out the haze on top of it that is indicative of imminent ovulation. So much for the estradiol stopping it from growing. Un-freaking-believable.

I called the nurse coordinator on my way out of the clinic to see what our options were. She didn't answer so I left her a message. I also sent Ellie an email of the findings. She had been worried about this exact scenario. We played arm-chair MD all morning and afternoon looking up all of the possibilities. We were both hoping that the RE would allow the follicle to ovulate and then transfer 5 days later in a quasi-natural transfer. I warned Scott about this; We have a live round in the chamber so he must not even make loving gestures in my general direction. When the nurse coordinator finally called back just before 5 pm, she told us that the RE had looked over the labs and found that my circulating hormone levels didn't match up with what they would expect for pre-ovulation, and that it was likely that the lining had already begun to breakdown. Not wanting to take any risks with the one embryo that Ellie and Matt have frozen, we had to cancel the October transfer and look ahead to the next opportunity. I stopped taking the estradiol that same day, and depending on when my cycle occurs naturally, we'll be able to put together a new medication plan for the next transfer. Without a doubt, the next one will include Lupron. That was the long, expensive, painful lesson that we all learned with this round.

Let It Go

Let me preface this post with the fact that I'm on a very high dose of estradiol, which is making me quite irritable, and more than a little nauseous (which makes me a little more irritable). No amount of Elsa singing 'Let It Go' will help, although I have the sudden urge to build a snowman. Admit it, you're still in mid-verse "the cold never bothered me anyway!" But I digress: Today's post is more introspective and less hearts and flowers than some of the others. I'm sure that the humor and whimsy will return soon, but today, my thoughts are about the tedious, unproductive nature of worry while trying to conceive.

Stop worrying. Stop thinking about it. Don't let it get to you. Ignore it. It will be what it will be. You can't change it by worrying. It's out of your control. Let it go. I've heard and said each of these things to myself many times, and yet, I find the advice hard to follow. While it's 100% true, I find no comfort in it. Somewhere deep down, I truly believe that if I work harder, try more, wish harder, hope more, and do something different than the next person, I will achieve greater success than they have. In most things in life, this really does hold true. Pregnancy, however, is not one of those things. If you could harness the power all of the hoping and wishing and praying of all of the women that have ever tried to get pregnant for more than one cycle, you could move mountains with it.

But there's a dark side to all of that hoping and wishing and praying: When the one thing that those women had their hopes and dreams set on doesn't happen, doesn't work, or happens and then tauntingly fades away, there's an emotional crash on the backside. Trying to conceive is often a very private adventure full of enthusiasm and excitement. Women daydream about what the positive test will look like, how they'll tell their partner, how their partner will react, how they'll tell their parents, whether or not they'll find out the gender, on and on. And while they're spending a great deal of time getting lost in the joy and visions of what it will be like when baby gets here, nobody entertains what it will be like when the test comes up negative or the doctor shows them an ultrasound with no heartbeat. I mean, who can blame them? You don't want to invite such terrible things to happen. Yet, a majority of the time, those things do happen.

For women trying to get pregnant in their 20s with no fertility issues, the chances of a successful pregnancy are 25%. In other words, they are 3 times more likely to see a stark, one-line negative test than the two lines they've been dreaming of. In their 30s, the likelihood drops to 20% each cycle, and by 40, there's only a 5% chance of successful pregnancy. Of the pregnancies that are achieved, about 1 in 5 will end in miscarriage in the first trimester. The odds are staggeringly pitiful.

So what makes us so punch drunk with visions of onsies and pacifiers and bottles and diaper bags? Certainly there's biology; an internal drive to procreate. But it also seems like the most bitingly painful casino game ever played. You might win big the first time you play - 'hey, my best friend did, so I probably will too.' The random reward schedule keeps you pulling that lever over and over again - 'I've lost so many times, this time HAS to be the winning one.' For women out there like me, we have somehow convinced ourselves that if we "try" hard enough, we'll overcome the odds and find success. I've beat my head against that wall 9 times in trying to conceive my own children. Come to find out, I'm totally normal - statistically speaking. But overachievers don't generally care for 'normal', thus all of the headache and heartache of my unsuccessful cycles.

When I came to the decision to be a stork, however, I was determined to leave the stress and worry to the parents. I wanted to know what it was like to just enjoy the experience of being pregnant. I am still certain that a worry-free pregnancy would be one of the greatest adventures in life, and look forward to it when it happens. Somewhere in the chaos of the hormones and the embryo transfer in August, I slipped back into the overachiever. I wished and I hoped and I tried(?) until the crash. As we embark on our second transfer next week, I am consciously aware that 'it will be what it will be', 'it's out of my control', and I need to 'stop worrying'.

While I know that I'm in a better place to handle whatever result of may come of this next transfer, I also know that it has come at a price. I haven't emailed or Skyped Ellie and Matt as much in the past three weeks as we did leading up to the first transfer. I know that they are excited and nervous, joyful and anxious, and a bundle of all of the emotions that build up in each cycle. While I'm cheering for them in the background, I recognize that I can't ride this roller-coaster with them. This isn't my trying-to-conceive road to walk anymore, and somehow, in watching their journey, I've found my way to letting it go.

Hormones and Needles and Tests - Oh My!

We've put another six weeks of the stork adventure under our belt, which was full of injections, pills, and anxious waiting. Of all of the parts of the process to date, this has been the most active in a day-to-day sense. From they day we left off of the last post, I've been on a constantly changing regimen of leuprorelin (Lupron), estradiol (Estrace), and progesterone in oil (PIO).

Now I'll be the first to admit that I can be a little OCD sometimes, and I take far too much pride in accurately following directions and doing a good job. But this ever-changing menagerie of dosages and drug combinations over a 4-week period is enough to make my head spin, and my subconscious constantly wonder if I took the right medications at the right time. To calm my inner Monica Geller, I found this nifty little pill organizer on Amazon, filled it with my oral medications for the upcoming week, then put dummy markers in each appropriate slot to remind me to do an injection on that day and time. The over-achiever in me beamed with pride.

It's probably time to address the elephant in the room: "How bad are the injections... really?" The Lupron was in a small insulin syringe with a tiny little needle (the small one in the picture). As long as the needle isn't dull in any way, you really don't feel it going in, and I really didn't feel the Lupron dispersing for the most part. The tough part about the Lupron injections is watching myself stab it into the skin. Even in the last few days of doing those, I would catch myself hesitating, hovering over the pinched skin, and have to talk myself into it. So all in all, the Lupron injections weren't terrible. The Lupron side-effects, on the other hand, were not as kind. I started with 10 units per day, and within a few days I had hot flashes and a slight headache. After a week, I was in a full-on battle against the INSANE weight gain, and I was noticeably slower in my thought processes. Lupron seriously made me dumber. By the time I stepped down to 5 units, I was in a hate-hate relationship with the drug, and threw myself a little party on the last day that I had to take it. That happened to also be the first day that I took the infamous PIO.

PIO gets a bad rap in the IVF world because it comes with (comparatively) HUGE needles, has to be delivered deep into the muscle, and is in oil - not a great solution for dispersion into the muscle. I read some great tips online from other IVFers before attempting any of the PIOs, and my dear, sweet husband, Scott, watched some very helpful YouTube videos with some professional tips. As most people recommend, I warmed the oil in the syringe to help it disperse once it's injected.

Buzzy Injection Pain Blocker

I also applied ice and vibration to the injection site for about 15 minutes. Ellie and Matt purchased a Buzzy for me to help with this part, for which I love them dearly! The rest of the work is Scott's to deal with. I place myself face down, he finds the right spot on my tush/hip, delivers the medication and does a wonderful job of massaging the area with the heating pad afterward. I've concluded that this is true love; someone that is happy and willing to rub my bum to keep it from hurting me the next day. What a catch. :)

Not all injections go according to plan, or with the luxuries of home, however. Shortly after starting the PIO, Scott and I had to attend an evening dinner party out of town, and we didn't have time to stop at the hotel to do the PIO injection first. Instead, I found myself with my pants dropped in the backseat of his pickup, because, well, you gotta do what you gotta do. While slightly more painful without ice or heat, Scott still did a great job, and I didn't end up with a bruise or a lump afterward. In fact, the only lump and bruise that I've gotten from the PIO injections came at the hands of our IVF nurse immediately following the transfer. Scott wasn't able to go with me, so she did the injection before I left the clinic that night. I knew it was going badly when I felt her pinch the skin instead of pulling it taut, and again at the end when she said "Wait here and hold very still. It's bleeding quite a bit, so I'm going to grab some tissue and a band-aid." I was thinking "BLEEDING??? Scott never makes me bleed!?" As I type, some 15 days later, I can still feel the distinct lump from that injection. If ever in that situation again, I think I'll take my chances and do the PIO on myself.

Did someone say "transfer"?? Ah yes, there was that exciting little event stuck in there in addition to all of the medication fun. :)  In fact, Matt and Ellie flew into town early in August to prepare for Ellie's egg retrieval. As we went through August, she had multiple visits to the clinic to check on her egg production progress, and I had two visits to ensure that the oven was fully pre-heated and ready to bake a sweet little bun. All of our appointments went great, and by the day of Ellie's retrieval, we were getting good news left and right. The RE ended up retrieving 9 eggs, 8 of which were mature, and all 8 fertilized into embryos through intracytoplasmic sperm injection (ICSI). We continued to be encouraged by day 3 when we learned that 6 of the 8 were still doing well.

On day 5 there were 5 excellent embryos, so Matt and Ellie decided to do preimplantation genetic diagnosis (PGD), and we pushed the transfer back a day to allow results to come in. On day 6, I traveled to the clinic in my lucky green shirt and my shamrock socks. I arrived with a full bladder as instructed, and was informed that the PGD results were not in yet. So I settled into the waiting room, only to find that the other woman in the waiting room was also a gestational carrier waiting for PGD results in order to transfer. We struck up quite a conversation over the 2 hours that we waited, trying to ignore the pain of the bladders that were ready to explode. Finally the results came in, showing that Matt and Ellie had 2 normal embryos from the 5 tested; 1 boy and 1 girl. We proceeded with the transfer of the best looking embryo of the two, and froze the other one. Thus began our intense wait.

Four days after the transfer I took a home pregnancy test, but nothing showed up. I retested on the fifth day after transfer and there was a faint second line - woohoo! Ellie and Matt were very encouraged to hear the news, while I was working hard to hold down my breakfast each day. Day 6 post-transfer brought the same faint second line, which made me a bit nervous. I was expecting it to get darker, but, as you all know, patience isn't my forte, so I chalked it up to being over-anxious to see progress. I tested again the next day, knowing that on the 8th day after the transfer we would have our first beta HCG blood test. The line was exactly the same as the previous two days, and as the day wore on, I felt less nausea than I had in over a week. I reported everything I knew to Ellie and Matt, so we were all cautiously optimistic going into the blood test. When the clinic called with the results of the blood test, it was only 2 mIU/ml, which is barely pregnant. If the pregnancy was viable, it should be have been above the single digits, so the clinic told me to stop all medications and allow my body to reset for a new cycle. Of course, Ellie and Matt were heartbroken, and I found myself in a combination of sad and mad at no one in particular. I was mad that we had all done so much work, did everything "right", received great news at every check point, and transferred a PGD normal embryo, only to have a failure on our hands. How does that happen!?!? The question is rhetorical of course, but that was the level of frustration that I had reached. I went home to tuck all of my medications and IVF supplies away in the closet, and found that Scott had brought me sushi, my favorite amber ale, and espresso ice cream to help me feel better. Have I mentioned that he's quite a catch? So Matt, Ellie, and I decided to Skype a few days later to discuss what happened and start to plan our next step. Based on our clinic's schedule, our options will be to transfer the one remaining frozen embryo in early October or mid-December. Regardless of which date is chosen, may the fertility odds be ever in our favor.

To Be or Not To Be

That is the question on this very important day. Today is July 23rd; the last business day before July 24th, the all-important first day of cycle medications. This is the day that all paperwork must be completed by in order to be on schedule for the transfer on August 26. For all of you out there making bets on whether it would really get done and signed in time, the final answer is.... kind of.

A full 9 days ago, I optimistically hoped it would be done in 48 hours... and then the gods laughed and laughed and laughed. It was a week of little to no news, pacing, nail biting, calendar watching stress. The nurse coordinator from the IVF clinic emailed me yesterday nervously asking if it was done yet, and I passed along the anxiety in kind to my attorney to see if she had heard anything from Ellie and Matt's attorney yet. While there was no official response, the nurse coordinator went ahead with sending the medications, and we all slept uneasily on it for another night. This morning I received a somewhat panicked email from Ellie and Matt that they had received the final version of the contract and were ready to sign it, but the one and only representative from the surrogacy agency that has to witness their signing and notarize the contract, unexpectedly went out of town and won't be back until Monday the 28th. Did I mention that dealing with this agency makes my teeth itch? Regardless, we have the finished contract in hand, and that's a win all on it's own. In the meantime, Ellie and I came up with a plan where my husband and I will sign and notarize the contract today, send it back to the attorneys this afternoon, and then Ellie and Matt will have it in their possession while waiting on the agency rep to return, allowing them to execute their portion. This was agreeable to the nurse coordinator in terms of starting the medications tomorrow and will keep us on schedule. As I said 23 days ago: coo coo cachoo, we have a completed contract... kind of.

Now comes the fun (?) part. I'll be giving myself an injection of Lupron in the abdomen once per day starting tomorrow for the next 28 days. I've rationalized that it's a tiny little insulin needle, and I've built up a nice "protective layer" over my abs, so this shouldn't hurt a bit. I'll let you know how that goes. The Lupron is very important though, as it will quiet my ovaries and prevent me from releasing an egg of my own during this process. We want to be VERY sure that the only little storkie in this adventure is Ellie and Matt's! So tomorrow is day 1, the beginning of an exciting and highly anticipated stork adventure. Let's do it!