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

And We're Off, Like a Herd of Turtles

It's that time again: Another month has passed, and the blog needs an update. If you've read any of the older entries, you'll notice a pattern of posting where there's a longer pause between updates during these contract and preparation periods, and more of a flutter of blog activity as we get into some of the more exciting surrogacy events. There are two main reasons for this. First, the contract and preparation periods are tediously long and rather boring. Second, as you may know by now from this blog, I am not a patient person, so I don't take the long, slow waiting as well as one might hope. More frequent updates from me during this period may come out as "Still no *@^$*# contract yet," and no one wants to read my constant Debbie Downer frustrations without some good news to help wash it down. With that said, brace yourself for a flurry of blog excitement on the horizon.

Exactly a month ago, I closed with "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." And then the gods laughed and laughed. T'was not meant to be for an end of May transfer. We experienced two major hiccups to the plan. First was that Wes and Mandy's attorney *must* get paid by the hour. I can't think of any other explanation for why someone would hold onto this document for days and weeks on end without signaling forward progress. Holy buckets! I have never seen someone work so slowly in my life. Working with her has led to me the conclusion that if I ever find myself in the situation of doing another stork contract and the IPs select her as their attorney, it's an automatic deal breaker for me. I have also decided that I would rather be subjected to an angry hoard of starving fire ants with no route of escape than to wrap myself up in another several month long contract negotiation, especially with that attorney or any others like her. But I digress. There was a secondary hold up as well.

Back in early April when we all visited the RE, Mandy and Wes also had to have blood drawn to meet FDA testing requirements for transferring the embryos to a third party (me!). Normally, IPs will have this done at the time of egg retrieval and/or sperm collection, but Mandy and Wes did not intend to use a surrogate at the time of their embryo creation, so the RE had no reason to run those tests at that time. Now that we're getting ready to start cycling, they need those results on file before we can get started. It was about two weeks after the results for Mandy, me, and Scott had come back that everyone started to question where Wes' results were. After some digging into it, the answer was that the lab lost his blood sample. This is quite problematic, as Wes is working an out-of-country job assignment, so he doesn't have access to lab to get another sample drawn quickly. It took about a week to get another sample drawn and submitted, but alas, the contract still wasn't done, so we waited patiently for the results. About a week ago, as we were all trying our hardest to pry the final draft of the contract out of the attorney's death grip, we got an email from the clinic saying that one of the infectious disease markers on Wes' blood panel came back positive, and that we would need to do some additional steps before proceeding. The positive result was for a relatively inconsequential virus and indicated a very old exposure that Wes had fully recovered from. Still, I had to have an antibody titer done to assess my immunity to it, meet with an infectious disease specialist to talk about the risk of contracting the virus from the embryo (highly improbable) and sign an FDA form stating that I assume that risk in moving forward with the transfer. Amazingly, I was able to whip through all of that in two days AND put some ink on the signature line of the contract last Tuesday. It was like some kind of post-Mother's Day miracle! Still holding the wet pages with a look of shock and awe on my face, the box of medications arrived on Saturday in order for me to start my first Lupron injection today.

We're cooking with gas now! We may still be a month away from transferring, but we have some dates to look forward to in that time span. I'll start Lupron tonight and my first monitoring appointment will be May 26, with two more monitoring appointments on June 2 and June 5. Then I'll fly out to the clinic on the 11th for our frozen single embryo transfer on June 12. This stork is officially no longer on standby; let the oven pre-heat begin!

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.