Laughter is the Best Medicine

Our OB appointment the other day went great.  The bleed appears to have finally resolved itself which is fantastic news!  I still need to talk to the doctor about whether I need to continue on the Lovenox as well as whether or not I can stay exercising again, but I'll do that when we go back in January for the nuchal fold measurements.

I'm so amazed at the technology that's available now.  My mom never had an ultrasound when she was pregnant with my sister or me and not only do I have pictures of the girls' development starting with their day 5 embryo images, but now I have ultrasound images which are so detailed due to 3D technology.  Just AMAZING!

What was even better was watching their spontaneous movements via ultrasound.  I swear they were dancing in there.  I can't feel anything yet, but it was so great to see.  I couldn't help but laugh at their little arms moving around and my laughter caused them to move around even more.  Clearly they like it when mom laughs.

Anyhow, below are their week 11 and 1 day pictures.  The four on the left are "Speck" and the two on the right are "Eire."  That's right.  We're calling them "Speck und Eire" while in utero.  It's German for "Bacon and Eggs."  I know...we're weird.  :)

Happy Holidays!!!

Changing of the Guard

Today is our first prenatal OB appointment as we officially "graduated" from the fertility clinic last week.  I'm looking forward to the change of pace, so to speak.  As much as I like the folks at SCRC, it's so good to be moving to the next phase of pregnancy.

Eric is going with me to the appointment today.  He's hoping to see the girls on an ultrasound again.  I'm looking forward to him meeting Tony.  I really love my OB and know Eric will feel better about being away in production if he feels confident that I'm in good hands.

That's about it.  Not a whole lot of report.  Just trying to take it easy and not overdo things over the holidays.  That's a challenge in and of itself, but at least I have a good excuse to not do much this year.

Here's to all having a wonderful holiday and enjoying time with family and friends.

Beating of Hearts

We had another appointment yesterday at the fertility clinic.  It was our nine week check up.  The girls are growing right on schedule, but was most amazing was hearing their heartbeats.  I am still in awe at the sound.  So wonderful.  So amazing!

This picture does not do the experience justice, but I don't have a recording, so...

The doctor is pleased with how the fetuses are developing.  There is still a bleed in my uterus, so he's going to refer me to a high risk OB to determine if I should go off the Lovenox.  To be honest, I would love to not have to give myself any more injections.  I won't need to see the high risk OB for a couple more weeks, so hopefully the bleed will get smaller again.  Until then I will continue to take it easy.

And I will continue to think about their little beating hearts.  It was truly amazing to hear and it has me singing "Beating of Hearts" by XTC.

You have heard
You have heard the loudest sound
In this and every world you can think of

Louder than tanks on the highway
Louder than bombers in flight
Louder than noises of hatred
Dancing us from darkest night is the rhythm of love
Powered on the beating of hearts

Ugh...

Nausea.  I've become all too acquainted with it as of late.  My doctor is happy that I'm feeling it and people say it's a great sign, but man...I could use a break from it.

All week I've been battling it.  And it's not just morning sickness.  Nope.  For me it starts about 10am and continues to gnaw at me until 7pm or so.

Add to that the fatigue and wow!  I'm either feeling sick or napping.

I did get these great acupressure bracelets called Psi Bands.  Found them on Amazon.com.  They seem to be working wonders, although I'm not 100% woozy-free.  I can only imagine where I'd be without them.  And for all I know it's all in my head, but either way, I'll take any relief I can get.

So, I've been taking it really easy.  Even though we had dinner plans three nights in a row over the holiday, I managed to rest most of each day.  Still, I spent almost the entire day Saturday sleeping on the couch.  Even today I was up for about two hours and then I napped for 30 minutes, was up for maybe two hours and then napped again for close to two hours and then spent the rest of the day quietly on the couch.

All of which leads to my giving up my ticket to a concert tomorrow night.  And it's not just any concert.  I purchased our tickets six months ago.  Roger Waters The Wall Live.  We have been looking forward to this concert for a long time now and as it has crept up and is now just 24 hours away, the anticipation is palpable.  I've told Eric that he should still go.  I wouldn't want us to both miss out.  I just know how wiped out I am lately and can't imagine making it through the show tomorrow after a day at the office.  Luckily it wasn't hard to find a friend to take my spot.  I know they'll have a great time.  Oh well...so much for it being the girls's first concert in utero.

And with that...it's almost 7:30pm.  I think I might take my meds and head to bed to read for a little bit before falling asleep...again.

Gratitude

I am a fortunate woman.  I have a wonderful husband, two slightly insane dogs, a home, a car, a career.  We have an amazingly supportive family and a phenomenal group of friends.

We were at Eric's boss's last night for Thanksgiving dinner.  One of the other guests asked us all to say what we were thankful for.  Everyone has very lovely and heart felt things to say.  Eric said so many lovely things about me during his turn and I immediately followed it up with a bit of a joke saying, "I'm thankful that I handled all the hormone shots well and didn't drive Eric away during this process."

What can I say?  I felt really self-conscious.  I didn't really know anyone there except Eric.  I've broken bread with a few of them on other occasions, but I don't feel all that comfortable around them.  Certainly not enough to be that open or vulnerable.  And after how loving and thoughtful Eric had just been in my direction, I was at a bit of a loss for words.

Tonight we're having dinner at one of my friend's homes.  Who knows if the situation will repeat itself and, if it does, who knows if I'll behave any differently.

All that said, I'm so very grateful for all that I have and all that is to come.  There are lots of changes coming and endless uncertainty in our future.  There are two little lives to care for coming next year and I'm already making their well being my number one priority.

The ultrasound the other day showed them again.  Growing nicely with good strong heartbeats.  The only thing of some concern is a small around of blood next to one of the gestational sacs.  It had been there the previous week and has about doubled in size.  Still, it's very small and the doctor doesn't want us to worry about it.  So, I'm taking it easy.  Napping and taking things slow and willing my body to stop the bleed and reabsorb the fluid.  Depending on how it looks next week, I might be sent to see a high risk OB to discuss what to do next.  I would really rather not have to do that, so hopefully my body will listen and correct itself.

Worrying about it certainly won't help.  So instead I will continue to be grateful and appreciate all the wonderful people in my life and look forward to meeting two more very important people next summer.

Six Weeks

It's still very early.  We know this, but it's hard not getting ahead of ourselves and thinking about names and needing a bigger house in a better public school district.  How are we going to manage travelling for a wedding when the babies are only four or five weeks old?  How much time am I going to take for maternity leave?  Do they make saddles for dogs to carry babies around on?

Yesterday we were in for our first OB ultrasound.  Most expectant mothers don't have an ultrasound this early on, but given how I came to be pregnant, we get to see what's going on a few weeks earlier than most.  The doctor came in and said "I'm so happy to see you guys in this room!"  We were pretty happy to be there too.  And then, moments later, we're looking at the monitor on the wall and he's pointing out the yolk sac and heartbeat of our growing baby. 

I cannot even begin to describe the feeling of awe looking at the little pixel fluttering on the monitor. That's a heartbeat. Wow! Eric jumped up from the chair beside me and got up close to the monitor. I swear he would have hugged it if he could. All I could do was smile.

And then the view was adjusted a bit and the doctor is pointing out the yolk sac and heartbeat of our other growing baby.

Eric choked up and put his hand on my shoulder and said, "I'm not one to say this very often, but I told you so."  You see, he had a feeling all along that two embryos implanted.  I didn't really have a sense of one or two and hadn't really thought too much about it.  All I really knew was that I didn't want all three to implant because I didn't want to undergo the selective reduction procedure.  I didn't want another surgery and I didn't want to choose.  Thankfully, we don't have to think about that anymore.

My activity level is still very restricted for now.  I'm in for weekly ultrasounds, blood work and blood pressure and weight checks for at least the next four weeks.  Assuming everything looks good, I'll be released to my OB after week 10.  Already the various hormones I've been on are starting to be reduced which makes me very happy.

Eric was more emotional than I was at the doctor's office.  He's a softie and I love that about him.  I just kept beaming a smile all day.  It's amazing to have all the stress and frustration of the past year and a half of trying to be replaced with the joy and excitement of finally expecting a baby -- babies! -- to arrive mid-2011.  Of course, when I got home I had a few teary moments of pure happiness.

The doctor cautioned us to not tell anyone that I'm pregnant or that we're expecting twins.  Like I said, it's still very early in the pregnancy and things could still change, but we're just not very good at keeping things to ourselves.  (Although we're not telling the doctor that we've told anyone, so don't anyone get any funny ideas.)

Thoughts...

I wouldn't call it a backlash, per se, but we've been met with some skepticism about being so open about the IVF process.  I understand peoples' surprise, but at the same time, talking about this, blogging about this...it is what has kept me sane.

I've always been one to internalize things.  It is a habit which started as a shy and insecure kid and still happens as a successful and confident adult.  There are just some things which are better kept to one's self.

But not this.  Not being able to conceive on our own has loaded us both with so much stress.  Of course, studies have shown that stress can effect our hormones and actually be a cause of infertility.  So, in order to contend with that stress, we decided to be open about the process.  Not just with our family, but also with our friends and colleagues.  And when I started writing this blog, it was my husband who encouraged me to share it to Twitter and Facebook.

Here's the reality -- so many couples wait until they are older to start thinking about starting a family.  The older we get, the harder it is to get pregnant.  It's just a fact.  We have a number of friends who are our age who are trying to conceive as well.  We wanted to make sure people knew there were options.  We wanted our experiences to be available to them, even if they didn't want to ask us directly.

One of the best things for us is having a very close couple give us the benefit of their experience five years ago.  Having my girlfriend's shoulder to cry on was invaluable and, looking back over the past six months and all the treatments and procedures, I can honestly say that I could not have done this without the support of my husband, family and friends.

And now that we're done with IVF, we're looking forward to sharing the experience of my pregnancy and the birth of our daughter(s) with everyone as well.

Oh...yeah.  I know many people will be thinking "Isn't it a bit early to tell people?" but, as Eric and I discussed this morning: This is our journey.  We get to choose who we share it with and when we share it.  Everyone has been there supporting us through all the disappointments.  Why wouldn't we share our good news and excitement with them as well?

Our first OB ultrasound is scheduled for November 17th.  We should know then if we're having more than one daughter.  And if my math is correct, I'm due around July 12th.

Restful

I'm about 20 hours into my 48 hours of bed rest.  Yesterday I was actually pretty tired, but today I'm full of energy.

So, Thursday 12 embryos were biopsied.  Friday morning I got the call scheduling the embryo transfer for Saturday at 10:30am.  The hadn't received the results of the genetic testing yet, but they wanted to get me scheduled all the same.

I woke up Saturday morning early.  The house was dark and quiet.  Eric was already awake.  I could smell the coffee perking.  It was cool in the bedroom and I was snug and warm under the blankets and I honestly thought it was Christmas morning.

We grabbed breakfast on the way to the clinic at one of our favorite places on Melrose, shared some good laughs and great conversations with the other regulars and then we headed out with oodles of well wishes on our side.

As we were waiting to be brought back for the transfer, our doctor arrived and said he was glad to see us there.  We told him that we hadn't heard the results of the testing and he sat down next to us to give us the news.

Of the 12 embryos, only four were normal.  Based on our ages, he said that ratio is pretty much right on target.  He said that for sure we had one star blastocyst.  He was going to get the growth report and we'd go over everything once we got to the transfer room.

Embryo #1 is our blastocyst.  Embryo #2 is at the morula stage (e.g., day 4).  Embryo #6 is a 12-celled embryo which is typically for late in day 3.  Embryo #7 is only 6-celled, so, while genetically normal, they weren't optimistic that it would grow any further.  These pictures were taken at approximately 7:20am.

We discussed which embryos would be transferred with our doctor and with one of the lead embryologists and we decided to transfer 1, 2 and 6.  I was prepped and by the time the embryos were brought in for transfer, embryo 2 had developed into a blastocyst and was hatching and embryo 6 was compacting to the morula stage.  Great news!

We were on our way home around 12:30.  The sun was shining and the air was so clear.  There's something about Los Angeles after it rains and, after a week of on-and-off rains, the city sparkled more than usual after a storm.

And now I'm just resting.  I've got loads of energy today, but I shall continue to follow doctor's orders and do a whole lot of nothing.  I'll just rest and let Eric keep taking care of me.  This morning he even made pancakes for breakfast.

On Call

The egg retrieval on Monday went great.  21 mature eggs were aspirated and 14 had fertilized by Tuesday morning.  That's right on the 2/3 fertilization rate average.

As of this morning, 12 looked great and were being biopsied for the genetic testing.  If results come back in Friday and look good, embryo transfer will be on Saturday, although there is a chance that the transfer won't be until Sunday.

Basically, we're on call pending the results of the testing. 

The doctor did say that he's very pleased with how the embryos look today and he's confident that we will get to the blastocyst stage this time.  He let me decide if I wanted to wait until day five to do the biopsy, but, as I told him, the impatient side of me doesn't want to wait a month to do the transfer.

Plus, day three testing has been the protocol for genetic testing for years.  It's only within the last two months that they have begun testing on day five blastocysts.  And I'm sure that he would not have given me an option if he didn't feel that it was warranted.

We're excited.  Eric has stocked up on NetFlix for our weekend entertainment.  We've cancelled our various plans and now we wait.

Here We Go Again...

It is official.  Egg retrieval will be on Monday at noon.

Of course this means I have to administer the trigger shot precisely at the stroke of midnight tonight.

WHAT?

Our doctor sure has one heck of a sense of humor.  Midnight?  Doesn't he realize I tend to go to bed by 9pm?  Especially while undergoing IVF.  Stimulation is tiring!

Hell, my ovaries are touching each other.  They are ready to be getting on with this, but trigger at midnight?

At least the nurse thanked me for being such a good sport.

Stay The Course

Those have been the orders from the doctor lately.  FSH at one-click above 25 and come back in two days for more blood work and another ultrasound.

I cannot deny that I'm feeling it this time.  I'm worn out.  I'm tired of all these doctor appointments.  I'm tired of trying to figure out what my insurance is covering and following up on the claims that are listed as "Processed" with no payments made.

Physically I'm feeling pretty run down.  Thankfully over the past few days of injections I have managed to not add to my bruise collection, so my abdomen is starting to feel better, but I'm ready to get on with this.  Let's get that egg retrieval scheduled so I can sit up straight without discomfort.

On a positive note, and if I remember correctly, there are 18 follicles between 10 mm and 18 mm growing.  Hopefully most will be close to 20 mm tomorrow.  If it's anything like last time, once they get close, the RE will up the FSH to help get as many as possible to cross that 20 mm threshold and we'll be able to schedule the retrieval for Tuesday or Wednesday.  Then, assuming everything looks good and the genetic testing doesn't show problems, embryo transfer will be six days later.

Here's to hoping!

The Waiting Game

We've all played it.  Whether it be waiting for something to end (the work day, the traffic jam, a particularly bad movie that your friends are enjoying) or for something to arrive (Christmas morning, your wedding day, a phone call, a promotion), we're all felt the anticipation (or dread) and all played games to help pass the time.

Lately I've been realizing how much this IVF process is a waiting game and it gets played every couple of days.  Injections, blood work, ultrasound and wait for a phone call. 

Everything looks good, more injections, blood work, another ultrasound and wait for a phone call.

New instructions, more injections, blood work, another ultrasound and wait for a phone call.

Another set of new instructions, more injections and tomorrow will bring about more blood work, another ultrasound and another wait.

I keep waiting for the cycle to be cancelled.  Today, as I sit somewhat uncomfortably thanks to the growing follicles, I'm already waiting for the call tomorrow afternoon.  Will we continue with the current FSH dosage?  Will it be reduced?  Increased?  Cancelled?

I need to distract myself, but I was reminded last night that I'm almost out of syringes and will need to get more.  Do I need to get those at the pharmacy or would the clinic be able to give me a few to use through the end of the cycle?  I would call today and ask, but whenever I've gotten ahead of myself on these types of things, I've ended up not needing whatever medication I picked up.

I have enough syringes to get me through Wednesday night.  If I need more, I'm sure Eric would be able to pick them up for me.

Still.  They are on my mind. 

Of course, that's possibly due to the fact that this time around my abdomen has been resistant to the needles.  I've managed to nick a capillary almost every time.  They don't bleed for more than a couple of seconds, but my belly is covered in little bruises.  I'm running out of non-black-and-blue skin to poke into and the waistline of my pants is managing to ride right along the bruise-corridor.

And my poor arm!  I've got a little red mark over the vein.  As much as it hurts a bit to have the blood drawn on the left arm, I think I might ask them to switch tomorrow to give the old right one a break.  I actually jumped a little yesterday when the tech tried to draw blood.  A tiny jump which caused the needle to pull out, so poor Mr. Right Arm got a double jab yesterday.

Up until yesterday I have been going to the gym to channel some of this waiting game anxiety, but that's really an option at this stage of stimulation.  Even though the follicles are small, I can feel them.  Walking around the grocery store yesterday wiped me out.  Perhaps I'll lounge in the hammock while reading or laugh at the dogs as they chase each other around the yard -- anything to take my mind off the process. 

I have no control over the outcome.  I'm following all of my RE's instructions.  Everything else is in his hands.  I have to trust that he's adjusting the meds to allow for the best possible outcome.

And so I wait.

Full Steam Ahead

The results are in.  My hormones are nicely suppressed and ovaries are nicely asleep.  So tomorrow I begin the FSH injections with the hopes of getting to another egg retrieval in about two weeks.

That's good news.

What's more on my mind tonight is how grateful I am for my husband.  He keeps me sane.  He keeps me laughing.  He motivates me.  Yes.  He keeps me sane.

Yesterday I was in a really bad head state.  Just really down on myself for no particular reason.  After a short nap he suggested we go to the gym.  I had hesitated starting my new membership since stim was potentially right around the corner, but realized that I can't put my life on hold during this process.  So to the gym we went.

It was my first time to the gym in over a year.  It was my first workout in at least two weeks.  It was my first time on a rowing machine since the 1980s.  It was great!

Sure, I'm a little sore, but I'm also so grateful.  I needed to spend that time on myself.  I needed to vent some frustration and stress in a constructive way.

I needed to be grateful.

Tomorrow is our second anniversary and Eric already gave me the greatest gift.  Gratitude.

A Good Sign

Today was an odd one.  Changes at work which have lots of my friends and coworkers concerned.  I completely understand where they are coming from, but I can't let myself get caught up in worrying.

I saw a doctor in my primary care physician's office on Monday in order to get the referral for the hematologist.  She questioned why my RE would have ordered all those blood tests after only one failed IVF attempt.  She actually said, "The thing is, if you do enough tests, eventually something will come back abnormal" and then promptly listened to my heart and lungs and felt my throat while having me swallow repeatedly.  When she asked if I was feeling otherwise okay, I said "I'm perfectly healthy with the exception of not being pregnant."

She then advised that she felt a nodule on my thyroid and was ordering an ultrasound and blood tests.  She'll call me if anything comes back abnormal, but said I probably wasn't pregnant due to a thyroid issue.  After all, she is an endocrinologist, even if not a reproductive endocrinologist.  She suspects that the PAI-1 gene anomaly is actually a "red herring."

So now I'm waiting for my referral to the hematologist and for an ultrasound of my thyroid.  On a side note, this doctor did say that it is up to my RE whether he wants to put me on an aspirin or Lovenox protocol and hematologist really doesn't need to be involved in that decision.

I have yet to speak with my RE about all this, although I did speak to his nurse about it and, while she did say he would call me today, he did not.  Still...I'm not going to get caught up in worrying.

As the work day was coming to a close, an allergy attacked seized control of my body.  I've been sneezing fairly uncontrollably for the past hour.  I took Benedryl 30 minutes ago to no effect.  The last time this happened was while I was taking Clomid.  Before that, this type of allergy attack occurred while I was taking birth control pills.

I don't know if this means that the Lupron I started yesterday is effecting me on some level or if some allergen just get into my system.

Still...I'm not going to get caught up in worrying.

As I pulled off the freeway near my home, rain started to fall.  Big drops splashed on my windshield, hood, roof.  Thunder rolled and a flash of lightning brightened the skies.  Moments later I pulled into my driveway to be welcomed home by a double rainbow over the neighborhood.  And while the dogs aren't terribly happy with the weather, I think of it as a good sign.  Of what, I'm not so sure, but a good sign all the same.

And So It Goes

I have had a lot of conversations with the RE over the past week.  In fact, I think today is the first day I haven't spoken to him since last Thursday (the weekend not included).  It feels odd.  I'm kind of hoping to hear from him regarding the various blood tests that were being run.

As for those tests, one result has come in.  Apparently I have an anomaly in my PIA-1 level.  Most people have an 4G/4G or 4G/5G allele.  I have a 5G/5G level.  My doctor spoke to a hematologist who said that, pending my seeing him or another hematologist, that most likely it would be recommended that I begin a course of injectable blood thinners post egg retrieval.  From the little bit I understand, this anomaly can cause a person to develop blood clots which, in the case of pregnancy, can prevent implantation and could also cause complications further along in pregnancy.

None of the other panels have come back yet.  Hopefully there won't be anything else unusual in those results, so only this one will need to be investigated further.

Of course, my RE wants me to see his friend who is at one of the most prominent practices in the city.  And, of course, they do not accept my insurance.  Even if they did, I would need to get a referral from my primary care physician.

So, in the hopes of seeing someone in-network (of which there are surprisingly few based on a preliminary search on-line), I have an appointment on Monday to secure a referral.  It's not with my primary care (he's booked through the end of October), but another doctor at the practice.  Hopefully his doctor will understand the urgency and will expedite the referral (my the potential egg retrieval date is in three weeks).

Failing a quick referral, I have spoken to the office manager at this specialist's office.  She was lovely.  While an initial consultation is only $325, if the doctor wants to order any tests, those can start anywhere from $200 - $300.  She gave me her direct number and said that, if I can't get an in-network referral quickly enough, I would be able to get an appointment with this doctor within a day or two of calling.

My RE also said that if I'm comfortable with adding the injectable blood thinner to my protocol this cycle, he will prescribe it without my first consulting with a hematologist.  And from what I've read on various fertility sites/forums, most women who have this same anomaly have been put on this med, so it appears to be the most likely course of action.

Tuesday I'm set to begin Lupron again.  While the initial protocol in my calendar dictated no changes from our first (failed) attempt with this med, after speaking with my RE, he opted to increase the dosage to prevent my body from "break through."  I'll know on October 4th if the suppression was successful.  My fingers are crossed.

4:26am

I can't sleep.  My problem is that I'm a thinker.  I always have been.  Hell, referring to obsessions in the title of this blog probably clued you in.

A thought will get in my head and then it's stuck there until something jars it loose or changes proving said train of thought was wrong, misguided or just not worth the time.

I'm having a really hard time letting go of this thought: Maybe we're just not meant to be parents.

I'm not fishing for folks to say "You are!  You are both loving and nurturing."  I'm simply stating what's in my head because, let's face it, when you try and try and try, it starts to feel that way.

Thursday eight or nine vials of blood were drawn to test me for antibodies that might be causing my body to reject the embryos and also to test to see if I might be making blood clots in the uterus which would prevent implantation.  The lab tech was kind enough to tell me my insurance isn't very good and I might have to pay for these panels myself and they're expensive.  Um...thanks D.  My doctor ordered the tests, so there is a reason for them.  It's not like I'm not going to do them, regardless of what my insurance covers.

Tomorrow it's more lab work and another ultrasound.  The doctor wants me to go back on birth control and then likely try a Lupron protocol again.  A protocol which caused an estrogen spike which cancelled the first IVF cycle we attempted.  I honestly cannot understand why we would go back to that and I asked the doctor.  He said we might do Ganirelix, but he wants to make sure that my ovaries are resting so either way, he'll want me on the birth control again.

Eric spoke to him later on.  Apparently the doctor thinks my reaction to the Lupron the first time was a "fluke."  There are a number of other factors that could have caused the spike and he doesn't think it was that medication, although he didn't elaborate on what any of those other factors may have been.  So much for avoiding them.  Supposedly he understands and appreciates my concern and anxiety about trying that protocol again, but he expressed to Eric that he wants to try this protocol again because he believes we might get a better result.

A better result than what?  Not having the cycle cancelled?  A better result than 15 mature and good looking eggs retrieved with the other protocol?  Or does he think the protocol used to get those 15 eggs caused there to be a problem with them, hence the stalling at day four of development?

I'm no expert on this science.  All I have to go with is what I'm told.  When the first cycle was cancelled, I spoke to the doctor and asked him if there was a better success rate with a particular protocol.  He said there wasn't.  Basically it's six of one, a half dozen of the other.  So I'm not sure what "better result" he was talking about with Eric.

I feel like I'm getting so many conflicting messages right now.  And maybe it's that I'm too close to the situation to be objective, but I think I might completely lose my mind if three weeks from now I go in for blood work after starting a Lupron protocol and the cycle is cancelled again.  The doctor said, "You'll probably hate me if that happens."  And while I don't think I would hate him, that's a bit extreme, I'm not sure that I'll trust him.

And on top of the expensive blood panels that my insurance which "isn't very good" likely won't cover and a protocol that I feel will only end in another cancelled cycle, the doctor feels that we should do genetic testing this time around since none of the embryos developed to the blastocyst stage.  My bad for thinking the two grade B embryos they transferred were at that stage.  And what if the testing show abnormalities in all our embryos?  What then?

Am I getting too far ahead of myself?  Yes.  Am I feeling pretty hopeless at this point?  Sure am.  It so different from how I felt when we decided to go down this path.  I was so sure that this would work and I knew it might not happen the first time, but even if that didn't happen, there would be frozen embryos and it would just be a matter of transferring a couple more.  Even that didn't happen.  And ultimately it all comes down to something my body isn't doing or my eggs being the problem.  So much for no one being to "blame."

And I know that Eric isn't putting the success or failure of this process on me, let's face it.  When it comes to fertility, it's always on the woman.  We try everything.  We read everything.  We're pointed to more resources.  We're put through the hormonal ringer.

Like I said.  I'm a thinker.  It's what I do.  And, lucky for me, it's kept me up for the past three hours.  And even luckier for me, I have a whole two hours before I have to leave to be at the clinic again.

Running the Numbers

Cycle 1:

11 injections
1 cancellation due to elevated estrogen

Cycle 2:
16 injections
9 blood tests
6 ultrasounds
1 surgery
4 embryos transferred
0 pregnancies

I'm not even going to get into the financial costs since most of those are still pending with insurance and I'm not at all sure how much we're going to have to pay out of pocket.

Eric is calling later today to make an appointment for us to meet with Dr. Ghadir (hopefully Friday) to go over the cycle and the detailed lab sheets to see if there is anything which indicates why none of the embryos implanted.  Depending on what that shows, we'll try again.

It has not been easy.  Since we started trying to conceive there has been so much hope and so much disappointment.  Every month when I would get my period it would be a disappointment, but at least it wasn't debilitating.  I mean, at least there was fun in trying, right?

The negative home pregnancy test after trying IUI was harder.  I had just hoped even more so that with that little bit of help we'd be there.

Now we've gone through a full IVF cycle and still have a bit fat negative staring us in the face.  When I got the news at 4pm yesterday, I cried...again.  It the hardest I've cried since we started this journey back in February 2009.  I cried so hard that my eye lids are still puffy.

So today I'm wearing what I am calling my power outfit.  It's what I wore on Eric's and my first date.  I wore it again on the night we went out to celebrate our engagement.  So, for what it's worth, I at least look hot, even if I'm not really feeling hot.

Not Much To Say

We're in the middle of the waiting game.  Only four more days to go.  I've driven myself a bit insane over thinking things when the reality is either an embryo has implanted or it hasn't.  There's really nothing I can do at this point to change the outcome of next week's blood test.

Instead I took a few minutes this morning to scan the pictures from the embryo transfer.

These were our embryos.  I have no idea which four were transferred, but I believe the two at the top were the two best out of the bunch.

And this is where they put them.

Don't Count Your Embryos Before They're Hatched

Yesterday was "The Big Day."  It seems I've had a few "The Big Day" days in my time with Eric, our first being our wedding day, the second being the egg retrieval and the third being the embryo transfer yesterday.

I felt a little anxious in the morning.  It wasn't that I was at all concerned about the procedure, but rather that this day had been four months in the making.

Upon getting to the clinic, Eric dropped me off so he could go find parking (the garage for the building is closed on weekends).  I went up to the fifth floor and waited.  One of the embryologists came out, called my name and then took be back to the room for the transfer.

It was a little room equipped with one of the most powerful air conditioning units which was actually labeled "IVF AVF" (I can only assume that it has some sort of a filter to sterilize the air while also cooling it significantly.

I then donned an ID bracelet and gown, popped a Valium and laid back on the table.

A few minutes later the ultrasound tech came in to check my bladder which needed to be full in order to best visualize my uterus.  Check.  My uterine lining looked great as well.

Doctor Ghadir arrived a few minutes.  He was in a jeans and a polo shirt.  Clearly he's only in the office on weekends for procedures since I had always seen him in shirt, tie and slacks on weekdays.  He then showed us pictures of our embryos and gave us the low down.

Two are grade B.  One is still in the morula phase and one is still at the 8-cell blastocyst phase.  The rest aren't developing well.

We started with 15 eggs of which seven fertilized which then increased to nine.  Then we were down to four or five grade A blastocysts and now we only had two good embryos and, let's face it, as Ghadir was running down the numbers my hopes were slowly being dashed.

There aren't any to freeze.  This is it.  If one doesn't take, we would have to go through everything again.  There are no second chances here.

His recommendation was to transfer the four I mention above.  The two that are a bit behind in development wouldn't be worth freezing and it is highly unlikely that all four would implant.

So that's what we did.

After it was done they slid me back on the table, recovered me with blankets, reclined the table and told me to rest for 30 minutes.

And when the clinic's staff left the room, I started to cry.  How is it possible that we went from so many possibilities to so few?  Eric tried to reassure me that there were two good embryos, but I couldn't hear him.  All I could think was that if this didn't work we'd have to start all over again.

The ultrasound tech came back in and said I could get dressed (I guess a half hour has passed) and I was still sobbing.  Eric asked if Dr. Ghadir was still there and she went to get him.

He did his best to assure me that I did everything I could.  I did everything right.  There were two good embryos and the other two may have just been a few hours behind in development.  He told me that some couples never even get to this phase.  Try not to worry, he said.  Try and stay positive.  It only takes one.

And so today, as I type this while laying on my side since I'm not to have the lap top actually on my lap (no one ever should because it's terrible for one's genitals, per Dr. Ghadir), I'm trying to stay positive.  I'm trying to remain hopeful.  I'm trying not to dwell on the ones that didn't develop.

If we end up having to (deciding to) do this all again, he said he'd likely increase the stimulant to try and get even more follicles to develop and he would also recommend genetic testing to determine if there is something else going on.

So the moral of the story is, don't count your embryos before they're hatched.  Otherwise, you might end up putting them all in one basket.

Grade A

According to Dr. Ghadir, when they checked on the embryo development Thursday morning, they had a bunch of "grade A eight celled" embryos going.  He said there was also one at seven cells.  The two eggs which were fertilized with the delayed ICSI procedure aren't doing that well.

I wish I could remember exactly how many grade A eight celled embryos we had developing.  I just don't remember.  I'm generally a smart woman who picks up on what people are saying in conversation pretty easily, but I'm starting to suspect that I need to have a basic knowledge of what is being discussed in order to have that quick understanding.

What's that?  Why no.  I don't have an innate understanding of reproductive endocrinology or embryo fertilization and development.  I've been learning a lot, but, let's face it.  It really is foreign to me.  Grade A embryos.  Excellent!  Although I don't think they can be called free-range or cage-free.  (Ugh...sorry.  A terrible joke that a coworker made, so I had to pass it on.)

Tomorrow is our embryo transfer day.  I'm expecting a call from a nurse at the center to give me the details of when to be there and what I need to do, if anything, to prepare.  Thereafter it's 48 hours of bed rest.  I already know that I'll be going a bit crazy just laying around for two days, but so be it.

In the end, all of this will be worth it.

Take Me Out To The Ball Game!

My phone rang around 11am Wednesday morning.  The caller ID read "Dr. Shahin Ghadir Work" and my heart skipped a beat.  When he called with the fertilization report on Tuesday he indicated that we would speak again on Thursday, so I was caught off guard upon seeing his name on my phone.

Now you have to understand.  There has been much talk of late in my office about a curse.  A number of coworkers have had family members pass away.  Others have been in car accidents or horse riding accidents or were simply afflicted with random, albeit not life threatening, ailments.  And while I'm not one to believe in such things, it has been such a prevalent topic of conversation as of late that for a split second I thought "Oh no.  Please don't tell me something happened to our potential embryos."

Thankfully my moment of worry was quickly replaced with joy.

"Good news," the doctor said.  "All the eggs that didn't fertilize with the natural process were directly inseminated and two more have fertilized.  It's called delayed ICSI."

"Wow.  Great.  I'm always happy to have our odds increase."

I thanked him for the call and quickly called Eric with the news.  He was just as happy as I.

Then I called my mom and confirmed that there are, indeed nine players fielded on a baseball team.  She and I chatted about how I'm handling all the meds I'm currently taking and a little bit about her starting to look at plans for coming out for a visit to help me when the time comes.

Then it was into a staff meeting where the curse was again mentioned.  I leaned next to a coworker I'm close to and said, "The curse doesn't exist.  We now have nine eggs fertilized.  If we were cursed the number would have decreased, not increased."

In the afternoon I spoke to Eric's folks.  He had spoken to them very briefly, so I explained more about it.

Later today I'm expecting a call from the doctor to get an update on the zygotes development.  I'm hoping that he can email me a picture of them.  Not that I expect I'll be able to tell which look like they are developing normally, but just to get a look at them.

Lucky Number Seven

Yesterday was the egg retrieval.  We left the house at 6:30am and we home around 10am.  By far the worst part was the starting of the IV. 

The procedure was incredibly quick and I woke from the anesthesia quickly and easily which is unlike my normal waking from sedation experience.  And, despite the Versed they administered moments before wheeling me in for the procedure, I do remember everything.

The embryologist I spoke to was named Jessica. 

Dr. Ghadir joked that my socks looked so comfortable that they might have to pass them around and let everyone try them on.  I responded that I was okay with that since I would be out anyhow, but that I would likely notice them being stretched out.

There is a hole in the operating table.  One's tail bone needs to be just above it.

And I remember the slight tingly feeling as the sedative was administered and them lifting my legs into the rests as I fell asleep.

I also remember Dr. Ghadir coming to see me shortly after I had awakened and saying he didn't see Eric in the lobby.  I told him that he was probably on his way back from breakfast.  That's when I first learned that they were able to retrieve 15 good looking eggs.  Then he departed and said he'd come back once Eric was there.

Moments later Eric was at my side and I told him they got 15.  He apologized for not being there when I woke up and I said not to worry about it.  Ghadir came back and asked him "How was breakfast?"  Eric said it was good and said that I told him they retrieved 15 eggs.  Ghadir looked at me and remarked, "You remembered that?"  I told him I have an impeccable memory, even on Versed.

We then learned that the plan was to split to eggs into two groups: seven would undergo natural fertilization where the sperm and egg hang out together and do their thing; either would undergo the ICSI process where they directly fertilize each egg with a single sperm cell.

As of this morning, seven eggs from the ICSI process have fertilized.  That's it.  And it's good news, but I can't help but wonder about the eggs which were in the dish with the sperm.  What if one of those were genetically brilliant?

Now we wait until Thursday to see how those lucky seven are developing and, assuming all progresses well, two embryos will be transferred into my uterus on Saturday morning.

Until then, it's lots of various meds to get the aforementioned uterus ready for implantation.

We're getting there.  Little by little.  Step by step.  Zygote by zygote.

Ovary-chiever

I have always been one of those people who try to hard.  Always putting in extra hours at work.  Always trying to do more in less time.  Always going non-stop and feeling like I haven't gotten anything done.

And my ovaries are apparently no different.  As of this morning I have 15 follicles dancing on my ovaries (nine of them one the left side alone).  They now range from 14 - 22mm.  I thought I heard the tech say that one was 29x14mm, but when I sat down with my nurse Maria a while later, I didn't see 29 on the chart.  Perhaps I misheard or misread the upside-down chart.  Who's to say?

Maria is fairly certain that the doctor will want me to stimulate one more evening, but that decision won't be made until they get back the results of my blood work.  If they decide to trigger me tonight, then I'll go in for blood work tomorrow morning and the egg retrieval on Sunday.  If they opt to stimulate one more night, then I'll be back in tomorrow morning for another ultrasound and more blood work and hopefully we'll trigger that evening which would mean blood work again on Sunday and the egg retrieval on Monday.

Anyway you slice it, I'm going to be a walking pin cushion as a result of these daily blood draws.

And while I'm ready to get on with this, I'm now finding myself with this internal debate: I'm 99% sure my doctor is rarely in the office on the weekends.  Given that the retrieval will be on Sunday or Monday, that means the embryo transfer would take place on the following Friday or Saturday, respectively.  I think it's reasonable to assume that my doctor will only be present for one of those two procedures and I'm not sure entirely sure if I feel more confident in his retrieving the eggs or transferring the embryos.  Of course all the doctors in the practice are capable and one of them would fill in if he doesn't happen to be available on any given day (weekend or otherwise).  It's just that I feel comfortable with him.  I feel like he understands my particular brand of neurosis with this process.

Oh well.  There really isn't anything I can do to change the timeline at this point.  It is what it is.  Two embryos will be transferred five days after the retrieval, assuming there are mature eggs which fertilize normally.  Even if Dr. Ghadir isn't present for one of the procedures, he's been actively monitoring everything this we started this back in May.

At this point I just need to breathe and believe.

My Aching Head

As this in vitro process has progressed, I've noticed that I have had a lot of headaches.  I'm not prone to them, but clearly they are a side effect of the process.

The first bad headaches, of course, came from the many tears shed at various occasions, whether they were a result of the incredibly acute pain from the HCG test or the IUI attempt being unsuccessful.  In those instances, however, the headache was shot lived.  I would take some Ibuprofen, go to sleep and wake up feeling like myself again.

Now, however, the headaches are brought on by the ever increasing hormones I'm injecting into my abdomen on a daily basis.

At first the headaches would come on around 4 or 5pm and sitting in a darker room would provide relief.  Then, over the weekend, the headaches started closer to noon.  I found that a midday nap would help a little bit, but then this morning I woke up with the headache.  I didn't realize how sensitive I would be to light until I was driving to the office where I now sit with the blinds drawn and soft light from a lamp illuminating the space around me.  I can only assume the increased sensitivity and earlier onset are a result of adding the Ganirelix into the mix.  That's the GnRH antagonist which I started administering last night and I'm guessing that combining it with the FSH results in hormonal madness, hence the bad headaches.

Tomorrow I head back in early for more blood work and another ultrasound.  I'm crossing my fingers that all my little follicles (13 at the last count) will be ready for for the trigger shot and that the egg retrieval will be on Friday.  We shall see.

Stimulating

On Tuesday I went in for an ultrasound and more blood work at 7:30am.  I did my best to keep busy at work while waiting for the results of the tests.  By 5pm I could barely think straight.  I could not help but imagine that my hormone levels were still out of whack and we'd have to wait another month before we tried again.  Thankfully, I my imagination proved to be way off.

A few minutes past five, my phone rang.  It was the nurse calling to say that all my test results were in and the doctor was very pleased.  All my hormone levels look good and my ovaries have 10+ little follicles all ready for stimulation.

So on Wednesday evening it began.  Our second IVF cycle, but the first with stimulation. 

I was completely freaked out while prepping the first injection.  It had been three weeks since the injection lesson, so I kept doubting that I was doing it right.  To top it off, the dogs were barking out of control, running in and out of the house, howling and just generally causing me to stress out during the process.

Nevertheless I got the vial loaded into the pen, attached the needle tip, dialed the dose and administered the first injection and WOW!  It stung!  Mind you, the medication was a bit chilly as it was supposed to be refrigerated prior to use and, while it says to let it get to room temperature before using, I didn't because it was late and I was doing this just before going to bed.  I decided I would do better the next time.

So, in anticipation of my second injection last night, I took the medication out of the refrigerator when I got home for work ensuring that it would have a good three hours to warm up 15 degrees.  Once again, I gave myself the injection right before bed.  It didn't sting as much, but it did still sting.

Whatever.  It isn't so bad that I can't handle it.

Tonight is the third FSH injection.  I haven't decided if I'm going to try something new to try and avoid the stinging sensation.  My guess is that I probably won't.

Tomorrow morning it's back to the RE's office for another ultrasound and more blood work.  Hopefully all will be progressing nicely so we can continue onto the egg retrieval sometime in the coming week.

Pricked and Probed

Tomorrow morning I go in for more blood work and yet another ultrasound.  Once again I'm hoping that my estrogen level will be low and that my ovaries will be resting like good little ovaries.

Of course, I started the day wondering what the hell was going on.  I had only taken the Provera for five days, but I woke up with my period.  I wasn't expecting that for another week.  I called and left a message at the nurses station letting them know the latest and asking if I should be concerned or if this will throw off getting my next IVF cycle started.  I know that I wasn't irrational in my message, but I also know that I didn't sound calm.

After waiting 2-1/2 hours for a response, I emailed the doctor.  He called me back within 10 minutes.  There's nothing to worry about.  If I have my period, then this is day one of my new cycle.  I can stop taking the Provera and plan to come in on day two or three for testing.  He then transfered me to the nurses station so I could get set up with those appointments.  I left another message.

About two hours later the nurse called and we set the appointments and she said we'd talk tomorrow once the results were in and the doctor had reviewed them. 

So I'm now trying to convince my body to produce little to no estrogen and thinking about researching homeopathic things I get do tonight to ensure the levels don't get too high.  I know it's crazy, but it's all I can do.

Maybe I'll lift weights and run after work.  Get those endorphins and testosterone flowing, right?

Terminated

We've watched all the "Terminator" movies, except for the first, in the past week.  Was hearing the word "terminated" so many times supposed to prepare me for our IVF cycle being terminated?

Mind you, they don't say "terminated."  They say that they're canceling the cycle, but in my head I keep hearing the terminated.

Anyhow, it turned out that my estrogen level had spiked into the mid-600s.  It started at 92.  Still, the ultrasound showed that my ovaries have no signs of follicles.  I was so baffled and upset Wednesday, that I called my husband, told him what happened, asked him to pick up a prescription for Provera at the pharmacy after his business dinner, and walked out of the office to come home, cry (more) and have a glass of wine.

Eric opted to cancel his dinner and pick up my prescription and a pizza instead.  Such a nice guy.

I spoke with the RE on Thursday.  Here's what I learned:

1. When the estrogen levels are high, it means they cannot "sync" my cycle which means they cannot control ovulation which they need to do into to retrieve as many eggs as possible to increase the chances of creating viable embryos in the lab;

2. The Provera will cause me to get my next cycle in about two weeks, as opposed to waiting for my hormones to regulate on their own, which could take a while;

3. On the next cycle, we'll use a different protocol which, depending on the baseline blood work and ultrasound of that cycle, would likely mean starting the FSH stimulation shots right away and then adding a GnRH antagonist to prevent premature ovulation;

4. There is no significant difference in the number of follicles produced between the two protocols; and

5. We picked the right RE for this process.  He told me not to get discouraged.  They see things like this every day and, while he's baffled at how my body has reacted to the Lupron, there are still plenty of options for us.  He knows how anxious people are to get started and finished with this process -- especially since most people who are at the clinic have been trying to get pregnant for at least a year.

We have other friends who have successfully gone through this process.  In fact, they used a different doctor at this same clinic.  I'm fortunate to be able to run things past my girlfriend.  She has been so hugely helpful throughout this process -- especially when things don't go as we had hoped.  She's been there.  In fact, she and her husband spoke and he remembers her having a problem with the Lupron as well.

Yay!  I'm not alone!!  (And clearly I picked a like-hormoned woman to be one of my closest friends.)

I Am Not A Patient Woman

My day started with a trip to the RE's office in Beverly Hills.  This means waking up by 6:30am and being out the door by 6:45am because you never can be too careful with traffic in the City of Angels.

Normally I'm normally just pouring myself a cup of tea at 7:15, but today I was being probed and pricked all in the hopes of everything looking good so we can move onto the next phase in this in vitro process.  My appointment was actually set for 7:30, but I arrived early and thankfully I didn't have to wait long.  I was in and out in five minutes, but needed to pick up a refill of one of the fertility meds and the pharmacy where I have the prescription didn't open until 8:30am.

So I went to the Roxbury Cafe which is next to the pharmacy to have a bite to eat and kill some time.  Try and I might, I was still done and ready to be on my way by 8:05am.  I decided to take a leisurely stroll around Beverly Hills.  I walked a one mile loop and got to the pharmacy right at 8:30am.

I walked inside and was told they weren't open yet.  I apologized and took a seat as I was told.  A moment later a woman asked my name and my doctor's name.  I gave her all that information and said that I had called for the refill yesterday and was told they would get authorization from the doctor's office.  Apparently that never happened.

Deep breath.

A side conversation between the woman at the counter and the pharmacist.  They decided to refill the prescription for me.  It would be a few minutes.

Phew.

I'm feeling a bit annoyed that the nurse never called to authorize a refill like we discussed on Friday.  At the same time, I'm grateful that the pharmacy is refilling the script so I don't have to come back later in the week or have my husband do the pick up for me.

I drive to work and am pleasantly surprised at the ease of the commute.  Either I'm going completely against the flow of traffic or everyone is on vacation because it is the morning rush hour.

Now, you would think that the ease of the morning would take the edge off my mood, but it doesn't really.  I'm just generally irritated, but I keep reminding myself that it's the hormones.

It's the hormones.

And then someone stopped by my office to ask how I'm doing.  I say fine and they ask "Really?"  I just look at her.  "I just know that you're going through a lot right now."  I say that I'm fine, maybe a bit run down, but fine.  "Good.  Try and get some sleep tonight."

Oh honey.  You just don't get it.  I'm sleeping fine.  Hell, I'm dreaming about pole dancing and how I'm amazing skilled in the art.  I mean, seriously skilled -- I can climb, spin, vamp like nobody's business.  In my dream I would probably make a nice living as an exotic dancer.  My hormones are out of whack and no amount of sleep can fix that or alleviate the exhaustion that comes from just not being balanced.

The hubby said, "We knew this wouldn't be easy" when I told him how I was feeling.  Um...hello?  I don't imagine it's that difficult for you.  I know you're concerned about how I'm feeling and I appreciate your trying to make me feel better, but this is all on my ovaries.  They're asleep, but are they really?  Am I still producing too much estrogen, despite the massive daily injection of Lupron?

I should be working right now.  I have so much on my to do list here, but I can't stop watching the clock.  It's now 3:30pm.  They must have received the results of the blood work by now.  Are my estrogen levels still too high?  Have they dropped enough to start stim shots tonight?  I so want to get on with this! 

I'm tempted to call, but always feel like the nurse is annoyed when I speak to her.  When I called after the last blood test, she had said that she was just about to go over my results with the doctor and she'd call me back in about a half hour.  It was closer to two hours and it killed me -- especially since the results meant we would have to wait at least a week to start the stim shots.

3:33pm.

3:34pm.

I should just call.  Even if I get voice mail, at least it will put me on her radar, right?

Breathe.  I need to remember to breathe.

Fluctuating

For the most part, I have been fortunate to not ride the waves of insanity as my hormones keep shifting around due to the whims of pharmecueticals.  I survived 4 rounds of Clomid of varying levels without any problems and, up until yesterday I was faring pretty well on the Lupron.

And then yesterday I noticed my patience wearing thin at every turn.  It seemed that from the moment I woke up I was irritated.

The dogs jumped on the bed to wake me up (something they do daily) to which I sternly said, "Go see your father."

Hubby and I had to drive by his office on the way to the farmer's market.  Traffic was non-existent for Los Angeles, but that didn't mean I wasn't feeling completely impatient in the car.

We stopped at a Starbucks in between his office and the farmer's market.  Let's just say the very powdery tasting green tea latte didn't make me smile.

I think I actually made it through the farmer's market without anything actually getting to me.  Hubby even bought me an orchid to bring to work.  (I of course left it at home this morning and am annoyed at that fact.)

We then sped off to a friend's for brunch.  It was filled with fun conversation, delicious crepes and their hopes that hubby's recent post to Facebook of "WOOHOO!!!" meant I was pregnant.  Alas, no.  We're actually doing in vitro was my response and proceeded to answer her questions about it -- all the while holding her 8-month-old little girl.

We left to head home to tackle a myriad of projects.  Hubby had to watch a scene from a movie for work.  One scene during which time I washed my car, planted three shrubs, weeded the flower beds, watered in all the plants in the front yard, moved along the laundry (including folding at least one load), emptied the dish washer, etc.

Let's just say, I didn't take well to hubby still being in front of the television and when he commented on the dirt that had apparently found itself a happy home across my forehead and cheek over the course of the previous two hours...I snapped a bit.

I laid in bed last night tired. Tired of trying to get pregnant. Tired of giving myself injections every day. Tired of needing help to get pregnant.

Sigh.

And then I woke up today.  I've felt on the verge of tears all day.  There is nothing wrong.  There is nothing that is actually even bothersome enough to cause me stress, but I'm ready to let the water works burst forth from my eyes.

I went for an hour long walk during my lunch break to clear my head and for a few minutes it worked.  The right song was playing and I was able to get into a rhythm.  But now I'm back at my desk and needing to go over something with one of the managers that reports to me.  I don't want to do it.  I don't want to deal with correcting mistakes and I fear it will be riddled with them.

Sigh.

I have two more days of the increased Lupron dosage before I go back in for another ultrasound and blood test.  I'm hoping that my estrogen level will be suppressed sufficiently to allow me to start the FSH injections.  I don't know how I'll react if I get a call from the nurse saying, "Your levels are still too high to start the stim shots."  I could quite possibly lose it and call my husband and say "We're done.  The meds aren't working and I feel like I'm starting to lose my mind."

A Fertile Mind

When I was younger it never occurred to me that I might be not be able to have children.  Hell, it never occurred to me that I would even want children.  I'm older now (37 to be exact) and for over a year now, I've been trying to get pregnant.

I remember taking my husband out to dinner for his birthday at Shiki Sushi.  We were having a nice meal and it suddenly dawned on me that it was time.  I needed to get off the pill so we could start trying.  As he put a piece of mackerel sushi into his mouth I said, "So.  I'm thinking that I'm going to stop taking the pill." Quite frankly, I think I'm lucky that mackerel didn't come out his nose because I had definitely surprised him.  I began to tell him about wanting to have kids and being 36 and knowing it might take some time to get the pill out of my system, etc.  He asked if he could think about it a bit and I said, "Sure, but my pill runs out at the end of the month and I don't want to refill the prescription."

The next day he called me at work and we were chatting a bit and randomly he said, "Let's do it."  "Let's do what?" I asked.  "Let's start our family."  YAY!!!

If only it were that easy.

I stopped taking the pill and never experienced a blip in my cycle.  Sure, that didn't mean I was ovulating, but at least I was still regular.

Then one month my breasts hurt so badly!  I was sure I was pregnant.  And when I was four days late I was certain of it so I took a pregnancy test.

I wasn't.

Then another month and another went by and then it was out anniversary.  At this point I had been tracking my cycle for a few months and using ovulation predictor kits to make sure we had sex during the fertile window.

Once again I was late.  I kept thinking it would be so great to find out I was pregnant on our first anniversary.  I woke up that morning and I could feel it.  The cramps.  I was getting my period.

Devastated.

That's when we agreed that if I wasn't pregnant before the holidays we would both get tested.

I wasn't and we didn't get tested...yet.

The new year came and went as did our birthdays.  I met with a new OB/GYN who decided to put me on clomid for up to three cycles prior to sending me off to a reproductive endocrinologist (RE).

During the third cycle with clomid, my husband went off to get tested and the results weren't great.  A few weeks later he got retested and we set up a consultation with the RE.

The consult went great.  The fertility clinic is one of the best in the country.  They boast a 50% success rate and, possibly best of all, they take insurance!

We decide that I'll do one more round of clomid, but this time with IUI (intrauterine insemination) and, while we're getting ready for that, I'll get all my testing done.

All my bloodwork came out fine.  My hormone levels are great.

Then I underwent the HSG test.  I can't remember what that actually stands for, but the excruciating pain that the test caused me will forever be etched in my memory.  What they hope for is a "fill and spill."  What they got with me was just fill.  So the doctor pushed more of the contrast fluid through the catheter into my uterus and managed to flush open one fallopian tube.  He tried on the other side and I yelped.  Yes!  I literally yelped and he said, "We're done" and then proceeded to tell me that my right tube was blocked.

Great.  Two strikes against us.

We agree to still try the IUI procedure since I had already taken the clomid and we would just hope that my follicles developed on the left ovary.

Of course they all developed on the right and that 10% chance of an egg migrating to the opposite tube didn't happen since again I got the old "negative" on the HPT.

Now I'm crying hysterically in bed and saying that I don't think I can take anymore of this.  We should just adopt.  Maybe we weren't meant to be parents.  Maybe we waited too long.

By morning I was feeling a bit more sane and I called the doctor with the news and he tells me that the next time I tell him I'm not pregnant that I'll "be punished."  Okay...many people might find that weird, but I laughed.  I appreciate that my RE knew me well enough after only a few meetings to know that I need to laugh to take some of the stress out of the process.

We decide to take a month off and just not think about trying to get pregnant.  We were going on a two week vacation and we would dive into in vitro when we got back.

And here we are now.  A few weeks into our first IVF cycle.  I went on the pill on day three of my cycle for two weeks.  A week ago I started self-injections with Lupron to further suppress my system.  So far I've already had two ultrasounds and two sets of blood work to check my hormone levels.  I had hoped to be starting my FSH shots this evening, but unfortunately my estrogen levels were still elevated so I have to wait.  I've doubled the dosage of the Lupron injections and have my third ultrasound and blood test scheduled for this coming Wednesday.  Fingers are crossed that my levels will be where they need to be so we can take the next step.

Fingers crossed.