2dp5dt: Transfer tales

We arrived at the clinic just before 10, as instructed. The waiting room was more crowded than I think I’ve ever seen it. At one point, there were two small children (one well behaved, one annoying - I think the well-behaved one is about to become a big brother). We sat, and waited, and waited, and sat. There seemed to be another transfer ahead of us (judging from her bloated, scruffy, water-bottle chugging presence). All well and good, but it was after 10:30 before we even met with the embryologist and at least 12 before the transfer prep (my transfer was scheduled for 11, of course). Due to a mix up with the nurses and my acupuncturist* (who was fantastic), I didn’t get my valium until after I was in the proceure room with my legs in the braces. It might have been nice to have been relaxed before that point, but whatever.

Transfer was fine. There was a bit of a thing with my bladder - we waited so long I had to pee like 5 times before we actually got in there, and just before it was time I had to, um, poo (and as the nurse politely acknowledged, “There’s no delicate way to say this, but I find it hard to go to the bathroom one way and not the other”) and then they decided my bladder wasn’t full enough and made me drink more, and then by the time they were ready to do the transfer, it was too full and they had to drain it a bit. Not the most fun ever, but more comfortable in the long run, I think. But otherwise, transfer apparently went very smoothly. Never having attended a transfer before, I have nothing to compare to, but Dr. Piles and Nurses Sweetie and Bruiser Positive (who I like loads more now that she took excellent care of me at both retrieval and transfer, and then mentioned that she went through IVF treatments herself, plus the thing about the poo) all seemed very positive.

And the best part was the embryologists report, which I think I’ve hesitated to share until this point due to some preliminary variation of survivor’s guilt. We transfered two 5-day blasts - one “perfect” and one “near-perfect” - and had 11 blasts to freeze. Yes, eleven. Even the embryologist was impressed. I am bowled over. This is better than even my fantasies of a good outcome for this cycle.

And now we wait, and hope that our ability to make lots of hardy embryos will translate to an ability to make actual babies. I mean, I’ve heard there’s a connection, but I’ve also heard you can get pregnant from having sex, so...

* The clinic usually works with this one local acupuncturist. Not my acupuncturist. I’ve been seeing my acupuncturist for about a year - starting after I gave up on my first clinic, all the way through the second, and now into the third. I think it’s great that the clinic has someone they like to work with, but the system shouldn’t rely on it. Apparently, the usual acupuncturist gets the gown and robe for the patient (from the nurses area, so I don’t really see how mine would have thought to do that) and somehow arranges the Valium (or tells the nurses when it’s time?). My acupuncturist (actually not my regular one, but another from the same practice who I’ve seen before) was just trying to go with the flow. If any of them had bothered to talk to each other, it would have been fine. But instead there was a bit of confusion. Oh well - it all worked out in the end.

A tale of two clinics, finally

I think I may give up on ever finding the perfect nickname for my RE. The closest I’ve come is Dr. Piles of Files, so named because when we had our first meeting with him (while we were in the process of choosing a clinic) I noticed that his desk was piled with files, and articles, and journals. It looked a lot like my office looks - cluttered with projects and ideas and research. And then we met with the second clinic and the RE’s office looked like it was straight out of a designer magazine - spotless, and beautiful, but with the air of being a showplace rather than a functional office. It was a lot like some other features of the Clinic That Wasn’t - Dr. FancyPants and the whole Fancy clinic were shiny, and pretty to look at, but it wasn’t clear how that would translate to my experience as a patient there. (The final straw, though, was a perky but completely clueless medical assistant/nurse who I learned would be our primary contact. Um, no thank you.) So back we went to the Clinic That Is - which is much more humble. No fancy pants decor, no shiny surgical suite with separate entrance, no staff of millions. But it means that I know all of the nurses, that my RE did all of my wandings (except once when the other RE did a baseline - but I haven’t seen him since), that I chat with the receptionist, that I don’t get lost in a maze of hallways or staffing issues, and that he actually reads articles, and journals, and patient files. In my current state of optimism, I’m pretty sure I made the right decision. I didn’t have a cookie cutter protocol. I had close monitoring. I saw my actual RE regularly. He waved at me on days when I was just there for bloodwork. The other clinic is very highly regarded, and proposed a totally different protocol that might also have worked well. Who knows? But I know for sure that I’d have had less direct contact with Dr. FancyPants than I have with Dr. Piles.

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On a totally unrelated note: I’m getting sick of G.atorade. I stocked up on what used to be my favorite flavor of G.atorade, and I’ve been faithfully staying hydrated. But it’s pretty much the only flavor I know, and I’m getting sick of it, and I have no idea what to get instead. The G.atorade labels can be so daunting - “Frost” and “Fierce” and “Xtreme” (oh my!). So, anyone have a favorite G.atorade flavor I should try? I’ll do a taste test and report on my findings, if you’d like.

Gratitude

Out of 20 retrieved, there were 15 mature, and 14 fertilized. We’re set for a 5-day transfer on Monday. I’m feeling better, though still a bit achy and bloated. Mostly, though, I’m just feeling incredibly thankful that we’ve made it this far.

Yesterday, when they came to take J back to contribute his part in all this, I was still pretty drugged and emotional. I said, “it’s not fair” which he took to mean it wasn’t fair that I was lying in a recovery room and he was going to jerk off. But really I meant it wasn’t fair that we had to do this at all when so many other people just get drunk one night and magically become pregnant. But when the embryologist called today I felt a huge wave of gratitude - that we were able to do IVF, that J’s parents were able to help us pay for it, that we had access to fertility clinics in our city, and schedules flexible enough to allow us to go through with it, and that we might actually have something to show for it. Every so often we look at each other, or hold hands for a moment, and whisper “fourteen.” It’s the magic number of hope, promise, potential. And I am incredibly thankful to have that to hold onto today.

More information than I can process

20 eggs retrieved. 12 are probably mature. The others are various categories of over or under maturity, but I couldn’t really tell you. J wrote it all down so maybe later I can make more sense of it. They also gave us some stats on his “specimen” which I completely ignored. For a girl who always wants all the info, all I wanted to hear was how many retrieved, and that the sperm were fine. So 20, and they are.

Soup, then bed.

Stims Day 12: Green light

Lining: 11mm
R: 20x20, 22x18, 16x16, and a bunch more that Dr. Smiles (hmm, maybe) didn’t measure
L: 17x15 and a bunch more

After what feels like forever, we’ve been given the green light. Circles have been drawn on my ass for the trigger shot tonight. Retrieval will be Wednesday (pending today’s bloodwork, of course). My body is looking forward to sleeping in tomorrow, and having one precious needle-free day. My left ovary was being shy, as usual. I asked if they were going to have trouble getting to it at retrieval and Dr. Jokester (nah, doesn’t have the right ring) said they’d charge extra. But then Nurse Sweetie admitted I’d probably feel the effects of the digging. Yeah, I figured.

Also, I have a cold. Dr. NoDrugs (just for this) doesn’t want me to take anything - not zinc, not Benadryl, not Sudafed, nothing. Oh, except Tylenol. And fluids. And rest. As I expected. It’s just a mild cold, but it’s the final straw in how crappy I feel. I spent the entire day yesterday lying on the couch, drinking liquids and napping, but I have to go to work today, since I’ll be out for a week after this.

Nurse Bruiser was incredibly perky and positive when she heard I was triggering. “Aren’t you excited?” she asked. I had to think about it for a minute - probably a minute too long. I guess I’m excited to be moving forward with this whole process, but I’m scared of the physical aspects of retrieval, and scared that my eggs are crap, and scared that J’s sperm will have a bad day, and just scared all around. I’ve heard that excitement and fear are two aspects of the same emotion, and if that’s true then sure, I’m excited.

Strap me in - the next phase of the roller coaster is beginning. Please keep all hands, arms, and syringes inside the vehicle at all times.

Stims Day 8: On the rise

My E2 has finally gotten with the program - it was up to 66 yesterday, and 159 today. I still have no idea what it’s supposed to be, but I know it’s supposed to be going up steadily - and it is - so I’ll just be happy with that for now. And this all almost makes up for the fact that I’ve suddenly become a hard stick - it took a couple of tries, a juice break, a heat pack, and a more skillful nurse to get blood today. Apparently I only have one vein in each arm - the right was bruised from a bad stick a couple of days ago, and the left was feeling okay but apparently felt the need to stage a revolt (and then I got dizzy and nauseated like I used to when I got blood drawn before it all became so commonplace).

I say all of this like it’s my body’s fault, but really I feel entirely comfortable blaming Nurse Bruiser, who gave me that first bruise a couple of days ago, and then tried and couldn’t get blood today. I have now reached the point in this process where I will demand that only certain nurses be allowed near me with needles - Nurse Bruiser is very nice, and she did a fine job of writing down Dr. StillHasNoNickname’s notes on my follicles (he’s still only measuring one on each side - at about 10mm each - though there are others that are a bit smaller that he’s not measuring), but she’s absolutely not going to do my bloodwork again. Nurse Fantastico, who finally succeeded (with little trouble, once I had some juice and felt better, and after she warmed me up because I was so cold my veins were constricted), can poke me whenever she wants - I’ll wait for her to be available, no matter how long it takes. And while I’m introducing (and naming) all the nurses, there’s also Nurse Coordinator (well, that’s what she is!) - she’s organized, and skilled, and businesslike - who is probably the only other I’d allow to stick me at this point, and Nurse Sweetie, who is very good at phone contact, and calling my meds in to the pharmacy, and answering questions. As long as they each get to do the thing they’re best at, it will all work out.

Did I mention that there’s something living in our attic crawl space? I know I wanted to hear the pitter patter of little feet, but this is not what I had in mind.

Stims Day 6: Low and slow

Six days of stims and my E2 finally broke 20 - now it’s a whopping 21. Talk about slow. Geez.

I seem to lack the focus for narrative, but here are the things I’m thinking about anyway:

Thing 1: My E2. Yeah, it’s low. But we’re hoping that now that they’ve ramped up my dosage I’ll start moving along. It does make my anticipated cycle calendar a lovely relic. No idea what the schedule will be at this point. This really is the most draining aspect - I anticipated mood swings and physical discomfort, but the emotional roller coaster of stims is something else entirely. And not particularly pleasant at this point (though better today than yesterday).

Thing 2: After waiting forever for instruction callbacks yesterday (I called 4 times, but the lab was slow, and then they had the numbers but didn’t have instructions, and then the doctor was on the phone so they still didn’t have instructions) I checked my email and found, of course, a birth announcement. I actually suspect there’s a story here, since the birthdate was mid-October, and the announcement just came yesterday? I think mid-October was maybe a month early. Who knows? All I can think about this right now is how it’s not fair that the lesbians were able to have a baby before me. (Disclaimer: As I’ve said before, I don’t have any problem with gays and lesbians and single people and whomever else having kids, but it’s really a kind of slap in the face that the lesbians who between them have two uteri but no penis managed to conceive more easily than us.)

Thing 3: I was reading over some of my past blog entries (somehow #100 came and went and I totally missed it) and I think I used to have more to say, and say it better. I’m just not feeling so satisfied with my ability to express myself.

Thing 4: I have been working on these papers forever, and they’re still not done, and I’m not getting a lot done because I’m trying to keep my stress down and the papers are stressful. Though really, it’s the not-being-done that’s stressful. But I just read that article on infertility and stress in Psychology Today and it reminded me that it’s really okay for me to try to keep my stress level down - at least the parts I can somewhat control - while we’re doing this cycle. But I don’t know how I’m ever going to finish my papers at this rate.

Thing 5: I am trying to come up with a nickname for my RE. I have a contender, but I have to see if it still resonates next time I see him, or if it was something specific to today’s visit. I’m sure you’re all anxiously waiting for this news, right?

Stims Day 3: At a snail’s pace

Today’s E2 was still under 20, so I’m off to a very slow start. They’re upping my Follistim to 75 and dropping the Lupron to a more normal 5 units. As long as the E2 goes up tomorrow, I think it’ll be fine - just slow. (Better slow than too fast, though.)

I’m going up to my grandma’s house tomorrow - my mom will be there and I thought it would be nice to just hang out. J is working a bunch this week (not the best timing, but he should be free next week between retrieval and transfer, which is what I was really worried about) and the other day I thought, “I want my mommy.” I suspect this won’t be as supportive as I’d hoped in that moment, but if nothing else I’ll get to show off my injection skills to my mother, who I think can’t quite believe that I’m actually doing this. Me, the one with the major needle phobia. So I’m strangely looking forward to doing an injection as if there’s nothing to it. I might even bring the mixing stuff for the Menopur, even though I won’t need it, so I can show her what that’s like (because the FolliPen, while a cool contraption, isn’t so iconic an image as a good ol’fashioned needle and syringe - if that makes any sense).

I read an academic article about IVF once that pointed out that while we use the phrase “IVF” to refer to the whole process, the actual aspect of in-vitro fertilization is just a tiny portion of the larger experience, and one of the few parts that doesn’t involve the woman’s body. The rest of the process - the blood draws and ultrasounds and injections - make up a large portion of the experience of going through an “IVF” cycle, but are largely invisible or unacknowledged in the medical perspective. I think my desire to show-off my injection skills is part of an attempt to get some recognition for this part of the process. I think people who don’t know anything about IVF end up focusing on the sexy medical aspects - the frankensteinian medicine, cutting edge technology involved in using donor eggs or gestational surrogacy - and largely ignoring the personal experience of the process. Like me, stabbing myself in the gut with three needles a day, for example.

Stims Day 1: Let’s get this party started - updated

Not that I feel like partying, mind you.

Baseline yesterday was fine. They were training a new nurse (she was just observing) so there was a bit of extra explanation from the doctor - why is it called E2 (the experienced nurse said, “Because it’s shorter than estradiol” which was cute) and the like. The injection training was also useful - I was worried that it would just be a description, but they had a fake cartridge for the pen, and they showed me how to use the Q-caps that came with the Menopur (only after I asked - initially, she showed me how to do the mixing with the needle). So that was good. And those Q-caps are very cool. Initially I scoffed - I’m not afraid of the mixing needle or anything - but they’re really nice to use. (See update below!)

Here’s the protocol: I’m staying on 10 units of Lupron (higher than their normal protocol) and adding 75iu (one vial) of Menopur and 50u (whatever those units are) of Follistim. I asked for an explanation of the Gatorade thing, and whether I should just stock up now (it’s on sale this week, y’know?) and Dr. HasNoNicknameButWillSoon chuckled at me like I was some cute paranoid freak and told me they’re trying very hard to keep me from needing it. Which is all well and good but given how crappy my response ever was to oral meds, and given that I have no history with injectables, I’m scared they’re going to end up being too cautious.

In any case, the shots today were okay. The Menopur hurt a bit going in - I think it’s just the volume of fluid. The Follistim really did sting as I’d heard about but forgotten. But I didn’t ice for the Folli so maybe that will help for next time. Getting the pen all set up was a bit daunting, but once it was all assembled I can see how it’ll be much easier to use.

Nothing much else to report. Though maybe tomorrow I’ll share what Dr. Groovy had to say about my current state of mind.

Updated to add: Here’s a link to instructions on using the Q-cap, since I didn’t seem them in the package with the Menopur. Basically, the device screws on to the syringe - so you screw off the big mixing needle that probably came attached to the syringe (at least mine did) and screw on the Q-cap. It has a sort of poky-needle thing in a kind of collar. You push it down over whichever vial you’re working with, and it pokes through like a needle and the collar sort of clicks over the rim of the vial to hold it on. It looks weird the first time, but I think I like it - not for any fear of the mixing needles, but it’s easier to hold. Let me know if you need more guidance (and the link above lets you download instructions with pictures, too.)

Anticipation and anxiety

Tomorrow morning is our baseline scan (Again. I had what I thought was a baseline before starting the BCPs, but I guess this one checks that I’m actually suppressed now?) and injection training (hopefully) and then I’ll probably be starting stims on Thursday. At least according to the original cycle calendar, though I’m trying not to get very attached to it, because it could change and all that.

I tried to recreate the clinic’s calendar in a better format, so I could have a space to write the dosage for each day and check off when I’ve taken various meds, but I couldn’t make it work. Which is unfortunate, since this morning I almost left the house without doing my Lupron injection, and at bedtime I always have to double check that I’ve taken my evening meds. I can’t imagine what it’s going to be like when I add in all the injectables.

I opened back up my big box of needles and potions, and maybe I’m weird, but I’m not sure I like the Follistim pen. Sure, it comes in a snazzy case and all, but it’s hard to pull it out of those elastic straps, and I don’t really understand the needle-in-a-cup thing, or the spinning dosage thing, and I’m sure I’ll be convinced with how easy it is later on but right now it seems far more complicated than just mixing the powder with the water the old fashioned way.

Apparently, over the past couple of years I’ve developed a fear of the unknown. Sometimes I get really anxious about finding my way someplace I’ve never been, or calling someone I’ve never met, or knowing how to inject the medication properly. (Okay, maybe that last one would happen regardless, but otherwise I didn’t used to be so fearful.) You can imagine how great IVF is in this regard - one big bundle of unknowns. Most of the time I cope pretty well - I think watching this process through so many other blogs makes it feel much less unknown. But when I confront something and don’t already know what to expect, I get anxious.

Also, while I really like that my clinic knows that I’m a control freak (Hi Heathers!) and is willing to give me the numbers instead of just telling me that things are “fine” - I’m worried that they’re being a bit too lax sometimes. It’s fine right now, because I take good notes and I follow up on things that don’t match up (the prednisone I’m on, for example, didn’t make it onto my cycle calendar until I asked when I was supposed to start taking it - maybe they would have noticed in time, but maybe not), but what if I slip one day and forget to follow up on something that they really should be taking care of? At some point I’ll have to let go and trust that they know what they’re doing, but that’s so hard to do.

Basically I’m feeling overwhelmed. And a little bit dazed. And my heart is racing. And I think all this general anxiety has rendered me unable to write anything more substantial than this mindstream of a post. Hopefully I’ll have something more coherent (or even, dare I hope it, prosaic) soon.*

* Maybe I’ll even be able to get some of my actual academic writing done, since I’m supposed to be finishing a draft of one of my papers this week. Ha!

I really missed you guys too...

...only this had nothing to do with Disneyland.

I went to a screening of a film about menstruation. It was interesting, I guess. I’ll hold off on critical analysis for a moment, but I’ll start with an observation - people in the “real world” are not used to talking about the nitty gritty of their bodily functions in public. The number of times I had to restrain myself from saying things like “I need to run to the bathroom and see if I’m still spotting” was boggling. (Actually, I was restraining myself from having any sort of deep conversation - I was trying to be in small-talk mode. Didn’t completely work, though I only shared my deeper analysis with a tiny group of people, two of whom I don’t even know that well...)

The film is, as I said, about menstruation. Specifically, it centers loosely around the question of menstrual suppression - using Depo Provera or continuious BCPs to reduce the number of bleeds. My first bafflement of the evening was the realization that lots and lots of women don’t understand how their bodies work. Women don’t realize that the period they’re having when they’re on “regular” BCPs isn’t really a period at all, but just withdrawal bleeding. They don’t investigate the future health ramifications of Depo. Many of them wish they could just stop getting their period all together.*

What I found most disturbing was the absense of attention to the concept of fertility. I don’t just mean that they failed to mention the potential after-effects of something like Depo on a woman’s fertility, but that the notion that menstruation is tied to reproductive functioning seemed like it was missing from the film. How do you talk about menstruation without acknowledging its link to fertility and reproduction? Many (most?) women use BCPs and other forms of monthly or longer menstrual control/suppression not to rid their bodies of menstruation, but as contraception.

Another angle on the same point: Getting a period means (in most cases... there are exceptions... standard disclaimers apply... blah, blah, blah) that you’re not pregnant. If you’re 17, that period after you missed a pill is probably a big relief. If you’re 27 (or whatever) and TTC, that period is like a punch in the gut. Both mean you’re not pregnant, but not being pregnant signifies different things to different people.

Obviously, I don’t expect the filmmaker to have incorporated every aspect of menstruation in the film. That just wouldn’t be feasible. But I do think that some general reference to the notion that periods are inherently linked to women’s reproductive functioning might have been in order. I’m just saying.

Now I need to run to the bathroom and see if my period is really starting so we can get this show on the road.

* I certainly understand that there are circumstances (fibriods, endo, and the like) that would warrant menstrual suppression. But lots of women just don’t want the bother, which seems very different to me. Not inherently bad (though I fought so hard to get my body to have periods that it’s a bit foreign) but very different.

Didja miss me?

Okay, so I wasn’t gone that long. But it was fun and relaxing and just what we needed. Plus, I’m back and I still have a bit of weekend left...

Disneyland was great. We went for the full day on Friday, arriving just after opening and staying until just before closing. (The picture is actually from our brief side-trip over to California Adventure. Yep, that's us - or at least, our backsides!) We rode Space Mountain twice (it would have been more, but the ride was closed for a while). The second time we sat in the front and it was fantastic and fun and exhilarating and I still hope I can’t do it again for a while. But, you know, it was good. We also really enjoyed the fireworks show - they’re running a special show for the park’s 50th Anniversary, and it incorporates bits (sound and otherwise) from some of the attractions. Hard to explain, though it included fireworks being volleyed back and forth like cannons in Pirates of the Carribean (which seems longer every time I ride it, and not necessarily in a good way - though that could also be attributed to the gaggle of teenagers on our boat) and lasers and a big explosion from Star Tours and the castle lit as if it was part of the old Main Street Electrical Parade... like I said, it’s really hard to explain, but it was really fun. And we did lots of the smaller rides, too (including the Teacups - that's us trying to make the cup spin before the ride even started!)The whole trip was great, actually. We found a good deal on a nice hotel a bit removed from the Disney chaos, and we had a comfy bed and it was clean and we ordered room service and it was just really nice. (And I managed to transport the Lupron and the needles and all that smoothly and without too much fuss, and I took the last of my BCPs, so we're really close now...)

Like a kid on Christmas

I got a big box in the mail today full of all the things every kid dreams of - vials and powders and pills and, best of all, lots and lots and lots of needles. Oh it was just a swell package! If you don’t have one, you should run right out and order your own. (And then I promptly boxed back up everything that doesn’t need to be refrigerated, so I can get the joy of opening it again next week when I’ll actually get to play with use it all.)

In other kid-like news, we’re off for a quick getaway to Disneyland to ride all the rides that I will hopefully soon be unable to ride, and to see all the fun 50th anniversary special events and displays and the like. A last hurrah, if you will. (Also a last hurrah before I start stims next week.) We managed to find what’s turned out to be a really nice hotel (I’m using the free wireless internet in the lobby!) and we’re going to order room service and relax. And maybe watch some HBO (since we only have basic cable at home).

I’ll update when we get back...