Tuesday, September 25, 2012

A funny thing happened at transfer

The call came that morning, 3dpt (or three days post transfer, for those who may not be familiar w/ infertility speak): one good looking 6-celled, and one fair 8-celled embryo (good enough for me!), all ready for transfer.  Started on my twenty ounces and mama and I were out the door.

No husband required on transfer day.  No fasting required, either.  Quite a change from retrieval day, where my mom and I waited, dressed and ready, on the sofa downstairs watching "Today," and poor sweet hubs had to "produce a sample" just one floor up (we're talking ten feet as the crow flies, our ceilings aren't that tall). 

Prior to transfer, I again combed the internet looking for what I could expect to feel during and after. I came upon many comments in which women said things like "the full bladder was the worst part." Clearly, I thought, these women did not work in health care.  For over ten years in the outpatient setting, my bladder had been trained against the urge to relieve myself.  I considered myself somewhat of a ninja in that area.  I could potentially wait for hours if I was busy enough, all while providing comprehensive care and patient education. Heh heh.  I would sail through this and then my mom and I could spend the day watching season season two of Downton Abbey.

I may have gone a little overboard on the water.  They said 20 ounces.  I have a 32 oz Nalgene.  I downed half of it and brought it with me to my appointment. 

Dr. M was running a bit late.  Just more time for me to ensure that I got plenty of water in that bladder so they could visualize my uterus and implant those embies exactly where they needed to be.  I was transferred into a holding pen for infertiles.  A narrow hallway with small curtained rooms on each side.  My mom could come with.  Perfect!  More time for girl chat.   

Let's say I began consuming water in earnest like a good patient at approximately 9 a.m.  Arrived to surgi-center at 9:30, transferred to infertile girl holding pen at 10 or so.  At 10:30 (past the time of my scheduled transfer), I looked at the clock and voiced to mama that I really needed to pee.  Laugh laugh laugh.  All for the sake of having a baby.  I was certain to be taken back soon.

11:15 a.m.: bladder distention pain begins interfering with ability to hold a conversation.  I can no longer laugh; am afraid I may pee, and also it just hurts.  Any voluntary or involuntary increase in intra-abdominal pressure increases the cramping, and I begin to fear for the integrity of my bladder.  Minutes later a nurse comes to retrieve me.  I gingerly get up and take step by painful step down the hall towards my embies and the transfer room.  Loading and unloading my pelvis during walking causes cramping, and I have to assume a somewhat hunched posture.

The transfer room is climate controlled and adjoins the embryology lab, so my little embies don't have to go far to be transferred.  I'm invited to "get up" on the plinth, making sure I position a folded pillow under my pelvis.  Ummm...as stated before, any voluntary or involuntary abdominal contraction significantly increases the pain on the stretched out smooth muscle of my bladder.  Trying to "back oneself up" on a mound of pillow on top of a high table: not so easy.  Or comfortable.  I could barely bridge to scoot the pillow back under my pelvis when I managed to heave myself onto the table. 

So I'm about to burst, nether-regions angled up to my poor doctor, who will certainly be covered in urine if I can't do some serious yoga breathing and get through this.  And then what happens is you get a speculum inserted, and someone else presses down on your bladder with the ultrasound head.  I remember hearing "WOW, that's a full bladder" prior to closing my eyes and breaking out in a a cold sweat.  The procedure took only moments, but passing out was a serious option at one point.  Not sure what they would have done, I was already supine.  But I remained conscious and they soon wheeled me back to the holding pen, my pelvis still elevated and my body somewhat crooked over that mound of pillow.  Any attempt to reposition myself would result in wetting the bed.  "Fifteen minutes and then you can get up," my nurse instructed and set a timer.  When I voiced concern that, really, I may pee the bed, he smiled sweetly and patted me.  Realization: those women in the blogs were right.

My mom noted that I was devoid of color, and my hair had been plastered to my face by my cold sweat.  She felt under my neck and shoulders and exclaimed "you're soaking wet!"  Yes, well, just a wee nervous system response to an organ whose walls are strained to near rupture.  I could only lay there, half on my mound of pillow, miserable, until my time was up.  And when it was, I could not get out of bed.  I literally could not contract my abdominals to roll or sit up in bed. My attempts to do so resulted in a flailing of limbs that sent my gown above my waist and mom exclaiming "honey!," and then checking the integrity of the curtain across our little pen before restoring my modesty and helping me out of bed.

The relief was not as sweet as thought.  My bladder had been through some trauma.  I sat for about 10 minutes in the bathroom, letting the loose walls of my bladder slowly shrink down to size dribble by dribble. I felt as if I may have betrayed my body slightly by not acting on it's obvious and urgent distress signals.  I was exhausted.

On the way back home, my mom recounted how, in the minutes that I was gone from my holding pen, other women began to drop like flies.  It was only Dr. M doing transfers for all of these ladies.  He was obviously very busy and somewhat backed up.  She heard one patient shuffle off to the bathroom in her little surgical stocking feet, and then heard a flush.  Then it happened again. The would-be glory of knowing that I didn't falter in my bladder-holding efforts was diminished by the vague fear that irreversible damage may have been done.

Back home in my bed, my mom making cookies downstairs, I felt like I'd run a marathon instead of enjoyed a Downton Abbey marathon.  I curled up for a nap to let my insides settle back to their rightful places.






Making progress: eggcellent!

We began ovarian stimulation for our first IVF cycle with what seemed a very reasonable dose of Follistim (150) and Menopur (2 vials) daily.  Within a few days, it was clear that my ovaries were languishing about, and my dose was increased to 300 Follistim, and 4 and then finally 5 vials Menopur.

A quick note about these injections.  They were nothing like the Gonal-F I took for IUI.  These things were no joke.  They definitely burned and a collection of bruises sprang up around my lower abdomen.  I went from a proud needle wimp convert with Gonal F to a whiny, wine-guzzling, and sometimes teary mess when I had to do these shots.  After 2 days of needing half a bottle of red to man up and inject myself, my sweet hubs took over.  The whining stopped.  He was a pro.We quickly had a routine.  He prepped the Follistim, I the Menopur.

Whereas I noticed no difference in how I felt or my mood with Gonal-F, with this new cocktail, I (and surely the hubs) noticed some irritability.  I think this could have also been due to the increases stress of knowing that this was kind of it for us, our second to last try.

At one point I believe we calculated each day of injections to be over $400 out of pocket.  I can't remember the numbers exactly, but again, let me just say we are SO VERY BLESSED to have family support.  We couldn't have done it all on our own.

I was scared to death they were going to cancel my cycle the first week; my ovaries responded at a snail's pace.  But they did respond, and we kept up with our injections and monitoring.  Fourteen days of stims, and we triggered two days later.  I was so so excited.  My sweet mama was in town for the week of retrieval and transfer.  She arrived bearing food, a huge Easter basket for her 34 year old, and an endless well of emotional support.  While I worked a day or two that week before retrieval and between retrieval and transfer, she cleaned the house and did more cooking, made Harris Teeter runs, and lunched with my mother in law.  We were basically ready for her to move in.

Retrieval was a breeze since I'd had the polypectomy a few weeks earlier.  Wasn't nervous, just very excited.  Nine eggs retrieved out of eleven.  Not bad.  The next day I was a bit of a wreck waiting to see how many eggs fertilized with ICSI.  Four fertilized.  I began looking up stats on the likelihood one or more would make it to blastocyst.  They tentatively scheduled a day three transfer.  I got a bit  panicky seeing posts like "we got 18 eggs, 13 fertilized, 10 blastocysts for day 5 transfer!"

A few miles away in the embryology lab, there were three collections of cells.  Beings made up of myself and my sweet husband.  It made me smile to think of it.  Little embryos that were neither him or me, but us together.  A friend had a baby the day before my transfer, at the very hospital campus where our little embies were being watched over.  I thought of them and hoped they were cozy and multiplying in their petri dishes while I visited my friend, her husband, and their new little bundle.


Sunday, September 23, 2012

Moving onto IVF

At this point, it came as not shock to go online and see women who had a history of four, five, and even eight IVF cycles.  So it was with both renewed hope and a nagging feeling that we entered the IVF program.  Because of my FSH levels, the darling hubs and I did not qualify for the "shared risk" program many fertility clinics offer.  This coupled with the fact that our insurance did not provide any coverage for IVF was a bit of a blow.  We signed up for the "multi-cycle discount," which was a 40% discount off fee-for-service, and gave us two tries, non-refundable.  Begin stomach upset and altered sleep patterns.  I spent the month leading up to the procedure on the pill and trying to adjust to the fact that within a few months, we would either have succeeded or failed at our only chance to have "our" baby.  By "our," I meant a baby made of genetic material from both myself and that darling man I married.

Terrifying does not begin to describe it.  We were wagering the farm on this marvel of reproductive science which I had initially thought would be our chance for success.  The more I searched blogs for women going through the same experience, the more I realized that although it's a modern miracle, IVF does not work for all women.  Some of these women had success several times into it.  We had two tries.  Period (no pun intended).  No money back, just expensive menstrual cycles if it didn't work.

Near the end of my cycle on the pill, I went for my mock transfer.  No fancy name.  People said it wasn't as bad as the HSG.  Heck, with all that had been going on in the nether-regions, I figured it would be a piece of cake.  Not so much.  I found it more uncomfortable than the HSG as I experienced intense cramping.  And Dr. M had to use a little ol' contraption called the "tenaculum."  If you haven't had the pleasure of knowing this device up close and personal, Google it or wait for your doctor to ask the nurse to hand one over.  The real trauma was when he told me, yep, got a polyp right where we want the embryo to implant, gotta take care of that first.  Could back up your schedule a bit.  What?

Mini melt-down ensued.

My regular gyno managed to schedule my surgery for the next week.  My stim start date would not need to be pushed back another cycle.  Things were working out!  Besides wisdom tooth extraction over college break, this was my first "surgery."  I was a nervous nelly, but it ended up being a  piece of cake and I had virtually no cramping.  Polly polyp was gone.  Stims: bring it!


Thursday, September 20, 2012

A note on social media

To my pregnant friends and acquaintances on Facebook:

FYI I'm infertile.  Haven't exactly put that out there in my status updates, but I am.  And, yes, I'm probably jealous that you are pregnant, but that doesn't mean that I'm unable to be happy for you.  I would love to share in your joy.  Although probably not at your baby shower (unless you're one of those very near & dear to my heart); it's too hard on my husband when I come home in tears and end up spending another Saturday night watching "Julie & Julia" or "My Big Fat Greek Wedding."  However happy I am for you, there are a few things you should be aware of.

I may be a teensy bit sensitive seeing as the hubs and I are out over 30k and all we have to show for it are a few expensive periods, but I don't want to hear about the intensity/frequency of your progesterone-induced nausea/vomiting.  Even hinting at a change in your bowel movements is not appropriate talk on the ol' FB, never mind that my FSH is closer to 20 than 10.  If you want to do it under a name like "mommy2b," feel free.  But having your date of birth, place of employment, and favorite movies beside a comment like "50% effaced!!!" is a little much.

When you post "these pregnancy hormones are awful," realize that it takes a lot of emotional energy to refrain from responding "how about ovarian hyperstimulation followed by transvaginal progesterone thrice daily and then not getting pregnant!"  And my stores of emotional energy have been drained pretty low in the past nearly 2 and a half years of trying to get pregnant.  Please stop tempting me.

Posting your positive home pregnancy test pee stick as your new profile picture may be cute to some, but I find it, again, a bit much.  Perhaps because it felt like I'd gotten kicked in the abdomen.  A classy post about your new addition is wonderful and I will probably "like" your status.  Pee stick profile pics almost guarantee I will have to "hide" you from my news feed for the next 40 weeks because, frankly, if you're posting a pee stick, then god knows what else will come up.

Please consider limiting your pregnancy complaints on FB.  It's amazing and scary what your body is going through, and you deserve to vent about your changing body and bodily functions.  But doing so via FB on a regular basis makes me want to scratch your eyes out.  Plus I know I'm not the only one who finds it gauche.  Know that for every pregnancy complaint, one of my hairs turns grey and kind of kinky.  Help me out here.

Best,
Babylessinbaltimore


Tuesday, September 18, 2012

When IUI doesn't work

It did not work.  Three times.  And the last time my FSH was 15.9. Dr. Mc was a bit worried and advised progressing to IVF immediately.  No insurance coverage + not eligible for "money back guarantee" (FSH levels were too high) = major meltdown.


Let me just say at this point it was more "judicious use" than "abstention from" products such as wine, beer, or OTC headache remedies during the two week wait (known as the horrid acronym 2WW in the world of infertiles).  A girls's got to get through it without completely loosing her sanity .



Meanwhile, babies had been conceived, born, and started on solids since we'd first attempted to have a baby.  As if my patience wasn't already worn razor thin, there's a wait time associated with the start of each cycle of IVF.  Papers have to be signed, money changes hands (thank God for the support from our family), and ironically, birth control pills are taken for a month to regulate cycles before attempting IVF.  This was in  the depths of winter, while my husband finished his doctorate in his free time.  It left a lot of lonely weekends for me to prowl the internet.  the hubs would sometimes question "do you think that's a good idea?"  But I was compelled.  I would sit cross-legged on the sofa pouring over blogs and sobbing at the loss of other women, at the words they spilled that I so understood.  My feelings were so raw at that time that I couldn't fathom attempting to corral them into words.



That winter also coincided with the shift of Facebook from a way to stay connected to old friends, to an all out baby/baby bump tracking media site.  Nary a day went by without a picture of a naked newborn on a hospital scale with it's weight captured in digital numbers.  Sorority sisters, grad school buddies, ex-boyfriends, people I shudder to think of as parents: all apparently preggers or with newborns.  It seemed every post on Facebook was about an infant, a child, a pregnancy.  I felt that I didn't have a place, I had nothing I could say to rival the joys and hilarities of being a parent.  Even with support of family and friends, the sadness and anger was overwhelming at times.  There was quite a bit of wine consumed that winter while I waited out my cycle on the pill, so it was a good thing I was over that whole"limiting alcohol while you're TTC" thing.

Mission: artificial insemination

The closest I've ever gotten to a picture of my own baby is a print-out of the eleven follicles growing in my ovaries prior to my first egg retrieval.  There they were, listed by size in millimeters, little follicles in the right ovary, then the left.  It came from the same ultrasound machine they use for women who are actually pregnant with babies.  It felt official.  And I was hopeful.

My sweet boy and I spent several months following our consult with our reproductive endocrinologist (Dr. M) trying out intrauterine insemination (IUI).  This was covered 50% by our insurance.  Fantastic!  We also found out we had zero coverage for IVF.  I remember writing that down as an afterthought when I spoke to the Blue Choice rep.  Again, naively, I believed we wouldn't need to go that far.  I had some minor diminished ovarian reserve.  I was healthy.  I was under 35.

There were daily injections, from around the time my cycle started through ovulation.  I felt pretty grown-up that I could inject myself (although the hubs still had to push the plunger down).  No pain associated.  Minimal if any body or mood changes.  Every other day (and sometimes daily) bloodwork and ultrasounds to monitor follicle development and time the insemination with ovulation.  The first try hubs and I both really thought this would work.  How could it not?  Between the doctors, nurses, and residents in on the goings-on in my ovaries, we were certain this was our time.  We did everything right.  I abstained from drinking, Tylenol, NSAIDs, caffeine.  Dr. M inseminated me with millions of the hubs' grade A boys, I shook his hand, thanked him, and then he said "good luck."  When he said that, I felt a little anxious.  Would I need luck?  This is down to a science, how can it not work?

How did I get here?

Let me set the stage. 

May 2010.  A year into my marriage, my dear husband and I were at last on the same page about kids.  Despite my possibly genetic neurotic tendencies (would baby inherit?) and our mountain of grad school debt, we both agreed we'd like to try to have a baby.  Now. 

We smiled through a few months of TTC without success.  Mind you, when you start the whole trying to conceive thing (lovingly referred to as TTC in infertility circles), a few things happen simultaneously, or at least they did for us:

1) Aunt Flo (AF) unleashes the cracken of cramps. Every month.  She also settles in with startling regularity of the likes you've never experienced.
2) Pregnant women come out of the woodwork.  I mean every where.  At work.  On public transport.  Beside you in the produce aisle.  In Nordstrom. On Facebook.  As your patient.  I'm talking hordes.
3) Glowing mothers with babies in chic 3-wheeled strollers multiply exponentially and all appear to live w/ in a 1 mile radius of your house.
4) Neighbors with multiple children announce "oops--snow storm baby!" 
5) Patients/neighbors/strangers/clergy/family/friends begin inquiring "so when are you guys going to have kids."
6) Pottery Barn Kids suddenly arrives in mailbox every 3 weeks along w/ regular catalog. Possible nursery scenarios for the front bedroom develop.  I was actually naive enough to purchase a paint color several months into trying.  Thank GOD we decided against repainting until we "knew" we would have a baby. 

Repeat for several months.

6 months TTC:  First gyno visit in years--oops!  Get the system checked out.  Orders diagnostic ultrasound (my first experience with dildo-sound) and bloodwork to be sure.  All systems go!

9 months:  Dominican vacay!  The hubs and I are CERTAIN it will happen this week, if you know what I mean.  Relaxation, few clothes, great booze and food.  Somewhat of a gnawing sensation started when AF arrived thereafter.

10 months:  Purchase oodles of ovulation kits and basal temp thermometer and begin tedious charting.  Kept that up for several months so I could present to future doctors.

And about that time:  My brother and sister in law announced THEIR amazing news.  I look back on that rainy night and alternate between feeling both selfish and just being human for getting off he phone with them and crying like I'd been wronged.  We'd been trying for 9 months,  why not us?  I wanted it first!  What's wrong with me/you?  The desperately TTC part of me began to feel angry.  Not at them.  Not at anyone in particular, except maybe pregnant ladies just because I wanted to be one and I couldn't.

10 months: Start acupuncture.  Bring in my little charts.  Continue weekly-->every other week for 4 months. No dice.

15 months:  Houston, we have a problem.  Hubs and I decide to seek help.  Not the gyno, but the infertility specialist; introduction to reproductive endocrinologist follows.  Another systems check.  Hmmm...a small elevation in FSH (12.9) and the hubs' guys had some morphology issues.  Nothing crazy.  Shouldn't really be a big deal.


Before TTC, I used to pass a pregnant woman on the street and think "awww...how cute, she's going to be a mommy."  In those 15 months, all of that had all changed.  The first thing that came to my mind was usually "she has no idea how lucky she is," accompanied by an urge to grab her by the shoulders, shake her, and ask her if, in fact, she actually had any idea how lucky she was.

Once we initiated a visit w/ the RE, we wanted to get things started ASAP.  We certainly weren't getting any younger; I'd just turned 34.  Let the roller coaster begin.