Not how I thought this would end

Today we were all ready for the transfer. I was thinking two, maybe three embryos. At least one. But the doctor called this morning and said that after fertilizing a few days ago, they all three stopped growing. Just stopped. No explanation as to why. But that means there are no embryos to transfer. No bed rest today. No pregnancy test in 2 weeks. That's it.

I've been through a range of emotions already, from devastation to rage to despair and defeat. Now I'm just a little numb. I don't really know what to do with myself. I guess I could have some caffeine or alcohol today. I could probably start running about a week or so. But those things are little consolation. Maybe Dane and I will try to take a vacation before I begin residency. Who knows. I think today I will lay on the couch and watch a mindless movie. I just don't think I can concentrate on anything else.

It's hard to believe it's over, just like that. We'll still find a way to be parents some day, but probably not until after residency. Thanks for following along on this crazy journey.
~Sarah

Waiting by the phone

Today was one of the most frustrating days so far. I expected to hear from either the doctor or the embryologist this morning with an update on the other eggs and the fertilized embryos. But no call came. I tried very hard to be patient. Yesterday they called at about noon. So today I waited until 2:30 and called the office. Being a Sunday, they have only an answering service on the phones, whether someone is there or not. So I left my name and number, and a nurse was supposed to call me back in a few minutes. Half an hour later she called back.

This nurse was surprised that I was supposed to hear from someone today because they've all gone home already. And if I am actually supposed to have a transfer tomorrow, someone should have told me when and where to show up, among other things. She sounded skeptical of my story, but promised to investigate and get back to me. Another hour went by and the nurse called back to say that my transfer will be tomorrow, and my doctor would be calling me soon to discuss further. But what about the embryos, I asked. She said none of the other eggs had matured. So they didn't even get to try to fertilize them. That's all she knew. She had no update on the existing embryos, how they looked, if they were still all good, or anything. She said the doctor would call and the doctor would know more.

The doctor finally called at 8pm. She had been on call today in what she described as a very crazy day, and she apologized for not calling sooner. She confirmed everything the nurse had said initially, and didn't really have any new information beyond that. They won't have an update on the three initially fertilized embryos until tomorrow morning. At that point we'll discuss the plan. If there are one or two embryos only, they will transfer all they have. If there are three, and they all look great, then we'll have to discuss. The possibility of triplets is concerning, but freezing/thawing just one embryo is very risky as only 80% tend to survive that process. So we'll see what they say tomorrow on that.

The nurse and the doctor say I should try to get some rest. Try to relax. I'm gonna go take a hot bath right now. But I don't really know how to put my mind at ease. It feels like so much is at stake. So much is resting on this one attempt. I had really, really hoped that there would be a few backups. But I'll give it my best. After the transfer tomorrow then I'm on strict bed rest (I can get up for bathroom breaks only) for the remainder of Monday and all day Tuesday. I've already TiVo'd lots of movies and have a good book picked out. It will probably be the longest amount of rest I'll get for the next few years, at least until residency is done. If I have triplets, it will be even longer. I'll try to relish it.

hurdles

Yesterday's excitement of harvesting 11 eggs was relatively short lived. The doctor called today to inform us that only 3 had fertilized normally. So here's the breakdown: 4/11 were too immature to try to fertilize yesterday, so they'll try today and tell us how it went tomorrow. 1/11 appears to have done nothing. 3/11 fertilized abnormally by allowing more than one sperm to penetrate the egg, so they are genetically incompatible with life as they have 3 or more copies of all the genes, instead of the normal 2. And that leaves the 3 normal ones. Three is better than zero, but it is quite disappointing nonetheless.

Tomorrow she'll call back and tell me if those three are still growing ok, and if any of the 4 previously immature were able to fertilize. They will actually use a procedure called ICSI (Intra Cytoplasmic Sperm Injection) to try to maximize fertilization for those others. I don't really expect any of them to fertilize given that they were immature at retrieval, but we'll see.

I just feel like I'm running a race with an unknown number of hurdles. Everytime I jump over one, I hope that the end of the race is coming soon and there won't be any other hurdles, but then there's another one waiting. And I keep watching all these people around me running a simple hundred yard dash with narry a hurdle in sight. And I have no choice but to keep running, and keep jumping. Or just give up on the race. I don't want to give up, but I'm tired. I'm mentally tired and emotionally tired, and quickly becoming physically tired.

I asked Dane today, "When does the disappointment end?" He said "When you stop trying". It's not the answer I want, but it's the truth.

Short, sweet, and to the number

We got 11 eggs!! The retrieval went well, and Versed is a fantastic drug. The embryologist informed us that they were able to retrieve 11 eggs, which is great compared to the 3 we got last time. They'll call tomorrow with the fertilization report. On average, they expect about 60-70% fertilization rate, assuming there are no problems. So we'll see what they say tomorrow.

a tide of emotions

ok, i'm definitely emotional. I just got a call back from the pharmacy and they agreed that there was a mixup about the extra medication, and they are going to take it back. They will credit my account the $600 when they receive the medication back, and they are paying for shipping. This news made me teary, in a good way.

after last night's post and subsequent shot (ouch), I laid awake in bed for what seemed like forever just thinking about all the what ifs. What if this works and i get pregnant? How will that work with my residency? Where would we put the crib? What would we name the baby? What if this doesn't work? Would we adopt a baby? International or domestic? Would anyone choose us to adopt their baby? Would we want to have a white baby and play it off as our own, or would we pick any race/color/ethnicity and have it be totally obvious and open that the child is adopted? How ironic would it be if we got pregnant on our own after two failed IVF attempts? How exciting would it be to be able to share that news with Dane after secretly buying a pregnancy test at the store? And then we could tell all of our friends and family! it would be so exciting! you can see how all of this mind racing is not good for sleeping. so another nap could be in my future today.

I met with the nurse this morning, and the reason they decided to trigger ovulation for Friday retrieval is that all of a sudden my eggs starting growing like crazy! One of them grew nearly a whole centimeter in just one day!! And there appear to be 5-6 on each side right now. They won't all be good probably, but if we get a few from each side, that would be double what we had last time. My estrogen level is now around 3000-4000! So I guess I have an excuse for being emotional. I'll get one more call this afternoon to let me know if the trigger shot worked based on my blood test results. If not, I go in for a booster. But either way, tomorrow at noon will be the retrieval. Just our luck that tomorrow at 10am is supposed to be the peak of a big spring snow storm slated to bring in 1-2 feet of snow to the metro area!! The plan will be to leave early, drive slow, take the 4-runner, and let dane be the one behind the wheel. If we had a wreck on the way down there, I believe it would be grounds for my wanting to leave Colorado. I will say my prayers for safe travels.

Let the countdown begin.

I have no idea if blogspot tells you what time I'm writing these things, but it is currently 12:40am in Denver. In 20 minutes I'm supposed to give myself a huge shot in the bum that will trigger ovulation exactly 36 hours later. That would be 1pm on Friday afternoon. Luckily, at Noon on Friday I will be falling deep asleep under the watchful eye of an anesthetist, while the doctor harvests my eggs.
This is a very precisely timed operation, and it seems I got the raw end of the deal. They usually start the egg retrievals early in the morning, meaning most people give themselves this shot at a normal time, like 9pm or 10pm. But if they have a lot to do in one day, then they continue scheduling until they are all done. The nurse initially thought I would be ready for retrieval on Saturday or Sunday. But all of a sudden in the last two days my eggs started growing a lot faster. And it's also possible that my body decided to trigger ovulation on its own and their hand is now forced. I'm not sure which it is, but I have the instructions to go ahead. And I've unfortunately drawn the short straw and have the latest egg retrieval appointment. Hence, the 1am shot.

Honestly though, I'm glad this is finally happening now. This morning I was really going down hill with respect to mood and patience. I've been doing ok so far, but for the past few nights I've been getting more dizzy and nauseus at night. So I don't think I've been sleeping so well. And this morning I awoke to a phone call saying my morning monitoring appointment would have to be moved to another office much further away because the ultrasound tech at my normal office called in sick. This was quite an inconvenience in an already busy day, but what choice did I have? Next I picked up my latest shipment of world's most expensive medication, only to find they sent me double the amount that I ordered. And they charged me for it! I promptly called their helpdesk, but the woman said a Patient Services Representative would have to sort it out and call me later. She made it sound like the problem was mine, not theirs. I was sooo furious. And at that point, I totally lost it. I was crying, sobbing, completely breaking down. Not on the phone of course, just in the car with Dane. I said how much I hate all of this and I can't wait until it's done. I said I would never, ever, ever go through this again. And I thought, but didn't say, that having kids was probably not worth all of this bullshit.

We came home and I decided the best thing was to lay down for a bit. Two hours later I woke feeling much better. The medication shipment mistake has not quite been resolved despite my calling again, but at least the second customer representative was more friendly and apologetic for the mistake. In any case, the situation certainly did not warrant such drama. I was even aware of that at the time. But I felt completely at the mercy of my emotional surge. So it's better that their going to finally get these estrogen making buggers out, and I can hopefully go back to dealing with this incredibly stressful situation like a normal person instead of like a crazy possessed person.

oop, it's 12:58. Gotta go.

Still growing

I've had so many things I wanted to post about lately, but my time availability and access to internet have been cut short by moving. So I'll see if I can cover the important stuff. Things are going well. My ovaries are both growing steadily with multiple follicles. It looks like the retrieval will probably be this weekend. The bad thing about it taking so long for the follicles to reach the right size is that: a)it is really, really expensive to keep getting refill meds to help them keep growing, and b) the lining of my uterus (endometrium) just keeps getting thicker and thicker with all of this estrogen hanging around. This morning it was 15 mm thick. At about 17mm it will be too thick and they will have to freeze the embryos and transfer them another time. That's fine in theory, but could be difficult to time a two day break from residency (necessary for two days bedrest after transfer) with the right moment in my cycle for transfer. Oh, and it means more money. Everything is more money.

But all told, I'm doing fine. My estrogen is now above 1000 and I'm beginning to feel the effects. In the evenings I have waves of nausea and dizziness. My appetite has improved a little, but when I do eat, then I regret it for all of the nausea. Perhaps this is a primer for pregnancy. But I'm sleeping ok, no hot flashes. And I haven't had any full blown migraines either. This time around has been much easier in the way of symptoms.

And yet, I still want to be babied a little bit. It's probably silly, but I want people to dote on me over all of this. It sucks to take all these shots and go in for all the blood draws. It sucks to feel so hormonally pulled all the time. And it sucks to have no ability to exercise as an outlet. Oh, and I really would love a cup of coffee in the morning and a beer in the evening. Instead, I just watch everyone around me enjoy those things. As much as I want those around me to enjoy themselves and not be inconvenienced by me, I hate to suffer alone. Misery really does love company, or at least an occasional foot rub :)

The other morning at one of my monitoring appointments, I felt a little bit less alone. A young, pretty woman about my age got on the elevator with me and walked into the fertility clinic ahead of me. She seemingly had the same type of appt as me, and may also be doing IVF. I'll never know. Two other young, pretty women came in while I was waiting. It was the first time that the waiting room was not filled with women in their 40s! I always feel very alone when I'm the only young person in the office. Like this shouldn't be happening to me. Infertility should be a problem only for those who wait a long time to have kids. But that particular morning, we were all in the same young, pretty boat. I felt for them. I wanted to tell them that I understood what they were going through. I wanted all of us to commiserate about all of our friends who were having babies while we were not. Instead, I read Cosmo and waited to be called. But for a moment, I felt less alone.

I think deep down we all want to find people who are like us. People who can understand without having to explain. Not that I want to be best friends and go on outings with all of these infertile girls. My friends are friend enough, and I feel very loved and supported. It's just nice to know that someone, somewhere, understands completely.

Pincushion Princess

I have now been on the medications for a week, and it looks like I'll have about 5 more days, give or take. My eggs are all growing, although not exactly at the same rate. Some of them seem to be trying to win the size race, which is not really what we want. But they are at least producing estrogen like they are supposed to. My level yesterday was 190. I should get another level today.

But I have a whole new respect for these numbers. As a doctor, I order and evaluate lab tests all the time. It's an essential part of many, if not most, evaluations. But as useful as the blood can be in determining how to care for someone, people don't come with a spigot on their venous system. It takes a skilled hand to gently insert a needle and tap the vein. Lucky for me, the phlebotomist/nurse who draws my blood at the clinic is one of the best.

But even the best can have trouble some days. Today, my veins were not playing along. Given the two holes that already grace my left antecubital fossa (the front side of your elbow), my veins decided to run and hide today when they saw Ruby approaching with that needle. She tried for a new vein on the outer side, but after much digging around she had to abandon that site. Instead she went for the tried and true big blue vein on the inner side. This one hurts. No, I should say IT HURTS! Every time. I usually ask people not to stick me there because of the sensitivity, but it seems to just thrive in that protected environment, becoming bigger, bluer, and more tempting to those weilding needles. But the crappy thing is, she had to dig for that one too! Was Ruby off her game this morning? Were my veins still asleep in bed due to the early hour? I don't know, but I left with lots of gauze and a very sore arm. Sadly, I know there are many more days of the same waiting for me. Maybe I'll do some curls tomorrow morning before I arrive...

In any case, I'm developing a greater appreciation for what patients must endure at the hospital every time I sign a little order asking for a blood test. And taking blood out is not the only time people get poked. We also put things in. It's almost impossible to rent a room in a hospital without getting fluids pumped directly in via IV. And then there are the medications that get administered IV drip, IV push, subQ, and IM. I'm lucky that my current regimen only includes subQ shots, which means tiny needles that don't go very far in. But my "pinch an inch" tummy is beginning to look a lot like a mine field of bruises. Last night required two shots for one dose of medicine due to the increase in dose. And what do you know? It's time for my next shot.

For all of you reading out there, thank you for your love and support. I think my anxiety level is much lower this time around since I have an outlet for my thoughts and feelings, and so many loving supporters. Happy Good Friday everyone.

Going for broke

I've taken 5 days of the stimulation meds so far, and this morning I had my first monitoring appointment. This consists of a vaginal ultrasound to look at my ovaries and measure the size of each follicle, and a blood draw to measure the levels of estradiol, progesterone, and LH. The estradiol will tell them how functional my follicles are, and the progesterone and LH will tell them if my body is about to ovulate. So I want the estradiol to go up, and the LH and progesterone to stay low.
Today, everything looked great. The nurse said today was sort of like a baseline. They counted the follicles, and hopefully I'll have somewhere between 10 and 15 when all is said and done. They all seem to be about the same size and growing at about the same rate, which is good. My estradiol is only 71, but she said that was normal. I'll go back on Thursday for another such appointment, and hopefully everything will be progressing well.

In the meantime, they've increased my dose of Gonal-F. I was taking 300 IU per night, and now I'm up to 450 IU per night! I suppose I've got nothing to lose, so let's go for broke. I don't really know what the upper limit is on the dosing for Gonal-F, or if there is one. But this feels like a pretty high dose given that I was taking 225 IU for my previous IVF. I expect to get more hot flashes, mood swings, and headaches with this change, and with my increasing estradiol level. We'll see. So far, the side effects have been minimal. In fact, I would actually say I've had more energy lately, and a decreased appetite! I can't help but wonder if this is more like the way I should feel all the time, if my ovaries were making the right amount of steroid hormones all the time... Would be quite a bonus if I could drop a few pounds in the midst of all of this, but that seems unlikely given my now total lack of exercise. I'll just try not to gain any weight I guess.

Well, none of this is a guarantee. But I like having something positive in the end, even if it isn't what I set out to get. So my silver lining (albeit small and arguably insignificant) is that I'm going to take this opportunity to whiten my teeth. Given my forced time away from red wine, coffee, and soda, I've got time to let some whitener do its job. All the products say that for the best results you have to stay away from such staining liquids during the two weeks or so that you use them. So I'm wearing my Crest WhiteStrips right now. My gums are tingling. Come to think of it, so are my ovaries... :)

Distracted

As of yesterday, I've started taking the stimulation meds. The Menopur (LH agonist) is a subcutaneous shot in the morning that makes me feel queasy a few hours later, and in the evening I take a subQ shot of Gonal F (FSH agonist) and a pill of dexamethasone. Supposedly the Gonal F can make you dizzy, but I take it at bedtime to avoid feeling it.

I probably would have something more insightful and eloquent to write about with the beginning of these meds, but I have been distracted by having mangled my car on an icy highway road yesterday. I'm fine, and the other people are fine, but it was terrifying to slide out of control on a mountain highway in the midst of an unexpected snow storm. My car will be repaired and insurance will pay for it, so the damage is really quite minimal in the end. But I am frustrated with all the April snow, and feeling helpless at having planned my trip so meticulously to avoid driving through bad weather only to hit a freak snow storm 45 minutes from home!
I hate pointless destruction, so I've tried to come up with things I've learned from this so as to avoid a similar situation in the future. So far I've got: If I'm in the civic and it begins to snow, turn around and go home. Also, when it's icy, the brakes make you slide, so stay far enough from the person in front of you that you have time to stop with gravity and friction alone. (It is quite frustrating to feel as if I've gone from a confident and controlled motorist, to a scared and helpless "not from here" driver. Everyone complains about people who don't know how to drive on snow and ice, but they never offer up any helpful pointers!)

So you can see why I have been less focused on the IVF. But I am certainly excited that the ultrasound and bloodwork were good yesterday, and I got the go ahead on the meds described above. I'll go back next week for some monitoring, and hopefully my ovaries are on their way to being huge.