Monday, June 30, 2014

The Summer of the FET

I was not given a large window to wallow in the sorrow of our latest failure. The day after my early negative test and hideous period, I was on the phone discussing this cycle, the next cycle, and getting my whole plan in place. By Saturday I had received my FET plan in the mail, placed the order for my meds, and I knew exactly when my next pregnancy test would be.

A little dizzying, no?

To go from the devastation of what seemed hopeful to the same old negative phone call straight into the hopeful period before another try, a promising new try with new components, so quickly... it made my head spin just a little bit.

I am not so flexible anymore that I can just turn around and put all my energy into the DS FET cycle happening in August. I can't flip a switch (and I think it would be pretty disturbing if I could and maybe a sign that I am less healthy in the mind, not more) and be all hopeful and not sad anymore that our little Bryce embryos didn't make it. I am mopey. The smallest things can make me cry, from commercials to TV shows. COSMOS made me cry, for the love of all that's holy. There was a whole sequence of big hands holding baby hands and the importance of looking forward to our future generations, and it left me feeling sad and empty and future-generation-less.

BUT, lest you think this is a woe-is-me, life-really-sucks post, it's actually not. I have to honor that piece of things, because otherwise you would smell the bullshit and be like, REALLY? You can really let go of that pain and disappointment and loss of another cycle THAT QUICKLY? I am sad, but we have made some plans. WE WILL NOT LET ANOTHER SUMMER BE SWALLOWED UP BY INFERTILITY.

One of the things we did once we had our FET dates was to say, you know what? FETs are relatively easy and the amazingness of this very overwhelming calendar with all, ALL of our dates laid out for us is that we can PLAN A VACATION in July. Let's DO THIS THING. So, we have planned a vacation. We are going to Maine! In July!

Previously, we took a lovely vacation to Maine three summers in a row. We went in late June as soon as school was out and we literally left right after the closing ceremony and drove up to New Hampshire, stayed overnight, then drove the rest of the way to the camp we rented on a pond (looks like a lake to me) near Ellsworth, about a half hour or so from Mt Desert Island and all Acadia has to offer. Our vacation was amazingly relaxing, with decisions revolving around whether we were cooking dinner or going out, staying at the camp and kayaking on the pond or hiking in Acadia National Park, pond or ocean, one bottle of wine or two. It looked like this:
Me, 2011 (so 2 years of IVF in but still smiling), hiking Pigeon Hill
Bryce, 2010, Isle au Haut, the summer of our first IVF but before meds started.
2011, Reading on the camp deck but that citronella is doing
diddly squat because Maine mosquitos are EVIL

2010 Wine Lineup. I think this is the end of the trip, I HOPE this
is the end of the trip because that's 7 bottles and we stayed 7
nights and went out to dinner a few times... :)
Like I said, relaxing. Except the third time we went, in 2011, we had done two IVF cycles and were gearing up for a third one (the one later that summer that would give us the Ectopic Experience) and we were feeling a little sad. We had envisioned bringing a baby here, thought about how that would change our activities but make it even more enjoyable. We ate dinner at a restaurant in Bar Harbor overlooking the harbor and the town park every year on or near our last night, and by this year the sameness and missing pieceness was weighing heavy. Watching families roll around in the grass and chasing fireflies started to feel less like, "Next year that will be us!" and more like "Will that EVER be us?" And then, the next couple of years our IVF calendars were not favorable for going on vacation and the costs of treatment skyrocketed and we just couldn't do it.

BUT NO MORE! No more depressing summers where I scrounge for a photo for the Fall Slideshow From Hell where everyone shares their family vacations and new babies! No more summers that go by and Bryce and I wonder where the time has gone and if all we ever do is infertility treatment and related ilk! No more super expensive treatment thanks to the packages at our new clinic, and so we can reasonably afford a getaway without feeling smooshed! We're back, baby!

With some differences. We are not going to the camp, because it is too last minute. Also, we are not going to Acadia (even though I really wanted to visit again), because apparently that area after July 4th is incredibly crowded and not as enjoyable. Also, the whole "doing the same thing" weighed on Bryce and he convinced me that going somewhere new, somewhere that we hadn't envisioned bringing our own families, somewhere where we wouldn't think about how we could have had a two or three or four year old had things worked out because we have no memories there, just new ones to build. So, we are staying in two different areas. Three nights in Vinalhaven, ME -- an island that's an hour and fifteen minute ferry ride from Rockland. It has a town and lots of parks and two granite swimming quarries, and we are planning on taking a boat out with an ornithologist to see birds on outlying islands (and, ohmygod I hope, PUFFINS). Our room is practically on a pier over running water. Go google earth Vinalhaven--it's pretty awesome. We are bringing books and food and hiking clothes. We are going to enjoy our private deck and drink some wine. I don't have to worry about egg quality for FET, so adios, Egg Boot Camp! Then, after we get back to the mainland, we stay one night in Damariscotta, a really awesome little town on a tidal river with an amazing bookstore. I love Maine for having lots of independent bookstores, because we have virtually NONE here in Rochester. Makes my heart happy to buy books from someone who has decided that they want to create a place to buy and enjoy books that is not owned by a corporation. Here's a link to the bookstore, also worthwhile because they have a camera that shows downtown Damariscotta in all its tiny but picturesque glory: Maine Coast Bookshop. We bookend the trip with a short visit to Bryce's mom and stepfather and Grammie. We were at first sad to miss the amazing ping pong playing that we enjoyed in the basement of the camp in previous years (tipsy/intoxicated ping pong being a favorite sport of ours, you can really see when your hand-eye coordination goes downhill), but lo and behold the inn we're staying at at Damariscotta has PING PONG! In the BOATHOUSE! We are so going to go down there and play.

The other difference is needles. I have sworn up and down that I cannot and will not travel with needles, and while I have done needles at family visits to Maine I really didn't want to bring them on a vacation (and I stand by my NO NEEDLES ON A PLANE rule). I have no choice. I start Lupron midweek, and it's vacation Lupron or no vacation at all, so all our rooms have a refrigerator. Whatever, Lupron has to be less horrific when you're staying on an ISLAND in MAINE, right? It's just an insulin needle so no biggie. More concerning is the vacation we're taking at the end of August to meet up with Bryce's dad and stepmom, in Vermont, where we will have to travel with PIO. UGH.

Because, my lovely friends, I cannot escape the PIO this time. It is firmly part of their FET protocol, and to be honest I wasn't crazy about the Crinone because I received my period so early and so felt like it wasn't enough. Completely against the literature, I know, but there is some comfort in being able to see my progesterone levels in my blood. Because you can be damn sure that I'm asking for and receiving post-transfer monitoring of my progesterone and estrogen levels just to be reassured that my body's not being stupid. Plus, the FET protocol calls for estrace through "stimulation" and then a lower level through early pregnancy should I be so lucky. I am continuing the Ben.adryl before and after transfer and the Levoq.uin before transfer. There are some new and shiny additions that will be made before we get started to look into other things that might help my obviously hideous implantation failure issue.

But, the biggest difference is the embryos with this FET. New component. We are fortunate enough to have FOUR lovely frozen blasts from our sperm donor, and two of those amazing cell clusters are going back into me. We will see if the DS is a magic ingredient. Bryce swears he's good with it, and he thinks that this is the thing. That it's not that my uterus is a ghostly shipyard where nothing casts anchor but instead drifts off into Elsewhere (I'm trying to be kinder to myself and avoid the death metaphors). It's that we haven't had embryos that were capable of staying for the long haul. What a tough double-edged sword this is. How hard it is for each of us not to assign blame to ourselves, yet whole-heartedly try to convince the other that they are at not at fault, there is no fault. How much we have invested in all this, how joyful we will be if this works out and then trepidatious about how to navigate parenting with donor gametes. How terrifying it is to think that the first FET might not work and it might not be a sign that all is lost but just a statistics game, but the fear that would stab deep into our hearts would be considerable. But let's not go there. Let's assume that the FET will work, that we make it, that all this ends in something other than heartbreak and emptiness. I have to be honest, I know a fair number of people who went donor sperm in one way or another and when they did, they got pregnant. So who knows? There is so little out there, I feel, on sperm issues beyond motility and counts. Maybe the mystery will be the answer to our mystery.

The upshot is, although we are spending a large chunk of the summer embroiled in infertility, with my lovely person being under the influence of 10 units of Lupron a day for ALMOST A MONTH (oh, poor Bryce), and a transfer in August with a test that didn't quite make it before school starts (AAAAAAACCCCKKKKK), WE ARE NOT LETTING IT CONSUME US ENTIRELY. We blow a big fat raspberry at infertility and off to the coast of Maine we go. We need to, desperately. We need some change, something joyful, something to look forward to that doesn't involve pictures of embryos that get stuffed in a drawer. Something that even if it rains every single day (which it won't), we will enjoy and have memories of and look back on as a time when trying for our family sucked but man, we made the best of it.

Thursday, June 26, 2014

The Ninth Time is NOT the Charm

First off, thank you to those who commented wonderful messages of hope on my last post. I can't bring myself to reply to the ones I didn't get to before things went downhill, because I want to keep that hope alive in that moment in time, suspended where everything was possible. If I reply now I will destroy that moment.

I was supposed to write a post during my wait about how despite my assertions that I am DONE with magical thinking and that there are no such things as "good omens" or whatever during cycles, because so many supposedly good omens have come and gone (mating turtles! full moons! special dates! fertile Chinese new years!) that I have no faith in them, there were a few this time that were hard to ignore (and yet didn't mean a freaking thing). Our retrieval was on Friday the 13th, a historically lucky day for me. It was a full moon (again), and not only that, it was the Full Honey Moon, which is especially meaningful somehow. I stimmed over Father's Day and this was our last chance with Bryce's genetic material. While it all somehow, bizarrely, gave me hope during the cycle, it all MEANT NOTHING.

Monday, the first day of school with no classes, a strange time with no time constraints and sweaty buildings where you try to wrap up and clean up and file and decide what materials you're bringing home, I went to the bathroom and discovered spotting on my necessary-due-to-Crinone pantyliner. I was ECSTATIC. Cautiously at first, and then I thought... The only times I've had spotting on or around this cycle day are when I've been pregnant. It's true. For whatever reason, even with the freakshow ectopic pregnancy, I had implantation bleeding. And here I was, right around that time, spotting just like I had those (somewhat) magical times. I tried to temper my excitement, but I couldn't. I got a little giddy. I started imagining how many were staying put in there, hoping for two but trying not to be greedy and feeling like more likely there was one, there's only ever been one, and how amazing that would be. I started thinking about how the due date for this pregnancy would be in March, right around my husband's birthday. I got wayyyy ahead of myself.

Because Tuesday, Tuesday came and I was still spotting. Which was NOT like the implantation bleeding I'd had before. But none of those pregnancies were normal and healthy, so I thought maybe healthy pregnancies have more blood--they burrow more robustly; snuggle in deeper. I was shaken though. My giddiness turned into butterflies of another, more sinister sort. I started thinking about the weekend, when I thought the Benad.ryl had turned against me and I had a hard time functioning, and I had a migraine from Friday through Sunday night. I could attribute it to the Ben.adryl, or to weather patterns and barometric pressure gradients, but secretly I was terrified that it was a sign my hormones were all fucked up. In addition to odd medications and air pressure changes, my migraines are caused by hormonal shifts. Notably when my estrogen plummets. So much so that once upon a time before I went gluten free and my migraines actually got better (I used to suffer weeks out of every month instead of days) I was put on a birth control pill that had estrogen during some of the placebo days, because it helped my migraines. I was suspicious, and I hadn't called the doctor because I thought it was the allergy pills. And now it was probably too late to do anything about it, if that was the case. (I can make absolutely anything about any cycle my fault somehow. I know, logically, that nothing I did or did not do made a difference in this cycle, but it felt like I missed a clue and could have saved things. Which is patently ridiculous, but I can't help myself.)

The worst though was Wednesday. I hadn't called the doctor Tuesday because it was still spotting and that, especially with the Crinone, wasn't immediately HORRIBLE news. I know people who spotted through the Crinone and through the first trimester and have wonderful, beautiful babies now. It's just that those stories don't ever seem to come true for me. Wednesday I got up and was greeted not with spotting but with bleeding. Light bleeding, but there had been a shift and now there was definitely something amiss that I couldn't attribute to anything remotely positive and so I freaked out. I showered, gross bits of blood-tinged Crinone going down the drain, and sobbed. I dosed myself with my morning Crinone and laid down on the couch with a pillow under my butt. Maybe the Crinone wasn't going where it needed to. Maybe I sucked at Crinone. Maybe if I inverted myself the bleeding would stop. I texted my doctor and begged for an answer to this that was positive, that I was needlessly panicking, that there were a zillion stories like this that ended in healthy babies. I also begged for the reassurance of bloodwork. Estrogen and progesterone, to see if really there was an issue (not that that could be fixed at this point), but honestly I wanted to know that the bleeding was that good kind, the kind that scares you unnecessarily but ends in a healthy albeit neurotic pregnancy.

My doctor thankfully did not think I was nuts for texting at 7:15 am, and set up bloodwork for me, but included an HCG with the caveat to "not freak out." So I thought it was something that if it was positive, hurrah, but if it was negative, not necessarily a death knell for those precious three Bryce embryos hanging on for dear life inside me. I contacted a friend at school and let her know I had to go get bloodwork but I could come in briefly and get some of my stuff before making sure I was home by 12:30 to receive the results call. I was missing the end of year breakfast and I had pounds of pineapple in a bowl in my fridge that I was supposed to bring. I felt guilty, and I wanted closure on this year. I wanted the last day of school to really be the last day of school. But, I was emphatically told to stay home, take care of yourself, don't come in, she would talk to the principal, I'd be better off not going in and being asked if I was OK over and over again since about a zillion people know and teaching in a middle school can kind of be like BEING in middle school all over again. (Lucky me middle school was the absolute armpit of my life and I was subject to a lot of cruelty, and so middle school adult antics are NOTHING.) So I stayed home.

I received encouraging texts from my doctor, who was also hoping for a positive HCG and a reassurance that all was fine and we were on our way to being done with this godforsaken process. I took a nap, as I'd already taken my first dose of Benadr.yl and the siren song of the couch is too much for me under the pink pill influence. I read my book, a sad sap book about two teenage girls who lose their parents in a tragic small craft plane accident in the Grand Canyon and then are separated by coasts due to their parents' will and the fact that they are half sisters so the oldest has a biological father she can live with. Their lives take dramatically different turns. I love books where I can feel like "ok, it could be worse, I may not be pregnant but I wasn't orphaned at 13."

True to his word, since now I know they receive bloodwork results from the labs by 12:30 and typically make their calls between 1:00 and 2:00, and my doctor said that they would call me ASAP, I got my call by 12:45ish. The nurse, the funny-but-rough-around-the-edges nurse from retrieval, asked if I could talk. She said, "I'm sorry, it was negative." It didn't register, because I was like, "Yeah, but it's early, so SO WHAT? What was my estrogen? What was my progesterone?" Very awkward silence when I asked about the other levels instead. She said they were both low, but that they haven't found that estrogen levels matter a whit with early pregnancy -- they have had pregnant women with low and high levels and it hasn't indicated much. Progesterone was on the low side, but with Crinone it doesn't enter the bloodstream the same way as PIO so that wasn't so concerning either. But, she repeated, the HCG was negative. "So, um, what does that mean exactly at this point?" I asked, because silly silly me was still hopeful this meant nothing at this point because my test was supposed to be MONDAY and it was WEDNESDAY and shouldn't there be plenty of time for a late bloomer to make itself known? I mean, twins were out of the question now, but one little late bloomer? Especially because we had morulas at transfer and not blasts, so maybe the timeline is off a day? Silence again, then "Well, it means you're not pregnant." I now verbally vomited my late bloomer theory and my (wrong) assumption that the HCG wasn't necessarily supposed to be positive, that it was just another data point, and I must have sounded so desperate that after a little pause she said she'd go talk to the doctor and could I hold, she would check on this line of reasoning. This ridiculously Pollyanna, I believe in rainbows and unicornpuppies line of thinking that I am ALWAYS capable of and is NEVER actually true. I don't know whether to be proud of my ability and capacity to hope in the face of certain disappointment or whether someone should just slap me a la Cher in Moonstruck and yell, "Snap out of it!"

I waited while some song on the hold music ironically had some kind of breakup lyrics that had the line "baby you're gone" or something like it in it and I was thinking, hmmmm. This is not good. The nurse came back on the line and said, "Dr. Fabulous checked the dates and the HCG level is pretty definitive that you are not pregnant... at this point in the cycle there should at least be a low positive. I'm so sorry." At this point in things I am determined NOT TO CRY on the phone. It must suck so bad to make those awful phone calls. I feel very sorry for the nurses who get to give both the best news in the world and the most depressing news in the world, and for someone like me where everyone is always pulling for our misery to finally be over it always seems to have an extra layer of sympathy and sadness, and I don't want to make it worse by bawling. I did that in the beginning, and it made them feel worse and it made me feel worse so I just bottle it temporarily until I get off the phone. Because really, the primary reaction I get is just numb at first right now.

There was conversation to get through first, though. I did have the option of waiting, continuing the Crinone a few more days and then retesting either Saturday or Monday to make sure it was truly negative. But if I got a full flow period during those days, it was all over and I'd discontinue meds and call them with my Day One so that I could get started on our FET with the DS embryos. JUST KEEP SWIMMING JUST KEEP SWIMMING. I couldn't decide what I wanted to do, and I felt like maybe continuing was just awful torture but what if there was some kind of late bloomer and I denied it a shot? The nurse left me with the thought that I did not have to decide right now, I could call back later after I'd processed everything.

I fell spectacularly apart after I got off the phone. I called Bryce and told him, and I felt just SO AWFUL. It was a double loss, because here were three beautiful embryos that we were hoping would stay, but it was also our last shot with Bryce's genetic material. So we got to mourn both the loss of the cycle and loss of his DNA all at once. He came home from work for a couple of hours and we just held each other and cried. And decided that I would continue the Crinone for a few more days, what the hell, and then test Saturday. But then I went to the bathroom. And it was unmistakable. The decision was made for us, I had a full-flow, vicious period (all that lovely 11.5mm lining had to go somewhere), and it was definitively, inescapably over. I sobbed in the bathroom. I cried and cried and cried, because even though in a weird way it was a blessing to have that closure and not hold on to hope any longer, the fact that it was OVER over and in my face just broke my heart. There was zero hope. We needed to shift gears after mourning this loss, and somehow find energy to put into the FET.

But first, Steel Magnolias. Because I hadn't cried enough, and pithy southern women make me happy. [If you live under a rock and have never seen this wonderful movie, be warned of spoilers, but really if you watch the trailer you know that there is tragedy to be had and nothing I say in this paragraph will actually spoil the movie for you.] Bryce went back to work and I watched a movie I haven't seen in years but always makes me laugh and cry, cry, cry. That Sally Field is fantastic. Her "I'm fine" monologue in the cemetery is just pure genius. The rawness of her loss and the unfairness was a perfect representation of how I felt in that moment. I mean, I hadn't lost my daughter to diabetes because she just wanted a baby more than anything and she felt that "I'd rather have twenty minutes of wonderful than a lifetime of nothing special," I hadn't known from the moment she got married that she'd make this horrible decision that would bring her joy in the short run but end her life prematurely and been powerless to do anything about it, but I felt her feeling of powerlessness in the face of loss. That as much as you try to control how things turn out, you just can't. I sobbed and sobbed as she screamed that she didn't understand why things had turned out this way, that it made no sense.

And now today, today my eyelids are no longer so swollen I look like a frog, and I no longer feel like crying constantly, and I will watch something funny to balance out the sadsapness of yesterday, and I will do laundry and go for a walk and start thinking about how to prepare for the FET. Or how not to prepare. I do not regret doing all the things I did for this cycle, but I think I might take a bit more relaxed stance on the FET. That's for my next post, because already this FET looks to be very different. Onward we go.

I'm sorry there's not good news. I'm sorry the promise of this cycle turned out to be just like the others, that I now have twenty-three embryos that have come and gone through what feels like a toxic wasteland of a uterus that is really just a place that embryos go to die. There is nothing concrete to substantiate this, but I feel like my body killed Bryce's embryos and no matter how illogical this is and how hard on myself that is, I can't shake the feeling that my body sucked this time. It could be the chromosomal abnormalities we suspect exist in the sperm, that you can't tell by just looking at the embryos. It could be the same thing that's happened to most of our embryos and that when we use the other embryos that are DS, it will all come together. But I am scared. I am scared that my body is also a problem and I will kill the DS embryos too and THEN where will we be? I am scared that we will get to the end of our year of treatment that we agreed to and still have nothing. I am scared that pregnancy will never happen for us, that we will be among the elite group for whom IVF in whatever iteration JUST DOESN'T WORK. And we will never have an answer. I will live my life never knowing why my body couldn't hold a baby. Or, maybe the DS embryos will end this all for us. We just don't know. We just have to keep on swimming through this muck, through this difficult, exhausting process, until we reach our point where we have resolution, whatever that looks like. I will restore my hope and capacity to believe in miracles and we will do everything we can to make this dream, this seemingly impossible dream, of being pregnant with our baby and being present for the whole entirety of his/her/their existence, from the very beginning. It's not impossible. It just keeps feeling more and more improbable.

Thank you for your support through each of these cycles that unfortunately end in the same place of loss and disbelief every single time, just some a little later than others. It means so much to me to not be alone, to know that so many of you know how this feels. And some hold hope for me that despite a long, long road of loss, there can be a happy ending after the bend. I just can't see it yet, but it's there, waiting for me. For us.

Saturday, June 21, 2014

Transfer Day

Ahhh, one part of the wait is over and the bigger, scarier wait is upon us. I am fully loaded up. My uterus has embryos in it. And those embryos are beautiful Bryce babies!

After I wrote my post about waiting to wait, we did actually get a Day Three update in the evening. Which made me feel better, because the thought of not receiving any news on our growing potential progeny until transfer day was making me twitchy. I was going to go with the flow, but the flow was definitely not in my comfort zone.

Our day three update: THREE of Bryce's four fertilized eggs were "amazing" 8-celled embryos! THREE! 75% kept on keeping on! Amazing. We also had "a good number" of 8-celled embryos from the donor (no specific number, but seeing as how we had nearly 3x the donor embryos to start, we weren't worried). Then no more updates until Transfer Day so the little guys and gals could rest undisturbed and do what they needed to do in the optimal conditions.

We were amazed at the progress of Bryce's embryos. We honestly weren't expecting such a robust response--we were hoping for one, best case scenario two. The wait wasn't over, there was still time for the dastardly attrition to kick in that always does for us, but so far, so good. Starting with only four fertilized eggs with Bryce's DNA felt like a scary low number, but a bit less so after our good news. (Not gonna lie, caused a little WTF feeling too, like, "is it really the sperm if we have so many out of so few?" BUT, blast development is only the second of four hurdles for sperm so we couldn't get too ahead of ourselves.)

On transfer day itself, we were driving to Buffalo (well, Bryce was driving to Buffalo, because I had to take my Valium for cervix/uterus relaxation and maybe a little Jess relaxation) and we got the call, right as we were at the BUFFALO: An All-American City sign on the thruway.

THREE. We had THREE Bryce embryos still, two days later. They weren't quite blasts yet--they were morulas. But beautiful morulas (look at my last post for the chart on embryo development... morulas are what they're supposed to look like on Day 4). No degeneration, no fragmentation, just a little poky. But, some were already entering the transition phase to blast. Well color me ecstatic, because the fact that THREE made it to Day Five was SPECTACULAR! So what if they were a bit behind? I teach special ed, I know that not everyone develops at the same rate but it doesn't mean you're any less brilliant! I loved them already. We also had SIX embryos from the donor--some early blasts, some also transitioning morulas, but not obviously different from Bryce's so far. And, actually, when you think about it, Bryce had a 75% rate while the donor had a 55% rate of embryo development. GO TEAM BRYCE! Interestingly, the ones that were furthest ahead were the ones that had been fertilized in the dish (the IMMATURE eggs, I might add, that would have been discarded at another clinic...blows my mind). The ICSI ones were further behind. Something to say for that whole Darwin aspect of the fight for the right to fertilize...

Now we had a choice. How many?

This is where I feel a tiny bit like a hypocrite. When we were doing donor egg and I was researching like mad to make sure that we did the best things for the best outcomes, so much came up about Single Embryo Transfer. SET is predominant in countries with insurance coverage for IVF, SET sets you up for a healthier pregnancy and less chance of the NICU, SET allows that one embryo a primo chance for implantation without any others in the mother ship. Except... SET might have been good for our first fresh donor egg cycle, but for a cycle with our own eggs and stuff? Apparently not recommended. Given that this is our 9th transfer (ugh I hate putting that in writing), and we have serious implantation issues, and I'm 38 now, it's just not our best option.

However, we had TWO options on transfer day. Transfer two and hope the third freezes, or transfer all three. Transferring all three sounded crazypants, but our doctor explained that there were several compelling reasons to do it. 1) embryos weren't on-time blasts, they were a step behind; 2) three is still within the ASRM ethical guidelines for transferring to someone like me who is like the Death Star for embryos; 3) given our history and our previous transferring of three thawed frozen blasts, I've only ever gotten pregnant with a singleton that miscarried; 4) we might not get to freeze that last Bryce embryo if we didn't choose to transfer it. BUT, on the other side, 1) I love all my embryos but the idea of triplets makes me full on convulsive, not twitchy; 2) even a twin pregnancy holds higher risks to babies and mama, and a trip to the NICU becomes much, much more likely; 3) triplets or more (splitting is not off the table) hold the risk of the selective reduction conversation, a conversation I desperately do not wish to have ever ever ever, even though 3 or more babies can mean serious risks and life threatening situations for everyone involved.

Argh. I'm not gonna lie to you -- I wanted to do all three. And not necessarily for the most logical reasons. I AM SO FREAKING TIRED. I also wanted to give Bryce's embryos the best chance possible of doing the trick. And, at this point, twins (while scary) sound pretty appealing. To be done in one shot selfishly makes me feel less icky about the risks. PLUS I know people who have transferred well over three and had twins. And I know people who have had triplets and everyone was healthy. I know this is the exception, not the rule. I also rationalized that I suck at getting pregnant and the idea that all of them would suddenly implant was laughable. We simply don't have the history for that. BUT, Bryce was terrified at the prospect of three. The prospect of risks to my health and the health of our babies. The fact that my lining has been pretty darn impressive this cycle was a worry to him, because what if that means I'm suddenly way more receptive than I've ever been? What if they all take because this cycle is so awesome? THEN WHAT?

We talked it over with our doctor, both on the way and in person once we got there. And the upshot was, three was our best chance. We upped our chances of getting pregnant with twins pretty significantly, and triplets are a possibility but a very, very small one. I didn't want to leave any Bryce embryos behind. I felt confident enough that we weren't sure if they would all make it to blast that transferring three felt less crazy. And so... The Three Babyteers are hanging out in my uterus right this very minute.

Sometimes I freak out when I think, OMG, we put THREE babylings in me. What the hell were we thinking? And then I think, you know what? What will be will be. These are embryos 21, 22, and 23 to enter the (I hope previous) wasteland of my womb. I welcome you all, but with my track history, it will be something else if you all make it to the finish line. So we are nervous, of course, but feel mostly that we have made the right decision.

Looking over this incredibly scary loading of three babylings into my relaxed uterus was my beautiful Buddha statue that Bryce gave to me for Christmas after our miscarriage. It was supposed to go in the Secret Garden, but then we didn't want anything to happen to it so we kept it on the baker's rack in the dining
room, where we can see it all the time. The Buddha is in the form of a little boy, holding an open book in his lotus lap. In the center of that open book is a rose quartz heart that a fertility friend sent me for good luck, because rose quartz has healing properties supposedly and is good for fertility. I put the heart facing out, pointing at me on the ultrasound table and Bryce holding my hand. There was something beautiful about the symbol of our lost baby looking over a new beginning. I didn't cry this time, fearful that we were sending our embryos to sudden death. I felt peaceful. We watched the flash that indicated that the babylings were home, and then it was over.

Interestingly enough, I did not rest long on the table. My doctor said that there have been recent studies that show that the 20-30 minute rest on the table is not necessary, that in samples where women rested and where women got right up and walked out, the walking women got pregnant more often. Very interesting. So I compromised and laid there for 5 minutes or so, then got up and tried not to freak out about it. We left with our Buddha in my arms (I really did not care at all if people thought I looked weird; YOU try doing this 8 previous times and see what crazy stuff you're willing to entertain!) and had a healthy (but ridiculously expensive) lunch at an organic cafe down the street, and then I went home to rest on the couch. Again, not to lie down for days, but to rest upright on the couch and then take it easy the next day. I went to school on the third, and so I was on my feet (but not doing anything crazy). IT MADE ME SO NERVOUS, at first. But really -- do the fertiles lie down for days after they boogie between the sheets? I know the stakes are higher for us, but does it really make a difference? I guess we'll find out.

Our ninth transfer, done. I feel pretty calm and peaceful, not the tight mess I usually am. I am determined not to examine every little twinge for signs this time. Last time I swore I was pregnant, and I wasn't. I give up. I am not a pregnancy divining rod wielder. I have no clue. So I surrender. I surrender myself to this process, I surrender myself to my embryos, I surrender myself to my lining, I surrender myself to the mystery. What's going to happen will happen. And, according to a timeline I once saw on Operation Baby Gage's blog (at the bottom), if it's going to happen, it's already begun and I can't stop or start it. I can only hope that this is the end, the ninth's time's the charm, that our last shot with Bryce's material is the jackpot. (Incidentally, we froze FOUR donor blasts, so maybe part of my Zen is that we have insurance in the freezer.) It's so hard to truly, truly let go. But I'm going to try, even though that's kind of an oxymoron. With letting go there is no try, only do. Thanks, Yoda. I'm going to be really good to myself over these next long days of wait, longer than usual because the clinic does 17 days from retrieval for the first beta. SEVENTEEN DAYS! Torture, but then the results are indisputable. No wiggle room. No doubt. I can do this. We can do this.

Thank you for all of the waiting with me -- it helps make the wait feel less lonely. There's strength in numbers. Please hold me, and Bryce, and our Three Babyteers in your hearts during this time... we can use all the positive energy we can get to stay calm, stay centered, and hopefully stay pregnant, not just Pregnant Until Proven Otherwise.

Monday, June 16, 2014

Waiting to Wait; A Bizarre Protocol Addition

Ok, little embryos... you've been hanging out in that dark, special-medium soup for three days now. If we were doing a three-day transfer you'd already be in my uterus, and I'd be that once-wonderful, now-terrifying Pregnant Until Proven Otherwise state.

But, we're holding out for blasts, so you're still in the dark.

And so are we.

It's like a practice run on the two-week-wait--will I be able to keep sane and busy and not drive myself crazy? Because right now, I have not received word on our little embryos since Saturday, when we got our fertilization report. As of then, 15 fertilized eggs were starting to divide and work their magic, 4 of Bryce's and 11 of the donor's. Are there still 15 in there? I doubt it. How many are left, still dividing and making their way from 8-celled to morula? For reference, here is a cool chart I lifted from I hope I cited it ok, because it is really awesome and if I drew it myself it would be a hot, hot mess.

Stages of embryonic development

Previously, we have done all of our fresh transfers at the other clinic at the 3-day point, when most of them were 8 celled (but we occasionally had a 6 or 7 celled embryo in the mix as well). Then the rest were left to keep dividing to the 5-day mark and frozen at the 6-day mark. When we did our DE cycle, we actually had fresh blastocysts, which was novel! Then we had three to freeze at the 6-day mark, but only one looked good upon thaw. 

Newer research shows that blastocyst transfers are the best way to go. We heard it over and over from our second opinions and all the internet research I did for other clinics that are well-known. On the flip side, I know people who transferred one lonely 2-day embryo for fear it wouldn't make it to Day Three and that embryo is now a toddler. So, it doesn't mean that earlier transfers are a waste of time. However, overwhelmingly, the research shows that making it to blast is a chromosomal hurdle. If an embryo can make it to blast, it has more going for it in terms of normality and possibility of implanting. CCRM actually said that they don't consider embryos who don't make it to blast as likely to do anything, so they only do blast transfers. Success rates are apparently higher with blast transfers, too. 

Here's the downside though -- you lose a fair number of embryos when you wait for blasts. You can start out with 15, and end up with 2-4. We are hoping for a 40-60% blast production, which would leave us with up to 10, but somehow I think that's hoping for too much. I would be ecstatic with 6, because that would give us two FETs after our fresh transfer. But it could very well be less. 

The biggest fear is that we don't end up with anything from the Bryce Batch. We're only starting out with 4, and historically speaking we have quite the attrition rate with our own materials. While I'm feeling great that a full 75% of my eggs fertilized (GO EGGS!), I feel guilty because we don't have a whole lot of faith left in our sperm. After 5 fresh transfers using our own sperm, the attrition rate plummets and we don't know if a new lab will make up for whatever it is that's going on. The last SA that we have showed higher numbers than ever, which is fantastic! Except our morphology was <1% normal. Which is not fantastic. I am not a morphology expert, so if you are and can explain this better please leave a detailed comment below, but I'm pretty sure the wonky-shaped sperm have a higher rate of being chromosomally abnormal. But, I'm not sure if they can even fertilize, so maybe our Fantastic Four are in the clear on that score. I could look up all our old numbers, either in my trusty notebook or my old blogs, but I am refusing to do that. What possible good could it do to know our historical rates of crappiness, when we have so many changed variables? I am really attempting to be more in the present with this cycle. 

And so I am sitting on my hands and refusing to call the clinic to find out what's up with our little dividing babylings. When I spoke to the doctor who did the retrieval on Saturday, he said that they really don't like to look at them hardly at all because it can disrupt things. So no news is good news. We may not get any updates until Wednesday morning, the morning of transfer, which is REALLY HARD TO WRAP MY HEAD AROUND. I am used to getting an update on a more regular basis, but maybe all that peeking meant my embryos weren't as robust as they should have been. I am going to let it lie. Even though that is REALLY HARD. I want to know. But, what good has knowing done in the past? Still no baby... so maybe embracing the not knowing is to embrace the mystery of this whole process. Even with everything we do know about how to help babies come to be, there is still so much we don't know and may never know about the mysteries of implantation. So we wait. Until we have the REAL wait. 

And that REAL wait is a bit longer here. They don't count from retrieval. They count from transfer. And it's a longer number than I'm used to. So I will be waiting a really, really, really long time for my beta. Like, a how-can-I-resist-peeing-on-that-stick-I-have-hidden-in-the-back-of-the-bathroom-cabinet long time. I am going to need some strategies. Plus school is out after next Thursday, and so I won't have as much to keep me busy. Maybe I can just sleep through the what feels like THREE weeks of waiting. Maybe they can put me in a little coma so I can wake up and find out if I'm pregnant or not. I dreamed I was last night, and while that's encouraging by a smidgen, it's just a dream. That I hope becomes reality, but it was a lovely dream while it lasted. 

The last piece to today's post is my new addition to my protocol. Speaking of being in a coma throughout my wait, I am apparently to take 25 mg of Bena.dryl THREE TIMES A DAY starting tomorrow. Apparently, this is a protocol that came out of Colorado and then was swiped by a New Jersey clinic and now has been appropriated by my doctor to try on me. The thought is that with patients with recurrent implantation failure (me, me, me), maybe there is an inflammatory response that can be mitigated with the antihistimine. And in the cases where they've done the weird allergy med treatment, there have been increased pregnancy success rates. Very strange, not gonna lie. BUT, it kind of makes sense. I am ridiculously allergic when it comes to my skin. I have broken out into hives that covered my entire body with just the wrong detergent. When my cat's claws get me, no matter how superficial, I get this raised bubble around the scratch. I am allergic to Bryce's beard. That's right, as awkward as it is to imagine how this might come to pass, when his beard touches my skin I break out immediately into big, puffy, angry hives. Sometimes I get hives and I have no idea what I've touched. Air? Could I be allergic to air? My first acupuncturist said I had "very high histimines," so I guess that makes sense. Plus, not to overshare or anything, but I have that really gross Geographic Tongue thing. Go look it up, it's not horribly gross but not the most beautiful thing in the world either. I find that when my body is under stress, my tongue acts up and gets all uneven and sensitive. The "raw" patches FEEL raw and like I've eaten about 5 atomic sourballs in a row. I can't tolerate acidic foods like orange juice. When I stim and I'm on all the fertility meds, my tongue acts up. When I'm sick, my tongue acts up. When I'm stressed, my tongue acts up. I've always wondered but have been unable to find any correlation between my tongue and allergy or autoimmune responses. Because, I've got that whole Celiac thing, too. Inflammatory is my middle name. So yeah, sure--pump me up with Bena.dryl until 6.5 weeks of pregnancy, why not? If it gets me pregnant, I will be thrilled. 

And conversely, if it's the BENAD.RYL THAT GETS ME PREGNANT, I may shit myself. That would be so crazy that one of the fixes could be an over the counter drug that helps Bryce to get to sleep on insomniac nights. 

And it makes me nervous. Will I be Sleeping Beauty for these couple of weeks? How am I going to DRIVE? It doesn't affect me as hardcore as it does Bryce, but I do still get sleepy. Will I get used to it? I have to start the regimen tomorrow, and tomorrow is my first day back to school AND a marathon day -- full day of school plus the 8th grade awards ceremony from 7:30 to as late as 9. I AM IN TROUBLE. I figure I can take my first dose after I get to school, so I don't have to worry about sleepy morning driving. Then though I'm screwed for the afternoon. Tomorrow I'm crashing at a friend's house between school and ceremony, but what will I do Friday? Or all the days next week when I have to be in school, cleaning up/ closing up shop/ prepping for next year??? SO CRAZY. I will let you know how it goes. Hopefully I don't end up the narcoleptic teacher who gets drawn on with sharpies the last day of school. 

Wish me peace to make it through these days with my sanity intact. Wish me the serenity to NOT bomb the phone lines of my clinic with calls begging for info on our miniature progeny's progress. Wish me the ability to stay awake while I'm bombarded with massive amounts of benad.ryl. I'm going to try my best, but in the meantime, I'm going to nap. Because it makes the waiting time less.

Saturday, June 14, 2014

Hello, Retrieval!

How interesting to experience retrieval again, after two years of hiatus, and at a different clinic. I have the utmost respect for you ladies that travel significantly for your treatment--we drive an hour and fifteen minutes now, but that adds such an additional layer of complexity that I really wasn't expecting. What's an extra hour? No big deal... we originally thought, because it didn't seem like it was. But then add in that for each ultrasound we were saying adios to three hours plus of our days, where it used to be maybe 45 minutes or so, and that adds up. Especially since Bryce can't make it to all of them with me anymore.

But, our last ultrasound was Tuesday! I was almost ready, and instead of having me come back Wednesday, they just had me continue my regular dialed-down dose Tuesday night (100 follistim, the smidgen of low dose HCG, and my last Ganarelix) and then triggered me Wednesday night with Ovidrel, then a last-hurrah boost of 300 follistim to really pump me up. I have to say I'm proud of myself for not being so obsessive for this cycle. I did not frantically write down all my follicle sizes, I just wrote an approximate number and the range of sizes. As of Tuesday I had 24 or so, mostly at the 17-22 range but with the majority still 17-19. That ovidrel that's so carefully timed for retrieval (when they say take it at 7:00, they mean TAKE IT AT SEVEN O'CLOCK OR ELSE) also does some of that final "ripening" -- so needless to say on Thursday I was one stuffed chicken. I continued the taking it easy, although I added in the whole "getting school work done" so that if I felt crappy all weekend I didn't have to worry about it for Monday and Tuesday, when hopefully I can be in school.

[NOTE: I am going to share some specifics of our cycle here. If you are friends or family in my non-virtual world, please pretend you didn't see this. It is so hard to both want to share updates semi-anonymously and also have family and friends who read this thing. Understandably, it puts a lot of pressure on us when everyone knows when everything is going down. Soooo... pretend you know nothing and don't ask for news that I don't offer please -- when we are ready to offer up news publicly, we totally, totally will.]

Because our clinic is an hour and fifteen minutes away, on a thruway that seems to have a glut of freshly dead deer on the sides of the road, I did not want to take any chances. We booked a hotel 5 minutes away and decided to make a bit of a getaway out of the experience, given that our retrieval arrival time was 7:30 and I did NOT want to be a) leaving the house at 5:45 to account for deer/accidents/weather or b) awake for an hour or so before retrieval, since no food and no drink makes Jess a cranky cranky hangry girl... So, I packed up our things and Bryce left work a bit early and we went out for a nice dinner despite my feeling like a complete and total salmon chock full of roe and ready to burst. A girl deserves a delicious meal out before having a needle pierce her vaginal wall and retrieve a zillion eggs from swollen, fluid-filled follicles, right? We chose not to eat in Buffalo, because with Celiac it can be tough to find a place that is truly good about being gluten free and I wanted delicious AND to not be miserable on the toilet, worried that I was going to burst my eggs with my gastrointestinal fury. So we went to a place called Simply Crepes, that has buckwheat crepes and my ultimate favorite deliciousness, the Reuben Crepe (GOD I loved reubens, and it was so sad when I thought I might never have one again). And maybe a Nutella-and-sauteed-banana crepe for dessert. Because I needed to be full so I didn't feel awful the next morning, right?

The drive was uneventful, and we talked about our whole debacle with the sperm donor split. Originally we thought 50/50, but then we switched to 50/50 up until 10 eggs each, and then anything over 10 went to the donor. Plus, any immature eggs that they could mature in vivo (craziness) would go to the donor, because they'd mix the eggs in the dish with solution and about 25,000 free floating sperm doing a whole Darwin thing, and the donor was much better option for that. We talked it through with our doctor on the phone, especially since he was away for the weekend and wasn't going to be there for the retrieval. Initially something that caused me a bit of nervousness, but we were happy with the other doctor who'd be doing the procedure and ours was heavily involved via phone and our lovely doctor will DEFINITELY be doing the transfer. So we felt good. The drive was uneventful, minus a heavy downpour/thunderstorm about 2/3 of the way there.

The hotel was beautiful-- brand new, cozy, with a refrigerator for my 10:30 pm snack so I again hopefully could avoid being too hangry the next morning:
Snuggle chair!

Fancy schmancy King bed, look at those gooseneck reading lights!
We got settled in with our books and magazines and (gasp!) cable TV, a novelty for us as we don't have it at home. Bryce immediately found some North Country Game Warden reality TV show about game wardens in Maine, which was highly entertaining to him because it a) sounded and looked like home and b) they were walking around with radio he makes. I was bummed because I forgot the adorable critters memory game that I like to play when we go to camp or I'm laid up. Oh well. I have to say, staying in the hotel was a really great move. It lowered the stress quotient by quite a bit and made it feel like we were going on an adventure, because let's face it, we were totally embarking on a new adventure. A new old adventure. Hopefully with a happy ending this time. 

We took some pictures of us in the room for posterity--one nice, and one with Bryce being a complete weirdo that I can't help but share: 

Lovebirds and hopeful parents-to-be on Retrieval Eve
Oh how I love you, goofy, goofy Bryce.

I had straightened my hair earlier in the day, because I find it so much easier to blow it out before procedures. If I'm going to be in bed for days, and I'm going to need to get going quickly in the morning, blowing it out is so much easier than ending up like Roseanne Rosannadanna. Also, before retrievals, transfers, and even just ultrasounds I feel the need to take The Boyfriend Shower. A term coined by a girl I lived with my senior year in college, whose boyfriend went somewhere else and when he arrived for visits she liked to be all done up. The Boyfriend Shower involves lots of shaving, and moisturizing, and generally making yourself super presentable in the nether area. I know that docs don't care, but I feel better if it's not like a 70s jungle down there and my legs are shaved, because if someone's got to be down there with a searchlight for 20 minutes, I can at least make it so that I don't feel self-conscious and maybe that's appreciated. Such an awkward situation, so so so awkward, but The Boyfriend Shower makes me feel a little better about being on display. Ugh. 

The morning of retrieval I got up to shower and felt SO RESTED. The bed was on the firmer side, which is apparently my body's friend. Best night of sleep in a long time. Sadly, Bryce needs a soft and cushy bed, and so he was miserable. Which sucked because he was obviously the one driving home. We decided to leave our stuff in the hotel since checkout was noon (!) and we could maybe rest a bit before getting on the road home. 

At the clinic, they moved FAST! I am used to an hour before retrieval or so of preparation, and they were done in 30 minutes. I finally got to meet the IVF nurse I talk to on the phone so much, and I LOVE HER. She was kind and funny and a little rough, which is how I enjoy people best! She did a killer IV insertion, too--my veins suck and I am always nervous that after not drinking beforehand it's going to take a while. Probably because I have had experiences where it took THREE TRIES to get the IV in pre-retrieval, once involving needing to redo it while I was on the table receiving anesthesia and it was leaking out all over my hand. NOT PLEASANT. So, the nurse was awesome and got it on the first try, very little pain, super secure, and awesome. The anesthesiologist came in briefly and asked me a few questions, mostly about my asthma, and then POOF! I was being instructed to empty my bladder and walk through the door to the procedure room. Kiss Bryce goodbye for now and off I went. 

Here's where the differences really showed. When I came out of anesthesia, I was almost completely lucid. Which was weird, because usually I'm loopy for quite some time. It's twilight sedation and not the heavier general, but still -- I think at my previous clinic they put pain meds right in the IV at the end, and I don't think that happened here. I was in A LOT of pain. The most I've ever had after a retrieval, if memory serves. I mean, I'm two years older than I was the last time and I think that maybe my body is not-so-subtly trying to tell me that I'm no spring chicken anymore, but it was REALLY painful. More on my right side than my left. A lot of writhing and crying. I wished for that demerol that I got post-hysteroscopy in my IV, because THAT was amazing stuff. The percoset didn't even help that much, which was really sad. It also hurt to pee, so my final bladder emptying was like a torture exercise. Not the actual peeing, but the moments before the urine is released. I don't know if it was irritating my already swollen and angry ovaries or what, but OW. The nice thing though was that they actually had gluten free snacks for after! GF pretzels and a GF rice crispy treat. A FIRST for me! I had brought crackers just in case but how thoughtful to think of the poor food allergy people. I wolfed them both down.

The doctor came in and gave us our egg numbers -- 20 retrieved! Not our best retrieval, but not our worst either, and 20 is a BEAUTIFUL number! Then he said only 12 were mature. Yikes. That meant 6 for Bryce and 6 for the donor, and then the attempt to fertilize the immature ones in vivo at a typical rate of 30-40%. Scary. It started sinking in that we may not have any blasts to transfer from Bryce, depending on how many fertilized and how they developed. But, we were still really happy with the results, just a bit sobered at the thought that our choice may be made up for us. 

We left to go home, and I was so bloated and painful and writhy that Bryce ran up and grabbed the rest of our stuff and checked us out of the hotel so that I could get home and in bed. I hurt all the way up to my ribcage. It was a rough, rough day for pain-- I couldn't lie on my side, I couldn't lie any way but on my back, slightly elevated, with my legs curled a bit. Movement hurt. Getting up to pee hurt. Breathing hurt. I cried and moaned a lot and the percoset really just seemed to take things from a 9 to a 6. So sad. But I drifted in and out of consciousness and read my People magazine cover to cover and messed around on my phone. I woke up in the evening and my shoulder hurt, hurt a lot. Which was concerning, because two things can cause shoulder pain other than awkward sleeping positions -- gas, or internal bleeding. My seeming gas pains hurt my entire abdomen, largely on the right side, and all the way under my ribcage. I felt better if I burped, but only slightly, and I was a little concerned. Plus I was really nauseous and couldn't eat much without feeling like I was going to yark all over the place. Thankfully I didn't, but it was a very unpleasant day and evening. 
Despite the unpleasantness, I had fun with my school
library mustache bookmark. This is me, wild and crazy
on narcotics. 
This morning I felt a bit better -- I slept in 2 hour increments, getting up to pee and trying not to cry my way through it so Bryce could get some sleep. Then, at 8:30, we got our fertilization report call. 

HOLY SMOKES! GREAT news. GREAT, like the best fertilization report I think we've ever had. Here's how it laid out: 
Bryce: 4/6 fertilized (yay!)
Donor: 5/6 fertilized (yay!)
Immature: 6/8 fertilized with donor sperm (HOLY CRAP! WAYYYY over 40% best case scenario!)

So overall we have 15/20 eggs that were fertilized. A beautiful, beautiful number! Now we just hope that at least one of Bryce's makes it to blast so that we can have our last shot go all the way to the end. But 15! 15 possibilities hanging out in the lab is better than we could have hoped for. 

The doctor asked how I was feeling, and I mentioned the horrible pain and that it was mostly on the right side, plus the gas pain weirdness. He said that I had blood floating about from the retrieval, not a lot, but if I laid flat or only at a slight incline then it could have traveled to my diaphragm, which caused the shoulder and ribcage pain. He said to lie at an incline from here on out and apologized for not mentioning that yesterday. No worries, nobody ever mentioned that to me in any of my previous 4 retrievals, so that was fine. He also said that I could be feeling shitty through Wednesday's transfer, because as he put it, "You turned into quite the Easter Bunny!" As long as I can make it into school Monday and Tuesday, I'm fine. Even if I can't make it Monday I MUST make it Tuesday. (Within reason, because of course health comes first, but I figure taking it easy today and tomorrow and managing pain with meds should make things manageable for Monday). I can always go home if needed. 

There it is! My retrieval rituals, the hotel fabulousness, the incredible haul and fertilization report, and the surprising level of pain this time. I am so excited for what the next few days bring. I am hopeful. I have shifted from 80-20 terrified-excited to 60-40. At least. Two hurdles crossed -- retrieving those suckers and then having them fertilize. Now for the blast hurdle and the implantation hurdle. Bring it on, Universe. I just know that it's possible for us to have a happy ending. 

Tuesday, June 10, 2014

How We Picked Our Sperm Donor

I haven't really talked much about the donor sperm aspect of our upcoming cycle. I've been so deep in the fears of stimming again after doing DE that was apparently not entirely necessary that I've focused mostly on that, especially because of the cancelled cycle in April. (The good cancelled where I had too much of a good thing, if there can be such a concept as a good cancellation.) It's not really doing a service to the incredibly fraught decision to do a split cycle -- half my husband's sperm and half the donor that we chose. I think it's because we still have that other half and we are hanging desperately, despite 8 cycles of evidence to the contrary, to the hope that a new lab will solve our problems and we can truly have children that are genetically both of ours. We focus on Bryce's half until we have to make the decision to go with the donor, because we both believe that we need to have one more try before we make that leap. Even though the leap was partially made when we had the cryopreserved vial of sperm sent to our clinic in Buffalo. Half my retrieved eggs will be fertilized with our sperm, and half with the donor. All kept separate so we can do ours first and the donor second. This has truly been a weird and wild journey through nearly every aspect of infertility, and the switch from donor egg to donor sperm is definitely among the strangest. It is our final frontier of medical treatment. The last stop on the train to tiny people living in my belly, for a while.

When we thought we needed to use donor eggs, we went through a whole process to be matched with an egg donor. Now that we are facing a possible donor sperm cycle, we had to go through the process of choosing a cryobank and then choosing a donor. Very, very different. For us, at least, because the egg donor matching was largely out of our hands.

It went like this: Fill out a profile for myself. Note all the things about me that make me physically me -- hair color, eye color, skin tone, hair texture, height, weight, build. Then note a few things about my personality. Now, fill out what felt like a doll order form for the donor. Same information, but now make it so that it's clear where you have wiggle room. Is there a range in eye color? Hair color? skin tone? Ethnic background? What personality traits are most important? What should be starred and double starred to be clear that some things matter more than others, like proven fertility? Then, mail these scary scary documents to the clinic and wait to be sent a profile of a potential donor, chosen for you by the doctors and the donor coordination nurse out of the pool of donors that have been approved. Approve your donor and wait for a schedule, or say no thanks, please find me someone else and keep the matching process going. It was incredibly difficult. I held on to those papers for months before mailing them because it was just too scary to finalize our decisions. What if we chose wrong on one element? What truly gets passed down? A lot of heavy conversations. A lot of tears. A lot of mourning and feeling like a total failure. 

So when we had to make decisions for a sperm donor, the fact that WE GOT TO MAKE ALL THE DECISIONS was kind of novel. We had a choice of three cryobanks. We went with Cali.fornia Cry.obank because they gave A LOT of information, had great reviews, and had extensive childhood photos. 

It was very important to us that we make this decision together, but that Bryce had final say. Just because we'd had all the discussions about genetics and whether or not they were all that important when it was my material that was being swapped out for donor didn't mean that we were done having these discussions when it came to his material. It's different for men. For women, assuming you are doing the carrying, you get to experience pregnancy. You get to have influence through epigenetics -- your blood transfer actually impacts the genes of the growing baby. A man has one contribution, from the physical aspect. It was (and is) pretty devastating. However, we do this because the experience of pregnancy as a couple is important to us. The prenatal environment, the preparation, the nesting, the birth story -- we want all that. I probably want it a bit more, but we are agreed that if we can be pregnant, we'd like to explore every avenue for that to happen. (Although at this point we are too exhausted to attempt donor egg/donor sperm. No more funds for that; we need to save our funds for pursuing infant adoption if the donor option we've chosen is a bust, because we will be parents. We will.) While donor sperm is a difficult pill to swallow, it could be our best option. Of course we hope that the first cycle with all our material works first, but even with that on the table we have to be ready to use the donor sperm embryos. It took a long time for Bryce to come to grips with this decision, truly. I worried, a lot, because we weren't on the same page. There were a lot of emotions to work through -- the sense of having failed was tremendous, especially since this was all happening on the cusp of Bryce's 40th birthday. It was a lot to take in and a lot to acclimate to, even after the decision had been made (I could relate, because I also went through a period after we'd made the decision to do egg donor where I knew the decision was made, but I felt just awful about it and mourned. A lot.) But before we could choose a donor, we needed to be 100% okay with this option and ready to start looking at our choices with open minds and hearts. 

One exercise that we did before going to the overwhelming sea of online profiles was to treat it a little like the egg donor process. Bryce and I sat down with a notebook each and wrote down all the things that we wanted our donor to have. All the things that could be passed on by the sperm physically, and then some personality traits, because who knows? There's nature and nurture and sometimes it seems like a bit of both (although I hold tight to nurture or crapshoot for a lot of the personality components). We made our lists separately, and then shared them a few items at a time. It was kind of surprising to Bryce (but not to me) that we picked nearly identical attributes. All the things that Bryce finds most important about himself are the things that I love so dearly, so I would actually be a little worried if our lists were too disparate. We were both thrilled that we were so synchronous in our "wishlist."

I won't share it all, but we totally agreed on physical -- light-to-medium skin tone, light eyes (actual color doesn't matter because he's green-hazel and I'm gray-blue, so we could have any permutation of those), tall (6' or more), and adult hair color blonde or brown but definitely, definitely a towhead as a child. Bryce was a towhead and we've always imagined this little child with whiteblonde ringlets running around. This is where childhood photos are important--we care what the donor looked like as a kid. We couldn't care less what he looks like as an adult, because so many outside factors go into how you look as an adult--hairstyle, coloring, facial hair, build--all of that is malleable depending on lifestyle and choices, and as an adult you don't necessarily look like your parents. But we kind of hoped for a child that looked like one of us or a combo of both of us. That's the original hope, at least. Not the most important thing in the world, and even if it was both of our genetics in the mix we could end up with a surprise, like several friends of mine who sprouted adorable carrot-topped children despite not being even remotely redheaded themselves. But, if we're starting off at a bit of a disadvantage using someone else's genetic material, we could at least stack the deck to try to make the match as close as possible.

Then came the personality aspect. We both were looking for the same thing -- math/engineering/architect background, with musical/artistic/creative tendencies or hobbies. That mix of math/science and arts/music is crucial to us. Bryce is an engineer and reads math books FOR FUN (yes, you read that right, I don't personally understand it but he loooooves his complex math books that literally make me twitch), but he also is a talented guitar player who learned entirely by ear, he has a vast appreciation for all types of music, and he is quite the artist. In terms of drawing design plans for woodworking projects and also creepy little doodles that grace my birthday/anniversary cards (I had an anniversary werewolf on my envelope and it was fantastic). That balance is very, very important. Also, outdoorsiness. A sense of humor. At least a master's degree (not for the "pedigree" crap that articles on "designer genes" from sperm or egg donation tout, but because it takes perseverance and a desire to learn and continue after a passion to get a graduate degree.) Plus a few other things I choose to keep private. It's so weird to think of all these qualities hanging out in a microscopic sperm head. But, just in case, we wanted to look for those things. 

Once Bryce was ready to start actually looking, we got our subscription to the cryobank's information. That's what they call it, a subscription, like a magazine or access to online content or something. We paid for the largest subscription--because you just got SO MUCH. You got childhood photos and a description. You got facial feature analysis. You got an essay written by the donor on his reasons for donating and who he is as a person. You got to hear the donor being interviewed by a staff member, so you could hear his voice and see if he was a decent person--does he treat the interviewer like an equal? Does he sound douchey? Does he sound pretentious? There was a host of information available with the superdeluxe subscription, so we went for it.

The website itself was just surreal. Like the way we met, on Match, only instead of searching for your soulmate you're searching for half the genetic material to make your long-awaited baby. Very, very strange. And very, very overwhelming--hundreds and hundreds of profiles to go through. We tried putting all our criteria in at first, and that turned up NOTHING. So, we scaled back significantly. I don't remember what parameters we put in were, but Bryce tells me it was just "towheaded pictures." The very first person we saw was THE DONOR.

He had virtually everything on our list. Like, a CREEPY amount of everything. He had a childhood photo that was very similar to one of Bryce's childhood photos -- towheadedness and facial expression and all. He was in the type of field that we were looking for and had advanced degrees and he both played guitar and was an artist for fun. He sounded like a really nice guy (if a little bit impressed with himself, but we were kind of like, BRAVO, MAN. BRAVO, because he really was impressive). Which was also kind of a nice boost for us, because I could be like, "See? See how impressed you are with all these accomplishments and hobbies and interests and everything? THIS IS HOW I FEEL ABOUT YOU!!!" It was eye-opening. The most bizarre moment in parsing through the considerable amount of information we had on this person was when we found out that his favorite guitarists were the same as my husband's favorite guitarists. Like, really esoteric acoustic people, one of whom has been dead for like 20 years and was never universally popular, and the other who actually came to Rochester a few years ago and we saw live. And who wrote our wedding song. That was the clincher.

But, we felt like, "Should we go with the first profile we view?" Was that good consumerism? Did that matter in this situation, where it felt incredibly strange that we were essentially BUYING semen and if we did enjoy this person enough to make him OUR donor, then all we had to do was "add to cart?" How do you add a PERSON to the cart? There were many jokes about how the "cart" should be uterus-shaped or vagina-shaped or something, because it was weird. Seriously weird. So we looked around, but no one came close to the first donor we saw. So we decided to sit on it, because we didn't need it until probably April and it was only late January.

But then, a few weeks later in February, we looked up the donor's profile again and there was only a few vials left. PANIC ensued. We didn't know--we simply didn't know that particular semen just flies off the cryofrozen shelves. We didn't know that if you find a donor you like, you'd better pounce. Bryce freaked out. All of a sudden, it was painfully clear that THIS DONOR was THE DONOR, and ohmygod if we missed out that would be completely horrific. So much regret. The process was already pretty rife with regrets and worries and feelings of sadness and loss, but to find the perfect donor and then lose him because we didn't act quickly enough? BAD.

I jumped on everything and called the cryobank, asking if we could put a vial on hold. Which apparently you can do for 24 hours. I called our clinic to see if we could have it shipped to them this early and have them store it frozen properly--which they could on all counts. I went to complete the transaction online but apparently when there's less than 5 vials available you can only order it over the phone. This whole process of ordering was really freaking me out a bit, because it felt very much like retail and I don't want to feel like we are BUYING our genetic material, but let's face it--we are. It's not quite the same as egg donation. However, the screening at this bank was impeccable and the information we had made us feel good that this donor was not just out to make a quick buck and spread his genes across the country. So I got the info together to fax over so that we could order over the phone and faxed it through Sta.ples. It was a bunch of pages, information from us, and a contract stating that we won't try to contact the donor and a bunch of other things.

Once the information was received I could make the purchase over the phone. They tried to upsell me with their Family Completion program, called "Family Today, Family Tomorrow" (which I'm not going to lie, made me giggle because it sounded like something from Catching Fire, when Katn.iss says, "Panem today, Panem tomorrow, Panem forever"), but one vial with shipping was nearly $1000. Somewhere someone made it sound like donor sperm was cheap(er). Like it would be $500. I was not expecting this incredible bill! So, uh, NO. We decided we would take our chances with the one vial and if more became available later we would cross that bridge when we came to it. I could not in good conscience spend several thousand dollars on multiple vials of semen when I wasn't even sure we needed the first one.

Which brings me to our interesting situation. Our wonderful donor's goods are safely frozen in our clinic's cryofreezer, we have breathed a sigh of relief that we didn't miss the boat on this particular donor, and we are now headed into the surreal point where it actually gets used.

Our plan for this cycle was to do a 50/50 split. Which means, we take all the mature eggs that I produce and they retrieve, and then we fertilize half with our sperm and half with superdonor's sperm. Which is a little scary, because we are using up a whole expensive vial on just half my eggs, and go figure they don't make it easy to split the vial while still frozen, so it all goes to this one cycle. The fertilized eggs will be kept separately, so that we know whose are whose. Barring some bizarre state of affairs, we will have blasts from both sets of sperm. The first fresh transfer will be Bryce's batch (two max). We want to give those the absolute best chance possible. But then, then what? What if there are additional embryos from Bryce? Do we use those next if the first one fails so that we close that out, or do we say, "hmmm, they failed again, time to move on to donor" and transfer donor ones next? It is a sticky, sticky, icky wicket. We are giving Bryce's sperm another shot because we are at a new clinic, with a new lab, and he's been on some new supplements. So, maybe that will do the trick. Maybe all this business with my lining was a bigger part of our issue, and that's being addressed effectively now. (Just FYI, my lining was a whopping 9.1mm today, which I have NEVER EVER had, so I'd say we're in a better spot from the getgo.) But if it fails, we have to decide if we give it another shot or we move right on to donor. The other scenario is also sticky -- what if Bryce's get us pregnant? What if we are successful, and then we don't have any more Bryce embryos because we split with the donor? Do we do another fresh cycle with all Bryce's sperm for a sibling? Or do we embrace our thought that genetics aren't as important as everyone thinks they are and embrace the donor-created embryos? Oh, and don't forget, we still have those six 2PNs from the egg donor with Bryce. I JUST DON'T KNOW! There are so many additional people involved in our genetic mix!

Luckily for us, we don't have to worry about all those what-ifs quite yet. We just have to hope that we end up with blasts from Bryce to transfer next week, and then go from there. Just worry about those making it, and worry about the what-ifs later, when we actually have to make those decisions. I don't think it's a bad idea to let them marinate a little bit in our brains though, so that we are somewhat prepared for this bizarre, biological and ethical dilemma we may or may not find ourselves in. I laugh, laugh, laugh when I think about where we were five years ago when I was going to my OB/GYN's office and letting them know that my beloved husband-to-be had low sperm counts and maybe we could get a referral to a fertility clinic for a wedding present? THIS TYPE OF HEAVY DECISION MAKING NEVER CROSSED MY MIND. I don't think I even thought these types of dilemmas were truly possible outside the Lifetime Movie realm.

I hope that all of this information is helpful and not overwhelming. Bless you if you've made it all the way to the end, because this was A LOT of information. But, it's information that seems pretty lacking out there. Also, this is just one experience, from one cryobank, and not all cryobanks do things the same way. Our experience is also kind of weird in a way, but maybe not... maybe there are others facing this decision the same way. I'd love it if you'd leave a comment if you are in a similar boat, or if this was helpful to you! Peace to you all, especially as we make decisions we never, ever, EVER dreamed we'd have to make when hoping for a baby. 

Saturday, June 7, 2014

Wrapping Everything Up, Falling Apart

Here we go, seriously off and running. I am stimming like mad, and this time things haven't taken a turn to Crazytown. My estrogen is rising appropriately and not into the stratosphere; I have around 25ish follicles that are growing at about the same rate and within a few millimeters of each other, none at the expense of the others; and while I am VERY VERY UNCOMFORTABLE, I don't feel like I could die. So a big improvement on April's fiasco. I am looking at retrieval next week sometime, although apparently again closer to the end of the week.

This means that I am out of school all next week, because I don't have my own classroom and I am located in just about every corner of the school, the HOT HOT HOT MUGGY AXE-SMELLING school, and so am on my feet all day, carrying binders and books, running the gauntlet of summer-hyped middle schoolers who crowd the hall and whose energy is nearly visible as a cloud of hormones/summer lust above them. I can't do that when my ovaries are this swollen and I am this tired. I need to be resting. I need to be doing right by my eggles. Unfortunately, there are only two weeks left of school. So, my being out next week is a huge loss to me, and then because of transfer the following week I will only be in maybe 2 days the LAST WEEK OF SCHOOL. It is entirely possible that I will miss the VERY LAST day of school with my 8th graders.

I am not going to lie, I am fairly devastated by this.

Yes, I know that I have to put my family-building first, and priorities-priorities, and a host of other cliches that have been thrown my way when I express sadness at missing this capstone moment of a really, really great year. I'd like to think that it's a GOOD THING that I have cried over this loss. You know, maybe that means that I am a dedicated, invested teacher who cares deeply for the well-being of her students and doesn't want to miss these precious last moments before they become high school students?

It makes me angry. Really, really angry...because once again infertility is stealing from me. If I was missing the end of the year because I was bringing a baby into the world I would be sad, but it would be so worth it. And it would be visible to my students why I'm leaving at the end. Instead I have this vague "medical stuff" explanation that some have inferred to be surgery, and egg retrieval is a surgical procedure so that's not entirely misleading, but it sucks. I am missing out and I don't even know if this is going to result in that happiest of happy news and inevitable maternity leave next year. It's hard to imagine that we might actually make it at this point, but we keep at it because we still have hope and this is our final year of this and maybe, just maybe, we'll get lucky. Not that my current students will know.

I spent Thursday and Friday scoring the NYS Science 8 assessment, which was nice because I was sitting in air conditioning and not on my feet (of course it was blissfully cool out the past two days, so it felt a bit like the air conditioning boon was wasted). I've spent the past two weeks getting everything together for the last two weeks of school, madly figuring out my plans and hoping that I can be there for the crucial points. Not feeling optimistic after yesterday's appointement though. Yesterday, after scoring, I went back to my school to print all the materials and make copies and make keys and put post-its on everything denoting any additional information that was probably already on the June Instructional Calendar I made for all my classes and the detailed sub plans. It took FOREVER... but now I'm done. That pile of stress is over.

Yet I still cry when I think about the time I'm missing. I have loved this class so much. And my Special Class Reading and English classes in particular are close to my heart. Mostly because I start the year hoping that I can a) change their minds about reading and open their minds to the wonders of a good reading experience, b) create deeper thinkers, and c) completely blow out the water the presumptions of what these kids, the lowest readers in the school, are truly capable of. Because they are SMART. And they have incredible insights. They are just locked up behind their dyslexia or other learning disabilities or behavioral issues that compound all of the above (or possibly have been magnified by the incredible frustration of not being able to get thoughts out on paper the way they want). I have students who swore I'd fail at finding them books they'd love and that they hated reading and that was that, and now those students are reading further books by Lois Lowry and books by Joseph Bruchac and have found genres and decided that they want to try at this whole reading thing because, yeah, I guess it can be fun. VICTORY! I have students who shut down any time there was reading in class and who shut down any time there was writing, and now they are producing writing pieces that are 2+ pages long and well-crafted with thoughts that frequently blow my mind. I cried on Wednesday when I told my students I wouldn't be back for over a week (I think I hid it decently enough though), and I cried when my most reluctant students shared songs and movie trailers that they'd found that relate to The Giver and then thoughtfully explained exactly why afterwards (Imagine Dragons' Demons, Aviccii's Wake Me Up and Hey Brother for songs, The Island starring Ewan McGregor and Scarlett Johansson for movie, in case you were interested). They have grown so much. They have matured so much. I will truly, truly miss them.

So in the fervor of getting nearly TWO WEEKS of sub plans together, just in case, because who knows when transfer will be?, I felt simultaneously proud of my students, proud of my work with them, hopeful that the last two weeks will go ok without me, and completely devastated that infertility is stealing this from me. It is what it is, and I am grateful to have the flexibility to take this time off without any issues, and it will hopefully make a big difference in my stress level and my physical well-being as I head towards retrieval of my hopefully awesomesauce eggles. I just wish the timing was different. I wish that April had worked out so that June could have been just a few monitoring appointments and 3 days off for transfer. But it didn't, and I don't have a time machine or magic wand, so I have to be at peace with where we are right now. I have do that whole living in the present thing. It's just so hard when I feel that I have been robbed of so much, not to mention, you know, STILL NOT HAVING A BABY after all this.

Hopefully that's short lived. Hopefully things work out in such a way that I can be there for the last day of school. Hopefully we end June with a positive test and everything goes the way it is supposed to -- without heartbreak, without loss, without feeling further and further stuck in the mud. Let me unsanitize. Shit. I definitely feel stuck in the shit. But, as an awesome coping card that I found and will send to someone sometime in the next couple of months, "Sometimes the prettiest flowers come out of the biggest pile of shit."

And on that note, I leave you with lupines. Because no one can be sad or frustrated for long when there are gorgeous lupines to look at. And... my count is up to SIXTEEN blooms. Enjoy, and peace to all on this twisty turny road that really, really needs to come to its destination soon.

Pink lupines

"Peach" lupines that turned more yellow-and-violet

Close up on the interesting coloring of the "peach" ones

Both lupines in context of front/side gardens