Monthly Archives: December 2011

Another reason infertility kicks rocks

This doesn't even begin to show what nine kinds of ticked off looks like. I was here -- and for good doggone reason.

I mentioned that part of my stress during the last several weeks involved work. Aside from the initial problem that had me sitting in human resources, I got wind of the fact that my “medical condition” had come up in discussions toward the need for some type of resolution. Actually, the comment — which I received through a super-reliable source — essentially alluded to my “oversensitivity, likely a result of (my) medical condition.”

I’m a lot of things, but sensitive probably isn’t at the top of the list. Incorrect characteristic aside, I was nine kinds of ticked off. Yes, nine.

I was outraged at the lack of understanding, at the blanket application of what “undergoing infertility treatments” means. I was livid at the seeming sexism that drove the conversation. The belittling of a legitimate work concern because of my “medical condition” had me seeing red.

Post-rage — even though I’m still on the same drugs progesterone and estradiol, mind you (told you it wasn’t the drugs) — I remember that anger tends to be a secondary emotion. I’m ready to admit now that more than anything, my feelings were hurt.

Understanding the value of personal authenticity to myself and others, I try to live a fairly transparent life. Despite what my writings suggest, I’m not an open book. I’m more like a library offering. Through conversation and revelation of the type of person you are, in a way you can’t explain with words, you’re filling out an application for a library card. The way you fill out the paperwork gives me insight into what version of the book you can check out. Regardless of whether you get “Goodnight, Moon,” “Charlotte’s Web,” “Are You There, God? It’s Me Margaret,” “Fight Club” or “The Sun Also Rises,” you’re still getting the real me with all my quirks.

I was a small child for my age and would get questioning looks when I’d attempt to check out library books that looked well beyond my literary capacity. Eventually, though, some librarian would decide it was OK for a 12-year-old to read John Jakes’ “North and South” and let me have the book.

That’s how I felt when I said in a meeting that the work situation needed to be in the hands of someone with the authority to deal with it. Not only was that kind of power above my pay grade, I have other things I’m focused on, I said. “For example, my husband and I are undergoing fertility treatments.” At that point, injections and ultrasounds were normal to me. I said “undergoing fertility treatments” like people say, “We’re moving” or “Our car broke down.” It is a condition of life, a normal condition of life like anything else that sucks and requires a coming to terms. After you reach the terms, it is what it is: life. And I decided the person I’d spoken to was in a position to handle that. I was wrong.

Having my life used against me felt like a sucker punch to the gut. The irony was that such a twist of words never would’ve been used to describe a woman battling her way through cancer. What is it about infertility that makes that kind of marginalization OK?

I still haven’t figured that out; I did however address what I’d heard. Despite broad deliverance from tearing people down with my words, I had not forgotten how to border on intimidating. I’m a little person; it takes a little of that sometimes. But really, it was the use of the words “illegal, if not, then unethical,” a reference to the employee handbook and prayers that began with “God, go before me …” that seemed to have an impact.

The abundance of ignorance regarding infertility perpetuates the embarrassment that many of us feel in the need to utilize advanced reproductive technology. It keeps us silent and hidden and unnecessarily distant from the support we need. To break that cycle, we’ve got one option (and I stole this from Jeff Bridges in “The Contender”). It’s simple: Don’t be embarrassed.

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Pee-er Pressure (in the Mr.’s own words)

I'm comfortable with this scenario, but the Mr. needs something more.

I’m giving up my normal rant space to the Mr., who really wants — nay, needs — me to take a home pregnancy test. His offering is largely unedited — aside from those dreaded double spaces after each sentence. (Who still does that?) Nevertheless, despite promising ultrasounds and no evidence suggesting that there isn’t p-word outside of our cautious uncertainty, he wants to see a positive home test. Here’s why:  

About three and a half years ago, I had a question I really, really wanted to ask the woman I loved. Just a few simple words, but it was a monumental question. The big question. You know the one. It was the biggest question I’d ever asked her. Eventually, after a princely sum on a ring and tickets to a dinner whose taste I still can’t remember, I got my answer.

It was the answer I’d expected, hoped for, prayed for and was relieved to get. I’d seen the signs after all: She told me she loved me, moved halfway across the country for me, she laughed at my lame jokes and allowed me to experiment on her with my cooking. And rare was the day we hadn’t spent thinking of and talking about a future together. So, yeah, the signs were there. But it was the most real when she had that ring on her finger, that word of affirmation ringing in my ear. She later teased me about my nervousness, even while admitting that she wasn’t always sure that moment would ever come. Bottom line, we didn’t know till we knew.

So here we are again, where there’s a question to be answered. This time it’s not about matrimony. It’s about maternity. It isn’t about whether she’ll take my hand. It’s about whether we’ll form a band. There’re no musicians singing in the background, and instead of a diamond ring in my hand, I’ve got a cheap piece of plastic. Ain’t nothing sexy about where this stick goes and she probably won’t walk around with it on her finger (although that would make one heck of a mood ring).

(Now that I’ve conflated my proposal and a pregnancy test, my head is filled with images of how so many other questions would be more simply resolved if it could be settled with a little pee. Does she love me? Is she laughing at me or with me? Is she really mad I ate all of the cookies? Two lines for yes, one line for no.)

So, call it peer pressure. or pee-er pressure. Or just one more time where a guy’s gotta know. Sure it might be beside the point. Even a little bit anti-climactic. But, remember that Kay’s Jewelers jingle: “Every kiss begins with Kay”? Well, every pregnancy begins with pee.

Babe, all I’m saying is give pee a chance.

To pee or not to pee …


OK, so the question wasn't "to pee or not to pee." However, the real query did consider the value of seeking resolution once and for all. Aside from that, Mel Gibson's portrayal of "Hamlet" is my favorite. That other dude with the white hair creeps me out.

That is the question:
Whether ’tis nobler in the mind to suffer
the fears and uncertainty behind only seeing two tiny open-air blips via ultrasound
or to take arms against a sea of doubt
and by peeing on a stick end them.

Given that this post marks the third random Shakespearean reference (the second to “Hamlet,” my second-favorite tragedy), I opted for a little creativity. Besides I’m still trying to make light of spending the holidays in the hotel because of my landlord’s poor judgment over the gas line. This was really the last straw of the property manager’s continual missteps, so rather than be indefinitely displaced, we terminated our lease and suddenly found ourselves moving — days before Christmas. It’s not that I dislike the posh concession in living arrangements; I’ve just found it hard to obsess about the validity of the p-word and whether what we saw last Tuesday really meant what the doctor said it did.

Normally, I insist on knowing the reality of a situation — straight, no chaser. But with all the work drama and then the home front catastrophe, I’ve comfortably waded in plausible deniability. I have ultrasound pictures to prove what the doctor said, no evidence of a periodic relative, and I still awake daily with the feeling of clanging of chest cymbals but nothing else to prove p-word status. Thus, I decided that this is what a little bit p-word feels like. I’ve been OK with that, figuring that in a few more days, I’ll have another ultrasound and maybe that’s when I can get excited.

It’s sad — I feel sad thinking about the fact — that infertility can be so deflating month after month of doing what they say will work, could work, or worked for someone else that if signs show that it worked for you, you doubt it still to avoid getting your hopes up. And even though it’s fun to be deliberately obtuse about whether I am or I’m not the p-word, the real reason for it is really the fear that something will go wrong. Isn’t that why people don’t say they are until they’re 12 weeks or more along?

I think I’ve secretly accepted that I am. I even believe God’s confirmation through my relationship with Him. Perhaps I’m even at a place where I can accept whatever happens even if it’s the very worst that will hurt and kick rocks all at the same time. Where I am is further than I’ve ever gotten in this process, and I don’t take it for granted. I actually count this as a blessing in itself, well in advance of the one I seek. I’ve even told a decent handful of people, in part to make it real and then to have witnesses that I was at least here in case things change. And in believing all of that, I see no need to confirm it through an at-home urine pregnancy test. A negative test would end the mild uncertainty, but it would also end the fantasy. With that risk, I’m content to wait for a fetal heartbeat.

I could do that if this were just about me. Ah, but no possibly p-word wife is an island unto herself (John Donne reference!), and the king of this island, the Mr. himself, has spoken: “You’re taking a test.”

Ay, there’s the rub.

Double, double toil and trouble …

Despite good news, I'm still wary of the other shoe dropping. And given my reaction to a series of poop storms, I should also be watching for houses.

With infertility, silence sometimes means the worst has the happened. Fortunately, that isn’t the case, but as it always happens with every two-week wait and the optimism of each cycle, struggling to conceive means waiting for the other shoe to stomp all over your baby-building parade.

Under the invisible dangling shoe that has kept me quiet for the past few days, my human chorionic gonadotropin (hcg) levels doubled and then some, according to my latest blood test. Sunday, it was 148. Tuesday, it hit 552. It took a grueling hour to find that out.

I’d stepped away from my desk to pray with the rest of the company for the family of a recently deceased coworker, and the nurse called. A little shaken from the solemn office gathering and nervous about the call, I locked myself out of my voice mail. While waiting for the systems guy to reset my password, I tried calling the doctor’s office back. Every transfer to a live person went something like this:

“Name?” My name. S-P-E-L-L-E-D O-U-T. “Date of birth?” My birthdate and year. “Who’s your doctor?” My doctor. Then silence. “Let me transfer you to the IVF nurse.”

This was all too reminiscent of my low-ovarian reserve diagnosis. No one would tell me what the number was for my anti-mullerian hormone (AMH) test. I’d ask, and then they’d refer me to someone else. Essentially, this test can help determine the number of quality eggs a person has as well as determine gauge what the response might be to in-vitro fertilization. My test results suggested that my ovarian fertility potential hovered in the low- to very-low category. My doctor mentioned the use of donor eggs very early in this infertility process. I feared he was right and coped with the possibility by ignoring him.

That’s why is so unbelievable to me that, according to today’s doctor visit, he actually used what my husband called “the p word.” Here I was thinking the Mr. was being vulgar; instead he was marveling that the doctor kept casually referring to me being pregnant. I’d had moments of wanting to jump around like Doc Brown in “Back to the Future,” yelling, “It worked; 1.21 gigowatts!” but that still seemed a little premature. Short of that temptation, I’ve held out on using the p word and instead described my blood test results in strictly clinical terms.

Today, the Mr. and I had a brief moment of acceptance of a positive outcome. Then life kicked in and my focus returned to the poop storm spinning over work and now where we live. The latter is a horrific mess that would turn anybody into a Scrooge, or in my case, the B. on a Broomstick. That’s the bad news. The good news, in addition to the news I have yet to accept, is that trouble don’t last always. Praise God, it still will be a merry Christmas and a maybe even a very special one.

Meanwhile, I’ll be on the lookout for falling shoes — and houses.

 

Here’s to the numbers game

The "butterfly" part goes into a vein, and a blood collection tube attaches to the "vacuum." I gotta do this again in a couple days. It used to be fine, but now these little suckers are starting to hurt.

I made it to my first beta test without giving in to pressure to buy a home pregnancy test. I kinda floated through the last several days, having some symptoms of something but blaming everything on the drugs — not just my bad moods.

For example: In the lighter sleep of early morning, I tend to have a blanket tug of war with the Mr. That fight involves turning to one side with a death grip on the covers. After nearly three years, I can literally do this in my sleep. But for the past week, that sleeping turn has come with the equivalent of what feels like someone clanging cymbals on the girls. Mmhm, those girls. I wake up abruptly — mad — then stay awake for another hour or so until about five minutes before my alarm sounds. I blame this for my constant need for a nap before bed. And the vicious cycle continues.

Then, there are the slight pains in my side that go away as soon as I try to identify them. It’s like I’m leaning over to stretch, except I’m sitting still. In that case, I didn’t necessarily blame the drugs. I thought, as usual, it was something I ate from the dairy case. (Infer what you will.)

The whole point of the mind games was to downplay anything that could be unnecessarily attributed to a pregnancy that had not been confirmed. Instead of wishful thinking, it was careful thinking.

The game changer was the quick phone call from the nurse about an hour an a half after my blood test, 10 days post transfer. “I’m calling with good news that your beta level is positive at 148. You’ll keep taking your meds and come back Tuesday. Then, it should double to about 320.”

She didn’t say pregnant and I didn’t hear pregnant nor say pregnant to the Mr. But we all know 148 is a good sign. Still, I know not to get too excited — at least not yet. Here’s why: While anything above 25 milli-international units per milliliter (mIU/ml) equals a positive pregnancy test, the real proof is in how much the numbers increase in 48-72 hours. Even then, it’s only through ultrasound, somewhere between 1,000 and 2,000 mIU/ml, that we can get more accurate information about the pregnancy. That includes whether we’re carrying one or two babies.

I could come up with a multitude of Doomsday scenarios, but the possibility of them is enough to keep me grounded even despite the silly grin that the Mr.’s probably worn all day. It’s cute, and it reminds me that there’s hope. Don’t get me wrong: I am tickled chocolate brown and a little bit relieved, but I remain super cautious. I’m thankful to God because I consider this an answered prayer even though there are others to come. With all of that in mind, I’ll quietly celebrate 148 mIU/ml for what it is with a glass of water, more drugs and gummy prenatal vitamins. In the meantime, we’ll see what happens

Here’s to the numbers game. Cheers, big ears.

Alas, poor embryos. I knew them …

My quest for motherhood is like looking for red Skittles, i.e., good-quality eggs, in a bag of many colors. They're there; we just have to find them.

With the number of steps involved in the in-vitro process, I was bound to forget at least one. This would be the call from the andrologist on the status of the remaining five embryos.

I first Googled the phone number as I always do with unprogrammed calls and saw that it came from the hospital’s lab, my hospital. Neither the Mr. nor I could figure out why they were calling. Then, the message on “the status of your embryos” freaked me out even further. I figured it’d be about cost or storage options or how long we thought we wait before tapping into the frozen reserve. I called back immediately to find that neither assumption was true.

It was about the status of our embryos.

Retrospectively, it felt like what would happen in the hospital when a nurse would call family members about their loved ones. They never say, “Mrs. K died.” Instead, they talk about the status of Mrs. K’s condition and how the family should come in. If you’ve ever experienced the activity surrounding someone’s else death in a hospital bed, you can always tell what you’re in for just based on the cryptic language used when they call you. But this was no nurse; the woman is an andrologist. She was compassionately matter-of-fact but obviously not a patient-care practitioner. I don’t hold that against her. I appreciated the information and her willingness to repeat it until I was sure I understood.

Essentially, there are no longer five embryos. Before the transfer, there were seven. The best two of those — the ones dividing evenly with proper cell shape and most likely to implant — were transferred last week, three days after fertilization.

Three more simply didn’t reach the blastocyst stage, meaning they “failed to progress” to Day 5. (Blastocysts are more likely to survive the freezing and thawing process for a another transfer than “younger” embryos.) Another embryo became a blastocyst but then began dividing unevenly and soon “arrested” as well. These are the types of fertilized eggs that never would’ve implanted in the first place. Yet, it’s still feels a little bit a little bit depressing that they didn’t make it and that there aren’t more additional mini-me possibilities.

Yet there is room for rejoicing because one survived to the cyropreservation (freezing) stage and is expected to be there when we need it. Also, in perspective, the loss of three embryos makes sense. Embryo survival is closely linked to egg quality, and my unexplained infertility is blamed on a diminished ovarian reserve. That means that of all the eggs I have, I only have a few that are of good quality. The majority of them probably aren’t as likely to undergo fertilization and endure a full term. The in-vitro route makes the existence of those eggs more apparent.

Imagine it this way: you have a bag of Skittles, and only the red ones count. You could blindly stick your hand in the bag for one at a time, hoping for a red one. However, the more efficient way would be to grab a handful and pick out the red ones while avoiding the rest, which would likely be the majority of the bag. In-vitro fertilization is my efficient handful into motherhood.

The quest feels a little more daunting right about now with just one backup, but I’m trying not to let it shake me. I will not buy a home pregnancy test to try to get an early result. I will not obsess about any twinges or odd feelings. I’m just gon’ ride it out and pray for two more days.

It’s the %@*$# drugs

We're done with the injectables, but these two seem to pack a more emotional punch. The Mr. finds it funny; he's allowed. Everyone else, look out.

It’s the drugs. It’s the drugs. It’s the drugs.

At least, that’s what I’ve been telling myself as a result of reaching the highest levels of pissivity. (That’s an original derivative of a word I hate to use and wouldn’t, well, if not for the drugs.) I was warned of the side effects of estradiol and progesterone, but I wasn’t expecting the same work-related poop storm from a few weeks ago to keep spinning. I don’t have the time, the patience nor the willingness to address it, but here it is, and here I am, nine kinds of ticked off.

Soooo, maybe it’s not the drugs.

However, the fear and resulting paranoia that pressure from this clusterfox will hurt my chances of housing the Wonder Twins long term might be drug manufactured. It would make sense to think that every significant upset would have a negative effect, but honestly, it doesn’t. Medically anyway, no one thinks so.

In addition to preparing me for mood swings, fatigue, and general haziness, the RE-mandated psychologist addressed stress and how I’d deal with it. Her focus was specifically now, the time between the transfer and the first blood test determing whether the in-vitro cycle was successful. Even though she encouraged a coping strategy — because, obviously alcohol is out of the question — she insisted that everyday wanna-throw-a-shoe, to-Hades-with-everybody, dare-you-to-walk-in-front-of my-car varieties wouldn’t be enough to derail pregnancy. What would have an effect is stress related to fear for my life, of being evicted and otherwise homeless or of not having food. Anything less than that would be implantation gravy.

I was relieved to leave aside the pressure of always trying to relax. In trying for so long to conceive, I’ve heard “Just relax” enough times to consider the phrase profane. And telling me that never works anyway. So rather than “Keep Calm and Carry On” like the book says, I’m doing just fine aligning myself with its companion piece, “Screw Calm and Get Angry.”

And if you don’t like me when I’m angry, well, let’s go with that idea that it’s the blankety-blank drugs.

Send in the Embryos

This is a copy of the screen-grab image from the ultrasound at the moment of the embryo transfer.

It wasn’t on purpose, but I’ve been silent for a few days reveling in Thursday’s embryo transfer. It was nothing short of fascinating. It felt sacred and holy, an unexpectedly spiritual few minutes.

And that’s in spite of the intimate experience with an unfamiliar but funny doctor and his clueless intern. Bless her heart, I knew she bordered on inept because of preoccupation with the internal ultrasound probe that wasn’t part of this particular procedure. As instructed, I showed up with a full bladder. That meant an external ultrasound, but she’d missed the memo. (And sadly, she’d worked at the same hospital I had in the exact same position but on a different floor. I knew she should’ve known better.) When the doctor kindly corrected her, she pretended her gooped-up probe didn’t exist. To be nice, so did I. I even took shallow breaths so she wouldn’t lose her place with the external probe on my abdomen. I can’t take full credit for my behavior, though. My super-nice Mr. sat on a stool to my right, and his influence mellows me. Also, I didn’t have the benefit of the privacy sheet normally granted with exposure of the goods, and it’s hard to be critical with your hoo-hah on display. Fortunately, my monkey socks provided a nice diversion until the show started.

Just prior to the procedure, Dr. Funny Man passed the Mr. a good luck greeting card from the entire RE office. “Beautiful,” he said, “a family photo.” It was an image of the two embryos set aside for the transfer. And yeah, they were the most beautiful set of eight- and nine-cell embryos that ever existed. OK, it sounds weird, but the idea that these little babies could turn into real babies was just amazing to me. I think I’ve stared at that photo every day and several times a day since. I made it portable by taking a picture with my phone, and I look at that even more.

That picture might have been all I needed to see, but my excitement — while trying not to breathe too much for the Dr. Bailey intern reject — grew when the doctor pointed out everything on the screen. Amid the plumbing was his needle aimed at the ideal place. “Do you see me? Are you ready? Are you sure?” He yelled something to invisible people through talking through a hole in the wall and told us, “Bombs away. One, two. There they are.”

Two small somethings on the screen came through the needle and just sat tucked away right where they were placed. I cried a little staring at the movement I saw. I couldn’t look at the Mr. because it would’ve become a full-on Oprah ugly cry. And even though I felt it, crying just seemed a bit premature. I was fully aware, though, that whatever life that would come from this process would spring from something greater than a few doctors practicing medicine.

Regardless of the criticism surrounding infertility treatments, what I saw represented the presence of God in all things, including in what has been called “gravely evil.” Science only takes us so far; the rest really is up to God. And there ain’t nothin’ evil about that. Jerks.

Not the Octomama

ABC used to have a show called “Dinosaurs.” The youngest animal of this family referred to its father and, well, everyone else as “Not the Mama!” With that and seven fertilized eggs, a.k.a. embryos, ripe for implanting, let me say this once and for all as nice as I can muster:

Remember this "Dinosaurs" baby whose phrase was "Not the mama?" Let's take it a step further: not the octomama. I'll smile to be polite, but your octojoke really isn't funny.

I am not and will not be the freakin’ Octomama — not in a box, with a fox or eating lox. And no, I’m not even the septomama. Say it with me: Not. The. Octomama. Repeat as many times as needed to realize that any “jokes” related to Nadya Suleman aren’t funny and probably won’t be for anyone who has to undergo fertility treatments.

Weeks ago, The Mr. and I had a very detailed conversation together and with the hospital-provided therapist (a requirement for the in-vitro fertilization process at my particular facility) before arriving at the decision to implant two embryos at one time. So, even though we have been blessed with a singing group, a small basketball team or a volleyball team plus one, no doctor in his or her right mind would implant all seven. Here’s why:

  • Implanting more than the recommended number according to a potential mother’s age is like Russian roulette, not only with the chances of a live birth, but with the mother’s life. More babies, more problems (read: complications).
  • The greater the number of embryos in utero, the greater the likelihood that one or more of them might have to take one for the team. (I offer my apologies for attempting to soften the blow of reality.) Essentially, too many kids in the tub might force parents toward the decision of which ones stay and which ones have to be aborted to prevent the death of all. That’s real talk.
  • If multiples make it through pregnancy, the existence of many increases the risk of premature delivery. That’s days, or even, months in somebody’s NICU. It’s like a car accident. It’s one thing if it happens; if it occurs because your own recklessness, then it’s dumb.

We decided on two because, like most couples, we feared the risk of transferring one and having an unsuccessful cycle. We were adequately informed concerning single-embryo transfer, or SET, an industry-wide recommendation that all it takes is one, but we opted to roll this dice anyway. Aside from that, I really would love to have twins. Boys or girls, one of each, or a set of kittens with my nose and his eyes — any combination would make me happy.

As for the remaining five, we’ll literally have them on ice in case the first two don’t make it. (They’ll be frozen.) Should that happen, we’ll start again with two more. Or if we’re successful right out the gate, our frozen reserves will remain until it’s time for more children. Beyond the family size we choose, we’ll donate the rest to another couple who isn’t as fortunate as we’ve been to get to this point.

Fentanyl is your friend

This is a 2-cell embryo on Day 2.
So much for “conscious sedation.” I was out almost as soon as the nurse injected it into my IV. (We won’t talk about the collateral damage done to both arms to get the IV going in the first place.) Right before then, I’m told I started singing “Nowadays” from the musical “Chicago.”

“… You can live the life you like. You can even marry Harry but mess around with Ike. Good, isn’t it grand …” I vaguely remember that. And I can recall turning on my side for the rump shot of progesterone. Sade’s greatest hits played in the recovery room. I remember hearing it, but I don’t remember singing along. A nurse said she wanted my autograph, so I must’ve done a decent job. I was hazy but soon awake enough to walk. At home, I slept the rest of the day — the whole day.

I think I’m done with the abrupt sleepiness from the fentanyl, but the Mr. keeps reminding me that it hasn’t been 24 hours since the procedure (it’s 8 a.m.). That’s the recommended time before I can operate heavy machinery. I didn’t think of it like that, but I guess it is a good idea that I’m working from home today editing printouts from last week. Even with uncomfortable bloating and a literal pain in the behind, I find it hard not to be celebratory.

My doctor extracted 15 eggs. Based on today’s call from the embryologist (how do you even become one of those?), seven of the 15 were mature and all seven were fertilized. Now, it’s a matter of days before the transfer of two embryos and yet another dreaded two-week wait. I’m done with injectable medications. Instead, I’m taking antibiotics twice a day, estradiol twice a day and progesterone inserts three times a day. One is to ward off infection from the procedure and the other two held prepare my body for implantation, the next hurdle.