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.  

Countdown …

One innocent victim of my hormone-induced emotional outburst hours before the egg retrieval

So, just like a magwai, I can’t eat after midnight up until after the procedure Monday. It’s amazing how much you want something when someone says you can’t have it. I think the frustration is really just masked anxiety about whether everything will go as planned. I signed the waiver, but I’m still not worried about the more severe risks like excessive fluid buildup, stroke or death. I’m not sure about many things, but I’m most certain that God wouldn’t allow my last “meal” before meeting Him to be pineapple jelly crescent rolls, doxycycline and candied gummy pre-natal vitamins.

Speaking of God, I imagined laying out on the altar Hannah-style in church today after all because I just didn’t have the words to pray for what I want. We sang a song, “God is sovereign, holy and just and on His word we’ve got to trust. For the at the sound of His voice, the Earth became. When God speaks in your life, you won’t be the same.” Between the singing, ministering and worshiping, I felt my heart praying and the tears fell. It wasn’t a shining moment because I haven’t figured out how to cry and sing at the same time. Nevertheless, it was a moment that I felt like God and I were on the same page on this babies thing. It made worship at the next service that much easier. Even then, the tears kept flowing though. I’m sure it’s the estrogen.

According to the Mr., I’ve also been a little more aggressive in a way more characteristic of me PMS’ing. I never take it out on people — or at least not at people who can hear me — but it definitely comes out at the television, traffic, talking heads on TV. The victim on the way home from church was a squirrel pausing in the middle of the street. A squirrel! Yep, it’s got to be the drugs. And it’s expected to get way worse.

After the retrieval … (I should describe that. Using a transvaginal ultrasound to find the follicles, a doctor will guide a needle to where it’s supposed to go and extract fluid that should include an egg. If it does, the egg goes into an incubator. He or she will repeat that process until all the follicles are aspirated. The eggs will then pair with a fresh sample from the Mr., and then we wait.), I’ll start oral estrogen and, uh, non-oral progesterone. That’s supposed to not only make me sleepy but also edgy. Doesn’t that sound like fun for everybody?

I’ll keep taking the antibiotic to ward off any cooties from the procedure and wait again to hear about the number of eggs and the likely transfer date. In the meantime, at least immediately after the procedure, I’ll do nothing but feel the lovely haziness of good hospital drugs. As always, we’ll see what happens.

“Write this down and repeat it back to me.”

Monday is egg retrieval day, but hold the sparkling cider. I've had too many BFNs to get excited just yet.

“What? Huh? Wait. OK. Um, hold on. OK, I’m ready now. Go.”

That was the beginning of my conversation with the nurse today confirming that Monday will be my retrieval day, also known as the great Christmas Egg Hunt. I worried about the shots, and now I’m the subcutaneous injection queen. I worried about the drugs having no effect, and now I have 12 measurable follicles (right — 19, 17, 16, 14, 12, 12; left — 17, 15, 14, 13, 13 and 11). FYI, follicles grow 2 mm per day and are mature, meaning more likely to have mature eggs, around 18. The number of follicles does not necessarily correlate to viable eggs, and not all eggs retrieved will necessarily be fertilized. My awareness of the fact that there’s no guarantee that they’ll find enough quality eggs for fertilization basically gives me another reason to keep the sparkling cider on ice for now.

It’s not that I’m trying to be Debbie Downer; it’s just that at this point of trying to have children, I know all too well how it feels to get my hopes up and then let down with a BFN (big fat negative). After peeing on stick or two every month, you learn to take everything as it comes. I used to search for pregnancy T-shirts with funny sayings in anticipation of a positive test amid imaginary symptoms. I’d always feel dumb afterward for thinking too far ahead. Although by God, I’ve managed to accomplish many things and overcome situations that haunt people for life, my inability to get pregnant up to this point has always made me feel like something of a failure and occasionally like God wasn’t listening on this one. I kept praying but then encouraged other people to pray; though, I didn’t tell them about the struggle.

As for being a childless failure, cognitively, I know otherwise. Emotionally, though, it takes some convincing. Being happily married and struggling to have children feels like being the smart girl who isn’t considered pretty. You do a good job pretending it doesn’t matter, but then something happens as a reminder that you do. Some of my Facebook friends are fertile Myrtles; they’ve had two kids in the time I’ve been trying to have one. Stuff like that can get to you if you let it. I’ve tried not to let it, but I’m human. And maybe that was behind my annoyance with having to endure the entire in-vitro fertilization process to have the children I’ve been psychologically preparing for since 2005.

Now, here I am at the critical point — less than 36 hours from the egg retrieval but beyond the hard part — and I’m only thinking as far ahead as drug No. 6, a pre-emptive antibiotic that I’ll take orally starting in the morning.

Mindless update

I’d been concentrating so hard on that joyous news of follicles and a continued cycle that I nearly ignored the most profound display of unprofessionalism seen in my entire working career, and it was directed at me. There’s a lesson in everything, and perhaps mine was that life goes on despite all the interruptions of my infertility battles. So, in the midst of the ultrasound-blood work revolving door and phone gazing in hopes of a nurse’s call, I’m pretty sure I have to actually deal with a petty workplace problem before it becomes something else. I don’t have the patience for this, though, I’m not sure whether that’s a real reaction or whether it’s the drugs. They’re supposed to make me crazy at some point; I’m sure they’re already making me sleepy at odd times.

I’m currently on three medications, all administered via injection — Gonal F, Menopur and that evil Ganirelix acetate. The first two essentially create an ovarian Superman, and the latter is like the Kryptonite to keep the hero from winning and thereby ending the tale too soon. The idea is to develop follicles but to keep them, keep me from ovulating before doctors can go in and get the eggs. It’s for this reason that the Mr. and I have to keep our hands off of one another. Apparently, sex naturally triggers ovulation. How that for another counterintuitive fertility measure? Remember, this cycle started with me on birth control pills. So far, though, everything is working.

My estrogen level doubled from Tuesday to 1424. I do know that’s a positive sign, particularly now that, per a nurse’s message, I’m walking around with 10 measurable follicles. With Clomid, a drug given orally that I took for all three intrauterine inseminations, I only produced two follicles. Each time, they came from my right ovary. My left has been on vacation until recently. It’s now holding five at 11, 12, 13, 14 and 15 mm. The right has the remainder at 11, 12, 13, 16 and 16.

At this rate, the retrieval could happen in a few days. I’ll find out more — including how I feel about everything — at my next appointment in a few hours.

P.S. It was actually almost an hour and a half ago. This just didn’t post when it should have. I’m still pondering everything while trying to focus on work. Here we go …

Ganirelix is the Devil

This Ganirelix acetate shot might as well be a small taste of hell in injection form.

Not that anyone’s grading me, but in my on mind at least, I passed an inital hurdle in the in-vitro fertilization race. Based on results from Tuesday’s ultrasound, I have seven measurable follicles at decent sizes (three at 12 mm, two at 11, two at 10 and a lot of small ones) to keep the cycle going. It’s been my biggest fear that the $350 in prescription drugs and the past five days of shots to the gut would suddenly end in a canceled cycle. But today is cycle day seven, and we’re still on.

About those follicles: Everyone who ovulates does so because of an egg that matures inside a follicle before popping out in anticipation of a sperm hookup. My injectable medications have given me super-powered ovaries that have produced more than the typical one or two follicles that would ordinarily lead to one or two eggs. Mature follicles tend to measure about 18 mm. When I did the intrauterine inseminations, 18 mm meant it was time for a “trigger shot” of Ovidrel, an injection that encourages ovulation. I’ll still get the Ovidrel with in-vitro fertilization; it’ll just be exactly 36 hours before the retrieval.

That would be shot No. 4. But that one, I can handle. It’s that doggone Ganirelix that is most certainly from the devil. It burned after the Mr. injected me and left a bruise that is painful to the touch. I walked around work with my pants down, covered by my jacket. So far, it’s the worst thing that has happened in the process, and it’ll happen again — every morning until … Crap, I don’t know when it’ll stop.

All I can do is follow the advice of a diabetic friend with 15 years of needle experience and consider the pain an offering commemorating Christ’s ultimate sacrifice. It sounded trite when she first said it, but given the hell of this Ganirelix shot, it’s gon’ take Jesus, the 12 disciples and Rufus to take this devil down.

Next ultrasound and blood draw: Thursday.