Tag Archives: IVF

Reflections of the Way Things Used to Be

Last year this time, I was in New York with a fresh needle wound from the first shot of my in-vitro fertilization cycle. I was trying to be thankful for a wonderful husband, a promising job that fit my talents and general happiness with life despite the ache of not yet being pregnant and having to endure IVF at all. That was a difficult balance. It was even worse to battle such inner turmoil while wearing the permanent smile-face of holidays with in-laws who didn’t know or necessarily understand anything about me or anything I might be feeling. Empathy from outside of the infertility circle is hard to come by even after the explanations of why and how.

But. I. Survived.

And I came out with a story to tell happily ending with a real live Rufus and Reefus, born exactly three months, two weeks and three days ago. Even as I listen to them sleep in their cribs (for only the third freaking day ever FINALLY), it’s unbelievable that they actually exist way beyond a couple groups of dividing cells, a collection of heartbeats captured in a whirlwind doctor’s visit or even the invisible sources of discomfort in the late hours of labor. Ready or not (with emphasis on the NOT), they’re here.

Their presence means:

– I’m up at 5:43 a.m., having just nursed the boy for the third time this hour with him now wanting to play. (Grrr, boy, go to sleep!)

– I contemplate daily cutting my hair to a low fade to avoid looking a hot mess. (My stylist’s feelings will be so hurt.)

– I haven’t slept more than four hours at a time since a week before I delivered. (I’m done with the “I’m tired” complaints of my childless friends, BTW.)

– I ate Thanksgiving dinner with a baby on my lap, having cooked a minimal spread with another on my hip.

– I’m incredibly isolated from the civilized world most days and evenings and often lonely because of my husband’s work hours.

– This is life as I now know it with no end in sight.

Yet this year, even with all of that, I’m not superficially thankful with a veneer over the potentially heavy burdens of new motherhood. Instead, I’m overwhelmingly humble for the greatest gifts since salvation and welcoming of the collective discomforts that my babies bring. I can’t say I don’t complain — I do because, well, this crap is hard — but the comfort of this new family is greater than the discomfort of feeling it would never happen. This is true every day all day with baby giggles, smiles and developmental skills that put icing on the cake (which I can eat worry-free with the calorie burning of nursing). And I’m nothing but thankful for that. I’m also thankful for the smallest hope that led me to this point, the prayers of the people around me, those who remain to share in our children’s lives and to God, who made it all possible.

Recognizing that things didn’t have to work out in my favor has made every day with the twins a day of thanksgiving, regardless of what the calendar says. To those whose struggle continues, try to know that my heart is with you. Happy Thanksgiving (give or take four or five days. Sue me; I’ve got twins).

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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.

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.

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.