Friday, July 30, 2004

I love you Gorilla

Dr. Chickie called me yesterday. I had written out all my questions ahead of time. The answers went along the lines that defragmentation does not have a proven benefit; I'm young; our fragmentation is probably related to our morphology issues; and that I should try to be positive until my beta on Monday. I did well questioning her, although not my cool self I did keep it together until the end when she came to the "be positive" part. That expression always has the opposite effect on me.

Yesterday I remained in an emotional funk all day. I watched this show about a gorilla who speaks sign language and had lost her baby. They got her a little orange kitten. She loved the kitten so dearly and would treat it like a baby gorilla, although the kitten didn't respond like a baby gorilla. When laying on her back holding the kitten, she would flatten her feet to make a platform so that the kitten would be happier. She would also play with the kitten with her blanket and try to feed her. The little orange kitten was at first bewildered, but then got very used to it and would play back. The trainer asked the gorilla in sign language what they should name the kitten. The trainer offered the name Red, but the gorilla signed no. The trainer offered the name Banana, and the gorilla liked that name. But then the gorilla signed that she was bad because she didn't know the kitten's name, and she loved that kitten. While I had tears the whole time during this children's show, that part just got me crying.

Today, I'm feeling a lot better. I got an email back from another main San Francisco fertility center from an MD who thinks that my PCOS may be related to egg quality and the bad eggs causing fragmentation. He wants to run a whole new battery of tests on me to try a different stim cycle to get better quality eggs in the early part, then use a co-culture with the embryos that they use only for couples with previous poor quality embryos. It's given me something new to think about. A nice doctor, new alternatives, what do you know.

Thursday, July 29, 2004

The Good Patient

I get in arguments in the shower with my doctor.  Why didn't you offer defragmentation or assisted hatching if these technologies help with such fragmented embryos?  Everyday I tell myself I will call the office and question the IVF nurse about it.  It won't change anything, but it will get it out of my system.

So today I did.  I called and asked if they did defragmentation.  The nurse said no.  I asked if they did assisted hatching (I know they do) and the nurse said yes.  I asked why these weren't offered to me at time of transfer since they increase the odds of implantation when there are fragmented embryos.  And she said I'd have to wait until Monday when I come for the blood test to ask Dr. Chickie.  Realistically, I didn't expect her to have an answer, but I know from past experience that if I call with a question, they put it in my chart.  Then Dr. Chickie will hopefully see it and have a damn good explanation by the time I get there Monday.

I also told the nurse that since they don't do defragmentation in their lab and that's something I need, I probably would not be able to have future cycles with them.  Not that she cares, but I wanted to say it.

Did I call for a fight?  No, I wanted information.  Did I expect a fight?  Yes, because I knew that they wouldn't have any information for me.  An exercise in futility.  Isn't that the definition of my quest for another baby?  Hopefully my mind will now be more restful.  I'm tired of replaying these questions in my mind.

I still won't be able to sleep though.  Every night I've been waking up at 2am with my mind going haywire.  Why didn't they tell me on day 2 that the embryos were fragmented (I saw on the embryologist's report that they knew then) and to expect the day 3 transfer?  How did one of the eggs get polyspermia when they were doing ICSI?  Did they really try to ICSI all 17 mature eggs?  Why didn't I ask to transfer the 5 cell grade II embryo too since it didn't stand a chance anyway?  I beat myself up over that last one.  Like I killed it, and further hurt my chances by not speaking up.

I've read so many things about ICSI damaging the egg, causing fragmentation.  Maybe it was an inexperienced lab tech doing my ICSIs.  I'm especially suspicious of them being inexperienced if they don't know about defragmentation.  Maybe it was the media they were using.  I've read that a coculture can help ICSI embryos, since they have higher rate of fragmentation.  They were also doing that experiment with different air mixes with embryos.  They assured me that the experiment had already been done a million times and had shown only a possibility of better embryos, not hurting embryos.  What if it's not and they were lying to me?

Also, I'm not happy with the absolute lack of detail I've been given throughout.  No numbers for my lining.  No number measurements on size of follicles.  No exact count of follicles relayed to me.  The last E2 test, they didn't even call and tell me the results.  I still don't know why the repronex was added to my protocol at the end.  I know they know the answers to these questions, but didn't bother to let me know along the way.  And I didn't stand up for myself enough to get them.

So I guess I'm not just angry with them, but angry at myself.  I let myself down.  I tried to be the good patient, the compliant patient, the nice patient and I still ended up being labeled as emotional and demanding, but not getting the information I needed.  They took me for a push-over.  When it comes to me needing something so desperately, I'm not strong.  I don't want my personality to get in the way.  I want them to want to help me because I'm so friendly.  But then, I beat myself up afterwards for all that I should have said.  And when I try to speak up to them, I fall to pieces, giving them yet more ammunition about my weak character.

Valerie has always chided me about being a good patient.  She is a demanding patient.  She questions everything.  When in the hospital, she will demand why they are doing everything, and refuse tests or procedures she doesn't think are necessary.  Her doctor loves her still.  She finds her to be a good advocate for herself.

Me, I'm a terrible advocate for myself when it comes to infertility.  I should have demanded the more experienced physician.  I should have demanded all the detailed information.  I should have demanded that 4th embryo be transferred.  I should have asked more questions about what could be done for fragmented embryos before the transfer.

This is so opposite how I am with anything financial or with work.  I am a tough negotiator, just ask any dealer we've bought a car from.  I catch all their dirty tricks.  I wish I could be that way with my health.

It's just that desperation.  Wanting it so badly to work that I'll do anything.  I'll be quiet.  I'll be good.  Just please make this work.

And since it's not, now I'm angry.  It's like I'm my own big brother and going to go in there to demand why they were so mean to my baby sister.  How could they treat her like that?  Is it fair that I put all the blame on them and not on myself for not being a good enough advocate?  Probably not, but I am paying them.  They work for me.  They forgot that and so did I.

So now I will work on replaying out the argument I plan on presenting to Dr. Chickie.  I don't think she'll recognize me.  I only have to hope and pray that I can keep it together.  No crying.  No tears!

Typing this out got my blood boiling enough to call back.  I told them that since I don't have an exact appointment on Monday for my blood test I was concerned that I wouldn't be able to talk to Dr. Chickie then.  This new nurse agreed and told me that he'd leave a message for Dr. Chickie so that she can either call me back or can find time for me when I come in on Monday.  I went through it again to make sure that he understood my questions.  I'm not sure if he did.  They act like they've never heard of defragmentation.  Not only can I find information on it everywhere in the medical journals, but I saw it done on a NOVA documentary.  I'm just a patient, they are the ones who do this all the time.  Wouldn't they know more than me?

So they just told me that Dr. Chickie will try to call me between patients.  At least I won't have to play this one out in my mind anymore.  I just have to keep myself together until that call and during that call so I can ask her my questions.  I won't go into all my other hell with her receptionistas or not getting my detail and such.  Just keep it to the questions on fragmentation so I can get my answers.  Again, just being a good patient and nice person in my desperate search for answers.  I'm such a wimp.


Wednesday, July 28, 2004

The Black House

On the drive to school, we passed by the house under construction in our neighborhood that Janie likes to call her "Black House."  She told me that she's going to go to the store after school and buy some black and a little blue paint so that she can get the outside painted.  I asked about why she needed the blue paint for her Black House and she told me "Because the black is a little crazy."

She's been telling me about the Black House for probably a year.  It is stocked with all her favorite things, and at one time even had her other two Mommies there and a black Grandma.  That part about other Mommies really hurt my feelings, but she never knew it.  Of course her other Mommies would allow her to do a lot more than I do, or at least that's what she'd tell me when she'd get in trouble.  Now she tells me that I have a room there downstairs, and I can live there with her, but she will be the Mommy and I will be the little girl, and she and Daddy will get married.  Her ducks all have to share a room upstairs.  The inside is painted red and black, and has lots of toys.  She said her bed is black with little pink monsters on it at the dentist.  Monsters are allowed to come into her Black House as long as they're going to be nice.  One time they broke a chair and they had to sleep outside.  In the backyard is a beach just like her Grandma's house, with lots of dolphins and no sharks.

The construction on this house is going really slow, which is good.  I'm worried about what will happen when it is done and they paint it a color other than black.  I don't want her to give up her marvelous Black House with all its happy black walls and black furniture. I'm trying to figure out what story I will tell her to explain the non-black exterior color it will inevitably be painted.  Maybe the monsters repainted it while she was at school, or it's painted black only on the inside or only in the back.  Hmmm, what is a good reason for a Black House not to be black?

Tuesday, July 27, 2004

Symptomless in San Francisco

Hope, a fickle mistress, has abandoned me yet again.

I keep thinking about those 5 celled embryos.  If they couldn't make it to day 5, then why do I think the ones transferred would be still alive?  I've been reading too many message boards lately.  I hear about women who have 3 perfect 8 celled embryos transferred and still end up negative.  I think of my highly fragmented embryos and wonder how they could have a chance.  They don't nearly compare.  I also think of those women who have perfect embryos who do get pregnant.  I wish I still had that hope, that chance.

It's a constant battle between hope and reality, and reality is winning.  I'm going to follow every instruction, take every precaution, and still be negative.  The problem is that because of these fragmented embryos, I've lost hope that I could get a better result in the future.  I could go through all this again, and still have fragmented embryos at the end.  Knowing it leads there, with a dismal chance of success, I'm left alone and confused.

Over the weekend, I had symptoms.  My left breast was really sore.  My nipples were very very senstive.  My face was flush.  Now nothing.  The symptoms were the last things keeping me in the life boat.  Now I'm outside in the very cold ocean, holding onto the rope, unable to climb back in, just waiting for my grip to tire.  What will I do when they give me the news?  Just let go and finally sink into the cold dark ocean.

A month from now I'll be back in school.  My beloved Berkeley.  Everyone will exchange stories on how they spent their summer.  I should be in South Africa right now with my classmates, learning about industry there and tasting their wine.  Instead, I gave up that probably once in a lifetime chance so that I could cycle in the summer without my school stresses.  Now I look forward to being back at school.  Something to feed my mind.  New information and people to meet.  No one sticking me with needles or telling me I'm lucky when relaying that my embryos died.  I'll be jealous as hell at all their worldly travels, but as long as no one is pregnant, no one will get hurt.

When I describe my summer, I will lie and say that I was very busy in a new project at work.  It's not exactly a total lie, I am busy at work in that big project.  I just haven't been as devoted as I should be, as I usually am.  My heart isn't in it.  I'm tired.  I'm unfocused.  I'm eating too much and sleeping too little.  I've forgotten who I am.

Actually, what never changes is my inner core.  I do know who I am.  I know that I am Janie's mother and Matt's wife, and one hell of an analyst.  I'm a closet comedian, a frustrated photographer, and fiction eater.  I just keep tripping into these sinkholes of depression, while trying to pretend everything is fine.  I've got to pick myself up and keep going.  It's not over yet.  I may have given up hope, and I may not believe in miracles, but I cannot afford to feel sorry for myself.

I wish tonight I could eat some fresh chocolates, take a hot bubble bath, light a few candles, and lose myself in a good book.  Instead, I will probably stay up late working.  Getting things ready for my many meetings tomorrow.  What gall of these people to think I should keep working when I'm in absolutely no condition to concentrate.  Don't they know who I am?  I'm Pazel dammit and I'm not done yet.

Monday, July 26, 2004

My RE office "Friends"

I called to check on my 5-celled embryos this morning.  The lab worker said, "You're lucky, your report is here on top.  There was nothing to freeze."  Next time there is nothing to freeze, please don't start the sentence with telling me that I'm lucky.  It's just like that commercial.  "Pazel, you have PCOS.  Your husband has male factor.  Out of your 21 embryos, only 3 are worthy of transfer and they probably won't implant because they are so highly fragmented.  The others didn't make it to blastocyst to have any to freeze.  But I do have good news.  I just saved money on my life insurance by switcing to Geiko."

I should never call that office.  Whenever I deal with those medical office workers I end up wanting to break things.  I wonder if they've ever experienced any patient just go nutso in their office.  They'd probably just shake their heads, blame it on the drugs, and how those infertile women are just so demanding.  Hell yes I'm demanding.  I want to know details about my care.  I want copies of my medical records.  I want to know lab results.  I want my questions answered.  If it doesn't work, I want enough information to be able to find out why.  I am constantly evaluating where I think I should be in terms of hope and despair.  Should I continue or quit?  Is that so hard to understand?

Apparently it is.  The office handbook must have distinct rules on how to treat patients.  Act surprised if they cry at bad news.  Never keep tissues around; that will teach them not to cry.  Tell them they're wrong for believing you when you say that they will be called back next.  Keep all their medical information from them, and if you have to tell them anything make sure you do not give any details.  Never return their first call.  Never ever apologize.  Keep the rooms freezing cold.  Keep no wipes in the rooms for cleaning themselves.  Don't forget to remind them at all intervals to remain positive.  Don't those darn infertiles know that their negative HPTs are the direct result of their negative attitudes?  I mean look at me, I'm the most bubbly nurse here because I know that I'll never have to go through all this.  It makes me smile and hum as I take the patient's vitals and tell them that the procedure may be a bit uncomfortable.  Not that I had ever been through it, just that those infertiles are all such babies.  Ha, ha, babies.  Oh those infertiles just can't take a joke.  At least they do pay well.  Bad news for them means returning business for us.  We just have to make sure that the doctors continue to pay the lobbyists to keep our very profitable line of business from being covered by those low paying insurance companies.  I mean, if there was insurance coverage for IVF, anyone could go through it just because they were infertile.  Can you imagine?  And how would we be able to afford our lovely black granite countertops or little red sports cars?  You know those insurance companies would pay us something closer to cost.  At least the profitable pharmaceutical companies are on our side, as well as the profitable insurance companies.  Together we can make sure those demanding infertile women never get that coverage and we keep making beautiful money together.

----

My RE office "Friends" theme song

So no one told you getting pregnant could be this way
You can't O, you're broke, his sperm is D.O.A
There's always new things you should learn to fear
Because it's not working this day, this week, this month, or even this year
But ... I'll be there for you
Til the drug costs make you poor
I'll be there for you
Unless you call after four
I'll be there for you
'cause you're paying me to.


Saturday, July 24, 2004

Moderately Fragmented

Today I returned to the land of the vertical and actually ventured out. This morning was Janie's swim lesson. She is getting so confidant, she was actually dunking herself when the teacher wasn't looking just to prove it to herself that she wasn't afraid. How can my heart not jump out of its chest in pride? That's my girl.

I did some disturbing googling on fragmented embryos. The cause could be from damage done to the egg by the ICSI procedure. It could also be chromosonal or from bad lab conditions. Mostly, it is unexplained or correlated to age. Light fragmentation is no problem. Extreme fragmentation means they won't transfer the embryo. Moderate means lower chance of implantation, and that's what it looks like I've got. One site said that the rate of implantation could be as low as 5%. Hmmm, I don't like that statistic. Seems too even a number. How come not 7% or 3%? Besides, other things I read say that the number of cells is more important or that it isn't sure how much fragmentation is important when it isn't extreme. For the ones we transferred, I don't think it was extreme. Sure, some of the others were, but they are now in some biological trash bag somewhere on the Peninsula.

I don't know how the 5 cells are doing that we left to culture. If they made it to good blastocysts then we could freeze them. The odds are small, but I wonder. The lab didn't call, and I didn't call them either. As long as I don't then there's always a chance.

Most times I'm between excited that I have three embryos inside me and scared that I'm doing something wrong that will cause them not to implant. I've gotten past my initial great despair about the quality and loss of all those embryos and have moved on, maybe to denial because I know it's not acceptance. Part of me is a little angry too. I've read about defragmentation and wonder why that wasn't done, or offered or even brought up as to why it shouldn't be done. I've also read that assisted hatching is often used with fragmented embryos to give them a better chance of implanting. This information would have been a lot more useful before the transfer. Now I've just got questions as to whether there were things we could have done. That's the point isn't it? To do all that I can, to exhaust all efforts, to know that it was our best try. How can I accept and go on if I don't think all was done that could have been done?

I will instead try to push these thoughts to the back of the file. IF this doesn't work, (see, I'm trying to be positive by saying IF instead of WHEN), then I can go through all this with Dr. Chickie. All this and more.

I dwell on all of this here so that I don't throughout my days. Today I splurged on all new bedding for Janie's room. Ladybugs, butterflies, and flowers in a mix of bright colors. She was so excited. How could that not make me happy too?

Thursday, July 22, 2004

Transfer

Transfer was today. We had assumed we would be able to have enough quality embryos out of the 12 that we would be able to wait for a Day 5 blastoyst transfer. I felt so sure about it that I sent my husband to work this morning, two hours from the hospital. Because I live 90 minutes from the hospital, I had to head out before knowing whether it would happen or not. They called when I was driving on the bridge, half way over the San Francisco Bay. There would definitely be a transfer today. There were quality issues. They would be better off in me than in the lab. She read me the numbers for all 12 but it was hard to take in while I was driving. I immediately called Matt and told him to head over, even though he would never make it in time.

I was starting to get weepy, so next I called Valerie. She cheered me up telling me that my kids weren't happy at some hoity-toity Stanford, they wanted to go to a community college. I told her that they were just like any other caregiver watching my kids, demanding that they be picked up early for bad behavior. She actually got me to laugh again.

At the clinic...
Receptionist: Have a seat. They'll call your name any minute.
Pazel: (Not believing her for a minute, especially because I'm 20 minutes early.) I'd like to get the numbers for my embryos to look at while I wait.
R: We can't release that information without waivers.
P: The nurse just called and told me this information 20 minutes ago, but I was driving and couldn't write it down. I'd just like someone to tell me the same information now in person so I can.
R: I'm sorry but we just can't release medical information.
P: Let me talk to a nurse. Let's pretend I just called in the IVF Nurse Line.
R: (big sigh, these infertile women are so demanding) Just a minute.

Nurse: I'm sorry but we can't give out copies of lab reports.
P: I just want someone to tell me the same information they called and told me 20 minutes ago when I was in my car. I don't need a copy of the report.
N: I'd love to help you but I don't have the report. It must be in the lab.
P: My husband can't be here. I wanted to call and tell him the numbers but I don't remember them since I was driving and unable to write them down.
N: (big sigh, considering it, then...) Just a minute.

Then she actually went and got the report and read me the numbers. I was thankful, but falling down into that big black pit of depression. Why does everything have to be such a battle? Why do they make me be that crying pitiful person when I really want to be happy?

In the room, I reminded myself that stress could cause problems with implantation. I needed to get it together. I needed peace. I needed to remind myself that I could get pregnant. I have a shot. I dreamt of Cancun, the white sands, crashing waves, cool drink in my hand, and night of good sex ahead of me. Deep breaths. Time to shove critical, untrusting Pazel in the closet and pull out Pollyanna.

Luckily I was in the room for a while before the embryologist came in. I was calm, smiling, pretending that everything was fabulous, that I was playing a part in a play. He went over all the numbers with me nodding goofily at each piece of bad news. I asked questions. He seemed so uncomfortable telling me all this. He probably loves being in the lab and hates this part of working with patients, especially ones with bad news. I smiled and said reassuring things to him each time he told me something else.

Out of our 21 eggs, 17 were mature, and 12 fertilized. Out of the 12 that fertilized, there was 1-8 cell grade III, 1-7 cell grade II, 1-6 cell grade III, 1-5 cell grade II, 2-5 cell grade III, 1-4 cell grade IV, 4-3 cell grade IV, and 1-2 cell grade IV. The best embryos have more cells and the best quality, with grade I being perfect. Mine had tons of fragmentation. The embryologist said that this is more common with women over 40. I'm 33.

Dr. Chickie came in and recommended that we transfer the 8, 7, & 6 celled embryos which we did. There was nothing extraordinary about the transfer. I was just trying to keep my calm, happy facade so during the procedure I kept mentioning the baby bird that must be lost in the room (the ultrasound printer made little chirpy noises.) Matt showed up about 20 minutes after it was over, in time to follow me as I drove myself home. At home I took the Valium I had for the procedure and slept for the rest of the day.

I study my picture of the 3 embryos. It's impossible to tell which one is the 6 versus 7 versus 8 because of all the tiny pieces of stuff. Fragmentation. I left my hope on the bridge. I'm back to going through the motions. Laying down and resting. It's okay, I need to rest anyway. I wish I had more of that wonderful Valium. I loved that stuff. I want more. I just want to sleep and dream that everything is fine. I want to go back to yesterday when I had 12 embryos in the lab and was sure we'd make it to blastocyst with more to freeze.

Janie has been sweet. It seems that because of all my surgeries and various procedures this year I am either constantly recovering and/or taking some kind of shots or pills. She came and gave me a kiss on my "owie tummy" to make me feel better. She brought her puzzle next to me. I think in a desire to make it more interesting, before she starts the puzzle she will hide one or two of the pieces. She will then put the puzzle together and act surprised that there's pieces missing. She then asks me to look around while she searches. She goes off to search for it, exactly where she hid it. She then returns triumphant, and puts the last piece in. She loves the extra drama she just created.

Me, I'd rather do without the drama. I'd rather that all the pieces fell together. Instead I'm left with questions.

I'd always assumed that the reason we couldn't get pregnant was because I didn't ovulate regularly because of PCOS and our male factor issues. We were missing the two basic ingredients to make life. I figured that as soon as we put the two together, things would be fine. Now the fragmentation has given me all sorts of questions. I had assumed that during the IUIs, the sperm just wasn't reaching the egg. Now I'm thinking that maybe it was but that the embryos that resulted had quality issues. When we created Janie, there were 6 follicles. I had always joked that Matt's best swimmer arrived and had pick of the six eggs, with the others left alone. What if they were all fertilized, but only Janie's embryo was enough quality to divide and implant? I wonder what it looked like. Did it have fragmentation? How many cells at this point?

Dr. Chickie was of course positive. She asked me about selective reduction, as if all 3 could possibly implant. She reiterated that I was young. What does that mean considering I have the fragmentation of an older woman? That I could just try again? This is the million dollar question. Would we try again? Or would we just accept our one miracle and move on?

Tonight I'm not going to worry about that. There's lots of time to decide. Tonight I'll just stay laying down and resting. I'll act that I'm fine, as if we just put in high quality embryos. This is not the end of the world. This is just more new bad news to add to the bonfire.

Wednesday, July 21, 2004

Waiting

What do you do while you're waiting?

I can't focus enough to work.  I try to work on projects that are mindless busy jobs, but I get distracted.  I read blogs, but some make me cry.  I read comments and I'm overwhelmed by the caring and support.  (It means a lot when you reply with your kind words when I know what you're personally going through right now.)  I review my IVF books, but they are never enough information.

One thing I didn't mention about my retrieval day was about that afternoon.  I woke up from my long nap and walked out to find my dear husband in the dining room reading my blog.  He tried to quickly close it but I recognized the stationary.  He was borrowing my laptop to look at tools on ebay and decided to see what was in my favorites.  He found this and started reading.  He said it seemed amazingly similar to our own story, until it hit him that it was his own wife's words speaking to him.

He then asked me a few questions about some of the things I'd written (like about his mother).  That was really uncomfortable.  He had read my diary.  Although I tell him all my thoughts etc, by reading it he is focused solely on my point of view without the obvious distractions of the day.  He said that my entries are the same style as they were back when we used to exchange all those letters.  Just the subject matter has changed.

So now when I'm writing, I feel a little bit more inhibited knowing that he's reading.  It's not as if I've been writing anything scandalous about our sex life or famous men I'd love to attack if only given the freedom and opportunity.  It's as if I've been gossiping freely in a room of girlfriends, and then Matt comes in and sits down.  Dude, go get a beer and sand your shelves or something.  I always get to talk to him, I want some girl time.  Okay?

I think about the embies in the incubator.  Strange that there's this part of the process where they're on the other side of the bay from us.  A body of water separates us.  Just like children, part of us, but separate.  When they go to college will I be as obsessed wondering what they're doing every minute of the day?  Will I remember this wait or will it be one of those things that is softened by time?

--------

I'm getting a little deep.  I need to lighten up or I'll drive myself crazy.  How about a most embarrassing memory?

I was in college and working in retail, domestics department.  I had quickly dressed that day in a pair of clean but previously worn black jeans.

GRANDMOTHERLY COWORKER:  What's that by your shoes?
PAZEL:  Huh?  What?
GC:  There, sticking out of the bottom of your pants.  What is that?
P: (reaches down and eyes black fabric sticking out from pant leg, in an almost magician flourish pulls out black lacy used panties for all to see)
GC:  Your underwear?  How did those come off that way?
P: (shrugs, smiles, shoves panties in pocket, pretends it's a neat trick, reminds self to always check previously worn pants for previously worn panties from now on)

------

Most recent search that drove someone to my site...  Condom-balloons
Can I come to your party?  But really, are you looking for other good party accessories to go with the condom balloons or were you curious if they could actually be blown up?  I can assure you that they do make decent balloons.  My cousin and I once made several with my uncle's secret stash before my very Catholic grandmother walked in and nearly passed out.  The relatives that Thanksgiving were split between genuine shock and trying to stifle their laughter.  Guess which side I took after? 


Tuesday, July 20, 2004

Retrieval!

First and foremost, here's the numbers.  21 eggs were retrieved, 17 were mature, 12 fertilized.  Considering that I was told I had 10 follicles and a few immature ones, this news was a huge surprise.  I'm giddy over the 12.  I just can't believe it.
 
Second, let me tell you my long and drawn out retrieval story, especially for those who haven't been through it before.  For the first time, I went into the room to help Matt with his donation.  It was strange to go into this room together at the clinic for the sole purpose of getting it on, kind of like being teenagers and hiding in his parents' bathroom, but it worked.  Of course I was left lacking, but then that's not the point.
 
I was to be there at 9:30.  We dropped off the sample at 9:10.  I was told that they would call me back any minute.  At 9:30, I checked again and was told that I was next.  One by one all four other women in the waiting area were called back, probably for ultrasounds.  There were no more medical files standing up in the queue, so at 9:40 I checked in again.  This time she went back and checked and told me that the woman with the appointment before mine was late, so they would be late getting to me.  For some reason, although I had been happy and excited all morning, that news sent me swirling towards the drain.  I got weepy and emotional.  It really upset me that they would give the earlier appointment to someone who didn't even care enough to make it there on time.  (Probably not the reason she was late, but at the time it was my main thought.)  Of course this is irrational, I know that now and I knew that then too.  I can't explain how it was this one little thing that threw me off, but it did.
 
Then they called me back.  The perky young nurse asked what was the matter and I tried to explain but it came out jumbled between the tears.  She told me that she remembered I was emotional at my hysteroscopy too. (Not True! I was fine before and crying afterwards because it hurt like hell.)  Dr. Chickie came in and told me not to believe the women at the desk, because they tell everyone that they're next or will be called back any minute.  I hope they pay them well for that level of service.
 
In reality, it was just the stress of the day finally manifesting itself and not the tardiness of the schedule.  It was only 30 minutes late, not that big of a deal, but it seemed so upsetting at the time.
 
I laid in the pre-op/recovery room after getting my IV, waiting for the room to be ready.  I was reading O magazine, but I couldn't concentrate.  Soon enough I was in the OR, getting situated on the table with my knees in the stirrups.  The first drug, fentanyl (like morphine) really relaxed me.  I was relaxing all my muscles and thinking of plump little babies.  I was nearly swept away by the calmness until my nose started itching.  It got worse and worse until I had to scratch it.  To do so I had to unbundle my arm and reach under the air mask, but it did feel better.  The anesthesiologist told me it was a side effect of the drug.  Then they gave me the other drug which knocked me out immediately.
 
I woke up when they were moving me from the OR bed to the gurney.  I asked if anything was wrong because I imagined that they looked at my follicles and they must have ovulated already.  No, the procedure was over and everything was fine.  I told them that I had a dream about work, which I really hate because I feel like I should get paid for it.  Anesthesia makes you say the strangest things.
 
In other surgeries I've had (gallbladder & lumpectomy), I've woken up from the surgery crying.  This time I didn't.  I assume it's because the premise for the whole thing is different.  This is something that I wanted.  Not IVF particularly, but trying to get pregnant.  I see this leading somewhere pleasant.  So the wake up reaction is something mental or emotional.  Or, this doc used better drugs.
 
Because of the number of eggs and PCOS, I have a higher chance of getting OHSS (ovarian hyperstimulation syndrome) so I'm trying to follow the list of things to do and not do.  I slept most of yesterday.  Today I'm sore, but trying to work.  My biggest problem is that the thoughts of this are consuming me.  I can't fit work in anywhere.  It just doesn't seem that important.
 
Thursday we will decide based on quantity and quality whether to transfer possibly 3 then, or to hopefully wait until Saturday and transfer only 2.  I'm so excited by having 12 fertilized because I feel that my odds are good at getting some to transfer and some to freeze just in case.  I can't imagine going through this all again, and don't know if I can.  But, I know that if it doesn't work, that in a few months I would feel differently and would be wanting another try.
 
12 fertilized.  A dozen.  May they divide and prosper.

Sunday, July 18, 2004

Reproductive Autobiography

Tomorrow is retrieval. I can't believe it. I'm starting to become suspicious of all this hope. How could I be so hopeful when I don't know anything?

Just a little bit of our reproductive history...

When we first started trying, I read Taking Charge of Your Fertility, and charted my temperature daily as well as checking all my other fertility signs. After some very long cycles, I realized that I wasn't ovulating normally and went to see my OB/GYN. He ordered some initial tests including the semen analysis. When we got the results back he told me that we would only get pregnant using IVF with ICSI because of severe male factor issues. We weren't ready to go that far yet. We did a few months of clomid and OPKs, which got me ovulating but not pregnant. We went to REs and had more tests. I was diagnosed with PCOS. Our first IUI was on clomid only. We then started injectables and the cycle was cancelled because we had too many follicles (8), the risk of multiples was too high. We were told to abstain or use protection. We didn't, and still didn't get pregnant. Next IUI was a clomid/repronex combo with 6 follicles. It didn't work. We took a month off for the holidays. Then we did another clomid/repronex combo IUI with 6 follicles. At the IUI they told us it wasn't going to work because of the male factor, and that we needed to move on to IVF with ICSI. Miraculously it did work. Janie was born in Fall 2000.

In May 2001, I stopped breastfeeding and we started trying again. My cycles were very regular, every 28-30 days. In summer 2003 we started with new REs, doing necessary tests. In November 2003, I was 2 weeks late. A million tests later including 2 blood tests my hope was crushed. I wasn't pregnant, just probably stopped ovulating again. In December I had my gallbladder removed. Also in December I had a mammogram after finding a breast lump. It was removed in January and everything looked good. We did our first IUI shortly thereafter on gonal-f/clomid combo with 2 follicles (started with 10). Next was only gonal-f with 1 follicle (started with 7). The third IUI was on follistim with 7 follicles, and still negative. It was time to go on. IVF with ICSI.

So what I'm trying to say is that I've been expecting IVF with ICSI since 1998, and my retrieval date is finally tomorrow.

It's interesting being here after having one child. Are we infertile? We certainly can't conceive on our own, but after having one I know that what I'm going through now is not the same as what I felt like before. On the other hand, I'm not in the mommy's club. I was part of a mommy group after Janie was born. All our babies were born in the same month of the same year. But when they got to be about a year old, the other mothers started getting pregnant. They were so excited to have their next babies be spaced perfectly and to have so many with close due dates. I stopped going.

I don't know if this will work, but I like trying. I like having some hope. I think I'll keep it.

Saturday, July 17, 2004

Top 10

Retrieval is Monday morning!  I've been smiling ever since.  Dr. Chickie wouldn't give me exact figures on my follicles, she just said that there were about 10.  I think that means there's less but she's not telling me.  That's fine.  I'll know more Monday.  The day after tomorrow.  Knowing how fast my weekends usually fly by, it will be here in no time.
 
I wish I had 12 eggs, because then I could say that I was carrying a dozen.  Also, I could do a calendar with my 12 follicles.  December would be my biggest who was 21 in the ultrasound.  I'll paint that one like a big ole Santa follicle.  Maybe he/she could be posing with the many other smaller, probably immature follicles who can be the elves.
 
On Monday they will also choose Matt's Top Ten sperm to use to inseminate the 10 eggs with the ICSI.  I'm thinking of a magazine like People only called Hope To Be People, which will put out its 10 Sexiest Sperm edition.  "Number 1 likes to swim, has a perfect sized head, and DNA for a girl with dimples.  Number 2 also likes to swim, loves his long tail, and has DNA for a boy with curly hair. "  And so on...  It would be a great issue, my eggs will drool over it.  Maybe I should clip some pictures and post in my underwear so that my ovaries stay motivated.
 
I guess on the rollercoaster ride, I feel like we're starting to go down the first big hill.  Hope is soaring.  My hands are sky high.  Wheee.  I know that there's so much more in front of us, but I'm just so thankful to be at this point.
 
Valerie asked me what I would do if I actually got pregnant.  (I hate typing that p word when referring to myself.  Bad juju.  Anyways...)  I told her that if that happened, I would be totally shocked.   I think I would be more shocked than someone who got two lines after having a one night stand and using two forms of birth control.  It feels so improbable, that it could never happen to me.  Again.  Lightening doesn't strike twice.


Thursday, July 15, 2004

That's Incredible

Here's a little replay of some actual work email fun I had today...

TO:PAZEL FROM:DI -- Hi! I noticed that you accepted the meeting for Monday only tentatively. Is it a bad day?

FROM:PAZEL TO:DI -- Hi back at you. You're back from vacation early. Did something go wrong? Monday is a possible retrieval date or it could be Tuesday....Transfer will be 3-5 days later but I won't know exactly which days I'll be off until later....I have 10 follicles which is okay as long as they all still continue.... and so on.

TO:PAZEL FROM:DI -- Oh Pazel, I'm sorry. This is Bernadette. I'm checking Di's emails while she's on vacation and setting up meetings for her. I should have told you who I was when I sent that message. I forgot I was in her emails.

Fantabulous.

--------------

So I ran into a girl I barely knew in high school at my brother's BBQ in May. I knew from my brother that she had gone through IVF many times, but she was there at the party with her 8 month old. She commented to me on our daughter and asked if we plan on having more. Because I knew her history, I answered that we would love to but making babies is not so easy for us. She opened up and told me about her story. It includes 11 failed IUIs, 3 failed IVFs, 1 failed adoption (had woman stay with them the last 3 months, was her birth coach, mother changed her mind after the birth), and then a final IVF that worked. Pretty incredible. My brother had told me that he thought the other cycles didn't work because they bought all their drugs in Mexico except for the last one. (He loves pat explanations. I know the truth is never that easy.) She didn't mention this, but said that she felt it was the nearly a year off for the adoption stuff before the last IVF that was the winning ticke. (Fertiles, please read carefully. This does not mean that applying for adoption got her pregnant, nor was she any more relaxed. Instead it was her ovaries that needed to relax after those years of continous cycling before this IVF cycle.) In any case, I liked her more than I did in high school. She was no longer miss perfect, or at least she wasn't in the same way.

But here is the incredible part, and I will do my best to recite this by memory...

"For all our cycles, Mike would go into that room to give his sample. He told me he would never touch those magazines in there. He said that he wanted to have the baby with me, not some other woman in the pictures. So he would just imagine me, and that was enough."

blink
try hard not to laugh outloud
'uh-huh'
now quickly change the subject before you lose it

Overdose

The clinic called yesterday and woke up my big purple Panic Monster. I had her safely back in the closet with some yummy cookies. (I feed all my emotions, which is most evident when I'm in a bathing suit.) While my doctor said everything was fine yesterday at the ultrasound, the clinic called later and told me to pick up some Repronex from the pharmacy to start that night. They said my E2 levels were fine (990 compared to 222 on Monday, whatever that means), but that Dr. Chickie wanted to add something. The Panic Monster started yelling through the door that the follicles weren't all growing or else why would she be adding something. Maybe the attrition has begun. It took me 3 hours to drive to the pharmacy, pick up the meds, and get back home (after I'd already done that 3 hour trip that morning). I missed a big meeting at work that had been set up for my benefit. So last night we did the Lupron, Follistim pen, and now Repronex (1 amp). This added up to 5 separate shots because we had 3 separate ones of the Follistim pen.

I love my follistim pen. I was always anxious about breaking the glass on the gonal-f, and throwing away medicine when we needed only a portion of one of the amps. With the pen, I dial up my dose, put on a needle, and I'm ready to go. When you're out of the medicine, then the pen should stop injecting and stop at the dose you have left so you know how much to do in the next cartridge. We were getting confused because it wasn't stopping. We figured that the dose in the cartridge must be right because of FDA requirements or just from greed of for-profit pharmaceutical company, so it must be the pen calibration. So when we've gotten to the end of the cartridge, we've been injecting whatever is leftover thinking it wouldn't be much.

Last night, I needed to take 300 IUI of follistim, but we knew there was only 200 left in the pen. We dialed to 200 and injected it. We then took out the cartridge and inspected it. There seemed to be more than a little left. Matt thought maybe we had miscalculated what we had used, or that we had dialed incorrectly one of the times. So we injected the rest, then injected 100 from the new cartridge. Online last night I found out that the cartridges are overfilled by about 100-120 IU. So, we've been injecting an extra 100 IU almost every other day. Obviously, with my 10 follicles I have not overstimulated, but these gives me many questions.

What do I do now? Do I tell my doctor? It was an honest mistake. I'm so afraid that she will cancel the cycle or back off on the drugs. She's so much more conservative on the dosing than I would be. I've followed all instructions exactly as written, but I know now that I've got even more drugs than she knows. What I want to do is not say anything because I'm being monitored anyways. But what if the extra 100 IU every 2-3 days is messing up the monitoring or hurting my follicles. Could this cause some of them to stop growing? I could stop on that extra dosing starting now, but there's nothing I can do about the past.

If I bring it up, I'll feel exceptionally stupid, but it's more about the fear of them canceling the cycle or decreasing my stims. If I don't, then I fear that things will not go well, and I will have only myself to blame. Obviously my Panic Monster is now driving, not yet at Mr. Toad's Wild Ride stage of panic but there's always tonight. Any ideas?

Wednesday, July 14, 2004

Our Sappy Love Story

Today I had another ultrasound, and this time I didn't leave the office upset. This would be unusual. I still have 10 follicles, which I consider good now because I had expected some to stop growing. There's always Friday's scan, but at least today there are still 10. I've come to accept this number and just hope that they all continue to retrieval day. Speaking of which, Dr. Chickie said it may be Monday or Tuesday. The days will crawl by until then.

In the meantime, I thought I'd share a little bit about how I met and married my husband Matt. We've been married now for almost 12 years. Yep, 12 years and one child. Makes that toast at the wedding about having lots of babies seem kind of bad luck now. Anyways, this story starts a long time ago in a place far far away... California in the 80's.

Matt was the new boy at my high school, starting at the beginning of our senior year. The first time I saw him was at a sweet 16 birthday party, where he came as someone's date. I distinctly remember checking him out because he was new and good looking. Although I had a boyfriend, I decided that I wanted to get to know him. One day while passing classes at school, I said hi to him. It shocked him he said because he didn't know me and most students weren't friendly to new people at that school. What he didn't know was that I had just come to that high school my sophomore year so I knew what it was like to be new. Also, I thought he was tasty.

We became friends and he dated some of my friends. A year after graduation, he stopped by my apartment to invite me to his going away party. College wasn't working out, so he was leaving for the Army. At the party (a huge college, beer keg, bonfire affair), I arrived a few hours before my boyfriend who was still working. Matt had been drinking and confessed to me some feelings for me. The next morning, I stopped by his place just hours before he was to leave. I gave him my address and a hug that seemed to last forever. Then he had to go.

He wrote me from basic training, communications training, and jump school (he was becoming a paratrooper) and then from his final base. Our letters started out friendly, but pretty soon got to be more than that. I soon broke up with my high school sweetheart of over 3 years. Matt came back at Christmas to take me out on our first date. I got horribly sick (my roommate probably poisoned me) and couldn't go out. My roommate met him at the door and said he'd be going out with her instead with no word of my being sick... and he said he was crestfallen but he took her on our date! I couldn't reach him before he left again, but through letters and phone calls we got it all straightened out and I got a new roommate.

During summer break, I went out to visit him. Our first date consisted of him picking me up at the airport and driving me to the suite he reserved. We weren't alone but for a few minutes before I attacked him. (Would that be considered sleeping with him on the first date or is the year of letter writing counted towards something?) He showed me all around North Carolina that week until it was time for me to go home. About a week later he was in the first group sent to the Persian Gulf (first Gulf war, first President Bush, same Saddam).

During the time he was gone, all I wanted was him to come home alive. We exchanged letters, but his would take about a month to get to me. Occasionally he would find a pay phone and call me collect (from Saudi Arabia!). When he asked if it was expensive I lied. I picked up a second job to pay for my phone bills. Besides school, I wasn't interested in doing much else so why not.

When he came home 9 months later, I flew to North Carolina to see him get off the plane. It was the most exciting day of my life. The plane was late and the tarmac (landing area) was filled with families and signs. When the soldiers got off the plane, they first had to get in formation to hear the band play and some speech by a mucky-muck that went along the lines of "Blah blah blah service to our country, blah blah blah." I was first behind this velvet rope holding back the anxious families. As soon as they were let out, the MPs dropped the ropes and all us civilians started running for all the soldiers and the soldiers were running for us. The soldiers were all dressed alike, so finding each other was not easy. All around me there were reunions with crying parents, soldiers meeting their new babies, or scooping up their wives and kids. And then we found each other and it was incredible. I never wanted to be apart from him again.

At the end of the week, I flew back home to California. Another week or so and he flew back too. Two weeks later he flew back to North Carolina and I was not happy. I didn't wait all that time and hope for so much for us to be apart again. We decided to move in together. He flew back and the two of us drove across the United States together. We got an apartment off-base, and I waited tables. It was a very happy time. One day at the restaurant, in his fatigues, beret, and leather jacket (he drove a Harley then), he proposed. 9 months later, he finished his time in the military, we drove back across country to California, got married, and moved north to go back to school.

Obviously there's another almost 12 years from there to here, but I think that's a pretty good beginning.

In the meantime, I will be a good little hen and keep sitting on these eggs. I may not be gloriously happy, but at least I'm not smashing mad either. Kind of in the middle. They call me Mellow Yellow...

Tuesday, July 13, 2004

The Harrassment Begins

I knew it would happen. There was no doubt in my mind. Yesterday, while I was pouting about the ultrasound results, my MIL (Mother in Law) tried to call me. I saw her number in caller id and did not pick up. No way. But just her trying to call me upset me. That seems unreasonable, but I can't handle much of anything right now. About 2 hours later, after Matt was home from work, she called again and I made him answer it. All I could hear was his side of the conversation.

"Hi Mom...Nooo, she's busy right now...Well thanks Mom for the offer, but I don't think we need any help...Actually, we talk about this so much that we don't like talking about it..."

Pretty benign conversation right? Then why does it irritate me so? Matt hung up and said, "See, I told you she was only calling to offer to help." How exactly can she help? Buy him porn for his donation or sew me a cozy for my sharps container? I know why she was calling. She was wanting to ask me lots of questions, then tell me that she knows how I feel, and to laugh. She has a habit at laughing at all of my problems. She thought it was hilarious when my husband was gone for three weeks in October/November to repair the Los Angeles fire damage and he missed Halloween and his birthday. Why? Because my FIL used to do the same thing and miss all the holidays because of work. According to her, she knew how I felt. She always says this, than laughs and laughs, which clearly demonstrates to me that she doesn't. Matt doesn't want to hurt her feelings so it's always up to me to be the better person and see beyond the laughter. I can't. I'm not a better person. Right now I'm a bitter person, and I'm not in the mood.

This is exactly the reason we were keeping this a secret.

So last night Matt and I got into a small fight. I was mad that he told after he said that we wouldn't, when I had kept it from my mother for her whole visit. He didn't believe that I didn't tell my mother, and also claimed that I told all of Arizona so it didn't matter. I have told one sister, my best friend, and my 3 bosses. That's it. Now that his mother knows, I'm sure she's told his whole extended family. Matt felt that I was putting him in the middle by not dealing with his mother myself. I told him that I would gladly deal with his mother myself, but he wouldn't be happy with how I handled it. Definitely not. I guess I just felt like he too had abandoned me and left me to the wolves. I'm not a priority to him, at least not as high as his parents. (There's a long history to this, which I won't get into now.)

Now I've got to watch my phone or I could get unwanted calls on a subject that I do not want to talk about. And I've got to tell my family or it won't be fair. I'm frustrated and there's absolutely no hint on how to handle any of this in any of the 3 books I've read on IVF. Not a word.

Monday, July 12, 2004

Should Be Happy. I'm a 10.

10. 5 on each side, about the same size. I suppose I should be happy. Dr. Power Chickie was happy. 10 was her goal. My goal was higher. This is a numbers thing. I want more to have some leftover to freeze just in case. More importantly, I've had 10 follicles before and in the end I had only 2. The other 8 stopped growing. So now I'm on a ton more drugs, but got the same amount to start as before. How can I be excited about this? At the same time, I was also presented with my big bill for this fun cycle, to remind me how much I'm paying for this ride.

I should be satisfied I suppose. Some women would like to have 10 (of course they also probably finish what they start). But for me, when she told me, mentally I started thrashing the room, throwing the ultrasound machine aside, throwing the boxes of gloves at the walls, upending the chairs, screaming the whole time "I. Told. You. You Wouldn't Listen! I Told You It Wasn't Enough!" But, alas, I am not Hulk woman, so I nodded my head and told her only that it was not as much as I wanted. She said we could increase another 50 IU. Frankly, I don't think that's enough to get anything that could catch up. No. We spent our wad, we listened, we did as we were told, and we got what I figured we would. Not enough.

Yes, I should be happy but I'm not. I'm pissed, I'm sad, and I'm worried. I'm not grateful. I'm paying too much (money, time, opening my insides for all to poke at and comment on) for it to be not enough. In case you were wondering, my Bitter Bitch is typing today and refuses to hear any sort of encouragement or reason. There is none. I knew this would happen, I warned them and begged for more, yet I didn't do enough to stop it. I could have increased the dose those two days, but I listened to Dr. Chickie. Young, inexperienced, cold Dr. Chickie. I hope she's happy today, because I'm surely not. (Of course I also know that she probably does not think of me outside of the time when she's in the room with me. That's why she keeps forgetting my medical history, namely that I have a child already.)

On other notes, the receptionista had me review my account information to make sure it is correct. (I've been their patient since January, but okay.) It said that I am Unemployed. What? I've been at this job since 1997, full-time, non-stop. I know my other RE at their practice Dr. Been There even asked about my working for a hospital. Of all the spice girls, I'm Working Spice. Unemployed? It was like a final slap in the face.

Watch out everyone. Bitter Bitch coming through.

Saturday, July 10, 2004

Chicken or the Egg

We were driving home from Janie's swim lesson when I saw a sign. Something about the Hill and Valley Women's Club. I wonder if they have dances with the Peninsula Men's Club.

I love the weekends. I can clean or do projects or catch up on work or just hang out with my family. This weekend, I just want to get to Monday. Monday at my ultrasound I'll get my first idea how this dose is working out. Right now I just want to lay on the couch and dream of my ovaries like jiffy pop bags, growing huge with tons of follicles.

Yesterday I couldn't help but notice the many egg refernces all speaking to me. Janie watched Chicken Run which carries themes about the best hens having the highest egg production, and how valuable the eggs are. (No kidding!) Then Matt says that a biologist pointed out some pelican eggs in a nest. They were very large, but dead, so the biologist let his boss take them. He was going to bring them home to show his family, but left them locked in his truck. I hope it smells horrible by Monday.

My mother left this morning and I felt bad. She didn't mention anything about infertility or trying to conceive or the drugs in my refridgerator the whole time she visited. This is so unlike her. I have to assume my younger sister strongly warned her not to, because my requests in the past had been mostly ignored. I felt bad that I didn't tell her about the IVF. I'm sure she would want to know and ask questions. I told that stupid woman at my work, why not my mother? Oh, that's right, because she can't keep a secret to save her life. I just wish that I could trust her to keep it to herself so that I could share it with her. Instead I'm stuck feeling bad. I just can't win sometimes.

Friday, July 09, 2004

Come to my Party

My mood is definitely on the upswing. I'm home again, started my stims last night, and feeling fabulous. Of course it helps that just last night I encountered a few extra friendly men at the airport. I'm convinced that men find me more attractive the more fertile I get. Of course it could be my mood lifting as my hope starts to build, but I really think that it's something innate leftover from their cavemen days that helps them sense when a woman is fruitful, a good candidate for their seed. Generally I'm not. But, once I start stims I become not only fertile, but super fertile. I go from being plain jane to sexy mama, but without a change in wardrobe.

I am always surprised when I find that someone has read my blog. I read it and it's horrible. There are so many other blogs on infertility that are funny, insightful, interesting and entertaining. I fear mine is none of these, but long boring diary entries. Dear Diary, I'm sad. Dear Diary, I'm happy. Dear Diary, why are there no tissues in the ultrasound rooms when of course I will cry or at least need them to clean myself up afterwards. Who likes that blue goop to remain on them from the trojan-covered wand? I always have to root around in the drawers to find some scratchy paper towel type things to use to get myself back together. One of these days they're going to find me half-dressed, rifling through the cabinets, and fear that I've finally lost it and looking to steal all their lovely white drapes. Yes, and then I'm going to steal all your condoms too so I can have an IVF-theme party with condom balloons, guests in gowns, catheter drink straws, blindfolded game of wand the woman, and noise makers made from speculums. Oh yea, it will be fun. For the door prize, everyone will pull a number out of the hat and the one with the most follicles wins. It will actually be a fundraising event to raise money to buy Playgirl for the exam rooms. Why do the guys get all the fun? Why can't sexual gratification for women be incorporated somewhere into the process?

Thursday, July 08, 2004

Miracle Stories & Infertility Ballad

I don't know what happened, but I woke up feeling like myself again. The fog had lifted. Thank God!

While waiting for a meeting to start at work, another woman I work for/with Suzan was talking about birth plans with her pregnant assistant. For some reason I'll never understand, I spoke up and said that my next birth plan is to go straight to c-section. This got Suzan all excited. "Are you pregnant? Are you trying? Maybe you're pregnant." I love Suzan. I think she's bubbly and aggressive, very funny and unprofessional for a woman in charge. I tried to do my usual reverse maneuver, but it wasn't working, she seemed convinced I was pregnant and she had the scoop. I later went into her office and explained that this month we were going through our first IVF. That we had tried many different methods including 3 years 'natural' and this was something we were trying. Then something happened that I truly didn't expect. I got a speech on the miracles of not trying. You know what I'm talking about. Infamous stories all with the same moral that as soon as you stop trying or adopt you will suddenly fall pregnant. She was serious. She wanted me to believe. Me, practical me. She had hope in her eyes, gleaming with her insight on how to get pregnant. (After all, she got pregnant 2 weeks after stopping birth control pills, both times.) I didn't know what to say. All my witty responses I usually reserve for the uneducated had flown out the window. I was left stunned, nodding like an idiot, trying to look like it was good news. She even asked if we had talked about adoption or planned on adoption if it didn't work. Yep, I got miracle stories for lunch with a dessert of then-I-guess-you-can-always-adopt. Wow. I was starting to think that only my mother held such outdated, ignorant beliefs but here in front of me was an otherwise intelligent woman spouting nonsense to me as if it were fact. She then told me how she thought her brother and his wife loved their no kids lifestyle until they found out years later that they had been trying all that time to get pregnant but never could. She couldn't understand why they didn't tell her. I know, and I also know that I regret telling her with every inch of my soul.

--

On other subjects, I was thinking today of the need for more songs about infertility. The only one I can think of is Heart's "All I want to do is make love to you." It's even about male factor, a subject about my own life except that in the song she took the more inexpensive route to babyhood. I guess it wouldn't be romantic to sing about ICSI or picking a frozen sperm donor. I love this song, but I can't sing it around Matt or he gets uneasy.

There just aren't any, especially ballads. All the romantic songs end in marriage and babies. None have to do with infertility, much less secondary infertility or male factor. I'm not sure how the songs would go but maybe something like this...

We got married on a Saturday,
Planned on having babies right away,
But something happened on the way,
Because then the doctor had to say...

You've got no chance.
You don't get to dance.
There's no way for you to do it all on your own.
But you can try.
And you will cry.
Because you will never ever do it alone.

So she started taking lots of drugs,
And demanding extra loving hugs,
With the madness starting overnight
Because we couldn't do this one thing right.

We've got no chance.
We don't get to dance.
There's no way for us to do it on our own.
But we still try.
And it makes us cry.
Because we never wanted just the two of us alone.

Then one month she started IVF,
Hoping for one good try left.
Crossing fingers and our toes
Because deep inside we both know...

We've got one chance
For our turn to dance.
There's only one way for us to do it, not alone.
And so we'll try.
And it'll make us cry
Because we never got to do it on our own.

But we've got a chance.
We've got one chance.

Wednesday, July 07, 2004

Warmed Lupron

I'm not a shark today. This morning I was a wreck, and started crying at the drop of a hat. That's not me. That's not how I react to things. My meds got warm on my trip to Arizona. I put them in a semi-insulated cooler with a freezer pack. Unfortunately, it was 110 when I arrived, and the 1 hour car drive must have heated them up. The idea of them not working or having to buy more tore me to pieces this morning, and still makes me upset. I can't explain why. I called my Nurse "Help" line at my hospital and the nurse, who barely spoke English, kept telling me that it was okay that they were out of the fridge because it rarely gets that warm in Northern California. How many times did I tell her that I was in Arizona and it was 110? She told me it was okay, not to worry, and sent me on my way. I, of course, have absolutely no confidence in what she was saying. How could I when she didn't understand the concept of air travel?

I just called my pharmacist back home and he wasn't available. His assistant pharmacist said that it probably wasn't any good and would need to be replaced. He was kind enough to remind me that the box clearly states that it should be refrigerated. He said to call back and talk to my pharmacist in 30 minutes. In the meantime I called a pharmacist here in Arizona to make sure they'd still be open and he said that it would probably be okay since it wasn't out for a long time and didn't get too hot. He says that he is used to heat questions because he is in Arizona. I don't know what too hot means with medicine, but in any case I'm not having a good day. I'm on the edge of losing it and I fear for any traffic I face on my drive. For their own safety, may they not try to cut in front of me.

I wish I had more faith in what people are telling me, but I am too far gone. I believe that they are trying to reassure me so that they can get on with their own business. They do not have such a large stake in this as I do or else they would clearly have concern in their voices. I want them to sound near suicidal in their desire need to help me. Actually, if they were half as concerned, they would be running here to comfort me and bring me free replacement meds just to ease my troubled soul.

Alas, I am a simple princess unrecognized. My needs are simple... let the me one month from now come back and tell the me now all the answers. That future me knows how many follicles, how many fertilize, how many grow, how many transferred, how many frozen, and how many take. She is the only one who can help me, but she is the only one who I can't call. And a month from now I will be wanting to scream at present me to get replacement meds or not to worry so much. I will know all the answers and will be shaking my head at poor pitiful present me who knows nothing and fears everything. What is it about this process that turns me from a shark into bait? I am nothing but a shaking quivering mess, barely able to contain myself to ask a simple question about the viability of Lupron and Fertinex after it has been warmed up.

Tuesday, July 06, 2004

Want Stronger

I just got back from my ultrasound. I had a long talk with Dr. Chickie, and she's willing to up the dose of stims by 50 IU but doesn't think we should. She thinks the risk of overstim will be high. She looked me in the eye and said, "You're my patient. I want you to get pregnant and not get sick." I hope she's not just being conservative on the dose to cover her ass. I told her that a goal of 10 follicles is low if only 7 will fertilize, and 4 will be of good quality, then we'd have enough for this cycle but not enough for freezing. I want a plan B. I want to know that if it doesn't work, we can defrost and try again. There's not going to be another cache of money for another fresh cycle. But as she is young, younger than me, I am sure she's never been through this, and I am also sure that she doesn't fully grasp what I'm talking about. Oh sure, she speaks English and can understand the words, but not the full meaning. There's no way she can get it without having gone through it.

Part of it just seems so hopeless. I can't imagine success. I guess I should be able to since we do have Janie, except that I think she was such a fluke, medically assisted fluke, but still very much against the odds. I can't imagine coming up winning again. I can't grasp it. Maybe it's the 38 failed cycles we've been trying (since I stopped breast feeding) or the 3 failed IUIs. For each one, I would start out blooming follicle buds, only to have them stop growing eventually, ultrasound by ultrasound, until there was only 1 or 2 left of the 10 we began with. As they would decrease, so would my hope. I knew that we needed many targets because of our severe male factor, but they wouldn't listen. They were concerned with multiples, when I told them that I needed many to just have one. Multiples is not my problem, getting pregnant is. I'm so afraid that I'll go through this and once again, it will start out fantastic, lots of follicles, and then I'll have to go through the attrition as they falter and eventually quit. In the end I'm left with nothing but an empty wallet and a new defeat. Each one makes me more doubtful of their claims that they can get me pregnant, that my case is easier in comparison. If it's so easy, then how come it hasn't worked? Aren't you the great Stanford? Isn't that supposed to mean greater success not more failures?

I was thinking about Gena Davis on my drive home. Yes, she's had twins at what, 46? Yep, I'm sure it was donor eggs, but she definitely hasn't come forward with anything about her need for assistance with fertility. No. Celebrities just don't. I can respect that, because I like to keep my stuff secret too while I'm going through it, but not after the fact. Anyways, I like Gena Davis. I think she's quirky, and interesting. I like her movies and that she learned archery to such a level that she was or almost was going to be on the Olympic team. There was one movie I liked where she was an action hero, maybe a spy? The enemy had her tied to a water wheel and was repeatedly rolling her into the water to nearly drown her in an attempt to soften her up and extract some information. Instead, she got stronger and stronger and eventually broke free. It was a great scene. I wanted to be her. I want to get stronger and stronger against every action of my enemy. Instead, I think I put all my strength into just trying to look normal. It gets harder and harder. I wish it wasn't an act. I wish I could just be stronger against whatever they throw at me, but alas I am no heroine, just another patient. I'm not fighting for my life, but sometimes I feel like I'm fighting for a normal one.

I just want one more. Please. This little girl has been the world of difference to me and she is my sunshine. I know that I'm asking for too much to have that lightning strike again, but I have to ask. If it's not going to happen, I need to know that so I can move on, but I can't do that until I try, really try. It's more important than money or my job or most anything except Janie, and she'd really like a sibling.

What a horrible hormonal wreck I am and I'm only on CD3. I don't start my stims until Thursday. In the meantime, it's just about continuing the Lupron and hoping that I'm doing enough. That the dose is enough. That I'm getting all I can from Dr. Chickie and her band of merry maidens. I hope this won't end in a crash and burn. I can't promise I'll be stronger then or what I'll be like. I can only deal with today, and I'm not doing that well.

Well, maybe I am.

Monday, July 05, 2004

Elaine's Chart

Remember that episode of Seinfeld when Elaine had something in her chart that made all doctors not want to see her for her rash? I think I have the opposite. I think my chart says "Great Insurance! Recommend surgery and don't forget to leave something for the next doc."

My general practioner gave me a referral to an eye doctor today for surgery on my eye. I'm still holding onto the referral to the oral surgeon I got from my dentist in January to have my wisdom teeth out. In December I had my gall bladder removed and in January I had the breast lump removed. I've had the hysteroscopy, 3 IUIs, and a million ultrasounds and other doctor's appointments just this year as we've marched towards our IVF cycle this month. I cannot comprehend how to get more doctors appointments into my schedule, let alone more surgeries. I want to scream.. I'm a Healthy Woman Dammit! Leave Me Alone!

(Of course it could be said that *I* decided to have all the infertility treatments, except I don't see it that way. If I could decide, I would conceive my children at home with just my husband and for free.)

The only thing I had to comfort me this morning as I pulled myself out of bed after a late night of BBQ and fireworks was that this doctor would only be looking at my eye so at least no stirrups and under-gown examinations.

Friday, July 02, 2004

Soft on the outside, hard on the inside

My father likes to say that my sister Karen and I are opposites. Karen is my only older sibling, by 15 months. Dad says that Karen is hard on the outside but soft on the inside, like a chocolate covered marshmallow. From outward appearances she is tough. What can't be known from her surface is that she is very sensitive, writing poetry and fiction.

He describes me as her opposite in that I am soft on the outside but hard on the inside. (Nice thing for a father to say, isn't it?) I smile a lot, making jokes, and I'm very friendly. But apparently I am cold as steel on the inside in his opinion.

I find some truths in his comparison in that I am tougher than I appear. Maybe it's the dimples, round cheeks and smile that makes some people think I'm a pushover, until they find out that in business or finance I'm a shark. I have to be tough or I'd never survive. I have to be.

Last night I thought about this as I was flying home, keeping to myself and not striking up conversations with seatmates. I was unhappy because I didn't get my first class upgrade (for being a frequent flyer) so I had to sit in steerage. When I'm coming home from traveling for work, I'm exhausted. I feel like raw hamburger. I just want to read and try to relax. I fly so much that although I always look, there is no one to meet me at the gate when I arrive. No fanfare, no big deal.

Back to the IVF, nothing exciting going on there. I took my last birth control pill last night. I could say that it was my last one for life, but that would be bad juju so I'd better not. Instead I'll just say that I'm looking forward to the more exciting portions of this process... growing follicles. I'm hoping that I will produce plenty. I'm kind of concerned that I think what they are planning for my stims is too low. I can only afford one damn fresh cycle, so please let's crank it up a notch. Here's a little summary of the call I made today to 'reassure' myself.

Pazel~ Hi, this is Pazel. I called Monday with questions about my protocol and never got a call back.
Little Girl--I've been monitoring the phones all week. There is no way you called on Monday.
P~ Well I did. It went straight to voice mail and I left a detailed message stating-
LG--(first of many interruptions)Did you do option 2 or option 3?
P~Option 2 of course.
LG--No. I'm sure you didn't. I've returned all calls and you never left a message.
P~ I did. My question is regarding my stims. I'm concerned that they're too low considering the Lupron and that the dose isn't much different from when I did my last IUI. Then-
LG--It's not too low. Other patients have told us that it was too low and then they ended up overstimulating when we increased it. We will look at the number of follicles you have in the early u/s to tell if your level is high enough.
P~ From my past IUIs, you can see that I only finish 10-20% of the follicles I start, so-
LG--Other patients with male factor or PCOS (we've got both) tend to overstimulate so we have to keep the doses low. We will check on the first ultrasound and see how many you have and if it's only a few we can increase it.
P~ One IUI I stared with 10 and finished with 2. They changed the dose and I started with 7 and finished with 1-
LG--(interrupting very Ross Perot style) Can I finish? Can I finish?
P~ What?
LG--Like I said, we will check it on the CD 7 u/s and can adjust it up from there.
P~ My concern is that it took 3 cycles for you just to get the stims right for the IUIs because you had assumed I would overstimulate and perform like other patients when I don't. I can only afford to do this fresh cycle once and-
LG--We don't want to have to cancel your cycle because you overstimulate like other patients.
P~ I will cancel my cycle if I understimulate and only have a few. I-
LG--Oh we won't cancel for that. We can still do it with a few.
P~ Like I was saying, for *my* money, and considering I can only afford to do one fresh cycle, *I* will not go all the way to retrieval and transfer if I only have a few. It has to be worth it or-
LG--Dr. Power Chickie will see you on Tuesday and you can go over this with her then.
P~ I will. I definitely will.

So now during my u/s on Tuesday, I'll have to pin Dr. Power Chickie down long enough to tell her what I think of her office. First, I called and got no call back. Second, her Little Girl office worker basically called me a liar instead of maybe, oh I don't know, apologizing. Third, she was domineering and didn't hear a world I said. Had this been an actual emergency and I was under emotional duress from the drugs, I would have ripped her head off. Is this the type of treatment I am to expect from her office? I'm fine with confrontation when it is immediate, but because it's not until Tuesday I'll have to play it out many many times and probably lose sleep over it. Time to put that steel inner core to good use and not back down. Did I forget to mention that I hate medical office workers? Nurses are great. Doctors are fine. Medical office workers are self-anointed princess idiots from hell.

Thursday, July 01, 2004

Kinder, more gentler Pazel

Today I'm not so angry. I think the Lupron has washed out all the extra testosterone in my system from the PCOS, mellowing me out. I read in the detailed warnings that if a man takes Lupron for 2 weeks his testosterone will decrease to castrate levels.

Last night after dinner at Valerie's, we were laying on the couches watching The Last Samurai. During the long, pretty depressing movie, Valerie laid little A (6 weeks) in my arms for about an hour. She slept and I stopped watching the movie. I played with her fingers, touched her hair, and just listened to the tiny baby noises she makes as she sleeps. She continually makes these little baby coo noises with every breath, happy noises kind of like a cat purring but a lot more high pitched. When she's awake, you can't help but notice her Down's syndrome from her eyes and open mouth. The features become so very obvious that you can't help but notice. But, when she's sleeping in my arms, she looks and feels like any other baby and it's easier to just notice her features from Valerie and her husband instead of the Downs. Holding her is so peaceful and calming, as long as I keep my tears in and keep my mind off my own selfish needs and desires.

Today I'm suffering from rug burns on my knees from chasing Valerie's toddler earlier last night while crawling on her berber carpet. Every time I'd stop he'd give me the sign for more. (He's not deaf, just learning signs.) I couldn't turn him down. For the past 1 1/2 years he's been suspicious of me, and not wanting to play with me. This time he couldn't get enough of me. I wonder if it's because of his age, or maybe since everyone's been giving the baby attention, or perhaps he likes me because of my association with Janie (she's fabulous, so as her mother I must be okay).