Saturday, March 30, 2013

The Two Week Wait - Dos and Don'ts


  • Calmly submit to daily assault by giant needle.
  • Try this process with both lying down and standing up.  One might leave slightly less debilitating pain in that hip for the next 48 hours
  • Peel a whole pineapple and cut cross-wise into five equal sections.  Eat one section, including the core that tastes like wood, every day starting the day of your transfer.  Some hippies think the bromelain helps make the womb stickier
  • Keep your feet warm.  Wear socks.  Eschew the ballet flat look even though you're 6 feet tall and it's spring.  Socks and shoes.  Acupuncturists claim that warm feet = warm uterus.
  • Actively seek out relaxation activities (excluding all the awesome ones listed in the next section). Schedule a massage.  Meet with your acupuncturist.  Start a visualization ritual.
  • Hang out on the forums for neurotic women just like you.  They understand your need to overanalyze every tiny thing.  If you need a dictionary to know what's going on, try this.  
  • Remember that you're incredibly lucky to have had this opportunity, regardless of how uncomfortable or stressed you are.


  • Take baths or use heating pads, no matter how much those progesterone shots make you long for some intense heat therapy.
  • Drink wine, coffee, tea, or soda.  You will really need some wine, but no, you can't have any.
  • Exercise or exert yourself in such a way as to raise your internal body temperature.  You'll just have to continue not going to the gym you don't belong to.
  • Lift anything heavier than 10 pounds.
  • Don't have sex.  Orgasms cause uterine contractions.  It's like an earthquake for the poor embies.
  • Start home pregnancy tests too early.  That way lies madness.
  • Freak out too much about your weight fluctuations; this is a bloaty, floaty time.  You may also be craving inordinate amounts of dietary fat.  For instance, I just chased my morning oatmeal and blueberries with chips and guacamole.
  • Call your husband a filthy name right before he has to stab you with a very long needle.  He was only asking to use your car for five minutes.
  • Stab your husband right back with the needle, even if the mental rehearsing of it brings you unbounded joy.
  • Scream at your husband for not immediately replenishing the milk and butter.  He did not know that your every hope hung on buttered toast and steamed milk when you woke up.
  • Punch your husband for reacting so calmly to the above cursing, stabbing, and screaming.  That's how he deals.
  • Tearfully explain to your husband every morning how sorry you are and how unbelievably moody and out of control you feel.  He knows.  Just....shut up.

Sunday, March 24, 2013


Jake and I held our breath and grabbed for each other's hands when the embryologist came in to tell us about how our two soldiers fared over the last few days.  We had gotten past the point at which they would call and say "Don't come.  Both arrested," but for all we knew, we would still be putting in only one sickly looking embryo.  I braced myself for the worst and tried to keep breathing.

"As you know, two fertilized, and both look very good.  One has eight-cells, which is ideal, so I graded that a 6, our highest grade.  One has 9-cells, which might still be great, but because it's not the desired 8, I grade it a 5.  They both look very good."

It was at this point I started crying.  They're BOTH good?  We have TWO that look promising?  My terrible ovarian reserve didn't end up hurting us at all.  I couldn't even process my relief and gratefulness.  I had to restrain myself from kissing the doctor.  The fact that I was only wearing a sheet is probably all that kept me in that bed.

I love them so much.

Friday, March 22, 2013

Thing 1 and Thing 2

Tuesday morning the doctors confirmed that I had at least two follicles that were ready for harvesting, which means it was time to pull the trigger.  Literally.  I had to give myself a shot called the "Trigger."  It's meant to mimic the LH (luteinizing hormone) spike that normally occurs during the cycle to encourage the eggs to get too big for their britches.  I needed to take it EXACTLY 35 hours before they would harvest my eggs.  Three days later, that sucker still hurts.

Wednesday was a wonderful IVF reprieve: no appointments, no shots.  Thursday morning, I went in for retrieval.  They put me under mild, sleep-inducing anesthesia since, let's face it,  nobody wants to be wide awake while doctors shove a giant needle up their vagina.  Once I woke up again, the doctor informed me that they got four eggs.  Not great, but better than I was expecting last week.

After that, the nurse showed Jake how to give me the progesterone the arse.  As you can see on the above chart, progesterone is supposed to raise significantly after ovulation to support any developing pregnancy.  The problem is it's made by those little yellow spongey-looking things, the same ones that will be thoroughly mangled and drained by the egg retrieval process.  Though progesterone-in-oil intra-muscular injections are rumored to be quite painful and though the needle looked comically large, Jake did a great job!  I didn't have to curse at or kick him even once.  Before we left, Jake left the doctors with a fresh cup of baby batter.

The next morning, we got the highly anticipated fertilization report.  Apparently, that fourth egg wasn't mature enough to even be fertilized, so they tossed it aside.  The three remaining eggs got the ICSI treatment, and now two are actual oocytes (fertilized eggs).  They look like this:

See the two little circles in the center?  That would be Mama DNA and Daddy DNA.  They're snuggling and thinking hard about how to begin dividing.  Because we had planned on putting back two anyway, there's not much point in waiting for a Day 5 transfer, an option many couples take as they wait for the hardiest oocytes to develop into blastocysts, proving themselves worthy of transfer over all the other losers.  Hence, we'll stick them back in at the earliest opportunity, day 3, Sunday.  It's sad that we won't have the option of picking through a bunch for the best-developing embryos, but I'm just grateful that we even have two to work with at this point.  We're remaining very guarded with our optimism, but it's far from over.  We're still in this.

Monday, March 18, 2013


It's official.  I suck at making babies.

Even on the uber aggressive "poor responder" drug protocol, I am responding poorly.  I may only get 3 eggs out of two weeks of intensive drug dosing, a truly pitiful and dismal showing in the world of IVF. For best results, I should be getting closer to 15, though my antral follicle count prior to starting led them to believe I would make at LEAST a solid 8.  But 3?  Pathetic.

You may wonder why I would need 15 eggs to make a single baby, when most women do it just fine each month with just 1.  To begin with, of 15 retrieved eggs, not all will be mature enough to fertilize, only about 60-70%--down to 10 eggs.  Of those, which we'll fertilize with the ICSI method, only 70-80% may fertilize--down to 8 embryos.  At this point, we let them grow a minimum of 3 days; many embryos may die in the dish, some will fragment or fail to thrive, and a few may look ready to transfer, we'll say about 30%--about 3 embryos left.  Of those, the embryologist will grade them to decide which have the highest probability of implantation and implant the best two, freezing the other one only if it looks really strong.  After implantation, each embryo transferred has a 45% chance of making it to a live birth.  See why you'd want as many as possible?  See why I feel totally screwed and hopeless right now?  3.  Harumph.

Meanwhile, still sticking myself three times a day and shelling out even more money for a few more boxes of Gonal-F.  I'm also now going in every day for monitoring, rather than every other day.  I expect we'll do the egg retrieval by the end of the week.  I'm afraid this post wasn't very entertaining.

Saturday, March 16, 2013

Slow and Steady?

I'm about halfway through the stimulation phase of our IVF cycle, and I've had three monitoring appointments so far.  The point of these is to ensure that I'm being pushed hard enough by the drugs to be successful, but not so much that I'm at risk of Ovarian Hyper-Stimulation Syndrome (OHSS) (aka super scary ovarian explosion disease).    The things measured at each appointment include: thickness of the endometrium, number of visible follicles, diameter of biggest follicles, and the estradiol levels.  Here's my lady-bits' report card.

  • The endometrium should be between 6 and 14 mm thick.  Right now, I'm at 8mm.  Woot.
  • The total number of mature follicles before egg retrieval should be 5-8, as well as many smaller ones.  Right now, I have 3 leading ladies.
  • Mature follicles measure around 18-22 mm in diameter.  My 3 are about 9mm across.
  • Estradiol levels vary widely from woman to woman, but the key is that I should be roughly doubling my number every 48 hours.  Additionally, each mature follicle produces roughly 200 pg/mL.  My three measurements on Monday, Wednesday, and Friday have been 85, 101, and 220, respectively.

Soooo, I'm not growing eggs like gangbusters exactly, which is a tad discouraging since I'm on the maximum dosage of the aggressive protocol.  I keep imagining myself driving a really old car, in which I'm pushing the gas pedal all the way to the floor and only getting a tired put-put-put sputter.  The Doc acknowledges I'm showing some really low numbers, but she said the important thing to focus on is that I AM growing.  Trying to stay positive and keep my cortisol levels nice and loooow.  Sigh.  Well, who ever said making a baby was fun?  Oh, wait...

Monday, March 11, 2013

Shooting Up

I could be way off here, but I find this one of the most unusual and perhaps even fascinating aspects of the IVF cycle.  The injections...

Currently, my doctor has me following the Microdose Flare Protocol.  There are a number of different drug regimens out there, each differing slightly to accommodate the woman's unique infertility profile.  The Microdose Flare Protocol is a pretty aggressive course.  It is often cited as the "poor responder" treatment; you give it to women once they've already proven to have a hard time making eggs during an IVF cycle.  Why give it to me on our first try?  Take a look at this excellent chart below:

This shows AMH (Anti-Mullerian Hormone) levels for women over time.  Testing AMH levels can gauge the extent to which someone's biological clock is ticking away faster than the woman next to her.    The hormone being tested here is excreted by the small follicles in the ovaries (the little pockets where the eggs grow), and it gives the doctor an idea of just how many eggs are in reserve.  If you follow the solid curve on this graph, you'll see the average AMH levels for any particular age.  For someone my age, it should be about 20.  Mine is 7.2, which is right around the 25th percentile.  Another way to look at this chart is that I have the egg reserve of the average 39 year old.  This means I'm 30% less likely to produce enough eggs in this cycle to be successful.  Hence, BE AGGRESSIVE!  B-E AGGRESSIVE!

Right now, I'm taking three injections a day.  I use insulin needles and inject them subcutaneously (just below the skin).  It really doesn't hurt at all.  I find it way more painful to play with Harper for five minutes.

Lupron (2x/day) - This stimulates my pituitary gland to produce more of its own luteinizing hormone (LH) and follicle stimulating hormone (FSH).

Gonal F (1/day) - Synthetic version of FSH.  This one has to be mixed daily.  I pretend I'm a chemist.  I might get some of those sexy goggles and a white coat just for this ritual.

Low Dose HCG (1/day) - Synthetic version of LH.  This one is premixed, but they want me to combine it with the Gonal F in a single syringe.  It's nice because there's only one tiny prick for two drugs, but it sucks because getting both of these combined takes roughly twelve steps (no hyperbole here), and by my way of thinking, that's twelve unique opportunities to screw up.  (I wanted to film this unbelievably complex series of actions, but Jake assures me this would be weird.)

All this is to push my eggs to go bananas right now.  I went in for my first monitoring appointment today, and it seems like everything is going relatively smoothly.  They were able to see 9 follicles on the ultrasound, though they were very small, and my estradiol level was 85.  Trying to figure out whether that's good or not is really confusing.  I'll get back to you guys on that one.  Keep your fingers crossed, y'all!

Friday, March 8, 2013


After confirming ovulation last week, we were instructed to place a phone order with Freedom Fertility.  Tuesday afternoon, a large box arrived, overflowing with syringes, needles, glass bottles, alcohol swabs, even our very own biohazard "sharps" container.  Talk about playing doctor!  All that was left to do was stick a few of the meds in the fridge and wait for my period to arrive.  As a snowstorm started rumbling up the Shenandoah Valley, I snuggled under the covers and watched YouTube videos of calm, smiling women stabbing themselves in the belly for the chance at a child.  I prayed for strength.

When we woke up the next morning (a little late, as it was a highly anticipated snow day) we noticed that our power was out.  Oh well, we thought.  We'll just have to wait a while to get started on our day. We rescued the precious Leuprolide and HCG from the fridge and buried them in a plastic bag in the snow.  We hung out for a while, reading, knitting, worrying about the food in our fridge/freezer, then decided to go find someplace nearby serving hot food to cheer us up.  A dismal drive around town revealed that absolutely everywhere was out of power.  I was starting to get some major mood swings, partly from PMS but also greatly enhanced by the synthetic estrogen I've been taking.  Every few minutes I was hanging from the rafters silly, then collapsing in a pile of tears and self-pity.  Honestly, all I wanted was a warm bath and my heating pad.

The next morning, we woke up to an even colder, still dark apartment.  I was starting to lose it.  I had a paper due at class that night which I had lost an entire day to work on, my hair was a grease pit, and damn, my PMS was getting intense.  Bonnie called, wondering if we should meet for our injections lesson, in case my period didn't come until the weekend.  We agreed that would be best, but Jake had a meeting scheduled with a professor, and I hated that I would have to just drive up another day to get the baseline data done.  Just like that, Aunt Flo showed up, and Jake's professor canceled their meeting.  Was our luck finally changing?!  We drove up to Charlottesville in separate cars, played with some needles at Bonnie's desk until I felt confident I could do it, and had what essentially felt like a drive-by ultrasound.  We were instructed to start our shots the next morning.  Jake drove back, assuring me we would have power by the time I got back.  I just couldn't believe I was going to class at once so filthy and so unprepared.

Of course, the power wasn't on when I returned home at 10:30 pm.  In fact, the electricity company had changed their projected time of repair to late the next night.  I started blubbering immediately.  I couldn't do my first set of injections in the dark.  I couldn't go to school in the morning still dirty.  I couldn't worry any more that the snow was keeping our meds the right temperature.  I couldn't face the rest of a night full of cramps without my heating pad.  I....just....couldn't.  I wanted a hotel room with a mini-fridge, or I was going to explode.  Since Jake's not suicidal, he found a room within seconds while I packed up our meds and a change of clothes.  The only place nearby that offered mini-fridges was about $20 more than the next cheapest place, but like I said, I was a woman on a mission.

This is when Lady Fortune decided to give the Lewises a break.  At check in, the staff hooked us up with an extra-small room at a special discount, HALF the price of the competitors without mini-fridges!  This room was auspiciously nicknamed "The Baby Room" by the staff.  I couldn't keep from grinning.  There were cookies and hot coffee in the lobby, next to a sign reminding us of the full breakfast buffet in the morning.  We sighed with deep satisfaction and ambled up to our room, congratulating ourselves on making such an excellent decision.  Though the room was small, it had everything we needed, and we enjoyed a warm, clean, relaxed night of sleep.

The next morning I self-administered my first injection (not a big deal at all, it turns out) and went to school.  A few hours later, I got a beautiful text message from Jake: the power was ON.  Hallelujah!

Saturday, March 2, 2013

The "Told Ya So" Dance

When last we met, I was patiently for ovulation to occur.  Morning after morning, I kept getting turned down.  It was like the 9th grade Winter Dance all over again.  I called Bonnie, my new best friend IVF nurse, and asked her what would happen, hypothetically speaking, if I didn't ovulate this month at all.  She gently broke the news that it would be unwise for us to proceed with the planned drug protocol before confirming that I can ovulate on my own.  We would just have to wait until I did, maybe even a few months, if that's what it took.  Harumph.

So, the morning-stick-pee-sigh routine continued for another week, to no avail.  But meanwhile, my body was sending me some pretty unequivocal ovulation signs.  I won't get into the lady secrets here, but if you're interested, check out Taking Charge of Your Fertility.  I honestly consider it an indispensable owner's manual for anyone in possession of a vagina.  Now, what's a girl to do?  On the one hand, expensive technological tools are telling me that I didn't.  And yet natural methods are positively shouting that I did.  My girl Bonnie knew how to settle this one: a quick blood test to check for progesterone.  I was warned NOT to get it drawn at my local hospital, since they send out their samples and take several days, but was directed instead to nearby Staunton, 45 minutes away.

Luckily, the next day was one of Rockbridge County's famous snowless snow days.  I headed out to Staunton, surrendered my bodily fluids, and THEN was told that they would send it out late that night.  Grrr.  More waiting and anticipation.  Luckily, I knew where I could get a killer eggplant parmesan sandwich.  What?  That's totally related.

That night I could hardly sleep.  Did I?  Didn't I?  I DID!  Naw, you don't know crap.  The next morning's results couldn't come fast enough.  When I finally got a call from Charlottesville, I was shocked to hear that they did not yet have my results and were wondering when I was going to get that done.  WHA?!?  My disappointment turned to fury a few hours later when the lab in Staunton called to say that they had messed up my blood work, something about a red top instead of a gold top, or something completely asinine like that.  Needless to say, Bonnie had to talk me off the ledge.  We decided that, even though it's far, I better just hoof it up to Charlottesville to get my blood drawn right on site and not by idiots.  As a perk, I had a good excuse to skip a faculty meeting.

I had hoped that the results would be ready within two hours, before the office closed, but no such luck.  However, I got the call right when they opened the next morning.  I evidently shouted, "YES!" so loud into the phone that my friend Susan came over to hear the "apparently orgasmic news."